Showing papers by "Centers for Disease Control and Prevention published in 1993"
TL;DR: The classification system for HIV infection is revised to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions and the AIDS surveillance case definition is expanded.
Abstract: The following CDC staff members prepared this report: National Center for Infectious Diseases Division of HIV/AIDS Kenneth G. Castro, M.D. John W. Ward, M.D. Laurence Slutsker, M.D., M.P.H. James W. Buehler, M.D. Harold W. Jaffe, M.D. Ruth L. Berkelman, M.D. Office of the Director Associate Director for HIV/AIDS James W. Curran, M.D., M.P.H. 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults Summary CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 (1) and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have less than 200 CD4+ T-lymphocytes/uL, or a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14. This expansion includes the addition of three clinical conditions
4,203 citations
TL;DR: A ribosomal DNA-polymerase chain reaction (PCR) method has been developed for species identification of individuals of the five most widespread members of the Anopheles gambiae complex, a group of morphologically indistinguishable sibling mosquito species that includes the major vectors of malaria in Africa.
Abstract: A ribosomal DNA-polymerase chain reaction (PCR) method has been developed for species identification of individuals of the five most widespread members of the Anopheles gambiae complex, a group of morphologically indistinguishable sibling mosquito species that includes the major vectors of malaria in Africa. The method, which is based on species-specific nucleotide sequences in the ribosomal DNA intergenic spacers, may be used to identify both species and interspecies hybrids, regardless of life stage, using either extracted DNA or fragments of a specimen. Intact portions of a mosquito as small as an egg or the segment of one leg may be placed directly into the PCR mixture for amplification and analysis. The method uses a cocktail of five 20-base oligonucleotides to identify An. gambiae, An. arabiensis, An. quadriannnulatus, and either An. melas in western Africa or An. melas in eastern and southern Africa.
1,455 citations
TL;DR: An estimated 2 million patients develop nosocomial infections in the United States annually and the growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp.
Abstract: An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.
1,317 citations
TL;DR: Fungi are emerging as important nosocomial pathogens and control efforts should target fungal infections, especially fungemia, which has increased at all four major anatomic sites of infection.
Abstract: To identify pathogens causing nosocomial fungal infections and the secular trend in their incidence in US hospitals, data from the National Nosocomial Infections Surveillance System, 1980-1990, were analyzed. During that period, 30,477 fungal infections were reported. The rate rose from 2.0 to 3.8 infections/1000 discharges. The highest number of nosocomial fungal infections/1000 discharges was reported from the burn/trauma service (16.1). Candida albicans was the most frequently isolated fungal pathogen (59.7%), followed by other Candida species (18.6%). The rate increased at all four major anatomic sites of infection. Patients with bloodstream infections who had a central intravascular catheter were more likely to have a fungal pathogen isolated than were other patients with bloodstream infection (relative risk = 3.2; P < .001): 29% of fungemia patients and 17% of patients with bloodstream infection due to other pathogens died during hospitalization (P < .001). Fungi are emerging as important nosocomial pathogens and control efforts should target fungal infections, especially fungemia.
1,166 citations
TL;DR: A mysterious respiratory illness with high mortality was recently reported in the southwestern United States and nucleotide sequence analysis revealed the associated virus to be a new hantavirus and provided a direct genetic link between infection in patients and rodents.
Abstract: A mysterious respiratory illness with high mortality was recently reported in the southwestern United States. Serologic studies implicated the hantaviruses, rodent-borne RNA viruses usually associated elsewhere in the world with hemorrhagic fever with renal syndrome. A genetic detection assay amplified hantavirus-specific DNA fragments from RNA extracted from the tissues of patients and deer mice (Peromyscus maniculatus) caught at or near patient residences. Nucleotide sequence analysis revealed the associated virus to be a new hantavirus and provided a direct genetic link between infection in patients and rodents.
1,028 citations
TL;DR: By the early 1930s tuberculin skin testing had become a method for screening apparently healthy persons for infection with M. tuberculosis and evidence accumulated that not all reactions to purified protein derivative were positive.
