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Tay GTP, Smith K, He C, Ballard EL, Wood ME, Stockwell RE, Morawska L, Wainwright CE, Bell SC. Tolerability and effectiveness of face-masks in reducing cough aerosols for children with cystic fibrosis. J Cyst Fibros 2025; 24:368-373. [PMID: 39884883 DOI: 10.1016/j.jcf.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 12/31/2024] [Accepted: 01/07/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND People with cystic fibrosis (CF) are recommended to wear face-masks when in healthcare settings. We previously demonstrated that face-masks significantly reduce the release of Pseudomonas aeruginosa (P. aeruginosa) aerosols during coughing in adults with CF. There is a knowledge gap in relation to the impact of mask wear in children with CF. This study aimed to examine the tolerability and effectiveness in lowering emissions of hospital-grade surgical and one type of commercially available cotton face-mask in children with CF. METHODS Twenty children with CF and P. aeruginosa infection were recruited. Participants performed three cough manoeuvres in a validated cough aerosol system both with and without face-masks of differing wear time. Cough aerosols were sampled at two meters using an Andersen Cascade Impactor. Quantitative sputum and aerosol bacterial cultures were performed. Participants also rated the comfort levels of the face-masks. RESULTS P. aeruginosa was cultured from the sputum in eight participants (40 %). During uncovered coughing (reference manoeuvre), seven of the 20 participants produced aerosols containing bacterial pathogens. There was a reduction in aerosolised bacterial load during coughing with both surgical and cotton face-masks. The mean percent reduction in CFU with both types of face-masks was 82 % (95 % CI 56 - 108) during the immediate face-mask wear test compared to the uncovered cough test. Face-masks were generally well tolerated. CONCLUSIONS Face-masks are well tolerated and effective in reducing cough-generated bacterial aerosols in children with CF.
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Affiliation(s)
- George T P Tay
- The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kim Smith
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Congrong He
- International Laboratory for Air Quality and Health, School of Earth and Atmospheric Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Emma L Ballard
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Michelle E Wood
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rebecca E Stockwell
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, School of Earth and Atmospheric Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Scott C Bell
- The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
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Somorin YM, O'Connor GM. Assessment of microbial contamination in laser materials processing laboratories used for prototyping of biomedical devices. Access Microbiol 2023; 5:000494.v3. [PMID: 38188238 PMCID: PMC10765054 DOI: 10.1099/acmi.0.000494.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/02/2023] [Indexed: 01/09/2024] Open
Abstract
Microbial contamination of medical devices during pilot production can be a significant barrier as the laboratory environment is a source of contamination. There is limited information on microbial contaminants in laser laboratories and environments involved in the pilot production of medical devices. This study aimed to determine the bioburden and microbial contaminants present in three laser laboratories - an ISO class 7 clean room, a pilot line facility and a standard laser laboratory. Microbiological air sampling was by passive air sampling using settle plates and the identity of isolates was confirmed by DNA sequencing. Particulate matter was analysed using a portable optical particle counter. Twenty bacterial and 16 fungal genera were isolated, with the genera Staphylococcus and Micrococcus being predominant. Most isolates are associated with skin, mouth, or upper respiratory tract. There was no significant correlation between microbial count and PM2.5 concentration in the three laboratories. There were low levels but diverse microbial population in the laser-processing environments. Pathogenic bacteria such as Acinetobacter baumannii and Candida parapsilosis were isolated in those environments. These results provide data that will be useful for developing a contamination control plan for controlling microbial contamination and facilitating advanced manufacturing of laser-based pilot production of medical devices.
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Affiliation(s)
- Yinka M. Somorin
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
- Irish Photonic Integration Centre (IPIC), Tyndall National Institute, Cork, Ireland
| | - Gerard M. O'Connor
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
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Sreenivasulu H, Muppalla SK, Vuppalapati S, Shokrolahi M, Reddy Pulliahgaru A. Hope in Every Breath: Navigating the Therapeutic Landscape of Cystic Fibrosis. Cureus 2023; 15:e43603. [PMID: 37719614 PMCID: PMC10504422 DOI: 10.7759/cureus.43603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Cystic fibrosis (CF) has long posed a complex challenge to medical science. Still, the tides are turning with remarkable progress in prognosis and demographics, thanks to cutting-edge medical management and treatment breakthroughs. It affects multiple systems, necessitating a comprehensive approach to its management. This article thoroughly reviews the latest advancements in CF treatment across three key areas: respiratory care, infection prevention, and pharmacological management. In respiratory care, emphasis is placed on airway clearance therapies and nebulized saline, while infection prevention strategies encompass hand hygiene, respiratory etiquette, and environmental cleaning and disinfection. Pharmacological management explores pancreatic enzyme replacement therapy (PERT), antimicrobial treatments, cystic fibrosis transmembrane regulator (CFTR) modulators, and promising gene therapies. Patient education and support are highlighted as crucial components of effective CF management, while mental health assessments are emphasized due to CF patients' susceptibility to anxiety and depression. This review highlights the tremendous progress made in the management of CF. Integrating early detection, infection prevention, pharmacological interventions, gene therapy, and patient support is revolutionizing the care and quality of life for individuals with CF.
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Affiliation(s)
- Himabindu Sreenivasulu
- General Medicine, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Sudheer Kumar Muppalla
- Pediatrics, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Sravya Vuppalapati
- General Medicine, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | | | - Apeksha Reddy Pulliahgaru
- Pediatrics, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
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Karampatakis T, Tsergouli K, Roilides E. Infection control measures against multidrug-resistant Gram-negative bacteria in children and neonates. Future Microbiol 2023; 18:751-765. [PMID: 37584552 DOI: 10.2217/fmb-2023-0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
The increase in infections caused by multidrug-resistant (MDR) Gram-negative bacteria in neonatal and pediatric intensive care units over recent years is alarming. MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii have constituted the main causes of the MDR Gram-negative bacteria problem. The implementation of infection control measures such as hand hygiene, cohorting of patients, contact precautions, active surveillance and environmental cleaning could diminish their spread. Recently, water safety has been identified as a major component of infection control policies. The aim of the current review is to highlight the effectiveness of these infection control measures in managing outbreaks caused by MDR Gram-negative bacteria in neonatal and pediatric intensive care units and highlight future perspectives on the topic.
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Affiliation(s)
| | - Katerina Tsergouli
- Microbiology Department, Agios Pavlos General Hospital, Thessaloniki, 551 34, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Health Sciences, Hippokration General Hospital, Thessaloniki, 546 42, Greece
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Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial. BMC Anesthesiol 2023; 23:2. [PMID: 36597027 PMCID: PMC9807976 DOI: 10.1186/s12871-022-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation. METHODS Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation. RESULTS A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups. CONCLUSIONS Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) "retrospectively registered".
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BIS-guided sedation prevents the cough reaction of patients under general anaesthesia caused by extubation: a randomized controlled trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:5. [PMCID: PMC9933028 DOI: 10.1186/s44158-023-00088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact and faecal–oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Heavy aerosol production by coughing and the big peak expiratory flow in patients with respiratory infections (especially SARS-CoV-2) during recovery from general anaesthesia are the highest risk factors for infection in healthcare workers. To perform sedation before extubation significantly reduced the incidence of coughing during recovery from general anaesthesia. However, there are few studies on endotracheal tube removal under BIS-guided sedation in postanaesthesia care unit (PACU). We speculated that the BIS-guided sedation with dexmedetomidine and propofol would better prevent coughing caused by tracheal extubation and reducing peak expiratory flow. Methods Patients with general anaesthesia were randomly assigned to Group S (dexmedetomidine was infused in the operating room for 30 min, and the bispectral index (BIS) value was maintained 60–70 by infusion propofol at 0.5~1.5 μg/ml in the PACU until the endotracheal tubes were pulled out) and Group C (no dexmedetomidine and propofol treatment, replaced with the saline treatment). The incidence of coughing, agitation and active extubation, endotracheal tube tolerance and the peak expiratory flow at spontaneous breathing and at extubation were assessed. Results A total of 101 patients were randomly assigned to Group S (51 cases) and Group C (50 cases). The incidence of coughing, agitation and active extubation was significantly lower (1(51), 0(51) and 0(51), respectively) in Group S than (11(50), 8(50) and 5(50), respectively) in Group C (p < 0.05 or p < 0.01, respectively); the scores of cough were significantly reduced (1(1, 1)) in Group S than (1(1, 2)) in Group C (p < 0.01); and the endotracheal tube tolerance was significantly improved (0(0, 1)) in Group S than (1(1, 3)) in Group C (p < 0.001). The peak expiratory flow at spontaneous breathing and at extubation was significantly reduced (5(5, 7) and 6.5(6, 8), respectively) in Group S than (8(5, 10) and 21(9, 32)) in Group C (p < 0.001). Conclusions BIS-guided sedation with dexmedetomidine and propofol significantly prevented coughing and reduced peak expiratory flow during recovery from general anaesthesia, which may play an important role in preventing medical staff from contracting COVID-19. Trial registration Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) “retrospectively registered”.
