The Role of the Microbiome in Allergy, Asthma, and Occupational Lung Disease.

PURPOSE OF REVIEW: The human commensal microbiota is now widely accepted as a key regulator of human health and disease. The composition of the mucosal associated microbiota has been shown to play a critical role in the lung health. The role of the mucosal microbiota in the development and severity of allergy, asthma, and occupational lung disease is only beginning to take shape. However, advances in our understanding of these links have tremendous potential to led to new clinical interventions to reduce allergy, asthma, and occupational lung disease morbidity. RECENT FINDINGS: We review recent work describing the relationship and role of the commensal microbiota in the development of allergy, asthma, and occupational lung disease. Our review primarily focuses on occupational exposures and the effects of the microbiome, both in composition and function. Data generated from these studies may lead to the development of interventions targeted at establishing and maintaining a healthy microbiota. We also highlight the role of environmental exposures and the effects on the commensal microbial community and their potential association with occupational lung disease. This review explores the current research describing the role of the human microbiome in the regulation of pulmonary health and disease, with a specific focus on the role of the mucosal microbiota in the development of allergy, asthma, and occupational lung disease.

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2012-2020.

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2012-2020. Infections with chlamydia were the most common, followed in decreasing order of frequency by infections with genital human papillomavirus (HPV), gonorrhea, genital herpes simplex virus (HSV), and syphilis. Compared to males, females had higher rates of all STIs except for syphilis. In general, compared to their respective counterparts, younger service members, non-Hispanic Blacks, soldiers, and enlisted members had higher incidence rates of STIs. Although rates of chlamydia and gonorrhea increased among both male and female service members during the latter half of the surveillance period, there was a notable decrease in the rates of chlamydia in both sexes from 2019 through 2020, and the rates of gonorrhea decreased slightly for both males and females during 2018-2020. Rates of syphilis increased among male service members through 2018 but decreased during 2019-2020; the rate among female service members increased between 2012 and 2014, generally leveled off through 2018, increased in 2019, and then decreased in 2020. Rates of genital HSV declined during the period from 2016 through 2020 for both male and female service members. The rates of genital HPV decreased steadily between 2012 and 2020 in males and declined between 2015 and 2020 among females. Similarities to and differences from the findings of the last MSMR update on STIs are discussed.

A novel technique for protecting staff during microlaryngoscopy procedures.

OBJECTIVE: Microlaryngoscopy is an aerosol-generating procedure. This paper presents a novel approach for better protecting staff during microlaryngoscopy. METHODS: A clear plastic microscope drape is attached to the objective lens. Instead of using the drape to cover the microscope, it is pulled down to cover the patient's head and torso. The holes designated for the binoculars of the microscope are used for the surgeon hands, forming protective clear plastic sleeves. CONCLUSION: The proposed technique, which is simple, relatively inexpensive and technically feasible for any hospital to perform during microlaryngoscopy procedures, can increase safety and minimise droplet and aerosol exposure in the operating theatre.

Accidental exposure to Brucella abortus vaccines and occupational brucellosis among veterinarians in Minas Gerais state, Brazil.

