Category: Infection

Zurijeta / iStock A new meta-analysis of 11 studies reveals a 3.4% estimated prevalence of respiratory syncytial virus (RSV) infection during pregnancy, but with a wide range in estimates, according to a study published yesterday in The Journal of Infectious Diseases. The analysis comes during a year in which RSV has been the target of new vaccines and monoclonal antibody therapies. Though a mild respiratory illness in most adults, the virus can be severe in infants under 6 months of age, the elderly, and pregnant women. The meta-analysis, which looked for studies of reparatory illnesses in pregnancy, included 11 studies with pregnant women recruited from 2010 to 2022, for a total of 8,126 patients. The proportion of pregnant women with respiratory infections who tested positive for RSV ranged from 0.9% in a study in South Africa to 10.7% in a study conducted in Thailand, with a meta-estimate of 3.4% (95% confidence interval [CI], 1.9% to 54%). Few hospitalizations, no deaths The estimated incidence rate of prenatal RSV infection was 2.1 (95% CI, 1.3 to 3.0) per 1,000 person-months or 26.0 (95% CI, 15.8 to 36.2) per 1,000 person-years, the authors said. Hospitalizations were uncommon, and no RSV-associated deaths were observed. “Hospitalizations were uncommon, and no RSV-associated deaths were observed. Based on limited data from three studies, the odds of stillbirths, miscarriage, low birth weight, and small for gestational age did not differ between pregnant individuals who had antenatal RSV infection compared to those who did not,” the authors wrote. Some studies, however, showed increased odds of preterm delivery in pregnancies affected by RSV (3.6; 95% CI, 1.3 to 10.3). More studies should be conducted, the authors said, especially as maternal RSV vaccines are rolled out later this year.

Urinary tract infection (UTI) is a common health concern, with roughly 40% of women in the United States experiencing one at some point. This article will explain what UTIs are and what causes them. You’ll also learn about the symptoms of UTIs, how they affect men and women differently, and available treatment options. What is a urinary tract infection (UTI)? A urinary tract infection (UTI) occurs when harmful bacteria invade any part of the urinary system, including the kidneys, ureters, bladder and urethra, according to the Mayo Clinic. In most cases, UTIs affect the lower urinary tract, specifically the bladder and urethra. It’s important to note that women are more susceptible to UTIs than men. While a bladder-based infection can be painful and bothersome, it can lead to more severe health complications if left untreated and spread to the kidneys. How do you get a UTI? Urinary tract infections (UTIs) are primarily caused by microorganisms, typically bacteria, the Cleveland Clinic explains. These invaders often enter through the urethra and may infect the bladder. Left unchecked, the infection can ascend from the bladder, using the ureters as a pathway, eventually reaching the kidneys. This progression underscores the importance of timely treatment to prevent more serious complications. UTI causes Urinary tract infections (UTIs) can cause a range of uncomfortable symptoms, which can vary in intensity. If you’re experiencing any of the following, it might be a UTI: Pain in the abdomen, pelvis or lower back Pressure in the lower part of your pelvis Cloudy or foul-smelling urine Urinary incontinence Frequent urination Pain while urinating (dysuria) Blood in your urine (hematuria) Other UTI-associated symptoms, according to the Cleveland Clinic, may include: Pain in your penis Fatigue Fever Chills Nausea and vomiting Mental changes or confusion UTIs during hospitalization Urinary tract infection (UTI) is a prevalent hospital-acquired infection. Many of these infections are linked to use of urethral catheters, slender tubes placed into the bladder via the urethra to facilitate urine drainage. The U.S. Centers for Disease Control and Prevention estimates that 75% of UTIs contracted in the hospital are associated with urinary catheters. Between 15% and 25% of hospitalized patients have catheters. Prolonged catheter use is a chief risk factor for developing a catheter-associated UTI (CAUTI). UTI symptoms The symptoms of urinary tract infections (UTIs) can vary slightly depending on whether the infection occurs in women or men. UTI symptoms in women Urinary tract infections (UTIs) can show up differently in women compared to men. The