Isentress (raltegravir) was approved today by the U.S.
Food and Drug Administration for use with other antiretroviral drugs for the treatment of HIV-1 infection for children and adolescents ages 2-18.
The drug is part of a class of medications called HIV integrase strand transfer inhibitors that works by slowing the spread of HIV in the body.
It was first approved for use in adult patients in October 2007, under FDA’s accelerated approval program, which allows the agency to approve a drug to treat a serious disease based on clinical data showing that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients.
The program is designed to provide patients with earlier access to promising new drugs, but the company will be required to submit additional clinical information after approval to confirm the drug’s clinical benefit.
“Many young children and adolescents are living with HIV and this approval provides an important additional option for their treatment,” said Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research.
Isentress is a pill that can be taken twice daily, with or without food.
The pill is also available in a chewable form.
Because the two tablet formulations are not interchangeable, the chewable form is only approved for use in children ages 2 to 11.
A single, multi-center clinical trial of 96 children and adolescents ages 2-18 years with HIV-1 infection evaluated the safety and effectiveness of Isentress.
These patients previously received treatment for HIV-1 infection.
After 24 weeks of treatment with Isentress, 53 percent of these patients had an undetectable amount of HIV in their blood.
The most commonly reported severe, treatment-related side effects in patients taking Isentress include trouble sleeping (insomnia) and headache.
The frequency of these side effects is similar for children and adults.
One pediatric patient reported severe treatment-related insomnia, while another pediatric patient experienced a drug-related skin rash.
The drug should be discontinued if this occurs.
Isentress does not cure HIV infection. Patients must stay on continuous HIV therapy to control HIV infection and decrease HIV-related illnesses.
Isentress is made by Whitehouse Station, N.J.-based Merck & Co., Inc.
For more information:
• FDA: HIV and AIDS Activities 1
• FDA: Antiretroviral drugs used in the treatment of HIV infection2
• CDC: HIV/AIDS3
• HHS: AIDS News and Resources4
• AIDS Information5
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices.
The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
για το HIV/AIDS το Trafficking και τα Ανθρώπινα Δικαιώματα στην Ελλάδα και στο κόσμο...
Παρασκευή 6 Ιανουαρίου 2012
ΑΝΑΔΗΜΟΣΙΕΥΟΝΤΑΣ απο τον Αγγλικό τύπο σχετικά με τη δήλωση του NAZI - ΛΟΒΕΡ-DOS: ΝΑ ΑΠΕΛΑΘΟΥΝ ΟΙ ΕΚΔΙΔΟΜΕΝΕΣ ΜΕ HIV/AIDS από την Αθήνα και την Ελλάδα
ΛΟΒΕΡΔΟΣ: ΝΑ ΑΠΕΛΑΘΟΥΝ ΟΙ ΕΚΔΙΔΟΜΕΝΕΣ ΜΕ HIV/AIDS
Δεν είναι αλήθεια ότι όλες οι μετανάστριες εκδιδόμενες έχουν HIV/AIDS.
Είναι όμως αλήθεια οτι ο Υπουργός Υγείας θυμίζει συχνά άλλες εποχές και άλλους ανθρώπους.
Η όχι;;
Και διεθνώς ο διασυρμός...
From the Greek Streets - Irregular updates and articles on the situation in Greece, in English
“Deport AIDS-carrying migrant female prostitutes” – or, Nazi discourse for dummies
Successive messages flying into your inbox, did you read this?
The minister of health, Andreas Loverdos, was present at a “workshop for the promotion of public health” in Athens yesterday, December 15, 2011.
The minister comes from the social-democrat PASOK party, and he has ambitions of becoming its next leader and then possibly enough, a future prime minister.
Direct quotes:
Loverdos described “unregistered prostitution as a huge problem for the city, and its relationship with the spreading of AIDS”.
He emphasised that this is a “problem affecting the Greek family, as the spreading runs “from the undocumented female migrant to the Greek male customer, to the Greek family” … and he concluded by demanding:
“female prostitutes carrying the AIDS virus must be deported from the country”.
(source: Eleftherotypia daily)
In only a handful of words, Loverdos managed what would have been inconceivable only a few years ago.
He has managed to encapsulate a Nazi-like discourse treating women, migrants and patients all as human trash that need be expelled from public view and from “our” lives as a whole.
Along with him, the subservient mayor of IMF-run Athens, Kaminis (elected on a premise of civil society, remember) signed a memorandum of agreement with the minister.
If one were to visit the minister’s personal webpage, they would find the top page feature being an article on “the new identity of Olympiakos”, a popular football team in Greece.
At the time when public health is being dismantled bit by bit across the country, a discourse treating segments of the population as unwanted garbage is perfectly combined with an ode to the spectacle — it should only be expected to be so.
Until the moment, of course, when people reveal garbage such as Loverdos for what they truly are, and wipe them out of existence.
That moment cannot come soon enough.
Δεν είναι αλήθεια ότι όλες οι μετανάστριες εκδιδόμενες έχουν HIV/AIDS.
Είναι όμως αλήθεια οτι ο Υπουργός Υγείας θυμίζει συχνά άλλες εποχές και άλλους ανθρώπους.
Η όχι;;
Και διεθνώς ο διασυρμός...
From the Greek Streets - Irregular updates and articles on the situation in Greece, in English
“Deport AIDS-carrying migrant female prostitutes” – or, Nazi discourse for dummies
Successive messages flying into your inbox, did you read this?
The minister of health, Andreas Loverdos, was present at a “workshop for the promotion of public health” in Athens yesterday, December 15, 2011.
