RESUMEN
This is a cohort study of pediatric outpatients receiving total parenteral nutrition (TPN) and follow-up care in a Tennessee hospital between January and June 1999. The study was conducted following an increase in the incidence of candidemia. Of 13 children receiving home TPN, five had candidemia; three were due to Candida parapsilosis. Case patients were more likely to have an underlying hematologic disease (P = 0.02) as well as previous history of fungemia (P = 0.02). Two case patients had successive candidemia episodes 3 months apart; karyotypes and RAPD profiles of each patient's successive C. parapsilosis isolates were similar. Candida spp. were frequently detected in hand cultures from cohort members (four of 10) and family member caregivers (nine of 11); C parapsilosis was isolated from five caregivers. Our findings underscore the challenges of maintaining stringent infection control practices in the home health care setting and suggest the need for more intensive follow-up and coordination of home TPN therapy among pediatric patients.
Asunto(s)
Atención Ambulatoria , Candidiasis/etiología , Infección Hospitalaria/etiología , Fungemia/etiología , Nutrición Parenteral Total/efectos adversos , Adolescente , Candida/aislamiento & purificación , Candidiasis/epidemiología , Cuidadores , Niño , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Femenino , Fungemia/epidemiología , Mano/microbiología , Hospitales Pediátricos , Humanos , Incidencia , Lactante , Masculino , Factores de Riesgo , Especificidad de la Especie , Tennessee/epidemiologíaRESUMEN
Candida albicans strain diversity and fluconazole resistance were prospectively analyzed in oral strains from 29 adult human immunodeficiency virus (HIV)-positive patients followed for > 1 year who had five or more culture-positive clinic visits. Molecular typing consisted of genomic blots probed with the Ca3 repetitive element. Sixteen patients had one or more episodes of oropharyngeal candidiasis (OPC), 12 (75%) maintained the original genotype, whereas the remaining four patients had a succession of 2-3 genotypes. The original genotype, either alone or mixed with another strain or with non-C. albicans Candida spp., was recovered from oral lesions in 13 of 15 evaluable (86.7%) patients. C. dubliniensis was the infecting yeast in the remaining two patients. Different patterns of fluconazole resistance occurred in three OPC patients. One patient's infecting strain became less susceptible. A second patient was infected with a resistant genotype and a progressively more susceptible minor genotype variant. C. dubliniensis isolates from the third patient varied in susceptibility. Thirteen colonized patients who never developed OPC harbored a greater variety of C. albicans genotypes (2-6) than their infected counterparts (P = 0.35). OPC patients maintained their original endogenous C. albicans strains for prolonged periods, whether or not they demonstrated decreased in vitro susceptibility to fluconazole. The adaptation and maintenance of an endogenous C. albicans strain within its host may be linked to as yet uncharacterized factors.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Candida albicans/genética , Candidiasis Bucal/epidemiología , Epidemiología Molecular , Orofaringe/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Atención Ambulatoria , Antifúngicos/farmacología , Candida albicans/clasificación , Candida albicans/aislamiento & purificación , Candidiasis Bucal/microbiología , Farmacorresistencia Fúngica , Femenino , Fluconazol/farmacología , Seropositividad para VIH/complicaciones , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Técnicas de Tipificación MicológicaRESUMEN
To determine national trends in mortality due to invasive mycoses, we analyzed National Center for Health Statistics multiple-cause-of-death record tapes for the years 1980 through 1997, with use of their specific codes in the International Classification of Diseases, Ninth Revision (ICD-9 codes 112.4-118 and 136.3). In the United States, of deaths in which an infectious disease was the underlying cause, those due to mycoses increased from the tenth most common in 1980 to the seventh most common in 1997. From 1980 through 1997, the annual number of deaths in which an invasive mycosis was listed on the death certificate (multiple-cause [MC] mortality) increased from 1557 to 6534. In addition, rates of MC mortality for the different mycoses varied markedly according to human immunodeficiency virus (HIV) status but were consistently higher among males, blacks, and persons > or =65 years of age. These data highlight the public health importance of mycotic diseases and emphasize the need for continuing surveillance.
