Friday, January 04, 2013
Growth Factor: How Bacterial Infections Persist Through Antibiotics
Growth Factor: How Bacterial Infections Persist Through Antibiotics
By Katherine Harmon | Scientific American
Some strains of nasty bacterial infections, such as MRSA (methicillin-resistant Staphylococcus aureus), come loaded with resistance to antibiotics built right into their genes. But certain infections seem to acquire an ability to persist in the face of drugs that should knock them out--without developing the genetic hallmarks of antibiotic resistance. For decades, researchers have thought this holdout occurred because many antibiotics target cell growth, so even though most of the bacteria were killed by the drug, a select group simply shut down, going into a sort of hibernation, thereby allowing the infection to persist. In other words: if the bacteria aren't growing, they're also not dying.
But a new study suggests that quite the opposite is occurring: some surviving bacteria are actually flourishing and multiplying while under antibiotic attack. The findings were published online January 3 in Science.
"We thought that surviving bacteria made up a fixed population that stopped dividing," Neeraj Dhar, of the Swiss Federal Institute of Technology in Lausanne and study co-author, said in a prepared statement. Instead, a stable overall population was hiding a "very dynamic" colony, he said.
The researchers studied Mycobacterium smegmatis, a species closely related to the bacterium that causes tuberculosis (Mycobacterium tuberculosis), which often resists antibiotic treatment and remains a major health threat in many countries. The traditional analysis of a persistent culture of these bacteria would reveal that the population was not growing, which is what had led scientists to think that the colony had been reduced to non-proliferating "persister cells" that could better ride out the antibiotic attack by laying low. But using time-lapse images taken through a microscope of cells in a microfluidic culture (allowing study of small-scale changes), the researchers saw quite a different story.
"Using microfluidics, we can now observe every bacterium individually, instead of having to count a population," John McKinney, also of the Swiss Federal Institute of Technology, said in a prepared statement. Not only were the surviving cells not playing dead, they were just as likely to be growing as cells that died off.
McKinney and his team observed that even after the introduction of an antibiotic and the death of most bacterial cells, a large percentage of the so-called persister cells continuing to divide--129 of 153 progenitor cells they followed divided at least once in the face of antibiotic treatment. And this cycle of growth, division and death kept up for at least 10 days of exposure to the antibiotic.
The antibiotic was isoniazid (known by the drug names Laniazid and Nydrazid), which has been a common first-line treatment for tuberculosis. This antibiotic becomes an activated bacterium killer when it comes into contact with an enzyme called KatG that the bacteria produces. The enzyme, however, was not produced consistently, the researchers found. Instead, individual cells generated it in seemingly random spurts. So the cells that happened to have had pauses in their KatG production at just the right time were often able to avoid activating the antibiotic--and thus were saved from certain death.
Tuberculosis cells that should have been essentially identical, genetically, showed different propensities for survival, pointing to a possible role of epigenetic differences (such as those in gene expression) in determining cell survival. "This diversity is critical for microbial persistence in fluctuating environments because it ensures that some individuals may survive a lethal stress that would otherwise extinguish the population," the researchers explained in their paper.
Because cell survival does not seem to be tied to permanent genetic change in this case, it means the bacterial colony should remain susceptible to future antibiotic treatment, which could be good news for treating infections. However, given the low level of continued growth and change during exposure to antibiotics, "the bacteria can mutate and thus develop resistance in the presence of the antibiotic," Dhar said.
This discovery now paints a clearer picture of how antibiotic resistance can develop in persistent bacterial infections. With so many individual bacteria reproducing, "some of them can adapt to stressors that they have not previously encountered, thanks to the selection of persistent individuals," McKinney said. Such findings could help inform the creation of more effective antibiotics and perhaps expand to other illnesses, such as the persistence of cancer cells, although the researchers acknowledge that the persistence behavior of other bacterial infections might be quite different.
Nevertheless, the insights offer "a new approach for trying to figure out why some infections are so difficult to eliminate," McKinney said.
News Yahoo
Labels: antibiotics, bacterial infections, Laniazid, methicillin-resistant Staphylococcus aureus, MRSA, Mycobacterium tuberculosis, Nydrazid, persister cells
# posted by Pat O'Connor @ 7:31 AM
Tuesday, December 11, 2012
Injected bath salts linked to dangerous bacterial infections in Maine
Injected bath salts linked to dangerous bacterial infections in Maine
Posted Dec. 10, 2012, at 4:00 p.m.
Maine health officials are investigating a cluster of serious bacterial illnesses among users of synthetic bath salts.
Four patients with a history of injecting the drug were sickened by the Group A streptococcal bacterium over the last several weeks, according to a health alert issued by the Maine Center for Disease Control and Prevention. The common germ is responsible for strep throat and skin problems in its milder form but can also lead to life-threatening infections including the much-feared flesh-eating bacteria.
The first three cases arose in Aroostook County, followed by one in Penobscot County, said state epidemiologist Dr. Stephen Sears. The patients were between the ages of 23 and 37.
“Fortunately, they all survived,” he said. “It’s a pretty nasty infection.”
Two of the cases resulted in streptococcal toxic shock syndrome, which causes a rapid drop in blood pressure and can lead to organ failure. All of the patients were hospitalized, one required treatment in intensive care, and one developed necrotizing fasciitis, a condition that’s known as flesh-eating bacteria in its rare and most dangerous form.
The widely publicized infection — most recently grabbing headlines after forcing Georgia woman Aimee Copeland to undergo multiple amputations — destroys muscles, fat and skin tissue. The Maine patient, however, did not suffer the rapid, uncontrolled damage associated with flesh-eating bacteria, Sears said.
“This person, although having some tissue destruction, did not have the continuous, progressive problems we’ve seen described in other cases,” he said.
About a quarter of patients with necrotizing fasciitis die, while streptococcal toxic shock syndrome kills more than 35 percent of patients.
The Group A streptococcal bacterium is commonly found in the throat and on the skin, and people can carry it without experiencing symptoms or illness. It also causes cellulitis and impetigo, a highly contagious minor skin infection often caught by preschool-aged children.
Severe infections result when the otherwise tolerable bacterium infects blood and tissue. Healthy people can contract invasive forms of the disease, but those at higher risk include people with chronic illness, skin lesions, a history of alcohol abuse or injection drug use, as well as the elderly and those with suppressed immune systems.
The bacteria likely cropped up among bath salts users not through the sharing of needles but because injecting drugs gives it a way to enter the body, Sears said. For that reason, health officials are also concerned that the infection could strike users who inject drugs of any kind, he said.
“When you penetrate your skin you put yourself at much greater risk,” Sears said. “We don’t think that it’s necessarily in the bath salts themselves, that’s been one theory.”
Invasive Group A streptococcal disease strikes between 9,000 and 11,500 Americans every year, according to the U.S. CDC. Streptococcal toxic shock syndrome and necrotizing fasciitis each make up about 6 percent of those cases.
Severe Group A streptococcal infections are seasonal, and arise more often from December through April, Sears said. Thorough hand washing, especially after coughing and sneezing and before preparing food or eating, can limit the spread.
Maine CDC has advised physicians and other health providers to be on the lookout for the infections among intravenous drug users, but the public should also be aware, Sears said.
“What people need to know is that strep is around,” he said. “Even without an injection, if they happen to get really painful, red swollen skin, they need to take that seriously.”
Synthetic bath salts, which can be snorted, injected or smoked, first appeared in Maine last year and took hold in the Bangor area. Users often suffer from extreme paranoia, hallucinations and a dangerously high heart rate and body temperature.
Bath salts have been tied to at least one death in Maine.
Labels: bacterial infections, bath salts, flesh-eating bacteria, Group A streptococcal bacterium, necrotizing fasciitis, streptococcal toxic shock syndrome
# posted by Pat O'Connor @ 11:53 AM
Thursday, September 17, 2009
Corruption of Innate Immunity by Bacterial Proteases.
Corruption of Innate Immunity by Bacterial Proteases.
J Innate Immun. 2009 Jan
Potempa J, Pike RN.
Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland, and Department of Biochemistry and Molecular Biology, University of Georgia, Athens, GA, USA.
The innate immune system of the human body has developed numerous mechanisms to control endogenous and exogenous bacteria and thus prevent infections by these microorganisms. These mechanisms range from physical barriers such as the skin or mucosal epithelium to a sophisticated array of molecules and cells that function to suppress or prevent bacterial infection. Many bacteria express a variety of proteases, ranging from non-specific and powerful enzymes that degrade many proteins involved in innate immunity to proteases that are extremely precise and specific in their mode of action. Here we have assembled a comprehensive picture of how bacterial proteases affect the host's innate immune system to gain advantage and cause infection. This picture is far from being complete since the numbers of mechanisms utilized are as astonishing as they are diverse, ranging from degradation of molecules vital to innate immune mechanisms to subversion of the mechanisms to allow the bacterium to hide from the system or take advantage of it. It is vital that such mechanisms are elucidated to allow strategies to be developed to aid the innate immune system in controlling bacterial infections.
PubMedLabels: bacterial infections, Bacterial Proteases, endogenous bacteria, enzymes, exogenous bacteria, innate immunity
# posted by Pat O'Connor @ 6:45 AM
Thursday, March 20, 2008
Early neonatal bacterial infections: Could superficial bacteriologic samples at birth be limited?]
Early neonatal bacterial infections: Could superficial bacteriologic samples at birth be limited?
Arch Pediatr. 2008 Mar 10
Arch Pediatr. 2008 Mar 10
Noguer Stroebel A, Thibaudon C, Dubos JP, Djavadzadeh-Amini M, Husson MO, Truffert P.
Service de pédiatrie en maternité, pôle d’obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, rue Oscar-Lambert, 59037 Lille cedex, France.
