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Khoo BY, Hon PY, Leong J, Sai Rama Sridatta P, Thevasagayam NM, Loy SQD, Chua JJY, Ang BSP, Chow A, Marimuthu K, De PP, Ng OT, Vasoo S. Evaluation of NG-Test CARBA 5 version 2, Cepheid Xpert Carba-R, and carbapenem inactivation methods in comparison to whole-genome sequencing for the identification of carbapenemases in non-fermenting Gram-negative bacilli. J Clin Microbiol 2023; 61:e0031623. [PMID: 37671882 PMCID: PMC10512785 DOI: 10.1128/jcm.00316-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/11/2023] [Indexed: 09/07/2023] Open
Abstract
NG-Test CARBA 5 (NG-Biotech) is a rapid in vitro multiplex immunoassay for the phenotypic detection and differentiation of the "big five" carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM). Version 2 of this assay was evaluated alongside the Xpert Carba-R assay (Cepheid, Inc.), the modified carbapenem inactivation method (mCIM), and the CIMTris assay, with a collection of carbapenem-resistant non-fermenting Gram-negative bacilli comprising 138 Pseudomonas aeruginosa and 97 Acinetobacter baumannii isolates. Whole-genome sequencing (WGS) was used as the reference standard. For P. aeruginosa, NG-Test CARBA 5 produced an overall percentage agreement (OPA) with WGS of 97.1%, compared with 92.8% forXpert Carba-R and 90.6% for mCIM. For A. baumannii, as OXA-type carbapenemases (non-OXA-48) are not included, both the NG-Test CARBA 5 and Xpert Carba-R only had an OPA of 6.2%, while the CIMTris performed well with an OPA of 99.0%. The majority of A. baumannii isolates (95.9%) tested falsely positive for IMP on NG-Test CARBA 5; no IMP genes were found on WGS. No clear cause was found for this phenomenon; a cross-reacting protein antigen unique to A. baumannii is a possible culprit. NG-Test CARBA 5 performed well for carbapenemase detection in P. aeruginosa. However, results from A. baumannii isolates should be interpreted with caution.
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Affiliation(s)
- Bo Yan Khoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
| | - Pei Yun Hon
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Janice Leong
- Department of Laboratory Medicine, Tan Tock Seng Hospital, , Singapore
| | | | | | - Song Qi Dennis Loy
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Jasmine J. Y. Chua
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
- Department of Infection Prevention and Control, Tan Tock Seng Hospital, , Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, , Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, , Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, , Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, , Singapore
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, , Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, , Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, , Singapore
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2
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Ang BSP, Umapathi T, Lim T. The Changing Epidemiology of Central Nervous System Infection. Neuroimaging Clin N Am 2023; 33:1-10. [DOI: 10.1016/j.nic.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Chew HS, Tan M, Sanchalika A, Tan G, Ho EC, Ang BSP, Agrawal R, Yeo SB. Innovative dual-function protective scope mask and filtration system for aerosol generating ENT scope procedures. Laryngoscope Investig Otolaryngol 2022; 7:1376-1383. [PMID: 36258853 PMCID: PMC9575126 DOI: 10.1002/lio2.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background Aerosol-generating procedures (AGPs), such as nasoendoscopy, are considered high-risk during the COVID-19 pandemic due to risk of virus aerosol transmission. We aim to evaluate the efficacy of an innovative system in reduction of aerosol contamination. Methods Pilot study involving 15 healthy volunteers performing aerosol-generating activities with the prototype, compared with and without a standard surgical mask. Results We found an increased frequency of smaller-sized particle emissions for all four expiratory activities. The particle emission rate with the prototype mask was significantly slower over time for the smallest sized particle (0.3 μm) during breathing, speaking and singing compared with similar activities without the mask (p < .05). We found similar trends for coughing for larger particles but that did not reach statistical significance. Conclusion The innovation offers good protection against aerosol transmission through the physical barrier of the mask, the negative pressure environment within the mask, and the unit's dual filtration function. Level of evidence Level 2b.
