Infections in People Who Use Drugs: Staphylococcus Aureus and Group a Streptococcus What Workers Need to Know
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Family Practice
THE JOURNAL OF FAMILY ONLINE EXCLUSIVE PRACTICE Paul K. Carlton, Jr, MD, Brown recluse spider bite? FACS The Texas A&M University Consider this uniquely Health Science Center College Station, Tex conservative treatment [email protected] An antihistamine and observation work as well— and often better—than more intensive therapies. Practice recommendations oped it in 4 phases, which I describe in • Be concerned about brown recluse this article. Not only does this conser- envenomation when a patient vative approach consistently heal con- reports intensifying localized firmed brown recluse bite wounds, but pain disproportionate to physical should a bite be mistakenly attributed findings after a “bite” (C). to the brown recluse (or one of its rela- tives in the Loxosceles genus of spider), • Prescribe an oral antihistamine there is no harm to the patient, nor any alone to control symptoms, even big expense. with a necrotic wound, and mark the IN THIS ARTICLE patient’s progress over 24 hours (C). z Spider bite z Is a brown recluse • If the patient improves dramatically, to blame? or MRSA? continue the antihistamine; with little Due to limited experience among the Page E6 or no improvement, consider giving an wider medical community in identifying antibiotic with the antihistamine (C). spider envenomation,1-4 bite recognition and selection of appropriate therapy can Strength of recommendation (SOR) be difficult. A Good-quality patient-oriented evidence Early findings can be confusing. B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented Brown recluse bites typically feel like a evidence, case series pin prick. -
The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections
toxins Review The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections Patience Shumba 1, Srikanth Mairpady Shambat 2 and Nikolai Siemens 1,* 1 Center for Functional Genomics of Microbes, Department of Molecular Genetics and Infection Biology, University of Greifswald, D-17489 Greifswald, Germany; [email protected] 2 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland; [email protected] * Correspondence: [email protected]; Tel.: +49-3834-420-5711 Received: 20 May 2019; Accepted: 10 June 2019; Published: 11 June 2019 Abstract: Necrotizing soft tissue infections (NSTIs) are critical clinical conditions characterized by extensive necrosis of any layer of the soft tissue and systemic toxicity. Group A streptococci (GAS) and Staphylococcus aureus are two major pathogens associated with monomicrobial NSTIs. In the tissue environment, both Gram-positive bacteria secrete a variety of molecules, including pore-forming exotoxins, superantigens, and proteases with cytolytic and immunomodulatory functions. The present review summarizes the current knowledge about streptococcal and staphylococcal toxins in NSTIs with a special focus on their contribution to disease progression, tissue pathology, and immune evasion strategies. Keywords: Streptococcus pyogenes; group A streptococcus; Staphylococcus aureus; skin infections; necrotizing soft tissue infections; pore-forming toxins; superantigens; immunomodulatory proteases; immune responses Key Contribution: Group A streptococcal and Staphylococcus aureus toxins manipulate host physiological and immunological responses to promote disease severity and progression. 1. Introduction Necrotizing soft tissue infections (NSTIs) are rare and represent a more severe rapidly progressing form of soft tissue infections that account for significant morbidity and mortality [1]. -
Drug-Resistant Streptococcus Pneumoniae and Methicillin
NEWS & NOTES Conference Summary pneumoniae can vary among popula- conference sessions was that statically tions and is influenced by local pre- sound methods of data collection that Drug-resistant scribing practices and the prevalence capture valid, meaningful, and useful of resistant clones. Conference pre- data and meet the financial restric- Streptococcus senters discussed the role of surveil- tions of state budgets are indicated. pneumoniae and lance in raising awareness of the Active, population-based surveil- Methicillin- resistance problem and in monitoring lance for collecting relevant isolates is the effectiveness of prevention and considered the standard criterion. resistant control programs. National- and state- Unfortunately, this type of surveil- Staphylococcus level epidemiologists discussed the lance is labor-intensive and costly, aureus benefits of including state-level sur- making it an impractical choice for 1 veillance data with appropriate antibi- many states. The challenges of isolate Surveillance otic use programs designed to address collection, packaging and transport, The Centers for Disease Control the antibiotic prescribing practices of data collection, and analysis may and Prevention (CDC) convened a clinicians. The potential for local sur- place an unacceptable workload on conference on March 12–13, 2003, in veillance to provide information on laboratory and epidemiology person- Atlanta, Georgia, to discuss improv- the impact of a new pneumococcal nel. ing state-based surveillance of drug- vaccine for children was also exam- Epidemiologists from several state resistant Streptococcus pneumoniae ined; the vaccine has been shown to health departments that have elected (DRSP) and methicillin-resistant reduce infections caused by resistance to implement enhanced antimicrobial Staphylococcus aureus (MRSA). -
What Is Staphylococcus Aureus (Staph)?
