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S D Holmberg

Publications and source records attributed to S D Holmberg.

88 records · Page 5Linked to original sources
PubMed1988

Vibrios and Aeromonas.

There are many similarities in the Vibrionaceae that cause human illness in the United States (see Table 1). Vibrios are characteristically indigenous to marine, estuarine, and brackish environments. They are distributed mainly in Gulf of Mexico coastal water, and these organisms "bloom" when the water is warm. Outbreaks of disease in humans frequently occur in summer, coinciding with multiplication of vibrios in warm water. Sporadic cases and small outbreaks of cholera continue to occur in persons living on or near the Gulf of Mexico, but infection in most persons is unrecognized. In fact, more serious and frequent illnesses result from V. vulnificus wound infections and from gastroenteritis caused by vibrios other than V. cholerae 01. Underlying hepatic or neoplastic disease (especially leukemia) apparently increases the likelihood and severity of illnesses caused by V. vulnificus and Aeromonas. Some Vibrionaceae produce clinical illness by means of enterotoxins identical or similar to cholera toxin. For many others, hemolysins, cytotoxins, and other exotoxins are necessary to produce disease; the importance of these virulence factors often is not known or the importance of these virulence factors often is not known or is of doubtful significance. Also, purported pathogenicity as demonstrated by animal models, such as fluid accumulation in ligated ileal loops, is quite nonspecific and needs to be interpreted cautiously. For Plesiomonas, a mode of pathogenesis has not been discovered. Eating raw shellfish (frequently raw oysters) has been linked epidemiologically to enteric infections with most of these bacteria; foreign travel and exposure to seawater are other frequently observed epidemiologic associations with infection. Foreign travel, particularly to the Yucatan Peninsula of Mexico, has been strongly associated with the acquisition of non-01 V. cholerae and Plesiomonas organisms. Most Vibrionaceae in the United States are susceptible in vitro--and illnesses from them are responsive--to tetracycline, trimethoprim-sulfamethoxazole, and other common antimicrobial agents. However, as for other bacteria that cause diarrhea, the main treatment for uncomplicated disease is the judicious replacement of fluids and electrolytes lost in diarrhea. A loose network of surveilance for these organisms comprises hospital and public health laboratories in Gulf coastal states that plate diarrheal stools on TCBS agar. As recognized pathogens are more assiduously screened for, and as newly identified vibrios are definitely included or excluded as enteric pathogens, the clinical importance of these members of the Vibrionaceae family should become clearer.

Aeromonas↗
PubMed1986

Impact of epidemic cholera in a previously uninfected island population: evaluation of a new seroepidemiologic method.

During an investigation of a 1982 cholera outbreak in Truk, an area without endemic cholera, 254 post-outbreak serum specimens were collected from ill and well inhabitants of a single island. These were compared with 57 specimens collected in Truk in 1964, when heat-labile toxin-producing enterotoxigenic Escherichia coli was presumably endemic but cholera did not exist. The serum was tested for vibriocidal antibody and antitoxic antibodies to cholera toxin and heat-labile toxin and the ratio of the anti-cholera antitoxin to the anti-heat-labile antitoxin was calculated. The prevalences of elevated anti-cholera antitoxin and anti-heat-labile antitoxin levels were similar in both years: an elevated anti-cholera antitoxin was found in 30% of the 1964 and 80% of the 1982 specimens, while an elevated anti-heat-labile antitoxin was found in 40% (1964) and 84% (1982). In contrast, vibriocidal antibody titers were elevated in none of the 1964 but in 64% of the 1982 specimens, and the anti-cholera/anti-heat-labile antitoxin ratio was elevated in 4% (1964) and 42% (1982). The anti-cholera/anti-heat-labile antitoxin ratio appears to differentiate the antitoxic responses to Vibrio cholerae O1 and heat-labile toxin-producing enterotoxigenic E. coli, even in areas where both are prevalent, and should serve as a useful seroepidemiologic tool.

Adolescent↗
PubMed1986

Aeromonas intestinal infections in the United States.

