Prevalence of <Emphasis Type="Italic">Blastocystis hominis</Emphasis> and <Emphasis Type="Italic">Strongyloides stercoralis</Emphasis> infection in Okinawa,Japan

This study was conducted to clarify the prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Ryukyu University Hospital, Okinawa, Japan, between January 2004 and November 2006. Stool samples collected from 3,292 patients were examined by the direct smear method, formalin–ether sedimentation method, and agar plate culture method. The prevalence rate of B. hominis and S. stercoralis infection was 1.0 and 3.4%, respectively. The prevalence rate of B. hominis infection in patients aged >80 years old was significantly higher than that in patients <80 years old (P < 0.001). The prevalence rate of S. stercoralis infection was significantly higher in patients with B. hominis infection compared with those without (P < 0.001). This study demonstrated a prevalence rate for B. hominis and S. stercoralis infection and an association between B. hominis and S. stercoralis infection in Okinawa, Japan.     

In vitro sensitivity of Blastocystis hominis to garlic, ginger, white cumin, and black pepper used in diet

To determine the growth pattern and in vitro susceptibility of Blastocystis hominis to metronidazole (MTZ), garlic, ginger, white cumin, and black pepper. Stool specimens were collected from 16 irritable bowel syndrome (IBS) and 10 controls between July–November 2010. Stool microscopy and culture for B. hominis was performed. Drug susceptibility assays was done using 0.01 and 0.1 mg/ml of MTZ, garlic, ginger, white cumin, and black pepper. Effect was assessed on B. hominis culture after 48 h. Stool DNA was extracted using stool DNA extraction kit (Qiagen) and polymerase chain reaction (PCR) done using subtype-specific sequence-tagged-site primers. B. hominis genotype 3 and coinfection of 1 and 3 tended to grow well in culture compared to isolated type 1 infection. Exposed to MTZ at a concentration of 0.01 mg/ml, 38% (6/16) B. hominis from IBS did not grow in culture compared to 100% (10/10) of B. hominis from control (p = 0.001). When they were exposed to MTZ at 0.1 mg/ml, 56% (9/16) B. hominis from IBS did not grow in cultures compared to 100% (10/10) from control (p = 0.01). Forty-four percent (7/16) B. hominis from IBS did not grow in culture compared to 100% (10/10) B. hominis from control when exposed to garlic at a concentration of 0.01 mg/ml (p = 0.003) and following exposure to garlic at 0.1 mg/ml, 38% (6/16) B. hominis from IBS did not grow in cultures compared to 100% (10/10) from control (p = 0.001). B. hominis isolates from IBS had a cell count of 6,625 at a MTZ concentration of 0.01 mg/ml that reduced to 1,250 as MTZ concentration was increased to 0.1 mg/ml (p = 0.08). B. hominis from IBS with a mean cell count of 3 × 10⁵ at baseline decreased to 1 × 10⁴ when exposed to garlic at 0.01 mg/ml (p < 0.001) and to 1 × 10³ (p < 0.001) when garlic was 0.1 mg/ml. B. hominis from IBS cell count decreased to 1 × 10⁵ when exposed to white cumin at 0.01 mg/ml (p = 0.01) and to 1 × 10⁵ (p < 0.001) when white cumin was 0.1 mg/ml. Exposed to black pepper at 0.1 mg/ml, cell count of B. hominis from IBS decreased to 1 × 10⁵ (p = 0.01). B. hominis from IBS decreased to 1.3 × 10⁵ exposed to ginger at 0.01 mg/ml (p = 0.001). B. hominis isolates were mostly genotypes 3, type 1 and 3 coinfection, and non-typeable B. hominis isolates. B. hominis isolates from IBS mostly genotype 1 demonstrated an increased sensitivity to garlic at 0.01 mg/ml with a B. hominis cell count of 3,714 compared to 6,142 when exposed to 0.01 mg/ml of MTZ. However, this sensitivity did not increase as garlic concentration was increased to 0.1 mg/ml, for B. hominis cell count was 6,000 compared to 1,428 as MTZ was increased to 0.1 mg/ml.     

Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria

Studies have suggested a possible role for Blastocystis hominis and Dientamoeba fragilis in the etiology of irritable bowel syndrome (IBS). We studied the prevalence of B. hominis and D. fragilis in patients with IBS-diarrhea (IBS-D). Three hundred and thirty patients were enrolled, 171 (52%) with IBS-D and 159 (48%) were controls, respectively. Stool microscopy, culture, and polymerase chain reaction (PCR) for B. hominis and D. fragilis were done. B. hominis was positive by stool microscopy in 49% (83/171) of IBS compared to 24% (27/159) in control (p < 0.001). B. hominis culture was positive in 53% (90/171) in IBS compared to 16% (25/159) in control (p < 0.001). B. hominis PCR was positive in 44% (75/171) in IBS compared to 21% (33/159) in control (p < 0.001). D. fragilis microscopy was positive in 3.5% (6/171) in IBS-D compared to 0.6% (1/159) in control (p = 0.123). D. fragilis culture was positive in 4% (7/171) in IBS compared to 1.3% (2/159) in control (p = 0.176). D. fragilis PCR was positive in 4% (6/171) in IBS-D compared to 0% (0/159) in control (p = 0.030). B. hominis is common, while D. fragilis was less prevalent in our patients with IBS-D. B. hominis and D. fragilis culture had a better yield compared to stool microscopy and PCR.     

Occupational risk of human <Emphasis Type="Italic">Cytomegalovirus</Emphasis> and <Emphasis Type="Italic">Parvovirus</Emphasis> B19 infection in female day care personnel in the Netherlands; a study based on seroprevalence

Cytomegalovirus (CMV) and Parvovirus B19 infections acquired during pregnancy may result in developmental disabilities of the foetus. This study evaluates the occupational risk of these infections in female day care personnel. IgG seroprevalence was determined in 310 Dutch day care workers and 158 nursing school students. CMV seroprevalence was age-related, starting at 21% in those <20 years and reaching 65% in those >35 years. Between the ages of 20 and 24 years the CMV prevalence was higher in day care personnel than in controls, 50% versus 31% (p = 0.03). In the first 2 years of employment the risk of attracting CMV was significantly increased (OR_adj = 3.80; p < 0.001) and the occupational risk was also increased (OR_adj 2.19; p < 0.001). Parvovirus seropositivity (71–77%) was not related to age or working at a day care centre. In conclusion, an occupational risk was observed for CMV, but not for Parvovirus infection in female day care personnel. The fieldwork was performed at the Department of Infectious Diseases, South Limburg Public Health Service. Analyses and editing were finalised at the Department of Medical Microbiology, University Hospital Maastricht.     

Infection level of the Asian tapeworm (<Emphasis Type="Italic">Bothriocephalus acheilognathi</Emphasis>) in the cyprinid fish, <Emphasis Type="Italic">Schizothorax niger</Emphasis>, from Anchar Lake,relative to season,sex, length and condition factor

Various studies have shown that the Asian fish tapeworm, Bothriocephalus acheilognathi causes great economic loss in hatcheries, fish farms as well as in lakes. In order to understand the seasonal variation of infection in a nutrient-enriched lake, parasitological investigation was carried out in the indigenous cyprinid fish, Schizothorax niger Heckel 1838 from September, 2008 to August, 2009. Overall, this study revealed definite seasonality of infection (p < 0.05), with greater infection in summer (prevalence = 39.5%) and lesser in winter (prevalence = 8.1%). The prevalence among different seasons revealed significant differences (p < 0.05). Sex was not an important factor influencing the prevalence of the Asian tapeworm. A strong positive correlation (Pearson’s correlation, r = 0.7; p = 0.02) between total length of S. niger and number of Asian fish tapeworms was observed. Similarly, a strong positive correlation existed between weight of fish and number of tapeworms (Pearson’s correlation, r = 0.7; p = 0.005). Prevalence and mean abundance were positively and significantly correlated with water temperature (r = 0.8, p < 0.01 and r = 0.8, p < 0.01, respectively). Thus seasonal dynamics, total length and weight of the host significantly influenced the tapeworm infection. The above findings will be useful in devising the appropriate control strategies for the Asian tapeworm in wild fish in Kashmir valley as well as in similar climatic zones of other parts of the world. Also, information from this study will be used to assess the spread and extent of B. acheilognathi which is a potential threat to the indigenous fish fauna of Anchar Lake.     

