Weekly releases (1997–2007) - Volume 6, Issue 26, 27 June 2002

Data from the United States (US) were presented recently suggesting antiretroviral therapy (ART) during pregnancy in HIV women was not associated with an increased risk of prematurity (1). These findings contradict earlier findings from Europe which demonstrated a small but significant increased risk of premature delivery with use of combination therapy, especially when including a protease inhibitor (PI), and in particular when started before or in early pregnancy (2). But differences in populations and methodology applied could explain much of this apparent contradiction. Clinicians caring for HIV infected women should be aware of these findings.

In 2001, 22 266 cases of genital Chlamydia trachomatis infection were notified to Smittskyddsinstitutet (the Swedish Institute for Infectious Disease Control), giving an overall incidence of 250 cases per 100 000 population. This figure represents an increase of 15% compared with the previous year. This report is based on the report Communicable Diseases in Sweden 2001, published by the Department of Epidemiology at Smittskyddsinstitutet, which is available on the internet in an English edition (click here).

A sharp rise in registered HIV infections has been detected in Lithuania after investigation of an outbreak affecting prisoners in a particular prison. Between January and May 2002, a total of 230 infections were registered (figure 1). After the first diagnosis of HIV infection in the country in 1988, the number of registered HIV infections increased gradually until the end of 2001. In contrast in the neighboring countries of Latvia and Estonia, totals of 2006 infections and 2396 infections respectively had been registered by 15 May 2002. Since the collapse of the Soviet Union in the early 1990s, many common factors have been influencing HIV transmission in the former Soviet republics, among them a dramatic increase in drug misuse, a worsening economic situation, and increased unemployment.

Pneumococcal infections are the most frequent vaccine preventable cause of death in Germany next to influenza. Asplenic patients in particular should be vaccinated to avoid serious illness and even death, as the following case reported in Germany’s surveillance bulletin shows (1). A 37 year old woman who had had a splenectomy after a road traffic accident in 1990, and had recently been treated with mirtazapine as a hospital inpatient for postpartum depression, developed a feverish infection with shivers, dizziness, and vomiting three weeks after being discharged. The patient herself suspected food poisoning but no food samples were available for testing. She deteriorated and developed petechiae, and the next day the emergency doctor admitted her to intensive care. She developed Waterhouse-Friderichsen syndrome with disseminated intravascular coagulation (DIC) and died in the evening of the same day from septic toxic shock. No meningococci or botulinum toxin were found but Streptococcus pneumoniae was isolated from a blood specimen.