Treatment Update for Scrub Typhus

Size: px
Start display at page:

Download "Treatment Update for Scrub Typhus"

Transcription

1 448 Review Treatment Update for Scrub Typhus S. N. Kaore, P. Sharma, V. K. Yadav, R. Sharma Dept. of Pharmacology, People s College of Medical Sciences, Bhopal, M.P., India. N. M. Kaore, Dept. of Microbiology, People s College of Medical Sciences, Bhopal, M.P., India. D. G. Langade, Dept. of Pharmacology, People s College of Medical Sciences, Bhopal, M.P., India. Introduction Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi). It is distributed throughout the Asia Pacific region, being endemic in Korea, China, Taiwan, Japan, Pakistan, India, Thailand, Malaysia, and northern portions of Australia. However, cases also occur in the United States, Canada and Europe, being imported by tourists returning from endemic regions 1. Scrub typhus is manifested clinically by high fever, intense generalized headache, diffuse myalgias, and, in many patients, rash and an eschar at the site of the chigger bite. The diagnosis is suggested by the clinical history (including visit to an endemic area) and physical findings and confirmed by serologic testing or biopsy of an eschar 2. If not treated, fever may subside spontaneously after 2 weeks but the mortality rate may range between % 3. Treatment options for scrub typhus The treatment should be initiated early in the course of disease to reduce morbidity and mortality. The conventional treatment includes broad spectrum antibiotics like doxycycline and chloramphenicol, both of which are found effective for the treatment of scrub typhus, while tetracyclines are not recommended in children younger than 8 years of age because of risk of discolouration of teeth. Though seven days treatment is usually effective, but it is essential to monitor chloramphenicol therapy by repeating total blood counts. In severe cases, it is imperative to give appropriate supportive measures to abort progression to disseminated intravascular coagulation (DIC) or circulatory collapse. Azithromycin is an alternative for children. Although tetracyclines or chloramphenicol are the recommended drugs of choice for the treatment of scrub typhus, reports of Doxycycline-resistant strains have prompted a search for alternative treatments. Rifampicin and Azithromycin have been used successfully in areas where scrub typhus is resistant to the conventional therapy 4. Tetracycline derivatives are the mainstay of scrub typhus treatment. This drug inhibits bacterial by binding with 30S and possibly 50S ribosomal subunit(s). Tetracycline derivatives like Doxycycline are employed as mg twice a day for better compliance and quicker Address for correspondence: Dr S. N. Kaore, Dept. of Pharmacology, People s College of Medical Sciences, Bhopal, M.P., India.

2 449 defervescence. Tetracycline has also caused significant improvement in ARDS, a life threatening complication of scrub typhus 5. Inflammatory cytokines including TNF-α, IL-1β, and IL-6 are markedly unregulated in patients with scrub typhus. Doxycycline treatment rapidly reduces the production of these cytokines, corresponding to the early defervescence after the start of the treatment 6. The adult dose for doxycycline is mg twice a day and 5mg/kg/IV twice a day and should not exceed 200mg/day. Chloramphenicol, the other drug in conventional therapy also binds to 50 S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting. Monitoring serum levels is a useful aspect and dose can be adjusted to achieve the therapeutic concentrations (ie, peak mcg/ ml, trough 5-10 mcg/ml) 4. The dose is mg/kg/d orally or intravenous divided in 6 hourly doses. Aplastic anemia has been reported in all age groups and is an idiosyncratic reaction. The estimated incidence is about 1 in 24,000 to 40,000 courses of therapy. To prevent this complication, indiscriminate, prolonged or repeated use of the drug should be avoided. The peripheral blood smears should be examined at least once weekly during therapy and treatment should be stopped if the leukocyte count drops below 4000 cu. mm. or when the proportion of granulocytes is reduced below 40 percent. It must be noted that in life threatening condition the risk-benefit ratio should be considered and administration of chloramphenicol in pediatric age group and pregnant ladies should be avoided as far as possible. In this selected population, azithromycin and roxithromycin serve as good and efficacious alternatives. Azithromycin is a macrolide drug that attaches to 50S and interferes with translocation and thus inhibits. The remarkable pharmacokinetic properties are acid stability, rapid oral absorption, marked tissue distribution and intracellular penetration. Concentration in most tissues exceed that in plasma, particularly high concentration are attained inside macrophages and fibroblasts. Slow release from the intracellular sites contributes to its long terminal t ½ of more than 50 hours. It is convenient for once a day dosing and has better gastric tolerance. The side effects are mild gastric upset, abdominal pain, headache, dizziness, and elevated serum levels of ALT. It is not found to affect CYP3A4 enzyme, so drug interactions are less likely with drugs like theophylline, carbamezepine 7. A comparative trial of a single dose of azithromycin 500 mg versus doxycycline 200 mg for 1 wk daily, given in the treatment of mild scrub typhus, suggests that both are equally effective in terms of time taken for defervescence 8. Roxithromycin is a semi-synthetic long acting acid- stable drug with good enteral absorption and tissue penetration with t ½ of 12 hrs has been also used as an alternative drug for scrub typhus and found effective and safe in pediatric population. Its affinity for cytochrome P450 is lower but drug interactions with terfenadine, cisapride and others cannot be ruled out 4-9. Another study in Thailand showed that rifampicin, an antitubercular drug can be used to treat scrub typhus. But considering the most potential problem of resistance to rifampicin monotherapy, the combination of rifampicin with doxycycline was studied but unfortunately was not found effective. The same study also suggested that 1 wk 600 mg or 900 mg of rifampicin was superior to Doxycycline. These doses produced comparable defervescence, so can be used in areas resistant to the conventional therapy Scrub typhus in pregnancy The infection is uncommon in pregnancy, but when present it has serious consequences both for the mother and the foetus, if not appropriately controlled. It is difficult to validate a safe and an effective therapeutic regimen for this population since it is not common in pregnancy. A study suggests that azithromycin 500 mg single dose has proven effective and was not associated with relapse or any unfavourable outcomes 12. Preventive measures The public and physicians should be made aware that mites transmit disease. 2. Avoid mite infested areas. 3. Do not sit or lie on bare ground or grass; use a suitable ground sheet or other ground cover. Clearing of vegetation and chemical treatment of the soil may help to break up the cycle of transmission from chiggers to humans to other chiggers.