What is Staphylococcus aureus (staph)? Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics (also known as antimicrobials or antibacterials). However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia). What is MRSA (methicillin-resistant Staphylococcus aureus)? Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA. Who gets staph or MRSA infections? Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia. Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions? People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. -
Methicillin-Resistant Staphylococcus Aureus and Clostridium Difficile Infection Lab ID Event Report
Methicillin-Resistant Staphylococcus aureus and Clostridium difficile Infection Lab ID Event Report Facility Name: Date of Event Report: Sex: M F □ □ Date of Birth: Race: □ White □ Black or African American □ Asian □ Native Hawaiian or Other Pacific Islander □ American Indian or Alaska Native □ Other [specify] __________________ Ethnicity: □ Hispanic or Latino □ Not Hispanic or Latino □ Other Event Details Date Specimen Collected: Date Specimen Finalized: Specific Organism Type: (Check one) □ Methicillin-Resistant Staphylococcus aureus (MRSA) □ Clostridium difficile Infection (CDI) Specimen Source (e.g. blood, wound, sputum, bone, Specimen Body Site/System try to be as specific as possible urine, stool): (e.g. upper right arm, foot ulcer, gastrointestinal tract): Date Admitted to your Facility: Location at time of Specimen Collection (name of specific unit, ward, or floor): Date Admitted to Location: Has patient been discharged from your facility in the past 3 months? Yes No If Yes, date of last discharge from your facility: Comments Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)). For use by Michigan Department of Community Health (MDCH), Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit’s MRSA/CDI Prevention Initiative (Coordinator: Gail Denkins, SHARP Intern: Kate Manton); fax completed forms to (517) 335-8263, ATTN: Kate Manton. -
Staphylococcus Aureus (Staph Infection)
Staphylococcus aureus (Staph Infection) This sheet talks about exposure to Staphylococcus aureus and Staph infections in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider. What is Staphylococcus aureus / a Staph infection? Staphylococcus aureus (Staph) are a type of bacteria (germ). Staph bacteria are commonly found on the skin or in the nose. Most of the time, people will not have problems with these bacteria. However, if Staph gets inside the body through a cut or sore, this could lead to a Staph infection. Staph infection can cause boils or blisters on the skin; or infections in the lungs (pneumonia), bloodstream (sepsis), or in a wound. People with a higher chance of getting a Staph infection include sick people in hospitals, people recovering from surgeries or other medical procedures, people living in over-crowded conditions (shelters or prisons), children in daycare, intravenous (IV) drug users, people with weakened immune systems, people with chronic health conditions (like diabetes or cancer), athletes, and military personnel. Eating food that has been contaminated with Staph bacteria can also cause food poisoning. Symptoms can be severe vomiting and diarrhea with stomach pain that will start within a few hours after exposure. This type of infection with Staph bacteria usually is not serious and generally does not last for more than a day. I am pregnant. If my partner, other family member, or friend has a confirmed Staph skin infection, what can I do to reduce my chances of getting the infection? Do not touch the person’s sores, cuts, or bandages. -
Scarlet Fever Fact Sheet
Scarlet Fever Fact Sheet Scarlet fever is a rash illness caused by a bacterium called Group A Streptococcus (GAS) The disease most commonly occurs with GAS pharyngitis (“strep throat”) [See also Strep Throat fact sheet]. Scarlet fever can occur at any age, but it is most frequent among school-aged children. Symptoms usually start 1 to 5 days after exposure and include: . Sandpaper-like rash, most often on the neck, chest, elbows, and on inner surfaces of the thighs . High fever . Sore throat . Red tongue . Tender and swollen neck glands . Sometimes nausea and vomiting Scarlet fever is usually spread from person to person by direct contact The strep bacterium is found in the nose and/or throat of persons with strep throat, and can be spread to the next person through the air with sneezing or coughing. People with scarlet fever can spread the disease to others until 24 hours after treatment. Treatment of scarlet fever is important Persons with scarlet fever can be treated with antibiotics. Treatment is important to prevent serious complications such as rheumatic fever and kidney disease. Infected children should be excluded from child care or school until 24 hours after starting treatment. Scarlet fever and strep throat can be prevented . Cover the mouth when coughing or sneezing. Wash hands after wiping or blowing nose, coughing, and sneezing. Wash hands before preparing food. See your doctor if you or your child have symptoms of scarlet fever. Maryland Department of Health Infectious Disease Epidemiology and Outbreak Response Bureau Prevention and Health Promotion Administration Web: http://health.maryland.gov February 2013 . -
