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Li PH, Wong JCY, Chan JMC, Chik TSH, Chu MY, Ho GCH, Leung WS, Li TCM, Ng YY, Shum R, Sin WWY, Tso EYK, Wu AKL, Au EYL. Hong Kong Drug Allergy Delabelling Initiative (HK-DADI) consensus statements for penicillin allergy testing by nonallergists. Front Allergy 2022; 3:974138. [PMID: 36133403 PMCID: PMC9483020 DOI: 10.3389/falgy.2022.974138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Penicillin allergy testing has been traditionally performed by allergists, but there remains a huge deficit of specialists. A multidisciplinary effort with nonallergists would be invaluable to overcome the magnitude of penicillin allergy labels via the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI). These consensus statements (CSs) offer recommendations and guidance to enable nonallergists to screen for low-risk (LR) patients and perform penicillin allergy testing. Methods CSs were formulated by the HK-DADI Group using the Delphi method. An agreement was defined as greater than or equal to 80% consensus. Results A total of 26 CSs reached consensus after multiple rounds of Delphi. CSs were categorized into risk assessment, skin testing, drug provocation testing (DPT), and post-testing management. For risk assessment, the essentials of allergy history and exclusion criteria were detailed. Patients with only LR features can proceed with testing by nonallergists. Skin tests should be performed prior to DPT. Details regarding the timing, preparation, and interpretation of skin tests were elaborated. DPT remains the gold standard to diagnose genuine allergy or tolerance and should be performed when there is a low pretest probability following negative skin testing. Details of DPT preparations, dosing protocols, and interpretation were elaborated. For post-testing management, inaccurate allergy labels should be delabeled following negative DPT with proper patient counseling. Conclusion CSs support penicillin allergy testing by nonallergists in Hong Kong. LR cases can be managed by nonallergists at Spoke Clinics, with training and support of an allergist-led Hub.
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Affiliation(s)
- Philip H. Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Correspondence: Philip H. Li
| | - Jane C. Y. Wong
- Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Jacky M. C. Chan
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Thomas S. H. Chik
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - M. Y. Chu
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Grace C. H. Ho
- Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - W. S. Leung
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Timothy C. M. Li
- Division of Infectious Diseases, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y. Y. Ng
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Tuen Mun Hospital, Hong Kong SAR, China
| | - Rocky Shum
- Division of Microbiology, Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Winnie W. Y. Sin
- Division of Infectious Diseases, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Eugene Y. K. Tso
- Division of Infectious Diseases, Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Alan K. L. Wu
- Division of Microbiology, Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Elaine Y. L. Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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2
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Lau SKP, He Z, Tsang CC, Chan TTY, Luk HKH, Chan E, Li KSM, Fung J, Chow FWN, Tam AR, Chung TWH, Wong SCY, Que TL, Fung KSC, Lung DC, Wu AKL, Hung IFN, Teng JLL, Wernery U, Hui SW, Martelli P, Woo PCY. A Sensitive and Specific Competitive Enzyme-Linked Immunosorbent Assay for Serodiagnosis of COVID-19 in Animals. Microorganisms 2021; 9:1019. [PMID: 34068581 PMCID: PMC8150753 DOI: 10.3390/microorganisms9051019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/12/2022] Open
Abstract
In addition to human cases, cases of COVID-19 in captive animals and pets are increasingly reported. This raises the concern for two-way COVID-19 transmission between humans and animals. Here, we developed a SARS-CoV-2 nucleocapsid protein-based competitive enzyme-linked immunosorbent assay (cELISA) for serodiagnosis of COVID-19 which can theoretically be used in virtually all kinds of animals. We used 187 serum samples from patients with/without COVID-19, laboratory animals immunized with inactive SARS-CoV-2 virions, COVID-19-negative animals, and animals seropositive to other betacoronaviruses. A cut-off percent inhibition value of 22.345% was determined and the analytical sensitivity and specificity were found to be 1:64-1:256 and 93.9%, respectively. Evaluation on its diagnostic performance using 155 serum samples from COVID-19-negative animals and COVID-19 human patients showed a diagnostic sensitivity and specificity of 80.8% and 100%, respectively. The cELISA can be incorporated into routine blood testing of farmed/captive animals for COVID-19 surveillance.
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Affiliation(s)
- Susanna K. P. Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Zirong He
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Chi-Ching Tsang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Tony T. Y. Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Hayes K. H. Luk
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Elaine Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Kenneth S. M. Li
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Joshua Fung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Franklin W. N. Chow
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Anthony R. Tam
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong;
| | - Tom W. H. Chung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Sally C. Y. Wong
- Department of Pathology, Queen Elizabeth Hospital, King’s Park, Hong Kong; (S.C.Y.W.); (D.C.L.)
| | - Tak-Lun Que
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong;
| | - Kitty S. C. Fung
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong;
| | - David C. Lung
- Department of Pathology, Queen Elizabeth Hospital, King’s Park, Hong Kong; (S.C.Y.W.); (D.C.L.)
| | - Alan K. L. Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong;
| | - Ivan F. N. Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong;
| | - Jade L. L. Teng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
| | - Ulrich Wernery
- Central Veterinary Research Laboratory, P.O. Box 597, Dubai, United Arab Emirates;
| | - Suk-Wai Hui
- Ocean Park Corporation, Aberdeen, Hong Kong; (S.-W.H.); (P.M.)
| | - Paolo Martelli
- Ocean Park Corporation, Aberdeen, Hong Kong; (S.-W.H.); (P.M.)
| | - Patrick C. Y. Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; (Z.H.); (C.-C.T.); (T.T.Y.C.); (H.K.H.L.); (E.C.); (K.S.M.L.); (J.F.); (F.W.N.C.); (T.W.H.C.); (J.L.L.T.)
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3
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Teng JLL, Luo R, Tang BSF, Fong JYH, Wang L, Jia L, Wong CKS, Chan E, Leung AWS, Siu GKH, Chiu TH, Fung AMY, Wu AKL, Yeung ML, Lau SKP, Woo PCY. High Prevalence and Mechanism Associated With Extended Spectrum Beta-Lactamase-Positive Phenotype in Laribacter hongkongensis. Front Microbiol 2021; 12:618894. [PMID: 33633706 PMCID: PMC7902055 DOI: 10.3389/fmicb.2021.618894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
In this study, we reported the prevalence and mechanism associated with the extended-spectrum beta-lactamase (ESBL)-positive phenotype in Laribacter hongkongensis isolated from patients and fish. Using the inhibition zone enhancement test, 20 (95.2%) of the 21 patient strains and 8 (57.1%) of the 14 fish strains were tested ESBL-positive. However, ESBL genes, including SHV, TEM, CTX-M, GES, and PER, were not detected in all of these 28 L. hongkongensis isolates. No ESBL gene could be detected in either the complete genome of L. hongkongensis HLHK9 or the draft genome of PW3643. PCR and DNA sequencing revealed that all the 35 L. hongkongensis isolates (showing both ESBL-positive and ESBL-negative phenotypes) were positive for the ampC gene. When the AmpC deletion mutant, HLHK9ΔampC, was subject to the zone enhancement test, the difference of zone size between ceftazidime/clavulanate and ceftazidime was less than 5 mm. When boronic acid was added to the antibiotic disks, none of the 28 “ESBL-positive” isolates showed a ≥ 5 mm enhancement of inhibition zone size diameter between ceftazidime/clavulanate and ceftazidime and between cefotaxime/clavulanate and cefotaxime. A high prevalence (80%) of ESBL-positive phenotype is present in L. hongkongensis. Overall, our results suggested that the ESBL-positive phenotype in L. hongkongensis results from the expression of the intrinsic AmpC beta-lactamase. Confirmatory tests should be performed before issuing laboratory reports for L. hongkongensis isolates that are tested ESBL-positive by disk diffusion clavulanate inhibition test.
