RESUMEN
Non-O157 Shiga toxin-producing Escherichia coli (STEC) can cause severe illness, including hemolytic uremic syndrome (HUS). STEC O145 is the sixth most commonly reported non-O157 STEC in the United States, although outbreaks have been infrequent. In April and May 2010, we investigated a multistate outbreak of STEC O145 infection. Confirmed cases were STEC O145 infections with isolate pulsed-field gel electrophoresis patterns indistinguishable from those of the outbreak strain. Probable cases were STEC O145 infections or HUS in persons who were epidemiologically linked. Case-control studies were conducted in Michigan and Ohio; food exposures were analyzed at the restaurant, menu, and ingredient level. Environmental inspections were conducted in implicated food establishments, and food samples were collected and tested. To characterize clinical findings associated with infections, we conducted a chart review for case patients who sought medical care. We identified 27 confirmed and 4 probable cases from five states. Of these, 14 (45%) were hospitalized, 3 (10%) developed HUS, and none died. Among two case-control studies conducted, illness was significantly associated with consumption of shredded romaine lettuce in Michigan (odds ratio [OR] = undefined; 95% confidence interval [CI] = 1.6 to undefined) and Ohio (OR = 10.9; 95% CI = 3.1 to 40.5). Samples from an unopened bag of shredded romaine lettuce yielded the predominant outbreak strain. Of 15 case patients included in the chart review, 14 (93%) had diarrhea and abdominal cramps and 11 (73%) developed bloody diarrhea. This report documents the first foodborne outbreak of STEC O145 infections in the United States. Current surveillance efforts focus primarily on E. coli O157 infections; however, non-O157 STEC can cause similar disease and outbreaks, and efforts should be made to identify both O157 and non-O157 STEC infections. Providers should test all patients with bloody diarrhea for both non-O157 and O157 STEC.
Asunto(s)
Infecciones por Escherichia coli/epidemiología , Contaminación de Alimentos/análisis , Lactuca/microbiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Estudios de Casos y Controles , Análisis por Conglomerados , Diarrea/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Electroforesis en Gel de Campo Pulsado , Contaminación de Alimentos/estadística & datos numéricos , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Michigan , Oportunidad Relativa , Ohio , Restaurantes/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
Outbreaks of human salmonellosis associated with live poultry contact have been reported since 1955. Multiple Salmonella serotypes have been associated with these outbreaks, and specific outbreak strains have been repeatedly linked to single hatcheries over multiple years. During 2009, four multistate outbreaks of human Salmonella infections associated with direct and indirect exposure to live poultry purchased from mail-order hatcheries and agricultural feed stores were identified, resulting in 165 culture-confirmed cases in 30 states. This report describes the epidemiologic, environmental and laboratory investigations conducted by state and local health departments, state departments of agriculture, the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), National Poultry Improvement Plan (NPIP) and National Veterinary Services Laboratories (NVSL), and the Centers for Disease Control and Prevention (CDC). Case-patients were identified through PulseNet, the national molecular subtyping network for foodborne disease surveillance, and interviewed using the CDC standard live poultry contact questionnaire that asks about poultry-related exposures during the 7 days before illness onset. These outbreaks highlight the need to focus efforts on strategies to decrease and prevent human illness associated with live poultry contact through comprehensive interventions at the mail-order hatchery, agricultural feed store and consumer levels. Additional consumer education and interventions at mail-order hatcheries and venues where live poultry are sold, including agricultural feed stores, are necessary to prevent transmission of Salmonella from poultry to humans.
Asunto(s)
Enfermedades de las Aves de Corral/transmisión , Salmonelosis Animal/transmisión , Infecciones por Salmonella/epidemiología , Zoonosis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades/veterinaria , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Aves de Corral , Enfermedades de las Aves de Corral/epidemiología , Salmonella/clasificación , Salmonella/aislamiento & purificación , Infecciones por Salmonella/microbiología , Infecciones por Salmonella/transmisión , Salmonelosis Animal/epidemiología , Salmonelosis Animal/microbiología , Serotipificación , Estados Unidos/epidemiología , Adulto JovenRESUMEN
To provide a potentially therapeutic intervention and to collect clinical and laboratory data during an outbreak of hantavirus pulmonary syndrome (HPS), 140 patients from the United States with suspected HPS were enrolled for investigational intravenous ribavirin treatment. HPS was subsequently laboratory confirmed in 30 persons and not confirmed in 105 persons with adequate specimens. Patients with HPS were significantly more likely than were hantavirus-negative patients to report myalgias from onset of symptoms through hospitalization, nausea at outpatient presentation, and diarrhea and nausea at the time of hospitalization; they were significantly less likely to report respiratory symptoms early in the illness. The groups did not differ with regard to time from the onset of illness to the point at which they sought care; time from onset, hospitalization, or enrollment to death was significantly shorter for patients with HPS. At the time of hospitalization, patients with HPS more commonly had myelocytes, metamyelocytes, or promyelocytes on a peripheral blood smear, and significantly more of them had thrombocytopenia, hemoconcentration, and hypocapnia. Patterns of clinical symptoms, the pace of clinical evolution, and specific clinical laboratory parameters discriminated between these 2 groups.
