Multiple conditional logistic regression analysis for factors associated with case status.

<p>* Adjusted for Charlson co-morbidity index score, mechanical ventilation and piperacillin/tazobactam; OR = odds ratio.</p><p>Multiple conditional logistic regression analysis for factors associated with case status.</p

Risk factors associated with in-hospital mortality.

<p><b>*</b>Adjusted for Charlson co-morbidity index; OR = odds ratio; GNB = Gram-negative bacteria.</p><p>Risk factors associated with in-hospital mortality.</p

Univariate analysis of exposure to antibiotics (aminoglycosides, fluoroquinolones, carbapenems, third/fourth generation cephalosporins and piperacillin/tazobactam), corticosteroids, invasive medical devices and selected medical interventions among cases and controls.

<p>SD = standard deviation; OR = odds ratio.</p><p>Univariate analysis of exposure to antibiotics (aminoglycosides, fluoroquinolones, carbapenems, third/fourth generation cephalosporins and piperacillin/tazobactam), corticosteroids, invasive medical devices and selected medical interventions among cases and controls.</p

Univariate analysis of pre-hospital factors, HIV status, time at risk, surgery and antibiotic exposure among cases and controls.

<p>*Refers to laparotomy or thoracotomy;</p><p>**Refers to receiving any dose or either a carbapenem or fluoroquinolone or aminoglycoside or third/fourth generation cephalosporin or piperacillin/tazobactam;</p><p>OR = odds ratio</p><p>Univariate analysis of pre-hospital factors, HIV status, time at risk, surgery and antibiotic exposure among cases and controls.</p

Study design and selection of cases and controls.

<p>NDM-1 = New Delhi metallo-β-lactamase; RT-PCR = real-time polymerase chain reaction testing.</p

Duration of stay, time at risk and co-morbid status for cases and controls.

<p>SD = standard deviation; time at risk: from admission to discharge/death (controls) or NDM-1 diagnosis (cases); MPM-III = Mortality Probability Model III; total length of stay: time from admission to discharge/death; <i>p</i>-values calculated using Mann-Whitney U test.</p><p>Duration of stay, time at risk and co-morbid status for cases and controls.</p

An Outbreak of Lymphocutaneous Sporotrichosis among Mine-Workers in South Africa

<div><p>Background</p><p>The largest outbreak of sporotrichosis occurred between 1938 and 1947 in the gold mines of Witwatersrand in South Africa. Here, we describe an outbreak of lymphocutaneous sporotrichosis that was investigated in a South African gold mine in 2011.</p><p>Methodology</p><p>Employees working at a reopened section of the mine were recruited for a descriptive cross-sectional study. Informed consent was sought for interview, clinical examination and medical record review. Specimens were collected from participants with active or partially-healed lymphocutaneous lesions. Environmental samples were collected from underground mine levels. <i>Sporothrix</i> isolates were identified by sequencing of the internal transcribed spacer region of the ribosomal gene and the nuclear calmodulin gene.</p><p>Principal Findings</p><p>Of 87 male miners, 81 (93%) were interviewed and examined, of whom 29 (36%) had skin lesions; specimens were collected from 17 (59%). Sporotrichosis was laboratory-confirmed among 10 patients and seven had clinically-compatible lesions. Of 42 miners with known HIV status, 11 (26%) were HIV-infected. No cases of disseminated disease were detected. Participants with ≤3 years’ mining experience had a four times greater odds of developing sporotrichosis than those who had been employed for >3 years (adjusted OR 4.0, 95% CI 1.2–13.1). Isolates from 8 patients were identified as <i>Sporothrix schenckii</i> sensu stricto by calmodulin gene sequencing while environmental isolates were identified as <i>Sporothrix mexicana</i>.</p><p>Conclusions/Significance</p><p><i>S</i>. <i>schenckii</i> sensu stricto was identified as the causative pathogen. Although genetically distinct species were isolated from clinical and environmental sources, it is likely that the source was contaminated soil and untreated wood underground. No cases occurred following recommendations to close sections of the mine, treat timber and encourage consistent use of personal protective equipment. Sporotrichosis is a potentially re-emerging disease where traditional, rather than heavily mechanised, mining techniques are used. Surveillance should be instituted at sentinel locations.</p></div

Epidemic curve with cases of confirmed and probable sporotrichosis detected at a reopened section of a gold mine by month, Barberton, 2009–2011, n = 17.

<p>Epidemic curve with cases of confirmed and probable sporotrichosis detected at a reopened section of a gold mine by month, Barberton, 2009–2011, n = 17.</p

Phylogenetic analysis of the partial calmodulin gene sequences from 10 clinical outbreak isolates, 5 environmental outbreak isolates, 9 unrelated clinical strains and 10 reference strains.

<p>Phylogenetic analysis of the partial calmodulin gene sequences from 10 clinical outbreak isolates, 5 environmental outbreak isolates, 9 unrelated clinical strains and 10 reference strains.</p

Minimum inhibitory concentrations for the yeast phase of <i>Sporothrix schenckii</i> complex isolates, n = 13.

<p>*Species-level identity was determined by sequencing of the nuclear calmodulin gene;</p><p>^†multiple isolates from the same patient were not tested (i.e. isolates 38.2, 41.2 and 41.3);</p><p>abbreviations: AMB: amphotericin B; VRC: voriconazole; POS: posaconazole; ITC: itraconazole; BMD: broth microdilution test.</p><p>Minimum inhibitory concentrations for the yeast phase of <i>Sporothrix schenckii</i> complex isolates, n = 13.</p