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Lui L, Wong LC, Chen H, Yung RWH. Antibiogram data from private hospitals in Hong Kong: 6-year retrospective study. Hong Kong Med J 2022; 28:140-151. [PMID: 35400642 DOI: 10.12809/hkmj219806] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The surveillance of antibiotic resistance is critical for the establishment of effective control strategies. The antibiotic resistance situations in private hospitals in Hong Kong have not been systematically described. The objective of the study was to analyse antibiogram data from private hospitals and describe the temporal trends of non-susceptibility percentages in this setting. METHODS This retrospective descriptive study used antibiogram data from all private hospitals in Hong Kong that had been collected annually for 6 years (2014-2019). Data on six targeted bacteria and their corresponding multidrug-resistant organisms were included. RESULTS The non-susceptibility percentages of isolates remained stable or decreased during the study period: methicillin-resistant Staphylococcus aureus had a stable prevalence of approximately 20%; extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species had stable prevalences of 20% to 30% and 10% to 20%, respectively; multidrug-resistant Acinetobacter species had prevalences of approximately 2% to 8%, which decreased over time; multidrug-resistant Pseudomonas aeruginosa had prevalences of 0.0% to 0.3%; Streptococcus pneumoniae penicillin and macrolide non-susceptibility percentages were 2% to 9% and 71% to 79%, respectively. These values generally were comparable with findings from public hospitals and Residential Care Homes for the Elderly in Hong Kong. However, the prevalences of carbapenem-resistant Enterobacteriaceae, which are increasing in Hong Kong and other nations, were also increasing in our dataset despite their currently low values (<1% for Escherichia coli and <2% for Klebsiella species). CONCLUSION The antibiotic resistance landscape among private hospitals in Hong Kong is satisfactory overall; there remains a need for surveillance, antibiotic stewardship, and other infection control measures.
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Affiliation(s)
- L Lui
- Infection Control Branch, Centre for Health Protection, Hong Kong SAR Government, Hong Kong
| | - L C Wong
- Infection Control Branch, Centre for Health Protection, Hong Kong SAR Government, Hong Kong
| | - H Chen
- Infection Control Branch, Centre for Health Protection, Hong Kong SAR Government, Hong Kong
| | - R W H Yung
- Department of Pathology (Clinical Microbiology), Hong Kong Sanatorium & Hospital, Hong Kong
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2
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Zee JST, Chan CTL, Leung ACP, Yu BPW, Hung JRL, Chan QWL, Ma ESK, Lee KH, Lau CC, Yung RWH. Rapid antigen test during a COVID-19 outbreak in a private hospital in Hong Kong. Hong Kong Med J 2022; 28:300-305. [PMID: 35307652 DOI: 10.12809/hkmj219559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.
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Affiliation(s)
- J S T Zee
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong.,Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - C T L Chan
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - A C P Leung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - B P W Yu
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - J R L Hung
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Q W L Chan
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - E S K Ma
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - K H Lee
- Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
| | - C C Lau
- Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
| | - R W H Yung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong.,Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong.,Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
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3
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Zee JST, Lai KTW, Ho MKS, Leung ACP, Fung LH, Luk WP, Kwok LF, Kee KM, Chan QWL, Tang SF, Ma ESK, Lee KH, Lau CC, Yung RWH. Serological response to mRNA and inactivated COVID-19 vaccine in healthcare workers in Hong Kong: decline in antibodies 12 weeks after two doses. Hong Kong Med J 2021; 27:380-383. [PMID: 34657837 DOI: 10.12809/hkmj219744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] Open
Affiliation(s)
- J S T Zee
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - K T W Lai
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - M K S Ho
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - A C P Leung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - L H Fung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong
| | - W P Luk
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong
| | - L F Kwok
- Quality and Safety Division, Hong Kong Sanatorium & Hospital, Hong Kong
| | - K M Kee
- Quality and Safety Division, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Q W L Chan
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - S F Tang
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
| | - E S K Ma
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - K H Lee
- Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
| | - C C Lau
- Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
| | - R W H Yung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
- Infection Control Team, Hong Kong Sanatorium & Hospital, Hong Kong
