医护人员暴发肺炎衣原体肺炎12例临床特征分析

目的总结肺炎衣原体(CP)肺炎暴发流行的临床特征及治疗方法。方法收集2009-01-04—2009-03-01中国医科大学附属第四医院暴发流行的12例医护人员CP肺炎咽试纸标本,应用聚合酶联反应(PCR)检测DNA,使用微量免疫荧光技术检测CP的IgG和IgM抗体,同时对肺高分辨CT结果进行分析,并评价疗效。结果本组暴发流行的CP肺炎其病原学介于CP与鹦鹉热衣原体之间的一种变异的衣原体种,且更倾向于鹦鹉热衣原体。临床表现为乏力10例,周身酸痛10例,发热6例,咳嗽、咳少量白痰2例,心悸、气短2例,皮疹1例,稀水样便1例,12例均无咯血、胸痛、呼吸困难及精神症状,肺部体征均为阴性。所有患者肺部高分辨CT均有改变,表现为多发或单发以小叶为中心阴影和腺泡状结节影3例,病变可发生在两肺各个叶段,多以外、中带分布;以小叶分布的气腔实变和磨玻璃样阴影分别为4例和1例,伴有支气管血管束增厚3例;球形影1例;结节影与实变影混合存在3例。结论医护人员CP肺炎的暴发流行具有群体发病,早期高分辨CT检查更能真实地反映病变大小、多少和分布范围。对氟喹诺酮类联合大环内酯类药物治疗有效。诊断时应与严重急性呼吸综合征、禽流感、支原体肺炎等进行鉴别。     

Regional Pharmaceutical Preparation for Biological and Chemical Terrorism

Background: The United States National Office of Domestic Preparedness has determined that the threat of a biological or chemical attack is very real. As an active participant of a 13-county regional task force, one of the roles of the poison center was to determine the pharmaceutical needs of the community in the event of a terrorist action and develop a financially responsible method of acquisition and storage. Methods: Working with local health officials, an extensive literature review was conducted to identify possible biological and chemical poisons. Treatment recommendations were identified and an estimated amount to treat 5,000 people for 24 hrs was determined. Instead of purchasing the medications, a unique solution utilizing a regional pharmacy wholesaler was used. Discussion: An important element in a biological or chemical terrorist event is the availability of the pharmaceuticals and the capability of delivering them rapidly. The poison center is the ideal agency to help coordinate this endeavor since it is familiar with contemporary therapy and will be aware of the number, location, and status of casualties. Based on the expense involved in the purchase and storage of a large quantity of medications, utilizing a local pharmaceutical distribution company is fiscally responsible. Rotation through normal stock and being readily accessible is another benefit. Conclusion: The poison center serves a number of roles in the surveillance, recognition, and treatment of biological and chemical terrorism. Assisting in the development, implementation, and procurement of a pharmaceutical cache is yet another role.     

New generation sequencing in pathogen discovery and microbial surveillance

23rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

Berlin, Germany, 27–30 April 2013

The annual congress of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) is recognized as the largest European congress for the presentation and discussion of the key priorities and more recent scientific developments in the fields of clinical microbiology and infection. This year, it attracted almost 10,000 participants from all over the world. Keynote lectures, symposia, meet-the-expert sessions, educational workshops, poster and oral sessions covered the diagnosis, treatment, epidemiology and prevention of infectious diseases, as well as related basic microbiology. Moreover, interactive sessions addressing specific subjects underlined the important educational aspect of the ECCMID’s congress. The scientific program, abstracts, oral presentations are available at their website . This meeting report is focused on one of the several challenging and one of the most transversal topics of the meeting: the application of the next-generation sequencing (NGS) to the microbial world.     

Outbreaks of influenza‐like illness in long‐term care facilities in Winnipeg,Canada

Please cite this paper as: Mahmud et al. (2012) Outbreaks of influenza‐like illness in long‐term care facilities in Winnipeg, Canada. Influenza and Other Respiratory Viruses 10.1111/irv.12052 Background  Outbreaks of influenza‐like illness (ILI) are common in long‐term care facilities (LTCFs) and result in significant morbidity and mortality among residents. Objectives  We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. Methods  We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents’ death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Results  Of a total of 154 reported outbreaks, most (N = 80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Conclusions  Influenza‐like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks.     

Evolution of Ebola Virus Disease from Exotic Infection to Global Health Priority,Liberia, Mid-2014

Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country’s health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.     

Characteristics of Tuberculosis Cases that Started Outbreaks in the United States, 2002–2011

A review of 26 tuberculosis outbreaks in the United States (2002–2011) showed that initial source case-patients had long infectious periods (median 10 months) and were characterized by substance abuse, incarceration, and homelessness. Improved timeliness of diagnosis and thorough contact investigations for such cases may reduce the risk for outbreaks.     

前瞻性时空扫描统计量方法在手足口病暴发预警中的参数筛选

目的 根据手足口病的流行特点,比较和筛选时空扫描统计量方法较好的预警参数,从而更好的应用于手足口病暴发早期探测预警.方法 以真实的暴发事件作为参考数据,灵敏度、探测时间间隔和阳性预测值为评价指标,采用前瞻性时空扫描统计量方法,利用不同时空参数对山东省青岛市2009年6月手足口病病例数据逐日模拟预警探测,比较4种参数不同设定值的24种预警效果.结果 时间窗口设置为3天和基线设置为最近21天的病例数据进行时空扫描统计量预警运算,具有最优的预警效果.候选聚集区域范围的设定对预警效果无统计显著性.结论 采用前瞻性时空扫描统计量进行传染病暴发预警时,具有最优的参数,但相同的传染病在不同区域可能有不同的预警参数,下一步应该根据相同传染病在不同地区筛选最优参数方案.     

Pulmonary edema of enterovirus 71 encephalomyelitis is associated with left ventricular failure: implications for treatment

Epidemics of enterovirus 71 infections caused the rapid death of many children in Malaysia in 1997 and in Taiwan in 1998. Pulmonary edema occurred in most of the fatal cases and was considered to be neurogenic. The role of the heart was rarely investigated before. Between January 1998-January 2001, 34 consecutive patients who were admitted to the intensive care unit due to enterovirus infection were studied prospectively. Patients were divided into two groups: group I with pulmonary edema, and group II without pulmonary edema. Comparisons were made between the two groups based upon demographic, neurological, and cardiovascular manifestations. Group I consisted of 11 patients (5 boys, 6 girls; mean age, 22.8 months), and group II of 23 patients (12 boys, 11 girls; mean age, 28.8 months). There were no significant differences between the two groups in comparing sex, age, body weight, neurological severity, intracranial pressure, cell count, protein and glucose levels in cerebral spinal fluid, and blood pressure. All group I patients had left ventricular dysfunction, and their ejection fractions were significantly lower than those of patients in group II (37 +/- 11% vs. 75 +/- 6%, P < 0.001). Group I heart rates were higher than those of group II (175 +/- 24 vs. 137 +/- 25, P < 0.001). In group I, 9 patients who received conventional treatment died, and the only two survivors received left ventricular assist devices. In conclusion, the pulmonary edema of fulminant enterovirus 71 infection is associated with left ventricular failure. Left ventricular function is the major determinant of outcome. Early recognition of heart failure and aggressive cardiac intervention are life-saving. Pediatr Pulmonol. 2003; 35:263-268.