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7
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Nguyen TT, He C, Carter R, Ballard EL, Smith K, Groth R, Jaatinen E, Kidd TJ, Nguyen TK, Stockwell RE, Tay G, Johnson GR, Bell SC, Knibbs LD. The Effectiveness of Ultraviolet-C (UV-C) Irradiation on the Viability of Airborne Pseudomonas aeruginosa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013706. [PMID: 36294279 PMCID: PMC9602727 DOI: 10.3390/ijerph192013706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 05/17/2023]
Abstract
Pseudomonas aeruginosa (Pa) is the predominant bacterial pathogen in people with cystic fibrosis (CF) and can be transmitted by airborne droplet nuclei. Little is known about the ability of ultraviolet band C (UV-C) irradiation to inactivate Pa at doses and conditions relevant to implementation in indoor clinical settings. We assessed the effectiveness of UV-C (265 nm) at up to seven doses on the decay of nebulized Pa aerosols (clonal Pa strain) under a range of experimental conditions. Experiments were done in a 400 L rotating sampling drum. A six-stage Andersen cascade impactor was used to collect aerosols inside the drum and the particle size distribution was characterized by an optical particle counter. UV-C effectiveness was characterized relative to control tests (no UV-C) of the natural decay of Pa. We performed 112 tests in total across all experimental conditions. The addition of UV-C significantly increased the inactivation of Pa compared with natural decay alone at all but one of the UV-C doses assessed. UV-C doses from 246-1968 µW s/cm2 had an estimated effectiveness of approximately 50-90% for airborne Pa. The effectiveness of doses ≥984 µW s/cm2 were not significantly different from each other (p-values: 0.365 to ~1), consistent with a flattening of effectiveness at higher doses. Modelling showed that delivering the highest dose associated with significant improvement in effectiveness (984 µW s/cm2) to the upper air of three clinical rooms would lead to lower room doses from 37-49% of the 8 h occupational limit. Our results suggest that UV-C can expedite the inactivation of nebulized airborne Pa under controlled conditions, at levels that can be delivered safely in occupied settings. These findings need corroboration, but UV-C may have potential applications in locations where people with CF congregate, coupled with other indoor and administrative infection control measures.
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Affiliation(s)
- Thi Tham Nguyen
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia
- Correspondence:
| | - Congrong He
- International Laboratory for Air Quality & Health, School of Earth and Atmospheric Sciences, Faculty of Science, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Robyn Carter
- Centre for Children’s Health Research, Brisbane, QLD 4101, Australia
| | - Emma L. Ballard
- QIMR Berghofer Institute of Medical Research, Brisbane, QLD 4006, Australia
| | - Kim Smith
- Centre for Children’s Health Research, Brisbane, QLD 4101, Australia
| | - Robert Groth
- International Laboratory for Air Quality & Health, School of Earth and Atmospheric Sciences, Faculty of Science, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Esa Jaatinen
- School of Chemistry and Physics, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Timothy J. Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4032, Australia
- Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4006, Australia
| | - Thuy-Khanh Nguyen
- QIMR Berghofer Institute of Medical Research, Brisbane, QLD 4006, Australia
| | | | - George Tay
- The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Graham R. Johnson
- International Laboratory for Air Quality & Health, School of Earth and Atmospheric Sciences, Faculty of Science, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Scott C. Bell
- Centre for Children’s Health Research, Brisbane, QLD 4101, Australia
- The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- Translational Research Institute, Brisbane, QLD 4102, Australia
| | - Luke D. Knibbs
- Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
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Borg BM, Osadnik C, Adam K, Chapman DG, Farrow CE, Glavas V, Hancock K, Lanteri CJ, Morris EG, Romeo N, Schneider‐Futschik EK, Selvadurai H. Pulmonary function testing during SARS-CoV-2: An ANZSRS/TSANZ position statement. Respirology 2022; 27:688-719. [PMID: 35981737 PMCID: PMC9539179 DOI: 10.1111/resp.14340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
The Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) commissioned a joint position paper on pulmonary function testing during coronavirus disease 2019 (COVID-19) in July 2021. A working group was formed via an expression of interest to members of both organizations and commenced work in September 2021. A rapid review of the literature was undertaken, with a 'best evidence synthesis' approach taken to answer the research questions formed. This allowed the working group to accept findings of prior relevant reviews or societal document where appropriate. The advice provided is for providers of pulmonary function tests across all settings. The advice is intended to supplement local infection prevention and state, territory or national directives. The working group's key messages reflect a precautionary approach to protect the safety of both healthcare workers (HCWs) and patients in a rapidly changing environment. The decision on strategies employed may vary depending on local transmission and practice environment. The advice is likely to require review as evidence grows and the COVID-19 pandemic evolves. While this position statement was contextualized specifically to the COVID-19 pandemic, the working group strongly advocates that any changes to clinical/laboratory practice, made in the interest of optimizing the safety and well-being of HCWs and patients involved in pulmonary function testing, are carefully considered in light of their potential for ongoing use to reduce transmission of other droplet and/or aerosol borne diseases.