- Hospital Administration, Hong Kong Sanatorium & Hospital, Hong Kong
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4
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Zee JST, Lai KTW, Ho MKS, Leung ACP, Chan QWL, Ma ESK, Lee KH, Lau CC, Yung RWH. Serological response to mRNA and inactivated COVID-19 vaccine in healthcare workers in Hong Kong: preliminary results. Hong Kong Med J 2021; 27:312-313. [PMID: 34413252 DOI: 10.12809/hkmj219605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] Open
Affiliation(s)
- J S T Zee
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
- Infection Control Team, Hong Kong Sanatorium and Hospital, Hong Kong
| | - K T W Lai
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - M K S Ho
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - A C P Leung
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Q W L Chan
- Infection Control Team, Hong Kong Sanatorium and Hospital, Hong Kong
| | - E S K Ma
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - K H Lee
- Hospital Administration, Hong Kong Sanatorium and Hospital, Hong Kong
| | - C C Lau
- Hospital Administration, Hong Kong Sanatorium and Hospital, Hong Kong
| | - R W H Yung
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong
- Infection Control Team, Hong Kong Sanatorium and Hospital, Hong Kong
- Hospital Administration, Hong Kong Sanatorium and Hospital, Hong Kong
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5
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Chan AMW, Au WWY, Chao DVK, Choi K, Choi KW, Choi SMY, Chow Y, Fan CYM, Ho PL, Hui EMT, Kwong KH, Kwong BYS, Lam TP, Lam ETK, Lau KW, Lui L, Ng KHL, Wong MCS, Wong TY, Yeung CF, You JHS, Yung RWH. Antibiotic management of acute pharyngitis in primary care. Hong Kong Med J 2019; 25:58-63. [PMID: 30713150 DOI: 10.12809/hkmj187544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice.
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Affiliation(s)
| | - A M W Chan
- Hong Kong College of Family Physicians, Hong Kong
| | - W W Y Au
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong
| | - D V K Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital, Hospital Authority, Hong Kong
| | - K Choi
- Hong Kong Medical Association, Hong Kong
| | - K W Choi
- Hong Kong Society for Infectious Diseases, Hong Kong
| | - S M Y Choi
- Primary Care Office, Department of Health, Hong Kong
| | - Y Chow
- Quality HealthCare Medical Services Limited, Hong Kong
| | - C Y M Fan
- Professional Development and Quality Assurance, Department of Health, Hong Kong
| | - P L Ho
- IMPACT Editorial Board, Reducing bacterial resistance with IMPACT, 5th edition, Hong Kong
| | - E M T Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - K H Kwong
- Human Health Holdings Limited, Hong Kong
| | - B Y S Kwong
- Chief Pharmacist's Office, Hospital Authority, Hong Kong
| | - T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - E T K Lam
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - K W Lau
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - L Lui
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - K H L Ng
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | - M C S Wong
- Hong Kong Academy of Medicine, Hong Kong
| | - T Y Wong
- Centre for Health Protection Infection Control Branch, Department of Health, Hong Kong
| | | | - J H S You
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong
| | - R W H Yung
- Hong Kong Sanatorium & Hospital, Hong Kong
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6
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Lam TP, Lam KF, Ho PL, Yung RWH. Knowledge, attitude, and behaviour toward antibiotics among Hong Kong people: local-born versus immigrants. Hong Kong Med J 2015; 21 Suppl 7:S41-S47. [PMID: 26908273] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- T P Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong
| | - K F Lam
- Department of Statistics & Actuarial Science, The University of Hong Kong
| | - P L Ho
- Department of Microbiology, The University of Hong Kong
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7
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Tsang OTY, Wong ATY, Chow CB, Yung RWH, Lim WWL, Liu SH. Clinical characteristics of nosocomial norovirus outbreaks in Hong Kong. J Hosp Infect 2008; 69:135-40. [PMID: 18468726 DOI: 10.1016/j.jhin.2008.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 03/26/2008] [Indexed: 10/22/2022]
Abstract
Norovirus outbreaks occur worldwide every year and have become more frequent over the last few years. There were extensive outbreaks in Hong Kong from May to July 2006 and our aim was to describe nosocomial outbreaks from 1 May 2006 to 31 July 2006 in this retrospective observational study. A total of 38 confirmed norovirus outbreaks involving 218 patients were identified. Most of these patients were elderly with a mean age of 74.5 years (range: 3 months to 97 years); 62% of them were either totally or partially dependent for help with daily activities, 83.9% had underlying chronic medical problems and 56% had limited mobility. In all, 97.2% of individuals presented with diarrhoea and only 46.3% of them had vomiting. The median duration for diarrhoea was 3 days and the longest 24 days. The median duration of vomiting was one day and the longest 15 days. Fever occurred in one-third of all cases. Reverse transcriptase-polymerase chain reaction was positive for norovirus in 72.6% cases. We conclude that nosocomial norovirus infection often involves frail elderly patients with limited mobility and that these patients may have more prolonged symptoms.
