Übertragung von HBV, HCV und HIV durch infektiöses medizinisches Personal – eine Übersichtsdarstellung

This report analyzes 46 cases of personnel-to-patient transmissions of hepatitis B (HB), hepatitis C (HC) and HIV in health care settings. Similar circumstances were found for transmission of HB (40 cases, 404 infected patients), HC (4 cases, 224 infected patients) and HIV (2 cases, 7 infected patients). Cases with the highest number of transmissions (one anesthesiologist with 217 HC transmissions, and one EEG technologist with 75 HB transmissions) were attributed to poor infection control practices. As long as infected health care workers (HCW) adhere to general infection control measures, a risk for transmission to patients exists only from infected surgeons who perform 'exposure-prone invasive procedures'. Whether changes in duties of infected HCW are necessary should be decided on an individual basis. Often, the infected personnel were assumed to have acquired the disease occupationally. Medical practices and devices bearing a risk of infection should constantly be reviewed with regard to risk for patients and personnel.     

肾综合征出血热病毒对肾小管上皮细胞聚集状态的影响

目的　观察人胚肾小管上皮细胞 (RTC)受肾综合征出血热病毒 (HFRSV)感染后粘附聚集状态的改变和精氨酸 甘氨酸 天门冬氨酸序列 (Arg Gly Asp ,RGD)对这一改变的影响。方法　应用HFRSV感染体外培养的RTC ,采用原位分子杂交技术检测RTC内的HFRSV并用流式细胞仪(FACS)及血细胞计数仪观察比较正常组、感染组及感染后加RGD组细胞聚集状态的差别。结果　(1)FACS结果 :受HFRSV感染的RTC聚集性较正常组明显减弱 ,RGD能使感染组的聚集性进一步减弱。 (2 )血细胞计数仪计数结果 :正常组细胞悬液随时间延长聚集性逐渐增强 ,而感染组的聚集性则无明显变化 ,两组间有显著性差异。RGD组与感染组相比聚集性有减弱趋势 ,但统计学无差异。结论　HFRSV可能通过改变RTC的细胞骨架结构、使RTC脱落来参与肾综合征出血热 (HFRS)急性肾功能衰竭 (ARF)的发病 ;RGD能够影响受HFRSV感染后RTC的聚集状态 ,提示了RGD在肾综合征出血热ARF中的潜在治疗作用。     

Remote bypass grafts for managing infected popliteal artery lesions.

Infected false aneurysms of the popliteal artery may complicate vascular repairs for trauma or primary arterial disease. Adequate debridement and drainage are necessary if the limb is to be salvaged, but direct arterial grafting through the infected area cannot be performed safely. Vascular reconstruction can be accomplished by performing a femoropopliteal or iliopopliteal bypass through a lateral approach, then the infected artery can be removed safely through separate incisions. This technique was used successfully in managing four patients with infected popliteal artery pseudoaneurysms.     

Abdominal aortic aneurysm infected with Campylobacter fetus subspecies fetus

We report a survivor of Campylobacter fetus septicemia from an infected abdominal aortic aneurysm who was successfully treated with an anatomic graft reconstruction and antibiotics. According to a survey of the English-language medical literature this was the fourth such patient successfully treated. C. fetus sepsis associated with an abdominal aortic aneurysm was first reported in 1971. The first patient to survive reconstruction of an aortic tube graft aneurysm infected with C. fetus was reported in 1983. Because the natural history of an aneurysm infected by C. fetus appears to be rapid progression to rupture, patients should be operated on promptly. All patients reported in the literature who were operated on before rupture survived. Survival was independent of the type of reconstruction. When the aneurysm ruptured all patients died. Whereas extraanatomic bypass is generally considered the procedure of choice for an infected abdominal aneurysm, the aneurysms of our patient and three other patients cited in the literature were reconstructed with anatomically placed prosthetic grafts. In the absence of other contraindications such as a grossly evident purulent infection, an abdominal aortic aneurysm infected by C. fetus may represent a subset of infected aneurysms that can be treated successfully with an anatomically placed prosthetic graft and antibiotics.     

Evaluation of bacteria and biliary tract diseases

Bile specimens were taken for culture from 100 patients who had disease originating in the biliary tract. Routine cases of chronic cholecystitis with cholelithiasis were found to have a low incidence of infected bile. An acute process appears to be needed in order to produce infected bile, and an acute obstruction of the bile duct due to gallstones produced infected bile. An effort should be made to select these patients and begin antibiotic therapy as soon as possible.     