Asunto(s)
Micosis/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Quimioprevención , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Micosis/etnología , Micosis/etiología , Micosis/prevención & control , Infecciones Oportunistas/mortalidad , Vigilancia de la Población , Factores de Riesgo , Distribución por Sexo , Estados Unidos/epidemiologíaRESUMEN
An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pediatric emergency ward, with subsequent transmission to the premature nursery, pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for dissemination of the fungus. The outbreak could only be controlled after a health education campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk infants was introduced. In a case-control study, we identified a lower gestational age, a very low birth weight (<1,500 g), and a longer duration of hospital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 consecutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these neonates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patient and health care workers' hand isolates), and the results suggested that these isolates were identical. Our study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Fungemia/epidemiología , Micosis/epidemiología , Pichia/aislamiento & purificación , Antifúngicos/farmacología , Estudios de Casos y Controles , Infección Hospitalaria/microbiología , Femenino , Fungemia/microbiología , Mano/microbiología , Hospitales , Humanos , India/epidemiología , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/microbiología , Masculino , Pruebas de Sensibilidad Microbiana , Micosis/microbiología , Pediatría , Pichia/clasificación , Pichia/efectos de los fármacos , Factores de Riesgo , Piel/microbiologíaRESUMEN
To our knowledge, this is the first report of penicilliosis marneffei among patients with acquired immunodeficiency syndrome (AIDS) in Vietnam. The 4 patients we studied were from Ho Chi Minh City and the provinces of Tay Ninh, Dong Nai, and Kon Tum. In 2 patients, the infections were fatal.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Micosis/diagnóstico , Penicillium/aislamiento & purificación , Adulto , Humanos , Masculino , Micosis/microbiología , VietnamRESUMEN
Aspergillus flavus is second to A. fumigatus as a cause of invasive aspergillosis, but no standard method exists for molecular typing of strains from human sources. A repetitive DNA sequence cloned from A. flavus and subcloned into a pUC19 vector, pAF28, was used to type 18 isolates from diverse clinical, environmental, and geographic sources. The restriction fragment length polymorphisms generated with EcoRI- or PstI-digested genomic DNA and probed with digoxigenin-labeled pAF28 revealed complete concordance between patterns. Eighteen distinct fingerprints were observed. The probe was used to investigate two cases of cutaneous A. flavus infection in low-birth-weight infants in a neonatal intensive care unit (NICU). Both infants were transported by the same ambulance and crew to the NICU on the same day. A. flavus strains of the same genotype were isolated from both infants, from a roll of tape used to fasten their umbilical catheters, from a canvas bag used to store the tape in the ambulance, and from the tape tray in the ambulance isolette. These cases highlight the need to consider exposures in critically ill neonates that might occur during their transport to the NICU and for stringent infection control practices. The hybridization profiles of strains from a second cluster of invasive A. flavus infections in two pediatric hematology-oncology patients revealed a genotype common to strains from a definite case patient and a health care worker. A probable case patient was infected with a strain with a genotype different from that of the strain from the definite case patient but highly related to that of an environmental isolate. The high degree of discrimination and reproducibility obtained with the pAF28 probe underscores its utility for typing clinical and environmental isolates of A. flavus.
