Single Case Of Infection Research Articles

The AIRNS flap: An alternative to the bilobed flap for the repair of defects of the distal nose

Defects of the distal nose and nasal tip are inherently challenging to reconstruct. Although the bilobed flap has a pivotal role for the closure of such defects to achieve a satisfactory outcome, it demands meticulous planning and execution. We sought to present our experience of the advancement and inferior rotation of the nasal sidewall (AIRNS) flap as a possible alternative to the bilobed flap for reconstruction of the distal nose. All patients who underwent AIRNS repair after Mohs tumor extirpation of the nose at 2 regional skin cancer units since April 2011 were reviewed. In all, 45 patients underwent the AIRNS flap repair. There were 25 men and 20 women, with a mean age of 70 years (range 41-88). The average defect size was 1.2 × 1.2 cm. The majority of cases involved the nasal tip. A single case of postoperative infection occurred in a smoker, which resolved without any long-term sequelae. No cases of flap necrosis or nasal airflow obstruction were seen. All cases produced good or excellent cosmetic results. Because of blunting of the superior alar crease, which may be avoided in a bilobed repair, the AIRNS flap is best avoided in laterally based defects of the nasal alar. The AIRNS flap is a reliable, single-stage closure option that, in our opinion, is simpler in design and execution compared with the bilobed flap and thus adds to the reconstructive surgeon's armamentarium when faced with centrally located defects of the distal nose.

Is HIV infection associated with an increased risk for cholera? Insights from a mathematical model

Cholera, a waterborne gastroenteric infection, remains a significant threat to public health in sub-Saharan Africa, the region most heavily affected by HIV. It is biologically plausible that immune suppression caused by HIV infection predisposes to cholera. In this paper, a simple mathematical model is developed and comprehensively analyzed to assess whether HIV infection is associated with an increased risk for cholera or not. Analytical results of the model show that the quantities Rc and Rh, which represents the reproductive number for cholera and HIV infection, respectively, provide threshold conditions that determine cumulative new single and dual infection cases. These threshold conditions can be used to gain important insights on the epidemiological consequences of HIV and cholera coexistence in the community. Numerical results are provided to support the analytical findings. The findings suggest that in a cholera-endemic area, HIV infection is associated with an increased risk for cholera.

Mo1720 Frequency and Chronology of Extraintestinal Manifestations in the Swiss Inflammatory Bowel Disease Cohort

BACKGROUND/AIM: Patients treated with TNF-α inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (LTB). Prospective studies onmonitoring for TB reactivation and/or infection in this risk group are lacking. METHODS: We retested consecutive patients with inflammatory bowel disease (IBD) under therapy with TNFi for a minimum of 5 months for LTB by interferon-γ release assay (IGRA) and tuberculin skin test (TST). From each subject a detailed patient history and concomitant therapy were captured. RESULTS: After a median of 34.9 weeks (20.7-177.7) IGRA was retested in 184/227 patients (81.1%; Crohn's disease n= 139, ulcerative colitis n=45) initially screened for LTB and subsequently treated with TNFi. Additionally TST was re-administered in 144/227 subjects (63.4%). The majority of patients was TNFi naive (147/227, 79.9%). In 32 subjects isoniazid was provided prior and concurrently to TNFi due to LTB. In this subgroup retesting for LTB resulted in a reversion to negative in 6/13 patients (46.2%) and in 3/24 patients (12.5%, P=0.08) with a positive IGRA and positive TST at baseline, respectively. In patients without LTB at baseline no permanent IGRA conversion, but 6/144 (4.2%) TST conversions from negative to positive were observed. No single case of TB reactivation or infection was observed during the observation period. CONCLUSION: A conversion of IGRA during treatment with TNFi was not observed, but occurred for TST. IGRA frequently reverts to negative in patients with LTB after specific therapy and seems to be a sensitive method to monitor patients for LTB under treatment with TNFi.