U.S. Office on Women’s Health (OASH) lists these as common symptoms: Painful or burning sensation while urinating Frequent urges to urinate, with minimal urine output Pressure in the lower abdomen Foul-smelling or cloudy urine Blood in the urine (more prevalent in younger women) Fatigue, confusion or weakness (more common in older women) Fever, indicating potential kidney involvement — seek medical attention promptly if this occurs. “Some of these symptoms, such as a burning sensation during urination, can overlap with the symptoms of other vaginal infections, such as yeast infections — which are treated very differently from UTIs,” Houston Methodist Hospital urologist Dr. Chris Kannady writes in a hospital website. UTI symptoms in men While most urinary tract infections (UTIs) are diagnosed in women, in men over 50, an enlarged prostate can impede urine flow. That increases the risk that the bladder won’t empty completely and increase bacterial growth, Harvard Medical School explains. Cystitis (a bladder infection) is more common in men who are uncircumcised or who engage in anal intercourse. Other factors adding to men’s UTI risk include narrowing of the urethra and use of non-natural substances like rubber catheters. Here are some symptoms of UTI to watch for: Frequent urination beyond the usual Intense urge to urinate Pain, discomfort or a burning sensation during urination Waking up during the night to urinate Pain, pressure or tenderness in the lower abdomen Bedwetting in someone who usually stays dry at night Cloudy or foul-smelling urine Fever, with or without chills Nausea and vomiting Pain in the side or upper back UTI treatments Consult a health care provider to discuss how to get rid of a UTI. Antibiotics are necessary, chosen to combat the specific bacteria causing the infection. Once prescribed, follow the antibiotic regimen to the letter. Completing the full course, even if symptoms improve, is crucial to prevent a recurrence that may be harder to treat. In cases of recurring UTIs, a health care provider may suggest an antibiotic course occurring: Daily Every other day After sexual activity At the earliest sign of symptoms UTI medicine The Cleveland Clinic explains that health care providers often recommend various antibiotics for UTIs, including: Nitrofurantoin Sulfonamides, like sulfamethoxazole/trimethoprim (sulfa drugs) Amoxicillin Cephalosporins, such as cephalexin Doxycycline Fosfomycin Quinolones, for instance, ciprofloxacin or levofloxacin Living with a UTI Besides following your health care provider’s treatment plan, some lifestyle adjustments can enhance your physical and emotional wellness. Stay hydrated, empty your bladder often, and consider using a heating pad to alleviate discomfort. These simple habits can help you navigate the challenges of living with a UTI while on your path to recovery. Resources Cleveland Clinic: Urinary Tract Infections Harvard Medical School: Urinary Tract Infection in Men Houston Methodist: When to See a Doctor for a Urinary Tract Infection (UTI) Mayo Clinic: Urinary tract infection (UTI) U.S. Office on Women’s Health (OASH): Urinary Tract Infections StatPearls: Urinary Tract Infection U.S. Centers for Disease Control and Prevention: Catheter-Associated Urinary Tract Infections (CAUTI)

A cohort study examining the risk of hepatitis B virus (HBV) reactivation in people with HIV who switch to antiretrovirals (ARV) that don’t provide dual protection found that the overall risk is low, even among those with a positive hepatitis B core antibody. The results were presented by Rachel V. Denyer, MD, MRCP, of the Washington DC VA Medical Center and George Washington University, during a session at IDWeek 2023, taking place October 11-14, in Boston, Massachusetts. New ARVs introduced in the last 10 years, including dolutegravir-rilpivirine and long-acting injectable cabotegravir-rilpivirine, are becoming a preferred treatment for people with HIV, however; this discontinuation of drugs like tenofovir that include nucleos(t)ide reverse transcriptase inhibitors (NRTIs) that have dual activity against both HIV and HBV put individuals at risk of HBV reactivation. To better understand this risk, Denyer and colleagues used data from 60,290 people with HIV enrolled in the Veterans Aging Cohort Study to identify HBV reactivation in cAb-positive people with HIV who switched from ARV with HBV activity (AHB+) to regimens without HBV activity (AHB-). Key Takeaways Low Risk of HBV Reactivation: HBV reactivation