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PubMed1987

Overwintering of Culex mosquitoes in Sweden and their potential as reservoirs of human pathogens.

1. Culex pipiens L. and Cx torrentium Martini are suspected enzootic vectors in Sweden of Sindbis virus causing Ockelbo disease in man. To estimate their potential as virus reservoirs over the winter, mosquitoes were collected from August to May from a cellar in a rural area, central Sweden. The mosquitoes were dissected and examined for blood content, gonotrophic stage, parity and insemination, and tested for fructose. 2. Cx pipiens, Cx torrentium and Cx territans Walker constituted 94% of 887 females caught. A few Culiseta annulata (Schrank), Cs. alaskaensis (Ludlow) and An. maculipennis Meigen s.l. were also collected. 3. Data suggested that all blood-fed, parous Culex females disappeared during the winter and that only non-bloodfed, nulliparous females survived. 4. Fructose, detected in some of these females, and other plant sugars may be the main energy sources for winter survival. 5. Unless transovarially or venerally infected, Culex females are presumably of no or very limited importance in rural, central Sweden as winter reservoirs for blood-borne pathogens of vertebrates.

Animals↗
PubMed1990

Envelope glycoprotein of avian hemangioma retrovirus induces a thrombogenic surface on human and bovine endothelial cells.

Vascular endothelial cells are a target for blood-borne pathogens which may affect their integrity and thromboresistant properties. Here, we report that cultured bovine and human endothelial cells lose their thromboresistance following interaction with the avian hemangioma-inducing retrovirus. We show that the envelope (env) gene product, glycoprotein 85, is responsible for this effect, which appears soon after infection without viral replication or cell transformation. Induction of thrombogenicity is associated with a reduction in prostacyclin release and increased expression of tissue factor. These observations may explain the occurrence of thrombosis frequently observed in association with the hemangiosarcomas induced by avian hemangioma-inducing retrovirus. These unique endothelial cell-virus interactions may also be a model for the pathogenesis of various vascular diseases.

Animals↗
PubMed1992

In vivo binding and clearance of circulating antigen by bispecific heteropolymer-mediated binding to primate erythrocyte complement receptor.

We have used the avidin/biotin system to construct soluble, cross-linked bispecific heteropolymers containing mAb to both the primate E C receptor and the DNP group. These heteropolymers facilitate in vitro binding of DNP-bovine gamma-globulin (DNP-BGG) to both human and squirrel monkey E. Intravenous injection in squirrel monkeys of DNP-BGG followed by heteropolymer leads to E binding and clearance from the circulation of a significant fraction of both heteropolymer and DNP-BGG, without lysis or clearance of the E. This methodology may potentially be used to treat a variety of infectious diseases and other syndromes associated with blood-borne pathogens.

Animals↗
PubMed1992

Preventing human immunodeficiency virus transmission in the podiatric practice. The role of the podiatric medical assistant.

Rationales for the design and implementation of infectious disease control programs include protecting the health of patients and staff, reducing the risk of vulnerability in litigation, and complying with the regulatory environment that mandates such programs. The development and implementation of a comprehensive infectious disease control program is not a difficult project. The Universal Precautions Policy created by the CDC outlines basic recommendations for preventing the transmission of HIV. OSHA regulations also provide step-by-step guidelines that simplify adaptation of the CDC's policy to the podiatric medical practice. The execution of an effective infectious disease control program can be accomplished by the use of 10 basic protocols for the podiatric practice. These protocols provide the basis for policy, training, follow-up, and documentation. Design and implementation of this process within a podiatric medical practice can reduce dramatically the risk of inadvertent transmission of HIV and other blood-borne pathogens.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.

This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summarizes WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe adverse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed.

Adolescent↗
PubMed1992

Biology of factor IX.

Hemophilia B, one of two common hereditary bleeding disorders, is caused by a deficiency of factor IX in the circulation. Molecular mechanisms of hemophilia B are highly heterogeneous including gene deletions, insertions, complex rearrangements, and a large number of point mutations. Currently, hemophilia B is treated by plasma protein replacement therapy. This therapy is effective but exposes patients to possible side effects and complications such as infection of blood-borne pathogens including hepatitis viruses and HIV-1. Intensive efforts to develop alternative, safer therapies for hemophilia B, including somatic gene therapy, are now under way.

