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D D Juranek

Publications and source records attributed to D D Juranek.

At least 19 recordsLinked to original sources
PubMed1999

Declining CD4+ T-lymphocyte counts are associated with increased risk of enteric parasitosis and chronic diarrhea: results of a 3-year longitudinal study.

From January 1991 through September 1994, we observed people who were infected with HIV to assess the impact of enteric parasite-associated diarrhea. Respondents answered comprehensive questionnaires covering clinical and epidemiologic information and provided stool specimens monthly, which were examined unstained as well as stained with trichrome, chromotrope 2R, and with Kinyoun carbol-fuchsin, and with indirect immunofluorescence for Cryptosporidium. In all, 602 participants, who were interviewed, provided stool specimens at 3254 monthly visits. Parasites were associated with 50 of 354 (14.1%) acute diarrheal episodes (lasting < or = 28 days) and with 97 of 279 (34.8%) chronic episodes (lasting > 28 days). A parasite was associated with 31 of 222 (14.0%) episodes that occurred when CD4+ counts were > or = 200 cells/microl and with 150 of 566 (26.5%) episodes that occurred when CD4+ counts were < 200 cells/microl. The most commonly identified parasite was C. parvum, which was associated with 18 of 354 (5.1%) acute episodes and 36 (12.9%) of the 279 chronic episodes of diarrhea. In this patient population, enteric protozoan parasites were commonly associated with illness, particularly as immunosuppression worsened, and were more likely to be associated with chronic rather than acute diarrhea.

AIDS-Related Opportunistic Infections↗
PubMed1999

Detection by enzyme immunoassay of serum immunoglobulin G antibodies that recognize specific Cryptosporidium parvum antigens.

Human infection with Cryptosporidium parvum usually elicits characteristic immunoglobulin G (IgG), IgA, and IgM antibody responses against two sporozoite surface antigens with apparent molecular masses of approximately 27 and 17 kDa. We have determined that these two antigens are actually complex families of related antigens. We have developed two new enzyme-linked immunosorbent assays (ELISAs) for the detection and quantitation of serum IgG antibodies against both antigens. The assays utilize a recombinant form of the 27-kDa antigen and a partially purified native fraction isolated from sonicated whole oocysts that contains 17-kDa antigen. An immunoblot assay previously developed in our laboratory served as the reference, or "gold standard," seroassay for the assessment of the new ELISAs. Positive responses with the recombinant-27-kDa-antigen ELISA were correlated with the immunoblot results for the 27-kDa antigen, with a sensitivity and specificity of 90 and 92%, respectively. Similarly, positive responses with the partially purified native-17-kDa-antigen ELISA correlated with the immunoblot results for the 17-kDa antigen, with a sensitivity and specificity of 90 and 94%, respectively. For both ELISAs the median IgG antibody levels for serum sets collected during outbreaks of waterborne C. parvum infection were at least 2.5-fold higher than the levels determined for a nonoutbreak set. Using the immunoblot as the "gold standard," the new ELISAs were more specific and, in the case of the 27-kDa-antigen ELISA, more sensitive than the crude oocyst antigen ELISA currently in use. These assays will be useful in future epidemiologic studies.

Animals↗
PubMed1998

A survey of risk factors for cryptosporidiosis in New York City: drinking water and other exposures.

We conducted a survey to determine the prevalence of known and theoretical exposure risks for cryptosporidiosis among selected New York City residents. Subjects were recruited from outpatients attending either a practice for persons with HIV infection (n=160), or other medical practices (n=153), at The New York Hospital-Cornell Medical Center. Despite a greater concern for waterborne infection, 82% of HIV-infected subjects reported consuming municipal tap water compared to 69% of subjects from other medical clinics (OR 2.1, 95% Cl 1.2-3.6, P=0.006). Although 18% and 31% of subjects, respectively, denied any tap water consumption at home or work, all but one from each cohort responded positively to having at least one possible alternate source of tap water ingestion such as using tap water to brush teeth or drinking tap water offered in a restaurant. 78% and 76% of subjects, respectively, had at least one potential risk for exposure other than municipal water consumption, such as swimming in pools or contact with animals. Our findings indicate that it is possible to stratify the population into subsets by the amount of tap water consumed. This suggests that an observational epidemiologic study of the risk of contracting cryptosporidiosis from everyday tap water consumption is feasible.