INTRODUCTION: Without promptly started antibiotic therapy, early neonatal bacterial infections incur a significant mortality. Superficial bacteriologic samples at birth have in France a real place for the diagnosis and the decision to treat a neonate. OBJECTIVES: In order to limit their indication and their choice, the aim of this article was to describe the proportion of neonates with samples and to determine the diagnostic value of the gastric aspirate, the ear swab and the placental sample.
METHODS: Neonates born in the CHRU of Lille in 2005 and staying in the maternity ward were prospectively included. Criteria for samples, type of samples and diagnosis taken were noted. Sensibility, specificity, positive and negative predictive values and likelihood ratios for a positive test and a negative test were calculated.
RESULTS AND CONCLUSION: This study included 3918 neonates; 1.7% (65 children) were infected according to our criteria; 42.3% received bacteriologic samples. In accordance with the Anaes guidelines (2002), if mothers were Group B Streptoccocci positive and received intrapartum antibiotics (up to 2 injections) or did not have any screening test whithout any other indication of samples, the neonate did not have to receive bacteriologic samples. The gastric aspirate was the best exam thanks to the excellent negative predictive value of its direct examination: 99.4% (IC 95%: 98.8-99.7), its high likelihood ratio for a positive test: 10.04 (IC 95%: 8.29-12.15) and its low likelihood ratio for a negative test: 0.16 (IC 95%: 0.09-0.29); this sample could restrict the antibiotics' ratio given to the neonate. Placental sample could be taken only in certain indications.
ElsevierLabels: Anaes guidelines, bacterial infections, ear swab, gastric aspirate, Group B Streptoccocci positive, intrapartum antibiotics, neonatal, Placental sample
# posted by Pat O'Connor @ 5:07 PM
Saturday, November 03, 2007
Dangerous bacterial infections are on the rise
Dangerous bacterial infections are on the rise
What you can do to counter the trend and stay safe.
November 2007
When conducting hospital rounds a few months ago, Neil Fishman, M.D., saw five patients whose infections didn’t respond to any available antibiotic. “I was shocked,” says Fishman, an expert in antibiotic resistance with the Infectious Diseases Society of America in Arlington, Va. “I fear we’re at a tipping point--on the verge of returning to a pre-antibiotic era, when none of our antibiotics may work at all.”
Most bacterial infections can still be treated with at least one antibiotic. But there are emerging problems. For example:
Nearly 1 of every 3 pneumococci--the bacteria responsible for many pneumonias--has become resistant to penicillin, and 1 in 10 is resistant to most other antibiotics.
An antibiotic-resistant strain of staphylococcus that triggers potentially deadly lung and bloodstream infections is spreading through hospitals in this country and, increasingly, into communities.
Few if any antibiotics work against a bacterium called Acinetobacter baumannii, which has infected the wounds of many soldiers returning home from Iraq and Afghanistan, in some cases forcing doctors to amputate infected limbs.
Gonorrhea and tuberculosis are making a comeback, in part because the bugs responsible for them have developed defenses against previously used antibiotics.
Consumers have contributed to the growing crisis by not taking antibiotics properly and, in many cases, insisting that their doctor prescribe antibiotics for viral infections, such as the flu, ear infections, and the common cold, even though antibiotics work only against bacterial infections.
Doctors have made the situation worse by acquiescing to those ill-informed requests and, when antibiotics are required, sometimes prescribing the wrong dose, the wrong schedule, or the wrong medication. For example, recent research suggests that doctors often turn to newer, more powerful antibiotics when older ones would suffice. And some doctors use antibiotics for even more controversial purposes, such as the long-term treatment of Lyme disease or rheumatoid arthritis.
In hospitals, the combination of drug misuse and poor hygiene has brought the problem of antibiotic resistance to a crisis. Almost 5 percent of all hospitalized patients now acquire an infection during their stay; nearly 100,000 of them die each year as a result.
Here are some steps you can take in your home, your doctor’s office, and in the hospital to protect yourself from antibiotic-resistant bacteria.
SAFE AT HOME
The more an antibiotic is used as a drug and, to a lesser extent, in animal feed and possibly even household cleaners and other consumer products, the more opportunity bacteria have to adapt to it. Using the wrong drug dose or the wrong medication to treat infection can also breed resistance by allowing some bugs to survive, develop resistance, and multiply. So the key to combating antibiotic resistance is preventing unnecessary and inappropriate antibiotic use--tasks that start at home.
Don’t self-treat. Don’t use your own or other people’s leftover antibiotics to treat a self-diagnosed infection, since the drug may not be right for your current infection--if you have one. And don’t order antibiotics online without a prescription, since you might get the wrong drug, the wrong dose, or even a counterfeit product.
Use antibiotic creams sparingly. These over-the-counter products, such as neomycin (Mycitracin, Neosporin, and generic), are needed only for cuts that leave visible dirt or grit behind. In most other cases, washing the wound thoroughly with regular soap and water will provide all the protection you need.
Avoid “antibacterial” products. Soaps with the germ-killing ingredient triclosan don’t prevent infections when used at home, research suggests. Other antibacterial products, including deodorants, wipes, and cleaning products, probably don’t either. But their widespread use may make antibacterial soaps less effective for people who really need them, such as hospital and nursing-home staff. Prevent infection at home by washing hands with plain soap and water or an alcohol-based product like Purell.
Dispose of old antibiotics properly. Researchers have now detected antibiotics in the water supply, possibly from agricultural runoff, excretion from bodies, or old antibiotics dumped into toilets or thrown into landfills, where they may leach into rivers or the groundwater. So if you have old antibiotics in your medicine cabinet, take them to your pharmacist, who can give you advice on the best way to get rid of the drugs and may even participate in a medication-disposal program.
Consider purchasing certified-organic meat. Organic chicken, beef, and other meat don’t necessarily harbor fewer bacteria-resistant germs than regular meat, recent Consumer Reports tests have shown. And organic meat typically costs more. But at least animals raised organically haven’t been fed antibiotic-laced feed, and organic meat hasn’t been treated with antibiotics. So purchasing organic meat can help reduce the spread of antibiotics in the environment.
WORK WITH YOUR DOCTOR
Doctors know that antibiotics work only against bacteria, not viruses. But they often prescribe the drugs for likely viral infections “just to be safe” or to satisfy an insistent patient. So don’t expect or accept antibiotics for common respiratory-tract infections.
Even when you do require antibiotics, your doctor might not prescribe them appropriately. Here’s how to prevent those mistakes.
Get tested. Expect your doctor to check a blood count or take a culture of the infected tissue or fluid. That will help confirm the diagnosis of a bacterial infection before your doctor prescribes an antibiotic, and will help in matching the drug to the bug.
Fight it off. If you have only a mild infection, ask if you can delay treatment for a few days to see if your body can fight it off.
Consider short courses. Ask whether a brief course of antibiotics--such as the three-day plan advised for simple urinary tract infections--can clear the infection. (That approach should be tried only when studies have proved that short courses eliminate the infection.)
Ask about targeted drugs. “Narrow-spectrum” antibiotics that target the likely bacteria are usually better choices than broad-spectrum ones, which can trigger multiple resistances simultaneously. Those medications are often cheaper, too.
Take as directed.Many people stop taking antibiotics once they start feeling better. But unless you finish the course, some of the responsible bacteria will probably survive and perhaps adapt to the medication. So take all the antibiotic pills your doctor prescribes.
Be leery of preventive and long-term use. Doctors sometimes prescribe antibiotics to ward off recurrent urinary tract infections or before dental surgery. But such preventive use is appropriate only if self-help measures and short courses of antibiotics don’t work, or if you’re at high risk of a dental infection spreading to your heart because, for example, you have an artificial heart valve or certain congenital defects.
Some doctors prescribe antibiotics for months or even years to treat Lyme disease or rheumatoid arthritis. But recent guidelines for Lyme disease emphasize that two to four weeks of treatment usually provides maximum benefits. And though some evidence suggests that tetracycline antibiotics may help certain people with rheumatoid arthritis, researchers say that’s not because the disease is caused by an infection but because the drugs may interfere with certain cartilage-destroying enzymes. More important, that benefit appears small, especially compared with the success of other arthritis drugs now available.
BUG-FREE IN THE HOSPITAL
Surgical procedures, needles, and catheters can carry bugs into the body. And hospital staff may fail to take the necessary steps to stop the spread of infection. To cut your risk of contracting or inadvertently spreading an infection while in a hospital or nursing home:
Insist on clean hands. Expect everyone who touches you to first wash their hands with soap or an alcohol-based solution. If you don’t see them do that, politely ask them to. And ask doctors and nurses to clean their stethoscopes, too, since studies show that they seldom clean those instruments between patients.
Don’t swallow bacteria.Keep your hands away from your eyes, nose, and mouth, and don’t set food or utensils directly on tables or beds.
Monitor antibiotic use. Hospital patients are too often given antibiotics plus an acid-suppressing heartburn drug. That combination of drugs can allow invading bacteria to colonize in the gut and sometimes triggers hard-to-treat infections. Before some kinds of surgery, on the other hand, antibiotics may be underused. Ask your doctor if your operation poses a significant threat of infection and if you should receive a single dose of an appropriate antibiotic in the hour beforehand.
Ask about your catheter. The risk of catheter-associated urinary-tract infections increases the longer the catheter remains in place. So if you’re still using a catheter 48 hours after surgery, find out whether your nurse or your doctor has forgotten to remove it.
Choose your hospital. Ask your doctor or surgeon if he or she knows the infection rates for hospitals in your area and, if possible, ask to be admitted to the one with the lowest rate. The hospital-infection initiative Stop Hospital Infections of Consumers Union, the publisher of this newsletter, offers information on the roughly 20 states that now require hospitals to make infection rates public, and what you can do to help make other states take the same step.
