Infection Prevention and Control: Practical and Educational Advances

A topical collection in Tropical Medicine and Infectious Disease (ISSN 2414-6366). This collection belongs to the section "Infectious Diseases".

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Editors


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Collection Editor
School of Medicine, European University Cyprus, Nicosia, Cyprus
Interests: infection control; antimicrobial resistance; antimicrobial stewardship; medical education
Special Issues, Collections and Topics in MDPI journals

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Collection Editor
First Department of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: pediatric emergency, antimicrobial resistance; pediatric infectious diseases; medical education
Special Issues, Collections and Topics in MDPI journals

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Collection Editor
Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
Interests: infection control; antimicrobial resistance; public health; water hygiene

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Collection Editor
Hospital Beatriz Ângelo, Loures, Portugal
Interests: antimicrobial stewardship and consumption; human behaviour; infection prevention and control

Topical Collection Information

Dear Colleagues,

The importance of infection prevention and control in healthcare settings is well established and has been associated with improved healthcare, improved quality of life, and proven cost-effectiveness in the prevention of disease. Notably, five of the top ten global health threats, according to the World Health Organization’s strategic plan, are directly related to this field. In the face of the current COVID-19 pandemic, this underscores even more the necessity of infection prevention and control policies and preparedness.

However, a variable degree of heterogeneity exists in practices, policies, the implementation of programs, and education across the world. In order to close these gaps and streamline the global effectiveness of infection prevention and control, in-depth research into local and regional determinants and characteristics is imperative.

This Topical Collection will focus on recent advances in the field of prevention and control of infectious diseases, particularly from a practical and educational point of view. Potential topics include, but are not limited to: hand hygiene; personal protective equipment and other practices; healthcare-associated infections; outbreak investigation and management; vaccination; leadership and communication; and education and training.

Dr. Constantinos Tsioutis
Dr. Spyridon Karageorgos
Prof. Dr. Nico Mutters
Dr. Carlos Palos
Collection Editors

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Keywords

  • infection prevention
  • infection control
  • healthcare-associated infections
  • outbreak management
  • vaccine-preventable diseases
  • infection control programs
  • antimicrobial resistance
  • multidrug resistance
  • hand hygiene
  • personal protective equipment
  • infection control bundles
  • practical issues
  • health education
  • medical training.

Published Papers (29 papers)

2023

Jump to: 2022, 2021, 2020

27 pages, 3836 KiB  
Article
Legionnaires’ Disease in Occupational Settings: A Cross-Sectional Study from Northeastern Italy (2019)
by Matteo Riccò, Pietro Ferraro, Silvia Ranzieri, Giorgia Boldini, Ilaria Zanella and Federico Marchesi
Trop. Med. Infect. Dis. 2023, 8(7), 364; https://doi.org/10.3390/tropicalmed8070364 - 16 Jul 2023
Cited by 1 | Viewed by 1856
Abstract
In Italy, Legionnaires’ Disease (LD) causes >1000 hospital admissions per year, with a lethality rate of 5 to 10%. Occupational exposures could reasonably explain a substantial share of total cases, but the role of Occupational Physicians (OPs) in management and prevention of LD [...] Read more.
In Italy, Legionnaires’ Disease (LD) causes >1000 hospital admissions per year, with a lethality rate of 5 to 10%. Occupational exposures could reasonably explain a substantial share of total cases, but the role of Occupational Physicians (OPs) in management and prevention of LD has been scarcely investigated. The present survey therefore evaluates the knowledge, attitudes and practices (KAP) regarding LD from a convenience sample of Italian OPs, focusing on their participation in preventive interventions. A total of 165 OPs were recruited through a training event (Parma, Northeastern Italy, 2019), and completed a specifically designed structured questionnaire. The association between reported participation in preventive interventions and individual factors was analyzed using a binary logistic regression model, calculating corresponding multivariable Odds Ratio (aOR). Overall, participants exhibited satisfactory knowledge of the clinical and diagnostic aspects of LD, while substantial uncertainties were associated epidemiological factors (i.e., notification rate and lethality). Although the majority of participating OPs reportedly assisted at least one hospital (26.7%) and/or a nursing home (42.4%) and/or a wastewater treatment plant, only 41.8% reportedly contributed to the risk assessment for LD and 18.8% promoted specifically designed preventive measures. Working as OPs in nursing homes (aOR 8.732; 95% Confidence Intervals [95%CI] 2.991 to 25.487) and wastewater treatment plants (aOR 8.710; 95%CI 2.844 to 26.668) was associated with participation in the risk assessment for LD, while the promotion of preventive practice was associated with working as an OP in hospitals (aOR 6.792; 95%CI 2.026 to 22.764) and wastewater treatment plants (aOR 4.464, 95%CI 1.363 to 14.619). In other words, the effective participation of the OP in the implementation of preventive measures appears uncommon and is limited to certain occupational settings. Collectively, these results highlight the importance of tailoring specifically designed information campaigns aimed to raise the involvement of OPs in the prevention of LD in occupational settings other than healthcare. Full article
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13 pages, 2351 KiB  
Article
Civil Engineering and Malaria Risk: A Descriptive Study in a Rural Area of Cubal, Angola
by Eva Gil Olivas, Andreu Bruguera, Arlete Nindia E. Eugenio, João José Nunda, Armindo Tchiyanga, Fernando Graça Ekavo, Adriano Cambali, Milagros Moreno, Cristina Bocanegra García, Maria Luísa Aznar, Fernando Salvador, Adrián Sánchez-Montalvá and Israel Molina
Trop. Med. Infect. Dis. 2023, 8(2), 96; https://doi.org/10.3390/tropicalmed8020096 - 1 Feb 2023
Cited by 1 | Viewed by 1967
Abstract
(1) Background: Angola is among the high-burden countries with malaria cases globally. After 2013, we suspected an increase in the number of malaria cases in Cubal (Angola), previously in decline. Our objective was to evaluate the incidence rate in Cubal, overall and by [...] Read more.
(1) Background: Angola is among the high-burden countries with malaria cases globally. After 2013, we suspected an increase in the number of malaria cases in Cubal (Angola), previously in decline. Our objective was to evaluate the incidence rate in Cubal, overall and by neighborhood, for 2014, 2015, and 2016. (2) Methods: A retrospective, observational study was performed in Cubal (Angola) from January 2014 to December 2016, including all patients with a microbiologically confirmed diagnosis, treated at Cubal’s Hospitals for this period of time. The principal variables calculated were the incidence rates of 2014, 2015, and 2016 in Cubal (overall and by neighborhood). (3) Results: There were 3249 malaria cases. The incidence rates were 2.27, 10.73, and 12.40 cases per 1000 inhabitants in 2014, 2015, and 2016, respectively. In the neighborhood, Hamavoko-Kasseke, there was a 10.73-fold increase in incidence during this period. Additionally, Hamavoko-Kasseke presents an anomalous distribution of malaria cases. (4) Conclusions: We observed an increase in the incidence of malaria in Cubal during the three-year study period. The case distribution was highly heterogeneous with hyperendemic areas, and we found a chronobiological association between the construction of a civil engineering project. This information could be useful for deciding which malaria control strategies must be implemented in this area. Full article
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2022

