Surgical site infections: current management and role of new antibiotics
Purpose of review Management of SSI comprises prevention, extensive diagnosis, and appropriate treatment as well as follow-up. All these are interrelated matters. This review gives a brief update on the latest developments in the field, specifically on new antibiotics that may find a place in this complex field. Recent findings Avibactam and dalbavancin are novel antiinfectives. Although randomized controlled trials in SSI are lacking to date, preliminary data show that new drugs may be alternatives to existing treatment. Currently, they should be used only on the ground of susceptibility testing, and if standard drug...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: SPECIAL COMMENTARY: Edited by Matteo Bassetti Source Type: research

Meningitis vaccines in children: what have we achieved and where next?
Purpose of review This review highlights the recent impacts of vaccines against the major bacterial causes of meningitis in children, and the challenges for further prevention of bacterial meningitis, with a focus on Streptococcus pneumoniae, Neisseria meningitidis and group B Streptococcus. Recent findings Conjugate vaccines against S. pneumoniae and N. meningitidis have resulted in dramatic reductions in bacterial meningitis globally where they have been used. Recent licensure and use of capsular group B meningococcal protein vaccines have further reduced meningococcal meningitis in infants, young children and adole...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: PAEDIATRIC AND NEONATAL INFECTIONS: Edited by Saul N. Faust Source Type: research

Diagnosis and treatment of biofilm infections in children
Purpose of review Biofilm-associated infections cause difficulties in the management of childhood chronic infections and other diseases, due to the invasive nature of interventions which are often necessary for definitive management. Despite their importance, there are challenges in diagnosing biofilm infections and gaps in clinicians’ understanding regarding the significance of biofilms. Recent findings Many chronic infections associated with biofilms remain difficult or impossible to eradicate with conventional therapy. Surgical intervention, implant removal or long-term intermittent or suppressive antimicrobi...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: PAEDIATRIC AND NEONATAL INFECTIONS: Edited by Saul N. Faust Source Type: research

Paediatric sepsis
Purpose of review Sepsis remains among the leading causes of childhood mortality worldwide. This review serves to highlight key areas of knowledge gain and ongoing controversies pertinent to sepsis in children. Recent findings Several recent publications describe the epidemiology of paediatric sepsis, demonstrating the impact on child health in terms of mortality and morbidity, and the shortcomings of current paediatric sepsis definitions. Although emerging data support the importance of organ dysfunction as a hallmark of paediatric sepsis, the understanding of host susceptibility to sepsis and to sepsis severity rema...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: PAEDIATRIC AND NEONATAL INFECTIONS: Edited by Saul N. Faust Source Type: research

The nonpathogenic commensal Neisseria: friends and foes in infectious disease
Purpose of review Nonpathogenic commensal Neisseria are rarely considered in the clinical setting despite evidence that they can cause invasive opportunistic infections. In contrast, they may offer protection against pathogenic Neisseria, and such relationships are being actively explored in experimental studies. Recent findings Recent case reports are presented of invasive infection caused by nonpathogenic Neisseria in patients on novel biologic therapies. On the other hand, Neisseria lactamica, a nonpathogenic commensal, has been shown in human challenge studies to inhibit colonization by Neisseria meningitidis. Exp...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: PAEDIATRIC AND NEONATAL INFECTIONS: Edited by Saul N. Faust Source Type: research

