MEDSCAPE's Infectious Diseases MedPulse

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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 - REAL-LIFE X-FILES: AN INTERVIEW WITH LARRY I. LUTWICK, MD

Read a conversation with Dr. Lutwick about anthrax and other potential bioterrorist agents.

Medscape Infectious Diseases, 2001

http://id.medscape.com/44189.rhtml?srcmp=id-102601

LETTER - APPRECIATION FOR YOUR EDITORIAL

Lessons learned decades ago may be applicable to preventing international terrorism.

MedGenMed, October 25, 2001

http://id.medscape.com/44213.rhtml?srcmp=id-102601

IMAGES FROM THE DERMATOLOGY ATLAS - CUTANEOUS ANTHRAX

Would you recognize cutaneous anthrax?

Medscape Dermatology, 2001

http://id.medscape.com/44203.rhtml?srcmp=id-102601

COMBATING HIV INFECTION IN SOWETO, SOUTH AFRICA

Even though South Africa has more HIV-infected people than any other country in the world, it is still a country in denial; hundreds of thousands of South Africans who might have lived long and productive lives will have died because of the inertia of and lack of adequate response by the South African government.

http://www.medscape.com/44036.rhtml?srcmp=ms-102601

MANAGEMENT OF HIV INFECTION IN INJECTION-DRUG USERS

Social instability and a high prevalence of coexisting psychiatric disorders produce unique treatment challenges in HIV-infected injection-drug users

http://www.medscape.com/44035.rhtml?srcmp=ms-102601

BOOK REVIEW - BOOKS IN BRIEF

Look at 2 new illustrated texts -- one on tropical diseases, the other on laparoscopy and hysteroscopy.

MedGenMed, October 23, 2001

http://id.medscape.com/44190.rhtml?srcmp=id-102601

--MMWR--

UPDATE: INVESTIGATION OF ANTHRAX ASSOCIATED WITH INTENTIONAL EXPOSURE AND INTERIM PUBLIC HEALTH GUIDELINES, OCTOBER 2001

This report includes interim guidelines for postexposure prophylaxis for prevention of inhalational anthrax and other information to assist epidemiologists, clinicians, and laboratorians responding to intentional anthrax exposures.

http://id.medscape.com/44124.rhtml?srcmp=id-102601

RECOGNITION OF ILLNESS ASSOCIATED WITH THE INTENTIONAL RELEASE OF A

BIOLOGIC AGENT

This report provides guidance for health-care providers and public health personnel about recognizing illnesses or patterns of illness that might be associated with intentional release of biologic agents.

http://id.medscape.com/44125.rhtml?srcmp=id-102601

NOTICE TO READERS: ONGOING INVESTIGATION OF ANTHRAX --- FLORIDA, OCTOBER 2001

Testing of additional samples is in progress. Public health officials, in conjunction with the Federal Bureau of Investigation, are continuing the investigation.

http://id.medscape.com/44032.rhtml?srcmp=cc-102601

PUBLIC HEALTH DISPATCH: ACUTE FLACCID PARALYSIS ASSOCIATED WITH CIRCULATING VACCINE-DERIVED POLIOVIRUS --- PHILIPPINES, 2001

Travelers to the Philippines should ensure that they are vaccinated appropriately against polio according to national recommendations.

http://id.medscape.com/44030.rhtml?srcmp=id-102601

WEEKLY UPDATE: WEST NILE VIRUS ACTIVITY --- UNITED STATES, OCTOBER 10--16, 2001

During the week of Oct 10-16, 6 human cases of WNV encephalitis were reported in Florida (5) and Maryland (1)

http://id.medscape.com/44126.rhtml?srcmp=id-102601

WEEKLY UPDATE: WEST NILE VIRUS ACTIVITY --- UNITED STATES, OCTOBER 3--9, 2001

During the week of October 3--9, no human cases of WNV encephalitis were reported.

http://id.medscape.com/44031.rhtml?srcmp=id-102601

CIGARETTE SMOKING AMONG ADULTS --- UNITED STATES, 1999

Approximately 23.5% of adults were current smokers in 1999, representing a modest decline in prevalence since 1993.

http://id.medscape.com/44028.rhtml?srcmp=FM-102601

--JOURNALS--

GROUP A STREPTOCOCCAL SEPSIS AND OVARIAN VEIN THROMBOSIS AFTER AN

UNCOMPLICATED VAGINAL DELIVERY

Group A streptococcal puerperal sepsis is an uncommon peripartum infection marked by rapid invasion of tissue, lymphatics, and bloodstream, with potential progression to life-threatening toxin-mediated shock.

