Background: Prospective audit and feedback has been shown to decrease antimicrobial exposure and costs, while improving patient outcomes. We evaluated the appropriateness of piperacillin-tazobactam orders and the cost avoidance associated with optimization. Methods: Prospective audit and feedback was performed for all adult patients receiving at least two doses of piperacillin-tazobactam in a large tertiary care facility between January 18 and February 10, 2016. When the antimicrobial regimen was assessed to be suboptimal, a recommendation was made to optimize therapy. Cost avoidance was calculated by subtracting the cost of the new regimen from the cost of the original regimen. Results: Piperacillin-tazobactam orders were considered inappropriate 38.5% of the time. Respiratory indications were appropriate in only 52.6% of cases. Intra-abdominal and skin and soft tissue indications were appropriate 82.6% and 70% of the time, respectively. The cost avoidance associated with this study was projected to be Can$28,766 per year. Conclusions: The inappropriate use of piperacillin-tazobactam was high. There would be value in antimicrobial stewardship interventions targeting its use.
{"title":"Prospective audit and feedback of piperacillin-tazobactam use in a large urban tertiary care hospital","authors":"Nathan P. Beahm, S. Fryters","doi":"10.3138/JAMMI.2017-0011","DOIUrl":"https://doi.org/10.3138/JAMMI.2017-0011","url":null,"abstract":"Background: Prospective audit and feedback has been shown to decrease antimicrobial exposure and costs, while improving patient outcomes. We evaluated the appropriateness of piperacillin-tazobactam orders and the cost avoidance associated with optimization. Methods: Prospective audit and feedback was performed for all adult patients receiving at least two doses of piperacillin-tazobactam in a large tertiary care facility between January 18 and February 10, 2016. When the antimicrobial regimen was assessed to be suboptimal, a recommendation was made to optimize therapy. Cost avoidance was calculated by subtracting the cost of the new regimen from the cost of the original regimen. Results: Piperacillin-tazobactam orders were considered inappropriate 38.5% of the time. Respiratory indications were appropriate in only 52.6% of cases. Intra-abdominal and skin and soft tissue indications were appropriate 82.6% and 70% of the time, respectively. The cost avoidance associated with this study was projected to be Can$28,766 per year. Conclusions: The inappropriate use of piperacillin-tazobactam was high. There would be value in antimicrobial stewardship interventions targeting its use.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45243602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bach, A. P. Tsai, Chongya Niu, Geneviève Kerkerian, M. Payne, Karen L. Dallas, P. Rahmani, P. Wong
Plasmodium falciparum is the most common causative agent of severe malaria infections. Following inoculation, the incubation period typically ranges from 10 to 14 days, and, unlike other malaria species, there is no hypnozoite phase in the life cycle capable of causing latency. Despite this, we now understand that subclinical P. falciparum infections are possible and may even represent the majority of infections in endemic areas. We report a case of severe P. falciparum malaria in a previously healthy West African immigrant with no history of travel to an endemic region for 10 years before the development of symptoms. This case illustrates the possibility of a locally acquired malaria infection, versus the phenomenon of a recrudescent P. falciparum infection following a prolonged subclinical carriage period.
{"title":"A case of Plasmodium falciparum infection presenting 10 years after emigration from an endemic country","authors":"P. Bach, A. P. Tsai, Chongya Niu, Geneviève Kerkerian, M. Payne, Karen L. Dallas, P. Rahmani, P. Wong","doi":"10.3138/JAMMI.2017-0015","DOIUrl":"https://doi.org/10.3138/JAMMI.2017-0015","url":null,"abstract":"Plasmodium falciparum is the most common causative agent of severe malaria infections. Following inoculation, the incubation period typically ranges from 10 to 14 days, and, unlike other malaria species, there is no hypnozoite phase in the life cycle capable of causing latency. Despite this, we now understand that subclinical P. falciparum infections are possible and may even represent the majority of infections in endemic areas. We report a case of severe P. falciparum malaria in a previously healthy West African immigrant with no history of travel to an endemic region for 10 years before the development of symptoms. This case illustrates the possibility of a locally acquired malaria infection, versus the phenomenon of a recrudescent P. falciparum infection following a prolonged subclinical carriage period.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2017-0015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47162769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Streptococcus pneumoniae is a recognized important pathogen in Indigenous populations in the Sioux Lookout area of Northwestern Ontario, Canada. This study investigates the current epidemiology of invasive pneumococcal disease (IPD) in the Kenora area of Northwestern Ontario, which has a relatively large Indigenous population (30%). Methods: Data from January 2010 to December 2016 were retrieved from retrospective chart review at a hospital servicing a population of 19,380. Results: Thirty-one cases of IPD were identified. Regional incidence (26.6/100,000/year) is nearly three times the national rate (9.0/100,000/year). In adults, 66.7% of cases were caused by serotypes included in the 23-valent pneumococcal polysaccharide vaccine. All pediatric IPD cases were caused by serotypes not included in the 13-valent pneumococcal conjugate vaccine. Ninety per cent of cases had confirmed underlying disease. Conclusions: In the Kenora area, IPD incidence is comparable to incidence in the Sioux Lookout area. Improvement of pneumococcal vaccination uptake in senior and high-risk populations is required.
