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Biomedical subjects

A L Reingold

Publications and source records attributed to A L Reingold.

At least 91 records · Page 5Linked to original sources
PubMed1984

A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant.

From 15 to 21 August 1981, Pontiac fever affected 317 automobile assembly plant workers. Results of serologic tests were negative for Mycoplasma, Chlamydia, respiratory tract viruses, and previously described legionellae. A gram-negative, rod-shaped organism (WO-44C) that did not grow on blood agar, required L-cysteine for growth, and contained large amounts of branched-chain fatty acids was isolated from a water-based coolant. The organism did not react with antisera against other legionellae, and on DNA hybridization the organism was less than 10% related to other Legionella species. Geometric mean titers found by indirect fluorescent antibody testing to WO-44C were significantly higher in ill employees than in controls (p = 0.0001). Attack rates by department decreased linearly with the department's distance from the implicated coolant system. The etiologic agent apparently was a new Legionella species; we propose the name Legionella feeleii species nova (AATC 35072). This is the first outbreak of nonpneumonic legionellosis in which the etiologic agent is not L. pneumophila, serogroup 1.

Aerosols↗
PubMed1983

Legionella pneumonia in guinea pigs exposed to aerosols of concentrated potable water from a hospital with nosocomial Legionnaires' disease.

An investigation of an outbreak of nosocomial legionella pneumonia revealed that the potable water of the hospital was contaminated with a distinctive strain of Legionella pneumophila (designated the Le-1 strain), which was by culture and serology linked with human illness. To examine the possible role of this water in this outbreak, eight healthy guinea pigs were exposed to an aerosol of concentrated potable water. Seven animals developed pneumonia due to the Le-1 strain of L. pneumophila. In one of these guinea pigs, the Le-1 strain was also isolated from the blood and spleen. These results provide support to the theory that exposure of humans to aerosols of potable water contaminated with L. pneumophila may cause legionella pneumonia.

Aerosols↗
PubMed1983

Reactivity of serum from patients with suspected legionellosis against 29 antigens of legionellaceae and Legionella-like organisms by indirect immunofluorescence assay.

Sets of sera (444) submitted for diagnostic testing for legionellosis were tested against 29 indirect immunofluorescence assay (IFA) antigens prepared from the characterized Legionella species and Legionella-like organisms to determine the prevalence of antibodies to Legionella organisms. Reciprocal titers of 15% of the serum sets rose fourfold or more to greater than or equal to 128 (indicating seroconversion) against one or more Legionella antigens. The specificity of the test was 96% when evaluated in patients with pneumonia due to non-Legionella organisms. Antibodies were of the IgG, IgM, and (infrequently) IgA classes and were either specific for a single species (as defined by a difference in titer of fourfold or more) or reacted with common Legionella antigens (30 [45%] vs. 36 [55%] of 66 seroconversions, respectively). No single antigen detected half of the positive sera. Elevated IFA titers (of greater than or equal to 256) against single or multiple Legionella antigens occurred in 12% of 184 normal control sera. Therefore, only seroconversions to titers of greater than or equal to 128 should be considered indicative of recent Legionella infection.

Antigens, Bacterial↗
PubMed1982

Risk factors for development of toxic shock syndrome. Association with a tampon brand.

In September 1980, we interviewed by telephone 50 patients with menstrually associated toxic shock syndrome (TSS) who had onset of illness in July or August 1980. These women were asked to provide information about the type of menstrual sanitary products used during the menstrual period associated with their illness. We also interviewed 150 age-matched control subjects, who were asked the same questions for the menstrual period that occurred in the same month as the illness of the matched case. All 50 cases, but only 125 of 150 controls, used tampons. Among women using tampons, cases were more likely to have used Rely brand tampons when compared with controls. No differences were found between cases and controls in the absorbency of tampon products used. No other factors studied through analysis of a follow-up questionnaire mailed five months after the first study were found to be significantly associated with the development of menstrually associated TSS.

Female↗
PubMed1982

Toxic shock syndrome associated with surgical wound infections.

In 13 cases of toxic shock syndrome (TSS) associated with postoperative wound infections, clinical findings were similar to those observed in cases of TSS in menstruating women. While local signs of a surgical wounds infection were minimal, Staphylococcus aureus was recovered from cultures of wounds in 12 of 12 patients; multiple blood cultures were negative for 11 of 11 patients. Toxic shock syndrome due to surgical wound infections accompanied a wide variety of surgical procedures in both men and women and was not necessarily associated with menstruation in women. The median interval between surgery and onset of TSS was two days. Toxic shock syndrome can develop in association with surgical wound infections caused by S aureus and should be considered in the differential diagnosis of postoperative fever and hypotension.