3 Alternatively, prevent contact with infected mites by personal prophylaxis against the mite vector by impregnating clothes and blankets with miticidal chemicals (permethrin and benzyl benzoate) and the application of mite repellents (dibutyl phthalate, benzyl benzoate, diethyl toluamide, diethyltoluamide) to exposed skin surfaces. 5. Remove mites from humans. 6. Eliminate mites from sites by the application of chlorinated hydrocarbons (lindane, dieldrin, chlordane) to the ground and vegetation in camps, Table 1 Drug treatment strategies for scrub typhus Drug Dose MOA ADR Remarks Doxycycline 200 mg/d X 7 days Binds to 30S teeth discoloration phototoxicity renal toxicity - drug of choice - early defervescence - markers of inflammation:tnf-α, IL-1β, and IL-6 decrease in 24 hrs after starting treatment Chloramphenicol mg/kg/ d X 7 days aplastic anemia - early defervescence - conventional therapy - can be used in children, pregnant women (except in last trimester) Azithromycin 500 mg single dose mild gastric upset, abdominal pain, headache dizziness - early defervescence comparable to 1 wk doxycycline - safer alternative in pregnancy - less incidence of drug interactions Telithromycin 800 mg once daily X 5 days G.I. disturbances headache, taste disturbances - promising new antimicrobial agent - comparable to 200mg/d - doxycycline given for 5 days - drug interactions likely Roxithromycin mg twice daily diarrhoea, nausea, vomiting - as effective as conventional therapy - safer than conventional therapy - drug interactions more likely - than azithromycin Rifampicin a 600 mg/d X 1 wk OR 900 mg/d X 1 wk Inhibits DNA dep RNA polymerase G.I.upset, rash, fever, chills, dizziness - more effective than Doxycycline - used in resistant cases (more effective in combination with - doxycycline) Levofloxacin b 500 mg once Inhibits DNA gyrase G.I. upset - takes longer time for defervescence, this may contribute to fatality Note : Total duration of antibiotic therapy can be adjusted on case to case basis depending upon the severity of the disease. a. Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, Strickman D. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet (Lancet) Vol. 356 Issue 9235 Pg (Sep ) ISSN: b. Chen-Chi Tsai, Chorng-Jang Lay, Chun-Lung Wang, Yu-Huai Ho, Lih-Shinn Wang, Li-Kuang Chen, Levofloxacin versus tetracycline antibiotics for the treatment of scrub typhus; International Journal of Infectious Diseases: article in press, available at

4 451 mine buildings, and other populated zones in endemic areas. 7. Advise individuals travelling to endemic areas to wear protective clothing. 8. Antibiotic prophylaxis may be indicated to produce active immunity to scrub typhus. Chemoprophylaxis using doxycycline in high-risk groups (eg. military personnel) has been successful. Doses are weekly and must be started before exposure and continued for 6 weeks after exposure. Studies are underway. As per WHO, it has been shown that a single oral dose of chloramphenicol or tetracycline given every five days for a total of 35 days, with 5-day non-treatment intervals, actually produces active immunity to scrub typhus. This procedure is recommended under special circumstances in certain areas where the disease is endemic 14. Vaccine The historical aspects of vaccine development can be traced back to 1937, when it was first attempted by Wellcome foundation, United Kingdom and was tried finally in 1945 in human subjects in India for use by the Allied Land Forces, South-East Asia Command, in June 1945 (Wellcomes laboratory at Ely Grange, Frant, Sussex) 15,16,17. The major hurdle in vaccine production is existence of a large number of immunotypic and genotypic variants among the strains of O. tsutsugamushi and immunity to one strain does not confer immunity to another 18,19,20,21. An ideal vaccine should provide protection to all the strains present locally, in order to give an acceptable level of protection. This means that a vaccine developed for one locality may not be protective in another locality, because of antigenic variation. This complexity continues to hamper efforts to produce a viable vaccine 22. A truncated recombinant 56-kDa outer membrane of the Karp strain of Orientia tsutsugamushi (Kp r56) was evaluated in cynomolgus monkeys (Macaca fascicularis) for immunogenicity and safety as a vaccine candidate for the prevention of scrub typhus. This recombinant antigen induced strong humoral and cellular immune responses in two monkeys and was found to be well tolerated 23. Conclusion Without treatment the fever generally lasts for 14 days. In some cases the initial symptoms are lymphadenopathy and a rash that begins on the trunk and spreads outwards. The case fatality rate depends on the area, strain of rickettsia, and previous exposure to the disease but is consistently higher in the elderly. Death can occur from the primary infection or from secondary complications (e.g., pneumonitis, encephalitis, circulatory failure). Most fatalities occur by the end of the second week of infection 13. This infection is treated with antibiotics, the drug most commonly used is doxycycline and chloramphenicol is an alternative. A combination therapy with doxycycline and rifampicin should be used in areas where drugs used alone are not effective 24. Azithromycin or chloramphenicol is useful to treat infection in children or pregnant women, while doxycycline is relatively contraindicated in children. Antibiotic therapy brings about prompt defervescence. If the antibiotic treatment is discontinued too quickly, especially in patients treated within the first few days of the fever, relapses may occur. Secondary infections, such as bacterial pneumonia, should be treated appropriately. Total duration of antibiotic therapy can be adjusted on case to case basis depending upon the severity of the disease. No significant morbidity or mortality occurs in patients who receive appropriate treatment. Other alternative drugs include macrolides like azithromycin, roxithromycin, telithromycin and the antitubercular drug rifampicin. Rifampicin is used in resistant cases. Since no effective vaccine is available, it is prudent that case identification, public education, rodent control and habitat modification are the mainstay of strategies aimed at controlling the impact of scrub typhus on the human population. References 1. Padbidri V.S., Gupta N.P. Rickettsiosis in India: A review. J Indian Med Assoc 1978; 71 : , Seong S., Choi M. & Kim I. Orientia tsutsugamushi infection: overview and immune responses. Microbes and Infection. 3(1): 11 21, McPhee S.J., Papadakis M.A. Current Medical