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Affiliation(s)
- Jade L L Teng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ruibang Luo
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Bone S F Tang
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Jordan Y H Fong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Li Wang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lilong Jia
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chloe K S Wong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Elaine Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Amy W S Leung
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Gilman K H Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz-Ho Chiu
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ami M Y Fung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Man-Lung Yeung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Susanna K P Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Patrick C Y Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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4
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Yung YL, Cheng CK, Chan HY, Xia JT, Lau KM, Wong RSM, Wu AKL, Chu RW, Wong ACC, Chow EYD, Yip SF, Leung JNS, Lee CK, Ng MHL. Association of HLA-B22 serotype with SARS-CoV-2 susceptibility in Hong Kong Chinese patients. HLA 2020; 97:127-132. [PMID: 33179437 PMCID: PMC7898481 DOI: 10.1111/tan.14135] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID‐19) is a highly infectious disease caused by SARS‐CoV‐2. Since its first report in December 2019, COVID‐19 has evolved into a global pandemic causing massive healthcare and socioeconomic challenges. HLA system is critical in mediating anti‐viral immunity and recent studies have suggested preferential involvement of HLA‐B in COVID‐19 susceptibility. Here, by investigating the HLA‐B genotypes in 190 unrelated Chinese patients with confirmed COVID‐19, we identified a significant positive association between the B22 serotype and SARS‐CoV‐2 infection (p = 0.002, Bonferroni‐corrected p = 0.032). Notably, the B22 serotype has been consistently linked to susceptibility to other viral infections. These data not only shed new insights into SARS‐CoV‐2 pathogenesis and vaccine development but also guide better infection prevention/control.
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Affiliation(s)
- Yuk-Lin Yung
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Keung Cheng
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hoi-Yun Chan
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jenny T Xia
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin-Mang Lau
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond S M Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Sir Y. K. Pao Centre for Cancer, Prince of Wales Hospital, Hong Kong, China
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Raymond W Chu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alice C C Wong
- Department of Pathology, United Christian Hospital, Hong Kong, China
| | - Eudora Y D Chow
- Department of Pathology, United Christian Hospital, Hong Kong, China
| | - Sze-Fai Yip
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
| | | | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - Margaret H L Ng
- Blood Cancer Cytogenetics and Genomics Laboratory, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
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5
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Tsang CC, Tang JYM, Ye H, Xing F, Lo SKF, Xiao C, Han L, Wu AKL, Ngan AHY, Law KC, To YN, Sze DTT, Chim OHY, Hui TWS, Leung CWH, Zhu T, Yao C, Tse BPH, Lau SKP, Woo PCY. Rare/cryptic Aspergillus species infections and importance of antifungal susceptibility testing. Mycoses 2020; 63:1283-1298. [PMID: 32918365 DOI: 10.1111/myc.13158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The number of patients infected with Aspergillus rose dramatically in recent years. However, studies on the clinical spectrum and antifungal susceptibilities of non-classical (non-fumigatus, non-flavus, non-niger and non-terreus) pathogenic Aspergillus species are very limited. OBJECTIVES We examined the clinical spectrum and antifungal susceptibilities of 34 non-duplicated, non-classical Aspergillus isolates collected from Hong Kong, Shenzhen and Shanghai. METHODS The Aspergillus isolates were identified by internal transcribed spacer, partial BenA and partial CaM sequencing and phylogenetic analyses. Susceptibility testing against eight antifungals was performed following the European Committee for Antimicrobial Susceptibility Testing's methodology. RESULTS The 34 Aspergillus isolates were identified as 14 different rare/cryptic species of four sections (Flavi [n = 8], Nidulantes [n = 8], Nigri [n = 17] and Restricti [n = 1]). Except for one patient whose clinical history could not be retrieved, 72.7% of the remaining patients had underlying conditions predisposing them to Aspergillus infections. The most common diseases were pulmonary infections (n = 15), followed by skin/nail infections (n = 6), chronic otitis externa and/or media (n = 5), wound infections (n = 2) and mastoiditis/radionecrosis (n = 1), while three were colonisations. Five patients succumbed due to the infections during the admission, and another two died 5 years later because of chronic pulmonary aspergillosis. Antifungal susceptibility testing showed that they possessed different susceptibility profiles compared to the classical Aspergillus species. The majority of isolates characterised were sensitive or wild-type to amphotericin B. The minimum effective concentrations for all the three echinocandins were also low. CONCLUSION Susceptibility testing should be performed for infections due to these rare/cryptic Aspergillus species to guide proper patient management.
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Affiliation(s)
- Chi-Ching Tsang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - James Y M Tang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Simon K F Lo
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chenlu Xiao
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lizhong Han
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Antonio H Y Ngan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kwok-Cheung Law
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ying-Nam To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Dorothy T T Sze
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Pathology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Oscar H Y Chim
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Teresa W S Hui
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Carl W H Leung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tianrenzheng Zhu
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,School of Public Health, Southern Medical University, Guangzhou, China
| | - Chunyan Yao
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Brian P H Tse
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Susanna K P Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Patrick C Y Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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6
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Chan E, Wu AKL, Tse CWS, Lau SKP, Woo PCY. In vitro susceptibility of Salmonella enterica serovar Typhi to ceftolozane/tazobactam. J Antimicrob Chemother 2019; 74:528-530. [PMID: 30295743 DOI: 10.1093/jac/dky418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Elaine Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Cindy W S Tse
- Department of Pathology, Kwong Wah Hospital, Hong Kong, China
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China
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7
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Lui G, Tam A, Tso EYK, Wu AKL, Zee J, Choi KW, Lam W, Chan MC, Ting WM, Hung IFN. Melioidosis in Hong Kong. Trop Med Infect Dis 2018; 3:tropicalmed3030091. [PMID: 30274487 PMCID: PMC6161032 DOI: 10.3390/tropicalmed3030091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/27/2022] Open
Abstract
Melioidosis, although endemic in many parts of Southeast Asia, has not been systematically studied in Hong Kong, which is a predominantly urban area located in the subtropics. This review describes the early outbreaks of melioidosis in captive animals in Hong Kong in the 1970s, as well as the early reports of human clinical cases in the 1980s. A review of all hospitalized human cases of culture-confirmed melioidosis in the last twenty years showed an increasing trend in the incidence of the disease, with significant mortality observed. The lack of awareness of this disease among local physicians, the delay in laboratory diagnosis and the lack of epidemiological surveillance are among the greatest challenges of managing melioidosis in the territory.
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Affiliation(s)
- Grace Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
| | - Anthony Tam
- Department of Medicine, Queen Mary Hospital, Hong Kong, China.
| | - Eugene Y K Tso
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China.
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
| | - Jonpaul Zee
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong, China.
| | - Kin Wing Choi
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
| | - Wilson Lam
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
| | - Man Chun Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
| | - Wan Man Ting
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
| | - Ivan F N Hung
- Department of Medicine, Queen Mary Hospital, Hong Kong, China.
- Carol Yu Centre for Infection, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518172, China.
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8
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To KKW, Lu L, Fong CHY, Wu AKL, Mok KY, Yip CCY, Ke YH, Sze KH, Lau SKP, Hung IFN, Yuen KY. Rhinovirus respiratory tract infection in hospitalized adult patients is associated with T H2 response irrespective of asthma. J Infect 2018; 76:465-474. [PMID: 29454786 DOI: 10.1016/j.jinf.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We assessed the immunological response of hospitalized adult patients with rhinovirus infection, including critically-ill patients. METHODS The differential white blood cell (WBC) count and the levels of 29 plasma cytokines/chemokines were compared between 50 adult hospitalized patients with rhinovirus infection and 100 age-matched controls with influenza virus infection. RESULTS The demographics and comorbidities were similar between rhinovirus and influenza patients, but severe disease was more common for the rhinovirus cohort. Rhinovirus patients had significantly higher WBC counts than influenza patients, especially for eosinophil (P = 3.1 × 10-8). The level of the TH2 cytokine IL-5 was significantly higher among rhinovirus patients, while the levels of 9 other cytokines/chemokines were significantly lower among rhinovirus patients. The levels of CXCL-10 (IP-10), CCL-2 (MCP-1), IFN-α2, IFN-γ, IL-10, and IL-15 remained significantly lower among rhinovirus patients after correction for multiple comparisons. Notably, CXCL-10 had the highest area under the receiver operating characteristic curve (AUC) in differentiating rhinovirus from influenza patients (AUC, 0.918). In the patient subgroup without asthma, the difference in the WBC count and cytokine/chemokine levels between rhinovirus and influenza patients remained statistically significant. CONCLUSIONS Rhinovirus infection was characterized by a prominent TH2 response, even in patients without asthma. CXCL-10 (IP-10) is a potential biomarker in differentiating rhinovirus from influenza infection.
