Recent publications from TDC authors

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NCBI: db=pubmed; Term=(Yansouni C[Author]) OR (Iqbal A[Author] parasitology) OR (Ndao M[Author]) OR (Ward BJ[Author]) OR (Semret M[Author]) OR (Libman M[Author]) OR (Greenaway C[author]) OR (Barkati S[Author])
Updated: 12 hours 54 min ago

Concerns about composite reference standards in diagnostic research.

Sun, 01/21/2018 - 00:06
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Concerns about composite reference standards in diagnostic research.

BMJ. 2018 Jan 18;360:j5779

Authors: Dendukuri N, Schiller I, de Groot J, Libman M, Moons K, Reitsma J, van Smeden M

PMID: 29348126 [PubMed - in process]

Review of synthetic human faeces and faecal sludge for sanitation and wastewater research.

Tue, 01/16/2018 - 00:04
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Review of synthetic human faeces and faecal sludge for sanitation and wastewater research.

Water Res. 2017 Dec 30;132:222-240

Authors: Penn R, Ward BJ, Strande L, Maurer M

Abstract
Investigations involving human faeces and faecal sludge are of great importance for urban sanitation, such as operation and maintenance of sewer systems, or implementation of faecal sludge management. However, working with real faecal matter is difficult as it not only involves working with a pathogenic, malodorous material but also individual faeces and faecal sludge samples are highly variable, making it difficult to execute repeatable experiments. Synthetic faeces and faecal sludge can provide consistently reproducible substrate and alleviate these challenges. A critical literature review of simulants developed for various wastewater and faecal sludge related research is provided. Most individual studies sought to develop a simulant representative of specific physical, chemical, or thermal properties depending on their research objectives. Based on the review, a suitable simulant can be chosen and used or further developed according to the research needs. As an example, the authors present such a modification for the development of a simulant that can be used for investigating the motion (movement, settling and sedimentation) of faeces and their physical and biological disintegration in sewers and in on-site sanitation systems.

PMID: 29331910 [PubMed - as supplied by publisher]

Travel-Related Infections Among Pregnant Travellers to the Tropics: An Overview.

Wed, 01/10/2018 - 00:14
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Travel-Related Infections Among Pregnant Travellers to the Tropics: An Overview.

J Obstet Gynaecol Can. 2018 Jan 04;:

Authors: Kong LY, Libman MD, Yansouni CP

Abstract
Infectious diseases acquired during travel pose a significant health risk to pregnant travellers, who are more susceptible to both acquiring certain infections and developing severe complications. A review of the literature focusing on recent evidence-based guidelines was conducted with attention to tropical infections in the pregnant patient. A summary meant to serve as a succinct reference for health care professionals caring for pregnant women is presented. Magnitude of risk, clinical features, management, and preventive strategies of major travel-acquired infections of pertinence to the pregnant traveller are summarized, including malaria, arboviral infections, foodborne infections, helminthic infections, and influenza. Tables with details on specific infections within each group and guidance for reducing travel-related health risks in the pregnant patient are presented.

PMID: 29307707 [PubMed - as supplied by publisher]

Lessons Learned from Protective Immune Responses to Optimize Vaccines against Cryptosporidiosis.

Thu, 01/04/2018 - 09:38
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Lessons Learned from Protective Immune Responses to Optimize Vaccines against Cryptosporidiosis.

Pathogens. 2017 Dec 24;7(1):

Authors: Lemieux MW, Sonzogni-Desautels K, Ndao M

Abstract
In developing countries, cryptosporidiosis causes moderate-to-severe diarrhea and kills thousands of infants and toddlers annually. Drinking and recreational water contaminated with Cryptosporidium spp. oocysts has led to waterborne outbreaks in developed countries. A competent immune system is necessary to clear this parasitic infection. A better understanding of the immune responses required to prevent or limit infection by this protozoan parasite is the cornerstone of development of an effective vaccine. In this light, lessons learned from previously developed vaccines against Cryptosporidium spp. are at the foundation for development of better next-generation vaccines. In this review, we summarize the immune responses elicited by naturally and experimentally-induced Cryptosporidium spp. infection and by several experimental vaccines in various animal models. Our aim is to increase awareness about the immune responses that underlie protection against cryptosporidiosis and to encourage promotion of these immune responses as a key strategy for vaccine development. Innate and mucosal immunity will be addressed as well as adaptive immunity, with an emphasis on the balance between TH1/TH2 immune responses. Development of more effective vaccines against cryptosporidiosis is needed to prevent Cryptosporidium spp.-related deaths in infants and toddlers in developing countries.

