The Journal of infection
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The Journal of infection · Sep 2009
Practice GuidelineBritish Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children.
SUMMARY AND KEY RECOMMENDATIONS: The aim of these guidelines is to describe a practical but evidence-based approach to the diagnosis and treatment of central nervous system tuberculosis in children and adults. We have presented guidance on tuberculous meningitis (TBM), intra-cerebral tuberculoma without meningitis, and tuberculosis affecting the spinal cord. Our key recommendations are as follows: 1. ⋯ The principles of CNS tuberculosis diagnosis and treatment are the same for HIV infected and uninfected individuals, although HIV infection broadens the differential diagnosis and anti-retroviral treatment complicates management. Tuberculosis in HIV infected patients should be managed either within specialist units by physicians with expertise in both HIV and tuberculosis, or in a combined approach between HIV and tuberculosis experts. The co-administration of anti-retroviral and anti-tuberculosis drugs should follow guidance issued by the British HIV association (www.bhiva.org).
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The Journal of infection · Jul 2009
Matrix metalloproteases in bronchoalveolar lavage fluid of patients with type III Pseudomonas aeruginosa pneumonia.
In patients with ventilator-associated pneumonia (VAP), Pseudomonas aeruginosa type III (TTSS) secreting isolates have been linked to poor clinical outcomes. Differential expression of matrix metalloproteinases (MMPs) induced by type III effector proteins may herald an irreversible lung injury. ⋯ VAP linked to P. aeruginosa Type III phenotype portrays a divergent antibiotic treatment response in regards to the concentrations of metalloproteinases in the alveolar space. The imbalance between MMP-9 and TIMP-1 may determine the intensity of alveolocapillary damage and ultimate outcome of P. aeruginosa VAP.
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The Journal of infection · Jul 2009
Practice GuidelineFever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management.
International travel is increasing. Most physicians and general practitioners will encounter returned travellers with fever and the majority of travel-related infection is associated with travel to the tropics. In those returning from the tropics malaria must always be excluded, and HIV considered, from all settings. ⋯ The evidence base for much of the management of tropical infections is limited. These recommendations provide a pragmatic approach to the initial diagnosis and management of fever in returned travellers, based on evidence where it is available and on consensus of expert opinion where it is not. With early diagnosis and treatment the majority of patients with a potentially fatal infection related to travel will make a rapid and full recovery.
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The Journal of infection · Jul 2009
Influence of preoperative antibiotherapy on valve culture results and outcome of endocarditis requiring surgery.
Although medical-surgical therapy can reduce mortality in patients with infective endocarditis (IE), the optimal timing of surgery remains controversial. We evaluated the influence of preoperative antimicrobial therapy duration on positivity of valve culture and outcome. ⋯ Although the duration of adequate preoperative antimicrobial therapy is associated with the positivity of valve culture, the latter factor does not influence short- or long-term outcome.