Significant Difference In Infection Research Articles

A learning curve of total knee arthroplasty (TKA) based on surgical volume analysis

The purpose of this study is to discover valuable medical facts by utilizing the Taiwan National Health Insurance (NHI) database, which contains 32,200 records of TKA surgeries. Three main objectives of this paper include the following: (a) building learning curves of TKA from the target database; (b) characterizing how the TKA volume correlates with infection rate and mortality; (c) examining the differences of infection rate and mortality between the medical center (Group I) and the non-medical center (Group II). The TKA samples are classified into two groups according to their institution type (medical center and non-medical center). The Z-test is used to test whether there are differences in the infection rate and mortality between the two observed groups. This study also adopts linear/nonlinear regression to investigate the relationship between TKA volume and the infection rate (mortality). This study has three main findings: (a) it confirms a correlation between the TKA surgical volumes and certain outcomes, (b) surgeons and hospitals with higher TKA volumes exhibit better operation quality, lower postoperative complication rate, and (c) there are significant differences in infection and mortality rate between Group I and Group II.

Ten Years Stable Internal Fixation of Metacarpal and Phalangeal Hand Fractures—Risk Factor and Outcome Analysis Show No Increase of Complications in the Treatment of Open Compared With Closed Fractures

: Stable internal screw/plating systems for hand fractures have evolved during the last 20 years. The improved versatility leads to the increased use of these materials in open fractures, with the benefit of early mobilization. The aim of this retrospective study is to discern whether the broadening of the indications for these implants is accompanied by increased complication rates. : Data from 365 patients treated during the last 10 years at our department for metacarpal or phalangeal fractures with stable internal fixation by screw or plate were gathered and analyzed. : Uneventful bony consolidation was observed in 91.2% (n = 333). The functional results were excellent to acceptable in 85.2%, whereas in 14.8% (n = 54), the result was unsatisfactory, the latter group presenting with concominant soft tissue injury. There was no statistically significant difference in infection and nonunion rates when comparing open and closed fractures. : These results confirm that most patients with open metacarpal and phalangeal fractures can be treated by stable internal fixation.

Is Surgical Training Excellent in the United Kingdom? – Preliminary Results of an Ongoing Prospective Survey

Is Surgical Training Excellent in the United Kingdom? – Preliminary Results of an Ongoing Prospective Survey

Intestinal helminths and protozoa in children in pre-schools in Kafue district, Zambia

Intestinal parasitic infections are among the most widespread of human infections in developing countries, and children are the most vulnerable. The aim of this study was to determine the prevalence of the protozoa Cryptosporidium and Giardia, as well as prevalence and intensity of intestinal helminths in children attending pre-school or day-care centres in Kafue District, Zambia. Single stool samples were collected from 403 children from 10 pre-schools and were subjected to duplicate Kato-Katz thick smears to identify and quantify helminths. A commercial immunofluorescence kit was used to identify Cryptosporidium- and Giardia-positive samples. The overall prevalence of helminth infection was 17.9%. Ascarislumbricoides was found in 12.0%, hookworm in 8.3%, Taenia spp. in 0.9%, Hymenolepisnana in 0.6% and Schistosomamansoni in 0.3%. The overall prevalence of Cryptosporidium and Giardia was 28.0 and 29.0%, respectively, with more girls infected with Giardia (33.8%) than boys (22.7%) (P=0.02). Significant differences in infections with A. lumbricoides and Cryptosporidium were observed between the various pre-schools (P < 0.001). These findings indicate that intestinal parasites are prevalent in children enrolled in pre-schools in Zambia. Future studies should explore local factors associated with transmission of these infections, and consequently provide the necessary health education to parents and teachers.

