Background: Human Respiratory Syncytial Virus (HRSV) is a major viral pathogen associated with acute lower respiratory tract infections (ALRTI) in children. Using monoclonal antibodies against virus proteins, it is categorized into two distinct major groups, A and B. The second hypervariable region of the G protein ectodomain gene provides a reliable surrogate for phylogenetical studies. We carried out a phylogenetic analysis of the HRSV strains isolated from children hospitalized with ALRTI in Malaysia.Methods: Nasopharyngeal aspirates (NPA) were taken from children less than five years of age hospitalized with ALRTI to Hospital Serdang, Malaysia. RT-PCR was used to detect HRSV. The second hypervariable region at the carboxyl-terminal of the G gene was amplified and sequenced using primer sets GPA/F1 and GPB/F1. Neucleotide sequences were edited and aligned with Bioedite software and Clustal X program. The phylogenetic relationships of the samples were determined separately for group A and B using neighbor joining (NJ), maximum parsimony (MP) and Bayesian methods (BI).Results: HRSV was detected in 83 of 165 (50.3%) patients studied. Sequence analysis of 32 isolates showed that multiple lineages of HRSV group A and B serotypes co-circulated. The topologies resulting from the different methods (NJ, MP and BI) congruent with each other. Phylogenetic analysis of nine retrieved sequences showed that all the HRSV-A strains were clustered into the NA1 genotype. All the 23 HRSV-B strains belonged to BA genotypes consisted of a 60-nucleotide duplication region. They were classified into three different genotypes of BA10, BA9 and BA4, respectively.Conclusion: HRSV played a prominent role for hospitalization of children in our study. The sequences of the second hypervariable region of G protein ectodomain gene from HRSV A and B demonstrated remarkable genetic diversity. The present finding seems to be consistent with other studies which found the newly emerged HRSV genotypes of NA1 and BA genotypes are replacing the previously dominant genotypes. This is the first documentation of the phylogenetic relationship and genetic diversity of HRSV isolates among hospitalized children diagnosed with ALRTI in Malaysia.
We analyzed laboratory-based surveillance candidemia data from the National Infectious Disease Register in Finland and reviewed cases of candidemia from one tertiary-care hospital from 1995 to 1999. A total of 479 candidemia cases were reported to the Register. The annual incidence rose from 1.7 per 100,000 population in 1995 to 2.2 in 1999. Species other than Candida albicans accounted for 30% of cases without change in the proportion. A total of 79 cases of candidemia were identified at the hospital; the rate varied from 0.03 to 0.05 per 1,000 patient-days by year. Predisposing factors included indwelling catheters (81%), gastrointestinal surgery (27%), hematologic malignancy (25%), other types of surgery (21%), and solid malignancies (20%). Crude 7-day and 30-day case-fatality ratios were 15% and 35%, respectively. The rate of candidemia increased in Finland but is still substantially lower than in the United States. No shift to non–C. albicans species could be detected.
In February 1999, an outbreak of listeriosis caused by Listeria monocytogenes serotype 3a occurred in Finland. All isolates were identical. The outbreak strain was first isolated in 1997 in dairy butter. This dairy began delivery to a tertiary care hospital (TCH) in June 1998. From June 1998 to April 1999, 25 case patients were identified (20 with sepsis, 4 with meningitis, and 1 with abscess; 6 patients died). Patients with the outbreak strain were more likely to have been admitted to the TCH than were patients with other strains of L. monocytogenes (60% vs. 8%; odds ratio, 17.3; 95% confidence interval, 2.8-136.8). Case patients admitted to the TCH had been hospitalized longer before cultures tested positive than had matched controls (median, 31 vs. 10 days; P=.008). An investigation found the outbreak strain in packaged butter served at the TCH and at the source dairy. Recall of the product ended the outbreak.
Summary Background Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection. In short‐term the treatment has been shown to be safe, however, there are no large, long‐term follow‐up studies looking into the potential adverse effects. Aim To analyse the long‐term effect of FMT treatment in patients with recurrent C. difficile infection and to compare the outcome to antibiotic treated patients. Methods Altogether 84 patients of which 45 received a FMT treatment and 39 served as controls receiving antibiotics for the infection were followed on average for 3.8 years. Their recovery and medical status was evaluated using a retrospective questionnaire, determining their quality of life, gastrointestinal symptoms and new diseases potentially related to the FMT. Results There was no difference in the incidence of severe diseases (inflammatory bowel disease, cancer, autoimmune disease, allergy, neurological diseases) between the patient groups. In addition, weight gain did not differ between treatment groups. The FMT treated patients reported that their bowel habits improved significantly faster, they had less irregular bowel function and less symptoms of upper GI‐tract when compared to the patients treated with antibiotics. Significantly more patients in FMT‐group reported that their mental health improved after the treatment. The willingness to receive FMT treatment for potential new C. difficile infection was significantly higher in both treatment groups compared to other treatment options. Conclusion Our study highlights that FMT is a durable, safe and acceptable treatment option for patients with recurrent C. difficile infection also in long term, and it shows potential benefits over antimicrobial treatment.
BackgroundThe role of Epstein-Barr (EBV) virus in central nervous system (CNS) infections is not fully resolved. It is clearly associated with lymphoproliferative disease of immunosuppressed persons, and may cause encephalitis.MethodsWe reviewed the medical records, imaging and laboratory findings of all patients EBV DNA PCR positive in cerebrospinal fluid (CSF) during 2000 to 2009 in the Helsinki University Central Hospital.ResultsWe identified 32 patients with EBV DNA in CSF. 11 had history of allogeneic hematopoietic stem cell transplantation, 7 solid organ transplantation and 5 HIV/AIDS. 5 patients had no preceding immunodeficiency.In 8 of the cases, another pathogen was identified in CSF. These were M. tuberculosis (2), T. gondii (2), Aspergillus (1), Herpes simplex virus 1 (1), C. neoformans (1) and Human herpesvirus 6 (1). Altogether in 15/32 (47%) of the cases the clinician had a strong suspicion of cause other than EBV for the patients' CNS symptoms/findings.Of note, 7 of 11 (64%) patients with stem cell transplantation had encephalitis (univariate odds ratio 5.6; confidence Interval 1.1-27.4). Of these 6 had no other pathogen identified.ConclusionsEBV DNA was often found together with other microbial findings in CSF of immunocompromised patients. EBV seems to be associated with encephalitis in stem cell transplant recipients.
We studied the incidence among, risk factors for, and survival of adult patients with acute leukemia and hepatosplenic candidiasis during the period 1980 to 1993. Of 562 adult patients with acute leukemia, 38 (6.8%) had hepatosplenic candidiasis. The incidence of infection increased fivefold during the study period. The incidence was higher among patients with acute lymphatic leukemia (11.3%) than among those with acute myeloid leukemia (5.1%) (P = .01). The median survival was 9.5 months, and by the end of follow-up, 74% of patients had died. Patients whose leukemia was in remission before the last cytotoxic treatment preceding hepatosplenic candidiasis survived longer than did patients with newly diagnosed or refractory or relapsed leukemia (P = .0065). Eleven patients died within 3 months after the diagnosis of the infection: 7 of 16 with newly diagnosed leukemia, 4 of 10 with refractory or relapsed leukemia, and 0 of 12 with leukemia in remission (P = .028). In all of the patients who died within 3 months, infection was found at autopsy. In conclusion, the incidence of hepatosplenic candidiasis has significantly increased since 1980, and the outcome for patients with this infection is related to the stage of leukemia.
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