Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

With reports of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) continuing to increase and therapeutic options decrease, infection control methods are of increasing importance. Here we investigate the relationship between surveillance and infection control. Surveillance plays two roles with respect to control: it allows detection of infected/colonized individuals necessary for their removal from the general population, and it allows quantification of control success. We develop a stochastic model of MRSA transmission dynamics exploring the effects of two screening strategies in an epidemic setting: random and on admission. We consider both hospital and community populations and include control and surveillance in a single framework. Random screening was more efficient at hospital surveillance and allowed nosocomial control, which also prevented epidemic behaviour in the community. Therefore, random screening was the more effective control strategy for both the hospital and community populations in this setting. Surveillance strategies have significant impact on both ascertainment of infection prevalence and its control

The control of Corynebacterium pseudotuberculosis infection in sheep flocks : a mathematical model of the impact of vaccination, serological testing, clinical examination and lancing of abscesses

A mathematical model of Corynebacterium pseudotuberculosis infection in sheep flocks was used to evaluate strategies for control and elimination of caseous lymphadenitis (CIA). Control strategies tested were vaccination, serological testing and removal of seropositives, clinical examination and removal of sheep with abscesses, lancing abscesses, and appropriate combinations. Three different infection rates with and without replacement of culled ewes were used to evaluate the control options. Controls were either implemented immediately after infection was detected in a flock or once CIA was at endemic equilibrium, and with different frequencies of examination or testing. Elimination of infection was defined as 99% confidence that no sheep were infected with C. pseudo tuberculosis. The control strategies were evaluated by estimating the reduction in infection or probability of elimination and the number of ewes culled from the flock. Lancing abscesses reduced the prevalence of infection when the initial prevalence was 0.90, but vaccination combined with clinical examination reduced infection rapidly with little impact on lamb productivity. Further research is required to develop a diagnostic test with at least 0.90 specificity and sensitivity under field conditions before any methods of control can be recommended with confidence

Molar band re-use and decontamination: a survey of specialists

Objective: To determine the pattern of use and re-use of orthodontic molar bands, and examine infection control measures in a sample of UK orthodontists. Design: Questionnaire survey. Subjects and methods: Questionnaires were sent to 204 individuals selected at random from the UK Specialist Orthodontist list. Follow-up questionnaires were sent to those that had not replied within 8 weeks. An overall response rate of 74.5% was achieved. Main outcome measures: Orthodontic band use and re-use and cross-infection control. Results: The reported rates of pre-sterilization cleaning and sterilization of orthodontic instruments were 92 and 100%, respectively. Of the respondents, 90% were using bands for molar teeth with the remainder routinely used bonded attachments. Most clinicians (95%) using bands routinely re-used them after being tried-in with 5% discarding them. Pre-sterilization cleaning of re-used molar bands was carried out by 92% of respondents who reclaimed bands. Sterilization of these bands was then carried out by most specialists apart from 2. Conclusions: The majority of UK specialist orthodontists who responded to the questionnaire are adhering to universal precautions for cross-infection control and are carrying out approved decontamination procedures. The majority are also reusing orthodontic bands that have been tried in the mouth, but found to be the wrong size. The great diversity of reported procedures for decontamination of instruments and bands suggest that more research is required to provide guidelines into the most effective method

First hospital outbreak of the globally emerging Candida auris in a European hospital

Background: Candida auris is a globally emerging multidrug resistant fungal pathogen causing nosocomial transmission. We report an ongoing outbreak of C. auris in a London cardio-thoracic center between April 2015 and July 2016. This is the first report of C. auris in Europe and the largest outbreak so far. We describe the identification, investigation and implementation of control measures. Methods: Data on C. auris case demographics, environmental screening, implementation of infection prevention/control measures, and antifungal susceptibility of patient isolates were prospectively recorded then analysed retrospectively. Speciation of C. auris was performed by MALDI-TOF and typing of outbreak isolates performed by amplified fragment length polymorphism (AFLP). Results: This report describes an ongoing outbreak of 50 C. auris cases over the first 16 month (April 2015 to July 2016) within a single Hospital Trust in London. A total of 44 % (n = 22/50) patients developed possible or proven C. auris infection with a candidaemia rate of 18 % (n = 9/50). Environmental sampling showed persistent presence of the yeast around bed space areas. Implementation of strict infection and prevention control measures included: isolation of cases and their contacts, wearing of personal protective clothing by health care workers, screening of patients on affected wards, skin decontamination with chlorhexidine, environmental cleaning with chorine based reagents and hydrogen peroxide vapour. Genotyping with AFLP demonstrated that C. auris isolates from the same geographic region clustered. Conclusion: This ongoing outbreak with genotypically closely related C. auris highlights the importance of appropriate species identification and rapid detection of cases in order to contain hospital acquired transmission

