#staphylococcic

[jcsmicasereports]

Prevalence Of Staphylococcus Aureus In Nasal And Skin Of Apparently Healthy Food Handlers And Attendants In Restau by Iyevhobu Kenneth Oshiokhayamhe in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Food handlers play a major role in the transmission of food borne diseases which represents a global health burden. Carriage of Staphylococcus aureus, in general, and enterotoxigenic strains, in particular, is an important risk factor for the contamination of food. This study was undertaken to determine the prevalence and risk factors associated with nasal and skin carriage of Staphylococcus aureus among 150 food handlers working in different restaurant in Ekpoma. Thirty (10%) persons were found to be significant (P< 0.05) carriers of Staphylococcus aureus of which highest occurrence of 24 (16%) from anterior nasal nares and 6 (7.5%) from skin of food handlers and restaurant workers. Prevalence and distribution of Staphylococcus aureus in relation to gender among food handlers and restaurant workers, showed high occurrence in females of 17 (56.6%) than males 13 (43.3%) with no significant difference in comparison of variability (P>0.05). Susceptibility pattern of Staphylococcus aureus isolated from this study had high sensitivity pattern of 93% to Zennacef, 80% to Rocephin, 93% to Ciprofloxacin, 70% to Gentamycin, intermediate sensitivity to Septrin 53%, Streptomycin 50%, and resistant to Erythromycin 40%, Amoxacilin 36% and Ampiclox 17%. From this study, Staphylococcus aureus is the most prevalent among them isolates that colonizes the skin and mucosal surfaces of healthy food handlers and restaurant workers. These findings resurges the imperative need for protective measures including increased public awareness programs, regular monitoring of food handlers for food borne pathogens and intensive training on primary health care and hygiene and future research addressing effective methods for sustained eradication of Staphylococcal skin and nasal carriage are clearly warranted to reduce the high risk of subsequent infection. It is our opinion that concerted efforts need to be made to educate food handlers and restaurant workers on the importance of personal hygiene and the use of protective gadgets like nose masks while handling food products; since they serve as potential sources of staphylococcal food poisoning.

Keywords

Food, Handler, Staphylococcus, Restaurant, Nasal, Skin

INTRODUCTION

Staphylococcus aureus avoidable medical and economic burden, the true incidence and prevalence of pathogenic strain of foodborne diseases is difficult to quantify. Risk factors implicated in foodborne diseases as identified by Centers for Disease Control and Prevention included unsafe sources, inadequate cooking, improper holding, contaminated equipment and poor personal hygiene implicating that the food handler dimension is crucially important (FDA, 2009). Food handlers have been implicated in a plethora of foodborne diseases. It has been reported that one of the important pathogens often transmitted via food contaminated by infected food handlers is Staphylococcus aureus (Verkaik et al., 2011). Bacteria of the genus Staphylococcus are Gram-positive cocci that are microscopically observed as individual organisms (Francois and Schrenzelg, 2008). Staphylococcus aureus is pathogenic ubiquitous species and may be a part of human flora found in the axillae, the inguinal and perineal areas, and the anterior nares (Bayer et al., 1998).  Von Eiff et al., (2001) described 3 patterns of carriage: those who always carry a strain, those who carry the organism intermittently with changing strains, and a minority of people who never carry Staphylococcus aureus (Bayer et al., 1998). Persistent carriage is more common in children than in adults (Iwase et al., 2010). Nasal carriers may be divided into persistent carriers with high risk of infection and intermittent or non-carriers with low risk of infection (Blot et al., 2002). Direct invasion through breaks in the skin or mucus membrane leads into the production of superficial local infections such as folliculitis, furuncles and abscesses (Wertheim et al., 2005). This versatile pathogen is very well adapted to colonize the human skin and the human body provides some major ecological niches for this species. The anterior nares is the most frequent carriage site for Staphylococcus aureus, nonetheless extranasal sites typically harbor the organism including the skin, perineum and pharynx (Wertheim et al., 2005; Verkaik et al., 2011).

Until recently, reports on food contamination by Staphylococcus aureus, were mainly limited to occasional detections in the environment, the source of food and food itself. However, it is reported that human carriers are the most important source for transmission and the association between food handlers and the transmission of food borne disease frequently presents an investigative challenge (Jordá et al., 2012). Consideration into risk factors, transmission routes and many aspects of prevalence of carriage of foodborne pathogens among food handlers to eliminate carriage is necessary. Bodies concerned with food safety are left to consider whether interventions such as decolonization, continued monitoring or restrictions in the occupational activities are required (National Disease Surveillance Centre, 2004). Although skin carriage of Staphylococcus aureus, is less reported than nasal carriage, little is known about the prevalence and risk of skin carriage of enterotoxigenic strains of Staphylococcus aureus, among food handlers. Accordingly, the current study investigated the prevalence and risk factors associated with anterior nasal nares and skin carriage of Staphylococcus aureus, amongst food handlers working in different restaurant in Ekpoma Edo State.

Healthy carriers are potential source of Staphylococcus aureus infection and spread to other body sites as well as to other individuals. Staphylococcus aureus have been found frequently as aetiological of a variety of human infections. Centre for disease control (CDC) reported Staphylococcus aureus as primary source of infections, which could be transferred from individual to another, The organism also elaborates toxins that can cause specific diseases or syndromes and likely participate in the pathogenesis of staphylococcal infection. Enterotoxin-producing strains of S aureus cause one of the most common food-borne illnesses (food poisoning). The most common presentation is acute onset of vomiting and watery diarrhea 2-6 hours after ingestion. The symptoms are usually self-limited. The cause is the proliferation of toxin-producing organisms in uncooked or partially cooked food that an individual carrying the staphylococci has contaminated (Matthews et al., 1997). This study is set determines the prevalence of Staphylococcus aureus from skin and nasal nares of apparently healthy food handlers in restaurant which could be the source of  Staphylococcus aureus food contamination resulting to food born infection in Ekpoma.

MATERIALS AND METHODS

This project work from its inception, sample collection, sample analysis and compilation was carried out within a period of four months with a total of hundred Fifty Skin and nasal swab samples from different restaurant workers and food handlers in Ekpoma. A total of one hundred fifty (150) nasal and skin swab were randomly collected from male and female food handlers and restaurant workers grant consent.

Informed consent was requested and granted by the food handlers and restaurant workers under investigation. The concept of the study was explained to them and having understood its dimensions, granted their informed consent.

