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At least 127 records · Page 7Linked to original sources

Nosocomical Rhizopus infection (zygomycosis) in children.

Three children with the rare occurrence of zygomycosis are descibed: two had involvement of a solitary lesion of gangrenous cellulitis on the buttocks, and th third was a neonate with gastric performation and a gangrenous appendicitis. All three patients were compromised hosts (two with leukemia and one a premature infant with respiratory distress syndrome). All three patients appeared to have acquired the same organism. Rhizopus oryzae, from the same fomites, elastic bondages (Elastoplast). The Center for Disease Control has received several other reports of zygomycosis traceable to the same material. Alll three of our patients were cured of their infections. Early diagnosis and a combined surgical and chemotherapeutic approach appear to prevent death from zygomycosis.

Amphotericin B↗

Fulminant psittacosis.

Two patients died of psittacosis after presenting with generalised toxaemia, acute renal failure, and evidence of pancreatitis. Death was attributed to the virulence of the chlamydial strain and the delay in antemortem diagnosis. In one case Chlamydia psittaci was isolated from necropsy lung tissue. A third case of psittacosis suggested person-to-person or fomite spread, which is rarely reported. Infection was acquired from an apparently healthy, imported and quarantined cockatiel. Import restrictions on psittacines should thus be tightened and psittacosis should be made a notifiable disease.

Adult↗

Transmission of cytomegalovirus among infants in hospital documented by restriction-endonuclease-digestion analyses.

Over a 4-month period, 8 infants in an intensive-care unit were identified as excreting cytomegalovirus (CMV) in their urine. 7 of the 8 viral isolates were analysed by means of restriction-endonuclease-digestion analyses for molecular relatedness. CMV isolates from 3 babies had identical DNA-fragment migration patterns, indicating that all 3 babies were infected with the same strain of CMV. Epidemiological data indicate that CMV was transmitted from 1 infant to the other 2 babies through unidentified fomites within the nursery.

Cross Infection↗

An epidemiological and economic simulation model to evaluate the spread and control of infectious bovine rhinotracheitis in The Netherlands.

Bovine herpesvirus type I (BHV1), causing infectious bovine rhinotracheitis (IBR), was introduced in the Netherlands in 1971. In 1993, about 42% of the dairy cows had antibodies against BHV1. In the future, stricter requirements are anticipated regarding the health status of exported breeding cows and material. To support policymakers in their decisions on IBR eradication, a simulation model was developed in which the epidemiological and economic consequences of various control strategies were evaluated. This paper describes the model and provides an overview of some important outcomes. In the model, dairy herds were classified into different disease states based on (1) the reproduction ratio of the disease (R, defined as the number of secondary cases caused by one infectious animal) (2) the within-herd prevalence, within each value of R and (3) the expected number of infectious animals in an infectious herd within each prevalence range. The dynamic transition probability of a herd going from one state to another per week depends on direct contacts between animals, and other contacts such as transmission through fomites, indirect transmission through other species, airborne transmission and minor disease-specific routes such as venereal or iatrogenic transmission. Five control strategies, including both a voluntary vaccination program and a compulsory vaccination program for all dairy herds were evaluated. A voluntary vaccination program with 50% participation is not expected to lead to eradication of IBR. It appears that compulsory vaccination would be necessary to reach an IBR-free status.

Animals↗

The herpes simplex problem.

Most of the world's population is eventually infected with herpes simplex virus type 1, type 2, or both. Most infected persons harbor latent virus in nerve ganglia for the rest of their lives. True primary infections, nonprimary first-episode infections, and recurrent infections can be asymptomatic or clinical, but all of these are contagious. Past estimates of recurrent herpes affecting 20% to 40% of the population are probably low because of inadequate studies of asymptomatic shedding and genital recurrences. Herpes infections are spread primarily by close personal contact but some are contracted by fomites and medical-dental procedures. Latent virus harbored by almost everyone with frequent reactivation to produce symptomatic or asymptomatic, infectious recurrent disease poses a huge problem for control or eradication of herpes simplex infections. Public health measures will probably fail because they require too much alteration of the public's life-styles. So far, antiviral drugs do not eliminate latent virus from infected ganglia. That naturally infected persons can be reinfected, superinfected, or autoinoculated raises serious questions whether vaccines will eradicate the disease, although they might control some serious manifestations and limit some spreading. The problem of eradicating herpes is different from that of eradicating smallpox, where latent infections with infectious recurrences did not exist.