5 452 Diagnosis & Treatment; Rickettsial Diseases 48th edition, published by McGraw- Hill, pg emedicine, Fernandez A.D., Liang J.R. Scrub Typhus; updated on Jun 29, 2009: available at emedicine.medscape.com/article/ overview. 5. Izumo T., Yamaguchi M., Onizawa S., Kiguchi T., Nagai A. Severe case of Tsutsugamushi disease with disseminated intravascular coagulation and acute respiratory distress syndrome : Nihon Kokyuki Gakkai Zasshi.2008 May; 46(5): Chung D.R., Lee Y.S., Lee S.S. Kinetics of inflammatory cytokines in patients with scrub typhus receiving doxycycline treatment, J. Infect Jan; 56 (1):44-50 Epub 2007 Oct Zuckerman J.M. Macrolides and Ketolides: Azithromycin, clarithromycin, telithromycin. Infect Dis Clin North Am. 18:621, Kim Y.S., Yun H.J., Shim S.K., Koo S.H., Kim S.Y., Kim S. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis. 1;39(9): , 2004 Nov. 9. Epub 2004 Oct 11. Lee K.Y., Lee H.S., Hong J.H., Hur J.K., Whang K.T. Roxithromycin treatment of scrub typhus (tsutsugamushi disease) in children. Pediatr Infect Dis J. 22(2): , Feb Watt G., Kantipong P., Jongsakul K., Watcharapichat P., Phulsuksombati D., Strickman D. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet (Lancet) Vol. 356 Issue 9235 Pg (Sep ) ISSN: Panpanich R., Garner P. Antibiotics for treating scrub typhus. The Cochrane Database of Systematic Reviews Issue 3. mrw.interscience.wiley.com/cochrane/ clsyrev/ articles/cd002150/frame.html. 12. Yeon-Sook Kim, Hyo Jin Lee, Meayoung Chang, Sung Kyong Son, Yun Ee Rhee, Soo Kyong Shim Scrub Typhus during pregnancy and its treatment: A case series and review of literature. Am. J. Trop. Med. Hyg. 75(5), pp , Disease Control and Prevention, Public Health Notifiable Disease Management Guidelines June 2005, available at ND-Typhus-Scrub.pdf. 14. Available at CDS_faq_Scrub_ Typhus. pdf. 15. AWIC Newsletter: The Cotton Rat In Biomedical Research. newsletters/v5n2/5n2princ.htm#toc Far East Report. Hansard. 2 April hansard.millbanksystems.com/ written_answers/ 1946/apr/02/scrub-typhus-vaccine-far-east. 17. Kelly et al. The Past & Present Threat of Rickettsial Diseases to Military Medicine & International Public Health. Clinical Infectious Diseases. Vol. 34, SuppL. 4 : June 15, Shirai A., Tanskul P.L., Andre, R.G., et al. Rickettsia tsutsugamushi strains found in chiggers collected in Thailand. Southeast Asian J Trop Med Public Health. 12 (1): 1 6, Kang J.S., Chang W.H. Antigenic relationship among the eight prototype and new serotype strains of Orientia tsutsugamushi revealed by monoclonal antibodies. Microbiol Immunol. 43 (3): , Akira Tamura, Norio Ohashi, Yoko Koyama, Masahiro Fukuhara, Fumihiko Kawamori, Masamitsu Otsuru, Ping-Fuai Wu, Shen-Yu Lin Characterization of Orientia tsutsugamushi isolated in Taiwan by immunofluorescence and restriction fragment length polymorphism analyses, FEMS Microbiology Letters, Volume 150, Issue 2, 15 May 1997, Pages P.E. Fournier Genetic Variability of Orientia tsutsugamushi; International Journal of Infectious Diseases. Volume 12, Supplement 1, Pages e20-e21, December Kelly D.J., Fuerst P.A., Ching W.-M., Richards A.L. Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clinical Infectious Diseases. 48 (s3): S203 S230, Chattopadhyay S., Jiang J., Chan T.C., Manetz T.S., Chao C.C., Ching W.M., Richards A.L. Scrub typhus vaccine candidate Kp r56 induces humoral and cellular immune responses in cynomolgus monkeys. Infect Immun. 73(8): , Aug Panpanich R., Garner P. Antibiotics for treating scrub typhus. Cochrane Database Syst Rev. (1): CD002150, 2009.

Laboratory confirmation requires isolation of Bordetella pertussis or detection of B. pertussis nucleic acid, preferably from a nasopharyngeal swab.

Laboratory confirmation requires isolation of Bordetella pertussis or detection of B. pertussis nucleic acid, preferably from a nasopharyngeal swab. Pertussis Epidemiology in New Zealand New Zealand has continued to experience outbreaks of pertussis in recent decades. This is in part due to historically low immunisation rates and in part because immunity

More information

PERTUSSIS SURVEILLANCE AND RESPONSE PROTOCOL

PERTUSSIS SURVEILLANCE AND RESPONSE PROTOCOL PERTUSSIS SURVEILLANCE AND RESPONSE PROTOCOL Public Health Action 1. Educate the public, particularly parents of infants, about the dangers of whooping cough and the advantages of initiating immunization

More information

Ceftriaxone Therapy Vs. Ciprofloxacin In Treatment Of Typhoid Fever In Adult Patients.

Ceftriaxone Therapy Vs. Ciprofloxacin In Treatment Of Typhoid Fever In Adult Patients. Dec QMJ VOL.5 No.8 Ceftriaxone Therapy Vs. Ciprofloxacin In Treatment Of Typhoid Fever In Adult Patients. Radhi F.Alshaibani* الخلاصھ لا زالت حمى التایفوید سببا مھما من اسباب الامراض وفقدان ساعات العمل

More information

Mumps (Infectious parotitis) Acute viral illness, It is a disease caused by the mumps virus.

