The socio-economic impact of multidrug-resistant nosocomial infections: a qualitative study.

The burden of healthcare-associated infections (HCAIs) has traditionally been measured using clinical and economic outcomes. We conducted semi-structured interviews with 18 patients or their caregivers affected by HCAI caused by multidrug-resistant organisms to better understand the human impact of HCAI. Most patients had misconceptions about HCAI and antimicrobial resistance, leading to strong negative feelings towards HCAIs despite positive views of their healthcare providers. Communication issues across power imbalances need to be addressed to help deal with trauma of HCAIs. A holistic approach to HCAIs incorporating patient perspectives will likely help guide policymakers developing solutions to improve patient outcomes.

The effect of parasitism on personality in a social insect.

Individuals are known to differ consistently in various aspects of their behaviour in many animal species, a phenomenon that has come to be referred to as animal personalities. These individual differences are likely to have evolutionary and ecological significance, and it is therefore important to understand the precise nature of how environmental and physiological factors affect animal personalities. One factor which may affect personality is disease, but while the effects of disease on many aspects of host behaviour are well known, the effects on animal personalities have been little studied. Here we show that wood ants, Formica rufa, exhibit consistent individual differences in three personality traits: boldness, sociability and aggressiveness. However, experimental exposure to a virulent fungal parasite, Metarhizium pingshaense, had surprisingly little effect on the personality traits. Parasite-challenged ants showed marginal changes in sociability at high doses of parasite but no change in boldness or aggressiveness even when close to death. There was similarly little effect of other physiological stresses on ant personalities. The results suggest that individual personality in ants can be remarkably resilient to physiological stress, such as that caused by parasite infection. Future studies are needed to determine whether there is a similar resilience in solitary animals, as well as in other social species.

Vision-Related Quality-of-Life Outcomes in the Mycotic Ulcer Treatment Trial I: A Randomized Clinical Trial.

IMPORTANCE: Given the limitations in health care resources, quality-of-life measures for interventions have gained importance. OBJECTIVE: To determine whether vision-related quality-of-life outcomes were different between the natamycin and voriconazole treatment arms in the Mycotic Ulcer Treatment Trial I, as measured by an Indian Vision Function Questionnaire. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis (performed October 11-25, 2014) of a double-masked, multicenter, randomized, active comparator-controlled, clinical trial at multiple locations of the Aravind Eye Care System in South India that enrolled patients with culture- or smear-positive filamentous fungal corneal ulcers who had a baseline visual acuity of 20/40 to 20/400 (logMAR of 0.3-1.3). INTERVENTIONS: Study participants were randomly assigned to topical voriconazole, 1%, or topical natamycin, 5%. MAIN OUTCOMES AND MEASURES: Subscale score on the Indian Vision Function Questionnaire from each of the 4 subscales (mobility, activity limitation, psychosocial impact, and visual function) at 3 months. RESULTS: A total of 323 patients were enrolled in the trial, and 292 (90.4%) completed the Indian Vision Function Questionnaire at 3 months. The majority of study participants had subscale scores consistent with excellent function. After adjusting for baseline visual acuity and organism, we found that study participants in the natamycin-treated group scored, on average, 4.3 points (95% CI, 0.1-8.5) higher than study participants in the voriconazole-treated group (P = .046). In subgroup analyses looking at ulcers caused by Fusarium species and adjusting for baseline best spectacle-corrected visual acuity, the natamycin-treated group scored 8.4 points (95% CI, 1.9-14.9) higher than the voriconazole-treated group (P = .01). Differences in quality of life were not detected for patients with Aspergillus or other non-Fusarium species as the causative organism (1.5 points [95% CI, -3.9 to 6.9]; P = .52). CONCLUSIONS AND RELEVANCE: We found evidence of improvement in vision-related quality of life among patients with fungal ulcers who were randomly assigned to natamycin compared with those randomly assigned to voriconazole, and especially among patients with Fusarium species as the causative organism. Incorporation of quality-of-life measures in clinical trials is important to fully evaluate the effect of the studied interventions. TRIAL REGISTRATION: clinicaltrials.gov Identifier:NCT00996736.

Quality of life, disability scores, and distress index in fungal rhinosinusitis.

Our goal was to determine quality of life (QOL), disability, and distress in the day-to-day lives of patients suffering from fungal rhinosinusitis (FRS) based on a prospective questionnaire. The study included 125 patients suffering from FRS, excluding those with acute fulminant FRS and any other comorbid illness. The data were compared with data for 50 age- and sex-matched controls who did not have any other chronic illness and obtained outpatient services from the Department of Otolaryngology and Head and Neck Surgery of our institute. Analysis showed that patients with FRS had worse QOL, with an average score of 87.34 compared with 94.15 for the control group. QOL score further decreased to 85.31 for patients with extensive disease that included intracranial or intraorbital extension and to 71.1 in those with recurrent disease. Patients showed significant disability and had decreased work efficiency in disability parameters. Distress among these patients was also greater and further increased in those with extensive disease or recurrence. We conclude that patients with FRS have worse QOL, more disability, and more distress compared with age- and sex-matched controls. This issue needs to be addressed while treating cases of FRS.