PROTECT YOURSELF FROM STAPH INFECTIONS AT THE GYM
A strain of the bacterium methicillin-resistant Staphylococcus aureus (MRSA) has spread from hospitals into communities, mostly in gyms and health clubs, where people unknowingly share contaminated towels or athletic equipment. While the strain is less deadly than the version found in hospitals, it's now a leading cause of skin-related visits to the emergency room. To protect yourself, don't share towels, put a clean towel over workout mats, and wipe down equipment with the alcohol spray that most gyms provide. And see your doctor if you have signs of skin infection: boils or a localized, painful rash that doesn't heal.
Consumer Reports
What you can do to counter the trend and stay safe.
November 2007
When conducting hospital rounds a few months ago, Neil Fishman, M.D., saw five patients whose infections didn’t respond to any available antibiotic. “I was shocked,” says Fishman, an expert in antibiotic resistance with the Infectious Diseases Society of America in Arlington, Va. “I fear we’re at a tipping point--on the verge of returning to a pre-antibiotic era, when none of our antibiotics may work at all.”
Most bacterial infections can still be treated with at least one antibiotic. But there are emerging problems. For example:
Nearly 1 of every 3 pneumococci--the bacteria responsible for many pneumonias--has become resistant to penicillin, and 1 in 10 is resistant to most other antibiotics.
An antibiotic-resistant strain of staphylococcus that triggers potentially deadly lung and bloodstream infections is spreading through hospitals in this country and, increasingly, into communities.
Few if any antibiotics work against a bacterium called Acinetobacter baumannii, which has infected the wounds of many soldiers returning home from Iraq and Afghanistan, in some cases forcing doctors to amputate infected limbs.
Gonorrhea and tuberculosis are making a comeback, in part because the bugs responsible for them have developed defenses against previously used antibiotics.
Consumers have contributed to the growing crisis by not taking antibiotics properly and, in many cases, insisting that their doctor prescribe antibiotics for viral infections, such as the flu, ear infections, and the common cold, even though antibiotics work only against bacterial infections.
Doctors have made the situation worse by acquiescing to those ill-informed requests and, when antibiotics are required, sometimes prescribing the wrong dose, the wrong schedule, or the wrong medication. For example, recent research suggests that doctors often turn to newer, more powerful antibiotics when older ones would suffice. And some doctors use antibiotics for even more controversial purposes, such as the long-term treatment of Lyme disease or rheumatoid arthritis.
In hospitals, the combination of drug misuse and poor hygiene has brought the problem of antibiotic resistance to a crisis. Almost 5 percent of all hospitalized patients now acquire an infection during their stay; nearly 100,000 of them die each year as a result.
Here are some steps you can take in your home, your doctor’s office, and in the hospital to protect yourself from antibiotic-resistant bacteria.
SAFE AT HOME
The more an antibiotic is used as a drug and, to a lesser extent, in animal feed and possibly even household cleaners and other consumer products, the more opportunity bacteria have to adapt to it. Using the wrong drug dose or the wrong medication to treat infection can also breed resistance by allowing some bugs to survive, develop resistance, and multiply. So the key to combating antibiotic resistance is preventing unnecessary and inappropriate antibiotic use--tasks that start at home.
Don’t self-treat. Don’t use your own or other people’s leftover antibiotics to treat a self-diagnosed infection, since the drug may not be right for your current infection--if you have one. And don’t order antibiotics online without a prescription, since you might get the wrong drug, the wrong dose, or even a counterfeit product.
Use antibiotic creams sparingly. These over-the-counter products, such as neomycin (Mycitracin, Neosporin, and generic), are needed only for cuts that leave visible dirt or grit behind. In most other cases, washing the wound thoroughly with regular soap and water will provide all the protection you need.
Avoid “antibacterial” products. Soaps with the germ-killing ingredient triclosan don’t prevent infections when used at home, research suggests. Other antibacterial products, including deodorants, wipes, and cleaning products, probably don’t either. But their widespread use may make antibacterial soaps less effective for people who really need them, such as hospital and nursing-home staff. Prevent infection at home by washing hands with plain soap and water or an alcohol-based product like Purell.
Dispose of old antibiotics properly. Researchers have now detected antibiotics in the water supply, possibly from agricultural runoff, excretion from bodies, or old antibiotics dumped into toilets or thrown into landfills, where they may leach into rivers or the groundwater. So if you have old antibiotics in your medicine cabinet, take them to your pharmacist, who can give you advice on the best way to get rid of the drugs and may even participate in a medication-disposal program.
Consider purchasing certified-organic meat. Organic chicken, beef, and other meat don’t necessarily harbor fewer bacteria-resistant germs than regular meat, recent Consumer Reports tests have shown. And organic meat typically costs more. But at least animals raised organically haven’t been fed antibiotic-laced feed, and organic meat hasn’t been treated with antibiotics. So purchasing organic meat can help reduce the spread of antibiotics in the environment.
WORK WITH YOUR DOCTOR
Doctors know that antibiotics work only against bacteria, not viruses. But they often prescribe the drugs for likely viral infections “just to be safe” or to satisfy an insistent patient. So don’t expect or accept antibiotics for common respiratory-tract infections.
Even when you do require antibiotics, your doctor might not prescribe them appropriately. Here’s how to prevent those mistakes.
Get tested. Expect your doctor to check a blood count or take a culture of the infected tissue or fluid. That will help confirm the diagnosis of a bacterial infection before your doctor prescribes an antibiotic, and will help in matching the drug to the bug.
Fight it off. If you have only a mild infection, ask if you can delay treatment for a few days to see if your body can fight it off.
Consider short courses. Ask whether a brief course of antibiotics--such as the three-day plan advised for simple urinary tract infections--can clear the infection. (That approach should be tried only when studies have proved that short courses eliminate the infection.)
Ask about targeted drugs. “Narrow-spectrum” antibiotics that target the likely bacteria are usually better choices than broad-spectrum ones, which can trigger multiple resistances simultaneously. Those medications are often cheaper, too.
Take as directed.Many people stop taking antibiotics once they start feeling better. But unless you finish the course, some of the responsible bacteria will probably survive and perhaps adapt to the medication. So take all the antibiotic pills your doctor prescribes.
Be leery of preventive and long-term use. Doctors sometimes prescribe antibiotics to ward off recurrent urinary tract infections or before dental surgery. But such preventive use is appropriate only if self-help measures and short courses of antibiotics don’t work, or if you’re at high risk of a dental infection spreading to your heart because, for example, you have an artificial heart valve or certain congenital defects.
Some doctors prescribe antibiotics for months or even years to treat Lyme disease or rheumatoid arthritis. But recent guidelines for Lyme disease emphasize that two to four weeks of treatment usually provides maximum benefits. And though some evidence suggests that tetracycline antibiotics may help certain people with rheumatoid arthritis, researchers say that’s not because the disease is caused by an infection but because the drugs may interfere with certain cartilage-destroying enzymes. More important, that benefit appears small, especially compared with the success of other arthritis drugs now available.
BUG-FREE IN THE HOSPITAL
Surgical procedures, needles, and catheters can carry bugs into the body. And hospital staff may fail to take the necessary steps to stop the spread of infection. To cut your risk of contracting or inadvertently spreading an infection while in a hospital or nursing home:
Insist on clean hands. Expect everyone who touches you to first wash their hands with soap or an alcohol-based solution. If you don’t see them do that, politely ask them to. And ask doctors and nurses to clean their stethoscopes, too, since studies show that they seldom clean those instruments between patients.
Don’t swallow bacteria.Keep your hands away from your eyes, nose, and mouth, and don’t set food or utensils directly on tables or beds.
Monitor antibiotic use. Hospital patients are too often given antibiotics plus an acid-suppressing heartburn drug. That combination of drugs can allow invading bacteria to colonize in the gut and sometimes triggers hard-to-treat infections. Before some kinds of surgery, on the other hand, antibiotics may be underused. Ask your doctor if your operation poses a significant threat of infection and if you should receive a single dose of an appropriate antibiotic in the hour beforehand.
Ask about your catheter. The risk of catheter-associated urinary-tract infections increases the longer the catheter remains in place. So if you’re still using a catheter 48 hours after surgery, find out whether your nurse or your doctor has forgotten to remove it.
Choose your hospital. Ask your doctor or surgeon if he or she knows the infection rates for hospitals in your area and, if possible, ask to be admitted to the one with the lowest rate. The hospital-infection initiative Stop Hospital Infections of Consumers Union, the publisher of this newsletter, offers information on the roughly 20 states that now require hospitals to make infection rates public, and what you can do to help make other states take the same step.
PROTECT YOURSELF FROM STAPH INFECTIONS AT THE GYM
A strain of the bacterium methicillin-resistant Staphylococcus aureus (MRSA) has spread from hospitals into communities, mostly in gyms and health clubs, where people unknowingly share contaminated towels or athletic equipment. While the strain is less deadly than the version found in hospitals, it's now a leading cause of skin-related visits to the emergency room. To protect yourself, don't share towels, put a clean towel over workout mats, and wipe down equipment with the alcohol spray that most gyms provide. And see your doctor if you have signs of skin infection: boils or a localized, painful rash that doesn't heal.
Consumer Reports
Labels: bacterial infections, prevention
# posted by Pat O'Connor @ 9:48 AM
Sunday, July 15, 2007
Bacteria and Bacterial Infections in Public Pools
Bacteria and Bacterial Infections in Public Pools
Swimming in bacteria? What's lurking in the pool CBC News Online
On a hot summer day, taking a dip in the pool is a refreshing escape from the heat. But "fresh" might not be the right word if your swimming companions include bacteria that can cause vomiting, diarrhea and skin disease.
