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Biomedical subjects

M L Cartter

Publications and source records attributed to M L Cartter.

At least 37 records · Page 2Linked to original sources
PubMed1995

Cat-scratch disease--Connecticut, 1992-1993.

A prospective population-based surveillance system was established to characterize the epidemiology of cat-scratch disease (CSD) among residents of Connecticut who were reported to the state health department with a diagnosis of suspected CSD. During 1992 and 1993, 246 persons met the case definition, for an average statewide annual incidence of 3.7/100,000 persons. The median age of patients with CSD was 14 years (range, 1-64), and 52% were female. The age-specific attack rate was highest among persons < 10 years of age (9.3/100,000) and decreased with increasing age. Symptoms in addition to adenopathy were noted by 74% of case-patients. Eleven percent of all case-patients were hospitalized. There were no deaths. Most patients with clinically diagnosed CSD developed an immunologic response to Bartonella species. Our data suggest that although CSD is primarily a disease of younger persons, the age spectrum is wider than was commonly appreciated.

Adolescent↗
PubMed1994

Dose-response effects in an outbreak of Salmonella enteritidis.

The effects of ingested Salmonella enteritidis (SE) dose on incubation period and on the severity and duration of illness were estimated in a cohort of 169 persons who developed gastroenteritis after eating hollandaise sauce made from grade-A shell eggs. The cohort was divided into three groups based on self-reported dose of sauce ingested. As dose increased, median incubation period decreased (37 h in the low exposure group v. 21 h in the medium exposure group v. 17.5 h in the high exposure group, P = 0.006) and greater proportions reported body aches (71 v. 85 v. 94%, P = 0.0009) and vomiting (21 v. 56 v. 57%, P = 0.002). Among 118 case-persons who completed a follow-up questionnaire, increased dose was associated with increases in median weight loss in kilograms (3.2 v. 4.5 v. 5.0, P = 0.0001), maximum daily number of stools (12.5 v. 15.0 v. 20.0, P = 0.02), subjective rating of illness severity (P = 0.0007), and the number of days of confinement to bed (3.0 v. 6.5 v. 6.5, P = 0.04). In this outbreak, ingested dose was an important determinant of the incubation period, symptoms and severity of acute salmonellosis.

Adult↗
PubMed1994

A point-source foodborne listeriosis outbreak: documented incubation period and possible mild illness.

Listeria bacteremia occurred in 2 pregnant women whose only common exposure was attendance at a party. The incubation period, the possibility of mild disease due to Listeria infection, and foods associated with risk of disease were evaluated. Ten (28%) of 36 party attenders met a case definition, which included isolation of Listeria monocytogenes from blood or stool or two of the following: fever, musculoskeletal symptoms, nausea, vomiting, diarrhea. One of 25 stool cultures was positive. The 2 blood isolates and 1 stool isolate were serotype 4b and identical by enzyme typing. The incubation periods for illness in the 2 pregnant women were 19 and 23 days. Consumption of large amounts of shrimp, nonalcoholic beverages, Camembert cheese, and cauliflower was significantly associated with illness. Eating shrimp remained a significant risk factor for illness after controlling for consumption of other foods. This study suggests a milder illness may exist in healthy persons who consume foods contaminated with L. monocytogenes and demonstrates a prolonged incubation period for disease.

Adult↗
PubMed1994

Predictors of outcome in methadone programs: effect of HIV counseling and testing.

OBJECTIVE: To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes. DESIGN: Retrospective record review. SETTING: Four methadone maintenance programs in four cities in Connecticut, USA. PARTICIPANTS: Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part. INTERVENTIONS: HIV counseling and testing. MAIN OUTCOME MEASURES: Risk of treatment discontinuation and persistent in-treatment illicit drug use. RESULTS: The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pretreatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54% vs 59%; P = 0.08) but were less likely to show persistent illicit drug use (46% vs 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50% vs 52%), but more often showed persistent illicit drug use (57% vs 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for noncompliance with clinic rules, usually for failing to pay fees. CONCLUSIONS: HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.

