[Anesthesia and intensive care medicine--status report. XIIIth International Symposium on Anesthesia in Heidelberg, March 19-21, 2004].
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Anesthesia↗
Biomedical subjects
C Bopp
Publications and source records attributed to C Bopp.
Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy.
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P = 0.002). Infants < 1 year old (P = 0.05) and children 5-14 years old (P = 0.01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P = 0.02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P < 0.0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.
Adolescent↗
A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.
From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.
Case-Control Studies↗
Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States.
BACKGROUND: Strains of salmonella that are resistant to antimicrobial agents have become a worldwide health problem. A distinct strain of Salmonella enterica serotype typhimurium, known as definitive type 104 (DT104), is resistant to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline and has become a major cause of illness in humans and animals in Europe, especially the United Kingdom. METHODS: To characterize typhimurium DT104 infections in the United States, we analyzed data collected by local and state health departments and public health laboratories between 1979 and 1996 in national surveys of the antimicrobial-drug resistance of salmonella. Selected typhimurium isolates with the five-drug pattern of resistance were phage typed. RESULTS: The prevalence of typhimurium isolates with the five-drug pattern of resistance increased from 0.6 percent in 1979-1980 to 34 percent in 1996. In 1994-1995, such isolates were identified in samples from 36 of the 46 surveillance sites (78 percent). Thirty-nine of 43 typhimurium isolates with the five-drug pattern of resistance identified in 1994-1995 and 1996 were phage type DT104 or a closely related phage type. CONCLUSIONS: Multidrug-resistant typhimurium DT104 has become a widespread pathogen in the United States. More prudent use of antimicrobial agents in farm animals and more effective disease prevention on farms are necessary to reduce the dissemination of multidrug-resistant typhimurium DT104 and to slow the emergence of resistance to additional agents in this and other strains of salmonella.
Drug Resistance, Multiple↗
Epidemiologic application of a standardized ribotype scheme for Vibrio cholerae O1.
A standardized scheme of 27 different BglI ribotypes and subtypes of Vibrio cholerae O1 strains is proposed on the basis of data from 214 human and environmental strains isolated in 35 countries and 14 U.S. states over the past 60 years. The ribotype patterns obtained are reproducible and stable over time. Seven different but very similar ribotypes (1a to 1g) were observed among 16 strains of the classical biotype. Twenty ribotypes and subtypes were identified among 198 V. cholerae O1 strains of the El Tor biotype. Six different patterns were found among the strains causing the current seventh pandemic. Strains of ribotype 8 originated only in central African countries, while those of ribotype 3 originated mainly in Asia and the Pacific Islands. The most widely distributed strains were those of ribotype 6, which was subdivided into three very similar but still distinguishable subtypes. The present Latin American epidemic is caused by strains of ribotype 5. Strains of this ribotype were isolated from several other geographic locations but can be differentiated from the Latin American strains by other molecular methods. Strains associated with two documented environmental reservoirs exhibited three distinct ribotype patterns; those isolated from patients who ate food from the U.S. Gulf waters were all of ribotype 2, while the strains related to the northeast Australian rivers were of ribotypes 9 and 10. Nontoxigenic V. cholerae O1 strains originating in Latin America and the U.S. Gulf Coast did not form a specific cluster of ribotypes. Ribotyping in combination with other well-defined methods can assist in epidemiologic investigations, helping to trace the movement of strains and to identify their geographic origins.
Animals↗
Phage-typing scheme for Escherichia coli O157:H7.
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Bacteriophage Typing↗
Comparison of gauze swabs and membrane filters for isolation of Campylobacter spp. from surface water.
