Risk factors for acute bacterial cellulitis in hospitalized patients include predisposing factors and the presence of sites of pathogen entry on legs and toe webs. These findings indicate that improved awareness and management of toe web intertrigo, which may harbor bacterial pathogens, and other skin lesions might reduce the incidence of cellulitis.

Ivermectin is highly effective against animal intestinal nematodes and is used in the treatment of onchocerciasis in humans. A study was undertaken to compare the efficacy of the drug with that of albendazole in the treatment of uncomplicated strongyloidiasis. Sixty patients with confirmed Strongyloides stercoralis infection were enrolled in an open randomized study and given either albendazole, 400 mg/d for 3 d or ivermectin, 150-200 micrograms/kg in a single dose. Efficacy and tolerance were evaluated on days 7, 30 and 90. Each visit included a parasitological examination of 3 stool specimens, using saline and Kato smears and formalin-ether and Baermann concentrations. Fifty-three patients were eligible for evaluation. Parasitological cure was obtained in 24 of the 29 patients treated with ivermectin (83%) and in 9 of the 24 patients who were given albendazole (38%); ivermectin was significantly more effective than albendazole (P < 0.01). Clinical and biological adverse reactions were negligible in both treatment groups. The 20 patients who failed therapy were given a second treatment course with 150-200 micrograms/kg of ivermectin in a single dose or on 2 consecutive days. Sixteen patients were cured and the other 4 had only incomplete follow-up. Ivermectin therefore constitutes an acceptable therapeutic alternative for uncomplicated strongyloidiasis.

Summary:Purpose: To describe autistic spectrum disorders (ASDs) in a cohort of children with history of unprovoked seizures other than infantile spasms in the first year of life.Methods: The source of data was computer records from all the three pediatric departments in Iceland. Children diagnosed 1982-2000 with unprovoked seizures with onset between 28 days and 12 months of age (N = 102) were invited to participate in a study. Children with known developmental disorders and those whose parents had concerns regarding their child's development or behavior were investigated for possible ASD. Parents were asked to complete the Social Communication Questionnaire and children scoring 10 points or higher were further examined with the Autism Diagnostic Interview-Revised and observational measures.Results: Eighty-four children (82.4%), 28 boys and 56 girls, participated in the study and 36.9% (31/84) were investigated for possible ASD. Twenty-four (28.6%) had at least one neurodevelopmental disorder, 14.3% had mental retardation (MR), and six (7.1%) were diagnosed with ASD, all of whom also had MR and three of whom had congenital brain abnormalities.Conclusion: These results suggest that the estimated prevalence of ASD is higher in children with history of seizure in the first year of life than it is in the general population. There are indications that support the view that children with ASD and history of seizure in the first year of life have higher prevalence of congenital brain abnormalities and are more often female, than other children with ASD. Key Words: Epilepsy in infancy-Autism spectrum disorder-Social Communication Questionnaire-Autism Diagnostic Interview-Revised.A high frequency of seizure disorder was an important factor in demonstrating that autism had a neurobiological etiology (Barton and Volkmar, 1998). According to one review (Tuchman and Rapin, 2002), the data on reported frequency of epilepsy in autism ranges widely (5%-38.3%). Schain and Yannet (1960) were probably first to provide data that supports this association; in their study, 21 of 50 severely impaired autistic participants had a history of one or more seizures. Of those, 10 had their seizure onset in the first year of life, and three were diagnosed with infantile spasms. In a more recent study of 246 children with autism spectrum disorder (ASD), the majority of those who also had epilepsy (13 of 16) had their seizure onset in the first year of life, and four had infantile spasms (Wong, 1993). Further evidence indicates a peak incidence of seizures in early childhood in individuals with ASD (Olsson et al.,

The increasing incidence and changing epidemiology of invasive fungal infections continue to present many challenges to their effective management. The repertoire of antifungal drugs available for treatment is still limited although there are new antifungals on the horizon. Successful treatment of invasive mycoses is dependent on a mix of pathogen-, host- and antifungal drug-related factors. Laboratories need to be adept at detection of fungal pathogens in clinical samples in order to effectively guide treatment by identifying isolates with acquired drug resistance. While there are international guidelines on how to conduct in vitro antifungal susceptibility testing, these are not performed as widely as for bacterial pathogens. Furthermore, fungi generally are recovered in cultures more slowly than bacteria, and often cannot be cultured in the laboratory. Therefore, non-culture-based methods, including molecular tests, to detect fungi in clinical specimens are increasingly important in patient management and are becoming more reliable as technology improves. Molecular methods can also be used for detection of target gene mutations or other mechanisms that predict antifungal drug resistance. This review addresses acquired antifungal drug resistance in the principal human fungal pathogens and describes known resistance mechanisms and what in-house and commercial tools are available for their detection. It is emphasized that this approach should be complementary to culture-based susceptibility testing, given the range of mutations, resistance mechanisms and target genes that may be present in clinical isolates, but may not be included in current molecular assays.

