Antibiotic-resistant Campylobacter: an increasing problem

The case is described of a 27-year-old woman who presented with an acute diarrhoeal illness. She was initially poorly responsive to antibiotics and developed lymphocytic ascites. Diagnosis was difficult to establish, and peritoneal tuberculosis was considered to be the most likely cause of her symptoms. Serological tests eventually confirmed Campylobacter jejuni infection. Campylobacter is one of the most common bacterial diarrhoeal infections, and complications, except for colitis, are rare except in specific disease states--for example, patients with cirrhosis or undergoing peritoneal dialysis. Antibiotic resistance is an increasing problem, and this may potentially lead to a greater incidence of complications in the future.     

Comparison of basal broth media for the optimal laboratory recovery ofCampylobacter jejuni andCampylobacter coli

Background  

Campylobacter species are the most common known bacterial cause of acute diarrhoeal disease and incidences are increasing yearly in Ireland. Concern is expressed that this increase may be due to poor laboratory techniques in recognising these organisms as they are fastidious and technically demanding to culture.     

Identification of Serratia marcescens populations of nosocomial origin by RAPD-PCR

BACKGROUND: Serratia marcescens has been increasingly identified as a cause of infection in the immunocompromised host and in high-mortality-rate nosocomial outbreaks. It is thus important to use identification methods that allow study of the dynamics and evolution of nosocomial S. marcescens strains. The aim of this study was to identify S. marcescens strains isolated from nosocomial outbreaks in two pediatric hospitals by random amplification polymorphic DNA polymerase chain reaction (RAPD-PCR). METHODS: RAPD-PCR was used to study five S. marcescens populations isolated from four different nosocomial outbreaks that occurred in two pediatric hospitals. This method was compared with the widely used biotyping system described by Grimont and Grimont. RESULTS: The combination of biotypification and RAPD-PCR allowed accurate identification of S. marcescens strains isolated in nosocomial outbreaks at pediatric hospitals; by RAPD-PCR, we were able to analyze clonal variations in S. marcescens populations. We established bacterial dissemination patterns in hospital environments according to hospital administration of medical services and compared changes in bacterial DNA amplification patterns in each hospital related with clonal variations by selective pressures. CONCLUSIONS: RAPD-PCR is a useful method to identify S. marcescens strains associated with nosocomial outbreaks.     

Use of clopidogrel in coronary artery disease

Clopidogrel has an established and important role in the management of patients with coronary artery disease after an acute event. It is generally a well-tolerated drug. The major common problem associated with its use is the increased incidence of bleeding complications during or after coronary artery bypass graft surgery when clopidogrel is used within five days before surgery. For this reason, it is recommended to stop clopidogrel at least five days, and preferably one week before surgery.     

急性肾功衰86例临床病因、治疗及预后分析

目的探讨急性肾功能衰竭(ARF)患者的临床病因及治疗、预后的意义。方法对2009年1月～2011年2月我科收治的86例临床诊断ARF患者的病因及临床特点、治疗、预后进行分析。结果 86例ARF患者中,药物性所致32例(37.2%);肾实质疾病所致23例(26.7%);食物、毒物中毒所致13例(15.1%);梗阻性因素6例(6.9%);感染性因素6例;其他原因所致6例(13.9%)。结论目前,药物性因素是引起ARF的首位原因。伴有心脑血管系统疾病的老年患者,更易发生药物性ARF,且病死率高。此外,老年患者服用ACEI/ARB导致的ARF发病率较高,应引起重视。及时就医、早期的病因诊断及对症治疗尤为关键,目前透析治疗仍起主要作用。     

Common association of haemolytic uraemic syndrome with invasive Streptococcus pneumoniae infection in five Chinese paediatric patients

Haemolytic uraemic syndrome is an important cause of acute renal impairment in childhood. We review the incidence, and clinical and laboratory features of haemolytic uraemic syndrome in a Chinese population. Five patients were identified from 2006 to 2008. All patients were young children with associated invasive Streptococcus pneumoniae pulmonary infection. Serotypes 3, 14, and 19A were confirmed in four patients. The classical post-diarrhoeal form associated with Escherichia coli (O157:H7) infection was not seen. One patient died of acute respiratory failure. Streptococcus pneumoniae infection, as an associated condition in haemolytic uraemic syndrome, is important and relatively common in Chinese patients, especially among children. The acute clinical picture is similar to that reported in the western literature, except for an uncommon association with meningitis. The medium-term renal outcome of the Chinese population appears to be more favourable than the Caucasians. Widespread vaccination against Streptococcus pneumoniae may have resulted in changes in bacterial epidemiology and clinicians should be continuously aware of this severe disease. The use of washed blood components for transfusion in the acute stage requires further study.     

