RESUMEN
We describe an outbreak of Nocardia cyriacigeorgica soft-tissue infections attributable to unlicensed cosmetic injections and the first report using multilocus sequence typing sequence data for determining Nocardia strain relatedness in an outbreak. All 8 cases identified had a common source exposure and required hospitalization, surgical debridement, and prolonged antimicrobial therapy.
Asunto(s)
Técnicas Cosméticas/efectos adversos , Brotes de Enfermedades , Nocardiosis/epidemiología , Nocardiosis/microbiología , Nocardia/clasificación , Nocardia/aislamiento & purificación , Adulto , Antibacterianos/administración & dosificación , Análisis por Conglomerados , Enfermedades Transmisibles Emergentes/tratamiento farmacológico , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/microbiología , Enfermedades Transmisibles Emergentes/cirugía , ADN Bacteriano/química , ADN Bacteriano/genética , Desbridamiento , Femenino , Genotipo , Humanos , Incidencia , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Nocardia/genética , Nocardiosis/tratamiento farmacológico , Nocardiosis/cirugía , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/cirugíaRESUMEN
CONTEXT: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. OBJECTIVE: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. DESIGN, SETTING, AND PARTICIPANTS: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. MAIN OUTCOME MEASURES: Keratitis infection with Fusarium species. RESULTS: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. CONCLUSIONS: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.
Asunto(s)
Soluciones para Lentes de Contacto , Fusarium , Queratitis/epidemiología , Queratitis/microbiología , Micosis/epidemiología , Micosis/etiología , Adulto , Estudios de Casos y Controles , ADN de Hongos , Brotes de Enfermedades , Embalaje de Medicamentos , Contaminación de Equipos , Femenino , Fusarium/genética , Fusarium/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiologíaRESUMEN
Between April and June 2007, an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infections occurred in an intensive care unit in New Jersey. The outbreak was contained through active microbiologic surveillance, contact precautions, cohorting, and frequent room cleaning. This outbreak demonstrates the importance of rapid response in identifying and isolating patients to prevent further transmission.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Control de Infecciones/métodos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/biosíntesis , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Unidades de Cuidados Intensivos , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/prevención & control , Klebsiella pneumoniae/enzimología , New Jersey/epidemiología , Resistencia betalactámicaRESUMEN
PURPOSE: During 2003, the New Jersey Department of Health and Senior Services, in collaboration with other agencies, began planning and implementing voluntary smallpox vaccination clinics. METHODS: Surveys were distributed to all vaccinees, hospital bioterrorism coordinators, and local health departments to assess clinic experiences. RESULTS: During January-July 2003, 23 clinics were conducted with more than 1,000 participants. Of 670 persons vaccinated, 529 (79%) completed surveys. We received 65 surveys from 68 (77%) of 84 hospitals, and 25 responses from 22 regional health agencies. CONCLUSIONS: Vaccination is one component of preparedness; future initiatives must incorporate multiagency collaboration and developing public health infrastructure.