RESUMO
Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.
Assuntos
Cloranfenicol/uso terapêutico , Conjuntivite/microbiologia , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae , Rifampina/uso terapêutico , Administração Oral , Administração Tópica , Brasil , Portador Sadio , Criança , Pré-Escolar , Cloranfenicol/administração & dosagem , Conjuntivite/prevenção & controle , Feminino , Infecções por Haemophilus/microbiologia , Humanos , Lactente , Masculino , Orofaringe/microbiologia , Púrpura/microbiologia , Púrpura/prevenção & controle , Rifampina/administração & dosagem , Especificidade da EspécieRESUMO
In June, 1989, an outbreak of nosocomial listeriosis occurred in Costa Rica. Listeria monocytogenes was isolated from 9 ill infants 4 to 8 days old who were born after the delivery of an infant with early onset listeriosis. One nosocomial infection was fatal, 2 required mechanical ventilation and 1 resulted in hemiparesis. A higher proportion of cases than other infants born during the outbreak were delivered by cesarean section (55% vs. 24%, P = 0.04). Compared with the mothers of 36 random controls, case mothers were more often primiparous (odds ratio, 6.2, P = 0.03) or received general anesthesia before delivery (odds ratio, 4.4, P = 0.09). All infants were bathed with mineral oil from a multidose container. Culture of the oil by cold enrichment grew L. monocytogenes 4b with the same electrophoretic enzyme type as the outbreak strain. We hypothesize that aspiration of contaminated oil may have resulted in systemic listeriosis. General anesthesia may have increased the risk of aspiration. Lung tissue from the infant who died showed lipid-laden macrophages consistent with oil aspiration and had evidence of L. monocytogenes DNA detected by polymerase chain reaction. This is the first nosocomial outbreak of listeriosis in which a common source suggested epidemiologically was microbiologically confirmed. The high attack rate (greater than 200 times the United States rate of perinatal listeriosis) emphasizes the susceptibility of healthy neonates to L. monocytogenes. The results of our study led to the discontinuation of the use of mineral oil for bathing neonates in Costa Rica.
Assuntos
Infecção Hospitalar/etiologia , Surtos de Doenças , Listeriose/etiologia , Óleo Mineral/efeitos adversos , Estudos de Casos e Controles , Costa Rica/epidemiologia , Coleta de Dados , Contaminação de Medicamentos , Feminino , Humanos , Recém-Nascido , Listeriose/epidemiologia , MasculinoAssuntos
Conjuntivite Bacteriana/epidemiologia , Infecções por Haemophilus/epidemiologia , Púrpura/epidemiologia , Brasil , Pré-Escolar , Conjuntivite Bacteriana/história , Conjuntivite Bacteriana/microbiologia , Infecções por Haemophilus/história , Infecções por Haemophilus/microbiologia , Haemophilus influenzae , História do Século XVI , História do Século XIX , Humanos , Lactente , Púrpura/história , Púrpura/microbiologiaAssuntos
Infecções por Haemophilus/epidemiologia , Púrpura/epidemiologia , Brasil , Pré-Escolar , Conjuntivite Bacteriana/complicações , Conjuntivite Bacteriana/epidemiologia , Surtos de Doenças , Infecções por Haemophilus/complicações , Infecções por Haemophilus/mortalidade , Haemophilus influenzae/classificação , Haemophilus influenzae/isolamento & purificação , Humanos , Púrpura/etiologiaRESUMO
We performed a population-based case-control study of risk factors for primary invasive Haemophilus influenzae type b (Hib) disease in metropolitan Atlanta from July 1, 1983, through June 30, 1984. Active surveillance identified 102 cases in children less than 5 years of age, 89 of whom lived in households with telephones. We used random digit dialing to select 530 controls who were postmatched to cases by age. Multivariate analysis showed a significant association between Hib disease and two independent exposure factors, household crowding (odds ratio (OR) 2.7, 95% confidence limits (CL) 1.3 to 5.6) and day-care attendance. For day-care attendance, relative risk was highest in 2- to 5-month-old infants (OR 17.7, 95% CL 5.8 to 54.4) and declined to 9.4 (4.3 to 20.9) at ages 6 to 11 months, 5.0 (2.7 to 9.3) at 12 to 23 months, 2.7 (1.3 to 5.5) at 24 to 35 months, and 1.4 (0.5 to 4.0) in 36- to 59-month-old children. Fifty percent of all invasive Hib disease that occurred during the study period was attributable to exposure to day-care; the attributable risk for household crowding was 18%. Dose-response effects were observed for hours per week of day-care attendance and extent of household crowding. Breast-feeding was protective for infants less than 6 months of age (OR 0.08, 95% CL 0.01 to 0.59). After controlling for socioeconomic and other confounding factors, we could demonstrate no effect of black race on cumulative risk of invasive Hib disease. Our study defines high-risk groups and provides a population-based model of the interrelationship between risk factors associated with invasive Hib disease.