Behavioral changes in the termite, Coptotermes formosanus (Isoptera), inoculated with six fungal isolates.

The studies of pathogen-prevention behaviors of termites have focused on hygiene behavior directed only against highly virulent pathogens. Therefore, we compared behavioral changes in the subterranean termite Coptotermes formosanus following contact with entomopathogenic fungi with different levels of virulence. The fungal virulence was inferred from the daily mortality and the LD50 value in previous data. When untreated termites were allowed to contact their fungus-inoculated nestmates, mutual grooming was frequent during 30 min after inoculation. The inoculated termites were often attacked and eaten by their uninoculated nestmates, and then buried after death. Notably, there was no influence of fungal virulence on these pathogen-prevention behaviors. However, the fungal isolates and genera affected not only the frequency of the behaviors but also the horizontal transmission pattern, the number of dead individuals and the survival period before the first death following infection.

Raising awareness of amphibian Chytridiomycosis will not alienate ecotourists visiting Madagascar.

Chytridiomycosis (Bd) is contributing to amphibian extinctions worldwide but has so far not been detected in Madagascar. The high likelihood for Bd to spread to the island and efface this amphibian diversity and endemism hotspot requires respective conservation policies to be developed. Bd could be introduced by the large number of tourists that visit protected areas; therefore, increasing awareness among tourists and encouraging them to participate in safety measures should be a priority conservation action. However, concerns have been raised that tourists would not be able to distinguish between an amphibian disease harmless to humans and emerging diseases that would imply a danger for human health, invoking a negative image of Madagascar as an ecotourism destination. We evaluated whether informing tourists about this infectious animal disease would cause health scare and diminish trip satisfaction. Based on 659 respondents we found that most ecotourists favored to be informed about Bd and were proactive about participating in prevention measures, refuting previous concerns.

The rise of non-adaptive intelligence in humans under pathogen pressure.

Cleverness made our species the most successful primate on Earth, thus claiming that human intelligence is adaptive sounds to be a triviality. Not surprisingly, when establishing long-lasting pair-bonds, humans exhibit mate preferences in favour of clever partners, apparently to increase the chance that their offspring will be as clever as possible. Contrary to this well-established view, here I argue that the adaptive nature of human intelligence has never been proven in a strict evolutionary sense. Furthermore, the exceptional rise of intelligence in our species (and the lack of comparable phenomena in other apes) is best explained within the context of the Hamilton-Zuk Hypothesis. Apparently, humans have been subjected to an exceptionally strong selection pressure exerted by pathogens and parasites, and the human brain is particularly vulnerable to infections, thus cleverness is an ideal character to signal heritable genetic resistance against infections. In this scenario, human preference for intelligent mates is to increase the offspring's resistance against pathogens. Among other phenomena, this hypothesis can explain why humans enjoy wasting most of their intellectual capabilities for totally useless purposes, why prehistoric humans developed brains that made them potentially far more intelligent than required by their physical environment, and why we experience a continuous increase of human intelligence even in modern societies. Briefly, I argue that (1) human sexual selection favours intelligence as a signal of genetic resistance against pathogens, and (2) that intelligence enabled the rise of our species (in terms of population size and distribution) as an accidental side-effect.

Cognitive impairment associated with toxigenic fungal exposure: a response to two critiques.

Fox, Greiffenstein, and Lees-Haley (2005) and McCaffrey and Yantz (2005) criticized our 2004 article that reported neuropsychological evidence of cognitive impairment in a sample of individuals exposed to toxic molds who complained of cognitive difficulties (Gordon et al., 2004). They critiqued the study's justification, design, analyses, and conclusions and characterized it as poor epidemiology. This article is a rebuttal to their comments. It documents that both sets of negative comments are based on frequent inaccuracies, mischaracterizations of our findings, and red herrings. Furthermore, they failed to refute the implications of the study's main findings.

The effects of foot disease on quality of life: results of the Achilles Project.