The minister comes from the social-democrat PASOK party, and he has ambitions of becoming its next leader and then possibly enough, a future prime minister.
Direct quotes:
Loverdos described “unregistered prostitution as a huge problem for the city, and its relationship with the spreading of AIDS”.
He emphasised that this is a “problem affecting the Greek family, as the spreading runs “from the undocumented female migrant to the Greek male customer, to the Greek family” … and he concluded by demanding:
“female prostitutes carrying the AIDS virus must be deported from the country”.
(source: Eleftherotypia daily)
In only a handful of words, Loverdos managed what would have been inconceivable only a few years ago.
He has managed to encapsulate a Nazi-like discourse treating women, migrants and patients all as human trash that need be expelled from public view and from “our” lives as a whole.
Along with him, the subservient mayor of IMF-run Athens, Kaminis (elected on a premise of civil society, remember) signed a memorandum of agreement with the minister.
If one were to visit the minister’s personal webpage, they would find the top page feature being an article on “the new identity of Olympiakos”, a popular football team in Greece.
At the time when public health is being dismantled bit by bit across the country, a discourse treating segments of the population as unwanted garbage is perfectly combined with an ode to the spectacle — it should only be expected to be so.
Until the moment, of course, when people reveal garbage such as Loverdos for what they truly are, and wipe them out of existence.
That moment cannot come soon enough.
Tattoo-associated Mycobacterium haemophilum Skin Infection in Immunocompetent Adult, 2009 Volume 17, Number 9—September 2011
Ακολουθεί ένα πολύ ενδιαφέρον άρθρο που δημοσιεύθηκε στις 9 Σεπ 2011 με τίτλο: "Tattoo-associated Mycobacterium haemophilum Skin Infection in Immunocompetent Adult,2009"
των:
Meagan K. KayComments to Author , Tara R. Perti, and Jeffrey S. Duchin
Author affiliations:
Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.K. Kay);
Public Health–Seattle and King County, Seattle, Washington, USA (M.K. Kay,J.S.Duchin);
HealthPoint, Renton, Washington, USA (T.R. Perti);
University of Washington, Seattle (J.S. Duchin)
Suggested citation for this article
Abstract
After a laboratory-confirmed case of Mycobacterium haemophilum skin infection in a recently tattooed immunocompetent adult was reported, we investigated to identify the infection source and additional cases.
We found 1 laboratory-confirmed and 1 suspected case among immunocompetent adults who had been tattooed at the same parlor.
Mycobacterium haemophilum, a nontuberculous mycobacterial species, typically affects immunocompromised persons.
It produces subcutaneous nodules, papules, and pustules; less commonly it produces septic arthritis, osteomyelitis, pneumonitis, and disseminated infection (1,2).
This organism causes lymphadenitis in healthy children (3)
but rarely affects immunocompetent adults (4).
Although other species of nontuberculous mycobacteria, predominantly rapidly growing species, have been associated with wound infections, cosmetic surgery, body piercing, and tattooing (5–7),
M. haemophilum infection rarely has been reported as a complication of tattooing (8,9).
In November 2009, Public Health–Seattle and King County was notified of a chronic skin infection in an immunocompetent adult who had been recently tattooed; M. haemophilum had been isolated from the patient’s skin lesions.
We investigated to characterize the clinical features of the case, determine the source of the infection, and identify additional cases.
The Study
Figure. Thumbnail of Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm.
Photograph taken in October 2009, two months after tattooing.
Figure. Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm. Photograph taken in October 2009, two months after tattooing.
In August 2009, a healthy 44-year-old man (patient 1) received a tattoo on his left forearm at a commercial tattoo parlor.
Three days later, a painless rash developed at the tattoo site.
He applied antibacterial ointment, but the rash did not resolve; 12 days after rash onset, he sought care from his health care provider.
The patient denied fever and other focal or constitutional symptoms. Erythematous nodules of 3–5 mm diameter in the region of the tattoo were noted, and the patient was given ceftriaxone and trimethoprim/sulfamethoxazole for presumed pyogenic infection.
Two weeks later, the lesions were unimproved.
Aerobic culture of the lesions was conducted and clindamycin was prescribed; no organisms grew from the culture. In mid-September, the patient again visited his health care provider because the nodules remained unimproved.
Ceftriaxone was administered, and oral cephalexin was prescribed; an aerobic bacterial culture was repeated.
Two weeks later, the numerous nodular pustules confined to the tattoo region remained (Figure).
Test results for hepatitis B and C viruses and HIV were negative.
A swab of purulent material from 2 pustules was submitted for aerobic bacterial and fungal culture, an acid-fast bacilli (AFB) culture and smear, and a varicella-zoster virus direct fluorescent antibody assay and culture; clindamycin was prescribed. Samples were spread onto Middlebrook and chocolate agar plates and incubated at 30°C and onto Middlebrook agar plates and incubated at 37°C.
After 3 weeks, AFB were recovered from only the plates incubated at 30°C.
Using 16S rRNA gene sequencing, we identified the isolates as M. haemophilum.
The organism was sensitive to clarithromycin (<15 µg/mL), rifampin (<1 µg/mL), trimethoprim/sulfamethoxazole (<0.5/9.5 µg/mL), amikacin (<12 µg/mL), linezolid (<6 µg/mL), ciprofloxacin (<2 µg/mL), and moxifloxacin (<5 µg/mL) (10).
In December 2009, treatment with rifampin, ciprofloxacin, and clarithromycin was initiated.