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Affiliation(s)
- Kelvin K W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China; Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Lu Lu
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carol H Y Fong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ka-Yi Mok
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cyril C Y Yip
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Yi-Hong Ke
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kong-Hung Sze
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Susanna K P Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China; Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Ivan F N Hung
- Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China; Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China; Department of Microbiology, Queen Mary Hospital, Hong Kong, China.
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9
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Erdem H, Inan A, Guven E, Hargreaves S, Larsen L, Shehata G, Pernicova E, Khan E, Bastakova L, Namani S, Harxhi A, Roganovic T, Lakatos B, Uysal S, Sipahi OR, Crisan A, Miftode E, Stebel R, Jegorovic B, Fehér Z, Jekkel C, Pandak N, Moravveji A, Yilmaz H, Khalifa A, Musabak U, Yilmaz S, Jouhar A, Oztoprak N, Argemi X, Baldeyrou M, Bellaud G, Moroti RV, Hasbun R, Salazar L, Tekin R, Canestri A, Čalkić L, Praticò L, Yilmaz-Karadag F, Santos L, Pinto A, Kaptan F, Bossi P, Aron J, Duissenova A, Shopayeva G, Utaganov B, Grgic S, Ersoz G, Wu AKL, Lung KC, Bruzsa A, Radic LB, Kahraman H, Momen-Heravi M, Kulzhanova S, Rigo F, Konkayeva M, Smagulova Z, Tang T, Chan P, Ahmetagic S, Porobic-Jahic H, Moradi F, Kaya S, Cag Y, Bohr A, Artuk C, Celik I, Amsilli M, Gul HC, Cascio A, Lanzafame M, Nassar M. The burden and epidemiology of community-acquired central nervous system infections: a multinational study. Eur J Clin Microbiol Infect Dis 2017; 36:1595-1611. [PMID: 28397100 DOI: 10.1007/s10096-017-2973-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.
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Affiliation(s)
- H Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey.
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, 06010, Etlik, Ankara, Turkey.
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - E Guven
- Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, UK
| | - L Larsen
- Department of Infectious Diseases Q, Odense University Hospital, Odense, Denmark
| | - G Shehata
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - E Pernicova
- Avenier, Centres for Vaccination and Travel Medicine, Prague, Czech Republic
- Faculty Hospital Brno, Department of Infectious Diseases, Brno, Czech Republic
| | - E Khan
- Shifa International Hospital, Islamabad, Pakistan
| | - L Bastakova
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - S Namani
- Infectious Diseases Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - A Harxhi
- Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania
| | - T Roganovic
- Infectious Diseases Clinic, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - B Lakatos
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - S Uysal
- Department of Infectious Diseases and Clinical Microbiology, Seyfi Demirsoy State Hospital, Buca, İzmir, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - A Crisan
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - E Miftode
- Hospital of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - R Stebel
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - B Jegorovic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Z Fehér
- Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - C Jekkel
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - N Pandak
- General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia
| | - A Moravveji
- Social Determinants of Health Research Center, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - H Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - A Khalifa
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - U Musabak
- Department of Immunology and Allergy, Losante Hospital, Ankara, Turkey
| | - S Yilmaz
- Gulhane Medical Academy, Blood Bank, Clinical Microbiology Division, Ankara, Turkey
| | - A Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - N Oztoprak
- Antalya Education and Research Hospital, Antalya, Turkey
| | - X Argemi
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - M Baldeyrou
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - G Bellaud
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - R V Moroti
- Carol Davila University of Medicine and Pharmacy and Matei Bals National Institute for Infectious Diseases, Bucharest, Romania
| | - R Hasbun
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Salazar
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - A Canestri
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - L Čalkić
- Department of Infectious Diseases, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - L Praticò
- University Division of Infectious and Tropical Diseases, Piazza Spedali Civili, 25123, Brescia, Italy
| | - F Yilmaz-Karadag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - L Santos
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Pinto
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - P Bossi
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - J Aron
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - A Duissenova
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - G Shopayeva
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - B Utaganov
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - S Grgic
- Clinic for Infectious Diseases, University Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - G Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - A K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K C Lung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - A Bruzsa
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - L B Radic
- Department of Infectious Diseases, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - H Kahraman
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - M Momen-Heravi
- Department of Infectious Diseases, Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - S Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - F Rigo
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Konkayeva
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - Z Smagulova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - T Tang
- Infectious Diseases Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - P Chan
- Neurology Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - S Ahmetagic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - H Porobic-Jahic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - F Moradi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - S Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Y Cag
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - A Bohr
- Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - I Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - M Amsilli
- Infectious Diseases Unit, CHU Bicètre, Paris, France
| | - H C Gul
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - A Cascio
- Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - M Lanzafame
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Nassar
- Infection Control Department, Saudi German Hospital Group, Jeddah, Saudi Arabia
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10
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Lung DC, Tsang OTY, Choi KW, Hung IFN, Chan KM, Wu AKL, Tso EYK, Wu TC, Lam TS, Wong AWY, Ng KHL, Lui SSY, Hsu EK, Wong ATY. Review of first 36 cases of New Delhi metallo-β-lactamase-producing Enterobacteriaceae in Hong Kong. J Glob Antimicrob Resist 2017; 8:199-201. [PMID: 28192211 DOI: 10.1016/j.jgar.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- David C Lung
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China.
| | - Owen T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hospital Authority, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - K W Choi
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, 11 Chuen On Road, Tai Po, NY, Hong Kong SAR, China
| | - Ivan F N Hung
- Department of Medicine, University of Hong Kong, Room 405B, 4/F Professorial Block, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong SAR, China
| | - K M Chan
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China
| | - Alan K L Wu
- Department of Clinical Microbiology, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
| | - Eugene Y K Tso
- Department of Medicine and Geriatrics, United Christian Hospital, Hospital Authority, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China
| | - T C Wu
- Department of Medicine, Queen Elizabeth Hospital, Hospital Authority, 30 Gascoigne Road, Kowloon, Hong Kong SAR, China
| | - T S Lam
- Surveillance and Epidemiology Branch, Centre for Health Protection, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Ada W Y Wong
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Ken H L Ng
- Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong SAR, China
| | - Steffi S Y Lui
- Infection Control Branch, Centre for Health Protection, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Enoch K Hsu
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
| | - Andrew T Y Wong
- Infection Control Branch, Centre for Health Protection, G/F, 147C Argyle Street, Kowloon, Hong Kong SAR, China
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11
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Tsang CC, Xiong L, Poon RWS, Chen JHK, Leung KW, Lam JYW, Wu AKL, Chan JFW, Lau SKP, Woo PCY. Gordonia hongkongensis sp. nov., isolated from blood culture and peritoneal dialysis effluent of patients in Hong Kong. Int J Syst Evol Microbiol 2016; 66:3942-3950. [PMID: 27406710 DOI: 10.1099/ijsem.0.001292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Two bacterial strains, HKU50T and HKU46, were isolated in Hong Kong from the blood culture and the peritoneal dialysis effluent of two patients. The strains are Gram-stain-positive, acid-fast, non-motile, non-sporulating bacilli. They grow on Columbia agar with 5 % defibrinated sheep blood and brain-heart infusion agar under aerobic conditions with 5 % CO2 at 37 °C as pink-to-orange, non-haemolytic colonies. The strains are catalase-positive and oxidase-negative, and have a unique biochemical profile distinguishable from other closely related species. DNA sequencing revealed that both isolates possessed multiple intra-genomic 16S rRNA gene copies (99.8-100 % sequence identities to Gordonia lacunae NRRL B-24551T and Gordonia terrae NRRL B-16283T). Phylogenetic analysis of the 16S rRNA gene, secA1 and gyrB showed that the two isolates formed a distinct branch within the genus Gordonia and were most closely related to G. lacunae and G. terrae. DNA-DNA hybridization demonstrated ≤53.7 % and ≤49.4 % DNA relatedness between the two isolates and G. lacunae, and between the two isolates and G. terrae, respectively. Hierarchical cluster analysis of MALDI-TOF MS main spectrum profiles showed that strains HKU50T and HKU46 were closely related to each other, but were distinct from G. lacunae, G. terrae, or any other species of the genus Gordonia in the Bruker database. The chemotaxonomic traits of the two strains were highly similar, and the major fatty acids were summed feature 4 (iso-C15 : 0 2-OH/C16 : 1trans-9), C16 : 0, C18 : 1cis-9, and tuberculostearic acid. A novel species named Gordonia hongkongensis sp. nov. is proposed to accommodate strains HKU50T and HKU46, with strain HKU50T (=CCOS 955T=CIP 111027T=NBRC 111234T=NCCP 16210T) as the type strain.
