Validity of food consumption histories in a foodborne outbreak investigation.
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Disease Outbreaks↗
Biomedical subjects
M D Decker
Publications and source records attributed to M D Decker.
An outbreak of staphylococcal skin infections among river rafting guides.
Outbreaks of staphylococcal skin infections among healthy adults are most unusual. The authors report an epidemic of skin infections due to Staphylococcus aureus that involved river rafting guides in Tennessee, South Carolina, and North Carolina in summer 1982. Infections occurred only among employees of the rafting companies that provided communal, on-site housing; carriage rates of S. aureus were as high as 89% at those companies. A case-control study found that having had an infected roommate was significantly associated with infection, as was working at the livery with the most crowded housing. This outbreak appeared to be due to two factors: frequent minor skin wounds acquired while rafting, and prolonged close contact among the persons with wounds. It is likely that crowding and exposure to infected wounds led to elevated S. aureus carriage rates, which in turn increased the probability that wounds would become infected. Repeated immersion in water likely enhanced the development of infections.
Adolescent↗
Endocarditis and infections of intravascular devices due to Eikenella corrodens.
Eikenella corrodens, a microaerophilic gram-negative rod, is a normal inhabitant of human mucosal surfaces. Infections involving Eikenella have been reported with increasing frequency during the past 10 years. Despite a demonstrated ability to invade the blood stream, Eikenella has rarely been implicated in endocarditis or other vascular space infections. Two patients are reported with prolonged illness due to infection of peripheral vascular prostheses with E. corrodens and prior reports of Eikenella vascular space infections are reviewed. When Eikenella is the sole infecting organism, vascular space infections tend to be indolent. However, removal of vascular prostheses may be required for cure.
Adult↗
Cat scratch disease: an infection beyond the lymph node.
Cat scratch disease is a cause of regional lymphadenitis that usually pursues a benign course. Most patients with cat scratch disease are children or adolescents. We report an adult patient with cat scratch disease complicated by osteomyelitis of the thoracic spine.
Adult↗
Food-borne streptococcal pharyngitis in a hospital pediatrics clinic.
After a potluck luncheon, more than half the staff of a hospital pediatrics clinics became ill. Group A Streptococcus (M precipitin, nontypable; T agglutination type, 8/25; and serum opacity reaction, positive) was isolated from 12 of the 20 ill persons. Food-consumption analysis implicated a rice dressing as the vehicle of transmission. The dressing was prepared by a clinic employee in whom pharyngitis had developed three weeks before the luncheon. This is an unusual outbreak in that the implicated food product was not institutionally or commercially prepared and was not preponderantly composed of milk, eggs, or meat.
Disease Outbreaks↗
Tularemia and rhabdomyolysis.
Rhabdomyolysis as a complication of tularemia occurred in four patients in Tennessee over a four-year period. All patients were severely ill and had renal failure. Tularemia was not suspected initially in any of these patients. One patient died of complications of rhabdomyolysis. At autopsy, multiple abscesses were present within skeletal muscle, suggesting that rhabdomyolysis resulted from direct muscle involvement with Francisella tularensis. Tularemia should be considered in the differential diagnosis of patients with an acute febrile illness and rhabdomyolysis. Conversely, in patients with acute tularemia, the possibility of rhabdomyolysis should be entertained early, especially in those with evidence of myoglobinuria and/or impaired renal function.
Adult↗
The detection of penicillin-resistant pneumococci. The compliance of hospital laboratories with recommended methods.