Abstract: nounced the discovery of a cure for tuberculosis. The cure consisted of giving patients subcutaneous doses of tuberculin, a brownish, transparent liquid obtained from culture filtrates of MWcobacterium tuberculosis. This treatment caused a febrile reaction within 4 or 5 hours. In most cases, the fever was accompanied by vomiting, rigors, and other constitutional symptoms. Koch reported that the administration of increasing daily doses of tuberculin resulted in the rapid healing of mild cases of tuberculosis and in slow, progressive improvement in more serious cases [1]. Patients who did not have tuberculosis experienced slight pains in the limbs and transient fatigue when injected with tuberculin. Less than a year after the announcement, Koch's tuberculin was disproved as a cure for consumption [1]. Koch did not realize that he had discovered what would become one of the most widely used diagnostic tests ever developed. The observation of different responses to tuberculin in patients with and without tuberculosis led to the development of new methods of administering the antigen. The use of these new methods eliminated systemic symptoms but caused a local reaction at the injection site. Various methods of administration were tested, including the Pirquet cutaneous test, the Moro percutaneous patch test, the Mantoux intracutaneous test, and the Calmette conjunctival test [1]. The first three methods remain in use. By the early 1930s tuberculin skin testing had become a method for screening apparently healthy persons for infection with M. tuberculosis. At that time it was common practice to give a series of four or five graded doses of tuberculin before excluding the possibility of tuberculous infection. As the use of the tuberculin skin test increased, evidence accumulated that not all reactions to purified protein derivative
919 citations
TL;DR: There has been a marked increase in drug-resistant tuberculosis in New York City and previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance.
Abstract: Background In the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis. Methods We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention. Results Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the pro...
910 citations
893 citations
TL;DR: Fresh-pressed, unpreserved apple cider can transmit E coli O157:H7 organisms, which cause severe infections, and consumers can reduce their risk by only drinking cider made from apples that have been washed and brushed.
Abstract: Objective. —Esherichia coliO157:H7 causes hemorrhagic colitis and the hemolytic uremic syndrome. In the fall of 1991, an outbreak ofE coliO157:H7 infections in southeastern Massachusetts provided an opportunity to identify transmission by a seemingly unlikely vehicle. Design. —Case-control study to determine the vehicle of infection. New England cider producers were surveyed to assess production practices and determined the survival time ofE coliO157:H7 organisms in apple cider. Results. —Illness was significantly associated with drinking one brand of apple cider. Thirteen (72%) of 18 patients but only 16 (33%) of 49 controls reported drinking apple cider in the week before illness began (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.8 to 39.7). Among those who drank cider, 12 (92%) of 13 patients compared with two (13%) of 16 controls drank cider from cider mill A (lower 95% CI, 2.9;P Conclusions. —Fresh-pressed, unpreserved apple cider can transmitE coliO157:H7 organisms, which cause severe infections. Risk of transmission can be reduced by washing and brushing apples before pressing, and preserving cider with sodium benzoate. Consumers can reduce their risk by only drinking cider made from apples that have been washed and brushed. (JAMA. 1993;269:2217-2220)
881 citations
TL;DR: Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive and were also associated with an increased risk of nonfatal IHD.
Abstract: Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression--hopelessness--has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD.
749 citations
TL;DR: Intensified efforts to improve pneumococcal vaccine coverage among certain populations for whom vaccination is currently recommended is indicated, but universal revaccination is not warranted at this time.
Abstract: Objective. —To determine pneumococcal polysaccharide vaccine efficacy in selected populations at risk for serious pneumococcal infection for whom vaccination is currently recommended and to assess duration of protection after vaccination. Design. —Vaccine efficacy was estimated using indirect cohort analysis to compare the proportion of pneumococcal infections caused by serotypes included in the vaccines of vaccinated and unvaccinated persons who were identified during 14 years of national surveillance. Setting. —Hospital laboratories in the United States that submitted pneumococcal isolates to the Centers for Disease Control and Prevention between May 1978 and April 1992. Participants. —A total of 2837 persons older than 5 years who had pneumococcus isolated from blood or cerebrospinal fluid. Results. —Overall efficacy for preventing infection caused by serotypes included in the vaccine was 57% (95% confidence interval [Cl], 45% to 66%). Efficacy among persons with diabetes mellitus was 84% (95% Cl, 50% to 95%); with coronary vascular disease, 73% (95% Cl, 23% to 90%); with congestive heart failure, 69% (95% Cl, 17% to 88%); with chronic pulmonary diseases, 65% (95% Cl, 26% to 83%); and with anatomic asplenia, 77% (95% CI, 14% to 95%). Efficacy was not documented for patients with alcoholism or cirrhosis, sickle cell disease, chronic renal failure, lymphoma, leukemia, or multiple myeloma, although sample sizes were small for these groups. Efficacy for immunocompetent persons older than 65 years was 75% (95% Cl, 57% to 85%). Efficacy did not decline with increasing interval after vaccination: 5 to 8 years after vaccination it was 71% (95% Cl, 24% to 89%), and 9 years or more after vaccination it was 80% (95% Cl, 16% to 95%). Conclusions. —Intensified efforts to improve pneumococcal vaccine coverage among certain populations for whom vaccination is currently recommended is indicated, but universal revaccination is not warranted at this time. ( JAMA . 1993;270:1826-1831)
TL;DR: The observed downward trend in serum cholesterol levels has coincided with a continuing decline in coronary heart disease mortality, suggesting that the Healthy People 2000 goal of reducing the mean serum cholesterol level of US adults to no more than 200 mg/dL (5.17 mmol/L) is attainable.
Abstract: Objective. —To examine the secular trend in serum total cholesterol levels of the US adult population. Design. —Nationally representative cross-sectional surveys with both an inperson interview and a medical examination that included the measurement of blood lipid levels. Setting/Participants. —Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 through 1962, 1971 through 1974, 1976 through 1980, and 1988 through 1991. Results. —Mean serum total cholesterol levels in US adults aged 20 through 74 years have consistently declined over the time period 1960 through 1991. More than half of the decline occurred during the time period 1976 through 1991. This decline occurred across the entire distribution of serum cholesterol levels and in all age-sex groups. High-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels have not changed, suggesting that the decline in total cholesterol levels is due to a decline in low-density lipoprotein cholesterol levels. Conclusions. —These results document a continuing and substantial decline in serum cholesterol levels among US adults. They suggest that public health programs, designed to reduce cholesterol levels, are proving successful. The observed downward trend in serum cholesterol levels has coincided with a continuing decline in coronary heart disease mortality. These observations suggest that the Healthy People 2000 goal of reducing the mean serum cholesterol level of US adults to no more than 200 mg/dL (5.17 mmol/L) is attainable. (JAMA. 1993;269:3002-3008)
TL;DR: Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission, so the serologic test for rochalimaea may be useful diagnostically and suggest an etiologic role for this genus.
Abstract: Background Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test. Methods We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test. Results We identified 60 patients with cat scratch disease and 56 age-matched, cat-owning control subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regressi...
TL;DR: There is clear evidence of the effect on adherence of culturally influenced beliefs and attitudes about tuberculosis and its treatment, and additional research on adherence predictors is needed, but it should reflect the complexity of the problem.