Prevalence of toxin genes in consecutive clinical isolates of <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> and clinical impact

Even if Panton–Valentine leukocidin (PVL), toxic shock syndrome toxin-1 (TSST-1), staphylococcal enterotoxins (SEB and SEC), and exfoliative toxins (ETA and ETB) may be associated with severe infections, the clinical significance of their presence in clinical isolates of Staphylococcus aureus remains poorly documented. In this study, we evaluated the prevalence of toxin genes and the relationship between their presence and the severity of infection. We screened for the presence of these six toxin genes among 186 consecutive S. aureus clinical isolates (resistant or not to methicillin) during a two-month period. We compared the toxin gene profile between strains recovered from patients presenting uncomplicated infections (n = 151) and from patients suffering from severe infections (n = 35). At least one toxin gene was detected in 55 (29.6%) isolates as follows: pvl (n = 1), tst + sec (n = 5), seb (n = 19), seb + sec (n = 1), sec (n = 28), and eta (n = 1). The proportion of toxin-producing strains among patients with uncomplicated infections (27.8%) and patients with severe infections (37.1%) was not statistically different (p = 0.3044), even if the severity of infection tended to be associated with the presence of sec (p = 0.0655). Although the prevalence of toxin genes was relatively high herein, no statistically significant association between the severity of infection and the presence of toxin genes was observed.     

Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection

Although many Blastocystis infections remain asymptomatic, recent data suggest it also causes frequent symptoms. Therapy should be limited to patients with persistent symptoms and a complete workup for alternative etiologies. The goal of this study was to compare the natural evolution (no treatment) to the efficacy of Saccharomyces boulardii (S. boulardii) or metronidazole for the duration of diarrhea and the duration of colonization in children with gastrointestinal symptoms and positive stool examination for Blastocystis hominis. This randomized single-blinded clinical trial included children presenting with gastrointestinal symptoms (abdominal pain, diarrhea, nausea–vomiting, flatulence) more than 2 weeks and confirmed B. hominis by stool examination (B. hominis cysts in the stool with microscopic examination of the fresh stool). The primary end points were clinical evaluation and result of microscopic stool examination at day 15. Secondary end points were the same end points at day 30. Randomization was performed by alternating inclusion: group A, S. boulardii (250 mg twice a day, Reflor?) during 10 days; group B, metronidazole (30 mg/kg twice daily) for 10 days; group C, no treatment. At day 15 and 30 after inclusion, the patients were re-evaluated, and stool samples were examined microscopically. On day 15, children that were still symptomatic and/or were still B. hominis-infected in group C were treated with metronidazole for 10 days. There was no statistically significant difference between the three study groups for age, gender, and the presence of diarrhea and abdominal pain. On day 15, clinical cure was observed in 77.7% in group A (n, 18); in 66.6% in group B (n, 15); and 40% in group C (n:15) (p < 0.031, between groups A and C). Disappearance of the cysts from the stools on day 15 was 80% in group B, 72.2% in group A, and 26.6% in group C (p = 0.011, between group B and group C; p = 0.013, between group A and group C). At the end of the first month after inclusion, clinical cure rate was 94.4% in group A and 73.3% in group B (p = 0.11). Parasitological cure rate for B. hominis was very comparable between both groups (94.4% vs. 93.3%, p = 0.43). Metronidazole or S. boulardii has potential beneficial effects in B. hominis infection (symptoms, presence of parasites). These findings challenge the actual guidelines.     

