Outbreak of bacterial meningitis among patients undergoing myelography at an outpatient radiology clinic.

PURPOSE: To investigate an outbreak of bacterial meningitis at an outpatient radiology clinic (clinic A) and to determine the source and implement measures to prevent additional infections. METHODS: A case was defined as bacterial meningitis in a patient undergoing myelography at clinic A from October 11 to 25, 2010. Patients who underwent myelography and other procedures at clinic A during that period were interviewed, medical records were reviewed, and infection prevention practices were assessed. Case-patient cerebrospinal fluid (CSF) specimens, oral specimens from health care personnel (HCP), and opened iohexol vials were tested for bacteria. Bacterial isolates were compared using pulsed-field gel electrophoresis. A culture-negative CSF specimen was tested using a real-time polymerase chain reaction assay. RESULTS: Three cases were identified among 35 clinic A patients who underwent procedures from October 11 to 25, 2010. All case-patients required hospitalization, 2 in an intensive care unit. Case-patients had myelography performed by the same radiology physician assistant and technician on October 25; all patients who underwent myelography on October 25 were affected. HCP did not wear facemasks and reused single-dose iohexol vials for multiple patients. Streptococcus salivarius (a bacteria commonly found in oral flora) was detected in the CSF of 2 case-patients (1 by culture, 1 using real-time polymerase chain reaction) and in HCP oral specimens; 1 opened iohexol vial contained Staphylococcus epidermidis. Pulsed-field gel electrophoresis profiles from the case-patient S salivarius and the radiology physician assistant were indistinguishable. CONCLUSIONS: Bacterial meningitis likely occurred because HCP performing myelography did not wear facemasks; lapses in injection practices may have contributed to transmission. Targeted education regarding mask use and safe injection practices is needed among radiology HCP.

An acarologic survey and Amblyomma americanum distribution map with implications for tularemia risk in Missouri.

In the United States, tickborne diseases occur focally. Missouri represents a major focus of several tickborne diseases that includes spotted fever rickettsiosis, tularemia, and ehrlichiosis. Our study sought to determine the potential risk of human exposure to human-biting vector ticks in this area. We collected ticks in 79 sites in southern Missouri during June 7-10, 2009, which yielded 1,047 adult and 3,585 nymphal Amblyomma americanum, 5 adult Amblyomma maculatum, 19 adult Dermacentor variabilis, and 5 nymphal Ixodes brunneus. Logistic regression analysis showed that areas posing an elevated risk of exposure to A. americanum nymphs or adults were more likely to be classified as forested than grassland, and the probability of being classified as elevated risk increased with increasing relative humidity during the month of June (30-year average). Overall accuracy of each of the two models was greater than 70% and showed that 20% and 30% of the state were classified as elevated risk for human exposure to nymphs and adults, respectively. We also found a significant positive association between heightened acarologic risk and counties reporting tularemia cases. Our study provides an updated distribution map for A. americanum in Missouri and suggests a wide-spread risk of human exposure to A. americanum and their associated pathogens in this region.

Attitudes toward medical and mental health care delivered via telehealth applications among rural and urban primary care patients.

Adequate health care services are often not available in rural and remote areas, and this problem is expected to grow worse in the near future. "Telehealth" interventions represent a strategy for addressing access to care problems. We examined and compared attitudes toward medical and mental health care delivered via telehealth applications among adult rural (n = 112) and urban (n = 78) primary care patients. We also examined attitudes toward telehealth applications among a subset of patients with posttraumatic stress disorder (PTSD)--a group likely in need of specialized services. Both urban and rural patients were receptive to receiving medical and psychiatric services via telehealth. There were few meaningful differences across variables between urban and rural patients, and there were no meaningful differences by PTSD status. These findings support the feasibility of telehealth applications, particularly for rural patients who may not otherwise receive needed services.

Gender- and trauma-related predictors of use of mental health treatment services among primary care patients.

OBJECTIVE: Use of mental health care was investigated as a function of gender, traumatic event frequency, posttraumatic stress disorder (PTSD), and attitudes toward treatment among 194 primary care patients. METHODS: Patients were recruited from primary care clinics, administered the Stressful Life Events Screening Questionnaire, PTSD Symptom Scale, Attitudes Toward Seeking Professional Psychological Help-Short Form, and a survey on use of services. RESULTS: Lifetime mental health treatment was related to increased frequency of traumatic events, positive attitudes toward treatment, and probable PTSD. Recent use of mental health care and intensity of use were related to female gender and greater frequency of trauma. Regression models yielded significant associations for trauma frequency, positive treatment attitudes, and female gender. Trauma and PTSD were associated with use more than gender and treatment attitudes were. CONCLUSIONS: Use of and adherence to treatment may be improved by targeting attitudes toward treatment.