An outbreak of hantavirus pulmonary syndrome, Chile, 1997

A novel splice variant of RGS 9 was isolated from a rat hypothalamus, human retina, and a human kidney (Wilm's) tumor. This variant, termed RGS 9L, differs from the retinal form (termed RGS 9S) identified previously in that it contains a 211- (rat) or 205- (human) amino acid proline-rich domain on the carboxyl terminus. The pattern of RGS 9 mRNA splicing was tissue specific, with striatum, hypothalamus- and nucleus accumbens expressing RGS 9L, whereas retina and pineal expressed RGS 9S almost exclusively. This pattern of mRNA splicing seemed to be highly conserved between human and rodents, suggesting cell-specific differences in the function of these variants. Transient expression of RGS 9L augmented basal and beta-adrenergic receptor-stimulated adenylyl cyclase activity while suppressing dopamine D2 receptor-mediated inhibition. Furthermore, RGS 9L expression greatly accelerated the decay of dopamine D2 receptor-induced GIRK current. These results indicate RGS 9L inhibits heterotrimeric Gi function in vivo, probably by acting as a GTPase-activating protein. The human RGS 9 gene was localized to chromosome 17 q23-24 by radiation hybrid and fluorescent in situ hybridization analyses. The RGS 9 gene is within a previously defined locus for retinitis pigmentosa (RP 17), a disease that has been linked to genes in the rhodopsin/transducin/cGMP signaling pathway.     

Culture-amplified detection of dengue virus from serum in an outbreak of dengue fever

PURPOSE: To evaluate the effect of laser thermokeratoplasty (LTK) in eyes that previously had a lamellar corneal cut. SETTING: University of Al-Azhar, Cairo, Egypt, and Instituto Oftalmológico de Alicante, Spain. METHODS: In 15 eyes (10 patients), noncontact LTK was applied 6 to 8 weeks after a lamellar corneal cut had been made. Central pachymetry, keratometry, and videokeratography were performed and uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), and manifest and cycloplegic refractions measured before and 1, 6, 12, and 18 months after LTK. RESULTS: Mean follow-up was 19.13 months. Mean refraction was +5.93 diopters (D) +/- 1.9 (SD) before LTK and -0.43 +/- 1.5 D at 1 month, +1.63 +/- 1.6 D at 6 months, 1.91 +/- 1.41 at 12 months, and +2.01 +/- 1.5 D at the end of the study. Total regression did not occur in any case. Mean BSCVA before LTK was 0.66 +/- 0.2, and spontaneous visual acuity at the end of the study was 0.58 +/- 0.18. No patient lost any lines of preoperative BSCVA. There was no significant difference between the results at 12 months and at the end of the study. CONCLUSION: Corneal lamellar cutting appeared to improve the magnitude of the refractive effect of noncontact LTK and to decrease the amount of regression.     

An outbreak of Pontiac fever among children following use of a whirlpool

We investigated an outbreak of fever, most likely due to a contaminated whirlpool, among nine adults and six children residing in a summerhouse. The outbreak was characterized by a high attack rate, short incubation periods, influenza-like symptoms, and rapid recoveries, all features typical of Pontiac fever. However, the children had less-characteristic symptoms than the adults, and they did not have any sequelae. Findings on the children's chest radiographs were unremarkable, and none of the children had leukocytosis. Evidence of Legionella pneumophila infection was found in six cases: in one case by isolation of L. pneumophila serogroup 1 and detection of legionellae by PCR, and in five cases by seroconversion to the clinical isolate. Six additional cases had presumptive evidence of legionella infection, with seroconversion to Legionella micdadei antigen; a PCR assay was also positive for legionellae for one of these cases. In contrast, two adult nonusers of the whirlpool had no symptoms and no serological evidence of infection. Serological testing and cultures for other pathogens, as well as cultures of all environmental samples, were negative. This investigation demonstrates the differences between adults and children with respect to the clinical picture of Pontiac fever; furthermore, it shows that culture and PCR assay of tracheal aspirates for legionellae can be performed in a hospital setting for rapid diagnosis, although the sensitivities of these methods are low.     

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.     

'Public health status and perspectives' 1997. II. Developments in health status]

As a part of the report 'Public health status and forecasts' 1997 recent developments in the health status of the Dutch population and its determinants are described. Developments until the year 2015 are forecast on the basis of expected demographic and epidemiologic trends, according to expert opinions. Important findings are the unfavourable trends in lifestyle factors in adolescents and the expected increase by 25-60% in 2015 of the prevalence of diseases of old age like cancer, cardiovascular diseases, diabetes mellitus, dementia, chronic nonspecific lung diseases, visual and hearing impairments and diseases of the locomotor system.     

