Infection Diseases Following Natural Disaster in Children: Health Prevention and Assessment

[17] Diseases with a long incubation period (leishmaniasis and leptospirosis) and vector-borne diseases such as malaria and dengue should be considered as possible infections during the recovery phase (> 4 weeks) of natural disasters. [20] Outbreaks of group A streptococcus infection in camps could have devastating consequences, not just as a cause of respiratory infection, but also of wound infections. [10] In the post-earthquake period, the first wave of infectious diseases is caused by food-borne and/or water-borne infections, and/or by infections transmitted by respiratory droplets. [Extracted from the article] Copyright of Journal of Pediatric Infectious Diseases is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Emergency department care of ABSSSI with dalbavancin infusion, direct discharge, and outpatient telemedicine follow up: a study protocol.

Novel therapeutic strategies such as the long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI), who require intravenous antibiotics and would otherwise be hospitalized. The COVID-19 pandemic highlighted the need to develop strategies that may reduce hospitalization. The telehealth approach has shown success in remote management of cellulitis patients and could aid in the remote follow up of overall ABSSSI patients. This article describes a study protocol for the telemedicine follow up of patients diagnosed with ABSSSI in the ED, requiring intravenous treatment, receiving a single dalbavancin dose, and directly discharged. A telehealth system for remote follow up is evaluated as well as the possible inclusion of point-of-care ultrasound for the appropriate diagnosis of ABSSSI. The study will be conducted in compliance with regulatory requirements; and all collected data will be kept strictly confidential and in accordance with all relevant legislation on the control and protection of personal information. Dissemination of the study protocol may help increasing knowledge and awareness on this topic, with the aim of optimizing patient management, reducing hospitalization and lower the impact on healthcare associated costs.

Genotyping, virulence genes and drug resistance of MRSA strains isolated from skin and soft tissue infection in Tianjin

OBJECTIVE: To investigate and analyze the genotyping, virulence genes and drug-resistant genes of methicillin resistant Staphylococcus aureus (MRSA) strains isolated from skin and soft tissue infections in this area. METHODS: The skin secretions of 204 patients with skin and soft tissue infections in the Fifth Central Hospital of Tianjin between Jan. 2019 and Dec. 2020 were collected, and MRSA strains identified as non-repetitive strains were isolated. The Staphylococcal cassette chromosome mec (SCCmec) and Staphylococcal protein A gene (spa) genotyping and Panton-valentine leukocidin (PVL) gene carrying status were analyzed among the MRSA strains, and their relationship with drug resistance was analyzed. RESULTS: Totally 82 strains of S. aureus were isolated from the skin secretions of 204 patients with skin and soft tissue infections, including 44 strains of MRSA (53.66%). The most common SCCmec genotype was genotype III (accounting for 84.09%) and the most common spa genotype was genotype t030 (accounting for 84.09%). PVL genes encoding virulence factors were amplified in 5 strains (11.36%). The drug resistance rates of 44 MRSA strains to vancomycin and compound sulfamethoxazole were 0.00%, and all the strains were drug-resistant to penicillin. Different SCCmec and spa genotypes were highly resistant to erythromycin, cefazolin, clindamycin and levofloxacin, but the differences in drug resistance rates of different SCCmec genotypes to clindamycin and levofloxacin were significant (P < 0.05). The resistance rates of strains with PVL positive genes to chloramphenicol, gentamicin and tetracycline were significantly higher than those with PVL negative genes (P < 0.05). CONCLUSION: Strains carrying SCCmec III and spa t030 genotypes may be the dominant strains of MRSA in skin and soft tissue infections in this area. Spa genotypes and PVL gene have certain impact on drug resistance of MRSA, and the isolated MRSA strains are all sensitive to vancomycin and compound sulfamethoxazole, which can provide a reference for anti-MRSA treatment in this area.

Five years of outpatient parenteral antibiotic therapy with ceftriaxone in the paediatric emergency department: what clinical features are associated with need for admission?

