MEDSCAPE's Infectious Diseases MedPulse 12-21-01

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

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___________________ NEW FEATURE ARTICLES THIS WEEK ____________________

CONFERENCE NEWS REPORTS - 41ST INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, CHICAGO, DEC 16-19, 2001

From new mechanisms of antibiotic resistance to mysterious cases of

nosocomial transmission, the presentations at this year's ICAAC were worth

the wait. Click the link below to see the table of contents for our

thorough coverage of the leading infectious disease meeting of the year.

(And don't miss the extensive coverage of HIV topics by noted experts.)

http://www.medscape.com/conference/icaac01

ANTIBIOTIC RESISTANCE

by Charles W. Stratton, MD

-- Bad News from the Sentry Program: MRSA

-- Community-Acquired MRSA: A Dramatically Different Strain

-- A Surprising Increase in Macrolide Resistance in GAS

-- A Dangerous New Type of Resistance in Klebsiella

-- Double Trouble: Dual Mechanisms for Pneumococcal Macrolide Resistance in

a Single Strain

-- Fluoroquinolone Resistance in UTIs: The Next Big Problem?

FUNGAL INFECTIONS

by Luis Ostrosky-Zeichner, MD, and John H. Rex, MD

-- An Undiscovered Country: Antifungal Susceptibility Testing

-- Combination Antifungal Therapy: It's Here...Are We Ready?

-- Cryptococcal Meningitis: Variations on a Theme

DRUG NEWS

by Ben Lomaestro, PharmD

-- A Potpourri from the Pipeline

-- Mind the Gap: Antimicrobial-Associated Cardiotoxicity

-- How Good Are Guidelines for CAP?

OTHER STORIES

-- "The Plumber Did It!" and Other Strange Tales of Nosocomial Outbreaks

-- New Targets for Prion Disease

-- Current Research on Anthrax

-- Emerging Viruses, Natural and Otherwise

-- Clueless in Chicago: When Diagnosis is Difficult

-- Pushing the Envelope: A UTI Vaccine, Suppressive Herpes Therapy, and

Linezolid Resistance

-- New Guidelines for IV Catheter-Associated Infections

-- What's New? HHV-8 Transmission, S aureus Genomics

-- Use of Varicella Vaccine on the Rise, and Other Vaccine News

-- Do It Yourself: Patients Treating Themselves for UTIs

-- Screening for GBS Is Better Than the Risk-Based Approach

A SELECTION OF HIV STORIES

-- The Global AIDS Epidemic: The Highs and the Lows, by William A. O'Brien,

MD, MS

-- STDs and HIV: Deadly Synergy, by Myron S. Cohen, MD

-- Benefits of Hindsight: Treatment Discontinuation in Patients with

Marginal Indications for Starting HAART, by W. David Hardy, MD

-- Influence of PI Resistance Mutations on Response to

Saquinavir/Ritonavir, by Graeme Moyle, MD, MBBS

-- A New Approach to Draining the Reservoir of Latently HIV-Infected Cells, by

Joseph J. Eron Jr, MD

-- HIV Late Breakers: Prevalence of Resistance, Timing of Treatment

Initiation, and a Little More on Tipranavir, by Stephen L. Becker, MD

Table of Contents for ICAAC news:

http://www.medscape.com/conference/icaac01

CONFERENCE REPORT - 3RD INTERNATIONAL WORKSHOP ON ADVERSE DRUG REACTIONS AND LIPODYSTROPHY IN HIV

A number of hypothesis-testing studies and treatment trials were presented

at the meeting, but HIV lipodystrophy remains an extremely complicated

syndrome for which effective management is not at hand.

Medscape HIV/AIDS 7(6), 2001

http://id.medscape.com/46234.rhtml?srcmp=id-122101

A CROSS-NATIONAL STUDY OF ACUTE OTITIS MEDIA: RISK FACTORS, SEVERITY, AND TREATMENT AT INITIAL VISIT

Bacterial resistance to antimicrobial medications increases morbidity,

mortality, and costs.