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.     

An outbreak of malignant catarrhal fever in young rusa deer (Cervus timorensis)

On the basis of clinical signs and histological findings eight 9-month-old male rusa deer (Cervus timorensis) were diagnosed with sheep associated-malignant catarrhal fever. Following a variable course involving rectal temperatures around 40.5 degrees C, depression, inappetence, diarrhoea, corneal opacity and hypopyon all animals died or were euthanased over a 5-week period. Severe multifocal vasculitis, mainly periglomerular and in the arcuate vessels were consistent histological findings which in the past have been adequate to confirm clinical diagnosis of sheep associated-malignant catarrhal fever. A nested polymerase chain reaction test has been used to detect a sheep associated-malignant catarrhal fever PRC product, 238 base-pairs in size, in DNA extracted from lymphocyte preparations. The result supported the diagnosis of sheep associated-malignant catarrhal fever in these deer.     

Spotted fever imported into Norway in 1997

Tick-borne rickettsioses are important zoonoses in many tropical and subtropical areas. There has recently been an increase in the number of reported cases among tourists returning to Scandinavia. In this article we present all five serologically confirmed cases of tick-borne rickettsioses imported into Norway in 1997. The patients were Norwegian tourists who had visited South Africa (three cases), Zimbabwe, and Italy. Four cases had typical eschar and three had maculopapular exanthema. The patients were treated with either doxycycline or ciprofloxacin. No complications were reported. The diagnosis of tick-borne rickettsiosis was confirmed by the detection of specific IgM antibodies to Rickettsia conorii using micro-immunofluorescence in serum samples.     

An outbreak of campylobacter food poisoning in a health care setting

An outbreak of campylobacter food poisoning in a group of health care workers is reported. The outbreak involved 12 of 31 staff members attending a departmental party. Investigations revealed that a chicken dish was the most likely vehicle of infection. The relative risk of developing symptoms after eating this dish was 6.15 (P < 0.002). Further investigation established that not only had the cooking instructions been misunderstood but storage of the the food the morning of the party did not comply with Department of Health guidelines. The outbreak was associated with considerable morbidity and cost. It is important that health care workers other than professional catering staff are aware of the guidelines available to ensure the correct preparation and storage of food if such events are to be held in hospital departments. It is also important that manufacturers of chicken products ensure that labelling regarding further cooking is clear and in large print.     

An interstate outbreak of tick-borne relapsing fever among vacationers at a Rocky Mountain cabin

Clinical observation suggests that deformities of the foot and ankle are common in children with cerebral palsy. Two hundred children with cerebral palsy attending the Central Remedial Clinic were examined and photographed. The children had no previous surgical intervention and were between 1.5 and 19 years of age. Deformities were assessed and related to the type of cerebral palsy and mobility status.     

A nationwide outbreak of coconut-associated paratyphoid A fever in Singapore

A large outbreak of 167 cases of paratyphoid A was reported in Singapore during the period 15 February to 4 May 1996. Cases were distributed all over the country and no specific food establishment was implicated. The attack rate was highest among the Indian ethnic group between the ages of 25 and 34 years. A case-control study showed that consumption of a variety of food items in which imported deshelled coconut was used as an ingredient was statistically significantly associated with the illness (P < 0.001). As soon as the vehicle of transmission was suspected, the import of deshelled coconut was banned. No further cases were reported four weeks after the ban. The outbreak highlighted the need to maintain a high degree of vigilance against the introduction of infectious diseases through imported food.     

Specimen culture from all children in a day care center because of an outbreak of streptococcal infection

In an outbreak of recurrent group A streptococcal (GAS) pharyngotonsillitis between January and February 1997 at a Swedish preschool, involving 58% (11/19) of the children and several family members, clinical examination showed few of the children to manifest signs and symptoms of tonsillitis. However, throat specimens yielded GAS growth of the same T-type in 42% (8/19) of the children and in 30% (6/20) of family members, but in none of the staff. Strict hygiene, appropriate antibiotic treatment of all culture-positive individuals irrespective of symptoms, and non-attendance at the preschool during the first two days of treatment promptly terminated the outbreak and there were no cases of recurrence.