CAP Mortality Reduced by Vaccine
Prior pneumococcal vaccination significantly improves outcomes in adults hospitalized with community-acquired pneumonia, results of a recent retrospective study suggest.
Compared with unvaccinated adults, those who had received the pneumococcal vaccine were 50% less likely to die while in the hospital and 33% less likely to develop respiratory failure, after adjustment for confounding factors (Clin. Infect. Dis. 2006;42:1093–101).
“Whether or not [the vaccine] prevents pneumonia is almost irrelevant—it clearly has an effect on reducing death in the individuals who get pneumonia,” Dr. David N. Fisman, lead study author, said in a statement released by the Infectious Diseases Society of America.
Dr. Fisman of Drexel University in Philadelphia and his associates evaluated the benefits of prior pneumococcal vaccination in 62,918 consecutive adult patients hospitalized with community-acquired pneumonia at 109 hospitals.
In addition to the reductions in death or respiratory failure, vaccination also significantly reduced the in-hospital risk of acute respiratory distress syndrome, sepsis syndrome, and cardiac arrest. Overall, 12% of the cohort had received the vaccination, 23% were unvaccinated, and the vaccination status was unknown for the remaining 65% of the patients.
Acute Infection Ups Risk of DVT
The risks of deep vein thrombosis and pulmonary embolism appear significantly increased after acute urinary tract or respiratory infection, according to a large case-series study.
The risk rates of both DVT and PE were highest—almost double that at baseline—in the first 2 weeks after infection, and fell off over subsequent months, returning to baseline after 1 year.
In the first 2 weeks after acute urinary tract infection (UTI), the incidence ratio was 2.10 for DVT and 2.11 for PE. Within 2 weeks after an acute respiratory infection, the overall incidence ratio of DVT was 1.91. A reliable estimate of the risk ratio for PE was not possible for respiratory infection because of the possibility of diagnostic misclassification, reported Liam Smeeth, Ph.D., of the London School of Hygiene and Tropical Medicine and his colleagues (Lancet 2006;37:1075–9).
Using medical records from 1987 to 2004 provided by the U.K. Health Improvement Network's electronic database, the researchers selected 7,278 individuals for analysis from 10,284 who had a first DVT, and 3,755 from 5,574 who had a first PE.
The mean age at diagnosis was 68 years for both DVT and PE, and women made up 58% of the DVT and 57% of the PE populations. The size and accuracy of the Health Improvement Network database—over 20 million person-years of observation from 220 general practices—allowed for detailed analysis and elimination of potential confounders.
The study “confirms that acute infection should be considered in the list of precipitants for venous thromboembolic disease,” the authors wrote.
Test for HIV if Patient Has Delusions
Delusions of parasitosis are a “red flag” for possible HIV infection, Dr. Marcus Conant said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
What's the connection? It's crystal methamphetamine, a highly addictive drug that undermines judgment, heightens the sex drive, and is popular in groups where the incidence of HIV infection is rising. The drug often causes delusions, such as the feeling that bugs are crawling on or within the skin, said Dr. Conant, a dermatologist in private practice in San Francisco.
“Every patient I've seen in 2 years with delusions of parasitosis—and I've seen more and more and more of them—is on crystal meth,” Dr. Conant said.
The incidence of HIV infection is rising rapidly among women and minorities, as well as young gay men. Crystal meth users may be having sex with at-risk members of any of these groups. “You need to offer them an HIV test,” he advised.
Other red flags include presence of any major STD, including cutaneous STDs such as genital herpes, genital warts, and even crab lice.
For patients reluctant to have an HIV test, he suggested telling them you want “a look at your immune function to make sure cancer or leukemia isn't causing your problem.” Many patients will then agree to a CD4 count, which, if low, may persuade them to consent to an HIV test.