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Affiliation(s)
- Chi-Ching Tsang
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
| | - Lifeng Xiong
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
| | - Rosana W S Poon
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
| | - Jonathan H K Chen
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
| | - Kit-Wah Leung
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
| | - Jimmy Y W Lam
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR
| | - Jasper F W Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong, SAR.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, SAR.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, SAR.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, SAR
| | - Susanna K P Lau
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, SAR.,Department of Microbiology, The University of Hong Kong, Hong Kong, SAR.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, SAR.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, SAR.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, SAR
| | - Patrick C Y Woo
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, SAR.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, SAR.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, SAR.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, SAR.,Department of Microbiology, The University of Hong Kong, Hong Kong, SAR
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12
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Lau SKP, Yip CCY, Zhao PSH, Chow WN, To KKW, Wu AKL, Yuen KY, Woo PCY. Enterovirus D68 Infections Associated with Severe Respiratory Illness in Elderly Patients and Emergence of a Novel Clade in Hong Kong. Sci Rep 2016; 6:25147. [PMID: 27121085 PMCID: PMC4848506 DOI: 10.1038/srep25147] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/11/2016] [Indexed: 01/23/2023] Open
Abstract
Despite the recent emergence of enterovirus D68 (EV-D68), its clinical impact on adult population is less well defined. To better define the epidemiology of EV-D68, 6,800 nasopharyngeal aspirates (NPAs) from 2010–2014 were subject to EV-D68 detection by RT-PCR and sequencing of 5′UTR and partial VP1. EV-D68 was detected in 30 (0.44%) NPAs from 22 children and 8 adults/elderlies. Sixteen patients (including five elderly) (53%) had pneumonia and 13 (43%) patients were complicated by small airway disease exacerbation. Phylogenetic analysis of VP1, 2C and 3D regions showed four distinct lineages of EV-D68, clade A1, A2, B1 and B3, with adults/elderlies exclusively infected by clade A2. The potentially new clade, B3, has emerged in 2014, while strains closely related to recently emerged B1 strains in the United States were also detected as early as 2011 in Hong Kong. The four lineages possessed distinct aa sequence patterns in BC and DE loops. Amino acid residues 97 and 140, within BC and DE-surface loops of VP1 respectively, were under potential positive selection. EV-D68 infections in Hong Kong usually peak in spring/summer, though with a delayed autumn/winter peak in 2011. This report suggests that EV-D68 may cause severe respiratory illness in adults/elderlies with underlying co-morbidities.
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Affiliation(s)
- Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Cyril C Y Yip
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Pyrear Su-Hui Zhao
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Wang-Ngai Chow
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Kelvin K W To
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
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13
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Lau SKP, Lam CSK, Ngan AHY, Chow WN, Wu AKL, Tsang DNC, Tse CWS, Que TL, Tang BSF, Woo PCY. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry for rapid identification of mold and yeast cultures of Penicillium marneffei. BMC Microbiol 2016; 16:36. [PMID: 26965891 PMCID: PMC4787007 DOI: 10.1186/s12866-016-0656-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 03/02/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Penicillium marneffei is the most important thermal dimorphic fungus causing systemic mycosis in HIV-infected and other immunocompromised patients in Southeast Asia. However, laboratory diagnosis of penicilliosis, which relies on microscopic morphology and mycelial-to-yeast conversion, is time-consuming and expertise-dependent, thus delaying diagnosis and treatment. Although matrix -assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is useful for identification of various medically important fungi, its performance for identification of P. marneffei is less clear. RESULTS We evaluated the performance of the Bruker MALDI-TOF MS system for identification of mold and yeast cultures of 59 clinical strains and the type strain of P. marneffei using the direct transfer method, with results compared to four phylogenetically closely related species, P. brevi-compactum, P. chrysogenum, Talaromyces aurantiacus and T. stipitatus. Using the Bruker original database combined with BDAL v4.0.0.1 and Filamentous Fungi Library 1.0, MALDI-TOF MS failed to identify the 60 P. marneffei strains grown in mold and yeast phase (identified as P. funiculosum and P. purpurogenum with scores <1.7 respectively). However, when the combined database was expanded with inclusion of spectra from 21 P. marneffei strains in mold and/or yeast phase, all the remaining 39 P. marneffei strains grown in mold or phase were correctly identified to the species level with score >2.0. The MS spectra of P. marneffei exhibited significant difference to those of P. brevi-compactum, P. chrysogenum, T. aurantiacus and T. stipitatus. However, MALDI-TOF MS failed to identify these four fungi to the species level using the combined database with or without spectra from P. marneffei. CONCLUSIONS MALDI-TOF MS is useful for rapid identification of both yeast and mold cultures of P. marneffei and differentiation from related species. However, accurate identification to the species level requires database expansion using P. marneffei strains.
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Affiliation(s)
- Susanna K P Lau
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. .,Research Centre of Infection and Immunology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong, China. .,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. .,Department of Microbiology, The University of Hong Kong, Hong Kong, China.
| | | | - Antonio H Y Ngan
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Wang-Ngai Chow
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | - Cindy W S Tse
- Department of Pathology, Kwong Wah Hospital, Hong Kong, China
| | - Tak-Lun Que
- Department of Pathology, Tuen Mun Hospital, Hong Kong, China
| | | | - Patrick C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. .,Research Centre of Infection and Immunology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong, China. .,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. .,Department of Microbiology, The University of Hong Kong, Hong Kong, China.
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14
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Sridhar S, Fung KSC, Chan JFW, Lam JYW, Yip EKT, Hung IFN, Wu AKL, Que TL, Lau SKP, Woo PCY. High recurrence rate supports need for secondary prophylaxis in non-HIV patients with disseminated mycobacterium avium complex infection: a multi-center observational study. BMC Infect Dis 2016; 16:74. [PMID: 26861696 PMCID: PMC4748557 DOI: 10.1186/s12879-016-1411-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Long-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex (dMAC) infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting. The objective of this study was to determine the need of continuing secondary anti-MAC prophylaxis in non-HIV patients after completing treatment of the primary dMAC episode. Methods We conducted a ten-year multi-center analysis of non-HIV immunosuppressed patients with dMAC infections in Hong Kong. Results We observed sixteen patients with dMAC during the study period of which five (31 %) were non-HIV immunosuppressed patients. In the non-HIV immunosuppressed group, three patients completed a treatment course without secondary prophylaxis, one patient received azithromycin-based secondary prophylaxis and one patient was still receiving therapy for the first dMAC episode. All the three patients who completed treatment without being given secondary prophylaxis developed recurrent dMAC infection requiring retreatment. Conclusions In view of the high rate of dMAC infection recurrence in non-HIV immunocompromised patients following treatment completion, our data support long-term anti-MAC suppression therapy after treatment of the first dMAC infection episode in immunocompromised non-HIV patients, as is recommended for patients with advanced HIV. Tests of cell mediated immune function need to be evaluated to guide prophylaxis discontinuation in non-HIV patients.
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Affiliation(s)
- Siddharth Sridhar
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Kitty S C Fung
- Department of Microbiology, United Christian Hospital, Hong Kong, China
| | - Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Department of Microbiology, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Jimmy Y W Lam
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Eric K T Yip
- Department of Microbiology, Tuen Mun Hospital, Hong Kong, China
| | - Ivan F N Hung
- Division of Infectious Disease, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alan K L Wu
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Tak-Lun Que
- Department of Microbiology, Tuen Mun Hospital, Hong Kong, China
| | - Susanna K P Lau
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Department of Microbiology, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Patrick C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. .,Department of Microbiology, The University of Hong Kong, Hong Kong, China. .,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. .,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.