BACKGROUND: Foot diseases have a high prevalence in the general population, but their impact on quality of life has not been assessed in large-scale studies. The Achilles Project surveyed foot disease in patients visiting their primary care physician or dermatologist. METHODS: A total of 43 593 patients were asked about the impact of their condition on their quality of life: pain, discomfort in walking, limitations in daily activities, and embarrassment. RESULTS: Overall, 52.5% of patients had some aspect of their quality of life affected by their foot disease. More specifically, 30.7% of patients experienced pain, 40.3% had discomfort in walking, 19.6% had their daily activities limited, and 27.3% were embarrassed. The survey indicated a larger impact of foot disease on the quality of life of women vs. men in all categories, except for daily activities. Similarly, the elderly (> or = 65 years) were more affected by their foot disease, although they suffered no more embarrassment than other age groups. Participation in sports seemed to lower the proportion of patients who had their quality of life adversely affected. Non-fungal foot diseases, particularly ulcer and gangrene, are more likely to cause pain, discomfort in walking and limit daily activities, than fungal diseases. CONCLUSIONS: In general, non-fungal foot diseases caused pain, discomfort in walking and limitations in daily activities in more patients than fungal foot diseases, but a higher proportion of patients with fungal foot diseases were embarrassed by their condition than patients with non-fungal foot diseases. The study found that the impact of foot disease on quality of life may be greater than previously suggested. Given that effective treatments are available, routine examination of patients' feet by dermatologists and primary care physicians may help to reduce the burden of these foot conditions.

Cognitive impairment associated with toxigenic fungal exposure: a replication and extension of previous findings.

In this study, neuropsychological data and symptom reports from 31 individuals exposed to toxic mold were examined. Most participants were found to have reduced cognitive functioning in multiple domains, with memory and executive functions the most commonly affected areas. Rates of dysfunction were significantly greater than chance on more than half of the tests. Number of cognitive impairments was found to be related to depression, although few neuropsychological test scores were correlated with depression. Results also indicated that symptom report of the mold-exposed participants was not significantly different from that of matched groups of 65 persons with mild traumatic brain injury (TBI) and 26 individuals with moderate TBI. The mold-exposed participants reported significantly more symptoms than 47 people with no disability. This study adds to a growing body of literature (e.g., Baldo, Ahmad, & Ruff, 2002; Gordon, Johanning, & Haddad, 1999) relating exposure to mycotoxins to cognitive dysfunction.

Pyrogens specifically disrupt the acquisition of a task involving cognitive processing in the rat.

In addition to changes in body temperature and other metabolic and physiological responses corresponding to immune activation, pyrogens can induce profound behavioral changes referred to collectively as sickness behavior. One feature of sickness behavior, sometimes reported in clinical settings, but rarely exposed to experimental analysis, is depressed cognitive functioning. The present series of five experiments sought to demonstrate the existence of specific cognitive deficits in rats, independently of any confounding performance effects of pyrogen injections. The behavioral task used, called autoshaping, consisted of presenting hungry Wistar rats with a stimulus (introduction of a retractable lever) that predicted food delivery. Control rats quickly learned to press the lever, although this response does not influence the probability of food delivery. When pyrogens (250 micrograms/kg lipopolysaccharide, 4 micrograms/rat interleukin-1 beta, or 300 mg/rat yeast) were injected to rats during acquisition of this task, they severely disrupted acquisition while the pyrogen was active. The same treatments were, however, without effect on performance when injected later, when performance had stabilized. It is argued that these results demonstrate specific, performance-independent effects of pyrogens on the cognitive processes needed for the acquisition of this task. The results are discussed in terms of the relationship between these effects and the cytokines induced in the brain by pyrogens, and in terms of the exact nature of the cognitive process likely to be affected.

Life stress and chronic yeast infections.

This study investigated the relationships of positive and negative life change to yeast infections in women having a gynecological examination at a university health center. Subjects completed the Life Experiences Survey and a questionnaire about experiences with yeast infections and received, as a routine part of their visitation of the gynecology service, a standard gynecological examination, including a laboratory test for yeast infections. Positive life change was unrelated to any of the variables regarding yeast infections and was only minimally correlated with negative life change. Negative life change, while not related to the presence of current yeast infections, was positively correlated with the reported number of yeast infections during the past year, concern about these infections, and a number of physician visits for yeast infections. Negative life change was also negatively correlated with grade point average. Neither antibiotics nor contraceptive pill use interacted with negative life change to influence experiences with yeast infections.

[Advantages of short-term therapy in vaginal mycoses from a socio-psychological viewpoint]. / Vorteile der Kurzzeittherapie bei Vaginalmykosen unter sozialpsychologischen Aspekten.

As has become evident from an interview of 161 patients affected by vaginal mycosis, the subjective experience of the disease must be seen in relation to the sociopsychological problems involved. Assumed negative reactions to the disease in the patient's social environment as well as fear and uncertainty regarding the aetiology of the disease make it hard for the patient to accept her disease, which would surely favour a steadfast therapeutic behaviour. For the gynaecologist the finding of a "vaginal mycosis" represents an unproblematic affection since it is easily controllable with antimycotics. The result of this different approach to the disease by doctor and patient is non-compliance of the vaginal mycosis patient: the patient goes to see her doctor soon after the appearance of complaints, but tends to terminate treatment prematurely when the subjective complaints subside, in order to avoid a further confrontation with the disease. An adequate, short-term treatment of vaginal mycosis, the course of which is supervised both clinically and microbiologically, thus appears to be the right way of solving the problem of non-compliance.