Isospora infection in a homosexual man

A case of Isospora belli in a homosexual male is described. The procedures used for recovery and staining the cyst stages of Isospora are included.     

阑尾切除术切口感染因素分析及防治探讨

目的分析阑尾切除术切口感染的多种因素及探讨防治措施。方法回顾性分析我院近15年间收治各种类型阑尾炎1 360例的临床资料。全部病例均行阑尾切除术。结果1360例均治愈。术后切口感染48例,总感染率3.53%(48/1360)。其中单纯性阑尾炎881例,切口感染10例,占1.14%;慢性阑尾炎103例,无切口感染。化脓性阑尾炎232例,切口感染3例,占1.29%。坏疽性阑尾炎或阑尾穿孔144例,切口感染35例,占24.31%。结论针对单纯性、化脓性、坏疽性阑尾炎或阑尾穿孔术后可能引起切口感染的相关因素,提出对该病早期诊断、及时手术;注意切口妥加保护,避免长时间的手术操作,正确使用和安放腹腔引流物;合理选用抗生素,术后密切观察切口的炎症变化,早期处理,积极治疗与阑尾炎并存的呼吸道感染、肺结核、糖尿病等合并症,就能有效地将切口感染率降低到最低限度。     

赛多孢霉属侵袭感染的临床特征及实验室检查分析

目的探讨侵袭性赛多孢霉属感染的临床表现和实验室检查特点。方法收集2011年1月至2017年4月收治的8例赛多孢霉属患者的临床资料,对赛多孢霉属感染相关病例的临床表现、诱发因素和实验室检查的特点进行回顾性分析。结果8例患者中检出尖端赛多孢霉6株,波氏赛多孢霉1株,多育赛多孢霉1株。外伤、环境暴露和免疫力降低是赛多孢霉属感染的常见诱发因素。标本直接镜检均查见有隔菌丝,阳性率100%。菌落生长速度相对较快,侵袭力强,菌落形态多样,呈白色羊绒状至黑酵母样,随着培养时间的延长,从菌落中心开始颜色逐渐变深,结合镜下形态可进行菌属的快速鉴别。结论侵袭性赛多孢霉属感染病程进展迅速,病情凶险,以尖端赛多孢霉感染最多见。应加强对赛多孢霉属感染疾病的认识,提高诊治水平。     

医院真菌感染500例分析

目的探讨医院真菌感染,分析病原菌及病因。方法采集近3年住院患者感染的深部标本进行真菌培养API鉴定,浓度梯度法抽样做白色念珠菌的药敏试验,收集真菌感染患者临床资料并分析。结果 2006～2008年共检出500株真菌,各年检出率分别为24.2%、27.8%、48%。临床分离菌株除念珠菌外还分离到隐球菌、马尼尔菲青霉菌等。两性霉素B耐药率仅3.3%,而氟康唑的耐药率3年分别为3.4%、8.3%13.3%。长期使用广谱抗生素和慢性基础疾病患者真菌感染率较高。结论真菌感染及其耐药率逐年上升,并与基础疾病及抗生素的使用有关。     

耐甲氧西林金黄色葡萄球菌感染及其耐药性分析

目的 对不同临床标本中耐甲氧西林金黄葡萄球菌的感染及其耐药性进行分析,为临床抗感染治疗提供可靠的理论依据。方法 按照卫生部颁布的《全国医学检验操作规程》及试剂说明书进行操作,药敏结果按照NCCLs的标准进行判断。结果 金黄葡萄球菌的感染较为普遍,由于耐药菌株(耐甲氧西林金黄葡萄球菌,MRSA)的大量出现,其耐药性问题也较复杂。结论 耐甲氧西林金黄葡萄球菌的致病性不容忽视。     

Bacteremic vs nonbacteremic urinary tract infection in children

Aim

Bacteremia is an uncommon complication of urinary tract infection (UTI). The aim of this study was to identify risk factors for bacteremic UTI in pediatric patients.

