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Recovery of hepatitis A virus from a water supply responsible for a common source outbreak of hepatitis A.

An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis A. Well water samples were collected 3 months after illness onset in the index case and 28 days after illness onset in the last trailer park resident. Hepatitis A virus antigen (HAVAg) was detected in the samples by enzyme immunoassay from three of the five cell lines following two 30-day passages and from a fourth cell line following a third passage of 21 days.

Adult

Human West Nile virus lineage 2 neuroinvasive infection as a cause of fatal Guillain-Barré syndrome.

BACKGROUND: West Nile virus (WNV) is now endemic in Europe and continues to spread to several countries, with strains 1 and 2 primarily responsible for outbreaks. According to the European Centre for Disease Prevention and Control (ECDC), Italy accounts for the majority of locally acquired cases and West Nile neuroinvasive disease (WNND). CASE REPORT: We present the first case described in Italy and Europe of WNND-related Guillain-Barré syndrome (GBS). Phylogenetic analysis showed that the genome belonged to the WNV-2, sublineage 2a, clustering within sequences from genomes originating mainly from Hungarian 578/10 strain, a particularly virulent strain. CONCLUSION: The first case of GBS as a presentation of WNND in a European patient is reported, along with a review of all previously published cases of GBS related to WNND. The United States Centers for Diseases Control and Prevention (CDC) documented 13% of WNV infections manifest as GBS, with a gradual and slow improvement, often with residual neurologic deficits of varying severity. Physicians should be aware that the presentation of a patient to an emergency department with GBS, during a certain epidemiological period of the year, should raise the clinical suspicion that the GBS may be related to a WNND.

Humans

[Arnozán-Dubreuilh depilating folliculitis].

Male patient, aged twenty-six years. Having an eight-and-a-half-year- old dermatosis of localized evolution on scalp, under arms, thighs, pubis and legs, characterized by inflammatory papules and follicular and extra-adnexial pustules, tiny scars and lack of hair in the affected areas. The authors present a representative case of "depilating folliculitis" of (Arnozán and Dubreuilh) stressing the following: Uncommon frequency in our country but frequent in warmer climates where it is observed mainly among peasants and sugar-cane workers. Wide-depilated areas principally in folds. Seasonal outbreak. Good response to treatment. A revision of the theme is made emphasizing the histopathologic pathogenesis.

Adult

The virtual elimination of rubella and mumps from the United States and the use of combined measles, mumps and rubella vaccines (MMR) to eliminate measles.

The measles elimination effort, which began in 1978, has made dramatic contributions to the virtual elimination of rubella and congenital rubella syndrome (CRS) and the control of mumps in the USA. The use of combined MMR vaccine has resulted in immunization levels at school entry in excess of 95% against each of these diseases. As a result, record low levels of rubella, CRS, and mumps were reported in 1984. Continued use of MMR, along with improved surveillance and aggressive response to outbreaks, can be expected to eliminate rubella and mumps as well as measles.

Cost-Benefit Analysis

Water supply as a source of Pseudomonas aeruginosa in a hospital for hematological malignancies.

This report details of an investigation on a significant increase in nosocomial bacteremias due to multiply-resistant Pseudomonas aeruginosa strains which occurred in a hematological ward. Serotyping according to Habs method showed a high frequence of the serotype 12. Control cultures identified in the hospital building water reservoirs the presence of the organism. After disinfection of these water reservoirs, the frequence of nosocomial septicemias caused by serotype 12 Pseudomonas aeruginosa strains on the overall bacteremic episodes declined immediately and showed a declining trend in the following 13 months period. To conclude serotyping of Pseudomonas aeruginosa is a useful epidemiological marker and allows to discover from where the diffusion of the organism responsible of outbreaks starts.

Cancer Care Facilities

Epidemiological evaluation of influenza in Italy.

A statistical study of the mortality from all causes and from respiratory diseases was carried out in an evaluation of the influenza epidemics in Italy from 1956 to 1973. Type A influenzaviruses were responsible for outbreaks every 2-3 years. Type B influenzavirus appeared every 4 years and accounted for a single noteworthy epidemic in 1962-63. From the analysis of data on both general mortality and respiratory mortality a better evaluation of the extent of the influenza outbreaks could be made.

Disease Outbreaks

Poliomyelitis in Oman: acute flaccid paralysis surveillance leading to early detection and rapid response to a type 3 outbreak.

Countries are increasingly requesting guidance on carrying out acute flaccid paralysis (AFP) surveillance, aimed at detecting and confirming all cases of acute paralytic poliomyelitis. The experience of Oman provides many lessons in this respect. AFP surveillance in Oman was established systematically. First, an epidemiologist was assigned to coordinate surveillance, and a laboratory for performing polio-virus isolation was identified. Next, operational guidelines for AFP surveillance were developed and widely promoted among health staff. The quality of the system has been monitored for more than 3 years with selected performance indicators. From January 1990 to April 1993, 49 AFP cases were reported, corresponding to an average annual rate of 2.1 AFP cases per 100,000 children aged less than 15 years. A total of 98% of the AFP cases were investigated within 48 hours of being reported; two stool samples were obtained from 94% of the cases. Following complete investigation, nearly a third of the reported AFP cases were classified as being clinically compatible with Guillain-Barré syndrome. Four AFP cases, all reported in 1991, were confirmed to be due to wild type 3 poliovirus. Because AFP surveillance detected these cases rapidly, Oman was able to carry out outbreak control measures promptly and more than 350,000 extra doses of oral poliovirus vaccine were delivered to children under 6 years of age.