Antibodies, Viral↗

Feline viral respiratory disease. The carrier state, vaccination, and control.

A thorough understanding of the epizootiology of FCV and FRTV is critical when implementing control measures in premises with enzootic URD. Failure to properly segregate cats, reduce fomite contamination, or implement a vaccination schedule most suited to that population will undoubtedly allow perpetuation of disease. Several questions remain unanswered about URD in cats. Following several years of widespread routine vaccination, what is the prevalence of the carrier state in vaccinated cats? What are the immunologic mechanisms responsible for the development of the latent FRTV carrier state and the variable level of virus excretion in FCV carriers? Why do some cats terminate primary infections with these viruses without entering a chronic carrier phase? Could immunomodulating agents be used to terminate the carrier state in persistently infected animals?

Animals↗

Epidemiology of porcine reproductive and respiratory syndrome (PRRS): an overview.

PRRS disease was first recognised in the USA in 1987 and in Europe in 1990 and since then the disease has spread widely throughout many pig-producing countries. After a severe epidemic phase, the infection has become endemic. The prevalence of infection is generally high in infected countries. However, in areas with a low density of pigs, infection may spread slowly and if infected animal movements are not significant, farm-to-farm spread can be controlled and prevalence of infection maintained at a low level. The PRRS virus (PRRSV) was completely unknown before 1986, and the question of its origin remains unanswered. The exact epidemiologic relationship between American and European strains of PRRSV is difficult to establish because different isolates appear to belong to two distinct sub-populations which are only distantly antigenically related. In the environment, virus survival is optimal when temperature is cold and when ultra-violet light exposure is low (little sunshine). These conditions are easily attained in winter and that may explain why virus spread increases during this period. Pigs of any age (including wild boars) are the only animals known to be naturally infected with PRRSV. Relatively close contact between pigs is the primary factor in virus transmission. Aerial transmission is a second mechanism of spread, particularly in winter and particularly over distances of less than 3 km. A third route of transmission is via semen. The role of fomites is not clearly documented, however since the virus is excreted in faeces and urine, slurry should be considered as a potential source of contamination. Within herds, the virus spreads rapidly with up to 85 to 95% of pigs in a herd becoming sero-positive within two to three months. Thereafter, virus activity persists for extended periods (several month to years). Nevertheless, some authors have reported spontaneous elimination of PRRSV from infected farms. For the future, there remain questions concerning the possible evolution of the disease (in terms of its sanitary and economic impacts), and the possible influence of vaccines on the epidemiological features of PRRS.

Animals↗

The role of international transport of equine semen on disease transmission.

Despite the numerous benefits of having the capability to transport semen internationally, there are serious potential ramifications if that semen is contaminated with a communicable disease. Bacteria: Many commensal bacteria colonize the exterior of the stallion penis and are not regarded as pathogenic. They may be cultured from an ejaculate. Alterations of the normal bacterial flora on the exterior genitalia may cause the growth of opportunistic bacteria such as Klebsiella pneumonia, Pseudomonas aeruginosa, Streptococcus zooepidemicus, which, if inseminated, may cause infertility in susceptible mares. Contagious equine metritis (CEM), a highly transmissible, true venereal disease of horses, is caused by the gram-negative coccobacillis, Taylorella equigenitalis. Even with the use of rigorous testing protocols, the current techniques used may not ensure accuracy of results. Viruses: Equine coital exanthema (equine herpes virus type 3; EHV-3) is a highly contagious virus that causes painful lesions on the stallion's penis and mare's vulva. Although it is primarily transmitted through coitus, infected fomites have also been implicated in its spread. Therefore, it is possible that the virus can potentially be transmitted to the ejaculate through penile contact with an artificial vagina or sleeve. Equine arteritis virus appears to be becoming more prevalent in recent years. The most common method of transmission is through respiratory disease, but the organism can also be shed in the semen of asymptomatic stallions. Equine infectious anemia virus has also been found to be present in the semen of an infected stallion, although no evidence exists at this time that there is venereal transmission of this disease. Protozoa: Dourine, caused by Trympanosoma equiperidum, is a venereal disease found only in Africa, South and Central America and the Middle East. Serological testing using complement fixation is recommended for diagnosis. Piroplasmosis, a disease caused by Babesia equi or by a less severe strain, Babesia caballi, has received a great deal of attention in recent years due to the increased transfer of horses between countries. It is considered to be enzootic in many areas of the southern US, and is found throughout the world. The protozoal agent is most often spread by ticks, but mechanical transmission has also been documented; therefore, there is concern for venereal transmission if blood from an infected horse contaminates the semen.