A herbal cream consisting of Aloe vera, Lavandula stoechas, and Pelargonium roseum as an alternative for silver sulfadiazine in burn management

Background: Silver sulfadiazine (SSD) is the most used topical agent for the treatment of burn wounds. However, it has some side effects such as delayed and incomplete epithelialization, generation of black scars, and limited penetration to the depth of a wound. Objective: The present study investigated the efficacy of herbal combination cream containing Aloe vera gel and essential oils of Lavandula stoechas and Pelargonium roseum in the alleviation of symptoms in patients with superficial second-degree burns and comparison of its effects with those of SSD 1% cream. Methods: One hundred eleven patients with second-degree burns (occurring in the preceding 48 hours and affecting Results: Both groups experienced a significant reduction in the pain severity at day 14 compared to baseline (p 0.05). There was a single case of infection in the herbal cream group, which cleared with continuation of treatment. Conclusion: Our findings suggested that the herbal cream used here is superior to SSD 1% cream in the alleviation of pain and may serve as a natural alternative for treatment of second-degree burns. Keywords: Aloe vera, burn wound, Lavandula stoechas, Pelargonium roseum, silver sulfadiazine

Viral evolution and transmission effectiveness

Different viruses transmit among hosts with different degrees of efficiency. A basic reproductive number (R0) indicates an average number of cases getting infected from a single infected case. R0 can vary widely from a little over 1 to more than 10. Low R0 is usually found among rapidly evolving viruses that are often under a strong positive selection pressure, while high R0 is often found among viruses that are highly stable. The reason for the difference between antigenically diverse viruses with low R0, such as influenza A virus, and antigenically stable viruses with high R0, such as measles virus, is not clear and has been a subject of great interest. Optimization of transmissibility fitness considering intra-host dynamics and inter-host transmissibility was shown to result in strategies for tradeoff between transmissibility and diversity. The nature of transmission, targeting either a naïve children population or an adult population with partial immunity, has been proposed as a contributing factor for the difference in the strategies used by the two groups of viruses. The R0 determines the levels of threshold heard immunity. Lower R0 requires lower herd immunity to terminate an outbreak. Therefore, it can be assumed that the outbreak saturation can be reached more readily when the R0 is low. In addition, one may assume that when the outbreak saturation is reached, herd immunity may provide a strong positive selection pressure that could possibly result in an occurrence of escape mutants. Studies of these hypotheses will give us an important insight into viral evolution. This review discusses the above hypotheses as well as some possible mechanistic explanation for the difference in transmission efficiency of viruses.

Prevalence of Viruses with Diarrhea among Hospitalized Children West Gyeonggi Province

Purpose:This study was conducted to evaluate epidemiological data of the viral pathogens obtained from stool exams and provide information on the regional prevalence of infectious diarrheal disease west in Gyeonggi Province, Korea. Methods:We enrolled a cohort of children <10 years of age admitted for treatment of acute diarrhea at Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea. In total, 310 fecal specimens, documented to be free of common bacterial pathogens, were collected from pediatric patients during a 12-month period from January to December 2009 and were tested for the presence of rotavirus, parechovirus, adenovirus, astrovirus, enterovirus, and norovirus using polymerase chain reaction (PCR) and reverse transcription polymerase chain reaction (RT-PCR) assay. Results:The most common virus was parechovirus (16%), followed by adenovirus (15%), astrovirus (14%), rotavirus (13%), and enterovirus (5%). Interestingly, only one of the specimens was positive for norovirus. Single infection cases were detected in 173 (55.8%) of the 310 children, whereas mixed viral infections were detected in 10 (3.2%) of the same children. Viral gastroenteritis generally showed a double peak of incidence. Parechovirus, rotavirus, and adenovirus shared a similar pattern of peak incidence with overall viruses; however, astrovirus infections occurred more frequently in the spring. Eighty-five percent of the confirmed viral gastroenteritis cases developed in under 24 months. Conclusion:The results support the importance of parechovirus, adenovirus, astrovirus, and enterovirus as causative agents of diarrhea in children, which may be underestimated by current routine diagnostic testing. (Korean J Pediatr Infect Dis 2012;19:28-36)