Abstract: Several conclusions about measuring adherence can be drawn. Probably the best approach is to use multiple measures, including some combination of urine assays, pill counts, and detailed patient interviews. Careful monitoring of patient behavior early in the regimen will help predict whether adherence is likely to be a problem. Microelectronic devices in pill boxes or bottle caps have been used for measuring adherence among patients with tuberculosis, but their effectiveness has not been established. The use of these devices may be particularly troublesome for some groups such as the elderly, or precluded for those whose life styles might interfere with their use such as the homeless or migrant farm workers. Carefully designed patient interviews should be tested to determine whether they can be used to predict adherence. Probably the best predictor of adherence is the patient's previous history of adherence. However, adherence is not a personality trait, but a task-specific behavior. For example, someone who misses many doses of antituberculosis medication may successfully use prescribed eye drops or follow dietary recommendations. Providers need to monitor adherence to antituberculosis medications early in treatment in order to anticipate future problems and to ask patients about specific adherence tasks. Ongoing monitoring is essential for patients taking medicine for active tuberculosis. These patients typically feel well after a few weeks and either may believe that the drugs are no longer necessary or may forget to take medication because there are no longer physical cues of illness. Demographic factors, though easy to measure, do not predict adherence well. Tending to be surrogates for other causal factors, they are not amenable to interventions for behavior change. Placing emphasis on demographic characteristics may lead to discriminatory practices. Patients with social support networks have been more adherent in some studies, and patients who believe in the seriousness of their problems with tuberculosis are more likely to be adherent. Additional research on adherence predictors is needed, but it should reflect the complexity of the problem. This research requires a theory-based approach, which has been essentially missing from studies on adherence and tuberculosis. Research also needs to target predictors for specific groups of patients. There is clear evidence of the effect on adherence of culturally influenced beliefs and attitudes about tuberculosis and its treatment. Cultural factors are associated with misinformation about the medical aspects of the disease and the stigmatization of persons with tuberculosis. Culturally sensitive, targeted information is needed, and some has been developed by local tuberculosis programs.(ABSTRACT TRUNCATED AT 400 WORDS)
TL;DR: Substantial progress has been made in reducing the prevalence of highBlood cholesterol; yet a large proportion of all adults, approximately 29%, require dietary intervention for high blood cholesterol.
Abstract: Objective. —To estimate the current levels and trends in the proportion of US adults with high blood cholesterol based on guidelines from the second report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP II). Design. —Nationally representative cross-sectional surveys. Setting/Participants. —Data for 7775 participants 20 years of age and older from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III) (data collected from 1988 through 1991) and for 9797 participants 20 through 74 years of age from NHANES II (data collected from 1976 through 1980) were used. Results. —From the data collection period in NHANES II (1976 through 1980) to the period in NHANES III (1988 through 1991), the proportion of adults with high blood cholesterol levels (≥240 mg/dL [6.21 mmol/L]) fell from 26% to 20%, while the proportion with desirable levels ( Conclusions. —Substantial progress has been made in reducing the prevalence of high blood cholesterol; yet a large proportion of all adults, approximately 29%, require dietary intervention for high blood cholesterol. ( JAMA . 1993;269:3009-3014)
TL;DR: Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990, and Native Americans were at increased risk of acquiring these infections.
Abstract: Objective. —To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona. Design and Setting. —We retrospectively surveyed microbiology records from all 10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990. Demographic and clinical information was abstracted from the medical records of these patients. Patients. —A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years). Outcome Measures. —Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period. Results. —The annual age-adjusted incidence was 4.3 per 100 000 but was 46.0 per 100000 among Native Americans. Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality. From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly (χ 2 for trend P ≤.02 for each feature). A toxic shock—like syndrome occurred in 8% of infections since 1988, compared with none of the infections between 1985 and 1987 ( P =.04). Patients with the syndrome were younger than patients with other invasive infections (median age 15 vs 54 years, P =.02), and were less likely to have underlying medical conditions ( P =.008). Conclusions. —Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990. Native Americans were at increased risk of acquiring these infections. Patients with the streptococcal toxic shock—like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness. ( JAMA . 1993;269:384-389)
TL;DR: On the basis of DNA relatedness data, previous 16S rRNA sequence data, guanine-plus-cytosine contents, and phenotypic characteristics, neither Bartonella bacilliformis nor Rochalimaea species are closely related to other organisms currently classified in the order Rickettsiales.