In February 2010, the rash had improved, although healing papules and erythema were still present.
In March 2010, the patient discontinued treatment because of nausea.
By May 2010, the lesions had healed.
In mid-October 2009, the same health care provider evaluated a healthy 35-year-old man (patient 2) with a pustulo-nodular skin infection confined to shaded areas in a tattoo received in August 2009 at the same tattoo parlor.
During November–December 2009, standard aerobic bacterial or mycobacterial cultures from this patient’s lesions were performed, but no organisms were recovered.
We considered this to be a suspected case.
During December 2009, both patients were interviewed; no other potential epidemiologic links were identified.
Each patient denied exposure to recreational water, aquarium water, water with rusty sediment, or any other potential skin irritants.
To identify additional M. haemophilum cases, Public Health–Seattle and King County asked physicians to report atypical skin infections that developed after receipt of tattoos performed during June 1–December 1, 2009, and asked clinical laboratories to report atypical mycobacterial species recovered during the same period. No additional cases were identified.
During an investigation of the tattoo parlor on December 10, 2009, the operator reported having used similar procedures to tattoo each patient.
No deviations from Washington State safety and sanitation standards were recognized (11).
Municipal water was used in a rinse solution applied during and after tattooing and to dilute ink for shading.
Eleven environmental samples collected during the site visit included ink (1.5 L); tap water (1.5 L); liquid soap (1 L); petroleum jelly; and swabs of equipment, the soap dispenser port, and the tip of a reusable black-ink container.
All samples were submitted to the Centers for Disease Control and Prevention (Atlanta, GA, USA) for mycobacterial culture; no mycobacteria were recovered.
The tattoo parlor operator was instructed to use only sterile water for rinse solutions and dilution of tattoo dye.
Conclusions
Although the infectious agent was confirmed by culture for patient 1 only, the infection for patient 2 was consistent with M. haemophilum infection and patient 2 was epidemiologically linked to patient 1.
The nonspecific rash that developed 3 days after tattooing for patient 1 might be unrelated to M. haemophilum; however, the development of pustular nodules after 2 weeks is consistent with the incubation period for this infection.
Although punch biopsies are typically required for diagnosis of nodular lesions, M. haemophilum was cultured from a swab of the lesions.
The pustules were similar to those previously reported for tattoo-associated M. haemophilum infection (8) and might be associated with the presumed mode of inoculation.
Although the environmental reservoir for M. haemophilum is unknown, the organism is thought to be widespread in the environment (2).
Water has been a suspected reservoir because of the epidemiology of other environmental mycobacteria and because M. haemophilum has been detected by PCR in biofilms from research aquariums (12).
However, in most investigations, culture of M. haemophilum from environmental samples has been futile (2,5).
The interval of >4 months between the time patient 1 was tattooed and the environmental sample was collected might have further reduced the likelihood of recovering M. haemophilum.
Molecular methods such as PCR might be more successful than culture alone for detecting M. haemophilum infections.
No tattoo industry standards exist for the practice of diluting tattoo ink. Washington State does not specifically require tattoo artists to use steam-distilled or sterile water when rinsing needles or diluting ink; tap water is often used (11). However, legislation enacted in July 2010 prohibits mixing ink and pigments with improper ingredients (11).
Although infections attributable to water appear uncommon, we advise against using tap water for tattoo procedures.
Treatment for M. haemophilum infection among immunocompetent adults should be based on that used for immunocompromised patients for whom multidrug regimens, including clarithromycin, rifampin, rifabutin, and ciprofloxacin, are recommended (1,2,13).
Agents that seem to be active in vitro are amikacin, clarithromycin, ciprofloxacin, rifampin, and rifabutin (1,14).
Isolates have variable susceptibility to doxycycline and sulfonamides and are typically resistant to ethambutol, isoniazid, and pyrazinamide (1,13).
However, because no standardized methods for assessing antimicrobial drug susceptibility of M. haemophilum exist, in vitro susceptibility data must be used with caution.
Clinicians should consider M. haemophilum in the differential diagnosis of skin infections after tattooing, particularly chronic skin infections that are unresponsive to treatment with antimicrobial drugs, regardless of the patient’s immune status. M. haemophilum infections can be difficult to diagnose because the organism is slow growing and fastidious and requires iron supplementation and a lower incubation temperature for growth (30°–32°C) than other mycobacteria (15). Laboratory practices vary, and hemin might not be routinely added to all AFB cultures.
Therefore, for suspected cases, clinicians should alert the laboratory to use appropriate procedures to culture for M. haemophilum and other AFB.
Dr Kay is a veterinarian and an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention in Atlanta.
Her research interest is the epidemiology of infectious diseases.
Acknowledgment
We thank Heather O’Connell and Brandi Limbago for their help with testing of environmental samples, the staff at the University of Washington Medical Center Clinical Microbiology Laboratory for their assistance with identifying the organism from clinical specimens, and Troy Amundson for valuable assistance.