Assessment of iodine-treated filter media for removal and inactivation of MS2 bacteriophage aerosols

Aims: To investigate the performance of an iodine‐releasing filter medium for use as a protective device against airborne pathogens. Methods and Results: The filter’s physical and viable removal efficiencies (VRE) were investigated with challenges of MS2 bacteriophage aerosols, and the infectivity of MS2 collected on the filter was analysed. To test a proposed inactivation mechanism, media containing thiosulfate or bovine serum albumin (BSA) were put in impingers to quench and consume I2 released from the filter. In direct plating experiments, treated filters presented significantly higher VREs than did untreated filters; however, collection in excess BSA decreased VRE by half and in thiosulfate the apparent VRE decreased drastically. No significant difference in infectivity of retained viruses on treated and untreated filters was observed at the same environmental condition. Conclusions: Evidence presented herein for competition by dissolved I2 in infectivity assays supports a mechanism of induced displacement and capture of I2. It also requires that dissociation of iodine from the filter and capture of iodine by MS2 aerosols as they pass through the filter be factored in the design of the assessment methodology. The filter’s strong retention capability minimizes reaerosolization but also makes it difficult to discriminate the antimicrobial effect at the surface. Significance and Impact of the Study: This study shows the direct plating assay method to be sensitive to interference by iodine‐releasing materials. This requires reevaluation of earlier reports of VRE measurements.

Effects of the “all-fish” GH (growth hormone) transgene expression on resistance to Ichthyophthirius multifiliis infections in common carp, Cyprinus carpio L.

A study was undertaken on the susceptibility of the F 4 generation of “all-fish” growth hormone transgenic carp, Cyprinus carpio L., against Ichthyophthirius multifiliis infections. When 1-year old, transgenic carp, with non-transgenic carp and non-manipulated carp (controls) were split into three batches, and experimental infections were performed throughout the 3-month period. All 72 fish were successfully infected. It was shown that there was a significant difference ( P < 0.01) on infection level between transgenics and non-transgenics, and transgenics and controls. It possibly resulted from transgenics that had stronger non-specific immune functions. In addition, fish surface area affected significantly infection level ( P < 0.001). Carp with larger surface area harboured more parasites for each type of fish, but transgenic with larger surface area than non-transgenics and controls ( P < 0.01), loaded fewer parasites than others. Besides, the time of infection also greatly influenced ( P < 0.001) infection level. Results showed that there was a significant decline in parasite infectivity through October to November ( P < 0.001). It was likely to suggest that there existed senescence resulted in failure of any I. multifiliis isolate maintenance. Significant difference in infectivity between isolate G from grass carp and isolate H from gold fish suggested that different parasite strains may exist.

Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus

Objectives In a large retrospective study, the association of smoking with human papillomavirus (HPV) genotype and vaginal intraepithelial neoplasia (VAIN) grade was analyzed. Methods A SNOMED search was performed for vaginal biopsy or resection specimens diagnosed as VAIN over an 11-year period. The diagnosis of VAIN grade was confirmed by histological review. HPV genotype was determined by GP5+/6+ PCR and dot blot hybridization with type-specific oligonucleotide probes. Smoking history was obtained by chart review. Statistical analysis was performed using the chi-square test. Results We identified specimens from 111 patients (age range 15–84); 64% ( n = 71) were diagnosed with high-grade VAIN (HGVAIN) and 36% ( n = 40) with low-grade VAIN (LGVAIN). High-risk (HR) HPV genotypes were identified in 83% of specimens ( n = 92), other types in 17% ( n = 19). Twenty-one different HPV genotypes were detected in total. Smoking history was available for 81% ( n = 90). Forty-one percent ( n = 37) had a positive smoking history. There was no significant difference in infection with HR vs. other types ( p = 0.92) among smokers when compared to non-smokers. In patients with HR HPV genotypes, smokers were at an increased risk for HGVAIN lesions when compared to patients who had never smoked (83% vs. 59%, p = 0.02). Conclusions These data indicate an increased risk for HGVAIN in HR HPV positive women who smoke compared to HR HPV positive non-smokers.

Can daclizumab reduce acute rejection and improve long‐term renal function in tacrolimus‐based primary renal transplant recipients?

