ADY Blog

Mycoplasma Pneumoniae: The Most Common Cause of Pediatric Encephalitis?

noreply@blogger.com (ADY) — Sun, 20 Jan 2008 18:33:00 -0800

Christie LJ, Honarmand S, Talkington DF, et al
Pediatrics. 2007;120:305-313

Summary

This report details data collected as part of the California Encephalitis Project, begun in 1998. The current study patients represent those reported to the project from 1996-2006. Among many pathogens identified, Mycoplasma pneumoniae was the most common cause of encephalitis.

The authors completed this report to detail the history, physical, and laboratory findings of the children with M pneumoniae encephalitis in order to better understand the epidemiology of the process.

Cases were defined as patients with encephalitis and evidence of acute infection with M pneumoniae: those with positive serum IgM or rising IgG antibodies to M pneumoniae, or subjects with a positive polymerase chain reaction to M pneumoniae from either the spinal fluid or respiratory sample.

There were 1988 subjects in the project sample, and 111 (5.6%) had evidence of acute M pneumoniae infection. The majority of the patients (n = 84 [76%]) with M pneumoniae were younger than 19 years of age, with a median age of 11 years for those with M pneumoniae encephalitis. There were no gender differences.

Many of the patients had gastrointestinal symptoms (45%), but an almost equal percentage had respiratory symptoms. Only 15% of the adults with M pneumoniae encephalitis had gastrointestinal symptoms. Of the pediatric patients with M pneumoniae encephalitis, most (n = 59 [70%]) were diagnosed by virtue of an elevated serum IgM to M pneumoniae. An additional 19 pediatric cases had IgM values that were positive along with another marker (such as respiratory polymerase chain reaction (PCR), serum IgG change, etc).

Only 1 subject with M pneumoniae encephalitis had a positive cerebrospinal fluid (CSF) PCR for M pneumoniae. Nine percent of child cases had respiratory PCR positive for M pneumoniae. The median CSF white blood cell count was 33/mm³ among the patients with M pneumoniae encephalitis.

Overall, however, the CSF values for patients with M pneumoniae encephalitis did not differ from those of other etiologies. Magnetic resonance imaging demonstrated abnormalities in 49% of the M pneumoniae cases.

Fourteen percent of the patients suffered coma, and 4% of the M pneumoniae child cases died. The authors note that M pneumoniae was the identified agent twice as often as enterovirus among children and 7 times as often as herpes simplex virus, type 1.

The authors conclude that M pneumoniae was the most common causative agent identified in this series of patients, but CSF evidence of the infection is not usually found.

Viewpoint

The lesson of this article is that serum samples, usually IgM and a combination of IgM and IgG (acute and convalescent titers), are the best methods to make the diagnosis of M pneumoniae encephalitis. A second message is that the symptoms of these patients are so similar to those seen in other etiologies that M pneumoniae might not immediately come to mind during consideration of the differential; M pneumoniae has to be on the list of "usual suspects," or clinicians will likely greatly underdiagnose it in encephalitis cases. Finally, the authors note that the role of antibiotics in M pneumoniae encephalitis is not clear, primarily because it is not clear whether the CNS manifestations in M pneumoniae patients are the result of direct invasion or an autoimmune process which might not be improved directly by antibiotics.

Medical Care of the Cornea

noreply@blogger.com (ADY) — Sun, 20 Jan 2008 17:42:00 -0800

Microbial Keratitis

During a joint symposium with the Contact Lens Association of Ophthalmologists, Dr. William Ehlers^[1] presented an update on the Fusarium keratitis epidemic that began in 2005. Dr. Ehlers summarized the generally accepted features of keratomycosis, including its higher prevalence in warmer climates (it accounts for up to 35% of cases of microbial keratitis in the southern United States but only 1% of cases in the north). The proportion of cases of keratomycosis caused by Fusarium species also varies by region, again with most, at least prior to the contact lens-associated epidemic, occurring in the south. There are more than 20 million species of Fusarium, a filamentous, nonpigmented fungus, but Fusarium solani has typically been the most implicated and the most virulent in instances of keratomycosis in humans. Dr. Ehlers emphasized that human cases of keratomycosis appeared to be on the rise, even prior to the 2005 outbreak. Before the "epidemic," trauma, immunosuppression, debilitated ocular surface, and chronic topical steroid use were the predominant predisposing factors for an individual developing keratomycosis.

