An ongoing dialogue on HIV/AIDS, infectious diseases,
September 25th, 2009
MRSA in Pets
As every card-carrying ID specialist knows, hardly anything is more common these days than patients with — and questions about — methcillin-resistant Staph aureus, or MRSA.
And one question I’ve been hearing increasingly these days is “Could I be getting my recurrent infection from Rufus?”
To which the answer is, unfortunately, yes.
(I had a dog named Rufus. No offense intended to people out there actually named Rufus.)
Now along comes this article in the New York Times, which no doubt will stimulate the economy by prompting massive sales of hand-sanitizers, plus a flurry of trips to the vet to have Otto cultured.
(That’s Otto — our cat — in the picture, FYI.)
The article is self-explanatory — pets get MRSA, they can spread it to their owners and back — but did they have to put this caption under the picture of the dog?
INFECTION Don Graff of Belle Mead, N.J., with his English setter, Sunny. The dog contracted MRSA after a spider bite [emphasis added] but was given medication and has improved.
Spider bite! If there’s one thing this medical writer should have figured out in her background research for the piece, it’s that MRSA infections are frequently mistaken for spider bites.
And I’d bet good money that Sunny (the English setter in the Times story) never had one — for which I’m sure he’s quite relieved.
September 24th, 2009
HIV Vaccine Study Shows Promise …
So says this press release by the US Military HIV Research Program:
A Phase III clinical trial involving more than 16,000 adult volunteers in Thailand has demonstrated that an investigational HIV vaccine regimen was safe and modestly effective in preventing HIV infection. According to final results released by the trial sponsor, the U.S. Army Surgeon General, the prime boost combination of ALVAC® HIV and AIDSVAX® B/E lowered the rate of HIV infection by 31.2% compared with placebo … In the final analysis, 74 placebo recipients became infected with HIV compared to 51 in the vaccine regimen arm. The efficacy result is statistically significant. The vaccine regimen had no effect on the amount of virus in the blood of volunteers who became HIV-infected during the study.
This is great news, of course; we’ve become so used to hearing gloom and doom about HIV vaccine studies that one can’t help but be excited, despite the relatively low (but statistically significant) rate of protection.
Still, one suspects such a combination vaccine could be logistically difficult to manufacture and administer , especially since one arm of the strategy employs the live-canarypox virus ALVAC vector, and 5 injections were required.
Plus there is the issue of cross-clade protection — the vaccine was designed to protect against the most common strains circulating in Thailand (B and E). While B is quite common in North America and Western Europe, is is far less so in Sub-Saharan Africa, where the HIV epidemic is the most severe.
Nonetheless, if you put this news along with the proven protective effects of male circumcision and HIV treatment — the latter I believe to be greatly underestimated by the medical and non-medical community — things are definitely looking up in the HIV prevention arena.
Further details on the study will be presented at the AIDS Vaccine Conference, October 19-22 in Paris — interestingly a return to the same city where HIV was discovered.
September 16th, 2009
News Flash: The Internet Cannot Replace an Actual Human
Interested in researching the cause of AIDS? Well go ahead and give NetBase Solutions’ healthBase a try, but don’t expect much in the way of filtering:
One of the most unfortunate examples is when you type in a search for “AIDS,” one of the listed causes of the disease is “Jew.” Really. The ridiculousness continues. When you click on Jew, you can see proper “Treatments” for Jews, “Drugs And Medications” for Jews and “Complications” for Jews. Apparently, “alcohol” and “coarse salt” are treatments to get rid of Jews, as is Dr. Pepper!
To be fair, the site seems to have cleaned up its act quite a bit since this report — here’s an example of a search I just did. Most of the results are now much more plausible, but there’s still some wacky stuff there. HIV is the number two cause of AIDS (number two?), and number five is “Abbott” — and I don’t they’re referring to the guy up there in the baseball uniform.
Look, I’m all for using the internet for medical information, and acknowledge I can barely function without it these days. But this kind of advanced search engine takes lots and lots of human oversight, and for now the swarm of medical data out there in web-land can be as misleading as it is vast.
(Hat tip to Graeme M for the link.)
September 12th, 2009
49th ICAAC Starts Today
Browsing through the program book, I see these topics extensively covered:
- H1N1 and seasonal flu, in all their glory — transmission, pathogenesis, treatment, predictions
- Highly resistant GNR — acinetobacter, carbapenemases, ESBL, etc.
- MRSA — my personal favorite
- C diff — though perhaps a little less this year?
While no one expects ICAAC to be an HIV-focused meeting, usually there are a few important papers presented — last year, for example, NA-ACCORD and raltegravir in treatment-naives debuted at ICAAC.
But unless I’m missing something, I don’t see anything this year on the HIV front of comparable importance. One year blip or a sign of the times?
(FYI, the CDA — that’s the California Dental Association — is also having a meeting here. Their meeting-goers have much better teeth than ID doctors/microbiologists.)
September 4th, 2009
For Suspected H1N1, Get Out the N95 Masks?
So says the Institute of Medicine’s recommendations for protection of health care workers:
Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators … Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations.
Every so often — well, more like constantly — my wife (the primary care pediatrician in full-time practice) reminds me what life is like seeing patients outside of a tertiary care, academic medical setting.