Asunto(s)
Aspergilosis/diagnóstico , Aspergillus flavus/clasificación , Dermatomicosis/diagnóstico , Brotes de Enfermedades , Recién Nacido de Bajo Peso , Ambulancias , Aspergilosis/epidemiología , Aspergillus flavus/genética , Aspergillus flavus/aislamiento & purificación , Preescolar , Análisis por Conglomerados , Dermatoglifia del ADN , Sondas de ADN , Dermatomicosis/epidemiología , Genotipo , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Masculino , Microclima , Filogenia , Polimorfismo de Longitud del Fragmento de Restricción , Texas/epidemiologíaRESUMEN
Rapidly growing mycobacteria are capable of causing several clinical diseases in both immunosuppressed and immunocompetent individuals. A previously unidentified, rapidly growing mycobacterium was determined to be the causative agent of central line sepsis in a child with underlying metastatic hepatoblastoma. Four isolates of this mycobacterium, three from blood and one from the central venous catheter tip, were studied. Phenotypic characterization, HPLC and genetic analysis revealed that while this organism most closely resembled members of the Mycobacterium fortuitum complex and Mycobacterium senegalense, it differed from all previously described species. Phenotypic tests useful in differentiating this species from similar rapidly growing mycobacteria included: growth at 42 degrees C, hydrolysis of acetamide, utilization of citrate, production of arylsulfatase (3-d), acidification of D-mannitol and i-myo-inositol, and susceptibility to erythromycin, vancomycin and tobramycin. The name Mycobacterium septicum is proposed for this new species. The type strain has been deposited in Deutsche Sammlung von Mikroorganismen und Zellkulturen as DSM 44393T and in the American Type Culture Collection as strain ATCC 700731T.
Asunto(s)
Bacteriemia/microbiología , Cateterismo Venoso Central , Catéteres de Permanencia/microbiología , Infecciones por Mycobacterium/microbiología , Mycobacterium/clasificación , Mycobacterium/aislamiento & purificación , Composición de Base , Cromatografía Líquida de Alta Presión , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Genes de ARNr , Genotipo , Humanos , Datos de Secuencia Molecular , Mycobacterium/fisiología , Ácidos Micólicos/análisis , Hibridación de Ácido Nucleico , Fenotipo , Filogenia , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADNRESUMEN
An unlicensed injectable medicine sold as adrenal cortex extract (ACE*) and distributed in the alternative medicine community led to the largest outbreak of Mycobacterium abscessus infections reported in the United States. Records from the implicated distributor from January 1, 1995, to August 18, 1996, were used to identify purchasers; purchasers and public health alerts were used to identify patients. Purchasers and patients were interviewed, and available medical records were reviewed. Vials of ACE* were tested for mycobacterial contamination, and the product was recalled by the U.S. Food and Drug Administration. ACE* had been distributed to 148 purchasers in 30 states; 87 persons with postinjection abscesses attributable to the product were identified. Patient and vial cultures contained M. abscessus identical by enzymatic and molecular typing methods. Unusual infectious agents and alternative health practices should be considered in the diagnosis of infections that do not respond to routine treatment.
Asunto(s)
Absceso/epidemiología , Terapias Complementarias , Brotes de Enfermedades , Contaminación de Medicamentos , Infecciones por Mycobacterium/epidemiología , Mycobacterium/aislamiento & purificación , Absceso/tratamiento farmacológico , Absceso/terapia , Adolescente , Adulto , Anciano , Antibacterianos , Claritromicina/uso terapéutico , Drenaje , Electroforesis en Gel de Campo Pulsado , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium/tratamiento farmacológico , Infecciones por Mycobacterium/terapia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery. METHODS: Retrospective cohort study with selected procedural and laboratory investigations. RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found. The clinical findings, when carefully reviewed, were consistent with poor surgical-wound closure. CONCLUSIONS: The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis.