AIDS Serodiagnosis↗
PubMed1993

Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test.

BACKGROUND: Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test. METHODS: We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test. RESULTS: We identified 60 patients with cat scratch disease and 56 age-matched subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regression analysis found that in kitten-owning households, patients were more likely than controls to have been scratched or bitten by a cat or kitten (odds ratio, 12.4; 95 percent confidence interval, 1.0 to 150). Of 45 patients, 38 had serum samples with titers of 1:64 or higher for antibody to R. henselae, as compared with 4 of 112 samples from controls (P < 0.001). The positive predictive value of the serologic test was 91 percent. Of 48 serum samples from patients' cats, 39 were positive for antibodies to R. henselae, as compared with positive samples from 11 of 29 control cats (P < 0.001). CONCLUSIONS: Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission. The serologic test for rochalimaea may be useful diagnostically, and our results suggest an etiologic role for this genus.

Adolescent↗
PubMed1993

Foodborne giardiasis in a corporate office setting.

Giardiasis is the most commonly reported intestinal protozoal infection worldwide, but its relatively long incubation period and often insidious onset make detection of common-source outbreaks difficult. Few well-documented foodborne outbreaks of giardiasis have been reported. In November 1990, such an outbreak among insurance company employees resulted in 18 laboratory-confirmed and 9 suspected cases of giardiasis. A case-control study of 26 ill and 162 well employees implicated raw sliced vegetables served in the employee cafeteria and prepared by a food handler infected with Giardia lamblia as the probable vehicle (odds ratio, 5.1; 95% confidence interval, 1.4-22.7). This outbreak illustrates the potential for transmission of Giardia organisms to occur in commercial establishments through a frequently served food item.

Disease Outbreaks↗
PubMed1992

Predictors of outcome in methadone programs: effect of HIV counseling and testing.

OBJECTIVE: To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes. DESIGN: Retrospective record review. SETTING: Four methadone maintenance programs in four cities in Connecticut, USA. PARTICIPANTS: Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part. INTERVENTIONS: HIV counseling and testing. MAIN OUTCOME MEASURES: Risk of treatment discontinuation and persistent in-treatment illicit drug use. RESULTS: The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pre-treatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54 versus 59%; P = 0.08) but were less likely to show persistent illicit drug use (46 versus 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50 versus 52%), but more often showed persistent illicit drug use (57 versus 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for non-compliance with clinic rules, usually for failing to pay fees. CONCLUSIONS: HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.

Adult↗
PubMed1991

Occupational risk factors for infection with parvovirus B19 among pregnant women.

To identify exposures associated with parvovirus B19 infection during pregnancy, two groups of pregnant women were studied during an outbreak of erythema infectiosum (EI). Of 796 pregnant women from Connecticut who were tested serologically because of perceived exposure to B19, 53% (419/796) had serologic evidence of previous B19 infection, and 6% (23/376) of the rest had evidence of recent infection. Of 121 pregnant women who had not requested testing but who lived in a community where a large outbreak of EI had occurred among schoolchildren, 36% (43/121) had serologic evidence of previous infection, and only 3% (2/78) of the rest had had a recent infection. In the exposed group, 479 women returned a supplemental exposure questionnaire. The highest infection rates among susceptible women were for schoolteachers (16%, 10/64), followed by day care workers (9%, 2/22) and homemakers (9%, 4/46). Women working outside the home but not in school or day care settings had the lowest risk (4%, 3/80). This study suggests that there is risk for B19 infection in selected occupational settings and in households.

Child Day Care Centers↗
PubMed1990

Occupational risk of human parvovirus B19 infection for school and day-care personnel during an outbreak of erythema infectiosum.

