A review of nosocomial Salmonella outbreaks: infection control interventions found effective.

OBJECTIVE: To review nosocomial salmonellosis outbreaks to identify: mode of transmission; morbidity and mortality patterns; and recommendations for control and prevention. DESIGN: Documented nosocomial salmonellosis outbreaks in hospitals published from January 1995 to November 2011, written in the English language, were systematically reviewed. METHODS: The study methodology incorporated steps from the PRISMA statement for a high quality review process. Computer-aided searches of Scopus, CAB Global Health and CINAHL(®), the Cumulative Index to Nursing and Allied Health Literature were completed to identify relevant outbreak reports written in English. To validate the electronic search methodology, bibliographies and reference lists of relevant review articles were hand-searched. Public health and government websites were searched for nosocomial salmonellosis. RESULTS: Fifty-two relevant reports were identified. The most frequently reported routes of transmission were food 31/52 (59.6%) and person-to-person transmission 7/52 (13.5%). Actions taken during the outbreak to control transmission included improvements to: 1) infection control practices (41.8% of actions); isolation or cohorting patients, hand hygiene practices, and enhancing cleaning and disinfection in patient care areas; and 2) food handling practices (24.4% of actions); reviewing food preparation practices, enhancing cleaning and sanitation of the kitchen, and controlling food temperatures. Investigators made recommendations retrospectively in outbreak reports to provide direction to health centees but these recommendations were not statistically evaluated for effectiveness. CONCLUSIONS: More emphasis should be placed on improving food handling practices, such as training food workers, monitoring food temperatures, and not using raw foods of animal origin, to prevent nosocomial salmonellosis outbreaks in hospitals because almost 60% of the outbreaks were foodborne.

A review of nosocomial norovirus outbreaks: infection control interventions found effective.

The purpose of this study was to review documented outbreaks of enteric illness associated with nosocomial norovirus infections and to identify modes of transmission, morbidity and mortality patterns, and recommendations for control. Searches of electronic databases, public health publications, and federal, state/provincial public health websites were completed for 1 January 2000 to 31 December 2010. Computer-aided searches of literature databases and systematic searches of government websites identified 54 relevant outbreak reports. Transmission routes included person-to-person (18.5%), foodborne (3.7%) and in the majority (77.8%) the route was unknown. Actions taken during the outbreak to control infection included restricting the movements of patients and staff (22.5%), enhanced environmental cleaning (13.6%) and hand hygiene (10.3%). Rapid identification of norovirus outbreaks in hospitals is vital for the immediate implementation of infection control measures and isolation of infected individuals in this mainly immunocompromised population. Studies that statistically evaluate infection control measures are needed.

Review of enteric outbreaks in prisons: effective infection control interventions.

OBJECTIVES: To identify documented outbreaks, worldwide, of enteric illness in correctional facilities over the last 10 years to understand the epidemiology of the outbreaks and explicitly identify effective infection control measures. STUDY DESIGN: Review of literature and outbreak investigation reports. METHODS: Computer-aided searches of literature databases and systematic searches of government websites were completed to identify relevant outbreak reports. Reference lists were hand-searched to validate the electronic search methodology. Reports identified through personal communications with public health officials were also included. RESULTS: Of the 72 outbreaks meeting the inclusion criteria, 76% and 21% were associated with bacterial agents and viral agents, respectively. The majority of outbreaks were associated with Salmonella (n=20), Clostridium perfringens (n=14), norovirus (n=14), pathogenic Escherichia coli (n=10) and Campylobacter spp. (n=5). Transmission was primarily foodborne (67%). During an outbreak, the most common control measures included limiting movements of ill inmates and staff, and their exclusion from kitchen duty. The most common retrospectively reported preventative recommendations included monitoring food temperatures and effective infection control procedures. CONCLUSIONS: It is essential to monitor food temperatures to prevent enteric outbreaks in prisons. Training in safe food handling should be offered to inmates who work in the kitchen. Enteric outbreaks are best controlled by effective infection control practices, while active surveillance and early diagnosis may prevent further spread of illness.

A scoping review of Lyme disease research relevant to public health.

