Evaluation of antibiotic prescription for upper respiratory tract infections in the community pharmacy setting

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Parental views of antibiotic use in children with upper respiratory tract infections in Jordan

Purpose: To assess the knowledge, attitudes and practices of parents towards antibiotics use for upper respiratory tract infections (URTIs) in Jordan. Methods: A cross-sectional study was carried out at 10 private outpatients’ pediatric clinics across Amman-Jordan from September to December 2013. During the study period, 1329 parents of young children who fulfilled the inclusion criteria and agreed to participate were interviewed, and completed a validated structured questionnaire. Results: A large proportion of parents (903, 68 %) believed that weather change was the main cause of acute URTIs in their children. Although 1098 (82.8 %) of parents were aware that the recurrent use of antibiotics leads to a decrease in effectiveness due to bacterial resistance, 859 (64.6 %) of the respondents reported that they would give antibiotics without prescription. Fathers (135, 40.2 %), were significantly more aware that URTIs follow its natural course without antibiotic administration compared to mothers (N = 327, 32.9 %), respectively (p = 0.005). Conclusion: There is a lack of adequate parental knowledge concerning the use and misuse of antibiotics in children in Jordan. National publicity campaign should be mounted to improve awareness. Furthermore, existing laws should be enforced to prevent parents from purchasing antibiotics over-thecounter (OTC).

HEMATOLOGICAL ASSESSMENT IN FOUR BRAZILIAN TELEOST FISH WITH PARASITIC INFECTIONS, COLLECTED IN FEEFISHING FROM FRANCA, São Paulo, BRAZIL

The effects of parasitic infections in condition factor, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration (MCHC), and leucocytes and thrombocytes distribution in Piaractus mesopotamicus, Leporinus macrocephalus, hybrid tambacu (P. mesopotamicus x Colossoma macropomum and Brycon amazonicus collected in feefishing from Franca, São Paulo, Brazil were evaluated. Parasitized tambacu and L. macrocephalus had higher (p<0.05) condition factor than unparasitized fish. However, the contrary occurred in P. mesopotamicus and B. amazonicus. Changes in the hematocrit, hemoglobin and MCHC were not related to parasitism. Parasitic infections did not cause effect on leucocytes and thrombocytes percentage (p>0.05) of tambacu. In P. mesopotamicus parasitized by Monogenea Anacanthorus penilabiatus and dinoflagellate Piscinoodinium pillulare, increase in monocytes and decrease in thrombocytes percentage (p<0.05) were found. However, the same parasitic association in L. macrocephalus caused a decrease in lymphocytes percentage accompanied by increase in neutrophils percentage (p<0.05). In B. amazonicus, infection by Ichthyophthirius multifiliis, P. pillulare and monogeneans caused increase in neutrophils percentage.

Evidence of shared bovine viral diarrhea infections between red deer and extensively raised cattle in south-central Spain

Bovine viral diarrhea virus (BVDV) is a pestivirus that affects cattle production worldwide and that can infect other ungulates such as cervids and even wild boar (Sus scrofa). It is believed that domestic livestock can become infected through contact with wild animals, though it is known that infection can spread among wild animals in the absence of contact with livestock. Little is known about the sharing of BVDV infection between wild and domestic animals in the same habitat, which is important for designing eradication campaigns and preventing outbreaks, especially on hunting estates with high animal densities.

Unraveling Sarcocystis miescheriana and Sarcocystis suihominis infections in wild boar

Sarcocystis species are worldwide spread cyst-forming protozoa that can infect wild boar but little is known about the prevalence of these parasites. In this study we assessed the prevalence of Sarcocystis spp. infections in wild boars from northeastern Portugal, for which novel PCR testing assays targeting Sarcocystis genus, S. miescheriana and S. suihominis were implemented, and risk factors potentially associated with these infections were evaluated. Samples from muscle tissue, namely diaphragm (n = 102), oesophagus (n = 96) and heart (n = 101), were collected from a total of 103 wild boar hunted between October 2011 and February 2012. Diaphragm muscle was used for the PCR detection of Sarcocystis nucleic acids since a higher proportion of samples showed the presence of cysts during histological examination. PCR assay targeting Sarcocystis genus yielded a 73.8% infection rate, which indicate a high level of exposure to these protozoan parasites among wild boars. These samples showed to be positive with the S. miescheriana-specific PCR assay and no sample was positive with the S. suihominis-specific assay, suggesting that a single species infecting wild boar is circulating in Portugal. These results were confirmed by the partial sequencing of the 18S rRNA gene amplified from selected samples from different geographic regions. Adults, young adults and female wild boars were found to be more likely infected. Hunters have an important role in the life cycle of S. miescheriana since potentially infected viscera and carcasses can be left behind promoting the protozoan dissemination to the scavenging final hosts. If hunting dogs bite and ingest infected meat they can perpetuate the life cycle of Sarcocystis spp. spreading oocysts or sporocysts in the environment.