Association Between Carriage of Streptococcus Pneumoniae and Staphylococcus Aureus in Children
BRIEF REPORT Association Between Carriage of Streptococcus pneumoniae and Staphylococcus aureus in Children Gili Regev-Yochay, MD Context Widespread pneumococcal conjugate vaccination may bring about epidemio- Ron Dagan, MD logic changes in upper respiratory tract flora of children. Of particular significance may Meir Raz, MD be an interaction between Streptococcus pneumoniae and Staphylococcus aureus, in view of the recent emergence of community-acquired methicillin-resistant S aureus. Yehuda Carmeli, MD, MPH Objective To examine the prevalence and risk factors of carriage of S pneumoniae Bracha Shainberg, PhD and S aureus in the prevaccination era in young children. Estela Derazne, MSc Design, Setting, and Patients Cross-sectional surveillance study of nasopharyn- geal carriage of S pneumoniae and nasal carriage of S aureus by 790 children aged 40 Galia Rahav, MD months or younger seen at primary care clinics in central Israel during February 2002. Ethan Rubinstein, MD Main Outcome Measures Carriage rates of S pneumoniae (by serotype) and S aureus; risk factors associated with carriage of each pathogen. TREPTOCOCCUS PNEUMONIAE AND Results Among 790 children screened, 43% carried S pneumoniae and 10% car- Staphylococcus aureus are com- ried S aureus. Staphylococcus aureus carriage among S pneumoniae carriers was 6.5% mon inhabitants of the upper vs 12.9% in S pneumoniae noncarriers. Streptococcus pneumoniae carriage among respiratory tract in children and S aureus carriers was 27.5% vs 44.8% in S aureus noncarriers. Only 2.8% carried both Sare responsible for common infec- pathogens concomitantly vs 4.3% expected dual carriage (P=.03). Risk factors for tions. Carriage of S aureus and S pneu- S pneumoniae carriage (attending day care, having young siblings, and age older than moniae can result in bacterial spread and 3 months) were negatively associated with S aureus carriage. -
Clostridium Difficile Infection: How to Deal with the Problem DH INFORMATION RE ADER B OX
Clostridium difficile infection: How to deal with the problem DH INFORMATION RE ADER B OX Policy Estates HR / Workforce Commissioning Management IM & T Planning / Finance Clinical Social Care / Partnership Working Document Purpose Best Practice Guidance Gateway Reference 9833 Title Clostridium difficile infection: How to deal with the problem Author DH and HPA Publication Date December 2008 Target Audience PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Medical Directors, Directors of PH, Directors of Nursing, PCT PEC Chairs, NHS Trust Board Chairs, Special HA CEs, Directors of Infection Prevention and Control, Infection Control Teams, Health Protection Units, Chief Pharmacists Circulation List Description This guidance outlines newer evidence and approaches to delivering good infection control and environmental hygiene. It updates the 1994 guidance and takes into account a national framework for clinical governance which did not exist in 1994. Cross Ref N/A Superseded Docs Clostridium difficile Infection Prevention and Management (1994) Action Required CEs to consider with DIPCs and other colleagues Timing N/A Contact Details Healthcare Associated Infection and Antimicrobial Resistance Department of Health Room 528, Wellington House 133-155 Waterloo Road London SE1 8UG For Recipient's Use Front cover image: Clostridium difficile attached to intestinal cells. Reproduced courtesy of Dr Jan Hobot, Cardiff University School of Medicine. Clostridium difficile infection: How to deal with the problem Contents Foreword 1 Scope and purpose 2 Introduction 3 Why did CDI increase? 4 Approach to compiling the guidance 6 What is new in this guidance? 7 Core Guidance Key recommendations 9 Grading of recommendations 11 Summary of healthcare recommendations 12 1. -
Chapter 11 – PROKARYOTES: Survey of the Bacteria & Archaea
