Unsuspected Infection Research Articles

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care in Sudan

Background: Asymptomatic bacteriuria is common during pregnancy due to the apparent reduction in immunity of pregnant women, which appears to encourage the growth of both commensal and non-commensal microorganisms. The objective of this study was to determine the frequency of asymptomatic bacteriuria and identify the causative organisms among pregnant women. Methods and Results: This cross-sectional study was carried out at Ibrahim Malik Teaching Hospital and Bashaier University Hospital from April to July 2019 to assess the prevalence of asymptomatic bacteriuria among pregnant women. Fifty urine specimens were collected from pregnant women who didn’t show any signs or symptoms of UTI. Clean-catch mid-stream urine was collected into a sterile, universal container. Bacteriological culture and bacterial identification were carried out. The prevalence of asymptomatic bacteriuria in pregnant women in this study was 12%. Escherichia coli and Staphylococcus aureus were the most frequently isolated organisms: 2/6(33.3%) and 2/6(33.3%), respectively, followed by Proteus species 1/6(16.7%) and Klebsiella pneumonia 1/6(16.7%). Asymptomatic bacteriuria tended to increase from the first to the third trimester (1/8.3%, 2/11.1%, and 3/15%, respectively), but without statistical significance (P=0.845). We also found a trend to increase in the prevalence of asymptomatic bacteriuria with decreasing age: 2(15.4%) in the age group of 18-25 years, 3(11.5%) in the age group of 26-33 years, and only 1(9.1%) in the age group of 34-41 years (P=0.890). Conclusion: Periodic urine cultures should be performed routinely throughout pregnancy, especially during the first and third trimesters, to identify any unsuspecting unsuspected infection. Bacterial counts are of the most importance and should be done routinely. This measure will significantly reduce maternal and obstetric complications associated with pregnancy.

Retrospective evaluation of Chest CTs and [18F]-FDG PET/CTs in Oncological Patients with Unsuspected Asymptomatic Infection with COVID 19

Retrospective evaluation of Chest CTs and [18F]-FDG PET/CTs in Oncological Patients with Unsuspected Asymptomatic Infection with COVID 19

Tracheostomy Management during the COVID-19 Pandemic.

The ongoing coronavirus disease 2019 pandemic has led to unprecedented demands on the modern health care system, and the highly contagious nature of the virus has led to particular concerns of infection among health care workers and transmission within health care facilities. While strong data regarding the transmissibility of the infection are not yet widely available, preliminary information suggests risk of transmission among asymptomatic individuals, including those within health care facilities. We believe that the presence of a tracheostomy or laryngectomy stoma poses a unique risk of droplet and aerosol spread particularly among patients with unsuspected infection. At our institution, guidelines for the care of open airways were developed by a multidisciplinary open airway working group, and here we review those recommendations to provide practical guidance to other institutions.

An Unsuspected Infection Presenting as a Paratracheal Mass

From the *Department of Medicine and †Division of Infectious Disease, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Correspondence to: Daniel Gillett, MD, BMSc, Western University, 359 Piccadilly St, Unit 1, London, ON, Canada N6A 1S9. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose.

1474. Etiology of Pulmonary Granulomas: How Common is Unsuspected Infection?

BackgroundGranulomatous inflammation of the lung may be due to mycobacterial or fungal infections, sarcoidosis or vasculitis. When lung biopsy is performed due to suspicion of neoplasm, cultures may not always be done. In these cases, it is often not possible to order microbiologic testing when the pathology report is completed. The purpose of this study was to investigate how often patients with pulmonary nodules, who underwent biopsy for suspected malignancy, simultaneously have specimens sent for culture to assess for an infectious etiology.MethodsWe retrospectively reviewed the pathology reports of 36 patients from 2014 to 2015 who underwent lung biopsy of pulmonary nodules that showed granulomatous inflammation.ResultsThirty-six patients underwent lung biopsy of pulmonary nodules. One patient was excluded because their pathology report did not reveal any granuloma, resulting in a final sample size of 35 patients. Of these, eight (22.9%) patients simultaneously had specimens sent for mycobacterial and fungal cultures while the other 27 (77.1%) did not. Of the 27 patients who did not have specimens simultaneously sent for mycobacterial and fungal cultures, 17 (48.6% of the sample size) were diagnosed with lung cancer. The remaining 10 (28.6% of the sample size) patients did not have a definitive diagnosis because cultures were not sent for testing (Figure 1). Of the eight patients with cultures sent for testing, two (25%) had pulmonary tuberculosis, four (50%) had nontuberculosis mycobacterium infections, and two (25%) had fungal infections (one was Cryptococcus and one had mixed Aspergillus and Penicillium) (Figure 2).ConclusionWe conclude that pulmonary nodules may have an infectious etiology when biopsy is performed for a suspected malignancy. Specimens should routinely be sent for mycobacterial and fungal cultures regardless of presumptive diagnosis.Figure 1:Figure 2.(MTB, Mycobacterium tuberculosis; NTB, non-Mycobacterium tuberculosis)Disclosures All authors: No reported disclosures.

