Scabies outbreak in an intensive care unit with 1,659 exposed individuals--key factors for controlling the outbreak

OBJECTIVE: To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. DESIGN: Outbreak investigation. SETTING: The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center. METHODS: All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals. INTERVENTIONS: All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination. RESULTS: Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families. CONCLUSIONS: Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.

Compounds that bind to the gamma-aminobutyric acid benzodiazepine ionophore complex modulate the cellular response to oxidant stress

The γ-aminobutyric acid benzodiazepine (GABAA /BZDR) ionophore complex has been widely studied in the central nervous system (CNS) and it regulates Cl− ion movement across the plasma membrane. The complex has been found in the distal tubule and the thick ascending limb of the kidney. The goal of this study was to see if modulation of this complex by agonists or antagonists could affect the way Madin-Darby Canine Kidney (MDCK) cells responded to an oxidant stress induced by menadione. When compared to cells incubated with menadione alone, preincubation with lindane, a nonspecific GABAA antagonist, coincubation with bicuculline, a specific GABAA antagonist, and coincubation with FG7142, an inverse agonist for the BZDR, protected cells from menadione cytotoxicity. Preincubation of cells in media containing PK11195 had no effect on menadione cytotoxicity. Coincubation with flurazepam, a BZDR agonist, exacerbated menadione cytotoxicity. This suggests that modulation of the GABAA/BZDR ionophore complex within MDCK cells with agonists and antagonists can alter the cellular responsiveness to an oxidant-induced injury. These responses via agonists and antagonists may be due to alterations of Cl− ion influx during late stage necrotic cell death. ^

Compilation of measurements from two interdisciplinary STAR-shaped surveys in the North Sea: The ZISCH - Dataset

The measurements were obtained during two North Sea wide STAR-shaped cruises during summer 1986 and winter 1987, which were performed to investigate the circulation induced transport and biologically induced pollutant transfer within the interdisciplinary research in the project "ZISCH - Zirkulation und Schadstoffumsatz in der Nordsee / Circulation and Contaminant Fluxes in the North Sea (1984-1989)". The inventory presents parameters measured on hydrodynamics, nutrient dynamics, ecosystem dynamics and pollutant dynamics in the pelagic and benthic realm. The research program had the objective of quantifying fluxes of major budgets, especially contaminants in the North Sea. In spring 1986, following the phytoplankton spring bloom, and in late winter 1987, at minimum primary production activity, the North Sea ecosystem was investigated on a station net covering the whole North Sea. The station net was shaped like a star. Sampling started in the centre, followed by the northwest section and moving counter clockwise around the North Sea following the residual currents. By this strategy, a time series was measured in the central North Sea and more synoptic data sets were obtained in the individual sections. Generally advection processes have to be considered when comparing the data from different stations. The entire sampling period lasted for more than six weeks in each cruise. Thus, a time-lag should be considered especially when comparing the data from the eastern and the western part of the central and northern North Sea, where samples were taken at the beginning and at the end of the campaign. The ZISCH investigations represented a qualitatively and quantitatively new approach to North Sea research in several respects. (1) The first simultaneous blanket coverage of all important biological, chemical and physical parameters in the entire North Sea ecosystem; (2) the first simultaneous measurements of major contaminants (metals and organohaline compounds) in the different ecosystem compartments; (3) simultaneous determinations of atmospheric inputs of momentum, energy and matter as important ecosystem boundary conditions; (4) performance of the complex measurement program during two seasons, namely the spring plankton bloom and the subsequent winter period of minimal biological activity; and (5) support of data analysis and interpretation by oceanographic and meteorological numerical models on the same scales.

(Table 1) Concentrations of persistant organic pollutants in brain and liver of glaucous gulls, Bjørnøya, Svalbard archipelago

Dead and dying glaucous gulls (Larus hyperboreus) were collected on Bjornoya in the Barents Sea in 2003, 2004 and 2005. Autopsies of the seabirds only explained a clear cause of death for three (14%) of the 21 birds. A total of 71% of the birds were emaciated. Liver and brain samples were analysed for organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polybrominated diphenyl ether (PBDEs), hexabromo-cyclododecanes (HBCDs) and mercury (Hg). High levels of OCPs, PCBs, PBDEs and alpha-HBCD were found in liver and brain. Compared to the dead and dying glaucous gulls found 1989, the congeners' composition tended to change toward more persistent compounds in the 2003-2005 samples. The brain levels of OCPs and PCBs did not differ between 1989 and 2003-2005, while the liver levels were significantly lower. The brain/liver ratio for PCB and PBDE significantly decreased with halogenations of the molecule, indicating a clear discrimination of highly halogenated PCBs and PBDEs entering the brain. There was further a clear negative correlation between contaminant concentrations and body condition. The brain levels were not as high as earlier published lethal levels of p,p'-DDE or PCB. However, more recent studies reported a range of sub-lethal OCP- and PCB-related effects in randomly sampled glaucous gulls. An additional elevation of pollutants due to emaciation may increase the stress of the already affected birds. The high brain levels of OCP, PCB and PBDE of present study might therefore have contributed to the death of weakened individuals of glaucous gull.