Lyme disease (LD) is an emerging infectious disease in Canada associated with expansion of the geographic range of the tick vector Ixodes scapularis in eastern and central Canada. A scoping review of published research was prioritized to identify and characterize the scientific evidence concerning key aspects of LD to support public health efforts. Prior to initiation of this review, an expert advisory group was surveyed to solicit insight on priority topics and scope. A pre-tested search strategy implemented in eight databases (updated September 2016) captured relevant research. Pre-tested screening and data characterization forms were completed by two independent reviewers and descriptive analysis was conducted to identify topic areas with solid evidence and knowledge gaps. Of 19,353 records screened, 2,258 relevant articles were included in the review under the following six public health focus areas: a) surveillance/monitoring in North America (n=809); b) evaluation of diagnostic tests (n=736); c) risk factors (n=545); d) public health interventions (n=205); e) public knowledge, attitudes and/or perceptions in North America (n=202); and f) the economic burden of LD or cost-benefit of interventions (n=32). The majority of research investigated Borrelia burgdorferi (n=1,664), humans (n=1,154) and Ixodes scapularis (n=459). Sufficient research was identified for potential systematic reviews in four topic areas: a) accuracy of diagnostic tests; b) risk factors for human illness; c) efficacy of LD intervention strategies; and d) prevalence and/or incidence of LD in humans or B. burgdorferi sensu stricto in vertebrate reservoirs or ticks in North America. Future primary research could focus on closing knowledge gaps, such as the role of less studied vertebrate reservoirs in the transmission cycle. Results of this scoping review can be used to quickly identify and summarize relevant research pertaining to specific questions about LD or B. burgdorferi sensu lato in humans, vertebrate hosts or vectors, providing evidence-informed information within timelines that are conducive for public health decision-making.

The potential for acquiring cryptosporidiosis or giardiosis from consumption of mung bean sprouts in Norway: a preliminary step-wise risk assessment.

The current work evolved from a microbial survey of fruits and vegetables conducted in Norway between 1999 and 2001. This survey found that mung bean sprouts were more likely to be contaminated with Cryptosporidium and Giardia than the other produce included in the survey. To support this observation and to demonstrate to public health officials that this might be a risk warranting further attention, a simple risk assessment was initiated. Assuming that 60,000 people in Norway consume a single serving of bean sprouts per week, and contamination levels are similar to those found in the survey, it was calculated that there could be in the order of 20 cases of Giardia or Cryptosporidium infection per 100,000 population attributable to consumption of mung bean sprouts. A number of assumptions were made for the calculations, including parasite factors (e.g. viability, genotype), product factors (e.g. extent of product contamination) and host factors (e.g. composition and extent of consumer group). These assumptions and areas of uncertainty, where further data would improve the risk assessment, are highlighted throughout. Not only does the risk assessment identify new areas of research, but it also demonstrates how risk assessment can be used as a tool to try to influence public health surveillance.

The relationship of the abdominal aortic aneurysm to the tortuous internal carotid artery. Is there one?

During our investigation of the tortuous internal carotid artery in the presence of atherosclerosis, we noted a 44% incidence of abdominal aortic aneurysm. The incidence of abdominal aortic aneurysm in the adult population is 2% to 4%, and the incidence in a group of patients with carotid atherosclerosis has been reported to be 10%. This supports an association between the tortuous internal carotid artery and the abdominal aortic aneurysm independent of other risk factors. We found no significant difference in sex, age, or other atherosclerotic risk factors between those patients with and those without an abdominal aortic aneurysm. This suggests the possibility of weakness of the arterial wall as a cause of tortuous internal carotid artery and abdominal aortic aneurysm in this group of patients. Better histologic and biochemical definition of this possible weakness is warranted. From a clinical standpoint, we feel that the high association of the two conditions should not be ignored; patients found to have a tortuous internal carotid artery should be investigated and followed up carefully for the presence or subsequent development of aneurysmal degeneration of the aorta.

Raised carcinoembryonic antigen level as an indicator of recurrent disease in follow up of patients with colorectal cancer.

BACKGROUND: Serum carcinoembryonic antigen level is raised in 80% of patients undergoing colonic resection for cancer. Subsequent elevation in the follow-up period may precede signs and symptoms as an indicator of recurrent disease. there is little evidence that "classical" follow up of patients in the general surgical outpatient clinic improves either survival or quality of life. Regular carcinoembryonic antigen level estimation requested by the general practitioner, allied to day-case colonoscopic surveillance may be a more rational approach. AIM: A study was undertaken to investigate the relationship between raised carcinoembryonic antigen level and the recurrence of colorectal cancer in patients following a curative primary resection. METHOD: Retrospective analysis was carried out on the notes of 125 patients who had attended a dedicated hospital colorectal follow-up clinic between 1988 and 1992. Carcinoembryonic antigen level data were obtained by subsequent examination of the University of Edinburgh Department of Clinical Chemistry (immunoassay section) carcinoembryonic antigen database. RESULTS: A single carcinoembryonic level result of more than 100 ul-1 (normal range less than 60 ul-1) was found to be a highly sensitive (87%), specific (89%), and accurate (88%) indicator of recurrent disease. Raised carcinoembryonic antigen level preceded symptoms in 72% of patients with recurrence of colorectal cancer. CONCLUSION: Sequential laboratory estimation of carcinoembryonic antigen level organized by the general practitioner may represent an accurate method of detecting recurrent colorectal disease. Hospital review could be limited to colonoscopic surveillance and restaging of patients referred with evidence of recurrent disease.