合肥市小儿b型流感嗜血杆菌性脑膜炎的发病调查

目的了解合肥市小儿ｂ型流感嗜血杆菌（Ｈｉｂ）脑膜炎的流行情况。方法组成１３家医院的小儿化脓性脑膜炎协作组,收集合肥市１９９０～１９９２年３年的资料。监测所有临床诊断为急性细菌性脑膜炎的患儿,收集标本进行病原学研究。对脑脊液（ＣＳＦ）、血作常规细菌学检查,脑脊液、血和浓缩尿标本进行对流免疫电泳（ＣＩＥ）抗原检测,全部资料进行流行病学分析。结果３年中共有经临床确诊的小儿细菌性脑膜炎６０例,其中３１例（５１７％）Ｈｉｂ抗原阳性,而其中仅３例ＣＳＦ细菌培养出Ｈｉｂ。该市Ｈｉｂ脑膜炎年发病率１５岁以下儿童为４８１／１０万,５岁以下儿童为１０．６６／１０万,病死率为９７％,存活患儿２１４％留有精神和神经系统并发症和后遗症。结论用抗原检测结合细菌培养,可为９０％细菌性脑膜炎患儿作出病原学诊断。Ｈｉｂ是化脓性脑膜炎患儿中最常见的病原,但它的发病率较世界其它地区为低。     

贵阳、遵义地区慢性肺原性心脏病调查——附3945例临床分析

调查了1978年5月至1985年4月贵阳、遵义地区3945例肺心病。发现该病住院患病率逐年提高,住院率占同期各类器质性心脏病的首位。年龄以61岁以上多见;原发病多为慢支炎并肺气肿;肺心病急发诱因以呼吸道感染最多见。住院病死率逐年降低,平均为9.98%,死因以呼吸衰竭占首位。本文就本病的一些实验室检查进行了统计分析。     

川崎病的研究进展

川崎病是一种以全身血管炎为主要病变的急性发热性出疹性疾病,好发于5岁以下婴幼儿,但其病因和发病机制目前尚未完全清楚,其严重的并发症是心血管系统损害,并可形成冠状动脉扩张和冠状动脉瘤,已经成为小儿获得性心脏病的主要病因。近年来该病的发病率呈上升趋势,得到了各国学者的广泛关注和重视,现就目前有关川崎病的研究进展予以综述。     

26年来冠心病发病及死亡情况分析

本文收集我校两所附属医院1960～1985年冠心病住院病人4839例的临床资料,与国内外资料进行对比分析,发现我国冠心病发病逐年代增加,而病死率却逐年代下降。冠心病发病在10种心脏病中于60年代居第五位,到70年代跃居第一位,直到现在仍保持首位。     

Road traffic injury in Thailand：systematically underestimated？

Road traffic injury is the fifth leading cause of death and disability in Thailand,with an estimated one million people seriously injured and 14000 deaths each year.Given the magnitude of the problem,it is important to validate road traffic injury statistics,in order to determine trends and the effect of prevention efforts.The Ministry of Public Health established an injury surveillance system in 1995 to collect injury data from 4 provincial hospitals and one hospital in Bangkok.This system was designed to evaluate the quality of acute trauma care and referral services,and to improve injury prevention and control at local and national level.However,many injuries are not treated at health facilities where these data are collected.This is the first study to measure the reporting gap for injury statistics on a national level.We compared data from the Thai National Injury Survey to that gathered by the injury surveillance system and find that the former records a rate 3 times higher than the hospital-based injury surveillance system in all five regions(mean injury incidence:596/100000 vs 129/100000).Most injuries that need medical care are not treated in hospital,and do not count in the national statistics in Thailand.     

