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Biomedical subjects

A L Reingold

Publications and source records attributed to A L Reingold.

At least 73 records · Page 4Linked to original sources
PubMed1988

Prevalence of nontuberculous mycobacteria in water supplies of hemodialysis centers.

Infection of hemodialysis patients with nontuberculous mycobacteria (NTM) has been associated with water used in reprocessing hemodialyzers. This study was conducted to determine the prevalence of NTM and other bacteria in water samples collected over a 13-week period from 115 randomly selected dialysis centers in the United States. Total viable counts were determined by membrane filter assays; increased recovery of NTM was obtained by dosing a portion of each water sample with 1% formaldehyde (HCHO) before filtering. NTM were widely distributed and occurred with a high frequency in water supplies in dialysis centers. NTM were detected in water from 95 centers (83%), and 50% of all samples examined contained NTM. The results of this study support recommendations to use 4% HCHO or a chemical germicidal equivalent for disinfecting dialyzers that are to be reused.

Disinfection↗
PubMed1987

The relationship of tampon characteristics to menstrual toxic shock syndrome.

The pathogenic basis for the association of tampons with toxic shock syndrome (TSS) has not been explained adequately. Absorbency and chemical composition of tampons are related, and no prior study has had a sufficient number of cases to evaluate these independently as risk factors for disease. We compared national TSS passive surveillance data on the 285 tampon-associated menstrual cases of TSS reported from 1983 to 1984 with data on age- and year-matched controls from national surveys of tampon usage. Users of all brands of tampons had elevated risks when compared with non-tampon users (odds ratio, 32.8; 95% confidence interval, 15.5, 69.6). Regardless of the chemical composition of the tampon, increasing absorbency increased the odds ratio for TSS. Chemical composition also influenced odds ratios. Polyacrylate-containing tampons had odds ratios that were elevated but, once controlled for absorbency, that were lower than the odds ratios for cotton, rayon, and cotton/rayon tampons. The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.

Adolescent↗
PubMed1987

Toxic shock syndrome. Evaluation of national surveillance data using a hospital discharge survey.

Data from the Commission on Professional and Hospital Activities, Professional Activities Study were used to estimate the incidence and geographic distribution of hospitalized patients with toxic shock syndrome (TSS) in the United States in 1981 and 1982. There were 1004 discharges with a diagnosis of TSS from hospitals participating in the study. These discharges could not be validated using clinical criteria. Using these data, the projected incidences for the United States were 0.78/100,000 and 0.84/100,000 total population in 1981 and 1982, respectively. Female patients, 15 to 19 years of age, had the highest age-specific incidence (4.8/100,000). Race, sex, and geographic distributions of cases reported to the national surveillance system were similar to those of patients discharged with a diagnosis of TSS from hospitals participating in the study.

Adolescent↗
PubMed1986

Systemic mycoses in the United States, 1980-1982.

To evaluate temporal trends in the incidence of systemic mycoses resulting in hospitalization, we reviewed hospital discharge data from the Professional Activity Study of the Commission on Professional and Hospital Activities for 1980-1982. In comparison with results from similar studies in 1970 and 1976, the incidences of the mycoses that are more likely to be opportunistic and/or hospital-acquired infections (candidiasis, aspergillosis, cryptococcosis) increased in 1980-1982 as did the incidences of sporotrichosis and actinomycosis. At the same time the incidences of most community-acquired mycoses (histoplasmosis, coccidioidomycosis, and blastomycosis) remained stable or declined. These results are consistent with the increasing number of immunocompromised patients with severe underlying illnesses, who are at risk of developing opportunistic mycoses.

Cross Infection↗
PubMed1985

Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source.

Investigation of a recent outbreak of nosocomial legionnaires' disease--initially thought to be due to the documented presence of Legionella pneumophila in the hospital potable water--showed that aerosols from one or more cooling towers were the actual source of infection. From June 27 to Aug 25, 1983, nosocomial legionnaires' disease developed in 15 persons at a hospital in Rhode Island. Twelve (80%) of 15 case-patients occupied rooms in building 1, unit B, compared with eight (28%) of 29 control patients (odds ratio = 10.8; 95% confidence interval = 1.4 to 85.6). Subsequent investigation demonstrated that water in a cooling tower located 100 ft upwind of unit B was heavily contaminated with L pneumophila, serogroup 1, subgroup 1, 2, 4, 5. The same strain was isolated from nine of the patients and from the make-up water for the tower. Active surveillance during the ten months following decontamination of the cooling tower identified no additional cases of nosocomial legionnaires' disease, although the hospital potable water had not been treated. While recommendations have been made for controlling nosocomial legionnaires' disease by heating or hyperchlorination of hospital potable water, this outbreak demonstrates the importance of an adequate epidemiologic-environmental investigation in choosing the appropriate control strategy.

Adult↗
PubMed1985

Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine.

