Infection control in pulmonary and critical care medicine.

During the routine care of patients, pulmonary and critical care specialist may have significant exposure to respiratory infections and potentially infectious body fluids such as blood and pleural fluid. Bronchoscopy and intensive care services often require close contact with patients and the use of sharp devices required for intravascular catheterization. Rendering such care places physicians at risk for acquiring agents such as human immunodeficiency virus (HIV), hepatitis viruses, and Mycobacterium tuberculosis. As of December 1998, 188 cases of occupational transmission of HIV to health care workers (HCWs) in the United States have been reported to the Centers for Disease Control. Most documented cases of seroconversion involve percutaneous injury involving blood, with the greatest risks being associated with injury from a hollow-bore needle that has been in an infected patient's vein or artery. Because thousands of HIV-infected persons are unaware of their infection, HCWs must consider all patients to be infected with HIV and improve work practices accordingly. Nevertheless, elimination of all exposures is impossible, and postexposure prophylaxis with combination antiretroviral therapy is recommended for persons deemed a high risk of contracting HIV. Pulmonary specialists are at high risk of exposure to tuberculosis; proper precautions include isolation of patients with suspected tuberculosis and the use of DMF-HEPA respirator masks, especially while performing procedures like bronchoscopy. Contaminated bronchoscopes have been implicated in transmission and "pseudoinfection" of tuberculosis and nontuberculous mycobacteria, underscoring the need for rigorous cleaning and disinfection practices.

Hymenolepis diminuta: one of three enteric pathogens isolated from a child.

This article describes a case of enteritis in a 3.5-yr-old child with persistent diarrhea and the isolation of three gastrointestinal pathogens, including a rare human pathogen Hymenolepis diminuta (rat tapeworm). This is the first reported case in the northeastern United States in 20 yr and demonstrates that persons living in homes infested with rodents and arthropods are at risk of acquiring this infection.

Association of Blastocystis hominis with signs and symptoms of human disease.

Purged stools from 389 patients were evaluated microscopically for the presence of Blastocystis hominis. A total of five or more B. hominis cells per 40X field were observed in 43 patients (11%), and B. hominis was the only intestinal parasite present in 23 (6%) of these patients. Of the 23 patients, 19 had symptoms which included abdominal discomfort (15 patients), anorexia (10 patients), diarrhea (9 patients), and flatus (9 patients). The remaining four patients were asymptomatic. The proportion of eosinophils in the peripheral blood ranged from 4 to 12% in 11 (58%) of the symptomatic patients. Absolute eosinophil counts were greater than 250/microliter in 8 patients and greater than 400/microliter in 5 patients. Eosinophilia was not observed in the remaining symptomatic or asymptomatic patients. This study supports the emerging concept of the role of B. hominis as an intestinal parasite causative of human disease.

Group G streptococcal sacroiliitis.

We describe herein an unusual case of recurrent pyogenic sacroiliitis in an intravenous drug abuser. Blood cultures grew group G streptococcus. The patient was treated effectively with 7 wk of penicillin G. Group G streptococci are emerging as important pathogens of serious infections.