Molecular and Microbiological Characterization of Clostridium difficile Isolates from Single, Relapse, and Reinfection Cases

In this study, we investigated the correlation between the microbiological characteristics of Clostridium difficile clinical isolates and the recurrence of C. difficile-associated disease (CDAD). Twenty C. difficile isolates recovered from 20 single infection cases and 53 isolates from 20 recurrent cases were analyzed by pulsed-field gel electrophoresis (PFGE) and PCR ribotyping, and the cytotoxicity, antimicrobial susceptibility, and sporulation/germination rates of the isolates were examined. Recurrent cases were divided into relapse or reinfection cases by the results of C. difficile DNA typing. Among the 20 recurrent cases, 16 cases (80%) were identified to be relapse cases caused by the initial strain and the remaining 4 cases (20%) were identified to be reinfection cases caused by different strains. All 73 isolates were susceptible to both vancomycin and metronidazole, but resistance against clindamycin, ceftriaxone, erythromycin, and ciprofloxacin was found in 87.7%, 93.2%, 87.7%, and 100% of the isolates, respectively. No correlations between DNA typing group, cytotoxicity, and sporulation rate of isolates and infection status, i.e., single, relapse, or reinfection, were observed. However, the isolates recovered from relapse cases showed a significantly higher germination rate when incubated in medium lacking the germination stimulant sodium taurocholate. These results indicate that the germination ability of C. difficile may be a potential risk factor for the recurrence of CDAD.

Recommendations and current practices for the reconstitution and storage of botulinum toxin type A

Current guidelines from the Centers for Disease Control and Prevention (CDC) regarding the reconstitution and storage of botulinum toxin type A (BT-A) differ from those of the Centers for Medicare and Medicaid Services and current clinical practice. CDC guidelines require single-patient use of BT-A vials. Strict adherence to these guidelines creates waste and a significant financial impediment, and does not confer increased protection from infection, assuming standard safe injection practices are followed. This study examines current clinical practices and provides expert consensus recommendations regarding the reconstitution and storage of BT-A. A review of the literature on the sterility and efficacy of BT-A stored beyond the recommended time period of 4 hours is also presented. An Internet-based survey was used to analyze the current practices of physician members of the American Society for Dermatologic Surgery who administer botulinum type A toxins. After reconstitution, the majority of physicians (68.6%) routinely store BT-A for a period of greater than 1 week and safely use each toxin vial for more than one patient. Not a single case of infection was observed. This was a single survey with a 32.2% response rate. A single vial of BT-A can be safely administered to multiple patients, assuming standard safe injection techniques are followed. After reconstitution, Our data suggest that BT-A can be stored beyond the recommended time period of 4 hours.

Trust fends off mrsa for two years.

Trafford Healthcare NHS Trust in Manchester has gone two years without a single case of MRSA infection. Among Trafford General Hospital staff who gathered to celebrate the achievement were (from left) domestic Joanne Morton, microbiologist Barzo Faris and matron Julie Treadgold. In the foreground, infection control nurse Paula Halsall demonstrates a specialised microbe testing machine.

Viral load, genomic integration frequency of human papillomavirus 16 in cervical cancer and precancerous lesions