Sample Collection: One hundred and fifty specimen were collected randomly from males and females food handlers and restaurant workers within Ekpoma metropolis. The samples (150 nasal swabs and 150 skin swab). Nasal swab were collected in good light vision from subjects by bending their heads backward to collect the specimens deep down the anterior passages using a sterile swab stick. Both right and left nostrils were swabbed bearing labels as nasal swabs, sex, code number and date of collection. The swabs sticks were carefully returned to their sterile containers, sealed with adhesive tape and labelled accordingly. Skin swab was collected by swabbing their skin (especially their fore arm) with a swab moist with physiological saline aseptically and the swabs sticks were carefully returned to their sterile containers. Collected specimen was taken to the laboratory where bacteriological analysis was carried out immediately.

Procedure for Culture: The swab stick were used to make a primary inoculum on each agar surface (blood agar and chocolates agar plate). Spreading was done by streaking from the primary inoculum using a sterile inoculating wire loop to obtain discrete bacterial colonies. The plates were then incubated at 370C for 24 hours. Growth was observed after incubation, and the colonial morphology was studied carefully, noting the size, shape, edge, colour, consistency, haemolysis, elevation and opacity of the colonies.   This was followed by Gram staining (Ochei and Kolhatkar, 2000).

Method for Detection of Staphylococcus aureus: The colonies that were yellow pigmented or cream white (Cheesbrough, 2000) were sub-cultured onto mannitol salt agar and selected for catalase (using H2O2) and coagulase tests (using plasma). Mannitol fermenting and slide coagulase positive isolates were identified as Staphylocuccus aureus.

Antibiotic Sensitivity Test: Antibiotic disc such as Erythromycin, Gentamycin, Streptomycin, Ciprofloxacin, Ampicillin, Septrine, Zinnacef, Amoxicilin and Rocephin (manufactured by Abtek Biologicals Ltd) were used to test the susceptibility of Staphylococci aureus isolates obtained. The test isolates were inoculated into sterile peptone water broth. The antibiotic discs were placed aseptically on the seeded plate. They were incubated at 370C for 24hours and examined for zones of inhibition. The zones of inhibition were measured in millimetres and recorded. Antibiotic zones less than 10mm in diameter were recorded as been  resistant (R) by the organism while those with diameters of 10mm and above were recorded as sensitive (S)

Statistical Analysis: The collected data was expressed as Frequency and percentage. Comparison of qualitative variables was made using chi-square test. In all cases studied, the difference having p<0.05 were considered statistically significant using interactive calculation Chi square tool software (version 18).

RESULTS

Based on standard bacteriological analytical methods, from investigation of 300 samples of [nasal swab (150), skin swab (150)] from food handlers and restaurant workers in Ekpoma, revealed 30(10%) distribution of Staphylococcus aureus prevalence with the highest occurrence of 24 (16%) from nasal swab and 6 (7.5%) from skin swab. Other growths of non-Staphylococcus aureus were excluded from this study. The significant difference of Staphylococcus aureus isolates distribution among samples in this study was statistically significant (P< 0.05) with X2cal=26.057 p-value 0.000.

X2cal=26.057, Degree of freedom=2, p-value=0.0000 Key: N - Number , S. aureus: Staphylococcus aureus

X2cal=18.04, Degree of freedom=2, p-value=0.000, Key: N - Number

X2 cal=1.663, Degree of freedom=1, p-value=0.435, (p>0.05).

KEY:CN-Gentamycin, Z-Zennacef, R-Rocephin, CPX- Ciprofloxacin, SXT-Septrin, S-Streptomycin, E-Erythromycin AM- Amoxacilin , APXAmpiclox

DISCUSSION

Staphylococcus species are regional flora of the skin and mucus membrane of the body, certain species have been found frequently as aetiological agent of a variety of human and animal infections. The most common among these infections are the superficial supportive infection caused by Staphylococcus aureus. Infection can result to life threatening conditions disease spectrum which includes abscesses, septicemia, osteomyelitis, endocarditis and cellulitis, pneumonia, in addition to various toxin mediated diseases as toxic shock syndrome and staphylococcal food poisoning. The variety of such spectrum of clinical manifestations is mostly dependent on the numerous virulence factors produced by each strain (Vasconcelos and da Cunha, 2010). The ingestion of the preformed toxins produced by Staphylococcus aureus (enterotoxigenic strains) in food often results to the development of food poisoning. Findings from this investigation indicate a significant (P< 0.05) distribution of Staphylococcus aureus of 30(10%) prevalence with the highest occurrence of 24 (16%) from anterior nasal nares of food handlers and restaurant workers, 6 (7.5%) from skin swab which is in agreement with investigation reported by Mous-tafa et al., (2013) of 10.5% Nasal Carriage of Staphylococcus aureus and Risk Factors among Food Handlers-in Egypt. The findings from this studied in relation to area of study, was not in agreement with findings report by Eke et al., (2015), with a wide variation of 60% prevalence from 100 nasal swab analysis of food handlers and restaurant workers in Ekpoma. The reduced significant prevalence from this study is proportionately an improve hygiene of food handlers and workers in restaurant. This study variables revealed that gender, age, marital status nor level of education had no significant effect with respect to the nasal and skin carriage of Staphylococcus aureus. This study findings also reveal anterior nasal nares of food handlers and restaurant workers to harbour pathogenic Staphylococci species [Staphylococcus aureus 24(16%) to that of their skin 6(7.5%) with significant increase difference of (P>0.05) P- value 0.000].

Prevalence and distribution of Staphylococcus aureus in relation to gender among food handlers and restaurant workers, showed high occurrence in females food handlers and workers of 17 (56.6%) than males 13 (43.3%) with no significant difference in comparison of variability (P>0.05) and not in agreements with the findings by Eke et al., (2015), which report males food handlers to have high prevalence than the females in Ekpoma. The disparity of this report may be due to the subject who consent to participate as at time of study in regards to gender present in restaurant.

The sensitivity pattern of Staphyloccus aureus isolated from this study had high susceptibility to Gentamycin, Zennacef, Rocephin, Ciprofloxacin intermediate to Septrin, Streptomycin, and resistant to Amoxicillin, Erythromycin and Ampiclox which in agreement with the study reported by Eke et al., (2015). From this research it can be suggested that skin and nasal nares harbours Staphylococcus aureus which can be source of enterotoxigenic stains causing food born infection observed in our restaurant this days.

From all the organisms known to cause food born infection, Staphylococcus aureus is the most prevalent among them that is easily isolated and it colonizes the skin and mucosal surfaces of healthy individuals. The isolation of this organism learned to us that, as a microflora, it has a high percentage of causing infectious disease related to illness. Evidence from the result obtained has show that the skin and nasal nares has carrying capacity of Staphylococcus aureus. In contrast, healthy individuals as worker and food handlers in restaurant are risk factor of food born infection (food poisoning).