J Am Board Fam Pract 14(5):375-380, 2001

http://id.medscape.com/44207.rhtml?srcmp=id-102601

TOXOPLASMIC ENCEPHALITIS AND PRIMARY LYMPHOMA OF THE BRAIN -- THE SHIFT IN EPIDEMIOLOGY: A CASE SERIES AND REVIEW OF THE LITERATURE

HIV-infected patients who present with neurologic symptoms and who have contrast-enhancing focal brain lesions (FBLs) on imaging studies traditionally have received empiric treatment for toxoplasmic encephalitis (TE).

The AIDS Reader 11(9):444-449, 2001

http://id.medscape.com/44266.rhtml?srcmp=id-102601

_______________________________________________________________________________________________________________________________________________________________________________________________

--DON'T MISS THE CDC WEBCAST!--

ANTHRAX: WHAT EVERY CLINICIAN SHOULD KNOW

If you missed the live broadcast, this recording of the webcast from the CDC presents clinical guidelines and procedures for the early recognition, diagnosis, treatment, and reporting of anthrax exposure. A panel of experts from the CDC provide an overview of clinical, laboratory and public health preparedness for potential Bacillus anthracis incidence. Sponsored by the American Hospital Assn., American Medical Assn., Public Health Training Network, CDC, and the University of North Carolina School of Public Health.

http://www.medscape.com/webcast/anthrax

______________________________________________________________________

New Online CME sponsored by Bristol-Myers Squibb

Evolution of Fluroquinolones and Future Use: To inform practitioners about recurrent pathogens, the newest fluoroquinolone agents, their potential for use in the pediatric population, and the use of these newer agents in both recurrent otitis media and meningitis. CLICK HERE!

http://www.medscape.com/cl/mp/sponosor10.1

_______________________________________________________________________

___________________________________ NEWS ______________________________

--BIOTERRORISM: ANTHRAX DETECTION--

CEL-SCI, BIOMEDEX TO CREATE RAPID TEST FOR ANTHRAX IN HUMANS

Cel-Sci Corp. and Spokane, Washington-based biotech firm Biomedex have signed an agreement to create and market a rapid blood test for anthrax, Cel-Sci announced on Wednesday.

http://id.medscape.com/44242.rhtml?srcmp=id-102601

--BIOTERRORISM: ANTHRAX TREATMENT--

BAYER SEEKS TALKS WITH CANADA ON CIPRO

Germany's Bayer AG said on Monday it is seeking talks with the Canadian government, which came under fire on Friday for the decision to purchase yet-to-be-approved generic versions of the company's Cipro (ciprofloxacin) antibiotic, the treatment of choice for anthrax.

http://id.medscape.com/44104.rhtml?srcmp=id-102601

BAYER SAYS CANADIAN GOVERNMENT RECOGNIZES CIPRO PATENT

Germany's Bayer AG said on Tuesday the Canadian government recognized patent protection for its Cipro anti-anthrax drug and that Ottawa would only source Cipro from Bayer until the patent expires.

http://id.medscape.com/44144.rhtml?srcmp=id-102601

GLAXO SAYS NO SHORTAGE OF ANTIBIOTICS TO TREAT ANTHRAX

GlaxoSmithKline Plc said on Tuesday it would be prepared to scale up production of antibiotics for the treatment of anthrax if the need arose.

http://id.medscape.com/44146.rhtml?srcmp=id-102601

BARR READY TO MAKE GENERIC CIPRO IF NEEDED

Barr Laboratories said on Tuesday that it is prepared to make generic versions of the antibiotic Cipro (ciprofloxacin) should the US government determine the recent anthrax threat an emergency.