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Affiliation(s)
- Brigitte M. Borg
- Respiratory MedicineThe AlfredMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Christian Osadnik
- Department of PhysiotherapyMonash UniversityFrankstonVictoriaAustralia
- Monash Lung Sleep Allergy & ImmunologyMonash HealthClaytonVictoriaAustralia
| | - Keith Adam
- Sonic HealthPlusOsborne ParkWestern AustraliaAustralia
| | - David G. Chapman
- Respiratory Investigation Unit, Department of Respiratory MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Airway Physiology & Imaging Group, Woolcock Institute of Medical ResearchThe University of SydneyGlebeNew South WalesAustralia
- Discipline of Medical Science, School of Life Sciences, Faculty of ScienceUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Catherine E. Farrow
- Airway Physiology & Imaging Group, Woolcock Institute of Medical ResearchThe University of SydneyGlebeNew South WalesAustralia
- Respiratory Function Laboratory, Department of Respiratory and Sleep MedicineWestmead HospitalWestmeadNew South WalesAustralia
- Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | | | - Kerry Hancock
- Chandlers Hill SurgeryHappy ValleySouth AustraliaAustralia
| | - Celia J. Lanteri
- Department of Respiratory & Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
- Institute for Breathing and SleepAustin HealthHeidelbergVictoriaAustralia
| | - Ewan G. Morris
- Department of Respiratory MedicineWaitematā District Health BoardAucklandNew Zealand
| | - Nicholas Romeo
- Department of Respiratory MedicineNorthern HealthEppingVictoriaAustralia
| | - Elena K. Schneider‐Futschik
- Cystic Fibrosis Pharmacology Laboratory, Department of Biochemistry & PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
- School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Hiran Selvadurai
- Department of Respiratory MedicineThe Children's Hospital, Westmead, Sydney Childrens Hospital NetworkSydneyNSWAustralia
- Discipline of Child and Adolescent HealthSydney Medical School, The University of SydneySydneyNSWAustralia
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Fan Z, Pitmon E, Wen L, Miller J, Ehinger E, Herro R, Liu W, Chen J, Mikulski Z, Conrad DJ, Marki A, Orecchioni M, Kumari P, Zhu YP, Marcovecchio PM, Hedrick CC, Hodges CA, Rathinam VA, Wang K, Ley K. Bone Marrow Transplantation Rescues Monocyte Recruitment Defect and Improves Cystic Fibrosis in Mice. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:745-752. [PMID: 35031577 PMCID: PMC8855460 DOI: 10.4049/jimmunol.1901171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
Cystic fibrosis (CF) is an inherited life-threatening disease accompanied by repeated lung infections and multiorgan inflammation that affects tens of thousands of people worldwide. The causative gene, cystic fibrosis transmembrane conductance regulator (CFTR), is mutated in CF patients. CFTR functions in epithelial cells have traditionally been thought to cause the disease symptoms. Recent work has shown an additional defect: monocytes from CF patients show a deficiency in integrin activation and adhesion. Because monocytes play critical roles in controlling infections, defective monocyte function may contribute to CF progression. In this study, we demonstrate that monocytes from CFTRΔF508 mice (CF mice) show defective adhesion under flow. Transplanting CF mice with wild-type (WT) bone marrow after sublethal irradiation replaced most (60-80%) CF monocytes with WT monocytes, significantly improved survival, and reduced inflammation. WT/CF mixed bone marrow chimeras directly demonstrated defective CF monocyte recruitment to the bronchoalveolar lavage and the intestinal lamina propria in vivo. WT mice reconstituted with CF bone marrow also show lethality, suggesting that the CF defect in monocytes is not only necessary but also sufficient to cause disease. We also show that monocyte-specific knockout of CFTR retards weight gains and exacerbates dextran sulfate sodium-induced colitis. Our findings show that providing WT monocytes by bone marrow transfer rescues mortality in CF mice, suggesting that similar approaches may mitigate disease in CF patients.
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Affiliation(s)
- Zhichao Fan
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Elise Pitmon
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Lai Wen
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Jacqueline Miller
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Erik Ehinger
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Rana Herro
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Wei Liu
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Ju Chen
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Zbigniew Mikulski
- Microscopy and Histology Core Facility, La Jolla Institute for Immunology, La Jolla, CA
| | - Douglas J Conrad
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Alex Marki
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Marco Orecchioni
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Puja Kumari
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Yanfang Peipei Zhu
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Paola M Marcovecchio
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Catherine C Hedrick
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA
| | - Craig A Hodges
- Department of Genetics and Genome Sciences, Cystic Fibrosis Mouse Models Core, School of Medicine, Case Western Reserve University, Cleveland, OH; and
| | - Vijay A Rathinam
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Kepeng Wang
- Department of Immunology, School of Medicine, UConn Health, Farmington, CT
| | - Klaus Ley
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA;
- Department of Bioengineering, University of California San Diego, La Jolla, CA
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Nguyen TT, Johnson GR, Bell SC, Knibbs LD. A Systematic Literature Review of Indoor Air Disinfection Techniques for Airborne Bacterial Respiratory Pathogens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031197. [PMID: 35162224 PMCID: PMC8834760 DOI: 10.3390/ijerph19031197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023]
Abstract
Interrupting the transmission of airborne (<≈5 µm) respiratory pathogens indoors is not a new challenge, but it has attracted unprecedented interest due to the COVID-19 pandemic during 2020–2021. However, bacterial respiratory pathogens with known or potential airborne transmission account for an appreciable proportion of the communicable disease burden globally. We aimed to systematically review quantitative, laboratory-based studies of air disinfection techniques for airborne respiratory bacteria. Three databases (PubMed, Web of Science, Scopus) were searched, following PRISMA guidelines. A total of 9596 articles were identified, of which 517 were assessed in detail and of which 26 met the inclusion and quality assessment criteria. Seven air disinfection techniques, including UV-C light, filtration, and face masks, among others, were applied to 13 different bacterial pathogens. More than 80% of studies suggested that air disinfection techniques were more effective at inactivating or killing bacteria than the comparator or baseline condition. However, it was not possible to compare these techniques because of methodological heterogeneity and the relatively small number of the studies. Laboratory studies are useful for demonstrating proof-of-concept and performance under controlled conditions. However, the generalisability of their findings to person-to-person transmission in real-world settings is unclear for most of the pathogens and techniques we assessed.
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Affiliation(s)
- Thi Tham Nguyen
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- Correspondence:
| | - Graham R. Johnson
- School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Scott C. Bell
- Children’s Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4101, Australia;
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, QLD 4032, Australia
- Translational Research Institute, Brisbane, QLD 4102, Australia
| | - Luke D. Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
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11
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Stockman T, Zhu S, Kumar A, Wang L, Patel S, Weaver J, Spede M, Milton DK, Hertzberg J, Toohey D, Vance M, Srebric J, Miller SL. Measurements and Simulations of Aerosol Released while Singing and Playing Wind Instruments. ACS ENVIRONMENTAL AU 2021; 1:71-84. [PMID: 37155479 PMCID: PMC8525345 DOI: 10.1021/acsenvironau.1c00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Outbreaks from choir performances, such as the Skagit Valley Choir, showed that singing brings potential risk of COVID-19 infection. There is less known about the risks of airborne infection from other musical performances, such as playing wind instruments or performing theater. In addition, it is important to understand methods that can be used to reduce infection risk. In this study, we used a variety of methods, including flow visualization, aerosol and CO2 measurements, and computational fluid dynamics (CFD) modeling to understand the different components that can lead to transmission risk from musical performance and risk mitigation. This study was possible because of a partnership across academic departments and institutions and collaboration with the National Federation of State High School Associations and the College Band Directors National Association. The interdisciplinary team enabled us to understand the various aspects of aerosol transmission risk from musical performance and to quickly implement strategies in music classrooms during the COVID-19 pandemic. We found that plumes from musical performance were highly directional, unsteady and varied considerably in time and space. Aerosol number concentration measured at the bell of the clarinet was comparable to that of singing. Face and bell masks attenuated plume velocities and lengths and decreased aerosol concentrations measured in front of the masks. CFD modeling showed differences between indoor and outdoor environments and that the lowest risk of airborne COVID-19 infection occurred at less than 30 min of exposure indoors and less than 60 min outdoors.
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Affiliation(s)
- Tehya Stockman
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Shengwei Zhu
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Abhishek Kumar
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Lingzhe Wang
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Sameer Patel
- Department of Civil Engineering, Indian Institute of Technology, Gandhinagar, Gujrat 382355, India
| | - James Weaver
- National Federation of State High School Associations, Indianapolis, Indiana 46402, United States
| | - Mark Spede
- Department of Performing Arts, Clemson University, Clemson, South Carolina 29634, United States
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland 20740, United States
| | - Jean Hertzberg
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Darin Toohey
- Department of Atmospheric and Oceanic Sciences, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Marina Vance
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Jelena Srebric
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Shelly L. Miller
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
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12
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Butt RT, Janjua OS, Qureshi SM, Shaikh MS, Guerrero-Gironés J, Rodríguez-Lozano FJ, Zafar MS. Dental Healthcare Amid the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11008. [PMID: 34769526 PMCID: PMC8583530 DOI: 10.3390/ijerph182111008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023]
Abstract
The hustle and bustle of the planet Earth have come to a halt thanks to the novel coronavirus. The virus has affected approximately 219 million people globally; taken the lives of 4.55 million patients as of September 2021; and created an ambiance of fear, social distancing, and economic instability. The purpose of this review article is to trace the historical origin and evolution of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The virus is highly contagious with a unique feature of rapid mutations-the scientific research is paving the way for discoveries regarding novel coronavirus disease (COVID-19) diagnosis, features, prevention, and vaccination. The connections between the coronavirus pandemic and dental practices are essential because COVID-19 is transmitted by aerosols, fomites, and respiratory droplets, which are also produced during dental procedures, putting both the patient and the dentist at risk. The main emphasis of this paper is to highlight the psychological, economic, and social impact of this pandemic on dental practices throughout the world and under what circumstances and guidelines can dental health care be provided. In the current situation of the pandemic, an appropriate screening tool must be established either by using rapid molecular testing or saliva point-of-care technology, which will be effective in identifying as well as isolating the potential contacts and carriers in hopes to contain and mitigate infection. The blessing in disguise is that this virus has united the leaders, scientists, health care providers, and people of all professions from all around the world to fight against a common enemy.