In conclusion, a relatively high prevalence rate of Staphylococcus aureus in nasal nares and skin carriage was recorded among the investigated food handlers. Moreover, 10% of the investigated carriers harboured Staphylococcus aureus in their anterior nares increasing the likelihood of transmission of the pathogen to the handled food. These findings resurges the imperative need for protective measures including increased public awareness programs, regular monitoring of food handlers for food borne pathogens and intensive training on primary health care and hygiene. Finally, the current findings clearly highlight the significance of implementation of efficient quality control systems in areas of direct contact with food product as good manufacturing practices and standard operational procedures and future research addressing effective methods for sustained eradication of Staphylococcal skin and nasal carriage are clearly warranted to reduce the high risk of subsequent infection.

CONFLICT OF INTEREST

The authors declare no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.

FUNDING

This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

AUTHORS’ CONTRIBUTIONS

Iyevhobu, K.O. and Obodo, B.N., conceptualized the laboratory work and provided scientific guidance, Momoh A.R.M., Airefetalor, A.I. and Okobi, T.J. designed and wrote the manuscript while Etafo, J. and Osagiede, E.K. conducted experiments.

ACKNOWLEDGEMENTS

The authors would like to thank all the Laboratory and technical staffs of the department of Medical Laboratory Science, Ambrose Alli University Ekpoma, Edo State for their excellent assistance and St Kenny Research Consult, Ekpoma, Edo State for providing medical writing support/editorial support in accordance with Good Publication Practice (GPP3) guidelines.

[biology-geology-beaches-india]

The Science Notebooks of Satyendra Sunkavally, page 51.

[darkmaga-returns]

…as well as the history of the Polio bioweapon “vaccines” which were used to assassinate an incarcerated Jack Ruby with the very same SV40 promotor sequences that children and babies, in lesser concentrations so as to make it less obvious, are still being injected with today…

"They're giving COVID vaccines to 6-month-old children now...[but] we know that it ruins stem cells in pregnant women...[plus] Kevin McKernan [et al. found that] there's SV40 in it. There was [also] a staphylococcal endotoxin gene...[and] two snake genes in there." Suzanne Humphries (@DrSuzanneH7), a physician and the co-author of Dissolving Illusions, describes for Joe Rogan (@joerogan ) how the CDC still has three COVID injections on its "vaccination" schedule for six-month-old infants. Humphries notes "how bad [this] is" by highlighting the fact that the injections "ruin stem cells in pregnant women." The physician also highlights the fact that scientist and former R&D lead of the Human Genome Project at MIT Kevin McKernan found SV40 in the injections (which is linked to the development of cancer). Furthermore, Humphries says that there's also a staphylococcal endotoxin gene and "two snake genes" present in the genetical material in the COVID injections. Regarding why hospitals are willing to administer such dangerous injections to infants, Humphries says that "[it's] all a money game. That's really the bottom line of it."

[thedee-n]

Staphylococcus Aureus : This is the most dangerous of all of the many common staphylococcal bacteria. This bacteria often causes skin infections but can cause pneumonia, heart valve infections and bone infections.

# These bacteria are spread by having direct contact with an infected person

# skin infections are common but the bacteria can spread through the bloodstream and infect distant organs ; blisters, abscesses, and redness and swelling in the infected area.

Treatment: Antibiotics

Surgical removal of infected bone and or foreign material

…. Health is wealth …

[beardedmrbean]

A student nurse died of sepsis after being left waiting in A&E for almost 12 hours at the hospital where she worked, an inquest has heard.

Zoe Bell, 28, had finished a weekend of long shifts before she turned up at Stoke Mandeville Hospital in Buckinghamshire complaining of breathing difficulties.

Bell, from High Wycombe, had been taking on extra shifts at hospitals across the county to help pay for the last stage of her studies, Beaconsfield Coroners Court was told.

She began to suffer with a sore throat and struggled to get words out after finishing her last 12-hour shift on Dec 18 2022.

Phillip Ayres, her boyfriend, told the inquest: “It was not uncommon for her to be run down after a weekend of long shifts.”

She continued to deteriorate and was rushed to the hospital on Dec 23 2022.

Mr Ayres described how they had arrived shortly after 10pm and said she began suffering severe chest pain about an hour and a half later.

Nurses checked Bell while she was at the hospital but said her oxygen levels were normal and tried to test for tonsillitis. “It was made to seem as though there was nothing to worry about,” Mr Ayres told the court.

The inquest heard how A&E had been particularly busy at the time as a result of a high volume of flu cases, Covid and children with Strep-B.

By 4.30am, Bell and Mr Ayres were still in the waiting area but she developed “agonising” chest, back and shoulder pain.

“Zoe coughed up a small amount of blood in a sick bowl,” Mr Ayres said. “A nurse took all the same tests again. The nurse was convinced the blood was caused by Zoe’s constant coughing.”

He added: “Because Zoe was a nurse and she understood the staff were overwhelmed, I felt I had to be polite. It was like being caught between a rock and a hard place. I did not want to upset Zoe.”

‘No hope coming’

At around 4 or 5am, Mr Ayres said he “kicked up a bit of a fuss” and ensured Bell was seen by a doctor who suspected she had laryngitis, the inquest heard.

The couple were sent back to the waiting area, where “Zoe was panicked about having coughed up blood” and started hyperventilating, Mr Ayres said.

“By this point Zoe had enough,” he said. “She had got to a point where she wanted to go home. She was exhausted. She felt like there was no help coming.”

At 10am on Christmas Eve, Bell was taken into a part of A&E where patients are checked for the ward.

She became distressed, confused and disorientated and an emergency alarm was pulled. 

But Mr Ayres said: “There was a sense of relief, she was finally being seen and treated. She was so relieved to be finally getting help, she was so thankful and grateful.”

She continued to deteriorate and Nick Bell, her father, arrived at hospital just in time to see her being rushed into ICU at 12.30pm, the hearing was told. She died the same evening from heart failure.

A post-mortem examination concluded she had died of staphylococcal septicaemia (sepsis), bronchopneumonia, an acute lung injury as a result of influenza and a viral infection.

Mr Ayres told Crispin Butler, the Buckinghamshire coroner, that Bell always understood the struggles and strains of the NHS and dreamed of improving it so everyone could get the care they needed.

“It seems that the very thing she worked so hard towards was the very thing that let her down,” he said. “Her death is a loss to the NHS for her kindness and compassion and sheer determination.”

The inquest continues.

[ultra-francesca-mercury]

june14

1995

Irish blues rocker Rory Gallagher dies of a staphylococcal infection following a liver transplant at age 47.

[miss-biophys]

Czech scientist discovered the working mechanism of a miraculous antibiotics that can kill even the gold staphylococcus

This is the title of an interview that I did about my antibiotic research for a Czech magazine HROT. Full interview article here.