Adult↗
PubMed1997

Impact of a massive waterborne cryptosporidiosis outbreak on child care facilities in metropolitan Milwaukee, Wisconsin.

OBJECTIVE: We describe the impact of the 1993 waterborne cryptosporidiosis outbreak on metropolitan Milwaukee child care homes and centers. METHODS: Information on outbreak-related illness and changes in policies and practices was collected from directors of 117 facilities. Stool specimens from 129 diapered children from 11 centers were screened for Cryptosporidium. RESULTS: Most (74%) facility directors reported children or staff with diarrhea during the outbreak; however, only 4 (3.4%) facilities closed because of illness among staff or children. During the outbreak child care homes were less likely to exclude children with diarrhea than were child care centers. Among diapered children attending centers the Cryptosporidium prevalence was 30%; 29% of infected children had no history of diarrhea associated with the Milwaukee outbreak. CONCLUSIONS: Facilities continued to operate during the outbreak despite considerable illness among children and staff. The news media were effective means for providing public health information to child care facilities. Although secondary transmission undoubtedly took place in child care facilities, the presence of children with asymptomatic Cryptosporidium infections did not result in an increased risk of diarrhea in infant and toddler rooms.

Adult↗
PubMed1996

Surveillance for waterborne-disease outbreaks--United States, 1993-1994.

PROBLEM/CONDITION: Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance system for collecting and periodically reporting data that relate to occurrences and causes of waterborne-disease outbreaks (WBDOs). REPORTING PERIOD COVERED: This summary includes data for January 1993 through December 1994 and for previously unreported outbreaks in 1992. DESCRIPTION OF THE SYSTEM: The surveillance system includes data about outbreaks associated with water intended for drinking (i.e., drinking water) and those associated with recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and voluntarily reporting them to CDC on a standard form. RESULTS: For the 2-year period 1993-1994, 17 states and one territory reported a total of 30 outbreaks associated with drinking water. These outbreaks caused an estimated 405,366 persons to become ill, including 403,000 from an outbreak of cryptosporidiosis in Milwaukee, the largest WBDO ever documented in the United States, and 2,366 from the other 29 outbreaks. No etiologic agent was identified for five (16.7%) of the 30 outbreaks. The protozoan parasites Giardia lamblia and Cryptosporidium parvum caused 10 (40.0%) of the 25 outbreaks for which the etiologic agent was identified. Two outbreaks of cryptosporidiosis occurred in large metropolitan areas (i.e., Milwaukee and Las Vegas/Clark County) and were associated with deaths among immunocompromised persons. The waterborne nature of these two outbreaks was not recognized until at least 2 weeks after the onset of the Milwaukee outbreak and until after the end of the Las Vegas outbreak. Campylobacter jejuni was implicated for three outbreaks and the following pathogens for one outbreak each: Shigella sonnei, Shigella flexneri, non-O1 Vibrio cholerae (in a U.S. territory; the vehicle was commercially bottled water), and Salmonella serotype Typhimurium (the outbreak was associated with seven deaths). Eight outbreaks of chemical poisoning were reported: three were caused by lead (one case each), two by fluoride, two by nitrate and one by copper. Twenty (66.7%) of the 30 outbreaks were associated with a well-water source. Fourteen states reported a total of 26 outbreaks associated with recreational water, in which an estimated 1,714 persons became ill. Fourteen (53.8%) of these 26 were outbreaks of gastroenteritis. The etiologic agent in each of these 14 outbreaks was identified; 10 (71.4%) were caused by G. lamblia or C. parvum. Six of these 10 were associated with chlorinated, filtered pool water, and three with lake water. One of the latter was the first reported outbreak of cryptosporidiosis associated with the recreational use of lake water. Four outbreaks of lake water-associated bacterial gastroenteritis were reported, two caused by S. sonnei, one by S. flexneri, and one by Escherichia coli O157:H7. Nine outbreaks of hot tub- whirlpool-, or swimming pool-associated pseudomonas dermatitis were reported. Two outbreaks of swimming pool-associated dermatitis had a suspected chemical etiology. The child who had the one reported case of primary amebic meningoencephalitis, caused by infection with Naegleria fowleri, died. INTERPRETATION: The number of WBDOs reported annually has been similar for each year during 1987-1994, except for an increase in 1992. Protozoan parasites, especially C. parvum and G. lamblia, remain important etiologic agents of WBDOs. The outbreaks of cryptosporidiosis in Milwaukee and Las Vegas demonstrate that WBDOs can occur in large metropolitan areas. Surveillance methods are needed that expedite the detection of WBDOs and the institution of preventive measures (e.g., boil-water advisories). ACTIONS TAKEN: Surveillance data that identify the types of water systems, their deficiencies, and the etiologic agents associated with outbreaks are used to evaluate the adequacy of current technologies for prov