Analysis of cross infection using genomic fingerprinting in nosocomial urinary tract infection caused by Enterococcus faecalis

To evaluate cross infection and a possible outbreak of Enterococcus faecalis urinary tract infection (UTI) in our urology ward, we studied the DNA fingerprinting of E. faecalis strains isolated from nosocomial UTI patients, in the period 1982–1996, using arbitrarily primed polymerase chain reaction (AP-PCR) analysis. The serovar and amplified products of DNA extracted from clinically isolated urinary E. faecalis strains by the AP-PCR method were analyzed, and the respective isolation periods of E. faecalis-positive UTI patients were investigated. There were nine patients with E. faecalis UTI between March and May 1994 and all strains isolated from their urine specimens were serovar type 7. AP-PCR revealed that five of the nine isolates had the same pattern. It appeared that these strains had caused the outbreak of E. faecalis UTI. Cross-infection between patients with E. faecalis UTI was demonstrated by genomic fingerprinting, suggesting that cross infection had occurred via urinary catheters or by hand contact in our ward. We may, therefore, reasonably conclude that we should beware of the transmission of urinary E. faecalis and take countermeasures against its dissemination. Received: April 8, 1998 / Accepted: October 14, 1998     

重症感染并发播散性血管内凝血的临床特点与早期诊断探讨

总结180例重症感染患者的临床和实验室资料,发现75%(135例)合并有不同程度的凝血功能紊乱。按凝血试验的异常程度将患者分为4组;3项以上异常者(A组)71例(39.44%),2项异常者(B组)30例(16.67%),单项异常者(C组)34例(18.89%),无凝血异常者(D组)45例(45%),各组病死率及主要合并症(出血、休克、脏器功能衰竭)有显著性差异,病死率及合并脏衰个数与凝血功能异常程度呈正相关。反映凝血功能改变最敏感的指标是血小板数(Plt)和全血凝血时间(CT),与DIC相关性最大的指标依次是:Plt、CT、凝血酶原时间(PT)、部分凝血活酶时间(APTT),和纤维蛋白原(Fbg)。依据以上实验指标将感染合并凝血功能异常分为DIC前期(C组)、DIC早期(B组)和DIC期(A组)是符合临床实际情况的,并得到了统计学的支持。在此基础上提出了DIC的分期诊断标准。     

脑梗死患者幽门螺旋杆菌感染状况调查及其致病危险性分析

目的探讨幽门螺杆菌（Helicobacter pylori，HP）感染及其产生的毒力因子与脑梗死（cerebral infarefion，CI）的关系。方法采用ELISA方法检测对245例脑梗死患者和221例健康体检者血清中的抗．HP-IgG，用Westem-blot方法检测血清抗CagA抗体以及抗VacA抗体，比较合并HP感染的脑梗死患者与非HP感染者之间的差异。结果①脑梗死组抗．HP-IgG阳性率明显高于非脑梗死组（59．2％和41．6％，P〈0．05），去除常见的危险因素后，HP感染仍增加患脑梗死的危险性（OR=2．08，95％CI1．46—3．01）。②动脉粥样硬化性血栓性脑梗死组的HP感染率明显高于其余各类脑梗死组和非脑梗死组，P〈0．05；③HP CagA^＋VacA^＋毒力亚型感染增加患动脉粥样硬化性血栓性脑梗死的危险性（OR=2．96,95％CI1．84—4．74），而CagA^＋／VacA^＋毒力亚型和CagA^-VacA^-毒力亚型感染并未明显增加患动脉粥样硬化性血栓性脑梗死的危险性。结论HP感染是脑梗死危险因素，尤其与动脉粥样硬化性血栓性脑梗死相关，CagA^＋VacA^＋毒力亚型感染可能更增加患动脉粥样硬化性血栓性脑梗死的危险性。     

Neutrophil dysfunction and increased susceptibility to infection

Abstract. A critical evaluation of 3 years' experience using laboratory screening to detect neutrophil dysfunction is described. Neutrophil dysfunctions in patients with recurrent bacterial infections were investigated by using the following screening tests: (1) neutrophil chemotaxis towards N-formylmethionyl peptides (FMLP) and the complement fragment C5a; (2) neutrophil production of superoxide anions (O₂^-) in response to phorbol myristate acetate and opsonized zymosan particles; and (3) examination of May-Griinwald and myeloperoxidase cytochemical staining of peripheral blood smears. These tests were carried out in 100 patients suffering from infections and suspected of having altered neutrophil functional competence. A minority of patients was found to have well defined neutrophil dysfunction syndromes: chronic granulomatous disease (four cases), Chediak Higashi disease (one case) and myeloperoxidase deficiency (one case). Of the remaining 94 patiens, in whom infections localized to airways and/or skin predominated, 53 cases were found to have impaired chemotaxis (41 cases) or partial defects of the O^-₂ production. Defects of chemotaxis toward FMLP and those towards both FLMP and C5a were the most frequent abnormalities. No defect was found in the other 41 patients. Moreover, impaired neutrophil chemotaxis was found in some patients with selective IgA deficiency (five cases) or immotile cilia syndrome (seven cases). The results suggest that (a) additional screening tests are required to ameliorate the efficiency of the diagnostic work-up of the patients suspected to have neutrophil dysfunction; and (b) further evaluation, also at the molecular level, should be considered at least in selected cases of non-classified neutrophil dysfunction in order to clarify diagnosis and plan rational therapeutic strategies.     