I was really happy about this. I want people to know what we researchers are doing. But what I did not expect was email along these lines:

Dear Dr. Melcrová, I read your article in the magazine. I am suffering from staphylococcal infections for many years. Could you help me?

...I was in quite a shock. How should I reply? I am not a medical doctor. And my research is not yet approved for clinical practise. It's tough.

[nursingwriter]

Bacterial skin infection Dermatology & Reproduction Diseases (Zagazig University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 1 Bacterial skin infection Cutaneous infection - Direct infection of skin and adjacent tissues. - Impetigo. - Ecthyma. - Folliculitis. - Furunculosis. - Carbuncle. - cellulitis. - Secondary infection. - Eczema, infestations, scabies, pediculosis, ulcers, etc. - Cutaneous disease due to effect of bacterial toxin. - Staphylococcal scalded skin syndrome. - Toxic shock syndrome. Impetigo Definition: Impetigo is a common contagious superficial pyogenic infection of the skin. Two main clinical forms are recognized: - Non bullous impetigo (staphylococcus aureus, or by streptococci group A or by both organisms together). - Bullous impetigo (Staphylococcus aureus). Epidemiology: - Summer - Children are most often affected. - In adults, males predominate. - Poor hygiene and existing skin disease e.g., scabies, predispose to infection. Non bullous impetigo - the face especially around the nose and mouth and the limbs are the sites most commonly affected. - Erythematous macule thin-walled vesicle on an erythematous base pustule golden yellow crust erosion rapidly crusted again normal skin or slight hyper pigmentation. Impetigo contagiosum Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 2 Course and prognosis: - Itching is usually present in the vesicular stage and this helps the spread of the disease through autoinoculation. - usually runs an acute course and complete healing usually takes place in 5 to 10 days with no residual scar. Bullous Impetigo Clinical features: - The bullae are less rapidly ruptured and persist for 2-3 days. - Bullae are large. - After rupture thin crusts are formed. - Central healing and peripheral extension may give rise to circinate lesions. - Although the face is most often affected, the lesions may occur anywhere. - The buccal mucosa may be involved. Circinate impetigo Complications: - Eczematization. - Furunculosis, erysipelas and cellulitis. - post-streptococcal acute glomerulonephritis. the latent period for development of nephritis after streptococcal infection is 18-21 days. - Scarlet fever, urticaria and erythema multiforme may follow streptococcal impetigo. Treatment: 1- Removal of the crusts by: - Washing with soap and water. - Topical compresses with warm potassium permanganate solution 1/8000 is used. - Applying drying agent as gentian violet 1% in water. 2- Topical Antibiotic: - In mild and localized infection, a topical antibiotic alone may be sufficient. - Mupirocin ointment, Fusidic acid, Topical neomycin, Bacitracin. 3- Systemic Antibiotic: - The infection is widespread or severe. - Accompanied by lymphadenopathy. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 3 - There is reason to suspect a nephritogenic streptococcus. - An oral antibiotic such as flucloxacillin or erythromycin is indicated. Impetigo neonatorum - Its impetigo of the newborn and is a variety of bullous impetigo. - It usually begins between 4th and 10th day after birth, - it is highly contiguous and may be fatal. - Associated with constitutional symptoms as malaise and fever with extensive large bullae and the mm may be involved. - Diarrhea frequently occurs. - Bacteremia, pneumonia or meningitis may rapidly develop with fatal termination. - Isolation and treatment with IV antistaph. Ecthyma Definition: Is a Primary bacterial infection of the skin characterized by the formation of adherent crusts, beneath which ulceration occurs. - The disease may affect children and adults. - Poor hygiene and malnutrition are predisposing factors. Clinical features: - The crust is removed with difficulty to reveal a purulent irregular ulcer. - Healing occurs slowly leaving a slight scar. Treatment: - Improved hygiene and nutrition - The antibiotic chosen should be active against both strept and staph. Folliculitis - Infection of the hair follicles characterized by erythematous, follicular-based papules and pustules. May be superficial or deep. - In superficial folliculitis the inflammatory changes are confined to the ostium and healing occurs without scarring. - In deep folliculitis the inflammatory changes are more deep and healing occurs with scarring (furuncles, carbuncles, sycosis). Superficial bacterial folliculitis - An infection of the follicular osteum with staph aureus. - it is commonest in childhood and occur mainly in the scalp or scalp margins or on the limbs. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 4 - The individual lesion is a yellow pustule sometimes with a narrow red areola. Treatment: - Antibiotics topical or systemic may be required. Furuncles (Boil) - Deeper infections of the hair follicle characterized by inflammatory nodules with pustular drainage. - acute, usually necrotic infection of a hair follicle with staph aureus. - Common in adolescence and early adult life. - Tenderness and throbbing pain. - Heal with scar. Treatment: - Flucloxacillin systemically or another penicillinase resistant antibiotic. - Hot water compresses - A topical antibacterial agent reduces contamination of the surrounding skin. - occlusive dressings should be avoided. Carbuncle Etiology: - A carbuncle is a deep infection of a group of contiguous follicles with staph. aureus accompanied by intense inflammatory changes in the surrounding and underlying connective tissues. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 5 - They occur predominantly in men of middle or old age. Clinical features: - Painful, hard red swelling. - Pus is discharged from the multiple follicular orifices. - Constitutional symptoms may accompany or precede the development of the carbuncle. Treatment: - Flucloxacillin or another penicillinase resistant antibiotic should be given. - Surgical intervention may be needed. Cellulitis and erysipelas Bacterially: Cellulitis and erysipelas are predominantly streptococcal diseases. Definition: - Cellulitis is bacterial inflammation of the subcutaneous tissue. - Erysipelas is a bacterial infection of the dermis and upper subcutaneous tissue. - Erythema, heat, swelling and pain or tenderness are constant features. - In erysipelas the edge of the lesion is well demarcated and raised but in cellulitis it is diffuse. - In erysipelas blistering is common and there may be superficial hemorrhage into the blisters or in intact skin especially in elderly people. Complications: Without effective treatment, complications are common: fasciitis, myositis, subcutaneous abscesses, septiceamias and in some streptococcal cases nephritis. Treatment: - Penicillin is the treatment of choice and should be continued for 10 days. - In recurrent cases long-acting penicillin can prevent attacks. - In patients allergic to penicillin another drug commonly erythromycin should be taken. - Some patients may require lifelong prophylaxis. Erysipelas Cellulitis Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 6 Erythrasma Definition: Is a mild, localized superficial infection of the skin caused by gram positive rods Corynebacterium Minutissimum. Clinical features: - It occurs most commonly in the groins, axillae and the intergluteal and sub mammary flexures. - The patches are of irregular shape and sharply marginated, at first red but later becoming brown. D.D. of erythrasma: - Intertrigo: Frictional dermatitis. - Tinea cruris. - Pityriasis versicolor - Candidiasis. Fluorescence under wood’s light: Coral red fluorescence Treatment: - Topically applied azole antifungal agents such as clotrimazole and miconazole (although it is a bacterial infection), - local antibacterial preparations as fucidic acid. - erythromycin for 2 weeks is probably the most effective approach. Downloaded by James Mcknight (careerdigitals@gmail.com) lOMoARcPSD|28323056 Read the full article

[medchemexpressinhibitor-blog]

Kanamycins sulfate

Description

Kanamycins sulfate is a broad-spectrum antibiotic, can be used in certain severe staphylococcal or Gram-negative bacillary infections. Kanamycin sulfate has certain ototoxicity[1][2].

