Mycobacterium species, specifically M. abscessus and M. chelonae (MABs), are known to contaminate water systems and are uncommon causes of health care-associated infection, but morbidity can be significant and treatment complex.Odontogenic MAB infections occurred in patients following pulpotomy procedures at dental clinic A from 1 January to 6 September 2016. We identified confirmed and probable cases using culture data, imaging, pathology results, and surgical findings. Epidemiologic and clinical data including demographics, symptoms, laboratory findings, treatment regimens, and outcomes were extracted.Of 1082 at-risk patients, 71 case patients (22 confirmed; 49 probable) were identified. Median age was 6 years. Median symptom onset was 85 days postpulpotomy. Pain and/or swelling on admission occurred in 79%. On imaging, 49 of 70 had abnormalities of the mandible or maxilla, 13 of 70 had lymphadenopathy, and 19 of 68 had pulmonary nodules. Seventy were hospitalized (average of 8.5 days). Intravenous antibiotics were administered to 32 cases for a median length of 137 days. Clofazimine was administered to 29 patients as part of their multidrug regimen. Antibiotic treatment was associated with many adverse effects. Treated children showed evidence of jaw healing with resolved/improving pulmonary nodules at 1-year follow-up.This is the largest outbreak of invasive MAB infections associated with a pediatric dental practice. While infections were indolent, patients suffered medical and surgical consequences of treatment, including permanent tooth loss. Identification of this outbreak led to a change in water standards for pediatric dental procedures in California. Enhanced national dental water quality standards are needed to prevent future outbreaks.
Background: Therapies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its life-threatening respiratory infection coronavirus disease 2019 (COVID-19) have been evaluated, including COVID-19 convalescent plasma (CCP). Multiple large reports of CCP treatment in adults exist. Pediatric data on CCP safety and efficacy are limited. Methods: Single-center prospective, open-label trial looking at safety, antibody kinetics and outcomes of CCP (10 mL/kg, max 1 unit) treatment for COVID-19 in hospitalized pediatric patients with moderate to severe disease or at high-risk for serious illness. Results: Thirteen patients were enrolled. No infusion-related adverse events occurred. No hematologic or metabolic adverse events were noted during hospitalization or at 3-weeks. Ten patients had clinical improvement by day 7 (WHO eight-category ordinal severity scale for COVID-19). Following CCP, anti-SARS-CoV-2 anti-nucleocapsid IgG increased significantly at 24 hours and high levels were sustained at 7- and 21-days. Transient IgM response was noted. Twelve patients (92.3%) were discharged home, 9 (75%) by day 7 post-CCP. One remained on invasive ventilatory support 42 days after CCP and was eventually discharged to an intermediate care facility. The single patient death was retrospectively confirmed to have had brain death before CCP. Conclusion: CCP was well tolerated in pediatric patients, resulted in rapid antibody increase, and did not appear to interfere with immune responses measured at 21 days. More pediatric data are necessary to establish the efficacy of CCP, but our data suggest benefit in moderate to severe COVID-19 when used early. Other immunologic or antiviral interventions may be added as supported by emerging data.
Clinical guidelines advise against routine electrocardiograms (ECG) in low-risk, asymptomatic patients, but the frequency and impact of such ECGs are unknown.
Invasive neonatal disease due to Streptococcus pneumoniae is infrequent in developed countries such as the US, with a reported incidence of 1 to 2% of bacterial infections in children younger than the age of 1 month. The literature describes an extremely high mortality rate of ˜50% in these children. It has therefore been suggested that maternal vaginal cultures positive for pneumococcus should be regarded as pathologic, with consideration of intrapartum maternal treatment and perhaps empiric treatment of the neonate as well.1 However, because the pneumococcus is not routinely sought from vaginal cultures in pregnant women, it is unknown how many infants are exposed during the perinatal period, i.e. what the ratio is of infant invasion vs. maternal colonization for babies born in the US. The case described below prompted us to examine this question by conducting the following study. Case report. A 2-day-old infant was admitted for inconsolability, a bulging anterior fontanel and temperature of 38°C. He was the product of a 38-week uncomplicated gestation and was sent home after 1 day. There was no history of maternal fever, chorioamnionitis or colonization with group B Streptococcus. His white blood cell count was 1400/mm3 with 23% polymorphonuclear cells and 43% band forms. Cerebrospinal fluid analysis showed >500 white blood cells/μl with 78% polymorphonuclear cells, protein 609 mg/dl and glucose <10 mg/dl. Gram stain revealed Gram-positive cocci. Culture was positive for Streptococcus pneumoniae. The infant improved rapidly with antibiotic treatment. Methods. During a 12-month period (January 1, 1996, to December 31, 1996) a total of 1083 vaginal swabs were processed on patients presenting to an obstetric clinic at a large inner city teaching hospital for the purpose of screening for group B Streptococcus. Swabs were obtained from the vaginal introitus and transported to the laboratory in the Culturette transport system (Becton Dickinson). On arrival in the laboratory swabs were plated directly on trypticase soy agar with 5% sheep blood, and the swab then placed in LIM broth [Todd-Hewitt broth supplemented with gentamicin (8 mg/ml) and naladixic acid (15 mg/ml)]. An optochin-containing disk was placed on the first quadrant of the