1/10. Cluster of candida parapsilosis primary bloodstream infection in a neonatal intensive care unit.candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU). We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
2/10. histoplasmosis in pregnancy: case series and report of transplacental transmission.Although a healthy pregnancy seems to confer an increased susceptibility to systemic fungal infections, to our knowledge, no known association exists in the case of histoplasma capsulatum. In addition, to our knowledge, transplacental transmission of H capsulatum has not been previously described. We describe a series of patients treated at our institutions between 1997 and 2000 with evidence of transplacental transmission of H capsulatum. Mechanisms of increased risk of histoplasmosis during pregnancy are proposed, although this risk has yet to be proved.- - - - - - - - - - ranking = 3keywords = transmission (Clic here for more details about this article) |
3/10. An outbreak of herpes simplex virus type 1 in an intensive care nursery.Neonatal herpes simplex infection is not a common occurrence but one which warrants particular concern. An 1800-g premature infant who developed respiratory distress and died at 12 days unexpectedly yielded HSV from a culture of cerebrospinal fluid. There were no mucocutaneous lesions. Ten days later three other infants (ages 40, 69 and 11 days) developed vesicles which yielded herpes simplex. health care staff cohorts were assigned to "clean" or "exposed" nursery areas. The three secondarily infected cases were treated with vidarabine and did not develop systemic symptoms. Typing of the isolates using immunofluorescence and monoclonal antibodies revealed all to be herpes simplex type 1. Restriction endonuclease cleavage of viral dna determined that the isolates from the four infants were identical. The mothers of the infants denied any history of recent or recurrent herpes, and their cervical cultures were negative. The source of the outbreak has remained unknown. The possibility of manual transmission to the secondary cases remains likely despite standard infection control practices. Cohort isolation of all exposed patients prevented further spread.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
4/10. Dissimilar manifestations of intrauterine infection with echovirus 11 in premature twins.Echoviruses cause neonatal disease following intrauterine and intrapartum acquisition of the organism or by nosocomial infection. Dizygous twins apparently became infected following transplacental transmission of echovirus 11. At 5 days of age, both twins experienced poor feeding, lethargy and hypothermia, and evidence of coagulopathy and hepatitis. During the sixth week of illness, the convalescence of twin A was complicated by peritonitis and sepsis, and the infant died. Pathologic findings included scattered foci of dystrophic myocardial calcification, distortion of hepatic architecture with fibrous connective tissue surrounding regenerative nodules and large foci of dystrophic calcification, and adrenal hemorrhagic necrosis and calcification. Twin B recovered without sequelae. The disease in twin A was unusual because of the extensive myocardial involvement. Also of interest was the variability of disease in twins who presumably had received a similar inoculum of organism by the same route.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
5/10. Ascending transcervical herpes simplex infection with intact fetal membranes.A case of herpes simplex infection in the placenta and in an immature infant delivered to a mother with proved genital herpes infection is discussed. Infection occurred without premature rupture of membranes. Viral transmission could be attributed to ascending transcervical infection based on evidence of necrotizing chorioamnionitis in absence of villitis plus extensive and severe involvement of the skin and lungs. Such distinct documentation of transcervical infection in the presence of intact fetal membranes makes it obvious that delivery by cesarean section cannot prevent all cases of neonatal herpes infection.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
6/10. Fatal echovirus 11 disease in premature neonates.Four cases of fatal echovirus 11 disease occurred in premature infants during a community outbreak of enteroviral disease in massachusetts in 1979. Each infant developed nonspecific symptoms and jaundice at 4 to 6 days of age, and subsequent progressive hepatic failure and generalized bleeding. Only one infant survived longer than six days. Virus was recovered from multiple sites premortem, and from virtually all tissue cultured at autopsy. myocarditis was not present clinically or pathologically. Clinical and laboratory evidence implicated perinatal transmission of virus from mother to infant. Three mothers experienced a febrile illness with abdominal pain within the last five days of pregnancy. In two, the illness led to a false diagnosis of abruptio placenta and interruption of pregnancy by cesarian section. review of case reports of this syndrome caused by other echovirus serotypes revealed that many had similar perinatal events. Each mother ultimately developed neutralizing antibody to echovirus 11. However, all four infants were born without passively acquired antibody, probably because they were delivered prior to the appearance of specific maternal IgG. Although laboratory studies by others have shown other factors may be responsible for the ability of enterovirus to cause overwhelming disease in neonates, uncontrolled data from these four infants and their mothers suggest that timing of maternal illness in relation to delivery of the infant may also be important.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