Evidence for non-adaptive immune response in HIV infection

Increased levels of soluble forms of adhesion molecules such as intercellular adhesion molecule 1 (ICAM-1) and E-selectin have been found in the sera of HIV-infected patients and have been associated with disease progression. The aim of the present study was to investigate whether this phenomenon reflects activation of the non-adaptive immune response in HIV infection. Fifty-one patients with HIV infection (42 men, nine women) were classified into two subgroups: those with HIV infection but without evidence of AIDS indicator conditions (HIV infected non-AIDS cases, n  = 27) and those with AIDS (AIDS cases, n  = 24). The activation of non-adaptive immune response was evaluated as the production of reactive oxygen species that cause lipid peroxidation, which was assessed by measuring thiobarbituric reactive substances (TBARS) using the thiobarbituric acid assay (TBA). Plasma levels of von Willebrand factor (vWF), measured by rocket immunoelectrophoresis, were used to show activation of endothelial cells even in the absence of any other causative agent, in these patients. TBARS levels in non-AIDS cases were significantly higher than in control subjects ( n  = 17) or AIDS cases ( P  < 0.001). The mean vWF levels were higher in AIDS cases than in non-AIDS cases or normal subjects ( P  < 0.05). TBARS levels remained significantly higher in non-AIDS cases after adjusting for age, CD4 T-cell and neutrophil counts, antiretroviral therapy and vWF plasma levels. The above findings indicate that in HIV infection, the virus per se is responsible for the increased oxidative stress that in turn activates various transduction pathways, maybe leading to endothelial cell activation and shedding of adhesion molecules from the cell surface.     

Pneumocystis carinii infection in germ-free rats: implications for human patients

Pneumocystis carinii infections have been detected both serologically and histologically in untreated, germ-free and conventional rats killed immediately upon arrival from two commercial sources. Pneumocystis antigenemia was detected by counterimmunoelectrophoresis (CIE) and antibody was titered by indirect immunofluorescence. The data suggest that 1) P. carinii is enzootic in certain rat colonies; 2) in utero transmission is a distinct possibility; and 3) paucity of cysts does not rule out P. carinii, as trophozoites predominate in early or sub-clinical infections. Histologic data support the validity of CIE for noninvasive detection of P. carinii antigen. Infection with this agent may be missed by basing diagnosis upon the presence of cyst forms alone, and it may be more common than previously supposed. These data have significant implications for the natural history, diagnosis, and epidemiology of P. carinii with regard to the human host.     

Incidence of umbilical cord infection in neonates receiving 7.1% chlorhexidine gel and methylated-spirit in ibadan

Background

The optimal method of umbilical cord care after birth is still a controversial issue, as umbilical stump has remained a focus of infection in newborns. Use of topical antiseptics is one intervention that could reduce the incidence of infection by preventing or reducing the bacterial colonization of the umbilical cord in neonates.

Treatment and prevention of enterohemorrhagic Escherichia coli infection and hemolytic uremic syndrome

Over a quarter century after the discovery of verocytotoxin and the first report by Karmali and colleagues of cases of postdiarrheal hemolytic uremic syndrome (HUS) caused by verotoxigenic Escherichia coli (VTEC), otherwise known as Shiga-toxigenic E. coli (STEC), successful treatment of these infections has remained elusive. This is because the pathological insult producing the clinical picture of HUS occurs early in the disease process and curtails quickly, making treatment intervention a largely vain hope. Nevertheless, understanding of the pathogenesis of HUS has expanded and, as a result, we can expect a future breakthrough in the treatment of this life-threatening condition. This review examines the pathogenesis of HUS and explores targets for treatment, including the reasons why certain therapies have failed and why future therapies could be successful. This review also examines the status of vaccine development in prevention of VTEC/STEC disease.     

