Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Am J Infect Control ; 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33157181

RESUMO

A Veterans Affairs long term care facility on Long Island New York was confronted with a COVID-19 outbreak in late March to Mid-April 2020. Faced with a dwindling supply of PPE, the Infection Control team distributed supplies saved for a possible Ebola outbreak. A COVID unit was created within the nursing home facilitating the geographic isolation of cases; universal testing of residents and employees allowed for the implementation of proper quarantine measures. It was a multidisciplinary team approach led by the Infection Control team that successfully contained this outbreak.

2.
Am J Infect Control ; 48(9): 1119-1121, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32035688

RESUMO

Clostridium (or Clostridioides) difficile infection (CDI) is a common side effect of antimicrobial therapy and is increasingly linked with health care-associated transmissions. Antimicrobial stewardship programs (ASP) have demonstrated success in decreasing in-hospital CDI cases. We implemented an ASP targeting inappropriate or unnecessary use of all antibiotics especially empiric piperacillin-tazobactam and fluoroquinolone use. Concurrently, we monitored all health-care associated CDI. Our CDI cases were markedly decreased after initiation of our ASP.

6.
J Glob Infect Dis ; 11(1): 47-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814836

RESUMO

Spilled gallstones during laparoscopic cholecystectomy (LC) are common. Lost gallstones can lead to complications such as intra-abdominal abscesses, which can occur days, months, or even years after the procedure. Citrobacter koseri belongs to the family of Enterobacteriaceae. It is a low-virulence pathogen; however, it is linked to infections of the urinary tract and abdomen. We report the case of a 70-year-old diabetic male who presented with C. koseri- associated subhepatic abscess. Two years prior, he had emphysematous cholecystitis and liver abscess caused by C. koseri. During his LC, gallstones were spilled in the abdominal cavity and every effort was made to retrieve them. However, 2 years later, an aspiration of the subhepatic abscess revealed cholesterol fragments. We hypothesize that dislodged cholesterol gallstones and bile, contaminated with C. koseri, were the culprits for the appearance of the subhepatic abscess with the same organism 2 years after the LC.

9.
Ticks Tick Borne Dis ; 10(2): 407-411, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30573383

RESUMO

In North America, Lyme disease (LD) is caused predominantly by the spirochete Borrelia burgdorferisensu stricto, and is transmitted by blacklegged ticks. Long Island, New York, is highly endemic for the disease. The C6 peptide (C6P) is currently used as a screening test for LD in our institution. Our objective was to examine how screening with C6P concorded with diagnosis of LD at the Veterans Affairs Medical Center, Northport, Long Island. A retrospective chart-review of 2558 C6P tests was performed during the period of 1/1/2010 to 12/31/2016. Patients were categorized by Lyme Disease (LD) or no LD groups. LD group was defined as having an erythema migrans (EM) rash, or ≥ 2 IgM bands or ≥ 5 IgG bands on immunoblot. Out of the 409 patients with positive or equivocal C6P, 181 patients with LD were based on presence of EM, or Western blot IgM and IgG test results; 228 did not have LD. The positive predictive value of C6P was 44.5%. EM was the most common presentation. In the LD group, history of tick bite (P: 0.0001), headache (P: 0.0036), joint swelling (P: 0.0086) and myalgias (P: 0.0005) were more likely to be present. Zip code mapping of our cases mirrored those previously reported in the Suffolk County Department of Health. In our review we encountered a significant number of false positive C6 assays. False positive C6P tests were ordered by primary care physicians (PCP) (37%) followed by neurologists (33%). A history of tick exposure and clinical findings of early Lyme disease such as headaches or joint aches were more likely to denote a true positive C6 peptide test. Rigorous education of physicians about Lyme disease and pitfalls of our available diagnostic tests are needed for their proper utilization.


Assuntos
Proteínas de Bactérias/sangue , Doença de Lyme/epidemiologia , Peptídeos/sangue , Veteranos , Idoso , Anticorpos Antibacterianos/sangue , Artralgia/etiologia , Borrelia , Doenças Endêmicas , Eritema Migrans Crônico/microbiologia , Reações Falso-Positivas , Feminino , Cefaleia/etiologia , Humanos , Immunoblotting , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Doença de Lyme/diagnóstico , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Picadas de Carrapatos/epidemiologia
10.
J Glob Infect Dis ; 10(4): 226-227, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30581266

RESUMO

We report the case of a middle aged man, 43-pack-years active smoker, who upon radiographic screening for lung cancer found to have a non-spiculated lung nodule concerning for malignancy. Histologic evaluation of this lesion turned out to be a nodule due to Histoplasma capsulatum.