Iowa State wide Strategic Plan for Healthcare Associated Infections, October 28, 2015

Iowa State wide Strategic Plan for Healthcare Associated Infections, prevention, harm reduction, community care coordination, survey and data.

Mixed genotype Hepatitis C virus infections: incidence in Scotland and methods for detection

The diagnosis of mixed genotype hepatitis C virus (HCV) infection is rare and information on incidence in the UK, where genotypes 1a and 3 are the most prevalent, is sparse. Considerable variations in the efficacies of direct-acting antivirals (DAAs) for the HCV genotypes have been documented and the ability of DAAs to treat mixed genotype HCV infections remains unclear, with the possibility that genotype switching may occur. In order to estimate the prevalence of mixed genotype 1a/3 infections in Scotland, a cohort of 512 samples was compiled and then screened using a genotype-specific nested PCR assay. Mixed genotype 1a/3 infections were found in 3.8% of samples tested, with a significantly higher prevalence rate of 6.7% (p<0.05) observed in individuals diagnosed with genotype 3 infections than genotype 1a (0.8%). An analysis of the samples using genotypic-specific qPCR assays found that in two-thirds of samples tested, the minor strain contributed <1% of the total viral load. The potential of deep sequencing methods for the diagnosis of mixed genotype infections was assessed using two pan-genotypic PCR assays compatible with the Illumina MiSeq platform that were developed targeting the E1-E2 and NS5B regions of the virus. The E1-E2 assay detected 75% of the mixed genotype infections, proving to be more sensitive than the NS5B assay which identified only 25% of the mixed infections. Studies of sequence data and linked patient records also identified significantly more neurological disorders in genotype 3 patients. Evidence of distinctive dinucleotide expression within the genotypes was also uncovered. Taken together these findings raise interesting questions about the evolutionary history of the virus and indicate that there is still more to understand about the different genotypes. In an era where clinical medicine is frequently more personalised, the development of diagnostic methods for HCV providing increased patient stratification is increasingly important. This project has shown that sequence-based genotyping methods can be highly discriminatory and informative, and their use should be encouraged in diagnostic laboratories. Mixed genotype infections were challenging to identify and current deep sequencing methods were not as sensitive or cost-effective as Sanger-based approaches in this study. More research is needed to evaluate the clinical prognosis of patients with mixed genotype infection and to develop clinical guidelines on their treatment.

Noninvasive Ventilation and Droplet dispersion. Health professional protocols. Nurse perspective. in: Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events,

The past few decades have seen major impacts of different pandemics and mass casualty events on health resource use in terms of rising health cost and increased mortality.

Infections of Hypostomus spp. by Trypanosoma spp. and leeches: a study of hematology and record of these hirudineans as potential vectors of these hemoflagellates.

Dentre os Kinetoplastida, Trypanosoma é o gênero com maior ocorrência, infectando populações de peixes marinhos e de água doce em todo o mundo. Apresenta elevados níveis de prevalência, ocasiona impactos na saúde dos peixes e consequente perdas econômicas, principalmente para populações de peixes em situação de estresse. Este estudo investigou a infecção por Trypanosoma spp. e sanguessugas em Hypostomus spp. e parâmetros sanguíneos desse hospedeiro do sistema de tributários do Rio Tapajós, no Estado do Pará, Amazônia Oriental, Brasil. De 47 hospedeiros examinados, 89,4% estavam parasitados por Trypanosoma spp., e 55,4% tinham também sanguessugas na região da boca. A intensidade de Trypanosoma spp. aumentou com o tamanho dos hospedeiros, mas as condições corporais não foram influenciadas pelo parasitismo. O número de eritrócitos, hematócrito, hemoglobina, VCM, HCM, CHCM, número de leucócitos e trombócitos totais apresentaram variações e correlação negativa com a intensidade de Trypanosoma spp. no sangue dos hospedeiros. Os resultados sugerem que sanguessugas foram os vetores de Trypanosoma spp. in Hypostomus spp.

