Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 8 Articles
Background: In May 2005, a long-distance outbreak of Legionnairesââ?¬â?¢ disease (LD) caused by Legionella pneumophila\nserogroup 1 occurred in south-east Norway. The initial outbreak investigation without serology identified 56\nlaboratory-confirmed LD cases of whom 10 died. However, 116 patients with community-acquired pneumonia might\nbelong to the outbreak based on epidemiological investigations, but acute laboratory tests other than serology were\nnegative or not performed. To assess the true extent of the outbreak, we evaluated two serological assays in order to\nreclassify the 116 patients with indeterminate case status.\nMethods: Two polyvalent antibody tests, a serogroup 1ââ?¬â??6 immunofluorescence assay (IFA) and a serogroup 1ââ?¬â??7\nenzyme-linked immunosorbent assay (ELISA) were used. They were evaluated with cases defined as culture- or\nurinary antigen positive LD patients (n = 40) and non-cases defined as confirmed non-LD patients (n = 39) and\nhealthy control subjects (n = 62). The 116 patients, who were negative in culture, polymerase chain reaction\nand/or urinary antigen tests, were analysed by the same serological assays. Antibodies to the outbreak strain\nwere determined by immunoblotting.\nResults: In the evaluation study, the sensitivity and specificity of a ?4-fold IFA titre change was 38% and 100%,\nrespectively, with corresponding values of 30% and 99% for seroconversion in ELISA. A single high positive IFA\ntitre yielded sensitivity and specificity of 73% and 97%, respectively, with corresponding values of 68% and 96%\nfor a single high immunoglobulin (Ig) G and/or IgM in ELISA.\nBased on this evaluation, the following serological testing identified 47 more LD cases, and the outbreak thus\ncomprised 103 cases with a case fatality rate of 10%. About the same proportion (70%) of the urinary antigen\npositive and negative LD cases had antibodies to the serogroup-specific lipopolysaccharide of the outbreak\nstrain. In addition to the 103 LD cases, Legionella infection could not be verified or excluded in 32 patients\nbased on epidemiology and/or lack of microbiological sampling.\nConclusions: The acute-phase tests (culture, polymerase chain reaction, and urinary antigen) identified less than\n55% of the 103 patients in this outbreak. Serological testing thus remains an important supplement for diagnosis of\nLD and for determination of outbreak cases....
Background: To investigate clinical features of infectious endophthalmitis over five years in a South Korean\npopulation.\nMethods: Medical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions\nlocated in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed.\nResults: A total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per\nyear was developed. The annual incidence rate of postoperative endophthalmitis during 2006 ~ 2009 was 0.037%.\nThe ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade\nand spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most\ncommon past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract\noperation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification\n(95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and\nendogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than\ncounting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal\nantibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only.\nConclusions: Our study revealed that the development of infectious endophthalmitis was related with seasonal\nvariation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious\nendophthalmitis in South Korea....
Background: Our aim was to determine and characterize S. aureus (SA) isolated from infections in newborns for\nantibiotic resistance, virulence factors, genotypes, epidemiology and antibiotic consumption.\nMethods: Prospective surveillance of infections was conducted. Data about antibiotic treatment were analyzed.\nAntimicrobial susceptibility was assessed. PCR amplification was used to detect resistance and virulence genes.\nTyping methods such as PFGE, spa-typing and SCCmec were used.\nResults: SA was found to be associated with 6.5% of infections. Methicillin-Resistant Staphylococcus aureus\naccounted for 32.8% of SA-infections. An incidence of MRSA-infections was 1.1/1000 newborns. MRSA-infections\nwere diagnosed significantly earlier than MSSA-infections in these newborns (14th day vs. 23rd day (p = 0.0194)).\nMRSA-infections increased the risk of newborn�s death. Antibiotic consumption in both group was similar, but a\nhigh level of glycopeptides-usage for MSSA infections was observed.\nIn the MRSA group, more strains were resistant to erythromycin, clindamycin, gentamicin and amikacin than in the\nMSSA group. Hla gene was present in 93.9% of strains, and seg and sei in 65.3% of strains, respectively. One\ndominant clone was found among the 14 MRSA isolates. Fifteen strains belonging to SCCmec type IV were spa-t015\nand one strain belonging to SCCmec type V was spa-t011.\nConclusions: Results obtained in the study point at specific epidemiological situation in Polish NICU (more detailed\nstudies are recommended).\nHigh usage of glycopeptides in the MSSA infections treatment indicates the necessity of antimicrobial stewardship\nimprovement and introducing molecular screening for early identification of infections...
