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INTRODUCTION: The rate of spontaneous preterm-birth among pregnant women living with HIV on antiretroviral therapy (ART) is 3- to 4-fold higher when compared to HIV-negative women. The pathophysiology of preterm-birth related to HIV or ART remains unknown, especially as women living with HIV are often excluded from preterm birth studies. AREAS COVERED: This review discusses the currently available evidence on the prediction and prevention of preterm-birth in pregnant women living with HIV. A review of the literature was conducted of primary articles between 2005 and 2021 measuring the association or lack thereof between combination ART and preterm birth, as well as of other predisposing factors to preterm birth in women living with HIV, including cervical length, vaginal microbiome, and cervico-vaginal biomarkers. EXPERT OPINION: Further research into the effect of ART exposure on preterm-birth risk is critical, and development of preterm-birth predictive tools in this population should be a priority. Vaginal progesterone supplementation deserves further investigation as a therapeutic option to prevent recurrent preterm birth in pregnant women living with HIV. The ProSPAR study, a multicenter randomized controlled trial studying progesterone supplementation in pregnant women on protease inhibitor-based regimens, has been designed but is not yet recruiting patients.

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A 36-year-old man with well controlled HIV developed Campylobacter fetus aortitis. To prevent aortic rupture, emergent surgical resection and neo-aortoiliac replacement with his left femoral vein was conducted. After surgical intervention, he was successfully treated with intravenous ertapenem for 6 weeks followed by oral amoxicillin for 3 months.

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Staphylococcus pettenkoferi (S.pettenkoferi), originally described in Germany in 2002 by Trülzsch et al, is a coagulase negative staphylococcus whose clinical relevance is yet to be determined. With about 10 case reports in the literature from several parts of the world, there is no data on S. pettenkoferi infection from the United States. This is a retrospective cohort study of 80 patients ≥ 18 years of age who had at least 1 S. pettenkoferi-positive blood culture, identified by matrix-assisted laser desorption/ionization time-of-flight at a tertiary academic center in Detroit, Michigan. We describe the features of S. pettenkoferi-positive blood cultures in order to identify cases of true bacteremia. The mean age of the cohort was 66 ± 16 years and 1 out of 3 had immunosuppressing conditions. No case of true S.pettenkoferi bacteremia was identified. More studies are needed to determine its role as a pathogen in the United States.

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Introduction: In December 2019, SARS-CoV-2 originated from China, and spread rapidly to several countries, bringing a frightening scarcity of personal protective equipment (PPE). The CDC recommends N95 or higher-level particulate filtering respirators as part of the PPE while caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. With new evidence about the efficacy of facemasks, knowledge gaps remain.Areas covered: This reviews the history of respiratory viral pandemics and PPE use, exploring the influenza pandemics of the 20th and 21st century, and prior coronavirus pandemics. A literature search of PubMed and google was done between March 22nd to May 2nd, and on September 28, 2020. The evidence for PPE is described, to delineate their efficacy and 'best safe' practices. Solutions to ameliorate pandemic preparedness to meet surge-capacity to efficiently combat future pandemics, should they arise, are discussed.Expert opinion: PPE, when used appropriately in addition to other infection control measures, is effective protection during respiratory viral pandemics. The current evidence suggests that wearing facemasks in the community is protective, especially if used consistently and correctly with other infection control measures such as hand hygiene.