Abstract: DNA hybridization data (hydroxyapatite method, 50 to 70°C) indicate that Rickettsia prowazekii, the type species of the type genus of the family Rickettsiaceae, is substantially less closely related to Rochalimaea species than was previously thought. The levels of relatedness of Rickettsia prowazekii to Rochalimaea species and to Bartonella bacilliformis under optimal conditions for DNA reassociation were 0 to 14%, with 25.5% or greater divergence in related sequences. When stringent reassociation criteria were used, the levels of relatedness were 0 to 2%. The genera Bartonella and Rochalimaea are currently classified in different families (the Bartonellaceae and the Rickettsiaceae) in the order Rickettsiales. On the basis of DNA relatedness data, previous 16S rRNA sequence data, guanine-plus-cytosine contents, and phenotypic characteristics, neither Bartonella bacilliformis nor Rochalimaea species are closely related to other organisms currently classified in the order Rickettsiales. In fact, the closest relative of these organisms is Brucella abortus. It is therefore proposed that the family Bartonellaceae should be removed from the order Rickettsiales. Previous 16S rRNA sequence data and DNA hybridization data revealed high levels of relatedness between Bartonella bacilliformis and the four Rochalimaea species, indicating that these species are members of a single genus. It is proposed that the genus Rochalimaea should be united with the genus Bartonella in the family Bartonellaceae. The name Bartonella is retained as the genus name since it has nomenclatural priority over the name Rochalimaea. This means that new combinations for the Rochalimaea species must be created. Proposals are therefore made for the creation of Bartonella quintana comb. nov., Bartonella vinsonii comb. nov., Bartonella henselae comb. nov., and Bartonella elizabethae comb. nov.
TL;DR: Pulsed-field gel electrophoresis demonstrated both intrahospital and interhospital diversity among Vmr enterococci in the United States and was more useful than plasmid analysis for epidemiologic studies.
Abstract: We examined 105 clinical isolates of glycopeptide-resistant enterococci collected from 31 U.S. hospitals in 14 states during May 1988 to July 1992. The isolates included 82 Enterococcus faecium, 8 E. faecalis, 6 Enterococcus spp., 5 E. gallinarum, 3 E. casseliflavus, and 1 E. raffinosus. The isolates were categorized into the following four phenotypes of glycopeptide resistance on the basis of their MIC patterns: (i) 70 VanA (vancomycin [Vm] MIC, > or = 64 micrograms/ml; teicoplanin [Tei] MIC, 16 to > or = 128 micrograms/ml), (ii) 26 VanB (Vm MIC, 16 to 1,024 micrograms/ml; Tei MIC, < or = 2 micrograms/ml), (iii) 5 VanC (Vm MIC, 4 to 16 micrograms/ml; Tei MIC, < or = 2 micrograms/ml) in E. gallinarum, and (iv) 3 E. casseliflavus and 1 E. raffinosus isolates for which Vm MICs were 4 to 16 micrograms/ml and Tei MICs were < or = 1 micrograms/ml were called unclassified. Of the 101 isolates with the VanA, VanB, and VanC phenotypes, 99 were confirmed by production of a specific 1,030-, 433-, or 796-bp polymerase chain reaction product, respectively, and hybridization with the respective gene probe. The vanA gene was also detected in the E. raffinosus isolate for which the Vm MIC was 16 micrograms/ml and the Tei MIC was 1 microgram/ml. The vanA gene was located on either a 34- or a 60-kb plasmid in all of the U.S. isolates examined. Pulsed-field gel electrophoresis demonstrated both intrahospital and interhospital diversity among Vmr enterococci in the United States and was more useful than plasmid analysis for epidemiologic studies.
TL;DR: To halt the continuing spread of tuberculosis across the United States and to control transmission within hospitals, laboratories must recognize the urgency and optimize their procedures in reporting results of acid-fast smears, cultures, and drug susceptibility tests to clinicians.
Abstract: After years of declining case rates, tuberculosis is again a major public health problem in the United States. To compound the problem, serious outbreaks involving both patients infected with the human immunodeficiency virus (HIV) and HIV-infected and non-HIV-infected health care workers have been noted in several major metropolitan areas. Cases have also increased in other population groups, including the homeless, prisoners, migrant farm workers, and immigrants. The definitive diagnosis of tuberculosis depends on the isolation and identification of the etiologic agent, Mycobacterium tuberculosis, while design of an appropriate therapeutic regimen depends on the results of antituberculosis susceptibility testing. With this information in hand, the necessary infection control procedures and contact tracings can be initiated and informed decisions can be made regarding therapy. If laboratories cannot screen specimens rapidly for acid-fast bacilli, identify isolates in a timely manner, and provide drug susceptibility data in a short period of time, patient care may suffer and infectious patients may continue the chain of transmission. The laboratory has a major role to play in breaking this chain; the importance of completing thorough evaluations of clinical specimens for mycobacteria and, if mycobacteria are present, the importance of obtaining timely species identification and susceptibility testing results cannot be overemphasized. To halt the continuing spread of tuberculosis across the United States and to control transmission within hospitals, laboratories must recognize the urgency and optimize their procedures in reporting results of acid-fast smears, cultures, and drug susceptibility tests to clinicians.
