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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Severe Acute Respiratory Syndrome (SARS) epidemic illustrated the crucial role of infection surveillance and control measures in the combat of any highly transmissible disease. We conducted an interview survey of 121 medical staff 145 doctors, 46 staff nurses and 30 medical assistants) in a state hospital in Malaysia three months after the end of SARS epidemic (from October to December 2003). Staff was grouped according to those directly involved in the care of suspected SARS patients [S+ group n=41] and those who were not [S- group; n=80]. On hand washing following sneezing, coughing and touching patients, the proportions of medical staff that reported an increase after the SARS crisis were 22.3%, 16.5% and 45.5% respectively. On wearing masks, gloves, and aprons when meeting potentially infectious patients, the proportions that reported an increase were 39.7%, 47.1% and 32.2% respectively. Significantly more staff in S+ than S- group reported these increases. Sixty percent of staff was aware of changes in hospital infection control policies after SARS; 93.4% was aware of notifying procedures, and 81.8% was aware of whom to notify in the hospital. Regarding infection isolation ward, Infectious Control Nurse and Infection Control Committee Chairman in the hospital, the proportions of staff that could correctly name them were 39.7%, 38.3% and 15.7% respectively. Significantly more in S+ than S- group could do so. However, more than half the staff claimed ignorance on the knowledge of infection isolation ward (56.2%), Infection Control Nurse (57.9%) and Chairman (65.3%). Our findings demonstrated that SARS crisis had some positive impact on the infection control practices and awareness of medical staff especially on those with direct SARS involvement. Implications for future control of infectious diseases are obvious.
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PMID:Change in infection control practices and awareness of hospital medical staff in the aftermath of SARS. 1588 69

Infection by the cat lungworm Aelurostrongylus abstrusus is considered uncommon. Here, the authors report the clinical, diagnostic and therapeutic features of five infections recently observed in Italy. All cats were under 12 months of age. All except one cat had symptomatic infections, with cough, dyspnea, and weight loss with radiographic signs of broncopneumonia. All cats were eosinophilic. Larvae were present in fresh fecal smears and on flotation exam in all cats. Baermann larval recovery permitted definitive identification and, in one case, larvae per gram of feces (lpg) counts. One dose of ivermectin (400 microg/kg) was not effective in one cat, while one dose of selamectin (6 mg/kg) was effective in one of three cases and fenbendazole at 50 mg/kg given daily for 15 days was effective in four of four cases.
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PMID:Aelurostrongylus abstrusus (cat lungworm) infection in five cats from Italy. 1607 29

Staphylococcal species, usually Staphylococcus aureus or Staphylococcus epidermidis, account for 70% to 95% of pacemaker and cardiac defibrillator infections. Infection limited to the generator pocket may cause pain, redness and swelling that is often accompanied by drainage or fistula formation. In this instance, the generator should be removed and reimplanted at another site as cure is rare with antimicrobial therapy alone. Infection of the leads usually tracks along the wire to include the endocardial surface and may involve the tricuspid valve and pocket. Clinical manifestations vary from mild chronic non-specific symptoms to septic shock with marked localizing signs. Septic embolization to the lungs is common and may cause cough, chest pain and shortness of breath that may be misdiagnosed. Blood culture and trans-oesophageal echocardiography (TOE) are the most important investigations.TOE has a sensitivity of >90%. Lead infection without vegetations may occur and these infections should be treated as for endocarditis. Antimicrobial therapy is an important part of treatment but lead infections are unlikely to cured unless the device is removed. Vancomycin is suitable as initial antimicrobial therapy as this covers both S. aureus and coagulase-negative staphylococci. Flucloxacillin, dicloxacillin or a first-generation cephalosporin are preferred if the organism is sensitive. The addition of low-dose gentamicin may improve bacterial killing. The duration of antimicrobial therapy and timing of replacement of the device have not been determined but 2 weeks treatment before removal and 2-4 weeks treatment after replacement is commonly administered.
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PMID:Diagnosis and management of staphylococcal infections of pacemakers and cardiac defibrillators. 1627 Oct 62