The epidemiology of Campylobacter jejuni indicates that waterborne transmission is important; the organism has been isolated from seawater, fresh water, and estuarine sites. Membrane filtration, with and without use of an enrichment broth, has been the most common method for isolating C. jejuni from water. We evaluated two methods for isolating C. jejuni from water: membrane filtration and gauze filtration. The membrane filters evaluated included 0.22- and 0.45-micron-pore Millipore filters (Millipore Corp., Bedford, Mass.), 0.2- and 0.4-micron-pore Nuclepore filters (Nucleopore Corp., Pleasanton, Calif.), and a 0.45-micron-pore Zetapor filters (AMF Cuno, Meridian, Conn.). The gauze filters included both Moore and Spira swabs. Of the membrane filters evaluated, the 0.45-micron-pore Millipore and Zetapor filters were the most sensitive for recovery of C. jejuni from seeded waters. The 0.45-micron-pore Millipore filter placed in Oosterom broth was better for recovery of C. jejuni from seeded stationary surface waters than either the Spira or Moore swab. However, the 0.45-micron-pore Millipore filter placed on a plate or in enrichment broth was equivalent to the Spira gauze swab when used to examine water from Atlanta area streams. C. jejuni organisms were isolated from 9 of 24 surface water samples representing 5 of 12 streams.
Campylobacter fetus↗
[Dermatoses in the metallurgy industry].
The authors proceeded to a skin examination of 1,194 consecutive workers in a cutlery industry with 3,692 employees, in order to detect any cutaneous alterations among them. Only 223 (18.7%) had no skin pathology. Most of them, 971 (81.3%) presented some cutaneous disorder, related or not with their work. Hyperkeratosis of the fingers and hands (262 cases) caused by repeated traumas due to the manipulation of the instruments of work were the most noticeable and specific occupational skin alteration. In second place in order of frequency were the intertriginous mycotic inflammation of the toes: 255 cases. The authors call attention to the low incidence of the sexually transmitted diseases as well as of scabies, pediculosis and impetigo.
Adolescent↗
An outbreak of salmonellosis associated with a fatality in a healthy child: a large dose and severe illness.
In June 1982, an outbreak of Salmonella gastroenteritis occurred on a farm in Wyoming. All eight affected persons became severely ill 8-18 hours after they had eaten homemade ice cream. A previously healthy 13-year-old boy died 37 hours after exposure; his mother and four younger siblings were transferred to intensive care units in hospitals in adjoining states, and the remaining two adult males were hospitalized locally. Salmonella typhimurium was isolated from all eight ill persons, from the remaining ice cream, and from the family's hens whose eggs were used in the preparation of the ice cream. All Salmonella contained identical plasmids (60-, 5.6-, and 3.3-megadalton); the ice cream contained 10(6) salmonellae/g and, according to food histories, individuals consumed an estimated dose of between 10(8) and 10(9) organisms. The fatal illness occurred in the boy who had eaten the largest amount of ice cream (10(9) organisms). This report demonstrates that Salmonella can cause fatal illness in previously healthy individuals and that the incubation period and the severity of the illness may be related to the dose.
Adolescent↗
[Chromoblastomycosis caused by a new species: Taeniolella boppii].
The authors report a case of a 51-year-old woman, living in the extreme west of the Santa Catarina State (South of Brazil, near the Argentine border), who presented a vegetating plaque in the foot, associated with inflammatory nodules in the leg, according to the sporotrichoid form of chromoblastomycosis, with a histologic pattern distinct from the commonly observed. In culture the fungus produced exclusively and repeatidly colonies of a Cladosporium type. More detailed studies of the fungus made by Dante Borelli of Venezuela, proved it to be the type of a new species of Dematiaceous mould.
Chromoblastomycosis↗
Campylobacter enteritis associated with foodborne transmission.
During an outbreak of gastrointestinal illness at a boys summer camp in Connecticut in June-July 1980, Campylobacter jejuni was isolated from 16 of 41 ill persons but from none of 63 controls (P less than 0.001). When the indirect fluorescent antibody assay was used, cross-titering serum and isolates from five patients showed all isolates to be identical. Lack of serologic response in culture-negative ill persons suggested that a second etiologic agent may have been involved. Ten convalescent carriers treated with erythromycin had clearance of Campylobacter from their stools within 72 hours. Among 26 camp staff members affected, two clusters of illness were seen, each one week after a birthday party, one party on June 26 and the other on July 2. Eating cake at the parties was significantly associated with illness (p = 0.0002 and p = 0.019, respectively). Eating an edge or corner piece with more icing at one party was associated with illness (p = 0.024). The source of the contamination of the icing was not found. None of 15 ill campers had eaten birthday cake. Although rates of eating salad were not significantly different when ill campers were matched with healthy campers, the relative risk associated with eating salad was 5. Campylobacter was isolated from the hands of an infected staff member who, while ill, prepared salad for the campers.
