Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985-2018

Contains fulltext : 214001.pdf (publisher's version ) (Open Access

The problem isn’t growth - The problem is inequality

Abstract A case series of 14 patients with Raoultella bacteremia was compared with 28 Klebsiella oxytoca and 28 Klebsiella pneumoniae bacteremia cases. Forty-three percent of Raoultella bacteremia cases were associated with biliary tract disease, compared to 32% and 22% of patients with K. oxytoca and K. pneumoniae bacteremia, respectivel

Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985–2018

Background: Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an opportunistic infection across the tropics. Here, we provide a systematic overview of imported human cases in a non-endemic country over a 25-year period. Methods: All 55 Dutch microbiology laboratories were contacted in order to identify all B. pseudomallei positive cultures from 1990 to 2018. A response rate of 100% was achieved. Additionally, a systematic literature search was performed, medical-charts reviewed, and tissue/autopsy specimens were re-assessed. Results: Thirty-three travelers with melioidosis were identified: 70% male with a median-age of 54 years. Risk factors were present in most patients (n = 23, 70%), most notably diabetes (n = 8, 24%) and cystic fibrosis (n = 3, 9%). Countries of acquisition included Thailand, Brazil, Indonesia, Panama, and The Gambia. Disease manifestations included pneumonia, intra-abdominal abscesses, otitis externa, genitourinary, skin-, CNS-, and thyroid gland infections. Twelve (36%) patients developed sepsis and/or septic shock. Repeat episodes of active infection were observed in five (15%) and mortality in four (12%) patients. Post-mortem analysis showed extensive metastatic (micro)abscesses amongst other sites in the adrenal gland and bone marrow. Conclusions: The number of imported melioidosis is likely to increase, given rising numbers of (immunocompromised) travelers, and increased vigilance of the condition. This first systematic retrospective surveillance study in a non-endemic melioidosis country shows that imported cases can serve as sentinels to provide information about disease activity in areas visited and inform pre-travel advice and post-travel clinical management

How Much Variance in Offending, Self-Control and Morality can be Explained by Neighbourhoods and Schools? An Exploratory Cross-Classified Multi-Level Analysis

Criminological studies of contextual effects on adolescent offending have focused either on residential areas (considering effects of characteristics like disadvantage and collective efficacy) or on school characteristics (studying effects of organisation and social climate, for example). However, adolescents are simultaneously exposed to multiple contexts, and the influence of these contexts on their lives should be studied simultaneously rather than separately. The principal subject of this contribution lies in analysing to which extent there is unique neighbourhood level variation and unique school level variation in adolescent offending, and in two major and stable correlates of adolescent offending, morality and low self-control. Data are used from the Study of Peers, Activities and Neighbourhoods (SPAN), with 612 adolescents in various schools and neighbourhoods in the Netherlands. The results show that there is no unique neighbourhood level variance anymore after controlling for unique school level variance, while some variation at the school level still remains with regard to self-control and morality