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Biomedical subjects

P C Fleming

Publications and source records attributed to P C Fleming.

5 recordsLinked to original sources

A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli serotype O157:H7.

All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli O157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-to-person transmission could not be ruled out. The source of the infection was not identified.

Bacterial Toxins

Campylobacter enteritis.

Campylobacter jejuni/coli has recently become recognized as a common bacterial cause of diarrhea. Infection can occur at any age. The usual incubation period of campylobacter enteritis is 2 to 5 days. Fever, diarrhea and abdominal pain are the most common clinical features. The stools frequently contain mucus and, a few days after the onset of symptoms, frank blood. Significant vomiting and dehydration are uncommon. A rapid presumptive laboratory diagnosis may be made during the acute phase of the illness by direct phase-contrast microscopy of stools. Isolation of the organism from stools requires culture in a selective medium containing antibiotics and incubation under reduced oxygen tension at 42 degrees C. The organism persists in the stools of untreated patients for up to 7 weeks following the onset of symptoms. Erythromycin may produce a rapid clinical and bacteriologic cure, and should be used to treat moderately to severely ill patients as well as patients with compromised host defences. The emergence of erythromycin-resistant strains requires close monitoring. The epidemiologic aspects of campylobacter enteritis will be fully understood only when methods become available for differentiating strains of C. jejuni/coli. The historical background and current knowledge of campylobacter enteritis are reviewed in this paper.

Animals

Campylobacter enteritis in children.

In 37 children with Campylobacter enteritis seen over a 6-month period, ages ranged from 2 weeks to 15 years. The sex ratio (male:female) was three:two. Fever, diarrhea, and bloody stools occurred in about 90% of patients. Blood appeared in the stools characteristically 2 to 4 days after onset of symptoms. Over 90% of older children developed abdominal pain. Vomiting was mild and occurred in 30% of patients. Dehydration was not a feature. Infection occurred in all social classes and was not associated with parental occupation, travel, or animal contact. The illness often presented characteristically and a rapid laboratory diagnosis could be made in patients presenting acutely by direct phase-contrast microscopy of stools. The organism persisted in the stools for up to seven weeks in untreated patients, but could no longer be cultured after 48 hours of therapy with erythromycin, to which all strains were highly sensitive. Significant serologic responses were elicited using a serum bactericidal assay. The Skirrow-type selective medium used by us could be improved by increasing the concentration of polymyxin B sulfate to 5 microgram/ml.

Adolescent

O-serotyping Providencia alcalifaciens.

The O-serotyping scheme for Providencia was tested on Providencia alcalifaciens isolates collected mostly from two hospitals. The specificites of the somatic (O) antigens of P. alcalifaciens were found to be different from those of Providencia stuartii, and separation of the Providencia typing scheme to allow separate typing of each species led to more efficient typing. All but 4 of 86 isolates were typable. Eighteen serotypes occurred among 53 typable isolates obtained from a pediatric hospital, and 11 occurred among 19 isolates from a general hospital. Thirty-two percent of the isolates from the pediatric hospital belonged to serotype O3, the most frequently isolated and most widely distributed type. The use of the serotyping scheme for P. alcalifaciens is advocated for further studies to examine strains of the species for enteropathogenic types.

Agglutination Tests