Ultrasound Findings Associated With Antepartum Viral Infection.

This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital infection. Several ultrasound findings have been associated with in utero fetal infections. For the patient with a known or suspected fetal infection, sonographic identification of characteristic abnormalities can provide useful information for counseling and perinatal management. Demonstration of such findings in the low-risk patient may serve to identify the fetus with a previously unsuspected infection. The clinician should understand the limitations of ultrasound in the prenatal diagnosis of congenital infection and discuss them with the patient.

Identifying the correct cause of death: The role of post-mortem computed tomography in sudden unexplained death

A case report is presented of a sudden and unexpected death of a 28 year old female with unsuspected tuberculosis infection. The autopsy derived cause of death was related to pulmonary tuberculosis infection. However review of a pre-autopsy post-mortem computed tomography scan identified an unstable fracture of the third cervical vertebrae secondary to tuberculosis infection. This collapsed vertebrae was felt to more appropriately explain the sudden unexpected collapse and death. This case further supports the role of PMCT in sudden death medico-legal investigations.

Remembering Thomas Parran, His Contributions and Missteps Going Forward

Remembering Thomas Parran, His Contributions and Missteps Going Forward

The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure

In Europe, fetal loss due to Parvovirus B19 (B19V) is under-reported and a poorly addressed occupational risk to pregnant women. This is exemplified internationally, where it was unmentioned in the last two European Centre for Disease Prevention and Control (ECDC) annual surveillance reports or its 2009 special report on infections in pregnancy. To assess this potential for underestimating B19V fetal loss in pregnancy, we undertook a systematic review of practice in Northern Ireland in the management and reporting of B19V infections over a 12-month period of heightened transmission, one of six observed in a span of 9 years. Pregnant and non-pregnant women presented with symptomatic infection in 24 and 93 % of confirmed B19V infections, respectively, with no difference in viral loads. There was underinvestigation of viral causes of fetal loss, with only 143/2739 (5 %) tested for B19V, and a failure to follow up most non-immune women tested following rash contact. Occupational exposure was recorded in 31/60 (51.6 %) of pregnancies audited following rash exposure, the majority teachers or day care workers. Against a background seroprevalence of 66.5 % immunity in women of child-bearing years, two patterns of infection were identified. Firstly, pregnant women investigated for a rash or exposure to slapped cheek syndrome, where an infection incidence of 18 % was observed, resulted in 42 confirmed infections, all proceeding to healthy term deliveries. Secondly, pregnant women with unsuspected infection had six cases of confirmed B19V fetal loss, including four of 22 (18 %) diagnosed at autopsy, of which three were non-hydropic. While many studies have reported B19V fetal loss in pregnancy, there are no robust public health surveillance figures to draw on. That all six confirmed fetal losses came from the small number of miscarriages/stillbirths investigated, 143 out of 2739, suggests inadequate follow-up of those pregnancies where B19V-related fetal loss may be most common, and supports the need for enhanced surveillance pilots to address this significant gap in public health knowledge.

Unsuspected Infection Due to Listeria monocytogenes in a Prosthetic Knee Joint

Unsuspected Infection Due to Listeria monocytogenes in a Prosthetic Knee Joint

Babesiosis as a Cause of Fever in Patients Undergoing a Splenectomy

Babesiosis is an emerging infection most commonly acquired from a tick bite. We describe three hospitalized patients with fever attributable to babesiosis after a splenectomy. Splenectomy was done because of splenic enlargement due to unsuspected babesia infection in one patient and because of splenic perforation due to babesiosis in a second patient. The third patient underwent splenectomy for trauma and acquired babesiosis postoperatively from a blood transfusion. Our cases demonstrate the need to be vigilant for babesiosis in patients undergoing splenectomy.

Pseudobulbar syndrome in two patients with human immunodeficiency virus infection

Different forms of motor neuron disease occurring in association with HIV infection have been described. We present two patients with pseudobulbar syndrome and HIV infection, with no clinical or electromyographic signs of lower motor neuron loss. In patient 1, on follow-up, focal seizures led to additional investigations that identified unsuspected HIV infection and progressive multifocal leucoencephalopathy (PML). In patient 2, all investigations excluded an active HIV infection or central nervous system involvement, and the disease progression made primary lateral sclerosis (PLS) with pseudobulbar onset the most likely diagnosis. ALS-like syndrome can occur in association with HIV infection; however, the causal relationship remains uncertain. Patient 1 shows that PML is a possible cause for pseudobulbar syndrome, and our second patient demonstrates that ALS may also occur by chance in patients with HIV infection.