Prevention and treatment of recurrent Clostridioides difficile infection
Purpose of review Clostridioides difficile infection (CDI) is a significant burden on the health system, especially due to high recurrence rates. Since the beginning of the CDI epidemic in early 2000s, many strategies for combatting recurrence have been explored, with moderate success so far. This review will focus on the most recent developments in recurrent CDI prevention and treatment. Recent findings There are two main mechanisms of CDI recurrence: alteration in microbiome and poor antibody response. Development of new antibiotics aims to minimize damage to the microbiome. Fecal transplant or other microbiome repl...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Recent data on hepatitis E
Purpose of review Hepatitis E virus (HEV) has gained increased global recognition in recent years, particularly in developed countries. We summarized here a selection of the literature published since the 1st of June, 2017. Recent findings Longitudinal studies are increasingly conducted in Europe, to determine trends in HEV prevalence. The spectrum of mammals infected with HEV and potentially capable to transmit it to humans has widened. New virological data on HEV repCon and pathogenicity have been reported and clinical features of HEV infections have been precised or newly described. Finally, there are some new data...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Emerging concepts in the diagnosis, treatment, and prevention of travelers’ diarrhea
Purpose of review Traveller's diarrhea, though not life-threatening. is often a vexing problem, which impacts overall function of the traveller while on holiday. Increasing data is available regarding molecular diagnostic techniques, which may help obtain an early etiologic diagnosis. Use of antibiotics for traveller's diarrhea is controversial in this era of multidrug resistance and microbiome disruption. Recent findings Travel to the tropics promotes gut colonization with drug-resistant bacteria and this risk increases after treatment with antibiotics, leading to potential ecological impacts in the country of reside...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Newer approaches in diagnosis of diarrhea in immunocompromised patients
Purpose of review This review will focus on the epidemiology and cause of diarrheal illness in solid organ transplant and stem-cell transplant population recipients with a specific focus on the role of advanced multiplex technology in the diagnosis of diarrhea within this patient population. Recent findings A wide range of infectious and noninfectious causes of diarrhea have been described in immunocompromised patients. The most common infections noted are Clostridioides difficile, norovirus, and cytomegalovirus, whereas immunosuppressive drugs and mucositis are the most common noninfectious causes of diarrhea. Histor...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

A One Health approach to prevention, treatment, and control of campylobacteriosis
Purpose of review To review recent findings regarding the control and treatment of campylobacteriosis. Recent findings The application of improved diagnostics has led to an upward shift in the attributable burden of Campylobacter infections, in both the United States and Europe as well as in resource-poor settings. Increased focus has brought a fundamental feature of campylobacteriosis -- the ability to cause relapsing disease back into focus, and expanding data on antimicrobial resistance has lead from a switch in first-line therapy for severe diarrhea from quinolones to azithromycin in most contexts, even as evidenc...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Influence of histo blood group antigen expression on susceptibility to enteric viruses and vaccines
Purpose of review Gastroenteritis results in substantial morbidity and mortality worldwide, especially in young children in low-and-middle-income settings. Rotavirus and norovirus are the leading causes of viral gastroenteritis. Although introduction of rotavirus vaccines into childhood immunization programmes has reduced disease burden, vaccine effectiveness remains low in developing countries. Norovirus is replacing rotavirus as the most common cause of diarrhea hospitalization in settings where rotavirus vaccines are highly effective. Genetically determined host factors, such as expression of histo blood group antigen...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Current and new rotavirus vaccines
Purpose of review As of 2019, four rotavirus vaccines have been prequalified by the WHO for use worldwide. This review highlights current knowledge regarding rotavirus vaccines available, and provides a brief summary of the rotavirus vaccine pipeline. Recent findings Data generated from use of currently available products supports their effectiveness and impact in diverse settings. Rotavirus vaccines have a favorable risk–benefit profile, but previous associations of rotavirus vaccination with intussusception necessitate continued monitoring for this rare but serious adverse event. Implementation of rotavirus va...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: GASTROINTESTINAL INFECTIONS: Edited by Gagandeep Kang and Eric R. Houpt Source Type: research

