Publications by authors named "Tirdad T Zangeneh"

21 Publications

  • Page 1 of 1

A Comparative Analysis of Mucormycosis in Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes in the Southwest United States.

Am J Med 2021 May 8. Epub 2021 May 8.

Division of Infectious Diseases.

Background: Mucormycosis (zygomycosis) is an invasive fungal infection that carries a high risk of morbidity and mortality. Uncontrolled diabetes mellitus and other immunocompromising conditions are risk factors for mucormycosis development. We here describe the differences in characteristics and outcomes of mucormycosis among solid organ transplant, hematological malignancy, and diabetes mellitus groups at our institution.

Methods: We conducted a retrospective chart review over the period of 2009-2020, with identifying patients using the International Classification of Diseases, Ninth and Tenth Revisions. Clinical, laboratory, and outcome data were collected.

Results: There were 28 patients identified: 7 solid organ transplant, 3 hematological malignancy, and 18 diabetes mellitus patients were included in the study. Three solid organ transplant patients experienced an episode of rejection, and another 3 had cytomegalovirus infection prior to presenting with mucormycosis. Four of seven solid organ transplant patients had a history of diabetes mellitus, but the median hemoglobin A1C was lower than in the diabetes mellitus group (6.3 vs 11.5; P = .006). The mortality rate difference between solid organ transplant and diabetes mellitus was not statistically significant: 2/7 (28.57%) vs 5/18 (27.78%); P = .66. Patients with bilateral disease (pulmonary or sinus) had significantly higher mortality (80% vs 13%, P = .008). There was no difference in mortality outcomes among the different types of antifungal therapies administered.

Conclusion: A multispecialty approach is imperative in mucormycosis therapy. While the underlying risk factors were different, the outcomes were comparable for the solid organ transplant and diabetes mellitus groups. Future larger and longitudinal studies are recommended.
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http://dx.doi.org/10.1016/j.amjmed.2021.04.008DOI Listing
May 2021

A Single-Center Experience and Literature Review of Management Strategies for Infection in Hematopoietic Stem Cell Transplant Patients.

Infect Dis Clin Pract (Baltim Md) 2020 Jan;28(1):10-15

Department of Medicine, Division of Hematology and Oncology, University of Arizona, Tucson, AZ 85724.

Introduction: The aim of our study is to evaluate risk factors associated with the development of infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence and report outcomes of CDI in our patient population.

Methods: We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI.

Results: The overall incidence of CDI in HSCT patients was 9.4%. The incidence of CDI was higher in allogeneic HSCT (20%) versus autologous HSCT (4.8%). No statistically significant differences in age, gender, cancer type, transplant type were found between those who developed CDI and those who did not. However, patients with CDI had a longer length of stay (25 days) and used more antibiotics (30 days prior to and during admission for HSCT) than non-CDI patients (19 days). Only two of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after HSCT. No patient suffered from toxic megacolon or ileus and no patient underwent colectomy. There was no mortality associated with CDI at our center.

Conclusion: CDI has an incidence rate of 9.4% in HSCT recipients. Established risk factors including age, gender, cancer type, and transplant type were not identified as risk factors in our population. However, longer LOS and use of greater than four lines of antibiotics were observed among those with CDI compared to those without CDI.
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http://dx.doi.org/10.1097/ipc.0000000000000798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792527PMC
January 2020

Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature.

Transpl Infect Dis 2020 Oct 7;22(5):e13308. Epub 2020 Jul 7.

Division of Infectious Diseases, Banner University Medical Center, University of Arizona, Tucson, Arizona, USA.

A 42-year-old man presented with nausea, malaise, and pain at his renal graft site 4 months following deceased donor renal transplant. His transplantation had been complicated by urinary leak with delayed wound closure requiring ureteral revision with biologic mesh placement. The initial evaluation in the hospital revealed urinalysis with significant pyuria as well as abdominal CT imaging concerning for abscess formation anterior to the grafted kidney. Interventional radiology (IR) guided drainage of this abscess yielded growth of Enterococcus faecalis treated with intravenous ampicillin/sulbactam. He continued to have pain at his graft site and repeat imaging revealed a persistent abscess despite prolonged antimicrobial therapy. Urine cultures isolated Mycoplasma species. A repeat aspirate of abscess fluid collected and Mycoplasma hominis was identified by molecular test. Patient's symptoms abated and his abscess completely resolved on repeat imaging after completing a course of oral moxifloxacin and doxycycline. His immunosuppression did not require adjustment and the renal graft continued to function well following this therapy. Mycoplasma and Ureaplasma should be considered as a potential etiology for perinephric abscess in renal transplant recipients.
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http://dx.doi.org/10.1111/tid.13308DOI Listing
October 2020

Pulmonary Mucormycosis in a Heart Transplant Patient.