To evaluate the efficacy and safety of a tacrolimus-based immunosuppressive regimen with and without induction therapy using daclizumab in first cadaveric renal transplant recipients. Since January 2001, we studied the effect of daclizumab in a non-randomized and prospective study of 36 sequential first cadaveric renal transplant recipients. They were compared with a historical control group of 21 sequential first cadaveric renal transplant recipients without induction therapy. All patients received tacrolimus, azathioprine and corticosteroids as concomitant immunosuppressive therapy. Daclizumab was given at 1 mg/kg infusion 2 h before transplantation and then every 14 days for four more doses. Outcomes measured included incidence of acute rejection, patient survival, graft survival, annualized change in creatinine clearance (CrCl), cardiovascular risk profile, infection and malignancy. Fewer biopsy proven acute rejections were observed in the induction treatment group: 11.1% (4/36) versus 19% (4/21) but the rejection free survival was similar (P = 0.37). The patient survival and graft survival were comparable. The renal function was similar in both groups. There were also no significant difference in infection, malignancy and cardiovascular risk profile in both groups. Adding daclizumab to a tacrolimus-based therapy is safe but cannot further improve clinical efficacy.

Survey on Seroprevalence of Anti-Toxoplasma Gondii Antibodies in Cattle in Tabriz (Iran) by IFAT

Toxoplasmosis is a zoonotic disease in various species of animals caused by a sporozoan parasite, Toxoplasma gondii. The disease occurs throughout the world including Iran. This disease is a common infection of sheep, goats and it is recognized as one of major infection cause of reproductive failure. This survey was carried out to show the prevalence of this disease in cattle in Tabriz (Iran). 490 sera samples were collected from both native and industrial cattle. The Indirect Fluorescent Antibody Test (IFAT) was used to determine the rate of infection. The results of this survey are showed that the overall seroprevalence of antibody of Toxoplasma incattle in Tabriz is 15.91%. There was significant differences in infection to Toxoplasma gondii in the age group of cattle (P 1 years old cattle. Also a significant differences was observed between rate of infection and sex in cattle (P<0.0 l). In total the results of this study together with the previously recorded low seroprevalence of antibody to Toxoplasma in cattle in Iran and other countries support the impression that Toxoplasmosis is not widespread cause for abortion and a latent infection in cattle.

Water for wound cleansing

Background Various solutions have been recommended for cleansing wounds, however, normal saline is favoured as it is an isotonic solution and is less likely to interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. Objectives The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy Randomised and quasi-randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Register (June 2004), MEDLINE (1996-2004), EMBASE (1980-2004), CINAHL (1982-2004), and the Cochrane Controlled Trials Register (Issue 2, 2004). Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched. Selection criteria Randomised and quasi-randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis Trial selection, data extraction and quality assessment were carried out independently by two reviewers and checked by a third reviewer. Differences in opinion were settled by discussion. Some data were pooled using a fixed effects model. Main results Five trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline; three compared cleansing with no cleansing and one compared cleansing with procaine spirit with water. There were no standard criteria for the assessment of wound infection across the trials which limited the ability to pool the data. The major comparisons were water versus normal saline, and tap water versus no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16 (95% CI 0.01-2.96). Use of tap water to cleanse acute wounds in adults was associated with a lower rate of infection than saline (RR 0.55, 95% CI 0.31-0.97). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection, when compared with saline (RR 1.07, 95% CI 0.43-2.64). Similarly, no statistically significant differences in infection rates were seen when wounds were cleansed with tap water versus not cleansed at all (RR 0.81, 95% CI 0.31-2.12). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. Conclusions Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. In the absence of drinkable tap water, boiled and cooled water as well as distilled water can be used as cleansing agents.

Revascularization after segmental resection of lower extremity soft tissue sarcomas

Limb salvage surgery combined with vascular reconstruction has replaced amputation as the preferred treatment of soft tissue sarcomas involving major vascular structures of the extremities. We describe our experience with soft tissue sarcomas involving major vascular structures and examine outcomes according to the type of graft selected for arterial reconstruction. We also examine the effect of venous reconstruction on post-operative edema. This retrospective review includes 14 patients with lower extremity soft-tissue sarcomas that encased major vessels, requiring combined limb-preserving tumor resection and revascularization with a synthetic or autogenous saphenous vein graft. Edema in patients with and without venous reconstruction was compared. The incidence of infection, wound dehiscence, and graft thrombosis were compared according to arterial graft type. There was no significant difference in edema in patients with venous reconstruction and those without. There was also no significant difference in infection and graft thrombosis in patients with synthetic grafts and those with autogenous saphenous vein grafts. Wound dehiscence occurred more often in patients with synthetic grafts (P = 0.029). Although this study was small, these results suggest that further studies are needed to determine the roles that vascular graft selection and venous reconstruction play in clinical outcome.