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Affiliation(s)
- Hui Sing Chew
- Department of OtorhinolaryngologyTan Tock Seng HospitalSingaporeSingapore
| | - Marcus Tan
- The Biofactory Pte LtdSingaporeSingapore
| | - Acharyya Sanchalika
- Clinical Research and Innovation Office, Tan Tock Seng HospitalSingaporeSingapore
| | | | - Eu Chin Ho
- Department of OtorhinolaryngologyTan Tock Seng HospitalSingaporeSingapore
| | - Brenda Sze Peng Ang
- Department of Infectious DiseasesTan Tock Seng HospitalSingaporeSingapore
- National Centre for Infectious DiseasesSingaporeSingapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng HospitalSingaporeSingapore
- Singapore Eye Research InstituteSingaporeSingapore
| | - Seng Beng Yeo
- Department of OtorhinolaryngologyTan Tock Seng HospitalSingaporeSingapore
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4
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Lim WY, Tan GSE, Htun HL, Phua HP, Kyaw WM, Guo H, Cui L, Mak TM, Poh BF, Wong JCC, Setoh YX, Ang BSP, Chow ALP. The first nosocomial cluster of COVID-19 due to the Delta variant in a major acute-care hospital in Singapore - investigations and outbreak response. J Hosp Infect 2021; 122:27-34. [PMID: 34942201 PMCID: PMC8687717 DOI: 10.1016/j.jhin.2021.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The first large nosocomial cluster of COVID-19 in Singapore in April 2021 led to partial closure of a major acute-care hospital. We report our investigations and evaluate the effectiveness of the BNT162.b2 and mRNA1273 vaccines against the Delta variant. METHODS Close contacts of COVID-19 patients and the affected ward were identified and underwent surveillance for SARS-CoV-2 infection. Patient, staff and visitor cohorts were constructed and factors associated with infection evaluated. Phylogenetic analysis of patient samples was performed. Ward air exhaust filters were tested for SARS-CoV-2 virus. RESULTS There were 47 cases in total, comprising 29 patients, 9 staff, 6 ward visitors and 3 household contacts. All infections were of the Delta variant. Ventilation studies showed turbulent airflow and swabs from air exhaust filters were positive for SARS-Cov2. Vaccine breakthrough infections were seen in both patients and staff. Among patients, vaccination was associated with a 79% lower odds of infection with COVID-19 (adjusted OR =0.21, 95%CI 0.05-0.95) CONCLUSIONS: This cluster occurred despite an enhancement in infection control measures that the hospital had undertaken at the onset of this pandemic, but it was rapidly brought under control through case isolation, extensive contact tracing and quarantine measures, and led to enhancements in hospital personal protective equipment (PPE) use, introduction of routine rostered testing of inpatients and staff, and hospital infrastructure changes to improve ventilation within the general ward.
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Affiliation(s)
- Wei-Yen Lim
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | | | - Htet Lin Htun
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Hwee Pin Phua
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Win Mar Kyaw
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Huiling Guo
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Tze Minn Mak
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Bee Fong Poh
- Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | | | - Yin Xiang Setoh
- Environmental Health Institute, National Environment Agency, Singapore
| | - Brenda Sze Peng Ang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Angela Li Ping Chow
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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5
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Marimuthu K, Mo Y, Ling ML, Hernandez-Koutoucheva A, Fenlon SN, Bertrand D, Lye DC, Ang BSP, Perencevich E, Ng OT, Cooper BS, Nagarajan N, Chen SL, Barkham T. Household transmission of carbapenemase-producing Enterobacteriaceae: a prospective cohort study. J Antimicrob Chemother 2021; 76:1299-1302. [PMID: 33417711 DOI: 10.1093/jac/dkaa561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To estimate the transmission rate of carbapenemase-producing Enterobacteriaceae (CPE) in households with recently hospitalized CPE carriers. METHODS We conducted a prospective case-ascertained cohort study. We identified the presence of CPE in stool samples from index subjects, household contacts and companion animals and environmental samples at regular intervals. Linked transmissions were identified by WGS. A Markov model was constructed to estimate the household transmission potential of CPE. RESULTS Ten recently hospitalized index patients and 14 household contacts were included. There were seven households with one contact, two households with two contacts, and one household with three contacts. Index patients were colonized with blaOXA-48-like (n = 4), blaKPC-2 (n = 3), blaIMP (n = 2), and blaNDM-1 (n = 1), distributed among divergent species of Enterobacteriaceae. After a cumulative follow-up time of 9.0 years, three family members (21.4%, 3/14) acquired four different types of CPE in the community (hazard rate of 0.22/year). The probability of CPE transmission from an index patient to a household contact was 10% (95% CI 4%-26%). CONCLUSIONS We observed limited transmission of CPE from an index patient to household contacts. Larger studies are needed to understand the factors associated with household transmission of CPE and identify preventive strategies.