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Affiliation(s)
- Rabia Tariq Butt
- General Dental Practitioner, Al-Noor Clinics, Okara 56000, Pakistan;
| | - Omer Sefvan Janjua
- Department of Maxillofacial Surgery, PMC Dental Institute, Faisalabad Medical University, Faisalabad 38000, Pakistan;
| | - Sana Mehmood Qureshi
- Department of Oral Pathology, PMC Dental Institute, Faisalabad Medical University, Faisalabad 38000, Pakistan;
| | - Muhammad Saad Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Julia Guerrero-Gironés
- Gerodontology and Special Care Dentistry Unit, Hospital Morales Meseguer, Medicine School, University of Murcia, 30100 Murcia, Spain;
| | - Francisco J. Rodríguez-Lozano
- Gerodontology and Special Care Dentistry Unit, Hospital Morales Meseguer, Medicine School, University of Murcia, 30100 Murcia, Spain;
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute of Murcia, Clinical University Hospital Virgen de laArrixaca, University of Murcia, 30120 Murcia, Spain
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia; or
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
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13
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Marthin JK, Lucas JS, Boon M, Casaulta C, Crowley S, Destouches DMS, Eber E, Escribano A, Haarman E, Hogg C, Maitre B, Marsh G, Martinu V, Moreno-Galdó A, Mussaffi H, Omran H, Pohunek P, Rindlisbacher B, Robinson P, Snijders D, Walker WT, Yiallouros P, Johansen HK, Nielsen KG. International BEAT-PCD consensus statement for infection prevention and control for primary ciliary dyskinesia in collaboration with ERN-LUNG PCD Core Network and patient representatives. ERJ Open Res 2021; 7:00301-2021. [PMID: 34350277 PMCID: PMC8326680 DOI: 10.1183/23120541.00301-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction In primary ciliary dyskinesia (PCD) impaired mucociliary clearance leads to recurrent airway infections and progressive lung destruction, and concern over chronic airway infection and patient-to-patient transmission is considerable. So far, there has been no defined consensus on how to control infection across centres caring for patients with PCD. Within the BEAT-PCD network, COST Action and ERS CRC together with the ERN-Lung PCD core a first initiative has now been taken towards creating such a consensus statement. Methods A multidisciplinary international PCD expert panel was set up to create a consensus statement for infection prevention and control (IP&C) for PCD, covering diagnostic microbiology, infection prevention for specific pathogens considered indicated for treatment and segregation aspects. Using a modified Delphi process, consensus to a statement demanded at least 80% agreement within the PCD expert panel group. Patient organisation representatives were involved throughout the process. Results We present a consensus statement on 20 IP&C statements for PCD including suggested actions for microbiological identification, indications for treatment of Pseudomonas aeruginosa, Burkholderia cepacia and nontuberculous mycobacteria and suggested segregation aspects aimed to minimise patient-to-patient transmission of infections whether in-hospital, in PCD clinics or wards, or out of hospital at meetings between people with PCD. The statement also includes segregation aspects adapted to the current coronavirus disease 2019 (COVID-19) pandemic. Conclusion The first ever international consensus statement on IP&C intended specifically for PCD is presented and is targeted at clinicians managing paediatric and adult patients with PCD, microbiologists, patient organisations and not least the patients and their families. For the first time ever, an international consensus statement for infection prevention and control in PCD is presented. A total of 20 statements were developed in a collaboration of BEAT-PCD, COST Action, ERS CRC and ERN-LUNG PCD Core Network.https://bit.ly/3yuahKt
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Affiliation(s)
- June K Marthin
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, Clinical and Experimental Science, University of Southampton, Southampton, UK
| | - Mieke Boon
- Dept of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine, University Children's Hospital, Bern, Switzerland
| | - Suzanne Crowley
- Paediatric Dept of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Damien M S Destouches
- Association des Patients Ayant une Dyskinésie Ciliaire Primitive, Limeil-Brevannes, France.,Patient representative
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Amparo Escribano
- Pediatric Pulmonology Unit, Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Eric Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Claire Hogg
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Bernard Maitre
- Pulmonary Service, Centre constitutif Respirare, Centre Hospitalier intercommunal de Créteil, Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Gemma Marsh
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Vendula Martinu
- Paediatric Pulmonology, Paediatric Dept, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Antonio Moreno-Galdó
- Dept of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Huda Mussaffi
- Schneider Children's Medical Center of Israel, Petach-Tikva, Sackler School of Medicine, Tel-Aviv, Israel
| | - Heymut Omran
- Dept of General Paediatrics and Adolescent Medicine, University Hospital Muenster, Muenster, Germany
| | - Petr Pohunek
- Paediatric Pulmonology, Paediatric Dept, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Bernhard Rindlisbacher
- Kartagener Syndrom und Primäre Ciliäre Dyskinesie, Steffisburg, Switzerland.,Patient representative
| | - Phil Robinson
- Dept of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia.,Dept of Paediatrics, University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Deborah Snijders
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padua, Italy
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, Clinical and Experimental Science, University of Southampton, Southampton, UK
| | | | - Helle Krogh Johansen
- Dept of Clinical Microbiology, University Hospital Rigshospitalet, Copenhagen, Denmark.,Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim G Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Zheng C, Chen T, Lu J, Wei K, Tian H, Liu W, Xu T, Wang X, Wang S, Yang R, Yang Y, Liu Z, Wei H, Deng X. Adjuvant treatment and molecular mechanism of probiotic compounds in patients with gastric cancer after gastrectomy. Food Funct 2021; 12:6294-6308. [PMID: 34052844 DOI: 10.1039/d1fo01375k] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastrectomy is the main treatment for gastric cancer (GC) at present. Surgery improves the survival rate of patients, but the complications seriously affect the recovery and lack effective treatment measures. In the present study, probiotic compounds (4 strains; Lactobacillus plantarum MH-301 (CGMCC NO. 18618), L. rhamnosus LGG-18 (CGMCC NO. 14007), L. acidophilus and Bifidobacterium animalis subsp.lactis LPL-RH (CGMCC NO. 4599)), through clinical and animal model verification, were studied to try to find the auxiliary treatment measures after gastrectomy, and explore its potential mechanism. Clinical research results showed that probiotic compounds treatment could significantly lower postoperative inflammation, enhance immunity, resume gut microbiota composition and promote postoperative recovery. The results in rat models indicated that gastrostomy led to the aggravation of inflammation, the impairment of immunity and intestinal barrier, and the disorder of gut microbiota in vivo. Furthermore, probiotic compounds' administration could downregulate the inflammatory and permeability signaling pathways in the intestinal tissue, reduce the levels of proinflammatory factors, maintain the intestinal mucosal barrier and immune function, and recover the disorder of gut microbiota after gastrectomy in rats. Therefore, we conclude that probiotic compounds can restore gut microbiota homeostasis, reduce inflammation, maintain intestinal mucosal barrier and immunity, finally promote recovery after gastrectomy, and is expected to improve the prognosis of patients.
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Affiliation(s)
- Cihua Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.