Animals↗
PubMed1996

Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment.

OBJECTIVE: To determine the magnitude and source of an outbreak of cryptosporidiosis among persons with human immunodeficiency virus (HIV) infection and to determine whether the outbreak extended into the immunocompetent population. DESIGN: Matched case-control study and environmental investigation. SETTING: Clark County, Nevada. PARTICIPANTS: Adults with HIV infection (36 case-patients with laboratory-confirmed Cryptosporidium parvum infection and 107 controls), matched by physician or clinic and by CD4+ cell count category. MEASUREMENTS: Potential risk factors for infection, death rates, and data on water quality. RESULTS: Review of surveillance and microbiology records identified 3 cases of cryptosporidiosis in 1992 (the first year that cryptosporidiosis was reportable in Nevada), 23 cases in 1993, and 78 cases in the first quarter of 1994. Of the 78 laboratory-confirmed cases in the first quarter of 1994, 61 (78.2%) were in HIV-infected adults. Of these 61 adults, 32 (52.5%) had died by 30 June 1994; at least 20 of the 32 (62.5%) had cryptosporidiosis listed on their death certificates. In the case-control study, persons who drank any unboiled tap water were four times more likely than persons who drank only bottled water to have had cryptosporidiosis (odds ratio, 4.22 [95% Cl, 1.22 to 14.65]; P = 0.02). For persons with CD4+ cell counts less than 100 cells/mm3, the association between tap water and cryptosporidiosis was even stronger (odds ratio, 13.52 [Cl, 1.78 to 102.92]; P = 0.01). Additional data indicate that this outbreak also affected persons who were not infected with HIV. No elevated turbidity values or coliform counts and no Cryptosporidium oocysts were found in testing of source (Lake Mead) or finished (treated) water during the study period, but so-called presumptive oocysts were intermittently found after the investigation in samples of source water, filter backwash, and finished water. CONCLUSIONS: A cryptosporidiosis outbreak was associated with municipal drinking water, despite state-of-the-art water treatment and water quality better than that required by current federal standards. This outbreak highlights the importance of surveillance for cryptosporidiosis and the need for guidelines for the prevention of water-borne-Cryptosporidium infection among HIV-infected persons.

Adolescent↗
PubMed1996

Reduction of risk of watery diarrhea with point-of-use water filters during a massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin, 1993.