Brucellosis is an important occupational disease, mainly among veterinarians, because of their frequent contact with sick animals, contaminated secretions and live attenuated anti-Brucella vaccines. This study aimed to determine the prevalence of accidental exposure to S19 and RB51 vaccine strains and occupational brucellosis among veterinarians registered to administer vaccinations in Minas Gerais, Brazil, as well as to identify the risk factors associated with accidental exposure to anti-Brucella abortus vaccines. Data were collected through an online questionnaire. Three hundred and twenty-nine veterinarians were included in the analyses using stratified random sampling. A multivariate logistic regression analysis was used to evaluate the predictors of accidental exposure to S19 and RB51 strains. Nearly one third of the veterinarians registered to administer bovine brucellosis vaccination in Minas Gerais, 32.83% (108/329) (95% confidence interval [CI]: 27.78-38.19%), reported having been accidentally exposed to S19 or RB51 vaccine strains. The exposure factors associated with this outcome included a score of personnel protective equipment (PPE) use during work (odds ratio [OR], 0.94; 95% CI: 0.89-0.98) and a score of knowledge about brucellosis symptoms, classified as poor (base category), intermediate (OR, 0.26; 95% CI: 0.07-0.87) or good (OR, 0.22; 95% CI: 0.07-0.62). In addition, 4.56% (15/329) (95% CI: 2.57-7.41%) of veterinarians reported that they had brucellosis, of which 46.67% (7/15) considered that the disease was due to accidental exposure to anti-B. abortus live attenuated vaccine. The prevalence of accidental exposure to B. abortus vaccine strains among veterinarians from Minas Gerais enrolled in the control of bovine brucellosis was high. The reduced knowledge about human brucellosis symptoms and lack of appropriate PPE use were risk factors from unintentional contact with S19 and RB51 vaccine strains.

First Etiologically Confirmed Cases of Mycobacterium Marinum Infection in Bulgaria.

This study aimed to describe the first two microbiologically confirmed cases of cutaneous and soft tissue Mycobacterium marinum infection in Bulgaria. The isolation of the Nontuberculous Mycobacteria (NTM) strains and their species identification was performed at NRL TB, NCIPD using specific media and cultivation conditions, and PCR based Line Probe Assay (LPA) from the positive cultures. The two patients had closely related jobs to fishes and water reservoirs and both of them had a similar clinical manifestation of M. mari-num infection known as "swimming pool" or "fish tank" granuloma. The prolonged specific treatment with at least two-drug combina-tion of rifampicin plus ethambutol and some complications were a big challenge for clinicians as well as the patients.

[Occupationally acquired MRSA colonization and occupational dermatological assessments (BK-No. 3101 in the German list of Occupational Diseases) : Analysis of the DGUV documentation and expert opinion on a case with work-related MRSA-triggered atopic dermatitis]. / Beruflich erworbene MRSA-Besiedelung in der berufsdermatologischen Begutachtung (BK-Nr. 3101) : Auswertung der DGUV BK-Dokumentation und Gutachtenfall mit arbeitsbedingter MRSA-getriggerter atopischer Dermatitis.

BACKGROUND: Person-to-person transmitted infectious diseases can cause occupational diseases (OD). These are subsumed as BK-No. 3101 in the German list of OD which applies for individuals with a considerably higher risk for infection as a consequence of their professional activity compared to the general population. OBJECTIVES: The special medical and insurance law aspects of a work-related MRSA colonization are presented using the example of an expert opinion case and an evaluation of the BK reports of suspected occupational disease (BK No. 3101) of the German Social Accident Insurance (DGUV). PATIENTS AND METHODS: The BK documentation of the DGUV from 2007-2012 and the patient cohort from the Department of Dermatology, University Hospital Erlangen, presenting for expert assessment from 2007-2012 were retrospectively analysed for human-to-human transmitted infectious diseases of the skin (BK-No. 3101). RESULTS: Person-to-person transmission of infectious diseases of the skin is rare in the field of occupational dermatology. In the DGUV cohort, suspected BK-No. 3101cases amounted to 2.6% of all notified cases; recognized BK-No. 3101 cases accounted for 4.2% of all recognized cases, amongst which 9 were caused by MRSA. In contrast to a symptomatic infection, an asymptomatic MRSA colonization is not being recognized as BK-No. 3101. Bacterial superantigens can trigger atopic dermatitis (AD). In particular cases, occupationally acquired MRSA can elicit AD and may justify classification as an OD (BK-No. 3101). CONCLUSIONS: Early detection of MRSA colonization and eradication are necessary for rehabilitation. Management of skin diseases due to infectious diseases within the framework of OD is presented.

Occupational exposure to Brucella spp.: A systematic review and meta-analysis.