Amino Acid Sequence↗
PubMedDate not supplied

Evaluation of a needle-free intravenous access system.

Needle-stick injuries are one of the most severe hazards faced by nurses today. The most physically and emotionally devastating type of injury is from a needle contaminated with human immunodeficiency virus (HIV), but far more likely to occur is infection with other blood-borne pathogens, especially hepatitis B. The daily threat of needle-stick injuries adds yet another dimension of concern to the stresses inherent in working in a health care facility. Health care workers at greatest risk are those who manipulate needles and draw blood samples on a regular basis. With this concern in mind, a study was launched to evaluate a needle-free I.V. access system with respect to the following research objectives: 1) to assess the prevention/reduction of needle-stick risks and injuries; 2) to identify associated reduction in expenses; 3) to implement product and ease of use; and 4) to assess nursing satisfaction levels. This article describes the methodology used and the results of the study.

Catheters, Indwelling↗
PubMed1991

Mechanisms of glove tears and sharp injuries among surgical personnel.

OBJECTIVE: --The development of strategies to prevent exposure to blood for operating room personnel has been hampered by a lack of knowledge about the specific mechanisms of exposure. The purpose of this study was to classify the mechanisms of glove tears and sharp injuries in the operating room. DESIGN: --During a 3-month period, a nurse interviewed operating room personnel immediately after a glove tear or sharp injury had occurred. SETTING: --Yale-New Haven (Conn) Hospital is a tertiary care teaching hospital. RESULTS: --There were 249 glove tears and 70 sharp injuries. Visible skin contact with the patient's blood occurred in 156 glove tears (63%). The mechanism causing the tear could be identified in only 81 (33%). For 230 glove tears (92%), personnel were wearing single gloves. Of 70 sharp injuries, 47 (67%) were caused by needles and usually occurred during suturing. The following three mechanisms accounted for 40 sharp injuries (57%): (1) hands injured while stationary and holding an instrument, 11 (16%)-a position of risk not previously identified; (2) hands injured while retracting tissue, 12 (17%); and (3) injuries caused by sharp instruments not being used, 17 (24%). Instrument passage caused only four sharp injuries (6%). CONCLUSIONS: --The majority of glove tears have an unknown mechanism, and alteration in the manufacture or number of gloves worn may be helpful in reducing cutaneous blood exposures. The identification of specific mechanisms of sharp injuries should lead to effective strategies to prevent exposure to the human immunodeficiency virus and other blood-borne pathogens in the operating room.

Accidents, Occupational↗
PubMed1991

Blood contacts during surgical procedures.

Operating room personnel are at risk for infection with blood-borne pathogens through blood contact. To describe the nature and frequency of blood contact and its risk factors, trained observers monitored a sample of operations performed by six surgical services at Grady Memorial Hospital, Atlanta, Ga, for 6 months. In 62 (30.1%) of 206 operations, at least one blood contact was observed. Of 1828 operating room person-procedures observed, 96 (5.3%) had 147 blood contacts (133 skin contacts [90%], 10 percutaneous injuries [7%], and four eye splashes [3%]). The mean number of blood contacts per 100 person-procedures was highest for surgeons (18.6). The frequency of percutaneous injury was similar among surgeons and scrub staff (mean, 1.2 per 100 worker-procedures for each group). Risk factors for surgeons' blood contacts were (1) performing a trauma, burn, or orthopedic emergency procedure (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.0 to 8.7); (2) patient blood loss exceeding 250mL (OR, 2.1; 95% CI, 1.2 to 3.7); and (3) being in the operating room longer than 1 hour (OR, 3.3; 95% CI, 1.6 to 7.1). Of 110 blood contacts among surgeons, 81 (74%) were potentially preventable by additional barrier precautions, such as face shields and fluid-resistant gowns. Twenty-one (84%) of 25 blood contacts among surgeons in procedures in which all three risk factors were present were potentially preventable by additional barriers. Of 29 blood contacts among anesthesia and circulating personnel, 20 (69%) would have been prevented by glove use. For surgical procedures in which operating room personnel are at increased risk of blood contact, reevaluation of surgical technique, use of appropriate barrier precautions, and development of puncture-resistant glove materials are indicated.

Accidents, Occupational↗
PubMed1989

Infectious hazards in the clinical laboratory: a program to protect laboratory personnel.