References
Shah MK, Sebti A, Kiehn TE, Massarella SA, Sepkowitz KA. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis. 2001;33:330–7. DOIExternal Web Site IconPubMedExternal Web Site Icon
Saubolle MA, Kiehn TE, White MH, Rudinsky MF, Armstrong D. Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. Clin Microbiol Rev. 1996;9:435–47.PubMedExternal Web Site Icon
Armstrong KL, James RW, Dawson DJ, Francis PW, Masters B. Mycobacterium haemophilum causing perihilar or cervical lymphadenitis in healthy children. J Pediatr. 1992;121:202–5. DOIExternal Web Site IconPubMedExternal Web Site Icon
Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis. 2003;37:e100–1. DOIExternal Web Site IconPubMedExternal Web Site Icon
Piersimoni C, Scarparo C. Extrapulmonary infections associated with nontuberculous mycobacteria in immunocompetent persons. Emerg Infect Dis. 2009;15:1351–8. DOIExternal Web Site IconPubMedExternal Web Site Icon
Ferringer T, Pride H, Tyler W. Body piercing complicated by atypical mycobacterial infections. Pediatr Dermatol. 2008;25:219–22. DOIExternal Web Site IconPubMedExternal Web Site Icon
Preda VA, Maley M, Sullivan JR. Mycobacterium chelonae infection in a tattoo site. Med J Aust. 2009;190:278–9.PubMedExternal Web Site Icon
Giulieri S, Morisod B, Edney T, Odman M, Genne D, Malinverni R, Outbreak of Mycobacterium haemophilum infections after permanent makeup of the eyebrows. Clin Infect Dis. 2011;52:488–91. DOIExternal Web Site IconPubMedExternal Web Site Icon
Hamsch C, Hartschuh W, Enk A, Flux K. A Chinese tattoo paint as a vector of atypical mycobacteria—outbreak in 7 patients in Germany. Acta Derm Venereol. 2011;91:63–4.PubMedExternal Web Site Icon
National Committee for Clinical Laboratory Standards. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes. Approved standard. Document no. M24-A. Wayne (PA): The Committee; 2003.
Washington State Department of Licensing. Laws and rules: tattoos, body piercing, and body art [cited 2010 Jul 9]. http://www.dol.wa.gov/business/tattoo/laws.htmlExternal Web Site Icon
Whipps CM, Dougan ST, Kent ML. Mycobacterium haemophilum infections of zebrafish (Danio rerio) in research facilities. FEMS Microbiol Lett. 2007;270:21–6. DOIExternal Web Site IconPubMedExternal Web Site Icon
Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416. DOIExternal Web Site IconPubMedExternal Web Site Icon
Atkinson BA, Bocanegra R, Graybill JR. Treatment of Mycobacterium haemophilum infection in a murine model with clarithromycin, rifabutin, and ciprofloxacin. Antimicrob Agents Chemother. 1995;39:2316–9.PubMedExternal Web Site Icon
Straus WL, Ostroff SM, Jernigan DB, Kiehn TE, Sordillo EM, Armstrong D, Clinical and epidemiologic characteristics of Mycobacterium haemophilum, an emerging pathogen in immunocompromised patients. Ann Intern Med. 1994;120:118–25.PubMedExternal Web Site Icon
Figure
Figure. Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm. Photograph taken in October 2009, two months after tattooing.
Suggested citation for this article: Kay MK, Perti TR, Duchin JS.
Tattoo-associated Mycobacterium haemophilum skin infection in immunocompetent adult, 2009.
Emerg Infect Dis [serial on the Internet]. 2011 Sep [date cited].
http://dx.doi.org/10.3201/eid1709.102011External Web Site Icon
DOI: 10.3201/eid1709.102011
Table of Contents – Volume 17, Number 9—September 2011
των:
Meagan K. KayComments to Author , Tara R. Perti, and Jeffrey S. Duchin
Author affiliations:
Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.K. Kay);
Public Health–Seattle and King County, Seattle, Washington, USA (M.K. Kay,J.S.Duchin);
HealthPoint, Renton, Washington, USA (T.R. Perti);
University of Washington, Seattle (J.S. Duchin)
Suggested citation for this article
Abstract
After a laboratory-confirmed case of Mycobacterium haemophilum skin infection in a recently tattooed immunocompetent adult was reported, we investigated to identify the infection source and additional cases.
We found 1 laboratory-confirmed and 1 suspected case among immunocompetent adults who had been tattooed at the same parlor.
Mycobacterium haemophilum, a nontuberculous mycobacterial species, typically affects immunocompromised persons.
It produces subcutaneous nodules, papules, and pustules; less commonly it produces septic arthritis, osteomyelitis, pneumonitis, and disseminated infection (1,2).
This organism causes lymphadenitis in healthy children (3)
but rarely affects immunocompetent adults (4).
Although other species of nontuberculous mycobacteria, predominantly rapidly growing species, have been associated with wound infections, cosmetic surgery, body piercing, and tattooing (5–7),
M. haemophilum infection rarely has been reported as a complication of tattooing (8,9).
In November 2009, Public Health–Seattle and King County was notified of a chronic skin infection in an immunocompetent adult who had been recently tattooed; M. haemophilum had been isolated from the patient’s skin lesions.
We investigated to characterize the clinical features of the case, determine the source of the infection, and identify additional cases.
The Study
Figure. Thumbnail of Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm.
Photograph taken in October 2009, two months after tattooing.
Figure. Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm. Photograph taken in October 2009, two months after tattooing.
In August 2009, a healthy 44-year-old man (patient 1) received a tattoo on his left forearm at a commercial tattoo parlor.
Three days later, a painless rash developed at the tattoo site.
He applied antibacterial ointment, but the rash did not resolve; 12 days after rash onset, he sought care from his health care provider.
The patient denied fever and other focal or constitutional symptoms. Erythematous nodules of 3–5 mm diameter in the region of the tattoo were noted, and the patient was given ceftriaxone and trimethoprim/sulfamethoxazole for presumed pyogenic infection.
Two weeks later, the lesions were unimproved.