{"title":"Epidemiology of invasive pneumococcal disease in the city of Kenora, Ontario, Canada, and surrounding area (2010-2016)","authors":"Vic Eton, M. Ulanova","doi":"10.3138/JAMMI.2018-0025","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-0025","url":null,"abstract":"Introduction: Streptococcus pneumoniae is a recognized important pathogen in Indigenous populations in the Sioux Lookout area of Northwestern Ontario, Canada. This study investigates the current epidemiology of invasive pneumococcal disease (IPD) in the Kenora area of Northwestern Ontario, which has a relatively large Indigenous population (30%). Methods: Data from January 2010 to December 2016 were retrieved from retrospective chart review at a hospital servicing a population of 19,380. Results: Thirty-one cases of IPD were identified. Regional incidence (26.6/100,000/year) is nearly three times the national rate (9.0/100,000/year). In adults, 66.7% of cases were caused by serotypes included in the 23-valent pneumococcal polysaccharide vaccine. All pediatric IPD cases were caused by serotypes not included in the 13-valent pneumococcal conjugate vaccine. Ninety per cent of cases had confirmed underlying disease. Conclusions: In the Kenora area, IPD incidence is comparable to incidence in the Sioux Lookout area. Improvement of pneumococcal vaccination uptake in senior and high-risk populations is required.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49562803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.3138/JAMMI.2018-08.14
K. Laupland, Steven M. Johnson, L. Valiquette
{"title":"An aggressive-conservative surgical approach to the management of diabetic foot osteomyelitis","authors":"K. Laupland, Steven M. Johnson, L. Valiquette","doi":"10.3138/JAMMI.2018-08.14","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-08.14","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018-08.14","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42316315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Streptococcus equi subspecies zooepidemicus infections in humans can be contracted through contact with domestic animals or unpasteurized dairy products. Although infection in humans is rare, the course can be fulminant. We describe the case of a 75-year-old immunocompetent male who developed disseminated disease with bacteremia, native aortic valve endocarditis, suppurative pericarditis with cardiac tamponade, meningitis, and bilateral endophthalmitis. Despite treatment with pericardial drain placement, intravenous ceftriaxone, and rifampin, the patient unfortunately did not survive. To date, reported cases of disseminated infection by S. equi subsp zooepidemicus are few. Furthermore, with review of the literature, this case demonstrates the broadest organ system involvement reported. Of interest, previous studies have suggested an affinity of this organism for certain organ systems and this case corroborates an emerging association of S. equi subsp zooepidemicus with endophthalmitis. In addition, this is the second Canadian case of documented human infection, with both cases being similar in clinical features, presentation, and geographical location. This case report should serve to warn clinicians about complications and sites of haematogenous seeding in the setting of disseminated S. equi subsp zooepidemicus infections.
{"title":"An Atlantic Canada case of disseminated Streptococcus equi subspecies zooepidemicus infection","authors":"A. Chang, D. Webster","doi":"10.3138/JAMMI.2018-0026","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-0026","url":null,"abstract":"Streptococcus equi subspecies zooepidemicus infections in humans can be contracted through contact with domestic animals or unpasteurized dairy products. Although infection in humans is rare, the course can be fulminant. We describe the case of a 75-year-old immunocompetent male who developed disseminated disease with bacteremia, native aortic valve endocarditis, suppurative pericarditis with cardiac tamponade, meningitis, and bilateral endophthalmitis. Despite treatment with pericardial drain placement, intravenous ceftriaxone, and rifampin, the patient unfortunately did not survive. To date, reported cases of disseminated infection by S. equi subsp zooepidemicus are few. Furthermore, with review of the literature, this case demonstrates the broadest organ system involvement reported. Of interest, previous studies have suggested an affinity of this organism for certain organ systems and this case corroborates an emerging association of S. equi subsp zooepidemicus with endophthalmitis. In addition, this is the second Canadian case of documented human infection, with both cases being similar in clinical features, presentation, and geographical location. This case report should serve to warn clinicians about complications and sites of haematogenous seeding in the setting of disseminated S. equi subsp zooepidemicus infections.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018-0026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46214350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Singh, D. Tan, M. Hull, I. Bogoch, P. Macpherson, C. Tremblay, S. Shafran
Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are part of combination HIV prevention strategies that include behavioural interventions such as condoms and risk-reduction counselling. A 25-member panel was convened to develop Canadian guidelines for PrEP and nPEP, with the full guidelines recently published in the Canadian Medical Association Journal (CMAJ). This article provides a discussion beyond the guideline, highlighting areas of particular interest to infectious disease (ID) specialists and discusses the possible role of ID specialists as access to both PrEP and nPEP become more widely available across the country.
