Infectious Disease
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Item Open Access Methods and Compositions for Poxvirus A35R Protein(2012-11-22) Roper, RachelThe present invention provides methods and compositions for modulating an immune response in a subject, comprising administering to the subject an effective amount of an A35R protein or active fragment thereof of vaccinia virus or other poxvirus.Item Open Access A case control study of environmental and occupational exposures associated with methicillin resistant nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region(2014) Schinasi, Leah; Wing, Steve; Augustino, Kerri L.; Ramsey, Keith M.; Nobles, Delores L.; Richardson, David B.; Price, Lance B.; Aziz, Maliha; MacDonald, Pia D. M.; Stewart, Jill R.Background Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina. Methods MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types. Results From July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5. Conclusions Absence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry.Item Open Access Medical and Household Characteristics Associated with Methicillin Resistant Nasal Carriage among Patients Admitted to a Rural Tertiary Care Hospital(2013) Schinasi, Leah; Wing, Steve; MacDonald, Pia D. M.; Richardson, David B.; Stewart, Jill R.; L.Augustino, Kerri; Nobles, Delores L.; Ramsey, Keith M.Background Methicillin resistant Staphylococcus aureus (MRSA) poses a threat to patient safety and public health. Understanding how MRSA is acquired is important for prevention efforts. This study investigates risk factors for MRSA nasal carriage among patients at an eastern North Carolina hospital in 2011. Methods Using a case-control design, hospitalized patients ages 18 – 65 years were enrolled between July 25, 2011 and December 15, 2011 at Vidant Medical Center, a tertiary care hospital that screens all admitted patients for nasal MRSA carriage. Cases, defined as MRSA nasal carriers, were age and gender matched to controls, non-MRSA carriers. In-hospital interviews were conducted, and medical records were reviewed to obtain information on medical and household exposures. Multivariable conditional logistic regression was used to derive odds ratio (OR) estimates of association between MRSA carriage and medical and household exposures. Results In total, 117 cases and 119 controls were recruited to participate. Risk factors for MRSA carriage included having household members who took antibiotics or were hospitalized (OR: 3.27; 95% Confidence Interval (CI): 1.24–8.57) and prior hospitalization with a positive MRSA screen (OR: 3.21; 95% CI: 1.12–9.23). A lower proportion of cases than controls were previously hospitalized without a past positive MRSA screen (OR: 0.40; 95% CI: 0.19–0.87). Conclusion These findings suggest that household exposures are important determinants of MRSA nasal carriage in hospitalized patients screened at admission.Item Open Access Lesional modulation of peripheral monocyte leucotactic responsiveness in leprosy.(East Carolina University, 1987-11) Campbell, P. B.; Tolson, T. A.; Yoder, L.; Loesch, Julie; Krahenbuhl, J. L.Because the accumulation and activation of mononuclear phagocytes are critical to the host response to intracellular microbial pathogens, we evaluated mechanisms of peripheral monocyte leucotactic regulation in leprosy. Plasma from 53 of 67 patients was found to inhibit the locomotion of normal human monocytes. Neither the prevalence nor the magnitude of plasma leucotactic inhibitory activity correlated with disease histology or duration, type or duration of chemotherapy, or history of erythema nodosum leprosum. Plasma leucotactic inhibitory activity resided principally in a non-immunoglobulin, cell-directed inhibitor of 230,000 daltons molecular weight. Fractionation of plasma from patients with lepromatous leprosy revealed an additional, immunoglobulincontaining inhibitor of approximately 400,000 daltons weight, possibly an IgG-IgA immune complex. Production of leucotactic inhibitors by unstimulated and concanavalin A-stimulated peripheral mononuclear cells was normal; however, cutaneous explants from these patients spontaneously produced the 230,000 dalton leucotactic inhibitor in vitro. The ability of the lesions of leprosy to impede monocyte traffic may be an important pathogenetic mechanism. Originally published Clinical and Experimental Immunology, Vol. 70, No. 2, Nov 1987Item Open Access Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma.(East Carolina University, 1987-10) Rumley, Richard L.; Patrone, Nicholas A.; White, LindseyRat-bite fever results from an infection with the organism Streptobacillus moniliformis. Symptomatic patients often present with fever, malaise, cough, maculopapular rash, and occasional arthritis, and usually have a history of rodent exposure. This report describes a patient with rat-bite fever resulting in suppurative arthritis. The patient's diagnosis was made by culture of S moniliformis from his left wrist. The diagnosis was delayed, however, owing to the lack of an exposure history, atypical clinical presentation, and the unusual microbiologic characteristics shown by this organism. Originally published Annals of the Rheumatic Diseases, Vol. 46, No. 10, Oct 1987Item Open Access Clinical differences between pulmonary and extrapulmonary tuberculosis: a 5-year retrospective study.(East Carolina University, 1995-03) Antony, Suresh J.; Harrell, Vickie; Christie, John D.; Adams, Harry G.; Rumley, Richard L.This article describes the clinical, epidemiologic, laboratory, and treatment characteristics of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Eastern North Carolina, a primarily rural area. The database was obtained for 1988-1992 from the University Medical Center of Eastern North Carolina-Pitt County and East Carolina University School of Medicine (the tertiary care referral center for this region). One hundred thirty-eight culturepositive patients were enrolled in the study; 56% were PTB and 44% were EPTB. African- American males constituted 59% of the population. Sixty-nine percent of the patient base were uninsured. There was a bimodal age distribution of <40 and >60 years of age. Factors associated with PTB (reported as odds ratios) were white males (2.5), diabetes mellitus (5.4), and cancer (5.1). Factors associated with EPTB (reported as odds ratios) were African- American females, positive human immunodeficiency virus (HIV) serology (8.7), low hematocrit (32.6), and elevated alkaline phosphatase (199). This study emphasizes that in the latest resurgence of tuberculosis, impoverished rural areas, which have been ignored in earlier and present control efforts, are important reservoirs of disease. Originally published J Natl Med Assoc, Vol. 87, No. 3, Mar 1995