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15
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Tsang CC, Hui TWS, Lee KC, Chen JHK, Ngan AHY, Tam EWT, Chan JFW, Wu AL, Cheung M, Tse BPH, Wu AKL, Lai CKC, Tsang DNC, Que TL, Lam CW, Yuen KY, Lau SKP, Woo PCY. Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing. Diagn Microbiol Infect Dis 2015; 84:125-34. [PMID: 26658315 DOI: 10.1016/j.diagmicrobio.2015.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
Thirteen Aspergillus isolates recovered from nails of 13 patients (fingernails, n=2; toenails, n=11) with onychomycosis were characterized. Twelve strains were identified by multilocus sequencing as Aspergillus spp. (Aspergillus sydowii [n=4], Aspergillus welwitschiae [n=3], Aspergillus terreus [n=2], Aspergillus flavus [n=1], Aspergillus tubingensis [n=1], and Aspergillus unguis [n=1]). Isolates of A. terreus, A. flavus, and A. unguis were also identifiable by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The 13th isolate (HKU49(T)) possessed unique morphological characteristics different from other Aspergillus spp. Molecular characterization also unambiguously showed that HKU49(T) was distinct from other Aspergillus spp. We propose the novel species Aspergillus hongkongensis to describe this previously unknown fungus. Antifungal susceptibility testing showed most Aspergillus isolates had low MICs against itraconazole and voriconazole, but all Aspergillus isolates had high MICs against fluconazole. A diverse spectrum of Aspergillus species is associated with onychomycosis. Itraconazole and voriconazole are probably better drug options for Aspergillus onychomycosis.
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Affiliation(s)
- Chi-Ching Tsang
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Teresa W S Hui
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | - Kim-Chung Lee
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | | | - Antonio H Y Ngan
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Emily W T Tam
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Jasper F W Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Andrea L Wu
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Mei Cheung
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | - Brian P H Tse
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Tak-Lun Que
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | - Ching-Wan Lam
- Department of Pathology, The University of Hong Kong, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
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16
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Lau SKP, Wu AKL, Teng JLL, Tse H, Curreem SOT, Tsui SKW, Huang Y, Chen JHK, Lee RA, Yuen KY, Woo PCY. Evidence for Elizabethkingia anophelis transmission from mother to infant, Hong Kong. Emerg Infect Dis 2015; 21:232-41. [PMID: 25625669 PMCID: PMC4313635 DOI: 10.3201/eid2102.140623] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Genome sequencing can provide rapid insights on transmission and pathogenesis of emerging pathogens. Elizabethkingia anophelis, recently discovered from mosquito gut, is an emerging bacterium associated with neonatal meningitis and nosocomial outbreaks. However, its transmission route remains unknown. We use rapid genome sequencing to investigate 3 cases of E. anophelis sepsis involving 2 neonates who had meningitis and 1 neonate’s mother who had chorioamnionitis. Comparative genomics revealed evidence for perinatal vertical transmission from a mother to her neonate; the 2 isolates from these patients, HKU37 and HKU38, shared essentially identical genome sequences. In contrast, the strain from another neonate (HKU36) was genetically divergent, showing only 78.6% genome sequence identity to HKU37 and HKU38, thus excluding a clonal outbreak. Comparison to genomes from mosquito strains revealed potential metabolic adaptations in E. anophelis under different environments. Maternal infection, not mosquitoes, is most likely the source of neonatal E. anophelis infections. Our findings highlight the power of genome sequencing in gaining rapid insights on transmission and pathogenesis of emerging pathogens.
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17
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To KKW, Zhou J, Song YQ, Hung IFN, Ip WCT, Cheng ZS, Chan ASF, Kao RYT, Wu AKL, Chau S, Luk WK, Ip MSM, Chan KH, Yuen KY. Surfactant protein B gene polymorphism is associated with severe influenza. Chest 2014; 145:1237-1243. [PMID: 24337193 DOI: 10.1378/chest.13-1651] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surfactant proteins play a key role in alveolar stability. We examined whether single nucleotide polymorphisms (SNPs) related to the surfactant protein genes are associated with severe influenza. METHODS In the first cohort, 12 SNPs related to surfactant protein genes were compared between Chinese patients with severe and mild pandemic 2009 influenza A(H1N1) (A[H1N1]pdm09) infection who were matched for age, sex, and underlying risk conditions. The SNP rs1130866, which was significantly different between the two groups, was further genotyped in a second cohort of patients. Multivariate analysis was performed to control for confounding factors. The genotype frequencies were also compared with those of the general Han Chinese population. RESULTS This study consisted of 380 patients with A(H1N1)pdm09 infection. In the first cohort of 84 patients, the C allele of rs1130866, an SNP in the surfactant protein B gene (SFTPB), was significantly associated with severe disease (OR = 3.37, P = .0048), although the P value was .057 after Bonferroni correction. In the second cohort of 296 patients, the C/C genotype was confirmed in the univariate analysis to be associated with severe disease. Multivariate analysis of the second cohort showed that genotype C/C was an independent risk factor for severe A(H1N1)pdm09 infection (second cohort: OR = 2.087, P = .023). Compared to the general Han Chinese population, the C/C genotype was overrepresented in patients with severe A(H1N1)pdm09 infection (OR = 3.232, P = .00000056). CONCLUSIONS SFTPB polymorphism is associated with severe influenza. The role of SFTPB in influenza warrants further studies.
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Affiliation(s)
- Kelvin K W To
- State Key Laboratory for Emerging Infectious Diseases; Carol Yu Centre for Infection; Research Centre of Infection and Immunology; Department of Microbiology
| | - Jie Zhou
- Research Centre of Infection and Immunology; Department of Microbiology
| | | | - Ivan F N Hung
- Carol Yu Centre for Infection; Research Centre of Infection and Immunology; Department of Medicine, The University of Hong Kong, Pokfulam
| | | | | | | | - Richard Y T Kao
- State Key Laboratory for Emerging Infectious Diseases; Research Centre of Infection and Immunology; Department of Microbiology
| | - Alan K L Wu
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region
| | - Sandy Chau
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region
| | - Wei-Kwang Luk
- Department of Pathology, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
| | - Mary S M Ip
- Department of Medicine, The University of Hong Kong, Pokfulam
| | - Kwok-Hung Chan
- Carol Yu Centre for Infection; State Key Laboratory for Emerging Infectious Diseases; Research Centre of Infection and Immunology; Department of Microbiology
| | - Kwok-Yung Yuen
- Department of Microbiology; Research Centre of Infection and Immunology; Carol Yu Centre for Infection; State Key Laboratory for Emerging Infectious Diseases.
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18
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Woo PCY, Wu AKL, Tsang CC, Leung KW, Ngan AHY, Curreem SOT, Lam KW, Chen JHK, Chan JFW, Lau SKP. Streptobacillus hongkongensis sp. nov., isolated from patients with quinsy and septic arthritis, and emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis. Int J Syst Evol Microbiol 2014; 64:3034-3039. [PMID: 24912824 DOI: 10.1099/ijs.0.061242-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Two bacterial strains, HKU33(T) and HKU34, were isolated in Hong Kong from the pus aspirated from the right peritonsillar abscess of a patient with quinsy and the left elbow joint fluid of another patient with tophaceous gout and left elbow septic arthritis, respectively. The bacteria were Gram-stain-negative, non-motile, non-spore-forming, non-haemolytic pleomorphic bacilli. They grew best on Columbia agar with 5 % defibrinated sheep blood in an anaerobic environment or aerobic environment with 5 % CO2. They also grew on chocolate agar but not on MacConkey agar. They were catalase- and cytochrome oxidase-negative. They showed a unique profile of enzyme activities distinguishable from their closely related species. Phylogenetic analysis of the complete 16S rRNA gene, and partial groEL, gyrB and recA gene sequences showed the two isolates formed a distinct branch within the family Leptotrichiaceae, being related most closely to Streptobacillus moniliformis. Hierarchical cluster analysis of mass spectra of whole-cell protein contents showed that strains HKU33(T) and HKU34 were closely related to each other, but were distinct from Streptobacillus moniliformis, Sneathia sanguinegens and 'Leptotrichia amnionii'. The DNA G+C content of strain HKU33(T) was 26.0±2.1 mol% (mean±sd; n = 3). DNA-DNA hybridization demonstrated ≤45.02 % DNA relatedness between the two isolates and Streptobacillus moniliformis CCUG 13453(T). A novel species, Streptobacillus hongkongensis sp. nov., is proposed to accommodate strains HKU33(T) and HKU34, with HKU33(T) ( = JCM 18691(T) = NCTC 13659(T) = DSM 26322(T)) designated the type strain. Emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis are also given.
