Neonatal circumcision: a teaching plan to better inform parents.
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Biomedical subjects
Publications and source records attributed to P G Higgins.
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An unusually large outbreak of conjunctivitis caused by adenovirus type 4 involved 113 proved cases during a 7-month period. Though the disease was less severe than is commonly seen in epidemic keratoconjunctivitis caused by other serotypes, the cornea was affected in 23% of cases and symptoms persisted for at least 5 weeks in 6 patients. A concurrent increase in nonocular adenovirus type 4 infections in the Bristol area was not observed. Nine of the cases could have arisen as a result of hospital cross-infection.
Four hundred faecal samples, collected at approximately weekly intervals during the first year of life from nine babies, were examined for the presence of viruses. Only nine (2.3%) samples contained a virus detectable by electron microscopy, and on all but one occasion only one type of virus was present and that in small numbers. Thirty (7.5%) of the specimens contained an enterovirus other than poliovirus, and these represetned 10 infections in four of the children. All three types of poliovirus, probably vaccine derived, were excreted by each child, and one or more types were present in 87 (21.8%) of the samples. There was no evidence to suggest that any of the illnesses suffered by the children had been caused by faecal viruses. Infection with these viruses was uncommon in the first three months of life but more than 40% of faecal samples obtained from children between the ages of 3 months and 1 year contained a faecal virus.
Nineteen cases of keratoconjunctivitis caused by an adenovirus serologically related to types 10 and 19 are described. Seventeen of the patients presented over a period of 7 weeks and included 4 who were involved in a minor outbreak at a factory. The presentation and clinical features closely resembled those caused by adenoviruses types 8 and 19. Mild to severe follicular conjunctivitis, superficial punctate keratitis, discrete subepithelial opacities, membrane formation, and conjunctival scarring were all observed.
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During the period 1961-71 of 1785 viruses isolated from patients in the general population 503 (28%) were rhinoviruses, 465 (26%) influenza viruses, 248 (14%) enteroviruses, 234 (13%) herpes simplex virus, 132 (7%) parainfluenza viruses, 129 (7%) adenoviruses and 49 (3%) respiratory syncytial virus. Also isolated were 18 strains of mumps virus, 7 coronaviruses and 295 streptococci of groups A, C or G.Fluctuations were observed in the frequency with which respiratory syncytial virus, parainfluenza virus type 2, and the adenoviruses were isolated over the 10-year period.Influenza viruses types A and B, parainfluenza viruses types 1 and 2, respiratory syncytial virus, adenoviruses types 3, 4, 6, 7 and 21, and many enteroviruses were all associated with outbreaks.Infections with influenza viruses A and B and parainfluenza viruses types 1 and 2 came during the winter, whereas those with parainfluenza virus type 3, enteroviruses, and rhinoviruses were more frequently seen in the summer and early autumn.
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Seven representative isolates from six outbreaks of acute haemorrhagic conjunctivitis were shown to have the characteristics of enteroviruses. Two viruses differed from the remaining five isolates in producing paralysis in suckling mice and being resistant to 2-hydroxybenzyl-benzimidazole. These two viruses were also closely related antigenically and distinct from the other five viruses which were serologically similar to each other. Neither group of viruses was inhibited by antisera to the known enteroviruses and they probably represent two new enterovirus types one related to the Coxsackie A viruses and the other to the echoviruses.
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In two epidemics of acute enterovirus conjunctivitis the diagnosis could only be established by the use of human embryonic organ cultures. In one instance cultures of ciliated respiratory epithelium proved sensitive to the virus but similar culture failed to support growth of the virus from the second outbreak which was isolated in organ cultures of conjunctiva. The virus associated with a third outbreak had previously been isolated from the original material by culture in human embryo kidney cells, but it required passage in organ culture for its detection after the specimens had been diluted.
Of 129 strains of the Hong Kong variant of influenza A2 virus isolated from 176 respiratory infections, 105 (81.4%) were isolated in tissue culture, the remainder being detected only by the inoculation of fertile hen's eggs. Organ cultures of chick embryo trachea were at least as sensitive as monkey kidney tissue culture for the isolation of this virus but organ cultures of human embryonic ciliated epithelium were much less efficient. The reverse was true for strains of influenza B virus studied in 1970 and 1971 when eggs and chick embryo tracheal organ culture were of little value and organ cultures of human embryonic ciliated epithelium and monkey kidney tissue cultures were the systems of choice.