Am J Med 2020 09 19;133(9):e524-e525. Epub 2020 Mar 19.

University of Arizona, College of Medicine, Division of Infectious Diseases, Tucson.

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http://dx.doi.org/10.1016/j.amjmed.2020.02.020DOI Listing
September 2020

Unusual Presentations of Coccidioidomycosis in Conjunction With Autoimmune Syndromes: A Literature Review and Case Series.

J Clin Rheumatol 2020 Mar;26(2):e43-e47

Division of Rheumatology, Department of Internal Medicine, University of Arizona, Tucson, AZ Department of Internal Medicine, College of Medicine, University of Arizona, Tucson, AZ Department of Internal Medicine, College of Medicine, University of Arizona, Tucson, AZ; Division of Infectious Disease, The Valley Fever Center for Excellence, Department of Internal Medicine, University of Arizona, Tucson, AZ.

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http://dx.doi.org/10.1097/RHU.0000000000000825DOI Listing
March 2020

Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment.

Open Forum Infect Dis 2020 Jan 14;7(1):ofz533. Epub 2019 Dec 14.

Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA.

Background: Evidence regarding the safety of using proviral HIV-1 DNA genotype (DNA GT) to guide antiretroviral therapy (ART) is limited. We hypothesized that HIV RNA would not increase following ART adjustment guided by DNA GT in a university HIV clinic.

Methods: Data were obtained from electronic medical records of adult persons living with HIV-1 (PWH) who underwent DNA GT testing and changed ART between October 2014 and November 2017. Logistic regression was used to evaluate the effect of ART switch on HIV RNA over time.

Results: Eighty-three PWH had DNA GT performed, 66 (80%) switched ART, and 59 had postswitch follow-up. Data were analyzed pre-/postswitch for these 59 PWH (median age, 54 years; 71% LWH ≥10 years; 46% ≥2 previous regimens; 36% recent low-level viremia; 34% unknown medication history). On DNA GT, 58% had ≥1-class ART resistance, 34% ≥2-class, and 10% 3-class. Median follow-up (range) was 337 (34-647) days. There was no change in probability of HIV RNA ≥50 copies/mL over time ( > .05). At baseline, 76% had HIV RNA <50 vs 88% at last postswitch follow-up ( = .092). Protease inhibitor use decreased from 58% to 24% ( < .001). Average daily pills and dosing frequency decreased from 3.48 to 2.05 ( < .001) and 1.39 to 1.09 ( < .001), respectively; ART cost did not change.

Conclusions: DNA GT facilitated changes in ART in a treatment-experienced population without increases in HIV RNA. Decreased pill burden occurred without increased ART cost. Further studies to identify optimal use of DNA GT are needed.
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http://dx.doi.org/10.1093/ofid/ofz533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942490PMC
January 2020

Infection of Aortic Endograft Caused by Coccidioidomycosis.

Am J Med 2020 01 25;133(1):e1-e2. Epub 2019 Jul 25.

College of Medicine, Division of Infectious Diseases, University of Arizona, Tucson; College of Medicine, Valley Fever Center for Excellence, University of Arizona, Tucson.

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http://dx.doi.org/10.1016/j.amjmed.2019.07.013DOI Listing
January 2020

De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant.

Am J Transplant 2019 09 26;19(9):2517-2524. Epub 2019 Mar 26.

Division of Infectious Diseases, Banner University Medical Center, University of Arizona, Tucson, Arizona.