Percutaneous insertion of Dual Growth Rods using a new mobile bearing implant

Growth rods are commonly used for the treatment of scoliosis in the immature spine. Many variations have been proposed but breakage of implants is a common problem. Growth rod insertion commonly involves large exposures at initial insertion followed by multiple smaller procedures for lengthening. We present our early experiences using a percutaneous technique of insertion of a new titanium mobile bearing implant (Medtronic Inc). The implant allows some rotatory motion in the middle of the construct thus reducing construct stresses and thus possibly reducing rod breakage risk. Based on this small initial series with 12 months follow-up, percutaneous insertion of growth rods using the new implant is a safe and reliable technique although the infection rate in our sample was of note. This may be related to the titanium wear and inflammation seen in the soft tissues at time of operation and visualised on histology. No implants have required removal due to infection, and all infections were treated with debridement at next lengthening and suppressive antibiotics. Propionibacterium is one of the commonest infections seen with spinal implants and sometimes does not respond to simple antibiotic suppression. The technique allows preservation of the soft tissues until definitive fusion is needed and may lead to a decrease in hospital stay. The implant is low profile and seems to offer advantages over other systems on the market. Further follow up is needed to look at longer term outcomes with this new implant type.

A cluster-randomised intervention trial against Schistosoma japonicum in the Peoples' Republic of China: bovine and human transmission

Background Zoonotic schistosomiasis japonica is a major public health problem in China. Bovines, particularly water buffaloes, are thought to play a major role in the transmission of schistosomiasis to humans in China. Preliminary results (1998–2003) of a praziquantel (PZQ)-based pilot intervention study we undertook provided proof of principle that water buffaloes are major reservoir hosts for S. japonicum in the Poyang Lake region, Jiangxi Province. Methods and Findings Here we present the results of a cluster-randomised intervention trial (2004–2007) undertaken in Hunan and Jiangxi Provinces, with increased power and more general applicability to the lake and marshlands regions of southern China. The trial involved four matched pairs of villages with one village within each pair randomly selected as a control (human PZQ treatment only), leaving the other as the intervention (human and bovine PZQ treatment). A sentinel cohort of people to be monitored for new infections for the duration of the study was selected from each village. Results showed that combined human and bovine chemotherapy with PZQ had a greater effect on human incidence than human PZQ treatment alone. Conclusions The results from this study, supported by previous experimental evidence, confirms that bovines are the major reservoir host of human schistosomiasis in the lake and marshland regions of southern China, and reinforce the rationale for the development and deployment of a transmission blocking anti-S. japonicum vaccine targeting bovines.

The economic rationale for infection control in Australian hospitals

The objective of the present study was to predict the economic consequences of healthcare-acquired infections arising among admissions to Australian acute care hospitals. A quantitative algorithm informed by epidemiological and economic data was developed. All acute care hospitals in Australia were included in the study and the participants included all admissions to general medical and general surgical specialties. The main outcome measures were the numbers of cases of healthcare-acquired infection and bed days lost annually. It was estimated that there are 175 153 (95% credible interval 155 911 : 195 168) cases of healthcare-acquired infection among admissions to Australian hospitals annually, and the extra stay in hospital to treat symptoms accounts for 854 289 bed days (95% credible interval 645 091 : 1 096 244). If rates were reduced by 1%, then 150 158 bed days would be released for alternative uses. This would allow ~38 500 new admissions. Healthcare-acquired infections in patients cause bed blocks in Australian hospitals. The cost-effectiveness of hospital services might be improved by allocating more resources to infection control, releasing beds and allowing new admissions. There exists an opportunity to improve the efficiency of the Australian health care system.