Prevalence and associated factors of intestinal parasitisation: a cross-sectional study among outpatients with gastrointestinal symptoms in Catalonia,Spain

The aim of this study was to report the prevalence of intestinal parasites in stool specimens from outpatients in Catalonia (Spain), and to evaluate the association of age, seasonality, and gender on general parasitisation and by the most frequent detected species. A total of 13,913 samples from 8,313 patients (1–3 specimens per patient) reporting digestive disorders were examined between 1999 and 2005 as a part of medical examinations. Samples were fixed with MIF solution and microscopically examined as wet mounts. Permanent stain was obtained by the modified Ziehl–Neelsen technique for intestinal coccidia. Nineteen species of intestinal parasites were identified. Blastocystis hominis (585 patients) was the predominant species, followed by Giardia duodenalis (321), Dientamoeba fragilis (131), Entamoeba coli (60) and Cryptosporidium sp. (59). Prevalence of helminths was low, being Enterobius vermicularis as the most frequently reported helminth (49 patients). The overall parasitisation was 1,136/8,313 (13.7%); prevalence in adults was 19.8% with a maximum in spring (14.8%). In the adjusted models, age was the main factor associated with infection: adults, with B. hominis and Entamoeba coli (odds ratio (OR) = 6.0 and OR = 8.5, respectively) and children, with Cryptosporidium and Giardia (OR = 2.0 and OR = 3.3, respectively). However, seasonality cannot be considered related with infection. The total prevalence was low, taking into account that all the subjects examined presented gastrointestinal symptoms and that species traditionally considered as non-pathogenic were included in the study.     

Impact of empiric antibiotic regimen on bowel colonization in neonates with suspected early onset sepsis

The purpose of this study was to compare the impact of ampicillin and penicillin used for empiric treatment of early onset sepsis (EOS) on initial gut colonization by aerobic and facultative anaerobic microorganisms. A cluster-randomized, two-center, switch-over study was conducted in two paediatric intensive care units in Estonia and included 276 neonates. Rectal swabs were collected twice a week until discharge or day 60. Colonizing microbes were identified on species level and tested for ampicillin resistance (AR). The number of patients colonized with Gram negative microorganisms and Candida spp was similar in both treatment arms but ampicillin resulted in longer colonization duration (CD) of K. pneumonia (p = 0.012), AR Serratia spp (p = 0.012) and Candida spp (p = 0.02) and penicillin in that of AR Acinetobacter spp (p = 0.001). As for Gram positive microorganisms penicillin treatment was associated with a greater number of colonized patients and higher CD of Enterococcus spp and S. aureus but lower ones of S. haemolyticus and S. hominis. Influence of ampicillin and penicillin on initial gut colonization is somewhat different but these differences are of low clinical relevance and should not be a limiting step when choosing between these two antibiotics for the empiric treatment of EOS.     

Differentiation of <Emphasis Type="Italic">Mycobacterium kansasii</Emphasis> infection from <Emphasis Type="Italic">Mycobacterium tuberculosis</Emphasis> infection: comparison of clinical features,radiological appearance,and outcome

This retrospective study sought to systematically identify clinical and radiological features differentiating Mycobacterium kansasii from Mycobacterium tuberculosis infection. The sample included matched patients with a culture-positive diagnosis of M. tuberculosis infection (n = 121) or M. kansasii infection (n = 62) derived from the databases of two tuberculosis centers. Data on patient background and clinical features were collected, and chest radiographs were analyzed. Sixty percent of the M. kansasii group were native Israelis compared to 15% of the M. tuberculosis group (p = 0.0001). M. tuberculosis infection was associated with a higher rate of human immunodeficiency virus (HIV) infection (p = 0.03) and M. kansasii infection with a higher rate of lung disease (p = 0.0001). M. tuberculosis infection was characterized by a higher likelihood of bilateral disease (p = 0.005), pleural effusions, and lymphadenopathy (p = 0.006 and p = 0.001, respectively). There were ten deaths, all in the M. tuberculosis group. On multivariate logistic regression, the presence of chronic obstructive pulmonary disease and associated lung disease were significant predictors of M. kansasii infection. The findings show that there are group differences between the clinical features of the two infections. In the setting of pulmonary mycobacterial infection, the presence of coinfection with HIV, bilateral disease, pleural effusion, and lymphadenopathy make M. kansasii infection very unlikely.     