Adolescent↗
[Dermatoses in the spinning and weaving industry].
In order to detect cutaneous alterations among the workers of a textile industry, the authors proceeded to a dermatologic examination of 1207 persons, with special emphasis on skin conditions of the fingers and toes. The most noticeable and specific alteration related to the work was a linear hyperkeratosis of the lateral aspects of the first and second finger of the right hand--the fingers of prehension--submitted to repeated micro-traumas due to the manipulation of the threads. In second place in order of frequency were the intertriginous inflammation of the toes, due to the high level of temperature and humidity prevalent in some areas of the plant, besides the use of inadequate shoes and socks. Some suggestions are made for reducing the incidence of dermatologic risks.
Adolescent↗
Antibiotics for legionnaires' disease.
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Animals↗
Antibiotic treatment of guinea-pigs infected with agent of Legionnaires' disease.
Erythromycin and rifampicin (rifampin) were able to prevent death of guineapigs given intraperitoneal injections of the agent causing legionnaires' disease. Penicillin, chloramphenicol, tetracycline, and gentamicin showed no significant effect. On the basis of clinical experience and experimental observations, erythromycin is recommended for patients suspected to have legionnaires' disease. Combined therapy with erythromycin and rifampicin may be justified in patients with confirmed legionnaires' disease who are not responding to erythromycin alone or as part of a controlled antibiotic trial among suspected cases during an outbreak of legionnaires' disease.
Administration, Oral↗
[Netherton-Comel's syndrome].
Two cases of the so-called Netherton's syndrome are described and the relevant literature is reviewed. On the author's opinion there exists no relationship between the disease and ichthyosiform dermatoses. It fits more adequately in the group of the "Génodermatoses érythémato-desquamatives circinées variables" of Bazex and Dupré. The syndrome is characterized by the association of two tipical clinical features: "Trichorrhexis invaginata", reported by Netherton and the "Ichthyosis linearis circumflexa", described by Comel. The authors propose therefore the eponymous designation of "Syndrome of Netherton-Comel". As there exists no link with the group of the ichthyosiform dermatoses, the authors suggest the name of "Dyskeratosis figurata variabilis" for the disease described described by Comel.
Adolescent↗
[Therapy of chromoblastomycosis with a new method].
The author proposes a new method of treatment for chromoblastomycosis, using the association of two drugs of confirmed therapeutic activity: amphotericin B and 5-fluorocytosine. The aim was to obtain a synergistic action against the causative fungus. The method consists of the following: 50 mg. of amphotericin B is injected i.v. every other day --three times a week-- for three months. Total dosis: 36 ampoules. 5-fluorocytosine is simultaneously given orally --6 tablets of 500 mg. a day-- for three months in a total dosis of 540 tablets or 270 g. Seventeen patients were treated in this way up to now. Six interrupted the treatment on account of several reasons unrelated to treatment. The other 11 that completed this schedule, obtained clinical and histological cure. All were followed-up. No evidence of relapse was seen, even after 27 months of control. The safety of this method of treatment was demonstrated by the low incidence of side effects as inappetence, lassitude, nausea and weight loss. In these circumstances the discontinuance of the drugs for some days was sufficient to resume the treatment. Apparently this therapeutic schedule is the most effective up to now. It has the advantage of not causing resistance and by utilizing low concentrations of the drugs, protecting the patient against risks of toxicity.
Adult↗
The histoid variety of lepromatous leprosy.
Three cases of the so-called "histoid variety" of lepromatous leprosy are reported. This variety has definite clinical features, associated with characteristic histological and bacteriological findings. Some of the features presented by our patients are similar to those described originally by Wade, especially the resistance to treatment. Considering the discrepancies existing among the authors which studied the subject, our opinion is that further studies should be done in order to elucidate the controversial points,
Adult↗