Frequent Infectious Diseases Research Articles

Sexually Transmitted Diseases- Ten Years Experience In Benue State

Inflection by a number of viruses, bacteria, fungi, protozoa or anthropods are transmitted through heterosexual or homosexual contact. These sexually transmitted infection ( STD) can result in a wide variety of Clinical conditions. STDs rank among the most frequent infectious disease ( 1,2) . The world Health organization in(1995) estimated the incidence of four selected curable sexually transmitted disease – gonorrhea, syphilis, Chlamydia and triclononiasis among adults age 15 – 49 at 333million of these , the vast,. majority (3) occurred in the developing world (3). 45% in south and South East Asia, 20% in sub-Saharan Africa and 11% in Latin America and the Caribbean countries (3).

Seasonal fluctuations of head lice infestation in Germany

Pediculosis capitis is one of the most frequent infectious diseases in childhood. If not diagnosed and treated rapidly, considerable clinical pathology may develop. The ubiquitous parasitic skin disease is characterized by a lack of sound epidemiological data, and factors which influence disease occurrence are still enigmatic. To investigate whether, in Germany, head lice infestation follows a seasonal pattern, we analyzed the weekly head lice consultations at the Health Department of Braunschweig City, Lower Saxony, for a period of 5 years, and compared the data with the units of pediculocides sold by two wholesalers to German pharmacies during a period of 2 and 3 years, respectively. The number of consultations did not show a clear seasonality, although there was a tendency of fewer consultations during school holidays, and an increase when schools opened again after Christmas, Easter, summer, and autumn holidays. In contrast, the number of packages of pediculocides sold followed a distinct seasonal rhythm with a maximum between calendar week 34 and 40, i.e., from mid September to end of October. In Germany, occurrence of pediculosis capitis varies according to the season of the year with a maximum in late summer and early autumn.

Advances in the Knowledge and Clinical Applications of Lactic Acid Bacteria as Probiotics in the Urogenital Tract

Probiotics, defined as live microorganisms administered in high numbers to produce beneficial and physiological effects on the host, are increasingly applied to the prevention and treatment of many clinical situations in both human beings and animals. The female urogenital tract is one of the targets of probiotics, mainly by the frequency of infectious diseases that affects patients of all ages, including pregnant women and, potentially, newborns. Urogenital infections are associated with high morbidity and mortality rates as well as with high health care costs. The development of a probiotic formula to control these situations is of great interest. In this review, the mechanisms that support the probiotic action of lactic acid bacteria in the urogenital tract are summarized. Animal models used to test their effect on certain pathologies as well as clinical trials performed in humans are described. Some products currently available on the market are also mentioned.

CTLA4 targeting strategy in DNA vaccination against periodontitis

Periodontitis are among the most frequent infectious diseases affecting children and adolescents. The primary etiology of periodontal diseases is the bacterial plaque. Studies have demonstrated the feasibility of inducing immune responses by DNA vaccines against Porphyromonas gingivalis, the major aetiological agent of chronic periodontitis, and the subsequent development of periodontitis in animal models. But until now, the poor immunogenicity, particularly in large animals, is still a major problem in DNA vaccination. Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) is a membrane bound molecule mainly located on activated T cells. Its extracellular V-domain is considered to be involved in mediating the binding to the B7 molecule on antigen-presenting cells (APCs). By utilizing the interaction between CTLA4 and B7, specific antigens can be targeted to APCs by fusion to CTLA4 and DNA vaccines encoding CTLA4 and specific antigens greatly increased the systemic antibody responses following immunization in mice. We hypothesize that targeting antigens to APCs offers a potential strategy to enhance the immune responses generated by DNA vaccines against periodontitis.