Cryptosporidiosis in the immunocompromised: weighing up the risk

Cryptosporidiosis has been increasingly recognised as a cause of diarrhoeal illness in both immunocompetent and immunocompromised people. Massive outbreaks have been linked to municipal drinking water supplies in North America and Europe, but so far none have been reported in Australia. There is evidence that modes of transmission other than drinking water are more important. There can be no guarantee that infective Cryptosporidium oocysts will not contaminate an Australian water supply. Therefore, a permanent "boil water" warning may be warranted on medical advice in severely immunocompromised people, for whom cryptosporidiosis could be persistent and life threatening.     

广东省住院儿童疾病谱分析

目的 探讨儿童住院疾病谱特点.方法 对2010年广东省二级以上医院住院儿童数据中的主要诊断、性别、年龄等项目进行疾病谱的顺位和构成比分析.结果 影响儿童健康的前5位系统疾病分别是呼吸系统疾病（38.0%）、起源于围生期的某些情况（15.0%）、某些传染病和寄生虫病（11.1%）、消化系统疾病（11.1%）、损伤中毒和外因的某些其他后果（6.7%）,前5位疾病占住院疾病的81.9%.呼吸与消化系统疾病始终排在各年龄组前3的位置;呼吸系统疾病排名中,肺炎（45.08%）、急性上呼吸道感（17.1%）、急性支气管炎（14.1%）、急性扁桃体炎（5.2%）和急性细支气管炎（4.6%）分列前五位,呼吸系统类目疾病累计占86.1%.结论 儿童呼吸系统疾病是关注的重点,卫生防疫部门应针对儿童提供预防呼吸系统疾病的有效方法和措施,对于儿童不同年龄组别疾病顺位的差异,提出有针对性的防治措施.     

An audit of activity and outcome from a daily and a weekly "one stop" rapid assessment chest pain clinic

Objectives: The recent National Service Framework for coronary heart disease advocates the establishment of rapid assessment clinics for chest pain. But how should these clinics be organised and do they fulfil their objectives? The aim of this study was to compare referral patterns to a daily and a weekly "one stop" rapid access chest pain clinic (RACPC), and to examine clinical outcome in patients attending these clinics. Design: Patients were prospectively categorised into one of the following subgroups: "acute coronary syndrome", "stable coronary heart disease", or "low risk/non-coronary chest pain". Fatal and non-fatal outcomes were audited over eight months. Setting: Both RACPCs were situated within the cardiology departments of two large Glasgow teaching hospitals. Patients were seen by a cardiologist, and underwent non-invasive testing. Participants: A total of 633 patients with chest pain who were referred by their general practitioner; 500 came to the daily and 133 to the weekly clinic. Forty four (7%) were categorised as having an acute coronary syndrome, 267 (42%) as stable coronary artery disease, and 322 (51%) as low risk/non-coronary chest pain. Results: Referral patterns to the two clinics differed significantly. Compared with the weekly clinic, more patients with an acute coronary syndrome (7.8 v 3.8%) and low risk/non-coronary chest pain (55.2 v 35.6%), but fewer patients with stable coronary disease (37.0 v 61.6%) were referred to the daily clinic (p<0.00001). During follow up eight (1.3%) patients died from a cardiac cause, and eight (1.3%) patients suffered a myocardial infarction. None of these patients were classified as low risk/non-coronary chest pain. Conclusions: (1) RACPCs do provide an effective tool for the early assessment of patients with possible angina. (2) The frequency with which clinics are scheduled may be an important factor in determining how the service is utilised in practice.     

In search of pigbel: gone or just forgotten in the highlands of Papua New Guinea?