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Affiliation(s)
- O T Y Tsang
- Infectious Disease Centre, Princess Margaret Hospital, Hong Kong.
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8
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Ho PL, Que TL, Ng TK, Chiu SS, Yung RWH, Tsang KWT. Clinical outcomes of bacteremic pneumococcal infections in an area with high resistance. Eur J Clin Microbiol Infect Dis 2006; 25:323-7. [PMID: 16786378 DOI: 10.1007/s10096-006-0139-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 10/24/2022]
Abstract
In a retrospective study designed to gather information in a region with high antimicrobial resistance, the outcomes of 216 episodes of laboratory-confirmed pneumococcal bacteremia treated in Hong Kong between 1995 and 2001 were assessed. The patients had a mean age (+/-standard deviation) of 40+/-33.7 years. In all patients, the clinical diagnosis was confirmed by isolation of Streptococcus pneumoniae from blood (n=216), cerebrospinal fluid (n=7) and/or other sterile sites (n=12). Penicillin nonsusceptibility was found in 37.5% of the isolates (20.8% intermediate and 16.7% resistant). Penicillin nonsusceptibility was not a risk factor for inpatient mortality (p=0.7), nor did it affect duration of fever (p=0.4), requirement for intensive care unit admission (p=0.4) or development of suppurative complications (p=0.2). Advanced age (OR 11.3, 95%CI 4.5-28.2, p<0.01), critical illness (OR 11.3, 95%CI 4.5-28.2, p<0.001) and discordant therapy (OR 4.3, 95%CI 1.7-10.9, p<0.002) involving agents with poor anti-pneumococcal activity (but not penicillins and broad-spectrum beta-lactam agents) were significantly associated with mortality.
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Affiliation(s)
- P L Ho
- Centre of Infection and Department of Microbiology, Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China.
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9
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Abstract
Two hundred non-duplicate methicillin-resistant Staphylococcus aureus (MRSA) isolates causing bacteremia in patients in four major Hong Kong hospitals during the period 2000 to 2001 were characterized by antibiogram, pulsed-field gel electrophoresis (PFGE) using SmaI restriction enzymes, and determination of staphylococcal cassette chromosome mec (SCCmec) types. Nine PFGE types, A to I, were obtained. PFGE type A constituted 50% (99/200) of all isolates and was present in isolates from all four hospitals. PFGE types A to E, had previously been identified as the major types at one of the hospitals from 1988 to 2000. The majority had a resistance profile to tetracycline (T), erythromycin (E), clindamycin (D), gentamicin (G), tobramycin (To), and ciprofloxacin (Ci), and belonged to SCCmec type III; and representatives belonged to clonal complex 239 (CC 239) (MRSA with SCCmec type III and sequence type 239, designated ST 239-MRSA-III). PFGE types F to I were new patterns that had not been previously identified in isolates from Hong Kong. PFGE type F constituted 18% (35/200) of MRSAs, had resistance profile TEGToCi, and belonged to CC 5 (ST 5-MRSA-II). PFGE type G included 13% (26/200) of MRSAs, had resistance profile TECi, and belonged to CC 45 with SCCmec type I or II. PFGE type H had characteristics similar to those of CC 239, while PFGE type I included three isolates, two of which expressed resistance to oxacillin and fusidic acid only. Two of these strains had SCCmec IVa and carried sequence type 389, with a multilocus sequence typing allelic profile of 3-35-19-2-20-26-39. Contemporary MRSAs causing bacteremia in Hong Kong hospitals belong to three clonal complexes (CC 5, CC 45, and CC 239). The most prevalent MRSA clone in Hong Kong belongs to CC 239, with PFGE types A to E and H, SCCmec type III, ST 239, and a resistance profile of TEDGToCi.