Impaired interferon-γ responses, increased interleukin-17 expression, and a tumor necrosis factor–α transcriptional program in invasive aspergillosis

This article is available open access through the publisher’s website. Copyright @ 2009 Oxford University Press.Background - Invasive aspergillosis (IA) is the most common cause of death associated with fungal infection in the developed world. Historically, susceptibility to IA has been associated with prolonged neutropenia; however, IA has now become a major problem in patients on calcineurin inhibitors and allogenic hematopoetic stem cell transplant patients following engraftment. These observations suggest complex cellular mechanisms govern immunity to IA. Methods - To characterize the key early events that govern outcome from infection with Aspergillus fumigatus we performed a comparative immunochip microarray analysis of the pulmonary transcriptional response to IA between cyclophosphamide-treated mice and immunocompetent mice at 24 h after infection. Results - We demonstrate that death due to infection is associated with a failure to generate an incremental interferon-γ response, increased levels of interleukin-5 and interleukin-17a transcript, coordinated expression of a network of tumor necrosis factor–α-related genes, and increased levels of tumor necrosis factor–α. In contrast, clearance of infection is associated with increased expression of a number genes encoding proteins involved in innate pathogen clearance, as well as apoptosis and control of inflammation. Conclusion - This first organ-level immune response transcriptional analysis for IA has enabled us to gain new insights into the mechanisms that govern fungal immunity in the lung.The BBSRC, CGD Research Trust, and the MRC

Heterogeneities in leishmania infantum infection : using skin parasite burdens to identify highly infectious dogs

Background: The relationships between heterogeneities in host infection and infectiousness (transmission to arthropod vectors) can provide important insights for disease management. Here, we quantify heterogeneities in Leishmania infantum parasite numbers in reservoir and non-reservoir host populations, and relate this to their infectiousness during natural infection. Tissue parasite number was evaluated as a potential surrogate marker of host transmission potential. Methods: Parasite numbers were measured by qPCR in bone marrow and ear skin biopsies of 82 dogs and 34 crab-eating foxes collected during a longitudinal study in Amazon Brazil, for which previous data was available on infectiousness (by xenodiagnosis) and severity of infection. Results: Parasite numbers were highly aggregated both between samples and between individuals. In dogs, total parasite abundance and relative numbers in ear skin compared to bone marrow increased with the duration and severity of infection. Infectiousness to the sandfly vector was associated with high parasite numbers; parasite number in skin was the best predictor of being infectious. Crab-eating foxes, which typically present asymptomatic infection and are non-infectious, had parasite numbers comparable to those of non-infectious dogs. Conclusions: Skin parasite number provides an indirect marker of infectiousness, and could allow targeted control particularly of highly infectious dogs

The epidemiology of canine leishmaniasis: transmission rates estimated from a cohort study in Amazonian Brazil

We estimate the incidence rate, serological conversion rate and basic case reproduction number (R0) of Leishmania infantum from a cohort study of 126 domestic dogs exposed to natural infection rates over 2 years on Marajó Island, Pará State, Brazil. The analysis includes new methods for (1) determining the number of seropositives in cross-sectional serological data, (2) identifying seroconversions in longitudinal studies, based on both the number of antibody units and their rate of change through time, (3) estimating incidence and serological pre-patent periods and (4) calculating R0 for a potentially fatal, vector-borne disease under seasonal transmission. Longitudinal and cross-sectional serological (ELISA) analyses gave similar estimates of the proportion of dogs positive. However, longitudinal analysis allowed the calculation of pre-patent periods, and hence the more accurate estimation of incidence: an infection–conversion model fitted by maximum likelihood to serological data yielded seasonally varying per capita incidence rates with a mean of 8·66×10[minus sign]3/day (mean time to infection 115 days, 95% C.L. 107–126 days), and a median pre-patent period of 94 (95% C.L. 82–111) days. These results were used in conjunction with theory and dog demographic data to estimate the basic reproduction number, R0, as 5·9 (95% C.L. 4·4–7·4). R0 is a determinant of the scale of the leishmaniasis control problem, and we comment on the options for control

Biological control and biomass evaluation of Botrytis cinerea : a thesis presented in partial fulfilment of the requirements for the degree of Master of Applied Science at Massey University

The efficacy of biocontrol agents is often judged by symptom development on inoculated plants. This process can involve long delays, as with Botrytis infection of kiwifruit and an alternative, quicker approach would be useful. When biocontrol is successful, then pathogen biomass is limited hence a means of measuring the biomass of a pathogen on/in a target substrate (plant material) could be used as a tool for rapid estimation of biocontrol efficiency. Two yeast (Enterobacter agglomerans, Enterobacter aerogenes) and two bacteria (Candida sake, Trichosporon pullulans) with an already identified ability to attach to the surface of Botrytis cinerea and to reduce infection in tomato and kiwifruit, were evaluated for control of B. cinerea in bean, lettuce and rose in this study. Potential biological control and efficacy was assessed by measuring lesion size and percentage infection by B. cinerea. An investigation of methods of conidial application of B. cinerea to these crops tissue showed that disease severity and incidence were increased by a high concentration of wet spore application to bean and dry spore application to lettuce and rose tissue. Each application technique was used as the standard technique for biocontrol experiments on the crop on which it was most efficient. Three of the potential BCAs (Enterobacter agglomerans, Enterobacter aerogenes, Trichosporon pullulans) were found to reduce lesion size and percentage infection on all three crops at 20°C. Biological control by bacterial BCAs, Enterobacter agglomerans and Enterobacter aerogenes, were demonstrated by applying them to bean tissue at the time of inoculation with a suspension of 1x108 conidia per ml of B. cinerea. These two bacteria and the yeast, Trichosporon pullulans, showed biological control when applied to lettuce and rose tissue one or two days after inoculation with dry spores of B. cinerea. A potential rapid assessment of biocontrol efficiency of microorganisms has been demonstrated using Laser Scanning Confocal Microscope. A clear image of the fungal hyphae in the host tissue was produced in confocal microscopy by using glutaraldehyde as a fluorescent stain for B. cinerea hyphae. Biomass of B. cinerea at an early stage of infection in bean and lettuce tissues was successfully measured by computer analysis before and after application of yeast and bacterial biocontrol agents. BCAs application in both tissues prevented development of a large biomass of B. cinerea

Granulocytic myeloid-derived suppressor cells increased in early phases of primary HIV infection depending on TRAIL plasma level

Background It has been demonstrated that Myeloid Derived Suppressor Cells (MDSC) are expanded in HIV-1 infected individuals and correlated with disease progression. The phase of HIV infection during which MDSC expansion occurs, and the mechanisms that regulate this expansion remain to be established. In this study we evaluated the frequency of MDSC in patients during primary HIV infection, and factors involved in MDSC control. Methods Patients with primary (PHI) and chronic (CHI) HIV infection were enrolled. PHI staging was performed according to Fiebig classification, and circulating MDSC frequency and function were evaluated by flow cytometry. Cytokine levels were evaluated by Luminex technology. Results We found that granulocytic MDSC (Gr-MDSC) frequency was higher in PHI compared to healthy donors, but lower than CHI. Interestingly, Gr-MDSC expansion was observed in the early phases of HIV infection (Fiebig II/III), but it was not associated to HIV viral load and CD4 T cell count. Interestingly, in PHI Gr-MDSC frequency was inversely correlated with plasmatic level of TRAIL, while a direct correlation was observed in CHI. Further, lower level of GMCSF was observed in PHI compared with CHI. In vitro experiments demonstrated that, differently from CHI, recombinant TRAIL induced apoptosis of Gr-MDSC from PHI, can effect that can be abrogated by GM-CSF. Conclusion We found that Gr-MDSC are expanded early during primary HIV infection and may be regulated by TRAIL and GM-CSF levels. These findings shed light on the fine mechanisms regulating the immune system during HIV infection, and open new perspectives for immune-based strategies