Chagas Disease Screening Using Point-of-Care Testing in an At-Risk Obstetric Population.

Congenital transmission is the most important mode of transmission of Chagas disease (CD) in non-endemic countries. Identifying CD in reproductive-aged women is essential to reduce the risk of transmitting the disease to their children and offer treatment to women and their children, which could cure the disease. We evaluated the use of point-of-care (POC) testing for CD in postpartum patients. In our patient population, 16.7% (23/138) tested positive by POC testing, but confirmatory testing was negative for all patients. Among those considered high risk, 30% declined participation. Our results suggest limited utility of the point-of-care test used in our study and identify an opportunity for improvement to broaden diagnostic testing options. Our study also highlights the need to develop strategies to increase subject participation in future research.

Mycobacterium abscessus subspecies massiliense infection after skin graft and cholecystectomy in a burn patient.

Diagnosing skin and soft tissue infections due to rapidly growing mycobacteria (RGM) can often prove difficult, leading to delays in treatment. Postoperative infections caused by RGM are increasingly recognized both within and outside the USA, but are rarely encountered in burn units. We report a case of postoperative skin and soft tissue infection along a cholecystectomy incision in a burn patient caused by Mycobacterium abscessus subsp. massiliense. Postoperative infections caused by RGM require a high index of suspicion, often necessitating biopsy for definitive diagnosis. Physicians should consider this diagnosis when postoperative infections arise later than typically seen for routine bacterial infections and fail to respond to first-line therapy.

Severe Community-Acquired Pneumonia due to Acinetobacter baumannii in North America: Case Report and Review of the Literature.

Acinetobacter baumannii is a rare but emerging cause of fulminant community-acquired pneumonia (CAP-AB). We describe a patient from a rural area who developed acute respiratory distress syndrome and septic shock. We describe risk factors and characteristics of this syndrome and review published cases of CAP-AB from North America.

Understanding the Concept of Health Care-Associated Pneumonia in Lung Transplant Recipients.

BACKGROUND: Limited data are available regarding the etiologic impact of health care-associated pneumonia (HCAP) in lung transplant recipients. Therefore, our aim was to evaluate the microbiologic differences between HCAP and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in lung transplant recipients with a radiographically confirmed diagnosis of pneumonia. METHODS: We performed a retrospective cohort study of lung transplant recipients with pneumonia at one transplant center over a 7-year period. Eligible patients included lung transplant recipients who developed a first episode of radiographically confirmed pneumonia ≥ 48 h following transplantation. HCAP, HAP, and VAP were classified according to the American Thoracic Society/Infectious Diseases Society of America 2005 guidelines. χ² and Student t tests were used to compare categorical and continuous variables, respectively. RESULTS: Sixty-eight lung transplant recipients developed at least one episode of pneumonia. HCAP (n = 42; 62%) was most common, followed by HAP/VAP (n = 26; 38%) stratified in HAP (n = 20; 77%) and VAP (n = 6; 23%). Pseudomonas aeruginosa was the predominantly isolated organism (n = 22; 32%), whereas invasive aspergillosis was uncommon (< 10%). Multiple-drug resistant (MDR) pathogens were less frequently isolated in patients with HCAP compared with HAP/VAP (5% vs 27%; P = .009). Opportunistic pathogens were less frequently identified in lung transplant recipients with HCAP than in those with HAP/VAP (7% vs 27%; P = .02). Lung transplant recipients with HCAP had a similar mortality at 90 days (n = 9 [21%] vs n = 4 [15%]; P = .3) compared with patients with HAP/VAP. CONCLUSIONS: HCAP was the most frequent infection in lung transplant recipients. MDR pathogens and opportunistic pathogens were more frequently isolated in HAP/VAP. There were no differences in 30- and 90-day mortality between lung transplant recipients with HCAP and those with HAP/VAP.

Riesgo de infeccion por tuberculosis en el trabajador de la salud: Medellin 2001-2002 / Risk of tuberculosis infection among health care workers: Medellin 2001-2002

Objetivo: establecer la frecuencia de infección tuberculosa en el personal de la salud comparativamente con el personal no expuesto. Diseño: estudio de prevalencia analítico el cual compara un grupo de enfermeras en contacto con pacientes con tuberculosis contra un grupo de trabajadores no expuestos. Marco de referencia: enfermeras de los servicios de medicina interna y urgencias del Hospital General de Medellín (hospital de tercer nivel) con un grupo de empleados de una fábrica de tintas (Tintas S.A.). Participantes: se aplicó tuberculina a las enfermeras del servicio de medicina interna y urgencias del Hospital General de Medellín (HGM), n= 45 y empleados de una fábrica de tintas n = 54 que aceptaron participar en el estudio. Mediciones: se aplicó tuberculina tipo APLISOL® 5TU por la técnica de Mantoux tomando como valor positivo > 10 mm de induración. Se determinó la relación con la vacunación previa de BCG y el tiempo de exposición laboral en el grupo de trabajadores de la salud. Resultados: de las 45 enfermeras que se les aplicó tuberculina, el 51,1 por ciento resultó positivo y de los 54 empleados de la fábrica el 16,7 por ciento; siendo el riesgo 3,15 veces mayor en el grupo expuesto. p = < 0,001. No se halló relación con el tiempo de exposición P = 0,641 ni con la aplicación previa de BCG. Conclusión: el trabajador de la salud que ve pacientes con tuberculosis tiene un riesgo 3,15 veces mayor de ser infectado por el bacilo tuberculoso que la población general. Resaltamos la importancia de reforzar las medidas de prevención dentro de los hospitales y la aplicación de tuberculina en los trabajadores para conocer su estado de infección.