{"title":"Canadian guidelines on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP): Discussion beyond the guidelines and commentary on the role of infectious diseases specialists","authors":"A. Singh, D. Tan, M. Hull, I. Bogoch, P. Macpherson, C. Tremblay, S. Shafran","doi":"10.3138/JAMMI.2018-0024","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-0024","url":null,"abstract":"Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are part of combination HIV prevention strategies that include behavioural interventions such as condoms and risk-reduction counselling. A 25-member panel was convened to develop Canadian guidelines for PrEP and nPEP, with the full guidelines recently published in the Canadian Medical Association Journal (CMAJ). This article provides a discussion beyond the guideline, highlighting areas of particular interest to infectious disease (ID) specialists and discusses the possible role of ID specialists as access to both PrEP and nPEP become more widely available across the country.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018-0024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47018503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carla Penney, S. Boyd, A. Mansfield, J. Dalton, J. O’Keefe, P. Daley
Background: Antimicrobial stewardship is the promotion of responsible antimicrobial use to reduce antimicrobial resistance, antimicrobial toxicity and cost, and to reduce the incidence of nosocomial infections. Our objectives were to measure antibiotic use rate in 10 long-term care facilities (LTCF) during a 1-year period, and to determine the appropriateness of antimicrobial prescriptions. Methods: Antibiotic prescriptions from 10 long-term care facilities, between January 2015 and January 2016, were collected from a pharmacy database. A sample of500 prescriptions was randomly selected for chart review to determine the appropriateness of the prescribed antibiotic based on published guidelines. Results: We analyzed 3,148 prescriptions for 1,313 residents (2.40 prescriptions/patient/year, median duration 7 days). Antibiotic use rate was 21.16 Defined Daily Doses/1,000 patient-days/year, or 5.42 antibiotic days/1,000 patient-days/month. Of the 500 randomly selected prescriptions, 448 were analyzed for appropriateness. Mean age of included residents was 82.5 (SD 12.1 years). 288/448 (64.3%) were female, with an average activities of daily living (ADL) score of 19.3 (SD 8.5). Urinary tract infection was the most common indication for antibiotics (177/448, 39.5%), followed by lower respiratory tract infection (144/448, 32.1%) and skin and soft-tissue infection (76/448, 17.0%). 259/448 (57.8%) of prescriptions were inappropriate, including 115/163 (70.5%) given for urinary tract infection, 78/140 (55.7%) given for lower respiratory tract infection, and 15/68 (22.0%) given for skin and soft-tissue infection. Inappropriateness varied by long-term care facility (LTCF) between 18/41 (43.9%) and 15/21 (71.4%), and by drug class between 0/5 (0%) among penicillinase-resistant penicillins and 29/38 (76.3%) among macrolides. Conclusions: Antimicrobial use rate is high, and 57.8% of prescriptions are inappropriate. The least appropriate prescriptions are given for urinary tract infections. Appropriateness is highly variable by LTCF, indication, and drug class.