blood agar plate. Cultures were incubated for 18 to 24 h at 35°C. At this time the blood agar plate was examined for colonies consistent with S. pneumoniae, and the LIM broth2 was subcultured as described above. Organisms with colonial and microscopic characteristics consistent with S. pneumoniae (alpha-hemolytic, Gram-positive cocci which were catalase-negative) were definitively identified with susceptibility to optochin and the Quelling reaction. The use of the LIM broth was primarily for recovery of group B streptococci. LIM broth "spiked" with S. pneumoniae was incubated at 35°C for 18 to 27 h with recovery of the organism on subculture, confirming that it would support growth. Quantitative studies were not done to determine the sensitivity of the LIM broth culture because we were relying primarily on the direct plating of the specimen on blood agar with CO2 incubation as is standard procedure for cultivation of S. pneumoniae from respiratory and other body sites. Results. A total of 1083 swabs were processed in our microbiology laboratory during the 12-month period and screened for the presence of pneumococcus as discussed. Of these none yielded pneumococcal growth. Discussion. Pneumococcal infection of the female genital tract can cause endometriosis, salpingitis, pelvic inflammatory disease and abscesses and can be complicated by peritonitis. Pneumococci may reach the fetus or newborn and potentially lead to neonatal infection via four possible mechanisms: transplacentally secondary to maternal bacteremia; ascending infection from the maternal genital tract; passage through a colonized birth canal; or postpartum by respiratory spread. In the pre-penicillin era, pneumococcal puerperal and neonatal infections caused by pneumococcus appear to have been more common; in 1938 Nuckols and Hertig3 reviewed the literature and noted 74 cases of pneumococcal genital infection in women. Of these 37 were described as puerperal infections, with 17 associated with abortion. Mortality was 74% for patients with peritonitis. Westh et al.4 discuss 36 cases of maternal infection from 1938 to 1988. They describe 23 cases of neonatal disease with a mortality of 50%. In 1977 Bortolussi et al.5 reported on 5 cases of early onset pneumococcal sepsis, all seen in the first 24 h of life with respiratory distress and signs of severe sepsis. Three of the infants died. Geelon et al.6 reported in 1990 on 7 cases of pneumococcal sepsis and discuss features of an additional 43 cases gleaned from the literature. They noted that 60% of the infants were premature, 91% presented in the first 48 h of life, 64% had pneumonia and 38% had meningitis. Once again mortality was 50%. In the US pneumococcus accounts for <5% of cases of neonatal sepsis and meningitis.7 Other developed countries report similar low percentages of neonatal sepsis, 5.5% in Belgium in one study8 and 1.25% reported from Israel,9 with increased proportions in some developing countries such as Pakistan10 and Malawi (11.5%).11 Maternal colonization is likewise rare; Primhak et al.1 reviewed 15 000 urogenital swabs at Sheffield Hospital; only 5 were positive for pneumococcus. Our data indicate that colonization is equally uncommon in the US. It appears that the clinical features of pneumococcal neonatal sepsis are strikingly similar to those seen with early onset group B streptococcal sepsis. Our data support the low rate of urogenital colonization of pregnant women with pneumococci. Given the severity of previously reported neonatal disease, we hypothesize that newborns are rarely exposed to pneumococci and that neonatal host defense to this agent is insufficient, i.e. a high infant invasion to maternal colonization ratio compared with group B Streptococcus. Therefore maternal vaginal or infant surface cultures positive for pneumococcus should probably not be ignored (although infant colonization was not examined in our study). Given the above it has been suggested that consideration be given to penicillin prophylaxis during labor to women with pneumococcus isolated from the genital tract to prevent vertical transmission and neonatal septicemia. The efficacy of such an intervention would need to be evaluated. At the very least, given the high reported rate of mortality with neonatal pneumococcal diseases, these infants should be followed extremely carefully. With the possibility that neonatal pneumococcal disease may be becoming more prevalent in some developing countries, we suggest that our discussion lends support to consideration of maternal immunization in those areas with pneumococcal polysaccharide vaccine.12 This would provide passive protection to the neonate (analogous to maternal tetanus immunization) to be followed by active immunization of the infant with a glycoprotein conjugate vaccine, thereby hopefully reducing the total burden of pneumococcal disease in infancy.
ABSTRACT Results of starch gel electrophoresis of degraded whole casein by a gamma‐radiation induced mutant of L. bulgaricus showed that the mutant degraded whole casein much faster than the parent culture.
ABSTRACT Since little information is available on the role of Lactobacilli in the degradation of casein species (other than cow casein) and non‐milk protein substrates, this study was undertaken to gather information on degradative ability of lactobacilli on different protein substrates. Progressive enhancement in the liberation of tyrosine with an increase in incubation period was recorded in all the cultures. As regards the degradative ability of lactobacilli on protein substrates of nondairy origin, an increasing trend in proteolysis rate was noted up to 10 days. Results are of interest on account of faster degradation of certain protein substrates of nondairy origin by lactobacilli which contribute significantly to texture and flavor development in cultured milk‐based foods.
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