Adolescent

Antibody responses of cows during an outbreak of neosporosis evaluated by indirect fluorescent antibody test and different enzyme-linked immunosorbent assays.

Serum samples from 70 (33 aborting and 37 non-aborting) dairy cows from a herd in California were analyzed for Neospora caninum antibodies in different laboratories by various serologic assays including enzyme-linked immunosorbent assay (ELISA) with recombinant antigens (Nc4.1 and Nc14.1), kinetic ELISA, whole tachyzoite lysate ELISA, immunostimulating complex (iscom) ELISA, antigen capture competitive inhibition ELISA, and by the indirect fluorescent antibody test. Eighteen percent of pregnant cows in this herd had aborted within 2 mo of the index case. All 70 cows had antibodies to N. caninum by at least 1 of the tests. Antibody levels to N. caninum in aborting cows as a group were higher than in nonaborting cows. However, it was concluded that no serological test could be used to establish definitively that N. caninum caused the abortion in an individual cow.

Abortion, Veterinary

The molecular epidemiology of tuberculosis in Zaragoza, Spain: a retrospective epidemiological study in 1993.

SETTING: The incidence of tuberculosis (TB) in Spain is one of the highest in Europe. In Zaragoza region the incidence rate of tuberculosis and the acquired immune deficiency syndrome (AIDS) are close to the national average. OBJECTIVE: To better define the molecular epidemiology of tuberculosis in an area of Europe where this has not been previously studied. DESIGN: A retrospective epidemiological study on tuberculosis was conducted in Zaragoza, a region of Spain, in 1993. The study population consisted of 226 patients from whom positive culture and complete clinical and demographic data were available. Mycobacterium tuberculosis strains were typed by standard restriction fragment length polymorphism (RFLP). A cluster was defined as two or more isolates with identical RFLP patterns when five or more copies of IS6110 are present. The 137 non-clustered patients were compared with the 89 clustered patients and studied by using univariate analysis. RESULTS: Thirty-nine percent of the patients were clustered, suggesting possible recent transmission. Infection with drug-resistant M. tuberculosis was associated with a decreased risk of being in a cluster. The strains isolated from human immunodeficiency virus (HIV)-positive patients were not associated with clustering. We found that immigration was not a major determinant in the total number of TB cases. CONCLUSION: Immigration, HIV and drug resistance were not associated with recent transmission. More than 50% of the clusters contained two or three patients, indicating that small outbreaks were responsible for most of the tuberculosis cases. Our RFLP typing results indicate that a TB control programme should be implemented in Spain in order to lower transmission of TB.

AIDS-Related Opportunistic Infections

[Epidemiologic markers of Salmonella].

Salmonellae are enterobacteria responsible for outbreaks of human and animal clinical diseases, with important hygienic and economic consequences. Accurate epidemiological studies require the use of efficient markers, which make it possible to trace the establishment and diffusion of different bacterial strains and also to evaluate the similarities between different isolates. Numerous phenotypic and genotypic markers applicable to Salmonella are available for these epidemiological studies. Nevertheless, the relative interest of those markers depends on the serotypes, and a different hierarchy can be achieved for the Typhimurium and Enteritidis serotypes.

Animals

Genomic and antigenic variations of porcine reproductive and respiratory syndrome virus major envelope GP5 glycoprotein.

The objective of the present study was to evaluate the importance of genomic and antigenic variations which may have affected the major envelope glycoprotein GP5 of porcine reproductive and respiratory syndrome virus (PRRSV) isolates responsible for outbreaks in Quebec and Ontario, in comparison with the modified-live U.S. vaccine strain (MLV) and the European prototype strain from Lelystad (LV). Nucleotide sequence analyses of the open reading frame (ORF)5 genes showed that all of the isolates studied were heterogenous, amino acid (aa) identities varied from 88 to 99% with the MLV strain, and between 51 and 54% with the LV strain. The aa substitutions were randomly scattered across the protein, although one region between residues 26 and 39 was found to correspond to a hypervariable region which involved 0 to 3 potential N-glycosylation sites. The ORF5 encoded products of 5 of these isolates, including the MLV and LV strains, were expressed in E. coli as recombinant proteins fused to the glutathione S-transferase (GST) protein and used to raise hyperimmune anti-ORF5 sera in rabbits. The reactivity patterns of strain-specific hyperimmune anti-ORF5 sera and a panel of 4 monoclonal antibodies directed against the ORF5 gene product of the Quebec IAF-Klop strain of PRRSV, indicated that GP5 of field isolates also underwent antigenic variations. The data suggest that neutralizing epitopes, independent of conformation and glycosylation, are also associated with antigenic variability of the GP5 of PRRSV.

