Prevention of infection in the immunocompromised host.

The Association for Professionals in Infection Control and Epidemiology, Inc, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. This learner-paced study package is designated for 1.1 contact hours. APIC's California nursing provider number is CEP 7146. This continuing medical laboratory education activity is recognized by the American Society of Clinical Pathologists as meeting the criteria for 1 CMLE credit hour. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Continuing Competence Recognition Program. (See the instructions and examination at the end of the article.)Infectious diseases represent a major cause of morbidity and mortality in immunocompromised patients. Infectious complications are often predictable and may be preventable. This article is an overview of practical considerations in the care of immunocompromised patients. Recognizing the compromised host, identifying and correcting risk factors in advance, and reducing sources of infection all play a role in prevention. Topics were chosen to include the areas of care that differ from the immune competent patient, such as diet, pet therapy, handwashing, immunizations, augmentation of host resistance, prevention of pneumonia, and antibiotic prophylaxis. National practice guidelines are cited when possible; evidence-based literature review and experience are applied to situations lacking consensus statements. Treatment decisions are made in areas for which information is often incomplete. A systematic approach to care of the immunocompromised host, tailored to the individual patient's needs, should reduce the risk of infection.

The genital mycoplasmas.

The smallest free-living, self-replicating organisms known, the mycoplasmas have been the subject of intense research. Of the 12 species that have been found in association with humans, Mycoplasma pneumoniae, M. hominis, and Ureaplasma urealyticum have been clearly shown to have pathogenic properties. The newly described M. genitalium may also have the ability to cause disease. The syndromes with which these organisms have been associated in the genital tract are reviewed, as well as methods of diagnosis and therapy.

Needle-sharing among intravenous drug users in New Orleans.

We studied needle sharing among intravenous drug users in New Orleans, where needles are not controlled by prescription. Three hundred and eighty self-identified intravenous drug users were interviewed regarding needle-sharing practices, frequency of drug use, and drug(s) of choice. Overall, 65.8% admitted they regularly used needles which had been used by others. No significant differences in needle sharing were found by sex, race, frequency of injection, or drug of choice. A survey of pharmacies found that 85.5% have self-imposed restrictions on the sale of needles and syringes. Legal availability of injection equipment may not be equivalent to actual availability to the consumer.

Relapse of tularemia after aminoglycoside therapy: case report and discussion of therapeutic options.

We describe a patient with ulceroglandular tularemia who initially responded to therapy with gentamicin but then clinically relapsed. Ciprofloxacin was subsequently given for 28 days, and the patient was clinically cured. Aminoglycosides have been considered the drugs of choice in the treatment of tularemia; however, potential alternative treatments do exist. We review the English-language literature on this topic.

Human immunodeficiency virus: risk of exposure among health care workers at a southern urban hospital.

To assess the risk of exposure to the human immunodeficiency virus (HIV) among health care workers in a southern urban setting, random screening for antibodies to HIV was undertaken. Patients who were admitted for major trauma, for medical emergencies, or in labor were screened. Of 534 sera screened, 11 (2%) were seropositive. All but two of the seropositive patients were men. Rates were similar among black and white patients. Seven patients could be placed into an established risk group, but only one patient was known to have AIDS upon presentation to the emergency room. The mean age of seropositive individuals was 30.9 years; there were similar seroprevalence rates in each of four age groups among men. We conclude that there is a substantial risk of exposure to HIV in trauma and medical emergency centers; therefore all health care workers should practice universal barrier precautions whenever exposure to a patient's blood or body fluids is likely.

A DNA probe for detecting Mycoplasma genitalium in clinical specimens.

Despite decades of careful study, the etiologies of all cases of pelvic inflammatory disease (PID) and non-gonococcal urethritis (NGU) have yet to be described. Mycoplasma genitalium is a newly described organism which has been implicated as a cause of both PID and NGU. Because of fastidious growth requirements, prolonged incubation time and frequent overgrowth in clinical specimens by Mycoplasma hominis, non-culture methods need to be developed for its detection. We have cloned M. genitalium DNA by transfection into Escherichia coli using M13 as the vector. Using these segments as templates, we synthesized radiolabelled cDNAs that were tested for specific hybridization with M. genitalium, and clinically isolated genital mycoplasmas presumptively identified as M. hominis, and Ureaplasma urealyticum. A 256 base-pair segment was found to hybridize with M. genitalium with a sensitivity of 10(2) colour-changing units (CCUs). No cross-hybridization was observed with M. hominis, and cross-hybridization was observed only with large concentrations (greater than 10(6) CCUs) of U. urealyticum. Because of our choice of M13 as the vector, which contains the Lac Operon of E. coli, slight hybridization occurred with E. coli as well. This cDNA can be used against clinical specimens to determine the ecologic niche and spectrum of disease caused by M. genitalium.