Management of unexpected laboratory exposure to Burkholderia pseudomallei.

Burkholderia pseudomallei is a Gram-negative saprophytic bacillus that causes melioidosis. The infection is endemic in South-East of Asia and Northern Australia. B. pseudomallei has been designated as bioterrorism agent and its manipulation should be done in a biological safety level 3 capability. Workers in laboratories may be accidentally exposed to B. pseudomallei before its identification, with a risk of laboratory-acquired melioidosis. We want to describe a case of melioidosis occurred in our hospital and its management at laboratory. The objective of this article is to provide guidance to microbiologists confronted with a suspicious case of B. pseudomallei on the management of the exposition. We report here a couple of microbiological arguments that can usually guide microbiologists towards presumptive identification of B. pseudomallei. This case report shows the importance of MALDI-TOF MS accurate databases to ensure accurate microbial identification and antibiotic prophylaxis adapted to individuals who were exposed. We also want to underline the importance of developing an effective strategy of prevention against any accidental exposure that can occur in a microbiological laboratory.

Burkholderia pseudomallei Laboratory Exposure, Arizona, USA.

We describe an incidental Burkholderia pseudomallei laboratory exposure in Arizona, USA. Because melioidosis cases are increasing in the United States and B. pseudomallei reservoirs have been discovered in the Gulf Coast Region, US laboratory staff could be at increased risk for B. pseudomallei exposure.

Staggered enforcement of infection control and prevention measures following four consecutive potential laboratory exposures to imported Brucella melitensis.

From 2015 until 2020, Brucella melitensis was isolated four times in our microbiology laboratory. All patients had travelled in endemic-areas. Immediately after the first occurrence, all laboratory staff were risk-stratified and preventive and protective measures were applied according to CDC guidelines. Nineteen workers were exposed and needed chemoprophylaxis and follow-up. At each subsequent occurrence, risk analysis was performed, and additional measures were implemented accordingly, leading to a progressive reduction of exposed staff members to none the fourth time. We describe here the additional measures that permitted this important exposure reduction.

Are bio-based and biodegradable microplastics impacting for blue mussel (Mytilus edulis)?

The substitution of petrochemical plastics by bio-based and biodegradable plastics are in need of an evaluation for the potential toxic impacts that they can have on marine wildlife. This study aims to assess the toxicological effects of polylactic acid microparticles at two concentrations, 10 and 100 µg/L, during 8 days on the blue mussel, Mytilus edulis. No significant oxidative stress (catalase, glutathione-S-transferase and superoxide dismutase activities), neurotoxicity (acetylcholinesterase), or immunotoxicity (lysosomal membrane stability and acid phosphatase activity) were detectable. The multivariate analysis of metabolomic data allowed us to differentiate the individuals according to the exposure. From the loading plot of OPLS-DA, 48 ions down-regulated in the individuals exposed to microplastics. They were identified based on HRMS data as glycerophospholipids.

Brucellosis - laboratory workers' nightmare come true: A case study.

INTRODUCTION: Brucella spp. are rarely encountered organisms in the medical microbiology laboratory and, when encountered, can cause concern in laboratory workers. Laboratory personnel may in fact develop serious disease as a result of this exposure. This case highlights shortcomings in recognition of Brucella spp. from a patient presenting atypically as well as the follow-up and management of an infected patient. CASE PRESENTATION: The patient was an 8-year-old boy from a rural area of South Africa who presented to an academic hospital with a bladder mass and history of enuresis in September 2016. Brucella melitensis was isolated from a blood culture submitted to the laboratory. The child was subsequently treated for brucellosis in November 2016. MANAGEMENT AND OUTCOME: The source of infection in the patient was traced to consumption of unpasteurised milk from a local farmer. The patient was treated with doxycycline 100 mg twice daily and rifampicin 600 mg daily for 6 weeks and completed treatment, however he was not followed up at our hospital. The laboratory personnel, however, did not handle the specimen as a Biosafety Level 3 pathogen as this organism is not commonly encountered; they were provided with prophylaxis for brucellosis (rifampicin and doxycycline). CONCLUSION: Brucella spp. is a dangerous pathogen, easily capable of causing significant exposure in an unsuspecting and unprepared laboratory. The case discusses the management of brucellosis in the infected patient as well as the management of laboratory exposure to Brucella spp. Our case also describes the public health response to a case of brucellosis.