J Am Board Fam Pract 14(6):406-417, 2001

http://id.medscape.com/46341.rhtml?srcmp=id-122101

FLU SEASON UPDATE!

The remaining supply of flu vaccine is being made available in December,

and itÌs not too late for patients to get their flu shots. Get the

latest flu facts, vaccine supply news, CDC weekly surveillance reports,

and treatment and management information, free online from Medscape.

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

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___________________________________ NEWS ______________________________

-- EBOLA --

EBOLA SPREADS FROM GABON TO CONGO, LEAVES 15 DEAD

An Ebola virus outbreak that has killed 11 people in Gabon spread across

the border to Congo, where it has claimed 4 more lives, the WHO said on

Thursday.

http://id.medscape.com/46430.rhtml?srcmp=id-122101

WHO CONFIRMS SECOND EBOLA DEATH IN GABON

The WHO said on Friday that tests confirmed a second person had died of

Ebola in the central African state of Gabon and that the virus was believed

to have killed nine other people.

http://id.medscape.com/46216.rhtml?srcmp=id-122101

EBOLA OUTBREAK IN GABON THOUGHT TO BE CONTAINED

The Ebola virus has killed a 13th person in a remote corner of the central

African country of Gabon but health specialists reported on Wednesday that

measures to stop the spread of the outbreak seemed effective.

http://id.medscape.com/46380.rhtml?srcmp=id-122101

-- ANTHRAX --

B ANTHRACIS CAN DEVELOP RESISTANCE TO QUINOLONES AND MACROLIDES

Bacillus anthracis can develop resistance to many of the antibiotics used

to treat it, according to study findings presented here Tuesday at the 41st

ICAAC.

http://id.medscape.com/46324.rhtml?srcmp=id-122101

US TO OFFER ANTHRAX VACCINE TO EXPOSED GROUPS

The US government on Tuesday offered vaccination and extra antibiotics to

people who were exposed to inhalational anthrax in recent mail attacks as

an added precaution to prevent the development of the infection.

http://id.medscape.com/46379.rhtml?srcmp=id-122101

FDA COMPLETES PRE-APPROVAL INSPECTION OF BIOPORT'S ANTHRAX VACCINE PLANT

The US FDA said late Wednesday that it had completed a pre-approval

inspection of BioPort Corp.'s renovated vaccine manufacturing facility.

http://id.medscape.com/46434.rhtml?srcmp=id-122101

-- BIOTERRORISM --

PUBLIC-PRIVATE ALLIANCE AIMS TO IMPROVE US BIOTERROR SURVEILLANCE SYSTEM

A non-profit coalition of healthcare companies has entered into an alliance

with the US CDC aimed at using electronic data to help identify and respond

to bioterror attacks.

http://id.medscape.com/46211.rhtml?srcmp=id-122101

US HEALTH PROFESSIONALS PLAN BIOTERRORISM RESPONSE

'We will be judged by what we do from today to the future,' Dr. Michael

Osterholm said in his opening remarks at a conference on Understanding

Bioterrorism held here December 13.

http://id.medscape.com/46265.rhtml?srcmp=id-122101

CONGRESS GIVES FINAL APPROVAL FOR ANTI-BIOTERROR SPENDING

The US Congress on Thursday approved an $8.6 billion homeland defense

spending package that includes new money for enhancing the nation's

anti-bioterrorism public health infrastructure and food safety functions.

http://id.medscape.com/46422.rhtml?srcmp=id-122101

-- HEPATITIS --

AVENTIS OFFERS FREE TESTING TO RECIPIENTS OF RECALLED HEPATITIS A VACCINE

Aventis Pasteur MSD, the European vaccines joint venture set up by Merck

and Aventis, has urged individuals who received its VAQTA hepatitis A

vaccine to be tested--at the company's cost--to ensure the vaccine was

effective, according to a top company official in Germany.