Brucellosis is a neglected zoonotic disease of remarkable importance worldwide. The focus of this systematic review was to investigate occupational brucellosis and to identify the main infection risks for each group exposed to the pathogen. Seven databases were used to identify papers related to occupational brucellosis: CABI, Cochrane, Pubmed, Scielo, Science Direct, Scopus and Web of Science. The search resulted in 6123 studies, of which 63 were selected using the quality assessment tools guided from National Institutes of Health (NIH) and Case Report Guidelines (CARE). Five different job-related groups were considered greatly exposed to the disease: rural workers, abattoir workers, veterinarians and veterinary assistants, laboratory workers and hunters. The main risk factors and exposure sources involved in the occupational infection observed from the analysis of the articles were direct contact with animal fluids, failure to comply with the use of personal protective equipment, accidental exposure to live attenuated anti-brucellosis vaccines and non-compliance with biosafety standards. Brucella species frequently isolated from job-related infection were Brucella melitensis, Brucella abortus, Brucella suis and Brucella canis. In addition, a meta-analysis was performed using the case-control studies and demonstrated that animal breeders, laboratory workers and abattoir workers have 3.47 [95% confidence interval (CI); 1.47-8.19] times more chance to become infected with Brucella spp. than others individuals that have no contact with the possible sources of infection. This systematic review improved the understanding of the epidemiology of brucellosis as an occupational disease. Rural workers, abattoir workers, veterinarians, laboratory workers and hunters were the groups more exposed to occupational Brucella spp. infection. Moreover, it was observed that the lack of knowledge about brucellosis among frequently exposed professionals, in addition to some behaviors, such as negligence in the use of individual and collective protective measures, increases the probability of infection.

Occupational exposure to dust and to fumes, work as a welder and invasive pneumococcal disease risk.

OBJECTIVES: Occupational exposures to metal fumes have been associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) has not been characterised previously. METHODS: We studied 4438 cases aged 20-65 from a Swedish registry of invasive infection caused by Streptococcus pneumoniae. The case index date was the date the infection was diagnosed. Six controls for each case, matched for gender, age and region of residency, were selected from the Swedish population registry. Each control was assigned the index date of their corresponding case to define the study observation period. We linked cases and controls to the Swedish registries for socioeconomic status (SES), occupational history and hospital discharge. We applied a job-exposure matrix to characterise occupational exposures. We used conditional logistic analyses, adjusted for comorbidities and SES, to estimate the OR of IPD and the subgroup pneumonia-IPD, associated with selected occupations and exposures in the year preceding the index date. RESULTS: Welders manifested increased risk of IPD (OR 2.99, 95% CI 2.09 to 4.30). Occupational exposures to fumes and silica dust were associated with elevated odds of IPD (OR 1.11, 95% CI 1.01 to 1.21 and OR 1.33, 95% CI 1.11 to 1.58, respectively). Risk associated with IPD with pneumonia followed a similar pattern with the highest occupational odds observed among welders and among silica dust exposed. CONCLUSION: Work specifically as a welder, but also occupational exposures more broadly, increase the odds for IPD. Welders, and potentially others with relevant exposures, should be offered pneumococcal vaccination.

Antimicrobials and resistant bacteria in global fish farming and the possible risk for public health / Antimicrobianos e bactérias resistentes na piscicultura global e o possível risco para a saúde pública

The use of antimicrobials in fish farming is a reflection of the fast aquaculture development worldwide. The intensification of aquaculture to achieve market demands could lead to an increase in infectious diseases by pathogenic bacteria. Consequently, antimicrobials act as controls for emerging infectious diseases, but their use must follow the rules and regulations of the country where the activity is performed. Although the regulations impose limits to the use of antimicrobials in fish farming, many studies show that resistant bacteria are isolated from this system. The selection of resistant bacteria is not limited only to the use of antimicrobials, but also to co-selection of resistance genes or even with cross-resistance processes. Resistant bacteria from fish farming are a serious concern because they can be acquired by humans with handling or food chain, which may represent a public health problem. In the present review, we present an overview of antimicrobials use in aquaculture, the antimicrobial resistance and the impact of antimicrobial and bacterial resistance from a public health perspective.(AU)

