MEDSCAPE's Infectious Diseases MedPulse 12-07-01

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Emerging Trends in CMV Infection from HAART to Heart

Sunday, December 16, 2001, 6:30 - 9:00 am,

supported by Roche Pharmaceuticals, at the Chicago

Marriott Downtown, at the 41st Interscience Conferencehttp://hometown.aol.com/chevy974/myhomepagebaby.html

on Antimicrobial Agents and Chemotherapy (ICAAC)

For program description and registration, go to

http://www.cmv.icclink.com/register.html

_____________________

Announcing Evaluating the Future of Antiretroviral Therapy, Inside and Out,

USA. 16 December 2001

Get the latest information and register now for the CME certified Satellite

Symposium chaired by Michael Saag, MD, Sunday 16 December, 2001, 20.15 -

22.15 at the McCormick Place, Room E451, while attending the 41st

Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)

Supported by an unrestricted educational grant from

Roche and Trimeris Pharmaceuticals. http://InsandOutsofHIV.com

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MedPulse is a weekly index of key news and features on Medscape's

specialty sites compiled by Medscape's Editors.

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___________________ NEW FEATURE ARTICLES THIS WEEK ____________________

-- MEDSCAPE ORIGINAL ARTICLES --

TALKING ABOUT BIOTERRORISM -

SMALLPOX: THE WEAPON THAT KNOWS NO BORDERS

Dr. Stanley Foster, a former smallpox 'warrior,' believes surveillance and

containment should be the main approach to preparedness.

Medscape Infectious Diseases, 2001

http://id.medscape.com/45817.rhtml?srcmp=id-120701

JOURNAL SCAN - INFECTIOUS DISEASES 4(12)

David Haburchak, MD, summarizes and comments on important new publications,

including:

- First Inhalational Anthrax Case Due to Bioterrorism

- Goal-directed Therapy of Sepsis

- Risk Index for Postoperative Pneumonia

- A Single Swab for Multiple STDs

- RSV and Influenza-like Illness

http://id.medscape.com/45903.rhtml?srcmp=id-120701

EDITORIAL - INNOVATIVE APPROACHES TO CERVICAL CANCER PREVENTION

Reducing cervical cancer deaths in developing countries will require new

preventive, public health approaches.

Medscape Women's Health 6(6), 2001

http://id.medscape.com/45833.rhtml?srcmp=id-120701

AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES 52ND ANNUAL MEETING

Leading authorities provide clinically focused and comprehensive updates on

topical issues in liver disease and its complications.

http://id.medscape.com/45789.rhtml?srcmp=id-120701

FOCUS ON INFLUENZA

Coughing in Columbus, fever in Philadelphia, myalgia in Milwaukee --

where is influenza striking this week? And what are the best

approaches to diagnosis, treatment, and prevention? Find what

you are looking for in this collection of online resources available

on Medscape. Get the latest information from the Web's most

trusted medical resource.

http://www.medscape.com/mp/rc/usmd/influenzone

-- CHEST 2001 --

UNDERSTANDING OF THE WEAPONS OF CHEMICAL/BIOLOGICAL TERRORISM IS THE KEY TO

BEING PREPARED

Are clinicians ready to treat patients exposed to bioterrorism?

http://id.medscape.com/45887.rhtml?srcmp=id-120701

UPDATE ON THE USE OF DROTRECOGIN ALFA (ACTIVATED) FOR THE TREATMENT OF SEVERE SEPSIS

Will drotrecogin alfa (activated) emerge as a viable treatment for severe

sepsis?

http://id.medscape.com/45892.rhtml?srcmp=id-120701

CURRENT MANAGEMENT STRATEGIES FOR SEVERE SEPSIS AND SEPTIC SHOCK

R. Phillip Dellinger delivers the Roger C. Bone Memorial Lecture

http://id.medscape.com/45893.rhtml?srcmp=id-120701

CURRENT TRENDS IN MULTIDRUG-RESISTANT TUBERCULOSIS

What are the current treatment recommendations for multidrug-resistant

tuberculosis?

http://id.medscape.com/45894.rhtml?srcmp=id-120701

-- MMWR: ANTHRAX --

UPDATE: INVESTIGATION OF BIOTERRORISM-RELATED INHALATIONAL ANTHRAX -- CONNECTICUT, 2001

The source of exposure to B. anthracis for the 94-year-old CT resident

remains unknown, but the genetic characteristics of the isolate links this

case with the previous bioterrorism-related cases.

