Showing papers by "Centers for Disease Control and Prevention published in 1984"
TL;DR: It is demonstrated that antimicrobial-resistant organisms of animal origin cause serious human illness, and the need for more prudent use of antimicrobials in both human beings and animals is emphasized.
Abstract: It has been difficult to document the postulated sequence of events that begins with the selection of drug-resistant organisms in animals fed subtherapeutic amounts of antimicrobials and ends with clinically important infections in human beings. In early 1983 we identified 18 persons in four Midwestern states who were infected with Salmonella newport that was resistant to ampicillin, carbenicillin, and tetracycline and characterized by a 38-kilobase R plasmid. Twelve of these patients had been taking penicillin derivatives for medical problems other than diarrhea in the 24 to 48 hours before the onset of salmonellosis. Eleven patients were hospitalized for salmonellosis for an average of eight days, and one had a fatal nosocomial infection. We compared plasmid profiles of all human (six-state area) and animal (United States) S. newport isolates over an 18-month period and examined selected records of meat distribution. The results indicated that the patients had been infected before they took antimicrobials, by eating hamburger originating from South Dakota beef cattle fed subtherapeutic chlortetracycline for growth promotion. This study demonstrates that antimicrobial-resistant organisms of animal origin cause serious human illness, and emphasizes the need for more prudent use of antimicrobials in both human beings and animals.
377 citations
TL;DR: The diagnosis of cryptosporidiosis can now be made noninvasively, but increased diagnostic proficiency has led to little improvement in control or treatment of the disease.
Abstract: Cryptosporidium, an intestinal protozoan parasite, is a well-known cause of diarrhea in animals but has been recognized only recently as a cause of human disease. Since 1976, 58 cases of cryptosporidiosis in humans have been reported; 18 of the patients had normal immune function, and 40 had various immunologic abnormalities, the most common of which, acquired immune deficiency syndrome (AIDS), occurred in 33 patients. Patients with normal immune function had self-limited diarrhea, but patients with immunologic abnormalities often developed severe, irreversible diarrhea; 22 patients have died. The diagnosis of cryptosporidiosis can now be made noninvasively, but increased diagnostic proficiency has led to little improvement in control or treatment of the disease. Although 23 compounds have been evaluated in experimentally infected animals and 20 drugs have been used in human clinical trials, no effective chemotherapeutic agent for cryptosporidiosis has been identified to date.
310 citations
TL;DR: The authors review what is currently known about the prevalence of a wide variety of chronic disorders in childhood with an emphasis upon significant recent areas of change and the implications of these changes.
290 citations
TL;DR: RMSF was diagnosed later in those who died than in survivors, primarily because of atypical initial symptoms and the late onset of rash, and should be considered in any individual who, during the spring and summer, has been in RMSF-endemic areas and develops a fever.
Abstract: Most previous reports of Rocky Mountain spotted fever (RMSF) have included cases either not laboratory confirmed or confirmed by relatively weak diagnostic criteria. In the present study detailed epidemiological, clinical, and laboratory features of 262 confirmed or highly probable cases of RMSF reported from six states from 1977 to 1980 were analyzed. This analysis revealed that early clinical diagnosis of RMSF is difficult because the illness may have a gradual or an abrupt onset, the symptoms and signs may be unusual in timing or frequency, and the clinical appearance may vary depending on such factors as age and location of residence. RMSF was diagnosed later in those who died than in survivors, primarily because of atypical initial symptoms and the late onset of rash. RMSF should be considered in any individual who, during the spring and summer, has been in RMSF-endemic areas and develops a fever, regardless of the absence of rash or history of tick exposure.
287 citations
TL;DR: The results indicate that both tests are highly specific and sensitive for complicated Lyme disease but relatively insensitive for patients with erythema chronicum migrans alone.
Abstract: The sensitivity and specificity of an indirect immunofluorescence assay (IFA) and ELISA for Lyme disease were estimated. Sera from patients with Lyme disease, patients with other infections, and healthy individuals were examined. Significant cross-reactivity occurred only with sera from patients with syphilis, yaws, and pinta . All tested sera from patients with Lyme disease, however, gave negative results in the rapid reagin screening test and the microhemagglutination assay for antibodies to Treponema pallidum confirmatory for syphilis. When sera from patients with treponemal diseases were excluded from the analysis, the IFA and ELISA were highly specific, having 97% and 100% reliability, respectively. Sensitivity of both tests varied with the stage of disease but was 100% for both tests during complicated Lyme disease. The results indicate that both tests are highly specific and sensitive for complicated Lyme disease but relatively insensitive for patients with erythema chronicum migrans alone.
