Handbook of common communicable and infectious diseases pdf

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handbook of common communicable and infectious diseases pdf

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Infectious Diseases

Version 4. Version 3. Version 2. Version 1. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg. Recommend strong recommendation : Guideline panel is confident that the desirable effects of an intervention outweigh the undesirable effects. Most or all individuals will be best served by the recommended course of action.

Suggest weak or conditional recommendation : Guideline panel after discussion concludes that the desirable effects probably outweigh undesirable effects, but appreciable uncertainty exists.

See Figure 1 in the Executive Summary. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. Since that time, the guideline panel and methodologists have continued to monitor the literature and issue updates and addendums to these guidelines in response to evolving research.

Coronavirus disease COVID is a pandemic with a rapidly increasing incidence of infections and deaths. Many pharmacologic therapies are being used or considered for treatment.

Given the rapidity of emerging literature, the Infectious Diseases Society of America IDSA identified the need to develop living, frequently updated evidence-based guidelines to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID A detailed description of background, methods, evidence summary and rationale that support each recommendation, and research needs can be found online in the full text. In situations where promising interventions were judged to have insufficient evidence of benefit to support their use and with potential appreciable harms or costs, the expert panel recommended their use in the context of a clinical trial.

Conditional recommendation, Low certainty of evidence. Conditional recommendation, Very low certainty of evidence. Conditional recommendation, low certainty of evidence. Strong recommendation, Moderate certainty of evidence. Since the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID The panel has determined that when an explicit trade-off between highly uncertain benefits and known putative harms of these therapeutic agents were considered, a net positive benefit was not reached and could possibly be negative risk of excess harm.

The panel acknowledges that enrolling patients in randomized controlled trials RCTs might not be feasible for many frontline providers due to limited access and infrastructure. Should lack of access to clinical trials exist, we encourage setting up local or collaborative registries to systematically evaluate the efficacy and safety of drugs to contribute to the knowledge base. Each clinician can play a role in advancing our understanding of this disease through a local registry or other data collection efforts.

Within a span of months, COVID has become pandemic due to its transmissibility, spreading across continents with the number of cases and deaths rising daily [2]. While mortality appears to be more common in older individuals and those with comorbidities, such as chronic lung disease, cardiovascular disease, hypertension and diabetes, young people with no comorbidities also appear to be at risk for critical illness including multi-organ failure and death.

There has been an expanding number of studies rapidly published online and in academic journals; however, some of these may be of limited quality and are pre-published without sufficient peer-review. Critical appraisal of the existing studies is needed to determine if the existing evidence is sufficient to support currently proposed management strategies. The guideline panel is using a methodologically rigorous process for evaluating the best available evidence and providing treatment recommendations.

Two additional guidelines on diagnostic testing and infection prevention also have been developed. There continue to be several ongoing trials evaluating therapeutic agents for the treatment of COVID As data becomes available from these trials and if there is a preponderance of evidence to suggest the use of a therapeutic agent even in the context of clinical trials is no longer warranted it will be removed from future updates of the guideline and the removal will be noted in the updated guidelines.

If there is emerging evidence on the efficacy or safety of a therapeutic agent not mentioned in the current version of the guideline it will be included in future updates of the guideline. These recommendations are intended to inform patients, clinicians, and other health professionals by providing the latest available evidence.

The initial guideline panel assembled in March was composed of nine members including infectious diseases specialists as well as experts in public health as well as other front-line clinicians, specializing in pharmacology, pediatrics, medical microbiology, preventive care, critical care, hepatology, nephrology and gastroenterology.

The Evidence Foundation provided technical support and guideline methodologists for the development of this guideline. The conflict of interest COI review group for this guideline includes two representatives from IDSA who are responsible for reviewing, evaluating and approving all disclosures. All members of the expert panel have complied with the COI process for reviewing and managing conflicts of interest, which requires disclosure of any financial, intellectual, or other interest that might be construed as constituting an actual, potential, or apparent conflict, regardless of relevancy to the guideline topic.