O uso de antimicrobianos na piscicultura é um reflexo do rápido desenvolvimento da aquicultura em todo o mundo. A intensificação da aquicultura para suprir as demandas do mercado pode levar ao aumento de doenças infecciosas por bactérias patogênicas. Consequentemente, os antimicrobianos atuam no controle de doenças infecciosas emergentes, mas seu uso deve seguir as regras e regulamentos do país onde a atividade é realizada. Embora os regulamentos imponham limites ao uso de antimicrobianos na piscicultura, muitos estudos mostram que bactérias resistentes são isoladas desse sistema. A seleção de bactérias resistentes não se limita apenas ao uso de antimicrobianos, mas também à cosseleção de genes de resistência ou mesmo por meio do processo de resistência cruzada. As bactérias resistentes da piscicultura são uma preocupação séria, uma vez que tais bactérias podem ser adquiridas pelos seres humanos no manuseio ou na cadeia alimentar, o que pode representar um problema de saúde pública. Nesta revisão, apresentamos uma visão geral do uso de antimicrobianos na aquicultura, a resistência antimicrobiana e o impacto da resistência antimicrobiana e bacteriana do ponto de vista da saúde pública.(AU)

Hypersensitivity pneumonitis in a cystic fibrosis patient.

Hypersensitivity pneumonitis (HP) is a chronic inflammatory lung disease caused by repeated inhalation of antigenic substances. We present a case of metalworking fluids (MWFs)-HP sensitized to Pseudomonas oleovorans in a cystic fibrosis patient. This case illustrates that HP diagnosis remains challenging, especially in patients with another pulmonary disease, and that serodiagnosis contributes to identifying the precise microorganism involved. It also demonstrates that P. oleovorans is an important secondary aetiological agent in MWF-HP, less known than Mycobacterium immunogenum.

Caracterización epidemiológica de la infección por Leptospira spp. en caballos de trabajo y en personas ocupacionalmente expuestas en seis unidades de la Policía Nacional de Colombia / Epidemiological characterization of Leptospira spp. infection in working horses and in an occupationally exposed population in six Colombian police stations

Resumen Introducción. Los caballos de trabajo de la Policía Nacional tienen un estrecho contacto con sus manejadores y la población en general durante las actividades recreativas y de patrullaje, lo cual puede favorecer la transmisión de la leptospirosis en los caballos y el personal ocupacionalmente expuesto. Objetivo. Caracterizar epidemiológicamente la leptospirosis mediante pruebas de serología, urocultivo y reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) en caballos de trabajo y personal con riesgo ocupacional pertenecientes a seis unidades de la Policía Nacional de Colombia. Materiales y métodos. Se evaluaron 153 caballos machos castrados y 123 personas en las seis unidades en los municipios de Manizales, Pereira, Armenia, Ibagué, Tuluá y Cali. Se utilizaron tres formatos estructurados para recabar información y se obtuvieron muestras sanguíneas de las personas y de los caballos, las cuales se procesaron con la prueba de aglutinación microscópica (Macroscopic Agglutination Test, MAT) para 24 serogrupos. Se practicó el examen clínico de los caballos y se obtuvieron muestras de orina para el urocultivo y la PCR convencional. Resultados. La seroprevalencia de Leptospira spp. fue de 3,25 % (n=4) en las personas y de 85 % (n=130) en los caballos. Entre los caballos, los serogrupos Djasiman y Shermani fueron los más prevalentes. El urocultivo fue positivo en el 64,7 % (99/153) de las muestras, en tanto que los análisis de PCR fueron negativos. Se encontró una asociación estadísticamente significativa de la frecuencia de salida de las instalaciones (p=0,009) y la presencia de fauna silvestre (p=0,051) con la infección por el serogrupo Shermani. Conclusión. Las características epidemiológicas de la leptospirosis en los caballos sugieren una presentación endémica de la infección y su papel como reservorios de la bacteria; sin embargo, debe dilucidarse la patogenia de la enfermedad con estudios complementarios.