To investigate the association between viral load, genomic integration frequency of HPV 16 and cervical carcinogenesis and assess the probability that HPV 16 integration frequency may be utilized as a marker for cervical cancer. Forty cases of HPV16 single infection were selected from 337 cervical scrape samples by PCR (polymerase chain reaction) amplification and DNA sequencing. The copy numbers of E2, E6 and β-actin were quantified to evaluate the viral load and integration status by real-time PCR. (1) The median number of adjusted viral load of normal group, LSIL (low-grade squamous intraepithelial lesion) group, HSIL (high-grade squamous intraepithelial lesion) group and squamous cervical cancer group were 0.11, 18.55, 44.63 and 7.6 copies per cell respectively. The viral load was higher in LSIL-HSIL group than that in normal group while lower in squamous cervical cancer group than that in HSIL group. (2) The median number of E2/E6 was 0.93 in normal group, 0.84 in precancerous group (LSIL-HSIL) and 0.64 in squamous cervical cancer group respectively. It showed a descending trend with the progression of cervical disease. (3) With the disease development, the proportion of episomal form decreased (normal group 4/5, LSIL group 4/6, HSIL group 10/16, cervical squamous cancer group 5/13) whereas that of integrated form (mixed and totally integrated) increased (normal group 1/5, LSIL group 2/6, HSIL group 6/16, cervical squamous cancer group 8/13). Both totally integrated cases were cervical squamous cancer. (1) HPV 16 viral load may not be an ideal marker to predict cervical carcinogenesis. (2) Due to a positive correlation between HPV16 genomic integration frequency and cervical neoplastic progression, HPV 16 integration frequency may be a potential marker of early diagnosis for cervical lesion progression.

Eleven-Year Implant Survival Rates of the All-Polyethylene and Metal-Backed Modular Optetrak Posterior Stabilized Knee in Bilateral Simultaneous Cases

A prospective randomized study was conducted to determine if a design change in the articular surface geometry introduced in the Optetrak total knee to increase prosthetic joint conformity and further reduce polyethylene stress had any impact on implant survival, particularly when the all-polyethylene version of the implant was used. Forty-seven patients undergoing bilateral simultaneous total knee arthroplasties were randomized for the side, receiving an all-polyethylene tibial component and followed up for a mean 11.6 years. Survival rates for the all-polyethylene and metal-backed modular versions of the implant were both 98%, excluding a single case of deep infection. Survival rates with revision for aseptic loosening as an end point were 100%. The increase in tibial and femoral radii in the coronal plane of the Optetrak posterior stabilized knee did not result in a reduced implant survival rate in either the metal-backed modular or all-polyethylene versions of the implant.

Tratamiento de la hemoglobinuria paroxística nocturna con eculizumab: experiencia en España

Background and objectives Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal disease characterized by complement-mediated hemolysis, bone marrow failure and thrombosis. Eculizumab is a humanized monoclonal antibody that blocks the cytolytic component of the complement system by binding to complement C5. Material and Methods We report the results of eculizumab treatment in 25 PNH patients from different centers in Spain. Statistical analysis was perfomed with a SPSS v15.0 software. Results Fifty-eight per cent of the patients achieved transfusional independence after a median of 14 months. Transfusion requirements were reduced in 60% of the remaining cases. Fatigue resolved in 96% of the patients and smooth muscle dystony-related symptoms in all cases. A single case of treatment-related infection was observed. Conclusions Eculizumab controls effectively hemolysis and greatly improves clinical symptoms. The drug is safe and well tolerated, without significant adverse effects except meningococcal infection. Patients with suboptimal response to treatment must be assessed for bone marrow insufficiency and extravascular haemolysis.

Reconstruction of the alveolar cleft: effect of preoperative extraction of deciduous teeth at the sites of clefts on the incidence of postoperative complications

Our objective was to find out if the extraction of deciduous teeth at the sites of clefts 3–8 weeks before alveolar bone grafting (ABG) would reduce the number of postoperative complications. Chart reviews were reviewed retrospectively of patients who had had ABG from March 2006 to June 2009. To reduce variables only healthy, non-syndromic, cooperative patients were included. Eleven patients had had their deciduous teeth extracted at the cleft sites 3–8 weeks before ABG and 10 patients had had the extractions done intraoperatively at the same time as ABG. There was a single case of postoperative infection and no wound dehiscence in the preoperative extraction group, and there were no delays in postoperative orthodontic treatment. In the intraoperative group there were 3 cases of local wound infection and 6 cases of minor dehiscence, and orthodontic treatment was delayed for 3–6 months in all patients with complications. All patients had successful ABG, eruption of teeth, and orthodontic treatment; but patients who had their deciduous teeth at the cleft sites extracted preoperatively had fewer wound complications than patients whose extractions were done at the same time as the ABG.