Fungus is often not suspected initially when ophthalmologists evaluate a patient with keratitis or corneal ulcer. Suspicion should be heightened, however, because early diagnosis is key to salvaging the eye and eventual resurrection of useful vision. The appearance of a gray-white infiltrate with feathery edges and so-called "satellite lesions" should make the ophthalmologist particularly suspicious of keratomycosis. Confocal microscopy can be extremely helpful in demonstrating, through noninvasive techniques, frank fungal elements. Harvesting of material for slide preparation and culture is essential, with request for "special" stains, such as giemsa, PAS, methamine silver, and calciflor white techniques for demonstrating the fungal elements. Cultures should be established not only on Sabouraud's medium but also on blood agar plates held at room temperature.

In regard to the Fusarium epidemic beginning in Hong Kong and Singapore in 2005, with strong association in contact lens wearers using ReNu with MoistureLoc (Bausch & Lomb, Rochester, New York) for their lens care, Dr. Ehlers indicated that by April 9, 2006, the Centers for Disease Control and Prevention (CDC) had a list of 109 suspected cases in 17 states, 93 cases occurring in soft contact lens wearers. Bausch & Lomb withdrew ReNu with MoistureLoc permanently from the worldwide market in May 2006, and the company reported their hypothesis of the proposed mechanism of infection at the Congress of the Asia-Pacific Academy of Ophthalmology in Singapore in June of that year. The company estimated that corneal infection had occurred in approximately 1 in 16,667 ReNu with MoistureLoc users. Extensive investigations by Bausch & Lomb disclosed no contamination at production plants in Greenville, South Carolina, or in Milan, Italy, or evidence of product contamination, tampering, or counterfeiting, as well as no loss of efficacy at high temperature or humidity. All lots tested from both plants were highly effective in vitro. Controlled, monitored studies in humans using the ReNu with MoistureLoc products demonstrated unequivocally that it was safe and effective when used as directed. Patient noncompliance habits were ultimately believed to contribute to the reduction in disinfectant efficacy. These habits were identified as:

Irregular cleaning of contact lens cases,
Not replacing lens cases regularly,
Poor hygiene with respect to bottle caps,
Leaving bottles and lens cases open,
Poor hand washing and incomplete rinsing of hands,
No rinsing of lens, and
Topping off solution in contact lens cases.

Fusarium species were shown to be capable of adapting to polymer films on surfaces, and the product design with its "snap cap" was shown to be prone to polymer film formation. It was concluded that the high polymer content in ReNu with MoistureLoc combined with poor patient hygiene and habits reduced the margin of safety for the use of this product, hence its recall from the market. This saga has once again refocused our attention on the critical importance of correct contact lens care.

On the heels of the Fusarium outbreak, a rise in Acanthamoeba corneal infections has been observed -- and these infections also have a strong association with contact lens wear and poor contact lens hygiene habits. de Freitas and associates^[2] reported their findings of an analysis of corneal scrapings and contact lens cultures. The recovery of 175 Acanthamoeba isolates translated to an incidence rate of 15.9 Acanthamoeba-associated corneal infections per year. Nguyen and colleagues^[3] reported on similarly poor outcomes in patients with Acanthamoeba keratitis as in those with Fusarium keratitis and a similar need for corneal transplantation in an effort to save the eye. Five patients with deep stromal ulcers due to Acanthamoeba keratitis were treated with intensive antiparasitic medication followed by penetrating keratoplasty during the acute infectious phase of the disease because of progressive keratopathy and intractable patient pain. The grafts were large enough to be certain that the margins of excision encompassed all areas of active infection. The surgery proved to be not only therapeutic, in that the infection was cured through the surgery, but the visual outcomes were also surprisingly good, ranging from 20/20 to 20/40 (average follow up, 53 weeks).

Bacterial keratitis remains the number one cause of microbial keratitis, and Wagoner and colleagues^[4] reported on their analysis of 78 and 103 consecutive patients admitted in 1995 and in 2005, respectively, to a tertiary eye care center for bacterial keratitis. They demonstrated that significant improvements occurred between those 2 cohorts of patients, analyzed in the percentage of eyes achieving a microbiological cure with medical therapy and in those obtaining a final visual acuity of equal to or better than 20/40. They attributed this improvement to a standardization of inpatient microbiological therapeutic regimens and increased emphasis on adjunctive anti-inflammatory therapy. Rather than withhold topical corticosteroid therapy, practitioners employed it as soon as they were confident that the antimicrobial therapy was appropriate and was beginning to control the infection.

