RESUMO
Neisseria meningitidis is a leading cause of adult meningitis worldwide. From 5 to 14 August 1996, 8 cases of meningococcal disease occurred in Corrientes city (population 306,000) in northeastern Argentina. Those infected ranged in age from 15 to 45 years (median, 18.5). To determine risk factors for infection, a case-control study was done. Infecting isolates were serogrouped and underwent phenotyping by multilocus enzyme electrophoresis (MLEE) and pulsed-field gel electrophoresis (PFGE). Those infected were significantly more likely than those not infected to have had exposure to passive or active cigarette smoke or to have attended a particular disco. Isolates available from 6 case-patients were all serogroup C; all had identical MLEE and PFGE patterns. These data suggest that dance clubs or discos may be a focus of transmission of N. meningitidis among young people.
Assuntos
Surtos de Doenças , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Adulto , Argentina/epidemiologia , Estudos de Casos e Controles , DNA Bacteriano , Dança , Feminino , Humanos , Masculino , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/microbiologia , Pessoa de Meia-Idade , Neisseria meningitidis/classificação , Neisseria meningitidis/genética , Poluição por Fumaça de TabacoRESUMO
BACKGROUND: Hemodialysis is a common but potentially hazardous procedure. From February 17 to 20, 1996, 116 of 130 patients (89 percent) at a dialysis center (dialysis center A) in Caruaru, Brazil, had visual disturbances, nausea, and vomiting associated with hemodialysis. By March 24, 26 of the patients had died of acute liver failure. METHODS: A case patient was defined as any patient undergoing dialysis at dialysis center A or Caruaru's other dialysis center (dialysis center B) during February 1996 who had acute liver failure. To determine the risk factors for and the source of the outbreak, we conducted a cohort study of the 130 patients at dialysis center A and the 47 patients at dialysis center B, reviewed the centers' water supplies, and collected water, patients' serum, and postmortem liver tissue for microcystin assays. RESULTS: One hundred one patients (all at dialysis center A) met the case definition, and 50 died. Affected patients who died were older than those who survived (median age, 47 vs. 35 years, P<0.001). Furthermore, all 17 patients undergoing dialysis on the Tuesday-, Thursday-, and Saturday-night schedule became ill, and 13 of them (76 percent) died. Both centers received water from a nearby reservoir. However, the water supplied to dialysis center B was treated, filtered, and chlorinated, whereas the water supplied to dialysis center A was not. Microcystins produced by cyanobacteria were detected in water from the reservoir and from dialysis center A and in serum and liver tissue of case patients. CONCLUSIONS: Water used for hemodialysis can contain toxic materials, and its quality should therefore be carefully monitored.
Assuntos
Toxinas Bacterianas/efeitos adversos , Falência Hepática Aguda/etiologia , Peptídeos Cíclicos/efeitos adversos , Diálise Renal/efeitos adversos , Poluentes Químicos da Água/efeitos adversos , Abastecimento de Água , Adulto , Toxinas Bacterianas/análise , Estudos de Coortes , Cianobactérias/metabolismo , Humanos , Fígado/química , Falência Hepática Aguda/mortalidade , Microcistinas , Pessoa de Meia-Idade , Peptídeos Cíclicos/análise , Transtornos da Visão/induzido quimicamente , Vômito/induzido quimicamente , Microbiologia da Água , Poluentes Químicos da Água/análise , Abastecimento de Água/análiseRESUMO
Few reports of vancomycin-resistant enterococci have appeared outside the USA. Therefore, we evaluated the ability of five laboratories in Buenos Aires, Argentina, to perform susceptibility testing using the disk diffusion method. Laboratories had difficulty identifying the low- and intermediate-level vancomycin-resistant phenotypes. This suggests that the disk diffusion method used by laboratories abroad may fail to detect some vancomycin-resistant enterococci.
Assuntos
Antibacterianos/farmacologia , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Laboratórios/normas , Testes de Sensibilidade Microbiana/métodos , Vancomicina/farmacologia , Argentina , Técnicas Bacteriológicas/normas , Meios de Cultura , Resistência Microbiana a Medicamentos , Humanos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Cholera spread to Latin America in 1991; subsequently, cholera vaccination was considered as an interim intervention until long-term solutions involving improved water supplies and sanitation could be introduced. Three successive summer cholera outbreaks in northern Argentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this new vaccine. METHODS: This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the costs of vaccination with CVD 103-HgR in the relatively confined population of northern Argentina affected by the cholera outbreaks. Water supplies and sanitation in this area are poor but a credible infrastructure for vaccine delivery exists. RESULTS: In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-patients per 1000 population and assumptions of vaccine efficacy of 75% and coverage of 75%, vaccination of targeted high risk groups would prevent 1265 cases. CONCLUSION: Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132,100. The projected savings would be altered less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than by disease incidence changes. Our analysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; Indirect losses to trade and tourism had the greatest economic impact. However, vaccination with CVD 103-HgR was still cost-beneficial in the base case.