Trichinosis in sows slaughtered at a Kentucky abattoir

From July 26 to 30, 1976, diaphragmatic pillar samples were collected from 513 sows slaughtered at a federally inspected abattoir in Kentucky. The sows represented 5 marketing areas: Rushville, In (186); Cincinnati, Oh )158); Indianapolis, In (70); Georgetown, Ky (54); and Columbus, Oh (45). Using the pooled-sample digestion technique, 3 dead trichina larvae were identified in 1 sample pooled from 15 diaphragms (10 g each). An attempt to identify the individually infected sow(s) was unsuccessful, but the pooled sample originated from animals marketed at Rushville, In. The prevalence (1 of 513) was 0.194%.     

Juvenile palmar dermatitis acquired at swimming pools

INTRODUCTION: We describe a new childhood mechanical dermatosis of the hands due to swimming pools. OBSERVATIONS: We report two cases of a dermatosis of the hands occurring in children characterized by symetric erythematous plaques on the convexities of the palmar zone of the hands and fingers. It is due to repeated rubbing of the palms on rough pool wall. It disappears spontaneously when stopping this activity. DISCUSSION: We propose the French appellation of "dermatite palmaire juvenile des piscines" to design this entity which has already been described in the English dermatologic literature under the name of "pool palms". Its characteristic aspect should allow a rapid diagnosis.     

Stochastic epidemics: the probability of extinction of an infectious disease at the end of a major outbreak

The aim of this study is to derive an asymptotic expression for the probability that an infectious disease will disappear from a population at the end of a major outbreak ('fade-out'). The study deals with a stochastic SIR-model. Local asymptotic expansions are constructed for the deterministic trajectories of the corresponding deterministic system, in particular for the deterministic trajectory starting in the saddle point. The analytical expression for the probability of extinction is derived by asymptotically solving a boundary value problem based on the Fokker-Planck equation for the stochastic system. The asymptotic results are compared with results obtained by random walk simulations.     

Food-borne outbreak of streptococcal pharyngitis in an Israeli Airforce Base

OBJECTIVE: To determine if maternal hematocrit and serum albumin can predict intrauterine growth retardation and/or preterm delivery. METHODS: Analyses were performed during each trimester of pregnancy to evaluate the predictive value of these two common laboratory parameters as predictors of intrauterine growth retardation and/or prematurity. RESULTS: 1468 women participated in the study. Intrauterine growth retardation occurred in 9.9% and preterm delivery in 6.1%. A significant inverse correlation between hematocrit and albumin and birth weight was found (r = -0.005, p = 0.04, and r = -0.07, p = 0.007, respectively), albumin being a stronger predictor as demonstrated by multiple regression. Low hematocrit at the third visit was associated with a longer pregnancy duration (r = -0.06, p = 0.02). Woman with higher serum albumin levels at the second visit, had a longer pregnancy duration, possibly reflecting a better nutritional status (r = 0.057, p = 0.03). To determine the predictive value of hematocrit and serum albumin, the prevalence of intrauterine growth retardation and premature delivery in the highest quartiles were compared with the lowest, and no significant differences were observed (p > 0.1). CONCLUSION: Maternal hematocrit and serum albumin concentration cannot be used as useful predictors of intrauterine growth retardation or preterm delivery.     

Epidemiological survey of an outbreak of multiresistant Serratia marcescens by PCR-fingerprinting

During an outbreak of Serratia marcescens from May to November 1993 43 strains obtained from 27 ICU patients infected or colonized with multiresistant S. marcescens were genotypically characterized with random amplified polymerase chain reaction (RAPD-PCR)-fingerprinting. In addition, 43 epidemiologically unrelated control isolates were selected. PCR-fingerprinting identified ten different genotypes of S. marcescens among the outbreak related strains. One predominant genotype was demonstrated in 21/43 isolates of 11/27 patients. A cluster of this genotype was found in seven/eight patients on the cardiosurgical ICU. The epidemiologically unrelated strains all showed different genotypes as compared to the predominant type. This survey proved RAPD-PCR to be a highly discriminatory and reproducible method for epidemiological studies of S. marcescens strains in nosocomial outbreaks.     

The isolation of Bordetella bronchiseptic from an outbreak of canine pneumonia

This report describes an outbreak of bronchitis and bronchopneumonia among young dogs in a breeding kennel following the introduction of two pups from another area. Bordetella bronchiseptica was isolated in heavy culture from affected animals which responded well to antibacterial therapy. There was no evidence of distemper virus involvement. Important bacteriological properties of Bord. bronchiseptica are discussed particularly as they relate to its known pathogenicity in the young of several species of animal. During the outbreak reported, it was noted that only young pups were clinically affected and it is suggested that Bord. bronchiseptica may be pathogenic in a certain age-group within the canine population. This seems to require further investigation.     

Fragmented, distorted cricoid cartilage: an acquired abnormality

This paper reports the identification of the fragmented, distorted cricoid cartilage. The laryngeal findings in four patients with this acquired abnormality are presented. The postmortem whole organ serial section of their larynges is described and illustrated with horizontal sections from the Laryngeal Development Laboratory in Chicago. The histopathologic sequence, pathogenesis, and clinical relevance are elucidated.     

Group B rotavirus associated with an outbreak of neonatal lamb diarrhea

A 66-year-old woman was admitted because of postmenopausal vaginal bleeding. Diagnostic workup revealed a poorly differentiated endometrial adenocarcinoma. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was carried out (FIGO stage Ia, G3). One and a half years later she developed a solitary humeral metastasis which was treated by local radiotherapy and progesterone acetate. Because osseous metastases in endometrial adenocarcinoma are rare, the literature is reviewed. In analogy to the treatment of pulmonary metastases the option of disarticulation of the patient's arm is discussed.     