Jump to: 2023, 2021, 2020

13 pages, 692 KiB  
Article
SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit
by Angela Dramowski, Louisa M. Erasmus, Marina Aucamp, Aaqilah Fataar, Mark F. Cotton, Susan E. Coffin, Adrie Bekker and Andrew C. Whitelaw
Trop. Med. Infect. Dis. 2023, 8(1), 27; https://doi.org/10.3390/tropicalmed8010027 - 29 Dec 2022
Cited by 1 | Viewed by 3251
Abstract
Background: Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. Methods: We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance [...] Read more.
Background: Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. Methods: We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). Results: A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was ‘basic’ (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to ‘intermediate’ level (262). There was no change in the neonatal unit HA-BSI rate. Conclusion: Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice. Full article
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4 pages, 207 KiB  
Editorial
Infection Prevention and Control: Practical and Educational Advances
by Constantinos Tsioutis and Spyridon A. Karageorgos
Trop. Med. Infect. Dis. 2022, 7(8), 148; https://doi.org/10.3390/tropicalmed7080148 - 26 Jul 2022
Viewed by 1429
Abstract
Infection prevention and control (IPC) is associated with improved healthcare, better quality of life and cost-effectiveness in disease prevention [...] Full article
11 pages, 717 KiB  
Review
Circular Policy: A New Approach to Vector and Vector-Borne Diseases’ Management in Line with the Global Vector Control Response (2017–2030)
by Christiana Tourapi and Constantinos Tsioutis
Trop. Med. Infect. Dis. 2022, 7(7), 125; https://doi.org/10.3390/tropicalmed7070125 - 4 Jul 2022
Cited by 8 | Viewed by 3175
Abstract
Integrated Vector Management (IVM) has yielded exemplary results in combating and preventing vector-borne diseases (VBDs) and their vectors. It’s success and positive outcomes depend on the sound planning, implementation, enforcement, and validation of the locally adapted vector control efforts from the involved national [...] Read more.
Integrated Vector Management (IVM) has yielded exemplary results in combating and preventing vector-borne diseases (VBDs) and their vectors. It’s success and positive outcomes depend on the sound planning, implementation, enforcement, and validation of the locally adapted vector control efforts from the involved national sectors and stakeholders. Nevertheless, current realities create several implications impeding IVM’s performance. Hence, there is a need to adjust local IVM plans to several factors, such as (i) the rapidly changing and unpredictable environmental conditions (i.e., climate change, shift on species distribution, invasive species—Anopheles stephensi, Aedes aegypti and Ae. albopictus); (ii) the environmental impacts from human activities (i.e., fossil fuel use, food sources, industry, land use, urbanization and deforestation); (iii) changes in human demographics and the international movement of people (travelers and forcibly displaced persons due to conflicts and severe weather) increasing the risk of contracting and transmitting vector-borne diseases and shifting humanitarian emergencies and societal demands; (iv) the SARS-CoV2 pandemic outbreak and the implication on national public health systems; (v) the continuous flow of technological advancements and newly acquired knowledge; (vi) the realization of the strong link between planetary health and public health. Addressing these factors in IVM can become difficult, taking into consideration the numerous involved sectors, stakeholders, and fields in the management of vectors and vector-borne diseases (VBD). This document proposes and discusses the aspects and steps of a holistic approach, referenced as the Circular Policy, for national and local IVM strategies to be effective and adaptable, capable of providing the optimum outcomes. Full article
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11 pages, 669 KiB  
Article
Evaluating the Quality of Latent Tuberculosis Infection Screening in Ireland: A Single-Centre Retrospective Cohort Study
by James O’Connell, Joy Oguntuase, Brian Li, Cora McNally, Debbi Stanistreet, Samuel McConkey and Eoghan de Barra
Trop. Med. Infect. Dis. 2022, 7(2), 19; https://doi.org/10.3390/tropicalmed7020019 - 28 Jan 2022
Cited by 2 | Viewed by 2828
Abstract
Ireland is a country with a low incidence of tuberculosis (TB) (5.6 cases per 100,000 population in 2019) that should be aiming for TB elimination (fewer than 1 case per million of population). To achieve TB elimination in low-incidence countries, programmatic latent tuberculosis [...] Read more.
Ireland is a country with a low incidence of tuberculosis (TB) (5.6 cases per 100,000 population in 2019) that should be aiming for TB elimination (fewer than 1 case per million of population). To achieve TB elimination in low-incidence countries, programmatic latent tuberculosis infection (LTBI) management is important. This requires high-quality latent tuberculosis infection (LTBI) screening. Aim: To assess the quality of LTBI screening in a tertiary centre in Ireland using a framework. Methods: A retrospective review of the health care records of patients screened for TB in a tertiary centre in Ireland using an interferon-gamma release assay (IGRA) between 2016 and 2018 was performed. Three domains from the Institute of Medicine framework for health care quality, effectiveness, efficiency, and equity, were applied to measure the quality of LTBI screening. Results: Forty patients had LTBI and an indication for treatment, of whom 20% (8/40) were not offered treatment by the health care provider, 2.5% (1/40) did not accept treatment, and 10% (4/40) did not complete treatment. Seventy-five percent (6/8) of patients not offered treatment were non-Irish. The cost of screening per LTBI case identified was EUR 2048. Conclusions: This study evaluated the quality of LTBI screening using a framework and identified that LTBI screening in this tertiary centre needs to be scaled and expanded, and that treatment initiation needs to be improved, particularly among non-Irish nationals. Full article
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6 pages, 1125 KiB  
Communication
Hepatitis C Virus Infection in Eastern Libya: Efforts Needed to Improve HCV Testing and Linkage to Care in the Resource-Limited Setting
by Faisal Ismail, Soghra Haq, Islam El-Garawani and Eman Abdelsameea
Trop. Med. Infect. Dis. 2022, 7(2), 14; https://doi.org/10.3390/tropicalmed7020014 - 19 Jan 2022
Cited by 2 | Viewed by 2860
Abstract
Hepatitis C virus (HCV) is a significant public health problem, and the elimination of its infection by 2031 is a global goal. However, due to insufficient testing, lack of linkage to care (LTC) and treatment, Libya may be far from achieving this goal. [...] Read more.
Hepatitis C virus (HCV) is a significant public health problem, and the elimination of its infection by 2031 is a global goal. However, due to insufficient testing, lack of linkage to care (LTC) and treatment, Libya may be far from achieving this goal. This study aimed to explore HCV testing, the care and treatment of infected people, and to assess the burden of the infection among individuals who visited the main Medical Centre in Tobruk region, eastern Libya, for various medical and surgical conditions. A research team interviewed public health officials in Tobruk Medical Center, inspected available equipment, and obtained data available for people who were positive for antibodies to HCV (anti-HCV) as part of their routine pre-invasive procedures and pre-donation screening tests from January 2005 to April 2020. HCV antibody tests were positive for 612 cases out of 368,392 (0.17%). Of those who tested positive for anti-HCV antibodies, no one had followed up by RNA test for identifying individuals with chronic HCV infection, and there are no links to outpatient care and treatment. Our findings highlight the critical need for an up-to-date HCV diagnosis and linkage to care guidelines, which includes a follow-up RNA test for anti-HCV positive patients and early linkage to care for confirmed cases to accelerate the elimination of HCV infection from the community. Full article
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2021

