Escherichia coli Meningitis in a 72-year-old Woman.

Spontaneous community-acquired meningitis caused by E. coli is rare in the adult population. It is associated with a high risk of morbidity and mortality. We describe a case of a 72-year-old woman who presented with altered mental status and neck stiffness and was found to have E. coli meningitis. Urine cultures grew E. coli, representing a likely source. The E. coli strain was identified as sequence type 73 (E. coli ST73). Her symptoms and laboratory values improved following antibiotic initiation, and she was discharged from the hospital to a rehabilitation facility.

Burden of typhoid fever in Sulaimania, Iraqi Kurdistan.

BACKGROUND: Typhoid fever imposes a high disease burden worldwide, but resource limitations mean that the burden of typhoid fever in many countries is poorly understood. METHODS: The authors conducted a prospective surveillance study at the adult and pediatric teaching hospitals in Sulaimania, Iraqi Kurdistan. All patients presenting with an undifferentiated febrile illness consistent with typhoid were eligible for enrollment. Enrolled patients had blood cultures and Brucella serologies performed. Incidence was calculated with reference to census data. RESULTS: Both typhoid fever and brucellosis were common, and the incidence of typhoid fever was 21 cases/100 000 patient-years. Classic disease symptoms were uncommonly observed. DISCUSSION: Cost-effective surveillance projects to calculate disease burden of typhoid fever are practical and replicable. Typhoid has successfully adapted to the healthcare environment in Sulaimania. Additional work in the region should focus on antibiotic resistance and other enteric pathogens such as Brucella spp.

Acute bloody diarrhea: a medical emergency for patients of all ages.

Acute bloody diarrhea should be considered a medical emergency. Its causes are frequently serious or actionable or both and are usually identified. However, acute bloody diarrhea as a stand-alone clinical presentation has received little scholarly attention in the past several decades. Although the range of possible causes of acute bloody diarrhea is broad, infectious considerations are paramount and should always be prioritized in the evaluation of such patients. History, examination, and laboratory testing should be focused on minimizing time to diagnosis (and, by extension, to implementing appropriate therapy). Strategically chosen tests and imaging, avoidance of extraneous diagnostic pursuits, and provision of supportive care while awaiting diagnostic clarity are central to the adroit management of patients with acute bloody diarrhea. Diagnostic considerations differ somewhat between adults and children but have many elements in common, including the need for vigilance in detecting Escherichia coli O157:H7 infection. In this review, we discuss diagnostic approaches (emphasizing the importance of rapid, accurate, and thorough microbiologic investigation) and measures that can be taken to support patients while awaiting information that determines the cause of their disease. These topics are discussed in the context of the medical care that is available to children and adults with bloody diarrhea in most institutions in developed nations.

Clostridium difficile: the increasingly difficult pathogen.

The epidemiology of Clostridium difficile infection is changing as a result of the epidemic spread of the hypervirulent North American Pulsefield type 1 strain. Clinicians are likely to encounter this disease more frequently than ever in their practice, and should be familiar with the updates in its diagnosis and treatment.

Elements of influenza vaccination programs that predict higher vaccination rates: results of an emerging infections network survey.

INTRODUCTION: To address suboptimal influenza vaccination rates among health care workers, the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices recently issued recommendations designed to increase the number of health care workers vaccinated against influenza. The purpose of the present study was to determine how widely these recommendations have been implemented and to identify important elements of successful influenza vaccine programs. METHODS: The Infectious Diseases Society of America Emerging Infections Network surveyed 991 infectious diseases consultants. Infectious diseases consultants were asked about vaccination programs and vaccination rates at their respective institutions. Multinomial logistic regression models based on proportional odds were used to determine predictors of vaccination-rate categories. All program elements were significant univariable factors in predicting vaccination rates. Because the program elements were highly associated with one another, principal components analysis was used to find combinations of the covariates that would serve as optimal predictors of higher vaccination rates. RESULTS: Most infectious diseases consultants indicated that the vaccination rate for all health care workers in their institution had a range of 41%-60%. Vaccination rates were significantly higher in institutions that required signed declination statements (P = .004). In the model based on principal components analysis for predicting institutional vaccination rates, only the first principal component warranted retention (P < .001). In this component, the program elements weighted the most heavily were (1) offering the influenza vaccine free of charge, (2) providing adequate staff and resources, and (3) educating targeted groups of health care workers. Requiring signed declinations was not heavily weighted. CONCLUSION: Influenza vaccination rates remain suboptimal, and hospitals have not completely implemented the Healthcare Infection Control Practices Advisory Committee-Advisory Committee on Immunization Practices recommendations to maximize vaccination rates.

Overview of Verotoxigenic Escherichia coli †.

Verotoxigenic Escherichia coli are a recently described class of diarrheagenic E. coli . The most prominent member of this group, serotype O157:H7, is a well-recognized cause of hemorrhagic colitis and hemolytic uremic syndrome. This serious human pathogen has caused numerous outbreaks in the developed world and has contaminated such widely disparate foods as ground beef, apple cider, and lettuce. Serotypes other than O157:H7 have also been found to cause sporadic enteric disease and several outbreaks have been recently described. The non-O157 SLTEC are more frequently present in food animals and foods of animal origin than serotype O157:H7. Particular non-O157 serotypes (such as O26) have a definite association with HUS. Surveillance data from several regions suggests that there may be important differences in the distribution of serotypes causing HUS in different geographic areas. While more than 100 serotypes of E. coli have been identified as possessing one or more SLT genes, far fewer than that number have been convincingly associated with human illness. Current research needs to determine those additional virulence traits which confer pathogenicity on organisms possessing the SLT gene. Equally important will be to ascertain the relative contribution of different serotypes to human disease in order to develop sound, scientifically based, control strategies.