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1.
N Engl J Med ; 379(14): 1322-1331, 2018 10 04.
Artículo en Inglés | MEDLINE | ID: mdl-30281988

RESUMEN

BACKGROUND: Candida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection. METHODS: After identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing. RESULTS: A total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P<0.001) and systemic fluconazole exposure (multivariable odds ratio, 10.34; 95% CI, 1.64 to 65.18; P=0.01). C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes. Despite a bundle of infection-control interventions, the incidence of new cases was reduced only after removal of the temperature probes. All outbreak sequences formed a single genetic cluster within the C. auris South African clade. The sequenced isolates from reusable equipment were genetically related to isolates from the patients. CONCLUSIONS: The transmission of C. auris in this hospital outbreak was found to be linked to reusable axillary temperature probes, indicating that this emerging pathogen can persist in the environment and be transmitted in health care settings. (Funded by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University and others.).


Asunto(s)
Candida , Candidiasis/epidemiología , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Contaminación de Equipos , Equipo Reutilizado , Control de Infecciones/métodos , Unidades de Cuidados Intensivos , Termómetros/microbiología , Adulto , Candida/genética , Candida/aislamiento & purificación , Candidiasis/mortalidad , Candidiasis/transmisión , Estudios de Casos y Controles , Infección Hospitalaria/mortalidad , Infección Hospitalaria/transmisión , Femenino , Departamentos de Hospitales , Humanos , Incidencia , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis Multivariante , Neurología , Filogenia , Factores de Riesgo , Reino Unido/epidemiología
3.
Clin Infect Dis ; 56(2): 204-8, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23074307

RESUMEN

BACKGROUND: Congenital toxoplasmosis is a serious condition but little is known of the natural history of parasite development and associated fetal tissue destruction. METHODS: Two cases identified by ultrasound underwent induced abortion at 21 and 30 weeks' gestation. At autopsy, the placenta and fetal organs were examined by histology and immunocytochemistry employing anti-Toxoplasma stage-specific antibodies to confirm diagnosis and also provide information on the stage of parasite development. RESULTS: In both cases, maternal serology prior to termination showed both specific immunoglobulin M (IgM) and immunoglobulin G (IgG), whereas retrospective analysis of an earlier sample (12-14 weeks' gestation) showed only IgM reactivity consistent with infection occurring in the first trimester. The finding of a number of tissue cysts but few or no tachyzoites within the placenta and fetal adrenal and heart is characteristic of a chronic infection. However, in contrast, there were still areas of the fetal brain with large numbers of actively dividing, tissue-destructive tachyzoites. CONCLUSIONS: These observations show that continued parasite proliferation and tissue destruction can occur within the fetal brain even when there is a marked maternal immune response including maternal IgG. This finding strongly suggests that there may be benefits from treating cases of recently acquired congenital infection to destroy any remaining proliferating parasites located in immunologically protected sites such as the fetal brain.


Asunto(s)
Encéfalo/parasitología , Toxoplasmosis Congénita/parasitología , Adulto , Anticuerpos Antiprotozoarios/inmunología , Biopsia , Encéfalo/embriología , Encéfalo/patología , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/inmunología , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Placenta/parasitología , Placenta/patología , Embarazo , Diagnóstico Prenatal , Toxoplasma/crecimiento & desarrollo , Toxoplasma/inmunología , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/inmunología
4.
J Clin Microbiol ; 48(3): 770-8, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20042623

RESUMEN

A robust high-throughput multilocus sequence typing (MLST) scheme for Clostridium difficile was developed and validated using a diverse collection of 50 reference isolates representing 45 different PCR ribotypes and 102 isolates from recent clinical samples. A total of 49 PCR ribotypes were represented overall. All isolates were typed by MLST and yielded 40 sequence types (STs). A web-accessible database was set up (http://pubmlst.org/cdifficile/) to facilitate the dissemination and comparison of C. difficile MLST genotyping data among laboratories. MLST and PCR ribotyping were similar in discriminatory abilities, having indices of discrimination of 0.90 and 0.92, respectively. Some STs corresponded to a single PCR ribotype (32/40), other STs corresponded to multiple PCR ribotypes (8/40), and, conversely, the PCR ribotype was not always predictive of the ST. The total number of variable nucleotide sites in the concatenated MLST sequences was 103/3,501 (2.9%). Concatenated MLST sequences were used to construct a neighbor-joining tree which identified four phylogenetic groups of STs and one outlier (ST-11; PCR ribotype 078). These groups apparently correlate with clades identified previously by comparative genomics. The MLST scheme was sufficiently robust to allow direct genotyping of C. difficile in total stool DNA extracts without isolate culture. The direct (nonculture) MLST approach may prove useful as a rapid genotyping method, potentially benefiting individual patients and informing hospital infection control.


Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Clostridioides difficile/clasificación , Clostridioides difficile/genética , Dermatoglifia del ADN/métodos , Análisis de Secuencia de ADN/métodos , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/microbiología , Genotipo , Humanos , Lactante , Polimorfismo Genético , Ribotipificación , Sensibilidad y Especificidad
5.
Lancet Infect Dis ; 9(2): 108-17, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19179226

RESUMEN

Hepatitis C virus (HCV) infection is a major and growing global health problem, affecting about 170 million people worldwide, and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Currently, treatment is restricted to interferon alfa and ribavirin, which leads to a successful outcome in only about 50% of individuals. New effective treatments with tolerable side-effect profiles are needed urgently, but development has been hindered by an inability to culture HCV and a scarcity of animal models. Herein, we review progress in HCV biology, including cell culture and new animal models, and the contribution of this work to our understanding of the virus' life-cycle and pathogenesis and development of specifically targeted antiviral treatment. We also discuss changes in our understanding of HCV epidemiology, clinical manifestations, and diagnostics.