Jump to: 2023, 2022, 2020

8 pages, 1339 KiB  
Case Report
Myocarditis in a Pediatric Patient with Campylobacter Enteritis: A Case Report and Literature Review
by Anastasios-Panagiotis Chantzaras, Spyridon Karageorgos, Panagiota Panagiotou, Elissavet Georgiadou, Theodora Chousou, Kalliopi Spyridopoulou, Georgios Paradeisis, Christina Kanaka-Gantenbein and Evanthia Botsa
Trop. Med. Infect. Dis. 2021, 6(4), 212; https://doi.org/10.3390/tropicalmed6040212 - 16 Dec 2021
Cited by 2 | Viewed by 2354
Abstract
Myocarditis represents a potential complication of various infectious and noninfectious agents and a common diagnostic challenge for clinicians. Data regarding Campylobacter-associated myocarditis are limited. Here, a case of a 13-year-old female with Campylobacter jejuni gastroenteritis complicated by myocarditis is presented, followed by [...] Read more.
Myocarditis represents a potential complication of various infectious and noninfectious agents and a common diagnostic challenge for clinicians. Data regarding Campylobacter-associated myocarditis are limited. Here, a case of a 13-year-old female with Campylobacter jejuni gastroenteritis complicated by myocarditis is presented, followed by a literature review in order to retrieve information about Campylobacter-associated carditis in the pediatric population. A search on MEDLINE/PubMed yielded 7relevant cases in the last 20 years. Most of them (six/seven) were males and the mean age was 16.1 years. All patients presented with gastrointestinal symptoms followed in six/seven cases by chest pain within two to seven days. Campylobacter was isolated from stool cultures in six patients; abnormal electrocardiographic findings were detected in six; and abnormal echocardiographic findings in three of the cases. Five patients were treated with antibiotics. Full recovery was the clinical outcome in six patients, whereas one patient died. Concerning the nonspecific symptoms of patients with myocarditis, high clinical suspicion of this complication is necessary in cases where patients with a recent infection present with chest pain and elevated cardiac biomarkers. Full article
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14 pages, 549 KiB  
Article
An Intra-COVID-19 Assessment of Hand Hygiene Facility, Policy and Staff Compliance in Two Hospitals in Sierra Leone: Is There a Difference between Regional and Capital City Hospitals?
by Sulaiman Lakoh, Emmanuel Firima, Christine Ellen Elleanor Williams, Sarah K. Conteh, Mohamed Boie Jalloh, Mohamed Gbeshay Sheku, Olukemi Adekanmbi, Stephen Sevalie, Sylvia Adama Kamara, Mohamed Akmed Salim Kamara, Umu Barrie, Gladys Nanilla Kamara, Le Yi, Xuejun Guo, Chukwuemeka Haffner, Matilda N. Kamara, Darlinda F. Jiba, Enanga Sonia Namanaga, Anna Maruta, Christiana Kallon, Joseph Sam Kanu, Gibrilla F. Deen, Mohamed Samai, Joseph Chukwudi Okeibunor and James B. W. Russelladd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2021, 6(4), 204; https://doi.org/10.3390/tropicalmed6040204 - 29 Nov 2021
Cited by 13 | Viewed by 3401
Abstract
Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH [...] Read more.
Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy. Full article
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12 pages, 754 KiB  
Article
Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi
by Onduru Gervas Onduru, Rajhab Sawasawa Mkakosya, Susan Fred Rumisha and Said Aboud
Trop. Med. Infect. Dis. 2021, 6(4), 179; https://doi.org/10.3390/tropicalmed6040179 - 29 Sep 2021
Cited by 7 | Viewed by 2803
Abstract
Antimicrobial resistance due to extended-spectrum β-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical [...] Read more.
Antimicrobial resistance due to extended-spectrum β-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical samples were collected from 300 patients and screened for ESBL-E using a CHROMagarTM ESBL medium. Confirmation of ESBL production was done by a combination disk test (CDT). The prevalence of community-acquired ESBL-E was 16.67% (50/300, 95% CI = 12.43–20.91%). The most common ESBL-E species isolated was Escherichia coli (66%). All ESBL-E isolates were resistant to Trimethoprim-Sulfamethoxazole except for 2% of E. coli. Besides this, all ESBL-E were susceptible to Imipenem and only 4% were resistant to Meropenem. No patients with a positive ESBL-E phenotype had a history of hospital admission in the last three months, and the carriage of ESBL-E was neither associated with the demographic nor the clinical characteristics of participants. Our findings reveal a low presence of ESBL-E phenotypes in community patients. The low prevalence of ESBL-E in the community settings of Blantyre can be maintained if strong infection and antimicrobial use-control strategies are implemented. Full article
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6 pages, 428 KiB  
Brief Report
Clinical Outcomes of Adult Patients Hospitalized with COVID-19 after Vaccination
by Markos Kalligeros, Fadi Shehadeh, Evangelia K. Mylona, Matthew Kaczynski, Saisanjana Kalagara, Eleftheria Atalla, Maria Tsikala Vafea and Eleftherios Mylonakis
Trop. Med. Infect. Dis. 2021, 6(4), 175; https://doi.org/10.3390/tropicalmed6040175 - 26 Sep 2021
Cited by 9 | Viewed by 3514
Abstract
Vaccination remains the most effective way to prevent COVID-19. The aim of the present study was to assess the incidence of COVID-19 hospitalizations after vaccination, as well as the effect of prior vaccination on hospitalization outcomes among patients with COVID-19. We analyzed and [...] Read more.
Vaccination remains the most effective way to prevent COVID-19. The aim of the present study was to assess the incidence of COVID-19 hospitalizations after vaccination, as well as the effect of prior vaccination on hospitalization outcomes among patients with COVID-19. We analyzed and compared all consecutive patients, with or without prior vaccination, who were admitted to our hospital network due to COVID-19 from January to April 2021. Our primary outcome was to identify and describe cases of COVID-19 hospitalized after vaccination. We also utilized a multivariate logistic regression model to investigate the association of previous vaccination with hospitalization outcomes. We identified 915 consecutive patients hospitalized due to COVID-19 with 91/915 (10%) previously vaccinated with at least one dose of a COVID-19 vaccine. Utilizing our multivariate logistic regression model, we found that prior vaccination, regardless of the number of doses or days since vaccination, was associated with decreased mortality (aOR 0.44, 95% CI: 0.20–0.98) when compared to unvaccinated individuals. Our study showed that COVID-19 related hospitalization after vaccination may occur to a small percentage of patients, mainly those who are partially vaccinated. However, our findings underline that prior vaccination, even when partial, is associated with a decreased risk of death. Ongoing vaccination efforts should remain an absolute priority. Full article
