Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study

Bielaszewska M et al; Lancet Infectious Diseases, 2011; 11: 671-676.

Background: In an ongoing outbreak of haemolytic uraemic syndrome and bloody diarrhoea caused by a virulent Escherichia coli strain O104:H4 in Germany (with some cases elsewhere in Europe and North America), 810 cases of the syndrome and 39 deaths have occurred since the beginning of May, 2011. We analysed virulence profiles and relevant phenotypes of outbreak isolates (from 80 patients) recovered in our laboratory.

Interpretation: Augmented adherence of the strain to intestinal epithelium might facilitate systemic absorption of Shiga toxin and could explain the high progression to haemolytic uraemic syndrome. This outbreak demonstrates that blended virulence profiles in enteric pathogens, introduced into susceptible populations, can have extreme consequences for infected people.

The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever

Jentes ES et al; Lancet Infectious Diseases, 2011; 11: 622-632. Talk with Peter Hayward, editor Lancet ID

The changing epidemiology of yellow fever and continued reports of rare but serious adverse events associated with yellow fever vaccine have drawn attention to the need to revisit criteria for the designation of areas with risk for yellow fever virus activity, and to revise the vaccine recommendations for international travel. WHO convened a working group of international experts to review factors important for the transmission of yellow fever virus and country- specific yellow fever information, to establish criteria for additions to or removal from the list of countries with risk for yellow fever virus transmission, to update yellow fever risk maps, and to revise the recommendations for vaccination for international travel. This report details the recommendations made by the working group about criteria for the designation of risk and specific changes to the classification of areas with risk for transmission of yellow fever virus.

Interview with Pr. Philippa Musoke (Uganda) concerning the HIV prevention and treatment in mothers and children in resources limited countries during the International Conference organized by the International AIDS Society in Rome (17-20 July 2011).

Summary of The Lancet ( Jul 16, 2011 Vol 378, N. 9787, Pages 199 - 288) dedicated to HIV infection in view of the 6th Conference of the International AIDS Society (Rome, 17-20 july 2011)

New Regimens to Prevent Tuberculosis in Adults with HIV Infection (Martinson NA et al, N Engl J Med 2011; 365:11-20): "On the basis of the expected rates of tuberculosis in this population of HIV-infected adults, all secondary prophylactic regimens were effective. Neither a 3-month course of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was superior to 6 months of isoniazid."

Primary Isoniazid Prophylaxis against Tuberculosis in HIV-Exposed Children (Madhi SA et al., N Engl J Med 2011; 365:21-31): "Primary isoniazid prophylaxis did not improve tuberculosis-disease–free survival among HIV-infected children or tuberculosis-infection–free survival among HIV-uninfected children immunized with BCG vaccine. Despite access to antiretroviral therapy, the burden of tuberculosis remained high among HIV-infected children."

Lancet Infectious Diseases, July 2011: Consequence of HIV infection on malaria and therapeutic implications: a systematic review (Clara Flateau, Guillaume Le Loup, Gilles Pialoux, Lancet ID 2011; 11: 541–556)
Despite recent changes in the epidemiology of HIV infection and malaria and major improvements in their control, these diseases remain two of the most important infectious diseases and global health priorities. As they have overlapping distribution in tropical areas, particularly sub-Saharan Africa, any of their clinical, diagnostic, and therapeutic interactions might have important effects on patient care and public health policy. The biological basis of these interactions is well established. In this systematic review, we collate data on the effects of HIV on malaria and discuss their therapeutic consequences. HIV infection is associated with increased prevalence and severity of clinical malaria and impaired response to antimalarial treatment, depending on age, immunodepression, and previous immunity to malaria. HIV also aff ects pregnancy-specific immunity to malaria and response to intermittent preventive treatment. Co-trimoxazole prophylaxis and antiretroviral treatment reduce occurrence of clinical malaria; however, these therapies interact with antimalarial drugs, and new therapeutic guidelines are needed for concomitant use.

Lancet Infectious Diseases, June 2011:
Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis (Manish Pareek et al; Lancet Infect Dis 2011; 11: 435–444). Screening for latent infection using IGRA (Interferon Gamma Release Assay) methods can be implemented cost-effectively at a level of incidence that identifies most immigrants with latent tuberculosis, thereby preventing substantial numbers of future cases of active tuberculosis.

Lancet Infectious Diseases, June 2011: Gatifloxacin versus chloramphenicol for uncomplicated enteric fever: an open-label, randomised, controlled trial (Amit Arjyal et al., Lancet Infect Dis 2011; 11: 445–454): Although no more efficacious than chloramphenicol, gatifloxacin should be the preferred treatment for enteric fever in developing countries because of its shorter treatment duration and fewer adverse events.

Lancet Infectious DIseases, June 2011: Leprosy now: epidemiology, progress, challenges, and research gaps (Laura C Rodrigues and Diana N J Lockwood; Lancet Infect Dis 2011; 11: 464–470).
Leprosy continues to be a challenge to health worldwide, with about 250 000 new cases being detected every year. Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. A third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services. We review data and make recommendations for research on diagnosis, treatment, and prevention, such as further use of molecular analysis of the Mycobacterium leprae genome, implementation of BCG vaccination, and administration of chemoprophylaxis to household contacts. We also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy.

Lancet Infectious Diseases, March 2011: Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial (The Kesho Bora Study Group; Lancet Infect Dis 2011;11: 171–180): Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants. Revised WHO guidelines now recommend antiretroviral prophylaxis (either to the mother or to the baby) during breastfeeding if the mother is not already receiving antiretroviral treatment for her own health.