281 citations
TL;DR: The finding of a cluster of AIDS patients linked by sexual contact is consistent with the hypothesis that AIDS is caused by an infectious agent.
188 citations
TL;DR: A retrovirus isolated from three patients with the acquired immunodeficiency syndrome (AIDS) in the United States was morphologically and antigenically identical to lymphadenopathy associated virus isolated in France.
Abstract: A retrovirus isolated from three patients with the acquired immunodeficiency syndrome (AIDS) in the United States was morphologically and antigenically identical to lymphadenopathy associated virus isolated in France. Two of these isolates were from a blood donor-recipient pair, each of whom developed AIDS. Lymphadenopathy associated virus was isolated from the blood donor's lymphocytes 12 months after his onset of AIDS symptoms and from the blood recipient's lymphocytes 1 month after her onset of AIDS symptoms. Two isolates from the blood donor-recipient pair and an isolate from an epidemiologically unrelated homosexual man were examined by competitive radioimmunoassay to determine their antigenic relatedness to each other and to other human retroviruses. The major core proteins (p25) of the isolates were antigenically identical and all three isolates were identical to prototype lymphadenopathy associated virus isolated in France.
181 citations
TL;DR: The importance and origin of antimicrobial-resistant Salmonella infections were examined in 52 outbreaks investigated by the Centers for Disease Control between 1971 and 1983, and food animals were the source of 11 of 16 resistant and 6 of 13 sensitive outbreak strains.
Abstract: The importance and origin of antimicrobial-resistant Salmonella infections were examined in 52 outbreaks investigated by the Centers for Disease Control between 1971 and 1983. The case fatality rate was higher for patients infected with antimicrobial-resistant Salmonella (4.2 percent) than for those with antimicrobial-sensitive infections (0.2 percent). In the 38 outbreaks with identified sources, food animals were the source of 11 (69 percent) of 16 resistant and 6 (46 percent) of 13 sensitive outbreak strains.
181 citations
TL;DR: Replacement of fluid and electrolytes is the basis of treatment, and antimicrobial agents should be reserved for patients with chronic or serious illness, or for those at particular risk of serious illness (hepatobiliary disease, septicemia, neoplasms).
Abstract: Infections due to Aeromonas hydrophila and Plesiomonas shigelloides in immuno-compromised hosts have been well documented, but the role of these organisms in causing gastrointestinal disease in healthy persons is controversial. Despite difficulties in characterizing the exotoxins produced by Aeromonas species, there is accumulating evidence that these bacteria are capable of causing usually mild, self-limited diarrheal disease in previously healthy adults. Some pediatric patients may have protracted dysenteric symptoms. P. shigelloides, an organism closely related to Aeromonas species, may also cause diarrhea in the healthy host, but no exotoxins have yet been identified by the assays used to identify other bacterial enterotoxins. Replacement of fluid and electrolytes is the basis of treatment, and antimicrobial agents should be reserved for patients with chronic or serious illness, or for those at particular risk of serious illness (hepatobiliary disease, septicemia, neoplasms).
161 citations
TL;DR: The methods and reagents currently used for the immunodiagnosis of aspergillosis and candidiasis are reviewed and studies are being carried out to increase the sensitivity and reliability of these tests through the use of monoclonal antibodies and purified, clinically relevant antigens.
Abstract: The methods and reagents currently used for the immunodiagnosis of aspergillosis and candidiasis are reviewed. Problems associated with these techniques and approaches to resolving these problems are discussed. Latex agglutination and precipitin tests are used for detection of antibody in immunocompetent hosts. However, these tests are apparently inadequate when applied to the diagnosis of systemic candidiasis in compromised hosts. Enzyme immunoassays (EIAs) and radioimmunoassays (RIAs) can be used to detect antibodies in immunocompetent and compromised patients, but their value is limited because antibodies to the Candida species are detectable in healthy as well as colonized and infected patients. EIAs and RIAs are, however, promising for detection of antigenemia in patients with aspergillosis or candidiasis, and gas-liquid chromatography has been developed for the quantitation of serum arabinitol and mannose in candidiasis. Antigens of the Aspergillus and Candida species may circulate in patients' sera in the form of immune complexes. These may readily be dissociated by a variety of methods to permit the detection of diagnostically important antigens. Studies are being carried out to increase the sensitivity and reliability of these tests through the use of monoclonal antibodies and purified, clinically relevant antigens.
