The risk of acquiring Lyme disease or babesiosis from a blood transfusion

To determine the risk of acquiring Lyme disease or babesiosis from blood transfusion, serum was collected before and 6 weeks after patients received multiple transfusions during cardiothoracic surgery and antibodies to Borrelia burgdorferi and Babesia microti were measured. Of 155 subjects, 149 received 601 total units of packed red blood cells (PRBC) and 48 received 371 total units of platelets. No patient developed clinical or serologic evidence of Lyme disease; 1 (who received 5 units of PRBC) developed clinical and serologic evidence of babesiosis. The risk of acquiring Lyme disease from a transfused unit of PRBC was 0 (95% confidence interval [CI], 0-0.5%) and from a transfused unit of platelets was 0 (95% CI, 0-0.8%); the same risks for babesiosis were 0.17% (95% CI, 0.004%-0.9%) and 0 (95% CI, 0-0.8%), respectively. The risk of acquiring either Lyme disease or babesiosis from a blood transfusion in Connecticut is very low.     

Cat owners'' risk of acquiring a Helicobacter pylori infection

OBJECTIVES/STUDY DESIGN: A random survey of equal proportions of urban and rural North Carolina general dentists was conducted to assess their knowledge and adoption of radiographic quality assurance guidelines of the American Dental Association. RESULTS: A total of 159 surveys were returned representing a response rate of 51%. A majority of respondents answered "don't know" to questions dealing with intraoral and panoramic radiography units and darkroom monitoring. Higher levels of knowledge (58% to 77%) and adoption (63% to 86%) of guidelines were seen with film-processing activities. Linear regression demonstrated substantial positive association between knowledge and adoption of guidelines (R = 0.50). Stepwise multiple regression revealed positive associations of the demographic variables of years in practice, urban location, and age with greater knowledge of guidelines (R2 = 0.33, p < 0.05). Urban location was associated with increased likelihood of adoption of guidelines (R2 = 0.09, p < 0.05).     

Dengue fever: a risk to travelers

An outbreak of dengue fever occurred among a small group of Maryland and Pennsylvania residents following a trip to the British Virgin Islands in January 1996. Dengue fever is a mosquito-borne viral illness that occurs primarily in tropical urban areas. Most dengue infections are benign and self-limited, but some produce severe and fatal hemorrhagic disease. Although dengue is not endemic in the continental United States, travelers may acquire the infection during visits to the tropics. Physicians should consider dengue in the differential diagnosis of a patient with a febrile illness and a history of recent travel to a tropical area. Travelers to endemic areas should be advised to take precautions to prevent mosquito bites.     

The problem of Q fever in zoo ungulates]

Antibodies to Coxiella burnetii were recorded from approximately 13% of 469 ungulates which had been examined by means of micro-CFT (complement fixation test). Particular reference is made to a Q-fever situation in a musk ox herd. The results obtained from these investigations are likely to support the conclusion that latent Q-fever infection may be expected to occur in ungulates and to grow manifest in stress situations.     

Q fever during pregnancy: a public health problem in southern France

We describe five cases of Q fever in pregnant women that were diagnosed during the last 3 years in the town of Martigues in Southern France. Analysis of our cases and the 18 other published cases shows that Q fever is a significant cause of morbidity and mortality in pregnancy. The disease may present as an acute or chronic infection and can be reactivated during subsequent pregnancies, as is seen with other mammals. In Martigues, Q fever is present in at least one per 540 pregnancies and constitutes the most significant public health problem related to intrauterine infections.     