Characterization of baculovirus isolates from Trichoplusia ni populations from vegetable greenhouses

Abstract A survey of cabbage looper, Trichoplusia ni , populations in greenhouse vegetable crops in the Fraser Valley (FV) of British Columbia, Canada led to the isolation of a large number of Nucleopolyhedrovirus (NPV) single-infected-larva isolates. These NPVs were identified from cadavers by phase-contrast light microscopy and characterized as either T. ni SNPV (TnSNPV) or Autographa californica MNPV (AcMNPV) by mulitplex-PCR. Among the 57 NPV isolates collected in 2000, 54 were TnSNPV and three, all from one greenhouse, were AcMNPV. In 2001 over 100 single-infected-cadaver NPV isolates were characterized by PCR and all were TnSNPV. Restriction endonuclease (REN) analysis confirmed the PCR identification of individual isolates. In addition, REN analysis showed that all TnSNPV isolates had identical REN profiles that were similar to but distinct from the reference strain TnSNPV-RJ suggesting that TnSNPV-FV isolates constitute a single unique strain of the virus. In contrast, only a few AcMNPV were isolated and these constitute two strains based on REN profiles that were distinct from other AcMNPV strains. Dose–response bioassays with 2nd and 4th instar T. ni indicated there was no significant difference in infectivity of TnSNPV and AcMNPV isolates. However, in 5th instar T. ni AcMNPV was as much as 10-fold more infectious than TnSNPV. In addition, AcMNPV appeared to be more virulent as infected 4th instar larvae died approximately 18 h sooner than TnSNPV infected larvae. TnSNPV produced approximately five times more occlusion bodies per cadaver than AcMNPV. Both AcMNPV and TnSNPV appear to have good potential as candidates for biological control agents of T. ni.

High susceptibility of Neotricula aperta gamma-strain from Krakor and Sdau in Cambodia to Schistosoma mekongi from Khong Island in Laos

Neotricula aperta γ-strain snails collected from Krakor and Sdau in Cambodia were found to have the same or higher susceptibility to Schistosoma mekongi as N. aperta originally isolated from Khong in Laos. Infection rates of N. aperta γ-strain snails exposed to 3 miracidia at week 8 were: Khong γ-strain, 22.6%; Krakor γ-strain, 33.3%; and Sdau γ-strain, 67.4%. At week 10, the Sdau γ-strain showed the highest infection rate of 83.3%. We thus found significantly high susceptibility of the Sdau γ-strain to S. mekongi originally isolated from Khong. However, in another experiment, susceptibility of the Sdau γ-strain was rather comparable to that of Khong and Krakor γ-strain. We also found no significant differences in infection and survival rates between the Khong and Krakor γ-strain when the snails were exposed to 3 or 6 miracidia. This is the first report to confirm the high susceptibility in the laboratory of N. aperta γ-strain snails from endemic areas in Cambodia to S. mekongi originally isolated from Laos. The high susceptibility of N. aperta γ-strain snails to S. mekongi in distant areas may be an important factor in the endemic transmission of human schistosomiasis.

