Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections.

BACKGROUND: Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS: A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS: Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS: SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.

Reasons, health behaviors, and outcomes of no prenatal care: research that changed practice.

Changes in prenatal care practices resulted from a pilot study with 12 urban New Mexican women who received no prenatal care. The women were interviewed regarding their reasons for not receiving care during pregnancy, health behaviors, and perceived neonatal outcomes. Data on actual neonatal outcomes were taken from the medical record. Maternal reasons for no prenatal care were socio-demographic, system-related, attitudinal, and outside forces of job and childcare. To ensure a healthy baby, the women made changes in their nutrition, self-care activities, substance use, sleep, and exercise activities. All of the women perceived they had a healthy baby. Yet 61% of the neonates had complications and 45% were low birth weight. The research findings were used to develop a care management program that included case management and utilization management.

Health practices of adult Hispanic women.

The purpose of this focused ethnography was to discover the patterns and variability of health practices used by Hispanic women aged 20-40 years. Seven adult Hispanic women from an urban New Mexico county were interviewed four to seven times each about their health practices. The women described their views of good health. They were aware of current health promotion practices such as good nutrition and exercise. They also practised safety measures for themselves and their families. These women did not report any information on specific cultural disease prevention behaviours and described few practices related to their Hispanic culture. A theme that also emerged from the data was an emphasis on the importance of spirituality and the integration of the spiritual dimension as important to healthy living. Implications for health care providers include knowing that urban adult Hispanic women are versed in contemporary health literature and take better care of their families than of themselves.

Hydatid mole with a coexisting pregnancy.

Hydatid mole with a coexisting pregnancy is rare and presents a high risk for maternal and fetal morbidity and mortality. A case of hydatid mole with coexisting pregnancy that progressed to 24 weeks' gestation is presented. Maternal religious beliefs regarding pregnancy termination affected the medical plan of care. Although the woman was aware of the potential complications, pregnancy termination and karyotype testing were refused. Because of uncontrollable hemorrhage, a cesarean delivery was done. The genotypically normal fetus died 10 hours after birth. After delivery, preeclampsia, pulmonary edema, and renal failure developed in the woman, which resolved within 4 days.

Changes in health behaviors made by pregnant substance users.

A descriptive survey was conducted with 31 pregnant women who were substance users enrolled in a perinatal treatment program. The purpose of the study was to determine the women's health behaviors by using open-ended questions. Most of the women were between 20 and 29 years of age, Hispanic, not married, unemployed, and had partial or completed high-school education. The women had multiple pregnancies with few living children. The majority of the women were 4 to 6 months pregnant and all had received prenatal care. The women made health behavior changes during pregnancy related to nutrition, substance use, self-care, exercise, lifestyle, and seeking counseling. Over 52% of the women reported they made these behavioral changes because they wanted a healthy baby.

Variation of erythroid and myeloid precursors in the marrow and peripheral blood of volunteer subjects infected with human parvovirus (B19).

Infection of normal individuals with human parvovirus (B19) results in a mild disease (erythema infectiosum) but gives rise to aplastic crises in patients with chronic hemolytic anemias. The effects of this disease on hemopoiesis were investigated following intranasal inoculation of the virus into three volunteers. A typical disease ensued with a viremia peaking at 9 d. Marrow morphology 6 d after inoculation appeared normal but at 10 d there was a severe loss of erythroid precursors followed by a 1-2-g drop in hemoglobin, and an increase in serum immunoreactive erythropoietin. Erythroid burst-forming units (BFU-E) from the peripheral blood were considerably reduced, starting at the time of viremia and persisting for 4-8 d depending on the individual. Granulocyte-macrophage colony-forming units (CFU-GM) were also affected but the loss started 2 d later. Both CFU-GM and BFU-E showed a sharp overshoot at recovery. In the marrow, BFU-E and CFU-E were reduced at 6 and 10 d in the individual having the longest period of peripheral progenitor loss. In contrast, there was an increase in BFU-E and CFU-E in the subject with least change in peripheral progenitors. In the third subject, with an intermediate picture, there was a loss at 6 d but an increase at 10 d of erythroid progenitors. It is suggested that the architecture of the marrow might partially isolate progenitors from high titers of virus in the serum and individual variation in this respect might give the results observed.

Acute phase response of serum amyloid A protein and C reactive protein to the common cold and influenza.