PMID: 29295550 [PubMed]

Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada.

Sun, 12/31/2017 - 01:50
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Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada.

BMC Infect Dis. 2017 Dec 29;17(1):805

Authors: Andrew MK, Shinde V, Hatchette T, Ambrose A, Boivin G, Bowie W, Chit A, Dos Santos G, ElSherif M, Green K, Haguinet F, Halperin SA, Ibarguchi B, Johnstone J, Katz K, Langley JM, LeBlanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney J, McGeer A, Nichols MK, Powis J, Richardson D, Semret M, Stiver G, Trottier S, Valiquette L, Webster D, Ye L, McNeil SA, Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Serious Outcomes Surveillance Network and the Toronto Invasive Bacterial Diseases Network (TIBDN)

Abstract
BACKGROUND: The Serious Outcomes Surveillance (SOS) Network was established to monitor seasonal influenza complications among hospitalized Canadian adults and to assess the effectiveness of influenza vaccination against severe outcomes. Here we report age- and strain-specific vaccine effectiveness (VE) in preventing severe outcomes during a season characterized by mixed outbreaks of four different influenza strains.
METHODS: This prospective, multicentre, test-negative case-control study evaluated the VE of trivalent influenza vaccine (TIV) in the prevention of laboratory-confirmed influenza-hospitalization in adults aged ≥16 years (all adults) and adults aged 16-64 years (younger adults). The SOS Network identified hospitalized patients with diagnoses potentially attributable to influenza during the 2011/12 influenza season. Swabs collected at admission were tested by reverse transcriptase polymerase chain reaction (RT PCR) or viral culture to discriminate influenza cases (positive) from controls (negative). VE was calculated as 1-odds ratio (OR) of vaccination in cases versus controls × 100.
RESULTS: Overall, in all adults, the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 41.8% (95% Confidence Interval [CI]: 26.0, 54.3), and 42.8% (95% CI: 23.8, 57.0), respectively. In younger adults (16-64 years), the unadjusted and adjusted VEs of TIV against influenza-hospitalization were 35.8% (95% CI: 4.5, 56.8) and 33.2% (95% CI: -6.7, 58.2), respectively. In the all adults group, adjusted VE against influenza A/H1N1 was 72.5% (95% CI: 30.5, 89.1), against A/H3N2 was 86.1% (95% CI: 40.1, 96.8), against B/Victoria was 40.5% (95% CI: -28.9, 72.6), and against B/Yamagata was 32.3% (95% CI: -8.3, 57.7). The adjusted estimate of early season VE (from November 1 to March 11) was 54.4% (95% CI: 29.7-70.4), which was higher than late season (from March 11 to May 25) VE estimate (VE: 29.7%, 95% CI: -5.3, 53.1).
CONCLUSIONS: These results suggest that TIV was highly effective against A viruses and moderately effective against B viruses during a mild season characterised by co-circulation of four influenza strains in Canada. Findings underscore the need to provide VE assessment by subtype/lineage as well as the timing of vaccination (early season vs late season) to accurately evaluate vaccine performance and thus guide public health decision-making.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01517191. Registration was retrospective and the date of registration was January 17, 2012.

PMID: 29284435 [PubMed - in process]

A recurrent hydatid cyst of the thigh diagnosed 13 years after initial presentation.

Thu, 12/21/2017 - 00:50
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A recurrent hydatid cyst of the thigh diagnosed 13 years after initial presentation.