160 citations
TL;DR: In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi, and inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique.
Abstract: In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi. Eighty-six percent of cases had enteritis characterized by fever, abdominal pain, and diarrhea. In three separate case-control studies, drinking milk pasteurized by plant A was statistically associated with illness. In a survey of randomly chosen households, 8.3% of persons who recalled having drunk milk from plant A during the suspect period experienced a yersiniosislike illness. Inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique. Although outbreaks of enteric disease caused by pasteurized milk are rare in the United States, the ability of Y enterocolitica to grow in milk at refrigeration temperatures makes pasteurized milk a possible vehicle for virulent Y enterocolitica . The extent to which milk is responsible for sporadic cases of yersiniosis is unknown. ( JAMA 1984;251:483-486)
TL;DR: A sensitive and specific radioimmunoprecipitation test was developed for the detection of antibodies to the major core protein of LAV, p25 (molecular weight 25,000), and antibody to LAV p25 was found in the serum of 51 of 125 AIDS patients.
Abstract: Lymphadenopathy-associated virus ( LAV ), a human T- lymphotrophic retrovirus isolated from a homosexual man with lymphadenopathy, has been causally associated with acquired immunodeficiency syndrome (AIDS). A sensitive and specific radioimmunoprecipitation test was developed for the detection of antibodies to the major core protein of LAV , p25 (molecular weight 25,000). Antibody to LAV p25 was found in the serum of 51 of 125 AIDS patients, 81 of 113 patients with lymphadenopathy syndrome, 0 of 70 workers at the Centers for Disease Control (some of whom had handled specimens from AIDS patients), and 0 of 189 random blood donors. Of a group of 100 homosexual men from San Francisco whose serum was obtained in 1978, only one had antibody to LAV p25; in contrast, of a group of 50 homosexual men in the same community whose serum was obtained in 1984, 12 had antibodies to LAV p25.
TL;DR: That A. americanum is a potential vector is supported by its similarities to Ixodes dammini, the known tick vector, in seasonal distribution and host utilization.
Abstract: Amblyomma americanum is a likely secondary vector of Lyme disease in New Jersey. Ticks of this species were removed from the site of the characteristic skin lesion known as erythema chronicum migrans on two patients with the disease, and the Lyme disease spirochete was isolated from nymphs and adults of this species. That A. americanum is a potential vector is supported by its similarities to Ixodes dammini, the known tick vector, in seasonal distribution and host utilization. The extensive range of A. americanum may have great implications for potential Lyme disease transmission outside known endemic areas.
Journal Article•
TL;DR: The recognition of cases acquired in widely separated parts of the world involving multiple vectors suggests that cases may in the future be diagnosed in additional areas, including the coastal areas of the Northeast and Midwest and Ixodes pacificus in the West.
Abstract: Following the original description of erythema chronicum migrans (ECM) in Sweden in 1909, ECM became widely recognized in Europe. The first reported case of ECM acquired in the United States occurred in 1969, and in 1975 the full symptom complex now known as Lyme disease was recognized. In 1981, cases of Lyme disease were recognized in yet a third continent, Australia and, to date, cases acquired in at least 19 countries have been reported. Beginning with the original case reported in Sweden, clinical observations suggested that Ixodes ricinus ticks were a vector for ECM in Europe and the distribution of cases in Europe corresponds to the distribution of this tick, although one case outside this range has been reported following mosquito bites. Through similar observations, I. dammini and I. pacificus ticks have been established as vectors in the United States. In Australia, a vector has not been established, and none of the recognized vectors of Lyme disease occur there. The reporting of cases of Lyme disease from widely separated parts of the world involving multiple vectors suggests the disease may, in the future, be recognized in additional areas.
TL;DR: Serologic data suggest that LAV was present as early as 1977 in Zaire, and the presence of antibodies to lymphadenopathy-associated retrovirus (LAV) was determined by a radioimmunoprecipitation assay and an enzyme-linked immunosorbent solid assay of sera from Zairian patients with the acquired immune deficiency syndrome (AIDS) in 1983.