On Aug. 22, Quebec Environment Minister Claude Béchard announced all public pools in the province would be tested for chlorine and acid levels every three hours. Tests for bacteria levels would be done twice a month.
The new rules will come into effect in the coming months. Earlier in the week, lab tests showed outdoor swimming pools in Montreal and Laval, north of Montreal, were heavily contaminated with bacteria, viruses and fecal matter.
Test results must be submitted to the provincial government, Béchard said. Municipalities are responsible for pool safety in Quebec, but the province has the power to close facilities.
Elsewhere in Canada, documents obtained by CBC News showed that Winnipeg's environmental health inspectors shut down 13 pools and whirlpools in 2004 because of bacteria contamination, chlorine imbalance or unsafe conditions. And in Nova Scotia in 2003, a former public health officer sampled water in 19 public swimming pools and found unacceptably high levels of bacteria. The results failed to meet provincial guidelines.
It's a scary prospect that the local swimming pool could be a veritable microbial soup, bubbling with germs and parasites.
Where do the organisms come from?
The risk of illness and infection from swimming pools derives mostly from fecal contamination of the water. Vomit, mucus, saliva and skin are also sources of dangerous germs in the pool.
Sometimes these substances are released into the water by bathers, or they can come directly from birds and rodents. Viral outbreaks can also come from inadequate pool sanitation. Filtering the pool water and adding chlorine, salt and other disinfectants will usually control harmful germs in the water.
Gary Sanger, aquatics supervisor for the City of Toronto, says the city has a detailed process to keep the pools contaminant free. Pool officials test the water a half hour before a pool is open to the public, and every two hours thereafter. If there are any foreign substances such as vomit in the water, Sanger says, the pool is closed for cleaning and chlorination.
During the summer it becomes more difficult to control the bacteria, says Dr. John Carsley of the Montreal Public Health Department.
"It's a challenge to keep the chlorine at the right level, from what I understand," Carsley said. "Especially, the hotter it gets, the quicker the chlorine gets used up."
The more swimmers splashing in the water, the harder it is to maintain the appropriate levels of chlorine to keep the germs at bay. "The more people who get in the pool and the more demand in terms of microbial burden there is," he says.
The hotter the water the temperature, the better the habitat for bacteria. Hot tubs and natural spas with mineral water are an ideal breeding ground for germs such as legionella.
What kind of illnesses can I catch from swimming in a contaminated pool?
E.coli can lead to bloody diarrhea, as well as vomiting and fever in more severe cases. Elderly people and infants can develop haemolytic uraemic syndrome (HUS), which can lead to kidney failure. Shigella bacteria can cause diarrhea, fever and nausea.
Illnesses can also stem from parasites found in fecal matter in the water. The most common are Giardia and Cryptosporidium, or C. difficile, according to the World Health Organization. They are both highly contagious because infected individuals shed the sickness-causing germs in large amounts. Giardiasis is characterized by diarrhea, cramps, foul-smelling stools, loss of appetite, fatigue and vomiting. Symptoms of cryptosporidiosis include diarrhea, vomiting, fever and abdominal cramps.
It is difficult to directly link outbreaks of illness with pool water because the evidence is usually circumstantial, according to the WHO, such as a pattern between swimmers' symptoms and where they last swam. It's difficult to isolate these microbes from the water itself.
Are there pool sanitation regulations to control the bacteria levels in public pools?
There aren't nation-wide regulations for pool sanitation in Canada, but each province has its own set. They typically include testing the bacteria levels in the pool before opening it to the public, testing it regularly while people are swimming, and cleaning and disinfecting the pool regularly.
The World Health Organization also has a set of recommended guidelines for safe swimming.
What can I do to have a healthy and safe swim?
Both pool and swimmers have their part to play, Sanger says. Pool officials can control the contamination of pools by encouraging swimmers to shower before diving in, he says.
Sanger encourages parents to bathe their kids before bringing them into the pool. And he advises young children use disposable swim trunks designed to keep unwanted substances under wraps.
The World Health Organization recommends keeping small children in pools small enough to drain, in the event of accidental defecation.
As well, people with gastroenteritis — inflammation of the gastrointestinal tract or the pathway responsible for digestion including the mouth, esophagus, stomach and intestines, also known as the "stomach flu" — should not go to public or semi-public pools until at least a week after their illness.
Article
The Hidden Dangers of Public Pools
Summertime is here and everyone is ready to hit the public pool in an attempt to beat the heat. What many people don't realize is that their local pool might not be as safe as they assume. Here's a look at some of the most common dangers you and your family face when swimming in public waters. As much as we would like to think that the chlorine in the pool kills everything off, it might not be true. Bacteria and viruses can really thrive in a moist area like a pool and the area surrounding it. A pool must be very carefully maintained in order to keep harmful germs at bay and many pools simply lack the high standards that are necessary. Also, if too many people are using the pool at once, the chemicals in the water may not have a chance to kill everything off before others are infected.
Any kind of infection can be spread in the water. A swimmer suffering from a stomach problem will have the bacteria or virus on their skin and this is easily washed into the water, to be accidentally ingested by another person. This is particularly true where small children swim. Swim diapers don't hold everything in and even changing a diaper near the pool can result in bacteria getting into the water.
Certain types of bacteria, known as "crypto", are able to survive for long periods of time in the water, even well-chlorinated water. Others take up to an hour or two to die off, which leaves plenty of time to infect other people who are swimming in the pool. Viruses can usually survive for quite a bit more time. Chlorine and other pool chemicals are not a guarantee against contracting a disease while swimming in public areas.
The dangers of public pools don't end in the water. The dressing rooms can harbor mold which may cause respiratory problems in those who are sensitive to this sort of thing. The constant dampness harbors bacteria such as athlete's foot and the like.
To keep yourself and your kids safe, avoid wading pools where contamination is more likely. Ask about the pool maintainance schedule and how often the chlorine levels are tested. You might also want to take your family swimming on days when there are fewer people in the pool and avoid contributing to the problem by keeping sick kids out of the water. Also, try not to let any water get in your mouth, since this is how most bacteria and viruses get into the body.
In the dressing room, don't toss towels on the floor and then use them to dry off. Wearing flip flops or water shoes is a good way to avoid athlete's foot and other fungi that might cause problems, take them off poolside.
While pools can be a fun way to cool off, it pays to remember that they are the perfect place for germs, viruses and bacteria to grow. Play it safe and take the precautions listed above.
Article
Shigella: A Bacterial Infection on the Rise This Summer Health Depts. Say to Use Special Care Over Fourth of July Holiday By Sussy Published Jul 03, 2007
Article
Pseudomonas
Pseudomonas bacteria contamination is an emerging health concern that most pool and spa companies are unaware of, and most water testing performed by these companies do not check for bacteria contamination. "Hot tub rash" is many times incorrectly attributed to too much chlorine in the water when many times the culprit is actually Pseudomonas bacteria contamination. Cutting back on chlorine in these situations actually exacerbates the problem.
What is it?
Pseudomonas species are opportunistic pathogens that are part of the normal bacterial flora of the pharynx, mucous membranes and skin of humans. It flourishes in warm, moist areas which makes pools and hot tubs an ideal environment for this bacteria. In recent years the number of reported Pseudomonas outbreaks in recreational waters has risen dramatically. Pseudomonas is capable of causing significant illnesses including skin rashes (folliculitis), ear infections (swimmer’s ear), urinary tract infections, pneumonia and corneal ulcers (keratitis).
Why is it important?
Pseudomonas is a very virulent opportunistic pathogen and is becoming increasingly resistant to antibiotics. It is the most commonly isolated bacteria from skin rashes and ear infections associated with recreational waters.
Otitis externa, commonly known as "swimmer’s ear", is caused mainly by the species Pseudomonas aeruginosa. Symptoms include redness and swelling of the ear canal, itching, fluid leakage and severe pain. Pseudomonas frequently causes skin infections (folliculitis) involving a mild to moderate red, itchy rash. These rashes are often mistaken for chicken pox. The bacteria is also a significant contributor to urinary tract infections as well as secondary infections in hospitalized patients. Pseudomonas aeruginosa is one of the leading (and most damaging) causative agents of microbial keratitis in contact lens wearers. This bacteria is of major concern in hospitals, since it can cause severe secondary infections, such as pneumonia, in burn victims or immunocompromised persons.
In rare circumstances, Pseudomonas can cause more serious infections. In diabetic, elderly or immunocompromised persons, a life threatening condition known as malignant otitis externa could occur. The bacteria in the ear spreads to the surrounding tissue and bone potentially leading to muscle paralysis, meningitis or brain abscesses. In severe cases of microbial keratitis, the lesions on the cornea can ulcerate within 24-48 hours. Blindness can occur rapidly due to destruction of the interior eye structures.
Where is Pseudomonas?
Pseudomonas is commonly isolated from water and soil. It is normally found in low quantities in the pharynx, skin and mucous membranes of normal healthy persons. It proliferates in wet or moist areas, particularly pools and hot tubs and surrounding carpeted areas. Any recreational waters which have multiple users, such as public pools, are also possible sources of the bacteria. Inside the home, handtowels and sinktraps, are the areas most likely to contain Pseudomonas. This bacteria is of major concern in hospitals, since it has been indicated in secondary infections.
How do you get Pseudomonas?
Most hot tub mediated infections occur due to improper water maintenance or exceeding the maximum carrying capacity of the water. For example, when several bathers are in a small amount of water, the amount of water per person decreases. The disinfectants in the water are used up on the excessive amount of bacteria and debris supplied by each person so any remaining bacteria, such as Pseudomonas, will not be eliminated. When a person’s skin is heated, the follicles expand allowing the Pseudomonas bacteria to enter through the pores. Folliculitis, the most common result of this type of infection, is a mild to moderate skin rash. Swimmer’s ear occurs when the ear canal becomes sufficiently moist, usually while swimming, allowing the bacteria the opportunity to breed. They begin to colonize the canal and cause extreme discomfort, redness and swelling. Urinary tract infections are also regularly associated with Pseudomonas infections. In hospitals, Pseudomonas aeruginosa can infect persons with weakened immune systems, it can colonize catheters as well as therapeutic whirlpools.
