Category Archives: Infections

chest_CT_TB

TB: Bronchoscopy or sputum collection?

Excluding tuberculosis

The situation

Excluding the possibility of tuberculosis is a common clinical situation. Older patients, chronic lung disease and increased use of immunosuppression increase the risk of tuberculosis reactivation and have created an increasingly common scenario where active contagious tuberculosis needs to be excluded quickly and with minimum inconvenience. Continue reading

An excellent review on the future developments of influenza vaccines

This review was published in the Nov 18th, 2010 issue of the New England Journal of Medicine. It does a great job detailing the vaccine production and some of the pitfalls in developing newer universal vaccines; influenza vaccines that do not require annual shots. It is a must read.

Seasonal Influenza Flu – How often do side effects occur?

Lately I have been approached several times about the incidence of fever post vaccination. Data suggests that it is a rare and benign issue at best. In a placebo controlled trials it was no more frequent than in the control group.

Placebo-controlled trials demonstrated that among older persons and healthy young adults, administration of TIV is not associated with higher rates for systemic symptoms

Therefore the presence of low grade fever or the concern for fever should not be a contraindication for vaccination.

Also of interest is the recurring concern for Guillian-barre. In this series there were no cases in over 4 million doses administered.

This is link to the 2010-11 summary of the reported adverse reactions to influenza vaccination.

Influenza vaccination reduces MI and stroke in elderly- a published study

Just another reason to have the elderly vaccinated every year with Influenza vaccine along with appropriate 23-valent pneumococcal vaccine (when is pneumovax given?).

This prospective study in Hong Kong observed readmission rates among 36,000 elderly patients. The study found statistically significant decrease in the number of deaths, pneumonia, strokes and myocardial infarctions among the studied population.

One may ask “What does a vaccine have to do with prevention of stroke or MI?”. The reasons are that this population is at risk for these stressful infections. The burden of these conditions (sepsis) can further stress a compromised elderly patient and can “push” them into a stroke or and MI. These vaccine may not even completely prevent the illnesses themselves but by reducing the stress of the illness can go a long way in reducing morbidity and mortality from other conditions such as MI and strokes.

Also of note that very few if any “side effects” that are often cited in the lay media were seen. If there were more side effects it should have been seen in the higher hospitalization rate. In fact the vaccinated group had lower death and hospitalization rates.

For more information read the reference:

1. Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.

Drug Safety and Availability > FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections

Drug Safety and Availability > FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections.

A must read notice published by the FDA. It appears that there is a trend towards statistical inferiority of tigecycline when compared to standard therapy with regards to ventilator associated pneumonia. It is also notable that it did not show better outcomes in any category when compared to standard therapy.

This by no means indicates that tigecycline is an inferior drug but merely that it is about as good as other standard therapy on the market. Yes; it is a broader coverage drug similar to imipenem. But contrary to popular belief among my fellow colleagues, broader coverage drug not always equate with better drug or even a better outcome.

Keeping the coverage appropriate to the condition being treated using a drug that achieves appropriate serum levels at the site of the infection under the conditions currently present (pH, low O2 concentrations, neutropenia) will achieve optimal results.