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15
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Vanden Driessche K, Mahlobo PZ, Venter R, Caldwell J, Jennings K, Diacon AH, Cotton MF, de Groot R, Hens N, Marx FM, Warren RM, Mishra H, Theron G. Face masks in the post-COVID-19 era: a silver lining for the damaged tuberculosis public health response? THE LANCET. RESPIRATORY MEDICINE 2021; 9:340-342. [PMID: 33493446 PMCID: PMC7826055 DOI: 10.1016/s2213-2600(21)00020-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Koen Vanden Driessche
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa; Division of Paediatric Pulmonology, Department of Paediatrics, University Hospital Antwerp, Edegem, Belgium; Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Precious Z Mahlobo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa
| | - Rouxjeane Venter
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa
| | - Judy Caldwell
- Department of Health, City of Cape Town, Cape Town, South Africa
| | - Karen Jennings
- Department of Health, City of Cape Town, Cape Town, South Africa
| | - Andreas H Diacon
- Department of Medicine, Stellenbosch University, Cape Town, South Africa; TASK Applied Science, Cape Town, South Africa
| | - Mark F Cotton
- Family Clinical Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Ronald de Groot
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Niel Hens
- Family Medicine and Population Health (FAMPOP), Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), and Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Robin M Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa
| | - Hridesh Mishra
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SA/MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7550, South Africa.
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16
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Prihanti GS, Julianto NR, Sasmita AH, Nurfahmi A, Setyautami A, Rosyida D, Muslimawaty T, Fatmawati N. The Effectiveness of Cough Etiquette Counseling among People with Presumptive and Confirmed Tuberculosis. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i12021.26-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Tuberculosis (TB) is one of the most severe global health problems. The World Health Organization recommends the application of and compliance with infection control measures, one of which is cough etiquette to prevent transmission of pathogenic droplets. Purpose: The aim of the current research was to determine the effectiveness of cough etiquette counseling on changes in the knowledge, behavior, and awareness of patients with confirmed and suspected TB at Public Health Center (PHC) of C in K city. Methods: This research was designed as a pre-experimental study and was conducted in July 2018. The target population of the research comprised TB patients who were being treated in PHC of C in K city. The inclusion criteria were patients at PHC of C in K city with confirmed TB recorded between January and June 2018 and those with suspected TB reported between May and June 2018. This research was analyze based on univariable and bivariable analysis using T-testing and Wilcoxon testing. Results: There were significant differences in knowledge changes before and after cough etiquette counseling (mean difference = 3.72; p < 0.00). There was a significant difference in behavior before and after counseling (mean difference = 1.12; p = 0.04). There was also a significant difference in awareness before and after counseling (mean difference = 5.89; p < 0.00). Conclusion: Changes in knowledge, behavior, and awareness were observed in confirmed and suspected TB patients after cough etiquette counseling.
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17
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Rossitto M, Tabarini P, Tuccio Guarna Assanti V, Montemitro E, Pompilio A, Fiscarelli EV. Environmental Microbial Contamination during Cystic Fibrosis Group-Based Psychotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031142. [PMID: 33525434 PMCID: PMC7908138 DOI: 10.3390/ijerph18031142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/23/2022]
Abstract
Living with cystic fibrosis (CF) exposes patients to the risk of developing anxiety and depression, with therapeutic compliance reduction, hospitalization increase, and quality of life and health outcomes deterioration. As pulmonary infections represent the major cause of morbidity and mortality in patients with CF, environmental contamination due to droplet dispersion and the potential transmission from environment to such patients should be prevented. Therefore, in-person contact, including group-based psychotherapy, are strongly discouraged. Nevertheless, group sharing of disease-related experiences represents a way to recover the inner resources essential for dealing with a chronic pathology. Keeping in mind the guidelines for infection control, the aim of this study is to evaluate the risk of the dissemination of microorganisms in a restricted environment where patients with CF attend group psychotherapy sessions. Five patients, selected according to their microbiological status, attended 32 group-based psychological/psychoanalytic meetings. Before each session, they were asked to observe the infection control recommendations. Microbiological environmental monitoring (MEM) has been performed to evaluate both air and surface contamination. As reported, a strict observation of standard precautions allows one to avoid environmental contamination by pathogens of the CF respiratory tract. Although infection control guidelines discourage group-based psychological/psychoanalytic interventions, our observations report the feasibility and safety of group psychotherapy when strict precautions are taken.
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Affiliation(s)
- Martina Rossitto
- Cystic Fibrosis Diagnostic Unit, Laboratory and Specialistic Pediatrics Departments, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (V.T.G.A.)
| | - Paola Tabarini
- Neuroscience and Neurorehabilitation Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Vanessa Tuccio Guarna Assanti
- Cystic Fibrosis Diagnostic Unit, Laboratory and Specialistic Pediatrics Departments, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (V.T.G.A.)
| | - Enza Montemitro
- Cystic Fibrosis Center, Specialistic Pediatrics Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Arianna Pompilio
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ersilia Vita Fiscarelli
- Cystic Fibrosis Diagnostic Unit, Laboratory and Specialistic Pediatrics Departments, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (V.T.G.A.)
- Correspondence:
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18
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Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, von Delft A, Price A, Fridman L, Tang LH, Tang V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A 2021; 118:e2014564118. [PMID: 33431650 PMCID: PMC7848583 DOI: 10.1073/pnas.2014564118] [Citation(s) in RCA: 642] [Impact Index Per Article: 160.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people ("source control") with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.
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Affiliation(s)
- Jeremy Howard
- fast.ai, San Francisco, CA 94105;
- Data Institute, University of San Francisco, San Francisco, CA 94105
| | - Austin Huang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903
| | - Zhiyuan Li
- Center for Quantitative Biology, Peking University, Beijing 100871, China
| | - Zeynep Tufekci
- School of Information, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Vladimir Zdimal
- Institute of Chemical Process Fundamentals, Czech Academy of Sciences, CZ-165 02 Praha 6, Czech Republic
| | - Helene-Mari van der Westhuizen
- Department of Primary Health Care Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
- TB Proof, Cape Town 7130, South Africa
| | - Arne von Delft
- TB Proof, Cape Town 7130, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Amy Price
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Lex Fridman
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Lei-Han Tang
- Department of Physics, Hong Kong Baptist University, Hong Kong SAR, China
- Complex Systems Division, Beijing Computational Science Research Center, Beijing 100193, China
| | - Viola Tang
- Department of Information Systems, Business Statistics and Operations Management, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Gregory L Watson
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Christina E Bax
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Frederik Questier
- Teacher Education Department, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | - Larry F Chu
- Anesthesia Informatics and Media Lab, School of Medicine, Stanford University, Stanford, CA 94305
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095
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19
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Smyth AR, Smith SJ, Rowbotham NJ. Infection prevention and control in cystic fibrosis: One size fits all The argument against. Paediatr Respir Rev 2020; 36:94-96. [PMID: 31629644 DOI: 10.1016/j.prrv.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/17/2022]
Abstract
As awareness of the risks of cross infection has increased, infection prevention and control measures have become more draconian. Infection control measures can have a profound effect of the organisation and delivery of CF services and on the lives of people with CF outside the hospital. However, the consequences of inadequate infection control measures may be the permanent acquisition of a chronic infection which is virtually untreatable. Recommendations for infection prevention and control therefore must protect patients but should also be evidence-based and proportionate. This article will review the literature, juxtaposing evidence and popular practise.
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Affiliation(s)
- Alan R Smyth
- School of Medicine, University of Nottingham, Nottingham, UK; Nottingham Evidence Based Child Health Group, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham Children's Hospital, Nottingham, UK.
| | - Sherie J Smith
- School of Medicine, University of Nottingham, Nottingham, UK; Nottingham Evidence Based Child Health Group, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicola J Rowbotham
- School of Medicine, University of Nottingham, Nottingham, UK; Nottingham Evidence Based Child Health Group, School of Medicine, University of Nottingham, Nottingham, UK
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20
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Vanden Driessche K, Nestele J, Grouwels J, Duval EL. Exposure to cough aerosols and development of pulmonary COVID-19. J Breath Res 2020; 14:041003. [PMID: 33006317 DOI: 10.1088/1752-7163/abb28c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We hypothesized that most patients with severe pulmonary COVID-19 were exposed to cough aerosols. Among patients that were almost 100% certain which person infected them, only 14 out of 38 overall, and 9 out of 25 hospitalized patients requiring supplemental oxygen, were infected by someone who coughed, which did not support our hypothesis. Talking, especially with a loud voice, could be an alternative source generating SARS-CoV-2 aerosols. Further research is needed to determine how SARS-CoV-2 spreads. Avoiding to talk when you are not wearing your mask and not talking with a loud voice, 'voice etiquette', could be other public health interventions worthwhile exploring.