BACKGROUND: More children presenting to Emergency Departments (EDs) with acute infections are now directly referred for outpatient parenteral antibiotic therapy (OPAT). Sparse data exist on what clinical features in these children are associated with OPAT failure. We hypothesised that children who were younger or presented with systemic features of infection would be more likely to need admission. METHODS: We conducted a service evaluation over a 5-year period (12 September 2015-12 September 2020) at a single UK tertiary centre paediatric ED formally known as the Royal Hospital for Sick Children Edinburgh. All children referred from the ED for OPAT with ceftriaxone were included. OPAT failure was defined as a decision by a senior clinician of need for admission. Univariate statistical testing and multivariate logistic regression modelling were performed. RESULTS: 754 children received OPAT in the ED over a 5-year period. 95 children (13%) required admission for inpatient management. Need for admission was independently associated with having a positive blood culture (adjusted OR (aOR) 8.9; 95% CI 1.49 to 47; p=0.01) or an ultrasound performed (aOR 6.8; 95% CI 3.74 to 12.7; p<0.001). We observed no significant association between age and systemic features (fever, white cell count or C reactive protein) with need for admission in our multivariate analysis. CONCLUSION: In children presenting with acute infections to our paediatric ED who were deemed suitable by senior clinicians to be managed using OPAT with ceftriaxone, younger age (above 3 months) and the presence of systemic features were not independently associated with need for admission. Overall, our service was safe and no child came to harm from early ambulation during this evaluation.

Bordetella hinzii Pneumonia and Bacteremia in a Patient with SARS-CoV-2 Infection.

Patients with severe acute respiratory syndrome coronavirus 2 infection may have bacterial co-infections, including pneumonia and bacteremia. Bordetella hinzii infections are rare, may be associated with exposure to poultry, and have been reported mostly among immunocompromised patients. We describe B. hinzii pneumonia and bacteremia in a severe acute respiratory syndrome coronavirus 2 patient.

Outbreak of a novel disease caused by Staphylococcus pseudintermedius in raccoon dogs (Nyctereutes procyonoides).

This study reports outbreak of a new disease caused by Staphylococcus pseudintermedius (S. pseudintermedius) in raccoon dogs. The disease occurred in a breeding farm of raccoon dogs in Guan County of Shandong Province in China in August of 2019. 47% (425/896) of the raccoon dogs showed some abnormal symptoms; 17.6% (75/425) of which had severe skin and soft tissue infections (SSTIs), dyspnoea and severe pathological lesions in lungs, livers, etc; and 4.2% (18/425) of which died within 4 weeks. The pathogen of the disease was identified as S. pseudintermedius by mass spectrometer detection, animal pathogenicity tests, microscopic examination and biochemical reaction tests. Its nucleotide homology of 16S rRNA gene was 100% with that of other published strains, and its genotype was between the American and Brazilian strains from other animals. The isolated S. pseudintermedius strain from the diseased raccoon dogs could cause ulceration and suppuration in the skins and severe pathological lesions not only in raccoon dogs, but also in mice; and it is confirmed as a methicillin-resistant S. pseudintermedius (MRSP) strain by the amplification of mecA gene; and 12 sensitive drugs were screened by drug sensitivity tests. Full attention should be paid to the great economic loss and the potential zoonotic risk caused by the S. pseudintermedius in raccoon dogs, and this study can provide a reference for the clinical diagnosis and treatment of this new disease.

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London.

BACKGROUND: The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. METHODS: We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. FINDINGS: A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection. CONCLUSION: Currently, harm reduction equipment and resources for safe injecting are not meeting the needs of people who inject drugs who are street homeless or unstably housed. Preparation of injections with non-sterile water sources could precipitate bacterial and fungal infections, particularly when used without the application of heat. It is crucial that water for injection, also skin cleaning, is made available for the unstably housed and that harm reduction messaging is tailored to speak to the everyday realities of people who prepare and inject drugs in public spaces.