Epidemiology of Streptococcus pneumoniae and Staphylococcus aureus colonization in healthy Venezuelan children

Streptococcus pneumoniae and Staphylococcus aureus cause significant morbidity and mortality worldwide. We investigated both the colonization and co-colonization characteristics for these pathogens among 250 healthy children from 2 to 5 years of age in Merida, Venezuela, in 2007. The prevalence of S. pneumoniae colonization, S. aureus colonization, and S. pneumoniae–S. aureus co-colonization was 28%, 56%, and 16%, respectively. Pneumococcal serotypes 6B (14%), 19F (12%), 23F (12%), 15 (9%), 6A (8%), 11 (8%), 23A (6%), and 34 (6%) were the most prevalent. Non-respiratory atopy was a risk factor for S. aureus colonization (p = 0.017). Vaccine serotypes were negatively associated with preceding respiratory infection (p = 0.02) and with S. aureus colonization (p = 0.03). We observed a high prevalence of pneumococcal resistance against trimethoprim–sulfamethoxazole (40%), erythromycin (38%), and penicillin (14%). Semi-quantitative measurement of pneumococcal colonization density showed that children with young siblings and low socioeconomic status were more densely colonized (p = 0.02 and p = 0.02, respectively). In contrast, trimethoprim–sulfamethoxazole- and multidrug-resistant-pneumococci colonized children sparsely (p = 0.03 and p = 0.01, respectively). Our data form an important basis to monitor the future impact of pneumococcal vaccination on bacterial colonization, as well as to recommend a rationalized and restrictive antimicrobial use in our community.     

Multi-drug-resistant gram-negative bacterial infection in surgical patients hospitalized in the ICU: a cohort study

We sought to identify risk factors for postoperative infections, caused by multi-drug-resistant gram-negative bacteria (MDR-GNB) in surgical patients. This was a retrospective cohort study among patients hospitalized in the intensive care unit (ICU) for more than 5 days, following general surgical operations. Comparison of patients who developed infection caused by MDR-GNB with the remainder of the cohort showed that every minute of operative time, use of special treatments during hospitalization (antineoplastic, immunosuppressive or immunomodulating therapies), every day of metronidazole, and every day of carbapenems use, increased patients’ odds to acquire an infection caused by MDR-GNB by 0.7%, 8.9 times, 9%, and 9%, respectively [OR (95% CI): 1.007 (1.003–1.011), p = 0.001; 8.9 (1.8–17.3), p = 0.004; 1.09 (1.04–1.18), p = 0.039; 1.09 (1.01–1.18), p = 0.023, respectively]. The above were adjusted in the multivariable analysis for the confounder of time distribution of infections caused by MDR-GNB. Finally, the secondary comparison, with patients that did not develop any infection, showed that patients who had received antibiotics, within 3 months prior to admission, had 3.8 times higher odds to acquire an infection caused by MDR-GNB [OR (95% CI): 3.8 (1.07–13.2), p = 0.002]. This study depicts certain, potentially modifiable, risk factors for postoperative infections in patients hospitalized in the ICU for more than 5 days.     

Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis

Blastocystis hominis is the most common intestinal parasite in humans. An extensive genetic variability has been described recently in B. hominis isolates. The aim of this study was to analyze genotypes of B. hominis isolates obtained from the healthy individuals and patients with irritable bowel syndrome-diarrhea (IBS-D). The patients with IBS-D were enrolled from gastroenterology outpatient department at the Aga Khan University Hospital. History and physical examination was done. Stool microscopy, culture, and polymerase chain reaction for B. hominis genotyping were carried out. The study included 158 patients with IBS-D, mean age 41 ± 15, age range 16–83 years, and male/female ratio of 109:49. One hundred fifty-seven (49.8%) were taken as healthy control. The dominant B. hominis genotypes were genotype 1 in 87 (65%) and type 3 in 49 (37%). In IBS-D, genotype 1 was present in 75 (86%; P < 0.001) compared to 12 (14%) in controls while type 3 was present in 23 (47%) compared to 26 (53%) in controls (P < 0.001), respectively. Infection with single genotype of B. hominis was present in 70 (73%) with IBS-D and in 26 (27%) in control group while with multiple genotypes in 25 (64%) in IBS-D and 14 (36%) in control group (P = 0.30), respectively. Majority of our patients had typeable B. hominis infection. The genotype of B. hominis in IBS-D was type 1 while in control genotype 3 was predominant.     