C reactive protein (CRP) and serum amyloid A protein (SAA) are sensitive and rapid acute phase reactants, and their measurement for monitoring inflammatory disease and assessing the prognosis in secondary amyloidosis is gaining widespread acceptance. The changes in these proteins in eight subjects suffering from natural colds, 15 subjects with experimentally induced colds (rhinoviruses E1, 3, 9, 14, or 31), and eight with experimentally induced influenza (A/Eng/40/83) were studied. SAA concentration increased in 21 of the 23 subjects with natural or experimental rhinovirus colds (mean increase 95 mg/l); CRP concentration increased in 11 (mean increase 11 mg/l). All subjects with influenza showed pronounced increases in SAA concentrations (mean increase 642 mg/l) while six showed increases in CRP concentration (mean increase 22 mg/l). All these increases were highly significant (p less than 0.001). Asymptomatic excretors of both rhinovirus and influenza virus showed significant increases in SAA concentration (p = 0.015 for rhinovirus and p less than 0.001 for influenza virus) but not in CRP concentration. No changes in SAA or CRP values were seen in 12 volunteers after challenge with saline. These observations suggest that caution is required in the interpretation of estimations of SAA concentration and that it may be too sensitive an acute phase protein for clinical use as its concentration may be raised in both trivial and asymptomatic viral infections.

An outbreak of adenovirus type 4 conjunctivitis.

An unusually large outbreak of conjunctivitis caused by adenovirus type 4 involved 113 proved cases during a 7-month period. Though the disease was less severe than is commonly seen in epidemic keratoconjunctivitis caused by other serotypes, the cornea was affected in 23% of cases and symptoms persisted for at least 5 weeks in 6 patients. A concurrent increase in nonocular adenovirus type 4 infections in the Bristol area was not observed. Nine of the cases could have arisen as a result of hospital cross-infection.

An outbreak of adenovirus keratoconjunctivitis in bristol.

Nineteen cases of keratoconjunctivitis caused by an adenovirus serologically related to types 10 and 19 are described. Seventeen of the patients presented over a period of 7 weeks and included 4 who were involved in a minor outbreak at a factory. The presentation and clinical features closely resembled those caused by adenoviruses types 8 and 19. Mild to severe follicular conjunctivitis, superficial punctate keratitis, discrete subepithelial opacities, membrane formation, and conjunctival scarring were all observed.

Virus isolations from patients in general practice, 1961-71.

During the period 1961-71 of 1785 viruses isolated from patients in the general population 503 (28%) were rhinoviruses, 465 (26%) influenza viruses, 248 (14%) enteroviruses, 234 (13%) herpes simplex virus, 132 (7%) parainfluenza viruses, 129 (7%) adenoviruses and 49 (3%) respiratory syncytial virus. Also isolated were 18 strains of mumps virus, 7 coronaviruses and 295 streptococci of groups A, C or G.Fluctuations were observed in the frequency with which respiratory syncytial virus, parainfluenza virus type 2, and the adenoviruses were isolated over the 10-year period.Influenza viruses types A and B, parainfluenza viruses types 1 and 2, respiratory syncytial virus, adenoviruses types 3, 4, 6, 7 and 21, and many enteroviruses were all associated with outbreaks.Infections with influenza viruses A and B and parainfluenza viruses types 1 and 2 came during the winter, whereas those with parainfluenza virus type 3, enteroviruses, and rhinoviruses were more frequently seen in the summer and early autumn.

Viruses associated with acute respiratory infections in Royal Air Force personnel.

All respiratory illnesses which were reported to the medical officers between September 1966 and December 1967 on a Royal Air Force station of 350 men were studied virologically.THREE PERIODS OF INCREASED RESPIRATORY INFECTIONS WERE OBSERVED: two occurred in the autumn, one in each year, and the third in the winter during January and February. The autumnal outbreaks were associated mainly with rhinovirus infections, and high isolation rates (82.1, 65.9%) were achieved at these times. Few of the illnesses during the winter outbreak could be diagnosed in the laboratory, and no evidence was found of infection with ;coronaviruses'.Despite the entrance of 30 fresh recruits direct from civilian life every 5 weeks, the respiratory infections encountered on the station were very similar to those in the local population and were not predominantly infections with adenoviruses, Coevirus, and Mycoplasma pneumoniae, as previously reported from larger military recruit centres.