Evaluation of an intervention program for the control of an outbreak of shigellosis among institutionalized persons

After control measures were initiated to stop an outbreak of shigellosis in an institution for the developmentally disabled, there was a sharp decline in the number of cases of Shigella sonnei infection. Among ill residents, those treated with antibiotics had shorter mean duration of diarrhea (2.4 vs. 4.5 days, P < .01) and were less likely to have stool cultures positive for shigellae 2-4 weeks after onset of diarrhea (0/25 vs. 5/19; relative risk [RR] = undefined; P = .02). The attack rate was higher in villages where segregation of ill residents was not practiced (46/73 vs. 53/155; RR = 1.8; 95% confidence limits [CL], 1.4, 2.4). In individual housing units where ill residents were not segregated (preintervention), a correlation was found between mean duration of diarrhea and unit attack rates (r = .88; 95% CL, 0.29, 0.99). A study of all 305 residents 10 weeks after the intervention began revealed no positive stool cultures.     

Study of an outbreak of cefoxitin-resistant Klebsiella pneumoniae in a general hospital

During a 3-month period, six Klebsiella pneumoniae isolates resistant to cefoxitin and penicillin-inhibitor combinations were derived from patients in the intensive care unit of a hospital in Athens, Greece. Enterobacterial repetitive intergenic consensus PCR and pulsed-field gel electrophoresis provided evidence of the clonal origin of the isolates. Conventional techniques and ribotyping were inadequate in proving that the isolates were related. Resistance was due to a plasmidic class C beta-lactamase.     

Community-based investigation of an outbreak of acute viral conjunctivitis in urban slums

OBJECTIVE: To report clinical experience with intravesical instillations of 5-aminolevulinic acid (ALA) for the photodynamic therapy of superficial bladder cancer and to assess any side-effects of the treatment. PATIENTS AND METHODS: Ten patients (six men and four women, mean age 62.3 years, range 42-73) with refractory superficial bladder cancer were treated with photodynamic therapy using 5 g of ALA dissolved in 30 mL sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radiation integrals of 15, 30 or 60 J/cm2. At integrals of 15 or 30 J/cm2 red light (635 nm) was used and at 60 J/cm2, green light (514 nm, 40 J/cm2) was combined with a subsequent application of red light (635 nm, 20 J/cm2). RESULTS: After 10-12 weeks, four patients had a complete remission, two a partial remission, there was no change in three and one had progressive disease. Of those patients responding, the bladder was preserved in five after a mean follow-up of 15 months (range 6-27). There were no photodermatoses or bladder shrinkage in any patient. CONCLUSIONS: Photodynamic therapy with intravesically applied ALA is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side-effects which could preclude further clinical testing.     

Problems encountered at work by people with severe acquired hearing loss

A structured questionnaire concerning problems encountered at work was administered to 88 adults of employment age suffering from acquired sensorineural hearing loss (60 dB +). While respondents were not likely to be out of work by virtue of their hearing loss, they found it difficult to cope at work for a variety of reasons. Information from a subsequent open-ended interview threw some light on the validity of the questionnaire and in particular illustrated the need to combine quantitative and qualitative methods of data collection.     

Attack of the scabies: what to do when an outbreak occurs

Scabies remains a significant source of morbidity in nursing home residents because of its highly contagious nature. It is characterized by severe pruritus and papules, pustules, burrows, nodules, and occasionally urticarial lesions. Lesions are commonly found on the wrists, finger webs, antecubital fossae, axillae, areolae, periumbilical region, lower abdomen, genitals, and buttocks. Diagnosis is based on the history, physical examination, and demonstration of mites, eggs, or scybala on microscopic examination. Several topical scabicides are available, but permethrin cream appears to be less toxic and more effective in cases that are resistant to other agents. Successful management requires evaluation of individuals with close patient contact.     

Epidemiology of an unusually prolonged outbreak of typhoid fever in Terrassa, Spain

An unusually prolonged outbreak of typhoid fever, from 1988 to 1994, in Terrassa (Barcelona, Spain), was caused by a casual food handler who was a carrier. The pattern of this outbreak suggested intermittent low-level exposure to Salmonella typhi. We found 70 patients with S. typhi infections, 52 of whom were available for study. Medical records were reviewed and patients were interviewed with use of a standard questionnaire. Phage typing and pulsed-field gel electrophoresis (PFGE) for strain subtyping were used to confirm the epidemiological data. The 27 outbreak strains shared the same phage type and the same PFGE pattern. Four sporadic strains shared the same phage type as the outbreak strain. PFGE was found to be useful for differentiating strains for epidemiological purposes.     

Detection of Mycobacterium ulcerans in environmental samples during an outbreak of ulcerative disease

Mycobacterium ulcerans is an environmental bacterium which causes chronic skin ulcers. Despite significant epidemiological evidence to suggest that water is the source of infection, the organism has never been identified in the environment. Environmental water samples were collected from a small town in which an outbreak of 29 cases had occurred in a 3-year period. These were examined by mycobacterial culture and PCR amplification. Similar to previous studies, M. ulcerans was not cultured from the water samples. However, five samples were positive for M. ulcerans by PCR. These samples were collected from a swamp and a golf course irrigation system within the outbreak area. This is the first time that M. ulcerans has been demonstrated to be present in the environment and supports the postulated epidemiology of disease due to this organism.