http://id.medscape.com/44147.rhtml?srcmp=id-102601

PHYSICIANS ADVISED ABOUT TREATMENT, PREVENTION OF ANTHRAX IN CHILDREN

Dr. Steve Berman, president of the American Academy of Pediatrics, said that pediatricians are playing 'catch up' in trying to determine the best approach for treating anthrax in children.

http://id.medscape.com/44158.rhtml?srcmp=id-102601

PROTEIN PROTECTS CELLS FROM ACTION OF ANTHRAX TOXIN

Researchers have identified a membrane protein that binds to a component of the toxin secreted by Bacillus anthracis.

http://id.medscape.com/44165.rhtml?srcmp=id-102601

GOVERNMENT, BAYER REACH DEAL ON CIPRO PURCHASE

Bush administration officials announced Wednesday afternoon that they had struck a deal with Cipro maker Bayer AG on a massive federal purchase of the anti-anthrax drug.

http://id.medscape.com/44253.rhtml?srcmp=id-102601

SURVEY OF SCIENTISTS SHOWS NO URGENCY FOR CIPRO

Nine out of 10 US pharmaceutical scientists would not take the antibiotic Cipro to prevent anthrax if they were not exposed to it, according to a survey released on Wednesday.

http://id.medscape.com/44296.rhtml?srcmp=id-102601

J&J SEEKS ANTHRAX INDICATION FOR LEVOFLOXACIN, VOLUNTEERS TO DONATE DRUG TO US

Johnson & Johnson is seeking a broadened indication for its anti-infective drug Levaquin (levofloxacin) in the US to include treatment of anthrax, it said on Thursday.

http://id.medscape.com/44301.rhtml?srcmp=id-102601

--BIOTERRORISM: ANTHRAX CASES/INVESTIGATIONS IN THE US--

NEW YORK POST WORKER REPORTEDLY POSITIVE FOR ANTHRAX

An employee of tabloid newspaper The New York Post has tested positive for skin anthrax, CBS radio said Friday.

http://id.medscape.com/44068.rhtml?srcmp=id-102601

ANTHRAX FOUND AT TWO MORE FLORIDA POST OFFICES

Preliminary tests found 'minuscule' amounts of anthrax spores at two more Florida post offices that handled mail for the tabloid publishing company whose employee died of anthrax, health and postal officials said on Friday.

http://id.medscape.com/44069.rhtml?srcmp=id-102601

BUSH SAYS NO LINK IDENTIFIED SO FAR BETWEEN ANTHRAX AND BIN LADEN

President Bush said on Friday that the United States had yet to make a link between anthrax attacks in America and Osama bin Laden's network.

http://id.medscape.com/44067.rhtml?srcmp=id-102601

ANTHRAX USED IN ATTACKS MAY BE FROM SINGLE SOURCE

Investigators hunting down those responsible for a string of anthrax attacks in Washington, New York and Florida said on Friday the same strains were used, suggesting they came from a single source, and warned that more attacks were possible.

http://id.medscape.com/44070.rhtml?srcmp=id-102601

TWO POSTAL WORKER DEATHS ARE LIKELY ANTHRAX-RELATED

The deaths of two Washington, DC, postal workers were probably caused by anthrax, Surgeon General Dr. David Satcher said on Monday.

http://id.medscape.com/44099.rhtml?srcmp=id-102601

ANTHRAX TESTING EXPANDED FOR DC POSTAL WORKERS

With two Washington DC postal workers dead from suspected anthrax inhalation and two seriously ill with the disease, US authorities expanded anthrax testing on Tuesday to 36 post offices in the capital.

http://id.medscape.com/44141.rhtml?srcmp=id-102601

ANTHRAX CAUSED DC POSTAL WORKER DEATHS; NEW CASES IN NJ

Washington Mayor Anthony Williams on Tuesday confirmed that anthrax was the cause of death of two men who worked at the postal facility that processed mail for the US capital.

