A Phylogeographic Description of Histoplasma capsulatum in the United States.

Histoplasmosis is one of the most under-diagnosed and under-reported endemic mycoses in the United States. Histoplasma capsulatum is the causative agent of this disease. To date, molecular epidemiologic studies detailing the phylogeographic structure of H. capsulatum in the United States have been limited. We conducted genomic sequencing using isolates from histoplasmosis cases reported in the United States. We identified North American Clade 2 (NAm2) as the most prevalent clade in the country. Despite high intra-clade diversity, isolates from Minnesota and Michigan cases were predominately clustered by state. Future work incorporating environmental sampling and veterinary surveillance may further elucidate the molecular epidemiology of H. capsulatum in the United States and how genomic sequencing can be applied to the surveillance and outbreak investigation of histoplasmosis.

Targeted BRCA1/2 population screening among Ashkenazi Jewish individuals using a web-enabled medical model: An observational cohort study.

PURPOSE: This study aimed to evaluate uptake and follow-up using internet-assisted population genetic testing (GT) for BRCA1/2 Ashkenazi Jewish founder pathogenic variants (AJPVs). METHODS: Across 4 cities in the United States, from December 2017 to March 2020, individuals aged ≥25 years with ≥1 Ashkenazi Jewish grandparent were offered enrollment. Participants consented and enrolled online with chatbot and video education, underwent BRCA1/2 AJPV GT, and chose to receive results from their primary care provider (PCP) or study staff. Surveys were conducted at baseline, at 12 weeks, and annually for 5 years. RESULTS: A total of 5193 participants enrolled and 4109 (79.1%) were tested (median age = 54, female = 77.1%). Upon enrollment, 35.1% of participants selected a PCP to disclose results, and 40.5% of PCPs agreed. Of those tested, 138 (3.4%) were AJPV heterozygotes of whom 21 (15.2%) had no significant family history of cancer, whereas 86 (62.3%) had a known familial pathogenic variant. At 12 weeks, 85.5% of participants with AJPVs planned increased cancer screening; only 3.7% with negative results and a significant family history reported further testing. CONCLUSION: Although continued follow-up is needed, internet-enabled outreach can expand access to targeted GT using a medical model. Observed challenges for population genetic screening efforts include recruitment barriers, improving PCP engagement, and increasing uptake of additional testing when indicated.

The effect of the SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines on reporting standards in the quality improvement literature: a before-and-after study.

BACKGROUND: The SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines were developed to improve the reporting of quality improvement (QI) projects. The effect of the guidelines on the completeness of reporting in the QI literature is unknown. OBJECTIVES: Our primary objective was to determine if the completeness of reporting in the QI literature has been improved[OUP_CE13] since the introduction of the SQUIRE guidelines. METHODS: We performed a before-and-after evaluation of QI articles selected from four prominent journals of healthcare quality. Twenty-five articles published in each of two time periods (2006-2008 and 2010-2011) were confirmed to be QI projects using a standardised definition and were independently evaluated by two investigators as an interim evaluation of a planned larger sample. Articles were assessed using 50 statements of the SQUIRE guidelines, and the overall change in the completeness of reporting between the two groups was determined. The value of p<0.05 was considered significant. RESULTS: Both groups were similar in characteristics. There was no significant difference in the mean (SD) number of SQUIRE statements completed by authors before and after publication of the SQUIRE guidelines, 20.2 (5.0) versus 20.4 (7.0), p=0.9. The study was stopped early due to the absence of any significant trend in the completeness of reporting. DISCUSSION: There was no overall improvement observed in the completeness of reporting of QI projects after the publication of the SQUIRE guidelines, and the study was stopped early. There is potential for improvement in reporting standards, particularly for those guideline items or statements specific to QI projects.

Superiority of chlorhexidine 2%/alcohol 70% wipes in decontaminating ultrasound equipment.

