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Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
Trial registration. ClinicalTrials.gov identifier: NCT00966446
Infect Control Hosp Epidemiol 2016;1–8
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
Abstract
Recognition between leguminous plants and the specific rhizobial strains that nodulate them is mediated via a regulon of nodulation (nod) genes present in the bacteria. These nod genes are induced by flavonoids secreted from legume roots. Many of the nod gene products are involved in the synthesis of host-specific signals that are recognised by appropriate legume hosts. Recently (Lerouge et al., 1990), the signal molecule made by one strain of Rhizobium meliloti was identified as an acylated and sulphated, tetraglucosamine glycolipid and there is strong evidence that Rhizobium leguminosarum makes related but structurally distinct signals.
On the basis of these observations it is now possible to make sense of several similarities that have been recognised between nod gene products and enzymes of known function. Thus, for example, it appears that the nodM gene product is involved in the formation of glucosamine precursors of the signal molecule, whilst other gene products are likely to be involved in specific substitutions that confer host specificity to the signal molecule.
In addition to those nod gene products that are involved in the synthesis of the glycolipid, it is evident that there are other genes which may carry out a different role. Of particular interest is the nodO gene which encodes a secreted Ca2+-binding protein that has the potential to interact directly with plant cells. In the absence of the nodFEL genes, nodO is necessary for nodulation, indicating that the NodO protein can compensate for the loss of nodFEL function during infection.
Sediments of Balsam Meadow have produced a 11,000-yr pollen record from the southern Sierra Nevada of California. The Balsam Meadow diagram is divided into three zones. (1) The Artemisia zone (11,000–7000 yr B.P.) is characterized by percentages of sagebrush (Artemisia) and other nonarboreal pollen higher than can be found in the modern local vegetation. Vegetation during this interval was probably similar to the modern vegetation on the east slope of the Sierra Nevada and the climate was drier than that of today. (2) Pinus pollen exceeded 80% from 7000 to 3000 yr B.P. in the Pinus zone. The climate was moister than during the Artemisia zone. (3) Fir (Abies, Cupressaceae, and oak (Quercus) percentages increased after 3000 yr B.P. in the Abies zone as the modern vegetation at the site developed and the present cool-moist climatic regime was established. Decreased fire frequency after 1200 yr B.P. is reflected in decreased abundance of macroscopic charcoal and increased concentration of Abies magnifica and Pinus murrayana needles.
1. For chicks and rats pyridoxine, pyridoxal and pyridoxamine were equally active in terms of the free bases when given separately from the diet.
2. Under our experimental conditions pyridoxine mixed with the chick diet was stable, but 20% of pyridoxamine, and a variable amount of pyridoxal was lost.
3. The vitamin B6 activities measured with Saccharomyces carlsbergensis, chicks and rats respectively and expressed as μg. pyridoxine/g. freeze-dried milk were: raw milk 3·4, 3·2 and 4·9; evaporated milk 1·0, 2·1 and 2·7; stored evaporated milk 0·6, 1·4 and 2·0. For the chicks the milks were mixed with the diets; they were given separately to the rats.
4. The microbiological and biological results for raw milk agreed within the limits of experimental error. For the processed milks the differences between biological and microbiological tests were statistically significant.
5. All three methods of assay showed a 45–70% loss of vitamin B6 activity on processing and a further loss of 30% of the remainder after storage for 6 months at room temperature.
We are indebted to Mr J. Rothwell, Department of Dairying, University of Reading, for preparing the evaporated milk and to Dr B. Record, Ministry of Supply, Microbiological Research Establishment, Porton, for freeze-drying the milk. We should like to thank Dr S. K. Kon for his interest in this work.
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