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Ye HY, Xing FF, Yang J, Lo SKF, Lau RWT, Chen JHK, Chiu KHY, Yuen KY. High index of suspicion for brucellosis in a highly cosmopolitan city in southern China. BMC Infect Dis 2020; 20:22. [PMID: 31914937 PMCID: PMC6950854 DOI: 10.1186/s12879-019-4748-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/29/2019] [Accepted: 12/28/2019] [Indexed: 12/03/2022] Open
Abstract
Background Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China. Methods A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared. Results A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain. Conclusions Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
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Affiliation(s)
- Hai-Yan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Fan-Fan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Simon Kam-Fai Lo
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Ricky Wing-Tong Lau
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | | | | | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China. .,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. .,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. .,Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China.
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Yang J, Liu J, Xing F, Ye H, Dai G, Liu M, Lo SKF, Lau RWT, Chiu KHY, Chan JFW, Yuen KY. Nosocomial transmission of chickenpox and varicella zoster virus seroprevalence rate amongst healthcare workers in a teaching hospital in China. BMC Infect Dis 2019; 19:582. [PMID: 31277589 PMCID: PMC6612143 DOI: 10.1186/s12879-019-4222-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/16/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) is a highly contagious herpesvirus with potential for nosocomial transmission. However, the importance of nosocomial chickenpox outbreak in China has often been ignored. With the increasing immunocompromised population in China, a thorough review of issues related to nosocomial transmission and the seroprevalence rate of VZV among healthcare workers is necessary. METHODS Retrospective case finding for nosocomial transmission of chickenpox was conducted between January 1, 2013 and December 31, 2017. Cases were identified based on clinical features compatible with chickenpox. A cross-sectional study on the seroprevalence rate of VZV among healthcare workers (HCWs) was conducted between January 1, 2014 and December 31, 2017. The serum VZV antibodies of 1804 HCWs were measured by enzyme-linked immunosorbent assay (ELISA). The seroprevalence rate of VZV antibodies, the positive predictive value and negative predictive value of self-reported history of varicella were analyzed. The economic impact associated with nosocomial transmission of VZV was also assessed. RESULTS A total of 8 cases of chickenpox were identified in three nosocomial transmissions, including 4 HCWs who were infected nosocomially. The overall seroprevalence rate of VZV was 88.4%, which significantly increased with age (P < 0.01). The seroprevalence rates of HCWs with different genders and occupations showed no statistically significant differences. The positive and negative predictive values of a self-reported history of varicella were 80.8 and 10.6% respectively. An estimation of 163.3 person-days of work were lost in each nosocomial transmission and 86.7 infection control unit person-hours were required for each outbreak investigation. The cost of VZV IgG ELISA screening was estimated to be 83 USD per nosocomial transmission. CONCLUSIONS Nosocomial transmission of VZV occurred repeatedly in the hospital setting. An alarming 11.6% of HCWs were seronegative for VZV, which might increase the risk of nosocomial infection and outbreak for other susceptible co-workers and patients. This is especially important in the setting of a teaching hospital where many immunocompromised patients were managed. Furthermore, the positive predictive value of self-reported varicella on seroprevalence rate in our study was lower than those reported in other countries, therefore serological testing of VZV antibodies with subsequent vaccination for all non-immune HCWs should be considered.
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Affiliation(s)
- Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jieling Liu
- 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
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Guijian Dai
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Meiyuan Liu
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Simon Kam-Fai Lo
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Ricky Wing-Tong Lau
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Jasper Fuk-Woo Chan
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China.,Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China. .,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China. .,Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China. .,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China. .,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China.
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