Sequential case-control studies were used to monitor changes in the clinical protection induced by group A meningococcal polysaccharide vaccine over a 3-year period. Overall, vaccine efficacy declined from 87% 1 year after vaccination to 70% and 54% at 2 and 3 years, respectively. When stratified by age at time of vaccination the data showed that, although vaccine efficacy remained high in children greater than or equal to 4 years of age (vaccine efficacy 85%, 74%, and 67% at 1, 2, and 3 years after vaccination, respectively), it declined dramatically in those less than 4 years of age at time of vaccination (vaccine efficacy 100%, 52%, and 8%, respectively, at 1, 2, and 3 years after vaccination). Thus, a single dose of group A meningococcal vaccine does not yield lasting clinical protection in children less than 4 years of age.

Adolescent↗
PubMed1985

Staphylococcus aureus isolates from patients with nonmenstrual toxic shock syndrome. Evidence for additional toxins.

Although toxic shock syndrome toxin-1 (TSST-1) has been proposed as the toxin responsible for toxic shock syndrome, its role in this disease has not been proved. To study this question, we examined Staphylococcus aureus strains isolated from normally sterile sites in patients with nonmenstrual toxic shock syndrome for the presence of TSST-1 production. Only 20 (62.5%) of 32 produced TSST-1, compared with 41 (93%) of 44 vaginal isolates from patients with menstrual toxic shock syndrome. Of strains of S aureus from patients with nonmenstrual toxic shock syndrome, TSST-1-negative isolates were more likely to be associated with a fatal outcome and to not be phage group 1 than TSST-1-positive isolates. Seven of the TSST-1-negative strains were evaluated in a rabbit subcutaneous chamber model of toxic shock syndrome. Fifteen (60%) of 25 rabbits developed a toxic shock syndrome-like illness and nine died. Clinical signs and histopathologic findings in the rabbits were similar to those seen in rabbits inoculated with TSST-1-positive S aureus isolates. These results suggest that other, as yet unrecognized, toxins play a role in toxic shock syndrome, and that TSST-1 production may not be essential to the pathogenesis of toxic shock syndrome.

Adolescent↗
PubMed1985

Pasteurized milk as a vehicle of infection in an outbreak of listeriosis.

Between June 30th and August 30th, 1983, 49 patients in Massachusetts acquired listeriosis. Seven cases occurred in fetuses or infants and 42 in immunosuppressed adults; 14 patients (29 per cent) died. Of 40 Listeria monocytogenes isolates available for testing, 32 were serotype 4b. Two case-control studies, one matching for neighborhood of residence and the other for underlying disease, revealed that the illness was strongly associated with drinking a specific brand of pasteurized whole or 2 per cent milk (odds ratio = 9, P less than 0.01 for the neighborhood-matched study; odds ratio = 11.5, P less than 0.001 for the illness-matched study). The association with milk was further substantiated by four additional analyses that suggested the presence of a dose-response effect, demonstrated a protective effect of skim milk, associated cases with the same product in an independent study in another state, and linked a specific phage type with the disease associated with milk. The milk associated with disease came from a group of farms on which listeriosis in dairy cows was known to have occurred at the time of the outbreak. Multiple serotypes of L. monocytogenes were isolated from raw milk obtained from these farms after the outbreak. At the plant where the milk was processed, inspections revealed no evidence of improper pasteurization. These results support the hypothesis that human listeriosis can be a foodborne disease and raise questions about the ability of pasteurization to eradicate a large inoculum of L. monocytogenes from contaminated raw milk.

Adult↗
PubMed1985

Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10.

Between August 1978 and November 1983, 21 cases of pneumonia caused by Legionella pneumophila occurred in the Leiden University Hospital, mainly among immunocompromised patients. A new serogroup of L. pneumophila, designated serogroup 10 (prototype strain Leiden 1), was isolated from bronchial secretions of four patients, and five patients had serological evidence of infection with this organism. Nine patients had a culture-confirmed infection with L. pneumophila serogroup 1. L. pneumophila serogroups 1 and 10 were also isolated from the hot potable water supply in the building to which 19 of the 21 patients had been admitted. The isolates of L. pneumophila serogroup 1 from patients and the hot potable water were identical in studies with monoclonal antibodies and had the same plasmid profiles. These findings provide further evidence that in our hospital potable water contaminated with L. pneumophila is a source of infection, mainly in immunocompromised patients.

Adult↗
PubMed1985

Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers.

Between April and November 1982, 27 of 140 patients in a hemodialysis center in Louisiana were infected with rapidly growing mycobacteria; 14 had bacteremia alone, 3 had soft-tissue infections, 1 had an access-graft infection, and 9 had widely disseminated disease. Of 26 identified isolates, 25 were Mycobacterium chelonei ssp. abscessus, and one was an M. chelonei-like organism. One factor common to all patients was exposure to processed hemodialyzers (artificial kidneys). Environmental sampling of the water-treatment system showed widespread contamination with nontuberculous mycobacteria, which were also recovered from the patient's side (blood compartment) of five of 31 hemodialyzers that had been processed and were ready for use. The formaldehyde concentration was less than 2% in two of three such contaminated dialyzers tested. We hypothesize that patients became infected when their blood circulated through processed dialyzers that contained viable rapidly growing mycobacteria. This outbreak demonstrates that hemodialysis patients may be at risk for developing infections with rapidly growing mycobacteria and that such infections may go unrecognized when routine culture methods are used. It also emphasizes the importance of using effective procedures to disinfect dialyzers in hemodialysis centers.