Abstract Introduction: Police working horses are in close contact with their managers and the general population during recreational and patrol activities, which can favor the transmission of leptospirosis among the horses and the occupationally exposed personnel. Objective. To characterize epidemiologically leptospirosis through serology, urine culture and PCR in working horses and in the occupationally exposed population in six police stations in Colombia. Materials and methods. We tested 153 castrated male horses and 123 people in six police stations in the municipalities of Manizales, Pereira, Armenia, Ibagué, Tuluá, and Cali. Three structured formats were applied and blood samples were obtained from people and horses, which were processed with the Macroscopic Agglutination Test, (MAT) for 24 serogroups. Horses were subject to a clinical examination, and urine samples were obtained for urine culture and conventional PCR. Results. The seroprevalence of human Leptospira spp. was 3.25% (n=4) while in horses it was 85% (n=130). Among the horses, serogroups Djasiman and Shermani were the most prevalent. The urine culture was positive in 64.7% (99/153) of the samples, whereas PCR analyzes were negative. A statistically significant association was found between the frequency of exiting the facilities (p=0.009) and the presence of wildlife (p=0.0051) with the infection by serogroup Shermani. Conclusion. The epidemiological characteristics of leptospirosis in horses suggest an endemic presentation of the infection and its role as reservoirs of the bacteria; however, it is necessary to elucidate the pathogenesis of the disease with complementary studies.

Hajj abattoirs in Makkah: risk of zoonotic infections among occupational workers.

At completion of Hajj, the Islamic pilgrimage to Makkah, pilgrims give thanks for the blessing, and acceptance, of Hajj, marking the end of the pilgrimage by sacrificing an animal and distributing the sacrificial meat to the poor. With over two million Muslims making Hajj, each Hajj, more than 1.2 million heads of cattle: sheep, goats and camels are slaughtered. Over 16 000 abattoir workers work around the clock to sacrifice and process the cattle in keeping with Islamic law and public health guidelines. Because of their proximity to high densities of cattle and cattle meat, Makkah's abattoir workers are at risk of zoonosis. This was a longitudinal study aimed at determining the risk of some zoonotic diseases among male permanent abattoir workers during Hajj. Specifically, seroprevalence of antigens for Brucella, Crimean-Congo haemorrhagic fever (CCHF), Alkhurma haemorrhagic fever (AHF) and Rift Valley Fever (RVF) were determined, among the study participants. An enrolment questionnaire, and a follow-up questionnaire, with provision of 10 mL blood for testing 2 days before intense Hajj animal exposure, up to 20 days after intense animal exposure and between 30 and 42 days after Hajj butchering exposures. While working with livestock, study participants were interrogated on hand hygiene and personal protection. Eighty male permanent abattoir workers participated in the study. Majority, 96.25% (n = 77) declared washing their hands with soap and water, most 98.75% (n = 79) never used eye protection, few occupational workers dressed in personal protective clothing or footwear. All workers tested negative for CCHF and RVF, one was positive for AHF and six for Brucella. The risk of some zoonotic infections like Brucella and AHF is low among permanent occupational workers in the slaughtering house in Makkah during Hajj 2013. No serological evidence for CCHF and RVF viruses, even though workers showed low compliance with use of personnel protective equipment.

Legionelosis ocupacional en mayores de 18 años: revisión sistemática / Occupational legionella in adults over 18 years pf age: a systematic review

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: "Legionnaires' Disease" "Legionellosis" "Occupational Exposure" "Occupational Diseases". Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

Abstract The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

Mycobacterium avium paratuberculosis and Mycobacterium avium complex and related subspecies as causative agents of zoonotic and occupational diseases.

