Endogenous Endophthalmitis: yield of the diagnostic evaluation.

BACKGROUND: Endogenous endophthalmitis is an infection of the eye secondary to sepsis, occurring in 0.04-0.5% of bacteremia or fungemia. Risk factors include intravenous drug abuse (IVDA), diabetes, indwelling catheters, and immune suppression. Many patients have known or suspected bacteremia or fungemia; however, culture yield is reported to be low (approximately 50%). The purpose of this study is to elucidate the yield of diagnostic evaluation including microbial cultures over a 6.5 year period at an academic center in the United States. METHODS: Retrospective chart review of patients with endogenous endophthalmitis at the University of Florida from June 2011 to February 2018. RESULTS: Included are 40 eyes of 35 patients. Endophthalmitis was secondary to an endogenous source in 23.5% of all endophthalmitis cases observed. Intraocular culture positivity was 28.6% overall but was 0% after initiation of systemic antibiotics. Most commonly identified organisms from the eye were coagulase-negative Staphylococcus and Candida. Blood culture positivity was 48.6%, most commonly Staphylococcus. IVDA was noted with increasing frequency as a risk factor. Diagnosis of endophthalmitis upon hospital admission was associated with a higher intraocular culture positivity (P = 0.040) and a shorter hospital stay (P = 0.035). Computed tomography (CT) and magnetic resonance imaging (MRI) were the highest yield imaging modalities; X-ray and non-ocular ultrasound were less diagnostically useful. Echocardiogram was positive by transesophageal route (TEE) in 22% and in 9% by transthoracic (TTE) testing. Following discharge from the hospital, 48.4% of patients failed to follow up with outpatient ophthalmology. CONCLUSIONS: Based on the results of this study, the interdisciplinary team should consider directed imaging, eye cultures prior to antimicrobial administration, thorough history for IVDA, and caution with premature discharge from the hospital.

Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.

BACKGROUND: Treatment of latent tuberculosis infection (LTBI) is a key component in U.S. tuberculosis control, assisted by recent improvements in LTBI diagnostics and therapeutic regimens. Effectiveness of LTBI therapy, however, is limited by patients' willingness to both initiate and complete treatment. We aimed to evaluate the demographic, medical, behavioral, attitude-based, and geographic factors associated with LTBI treatment initiation and completion of persons presenting with LTBI to a public health tuberculosis clinic. METHODS: Data for this prospective cohort study were collected from structured patient interviews, self-administered questionnaires, clinic intake forms, and U.S. census data. All adults (>17 years) who met CDC guidelines for LTBI treatment between January 11, 2008 and May 6, 2009 at Wake County Health and Human Services Tuberculosis Clinic in Raleigh, North Carolina were included in the study. In addition to traditional social and behavioral factors, a three-level medical risk variable (low, moderate, high), based on risk factors for both progression to and transmission of active tuberculosis, was included for analysis. Clinic distance and neighborhood poverty level, based on percent residents living below poverty level in a person's zip code, were also analyzed. Variables with a significance level <0.10 by univariate analysis were included in log binomial models with backward elimination. Models were used to estimate risk ratios for two primary outcomes: (1) LTBI therapy initiation (picking up one month's medication) and (2) therapy completion (picking up nine months INH therapy or four months rifampin monthly). RESULTS: 496 persons completed medical interviews and questionnaires addressing social factors and attitudes toward LTBI treatment. 26% persons initiated LTBI therapy and 53% of those initiating completed therapy. Treatment initiation predictors included: a non-employment reason for screening (RR 1.6, 95% CI 1.0-2.5), close contact to an infectious TB case (RR 2.5, 95% CI 1.8-3.6), regular primary care(RR 1.4, 95% CI 1.0-2.0), and history of incarceration (RR 1.7, 95% CI 1.0-2.8). Persons in the "high" risk category for progression/transmission of TB disease had higher likelihood of treatment initiation (p < 0.01), but not completion, than those with lower risk. CONCLUSIONS: Investment in social support and access to regular primary care may lead to increased LTBI therapy adherence in high-risk populations.

Tuberculosis knowledge, attitudes, and beliefs among North Carolinians at increased risk of infection.

OBJECTIVE: The purpose of this study was to capture and describe knowledge, attitudes, and beliefs about tuberculosis (TB) among persons at high risk for TB infection. METHODS: We conducted 11 focus groups in 3 different populations at high risk for TB infection: Spanish-speaking immigrants, homeless shelter residents, and persons attending a drug/alcohol rehabilitation center. A standardized list of open-ended questions was used to guide discussion. Using grounded theory, transcripts of the focus group sessions were reviewed by 4 independent reviewers to identify emergent themes. FINDINGS: Participants (N = 52) generally understood that TB is an infectious disease that frequently affects the lungs and can be fatal if untreated. They also knew that a skin test can be used to diagnose TB. However, participants frequently had incorrect beliefs regarding the cause, transmission, and treatment of TB. Many participants thought that TB is transmitted in the same fashion as other infectious diseases such as human immunodeficiency virus or aquired immune deficiency syndrome (HIV/AIDS). A general sentiment of fear and aversion toward persons ill with TB was expressed. LIMITATIONS: Focus groups were a convenience sample and subjects were not necessarily representative of the underlying populations. CONCLUSIONS: Tuberculosis knowledge among high-risk populations is suboptimal, and false beliefs regarding transmission and treatment were common in this study. Knowledge regarding transmission of other infectious diseases such as HIV/AIDS was frequently translated into incorrect knowledge regarding TB. Stigma continues to be a barrier to TB diagnosis and treatment.