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In the present study, a total of 7793 samples from 5 different types of hosts were collected and tested, with a seroprevalence of 2.4% (184/7793). Although the seroprevalence of human and animal brucellosis is relatively low, numbers of human brucellosis cases reported have increased continuously from 2004 to 2018. A total of 118 Brucella strains containing 4 biotypes were obtained, including Brucella melitensis bv.1 ( n  = 8) and bv.3 ( n  = 106), Brucella abortus bv.3 ( n  = 3) and bv.7 ( n  = 1). Twenty-one shared MLVA-16 genotypes, each composed of 2 to 19 strains obtained from different hosts, suggest the occurrence of a brucellosis outbreak epidemic with multiple source points and laboratory infection events. Moreover, 30 shared MLVA-16 genotypes were observed among 59.6% (68/114) B. melitensis isolates from Zhejiang and strains from other 21 different provinces, especially northern provinces, China. The analysis highlighted the imported nature of the strains from all over the northern provinces with a dominant part from the developed areas of animal husbandry. These data revealed a potential transmission pattern of brucellosis in this region, due to introduced infected sheep leading to a brucellosis outbreak epidemic, and eventually causing multiple laboratory infection events. It is urgent to strengthen the inspection and quarantine of the introduced animals.

From 2015 to 2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events ( Brucella events) in 7 clinical laboratories (CLs). Most patients had traveled to countries where brucellosis is endemic and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as the clinicians did not consider brucellosis until they were notified that bacteremia with Brucella was suspected. In 3 Brucella events, the CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), which has a limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events, which accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including by procedures that could generate infectious aerosols. During 3 Brucella events, the CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each CL, the CL had previously isolated Brucella Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred. Laboratory assessments were conducted after the Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF MS for identification until BTAs have been ruled out., (Copyright © 2020 American Society for Microbiology.)

Coccidioides is a primary pathogenic fungus, which infects humans through highly infectious arthroconidia, causing substantial morbidity including life-threatening disseminated infections. Due to the low infectious dose, laboratory personnel might become infected during diagnostic procedures. Accordingly, coccidioidomycosis is reported as the most frequent laboratory-acquired systemic mycosis worldwide. This risk is aggravated in non-endemic countries, where the diagnosis may not be suspected. We report on an inadvertent exposure of 44 persons to Coccidioides posadasii in a clinical microbiology laboratory in Chile, the measures of containment after rapid diagnosis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the lessons learnt in a non-endemic setting., (Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

This study examined the literature on laboratory-acquired infections (LAIs) associated with scrub typhus (Orientia tsutsugamushi) and murine typhus (Rickettsia typhi) research to provide an evidence base for biosafety and biocontainment. Scrub typhus LAIs were documented in 25 individuals, from 1931 to 2000 with 8 (32%) deaths during the preantibiotic era. There were 35 murine typhus LAI reports and no deaths. Results indicated that the highest-risk activities were working with infectious laboratory animals involving significant aerosol exposures, accidental self-inoculation, or bite-related infections. A risk-based biosafety approach for in vitro and in vivo culture of O. tsutsugamushi and R. typhi would require that only high-risk activities (animal work or large culture volumes) be performed in high-containment biosafety level (BSL) 3 laboratories. We argue that relatively low-risk activities including inoculation of cell cultures or the early stages of in vitro growth using low volumes/low concentrations of infectious materials can be performed safely in BSL-2 laboratories within a biological safety cabinet., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.)