Ultrasound equipment is known to act as a reservoir for potentially pathogenic organisms. The aims of these studies were to establish current cleaning practices, to review the extent of bacterial contamination of ultrasound equipment in our hospital, to establish an effective cleaning regimen and to ensure that cleaning does not cause damage. A questionnaire was sent to all acute NHS hospitals in England to establish current cleaning practices. A review of our current practice was performed to establish the extent of bacterial contamination of ultrasound equipment currently in use. Laboratory studies compared cleaning the probes with soap and water with decontaminating with a chlorhexidine 2% and alcohol 70% wipe, including quantifying the residual effect. Accelerated aging was performed on the probe and staff surveyed to establish potential problems with using the wipes on the probe. The survey revealed that a variety of cleaning methods were used to decontaminate ultrasound probes; 57% of our ultrasound machines were contaminated with bacteria. The laboratory studies showed superiority of the chlorhexidine and alcohol wipes over soap and water due to a residual effect, both immediately after cleaning and after 24 hours. The staff survey demonstrated no apparent change in function of the probe after cleaning with the chlorhexidine wipes. Cleaning ultrasound probes with chlorhexidine and alcohol wipes is effective and provides additional protection against bacterial contamination due to its residual effect, and appears in the short term to have no detrimental effect on the probe.

Chlorhexidine to maintain cleanliness of laryngoscope handles: an audit and laboratory study.

CONTEXT: Laryngoscope handles are a potential vector for infection transmission and require adequate decontamination. OBJECTIVE: To establish an effective cleaning regimen for laryngoscope handles. DESIGN: Three laboratory studies and an audit cycle. SETTING: The Queen Elizabeth Hospital, King's Lynn, UK. MATERIALS: Twenty Heine laryngoscope handles. INTERVENTIONS: Twenty laryngoscope handles were contaminated with microbial broth and then disinfected with chemical wipes, either using Sani-Cloth CHG 2% (chlorhexidine 2%/alcohol 70%) or Tuffie 5 wipes. This was repeated with an interval of 24 h between cleaning and contamination. A further experiment repeatedly re-contaminated the handles at varying time intervals after cleaning. The audit established the current level of contamination of laryngoscope handles within the hospital, and this was repeated following a change in cleaning protocol. MAIN OUTCOME MEASURES: Bacterial growth on agar plates was counted as the number of colony forming units. RESULTS: Both Sani-Cloth CHG 2% and Tuffie 5 wipes were effective against microorganisms, including methicillin-resistant Staphylococcus aureus, immediately following wiping (P = 0.002). However, the chlorhexidine wipes also had a residual effect such that after wiping, the handle remained sterile following further contamination and this effect persisted for 24 h. Audit following the introduction of this practice showed significant improvements in the incidence and extent of contamination compared with the previous disinfection practice (P<0.002). CONCLUSION: Decontamination with Sani-Cloth CHG 2% wipes confers additional advantages over routine autoclaving or handle disposal, due to a residual effect. Autoclaving handles may be desirable on a scheduled basis and if Clostridium difficile is encountered.

Human infections due to Salmonella Blockley, a rare serotype in South Africa: a case report.

BACKGROUND: Infections due to nontyphoidal Salmonella have increased worldwide over the last couple of decades. Salmonella enterica serotype Blockley (Salmonella Blockley) infections is associated with chickens and is a rarely isolated serotype in human infections in most countries. CASE PRESENTATION: We report a case of human infections due to Salmonella Blockley in KwaZulu-Natal, South Africa in 2011. Three African males (aged 4, 14 and 16) presented to a clinic with diarrhoea, stomach cramps and headache. They started experiencing signs of illness a day after they consumed a common meal, consisting of meat, rice and potatoes. Stool specimens from the patients cultured Salmonella Blockley. The strains showed an indistinguishable pulsed-field gel electrophoresis pattern. CONCLUSION: This is the first recorded case of human infections due to Salmonella Blockley in South Africa.

Against all odds: diagnosing tuberculosis in South Africa.

Clinical and logistic systems to support the timely diagnosis of tuberculosis are currently not preventing large numbers of tuberculosis deaths in South Africa. Context-appropriate systems for the diagnosis of tuberculosis are entirely dependent on effective and responsive management of human resources and an uninterrupted supply of clinical materials. Attention to these components of the tuberculosis program is urgently needed before new diagnostic technologies can be expected to impact on tuberculosis mortality in resource constrained settings.