What constitutes excellence in Infectious Diseases practice?
October 17 2016
Natasha Chida and colleagues from Johns Hopkins have added narratives of excellence in ID practice to Colleen Christmas’ framework of what constitutes clinical excellence. These 7 domains meld together in masterful clinical practitioners in ID:
Cryptococcosis: Early diagnosis reduces neurological deficits
October 10 2016
Cryptococcosis is associated with significant mortality and morbidity including long-term neurological sequelae, especially in non-HIV infected people. A recent retrospective chart review report by Aye and colleagues from Australia (2016) found a significant association exists between delay in diagnosis and subsequent poor neurological outcomes.
Cryptococcus neoformans is predominantly responsible for infection in immunosuppressed patients including those with human immunodeficiency virus infection (HIV)/AIDS while Cryptococcus gattii mainly affects immunocompetent individuals, although both species can occur among different immune groups.The worse outcomes are more common in immunocompetent people compared with the immunocompromised possibly because of a longer delay in diagnosis.
Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis
September 30 2016
Key findings: Cough alone was a common presenting symptom, significant proportion of these patients does not have a detectable Aspergillus IgG and it’s difficult to distinguish Aspergillus nodules from other pathology on CT findings alone.
Thirty three patients with Aspergillus nodules have been described with radiology and histology findings combined with clinical features and laboratory parameters; in particular Aspergillus IgG has been published by Eavan Muldoon and colleagues. Lung nodules caused by Aspergillus spp have been peripherally mentioned by other authors, but not well described. They present as single or multiple nodule(s) usually without cavitation in immune competent hosts.
First outbreak of C. auris infections in South America
September 22 2016
C. auris has been increasingly reported in tertiary care hospitals, principally from India, Kuwait and South Africa. Now, 6 years after the first identifications in Asia, the first outbreak of C. auris in South America has been reported. Bloodstream isolates of C. auris were obtained from 18 critically ill patients admitted to a medical centre in Maracaibo, Venezuela centre over a 16 month period.. 13 paediatric patients (8 of whom were preterm neonates) and 5 adult patients were included and each had been admitted to the intensive care unit, exposed to antibiotics and multiple invasive medical procedures before developing fungemia.
Micafungin shown to be effective for candiduria
September 20 2016
Addressing a common problem in hospitals, Gabardi and colleagues show that intravenous micafungin eradicates candiduria in 75% of patients.
A recent shift in the epidemiology of candidiasis has been noted with an increase in the frequency of urinary tract infections (UTIs) caused by non-albicans Candida spp. commonly resistant to fluconazole. Echinocandins have fungicidal activity against Candida and penetrate well into the renal parenchyma. However, these agents achieve poor concentrations in the urine and are generally considered ineffective in the treatment of Candida UTIs.
In this retrospective analysis performed in two tertiary-care academic medical centers, 33 hospitalized patients with candiduria or Candida UTI who received micafungin and had follow-up urine cultures were evaluated. The most commonly recovered species were C. albicans (n=13) and C. glabrata (n=10). Twenty-five patients (75%) had an indwelling urinary catheter. UTI was diagnosed in 16 (48%). Only 3 (10%) had concomitant Candida bloodstream infection. Micafungin was used for a mean duration of 6 days.