Objective: To analyze and study types, infections routes and causes of global pathogenic microorganisms laboratory-acquired infections cases reported in the literatures from 2000 to 2009 and to discuss prevention and control strategies., Methods: (1) Pathological observation of hepatic specimens: hepatic tissue pathogenic microorganisms laboratory-acquired infections. Methods PubMed, Embase, Biosis and Webs of Science covering SCIE, SSCI, CPCI-S and CPCI-SSH are chosen as data sources, "laboratory-acquired (associated) infections" are searched as the key words to search laboratory-acquired infections literature published from 2000 to 2009, from which information and data are accessed to be collected, analyzed and researched., Results: There are 19 species of pathogenic microorganisms causing laboratory-acquired infections in the last 10 years, including 15 species of bacteria, accounting for 78.9%; 4 species of virus, accounting for 21.1%. There are 83 cases reported, of which there are 60 bacterial cases, accounting for 72.3%; and 23 virus cases, accounting for 27.7%. Ingestion and inhalation are main routes of infections, respectively accounting for 32.5% and 31.3%, which are mainly due to accidents, accounting for 47.0%., Conclusion: In recent years, pathogenic microbiology laboratory-acquired infections continue to occur, and it is mainly due to accidental infections, which expose laboratory workers' low sense of safety and deficient operation methods. Laboratory staff should strengthen their senses of safety and comply with safe operation procedures, which are still the key to prevent laboratory-acquired infections.

Brucellosis is a rare disease in Denmark. We describe one case of laboratory-acquired brucellosis from an index patient to a laboratory technician following exposure to an infected blood culture in a clinical microbiology laboratory.

A cluster of clinical isolates of Bordetella bronchiseptica was identified by microbiology laboratory personnel. A clinical and molecular epidemiologic study determined that this cluster represented a pseudo-outbreak due to bacterial contamination of rabbit blood used as a broth culture supplement. This pseudo-outbreak highlights the importance of quality assurance programs in the laboratory.

We report a case of laboratory-acquired meningococcal disease in a 31-y-old female research assistant. The clinical presentation of the case was atypical with polyserositis affecting knees, pleura and pericardium, without septicaemia or meningitis. The diagnosis was made by positive PCR for Neisseria meningitidis (genogroup C, genosubtype P1.7, 16, 35 and without mutations of the penA gene) in the patient's right knee. Serology confirmed the diagnosis after recovery. This case had an atypical clinical picture, exemplifies the use of non-culture methods for diagnosis and characterization, and reminds us about the importance of safe routines for the laboratory work.

This unit, in conjunction with local and national guidelines and regulations, provides the basic biosafety information needed to perform the procedures detailed in this manual. Topics discussed include routine precautions when working with biohazards, disinfectants, disposal of biohazards, biosafety levels (as established by the U.S. National Institutes of Health, and the Centers for Disease Control and Prevention), animal facilities, and clinical laboratories. In addition, resources for more information are provided in the Literature Cited and Key References sections and in URLs given text and within the Internet Resources section.

Neisseria meningitidis is infrequently reported as a laboratory-acquired infection. Prompted by two cases in the United States in 2000, we assessed this risk among laboratorians. We identified cases of meningococcal disease that were possibly acquired or suspected of being acquired in a laboratory by placing an information request on e-mail discussion groups of infectious disease, microbiology, and infection control professional organizations. A probable case of laboratory-acquired meningococcal disease was defined as illness meeting the case definition for meningococcal disease in a laboratorian who had occupational exposure to an N. meningitidis isolate of the same serogroup within 14 days of illness onset. Sixteen cases of probable laboratory-acquired meningococcal disease occurring worldwide between 1985 and 2001 were identified, including six U.S. cases between 1996 and 2000. Nine cases (56%) were serogroup B; seven (44%) were serogroup C. Eight cases (50%) were fatal. All cases occurred among clinical microbiologists. In 15 cases (94%), isolate manipulation was performed without respiratory protection. We estimated that an average of three microbiologists are exposed to the 3,000 meningococcal isolates seen in U.S. laboratories yearly and calculated an attack rate of 13/100,000 microbiologists between 1996 and 2001, compared to 0.2/100,000 among U.S. adults in general. The rate and case/fatality ratio of meningococcal disease among microbiologists are higher than those in the general U.S. population. Specific risk factors for laboratory-acquired infection are likely associated with exposure to droplets or aerosols containing N. meningitidis. Prevention should focus on the implementation of class II biological safety cabinets or additional respiratory protection during manipulation of suspected meningococcal isolates.