Behandlung der chronischen Osteomyelitis mit Gentamicin-PMMA-Ketten

In the treatment of chronic osteomyelitis radical removal of sequestrated bone fragments is of essential importance. Any antibiotic therapy-whether systemically or locally applied-can only be a supplementary measure. By implantation of gentamicin-PMMA-chains into infected cavities high local concentrations of the antibiotic can be achieved which are far above the minimal bactericidal concentrations of most common pathogens. As result of the very low concentrations of gentamicin in the serum and urine there is no hazard of nephrotoxicity and ototoxicity. Chronic sequestrating osteomyelitis, infected osteosyntheses and infected non-unions are the most important indications for the application of gentamicin-PMMA-chains.     

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.     

Advanced concepts in knee arthrodesis

The aim is to describe advanced strategies that can be used to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.     

Minimally Invasive Management of Pancreatic Abscess, Pseudocyst, and Necrosis: A Systematic Review of Current Guidelines

BACKGROUND: Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although there are no randomised trials to evaluate these techniques. The aims of this study were to review the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis and identify the degree of consensus between guidelines. METHODS: A MEDLINE search was performed to identify current guidelines from any professional body published in the English language. Guidelines were analysed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis. RESULTS: Sixteen guidelines were reviewed. Percutaneous catheter drainage for pancreatic abscess was recommended by eight guidelines; for infected pseudocysts, one guideline did not recommend its use and six recommended its use; for infected necrosis, two guidelines did not recommend its use and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis, endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations. CONCLUSIONS: Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst, and infected necrosis, and few recommendations were graded according to the strength of the evidence. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.     

An Update on Heart Transplantation in Human Immunodeficiency Virus–Infected Patients

Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well‐established treatment of end‐stage heart failure (ESHF) and is performed in selected HIV‐infected patients in developed countries. Few data are available on the prognosis of HIV‐infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV‐related events. Consequently, selected HIV‐infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV‐infected patients from all published experience on HT in HIV‐infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.     

Prosthetic mesh for infected abdominal wall defects? Report of a patient with a large full thickness abdominal wall defect and colostomy due to a gunshot wound.

Reconstruction of large, infected abdominal wall defects is often difficult. Local factors, such as defect size, presence of infection, adequate skin coverage and presence of enteric fistulae dictate the reconstructive method that can be used. Placement of prosthetic mesh materials into infected defects was generally not recommended due to a high rate of extrusion and fistulae. We present a patient with a large infected abdominal wall defect, exposed intestines and colostomy due to a gunshot wound that was successfully treated with a polypropylene mesh reinforcement and free latissimus dorsi muscle flap coverage. Twelve months following abdominal wall reconstruction with stable soft tissue cover, the patient is without any signs of hernia or infection. We conclude that prosthetic mesh repair of infected abdominal wall defects of such characteristics that preclude other reconstructive procedures can be attempted provided there is coverage with a well vascularised tissue.     

Pregnant adolescents living with HIV: what we know,what we need to know,where we need to go

Introduction : HIV‐infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV‐infected pregnant adolescents in low‐income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. Discussion : Emerging data from programmes in sub‐Saharan Africa highlight that HIV‐infected pregnant adolescents have poorer prevention of mother‐to‐child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV‐infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother‐to‐child HIV transmission among infants of HIV‐infected pregnant adolescents. Conclusions : While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent‐friendly services into PMTCT settings or targeting HIV‐infected pregnant adolescents with enhanced retention and follow‐up activities.     

Preparation of massive anti-infective reconstituted bone xenograft and related studies

The purpose of this study was to develop a new type of anti-infective bone transplantation material. A massive anti-infective reconstituted bone xenograft with calcium phosphate drug core (CPC-MARBX) was prepared; a drug delivery profile and capability of repairing large segmental infected bony defect were characterized with drug delivery tests and in the rabbit model with large segmental infected bony defect. CPC-MARBX was produced with relatively simple procedures. The duration of the drug delivery was about 25 days in vitro and 30 days in vivo. The infected bony defect was successfully repaired with good healing. CPC-MARBX is readily available and can be applied in repairing the large segmental infected bony defect.     

Trypanosoma cruzi infection induced changes in the innervation, structure and function of the murine bladder

PURPOSE: The involvement of the lower urinary tract in chronic Chagas' disease has received little attention. Therefore, we investigated pathology and functional alterations in the bladder of Trypanosoma cruzi infected mice. MATERIALS AND METHODS: CD1 mice were infected with 5 x 10 T. cruzi trypomastigotes of the Brazil strain of T. cruzi. At day 100 after infection bladder structure and function were examined by pathological evaluation, magnetic resonance imaging and cystometric studies. RESULTS: The bladder in infected mice weighed more and were large, dilated, deformed, friable and thin walled compared with control mice. Magnetic resonance imaging confirmed these observations. Inflammation, fibrosis and ganglionitis was observed. Cystometric studies revealed that baseline, threshold and micturition pressures were increased in infected mice. Bladder overactivity and decreased bladder compliance were also noted in infected mice. There were no detectable differences in bladder capacity, micturition volume or residual volume between infected and uninfected mice. CONCLUSIONS: Bladder abnormalities may be a more common clinical sequelae of T. cruzi infection than previously appreciated.     

