The latest medical research on Infectious Disease

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about infectious disease gathered by our medical AI research bot.

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Treatment of Candida Infections with Fluconazole in Adult Liver Transplant Recipients: Is TDM-guided Dosing Adaptation Helpful?

Transplant Infectious Disease

Fluconazole represents a common antifungal option for the treatment of Candida infections in liver transplant recipients. Although adequate antifungal exposure is known to correlate with favorable outcomes in patients with invasive candidiasis, therapeutic drug monitoring (TDM) of fluconazole is currently not recommended.

We conducted a retrospective study including adult liver transplant recipients receiving fluconazole for invasive candidiasis and undergoing TDM. We assessed the correlation between clinical variables, fluconazole trough plasma levels (Cmin ), and outcome.

Twenty-seven patients (74% males; median age 57 years) were included. Abdominal candidiasis was the most frequent infection (56%). Median duration of fluconazole therapy was 17 days (IQR 9 - 21). Fluconazole median Cmin was 11.0 mg/L (range 2.4 to 30.6 mg/L). Five (19%) patients required TDM-guided fluconazole dose increase. All-cause in hospital mortality was 33%. Fluconazole Cmin > 11 mg/L significantly correlated with clinical success (OR 8.78, 95% CI 1.13-67.8, P=0.04).

Our study identified decreased fluconazole Cmin as a factor associated with negative outcomes in liver transplant recipients with Candida infection. TDM of fluconazole may be advisable in this patient population. This article is protected by copyright. All rights reserved.

Epidemiology and Successful Containment of a Carbapenem Resistant Enterobacteriaceae Outbreak in a Southern Italian Transplant Institute.

Transplant Infectious Disease

Carbapenem-resistant enterobacteriaceae (CRE) infections are difficult to treat and pose a serious threat to solid organ transplant (SOT) recipients. At our institute we observed an infection burden in 2012.

In order to contain the spread of CRE infections, we established a taskforce to implement guidelines suggested by the Centers for Disease Control and Prevention (CDC) for this type of outbreak. Here, we describe the epidemiology of the outbreak in our SOT population, and the effectiveness of such interventions, by comparing levels of CRE hospital acquired infection (HAI) pre- and post-task force intervention (from January 2009 to December 2012, and from September 2013 to December 2016, respectively) through a linear regression model.

In this study we included 933 patients who underwent a total of 1017 SOT procedures, 286 of whom had a CRE-positive culture (28.8%), of which 65 (22.7% of CRE positive) developed infection. One-year mortality post-SOT was significantly higher in patients with CRE infection. After the taskforce intervention, the CRE HAI rate in SOT showed a significant inverse trend (event rate: -1.28, C.I. -1.70-0.86; p<0.01).

in the paucity of treatment options, the application of CDC measures in our SOT institute contributed significantly to containing CRE infections. This article is protected by copyright. All rights reserved.

Remission of Epstein-Barr virus-positive post-transplant lymphoproliferative disorder by conversion to everolimus in a kidney transplant recipient.

Transplant Infectious Disease

Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of transplantation. There is no clear consensus on the treatment of PTL...

A mathematical model to describe survival among liver recipients from deceased donors with risk of transmitting infectious encephalitis pathogens.

Transplant Infectious Disease

Between 2002 and 2013, the organs of thirteen deceased donors with infectious encephalitis were transplanted, causing infections in 23 recipients. As a consequence, organs from donors showing symptoms of encephalitis (increased probability of infectious encephalitis (IPIE) organs) might be declined. We had previously characterized the risk of IPIE organs using data available to most transplant teams and not requiring special diagnostic tests. If the probability of infection is low, the benefits of a transplant from a donor with suspected infectious encephalitis might outweigh the risk and could be lifesaving for some transplant candidates.

Using organ transplant data and Cox Proportional Hazards models, we determined liver donor and recipient characteristics predictive of post-transplant or waitlist survival and generated 5-year survival probability curves. We also calculated expected waiting times for an organ offer based on transplant candidate characteristics. Using a limited set of actual cases of infectious encephalitis transmission via transplant, we estimated post-transplant survival curves given an organ from an IPIE donor.