Aerobic culture of the lesions was conducted and clindamycin was prescribed; no organisms grew from the culture. In mid-September, the patient again visited his health care provider because the nodules remained unimproved.
Ceftriaxone was administered, and oral cephalexin was prescribed; an aerobic bacterial culture was repeated.
Two weeks later, the numerous nodular pustules confined to the tattoo region remained (Figure).
Test results for hepatitis B and C viruses and HIV were negative.
A swab of purulent material from 2 pustules was submitted for aerobic bacterial and fungal culture, an acid-fast bacilli (AFB) culture and smear, and a varicella-zoster virus direct fluorescent antibody assay and culture; clindamycin was prescribed. Samples were spread onto Middlebrook and chocolate agar plates and incubated at 30°C and onto Middlebrook agar plates and incubated at 37°C.
After 3 weeks, AFB were recovered from only the plates incubated at 30°C.
Using 16S rRNA gene sequencing, we identified the isolates as M. haemophilum.
The organism was sensitive to clarithromycin (<15 µg/mL), rifampin (<1 µg/mL), trimethoprim/sulfamethoxazole (<0.5/9.5 µg/mL), amikacin (<12 µg/mL), linezolid (<6 µg/mL), ciprofloxacin (<2 µg/mL), and moxifloxacin (<5 µg/mL) (10).
In December 2009, treatment with rifampin, ciprofloxacin, and clarithromycin was initiated.
In February 2010, the rash had improved, although healing papules and erythema were still present.
In March 2010, the patient discontinued treatment because of nausea.
By May 2010, the lesions had healed.
In mid-October 2009, the same health care provider evaluated a healthy 35-year-old man (patient 2) with a pustulo-nodular skin infection confined to shaded areas in a tattoo received in August 2009 at the same tattoo parlor.
During November–December 2009, standard aerobic bacterial or mycobacterial cultures from this patient’s lesions were performed, but no organisms were recovered.
We considered this to be a suspected case.
During December 2009, both patients were interviewed; no other potential epidemiologic links were identified.
Each patient denied exposure to recreational water, aquarium water, water with rusty sediment, or any other potential skin irritants.
To identify additional M. haemophilum cases, Public Health–Seattle and King County asked physicians to report atypical skin infections that developed after receipt of tattoos performed during June 1–December 1, 2009, and asked clinical laboratories to report atypical mycobacterial species recovered during the same period. No additional cases were identified.
During an investigation of the tattoo parlor on December 10, 2009, the operator reported having used similar procedures to tattoo each patient.
No deviations from Washington State safety and sanitation standards were recognized (11).
Municipal water was used in a rinse solution applied during and after tattooing and to dilute ink for shading.
Eleven environmental samples collected during the site visit included ink (1.5 L); tap water (1.5 L); liquid soap (1 L); petroleum jelly; and swabs of equipment, the soap dispenser port, and the tip of a reusable black-ink container.
All samples were submitted to the Centers for Disease Control and Prevention (Atlanta, GA, USA) for mycobacterial culture; no mycobacteria were recovered.
The tattoo parlor operator was instructed to use only sterile water for rinse solutions and dilution of tattoo dye.
Conclusions
Although the infectious agent was confirmed by culture for patient 1 only, the infection for patient 2 was consistent with M. haemophilum infection and patient 2 was epidemiologically linked to patient 1.
The nonspecific rash that developed 3 days after tattooing for patient 1 might be unrelated to M. haemophilum; however, the development of pustular nodules after 2 weeks is consistent with the incubation period for this infection.
Although punch biopsies are typically required for diagnosis of nodular lesions, M. haemophilum was cultured from a swab of the lesions.
The pustules were similar to those previously reported for tattoo-associated M. haemophilum infection (8) and might be associated with the presumed mode of inoculation.
Although the environmental reservoir for M. haemophilum is unknown, the organism is thought to be widespread in the environment (2).
Water has been a suspected reservoir because of the epidemiology of other environmental mycobacteria and because M. haemophilum has been detected by PCR in biofilms from research aquariums (12).
However, in most investigations, culture of M. haemophilum from environmental samples has been futile (2,5).
The interval of >4 months between the time patient 1 was tattooed and the environmental sample was collected might have further reduced the likelihood of recovering M. haemophilum.
Molecular methods such as PCR might be more successful than culture alone for detecting M. haemophilum infections.
No tattoo industry standards exist for the practice of diluting tattoo ink. Washington State does not specifically require tattoo artists to use steam-distilled or sterile water when rinsing needles or diluting ink; tap water is often used (11). However, legislation enacted in July 2010 prohibits mixing ink and pigments with improper ingredients (11).
Although infections attributable to water appear uncommon, we advise against using tap water for tattoo procedures.
Treatment for M. haemophilum infection among immunocompetent adults should be based on that used for immunocompromised patients for whom multidrug regimens, including clarithromycin, rifampin, rifabutin, and ciprofloxacin, are recommended (1,2,13).
Agents that seem to be active in vitro are amikacin, clarithromycin, ciprofloxacin, rifampin, and rifabutin (1,14).
Isolates have variable susceptibility to doxycycline and sulfonamides and are typically resistant to ethambutol, isoniazid, and pyrazinamide (1,13).
However, because no standardized methods for assessing antimicrobial drug susceptibility of M. haemophilum exist, in vitro susceptibility data must be used with caution.