The increasing risk of exposure to blood-borne pathogens in the health care setting makes the development of effective infection control programs in the laboratory workplace critical. Central to such programs is the concept of universal precautions. The program described here relates the level of protection or precaution to the potential danger for infection, given the laboratory workstation and task which is to be performed. Four Levels of Protection are described. Implementation of this program requires that each workstation and procedure in each laboratory section be reviewed by the laboratory director and supervisory personnel for risk of exposure. Implementation additionally requires that provisions be made for both the initial and continuing education of laboratory employees. Laboratory directors and supervisors should also monitor the program to ensure compliance. There will certainly be situations unique to individual institutions or laboratory settings that may require precautions or policies over and above those described by universal precautions. Laboratory policies will not gain acceptance if they are developed and implemented without the advice and cooperation of the hospital medical staff. Employee acceptance of infection control policies will be greater if actual development and implementation actively involves the laboratory personnel who will practice them. The program described here is but one approach to the problem. Employers and laboratory directors must understand that it is their responsibility to develop a program that provides appropriate safeguards for workers who may be exposed to infectious agents in the laboratory workplace and to ensure that employees are properly trained and educated in the proper use and application of those safeguards.

Acquired Immunodeficiency Syndrome↗
PubMed1988

HIV infection: risks to health care workers and infection control.

The risk for occupational transmission of HIV-1 in the health setting is extremely small. Current data from a number of prospective studies of health care workers sustaining adverse exposure to blood or other body fluids from patients infected with HIV-1 demonstrate that the rate for transmission of infection following a needlestick injury is approximately 0.5%. Similar data regarding the risk for occupational transmission of hepatitis B virus infection, however, indicates that the rate of transmission of infection with this virus following a needlestick injury may be as high as 30% and the risk for transmission of other blood-borne infections is poorly defined. Infection control precautions designed to minimize the risk for HIV-1 infection were recommended by CDC shortly following the first reported case of AIDS in the United States. These measures were implemented for patients diagnosed with or suspected to be infected with HIV-1, determined by history-taking or serologic evaluation. The inability of these mechanisms to accurately identify all infected individuals, coupled with the occurrence of undiagnosed or unrecognized blood-borne infections, emphasizes the need for health care workers to consider all patients as potentially infected with HIV-1 or other blood-borne pathogens. Implementation and enforcement of universal precautions should minimize exposure of health care personnel to blood and body fluids and thus substantially reduce the risk for occupational transmission of HIV-1 and other blood-borne infections in the health care environment.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Immunological characterization of pulmonary intravascular macrophages.

Pulmonary intravascular macrophages (PIMs) are lung macrophages found apposed to the endothelium of pulmonary capillaries. In many species, they are responsible for the clearance of blood-borne particulates and pathogens; however, little else is known about their roles as immunologic effector cells. We compared PIMs with pulmonary alveolar macrophages (PAMs) to determine the relative immunological activities of these two cell populations. Our results suggested that both populations possess similar phagocytic and bactericidal activities. In assays measuring cytotoxicity, PIMs were more cytotoxic than PAMs against virally infected target cells; however, differences between these macrophage populations were not as marked when noninfected targets were used. LPS-stimulated PIMs produced more T-cell proliferative cytokines than PAMs, and both populations of nonstimulated macrophages produced similar amounts of the cytokines. In contrast, PAMs produced more TNF alpha and NO2- than PIMs when both populations were stimulated with LPS; however, nonstimulated PAMs and PIMs produced similar amounts of TNF alpha and NO2. These data suggest that bovine PIMs are immunologically active. Differences between the degrees of activity of PIMs and PAMs indicate that these macrophage populations may have different roles in lung surveillance.

Animals↗
PubMed1991

[Acute hematogenous osteomyelitis due to ordinary germs in children with closed injuries. Study of a series of 44 cases].

The retrospective study of a series of 44 cases of acute hematogenous osteomyelitis in infants and children has shown that 16 out of the 44 patients (36%) have a history of previous trauma at the site of bone infection. Seven infants were less than one year of age. For the remaining 37 children the incidence of previous local trauma rose to 43% (16/37). This incidence is similar to that in previous studies. Acute hematogenous osteomyelitis follows blood-borne spread of a pathogen from a portal of entry. Why hematogenous infection selects a particular bone is an enigma. Trauma has been said to predispose to the localization of infection but the association between trauma and hematogenous osteomyelitis is only found in one-third of the cases in both this study and in previous series. However these cases with a history of local trauma raise questions regarding the concept of "locus minoris resistentiae" and its medicolegal consequences.