in people with HIV who switched to ARVs lacking dual protection against both HIV and HBV is generally low, even among those with a positive hepatitis B core antibody. Subgroup Differences: People with a positive hepatitis B surface antibody had a lower risk of reactivation in some cases. Patient-Provider Counseling: It’s important that providers discuss HBV reactivation risk when considering switching ARV regimens. It’s also advised that hepatitis serology results be reviewed prior to the switch. Overall, 7,860 individuals were identified who switched to AHB- regimens prior to December 31, 2022, and had prior positive cAb but negative hepatitis B surface antigen (sAg) prior to the switch. People with HIV with active HBV infection (positive sAg or detectable hepatitis B DNA before switching) were excluded, leaving 7,081 participants for analysis. The study also included people with HIV with a history of remote positive sAg who did not meet the criteria for active HBV infection. HBV reactivation was defined as the detection of hepatitis B DNA or sAg. The AHB+ regimens included lamivudine, emtricitabine, and/or tenofovir. Among people with HIV with positive cAb (n=115) who switched to AHB- regimens, HBV reactivation occurred in 1.6% of cases. Subgroup analyses revealed significant differences in reactivation risk between individuals with no prior positive sAg and those with a history of remote positive sAg (1.0% vs. 20.2%, P <.0001). Among people with HIV with no prior positive sAg, those with a positive hepatitis B surface antibody (sAb) had a lower risk of HBV reactivation (0.4%) compared to those without positive sAb (1.1%), though the difference was not statistically significant (P = .065). In cases with remote prior positive sAg, no difference in reactivation risk was observed based on sAb status (P = .64). Overall, the risk of HBV reactivation following a switch from AHB+ to AHB- regimens in people with HIV who are cAb-positive without prior positive sAg is low. Still, the study underscores the importance of patient-provider discussion of HBV reactivation risk when considering switching ARV regimens. Additionally, the investigators noted that providers should be conducting a “pre-switch review of all prior hepatitis serology results” to further characterize HBV status in patients with HIV. Click here for more coverage of IDWeek 2023. REFERENCE Denyer RV, Tate JP, Benator DA, Lim JK, Weintrob A. Hepatitis B Reactivation in Persons with HIV with Positive Hepatitis B Core Antibody after Switching to Antiretroviral Therapy without Hepatitis B Activity. Presented at: IDWeek 2023. October 11-14, 2023; Boston, MA. Abstract 1026.

View Larger Image By Benjamin Waldrum Oct. 13, 2023 | Holly Maples, Pharm.D., a national expert on pediatric infectious diseases and antimicrobial stewardship, was recently named a fellow of the Pediatric Infectious Diseases Society (PIDS). PIDS is the world’s largest organization of professionals dedicated to the treatment, control and eradication of diseases affecting children. Fellows are those who have achieved professional excellence and provided significant service to the profession. Applicants must be nominated by their peers and meet specified criteria, including continuing identification with the field of pediatric infectious diseases, national or local recognition, and publication of their work in strong biomedical journals. Nominees are reviewed and elected by the PIDS Board of Directors. Maples was one of 24 PIDS fellows named from the United States and around the world. She is an associate professor in the UAMS College of Pharmacy’s Department of Pharmacy Practice and is a board-certified pharmacist in infectious diseases. She is a clinical pharmacist at Arkansas Children’s and directs the Antimicrobial Stewardship Program there, which she established in 2007. In 2011, she was named the inaugural holder of the Jeff and Kathy Lewis Sanders Distinguished Chair in Pediatric Pharmacy. “PIDS fellows are national and international leaders in pediatric infectious diseases. Their expertise affects children not only globally, but also at the local level in their research teams, clinics, hospitals and communities,” said PIDS President C. Buddy Creech, M.D., MPH. “Fellowship in PIDS is one way of recognizing these accomplished physicians, educators, policymakers and scientists for their important contributions to our field.” Maples also helped establish a foundation in the state for antimicrobial stewardship, which