Brucellae are class 3 organisms and potential agents of bioterrorism. Because of effective public health measures, brucellosis has become a rare disease in industrialized countries, and clinical microbiology laboratories are frequently unfamiliar with the genus. A low index of suspicion by physicians or failure to notify the laboratory, equivocal Gram-stain results, misidentification of the organism by commercial systems, unsafe laboratory practices, and laboratory accidents have been responsible for numerous cases of exposure to the organism and laboratory-acquired disease in recent years. Discovery of a laboratory exposure to brucellae should prompt an exhaustive investigation of the event and its circumstances, definition of the population at risk, enforcement of safe laboratory practices, and antimicrobial drug prophylaxis for exposed persons. Inadvertent exposures to brucellae in the clinical laboratory indicate a widespread lack of preparedness to cope with eventual biologic threats involving use of the organism.

An investigation of four cases of infection with Escherichia coli O157:H7 among laboratorians from different clinical laboratories revealed that the DNA fingerprint pattern of each case isolate was indistinguishable from that of an isolate handled in the laboratory prior to illness. These data suggest that the infections were laboratory acquired, and they demonstrate the importance of laboratorians strictly adhering to biosafety practices recommended for the handling of infectious materials.

Objective: To determine the prevalence of positive tuberculin skin tests (TSTs), incidence of TST conversion, risk factors for positive TSTs, and history of active TB among HCWs in microbiology laboratories in New York City., Design: Two-year survey from May 1999 to June 2001., Setting: Nineteen microbiology laboratories., Results: During the first year, interviews were conducted with 345 laboratory HCWs (mean, 18 HCWs per site; range, 2 to 51) to assess the prevalence of positive TSTs, but 3 (1%) could not recall their result and were excluded from further analyses. The mean age of the remaining 342 HCWs was 48 years; 68% (n = 233) were female, 54% (n = 183) received bacille Calmette-Guerin (BCG) vaccination, and 71% (n = 244) were foreign born. The prevalence of a positive TST was 57% (n = 196), but only 20% (n = 39) of the HCWs received isoniazid. The incidence of TST conversion in the second year of the study was 1% (1 of 108). Multivariate analysis identified age (odds ratio [OR] per year, 1.05; 95% confidence interval [CI95], 1.02-1.08), foreign birth (OR, 3.80; CI95, 1.98-7.28), BCG immunization (OR, 4.89; CI95, 2.72-8.80), and employment in a mycobacteriology laboratory (OR, 2.14; CI95, 1.25-3.68) as risk factors for a positive TST. Only one HCW had been treated for active TB., Conclusions: The prevalence of positive TSTs was high among laboratory HCWs, but the TST conversion rate was low. Higher rates of treatment for latent TB infection are desirable.

A rapidly fatal case of pulmonary tularemia in a 43-year-old man who was transferred to a tertiary care facility is presented. The microbiology laboratory and autopsy services were not notified of the clinical suspicion of tularemia by the service caring for the patient. Despite having a laboratory bioterrorism procedure in place and adhering to established laboratory protocol, 12 microbiology laboratory employees were exposed to Francisella tularensis and the identification of the organism was delayed due to lack of notification of the laboratory of the clinical suspicion of tularemia. A total of 11 microbiology employees and two persons involved in performing the patient's autopsy received prophylactic doxycycline due to concerns of transmission. None of them developed signs or symptoms of tularemia. One microbiology laboratory employee was pregnant and declined prophylactic antibiotics. As a result of this event, the microbiology laboratory has incorporated flow charts directly into the bench procedures for several highly infectious agents that may be agents of bioterrorism. This should permit more rapid recognition of an isolate for referral to a Level B laboratory for definitive identification and should improve laboratory safety.