The occurrence of a massive waterborne outbreak of Cryptosporidium infection in Milwaukee, Wisconsin provided an opportunity to evaluate the effectiveness of point-of-use home water filters in preventing diarrheal illness associated with Cryptosporidium infection. Of 155 filter owners who responded to a televised request to contact the City of Milwaukee Health Department, 99 (64%) completed a self-administered questionnaire regarding their sources of drinking water, the characteristics of their home water filters, and diarrheal illness during the outbreak. Diarrhea among respondents was independently associated with residence in southern or central Milwaukee (the area served by the implicated South water treatment plant), having a home water filter with a pore diameter of greater than 1 micron, and drinking unfiltered tap water in a public building in southern Milwaukee. Among residents of southern and central Milwaukee, two (18%) of 11 persons who drank only submicron-filtered water at home and who did not drink unfiltered South plant water at work had watery diarrhea, compared with 50% (n = 2), 63% (n = 35), and 80% (n = 15) who reported drinking South plant water that was unfiltered or passed through a filter with a pore diameter > 1 micron at work only, home only, or both home and work, respectively (P = 0.02). The data indicate that use of submicron point-of-use water filters may reduce risk of waterborne cryptosporidiosis.

Adult↗
PubMed1995

Cryptosporidiosis: sources of infection and guidelines for prevention.

Cryptosporidium parvum is an important emerging pathogen in the United States and a cause of severe, life-threatening disease in patients with AIDS. No safe and effective form of specific treatment for cryptosporidiosis has been identified to date. The parasite is transmitted by ingestion of oocysts excreted in the feces of infected humans or animals. The infection can therefore be transmitted from person to person through ingestion of contaminated water (drinking water and water used for recreational purposes) or food, from animal to person, or by contact with fecally contaminated environmental surfaces. Outbreaks associated with all of these modes of transmission have been documented. Patients with human immunodeficiency virus infection should be made more aware of the many ways that Cryptosporidium species are transmitted, and they should be given guidance on how to reduce the risk of exposure. This article summarizes existing data on the various modes of transmission. It includes an in-depth look at waterborne transmission because as more research data are made available to the public, physicians will increasingly be asked by patients about the importance of this source of infection compared with other sources of infection.

AIDS-Related Opportunistic Infections↗
PubMed1994

Severe giardiasis in the United States.

Giardia lamblia is a common gastrointestinal pathogen but is not generally appreciated as a cause of severe illness. To describe the epidemiology of severe giardiasis, we reviewed data on hospital discharges from the United States and the state of Michigan and compared results for giardiasis with those for shigellosis. From 1979 to 1988, an estimated 4,600 persons were hospitalized for giardiasis annually in the United States; the incidence of giardiasis was 2.0 hospitalizations per 100,000 persons, compared with 2.4 hospitalizations per 100,000 persons for shigellosis. Rates of giardiasis were highest among children younger than 5 years old and women of childbearing age; the median length of hospital stay was 4 days (annual total, 23,238 days). Among residents of Michigan from 1983 to 1987, the average annual incidence of hospitalization was 1.4 per 100,000 persons for giardiasis, compared with 1.0 per 100,000 persons for shigellosis. Volume depletion was the most frequently listed codiagnosis (33.2%); 18.7% of children younger than 5 years old who had severe giardiasis had failure to thrive. Physicians should consider the diagnosis of giardiasis for persons with severe gastrointestinal illness.

Adolescent↗
PubMed1994

Infections with intestinal parasites in Peace Corps volunteers in Guatemala.

To assess the role of parasites in causing diarrhea in Peace Corps volunteers in Guatemala, 115 stool specimens from a case-control investigation (48 case [diarrhea] and 26 control episodes) were examined. A potentially pathogenic protozoan that could account for diarrheal illness was found for only 12% of the case episodes.

Adult↗
PubMed1994

Intestinal parasitism in the United States: update on a continuing problem.

