RESUMO
To evaluate recent trends in cholera in the United States, surveillance data from all cases of laboratory-confirmed toxigenic Vibrio cholerae O1 and O139 infection reported to the Centers for Disease Control and Prevention between 1995 and 2000 were reviewed. Sixty-one cases of cholera, all caused by V. cholerae O1, were reported. There was 1 death, and 35 (57%) of the patients were hospitalized. Thirty-seven (61%) infections were acquired outside the United States; 14 (23%) were acquired through undercooked seafood consumed in the United States, 2 (3%) were acquired through sliced cantaloupe contaminated by an asymptomatically infected food handler, and no source was identified for 8 (13%) infections. The proportion of travel-associated infections resistant to trimethoprim-sulfamethoxazole, sulfisoxazole, streptomycin, and furazolidone increased from 7 (8%) of 88 in 1990-1994 to 11 (31%) of 35 in 1995-2000. Foreign travel and undercooked seafood continue to account for most US cholera cases. Antimicrobial resistance has increased among V. cholerae O1 strains isolated from ill travelers.
Assuntos
Cólera/epidemiologia , Antibacterianos/farmacologia , Centers for Disease Control and Prevention, U.S. , América Central/epidemiologia , Cólera/transmissão , Manipulação de Alimentos , Frutas/microbiologia , Humanos , Incidência , Testes de Sensibilidade Microbiana , Alimentos Marinhos/microbiologia , América do Sul/epidemiologia , Viagem , Estados Unidos/epidemiologia , Vibrio cholerae/classificação , Vibrio cholerae/efeitos dos fármacos , Vibrio cholerae/isolamento & purificaçãoRESUMO
In 1992, an outbreak of chronic diarrhea occurred among passengers on a cruise ship visiting the Galapagos Islands, Ecuador. Passengers (548) were surveyed, and stool and biopsy specimens from a sample who reported chronic diarrhea were examined. On completed questionnaires, returned by 394 passengers (72%), 58 (15%) reported having chronic diarrhea associated with urgency (84%), weight loss (77%), fatigue (71%), and fecal incontinence (62%). Illness began 11 days (median) after boarding the ship and lasted 7 to >42 months. Macroscopic and histologic abnormalities of the colon were common, but extensive laboratory examination revealed no etiologic agent. No one responded to antimicrobial therapy. Patients were more likely than well passengers to have drunk the ship's unbottled water or ice before onset of illness and to have eaten raw sliced fruits and vegetables washed in unbottled water. Water handling and chlorination on the ship were deficient. Outbreaks of a similar illness, Brainerd diarrhea, have been reported in the United States. Although its etiology remains unknown, Brainerd diarrhea may also occur among travelers.
Assuntos
Diarreia/epidemiologia , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Diarreia/diagnóstico , Diarreia/etiologia , Surtos de Doenças , Equador/epidemiologia , Microbiologia Ambiental , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Frutas/microbiologia , Frutas/parasitologia , Frutas/virologia , Humanos , Navios , Viagem , Abastecimento de ÁguaRESUMO
Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemala ranked third in the hemisphere in reported cases of cholera. We conducted a case-control study with two age-, sex-, and neighbourhood-matched controls per patient in periurban Guatemala City. Twenty-six patients hospitalized for cholera and 52 controls were enrolled. Seven (47%) of 15 stool cultures obtained after admission yielded toxigenic Vibrio cholerae O1. All seven were resistant to furazolidone, sulfisoxazole, and streptomycin, and differed substantially by pulsed-field gel electrophoresis from the Latin American epidemic strain dominant in the hemisphere since 1991. In univariate analysis, illness was associated with consumption of left-over rice (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 1.4-36), flavored ices (-helados') (OR = 3.6, CI = 1.1 - 12), and street-vended non-carbonated beverages (OR = 3.8, CI = 1.2-12) and food items (OR = 11.0, CI = 2.3-54). Street-vended food items remained significantly associated with illness in multivariate analysis (OR = 6.5, CI = 1.4-31). Illness was not associated with drinking municipal tap water. Maintaining water safety is important, but slowing the epidemic in Guatemala City and elsewhere may also require improvement in street vendor food handling and hygiene.
Assuntos
Cólera/transmissão , Surtos de Doenças , Microbiologia de Alimentos , Vibrio cholerae/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cólera/epidemiologia , Cólera/microbiologia , Feminino , Guatemala/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vibrio cholerae/isolamento & purificação , Abastecimento de Água/análiseRESUMO
In late January 1991, epidemic cholera appeared in Peru. Within 2 months, 7922 cases and 17 deaths occurred in Piura, a Peruvian city of 361,868. A hospital-based culture survey showed that 79%-86% of diarrhea cases were cholera. High vibriocidal antibody titers were detected in 34% of the asymptomatic population. A study of 50 case-patients and 100 matched controls demonstrated that cholera was associated with drinking unboiled water (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.7-8.9), drinking beverages from street vendors (OR, 14.6; CI, 4.2-51.2), and eating food from street vendors (OR, 24.0; CI, 3.0-191). In a second study, patients were more likely than controls to consume beverages with ice (OR, 4.0; CI, 1.1-18.3). Ice was produced from municipal water. Municipal water samples revealed no or insufficient chlorination, and fecal coliform bacteria were detected in samples from 6 of 10 wells tested. With epidemic cholera spreading throughout Latin America, these findings emphasize the importance of safe municipal drinking water.
