非结核分枝杆菌疾病的现代诊断与治疗

非结核分枝杆菌（Nontuberculous mycobacterium) 常存在于自然环境中,可引起人类的慢性疾病。其感染发病率逐年上升,临床诊断和治疗较困难,且存在争议,需要长期而难以耐受的治疗过程,不易根治。美国胸科协会于2007年第3次发布了关于非结核分枝杆菌疾病的诊疗指南,阐明其感染的流行病学、诊断、治疗和预后。     

Blunt trauma as a risk factor for group A streptococcal necrotizing fasciitis

PURPOSE: Anecdotal reports suggest that blunt trauma and seemingly innocuous musculoskeletal injuries (e.g., muscle strains) are risk factors for developing necrotizing fasciitis (NF) and myositis caused by group A Streptococcus and other bacteria; however, this hypothesis has not been tested in analytic epidemiologic studies of invasive group A streptococcal (GAS) disease. We conducted two case-control studies to determine whether nonpenetrating trauma is a risk factor for either NF or severe cellulitis caused by GAS. METHODS: A secondary analysis of patients who were hospitalized throughout Florida for invasive GAS disease during a 4-year period was conducted. Two case series were used. The first series comprised patients who had severe GAS cellulitis. The second were patients who had GAS NF. Case-patients were compared to a single control series composed of patients with invasive GAS disease not including either NF or cellulitis (e.g., primary bacteremia, septic arthritis). RESULTS: After we adjusted for age, race, and clindamycin usage, GAS NF cases were 5.97 times as likely as controls to have a recent history of blunt trauma (p = 0.04). Patients with severe cellulitis were not more likely than controls to have associated blunt trauma. CONCLUSIONS: Nonpenetrating trauma is significantly associated with the development of GAS NF.     

Emergence of human rotavirus group a genotype G9 strains, Wuhan, China

Of 322 stool specimens collected from children with diarrhea from October 2005 through September 2006 in Wuhan, China, group A rotavirus was identified in 101 (31.4%). The most prevalent group A rotavirus genotype was G3P[8] (62.6%), followed by G1P[8](17.6%), G1+G3P[8](8.8%), G3P[4](6.6%), G1P[4](2.2%), and G9P[8](2.2%). The G9 strains were first detected in Wuhan.     

Assessing the health perspectives of unique populations of adolescents: a focus group study

Few articles report on youth's perceptions about health-related issues and needs and even fewer have given voice to youth with disabilities, chronic health conditions, or youth in therapeutic foster care. The purpose of this study was to explore perceptions of health issues from the perspectives of youth placed in therapeutic foster care, youth with chronic medical conditions, and youth with disabilities. Twelve focus groups with 67 youth aged 13-20 were conducted in rural, suburban, and urban communities in the Commonwealth of Virginia. Data analysis revealed both within unique group themes and themes that cut across unique groups. Youth in therapeutic foster care with chronic health conditions or with disabilities perceive themselves as being different from their peers. Participants in each group expressed concerns about the unique issues that they confront daily and how these challenges differentiate them from youth who do not share their life experiences. They expressed the desire for other youth to understand them better and to not treat them differently. Discussion and implications focus on the need to create programs to support the unique needs of these youth.     

The unique awards. Everyone's a winner

Everyone's a winner when it comes to healthcare awards. Seems there's a contest--or several--for every segment of the field. But while many of the awards serve useful purposes, the sheer number of them indicates the industry may have become too satisfied with itself.     

Deep necrotizing soft tissue infections. Necrotizing fasciitis and necrotizing myositis

The authors present a review on deep soft tissue infections--necrotizing fasciitis and necrotizing myositis, incl. the classification of myositis into sub-groups according to the causal agent. The authors describe the incidence of these diseases, basic clinical symptoms and therapeutic principles. Therapy is based on surgical treatment, antimicrobial treatment and in indicated cases on hyperbaric oxygen therapy (HBO).     

The "take a nurse to lunch" program. A unique focus group improves and promotes food services

Dan Booth is the director of hospitality services for MaineGeneral Health. For this 450-bed health care organization, he directs six departments, which include environmental services, food and nutrition, security, laundry services, telecommunications, and transportation. In this article he describes how his Take a Nurse to Lunch program operates, what its benefits are, and how it was implemented.     

The epidemiology of atypical mycobacterial diseases in northern England: a space-time clustering and Generalized Linear Modelling approach

The incidence of infection by mycobacteria, other than tubercle bacilli (MOTT) is increasing in the United Kingdom, Europe and the United States. These diseases increase morbidity and are an increasing public health concern. However, the epidemiology of disease due to these species is not well characterized. We used space-time clustering approaches and Generalized Linear Modelling to investigate the potential predictors of disease in cases of infection by organisms of the Mycobacterium avium complex (MAC) and M. malmoense recorded in the north of England during 2000-2005. There was significant spatial and temporal clustering in juvenile cases of infection by MAC but not for cases of infection in adults by either species. There were no significant predictors of infection by M. malmoense or juvenile cases of M. avium. Incidence of disease caused by M. avium in adults was significantly related to health deprivation and weakly related to rainfall. We consider possible reasons for the difference in epidemiology in infection by M. avium in adults and juveniles.     

Munchausen's syndrome--masquerading as necrotizing fasciitis.

We would like to present a novel form of Munchausen's syndrome which presented us with a difficult problem in the midst of the recent media hysteria regarding flesh eating bacteria. This condition, first described by Richard Asher in 1951, is often very difficult to diagnose and it is not, therefore, surprising that the victims have been through several episodes of treatment before the suspicions of staff are raised. It owes its name to a fictitious character, Baron Karl Friedrich Hieronymus Freihess von Munchausen, who recounted extraordinary and wildly exaggerated exploits of adventure and daring, not unlike patients who present with this condition. Our enquiries revealed that the laid down procedure when faced with a patient with this condition is that the regional medical officer (RMO) should be contacted. It is then his responsibility to contact other RMOs, who in turn pass the information on to accident and emergency consultants in their area.     

Development of a community health service: a unique collaborative alliance.

This case study describes the development of a public health satellite facility, the Health Source of Grandview, Missouri, a collaborative alliance sponsored by a public teaching/community medical center and a religious-sponsored community medical center. The needs and alternative solutions are examined and planning processes are discussed, including the issue of community needs and values as well as roadblocks and barriers to collaboration, and how this model meets the criteria for the new paradigm of community collaboration and partnership espoused by so many in this era of health care reform.     

Recent advances in molecular diagnostics and understanding mechanisms of drug resistance in nontuberculous mycobacterial diseases

Accumulating evidence suggests that human infections caused by nontuberculous mycobacteria (NTM) are increasing worldwide, indicating that NTM disease is no longer uncommon in many countries. As a result of an increasing emphasis on the importance of differential identification of NTM species, several molecular tools have recently been introduced in clinical and experimental settings. These advances have led to a much better understanding of the diversity of NTM species with regard to clinical aspects and the potential factors responsible for drug resistance that influence the different outcomes of NTM disease. In this paper, we review currently available molecular diagnostics for identification and differentiation of NTM species by summarizing data from recently applied methods, including commercially available assays, and their relevant strengths and weaknesses. We also highlight drug resistance-associated genes in clinically important NTM species. Understanding the basis for different treatment outcomes with different causative species and drug-resistance mechanisms will eventually improve current treatment regimens and facilitate the development of better control measures for NTM diseases.