Clinicians should consider M. haemophilum in the differential diagnosis of skin infections after tattooing, particularly chronic skin infections that are unresponsive to treatment with antimicrobial drugs, regardless of the patient’s immune status. M. haemophilum infections can be difficult to diagnose because the organism is slow growing and fastidious and requires iron supplementation and a lower incubation temperature for growth (30°–32°C) than other mycobacteria (15). Laboratory practices vary, and hemin might not be routinely added to all AFB cultures.
Therefore, for suspected cases, clinicians should alert the laboratory to use appropriate procedures to culture for M. haemophilum and other AFB.
Dr Kay is a veterinarian and an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention in Atlanta.
Her research interest is the epidemiology of infectious diseases.
Acknowledgment
We thank Heather O’Connell and Brandi Limbago for their help with testing of environmental samples, the staff at the University of Washington Medical Center Clinical Microbiology Laboratory for their assistance with identifying the organism from clinical specimens, and Troy Amundson for valuable assistance.
References
Shah MK, Sebti A, Kiehn TE, Massarella SA, Sepkowitz KA. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis. 2001;33:330–7. DOIExternal Web Site IconPubMedExternal Web Site Icon
Saubolle MA, Kiehn TE, White MH, Rudinsky MF, Armstrong D. Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. Clin Microbiol Rev. 1996;9:435–47.PubMedExternal Web Site Icon
Armstrong KL, James RW, Dawson DJ, Francis PW, Masters B. Mycobacterium haemophilum causing perihilar or cervical lymphadenitis in healthy children. J Pediatr. 1992;121:202–5. DOIExternal Web Site IconPubMedExternal Web Site Icon
Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis. 2003;37:e100–1. DOIExternal Web Site IconPubMedExternal Web Site Icon
Piersimoni C, Scarparo C. Extrapulmonary infections associated with nontuberculous mycobacteria in immunocompetent persons. Emerg Infect Dis. 2009;15:1351–8. DOIExternal Web Site IconPubMedExternal Web Site Icon
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Figure
Figure. Pustular rash caused by Mycobacterium haemophilum confined to the tattooed region of the forearm. Photograph taken in October 2009, two months after tattooing.
Suggested citation for this article: Kay MK, Perti TR, Duchin JS.
Tattoo-associated Mycobacterium haemophilum skin infection in immunocompetent adult, 2009.
Emerg Infect Dis [serial on the Internet]. 2011 Sep [date cited].
http://dx.doi.org/10.3201/eid1709.102011External Web Site Icon
DOI: 10.3201/eid1709.102011
Table of Contents – Volume 17, Number 9—September 2011
Η φτώχεια απειλεί τρία εκατομμύρια Έλληνες αναδημοσιεύμουμε από: Αριστοτέλους 17
Έντονη ανησυχία προκαλεί έρευνα της ΕΛΣΤΑΤ για την κλιμάκωση της φτώχειας στην Ελλάδα. Γυναίκες, μονογονεϊκά νοικοκυριά και παιδιά τα πρώτα θύματα. Στοιχεία που προκαλούν σοκ.
Την ώρα που η κυβέρνηση δίνει τη μάχη για να πιάσει τους στόχους που έχουν θέσει η τρόικα και οι δανειστές, στη χώρα συντελείται μια καταστροφή με απρόβλεπτες συνέπειες.
Η φτώχεια απειλεί όλο και περισσότερους Έλληνες κάτι που αποδεικνύεται και από τα στοιχεία της ΕΛΣΤΑΤ για το 2010.
Σύμφωνα με την ΕΛΣΤΑΤ, το 20,1% του πληθυσμού της Χώρας απειλείται από τη φτώχεια, όταν το κατώφλι υπολογίζεται στο 60%, της διάμεσου του συνολικού διαθέσιμου ισοδύναμου εισοδήματος.
Το χρηματικό όριο της φτώχειας ανέρχεται στο ετήσιο ποσό των 7.178 ευρώ ανά άτομο και σε 15.073 ευρώ για νοικοκυριά με δύο ενήλικες και δύο εξαρτώμενα παιδιά ηλικίας κάτω των 14 ετών.
Το μέσο ετήσιο ατομικό ισοδύναμο εισόδημα ανέρχεται σε 13.973,94 ευρώ και το μέσο ετήσιο διαθέσιμο εισόδημα των νοικοκυριών της χώρας σε 24.224,38 ευρώ.
Τα νοικοκυριά που βρίσκονται σε κίνδυνο φτώχειας εκτιμώνται σε 868.597 και τα μέλη τους σε 2.204.800.
Ο κίνδυνος φτώχειας για παιδιά ηλικίας 0-17 ετών (παιδική φτώχεια) ανέρχεται σε 23% και είναι υψηλότερος κατά, περίπου, τρεις ποσοστιαίες μονάδες από το αντίστοιχο ποσοστό του συνολικού πληθυσμού.
Ο κίνδυνος φτώχειας για άτομα ηλικίας άνω των 65 ετών υπολογίζεται σε ποσοστό 21,3% και είναι μειωμένος κατά 0,1 της ποσοστιαίας μονάδας σε σχέση με το προηγούμενο έτος.
Ο πληθυσμός σε κίνδυνο φτώχειας ή κοινωνικό αποκλεισμό ανέρχεται σε 3.030.900 άτομα.
Ο πληθυσμός που διαβιεί σε νοικοκυριά που δεν εργάζεται κανένα μέλος ή εργάζεται με μερική απασχόληση ανέρχεται σε 544.800 άτομα, ενώ στο προηγούμενο έτος ανερχόταν σε 488.200 άτομα.