Treatment of Clostridioides (Clostridium) difficile infection

Abstract

Clostridioides (formerly: Clostridium) difficile infection (CDI) is a major cause of diarrhoea for inpatients as well as outpatients. Usually, CDI is healthcare-associated but the number of community-acquired infections is increasing. CDI is generally associated with changes in the normal intestinal microbiota caused by administration of antibiotics. Elderly and immunocompromised patients are at greater risk for CDI and CDI recurrence. Recently, the treatment options of CDI have undergone major changes: current recommendations speak against using metronidazole for primary CDI, fidaxomicin and bezlotoxumab have been added to the treatment armamentarium and microbial replacement therapies have emerged. Several other therapies are undergoing clinical trials. In this article, we review current treatment guidelines, present the most recent data on the options to treat CDI and glance towards future developments.

• KEY MESSAGES

• The cornerstones for the treatment of CDI are vancomycin and fidaxomicin. Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence.

• In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence.

• Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI.

     

传染病病人疾病知识认知和健康教育需求调查及对策

目的了解传染病病人对疾病认识程度及健康教育需求情况,并制订针对性的预防对策。方法采用自行设计问卷调查表对228例住院传染病病人进行调查。结果传染病病人对自身传染病的相关知识了解程度缺乏,对疾病知识认识的综合掌握率为:知道为39.5%,部分知道为18.5%,不知道为42.0%;对疾病健康教育需求方面:96.5%病人认为需要了解消毒、隔离知识,94.7%病人认为需要了解疾病知识与病情知识,81.6%病人认为需要了解与治疗有关的药物知识,67.1%有自我保健指导知识了解需求,64.0%有心理疏导需求。结论重视传染病病人的健康教育,根据传染病的特点,开展多种形式的健康教育,提高病人对自身疾病认识,可促进病人疾病的顺利康复,并防止传染病扩散。     

亚胺培南耐药鲍曼不动杆菌的临床分布和药敏分析

目的了解该院鲍曼不动杆菌的临床分布及耐药性特征,为临床合理使用抗菌药物、降低院内感染率提供参考依据。方法按常规方法进行细菌培养,采用VITEK2Compact全自动微生物分析仪对临床分离病原菌进行鉴定和药敏试验,使用WHONET5.5软件进行数据统计分析。结果该院2009年8月至2011年9月共分离到鲍曼不动杆菌471株,85.4%（398株）的菌株分离自下呼吸道样本;重症监护室（ICU）和神经外科分别分离到222株（47.1%）、72株（15.3%）,分离自ICU和神经外科的鲍曼不动杆菌对19种抗菌药物的耐药率高于其他科室分离株（P〈0.01）;267株（56.7%）鲍曼不动杆菌对亚胺培南耐药,除头孢唑啉和呋喃妥因外,亚胺培南耐药株对阿米卡星等18种抗菌药物耐药率均高于敏感率,二者差异具有统计学意义（P〈0.05）。结论 ICU和神经外科重症患者是鲍曼不动杆菌的易感人群,亚胺培南耐药鲍曼不动杆菌多重耐药情况严重,实验室应加强鲍曼不动杆菌耐药性监测,规范临床用药,隔离泛耐药鲍曼不动杆菌感染者,防止医源性传播。     

胃大部切除术式与幽门螺杆菌感染相关性的研究

目的 观察Billroth Ⅰ式和Billroth Ⅱ式术后、胆汁反流与残胃幽门螺杆菌（HP）感染之间的关系。方法残胃组患者101例，其中Billroth Ⅰ式58例，Billroth Ⅱ式43例，同期未手术患者4501例作为对照组。残胃组内又分别根据HP、胆汁反流与否、反流程度分层比较。以快速尿素酶试验法及改良Giemsa染色检测HP。结果残胃组HP感染率（21．79％）显著低于对照组（41．16％），两组之间比较具有统计学意义（P〈0．05）；Billroth Ⅰ式组HP感染率为21．43％、Billmth Ⅱ式组HP感染率为22．22％，两组比较无统计学意义；Billroth Ⅰ式组胆汁反流阳性率57．14％与Billmth Ⅱ式组的88．89％相比较具有统计学意义（P〈0．001）；残胃胆汁反流阳性患者HP感染率为35．44％、胆汁反流阴性患者HP感染率为45．45％，两组比较具有统计学意义（P〈0．01）；残胃组患者不同程度胆汁反流的HP感染率之间无统计学意义；不同程度胆汁反流的HP现患比均〈1．0。结论残胃HP感染率低于未手术者，胆汁反流是HP感染的保护因素，但与HP感染严重程度无线性关系。