Treatment of Chronic Granulomatous Disease-Related Pulmonary Aspergillus Infection in Late Pregnancy.

Chronic granulomatous disease (CGD) is a primary immunodeficiency syndrome that results in increased risk for bacterial and fungal infections, as well as inflammatory/autoimmune complications. While CGD historically has been associated with early death in childhood, the life expectancy and morbidity of patients with CGD have greatly improved. Many patients with CGD now survive well into adulthood, and data on adult cohorts of patients with CGD have been published. However, reports of pregnancy management, complications, and outcomes for patients with CGD are sparse. In addition, management of invasive fungal infections, including use of newer triazole antifungals, during pregnancy has not been well described. We report a case of fungal lung infection in a pregnant woman with CGD, diagnosed during her second trimester, which was treated with multiple antifungal agents, including more than 12 weeks of isavuconazole therapy, resulting in resolution of infection and delivery of a healthy newborn at term.

Analysis of the Herschel/HEXOS Spectral Survey Towards Orion South: A massive protostellar envelope with strong external irradiation.

We present results from a comprehensive submillimeter spectral survey toward the source Orion South, based on data obtained with the HIFI instrument aboard the Herschel Space Observatory, covering the frequency range 480 to 1900 GHz. We detect 685 spectral lines with S/N > 3σ, originating from 52 different molecular and atomic species. We model each of the detected species assuming conditions of Local Thermodynamic Equilibrium. This analysis provides an estimate of the physical conditions of Orion South (column density, temperature, source size, & V LSR ). We find evidence for three different cloud components: a cool (T ex ~ 20 - 40 K), spatially extended (> 60″), and quiescent (ΔVFWHM ~ 4 km s -1) component; a warmer (T ex ~ 80 - 100 K), less spatially extended (~ 30″), and dynamic (ΔVFWHM ~ 8 km s -1) component, which is likely affected by embedded outflows; and a kinematically distinct region (T ex > 100 K; V LSR ~ 8 km s -1), dominated by emission from species which trace ultraviolet irradiation, likely at the surface of the cloud. We find little evidence for the existence of a chemically distinct "hot core" component, likely due to the small filling factor of the hot core or hot cores within the Herschel beam. We find that the chemical composition of the gas in the cooler, quiescent component of Orion South more closely resembles that of the quiescent ridge in Orion-KL. The gas in the warmer, dynamic component, however, more closely resembles that of the Compact Ridge and Plateau regions of Orion-KL, suggesting that higher temperatures and shocks also have an influence on the overall chemistry of Orion South.

Knowing prior methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization status increases the empirical use of glycopeptides in MRSA bacteraemia and may decrease mortality.

To compare the management and outcome of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in patients known to be MRSA-colonized/infected (C-patients) with the management and outcome in those not known to be colonized/infected (NC-patients), we conducted a 10-year retrospective review of MRSA bacteraemia in an adult tertiary hospital. Clinical data were obtained by chart review, and mortality data from linked databases. Prior MRSA colonization/infection status was available to treating clinicians at the time of the bacteraemia as a 'Micro-Alert' tag on the patient's labels, in medical charts, and in electronic information systems. C-patients accounted for 35.4% of all MRSA bacteraemia episodes. C-patients were more likely to be indigenous, to be diabetic, or to have a history of previous S. aureus infection. Markers of illness severity (Simplified Acute Physiology Score (SAPS)-II, need for admission to the intensive-care unit, length of stay, and metastatic seeding) were similar in both groups. Empirical therapy included a glycopeptide in 49.3% of C-patients vs. 18.9% of NC-patients (p <0.01), and contained an antibiotic to which the MRSA isolate tested susceptible in vitro in 56.7% of C-patients vs. 45.1% of NC-patients (p 0.13). All-cause 7-day and 30-day mortality were 7.5% vs. 18.9% (p 0.04), and 22.4% vs. 31.1% (p 0.20), in the C-patient and NC-patient groups, respectively. Knowing MRSA colonization status was significantly associated with lower 30-day mortality in Cox regression analysis (p <0.01). These data suggest that mortality from MRSA bacteraemia is lower in C-patients, which may reflect the earlier use of glycopeptides. The low use of empirical glycopeptides in septic patients known to be previously MRSA-colonized/infected may represent a missed opportunity for infection control to positively impact on clinical management.