MMWR 50(47):1049-1051, 2001. Centers for Disease Control

http://id.medscape.com/45800.rhtml?srcmp=id-120701

UPDATE: ADVERSE EVENTS ASSOCIATED WITH ANTHRAX PROPHYLAXIS AMONG POSTAL EMPLOYEES --- NEW JERSEY, NEW YORK CITY, AND THE DISTRICT OF COLUMBIA METROPOLITAN AREA, 2001

Overall rates of adverse events are similar to the frequency of adverse

events among persons on ciprofloxacin therapy for any indication.

Discontinuation of therapy caused by adverse events was similar to other

groups previously studied.

MMWR 50(47):1051-1054, 2001. Centers for Disease Control

http://id.medscape.com/45801.rhtml?srcmp=id-120701

-- MMWR --

SIMULTANEOUS ADMINISTRATION OF VARICELLA VACCINE AND OTHER RECOMMENDED CHILDHOOD VACCINES --- UNITED STATES, 1995--1999

No adverse effects have been reported of simultaneous administration of

DTP, Hib, MMR, and OPV on the immunogenicity of the varicella vaccine.

There is an increased risk for breakthrough disease in children who

received varicella vaccine <30 days after MMR, but not after the other

vaccines.

MMWR 50(47):1058-1061, 2001. Centers for Disease Control

http://id.medscape.com/45802.rhtml?srcmp=id-120701

HIV TESTING AMONG RACIAL/ETHNIC MINORITIES --- UNITED STATES, 1999

An estimated 300,000 HIV-infected persons in the United States may be

unaware of their HIV serostatus.

MMWR 50(47):1054-1058, 2001. Centers for Disease Control

http://id.medscape.com/45706.rhtml?srcmp=id-120701

WEEKLY UPDATE: WEST NILE VIRUS ACTIVITY ---UNITED STATES, NOVEMBER 14--20, 2001

Three human cases of WNV encephalitis or meningitis were reported from

Mass. (2) and NJ (1) this week.

MMWR 50(47):1061-1062, 2001. Centers for Disease Control

http://id.medscape.com/45707.rhtml?srcmp=id-120701

-- EMERGING INFECTIOUS DISEASES --

CLINICAL CONSEQUENCES AND COST OF LIMITING USE OF VANCOMYCIN FOR

PERIOPERATIVE PROPHYLAXIS: EXAMPLE OF CORONARY ARTERY BYPASS SURGERY

Routine use of vancomycin for perioperative prophylaxis is discouraged,

principally to minimize microbial resistance to it.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45835.rhtml?srcmp=id-120701

INTRAOPERATIVE REDOSING OF CEFAZOLIN AND RISK FOR SURGICAL SITE INFECTION IN CARDIAC SURGERY

Intraoperative redosing of prophylactic antibiotics is recommended for

prolonged surgical procedures, although its efficacy has not been assessed.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45836.rhtml?srcmp=id-120701

PNEUMOCOCCAL SURFACE PROTEIN A OF INVASIVE STREPTOCOCCUS PNEUMONIAE

ISOLATES FROM COLOMBIAN CHILDREN

Streptococcus pneumoniae is a major respiratory pathogen that also causes

meningitis, otitis media, and bacteremia.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45837.rhtml?srcmp=id-120701

EPIDEMIOLOGY OF AND SURVEILLANCE FOR POSTPARTUM INFECTIONS

The epidemiology of postpartum infections has not been well characterized.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45838.rhtml?srcmp=id-120701

MOLECULAR IDENTIFICATION OF STREPTOMYCIN MONORESISTANT MYCOBACTERIUM TUBERCULOSIS RELATED TO MULTIDRUG-RESISTANT W STRAIN

With the advent of molecular techniques, TB investigators have a powerful

tool to further the understanding of the transmission and phylogenetic

properties of M. tuberculosis.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45839.rhtml?srcmp=id-120701

EMERGING INFECTIOUS DISEASES IN AN ISLAND ECOSYSTEM: THE NEW ZEALAND PERSPECTIVE

Several unique features characterize infectious disease epidemiology in New

Zealand.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45880.rhtml?srcmp=id-120701

CHANGING EPIDEMIOLOGY OF Q FEVER IN GERMANY; 1947-1999

The epidemiology of Q fever in Germany was examined by reviewing relevant

studies since 1947 and by analyzing available surveillance data since 1962.

