Showing papers on "Infectious disease (medical specialty) published in 1992"

Tuberculosis: commentary on a reemergent killer.

Abstract: Tuberculosis remains the leading cause of death in the world from a single infectious disease, although there is little knowledge of the mechanisms of its pathogenesis and protection from it. After a century of decline in the United States, tuberculosis is increasing, and strains resistant to multiple antibiotics have emerged. This excess of cases is attributable to changes in the social structure in cities, the human immunodeficiency virus epidemic, and a failure in certain major cities to improve public treatment programs. The economic costs of not adequately addressing the problem of tuberculosis in this country are estimated from an epidemiological model.

The Male Predominance in the Incidence of Infectious Diseases in Children: A Postulated Explanation for Disparities in the Literature

Abstract: In children, a male predominance in the incidence of symptomatic disease has been reported for some infectious agents and not for others. Not only are the factors underlying these sex differences poorly understood, but it is also not clear why the differences are described only for selected infectious diseases. In this study of sex- and age-specific incidence of infectious diseases in children, a possible explanation for the inconsistencies in the literature was explored. The sex ratio in reported disease incidence in Israel during a period of about 20 years was examined for various viral and bacterial infections. In addition, an hypothetical mathematical model was developed which assumes increased susceptibility to infectious disease (such as in relative immune deficiency) in a proportion of males. In children aged under 4 years, a higher incidence among males was consistently observed for all diseases, and the sex ratio varied between 1.16 (95% confidence interval (CI): 1.13-1.18) for shigellosis to 1.98 (95% CI: 1.79-2.17) for viral meningitis. The highest ratios were associated with the diseases which tend to present asymptomatically most often, which is consistent with the predictions of the model. The male excess in symptomatic disease appears to be present for most infectious diseases and this should be taken into account in studies comparing observed disease incidence between groups with different sex ratios. The inconsistencies in reports on the excess male morbidity for infectious diseases may be due to variations in symptomatic to asymptomatic infection ratios.

A new world of infectious disease

Abstract: When Christopher Columbus crossed the Atlantic Ocean in 1492, he brought together two worlds of infection which had developed in virtual isolation from each other for thousands of years. The picture of infectious disease in the New World differed from that in the Old World in many ways, but probably most dramatically in the absence or near absence of crowd infections capable of causing severe epidemics. The devastating effects of these crowd diseases in the post-Columbian period are well known, with conditions such as smallpox, diphtheria, measles, malaria, bubonic plague, yellow fever, and possibly typhus killing thousands of Native Americans, thus allowing inhabitants of the eastern hemisphere to become firmly established in the western hemisphere. Less is known about the diseases present in the Americas prior to 1492, but they probably included treponemal infections (pinta and syphilis), tuberculosis, forms of leishmaniasis and trypanosomiasis, fungal diseases such as coccidioidomycosis and paracoccidioidomycosis, various coccal infections, Rocky Mountain spotted fever, Lyme disease, legionellosis, hydatid disease, and a variety of intestinal parasite infections. It must be noted, however, that some of these syndromes were likely already present in both hemispheres in 1492. Recent research suggests that adult rheumatoid arthritis may also have its origin in the Americas. © 1992 Wiley-Liss, Inc.

Infectious diseases and injuries in child day care : opportunities for healthier children

Abstract: Objective. —To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs. Design. —We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles. Setting. —Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs. Patients or Other Participants. —Primarily children in a variety of day-care settings, often compared with children cared for at home. Main Outcomes. —The occurrence of outbreaks and illness related to infectious disease and injury. Results. —Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home. Conclusions. —Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion. (JAMA. 1992;268:1720-1726)

Nutrition and immunoregulation. Significance for host resistance to tumors and infectious diseases in humans and rodents.