Sheep pox is a highly contagious disease of sheep caused by sheep pox virus. In the present study, 3698 lungs were collected from slaughtered sheep in and around Tirupati, AP, India and examined morphologically. 396 lungs were showed different pneumonic lesions. Among 396 lung lesions04 (1.01%) were diagnosed as Sheep pox. Grossly, the lungs revealed small to pea sized consolidated greyish white nodules visible from the lung surface. Adjacent to these lesions were congested and odematous. Histopathologically, pulmonary lesions consisted of hyperplastic or degenerative changes with mononuclear cells, neutrophils, typically sheep pox cells (SPC’s), which had vacuolated nucleus and marginated chromatin with occasional granular intra cytoplasmic inclusions. The nodules of lobular tissue revealed coagulative necrosis and serous exudates in alveolar paces. The adjacent lung tissue was variably congested and infiltrated with lymphocytes, neutrophils and macrophages. In two cases bronchi and bronchioles revealed desquamation of epithelial cells with various inflammatory cells. Based on above gross and histopathological lesions it was confirmed as sheep pox....
Background: Daily throughout 2011, about 900 new HIV infections occurred in children and 630 children died as a\nresult of AIDS-related complications worldwide. Late diagnosis, mortality trends, causes of and risk factors for death\nwere evaluated in vertically HIV-infected children.\nMethods: A retrospective 11-year study was conducted with Brazilian vertically HIV-infected children and adolescents\nusing patientsââ?¬â?¢ charts. Medical records, death certificates and the Ministry of Healthââ?¬â?¢s mortality database were verified\nfor mortality and cause of death. Diagnoses were made according to the CDC Revised Classification System for HIV\ninfection.\nResults: Of 177 patients included, 97 were female (54.8%). Median age at admission was 30 months (IQR: 5ââ?¬â??72\nmonths). Median follow-up was 5 years (IQR: 2ââ?¬â??8 years). After 11 years, 132 (74,6%) patients continued in follow-up, 11\n(6.2%) had been transferred and 8 (4.5%) were lost to follow-up. Twenty-six deaths occurred (14,7%), the majority\n(16/26; 61.5%) in children <3 years of age. Death cases decreased over time and the distribution of deaths was\nhomogenous over the years of evaluation. In 17/26 (65.4%) of the children who died, diagnosis had been made\nas the result of their becoming ill. Beginning antiretroviral therapy before 6 months of age was associated with\nbeing alive (OR = 2.86; 95% CI: 1.12ââ?¬â??7.25; p = 0.027). The principal causes of death were severe bacterial infections\n(57%) and opportunistic infections (33.3%).\nConclusions: In most of the HIV-infected children, diagnosis was late, increasing the risk of progression to AIDS and\ndeath due to delayed treatment. The mortality trend was constant, decreasing in the final two years of the study.\nBacterial infections remain as the major cause of death. Improvements in prenatal care and pediatric monitoring\nare mandatory....
