Arenavirus infection--Connecticut, 1994.

On August 20, 1994, the Connecticut Department of Public Health and Addiction Services received a report of a case of acute illness in a virologist suspected to be associated with Sabiá virus, a newly described arenavirus. This report preliminary findings from the case investigation.

Chagas disease. American trypanosomiasis.

Chagas disease, caused by the protozoan parasite, Trypanosoma cruzi, is a major source of morbidity and death in Latin America. Many infected immigrants from that region now reside in the United States, posing a risk of transfusion-associated transmission of the organism. Serologic testing is the cornerstone of diagnosing chronic T. cruzi infections, and improved assays are needed. Drug treatment is problematic because the two available drugs can have severe side effects and lack efficacy. T. cruzi infection can be particularly severe in immunosuppressed patients.

Laboratory-acquired brucellosis.

Brucellosis is endemic in Saudi Arabia and hospital laboratories are handling increasing numbers of specimens for diagnosis. We report four cases of laboratory-acquired brucellosis.

Tuberculosis por inoculación / Inoculation tuberculosis

Una bacterióloga sufrió un accidente por punción con una aguja con jeringa que contenía una cepa de Mycobacterium tuberculosis en un dedo de la mano. La zona de la punción se inflamó y la expresión del dedo 15 días después del accidente arrojó una gota de pus que puesta al microscopio permitió observar 3 bacilos ácido-alcohol resistentes con la técnica de Ziehl-Neelsen. Se diagnosticó tuberculosis por inoculación accidental y fue tratada como tal. Se discuten las características de este caso encuadrado como tuberculosis cutánea, cuando se produce como infección exógena por inoculación directa. (AU)

A bacteriologist suffered a puncture accident while manipulating a Mycobacterium tuberculosis strain, affecting a finger. The involved area swelled and a drop of pus came out after pressure on the finger 15 days afterwards. This was stained by Ziehl-Neelsen technique, and three acid-fast bacilli were observed. Tuberculosis was diagnosed, and proper treatment was started. We discuss the case, classified as cutaneous tuberculosis produced by exogenous infection through accidental direct inoculation. (AU)

Tuberculosis por inoculación / Inoculation tuberculosis

Una bacterióloga sufrió un accidente por punción con una aguja con jeringa que contenía una cepa de Mycobacterium tuberculosis en un dedo de la mano. La zona de la punción se inflamó y la expresión del dedo 15 días después del accidente arrojó una gota de pus que puesta al microscopio permitió observar 3 bacilos ácido-alcohol resistentes con la técnica de Ziehl-Neelsen. Se diagnosticó tuberculosis por inoculación accidental y fue tratada como tal. Se discuten las características de este caso encuadrado como tuberculosis cutánea, cuando se produce como infección exógena por inoculación directa.

A bacteriologist suffered a puncture accident while manipulating a Mycobacterium tuberculosis strain, affecting a finger. The involved area swelled and a drop of pus came out after pressure on the finger 15 days afterwards. This was stained by Ziehl-Neelsen technique, and three acid-fast bacilli were observed. Tuberculosis was diagnosed, and proper treatment was started. We discuss the case, classified as cutaneous tuberculosis produced by exogenous infection through accidental direct inoculation.

Laboratory-acquired sporotrichosis.

A case of laboratory-acquired sporotrichosis is described that was associated with research activities involving isolates of Sporothrix schenckii from the 1988 sporotrichosis epidemic in the USA. Infection occurred in the absence of apparent trauma or other predisposing factors. The possibility that S. schenckii can invade healthy and intact skin is suggested.

Trichophyton simii infection due to laboratory accident.

Trichophyton simii produced kerion on the intact forearm skin due to a laboratory accident within 5 days of contact. Early institution of griseofulvin resolved the condition in 15 days with no recurrence during 38 months of follow-up.

Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone.

Gonococcal conjunctivitis can be a severe disease with sequelae of corneal ulceration, hypopyon, and global perforation. Current recommended therapy is hospitalization and repeated courses of parenteral antibiotics. The authors report a case successfully managed with a single injection of the new third-generation cephalosporin, ceftriaxone.

Accidental Leishmania mexicana infection in an immunosuppressed laboratory technician.

A 30 year-old female laboratory technician under immunosuppressive treatment because of systemic lupus erythematosus (SLE) developed cutaneous leishmaniasis 8 months after accidental percutaneous inoculation of amastigote culture forms of Leishmania mexicana. Leishmania-specific PCR and restriction analysis patterns were identical for both the laboratory strain and the clinical specimen. The lesion was resistant to local paromomycin and oral ketoconazole, but responded to local application of meglumine antimonate. No signs of dissemination or visceralization occurred during the 5-month period of observation. However, a future recurrence cannot be excluded since a persistent infection even after clinical cure has always to be considered in leishmaniasis. Patients under immunosuppressive therapy are possibly at risk of clinical relapse or disseminating infection although there is no experience with regard to leishmaniasis mexicana. Serious infection may require interferon gamma as part of the treatment which may contribute to deterioration of concomitant diseases like SLE. In any case, the exposure of immunodeficient laboratory workers to Leishmania spp. should be avoided.

Francisella tularensis.

Francisella tularensis is an infection acquired from animals. Although the pathogen is not a cause of nosocomial infections, it is a major hazard to workers in the clinical microbiology laboratory and could easily become a problem for the infection control officer in this setting. The organism can be cultured from many sites but is difficult to recover unless the appropriate media are used. A number of clinical syndromes are caused by this pathogen. Most are characterized by an ulceration and regional lymphadenopathy. Typhoidal tularemia, however, can present as an obscure fever often complicated by pneumonia. The therapy of choice for tularemia is streptomycin although gentamicin and tobramycin are reasonable alternatives.

Diagnosis and management of human B virus (Herpesvirus simiae) infections in Michigan.

Three men who had worked at the same animal research facility and had had contact with macaque monkeys were infected with B virus (Herpesvirus simiae). Their clinical presentations varied from self-limited aseptic meningitis syndrome to fulminant encephalomyelitis and death. Patient 1 was treated only after a respiratory arrest and other signs of advanced brain stem dysfunction had occurred. He died 8 days after hospital admission, despite treatment with acyclovir. Patient 2 presented with subtle signs and symptoms of brain stem encephalitis. He received antiviral therapy with intravenous ganciclovir. Patient 3 had a headache without meningismus and was also treated with acyclovir. Both patients 2 and 3 survived and did not have objective sequelae. Viral culturing, ELISA and western blot antibody testing, and magnetic resonance imaging all proved useful in the diagnosis of these patients' conditions.