Invasive group B streptococcal infection in infants, Malawi

Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi. In Queen Elizabeth Central Hospital, Blantyre, Malawi, during May 2004-June 2005, GBS were isolated from routine blood and cerebrospinal fluid cultures from 57 infants. The incidence of early (EOD) and late onset (LOD) invasive GBS disease was 0.92 and 0.89 cases per 1,000 live births, respectively. Sepsis (52%) was the most common manifestation of EOD; meningitis (43%) and sepsis (36%) were the principal manifestations of LOD. The case-fatality rate was 33% overall (38% EOD, 29% LOD). Serotypes Ia and III were responsible for 77% of disease. All isolates were susceptible to penicillin, but 21% were resistant to erythromycin. The rate and manifestations of neonatal GBS disease in Malawi are similar to those in industrialized countries, but the case-fatality rate is higher than in industrialized countries. Effective locally relevant prevention strategies are needed.     

Adoption of protective behaviors among persons with recent HIV infection and diagnosis--Alabama, New Jersey, and Tennessee, 1997-1998

A comprehensive human immunodeficiency virus (HIV) prevention strategy includes knowledge of HIV status, counseling to reduce high-risk behavior, and referral for appropriate care (1). After diagnosis, a substantial percentage of HIV-infected persons reduce their high-risk sexual behaviors (2-4). This report presents data characterizing the sexual practices of persons with newly diagnosed HIV infection who have evidence of recently acquired infection. Characterizing these persons may assist in the development of risk-reduction efforts for HIV-infected populations to prevent further HIV transmission.     

HIV infection among paediatric in-patients in Blantyre, Malawi

To investigate the impact of HIV infection on hospital admission and death we studied children admitted to paediatric medical and surgical wards in Blantyre, Malawi, in March 2000. Unselected children whose parents or guardians consented to HIV testing of the child were recruited and HIV infection was determined by serology, with confirmation in children aged 15 months or less by PCR. We assessed the prevalence of HIV infection by age, clinical diagnosis and outcome of admission. Of 1064 admissions, 991 were tested for HIV infection, and 187 (18.9%) were infected. HIV was most common in children aged less than six months, 53 of 166 (32%). Parents of HIV-infected children were better educated, and more likely to have died, than those of uninfected children. Clinical symptoms and signs were not adequately sensitive or specific to be used for diagnosis of HIV. HIV was common in children with malnutrition (prevalence 40%), lower respiratory tract infection (29%) and sepsis (28%), and less prevalent among children with malaria (11%) or surgical admissions (11%). Almost 30% of HIV-infected children died, compared with 8.9% of uninfected children, and HIV-infected children constituted over 40% of in-patient deaths.     

Environmental mycobacteria in northern Malawi: implications for the epidemiology of tuberculosis and leprosy

More than 36000 individuals living in rural Malawi were skin tested with antigens derived from 12 different species of environmental mycobacteria. Most were simultaneously tested with RT23 tuberculin, and all were followed up for both tuberculosis and leprosy incidence. Skin test results indicated widespread sensitivity to the environmental antigens, in particular to Mycobacterium scrofulaceum, M. intracellulare and one strain of M. fortuitum. Individuals with evidence of exposure to 'fast growers' (i.e. with induration to antigens from fast growers which exceeded their sensitivity to tuberculin), but not those exposed to 'slow growers', were at reduced risk of contracting both tuberculosis and leprosy, compared to individuals whose indurations to the environmental antigen were less than that to tuberculin. This evidence for cross protection from natural exposure to certain environmental mycobacteria may explain geographic distributions of mycobacterial disease and has important implications for the mechanisms and measurement of protection by mycobacterial vaccines.     

Disease caused by non-tuberculous mycobacteria in a university hospital in Taiwan, 1997-2003

From January 1997 to December 2003, all patients with non-tuberculous mycobacteria (NTM) isolation who were treated at a university hospital in Taiwan were evaluated. Among the 2650 NTM isolates, 1225 (46.2%) were from 412 patients with clinically significant diseases. The annual incidence (per 100000 patients) of disease caused by NTM was 8.96 in 1997, 21.53 in 2002, and 16.55 in 2003. The major types of infections caused by NTM included isolated pulmonary infection and pleurisy (59.5%), skin/soft-tissue infections and osteomyelitis (13.8%), and disseminated diseases (13.3%). The two most common groups of organisms involved were rapidly growing mycobacteria (RGM) (41.4%) and Mycobacterium avium complex (MAC) (39%). The most common organism involved in isolated pulmonary infection and pleurisy was MAC (44.1%). RGM predominated in keratitis (94%), skin/soft-tissue infections and osteomyelitis (43.9%), and lymphadenitis (66.7%). This retrospective 7-year study demonstrated an increase in the incidence of NTM disease in a university hospital.     

HIV infection and fertility preferences in rural Malawi

Although HIV-prevalence and fertility rates in sub-Saharan Africa are among the highest in the world, little is known about how HIV infection affects the fertility preferences of men and women in the region. A quasi-experimental design and in-depth interviews conducted in rural Malawi are employed to examine how and through what pathways learning that one is HIV positive alters a person's childbearing desires. Among rural Malawians, particularly men, the desire to have more children decreases after receiving a positive HIV-test result. The motivations underlying this effect are greatly influenced by gender: women fear the physical health consequences of HIV-positive pregnancies and childbearing, whereas men see childbearing as futile because they anticipate their own early death and the deaths of their future children. Considerable ambivalence remains, nevertheless, particularly among women who strategize to live normal lives in spite of their infection, but whose definitions of "normal" vary.     