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Affiliation(s)
- Koen Vanden Driessche
- Division of Pulmonology, Department of Pediatrics, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Fennelly KP. Particle sizes of infectious aerosols: implications for infection control. THE LANCET. RESPIRATORY MEDICINE 2020; 8:914-924. [PMID: 32717211 PMCID: PMC7380927 DOI: 10.1016/s2213-2600(20)30323-4] [Citation(s) in RCA: 353] [Impact Index Per Article: 70.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of COVID-19 has been associated with infections and deaths among health-care workers. This Viewpoint of infectious aerosols is intended to inform appropriate infection control measures to protect health-care workers. Studies of cough aerosols and of exhaled breath from patients with various respiratory infections have shown striking similarities in aerosol size distributions, with a predominance of pathogens in small particles (<5 μm). These are immediately respirable, suggesting the need for personal respiratory protection (respirators) for individuals in close proximity to patients with potentially virulent pathogens. There is no evidence that some pathogens are carried only in large droplets. Surgical masks might offer some respiratory protection from inhalation of infectious aerosols, but not as much as respirators. However, surgical masks worn by patients reduce exposures to infectious aerosols to health-care workers and other individuals. The variability of infectious aerosol production, with some so-called super-emitters producing much higher amounts of infectious aerosol than most, might help to explain the epidemiology of super-spreading. Airborne infection control measures are indicated for potentially lethal respiratory pathogens such as severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Kevin P Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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22
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Kumar PS, Subramanian K. Demystifying the mist: Sources of microbial bioload in dental aerosols. J Periodontol 2020; 91:1113-1122. [PMID: 32662070 PMCID: PMC7405170 DOI: 10.1002/jper.20-0395] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
The risk of transmitting airborne pathogens is an important consideration in dentistry and has acquired special significance in the context of recent respiratory disease epidemics. The purpose of this review, therefore, is to examine (1) what is currently known regarding the physics of aerosol creation, (2) the types of environmental contaminants generated by dental procedures, (3) the nature, quantity, and sources of microbiota in these contaminants and (4) the risk of disease transmission from patients to dental healthcare workers. Most dental procedures that use ultrasonics, handpieces, air‐water syringes, and lasers generate sprays, a fraction of which are aerosolized. The vast heterogeneity in the types of airborne samples collected (spatter, settled aerosol, or harvested air), the presence and type of at‐source aerosol reduction methods (high‐volume evacuators, low volume suction, or none), the methods of microbial sampling (petri dishes with solid media, filter paper discs, air harvesters, and liquid transport media) and assessment of microbial bioload (growth conditions, time of growth, specificity of microbial characterization) are barriers to drawing robust conclusions. For example, although several studies have reported the presence of microorganisms in aerosols generated by ultrasonic scalers and high‐speed turbines, the specific types of organisms or their source is not as well studied. This paucity of data does not allow for definitive conclusions to be drawn regarding saliva as a major source of airborne microorganisms during aerosol generating dental procedures. Well‐controlled, large‐scale, multi center studies using atraumatic air harvesters, open‐ended methods for microbial characterization and integrated data modeling are urgently needed to characterize the microbial constituents of aerosols created during dental procedures and to estimate time and extent of spread of these infectious agents.
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Affiliation(s)
- Purnima S Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Kumar Subramanian
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH
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23
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Worden L, Wannier R, Blumberg S, Ge AY, Rutherford GW, Porco TC. Estimation of effects of contact tracing and mask adoption on COVID-19 transmission in San Francisco: a modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.09.20125831. [PMID: 32577672 PMCID: PMC7302226 DOI: 10.1101/2020.06.09.20125831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The current COVID-19 pandemic has spurred concern about what interventions may be effective at reducing transmission. The city and county of San Francisco imposed a shelter-in-place order in March 2020, followed by use of a contact tracing program and a policy requiring use of cloth face masks. We used statistical estimation and simulation to estimate the effectiveness of these interventions in San Francisco. We estimated that self-isolation and other practices beginning at the time of San Francisco's shelter-in-place order reduced the effective reproduction number of COVID-19 by 35.4% (95% CI, -20.1%-81.4%). We estimated the effect of contact tracing on the effective reproduction number to be a reduction of approximately 44% times the fraction of cases that are detected, which may be modest if the detection rate is low. We estimated the impact of cloth mask adoption on reproduction number to be approximately 8.6%, and note that the benefit of mask adoption may be substantially greater for essential workers and other vulnerable populations, residents return to circulating outside the home more often. We estimated the effect of those interventions on incidence by simulating counterfactual scenarios in which contact tracing was not adopted, cloth masks were not adopted, and neither contact tracing nor cloth masks was adopted, and found increases in case counts that were modest, but relatively larger than the effects on reproduction numbers. These estimates and model results suggest that testing coverage and timing of testing and contact tracing may be important, and that modest effects on reproduction numbers can nonetheless cause substantial effects on case counts over time.
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Affiliation(s)
- Lee Worden
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Rae Wannier
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Alex Y Ge
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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24
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Jo W, Pak C, Jegal Y, Seo KW. Boarding issue in a commercial flight for patients with cavitary pulmonary tuberculosis: A case report. World J Clin Cases 2020; 8:546-551. [PMID: 32110665 PMCID: PMC7031828 DOI: 10.12998/wjcc.v8.i3.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies have demonstrated that airborne transmission of Mycobacterium tuberculosis bacteria from patients with active pulmonary tuberculosis (TB) to other passengers or crew members can occur during long flights. As such, non-infectious TB patients are usually allowed to undertake air travel after taking the appropriate anti-TB drugs. However, the global guidelines for air travel for patients with TB are inconsistent and insufficiently detailed with respect to cavitary pulmonary TB (CPTB).
CASE SUMMARY Here, we report a case in which a patient with multiple CPTB was permitted air travel, following negative sputum acid-fast bacilli smear tests after administration of proper anti-TB medication. The patient’s culture results were pending.
CONCLUSION This case revealed that more specific guidelines regulating air travel for patients with CPTB are necessary.
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Affiliation(s)
- Woori Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan 44033, South Korea
| | - Chuiyong Pak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan 44033, South Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan 44033, South Korea
| | - Kwang Won Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan 44033, South Korea
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25
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Balfour-Lynn IM. Clinical papers of the year 2018 - Cystic fibrosis. Paediatr Respir Rev 2020; 33:58-61. [PMID: 31053358 DOI: 10.1016/j.prrv.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
This paper reviews the most important clinical papers in cystic fibrosis published in 2018, having searched all the literature on Pubmed. Focus is on CFTR modulator therapy, randomised controlled trials, and infection/microbiology issues.
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Affiliation(s)
- I M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, UK.