Assuntos
Cólera/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Cólera/transmissão , Ingestão de Líquidos , Fezes/microbiologia , Feminino , Microbiologia de Alimentos , Humanos , Gelo , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , População Urbana , Vibrio cholerae/classificação , Vibrio cholerae/imunologia , Vibrio cholerae/isolamento & purificação , Microbiologia da Água , Abastecimento de ÁguaRESUMO
La epidemia ha afectado principalmente la región costera del Perú, siendo Trujillo, ciudad capital del Departamento de la Libertad, una de las más afectadas al 30 de Abril de 1991 se habían reportado en la provincia de Trujillo 18,399 casos sospechosos de cólera (tasa de ataque de 2.9 por ciento), 7,494 hospitalizados y 73 fallecidos (razón fallecidos/atendidos 0.4 por ciento). Se realizó un estudio caso-control con 50 casos y 99 controles pareados. Los casos eran pacientes residentes en el Distrito de Víctor Larco, de la Provincia de Trujillo que, entre el 9 y 17 de Marzo, presentaron diarrea con deshidratación. Los resultados del estudio identificaron los siguientes factores asociados con la enfermedad: 1) beber agua sin hervir (odds ratio (OR) 4,8 con un intervalo de confianza (IC) del 95 por ciento de 1.9-12.3), 2) introducir las manos dentro de los depósitos donde se almacena el agua de bebida (OR=14.0. IC=1.8-108.0), 3) consumir agua de pozos superficiales (OR=3.5, IC 1.01-12.10), 4) haber asistido a fiestas sociales o familiares donde habían comido algún alimento (OR=3.5, IC 1.1-10.9) y 5) consumir repollo (OR=3.3, IC=1.2-9.2); este último alimento, cultivado en los alrededores del Distrito de Víctor Larco, es con frecuencia regado con agua de desague
Assuntos
Vibrio cholerae/isolamento & purificação , Surtos de Doenças/prevenção & controle , Cólera/epidemiologia , Cólera/etiologia , Cólera/história , Diarreia/classificação , Diarreia/etiologia , Diarreia/microbiologia , Desidratação/classificação , Desidratação/etiologia , Comportamento AlimentarRESUMO
El primer estudio de 50 casos y 100 controles pareados, mostró asociación significativa entre enfermedad y los factores siguientes: 1) Consumo de bebidas de vendedores ambulantes (OR=14.6, IC 95 por ciento=4.2-51). 2) Consumo de alimentos de vendedores ambulantes (OR=24.0, IC 95 por ciento=3.0-191) 3) Tomar agua sin hervir (OR=3.9, IC 95 por ciento=1.7-8.9). 4) Consumo de arroz cocinado que permaneció sin consumir 3 horas o más y que no fue recalentado antes de su ingesta (OR=3.1, IC 95 por ciento=1.2-8.4). 5) Introducir las manos dentro del depósito familiar donde se almacena el agua de consumo (OR=2.6, IC 95 por ciento=1.2-5.9). El segundo estudio de 32 casos y controles, quienes habían consumido algún alimento o bebida en vendedores ambulantes, demostró asociación significativa entre la enfermedad y el haber tomado bebidas con hielo en vendedores ambulantes (OR=4.0, IC 95 por ciento=1.04-16.6); no se encontró bebida ni comida particular asociada con la enfermedad. Adicionalmente realizaron una encuesta a 31 vendedores anbulantes de bebida, mostrando que el 90 por ciento de ellos añadían hielo a sus bebidas, el que era adquirido de una de las tres fábricas de hielo existentes en Piura
Assuntos
Cólera/epidemiologia , Cólera/etiologia , Cólera/história , Contaminação de Alimentos/análise , Poluição da Água/análise , Poluição da Água/prevenção & controle , Água Potável/análiseRESUMO
PURPOSE: To describe an outbreak of Escherichia coli O175:H7 infection resulting in a high rate of progression to hemolytic-uremic syndrome, and to attempt to identify predictors of and risk factors for progression. DESIGN: Case-control study among employees and comparison of daily clinical features in two groups: infected residents with subsequent development of HUS and those who had no complications. SETTING: Two institutions for retarded persons in Utah. PATIENTS: Twenty residents with E. coli O157:H7 infection (13 culture confirmed, 2 probable, and 5 possible); HUS developed in 8, and 4 died. Thirty-one infected employees (3 with culture-confirmed, 6 with probable, and 22 with possible infection). MEASUREMENTS AND MAIN RESULTS: In a case-control study among employees, infection was independently associated with eating ground beef from a single lot prepared at several barbecues and with close contact with a resident who had diarrhea. Five of eight residents in whom HUS developed had received trimethoprim-sulfamethoxazole, compared with none of seven who had no subsequent complications (p = 0.026); this finding may reflect antimicrobial treatment of patients with more severe illness. Compared with infected residents without complications, persons with HUS were younger (median age 13 vs 27 years, p = 0.043) and, by the third day of illness, had higher leukocyte counts (median 23.7 X 10(9)/L vs 9.1 X 10(9)/L, p = 0.018) and temperature (median 38.5 degrees C vs 37.0 degrees C, p = 0.016). Leukocytosis peaked on day 4, more than 24 hours before signs of HUS appeared. CONCLUSIONS: Food-borne outbreaks of E. coli O157:H7 in institutions may have devastating effects. Leukocytosis and fever may precede and predict HUS in patients with E. coli O157:H7 infection.