To document patterns of intestinal parasitism in the United States, we analyzed results of 216,275 stool specimens examined by the state diagnostic laboratories in 1987; parasites were found in 20.0%. Percentages were highest for protozoans: Giardia lamblia (7.2%), Entamoeba coli and Endolimax nana (4.2% each), Blastocystis hominis (2.6%), and Entamoeba histolytica (0.9%). The most commonly identified helminths were nematodes: hookworm (1.5%), Trichuris trichiura (1.2%), and Ascaris lumbricoides (0.8%). Identifications of G. lamblia increased broadly from the 4.0% average found in 1979, with 40 states reporting increases and seven reporting decreases. Seasonally, Giardia identifications increased in the summer and fall, especially in the Midwest. Nine states reported hookworms in more than 2% of specimens; none were states with indigenous transmission. We analyzed similar, but abbreviated, data for 1991; parasites were found in 19.7% of the 178,786 specimens and Giardia was found in 5.6%. States reporting percentages of Giardia identification in the highest quartile for both 1987 and 1991 were located in the Midwest or in the Northwest. Cryptosporidium was identified in both the 1987 and 1991 surveys; it had not been identified in a previous survey. For each year, Cryptosporidium was reported from 25 states across the country (for both years in 17 states). We conclude that intestinal parasitism should not be overlooked as a cause of gastrointestinal illness in the United States and that the prevalence of Giardia may be increasing.

Animals↗
PubMed1993

Surveillance for waterborne disease outbreaks--United States, 1991-1992.

PROBLEM/CONDITION: Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance program for collection and periodic reporting of data on the occurrence and causes of waterborne disease outbreaks. REPORTING PERIOD COVERED: January 1991 through December 1992. DESCRIPTION OF SYSTEM: The surveillance system includes data about outbreaks associated with water intended for drinking and also about those associated with recreational water. State and local public health departments are the agencies with primary responsibility for the detection and investigation of outbreaks. State and territorial health departments report these outbreaks to CDC on a standard form. RESULTS: For the 2-year period 1991-1992, 17 states and territories reported 34 outbreaks associated with water intended for drinking. The outbreaks caused an estimated 17,464 persons to become ill. A protozoal parasite (Giardia lamblia or Cryptosporidium) was identified as the etiologic agent for seven of the 11 outbreaks for which an agent was determined. Five (71%) of the outbreaks caused by protozoa were associated with a surface-influenced groundwater source. One outbreak of cryptosporidiosis was associated with filtered and chlorinated surface water. Shigella sonnei and hepatitis A virus were implicated in one outbreak each; both were linked to consumption of contaminated well water. Two outbreaks due to acute chemical poisoning were reported; one had an associated fatality. No etiology was established for 23 (68%) of the 34 outbreaks, including the largest one reported during this period, in which an estimated 9,847 persons using a filtered surface water supply developed gastroenteritis. Most (76%) of the 34 outbreaks were associated with a well water source. Twenty-one states reported 39 outbreaks associated with recreational water, in which an estimated 1,825 persons became ill. The most frequently reported illness was hot tub- or whirlpool-associated Pseudomonas dermatitis (12 outbreaks). Of 11 outbreaks of swimming-associated gastroenteritis, six were caused by Giardia or Cryptosporidium, including three outbreaks associated with chlorinated, filtered pool water. The first reported outbreak of Escherichia coli O157:H7 infection associated with recreational exposure occurred during this period. Primary amebic meningoencephalitis, caused by Naegleria fowleri infection, resulted in six deaths. INTERPRETATION: The number of waterborne disease outbreaks reported per year has not changed substantially in the past 5 years. However, etiologic agents only recently associated with waterborne disease, such as E. coli O157:H7 and Cryptosporidium, are being reported more frequently and from new settings. Water quality data for outbreaks during the period 1991-1992 indicate that available water disinfection technology is not always in place or used reliably.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1993

Babesiosis in Washington State: a new species of Babesia?