Mumps (Infectious parotitis) Acute viral illness, It is a disease caused by the mumps virus. Mumps (Infectious parotitis) Acute viral illness, It is a disease caused by the mumps virus. ١ د. وجدان اكرم Parotitis and orchitis described by Hippocrates in 5th century B.C. Viral etiology described

More information

Pertussis Information for GPs and other Health Care Providers on Clinical and Public Health Management. March 2010

Pertussis Information for GPs and other Health Care Providers on Clinical and Public Health Management. March 2010 Pertussis Information for GPs and other Health Care Providers on Clinical and Public Health Management March 2010 Infectious Agent Bordetella pertussis (a bacterium) Clinical Features Infants and Young

More information

Disclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics

Disclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics Mitzi Joi Williams, MD Neurologist MS Center of Atlanta, Atlanta, GA Disclosures Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics

More information

A Look into a Natural Treatment Option for Gingivitis

A Look into a Natural Treatment Option for Gingivitis Bleeding Gums? A Look into a Natural Treatment Option for Gingivitis by Dr. Janna Levanto, HBK, ND Biologics Naturopathic Clinic 3050 Yonge St. Suite 203 Toronto, ON M4N 2K4 Dr.Levanto@biologicsclinic.com

More information

PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County

PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County PENNSYLVANIA DEPARTMENT OF HEALTH 2015 PAHAN 307 04-02-ADV Pertussis in Centre County DATE: 04/02/2015 TO: Health Alert Network FROM: Karen M. Murphy, PhD, RN, Acting Secretary of Health SUBJECT: DISTRIBUTION:

More information

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY Severe liver injury including fatal liver failure has been

More information

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011

Alberta Health and Wellness Public Health Notifiable Disease Management Guidelines August 2011 August 2011 Pertussis Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) August 2011 August 2011 December 2005 Case Definition

More information

While in the Amazon jungle of Peru during January of 2005, an infectious disease

While in the Amazon jungle of Peru during January of 2005, an infectious disease Dengue Fever: A Bad Case of Flu While in the Amazon jungle of Peru during January of 2005, an infectious disease physician from the United States told me and my students that dengue fever is not in the

More information

Cryptococcal Screening Program Case Studies

Cryptococcal Screening Program Case Studies Slide 1 Cryptococcal Screening Program Case Studies Image courtesy of World Health Organization National Center for Emerging and Zoonotic Infectious Diseases Mycotic Diseases Branch Slide 2 Note to trainers

More information

Chapter 10 Human Immuno Deficiency Virus Infection

Chapter 10 Human Immuno Deficiency Virus Infection 143 Chapter 10 Human Immuno Deficiency Virus Infection Chapter 10 Human Immuno Deficiency Virus Infection...143 HIV infection...144 Clinical Features...146 Clinical Staging of HIV infection recommended

More information

FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH)

FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH) FREQUENTLY ASKED QUESTIONS ABOUT PERTUSSIS (WHOOPING COUGH) What is pertussis? General Questions About Pertussis Pertussis, or whooping cough, is a contagious illness that is spread when an infected person

More information

Indicated for flu treatment for ages 2 weeks and older

Indicated for flu treatment for ages 2 weeks and older DOSAGE AND ADMINISTRATION IN ADULT AND PEDIATRIC PATIENTS Please see Important Safety Information on pages 6 8. Indicated for flu treatment for ages 2 weeks and older Available in 30-mg, 45-mg, and 75-mg

More information

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases

Zika Virus. Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases Zika Virus Fred A. Lopez, MD, MACP Richard Vial Professor Department of Medicine Section of Infectious Diseases What is the incubation period for Zika virus infection? Unknown but likely to be several

More information

THIS IS AN OFFICIAL NH DHHS HEALTH ALERT

THIS IS AN OFFICIAL NH DHHS HEALTH ALERT THIS IS AN OFFICIAL NH DHHS HEALTH ALERT Distributed by the NH Health Alert Network Health.Alert@nh.gov August 13, 2015 1400 EDT (2:00 PM EDT) NH-HAN 20150813 Updated Centers for Disease Control (CDC)

More information

Zika Virus. History of Zika virus

Zika Virus. History of Zika virus Zika Virus Zika fever is caused by the Zika virus (ZIKV), an arthropod-borne virus (arbovirus). The Zika virus is a member of the Alphavirus genus in the family Togaviridae. It is related to dengue, yellow

More information

Frequently Asked Questions: Pre-Exposure Prophylaxis (PrEP) for HIV Infection Massachusetts Department of Public Health Updated July 2013

Frequently Asked Questions: Pre-Exposure Prophylaxis (PrEP) for HIV Infection Massachusetts Department of Public Health Updated July 2013 Frequently Asked Questions: Pre-Exposure Prophylaxis (PrEP) for HIV Infection Massachusetts Department of Public Health Updated July 2013 On July 16, 2012, the Food and Drug Administration (FDA) approved

More information

Guideline. Treatment of tuberculosis in patients with HIV co-infection. Version 3.0

Guideline. Treatment of tuberculosis in patients with HIV co-infection. Version 3.0 Guideline Treatment of tuberculosis in patients with HIV co-infection Version 3.0 Key critical points Co-infection with Tuberculosis (TB) and HIV is common in many parts of the world, especially sub-saharan

More information

Exposure. What Healthcare Personnel Need to Know

Exposure. What Healthcare Personnel Need to Know Information from the Centers for Disease Control and Prevention National Center for Infectious Diseases Divison of Healthcare Quality Promotion and Division of Viral Hepatitis For additional brochures

More information

Varicella Infection in the Neonate GL366

Varicella Infection in the Neonate GL366 Varicella Infection in the Neonate GL366 Approval and Authorisation Approved by Job Title Date N Pritchard Chair Neonatal Procedure and policy Oct 2009 Committee Change History Version Date Author Reason

