Medscape CME Activity

Despite the high prevalence of tuberculosis in Brazil, patients with nontuberculous disease exist who are not being detected and given treatment.

Persons from high tuberculosis settings often acquire HIV infection during the peri-immigration period.

Clinicians should consider this virus in the differential diagnosis of hepatitis, regardless of patient travel history.

Outbreak investigations can identify industrial gaps and regulatory measures to protect food.

Young children, Black children, and those without private insurance were at higher risk for hospitalization.

Pathogen prevalence differs during periods of health and at onset of acute otitis media.

Coccidioidomycosis is a fungal disease that occurs throughout the Americas. It is contracted by inhaling spores, which are carried in dust. Therefore, it occurs most commonly in dry areas and in persons who work in dusty conditions (such as agricultural workers, construction workers, military personnel, and archeological site workers). A substantial number of people die of this disease each year, so researchers examined what other factors increase the risk for death. They found that risk for death was highest among men, elderly persons (>65 years), Hispanics, Native Americans, residents of California and Arizona, and those who also had HIV or other immune-suppressive conditions. Physicians should be aware of which patients are at increased risk and should ask patients about their travel history or occupation to determine possible sources of exposure.

Identification of virulent strains emphasizes the need for molecular surveillance.

Restricted Fluoroquinolone use in humans and food animals has result in low rates of resistance in human pathogens

Variations between practice and national recommendations could inform clinical education in future influenza seasons.

Evidence is limited but sufficient to sustain current vaccination recommendations.

What would you do if you had a sexually transmitted disease that was untreatable with antibiotics? That is the situation we may be heading toward. In the United States, gonorrhea is the second most common reportable infection. Over the years, the organism that causes it, N. gonorrhoeae, has acquired resistance to several classes of antibiotics including, most recently, the fluoroquinolones. In fact, widespread resistance led CDC to stop recommending fluoroquinolones for gonorrhea treatment in 2007. Today, cephalosporin-based combination therapy is the last remaining option currently recommended for gonorrhea treatment. Understanding of the causes of drug resistance is needed so that control measures can be improved and the effectiveness of the few remaining drugs can be maintained. This article investigates possible causes for the emergence of fluoroquinolone-resistant N. gonorrhoeae that occurred several years ago. Fluoroquinolone-resistant strains spread in the United States in the late 1990s and spread more rapidly among men who have sex with men (MSM) than among heterosexual men. One possible explanation for the rise in drug resistance, especially among heterosexuals, is acquisition of resistant gonorrhea through travel. Certain drug-resistant strains of N. gonorrhoeae, particularly the multidrug resistant strains (also resistant to penicillin and tetracycline) circulating among MSM, seemed to be able to reach high prevalence levels through domestic transmission, rather than through frequent importation. After resistance emerged in a geographic area, resistant strains appeared among MSM and heterosexuals within several months. When resistance is detected in either MSM or heterosexuals, prevention efforts should be directed toward both populations.

Bacterial infection after liver transplant is fairly common, mostly because liver transplant patients are severely ill and the surgery is very complex. Adding to the seriousness of this situation is that some bacteria are resistant to many antimicrobial drugs. However, treating all infections as drug resistant would lead to even more drug resistance, so only patients at highest risk should receive the most powerful drugs. But who is at highest risk? A recent study in France screened fecal samples of liver transplant candidates and found that post-operative infections were most likely for those patients who already had certain bacteria in their feces before surgery. Thus, fecal screening for those multiresistant bacteria should be considered for all liver transplant candidates so that if post-operative infection develops, those at high risk can receive the most specific drugs right away.

The book on iatrogenic Creutzfeldt-Jakob disease (CJD) in humans is almost closed. This form of CJD transmission via medical misadventures was first detected in 1974. Today, only occasional CJD cases with exceptionally long incubation periods still appear. The main sources of the largest outbreaks were tissues from human cadavers with unsuspected CJD that were used for dura mater grafts and growth hormone extracts. A few additional cases resulted from neurosurgical instrument contamination, corneal grafts, gonadotrophic hormone, and secondary infections from blood transfusions. Although the final solution to the problem of iatrogenic CJD is still not available (a laboratory test to identify potential donors who harbor the infectious agent), certain other measures have worked well: applying special sterilization of penetrating surgical instruments, reducing the infectious potential of donor blood and tissue, and excluding donors known to have higher than normal risk for CJD.

Amebic colitis is increasing among younger men who have syphilis or HIV.

Since the 2009 flu pandemic, questions have been raised about the risk for flu to health care workers. But what about other workers? Does having a job put a person at risk for flu? And does the type of job influence this risk? According to a CDC study, having a job is actually associated with a lower risk for hospitalization for flu, possibly because workers are generally young and healthy. But among workers who are hospitalized for flu, certain industries of employment were more common than others. Not surprisingly, the industry posing the highest risk was health care. Others included transportation and warehousing, administrative and support services, waste management and remediation services, and accommodation and food services. In the event of another pandemic, this information can be used to prioritize who should receive vaccine and to decide who needs personal protective equipment like face masks or respirators.

Most dairy-associated outbreaks occurred in states that permitted sale of these products.

Pneumococcal prevention strategies should be emphasized during future influenza pandemics.

An underlying gastrointestinal condition is a risk factor for this disease.

Travelers could reintroduce rabies into western Europe.

This group was associated with the Western world, trimethoprim/sulfamethoxazole resistance, and diverse hosts/specimens.

Encephalopathy and unexpected cardiopulmonary arrest were the leading causes of death.

Antifungal drug resistance is associated with high death rates among patients with invasive aspergillosis.

Modestly increased rates of admission or emergency department visits would have caused substantial overcrowding.

Additional public and provider education are needed to reduce delays in diagnosis.

Mycobacterium tuberculosis was the most common pathogen.