1/3. A phylogenetic analysis elucidating a case of patient-to-patient transmission of hepatitis c virus during surgery.A phylogenetic hepatitis c virus (HCV) assay based on the core-Envelope 1 (C-E1) region was developed and used to elucidate a case of a patient-to-patient transmission. The index patient showed clinical symptoms of hepatitis seven weeks after surgery for hallux valgus under general anaesthesia. She progressed to a chronic persistent infection as indicated by positive HCV PCR results two years after surgery. Before her operation, a patient with HCV antibodies and positive HCV PCR had undergone surgery in the same room. There were two possibilities whereby the index patient could have been infected with hepatitis c, either through her work as a nurse or by transmission during surgery. By sequencing the 5' non-coding region PCR product, we found that both patients were infected with genotype 1a. Phylogenetic analysis with the variable C-E1 region suggested that the two patients clustered together with a bootstrap 100% in a tree with 75 sequence references. We further performed a phylogenetic analysis in this region with the genotype 1a reference sequences and an additional 25 genotype 1a sequences consecutively collected from Danish patients with HCV. The two patients still clustered together, supported by a high bootstrap 1000 value of 999. Homology analyses combined with the epidemiological findings indicate that the patient operated on in the same room before the index case was the most likely source of transmission. The mode of transmission could not be conclusively established, but a reusable part of the anaesthetic respiratory circuit is a possibility and a well known risk.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Extradural anaesthesia for repeated surgical treatment in the presence of infection.The use of extradural catheters in patients with systemic or localized infection is controversial. The catheter may act as a focus for secondary infection resulting in an extradural abscess. in this study we have examined the use of extradural catheters for anaesthesia over the past 7 yr in patients with localized infections. The records of 69 patients were reviewed and patients interviewed (letter/phone). These patients had a total of 120 extradural catheters placed and received, on average, four anaesthetics, with the extradural catheter remaining in place for a mean of 9 days. On 12 occasions (eight patients) the catheter was removed because of signs or symptoms of local infection. Specific antibiotic therapy was not initiated, but ongoing therapy was continued. A single case of spondylitis was the only serious complication found but was not related to the extradural technique. We conclude that extradural anaesthesia for patients who require repeated surgical treatments for abscesses or infected wound is a relatively safe procedure.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
3/3. Bacterial meningitis following combined spinal-epidural analgesia for labour.We report a case of streptococcus salivarius meningitis following combined spinal-epidural analgesia for labour. Although rare, bacterial meningitis following combined spinal-epidural anaesthesia is being increasingly described. We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |