Biomedical subjects

M Elcock

Publications and source records attributed to M Elcock.

5 recordsLinked to original sources

PubMed1997

Outbreak of drug-resistant tuberculosis with second-generation transmission in a high school in California.

BACKGROUND: In spring 1993, four students in a high school were diagnosed with tuberculosis resistant to isoniazid, streptomycin, and ethionamide. METHODS: To investigate potential transmission of drug-resistant tuberculosis, a retrospective cohort study with case investigation and screening by tuberculin skin tests and symptom checks was conducted in a high school of approximately 1400 students. Current and graduated high-school students were included in the investigation. DNA fingerprinting of available isolates was performed. RESULTS: Eighteen students with active tuberculosis were identified. Through epidemiologic and laboratory investigation, 13 cases were linked; 8 entered 12th grade in fall 1993; 9 of 13 had positive cultures for Mycobacterium tuberculosis with isoniazid, streptomycin, and ethionamide resistance, and all 8 available isolates had identical DNA fingerprints. No staff member had tuberculosis. One student remained infectious for 29 months, from January 1991 to June 1993, and was the source case for the outbreak. Another student was infectious for 5 months before diagnosis in May 1993 and was a treatment failure in February 1994 with development of rifampin and ethambutol resistance in addition to isoniazid, streptomycin, and ethionamide. In the fall 1993 screening, 292 of 1263 (23%) students tested had a positive tuberculin skin test. Risk of infection was highest among 12th graders and classroom contacts of the two students with prolonged infectiousness. An additional 94 of 928 (10%) students tested in spring 1994 had a positive tuberculin skin test; 22 were classroom contacts of the student with treatment failure and 21 of these had documented tuberculin skin test conversions. CONCLUSION: Extensive transmission of drug-resistant tuberculosis was documented in this high school, along with missed opportunities for prevention and control of this outbreak. Prompt identification of tuberculosis cases and timely interventions should help reduce this public health problem.

Adolescent↗

PubMed1997

Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents.

For persons infected with Mycobacterium tuberculosis resistant to isoniazid (INH), rifampin is recommended for the prevention of active disease. However, the adverse effects and acceptability of this preventive therapy are largely uncharacterized. We prospectively followed 157 high-school students exposed to, and probably infected with, M. tuberculosis strains resistant to INH. All 157 students were prescribed preventive therapy with rifampin (10 mg/kg up to 600 mg daily) for 24 wk. While receiving therapy, 41 (26%) reported one or more adverse effects; of these, 18 had therapy interrupted temporarily, two permanently. Four (2.5%) had alanine aminotransferase elevations greater than two times the upper limit of normal (range, 91 to 161 U/L); of these, one had therapy permanently stopped. Six (3.8%) self-discontinued therapy. No student was found to have active disease during the 2 yr of the study (exact 95% upper confidence limit, 2.2). We assumed that without preventive therapy, seven cases of tuberculosis would have occurred during these 2 yr. Therefore, we estimated that rifampin had a minimum protective effect of 56%. In conclusion, preventive therapy with rifampin was well tolerated and well accepted, and it appears effective in preventing active tuberculosis.

Adolescent↗

PubMed1995

Artificial implants and soft tissue sarcomas.

The carcinogenic potential of artificial implants has been of concern in recent years. Case reports and animal studies, dating back to the 1950s, have reported possible associations between artificial implants and soft tissue sarcomas, but epidemiologic data have been lacking. In a recent study of soft tissue sarcomas and military service, data on artificial implants were collected but not presented. This paper examines a possible association between artificial implants and soft tissue sarcomas.

Confidence Intervals↗

PubMed1993

Update on artificial sweeteners and bladder cancer.

Review of the most recent epidemiologic studies indicates there is no detectable association between artificial sweetener consumption and bladder cancer. The summary relative risk from a meta-analysis of all case-control studies approaches unity (RR .97). This analysis, in combination with new evidence for a unique mechanism of saccharin carcinogenicity in the male rat, leads to the conclusion that saccharin is not related to bladder cancer in humans.

Animals↗

PubMed1993

Active AIDS surveillance: hospital-based case finding in a metropolitan California county.

OBJECTIVES: Health departments that use passive surveillance alone cannot be sure of the level of complete and accurate reporting of acquired immunodeficiency syndrome (AIDS) cases. We sought to develop a model of active AIDS case reporting using limited county resources. METHODS: A validation study of AIDS case reporting using discharge diagnosis codes was undertaken to assess underreporting. Hospital-specific protocols for active surveillance were developed. RESULTS: The validation study revealed that 24% of AIDS cases in all hospitals were not reported through passive surveillance in 1990. In the first 3 months of 1991, active surveillance identified nine unreported cases (69% of the total cases reported) in one hospital. These underreporting estimates far exceed the 15% national underreporting rate estimated by the Centers for Disease Control. CONCLUSIONS: A method of hospital-based case finding was developed and serves as the model for implementing an ongoing program of active surveillance needed to ensure complete, accurate, and timely reporting of diagnosed AIDS cases. Application of this model may be helpful in attempts to minimize underreporting.

Acquired Immunodeficiency Syndrome↗