Asunto(s)
Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Animales , Antivirales/farmacología , Farmacorresistencia Viral , Hepacivirus/efectos de los fármacos , Hepacivirus/fisiología , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos
6.
J Med Microbiol ; 68(3): 395-397, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30663952

RESUMEN

PURPOSE: Polymerase chain reaction (PCR) is increasingly being used to detect enteric pathogens and is currently NICE's recommended practice. We wished to evaluate the performance characteristics of PCR for the detection of salmonella in consecutive stool samples in a real-world setting, compared to the gold standard of enrichment culture. METHODOLOGY: We performed a prospective study over 9 months in which the PCR and culture results for salmonella were scrutinized for all stool samples sent to the laboratory. All stool samples underwent selenite enrichment culture for salmonella with confirmation being obtained using the API 10S and serotyping. Samples also underwent PCR using the BD MAX Enteric Bacterial Panel. The sensitivity and specificity of PCR in detecting salmonella were compared to those of enrichment culture. RESULTS: Six thousand three hundred and seventy-two stool culture and PCR pairs from 5619 patients were analysed. The prevalence of salmonella was found to be 1.2 %. The sensitivity, specificity, positive predictive value and negative predictive value of PCR versus culture were 89 % (67/75), 99.8 % (6286/6297), 86 % (67/78) and 99.9 % (6286/6294), respectively. CONCLUSION: Enrichment culture is significantly more sensitive than PCR using the BD MAX Enteric Bacterial Panel for detecting salmonella in stool. Where PCR testing is used for the detection of enteric pathogens, we recommend that enrichment culture for salmonella be continued in parallel, unless the PCR method is shown to be at least as sensitive as culture.


Asunto(s)
Técnicas Bacteriológicas , Heces/microbiología , Reacción en Cadena de la Polimerasa , Salmonella/aislamiento & purificación , Diarrea/microbiología , Humanos , Técnicas de Diagnóstico Molecular , Valor Predictivo de las Pruebas , Estudios Prospectivos , Salmonella/genética , Salmonella/crecimiento & desarrollo , Sensibilidad y Especificidad
7.
J Clin Pathol ; 60(8): 927-30, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17158638

RESUMEN

OBJECTIVE: To review the first year of a monthly urine cytology screening service, introduced to identify renal transplant patients at risk of polyoma virus nephropathy (PVN), at an early, potentially treatable, stage. METHODS AND RESULTS: Monthly urine samples (n = 392) were received from 97/108 transplant recipients in 2005. Of 56 patients with follow-up >6 months, 20% and 9% had significant (>10 decoy cells/cytospin) and non-significant positive cytology, respectively. The first positive urine samples occurred most commonly in the second and third month post-transplantation and patients with significantly positive samples had higher 3-month and 6-month serum creatinine levels than patients with negative urine cytology (p<0.01). Four patients with positive urine cytology had a subsequent positive plasma BK virus PCR; 3/97 patients had biopsy-proven PVN, all in the third month, 1-6 weeks after first positive urine samples. CONCLUSIONS: Significant PV viruria is common following renal transplantation with onset usually within the first 3 months. Viruria is associated with worse graft function at 3 and 6 months. The time between urine positivity and clinical PVN is short. More frequent early urine screening would be required to achieve clinical benefit.


Asunto(s)
Enfermedades Renales/orina , Trasplante de Riñón , Infecciones por Polyomavirus/orina , Infecciones Tumorales por Virus/orina , Antiinfecciosos/uso terapéutico , Ciprofloxacina/uso terapéutico , Humanos , Terapia de Inmunosupresión/métodos , Enfermedades Renales/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Poliomavirus/aislamiento & purificación , Infecciones por Polyomavirus/diagnóstico , Infecciones por Polyomavirus/tratamiento farmacológico , Complicaciones Posoperatorias , Infecciones Tumorales por Virus/diagnóstico , Infecciones Tumorales por Virus/tratamiento farmacológico
8.
J Infect Dis ; 186(7): 932-9, 2002 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-12232833

RESUMEN

Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of infection with HTLV-I. A population association study of 229 patients with HAM/TSP and 202 healthy carriers of HTLV-I in southern Japan showed that this outcome of HTLV-I infection and the HTLV-I provirus load are under polygenic control. Of 58 polymorphic sites studied in 39 non-HLA candidate gene loci, 3 new host genetic factors that influenced the risk of HAM/TSP or the provirus load of HTLV-I were identified. The promoter TNF -863A allele predisposed to HAM/TSP, whereas SDF-1 +801A 3'UTR, and IL-15 191C alleles conferred protection. Knowledge of HTLV-I-infected individuals' ages, sex, provirus load, HTLV-I subgroup, and genotypes at the loci HLA-A, HLA-C, SDF-1, and TNF-alpha allowed for the correct identification of 88% of cases of HAM/TSP in this Japanese cohort.


Asunto(s)
Portador Sano/virología , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Herencia Multifactorial , Paraparesia Espástica Tropical/virología , Provirus/aislamiento & purificación , Alelos , Portador Sano/inmunología , Quimiocina CXCL12 , Quimiocinas CXC/genética , Estudios de Cohortes , Predisposición Genética a la Enfermedad , Antígenos HLA-A/genética , Antígenos HLA-C/genética , Humanos , Interleucina-15/genética , Japón , Paraparesia Espástica Tropical/genética , Paraparesia Espástica Tropical/inmunología , Regiones Promotoras Genéticas , Factor de Necrosis Tumoral alfa/genética , Carga Viral
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