Chapter 11 – PROKARYOTES: Survey of the Bacteria & Archaea 1. The Bacteria 2. The Archaea Important Metabolic Terms Oxygen tolerance/usage: aerobic – requires or can use oxygen (O2) anaerobic – does not require or cannot tolerate O2 Energy usage: autotroph – uses CO2 as a carbon source • photoautotroph – uses light as an energy source • chemoautotroph – gets energy from inorganic mol. heterotroph – requires an organic carbon source • chemoheterotroph – gets energy & carbon from organic molecules …more Important Terms Facultative vs Obligate: facultative – “able to, but not requiring” e.g. • facultative anaerobes – can survive w/ or w/o O2 obligate – “absolutely requires” e.g. • obligate anaerobes – cannot tolerate O2 • obligate intracellular parasite – can only survive within a host cell The 2 Prokaryotic Domains Overview of the Bacterial Domain We will look at examples from several bacterial phyla grouped largely based on rRNA (ribotyping): Gram+ bacteria • Firmicutes (low G+C), Actinobacteria (high G+C) Proteobacteria (Gram- heterotrophs mainly) Gram- nonproteobacteria (photoautotrophs) Chlamydiae (no peptidoglycan in cell walls) Spirochaetes (coiled due to axial filaments) Bacteroides (mostly anaerobic) 1. The Gram+ Bacteria Gram+ Bacteria The Gram+ bacteria are found in 2 different phyla: Firmicutes • low G+C content (usually less than 50%) • many common pathogens Actinobacteria • high G+C content (greater than 50%) • characterized by branching filaments Firmicutes Characteristics associated with this phylum: • low G+C Gram+ bacteria -
Activation of the Bile Acid Pathway and No Observed Antimicrobial Peptide Sequences in the Skin of a Poison Frog
INVESTIGATION Activation of the Bile Acid Pathway and No Observed Antimicrobial Peptide Sequences in the Skin of a Poison Frog Megan L. Civitello,* Robert Denton,* Michael A. Zasloff,† and John H. Malone*,1 *Institute of Systems Genomics, Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut 06269 and †Georgetown University School of Medicine, MedStar Georgetown Transplant Institute, Washington D.C. 20057 ORCID IDs: 0000-0002-8629-1376 (R.D.); 0000-0003-1369-3769 (J.H.M.) ABSTRACT The skin secretions of many frogs have genetically-encoded, endogenous antimicrobial KEYWORDS peptides (AMPs). Other species, especially aposematic poison frogs, secrete exogenously derived alkaloids Anti-microbial that serve as potent defense molecules. The origins of these defense systems are not clear, but a novel bile- peptides acid derived metabolite, tauromantellic acid, was recently discovered and shown to be endogenous in defensive poison frogs (Mantella, Dendrobates, and Epipedobates). These observations raise questions about the secretions evolutionary history of AMP genetic elements, the mechanism and function of tauromatellic acid produc- phylogenetic tion, and links between these systems. To understand the diversity and expression of AMPs among frogs, history we assembled skin transcriptomes of 13 species across the anuran phylogeny. Our analyses revealed a bile acid pathway diversity of AMPs and AMP expression levels across the phylogenetic history of frogs, but no observations of AMPs in Mantella. We examined genes expressed in the bile-acid metabolic pathway and found that CYP7A1 (Cytochrome P450), BAAT (bile acid-CoA: amino acid N-acyltransferase), and AMACR (alpha- methylacyl-CoA racemase) were highly expressed in the skin of M. -
Streptococcus Pneumoniae Technical Sheet
technical sheet Streptococcus pneumoniae Classification On necropsy, a serosanguineous to purulent exudate Alpha-hemolytic, Gram-positive, encapsulated, aerobic is often found in the nasal cavities and the tympanic diplococcus bullae. The lungs can have areas of firm, dark red consolidation. Fibrinopurulent pleuritis, pericarditis, Family and peritonitis are other changes seen on necropsy of animals affected by S. pneumoniae. Histologic Streptococcaceae lesions are consistent with necropsy findings, Affected species and bronchopneumonia of varying severity and fibrinopurulent serositis are often seen. Primarily described as a pathogen of rats and guinea pigs. Mice are susceptible to infection. Agent of human Diagnosis disease and human carriers are a likely source of An S. pneumoniae infection should be suspected if animal infections. Zoonotic infection is possible. encapsulated Gram-positive diplococci are seen on a smear from a lesion. Confirmation of the diagnosis is Frequency via culture of lesions or affected tissues. S. pneumoniae Rare in modern laboratory animal colonies. Prevalence grows best on 5% blood agar and is alpha-hemolytic. in pet and wild populations unknown. The organism is then presumptively identified with an optochin test. PCR assays are also available for Transmission diagnosis. PCR-based screening for S. pneumoniae Transmission is primarily via aerosol or contact with may be conducted on respiratory samples or feces. nasal or lacrimal secretions of an infected animal. S. PCR may also be useful for confirmation of presumptive pneumoniae may be cultured from the nasopharynx and microbiologic identification or confirming the identity of tympanic bullae. bacteria observed in histologic lesions. Clinical Signs and Lesions Interference with Research Inapparent infections and carrier states are common, Animals carrying S.