Assuntos
Infecções por Haemophilus/epidemiologia , Fatores Etários , Creches , Pré-Escolar , Aglomeração , Exposição Ambiental , Feminino , Georgia , Infecções por Haemophilus/transmissão , Humanos , Lactente , Masculino , Risco , Fatores Socioeconômicos , Estatística como AssuntoRESUMO
Following a private party in Río Piedras, PR, 23 (56 percent) of those who attended developed an illness characterized by pharyngitis, myalgia, fatigue, headache, and fever. Consumption of carrucho (conch) salad was significantly associated with illness (P = 0.013, Fisher's exact test). Group A beta-hemolytic streptococci (M nontypable T12, serum opacity factor positive) were isolated both from throat cultures in 11 of 47 persons who attended the party and from the implicated food. The original source of contamination of the conch salad was not identified. Because complications may still occur from such infections and only a small percentage of persons with sore throats seek medical attention and ultimately receive treatment for their illnesses, it is important to recognize these outbreaks.
Assuntos
Surtos de Doenças/epidemiologia , Contaminação de Alimentos , Faringite/epidemiologia , Métodos Epidemiológicos , Microbiologia de Alimentos , Humanos , Faringite/etiologia , Porto Rico , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
In the period 1971-1981, 1,835 cases of leprosy were reported in the United States; only 10% of these cases were indigenous. Since 1977, the number of new cases reported each year has risen because of an increase in imported cases of disease, a situation reflecting the increased number of refugees and immigrants who have entered the United States from areas endemic for leprosy. Forty-five of the 50 states reported cases. In only 25% of the imported cases were the patients known to have had leprosy at the time of immigration; the remaining 75% were diagnosed in this country. The highest rate of disease onset for this latter group occurred within 12 months after entry into the United States, but cases continued to be reported 10 years after entry. Active refugee resettlement programs have widely distributed persons with leprosy, contacts of diseased persons, and persons from endemic areas throughout the 50 states, a situation necessitating the development of expertise by medical professionals and public health officials in the diagnosis, treatment, and long-term follow-up of patients with leprosy.
Assuntos
Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Animais , Tatus , Ásia/etnologia , Criança , Pré-Escolar , Emigração e Imigração , Feminino , Humanos , Lactente , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , México/etnologia , Pessoa de Meia-Idade , Ilhas do Pacífico/etnologia , Refugiados , Risco , Fatores de Tempo , Estados UnidosRESUMO
Outbreaks of legionnaires' disease (LD) in tourists visiting Italian and Spanish resorts have been recently reported. An unusual number of reports of LD in tourists visiting the US Virgin Islands prompted an investigation of risk factors for development of LD in this area. Twenty-seven cases of LD were identified between 1979 and 1982 through press reports, personal communication, the national LD surveillance system, a review of hospital records, and a mail survey. Twenty-four of 27 persons with the disease had visited St Croix and 12 of them had stayed at a single hotel in 1981. Available evidence suggested that infection was due to Legionella pneumophila serogroup 1; L pneumophila serogroups 1 and 3 and several new Legionella species were isolated from the potable water system at the hotel. Following hyperchlorination of the potable water system, no further cases of LD in hotel visitors have been identified to date.
Assuntos
Surtos de Doenças/epidemiologia , Doença dos Legionários/epidemiologia , Viagem , Surtos de Doenças/diagnóstico , Feminino , Humanos , Legionella/isolamento & purificação , Doença dos Legionários/diagnóstico , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estações do Ano , Testes Sorológicos , Inquéritos e Questionários , Ilhas Virgens AmericanasRESUMO
From November 1, 1981, through April 30, 1982, we performed a case-control study of primary invasive Haemophilus influenzae infections in children in Colorado. Information was collected for 121 (83%) of 146 children with positive cultures and for 196 (67%) of 292 age-matched controls selected at random from birth certificates. Infected children were more likely to have attended a day care center or nursery (DCC/N) and to have an elementary school-aged household member. For attendance at DCC/N, the relative risk was significantly increased only for children 12 months of age or older, and increased with the size of the DCC/N. After controlling for DCC/N attendance and school-aged siblings, children younger than 6 months of age with infection were significantly less likely to have been breast-fed, suggesting a protective effect of breast-feeding. We identified DCC/N attendees, especially those older than 1 year of age, to be at increased risk of primary H. influenzae disease. They could benefit from immunization.