Mycobacterium avium complex (MAC) and Mycobacterium avium paratuberculosis (MAP) cause zoonotic infections transmitted by birds and livestock herds. These pathogens have remained as serious economic and health threats in most areas of the world. As zoonotic diseases, the risk of development of occupational disease and even death outcome necessitate implementation of control strategies to prevent its spread. Zoonotic MAP infections include Crohn's disease, inflammatory bowel disease, ulcerative colitis, sarcoidosis, diabetes mellitus, and immune-related diseases (such as Hashimoto's thyroiditis). Paratuberculosis has classified as type B epidemic zoonotic disease according to world health organization which is transmitted to human through consumption of dairy and meat products. In addition, MAC causes pulmonary manifestations and lymphadenitis in normal hosts and human immunodeficiency virus (HIV) progression (by serotypes 1, 4, and 8). Furthermore, other subspecies have caused respiratory abscesses, neck lymph nodes, and disseminated osteomyelitis in children and ulcers. However, the data over the occupational relatedness of these subspecies is rare. These agents can cause occupational infections in susceptible herd breeders. Several molecular methods have been recognized as proper strategies for tracking the infection. In this study, some zoonotic aspects, worldwide prevalence and control strategies regarding infections due to MAP and MAC and related subspecies has been reviewed.

Occupational risk for personnel working in veterinary clinics through exposure to vectors of rickettsial pathogens.

Workers at veterinary clinics are exposed to zoonotic pathogens, which, though infrequently, can lead to serious consequences. The aim of the present study was to estimate the seroprevalence for rickettsial pathogens in veterinary clinic personnel in Ciudad Juárez, Chihuahua, Mexico. Voluntary participants included 106 veterinarians, 19 pet groomers, 36 veterinary assistants and 6 administrative workers who supplied blood samples taken by venipuncture. Detection of Rickettsia rickettsii, Ehrlichia spp. and Anaplasma phagocytophilum was conducted by indirect immunofluorescence assay (IFA) and polymerase chain reaction (PCR) techniques. To determine risk factors for the seroprevalence, the study considered social, demographic and occupational variables as well as the clinical signs and symptoms of the participants. Logistic regression procedures were performed, and the odds ratio (OR) was calculated with confidence intervals corresponding to a probability of 95%. The results indicate that 54% of the participants had a positive seroreaction to at least one of the pathogens evaluated and 2% were positive to all. The coexposure was as follows: 3% to R. rickettsii and A. phagocytophilum, 9% to Ehrlichia spp. and A. phagocytophilum, and 2% to Ehrlichia spp. and R. rickettsii. It was established that grooming posed the highest risk for R. rickettsii exposure. The implementation of appropriate management practices for zoonotic diseases is recommended to avoid health problems that may be life threatening to personnel in veterinary clinics.

Infectious diseases affecting occupational divers: review of 2017 literature.

BACKGROUND: Occupational divers are prone to many health risks. For instance, they can get infections. We reviewed the infectious diseases in occupational divers. MATERIALS AND METHODS: This is a literature review which went on up to 31.12.2017. The research was carried out on Medline and Scopus databases, in French and English languages. RESULTS: Fifteen papers report cases of infections in occupational divers. They are mainly skin infections, but also ear-nose-throat and ophthalmological infections. DISCUSSION AND CONCLUSIONS: According to data collected, infections among occupational divers are quite scarce. These diseases are not specific to the workplace, and are comparable with data on recreational diving. Prevention is mainly based on hygiene and equipment maintenance.

Mycobacterium abscessus infection in a spa worker.

Mycobacterium abscessus (M. abscessus) is a non-tuberculous mycobacterium widely present in the natural environment and is now being increasingly identified as a cause of human disease. However, it can cause skin and soft tissue infection following trauma or surgery. We report a case of a skin ulcer associated with M. abscessus in a spa worker. Frequently, contamination with atypical mycobacteria occurs through tap water. However, in most outbreaks the infection source remains unknown. For an early diagnosis, it is important to perform biopsies and mycobacterium cultures. No specific treatment for skin infection with M. abscessus has been established; it depends on the immune status of the host and the extent of disease. Although it is rare, non-tuberculous mycobacterial infection should be part of the differential diagnosis of cutaneous ulcers, especially on trauma-prone areas.