The effect of targeted selective anthelmintic treatment on the seroprevalence of the lungworm Dictyocaulus viviparus in cattle was investigated. The study was commenced on an organic dairy enterprise in Sweden in November 1998 after the observation of an outbreak dictyocaulosis in the herd, and then continued for almost 3 years. The first year sampling was conducted on a monthly basis and then biannually with the exception of between August and November 2000 when sampling was performed monthly following a second outbreak of dictyocaulosis. Throughout the study, blood samples were examined for specific IgG(1) levels from all animals in the herd that had been grazing for more than 3 months. At the first sampling occasion, 13% out of the 90 blood samples were seropositive. One month later, after targeted selective treatment with eprinomectin (Eprinex), Merial), the whole herd was seronegative. Seroprevalence then gradually increased and 1 year later it returned to levels similar to those observed at the start of the study. At turnout in April 2000, seroprevalence was 1.3% but it then rapidly increased to 28% and 30% in August and September, respectively. This increase was mainly due to an increase in FSG animals of which many were coughing. Consequently, all seropositive animals were injected with ivermectin (Ivomec), Merial) at 0.05 mg/kg body weight in late August 2000. Although all animals recovered, seroprevalence was only reduced to 12% 1 month later. The differences in seroprevalence after both of these anthelmintic treatments were probably attributed to the timing. The first deworming with eprinomectin was conducted in November when the infection already was transient, whereas ivermectin in connection with the second outbreak was injected in a more acute phase of the infection cycle. Infection levels in 2001 were low with seroprevalences of 2.3% and 5.6% in May and September, respectively. These results show that dictyocaulosis in Sweden can be effectively controlled by the use of macrocyclic lactones. However, the infection was not eradicated from the herd despite close monitoring of the seroprevalence and targeted selective treatment of every seropositive animal on two occasions.
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PMID:Targeted selective treatment of lungworm infection in an organic dairy herd in Sweden. 1654 76

West Nile virus (WNV) is a member of the Flaviviridae family, genus Flavivirus. Its reservoir hosts are wild birds. Infection is transmitted to humans by infected mosquitoes of the genus Culex. In most cases, it is either asymptomatic or manifests itself as mild fever. Typically, WNV illnesshas a sudden onset with fever above 39 degrees C and accompanying symptoms such as chills, headache, arthralgia, myalgia, back ache, cough and sore throat. Gastrointestinal symptoms are frequently reported. Generalized lymphadenopathy and conjunctivitis may develop. In some patients the infection can progress to meningoencephalitis. Diagnosis is currently based on detection of IgM antibodies in blood and cerebrospinal fluid or direct detection of WNV RNA.
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PMID:[West Nile virus fever]. 1661 42

If an influenza pandemic occurs, the spread of the virus should be reduced for as long as possible while an effective vaccine is produced. Influenza spreads mainly by large respiratory droplets (> 5 microm) depositing onto the mucosal surfaces of the eye, mouth or respiratory tract. Hands are another major means for spread, and are frequently contaminated by droplets. The most effective way to reduce the spread of the virus is with good infection control practices and social distancing. Infection control practices include the use of personal protective equipment (PPE), hand hygiene, and respiratory hygiene and cough etiquette. Infected people should be isolated and spatial separation observed in common areas where infected people may be present. Any practices that create aerosols (eg, nebulisation) should be avoided, unless performed with appropriate precautions, especially with all people in the room wearing appropriate PPE. Now is the time to re-examine all our current practices so that we are better prepared, well practised and have good infection control practices in place for all transmissible respiratory infections.
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PMID:Infection control and pandemic influenza. 1711 53

Influenza viruses represent Orthomyxoviridae family. Spherical virions are 80-120 nm in diameter and have two-layer lipid envelope. The following proteins are coded by 8 or 7 segments of the single-stranded RNA: nucleoprotein (NP), polymerase PB2, PB1 and PA, member protein--M1 and M2, glycoproteins--hemagglutinin (HA) and neuraminidase (NA). HA and NA form spikes on the virion surface. On the basis of antigenic differences there are distinguished three types of influenza virus-A, B and C. Besides, influenza A viruses occur in different subtypes, depending on the features of HA and NA. One of influenza characteristics is its antigenic changeability: antigenic drift and antigenic shift. Infection occurs by droplet route, sometimes through direct contact with infected person or surface. Influenza virus attacks epithelial cells of upper respiratory tract, where replication takes place resulting in the production of approximately 1000 of progeny virions during a single 6-12 h cycle in one cell. Necrosis of ciliary cells of mucosa facilitates invasion of bacterial pathogens. Incubation period lasts on average 1-2 days. Influenza illness without complications characterizes the sudden onset of respiratory symptoms and systemic symptoms. Regression of symptoms usually occurs after 3-5 days, but cough and malaise may be observed for over 2 weeks. Reasons for the severe course of the disease or even death are post-influenza complications, e.g. viral pneumonia and bronchitis, bronchiolitis in children, secondary bacterial pneumonia, otitis media, myocarditis and pericarditis, Reye's syndrome, myositis, myoglobinuria, neurological complications and exacerbation of existing chronic diseases. In the case of influenza there is no possible to make the unquestionable diagnosis only on the basis of clinical picture of the disease. Therefore in some circumstances there is important to make some diagnostic laboratory tests as RT-PCR, immunofluorescence assay or isolation of virus and detection of the specific antibodies. The main determinants of the immunity to influenza virus infection are antihemagglutinin (anti-HA) antibodies and antineuraminidase antibodies (anti-NA). The former play fundamental role for the protection against the infection, while anti-NA antibodies limit virus spreading and contribute to a milder course of the disease. In the response to influenza infection there are observed serum immunoglobulines IgG and IgM (after the first contact with the antigen), while immunoglobulines IgA are produced rarely. The latter are produced locally in the high concentrations on the mucus of respiratory tract. Cellular immunological response is important for recovery from influenza where a significant role of cytotoxic T lymphocytes should be emphasized. These lymphocytes are able to kill infected cells in the earliest phases of replication before the progeny virions are formed.
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PMID:[Various sides of influenza, part I--structure, replication, changeability of influenza viruses, clinical course of the disease, immunological response and laboratory diagnostics]. 1716 90