Maternal flu, fever, and the risk of neural tube defects: a population-based case-control study

Results of clinical and epidemiologic studies have shown an increased risk for neural tube defects (NTD) in infants whose mothers were exposed to heat during pregnancy. However, the risk for NTD in infants whose mothers had influenza during pregnancy has not been well studied. This population-based case-control study of infants born in metropolitan Atlanta, Georgia, from 1968 through 1980 included 385 infants with NTD, 3,647 infants with other birth defects, and 2,676 infants without birth defects. Of the 385 mothers of case infants, 31 reported having a 2-day or longer episode of flu with fever from 1 month before through 3 months after conception (odds ratio (OR) = 3.0; 95% confidence interval (CI) 1.9-4.7). Infants of mothers who took medications for their episodes of flu with fever had an even higher risk for NTD (OR = 4.3, 95% CI 2.6-7.1). When mothers of infants with birth defects other than NTD were used as controls, an increased risk of NTD remained for flu with fever (OR = 1.7, 95% CI 1.1-2.5). There was no increased risk for NTD among the infants of mothers who reported fever from causes other than flu. Because of the heterogeneity of maternal flu, the individual contributions of infection, fever, and medications remain difficult to disentangle.     

Ovine trypanosomosis: a seroepidemiological survey in coastal Guyana

The objective of this study was to determine the seroprevalence rates of Trypanosoma vivax and Trypanosoma evansi in sheep in coastal Guyana. Blood samples were taken from a systematic random sample of one hundred and ninety-three (193) sheep on twenty-two (22) farms in Region 5, Mahaica/Berbice, a coastal area of Guyana. Age, breed, sex, and farm of origin were recorded for all sampled sheep. One hundred and seventy-six (176) serum samples were submitted for Indirect Fluorescent Antibody (IFA) testing for T. vivax and T. evansi. Fluorescence was graded as 0 (negative), 1+(very weak), 2+(weak), 3+(strong) or 4+(very strong), measured at 1:160 dilution of serum. Samples were considered to be sero-positive if any fluorescence was observed. Indirect Fluorescent Antibody results were received for one hundred and sixty-one (161) samples. One hundred and three (64%) sera were sero-positive for Trypanosoma sp. Of these, 38 (23.6%) sera were positive to T. evansi only, 11 (6.8%) were positive to T. vivax only and 54 (33.5%) were positive for both. As cross reactions occur between T. vivax and T. evansi, it was difficult to determine the true species of exposure for the sera which tested positive to both species. The overall sero-prevalence rate of 64% suggests that trypanosomosis is endemic in sheep in coastal Guyana. This was the first serological evidence of T. evansi in Guyana. Although T. vivax is believed to be pathogenic in sheep, the clinical significance of T. evansi remains unknown. The vector of both species of trypanosomes in sheep on the north coast of South America also is not known.     

Suggestion against an oral-oral route of transmission for Helicobacter pylori infection: a seroepidemiological study in a rural area

In this study the seroepidemiology of H. pylori and Epstein-Barr virus was compared in the same setting. A sample of 705 subjects completed a structured questionnaire. A serum sample was drawn from each subject and assayed for H. pylori IgG. Antibodies to Epstein-Barr virus were determined in a subgroup of 466 subjects. Cross-tabulation of data showed that 274 (58.8%) subjects were seropositive and 20 (4.3%) were seronegative for both infections, 17 (3.6%) were seropositive for H. pylori, and 155 (33.3%) were seropositive for Epstein-Barr virus (odds ratio=2.08, 95% confidence interval: 1.008-4.3). Nevertheless, the agreement between H. pylori and Epstein-Barr virus seropositivity was no better than chance (kappa=0.067) and the age-related seroprevalence curve of Epstein-Barr virus was similar in H. pylori seropositive and seronegative subjects. Furthermore, multiple logistic regression analysis did not show any risk factor shared by both infections. The findings of this study do not support the hypothesis that H. pylori and Epstein-Barr virus share a common mode of transmission. It can be speculated that the oral cavity may not be an important reservoir for H. pylori.     