7/10. Congenital syphilitic skeletal manifestations in a premature infant revisited.Increasing rates of congenital syphilis have been reported in recent years despite the availability of adequate therapy. In our perinatal-neonatal center, approximately 1.5% of newborns have reactive serologic tests for syphilis. Untreated or partly treated maternal syphilis can adversely affect neonatal outcome since the treponeme can cross the placenta at any time during pregnancy. As a result of hematogenous placental transmission, neonatal manifestations are usually systemic and similar to the secondary stage of syphilis, and include hepatosplenomegaly, jaundice, neurosyphilis, and skeletal changes. A case of early congenital syphilis in an extremely premature infant with primary skeletal involvement is presented.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
8/10. Neonatal trichosporon beigelii infection: report of a cluster of cases in a neonatal intensive care unit.trichosporon beigelii, a ubiquitous yeast found in soil, causes superficial dermatologic infections in normal hosts and rare cases of disseminated disease among immunocompromised patients. Neonatal cases are exceptionally rare. We report a cluster of cases of T. beigelii infections in a tertiary care hospital in Rochester, NY, during May to July, 1991. Three cases occurred in very low birth weight premature infants (23 to 25 weeks of gestation), two of whom died. The organism was isolated from urine alone in one case, skin and blood in one case and blood, tracheal aspirate and central venous catheter tip in one case. In a fourth, full term infant with respiratory distress syndrome T. beigelii was grown only from a femoral central venous catheter tip with no clinical evidence of infection. An epidemiologic investigation was performed and the mode of transmission in this outbreak was not identified, although cross-infection was suspected in the initial two cases. Our isolates were inhibited but not killed by usually achievable concentrations of amphotericin b. T. beigelii may cause outbreaks of serious infection in neonatal intensive care units, especially among premature infants.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
9/10. Nosocomial infection with rhizopus microsporus in preterm infants: association with wooden tongue depressors.BACKGROUND: We report four cases of cutaneous infection with rhizopus microsporus in vulnerable preterm infants in one neonatal nursery. methods: There was no overlap in hospital stay between the first two cases and an extensive programme of environmental sampling was therefore initiated, with special attention being paid to items that had close contact with infants' skin. Samples were cultured by standard techniques, including fungal culture with Sabouraud's medium. Filamentous fungi with non-septate hyphae were presumptively identified as agents of mucormycosis and referred to the mycology Reference Laboratory, Bristol, UK, for speciation. FINDINGS: The source of infection was identified as wooden tongue depressors, which were used on the nursery to construct splints for intravenous and arterial cannulation sites. The outbreak was ended by the removal of these items from the nursery. INTERPRETATION: Wooden tongue depressors can be a vehicle for transmission of mucormycosis. The combination of warm, humid conditions in neonatal incubators, particularly in association with occlusive dressings, may favour cutaneous fungal invasion and put small, sick babies at risk of infection.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
10/10. molecular epidemiology of staphylococcal scalded skin syndrome in premature infants.BACKGROUND: Outbreaks of nosocomial staphylococcal scalded skin syndrome (SSSS) in infants have been well-described associated with the well baby nursery or delivery room. We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak. methods: staphylococcal scalded skin syndrome was diagnosed in two infants in the NICU: Case I (a 47-day-old, formerly 530-g female); and Case II diagnosed 48 h later (a 41-day old, formerly 706-g female). Multiple infection control measures were implemented: (1) isolation and intravenous antibiotic treatment of cases; (2) placement of exposed infants into a cohort; (3) prophylactic mupirocin treatment of the anterior nares of all infants in the NICU and staff colonized with staphylococcus aureus; and (4) personnel hand washing with hexachlorophene. Detection of exfoliative toxin A and studies to determine the genetic relatedness of S. aureus strains isolated from patients and staff were performed. RESULTS: In addition to the two SSSS cases, S. aureus was isolated from 2 of 12 (17%) exposed asymptomatic infants, 2 of 20 (10%) ancillary staff, 8 of 30 (27%) nurses and 6 of 24 (25%) physicians. Exfoliative toxin A-producing strains were isolated from both cases and one asymptomatic infant. No toxin was expressed by strains isolated from staff. pulse field gel electrophoresis demonstrated genetically identical strains of S. aureus from the two SSSS cases and the asymptomatic infant, whereas three staff members harbored strains genetically related to the case strain. Unexpectedly two additional unique clusters of genetically related S. aureus strains were identified from the surveillance cultures. CONCLUSIONS: This report documents the rare occurrence of nosocomial SSSS attributed to transmission in the NICU among extremely low birth weight infants. Multiple infection control strategies were effective in limiting the outbreak. molecular epidemiology investigation supported a unique S. aureus strain responsible for this event and the presence of bidirectional spread between staff and patients of non-toxin-producing strains.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
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