IDCases. 2018;11:12-15

Authors: Barkati S, Butler-Laporte G, Ndao M, Kabiawu Ajise O, Semret M, Yansouni CP, Libman M

Abstract
This case presents a hydatid cyst of the thigh in a 57-year-old patient born and raised in rural Montenegro. He presented with a painful erythematous mass on the lateral aspect of the right thigh at the site of a previous cystic mass resection 13 years earlier. Complete surgical resection was conducted, histopathology revealed laminated membranes and polymerase chain reaction was positive for Echinococcus granulosus. Primary musculoskeletal hydatidosis is a rare entity and diagnosis is challenging. Any cystic lesion in a patient from an endemic area should raise the possibility of echinococcosis, regardless of anatomic location. The key aspects of diagnosis, albendazole treatment and surgical management are discussed.

PMID: 29255673 [PubMed]

The establishment of surrogates and correlates of protection: useful tools for the licensure of effective influenza vaccines?

Wed, 12/20/2017 - 00:05
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The establishment of surrogates and correlates of protection: useful tools for the licensure of effective influenza vaccines?

Hum Vaccin Immunother. 2017 Dec 18;:0

Authors: Ward BJ, Pillet S, Charland N, Trepanier S, Couillard J, Landry N

Abstract
The search for a test that can predict vaccine efficacy is an important part of any vaccine development program. Although regulators hesitate to acknowledge any test as a true 'correlate of protection', there are many precedents for defining 'surrogate' assays. Surrogates can be powerful tools for vaccine optimization, licensure, comparisons between products and development of improved products. When such tests achieve 'reference' status however, they can inadvertently become barriers to new technologies that do not work the same way as existing vaccines. This is particularly true when these tests are based upon circularly-defined 'reference' or, even worse, proprietary reagents. The situation with inactivated influenza vaccines is a good example of this phenomenon. The most frequently used tests to define vaccine-induced immunity are all serologic assays: hemagglutination inhibition (HI), single radial hemolysis (SRH) and microneutralization (MN). The first two, and particularly the HI assay, have achieved reference status and criteria have been established in many jurisdictions for their use in licensing new vaccines and to compare the performance of different vaccines. However, all of these assays are based on biological reagents that are notoriously difficult to standardize and can vary substantially by geography, by chance (i.e. developing reagents in eggs that will antigenitically match the human virus) and by intention (ie: choosing reagents that yield the most favorable results). This review describes attempts to standardize these assays to improve their performance as surrogates, the dangers of over-reliance on 'reference' serologic assays, the ways that manufacturers can exploit the existing regulatory framework to make their products 'look good' and the implications of this long-established system for the introduction of novel influenza vaccines.

PMID: 29252098 [PubMed - as supplied by publisher]

A Phase III Diagnostic Accuracy Study of a Rapid Diagnostic Test for Diagnosis of Second-Stage Human African Trypanosomiasis in the Democratic Republic of the Congo.

Wed, 12/20/2017 - 00:05
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A Phase III Diagnostic Accuracy Study of a Rapid Diagnostic Test for Diagnosis of Second-Stage Human African Trypanosomiasis in the Democratic Republic of the Congo.

EBioMedicine. 2017 Dec 06;:

Authors: Boelaert M, Mukendi D, Bottieau E, Kalo Lilo JR, Verdonck K, Minikulu L, Barbé B, Gillet P, Yansouni CP, Chappuis F, Lutumba P

Abstract
OBJECTIVES: To estimate the diagnostic accuracy of HAT Sero K-SeT for the field diagnosis of second-stage human African trypanosomiasis (HAT).
DESIGN: A phase III diagnostic accuracy design. Consecutive patients with symptoms clinically suggestive of HAT were prospectively enrolled. We compared results of the index test HAT Sero K-SeT with those of a composite reference standard: demonstration of trypanosomes in cerebrospinal fluid (CSF), or trypanosomes detected in any other body fluid AND white blood cell count in CSF >5/μl.
SETTING: Rural hospital in the Democratic Republic of the Congo.
PARTICIPANTS: All patients above five years old presenting at Mosango hospital with a neurological problem of recent onset at the exclusion of trauma.
INTERVENTIONS: n.a.
MAIN OUTCOME MEASURES: Sensitivity and specificity of HAT Sero K-SeT test.
RESULTS: The sensitivity of the HAT Sero K-SeT was 8/8 or 100.0% (95% confidence interval: 67.6 to 100.0%) and the specificity was 258/266 or 97.0% (94.2% to 98.5%).
CONCLUSION: The high sensitivity of the HAT Sero K-SeT is in line with previously published estimates, though the sample of HAT cases in this study was small. The specificity estimate was very high and precise. This test, when negative, allows the clinician to rule out HAT in a clinical suspect in a hospital setting in this endemic region.