Solid organ transplant recipients who contract coccidioidomycosis are at risk for complicated, protracted, disseminated, and severe disease. To date, no studies have described outcomes for patients who develop coccidioidomycosis only after the first posttransplant year. This study was a joint project of Mayo Clinic Hospital, Phoenix, Arizona, and the University of Arizona/Banner University Medical Center, Tucson, Arizona. We retrospectively reviewed electronic health records for patients with a history of solid organ transplant between January 1, 1998, and October 11, 2014, who developed coccidioidomycosis after the first transplant year. We identified 91 patients. Of those, 37/91 (40.7%) had pulmonary coccidioidomycosis (29/37 [78.4%] were symptomatic); and 5/91 (5.5%) had extrapulmonary disease (all were symptomatic). One patient (1.1%) died. Coccidioidomycosis was evident in 2/91 (2.2%) patients within 3 months of antirejection treatment. Many of the patients (51/91 [56.0%]) had asymptomatic coccidioidomycosis, 27 (27.9%) of whom were followed up closely but did not receive antifungal medication and had no sequelae. Although solid organ recipients taking low-level immunosuppression after the first posttransplant year appeared to have less symptomatic, disseminated, or fatal coccidioidal infection than historical cohorts, this remains an important infection with morbidity and mortality even after the first posttransplant year.
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http://dx.doi.org/10.1111/ajt.15324DOI Listing
September 2019

Top Questions in the Diagnosis and Treatment of Coccidioidomycosis.

Open Forum Infect Dis 2017 12;4(4):ofx197. Epub 2017 Sep 12.

The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.

Revised and greatly expanded treatment guidelines for coccidioidomycosis were published last year by the Infectious Diseases Society of America. We have selected 4 questions that commonly arise in the management of patients suspected of this disease and for which there remain divided opinions.
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http://dx.doi.org/10.1093/ofid/ofx197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903411PMC
September 2017

A rare case of pyogenic pericarditis secondary to .

BMJ Case Rep 2018 Mar 28;2018. Epub 2018 Mar 28.

Infectious Diseases, The University of Arizona College of Medicine, Tucson, Arizona, USA.

We report an extremely rare case of purulent pericarditis caused by the normally commensal oral flora, a species and member of the group (previously also known by the eponymous ' for American Willoughby Dayton Miller). This case is a previously healthy 71-year-old immunocompetent woman from Arizona who presented with a 5-day history of progressive shortness of breath and chest tightness, and subjective fever and chills, but without history of nausea, vomiting, night sweats, recent travel, autoimmune disease or sick contacts. Early recognition and intervention of purulent pericarditis allow patients like the one outlined in this case to achieve full recovery.
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http://dx.doi.org/10.1136/bcr-2017-223804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878310PMC
March 2018

Recurrence of urinary tract infections and development of urinary-specific antibiogram for kidney transplant recipients.

J Glob Antimicrob Resist 2018 03 30;12:119-123. Epub 2017 Aug 30.

Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Banner - University Medical Center Tucson, Tucson, AZ, USA.

Objectives: Urinary tract infection (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. Whilst the use of annual institutional antibiograms may help guide appropriate empirical antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns. This study determined the frequency of UTI recurrence during the first year after kidney transplantation as well as differences in antimicrobial susceptibility between an institutional antibiogram and the disease-specific antibiogram for patients following kidney transplantation.

Methods: In this study, adult patients with at least one UTI during an inpatient admission within 1 year post kidney transplantation were evaluated. A disease-specific antibiogram for UTIs in kidney transplant recipients was prepared based on culture results and was compared with the annual institutional antibiograms.

Results: Of 299 kidney transplants performed during the study period, 66 subjects meet the study inclusion criteria, of whom 47% had two or more UTIs within the first year after kidney transplant. In comparison with the institutional antibiogram, Escherichia coli isolated from urine samples from kidney transplant recipients were significantly more resistant to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin and gentamicin (P<0.0001).

Conclusions: Multiple UTIs are common in kidney transplant recipients during the first year post-transplantation. E. coli urinary isolates were significantly more resistant to multiple antibiotic drug classes in this patient population compared with the general hospital population. Antimicrobial stewardship programmes at transplant centres should consider producing disease-specific antibiograms specifically for transplant recipients to improve empirical antibiotic selection guidance.
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http://dx.doi.org/10.1016/j.jgar.2017.08.009DOI Listing
March 2018

Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia.

Med Mycol Case Rep 2017 Jun 23;16:8-11. Epub 2017 Mar 23.

Division of Infectious Diseases, Department of Medicine, Banner University Medical Center, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA.