When contact lens hardware or cleansing solution becomes contaminated, the risk for developing microbial keratitis is greatly increased. Since Pseudomonas is a normal inhabitant of the skin, the bacteria can be passed directly from the skin to the contact lens. It can also be transferred to handtowels, which when reused would transfer the bacteria back to the hands. Studies show that Pseudomonas is capable of surviving in many commercial saline solutions, in which case, contaminated lenses would not be properly cleansed by saline solution alone. Exceeding the recommended wear time of contact lenses has been reported as probably being the largest contributor to microbial keratitis. Pseudomonas aeruginosa has several structural and chemical components that make it especially adept at adhering to the corneal surface of the eye. Over wear of lenses weakens the eye’s defenses and makes the cornea more susceptible to bacterial infection and damage.
What should you do about it?
If you own a pool or a hot tub testing should be done to ensure that the bacteria is not present in your system. If Pseudomonas is detected, the extent to which it is present should be determined. Proper steps should be incurred to remove the bacteria. The rashes associated with
Pseudomonas bacteria are often attributed to excess chlorination so people tend to under chlorinate their pools and hot tubs. Pseudomonas folliculitis and urinary tract infections can sometimes be avoided by bathing after swimming, removing wet swimsuits immediately, and avoiding public pools with multiple swimmers.
Proper pH of the water and attentive maintenance is vital to prevent Pseudomonas from establishing itself in your pool or hot tub. If Pseudomonas is left untreated, the bacteria will cover itself in a protective slime layer which is resistant to chlorine. It will then colonize your pool or hot tub, which is characterized by a slimy layer on the sides of the pool particularly in low flow areas. When this happens, the removal of the bacteria is much more difficult. The pool or spa may have to be drained and scrubbed. A professional should be consulted.
Indicators that Pseudomonas may be present in your pool are visible signs of the bacteria, frequent occurrences of swimmer’s ear, skin rashes, urinary tract infections etc. in you or your family members.
An ophthalmologist should be consulted in all cases of eye infections. Proper contact lens wear and maintenance is strongly recommended to avoid Pseudomonas corneal infections. Non-clinical surface samples (i.e. sinks, drains, carpet by pool areas) may be taken and analyzed by a laboratory to determine the source of the bacteria. Medical questions or concerns should be directed towards your ophthalmologist or physician.
Article
Swimming in bacteria? What's lurking in the pool CBC News Online
On a hot summer day, taking a dip in the pool is a refreshing escape from the heat. But "fresh" might not be the right word if your swimming companions include bacteria that can cause vomiting, diarrhea and skin disease.
On Aug. 22, Quebec Environment Minister Claude Béchard announced all public pools in the province would be tested for chlorine and acid levels every three hours. Tests for bacteria levels would be done twice a month.
The new rules will come into effect in the coming months. Earlier in the week, lab tests showed outdoor swimming pools in Montreal and Laval, north of Montreal, were heavily contaminated with bacteria, viruses and fecal matter.
Test results must be submitted to the provincial government, Béchard said. Municipalities are responsible for pool safety in Quebec, but the province has the power to close facilities.
Elsewhere in Canada, documents obtained by CBC News showed that Winnipeg's environmental health inspectors shut down 13 pools and whirlpools in 2004 because of bacteria contamination, chlorine imbalance or unsafe conditions. And in Nova Scotia in 2003, a former public health officer sampled water in 19 public swimming pools and found unacceptably high levels of bacteria. The results failed to meet provincial guidelines.
It's a scary prospect that the local swimming pool could be a veritable microbial soup, bubbling with germs and parasites.
Where do the organisms come from?
The risk of illness and infection from swimming pools derives mostly from fecal contamination of the water. Vomit, mucus, saliva and skin are also sources of dangerous germs in the pool.
Sometimes these substances are released into the water by bathers, or they can come directly from birds and rodents. Viral outbreaks can also come from inadequate pool sanitation. Filtering the pool water and adding chlorine, salt and other disinfectants will usually control harmful germs in the water.
Gary Sanger, aquatics supervisor for the City of Toronto, says the city has a detailed process to keep the pools contaminant free. Pool officials test the water a half hour before a pool is open to the public, and every two hours thereafter. If there are any foreign substances such as vomit in the water, Sanger says, the pool is closed for cleaning and chlorination.
During the summer it becomes more difficult to control the bacteria, says Dr. John Carsley of the Montreal Public Health Department.
"It's a challenge to keep the chlorine at the right level, from what I understand," Carsley said. "Especially, the hotter it gets, the quicker the chlorine gets used up."
The more swimmers splashing in the water, the harder it is to maintain the appropriate levels of chlorine to keep the germs at bay. "The more people who get in the pool and the more demand in terms of microbial burden there is," he says.
The hotter the water the temperature, the better the habitat for bacteria. Hot tubs and natural spas with mineral water are an ideal breeding ground for germs such as legionella.
What kind of illnesses can I catch from swimming in a contaminated pool?
E.coli can lead to bloody diarrhea, as well as vomiting and fever in more severe cases. Elderly people and infants can develop haemolytic uraemic syndrome (HUS), which can lead to kidney failure. Shigella bacteria can cause diarrhea, fever and nausea.
Illnesses can also stem from parasites found in fecal matter in the water. The most common are Giardia and Cryptosporidium, or C. difficile, according to the World Health Organization. They are both highly contagious because infected individuals shed the sickness-causing germs in large amounts. Giardiasis is characterized by diarrhea, cramps, foul-smelling stools, loss of appetite, fatigue and vomiting. Symptoms of cryptosporidiosis include diarrhea, vomiting, fever and abdominal cramps.
It is difficult to directly link outbreaks of illness with pool water because the evidence is usually circumstantial, according to the WHO, such as a pattern between swimmers' symptoms and where they last swam. It's difficult to isolate these microbes from the water itself.
Are there pool sanitation regulations to control the bacteria levels in public pools?
There aren't nation-wide regulations for pool sanitation in Canada, but each province has its own set. They typically include testing the bacteria levels in the pool before opening it to the public, testing it regularly while people are swimming, and cleaning and disinfecting the pool regularly.
The World Health Organization also has a set of recommended guidelines for safe swimming.
What can I do to have a healthy and safe swim?
Both pool and swimmers have their part to play, Sanger says. Pool officials can control the contamination of pools by encouraging swimmers to shower before diving in, he says.
Sanger encourages parents to bathe their kids before bringing them into the pool. And he advises young children use disposable swim trunks designed to keep unwanted substances under wraps.
The World Health Organization recommends keeping small children in pools small enough to drain, in the event of accidental defecation.
As well, people with gastroenteritis — inflammation of the gastrointestinal tract or the pathway responsible for digestion including the mouth, esophagus, stomach and intestines, also known as the "stomach flu" — should not go to public or semi-public pools until at least a week after their illness.
Article
The Hidden Dangers of Public Pools
Summertime is here and everyone is ready to hit the public pool in an attempt to beat the heat. What many people don't realize is that their local pool might not be as safe as they assume. Here's a look at some of the most common dangers you and your family face when swimming in public waters. As much as we would like to think that the chlorine in the pool kills everything off, it might not be true. Bacteria and viruses can really thrive in a moist area like a pool and the area surrounding it. A pool must be very carefully maintained in order to keep harmful germs at bay and many pools simply lack the high standards that are necessary. Also, if too many people are using the pool at once, the chemicals in the water may not have a chance to kill everything off before others are infected.
Any kind of infection can be spread in the water. A swimmer suffering from a stomach problem will have the bacteria or virus on their skin and this is easily washed into the water, to be accidentally ingested by another person. This is particularly true where small children swim. Swim diapers don't hold everything in and even changing a diaper near the pool can result in bacteria getting into the water.
Certain types of bacteria, known as "crypto", are able to survive for long periods of time in the water, even well-chlorinated water. Others take up to an hour or two to die off, which leaves plenty of time to infect other people who are swimming in the pool. Viruses can usually survive for quite a bit more time. Chlorine and other pool chemicals are not a guarantee against contracting a disease while swimming in public areas.
The dangers of public pools don't end in the water. The dressing rooms can harbor mold which may cause respiratory problems in those who are sensitive to this sort of thing. The constant dampness harbors bacteria such as athlete's foot and the like.
To keep yourself and your kids safe, avoid wading pools where contamination is more likely. Ask about the pool maintainance schedule and how often the chlorine levels are tested. You might also want to take your family swimming on days when there are fewer people in the pool and avoid contributing to the problem by keeping sick kids out of the water. Also, try not to let any water get in your mouth, since this is how most bacteria and viruses get into the body.
In the dressing room, don't toss towels on the floor and then use them to dry off. Wearing flip flops or water shoes is a good way to avoid athlete's foot and other fungi that might cause problems, take them off poolside.
While pools can be a fun way to cool off, it pays to remember that they are the perfect place for germs, viruses and bacteria to grow. Play it safe and take the precautions listed above.
Article
Shigella: A Bacterial Infection on the Rise This Summer Health Depts. Say to Use Special Care Over Fourth of July Holiday By Sussy Published Jul 03, 2007
Article
Pseudomonas
Pseudomonas bacteria contamination is an emerging health concern that most pool and spa companies are unaware of, and most water testing performed by these companies do not check for bacteria contamination. "Hot tub rash" is many times incorrectly attributed to too much chlorine in the water when many times the culprit is actually Pseudomonas bacteria contamination. Cutting back on chlorine in these situations actually exacerbates the problem.