http://id.medscape.com/44157.rhtml?srcmp=id-102601

ANTHRAX FOUND AT REMOTE WHITE HOUSE MAIL SITE

Anthrax was detected Tuesday afternoon at the remote military facility where all mail for the White House is screened, the White House said on Tuesday.

http://id.medscape.com/44160.rhtml?srcmp=id-102601

THOUSANDS OF NEW YORK POSTAL WORKERS TO GET ANTHRAX TEST

The US Postal Service announced on Wednesday that thousands of postal workers in New York City will be tested and treated for possible anthrax exposure, saying its staff is now on the front line of President Bush's war against terrorism.

http://id.medscape.com/44249.rhtml?srcmp=id-102601

CDC CONFIRMS 4 ANTHRAX CASES DUE TO INTENTIONAL EXPOSURE

The US Centers for Disease Control and Prevention (CDC) on Thursday confirmed that 4 of 12 people infected with anthrax in the US had been exposed to the rare but potentially deadly bacteria intentionally through the mail.

http://id.medscape.com/44286.rhtml?srcmp=id-102601

ANTHRAX SUSPECTED IN HOSPITALIZED SENATE MEDIA WORKER

A US congressional reporter has been hospitalized, possibly for anthrax inhalation, and a fifth location in the US Capitol complex has tested positive for the potentially deadly bacteria, authorities said on Wednesday.

http://id.medscape.com/44295.rhtml?srcmp=id-102601

--BIOTERRORISM: FUNDING AND PREPARATION--

US ANTHRAX ATTACKS SPUR PREPAREDNESS FOR BIOLOGICAL ASSAULTS

As a week of anthrax scares on Capitol Hill and in a few cities around the country came to a close, US health authorities strove to keep information about bioterrorism flowing through media briefings, even when there was not necessarily any new information to provide.

http://id.medscape.com/44071.rhtml?srcmp=id-102601

EU DRUG REFORMS MIGHT HELP COMBAT BIOLOGICAL ATTACK

Plans to reform European drug regulation could help combat bioterrorism, the head of the European Medicines Evaluation Agency (EMEA) said on Friday.

http://id.medscape.com/44110.rhtml?srcmp=id-102601

SENATORS TO PUSH FOR $2.3 BILLION BIOTERRORISM PACKAGE

Senators Tom Harkin, D-Iowa, and Arlen Specter, R-Pa., have put together a $2.3 billion funding package aimed at combatting bioterrorism that they hope to push through Congress before the end of the current session, Harkin said on Tuesday.

http://id.medscape.com/44149.rhtml?srcmp=id-102601

EU TO REVIEW DEFENSES AGAINST FOOD CHAIN ATTACK

The European Union needs an 'urgent review' of its defense mechanisms against any potential bioterrorism attack on its food chain, EU Food Safety Commissioner David Byrne said on Tuesday.

http://id.medscape.com/44159.rhtml?srcmp=id-102601

--BIOTERRORISM: OTHER AGENTS--GERMANY WEIGHS REINTRODUCTION OF SMALLPOX VACCINE

The German government is considering whether to reintroduce smallpox vaccinations in light of concerns that the deadly disease could be used as a terrorist weapon, according to a spokeswoman at the Robert Koch Institute.

http://id.medscape.com/44108.rhtml?srcmp=id-102601

US TO CHOOSE SMALLPOX VACCINE SUPPLIER SOON

US health officials said Tuesday they plan to choose a company soon to make 250 million doses of smallpox vaccine to give the government enough shots for each American if needed after a bioterror attack.

http://id.medscape.com/44239.rhtml?srcmp=id-102601

CLINTON RECEIVES SALMONELLA-TAINTED VIALS IN MAIL

Former President Bill Clinton received vials in the mail that were tainted with salmonella, but authorities said on Thursday they saw no connection to a string of anthrax attacks in New York, Washington and Florida.

http://id.medscape.com/44297.rhtml?srcmp=id-102601

--TUBERCULOSIS--

HIGH IRON INTAKE TIED TO INCREASED TB RISK IN ZIMBABWE

Elevated levels of dietary iron appear to be associated with an increased risk of pulmonary tuberculosis in rural Africans, researchers report in the October issue of The Journal of Infectious Diseases.