Approach to ocular toxoplasmosis including pregnant women
Purpose of review To discuss available information on the effectiveness of anti-toxoplasma therapy for ocular toxoplasmosis and to provide clinicians with a practical approach to the disease. Recent findings Only eleven randomized studies were identified. In the three studies for acute retinitis, there was a clear trend in favor of treatment. In the two studies for the prevention of recurrences, trimethoprim–sulfamethoxazole prophylaxis was superior to placebo. In the six studies comparing different regimens, there was no statistically significant difference between the regimens. In the setting of acute posterio...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Cutaneous leishmaniasis in the 21st century: from the laboratory to the bedside
Purpose of review Despite modern advances in molecular diagnostic tools and a better understanding of its complex pathophysiology, cutaneous leishmaniasis, a neglected tropical disease, remains a major global health problem. Laboratory methods to inform prognosis and treatment are not widely available, the therapeutic options are limited and have significant adverse effects, and emergence of drug resistance is a further complication. New advances in the understanding of the role of Leishmania RNA virus (LRV) as a prognostic factor, speciation methods and antimicrobial resistance testing and their limitations will be disc...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Severe malaria: update on pathophysiology and treatment
Purpose of review Malaria threatens the lives of over 200 million individuals with the disease each year. Plasmodium falciparum is the predominant cause of severe malaria which may be lethal and result in neurocognitive sequelae despite appropriate treatment. We review recent advances regarding the pathophysiology of severe malaria and treatment recommendations for severe disease in the United States. Recent findings Infected red blood cell (iRBC) sequestration in microvascular beds is a critical factor in the development of severe malaria syndromes. Interactions between iRBC variant adhesive peptides and the endothel...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Tafenoquine: the new kid on the block
Purpose of review This is a review of tafenoquine, a new antimalarial drug. Here we examine the recent literature supporting the use of tafenoquine and summarize the opportunities and challenges for its well tolerated use worldwide. Recent findings Tafenoquine was recently approved by the US Food and Drug Administration for the treatment of dormant liver stage (hypnozoite) in Plasmodium vivax and for malaria prophylaxis. Single-dose tafenoquine provides equivalent efficacy to 14 days of primaquine for radical cure in P. vivax, and it can be dosed weekly to prevent malaria. However, tafenoquine can only be used in pati...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

WHO's new rabies recommendations: implications for high incidence countries
Purpose of review Rabies is virtually always fatal; however, it is nearly 100% preventable with timely and appropriate prophylactic immunization. This review summarizes the recently revised WHO guidelines for rabies prophylaxis published in 2018, following a scientific review by a strategic advisory group of experts on immunization. The scientific basis for the major changes and its implications for countries with high disease burden are also discussed. Recent findings The key changes in the updated WHO 2018 guidelines for rabies prophylaxis include abbreviated vaccination regimens for pre and postexposure prophylaxis...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

The first licensed dengue vaccine: can it be used in travelers?
Purpose of review The first dengue vaccine (Dengvaxia) was endorsed by the European Medicine Agency and the US Food and Drug Administration. Given the excess risk of severe dengue in seronegative vaccinees, use is restricted to seropositive individuals. Dengvaxia confers high protection against severe dengue in seropositive vaccinees. Recent findings With increasing global travel, the probability of travelers being seropositive increases. Such seropositive travelers may be at increased risk of severe dengue as a result of a second dengue infection during repeat travel. Nevertheless, the use of Dengvaxia in travelers r...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Fractional-dose yellow fever vaccination: how much more can we do with less?
Purpose of review Climate change, deforestation, urbanization, and increased population mobility have made the risk of large outbreaks of yellow fever more likely than ever. Yellow fever vaccine production barely meets demands. In this review, we address the causes of the recent yellow fever outbreaks, why fractional dose yellow fever vaccination works, the role of virus neutralizing antibodies in the protection against yellow fever, and the need for revaccination. Recent findings Human activities have profoundly changed the epidemiology of yellow fever. The excess of infectious viral particles in routine yellow fever...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Zika circulation, congenital syndrome, and current guidelines: making sense of it all for the traveller
Purpose of review Zika virus (ZIKV) swept through the Americas and led to recognition of its neurotropism. Zika circulation elsewhere in the world, nonvector transmission including maternal–fetal/sexual/transfusion routes, and additional reports on congenital Zika syndrome (CZS) and Guillain–Barré syndrome (GBS) have been published. Recent findings In 2018–2019, ZIKV transmission occurred in Cuba, India, and is suspected to appear sporadically in other countries. Maternal–fetal ZIKV transmission appears to occur in about 26% of ZIKV-infected pregnant women. The US ZIKV Pregnancy and Infa...
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - September 7, 2019 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Controversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention
Purpose of review Health agencies recommend transmission-based precautions, including contact, droplet and airborne precautions, to mitigate transmission of respiratory viruses in healthcare settings. There is particular controversy over the importance of aerosol transmission and whether airborne precautions should be recommended for some respiratory viruses. Here, we review the current recommendations of transmission-based precautions and the latest evidence on the aerosol transmission of respiratory viruses. Recent findings Viral nucleic acids, and in some instances viable viruses, have been detected in aerosols in ...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

One hundred years after the 1918 pandemic: new concepts for preparing for influenza pandemics
This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system. Recent findings We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conv...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

