Two women in labor received intrapartum spinal anesthesia from the same anesthesiologist approximately 1 h apart. Within 15 h, both patients developed Streptococcus salivarius meningitis and one patient died. Blood and cerebrospinal fluid (CSF) samples from both patients and tongue swab specimens from the anesthesiologist yielded isolates of an indistinguishable S. salivarius strain.Streptococcus salivarius is commonly found among normal oral flora, where it is the predominant species cultivated from tongue dorsa (13), and has been used as a reliable marker for forensic identification of saliva using DNA amplification techniques (14). Recent multilocus-sequence-based investigations have indicated that, similar to other streptococcal species (1,7,8), S. salivarius is a distinct species that displays high genetic diversity and undergoes a high level of genetic exchange (3, 6).Of 75 cases of meningitis occurring after lumbar puncture recorded from 1952 to 1998, all 56 cases where bacterial classification was provided were due to streptococcal species, with S. salivarius the most common species identified (2). Independent cases of S. salivarius meningitis circumstantially linked to the same anesthesiologist have previously been reported (15,17).Recently, 2 women in Ohio developed S. salivarius meningitis shortly after receiving intrapartum spinal anesthesia (4). Initial investigation revealed that the blood and cerebrospinal fluid (CSF) isolates from the two patients displayed identical chromosomal restriction digest patterns resolved by pulsedfield gel electrophoresis (PFGE). Putative S. salivarius was identified within oral and saliva specimens of the anesthesiologist (taken 2 days after the anesthesia had been administered to the patients) using previously described PCR assays for this species (12,14). Initial attempts to isolate S. salivarius from the anesthesiologist carriage specimens were not successful, possibly in part because the anesthesiologist had received ciprofloxacin for meningococcal prophylaxis within 12 h of the onsets of symptoms in the 2 patients. Here, we report additional data on this investigation, including the successful isolation from these specimens of a strain of S. salivarius that was genetically indistinguishable from the case strain.The isolates from the 2 meningitis cases were identified as S. salivarius by a conventional biochemical identification scheme (9) and the rapid ID32 STREP method (bioMérieux, Inc.) as described by the manufacturer (10). The isolates were urease positive and had identical biochemical patterns. The rapid ID32 STREP method also displayed identical profiles, with 99.9% identity to the S. salivarius standard profile in the manufacturer's database. These isolates were atypical with regard to most reference strains of S. salivarius isolates because of their ability to acidify sorbitol (9). Dorsal tongue, buccal, and nasopharyngeal (NP) swabs taken from the anesthesiologist 2 days after administration of anesthesia were shipped to the CDC Streptococcus Laboratory ...
BackgroundIn Kenya, >1,200 laboratory-confirmed 2009 pandemic influenza A (H1N1) (pH1N1) cases occurred since June 2009. We used population-based infectious disease surveillance (PBIDS) data to assess household transmission of pH1N1 in urban Nairobi (Kibera) and rural Lwak.MethodsWe defined a pH1N1 patient as laboratory-confirmed pH1N1 infection among PBIDS participants during August 1, 2009–February 5, 2010, in Kibera, or August 1, 2009–January 20, 2010, in Lwak, and a case household as a household with a laboratory-confirmed pH1N1 patient. Community interviewers visited PBIDS-participating households to inquire about illnesses among household members. We randomly selected 4 comparison households per case household matched by number of children aged <5. Comparison households had a household visit 10 days before or after the matched patient symptom onset date. We defined influenza-like illnesses (ILI) as self-reported cough or sore throat, and a self-reported fever ≤8 days after the pH1N1 patient's symptom onset in case households and ≤8 days before selected household visit in comparison households. We used the Cochran-Mantel-Haenszel test to compare proportions of ILIs among case and comparison households, and log binomial-model to compare that of Kibera and Lwak.ResultsAmong household contacts of patients with confirmed pH1N1 in Kibera, 4.6% had ILI compared with 8.2% in Lwak (risk ratio [RR], 0.5; 95% confidence interval [CI], 0.3–0.9). Household contacts of patients were more likely to have ILIs than comparison-household members in both Kibera (RR, 1.8; 95% CI, 1.1–2.8) and Lwak (RR, 2.6; 95% CI, 1.6–4.3). Overall, ILI was not associated with patient age. However, ILI rates among household contacts were higher among children aged <5 years than persons aged ≥5 years in Lwak, but not Kibera.ConclusionsSubstantial pH1N1 household transmission occurred in urban and rural Kenya. Household transmission rates were higher in the rural area.
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