RESUMO
Japanese encephalitis (JE) virus is a mosquito-borne flavivirus endemic throughout Asia. Incidence in non-endemic countries is rare, with an estimate of less than one case per one million travelers. Most human JE infections are asymptomatic or cause a mild, nonspecific febrile illness. Neurological involvement, if present, is usually severe and associated with high mortality or ongoing neurological sequelae in survivors. Ocular manifestations are rare with JE, but uveitis has been described to be associated with other flavivirus infections, including West Nile virus. We report the first probable case of JE chorioretinitis acquired by a 45-year-old Australian traveler to Bali. This case highlights the importance of a detailed ocular examination when there is clinical suspicion of JE.
Assuntos
Coriorretinite/diagnóstico por imagem , Vírus da Encefalite Japonesa (Espécie)/imunologia , Encefalite Japonesa/diagnóstico por imagem , Austrália , Coriorretinite/virologia , Vírus da Encefalite Japonesa (Espécie)/isolamento & purificação , Encefalite Japonesa/patologia , Encefalite Japonesa/virologia , Olho/diagnóstico por imagem , Olho/patologia , Olho/virologia , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , ViagemRESUMO
A follow-up cohort study was undertaken to document clearance of fecal vancomycin-resistant Enterococcus faecium carriage in 19 infants colonized during a hospital outbreak. By the conclusion of the 14-month study period, all participants had returned terminal negative fecal specimens, supporting the hypothesis that carriage is transient in this population.
Assuntos
Surtos de Doenças , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Resistência a Vancomicina , Antibacterianos/uso terapêutico , Estudos de Coortes , Enterococcus faecium/efeitos dos fármacos , Fezes/microbiologia , Seguimentos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Recém-Nascido , Pacientes Internados , Vancomicina/uso terapêutico , Vitória/epidemiologiaRESUMO
OBJECTIVE: To describe successful termination of an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) colonization within a neonatal service. SETTING: Multisite neonatal intensive care unit and special care nurseries within a single health care service. PARTICIPANTS: Forty-four cases of VREfm-colonized neonatal inpatients-including 2 clinical isolates (eye swab and catheter-urine specimen) and 42 screening isolates. INTERVENTIONS: Active surveillance cultures, patient isolation, contact precautions, enhanced environment cleaning, and staff and parent education. Whole genome sequencing and multilocus sequence typing were used to characterize the outbreak and refine infection control procedures. RESULTS: Peak prevalence of VREfm colonization across all sites was 31% upon discovery of the outbreak. Subsequent to the intervention, transmission was halted within 8 weeks and no further isolates of the outbreak strain have been detected as of 12 months following outbreak cessation. Environmental swabs revealed VREfm colonization of baby-weighing scales, a baby bath, and a pharmacy refrigerator within the neonatal intensive care unit. All isolates were of a single multilocus sequence type (sequence type 796) and highly clonal at the core genome level. CONCLUSIONS: Bundled infection control interventions were effective in rapidly terminating a clonal outbreak of sequence type 796 VREfm colonization within a neonatal inpatient service. Strain-typing and active surveillance cultures were critical in guiding the management of this outbreak. The closed environment of a neonatal unit likely facilitated eradication of the patient and environment reservoirs of VREfm colonization.