RESUMO
BACKGROUND: Nosocomial transmission of group A streptococcus (GAS) has been well described. Instances resulting in fulminant disease among health care workers have not been described. Contact and droplet precautions have been advised to minimize the risk of nosocomial transmission. We aimed to determine whether a case of invasive GAS pneumonia and streptococcal toxic shock syndrome in a respiratory therapist was acquired as a result of caring for a patient with GAS necrotizing fasciitis. Contacts of these patients were screened to determine if they were the reservoir of the GAS. Genetic testing to confirm clonal transmission was conducted. METHODS: Contacts of the patients with GAS infection were screened using questionnaires and testing of pharyngeal specimens. Specimens from patients and carriers of GAS who were identified during screening were subjected to pulsed-field gel electrophoresis and emm gene typing. RESULTS: We identified 705 contacts of the 2 patients; all contacts had oropharyngeal specimens collected for culture. Only the index patient and the respiratory therapist yielded identical pulse-field gel electrophoresis GAS isolates, with clonality indicated by emm typing. CONCLUSIONS: Nosocomial transmission of GAS from a patient to a health care worker who developed streptococcal toxic shock syndrome may have occurred after the index patient had received 48 h of antibiotic therapy and despite placement in contact isolation. Isolation guidelines for patients with severe GAS infection may need to be reviewed.
Assuntos
Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus pyogenes/isolamento & purificação , Adulto , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Técnicas de Tipagem Bacteriana , Proteínas de Transporte/genética , Análise por Conglomerados , Impressões Digitais de DNA , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Fasciite Necrosante , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Exposição Ocupacional , Pneumonia Bacteriana/microbiologia , Choque Séptico/microbiologia , Streptococcus pyogenes/classificação , Streptococcus pyogenes/genéticaRESUMO
Thirty-eight of 295 subjects participating in a randomized, double-blind, placebo-controlled trial of the efficacy of daily administration of atovaquone/proguanil for malaria prevention developed malaria at some time during the 20-week prophylaxis period. These subjects (3 atovaquone/proguanil recipients and 35 placebo recipients) were treated with 4 tablets of atovaquone/proguanil per day for 3 days. Atovaquone/proguanil provided safe, well-tolerated, and effective therapy for uncomplicated malaria in nonimmune Indonesians.