Sir,The frequent dermatophyte infections of swimmer's feet are most likely related to increased exposure to dermatophytes and maceration of skin (1). Fungal particles are shed from infected tissues and found on the floors of shared bathing facilities (2)(3)(4)(5). Two studies have revealed a higher level of contamination in men's dressing rooms than in women's (2, 4), and a higher rate of tinea pedis in boys than girls has been reported (6).In a pilot study of dermatophyte contamination in a swimming pool facility in Reykjavik informal interviews with the swimming pool personnel indicated that the women's area was cleaned more frequently and extensively than the men's area.The aim of the present study was to confirm the differences observed in dermatophyte contamination between the respective dressing rooms and explore whether they were affected by standardization of cleaning methods. MATERIALS AND METHODSThe study was conducted in an outdoor swimming pool facility in Reykjavik that receives 500,000-600,000 swimmers annually. The facility is open from 6:50 am to 9:30 pm on weekdays. Swimmers are divided into three age categories: i) <16 years; ii) 16-66 years and iii) >66 years. The indoor facilities examined comprised men's and women's dressing rooms that lead to shower rooms where every swimmer bathes before entering the pool. Men's and women's shower rooms lead to a common corridor, then to the poolside.The study period included all weekdays throughout a 4-week period in March 1999. Samples were taken twice daily, between 10 and 11 am and 4 and 5 pm. Three floor sites were sampled each time, two in men's and women's dressing rooms areas next to the shower rooms, and one in a common corridor leading from shower rooms to poolside. The floors in dressing rooms and shower rooms are tiled, and the corridor floor is covered with a net-like plastic carpet. Weekly samples from seven sites in dressing rooms, shower rooms and corridor were taken before opening hours.Dressing rooms and shower rooms were cleaned thoroughly every night by the use of automated machines (dressing rooms) and with water jets and scrubbing (shower rooms). Chlorinated detergents were used in both areas. During opening hours cleaning was carried out by the shower guards, female in the women's area and male in men's area. The shower rooms were flushed with cold water and the dressing rooms were swept with dry, furry cotton mops that were changed daily. Plastic carpets in the corridor were flushed each night; the cleaning procedure and frequency were kept constant during the study. During the first 2 weeks of the study (period 1), the shower guards maintained their usual cleaning methods. The shower rooms were flushed with cold water every 1-3 hours and in the dressing rooms the floor next to the shower rooms was mopped several times a day in order to keep it dry and non-slippery. The rest of the dressing rooms was mopped 2-4 times a day on the women's side and at least once a day on the men's side. Female personnel claimed that cleaning in the wom...

The epidemiology of infectious diarrhea influences the microbiological investigation of the disease, and is best elucidated through prospective studies. We undertook such a study in a Nordic country. Patients of all age groups who had acute diarrhea were recruited prospectively from general practice clinics in Iceland. They completed a questionnaire and provided stool samples for the detection of pathogenic viruses, bacteria, and parasites. Of the 464 recruited patients, 211 (45%) had 224 infections. The most common pathogens were calici- and rotaviruses (23% and 18% of 224 infections, respectively), Campylobacter jejuni (17%), Cryptosporidium species (12%), and Salmonella serotypes (10%). Other agents found were Giardia lamblia, astro- and adenoviruses, and Yersinia enterocolitica. Viral pathogens were associated with vomiting, illness for ≤7 days, and younger age groups, while bacterial pathogens were associated with fever, rectal pain, and local or foreign travel, and parasitic pathogens with illness for >7 days. Detection rates for viral infections in the elderly and for Cryptosporidium species were higher than expected. Our study indicates the existence of regional differences in pathogen prevalence that should be taken into account when implementing guidelines for stool testing in patients with acute diarrheal disease.

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Objectives: Mycoplasma genitalium (MG) is prevalent among attendees in sexually transmitted infections (STI) clinics and therapy is hampered by rapidly rising levels of resistance to azithromycin and moxifloxacin. In this study we evaluated, for the first time in Iceland, the prevalence of MG and azithromycin and moxifloxacin resistance-associated mutations, and assessed the diagnostic performance of the CE/IVD-marked S-DiaMGTV (Diagenode Diagnostics) versus the US FDA/CE/IVD-approved Aptima MG (AMG; Hologic) for MG detection. Methods: From October 2018 to January 2019, urine and vaginal swabs were provided by male and female attendees at Iceland‘s only STI clinic. Specimens were tested with S-DiaMGTV and AMG, and resistance-associated mutations were determined by 23S rRNA gene and parC sequencing. Demographic and clinical data were collected from patient records. Results: MG prevalence was 9.3% overall; 7.7% (38/491) among male and 10.9% (53/487) among female participants. Azithromycin and moxifloxacin resistance-associated mutations were found in 57.0% (45/79) and 0.0% (0/80) of evaluable specimens, respectively. Sensitivity was 72.5% and 100%, and specificity was 99.9% and 100% for S-DiaMGTV and AMG, respectively. No association was found between MG and symptoms of urethritis in men. Conclusions: Prevalence rates for MG and azithromycin resistance-associated genes in Iceland are among the highest reported in Europe. The significantly higher sensitivity of AMG over that of S-DiaMGTV can have important clinical implications. More information is urgently needed to clarify the significance of false-negative results obtained with S-DiaMGTV and other similarly performing, widely used real-time PCR methods for diagnosis and management of this sexually transmitted infection.