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Recent Advances in Tuberculosis Diagnosis: IGRAs and Molecular Biology
Opinion statement Tuberculosis (TB) is one of the most deadly, curable infectious diseases. In 2012, the World Health Organization (WHO) reported 8.6 million new TB cases and 1.3 million deaths. Despite intensive research to improve tuberculosis diagnosis and drug susceptibility testing, TB still remains one of the most threatening curable infectious diseases. Effective control of TB remains in prevention, the immediate detection of Mycobacterium tuberculosis and rapid detection of drug-resistant strains, followed by prompt implementation of an adequate anti-tuberculous therapy. Providing rapid antibiotic...
Source: Current Treatment Options in Infectious Diseases - October 23, 2014 Category: Infectious Diseases Source Type: research

Current Opinions in the Treatment of Pulmonary Nontuberculous Mycobacteria in Non-Cystic Fibrosis Patients: Mycobacterium abscessus Group, Mycobacterium avium Complex, and Mycobacterium kansasii
Opinion statement Treatment of pulmonary infections caused by Mycobacterium avium complex (MAC) and Mycobacterium kansasii involves multidrug oral therapy with a macrolide (azithromycin or clarithromycin), ethambutol, and a rifamycin (rifampin or rifabutin). Patients with M. kansasii rapidly respond to a regimen of intermittent (three times weekly) or daily administration of this three-drug regimen. Patients with MAC respond more slowly and often require adjustment of the multidrug regimen because of drug intolerance. The usual treatment for patients with MAC nodular disease takes 15–18 months, with a g...
Source: Current Treatment Options in Infectious Diseases - October 16, 2014 Category: Infectious Diseases Source Type: research

Current Treatment Options in Tuberculosis
Opinion statement Tuberculosis (TB) is a leading cause of morbidity and ranks among the ten most common causes of death worldwide. Due to the wide range of clinical pictures TB can cause, diagnosis is often difficult and, especially in low-incidence countries, is sometimes underestimated. Therefore, it is important to consider the diagnosis of TB, especially in immunocompromised patients, and contact TB experts if diagnosis is unclear. Since the emergence of resistant strains is increasing, it is important to test resistance once TB is diagnosed. A drug-susceptible TB is treated with a standard 6-month ch...
Source: Current Treatment Options in Infectious Diseases - October 4, 2014 Category: Infectious Diseases Source Type: research

Use of Intravenous Immunoglobulin in Critically Ill Patients
Opinion statement Intravenous immunoglobulin (IVIG) has been suggested for the treatment of many ailments due to its ability to modulate the immune system and to provide passive immunity to commonly circulating pathogens. Its use as primary and adjunctive therapy for the treatment of conditions affecting critically ill patients is an attractive option, especially when alternative therapy does not exist. The body of literature on the use of IVIG for the treatment of several serious conditions, including sepsis, toxic shock syndrome, acute myocarditis, Stevens-Johnson syndrome, toxic epidermal necrolysis, a...
Source: Current Treatment Options in Infectious Diseases - September 20, 2014 Category: Infectious Diseases Source Type: research

Epidemiology and Treatment of Multidrug-Resistant Acinetobacter baumannii
Opinion statement Multidrug-resistant Acinetobacter baumannii (MDRAB) is a global threat and a frequent cause of serious nosocomial infections, such as ventilator-associated pneumonia, bacteremia, or meningitis. When available, carbapenems are the first-line treatment, at least for severe infections. Due to its efficacy and narrow spectrum, we consider sulbactam to be the best choice for carbapenem-resistant A. baumannii (CRAB). Unfortunately, susceptibility to sulbactam is unusual among these strains. Colistin should be reserved for treating infections produced by A. baumannii resistant to both carbapene...
Source: Current Treatment Options in Infectious Diseases - September 12, 2014 Category: Infectious Diseases Source Type: research