Animals↗

Transmission and prevalence of Burkholderia cepacia in Welsh cystic fibrosis patients.

From 1987 to 1994, 16 of 162 cystic fibrosis (CF) patients attending CF clinics at three different hospitals in South Wales, U.K. were found to have respiratory secretions colonized with Burkholderia cepacia (B. cepacia). Bacteriological typing by polymerase chain reaction (PCR) ribotyping demonstrated seven strains of B. cepacia among these 16 CF patients. This typing confirmed that cross-infection was the mechanism of colonization in six of the nine patients who were colonized at the paediatric CF clinic at the University Hospital of Wales in Cardiff, and in three of the six patients who were colonized at the adult CF clinic at Llandough Hospital in Cardiff (cross-infection rate nine of 16 patients or 56%). A search was made for a nosocomial source, with screening of wards and clinics. Swabs from fomites produced four positive cultures for B. cepacia. Two isolates had the same PCR ribotype as that of the previous CF room occupant. To establish prevalence of B. cepacia among CF children living throughout Wales, respiratory secretions were cultured from 151 of 186 CF children (age < 16 years). This failed to demonstrate B. cepacia colonization other than in the CF patients already identified.

Adult↗

Tinea capitis: new perspectives on an old disease.

Tinea capitis caused by Trichophyton tonsurans is a common infection in children, and has become a significant public health problem in the United States. Epidemics of tinea capitis occur both in families and in institutions such as schools and day care centers. Infection is often difficult to eradicate. Fomites and asymptomatic carriers likely contribute to the spread of the disease and to re-infection of treated patients. The morphology of tinea capitis is diverse, from seborrhea-like scaling to tender, inflammed nodules on the scalp. Because a lengthy course of systemic griseofulvin is required to treat this infection, management of tinea capitis can be challenging. As newer antifungal agents are developed, more effective and convenient therapy for tinea capitis may become available.

Adult↗

An epizootic of highly virulent feline calicivirus disease in a hospital setting in New England.

This article reports an outbreak of 24 cases of an unusually virulent feline calicivirus (FCV) infection in a small animal hospital. The circumstances and disease signs were very similar to those recently described in an outbreak of FCV hemorrhagic disease in Northern California (Vet. Microbiol. 73 (2000) 281). The virus entered the facility through shelter cats showing upper respiratory signs. Affected cats manifested high fever, anorexia, labored respirations, oral ulceration, facial and limb edema, icterus, and pancreatitis. The infection spread rapidly among the patients by contaminated animal caretakers and hospital equipment. One case of fomite transmission from an employee to a housecat was documented. Prior vaccination, even with multiple doses of FCV-F9-based live calicivirus vaccine, was not protective. Affected cats often required extensive supportive care for 7-10 days, and the overall mortality from death and euthanasia was 32%. The strain of FCV responsible for this outbreak was genetically and serologically distinct from the FCV strain responsible for a similar epizootic and the FCV-F9 strain contained in most vaccines. Outbreaks of this type are being reported with increasing frequency, and are often associated with the practice of treating sick shelter cats in private practices. Similar to the present epizootic, outbreaks of FCV hemorrhagic disease have been self-limiting, but require prompt application of strict quarantine, isolation, personnel sanitation, and disinfection procedures.