Abstract: The presence of antibodies to lymphadenopathy-associated retrovirus (LAV) was determined by a radioimmunoprecipitation assay and by an enzyme-linked immunosorbent solid assay of sera from Zairian patients with the acquired immune deficiency syndrome (AIDS) in 1983. Thirty-five of 37 patients (94 percent) and 32 of 36 patients (88 percent), respectively, were seropositive by the two tests. In a control group of 26 patients, six (23 percent) showed positive results in these tests. Of these six control patients, five had clinically demonstrable infectious diseases and a low ratio of T4 to T8 lymphocytes. In addition, sera collected from a control group of Zairian mothers in 1980 were positive for LAV in 5 of 100 cases. Other serologic data suggest that LAV was present as early as 1977 in Zaire.
TL;DR: Findings suggest that, even in the United States, women who avoid obstetric care have a greatly increased risk of perinatal and maternal death.
TL;DR: Serum levels of equine-botulism antitoxin to toxin types A, B, and E were measured in four type-A botulism patients who had received equine's antitoxin and Antitoxin levels were not proportionate to the amount injected and did not appear to be affected by whether the route of administration was iv or im.
Abstract: Serum levels of equine-botulism antitoxin to toxin types A, B, and E were measured in four type-A botulism patients who had received equine-botulism antitoxin. High circulating levels capable of neutralizing in excess of 1 X 10(8), 9 X 10(7), and 6 X 10(6) 50% mouse lethal doses of toxin of types A, B, and E, respectively, were detected. There was little depletion of type-A antitoxin even though two of the patients had circulating type-A toxin before treatment. The half-life for antitoxin persistence for one patient was calculated as being 6.5, 7.6, and 5.3 days for antitoxin types A, B, and E, respectively. Antitoxin levels were not proportionate to the amount (range, 2-4 vials) injected and did not appear to be affected by whether the route of administration was iv or im. Peak serum levels of antitoxin were 10-1,000 times higher than amounts needed to neutralize the toxin measured in the serum of these and other patients with botulism.
TL;DR: All of the methods tested for viral inactivation markedly altered certain serum proteins, making these methods unsuitable for samples that are to be tested for certain enzyme levels and coagulation factors.
Abstract: Clinical specimens from patients infected with Lassa, Ebola, or Marburg virus may present a serious biohazard to laboratory workers. We have examined the effects of heat, alteration of pH, and gamma radiation on these viruses in human blood and on the electrolytes, enzymes, and coagulation factors measured in laboratory tests that are important in the care of an infected patient. Heating serum at 60 degrees C for 1 h reduced high titers of these viruses to noninfectious levels without altering the serum levels of glucose, blood urea nitrogen, and electrolytes. Dilution of blood in 3% acetic acid, diluent for a leukocyte count, inactivated all of these viruses. All of the methods tested for viral inactivation markedly altered certain serum proteins, making these methods unsuitable for samples that are to be tested for certain enzyme levels and coagulation factors.
TL;DR: The relatively large proportion of multiresistant Salmonella among isolates from persons with these risk factors suggests that to cause disease, resistant organisms are more dependent than are sensitive organisms on host characteristics.
Abstract: Antimicrobial resistance patterns of Salmonella isolates from persons in randomly selected urban and rural counties in the United States were examined along with clinical and epidemiological characteristics of the host. Multiresistant strains, isolated from 66 (12.2%) of 542 persons evaluated, were associated with five of 20 variables in univariate analyses: serotype heidelberg, host of Hispanic origin, host exposure to penicillins within four weeks before stool culture, age greater than or equal to 60 years, and regular antacid use. By multiple linear regression, the first three variables were each significantly associated with infections due to multiresistant Salmonella. One or more of the last three variables, thought to be host factors that may promote disease, were present for persons yielding 38% of multiresistant strains but only 12% of sensitive strains (P less than .001). The relatively large proportion of multiresistant Salmonella among isolates from persons with these risk factors suggests that to cause disease, resistant organisms are more dependent than are sensitive organisms on host characteristics.
TL;DR: There is no solid evidence that pregnancy has an adverse effect on tuberculosis, and with early diagnosis and prompt, adequate chemotherapy, the outcome of pregnancy in a woman with tuberculosis is likely to be good.
TL;DR: The father and two daughters repeatedly experienced episodes of emesis and abdominal pain after drinking water drawn from their kitchen faucet, and it is suspected that copper levels increased in water when the water remained stagnant in the main.
