RESUMEN
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.
Asunto(s)
Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/transmisión , Streptococcus pyogenes/aislamiento & purificación , Adulto , Antígenos Bacterianos/genética , Proteínas de la Membrana Bacteriana Externa/genética , Técnicas de Tipificación Bacteriana , Proteínas Portadoras/genética , Análisis por Conglomerados , Dermatoglifia del ADN , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Fascitis Necrotizante , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Exposición Profesional , Neumonía Bacteriana/microbiología , Choque Séptico/microbiología , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/genéticaRESUMEN
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.