Emerging Infectious Diseases 7(5), 200

http://id.medscape.com/45881.rhtml?srcmp=id-120701

FIRST ISOLATION OF LA CROSSE VIRUS FROM NATURALLY INFECTED AEDES ALBOPICTUS

La Crosse virus, a California serogroup bunyavirus, is the leading cause of

pediatric arboviral encephalitis in the United States.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45883.rhtml?srcmp=id-120701

FACTORS CONTRIBUTING TO THE EMERGENCE OF ESCHERICHIA COLI O157 IN AFRICA

In 1992, a large outbreak of bloody diarrhea caused by E. coli O157

infections occurred in southern Africa.

Emerging Infectious Diseases 7(5), 2001

http://id.medscape.com/45884.rhtml?srcmp=id-120701

-- INFECTIONS in MEDICINE: VACCINE ISSUE --

VACCINES IN THE 21ST CENTURY

New concepts in vaccination, including recombinant subunits, reassortment

virus techniques, live vectors, and naked DNA technology, are just over the

horizon.

http://id.medscape.com/45748.rhtml?srcmp=id-120701

CURRENT ADULT AND PEDIATRIC VACCINE RECOMMENDATIONS

More than 40,000 lives would be saved each year in the US if routine

vaccines against pneumococcal infection, influenza, and hepatitis B were

fully utilized.

http://id.medscape.com/45749.rhtml?srcmp=id-120701

IMMUNIZATIONS INVOLVED WITH INTERNATIONAL ADOPTION AND TRAVEL

Preparation for international adoption should include a detailed pretravel

assessment of the immunization status of the adopting family, and the

immunization status of foreign-born children should be reviewed and updated

shortly after their arrival.

http://id.medscape.com/45750.rhtml?srcmp=id-120701

VACCINES IN THE PIPELINE -- AN OVERVIEW

Vaccines in developent include those against CMV, group B streptococci,

HIV, hepatitis C, rotavirus, pertussis in adolescents and adults, human

papillomavirus, genital herpes, tuberculosis, malaria, serotype B

meningococci, and multidrug-resistant staphylococci.

http://id.medscape.com/45751.rhtml?srcmp=id-120701

COST-EFFECTIVENESS OF A POTENTIAL VACCINE FOR COCCIDIOIDES IMMITIS

Vaccination of children in highly endemic regions would provide a large

health benefit and would reduce total health care expenditures.

http://id.medscape.com/45882.rhtml?srcmp=id-120701

-- OTHER JOURNALS --

CURRENT TREATMENT CONSIDERATIONS IN COMMUNITY-ACQUIRED PNEUMONIA IN OLDER PATIENTS

The incidence of community-acquired pneumonia increases markedly in older

individuals, among whom the principal risk factor for CAP is chronic

underlying disease.

Drug & Ther Perspect 17(21):5-8, 2001

http://id.medscape.com/45785.rhtml?srcmp=id-120701

FIRST REPORTS OF ADVERSE DRUG REACTIONS (ADRS) IN RECENT WEEKS

Reports of ADRs to amoxicillin/clavulanate, antiretrovirals, and quinolones.

Drug & Ther Perspect 17(21):15, 2001

http://id.medscape.com/45788.rhtml?srcmp=id-120701

LOPINAVIR-RITONAVIR: A NEW PROTEASE INHIBITOR

The exact resistance patterns of lopinavir-ritonavir are unknown, but the

HHS strongly recommends it for the initial treatment of HIV-infected adults

and adolescents.

Pharmacotherapy 21(11):1352-1363, 2001

http://id.medscape.com/45790.rhtml?srcmp=id-120701

HIV-ASSOCIATED WASTING IN THE ERA OF HAART: A PRACTICE-BASED APPROACH TO

DIAGNOSIS AND TREATMENT

Malnutrition, weight loss, and wasting have remained hallmarks of HIV

disease since the beginning of the AIDS epidemic.

The AIDS Reader 11(11):557-560, 566-569, 2001

http://id.medscape.com/45824.rhtml?srcmp=id-120701

TRACHEOESOPHAGEAL FISTULA AND MASSIVE PNEUMOPERITONEUM AFTER PROLONGED MECHANICAL VENTILATION

Tracheoesophageal fistula is one of the uncommon but serious sequelae of

endotracheal intubation.

