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PubMedDate not supplied

Patient-care directives and infection control: the potential conflict of interest during epidemics in long-term care facilities.

Patient-care directives in long-term care facilities ensure that the aggressiveness of diagnostic and therapeutic interventions accurately reflects the desires of the patient. The results of our investigation of two outbreaks of fatal respiratory illness in long-term care facilities illustrate how patient-care directives may have delayed response to the outbreaks. Despite a cluster of deaths in each facility, staff delayed collection of laboratory specimens until patients with no directives restricting the medical workup became ill. Directives focus on the needs of the individual patient and family, but when an outbreak occurs, they may conflict with community needs. The challenge for the infection control practitioner is to recognize when community needs outweigh individual desires so that appropriate laboratory investigations can identify the cause of the illness.

Advance Directives↗

PubMed1989

Foodborne disease outbreaks of chemical etiology in Thailand, 1981-1987.

A study was conducted to determine the current situation of chemical foodborne outbreaks in Thailand for the period 1981-1987. Seventy-three outbreaks of chemical poisoning involving 1236 persons of whom 54 died were reported. Twenty outbreaks affecting 722 cases were caused by insecticide poisoning and methomyl was the most commonly recognized insecticide involved. Poisonous plants were responsible for 43 outbreaks with 420 cases. Mushroom poisoning was the most common entity (21 outbreaks, 211 cases), with plant seed poisoning next (9 outbreaks, 179 cases). There were 8 outbreaks following consumption of poisonous seafoods. Mussels were identified to be the vector in the outbreak of PSP. Horseshoe crabs which served as the vehicles for 4 outbreaks were also suspected to be associated with PSP. Puffer fish accounted for the remaining 3 outbreaks involving 6 cases of tetradotoxin poisoning. More complete reporting and more effort in outbreak investigations are needed for appropriate preventive and control measures.

Adolescent↗

PubMed1986

Involvement of infants, children, and adults in a rotavirus gastroenteritis outbreak in a kibbutz in southern Israel.

An outbreak of acute gastroenteritis in a kibbutz in southern Israel, characterized by diarrhea, fever, vomiting, and abdominal pain, involved 32 kibbutz members of all ages. Nineteen percent of the children and 3.5% of the adults were ill. Transmission of the illness occurred in direct proportion to the degree of close contact, involving first infants, then mothers and nursery staff, and only later youngsters, adolescents, and fathers. Stool samples obtained from 32 kibbutz members with clinical illness and from 44 asymptomatic close contacts were examined for the presence of rotavirus antigen. Fifty-six percent of symptomatic members were positive for rotavirus antigen as compared with 4.5% of asymptomatic close contacts. Positivity of stool samples correlated inversely with the number of days elapsed after onset of illness until the sample was obtained. Serologic studies carried out on acute and convalescent sera of symptomatic and asymptomatic subjects further supported a rotavirus etiology for the outbreak. RNA profiles of stool sample extracts obtained by polyacrylamide gel electrophoresis and silver staining indicate that one electropherotype may have been responsible for the outbreak.

Adolescent↗

PubMed1999

Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak.

Western Australia (WA) has been able to prevent methicillin-resistant Staphylococcus aureus (MRSA) strains from outside of the state from becoming established in its hospitals. Recently, a single-strain outbreak of MRSA occurred in a WA metropolitan teaching hospital following admission of an infected patient from a remote community. The strain responsible for the outbreak was unrelated to any imported strains and spread rapidly in the hospital. Screening of two remote communities in the region from which the index case came revealed that 42% of the people in one community and 24% in the other carried MRSA. Isolates were typed by resistance pattern, plasmid analysis, contour-clamped homogeneous electric field electrophoresis, bacteriophage pattern, and coagulase gene restriction fragment length polymorphism. It was found that of the people carrying MRSA, 39% in the former community and 17% in the latter community were carrying an MRSA strain which was indistinguishable from the strain that caused the hospital outbreak.

Cross Infection↗

PubMed1994

Characterization of epidemic Neisseria meningitidis serogroup C strains in several Brazilian states.

Epidemic strains of the Neisseria meningitidis C:2b:P1.3 electrophoretic type 11 complex were responsible for an outbreak in Curitiba, Parana State, Brazil, from 1990 to 1991. Strains of this complex were also isolated in other Brazilian states and were responsible for a meningococcal disease epidemic in São Paulo State in 1990. Serotyping both with monoclonal antibodies and by multilocus enzyme electrophoresis was useful for typing these epidemic strains related to the increased incidence of meningococcal disease. The genetic similarity of members of the electrophoretic type 11 complex was confirmed by the ribotyping method by using EcoRI or ClaI endonuclease restriction enzymes.