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26
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Stockwell RE, Wood MEL, Ballard E, Moore V, Wainwright CE, Bell SC. Current infection control practices used in Australian and New Zealand cystic fibrosis centers. BMC Pulm Med 2020; 20:16. [PMID: 31952502 PMCID: PMC6969421 DOI: 10.1186/s12890-020-1052-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2013 update of the Infection Prevention and Control (IP&C) Guideline outlined recommendations to prevent the spread of CF respiratory pathogens. We aimed to investigate the current infection control practices used in Australian and New Zealand (NZ) CF centers. METHODS Two online surveys were distributed to Australian and NZ CF centers regarding the uptake of selected IP&C recommendations. One survey was distributed to all the Medical Directors and Lead CF Nurses and the second survey was distributed to all the Lead CF Physiotherapists. RESULTS The response rate was 60% (60/100) for medical/nursing and 58% (14/24) for physiotherapy. Over 90% (55/60) of CF centers followed CF-specific infection control guidelines and consistent infection control practices were seen in most CF centers; 76% (41/54) had implemented segregation strategies for ambulatory care and no CF centers housed people with CF in shared inpatient accommodation. However, the application of contact precautions (wearing gloves and apron/gown) by healthcare professionals when reviewing a CF person was variable between CF center respondents but was most often used when seeing CF persons with MRSA infection in both ambulatory care and hospital admission (20/50, 40% and 42/45, 93% of CF centers, respectively). Mask wearing by people with CF was implemented into 61% (36/59) of centers. Hospital rooms were cleaned daily in 79% (37/47) of CF centers and the ambulatory care consult rooms were always cleaned between consults (49/49, 100%) and at the end of the clinic session (51/51, 100%); however the staff member tasked with cleaning changed with 37% (18/49) of CF centers responding that CF multidisciplinary team (MDT) members cleaned between patients whereas at the end of the clinic session, only 12% (6/51) of the CF MDT cleaned the consult room. CONCLUSIONS Overall, Australian and NZ CF centers have adopted many recommendations from the IP&C. Although, the application of contact precautions was inconsistent and had overall a low level of adoption in CF centers. In ~ 25% of centers, mixed waiting areas occurred in the ambulatory care. Given the variability of responses, additional work is required to achieve greater consistency between centers.
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Affiliation(s)
- Rebecca Elizabeth Stockwell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Michelle ELizabeth Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - Emma Ballard
- Statistical Support Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Vanessa Moore
- Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - Claire Elizabeth Wainwright
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Respiratory and Sleep Medicine, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Scott Cameron Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia. .,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia. .,Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
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27
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Kim C, delaRiva-Velasco E, Budhram A, Farri F, Krich D, Nolan SS, Gjonaj S, Paul L, Dozor AJ, Welter JJ. Incidence and prevalence of common respiratory pathogens before and after implementation of the Cystic Fibrosis Foundation Infection Prevention and Control Guideline. J Infect Prev 2020; 21:7-13. [PMID: 32030098 PMCID: PMC6978569 DOI: 10.1177/1757177419872538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/28/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The 2013 Cystic Fibrosis Foundation's Infection Prevention and Control Guideline (CFF IP&C) was developed to reduce the risk of acquisition and transmission of respiratory pathogens in patients with cystic fibrosis (CF). OBJECTIVE We hypothesised that the incidence of common CF respiratory pathogens would decrease at our centre after implementation of the guideline. METHODS All patients with CF seen at our centre from August 2012 through August 2017 who had respiratory cultures were included. Patients were excluded from incidence analysis if they did not have at least one culture per year. Quarterly data were collected for one year before and three years after implementation of the guidelines to determine the incidence and prevalence of seven organisms commonly found in respiratory cultures of patients with CF. RESULTS Quarterly and annual incidence and prevalence rates of common organisms did not change during the study period. DISCUSSION There were no significant differences in the incidence or prevalence of common respiratory organisms in the first three years after implementation of the CF IP&C guideline. Long-term follow-up is needed to determine if changes occur over time.
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Affiliation(s)
- Christy Kim
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Elizabeth delaRiva-Velasco
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Arvind Budhram
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Folashade Farri
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Daniel Krich
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Sheila S Nolan
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Infectious Disease, Valhalla, NY, USA
| | - Suzette Gjonaj
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - Lisa Paul
- Westchester Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Valhalla, NY, USA
| | - Allen J Dozor
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
| | - John J Welter
- New York Medical College and Maria Fareri Children’s Hospital at Westchester Medical Center Division of Pediatric Pulmonology, Allergy and Sleep Medicine and the Armond V. Mascia Cystic Fibrosis Center, Valhalla, NY, USA
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28
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Stockwell RE, Wood ME, He C, Sherrard LJ, Ballard EL, Kidd TJ, Johnson GR, Knibbs LD, Morawska L, Bell SC. Face Masks Reduce the Release of Pseudomonas aeruginosa Cough Aerosols When Worn for Clinically Relevant Periods. Am J Respir Crit Care Med 2019; 198:1339-1342. [PMID: 30028634 DOI: 10.1164/rccm.201805-0823le] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Rebecca E Stockwell
- 1 QIMR Berghofer Medical Research Institute Brisbane, Queensland, Australia.,2 University of Queensland Brisbane, Queensland, Australia
| | - Michelle E Wood
- 1 QIMR Berghofer Medical Research Institute Brisbane, Queensland, Australia.,2 University of Queensland Brisbane, Queensland, Australia.,3 The Prince Charles Hospital Brisbane, Queensland, Australia
| | - Congrong He
- 4 Queensland University of Technology Brisbane, Queensland, Australia and
| | | | - Emma L Ballard
- 1 QIMR Berghofer Medical Research Institute Brisbane, Queensland, Australia
| | - Timothy J Kidd
- 1 QIMR Berghofer Medical Research Institute Brisbane, Queensland, Australia.,2 University of Queensland Brisbane, Queensland, Australia
| | - Graham R Johnson
- 4 Queensland University of Technology Brisbane, Queensland, Australia and
| | - Luke D Knibbs
- 2 University of Queensland Brisbane, Queensland, Australia
| | - Lidia Morawska
- 4 Queensland University of Technology Brisbane, Queensland, Australia and
| | - Scott C Bell
- 1 QIMR Berghofer Medical Research Institute Brisbane, Queensland, Australia.,2 University of Queensland Brisbane, Queensland, Australia.,3 The Prince Charles Hospital Brisbane, Queensland, Australia
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29
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Savant AP, McColley SA. Cystic fibrosis year in review 2018, part 1. Pediatr Pulmonol 2019; 54:1117-1128. [PMID: 31106528 DOI: 10.1002/ppul.24361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022]
Abstract
Cystic fibrosis research and case reports were robust in the year 2018. This report summarizes research and cases related to Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapies, inflammation and infection, epidemiology and the physiologic, and imaging assessment of disease.
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Affiliation(s)
- Adrienne P Savant
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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30
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Kidd TJ, Grimwood K, Bell SC. Abolition of Pseudomonas aeruginosa AUST-01 from an Australian CF center: Do other strains remain? Pediatr Pulmonol 2019; 54:515-516. [PMID: 30741479 DOI: 10.1002/ppul.24258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/03/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.,Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The University of Queensland, Child Health Research Centre, Brisbane, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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31
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Bell SC, Stuart RL. Infection risks for patients from healthcare workers with cystic fibrosis ‐ Reply. Respirology 2019; 24:393-394. [DOI: 10.1111/resp.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Scott C. Bell
- Adult Cystic Fibrosis CentreThe Prince Charles Hospital Brisbane QLD Australia
| | - Rhonda L. Stuart
- Department of Infectious DiseasesMonash Health Clayton VIC Australia
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32
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Stockwell RE, Chin M, Johnson GR, Wood ME, Sherrard LJ, Ballard E, O'Rourke P, Ramsay KA, Kidd TJ, Jabbour N, Thomson RM, Knibbs LD, Morawska L, Bell SC. Transmission of bacteria in bronchiectasis and chronic obstructive pulmonary disease: Low burden of cough aerosols. Respirology 2019; 24:980-987. [PMID: 30919511 DOI: 10.1111/resp.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Aerosol transmission of Pseudomonas aeruginosa has been suggested as a possible mode of respiratory infection spread in patients with cystic fibrosis (CF); however, whether this occurs in other suppurative lung diseases is unknown. Therefore, we aimed to determine if (i) patients with bronchiectasis (unrelated to CF) or chronic obstructive pulmonary disease (COPD) can aerosolize P. aeruginosa during coughing and (ii) if genetically indistinguishable (shared) P. aeruginosa strains are present in these disease cohorts. METHODS People with bronchiectasis or COPD and P. aeruginosa respiratory infection were recruited for two studies. Aerosol study: Participants (n = 20) underwent cough testing using validated cough rigs to determine the survival of P. aeruginosa aerosols in the air over distance and duration. Genotyping study: P. aeruginosa sputum isolates (n = 95) were genotyped using the iPLEX20SNP platform, with a subset subjected to the enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) assay to ascertain their genetic relatedness. RESULTS Aerosol study: Overall, 7 of 20 (35%) participants released P. aeruginosa cough aerosols during at least one of the cough aerosol tests. These cough aerosols remained viable for 4 m from the source and for 15 min after coughing. The mean total aerosol count of P. aeruginosa at 2 m was two colony-forming units. Typing study: No shared P. aeruginosa strains were identified. CONCLUSION Low viable count of P. aeruginosa cough aerosols and a lack of shared P. aeruginosa strains observed suggest that aerosol transmission of P. aeruginosa is an unlikely mode of respiratory infection spread in patients with bronchiectasis and COPD.
