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Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China.
A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared.
A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain.
Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
Pedro M Machado
Axial spondyloarthritis is a chronic inflammatory disease affecting the axial skeleton. Axial spondyloarthritis is diagnosed clinically on the basis of pattern recognition of a combination of clinical, laboratory, and imaging features.1,2 Patients with axial spondyloarthritis can be further phenotyped into radiographic axial spondyloarthritis (also known as ankylosing spondylitis) and non-radiographic axial spondyloarthritis, depending on the presence (or not) of definite abnormalities of the sacroiliac joints on pelvic radiographs.
Atul Deodhar, Désirée van der Heijde, Lianne S Gensler, Tae-Hwan Kim, Walter P Maksymowych, Mikkel Østergaard, Denis Poddubnyy, Helena Marzo-Ortega, Louis Bessette, Tetsuya Tomita, Ann Leung, Maja Hojnik, Gaia Gallo, Xiaoqi Li, David Adams, Hilde Carlier, Joachim Sieper, COAST-X Study Group
Ixekizumab was superior to placebo for improving signs and symptoms in patients with non-radiographic axial spondyloarthritis at weeks 16 and 52. Reports of adverse events were similar to those of previous ixekizumab studies. Ixekizumab offers a potential therapeutic option for patients with non-radiographic axial spondyloarthritis who had an inadequate response or were intolerant to NSAID therapy.
Maria G Tektonidou
JAK and signal transducers and activators of the transcription signal transduction (known as STAT) pathway and upstream cytokine receptor signalling have a principal role in the pathogenesis of many inflammatory and autoimmune conditions, including inflammatory bowel disease, psoriasis, rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus.1 There are four JAKs in humans, JAK1, JAK2, and JAK3, and TYK2. Several JAK inhibitors have been developed over the past decade targeting a broad range of JAKs (ie, pan-JAK) or only specific JAKs (ie, selective JAK inhibitors), providing promising alternatives to parenteral biological disease-modifying antirheumatic drugs (DMARDs) in some autoimmune disorders.
Désirée van der Heijde, In-Ho Song, Aileen L Pangan, Atul Deodhar, Filip van den Bosch, Walter P Maksymowych, Tae-Hwan Kim, Mitsumasa Kishimoto, Andrea Everding, Yunxia Sui, Xin Wang, Alvina D Chu, Joachim Sieper
Upadacitinib 15 mg was efficacious and well tolerated in patients with active ankylosing spondylitis who had an inadequate response or contraindication to non-steroidal anti-inflammatory drugs. These data support the further investigation of upadacitinib for the treatment of axial spondyloarthritis.
The classic Lemierre’s syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported.
We describe an unusual case of a previously healthy 58-year-old male with Lemierre’s syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre’s syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis.
This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre’s syndrome is redefined here to take into consideration non-cervical sites.
Dalbavancin is a novel lipoglycopeptide with potent activity against several gram-positive pathogens, an excellent safety profile and a long elimination half-life.
In this case series observed at the University Hospital of Vienna between 2015 and 2017, all adult patients with gram-positive infections who received at least one dosage of dalbavancin were screened (n = 118). A total of 72 patients were included in the final analysis. The number of included patients stratified by the source of infection was: skin and soft tissue infection (SSTI) (n = 26), osteomyelitis (n = 20), spondylodiscitis (n = 14), acute septic arthritis (n = 4) and prosthetic joint infection (n = 8).
In 46 patients (64%), clinical cure was detected at the end of dalbavancin therapy without additional antibiotic therapy. Of the 26 patients who received additional antibiotic therapy other than dalbavancin, 15 patients (21%) showed no clinical improvement under dalbavancin therapy, four patients (5%) had side effects (nausea n = 1, exanthema n = 2, hyperglycemia n = 1), and in seven patients (10%) clinical improvement under dalbavancin therapy was detected but antibiotic therapy was de-escalated to an oral drug.
We demonstrated high clinical effectiveness of dalbavancin for acute gram-positive infections primarily acute SSTI, acute septic arthritis, acute osteomyelitis and spondylodiscitis. In patients with biofilm-associated infection (chronic infection or joint prosthesis), source control was absolutely necessary for treatment success.