{"title":"Antimicrobial use and suitability in long-term care facilities: A retrospective cross-sectional study","authors":"Carla Penney, S. Boyd, A. Mansfield, J. Dalton, J. O’Keefe, P. Daley","doi":"10.3138/JAMMI.2018-0021","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-0021","url":null,"abstract":"Background: Antimicrobial stewardship is the promotion of responsible antimicrobial use to reduce antimicrobial resistance, antimicrobial toxicity and cost, and to reduce the incidence of nosocomial infections. Our objectives were to measure antibiotic use rate in 10 long-term care facilities (LTCF) during a 1-year period, and to determine the appropriateness of antimicrobial prescriptions. Methods: Antibiotic prescriptions from 10 long-term care facilities, between January 2015 and January 2016, were collected from a pharmacy database. A sample of500 prescriptions was randomly selected for chart review to determine the appropriateness of the prescribed antibiotic based on published guidelines. Results: We analyzed 3,148 prescriptions for 1,313 residents (2.40 prescriptions/patient/year, median duration 7 days). Antibiotic use rate was 21.16 Defined Daily Doses/1,000 patient-days/year, or 5.42 antibiotic days/1,000 patient-days/month. Of the 500 randomly selected prescriptions, 448 were analyzed for appropriateness. Mean age of included residents was 82.5 (SD 12.1 years). 288/448 (64.3%) were female, with an average activities of daily living (ADL) score of 19.3 (SD 8.5). Urinary tract infection was the most common indication for antibiotics (177/448, 39.5%), followed by lower respiratory tract infection (144/448, 32.1%) and skin and soft-tissue infection (76/448, 17.0%). 259/448 (57.8%) of prescriptions were inappropriate, including 115/163 (70.5%) given for urinary tract infection, 78/140 (55.7%) given for lower respiratory tract infection, and 15/68 (22.0%) given for skin and soft-tissue infection. Inappropriateness varied by long-term care facility (LTCF) between 18/41 (43.9%) and 15/21 (71.4%), and by drug class between 0/5 (0%) among penicillinase-resistant penicillins and 29/38 (76.3%) among macrolides. Conclusions: Antimicrobial use rate is high, and 57.8% of prescriptions are inappropriate. The least appropriate prescriptions are given for urinary tract infections. Appropriateness is highly variable by LTCF, indication, and drug class.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42377252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Valbuena, A. Bai, A. Showier, M. Meem, M. Steinberg, C. Bell, A. Morris
Background: Staphylococcus aureus bacteremia (SAB) results in high morbidity and mortality. Infectious diseases (ID) consultation for SAB has been associated with improved process measures and outcomes in SAB. Recent guidelines have been implemented to include ID consultation in the management of positive SAB culture. We sought to determine whether a policy of mandatory ID consultation for SAB would improve management and mortality. Methods: We conducted a retrospective quasi-experimental study of patients with SAB at three academic hospitals comparing adherence to process measures, and mortality as a secondary measure, before and after implementation of a hospital policy of mandatory ID consultation for all cases of SAB. Results: ID consultation was performed in 239/411 (58%) patients in the pre-intervention period and 196/205 (96%) patients in the post-intervention period (p < 0.0001). Compared with pre-intervention, mandatory consultation was associated with better adherence to quality process measures including echocardiography (319/411 (78%) versus 186/205 (91%) p < 0.0001), subsequent blood culture within 2–4 days (174/411 (42%) versus 143/205 (70%) p < 0.0001) and avoidance of vancomycin as definitive antibiotic therapy for methicillin-susceptible S. aureus (MSSA) (54/347 (16%) versus 13/177 (7%) p = 0.0082). In-hospital mortality rate was 94/411 (23%) in the pre-intervention group and 33/205 (16%) in the post-intervention group. The unadjusted sub-distribution hazard ratio (sHR) for in-hospital mortality in the postintervention period was 0.67 (95% CI 0.45 to 0.99, p = 0.0447). After adjusting for significant prognostic factors, post-intervention in-hospital mortality had an sHR of 0.79 (95% CI 0.52 to 1.20, p = 0.2686). Conclusions: A policy of mandatory ID consultation for patients with SAB was easily implemented leading to consultation in nearly all SAB patients and improved adherence to standard of care process measures. In-hospital mortality did not improve significantly after adjusting for patient characteristics. Our study provides the framework to support this easily implemented institutional policy in academic hospitals.