Bacterial Typing Techniques↗

PubMed1999

Clostridium difficile: an update on its epidemiology and role in hospital outbreaks in England and Wales.

Data from the surveillance system of general outbreaks of infectious intestinal disease and from laboratory reports collated by the Communicable Disease Surveillance Centre (CDSC) and requests for outbreak investigation by the PHLS Anaerobe Reference Unit were used to evaluate the current epidemiology of Clostridium difficile infection in England and Wales. Between January 1992 and December 1996, CDSC received 10,220 laboratory reports of C difficile isolation from patient's faeces and 26,873 of toxin in faeces. Over 75% of all reports were of people aged 64 years and over. The surveillance system captured a minimum data set on 694 hospital outbreaks of infectious intestinal disease. C. difficile was responsible for 109 (15%) outbreaks affecting 1625 people, of whom 1152 were found to have a C. difficile toxin producing strain. The median duration of outbreaks was 11 days. Fingerprinting by Pyrolysis Mass Spectrometry (PMS) was performed by the PHLS Anaerobe Reference Unit in 60 outbreaks, and typing by Polymerase Chain Reaction ribotyping (PCR) in 14.

Adolescent↗

PubMed1977

Serotypes of Bacillus cereus from outbreaks of food poisoning and from routine foods.

A provisional serotyping scheme was used to type cultures of Bacillus cereus from 84 outbreaks of food poisoning in seven countries; 283 of the 337 (84%) cultures tested were typable. In 35 of the 61 outbreaks associated with a vomiting-type syndrome, foods, clinical specimens or both yielded H-serotype 1 only. Type 1 strains together with other sterotypes were isolated in seven outbreaks. In 14 outbreaks types 3, 4, 5, 8 or a mixture of serotypes were present. Untypable strains were isolated in five outbreaks. Two of the nine diarrhoeal-type outbreaks yielded serotype 1 only. Types 2, 6, 8, 9, 10 and a mixture of type 12 and an untypable strain appeared to be responsible for one outbreak each. Although 16 of the 18 recognized serotypes were present among cultures of B. cereus from various routine foods, only 156 of the 400 (39%) isolates tested were typable.

Australia↗

PubMed2002

Outbreak of nosocomial fungemia caused by Candida glabrata.

An outbreak of Candida glabrata fungemia that was thought to be associated with bottles used for milk feeds occurred at our children's infectious diseases clinic. This cluster of cases was investigated using a case-control study. Isolates were identified by conventional methods and karyotyped using pulsed-field gel electrophoresis (PFGE) of genomic DNA. Potential risk factors for nine hospitalized children with candidemia and 14 controls were long-term hospitalization and treatments with more than two antibiotics. Electrophoretic karyotyping showed a single chromosomal pattern for these outbreak isolates and, in addition, they all had the same antifungal susceptibility results. These findings suggest that clonal dissemination of a single strain was responsible for this outbreak. Karyotyping by PFGE appears to be a useful molecular typing method for strains of C. glabrata.

Antifungal Agents↗

PubMed1994

An outbreak of illness among schoolchildren in London: toxic poisoning not mass hysteria.

STUDY OBJECTIVE: To determine the cause of an outbreak of acute gastrointestinal illness that occurred shortly after lunch in children attending a school in London, UK. DESIGN: A questionnaire survey of children at the affected school was carried out on the day after the incident. Microbiological, environmental, and toxicological investigations were also undertaken. SETTING: A school in London, UK. PARTICIPANTS: Altogether 374/468 (80%) of the children who had eaten lunch at the school on the day of the incident completed a questionnaire. MAIN RESULTS: There was a significant association between illness and the consumption of raw cucumber (relative risk = 6.1; 95% confidence interval 2.2, 16). Microbiological investigation of the foods served at lunch did not show any pathogens and toxicological investigations suggested that the cucumbers were contaminated by a pesticide. CONCLUSIONS: Although the outbreak displayed several typical features of mass psychogenic illness, the most probable cause was a toxic chemical present in cucumber served at lunch. Those responsible for investigating outbreaks of illness should be aware of the possible toxicological causes and the appropriate modes of investigation. They should be wary of too readily attributing a psychogenic cause to unusual outbreaks of acute illness in schoolchildren.

Acute Disease↗

PubMed1994

Emerging infectious diseases in the United States, 1993.

Three outbreaks of disease in the United States in 1993 caused by Escherichia coli O157:H7, Cryptosporidium organisms, and a previously unrecognized hantavirus clearly illustrate the increasing challenges posed by emerging infectious diseases. The largest US outbreak of E. coli O157:H7 infection reported occurred as a result of contaminated hamburgers served at a fast-food restaurant chain. The largest recorded waterborne disease outbreak in US history was due to contamination of a municipal water supply with cryptosporidia. In the southwestern United States, hantavirus was first recognized as the cause of a pulmonary syndrome with a mortality rate exceeding 50%. The detection of and response to these outbreaks document the need for a strong partnership between the clinical and public health sectors to prevent and control diseases. Health care reform in the United States provides an opportunity to address critical needs, such as improved surveillance and diagnosis, to ensure timely detection of and rapid response to newly emerging infectious diseases.