An unusual case of pelviureteric junction obstruction.

We describe an unusual case of pelviureteric junction obstruction in a child due to a benign ureteric polyp. Benign neoplasms of the ureter are uncommon in adults and extremely rare in children.

Splenic torsion in a wandering spleen, presenting as an acute abdominal mass.

A childhood splenic torsion presenting as an acute abdominal mass is reported.

A descriptive analysis of giardiasis cases reported in Ontario, 1990-1998.

Cases of giardiasis in Ontario were described using notifiable disease data from the Ontario Ministry of Health for the years 1990-1998 inclusive. The mean annual age- and sex-adjusted incidence rate was 25.77 cases per 100,000 population for the 25,289 cases reported. Children under five years of age had the highest incidence of disease. Males had a higher mean annual incidence in all age groups. Four deaths occurred among cases. The most frequently reported symptoms were loose stools or watery diarrhea (50.1%). A seasonal pattern was noted, peaking in late summer and early autumn. The most frequently reported probable risk settings were the home (40.1%) and travel (39.1%). The study findings suggest that a high proportion of cases occur in urban areas and spatial analysis showed the highest incidence around Lake Huron and Georgian Bay. Unfiltered water and person-to-person contact are believed to be important sources of infection.

Necrolytic migratory erythema in glucagonoma syndrome.

A 32-year-old female Chinese presenting with typical features of necrolytic migratory erythema due to glucagonoma syndrome is reported. The clinical, biochemical, histopathological, and electron-microscopic findings are described. Various different aspects of this rare entity are discussed.

Follow-up of spina bifida children with and without upper renal tract changes at birth.

The aim of this study was to assess 2 groups of children with spina bifida; one with and the other without upper renal tract (URT) changes at birth and to evaluate the outcome of their management. In Group 1, there were 148 patients who had normal URT at birth. They were studied for a mean follow-up of 131 months. Twenty-eight per cent developed URT changes in later life. The median time interval for URT changes to develop between birth and the first assessment which showed abnormal finding, was 33 months and between the last normal URT assessment and the development of URT changes, was 16 months. Six patients with URT changes were treated conservatively and 36 required intervention. Twenty-eight of 42 patients showed initial improvement of URT changes but 25 subsequently deteriorated. In 3 patients renal function deteriorated with renal failure in one and renal impairment in 2. In Group 2, 24 patients who had URT changes present at birth were also studied for a mean follow-up of 115 months. The URT changes in 8 patients deteriorated after the initial assessment over a median time of 15 months. Twelve patients' URT changes improved spontaneously without active intervention over a median time interval of 16 months but 5 subsequently deteriorated. Overall, the prognosis of children with URT changes at birth did not seem to be any worse than children developing changes later in life. Lesions of sacral and thoraco-lumbar regions of the spine were most commonly associated with URT changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Value of antenatal diagnosis of abnormalities of the urinary tract.

OBJECTIVE: To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN: Retrospective study. SETTING: Two obstetric units in Glasgow. SUBJECTS: 62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS: Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT: Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS: Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS: The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.

Colorectal carcinoma: presentation and management in a general hospital.

Over a five year period (1981-1986), 44 consecutive patients who presented with colorectal carcinoma were studied prospectively. Forty one (93%) patients underwent surgery, 11 as an emergency. The operative mortality was 7.3% and the wound infection rate was 12.2%. Of the original 44 patients only 18 (41%) are still alive at the end of the study period. The presentation, treatment and prognosis of patients with colorectal cancer in a general hospital are discussed.

Enteric outbreaks in long-term care facilities and recommendations for prevention: a review.

Outbreaks of enteric illness in long-term care facilities (LTCFs) were reviewed to identify preventative recommendations. Systematic review methodology identified outbreak reports of gastrointestinal illness in LTCFs either published or that occurred from January 1997 to June 2007. The inclusion criteria captured 75 outbreaks; 23 (31%) associated with bacterial agents and 52 (69%) with viral agents. Transmission was mainly foodborne (52%) for those of bacterial origin and person-to-person (71%) for viral outbreaks. Norovirus infection was associated with 58% of hospitalizations. Sixty deaths were reported, about half from Salmonella infections. Recommendations for foodborne outbreaks emphasized appropriate sourcing and preparation of eggs, staff training, and temperature control during food preparation. Recommendations from outbreaks transmitted person-to-person centred on controlling residents' movements, effective environmental cleaning and disinfection, cancelling social events and restricting visitors, excluding ill staff, encouraging effective hand hygiene, and preventing cross-contamination through gloving and gowning. In none of the 75 published outbreak reports were the suggested recommendations evaluated for effectiveness in controlling the outbreak. Applied research of this type could greatly help in the acceptance of prevention and control strategies.