More information

Elements for a Public Summary

Elements for a Public Summary VI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology Hunter syndrome is a rare genetic disease which mainly affects males of all ethnicities. The incidence rate ranges from 0.6 to

More information

Dengue virus. Essential Information

Dengue virus. Essential Information Dengue virus Essential Information Origins The dengue viruses are members of the Flavivirus family, and are medium sized enveloped viruses. Enveloped viruses are easy to kill on environmental surfaces

More information

Coventry & Warwickshire Area Prescribing Committee

Coventry & Warwickshire Area Prescribing Committee Coventry & Warwickshire Area Prescribing Committee Guidance on the use of pimecrolimus cream and tacrolimus ointment in moderate to severe atopic dermatitis This should be read in conjunction with the

More information

Parents and Grandparents

Parents and Grandparents Parents and Grandparents Vaccination for parents and grandparents is vital to help protect newborn babies against whooping cough. Protect your baby by being immunised too. To find out more about Boostrix

More information

Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis

Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis ANTIBIOTIC-ASSOCIATED DIARRHEA Disturbance of the normal colonic microflora Leading to alterations in bacterial degradation

More information

Guidelines for the Diagnosis and Treatment of Primary Immune Deficiency

Guidelines for the Diagnosis and Treatment of Primary Immune Deficiency Guidelines for the Diagnosis and Treatment of Primary Immune Deficiency Bruce Mazer MD McGill University Health Center Montreal Children s Hospital Meakins Christie Laboratories National Consensus Canadian

More information

Health Professionals Advice: Azithromycin now fully funded 3 December 2012

Health Professionals Advice: Azithromycin now fully funded 3 December 2012 Health Professionals Advice: Azithromycin now fully funded 3 December 2012 SITUATION UPDATE The Pertussis epidemic has continued all year, and is expected to continue throughout 2013. Between 1 January

More information

Pertussis Whooping Cough Update

Pertussis Whooping Cough Update May 3, 1 Dear Kitsap County Providers, This is an update about our current status of pertussis cases here in Kitsap County. We currently have 35 cases as outlined below. See the epidemiology curve (Figure

More information

Guideline. Treatment of tuberculosis in pregnant women and newborn infants. Version 3.0

Guideline. Treatment of tuberculosis in pregnant women and newborn infants. Version 3.0 Guideline Treatment of tuberculosis in pregnant women and newborn infants Version 3.0 Key critical points The decision to treat tuberculosis (TB) in pregnancy must consider the potential risks to mother

More information

DVT/PE Management with Rivaroxaban (Xarelto)

DVT/PE Management with Rivaroxaban (Xarelto) DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular

More information

in the postpartum period in order to improve maternal and perinatal health.

in the postpartum period in order to improve maternal and perinatal health. Iron and folate INTEGRATED MANAGEMENT OF PREGNANCY AND CHILDBIRTH (IMPAC) Standards for Maternal and Neonatal Care The standard All pregnant women in areas of high prevalence of malnutrition should routinely

More information

WARNING LETTER. According to its approved product labeling (PI) (in pertinent part, emphasis original):

WARNING LETTER. According to its approved product labeling (PI) (in pertinent part, emphasis original): DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration Silver Spring, MD 20993-0002 TRANSMITTED BY FACSIMILE Sapan A. Shah, Ph.D. President and Chief Executive Officer

More information

SCRUB TYPHUS DURING PREGNANCY AND ITS TREATMENT: A CASE SERIES AND REVIEW OF THE LITERATURE

SCRUB TYPHUS DURING PREGNANCY AND ITS TREATMENT: A CASE SERIES AND REVIEW OF THE LITERATURE Am. J. Trop. Med. Hyg., 75(5), 2006, pp. 955 959 Copyright 2006 by The American Society of Tropical Medicine and Hygiene SCRUB TYPHUS DURING PREGNANCY AND ITS TREATMENT: A CASE SERIES AND REVIEW OF THE

More information

Pertussis: halting the epidemic by protecting infants. 34 BPJ Issue 51

Pertussis: halting the epidemic by protecting infants. 34 BPJ Issue 51 Pertussis: halting the epidemic by protecting infants 34 BPJ Issue 51 Infants who have not yet completed the National Immunisation Schedule and children who are not immunised, or only partially immunised

More information

Malaria and its symptoms

Malaria and its symptoms Many travelers acquire malaria, a potentially life-threatening disease, during travel to tropical and subtropical countries. If you are traveling to Mexico and Central America, Haiti, the Dominican Republic,

More information

Source:

Source: Novel Influenza H1N1 Joseph C. Frantz, Ph.D. Director, Pharmaceutical Technology Sanofi Pasteur, Swiftwater, PA Lecture Outline Origins of a virus Microbiology of the virus Viruses and human disease Influenza

More information

Common Infectious Diseases. Chapter 28 Lesson 2

Common Infectious Diseases. Chapter 28 Lesson 2 Common Infectious Diseases Chapter 28 Lesson 2 Respiratory Infections Respiratory tract infections are infections of the breathing passages, which range from the nose to the alveoli of the lungs. Most

More information

Varicella and Varicella Vaccine

Varicella and Varicella Vaccine Varicella and Epidemiology and Prevention of Vaccine- Preventable Diseases Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

More information

CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia

CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia CMV infection in HIV infected patient Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia Background CMV infection are commonly found as HIV co-infection Vertical transmission is the important

More information

Appendix B: Provincial Case Definitions for Reportable Diseases

Appendix B: Provincial Case Definitions for Reportable Diseases Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Reportable Diseases Disease: Lassa Fever Revised December 2014 Lassa Fever 1.0 Provincial Reporting Confirmed and probable cases

More information

HEPATITIS B The Importance of the Hepatitis B Vaccine

HEPATITIS B The Importance of the Hepatitis B Vaccine HEPATITIS B The Importance of the Hepatitis B Vaccine Since 1982, a hepatitis B vaccine has been available to prevent hepatitis B virus infection. Today, the vaccine is made using recombinant DNA technology

More information

Pneumococcal & Influenza Vaccine Administration for Hospitalized Patients

Pneumococcal & Influenza Vaccine Administration for Hospitalized Patients Pneumococcal & Influenza Vaccine Administration for Hospitalized Patients Gonzalo Bearman MD, MPH Assistant Professor of Internal Medicine Divisions of Quality Health Care & Infectious Diseases Associate

More information

Remove this cover sheet before redistributing and replace it with your own. Please ensure that DPHHS is included on your HAN distribution list.