11.
Infect Dis Clin Pract (Baltim Md) ; 26(4): 208-210, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30034207

RESUMO

Background: Clonorchiasis caused by Clonorchis sinensis and opisthorchiasis caused by Opisthorchis viverrini are prevalent in the Far East, including Vietnam. The causal relationship between the 2 liver flukes and cholangiocarcinoma (CCA) has been well documented. Cholangiocarcinoma, a rare tumor of bile ducts, usually occurs in the sixth-seventh decade of life. In the United States, 8000 people are diagnosed with CCA each year. US Vietnam Veterans, 5 decades after the end of the war, are being diagnosed with CCA. Although CCA is linked to several conditions, no study has been done to our knowledge linking C. sinensis or O. viverrini as the culprits for CCA diagnosis in Vietnam Veterans. Methods: A pilot prospective epidemiological study was performed at the Northport Veterans Affairs Medical Center. We screened Vietnam Veterans for exposure to eating raw or undercooked fish from the rivers in Vietnam during their service. Serological testing was performed by the multiantigen enzyme-linked immunosorbent assay in Seoul National University of Medicine, South Korea. Results: Of the 97 Veterans screened, 50 met the inclusion criteria with 1 Veteran being diagnosed with CCA. Of the 50 Veterans, 24% tested positive for serum IgG antibodies to C. sinensis. Those who tested positive had no detectable liver fluke parasites by fecal examination. Conclusions: Our study is the first to show evidence of exposure to liver flukes in US soldiers during their service in the Vietnam War. Further research is needed to examine the possible link of liver fluke infection and risk for developing CCA in Vietnam Veterans.

13.
J Korean Med Sci ; 27(7): 830-3, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22787385

RESUMO

A retrospective review of 4,721 human immunodeficiency virus (HIV)-infected patients, followed at St. Luke's Roosevelt Hospital Center, New York City, was conducted from January 1, 2005 to December 31, 2009. HIV-Hepatitis B virus (HBV) co-infection rate was 218/4,721, 4.6%. Among co-infected patients, 19 patients (19/218, 8.7%) died; 13 patients (13/19, 68.4%) died from non-acquired immune deficiency syndrome (AIDS) defining including 2 patients with liver failure. More non-survivors (5 patients, 5/19, 26.3%) had liver cirrhosis than those who survived (8 patients, 8/199, 4.0%; P = 0.002). There were more patients with positive HBV e antigen (HBeAg) among non-survivors, (12 patients, 12/19, 63.2%) than among survivors (74 patients, 74/199, 37.2%; P = 0.047). HIV-HBV co-infection is associated with increased overall mortality. Therefore, use of dual active antiretrovirals, particularly, tenofovir (TDF) based regimen for optimal suppression of HIV-HBV and immune restoration with prevention of high risk behaviors may contribute to improved outcomes.


Assuntos
Infecções por HIV/diagnóstico , Hepatite B/diagnóstico , Adenina/análogos & derivados , Adenina/uso terapêutico , Adulto , Fármacos Anti-HIV/uso terapêutico , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Antígenos E da Hepatite B/sangue , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Organofosfonatos/uso terapêutico , Estudos Retrospectivos , Tenofovir
14.
Gut Liver ; 6(1): 86-91, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22375176

RESUMO

BACKGROUND/AIMS: To assess the durability of protective hepatitis B surface antibody (anti-HBs) titers in HIV-infected patients who responded to double-dose hepatitis B virus (HBV) rescue vaccination. METHODS: A retrospective chart review was performed for HIV-infected patients who received the double-dose HBV rescue vaccination at 0-, 1-, and 2-month intervals after they had failed conventional HBV vaccination series. A protective antibody response was defined as an anti-HBs titer ≥10 mIU/mL. RESULTS: Of 54 HIV-infected patients who received a double-dose HBV rescue vaccination, 44 patients (81.5%) had a positive response and achieved protective anti-HB titers. Of the 44 patients who developed protective anti-HB titers, 33 patients received an evaluation of their anti-HB titers 12 months later. Of the 33 patients, 19 (57.6%) had persistent protective anti-HB titers (persistent responders, PR), and 14 patients (42.4%) lost their protective anti-HB titers (nonpersistent responders, NPR). There were significantly more patients who had an undetectable HIV viral load (<50 copies/mL) at baseline and follow-up in the PR group (11/19, 57.9%) than in the NPR group (3/14, 21.4%, p=0.036). Logistic regression analysis showed that an undetectable HIV viral load at baseline and follow-up (odds ratio, 12.973; 95% confidence interval, 1.189 to 141.515; p=0.036) was associated with PR. CONCLUSIONS: Protective anti-HB titers may decrease over time after successful double-dose HBV rescue vaccination in HIV-infected patients. HIV viral load suppression could improve the persistence of anti-HB titers.