South Med J 94(10):1027-1029

http://id.medscape.com/45831.rhtml?srcmp=id-120701

TODAY'S QUESTION --

TODAY'S ?? - ANTHRAX PROPHYLAXIS AND BREASTFEEDING

What is the recommended antimicrobial prophylaxis for breastfeeding mothers

with suspected anthrax exposure?

http://id.medscape.com/45904.rhtml?srcmp=id-120701

_______________________________________________________________________

___________________________________ NEWS ______________________________

-- BIOTERRORISM --

TRACES OF ANTHRAX FOUND IN A CONNECTICUT LETTER

Trace amounts of anthrax, that could have resulted from cross

contamination, were found in a letter sent to a Connecticut family that

lived near a 94-year-old woman who died of anthrax earlier this month,

Connecticut officials said on Friday.

http://id.medscape.com/45698.rhtml?srcmp=id-120701

AMA WANTS MORE STUDY OF MASS SMALLPOX VACCINATION; RESCINDS MANDATORY HIV TESTING IN PREGNANCY

The American Medical Association's House of Delegates voted Tuesday to take

a cautious approach to a national smallpox vaccination program, urging the

federal government to wait for good science before ordering universal

vaccinations.

http://id.medscape.com/45872.rhtml?srcmp=id-120701

PUBLIC INFORMATION WILL BE KEY TO EFFECTIVE BIOTERRORISM RESPONSE

The primary defense against the spread of smallpox or other infectious

agent used in a bioterrorist attack should not involve a large-scale

quarantine of potentially exposed individuals, as some emergency management

personnel have proposed, US researchers assert.

http://id.medscape.com/45873.rhtml?srcmp=id-120701

HOUSE MEMBERS UNVEIL BIPARTISAN BIOTERRORISM BILL

The House could vote as soon as next week on a comprehensive, bipartisan

bill aimed at improving the nation's preparedness for biological or

chemical attacks.

http://id.medscape.com/45923.rhtml?srcmp=id-120701

-- EBOLA VIRUS --

MYSTERIOUS ILLNESS KILLS SIX IN GABON'S EBOLA ZONE

Six people have died of a mysterious illness in a part of Gabon where the

Ebola virus killed at least 66 people in 1996, the country's health

minister said on Wednesday.

http://id.medscape.com/45858.rhtml?srcmp=id-120701

HIV AND EBOLA SHARE SAME MECHANISM FOR BUDDING FROM INFECTED CELLS

HIV and Ebola virus both recruit the Tsg101 protein from infected cells to

complete their budding process, investigators from the Aaron Diamond AIDS

Research Center in New York report in the December issue of Nature Medicine.

http://id.medscape.com/45705.rhtml?srcmp=id-120701

-- BSE/CJD --

RISK OF BOVINE SPONGIFORM ENCEPHALOPATHY LOW IN US

The USDA said Friday that a recent study found little risk of bovine

spongiform encephalopathy in US cattle.

http://id.medscape.com/45697.rhtml?srcmp=id-120701

-- HIV/AIDS --

UNIVERSAL HIV SCREENING AT AMSTERDAM STD CLINIC APPEARS TO BE COST-EFFECTIVE

In the Netherlands, at least, screening all attendees at an STD clinic for

HIV infection appears to be cost-effective, based on the costs of other

infectious disease control measures.

http://id.medscape.com/45724.rhtml?srcmp=id-120701

-- INFLUENZA --

APOPTOTIC INFLUENZA PROTEIN MAY TARGET IMMUNE CELLS

A newly discovered protein, PB1-F2, encoded by influenza A virus, prompts

apoptosis and may serve to kill immune cells, according to researchers in

the US and Germany.

http://id.medscape.com/45745.rhtml?srcmp=id-120701

-- TUBERCULOSIS --

SERIOUS TB SPECIALIST SHORTAGE SEEN IN UK

The UK is 'desperately' short of staff to monitor and treat the growing

number of tuberculosis cases, the British Thoracic Society warned at its

winter meeting in London on Wednesday.