Formal infectious diseases consultation is associated with decreased mortality in Staphylococcus aureus bacteraemia.

To determine the impact of infectious diseases consultation (IDC) in Staphylococcus aureus bacteraemia. All MRSA bacteraemia and a random subset of MSSA bacteraemia were retrospectively analysed. Out of 599 SAB episodes, 162 (27%) were followed by an IDC. Patients with IDC were younger and more frequently intravenous drug users, but fewer resided in a long-term care facility or were indigenous. Hospital length of stay was longer (29.5 vs 17 days, p < 0.001), and endocarditis (19.1% vs 7.3%, p < 0.001) and metastatic seeding (22.2% vs 10.1%, p < 0.001) were more frequent in the IDC group; however, SAPS II scores were lower in the IDC group (27 vs 37, p < 0.001). ICU admission rates in the two groups were similar. The isolate tested susceptible to empirical therapy more frequently in the IDC group (88.9% vs 78.0%, p = 0.003). Seven-day (3.1 vs 16.5%), 30-day (8.0% vs 27.0%) and 1-year mortality (22.2% vs 44.9%) were all lower in the IDC group (all p < 0.001). Multivariate analysis showed that effective initial therapy was the only variable associated with the protective effect of IDC. In patients with SAB, all-cause mortality was significantly lower in patients who had an IDC, because of the higher proportion of patients receiving effective initial antibiotics.

Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case-control study.

Differences between the features of invasive community-onset methicillin-resistant Staphylococcus aureus (cMRSA) and methicillin-susceptible S. aureus (cMSSA) infections are incompletely understood. Fifty-seven patients with invasive cMRSA infection were prospectively identified at two teaching hospitals; for each cMRSA case, two cases of invasive cMSSA infection acted as controls. The primary outcome was 30-day all-cause mortality. Patients with invasive cMRSA infection were more likely to be Aboriginal (25% vs. 14%, age-adjusted odds ratio [OR] 2.5, p = 0.037), reside in a long-term care facility and/or have been hospitalised in the previous year (51% vs. 34%, p = 0.04) and less likely to have endocarditis (2% vs. 12%, p = 0.02) or require admission to an intensive care unit or high-dependency area (7% vs. 21%, p = 0.02). All-cause mortality at 30 days was similar in the cMRSA and cMSSA groups (9% vs. 7%, p = 0.68). Panton-Valentine leukocidin (PVL) genes were detected in a similar proportion of cMRSA and cMSSA isolates (32% vs. 27%, p = 0.49) and the presence of PVL genes was associated with younger age (35 years vs. 55 years, p < 0.001), Aboriginal ethnicity (38% vs. 10%, p < 0.001), skin and soft-tissue infection (54% vs. 19%, p < 0.001), lower illness severity at presentation (SAPS II score 9 vs. 21, p = 0.001) and shorter hospitalisation (9 days vs. 24 days, p < 0.001). Patients with "PVL-positive" and "PVL-negative" S. aureus infection had similar 30-day all-cause mortality (4% vs. 9%, p = 0.28). Few clinical features differentiated patients with invasive cMRSA infection from those with infection caused by cMSSA. Invasive "PVL-positive" S. aureus infection was associated with less morbidity but similar mortality to "PVL-negative" infection.

Community-associated versus healthcare-associated methicillin-resistant Staphylococcus aureus bacteraemia: a 10-year retrospective review.

The objective was to compare the epidemiology and outcome of healthcare- (HA-) and community-associated (CA-) MRSA bacteraemia. A 10-year retrospective study of MRSA bacteraemia was carried out. Episodes were classified according to established criteria. Molecular typing was performed on a subset of isolates. Of 197 MRSA bacteraemia episodes, 178 (90.4%) were classified as HA-MRSA and 19 (9.6%) as CA-MRSA. All-cause 7- and 30-day mortality rates were similar in the HA and CA-MRSA bacteraemia groups; however, 1-year mortality was higher in the HA-MRSA bacteraemia group (48.3% vs 21.1% [p = 0.023]). Thirty-day all-cause mortality was significantly lower if empiric antimicrobial therapy included agent(s) to which the isolate tested susceptible, compared with patients receiving "inactive" therapy (19% vs 35.1% [p = 0.011]). The majority of MRSA bacteraemia episodes were caused by clones known to circulate in the community. All-cause mortality is as high in HA- as in CA-MRSA bacteraemia. Thirty-day mortality was significantly reduced if the patient received an antibiotic with activity against the MRSA isolate.

Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection.

OBJECTIVE: To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner. SETTING: A medical practitioner's office and 4 hospitals in Perth, Western Australia. PATIENTS: Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner. METHODS: We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner. RESULTS: Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified. CONCLUSIONS: This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.

Controlling a multicenter outbreak involving the New York/Japan methicillin-resistant Staphylococcus aureus clone.

OBJECTIVE: To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistant Staphylococcus aureus (MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility. SETTING: A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region. INTERVENTIONS: A comprehensive, statewide MRSA epidemiological investigation and management policy. RESULTS: In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread. CONCLUSIONS: The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.

Type V staphylococcal cassette chromosome mec in community staphylococci from Australia.

Twenty Australian community staphylococci harboring the type V staphylococcal cassette chromosome mec (SCCmec) were found to belong to eight multilocus sequence types. Five were previously unreported novel type V SCCmec elements. The mec complexes were of two types, based on the polymorphisms in the IS431 transposase genes. Five isolates were multiresistant.

Evaluation of a Wellness-Based Mindfulness Stress Reduction intervention: a controlled trial.

PURPOSE: To determine if participation in a Wellness-Based Mindfulness Stress Reduction intervention decreases the effect of daily hassles, psychological distress, and medical symptoms. DESIGN: A randomized controlled trial of a stress reduction intervention with a 3-month follow-up. SETTING: A university setting in West Virginia. SUBJECTS: A total of 103 adults, with 59 in the intervention group and 44 in the control group. Eight-five percent of subjects completed the intervention. Fifty-nine percent and 61% of the intervention and control subjects completed the study, respectively. INTERVENTION: The intervention consisted of an 8-week group stress reduction program in which subjects learned, practiced, and applied "mindfulness meditation" to daily life situations. The control group received educational materials and were encouraged to use community resources for stress management. MEASURES: The Daily Stress Inventory assessed the effect of daily hassles, the Revised Hopkins Symptom Checklist measured psychological distress, the Medical Symptom Checklist measured number of medical symptoms, and a Follow-up Questionnaire measured program adherence. RESULTS: Intervention subjects reported significant decreases from baseline in effect of daily hassles (24%), psychological distress, (44%), and medical symptoms (46%) that were maintained at the 3-month follow-up compared to control subjects (repeated measures analysis of variance [ANOVA]; p < .05). CONCLUSIONS: Self-selected community residents can improve their mental and physical health by participating in a stress reduction intervention offered by a university wellness program.

Excess hospital admissions for pneumonia and influenza in persons > or = 65 years associated with influenza epidemics in three English health districts: 1987-95.

OBJECTIVES: To study the association between community influenza activity and acute hospital admissions for pneumonia and influenza among elderly persons. DESIGN: Multiple regression analysis of acute hospital admissions against community influenza activity, air temperature and seasonal and long-term trends. SETTING: Three English health districts: 1987-95. SUBJECTS: Persons aged > or = 65 years. OUTCOME MEASURES: Acute hospital admissions for pneumonia and influenza (ICD9: 480-487); excess hospital admissions during epidemic periods. RESULTS: The final regression model explained 70% of the total variation in hospital admissions for pneumonia and influenza, including 14% due to community influenza activity. However, most variation was explained by long-term and seasonal changes unrelated to influenza. In the large influenza epidemic of 1989/90 a typical health district (500,000 total population) experienced 56 excess admissions for pneumonia and influenza attributable to epidemic influenza among persons aged > or = 65 years, requiring 672 additional bed-days. However the figure varied widely between seasons and over the whole study period, the average winter excess was 17.5 admissions per health district, requiring an additional 210 bed-days. CONCLUSIONS: Influenza epidemics exert a variable impact on acute hospital admissions for pneumonia and influenza among elderly persons, which in the past have been poorly quantified. Although the absolute numbers of excess admissions is modest, their impact on bed availability may be considerable because of the duration of hospital stay in elderly persons.

New strategy for the design of ligands for the purification of pharmaceutical proteins by affinity chromatography.