PMID: 29246478 [PubMed - as supplied by publisher]

Cleaning the grey zones of hospitals: A prospective, crossover, interventional study.

Sat, 12/16/2017 - 01:33
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Cleaning the grey zones of hospitals: A prospective, crossover, interventional study.

Am J Infect Control. 2016 Dec 01;44(12):1582-1588

Authors: Semret M, Dyachenko A, Ramman-Haddad L, Belzile E, McCusker J

Abstract
BACKGROUND: Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. In this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (GZ), on health care-acquired transmission rates.
METHODS: The intervention consisted of specific GZ cleaning by an extra cleaner (in addition to routine cleaning) on 2 structurally different acute care medical wards for a period of 6 months each, in a crossover design. Data on health care-acquired transmissions of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, and Clostridium difficile were collected during both periods. Adjusted incidence rate ratios (IRRs) using Poisson regression were calculated to compare transmission of pathogens between both periods on both wards.
RESULTS: During the intervention VRE transmission was significantly decreased (2-fold) on the ward where patients had fewer roommates; cleaning of GZ did not have any effect on the ward with multiple-occupancy rooms. There was no impact on methicillin-resistant S aureus transmission and only a nonsignificant decrease in transmission of C difficile.
CONCLUSIONS: Our data provide evidence that targeted cleaning interventions can reduce VRE transmission when rooming conditions are optimized; such interventions can be cost-effective when the burden of VRE is significant. Enhanced cleaning interventions are less beneficial in the context of room sharing where many other factors contribute to transmission of pathogens.

PMID: 27397907 [PubMed - indexed for MEDLINE]

A Bivalent Meningococcal B Vaccine in Adolescents and Young Adults.

Fri, 12/15/2017 - 00:39
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A Bivalent Meningococcal B Vaccine in Adolescents and Young Adults.

N Engl J Med. 2017 12 14;377(24):2349-2362

Authors: Ostergaard L, Vesikari T, Absalon J, Beeslaar J, Ward BJ, Senders S, Eiden JJ, Jansen KU, Anderson AS, York LJ, Jones TR, Harris SL, O'Neill R, Radley D, Maansson R, Prégaldien JL, Ginis J, Staerke NB, Perez JL, B1971009 and B1971016 Trial Investigators

