Archive for April, 2013

Molecular pathogenesis of infections caused by Legionella pneumophila.

Clin Microbiol Rev. 2010 Apr;23(2):274-98.

Newton HJ, Ang DK, van Driel IR, Hartland EL.


Department of Microbiology and Immunology, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.


The genus Legionella contains more than 50 species, of which at least 24 have been associated with human infection. The best-characterized member of the genus, Legionella pneumophila, is the major causative agent of Legionnaires’ disease, a severe form of acute pneumonia. L. pneumophila is an intracellular pathogen, and as part of its pathogenesis, the bacteria avoid phagolysosome fusion and replicate within alveolar macrophages and epithelial cells in a vacuole that exhibits many characteristics of the endoplasmic reticulum (ER). The formation of the unusual L. pneumophila vacuole is a feature of its interaction with the host, yet the mechanisms by which the bacteria avoid classical endosome fusion and recruit markers of the ER are incompletely understood. Here we review the factors that contribute to the ability of L. pneumophila to infect and replicate in human cells and amoebae with an emphasis on proteins that are secreted by the bacteria into the Legionella vacuole and/or the host cell. Many of these factors undermine eukaryotic trafficking and signaling pathways by acting as functional and, in some cases, structural mimics of eukaryotic proteins. We discuss the consequences of this mimicry for the biology of the infected cell and also for immune responses to L. pneumophila infection.


April 30, 2013 at 2:51 pm

An outbreak of scabies in a teaching hospital – Lessons learned.

Infect Control Hosp Epidemiol. 2001 Jan;22(1):13-8.

Obasanjo OO, Wu P, Conlon M, Karanfil LV, Pryor P, Moler G, Anhalt G, Chaisson RE, Perl TM.


Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD, USA.



To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences.


Outbreak investigation, case-control study, and chart review.


Large tertiary acute-care hospital.


A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy.


HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients with Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.



April 30, 2013 at 2:47 pm

Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy.

Acta Orthop. 2013 Feb;84(1):82-6.

Coelho-Prabhu N, Oxentenko AS, Osmon DR, Baron TH, Hanssen AD, Wilson WR, Steckelberg JM, Baddour LM, Harmsen WS, Mandrekar J, Berbari EF.


Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA.



There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty.


We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission.


339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10).


EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.


April 30, 2013 at 2:42 pm

Hand hygiene practices and resources in a teaching hospital in Ghana.

J Infect Dev Ctries. 2013 Apr 17;7(4):338-47.

Yawson AE, Hesse AA.


Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana.



Nosocomial infections have long been neglected in Sub-Saharan Africa, and hand hygiene (HH) is usually neglected in hospital settings. This study aimed to provide baseline data on HH compliance among health workers and HH resources in a large West African teaching hospital.


A cross-sectional, unobtrusive observational study assessed personal and care-related HH compliance among doctors and nurses and HH resources in 15 service provision centres of the Korle-Bu Teaching Hospital (KBTH), Ghana, in 2011. Data was collected with an infection prevention checklist and health worker HH compliance form, based on World Health Organization guidelines.


Care-related HH compliance of doctors and nurses was low and basic HH resources were deficient in all 15 service centres. Care-related HH compliance among doctors ranged from 9.2% to 57% and 9.6% to 54% among nurses. HH compliance was higher when risk was perceived to be higher (i.e., in the emergency and wound dressing/treatment rooms and labour wards). The neonatal intensive care unit (NICU) showed the highest level of compliance among health workers. Facilities for HH, particularly alcohol hand rub and liquid soap dispensers were shown to be deficient.


Care-related HH compliance among doctors and nurses in this large West African hospital is low; however, the NICU, which had implemented HH interventions, had better HH compliance. HH intervention programs should be designed and promoted in all service centres. Also, the introduction of alcohol-based hand rubs as an accessible and effective HH alternative in Korle-Bu Teaching Hospital is recommended.


April 30, 2013 at 2:36 pm

Isolation and characterization of H7N9 viruses from live poultry markets

Chinese Science Bulletin April 2013

SHI JianZhong1†, DENG GuoHua1†, LIU PeiHong2, ZHOU JinPing2, GUAN LiZheng1, LI WenHui1, LI XuYong, GUO Jing1, WANG GuoJun1, FAN Jun1, WANG JinLiang1, LI YuanYuan1, JIANG YongPing1, LIU LiLing1, TIAN GuoBin1, LI ChengJun1* & CHEN HuaLan1*

1 Animal Influenza Laboratory, State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute,

Chinese Academy of Agricultural Sciences, Harbin 150001, China;

