Microsporidiosis: not just in AIDS patients.

Curr Opin Infect Dis. 2011 Aug 12;

Authors: Didier ES, Weiss LM

PURPOSE OF REVIEW: Microsporidia have emerged as causes of opportunistic infections associated with diarrhea and wasting in AIDS patients. This review describes recent reports of microsporidiosis in HIV-infected individuals and the growing awareness of microsporidiosis in non-HIV-infected populations. RECENT FINDINGS: Microsporidia were only rarely recognized as causes of disease in humans until the AIDS pandemic. Implementation of combination antiretroviral therapy (cART) to curtail HIV replication and restore immune status drastically reduced the occurrence of opportunistic infections, including those due to microsporidia, in HIV-infected individuals. In developing countries where cART is not always accessible, microsporidiosis continues to be problematic. Improvement of diagnostic methods over the previous 25 years led to identification of several new species of microsporidia, many of which disseminate from enteric to systemic sites of infection and contribute to some unexpected lesions. Among non-HIV-infected but immune-suppressed individuals, microsporidia have infected organ transplant recipients, children, the elderly, and patients with malignant disease and diabetes. In otherwise healthy immune-competent HIV seronegative populations, self-limiting diarrhea occurred in travelers and as a result of a foodborne outbreak associated with contaminated cucumbers. Keratitis due to microsporidiosis has become problematic and a recent longitudinal evaluation demonstrated that non-HIV-infected individuals seropositive for microsporidia who had no clinical signs continued to intermittently shed organisms in feces and urine. SUMMARY: Greater awareness and implementation of better diagnostic methods are demonstrating that microsporidia contribute to a wide range of clinical syndromes in HIV-infected and non-HIV-infected people. As such, microsporidia should be considered in differential diagnoses if no other cause can be defined.

PMID: 21844802 [PubMed - as supplied by publisher]

New Gram-positive antibiotics: better than vancomycin?

Curr Opin Infect Dis. 2011 Aug 12;

Authors: van Hal SJ, Paterson DL

PURPOSE OF REVIEW: Despite concerns about vancomycin use in the treatment of multidrug-resistant Gram positives, evidence for better therapeutic outcomes with alternative antibiotics is lacking. This review focuses on recent advances. RECENT FINDINGS: Combination therapy with vancomycin-rifampin, although associated with better cure rates, resulted in the emergence of high rates of rifampin resistance. Of the newer anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotics, ceftopibrole, ortivancin and dalbavancin require further development prior to a further assessment by the United States Food and Drug Administration. Ceftaroline, telavancin and daptomycin were associated with comparable clinical cure rates compared with vancomycin in the treatment of complicated MRSA skin and soft tissue infections. In the treatment of hospital-acquired pneumonia, both telavancin and linezolid resulted in significantly greater clinical cure rates compared with vancomycin. Despite greater clinical cure rates, no difference in overall or infection-related mortality was detected. Of concern is the appearance of daptomycin and linezolid resistance following increased use. Toxicity profiles (especially of linezolid) are comparable to vancomycin provided short-duration therapy is prescribed. The first reports of daptomycin-induced acute eosinophillic pneumonia were described in 2010. SUMMARY: Based on current evidence, greater microbiological and clinical cure rates are achieved with alternative agents. However, these differences do not translate into mortality benefits compared with vancomycin for the treatment of S. aureus infections.

PMID: 21844804 [PubMed - as supplied by publisher]