15.
AIDS Res Hum Retroviruses ; 28(3): 235-41, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21644847

RESUMO

Few studies have examined the vitamin D status in HIV-infected patients. A cross-sectional retrospective chart review of 2992 HIV-infected patients was conducted from 9/2008 to 5/2009. A total of 274 adult patients had 25-hydroxyvitamin D [25(OH)D] obtained by radioimmunoassay. None was receiving vitamin D (vitD) supplements. Vitamin D status was defined as the following: vitD deficiency (vitDd) as 25(OH)D <25 nmol/liter, vitD insufficiency (vitDi) as 25(OH)D 25-74 nmol/liter, and vitD optimal (vitDo) as 25(OH)D ≥75 nmol/liter. We analyzed demographic/laboratory data. vitDd, vitDi, and vitDo were 21.2% (58 patients, 58/274), 68.6% (188 patients, 188/274), and 10.2% (28 patients, 28/274), respectively. There were significant racial differences. Blacks were 60.3% (35 patients, 35/58), 40.4% (76 patients, 76/188), and 28.6 % (8 patients, 8/28) in vitDd, vitDi, and vitDo, respectively, p=0.002. CD4 T cell count was not different in these three groups. However, HIV viral load was significantly different. Median log (10) HIV viral load was 2.31 with IQR 1.70-409, 1.70 with IQR 1.70-2.96, and 1.70 with IQR 1.70-2.78 in vitDd, vitDi, and vitDo, respectively, p=0.039. Multivariate logistic regression analysis showed that black race [odd ratio (OR) 4.108, 95% confidence interval (CI) 1.462-11.543, p=0.007] and HIV viral load>50 copies/ml (OR 2.396, 95% CI 1.120-5.127, p=0.024) were significantly associated with vitamin D deficiency. Vitamin D deficiency was highly prevalent in HIV-infected patients. Detectable HIV viremia and dark skin (black ethnicity) were significantly associated with vitamin D deficiency. Evaluation of vitamin D status in HIV-infected patients should be considered and further studies are needed to define the effects of vitamin D.


Assuntos
Afro-Americanos/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Pigmentação da Pele , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Soropositividade para HIV/etnologia , Humanos , Modelos Logísticos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Análise Multivariada , Cidade de Nova Iorque/epidemiologia , Razão de Chances , Prevalência , Radioimunoensaio , Estudos Retrospectivos , Fatores de Risco , Carga Viral , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/etnologia
16.
Chin Med J (Engl) ; 124(14): 2123-6, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21933613

RESUMO

BACKGROUND: Recent studies have reported overall increasing rates of syphilis with a high rate of human immunodeficiency virus (HIV) co-infection. However, there is little information about factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients. We conducted a study to evaluate factors associated with syphilis treatment failure/re-infection in HIV co-infected patients. METHODS: We reviewed 3542 medical records of HIV-infected patients from January 2005 to December 2007 followed up at HIV Clinic in New York City. Patients were categorized by rapid plasma regain titer (RPR) into success/serofast (4-fold decrease in RPR by 12 months after treatment, RPR conversion to nonreactive, persistently stable reactive RPR with no 4-fold increase), and failure/re-infection (failure to decrease 4 folds in RPR by 12 months after treatment, 4-fold increase in RPR from baseline). RESULTS: Among a total of 156 patients who met the eligibility criteria, 122 (78.2%) were under success/serofast category, and 34 (21.8%) were under failure/re-infection category. HIV viral load, CD4 cell count, and use of highly active antiretroviral therapy (HAART) were not associated with syphilis treatment failure/re-infection. However, early syphilis stage (OR: 11.036, 95%CI: 2.499 - 48.740, P = 0.002) and high (> 1:64) RPR titers (OR: 715.921, 95%CI: 422.175 - 23 113.396, P < 0.001) were significantly associated. CONCLUSIONS: No correlations were seen with depressed immune states with syphilis treatment failure and/or re-infection. However, association with early stage syphilis suggests that risky psychological sexual behaviors may be the most important leading factor, emphasizing needs for safe sex education.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Sífilis/tratamento farmacológico , Sífilis/imunologia , Adulto , Contagem de Linfócito CD4 , Feminino , Humanos , Imunossupressão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento
17.
J Med Case Rep ; 5: 209, 2011 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-21615962