Pulmonary <Emphasis Type="Italic">Mycobacterium simiae</Emphasis> infection: comparison with pulmonary tuberculosis

To identify the clinical and radiological features distinguishing Mycobacterium simiae respiratory infection from pulmonary tuberculosis, the demographics, underlying conditions, and clinical and radiological findings of 121 consecutive patients with pulmonary tuberculosis and 102 with M. simiae respiratory infection were compared retrospectively. In the M. simiae group, the patients were older (mean age 69 ± 16 years vs. 47 ± 21 years, p = 0.0001), with a female predominance (62% vs. 45%, p = 0.008). Only 4% were of Ethiopian origin compared to 25% of the tuberculosis group (p = 0.0001). M. simiae infection was associated with significantly higher rates of smoking history, underlying chronic obstructive pulmonary disease, zero human immunodeficiency virus (HIV) infection compared to 10% in the tuberculosis group (p = 0.001), blunted symptoms, and noncavitary infiltrates in the lower/middle lobes on chest X-ray. HIV-negative patients with M. simiae respiratory infection are distinguishable from patients with pulmonary tuberculosis by several demographic, clinical, and radiological features. These findings have important diagnostic and therapeutic implications.     

Soluble inflammatory markers as predictors of liver histological changes in patients with chronic hepatitis C virus infection

Host immune response seems to be mainly responsible for the progression of liver disease among patients with hepatitis C virus (HCV) infection. Immune activation involves the release of cytokines and their receptors that can be measured in plasma samples. The study aimed to evaluate the association between plasma levels of chemokines and soluble tumor necrosis factor receptors (sTNFR) and liver histological changes among patients with chronic HCV infection. Seventy-one treatment-naive patients were included. Plasma levels of CCL2, CCL3, CCL11, CCL24, CXCL9, CXCL10, sTNFR1, and sTNFR2 were measured and liver histological findings were reviewed. Plasma levels of CXCL9, sTNFR1, and sTNFR2 were significantly associated with liver fibrosis, with higher median levels found among patients with moderate/severe fibrosis (F ≥ 2) if compared to those with no or mild fibrosis (p = 0.014; p = 0.012; p = 0.009, respectively). Plasma sTNFR2 levels were significantly associated with necroinflammatory activity, with higher median levels among patients with moderate/severe activity (A ≥ 2) if compared to those with no or mild activity (2.34 ng/mL vs. 1.99 ng/mL; p = 0.019). In conclusion, plasma levels of CXCL9, sTNFR1, and sTNFR2 were independently associated with liver histological changes, suggesting a role of TNF activation and Th1-type cell-mediated immune response in the pathogenesis of HCV infection.     

<Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis> pneumonia in cancer patients without traditional risk factors for infection, 1997–2004