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Affiliation(s)
- Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yin Mo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.,Division of Infectious Diseases, National University Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Shannon N Fenlon
- Laboratory of Bacterial Genomics, Genome Institute of Singapore, Singapore
| | - Denis Bertrand
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - Eli Perencevich
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Niranjan Nagarajan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - Swaine L Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Laboratory of Bacterial Genomics, Genome Institute of Singapore, Singapore
| | - Timothy Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
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Tan THY, Toh MPHS, Vasoo S, Lye DCB, Ang BSP, Leo YS, Lee VJM, Puah SH, Kurup A. Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months. Ann Acad Med Singap 2020. [DOI: 10.47102/annals-acadmedsg.2020306] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As of 27 October 2020, there have been 57,980 confirmed cases of COVID-19 in Singapore, with 28 fatalities. To summarise the Singapore experience in managing and containing COVID-19 based on available published data and from relevant sources, a review of literature using research databases such as PubMed and OVID Medline, along with non-peer-reviewed articles and other sources, was conducted with the search terms ‘COVID-19’ and ‘Singapore’. Research conducted in Singapore has provided insight into the clinical manifestations and period of infectivity of COVID-19, demonstrated evidence of pre-symptomatic transmission, linked infection clusters using serological tools, and highlighted aspects of hospital-based environmental contamination. It has also provided guidance for diagnostic testing and has described immune and virologic correlates with disease severity. Evidence of effectiveness of containment measures such as early border control, rigorous contact training, and calibrated social distancing measures have also been demonstrated. Singapore’s multipronged strategy has been largely successful at containing COVID-19 and minimising fatalities, but the risk of re-emergence is high. Keywords: Epidemiology, management, prevention, transmission
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7
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Tan THY, Toh MPHS, Vasoo S, Lye DCB, Ang BSP, Leo YS, Lee VJM, Puah SH, Kurup A. Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months. Ann Acad Med Singap 2020; 49:764-778. [PMID: 33283840] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As of 27 October 2020, there have been 57,980 confirmed cases of COVID-19 in Singapore, with 28 fatalities. To summarise the Singapore experience in managing and containing COVID-19 based on available published data and from relevant sources, a review of literature using research databases such as PubMed and OVID Medline, along with non-peer-reviewed articles and other sources, was conducted with the search terms 'COVID-19' and 'Singapore'. Research conducted in Singapore has provided insight into the clinical manifestations and period of infectivity of COVID-19, demonstrated evidence of pre-symptomatic transmission, linked infection clusters using serological tools, and highlighted aspects of hospital-based environmental contamination. It has also provided guidance for diagnostic testing and has described immune and virologic correlates with disease severity. Evidence of effectiveness of containment measures such as early border control, rigorous contact training, and calibrated social distancing measures have also been demonstrated. Singapore's multipronged strategy has been largely successful at containing COVID-19 and minimising fatalities, but the risk of re-emergence is high.