Assuntos
Infecção Hospitalar , Infecções por Escherichia coli , Síndrome Hemolítico-Urêmica/etiologia , Institucionalização , Deficiência Intelectual , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Criança , Infecção Hospitalar/sangue , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Diarreia/etiologia , Diarreia/microbiologia , Diarreia Infantil/etiologia , Diarreia Infantil/microbiologia , Surtos de Doenças , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Fezes/microbiologia , Doenças Transmitidas por Alimentos/complicações , Humanos , Contagem de Leucócitos , Fatores de Risco , Utah/epidemiologiaRESUMO
To determine the role of Vibrio cholerae as a cause of diarrheal illness in Cancun, Mexico, an investigation was conducted in July and August 1983. Although toxigenic V. cholerae 01 were not found, non-01 V. cholerae were isolated from 22 (16%) of 134 stools from persons with diarrheal illness and none of 22 stools from well persons; 58 (92%) of 63 sewage samples; 12 (86%) of 14 untreated well water samples; a home storage tank for treated water; and 5 (21%) of 24 samples of raw seafood. None of the V. cholerae isolates from patients were toxigenic. The illness occurred mainly in small children, and were characterized principally by diarrhea and abdominal pain. No patient was seriously ill, and all recovered without sequelae. Seven different serotypes of non-01 V. cholerae were isolated from the stool specimens, and Smith serotype 12 accounted for 10 (46%) of the 22 isolates. A matched-pair case-control study found that cases were more likely than controls to have eaten home prepared gelatin (P = 0.03, OR = 5/0) and seafood (P = 0.06, OR = 4/0).
Assuntos
Cólera/microbiologia , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/etiologia , Diarreia/microbiologia , Feminino , Microbiologia de Alimentos , Humanos , Lactente , Masculino , México , Pessoa de Meia-Idade , Vibrio cholerae/isolamento & purificação , Microbiologia da ÁguaRESUMO
Three cases of hemolytic uremic syndrome with bloody diarrhea occurred during an outbreak of diarrheal illness in children aged 4 months to 9 years who attended a day care center. Thirty-six (34%) of 107 had diarrhea (three or more loose or watery stools in 24 hours) lasting greater than or equal to 3 days. Thirty-one (48%) of 64 children younger than 4 years of age but only (12%) of 43 in the older classes became ill (relative risk 4.0, P less than 0.001). Eleven (31%) of the 36 children with diarrhea had blood in their stools. Sequential movement of illness from class to class was consistent with person-to-person spread. Ten (18%) of 56 family members of ill children but only one of 45 family members of well children younger than 4 years of age developed a diarrheal illness (P less than 0.05). Escherichia coli O157:H7 was detected in two of eight stool specimens from children who had bloody diarrhea (one with hemolytic uremic syndrome), two of seven with nonbloody diarrhea, and none of nine who remained well. All three stool specimens obtained at less than or equal to 6 days compared with one of nine obtained at greater than 6 days after onset yielded this organism (P less than 0.02). E. coli O157:H7 can cause hemolytic uremic syndrome and both nonbloody and bloody diarrhea, and can spread within families and through modes other than foodborne transmission.
Assuntos
Creches , Diarreia/etiologia , Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Síndrome Hemolítico-Urêmica/etiologia , Criança , Pré-Escolar , Escherichia coli/classificação , Infecções por Escherichia coli/complicações , Fezes/microbiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , MasculinoRESUMO
After the Puerto Rico Department of Health received a report of salmonellosis in an infant who had contact with a pet turtle, we conducted a case-control study in two urban areas in Puerto Rico to measure the extent of pet turtle-associated salmonellosis there. Ten (17%) of 60 infants with salmonellosis but none of their matched controls had a history of exposure to a pet turtle in the two weeks before onset of illness. Two other case patients were also exposed to a pet turtle--an 8-year-old child and an adult with acquired immunodeficiency syndrome and Salmonella bacteremia. A variety of Salmonella serogroups were represented in the turtle-associated cases. All turtle lots collected from pet shops in Puerto Rico were culture-positive for Salmonella; 89% yielded Salmonella pomona. Contamination of the turtles probably occurred at the farm before distribution, since S pomona was also isolated from turtles exported from the same farm to Guam and to Yugoslavia. The estimated 3 to 4 million turtles exported annually from the United States are an important potential route for global dissemination of human salmonellosis.