New and novel rapid diagnostics that are impacting infection prevention and antimicrobial stewardship
Purpose of review The current review summarizes advances in rapid diagnostic testing that impacts infection prevention and antimicrobial stewardship programs. Recent findings A variety of rapid diagnostic technologies to identify organisms in cultured blood are now available. When coupled with antimicrobial stewardship (ASP), these rapid technologies can optimize antimicrobial utilization and patient outcomes. Two rapid molecular panels that detect organisms related to pneumonia are available and may impact infection prevention surveillance definitions. Three molecular tests are available for the detection of meningit...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Norovirus in health care and implications for the immunocompromised host
Purpose of review The majority of norovirus outbreaks in the United States occur in healthcare facilities. With the growing population of immunocompromised hosts who are in frequent contact with healthcare facilities, norovirus is not only a threat to hospitals and nursing homes but also to these individuals. This review summarizes the impact of norovirus infection on healthcare facilities and immunocompromised hosts. Recent findings The natural history of norovirus infection in immunocompromised individuals remains poorly understood. Although host immune responses play a critical role in reducing duration of viral sh...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Personal protective equipment for viral hemorrhagic fevers
This article reviews VHF with reported human-to-human transmission and describes updates about personal protective equipment (PPE) for healthcare personnel (HCP) and others. We summarize existing information about appropriate PPE use, training, and compliance for care of VHF patients in endemic and nonendemic countries, as well as addresses the challenges HCP experience when using PPE. Recent findings PPE is essential in protecting HCP from exposure to disease-causing pathogens. Recent evidence shows that anyone involved in care, management, and transport of certain VHF patients must use elements of PPE as part of appro...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Anticytokine autoantibodies leading to infection: early recognition, diagnosis and treatment options
Purpose of review The current review gives a concise and updated overview of the relative new field of anticytokine autoantibodies (ACAA) and associated infections with a focus on recent findings regarding clinical manifestions, diagnostic and treatments. Recent findings Several recent case reports of unusual presentations of patients with neutralizing autoantibodies to IFN-γ and granulocyt macrophage colony-stimulating factor and expand the spectrum of clinical manifestations and suggest that anticytokine-mediated acquired immunodeficiency causing susceptibility to infection may be underdiagnosed. There is an e...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Risk of invasive fungal infections during hospital construction: how to minimize its impact in immunocompromised patients
Purpose of review Fungal outbreaks have been reported in healthcare settings, showing that construction activities are a serious threat to immunocompromised hosts. Preventive measures to control fungal outbreaks (especially Aspergillus spp.) are considered essential during hospital construction. In this article, we update the main advances in each of preventive strategies. Recent findings Anticipation and multidisciplinary teamwork are the keystone for fungal outbreaks prevention. Strategies focused on environmental control measures of airborne dissemination of fungal spores have proven to be successful. It is importa...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Molecular diagnosis of Pneumocystis pneumonia in immunocompromised patients
Purpose of review Pneumocystis pneumonia (PCP) is a frequent opportunistic infection associated with a high mortality rate. PCP is of increasing importance in non-HIV immunocompromised patients, who present with severe respiratory distress with low fungal loads. Molecular detection of Pneumocystis in broncho-alveolar lavage (BAL) has become an important diagnostic tool, but quantitative PCR (qPCR) needs standardization. Recent findings Despite a high negative predictive value, the positive predictive value of qPCR is moderate, as it also detects colonized patients. Attempts are made to set a cut-off value of qPCR to d...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Clostridioides difficile in transplant patients: early diagnosis, treatment, and prevention
Purpose of review Clostridioides difficile infection is common in solid organ transplant and hematopoietic stem-cell transplant recipients and is associated with significant morbidity and mortality. These populations are also underrepresented in clinical trials, making optimal management difficult. Because of this, management of these populations follows national guideline recommendations. This review aims to summarize the recent relevant literature pertaining to the clinical management of C. difficile infection in transplant patients, with a particular focus on diagnosis, treatment, and prevention. Recent findings Ea...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Approach to infection and disease due to adenoviruses in solid organ transplantation
Purpose of review Adenoviruses are an important cause of morbidity and mortality of solid organ transplant patients and remain a clinical challenge with regard to diagnosis and treatment. In this review, we provide an approach to identification and classification of adenovirus infection and disease, highlight risk factors, and outline management options for adenovirus disease in solid organ transplant patients. Recent findings Additional clinical data and pathologic findings of adenovirus disease in different organs and transplant recipients are known. Unlike hematopoietic cell transplant recipients, adenovirus blood ...
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Editorial: Diagnosis of infection in immunocompromised patients: from microscopy to next generation sequencing and host gene signatures
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by José G. Montoya Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - June 29, 2019 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Typhoid and Paratyphoid Fever - A Call to Action: Erratum
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: ERRATUM Source Type: research