Ocular Rosacea

Zaidman^[5] reported on the efficacy of once-daily oral azithromycin in the treatment of children with ocular rosacea. Two children, aged 3 and 8 years, had histories of recurrent chalazia, chronic meibomian gland dysfunction and blepharitis, corneal neovascularization, and recurrent phlectenular keratitis. They were diagnosed with pediatric ocular rosacea, and systemic azithromycin suspension was prescribed (15 mg/kg/day for 8 weeks), along with 10 days of topical therapy with a corticosteroid-antibiotic suspension. The author reported that the acute keratitis resolved rapidly, with no recurrence of the disease after the cessation of the topical and systemic program.

Corneal Neovascularization

Corneal neovascularization therapy with the vascular endothelial growth factor inhibitor bevacizumab continues to be a hot topic. Bahar^[6] described the regression of corneal vessels, documented by serial photography graded by 2 masked observers, after the administration of subconjunctival bevacizumab in 10 patients with corneal neovascularization. The average follow-up time was 3.5 months. No adverse events were reported, and 7 of the 10 patients demonstrated at least partial regression of the vessels. The authors concluded that subconjunctival bevacizumab is well tolerated and is associated with at least partial regression of corneal neovascularization.

Topical bevacizumab therapy for corneal neovascularization was evaluated by DeStafeno and Kim.^[7] Product concentration of 10 mg/mL was applied 4 times daily for 25 days in 2 patients with corneal neovascularization. The authors reported a "marked" reduction in superficial and deep corneal neovascularization with no adverse events noted.

External Disease

Anzaar and colleagues^[8] reported on their experience with the use of systemic tacrolimus for patients with otherwise treatment-resistant atopic keratoconjunctivitis. They described 3 patients who had failed multiple topical and systemic treatment programs. All 3 patients had a dramatic improvement in the signs and symptoms of atopic keratoconjunctivitis, and all had associated improved visual acuity. This report adds to a growing body of evidence that systemic calcineurin and inhibitor therapy can be, even in instances where topical therapy with calcineurin inhibitors has failed, effective not only for the ocular manifestations of atopic keratoconjunctivitis but for the associated eczema as well.

Yadav and associates^[9] reported on the efficacy of 5% povidone iodine as a lid scrub in the care of patients with blepharitis. The authors employed lid hygiene 2 times per day with a cotton tipped applicator dipped in 5% povidone iodine solution in 100 patients. Slit lamp examinations were performed for 1 week thereafter, monitoring for crusting, scaling, lid margin erythema, edema, and discharge, all graded on a scale of 0 to 3+. On day 7, the scales had been reduced in 98% of patients, erythema and edema had been reduced in 93.4%, and discharge reduced in 92.7%. The authors concluded that 5% povidone iodine is safe for ocular use, is well-tolerated, and is more effective than shampoo and lid scrubs for patients with chronic blepharitis.

Corneal Collagen Crosslinking

A relatively new and novel strategy for treating patients with keratoconus received more exposure at the AAO meeting. Specifically, corneal collagen crosslinking with riboflavin and ultraviolet radiation was highlighted by 2 groups.^[10,11] In a controlled case series,^[10] 16 eyes with keratoconus underwent corneal crosslinking using riboflavin and ultraviolet light (395 nm). Improvements in vision were recorded as early as 1 month following the treatment, and the treatment was associated with a cessation of keratoconus progression in all patients. No one lost vision, 8 patients maintained vision, and 3 gained 1 line, with 1 patient gaining 2 lines of vision. An expansion of an earlier report^[11] showed improvement in the results of 38 eyes of 19 patients 6 months following this procedure. The maximum keratometry reading decreased by 1.75 diopters, the best corrected visual acuity improved by 0.04 in the fellow untreated eye, the maximum keratometry reading increased by .24 diopters, and vision decreased by .02. The authors concluded that corneal collagen crosslinking appears to be a safe procedure that stops the progression of keratoconus and even reduces to some degree the steepness of the corneal curvature.

