Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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In a prospective observational study of 54 patients with human immunodeficiency virus-associated cryptococcal meningitis, the early fungicidal activity of amphotericin B (1 mg/kg/day) was significantly greater than that of fluconazole (400 mg/day). Compared with antiretroviral therapy-naive patients, patients developing cryptococcal meningitis while already receiving antiretroviral therapy had lower baseline fungal burdens and a longer median duration of survival, but there were no differences observed in fungal clearance, cerebrospinal fluid proinflammatory cytokines, or 10-week mortality.
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Since its introduction to North America in 1999, human infection with West Nile virus (WNV) has resulted in considerable acute morbidity and mortality. Although the ongoing epidemic has resulted in a great increase in our understanding of the acute clinical features of human illness and helped to define associated clinical syndromes, far less is known about potential long-term clinical and functional sequelae. ⋯ West Nile poliomyelitis may result in limb weakness and ongoing morbidity that is likely to be long term. Although further assessment is needed, the long-term neurological and functional sequelae of WNV infection are likely to represent a considerable source of morbidity in patients long after their recovery from acute illness.
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We investigated an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection among US service members injured in Iraq. ⋯ Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies may be required to prevent the transmission of pathogens in combat field hospitals.
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Needleless intravascular catheter connector valves have been introduced into clinical practice to minimize the risk of needlestick injury. However, infection-control risks associated with these valves may be underappreciated. In March 2005, a dramatic increase in bloodstream infections was noted in multiple patient care units of a hospital in temporal association with the introduction of a needleless valve into use. ⋯ A significant association between primary bloodstream infection and a needleless connector valve was observed. Evaluation of needleless connector valves should include a thorough assessment of infection risks in prospective randomized trials prior to their introduction to the market.
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Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
A vaccine to prevent herpes zoster was recently approved by the United States Food and Drug Administration. We sought to determine the cost-effectiveness of this vaccine for different age groups. ⋯ The cost-effectiveness of the varicella zoster vaccine varies substantially with patient age and often exceeds $100,000 per quality-adjusted life year saved. Age should be considered in vaccine recommendations.