Pub Date : 2013-04-19DOI: 10.2174/1874279301307010021
F. V. Leth, P. Gondrie
§rather than one-off contractual assignments, to ensure adequate knowledge of the local context and differential needs of the NTP over time. To complement the work of the general TA consultants, KNCV instituted a research unit to accommodate the need for evidence-based solutions to programmatic obstacles. Epidemiologists work in close collaboration with the general TA consultants as well as within the international TB-research community at large. This results in strong research support embedded in the longterm cooperation between NTPs and KNCV. West et al. showed that such a set-up can meet the two critical functions of an ideal TA system: incorporation of in-depth knowledge of the needs of the programme, and continuous evaluation of emerging knowledge and determination of which is relevant to the programmes to which TA is provided [2]. The articles in the Supplement highlight some of the TA activities of KNCV. It brings the TA activities and their results from the “grey” unpublished literature, where the reports most often end up, into the public domain. It also gives insight into the often “concealed” relationship between clinical practise and public health, which is influenced by the effectiveness of NTPs and their TA organizations.
{"title":"Editorial - Technical Assistance to Tuberculosis Control Programmes as a Platform forInfectious Disease Research","authors":"F. V. Leth, P. Gondrie","doi":"10.2174/1874279301307010021","DOIUrl":"https://doi.org/10.2174/1874279301307010021","url":null,"abstract":"§rather than one-off contractual assignments, to ensure adequate knowledge of the local context and differential needs of the NTP over time. To complement the work of the general TA consultants, KNCV instituted a research unit to accommodate the need for evidence-based solutions to programmatic obstacles. Epidemiologists work in close collaboration with the general TA consultants as well as within the international TB-research community at large. This results in strong research support embedded in the longterm cooperation between NTPs and KNCV. West et al. showed that such a set-up can meet the two critical functions of an ideal TA system: incorporation of in-depth knowledge of the needs of the programme, and continuous evaluation of emerging knowledge and determination of which is relevant to the programmes to which TA is provided [2]. The articles in the Supplement highlight some of the TA activities of KNCV. It brings the TA activities and their results from the “grey” unpublished literature, where the reports most often end up, into the public domain. It also gives insight into the often “concealed” relationship between clinical practise and public health, which is influenced by the effectiveness of NTPs and their TA organizations.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"222 1","pages":"21-22"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060567","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 : 2013-04-19DOI: 10.2174/1874279301307010030
E. Shimeles, Getachew Wondimagegn, A. Bedru, Addisalem Yilma, D. Assefa, Tesfaye Abicho, E. Diro, Yasmin Hashim, V. Ombeka, R. L'herminez, E. Klinkenberg
Implementation and scale up of programmatic management of drug resistant tuberculosis (PMDT) has proven to be a challenge in many resource-constrained settings like in Ethiopia, despite the political commitment. A critical programmatic gap analysis was conducted by technical experts to develop feasible recommendations for incorporating multi drug resistant tuberculosis (MDR-TB) management in the national TB program following international guidelines and receiving continuous technical and financial support. The major achievement was building of technical capacity in the country at the level of a national MDR-TB technical working group (TWG) as well as at the level of the MDR-TB treatment hospitals among the MDR management teams. In addition, guideline development, improved access to second line drugs and renovation of health facilities in accordance with TB infection control standards contributed to optimize implementation. Between February 2009 and September 2012, 575 MDR-TB patients accessed treatment under the program. Building programmatic and clinical capacity at different levels of the health system in combination with strong political commitment and partner's engagement were key elements of the PMDT approach. Structured technical assistance combined with financial support during key steps was critical in the initiation and subsequent scale up of the program.