http://id.medscape.com/44057.rhtml?srcmp=id-102601

WORLD BANK, WHO ANNOUNCE GLOBAL ANTI-TB PLAN

Officials at the World Bank and the World Health Organization have launched a new global plan to drastically cut tuberculosis infection and death rates in poor countries.

http://id.medscape.com/44155.rhtml?srcmp=id-102601

--WEST NILE VIRUS--

LOUISIANA MAN DIAGNOSED WITH WEST NILE VIRUS

A Louisiana man has been found to have the state's first human case of the potentially fatal West Nile virus, health officials said on Tuesday.

http://id.medscape.com/44241.rhtml?srcmp=id-102601

--HEPATITIS--

NATIONAL MEDICAL ASSOCIATION ISSUES NEW HEPATITIS GUIDELINES

The National Medical Association (NMA), in a concerted effort to help eliminate hepatitis in the African-American community, has issued new guidelines for the prevention and treatment of viral hepatitis.

http://id.medscape.com/44150.rhtml?srcmp=id-102601

--VACCINES--

CONJUGATE MENINGOCOCCAL VACCINE CAUSES FEW ADVERSE EVENTS IN INFANTS

When administered to infants, the conjugate group C meningococcal vaccine causes few adverse events, most of which are considered mild, according to results of a prospective study conducted in the UK.

http://id.medscape.com/44089.rhtml?srcmp=id-102601

MUCOSAL IMMUNIZATION FOR C. TRACHOMATIS INFECTION MAY BE FEASIBLE

Chlamydia trachomatis infection induces expression of vascular cell adhesion molecule-1 (CD106) and mucosal vascular addressin cell adhesion molecule-1 (MAdCAM-1) on fallopian tube mucosal cells, according to a report published in the October 1st issue of the Journal of Infectious Diseases.

http://id.medscape.com/44113.rhtml?srcmp=id-102601

--FOOD-BORNE ILLNESS--

EUROPEAN CENTER AIMS TO CUT FOOD RISKS

In an effort to reduce the burden of human illness resulting from poor animal and food hygiene, an Austrian university has set up a training college that combines study of human and animal health.

http://id.medscape.com/44248.rhtml?srcmp=id-102601

GENOMES OF TWO SALMONELLA BACTERIA MAPPED

Scientists have mapped the genomes of two Salmonella bacteria, including the etiologic agent of typhoid fever, according to two reports in the October 25th issue of Nature.

http://id.medscape.com/44259.rhtml?srcmp=id-102601

--NEONATAL INFECTIONS--

VASCULAR REACTIVITY TEST MAY HELP DIAGNOSE SEPTICEMIA IN NEONATES

The early diagnosis of neonatal sepsis could be facilitated by the detection of increased reactive hyperemia and elevated cytokine levels, according to new findings published in the October issue of Pediatrics Electronic Pages.

http://id.medscape.com/44228.rhtml?srcmp=id-102601

GANCICLOVIR PREVENTS WORSENING OF CMV-RELATED HEARING LOSS IN INFANTS

Ganciclovir can prevent hearing loss or progression of hearing loss in infants with symptomatic congenital cytomegalovirus (CMV), according to the results of a study presented at the American Academy of Pediatrics 2001 national conference and exhibition.

http://id.medscape.com/44233.rhtml?srcmp=id-102601

--HIV/AIDS--

ON-SITE HEALTHCARE IMPROVES COMPLIANCE BY HIV-INFECTED FEMALE DRUG USERS

Easy access to treatment services can have a significant impact on compliance with antiretroviral therapy (ART) by HIV-infected women who use injection drugs, according to researchers in the US.

http://id.medscape.com/44041.rhtml?srcmp=id-102601

UNIQUE POSTERIOR KERATOPATHY SEEN IN HIV-INFECTED MEN

Unusual precipitates in the posterior cornea have been observed in six HIV-infected men, according to physicians from four different centers.

