RESUMEN
A 26-year-old suspected Iraqi insurgent is brought to a Troop Medical Clinic in Baghdad, Iraq, with curious marks on his body. On questioning, he describes productive cough, subjective fever, drenching night sweats, and unintentional weight loss. This case shows a condition with which Western physicians are generally unfamiliar but one which quite possibly could be encountered by the deploying provider.
Asunto(s)
Terapias Complementarias/efectos adversos , Neumonía/terapia , Enfermedades de la Piel/etiología , Adulto , Humanos , Irak , MasculinoRESUMEN
A carbapenem-resistant Alcaligenes faecalis strain was isolated from a surveillance swab of a service member injured in Afghanistan. The isolate was positive for bla(NDM) by real-time PCR. Species identification was reevaluated on three identification systems but was inconclusive. Genome sequencing indicated that the closest relative was Acinetobacter schindleri and that bla(NDM-1) was carried on a plasmid that shared >99% identity with one identified in an Acinetobacter lwoffii isolate. The isolate also carried a novel chromosomally encoded class D oxacillinase.
Asunto(s)
Acinetobacter/enzimología , Acinetobacter/genética , beta-Lactamasas/genética , Acinetobacter/aislamiento & purificación , Infecciones por Acinetobacter/microbiología , Afganistán , Cromosomas Bacterianos , ADN Bacteriano/química , ADN Bacteriano/genética , Humanos , Datos de Secuencia Molecular , Plásmidos , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia de ADNRESUMEN
We determined the in vitro MIC of arbekacin against 200 Acinetobacter isolates recovered from wounded soldiers. The median MIC was 2 microg/ml (range, 0.5 to > 64 microg/ml). A total of 97.5% of the isolates had arbekacin MICs of < 8 microg/ml and 86.5% had MICs of < or = 4 microg/ml. There was no association between the arbekacin MIC and susceptibility to 16 other antibiotics or the specimen source (P = 0.7239). Synergy testing suggested an enhanced effect of arbekacin-carbapenem combinations.
Asunto(s)
Acinetobacter baumannii/efectos de los fármacos , Aminoglicósidos/farmacología , Antibacterianos/farmacología , Hospitales Militares , Acinetobacter baumannii/aislamiento & purificación , Carbapenémicos/farmacología , Dibekacina/análogos & derivados , Dibekacina/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , GuerraRESUMEN
Since the invasions of Iraq and Afghanistan, the epidemiologic traits of clinical isolates at Walter Reed Army Medical Center have shifted toward drug-resistant strains of microorganisms, particularly among the gram-negative bacteria. Moreover, antibiotic prescribing patterns during this period have changed remarkably and mirror the emergence of these organisms at our institution.
Asunto(s)
Antibacterianos/economía , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Hospitales Militares , Personal Militar , Pautas de la Práctica en Medicina , Guerra , Afganistán , Antibacterianos/farmacología , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Cocos Grampositivos/efectos de los fármacos , Humanos , Incidencia , Irak , Pruebas de Sensibilidad Microbiana , Estados UnidosRESUMEN
PURPOSE OF REVIEW: The infectious disease challenges of war include pathogens endemic to the geographic area of operations as well as wound infections with common environmental microorganisms. This review summarizes papers, unpublished data and personal communications from 2004-2005 pertaining to infectious diseases during war with a focus on the current operations in Iraq and Afghanistan. RECENT FINDINGS: To date, there have been several hundred cases of cutaneous leishmaniasis and five cases of visceral leishmaniasis among US military personnel serving in southwest Asia. There have been reports of malaria in soldiers serving in Afghanistan and an outbreak of acute eosinophilic pneumonia among soldiers serving in or near Iraq. Diarrheal illness is a well-known threat to military operations and remains problematic for combatants throughout the theater of operations. Infectious complications caused by multiply drug-resistant Acinetobacter baumannii have been particularly challenging for healthcare providers managing the wounded evacuated from Iraq. We are now facing outbreaks of nosocomial infection with this pathogen in military treatment facilities in Europe and the USA. SUMMARY: Historically, infectious diseases have had significant impact on the conduct of military operations, and the conflict in southwest Asia is no exception. Physicians caring for returning military personnel should be aware of the diseases prevalent in this campaign, particularly cutaneous leishmaniasis and infections with multiply drug-resistant A. baumannii.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Personal Militar , Guerra , Afganistán , Humanos , IrakRESUMEN
The third in a series reviewing the HIV/AIDS antiretroviral drugs, this report summarizes the interactions between antiretrovirals and common drugs of abuse. In an overview format for primary care physicians and psychiatrists, the metabolism and drug interactions in the context of antiretroviral therapy are presented for the following drugs of abuse: alcohol, benzodiazepines, cocaine, GHB (liquid X), ketamine (special K), LSD (acid), MDMA (Ecstasy), opiates, PCP (angel dust), and THC (marijuana).
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antirretrovirales/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Drogas Ilícitas/efectos adversos , Antirretrovirales/administración & dosificación , Antirretrovirales/farmacocinética , Sistema Enzimático del Citocromo P-450/metabolismo , Interacciones Farmacológicas , Inducción Enzimática/efectos de los fármacos , Infecciones por VIH/enzimología , Humanos , Drogas Ilícitas/farmacocinética , Cooperación del Paciente , Educación del Paciente como AsuntoRESUMEN
The second in a series reviewing the HIV/AIDS antiretroviral drugs. This review summarizes the non-protease inhibitor antiretrovirals: nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs), the nonnucleoside reverse transcriptase inhibitors (NNRTIs), and cell membrane fusion inhibitors. In an overview format for primary care physicians and psychiatrists, this review presents the mechanism of action, side effects, toxicities, and drug interactions of these agents.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adenina/análogos & derivados , Antirretrovirales/uso terapéutico , Desoxicitidina/análogos & derivados , Interacciones Farmacológicas , Inhibidores de Fusión de VIH/uso terapéutico , Seropositividad para VIH/tratamiento farmacológico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adenina/uso terapéutico , Alquinos , Antirretrovirales/farmacología , Benzoxazinas , Permeabilidad de la Membrana Celular/efectos de los fármacos , Ciclopropanos , Delavirdina/uso terapéutico , Desoxicitidina/uso terapéutico , Didanosina/uso terapéutico , Didesoxinucleósidos/uso terapéutico , Emtricitabina , Humanos , Lamivudine/uso terapéutico , Nevirapina/uso terapéutico , Organofosfonatos/uso terapéutico , Oxazinas/uso terapéutico , Inhibidores de la Transcriptasa Inversa/farmacología , Estavudina/uso terapéutico , Tenofovir , Zalcitabina/uso terapéutico , Zidovudina/uso terapéuticoRESUMEN
This column is the first in a series on HIV/AIDS antiretroviral drugs. This first review summarizes the history of HIV/AIDS and the development of highly active antiretroviral therapy (HAART) and highlights why it is important for non-HIV specialists to know about these drugs. There are four broad classes of HIV medications used in varying combinations in HAART: the protease inhibitors, nucleoside analogue reverse transcriptase inhibitors, the non-nucleoside reverse transcriptase inhibitors, and cell membrane fusion inhibitors. This paper reviews the mechanism of action, side effects, toxicities, and drug interactions of the protease inhibitors.