La tuberculose pulmonaire provoque un déséquilibre du diabète: Étude rétrospective de 60 malades en Tunisie

Tuberculosis is a frequent infectious disease in Tunisia. The estimated case rate is 22.3 per 100,000 inhabitants. The risk of tuberculosis is 2 to 6 times greater in patients with diabetes. The purpose of this study was to analyze the particularities in the etiology, diagnosis and bacteriologic course of pulmonary tuberculosis in patients with diabetes and to evaluate the impact of tuberculosis on diabetes control.This retrospective case-control study of 142 patients with confirmed pulmonary tuberculosis seen from 2000-2006 compared the 60 patients with diabetes with the 82 without diabetes.Diabetes was more frequent in older patients with tuberculosis and in women. 91.5% had type 2 diabetes. A history of contact with people with tuberculosis was significantly less frequent in the group with diabetes (13.3% vs 30.5%; p=0.01). Tuberculosis symptoms and their duration did not differ between the 2 groups. Basal lesions and cavitation occurred more frequently in the patients with diabetes, but this difference was not significant. The time for conversion to negative of sputum culture was longer in case patients (43+/-27 days) than in controls (28.2+/-20.5) (p=0.03). The proportion of patients with uncontrolled diabetes was elevated, and 50% required frequent insulin treatment.Tuberculosis is frequently associated with diabetes, usually due to reactivation of Mycobacterium tuberculosis. It is characterized by a longer time to culture conversion to negative and a risk of uncontrolled diabetes that requires frequent treatment adjustment and insulin use.

Sinergismo entre ajoeno y ketoconazol en aislamientos de Microsporum canis. Un estudio preliminar mediante la determinación de la concentración inhibitoria fraccional (CIF)

Fungal infections are probably the most frequent infectious diseases affecting human being. Resistance to different anti-fungal drugs, and their bioavailability in the infection site, represent a problem for treatment. Looking for effective solutions, combination of two or more antifungal drugs to obtain an additive effect or synergic effect that potent antifungal activity has been investigated. In this study, the effect (additive, antagonist or synergistic) of ajoene and ketoconazole combination was evaluated in the growth and proliferation of filamentous fungi. Interactions in vitro were investigated in three isolates of Microsporum canis through a preliminary study using micro dilution, according to recommendations of NCCLS M-38A, with several modifications. Results obtained for CIF of each isolates studied (CIF = 0.18 0.36 microM), demonstrate that exists a very potent synergistic effect, when they are combined, and it represents a hope for future clinic trials to treat resilient fungal infections caused by M. canis.

Perianal Streptococcal Dermatitis: An Important Differential Diagnosis in Pediatric Patients

Perianal streptococcal dermatitis is an infectious disease that predominantly affects younger children and is mostly caused by Group A beta-hemolytic streptococci. Although patients are mostly seen primarily by their pediatrician or family physician, the diagnosis is not infrequently established just after referral to a dermatologist or colorectal surgeon. We report a case series of 124 children, aged 14 years or younger, who were seen at our office for anorectal complaints between February 2003 and September 2006. Twenty-one of 124 patients (16 percent) were diagnosed with perianal streptococcal dermatitis on the basis of a positive perianal swab by microbiologic analysis. Perianal streptococcal dermatitis was the most frequent infectious disease in that age group in our practice. Sixteen (of 21, 76 percent) patients were male, and the mean age was 6.3 years. One course of systemic antibiotic treatment augmented by additional local antiseptic ointment in selected cases cured all patients within 10 to 14 days. One patient presented with a new perianal streptococcal dermatitis episode five months after treatment and was successfully retreated with an oral antibiotic. With this report, we wish to alert the colorectal community of the diagnosis because it may be underdiagnosed in our practices and thereby lead to prolonged discomfort, protracted disease, and potentially harmful sequelae for these typically very young patients.

水痘に合併した小児顔面神経麻痺例

Chickenpox is one of the most frequent infectious diseases during childhood. However, instances of this disorder being complicated by facial paralysis alone are rare. In a 4-year-old girl, chickenpox-related exanthema appeared. Thereafter, right facial movements became impaired, and the girl was diagnosed with facial paralysis. There were no other neurological abnormalities. After 6 weeks of steroid therapy, a complete response was achieved.