Palifermin improves severe mucositis, swallowing problems, nutrition impact symptoms, and length of stay in patients undergoing hematopoietic stem cell transplantation

The aim of this study was to compare palifermin, a recombinant form of human keratinocyte growth factor, with standard treatment on outcomes in patients receiving a high dose of chemotherapy conditioning regimen, undergoing hematopoietic stem cell transplantation (HSCT). Over a 1-year period, a series of 59 patients were included: 32 patients (palifermin) were compared with 27 patients (standard treatment). Outcomes assessed at day 8 posttransplantation were mucositis, swallowing, nutrition impact symptoms, dietary intake, time to engraftment, length of stay, infection, and cumulative dose and duration of narcotic administration. There was a significant reduction in the incidence of severe oral mucositis (13 vs 48%, p=0.003), swallowing problems (p=0.044), number of nutrition impact symptoms experienced (4.9 vs 6.0, p=0.003), and length of stay (14 vs 18 days, p=0.026) in the palifermin group compared to standard care. There was no significant difference in infection, dietary intake, time to engraftment or cumulative dose and duration of narcotic administration between groups. Beneficial outcomes were observed from the use of palifermin in patients undergoing HSCT after a high dose of chemotherapy conditioning regimen. A randomized clinical trial is needed to confirm these results.

Prevalence of Fasciolosis in Zambian Cattle Observed at Selected Abattoirs with Emphasis on Age, Sex and Origin

The aim of this study was to determine the prevalence and some factors influencing occurrence of fasciolosis in cattle, carried out at selected major abattoirs in Zambia. Of 841 cattle livers inspected and 677 faecal samples analysed, prevalence rates of 53.9% and 48.9%, respectively, were found. Cumulative prevalence of 60.9% (n = 677) was recorded. According to age, no significant difference of infection was found. Female cattle on liver inspection (59.3%) and coprological examination (65.2%) had significantly higher (P < 0.001) rates than males (44.5% and 36.3% respectively). Origin of cattle had a significant influence (P < 0.001) on the prevalence rate. According to fluke egg count classification, 68.5% of cattle had light infection, 20.9% moderate, 4.4% heavy and 6.2% severe. These results indicate that Fasciola gigantica infection is an important condition that leads to high liver condemnations and/or trimmings in cattle tendered for slaughter.

Glucosyltransferases of viridans streptococci are modulins of interleukin-6 induction in infective endocarditis.

The glucosyltransferases (GTFs) of viridans streptococci, common pathogens of infective endocarditis, are extracellular proteins that convert sucrose into exopolysaccharides and glucans. GTFs B, C, and D of Streptococcus mutans are modulins that induce, in vitro and in vivo, the production of cytokines, in particular interleukin-6 (IL-6), from monocytes. The roles of S. mutans GTFs in infectivity and inflammation in situ were tested in a rat experimental model of endocarditis. No significant differences in infectivity, in terms of 95% infective dose and densities of bacteria inside vegetations, were observed between laboratory strain GS-5 and two clinical isolates or isogenic mutant NHS1DD, defective in the expression of GTFs. In aortic valves and surrounding tissues, IL-6 was detected by Western blots and immunostaining 24 h after GS-5 infection, was maintained over 72 h, and was followed by production of tumor necrosis factor alpha but not IL-1beta. Animals infected with NHS1DD showed markedly lower levels of IL-6 (less than 5% of that of parental GS-5-infected rats), while tumor necrosis factor alpha was unaffected. In contrast, animals infected with NHR1DD, another isogenic mutant expressing only GtfB, showed a much smaller reduction (down to 56%). These results suggest that GTFs are specific modulins that act during acute inflammation, inducing IL-6 from endothelial cells surrounding the infected valves without affecting bacterial colonization in vegetations, and that IL-6 might persist in chronic inflammation in endocarditis.

Horizontal transmission of fungal infection by Metarhizium anisopliae in parasitic Psoroptes mites (Acari: Psoroptidae)