Pesticide and herbicide residues in sediments and seagrasses from the Great Barrier Reef world heritage area and Queensland coast

Pesticides and herbicides including organochlorine compounds have had extensive current and past application by Queensland's intensive coastal agriculture industry as web as for a wide range of domestic, public health and agricultural purposes in urban areas, The persistent nature of these types of compounds together with possible continued illegal use of banned organochlorine compounds raises the potential for continued long-term chronic exposure to plants and animals of the Great Barrier Reef. Sediment and seagrass samples were collected from 16 intertidal and 25 subtidal sampling sites between Torres Strait and Townsville, near Mackay and Gladstone, and in Hervey and Moreton Bays in 1997 and 1998 and analysed for pesticide and herbicide residues. Low levels of atrazine (0.1-0.3 mug kg(-1)), diuron (0.2-10.1 mug kg(-1)), lindane (0.08-0.19 mug kg(-1)), dieldrin (0.05-0.37 mug kg(-1)), DDT (0.05-0.26 mug kg(-1)), and DDE (0.05-0.26 mug kg(-1)) were detected in sediments and/or seagrasses. Contaminants were mainly detected in samples collected along the high rainfall, tropical coast between Townsville and Port Douglas and in Moreton Bay. Of the contaminants detected, the herbicide diuron is of most concern as the concentrations detected have some potential to impact local seagrass communities, (C) 2000 Elsevier Science Ltd. All rights reserved.

Stable isotopes, PCBs and pesticide concentrations in zooplankton, seawater and POM from Kongsfjorden and Liefdefjorden, Svalbard

Differences in bioaccumulation of persistent organic pollutants (POPs) between fjords characterized by different water masses were investigated by comparing POP concentrations, patterns and bioaccumulation factors (BAFs) in seven species of zooplankton from Liefdefjorden (Arctic water mass) and Kongsfjorden (Atlantic water mass), Svalbard, Norway. No difference in concentrations and patterns of POPs was observed in seawater and POM; however higher concentrations and BAFs for certain POPs were found in species of zooplankton from Kongsfjorden. The same species were sampled in both fjords and the differences in concentrations of POPs and BAFs were most likely due to fjord specific characteristics, such as ice cover and timing of snow/glacier melt. These confounding factors make it difficult to conclude on water mass (Arctic vs. Atlantic) specific differences and further to extrapolate these results to possible climate change effects on accumulation of POPs in zooplankton. The present study suggests that zooplankton do biomagnify POPs, which is important for understanding contaminant uptake and flux in zooplankton, though consciousness regarding the method of evaluation is important.

(Table 1) Annual mean concentrations of atmospheric a- and g-Hexachlorocyclohexane at stations Alert, Canada and Zeppelin, Norway

Twelve year datasets of weekly atmospheric concentrations of alpha- and gamma-HCH were compared between the two Arctic monitoring stations of Alert, Nunavut, Canada, and Zeppelin Mountain, Svalbard, Norway. Time-series analysis was conducted with the use of dynamic harmonic regression (DHR), which provided a very good model fit, to examine both the seasonal behaviour in these isomers and the longer-term, underlying trends. Strong spatial differences were not apparent between the two sites, although subtle differences in seasonal behaviour and composition were identified. For example, the composition of gamma-HCH to total HCH (alpha + gamma) was greater at Zeppelin compared to Alert, probably reflecting this site's proximity to major use regions of lindane. Pronounced seasonality in air concentrations for gamma-HCH was marked by a 'spring maximum event' (SME), confirming earlier studies. For alpha-HCH, the SME was much weaker and only evident at Alert, whereas at Zeppelin, seasonal fluctuations for alpha-HCH were marked by elevated concentrations in summer and lower concentrations during winter, with this pattern most apparent for the years after 2000. We attribute this difference in spatial and temporal patterns to the Arctic oscillation. A similar climatic pattern was not evident at either site in the gamma-HCH data. Seasonally adjusted, long-term trends revealed declining concentrations at both sites for alpha- and gamma-HCH over the entire time-series. Recent legislation affecting lindane use appear to account for this decline in gamma-HCH, with little evidence of a delay or 'lag' between the banning of lindane in Europe (a main source region) or Canada, and a decline in air concentrations observed at both Arctic sites.