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BACKGROUND: Hepatitis is a viral infection of the liver. It is mainly transmitted between people through contact with infected blood, frequently from mother to baby in-utero. Hepatitis B poses significant risk to the fetus and up to 85% of infants infected by their mothers at birth develop chronic hepatitis B virus (HBV) infection. Hepatitis B immunoglobulin (HBIG) is a purified solution of human immunoglobulin that could be administered to the mother, newborn, or both. HBIG offers protection against HBV infection when administered to pregnant women who test positive for hepatitis B envelope antigen (HBeAg) or hepatitis B surface antigen (HBsAg), or both. When HBIG is administered to pregnant women, the antibodies passively diffuse across the placenta to the child. This materno-fetal diffusion is maximal during the third trimester of pregnancy. Up to 1% to 9% infants born to HBV-carrying mothers still have HBV infection despite the newborn receiving HBIG plus active HBV vaccine in the immediate neonatal period. This suggests that additional intervention such as HBIG administration to the mother during the antenatal period could be beneficial to reduce the transmission rate in utero. OBJECTIVES: To determine the benefits and harms of hepatitis B immunoglobulin (HBIG) administration to pregnant women during their third trimester of pregnancy for the prevention of mother-to-child transmission of hepatitis B virus infection. SEARCH METHODS: We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded (Web of Science), SCOPUS, African Journals OnLine, and INDEX MEDICUS up to June 2016. We searched ClinicalTrials.gov and portal of the WHO International Clinical Trials Registry Platform (ICTRP) in December 2016. SELECTION CRITERIA: We included randomised clinical trials comparing HBIG versus placebo or no intervention in pregnant women with HBV. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. We analysed dichotomous outcome data using risk ratio (RR) and continuous outcome data using mean difference (MD) with 95% confidence intervals (CI). For meta-analyses, we used a fixed-effect model and a random-effects model, along with an assessment of heterogeneity. If there were statistically significant discrepancies in the results, we reported the more conservative point estimate. If the two estimates were equal, we used the estimate with the widest CI as our main result. We assessed bias control using the Cochrane Hepato-Biliary Group suggested bias risk domains and risk of random errors using Trial Sequential Analysis (TSA). We assessed the quality of the evidence using GRADE. MAIN RESULTS: All 36 included trials originated from China and were at overall high risk of bias. The trials included 6044 pregnant women who were HBsAg, HBeAg, or hepatitis B virus DNA (HBV-DNA) positive. Only seven trials reported inclusion of HBeAg-positive mothers. All 36 trials compared HBIG versus no intervention. None of the trials used placebo.Most of the trials assessed HBIG 100 IU (two trials) and HBIG 200 IU (31 trials). The timing of administration of HBIG varied; 30 trials administered three doses of HBIG 200 IU at 28, 32, and 36 weeks of pregnancy. None of the trials reported all-cause mortality or other serious adverse events in the mothers or babies. Serological signs of hepatitis B infection of the newborns were reported as HBsAg, HBeAg, and HBV-DNA positive results at end of follow-up. Twenty-nine trials reported HBsAg status in newborns (median 1.2 months of follow-up after birth; range 0 to 12 months); seven trials reported HBeAg status (median 1.1 months of follow-up after birth; range 0 to 12 months); and 16 trials reported HBV-DNA status (median 1.2 months of follow-up; range 0 to 12 months). HBIG reduced mother-to-child transmission (MTCT) of HBsAg when compared with no intervention (179/2769 (6%) with HBIG versus 537/2541 (21%) with no intervention; RR 0.30, TSA-adjusted CI 0.20 to 0.52; I2 = 36%; 29 trials; 5310 participants; very low quality evidence). HBV-DNA reduced MTCT of HBsAg (104/1112 (9%) with HBV-DNA versus 382/1018 (38%) with no intervention; RR 0.25, TSA-adjusted CI 0.22 to 0.27; I2 = 84%; 16 trials; 2130 participants; low quality evidence). TSA supported both results. Meta-analysis showed that maternal HBIG did not decrease HBeAg in newborns compared with no intervention (184/889 (21%) with HBIG versus 232/875 (27%) with no intervention; RR 0.68, TSA-adjusted CI 0.04 to 6.37; I2 = 90%; 7 trials; 1764 participants; very low quality evidence). TSA could neither support nor refute this observation as data were too sparse. None of the trials reported adverse events of the immunoglobulins on the newborns, presence of local and systemic adverse events on the mothers, or cost-effectiveness of treatment. AUTHORS' CONCLUSIONS: Due to very low to low quality evidence found in this review, we are uncertain of the effect of benefit of antenatal HBIG administration to the HBV-infected mothers on newborn outcomes, such as HBsAg, HBV-DNA, and HBeAg compared with no intervention. The results of the effects of HBIG on HBsAg and HBeAg are surrogate outcomes (raising risk of indirectness), and we need to be critical while interpreting the findings. We found no data on newborn mortality or maternal mortality or both, or other serious adverse events. Well-designed randomised clinical trials are needed to determine the benefits and harms of HBIG versus placebo in prevention of MTCT of HBV.

