110 research outputs found
Clostridium difficile infection
No full textClostridium difficile is a rod-shaped, Gram-positive anaerobic bacterium which produces spores that enable it to survive in the environment for prolonged periods (Fig 1). Although first isolated in 1935, it was identified as the causal agent of antibiotic associated diarrhoea and pseudomembranous colitis only in the 1970s. C. difficile-associated disease (CDAD) has become an increasingly important nosocomial infection in the UK and throughout the western world over recent years (Fig 2). In addition to morbidity and mortality, CDAD imposes a huge economic burden on the health services
Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature
No full textAbstract Introduction This case report describes a rare condition: community-acquired adenovirus pneumonia in an immunocompetent adult. The diagnosis was achieved by using a multiplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and highlights the usefulness of these novel molecular diagnostic techniques in patients hospitalized with acute respiratory illness. We also performed a literature search for previously published cases and present a summary of the clinical, laboratory and radiological features of this condition. Case presentation A 44-year-old immunocompetent Caucasian woman was admitted to our hospital with an acute febrile respiratory illness associated with a rash. Her blood tests were non-specifically abnormal, and tests for bacterial pathogens were negative. Her condition rapidly deteriorated while she was in our hospital and required mechanical ventilation and inotropic support. A multiplex real-time RT-PCR assay performed on respiratory specimens to detect respiratory viruses was negative for influenza but positive for adenovirus DNA. The patient recovered on supportive treatment, and antibiotics were stopped after 5 days. Conclusions Community-acquired adenovirus pneumonia in immunocompetent adult civilians presents as a non-specific acute febrile respiratory illness followed by the abrupt onset of respiratory failure, often requiring mechanical ventilation. Its laboratory and radiological features are typical of viral infections but also are non-specific. Novel multiplex real-time RT-PCR testing for respiratory viruses enabled us to rapidly make the diagnosis in this case. The new technology could be used more widely in patients with acute respiratory illness and has potential utility for rationalization of the use of antibiotics and improving infection control measures.</p
Eumycetoma of the hand caused by Leptosphaeria tompkinsii and refractory to medical therapy with voriconazole
No full textWe report on the first case of eumycetoma caused by the organism Leptosphaeria tompkinsii to be diagnosed and possibly acquired within the United Kingdom. Conventional culture of fungal grains and surgical tissue specimens was negative and the diagnosis was achieved using panfungal polymerase chain reaction and sequencing technology. Despite limited surgical resection and prolonged antifungal therapy with voriconazole, the patient developed progressive disease with mycetoma bone involvement. This case highlights the usefulness of molecular diagnostic techniques in eumycetoma where organisms may fail to grow with conventional culture or be difficult to identify morphologically. It also reminds us that eumycetoma is a difficult infection to treat and despite optimism regarding the efficacy of the newer triazole antifungals in this condition, treatment failures may still occur
Respiratory virus infection in chronic chest disease.
No full textThis thesis describes the impact of respiratory virus infections in patients with chronic chest disease and investigates the role of influenza vaccine and the possibility of preventing infection with intranasal interferon. The thesis begins by defining respiratory virus infection and presenting a brief historical introduction. This is followed by an account of the important respiratory viruses, the major causes of chronic chest disease and the relationship between respiratory virus infections and exacerbations of chest disease. The introduction concludes by describing the nature of interferons and reviews clinical trials of interferon therapy. The subjects, materials and methods are followed by the results of the clinical and laboratory studies. Respiratory virus infections were significantly more severe in adults with chronic chest disease than in previously healthy individuals. Unfortunately prophylaxis with intranasal interferon was not associated with any benefit. A preliminary study in children with cystic fibrosis showed that rhinoviruses were associated with exacerbations of lung disease. A survey of General Practitioners in the Trent Region revealed that less than 20% of susceptible patients were vaccinated against influenza and identified several factors which were associated with improved vaccination rates. A study in patients with asthma found that only 9% had received influenza vaccine prior to the 1989-90 influenza epidemic. Influenza vaccination was not associated with any significant reduction in the proportion of asthmatic patients who developed influenza-like symptoms during the influenza outbreak and many episodes of illness were thought to have resulted from other respiratory viruses. All studies suffered from difficulties in establishing a diagnosis of respiratory virus infection, with viruses isolated from less than 15% of acute nasopharyngeal swabs and fewer than 25% of paired serum samples showing a significant antibody rise. The implications of the results and future possibilities are discussed
A molecular analysis of non-fimbrial adhesins in uropathogenic Escherichia coli.
No full textBacterial adherence is one of the most important virulence factors in the pathogenesis of urinary tract infections. The majority of clinical isolates of Escherichia coli adhere to uroepithelial cells via specific organelles known as fimbriae or pili which project from the surface. A proportion of urinary isolates possess adhesins which diffusely surround the bacteria forming an adhesive protein capsule. These are described as non-fimbrial adhesins. The molecular biology and clinical significance of this group of adhesins is relatively poorly understood. The work presented in this thesis describes the cloning and comparison of four non-fimbrial adhesins (NFA-1 to NFA-4) identified in strains of Escherichia coli isolated from patients with urinary tract infections. The NFA-2 and NFA-4 adhesin subunit gene sequences were determined. The gene complexes encoding the four non-fimbrial adhesins were of similar size and complexity. NFA-1 and NFA-2 were antigenically distinct but shared a close degree of nucleotide and amino acid homology. Comparison of NFA-1 and NFA-2 sequences with other published sequences showed that they were related to members of the Dr adhesin family. NFA-3 and NFA-4 appeared to be unrelated adhesins, however the nucleotide sequence of the NFA-4 adhesin subunit proved to be identical to the previously described M-adhesin. The clinical importance of this group of non-fimbrial adhesins was investigated by colony blotting studies. The results showed that NFA-1, NFA-2 and NFA-4 were associated with isolates causing lower urinary tract infections but NFA-3 did not appear to play an important role in urinary tract infection. The significance of the results is discussed
A Multi-Faceted Approach of One Teaching Hospital NHS Trust during the Clostridium difficile Epidemic—Antibiotic Management and Beyond
No full textThe incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, implemented a number of interventions, which led to an 80% reduction in new cases over a twelve month period. Changes were introduced as a result of collaboration between the Infection Prevention team, the departments of Microbiology and Infectious Diseases, and with the support of the Trust Executive. These strategies are described in detail and included; implementation of antimicrobial stewardship, specific hygiene and cleaning measures, the introduction of a care pathway form for all infected patients, the opening of an isolation ward for patients with CDI, strengthened organisation and clinical management, and rigorous attention to education within the Trust. The implementations described are of continued relevance in the face of new infection challenges, such as the increasing incidence of multi-drug resistant organisms
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