Zerebrale Tuberkulose bei HIV-Infektion

BACKGROUND Tuberculosis is the most frequent infectious disease causing death worldwide. The main risk factor is an HIV infection. CNS involvement occurs in 5 - 20 % of HIV infected patients with tuberculosis. MATERIAL AND METHODS We investigated all cases of CNS tuberculosis in HIV infection treated in a German university hospital from 1998 to 2006. Clinical symptoms, differential diagnosis, diagnostic and therapeutic standards of cerebral tuberculosis, including specific aspects in HIV infection, are discussed. RESULTS The incidence of CNS tuberculosis in HIV infected patients was 1.5 %. All patients were transiently treated in an ICU. Related to all HIV infected patients admitted to an ICU, the incidence of CNS tuberculosis was 10 %. CONCLUSIONS Tuberculosis is an important differential diagnosis in HIV infected patients with focal and diffuse brain lesions. Due to the HIV associated immunodeficiency syndrome, atypical diagnostic results are seen frequently. Extensive diagnostic investigations should be performed, including biopsy and search for extra cerebral manifestation. An antituberculous treatment is indicated even in cases suspicious of cerebral tuberculosis. HAART reduces the mortality risk significantly.

Die aktuelle Tuberkulosesituation in Deutschland und die Auswirkungen der globalen Situation

Tuberculosis (TB), like HIV/AIDS and malaria, belongs to the most frequent infectious diseases worldwide. About one-third of the world's population is infected with Mycobacterium tuberculosis (M. tuberculosis), and 5-10 % of those infected develop tuberculosis in the course of their lives. It is estimated that there were approx. 8.9 million new infections worldwide in 2004, representing an incidence of approx. 140/100,000. 3.9 million cases (62/100,000) were classified as smear positive. It is assumed that one smear-positive patient infects about 10-15 other people in the course of one year, and the infection risk is particularly high in HIV-positive persons. For Germany as a low-incidence country, the impact of growing global migration is a key point for future effective prevention of infection. Although the incidence of tuberculosis in Germany is decreasing according to the Robert Koch Institute, public health authorities should nevertheless consider the possible re-import of this infectious disease as a serious problem, in particular in view of the rising resistance rates.

Aptamer from whole-bacterium SELEX as new therapeutic reagent against virulent Mycobacterium tuberculosis

Worldwide, tuberculosis (TB) remains the most frequent and important infectious disease causing morbidity and death. One-third of the world’s population is infected with Mycobacterium tuberculosis (MTB), the etiologic agent of TB. Because of the global health problems of TB, the development of potent new anti-TB drugs without cross-resistance with known antimycobacterial agents is urgently needed. In this study, we have applied a Systematic Evolution of Ligands by Exponential Enrichment (SELEX) process to identify a single aptamer (NK2) that binds to virulent strain M. tuberculosis (H37Rv) with high affinity and specificity. We have found that this aptamer improves CD4 +T cells to produce IFN-γ after binding to H37Rv. The different component between H37Rv and BCG was identified as some membrane protein. Moreover, the survival rates of mice challenged with i.v. H37Rv have been prolonged after treatment with single injection of aptamer NK2. The bacterial numbers were significantly lower in the spleen of mice treated with aptamer NK2. The histopathological examination of lung biopsy specimens showed lesser pulmonary alveolar fusion and swelling in the presence of the aptamer. These results suggest that aptamer NK2 has inhibitory effects on M. tuberculosis and can be used as antimycobacterial agent.

MORBIDITY AND MORTALITY OF BALD EAGLES (HALIAEETUS LEUCOCEPHALUS) AND PEREGRINE FALCONS (FALCO PEREGRINUS) ADMITTED TO THE WILDLIFE CENTER OF VIRGINIA, 1993–2003

Medical records from 111 threatened bald eagles (86%, Haliaeetus leucocephalus) and peregrine falcons (14%, Falco peregrinus) admitted to the Wildlife Center of Virginia from 1993 to 2003 were reviewed to identify submitters, causes of morbidity and mortality, and final disposition. Half of all patients admitted were submitted by the Virginia Department of Game and Inland Fisheries personnel. Trauma was the most common reason for presentation in bald eagles (70%) and peregrine falcons (81%). Additional causes of morbidity and mortality in bald eagles included toxicoses (10%), infectious diseases (8%), and orphaned young (1%). Neoplasia was confirmed in two trauma cases, suggesting underlying disease might have increased susceptibility to acute traumatic injuries. Peregrine falcons were also admitted for infectious disease (19%). The most frequent infectious disease for both species was West Nile virus. Thirty-nine percent of patients were released back into the wild, 28% were euthanized, 20% died, and 13% were placed in captivity. Postrelease monitoring that would determine whether rehabilitated animals survived to contribute to threatened populations was not performed in this study.

