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May 17, 2001
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Serratia Infections at a Hemodialysis Center Due to Contaminated Epoetin Alfa
During a one-month period at a hemodialysis center, there were 10 bloodstream infections with Serratia liquefaciens
. A case-control investigation showed an association of the infections with higher doses of epoetin alfa. A review of procedures found that preservative-free, single-use vials were punctured multiple times in order to pool and administer residual epoetin alfa. The organism was isolated from pooled epoetin alfa.
Hemodialysis centers are under pressure to contain costs, and avoiding waste of expensive medications can yield substantial savings. This serious outbreak was traced to extrinsic contamination from the pooling and subsequent use of the epoetin alfa left in single-use vials. Dialysis units should use medication vials containing the doses most appropriate to their clinical needs.
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Association of Viral Genome with Graft Loss in Children with Cardiac Transplants
The survival of patients after cardiac transplantation is limited by rejection of the graft and by coronary vasculopathy. In this study of children who had received heart transplants, cardiac-biopsy specimens were tested by the polymerase chain reaction (PCR) for evidence of viral infection. The presence of viral genome, particularly adenovirus, predicted the subsequent occurrence of graft loss due to rejection or coronary vasculopathy.
The findings of this study are important because they point to viral infection of the heart as a possible precipitating event leading to the loss of the transplanted heart. The observations suggest that prevention and treatment of cardiac viral infection should be studied as an approach to preserving grafts.
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Tick-Bite Eschars
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Rickettsia africae Infections in Travelers to Africa
In more than 100 patients who became ill after traveling in sub-Saharan Africa and who were given a diagnosis of African tick-bite fever, nearly all had laboratory evidence of Rickettsia africae infection. All but six had eschars from tick bites, and almost half had a rash. The febrile illness was mild, and all patients recovered. The infection responded to deoxycycline.
R. africae is transmitted by ticks found on cattle and game, and the resulting infection is highly prevalent in sub-Saharan Africa. These investigators used three specific laboratory tests to document R. africae infections in returning tourists. These tests can help distinguish this mild infection from other, more severe rickettsial infections. This tick-borne disease is of international importance.
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Before Surgery (Left)
and 28 Months after
Surgery (Right)
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Replacement of an Avulsed Phalanx with Tissue-Engineered Bone
This report describes the implantation of tissue-engineered bone in a man in whom the distal phalanx of the thumb had been avulsed. The implant consisted of a phalanx-like scaffold of coral into which autologous periosteal cells, which had been expanded in vitro, were injected. Postoperatively, the man had good function and strength in the thumb. Serial radiographs revealed the formation of a bone-like structure, and a biopsy 10 months after the procedure revealed it to be composed of 30 percent coral, 5 percent bone, and 65 percent soft tissue.
The use of autologous bone cells in conjunction with inert scaffolding material should be better than the use of autografts or inert substances alone as a way to replace small bones. Cells from the patient are used, and the scaffolding is ultimately resorbed. As it is further perfected, the use of this type of procedure will undoubtedly increase, and in time, the use of readily obtainable stem cells will probably replace the need for bone cells.
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Shattuck Lecture -- Neurodegenerative Diseases and Prions
The 2000 Shattuck Lecture was given by Dr. Stanley B. Prusiner, who won a Nobel prize in 1997 for his discovery of prions, a new class of infectious agents made entirely of proteins. Prions arise through the mutation of a cellular gene and reproduce by converting the normal prion protein (PrP) into an infectious form. Prions cause Creutzfeldt-Jakob disease and bovine spongiform encephalopathy ("mad cow disease"). In this lecture, lessons learned from studies of these disorders are brought together in a unifying concept of infectious prion diseases, Alzheimer's disease, Parkinson's disease, and other degenerative disorders of the brain.
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Medical Progress: Oral Contraceptives and the Risk of Venous Thrombosis
The recognized association between oral contraceptives and venous thrombosis led to the development of contraceptives containing lower doses of estrogen. This review clarifies the extent of the risk of venous thrombosis associated with the oral contraceptives currently in use and focuses on the increased risk observed with preparations containing third-generation progestins. The authors discuss the effects of prothrombotic genetic mutations on the risk of thrombosis associated with oral contraceptives, as well as the mechanisms that may underlie the increased risk. The article also offers practical advice for the prescribing physician.
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