Adolescent↗
PubMed1982

Toxic-shock syndrome not associated with menstruation. A review of 54 cases.

An increasing proportion of reported cases of toxic-shock syndrome (TSS) are not associated with menstruation (13.2% of reported cases with onset in 1981). The 54 cases of TSS not associated with menstruation reported through the U.S.A. national surveillance system between January, 1980, and June, 1981, were either associated with Staphylococcus aureus infections (cutaneous or subcutaneous lesions, infected surgical wounds, bursitis, mastitis, adenitis, lung abscess, or primary bacteraemia) or followed childbirth by vaginal delivery and caesarean section. Patients with TSS not associated with menstruation differed significantly in age and racial distributions from those with menstruation-associated TSS, and 17 of them were male. The clinical features of TSS not associated with menstruation and the characteristics of the S. aureus strains isolated from these patients were similar to those observed in TSS related to menstruation. The median incubation period of the disease in the post-surgical cases was 2 days. TSS can occur in many clinical settings in patients of both sexes and of all ages and racial groups.

Adolescent↗
PubMed1982

Transmission of hepatitis B by an oral surgeon.

An outbreak of hepatitis B in southeastern Connecticut was traced to an oral surgeon. In a serosurvey of his 754 noninstitutionalized patients, 511 (68%) participated. The rates of seropositivity for hepatitis B surface antigen (HBsAg) or antibody to HBsAg by year of oral surgery were 4.8% in 1977, 7.4% in 1978, and 14.8% in 1979. The transmission of hepatitis B, as measured by seropositivity, occurred between November 1978 and August 1979; the peak transmission was in February (31.2% seropositivity). Seropositivity was strongly correlated with the extent of surgical trauma (P less than 0.0001). HBsAg subtyping revealed that the oral surgeon and all four subtypable patients demonstrated both d and y reactivity, as did the patient from whom it was most likely the oral surgeon acquired his infection: a mentally retarded patient who had 24 extraction in March 1978. This study demonstrates that the transmission of hepatitis B between dental practitioners and their patients frequently results in subclinical infections.

Adolescent↗
PubMed1982

Nonmenstrual toxic shock syndrome: a review of 130 cases.

One hundred and thirty cases of toxic shock syndrome not associated with menstruation have been reported to the Centers for Disease Control, including 57 with onset in 1981 (12% of reported cases in 1981). These cases show that the syndrome occurs in a wide range of clinical settings and is associated with Staphylococcus aureus infections at a variety of sites: focal cutaneous and subcutaneous lesions, surgical-wound infections, postpartum infections, adenitis, bursitis, deep abscesses, and "primary" bacteremia. Although the clinical characteristics of nonmenstrual toxic shock syndrome are identical to those for menstrual toxic shock syndrome, the epidemiologic and demographic features are different. Of particular interest is the contrast in the racial distribution of the menstrual and nonmenstrual cases. Toxic shock syndrome can occur in persons of any age, race, or sex and must be considered in the differential diagnosis for any patient with a compatible illness.

Adolescent↗
PubMed1982

Toxic shock syndrome surveillance in the United States, 1980 to 1981.

Between 1 January 1980 and 18 October 1981, investigators from the Centers for Disease Control collected information on 1407 cases of toxic shock syndrome using a nationwide passive surveillance system. Ninety-two percent of the reported cases were associated with menstruation. Information available on the type of menstrual device used shows that 99% of the cases occurred in tampon users. Menstrual cases occurred predominantly in whites (98%) under the age of 25 (65%). The case/fatality ratio for menstrual toxic shock syndrome was 3.1% for cases with onset in 1981. The distribution of reported cases by date of onset showed a gradual increase in the number reported before the summer of 1980, a sharp increase during the summer and early fall of 1980, a marked decrease in the late fall of 1980, and a subsequent gradual decrease. Factors affecting the incidence and reporting of toxic shock syndrome during these periods include changes in the number of tampon users, changes in the availability and usage patterns of tampons, changes in the prevalence of toxin-producing strains of Staphylococcus aureus, improved recognition of the syndrome, and publicity.

Adolescent↗
PubMed1982

Vaginal colonization with Staphylococcus aureus in healthy women: a review of four studies.

Four studies assessed the frequency of vaginal Staphylococcus aureus colonization in healthy women and associated risk factors. An association was found between S. aureus vaginal colonization and colonization at the labia minora and the anterior nares. Significant risk factors associated with an increased risk of vaginal S. aureus in at least one study were a history of genital herpes simplex infection, insertion of tampons without an applicator, and the use of Rely (Procter & Gamble) tampons. The use of systemic antibiotics within 2 weeks of the vaginal culture decreased the risk of recovery of S. aureus. The overall frequency of vaginal S. aureus in the 808 women in the four studies was 9.2%.