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Affiliation(s)
- Margaret Ip
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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10
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Lam K, Tsang OTY, Yung RWH, Lau KK. Japanese encephalitis in Hong Kong. Hong Kong Med J 2005; 11:182-8. [PMID: 15951583] [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: 05/02/2023] Open
Abstract
OBJECTIVES To review past and present patterns of occurrence of Japanese encephalitis in Hong Kong and across Asia. A better understanding of the disease should facilitate the formulation of an effective strategic plan to prevent a future epidemic. DATA SOURCES Report of local cases, and literature search of MEDLINE up to November 2004. STUDY SELECTION Literature and data related to Japanese encephalitis. DATA EXTRACTION Relevant information and data were reviewed by the authors. DATA SYNTHESIS Since 16 July 2004, under the ordinance of Hong Kong, Japanese encephalitis has been a notifiable disease. In the past, Japanese encephalitis has reached epidemic proportions in Japan, South Korea, and some areas in China. It has spread globally and has a worldwide incidence of 35 000 to 50 000 cases per year with 10 000 deaths. Mortality is about 30% and survivors often suffer serious long-term morbidity. In 2004, there were five local cases of Japanese encephalitis in Hong Kong. Subsequent serological surveillance of serum samples from 1547 local inhabitants revealed that 37 were positive, ie 2.4% of local inhabitants had been exposed to the Japanese encephalitis virus in the past. Most local inhabitants are immunologically naive to Japanese encephalitis virus. Most infections in endemic areas are asymptomatic. Patients with symptomatic Japanese encephalitis usually present with fever, headache, and confusion. Other signs include neurosis, poliomyelitis, and convulsion. Investigations including magnetic resonance imaging, electroencephalography, and single photon emission computed tomography are not specific. A definitive diagnosis depends on serological studies. Treatment is mainly supportive. CONCLUSIONS The control of Japanese encephalitis in Hong Kong relies on an accurate surveillance system, vector control, vector avoidance, and vaccination of the at-risk population. At present, vaccination should be limited to travellers to endemic areas who would stay for longer than 1 month.
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Affiliation(s)
- K Lam
- Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong.
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Abstract
AIMS To define epidemiology, clinical disease, and outcome of gemella bacteraemia by 16S rRNA gene sequencing. To examine the usefulness of the Vitek, API, and ATB systems in identifying two gemella species. METHODS All alpha haemolytic streptococci other than Streptococcus pneumoniae isolated from blood cultures during a six year period were identified by conventional biochemical methods, the Vitek system, and the API system. 16S rRNA gene sequencing was performed on all isolates identified by both kits as gemella with >or= 95% confidence or by either kit as any bacterial species with < 95% confidence. The ATB expression system was used to identify the two isolates that were defined as gemella species by 16S rRNA gene sequencing. RESULTS Of the 302 alpha haemolytic streptococci other than S pneumoniae isolated, one was identified as Gemella morbillorum, and another as Gemella haemolysans by 16S rRNA gene sequencing. The patient with monomicrobial G morbillorum bacteraemia was a 66 year old man with community acquired infective endocarditis with septic thromboemboli. The patient with G haemolysans bacteraemia was a 41 year old woman with hospital acquired polymicrobial bacteraemia during the neutropenic period of an autologous bone marrow transplant for non-Hodgkin's lymphoma, the first case of its kind in the English literature. The API and ATB expression systems only identified the second strain as G haemolysans at 94% and 99% confidence, respectively, whereas the Vitek system identified none of the two strains correctly at > 70% confidence. CONCLUSIONS Gemella bacteraemia is uncommon. 16S rRNA gene sequencing is the method of choice for identification of gemella and gemella-like isolates.