Molecular Weight：582.58

Formula：C18H38N4O15S

CAS No.：70560–51–9

Appearance：Solid

Color：White to off-white

SMILES：[Kanamycins (sulfate)]

Shipping：Room temperature in continental US; may vary elsewhere.

Storage：4°C, sealed storage, away from moisture

*In solvent : -80°C, 6 months; -20°C, 1 month (sealed storage, away from moisture)

[medsupplycanada]

Best Surface Disinfectants for Medical Organizations and Healthcare Departments

Infection control is a cornerstone of patient safety in hospitals and healthcare systems, and surface disinfectant wipes play a pivotal role in this effort. When visible contamination isn’t properly addressed, the risk of cross-infection during patient interactions skyrockets. Cleaning and disinfecting environmental surfaces and medical equipment is no small feat for healthcare facilities, but the payoff is significant: studies show that proper disinfection can slash hospital-acquired infections (HAIs) by nearly 30%. This makes it one of the most impactful practices in modern healthcare.

The urgency of effective disinfectants has been magnified by global pandemics like COVID-19, bringing their importance into sharp focus. Research confirms that these products can eliminate up to 99.9% of germs—including tough customers like coliform, Klebsiella, and staphylococcal bacteria—on surfaces. This article dives into the best surface disinfectants available, how they work, and key factors healthcare organizations should consider when selecting the right ones.

What Are Surface Disinfectants?

Surface disinfectants are specialized agents designed to wipe out infectious microorganisms on surfaces, making them indispensable in healthcare settings where sterilization is non-negotiable. Their effectiveness hinges on their chemical makeup, which can be broadly divided into general-purpose and pathogen-specific disinfectants. These chemicals work by disrupting the structure or function of bacteria, viruses, or their byproducts, either neutralizing them or stopping their growth entirely.

Common Ingredients in Surface Disinfectants

Here’s a rundown of the heavy hitters you’ll find in these products:

Alcohol: A broad-spectrum warrior that takes down many bacteria and viruses.

Chlorine Compounds: Famous for water treatment, these are also surface disinfection powerhouses.

Quaternary Ammonium Compounds (Quats): These destroy bacteria and viruses, making them a go-to for wipes and sprays.

Types of Surface Disinfectants

Wipes

Surface disinfectant wipes are the gold standard for convenience, perfect for quick cleanups on door handles, light switches, or medical equipment. Pre-moistened and ready to use, they require no additional tools, saving time in fast-paced environments.

CaviWipes1™ Surface Disinfectant Wipes: Powerful Protection These wipes pack a punch, killing viruses (including SARS-CoV-2) and bacteria in just one minute. Bleach-free and safe on most surfaces, they come in various sizes. Key features include:

Fast-acting, durable, non-woven wipes soaked in CaviCide1™.

One-minute kill time for viruses, bacteria (including TB), and more.

Fragrance-free and available in multiple configurations.

Sprays

Disinfectant sprays shine on larger surfaces or hard-to-reach spots, pairing well with reusable cloths or paper towels. Their versatility makes them a staple in healthcare settings.

Lysol Disinfectant Spray: Protect Your Home A household name, Lysol kills 99.9% of viruses and bacteria, including cold, flu, and COVID-19 strains. It’s great for creating a hygienic environment with features like:

Protection against viruses, bacteria, fungi, and mold.

Sanitizes soft surfaces and comes in scents like crisp linen or cherry blossom.

Liquid Cleaners

For heavy-duty cleaning, liquid disinfectants are the way to go. Highly concentrated, they require dilution but excel at tackling thick grime when used correctly.

Disinfectant Cleanser IV—Arjo This fifth-generation quat-based cleaner is tough on germs yet gentle on surfaces like metals, plastics, and fiberglass. Highlights include:

Hospital-grade, one-step cleaning and disinfection.

Non-corrosive and compatible with whirlpool systems.

High concentration for maximum efficiency.

Factors to Consider When Choosing the Best Surface Disinfectant

Effectiveness Against Pathogens Different surfaces harbor different threats. Look for products that target specific pathogens like E. coli, Staphylococcus, or viruses such as COVID-19 and influenza.

Surface Compatibility Not all disinfectants play nice with every surface. Some can damage electronics or wooden furniture, so always check compatibility details.

Ease of Use In healthcare’s high-speed world, ready-to-use wipes save time compared to sprays or liquids that need prep. Match the product to your workflow.

Eco-Friendliness With sustainability in the spotlight, biodegradable wipes and chemical-free options are gaining traction, helping reduce the healthcare industry’s environmental footprint.

Safety Toxicity matters, especially around vulnerable populations like kids or pets. Opt for non-toxic, skin-friendly formulations.

Making the Right Choice

Picking the best surface disinfectant isn’t a one-size-fits-all decision. While germ-killing power is critical, don’t sleep on surface compatibility, usability, eco-impact, and safety. Balancing these factors ensures a solution that protects patients and staff alike.

Best Practices for Disinfection

Follow Manufacturer Instructions: Stick to the recommended use for optimal results.

Routine Cleaning: Schedule regular disinfection of high-touch surfaces to curb infection risks.

Staff Training: Educate healthcare workers on proper techniques and product use.

Regular Evaluation: Periodically assess your disinfectants’ performance and adjust as needed.

Top Recommendations for Surface Disinfectants

With so many options, here are some standout choices:

Best Overall: Lysol Disinfectant Spray Versatile and effective, it kills 99.9% of germs, including COVID-19, on hard and soft surfaces alike.

Best Wipes for Everyday Use: Clorox Disinfecting Wipes Quick and easy, these wipes zap 99.9% of germs in under a minute—perfect for daily use.

Best Eco-Friendly Option: Seventh Generation Disinfecting Wipes Plant-based and biodegradable, they kill 99.9% of germs without harming the planet.

Best for Electronics: Alcohol Wipes With 70%+ isopropyl alcohol, these wipes safely disinfect phones and laptops.

Best Budget-Friendly: Homemade Disinfectants Mix vinegar and alcohol for a cost-effective, antibacterial solution (skip natural stone surfaces).

Conclusion

Choosing the right surface disinfectant is a critical step in safeguarding healthcare environments. Whether it’s the rapid action of wipes, the coverage of sprays, or the power of liquid cleaners, the best choice depends on your facility’s needs. Prioritize effectiveness, safety, and sustainability to protect patients, staff, and the broader community. For a wide range of options, check out suppliers like MedSupply to find the perfect fit for your infection control strategy. Properly wielded, these tools can transform healthcare spaces into safer havens for all.

[darkmaga-returns]

CHD Defender just released a video interview with Drs. Pierre Kory and Ben Edwards, who obtained access the medical records of the 6-year-old girl who, while recovering from measles, fell ill with pneumonia.

According to Dr. Kory, the hospital correctly diagnosed her with a secondary bacterial infection of her lungs and administered a broad spectrum antibiotic. However, the hospital failed to administer a macrolide antibiotic that is indicated for treating mycoplasma infections. Even after the patient tested positive for mycoplasma, the hospital delayed administering a macrolide antibiotic for ten hours. One wonders why there was such a delay.

Reviewing the literature on the Spanish Flu of 1918, I see that the severe pneumonia recorded by army doctors Camp Funston at Fort Riley, Kansas—the outbreak’s epicenter—was caused by an extremely virulent secondary Staphylococcal infection. As one Army doctor described the disease progression:

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen … and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes

An especially puzzling feature of the Spanish Flu is that it struck people in their twenties much harder than people over fifty. Influenza and pneumonia death rates for 15- to 34-year-olds were more than 20 times higher in 1918 than in previous years. I wonder if soldiers crowded into unhygienic training camps were simultaneously exposed to high loads of staphylococcus bacteria. As this was before the discovery of penicillin, there was no way to treat this illness.

[myrawjcsmicasereports]

 Clinical Case Reports – 1970 by P. Syamasundar Rao in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

In this paper five case reports were presented and include congenital pulmonary cyst, Wilson-Mikity syndrome, diaphragmatic eventration; foreign body in the bronchus, and cor pulmonale that developed after implantation of a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. For each case report, clinical, chest x-ray, electrocardiogram and other pertinent findings were presented. This was followed by discussion of etiology, diagnosis, and treatment options, as appropriate.

Keywords: congenital pulmonary cyst; diaphragmatic eventration; Wilson-Mikity syndrome; foreign body in the bronchus; cor pulmonale

Introduction

During the academic clinical practice for over five decades, the author had the unique opportunity to observe and document many interesting clinical case scenarios. The purpose of this review is to revisit these interesting cases. Because of the voluminous amount of this material, the material may be divided into a five-part series. Each of these case reports, while rare and important clinical observations, do demonstrate a clinical point that is useful to the pediatricians, pediatric cardiologists and/or other physicians.

Congenital Pulmonary Cyst

Case Report

A female infant with a birth weight of  6 lb 7 oz, born after a full-term, normal pregnancy and delivery with an Apgar score of 9 presented at three weeks of age with a two-week history of tachypnea. There were no other symptoms and the infant’s physical examination was normal except for tachypnea (respiratory rate of 50 per minute) and mild inter-costal and sub costal retractions. A chest roentgenogram was obtained (Figure 1) which was interpreted as pulmonary cyst. The heart was pushed to the right by the cyst (dextroposition of the heart). At thoracotomy, a huge lung cyst, involving the lower lobe of the left lung, was found, and was resected and the patient made an uneventful recovery.

Chest x-ray in posterio-anterior (A) and lateral (B) views demonstrating a large pulmonary cyst, marked with arrows. Note that the heart is pushed to the right, dextroposition of the heart. Reproduced from Rao PS. Amer J Dis Child 1970; 119:341-2.

Discussion

Congenital pulmonary cysts in the neonate are uncommon and are considered as errors in embryological development. They are of several categories namely, bronchogenic cell, alveolar cell, and combined cell types, based on the cellular component of the cell wall of the cyst. The symptoms depend largely upon the size of the cyst. These patients may not be discovered until a chest x-ray is performed for other reasons or may present with symptoms of tachypnea, dyspnea, and cyanosis in the neonatal period secondary to compression of lung tissue. The findings depend upon the size and location of the cyst. Dextroposition of the heart or tracheal shift and hyper-resonance, diminished breath sounds, and rales may be detected on physical examination. The chest x-ray findings may demonstrate a cyst, as in our case (Figure 1) or may be misinterpreted as pneumothorax. Other conditions simulating the cyst are staphylococcal pneumonia, diaphragmatic hernia, congenital lobar emphysema, sequestrated lobe, and hydro-pneumothorax or pyo-pneumothorax. In symptomatic cases, cystectomy, segmentectomy, lobectomy, or pneumonectomy, depending upon the size and location of the cyst is suggested. Percutaneous aspiration of the cyst is not recommended except as an emergency measure to relieve the tension. Some authorities advocate no surgical intervention because of the possibility of spontaneous regression of the pulmonary cysts, but most authorities recommend surgical excision of the cysts [1].

Late Respiratory Distress in a Premature Infant

Case Report

A premature male infant was born at 25 weeks of gestation and weighed 2 lb 12 oz at birth. Abruptio placenta and prolapse of the umbilical cord complicated the delivery and required resuscitation with oxygen. The chest x-ray was normal at that time. The baby was placed in an incubator in 35 percent oxygen, which was discontinued within 24 hours. At the age of 31 days, tachypnea and recurrent apnea with cyanosis developed. Auscultation revealed bilateral rales in the chest, again necessitating resuscitation with O2, administered by bag and mask. Chest x-ray (Figure 2) revealed a diffuse parenchymal reticular pattern with multifocal areas of radiolucency. This roentgenographic pattern, along with the clinical findings, is essentially diagnostic of the Wilson-Mikity syndrome.

Discussion

Wilson an Mikity originally described this condition in 1960, and is now called Wilson-Mikity syndrome.2 The etiology is not clearly understood but is considered to be due to pulmonary dysmaturity with uneven postnatal development of pulmonary alveoli in the premature infants.2 No consistent relationship with O2 therapy has been established. Bronchopulmonary dysplasia is another condition seen in the neonatal period and should be distinguished from Wilson-Mikity syndrome. The cystic appearance on the chest x-ray in the third stage of bronchopulmonary dysplasia resemble those of Wilson-Mikity syndrome; however, it follows treatment of severe hyaline membrane disease with high concentrations of O2 and artificial ventilation.2 The clinical presentation of Wilson-Mikity syndrome is characteristic in that the infant is premature with minimal or no respiratory distress at birth but, develops progressive respiratory distress, with dyspnea, tachypnea, cough, cyanosis, and rales in a few days to weeks. Diffuse reticular pattern of both lungs with areas of multifocal radiolucency are usually seen, similar to those seen in figure 2. Progressive pulmonary insufficiency with signs of right heart failure develop in patients with fatal outcome. But, about half of the patients eventually recover from their pulmonary disease. Pulmonary function studies are abnormal with decreased lung compliance, increased expiratory flow resistance, and increased breathing effort. Respiratory acidosis develops in spite of increased minute volume. Arterial O2 desaturation is thought to be secondary to intrapulmonary right-to-left shunting.2 The treatment is largely supportive [2].

Fever, Vomiting and Dome-Shaped Density in Right Thorax

Case Report

A four-month-old boy presented with a history of fever, poor feeding, vomiting, and slight cough for two days. Past history is essentially normal except for an Apgar score of 6 at birth. Breath sounds were diminished at the right base. Laboratory studies were normal. Chest x-ray (Figure 3) was performed which revealed a dome-shaped density in the right thorax which did not coincide with any pulmonary lobe or segment. The elevation of the inferior liver margin in the abdomen indicated that the abnormal shadow was liver. Based on these findings eventration of the right hemi-diaphragm was suspected. To confirm the diagnosis, a diagnostic pneumoperitonium was performed (Figure 4) which confirmed the diagnosis.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing a dome-shaped density in the right thorax (the x-ray was reversed by the printer). The distribution of the density did not coincide with any pulmonary lobe or segment. The elevation of the inferior hepatic margin in the abdomen indicated that the abnormal shadow was liver. Reproduced from Rao PS and Patel JK. Chest 1970; 58:89-90.

 Diagnostic pneumoperitonium with chest x-ray in lateral view. This demonstrated air below the diaphragm suggesting eventration of the diaphragm instead of pneumonia or other lung pathology. Modified from Rao PS and Patel JK. Chest 1970; 58:89-90.

Discussion

Eventration of the diaphragm is classified into adult and infantile types [3]. It is generally thought to be the result of congenital mal-development of the diaphragmatic musculature. However, such an abnormality may occasionally be caused by phrenic nerve injury during birth. The true incidence of eventration is not known, but in mass x-ray surveys of adults, it was found to be one in 10,000 [3]. Total eventration is thought to be more common on the left side and partial eventration on the right [3].

Clinical findings largely depend on the extent of eventration. There may be no symptoms or the patient may present with dyspnea, tachypnea, and cyanosis in the newborn period, requiring immediate treatment. Seesaw cyclic motions of the epigastrium with respiration and Hoover's sign (uninhibited divergence of costal margin from midline on inspiration), if present, are helpful in making the diagnosis. Percussion on the affected side may be dull or tympanic depending on the organs migrated under the diaphragm.

Fluoroscopy and chest x-rays are generally useful in arriving at the diagnosis. In right-sided eventrations, the lesser amount of liver shadow in the abdomen, i.e., elevation of the inferior margin of the liver helps to distinguish eventration from the other conditions [3]. Diagnostic pneumoperitonium is likely to establish the diagnosis, but the current availability of ultrasound technology, diagnostic pneumoperitoneum may not be necessary at the present time.

Symptomatic newborns with diaphragmatic eventration should be treated surgically; plication of the eventrated diaphragm is successful in relieving the symptoms with good long-term results. Some authorities suggest that asymptomatic patients also should be addressed surgically [3].

Foreign Body (Peanut) in The Left Main Stem Bronchus

Case Report

A 13-month-old girl with a history of poor appetite, loss of weight, cough, and intermittent low grade fever was admitted to the hospital for evaluation and treatment. No history of choking episodes was elicited. History revealed that a relative who had active pulmonary tuberculosis lived with the infant's family for a short period of time four months prior to the current admission. Because of this reason, the local health department performed tuberculin skin test which was positive and treatment with isoniazid was initiated. On examination her weight and height were between the third and tenth percentile. Decreased breath sounds on auscultation and hyper tympanic note on percussion were noted over the left side of the chest.

Intermediate strength purified protein derivative (PPD) was positive. Chest roentgenograms were obtained (Figure 5). Based on the history, physical examination, and chest x-ray findings, a diagnosis of endobronchial tuberculosis was entertained. However, prior to beginning treatment, bronchoscopy was performed to appraise the extent of airway encroachment.

Discussion

Autoimmune encephalitis is a condition that can be easily missed as it is not commonly considered in the differential diagnosis of various medical presentations. However, such diagnosis should be always taken into consideration when a person, particularly a child, presents with a new onset of refractory status epilepticus (NORSE) and/or new behavioral or psychiatric conditions. An early diagnosis of AE is essential, as the treatment is different from other conditions. With correct timely interventions the outcome is frequently favorable.

Though SARS-Cov-2 virus rarely invades the nervous system, Covid-19 infection frequently causes neurological symptoms like headache, delirium, anosmia, and dysgeusia [14]. One of the mechanisms of indirect nervous system involvement is through inflammatory response and immune dysregulation. There are few recorded cases of indirect involvement of CNS by auto-antibodies that are directed against the surface and synaptic protein. This case is one of the rare cases of Anti NMDA antibody autoimmune encephalitis that is associated with Covid-19 infection [15]. It indicates that in the era of COVID-19, high vigilance is required as a possible association may increase AE incidence.

A recent systemic review that analyzed 16 studies, including a total of 161 patients with NORSE [16], showed that the most frequent cause was AE. In addition to the well-known association with teratoma and cancer, AE, and specifically Anti-NMDA receptor Ab encephalitis, could be associated with a SARS‑CoV‑2 infection, either concomitantly or as post-infection manifestation. In this reported case, immunotherapy, in addition to anti-seizure medication, showed to be effective.

The main limitation of this report is the relatively short follow-up period. Observation of the child is ongoing to detect possible medium- or long-term consequences.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing hyper-aeration of the left lung and a slight shift of the heart and mediastinum to the right. The left diaphragm is also flattened. There are no areas of infiltration or consolidation in the lung, but prominent densities (arrows in A and B) suggestive of enlarged lymph nodes were also seen. Modified from Rao PS, et al. Amer J Dis Child 1970; 120:51-52.

Positive PPD in an infant with poor appetite, loss of weight, and fever is suggestive of primary tuberculosis. This is particularly so given the patient's exposure to a subject with active pulmonary tuberculosis. The x-rays show hyper aeration of the left lung with a shift of the heart and mediastinum to the right. The left leaf of the diaphragm is also flattened. While there are no areas of infiltration or consolidation were seen, prominent shadows suggesting enlarged lymph nodes were seen (arrows in figure 5). Endobronchial tuberculosis with compression of the bronchus by adenopathy may produce changes seen figure 5.