Perinatal transmission of hepatitis C virus - Santo André Hospital, Leiria 2002-2006

Vertical transmission of hepatitis C virus (HCV) is the main route of infection in children, occurring in few cases (five percent). Current recommendations for HCV screening include first anti-HCV testing at age > 18 months, reducing false positives and false negatives. Positive results must be confirmed by the presence of HCV RNA on two different occasions. To characterize the population of children born to HCV-positive mothers, to identify risk factors for perinatal HCV transmission and to improve the approach to HCV screening. The study was conducted in two phases. An analytic retrospective study enrolling children born to HCV-positive mothers between January 2002 and December 2006 was done, followed by a transversal analysis in order to repeat anti-HCV testing, in cases that didn't meet current recommendations for HCV screening and in those without any HCV screening. Fifty-nine children born to HCV-positive mothers in a total of 12 985 births were included, corresponding to a prevalence of 0,45%. A high rate of inadequate pregnancy surveillance, prematurity and low birth weight, mainly in children born to addicted mothers was found. A child with HCV infection without any risk factor for perinatal transmission was found. Among children with negative anti-HCV at age 18 months, half had done anti-HCV prior to nine months of age, all were positive. Children discharged because of negative anti-HCV at nine months of age were called in a second phase of the study, for new anti-HCV at age > 18 months. All were negative. Perinatal HCV transmission rate was 2,9%. There was no identified risk factor for perinatal transmission in the single case of HCV infection. A high rate of prematurity, low birth weight and inadequate surveillance of pregnancy was found, with statistical significance to relation with mother addiction. Regarding anti-HCV at age < 18 months, a high rate of false positives but no false negative results were found. This study has enabled the detection and correction of mistakes in the approach to HCV screening.

Etiology analysis of 165 infant patients with viral pneumonia

Objective To comprehend etiology and clinical manifestation changes of infant pneumonia in this locality.Methods Indirect immunofluorescence (IIF) assay was applied in children with acute pneumonia to detect serum 11 kinds of viruses[respiratory syncytial virus (RSV),adenovirus (ADV),influenza virus (IFV-A+B),parain fluenza virus(PIV14) ,coxsackie B,virus(CB1V),Coxsackie A7 virus (CA7V) ,ECHO virus]specific antibody IgM,according to the serum virus-specific IgM positive,C-reactive protein(CRP)<8mg/L and no other pathogenic infection and laboratory evidence for the conditions of 436 cases detected in children with pneumonia.Results Detected a total 125 cases of antibody-positive,the positive detection rate is 37.99%.Of which 103 cases of single virus infection .accounting for 82.4% ,22 cases of mixed infection,accounting for 17.6%.RSV infection on top of the list followed by the rest of IFV,ADV and PIV.Infants of different ages,different seasons of the different types of virus susceptibility.Conclusion Pneumonia in infants were caused by pathogenic bacteria in addition to the virus of a wide range,and the incidence of age,the peak seasons and the clinical manifestations were vary.From an early stage of infection pathogen detection,clearing pathogen type,making the correct diagnosis of pneumonia in the treatment of infants had an important guiding significance. Key words: Infant; Pneumonia; Virulence; Analyses of viral etiology

Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

A series of 49 pilon fractures in a tertiary referral centre treated definitively by open reduction and internal fixation have been assessed and the complications of such injuries examined. A retrospective analysis of case notes, radiographs and computerised tomographs over a seven-year period from 1999-2006 was performed. Infection was the most common postoperative problem. There were seven cases of superficial infection. There was a single case of deep infection requiring intravenous antibiotics and removal of metalwork. Other notable complications were those of secondary osteoarthritis (three cases) and malunion (one case). The key finding of this paper is the 2% incidence of deep infection following the direct operative approach to these fractures. The traditional operative approach to such injuries (initially advocated by Rüedi and Allgöwer in Injury 2:92-99, 1969) consisted of extensive soft tissue dissection to gain access to the distal tibia. Our preferred method is to access the tibia via the "direct approach" which involves direct access to the fracture site with minimal disturbance of the soft tissue envelope. We therefore believe that open reduction and internal fixation of pilon fractures via the direct approach to be a safe technique in the treatment of such devastating injuries.