{"title":"Role of Technical Assistance in the Establishment and Scale Up ofProgrammatic Management of Drug Resistant Tuberculosis (PMDT) inEthiopia","authors":"E. Shimeles, Getachew Wondimagegn, A. Bedru, Addisalem Yilma, D. Assefa, Tesfaye Abicho, E. Diro, Yasmin Hashim, V. Ombeka, R. L'herminez, E. Klinkenberg","doi":"10.2174/1874279301307010030","DOIUrl":"https://doi.org/10.2174/1874279301307010030","url":null,"abstract":"Implementation and scale up of programmatic management of drug resistant tuberculosis (PMDT) has proven to be a challenge in many resource-constrained settings like in Ethiopia, despite the political commitment. A critical programmatic gap analysis was conducted by technical experts to develop feasible recommendations for incorporating multi drug resistant tuberculosis (MDR-TB) management in the national TB program following international guidelines and receiving continuous technical and financial support. The major achievement was building of technical capacity in the country at the level of a national MDR-TB technical working group (TWG) as well as at the level of the MDR-TB treatment hospitals among the MDR management teams. In addition, guideline development, improved access to second line drugs and renovation of health facilities in accordance with TB infection control standards contributed to optimize implementation. Between February 2009 and September 2012, 575 MDR-TB patients accessed treatment under the program. Building programmatic and clinical capacity at different levels of the health system in combination with strong political commitment and partner's engagement were key elements of the PMDT approach. Structured technical assistance combined with financial support during key steps was critical in the initiation and subsequent scale up of the program.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"30-35"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060665","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 : 2013-04-19DOI: 10.2174/1874279301307010065
F. V. Leth, E. Klinkenberg
Many National Tuberculosis Programmes (NTPs) receive Technical Assistance (TA) for the implementation and evaluation of their TB-control strategies. KNCV tuberculosis Foundation (KNCV) in the Netherlands is a TA organization providing assistance for many years in over 30 countries. The NTPs use their own surveillance data to assess TB control strategies. These data are not accurate enough to serve as valid epidemiological parameters. KNCV adds an epidemiological research component to the general TA. Epidemiological research does give the evidence-base needed for TB control. Embedding this research in continued programme support from TA consultants has been fruitful. This paper details KNCV's experiences with such TA plus epidemiological research approach, specially in conducting large-scale population-based surveys: tuberculin surveys, TB prevalence surveys, and drug resistance surveys. The lessons learned include the added value of long-term programme support, of a thorough knowledge of the survey's situational context, of in-country capacity building, and of guidelines for guiding, as opposed to dictating, research.
{"title":"Epidemiological Surveys Embedded in Technical Assistance to Tuberculosis Control Programmes","authors":"F. V. Leth, E. Klinkenberg","doi":"10.2174/1874279301307010065","DOIUrl":"https://doi.org/10.2174/1874279301307010065","url":null,"abstract":"Many National Tuberculosis Programmes (NTPs) receive Technical Assistance (TA) for the implementation and evaluation of their TB-control strategies. KNCV tuberculosis Foundation (KNCV) in the Netherlands is a TA organization providing assistance for many years in over 30 countries. The NTPs use their own surveillance data to assess TB control strategies. These data are not accurate enough to serve as valid epidemiological parameters. KNCV adds an epidemiological research component to the general TA. Epidemiological research does give the evidence-base needed for TB control. Embedding this research in continued programme support from TA consultants has been fruitful. This paper details KNCV's experiences with such TA plus epidemiological research approach, specially in conducting large-scale population-based surveys: tuberculin surveys, TB prevalence surveys, and drug resistance surveys. The lessons learned include the added value of long-term programme support, of a thorough knowledge of the survey's situational context, of in-country capacity building, and of guidelines for guiding, as opposed to dictating, research.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"65-71"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061514","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 : 2013-04-19DOI: 10.2174/1874279301307010054
A. Tursynbayeva, M. Idrissova, Tatyana Markabaeva, Gayni Usenova, Gulbaram Utepkaliyeva, G. Akhmetova, Lazzat Suleymenova, Gaukhar Urankayeva, S. Hof
In Kazakhstan, tuberculosis (TB) patients are screened for human immunodeficiency virus (HIV), and HIV- infected individuals are screened for active TB. However, there is no exchange of case-based information between the TB and HIV/AIDS programs. To assess the proportion of co-infected patients registered as such in both registers and to assess reasons for patients missing in either register, we compared 2009 data from the TB and HIV/AIDS registers from two areas in Kazakhstan. Almaty city and the adjacent Almaty oblast, represent 22% of the country's population. Also, co-infected patients as well as a number of HIV-infected individuals were interviewed. In total, 85 patients diagnosed with TB and HIV were registered, of whom 73 were registered in the TB register, 79 in the HIV/AIDS register, and 67 in both registers. In the TB register, twelve patients were wrongly recorded as HIV negative. Only 9 (11%) out of the 82 patients who started treatment (three died shortly after diagnosis) had been prescribed antiretroviral treatment. In conclusion, gaps and mistakes with regard to TB/HIV patients were identified in both registers. Collaboration between the TB and HIV/AIDS centers was strengthened, which includes routine monitoring of TB/HIV diagnoses and treatment. This should lead to improved quality of care for TB/HIV patients and an improved insight in TB/HIV epidemiology.