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8
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Tay JY, Lim PL, Marimuthu K, Sadarangani SP, Ling LM, Ang BSP, Chan M, Leo YS, Vasoo S. De-isolating Coronavirus Disease 2019 Suspected Cases: A Continuing Challenge. Clin Infect Dis 2020; 71:883-884. [PMID: 32100024 PMCID: PMC7358676 DOI: 10.1093/cid/ciaa179] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jun-Yang Tay
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Poh Lian Lim
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sapna Pradip Sadarangani
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Li Min Ling
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Monica Chan
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
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9
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Goh GX, Tan K, Ang BSP, Wang LF, Tchoyoson Lim CC. Neuroimaging in Zoonotic Outbreaks Affecting the Central Nervous System: Are We Fighting the Last War? AJNR Am J Neuroradiol 2020; 41:1760-1767. [PMID: 32819907 DOI: 10.3174/ajnr.a6727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022]
Abstract
When preparing for the coronavirus disease 2019 pandemic and its effects on the CNS, radiologists should be familiar with neuroimaging appearances in past zoonotic infectious disease outbreaks. Organisms that have crossed the species barrier from animals to humans include viruses such as Hendra, Nipah, Severe Acute Respiratory Syndrome, and influenza, as well as bacteria and others. Brain CT and MR imaging findings have included cortical abnormalities, microinfarction in the white matter, large-vessel occlusion, and features of meningitis. In particular, the high sensitivity of diffusion-weighted MR imaging in detecting intracranial abnormalities has been helpful in outbreaks. Although the coronaviruses causing the previous Severe Acute Respiratory Syndrome outbreak and the current coronavirus disease 19 pandemic are related, it is important to be aware of their similarities as well as potential differences. This review describes the neuroimaging appearances of selected zoonotic outbreaks so that neuroradiologists can better understand the current pandemic and potential future outbreaks.
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Affiliation(s)
- G X Goh
- From the Emerging Infectious Diseases Programme (G.X.G., L.-F.W.), Duke-NUS Medical School, Singapore
| | - K Tan
- Departments of Neurology (K.T.)
| | - B S P Ang
- Department of Infectious Diseases and Infection Prevention and Control (B.S.P.A.), Tan Tock Seng Hospital, Singapore
| | - L-F Wang
- From the Emerging Infectious Diseases Programme (G.X.G., L.-F.W.), Duke-NUS Medical School, Singapore
| | - C C Tchoyoson Lim
- Neuroradiology (C.C.T.L.), National Neuroscience Institute and Duke-NUS Medical School, Singapore
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10
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Ong SWX, Coleman KK, Chia PY, Thoon KC, Pada S, Venkatachalam I, Fisher D, Tan YK, Tan BH, Ng OT, Ang BSP, Leo YS, Wong MSY, Marimuthu K. Transmission modes of severe acute respiratory syndrome coronavirus 2 and implications on infection control: a review. Singapore Med J 2020; 63:61-67. [PMID: 32729311 DOI: 10.11622/smedj.2020114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/08/2023]
Abstract
The complete picture of transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence of its transmission modes, our preliminary research findings and implications on infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 RNA in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet to airborne transmission depending on patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.
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Affiliation(s)
- Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | | | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Surinder Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | | | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health Systems, Singapore
| | | | | | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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11
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Affiliation(s)
| | | | - Hao Li
- Tan Tock Seng Hospital, Singapore
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12
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Chia PY, Coleman KK, Tan YK, Ong SWX, Gum M, Lau SK, Lim XF, Lim AS, Sutjipto S, Lee PH, Son TT, Young BE, Milton DK, Gray GC, Schuster S, Barkham T, De PP, Vasoo S, Chan M, Ang BSP, Tan BH, Leo YS, Ng OT, Wong MSY, Marimuthu K. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun 2020; 11:2800. [PMID: 32472043 DOI: 10.1101/2020.03.29.20046557] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 05/20/2023] Open
Abstract
Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01, χ2 test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 µm and 1-4 µm in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | | | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Marcus Gum
- DSO National Laboratories, Singapore, Singapore
| | | | | | - Ai Sim Lim
- DSO National Laboratories, Singapore, Singapore
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Pei Hua Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Than The Son
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Gregory C Gray
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- School of Medicine and Global Health Institute, Duke University, Durham, NC, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Stephan Schuster
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Timothy Barkham
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Partha Pratim De
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Monica Chan
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oon-Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore.
- Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore.