The effects of metaldehyde on non-target aquatic macroinvertebrates: Integrating field and laboratory-based evidence.

The use of pesticides has historically helped improve agricultural productivity, although their continued use may have unforeseen effects upon the natural environment when not applied appropriately. Metaldehyde is a commercial pesticide widely used to reduce crop losses resulting from terrestrial mollusc damage. However, following precipitation and runoff it frequently enters waterbodies with largely unknown consequences for aquatic fauna. This study represents one of the first attempts to examine its potential effects on aquatic macroinvertebrate communities at sites known to have experienced elevated metaldehyde concentrations alongside unaffected control sites. In addition, a series of laboratory exposures specifically examined the effects of metaldehyde on the survivorship of non-target aquatic mollusc species. When the entire aquatic macroinvertebrate community and aquatic mollusc community were considered, limited differences were observed between metaldehyde affected and control sites based on field data. Laboratory exposures highlighted that for the molluscs examined, gastropods (Bithynia tentaculata, Planorbis planorbis, Radix balthica and Potamopyrgus antipodarum) had a greater tolerance to metaldehyde than bivalves (Sphaerium corneum and Corbicula fluminea). However, the concentrations required to reduce survivorship of all species were much greater than those ever recorded historically under field conditions. The results suggest that the differences in the community composition recorded between sites exposed to elevated metaldehyde concentrations and control sites were probably due to nutrient loading (N and P from agricultural fertilizers) rather than metaldehyde. However, these results do not negate wider concerns regarding metaldehyde use, particularly issues caused when ingested by vertebrate wildlife, livestock or children and pets in domestic settings.

Imported Brucellosis In The Era Of Dramatically Increasing Immigrants And Foreign Travelers From Endemic Areas: Occupational Hazards Of Secondary Infection Among Laboratory Technicians In A Nonendemic Country.

BACKGROUND: Brucellosis, an important zoonotic disease, is endemic in various parts of the world. Patients diagnosed with brucellosis in developed countries are often travelers and immigrants from endemic areas. This pathogen is listed as biosafety level 3, which means that it is highly contagious and therefore a risk to clinical laboratory technicians. CASE PRESENTATION: A 43-year-old Chinese man, who could not understand Japanese, visited our hospital because of an intermittent fever that had persisted for 5 months. Associated symptoms included muscle pain whenever he had a fever. He reported currently working as a welder in Japan. However, his previous employment working in animal husbandry in Heilongjiang, mainland China was not determined at the initial visit owing to language barriers. Two sets of blood culture showed nonfermenting gram-negative bacilli, initially misidentified as Ochrobactrum anthropi and subsequently identified as Brucella abortus. Six-week doxycycline and rifampicin were administered, with intravenous gentamicin for the initial 1 week. The patient recovered without relapse, confirmed by the negative result of a Brucella agglutination test. The patient's wife and three laboratory technicians were required to undergo blood examinations, which revealed no evidence of infection; however, they received prophylaxis with 3 weeks' doxycycline and rifampicin. CONCLUSION: In nonendemic countries, immigrants with imported brucellosis can be treated, to prevent secondary brucellosis infection, an occupational hazard among laboratory technicians. Greater attention is needed for positive findings of blood cultures, which may initially be misidentified as O. anthropi. When providing medical care for immigrants with fever of unknown origin, it is especially important for primary care physicians to overcome language barriers so as to assess pertinent information regarding their home country, such as previous employment, to prevent the spread the imported zoonoses in the era of a dramatically increasing number of immigrants and foreign travelers.

Laboratory exposure to Coccidioides: lessons learnt in a non-endemic country.