Ποιοι απειλούνται κυρίως από τη φτώχεια
Νέοι, άνεργοι, γυναίκες και ηλικιωμένοι είναι τα πρώτα θύματα της φτώχειας. Αναλυτικά σύμφωνα με τα στοιχεία της ΕΛΣΤΑ, οξύτατα προβλήματα αντιμετωπίζουν:
*Γυναίκες άνεργες (40,0%)
*Μονογονεϊκά νοικοκυριά με, τουλάχιστον, ένα εξαρτώμενο παιδί (33,4%)
*Νοικοκυριά με έναν ενήλικα ηλικίας 65 ετών και άνω (30,1%)
*Νοικοκυριά με 3 ή περισσότερους ενήλικες με εξαρτώμενα παιδιά (29,3%)
*Μονοπρόσωπα νοικοκυριά με μέλος θήλυ (27,7%)
*Παιδιά ηλικίας 0-17 ετών (23,0%)
Χαρακτηριστικά πληθυσµού σε κίνδυνο φτώχειας
Το ποσοστό κινδύνου φτώχειας είναι υψηλότερο στις γυναίκες, σε σχέση µε τους άνδρες, 20,9% και 19.3%, αντίστοιχα.
Τα µονοπρόσωπα νοικοκυριά µε θήλυ µέλος απειλούνται από τη φτώχεια σε ποσοστό 27,7%, ενώ τα αντίστοιχα µε άρρεν µέλος σε ποσοστό 26,3%.
Ο κίνδυνος φτώχειας για άτοµα ηλικίας άνω των 65 ετών υπολογίζεται σε ποσοστό 21,3%, ενώ για άτοµα ηλικίας έως 17 ετών σε ποσοστό 23%.
Ο κίνδυνος φτώχειας για άτοµα ηλικίας άνω των 75 ετών υπολογίζεται σε ποσοστό 25,5%, ενώ για άτοµα ηλικίας 75 ετών και κάτω σε ποσοστό 19,6 %.
Ο κίνδυνος φτώχειας των νοικοκυριών µε έναν γονέα και τουλάχιστον ένα εξαρτώµενο παιδί ανέρχεται στο 33,4%, ενώ ο αντίστοιχος δείκτης για τα νοικοκυριά µε δύο γονείς και ένα εξαρτώµενο παιδί ανέρχεται στο 21,6%.
Οι εργαζόµενοι κινδυνεύουν λιγότερο από τους ανέργους και τους οικονοµικά µη ενεργούς (συνταξιούχους, νοικοκυρές, κ.λ.π.).
Το ποσοστό κινδύνου φτώχειας των εργαζοµένων ανέρχεται στο 13,8% (άνδρες 16,4% και γυναίκες 10,2%), των λοιπών µη οικονοµικά ενεργών στο 27,4% και των ανέργων στο 38,5%.
Ο σχετικός κίνδυνος φτώχειας για τους εργαζοµένους µε πλήρη απασχόληση ανέρχεται στο 11,7%, ενώ για τους εργαζοµένους µε µερική απασχόληση ανέρχεται στο 29,4%.
Τα νοικοκυριά που διαµένουν σε ιδιόκτητη κατοικία απειλούνται από φτώχεια κατά 18,5%, ενώ αυτά που διαµένουν σε ενοικιασµένη κατοικία κατά 27,2%.
Ο σχετικός κίνδυνος φτώχειας ηλικιωµένων 75 ετών και άνω κατά ιδιοκτησιακό καθεστώς της κατοικίας τους ανέρχεται για τους ιδιοκτήτες στο 26,3%, ενώ για τους ενοικιαστές στο 18%.
πηγές:
Από: http://news247.gr/ellada/eidiseis/h_ftwxeia_apeilei_toys_ellhnes.1561097.html
Βλ. επίσης Δελτίο Τύπου Ελ.Στατ.
"Έρευνα εισοδήματος και συνθηκών Διαβίωσης των Νοικοκυριών 2010", όπως δημοσιεύθηκε στις 3/1/2012:
http://www.protothema.gr/files/1/2012/01/03/%CE%9A%CE%AF%CE%BD%CE%B4%CF%85%CE%BD%CE%BF%CF%82%20%CF%86%CF%84%CF%8E%CF%87%CE%B5%CE%B9%CE%B1%CF%82.pdf
Την ώρα που η κυβέρνηση δίνει τη μάχη για να πιάσει τους στόχους που έχουν θέσει η τρόικα και οι δανειστές, στη χώρα συντελείται μια καταστροφή με απρόβλεπτες συνέπειες.
Η φτώχεια απειλεί όλο και περισσότερους Έλληνες κάτι που αποδεικνύεται και από τα στοιχεία της ΕΛΣΤΑΤ για το 2010.
Σύμφωνα με την ΕΛΣΤΑΤ, το 20,1% του πληθυσμού της Χώρας απειλείται από τη φτώχεια, όταν το κατώφλι υπολογίζεται στο 60%, της διάμεσου του συνολικού διαθέσιμου ισοδύναμου εισοδήματος.
Το χρηματικό όριο της φτώχειας ανέρχεται στο ετήσιο ποσό των 7.178 ευρώ ανά άτομο και σε 15.073 ευρώ για νοικοκυριά με δύο ενήλικες και δύο εξαρτώμενα παιδιά ηλικίας κάτω των 14 ετών.
Το μέσο ετήσιο ατομικό ισοδύναμο εισόδημα ανέρχεται σε 13.973,94 ευρώ και το μέσο ετήσιο διαθέσιμο εισόδημα των νοικοκυριών της χώρας σε 24.224,38 ευρώ.