The assessment of disclosed relationships for possible COI is based on the relative weight of the financial relationship i. The COI review group has ensured that the majority of the panel and chair is without potential relevant related to the topic conflicts for the duration of their term on the panel.

The chair and all members of the technical team have been determined to be unconflicted. Clinical questions included in this guideline were developed into a PICO format Population, Intervention, Comparison, Outcomes [5] and prioritized according to available evidence that met the minimum acceptable criteria i. Panel members prioritized patient-important outcomes such as mortality, development of ARDS need for non-invasive or invasive ventilation and clinical improvement such as disease-oriented outcomes inferred by radiological findings or virologic cure , and severe adverse events SAE leading to treatment discontinuation.

Serious adverse events are death, life threatening reactions, those that require hospitalization, result in disability or permanent damage or require an intervention to prevent permanent impairment [6]. Additional drug specific harms were evaluated when clinically relevant, including possible drug-drug reactions, if applicable. The National Institute for Health and Care Excellence NICE highly-sensitive search was reviewed by the methodologist in consultation with the technical team information specialist and was determined to have high sensitivity [7].

Ovid Medline and Embase were searched from through September 18, Horizon scans have been performed regularly during the evidence assessment and recommendation process to locate additional grey literature and manuscript pre-prints.

Reference lists and literature suggested by panelists were reviewed for inclusion. No restrictions were placed on language or study type. Two reviewers independently screened titles and abstracts, as well as eligible full-text studies.

When acceptable RCTs of effectiveness were found, no additional non-randomized studies or non-comparative evidence i. Evidence from single arm studies reporting on non-comparative rates of outcomes of interest were included if a historical control event rate could be estimated from the literature. Reviewers extracted relevant information into a standardized data extraction form. For several interventions, no direct evidence was available other than case reports or mechanistic considerations.

The panel either decided to include plausible indirect evidence and make a recommendation e. Data extracted from the available evidence included: mortality, clinical progression or improvement as reported in the studies, virologic clearance, and adverse events.

Where applicable, data were pooled using random effects model fixed effects model for two or fewer trials or pooling of rates using RevMan [8]. As higher quality direct evidence for clinical outcomes becomes available, outcomes previously deemed critical by the panel became less important for decision-making. For example, at the time of the first guideline, clinical improvement outcomes e. However, with the recent publication of RCTs and non-randomized studies reporting on direct measures of clinical improvement, results of radiographic studies were deemed to be less critical for decision making.

The panel considered core elements of the GRADE evidence in the decision process, including Certainty of evidence and balance between desirable and undesirable effects. Additional domains were acknowledged where applicable feasibility, resource use, acceptability.

For all recommendations, the expert panelists reached consensus. Voting rules were agreed on prior to the panel meetings for situations when consensus could not be reached. Figure 1 provides the suggested interpretation of strong and weak recommendations for patients, clinicians, and healthcare policymakers. Detailed suggestions about the specific research questions that should be addressed are found in the table see Table s2.

SHEA has reviewed and provided endorsement of its contents. Regular, frequent screening of the literature will take place to determine the need for revisions based on the likelihood that any new data will have an impact on the recommendations.

When necessary, the entire expert panel is reconvened to discuss potential changes. Changes to these guidelines will fall into one of two categories: update or amendment. An update involves a search for new studies, and if any new studies are found, they will be critically appraisal and the pertinent section will be removed and replaced with the updated section.

An amendment involves a change or correction to the document, without any search for new studies and their appraisal. Systematic review and horizon scan of the literature identified references of which 48 informed the evidence base for these recommendations Figure s1. Characteristics of the included studies can be found in the supplementary materials. Recommendation 1. Recommendation 2. Strong recommendation, Low certainty of evidence. Hydroxychloroquine HCQ and chloroquine are 4-aminoquinoline drugs developed in the mid th century for the treatment of malaria [13].