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Affiliation(s)
- Rebecca E Stockwell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Melanie Chin
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,Division of Respirology, The University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michelle E Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | | | - Emma Ballard
- Statistical Support Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Peter O'Rourke
- Statistical Support Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kay A Ramsay
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Timothy J Kidd
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nassib Jabbour
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rachel M Thomson
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,Gallipoli Medical Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
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33
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Rowbotham NJ, Palser SC, Smith SJ, Smyth AR. Infection prevention and control in cystic fibrosis: a systematic review of interventions. Expert Rev Respir Med 2019; 13:425-434. [DOI: 10.1080/17476348.2019.1595594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nicola J Rowbotham
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Sally C Palser
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Sherie J Smith
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Alan R Smyth
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
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34
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Zuckerman JB, Saiman L. Use of Masks in Patients with Cystic Fibrosis. Am J Respir Crit Care Med 2018; 198:1588-1589. [DOI: 10.1164/rccm.201807-1248le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Lisa Saiman
- Columbia University Medical CenterNew York, New Yorkand
- New York-Presbyterian HospitalNew York, New York
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35
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Wood ME, Stockwell RE, Bell SC. Reply to Zuckerman and Saiman: Use of Masks in Patients with Cystic Fibrosis. Am J Respir Crit Care Med 2018; 198:1589-1590. [PMID: 30235006 DOI: 10.1164/rccm.201808-1476le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michelle E Wood
- The Prince Charles HospitalBrisbane, Australia.,QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
| | - Rebecca E Stockwell
- QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
| | - Scott C Bell
- The Prince Charles HospitalBrisbane, Australia.,QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
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36
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Parkins MD, Somayaji R, Waters VJ. Epidemiology, Biology, and Impact of Clonal Pseudomonas aeruginosa Infections in Cystic Fibrosis. Clin Microbiol Rev 2018; 31:e00019-18. [PMID: 30158299 PMCID: PMC6148191 DOI: 10.1128/cmr.00019-18] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic lower airway infection with Pseudomonas aeruginosa is a major contributor to morbidity and mortality in individuals suffering from the genetic disease cystic fibrosis (CF). Whereas it was long presumed that each patient independently acquired unique strains of P. aeruginosa present in their living environment, multiple studies have since demonstrated that shared strains of P. aeruginosa exist among individuals with CF. Many of these shared strains, often referred to as clonal or epidemic strains, can be transmitted from one CF individual to another, potentially reaching epidemic status. Numerous epidemic P. aeruginosa strains have been described from different parts of the world and are often associated with an antibiotic-resistant phenotype. Importantly, infection with these strains often portends a worse prognosis than for infection with nonclonal strains, including an increased pulmonary exacerbation rate, exaggerated lung function decline, and progression to end-stage lung disease. This review describes the global epidemiology of clonal P. aeruginosa strains in CF and summarizes the current literature regarding the underlying biology and clinical impact of globally important CF clones. Mechanisms associated with patient-to-patient transmission are discussed, and best-evidence practices to prevent infections are highlighted. Preventing new infections with epidemic P. aeruginosa strains is of paramount importance in mitigating CF disease progression.
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Affiliation(s)
- Michael D Parkins
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie J Waters
- Translational Medicine, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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37
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Bell SC, Armstrong D, Harrington G, Jardine L, Divakaran R, Loff B, Middleton PG, McDonald T, Rowland K, Wishart M, Wood ME, Stuart RL. Work environment risks for health care workers with cystic fibrosis. Respirology 2018; 23:1190-1197. [PMID: 30215873 DOI: 10.1111/resp.13404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/22/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
In Australia and New Zealand, >50% of people with cystic fibrosis (CF) are adults and many of these people are pursuing vocational training and undertaking paid employment. More than 6% of adults with CF are working in health care. There is limited guidance in literature to support health care workers with CF (HCWcf) in training and in employment to support safe practice and to provide protection for themselves and their patients from the acquisition of health care associated infection. A multidisciplinary team of CF and Infectious Disease Clinicians, Infection Prevention and Control Practitioners, HCWcf, academic experts in medical ethics and representatives from universities, appraised the available evidence on the risk posed to and by HCWcf. Specific recommendations were made for HCWcf, CF health care teams, hospitals and universities to support the safe practice and appropriate support for HCWcf.
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Affiliation(s)
- Scott C Bell
- Department of Thoracic Medicine, Adult Cystic Fibrosis Centre, The Prince Charles Hospital and QIMR Berghofer Medicine Research Institute, Brisbane, QLD, Australia
| | - David Armstrong
- Monash Children's Cystic Fibrosis Centre, Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | | | - Luke Jardine
- Department of Neonatology, Mater Mothers' Hospital, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Bebe Loff
- Michael Kirby Centre for Public Health and Human Rights, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter G Middleton
- Department Respiratory and Sleep Medicine, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Tim McDonald
- Department of Paediatrics, Canberra Hospital, Canberra, ACT, Australia
| | - Karen Rowland
- Department of Infectious Disease, Calvary Hospital, Adelaide, SA, Australia
| | - Michael Wishart
- Department of Infection Control and Prevention, Holy Spirit Northside, Brisbane, QLD, Australia
| | - Michelle E Wood
- Department of Physiotherapy and Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rhonda L Stuart
- Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
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38
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Wood ME, Stockwell RE, Johnson GR, Ramsay KA, Sherrard LJ, Kidd TJ, Cheney J, Ballard EL, O'Rourke P, Jabbour N, Wainwright CE, Knibbs LD, Sly PD, Morawska L, Bell SC. Cystic fibrosis pathogens survive for extended periods within cough-generated droplet nuclei. Thorax 2018; 74:87-90. [PMID: 29627800 DOI: 10.1136/thoraxjnl-2018-211567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 01/21/2023]
Abstract
The airborne route is a potential pathway in the person-to-person transmission of bacterial strains among cystic fibrosis (CF) populations. In this cross-sectional study, we investigate the physical properties and survival of common non-Pseudomonas aeruginosa CF pathogens generated during coughing. We conclude that Gram-negative bacteria and Staphylococcus aureus are aerosolised during coughing, can travel up to 4 m and remain viable within droplet nuclei for up to 45 min. These results suggest that airborne person-to-person transmission is plausible for the CF pathogens we measured.
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Affiliation(s)
- Michelle E Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca E Stockwell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kay A Ramsay
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura J Sherrard
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Timothy J Kidd
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Joyce Cheney
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Emma L Ballard
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Peter O'Rourke
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nassib Jabbour
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Peter D Sly
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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39
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Simmonds NJ, Bush A. The Man in the Paper Mask: One (Mask) for All and All for . . . Cystic Fibrosis? Am J Respir Crit Care Med 2018; 197:281-283. [DOI: 10.1164/rccm.201710-2001ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nicholas J. Simmonds
- Royal Brompton HospitalLondon, United Kingdomand
- Imperial College LondonLondon, United Kingdom
| | - Andrew Bush
- Royal Brompton HospitalLondon, United Kingdomand
- Imperial College LondonLondon, United Kingdom
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