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15 pages, 1249 KiB  
Article
Hantaviruses in Agricultural and Forestry Workers: Knowledge, Attitudes and Practices in Italian Physicians
by Matteo Riccò, Pietro Ferraro, Simona Peruzzi, Federica Balzarini and Silvia Ranzieri
Trop. Med. Infect. Dis. 2021, 6(3), 169; https://doi.org/10.3390/tropicalmed6030169 - 20 Sep 2021
Cited by 5 | Viewed by 2429
Abstract
Hantaviruses are viral pathogens usually endemic in rodent populations. Human exposure follows inhalation of dusts contaminated with rodent excreta, and most individuals have been infected in occupational settings heavily contaminated with rodent droppings, such as agricultural and forestry. To date, knowledge, attitudes and [...] Read more.
Hantaviruses are viral pathogens usually endemic in rodent populations. Human exposure follows inhalation of dusts contaminated with rodent excreta, and most individuals have been infected in occupational settings heavily contaminated with rodent droppings, such as agricultural and forestry. To date, knowledge, attitudes and practices of medical professionals, especially occupational physicians (OP), regarding hantavirus disease in at-risk workers have been scarcely investigated. We investigated these topics through a structured questionnaire administered through an online survey of 223 medical professionals (42.2% of them working as OP). Adequate general knowledge of hantavirus disease was found in 48.9% of respondents, with OP exhibiting a better understanding of clinical features of human hantavirus infections. OP aware of the endemic status of hantavirus in North-Eastern Italy exhibited higher risk perception for agricultural workers (odds ratio 21,193, 95% confidence interval 3.666–122.505). On the contrary, a better knowledge of hantaviruses was association with acknowledging an increased risk of hantavirus infection in forestry workers (odds ratio 5.880, 95% confidence interval 1.620–21.343). Hantavirus in Italy represent an often-overlooked biological risk in occupational settings. The lack of preventive immunization, the inappropriate risk perception and the unsatisfying awareness of hantavirus issues collectively stress the importance of appropriate information campaigns among health care providers. Full article
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17 pages, 1227 KiB  
Review
Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People
by Katherine M. Laycock, Leslie A. Enane and Andrew P. Steenhoff
Trop. Med. Infect. Dis. 2021, 6(3), 148; https://doi.org/10.3390/tropicalmed6030148 - 5 Aug 2021
Cited by 6 | Viewed by 9888
Abstract
Adolescents and young adults (AYA, ages 10–24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care [...] Read more.
Adolescents and young adults (AYA, ages 10–24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally. Full article
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8 pages, 633 KiB  
Communication
A Cluster of Plasmodium ovale Infections in Belgian Military Personnel after Deployment in Kindu, Democratic Republic of Congo: A Retrospective Study
by Diana Isabela Costescu Strachinaru, An Wauters, Marjan Van Esbroeck, Mihai Strachinaru, Peter Vanbrabant and Patrick Soentjens
Trop. Med. Infect. Dis. 2021, 6(3), 125; https://doi.org/10.3390/tropicalmed6030125 - 8 Jul 2021
Cited by 3 | Viewed by 4195
Abstract
Plasmodium ovale malaria is often neglected due to its less severe course compared to Plasmodium falciparum. In 2011–2012, Belgian Armed Forces identified a cluster of P. ovale cases among military personnel after deployment in the Democratic Republic of Congo (DRC). In this [...] Read more.
Plasmodium ovale malaria is often neglected due to its less severe course compared to Plasmodium falciparum. In 2011–2012, Belgian Armed Forces identified a cluster of P. ovale cases among military personnel after deployment in the Democratic Republic of Congo (DRC). In this retrospective, monocentric, observational study, clinical and biological features of soldiers diagnosed with P. ovale after deployment in DRC were reviewed. Species diagnosis was based on polymerase chain reaction (PCR) and/or thick blood smear. Medical records of 149 soldiers screened at the Queen Astrid Military Hospital after deployment were reviewed. Eight cases (seven P. ovale infections and one P. ovale—falciparum coinfection) were identified. All had positive thick smears, and seven were confirmed by PCR. Chemoprophylaxis was mefloquine in all subjects. Median time of disease onset was 101 days after return from the endemic region. Median delay between return and diagnosis was 103 days. All P. ovale bouts were uncomplicated. None had relapses after primaquine treatment. This military cohort highlights a hotspot of P. ovale in Eastern DRC. Non-specific symptoms, the less severe presentation, the lack of sensitive parasitological tools in the field and long delays between infection and symptoms probably lead to underestimation of P. ovale cases. Full article
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11 pages, 262 KiB  
Article
Rectal Colonization by Drug Resistant Bacteria in Nursing Home Residents in Crete, Greece
by Aikaterini Moschou, Petros Ioannou, Eleni Moraitaki, Dimitra Stafylaki, Sofia Maraki, George Samonis and Diamantis P. Kofteridis
Trop. Med. Infect. Dis. 2021, 6(3), 123; https://doi.org/10.3390/tropicalmed6030123 - 5 Jul 2021
Cited by 5 | Viewed by 4081
Abstract
(1) Background: In an area with a high prevalence of multi-drug resistant Gram-negative bacteria (MDR-GNB), we investigated the colonization of nursing home residents by such organisms. (2) Methods: A point prevalence study was performed in six nursing homes of the Heraklion area on [...] Read more.