AIDS并发非结核分枝杆菌感染的临床分析

目的 探讨AIDS患者合并非结核分枝杆菌(Nontuberculous mycobacteria,NTM)感染的临床特点.方法 选择33例AIDS并发NTM感染患者,分析其临床特点、病变部位、免疫状态等,并与AIDS并发结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染患者比较.结果 33例AIDS合并NTM感染者中,CD4+T细胞计数的中位数为18个/μl,HGB(93.8±22.9)g/L,29例患者(87.9%)出现贫血;单核细胞比例(8.66±5.08)%,16例(48.5%)单核细胞比例升高;ALB(32.7±5.2)g/L,31例(93.9%)ALB降低.播散性NTM为18例,占54.5%.病变部位以肺部为主,CT主要表现为炎症渗出,多发结节影,部位不固定,呈现弥散趋势24例(72.7%).与同期培养为MTB感染者比较,在临床、实验室特点方面差异无统计学意义.结论 AIDS患者合并NTM多发生于免疫功能严重低下的情况,易合并贫血及低蛋白血症.NTM感染的临床特点与MTB感染不易鉴别.     

Self-reported visual impairment among persons with diagnosed diabetes --- United States, 1997--2010

Diabetes can lead to visual impairment (VI) and blindness (1). However, early detection and treatment of many common eye diseases, such as diabetic retinopathy and glaucoma, can reduce the risk for developing VI (1). Surveillance of VI among persons with diabetes is important for evaluating the effectiveness of efforts to reduce VI and other complications of diabetes. To examine trends in the prevalence of self-reported VI among adults (persons aged ≥18 years) with diagnosed diabetes in the United States and to assess reported access to eye-care providers, CDC analyzed 1997-2010 data from the National Health Interview Survey (NHIS). This report describes the results of that analysis, which indicated that although the number of adults with diagnosed diabetes reporting VI increased, the age-adjusted percentage of adults with diagnosed diabetes who reported VI declined significantly, from 23.7% in 1997 to 16.7% in 2010. During this 14-year period, age-adjusted VI prevalence declined significantly among most categories of adults with diabetes: men, women, whites, Hispanics, those with some college or higher education, and those diagnosed with diabetes for ≥3 years. Prevalence also declined among those aged ≥45 years. The percentage of adults with diagnosed diabetes and self-reported VI who reported having consulted an eye-care provider in the past year remained constant at approximately 63%. Continued efforts are needed to sustain and improve the declining trends in self-reported VI and to increase rates of recommended eye examinations in the population with diabetes.     

Pulmonary infection caused by non-tuberculous mycobacteria in two patients with bronchiectasis

Two patients, a woman aged 67 years and a man aged 80 years, had chronic cough among other respiratory symptoms. In the woman, chest radiograph and CT-scan revealed partial atelectasis of the middle lobe and bronchiectasis. In the man, an interstitial pattern was seen on chest radiograph, and CT scan showed diffuse bronchiectasis. In both the man and the woman, non-tuberculous mycobacteria were identified (Mycobacterium avium complex and Mycobacterium abscessus, respectively). Treatment was successful in both patients. Non-tuberculous mycobacteria can cause considerable pulmonary infection in patients with bronchiectasis.     

Nosocomial group A streptococcal infections associated with asymptomatic health-care workers--Maryland and California, 1997

Group A Streptococcus (GAS), a common cause of pharyngitis and uncomplicated skin and soft tissue infections, can cause serious invasive infections (including necrotizing fasciitis and streptococcal toxic-shock syndrome [STSS]) and death. Since 1965, at least 15 postoperative or postpartum GAS outbreaks attributed to asymptomatic carriage in health-care workers (HCWs) have been reported. This report describes two nosocomial outbreaks of GAS infection in Maryland and California during 1996-1997; the findings suggest that early infection-control measures that include active surveillance may interrupt transmission and prevent morbidity and mortality.     

Group B Streptococcus and HIV infection in pregnant women, Malawi, 2008-2010

To determine whether an association exists between group B streptococcus carriage and HIV infection, we recruited 1,857 pregnant women (21.7% HIV positive) from Queen Elizabeth Central Hospital, Blantyre, Malawi. Overall, group B streptococcus carriage was 21.2% and did not differ by HIV status. However, carriage was increased among HIV-positive women with higher CD4 counts.     

Disseminated Neocosmospora vasinfecta infection in a patient with acute nonlymphocytic leukemia

We report Neocosmospora vasinfecta infection following chemotherapy for acute nonlymphocytic leukemia. N. vasinfecta, a plant pathogen, was identified by culture and genetic sequencing. Susceptibility testing revealed in vitro resistance for common antifungals.     

手术切口非结核分枝杆菌感染1例

非结核分枝杆菌(nontuberculous mycobacteria,NTM)是指结核分枝杆菌、牛分枝杆菌与麻风分枝杆菌以外的分枝杆菌。NTM是自然界中广泛存在的条件致病菌,存在于水、土壤和气溶胶中,可以导致免疫力低下的患者发生感染［1］。2013年2月,本院心胸外科医生报告1例手术切口迁延不愈的病例,医院感染管理部（院感部）接到报告后根据临床症状及微生物实验室检验结果,确认为NTM（快速生长型）感染病例。遂结合文献,对感染的原因开展现场与流行病学调查,现报告如下。