To evaluate the clinical and epidemiologic aspects of aeromonas enteritis, we studied the cases of 34 persons nationwide from whom Aeromonas hydrophila had been isolated in large numbers from stool in 1984. Compared with 68 control subjects, these patients were more likely to have drunk untreated water, usually from private wells (odds ratio = 20.9; p less than 0.01). Eighteen of the isolates belonged to a single DNA-relatedness group of the eight described for Aeromonas species, but no clear correlation between illnesses in patients and any tested genotypic or phenotypic characteristic of recovered organisms was found. Gastrointestinal complaints tended to be chronic in infected adults and acute and severe in children. Nine patients had become ill after taking antimicrobial agents to which recovered Aeromonas species were resistant; 5 persons took antimicrobials to which their Aeromonas strains were susceptible and had alleviation or resolution of their gastrointestinal symptoms. These findings indicate that at least some Aeromonas strains are enteropathogenic for the normal host and that these organisms are acquired by drinking untreated water.

Adult↗
PubMed1986

Plesiomonas enteric infections in the United States.

Thirty-one persons nationwide from whom Plesiomonas shigelloides was isolated in large numbers from stool in 1984 were compared with 62 matched control subjects. Infection with P. shigelloides was strongly associated with eating uncooked shellfish, usually raw oysters, in the 48 hours before the onset of illness (p less than 0.00001) and with foreign travel (p less than 0.00006), usually to Mexico. Most ill persons had self-limited diarrhea with blood and mucus in stool and other clinical findings that suggested enteroinvasiveness of infecting organisms. Two patients developed their illnesses after taking ampicillin for reasons unrelated to diarrhea; plesiomonads recovered from their stools were resistant to ampicillin. Seven persons with gastrointestinal complaints had alleviation or resolution of their symptoms after taking antimicrobial agents to which recovered plesiomonads were susceptible. These findings suggest that P. shigelloides may cause enteric disease in the normal host, that it may be acquired from eating uncooked shellfish, and that it may be a cause of travelers' diarrhea.

Adolescent↗
PubMed1984

Drug-resistant Salmonella from animals fed antimicrobials.

It has been difficult to document the postulated sequence of events that begins with the selection of drug-resistant organisms in animals fed subtherapeutic amounts of antimicrobials and ends with clinically important infections in human beings. In early 1983 we identified 18 persons in four Midwestern states who were infected with Salmonella newport that was resistant to ampicillin, carbenicillin, and tetracycline and characterized by a 38-kilobase R plasmid. Twelve of these patients had been taking penicillin derivatives for medical problems other than diarrhea in the 24 to 48 hours before the onset of salmonellosis. Eleven patients were hospitalized for salmonellosis for an average of eight days, and one had a fatal nosocomial infection. We compared plasmid profiles of all human (six-state area) and animal (United States) S. newport isolates over an 18-month period and examined selected records of meat distribution. The results indicated that the patients had been infected before they took antimicrobials, by eating hamburger originating from South Dakota beef cattle fed subtherapeutic chlortetracycline for growth promotion. This study demonstrates that antimicrobial-resistant organisms of animal origin cause serious human illness, and emphasizes the need for more prudent use of antimicrobials in both human beings and animals.

Adolescent↗
PubMed1984

Animal-to-man transmission of antimicrobial-resistant Salmonella: investigations of U.S. outbreaks, 1971-1983.

The importance and origin of antimicrobial-resistant Salmonella infections were examined in 52 outbreaks investigated by the Centers for Disease Control between 1971 and 1983. The case fatality rate was higher for patients infected with antimicrobial-resistant Salmonella (4.2 percent) than for those with antimicrobial-sensitive infections (0.2 percent). In the 38 outbreaks with identified sources, food animals were the source of 11 (69 percent) of 16 resistant and 6 (46 percent) of 13 sensitive outbreak strains.

Animals↗
PubMed1984

Foodborne transmission of cholera in Micronesian households.