Asunto(s)
Extracción de Catarata/efectos adversos , Errores Diagnósticos , Brotes de Enfermedades , Escleritis/diagnóstico , Infección de la Herida Quirúrgica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
In June 1994, 18 people developed serologically confirmed histoplasmosis following cave exploration associated with the annual National Speleological Society Convention in Bracketville, Texas. Six others had an undiagnosed illness suspected to be histoplasmosis. Two persons were hospitalized. We conducted a survey of convention attendees and a nested case-control study of those entering caves. We also conducted a histoplasmin skin test survey of a subgroup of the society, the Texas Cavers Association, who were attending a reunion in October 1994. Among the national convention attendees, exposure to two caves was identified as responsible for 22 (92%) of the 24 cases; 12 (75%) of 16 people exploring one cave (Cave A) and 10 (77%) of 13 exploring a separate cave (Cave B) developed acute histoplasmosis. Additional risk-factors included fewer years of caving experience, longer time spent in the caves, and entering a confined crawl space in Cave A. Of 113 participants in the separate skin test survey, 68 (60%) were found to be skin test positive, indicating previous exposure to Histoplasma capsulatum. A positive skin test was significantly associated with male sex and more years of caving experience. Those less experienced in caving associations should be taught about histoplasmosis, and health care providers should pursue histories of cave exposure for patients with bronchitis or pneumonia that does not respond to initial antibiotic therapy.
Asunto(s)
Brotes de Enfermedades , Histoplasma/patogenicidad , Histoplasmosis/epidemiología , Adolescente , Adulto , Animales , Anticuerpos Antifúngicos/sangre , Estudios de Casos y Controles , Centers for Disease Control and Prevention, U.S. , Quirópteros , Estudios de Cohortes , Pruebas de Fijación del Complemento , Femenino , Histoplasma/inmunología , Histoplasmina/inmunología , Histoplasmosis/inmunología , Humanos , Inmunodifusión , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Pruebas Cutáneas , Sociedades , Encuestas y Cuestionarios , Texas/epidemiología , Estados UnidosRESUMEN
In May 1996, the Georgia Division of Public Health was notified about a cluster of persons with Salmonella Enteritidis (SE) infections in Waycross, Georgia. A matched pair case-control study to determine risk factors for illness found a statistically significant association of SE infection with a history of having eaten at Restaurant A during the 5 days before onset of illness (relative risk = 13 [95% confidence interval (CI) = 3-62, P < 0.01]). In a second case-control study, to determine specific food exposures, consumption of a deep-fried Mexican dish (chile relleno) (4 of 21 cases vs. 0 of 26 controls, odds ratio undefined, 95% CI > 1.46, P = 0.034) was found to be significantly associated with SE infection. An environmental investigation found evidence of suboptimal food storage and cooking temperatures at Restaurant A; cross contamination of foods may have contributed to the low attributable risk identified for chile rellenos. Five of 37 Restaurant A food and environment specimens yielded SE strains. All five positive specimens were from chiles rellenos. Of the seven outbreak-associated strains (six patient isolates and one food isolate from Restaurant A) for which phage typing was conducted, all were phage type 34. A FDA traceback investigation through Restaurant A's single-egg supplier identified the potential source as three interrelated farms in South Carolina. Environmental culture from one of these farms yielded SE phage type 34. As a result of this outbreak, FDA helped institute a statewide egg quality-assurance programme in South Carolina to minimize SE contamination of eggs.
Asunto(s)
Huevos/microbiología , Restaurantes , Infecciones por Salmonella/epidemiología , Infecciones por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificación , Crianza de Animales Domésticos , Animales , Estudios de Casos y Controles , Pollos , Brotes de Enfermedades , Femenino , Microbiología de Alimentos , Georgia/epidemiología , Humanos , Masculino , Enfermedades de las Aves de Corral/microbiología , Restaurantes/normas , Infecciones por Salmonella/prevención & control , Salmonelosis Animal/epidemiología , Salmonelosis Animal/microbiología , Salmonella enteritidis/clasificaciónRESUMEN
From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hospital developed Candida albicans fungemia or endophthalmitis. The case patients' surgeries were clustered on two days. To identify risk factors for C. albicans infections, we conducted a cohort study comparing these 4 patients with 67 control patients who had surgeries on the same days but did not acquire C. albicans infections. The participation of anesthesiologist 9 (relative risk [RR], undefined; P < 0.001) and receipt of intravenous propofol, an anesthetic agent without preservative, which was administered by an infusion pump (RR, 8.8; P = 0.048) were identified as risk factors for C. albicans infections. The anesthetic had been recently introduced in the hospital. Hand cultures of 8 of 14 (57%) anesthesiologists were positive for Candida species; one yielded C. albicans. Anesthesiologist 9 was the only one to use stored syringes of propofol in the infusion pump and to reuse propofol syringes. DNA fingerprinting with a digoxigenin-labeled C. albicans repetitive element 2 probe and electrophoretic karyotyping showed two distinct banding patterns among patient isolates. We hypothesize that extrinsic contamination of propofol by anesthesiologist 9 likely resulted in C. albicans infections. These data suggest that strict aseptic techniques must be used when preparing and administering propofol.