In order to elucidate the spectrum of Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors, 44 cancer patients (cases) with S. maltophilia pneumonia in whom S. maltophilia pneumonia risk factors were not present were compared with two S. maltophilia pneumonia risk groups (controls) including 43 neutropenic non-intensive care unit (ICU) and 21 non-neutropenic ICU patients. The case and control patients had similar demographic and underlying clinical characteristics. Compared with case patients with S. maltophilia pneumonia, neutropenic patients had higher exposure to carbapenem antibiotics (58 vs. 41%; p < 0.03), more frequent hematologic malignancy (95 vs. 64%; p < 0.0003), and they presented with concurrent bacteremia more often (23 vs. 0%; p < 0.0005). Patients with S. maltophilia pneumonia in the ICU needed vasopressor therapy more frequently than cases (62 vs. 5%; p < 0.0001). Hospital-acquired S. maltophilia pneumonia was more common among controls than cases (98 vs. 61%; p < 0.000002). Among the cases, 15 (34%) received outpatient oral antimicrobial therapy, while 29 were hospitalized and eight (28%) were subsequently admitted to the ICU. The mean duration of ICU stay, even among these eight patients (19 ± 40 days), was comparable to that of patients with neutropenia (23 ± 26 days) and those who developed S. maltophilia pneumonia during their ICU stay (34 ± 22 days; p = 0.46). The overall infection-associated mortality in the 108 patients with S. maltophilia pneumonia was 25%. Twenty percent of patients without traditional risk factors for S. maltophilia pneumonia died due to progressive infection. In a multivariate logistic regression analysis, only admission to the ICU predicted death (odds ratio 33; 95% confidence interval, 4.51–241.2; p < 0.0006). The results of this study indicate S. maltophilia pneumonia is a serious infection even in non-neutropenic, non-ICU patients with cancer. This work was presented in part at the 15th European Congress of Clinical Microbiology and Infectious Diseases, Copenhagen, Denmark, April 2–5, 2005 (abstract no P1374) and at the 45th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington D.C., December 16–19, 2005 (abstract no K-1535).     

Clinical features,antimicrobial susceptibilities,and outcomes of <Emphasis Type="Italic">Elizabethkingia meningoseptica</Emphasis> (<Emphasis Type="Italic">Chryseobacterium meningosepticum</Emphasis>) bacteremia at a medical center in Taiwan, 1999–2006

A total of 118 patients with Elizabethkingia meningoseptica bacteremia at a medical center in Taiwan from 1999 to 2006 were studied. Minimum inhibitory concentrations (MICs) of 99 preserved isolates were determined. The incidence (per 100,000 admissions) of E. meningoseptica bacteremia increased from 7.5 in 1996 to 35.6 in 2006 (p = 0.006). Among them, 84% presented with fever, 86% had nosocomial infections, and 60% had acquired the infection in intensive care units (ICUs). The most common underlying diseases were malignancy (36%) and diabetes mellitus (25%). Seventy-eight percent of patients had primary bacteremia, followed by pneumonia (9%), soft tissue infection, and catheter-related bacteremia (6%). Forty-five patients (38%) had polymicrobial bacteremia. Overall, the 14-day mortality was 23.4%. Multivariate analysis revealed E. meningoseptica bacteremia acquired in an ICU (p = 0.048, odds ratio [OR] 4.23) and presence of effective antibiotic treatment after the availability of culture results (p = 0.049, OR 0.31) were independent predictors of 14-day mortality. The 14-day mortality was higher among patients receiving carbapenems (p = 0.046) than fluoroquinolones or other antimicrobial agents. More than 80% of the isolates tested were susceptible to trimethoprim-sulfamethoxzole, moxifloxacin, and levofloxacin. The MIC₅₀ and MIC₉₀ of the isolates to tigecycline and doxycycline were both 4 μg/mL and 8 μg/ml, respectively.     

A prevalence screen of MRSA nasal colonisation amongst UK doctors in a non-clinical environment

Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage in healthcare workers (HCWs) is both contentious and confounded by a lack of knowledge of background prevalence rates. This study examines prevalence of nasal MRSA carriage amongst a spectrum of medical professionals in a non-clinical environment. Medical conference attendees volunteered for screening for nasal MRSA carriage, and anonymised demographic data and attitudes towards screening were recorded. Two hundred sixty volunteers participated. One hundred seventy-three participants (67%) were from the British Medical Association′s Annual Representatives Meeting, and 87 participants (33%) were attending the Association of Surgeons in Training conference. Six (2%) participants were positive for MRSA nasal carriage (BMA = 1%, ASIT = 5%; p = 0.099). Participants from a surgical specialty (4.8%) were more likely to be MRSA positive (p = 0.039). All positive samples came from male participants (p = 0.182). However, there was no significant association with gender, seniority or country of employment and MRSA status. Routine screening for MRSA was supported by 63% of participants in HCWs; 36% had previously undergone such screening. MRSA nasal carriage rates within this cross-sectional study are lower than studies reporting carriage rates in HCWs within the clinical environment. Further research is required to examine the relationship between MRSA nasal colonisation status of a HCW and subsequent MRSA infection in patients.     

Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan

Background/purposeTuberculosis (TB) in the elderly population remains a major challenge in areas with intermediate disease burden like Taiwan. Despite the increasing burden and high risks of TB in the elderly population, particularly those living in long-term care facilities (LTCFs), diagnostic testing for latent tuberculosis infection (LTBI) has not been carefully evaluated in this group. This study aimed to investigate the prevalence and predictors of LTBI in older adults living in LTCFs.MethodsOlder adults living in seven LTCFs in Taiwan were prospectively enrolled between January and July 2017. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine presence of LTBI. Predictors for LTBI were analyzed.ResultsA total of 258 participants were enrolled, including 240 older residents (mean age, 81.6 years; male, 51.2%) and 18 employees (mean age, 64.8 years; male, 22.2%). The proportion of independent status in ambulation assessments significantly declined with aging (p < 0.001). The IGRA-positivity rate in LTCFs was 31.4% (81/258), which consisted of 73 (30.4%) residents and 8 (44.4%) employees. The IGRA results were different with respect to the ambulation status (p = 0.052). In the multivariate logistic regression analysis, the only independent predictor of LTBI among older adults in LTCFs was independent ambulation (odds ratio, 2.16; 95% confidence interval, 1.09–4.28; p = 0.027).ConclusionsThere was a high prevalence of LTBI among older adults in LTCFs in Taiwan. Independent ambulation was the only independent predictor of LTBI.     

Anti-<Emphasis Type="Italic">Saccharomyces cerevisiae</Emphasis> Antibodies are Frequent in Type 1 Diabetes

Anti-Saccharomyces cerevisiae antibodies (ASCA) have been described in many autoimmune diseases in which there is an increased intestinal permeability. Also in type 1 diabetes (T1D), there is an increased intestinal permeability. Since no data are available about ASCA in T1D, we evaluated, retrospectively, the frequency of ASCA in this disease. ASCA, IgG, and IgA, were determined by ELISA in sera of 224 T1D patients in which coeliac disease has been excluded and 157 healthy control group. The frequency of ASCA (IgG or IgA) was significantly higher in T1D patients than in the control group (24.5% vs. 2.5%, p < 10⁻⁷). The same observation was found in children and in adult patients when we compare them to healthy children and blood donors group respectively. Compared to children, adult patients with T1D showed significantly higher frequencies of ASCA of any isotype (38% vs. 13.7%, p < 10⁻⁴), both ASCA IgG and IgA (12% vs. 1.6%, p = 0.002), ASCA IgG (35% vs. 9.8%, p < 10⁻⁵) and ASCA IgA (15% vs. 5.6%, p = 0.001). The frequency of ASCA was statistically higher in females of all T1D than in males (30.8% vs.17.7%, p = 0.03), in girls than in boys (22% vs.6.2%, p = 0.017), and significantly higher in men than in boys (35.7% vs. 6.2%, p < 10⁻⁴). The frequency of ASCA IgG was significantly higher than that of ASCA IgA in all T1D patients (21% vs. 9.8%, p < 0.002), in all females (26.5% vs. 10.2%, p < 0.002), in women (37.9% vs. 12%, p < 0.001). The frequency of ASCA was significantly higher in all long-term T1D than in an inaugural T1D (29% vs. 14.5%, p = 0.019). The same observation was found in adults (45.8% vs. 17.8%, p = 0.01). In long-term T1D patients, ASCA were significantly more frequent in adults than children (45.8% vs. 14.5%, p < 10⁻⁴). The frequency of ASCA IgG was significantly higher in long-term T1D than in an inaugural T1D (25.2% vs. 11.6%, p = 0.03). Patients with T1D had a high frequency of ASCA.