During a cholera epidemic in Truk (Micronesia), in a survey of 1 village, transmission of Vibrio cholerae O1 in the 28 households with illness appeared to be through food contaminated in the home. Households in which the index case was a foodhandler had significantly higher attack rates than households in which the index case was not a foodhandler. Members of households with illness were significantly more likely to become ill if they had eaten food prepared by a foodhandler who had recently been ill. A matched-pair case-control study on several adjacent islands confirmed this relation. Those who had tended an ill person were not at increased risk of cholera in either study. This study suggests that in this outbreak, foodborne transmission of V cholerae O1 was more important than contact spread.

Cholera↗
PubMed1984

Staphylococcal food poisoning in the United States. New facts and old misconceptions.

To determine the current epidemiologic characteristics of staphylococcal food-borne disease (SFD), we reviewed 131 outbreaks reported to the Centers for Disease Control, Atlanta, from 1977 through 1981. Staphylococcal food-borne disease was the second most common cause of reported food-borne illness, affecting more than 7,000 persons during the five-year period; 10% of these patients visited or were admitted to hospitals for their illnesses. The proportion of outbreaks attributable to Staphylococcus aureus enterotoxins A through E has changed, with enterotoxin A being the only toxin incriminated during the last three years of this review. Milk--the most common source of enterotoxin C- and D-producing strains--and commercially packed foods are less common causes of SFD outbreaks now than they were before 1960. However, previously cooked, proteinaceous foods remain preeminent in causing SFD. The presence or absence of fever in infected persons, skin lesions in food handlers, or large numbers of staphylococci in food were unreliable as diagnostic criteria. Thorough epidemiologic investigation remains crucial to identifying SFD and its sources.

Disease Outbreaks↗
PubMed1984

Comparison of plasmid profile analysis, phage typing, and antimicrobial susceptibility testing in characterizing Salmonella typhimurium isolates from outbreaks.

We compared the phage types, antimicrobial resistance patterns, and plasmid profiles of 20 groups of isolates received at the Centers for Disease Control from Salmonella typhimurium outbreaks between 1975 and 1982 to determine the most useful laboratory method for identifying epidemiologically related isolates of S. typhimurium. In 18 (90%) of the 20 outbreaks, epidemiologically related isolates were identified as being the same by each of the three methods. In a subgroup of nine outbreaks in which isolates unrelated to the outbreak were submitted for comparison, outbreak isolates were differentiated from such control isolates six times (67%) by phage typing alone, four times (44%) by antimicrobial susceptibility testing alone, and eight times (89%) by plasmid profile analysis alone. Epidemic isolates were multiply susceptible, nontypable, or without plasmids in 14 (70%), 1 (5%), and 3 (15%), respectively, of the 20 outbreaks. Plasmid analysis appeared to be at least as specific as phage typing in identifying epidemiologically related isolates of S. typhimurium as being the same or in differentiating them from control specimens; both techniques appeared to be superior to antimicrobial susceptibility testing.

Anti-Bacterial Agents↗
PubMed1984

Vibrio fluvialis and Vibrio furnissii isolated from a stool sample of one patient.

Vibrio fluvialis and Vibrio furnissii have been associated with diarrhea but have rarely been isolated in the United States. We received strains of V. fluvialis and V. furnissii that were isolated from the stool of a 1-month-old baby. A description of these two strains and the case history of the patient are given in this report.

Anti-Bacterial Agents↗
PubMed1983

Streptococcal pharyngitis and acute rheumatic fever in Rhode Island.

A comprehensive survey of physicians, laboratories, and hospital records in Rhode Island showed that more than 157,000 throat cultures for a population of 930,000 people were done in 1980. Eighty-seven percent of primary care physicians prescribed antibiotic therapy before culture results were known, and almost 40% continued antibiotic therapy for ten days regardless of culture results. The throat culture positivity rate for beta-hemolytic Streptococcus was 17% statewide in 1980. Only three definite and seven possible cases of acute rheumatic fever were identified by hospital chart reviews and a physician survey covering the five years 1976 through 1980. Current throat culture practices probably have little influence on treatment of streptococcal pharyngitis and control of rheumatic fever in the state.