{"title":"Improving Surveillance on Tuberculosis and HIV Co-Infection inKazakhstan","authors":"A. Tursynbayeva, M. Idrissova, Tatyana Markabaeva, Gayni Usenova, Gulbaram Utepkaliyeva, G. Akhmetova, Lazzat Suleymenova, Gaukhar Urankayeva, S. Hof","doi":"10.2174/1874279301307010054","DOIUrl":"https://doi.org/10.2174/1874279301307010054","url":null,"abstract":"In Kazakhstan, tuberculosis (TB) patients are screened for human immunodeficiency virus (HIV), and HIV- infected individuals are screened for active TB. However, there is no exchange of case-based information between the TB and HIV/AIDS programs. To assess the proportion of co-infected patients registered as such in both registers and to assess reasons for patients missing in either register, we compared 2009 data from the TB and HIV/AIDS registers from two areas in Kazakhstan. Almaty city and the adjacent Almaty oblast, represent 22% of the country's population. Also, co-infected patients as well as a number of HIV-infected individuals were interviewed. In total, 85 patients diagnosed with TB and HIV were registered, of whom 73 were registered in the TB register, 79 in the HIV/AIDS register, and 67 in both registers. In the TB register, twelve patients were wrongly recorded as HIV negative. Only 9 (11%) out of the 82 patients who started treatment (three died shortly after diagnosis) had been prescribed antiretroviral treatment. In conclusion, gaps and mistakes with regard to TB/HIV patients were identified in both registers. Collaboration between the TB and HIV/AIDS centers was strengthened, which includes routine monitoring of TB/HIV diagnoses and treatment. This should lead to improved quality of care for TB/HIV patients and an improved insight in TB/HIV epidemiology.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"53 1","pages":"54-59"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061453","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 : 2013-02-28DOI: 10.2174/1874279301307010006
P. Yagupsky
Increasing recognition of Kingella kingae as an important pathogen of early childhood in recent years has elicited interest in the study of the asymptomatic carriage of the organism, its dissemination in the human population, and the role played by colonization of the upper respiratory tract in the pathogenesis of K. kingae invasion of the skeletal system and the endocardium. Research has revealed that K. kingae is a frequent component of the normal oropharyngeal microbiota, disclosed the subtle molecular mechanisms responsible for adherence of the bacterium to the pharyngeal mucosa, and revealed the presence of a potent RTX toxin, probably implicated in breaching the epithelial barrier, survival of the organism in the bloodstream, and damage to bone and joint tissues. Epidemiological studies have shown that carriage of K. kingae peaks in 6-30 month-old children, coinciding with the age of increased susceptibility to invasive disease, and daycare-center attendance represent a significant risk factor for pharyngeal colonization. The organism is transmitted from person-to- person by close contact between family members, playmaytes, and day-care center attendees. Carriage is characterized by frequent turnover of colonizing strains, similar to what has been described in other pathogens of respiratory origin.