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Affiliation(s)
- Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, PR China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, PR China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, PR China
| | - Alan K L Wu
- Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, PR China
| | - Chi-Ching Tsang
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Kit-Wah Leung
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Antonio H Y Ngan
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Shirly O T Curreem
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Kwok-Wai Lam
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Jonathan H K Chen
- Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Jasper F W Chan
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, PR China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, PR China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, PR China.,Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
| | - Susanna K P Lau
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, PR China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, PR China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, PR China.,Department of Microbiology, The University of Hong Kong, Hong Kong, PR China
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19
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Liu R, To KKW, Teng JLL, Choi GKY, Mok KY, Law KI, Tso EYK, Fung KSC, Wu TC, Wu AKL, Fung SH, Wong SCY, Trendell-Smith NJ, Yuen KY. Mycobacterium abscessus bacteremia after receipt of intravenous infusate of cytokine-induced killer cell therapy for body beautification and health boosting. Clin Infect Dis 2013; 57:981-91. [PMID: 23825355 DOI: 10.1093/cid/cit443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We report the first series of Mycobacterium abscessus bacteremia after cytokine-induced killer cell therapy for body beautification and health boosting. METHODS The clinical manifestations, laboratory and radiological investigations, cytokine/chemokine profiles, and outcomes were described and analyzed. RESULTS Four patients were admitted, and 3 patients had septic shock. Chest radiographs showed pulmonary infiltrates in all patients. Three patients developed peripheral gangrene, and 1 patient required lower limb and finger amputations. Patient 1 also developed disseminated infection including meningitis and urinary tract infection. Postmortem examination of patient 1 showed focal areas of pulmonary hemorrhage and diffuse alveolar damage, splenic infarct, adrenal necrosis, and hemorrhage, and acid-fast bacilli (AFB) were seen in the lung, liver, kidney, and adrenal gland. Patient 2 developed inguinal granulomatous lymphadenitis about 40 days after onset of lower limb gangrene. Wedge-shaped pulmonary infarcts were found in patient 3, and retinitis and subcutaneous lesions developed in patient 4. Patients in septic shock had dysregulated cytokine/chemokine profiles. Patient 4 with relatively milder presentation had increasing levels of interleukin 17 and cytokines in the interferon-γ/interleukin 12 pathway. All survivors required prolonged intravenous antibiotics. Blood cultures grew M. abscessus for all patients, and admission peripheral blood smear revealed AFB for 3 patients. Mycobacterium abscessus was also isolated from respiratory specimens (2 patients), urine (1 patient), and cerebrospinal fluid (1 patient). Time to initial blood culture positivity (patients 1, 2, and 3: ≤52 hours; patient 4: 83 hours) appeared to correlate with disease severity. CONCLUSIONS Empirical coverage for rapidly growing mycobacteria should be considered in patients with sepsis following cosmetic procedures.
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20
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To KKW, Lau SKP, Wu AKL, Lee RA, Ngan AHY, Tsang CCC, Ling IWH, Yuen KY, Woo PCY. Phaeoacremonium parasiticum invasive infections and airway colonization characterized by agar block smear and ITS and β-tubulin gene sequencing. Diagn Microbiol Infect Dis 2012; 74:190-7. [PMID: 22921816 DOI: 10.1016/j.diagmicrobio.2012.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/01/2012] [Accepted: 06/18/2012] [Indexed: 11/28/2022]
Abstract
Phaeoacremonium parasiticum is an environmental dematiaceous mold rarely associated with human infections. We present here 2 cases of P. parasiticum invasive infections, including the first report of P. parasiticum respiratory tract infection, and 1 case of airway colonization, which all 3 strains of P. parasiticum were identified using agar block smear and ITS and β-tubulin gene sequencing. All 3 isolates grew initially as white to creamy, yeast-like colonies. After 21 days of incubation at 25 °C, 1 isolate remained light brown, atypical of P. parasiticum. Microscopic examination of agar block smear preparations of all 3 isolates showed thick-walled, medium brown conidiophores that were branched and slightly swollen at the base. The sequences of the ITS and β-tubulin genes of the 3 isolates were identical to those of P. parasiticum. Cases of P. parasiticum infections should be confirmed by a polyphasic approach using morphologic characterization and ITS and β-tubulin gene sequencing.
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Affiliation(s)
- Kelvin K W To
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
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21
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Cheng VCC, Wu AKL, Hung IFN, Tang BSF, Lee RA, Lau SKP, Woo PCY, Yuen KY. Clinical Deterioration in Community Acquired Infections Associated with Lymphocyte Upsurge in Immunocompetent Hosts. ACTA ACUST UNITED AC 2009; 36:743-51. [PMID: 15513401 DOI: 10.1080/00365540410022602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical deterioration during the course of community-acquired infections can occur as a result of an exaggerated immune response of the host towards the inciting pathogens, leading to immune-mediated tissue damage. Whether a surge in the peripheral lymphocyte count can be used as a surrogate marker indicating the onset of immunopathological tissue damage is not known. In this study, we report the clinical presentations and outcomes of a cohort of immunocompetent patients with non-tuberculous community acquired infections who experienced clinical deterioration during hospital stay (n=85). 12 (14.1%) patients had a surge in lymphocyte count preceding their clinical deteriorations, and their diagnoses included viral pneumonitis , viral encephalitis , scrub typhus , leptospirosis , brucellosis , and dengue haemorrhagic fever . The clinical manifestations during deterioration ranged from interstitial pneumonitis , airway obstruction , CNS disturbances , and systemic capillary leak syndrome , all of which were thought to represent immunopathological tissue damages. When compared with patients without lymphocyte surge, these patients were more likely to be infected with fastidious/viral pathogens (0 vs 12; p<0.05), in addition to having lower mean baseline lymphocyte counts (403+/-181 vs 1143+/-686 cells/microl; p<0.05). We postulate that the peripheral lymphocyte count may be a useful surrogate marker indicating the presence of immunopathological damage during clinical deterioration in certain infectious diseases.