Acute Disease↗
PubMed1992

Neisserial surface variation: how and why?

Neisseria gonorrhoeae exhibits striking variability in several of its surface components (pili, Opa proteins and lipooligosaccharide) in vivo and in vitro. Such flagrant variation of this mucosal pathogen's surface components contrasts sharply with changes in single surface components of blood-borne trypanosomes and borreliae. Despite these differences, similar molecular events are sometimes involved.

Animals↗
PubMed1991

[Therapy and prognosis of bacterial arthritis: a retrospective analysis].

Antibiotic therapy and immediate drainage of the infected joint are established practice in the treatment of septic arthritis. The best method of drainage (repeated puncture, arthroscopy or surgical discharge) remains controversial. We analyze 34 patients with septic arthritis admitted to our hospital from 1984 to 1988. The pathogen was Staphylococcus aureus in 19 cases (56%), streptococcus in 6 (18%), pneumococcus in 2 (6%), other bacteria in (9%) and unknown in 4 (12%). In 62% the infection was blood-borne. The knee was affected in 12 cases (35%) and the shoulder in 10 (30%). A preceding joint puncture was the main source of infection. In 24 patients (70%) the initial joint drainage was by repeated puncture, while in 10 cases (30%) surgical drainage was the initial treatment. In 11 of the 24 patients initially treated by repeated puncture, surgical drainage was needed in the course of treatment because of persistent local infection of the joint. In only 13 (39%) was "medical" treatment alone effective. 5 patients died (14.7), 3 (8.8%) due to the infection. All deaths occurred in the "medical" group. 21 patients were asked about symptoms in the affected joint. In 71% there were no problems or only minimal ones, while in 29% there were distinct problems. 5 of the 6 patients with severe symptoms had been treated by repeated puncture. We conclude that surgical drainage of an infected joint is prescribed too rarely in departments of rheumatology and internal medicine. Arthroscopic or surgical drainage is indicated in cases of coxarthritis, omarthritis, in cases where symptoms last longer than 7 days and in patients with severe sepsis.

Adult↗
PubMed1991

Epidemiology and pathogenicity of human retroviruses.

The human retroviruses can be divided into oncovirus (HTLV-I and HTLV-II) and lentivirus strains (HIV-1 and -2). The HTLVs are endemic in Central Africa, the Caribbean Islands and in southwest Japan, but now tend to spread through the i.v.-drug user population in the USA and in some countries in Western Europe. HTLV infection is associated with a malignant form of adult T-cell leukemia, tropical spastic paraparesis (TSP) and an associated myelopathy (HAM). The pathogenic mechanisms of HTLV are as yet poorly understood. HIV infection is spreading rapidly almost world-wide and has reached epidemic proportions in Central Africa, parts of South America and in certain populations in industrialized countries that have risk behaviour for contracting venereal or blood-borne infections. The mechanisms of HIV-induced immune suppression are still not entirely clear, as direct T-lymphocyte destruction after viral infection cannot account for the almost complete loss of CD4 T-cells in the final stages of disease. Various indirect mechanisms of HIV-induced immune cell destruction are outlined below.

Biological Products↗
PubMedDate not supplied

The i.v. nurse and the i.v. drug abuser: medical and psychosocial implications.

When I.V. nurses treat I.V. drug abusers, they must be aware of the medical and psychosocial issues relevant to this group. Medical issues include the I.V. drug abuser's depleted venous access and this group's high rate of infection with HIV and other blood pathogens. Psychosocial issues relate to the various social and psychological problems associated with drug abuse. Further, when caring for these patients who are at high risk for HIV and other serious blood infections, the I.V. nurse may experience a conflict between her desire to care for the patient and her fear of contracting HIV or another infection through patient contact. Education is recommended so that I.V. nurses can reduce their risk of infection with blood-borne diseases and can better understand these patients. Also suggested are a multidisciplinary approach to treatment and referral to drug rehabilitation programs.

Acquired Immunodeficiency Syndrome↗