Abstract: Three of four family members reported recurrent episodes of gastrointestinal illness while residing in a house in a small northwestern Vermont village. The father and two daughters repeatedly experienced episodes of emesis and abdominal pain after drinking water drawn from their kitchen faucet. One early-morning water sample taken from the family household contained a copper level of 7.8 mg/L, which is above the standard for drinking water (1.0 mg/L). Values for the second daughter's copper in hair analysis (1,200 micrograms/g) and copper in nail analysis (100 micrograms/g) were elevated (normal range 11 to 53 micrograms/g). The household was at the end of a 3/4-in (19.05-mm) copper main, and it is suspected that copper levels increased in water when the water remained stagnant in the main. All symptoms of the family resolved when they stopped drinking water in their home. This is the first report of copper-induced gastrointestinal illness attributable to a public supply of drinking water.
TL;DR: An outbreak of subacute poisoning occurred among nine members of a family; eight were ill with gastrointestinal symptoms, four developed encephalopathy, and two died; this is only the second reported outbreak of fatal arsenic poisoning from contaminated drinking water and one of few instances where illness followed exposure to a toxic substance which was disposed of, or possibly disposed, in an indiscriminate manner.
Abstract: An outbreak of subacute poisoning occurred among nine members of a family; eight were ill with gastrointestinal symptoms, four developed encephalopathy, and two died. Abnormal liver function tests and leukopenia were common laboratory findings. Epidemiologic and environmental investigations traced the source of arsenic exposure to a farm well with water containing 108 ppm arsenic. The soil adjacent to the well was also contaminated with arsenic, possibly from waste pesticide. Presumably, arsenic gained access to the well through obvious leaks in the well's casing. To our knowledge, this is only the second reported outbreak of fatal arsenic poisoning from contaminated drinking water and one of few instances where illness followed exposure to a toxic substance which was disposed of, or possibly disposed of, in an indiscriminate manner.
TL;DR: A set of eight monoclonal antibodies produced against Plasmodium falciparum produced small dots of fluorescence in schizonts and individual merozoites, but there was no reactivity with other human, nonhuman primate, or rodent Plas modium species.
Abstract: We characterized a set of eight monoclonal antibodies produced against Plasmodium falciparum. In an indirect fluorescent antibody assay the antibodies produced small dots of fluorescence in schizonts and individual merozoites. This merozoite-associated dot reactivity occurred with 21 different strains of P. falciparum, but there was no reactivity with other human, nonhuman primate, or rodent Plasmodium species. Three of the monoclonal antibodies precipitated proteins of Mr 145,000, 135,000, and 104,000. Five of the monoclonal antibodies precipitated proteins of Mr 78,000, 63,000, 42,000, and 40,000.
TL;DR: Comparison of the reaction pattern of isolates of rabies virus collected from areas of major rabies outbreaks suggests that this new epizootic originated with the transportation of rabid raccoons from the southeastern United States.
Abstract: A panel of 23 monoclonal antibodies to the nucleocapsid protein of rabies virus was used to study the antigenic character of isolates of rabies virus from raccoons in the mid-Atlantic region of the United States. Comparison of the reaction pattern of these isolates with that of isolates of rabies virus collected from areas of major rabies outbreaks (skunk rabies in the midwestern United States, fox rabies in the northeastern United States, and raccoon rabies in the southeastern United States) suggests that this new epizootic originated with the transportation of rabid raccoons from the southeastern United States.
Journal Article•
TL;DR: Infants and preschool children are intermingled in child care facilities that often lack adequate toilet and hand-washing facilities and are frequently staffed by individuals with little or no training in the area of infection control.
Abstract: The number of day care centers and home care facilities has steadily increased in the United States. Recent interest has focused on the possible relationship between attendance at child day care facilities and the occurrence of certain infectious diseases. A variety of infectious agents have been reported as causes of illness among children and staff in day care programs. In general, however, concurrent risks for these infections among children attending and those not attending day care programs have not been established by prospective studies. A review is made of the pathogens that have been associated with infections in day care settings, patterns of occurrence of infectious diseases in day care facilities, aspects of control and prevention of these diseases, and controversies related to infectious diseases in child day care facilities. Aspects of this problem that warrant further research are outlined.
TL;DR: This outbreak shows that major epidemics can occur in areas that have high overall community vaccination levels and Identification and vaccination of subpopulations with low coverage is essential for the control of poliomyelitis.
TL;DR: This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.