Screening of latent tuberculosis infection among health care workers working in Hajj pilgrimage area in Saudi Arabia, using interferon gamma release assay and tuberculin skin test.

BACKGROUND: Interferon gamma release assays (IGRA) is highly specific for Mycobacterium tuberculosis and is the preferred test in BCG-vaccinated individuals. The few studies that have screened health care workers (HCWs) in Saudi Arabia for latent tuberculosis infection (LTBI) using IGRA have varied in agreement with the traditional tuberculin skin test (TST). OBJECTIVE: Assess the prevalence of LTBI among HCWs working in the Hajj pilgrimage using IGRA and TST and measuring their agreement. DESIGN: Cross-sectional prospective. SETTING: Multiple non-tertiary care hospitals. PATIENTS AND METHODS: HCWs who worked during the Hajj pilgrimage in Saudi Arabia in December 2015. Data was collected by standarized questionnaire. Samples were drawn and analyzed by standard methods. MAIN OUTCOME MEASURES: The prevalence of LTBI among HCW and the agreement by kappa statistic between QFT-GIT and TST. SAMPLE SIZE: 520 subjects. RESULTS: Nurses accounted for 30.7% of the sample and physicians, 19.2%. The majority were BCG vaccinated (98.5%). There were a total of 56 positive by QFT-GIT and the LTBI rate was 10.8%. In 50 QFT positive/476 TST negative the LTBI rate was 10.5% in discordant tests, and in 6 QFT positive/44 TST positive it was 13.6% in concordant tests. The overall agreement between both tests was poor-83% and kappa was 0.02. LTBI prevalence was associated with longer employment (13.1 [9.2] years). The QFT-GIT positive test was significantly higher in physicians (P=.02) and in HCWs working in chest hospitals 16/76 (21.05%) (P=.001). CONCLUSION: Agreement between the tests was poor. QFT-GIT detected LTBI when TST was negative in HCWs who had a history of close contact with TB patients. LIMITATIONS: A second step TST was not feasible within 2-3 weeks. CONFLICT OF INTEREST: None.

Occupational CNS aspergillosis in an immunocompetent individual a diagnostic challange.

INTRODUCTION: Immunocompetent individuals are rarely affected by Aspergillus species and its prime importance lies in immunocompromised patients where it can cause disease, ranging from primarily pulmonary infections to dissemination anywhere in the body. Invasive aspergillosis (IA) occurs in patients with risk factors including prolonged neutropenia, neutrophil dysfunction, patient on cytotoxic drugs, steroid therapy, hematological malignancy, AIDS or in patients with bone marrow transplantation. A recently documented risk factor for IA is the exposure to environmental aspergillus spores at construction sites which makes it an important public health issue. We report here a case of primary CNS aspergillosis in an immunocompetent person who was initially diagnosed as a case of meningioma, and had a history of working in an area with excessive ongoing construction. He had no other primary focus of infection anywhere in the body. He was timely diagnosed and broad spectrum antifungals were started immediately. MATERIAL AND METHODS: The brain biopsy and pus sampleas were subjected to direct microscopy using KOH mount and lactophenol cotton blue (LPCB) stain and culture on Sabourad's Dextrose Agar in Microbiology laboratory. Later patient was started on fluconazole and caspofungin. RESULTS: Thin, hyaline, septate hyphae on direct microscopy and growth of Aspergillus flavus on SDA culture were observed. The patient improved only with antifungals, without surgery. DISCUSSION: This case study highlights the importance of keeping the differential diagnosis of Aspergillus spp. in mind even in individuals with no immunodeficiency. The immunocompetent individuals have better prognosis and if timely diagnosed, can be treated even without surgery. The prevalence of aspergillus spores at construction and demolition sites makes it an important public health issue, hence precautions must be advocated at these sites.