Journal Article•
TL;DR: (CDC)
Abstract: (CDC) National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health. Dr. Kolbe is Director of the Division, Dr. Collins is Chief of the Division's Surveillance and Evaluation Research Branch, and Dr. Kann is Chief of the Branch's Surveillance Research Section. In addition to the authors of the next eight articles, the following persons were also responsible for the development of the system: Marcie L. Cynamon, CDC; Gary Nelson, CDC; Owen Thornberry, PhD, CDC; Benedict Truman, MD, MPH, CDC; and Barbara Williams, PhD, Westat, Inc.
TL;DR: This review examines published articles on body weight and weight change from nationally representative data on U.S. adults and finds that the distribution of body weight in women is more variable and skewed toward heavier body weights than that in men.
Abstract: Data on body weight and weight change collected from nationally representative samples of U.S. adults are reviewed. The body mass index (weight [kg]/height [m2]) has a low correlation with height and is used to compare body weights between persons of differing heights. The BMI varies to a greater degree in women than in men. Below the 75th percentile of the BMI distribution, women have lower BMIs than men, whereas at the 75th percentile and above, women have higher BMIs than men. Overweight is defined as a BMI of 27.8 or more in men and of 27.3 or more in women, corresponding to approximately 20% or more above desirable weight in the 1983 Metropolitan Life Insurance Company tables. For persons of average height (men, 5'9"; women, 5'4") this definition is equivalent to a body weight above 85 kg (187 pounds) in men and above 72 kg (158 pounds) in women. Among adults 20 to 74 years of age, 24% of men and 27% of women are overweight, yielding an estimated total of 34 million persons in the United States. The prevalence of overweight increases with age, for both men and women but to a greater degree in women. Blacks and Hispanics have a higher prevalence of overweight than do whites, especially among women. Between 1960 and 1980, the prevalence of overweight among whites increased by 3% in women and by 6% in men. In blacks, however, the prevalence of overweight increased by 7% in women and by 28% in men. Longitudinal body weight measurements taken 10 years apart show that adults younger than 55 years tend to gain weight, whereas those 55 years and older tend to lose weight. The youngest adults gain the most weight, and the oldest adults lose the most weight. In all age groups, women have substantially greater variation in their 10-year weight change than do men.
TL;DR: In this article, the authors defined the frequency of this new deficiency among thrombophilic patients and among patients previously identified with heterozygous protein C or protein S type I deficiency.
TL;DR: This investigation of patients with idiopathic CD4+ T-lymphocytopenia and unexplained opportunistic infections indicates that the disorder is rare and represents various clinical and immunologic states.
Abstract: Background The clinical and public health importance of recent reports of patients with CD4+ T-lymphocytopenia without human immunodeficiency virus (HIV) infection is unclear. We conducted investigations to determine the demographic, clinical, and immunologic features of patients with idiopathic CD4+ T-lymphocytopenia; whether the syndrome is epidemic or transmissible; and the possible causes. Methods We reviewed 230,179 cases in the Centers for Disease Control and Prevention (CDC) AIDS Reporting System and performed interviews, medical-record reviews, and laboratory analyses of blood specimens from adults and adolescents who met the CDC case definition of idiopathic CD4+ T-lymphocytopenia (<300 CD4+ cells per cubic millimeter or a CD4+ cell count <20 percent of total T cells on two occasions and no evidence of infection on HIV testing), their sexual contacts, household contacts, and persons who had donated blood to them. Results We interviewed 31 of the 47 patients identified with idiopathic CD4+ T-lymph...
TL;DR: The findings suggest that the waves of HIV-1 infection in injecting drug users and in sexually infected patients in Thailand may not be epidemiologically linked, and nucleotide divergence data point to the separate introductions of the two genotypes in Thailand.
TL;DR: The patterns of use and associated toxicity of postexposure zidovudine use among enrolled workers are focused on and the failure of zidvudine to prevent HIV infection in one worker is reported.