Mutation frequency of non-ESBL phenotype SENTRY (Asia-Pacific) isolates of Klebsiella pneumoniae conversion to an ESBL positive phenotype

Extended spectrum β-lactamases or ESBLs, which are derived from non-ESBL precursors by point mutation of β-lactamase genes (bla), are spreading rapidly all over the world and have caused considerable problems in the treatment of infections caused by bacteria which harbour them. The mechanism of this resistance is not fully understood and a better understanding of these mechanisms might significantly impact on choosing proper diagnostic and treatment strategies. Previous work on SHV β-lactamase gene, blaSHV, has shown that only Klebsiella pneumoniae strains which contain plasmid-borne blaSHV are able to mutate to phenotypically ESBL-positive strains and there was also evidence of an increase in blaSHV copy number. Therefore, it was hypothesised that although specific point mutation is essential for acquisition of ESBL activity, it is not yet enough, and blaSHV copy number amplification is also essential for an ESBL-positive phenotype, with homologous recombination being the likely mechanism of blaSHV copy number expansion. In this study, we investigated the mutation rate of non-ESBL expressing K. pneumoniae isolates to an ESBL-positive status by using the MSS-maximum likelihood method. Our data showed that blaSHV mutation rate of a non-ESBL expressing isolate is lower than the mutation rate of the other single base changes on the chromosome, even with a plasmid-borne blaSHV gene. On the other hand, mutation rate from a low MIC ESBL-positive (≤ 8 µg/mL for cefotaxime) to high MIC ESBL-positive (≥16 µg/mL for cefotaxime) is very high. This is because only gene copy number increase is needed which is probably mediated by homologous recombination that typically takes place at a much higher frequencies than point mutations. Using a subinhibitory concentration of novobiocin, as a homologous recombination inhibitor, revealed that this is the case.

Effect of female sex hormones on Chlamydia trachomatis growth and gene expression

Transmissible diseases are re-emerging as a global problem, with Sexually Transmitted Diseases (STDs) becoming endemic. Chlamydia trachomatis is the leading cause of bacterially-acquired STD worldwide, with the Australian cost of infection estimated at $90 - $160 million annually. Studies using animal models of genital tract Chlamydia infection suggested that the hormonal status of the genital tract epithelium at the time of exposure may influence the outcome of infection. Oral contraceptive use also increased the risk of contracting chlamydial infections compared to women not using contraception. Generally it was suggested that the outcome of chlamydial infection is determined in part by the hormonal status of the epithelium at the time of exposure. Using the human endolmetrial cell line ECC-1 this study investigated the effects of C. trachomatis serovar D infection, in conjunction with the female sex hormones, 17β-estradiol and progesterone, on chlamydial gene expression. While previous studies have examined the host response, this is the first study to examine C.trachomatis gene expression under different hormonal conditions. We have highlighted a basic model of C. trachomatis gene regulation in the presence of steroid hormones by identifying 60 genes that were regulated by addition of estradiol and/or progesterone. In addition, the third chapter of this thesis discussed and compared the significance of the current findings in the context of data from other research groups to improve our understanding of the molecular basis of chlamydial persistence under hormonal different conditions. In addition, this study analysed the effects of these female sex hormones and C. trachomatis Serovar D infection, on host susceptibility and bacterial growth. Our results clearly demonstrated that addition of steroid hormones not only had a great impact on the level of infectivity of epithelial cells with C.trachomatis serovar D, but also the morphology of chlamydial inclusions was affected by hormone supplementation.

Effects of inoculating dose on the kinetics of Chlamydia muridarum genital infection in female mice

Chlamydia trachomatis infections have been implicated in problems such as pelvic inflammatory disease and infertility in females. Although there are some studies examining the kinetics of ascending infection, there is limited information on the kinetics of pathology development and cellular infiltrate into the reproductive tissues in relation to the effects of inoculating dose, and a better understanding of these is needed. The murine model of female genital tract Chlamydia muridarum infection is frequently used as a model of human C. trachomatis reproductive tract infection. To investigate the kinetics of ascending genital infection and associated pathology development, female BALB/c mice were intravaginally infected with C. muridarum at doses ranging from 5102 to 2.6106 inclusion forming units. We found that the inoculating dose affects the course of infection and the ascension of bacteria, with the highest dose ascending rapidly to the oviducts. By comparison, the lowest dose resulted in the greatest bacterial load in the lower reproductive tract. Interestingly, we found that the dose did not significantly affect inflammatory cell infiltrate in the various regions. Overall, this data show the effects of infectious dose on the kinetics of ascending chlamydial infection and associated inflammatory infiltration in BALB/c mice.