What is it?
Pseudomonas species are opportunistic pathogens that are part of the normal bacterial flora of the pharynx, mucous membranes and skin of humans. It flourishes in warm, moist areas which makes pools and hot tubs an ideal environment for this bacteria. In recent years the number of reported Pseudomonas outbreaks in recreational waters has risen dramatically. Pseudomonas is capable of causing significant illnesses including skin rashes (folliculitis), ear infections (swimmer’s ear), urinary tract infections, pneumonia and corneal ulcers (keratitis).
Why is it important?
Pseudomonas is a very virulent opportunistic pathogen and is becoming increasingly resistant to antibiotics. It is the most commonly isolated bacteria from skin rashes and ear infections associated with recreational waters.
Otitis externa, commonly known as "swimmer’s ear", is caused mainly by the species Pseudomonas aeruginosa. Symptoms include redness and swelling of the ear canal, itching, fluid leakage and severe pain. Pseudomonas frequently causes skin infections (folliculitis) involving a mild to moderate red, itchy rash. These rashes are often mistaken for chicken pox. The bacteria is also a significant contributor to urinary tract infections as well as secondary infections in hospitalized patients. Pseudomonas aeruginosa is one of the leading (and most damaging) causative agents of microbial keratitis in contact lens wearers. This bacteria is of major concern in hospitals, since it can cause severe secondary infections, such as pneumonia, in burn victims or immunocompromised persons.
In rare circumstances, Pseudomonas can cause more serious infections. In diabetic, elderly or immunocompromised persons, a life threatening condition known as malignant otitis externa could occur. The bacteria in the ear spreads to the surrounding tissue and bone potentially leading to muscle paralysis, meningitis or brain abscesses. In severe cases of microbial keratitis, the lesions on the cornea can ulcerate within 24-48 hours. Blindness can occur rapidly due to destruction of the interior eye structures.
Where is Pseudomonas?
Pseudomonas is commonly isolated from water and soil. It is normally found in low quantities in the pharynx, skin and mucous membranes of normal healthy persons. It proliferates in wet or moist areas, particularly pools and hot tubs and surrounding carpeted areas. Any recreational waters which have multiple users, such as public pools, are also possible sources of the bacteria. Inside the home, handtowels and sinktraps, are the areas most likely to contain Pseudomonas. This bacteria is of major concern in hospitals, since it has been indicated in secondary infections.
How do you get Pseudomonas?
Most hot tub mediated infections occur due to improper water maintenance or exceeding the maximum carrying capacity of the water. For example, when several bathers are in a small amount of water, the amount of water per person decreases. The disinfectants in the water are used up on the excessive amount of bacteria and debris supplied by each person so any remaining bacteria, such as Pseudomonas, will not be eliminated. When a person’s skin is heated, the follicles expand allowing the Pseudomonas bacteria to enter through the pores. Folliculitis, the most common result of this type of infection, is a mild to moderate skin rash. Swimmer’s ear occurs when the ear canal becomes sufficiently moist, usually while swimming, allowing the bacteria the opportunity to breed. They begin to colonize the canal and cause extreme discomfort, redness and swelling. Urinary tract infections are also regularly associated with Pseudomonas infections. In hospitals, Pseudomonas aeruginosa can infect persons with weakened immune systems, it can colonize catheters as well as therapeutic whirlpools.
When contact lens hardware or cleansing solution becomes contaminated, the risk for developing microbial keratitis is greatly increased. Since Pseudomonas is a normal inhabitant of the skin, the bacteria can be passed directly from the skin to the contact lens. It can also be transferred to handtowels, which when reused would transfer the bacteria back to the hands. Studies show that Pseudomonas is capable of surviving in many commercial saline solutions, in which case, contaminated lenses would not be properly cleansed by saline solution alone. Exceeding the recommended wear time of contact lenses has been reported as probably being the largest contributor to microbial keratitis. Pseudomonas aeruginosa has several structural and chemical components that make it especially adept at adhering to the corneal surface of the eye. Over wear of lenses weakens the eye’s defenses and makes the cornea more susceptible to bacterial infection and damage.
What should you do about it?
If you own a pool or a hot tub testing should be done to ensure that the bacteria is not present in your system. If Pseudomonas is detected, the extent to which it is present should be determined. Proper steps should be incurred to remove the bacteria. The rashes associated with
Pseudomonas bacteria are often attributed to excess chlorination so people tend to under chlorinate their pools and hot tubs. Pseudomonas folliculitis and urinary tract infections can sometimes be avoided by bathing after swimming, removing wet swimsuits immediately, and avoiding public pools with multiple swimmers.
Proper pH of the water and attentive maintenance is vital to prevent Pseudomonas from establishing itself in your pool or hot tub. If Pseudomonas is left untreated, the bacteria will cover itself in a protective slime layer which is resistant to chlorine. It will then colonize your pool or hot tub, which is characterized by a slimy layer on the sides of the pool particularly in low flow areas. When this happens, the removal of the bacteria is much more difficult. The pool or spa may have to be drained and scrubbed. A professional should be consulted.
Indicators that Pseudomonas may be present in your pool are visible signs of the bacteria, frequent occurrences of swimmer’s ear, skin rashes, urinary tract infections etc. in you or your family members.
An ophthalmologist should be consulted in all cases of eye infections. Proper contact lens wear and maintenance is strongly recommended to avoid Pseudomonas corneal infections. Non-clinical surface samples (i.e. sinks, drains, carpet by pool areas) may be taken and analyzed by a laboratory to determine the source of the bacteria. Medical questions or concerns should be directed towards your ophthalmologist or physician.
Article
Labels: bacterial infections, C. difficile, Giardia and Cryptosporidium, Pseudomonas, public pools, Shigella
# posted by Pat O'Connor @ 3:41 AM
Monday, June 18, 2007
Bacteriophages: an appraisal of their role in the treatment of bacterial infections.
Bacteriophages: an appraisal of their role in the treatment of bacterial infections.
Int J Antimicrob Agents. 2007 Jun
Hanlon GW.
School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK.
Bacteriophages were first used successfully to treat bacterial infections a decade before penicillin was discovered. However, the excitement that greeted those initial successes was short-lived, as a lack of understanding of basic phage biology subsequently led to a catalogue of clinical failures. As a consequence, bacteriophage therapy was largely abandoned in the West in favour of the newly emerging antibiotics.
Now, as the problem of antibiotic resistance becomes ever more acute, a number of scientists and clinicians are looking again at bacteriophages as a therapeutic option in the treatment of bacterial infections. The chances of success second time round would appear to be much better given our current extensive knowledge of bacteriophage biology following their important role in underpinning the advances in molecular biology.
We also have available to us the experience of nearly 80 years of clinical usage in the countries of the former Soviet Union and Eastern Europe as well as a political climate that encourages sharing of that knowledge.
This review outlines those features of bacteriophages that contribute to their utility in therapy and explores the potential for their re-introduction into Western medicine. An abundance of clinical evidence is available in the Soviet literature but much of this is technically flawed and a more realistic appraisal of the clinical value of phages can be obtained from animal studies conducted in the West. As interest in bacteriophages increases, a number of companies throughout the world have begun investing in phage technology and this has led to novel approaches to therapy, some of which will be discussed.
PMID: 17566713 [PubMed - as supplied by publisher]
Int J Antimicrob Agents. 2007 Jun
Hanlon GW.
School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK.
Bacteriophages were first used successfully to treat bacterial infections a decade before penicillin was discovered. However, the excitement that greeted those initial successes was short-lived, as a lack of understanding of basic phage biology subsequently led to a catalogue of clinical failures. As a consequence, bacteriophage therapy was largely abandoned in the West in favour of the newly emerging antibiotics.
Now, as the problem of antibiotic resistance becomes ever more acute, a number of scientists and clinicians are looking again at bacteriophages as a therapeutic option in the treatment of bacterial infections. The chances of success second time round would appear to be much better given our current extensive knowledge of bacteriophage biology following their important role in underpinning the advances in molecular biology.
We also have available to us the experience of nearly 80 years of clinical usage in the countries of the former Soviet Union and Eastern Europe as well as a political climate that encourages sharing of that knowledge.
This review outlines those features of bacteriophages that contribute to their utility in therapy and explores the potential for their re-introduction into Western medicine. An abundance of clinical evidence is available in the Soviet literature but much of this is technically flawed and a more realistic appraisal of the clinical value of phages can be obtained from animal studies conducted in the West. As interest in bacteriophages increases, a number of companies throughout the world have begun investing in phage technology and this has led to novel approaches to therapy, some of which will be discussed.
PMID: 17566713 [PubMed - as supplied by publisher]
Labels: bacterial infections, bacteriophages
# posted by Pat O'Connor @ 10:49 AM
Sunday, June 10, 2007
Role of the innate immune system in host defence against bacterial infections: focus on the Toll-like receptors.
Role of the innate immune system in host defence against bacterial infections: focus on the Toll-like receptors.
J Intern Med. 2007 Jun;
Albiger B, Dahlberg S, Henriques-Normark B, Normark S.
Medical Microbiology, Department of Laboratory Medicine, Lund University, Malmö, Sweden.
The innate immunity plays a critical role in host protection against pathogens and it relies amongst others on pattern recognition receptors such as the Toll-like receptors (TLRs) and the nucleotide-binding oligomerization domains proteins (NOD-like receptors, NLRs) to alert the immune system of the presence of invading bacteria. Since their recent discovery less than a decade ago, both TLRs and NLRs have been shown to be crucial in host protection against microbial infections but also in homeostasis of the colonizing microflora. They recognize specific microbial ligands and with the use of distinct adaptor molecules, they activate different signalling pathways that in turns trigger subsequent inflammatory and immune responses that allows a immediate response towards bacterial infections and the initiation of the long-lasting adaptive immunity.