http://id.medscape.com/46214.rhtml?srcmp=id-122101

VACCINATING CHILDREN AGAINST HEPATITIS A REDUCES DISEASE RATE IN COMMUNITY

Results of a community-based demonstration project show that hepatitis A

vaccination of children significantly reduces the rate of infection among

both children and adults.

http://id.medscape.com/46378.rhtml?srcmp=id-122101

-- ANTIBIOTIC RESISTANCE --

FORMULARY MANIPULATION EFFECTIVELY CONTROLS VRE INFECTION RATE

Restricting the empiric use of 3rd generation cephalosporins for mixed

infections and using piperacillin/tazobactam instead may help control the

emergence of vancomycin-resistant enterococcus, according to study findings

presented on Monday at the 41st ICAAC.

http://id.medscape.com/46302.rhtml?srcmp=id-122101

ANTIBIOTIC USE FAVORS GLYCOPEPTIDE-RESISTANT COAGULASE-NEGATIVE STAPHYLOCOCCI

Previous antibiotic exposure and other factors foster the emergence of

glycopeptide-resistant coagulase-negative staphylococcal bacteremia,

according to a report in the November 15th issue of Clinical Infectious

Diseases.

http://id.medscape.com/46194.rhtml?srcmp=id-122101

GARLIC EXTRACT SHOWS ACTIVITY AGAINST DRUG-RESISTANT BACTERIA

Garlic extract appears to be active against two types of drug-resistant

bacteria, investigators reported on Wednesday at the 41st ICAAC.

http://id.medscape.com/46407.rhtml?srcmp=id-122101

NEW ACNE DRUG HAS FEWER ADVERSE EFFECTS

MBI 594AN appears to attack acne-causing bacteria so quickly that they

don't have a chance to become resistant.

http://id.medscape.com/46237.rhtml?srcmp=id-122101

-- VARICELLA --

MOST CHILDREN WITH A NEGATIVE OR UNKNOWN VARICELLA HISTORY ARE IMMUNE

Contrary to widely held beliefs, most 10-year-old children with negative or

unknown chickenpox histories are actually immune to varicella, according to

a report by Canadian investigators.

http://id.medscape.com/46200.rhtml?srcmp=id-122101

LOW VARICELLA VACCINE EFFECTIVENESS IDENTIFIED AT DAY CARE CENTER

New study findings indicate that, at least among one group of children, the

varicella vaccine is much less effective than previously reported.

http://id.medscape.com/46369.rhtml?srcmp=id-122101

-- SLEEPING SICKNESS --

TEST FOR SRA GENE IN CATTLE TRYPANOSOMES MAY CONTROL HUMAN SLEEPING SICKNESS

A newly developed test to identify Trypanosoma brucei rhodesiense in

livestock is expected to reduce the public health burden of sleeping

sickness in east Africa.

http://id.medscape.com/46215.rhtml?srcmp=id-122101

-- FUNGAL INFECTIONS --

EMEA BACKS VORICONAZOLE FOR INVASIVE FUNGAL INFECTION

The European Medicines Evaluation Agency on Friday said that its scientific

committee has recommended Pfizer's anti-fungal drug voriconazole (Vfend) to

treat invasive aspergillosis and invasive infections due to Candida,

Scedosporium and Fusarium species.

http://id.medscape.com/46218.rhtml?srcmp=id-122101

CRYPTOCOCCUS NEOFORMANS VIRULENCE DEVELOPED AS ENVIRONMENTAL DEFENSE

The virulence of C neoformans in HIV-infected patients and other

immunocompromised individuals appears to result from adaptations evolved

for protection against environmental amoebae, investigators in New York report.

http://id.medscape.com/46221.rhtml?srcmp=id-122101

-- RESPIRATORY TRACT --

ZINC NASAL SPRAY DOES NOT PREVENT OR TREAT THE COMMON COLD

Adding to the growing body of conflicting evidence, the results of a new

study indicate that the use of intranasal zinc gluconate does not prevent

or treat the common cold.