Asunto(s)
Anestésicos Intravenosos/efectos adversos , Candidiasis/etiología , Contaminación de Medicamentos , Complicaciones Posoperatorias/etiología , Propofol/efectos adversos , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A rapidly growing mycobacterium similar to strains in the present Mycobacterium fortuitum complex (M. fortuitum, M. peregrinum, and M. fortuitum third biovariant complex [sorbitol positive and sorbitol negative]) was isolated from a surgically placed central venous catheter tip and three cultures of blood from a 2-year-old child diagnosed with metastatic hepatoblastoma. The organism's unique phenotypic profile and ribotype patterns differed from those of the type and reference strains of the M. fortuitum complex and indicate that this organism may represent a new pathogenic taxon.
Asunto(s)
Bacteriemia/microbiología , Cateterismo Venoso Central/efectos adversos , Infecciones por Mycobacterium/microbiología , Mycobacterium/aislamiento & purificación , Sepsis/microbiología , Bacteriemia/etiología , Carcinoma Hepatocelular/complicaciones , Preescolar , ADN Bacteriano/genética , Humanos , Neoplasias Hepáticas/complicaciones , Masculino , Mycobacterium/clasificación , Mycobacterium/patogenicidad , Infecciones por Mycobacterium/etiología , Mycobacterium fortuitum/clasificación , Infecciones Oportunistas/etiología , Infecciones Oportunistas/microbiología , Fenotipo , Sepsis/etiologíaRESUMEN
Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A. A case-control study comparing case-patients (n=5) with open heart surgery patients without subsequent sternotomy site infections (n=50) identified as risk factors diabetes (4/5 vs. 11/50, P<.02) and exposure to a particular anesthesiologist (anesthesiologist A; 4/5 vs. 9/50, P<.01). Four case-patients' isolates and a hand isolate of anesthesiologist A had an identical ribotype pattern (strain 1); the remaining case-patient's isolate and multiple isolates from anesthesiologist A's hands and home had a different ribotype pattern (strain 2). An intensified hand-washing regimen, barriers (gloves, gowns), and cleaning of anesthesiologist A's house were associated with termination of the outbreak. This is the first reported nosocomial N. farcinica outbreak to document the source and person-to-person transmission epidemiologically and molecularly.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Infección Hospitalaria/epidemiología , Nocardiosis/epidemiología , Esternón/cirugía , Infección de la Herida Quirúrgica/epidemiología , Anciano , Estudios de Casos y Controles , Infección Hospitalaria/transmisión , Brotes de Enfermedades , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Masculino , Persona de Mediana Edad , Nocardia/clasificación , Nocardiosis/transmisión , Factores de Riesgo , Serotipificación , Infección de la Herida Quirúrgica/microbiología , Estados UnidosRESUMEN
Mycobacterium malmoense is a nontuberculous mycobacterium rarely encountered in the United States. However, isolations of M. malmoense from 73 patients (11 in 1992, 35 in 1993, and 27 in 1994) were reported to the Centers for Disease Control and Prevention. We contacted state mycobacteriology laboratories and health care providers of patients whose M. malmoense isolations were reported from January 1993 through June 1995. To assign disease status for these patients, we used the criteria of the American Thoracic Society. Of 60 evaluable patients with disease status, only six (10%) had disease due to M. malmoense (five adults with pulmonary disease and one child with cervical lymphadenitis). We conclude that the number of patients with disease due to M. malmoense remains low. Increased isolation of this species may be due to the increased use of more sensitive and specific laboratory methods. For surveillance purposes, multiple M. malmoense isolates and age of younger than 10 years appear to be the best predictors for M. malmoense disease.