Hydroxychloroquine differs from chloroquine only in the addition of a hydroxyl group and is associated with a lower incidence of adverse effects with chronic use [13]. Both drugs have been used in the treatment of autoimmune diseases because of their immunomodulatory effects on several cytokines, including IL-1 and IL-6 [13]. There is some evidence that these drugs also have antiviral properties against many different viruses, including the coronaviruses [14, 15].

They have demonstrated in vitro activity against SARS-CoV-2, which range considerably between studies, but are generally within the range of predicted achievable tissue concentrations [14, ]. The in vitro activity, the extensive use for other conditions, and widespread availability of generic versions of the drug made it an attractive option for treatment of COVID Interest in combinations of HCQ with azithromycin AZ began when investigators in a small, uncontrolled study of hydroxychloroquine use for COVID noticed a higher frequency of patients achieving virologic response in the six subjects who received AZ to prevent bacterial infection [19].

Azithromycin, widely utilized as an antibacterial agent, has also been shown to have in vitro antiviral activity against a variety of ribonucleic acid viruses []. While the exact mechanism of antiviral activity is unknown, possibilities include inhibiting endocytosis and limiting viral replication [23] and the induction of interferon [22, 24].

Macrolides have also been shown to have anti-inflammatory activity [25, 26]. Our search identified eight RCTs and seven comparative cohort studies of hospitalized patients with confirmed COVID treated with HCQ with reported mortality, clinical progression or clinical improvement, and adverse events outcomes [] Table s3a Table 1. In addition, we identified one RCT, four comparative cohort studies, and one case-control study reporting adjusted analyses of hospitalized patients with confirmed COVID treated with HCQ plus AZ with reported mortality, failure of virologic clearance assessed with polymerase chain reaction [PCR] test , clinical improvement, and adverse events i.

One RCT reported that persons treated with HCQ experienced a longer time until hospital discharge median 16 days compared with 13 days and lower probability of being discharged alive within the day study period rate ratio: 0. The panel agreed that the overall certainty of evidence against treatment with HCQ was moderate due to concerns with imprecision around the risk for a trend towards harms from increased mortality. Ritonavir is added to the combination as a pharmacokinetic enhancer due to its strong inhibition of cytochrome P 3A4, a metabolic pathway for lopinavir metabolism.

This study had limitations including a control group from early in the outbreak when management strategies likely differed significantly [61]. During the early phase of COVID, triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin shortened the duration of viral shedding and hospital stay in patients with mild to moderate COVID in an open-label, randomized, phase II trial [64].

Handbook of Common Communicable and Infectious Diseases

It requires a living cell in which to multiply. A viral infection can lead to a spectrum of symptoms from asymptomatic no overt symptoms to severe disease. People may get viruses by swallowing or inhaling them, by being bitten by insects, or through sexual contact. Most commonly, viral infections involve the nose, throat, and upper airways, or systems such as the nervous, gastrointestinal, and reproductive systems. Doctors may base the diagnosis on symptoms, blood tests and cultures, or examination of infected tissues.

Overview of Viral Infections

Here's a unified evidence-based approach to problems encountered in trauma and critical care surgica.. Netter''''s Infectious Diseases provides a comprehensive yet concise overview of current global infe.. Transplant Infections is a practical, clinically focused reference covering the common and more unus..

List of dog diseases

Version 4. Version 3. Version 2. Version 1. Equivalent total daily doses of alternative glucocorticoids to dexamethasone 6 mg daily are methylprednisolone 32 mg and prednisone 40 mg. Recommend strong recommendation : Guideline panel is confident that the desirable effects of an intervention outweigh the undesirable effects. Most or all individuals will be best served by the recommended course of action.

This list of dog diseases is a selection of diseases and other conditions found in the dog. Some of these diseases are unique to dogs or closely related species, while others are found in other animals, including humans. Not all of the articles listed here contain information specific to dogs. From Wikipedia, the free encyclopedia. Wikipedia list article. Main article: Dog health.

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