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Affiliation(s)
- Vincent C C Cheng
- Division of Infectious Diseases, Centre of Infection Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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22
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Cheng VCC, Li IWS, Wu AKL, Tang BSF, Ng KHL, To KKW, Tse H, Que TL, Ho PL, Yuen KY. Effect of antibiotics on the bacterial load of meticillin-resistant Staphylococcus aureus colonisation in anterior nares. J Hosp Infect 2008; 70:27-34. [PMID: 18632184 DOI: 10.1016/j.jhin.2008.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
Abstract
Prevalence of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) infection or colonisation has been associated with antimicrobial consumption. The impact of antibiotic treatment on nasal colonisation is unknown. We conducted a three-month prospective study of 116 patients with extranasal MRSA infection or colonisation, whose nasal MRSA bacterial loads were determined during and after various antibiotic courses over a period of three weeks. Environmental swabs were also taken from the near patient environment. Concomitant nasal MRSA carriage was observed in 76.7% of extranasal MRSA-colonised or -infected patients. The median nasal MRSA bacterial load increased significantly from 2.78 (range 0-6.15) to 5.30 (range 2.90-8.41) log(10) cfu per swab (cfu/swab) (P<0.001) over 21 days during beta-lactam therapy. It also increased from 0 (range 0-4.00) to 4.30 (range 0-7.46) log(10)cfu/swab (P=0.039) over 14 days during fluoroquinolone therapy. Median bacterial loads were significantly higher for beta-lactam- and fluoroquinolone-treated patients on day 7 [4.78, range 0-7.30], day 14 [4.30, range 0-7.60] and day 21 [5.30, range 2.90-8.41] than controls not receiving antibiotics (P<0.05). These loads then decreased by 2-5log(10)cfu/swab 2 weeks after discontinuation of antibiotics. The environment of patients receiving beta-lactam agents (relative risk: 3.55; 95% confidence interval: 1.30-9.62; P=0.018) or fluoroquinolones (4.32; 1.52-12.31; P=0.008) demonstrated more MRSA contamination than the environment around control patients (0.79; 0.67-0.93; P=0.002). Patients on beta-lactam or fluoroquinolone therapy have increased incidence of MRSA colonisation and higher nasal bacterial loads, and appear to spread their MRSA into the near patient environment.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong SAR, China
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Cheng VCC, Wu AKL, Cheung CHY, Lau SKP, Woo PCY, Chan KH, Li KSM, Ip IKS, Dunn ELW, Lee RA, Yam LYC, Yuen KY. Outbreak of human metapneumovirus infection in psychiatric inpatients: implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks. J Hosp Infect 2007; 67:336-43. [PMID: 18022285 DOI: 10.1016/j.jhin.2007.09.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 09/20/2007] [Indexed: 11/19/2022]
Abstract
Nosocomial outbreaks of infectious diseases in psychiatric facilities are not uncommon but the implementation of infection control measures is often difficult. Here, we report an outbreak of an acute respiratory illness in a psychiatric ward between 29 July and 20 August 2005 involving 31 patients. Human metapneumovirus was detected in seven (23%) patients by reverse transcription-polymerase chain reaction and nucleotide sequencing. A review of outbreak surveillance records showed that six nosocomial outbreaks occurred in the year 2005, of which four (67%) were confirmed or presumably related to a respiratory viral infection. Directly observed deliveries of alcohol hand rub 4-hourly during daytime to all psychiatric patients was instituted in December 2005. Only one nosocomial respiratory viral outbreak occurred in the following year. The total number of patients and staff involved in nosocomial outbreaks due to presumed or proven respiratory virus infections decreased significantly from 60 to six (P<0.001), whereas those due to all types of nosocomial outbreaks also decreased from 70 to 24 (P=0.004). Alcohol hand rub has been shown to have potent bactericidal and virucidal activity against a wide range of nosocomial pathogens. Regular use of directly observed alcohol hand rub may decrease the incidence and scale of nosocomial outbreaks due to enveloped respiratory viruses especially in mentally incapacitated patients.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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Ng WL, Chu CM, Wu AKL, Cheng VCC, Yuen KY. Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus. QJM 2006; 99:37-47. [PMID: 16371405 DOI: 10.1093/qjmed/hci155] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with systemic lupus erythematosus (SLE) frequently suffer from infections, but the predisposing risk factors, as well as the exact frequency and nature of such infections, are not fully understood. AIM To describe the frequency, types and risk factors for infections in a group of Chinese patients in the early stage of SLE in Hong Kong. DESIGN Retrospective record study. METHODS We reviewed the case records of 91 Chinese SLE patients, presenting <12 months after SLE diagnosis. Details of major infections (requiring intravenous antimicrobial therapy, or any confirmed mycobacterial infection) and minor infections were reviewed. Clinical and laboratory features, the systemic lupus erythematosus disease activity index (SLEDAI) at presentation and drug treatment were recorded and analysed. RESULTS There were 48 major infections and 62 minor infections during 260 patient-years of follow-up. A lymphocyte count < or =1.0 x 10(9)/l at presentation was independently associated with an increased risk for major infection: hazard ratio 4.7 (95%CI 1.6-13.7), p = 0.005. SLEDAI, use of corticosteroids and immunosuppressive therapy were all not associated with increased risk of infection. DISCUSSION Lymphopenia was an important risk factor for major infections in this group of Chinese patients in the early stages of SLE. SLE patients with lymphopenia at presentation should be closely monitored for the development of infective complications.
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Affiliation(s)
- W L Ng
- Division of Rheumatology, Department of Medicine & Geriatrics, United Christian Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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25
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Woo PCY, Lau SKP, Tsoi HW, Huang Y, Poon RWS, Chu CM, Lee RA, Luk WK, Wong GKM, Wong BHL, Cheng VCC, Tang BSF, Wu AKL, Yung RWH, Chen H, Guan Y, Chan KH, Yuen KY. Clinical and molecular epidemiological features of coronavirus HKU1-associated community-acquired pneumonia. J Infect Dis 2005; 192:1898-907. [PMID: 16267760 PMCID: PMC7110183 DOI: 10.1086/497151] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 05/30/2005] [Accepted: 06/07/2005] [Indexed: 02/04/2023] Open
Abstract
BackgroundRecently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown MethodsProspectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The pol spike (S), and nucleocapsid (N) genes were also sequenced ResultsNPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol S, and N genes revealed 2 genotypes of CoV-HKU1 ConclusionsCoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses
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Affiliation(s)
- Patrick C. Y. Woo
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
- Reprints or correspondence: Dr Kwok-yung Yuen, Div. of Infectious Disease, Dept. of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong ()
| | - Susanna K. P. Lau
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Hoi-wah Tsoi
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Yi Huang
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Rosana W. S. Poon
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Chung-ming Chu
- Division of Respiratory Medicine, Department of Medicine, United Christian Hospital
| | - Rodney A. Lee
- Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and
| | - Wei-kwang Luk
- Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China
| | - Gilman K. M. Wong
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Beatrice H. L. Wong
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Vincent C. C. Cheng
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Bone S. F. Tang
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Alan K. L. Wu
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Raymond W. H. Yung
- Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and
| | - Honglin Chen
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Yi Guan
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Kwok-hung Chan
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
| | - Kwok-yung Yuen
- Division of Infectious Disease, Department of Microbiology, The University of Hong Kong
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Ng KHL, Wu AKL, Cheng VCC, Tang BSF, Chan CY, Yung CY, Luk SH, Lee TW, Chow L, Yuen KY. Pulmonary artery thrombosis in a patient with severe acute respiratory syndrome. Postgrad Med J 2005; 81:e3. [PMID: 15937197 PMCID: PMC1743280 DOI: 10.1136/pgmj.2004.030049] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Severe acute respiratory syndrome (SARS) is an emerging infectious disease with both pulmonary and extra-pulmonary manifestations. Although coagulation abnormalities are common in these patients, clinically overt thromboembolic events are rarely reported. This report describes the first case of pulmonary artery thrombosis in a patient with laboratory confirmed SARS.
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Affiliation(s)
- K H L Ng
- Department of Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
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27
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Lau EMC, Chan FWK, Hui DSC, Wu AKL, Leung PC. Reduced bone mineral density in male Severe Acute Respiratory Syndrome (SARS) patients in Hong Kong. Bone 2005; 37:420-4. [PMID: 15993669 PMCID: PMC7103402 DOI: 10.1016/j.bone.2005.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Revised: 01/23/2005] [Accepted: 04/22/2005] [Indexed: 10/31/2022]
Abstract
During the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, patients were treated with very high doses of corticosteroid and ribavirin. The detrimental effects of such treatment on the bone mineral density (BMD) of SARS patients are unknown. To compare the BMD of SARS patients with normal range data, a cross-sectional survey was conducted. The bone mineral density of 224 patients with SARS, who were treated with an average of 2753 mg (SD = 2152 mg) prednisolone and 29,344 mg (SD = 15,849 mg) of ribavirin was compared to normal data. Six percent of men had a hip BMD Z score of < or =-2 (P = 0.057 for testing the hypothesis that >2.5% of subjects should have a Z score of < or =-2). Moreover, there was a negative association (r = -0.25, P = 0.023) between the duration of steroid therapy and BMD in men. We conclude that male SARS patients had lower BMD at the hip than normal controls, and this could be attributed to prolonged steroid therapy.
