Emerging Issues and Controversies in Infectious Disease

Transcription

1 Emerging Issues and Controversies in Infectious Disease

2 Emerging Infectious Diseases of the 21st Century I.W. Fong Professor of Medicine, University of Toronto Infectious Diseases, St. Michael s Hospital For other titles in this series, go to: A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

3 I.W. Fong Editor Emerging Issues and Controversies in Infectious Disease

4 I.W. Fong Professor of Medicine University of Toronto St. Michael s Hospital 30 Bond Street Toronto ON M5B 1W8 Canada fongi@smh.toronto.on.ca ISBN e-isbn DOI: / Library of Congress Control Number: # Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper. springer.com

5 This book is dedicated to my wife, Cheryl, and to our grandchildren, Miranda and Aiden. v

6 Preface The past decade has been highlighted by numerous advances in medical scientific knowledge, medical technology, and diagnostic techniques but there have been fewer dramatic changes or improvements in the management of medical conditions. This volume in the Emerging Infectious Disease of the 21st century series, addresses some of the emerging issues and controversies in Infectious Diseases. The author has chosen these topics for review based on questions and contentions raised by medical residents, internists, emergency physicians, clinical infectious disease specialists, and family physicians. Hopefully the volume will provide guidance and answers to frequently asked questions in infectious disease to the generalists, specialists, and trainees in these areas, thus, facilitating improved patient care, prudent, and cost-effective management and investigation of these disorders. This volume reviews the diagnosis and treatment of some common infections facing clinicians and family physicians such as sinusitis, otitis media, and pertussis. Recent studies and surveys have shown that these conditions are often overdiagnosed and treated unnecessarily with antibiotics. The approach and guidelines for diagnosis and management are reviewed in this volume. Other more complicated but less common conditions challenging internists, clinical infectious disease consultants, and other specialists are also reviewed (i.e., meningitis, ventilator associated pneumonia, sepsis, hepatitis C, B, etc.). This book discusses current guidelines provided by various medical societies for various infections, and analyzes the evidence to support those guidelines as well as contentious issues. vii

7 Contents Section A: Bacterial and Fungal Infections 1 Issues in Central Nervous System Infections Bacterial Meningitis Introduction Pathophysiology of Meningitis Clinical Issues in Meningitis Adjunctive Therapy in Tuberculous Meningitis Background Treatment of Tuberculous Meningitis Adjunctive Therapy in Fungal Meningitis Background Future Directions References Emerging Issues in Head and Neck Infections Current Issues in Sinusitis Background Pathophysiology of Sinusitis Issues in Diagnosis of Bacterial Sinusitis Microbiology of Sinusitis Treatment of Acute Bacterial Sinusitis Management of Chronic Sinusitis Issues in Acute Otitis Media Clinical Practice Guidelines Future Directions References Section B: Emerging Trends in Pulmonary Infection 3 Current Issues in Ventilator-Associated Pneumonia Background Issues in the Diagnosis of VAP Microbiological Techniques for Diagnosis ix

8 x Contents New Diagnostic Methods for VAP Microbial Etiology of VAP Issues in Treatment of VAP Prevention of VAP Antibiotic Prophylaxis for Prevention of VAP Maintaining Gastric Acidity to Prevent VAP Methods to reduce Aspiration Ventilator Circuit and VAP Summary of Prevention Future Directions References Emerging Issues in Pulmonary Infections of Cystic Fibrosis Introduction Pathobiology of Cystic Fibrosis Microbiology Pseudomonas aeruginosa Late-Emerging Pathogens Stentotrophomonas and Alcaligenes Species Mycobacteria Species Aspergillus Species and Other Fungi Viral Infections Management of Infections in CF Infants with CF Antipseudomonal Therapy Maintenance Therapy Treatment of Pulmonary Exacerbation Treatment of Other Emerging Pathogens Prevention of Infections in CF Adjunctive Therapy for Pulmonary Exacerbation Anti-inflammatory Therapy Future Directions References Re-Emergence of Childhood Respiratory Infections in Adults (RSV & Pertussis) A: Respiratory Syncytial Virus infection in Adults Introduction Microbiology and Pathogenesis Immunity Epidemiology Management in Adults Prevention Future Directions References