teaches responsible use of antimicrobial medicines to effectively treat infections, reduce overuse and combat resistance. Antimicrobials are medicines used to prevent and treat infections in humans, animals and plants. However, antimicrobial resistance occurs when viruses and bacteria no longer respond to medication, making infections harder to treat. It is a growing global threat to human health, according to the World Health Organization. “Antimicrobial stewardship is about ensuring that we are selecting the right antibiotic at the right dose for the right duration to optimize efficacy, prevent toxicity and minimize resistance,” Maples said. “I was initially drawn to this work early in my career through some amazing pediatric infectious diseases physicians. That was my foundation when I began the Antimicrobial Stewardship Program at Arkansas Children’s. I am truly honored to be one of the first pharmacists selected as a PIDS fellow.” “The PIDS fellow designation truly highlights Dr. Maples’ national prominence in the area of pediatric antimicrobial stewardship,” said Amy Franks, Pharm.D., professor and chair of the Department of Pharmacy Practice. “She is one of only two pharmacists in the country to obtain this national recognition, and it is a well-deserved honor.” “We are so fortunate to have Dr. Maples as a part of our team here and I’m really looking forward to all that we will continue to build together in antimicrobial stewardship,” said Jessica Snowden, M.D., professor and division chief of the Pediatric Infectious Disease Division and vice dean for research at Arkansas Children’s. “This well-deserved honor speaks to her tremendous national reputation as a leader in pediatric antimicrobial stewardship.” Maples joined the College of Pharmacy in 2003 and established a clinical pharmacy practice at Arkansas Children’s. In 2006, she developed a program between both organizations training pediatric pharmacy practitioners in the care and management of pediatric patients with infectious diseases. In 2010, she established a pediatric infectious disease and antimicrobial stewardship residency program, which became a fellowship program in 2015. Maples earned her Doctor of Pharmacy degree from Ohio Northern University in Ada, Ohio, in 2000 and completed a residency in pediatric pharmacy practice at Spectrum Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan in 2001. She completed a pediatric pharmacology fellowship at UAMS and Arkansas Children’s in 2003.

Elena Elisseeva/iStock The Journal of Infectious Diseases has posted a prospective study showing that 40% of a group of college-aged women in Quebec had human papillomavirus (HPV) infections within 2 years of starting a heterosexual relationship. A McGill University-led research team tested vaginal samples from 502 women aged 18 to 24 years self-collected at six university clinic visits over 2 years for 36 types of HPV from 2005 to 2011. The women, who had begun a sexual relationship with a man within the past 6 months, also completed questionnaires on sociodemographic factors and sexual behavior. Persistent HPV infections cause most precancerous cervical lesions and cancers. While most infections in young women resolve, some persist, and a large proportion of “incident” cases in older women are reactivations of previous infections, the study authors said. Cervical cancer highly preventable with HPV vaccine By 2 years, new-onset HPV infections were detected in 40.4% of the women. Subgenus 1 infections (43.4%), subgenus 2 (47.1%), and subgenus 3 (46.6%) infections cleared at similar rates per 1,000 infection-months, and infections present at baseline cleared at comparable rates as incident infections. HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections persist longer than their low oncogenic risk subgenera 1 and 3 counterparts. “Our analyses of individual HPV types and our HPV-level group analyses provide descriptive natural history estimates for cervical cancer prevention planning,” the researchers wrote. “HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections persist longer than their low oncogenic risk subgenera 1 and 3 counterparts.” They noted that cervical cancer, which made up 3.1% of the global cancer burden in 2020, is highly preventable through the use of the HPV vaccine introduced in 2006. The vaccine “prevents infection with HPV types found in 89.5% of invasive cervical cancers, and molecular HPV testing is an efficacious screening strategy,” they wrote.