We report a case of tinea corporis in Japan caused by Arthroderma benhamiae. A 53-year-old female scientist, who had been working on dermatophytes in a laboratory, noticed pruritic erythema on the outer corner of her left lower eyelid. She used a steroid ointment for three days, but the lesion continued to expand. When she visited our clinic, the erythema was 15 mm in diameter and clearly demarcated with a slightly depressed center. A scale from the periphery of the erythema was positive with direct KOH examination, and T mentagrophytes was isolated from the lesion. The erythema was successfully treated with topical application of butenafine hydrochloride. The isolate was mated with a (+) strain of the Americano-European race of A. benhamiae. Using the most sensitive molecular typing method, restriction exzyme analysis of the non-transcribed spacer region of the ribosomal DNA, the restriction profile of the isolate was the same as that of strains used in her laboratory but different from those of any Japanese isolates associated with pet animals. The results suggest that the patient became infected during her experiment.

Mycobacterium scrofulaceum was isolated from three clinical specimens over a period of 2 months. In the preceding 10 years, the institution had not reported any cases of this unusual mycobacterium. Investigation and confirmatory molecular testing indicated a laboratory control strain to be the source of contamination.

Background: Saudi Arabia is hyperendemic for brucellosis, with more than 8000 cases reported each year to public health authorities. During 1998, brucellosis ranked as the No. 1 reportable communicable disease (22.5%) in Saudi Arabian National Guard communities. King Fahad Hospital is the major referral center for National Guard personnel in the nation's central region., Methods and Results: From 1991 to 2000, brucellosis developed in 7 expatriate hospital employees. Six employees were bacteriology technologists, and one was a pathologist. Each had a clinical syndrome compatible with brucellosis (headache, fever, rigors, sweats, and myalgias) plus elevated Brucella sp serum agglutinin titers > or = 1:1280; one patient also had positive blood cultures. All patients responded to anti-Brucella therapy. Two patients had relapses, and complications occurred in four patients (septic endophlebitis of the leg, infected prosthesis, epididymoorchitis, and lumbar spondylitis). In all these employees except the pathologist, the infection was associated with processing Brucella sp cultures., Conclusion: Despite the enforcement of stringent infection control measures including the use of a class II biosafety hood in the laboratory, the problem of nosocomial brucellosis persists because of the large number of infected specimens handled by the laboratory (17,500 specimens per year). Ultimately, risk reduction depends on efforts to reduce disease endemicity in the country. In the meantime, conversion of the laboratory to biosafety level 3 is under way.

We report a case of scrub typhus pneumonitis in a laboratory worker who apparently acquired it through the respiratory tract. The patient was suffering from fever, cough and dyspnea. He had both cervical and axillary lymphadenopathy, and hepatomegaly. A chest X-ray showed interstitial infiltrates. A diagnosis of scrub typhus was established upon isolation of Orientia tsutsugamushi. 12 days before the patient showed symptoms, he had purified O. tsutsugamushi proteins from infected cells using an ultrasonication method which could generate aerosols containing O. tsutsugamushi.

Aims: To identify the number and type of infections occurring in United Kingdom clinical laboratories during 1994 and 1995, following similar surveys covering 1970 to 1989., Methods: A retrospective questionnaire survey was undertaken of 397 responding UK clinical laboratories covering 1994 and 1995. A follow up telephone survey was undertaken with each of the laboratories from which a questionnaire had been received indicating a possible or probable laboratory acquired infection during 1994 or 1995., Results: Questionnaires were sent to 659 laboratories or organisations which were thought to have laboratories, of which 557 responded (response rate of 84.5%). Of these, only 397 were from organisations with laboratories. Over 55,000 person-years of occupational exposure were covered, and only nine cases identified, giving an infection incidence rate overall of 16.2/100,000 person-years, compared with 82.7 infections/100,000 person-years found in a similar survey covering 1988 and 1989, reported previously. Infections were commonest in females, in relatively young staff, in microbiology laboratory workers, and in scientific/technical employees. Gastrointestinal infections predominated, particularly shigellosis, but few specific aetiological factors relating to working practices were identified. No hepatitis B cases were reported., Conclusions: The small number of cases identified indicates high standards of infection control, though there is still room for improvement. Periodic studies of this kind are not adequate for comprehensive monitoring of the incidence of laboratory acquired infections. That will require the introduction of a routine, active surveillance programme or prospective survey which has the support and commitment of the laboratories themselves.