Abstract: Nutrition is a critical determinant of immunocompetence and risk of illness and death largely due to infectious disease. It is now established that undernourished individuals have impaired immune responses. The most consistent abnormalities are seen in cell-mediated immunity, complement system, phagocytes, mucosal secretory antibody response and antibody affinity. These changes, together with other handicapping factors observed in underprivileged societies, lead to more infections. It is now recognized that deficiencies of single nutrients also impair immune responses. The best studied are zinc, iron, vitamin B-6, vitamin A, copper and selenium. If malnutrition occurs during fetal life, as epitomized by small-for-gestational age infants, the effects on cell-mediated immunity are very significant and long lasting. There is much recent evidence to suggest that at the other end of the age spectrum, namely old age, nutrition plays an important role in maintenance of optimum immunity. Based on these data, several studies have documented the critical importance of nutrition in resistance to a variety of infectious challenges, including Salmonella, Listeria and coxsackie B. Similarly, in vitro and in vivo responses to tumor cells are modulated by nutrition. These interactions of nutrition and immunity have several practical applications, including resistance to infections and tumors and the development of designer formulas that might help reduce the occurrence of opportunistic infections in immunocompromised hosts.

Viral infection in the renal transplant recipient.

Abstract: The viral infections with greatest impact on the renal transplant recipient are those due to cytomegalovirus, Epstein-Barr virus, and the two hepatitis viruses, hepatitis B and C. All of these are modulated by the administered immunosuppressive therapy, and all have both direct and indirect effects on the transplant patient. The direct effects are the infectious disease clinical syndromes that are produced (fever and malaise, pneumonia, hepatitis, and so forth). The indirect effects are several--all of these viruses contribute to the patient's net state of immunosuppression, predisposing him or her to the development of opportunistic superinfection with a variety of pathogens. In addition, both Epstein-Barr virus and hepatitis B virus have been clearly linked to the development of certain malignancies (lymphoproliferative disease and hepatocellular carcinoma, respectively). Finally, cytomegalovirus has been linked to allograft injury. Although antiviral strategies effective for cytomegalovirus and Epstein-Barr virus infection are being developed, similar programs are not yet available for the hepatitis viruses.

The epidemiology of measles.

Abstract: Measles is a highly infectious disease which has a major impact on child survival, particularly in developing countries. The importance of understanding the epidemiology of this disease is underlined by its ability to change rapidly in the face of increasing immunization coverage. Much is still to be learned about its epidemiology and the best strategies for administering measles vaccines. However, it is clear that tremendous progress can be made in preventing death and disease from measles with existing knowledge about the disease, and by using the presently available vaccines and applying well-tried methods of treating cases. Research in the coming decade may provide more effective vaccines for use in immunization programmes. An understanding of the basic epidemiology of measles is a prerequisite for effective control measures.

Nurses' willingness to perform AIDS patient care.

Abstract: We evaluated nurses from hospitals with different prevalences of AIDS patients and with different levels of nursing education to measure their willingness to provide care to AIDS patients. Nurses who were most experienced in AIDS patient care, employed in high-prevalence hospitals, and who considered themselves most knowledgeable about infectious disease consistently were less willing to provide nursing care for AIDS patients. Nurses with BSN or MSN education employed in hospitals with low and moderate prevalence of AIDS were the most willing to provide AIDS patient care. The results are discussed in light of recent research on universal precautions adherence and factors that may contribute to increasingly negative attitudes for nurses who provide sustained AIDS patient care.

A discrete-time model for the statistical analysis of infectious disease incidence data.

Abstract: A discrete-time model is devised for the per-time-unit distribution of infectious disease cases in a sample of households. Using the time at which an individual is identified (e.g., when illness symptoms appear) as a marker for being infected, the probabilities of becoming infected from the community or from a single infectious household member are estimated for various risk factor levels. Maximum likelihood procedures for estimating the model parameters are given. An individual may be classified with regard to level of susceptibility and level of infectiousness. The model is fitted to a combination of symptom and viral culture data from a rhinovirus epidemic in Tecumseh, Michigan. In general, it is observed that decreasing risk of infection is associated with increasing age.