FRIDAY, Oct. 13, 2023 (HealthDay News) — Wastewater (WW) surveillance allows monitoring of endemic respiratory viral infections, according to a study presented at the annual meeting of the Infectious Diseases Society of America (IDWeek), held from Oct. 11 to 15 in Boston. Kristine Du, from the Cumming School of Medicine at the University of Calgary in Alberta, Canada, and colleagues examined the occurrence of influenza A (IAV), influenza B (IBV), and respiratory syncytial virus (RSV) RNA in WW treatment plants (WWTPs) in Alberta’s largest city and the correlation with clinical disease. Twenty-four-hour composite WW samples were collected weekly from three WWTPs in Calgary between March 2022 and April 2023. WW was concentrated and RNA was extracted. Viral RNA was quantified using a commercial TaqMan assay. A composite city-wide metric for each target was created using flow rates at each WWTP. The researchers observed peaks in IAV, IBV, and RSV in Calgary’s WW for November to December 2022, February to April 2023, and November 2022 to February 2023, respectively. There was a positive correlation seen for the composite IAV signal with weekly confirmed clinical cases within the Calgary Zone, which was seen regardless of influenza typed as H3N2 or H1N1 or untyped. Across the entire province, specimen test positivity rates correlated with Calgary’s WW measured IAV. Across the entire province, the IBV WW signal correlated with clinical cases and test positivity rates. Across Alberta, Calgary’s RSV WW correlated with clinical cases and test positivity rates. #placement_588494_0_i{width:100%;margin:0 auto;} “Knowing what viruses are coming down the pike can help prepare individuals and communities appropriately,” Du said in a statement. Press Release More Information

The Denver Zoo’s African lion pride leader was euthanized Wednesday after a severe infection spread to his lung and bones, the Zoo announced Thursday. Tobias, the seven-year-old lion, had several other medical conditions, including inflammatory bowel disease and chronic kidney disease, when the veterinary team at the Helen and Arthur E. Johnson Animal Hospital found the infection. “Our Animal Care Specialists and Veterinary Medicine team made the difficult decision to euthanize Tobias to relieve any suffering given the poor prognosis,” a post of the Denver Zoo’s Facebook page stated. Tobias was born at the Buffalo Zoo in 2016 and moved to the Denver Zoo in 2018 as part of a species survival plan to join Denver’s pride and support conservation efforts. Tobias had three adorable cubs at the Denver Zoo, Tatu, Oskar and Araali, and his care team said he was a great father. “He was an incredible father who enjoyed playing, snuggling and teaching his offspring everything they needed to know about how to be a lion,” according to the post. The remaining members of the pride are still doing well, but animal care specialists will closely monitor Araali, Neliah, Kamara, and Sabi over the next few weeks, zoo officials said.

Groups beyond men having sex with men (MSM) need increased post-exposure prophylaxis (PrEP) awareness and improved accessibility to reduce new infections, according to a Lancet HIV editorial.1 With the UN Global AIDS Update revealing that HIV infection reduction goals are coming up short, more needs to be done to increase awareness and accessibility to prevent new infections. In 2022 there were 1.3 million new cases of HIV. There was a modest reduction of 200,000 cases in 2022 compared with 2021, but this falls short of the 370,000 case reduction goal for 2025.2 Reducing infections requires expanding PrEP education and accessibility beyond traditionally targeted groups like MSM, where PrEP has been quite successful in reducing infections, the editorial stated. Other populations are seeing a rise in infections, such as women. And while new PrEP method such as the dapivirine vaginal ring and the long-acting injectable cabotegravir are available, rates of PrEP usage are lower in women. “Information and choice are particularly important for women, who in a country such as the USA comprise 18% of new HIV diagnoses but represent only 8% of PrEP users,” the editorial noted. Regulatory requirements in various countries also slow the new methods of PrEP uptake, such as in South Africa where the product packaging does not meet regulatory requirements. Supply and cost are also a barrier, and delays for the vaginal ring have also been caused by post-importation testing, the editors wrote. Another barrier is political undermining of reproductive health matters throughout the world. According to the editorial, while the US was the first country that approved oral PrEP in 2012, in July the PrEP Coverage Act, which would provide zero-cost coverage for both insurance payers and establish a national grant program for the uninsured, was blocked by a Texas federal judge who said the act violates private companies’ religious freedom. “The ruling casts a grave shadow over Americans’ access to HIV prevention,” the editors wrote. Pragna Patel, MD, MPH, chief medical officer and senior medical and science advisor in the Coronavirus and Other Respiratory Viruses Division (CORVD) at the Center for Disease Control and Prevention, spoke with Drug Topics® about PrEP awareness and accessibility. She said that the dapivirine vaginal ring and long-acting injectable cabotegravir can help overcome stigmas and barriers for preventing HIV in women in places with high HIV rates where discretion is vital, such as sub-Saharan Africa. “They are more discreet than carrying a bottle of pills that can jiggle in a bag which are hard to keep private,” she said. “In sections of the US, women and girls may have similar challenges, especially in conservative states where sex outside of marriage is frowned upon and women may also need to be discreet,” Patel noted. She said patients need to be educated at all points of care, and pharmacists are uniquely positioned to reach women and adolescents in ways traditional providers are not. Patel told Drug Topics® that pharmacists can increase awareness and accessibility for PrEP because the healthcare system is increasingly relying on them during drug shortages and regulatory challenges. “Point of care for sexually transmitted diseases is shifting more and more to pharmacies which can offer another opportunity for patients to learn about PrEP,” she said. The pharmacist role is becoming even more important due to the burden on the healthcare system, Patel said. Considering recent legal challenges to gender affirming and reproductive healthcare, pharmacists play an essential part to help marginalized populations have access to HIV prevention, Patel noted. “Pharmacists have a voice and a place to communicate on patients’ behalf,” Patel said. “They can advocate for patient care at the pharmacy where they can be engaged in ways providers aren’t. They may have better understanding about the need for PrEP, particularly for adolescents who may feel they don’t have the same level of privacy at a provider’s office.” References 1. Bridging accessibility gaps in HIV prevention. Editorial. Lancet HIV. 2023;10(8):e485. doi:10.1016/S2352-3018(23)00180-7 2. Joint United Nations Programme on HIV/AIDS (UNAIDS). The path that ends AIDS: 2023 UNAIDS Global AIDS Update. Geneva: Joint United Nations Programme on HIV/AIDS, 2023.https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update_en.pdf. Accessed August 17, 2023.