Remove this cover sheet before redistributing and replace it with your own. Please ensure that DPHHS is included on your HAN distribution list. State of Montana Health Alert Network DPHHS HAN ADVISORY Cover Sheet DATE: May 15, 2012 SUBJECT: Pertussis INSTRUCTIONS: DISTRIBUTE to your local HAN contacts. This HAN is intended for general sharing

More information

Other Causes of Fever

Other Causes of Fever T e c h n i c a l S e m i n a r s Other Causes of Fever Febrile Illness Causes Fever After Seven Days Referral Relapsing Fever - Borreliosis Overview JHR Adaptation Sore Throat Overview Prevention Management

More information

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant

SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant SOGC recommendation on ZIKA virus exposure for clinicians caring for pregnant women and those who intend to get pregnant Foreword The rapid emergence of Zika virus as a potential causative agent for fetal

More information

BE SURE. BE SAFE. VACCINATE.

BE SURE. BE SAFE. VACCINATE. DON T GET OR GIVE THE FLU THIS YEAR THANK YOU Vaccination is the only protection. www.immunisation.ie BE SURE. BE SAFE. VACCINATE. FLU VACCINE 2013-2014 Healthcare workers prevent the spread of flu and

More information

Immunization Healthcare Branch. Meningococcal Vaccination Program Questions and Answers. Prepared by

Immunization Healthcare Branch. Meningococcal Vaccination Program Questions and Answers. Prepared by Immunization Healthcare Branch Meningococcal Vaccination Program Questions and Answers Prepared by Immunization Healthcare Branch (IHB), Defense Health Agency Last Updated: 27 Mar 06 www.vaccines.mil 877-GET-VACC

More information

Diagnosis, Treatment and Prevention of Typhoid Fever in the Children of Bangladesh: A Microbiologist s View.

Diagnosis, Treatment and Prevention of Typhoid Fever in the Children of Bangladesh: A Microbiologist s View. Diagnosis, Treatment and Prevention of Typhoid Fever in the Children of Bangladesh: A Microbiologist s View. Samir K Saha, Ph.D. Department of Microbiology Dhaka Shishu Hospital Bangladesh Typhoid Fever:Salmonella

More information

Adult Inclusion Conjunctivitis

Adult Inclusion Conjunctivitis Adult Inclusion Conjunctivitis Dr. Victor Malinovsky 2006 General Characteristics Chlamydia are obligate intracellular parasites, C. trachomatis causes inclusion conjunctivitis, trachoma, cervicitis (women)

More information

Before, Frank's immune cells could

Before, Frank's immune cells could Before, Frank's immune cells could barely recognize a prostate cancer cell. Now, they are focused on it. Stimulate an immune response against advanced prostate cancer Extend median survival beyond 2 years

More information

abacavir, zidovudine, lamivudine: 1 abacavir, zidovudine and lamivudine fixed dose combination for first line treatment of HIV infection Abacavir/AZT/3TC is a fixed dose combination of three drugs recommended

More information

ALBERTA IMMUNIZATION POLICY GUIDELINES

ALBERTA IMMUNIZATION POLICY GUIDELINES ALBERTA IMMUNIZATION POLICY GUIDELINES Hepatitis Vaccines. Hepatitis A Vaccines Refer to the vaccine product monograph and the Canadian Immunization Guide for further Product monographs are available on

More information

1. ML is a 14-month-old girl diagnosed with acute otitis media. She presented to the pediatric

1. ML is a 14-month-old girl diagnosed with acute otitis media. She presented to the pediatric 1 Chapter 72, Self-Assessment Questions 1. ML is a 14-month-old girl diagnosed with acute otitis media. She presented to the pediatric clinic today with a fever of 102.4 F (39.1 C) and tugging of her right

More information

PAEDIATRIC ACUTE CARE GUIDELINE. Varicella. This document should be read in conjunction with this DISCLAIMER

PAEDIATRIC ACUTE CARE GUIDELINE. Varicella. This document should be read in conjunction with this DISCLAIMER Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Varicella Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should be read in conjunction

More information

Prospects for Vaccines against Hepatitis C Viruses. T. Jake Liang. M.D. Liver Diseases Branch NIDDK, NIH, HHS

Prospects for Vaccines against Hepatitis C Viruses. T. Jake Liang. M.D. Liver Diseases Branch NIDDK, NIH, HHS Prospects for Vaccines against Hepatitis C Viruses T. Jake Liang. M.D. Liver Diseases Branch NIDDK, NIH, HHS HCV Vaccine Prevention strategies Protective immunity Barriers and solutions Vaccine candidates

More information

Safety of HPV vaccination: A FIGO STATEMENT

Safety of HPV vaccination: A FIGO STATEMENT Safety of HPV vaccination: A FIGO STATEMENT July, 2013 Human papillomavirus vaccines are used in many countries; globally, more than 175 million doses have been distributed. Extensive pre- and post-licensure

More information

Comparison of pharmacokinetics and efficacy of oral and injectable medicine

Comparison of pharmacokinetics and efficacy of oral and injectable medicine Comparison of pharmacokinetics and efficacy of oral and injectable medicine Outline Background Results Antibiotics Non steroidal anti-inflammatory drugs (NSAIDs) Vitamins Conclusions and recommendations

More information

NHS FORTH VALLEY. Varicella Care Pathway for GPs

NHS FORTH VALLEY. Varicella Care Pathway for GPs NHS FORTH VALLEY Date of First Issue 01/04/2006 Approved 05/05/2012 Current Issue Date 28/04/2014 Review Date 28/04/2016 Version 1.2 EQIA Yes 01/04/2012 Author / Contact Debbie Forbes Group Committee Unit