Amino Acid Sequence

Viability of Cryptosporidium parvum oocysts in natural waters.

Water-borne transmission of the coccidium Cryptosporidium parvum Tyzzer, 1912 is frequently responsible for outbreaks of human cryptosporidiosis. One of the most important was reported in 1993 in Milwaukee in the United States, where 403,000 cases were recorded. The determination of the percentage of oocysts excystated is the first step in evaluating their viability, but it alone is not sufficient. This percentage depended on the conditions of storage and also the presence of oxidant or disinfectent agents in water. The percentage of excystation is not always related to viability. Therefore, determination of the viability of excysted sporozoites by determining their infectivity for enterocytic Caco2 cell lines in culture provides information essential for evaluating the risk of contaminated drinking water.

Animals

The value of complement fixation and haemagglutination inhibition tests in the diagnosis of influenza A.

Antibody response of 133 influenza A patients from three outbreaks since 1972-73 was analyzed by complement fixation (CF) and haemagglutination inhibition (HI) methods. During the first outbreak, a significant response was more often measured by CF than by HI. During the last outbreak HI appeared more useful than CF for routine serological diagnosis; 23% of cases verified by HI were missed by CF. The poor response of CF antibodies was associated with the high level of pre-infection antibodies.

Adolescent

The immune response in a cat-related outbreak of Q fever as measured by the indirect immunofluorescence test and the enzyme-linked immunosorbent assay.

The isotypic immune response of 16 individuals who developed Q fever pneumonia following exposure to an infected parturient cat was studied. The enzyme-linked immunosorbent (ELISA) test was used to detect IgM, IgA, and IgG antibodies to phase I and phase II Coxiella burnetii whole-cell antigens and to the phase I lipopolysaccharide. The indirect immunofluorescent antibody (IFA) test was also used to detect antibodies to phase I and phase II whole cells. None of the 16 subjects developed antibodies to the phase I lipopolysaccharide. The ELISA was more sensitive than the IFA test. IgM antibodies to phase II antigen were detectable by ELISA in 80% of the subjects at the time of onset of symptoms and were still present in 7 of the 8 tested at 32 weeks following the onset of symptoms. In all instances (ELISA: IgG, IgM; IFA: IgG, IgM) phase II antibodies developed earlier and reached higher levels than did phase I antibodies. The absence of antibodies to phase I lipopolysaccharide in acute Q fever combined with our unpublished findings of antibodies to phase I lipopolysaccharide in chronic Q fever suggests that this test may be used to distinguish acute from chronic Q fever.

Adult

Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease.

BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure. METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated. RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10% (34 of 351) of students were meningococcal carriers and 3.4% (12 of 351) carried the epidemic strain. After prophylaxis 2.5% (5 of 196) were carriers and 1.0% (2 of 196) carried the epidemic strain. Rifampin was 85% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes. CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.

Adolescent

Neonatal infections in puppies caused by Escherichia coli serogroups 04 and 025.

Three cases of neonatal E. coli infection in Newfoundland dogs are described. The serological examination showed that the implicated E. coli belonged to sero-group 04 in two outbreaks while sero-group 025 was responsible for one outbreak. In one of the kennels with implication of 04, this 0-group was also isolated from adult dogs with diarrheal conditions.

Animals

Outbreak of nosocomial infections due to Klebsiella pneumoniae producing SHV-4 beta-lactamase.

One hundred and fifty-four clinical isolates of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins, aztreonam and amikacin were responsible for an outbreak of nosocomial infections lasting eight months in a university hospital in Paris. This outbreak occurred in the intensive care unit (39 patients), haematology units (8 patients) and surgical and medical units (11 patients). Antibiotic resistant strains were isolated from the urinary tract (48%), wound and drainage fluids (21%), respiratory tract (14%), blood (12%) and stools (5%). High resistance to oxyimino-beta-lactams was mediated by a plasmid-encoded beta-lactamase with an isoelectric point of 7.8 (SHV-4). This CAZ-type enzyme conferred a higher level of resistance to ceftazidime and aztreonam (geometric mean MIC 135 mg/l) than to cefotaxime (geometric mean MIC 14 mg/l). All isolates were of the same biotype (weakly urease positive and no sucrose fermentation). Eight Klebsiella pneumoniae strains isolated in different units and at different times of the outbreak were of the same serotype, had common plasmid patterns and harboured a large self-transferable plasmid of about 180 kilobases encoding resistance to penicillins, oxyimino-beta-lactams, aminoglycosides, tetracycline and trimethoprim. These eight large plasmids had indistinguishable EcoRI restriction patterns. These results suggest that a single strain of Klebsiella pneumoniae was responsible for this outbreak.

Anti-Bacterial Agents