Abstract
BACKGROUND: MenB-FHbp is a licensed meningococcal B vaccine targeting factor H-binding protein. Two phase 3 studies assessed the safety of the vaccine and its immunogenicity against diverse strains of group B meningococcus.
METHODS: We randomly assigned 3596 adolescents (10 to 18 years of age) to receive MenB-FHbp or hepatitis A virus vaccine and saline and assigned 3304 young adults (18 to 25 years of age) to receive MenB-FHbp or saline at baseline, 2 months, and 6 months. Immunogenicity was assessed in serum bactericidal assays that included human complement (hSBAs). We used 14 meningococcal B test strains that expressed vaccine-heterologous factor H-binding proteins representative of meningococcal B epidemiologic diversity; an hSBA titer of at least 1:4 is the accepted correlate of protection. The five primary end points were the proportion of participants who had an increase in their hSBA titer for each of 4 primary strains by a factor of 4 or more and the proportion of those who had an hSBA titer at least as high as the lower limit of quantitation (1:8 or 1:16) for all 4 strains combined after dose 3. We also assessed the hSBA responses to the primary strains after dose 2; hSBA responses to the 10 additional strains after doses 2 and 3 were assessed in a subgroup of participants only. Safety was assessed in participants who received at least one dose.
RESULTS: In the modified intention-to-treat population, the percentage of adolescents who had an increase in the hSBA titer by a factor of 4 or more against each primary strain ranged from 56.0 to 85.3% after dose 2 and from 78.8 to 90.2% after dose 3; the percentages of young adults ranged from 54.6 to 85.6% and 78.9 to 89.7%, after doses 2 and 3, respectively. Composite responses after doses 2 and 3 in adolescents were 53.7% and 82.7%, respectively, and those in young adults were 63.3% and 84.5%, respectively. Responses to the 4 primary strains were predictive of responses to the 10 additional strains. Most of those who received MenB-FHbp reported mild or moderate pain at the vaccination site.
CONCLUSIONS: MenB-FHbp elicited bactericidal responses against diverse meningococcal B strains after doses 2 and 3 and was associated with more reactions at the injection site than the hepatitis A virus vaccine and saline. (Funded by Pfizer; ClinicalTrials.gov numbers, NCT01830855 and NCT01352845 ).

PMID: 29236639 [PubMed - in process]

Travel-Associated Zika Virus Disease.

Wed, 12/13/2017 - 00:49
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Travel-Associated Zika Virus Disease.

Ann Intern Med. 2017 06 20;166(12):913-914

Authors: Hamer DH, Chen LH, Libman M, Grobusch MP, Esposito DH

PMID: 28630988 [PubMed - indexed for MEDLINE]

Plant-made virus-like particle vaccines bearing the hemagglutinin of either seasonal (H1) or avian (H5) influenza have distinct patterns of interaction with human immune cells in vitro.

Wed, 12/13/2017 - 00:49
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Plant-made virus-like particle vaccines bearing the hemagglutinin of either seasonal (H1) or avian (H5) influenza have distinct patterns of interaction with human immune cells in vitro.

Vaccine. 2017 May 02;35(19):2592-2599

Authors: Hendin HE, Pillet S, Lara AN, Wu CY, Charland N, Landry N, Ward BJ

Abstract
INTRODUCTION: The recent emergence of avian influenza strains has fuelled concern about pandemic preparedness since vaccines targeting these viruses are often poorly immunogenic. Weak antibody responses to vaccines have been seen across multiple platforms including plant-made VLPs. To better understand these differences, we compared the in vitro responses of human immune cells exposed to plant-made virus-like particle (VLP) vaccines targeting H1N1 (H1-VLP) and H5N1 (H5-VLP).
METHODS: Peripheral blood mononuclear cells (PBMC) from healthy adults were stimulated ex vivo with 2-5µg/mL VLPs bearing the hemagglutinin (HA) of either H1N1 (A/California/7/2009) or H5N1 (A/Indonesia/5/05). VLP-immune cell interactions were characterized by confocal microscopy and flow cytometry 30min after stimulation with dialkylaminostyryl dye-labeled (DiD) VLP. Expression of CD69 and pro-inflammatory cytokines were used to assess innate immune activation 6h after stimulation.
RESULTS: H1- and H5-VLPs rapidly associated with all subsets of human PBMC but exhibited unique binding preferences and frequencies. The H1-VLP bound to 88.7±1.6% of the CD19+ B cells compared to only 21.9±1.8% bound by the H5-VLP. At 6h in culture, CD69 expression on B cells was increased in response to H1-VLP but not H5-VLP (22.79±3.42% vs. 6.15±0.82% respectively: p<0.0001). Both VLPs were rapidly internalized by CD14+ monocytes resulting in the induction of pro-inflammatory cytokines (i.e.: IL-8, IL-1β, TNFα and IL-6). However, a higher concentration of the H5-VLP was required to induce a comparable response and the pattern of cytokine production differed between VLP vaccines.
CONCLUSIONS: Plant-made VLP vaccines bearing H1 or H5 rapidly elicit immune activation and cytokine production in human PBMC. Differences in the VLP-immune cell interactions suggest that features of the HA proteins themselves, such as receptor specificity, influence innate immune responses. Although not generally considered for inactivated vaccines, the distribution and characteristics of influenza receptor(s) on the immune cells themselves may contribute to both the strength and pattern of the immune response generated.