Seven children are hospitalized, including four who are seriously ill, following a field trip to an animal exhibit in Northeast Tennessee, officials said Friday. Students from Washington and Sullivan counties visited an animal exhibit at the Appalachian Fairgrounds on September 26-27. Since then, several cases of illness caused by Shiga-toxin-producing E. coli have been reported. Here is a statement from Regional Medical Officer for the Northeast Regional Health Office, Dr. David Kirschke, MD: The Northeast Regional Health Office and the Sullivan County Health Department are investigating cases of illness caused by Shiga-toxin-producing E. coli (STEC) among elementary school children in Washington and Sullivan counties. These illnesses occurred after some classes visited an animal exhibit at the fairgrounds on September 26 and 27. So far, 7 children have been hospitalized and 4 are seriously ill with complications.

Traffic police personnel takes a water break on a hot day at CSMT, Mumbai. (SL Shanth Kumar/BCCL Mumbai) Friday, October 13: In Mumbai, October ushers in a peculiar weather shift, marking the transition from monsoon to winter. While Mumbaikars are no strangers to this ‘second summer’, the onset of what locals call ‘October heat’ has been particularly intense this year. After the southwest monsoon graciously bowed out of the city on October 6, a swift return of hot and dry weather has Mumbaikars sweltering, coughing and more. Throughout this week, the mercury levels have been consistently high, with maximum temperatures dancing between 34-36°C. This surge in heat is more than 2°C above Mumbai’s typical average of 32.7°C for this time of the year. The culprit behind this warmth is the arrival of easterly winds, ushering in dry air that’s keeping the heat locked in. According to the India Meteorological Department (IMD), daytime highs of 34-36°C are predicted to persist throughout the weekend. Any respite is unlikely until the start of next week, when the maximum temperatures may finally stabilise around 33°C, per the IMD’s early projections. While the city bakes in this heat, the air quality has remained relatively steady, clocking in at a ‘moderate’ 111 on the air quality index (AQI) today. No major fluctuations in the AQI are expected for the next three days, providing a silver lining amidst the rising temperatures. Advertisement Unfortunately, the sweltering conditions have triggered a spike in cases of viral fever, dehydration, giddiness and heat stroke across the city. Civic, state and private hospitals have all reported an upswing in the number of people seeking treatment over the past week. Extreme heat can create ideal conditions for viruses to thrive, while simultaneously weakening the body’s immune response. This makes people more susceptible to fevers, colds and other viral infections. As Mumbai navigates these uncomfortable weather patterns, the old adage ‘prevention is better than cure’ certainly holds true. Therefore, avoid direct sunlight and limit outdoor activities during the noon and afternoon hours unless absolutely necessary. For those unavoidable outings, don’t forget your sunscreen, protective headgear and umbrellas. Keeping wet wipes on hand can offer a refreshing break from the heat. Hydration is key, so along with water, consider sipping on fruit juices, coconut water and buttermilk, as they offer a rich supply of essential vitamins and minerals. ** For weather and science updates on the go, download The Weather Channel App (on Android and iOS store). It’s free!