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Mycobacterium terrae complex has been recognized as a cause of tenosynovitis, with M. terrae and Mycobacterium nonchromogenicum reported as the primary etiologic pathogens. The molecular taxonomy of the M. terrae complex causing tenosynovitis has not been established despite approximately 50 previously reported cases. We evaluated 26 isolates of the M. terrae complex associated with tenosynovitis or osteomyelitis recovered between 1984 and 2014 from 13 states, including 5 isolates reported in 1991 as M. nonchromogenicum by nonmolecular methods. The isolates belonged to three validated species, one new proposed species, and two novel related strains. The majority of isolates (20/26, or 77%) belonged to two recently described species: Mycobacterium arupense (10 isolates, or 38%) and Mycobacterium heraklionense (10 isolates, or 38%). Three isolates (12%) had 100% sequence identity to each other by 16S rRNA and 99.3 to 100% identity by rpoB gene region V sequencing and represent a previously undescribed species within the M. terrae complex. There were no isolates of M. terrae or M. nonchromogenicum, including among the five isolates reported in 1991. The 26 isolates were susceptible to clarithromycin (100%), rifabutin (100%), ethambutol (92%), and sulfamethoxazole or trimethoprim-sulfamethoxazole (70%). The current study suggests that M. arupense, M. heraklionense, and a newly proposed species ("M. virginiense" sp. nov.; proposed type strain MO-233 [DSM 100883, CIP 110918]) within the M. terrae complex are the major causes of tenosynovitis and osteomyelitis in the United States, with little change over 20 years. Species identification within this complex requires sequencing methods.

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Salmonella choleraesuis is one of the least commonly reported nontyphoidal salmonellae in the United States, accounting for only 0.08% and ranking lower than 20th place among all human source salmonellosis reported to the CDC in 2009. In the state of Connecticut, only 12 cases have been reported since 1998 and our case is the only case since 2008. We report a case of invasive Salmonellosis caused by Salmonella choleraesuis in a patient on an antitumor necrosis factor- α agent (adalimumab) who recently returned from a trip to the Dominican Republic.

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BACKGROUND: Hepatitis B virus (HBV) infection in Nigeria has remained a Public Health issue. It is a major cause of mortality, especially in developing countries. Vertical transmission of hepatitis B virus infection is thought to be a major route of transmission in low resource areas. In spite of this, routine antenatal screening for hepatitis B infection is not yet practiced in many Nigerian hospitals. This paper present the findings of a study conducted among antenatal women in Nnewi, Nigeria. METHODS: It was a cross-sectional study carried out over a 3-month period (August-October, 2009). Recruitment of 480 women attending antenatal clinics in Nnewi, Nigeria was done by simple random sampling using computer generated random numbers. HBsAg screening was done using rapid ELISA Kits. Statistical analysis was computed using STATA 11 package. The results were subjected to analysis using cross tabulations to explore statistical relationships between variables. Chi square test was used to explore proportional relationship between groups. The level of statistical significance was set at p < 0.05 (providing 95% confidence interval). RESULTS: Four hundred and eighty pregnant women were recruited into the study. Of these, 40 tested positive to HBsAg, accounting for 8.3% of the sample population. The age of the subjects studied varied from 14 to 45 years (mean age--24.3 years) while the mean parity was 2.18. The HIV/HBV co-infection rate was 4.2%. The vertical transmission rate was 51.6%. There were statistically significant relationships between HBV infection and previous history of tribal marks/tattoos (χ2 = 27.39, P = 0.001, df = 1), history of contact with previously infected HBV patients (χ2 = 23.11, P = 0.001, df = 1) and occupation of the women (χ2 = 51.22, P = 0.001, df = 1). Multiple sexual partners, blood transfusion, dental manipulations, sharing of sharps/needles, and circumcision were not significant modes of transmission. There was no statistically significant relationship between maternal age, educational level and HBV infection. CONCLUSION: The authors argued that hepatitis B screening in pregnancy should be made routine practice in Nigeria because of the low pick up rate of the infection based only on risk factors for the disease.

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