Flexibility of rapid-acting insulin analogues in children and adolescents with diabetes mellitus

Background: Every year, ~70,000 children aged <15 years develop type 1 diabetes mellitus (DM) worldwide. Achieving glycosylated hemoglobin control is a very important aim, but quality-of-life concerns for the child and the family should also have high priority in the management of pediatric DM. Objective: This review outlines some of the issues involved in treating type 1 DM in children and adolescents, as well as the use of rapid-acting insulin analogues in basal-bolus therapy and continuous subcutaneous insulin infusion pumps. Methods: This review article was based on a presentation at a satellite symposium entitled “Realising the Value of Modern Insulins: Reaching Further with Rapid-ActingInsulinAnalogues”that was convenedduring the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa. Results: Treating children and adolescents with DM is a challenge that should not be ignored. Furthermore, DM in children is quite different from that in adults. Numerous factors have to be taken into account when evaluating treatment for children with DM in comparison with treatment for adult DM: sleep patterns; unpredictable activities, especially eating behaviors; limited size of injection sites, making it difficult to rotate injections; higher insulin sensitivity; and frequent infectious diseases. In addition, achieving normal psychosocial development may be just as important as achieving strict metabolic control in this population. Rapid-acting insulin analogues can be used effectively in these individuals with type 1 DM. The pharmacokinetic profile of insulin aspart suggests that it is suitable for flexible mealtime administration in children and adolescents. Indeed, clinical studies in children and adolescents have shown the efficacy and tolerability of postprandial administration of insulin aspart, particularly in comparison with soluble human insulin. Postprandial administration of insulin aspart, compared with preprandial soluble human insulin, has alsobeenstudiedinveryyoungchildren(aged2-6years); similar metabolic control and increased parent preference for insulin aspart were reported. Conclusions: Rapid-acting insulin analogues in children and adolescents with type 1 DM are effective and well tolerated; they can be injected postprandially, and this is a reliable option that can be recommended to patients and their families.

Psychosis during peginterferon-alpha2a and ribavirin therapy: case report

Pegylated Interferon-alpha, combined with ribavirin, gives high sustained virological response in patients with hepatitis C virus, an important public health problem and one of the most frequent chronic infectious diseases worldwide. Though it has therapeutic benefits, treatment with IFN-alpha may be complicated by various side effects, especially symptoms of major depression and acute mania. Psychosis is a rare side effect, and its management usually includes discontinuation of IFN-alpha. We report a case of psychotic disorder that occurred during therapy with pegylated Interferon-alpha given associated with ribavirin. After good response to psychiatric treatment, it became possible to finish the anti-viral therapy.

Phase I Clinical Study of Donor Lymphocyte Infusion Depleted of Alloreactive T Cells after Haplotype Mismatched Myeloablative Stem Cell Transplantation To Limit Infections and Malignant Relapse without Causing GVHD.