2 Shanghai Animal Disease Control Center, Shanghai 201103, China

On March 31, 2013, the National Health and Family Planning Commission announced that human infections with a previously undescribed influenza A (H7N9) virus had occurred in Shanghai and Anhui Province, China. To investigate the possible origins of the H7N9 viruses causing these human infections, we collected 970 samples, including drinking water, soil, and cloacal and tracheal swabs of poultry from live poultry markets and poultry farms in Shanghai and AnhuiProvince. Twenty samples were positive for the H7N9 influenza virus. Notably, all 20 viruses were isolated from samples collected from live poultry markets in Shanghai. Phylogenetic analyses showed that the six internal genes of these novel human H7N9 viruses were derived from avian H9N2 viruses, but the ancestor of their HA and NA genes is uncertain. When we examined the phylogenetic relationship between the H7N9 isolates from live poultry markets and the viruses that caused the human infections, we found that they shared high homology across all eight gene segments. We thus identified the direct avian origin of the H7N9 influenza viruses that caused the human infections. Importantly, we observed that the H7N9 viruses isolated from humans had acquired critical mutations that made them more “human-like”. It is therefore imperative to take strong measures to control the spread of H7N9 viruses in birds and humans to prevent further threats to human health.


April 26, 2013 at 8:38 am

Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China

N Engl J of Medic April 24, 2013

Qun Li, M.D., Lei Zhou, M.D., Minghao Zhou, Ph.D., Zhiping Chen, M.D., Furong Li, M.D., Huanyu Wu, M.D., Nijuan Xiang, M.D., Enfu Chen, M.P.H., Fenyang Tang, M.D., Dayan Wang, M.D., Ling Meng, M.D., Zhiheng Hong, M.D., Wenxiao Tu, M.D., Yang Cao, M.D., Leilei Li, Ph.D., Fan Ding, M.D., Bo Liu, M.D., Mei Wang, M.D., Rongheng Xie, M.D., Rongbao Gao, M.D., Xiaodan Li, M.D., Tian Bai, M.D., Shumei Zou, M.D., Jun He, M.D., Jiayu Hu, M.D., Yangting Xu, M.D., Chengliang Chai, M.D., Shiwen Wang, M.D., Yongjun Gao, M.D., Lianmei Jin, M.D., Yanping Zhang, M.D., Huiming Luo, M.D., Hongjie Yu, M.D., M.P.H., Lidong Gao, M.D., Xinghuo Pang, M.D., Guohua Liu, M.D., Yuelong Shu, Ph.D., Weizhong Yang, M.D., Timothy M. Uyeki, M.D., M.P.H., M.P.P., Yu Wang, M.D., Fan Wu, M.D., and Zijian Feng, M.D., M.P.H.


The first identified cases of avian influenza A (H7N9) virus infection in humans occurred in China during February and March 2013. We analyzed data obtained from field investigations to characterize the epidemiologic characteristics of H7N9 cases in China as of April 17, 2013.


Field investigations were conducted for each confirmed case of H7N9 virus infection. A patient was considered to have a confirmed case if the presence of the H7N9 virus was verified by means of real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR), viral isolation, or serologic testing. Information on demographic characteristics, exposure history, and illness timelines was obtained from patients with confirmed cases. Close contacts were monitored for 7 days for symptoms of illness. Throat swabs were obtained from contacts in whom symptoms developed and were tested for the presence of the H7N9 virus testing by means of real-time RT-PCR.


Among 82 persons with confirmed H7N9 virus infection, the median age was 63 years (range, 2 to 89), 73% were male, and 84% were urban residents. Confirmed cases occurred in six areas of China. Of 77 persons with available data, 4 were poultry workers, and 77% had a history of exposure to live animals, including chickens (76%). A total of 17 persons (21%) died after a median duration of illness of 11 days, 60 remain critically ill, and 4 with clinically mild cases were discharged from the hospital; 1 pediatric patient was not admitted to the hospital. In two family clusters, human-to-human transmission of H7N9 virus could not be ruled out. A total of 1251 of the 1689 close contacts of case patients completed the monitoring period; respiratory symptoms developed in 19 of them (1.5%), all of whom tested negative for the H7N9 virus.


Most persons with confirmed H7N9 virus infection were critically ill and epidemiologically unrelated. Laboratory-confirmed human-to-human H7N9 virus transmission was not documented among close contacts, but such transmission could not be ruled out in two families.


April 24, 2013 at 10:27 pm

Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for persons aged 0 through 18 years–United States, 2013.

MMWR Surveill Summ. 2013 Feb 1;62 Suppl 1:2-8.

ACIP Childhood/Adolescent Immunization Work Group, Akinsanya-Beysolow I, Jenkins R, Meissner HC; Centers for Disease Control and Prevention (CDC).

Collaborators (21)

Jenkins R, Karron R, Rubin LG, Meissner H, Middleman AB, Lett S, Peterson D, Barry C, Schlamm E, Brewer K, Stinchfield P, Spence R, Kroger A, Atkinson WL, Hamborsky J, Wolfe C, Weaver D, Wolicki J, Barnett M, Mirza Z, Akinsanya-Beysolow I.







April 24, 2013 at 10:25 pm

Pneumonia immunization in older adults: review of vaccine effectiveness and strategies.

Clin Interv Aging. 2012;7:453-61.