Kymionis and associates^[12] evaluated corneal tissue alterations after corneal crosslinking with riboflavin and ultraviolet radiation in corneal ectatic disorders, specifically patients with keratoconus or post-LASIK corneal ectasia. The patients were evaluated monthly for 6 months following the procedure, and anterior cornea stromal was found to be depleted of keratocyte nuclei following therapy and at the first 3 monthly visits. The collagen fibers in the superior stromal were distributed unevenly, taking a "net-like" appearance, with recolonization of the superior corneal stroma demonstrable over months 4, 5, and 6 postprocedure. The authors concluded that corneal collagen crosslinking induces significant alterations in corneal morphology at the microscopic level.

Source = http://www.medscape.com/viewarticle/567990?src=mp

Guidelines Updated for Use of Tumor Markers in Breast Cancer

noreply@blogger.com (ADY) — Tue, 15 Jan 2008 06:56:00 -0800

November 13, 2007 — The American Society of Clinical Oncology (ASCO) has updated its recommendations for use of tumor markers in prevention, screening, treatment, and surveillance of breast cancer. The revised guidelines were published in the October 22 Early Release Article issue of the Journal of Clinical Oncology, after approval by the ASCO Board of Directors Executive Committee on July 12, 2007.

In 1996, ASCO first published evidence-based clinical practice guidelines regarding the use of tumor markers in breast cancer. An Update Committee of the original Expert Panel updates these guidelines at intervals, with the last update regarding tumor markers in breast cancer published in 2000.

"For the 2007 update, the Panel expanded the scope of the guidelines to include a broader range of markers in breast cancer," write Lyndsay Harris, MD, from the Yale Cancer Center, Yale University in New Haven, Connecticut, and colleagues from ASCO. "In addition, the impact of genomic technologies was considered in the Update. While molecular subtyping is still in its infancy, and subgroups are not well defined, the use of multiparameter technologies in clinical practice has considerable potential."

Using computerized literature searches of MEDLINE and the Cochrane Collaboration Library, the Update Committee reviewed and analyzed data published since 1999, particularly focusing on available systematic reviews and meta-analyses of published studies on tumor markers. Recommendations were based on significant health outcomes, namely overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness.

Of 13 categories of breast tumor markers considered, 6 were new to these guidelines. The categories recommended for use in practice, based on evidence of clinical use, were CA 15-3, CA 27.29, carcinoembryonic antigen (CEA), estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), urokinase plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1), and certain multiparameter assays for gene expression. However, not all applications for these markers were supported.

Categories for which available evidence was insufficient to support routine use in clinical practice was DNA/ploidy by flow cytometry, p53, cathepsin D, cyclin E, proteomics, certain multiparameter assays, detection of bone marrow micrometastases, and circulating tumor cells (CTCs).

Specific changes from the 2000 guidelines are as follows:

ER and PgR should be measured on every primary invasive breast cancer and may be measured on metastatic lesions if the results would affect treatment planning. Steroid hormone receptor status should be used to identify patients most likely to benefit from endocrine therapies. In patients with ductal carcinoma in situ (DCIS) who are candidates for hormonal therapy, data are insufficient to recommend routinely measuring ER and PgR.
Immunohistochemically based markers of proliferation are new to the guidelines. Present data are insufficient to recommend measuring markers of proliferation to assign patients to prognostic groups. These include Ki67, cyclin D, cyclin E, p27, p21, thymidine kinase, and topoisomerase II.
To guide selection of trastuzumab in the adjuvant or metastatic setting, HER2 expression or amplification should be evaluated in every primary invasive breast cancer, either at the time of diagnosis or at the time of recurrence.
HER2 may be useful to predict response to specific chemotherapeutic agents. Based on level II evidence, overexpression of HER2 (3+ by protein or > 2.0 fluorescent in situ hybridization [FISH] ratio by gene amplification) identifies patients who may benefit more from anthracycline-based adjuvant therapy. Assuming there are no contraindications to anthracycline therapy, and that chemotherapy is being considered for a patient with HER2-positive breast cancer, it is recommended that an anthracycline be strongly considered. In the context of trastuzumab therapy, there is level I evidence that a regimen without anthracycline may produce similar outcomes. The Update Committee does not currently recommend that HER2 be used to guide use of taxane chemotherapy in the adjuvant setting.
uPA and PAI-1 as a marker for breast cancer is a new topic to the guidelines. In patients with newly diagnosed, node-negative breast cancer, uPA and PAI-1 measured by enzyme-linked immunosorbent assays (ELISAs) on 300 mg or more of fresh or frozen breast cancer tissue may be used to determine prognosis. Especially in hormone receptor–positive women who will receive adjuvant endocrine therapy, low levels of both markers are associated with a sufficiently low risk for recurrence that chemotherapy will only confer minimal additional benefit. Compared with observation alone, cyclophosphamide, methotrexate, and 5-fluorouracil (CMF)-based adjuvant chemotherapy offers substantial benefit in patients with high risk for recurrence, based on high levels of uPA and PAI-1.
Cyclin E fragments as markers for breast cancer is a new topic to the guidelines. Currently available data are insufficient to recommend use of whole-length or fragment measurements of cyclin E to manage patients with breast cancer.
Proteomic analysis for breast cancer is new to the guidelines; present data are insufficient to support use of proteomic patterns to manage breast cancer.
Multiparameter analysis of gene expression for breast cancer is new to the guidelines. The Oncotype DX assay (Genomic Health Inc, Redwood City, California) can be used to predict the risk for recurrence in newly diagnosed patients with node-negative, estrogen-receptor–positive breast cancer who are treated with tamoxifen. Oncotype DX may help identify patients who should most benefit from adjuvant tamoxifen and who may not require adjuvant chemotherapy. Patients with high recurrence scores seem to benefit relatively more from adjuvant chemotherapy with (C)MF than from tamoxifen.
Bone marrow micrometastases as markers for breast cancer are a new topic to the guidelines. Currently available evidence is insufficient to recommend evaluation of bone marrow micrometastases for management of patients with breast cancer.
CTC assays as markers for breast cancer is a new topic to the guidelines. CTCs should not be used to diagnose breast cancer or to guide any treatment decisions in patients with breast cancer. The recently Food and Drug Administration–cleared CellSearch Assaytest (Veridex, Warren, New Jersey) for CTC cannot be recommended in patients with metastatic breast cancer.