Patients with very high risk hematologic malignancies who cannot find an HLA-matched related or unrelated donor can benefit from haplo-mismatched transplantation. The latter is, however, complicated by frequent and severe infectious complications and disease relapse due to delayed immune reconstitution. We have previously reported that photodynamic therapy (PDT) could selectively deplete donor alloreactive populations while preserving lymphocytes for immune responses. Indeed, the dibromorhodamine derivative TH9402 (Celmed BioSciences) has a propensity to accumulate in activated but not resting T cells. We present results of an ongoing Phase I clinical trial of haplo-mismatched allogeneic stem cell transplant (SCT) supplemented with donor lymphocyte infusions (DLIs) PDT depleted of host-reactive T cells. Nine high-risk patients with hematologic malignancies (5 AML relapsed or refractory, 2 MDS, 1 NHL relapsing after autologous SCT, 1 refractory CLL) entered the trial, 7 are evaluable for acute GVHD and reconstitution. Patients (4 M, 3 F) underwent transplantation with donor cells mismatched at 3 HLA Ags: 2 patients; 2Ags: 4 pts, and DR only: 1 pt). Donor mononuclear cells (MNCs) were incubated with recipient MNCs for 4 days, exposed to TH9402 PDT, stored frozen, and administered on day 30±3 after transplant at 3 graded DLI dose levels: 1×104 (1pt), 5×104 (3pts), and 1.3 x105 (3pts) CD3+ cells/kg. Anti-host cytotoxic T lymphocyte precursors (CTLp) were depleted from DLIs by approximately 1.5 logs, and flow cytometry showed greater than 90% elimination of activated T cells (CD4+CD25+ and CD8+CD25+) by TH9402 PDT. All stem cell grafts underwent in vitro immunomagnetic T cell depletion using CD34+ positive cell selection (Miltenyi). Median age at SCT was 57 years (range: 40–58). Five patients were in partial remission or had progressive disease, and 2 patients were in complete remission at the time of SCT. The myeloablative regimen consisted of TBI (1200 cGy), thiotepa (5 mg/kg) and fludarabine (40 mg/m2/day for 5 days) followed by infusion of CD3 depleted HSC grafts. A median of 9.2×106 CD34+ cells/kg were infused on day 0. No GVHD prophylaxis was administered. Evaluable patients showed durable hematologic engraftment: median time to >0.5×109 granulocytes/L was 10.5 days (8–20), and to >20×109 platelets/L without transfusion, 12 days (9–137) and achieved complete donor chimerism. No patient developed acute GVHD (grade II–IV), while 3 patients developed signs of chronic GVHD. Two patients died: one (cohort 1) of a post-transplant lymphoproliferative disease, and one (cohort 2), of relapsed AML. No other patient relapsed. Two pts (1 in cohort 2 and 1 in cohort 3) recovered greater than 0.3×109 CD3+ and CD4+ cells/L at 2 and 5 months post-DLI, and 4 pts had >0.2×109 CD3+ cells/L at 6 mo post-DLI. Although 4 patients developed infectious complications (HSV, CMV, Nocardia, Aspergillus), all resolved rapidly with appropriate therapy. The overall disease-free-survival and survival are 57% at 1 year (median follow-up: 9.4 mo). Our results indicate that the post-transplant infusion of a PDT treated DLI is feasible, does not induce acute GVHD, and may accelerate T cell reconstitution. This PDT strategy could represent an appealing alternative for patients in the higher age range who are at high risk for GVHD.

Unusual cardiac features in cholestatic hepatitis A in an adolescent: Improvement with corticosteroid treatment

Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. Extra-hepatic manifestations of acute hepatitis A virus are rare in pediatric age group. We report a case of a 16-year-old, otherwise healthy adolescent who had viral hepatitis A with cardiac manifestations. The patient is the first pediatric case of hepatitis A with a combination of hypotension, persistent bradycardia and progressive cholestasis.

Pneumonie – erregerbasierte oder konstellationsbasierte Therapie?

Community-acquired pneumonia is one of the most frequent infectious diseases with high morbidity and mortality. Early and sufficient antibiotic treatment is crucial for the prognosis of the patient. The underlying pathogens are mostly unknown at the onset of symptoms. The choice of antibiotic treatment depends on the suspected pathogens, derived from the typical germs and the typical resistances in a certain area. In addition, individual risk factors, such as age, severity of the diseases, comorbidities, and previous antibiotic treatment have a major impact on the probability of dying for an individual patient. These factors must be considered at the beginning of any treatment. Pathogen-based treatment has to be switched to constellation-based treatment.