Central Nervous System (CNS) vasculitis is the most common life-threatening complication of coccidioidal meningitis. It is manifested by cerebral ischemia, hemorrhage, and infarction. We report a case of CNS vasculitis in a patient receiving chemotherapy and review of the literature on coccidioidal meningitis. The patient was treated with combination antifungal therapy and a short course of high dose corticosteroids with a modest improvement in her neurological examination after initiation of steroids.
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http://dx.doi.org/10.1016/j.mmcr.2017.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374848PMC
June 2017

An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis.

Surg Neurol Int 2016 25;7:61. Epub 2016 May 25.

Department of Surgery, Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA.

Background: Rhinocerebral mucormycosis occurs in immunocompromised hosts with uncontrolled diabetes, solid organ transplants, and hematologic malignancies. Primary disease is in the paranasal sinuses but often progresses intracranially, via direct extension or angioinvasion. Rhinocerebral mucormycosis is rapidly fatal with a mortality rate of 85%, even when maximally treated with surgical debridement, antifungal therapy, and correction of underlying processes.

Methods: We performed a retrospective chart review of patients with rhinocerebral mucormycosis from 2011 to 2014. These patients were analyzed for symptoms, surgical and medical management, and outcome. We found four patients who were diagnosed with rhinocerebral mucormycosis. All patients underwent rapid aggressive surgical debridement and were started on antifungal therapy on the day of diagnosis. Overall, we observed a mortality rate of 50%.

Results: An early aggressive multidisciplinary approach with surgical debridement, antifungal therapy, and correction of underlying disease have been shown to improve survivability in rhinocerebral mucormycosis.

Conclusion: A multidisciplinary approach to rhinocerebral mucormycosis with otolaryngology, neurosurgery, and ophthalmology, infectious disease and medical intensivists can help reduce mortality in an otherwise largely fatal disease. Even despite these measures, outcomes remain poor, and a high index of suspicion must be maintained in at-risk populations, in order to rapidly execute a multifaceted approach.
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http://dx.doi.org/10.4103/2152-7806.182964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882964PMC
June 2016

Polymicrobial Pituitary Abscess Predominately Involving Escherichia coli in the Setting of an Apoplectic Pituitary Prolactinoma.

Case Rep Infect Dis 2016 23;2016:4743212. Epub 2016 Feb 23.

Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine, Banner-University Medical Center, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.

Pituitary abscess is a rare intracranial infection that can be life-threatening if not appropriately diagnosed and treated upon presentation. The most common presenting symptoms include headache, anterior pituitary hypofunction, and visual field disturbances. Brain imaging with either computed tomography or magnetic resonance imaging usually reveals intra- or suprasellar lesion(s). Diagnosis is typically confirmed intra- or postoperatively when pathological analysis is done. Clinicians should immediately start empiric antibiotics and request a neurosurgical consult when pituitary abscess is suspected. Escherichia coli (E. coli) causing intracranial infections are not well understood and are uncommon in adults. We present an interesting case of an immunocompetent male with a history of hypogonadism presenting with worsening headache and acute right eye vision loss. He was found to have a polymicrobial pituitary abscess predominantly involving E.   coli in addition to Actinomyces odontolyticus and Prevotella melaninogenica in the setting of an apoplectic pituitary prolactinoma. The definitive etiology of this infection was not determined but an odontogenic process was suspected. A chronic third molar eruption and impaction in close proximity to the pituitary gland likely led to contiguous spread of opportunistic oral microorganisms allowing for a polymicrobial pituitary abscess formation.
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http://dx.doi.org/10.1155/2016/4743212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781952PMC
March 2016

Coccidioidomycosis with Pericardial Involvement: Case Report and Literature Review.

Am J Med 2016 Mar 28;129(3):e21-5. Epub 2015 Nov 28.

Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, Tucson; Division of Infectious Diseases, University of Arizona, Banner University Medical Center - Tucson, Tucson. Electronic address:

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http://dx.doi.org/10.1016/j.amjmed.2015.11.009DOI Listing
March 2016

Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!

Am J Ther 2016 Jul-Aug;23(4):e1074-7

Department of Internal Medicine, University of Arizona, Tucson, AZ.

Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.
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http://dx.doi.org/10.1097/MJT.0000000000000288DOI Listing
February 2017

Positive (1-3) B-d-glucan and cross reactivity of fungal assays in coccidioidomycosis.