Infectious causes of stroke
Purpose of review Stroke continuous to be a leading cause of debility in the world. Infections have been associated with stroke, but are not considered as directly causal, and so they are not often included in the traditional stroke workup and management. They are especially important in patients with stroke of undetermined etiology, and in certain patient populations, such as young patients without traditional risk factors, and immunocompromised patients. Recent findings There has been strong evidence for infectious conditions, such as endocarditis, and pathogens, such as varicella zoster in stroke causation, and mor...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Update on fungal infections of the central nervous system: emerging pathogens and emerging diagnostics
Purpose of review Fungal infections of the central nervous system (CNS) are relatively uncommon but associated with significant morbidity and mortality. We reviewed recent literature highlighting new approaches to management of these complex patients. Recent findings Fungal infections are increasingly recognized as important causes of CNS disease in both immunocompromised and immunocompetent hosts. Globally, cryptococcal meningitis remains a leading cause of death in HIV-infected persons in resource-limited settings. Emerging fungal pathogens with increased virulence and resistance to numerous classes of antifungal ag...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Human prion diseases
Purpose of review Prion diseases are rapidly progressive neurodegenerative conditions that can be difficult to diagnose and are transmissible under specific circumstances. The authors will provide background regarding prion disease and focus on diagnostic tools. Recent findings Prion disease is caused by misfolded prion protein. The three possible causes of prion disease include sporadic (85%), genetic (10–15%), and acquired ( (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Update on spinal epidural abscess
Purpose of review Spinal epidural abscess (SEA) is still a rare but potentially very morbid infection of the spine. In recent years, the incidence has risen sharply but the condition remains a medical conundrum wrought with unacceptably long diagnostic delays. The outcome depends on timely diagnosis and missed opportunities can be associated with catastrophic consequences. Management and outcomes have improved over the past decade. This review focuses on risk factors and markers that can aid in establishing the diagnosis, the radiological characteristics of SEA on MRI and their clinical implications, as well as the impor...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Lyme neuroborreliosis
Purpose of review To review the recent evidence clarifying the symptomatology and diagnosis of nervous system Lyme disease. Recent findings Two-tier testing combining pairs of ELISAs, using C6 or VlsE assays to replace second tier Western blots, may eliminate confusion about test interpretation. Cerebrospinal fluid (CSF) can be informative in diagnosing central nervous system (CNS) Lyme disease, not peripheral nervous system (PNS) disorders. CSF CXCL13 may provide useful adjunctive information in CNS infection; its specificity remains to be defined. Lyme encephalopathy is not indicative of CNS infection. Post treatmen...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Immune-mediated encephalitis for the infectious disease specialist
Purpose of review Autoimmune encephalitis is increasingly recognized and must be distinguished from infectious forms of encephalitis. Moreover, physicians should be aware of infectious triggers of autoimmune encephalitis and of infectious complications associated with treatment. Recent findings Recent epidemiological studies suggest that the incidence of autoimmune encephalitis may rival that of infectious encephalitis. Although distinguishing autoimmune from infectious forms of encephalitis on clinical grounds can be challenging, recently proposed diagnostic criteria can provide some assistance. There has been an exp...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Advances in molecular diagnostic testing for central nervous system infections
Purpose of review Central nervous system (CNS) infections present an ongoing diagnostic challenge for clinicians, with an aetiological agent remaining unidentified in the majority of cases even in high-income settings. This review summarizes developments in a range of diagnostic methods published in the past 18 months. Recent findings Several commercial assays exist for the detection of viral, bacterial and fungal pathogens using single multiplex PCR. Multicentre validation of the Biofire FilmArray panel illustrated high sensitivity for bacterial and fungal pathogens, but poor results for Cryptococcus species detectio...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Herpes simplex virus encephalitis update
