Updates: Sex and Travel; Cardiac Involvement in Neonatal Candidemia
Sex & Travel: Postexposure STD Screening
Sources: Matteelli A, Carosi G. Clin Infect Dis. 2001;32:1063-1067; Correia JJ, et al. J Travel Med. 2001;8:263-266.
|
Travelers are an important risk group for sexually transmitted diseases (STDs)—various surveys suggest that anywhere from 5% to 50% of travelers engage in sexual activity when traveling, the majority of which is unprotected. A recent survey of blood and body fluid exposures in international travelers found that sexual activity with a new partner was the most frequent form of risk behavior in travelers (9%), followed by sharing hygienic items (toothbrushes, razors, etc.) (5%), percutaneously-administered traditional medical therapy (injections, IVs) (3.2%), acupuncture (1%), body piercing and tattooing (0.5%), and abrasive injuries (0.5%). Clinicians should be aware of those factors that increase the likelihood of sexual activity abroad, including male sex, unmarried status, younger age, travel alone, a history of unprotected/casual sex at home, travel to a recurrent destination, and alcohol use.
While education and counseling are important components of prevention, written materials (which can be read at a later time point) appear to have the greatest effect. The distribution of free condoms and fun lubricants in travel clinics (similar to what we offer in our HIV/AIDS clinic) may also help promote the idea of safer sex. These studies have also wisely suggested that physicians should schedule travelers at higher risk for sexual behavior for follow-up STD screening when they return, even if they are asymptomatic or admit to condom use. This would include urine LCR/PCR for gonorrhea and chlamydia, and serologic studies for HIV, HBV, and syphilis. Given the frequency of blood and body fluid exposures, vaccination for hepatitis B should be more broadly encouraged in travelers, especially homosexuals, frequent travelers, sex tourists, and persons who plan to be abroad for more than 3 months.
Cardiac Involvement in Neonatal Candidemia
Source: Noyola DE, et al. Clin Infect Dis. 2001;32:1018-1023.
A recent case of neonatal candidemia associated with an abnormal echocardiogram with a left ventricular echodensity prompted questions regarding the frequency and clinical significance of this finding. Shortly thereafter Noyola and colleagues reported their findings of the frequency of cardiac, renal, hepatic, and ocular abnormalities in 86 neonates with candidemia from 1989 to 1999. The median gestational age was 26 weeks, and the median age at the onset of candidemia was 22 days (range, 2 to 196 days). Of the 86 infants, 100% had received antibiotics (with a median duration of use of 12 days), 93% had received total parenteral nutrition, 88% had umbilical cord catheterization, 55% had central venous lines placed at the time of diagnosis, and 37% had received corticosteroids.
Candida albicans and C parapsilosis accounted for the majority of isolates (62.8% and 30.2%, respectively). The frequency of end-organ involvement due to either of these species was similar, although C parapsilosis is generally considered more virulent. Patients with > 5 days of candidemia were at greatest risk for end-organ involvement. Almost half (46.5%) of the infants had Candida isolated from sites other than blood: 10 of 68 (14.7%) in whom CSF was examined had positive CSF cultures; 3 had evidence of fungal dermatitis; and one had positive synovial fluid cultures.
Various examinations and radiographic studies were performed in 81 infants (5 infants quickly died). Nearly one fourth (23.5%) of the infants had end-organ involvement. Ocular involvement characteristic of Candida was found in 4 of 67 (6%) of infants in whom ophthalmologic exams were performed; only 1 had endophthalmitis (which eventually required vitrectomy). Only 5 (7.7%) had evidence of hepatic or renal involvement.
Cardiac involvement, as suggested by the results of echocardiography performed in 72 infants, was found in 11 (15.3%), including thrombus in the superior or inferior cava in 6, vegetations or echodense masses in the ventricles or atrium in 4, and increased echogenicity of the mitral valve in 2. The duration of candidemia was similar for patients with normal vs. abnormal echocardiograms (5 vs 4 days, respectively).
All of the infants received amphotericin B (4 received additional antifungal agents). Patients with eye and cardiac involvement received a greater number of doses of amphotericin B (32.5 and 29.5 doses, respectively) compared with those without end-organ involvement (25.7 doses). The overall mortality was similar for infants with end-organ involvement vs. those without (31.5% vs 26.4%, respectively). However, the mortality for patients with cardiac involvement appeared to be somewhat greater. Three of 11 infants with cardiac involvement died during treatment, and 2 more died after treatment was discontinued of other causes. In addition, 5 of the surviving patients with cardiac involvement had persistent abnormalities by echocardiogram at the end of therapy.
Dr. Kemper, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, is Associate Editor of Infectious Disease Alert.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.