OBJECTIVE: To characterize the etiologic agent (WA1) of the first reported case of babesiosis acquired in Washington State. DESIGN: Case report, and serologic, molecular, and epizootiologic studies. SETTING: South-central Washington State. PATIENT: A 41-year-old immunocompetent man with an intact spleen who developed a moderately severe case of babesiosis. MEASUREMENTS: Serum specimens from the patient were assayed by indirect immunofluorescent antibody (IFA) testing for reactivity with seven Babesia species and with WA1, which was propagated in hamsters inoculated with his blood. A Babesia-specific, ribosomal-DNA (rDNA) probe was hybridized to Southern blots of restriction-endonuclease-digested preparations of DNA from WA1, Babesia microti, and Babesia gibsoni. Serum specimens from 83 family members and neighbors were assayed for IFA reactivity with WA1 and B. microti. Small mammals and ticks were examined for Babesia infection. RESULTS: The patient's serum had very strong IFA reactivity with WA1, strong reactivity with B. gibsoni (which infects dogs), but only weak reactivity with B. microti. DNA hybridization patterns with the rDNA probe clearly differentiated WA1 from B. gibsoni and B. microti. Four of the patient's neighbors had IFA titers to WA1 of 256. The tick vector and animal reservoir of WA1 have not yet been identified, despite trapping 83 mammals and collecting 235 ticks. CONCLUSIONS: WA1 is morphologically indistinguishable but antigenically and genotypically distinct from B. microti. Some patients elsewhere who were assumed to have been infected with B. microti may have been infected with WA1. Improved serodiagnostic and molecular techniques are needed for characterizing Babesia species and elucidating the epidemiology of babesiosis, an emergent zoonosis.

Adolescent↗
PubMed1993

American cutaneous leishmaniasis in U.S. travelers.

OBJECTIVE: To characterize the exposures and practices of U.S. travelers who acquired cutaneous leishmaniasis in the Americas and to highlight problems they encountered in seeking medical care from U.S. physicians. DESIGN: A retrospective review of Centers for Disease Control and Prevention Drug Service records and a telephone survey of patients. PATIENTS: Fifty-nine civilian U.S. travelers with American cutaneous leishmaniasis for whom the Drug Service released sodium stibogluconate between 1 January 1985 and 30 April 1990; 58 travelers (98%) were interviewed. MAIN MEASUREMENTS: Travel destination, exposure duration, knowledge about leishmaniasis, and time from noticing skin lesions to release of drug. RESULTS: Overall, travelers acquired leishmaniasis in as many as 14 countries; 33 of 59 travelers (56%) were infected in Mexico or Central America. Twenty-seven travelers (46%) were conducting field studies and 23 (39%) were tourists, visitors, or tour guides. At least 15 persons (26% of the 58 interviewed travelers) were in forested areas for 1 week or less; at least 6 of these persons had a maximum exposure of 2 days. Ten persons (17%) were home at least 1 month before they noticed skin lesions. Patients consulted from one to seven physicians (mean, 2.1 physicians) before leishmaniasis was diagnosed. Overall, the median time from noticing lesions to the release of drug was 112 days (range, 13 to 1022 days); however, the median was only 55 days for 13 patients (22%) unusually knowledgeable about leishmaniasis and was a maximum of 60 days for 16 patients (28%) (including 7 of the 13 unusually knowledgeable patients) who generally consulted physicians exceptionally knowledgeable about infectious and tropical diseases. CONCLUSIONS: Travelers to forested areas in Mexico and Central and South America and their physicians need to be educated about the risk for acquiring leishmaniasis even during short stays, as well as about effective preventive measures; and appropriate medical management [corrected].

Adolescent↗
PubMed1993

Increased exposure to cryptosporidia among dairy farmers in Wisconsin.

Cryptosporidium infection is an important cause of diarrhea in humans and livestock; no effective therapy is known. A self-administered questionnaire and an ELISA were used to assess the risk of exposure to cryptosporidia among 70 dairy farmers and 50 who were not dairy farmers in Wisconsin. Dairy farmers (44.3%) were more likely to be seropositive for cryptosporidia than were other persons (24.0%; relative risk = 1.9). Among dairy farmers, age > or = 50 and use of a canister method of milking were associated with seropositive status. Among persons who were not dairy farmers, feeding or milking cows was associated with being seropositive. These findings suggest that dairy farmers and other persons who have contact with cattle are at greater risk of Cryptosporidium infection than are persons who do not have such contact. Identification and avoidance of farming practices associated with Cryptosporidium infection may reduce the risk of infection among dairy farmers.

Adult↗