AIDS: The Making of a Chronic Disease

Abstract: The sudden appearance of the acquired immunodeficiency syndrome (AIDS) in the early 1980s, its rapid spread, and its devastating consequences gave experts many reasons to make historical analogies to the plagues of the distant past. The infectious disease model was the basis for much of the AIDS policy made during the 1980s, with the emphasis on disease surveillance and containment. It was against this backdrop that Elizabeth Fee and Daniel M. Fox published their first compilation of essays, AIDS: The Burdens of History , in 1988. As AIDS moves into its second decade, however, its predominant features, from both a health policy and clinical perspective, no longer resemble those of an infectious disease, but rather those of a chronic disease. Owing mainly to advances in medical therapies, the most pressing issues to be dealt with now are medical management and health care availability. This shift in historical perception from AIDS as

Characterization of field isolates of suid herpesvirus 1 (Aujeszky's disease virus) as derivatives of attenuated vaccine strains

Abstract: Field isolates of suid herpesvirus 1 (Aujeszky's disease virus) from Poland and Hungary were identified by restriction fragment pattern analysis as derivatives of attenuated vaccine strains. The Polish isolates were found to be related to the BUK-TK-900 strain (Suivac A) which is widely used as a live vaccine in Poland, and the Hungarian isolates were related to the Bartha K-61 vaccine strain widely used in Hungary. Pigs experimentally infected with derivatives of BUK-TK-900 or BUK-TK-900 itself were found to develop gI-antibodies, while pigs infected with derivatives of Bartha K-61 showed a gI-negative response.

Potentiation of host resistance against microbial infections by lentinan and its related polysaccharides.

Abstract: Cytotoxic anticancer agents are generally accompanied by severe side effects in a host, and reduce resistance against cancer and infectious diseases, especially by destroying lymphoid cells and bone marrow cells. As a result, many cancer patients die of various kinds of pneumonitis, septicemia, uremia or other secondary diseases. There are, however, reliable clinical evidence to support the existence of intrinsic resistance against cancer and infectious disease in the human body. An increase in this resistance may be one of the most important facets in the development of pharmaceutical therapy against such diseases.

Strategies for prevention of infection after cardiac transplantation.

Abstract: Infection remains a major cause of morbidity and mortality after cardiac transplantation. Most infections occur during the first few months after transplantation. Although late infection does occur, the risk of infection during maintenance immunosuppression is low in the absence of recurrent rejection that necessitates augmentation of suppression of the immune response. Before cardiac transplantation, the risk factors for infectious disease in potential candidates should be assessed. A detailed history of past infections should be elicited, and patients should be screened for the presence of active indolent infection. In addition, potential donors must be thoroughly assessed for organ-transmittable infection. Many common infections that may occur after cardiac transplantation can be prevented with the use of appropriate prophylactic regimens directed toward cytomegalovirus, Toxoplasma gondii, Pneumocystis carinii , and herpes simplex virus. Periodic surveillance serologic tests and cultures after cardiac transplantation facilitate early diagnosis and prompt institution of appropriate therapy

Mortality Trends of American Missionaries in Africa, 1945–1985

Abstract: Mortality trends of missionary staff serving in sub-Saharan Africa were tracked for the period 1945-1985. For 1945-1970, when more complete incidence data were available, the missionary death rate was approximately 40% lower, after adjustment, than would be expected in a comparable US population. This trend persisted through 1985. Between 1945 and 1970, the largest number of fatalities was attributable to malignancy, atherosclerosis, accidents, and infectious disease, and the greatest mortality risks, compared with the US experience, were from homicides, the complications of pregnancy, and infections, notably malaria, hepatitis, and polio. Beginning in the late 1950s, motor vehicle accidents became the leading cause of death. Since the 1960s, accidental causes of death have been approximately 50% higher than in the US, and homicides have been four times higher. During this same period, the infectious disease death rate decreased to approximately that within the US. Currently, the leading causes of mortality are motor vehicle accidents, malignancy, and atherosclerosis, followed by other accidental causes, notably aircraft mishaps and drownings. Viral hepatitis is presently the leading infectious disease cause of death. Other contemporary lethal infections include malaria, rabies, typhoid, Lassa fever, and retroviral infection. It was concluded that missionaries in sub-Saharan Africa had a death rate approximately half that expected in a comparable domestic control population. Preventive strategies, particularly relative to accident and infectious disease prevention, could effectively reduce mortality risk further.