Discussion

Even though there was no history of choking or aspiration, the possibility of foreign body aspiration should be considered in this age group. Consequently, bronchoscopy was performed which revealed a peanut in the left main stem bronchus and was extracted during bronchoscopy. The peanut and the adjacent edema of the bronchus caused partial bronchial obstruction and acted as a check valve, so the air entered the left lung but, unable to leave the left lung since the bronchus becomes smaller during expiration, producing the roentgenographic appearance shown in figure 5. The baby improved and the treatment with isoniazid was continued because of the positive PPD.

Cor Pulmonale as a Complication of Ventriculoatrial Shunts

Introduction

Cerebral ventricle-to-right atrial shunts with Pudenz-Heyer or Spitz-Holter valves were widely used to treat hydrocephalus in the 1960s. Development of pulmonary hypertension with chronic cor pulmonale is rare with these shunts. We reported a patient who developed such a complication along with description of specialized pulmonary function studies in the early detection of such complication [5].

Case Report

An 11-year-old white boy was hospitalized in April 1969 with a history of progressive weakness, dyspnea, and pedal edema. He was diagnosed to have hydrocephalus and had a ventriculo-atrial shunt with a Pudenz-Heyer valve implanted at the age of 6 months. The shunt was thought to be functioning well when he was evaluated at the age of 2 years. He was asymptomatic until he was 9.5 years old, when he developed signs of congestive heart failure (CHF) and was treated at another hospital with digitalis and diuretics with some improvement. Right heart catheterization at the same institution revealed a mean right atrial pressure of 35 mmHg and right atrial angiography revealed slow emptying of the contrast, filling defects on the right lateral atrial wall and in the right and left pulmonary arteries. The ventriculo-atrial shunt was removed shortly thereafter. The patient was referred to our group for further evaluation and management [5].

Pertinent findings on examination included height and weight below the third percentile, head circumference above the 97th percentile, pretibial edema, prominent “a” wave in the left side of the neck, no venous pulsations on the right side, palpable right ventricular heave, markedly accentuated single second heart sound, an audible fourth heart sound at left lower sternal border, a Grade I/VI ejection systolic murmur at the mid-left sternal border, liver edge palpable 5 cm below the right costal margin, clear lung fields on auscultation, and normal neurological examination.

Electrocardiogram (ECG) (Figure 6) and the vectorcardiogram (not shown) revealed right atrial and ventricular hypertrophy. Chest roentgenogram (Figure 7) showed moderate cardiomegaly and prominent main pulmonary artery (PA) segment and clear lung fields. Lung scan with 131I-labeled macro-aggregated albumin was suggestive of multiple pulmonary emboli. Blood gas analysis showed pH 7.56; PaO2 80 mmHg, PaCO2 23 mmHg and bicarbonate 24 mEq/liter. Routine pulmonary function studies revealed restrictive lung disease. The ratio of wasted ventilatory volume (physiological dead space) to tidal volume (VD:VT) using Bohr's equation was 0.58 (normal 0.3 or less).

Electrocardiogram shows right axis deviation with right atrial hypertrophy and marked right ventricular hypertrophy. Reproduced from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Chest x-ray in posteroanterior view demonstrating cardiomegaly and prominent main pulmonary artery segment (arrow). The peripheral pulmonary vasculature is diminished. Modified from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Vigorous treatment with digitalis and diuretics resulted in only temporary relief. During the next year, he continued to deteriorate and died of intractable right ventricular failure. Postmortem revealed right atrial thrombosis, severe right ventricular hypertrophy, multiple thrombo-emboli in the large and medium-sized pulmonary arteries, and intimal proliferation of the pulmonary arterioles.

Discussion

The case presented demonstrated development of cor pulmonale secondary to pulmonary thrombo-embolism which was produced by thrombi that arose following a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. The causes of thrombo-embolic complications were not well understood, but the hypotheses, as reviewed by us [5], include infection, periarteritis due to autoimmune reaction of the pulmonary vessels to protein of cerebrospinal fluid, release of brain thromboplastin resulting in thrombosis at the point of contact with plasma coagulation factors, and simply the presence of a foreign body in the cardiovascular system for prolonged periods of time.

Early detection of pulmonary hypertension by periodic (every six months) evaluation by chest x-ray and ECG studies was suggested by some investigators, but early detection of pulmonary hypertension is of limited value since obstruction of 60% of the pulmonary vascular bed occurs by the time pulmonary hypertension develops [5]. Detection of multiple filling defects on radioisotope scanning in a child with a ventriculo-atrial shunt would be suggestive of pulmonary embolization and might be useful in early identification. Based on the observations of Nadel and associates [6] and those of ours [5], we suggested that specialized pulmonary function studies such as VD:VT, pulmonary diffusing capacity, pulmonary capillary blood volume, blood gas, and pH be performed periodically to detect obstruction of pulmonary vasculature prior to the development of pulmonary hypertension and cor pulmonale [5]. However, it should be noted that ventriculo-atrial shunts are no longer performed to treat hydrocephalus, but instead ventriculo-peritoneal shunts are used at the present time.

In summary, a rare case of pulmonary thrombo-embolism with resultant pulmonary hypertension and cor pulmonale following ventriculo-atrial shunt for hydrocephalus was presented with the recommendation to use of special pulmonary function studies for early detection and if found to be positive, immediate removal of the shunt system may eliminate further embolization into the lungs and prevent irreversible pulmonary vascular disease.

[moleculardepot]

Anti-SND1 Antibody Rabbit Polyclonal (Human)

Anti-SND1 Antibody Rabbit Polyclonal (Human) Catalog number: B2020098 Lot number: Batch Dependent Expiration Date: Batch dependent Amount: 100 uL Molecular Weight or Concentration: NA Supplied as: Liquid Applications: a molecular tool for various biochemical applications Storage: -20°C Keywords: Anti-100 kDa coactivator, Anti-EBNA2 coactivator p100, Anti-Staphylococcal nuclease domain-containing…

[ultra-francesca-mercury]

june 14, 1995

Irish blues rocker Rory Gallagher dies of a staphylococcal infection following a liver transplant at age 47.

[twinkl22004]

"Hyper-IgE Syndrome", Victor McKusick, Mendelian Inheritance in Man, 1966. 高免疫球蛋白E綜合徵。(HIES1).

Here I present: “Hyper-IgE Syndrome“, Victor McKusick, Mendelian Inheritance in Man’, 1966. 高免疫球蛋白E綜合徵。(HIES1). INTRODUCTION. Hyper-IgE syndrome type-1 with recurrent  infections (HIES1) is an autosomal dominant immunologic disorder characterized by chronic eczema (atopy), recurrent Staphylococcal infections, increased serum IgE, and eosinophilia. Other more variable immunologic abnormalities…