Animals↗

[Pharyngitis due to Burkholderia cepacia. Person-to-person transmission].

Burkholderia cepacia is a Gram-negative bacillus that is widely distributed in nature; it is isolated from the ground, water, plants and vegetables. Generally, it produces nosocomial infection due to contamination of disinfectants, medical equipment, prosthetic material and drugs, such as anesthetics or liquids used in urological irrigation. The most probable mechanism of transmission is through hospital material or through fomites among people after contact for several weeks or months. Recently, it has been considered as an important pathogen in immunocompromised patients, or in those with significant underlying diseases, such as chronic granulomastosis or cystic fibrosis. We present a case of pharyngitis due to B. cepacia and its transmission within a few days in two immunocompetent twin siblings without previous underlying diseases. The infection disappeared after specific treatment for this microorganism was started. We believe that samples should be taken from the pharynx and nasal pits in patients with acute upper respiratory tract processes that do not respond to empiric antibiotic treatment, before classifying them as viral infection without etiologic diagnosis.

Burkholderia Infections↗

Chemical disinfection of human rotavirus-contaminated inanimate surfaces.

Fomites may play a role in the transmission of rotavirus infections, and in view of this, 27 disinfectants were evaluated for their ability to inactivate human rotavirus (HRV) on contaminated non-porous inanimate surfaces. Disks of stainless steel, glass and two types of plastics were contaminated with about 10(7) plaque-forming units of HRV suspended in faecal matter. The inoculum was allowed to dry and an equal volume of the product under test was applied to the contaminated surface. After contact for 1 min, the action of the disinfectant was stopped by dilution. Surviving infectious virus on the disks was determined by plaque assay in MA-104 cells. A product was considered to be effective if it could reduce the virus titre by at least 3 log10. Only 33.3% (9/27) of the formulations tested proved to be effective. Further testing of the effective products, which included antiseptics, instrument soaks and hard-surface disinfectants, showed that all of them could, in fact, reduce the virus titre on contaminated surfaces by at least 6 log10. These findings show the relative resistance of HRV to a wide range of chemical disinfectants in common use, and also emphasize the need for a more thorough evaluation of the virucidal potential of formulations regularly employed in attempts to prevent and control outbreaks of rotaviral diarrhoea.

Disinfectants↗

The nosocomial colonization of T. Bear.

A national effort to reduce nosocomial infections includes a program developed at the National Institutes of Health to encourage handwashing in hospitals and day care centers. The program promotes a symbolic teddy bear (T. Bear) with slogans to remind hospital personnel and patients to practice handwashing. One of the items used is a stuffed toy T. Bear to be dispensed to the hospitalized child. Considering the manner in which children handle stuffed toys, we suspected the T. Bear might serve as a "fomite" for transmission of nosocomial microbes. A prospective study of 39 sterilized T. Bears revealed that all became colonized with bacteria, fungi, or both within 1 week of hospitalization. Hospital acquired organisms cultured from the T. Bear included Staphylococcus epidermidis, Staphylococcus aureus, alpha streptococci, Corynebacterium acnes, Micrococcus sp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bacillus sp, and species of Candida, Cryptococcus, Trichosporon, Aspergillus and others. Concomitant cultures of the patients revealed similar isolates. Although the T. Bear handwashing campaign should not be discredited, the promotional toy may pose an unnecessary expense and hazard and should not be used in hospitals or day care centers.

Attitude of Health Personnel↗

An outbreak of viral gastroenteritis following environmental contamination at a concert hall.

In January 1999, an outbreak of viral gastroenteritis affected more than 300 people who attended a metropolitan concert hall over a 5-day period. Norwalk-like virus (NLV) was confirmed in faecal samples by reverse transcription polymerase chain reaction assay. The index case was a concert attendee who vomited in the auditorium and adjacent male toilet. Gastrointestinal illness occurred among members of 8/15 school parties who attended the following day. Children who sat on the same level of the auditorium as the index case were much more likely to be ill than those seated elsewhere (relative risk 7.1, 95% confidence interval 5.4-9.2. P < 0.001). The majority of other reported cases had not been present on the evening of the vomiting incident. Disinfection procedure was poor and the disinfectant used contained no sodium hypochlorite. Transmission most likely occurred through direct contact with contaminated fomites. The outbreak has implications for disinfection procedures following vomiting incidents at public venues.