http://id.medscape.com/46248.rhtml?srcmp=id-122101

VENTILATOR-ASSOCIATED PNEUMONIA IS COMMON AMONG US INTENSIVE CARE PATIENTS

Nearly 1 in 10 patients who receive mechanical ventilation at ICUs in the

US develop ventilator-associated pneumonia, according to study findings

presented on Monday at the 41st ICAAC.

http://id.medscape.com/46262.rhtml?srcmp=id-122101

-- HIV/AIDS --

ANTIRETROVIRALS INEFFECTIVE AGAINST PNEUMOCYSTIS CARINII

Antiretroviral drugs effective against HIV-1 have little or no activity

against P carinii in in vitro or in vivo tests, according to a report in

the November 15th issue of The Journal of Infectious Diseases.

http://id.medscape.com/46251.rhtml?srcmp=id-122101

HIV-1 MAY REVERT TO LESS PATHOGENIC STRAIN A FEW DAYS AFTER STARTING HAART

Previous study findings indicate that highly active antiretroviral therapy

(HAART) can cause a shift from HIV-1 strains that use the CXCR4 T cell

coreceptor (X4) to less pathogenic strains that use the CCR5 coreceptor (R5).

http://id.medscape.com/46323.rhtml?srcmp=id-122101

HIGH PREVALENCE OF DRUG-RESISTANT HIV IDENTIFIED IN US

Nearly 80% of HIV-infected adults in the US harbor a viral strain that is

resistant to one or more antiretroviral agents, according to study findings

presented on Tuesday at the 41st ICAAC.

http://id.medscape.com/46310.rhtml?srcmp=id-122101

EARLY DATA SUGGEST LOW TERATOGENIC POTENTIAL OF ANTIRETROVIRAL DRUGS

While it may take several years to accumulate enough data to reach

definitive conclusions, early data from the antiretroviral pregnancy

registry (APR) suggest that antiretroviral drug use during pregnancy does

not increase the risk of birth defects.

http://id.medscape.com/46309.rhtml?srcmp=id-122101

ANTIRETROVIRALS PLUS PCP PROPHYLAXIS INCREASE RISK FOR CONGENITAL DEFECTS

Among HIV-positive women, exposure to the combination of folate antagonists

for P carinii pneumonia (PCP) prophylaxis and antiretroviral drugs during

the first trimester increases the risk of congenital abnormalities in their

offspring.

http://id.medscape.com/46410.rhtml?srcmp=id-122101

NO INCREASE IN VIOLENCE SEEN IN NEEDLE EXCHANGE PROGRAM NEIGHBORHOODS

Individuals who live close to needle exchange programs (NEPs) do not report

greater levels of violence or robbery than individuals living in other

neighborhoods with similar substance abuse rates, according to a report in

the November 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

http://id.medscape.com/46316.rhtml?srcmp=id-122101

-- IMMUNIZATION --

CDC UPDATES ADVICE ON PNEUMOCOCCAL CONJUGATE VACCINE USE DURING SHORTAGE

A continuing shortage of the pneumococcal conjugate vaccine has prompted

the US CDC to recommend that some doses still be deferred for healthy children.

http://id.medscape.com/46429.rhtml?srcmp=id-122101

CHILDHOOD VACCINATIONS ARE NOT ASSOCIATED WITH RISK OF TYPE 1 DIABETES

There is no association between routinely recommended childhood vaccines

and an increased risk of type 1 diabetes, according to a report in the

online December edition of Pediatrics.

http://id.medscape.com/46267.rhtml?srcmp=id-122101

DOSE-DEPENDENT IMMUNE INTERFERENCE IDENTIFIED WITH COMBINATION VACCINE USE

A weakened immune response to Haemophilus influenza type b has been noted

in children after immunization with a Hib/diphtheria-tetanus

toxoids-acellular pertussis combination vaccine.