9 Contents xi B: Pertussis in Adults Introduction Microbiology and Pathogenesis Immunity Epidemiology Diagnosis and Management Prevention Future Directions References Section C: New Concepts and Trends 6 New Concepts and Emerging Issues in Sepsis Introduction Definitions Immune Response Pathogenesis Hemodynamics Mechanisms Apoptosis of Immune Cells Immunoparalysis Tissue Oxygenation Coagulation Complement System ARDS in Sepsis Management in Sepsis Early Goal-Directed Therapy Antimicrobial Therapy in Severe Sepsis Activated Protein C Corticosteroids in Severe Sepsis Intensive Insulin Therapy Vasopressin and Vasopressors Blood Products in Sepsis Ventilation and Other Adjunctive Therapy Immunotherapies for Sepsis Genetics and Sepsis Future Directions Conclusion References Febrile Neutropenia: Management Issues Introduction Pathogenesis Febrile Neutropenia Definition Microbiology and Etiology

10 xii Contents Initial Antibiotic Therapy High-Risk Patients Choice of Monotherapy Duration of Therapy Empiric Antifungal Therapy Prevention Prophylactic Antibiotics Colony-Stimulating Factors Antifungal Prophylaxis Future Directions References Emerging Issues and Trends in Clostridium difficile Colitis Introduction Microbiology Pathogenesis Binary Toxin and New Hypervirulent Strains Clinical Aspects Antibiotic-Associated Diarrhea Risk Factors for CDAD Diagnosis Management Specific Therapy Recurrences of CDAD Prevention Future Directions References Probiotics in Infectious Diseases Introduction Background Mechanisms of Action Mucosal Integrity Colonization Resistance Inactivation of Microbial Toxins Immunomodulation Bacterial Translocation Clinical Application of Probiotics Probiotics for Newborns and Children Antibiotic-Associated Diarrhea Urogenital Infections Probiotics in Vaginitis Miscellaneous Infections Probiotics as Food Additives Adverse Effects of Probiotics

11 Contents xiii 9.7 Conclusion and Future Directions References Device-Related Infections Introduction Pathogenesis of Device-Related Infections Impairment of Local Defence Resistance to Antimicrobial Agents Specific Device-Related Infections Intravascular Devices Prevention of Central versus Catheter Infections Cardiovascular Device Infectious Cardiac Devices and Infections Trends in Prosthetic Valve Endocarditis Infections of ICD, LVAD and Pacemakers Vascular Grafts Future Directions References Current Concepts of Orthopedic Implants and Prosthetic Joint Infections Introduction Microbiological Aspects Diagnosis Clinical Presentation Management Basis of Medical Therapy Principles of Surgical Management Treatment Algorithm Issues with Antimicrobial Therapy Prevention of Orthopedic Device Infections Future Directions Conclusion References Combination Antimicrobial Therapies Introduction Bacterial Infections Bacterial Infective Endocarditis In Vitro Testing of Synergy Animal Models of Infective Endocarditis Clinical Trials in Bacterial Endocarditis Gram-Negative Bacilli Infections Community-Acquired Pneumonia

12 xiv Contents 12.3 Fungal Infections and Combination Therapy In Vitro Antifungal Combination Assays Antifungal Combinations for Candida species Combination Therapy for Cryptococcal Meningitis Combination Therapy for Invasive Aspergillosis Viral Infections Chronic Hepatitis C Infections Chronic Hepatitis B Virus Parasitic Infections Antimalarial Combination Therapies Filariasis Therapies Leishmaniasis African Trypanosomiasis (Sleeping Sickness) Conclusion Future Directions References Index

13 Acknowledgment I am very grateful to Winnie Yau for her secretarial and administrative assistance and to Maria Isabel Suarez, Bogusia Skucinska, and my wife (Cheryl) for their stenographic assistance in the preparation of this manuscript. I am also indebted to Carolyn Ziegler for her invaluable assistance in performing literature searches. xv