(1) Background: In an area with a high prevalence of multi-drug resistant Gram-negative bacteria (MDR-GNB), we investigated the colonization of nursing home residents by such organisms. (2) Methods: A point prevalence study was performed in six nursing homes of the Heraklion area on the island of Crete. A rectal swab was taken and cultured from each participant, while additional risk factors such as recent hospitalization or antimicrobial usage were recorded and evaluated. (3) Results: A total of 137 nursing home residents were included in the study. Their mean age was 82.1 years and 19.7% were males. In total, cultures yielded 255 GNB; E. coli, K. pneumoniae and P. aeruginosa were the most common. Among the microorganisms cultured, 17.6% had the extended-spectrum beta-lactamase phenotype, while 18% were MDR. A statistically significant association was found between recent antimicrobial use and colonization by MDR-GNB; (4) Conclusions: Colonization by MDR-GNB was found to be highly prevalent in nursing home residents. Recent antimicrobial use was associated with MDR-GNB carriage. Full article
8 pages, 2269 KiB  
Communication
Encephalitis in Thailand: A Neglected Disease Increasingly Caused by Enterovirus
by Pasin Hemachudha, Sininat Petcharat, Soawapak Hinjoy, Abhinbhen W. Saraya and Thiravat Hemachudha
Trop. Med. Infect. Dis. 2021, 6(3), 117; https://doi.org/10.3390/tropicalmed6030117 - 30 Jun 2021
Cited by 5 | Viewed by 6426
Abstract
From 2013 to 2018, the Thai Red Cross Emerging Infectious Disease–Health Science Center (TRC-EID-HS), in collaboration with the Department of Disease Control (DDC) and the Ministry of Public Health (MOPH) Thailand, conducted encephalitis surveillance. A total of 1700 cerebrospinal fluid (CSF) samples from [...] Read more.
From 2013 to 2018, the Thai Red Cross Emerging Infectious Disease–Health Science Center (TRC-EID-HS), in collaboration with the Department of Disease Control (DDC) and the Ministry of Public Health (MOPH) Thailand, conducted encephalitis surveillance. A total of 1700 cerebrospinal fluid (CSF) samples from patients with encephalitis were tested by a predesigned multiplex PCR. Diagnosis was made in 318 cases (18.7%), 86 (27%) of which were caused by Epstein–Barr virus (EBV), 55 (17.3%) by enteroviruses (EV), 36 (11.3%) by varicella–zoster virus (VZV), 31 (9.7%) by cytomegalovirus (CMV), 25 (7.8%) by herpes simplex virus type 1 (HSV-1), and 20 (6.3%) by human herpesvirus 6 (HHV-6). Results were compared with 3099 CSF samples from patients with encephalitis collected between 2002 to 2012, which were tested by specific PCR assays. Diagnosis was made in 337 (10.9%) of these cases, and 91 (27%) were CMV, 79 (23.4%) were VZV, 72 (21.4%) were EBV, 39 (11.6%) were EVs, 39 (11.6%) were HSV-1, 33 (9.8%) were HSV-2, and 2 (0.6%) were Dengue virus (DENV). The change in the pattern toward EVs as a major cause of viral encephalitis was unexpected, and a change in viral neurotropism may be responsible. Full article
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9 pages, 469 KiB  
Article
Performance of MALDI–TOF Mass Spectrometry in the Philippines
by Morichika Osa, Maria Cecilia Belo, Zita Dela Merced, Annavi Marie G. Villanueva, Jaira Mauhay, Alyannah Celis, Melissa Catli, Shuichi Suzuki, Tatsuya Ukawa, Shingo Tamaki, Bhim Gopal Dhoubhadel, Koya Ariyoshi, Elizabeth Freda O. Telan, Dorcas Valencia Umipig, Christopher M. Parry, Nobu Saito and Chris Smith
Trop. Med. Infect. Dis. 2021, 6(3), 112; https://doi.org/10.3390/tropicalmed6030112 - 26 Jun 2021
Cited by 4 | Viewed by 5376
Abstract
Identification of the causative pathogen in infectious diseases is important for surveillance and to guide treatment. In low- and middle-income countries (LMIC), conventional culture and identification methods, including biochemical methods, are reference-standard. Biochemical methods can lack sensitivity and specificity and have slow turnaround [...] Read more.
Identification of the causative pathogen in infectious diseases is important for surveillance and to guide treatment. In low- and middle-income countries (LMIC), conventional culture and identification methods, including biochemical methods, are reference-standard. Biochemical methods can lack sensitivity and specificity and have slow turnaround times, causing delays in definitive therapy. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI–TOF MS) is a rapid and accurate diagnostic method. Most studies comparing MALDI–TOF MS and biochemical methods are from high-income countries, with few reports from LMIC with tropical climates. The aim of this study was to assess the performance of MALDI–TOF MS compared to conventional methods in the Philippines. Clinical bacterial or fungal isolates were identified by both MALDI–TOF MS and automated (VITEK2) or manual biochemical methods in the San Lazaro Hospital, Metro Manila, the Philippines. The concordance between MALDI–TOF MS and automated (VITEK2) or manual biochemical methods was analyzed at the species and genus levels. In total, 3530 bacterial or fungal isolates were analyzed. The concordance rate between MALDI–TOF MS and biochemical methods was 96.2% at the species level and 99.9% at the genus level. Twenty-three isolates could not be identified by MALDI–TOF MS. In this setting, MALDI–TOF MS was accurate compared with biochemical methods, at both the genus and the species level. Additionally, MALDI–TOF MS improved the turnaround time for results. These advantages could lead to improved infection management and infection control in low- and middle-income countries, even though the initial cost is high. Full article
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40 pages, 1375 KiB  
Review
Schistosomiasis with a Focus on Africa
by Oyime Poise Aula, Donald P. McManus, Malcolm K. Jones and Catherine A. Gordon
Trop. Med. Infect. Dis. 2021, 6(3), 109; https://doi.org/10.3390/tropicalmed6030109 - 22 Jun 2021
Cited by 62 | Viewed by 17601
Abstract
Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails [...] Read more.
Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic. Full article
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17 pages, 1860 KiB  
Review
Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome
by Elizabeth M. Traverse, Hannah K. Hopkins, Vedana Vaidhyanathan and Kelli L. Barr
Trop. Med. Infect. Dis. 2021, 6(3), 108; https://doi.org/10.3390/tropicalmed6030108 - 22 Jun 2021
Cited by 15 | Viewed by 5367
Abstract
Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In [...] Read more.
Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In adults, case reports include symptoms ranging from tachycardia and arrythmia, to myocarditis and cardiac arrest. In children, case reports describe symptoms such as arrythmia, myocarditis, and heart failure. Case reports of perinatal and neonatal CHIKV infections have also described cardiovascular compromise, including myocardial hypertrophy, ventricular dysfunction, myocarditis, and death. Myocarditis refers to inflammation of the heart tissue, which can be caused by viral infection, thus becoming viral myocarditis. Since viral myocarditis is linked as a causative factor of other cardiomyopathies, including dilated cardiomyopathy, in which the heart muscle weakens and fails to pump blood properly, the connection between CHIKV and the heart is concerning. We searched Pubmed, Embase, LILACS, and Google Scholar to identify case reports of CHIKV infections where cardiac symptoms were reported. We utilized NCBI Virus and NCBI Nucleotide to explore the lineage/evolution of strains associated with these outbreaks. Statistical analysis was performed to identify which clinical features were associated with death. Phylogenetic analysis determined that CHIKV infections with cardiac symptoms are associated with the Asian, the East Central South African, and the Indian Ocean lineages. Of patients admitted to hospital, death rates ranged from 26–48%. Myocarditis, hypertension, pre-existing conditions, and the development of heart failure were significantly correlated with death. As such, clinicians should be aware in their treatment and follow-up of patients. Full article
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12 pages, 1735 KiB  
Review
Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review
by Resi Pucci, Andrea Cassoni, Daniele Di Carlo, Marco Della Monaca, Umberto Romeo and Valentino Valentini
Trop. Med. Infect. Dis. 2021, 6(2), 106; https://doi.org/10.3390/tropicalmed6020106 - 21 Jun 2021
Cited by 7 | Viewed by 6514
Abstract
Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two [...] Read more.
Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two individuals. A case of a 36-year-old pregnant patient with a submandibular abscess caused by an odontogenic infection is reported, followed by a comprehensive systematic review of the literature in order to retrieve information regarding severe odontogenic infections and adverse pregnancy outcomes. The review was conducted according to the PRISMA guidelines using PubMed, Scopus, and Google Scholar databases. A total of 69 cases were included in the qualitative analysis. The mean age was 27.72 years. Patients were managed with surgery in combination with antibiotics. Nine infectious-related cesarean sections were detected, and preterm birth was associated in 3 cases, low birth weight in 2 cases, death of the fetus in 9 cases (13%), and maternal death in 4 cases (5.8%). The possible compromise of oral health during pregnancy is well known; however, severe odontogenic infections are rarely considered in the literature, and they may be associated with severe and life-threatening complications for both mother and the fetus. Full article
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16 pages, 2782 KiB  
Article
Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar
by Giovanni S. P. Malloy, Margaret L. Brandeau and Jeremy D. Goldhaber-Fiebert
Trop. Med. Infect. Dis. 2021, 6(2), 101; https://doi.org/10.3390/tropicalmed6020101 - 11 Jun 2021
Cited by 7 | Viewed by 5693
Abstract
Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread [...] Read more.
Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread of plague between interacting populations of humans, rats, and fleas and performed a cost-effectiveness analysis calibrated to a 2017 Madagascar outbreak. We assessed three interventions alone and in combination: expanded access to antibiotic treatment with doxycycline, mass distribution of doxycycline prophylaxis, and mass distribution of malathion. We varied intervention timing and coverage levels. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY (GDP per capita in Madagascar), was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective. Our analysis highlights the potential for rapid expansion of access to doxycycline upon recognition of plague outbreaks to cost-effectively prevent future large-scale plague outbreaks and highlights the importance of intervention timing. Full article
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18 pages, 2756 KiB  
Article
Evolution of Rabies in South America and Inter-Species Dynamics (2009–2018)
by Mauro Meske, Angela Fanelli, Felipe Rocha, Lina Awada, Paula Caceres Soto, Neo Mapitse and Paolo Tizzani
Trop. Med. Infect. Dis. 2021, 6(2), 98; https://doi.org/10.3390/tropicalmed6020098 - 9 Jun 2021
Cited by 23 | Viewed by 8073
Abstract
Rabies is listed as one of the World Health Organisation’s (WHO) Neglected Tropical Diseases Worldwide, with a significant impact in South America. This paper explores the dynamics of rabies cases in humans, pets (dogs and cats), livestock and wildlife (bats in particular) in [...] Read more.
Rabies is listed as one of the World Health Organisation’s (WHO) Neglected Tropical Diseases Worldwide, with a significant impact in South America. This paper explores the dynamics of rabies cases in humans, pets (dogs and cats), livestock and wildlife (bats in particular) in South America during the period 2009–2018. The data used in this study were derived from the two main databases for rabies in South America: the OIE-WAHIS from the World Organisation for Animal Health (OIE) and PANAFTOSA’s Regional Information System for the Epidemiological Surveillance of Rabies (SIRVERA). Being a neglected disease with possible underreporting in some areas, the reported rabies cases may not always represent the real disease burden. The analysis focuses on the evolution of the number of cases in time and their spatial distribution, as well as on the main source of infections in humans, determined by laboratory assays of the antigenic variant or through epidemiological investigations. Additionally, Generalised Linear Mixed Models (GLMM) were used to evaluate the risk factors associated with the occurrence of human cases. Our results show that the highest impact of the disease in terms of number of cases was reported on livestock, while the overall number of cases (in animals and humans) progressively decreased along the study period. The spatial distribution of rabies in livestock showed two main clusters in the north-western (mainly Colombia) and in the south-eastern part of the affected area (Brazil), and a third smaller cluster in Peru. A cluster in dogs was observed in Bolivia. Out of the 192 human cases reported during the study period, 70% of them were transmitted by bats. The number of human cases reported during the study period were significantly associated with the number of rabies cases reported in livestock, pets and wildlife. Despite the overall decreasing case report rate, the disease still represents a major animal and public health concern in South America, and new strategies for compiling systematic information, networking and education are needed, as well as the education and training of veterinary staff. Full article