Animals↗

PubMed1994

Perinatal listeriosis in a Dutch woman returning from holiday in France.

A case is reported of perinatal infection and fetal death due to Listeria monocytogenes serotype 4B in a 28-weeks pregnant woman, who had spent her holiday in an area in France where an epidemic outbreak of listeriosis had occurred. Sero- and phage-typing combined with sensitive DNA-typing demonstrated that the Listeria was identical to the strain responsible for the outbreak in France. Although listeriosis appears to be an uncommon cause of perinatal infection, practicing obstetricians should be aware of the possibility.

Adult↗

PubMed2000

Phenotypic and genetic characterization of Lactococcus garvieae isolated in Spain from lactococcosis outbreaks and comparison with isolates of other countries and sources.

The phenotypic and genetic analysis results for 84 isolates of Lactococcus garvieae (including 62 strains from trout with lactococcosis from four different countries, 7 strains from cows and water buffalos with subclinical mastitis, 3 from water, and 10 from human clinical samples) are presented. There was great phenotypic heterogeneity (13 different biotypes) based on the acidification of saccharose, tagatose, mannitol, and cyclodextrin and the presence of the enzymes pyroglutamic acid arylamidase and N-acetyl-beta-glucosaminidase. L. garvieae also exhibited high genetic diversity by pulsed-field gel electrophoresis (PFGE), with 19 different pulsotypes among the isolates of L. garvieae studied. Only epidemiologically related strains, like the Spanish and Italian fish isolates and the cow and water buffalo isolates, displayed a close genetic relationship by PFGE, while the strains isolated from sporadic clinical cases, like the human isolates, were genetically unrelated. Overall, a general correlation between phenotypic and genetic data was observed. Epidemiological analysis of biotype and PFGE results indicated that the trout lactococcosis outbreaks in Spain and Portugal and those in France and Italy were produced by genetically unrelated clones. In Spain, two different clones were detected; the outbreaks diagnosed from 1995 onward were produced by a clone (biotype 2, pulsotype A1) which, although genetically related, was different from the one that was responsible for the outbreaks studied between 1991 and 1994 (biotype 1, pulsotype B). The Portuguese isolate had a biochemical profile identical to that of the Spanish strain isolated from 1995 onward and is also genetically closely related to this strain (pulsotype A2). There was a close relationship between the two pulsotypes (E and F) found in the Italian isolates. The French isolate (biotype 3, pulsotype D) was not genetically related to any other L. garvieae fish isolate. These results suggest the existence of diverse infection sources for the different lactococcosis outbreaks.

Animals↗

PubMed2002

Practical lessons from the management of an outbreak of small round structured virus (Norwalk-like virus) gastroenteritis.

An outbreak of viral gastroenteritis caused illness in 92 people during October 2000. All the cases had an association with one hotel and 80% of cases identified had attended one of two buffet meals on 18th October 2000. Cohort analysis did not implicate any particular foodstuff in this outbreak. All bacteriological tests on food samples were negative. Small round structured virus (SRSV)/Norwalk-like virus (NLV) particles were seen by electron microscopy in 6 out of 27 stool samples submitted for analysis. This paper describes the outbreak and in particular the lessons learned from the management and control of it. These include practical points with regard to the outbreak control team, liaison with the microbiology laboratory, handling data, agreeing a case definition, and occupational health issues. All can be applied elsewhere by those responsible for managing outbreaks at a local level.

Caliciviridae Infections↗

PubMed2005

[Lice and lice-borne diseases in humans].

Among the three lice which parasite the human being, the human body louse, Pediculus humanus humanus, is a vector of infectious diseases. It lives and multiplies in clothes and human infestation is associated with cold weather and a lack of hygiene. Three pathogenic bacteria are transmitted by the body louse: 1) Rickettsia prowazekii, the agent of epidemic typhus of which the most recent outbreak (and the largest since World War II) was observed during the civil war in Burundi; 2) Borrelia recurrentis, the agent of relapsing fever, historically responsible of massive outbreaks in Eurasia and Africa, which prevails currently in Ethiopia and neighboring countries; 3) Bartonella quintana, the agent of trench fever, bacillary angiomatosis, chronic bacteremia, endocarditis, and lymphadenopathy. Body louse infestation, associated with a decline in social and hygienic conditions provoked by civil unrest and economic instability, is reemergent worldwide. Recently, a forth human pathogen, Acinetobacter baumannii, has been associated to the body louse.