Human parvovirus B19, the cause of erythema infectiosum, has recently been associated with adverse fetal outcomes. During a large outbreak of erythema infectiosum in Connecticut, a survey was conducted on 571 (90%) of 634 school and day-care personnel to determine the risk of acquiring B19 infection. Serologic evidence of B19 infection was determined by using an enzyme-linked immunosorbent assay. Of the school and day-care personnel, 58% had evidence of previous B19 infection. The minimal rate of B19 infection in susceptible personnel during the outbreak was 19%. The risk was increased for teachers and day-care providers who had contact with younger children and with greater numbers of ill children. These results suggest that B19 infection is an occupational risk for school and day-care personnel.

Adult↗
PubMed1990

Management and outcomes of pregnancies complicated by human B19 parvovirus infection: a prospective study.

During a large statewide outbreak of fifth disease in Connecticut in 1988, 39 pregnant women were identified who had serologic evidence of recent human B19 parvovirus infection. The patients were followed up prospectively with targeted fetal ultrasonographic examinations to detect signs of fetal hydrops. Of these 39 pregnant women, 37 had healthy infants and two patients had miscarriages. None of the fetuses developed hydrops. We propose that pregnant women exposed to B19 parvovirus be tested for evidence of IgG and IgM B19-specific antibodies and that targeted fetal ultrasonography be considered when IgM antibodies are found. Percutaneous umbilical blood sampling and intrauterine transfusion can be considered in cases of B19 parvovirus-associated hydrops and anemia. The overall fetal loss rate in this prospective follow-up group was 5%.

Abortion, Spontaneous↗
PubMed1990

Influenza outbreaks in nursing homes: how effective is influenza vaccine in the institutionalized elderly?

During the 1984-1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p less than .05); only three (14%) vaccinated residents had HI titers of greater than or equal to 40. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.

Adult↗
PubMed1990

Providing HIV counseling and testing services in methadone maintenance programs.

Counseling about AIDS and optional confidential testing for antibody to HIV-1 have been available in state-supported methadone maintenance programs in Connecticut since 1 January 1987. In the first 2 years of the program, 2118 people received pre-test counseling. Overall, 1521 people agreed to anti-HIV-1-antibody testing and 1010 received post-test counseling. Other than the pre- and post-test counseling sessions, a total of 1600 HIV counseling sessions were conducted. This is the first statewide program for providing HIV counseling and testing in methadone maintenance programs in the United States. Our experience suggests that the prevention of both drug use and HIV-1 transmission can be integrated in drug treatment centers.

AIDS Serodiagnosis↗
PubMed1989

The epidemiology of Lyme disease in Connecticut.

The overall incidence for Lyme disease for Connecticut residents in 1988 was 22 per 100,000. The highest rates were among residents of New London (108 per 100,000) and Middlesex Counties (72 per 100,000), although the greatest increase in incidence between 1985 and 1988 occurred among residents of Fairfield County (2 per 100,000 in 1985, 14 per 100,000 in 1988). Lyme disease is a statewide problem; in 1988 cases were reported among residents of 104 of Connecticut's 169 towns and cities. The disease burden in some communities is high with case rates approaching 1% of the population per year. Data from 1977 and 1985 suggest a three- to eightfold increase during that period in the occurrence of Lyme disease in the communities near the mouth of the Connecticut River. Continued reporting of cases with supporting clinical information is needed to improve Lyme disease surveillance and establish disease trends.

Connecticut↗
PubMed1989

Lyme disease prevention--knowledge, beliefs, and behaviors among high school students in an endemic area.

We surveyed 153 high school students in an area highly-endemic for Lyme disease. All students were familiar with Lyme disease; 14 students reported having had the disease. Ninety per cent of students believed tick-avoidance behavior could prevent Lyme disease, but fewer than half reported practicing any preventive behaviors. Students who believed a specific behavior was preventive were 3-6 times more likely than others to practice that behavior. Schools in endemic areas should educate students about Lyme disease.

Connecticut↗