RESUMO
Tick-borne relapsing fever (TBRF) is a bacterial infection transmitted by tick bites that occurs in several different parts of the world, including the western United States. We describe 6 cases of TBRF acquired in the White Mountains of Arizona, USA, and diagnosed during 2013-2018. All but 1 case-patient had recurrent fever, and some had marked laboratory abnormalities, including leukopenia, thrombocytopenia, hyperbilirubinemia, and elevated aminotransaminases. One patient had uveitis. Diagnosis was delayed in 5 of the cases; all case-patients responded to therapy with doxycycline. Two patients had Jarisch-Herxheimer reactions. The White Mountains of Arizona have not been previously considered a region of high incidence for TBRF. These 6 cases likely represent a larger number of cases that might have been undiagnosed. Clinicians should be aware of TBRF in patients who reside, recreate, or travel to this area and especially for those who sleep overnight in cabins there.
Assuntos
Febre Recorrente/epidemiologia , Adulto , Idoso , Animais , Arizona/epidemiologia , Borrelia , Pré-Escolar , Eritrócitos/microbiologia , Eritrócitos/patologia , Feminino , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Febre Recorrente/diagnóstico , Febre Recorrente/história , Febre Recorrente/microbiologia , Vigilância de Evento Sentinela , Carrapatos/microbiologiaAssuntos
Coccidioidomicose/diagnóstico , Derrame Pericárdico/etiologia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Dor no Peito/etiologia , Tosse/etiologia , Dispneia/etiologia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Ultrassonografia , Adulto JovemAssuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Revisão de Uso de Medicamentos/organização & administração , Sistemas de Registro de Ordens Médicas/organização & administração , Oxazolidinonas/uso terapêutico , Acetamidas/administração & dosagem , Anti-Infecciosos/administração & dosagem , Revisão de Uso de Medicamentos/métodos , Humanos , Linezolida , Oxazolidinonas/administração & dosagem , Avaliação de Programas e Projetos de SaúdeAssuntos
Clostridioides difficile , Infecção Hospitalar/prevenção & controle , Descontaminação/métodos , Desinfetantes/farmacologia , Enterocolite Pseudomembranosa/prevenção & controle , Quartos de Pacientes , Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/crescimento & desenvolvimento , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Enterocolite Pseudomembranosa/microbiologia , Enterocolite Pseudomembranosa/transmissão , Humanos , Peróxido de Hidrogênio/farmacologia , Hipoclorito de Sódio/farmacologia , Esporos Bacterianos/efeitos dos fármacos , Esporos Bacterianos/crescimento & desenvolvimentoRESUMO
Keyboards in intensive care units have been shown to serve as reservoirs for multidrug-resistant microorganisms. The thoroughness of disinfection cleaning of keyboards on computers on wheels (COWs) in an intensive care units of an academic medical center were evaluated using an invisible florescent marker, and the movements of the COWs were tracked using their serial numbers. Following a series of educational and programmatic interventions, we were able to improve the thoroughness of cleaning to 100%.
Assuntos
Computadores , Desinfecção/métodos , Microbiologia Ambiental , Boston , Educação , Pesquisa sobre Serviços de Saúde , Humanos , Unidades de Terapia IntensivaRESUMO
The mechanism of the age-associated decrease in CD8+ T cell response of mice to virus infection was examined in young adult (6 months) and aged (22 months) C57BL/6 mice during primary pulmonary influenza A virus infection. A significant age-associated decrease in both the percentage (P<0.0001) and number (P<0.05) of CD8+ T cells binding MHC Class I tetramers containing influenza A nucleoprotein (NP) epitope and in virus-specific CTL activity (P<0.05) was observed with pulmonary lymphocytes. The percentage of NP+CD8+ cells of individual mice strongly correlated with NP-specific cytotoxic activity (r(2)=0.77, P<0.02) and with the percentage of CD8+ cells that produced interferon-gamma (r(2)=0.86, P<0.002) in both young and aged mice. Comparable expression of the CD28, CD25, and the memory CD44(hi)/CD62L(lo) phenotype was detected on NP+CD8+ lymphocytes from mice of both age groups. There was a delay in the maximal expansion of NP+CD8+ cells in aged compared to young mice that paralleled a delay in maximal cytotoxic activity and in virus clearance. These data suggest that the age-related impairment of CD8+ lymphocyte activity during a primary influenza A infection is due to a defect in the expansion, rather than in effector activity, of influenza-specific CD8+ T cells.