More information

Drug-resistant Tuberculosis

Drug-resistant Tuberculosis page 1/6 Scientific Facts on Drug-resistant Tuberculosis Source document: WHO (2008) Summary & Details: GreenFacts Context - Tuberculosis (TB) is an infectious disease that affects a growing number of

More information

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA 2010 1 TB prophylaxis GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS Background

More information

Drug Utilization and Evaluation of Cephalosporin s At Tertiary Care Teaching Hospital, Bangalore

Drug Utilization and Evaluation of Cephalosporin s At Tertiary Care Teaching Hospital, Bangalore Research Article Drug Utilization and Evaluation of Cephalosporin s At Tertiary Care Teaching Hospital, Bangalore HS. Shekar 1*, HR. Chandrashekhar 2, M. Govindaraju 3, P. Venugopalreddy 1, Chikkalingiah

More information

Frequently asked questions for malaria

Frequently asked questions for malaria Frequently asked questions for malaria 1. What is malaria? Malaria is an infectious disease caused by a parasite that is transmitted through bite of an infected mosquito at night. There are two main types

More information

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal Background 1 Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Alyssa Cavanaugh, PharmD PGY1 Pharmacy Resident Children s Hospital of Michigan **The speaker has no actual or

More information

Tuberculousmeningitis: what is the best treatment regimen?

Tuberculousmeningitis: what is the best treatment regimen? Tuberculousmeningitis: what is the best treatment regimen? H S Schaaf Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University

More information

SYPHILIS (REPORTABLE)

SYPHILIS (REPORTABLE) SYPHILIS (REPORTABLE) Please Note: On April 25, 2016, in collaboration with the Public Health Agency of Canada; the BCCDC issued interim Syphilis treatment guidelines effective immediately in response

More information

Recommendations for Emergency Departments in Caring for Potential Ebola Virus Disease (EVD) Patients

Recommendations for Emergency Departments in Caring for Potential Ebola Virus Disease (EVD) Patients Recommendations for Emergency Departments in Caring for Potential Ebola Virus Disease (EVD) Patients Provincial Ebola Expert Working Group March 10, 2015 Contents A. Preamble... 3 B. Guiding Principles...

More information

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism

! What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism What Parents Should Know About Measles-Mumps-Rubella (MMR) Vaccine and Autism Autism Q. What is autism? Autism is a spectrum of chronic developmental disorders. The main characteristics of autism are difficulties

More information

GRANIX (tbo-filgrastim)

GRANIX (tbo-filgrastim) RATIONALE FOR INCLUSION IN PA PROGRAM Background Neutropenia is a hematological disorder characterized by an abnormally low number of neutrophils. A person with severe neutropenia has an absolute neutrophil

More information

Skin and Soft Tissue Infection Guideline, including Diabetic Foot Ulcer Infection

Skin and Soft Tissue Infection Guideline, including Diabetic Foot Ulcer Infection Skin and Soft Tissue Infection Guideline, including Diabetic Foot Ulcer Infection Written by: Dr Ken Agwuh, Consultant Microbiologist Date: March 2016 Approved by: Drugs & Therapeutics Committee Date:

More information

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy

Goals of Therapy. Treatment Options for Hepatitis C. Patterns of Response. Progress in Hepatitis C Therapy Treatment Options for Hepatitis C Helen S. Te, M.D. Center for Liver Diseases University of Chicago Hospitals Chicago, Illinois Primary: To eliminate the virus Goals of Therapy Secondary: To decrease inflammation

More information

160S01105, Page 1 of 7. Human Hepatitis B Immunoglobulin, solution for intramuscular injection.

160S01105, Page 1 of 7. Human Hepatitis B Immunoglobulin, solution for intramuscular injection. 160S01105, Page 1 of 7 New Zealand Data Sheet Hepatitis B Immunoglobulin-VF NAME OF THE MEDICINE Human Hepatitis B Immunoglobulin, solution for intramuscular injection. DESCRIPTION Hepatitis B Immunoglobulin-VF

More information

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis

HEPATITIS WEB STUDY Acute Hepatitis C Virus Infection: Epidemiology, Clinical Features, and Diagnosis HEPATITIS WEB STUDY Acute C Virus Infection: Epidemiology, Clinical Features, and Diagnosis H. Nina Kim, MD Assistant Professor of Medicine Division of Infectious Diseases University of Washington School

More information

Tuberculosis in Pregnancy

Tuberculosis in Pregnancy Tuberculosis in Pregnant versus non- Tuberculosis in Pregnancy Mark J. Granada, MD Means of Spreading TB bacilli Coughing Sneezing Singing Spitting Laughing Rarely, pregnant TB patient may pass TB to unborn

More information

Disease Modifying Therapies for MS

Disease Modifying Therapies for MS Disease Modifying Therapies for MS The term disease-modifying therapy means a drug that can modify or change the course of a disease. In other words a DMT should be able to reduce the number of attacks

More information

Teriflunomide is the active metabolite of Leflunomide, a drug employed since 1994 for the treatment of rheumatoid arthritis (Baselt, 2011).

Teriflunomide is the active metabolite of Leflunomide, a drug employed since 1994 for the treatment of rheumatoid arthritis (Baselt, 2011). Page 1 of 10 ANALYTE NAME AND STRUCTURE TERIFLUNOMIDE Teriflunomide TRADE NAME Aubagio CATEGORY Antimetabolite TEST CODE PURPOSE Therapeutic Drug Monitoring GENERAL RELEVANCY BACKGROUND sclerosis. The

More information

Frequently asked questions about whooping cough (pertussis)

Frequently asked questions about whooping cough (pertussis) Frequently asked questions about whooping cough (pertussis) About whooping cough What is whooping cough? Whooping cough is a highly contagious illness caused by bacteria. It mainly affects the respiratory

More information

Borderless Diseases By Sunny Thai

Borderless Diseases By Sunny Thai Borderless Diseases By Sunny Thai Millennium Development Goal #6 6. Combat HIV/AIDS, malaria and other borderless diseases. A. Halt and begin reversing spread of HIV by 2015. B. Achieve universal access

More information

FAQs on Influenza A (H1N1-2009) Vaccine

FAQs on Influenza A (H1N1-2009) Vaccine FAQs on Influenza A (H1N1-2009) Vaccine 1) What is Influenza A (H1N1-2009) (swine flu) 1? Influenza A (H1N1-2009), previously known as "swine flu", is a new strain of influenza virus that spreads from

More information

Further information on foodborne illness is available at and

Further information on foodborne illness is available at  and Hepatitis A Epidemiology in New Zealand The incidence of hepatitis A in New Zealand has decreased sharply since the 1960s, and currently about half the cases notified have a history of overseas travel.