{"title":"Respiratory Colonization by Kingella kingae, Person-to-Person Transmission, and Pathogenesis of Invasive Infection","authors":"P. Yagupsky","doi":"10.2174/1874279301307010006","DOIUrl":"https://doi.org/10.2174/1874279301307010006","url":null,"abstract":"Increasing recognition of Kingella kingae as an important pathogen of early childhood in recent years has elicited interest in the study of the asymptomatic carriage of the organism, its dissemination in the human population, and the role played by colonization of the upper respiratory tract in the pathogenesis of K. kingae invasion of the skeletal system and the endocardium. Research has revealed that K. kingae is a frequent component of the normal oropharyngeal microbiota, disclosed the subtle molecular mechanisms responsible for adherence of the bacterium to the pharyngeal mucosa, and revealed the presence of a potent RTX toxin, probably implicated in breaching the epithelial barrier, survival of the organism in the bloodstream, and damage to bone and joint tissues. Epidemiological studies have shown that carriage of K. kingae peaks in 6-30 month-old children, coinciding with the age of increased susceptibility to invasive disease, and daycare-center attendance represent a significant risk factor for pharyngeal colonization. The organism is transmitted from person-to- person by close contact between family members, playmaytes, and day-care center attendees. Carriage is characterized by frequent turnover of colonizing strains, similar to what has been described in other pathogens of respiratory origin.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060481","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 : 2013-02-08DOI: 10.2174/1874279301307010001
M. Brouwer, P. S. Gudo, Chalice Mage Simbe, P. Perdigão, F. V. Leth
No tool exists to identify potential under-diagnosis of smear-negative and extrapulmonary TB. In an ecological study, we used a simple tool plotting percentages of smear-positive pulmonary TB amongst newly diagnosed TB in African region countries and provinces in Mozambique against the country's and provinces' HIV prevalence. We visually inspected the plots to determine potential under-diagnosis of smear-negative and extrapulmonary TB in three facilities in Manica Province, Mozambique. In these facilities, we found 67% smear-positivity among new TB cases in an area with HIV prevalence of more than 10%. All African region countries with an HIV prevalence of more than 10% had a smear-positivity lower than 50%. Most Mozambican provinces with a high HIV prevalence have smear-positivity rate of below 51%. Our findings show that benchmarking can be used to assist in identifying potential under-diagnosis of smear-negative and extrapulmonary TB. The findings also suggest that potentially under-diagnosis of these forms of TB exists in the study population.
{"title":"Benchmarking to Assess Potential Under-Diagnosis of Smear-Negative and Extrapulmonary Tuberculosis. A Case Study from Mozambique","authors":"M. Brouwer, P. S. Gudo, Chalice Mage Simbe, P. Perdigão, F. V. Leth","doi":"10.2174/1874279301307010001","DOIUrl":"https://doi.org/10.2174/1874279301307010001","url":null,"abstract":"No tool exists to identify potential under-diagnosis of smear-negative and extrapulmonary TB. In an ecological study, we used a simple tool plotting percentages of smear-positive pulmonary TB amongst newly diagnosed TB in African region countries and provinces in Mozambique against the country's and provinces' HIV prevalence. We visually inspected the plots to determine potential under-diagnosis of smear-negative and extrapulmonary TB in three facilities in Manica Province, Mozambique. In these facilities, we found 67% smear-positivity among new TB cases in an area with HIV prevalence of more than 10%. All African region countries with an HIV prevalence of more than 10% had a smear-positivity lower than 50%. Most Mozambican provinces with a high HIV prevalence have smear-positivity rate of below 51%. Our findings show that benchmarking can be used to assist in identifying potential under-diagnosis of smear-negative and extrapulmonary TB. The findings also suggest that potentially under-diagnosis of these forms of TB exists in the study population.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2013-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060437","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 : 2012-12-11DOI: 10.2174/1874279301206010065
M. Ijaz, J. Rubino
Enteric infections in the early years of childhood can exacerbate underlying malnutrition and, if not addressed, can lead to a vicious and synergistic cycle of malnutrition-enteric infection-malnutrition. Cognitive impairment is a key detrimental outcome associated with this cycle of malnutrition and enteric infection. Mechanistically, diversion of metabolic resources away from the developing brain under conditions of nutritional stress may underlie the impairment of cognitive function. Evidence indicates that the effects of the synergy between malnutrition and enteric pathogens last far beyond the time of infection and can lead to long-term effects on cognition. Indeed, emerging evidence suggests a potential for later-life vulnerability to neurodegenerative diseases as a consequence of enteric infectious diseases on early-life brain development. Simple interventions for improving hygiene have proven to lessen the burden of enteric infectious disease. The mitigational role of good hygiene practices has the potential to break the vicious cycle of malnutrition and enteric infection, and contribute to improving the cognitive development potential of children at risk.
