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Endemic infectious diseases for which infection confers permanent immunity are described by a system of nonlinear Volterra integral equations of convolution type. These constant-parameter models include vital dynamics (birth and deaths), immunization and distributed infectious period. The models are shown to be well posed, the threshold criteria are determined and the asymptotic behavior is analysed. It is concluded that distributed delays do not change the thresholds and the asymptotic behaviors of the models.
The utilization of beds and their non-utilization because of epidemic-emergency causes and other causes were analysed in the period from February 1988 to January 1989 in a hospital department for observation and infectious diseases under conditions not intended for treatment of patients with communicable diseases From 20 to 30% of beds could not be utilized due to the necessity of treatment under conditions of isolation. The utilization of beds was higher in the period from October to May, and lower in the period from June to September.
Infectious diseases (ID) specialists have played a major role in patient care, infection control, and antibiotic management for many years. With the rapidly changing nature of health care, it has become necessary for ID specialists to articulate their value to multiple audiences. This article summarizes the versatile attributes possessed by ID specialists and delineates their value to patients, hospitals, and other integral groups in the health care continuum.
Many infectious diseases have been hypothesized to represent common virus infections in which only small proportions of cases result in clinically recognizable disease. In order to find a method of studying this class of diseases, a mathematical model of the age distribution of clinical disease was developed using poliomyelitis as a prototype. The model is shown to fit the age distribution of reported poliomyelitis in a variety of localities before the use of artificial immunization. The true yearly rate of infection is easily estimated and ranges from .11 in rural Sweden to 1.20 in Chile. The model accounts for several major features of poliomyelitis epidemiology, including the shift to older ages and the high rate of clinically apparent disease which were frequently observed in populations which could be expected to have a comparatively low rate of spread. An examination of the age distribution of other diseases by these methods may provide a method of identifying other common infections which only occasionally result in clinically apparent disease.
Infectious disease emergencies are those in which delays in diagnosis or treatment may lead to untoward harm. Recent developments in the field offer few new therapies, but rather emphasize familiar infections in new guises or clarify approaches to troublesome entities. An enduring concern for the legal risks implicit in the care of infected children has recently received new attention.
Infectious diseases are the cause of the majority of pediatric emergency visits, although only a minority constitute true emergencies. Progress in identifying the true emergencies continues.
New infectious diseases and microorganisms continue to be described. They may be blood- or arthropod-borne, or spread by the respiratory, sexual or faecal-oral route; in some cases, modes of transmission remain unknown or new ones have been described. Complex factors have contributed to the re-emergence of older pathogens in both developing and developed countries. Changes in medical and surgical practice have led to the frequent description of resistant gram-positive and negative bacteria, fungi and bacteria. Although many of the newly described agents may not be directly relevant to routine anaesthetic and intensive care practice, their impact on both patients and staff can be minimized by adherence to rational infection control guidelines, understanding of local disease and anti-microbial resistance patterns, sensible patient evaluation and access to expert advice. Given recent history, it can be expected that new microorganisms and clinical syndromes will continue to appear.
"Emerging" infectious diseases can be defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. Among recent examples are HIV/AIDS, hantavirus pulmonary syndrome, Lyme disease, and hemolytic uremic syndrome (a foodborne infection caused by certain strains of Escherichia coli). Specific factors precipitating disease emergence can be identified in virtually all cases. These include ecological, environmental, or demographic factors that place people at increased contact with a previously unfamiliar microbe or its natural host or promote dissemination. These factors are increasing in prevalence; this increase, together with the ongoing evolution of viral and microbial variants and selection for drug resistance, suggests that infections will continue to emerge and probably increase and emphasizes the urgent need for effective surveillance and control. Dr. David Satcher's article and this overview inaugurate Perspectives, a regular section in this journal intended to present and develop unifying concepts and strategies for considering emerging infections and their underlying factors. The editors welcome, as contributions to the Perspectives section, overviews, syntheses, and case studies that shed light on how and why infections emerge, and how they may be anticipated and prevented.
Four infectious diseases that are associated with high rates of morbidity and mortality are Rocky Mountain spotted fever, meningococcal disease, staphylococcal toxic shock syndrome, and streptococcal toxic shock syndrome. These diseases necessitate a timely diagnosis and treatment, which may be facilitated by recognition of the characteristic cutaneous findings. Herein the clinical manifestations, diagnosis, and management are presented, with emphasis on the dermatologic signs of each disease. A dermatology consultation can be valuable, but all physicians should be familiar with the cutaneous findings of these potentially life-threatening diseases.
Emerging infectious diseases pose a significant but underappreciated threat to public health. In a world where international travellers, immigrants, and refugees can carry dangerous organisms almost anywhere, no region should be considered free from risk. Outbreaks of disease may be caused by newly recognized pathogens and drug-resistant organisms. These outbreaks demonstrate the need for improved worldwide surveillance and for improved compliance with guidelines for the use of antimicrobial agents.
Infectious disease alters sleep patterns in rabbits, but the recuperative value of enhanced sleep during infectious disease has not been experimentally verified. To evaluate the relationship between specific sleep patterns and the clinical response to infectious disease, we classified sleep patterns in rabbits inoculated with E. coli, S. aureus, or C. albicans on the basis of the duration of the period of enhanced sleep. Patterns characterized by a long period of enhanced sleep were associated with a more favorable prognosis and less severe clinical signs than were patterns characterized by relatively short periods of enhanced sleep followed by prolonged sleep suppression. A contrasting analysis of these data indicated that animals that eventually died demonstrated reduced sleep compared to rabbits that survived the infection. These observations are consistent with the hypothesis that dynamic changes in sleep over the course of an infectious disease aid in recuperation.