More information

Biologic Treatments for Rheumatoid Arthritis

Biologic Treatments for Rheumatoid Arthritis Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been

More information

AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS

AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS AIR FORCE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS An Air Force addendum to the TRI-SERVICE REPORTABLE EVENTS GUIDELINES & CASE DEFINITIONS Prepared by: Air Force Institute for Operational Health

More information

Hepatitis C Vaccines: Are we making progress?

Hepatitis C Vaccines: Are we making progress? Hepatitis C Vaccines: Are we making progress? Second International Hepatitis Cure and Eradication Meeting. Vancouver November, 2015 Objectives: Review the need for a preventive vaccine in 2015. Identify

More information

PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION

PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION PROTOCOL FOR THE MANAGEMENT OF CLOSE CONTACTS OF PERTUSSIS INFECTION Printed copies must not be considered the definitive version DOCUMENT CONTROL PROTOCOL NO. 1.03 Policy Group Infection Control Committee

More information

Haemophilus Influenzae (meningitis and invasive

Haemophilus Influenzae (meningitis and invasive Haemophilus Influenzae (meningitis and invasive disease)! Report immediately 24/7 by phone upon initial suspicion or laboratory test order PROTOCOL CHECKLIST Enter available information into Merlin upon

More information

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol)

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) 1. Hepatotoxicity: In Active TB Disease a. Background: 1. Among the 4 standard anti-tb drugs,

More information

UNDERSTANDING HAIR THINNING/HAIR LOSS

UNDERSTANDING HAIR THINNING/HAIR LOSS UNDERSTANDING HAIR THINNING/HAIR LOSS INDICATION AUBAGIO (teriflunomide) is indicated for the treatment of patients with relapsing forms of multiple sclerosis. IMPORTANT SAFETY INFORMATION WARNING: HEPATOTOXICITY

More information

Carla Duff, CPNP MSN CCRP Clinical Advanced Registered Nurse Practitioner University of South Florida Division of Allergy, Immunology, and

Carla Duff, CPNP MSN CCRP Clinical Advanced Registered Nurse Practitioner University of South Florida Division of Allergy, Immunology, and Carla Duff, CPNP MSN CCRP Clinical Advanced Registered Nurse Practitioner University of South Florida Division of Allergy, Immunology, and Rheumatology Intravenous Subcutaneous IVIg SCIg What should you

More information

Diagnosis, Treatment and Response of Rocky Mountain Spotted Fever (RMSF) for Non Medical Professionals. Objectives

Diagnosis, Treatment and Response of Rocky Mountain Spotted Fever (RMSF) for Non Medical Professionals. Objectives Diagnosis, Treatment and Response of Rocky Mountain Spotted Fever (RMSF) for Non Medical Professionals Joanna Regan, MD, MPH, FAAP Medical Epidemiologist Rickettsial Zoonoses Branch Integrated Pest Management

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace

More information

18.5 Percent Overall Response Rate Observed in Pembrolizumab-Treated Patients with this Aggressive Form of Breast Cancer

18.5 Percent Overall Response Rate Observed in Pembrolizumab-Treated Patients with this Aggressive Form of Breast Cancer News Release Media Contacts: Annick Robinson Investor Contacts: Joseph Romanelli (514) 837-2550 (908) 740-1986 Stephanie Lyttle NATIONAL Public Relations (514) 843-2365 Justin Holko (908) 740-1879 Merck

More information

INDICATIONS FOR USE OF ANTI-D IMMUNOGLOBULIN

INDICATIONS FOR USE OF ANTI-D IMMUNOGLOBULIN The Guidelines for use of Anti-D Immunoglobulin have been prepared by NZ Blood Service for use by Midwives and Medical Practitioners involved in caring for pregnancies or obstetric practice in New Zealand.

More information

Chapter 3. Immunity and how vaccines work

Chapter 3. Immunity and how vaccines work Chapter 3 Immunity and how vaccines work 3.1 Objectives: To understand and describe the immune system and how vaccines produce immunity To understand the differences between Passive and Active immunity

More information

Dengue Fever and Prevention Zika Virus Disease

Dengue Fever and Prevention Zika Virus Disease Dengue Fever and Prevention Zika Virus Disease Department of Public Health and Caring Sciences Pranee Lundberg Dengue Fever and Prevention Dengue Fever Globally, dengue is the most common mosquito-borne

More information

Novel Influenza A (H1N1)

Novel Influenza A (H1N1) Novel Influenza A (H1N1) H1N1 Healthcare Briefings September 10, 2009 P. Bryon Backenson Director, Investigations Unit Bureau of Communicable Disease Control New York State Department of Health What is

More information

Multiple Myeloma. This reference summary will help you understand multiple myeloma and its treatment options.

Multiple Myeloma. This reference summary will help you understand multiple myeloma and its treatment options. Multiple Myeloma Introduction Multiple myeloma is a type of cancer that affects white blood cells. Each year, thousands of people find out that they have multiple myeloma. This reference summary will help

More information

Future strategies for myeloma: An overview of novel treatments In development

Future strategies for myeloma: An overview of novel treatments In development Future strategies for myeloma: An overview of novel treatments In development Dr. Matthew Streetly Guys and St. Thomas NHS Trust How far have we come? Melphalan and prednisolone VAD Autologous SCT Thalidomide

More information