A new approach for the identification of ligands for the purification of pharmaceutical proteins by affinity chromatography is described. The technique involves four steps. Selection of an appropriate site on the target protein, design of a complementary ligand compatible with the three-dimensional structure of the site, construction of a limited solid-phase combinatorial library of near-neighbour ligands and solution synthesis of the hit ligand, immobilisation, optimisation and application of the adsorbent for the purification of the target protein. This strategy is exemplified by the purification of a recombinant human insulin precursor (MI3) from a crude fermentation broth of Saccharomyces cerevisiae.

The cercaria of Galactosomum bearupi Pearson, 1973 (Trematoda: Heterophyidae) at Heron and Masthead Islands, Great Barrier Reef, Australia.

Magnacercous cercariae, all morphologically identical but with different coloured tails, were found naturally infecting the intertidal prosobranch gastropod Clypeomorus batillariaeformis Habe & Kosuge (Cerithiidae) at Heron and Masthead Islands. Several species of coral-dwelling fishes were exposed to magnacercous cercariae. Active ingestion by the fish, followed by the complete development of the metacercaria in the optic lobes, occurred in Pomacentrus molluccensis Bleeker, but not in Dascyllus aruanus (L.), where development stopped short after encystment. All cercariae turned out to belong to the same species, Galactosomum bearupi Pearson, 1973. Natural infections of G. bearupi metacercariae were found in eight species of fish at Heron Island: Pomacentrus molluccensis, P. wardi Whitley, P. bankanensis Bleeker, P. flavicauda Whitley, Stegastes cf. fasciolatus (Ogilby), Sillago maculata Quoy & Gaimard, S. cf. ciliata Cuvier and Crenimugil crenilabris (Forsskål). This represents the fourth account of the cercaria of a species of Galactosomum.

Light microscopic observations on the relationships between 5-hydroxytryptamine-immunoreactive axons and dorsal spinocerebellar tract cells in Clarke's column in the cat.

Serotonin (5-HT) exerts a variety of effects on the excitability of motoneurons, interneurons, and ascending tract cells. Spinocerebellar-tract cells in the dorsal horn receive synaptic connections from serotoninergic axons, but little is known about the relationships between serotoninergic axons and dorsal spinocerebellar tract (DSCT) cells in Clarke's column. We studied these relationships by using a combination of immunohistochemical localization of 5-HT-immunoreactive boutons and intracellular staining with horseradish peroxidase (HRP) or neurobiotin of identified DSCT cells in vivo. In the adult cat, Clarke's column displayed a lower density of 5-HT-immunoreactive axons and boutons than adjacent regions of the spinal gray matter. Eleven intracellularly stained DSCT cells were analyzed with light microscopy, and six of these cells were entirely reconstructed in three dimensions. A total of 3,739 close appositions (340+/-101 per postsynaptic neuron: mean +/- SD) were observed on the labeled DSCT cells. The majority (97%) of the appositions were formed on dendrites, including proximal and distal branches, with an average density of about 1.4 appositions per 1,000 microm2 of dendritic membrane. These results indicate that the bulbo-spinal serotoninergic system(s) provide direct innervation of Clarke's column-DSCT cells in the upper lumbar spinal cord and that the inputs are spread widely over all regions of the target neurons' soma-dendritic membrane.

Proposed division of the genus Heterophyes Cobbold, 1865 (Trematoda : Heterophyidae).

A new genus, Alloheterophyes, is erected for Heterophyes chini Pearson & Pearson, 1983 and for H. superspinata Leonov & Belogurov, 1965, with which H. bitorquata Pearson & Pearson, 1983 is synonymised. New host and locality records are given. Alloheterophyes differs from Heterophyes in having: (i) a seminal vesicle of two tandem chambers, the distal with a thicker wall; (ii) a uterine seminal receptacle; (iii) an unspined genital atrium; (iv) an inflated, almost triangular excretory bladder; (v) a ventral sucker not close to the gut fork; (vi) the final loop of the uterus dextral to the gonotyl; and (vii) a clavate shape.

The value of MR imaging in differentiating between hard and soft cervical disc disease: a comparison with intraoperative findings.