Lactobacillus Prophylaxis for Candida Vaginitis

Abstract: Excerpt Candidavaginitis is a common infectious disease. It is probably the most common manifestation of candidiasis and represents infection by a microorganism that normally resides on the vaginal...

The dynamics and control of bovine tuberculosis in possums.

Abstract: A model for the dynamics of an infectious disease in a wild animal population is analysed. The model incorporates susceptible, infected but not infectious, and infectious classes, with no recovery from disease, density-dependent regulation of host birth and death rates, and pseudo-vertical transmission. The existence and local stability of equilibrium levels are determined. Expressions for the intensity of three alternative control measures - the culling, sterilization, and vaccination of host animals - required to eradicate the disease are obtained. Finally, the model is applied to possible control measures against bovine tuberculosis infection in possums in New Zealand.

Pneumothorax in AIDS

Abstract: A total of 237 patients with AIDS have been observed in the infectious Disease Division of the United Hospitals of Bergamo during the past six years. Five patients (4.21%), suffering from TB and PCP, revealed PNX which was characterised by being bilateral and recurrent; it was a concomitant cause of death in 2 patients. The complications which occurred included acute pulmonary heart, pulmonary edema due to reexpansion and irreversible shock.

Infectious disease in emergency medicine

Abstract: This reference on infectious disease is geared to the needs of the emergency physician. It focuses on symptoms and guides the physician through decisions that must be made before the aetiologic organism is known. Emphasis is placed on differential diagnosis and disposition decision-making based on presenting symptoms, patients' characteristics, and circumstances of exposure. Coverage includes explicit admission/discharge criteria, Centres for Disease Control recommendations for hazardous exposures, and detailed treatment guidelines for infections of every organ.

Rapid Classification of Positive Blood Cultures

Abstract: To the Editor. —The authors of a recent study 1 evaluating the interpretation of positive blood cultures are to be commended for publicizing the unglamorous but important truth that infectious disease specialists commonly categorize positive blood cultures as reflecting true bacteremia as opposed to contamination, based on a few simple clinical and laboratory parameters. Whether it was really necessary to perform complex statistical analyses on an extensive data set to reach the study's conclusions is arguable, since the same conclusions probably could have been arrived at equally well through brief conversations with the participating infectious diseases specialists. The important point is that infectious disease specialists do indeed use time to culture positivity, number of cultures positive, organism type, and the pretest clinical likelihood of bacteremia to assess the validity of a positive blood culture. Infection at a different site caused by the same organism is also an important consideration; this

Cases in Medical Microbiology and Infectious Diseases

Abstract: Table of Contents Table of Normal Values Inside Front Cover Acknowledgments viii Introduction to the Third Edition ix To the Student xiii A Primer on the Laboratory Diagnosis of Infectious Diseases 1 ONE Genitourinary Tract Infections 27 TWO Respiratory Tract Infections 55 THREE Gastrointestinal Infections 143 FOUR Skin and Soft Tissue Infections 201 FIVE Central Nervous System Infections 241 SIX Systemic Infections 299 SEVEN Emerging and Reemerging Infectious Diseases 353 Glossary 407 Index 432

Private Choices, Social Costs, and Public Policy: An Economic Analysis of Public Health Issues

Abstract: Introduction Cigarette Smoking Substance Abuse Infectious Disease Racial Disparities in Health and Mortality Children-at-Risk Teenage Pregnancy and Childbearing Conclusion Bibliography

From the Infectious Diseases Society of America. Infectious Disease Manpower in the United States—1986. 2. Changes in Practice Patterns Over Time and Training Needs

Abstract: Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.