Unsuspected infection of laboratory animals with human adenovirus‐36 compromises experimental findings

Human adenovirus‐36 (Ad‐36) affects biochemical functions and induces obesity in chickens, mice, rats, monkeys, and humans. The viral E4orf1 gene directly affects lipogenic enzymes to produce adiposity. Ad‐36 infection alters lipid & glucose metabolism, gene expression, and body composition. Serum antibodies (AB) assayed by serum neutralization (SN) are specific evidence of infection. We determined prevalence of unsuspected (natural) Ad‐36 infection in multiple laboratory species and report how experimental data are affected. We obtained serum from 40 rats (Harlan Labs, IN); 15 rhesus monkeys in the Aging Study, Wisconsin National Primate Res Ctr; 8 rabbits from US Biological (MA) & 6 cows (culture media serum). We fed rats a 36% or 48% kcal fat diet and measured wt gain and body fat. 25% of rats arrived at the lab with unsuspected Ad‐36 infection. Hi fat feeding induced greater wt gain (36.6 vs 9.6 g, p<.02) and 51% more body fat (82 vs 54 g, p<.02) in infected vs uninfected rats. 100% of monkeys became Ad‐36+ over the 7 yr study; all gained wt and lowered serum cholesterol (p<.05). 50% of rabbits were Ad‐36+ on arrival. Antibodies were present in 4 of 6 bovine sera and interfered in the SN assay.ConclusionsUnsuspected Ad‐36 infection occurs in lab animals from suppliers and in university vivariums. Laboratory animals should be tested for Ad‐36 status before experiments are performed as Ad‐36 may compromise outcomes.

Unusual Infection in the Foot of a Barefoot Gardener

We report a case of an unusual and unsuspected chronic infection creating a soft-tissue mass in the foot of a 35-year-old woman. The causative agent, Mycobacterium gordonae, is usually encountered as a laboratory contaminant. Only rarely does it manifest as a clinical infection. The patient's presumed predisposing risk factor was a history of barefoot gardening. An iatrogenic source, corticosteroid injections, was also considered.

An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.

During outbreaks, hospital workers are at high risk for nosocomial infection with severe acute respiratory syndrome (SARS)-associated coronavirus. To examine how hospital workers became infected and whether they transmit the virus to their families. Retrospective descriptive study. 529-bed community hospital in Hong Kong. 40 hospital workers infected with SARS-associated coronavirus over a 6-week period (25 March through 5 May 2003). Percentage of infected hospital workers according to job category. The cumulative incidence was highest among health care assistants, followed by physicians and nurses (8%, 5%, and 4%, respectively). Most hospital workers were infected from direct contact with patients with SARS, who primarily were in general wards and had unsuspected infection. At the time of contact, all hospital workers had used masks but not necessarily other protective devices. Affected hospital workers did not infect their families. Before isolation of all patients with clinically confirmed or suspected SARS, routine use of several protective devices, and training of staff in infection control, many health care workers were infected with SARS from patients with unsuspected cases.

Unsuspected infection is infrequent in asymptomatic outpatients with refractory ascites undergoing therapeutic paracentesis.

Large-volume paracentesis is a safe and effective means of treating patients with refractory ascites. However, there is limited information regarding the need for ascitic fluid studies in asymptomatic outpatients presenting for therapeutic paracentesis. The aim of this prospective study was to define the incidence and natural history of peritoneal fluid infection in asymptomatic outpatients undergoing therapeutic paracentesis. Over a 13-month period, 118 therapeutic paracenteses were performed in 29 outpatients with decompensated cirrhosis (Child-Pugh class B = 38%, C = 62%). After a brief medical history and physical examination, ascitic fluid cell count with differential and culture were obtained from all participating subjects. Seven (24%) of the subjects were receiving norfloxacin prophylaxis, accounting for antibiotic coverage during 40% of the procedures performed. The clinical course and outcome of study subjects during a mean follow-up of 137 days was reviewed. All 118 (100%) of the ascitic fluid samples demonstrated absolute neutrophil counts of <250/mm3 (mean = 6.5 +/- 22.5 pmn/mm3). Asymptomatic bacterascites was identified from three of the 118 (2.5%) fluid samples, but all of these subjects spontaneously recovered without treatment or sequelae. During follow-up, six episodes of symptomatic or hospital-associated peritoneal fluid infection were identified in study participants, emphasizing the importance of fluid studies in other clinical settings. Although further studies are needed, the routine culture of ascitic fluid in asymptomatic outpatients with refractory ascites requiring therapeutic paracentesis may not be necessary when there is a low index of suspicion for occult infection. In circumstances of clinical uncertainty, however, obtaining ascitic fluid cell counts with differential is recommended to insure patient safety.

