Early diagnosis model for meningitis supports public health decision making.

OBJECTIVE: To develop a predictive model for rapid differential diagnosis of meningitis and meningococcal septicaemia to support public health decisions on chemoprophylaxis for contacts. METHODS: Prospective study of suspected cases of acute meningitis and meningococcal septicaemia admitted to hospitals in the South West, West Midlands and London Regions of England from July 2008 to June 2009. Epidemiological, clinical and laboratory variables on admission were recorded. Logistic regression was used to derive a predictive model. RESULTS: Of the 719 suspect cases reported, 385 confirmed cases were included in analysis. Peripheral blood polymorphonuclear count of >16 × 10(9)/l, serum C-reactive protein of >100 mg/l and haemorrhagic rash were strongly and independently associated with diagnosis of bacterial meningitis and meningococcal septicaemia. Using a simple scoring system, the presence of any one of these factors gave a probability of >95% in predicting the final diagnosis. CONCLUSION: We have developed a model using laboratory and clinical factors, but not dependent on availability of CSF, for differentiating acute bacterial from viral meningitis within a few hours of admission to hospital. This scoring system is recommended in public health management of suspected cases of meningitis and meningococcal septicaemia to inform decisions on chemoprophylaxis

Screening of new entrants for tuberculosis: responses to port notifications.

BACKGROUND: Tuberculosis in England and Wales is associated with recently arrived immigrants. Screening new entrants for tuberculosis has received considerable attention recently. Despite several calls to reorganize screening processes for new entrants because of perceived ineffectiveness, some systems at ports have remained largely unchanged, including notification arrangements. METHODS: A postal questionnaire was sent to Consultants in Communicable Disease Control (CsCDC) who normally receive port health notification forms from London Heathrow Port Health Control Unit relating to new entrants who had either been screened and found to have a normal chest X-ray, not had an chest X-ray due to pregnancy or young age or whose examination was inconclusive (Port 101 and 102 forms). RESULTS: Almost half of the responding CsCDC attempted to follow-up all Port 101 and 102 referrals; of these CsCDC, 46 percent reported that they were actually able to follow-up under 50 percent. CsCDC had developed their own criteria to aid decisions as to which referrals to follow-up. CONCLUSION: The follow-up by CsCDC of new entrants passing through Heathrow Port Health Control Unit who have been screened and found to have a normal chest X-ray, not had an X-ray due to pregnancy or young age, or whose examination was inconclusive varies considerably and there is no consistent national practice. Substantial efforts are being expended on attempting to follow-up new entrants, many of whom may be at low risk of tuberculosis. The effectiveness (and efficiency) of this approach is probably low

The molecular epidemiology of a large outbreak of hepatitis B linked to autohaemotherapy

Background Unregulated skin-piercing procedures potentially facilitate the transmission of bloodborne pathogens. In February, 1998, a patient who had recently received autohaemotherapy at an alternative medicine clinic in the UK was diagnosed with acute hepatitis B. The autohaemotherapy procedure involved the drawing of 1 mL of the patient's blood, mixing with saline, and reinjection of the autologous blood mixture. We investigated the extent of hepatitis B virus (HBV) infection in patients and staff of the clinic. Methods Patients who had attended the clinic between January, 1997, and February, 1998, were tested for serological markers of HBV, and for HBV DNA by PCR. HBV DNA was sequenced to assess the relatedness of the virus identified in the cases. We analysed the number and dates of visits with regard to HBV status. Findings Serum samples were received from 352 patients and four staff members. Serological evidence of exposure to HBV was found in 57 (16%). Of the 33 patients and staff who were positive for hepatitis B surface antigen, 30 (91%) showed complete nucleotide identity in the DNA segments derived from the surface and core genes. Five patients with linked infection had markers of chronic hepatitis B, and one of these was regarded as the likely source of the outbreak. The attack rate was associated with the number of visits (p Interpretation We have described a large community-based outbreak of hepatitis B due to transmission by a single HBV variant. Our findings emphasise the continuing risk of transmission of bloodborne viruses in all health-care settings where skin-piercing procedures are used

Multicenter evaluation of the Staphylococcus QuickFISH method for simultaneous identification of Staphylococcus aureus and coagulase-negative staphylococci directly from blood culture bottles in less than 30 minutes.

A novel rapid peptide nucleic acid fluorescence in situ hybridization (FISH) method, Staphylococcus QuickFISH, for the direct detection of Staphylococcus species from positive blood culture bottles was evaluated in a multicenter clinical study. The method utilizes a microscope slide with predeposited positive- and negative-control organisms and a self-reporting 15-min hybridization step, which eliminates the need for a wash step. Five clinical laboratories tested 722 positive blood culture bottles containing gram-positive cocci in clusters. The sensitivities for detection of Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were 99.5% (217/218) and 98.8% (487/493), respectively, and the combined specificity of the assay was 89.5% (17/19). The combined positive and negative predictive values of the assay were 99.7% (696/698) and 70.8% (17/24), respectively. Studies were also performed on spiked cultures to establish the specificity and performance sensitivity of the method. Staphylococcus QuickFISH has a turnaround time (TAT) of(HOT) of/CoNS identification simultaneously with Gram stain results

Multicenter Evaluation of the Staphylococcus QuickFISH Method for Simultaneous Identification of Staphylococcus aureus and Coagulase-Negative Staphylococci Directly from Blood Culture Bottles in Less than 30 Minutes

A novel rapid peptide nucleic acid fluorescence in situ hybridization (FISH) method, Staphylococcus QuickFISH, for the direct detection of Staphylococcus species from positive blood culture bottles was evaluated in a multicenter clinical study. The method utilizes a microscope slide with predeposited positive- and negative-control organisms and a self-reporting 15-min hybridization step, which eliminates the need for a wash step. Five clinical laboratories tested 722 positive blood culture bottles containing Gram-positive cocci in clusters. The sensitivities for detection of Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were 99.5% (217/218) and 98.8% (487/493), respectively, and the combined specificity of the assay was 89.5% (17/19). The combined positive and negative predictive values of the assay were 99.7% (696/698) and 70.8% (17/24), respectively. Studies were also performed on spiked cultures to establish the specificity and performance sensitivity of the method. Staphylococcus QuickFISH has a turnaround time (TAT) of <30 min and a hands-on time (HOT) of <5 min. The ease and speed of the method have the potential to improve the accuracy of therapeutic intervention by providing S. aureus/CoNS identification simultaneously with Gram stain results

Rapid detection of Enterococcus spp. direct from blood culture bottles using Enterococcus QuickFISH method: a multicenter investigation.

The performance of a diagnostic method for detection and identification of Enterococcus spp. directly from positive blood culture was evaluated in a clinical study. The method, Enterococcus QuickFISH BC, is a second-generation peptide nucleic acid (PNA) fluorescence in situ hybridization (FISH) test, which uses a simplified, faster assay procedure. The test uses fluorescently labeled PNA probes targeting 16S rRNA to differentiate Enterococcus faecalis from other Enterococcus spp. by the color of the cellular fluorescence. Three hundred fifty-six routine blood culture samples were tested; only 2 discordant results were recorded. The sensitivities for detection of Enterococcus faecalis and non-faecalis Enterococcus were 100% (106/106) and 97.0% (65/67), respectively, and the combined specificity of the assay was 100%. The combined positive and negative predictive values of the assay were 100% (171/171) and 98.9% (185/187), respectively

Prevalence of Psychiatric and Substance Abuse Symptomatology Among HIV-Infected Gay and Bisexual Men in HIV Primary Care

BACKGROUND: The presence of psychiatric symptoms in gay/bisexual men managing HIV are under-identified and under-treated and can interfere with optimal HIV disease management. There is a paucity of prevalence reports of these symptoms in this group, identified in the primary HIV care setting. Few studies have compared prevalence rates based on empirically supported screening tools in relation to diagnoses made in primary care. OBJECTIVE: The purpose of this study was to identify the prevalence of psychiatric symptoms and substance abuse in HIV-infected gay/bisexual men and to estimate the proportion of those who had been diagnosed within their primary medical care setting. METHOD: Participants (n =503) were HIV-infected gay/bisexual men screened for participation in a HIV prevention trial and completed psychosocial assessment. Data were also extracted from patients’ electronic medical record. RESULTS: Over 47% met diagnostic screen-in criteria for any anxiety disorder of whom approximately one-third were identified in primary care. More than 22% screened in for a depressive mood disorder approximately 50% of whom had been identified. One quarter of the sample had elevated substance abuse symptoms, 19.4% of whom were identified in primary care. Of those with symptoms of alcohol abuse (19.9%) 9.0% of those were identified. CONCLUSION: These results provide some evidence suggesting that mood, anxiety and substance abuse symptomatology are prevalent among HIV-infected gay/bisexual men and are under-identified in primary care Increased mental health and substance use screening integrated into HIV primary care treatment settings may help to identify more gay/bisexual men in need of treatment