http://id.medscape.com/44047.rhtml?srcmp=id-102601

DRUG RESISTANCE REPORTED IN HIV-INFECTED CHILDREN RECEIVING NELFINAVIR

HIV-infected children who receive antiretroviral regimens containing nelfinavir may develop resistance mutations similar to those seen in HIV-infected adults, researchers report.

http://id.medscape.com/44078.rhtml?srcmp=id-102601

ADVERSE EVENTS INCREASE WHEN HAART INVOLVES THREE DRUG CLASSES OR TWO PIS

In a study nested within the Swiss HIV Cohort Study, the prevalence of adverse events associated with highly active antiretroviral therapy (HAART) was higher when the patient received three classes of antiretroviral drugs or two protease inhibitors (PIs) than when one or no PI was included in the regimen.

http://id.medscape.com/44062.rhtml?srcmp=id-102601

PROPHYLAXIS FAILURE TIED TO INFECTION WITH A SPECIFIC P CARINII GENOTYPE

Infection with Pneumocystis carinii type 6 is linked to anti-P carinii pneumonia (PCP) prophylaxis failure, according to a report published in the October 1st issue of Clinical Infectious Diseases.

http://id.medscape.com/44051.rhtml?srcmp=id-102601

SENATE APPROVES FUNDING OF INTERNATIONAL ANTI-AIDS EFFORTS

The US Senate on Wednesday night approved $415 million in international aid geared toward prevention and treatment of HIV infection and AIDS.

http://id.medscape.com/44290.rhtml?srcmp=id-102601

--OTHER STDS--

DIGENE STD TEST CLEARED IN JAPAN

Japan's Ministry of Health has cleared for sale Digene's Hybrid Capture 2 CT/GC Test for detection of chlamydia and gonorrhea in women, the firm said on Tuesday.

http://id.medscape.com/44162.rhtml?srcmp=id-102601

--OTHER ID NEWS--

LASER TREATMENT CAN OFFER QUICK SYMPTOM RELIEF OF ACUTE OTITIS MEDIA

Laser-assisted tympanic membrane fenestration (LTMF), combined with tympanocentesis, can be effective in as many as 70% of patients with otitis media with effusions (OME) that is unresponsive to medical management, according to Dr. Ellen S. Deutsch of the Alfred I. duPont Hospital for Children, Wilmington, Delaware, who presented her findings here on Sunday.

http://id.medscape.com/44079.rhtml?srcmp=id-102601

AMIKACIN SUPPLEMENT DOES NOT IMPROVE FEBRILE NEUTROPENIA OUTCOME

Addition of the aminoglycoside antibiotic amikacin to piperacillin-tazobactam treatment of patients with febrile neutropenia prompts no additional improvement, Italian researchers report in the October 15th issue of Clinical Infectious Diseases.

http://id.medscape.com/44272.rhtml?srcmp=id-102601

DOWNREGULATED GENE IN PSEUDOMONAS BIOFILM INCREASES TOBRAMYCIN RESISTANCE

Despite striking differences between free-living Pseudomonas aeruginosa cells and those that form biofilms, only about 1% of genes are differentially expressed in the two growth modes, according to a report in the October 25th issue of Nature.

http://id.medscape.com/44257.rhtml?srcmp=id-102601

______________________________________________________________________

_______________________________ MEMBER NEWS

___________________________ BIOTERRORISM

RESOURCE CENTER: ARE WE PREPARED FOR A BIO-TERRORIST ATTACK?

http://www.medscape.com/mp/rc/bioterrorism

ANTHRAX: WHAT EVERY CLINICIAN SHOULD KNOW

This recording of the live webcast from the CDC presents clinical guidelines and procedures for the early recognition, diagnosis, treatment, and reporting of anthrax exposure. A panel of experts from the CDC provide an overview of clinical, laboratory and public health preparedness for

potential Bacillus anthracis incidence. Sponsored by the American Hospital Assn., American Medical Assn., Public Health Training Network, CDC, and the University of North Carolina School of Public Health.

http://www.medscape.com/webcast/anthrax

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