Molecular epidemiology of an outbreak of human parainfluenza virus 3 among oncology patients.

A hospital outbreak of human parainfluenza virus type 3 (HPIV-3) in haematologic oncology patients is described in 12 patients over a four-week period. Exposure histories and molecular analysis of HPIV-3 isolates suggest that both community-acquired and nosocomially transmitted infections occurred during this outbreak. Molecular analysis of HPIV-3 isolates indicated that a chain of transmission occurred among multiple patients in an oncology ward. This transmission was later determined to be associated with the movement of fomites, visitors, and activities in the unit. The infection prevention team stopped nosocomial spread of HPIV-3 through interventions including advanced cleaning procedures.

Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction.

Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.

Detection of Pneumocystis jiroveci in respiratory specimens by four staining methods.

We examined four staining methods on replicate smears of 313 respiratory specimens submitted for Pneumocystis jiroveci examination. The sensitivity and specificity of Calcofluor white stain (CW) were 73.8 and 99.6%, respectively. The sensitivity and specificity of Grocott-Gomori methenamine silver stain (GMS) were 79.4 and 99.2%, respectively. The sensitivity and specificity of Diff-Quik stain were 49.2 and 99.6%, respectively. The sensitivity and specificity of Merifluor Pneumocystis stain were 90.8 and 81.9%, respectively. Only CW and GMS had positive and negative predictive values of >90%.

Influenza pneumonia in lung transplant recipients: clinical features and association with bronchiolitis obliterans syndrome.

Influenza infection is increasingly recognized to cause significant morbidity and mortality in the community, especially in pediatric patients and elderly persons. Influenza infection, however, has not been well described among thoracic organ transplant recipients. We provide the first detailed clinical, radiographic, and histologic description of influenza pneumonia among three lung transplant recipients. The presentation varied considerably among the three patients and, in some cases, was atypical for influenza. Despite treatment, a persistent decline in pulmonary function occurred in all three patients after the acute illness. Interestingly, on follow-up biopsy specimens, each patient had histologic evidence of acute rejection and/or obliterative bronchiolitis. Additional research, therefore, is needed to clarify the relationship between influenza infection, acute rejection, and obliterative bronchiolitis.

Respiratory viral infections in lung transplant recipients: radiologic findings with clinical correlation.

PURPOSE: To evaluate radiologic finding of respiratory viral infection in lung transplant recipients with clinical correlation. MATERIALS AND METHODS: Over 5 years, 21 episodes of respiratory viral infection (parainfluenza [n = 9], respiratory syncytial virus [n = 8], adenovirus [n = 5], influenza [n = 2]) were diagnosed 6-727 days (mean, 270 days) after lung transplantation in 20 recipients. Chest radiographs, computed tomographic (CT) images, and clinical records were reviewed. RESULTS: Sixteen episodes of respiratory viral infection were diagnosed in patients with symptoms of lower respiratory tract infection or acute allograft dysfunction; five were diagnosed in asymptomatic patients. Chest radiographs were abnormal in 11 (52%) episodes; findings included heterogeneous or homogeneous opacities and masslike consolidation. All patients with radiographic abnormalities were symptomatic. Chest radiographs were unchanged from baseline in 10 (48%) episodes; in one, CT revealed findings not depicted at radiography. Adenoviral infection (n = 5) was typically symptomatic, was associated with new radiographic abnormalities, and was rapidly lethal (n = 4). Infection with parainfluenza and/or respiratory syncytial virus was commonly asymptomatic and was not associated with radiographic abnormalities; affected patients had good outcomes. CONCLUSION: Respiratory viral infections are important causes of morbidity and mortality in lung transplant recipients. Radiographic abnormalities in patients with respiratory viral infections were usually accompanied by symptoms of lower respiratory tract infection. Adenoviral infection was frequently accompanied by progressive pulmonary opacity and fatal outcome.

Community respiratory viral infection in adult lung transplant recipients.

STUDY OBJECTIVE: To define the epidemiology, clinical manifestations, and long-term complications of respiratory viral infections in adult lung transplant recipients. DESIGN: Retrospective review of the records of 122 adult lung transplant recipients over a 5-year period at one institution. RESULTS: Ten episodes of infection with respiratory syncytial virus, parainfluenza, influenza, or adenovirus were identified. All patients presented with symptoms of respiratory tract infection. Two patients died acutely and four patients subsequently had development of obliterative bronchiolitis (OB). CONCLUSIONS: These data suggest community respiratory viral infections cause significant morbidity and mortality in lung transplant recipients. Further prospective studies are warranted to clarify the relationship between respiratory viral infection and OB and to define the optimal therapy for these viral infections.

Response of human ciliated respiratory epithelium to brief in vivo ozone exposure: an ultrastructural study.

Ciliated nasal epithelium obtained from human volunteers exposed under controlled conditions to 0.4 ppm of ozone for 4 hr was examined by transmission electron microscopy. These investigations were initiated to evaluate the utility of human ciliated nasal epithelium as a model for the characterization of possible ultrastructural level cytopathic effects induced by short-term, low-level in vivo exposure to ozone. Particular attention was given to both the qualitative and quantitative evaluation of ciliated cells in the nasal respiratory epithelium in response to ozone exposure. The results of these investigations indicated that cell structure is generally retained and no appreciable manifestation of injury is evident in human nasal mucosa in response to the regimen of ozone exposure employed during these studies. Although these investigations were completed under highly controlled circumstances and with the constraints attendant to research on humans subjects, they may provide a fundamental base for future examinations of the potential injurious effects of ozone on human respiratory epithelium under conditions more relevant to habitual environmental exposure.

The increase in dental disease in the northern states of Nigeria and its manpower implications.

An epidemiological survey of dental decay was carried out in the six northern states of Nigeria on a population sample of 1396. The average number of decayed, missing and filled (DMF) teeth per person for the whole sample was 2-7. The percentage of caries-free persons was 47-1. Dental decay was more severe and widespread in the cities, where the mean DMF value was 2-8 and 42 per cent were caries-free, than in the villages, where the mean DMF value was 2-0 and 66-9 per cent were caries-free. The mean DMF index for the age group 10-19 years (which formed nearly 60 per cent of the sample) was 3-1, and untreated dental decay alone almost entirely accounted for this figure. This amount of untreated dental disease is an indication of the lack of dental treatment available as a consequence of the shortage of dental manpower, since only 15 dentists are available for a population of 28 800 000 in this area. Examination of the dietary habits of the population studied showed a remarkable level of consumption of sweets and sweet foods both in villages and cities. Overall, no fewer than 87 per cent of the people admitted to taking these cariogenic foods as snacks between meals. These habits are sufficient to explain the alarmingly increased incidence of dental decay and the decline in the number of caries-free persons when compared with earlier studies. This is an unhappy augury for the future dental health of Nigeria. The evidence of deterioration of dental health makes a national programme of dental health education and preventive dental treatment a matter of urgency. This necessitates a considerable increase in dental manpower if the population is to receive the maximum benefit.