Sexual subcultures and degree of risk for acquiring HIV in adolescents in a marginal neighborhood

OBJECTIVE: To describe the sexual subcultures and the risk of acquiring HIV among adolescents in Guadalajara, Jalisco MATERIAL AND METHODS: The study took place during August 1994. A cross-sectional study design was used; data collection was done using pile sorts of 20 males and 20 females aged between 15 and 19 years. Data analysis was done by means of hierarchical clustering, multidimensional scaling, cultural consensus and correspondence techniques. RESULTS: Males: this cluster presented a sexual subculture pattern of free expression associated to high risk behaviors. Females: this cluster showed a sexual subculture pattern of celibacy, associated to low risk. Correspondence analysis: a correlation was found among adolescents between their sexual subcultures and risk of acquiring HIV. CONCLUSIONS: Among males, the free expression sexual subculture included high risk sexual behavior for acquiring HIV. Among females, the celibacy sexual subculture included low risk sexual behavior. Nevertheless, both males and females presented high risk sexual behaviors, since they engage in unprotected sexual practices.     

A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area?

OBJECTIVE: To compare the effect of a gonadotropin releasing hormone (GnRH) analog plus 'add-back' oral contraceptive (OC) therapy with OC therapy alone on the clinical and hormonal parameters that are characteristic of polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized study. SUBJECTS: Thirty PCOS patients were randomly assigned to treatment with leuprolide acetate for depot suspension plus a combined monophasic OC (Group I) or to OC alone (Group II). METHODS: Hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH), LH : FSH concentration ratio, estradiol, androstenedione, testosterone), clinical (Ferriman-Gallwey score), ultrasonographic (ovarian volume, number of subcapsular follicles, stromal score) and Doppler (uterine artery and ovarian intraparenchymal vessels' pulsatility index, ovarian stromal vascularization) parameters were evaluated during 6 months' therapy and 6 months' follow-up. RESULTS: Significant changes in all the parameters analyzed occurred as a result of therapy and the changes were more marked in the group undergoing treatment with GnRH analog plus OC. CONCLUSIONS: GnRH analog plus OC use has a more rapid and marked effect on the hormonal milieu as well as the ovarian architecture and vascularization in patients with PCOS than OC used alone. The former treatment may be a more efficient therapy for PCOS.     

The latest seroepidemiological pattern of hepatitis A in Japan

Age-specific prevalence of anti-hepatitis A virus antibody (anti-HAV) was surveyed with 2,708 sera collected in 1994 in various areas of Japan. By age-group analyses, we found strong association of anti-HAV antibody with higher age group. The prevalence ratios of antibody in the groups of 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64 and 65 years or older were 0, 4.2, 22.0, 44.8, 57.6, 76.4, 84.5 and 91.4%, respectively. Geometric mean titers of anti-HAV antibody in the positive age groups were approximately 6,000 mIU/ml. The seropositives among older population were ascribed to the infections more than 40 years ago and the high anti-HAV titers have been maintained since that time. In Japan, people younger than 40 years of age are extremely risky to HAV infection, since 99% have no antibody. Those in forties are also risky since two-thirds of them are seronegative. In Japan, an inactivated vaccine was licensed in 1994. Vaccination may be recommended for such high-risk groups as travelers going to endemic areas, patients who have received blood product medication and child-care staffs.     

Comparison of immunofluorescence with enzyme immunoassay for detection of Q fever

To evaluate enzyme immunoassay (EIA) as an alternative to indirect immunofluorescence assay (IFA) to screen for Q fever in humans, 157 serum samples from patients suspected of having the disease were tested for immunoglobulin G antibodies to Coxiella burnetii. The agreement between the tests and the sensitivity of EIA were excellent (96.8% and 98.4%, respectively) when an IFA titer of > 1/160 was considered positive. All serum samples with a titer of > 1/320 in the IFA were also positive by the EIA. The EIA seems to be an acceptable alternative to IFA for screening for Q fever.     