{"title":"Mandatory infectious diseases consultation leads to improved process measure adherence in the management of Staphylococcus aureus bacteremia: A multicentre, quasi-control study","authors":"V. Valbuena, A. Bai, A. Showier, M. Meem, M. Steinberg, C. Bell, A. Morris","doi":"10.3138/JAMMI.2017-0014","DOIUrl":"https://doi.org/10.3138/JAMMI.2017-0014","url":null,"abstract":"Background: Staphylococcus aureus bacteremia (SAB) results in high morbidity and mortality. Infectious diseases (ID) consultation for SAB has been associated with improved process measures and outcomes in SAB. Recent guidelines have been implemented to include ID consultation in the management of positive SAB culture. We sought to determine whether a policy of mandatory ID consultation for SAB would improve management and mortality. Methods: We conducted a retrospective quasi-experimental study of patients with SAB at three academic hospitals comparing adherence to process measures, and mortality as a secondary measure, before and after implementation of a hospital policy of mandatory ID consultation for all cases of SAB. Results: ID consultation was performed in 239/411 (58%) patients in the pre-intervention period and 196/205 (96%) patients in the post-intervention period (p < 0.0001). Compared with pre-intervention, mandatory consultation was associated with better adherence to quality process measures including echocardiography (319/411 (78%) versus 186/205 (91%) p < 0.0001), subsequent blood culture within 2–4 days (174/411 (42%) versus 143/205 (70%) p < 0.0001) and avoidance of vancomycin as definitive antibiotic therapy for methicillin-susceptible S. aureus (MSSA) (54/347 (16%) versus 13/177 (7%) p = 0.0082). In-hospital mortality rate was 94/411 (23%) in the pre-intervention group and 33/205 (16%) in the post-intervention group. The unadjusted sub-distribution hazard ratio (sHR) for in-hospital mortality in the postintervention period was 0.67 (95% CI 0.45 to 0.99, p = 0.0447). After adjusting for significant prognostic factors, post-intervention in-hospital mortality had an sHR of 0.79 (95% CI 0.52 to 1.20, p = 0.2686). Conclusions: A policy of mandatory ID consultation for patients with SAB was easily implemented leading to consultation in nearly all SAB patients and improved adherence to standard of care process measures. In-hospital mortality did not improve significantly after adjusting for patient characteristics. Our study provides the framework to support this easily implemented institutional policy in academic hospitals.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2017-0014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48008215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.3138/JAMMI.2018.06.26
Joan L. Robinson, C. Hughes
{"title":"Prevention of in utero and intrapartum transmission of human immunodeficiency virus infection","authors":"Joan L. Robinson, C. Hughes","doi":"10.3138/JAMMI.2018.06.26","DOIUrl":"https://doi.org/10.3138/JAMMI.2018.06.26","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018.06.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45427825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julie Zhu, M. H. Laghari, T. Hussaini, V. Marquez, S. Erb, E. Yoshida, A. Wright
Herpes simplex virus type 2 (HSV-2) is a rare cause of herpes encephalitis. We report a case of severe right limbic encephalitis presenting as an altered level of consciousness in a post-liver transplant adult man. HSV-2 was identified by polymerase chain reaction in the cerebrospinal fluid (CSF). Concurrent active perineal skin eruptions were positive for HSV-2, confirming the theory of disseminated HSV-2 from genitals to brain. Intravenous acyclovir was given for 3 weeks. Although the outcome was an improved level of consciousness, the patient was left with significant residual neurological morbidity. Our experience emphasizes the importance of HSV prophylaxis in those with positive serostatus pre-transplant, and not on cytomegalovirus (CMV) prophylaxis in the immediate post-transplant period. We also recommend stringent pre-transplant assessment, including specific and direct questioning of candidates regarding a history of sexually transmitted infections (STIs), a determination of HSV serostatus, and the examination and testing of any suspicious lesions.
{"title":"Disseminated herpes simplex virus 2 (HSV-2) encephalitis in a liver transplant recipient: Potential implications for liver transplant programs","authors":"Julie Zhu, M. H. Laghari, T. Hussaini, V. Marquez, S. Erb, E. Yoshida, A. Wright","doi":"10.3138/JAMMI.2018-0016","DOIUrl":"https://doi.org/10.3138/JAMMI.2018-0016","url":null,"abstract":"Herpes simplex virus type 2 (HSV-2) is a rare cause of herpes encephalitis. We report a case of severe right limbic encephalitis presenting as an altered level of consciousness in a post-liver transplant adult man. HSV-2 was identified by polymerase chain reaction in the cerebrospinal fluid (CSF). Concurrent active perineal skin eruptions were positive for HSV-2, confirming the theory of disseminated HSV-2 from genitals to brain. Intravenous acyclovir was given for 3 weeks. Although the outcome was an improved level of consciousness, the patient was left with significant residual neurological morbidity. Our experience emphasizes the importance of HSV prophylaxis in those with positive serostatus pre-transplant, and not on cytomegalovirus (CMV) prophylaxis in the immediate post-transplant period. We also recommend stringent pre-transplant assessment, including specific and direct questioning of candidates regarding a history of sexually transmitted infections (STIs), a determination of HSV serostatus, and the examination and testing of any suspicious lesions.","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3138/JAMMI.2018-0016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48750842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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