Infections Treatment and Prevention Today
1 in 5 Kids With Cold Develops Middle Ear Infection
WEDNESDAY, Feb. 16 (HealthDay News) — About one in five children with a cold or other respiratory viral infection develops a middle ear infection that may range from mild to severe, says a new study.
U.S. researchers looked at the number of cases of middle ear infection — acute otitis media — among 294 children, ages 6 months to 3 years. Overall, 22 percent of the children developed a middle ear infection during the first week of respiratory infection.
A diagnosis of acute otitis media was based on the presence of symptoms such as fever and earache, plus inflammation of the eardrum and fluid in the middle ear. Along with the 22 percent of children who developed the ear infection, another 7 percent had inflammation of the eardrum without fluid in the middle ear.
Among the children with the middle ear infection, eardrum inflammation was rated mild in 8 percent, moderate in 59 percent and severe in 35 percent. Of the 126 children who had the infection in both ears, the infection was more pronounced in one ear in 54 percent of the cases.
In general, children with the infection were treated without antibiotics whenever possible. Of the 28 children with mild middle ear infection, 24 improved without antibiotics, four got worse and three of them eventually required antibiotics.
The study appears in the February issue of The Pediatric Infectious Disease Journal.
The findings suggest that many children with mild middle ear infections can be managed without antibiotics, said lead author Dr. Stella U. Kalu, University of Texas Medical Branch at Galveston, and colleagues, in a journal news release.
Infection Control Checklist Reduces CLABSIs, Mortality
Older Americans who were treated in Michigan intensive care units were less likely to die while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS’ Agency for Healthcare Research and Quality.
The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections, which was found to also decrease the likelihood of mortality. The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety and improving communication among ICU staff teams. The Project also implements practices based on guidelines by the Centers for Disease Control and Prevention, such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia.
Researchers analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that a person’s chance of dying decreased by approximately 24 percent in Michigan after the program was implemented, compared to by only 16 percent in surrounding Midwestern states where the program was not implemented.
First U.S. Cowpox Infection: Acquired From Lab Contamination
A student laboratory worker at the University of Illinois, Urbana-Champaign, is the first person in the United States to come down with cowpox, a less dangerous relative of smallpox, and the culprit is lab contamination. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) reported last week at the International Meeting on Emerging Diseases and Surveillance in Vienna that the unvaccinated patient was infected by a genetically modified cowpox virus strain in her research lab, one she had never even worked with, by inadvertently handling contaminated materials.
Cowpox exists in the wild in Europe and Asia, where it is carried by rats and other animals and is often reported in veterinarians and zoo workers, but isn’t found in the United States except in research labs. It can severely affect immunocompromised patients, but is not normally lethal. CDC still recommends smallpox vaccination for all lab workers who come in contact with intact orthopoxviruses, a category that includes vaccinia, cowpox, and other animal viruses. The cowpox patient had declined vaccination since she had no intention of handling the virus, and the lab hadn’t worked on cowpox for 5 years previous to the incident.
However, CDC investigators found cowpox DNA in many locations around the lab and in stocks of purportedly harmless virus, although no live poxvirus was found on surfaces. The student said she didn’t recall an injury or needle stick prior to developing a painful lesion on her finger in July 2010, so it seemed the infection likely occurred from handling chemicals and contaminated samples. In October, a biopsy was sent to CDC, which worked with the Illinois Department of Public Health (IDPH) to identify the disease as cowpox caused by one of the modified virus strains stored in the lab’s freezer.
Mary Reynolds, an epidemiologist in the CDC’s Division of High-Consequence Pathogens and Pathology who worked on the study, said that CDC and IDPH have made safety recommendations to the University of Illinois’s biological safety department that are now under consideration. University spokesperson Robin Kaler said that while the investigation showed that the lab had been following established campus policy for storing hazardous materials, the campus is now taking steps to ensure that all people in a lab with such materials are aware of safety procedures. The laboratory personnel worked with investigators to track the course of the infection and concluded that no data from the contaminated samples had been published.
Gigi Kwik Gronvall of the Center for Biosecurity of the University of Pittsburgh Medical Center in Baltimore, Maryland, calls the incident “one more example of many examples that speaks to the need for more vigilance” in lab practices. Infections from labs, she says, could be far more common than reported, partly because labs don’t want the blame and partly because in the absence of a needle stick, patients have trouble pinning down why they are sick. Identifying the cause may be particularly difficult in the case of infection by recombinant organisms, which must be reported to the National Institutes of Health and CDC. A patient’s symptoms may be different than those caused by a wild organism. Fortunately in this case the distinct pustule formed by cowpox was telling.
“We’re becoming quite interested in the concept of people inadvertently being infected with recombinant organisms, not necessarily because of a high safety risk but because of the challenge it provides to state health departments in confirming diagnosis,” says Reynolds. Genetic modification of viruses can confound the usual DNA sequencing methods used to identify the virus and make it even more difficult to track down the source. Reynolds says that CDC investigators are beginning to work with the National Institutes of Health Office of Biotechnology Activities and state public health agencies to discuss better ways to diagnose such infections.