Circulating cytokine balance and activation markers of leucocytes in Q fever

The present study was done to assess the tolerance of rats for 3-acetoxyandrost-5-ene-7,17-dione (7-oxo-DHEA-acetate, 7-ODA) when administered as a single oral gavage dose. Five groups of Sprague-Dawley rats (Crl:CD (SD) BR VAF/Plus) (five/sex/group) were treated with 7-ODA at a dose level of 0 (control), 250, 500, 1000, or 2,000 mg/kg of body weight in a dose volume of 10 ml/kg. Food and water were provided ad libitum. All animals survived in good health to the scheduled sacrifice on Day 15. The single oral administration of 7-ODA had no apparent effects on body weight. Food consumption was significantly higher for all female treated groups during week two; however, the statistically significant differences were not considered to be of clinical consequence. Treatment caused no apparent changes of gross or microscopic anatomical structures of nine different organs. This study demonstrated that the no-observable adverse effect level for a single oral dose of 7-ODA in male and female rats was 2,000 mg/kg.     

Case management study: polyarthritis with fever

In most cases, a thorough initial evaluation will reveal the cause of fever and polyarthritis. However, in some patients the initial diagnosis may be unclear and, as time passes, the characteristic clinical patterns emerge. Recurrent attacks are suggestive of other conditions such as crystal-induced arthritis, Lyme disease, and Mediterranean fever. In rheumatoid arthritis and Reiter's syndrome, the fever resolves and the articular findings predominate with the passage of time. Similarly, Still's disease is initially diagnosed on the basis of clinical criteria, and later confirmed by the evolution of chronic polyarthritis. Diagnostic approaches for the evaluation of patients presenting with acute arthritis have been published and are readily available (2,8,9). The most reliable way to establish the diagnosis for a rheumatic disease is thoughtful and thorough evaluation by an experienced clinician (3,10). Certain discriminating features and confirmatory tests can aid in the diagnosis of polyarthritis with fever (Tables 2 and 3).     

The risk profile of childhood leukaemia in Greece: a nationwide case-control study

The risk profile of childhood leukaemia in Greece was studied through a case-control investigation that included all 153 incident cases of the disease, ascertained throughout the country during 1993 and 1994, and two hospital controls for every case matched for gender, age and place of residence. The data were analysed using conditional logistic regression and the associations are expressed in terms of adjusted odds ratios (OR) and their 95% confidence intervals. Cases were born to mothers of a higher standard education, the OR for an increment of four schooling years being 1.48 (1.17-1.87) and had higher birth weight, the OR for an increment of 500g being 1.36 (1.04-1.77). Pet ownership and birth after a pregnancy with anaemia were associated with increased risk, the ORs being 2.18 (1.14-4.16) and 2.60 (1.39-4.86) respectively. From the frequency analyses, indicative inverse associations were found with birth order, household crowding and previous hospitalization with allergic diseases, whereas indicative positive associations were found with diabetes mellitus during pregnancy and with neonatal jaundice. Substantial or significant elevations were not found with respect to maternal smoking and coffee drinking during pregnancy, diagnostic radiography and ultrasonographic examinations or blood transfusions. A significant inverse association with maternal consumption of alcohol could be due to multiple comparisons, but a detrimental effect can probably be excluded. A non-significant positive association with total shots of viral vaccinations and a weak non-significant inverse association with breast feeding were also found. We interpret the findings of this study as being compatible with acute childhood leukaemia being linked with delayed development of herd immunity to fairly common infectious agents, in conjunction with accelerated perinatal and early post-natal growth.     

Q fever (Coxiella burnetii) investigations in dairy cattle: challenge of immunity after vaccination

The immunity of Holstein-Friesian dairy cows vaccinated against Coxiella burnetii was challenged with 4 X 10(8) infective guinea pig doses of viable rickettsiae. Cows that were vaccinated had normal full-term calves, whereas 2 nonvaccinated cows aborted late in pregnancy. Intrauterine infection of the fetus was indicated by recovery of the organism from tissues of the fetus. Coxiella burnetii was recovered from milk, colostrum, and placenta of vaccinated and nonvaccinated cows after challenge inoculation, but the rickettsiae recovered were as many as 1,000 times more numerous in nonvacinated cows.