Biomedical subjects
M Layton
Publications and source records attributed to M Layton.
Fulminant hepatic failure due to Budd Chiari syndrome.
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Malaria surveillance in New York City: 1991-1996.
BACKGROUND: The transmission of malaria has increased in recent years in many countries where it was once eradicated or under control, and malaria remains a major cause of morbidity and mortality throughout the developing world. Imported cases of malaria have been increasing in New York City and throughout the United States during the past decade. The New York City Department of Health has modified its malaria surveillance program in order to improve the assessment of diagnosis and treatment of malaria in New York City residents and to provide appropriate advice to health professionals who treat these patients. OBJECTIVES: To describe the epidemiologic and clinical characteristics of laboratory-confirmed cases of malaria diagnosed in New York City residents from January 1, 1991, through December 31, 1996. METHODS: The retrospective study of case reports was carried out by the Malaria Surveillance Program of the Bureau of Communicable Diseases, New York City Department of Health, New York City, NY. It included the laboratory diagnosis of malaria and the species involved, and included also descriptive epidemiologic information of patients with malaria (age, sex, race/ethnicity, date and place of onset of illness, travel history, immigration status, previous history of malaria, history of blood transfusion, drugs used for treatment or prophylaxis), as well as a record of clinical complications of the infection (thrombocytopenia, hemolysis, anemia, cerebral malaria, renal failure, respiratory distress syndrome, fatal outcome). RESULTS: Malaria was diagnosed in 988 residents of New York City during the 5-year period from January 1, 1991, through December 31, 1995. The largest number of cases, 254 (26%), occurred in 1996, with the majority of these cases (76%) observed between the months of May and October. Sixty-four percent (627) of these cases were males. The age range of cases was from newborn (first day of life) to 83 years (median, 31 years). Of the 962 cases of whom the racial/ethnic identity was known, 580 (59%) were black/non-Hispanic and 255 (26%) were Asian/Pacific Islander. Travel outside of the United States was reported by 958 patients, the majority to Africa (569/958, 59%). Only 139 patients (14%) claimed the use of malaria prophylaxis during travel. Plasmodium falciparum was identified in 505 (51%) and P. vivax in 356 (36%) of the cases. Clinical complications included hemolysis with severe anemia, thrombocytopenia, cerebral malaria, renal failure, and respiratory distress syndrome. All four fatal cases involved infections with P. falciparum, either alone or in combination with another plasmodia species. CONCLUSIONS: Imported cases of malaria occur frequently in New York City and may be associated with serious complications. Health care providers should consider this diagnosis in patients who have recently travelled or arrived from abroad, presenting with headache, fever, and other constitutional symptoms. There are many missed opportunities for the use of malaria prophylaxis, and physicians should familiarize themselves with current recommendations for malaria prophylaxis for travel to areas of the world where people are at risk for the transmission of malaria.
Laboratory survey of drug-resistant Streptococcus pneumoniae in New York City, 1993-1995.
Wide geographic variation in the prevalence of drug-resistant Streptococcus pneumoniae demonstrates the importance of tracking antimicrobial resistance locally. This survey of hospital microbiology laboratories in New York City found that penicillin resistance (MIC > or = 2.0 micrograms/ml) increased from 1.5% of S. pneumoniae isolates in 1993 to 6.3% in 1995 and that in 1995, one-third of isolates nonsusceptible to penicillin (MIC > or = 0.1 microgram/ml) were also nonsusceptible to an extended-spectrum cephalosporin (MIC > or = 1 microgram/ml).
The role of pathology in an investigation of an outbreak of West Nile encephalitis in New York, 1999.
An outbreak of encephalitis occurred in New York City in late August 1999, the first caused by West Nile virus in North America. Histopathologic and immunopathologic examinations performed on human autopsy materials helped guide subsequent laboratory and epidemiologic investigations that led to identification of the etiologic agent.
Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000.
Outbreaks of West Nile (WN) virus occurred in the New York metropolitan area in 1999 and 2000. Nineteen patients diagnosed with WN infection were hospitalized in New York and New Jersey in 2000 and were included in this review. Eleven patients had encephalitis or meningoencephalitis, and eight had meningitis alone. Ages of patients ranged from 36 to 87 years (median 63 years). Fever and neurologic and gastrointestinal symptoms predominated. Severe muscle weakness on neurologic examination was found in three patients. Age was associated with disease severity. Hospitalized cases and deaths were lower in 2000 than in 1999, although the case-fatality rate was unchanged. Clinicians in the Northeast should maintain a high level of suspicion during the summer when evaluating older patients with febrile illnesses and neurologic symptoms, especially if associated with gastrointestinal complaints or muscle weakness.
Widespread West Nile virus activity, eastern United States, 2000.
In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection.