Comparative analysis of patients with chronic pulmonary aspergillosis and invasive pulmonary aspergillosis: a ten-year retrospective study

Poster Presentation: e-POSTER VIEWING: Mycology: paper no. EV0981postprin

Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature

Background: Prolonged asymptomatic carriage of vancomycin-resistant enterococci (VRE) in the gastrointestinal tract and the lack of effective decolonization regimen perpetuate the endemicity of VRE in the healthcare settings.Case presentation: We report a regimen for decolonization of gastrointestinal carriage of VRE by a combination of environmental disinfection, patient isolation, bowel preparation to wash-out the fecal bacterial population using polyethylene glycol, a five-day course of oral absorbable linezolid and non-absorbable daptomycin to suppress any remaining VRE, and subsequent oral Lactobacillus rhamnosus GG to maintain the colonization resistance in four patients, including two patients with end-stage liver cirrhosis, one patient with complication post liver transplant, and one patient with complicated infective endocarditis. All patients had clearance of VRE immediately after decolonization, and 3 of them remained VRE-free for 23 to 137 days of hospitalization, despite subsequent use of intravenous broad-spectrum antibiotics without anti-VRE activity.Conclusion: This strategy should be further studied in settings of low VRE endemicity with limited isolation facilities. © 2014 Cheng et al.; licensee BioMed Central Ltd.published_or_final_versio

Metabolomic profiling of Burkholderia pseudomallei using UHPLC-ESI-Q-TOF-MS reveals specific biomarkers including 4-methyl-5-thiazoleethanol and unique thiamine degradation pathway

© 2015 Lau et al.Background: Burkholderia pseudomallei is an emerging pathogen that causes melioidosis, a serious and potentially fatal disease which requires prolonged antibiotics to prevent relapse. However, diagnosis of melioidosis can be difficult, especially in culture-negative cases. While metabolomics represents an uprising tool for studying infectious diseases, there were no reports on its applications to B. pseudomallei. To search for potential specific biomarkers, we compared the metabolomics profiles of culture supernatants of B. pseudomallei (15 strains), B. thailandensis (3 strains), B. cepacia complex (14 strains), P. aeruginosa (4 strains) and E. coli (3 strains), using ultra-high performance liquid chromatography-electrospray ionization-quadruple time-of-flight mass spectrometry (UHPLC-ESI-Q-TOF-MS). Multi- and univariate analyses were used to identify specific metabolites in B. pseudomallei. Results: Principal component and partial-least squares discrimination analysis readily distinguished the metabolomes between B. pseudomallei and other bacterial species. Using multi-variate and univariate analysis, eight metabolites with significantly higher levels in B. pseudomallei were identified. Three of the eight metabolites were identified by MS/MS, while five metabolites were unidentified against database matching, suggesting that they may be potentially novel compounds. One metabolite, m/z 144.048, was identified as 4-methyl-5-thiazoleethanol, a degradation product of thiamine (vitamin B1), with molecular formula C6H9NOS by database searches and confirmed by MS/MS using commercially available authentic chemical standard. Two metabolites, m/z 512.282 and m/z 542.2921, were identified as tetrapeptides, Ile-His-Lys-Asp with molecular formula C22H37N7O7 and Pro-Arg-Arg-Asn with molecular formula C21H39N11O6, respectively. To investigate the high levels of 4-methyl-5-thiazoleethanol in B. pseudomallei, we compared the thiamine degradation pathways encoded in genomes of B. pseudomallei and B. thailandensis. While both B. pseudomallei and B. thailandensis possess thiaminase I which catalyzes degradation of thiamine to 4-methyl-5-thiazoleethanol, thiM, which encodes hydroxyethylthiazole kinase responsible for degradation of 4-methyl-5-thiazoleethanol, is present and expressed in B. thailandensis as detected by PCR/RT-PCR, but absent or not expressed in all B. pseudomallei strains. This suggests that the high 4-methyl-5-thiazoleethanol level in B. pseudomallei is likely due to the absence of hydroxyethylthiazole kinase and hence reduced downstream degradation. Conclusion: Eight novel biomarkers, including 4-methyl-5-thiazoleethanol and two tetrapeptides, were identified in the culture supernatant of B. pseudomallei.published_or_final_versio

Infection Control Preparedness for Human Infection With Influenza A H7N9 in Hong Kong

Objective. To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong Design. A descriptive study of responses to the emergence of influenza A H7N9 Setting. A university-affiliated teaching hospital Participants. Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9 Methods. A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities Results. From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P= 0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcriptionpolymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9 Conclusions. Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated. © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved.published_or_final_versio

Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization

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A novel psittacine adenovirus identified during an outbreak of avian chlamydiosis and human psittacosis: zoonosis associated with virus-bacterium coinfection in birds

Chlamydophila psittaci is found worldwide, but is particularly common among psittacine birds in tropical and subtropical regions. While investigating a human psittacosis outbreak that was associated with avian chlamydiosis in Hong Kong, we identified a novel adenovirus in epidemiologically linked Mealy Parrots, which was not present in healthy birds unrelated to the outbreak or in other animals. The novel adenovirus (tentatively named Psittacine adenovirus HKU1) was most closely related to Duck adenovirus A in the Atadenovirus genus. Sequencing showed that the Psittacine adenovirus HKU1 genome consists of 31,735 nucleotides. Comparative genome analysis showed that the Psittacine adenovirus HKU1 genome contains 23 open reading frames (ORFs) with sequence similarity to known adenoviral genes, and six additional ORFs at the 3′ end of the genome. Similar to Duck adenovirus A, the novel adenovirus lacks LH1, LH2 and LH3, which distinguishes it from other viruses in the Atadenovirus genus. Notably, fiber-2 protein, which is present in Aviadenovirus but not Atadenovirus, is also present in Psittacine adenovirus HKU1. Psittacine adenovirus HKU1 had pairwise amino acid sequence identities of 50.3–54.0% for the DNA polymerase, 64.6–70.7% for the penton protein, and 66.1–74.0% for the hexon protein with other Atadenovirus. The C. psittaci bacterial load was positively correlated with adenovirus viral load in the lung. Immunostaining for fiber protein expression was positive in lung and liver tissue cells of affected parrots, confirming active viral replication. No other viruses were found. This is the first documentation of an adenovirus-C. psittaci co-infection in an avian species that was associated with a human outbreak of psittacosis. Viral-bacterial co-infection often increases disease severity in both humans and animals. The role of viral-bacterial co-infection in animal-to-human transmission of infectious agents has not received sufficient attention and should be emphasized in the investigation of disease outbreaks in human and animals. © 2014 To et al.published_or_final_versio

The use of augmented reality for solving arithmetic problems for preschool children

Preschool children are required to acquire problem-solving ability and related time and sequence concepts to solve mathematical story problems. The maturation and pervasion of disruptive technologies, such as augmented reality (AR), may help preschool children to better acquire this knowledge and skills. However, it is still unknown how preschoolers would make use of AR as a learning tool for tackling arithmetic story problems with the involvement of the concepts of time and sequence. Consequently, the present study attempted to employ direct observation and interview methods to compare and gain insights into young children’s learning behaviors under traditional 2D pictorial and AR contexts. In line with the early development trajectories of a normal child aged 4–6 years old, a series of planned arithmetic problems which primarily comprised seriation (e.g. first, second, third) and scheduling (e.g. arriving, leaving) concepts were structured in scenario-based stories and designed specifically for preschool children. The findings of the current study reveal that AR intervention may well develop the problem-solving and independent mathematical thinking ability for preschool children by encouraging them to consider all information involved in the story problems, rather than simply guessing the answer from a 2D pictorial mode. Finally, based on the fact that the majority of preschool children still rely on a concrete counting method, the recommendation is to integrate AR technology into the traditional pictorial scenarios for the purpose of supporting the development of children’s ability to solve arithmetic story problem

Intravitreal ranibizumab for neovascular glaucoma: an interventional case series

Objective: To evaluate the efficacy of ranibizumab in treating neovascular glaucoma. Design: Prospective interventional case series. Participants: Six eyes of 6 patients. Method: Six eyes with refractory neovascular glaucoma were treated with one dose of 0.5 mg intravitreal ranibizumab followed by laser panretinal photocoagulation. Patients were divided into 2 groups based on angle status for comparison. Recurrence was defined as re-emergence of iris neovascularization, and an intraocular pressure of more than 21 mm Hg after stabilization. Results: The patients’ mean age was 59 years and the mean follow-up 23 weeks. Three eyes had open-angle glaucoma, and three had a closed-angle configuration glaucoma. In 5 (83%) of the eyes, neovascularization completely regressed within the first 48 hours of intravitreal ranibizumab injection. Overall mean intraocular pressure dropped from 27.0 mm Hg pretreatment to 18.3 mm Hg 1 week post–intravitreal ranibizumab. The mean anti-glaucoma drop usage decreased from 4.2 pre-treatment to 2.2 one month later. There was no recurrence throughout the initial 3 months, but 2 eyes with closed-angle configuration glaucoma recurred, with a mean time to recurrence of 14 weeks. Conclusions: These results suggested that intravitreal ranibizumab is a useful and safe adjunct in the management of neovascular glaucoma.link_to_OA_fulltex