{"title":"Impact of Infectious Diseases on Cognitive Development in Childhood andBeyond: Potential Mitigational Role of Hygiene","authors":"M. Ijaz, J. Rubino","doi":"10.2174/1874279301206010065","DOIUrl":"https://doi.org/10.2174/1874279301206010065","url":null,"abstract":"Enteric infections in the early years of childhood can exacerbate underlying malnutrition and, if not addressed, can lead to a vicious and synergistic cycle of malnutrition-enteric infection-malnutrition. Cognitive impairment is a key detrimental outcome associated with this cycle of malnutrition and enteric infection. Mechanistically, diversion of metabolic resources away from the developing brain under conditions of nutritional stress may underlie the impairment of cognitive function. Evidence indicates that the effects of the synergy between malnutrition and enteric pathogens last far beyond the time of infection and can lead to long-term effects on cognition. Indeed, emerging evidence suggests a potential for later-life vulnerability to neurodegenerative diseases as a consequence of enteric infectious diseases on early-life brain development. Simple interventions for improving hygiene have proven to lessen the burden of enteric infectious disease. The mitigational role of good hygiene practices has the potential to break the vicious cycle of malnutrition and enteric infection, and contribute to improving the cognitive development potential of children at risk.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"6 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2012-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060423","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 : 2012-10-02DOI: 10.2174/1874279301206010060
A. Olesen
In this paper, we review the existing knowledge on the risk of infections in chronic skin disease. The normal skin is a major physiological barrier to most microorganisms. In patients with chronic skin diseases the epidermal barrier function is disrupted and the concentration of antimicrobial peptides may be reduced. Several case series and case-control studies of selected hospitalized patients confirm a high risk of colonization with S. aureus and cutaneous infections among patients with atopic dermatitis, psoriasis, and erythroderma. Cellulitis is a common secondary skin infection associated with leg ulcer, varicose veins, lymphedema, tinea pedis, and leg dermatoses. Pox, Human papilloma, and Herpes viruses, some dermatophytes and candida albicans often give rise to secondary skin infections in chronic skin disease. Concerning infection of other organs than the skin, a few studies have shown that atopic dermatitis patients are more prone to upper and lower respiratory tract infection. One study of severe psoriasis patients has shown increased mortality due to infections. Patients with chronic skin disease may have more severe infections with prolonged periods of antibiotic treatments and worse prognosis compared with skin healthy controls, but more data from population-based studies including detailed data on relevant risk factors and confounders is needed.
{"title":"Chronic Skin Disease and Risk of Infection","authors":"A. Olesen","doi":"10.2174/1874279301206010060","DOIUrl":"https://doi.org/10.2174/1874279301206010060","url":null,"abstract":"In this paper, we review the existing knowledge on the risk of infections in chronic skin disease. The normal skin is a major physiological barrier to most microorganisms. In patients with chronic skin diseases the epidermal barrier function is disrupted and the concentration of antimicrobial peptides may be reduced. Several case series and case-control studies of selected hospitalized patients confirm a high risk of colonization with S. aureus and cutaneous infections among patients with atopic dermatitis, psoriasis, and erythroderma. Cellulitis is a common secondary skin infection associated with leg ulcer, varicose veins, lymphedema, tinea pedis, and leg dermatoses. Pox, Human papilloma, and Herpes viruses, some dermatophytes and candida albicans often give rise to secondary skin infections in chronic skin disease. Concerning infection of other organs than the skin, a few studies have shown that atopic dermatitis patients are more prone to upper and lower respiratory tract infection. One study of severe psoriasis patients has shown increased mortality due to infections. Patients with chronic skin disease may have more severe infections with prolonged periods of antibiotic treatments and worse prognosis compared with skin healthy controls, but more data from population-based studies including detailed data on relevant risk factors and confounders is needed.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"6 1","pages":"60-64"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060383","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 : 2012-10-02DOI: 10.2174/1874279301206010027
R. Thomsen, A. Mor
This review provides an update on the risk of several important community-acquired infections seen in patients with diabetes: respiratory tract infections, urinary tract infections, and bacteremia. Respiratory tract infections: Recent epidemiological evidence shows a modest (1.25 to 1.75-fold) risk increase for hospitalization with pneumonia associated with diabetes. The increase of risk for tuberculosis is of similar magnitude in highly developed countries, and possibly higher in low-income countries. Poor glycemic control and long diabetes duration predict higher risk for both pneumonia and tuberculosis. Limited data is available for diabetes and influenza, yet both influenza and pneumococcal vaccination is recommended in patients with diabetes. Urinary tract infections: The risk of asymptomatic bacteriuria and cystitis is 1.5 to 2 times increased in diabetes patients, while their risk of pyelonephritis may be 2 to 4 times increased. Treatment of asymptomatic bacteriuria in diabetes is generally not recommended. Diabetes duration and chronic complications including cystopathy appear to be more important risk factors than current glycemic control, but further evidence is needed. Modifiable risk factors for urinary tract infection are the same as in persons without diabetes. Bacteremia: The risk of bacteremia due to pneumococci is approximately 1.5 times increased in diabetes, similar to the increased risk for pneumonia. In comparison, diabetes is associated with 2.5 to 3 times increased risk for bacteremia due to E. coli and other enterobacteria, often due to a urinary tract focus. Diabetes is also associated with a 2 times increased risk for hemolytic streptococcal bacteremia, and 3 times increased risk for invasive group B streptococcal infection. Limited data is available for staphylococcal bacteremia. Conclusions: Increased infection surveillance and unmeasured confounding factors among diabetic patients may contribute to the observed increased infection risk, yet outcomes following infection are similar or worse in diabetes patients. In conclusion, there is epidemiological evidence that individuals with diabetes have a substantially increased risk of a number of important infections. Clinicians should remain vigilant for infections in this increasing group of patients.