Asunto(s)
Infecciones por Mycobacterium/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Incidencia , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/diagnóstico por imagen , Infecciones por Mycobacterium/tratamiento farmacológico , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
Nosocomial Candida albicans infections have become a major cause of morbidity and mortality in neonates in neonatal intensive care units (NICUs). To determine the possible modes of acquisition of C. albicans in hospitalized neonates, we conducted a prospective study at Grady Memorial Hospital, Atlanta, Ga. Clinical samples for fungal surveillance cultures were obtained at birth from infants (mouth, umbilicus, and groin) and their mothers (mouth and vagina) and were obtained from infants weekly until they were discharged. All infants were culture negative for C. albicans at birth. Six infants acquired C. albicans during their NICU stay. Thirty-four (53%) of 64 mothers were C. albicans positive (positive at the mouth, n = 26; positive at the vagina, n = 18; positive at both sites, n = 10) at the time of the infant's delivery. A total of 49 C. albicans isolates were analyzed by restriction endonuclease analysis and restriction fragment length polymorphism analysis by using genomic blots hybridized with the CARE-2 probe. Of the mothers positive for C. albicans, 3 of 10 were colonized with identical strains at two different body sites, whereas 7 of 10 harbored nonidentical strains at the two different body sites. Four of six infants who acquired C. albicans colonization in the NICU had C. albicans-positive mothers; specimens from all mother-infant pairs had different restriction endonuclease and CARE-2 hybridization profiles. One C. albicans-colonized infant developed candidemia; the colonizing and infecting strains had identical banding patterns. Our study indicates that nonperinatal nosocomial transmission of C. albicans is the predominant mode of acquisition by neonates in NICUs at this hospital; mothers may be colonized with multiple strains of C. albicans simultaneously; colonizing C. albicans strains can cause invasive disease in neonates; and molecular biology-based techniques are necessary to determine the epidemiologic relatedness of maternal and infant C. albicans isolates and to facilitate determination of the mode of transmission.
Asunto(s)
Candida albicans/clasificación , Candidiasis/transmisión , Infección Hospitalaria/transmisión , Candida albicans/genética , Candida albicans/aislamiento & purificación , Candidiasis/epidemiología , Candidiasis/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , ADN de Hongos/análisis , Genotipo , Humanos , Recién Nacido , Unidades de Cuidados Intensivos , Polimorfismo de Longitud del Fragmento de Restricción , Estudios ProspectivosRESUMEN
BACKGROUND: Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. When a cluster of patients with Malassezia pachydermatis infection was identified in an intensive care nursery, we initiated an investigation. METHODS: A case patient was defined as any infant in the intensive care nursery who had a positive culture for M. pachydermatis between October 17, 1993, and January 18, 1995. We conducted a cohort study to identify risk factors for colonization and infection with M. pachydermatis. We collected cultures from the infants and the health care workers and from the health care workers' pets, since this organism has been associated with otitis externa in dogs. RESULTS: Fifteen infants met the case definition: eight with bloodstream infections, two with urinary tract infections, one with meningitis, and four with asymptomatic colonization. The case patients were significantly more likely than the other infants to weigh 1300 g or less (15 of 65 vs. 0 of 419, P<0.001). In a multivariate analysis of infants weighing 1300 g or less, the independent risk factors for colonization or infection with M. pachydermatis were a greater severity of concomitant illness (odds ratio, 19.7; P=0.001), arterial catheterization for nine or more days (odds ratio, 29.5; P=0.027), and exposure to Nurse A (odds ratio, 74.7; P=0.004). In a point-prevalence survey, 9 additional infants, 1 health care worker, and 12 of the health care workers' pet dogs had positive cultures for M. pachydermatis. The isolates from all 15 case patients, the 9 additional colonized infants, 1 health care worker, and 3 of the 12 dogs had identical patterns of restriction-fragment-length polymorphisms. CONCLUSIONS: In this outbreak, it is likely that M. pachydermatis was introduced into the intensive care nursery on health care workers' hands after being colonized from pet dogs at home. The organism persisted in the nursery through patient-to-patient transmission.
