A severe viral illness caused by a newly discovered coronavirus was first reported in the Middle East in 2012. The virus has since been named the Middle East respiratory syndrome coronavirus ...(MERS-CoV). MERS-CoV cases have been reported in several countries around the world in travelers from the Middle East. The illness has a high mortality rate. Limited human-to-human transmission has occurred including transmission to health care workers. The source of the virus remains unclear, but camels are a possible source. Two unrelated imported cases of MERS-CoV have been reported in the United States. Neither a vaccine nor effective therapy against the virus is available. International cooperation and information sharing will be key to understanding and ending the MERS-CoV outbreak.
Zika virus has recently emerged as a new public health threat. An arthropod-borne virus named after the Zika forest in Uganda, it was first discovered in 1947. The virus caused only sporadic cases of ...Zika infection in Africa and Southeast Asia until 2007, when the first large outbreak occurred in the Yap State in the Federated States of Micronesia. Another outbreak in French Polynesia in 2013 was notable for being associated temporally with an increase in cases of Guillain-Barré syndrome. In 2015, the virus was first reported in Brazil and since then has spread explosively through several additional countries in South and Central America and the Caribbean. Simultaneously, several of these countries have seen a dramatic increase in the incidence of infants born with microcephaly. The rapid spread of Zika virus through the Americas, together with the association of infection with microcephaly and Guillain-Barré syndrome, has resulted in the World Health Organization declaring a public health emergency. Zika virus has the potential to spread to new areas where the Aedes mosquito vector is present and therefore presents a risk to the United States. This concise review describes the clinical features of Zika virus infection and provides advice for clinicians on counseling travelers and others about the disease.
Herpes zoster (HZ), commonly called shingles , is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of ...aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine.
Staphylococcus aureus is a leading cause of bacteremia in hospitalized patients. Whether or not S. aureus bacteremia (SAB) is associated with clonality, implicating potential nosocomial transmission, ...has not, however, been investigated. Herein, we examined the epidemiology of SAB using whole genome sequencing (WGS). 152 SAB isolates collected over the course of 2015 at a single large Minnesota medical center were studied. Staphylococcus protein A (spa) typing was performed by PCR/Sanger sequencing; multilocus sequence typing (MLST) and core genome MLST (cgMLST) were determined by WGS. Forty-eight isolates (32%) were methicillin-resistant S. aureus (MRSA). The isolates encompassed 66 spa types, clustered into 11 spa clonal complexes (CCs) and 10 singleton types. 88% of 48 MRSA isolates belonged to spa CC-002 or -008. Methicillin-susceptible S. aureus (MSSA) isolates were more genotypically diverse, with 61% distributed across four spa CCs (CC-002, CC-012, CC-008 and CC-084). By MLST, there was 31 sequence types (STs), including 18 divided into 6 CCs and 13 singleton STs. Amongst MSSA isolates, the common MLST clones were CC5 (23%), CC30 (19%), CC8 (15%) and CC15 (11%). Common MRSA clones were CC5 (67%) and CC8 (25%); there were no MRSA isolates in CC45 or CC30. By cgMLST analysis, there were 9 allelic differences between two isolates, with the remaining 150 isolates differing from each other by over 40 alleles. The two isolates were retroactively epidemiologically linked by medical record review. Overall, cgMLST analysis resulted in higher resolution epidemiological typing than did multilocus sequence or spa typing.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background The best strategy for active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) remains unclear. We attempted to identify a risk factor score to predict MRSA colonization ...at hospital admission. Methods Data on 9 variables reported as risk factors for MRSA colonization were analyzed, and a risk factor score to predict MRSA colonization was generated using multivariable logistic regression and receiver operating characteristic curve analyses. This risk score was then prospectively validated. Results Four risk factors (nursing home residence, diabetes, hospitalization in the past year, and chronic skin condition/infection) were significantly associated with MRSA colonization (c-statistic = 0.846). A cut-off score of 8 or greater would result in screening 20% of admissions and would detect 71% of MRSA-colonized patients. In the prospective validation study, a cut-off score of 8 or greater required screening 21% of admissions and detected 54% of MRSA. Nursing home residence was the best predictor of MRSA colonization. Conclusion A similar risk factor-based screening strategy could be used to predict MRSA colonization in other institutions. Our data support routine screening of nursing home patients at hospital admission.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures. This review ...provides a summary of CAUTI reduction strategies that are specific to the intensive care setting.
The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.
CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.
OBJECTIVE To describe the clinical course and outcome of adults hospitalized with the 2009 H1N1 influenza infection. PATIENTS AND METHODS In this retrospective study, we reviewed the electronic ...medical records of patients with H1N1 influenza infection treated at Mayo Clinic in Rochester, MN, from May 1, 2009, through December 31, 2009. RESULTS We identified 1053 patients with H1N1 influenza infection; this study consists of 66 hospitalized adults (6%). Patients' mean ± SD age was 46.9±17.8 years. The 3 most common comorbidities were hypertension in 31 patients (47%), obesity in 29 (44%), and diabetes mellitus in 21 (32%). The most common symptoms were cough in 58 patients (88%), fever or chills in 55 (83%), and dyspnea in 47 (71%). Twenty-nine patients (44%) were admitted to the intensive care unit (ICU). Dyspnea and thrombocytopenia were more common in the ICU patients. The hospital, 28-day, and 90-day mortality rates were 8% (5/66), 11% (7/66), and 14% (9/66), respectively. Among the 29 ICU patients, 23 (79%) received mechanical ventilation, and 16 (55%) developed acute lung injury or acute respiratory distress syndrome. Rescue therapy for refractory respiratory failure was provided for 6 patients (21%). Of the 29 ICU patients, 10 (34%) required vasopressor support, and 4 (14%) required acute renal replacement therapy. CONCLUSION Hospitalized adults with H1N1 influenza infection are relatively young, and a significant number require treatment in the ICU. Among the patients who require ICU admission, most develop acute lung injury or acute respiratory distress syndrome and require mechanical ventilator support.
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