HIV Treatment
Opinion Statement How would we treat this disease? The outlook for people living with HIV (PLWH) has been transformed by the availability of effective antiretroviral therapy. Vast improvements in drug efficacy, tolerability, safety and convenience have been achieved over recent years and in the UK, patients on suppressive treatment with immune reconstitution have the same life expectancy as the general population. A number of well-researched guidelines for initial HIV therapy form the foundation for HIV treatment decisions. Across the board recommended first-line therapy consists of ...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Treatment Options in Invasive Aspergillosis
Opinion statement Aspergillus species are septated molds that cause a wide spectrum of clinical syndromes. Among these, invasive aspergillosis (IA) causes very high morbidity and mortality among the most severely immunosuppressed, especially those with profound qualitative or quantitative neutropenia. Empirical, pre-emptive, and targeted approaches have been attempted to blunt establishment of infection with variable success. The preferred treatment of primary IA is voriconazole, which has been found to be superior to amphotericin B. Azoles interfere with the synthesis of ergoster...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Approach to the Diagnosis of Histoplasmosis, Blastomycosis and Coccidioidomycosis
Opinion statement The consequences of failing to consider the diagnosis of an endemic fungal infection may be catastrophic. The diagnosis can be made most rapidly by microscopic examination of tissues or by antigen detection in body fluids. These methods are recommended in patients with evidence for acute pulmonary disease, in patients with findings that are concerning for progressive and/or disseminated infection, and in those who are ill enough to require hospitalization. Antibody detection is most sensitive when using enzyme-linked immunoassay methods. However, antibody assays may be falsely negative...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Dengue: Moving from Current Standard of Care to State-of-the-Art Treatment
Opinion statement Treatment of dengue remains supportive in the absence of targeted antiviral therapy or approved vaccines. Responsive fluid management is key to preventing progression to shock or other severe manifestations. The dynamic natural history of dengue infection and its influence on hemodynamic homeostasis needs to be carefully considered in the planning of individualized therapy. Though largely self-limiting, the sheer burden of dengue disease on the global population will result in atypical manifestations especially in children, older adults, and comorbid patients. Management of these has n...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Therapy of AIDS-Related Cryptococcal Meningitis
Opinion statement Cryptococcal meningitis is a common and severe opportunistic infection in advanced HIV, with the highest burden of disease in resource-poor settings in sub-Saharan Africa. It is invariably fatal if left untreated, and carries a high mortality even with treatment. High fungal burden, raised intracranial pressure, and reduced level of consciousness at presentation are associated with poorer outcomes. The recommended treatment strategy consists of a two-week induction phase, then eight weeks of consolidation therapy, followed by long-term maintenance therapy until restoration of immune fu...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Cytomegalovirus Treatment
Opinion statement In treating cytomegalovirus (CMV) infection, it is crucial to decide whether one is treating pre-emptively or if one is treating established disease. Disease may be further divided into viral syndrome and tissue-invasive disease. Generally, mild disease in immunosuppressed patients may be treated with oral valganciclovir. Treatment may also be started with valganciclovir for CMV retinitis in AIDS patients. In other tissue-invasive syndromes, starting with intravenous ganciclovir or foscarnet at full doses (adjusted for renal function) is preferred. Treatment at full doses should be con...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Seasonal Human Influenza: Treatment Options
Opinion statement Seasonal influenza can be a self-limiting illness in healthy individuals but is associated with short-term morbidity and economic burden. Influenza can cause significant morbidity and mortality in young children, the elderly, pregnant and post-partum women, patients with co-morbidities and the immunocompromised. Neuraminidase inhibitors (NAIs) are the treatment of choice for influenza due to widespread resistance to the adamantanes. NAIs are efficacious for the treatment of influenza in ambulatory patients with mild illness, when initiated within 48 h of symptom onset. Early treatment...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Clinical Management of Viral Hemorrhagic Fevers
Opinion statement Viral hemorrhagic fever is a severe potentially fatal infectious disease. The human to human transmission risk poses a serious public health threat. In an age of increasing tropical travel and greater interaction with animal eco-systems this threat is significant. The threat of viral hemorrhagic fevers as a method of biological warfare has created greater interest especially in areas of treatment options. There is increasing evidence that aggressive goal directed supportive treatment is essential in preventing morbidity and mortality. Directed specific anti-viral therapy is recommended...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Use of Intravenous immune globulin in Critically Ill Patients
Opinion statement Intravenous immune globulin (IVIG) preparations have been suggested for many years for the treatment of various conditions. It is apparent, through in vitro and in vivo studies, that IVIG exerts potent anti-inflammatory and immunomodulatory effects. However, the mechanism of action remains mostly unknown. The following article reviews the current literature and summarizes what is known about the mechanism of action of IVIG and the use of IVIG to treat certain conditions. Specifically, the use of IVIG for treatment of critically ill patients is outlined. (Source: Current Treatment Optio...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research

Outcome Assessments in Clinical Trials of Cryptococcal Meningitis: Considerations on Use of Early Fungicidal Activity as a Potential Surrogate Endpoint for All-Cause Mortality
Opinion statement Cryptococcal meningitis (CM) is a common disease in resource-challenged settings, with a high mortality within weeks of disease onset. Mortality remains high with current treatments, so more effective interventions are needed to decrease mortality. There has been interest in using the outcome assessment of quantification of fungus from cerebrospinal fluid as a replacement (surrogate) endpoint for all-cause mortality (ACM) as a means of decreasing sample size in randomized clinical trials in CM. To evaluate a biomarker as a potential surrogate endpoint to replace ACM requires several st...
Source: Current Treatment Options in Infectious Diseases - September 1, 2014 Category: Infectious Diseases Source Type: research