54% (1,256) of patients registered from 2002-2006 who died or were removed from the waiting list due to deteriorated condition within 1 year could have had an at least marginal estimated benefit by accepting an IPIE liver with some probability of infection, with the odds increasing to 86% of patients if the probability of infection was low (5% or less). Additionally, 54% (1,252) were removed from the waiting list prior to their estimated waiting time for a non-IPIE liver and could have benefited from an IPIE liver.

Improved allocation and utilization of IPIE livers could be achieved by evaluating the patient-specific trade-offs between (i) accepting an IPIE liver and (ii) remaining on the waitlist and accepting a non-IPIE liver after the estimated waiting time. This article is protected by copyright. All rights reserved.

Early Infectious Complications after Autologous Hematopoietic Cell Transplantation for Multiple Myeloma.

Transplant Infectious Disease

The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care.

We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007-2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS).

Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38-48), any infection 21% (17-25), bacterial 17% (14-21), viral 4% (3-7) and fungal 1% (0.5-3), central line-associated blood stream infection 3% (2-6), and C. difficile colitis 6% (4-8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, p<0.01), more readmissions (31% vs. 8%, p<0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, p<0.01). 100-day mortality was low and similar between groups (2% vs 1%, p=0.28). In landmark analysis of 404 100-day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03-2.30], P=0.03), although there was no difference in NRM and RFS.

Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients. This article is protected by copyright. All rights reserved.

Serological and molecular screening of umbilical cord blood for Toxoplasma gondii infection.

Transplant Infectious Disease

Human umbilical cord blood has proven to be a successful alternate source of hematopoietic stem cells for pediatric patients with major hematologic disorders. Toxoplasma gondii is a global opportunistic protozoan which cause fatal complications in immunocompromised individuals.

Our goal is to study the prevalence of toxoplasmosis in umbilical cord blood (UCB) and to assess the sensitivity of ELISA and PCR for Toxoplasma infection screening.

One hundred cord blood samples were collected immediately after delivery. Anti-Toxoplasma IgG and IgM antibodies were determined using ELISA method; Toxoplasma DNA was detected using nested PCR technique. Total nucleated cells (TNC) and HB were also determined. Demographic data and risk factors data related to the transmission of toxoplasmosis, were collected from mothers.

Among 100 cord blood samples, 36 (36%) were positive for anti-Toxoplasma IgG antibodies and 6 (6%) were positive for anti- Toxoplasma IgM antibodies. The nested PCR showed 11 (11%) samples containing Toxoplasma DNA from which, 6 (55%) samples were IgM positive. There was no significant association between the risk of Toxoplasma transmission and cord blood positivity for toxoplasmosis.

Owing to the prevalence of toxoplasmosis, its rapid progression and its fatal outcome in immunocompromised patients, cord blood screening for toxoplasmosis with nested PCR should be incorporated into cord blood bank screening protocols. This article is protected by copyright. All rights reserved.

What will it take to eliminate drug-resistant tuberculosis?

Int J Tuberc

Drug-resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but this situation is slowly changing. If the world is to drast...

Why every word counts: towards patient- and people-centered tuberculosis care.

Int J Tuberc

Tuberculosis (TB) remains a major public health concern worldwide. To combat the global epidemic, the World Health Organization (WHO) launched the ...

Histologically confirmed tuberculosis-associated obstructive pulmonary disease.

Int J Tuberc

Although chronic airflow limitation (CAL) is an important long-term consequence of tuberculosis (TB), little is known about the disease process. We...

Engaging with civil society to improve access to LTBI screening for new migrants in England: a qualitative study.

Int J Tuberc

SETTING The latent tuberculous infection (LTBI) programme in England, UK, offers testing and treatment to new migrants from high tuberculosis incid...

Cost-effectiveness of tuberculosis screening for migrant children in a low-incidence country.

Int J Tuberc

BACKGROUND Detection of latent tuberculous infection (LTBI) is important to prevent progression to active tuberculosis (TB), particularly in migran...