ABSTRACT
During 2012-2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients.
Subject(s)
Disease Outbreaks , Drug Contamination , Meningitis, Fungal/epidemiology , Meningitis, Fungal/transmission , Steroids/administration & dosage , Female , History, 21st Century , Humans , Kaplan-Meier Estimate , Male , Meningitis, Fungal/history , Meningitis, Fungal/mortality , Mortality , Public Health , Public Health Surveillance , United States/epidemiologySubject(s)
Analgesics/administration & dosage , Drug Compounding/standards , Drug Contamination/prevention & control , Steroids/administration & dosage , Accreditation/standards , Analgesics/adverse effects , Analgesics/chemistry , Animals , Humans , Injections, Epidural , Meningitis, Fungal/microbiology , Meningitis, Fungal/prevention & control , Meningitis, Fungal/transmission , Patient Safety , Practice Guidelines as Topic/standards , Preservatives, Pharmaceutical/adverse effects , Quality Control , Steroids/adverse effects , Steroids/chemistryABSTRACT
In cases of central nervous system infection, it is crucial for the neuroradiologist to provide an accurate differential diagnosis of the possible pathogens involved so that treating physicians can be aided in the choice of empiric therapy. This approach requires the radiologist to be aware of local epidemiology and have knowledge of infectious agents that are endemic to their area of practice. This article reviews and discusses the changing epidemiology of pathogens most often observed in meningitis, brain abscess, epidural abscess, postoperative infections, and human immunodeficiency virus infection.
Subject(s)
Bacterial Infections/epidemiology , Central Nervous System Parasitic Infections/epidemiology , Meningitis, Bacterial/epidemiology , Meningitis, Fungal/epidemiology , Meningitis, Viral/epidemiology , Meningitis/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/prevention & control , AIDS-Related Opportunistic Infections/transmission , Bacterial Infections/diagnosis , Bacterial Infections/prevention & control , Bacterial Infections/transmission , Brain Abscess/diagnosis , Brain Abscess/epidemiology , Brain Abscess/prevention & control , Central Nervous System Parasitic Infections/diagnosis , Central Nervous System Parasitic Infections/prevention & control , Central Nervous System Parasitic Infections/transmission , Cross-Sectional Studies , Developing Countries , Diagnosis, Differential , Humans , Meningitis/diagnosis , Meningitis/prevention & control , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/prevention & control , Meningitis, Bacterial/transmission , Meningitis, Fungal/diagnosis , Meningitis, Fungal/prevention & control , Meningitis, Fungal/transmission , Meningitis, Viral/diagnosis , Meningitis, Viral/prevention & control , Meningitis, Viral/transmission , Prognosis , Risk Factors , Surgical Wound Infection/diagnosis , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Travel , VaccinationABSTRACT
The objective of the present work was to carry out a survey of soil samples taken from different areas of a hospital of infectious disease located in the city of Córdoba, where three AIDS patients were hospitalized during different periods in the same ward. The three of them returned with meningeal cryptococcosis between three or five months after having been discharged. Cryptococcus neoformans was isolated in 8/10 samples collected outside the hospital, near the pigeon house. The samples collected from the AIDS patients ward and its surroundings were negative. These findings suggest that the patients may have been infected by the fungus during their first stay in hospital.