Isolations of pneumococci with diminished susceptibility to penicillin have been reported with increasing frequency in recent years. The first reported isolations of such organisms in Tennessee occurred in December 1982, and prompted a survey of acute-care hospitals to determine the methods being used to test pneumococcal isolates for penicillin susceptibility. All 77 acute-care hospitals in Tennessee with 100 or more beds were surveyed. Eighteen (23%) did not test the penicillin susceptibility of any pneumococcal isolates obtained from blood or cerebrospinal fluid. Thirty-eight hospitals (49%) tested some or all such isolates, but did not perform the tests in accord with established standards; 21 (27%) properly tested all such isolates. There was no correlation between the proper testing of pneumococcal isolates for penicillin susceptibility and the mode of governance, numbers of beds, or medical school affiliations of the respondent hospitals. It is recommended that appropriate pneumococcal isolates be tested for penicillin susceptibility. Such testing is most reliably performed by the disk diffusion method, using a 1-microgram oxacillin disk.
Adult↗
The incidence of hepatitis B in Tennessee prisoners.
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Adult↗
Should prisoners be immunized against hepatitis B?
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Hepatitis B↗
The use and efficacy of child restraint devices. The Tennessee experience, 1982 and 1983.
The Tennessee Child Passenger Protection Act, mandating the use of child restraint devices for children younger than 4 years, took effect in 1978. In the years 1978 through 1983, eighty-one children younger than 4 years died in Tennessee traffic accidents; only two were in child restraint devices. During this period, as child restraint device use rose from 8% to more than 30%, the number of deaths among children younger than 4 years declined more than 50%. Analysis of supplemental accident reports filed in investigations of motor vehicle accidents involving children younger than 4 years during 1982 and 1983 showed that child restraint devices are highly effective in preventing death and in preventing or reducing injury. Children not in child restraint devices were 11 times more likely to die in an accident than children in child restraint devices. Children traveling in the arms of an adult were exposed to a risk of injury or death comparable to that of children left entirely unrestrained.
Accident Prevention↗
Seroepidemiology of hepatitis B in Tennessee prisoners.
A prevalence serosurvey was performed on an 11.7% sample of the 6,503 adult male inmates in Tennessee prisons. On the basis of the sample, 0.9% of the prisoners possessed hepatitis B surface antigen, and 29.5% had one or more serum markers for hepatitis B virus (HBV). Thirty-two possible risk factors were analyzed for association with possession of HBV serum markers. The significant risk factors for possession of HBV markers in this population were found to be age, intravenous drug use while not incarcerated, intravenous drug use while incarcerated, race, education, military service history, and duration of prior and current imprisonments, in that order of importance. Given the modest contribution of incarceration to overall risk, mass immunization of prisoners against HBV seems unwarranted. Prisoners with unusually long sentences or who use intravenous drugs in prison are subgroups at particularly high risk. The logistic model can be used to target a serological screening and immunization program.
Adolescent↗
Seroepidemiology of hepatitis A in Tennessee prisoners.
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Adult↗
Gogarty and Joyce.
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History of Medicine↗
Letter: Startle reaction to air-bag restraints.
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Accident Prevention↗
Association of self-reported injury and alcohol consumption in medical outpatients.
OBJECTIVE: This study was designed to examine the association between minor injury and level of alcohol consumption among adult outpatients. DESIGN: Self-administered survey of alcohol use and level of injury in prior month. SETTING: Adult outpatients attending a university-based general internal medicine private practice. PATIENTS/PARTICIPANTS: During a four-month period, 1,011 patients aged 18-65 years were asked to complete questionnaires while waiting to see a physician. The 791 who completed all forms appropriately are included in this study. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The total number of drinks and the total number of injuries reported during the preceding month were calculated. Nondrinkers reported an average of 0.51 (SD = 1.18) injuries in the prior month; and drinkers, 0.92 (SD = 1.70) injuries. Minor injuries were reported more frequently by heavier alcohol consumers only among younger patients (RR = 1.88). There was no association between reported injury and alcohol consumption among patients over 50 years of age (RR = 0.90). CONCLUSIONS: Minor injury is associated with heavier alcohol consumption in younger patients attending a general medical practice, but not among older patients. Further research is needed to establish a causal relationship between alcohol drinking and minor injury.
Adolescent↗