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Infections In Medicine Journal

Infections In Medicine Journal

Ehrlichia species, which are transmitted by ticks, may cause
human monocytotrophic ehrlichiosis and human granulocytic
anaplasmosis. Symptoms of infection include fever, headache,
myalgia, progressive leukopenia, thrombocytopenia, and anemia.
Diagnosis is based on clinical findings, although serological
tests can identify the specific infectious ehrlichial organism.
Tick repellents, particularly permethrin, can help prevent tick
bites and lower the risk of infection by tick-borne pathogens.
Tetracycline antibiotics are therapeutic for treatment of
ehrlichial infections. [Infect Med. 2008;25:425-429]

WNV first appeared in the United States in 1999.1 This infection "got no respect" even though it caused significant morbidity and mortality while crossing the United States unabated for the past 9 years. Patients died mainly of neuroinvasive complications such as encephalitis and a polio-like paralysis. The lack of respect became a reality to clinicians in Phoenix in 2004 when they found themselves poorly prepared to manage the many acutely ill patients affected by WNV. That there was a lack of practical information about how to manage WNV became readily apparent to these clinicians.

The successful management of immunosuppression following
solid organ transplant requires a delicate balance between
preventing allograft rejection and minimizing the risk of
infection. Strategies that may reduce the risk of de novo
opportunistic infection and emergence of latent infection
during the early posttransplant period-specifically infection
caused by Cytomegalovirus, opportunistic fungi such as
Aspergillus
and Candida, and bacteria such as Pneumocystis
jiroveci
and Mycobacterium tuberculosis-are presented in this
review. [Infect Med. 2008;25:403-415]

Previous case reports have suggested an association between
human T-cell lymphotropic virus (HTLV) types 1 and 2
infection and chronic nonprogressive HIV infection. Evidence
is lacking about the specifics of how the two are related. We
report 2 cases of chronic nonprogressive HIV infection (of
9 and 13 years' duration, respectively) in women in whom
HTLV coinfection was diagnosed. These cases provide clinical
support that HTLV coinfection may serve as a protective factor
against progression of HIV infection. Possible reasons for this
relationship and potential future research are discussed.
[Infect Med. 2008;25:416-420]

Within the past decade, the incidence of methicillin-resistant
Staphylococcus aureus (MRSA) has increased significantly,
spreading from the hospital to the community setting. Patients
with skin infections whose condition is stable should be treated
with antibiotic therapy as well as with incision and drainage,
whereas patients with severe disease require hospitalization
and intravenous therapy. In addition to community-acquired
MRSA, a new strain of Clostridium difficile, BI/NAP1, has led to
clinical challenges in infectious diseases medicine. The strain
has been associated with recurrent infection; more severe disease
that mandates urgent colectomy; and dramatically higher
mortality in vulnerable populations, such as older adults. Oral
vancomycin, rather than metronidazole, may be slightly more
effective in patients with severe disease. Also, new strains of
Chlamydia
and Treponema are posing potential complications to
the treatment of sexually transmitted diseases such that clinicians
need to be judicious in selecting antibiotic therapy in accordance
with factors related to geography and patient population.
[Infect Med. 2008;25:421-424]

A new study confirmed the value of real-time polymerase chain reaction (PCR) assay as a rapid method of screening for group B streptococci (GBS) colonization during parturition.1 Using real-time automated PCR assay, DNA amplification testing, and standard culture, Edwards and colleagues1 comparatively looked at the detection of GBS colonization in women who were in the 35th to 37th week of pregnancy and in women who were about to give birth. A true-positive result was defined as a positive molecular test and a positive culture finding. Compared with culture, the sensitivity rate of PCR was 91.1%, the specificity was 96.0%, the predictive value was 87.8%, the negative predictive value was 97.1%, and the accuracy was 94.8%. As anticipated, PCR assay was more sensitive than DNA amplification testing (91.1% vs 79.3%). Neither specificity, positive predictive value, nor detection of GBS prevalence was statistically divergent.

Most travelers to third-world countries encounter healthrelated
problems during their stay and may require medical
attention on returning home. Although malaria is still the
most common diagnosis among travelers to the developing
world, several other infectious diseases, such as avian influenza,
dengue fever, chikungunya fever, leishmaniasis, and
multidrug-resistant tuberculosis, are growing in importance.
Clinicians need to stay informed about travel requirements
and vaccine recommendations for US citizens. [Infect Med.
2008;25:352-386]

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