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Affiliation(s)
- P C Y Woo
- Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital Compound, Hong Kong
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12
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Cheng VCC, Woo PCY, Lau SKP, Cheung CHY, Yung RWH, Yam LYC, Yuen KY. Peripartum tuberculosis as a form of immunorestitution disease. Eur J Clin Microbiol Infect Dis 2003; 22:313-7. [PMID: 12743831 DOI: 10.1007/s10096-003-0927-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [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: 10/25/2022]
Abstract
The aim of this study was to assess the clinical spectrum of peripartum tuberculosis from the perspective of immunorestitution disease. Of 29 patients with peripartum tuberculosis, 27 (93.1%) had extrapulmonary tuberculosis, 20 (69%) of whom were affected in the central nervous system. Twenty-two (75.9%) patients had no clinical features suggestive of tuberculosis during pregnancy. The median time from delivery to the onset of immunorestitution was 4 days, but treatment with anti-tuberculous therapy was delayed for a median time of 27 days after the onset of symptoms. Despite therapy, 11 (38%) patients died and 4 (13.8%) had residual functional deficits. Peripartum tuberculosis is an important differential diagnosis of postpartum fever (of unknown origin) without localized signs.
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Affiliation(s)
- V C C Cheng
- Division of Infectious Diseases, Center of Infection, Queen Mary Hospital, The University of Hong Kong, University Pathology Building, Hong Kong
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13
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Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, Nicholls J, Yee WKS, Yan WW, Cheung MT, Cheng VCC, Chan KH, Tsang DNC, Yung RWH, Ng TK, Yuen KY. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361:1319-25. [PMID: 12711465 PMCID: PMC7112372 DOI: 10.1016/s0140-6736(03)13077-2] [Citation(s) in RCA: 2103] [Impact Index Per Article: 100.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND An outbreak of severe acute respiratory syndrome (SARS) has been reported in Hong Kong. We investigated the viral cause and clinical presentation among 50 patients. METHODS We analysed case notes and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters. We defined the clinical presentation and risk factors associated with severe disease and investigated the causal agents by chest radiography and laboratory testing of nasopharyngeal aspirates and sera samples. We compared the laboratory findings with those submitted for microbiological investigation of other diseases from patients whose identity was masked. FINDINGS Patients' age ranged from 23 to 74 years. Fever, chills, myalgia, and cough were the most frequent complaints. When compared with chest radiographic changes, respiratory symptoms and auscultatory findings were disproportionally mild. Patients who were household contacts of other infected people and had older age, lymphopenia, and liver dysfunction were associated with severe disease. A virus belonging to the family Coronaviridae was isolated from two patients. By use of serological and reverse-transcriptase PCR specific for this virus, 45 of 50 patients with SARS, but no controls, had evidence of infection with this virus. INTERPRETATION A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. Serological and molecular tests specific for the virus permitted a definitive laboratory diagnosis to be made and allowed further investigation to define whether other cofactors play a part in disease progression.
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Affiliation(s)
- JSM Peiris
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong,Correspondence to: Prof J S M Peiris, Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region, China
| | - ST Lai
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - LLM Poon
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Y Guan
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - LYC Yam
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - W Lim
- Government Virus Unit, Department of Health, Hong Kong
| | - J Nicholls
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - WKS Yee
- Department of Medicine, Kwong Wah Hospital, Hong Kong
| | - WW Yan
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - MT Cheung
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - VCC Cheng
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - KH Chan
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - DNC Tsang
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - RWH Yung
- Department of Medicine and Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - TK Ng
- Department of Medicine, Intensive Care and Pathology, Princess Margaret Hospital, Hong Kong
| | - KY Yuen
- Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong
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