Our study reveals that for respiratory exhalation flows, the sizes of the largest droplets that would totally evaporate before falling 2 m away are between 60 and 100 microm, and these expelled large droplets are carried more than 6 m away by exhaled air at a velocity of 50 m/s (sneezing), more than 2 m away at a velocity of 10 m/s (coughing) and less than 1 m away at a velocity of 1 m/s (breathing). These findings are useful for developing effective engineering control methods for infectious diseases, and also for exploring the basic transmission mechanisms of the infectious diseases. There is a need to examine the air distribution systems in hospital wards for controlling both airborne and droplet-borne transmitted diseases.

Paradoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) ( P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.

Dual vaccination with PPV and TIV is effective in protecting elderly persons with chronic illness from developing complications from respiratory, cardiovascular, and cerebrovascular diseases, thereby reducing hospitalization, coronary or intensive care admissions, and death.

. Overall, the Biotyper system generated significantly more accurate identifications than the Vitek MS IVD system (P ‫؍‬ 0.016; 177 versus 167 out of 181 specimens). The Biotyper system identified the minority species among polymicrobial blood cultures. We also compared the performance of an in-house extraction method with that of the Sepsityper on both MALDI-TOF MS systems. The in-house method generated more correct identifications at the genus level than the Sepsityper (96.7% versus 93.5%) on the Biotyper system, whereas the two methods exhibited the same performance level (88.0% versus 88.0%) on the Vitek MS IVD system. Our study confirmed the practical advantages of MALDI-TOF MS, and our in-house extraction method reduced the reagent cost to $1 per specimen, with a shorter turnaround time of 3 h, which is highly cost-effective for a diagnostic microbiology service. Bloodstream infection is a condition associated with high morbidity and mortality (1, 2). The rapid identification of bloodstream pathogens is critical to clinical management and the choice of appropriate antibiotic treatments (3, 4). Currently, microbiologic diagnosis of bacteremia relies on subculture of positive blood culture broths on solid medium for an 18-to 24-h incubation period followed by biochemical tests or an automated preformed enzyme assay for identification of the bacteria (5). In general, laboratory diagnosis of common pathogens requires 18 to 48 h, while diagnosis of fastidious organisms requires longer incubation and identification procedures. Although the use of modern techniques such as fluorescence in situ hybridization and PCR can shorten the identification time (6), these operations require specialized equipment and technical expertise and the targeted pathogens are limited in a single run (7). Therefore, the introduction of a simple, rapid, broad-spectrum, and cost-effective system for the identification of blood culture pathogens is imperative.Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was developed in the 1980s, and this technique had been widely used for biomolecule analysis in the chemical industry for over 10 years. In recent years, MALDI-TOF MS was introduced for bacterial identification, which revolutionized the diagnostic microbiology service (8). Two manufacturers, bioMérieux (Marcy l'Etoile, France) and Bruker Daltonics (Bremen, Germany), are marketing efficient MALDI-TOF systems, the Vitek-MS and the Microflex LT, respectively, that allow the identification of bacteria and yeasts in a few minutes instead of the hours required by traditional methods. The practical use of MALDI-TOF MS for microorganism identification directly from positive blood culture specimens has been substantiated by a number of studies (9-13). Generally, studies have shown high identification rates for various types of organisms with the use of MALDI-TOF MS . However, various organism isolation methods from blood were used in those studies and therefore method standardization is necessary. The...

A case-control study was conducted to identify the risk factors associated with levofloxacin-resistant Streptococcus pneumoniae (LRSP) colonization or infection. Twenty-seven case patients (patients with LRSP) were compared with 54 controls (patients with levofloxacin-susceptible S. pneumoniae). Risk factors that were significantly associated with LRSP colonization or infection, according to univariate analysis, included an older age (median age, 75 years for case patients versus 72.5 years for controls), residence in a nursing home (odds ratio [OR], 7.2), history of recent (OR, 4.6) and multiple (OR, 4.4) hospitalizations, prior exposure to fluoroquinolones (OR, 10.6) and beta-lactams (OR, 8.6), presence of chronic obstructive pulmonary disease (COPD; OR, 5.9), and nosocomial origin of the bacteria (OR, 5.7). Multivariate analysis showed that presence of COPD (OR, 10.3), nosocomial origin of the bacteria (OR, 16.2), residence in a nursing home (OR, 7.4), and exposure to fluoroquinolones (OR, 10.7) were independently associated with LRSP colonization or infection. Thus, a distinct group of patients with COPD is the reservoir of LRSP.

No abstract

Our study showed that amino acid positions 146 and 572 are associated with rifampicin resistance in M. tuberculosis in addition to the RRDR. Molecular assays for identifying rifampicin-resistant M. tuberculosis might be improved in terms of accuracy by including these two positions.

After the outbreak of severe acute respiratory syndrome in Hong Kong, the importance of preventing nosocomial transmission of respiratory viruses has become a top priority in infection control. During the containment and early mitigation phases of the swine-origin influenza virus (S-OIV) A H1N1 pandemic, an infection control bundle consisting of multiple coherent measures was organised by our infection control team to minimise nosocomial transmission. This included repeated open staff forum achieving high attendance; early recognition of index cases among inpatients by liberal testing; early relief of sick staff from work; directly observed hand hygiene practice during outbreaks; and monitoring of compliance with infection control practice. During the first 100 days (from 1 May to 8 August 2009) when the first 100 laboratory-confirmed patients with S-OIV and 12 infected healthcare workers (HCWs) were identified, a total of 836 asymptomatic exposed persons (184 patients and 652 HCWs) were required to undergo a seven-day medical surveillance. The infection control nurses monitored them for the onset of symptoms. Four (0.48%) exposed persons (one house officer, two non-clinical staff, and one patient) were virologically confirmed with S-OIV. Not wearing a surgical mask either by the exposed persons during contact with the index cases (4/4 vs 264/832, P=0.010) or vice versa (4/4 vs 300/832, P=0.017, Fisher's exact test) were found to be significant risk factors for nosocomial acquisition of S-OIV.