External auditors for infection control.
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Biomedical subjects
Publications and source records attributed to G D Corcoran.
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AIMS: To detect enteric microsporidia in faecal specimens from patients with the acquired immunodeficiency syndrome (AIDS), and to identify the spores to species level without using invasive procedures. METHODS: Formalised faecal preparations were examined using a modification of the strong trichrome staining method to demonstrate microsporidian spores. Six positive specimens were prepared for electron microscopy by emulsification and separation using a 9% Ficoll gradient. RESULTS: The modified staining technique readily identified microsporidian spores. Spores of different species showed variation in size. Identification using electron microscopy was successful for five of the six positive specimens examined. It was unsuccessful for one specimen in which spores were less abundant on initial staining. CONCLUSIONS: The modified strong trichrome staining method is a useful way of detecting spores of intestinal microsporidia in faecal specimens. Variation in spore size may permit provisional identification by light microscopy. Electron microscopic examination of faecal preparations is useful for identifying spores to species level.
The Wolf 35100 and DSD-91 endoscope disinfection machines were compared. Using a total viable count method, the degree of contamination of an Olympus GIFXQ20 endoscope was assessed following inoculation with a suspension of Pseudomonas aeruginosa and again following disinfection cycles in each machine, using 2% glutaraldehyde as the disinfectant. Both machines performed satisfactorily, with an average reduction of between 7 and 8 log10 cfu ml-1 P. aeruginosa following disinfection. The dilution effect on the glutaraldehyde of repeated disinfection cycles was also assessed for each machine. After 40 cycles in the DSD-91 and 25 cycles in the Wolf 35100 machines, the dilution of glutaraldehyde may give rise to concern, especially if adequate pre-cleaning of the endoscope is not carried out. The DSD-91 machine has certain advantages over the Wolf 35100 in terms of endoscope capacity, running costs and ease of maintenance. Both machines give similar results for endoscope disinfection.
A case of neonatal osteomyelitis in a baby with Down's syndrome is described. The causative organism was a non-encapsulated Haemophilus influenzae biotype I, which was isolated from pus at the site of infection. This organism has not previously been reported as a cause of neonatal osteomyelitis.
A cohort of 66 patients on maintenance haemodialysis was examined for serological (anti-HCV) and virological (HCV-RNA) evidence of infection with hepatitis C virus (HCV). Nine (13.6%) were anti-HCV positive, all of whom had detectable HCV-RNA in their serum. Statistical analysis of various risk factors (including length of time on haemodialysis, history of blood transfusion, history of renal transplantation and of previous hepatitis B infection) showed that only the length of time on haemodialysis was significantly associated with the acquisition of HCV infection. Genotypic analysis showed that five patients were infected with genotype 1 and a further two were infected with genotype 4. The latter finding is of significance because strains of genotype 4 are extremely uncommon in Western Europe. These results demonstrate that intra-unit transmission of HCV-infection took place in a group of patients on maintenance haemodialysis.
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Three methods, O-serotyping, phage typing and susceptibility to bacteriocins, were used to type 357 clinical isolates of Enterobacter cloacae cultured from 219 patients. One hundred and sixty isolates were typed by serology and phage typing. When these two methods were used, primary classification of isolates was based on serology (65.7% typable) and phage typing for further subdivision (94.1% typable). When all the isolates were typed by cloacin susceptibility, 81.5% of them were typable. Maximum discrimination between cultures was achieved when the three methods were used together; no single method was sufficiently discriminatory. There was a close parallel between serotyping and bacteriocin lysis pattern. The latter was easy to perform and the results were achieved within 48 h. By applying this typing system two episodes of cross-infection were identified in a haematology/oncology unit and intensive care unit.
Liver abscess formation due to Fusobacterium nucleatum is rare. We describe an HIV-I antibody positive man, with normal surrogate markers of cell-mediated immunity, who presented with F. nucleatum bacteraemia and liver abscess formation. He was found to have IgG2 subclass deficiency. This case illustrates the clinical importance of altered B-cell function in patients who are at an early stage of HIV disease.
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The treatment of an infected vascular graft invariably requires an extra-anatomic bypass through a non-infected tissue plane, as simple drainage with antibiotics is rarely successful. We report a case in which an established infection of a prosthetic vascular graft with Salmonella dublin was successfully treated with simple drainage and a prolonged course of oral ciprofloxacin.
A case of septicaemia caused by Pediococcus pentosaceus is described. The role played by pediococci, and other vancomycin-resistant Gram-positive cocci, in disease states is examined. We suggest that in immunocompromised patients these organisms act as opportunist pathogens. This would appear to be the first reported case of P. pentosaceus septicaemia.
Invasive pneumococcal infection is a major health problem with considerable mortality. In most patients the diagnosis is relatively straightforward but this study points out that in many, especially children, it is difficult because of a lack of clinical signs of septicaemia. While chronic respiratory disease is a major predisposing factor, malignancy and immune disorders are also common underlying features. Certain risk groups may benefit considerably from vaccination. The treatment of established infection is now complicated by the emergence of resistant strains, but penicillin remains the mainstay of therapy.