Biomedical subjects
Publications and source records attributed to L M Drusin.
An outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
During an 18-month period in a burn center (January 1995 through June 1996), 109 single-patient MRSA isolates were identified and 102 isolates (94%) were available for DNA fingerprinting. Ninety-nine isolates (97%) carried the mecA polymorph I and Tn554 type E. Pulsed-field electrophoresis (PFGE) identified 8 patterns, of which 60 isolates were of pattern F2. The I:E:F clonal type and a stable drug multidrug resistant phenotype (sensitivity only to trimethoprim/sulfamethoxazole and vancomycin) indicated that these isolates were closely related to the Iberian clone of MRSA, which is widely spread in Europe. The initial source of I:E:F isolates was sputum 49%, blood 23%, wound 16%, urine 7%, and intravascular catheter tip 5%. Fifty-four percent of patients had smoke inhalation injury, and 51/53 required intubation or tracheostomy. Forty-three isolates were considered invasive (positive blood culture). The overall mortality was 30%. Despite infection control measures, the I:E:F clone continued to be recovered from patients during the 18 months of study. This outbreak is the first known report of the Iberian MRSA clone in the United States.
During a 7-month period, 29 units of feline whole blood in a hospital blood bank were confirmed, and 2 units were suspected, to be contaminated with Serratia marcescens. An investigation of the outbreak identified S marcescens in a jar of alcohol-soaked cotton balls and in a bag of saline solution used during venipuncture. Fifteen of the contaminated units were administered to 14 cats, and 6 of the 14 developed clinical signs of a transfusion reaction. The most common sign was vomiting; 4 cats died. The report underscores the importance of using aseptic techniques during collection of blood for transfusion and of thoroughly investigating any transfusion reaction.
OBJECTIVE: To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine. DESIGN: Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster. SETTING: A 988-bed tertiary-care university hospital. RESULTS: In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care. CONCLUSIONS: Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees.
Seven members of staff in a paediatric intensive care unit and two of their relatives developed hepatitis A over a period of five days. A 13 year old boy who was incontinent of faeces prior to his death, was presumed to be the source of infection. Two hundred and sixty seven other members of staff underwent serological testing and were given prophylactic pooled gamma globulin. Twenty three per cent were immune before exposure. Of people born in the United States, those at highest risk of developing the disease are physicians, dentists, nurses and those under the age of 40. Of those born outside the United States, being white and under the age of 30 are the two main risk factors. Data from a questionnaire sent to 19 nurses at risk (six cases, 13 controls) suggested that sharing food with patients or their families, drinking coffee, sharing cigarettes and eating in the nurses' office in the intensive care unit were associated with an increased incidence of hepatitis. Nurses with three or four of these habits were at particular risk. The costs of screening and prophylaxis were US $64.72 per employee, while prophylaxis alone would have cost US $8.42 per employee. Assessing risk factors on the one hand and costs of prophylaxis on the other are important elements in the control of nosocomial infections.
Acquired immune deficiency syndrome (AIDS) is a new disease caused almost certainly by a transmissible agent, which is most likely a retrovirus termed HTLV-III. The disease is mainly spread by sexual, especially homosexual contact. Blood-borne transmission is another recognized form of spreading of the disease; it seems, however, that the disease is not readily spread via casual, non-sexual, or other than blood-borne routes. Although the disease is still concentrated in the major metropolitan areas of the United States, it is now increasingly observed in several countries throughout the world. The basic characteristic of the disease is a profound dysregulation of the immune system as proved by a qualitative and quantitative defect of helper T-lymphocytes as well as by B-cell hyperactivity. Clinical manifestations are those of severe and life-threatening opportunistic infections and unusual neoplasms, particularly Kaposi's sarcoma. The mortality is extremely high and may well approach 100%. Therapeutic efforts include the treatment of opportunistic infections and the search for agents which may reconstitute immunologic competence.
Clinical manifestations of primary, secondary, congenital, and late syphilis are described. Darkfield examination is the most important laboratory method for diagnosis of primary syphilis. The VDRL and FTA-ABS are the most common serologic tests used for diagnosis and follow-up. Penicillin remains the treatment of choice in nonallergenic patients.