Asunto(s)
Infección Hospitalaria/transmisión , Brotes de Enfermedades , Perros/microbiología , Malassezia/aislamiento & purificación , Micosis/transmisión , Personal de Hospital , Animales , Animales Domésticos/microbiología , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Transmisión de Enfermedad Infecciosa , Femenino , Personal de Salud , Humanos , Lactante , Recién Nacido , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Unidades de Cuidado Intensivo Neonatal , Malassezia/clasificación , Masculino , Micosis/epidemiología , Micosis/microbiología , Micosis/veterinaria , Oportunidad Relativa , Factores de Riesgo , Zoonosis/microbiología , Zoonosis/transmisiónRESUMEN
The recent emergence of invasive infections due to Nocardia spp., including nosocomial outbreak, is now evident. Newer molecular diagnostic and typing methods are developed. Although sulfonamide-based therapy is generally effective, optimal treatment may be guided by antimicrobial susceptibility testing of isolates. The improved classification of nocardiae and other related genera such as actinomadurae, using the 16S ribosomal RNA sequencing, provide a sound basis for improved diagnostic methods for the identification of members of clinically significant species. The commonest cause of eumycetoma in Sudan is Madurella mycetomatis, and Streptomyces somaliensis and Actinomadura madurae for actinomycetoma. The humoral immunity response in actinomycetoma patients and in experimental mice was measured and significant titre of anti-P24 antibody was demonstrated.
Asunto(s)
Micetoma , Nocardiosis , Actinomycetales/clasificación , Actinomycetales/aislamiento & purificación , Animales , Técnicas de Tipificación Bacteriana , Humanos , Ratones , Micetoma/epidemiología , Micetoma/microbiología , Micetoma/terapia , Nocardia/clasificación , Nocardia/aislamiento & purificación , Nocardiosis/epidemiología , Nocardiosis/microbiología , Nocardiosis/terapia , Sudán/epidemiologíaRESUMEN
In 1991, 1208 cases of coccidioidomycosis were reported to the California Department of Health Services, compared with an annual average of 450 during 1986-90. We conducted a study in Tulare County to define the epidemiology of the disease and identify risk factors for severe disease, focusing on the epidemic period September 1991-December 1991. To identify cases, we used data from the Coccidioidomycosis Serology Laboratory at the University of California, Davis, other laboratories, and the Tulare County Health Department's coccidioidomycosis reporting system. We compared patients who were hospitalized with those who were not to determine risk factors for severe disease. We identified 128 cases of acute coccidioidomycosis diagnosed between 1 September and 31 December 1991 (attack rate 41/100,000); south central Tulare County had the highest attack rate. Thirty-five (27%) case-patients were hospitalized. Male sex (relative risk (RR) 2.5, 95% confidence interval (CI) 1.2-5.0), black people and Asian races (RR 4.8, 95% CI 2.4-9.6), and age > or = 20 years (RR 8.3, 95% CI 1.2-57.4) were univariately significant and remained independently associated with hospitalization in multivariate analysis. The 1991 Tulare County outbreak of coccidioidomycosis was part of a much larger outbreak that began in California during 1991 and continued through 1993. The outbreak was preceded by an unusually rainy spring. Although dust reduction measures during times of increased coccidioidomycosis incidence can help reduce exposure, definitive control awaits the development of a safe, effective vaccine.