Med Mycol 2015 Feb 24;53(2):171-3. Epub 2014 Dec 24.

University of Arizona College of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Tucson, Arizona.

Fungal antigen testing in immunosuppressed patients has emerged as a powerful diagnostic tool. Some assays are relatively nonspecific, and misinterpretation can have severe clinical consequences. Additionally, when new assays become commercially available it is important to evaluate the potential for cross reactivity. We recently observed several immunosuppressed patients with positive (1→3)-β-D-glucan (BG) who were eventually diagnosed with coccidioidomycosis in the endemic area of Tucson, Arizona. Although the BG assay is known to detect glucans of many fungal pathogens, reports of cross-reactivity with Coccidioides remain sparsely reported. To test the cross-reactivity of fungal antigens in detection assays, serum samples from patients with coccidioidomycosis testing positive for Coccidioides antigen were evaluated for BG. Of 12 samples positive for Coccidioides antigen (≥0.07 ng/ml), 11 (92%) were positive by BG (>80 pg/ml), and of 11 positive for Aspergillus galactomannan, 10 (91%) were positive by BG (>80 pg/ml). We conclude that the BG assay is nonspecific, detecting glucans from many fungal pathogens, including Coccidioides. In the endemic area, a positive BG warrants further specific testing.
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http://dx.doi.org/10.1093/mmy/myu077DOI Listing
February 2015

Coccidioidomycosis of the genitourinary tract: a case report and discussion.

Urology 2014 Dec 11;84(6):e30-1. Epub 2014 Oct 11.

Department of Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ. Electronic address:

Coccidioides species (Coccidioides immitis and Coccidioides posadasii) are dimorphic fungi endemic to the Southwestern United States. Initial infection ranges from asymptomatic to mild upper respiratory tract symptoms and may disseminate to other organs including the genitourinary tract. Genitourinary complaints may be the initial presenting signs and symptoms among a minority of patients. We report a case of genitourinary coccidioidomycosis and discussion of genitourinary disease with coccidioidomycosis.
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http://dx.doi.org/10.1016/j.urology.2014.08.005DOI Listing
December 2014

Disseminated Infection Caused by Eggerthella lenta in a Previously Healthy Young Man: A Case Report.

Case Rep Infect Dis 2012 17;2012:517637. Epub 2012 Dec 17.

Department of Medicine, The University of Arizona Medical Center, University of Arizona, Tucson, AZ 85724, USA.

Anaerobic bacteria are the predominant normal flora of the mucous membranes which may cause life-threatening disseminated infections and are often difficult to culture from infected sites. Eggerthella (previously known as Eubacteria species) is an anaerobic, nonsporulating, nonmotile, Gram-positive rod that is found in the human colon and feces and has been isolated from various other clinical specimens. We report a case of complicated disseminated anaerobic bacterial infection with Eggerthella lenta in a healthy immunocompetent man causing multiple brain abscesses, liver abscesses, necrotizing pneumonia, and osteomyelitis of the left radial bone. He was successfully treated with empiric penicillin G and metronidazole.
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http://dx.doi.org/10.1155/2012/517637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533611PMC
January 2013

Impact of conjugate pneumococcal vaccines on the changing epidemiology of pneumococcal infections.

Expert Rev Vaccines 2011 Mar;10(3):345-53

Division of Infectious Diseases, University of Miami Miller School of Medicine and the Miami Veterans Affairs Healthcare System, Miami, FL, USA.

Streptococcus pneumoniae-related infections have a major global impact on healthcare, especially in the developing world, and are considered the number one vaccine-preventable cause of death in children. There are more than 90 pneumococcal serotypes and 46 serogroups. The first capsular polysaccharide pneumococcal vaccine was licensed in the USA in 1977 for individuals older than 2 years of age at high risk for pneumococcal disease. Two decades later, the first 7-valent pneumococcal polysaccharide-protein conjugate vaccine completed the required clinical trials and was introduced as part of the national immunization program of various countries. New-generation vaccines that include emerging serotypes, while maintaining protection against the 7-valent pneumococcal serotypes, have recently been approved. With the addition of these serotypes, the majority of potential pneumococcal serotypes causing invasive disease in most parts of the world could be covered.
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http://dx.doi.org/10.1586/erv.11.1DOI Listing
March 2011