For a 24-month period (1977 through 1978), the determinants of neonatal intensive care unit (NICU) mortality were examined retrospectively in 133 consecutively admitted newborn infants who weighed less than 1,000 g at birth. Seventy-one (53.4%) died during the first five days of life, 27 (20.3%) died after the first five days of life, and 35 (26.3%) were eventually discharged from the unit. Neonatal infection was the key determinant of increased mortality after the first five days of life. In these patients, gram-positive organisms were recovered from 54% (14/26) of all body fluid cultures from 21 infected infants. Infections included Staphylococcus epidermidis (27% [7/26]), Staphylococcus aureus (15% [4/26]), and Escherichia coli (11% [3/26]). We propose that reducing the incidence of neonatal infections is necessary to substantially improve late NICU mortality in these very-low-birth-weight neonates.
An air-fluidized bed was found to be a potential bacteriologic hazard when used by heavily infected burned patients. Even after following the manufacturer's protocol for eliminating bacteria from the bed and for cleaning the filter sheet, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus fecalis, Escherichia coli, and Serratia marcescens were recovered. Use of the bed was suspended until an effective disinfecting procedure was developed for the filter sheet and weekly removal of solid materials from the bed was instituted.
Explore the source record for details and available documents.
As early syphilis becomes more uncommon in the community, it will present frequently to the tertiary hospital as a diagnostic problem. Twenty patients with classic signs and symptoms of primary and secondary syphilis in whom the correct diagnosis was initially missed are presented. The importance of a routine admission Venereal Disease Research Laboratory test (VDRL) in making the correct diagnosis is emphasized. The laboratory techniques for diagnosing syphilis and recommended treatment schedules are presented. Clinical manifestations of herpes progenitalis, problems with pregnancy and association with cervical carcinoma are also presented. Enteric diseases (hepatitis, shigellosis, giardiasis and amebiasis) as sexually transmitted diseases in homosexual men are summarized.
Serratia marcescens is an important pathogen in hospitalized urologic patients. We herein describe an epidemic of 134 urinary tract infections caused by a multipe antibiotic-resistant Serratia marcescens. A common source in the cystoscopy area was responsible for 105 infections Cross-contamination on patient floors amplified the magnitude of the epidemic. There was significant patient morbidity, although no deaths could be attributed directly to the outbreak. Particular attention is directed to patient risk factors and the clinical significance of nosocomial Serratia marcescens infections. The clinical approach to epidemic antibiotic-resistant Serratia urinary tract infection should not rely primarily on antibiotic therapy. Stress is placed on the importance of an interdisciplinary approach to hospital-acquired infections in general and Serratia marcescens urinary tract infections in particular.
To assess the Papanicolaou smear as a screening test for asymptomatic gonorrhoea 311 women who had had simultaneous Papanicolaou smears and cervical cultures performed were studied. Of the 151 women who were culture-positive only 27 (18%) had a positive result by Papanicolaou smear. The presence of either endocervical or metaplastic cells did not increase the frequency with which gonococci were recognised. The eight cytotechnologists spent at least 30 minutes for each case looking for diplococci; the variability between observers was high. The possibility of using an already widely accepted diagnostic technique, such as the cytological smear, as a means of screening for gonococci is very attractive. Unfortunately in this study the excessive time taken to examine the slides, the poor correlation of observers' findings, and a low sensitivity for finding diplococci made the Papanicolaou smear an impractical method for detecting gonorrhoea in asymptomatic women.
Explore the source record for details and available documents.
In 19 of 20 patients in whom the correct diagnosis of primary or secondary syphilis was not obvious initially, a positive routine admission VDRL test result was the first indication of the correct diagnosis. A retrospective study during a one-month period to correlate hospital admissions by clinical service with required routine admission serologic tests for syphilis disclosed an overall compliance rate of only 37.1% (range, 94.6% to 8.0%). Of the 38 patients who did have a positive admission VDRL test result, 55.3% were falsely positive. The false-positive rate was slightly higher for weakly reactive titers than it was for higher titers. The routine serologic testing program uncovered 129 and 116 new cases of syphilis during 1976 and 1977, respectively. The decision to continue the routine admission VDRL screening program was made because the consequences of an incorrect diagnosis could be very great for an individual patient.
Explore the source record for details and available documents.