Τα νοικοκυριά που βρίσκονται σε κίνδυνο φτώχειας εκτιμώνται σε 868.597 και τα μέλη τους σε 2.204.800.
Ο κίνδυνος φτώχειας για παιδιά ηλικίας 0-17 ετών (παιδική φτώχεια) ανέρχεται σε 23% και είναι υψηλότερος κατά, περίπου, τρεις ποσοστιαίες μονάδες από το αντίστοιχο ποσοστό του συνολικού πληθυσμού.
Ο κίνδυνος φτώχειας για άτομα ηλικίας άνω των 65 ετών υπολογίζεται σε ποσοστό 21,3% και είναι μειωμένος κατά 0,1 της ποσοστιαίας μονάδας σε σχέση με το προηγούμενο έτος.
Ο πληθυσμός σε κίνδυνο φτώχειας ή κοινωνικό αποκλεισμό ανέρχεται σε 3.030.900 άτομα.
Ο πληθυσμός που διαβιεί σε νοικοκυριά που δεν εργάζεται κανένα μέλος ή εργάζεται με μερική απασχόληση ανέρχεται σε 544.800 άτομα, ενώ στο προηγούμενο έτος ανερχόταν σε 488.200 άτομα.
Ποιοι απειλούνται κυρίως από τη φτώχεια
Νέοι, άνεργοι, γυναίκες και ηλικιωμένοι είναι τα πρώτα θύματα της φτώχειας. Αναλυτικά σύμφωνα με τα στοιχεία της ΕΛΣΤΑ, οξύτατα προβλήματα αντιμετωπίζουν:
*Γυναίκες άνεργες (40,0%)
*Μονογονεϊκά νοικοκυριά με, τουλάχιστον, ένα εξαρτώμενο παιδί (33,4%)
*Νοικοκυριά με έναν ενήλικα ηλικίας 65 ετών και άνω (30,1%)
*Νοικοκυριά με 3 ή περισσότερους ενήλικες με εξαρτώμενα παιδιά (29,3%)
*Μονοπρόσωπα νοικοκυριά με μέλος θήλυ (27,7%)
*Παιδιά ηλικίας 0-17 ετών (23,0%)
Χαρακτηριστικά πληθυσµού σε κίνδυνο φτώχειας
Το ποσοστό κινδύνου φτώχειας είναι υψηλότερο στις γυναίκες, σε σχέση µε τους άνδρες, 20,9% και 19.3%, αντίστοιχα.
Τα µονοπρόσωπα νοικοκυριά µε θήλυ µέλος απειλούνται από τη φτώχεια σε ποσοστό 27,7%, ενώ τα αντίστοιχα µε άρρεν µέλος σε ποσοστό 26,3%.
Ο κίνδυνος φτώχειας για άτοµα ηλικίας άνω των 65 ετών υπολογίζεται σε ποσοστό 21,3%, ενώ για άτοµα ηλικίας έως 17 ετών σε ποσοστό 23%.
Ο κίνδυνος φτώχειας για άτοµα ηλικίας άνω των 75 ετών υπολογίζεται σε ποσοστό 25,5%, ενώ για άτοµα ηλικίας 75 ετών και κάτω σε ποσοστό 19,6 %.
Ο κίνδυνος φτώχειας των νοικοκυριών µε έναν γονέα και τουλάχιστον ένα εξαρτώµενο παιδί ανέρχεται στο 33,4%, ενώ ο αντίστοιχος δείκτης για τα νοικοκυριά µε δύο γονείς και ένα εξαρτώµενο παιδί ανέρχεται στο 21,6%.
Οι εργαζόµενοι κινδυνεύουν λιγότερο από τους ανέργους και τους οικονοµικά µη ενεργούς (συνταξιούχους, νοικοκυρές, κ.λ.π.).
Το ποσοστό κινδύνου φτώχειας των εργαζοµένων ανέρχεται στο 13,8% (άνδρες 16,4% και γυναίκες 10,2%), των λοιπών µη οικονοµικά ενεργών στο 27,4% και των ανέργων στο 38,5%.
Ο σχετικός κίνδυνος φτώχειας για τους εργαζοµένους µε πλήρη απασχόληση ανέρχεται στο 11,7%, ενώ για τους εργαζοµένους µε µερική απασχόληση ανέρχεται στο 29,4%.
Τα νοικοκυριά που διαµένουν σε ιδιόκτητη κατοικία απειλούνται από φτώχεια κατά 18,5%, ενώ αυτά που διαµένουν σε ενοικιασµένη κατοικία κατά 27,2%.
Ο σχετικός κίνδυνος φτώχειας ηλικιωµένων 75 ετών και άνω κατά ιδιοκτησιακό καθεστώς της κατοικίας τους ανέρχεται για τους ιδιοκτήτες στο 26,3%, ενώ για τους ενοικιαστές στο 18%.
πηγές:
Από: http://news247.gr/ellada/eidiseis/h_ftwxeia_apeilei_toys_ellhnes.1561097.html
Βλ. επίσης Δελτίο Τύπου Ελ.Στατ.
"Έρευνα εισοδήματος και συνθηκών Διαβίωσης των Νοικοκυριών 2010", όπως δημοσιεύθηκε στις 3/1/2012:
http://www.protothema.gr/files/1/2012/01/03/%CE%9A%CE%AF%CE%BD%CE%B4%CF%85%CE%BD%CE%BF%CF%82%20%CF%86%CF%84%CF%8E%CF%87%CE%B5%CE%B9%CE%B1%CF%82.pdf
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