In this review, we will focus on the role of the TLRs against bacterial infections in humans in contrast to mice that have been used extensively in experimental models of infections and discuss their role in controlling normal flora or nonpathogenic bacteria. We also highlight how bacteria can evade recognition by TLRs.
PMID: 17547708 [PubMed - in process]
What is the role of Toll-like receptors in bacterial infections?
J Intern Med. 2007 Jun;
Albiger B, Dahlberg S, Henriques-Normark B, Normark S.
Medical Microbiology, Department of Laboratory Medicine, Lund University, Malmö, Sweden.
The innate immunity plays a critical role in host protection against pathogens and it relies amongst others on pattern recognition receptors such as the Toll-like receptors (TLRs) and the nucleotide-binding oligomerization domains proteins (NOD-like receptors, NLRs) to alert the immune system of the presence of invading bacteria. Since their recent discovery less than a decade ago, both TLRs and NLRs have been shown to be crucial in host protection against microbial infections but also in homeostasis of the colonizing microflora. They recognize specific microbial ligands and with the use of distinct adaptor molecules, they activate different signalling pathways that in turns trigger subsequent inflammatory and immune responses that allows a immediate response towards bacterial infections and the initiation of the long-lasting adaptive immunity.
In this review, we will focus on the role of the TLRs against bacterial infections in humans in contrast to mice that have been used extensively in experimental models of infections and discuss their role in controlling normal flora or nonpathogenic bacteria. We also highlight how bacteria can evade recognition by TLRs.
PMID: 17547708 [PubMed - in process]
What is the role of Toll-like receptors in bacterial infections?
Semin Immunol. 2007 Feb
Gerold G, Zychlinsky A, de Diego JL.
Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Berlin, Germany. gerold@mpiib-berlin.mpg.de
Innate immunity relies on signalling by Toll-like receptors (TLRs) to alert the immune system of the presence of invading bacteria. TLR activation leads to the release of cytokines that allow for effective innate and adaptive immune responses. However, the contribution of different TLRs depends on the site of the infection and the pathogen. This review will describe the involvement of TLRs in the development of three different bacterial infections as well as our current understanding of the role of TLRs during microbial pathogenesis.
Science DirectLabels: bacterial infections, immune responses, immunity, Toll-like receptors (TLRs)
# posted by Pat O'Connor @ 5:20 AM
Sunday, May 27, 2007
Predisposition to infection in patients with pemphigus
Predisposition to infection in patients with pemphigus
Presse Med. 2007 May 18
Belgnaoui FZ,
Senouci K,
Chraibi H,
Aoussar A,
Mansouri F,
Benzekri L,
Ourhroui MA,
Abouqal R,
Heid E,
Hassam B.
Service de dermatologie, Hopital Ibn Sina, Rabat, Maroc.
INTRODUCTION: The relation between pemphigus and infection is complex. The aim of this work was to determine the frequency and impact of infection as well as the factors associated with it among our patients with pemphigus.
METHODS: This retrospective case series examined records of patients with pemphigus admitted to the dermatology unit of Ibn Sina University Hospital of Rabat between 1989 and 2004. We compared the patients with and without infections as well as the patients with and without severe bacterial infections according to patient profile and outcome. The principal outcome measure was death and the secondary measure, duration of hospitalization.
RESULTS: Of the 141 patients with pemphigus included in our study, 68% developed an infection. Infections were bacterial in 52% of cases, fungal in 50%, herpetic in 19% and parasitic in 1.5%. They were associated with diabetes mellitus and immunosuppressive drugs. Severe bacterial infection was frequent in patients with diabetes and rare in those treated with corticosteroids or with pemphigus foliaceous. Death occurred significantly more often among infected subjects (p=0.01), especially those with severe bacterial infections
DISCUSSION: Our study confirms the predisposition to all types of infection among patients with pemphigus, as well as the undeniable role its treatment plays in promoting infection. Severe bacterial infections were most often contracted before hospitalization. The literature reports a wide variety of infections, with pemphigus-herpes documented most often. Prevention and management require hygienic measures as well as early diagnosis and treatment of pemphigus and infections. Preventive treatment may be considered, but studies are needed to define the patients who might benefit from it.
Masson
Pemphigus
Introduction
Pemphigus is characterized by blisters on your skin and mucous membranes. The blisters rupture easily, leaving open sores, which may ooze and become infected. The signs and symptoms of the three main types of pemphigus differ depending on the type:
Pemphigus vulgaris. The most common form, pemphigus vulgaris usually begins with blisters in your mouth, which then erupt on your skin. Blisters also can break out on the mucous membranes of your genitals. The blisters typically are painful, but don't itch.
Pemphigus foliaceus. This type doesn't usually affect mucous membranes. The blisters, which usually begin on your face and scalp and later erupt on your chest and back, usually aren't painful. They tend to be crusty and itchy.
Paraneoplastic pemphigus. This form causes painful sores on your mouth and lips and in your esophagus, as well as skin lesions. This form of pemphigus also can cause lesions in your lungs, resulting in progressive lung disease and making it difficult for you to breathe (dyspnea).
Causes
The exact cause of pemphigus is unknown, but it may be an autoimmune disorder.
Normally, your immune system attacks foreign invaders, such as harmful viruses and bacteria. But in pemphigus, your immune system produces antibodies that attack healthy cells in your skin or mucous membranes, specifically proteins called desmogleins. Desmogleins bind skin cells to each other. The antibodies cause separation of the cells of the top layer of your skin (epidermis). This reaction is known as acantholysis.
Paraneoplastic pemphigus generally occurs in people who have cancer, most commonly non-Hodgkin's lymphoma and chronic lymphocytic leukemia. In cases in which the cancer hasn't yet been discovered, the appearance of pemphigus blisters may alert doctors to look for a malignancy.
See your doctor if you develop blisters inside your mouth or on your skin. If you've been treated for pemphigus, see your doctor if you develop any of the following:
New blisters or sores
A rapid spread in the number of sores
Fever
Chills
Achy muscles or joints
A general sense of feeling ill (malaise)
Screening and diagnosis
Because it's uncommon, pemphigus may be difficult to diagnose. Blisters are common to a number of conditions, so besides taking a medical history and visually examining your skin and mouth, your doctor may lightly rub unblistered skin with a cotton swab or finger. With pemphigus, the top layers of your skin are likely to separate easily from the lower layers (positive for Nikolsky's sign). Other tests may include:
Skin biopsy. In this test, a piece of tissue from a blister is removed and examined under a microscope. Examination of the biopsy tissue may also involve a process called direct immunofluorescence (DIF). DIF entails staining the tissue with fluorescent dye to make the antibodies "light up" under a special microscope so they can be identified.
Blood tests. The purpose of these tests is to detect and identify antibodies (anti-desmogleins) in your blood.
Complications
The most common complications of pemphigus are infection of your skin and spread of infection through your bloodstream (sepsis). Systemic infection can be fatal.
Complications of paraneoplastic pemphigus include respiratory problems. The mortality rate for this type of pemphigus is estimated to be 90 percent, independent of the underlying cancer.
Other complications are the possible side effects of the medications used to treat pemphigus, particularly corticosteroids.
Treatment
Treatment, which aims at reducing signs and symptoms and preventing complications, is most effective when it begins as early as possible. The less widespread pemphigus is, the easier it may be to control. Specific treatment methods depend on the severity of the disease.
Mild pemphigusIf your pemphigus isn't too widespread, you may be able to remain at home for treatment. The mainstay of treatment is usually corticosteroids, such as prednisone. However, using corticosteroids over an extended time or in high doses may cause serious side effects, including:
Weight gain
Mood swings
Elevated blood sugar (diabetes)
Osteoporosis
Redistribution of body fat, leading to a round face (moon face)
Hair loss
Increased chance of infection because of suppression of the immune system
Corticosteroids may be combined with other medications, including:
Immunosuppressants. These medications, such as azathioprine (Imuran) or methotrexate (Rheumatrex), help keep your immune system from attacking healthy tissue. These drugs have serious side effects, including increased risk of infection.
Antibiotics and antifungal medications. These may be prescribed to control or prevent infections.
Severe pemphigusWidespread pemphigus may require you to stay in the hospital, where you may receive treatment similar to treatment for severe burns. The open sores make you highly vulnerable to infection, which if it spreads to your bloodstream, may be fatal. Besides the medications listed above, you may be given:
Fluids. Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — and proteins.
Intravenous feeding. This may be necessary if mouth sores make it painful for you to eat.
Anesthetic mouth lozenges. These can help control pain of mild to moderate mouth sores.
Therapeutic plasmapheresis. In this process, the fluid part of your blood, called plasma, is removed from blood cells by a device known as a cell separator. The purpose is to get rid of the antibodies that are attacking your skin. The plasma is replaced with donated plasma or intravenous fluids.
Presse Med. 2007 May 18
Belgnaoui FZ,
Senouci K,
Chraibi H,
Aoussar A,
Mansouri F,
Benzekri L,
Ourhroui MA,
Abouqal R,
Heid E,
Hassam B.
Service de dermatologie, Hopital Ibn Sina, Rabat, Maroc.
INTRODUCTION: The relation between pemphigus and infection is complex. The aim of this work was to determine the frequency and impact of infection as well as the factors associated with it among our patients with pemphigus.
METHODS: This retrospective case series examined records of patients with pemphigus admitted to the dermatology unit of Ibn Sina University Hospital of Rabat between 1989 and 2004. We compared the patients with and without infections as well as the patients with and without severe bacterial infections according to patient profile and outcome. The principal outcome measure was death and the secondary measure, duration of hospitalization.