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19 pages, 2439 KiB  
Review
Lymphocytic Choriomeningitis—Emerging Trends of a Neglected Virus: A Narrative Review
by Tatjana Vilibic-Cavlek, Vladimir Savic, Thomas Ferenc, Anna Mrzljak, Ljubo Barbic, Maja Bogdanic, Vladimir Stevanovic, Irena Tabain, Ivana Ferencak and Snjezana Zidovec-Lepej
Trop. Med. Infect. Dis. 2021, 6(2), 88; https://doi.org/10.3390/tropicalmed6020088 - 25 May 2021
Cited by 27 | Viewed by 7933
Abstract
Lymphocytic choriomeningitis virus (LCMV) is a neglected rodent-borne zoonotic virus distributed worldwide. Since serologic assays are limited to several laboratories, the disease has been underreported, often making it difficult to determine incidence and seroprevalence rates. Although human clinical cases are rarely recorded, LCMV [...] Read more.
Lymphocytic choriomeningitis virus (LCMV) is a neglected rodent-borne zoonotic virus distributed worldwide. Since serologic assays are limited to several laboratories, the disease has been underreported, often making it difficult to determine incidence and seroprevalence rates. Although human clinical cases are rarely recorded, LCMV remains an important cause of meningitis in humans. In addition, a fatal donor-derived LCMV infection in several clusters of solid organ transplant recipients further highlighted a pathogenic potential and clinical significance of this virus. In the transplant populations, abnormalities of the central nervous system were also found, but were overshadowed by the systemic illness resembling the Lassa hemorrhagic fever. LCMV is also an emerging fetal teratogen. Hydrocephalus, periventricular calcifications and chorioretinitis are the predominant characteristics of congenital LCMV infection, occurring in 87.5% of cases. Mortality in congenitally infected children is about 35%, while 70% of them show long-term neurologic sequelae. Clinicians should be aware of the risks posed by LCMV and should consider the virus in the differential diagnosis of aseptic meningitis, especially in patients who reported contact with rodents. Furthermore, LCMV should be considered in infants and children with unexplained hydrocephalus, intracerebral calcifications and chorioretinitis. Despite intensive interdisciplinary research efforts, efficient antiviral therapy for LCMV infection is still not available. Full article
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8 pages, 255 KiB  
Article
Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers
by Verónica Montiel, Daniel Pérez-Prieto, Simone Perelli and Joan Carles Monllau
Trop. Med. Infect. Dis. 2021, 6(2), 43; https://doi.org/10.3390/tropicalmed6020043 - 31 Mar 2021
Cited by 8 | Viewed by 2951
Abstract
Purpose: The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the [...] Read more.
Purpose: The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. Materials and Methods: This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. Results: A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. Discussion: The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior. Full article
12 pages, 700 KiB  
Systematic Review
Presence of Methicillin-Resistant Staphylococcus aureus (MRSA) on Healthcare Workers’ Attire: A Systematic Review
by Pavlina Lena, Angela Ishak, Spyridon A Karageorgos and Constantinos Tsioutis
Trop. Med. Infect. Dis. 2021, 6(2), 42; https://doi.org/10.3390/tropicalmed6020042 - 31 Mar 2021
Cited by 11 | Viewed by 4655
Abstract
Contaminated healthcare workers’ (HCW) clothing risk transferring methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. We performed a systematic review in Pubmed and Scopus for 2000–2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to analyze evidence of MRSA [...] Read more.
Contaminated healthcare workers’ (HCW) clothing risk transferring methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. We performed a systematic review in Pubmed and Scopus for 2000–2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to analyze evidence of MRSA on HCW attire. The primary study outcome was MRSA isolation rates on HCW clothing in healthcare settings. Out of 4425 articles, 23 studies were included: 18 with 1760 HCWs, four with 9755 HCW–patient interactions and one with 512 samples. There was a notable variation in HCWs surveyed, HCW attires, sampling techniques, culture methods and laundering practices. HCW attire was frequently colonized with MRSA with the highest rates in long-sleeved white coats (up to 79%) and ties (up to 32%). Eight studies reported additional multidrug-resistant bacteria on the sampled attire. HCW attire, particularly long-sleeved white coats and ties, is frequently contaminated with MRSA. Banning certain types and giving preference to in-house laundering in combination with contact precautions can effectively decrease MRSA contamination and spread. Full article
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11 pages, 1469 KiB  
Article
Doctors’ Perceptions, Attitudes and Practices towards the Management of Multidrug-Resistant Organism Infections after the Implementation of an Antimicrobial Stewardship Programme during the COVID-19 Pandemic
by Nikolaos Spernovasilis, Despo Ierodiakonou, Christos Spanias, Anna Mathioudaki, Petros Ioannou, Emmanouil C. Petrakis and Diamantis P. Kofteridis
Trop. Med. Infect. Dis. 2021, 6(1), 20; https://doi.org/10.3390/tropicalmed6010020 - 5 Feb 2021
Cited by 11 | Viewed by 3857
Abstract
Background: Greece is among the European countries with the highest consumption of antibiotics, both in community and hospital settings, including last-line antibiotics, such as carbapenems. We sought to explore doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) [...] Read more.
