A world wide web guide to pediatric infectious diseases.

Pediatric infectious disease is a subspecialty constantly evolving in terms of scientific information. A novel means of attaining medical information that has emerged in recent years is the World Wide Web (WWW). The authors sought to assess availability and content of sites offering information on pediatric infectious diseases in the WWW. Websites chosen by two authors were evaluated by a specialist in pediatrics and a specialist in infectious diseases, and a representative list was constructed. A sub-search was performed for immunization-related websites. Websites from national and international institutions focusing on pediatrics in general or pediatric infectious diseases in particular offer ample information for health professionals and parents/public. There is an over-representation of vaccination-related material in the WWW, whereas no sites related to bioterrorism and children were considered as significant for inclusion during the process. Free access to related research remains a controversial issue.

The globalization of leptospirosis: worldwide incidence trends.

OBJECTIVES: Leptospirosis continues to be a significant zoonosis of the developing world. Globalization, in the context of international travel, particularly for recreational activities and military expeditions, has led to increased exposure of individuals from the developed world to the disease, as recent outbreaks show. METHODS: We evaluated the trends in annual leptospirosis incidence for individual countries worldwide through reports from national and international organizations, the published medical literature on the subject, and web searches with the terms 'leptospirosis' and the individual country names. Inter-country variations in leptospirosis incidence, when relevant official data were available, were also analyzed. RESULTS: The Caribbean and Latin America, the Indian subcontinent, Southeast Asia, Oceania, and to a lesser extent Eastern Europe, are the most significant foci of the disease, including areas that are popular travel destinations. CONCLUSIONS: Leptospirosis is a re-emerging zoonosis of global importance and unique environmental and social correlations. Attempts at global co-ordination and recognition of the true burden of an infectious disease with significant mortality should be encouraged.

World Wide Web hepatitis B virus resources.

BACKGROUND: Hepatitis B virus infection is a global public health issue, often under-discussed due to social prejudices related to its mode of transmission. The World Wide Web, an increasingly popular means of dissemination of health-related information, can serve continuing medical practitioner awareness and enhance public health literacy. OBJECTIVE: The authors sought to investigate the existence of, and evaluate the content of websites offering information on hepatitis B. STUDY DESIGN: Sites were selected by certain criteria (sponsor, language options, free access, validation of content by independent medical and non-medical personnel), which unavoidably rendered the lists subjective. RESULTS: At least three medical personnel-oriented websites (American Association for the Study of Liver Diseases, Clinical Care Options and The Hepatitis B Foundation sites) offer significant, up to date information on hepatitis B for clinicians. Sites offering information for the public used simple patterns as fact sheets and question-answer sets. The majority of the sites were based in the US. CONCLUSIONS: Hepatitis B virus infection is adequately represented in the web, regarding the needs of medical practitioners. Dissemination of information for the public appears in various modes, and at least at present, can only safely be achieved through simplified reports on the disease.

Challenges in Brucella bacteraemia.

Brucella possesses unique historical, epidemiological, phylogenetic and pathogenetic characteristics that constantly reinforce the pathogen's place at the epicentre of scientific interest. One such unique characteristic is the significance of bacteraemia in the course of the disease. Bacteraemia in brucellosis may be periodically present, of limited practical diagnostic importance, and of doubtful significance as an index of bacteriological cure. On the other hand, recognition of bacteraemia augments prognosis, typing and biotyping (and thus further research). Recent advances in molecular diagnosis with the help of real time polymerase chain reaction (rtPCR) have shown that bacteraemia in brucellosis may persist, at culture non-detectable levels, for protracted periods even after apparent clinical cure. This raises important issues for future research, implying that the pathogen may actually be non-eradicable.

The new global map of human brucellosis.

The epidemiology of human brucellosis, the commonest zoonotic infection worldwide, has drastically changed over the past decade because of various sanitary, socioeconomic, and political reasons, together with the evolution of international travel. Several areas traditionally considered to be endemic--eg, France, Israel, and most of Latin America--have achieved control of the disease. On the other hand, new foci of human brucellosis have emerged, particularly in central Asia, while the situation in certain countries of the Near East (eg, Syria) is rapidly worsening. Furthermore, the disease is still present, in varying trends, both in European countries and in the USA. Awareness of this new global map of human brucellosis will allow for proper interventions from international public-health organisations.

Acute nephritis and respiratory tract infection caused by Mycoplasma pneumoniae: case report and review of the literature.

A 6-year-old boy presented with an acute infection caused by Mycoplasma pneumoniae associated with respiratory tract and kidney involvement. Renal manifestations included acute nephritis with decreased C3 fraction of serum complement, occurring concomitantly with the respiratory symptoms. The child had an excellent outcome, with rapid normalization of C3 and complete resolution of the acute nephritis.

Future trends in human brucellosis treatment.

The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior. Current alternative approaches such as co-trimoxazole-containing regimens, should be widely evaluated as being more cost-effective. New methods of delivery such as gentamicin-loaded microparticles, neutralisation of the environment where Brucella resides and use of novel antibiotics such as tigecycline may be of importance in the future. The role of immunomodulation, widely but inconsistently applied in 'chronic' brucellosis, should be further evaluated in all disease stages to define if it is of any use. The development of a subcellular vaccine would be an important step forward although one has to take into account the multiple interactions between Brucella and the immune system, various technical problems and the lack of funds. Reviewing existing attempts at the development of such a vaccine, the authors conclude that a trivalent subcellular vaccine may be needed for adequate efficacy.