The authors submit information on a new categorization of microscopic fungi causing human mycoses, as well as criteria of their classification in bio-risk groups (BioSafety Level-BSL) proposed by the European Confederation of Medical Mycology. According to the risk of infection of laboratory workers during handling of cultures isolated from biological specimens almost 400 species of fungi were divided into three groups (BSL 1 and BSL 2-fungi which can produce systemic infections in subjects with immunodeficiencies, or superficial infections in healthy subjects, BSL 3-fungi which can produce severe systemic infections also in healthy subjects). At the same time they express reservations to the classification of some species into groups.

Pneumonia is one of the principal manifestations of Q fever, a disease caused by Coxiella burnetii. This bacterium can replicate only within cells, yet it is capable of surviving in the environment because it can withstand drying and substantial temperature variations. Livestock, especially sheep, goats and cattle, are a major reservoir of C burnetii. The organism is transmitted to humans by direct contact with animal products, especially during parturition. Aerosols have transmitted infection over considerable distances. The illness is characterized by an influenza-like syndrome with patchy pulmonary infiltrates. The pneumonia may be accompanied by biochemical evidence of mild hepatitis. The diagnosis is established serologically. Tetracycline or doxycycline provide effective therapy.

Strains of Salmonella typhi implicated in two separate cases of laboratory acquired infection from patients and the medical laboratory technologists who processed the patients' samples were analysed by pulsed-field gel electrophoresis. Although all four isolates were of bacteriophage type E1, PFGE was able to demonstrate that the strains responsible for the two laboratory acquired cases were not genetically related. The PFGE patterns of the isolates from the MLTs were found to be identical to those of the corresponding patients after digestion with restriction enzyme AvrII. This provided genetic as well as epidemiological evidence for the source of the laboratory acquired infections.

Guineapigs that were intranasally inoculated with pneumonia virus of mice (PVM) seroconverted to PVM by 11 days post-infection. During the course of study (2-60 days post-infection) no gross or histologic lesions were identified within the lungs that could be attributed to PVM infection. Mild rhinitis and tracheitis were found in most animals and acute purulent bronchopneumonia in two animals, which may have resulted from spontaneous subclinical Bordetella bronchiseptica infection. Viral and bacterial respiratory diseases of the guineapig are briefly reviewed.

An estimated 500,000 laboratory workers in the United States are at risk of exposure to infectious agents that cause disease ranging from inapparent to life-threatening infections, but the precise risk to a given worker unknown. The emergence of human immunodeficiency virus and hantavirus, the continuing problem of hepatitis B virus, and the reemergence of Mycobacterium tuberculosis have renewed interest in biosafety for the employees of laboratories and health care facilities. This review examines the history, the causes, and the methods for prevention of laboratory-associated infections. The initial step in a biosafety program is the assessment of risk to the employee. Risk assessment guidelines include the pathogenicity of the infectious agent, the method of transmission, worker-related risk factors, the source and route of infection, and the design of the laboratory facility. Strategies for the prevention and management of laboratory-associated infections are based on the containment of the infectious agent by physical separation from the laboratory worker and the environment, employee education about the occupational risks, and availability of an employee health program. Adherence to the biosafety guidelines mandated or proposed by various governmental and accrediting agencies reduces the risk of an occupational exposure to infectious agents handled in the workplace.

Several serotypes of Pseudomonas (P.) aeruginosa were isolated from the oral cavities of researchers, but no positive cases were found among the animals they had contacted or in the environment. These results indicated that researchers are not a source of P. aeruginosa infection for animals. However, P. aeruginosa was detected on the hands of researchers and animal caretakers after they finished their work. The same serotype of P. aeruginosa was found in the animals and the environment. These findings demonstrated that the researchers and the animal caretakers were contaminated with P. aeruginosa by the animals, and then became infective vehicles.