Infectious diseases continue to elicit worldwide attention. Many of these diseases have rheumatic manifestations as an incidental or principal feature. Because this is particularly true in children, rheumatic manifestations of infectious diseases in this population continue to be an area of great importance to rheumatologists. A variety of bacteria, viruses, fungi, and parasitic organisms can give rise to infectious diseases with rheumatic manifestations. A high index of clinical suspicion is frequently necessary for an accurate diagnosis. Prompt diagnosis and early and appropriate therapeutic intervention are usually required for a successful, and frequently curative, outcome. Over the past year, studies have addressed the pathogenetic mechanisms and clinical spectrum of the rheumatic manifestations of infectious diseases in children. There has been particular emphasis on septic arthritis, osteomyelitis, sickle-cell disease, and hepatitis C viral infection. There remains the daunting and unfortunate possibility of large numbers of children developing HIV-associated arthritis.
Localized outbreaks of meningococcal disease in the United States and Canada continue to cause serious alarm within communities as a result of the fulminating pattern of the disease, high mortality rate, and high incidence among adolescents. The increasing number of outbeaks since 1991 has raised questions about the management and prevention of further cases during an outbreak. The purpose of this statement is to guide primary-care physicians in their role in infection control and prevention of both sporadic cases and outbreaks of invasive meningococcal disease. This statement provides information on the epidemiology of meningococcal disease, including definitions of sporadic, secondary, and coprimary cases, clusters of cases, and outbreaks. Data are presented on identification of cases, disease risk of contacts, and agents for chemoprophylaxis, and recommendations are given for: (1) risk assessment of contacts, (2) administration of chemoprophylaxis, (3) appropriate use of meningococcal vaccine, (4) appropriate use of the microbiology laboratory, (5) the necessity for timely and appropriate reporting of invasive meningococcal disease to local public health authorities, and (6) information on counseling and public education that may be helpful during an outbreak to minimize public anxiety. An additional section, "Information for Sharing," which uses a question-and-answer format and which may be helpful to parents and community and health care workers during an outbreak, is also provided.
Infectious diseases and especially diarrheal diseases have been noted to have an adverse effect on the growth of underprivileged children in developing countries. Diarrheal diseases have been estimated to account for 10-80% of growth retardation in the first few years of life, with the magnitude of effect possibly modified by other factors, such as the adequacy and source of dietary intake, treatment and feeding practices during and following illness and the opportunity for catch-up growth after illness. In the only study in which infectious diseases and routine dietary intake have been evaluated simultaneously, inadequate dietary intake rather than infectious diseases, was found to have the predominant role in growth faltering. Although reduction in infectious diseases is desirable for many reasons, the relative feasibility and cost of this approach to improve nutritional status must be compared with more direct nutrition interventions.
A questionnaire was sent to 1,500 members and fellows of the Infectious Diseases Society of American to elicit their views on the use of antimicrobial agents. The rate of return was 58.7%. A high proportion of respondents (86.8%) stated that they had a strong professional interest in antimicrobial therapy and were active in infection control and antibiotic use in their institutions--488 hospitals including community, university, children's, and governmental facilities. The membership was concerned with problems of antibiotic use in hospitals, laboratory methods of reporting susceptibility, promotional practices of industry, and development of microbial resistance. Members were troubled by how best to deal with excessive use of antibiotics in hospitals. Respondents strongly supported efforts to improve the control of antimicrobial use in hospitals and to examine issues of drug use and resistance in developing countries; they provided suggestions for development of a code of ethical conduct with industry.
Infectious diseases were rife during the early years of the Singapore Medical College, which was established in 1905. The current Department of Microbiology in the National University of Singapore (NUS) has its historical roots in the Departments of Bacteriology and Parasitology, which were established in 1925 and 1950 respectively. With the achievements since its inception, and with its present research focus on Infectious Diseases, Immunology, Applied and Environmental Microbiology, it is poised to face the microbiological challenges of the 21st century. Over the decades, the structure of the medical microbiology course in NUS has modernised, culminating in the current emphasis on its practical utility in clinical practice. Coordinated by the Department of Microbiology, the Microbiology and Infectious Diseases module and the Immunology module both adopt integrated multidisciplinary approaches that aim to introduce students to the language and fundamental concepts in microbiology, infectious diseases and immunology.
The epidemiological situation of Szczecin following the liberation was both difficult and dangerous. Numerous cases of typhus, diphteria ague, venereal diseases, typhoid and dysentery were noted and an urgent need of dealing with them was necessary. Thus an infectious diseases ward was opened in 1945 at 4 Arkońska Str. Its organiser was dr Elzbieta Buk. Despite of lack of both medical staff and equipment as well as medicines in its first month of operation the ward had 160 patients. Mostly they suffered from typhus, diphtheria, dysentery and typhoid. Mortality was high: 37 patients died. Till the end of 1945 674 patients were treated, most in September. The patients were mostly Germans, Poles, Russians, Ukranians, Belorussians and occasionally French. The most frequent was typhus though there were cases of malaria and rabies. Typhoid TB, dysentery and diphtheria were also observed. In 1946/47 more wards were opened dealing with lung, skin, venereal and children's diseases. The last one directed by Dr Krystyna Stawiarska hod its scarlet fever and diphtheria sections and simultaneously an analytical and a bacteriological labs were set up and due to Dr Stanislae Swierczyśski determination they enabled basic diagnostics. Slowly post-war epidemics were contained and both infections mortality and admissions grew smaller.