Morata, L., Cobo, J., Fernandez-Sampedro, M., Vasco, P. G., Ruano, E., Lora-Tamayo, J., Sanchez Somolinos, M., Ruano, P. G., Nieto, A. R., Arnaiz, A., Estebanez Munoz, M., Jimenez-Mejias, M. E., Lozano Serrano, A. B., Munez, E., Rodriguez-Pardo, D., Argelich, R., Arroyo, A., Barbero, J. M., Cuadra, F., Del Arco, A., del Toro, M. D., Guio, L., Jimenez-Beatty, D., Lois, N., Martin, O., Martinez Alvarez, R. M., Martinez-Marcos, F. J., Porras, L., Ramirez, M., Vergas Garcia, J., Soriano, A.
Background: Dalbavancin is a lipoglycopeptide with potent activity against gram-positive microorganisms, with a long half-life, favorable safety profile and a high bone concentration which makes it an interesting alternative for osteoarticular infections.Patients and Methods: Multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis or orthopedic implant related infections) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated.Results: A total of 64 patients were included. S. epidermidis and S. aureus were the most frequent microorganism. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events and none patient had to discontinue dalbavancin. In 45 cases infection was related to an orthopedic implant. The material was retained in 23 cases, 15 (65.2%) were classified as cured and 8 (34.8%) presented improvement. In 21 cases the implant was removed and 16 (76.2%) were considered as success, 4 (19%) as improvement and 1 (4.8%) as failure. Among the 19 cases without implants 14 (73.7%) were considered cured, 3 (15.8%) as improvement and 2 (10.5%) as failures.Conclusion: The results show that dalbavancin is a well-tolerated antibiotic, even when administering > 2 doses, and is associated with a high cure rate. This is preliminary data with a short follow-up, therefore, it is necessary to have more experience and in the future to establish the most appropriate dose and frequency.
M. Gagliano, L.R. Suardi, C. Marchiani, G. Bandini, N. Palagano, E. Cioni, A. Moggi Pignone
Specialespecifikt kursus om immundefekt og feber af ukendt årsag
28.01.2020 - 29.01.2020
International Congress on Infectious Diseases (ICID) 2020
Kuala Lumpur, Malaysia
20.02.2020 - 23.02.2020
Dansk Selskab for Intern Medicin (DSIM) årsmøde og overrækkelse af Hagedorn prisen 2020
Novo Nordisk Fonden, Tuborg Havnevej 19, 2900 Hellerup
Conference on Retroviruses and Opportunistic Infections (CROI) 2020
Boston, Massachusetts, USA
8.03.2020 - 11.03.2020
Når CROI går i fisk - med transmissioner fra CROI 2020
10.03.2020 - 11.03.2020
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
How to Choose Target Facilities in a Region to Implement Carbapenem-Resistant Enterobacteriaceae (CRE) Control Measures
23.01.2020Clinical Infectious Diseases Advance Access
Evaluation of Genotypic Antiviral Resistance Testing as an Alternative to Phenotypic Testing in a Patient with DOCK8 Deficiency and Severe HSV-1 Disease
23.01.2020The Journal of Infectious Diseases Advance Access
Bronchiectasis;a progressive phenotype of Chronic Obstructive Pulmonary Disease
22.01.2020Clinical Infectious Diseases Advance Access
BRONCHIAL INFECTION AND temporal evolution OF bronchiectasis in patients with chronic obstructive pulmonary disease
22.01.2020Clinical Infectious Diseases Advance Access
More Screening or More Disease? Gonorrhea Testing and Positivity Patterns among Men in Three Large Clinical Practices in Massachusetts, 2010-2017
22.01.2020Clinical Infectious Diseases Advance Access
Hvad synes Professor Jens Lundgren om"Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV."?
Hvad tænker Professor Troels Lillebæk om"The global prevalence of latent tuberculosis: a systematic review and meta-analysis."?
Hvad mener Professor Lars Østergaard om artiklen"Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial."?
Hvad mener Professor Thomas Benfield om artiklen"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvorfor anbefaler Professor Niels Obel artiklen"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
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