Since the American Academy of Pediatrics published a statement titled "Infection Control in Physicians' Offices" (Pediatrics. 2000;105[6]:1361-1369), there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated annually, and enforced. The standard precautions for hospitalized patients from the Centers for Disease Control and Prevention, with a modification from the American Academy of Pediatrics exempting the use of gloves for routine diaper changes and wiping a well child's nose or tears, are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration to take precautions to identify and protect employees who are likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of standard precautions include hand hygiene (ie, use of alcohol-based hand rub or hand-washing with soap [plain or antimicrobial] and water) before and after every patient contact; implementation of respiratory hygiene and cough-etiquette strategies for patients with suspected influenza or infection with another respiratory tract pathogen to the extent feasible; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices and evaluation and implementation of needle-safety devices; appropriate use of personal protective equipment such as gloves, gowns, masks, and eye protection; and appropriate sterilization, disinfection, and antisepsis.
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PMID:Infection prevention and control in pediatric ambulatory settings. 1776 40

Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) is a serious opportunistic infection in children and adolescents with cancer. It was the most common cause of death among children receiving chemotherapy prior to the inclusion of PCP prophylaxis as part of standard care for children with leukemia. The incidence of PCP has decreased significantly since initiation of prophylaxis; however, breakthrough cases continue to occur. Hematologic malignancies, brain tumors necessitating prolonged corticosteroid therapy, hematopoietic stem cell transplantation, prolonged neutropenia, and lymphopenia are the most important risk factors for PCP in children not infected with HIV. Of children with leukemia, 15-20% may develop PCP in the absence of prophylaxis. Infection with P. jiroveci occurs early in life in most individuals. However, clinically apparent disease occurs almost exclusively in immunocompromised persons. Dyspnea, cough, hypoxia, and fever are the most common presenting symptoms of PCP. Chest radiography and high-resolution CT scans of the chest demonstrate a characteristic ground-glass pattern. Induced sputum analysis and bronchoalveolar lavage are the diagnostic procedures of choice. Gomori's methenamine-silver stain, Geimsa or Wright's stain, and monoclonal immunofluorescent antibody stains are most commonly used to make a diagnosis. However, identification of P. jiroveci DNA using polymerase chain reaction assays in bronchoalveolar lavage fluid is more sensitive. Trimethoprim-sulfamethoxazole (TMP-SMZ; cotrimoxazole) is the recommended drug for the treatment of PCP. Patients who are intolerant of TMP-SMZ or who have not responded to treatment after 5-7 days of therapy with TMP-SMZ should be treated with pentamidine. A short course of corticosteroids is recommended for moderate to severe cases of PCP within the first 72 hours after diagnosis. Mutations in the dihydropteroate synthetase gene may confer resistance to TMP-SMZ; however, the clinical relevance of these mutations is not well established. TMP-SMZ is the most commonly used agent for prophylaxis. Myelosuppression is the most important adverse effect of TMP-SMZ and the most frequent cause for choosing alternative prophylactic agents in children undergoing chemotherapy. Alternative agents for chemoprophylaxis include dapsone, aerosolized pentamidine, and atovaquone. Alternative prophylactic agents must be used in patients developing myelosuppression secondary to TMP-SMZ or dapsone.
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PMID:Management of Pneumocystis jiroveci pneumonia in children receiving chemotherapy. 1792 2

Infections caused by Aspergillus spp. in immunocompromised or atopic patients may present as invasive aspergillosis, allergic bronchopulmonary aspergillosis and aspergilloma. In this report a 69 years old female patient admitted to the hospital with the complaints of intermittent cough and sputum and diagnosed as endonbronchial aspergilloma, has been presented. The patient was not immunocompromised, however she has bronchial asthma for 10 years and the disease is now under control. The chest radiography and computed tomography revealed lung infiltration with undefined borders, and bronchoscopy demonstrated the presence of a mass at left lower lobe. In the pathologic examination of biopsy specimen with the use of methenamine silver and PAS methods, hyphae formations concordant with Aspergillus were detected. The direct microscopic examinations of biopsy material and sputum obtained after bronchoscopy, have also revealed the presence of hyphae. A. fumigatus was isolated from the cultures of biopsy material and sputum specimen. The patient was diagnosed as endonbronchial aspergilloma, however the follow-up was failed since she has not accepted medical or surgical treatment. In conclusion, aspergilloma should be considered in the differential diagnosis of mass lesions in the endobronchial area.
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PMID:[A case of endobronchial aspergilloma]. 1844 75


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