Her response to this recommendation to use N95 respirators for evaluation of all “influenza-like illness”?
Amazement, incredulity, bafflement, dismay. Seeing as waiting rooms of pediatricians’ offices in the winter are filled with kids with cough, runny nose, and fever, I can certainly understand her response. If these guidelines were followed literally, everyone in these offices would have to wear such a mask virtually all day — never mind the high cost and short supply of N95s, the logistics of fit-testing everyone, the effect on provider morale, etc.
In short, since following this recommendation is currently impossible, one possible response would be to refer all such patients to hospitals. Bad for everyone.
Let’s hope when the CDC reviews these guidelines, they can provide some more practical (i.e., actually do-able) advice for people in practice.
September 2nd, 2009
Etravirine Warning
From the FDA Advisory:
There have been postmarketing reports of cases of Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema multiforme, as well as hypersensitivity reactions characterized by rash, constitutional findings, and sometimes organ dysfunction, including hepatic failure. Intelence therapy should be immediately discontinued when signs and symptoms of severe skin or hypersensitivity reactions develop.
These rare — but potentially life-threatening — reactions have been reported with all the NNRTIs. From my extremely unsophisticated perspective (the less said about my biochemistry performance in med school the better), the molecular structure of these drugs look quite different.
So what is it with this drug class?
August 26th, 2009
Late Summer Odds and Ends: Circumcision, H1N1 Vaccine, Lyme Movie, etc.
A few ID/HIV items to cover before summer “unofficially” ends (Sept 1? Kids back at school? Labor Day?):
- Will US Public Health officials recommend infant male circumcision to prevent HIV? They might be considering such a move, but I suspect it will not be strongly promoted. After all, none of the studies demonstrating its efficacy have been done in developed countries, and the pattern of the US epidemic — predominantly gay men and women of infected male partners — excludes the very group circumcision has been shown to protect: circumcised heterosexual men. Look for lots of CDC-ese in these guidelines, with terms such as “consider” and “might choose” and “be offered.”
- Getting lots of questions from my patients about the H1N1 vaccine. Some decent interim answers here. When available? (Don’t know yet.) Who will get it? (The young, pregnant women, those at risk for severe flu) Will there be enough? (Maybe.) Will the regular flu vaccine still be needed? (Yes.) Will this season’s flu vaccination programs/clinics/sites be civilized affairs with minimal panic, anger, waiting lines, frustration? (I hope so, but the media will do their best to portray the situation otherwise.)
- Anyone see this movie on chronic Lyme? Would love to hear your impressions. I have not seen it — but this will definitely be a Netflix choice when it a appears on DVD. (Note that I did not link to Netflix; I’m a big fan, but they are the most egregious purveyors of annoying pop-up ads in the universe right now.)
- How’s this for a new definition of contagious? Be reassured: my little teaser photo has been thoroughly autoclaved.
Enjoy the sunshine …
August 20th, 2009
The V.A. Opts Out
Read all about it here:
As of August 17, 2009, written (signature) consent is no longer required for HIV testing in the VHA. Instead, patients will provide verbal informed consent prior to HIV testing. Furthermore, scripted pre-test and post-test counseling are no longer mandated.
Since the VA is the largest HIV provider in the nation — and has an exceptional electronic medical record/database — it will be fascinating to see how this policy influences new case detection, linkage to care, and whether there are any negative repurcussions.
Nice page of FAQs here. And though you’re sick of hearing from me on this issue, I totally agree with this move.
August 14th, 2009
Who Gets Toxoplasmosis in the United States?
This might seem bizarre, but one of the reasons I chose to go into Infectious Diseases as a field was the names of the diseases (and often the micro-organisms that caused them) sounded so darn cool.
For example, if you were a science fiction writer you could hardly come up with a better-sounding name for a mysterious disease than “toxoplasmosis.” Or its full name, “Toxoplasma gondii”.
Major Pribulon, I’d advise against taking your Colonial Defense Armada into Sector 18, Ambrilla Zone — I hear reports of a widespread outbreak of TOXOPLASMOSIS.
Wow, that sounds scary.
Anyway, from the only toxoplasma diagnostic reference lab in the United States — the one at Stanford, founded by Jack Remington, now headed by Jose Montoya — comes this fascinating paper on risk factors for acquiring toxoplasmosis in this country. It’s a case-control study using 148 newly-acquired cases from their serology lab, comparing them with 413 negative controls. Here are the significant risks:
- eating raw ground beef or rare lamb
- eating locally cured, dried, or smoked meat
- working with meat
- drinking unpasteurized goat’s milk
- having 3 or more (!) kittens
- eating raw oysters, clams, or mussels
Interesting that having 1 or 2 kittens was not a risk factor, and neither was gardening. Raw shellfish consumption is one I hadn’t heard before; there are several plausible explanations:
Oysters, clams, and mussels are filter feeders that concentrate T. gondii, as has been shown under experimental conditions. Sea otters in California have been found to be infected with T. gondii, and it is likely that they are often infected by eating mollusks, which filter T. gondii from seawater. The seawater in California is thought to be contaminated by T. gondii oocysts that originate from cat feces, survive or bypass sewage treatment, and travel to the coast through river systems.
And don’t forget: stay out of the Ambrilla Zone, Sector 18.
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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