Pattern of Paediatric external hernia in Eku, Nigeria

Introduction: Paediatric external hernias form a major part of a general surgeon’s workload in Nigeria. The epidemiological pattern and management of external abdominal hernias in children was examined in a referral center in the country. Methods: A two-year retrospective study of all external abdominal hernias that presented at Baptist Medical Center, Eku (BMCE) from January 1st 2004 to December 31st 2005 was done. Case notes of all children with external abdominal hernia seen in the center were retrieved and analyzed. Results: There were 37 cases of external hernias in children available for the study. 91.8% of these cases were male and 8.2% were female. 94.6% of the patients had inguinal hernias and the other varieties were relatively uncommon. 8 cases (22.86%) were obstructed and two of the obstructed hernias were strangulated. There was a single case (2.70%) of wound infection and no mortality was recorded in this series. Conclusion: The pattern of external paediatric hernia in Baptist Medical Center, Eku was similar to other parts of the country. Early presentation and elective surgical management are recommended for improving treatment outcome. Improved public awareness of the condition and its potential complications will lead to earlier presentation and inclusion of hernia repair into existing child health programs will provide elective hernia repair in a wide scale. Keywords: Paediatric hernia, Eku, Nigeria.

Treatment of diaphyseal forearm bone fractures by Locking Compression Plate (LCP)

Purpose:To evaluate the use of locking compression plates in the treatment of diaphyseal fractures of forearm. Methods:30 patients of forearm fractures were included in the study with 26 males and 4 females having mean age of 34 years. Follow up was done at 3, 6 and 12 months. Clinical assessment was done for the functional outcome according to Anderson criteria. Results:All the fractures united with mean union time 12.6 weeks. There was not a single case of nonunion with only 2 cases of delayed union. There was a single case of infection which was managed conservatively. None of the cases required bone grafting. Conclusion:Locking compression plate is no doubt an effective bridging device used for treating comminuted fractures, but its superiority over conventional plating in the treatment of simple factures is yet to be proven.

Monitoring Quality and Safety in Anesthesia: Are Large Numbers Enough?

Monitoring Quality and Safety in Anesthesia: Are Large Numbers Enough?

The birth of a Trichinella britovi focus on the Mediterranean island of Sardinia (Italy)

For 60 years, the islands of the Mediterranean basin were considered to be Trichinella-free. In April 2005, an outbreak of human trichinellosis due to the consumption of infected pork involved 11 persons in the villages of Orgosolo and Lanusei (Nuoro province) on the island of Sardinia (Italy). We conducted an investigation to identify free-range and backyard pigs and other humans with Trichinella infection in the area of the 2005 outbreak. We also tested wild animals from various parts of Sardinia. In December 2005, eight persons were found to have been infected, and in May 2007 there was a single case of infection. The sources of all infections were domestic pigs. Artificial digestion of muscle samples from 681 pigs (325 free-range and 356 backyard pigs) revealed Trichinella sp. larvae in four sows (1.2%). All larvae, including those from the consumed pork products, were identified as Trichinella britovi. All infected pigs originated from the Orgosolo municipality. None of the 6188 wild boars (Sus scrofa) or 13 red foxes (Vulpes vulpes) examined were positive for Trichinella sp., suggesting that this parasite is restricted to free-range pigs. The origin of infected animals on Sardinia remains to be determined, although it could be related to the presence of T. britovi-infected animals on the island of Corsica (France).