PMID: 28389100 [PubMed - indexed for MEDLINE]

Congenitally transmitted Chagas disease in Canada: a family cluster.

Thu, 12/07/2017 - 00:37
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Congenitally transmitted Chagas disease in Canada: a family cluster.

CMAJ. 2017 Dec 04;189(48):E1489-E1492

Authors: Plourde PJ, Kadkhoda K, Ndao M

PMID: 29203618 [PubMed - in process]

Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

Sat, 12/02/2017 - 00:31
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Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

Clin Infect Dis. 2016 Dec 15;63(12):e202-e264

Authors: Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A

Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.

PMID: 27941151 [PubMed - indexed for MEDLINE]

Diagnosis and Clinical Management of Schistosoma haematobium-Schistosoma bovis Hybrid Infection in a Cluster of Travelers Returning From Mali.

Sat, 12/02/2017 - 00:31
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Diagnosis and Clinical Management of Schistosoma haematobium-Schistosoma bovis Hybrid Infection in a Cluster of Travelers Returning From Mali.

Clin Infect Dis. 2016 Dec 15;63(12):1626-1629

Authors: Soentjens P, Cnops L, Huyse T, Yansouni C, De Vos D, Bottieau E, Clerinx J, Van Esbroeck M

Abstract
Ten Belgian travelers returned from Mali with a Schistosoma haematobium-Schistosoma bovis hybrid infection, confirmed by DNA sequencing from eggs. Clinical symptoms and laboratory findings resembled those of classic acute schistosomiasis, but the detected eggs were morphologically unusual.

PMID: 27941144 [PubMed - indexed for MEDLINE]

Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

Sat, 12/02/2017 - 00:31
Related Articles

Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

Clin Infect Dis. 2016 Dec 15;63(12):1539-1557

Authors: Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A

Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.

PMID: 27941143 [PubMed - indexed for MEDLINE]

The Art of Writing and Implementing Standard Operating Procedures (SOPs) for Laboratories in Low-Resource Settings: Review of Guidelines and Best Practices.

Thu, 11/30/2017 - 00:14
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The Art of Writing and Implementing Standard Operating Procedures (SOPs) for Laboratories in Low-Resource Settings: Review of Guidelines and Best Practices.

PLoS Negl Trop Dis. 2016 11;10(11):e0005053

Authors: Barbé B, Verdonck K, Mukendi D, Lejon V, Lilo Kalo JR, Alirol E, Gillet P, Horié N, Ravinetto R, Bottieau E, Yansouni C, Winkler AS, van Loen H, Boelaert M, Lutumba P, Jacobs J

PMID: 27812100 [PubMed - indexed for MEDLINE]

Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting.

Thu, 11/30/2017 - 00:14
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Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting.

Am J Infect Control. 2016 Nov 01;44(11):1396-1398

Authors: Yee C, Suarthana E, Dendukuri N, Nicolau I, Semret M, Frenette C

Abstract
A retrospective cohort design was used to study the impact of a multiplex respiratory virus panel polymerase chain reaction test in 186 adult patients with suspected influenza-like illness. Decisions regarding continuation of empirical antiviral therapy appear to be impacted by the test. However, the impact on reducing antibiotic use remains unclear.

PMID: 27311514 [PubMed - indexed for MEDLINE]

Multiplex Respiratory Virus Testing for Antimicrobial Stewardship: A Prospective Assessment of Antimicrobial Use and Clinical Outcomes Among Hospitalized Adults.

Sun, 11/19/2017 - 01:32
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Multiplex Respiratory Virus Testing for Antimicrobial Stewardship: A Prospective Assessment of Antimicrobial Use and Clinical Outcomes Among Hospitalized Adults.