There is sufficient evidence from the literature to demonstrate the risk involved in handling the dimorphic pathogens without suitable containment facilities. The number of fungi considered a severe hazard is fortunately low, but impeccable working practices and continuous vigilance are necessary to minimize accidents and to prevent them leading to worse catastrophies. The continuing discovery of new opportunistic pathogenic fungi requires frequent, objective and cautious review of the hazard groupings to accommodate them.

A specimen of cerebrospinal fluid was initially handled with 'category 3' precautions because the patient came from Somalia, where tuberculosis and HIV infection are endemic. An isolate from the specimen, initially thought to be a Neisseria species, was subsequently handled on the open bench. It was later identified as Brucella melitensis. Laboratory procedures should allow for the possibility of brucella in such specimens until a positive identification has been made.

On August 20, 1994, the Connecticut Department of Public Health and Addiction Services received a report of a case of acute illness in a virologist suspected to be associated with Sabiá virus, a newly described arenavirus. This report preliminary findings from the case investigation.

Numerous studies implicated Helicobacter pylori as one causative agent producing gastritis and dyspepsia. Recent reports focus on another bacterium, Gastrospirillum hominis, as a possible pathogen producing gastritis. We report a 30-year-old researcher who became acutely ill with epigastric pain indicative of esophagitis or peptic ulcer disease. Gastritis and a gastric ulcer were observed endoscopically. Histological examination of the gastric mucosa revealed an acute gastritis and large spiral-shaped organisms. The spiral forms were present in large quantities in the gastric mucosa of experimental animals (cats) handled by the patient in his research. Electron microscopy confirmed that the organisms from the cat and patient were morphologically identical. The patient was successfully treated with bismuth subsalicylate. His symptoms resolved and the organisms were cleared from his stomach. This study provides evidence that another bacterium, a Gastrospirillum, may cause gastritis in man and may be transmitted from animal to man.

Two cases of laboratory-acquired infections due to Neisseria meningitidis were suspected to have occurred in two French hospitals. The first case occurred shortly, i.e., 3 days, after one strain had been handled by a laboratory technician, and the link between this strain and the strain causing meningitis was easily established. In the second case, infection occurred 3 weeks after 10 strains had been handled by a technician. In this case, it was necessary to use high-resolution markers in order to establish the link between the infecting strain and 1 of the 10 strains handled. The antigenic formulae of the two infecting strains (serogroup:serotype:subtype) were, respectively, C:NT:P1.12 and B:2a:P1.2. Outer membrane protein profile analysis and multilocus enzyme electrophoresis unequivocally confirmed the identity of the respective strains.

A case of laboratory-acquired infection with Escherichia coli O157:H7 is presented. Evidence of the identity of the infecting strain was provided by toxin type and plasmid profiles. Because no obvious technical errors in laboratory practices could be demonstrated we conclude that the infecting dose for E. coli O157:H7 may be small. The clinical course was uncomplicated; during reconvalescence, the patient's serum recognized a unique 87 kDa band on immunoblots of the infecting strain.

Safety practices are a necessary part of the physician office laboratory operation. The Occupational Safety and Health Administration (OSHA) inspects office laboratories constantly and a physician must be aware of the condition of the laboratory at all times.

The benefits of using animal or human cell cultures have been clearly demonstrated in diagnostic and therapeutic research and in their application for manufacturing. Cell cultures serve as a tools for the production of vaccines, receptors, enzymes, monoclonal antibodies and recombinant DNA-derived proteins. They represent an integral part of drug development for which corresponding facilities, equipment and manufacturing processes are required. Although the cells themselves offer no particular risk to workers in laboratories and production areas or to the environment, the cell cultures may be contaminated with viruses, mycoplasma, bacteria, yeast and fungi or might contain endogenous viruses. The containment level for animal and human cells is therefore determined by the risk class of these agents. The history of animal and human cell cultures has proved that they can be handled safely. The recommendations in this publication concern the safe handling of cell cultures (tissue explants, primary cell cultures) and permanent cell lines of animal and human origin. A classification system of safety precautions has been elaborated according to the potential for contamination with the pathogenic agents involved.