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Affiliation(s)
- E M C Lau
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
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28
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Hung IFN, Wu AKL, Cheng VCC, Tang BSF, To KW, Yeung CK, Woo PCY, Lau SKP, Cheung BMY, Yuen KY. Fatal Interaction between Clarithromycin and Colchicine in Patients with Renal Insufficiency: A Retrospective Study. Clin Infect Dis 2005; 41:291-300. [PMID: 16007523 DOI: 10.1086/431592] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 03/16/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Clarithromycin is frequently used to treat community-acquired pneumonia in elderly persons. Like erythromycin, it may interact with other drugs by interfering with metabolism by cytochrome P450 enzymes and with the P-glycoprotein transporter system. Colchicine, used for treatment of acute gout and for prophylaxis, may cause bone marrow toxicity. It is metabolized by CYP3A4 and is transported by P-glycoprotein. Initial case reports suggested potentially fatal interactions between clarithromycin and colchicine. METHODS A retrospective study was conducted with 116 patients who were prescribed clarithromycin and colchicine during the same clinical admission. Case-control comparisons were made between patients who received concomitant therapy with the 2 drugs and patients who received sequential therapy. We assessed the clinical presentations and outcomes of the 2 patient groups and analyzed the risk factors associated with fatal outcomes. RESULTS Nine (10.2%) of the 88 patients who received the 2 drugs concomitantly died. Only 1 (3.6%) of the 28 patients who received the drugs sequentially died. Multivariate analysis of the 88 patients who received concomitant therapy showed that longer overlapped therapy (relative risk [RR], 2.16; 95% confidence interval [CI], 1.41-3.31; P< or =.01), the presence of baseline renal impairment (RR, 9.1; 95% CI, 1.75-47.06; P<.001), and the development of pancytopenia (RR, 23.4; 95% CI, 4.48-122.7; P<.001) were independently associated with death. CONCLUSIONS Clarithromycin increases the risk of fatal colchicine toxicity, especially for patients with renal insufficiency. Since there are other drugs for treatment of pneumonia and gout, these 2 drugs should not be coprescribed, because of the risk of fatality.
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Affiliation(s)
- I F N Hung
- Research Center of Infection and Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Tang BSF, Chan KH, Cheng VCC, Woo PCY, Lau SKP, Lam CCK, Chan TL, Wu AKL, Hung IFN, Leung SY, Yuen KY. Comparative host gene transcription by microarray analysis early after infection of the Huh7 cell line by severe acute respiratory syndrome coronavirus and human coronavirus 229E. J Virol 2005; 79:6180-93. [PMID: 15858003 PMCID: PMC1091719 DOI: 10.1128/jvi.79.10.6180-6193.2005] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The pathogenesis of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) at the cellular level is unclear. No human cell line was previously known to be susceptible to both SARS-CoV and other human coronaviruses. Huh7 cells were found to be susceptible to both SARS-CoV, associated with SARS, and human coronavirus 229E (HCoV-229E), usually associated with the common cold. Highly lytic and productive rates of infections within 48 h of inoculation were reproducible with both viruses. The early transcriptional profiles of host cell response to both types of infection at 2 and 4 h postinoculation were determined by using the Affymetrix HG-U133A microarray (about 22,000 genes). Much more perturbation of cellular gene transcription was observed after infection by SARS-CoV than after infection by HCoV-229E. Besides the upregulation of genes associated with apoptosis, which was exactly opposite to the previously reported effect of SARS-CoV in a colonic carcinoma cell line, genes related to inflammation, stress response, and procoagulation were also upregulated. These findings were confirmed by semiquantitative reverse transcription-PCR, reverse transcription-quantitative PCR for mRNA of genes, and immunoassays for some encoded proteins. These transcriptomal changes are compatible with the histological changes of pulmonary vasculitis and microvascular thrombosis in addition to the diffuse alveolar damage involving the pneumocytes.
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Affiliation(s)
- Bone S F Tang
- Department of Microbiology, State Key Laboratory of Emerging Infectious Diseases, Center of Infection and Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Abstract
STUDY OBJECTIVE To study the demographics and sputum microbiology of patients admitted to a teaching hospital with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). DESIGN A retrospective study. SETTING A tertiary university hospital in Hong Kong. PATIENTS All episodes of AECOPD, patient demographics, length of stay, sputum culture and radiological results admitted in the first half of the year 2000 were retrieved from hospital records. RESULTS There were 329 patients with 418 episodes of AECOPD without concomitant pneumonia. The age of the patients was 74.4+/-8.3 years. The acute hospital length of stay for an episode of AECOPD was 7.3+/-6.5 days. Haemophilus influenzae was the commonest organism found in sputum (23.1%), followed by Pseudomonas aeruginosa (6.3%) and Streptococcus pneumoniae (4.0%). Mycobacterium tuberculosis was found in 1.1% of the admissions. Presence of organisms in sputum had no association with the hospital length of stay and intensive care unit admissions. In patients whose FEV1 was >50% of predicted values, there was a higher chance of positive sputum growth of H. influenzae than those with FEV1 <50% (16/44 vs. 31/162 episodes, respectively, P=0.02). CONCLUSIONS H. influenzae was the commonest bacterium isolated in sputum in patients with AECOPD. In areas endemic of tuberculosis, it is advisable to use fluoroquinolones for AECOPD with caution.
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Affiliation(s)
- Fanny W S Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan shing Street, Shatin, New Territories, Hong Kong
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Wong CK, Lam CWK, Wu AKL, Ip WK, Lee NLS, Chan IHS, Lit LCW, Hui DSC, Chan MHM, Chung SSC, Sung JJY. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol 2004; 136:95-103. [PMID: 15030519 PMCID: PMC1808997 DOI: 10.1111/j.1365-2249.2004.02415.x] [Citation(s) in RCA: 918] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease caused by a novel coronavirus, but its immunopathological mechanisms have not yet been fully elucidated. We investigated changes in plasma T helper (Th) cell cytokines, inflammatory cytokines and chemokines in 20 patients diagnosed with SARS. Cytokine profile of SARS patients showed marked elevation of Th1 cytokine interferon (IFN)-gamma, inflammatory cytokines interleukin (IL)-1, IL-6 and IL-12 for at least 2 weeks after disease onset, but there was no significant elevation of inflammatory cytokine tumour necrosis factor (TNF)-alpha, anti-inflammatory cytokine IL-10, Th1 cytokine IL-2 and Th2 cytokine IL-4. The chemokine profile demonstrated significant elevation of neutrophil chemokine IL-8, monocyte chemoattractant protein-1 (MCP-1), and Th1 chemokine IFN-gamma-inducible protein-10 (IP-10). Corticosteroid reduced significantly IL-8, MCP-1 and IP-10 concentrations from 5 to 8 days after treatment (all P < 0.001). Together, the elevation of Th1 cytokine IFN-gamma, inflammatory cytokines IL-1, IL-6 and IL-12 and chemokines IL-8, MCP-1 and IP-10 confirmed the activation of Th1 cell-mediated immunity and hyperinnate inflammatory response in SARS through the accumulation of monocytes/macrophages and neutrophils.
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Affiliation(s)
- C K Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Cheng VCC, Hung IFN, Wu AKL, Tang BSF, Chu CM, Yuen KY. Lymphocyte surge as a marker for immunorestitution disease due to Pneumocystis jiroveci pneumonia in HIV-negative immunosuppressed hosts. Eur J Clin Microbiol Infect Dis 2004; 23:512-4. [PMID: 15141339 DOI: 10.1007/s10096-004-1140-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- V C C Cheng
- Division of Infectious Diseases, Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Abstract
BACKGROUND AND AIMS Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection. METHODS A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction. RESULTS Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 +/- 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset. CONCLUSIONS Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.
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Affiliation(s)
- Wai K Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Abstract
BACKGROUND AND AIMS Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection. METHODS A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction. RESULTS Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 +/- 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset. CONCLUSIONS Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.
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Affiliation(s)
- Wai K Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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35
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Abstract
BACKGROUND AND AIMS Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection. METHODS A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction. RESULTS Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 +/- 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset. CONCLUSIONS Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.
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Affiliation(s)
- Wai K Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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36
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Wong VWS, Dai D, Wu AKL, Sung JJY. Treatment of severe acute respiratory syndrome with convalescent plasma. Hong Kong Med J 2003; 9:199-201. [PMID: 12777656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In March 2003, an outbreak of severe acute respiratory syndrome started in Hong Kong. A 57-year-old woman had a typical presentation, including fever, non-productive cough, malaise, lymphopenia, and raised liver aminotransferases. The clinical course and successful treatment with convalescent plasma, ribavirin, and corticosteroids are discussed.
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Affiliation(s)
- V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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