Throughout the 1960s and 1970s, pigbel (enteritis necroticans) was the most common cause of death in children over the age of 1 year in hospitals in the highlands of Papua New Guinea (PNG). There has been recent widespread perception that after the successful vaccination program in the 1980s the disease virtually disappeared. A new vaccine is now available, but disease burden information is conflicting: despite almost no pigbel being reported from major hospitals there have been many reports of the disease from outlying health centres. This study aimed to provide information on the disease burden of pigbel in PNG, so that appropriate vaccine policy decisions could be made. We conducted a 12-month prospective study of all cases of acute abdomen in children presenting to 38 health facilities, 29 health centres and 9 hospitals in the highlands. Children were eligible for inclusion if they were aged 1-12 years and had abdominal pain of less than 2 weeks' duration. A standardized case definition of pigbel was used to distinguish cases of acute abdominal pain very likely to be due to pigbel from cases very likely to be accounted for by other diagnoses (such as gastroenteritis, typhoid, dysentery, intussusception, urinary tract infection and others). A total of 119 cases of acute abdomen were reported from 17 of the 38 health facilities involved. Of these 119 cases 11 met the criteria for pigbel and a further 8 were probable cases. There were 4 deaths among the 119 children with acute abdomen: 2 from definite pigbel, 1 from probable pigbel and the other due to complications of measles. In 2002 pigbel was the cause of between 9% and 16% of presentations with acute abdominal pain in children in the PNG highlands. The overall disease burden of pigbel was relatively small (19 definite or probable cases and 3 deaths in 12 months). However, there was substantial geographical clustering of cases: more than 50% of the definite cases occurred in children living within three electorates on the Western Highlands-Enga provincial border, no more than 40 km from each other. This study will be useful in planning pigbel vaccine policy and future surveillance.     

Spectrum and antimicrobial resistance of common pathogenic bacteria isolated from patients with acute exacerbation of chronic obstructive pulmonary disease in mainland of China

Background Bacteria-induced respiratory infection has been long considered to be the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Therefore,a clear picture about the distribution and drug-resistance of pathogenic bacteria in the lower airways should be helpful for treatment of the disease.So far,data on this topic among Chinese are lacking.Methods A surveillance study was performed in consecutive patients with AECOPD at five areas in China between October 2006 and April 2008.The sputum from these patients was cultured and isolated for bacteria.Agar dilution method was used to determine the minimal inhibitory concentrations (MICs) of levofloxacin and other 15 antibiotics against these strains.Results Three hundred and fifty-nine pathogenic bacterial strains were isolated among 884 patients with AECOPD.The predominant bacteria were Pseudomonas aeruginosa (21.7％),Klebsiella pneumoniae (12.3％),Haemophilus influenzae (14.2％) and Streptococcus pneumoniae (11.7％),followed by Haemophilus parainfluenzae (9.5％),Acinetobacter baumannii (7.8％),Moraxella catarrhalis (6.4％) and Escherichia coli (3.6％).The majority of bacterial pathogens isolated in this study were susceptible to fluoroquinolones,ceftazidime,cefepime and imipenem.Conclusions Gram-negative bacilli are the leading pathogens in patients with AECOPD in China.Haemophilus parainfluenzae may be one of the most important pathogens in AECOPD.This study provides evidence for local surveillance of AECOPD pathogens and appropriate choice of antimicrobials in China.     

急性肾功能衰竭78例临床分析

目的：了解大理地区急性肾衰发病及防治现状。方法：分析大理地区二所综合医院１９９３年～１９９７年收治７８例急性肾衰的发病率、病因构成、死亡原因、死亡率与防治措施和特点。结果：该地区急性肾功能衰竭发病率在住院患者中的比例为５５％,引起急性肾功能衰竭主要病因生鱼胆中毒占４１％（３７／７８例）。死亡原因主要为多脏器功能衰竭。血液透析组死亡率９２３％,非透析组死亡率３８５％,两组之间存在统计学差异（Ｐ＜００１）。结论：急性肾功能衰竭在大理地区发病率偏高,食生鱼胆是主要病因。加强卫生宣教工作,发病后进行血液净化治疗是降低发病率和死亡率的关键。     

SUDDEN CARDIAC DEATH AMONG AUTOPSIED CASES

Sixty-eight sudden cardiac deaths (10.6%) in 642 autopsied cases of cardiovascular diseases were studied. The incidence was highest in ischemic heart disease (29.6%). Cardiac arrest was the most frequent direct cause of death in ischemic heart disease with or without acute myocardial infarction. Embolism was an important immediate cause of sudden death in theumatic heart disease, pulmonary heart disease and infectious endocarditis.