Volume 64, Issue 8, 15 April 2017

Little is known regarding the optimal treatment of ventriculoperitoneal (VP) shunt infections in adults. VP shunt removal, particularly with a 2-stage replacement strategy when the patient is shunt dependent, remains the optimal choice of treatment and does not increase morbidity.

Cognitive-behavioral therapy is effective in reducing fatigue severity in patients with Q fever fatigue syndrome (QFS). Long-term treatment with doxycycline does not reduce fatigue severity in QFS patients compared to placebo and should not be advised.

A community based, second-line treatment cohort of 102 subjects was followed monthly in community clinics with a total of 178 patient-years of follow-up; second-line virological failure was frequent in this setting.

This study demonstrates that immune responses and side-effect profiles following diethylcarbamazine or ivermectin treatment of loiasis are similar. Changes in eosinophil counts and eosinophil activation posttreatment suggest that eosinophils play a key role in the posttreatment responses to both drugs.

Daptomycin displays a dose-dependent clinical response against vancomycin-resistant Enterococcus faecium bloodstream infection. A daptomycin dose of ≥9 mg/kg was associated with better patient survival than a dose of 7–9 mg/kg, followed by a dose of 6–7 mg/kg.

SWIFT-C is an open-label, 2-cohort clinical trial that is assessing the safety and efficacy of 12 weeks of sofosbuvir plus ribavirin for treatment of acute hepatitis C virus in human immunodeficiency virus–infected patients. The relapse rate was high (41%), suggesting a need for better therapeutic options.

Compared to 0–1 dose of intermittent preventive treatment of malaria using sulfadoxine-pyrimethamine, ≥2 doses protects pregnant women against adverse birth outcomes attributable to malaria infection and to curable sexually transmitted and reproductive tract infections.

Despite the widespread use of quinolones ear drops, no studies have examined their adverse effect on the eardrum. Children receiving quinolone ear drops are 60% more likely to have eardrum perforations in comparison to those received neomycin ear drops.

Among patients presenting with diverse neurological problems at a single center, cerebrospinal fluid discordance or escape was observed in 15% and was associated with diffuse white matter signal abnormalities on cranial magnetic resonance imaging.

The safe establishment of a protocol for a human challenge model for Salmonella Paratyphi A can be used to expedite the evaluation of novel vaccine candidates and provides insight into the clinical and immune response to paratyphoid infection.

We evaluated 3 modified 2-tiered testing protocols for Lyme disease, which substitute noncomplex, objectively interpreted, inexpensive serologic assays for Western blotting. Compared with conventional 2-tiered testing, each modified protocol provided comparable or greater sensitivity in early disease and was comparably specific.

Exposure of ventilated patients to antibiotics, often to several, does not efficiently reduce lower airway colonization by Staphylococcus aureus or progression to ventilator-associated tracheobronchitis or ventilator-associated pneumonia. Staphylococcus aureus competes with the normal respiratory flora during airway colonization.

The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV.

The evolution of broadly neutralizing antibodies (bNAbs) in spontaneous controllers of HIV appears in the setting of low but persistent viral replication, in the absence of significant viral diversity, but in the presence of a unique inflammatory signature.

One-third of the UK/Ireland national pediatric HIV cohort has transferred to adult care. Three-quarters of adolescents were on ART at transfer, of whom 74% were virologically suppressed <400 cps/mL. The prevalence of triple class resistance was 12%.

MenB-FHbp (factor H binding protein), a serogroup B meningococcal vaccine, was used to control a college outbreak. We investigated MenB-FHbp impact on nasopharyngeal meningococcal carriage, the primary source of meningococcal transmission. MenB-FHbp did not rapidly reduce meningococcal carriage or prevent serogroup B carriage acquisition.

The Joint Commission issued antimicrobial stewardship standards, consisting of 8 elements of performance, applicable to hospitals effective January 1, 2017. Little guidance exists on “how” to implement them. Real-world experience from established antimicrobial stewardship programs describes how hospitals can comply.