"It is important to emphasize that guidelines and technology assessments cannot always account for individual variation among patients," the guidelines authors conclude. "They are not intended to supplant physician judgment with respect to particular patients or special clinical situations, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments reasonably directed at obtaining the same result."

Some of the guidelines authors have disclosed various financial relationships with Adjuvant Inc, LabCorp, Veridex, Fujiribo Diagnostics Inc, Genomic Health, Abraxis, American Biosciences, AvariaDx, Cytogen Corp, Monogram Bioscience, Pfizer, Precision Therapeutics Inc, Rudential Financial, QuatRx Pharm, Siemens Medical Solutions Diagnostics, StemCapture, Ciphengen, Tanox, Third Nerve LLC, Health Discovery Corp, Genenech, AstraZeneca, Immunicon, GlaxoSmithKline, Wyeth Ayerts-Genetics Institute, and Novartis.

Health Tip: Dealing With Dandruff

noreply@blogger.com (ADY) — Mon, 7 Jan 2008 23:06:00 -0800

(HealthDay News) -- Dandruff, also known as seborrheic dermatitis, occurs when flakes of skin develop on the scalp or inside the ear.

The skin condition, which can run in families, may be triggered by stress, fatigue, oily skin, acne or using hair or skin products that contain alcohol, the U.S. National Library of Medicine says. Infrequent showering or shampooing may also trigger dandruff.

To treat the condition, over-the-counter dandruff or medicated shampoos should be used daily. Active ingredients in these shampoos include salicylic acid, coal tar, zinc, resorcin, ketoconazole or selenium.

The hair and other affected areas should be washed for about five minutes before rinsing thoroughly.

Tips to control heartburn symptoms

noreply@blogger.com (ADY) — Mon, 7 Jan 2008 22:44:00 -0800

Symptoms of gastroesophageal reflux disease

-- Diana Kohnle

(HealthDay News) -- Gastroesophageal reflux disease (GERD) occurs when a muscle at the end of the esophagus does not close properly, allowing irritating stomach contents to leak back into the esophagus. Symptoms include heartburn and acid indigestion.

If you have these symptoms more than twice a week, it may be GERD.

Medication can help tame GERD, and the U.S. National Library of Medicine offers these additional suggestions to control symptoms:

Avoid foods that may cause heartburn, like fatty, spicy or acidic foods.
Eat small meals.
Avoid eating right before bedtime.
Wear loose-fitting clothing.
Maintain a healthy body weight.