- Tan Tock Seng Hospital, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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13
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Kyaw WM, Vasoo S, Ho HJA, Chan M, Yeo TW, Manauis CM, Ang H, Pratim De P, Ang BSP, Chow ALP. Monitoring healthcare professionals after monkeypox exposure: Experience from the first case imported to Asia. Infect Control Hosp Epidemiol 2020; 41:373-375. [PMID: 31915078 DOI: 10.1017/ice.2019.362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Win Mar Kyaw
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Shawn Vasoo
- Infectious Disease Department, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Hanley Jian An Ho
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Monica Chan
- Infectious Disease Department, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Tsin Wen Yeo
- Infectious Disease Department, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
| | | | - Hou Ang
- Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore
- Infection Prevention and Control Unit, Tan Tock Seng Hospital, Singapore
| | - Angela Li Ping Chow
- National Centre for Infectious Diseases, Singapore
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
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14
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Lwin MO, Yung CF, Yap P, Jayasundar K, Sheldenkar A, Subasinghe K, Foo S, Jayasinghe UG, Xu H, Chai SC, Kurlye A, Chen J, Ang BSP. FluMob: Enabling Surveillance of Acute Respiratory Infections in Health-care Workers via Mobile Phones. Front Public Health 2017; 5:49. [PMID: 28367433 PMCID: PMC5355489 DOI: 10.3389/fpubh.2017.00049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/18/2016] [Accepted: 02/28/2017] [Indexed: 11/13/2022] Open
Abstract
Singapore is a hotspot for emerging infectious diseases and faces a constant risk of pandemic outbreaks as a major travel and health hub for Southeast Asia. With an increasing penetration of smart phone usage in this region, Singapore's pandemic preparedness framework can be strengthened by applying a mobile-based approach to health surveillance and control, and improving upon existing ideas by addressing gaps, such as a lack of health communication. FluMob is a digitally integrated syndromic surveillance system designed to assist health authorities in obtaining real-time epidemiological and surveillance data from health-care workers (HCWs) within Singapore, by allowing them to report influenza incidence using smartphones. The system, integrating a fully responsive web-based interface and a mobile interface, is made available to HCW using various types of mobile devices and web browsers. Real-time data generated from FluMob will be complementary to current health-care- and laboratory-based systems. This paper describes the development of FluMob, as well as challenges faced in the creation of the system.
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Affiliation(s)
- May Oo Lwin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU) , Singapore , Singapore
| | - Chee Fu Yung
- KK Women's and Children's Hospital (KKH) , Singapore , Singapore
| | - Peiling Yap
- Tan Tock Seng Hospital (TTSH) , Singapore , Singapore
| | - Karthikayen Jayasundar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU) , Singapore , Singapore
| | - Anita Sheldenkar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU) , Singapore , Singapore
| | - Kosala Subasinghe
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU) , Singapore , Singapore
| | - Schubert Foo
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU) , Singapore , Singapore
| | | | - Huarong Xu
- Tan Tock Seng Hospital (TTSH) , Singapore , Singapore
| | | | - Ashwin Kurlye
- Institute of Media Innovation (IMI) , Singapore , Singapore
| | - Jie Chen
- KK Women's and Children's Hospital (KKH) , Singapore , Singapore
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15
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Ang BSP, Tay SY, Umayam M, Poh BF, Krishnan PU. “Screening at the door” - continuous rapid molecular screening for MRSA at emergency department is efficacious and effective. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475143 DOI: 10.1186/2047-2994-4-s1-p189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Low JGH, Quek AML, Sin YK, Ang BSP. Mycotic aneurysm due to Burkholderia pseudomallei infection: case reports and literature review. Clin Infect Dis 2004; 40:193-8. [PMID: 15614712 DOI: 10.1086/426590] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 06/11/2004] [Accepted: 08/25/2004] [Indexed: 11/03/2022] Open
Abstract
Melioidosis caused by Burkholderia pseudomallei infection is endemic in Southeast Asia and Northern Australia. Cardiovascular complications resulting in mycotic aneurysms are very rare. To our knowledge, there have only been 6 isolated case reports published in the literature to date. We report 6 cases of melioidosis in Singapore that presented as aortic aneurysms.
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Affiliation(s)
- Jenny Guek Hong Low
- Infectious Disease Unit, Department of Internal Medicine, Singapore General Hospital, Singapore.
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17
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Abstract
Eikenella corrodens is part of the normal flora of the mouth and upper respiratory tract and is usually associated with dental and head and neck infections. We report a case of Eikenella discitis occurring soon after spinal surgery in an otherwise healthy patient, review the literature on bone and joint infections unrelated to human bites and fist-fight injuries, and stress the importance of definitive diagnosis in post-operative spinal infections.
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Affiliation(s)
- B S P Ang
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433.
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