Background: Greece is among the European countries with the highest consumption of antibiotics, both in community and hospital settings, including last-line antibiotics, such as carbapenems. We sought to explore doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) infections after the implementation of an antimicrobial stewardship programme (ASP) in a tertiary academic hospital during the COVID-19 pandemic. Methods: A self-administered, internet-based questionnaire survey was completed by doctors of the University Hospital of Heraklion in Crete, Greece. Results: In total, 202 (59.1%) hospital doctors fully completed the questionnaire. Most of them agreed that the prospective audit and feedback ASP strategy is more effective and educational than the preauthorization ASP strategy. ASP implementation prompted most respondents to monitor the continuously evolving microbiological data of their patients more closely and affected them towards a multidisciplinary and personalised care of patients with infections caused by MDROs and towards a more rigorous implementation of infection prevention and control measures. The vast majority of participants (98.5%) stated that ASP must be continued and further developed during the COVID-19 pandemic. Conclusion: The ASP implementation in our hospital had a beneficial impact on doctors’ perceptions, attitudes and practices with regard to the management of infections due to MDROs. Full article
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10 pages, 593 KiB  
Review
Infective Endocarditis by Yersinia Species: A Systematic Review
by Petros Ioannou, Georgios Vougiouklakis, Stella Baliou, Eugenia Miliara and Diamantis P. Kofteridis
Trop. Med. Infect. Dis. 2021, 6(1), 19; https://doi.org/10.3390/tropicalmed6010019 - 2 Feb 2021
Cited by 15 | Viewed by 3521
Abstract
Yersinia spp. are non-spore-forming Gram-negative bacilli. They comprise only three species known to cause disease in humans, namely Y. pestis, Y. enterocolitica and Y. pseudotuberculosis. Since infective endocarditis (IE) is rarely caused by Yersinia, the management of these infections can [...] Read more.
Yersinia spp. are non-spore-forming Gram-negative bacilli. They comprise only three species known to cause disease in humans, namely Y. pestis, Y. enterocolitica and Y. pseudotuberculosis. Since infective endocarditis (IE) is rarely caused by Yersinia, the management of these infections can be problematic due to the lack of experience. The purpose of this study was to systematically review all published cases of IE by Yersinia species in the literature. A systematic review of PubMed, Scopus and Cochrane Library (through 1 November 2020) for studies providing epidemiological, clinical and microbiological information as well as data on treatment and outcomes of IE caused by Yersinia species was performed. A total of 12 studies, containing data of 12 patients, were included. A prosthetic valve was present in 17% of patients. The mitral valve was the most commonly infected site, followed by the aortic valve. Fever, sepsis and embolic phenomena were common clinical signs, followed by heart failure. Aminoglycosides, cephalosporins and quinolones were the most commonly used antimicrobials. Clinical cure was noted in 83%, while overall mortality was 17%. This systematic review describes IE by Yersinia and provides information on patients’ epidemiology, clinical signs and the related therapeutic strategies and outcomes. Full article
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12 pages, 282 KiB  
Article
Compliance to Screening Protocols for Multidrug-Resistant Microorganisms at the Emergency Departments of Two Academic Hospitals in the Dutch–German Cross-Border Region
by Lisa B. Gunnink, Donia J. Arouri, Floris E.J. Jolink, Mariëtte Lokate, Klaas de Jonge, Stefanie Kampmeier, Carolin Kreis, Michael Raschke, Mirjam Kleinjan, Jan C. ter Maaten, Alex W. Friedrich, Erik Bathoorn and Corinna Glasner
Trop. Med. Infect. Dis. 2021, 6(1), 15; https://doi.org/10.3390/tropicalmed6010015 - 26 Jan 2021
Cited by 3 | Viewed by 3360
Abstract
Infections caused by multidrug-resistant organisms (MDROs) are associated with prolonged hospitalization and higher risk of mortality. Patients arriving in the hospital via the emergency department (ED) are screened for the presence of MDROs in compliance with the screening protocols in order to apply [...] Read more.
Infections caused by multidrug-resistant organisms (MDROs) are associated with prolonged hospitalization and higher risk of mortality. Patients arriving in the hospital via the emergency department (ED) are screened for the presence of MDROs in compliance with the screening protocols in order to apply the correct isolation measures. In the Dutch–German border region, local hospitals apply their own screening protocols which are based upon national screening protocols. The contents of the national and local MDRO screening protocols were compared on vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenemase-producing and carbapenem-resistant Enterobacteriaceae (CPE/CRE). The practicality of the screening protocols was evaluated by performing an audit. As a result, the content of the MDRO screening protocols differed regarding risk factors for MDRO carriage, swab site, personal protective equipment, and isolation measures. The observations and questionnaires showed that the practicality was sufficient; however, the responsibility was not designated clearly and education regarding the screening protocols was deemed inappropriate. The differences between the MDRO screening protocols complicate patient care in the Dutch–German border region. Arrangements have to be made about the responsibility of the MDRO screening, and improvements are necessary concerning education regarding the MDRO screening protocols. Full article

2020

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12 pages, 304 KiB  
Review
Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients
by Ferdinando Iannotti, Paolo Prati, Andrea Fidanza, Raffaele Iorio, Andrea Ferretti, Daniel Pèrez Prieto, Nanne Kort, Bruno Violante, Gennaro Pipino, Alfredo Schiavone Panni, Michael Hirschmann, Marco Mugnaini and Pier Francesco Indelli
Trop. Med. Infect. Dis. 2020, 5(4), 186; https://doi.org/10.3390/tropicalmed5040186 - 11 Dec 2020
Cited by 44 | Viewed by 6683
Abstract
Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk [...] Read more.
Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI. Full article
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