J Infect Dis. 2017 Nov 15;216(8):936-944

Authors: Semret M, Schiller I, Jardin BA, Frenette C, Loo VG, Papenburg J, McNeil SA, Dendukuri N

Abstract
Background: Respiratory tract infections are frequent causes of hospitalization and initiation of empirical antimicrobial therapy. Testing for a broad panel of respiratory viruses has been advocated as a useful tool for antibiotic stewardship. We conducted a prospective observational study to assess the impact of rapid viral test results on antimicrobial prescriptions and clinical outcomes among hospitalized adults.
Methods: Eight hundred patients admitted with respiratory symptoms were tested by a 12-virus respiratory panel (RVP) during 3 consecutive winters in Montreal, Canada. The primary outcome measure was change in antimicrobial prescriptions (ie, de-escalation of empirical antimicrobial therapy or commencement of new antimicrobial therapy) after RVP results were available. Clinical outcomes were also assessed.
Results: Influenza virus was identified in 53% of individuals in the study population, and other viruses were identified in 10%. Influenza virus positivity was associated with shorter duration of hospitalization and appropriate antiviral management. Antibiotic management was most significantly correlated with radiographic suspicion of pneumonia and less so with results of the RVP. Positivity for viruses other than influenza virus was not correlated with significantly different outcomes.
Conclusions: Physicians respond to results of testing for influenza virus when managing hospitalized adult patients but respond less to test results for other viruses. These data can inform the design of stewardship interventions and the selection of viral testing panels for hospitalized patients.

PMID: 29149338 [PubMed - in process]

Resource Utilization and Cost of Influenza Requiring Hospitalization in Canadian Adults: A Study from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network.

Sun, 11/12/2017 - 02:02

Resource Utilization and Cost of Influenza Requiring Hospitalization in Canadian Adults: A Study from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network.

Influenza Other Respir Viruses. 2017 Nov 10;:

Authors: Ng C, Ye L, Noorduyn SG, Hux M, Thommes E, Goeree R, Ambrose A, Andrew MK, Hatchette T, Boivin G, Bowie W, ElSherif M, Green K, Johnstone J, Katz K, Leblanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney J, McGeer A, Poirier A, Powis J, Richardson D, Sharma R, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA, Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN) Investigators the Toronto Invasive Bacterial Diseases Network (TIBDN) Investigators

Abstract
BACKGROUND: Consideration of cost determinants is crucial to inform delivery of public vaccination programs.
OBJECTIVES: To estimate the average total cost of laboratory-confirmed influenza requiring hospitalization in Canadians prior to, during, and 30 days following discharge. To analyze effects of patient/disease characteristics, treatment, and regional differences in costs.
METHODS: Study utilized previously recorded clinical characteristics, resource use, and outcomes of laboratory-confirmed influenza patients admitted to hospitals in the Serious Outcomes Surveillance (SOS), Canadian Immunization Research Network (CIRN), from 2010/11 - 2012/13. Unit costs including hospital overheads were linked to inpatient/outpatient resource utilization before and after admissions.
RESULTS: Dataset included 2,943 adult admissions to 17 SOS Network hospitals, 24 Toronto Invasive Bacterial Disease Network hospitals. Mean age was 69.5 years. Average hospital stay was 10.8 days (95% CI: 10.3, 11.3), general ward stays were 9.4 days (95% CI: 9.0, 9.8) and ICU stays were 9.8 days (95% CI: 8.6, 11.1) for the 14% of patients admitted to the ICU. Average cost per case was $14,612 CAD (95% CI: $13,852, $15,372) including $133 (95% CI: $116, $150) for medical care prior to admission, $14,031 (95% CI: $13,295, $14,768) during initial hospital stay, $447 (95% CI: $271, $624) post-discharge, including readmission within 30 days.
CONCLUSION: The cost of laboratory-confirmed influenza was higher than previous estimates, driven mostly by length of stay and analyzing only laboratory-confirmed influenza cases. The true per patient cost of influenza-related hospitalization has been underestimated and prevention programs should be evaluated in this context. This article is protected by copyright. All rights reserved.

PMID: 29125689 [PubMed - as supplied by publisher]

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