Pharmacoeconomic evaluation of cefaclor in the pharyngo-tonsillitis and acute otitis in children

Pharyngotonsillitis (FT) and acute otitis media (OMA) are among the most frequent infectious diseases of the childhood and exact a heavy toll on the Italian national health service (INHS), families and society as a whole. In case of established or suspected bacterial origin, current treatment guidelines for FT recommend 5-10 days of oral antibiotics, chosen among available penicillins, cephalosporins, or macrolides. More controversial appears the systematical use of an antibiotic for OMAs, but prevalent expert opinion suggests use of the same agents. In this paper, an economical appraisal of five of the most prescribed oral antibiotics for these indications in Italy (cefaclor, amoxicyllin, amoxicyllin/clavulanate, clarithromycin and azithromycin) is provided. The evaluation was conducted through the development and implementation of two distinct models, constructed to reflect national treatment patterns of these infections. Clinical and economical data were obtained from several sources: literature review, including published meta-analyses, consultation of an expert panel and, most importantly, from the results of a specific questionnaire-based survey completed by 136 pediatricians, based throughout Italy. The models were run to conduct both cost-effectiveness and cost-minimization analyses, that consistently indicated cefaclor and amoxicyllin to be substantially equivalent in terms of total costs to the INHS and the Italian society, but significantly more convenient than amoxicyllin/clavulanate, claritrhomycin or azithromycin. Extensive probabilistic sensitivity analyses confirmed the robustness of this conclusion.

Dermal and bronchial symptoms in children: are they caused by PAH containing parquet glue or by passive smoking?

In 1997 a new source of potential polycyclic aromatic hydrocarbon (PAH) exposure was discovered: very high levels of (PAHs) and benzo-a-pyrene (BaP) were detected in household dust from former American Forces housing in Frankfurt am Main, Germany, built in 1955/1956. This contamination was caused by a parquet glue containing coal tar, the use of which was formerly a standard building practice in Germany. Children were considered to be at special risk for exposure to PAHs when playing on the floor via mouthing. Therefore, the children's symptoms and complaints were analysed for association with PAH contamination in parquet glue and household dust as well as with internal exposure to PAHs via determination of 1-hydroxypyrene in urine samples. Two hundred and eighty seven children <6 years of age living more than 12 months in the former US-housing estates are enrolled in this analysis, representing 22.3% of the children <6 years of age living there. Their spot urine samples were analysed for 1-hydroxypyrene. The level of BaP in parquet glue and in household dust was available in the homes of 215 and 212 children, respectively. There were no hints for differences in PAH contamination in parquet glue or in household dust of the participants' flats compared to the flats of the non responders. In 246 cases data on environmental tobacco smoke exposure at home was known as well. Data on symptoms and complaints observed by their parents during the preceding 12 months (1-year prevalence) were obtained using the ISAAC questionnaire (modified). The following 1-year prevalences were reported: 15% itching eczema in elbows, 10% itching and urticaria, 6% itching in the palate and throat, 20% sneezing and running nose or stuffed nose, 15% nosebleed; 25% wheezing, 42% dry cough, and 60% frequent infectious disease. No consistent associations between symptoms and BaP in parquet glue or in household dust or urinary levels of 1-hydroxypyrene in the children could be found. However, associations between symptoms and exposure to environmental tobacco smoke at home were to be seen, significant for dermal and bronchial symptoms. Informed about PAHs in parquet glue and household dust many parents demanded for total redevelopment of their flats. According to statistical evaluation of the children's symptoms, observed by their parents, no hints for an association with exposure via BaP in parquet glue or household dust were found. However, significant associations between symptoms and the exposure to environmental tobacco smoke were observed, especially bronchial and dermal symptoms. Therefore instead of redevelopment of flats with parquet glue containing coal tar, intensified information on the harmful effects of passive smoking in childhood seems to be mandatory.

Risikofaktoren für die ambulant erworbene Pneumonie (Community Acquired Pneumonia)

Community acquired pneumonia (CAP) is the most frequent mortal infectious disease in the western industrial countries. So far no detailed information about incidence, pathogenetic agents, medical service and risk factors existed within Germany. This article reviews international studies, which identified risk factors for CAP.The MEDLINE database search comprised 743 articles from 1966 to December 2003. Ten published studies analysing risk factors for CAP were included in this study.Age, gender, smoking and chronic lung diseases ranged among the leading risk factors. Other variables, like medication, dangerous substances, alcohol or sociodemographic factors have so far been insufficiently proved.Comparable data concerning CAP in Germany are currently inadequate. In order to improve the data situation, in 2002, the Community Acquired Pneumonia NETwork (CAPNET) was established. CAPNET assembles and soon intends to publish detailed information about incidence and risk factors of Community Acquired Pneumonia.