Animals↗

PubMed1997

Nosocomial hepatitis B virus infection associated with reusable fingerstick blood sampling devices--Ohio and New York City, 1996.

Fingerstick devices are widely used for capillary-blood sampling for glucose monitoring in patients with diabetes. In 1996, outbreaks of hepatitis B virus (HBV) infection occurred among patients with diabetes in an Ohio nursing home and in a New York City hospital. In response to these outbreaks, nursing-home and hospital personnel, state and local public health officials, and CDC conducted epidemiologic investigations. This report summarizes the investigations, which suggest that, in both outbreaks, HBV transmission was associated with use of spring-loaded fingerstick devices on multiple patients.

Blood Glucose↗

PubMed2001

Outbreak of infection with multidrug-resistant Klebsiella pneumoniae carrying bla(IMP-8) in a university medical center in Taiwan.

Klebsiella pneumoniae strains with the transferable carbapenem-hydrolyzing metallo-beta-lactamases, which include IMP- and VIM-type enzymes, remain extremely rare. To investigate whether IMP- or VIM-producing K. pneumoniae isolates had spread at a university medical center in Taiwan, a total of 3,458 clinical isolates of K. pneumoniae consecutively collected in 1999 and 2000 were tested by the agar diffusion method, colony hybridization, PCR, and nucleotide sequencing. A total of 40 isolates (1.2%), or 17 nonrepetitive isolates, from 16 patients were found to carry bla(IMP-8), a metallo-beta-lactamase gene recently identified from a K. pneumoniae strain in Taiwan. Carriage of bla(VIM) or other bla(IMP) genes was detected in none of the remaining isolates. Of the 17 nonrepetitive bla(IMP-8)-positive isolates, 15 isolates (88.2%) appeared susceptible to imipenem (MICs, <or=4 microg/ml) and meropenem (MICs, <or=1 microg/ml), indicating the difficulty in detecting bla(IMP-8) in K. pneumoniae by routine susceptibility tests; 14 isolates (82.4%) produced SHV-12 as well; and 14 isolates (82.4%) were also resistant to fluoroquinolones. The organisms caused wound infections in eight patients and bloodstream infections in three patients. They were not directly associated with the death of nine patients. Before the recovery of the bla(IMP-8)-positive isolates, all 16 patients had undergone various surgical procedures, and 15 patients had been admitted to the surgical intensive care unit, suggesting a nosocomial outbreak. Two major patterns were observed by pulsed-field gel electrophoresis for 14 of the 17 nonrepetitive isolates, indicating that the clonal spread was mainly responsible for the outbreak.

Adult↗

PubMed2005

A veterinarian's experience of the spring 2004 avian influenza outbreak in Laos.

Since it was first reported in December 2003, the outbreak of avian influenza A/H5N1 has spread to at least nine countries in Asia, affected multiple species of animals, and caused at least 42 human deaths. The magnitude and extent of this zoonotic outbreak are unprecedented, continue to grow, and threaten the start of a global human influenza pandemic. Control of the H5N1 outbreak has required the implementation of integrated human and veterinary health surveillance and response efforts. These efforts have also necessitated an unprecedented level of bilateral and multilateral international communication and cooperation. This report describes the contribution of one public-health veterinarian to the H5N1 outbreak response effort in Laos, and emphasises the value of multidisciplinary approaches to addressing this and future emerging infectious disease outbreaks.

Animals↗

PubMed2003

Ultra-sonic nebulizers as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in a university tertiary care hospital.

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred on a head and neck surgical (HNS) ward of a university hospital in Amsterdam. The outbreak lasted from May 2000 until November 2000, and MRSA spread to two intensive care units. Amplified fragment length polymorphism analysis indicated that a single clone was responsible for the outbreak. Phage-typing indicated that this clone was of a type that was uncommon in The Netherlands. Strict isolation of patients, according to the Dutch national guidelines, was instituted. During the outbreak, surveillance culture specimens, from patients, healthcare workers, and the environment, were obtained at regular intervals. MRSA was found in the dust filters of nebulizers through which air from the room was filtered and subsequently humidified. These nebulizers were used to humidify tracheostomies. The dust filters were not maintained according to the guidelines. Restricted use and cleaning and disinfection of all ultra-sonic nebulizers led to termination of the outbreak. The outbreak illustrates that to terminate transmission of outbreak strains of MRSA, meticulous measures are necessary, which not only include strict isolation precautions, but also decontamination of the environment. In addition, it demonstrates the necessity of adhering to cleaning and disinfection guidelines for all medical and nursing equipment used in the hospital.

Disease Outbreaks↗