Assaad U, El-Masri I, Porhomayon J, El-Solh AA.


Division of Pulmonary, Critical Care, and Sleep Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA.


Vaccination remains the primary preventive strategy in the elderly against Streptococcus pneumoniae and influenza infections. The effectiveness of this strategy in preventing pneumonia has been in doubt despite the increase in vaccination coverage among older adults. Randomized controlled trials (RCTs) and observational studies aimed at determining clinical outcomes and immune response following pneumococcal vaccination have yielded conflicting results. The protective efficacy of pneumococcal vaccination against pneumonia in older adults has not been firmly established due to a lack of RCTs specifically examining patients ≥ 65 years of age. Similarly, the reported benefits of influenza vaccination have been derived from observational data. The assessment of clinical benefit from influenza vaccination in the elderly population is complicated by varying cohorts, virulence of the influenza strain, and matching of vaccine and circulating viral strains. The presence of selection bias and use of nonspecific end points in these studies make the current evidence inconclusive in terms of overall benefit. The development of more immunogenic vaccines through new formulations or addition of adjuvants holds the promise of revolutionizing delivery and improving efficacy. Dismantling existing barriers through education, providing technology assistance predominantly to developing countries, and establishing clear regulatory guidance on pathways for approval are necessary to ensure timely production and equitable distribution.


April 23, 2013 at 2:03 pm

The treatment of scabies with ivermectin.

N Engl J Med. 1995 Jul 6;333(1):26-30.

Meinking TL, Taplin D, Hermida JL, Pardo R, Kerdel FA.


Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL, USA.



Ivermectin is an anthelmintic agent that has been a safe, effective treatment for onchocerciasis (river blindness) when given in a single oral dose of 150 to 200 micrograms per kilogram of body weight. Anecdotal reports of improvement in patients who suffered from infestation with the mite Sarcoptes scabiei suggest that the ectoparasitic disease scabies might be treated with ivermectin.


We conducted an open-label study in which ivermectin was administered in a single oral dose of 200 micrograms per kilogram to 11 otherwise healthy patients with scabies and to 11 patients with scabies who were also infected with the human immunodeficiency virus (HIV), 7 of whom had the acquired immunodeficiency syndrome. All patients received a full physical and dermatologic examination; scrapings from the skin of all patients tested positive for scabies. Patients were reexamined two and four weeks after treatment, when the scrapings for scabies were repeated. The patients used no other scabicides during the 30 days before ivermectin treatment or during the 4-week study period.


None of the 11 otherwise healthy patients had evidence of scabies four weeks after a single dose of ivermectin. Of the 11 HIV-infected patients, 2 had < or = 10 scabies lesions before treatment, 3 had 11 to 49 lesions, 4 had > or = 50 lesions, and 2 had heavily crusted skin lesions. In eight of the patients the scabies was cured after a single dose of ivermectin. Two patients received a second dose two weeks after the first. Ten of the 11 patients with HIV infection (91 percent) had no evidence of scabies four weeks after their first treatment with ivermectin.


The anthelmintic agent ivermectin, given in a single oral dose, is an effective treatment for scabies in otherwise healthy patients and in many patients with HIV infection.



April 23, 2013 at 2:00 pm

Invasive pneumococcal disease among adults: associations among serotypes, disease characteristics, and outcome.

Clin Infect Dis. 2009 Jul 15;49(2):e23-9.

Jansen AG, Rodenburg GD, van der Ende A, van Alphen L, Veenhoven RH, Spanjaard L, Sanders EA, Hak E.


Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.



The Streptococcus pneumoniae polysaccharide capsule may be related to invasive pneumococcal disease (IPD) course.


We performed a retrospective cohort study with nationally representative surveillance data from 1075 hospitalized patients with IPD from the Netherlands from 1 June 2004 through 31 May 2006 in the prevaccination era. Serotypes were grouped according to invasive disease potential, rate of the most serious clinical syndromes of meningitis and bacteremia without focus, and case-fatality rates. Multivariable logistic regression analysis was performed to obtain odds ratios adjusted for baseline confounders for the association of serotypes and these outcomes, using the serotypes with the lowest rates as reference.


IPD caused by serogroups with low invasive disease potential concerned meningitis or bacteremia without focus in 22% of cases, and 74% of patients had an underlying comorbidity. For highly invasive serogroups these figures were 10% (P < .01) and 56% (P < .01). Individual serotypes varied in the relative rate by which they caused meningitis or bacteremia without focus. Compared with the reference group composed of serotypes 1, 5, 7F, 15B, 20, and 33F, the group of serotypes 3, 19F, 23A, 16F, 6B, 9N, and 18C was associated with increased case-fatality rates (group adjusted odds ratio, 2.6; 95% confidence interval, 1.5-4.7).


The serotype appeared to be independently associated with IPD severity in adults, which indicates that careful monitoring of IPD after implementation of conjugate vaccines is necessary.



April 21, 2013 at 11:05 am

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