Adult↗

Molecular typing study of the Microsporum canis strains isolated from an outbreak of tinea capitis in a school.

Tinea capitis is a dermatophyte infection of the scalp that occurs most often in prepubescent children. Tinea capitis may be transmitted by shared use of contaminated hairbrush, by contact with fomites or by direct physical contact with an infected person. Occasionally, outbreak of tinea capitis would happen under some special conditions. Last year, we found an outbreak of tinea capitis in a school due to Microsporum canis. In epidemiological study, we performed the prevalence survey to all of the exposed persons by physical examinations and mycological laboratory tests, including KOH preparation and fungal cultures. We also investigated the environment in the school. In molecular typing study of the M. canis isolated from patients and the environment, random primer amplification polymorphic DNA (RAPD) method, the specific amplification of subrepeat element in the ribosomal DNA nontranscribed spacer (NTS), and the analysis of DNA sequence in the intertranscribed spacer (ITS) of rDNA were performed. The total number of exposed children was seventy-one, among them forty-two were attacked by tinea capitis. The ratio between boy and girl was 13:1. The ages of the patients was ranged from 3.5 years old to 10 years old. Four patients bred cat or dog as pet. Most patients appeared noninflammatory type of tinea capitis and several patients were inflammatory type. Under microscopic examination the invaded hair were all ectothrix. The pathogens isolated from these patients were M. canis. And we also isolated M. canis from the carpet and the pillowcase in the school. The patterns of total strains of M. canis in the RAPD method and PCR amplification of the rDNA NTS region study were identical, and the isolates from patients and the environment contained the same DNA sequences in the ITS region. The outbreak of tinea capitis was caused by M. canis. The M. canis isolated from patients and from the environment were probably the same origin.

Child↗

Severe Acute Respiratory Syndrome (SARS) and the GDP. Part I : Epidemiology, virology, pathology and general health issues.

The health profession faces a new challenge with the emergence of a novel viral disease Severe Acute Respiratory Syndrome (SARS), a form of atypical pneumonia caused by a coronavirus termed SARS-CoV. This highly infectious disease has spread through 32 countries, infecting more than 8,400 patients with over 790 deaths in just over 6 months. Over one quarter of those infected were unsuspecting healthcare workers. The major transmission mode of SARS-coronavirus appears to be through droplet spread with other minor subsidiary modes of transmission such as close contact and fomites although air borne transmission has not been ruled out. There is as yet no definitive treatment protocol. Although the peak period of the outbreak is likely to have passed and the risk of SARS in the UK is therefore assessed to be low, the World Health Organisation has asked all countries to remain vigilant lest SARS re-emerges. Recent laboratory acquired cases of SARS reported from Taiwan and Beijing, China are a testimony to this risk. Until reliable diagnostic tests, vaccine and medications are available, control of SARS outbreaks depends on close surveillance, early identification of index cases, quick isolation of carriers and effective infection control and public health measures.

China↗

Severe acute respiratory syndrome (SARS) and the GDP. Part II: implications for GDPs.

The transmission modes of SARS-coronavirus appear to be through droplet spread, close contact and fomites although air borne transmission has not been ruled out. This clearly places dental personnel at risks as they work in close proximity to their patients employing droplet and aerosol generating procedures. Although the principle of universal precautions is widely advocated and followed throughout the dental community, additional precautionary measures - termed standard precaution may be necessary to help control the spread of this highly contagious disease. Patient assessment should include questions on recent travel to SARS infected areas and, contacts of patients, fever and symptoms of respiratory infections. Special management protocols and modified measures that regulate droplet and aerosol contamination in a dental setting have to be introduced and may include the reduction or avoidance of droplet/aerosol generation, the disinfection of the treatment field, application of rubber dam, pre-procedural antiseptic mouthrinse and the dilution and efficient removal of contaminated ambient air. The gag, cough or vomiting reflexes that lead to the generation of aerosols should also be prevented.

Aerosols↗