Twenty Rhipicephalus sanguineus ticks collected in eastern Arizona were tested by PCR assay to establish their infection rate with spotted fever group rickettsiae. With a nested PCR assay which ...detects a fragment of the Rickettsia genus-specific 17-kDa antigen gene (htrA), five ticks (25%) were found to contain rickettsial DNA. One rickettsial isolate was obtained from these ticks by inoculating a suspension of a triturated tick into monolayers of Vero E6 monkey kidney cells and XTC-2 clawed toad cells, and its cell culture and genotypic characteristics were determined. Fragments of the 16S rRNA, GltA, rOmpA, rOmpB, and Sca4 genes had 100%, 100%, 99%, 99%, and 99%, respectively, nucleotide similarity to Rickettsia massiliae strain Bar29, previously isolated from R. sanguineus in Catalonia, Spain (L. Beati et al., J. Clin. Microbiol. 34:2688-2694, 1996). The new isolate, AZT80, does not elicit cytotoxic effects in Vero cells and causes a persistent infection in XTC-2 cells. The AZT80 strain is susceptible to doxycycline but resistant to rifampin and erythromycin. Whether R. massiliae AZT80 is pathogenic or infectious for dogs and humans or can cause seroconversion to spotted fever group antigens in the United States is unknown.
Background: Antimicrobial resistance is one of the causes of treatment failure in women after standard nitroimidazole therapy for Trichomonas vaginalis infections. The Centers for Disease Control and ...Prevention provides drug susceptibility testing and guidance for treatment failures but the efficacy of the alternate recommendations has not been assessed. Methods: T. vaginalis isolates from women who had failed at least 2 courses of standard therapy for trichomoniasis were submitted to the Centers for Disease Control and Prevention for susceptibility testing. Alternative treatment recommendations were provided based on in vitro drug susceptibility results and clinical outcomes were collected. Results: Drug susceptibility results were available for 175 women tested between January 2002 and January 2008. In vitro, 115 of the 175 isolates demonstrated metronidazole resistance. For all isolates resistant to metronidazole, in vitro resistance to tinidazole was similar or lower. Clinical treatment outcomes were available for 72 women. Of the women receiving an alternative recommended nitroimidazole regimen, 30 (83%) of 36 were cured compared with 8 (57%) of 14 women who received a lower dose than recommended. Clinical and microbiologie success was attained in 59 (82%) of 72 women whose follow-up information was available, with some women requiring multiple treatment courses. Conclusions: Clinical and microbiologie cure rates were higher for women who were treated in accordance with the recommendation provided after in vitro testing compared with those who received a lower dose or a different drug. Susceptibility testing leading to tailored treatment may have a beneficial role for management of women with persistent trichomoniasis.
Babesiosis Surveillance — 18 States, 2011 Herwaldt, Barbara L; Montgomery, Susan; Woodhall, Dana ...
MMWR. Morbidity and mortality weekly report,
07/2012, Letnik:
61, Številka:
27
Journal Article, Newsletter
Babesiosis is caused by protozoan parasites of the genus Babesia that infect red blood cells. Babesia infection can range from asymptomatic to life threatening. Clinical manifestations might include ...fever, other nonspecific influenza-like symptoms, and hemolytic anemia. Babesia parasites in nature usually are tickborne but they also are transmissible via blood transfusion or congenitally. In recent years, reports of tickborne and transfusion-associated cases have increased in number and geographic distribution. However, the lack of a standard case definition hindered the ability of public health authorities to monitor cases and to develop evidence-based prevention and control measures. In January 2011, national surveillance for human babesiosis was begun in 19 jurisdictions (18 states and one city), using a standard case definition developed jointly by CDC and the Council of State and Territorial Epidemiologists. This report summarizes the results for 2011. For the first year of babesiosis surveillance, health departments notified CDC of 1,124 confirmed and probable cases. Cases were reported by 15 of the 18 states where babesiosis was reportable; however, 1,092 cases (97%) were reported by seven states (Connecticut, Massachusetts, Minnesota, New Jersey, New York including New York City, Rhode Island, and Wisconsin). Cases were identified in persons aged <1-98 years; 57% were in persons aged ≥60 years. Among patients for whom data were available, 82% (717 of 879) had symptom onset dates during June-August. Ongoing national surveillance using the standard case definition will provide a foundation for developing evidence-based prevention and control measures to reduce the burden of babesiosis.
Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in ...metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management-analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management-be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .
This report of donor‐derived Strongyloides highlights the need for testing of at‐risk donors and prompt communication between centers and OPOs to avoid adverse consequences of donor‐derived infection.
Babesiosis is a potentially life-threatening disease caused by intraerythrocytic parasites, which usually are tickborne but also are transmissible by transfusion. Tickborne transmission of Babesia ...microti mainly occurs in 7 states in the Northeast and the upper Midwest of the United States. No Babesia test for screening blood donors has been licensed.
To ascertain and summarize data on U.S. transfusion-associated Babesia cases identified since the first described case in 1979.
Case series.
United States.
Case patients were transfused during 1979-2009 and had posttransfusion Babesia infection diagnosed by 2010, without reported evidence that another transmission route was more likely than transfusion. Implicated donors had laboratory evidence of infection. Potential cases were excluded if all pertinent donors tested negative.
Distributions of ascertained cases according to Babesia species and period and state of transfusion.
159 transfusion-associated B. microti cases were included; donors were implicated for 136 (86%). The case patients' median age was 65 years (range, <1 to 94 years). Most cases were associated with red blood cell components; 4 were linked to whole blood-derived platelets. Cases occurred in all 4 seasons and in 22 (of 31) years, but 77% (122 cases) occurred during 2000-2009. Cases occurred in 19 states, but 87% (138 cases) were in the 7 main B. microti-endemic states. In addition, 3 B. duncani cases were documented in western states.
The extent to which cases were not diagnosed, investigated, reported, or ascertained is unknown.
Donor-screening strategies that mitigate the risk for transfusion transmission are needed. Babesiosis should be included in the differential diagnosis of unexplained posttransfusion hemolytic anemia or fever, regardless of the season or U.S. region.
None.
Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. Immunocompetent hosts typically are asymptomatic, despite chronic Strongyloides infection. In contrast, ...immunocompromised patients are at risk for hyperinfection syndrome and disseminated disease, with a fatality rate >50%. The infection source for immunocompromised patients, such as solid organ transplant recipients, is not always apparent and might result from reactivation of chronic infection after initiation of immunosuppressive therapy or transmission from the donor. In October 2012, the United Network for Organ Sharing (UNOS) notified CDC of a left kidney and pancreas recipient in Pennsylvania diagnosed with strongyloidiasis. This report summarizes the results of the investigation of the source of Strongyloides infection in three of four organ recipients. Testing of pretransplant donor and recipient sera confirmed that infection in the recipients was donor derived. This investigation underscores the importance of prompt communication between organ procurement organizations, transplant centers, and public health authorities to prevent adverse events in recipients when transmission is suspected. Additionally, it emphasizes the utility of stored pretransplant samples for investigation of suspected transplant-transmitted infections and the need to consider the risk for Strongyloides infection in organ donors.
Purpose
Diarrhea is recognized as a common adverse event associated with tyrosine kinase inhibitors (TKIs), with those targeting the ErbB family of receptors being associated with the highest rate of ...diarrhea.
Methods
This paper reviews data on the incidence, timing, and duration of diarrhea associated with US Food and Drug Administration-approved ErbB family-targeted TKIs from the published literature, and sets forth recommendations for management.
Results
In the absence of anti-diarrheal prophylaxis the incidence of any-grade diarrhea varies and typically occurs early during the course of treatment. Although it is difficult to determine if the incidence and severity of diarrhea is related to inhibition of a particular kinase target because of the multi-targeted and overlapping activity of many agents, evidence suggests that second-generation TKIs with broader target profiles (i.e., afatinib, lapatinib, neratinib) result in a higher incidence of diarrhea compared with highly specific first- (erlotinib, gefitinib) or third- (osimertinib) generation agents. The mechanisms responsible for TKI-associated diarrhea are not fully understood and are likely multi-factorial, involving dysregulated ion transport, inflammation, and mucosal injury. Management strategies have been developed—and continue to be refined—to prevent and reduce the severity and duration of TKI-associated diarrhea. For agents associated with more significant symptoms, anti-diarrheal prophylaxis reduces the incidence and severity of diarrhea, and ongoing studies are evaluating specific strategies to further reduce incidence and duration of TKI-associated diarrhea.
Conclusions
Continued investigations into risk factors and pharmacogenomic markers for diarrhea may further improve management of this common toxicity.
PDF