Abstract Ectoparasitic mites of the genus Psoroptes cause mange in a wide range of domestic and wild vertebrate hosts. The mite infestation may be localised in the ear of the host, or be more generalised over the body. In the latter case, infestation may be debilitating and often fatal, particularly in domesticated cattle, sheep and goats. At present, control depends on the use of organophosphate or pyrethroid plunge dips or injectable endectocides. A series of in vivo bioassays are described here to further evaluate the use of an entomopathogenic fungus, Metarhizium anisopliae (Metschnikoff) as a biological control agent for Psoroptes mites. Mites were obtained from the ears of rabbits ( Psoroptes ovis (Hering) syn. Psoroptes cuniculi ). High levels of mortality (>94%) were observed in all life-cycle stages when exposed to a 1 × 10 8 conidia ml −1 suspension; there were no significant differences in infection between the different life-cycle stages. The treatment of eggs, however, had no effect on hatch rate. The horizontal transmission of the pathogen was considered by placing live uninfected mites in experimental chambers with an infected cadaver, but preventing direct contact using a mesh cage which would allow the passage of conidia but exclude direct physical contact. None of the uninfected mites showed signs of mycosis-induced mortality, indicating that direct contact with the cadaver was required for infection. Uninfected live mites were then brought into direct contact with an infected cadaver by a single touch of the mite to the cadaver ( M. anisopliae between infected Psoroptes mites, when used as a biological control agent, on an infected host is discussed.

Outcome of hip arthroplasty in octogenarians compared with younger patients.

octogenarians are more likely to require blood transfusions and a longer hospital stay, with less improvement in clinical outcome at 18 months after primary hip arthroplasty. (Hip International 2005; 15: 206-11).

Outcome of hip arthroplasty in octogenarians compared with younger patients

octogenarians are more likely to require blood transfusions and a longer hospital stay, with less improvement in clinical outcome at 18 months after primary hip arthroplasty. (Hip International 2005; 15: 206-11).

Pegfilgrastim Versus Filgrastim To Accelerate Hematopoietic Recovery after High Dose Melphalan and Autologous Hematopoietic Stem Cell Transplant (ASCT) for Multiple Myeloma.

High-dose melphalan followed by ASCT is a common component of the early treatment for patients with multiple myeloma. Daily subcutaneous injections of filgrastim (Neupogen) at 5 ug/kg/day until ANC > 500/ul are routinely administered at our center from day +4 following ASCT, in order to accelerate hematopoietic recovery and lessen neutropenic complications. Pegfilgrastim (Neulasta) as a single 6 mg fixed dose subcutaneous injection has been shown to have similar efficacy and ease of use when compared to filgrastim in the non-transplant setting, but little data is available in the transplant setting. We began using pegfilgrastim day +1 following ASCT for patients with multiple myeloma and performed a retrospective cohort study comparing those who received filgrastim (n=6) with those who received pegfilgrastim (n=11). Transplants occurred between July 2002 and January 2004 and included all patients transplanted for myeloma in that time period for whom sufficient data was available. All patients had at least 2 x 106 CD34+ cells/kg peripheral stem cells harvested after cytoxan and filgrastim mobilization. Main outcome measures were: days from stem cell infusion to WBC nadir, days to ANC>500/ul, and days to ANC>1000/ul. Subjects were excluded if CBCs were drawn less frequently than every four days. There were no significant differences between the filgrastim and pegfilgrastim groups with respect to the following demographic variables: age, gender, hemoglobin, creatinine, calcium, albumin and beta-2 microglobulin at diagnosis. The groups were also balanced with respect to SPEP, UPEP, presence of lytic lesions and number of prior lines of therapy. The median number of CD34+ cells infused was similar: 5.7 x 106 in the filgrastim group vs 4.8 x 106 in the pegfilgrastim group (p=0.28). After transplant, median number of days to WBC nadir in the filgrastim group (FG) was 7 (range 5–9) vs 6 (range 5–8) in the pegfilgrastim group (PG) (p=0.31). However, median number of days to ANC>500/ul in the FG was 11.5 (range 11–17) vs 10 (range 9–12) for PG (p=0.02). Similarly, median number of days to ANC>1000/ul was 12 (range 11–17) for FG vs 11 (range 10–13) for PG (p=0.03). Five of six patients in the FG had neutropenic fever after transplant, compared to five of eleven patients in the PG (p=0.30). Currently, no significant differences in infection or relapse rates between groups have been noted and there were no deaths in either group. In this retrospective cohort study, pegfilgrastim was safe and at least equivalent to filgrastim for accelerating hematopoiesis after ASCT for multiple myeloma. Furthermore, there was no significant difference in the incidence of neutropenic fever, infection and survival, suggesting a similar clinical utility.