Adult↗
PubMed1985

Toxic shock in the United States of America: epidemiology.

Toxic-shock syndrome (TSS), a severe multisystem febrile illness caused by S. aureus, occurs in a wide variety of clinical settings. Although the majority of reported cases in the United States continue to be associated with menstruation and tampon use, TSS also occurs in postpartum women and in patients with infected surgical wounds, cutaneous and subcutaneous infections, and infections at other body sites. Well documented cases of TSS have now been reported from countries around the world.

Adolescent↗
PubMed1984

Predisposition to invasive pneumococcal illness following parainfluenza type 3 virus infection in chimpanzees.

An outbreak of invasive disease, including pneumococcal bacteremia, meningitis, and pneumonia, involved 17 of 83 (20.5%) chimpanzees at a primate rehabilitation unit. Invasive disease was more common in splenectomized than in nonsplenectomized animals (42.9% vs 18.4%), but the difference was not statistically significant. The outbreak followed closely an outbreak of upper respiratory tract infection (URTI) that occurred with equal frequency in splenectomized and nonsplenectomized chimpanzees. Those with URTI were 5.7 times as likely to develop invasive disease than those without URTI (P less than 0.005). Fourteen of 20 (70%) chimpanzees with recent URTI and serologically examined had a 4-fold or greater rise in titer to parainfluenza type 3 virus. The outbreak of invasive disease occurred despite the fact that most of the chimpanzees had been vaccinated with pneumococcal vaccine. Efficacy of pneumococcal vaccine could not be demonstrated among any segment of the chimpanzee population, and testing of sera from 23 vaccinated chimpanzees against 4 pneumococcal serotypes (3, 6, 8, and 14) failed to show a meaningful immune response. The findings demonstrated that viral URTI can predispose primates to invasive infections and suggested that pneumococcal vaccine is not protective in chimpanzees.

Adult↗
PubMed1984

Disinfection procedures and infection control in the outpatient oral surgery practice.

The infection control and disinfection procedures employed by 434 oral surgeons were surveyed. Gloving practices varied substantially, with 55% of respondents wearing gloves during less than or equal to 10% of patient contacts and only 24% wearing gloves routinely. Gloving practices correlated strongly with having been taught in dental school or during residency training to wear gloves. While 100% of participants had received instruction in the use of intravenous fluids in dental school or residency training, usage patterns differed substantially from those currently recommended in hospitals and in outpatient, nondental surgical settings. Of the respondents who used intravenous fluids in an office setting, 68% used a single bag or bottle for more than one patient. The median number of patients receiving intravenous fluid from a single bag or bottle was 12, and the median duration of use of a single unit was three days. It was noted that infection control and disinfection procedures varied significantly by type of practice (private vs. other nonmilitary vs. military practices).

Adult↗
PubMed1984

Production of toxic-shock-associated protein(s) in Staphylococcus aureus strains isolated from 1956 through 1982.

A total of 281 Staphylococcus aureus strains selected from those submitted to the Centers for Disease Control for phage typing between 1956 and 1982 were tested for the production of toxic-shock-associated protein (TSAP) by isoelectric focusing (IEF) and solid-phase radioimmunoassay. The results suggest that the observed temporal trends in the incidence of toxic-shock syndrome were not primarily due to changes in the distribution of TSAP-positive strains of S. aureus. Overall, 39 (14%) were TSAP positive by both methods. The earliest positive strain was an isolate submitted in 1957. TSAP-positive strains were most prevalent in the group of isolates submitted in 1976 for which 29% reacted, but the percent positive subsequently declined for isolates submitted in later years. TSAP production was more frequent among strains of phage types 29, 29/52, and 52 than among other strains. The use of IEF to identify TSAP detected false-positive proteins. Seven strains were positive by IEF and negative by solid-phase radioimmunoassay, whereas only one was positive by solid-phase radioimmunoassay and negative by IEF.

Bacterial Proteins↗
PubMed1984

Trans-isolate medium: a new medium for primary culturing and transport of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae.

A diphasic medium, Trans-Isolate medium, was developed for the transport of primary cultures of cerebrospinal fluids from patients with bacterial meningitis. It consists of a charcoal-starch agar slant and soybean-casein digest-gelatin broth buffered at pH 7.2 with 0.1 M 3-(N-morpholino)propanesulfonic acid buffer. In the laboratory, this medium supported the growth and survival of stock cultures of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae for at least 3 months. Under field conditions in Africa, cerebrospinal fluids from patients suspected of having bacterial meningitis were inoculated directly onto plates of chocolate agar medium and into bottles of Trans-Isolate medium. An etiological agent was isolated from 52 spinal fluids by direct plating. After shipment to Atlanta, Ga., 2 to 4 weeks later, the same etiological agents were recovered from 38 bottles of Trans-Isolate medium.

Bacteriological Techniques↗