The aim of this study is to assess the accuracy of MRI alone in the differentiation of soft cervical disc protrusion from osteophytic compression in cervical disc disease. In a retrospective study, the MRI scans of 41 patients with cervical disc disease, who had previously undergone surgery, were presented to three independent observers, randomly on two different occasions, to identify the accuracy of the diagnosis of the presence of hard or soft disc or both as a cause of compression. The observers (two neurosurgeons and one neuroradiologist) were not involved with the treatment of the cases at any stage and were unaware of the surgical findings. Their observations were compared with those of the surgeon recorded at operation. The intra-observer agreement was poor for diagnosis into three categories as hard or soft disc or both. In distinguishing between the presence or absence of hard disc, there was moderate to good (Kappa = 0.6) intra observer and fair to moderate (Kappa = 0.4) interobserver agreement. The sensitivity of diagnosis of a hard disc was high (87%) but specificity was low (44%), due to the overestimation of the presence of hard disc. There was a significantly higher incidence of hard disc in the elderly age group (76% over the fifth decade, P = 0.0073). It is concluded that MRI alone is not a very efficient diagnostic tool in distinguishing between hard and soft disc in the cervical disc disease.

Perceptions and knowledge of breast cancer among African-American women residing in public housing.

OBJECTIVE: The purpose of this study, theoretically based on the Health Belief Model, was to assess breast cancer perceptions, knowledge, and screening behavior of low-income, African-American women residing in public housing. METHODS: One hundred twenty (120) randomly selected women were interviewed to determine their perceived susceptibility to breast cancer, perceived severity of the disease, perceived barriers to breast cancer screening, and perceived benefits of mammography. Knowledge about breast cancer causes, risk factors, symptoms, and screening was also assessed. Contingency tables and Student's t test were used to analyze the data. RESULTS: The results demonstrated that 80.7% of women aged 40 and older had a previous mammogram. Approximately 92% of women reported having a clinical breast examination, and 75.8% performed breast self-examination. Knowledge of breast cancer was poor among the women in this study. Most women did not perceive themselves or a particular racial or economic group to be more susceptible to breast cancer. Moreover, the women in the sample did not perceive breast cancer as a fatal disease. Overall, women in the sample endorsed the benefits of mammography and denied the relevance of commonly cited barriers to breast cancer screening. The constructs of the Health Belief Model were not significantly related to mammography or breast self-examination. However, perceived severity and perceived barriers were found to be significantly related to clinical breast examination. CONCLUSIONS: Rates of early detection behaviors in this sample are commendable. Future research should focus on actual determinants and facilitators of regular screening behavior within a theoretical framework that incorporates cultural, ethnic, and socioeconomic diversity.

Risk factors for hospital-acquired urinary tract infection in a large English teaching hospital: a case-control study.

About 10% of patients in hospital develop a hospital-acquired infection (HAI); the most commonly affected site is the urinary tract. Many studies have examined risk factors for HAI but few have adjusted for confounding and interaction. We performed a prospective case-control study on six acute wards of a busy English teaching hospital to assess risk factors for hospital-acquired urinary tract infection (HAUTI). Over a 2-year period, 136 cases were identified (2.8% of all patient episodes) along with 408 controls. Multiple logistic regression revealed that female sex, increased length of stay, elective admission, surgical operation, and transurethral and repeated intermittent catheterization were all significant independent risk factors for HAUTI. However, specialty of admission was also a significant risk factor when added to the model and, under these conditions, only length of stay and catheterization also remained significant. We detected significant interactions suggesting that the risk of HAUTI is maximal among women undergoing elective surgery, especially those who are catheterized; however, the overall risk of HAUTI among patients admitted electively was greater than for patients admitted as emergencies.

Distribution of 5-hydroxytryptamine-immunoreactive boutons on immunohistochemically-identified Renshaw cells in cat and rat lumbar spinal cord.

A combination of anti-gephyrin- and anti-calbindin D28k-immunoreactivity was used to identify 129 and 171 Renshaw cells and their dendrites in cat and rat lumbar spinal cord, respectively. Using anti-5-hydroxytryptamine-immunoreactivity to label serotoninergic fibers and boutons, 1048 serotoninergic boutons were observed in close contact with the immunolabeled Renshaw cells, with an average of 4.4 and 2.8 close contacts on cat and rat Renshaw cells, respectively. Two-thirds of the observed appositions were formed on the somatic membrane.