Successful treatment for infected aortic aneurysm using endovascular aneurysm repairs as a bridge to delayed open surgery

Management of infected aortic aneurysms, which can be life-threatening, remains challenging. Open surgical treatments, including debridement of the infected aorta and the surrounding tissue and either in situ reconstruction or extra-anatomic bypass covering with omentum or muscle flap, are the mainstay of therapy. However, increasing advances in technology have made endovascular treatment of infected aneurysms feasible. The present study describes the first clinical report of successful treatment of an infected aneurysm using endovascular techniques in the acute phase, followed by delayed open surgery.     

Abscess of the falciform ligament in a child with a ventriculoperitoneal shunt

Falciform ligament abscess resulting from an infected ventriculoperitoneal shunt has not previously been described. This unusual type of abscess should be considered in a patient with an infected ventriculoperitoneal shunt who presents with epigastric tenderness. Signs of peritonitis may not be present if the abscess is localized. Imaging studies such as ultrasound or CT scan may frequently establish the diagnosis.     

Low CD4/CD8 ratio in classical swine fever postnatal persistent infection generated at 3 weeks after birth

Classical swine fever virus (CSFV) is one of the most important pathogens affecting swine. After infection with a moderate virulence strain at 8 hours after birth, CSFV is able to induce viral persistence. These animals may appear clinically healthy or showed unspecific clinical signs despite the permanent viremia and high viral shedding, in absence of immune response to the virus. Given the role played by this infection in disease control, we aimed to evaluate the capacity of CSFV to induce postnatal persistent infection at 3 weeks after birth. Nine pigs were CSFV infected and sampled weekly during 6 weeks and viral, clinical, pathological and immunological tests were carried out. Also, the CD4/CD8 ratio was calculated with the purpose to relate this marker with the CSFV persistent infection. The IFN‐α response was detected mainly 1 week after infection, being similar in all the infected animals. However, 44.4% of animals were CSFV persistently infected, 33.3% died and 22.2% developed specific antibody response. Interestingly, in persistently infected pigs, the T‐CD8 population was increased, the T‐CD4 subset was decreased and lower CD4/CD8 ratios were detected. This is the first report of CSFV capacity to confer postnatal persistent infection in pigs infected at 3 weeks after birth, an age in which the weaning could be carried out in some swine production systems. This type of infected animals shed high amounts of virus and are difficult to evaluate from the clinical and anatomopathological point of view. Therefore, the detection of this type of infection and its elimination in endemic areas will be relevant for global CSF eradication. Finally, the low CD4/CD8 ratios found in persistently infected animals may be implicated in maintaining high CSFV replication during persistence and further studies will be performed to decipher the role of these cells in CSFV immunopathogenesis.     

Early experience with infectious complications of percutaneous femoral artery closure devices

Percutaneous femoral artery closure devices are being used routinely after cardiac catheterizations. The use of these devices has been advocated to decrease length of stay, promote early ambulation, and prevent bleeding. We reviewed the use of these devices in our institution and report three cases of infectious complications (two pseudoaneurysms and one infected hematoma). Reports of infected pseudoaneurysms after cardiac catheterization before the implementation of these devices are rare. The use of these devices may be associated with an increased incidence of infected femoral pseudo-aneurysms.     

Superficial Femoral Vein and Superficial Femoral Artery as Replacement for Infected Axillofemoral Graft

We report successful replacement of infected axillofemoral bypass with a combined femoral vein and superficial femoral artery graft. The new graft was transferred through the tunnel left after infected prosthesis removal. Good early and long-term results indicate that this may be a sufficient procedure.     

Should cystic fibrosis patients infected with Burkholderia cepacia complex be listed for lung transplantation?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether lung transplantation remained a beneficial treatment for cystic fibrosis (CF) patients infected or colonized with Burkholderia cepacia complex (BCC) prior to lung transplantation (LTx). Of the 25 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were clearly in favor of maintaining access to LTx lists for BCC infected or colonized CF patients. In other words, access to LTx should not be denied to BCC infected CF patients in that the beneficial effects of LTx do not differ with respect to non-infected patients: comparison showed neither a difference in survival nor a higher mortality risk. However, results would differ for Burkholderia cenocepacia infected CF patients prior to LTx: both short- and long-term survival are significantly lower when B. cenocepacia infected patients are compared to other BCC infected patients or non-infected patients. Hence, current evidence shows that careful screening of all BCC suspected CF patients and risk-aware multidisciplinary management should be achieved before listing patients for LTx. This would allow identification of different bacterial species (in particular, B. cenocepacia) present and optimize lung transplantation survival outcomes.