This article is an update on the topic based on a review of recent studies from 2017 to 2018. Recent findings Acyclovir is still the first line treatment, and no new drugs are currently available for clinical use. The major considerations for HSV encephalitis are as follows: point one, clinical evaluation remains the most important factor, as though CSF HSV PCR has a good sensitivity, in a small proportion of patients the initial testing might be negative. MRI brain is the first line imaging test, and mesial temporal lobe involvement and other typical findings are important for diagnosis; point 2, there should be emphas...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Update and advances in community acquired bacterial meningitis
Purpose of review Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens. Recent findings Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Editorial: Foreword
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Genotypic and phenotypic adaptation of pathogens: lesson from the genus: Bordetella
Purpose of review To relate genomic changes to phenotypic adaptation and evolution from environmental bacteria to obligate human pathogens, focusing on the examples within Bordetella species. Recent findings Recent studies showed that animal-pathogenic and human-pathogenic Bordetella species evolved from environmental ancestors in soil. The animal-pathogenic Bordetella bronchiseptica can hijack the life cycle of the soil-living amoeba Dictyostelium discoideum, surviving inside single-celled trophozoites, translocating to the fruiting bodies and disseminating along with amoeba spores. The association with amoeba may ha...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Regulation of virulence and antibiotic resistance in Gram-positive microbes in response to cell wall-active antibiotics
Purpose of review Antibiotic stress can evoke considerable genotypic and phenotypic changes in Gram-positive bacteria. Here, we review recent studies describing altered virulence expression in response to cell wall-acting antibiotics and discuss mechanisms that coordinate regulation of the antibiotic response. Recent findings Pleiotropic effects induced by antibiotic exposure include alterations to bacterial metabolism, cell wall structure and antibiotic resistance. In addition, subinhibitory concentrations of cell wall-active (CWA) antibiotics have increasingly been shown to induce the production of exotoxins and bio...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Monoclonal antibody-based therapies for bacterial infections
Purpose of review This review highlights recent developments in the development of monoclonal antibodies to treat bacterial disease, including preclinical advances and the status of current clinical trials. Recent findings Monoclonal antibody (mAb) therapy is becoming increasingly promising in the infectious disease field. Though bacterial exotoxins continue to be a mainstay of mAb targets, searches for protein targets on the surface of bacteria have uncovered new mechanisms of antibody-mediated action against bacteria. Additionally, surveys of the polysaccharide serotype prevalence among antibiotic-resistant bacteria...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Metabolic immunomodulation of macrophage functional plasticity in nonhealing wounds
Purpose of review Despite modern advances in medicine, nonhealing wounds are the number one cause of nontraumatic, lower-limb amputation. Nonhealing wounds are characterized by a healing process stalled between inflammation and tissue remodel/repair, a stage characterized by a shift in macrophage functional phenotype. Characterization of diversity in macrophage functional phenotype in wounds and metabolic contributions to macrophage polarization are discussed. Recent findings Macrophage functional diversity in phenotype has recently evolved from duality (classically activated, pro-inflammatory M1 and alternatively act...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Immune memory characteristics of innate lymphoid cells
Purpose of review Immune memory is essential for host defense against invaders and it is also used as a basis for vaccine development. For these reasons, it is crucial to understand its molecular basis. In this review, we describe recent findings on memory characteristics of innate-like lymphocytes and its contribution to host protection. JOURNAL/coidi/04.02/00001432-201906000-00004/figure1-4/v/2019-04-25T014735Z/r/image-tiff Recent findings In addition to adaptive immune cells, innate cells are also able to mount memory responses through a process called ‘trained immunity.’ Importantly, the lymphoid line...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

A delicate balancing act: immunity and immunopathology in human H7N9 influenza virus infections
Purpose of review A delicate balance exists between a protective and detrimental immune response to an invading viral pathogen. Here, we review the latest advancements in our understanding of immunity and immunopathology during H7N9 influenza A virus (IAV) infections and its relevance to disease management and diagnosis. Recent findings Recent studies have highlighted the role of specific leukocytes in the pathogenesis of H7N9 IAV infections and potential diagnostic role that host cytokine profiles can play in forecasting disease severity. Furthermore, alterations in diet have emerged as a possible preventive measure ...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research