Coccidioides is a primary pathogenic fungus, which infects humans through highly infectious arthroconidia, causing substantial morbidity including life-threatening disseminated infections. Due to the low infectious dose, laboratory personnel might become infected during diagnostic procedures. Accordingly, coccidioidomycosis is reported as the most frequent laboratory-acquired systemic mycosis worldwide. This risk is aggravated in non-endemic countries, where the diagnosis may not be suspected. We report on an inadvertent exposure of 44 persons to Coccidioides posadasii in a clinical microbiology laboratory in Chile, the measures of containment after rapid diagnosis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the lessons learnt in a non-endemic setting.

Evaluation of airborne asbestos exposure from routine handling of asbestos-containing wire gauze pads in the research laboratory.

Three independently conducted asbestos exposure evaluations were conducted using wire gauze pads similar to standard practice in the laboratory setting. All testing occurred in a controlled atmosphere inside an enclosed chamber simulating a laboratory setting. Separate teams consisting of a laboratory technician, or technician and assistant simulated common tasks involving wire gauze pads, including heating and direct wire gauze manipulation. Area and personal air samples were collected and evaluated for asbestos consistent with the National Institute of Occupational Safety Health method 7400 and 7402, and the Asbestos Hazard Emergency Response Act (AHERA) method. Bulk gauze pad samples were analyzed by Polarized Light Microscopy and Transmission Electron Microscopy to determine asbestos content. Among air samples, chrysotile asbestos was the only fiber found in the first and third experiments, and tremolite asbestos for the second experiment. None of the air samples contained asbestos in concentrations above the current permissible regulatory levels promulgated by OSHA. These findings indicate that the level of asbestos exposure when working with wire gauze pads in the laboratory setting is much lower than levels associated with asbestosis or asbestos-related lung cancer and mesothelioma.

An accidental laboratory exposure to Brucella melitensis: the prospective post-exposure management and a detailed investigation into the nature of the exposure.

Our aim was to prospectively manage 22 Brucella-exposed individuals and identify the lapses in laboratory practices that lead to the exposure. The exposed individuals were risk-stratified, assessed for post-exposure prophylaxis (PEP), counselled to self-monitor symptoms and followed-up with three serology tests. Staff laboratory practices were recorded. Ten out of 13 high-risk individuals received PEP within 48 h of exposure. Compliance with PEP and serology monitoring was 90 and 96 %, respectively. No brucellosis cases were documented. A single handler manipulated the Brucella isolate on the open bench. Movement of the isolate was tracked in detail, highlighting various points of laboratory non-conformance. Early PEP intervention is effective in preventing acquired brucellosis. Our pragmatic post-exposure management achieved high PEP and serology compliance. We experience first-hand how regular staff engagement motivated PEP adherence and interval blood sampling attendance. The enforcement of practical strategies and safety practices was also implemented without compromising our laboratory processing times.

Human Brucella canis Infection and Subsequent Laboratory Exposures Associated with a Puppy, New York City, 2012.

Human Brucella canis infection incidence is unknown. Most identified cases are associated with pet dogs. Laboratory-acquired infections can occur following contact with Brucella spp. We identified a paediatric B. canis case, the source and other exposed persons. A 3-year-old New York City child with fever and dyspnoea was hospitalized for 48 h for bronchiolitis. After her admission, blood culture grew B. canis, she was prescribed anti-microbials and recovered. B. canis was also isolated from blood of the child's pet dog; these isolates were genetically similar. The dog originated from an Iowa breeding facility which was quarantined after identification of the dog's infection. Additionally, 31 laboratory workers were exposed and subsequently monitored for symptoms; 15 completed post-exposure prophylaxis. To our knowledge, this is the first report strongly suggesting B. canis zoonotic transmission to a child in the United States, and highlights the need for coordinated control policies to minimize human illness.

Laboratory exposure to Brucella melitensis in Denmark: a prospective study.

Brucella species are a frequent cause of laboratory-acquired infections. This report describes the handling of a laboratory exposure of 17 laboratory staff members exposed to Brucella melitensis in a large microbiology laboratory in a brucella-non-endemic area. We followed the US Centers for Disease Control and Prevention guidelines, but, of 14 staff members classified as high-risk exposure, none accepted post-exposure prophylaxis. However, in a period of 6 months of follow-up, none of the exposed laboratory workers developed brucellosis and all obtained sera were negative for antibrucella antibodies. We therefore question the value of routine serological follow-up.