RESULTS: Of the 141 patients with pemphigus included in our study, 68% developed an infection. Infections were bacterial in 52% of cases, fungal in 50%, herpetic in 19% and parasitic in 1.5%. They were associated with diabetes mellitus and immunosuppressive drugs. Severe bacterial infection was frequent in patients with diabetes and rare in those treated with corticosteroids or with pemphigus foliaceous. Death occurred significantly more often among infected subjects (p=0.01), especially those with severe bacterial infections
DISCUSSION: Our study confirms the predisposition to all types of infection among patients with pemphigus, as well as the undeniable role its treatment plays in promoting infection. Severe bacterial infections were most often contracted before hospitalization. The literature reports a wide variety of infections, with pemphigus-herpes documented most often. Prevention and management require hygienic measures as well as early diagnosis and treatment of pemphigus and infections. Preventive treatment may be considered, but studies are needed to define the patients who might benefit from it.
Masson
Pemphigus
Introduction
Pemphigus is a group of rare skin disorders that cause blisters of your skin or mucous membranes, such as in your mouth or on your genitals.
Pemphigus usually occurs in people between the ages of 30 and 60, but it also can affect children and older adults. Men and women develop pemphigus equally, and it affects all races and cultures. However, pemphigus tends to be more common in people of Middle Eastern or Jewish descent.
Usually a chronic condition, pemphigus is best controlled by early diagnosis and treatment, which may include medications or treatments similar to those used for severe burns. Left untreated, pemphigus may be fatal.
Signs and symptomsPemphigus is characterized by blisters on your skin and mucous membranes. The blisters rupture easily, leaving open sores, which may ooze and become infected. The signs and symptoms of the three main types of pemphigus differ depending on the type:
Pemphigus vulgaris. The most common form, pemphigus vulgaris usually begins with blisters in your mouth, which then erupt on your skin. Blisters also can break out on the mucous membranes of your genitals. The blisters typically are painful, but don't itch.
Pemphigus foliaceus. This type doesn't usually affect mucous membranes. The blisters, which usually begin on your face and scalp and later erupt on your chest and back, usually aren't painful. They tend to be crusty and itchy.
Paraneoplastic pemphigus. This form causes painful sores on your mouth and lips and in your esophagus, as well as skin lesions. This form of pemphigus also can cause lesions in your lungs, resulting in progressive lung disease and making it difficult for you to breathe (dyspnea).
Causes
The exact cause of pemphigus is unknown, but it may be an autoimmune disorder.
Normally, your immune system attacks foreign invaders, such as harmful viruses and bacteria. But in pemphigus, your immune system produces antibodies that attack healthy cells in your skin or mucous membranes, specifically proteins called desmogleins. Desmogleins bind skin cells to each other. The antibodies cause separation of the cells of the top layer of your skin (epidermis). This reaction is known as acantholysis.
Paraneoplastic pemphigus generally occurs in people who have cancer, most commonly non-Hodgkin's lymphoma and chronic lymphocytic leukemia. In cases in which the cancer hasn't yet been discovered, the appearance of pemphigus blisters may alert doctors to look for a malignancy.
Risk factors
Pemphigus isn't contagious, and there's no way to predict who'll get it. However, your risk increases if:
You're between the ages of 30 and 60.
You're of Mediterranean or Jewish descent.
You have another autoimmune condition, particularly myasthenia gravis, a chronic disorder characterized by muscle weakness and fatigue, or thymoma, a tumor of the thymus. The thymus is an organ that produces white blood cells known as lymphocytes, an important part of your immune system.
See your doctor if you develop blisters inside your mouth or on your skin. If you've been treated for pemphigus, see your doctor if you develop any of the following:
New blisters or sores
A rapid spread in the number of sores
Fever
Chills
Achy muscles or joints
A general sense of feeling ill (malaise)
Screening and diagnosis
Because it's uncommon, pemphigus may be difficult to diagnose. Blisters are common to a number of conditions, so besides taking a medical history and visually examining your skin and mouth, your doctor may lightly rub unblistered skin with a cotton swab or finger. With pemphigus, the top layers of your skin are likely to separate easily from the lower layers (positive for Nikolsky's sign). Other tests may include:
Skin biopsy. In this test, a piece of tissue from a blister is removed and examined under a microscope. Examination of the biopsy tissue may also involve a process called direct immunofluorescence (DIF). DIF entails staining the tissue with fluorescent dye to make the antibodies "light up" under a special microscope so they can be identified.
Blood tests. The purpose of these tests is to detect and identify antibodies (anti-desmogleins) in your blood.
Complications
The most common complications of pemphigus are infection of your skin and spread of infection through your bloodstream (sepsis). Systemic infection can be fatal.
Complications of paraneoplastic pemphigus include respiratory problems. The mortality rate for this type of pemphigus is estimated to be 90 percent, independent of the underlying cancer.
Other complications are the possible side effects of the medications used to treat pemphigus, particularly corticosteroids.
Treatment
Treatment, which aims at reducing signs and symptoms and preventing complications, is most effective when it begins as early as possible. The less widespread pemphigus is, the easier it may be to control. Specific treatment methods depend on the severity of the disease.
Mild pemphigusIf your pemphigus isn't too widespread, you may be able to remain at home for treatment. The mainstay of treatment is usually corticosteroids, such as prednisone. However, using corticosteroids over an extended time or in high doses may cause serious side effects, including:
Weight gain
Mood swings
Elevated blood sugar (diabetes)
Osteoporosis
Redistribution of body fat, leading to a round face (moon face)
Hair loss
Increased chance of infection because of suppression of the immune system
Corticosteroids may be combined with other medications, including:
Immunosuppressants. These medications, such as azathioprine (Imuran) or methotrexate (Rheumatrex), help keep your immune system from attacking healthy tissue. These drugs have serious side effects, including increased risk of infection.
Antibiotics and antifungal medications. These may be prescribed to control or prevent infections.
Severe pemphigusWidespread pemphigus may require you to stay in the hospital, where you may receive treatment similar to treatment for severe burns. The open sores make you highly vulnerable to infection, which if it spreads to your bloodstream, may be fatal. Besides the medications listed above, you may be given:
Fluids. Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — and proteins.
Intravenous feeding. This may be necessary if mouth sores make it painful for you to eat.
Anesthetic mouth lozenges. These can help control pain of mild to moderate mouth sores.
Therapeutic plasmapheresis. In this process, the fluid part of your blood, called plasma, is removed from blood cells by a device known as a cell separator. The purpose is to get rid of the antibodies that are attacking your skin. The plasma is replaced with donated plasma or intravenous fluids.
Self-care
Pemphigus and some of the drugs used to treat it render your skin fragile and prone to infection. Here are some things you can do:
Minimize trauma to your skin. Avoid situations in which your skin could be touched or bumped, such as contact sports.
Ask your doctor for wound care instructions. Taking good care of your wounds can help prevent infection and scarring.
Use talcum powder. Generously sprinkling talcum powder on your sheets may help keep oozing skin from sticking.
Use lotions or dressings. To ease discomfort, treat sores and blisters with soothing or drying lotions or wet dressings.
Coping skills
Some cases of pemphigus can be debilitating, especially before treatment starts to work. To help you cope with the disease and the effects of the drugs used for treatment, you may find it helpful to talk to others with the condition. You can find in-person or virtual support groups.
Ask your dermatologist or contact the International Pemphigus Foundation.
Mayo ClinicLabels: bacterial infections, pemphigus, pemphigus-herpes
# posted by Pat O'Connor @ 9:45 AM
Saturday, May 19, 2007
Bacterial Infection-Related Morbidity and Mortality in Cirrhosis.
Bacterial Infection-Related Morbidity and Mortality in Cirrhosis.
Am J Gastroenterol. 2007 May
Christou L,
Pappas G,
Falagas ME.
Division of Internal Medicine of the Medical School at the University of Ioannina, Ioannina, Greece.
OBJECTIVES:
Bacterial infections are acknowledged causes of morbidity and mortality in cirrhotic patients; yet, apart from spontaneous bacterial peritonitis, other infection issues have been understudied. We evaluated the existing medical data on infectious risks and related preventive and treatment data for cirrhotic patients.
METHODS:
Am J Gastroenterol. 2007 May
Christou L,
Pappas G,
Falagas ME.
Division of Internal Medicine of the Medical School at the University of Ioannina, Ioannina, Greece.
OBJECTIVES:
Bacterial infections are acknowledged causes of morbidity and mortality in cirrhotic patients; yet, apart from spontaneous bacterial peritonitis, other infection issues have been understudied. We evaluated the existing medical data on infectious risks and related preventive and treatment data for cirrhotic patients.
METHODS:
Medical literature search through MEDLINE, using a variety of keywords focused on: (a) immunodeficiency parameters of cirrhosis and attempts at therapeutic reversal, (b) relative incidence of various focal infections and implications for prevention, and (c) specific pathogens posing a risk in cirrhosis and availability of preventive strategies.
RESULTS:
Immunodeficiency in cirrhosis is multifactorial and might not be reversed by isolated interventions. Epidemiologic data on the incidence of specific infections and risk factors are scarce, only Child-Pugh stage C being a common denominator. A variety of common, such as Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis, as well as uncommon pathogens possess significant risks in cirrhosis. Certain aspects of these risks remain though unrecognized.
CONCLUSIONS:
To better understand the overall burden of bacterial infections on cirrhotic patients' survival, more data on preventive efficacy of pneumococcal vaccination, on the overall burden of tuberculosis, and the relative incidence of specific infections as endocarditis are warranted.
PMID: 17509025 [PubMed - as supplied by publisher]
Labels: bacterial infections, cirrhosis, immunodeficiency, mycobacterium, Staphylococcus aureus, streptococcus pnuemoniae
# posted by Pat O'Connor @ 8:11 PM