Anti-Bacterial Agents↗
PubMed1982

In-vitro studies of interactions between tampons and Staphylococcus aureus.

In-vitro studies were done to investigate the role of tampons and Staphylococcus aureus in toxic shock syndrome. Tampons did not enhance the growth of S. aureus in nutrient broth or human blood. Intrinsic contamination of tampons with S. aureus was not found among the 504 tampons cultured (95% confidence limits of fraction contaminated; 0 to 0.007). Toxin-producing S. aureus persisted significantly longer on artificially contaminated Rely tampons (Procter & Gamble) than on the other brands tested. The proportion of clinical isolates of S. aureus capable of producing toxin increased from two of 36 in 1960 to eight of 20 in 1979 (p = 0.002, Fisher's exact test). This general increase in the proportion of toxin-producing strains may partially explain the increase in cases of toxic shock syndrome in recent years.

Bacillus↗
PubMedDate not supplied

Role of legionellae in acute infections of the lower respiratory tract.

The genus Legionella currently comprises 24 species and multiple serogroups. Despite the continuing development and increasing availability of new and improved laboratory tests for diagnosing legionella infections, the incidence of such infections remains poorly defined. The most frequently cited estimate of 25,000 to 50,000 cases of legionella pneumonia per year in the United States is based on a single study with a number of methodologic limitations. While numerous studies of the etiology of pneumonia have been published, it is usually not possible to calculate incidence from these investigations. The proportion of pneumonia cases attributable to legionella species has ranged from less than 1% to greater than 30%. Differences in the diagnostic methods employed in various studies and questions concerning the representativeness of the patients studied make it difficult to determine how much of the observed variation is due to true geographic and temporal differences in the incidence of legionella pneumonia. Further studies are needed to define the incidence of acute lower respiratory tract infections due to Legionella.

Acute Disease↗
PubMedDate not supplied

Update through 1985 on the incidence of toxic shock syndrome among members of a prepaid health plan.

Through hospital records of men and women aged 15-34 years who were members of the Northern California Kaiser-Permanente Medical Care Program, trends in the incidence of toxic shock syndrome (TSS) requiring hospitalization in 1984-1985 were examined, and the results were compared with those for the period 1972-1983. No definite or probable cases of TSS were found in men during either 1984 or 1985. A total of 16 cases of TSS (10 definite and six probable) were found in women in 1984-1985. Ten (71%) of 14 cases for which the menstrual status of the patient could be determined unambiguously from the medical record occurred during menstruation, and two of the four nonmenstrual cases occurred in postpartum women using barrier contraception. Of the 16 cases, 14 (88%) were diagnosed as TSS or probable TSS by the attending physician, although only nine (64%) of the 14 diagnosed cases were given the correct discharge code. While trends in the incidence of TSS requiring hospitalization in women 15-34 years of age generally paralleled changes in the absorbency of available tampons, the contribution of other factors (e.g., changes in the chemical composition of tampons, changes in patterns of tampon use) to these trends could not be assessed.

Adolescent↗
PubMedDate not supplied

Active surveillance for toxic shock syndrome in the United States, 1986.

Active surveillance for toxic shock syndrome (TSS) was established in 1986 in Los Angeles County and in the states of Missouri, New Jersey, Oklahoma, Tennessee, and Washington. Case reports were solicited through biweekly contact with all acute-care hospitals. One hundred sixteen definite and 63 probable cases were reported; 85% of the cases occurred in female patients and 15% in male patients. Among cases in females, 83 (55%) were menstrual; the mean age of the patients with menstrual cases was 23 years (range, 12-46 years). The overall incidence of TSS was 0.53/100,000. The cumulative incidence varied significantly by region, ranging from 1.23/100,000 in Oklahoma to 0.22/100,000 in New Jersey (P = .0001); the incidence in all other areas ranged from 0.39/100,000 to 0.70/100,000. The incidence of menstrual TSS was 1.05/100,000 women 15-44 years of age and peaked in women between the ages of 15 and 19 years at 1.52/100,000. The incidence was higher in whites than in nonwhites for both menstrual TSS (1.21/100,000 vs. 0.34/100,000, P = .002) and nonmenstrual TSS (0.30/100,000 vs. 0.14/100,000, P = .031). Our data indicate that TSS continues to be a cause of morbidity. Although there is underreporting in national passive surveillance, the proportion of menstrual cases reported through active surveillance was similar to that reported to the passive system in 1986.

Adolescent↗