Background: Nearly one third of the world is infected with latent tuberculosis infection (LTBI) and a vast pool of\nindividuals with LTBI persists in developing countries, posing a major barrier to global TB control. The aim of the\npresent study was to determine the prevalence of LTBI and the associated risk factors among adults in Kampala,\nUganda.\nMethods: We performed a secondary analysis from a door-to-door cross-sectional survey of chronic cough conducted\nfrom January 2008 to June 2009. Urban residents of Rubaga community in Kampala aged 15 years and older who had\nreceived Tuberculin skin testing (TST) were included in the analysis. The primary outcome was LTBI defined as a TST\nwith induration 10 mm or greater. Multivariable logistic regression analyses were used to assess the risk factors associated\nwith LTBI.\nResults: A total of 290 participants were tested with TST, 283 had their tests read and 7 didnââ?¬â?¢t have the TST read\nbecause of failure to trace them within 48ââ?¬â??72 hours. Of the participants with TST results, 68% were female, 75% were\n15ââ?¬â??34 years, 83% had attained at least 13 years of education, 12% were smokers, 50% were currently married, 57% left\nhome for school or employment, 21% were HIV positive and 65% reported chronic cough of 2 weeks or longer. The\noverall prevalence of LTBI was 49% [95% CI 44ââ?¬â??55] with some age-and sex-specific differences. On multivariable analysis,\nleaving home for school or employment, aOR = 1.72; [95%CI: 1.05, 2.81] and age 25ââ?¬â??34, aOR = 1.94; [95%CI: 1.12, 3.38];\n35 years and older, aOR = 3.12; [95%CI: 1.65, 5.88] were significant risk factors of LTBI.\nConclusion: The prevalence of LTBI was high in this urban African setting. Leaving home for school or employment and\nolder age were factors significantly associated with LTBI in this setting. This suggests a potential role of expansion of\noneââ?¬â?¢s social network outside the home and cumulative risk of exposure to TB with age in the acquisition of LTBI. Our\nresults provide support for LTBI screening and preventive treatment programs of these sub-groups in order to enhance\nTB control....
Background: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes\nare poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after\nART initiation, based on data from an active surveillance system established within a network of specialized care facilities\nin West African cities.\nMethods: Within the International epidemiological Database to Evaluate AIDS (IeDEA) - West Africa collaboration,\nwe conducted a prospective, multicenter data collection that involved two facilities in Abidjan, C�´te dâ��Ivoire and\none in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form.\nA simple case-definition of severe morbidity (death, hospitalization, fever > 38�°5C, Karnofsky index < 70%) was used\nat any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according\nto the WHO clinical classification or as degree 3 or 4 of the ANRS scale.\nResults: From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with\n1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%),\nsuspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common\nspecific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as\nsyndromic in one out of five events recorded during this study.\nConclusions: This study highlights the ongoing importance of conventional infectious diseases among severe\nmorbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional\nstudies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion....
Background: In the Mitra plus study of prevention of mother-to-child transmission of HIV-1, which included 501\nwomen in Dar es Salaam, Tanzania, triple antiretroviral therapy (ART) was given from late pregnancy throughout\nbreastfeeding up to 6 months postnatally. Here we report findings in a sub-cohort of women with ?200 CD4cells/?L at\nenrolment who were continued on ART for life and followed up during 24 months after delivery to determine virologic\nand immunologic responses, drug resistance and mortality.\nMethods: Blood samples for viral load and CD4 counts testing were collected at enrolment and at 3, 6, 12 and 24 months\npostpartum. HIV drug resistance testing was performed at 12 months. Data analysis included descriptive statistics and\nmultivariate analysis using Generalized Estimated Equations of 73 women with at least two postpartum assessments.\nThe mortality analysis included 84 women who had delivered.\nResults: The proportion of women with a viral load ?400 copies/mL was 97% (71/73) at enrolment, 16% (11/67), 22%\n(15/69), 61% (36/59) and 86% (48/56) at 3, 6, 12 and 24 months postpartum, respectively. The proportion of women with\nimmunologic failure was 12% (8/69), 25% (15/60) and 41% (24/58) at 6, 12 and 24 months, respectively. At 12 months,\ndrug resistance was demonstrated in 34% (20/59), including 12 with dual-class resistance. Self-report on drug adherence\nwas 95% (64/68), 85% (56/66), 74% (39/53) and 65% (30/46) at 3, 6, 12 and 24 months, respectively. The mortality rate\nwas 5.9% (95% CI 2.5-13.7%) at 24 months. The probability of virologic and immunologic failure was significantly higher\namong women who reported non-perfect adherence to ART at month 24 postpartum.\nConclusions: Following an initial decline of viral load, virologic failure was common at 12 and 24 months postpartum\namong women initiated on ART for life during pregnancy because of low CD4 cell counts. A high proportion of viremic\nmothers also had resistance mutations. However, at 24 months follow-up, the mortality rate was still fairly low. Continuous\nadherence counseling and affordable means of monitoring of the virologic response are crucial for successful implementation\nof the WHO Option B+ guidelines to start all HIV-infected pregnant women on ART for life....
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