Microsporidial infections in immunocompromised hospitalized patients

Microsporidia Encephalitozoon cuniculi, obligate intracellular sporeforming protozoan parasite infecting a wide range of vertebrate and invertebrate host, has been described as opportunistic pathogen in severely immunocompromised human host. An antibody immune response to the presence of antibodies against Encephalitozoon cuniculi was investigated serologically using indirect immunofluorescence antibody test (IFAT). Of the total number of 113 sera from immunologically compromised patients examined, 5 were positive at the titre 1:32, 5 at the titre 1:64, and 6 at the titre 1:256. From total number of positive respondent patients were 12 children and 4 adults.     

Acyclovir-resistant herpes simplex virus infections in immunocompromised patients]

In order to determine the sensitivity of herpes simplex virus (HSV) isolates from immunocompromised patients treated with antiviral compounds, a retrospective study was carried out in the Clinical Virology Department of the University Medical Centre, Amsterdam. Virus isolates from four AIDS patients and one bone marrow transplant recipient were examined for their sensitivity for the antiviral compounds used by means of plaque reduction assay. In some of the virus isolates, from patients in whom resistance was assumed on clinical grounds, in vitro resistance of the HSV to acyclovir (ACV) could be demonstrated, both after oral and after parenteral administration. There was a clear correlation between the clinical course of the HSV infection and in vitro resistance. ACV resistant virus isolates were sensitive to foscarnet, both clinically and in vitro. In immunocompromised patients treated for some time with ACV for HSV infection, resistance should be considered at lack of results or progression of the lesion and when necessary be demonstrated in vitro. Alternative therapy then consists of intravenous foscarnet treatment.     

Quality management for preventing healthcare-acquired infections. The importance of surveillance

Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.     

Clinical picture of Herpesviridae infections among immunocompromised patients: bone marrow and solid organ transplants recipients

The human herpes virus (HHV) family (herpesviridae) are large DNA viruses containing eight important, ubiquitous human pathogens. This group of viruses encompasses: herpes simplex virus (HSV types 1 and 2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6, HHV-7 (cause roseola or exanthema subitum in children) and Kaposi sarcoma herpes virus--(KSHV). The outstanding property of herpes viruses is lifelong persistence of infection and potential periodic reactivation, particularly often among immunocompromised patients. Herpesvirus infections are associated with a wide spectrum of diseases ranging from local ulceration to serious systemic illnessess or malignancies. These infections are one of the major cause of morbidity and mortality in the immunocompromised patients.     

2010–2015年广东省深圳市其他感染性腹泻监测分析

  目的  对学校诺如病毒感染性疫情传播能力进行估算,对停课措施和呕吐物处理进行效果评估,为制定疾病管理策略和控制措施提供依据。  方法   选取2015 — 2019年深圳市福田区学校发生的诺如病毒感染性疫情53起,采用SEIR动力学模型对疫情数据进行模拟,计算疫情的基本再生系数R₀来评价疫情传播能力,计算疫情的累计罹患率和疫情持续时间来评价控制措施的防控效果。  结果   学校诺如病毒感染性疫情无干预情况下基本再生系数R₀为11.54（10.52,13.60）,不同年份、流行季节与非流行季节、不同类型学校诺如病毒感染性疫情的基本再生系数R₀差异均无统计学意义（P > 0.05）;停课3 d的疫情累计罹患率明显低于不采取停课措施的疫情（Z = 8.875,P < 0.001）,疫情持续时间明显短于不采取停课措施的疫情（Z = 8.172,P < 0.001）;有学生在教室内呕吐的疫情R₀高于没有学生在教室内呕吐的疫情（Z = 5.523,P < 0.001）,处理呕吐物时其他学生离开教室的疫情R₀低于学生没有离开教室的疫情（Z = 2.893,P = 0.003）。  结论  学校诺如病毒感染性疫情传播能力强,采取停课措施和当教室内有学生出现呕吐症状时将其他学生带离教室能有效减低疫情的传播蔓延。     

Hepatitis E Virus seroprevalence and chronic infections in patients with HIV, Switzerland

We screened 735 HIV-infected patients in Switzerland with unexplained alanine aminotransferase elevation for hepatitis E virus (HEV) immunoglobulin G. Although HEV seroprevalence in this population is low (2.6%), HEV RNA can persist in patients with low CD4 cell counts. Findings suggest chronic HEV infection should be considered as a cause of persistent alanine aminotransferase elevation.     