http://id.medscape.com/46360.rhtml?srcmp=id-122101

-- DRUG NEWS --

FDA OKAYS PFIZER'S ZITHROMAX AS ONE-DOSE TREATMENT FOR PEDIATRIC OTITIS MEDIA

Pfizer Inc. said on Monday that the US FDA has approved the company's oral

antibiotic Zithromax (azithromycin) as both a single-dose and three-day

regimen for the treatment of pediatric middle ear infections.

http://id.medscape.com/46271.rhtml?srcmp=id-122101

-- HERPESVIRUSES --

KAPOSI'S SARCOMA-ASSOCIATED HERPESVIRUS MAY BE VERTICALLY TRANSMITTED

New findings suggest that Kaposi's sarcoma-associated herpesvirus (KSHV)

can be transmitted from mother to child, adding new fuel to a long-standing

debate on the routes of transmission of this virus.

http://id.medscape.com/46296.rhtml?srcmp=id-122101

-- URINARY TRACT --

VAGINAL VACCINE MAY PREVENT RECURRENT URINARY TRACT INFECTIONS

In women with recurrent urinary tract infections (RUTIs), use of an

investigational vaginal vaccine was tied to longer infection-free periods

than was placebo use, according to phase II study findings presented here

on Monday at the 41st Annual Interscience Conference on Antimicrobial

Agents and Chemotherapy.

http://id.medscape.com/46308.rhtml?srcmp=id-122101

-- DIARRHEA --

RIFAXIMIN COULD REPLACE CIPROFLOXACIN AS FIRST CHOICE FOR TRAVELER'S DIARRHEA

An investigational antibiotic could be the next treatment of choice for

traveler's diarrhea, according to a Texas researcher who recently conducted

a study of the drug.

http://id.medscape.com/46408.rhtml?srcmp=id-122101

-- TUBERCULOSIS --

MODEST HIV INCIDENCE RATE CAN DOUBLE SIZE OF TB OUTBREAK

Even a moderate HIV epidemic can significantly increase the frequency and

severity of TB outbreaks if TB treatment rates are inadequate,

investigators report.

http://id.medscape.com/46428.rhtml?srcmp=id-122101

-- OTHER INFECTIOUS DISEASE NEWS --

RUBELLA RISK HIGH AMONG FOREIGN-BORN HISPANICS

An outbreak of rubella in Arkansas in 1999 highlights the identification of

Hispanic, foreign-born persons as the main reservoirs of rubella virus in

the United States, according to the CDC.

http://id.medscape.com/46417.rhtml?srcmp=id-122101

M SZULGAI KERATITIS LINKED TO ICE USE DURING LASIK SURGERY

The ice water that some ophthalmologists use to chill laser-assisted in

situ keratomileusis (LASIK) lavage fluids may be contaminated with

Mycobacterium szulgai and increase a patient's risk of developing M.

szulgai keratitis.

http://id.medscape.com/46254.rhtml?srcmp=id-122101

UNDIFFERENTIATED OLIGOARTHRITIS MAY HAVE INFECTIOUS ETIOLOGY

Chlamydia and Borrelia DNA can be detected in the synovial fluid of 29% of

patients with undifferentiated oligoarthritis, according to a study

published in the November issue of Arthritis and Rheumatism.

http://id.medscape.com/46199.rhtml?srcmp=id-122101

STREPTOCOCCAL INFECTION LINKED TO PSYCHIATRIC DISORDERS IN CHILDREN

Group A streptococcal tonsillopharyngitis, if it occurs repeatedly and is

untreated, can lead to the development of obsessive compulsive disorder and

Tourette's syndrome, according to study findings presented on Tuesday at

the 41st ICAAC.

http://id.medscape.com/46366.rhtml?srcmp=id-122101

BETA-HELICES MAY ACT AS 'EARLY WARNING SYSTEM' FOR EMERGING PATHOGENS

Analysis of primary amino acid sequences that give rise to parallel

beta-helical proteins led to the chance discovery that this long,

three-dimensional structure is associated with many human pathogens.

http://id.medscape.com/46382.rhtml?srcmp=id-122101

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