{"title":"Diabetes and Risk of Community-Acquired Respiratory Tract Infections, Urinary Tract Infections, and Bacteremia","authors":"R. Thomsen, A. Mor","doi":"10.2174/1874279301206010027","DOIUrl":"https://doi.org/10.2174/1874279301206010027","url":null,"abstract":"This review provides an update on the risk of several important community-acquired infections seen in patients with diabetes: respiratory tract infections, urinary tract infections, and bacteremia. Respiratory tract infections: Recent epidemiological evidence shows a modest (1.25 to 1.75-fold) risk increase for hospitalization with pneumonia associated with diabetes. The increase of risk for tuberculosis is of similar magnitude in highly developed countries, and possibly higher in low-income countries. Poor glycemic control and long diabetes duration predict higher risk for both pneumonia and tuberculosis. Limited data is available for diabetes and influenza, yet both influenza and pneumococcal vaccination is recommended in patients with diabetes. Urinary tract infections: The risk of asymptomatic bacteriuria and cystitis is 1.5 to 2 times increased in diabetes patients, while their risk of pyelonephritis may be 2 to 4 times increased. Treatment of asymptomatic bacteriuria in diabetes is generally not recommended. Diabetes duration and chronic complications including cystopathy appear to be more important risk factors than current glycemic control, but further evidence is needed. Modifiable risk factors for urinary tract infection are the same as in persons without diabetes. Bacteremia: The risk of bacteremia due to pneumococci is approximately 1.5 times increased in diabetes, similar to the increased risk for pneumonia. In comparison, diabetes is associated with 2.5 to 3 times increased risk for bacteremia due to E. coli and other enterobacteria, often due to a urinary tract focus. Diabetes is also associated with a 2 times increased risk for hemolytic streptococcal bacteremia, and 3 times increased risk for invasive group B streptococcal infection. Limited data is available for staphylococcal bacteremia. Conclusions: Increased infection surveillance and unmeasured confounding factors among diabetic patients may contribute to the observed increased infection risk, yet outcomes following infection are similar or worse in diabetes patients. In conclusion, there is epidemiological evidence that individuals with diabetes have a substantially increased risk of a number of important infections. Clinicians should remain vigilant for infections in this increasing group of patients.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"6 1","pages":"27-39"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060493","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 : 2012-10-02DOI: 10.2174/1874279301206010040
S. Johnsen, M. L. Svendsen, Annette Ingeman
Stroke is a major cause of mortality and morbidity worldwide and efforts to reduce the impact of the disease are strongly needed. Patients with acute stroke have an increased risk of in-hospital complications, in particular pneumonia and urinary tract infections. These infections are associated with an adverse patient outcome and increased health care costs. Here we review the existing knowledge on the risk and consequences of post-stroke pneumonia and UTI in adult patients and discuss the evidence of possible targets for intervention.
{"title":"Infection in Patients with Acute Stroke","authors":"S. Johnsen, M. L. Svendsen, Annette Ingeman","doi":"10.2174/1874279301206010040","DOIUrl":"https://doi.org/10.2174/1874279301206010040","url":null,"abstract":"Stroke is a major cause of mortality and morbidity worldwide and efforts to reduce the impact of the disease are strongly needed. Patients with acute stroke have an increased risk of in-hospital complications, in particular pneumonia and urinary tract infections. These infections are associated with an adverse patient outcome and increased health care costs. Here we review the existing knowledge on the risk and consequences of post-stroke pneumonia and UTI in adult patients and discuss the evidence of possible targets for intervention.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"6 1","pages":"40-45"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060504","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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