Speech and language skills: their importance in development

This article presents an overview of speech and language difficulties in children and briefly comments on intervention practices. Difficulties affecting the development of speech and language in children are considered to be the most common of paediatric disabilities and may have long-lasting effects on social skills, behaviour, education and employment. Referral to speech and language therapy services is crucial and primary health care workers have an important role in identifying those at risk. Some signposts for referral are given, though mechanisms and criteria will differ from Trust to Trust. Communication is acknowledged to be a central element in an individual's health and well-being and is critical to emotional, cognitive and social functioning. The application of the ICF framework is considered.     

Sexually transmitted infections: prevention and management

In the early 21st century, STI and HIV have been linked inextricably. Although the focus of this article is STI, some discussion on the diagnosis and management of individuals with HIV infection is necessary. The history of HIV diagnosis in the workplace is checkered. The authors have seen cases of prospective workers being subjected to HIV testing without their knowledge as part of a pre-employment medical examination. If the test came back positive, the men were told that they would not be employed without explanation. This approach is a breech of the human rights of the individual being tested and cannot be condoned. Any HIV testing must be done with the full and informed consent of the individual, with counseling given before and after testing to enable individuals with HIV infection to seek care and protect their families and to give individuals without HIV infection counseling on risk reduction. Men and women who present with an STI are at risk for HIV infection. With increasing options for management and secondary prevention, it is important to recognize people who are at risk. This identification should be done through HIV VCT. The location, funding, and supervision of VCT sites related to workplace populations should be a subject for serious debate. Although fears of mass layoffs after HIV testing largely have been unfounded, it is natural for workers to be fearful, unless there is a clearly articulated policy stating that the company observes and enforces nondiscriminatory practices. The workplace examples show that syndromic STI management, allied to comprehensive prevention programs, can have a genuine and measurable impact on STI prevalence. The potential interventions and partners are listed in Table 2. A community-based, randomized study in Tanzania showed that the institution of a well-managed STI syndromic management program can reduce HIV incidence by up to 40%, in the context of a rising HIV epidemic. Presumptive STI treatment for female sex workers (see Box 1) may prove useful as a short-term measure to reduce high STI prevalence rates while more sustainable preventive and curative services are established. The laboratory diagnosis of STIs remains problematic in the face of commonly available technologies of limited sensitivity and specificity and often substandard quality-assurance practices. For these and other reasons, syndromic management became the recommended strategy for treating STIs. The availability of rapid, accurate, and inexpensive diagnostics, especially for cervical infections for women, would alter management recommendations. Work is being done by the WHO and others to develop and assess low-cost diagnostics. Managing STIs and altering the behavior that leads to STIs are essential elements of any HIV prevention and management program. The issues surrounding a practical, compassionate, and comprehensive HIV program can be difficult. Numerous publications exist to help program managers navigate these issues and appropriately tailor a program to the needs of individual organizations. Some of these publications are listed in the next section.     

Molecular epidemiology of coagulase-negative staphylococci isolated from immunocompromised patients.

OBJECTIVE: To define the source of invasive coagulase-negative staphylococci (CNS) and the epidemiology of strain variation in immunocompromised patients. DESIGN: Weekly microbial surveillance cultures were obtained from the nares, throat, skin, rectum, and urine. Plasmid pattern analysis was performed on all coagulase-negative staphylococci isolated from blood cultures and on selected strains from the surveillance sites. SETTING: A 902-bed, university-owned, tertiary-care referral hospital. PARTICIPANTS: Forty-four patients on the bone marrow transplant or hematologic malignancy services. RESULTS: Plasmid pattern analysis was performed on 340 surveillance isolates (median = 7 per patient) and 201 bloodstream isolates (median = 3 per patient). Patients were colonized with numerous unique strains (median = 5 per patient) of coagulase-negative staphylococci. The 44 patients had 108 episodes of positive blood cultures, 20 of which were preceded by colonization with the same strain. Isolation of the matching strain from surveillance cultures preceded the positive blood culture by 1 to 8 days in 9 episodes and 18 to 389 days in 11 episodes. The matching strain was isolated from the skin in only 6 (30%) of those episodes and from mucosal sites in 70%. Of the 108 episodes of positive blood cultures, 21 were identified as nosocomial bloodstream infections. Four of the 21 nosocomial bloodstream infections were preceded by colonization with the same strain. In all 4 episodes, the infecting strain was cultured from the nares before the blood cultures were obtained. CONCLUSIONS: Our results suggest that mucous membranes might be sources for strains of CNS causing bacteremia.