http://id.medscape.com/45777.rhtml?srcmp=id-120701

-- MEASLES --

EARLY TWO-DOSE MEASLES VACCINATION DEEMED USEFUL IN ENDEMIC AREAS

An early two-dose measles vaccination schedule can improve vaccination

coverage in areas at high risk of measles among infants, according to an

analysis of the schedule's impact in Dade County, Florida.

http://id.medscape.com/45778.rhtml?srcmp=id-120701

-- DRUG APPROVALS --

LANNETT WINS APPROVAL FOR GENERIC ISONIAZID

Generic drugmaker Lannett Company Inc. said on Tuesday that it has received

approval from the US FDA to market a 300-mg tablet formulation of isoniazid.

http://id.medscape.com/45780.rhtml?srcmp=id-120701

BAYER WINS FDA APPROVAL FOR INTRAVENOUS AVELOX

Bayer Corporation said on Tuesday that it has received approval from the

FDA to market an intravenous formulation of Avelox (moxifloxacin), a

broad-spectrum antibiotic in the same class as the firm's Cipro

(ciprofloxacin).

http://id.medscape.com/45781.rhtml?srcmp=id-120701

-- FUNGAL INFECTIONS --

FLUCONAZOLE PROPHYLAXIS PREVENTS FUNGAL INFECTIONS IN PRETERM INFANTS

When given during the first 6 weeks of life, fluconazole effectively

prevents fungal colonization and invasive fungal infections in extremely

low-birthweight infants, according to a report in the December 6th issue of

the New England Journal of Medicine.

http://id.medscape.com/45847.rhtml?srcmp=id-120701

-- MALARIA --

GLAXOSMITHKLINE MALARIA VACCINE SAFE AND EFFECTIVE

RTS,S/AS02 (GlaxoSmithKline Biologicals, Rixensart, Belgium) is the first

pre-erythrocytic malaria vaccine to offer significant protection for

semi-immune adults exposed to natural infection, according to results from

a randomized trial conducted in The Gambia.

http://id.medscape.com/45917.rhtml?srcmp=id-120701

-- INFECTIONS in ONCOLOGY --

PACLITAXEL USE BY BREAST CANCER PATIENTS TIED TO PNEUMONITIS AFTER RADIOTHERAPY

Breast cancer patients treated with paclitaxel and radiation therapy (RT)

are much more likely to develop pneumonitis than similar patients treated

with a different chemotherapeutic agent, according to a report published in

the December 5th issue of the Journal of the National Cancer Institute.

http://id.medscape.com/45761.rhtml?srcmp=id-120701

-- OTHER ID NEWS --

SURGEON GENERAL CALLS CDC'S ATLANTA LABS A NATIONAL DISGRACE

US Surgeon General Dr. David Satcher said Monday that the United States

should be 'ashamed of the condition of the laboratories at the Centers for

Disease Control and Prevention in Atlanta.'

http://id.medscape.com/45742.rhtml?srcmp=id-120701

GROUP A STREP BINDS CD44 TO OPEN TIGHT EPITHELIAL JUNCTIONS, INVADE TISSUE

The invasive nature of group A streptococcus appears to derive from the

binding of the bacteria's hyaluronic acid capsular polysaccharide and CD44,

the hyaluronic acid-binding protein on epithelial cells.

http://id.medscape.com/45878.rhtml?srcmp=id-120701

HIGH CONSUMPTION OF ASTHMA MEDICATION LINKED TO HIGHER RATE OF ANTIBIOTIC USE

Researchers in Boston have disproved their own hypothesis that underuse of

anti-inflammatory medications by asthmatics is related to overprescription

of antibiotics.

http://id.medscape.com/45906.rhtml?srcmp=id-120701

CDC REPORTS FOUR CASES OF SEPTIC ARTHRITIS AFTER ACL RECONSTRUCTION

Four patients undergoing anterior cruciate ligament (ACL) reconstruction in

Florida and Louisiana last year acquired septic arthritis, probably due to

contaminated bone-tendon-bone allografts, according to the CDC.

http://id.medscape.com/45932.rhtml?srcmp=id-120701

BACTERIOPHAGE ENZYME RAPIDLY KILLS STREPTOCOCCUS PNEUMONIAE

In a mouse model, researchers have demonstrated that a bacteriophage lytic

enzyme, called Pal, kills 15 types of Streptococcus pneumoniae on contact.

http://id.medscape.com/45936.rhtml?srcmp=id-120701

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