Unsuspected infection is infrequent in asymptomatic outpatients with refractory ascites undergoing therapeutic paracentesis

OBJECTIVE: Large-volume paracentesis is a safe and effective means of treating patients with refractory ascites. However, there is limited information regarding the need for ascitic fluid studies in asymptomatic outpatients presenting for therapeutic paracentesis. The aim of this prospective study was to define the incidence and natural history of peritoneal fluid infection in asymptomatic outpatients undergoing therapeutic paracentesis. METHODS: Over a 13-month period, 118 therapeutic paracenteses were performed in 29 outpatients with decompensated cirrhosis (Child-Pugh class B = 38%, C = 62%). After a brief medical history and physical examination, ascitic fluid cell count with differential and culture were obtained from all participating subjects. Seven (24%) of the subjects were receiving norfloxacin prophylaxis, accounting for antibiotic coverage during 40% of the procedures performed. The clinical course and outcome of study subjects during a mean follow-up of 137 days was reviewed. RESULTS: All 118 (100%) of the ascitic fluid samples demonstrated absolute neutrophil counts of <250/mm 3 (mean = 6.5 ± 22.5 pmn/mm 3). Asymptomatic bacterascites was identified from three of the 118 (2.5%) fluid samples, but all of these subjects spontaneously recovered without treatment or sequelae. During follow-up, six episodes of symptomatic or hospital-associated peritoneal fluid infection were identified in study participants, emphasizing the importance of fluid studies in other clinical settings. CONCLUSIONS: Although further studies are needed, the routine culture of ascitic fluid in asymptomatic outpatients with refractory ascites requiring therapeutic paracentesis may not be necessary when there is a low index of suspicion for occult infection. In circumstances of clinical uncertainty, however, obtaining ascitic fluid cell counts with differential is recommended to insure patient safety.

A prospective study of daily measurement of C-reactive protein in serum of adults with neutropenia.

A total of 1,622 daily measurements of the level of C-reactive protein (CRP) in the serum of 40 hospitalized patients with neutropenia were made during 55 study periods from October 1990 through February 1993 (mean, 29.5 measurements per period). Clinical events were categorized into four groups: group I (bloodstream infection), group II (significant bacterial or fungal infection without bloodstream infection), group III (fever without an obvious source), and group IV (drug-related fever). There was a strong association between baseline elevation of the CRP level (> or = 100 mg/L) and tumor-associated fever (P = .0005); the resolution of such fever coincided with a decrease in the CRP level following chemotherapy. Levels of CRP increased by > or = 40 mg/L in 10 (31%) of 32 cases during the 48-72 hours preceding the clinical diagnosis of a subsequently demonstrable infection--often pneumonia without bloodstream infection. CRP values on day 2 (1 day after the diagnosis of a clinical event) were significantly higher for events in groups I and II than for those in group III (P < .01) but not those in group IV. With regard to significant infections, a day-2 CRP value of > or = 40 mg/L was 100% sensitive and an increase in CRP level of > or = 50 mg/L from day 1 to day 2 had a positive predictive value of 95%. We conclude that serial measurements of serum CRP levels may be helpful in determining the extent of evaluation required for a newly febrile neutropenic patient and possibly in accelerating the detection of an otherwise unsuspected infection.

Routine serologic screening for syphilis in hospitalized patients: high prevalence of unsuspected infection in the elderly.

To evaluate the potential yield of routine serologic testing for syphilis in hospitalized patients. Sera from consecutive patients admitted to an inpatient general medical service of a Baltimore hospital were tested using the RPR and FTA-ABS tests for syphilis. Two hundred ninety-one (149 males and 142 females) of 344 patients (85%) hospitalized during the study period participated, with ages ranging from 17 to 98 years. Seventy-seven percent of participants were African-American. Results of serologic tests for syphilis and human immunodeficiency virus were correlated with questionnaire responses. Associations were sought between results of serologic testing and demographic characteristics, medical problems, and a history of syphilis. No patient had an admitting diagnosis of syphilis. Thirty-seven patients (13%) had both reactive RPR and FTA-ABS tests. Although serologic evidence of syphilis was significantly associated with age older than 50 years and with a history of syphilis, 59% of patients with both reactive RPR and FTA-ABS tests did not give a history of syphilis. Ten percent of patients were HIV seropositive; however HIV seropositivity was not significantly associated with serologic evidence of syphilis. Unsuspected latent syphilis was common in this population. Routine serologic screening for syphilis should be considered in some hospitals.

25. The rational use of the HIV antibody test

The clinical skills of the medical profession can be used to identify unsuspected HIV infection in a cost-effective way. However, other strategies are needed to optimise the detection of HIV infection and achieve the benefits to patients and the community that result from detection.