Abstract: Objective: To study the risk for human immunodeficiency virus (HIV) infection and the patterns of use and associated toxicity of zidovudine among health care workers after an occupational exposure ...
TL;DR: Molecular analyses suggest that a highly mobile genetic element--eg, a transposon--is responsible for the rapid spread of vancomycin resistance in New York City.
TL;DR: Alignment of predicted amino acid sequences showed that the structural proteins of EBO and MBG contain large regions of homology despite the absence of serologic cross-reactivity.
TL;DR: Treatment with chloroquine can no longer be considered adequately effective therapy of clinical P. falciparum malaria in very young children in these areas of Africa.
Abstract: Emphasis on retaining chloroquine as the first-line therapy for Plasmodium falciparum infections in most of sub-Saharan Africa for as long as it remains effective has resulted in widespread reliance on chloroquine in areas where it can have little effect on P. falciparum parasitemia. To address this issue, clinical, parasitologic, and hematologic responses to chloroquine or pyrimethamine/sulfadoxine treatment were assessed among very young children in Malawi (n = 153) and Kenya (n = 73). The median time to resumption of clinical symptoms in chloroquine-treated children was 13.5 days in Malawi and 9.5 days in Kenya. Children treated with pyrimethamine/sulfadoxine maintained clinical improvement and had greater increases in their hemoglobin concentration during the follow-up period than did children treated with chloroquine. Treatment with chloroquine failed to produce either a durable clinical improvement or optimal hematologic recovery. Consequently, chloroquine can no longer be considered adequately effective therapy of clinical P. falciparum malaria in very young children in these areas of Africa.
TL;DR: This report estimates the prevalence of various body weight perceptions and weight control practices among U.S. adolescents and adults and examines data from two surveys, the Youth Risk Behavior Surveillance System and Behavioral Risk Factor Surveillance System, which collected data from adults in 38 states and the District of Columbia in 1989.
Abstract: Objective: To estimate the prevalence of various weight-loss practices in U.S. adolescents and adults. Design: The Youth Risk Behavior Survey, a self-administered survey of a random sample of high ...
TL;DR: Higher BMI was associated at all ages with higher plasma triglyceride level, lower HDL cholesterol level, and higher total and non-HDL cholesterol levels, and in young men, the higher total cholesterol level was reflected mainly in the LDL cholesterol level; in middle-aged and older men, in the non- HDL fraction.
Abstract: Background: The influence of body weight on serum Lipids is often overlooked in clinical practice. Methods: The association between body weight adjusted for height as calculated by body-mass index (BMI) and se[ill]um lipid and lipoprotein levels in white men was examined using the second National Health and Nutrition Examination Survey (NHANES II). Lipid results were categorized into six different levels of BMI: (1) 21.0 kg/m 2 or lower, (2) 21.1 to 23.0 kg/m 2 , (3) 23.1 to 25.0 kg/m 2 , (4) 25.1 to 27.0 kg/m 2 , (5) 27.1 to 30.0 kg/m 2 , and (6) greater than 30.0 kg/m 2 , and three age groups: (1) young men (20 through 44 years), (2) middle-aged men (45 through 59 years), and (3) older men (60 through 74 years). Results: Using linear trend analysis, changes in BMI from categories 2 to 5 in young men were associated with a total cholesterol level 0.59 mmol/L (23 mg/dL) higher ( P P P =.03). For middle-aged men and older men, the same change in BMI was associated with smaller but still significant differences in total cholesterol levels (higher by 0.31 mmol/L [12 mg/dL] [ P P P P P P Conclusion: Excess body weight is associated with deleterious changes in the lipoprotein profile. Higher BMI was associated at all ages with higher plasma triglyceride level, lower HDL cholesterol level, and higher total and non-HDL cholesterol levels. In young men, the higher total cholesterol level was reflected mainly in the LDL cholesterol level; in middle-aged and older men, in the non-HDL fraction. Programs to reduce coronary heart disease by improving lipid levels should include more emphasis on achieving and maintaining ideal body weight. (Arch Intern Med. 1993;153:1093-1103)