RESUMO

INTRODUCTION: Few cases of Epstein-Barr virus myelitis have been described in the literature. Multi-centric Castleman's disease is a lymphoproliferative disorder that is well known for its associations with the human immunodeficiency virus, human herpes virus 8, and Kaposi's sarcoma. The concurrent presentation of these two diseases in a patient at the same time is extremely unusual. CASE PRESENTATION: We describe the case of a 43-year-old Caucasian man with acquired immune deficiency syndrome who presented with fever, weight loss and diffuse lymphadenopathy, and was diagnosed with multi-centric Castleman's disease. He presented three weeks later with lower extremity weakness and urinary retention, at which time cerebrospinal fluid contained lymphocytic pleocytosis and elevated protein. Magnetic resonance imaging demonstrated abnormal spinal cord signal intensity over several cervical and thoracic segments, suggesting the diagnosis of myelitis. Our patient was ultimately diagnosed with Epstein-Barr virus myelitis, as Epstein-Barr virus DNA was detected by polymerase chain reaction in the cerebrospinal fluid. CONCLUSION: To the best of our knowledge, this is the first case of multi-centric Castleman's disease followed by acute Epstein-Barr virus myelitis in a human immunodeficiency virus-infected patient. Clinicians caring for human immunodeficiency virus-infected patients should be vigilant about monitoring patients with increasing lymphadenopathy, prompting thorough diagnostic investigations when necessary.

19.
J Cardiol Cases ; 3(3): e170-e172, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30524604

RESUMO

Brain abscesses have cardiac etiology in 5% of cases with valvular heart disease and endocarditis being the most common. Congenital heart disease with the risk of right to left shunt and paradoxical embolization is also a culprit. Our case describes a young patient with a prior undiagnosed patent foramen ovale (PFO), who presented with solitary brain abscess without any underlying primary source of infection. Since there was no evidence of contiguous spread of infection by computed tomography or magnetic resonance imaging scans, hematogenous spread of the streptococcal species was the most likely etiology. Transesophageal echocardiography (TEE) revealed no evidence of valvular endocarditis but did show intracardiac right-to-left shunting via a PFO. We suggest that all patients with a brain abscess of an unclear etiology caused be screened for a PFO with a TEE and bubble study.

20.
AIDS Patient Care STDS ; 24(7): 403-7, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20586648

RESUMO

Impaired hepatitis B virus vaccine (HBVV) efficacy has been observed in HIV-infected patients. We assessed the immunogenicity of double-dose (DD) hepatitis B virus revaccination in patients who had failed to respond to standard vaccination. A retrospective chart review of 4,663 patients ensued in two urban HIV clinics between January 2004 and March 2009. Of 363 patients who received three standard doses (SDs) of HBVV, 126 (34.7%) responded with detectable hepatitis B surface antibody [(HBsAb) HBsAb titer of > or =10 mIU/ml] and 237 (65.3%) nonresponders (NRs) remained seronegative. Among NRs, 61 received three to eight additional SDs of HBVV; 29 received three double doses (DDs) of HBVV (40 microg/dose), spaced at monthly dosing intervals; and 11 received from one to five additional SD HBVV (who remained seronegative) and then received three DDs HBVV. Response rate was significantly higher among the 40 DD recipients than among the 61 who received only additional SD (34/40, 85%, vs. 36/61, 59%; p = 0.006). In the revaccinated NR group (61 SD + 40 DD), a logistic regression analysis found that use of highly active antiretroviral therapy (HAART) (OR, 10.166; CI, 1.359-76.026; p = 0.024), and CD4 cell counts > or =200 cells/mm(3) at the time of revaccination (OR, 9.233; CI, 1.393-61.207; p = 0.021) were associated with HBsAb response, as was DD HBV revaccination (OR, 4.177; CI, 1.282-13.614; p = 0.018). Rescue DD hepatitis B vaccination appears to improve the HBsAb response rate significantly in HIV-infected NR patients, especially after an adequate immune restoration with HAART. More prospective studies are needed to confirm these findings.


Assuntos
Infecções por HIV/imunologia , Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Imunização Secundária/métodos , Adulto , Feminino , Infecções por HIV/complicações , Anticorpos Anti-Hepatite B/sangue , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...