Heavy kids face hefty heart risks as they age

noreply@blogger.com (ADY) — Mon, 7 Jan 2008 21:31:00 -0800

NEW YORK - The chicken nuggets are coming home to roost. By the time today’s teens are middle age, the rate of heart disease could be 16 percent higher because of the extra pounds they are carrying around today, a U.S. study suggests.

A second study, by Danish researchers, documents a connection between excess weight in even younger kids and heart disease in adults — especially boys.

The two reports in Thursday’s New England Journal of Medicine may well be underestimating the future health effects of childhood obesity, said Dr. David Ludwig, director of an obesity program at Children’s Hospital Boston.

“We’ve simply never had a generation that’s been this heavy from so early in life. The consequences of that are unprecedented and unknown,” said Ludwig, who was not involved in the research.

While the U.S. projections were based on a computer model, the Danish study is a large, decades-long look at what happened in real life to 277,000 children as they grew up. Some 14,500 of them — twice as many men as women — had heart disease or died from it before age 60.

The researchers found that the more overweight a child was between ages 7 and 13, the greater the risk of heart disease was in adulthood. The relationship was strongest in boys and increased with age.

For example, an average-size 13-year-old boy had a 12 percent risk. But for a boy of the same age and height who weighed about 25 pounds more, the risk went up by one-third, to 16 percent.

“Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having a (coronary heart disease) event in adulthood,” said the researchers from the Institute of Preventive Medicine in Copenhagen.

1 in 3 U.S. kids overweight
Today, about a third of U.S. youngsters are either overweight or obese. Increasing numbers of obese children are being diagnosed with type 2 diabetes, high blood pressure, bad cholesterol and other obesity complications that were seldom seen in children before.

Some of those complications are risk factors for heart disease, which could explain the link between childhood weight and a higher risk of heart disease, the Danish researchers suggest. Or it could be because many heavy children — although not all — become heavy adults, they said.

Their study used detailed health records kept for every schoolchild in Denmark. They calculated the body mass index, which is based on height and weight, for children born between 1930 and 1976. Using hospital discharge records and a death registry, they tracked the children from age 25 to find out who had heart disease by age 60.

One of the researchers, Jennifer Baker, said previous studies that have looked at the issue have been inconsistent, and this is the “first to convincingly demonstrate that excess weight in childhood is associated with heart disease in adulthood.”

The U.S. researchers used obesity figures for U.S. teens in 2000 to estimate that as many as 37 percent of men would be obese when they reached 35, compared to 25 percent now. For women, as many as 44 percent would be obese; now the rate is 32 percent.

Using a computer model, they estimated that by the time the teens are 50, the rate of heart disease will rise 5 percent to 16 percent — as many as 100,000 extra cases. They also projected heart disease deaths could rise by as much as 19 percent.

“If we do nothing, the health consequences are really going to be quite dramatic,” said Dr. Kirsten Bibbins-Domingo, of the University of California, San Francisco, lead author of the study.

Projections of increasing rates of heart disease and deaths between ages 35 and 50 were particularly striking, she said.

“This is an age when people are normally working, they’re raising their families. They’re not worried about going to the doctor or worried about dying or having a heart attack,” said Bibbins-Domingo.

The researchers noted that their predictions are based on current treatments and trends for obesity and heart disease, and changes in prevention and treatment could make a difference.

Influenza meningkatkan resiko serangan jantung dan stroke

noreply@blogger.com (ADY) — Mon, 7 Jan 2008 20:54:00 -0800

Influenza dan infeksi saluran pernapasan secara signifikan dapat meningkatkan resiko serangan jantung atau stroke, menurut penelitian yang dipublikasikan oleh European Heart Journal.
Infeksi mengubah sistem pembekuan darah menjadi over aktif, suatu proses inflamasi.
Penelitian lain menunjukkan hubungan antara peradangan / inflamasi dengan serangan jantung. Resiko mutlak dari serangan jantung atau stroke pada seseorang dengan infeksi pernapasan masih rendah yaitu kurang dari 2 %.
Tapi jumlah serangan jantung dan kematian dapat dicegah dengan pengobatan yang proaktif.
Bahaya mungkin muncul jika dipicu secara relatif oleh infeksi yang parah seperti influenza, bronkhitis dan pneumonia.
Influenza adalah infeksi yang serius terutama pasien dengan penyakit jantung karena dapat memicu terjadinya serangan jantung. Sehingga diperlukan perlindungan bagi pasien penyakit jantung (vaksinasi flu).
Source : http://www.healthcentral.com