Acute Disease↗
PubMedDate not supplied

The global distribution of human immunodeficiency virus type 2 (HIV-2) infection.

We reviewed published reports of infection with human immunodeficiency virus type 2 (HIV-2) to provide a picture of its geographic distribution, pathogenicity, modes of transmission, and risk to the blood supply. Since the first reports in 1986, 627 HIV-2-seropositive persons have been reported; 604 of these were in natives of West Africa. Acquired immunodeficiency syndrome (AIDS) had developed in 42 patients, while 8 patients had AIDS-related complex. Transmission by sexual intercourse was the usual reported mode of spread. The modes of transmission of HIV-2 are thought to be the same as those for HIV-1, but perinatal transmission and transmission by sharing of needles among intravenous drug abusers have not yet been reported. The virus has not been identified in blood donors in the United States or West Germany, but two HIV-2-infected blood donors were reported in France. Further epidemiologic studies are needed to define the spectrum of disease, modes of transmission, and risk of HIV-2 to the blood supply.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Epidemiologic characteristics of blood donors with antibody to human immunodeficiency virus.

From March 1985 through July 1986, blood donors who were positive for antibody to human immunodeficiency virus (HIV) were evaluated at three major blood centers in the United States. Of 818,629 donations, 450 (0.05%) were HIV antibody-positive. The seroprevalence decreased from 0.07 to 0.04 percent during the study period, due perhaps to a decline in repeat donors. HIV-seropositive donors tended to be 20 to 29 years old (52%) and male (88%). HIV seroprevalence among white donors (2/10,000 donations) was less than that among Hispanic (9/10,000; p less than 0.0001) and black donors (31/10,000; p less than 0.0001). Of 152 seropositive men interviewed, 77 percent reported sexual contact with men; of this latter group, 53 percent were bisexual. Fifteen (44%) of 34 seropositive women had apparently acquired infection from heterosexual contact, and an equal number denied having any known risk factors for HIV infection. Educational efforts must address women and bisexual men who do not perceive themselves to be at risk for HIV infection and should be specifically designed for the mores of different racial and ethnic groups.

AIDS-Related Complex↗
PubMedDate not supplied

Aeromonas hydrophila and Plesiomonas shigelloides as causes of intestinal infections.

Infections due to Aeromonas hydrophila and Plesiomonas shigelloides in immuno-compromised hosts have been well documented, but the role of these organisms in causing gastrointestinal disease in healthy persons is controversial. Despite difficulties in characterizing the exotoxins produced by Aeromonas species, there is accumulating evidence that these bacteria are capable of causing usually mild, self-limited diarrheal disease in previously healthy adults. Some pediatric patients may have protracted dysenteric symptoms. P. shigelloides, an organism closely related to Aeromonas species, may also cause diarrhea in the healthy host, but no exotoxins have yet been identified by the assays used to identify other bacterial enterotoxins. Replacement of fluid and electrolytes is the basis of treatment, and antimicrobial agents should be reserved for patients with chronic or serious illness, or for those at particular risk of serious illness (hepatobiliary disease, septicemia, neoplasms).

Adolescent↗
PubMedDate not supplied

Health and economic impacts of antimicrobial resistance.

For comparison of the impacts of infections due to antimicrobial-resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria, data were evaluated from 175 published and unpublished reports of investigations of nosocomial and community-acquired infections with selected bacteria. The evaluation of outcomes of hospital-acquired infections with resistant organisms was often confounded by risk factors also associated with poor outcomes. Nevertheless, for both nosocomial and community-acquired infections, the mortality, the likelihood of hospitalization, and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria. Poor outcomes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical problems. Although the adverse economic and health effects of drug-resistant bacterial infections can only be roughly quantified, it is concluded that antimicrobial resistance is an important health problem and an economic burden to society.

Bacterial Infections↗