Asunto(s)
Antivirales/uso terapéutico , Infecciones por Hantavirus/tratamiento farmacológico , Enfermedades Pulmonares/tratamiento farmacológico , Ribavirina/uso terapéutico , Antivirales/efectos adversos , Análisis de los Gases de la Sangre , Electrólitos , Femenino , Orthohantavirus , Humanos , Infusiones Intravenosas , Pruebas de Función Renal , Pruebas de Función Hepática , Enfermedades Pulmonares/virología , Masculino , Recuento de Plaquetas , Tiempo de Protrombina , Análisis de Regresión , Ribavirina/efectos adversos , Factores de TiempoRESUMEN
Tuberculosis cases have recently declined in the United States, renewing interest in disease elimination. We examined the epidemiology of tuberculosis from 1991 through 1997 at an inner-city public hospital and assessed population-based tuberculosis rates by ZIP code in the 8 metropolitan Atlanta counties. During the 7 years, 1378 new patients had tuberculosis diagnosed at our hospital (mean, 197 patients/year), accounting for 25% of tuberculosis cases in Georgia. Coinfection with human immunodeficiency virus (HIV) was common, but a significant decrease in the proportion of HIV-infected patients with tuberculosis was noted over time. Most patients were members of a minority group (93%) and were born in the United States (96%). Two inner-city ZIP code areas had annual tuberculosis rates >120 cases per 100,000 persons, and 8 ZIP code areas had annual rates of 47-88 cases per 100,000 persons between 1993 and 1997, compared with the annual national average of 8.7 cases per 100,000 persons. Our hospital continues to care for large numbers of tuberculosis patients, and rates of tuberculosis remain high in the inner city. These data mandate a concentration of efforts and resources in urban locations if tuberculosis control and elimination is to be achieved in the United States.
Asunto(s)
Tuberculosis/epidemiología , Femenino , Georgia/epidemiología , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Rifampin/uso terapéutico , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the risk of tuberculosis (TB) transmission to patients potentially exposed to two healthcare providers who worked in outpatient settings for several weeks prior to being diagnosed with acid-fast bacilli smear-positive pulmonary TB. DESIGN: Potentially exposed patients were notified by letter and television reports of the recommended evaluation for TB infection or disease and availability of free screening at the hospital. Prevalence of infection in the screened patients and the incidence rate of TB over the subsequent 2 years were compared to those of a control group of unexposed outpatients. SETTING: An urban inner-city hospital. PATIENTS: 1,905 patients with potential exposure to the ill healthcare workers; 487 (25%) presented for evaluation. Controls consisted of 951 unexposed patients. RESULTS: 361 potentially exposed patients had their tuberculin test read; 97 (27%) had a purified protein derivative > or = 10 mm. In the comparison group, 148 (25%) of 600 with test readings had a > or = 10-mm reaction (risk ratio, 1.18; 95% confidence interval, 0.86-1.60). In multivariate analysis, male gender, non-white race, and older age were significantly associated with a positive tuberculin test; exposure was not. No TB cases were identified during screening. Two years after the exposure, 7 TB cases had been reported to the state registry among 1,905 potentially exposed patients (184 cases/100,000 person-years) versus 4 cases in the comparison group of 951 (210 cases/100,000 person-years). CONCLUSIONS: Evaluation of patients exposed to healthcare workers with TB disease in ambulatory settings of an inner-city hospital revealed no evidence of transmission of Mycobacterium tuberculosis due to the exposure.
Asunto(s)
Infección Hospitalaria/transmisión , Personal de Salud , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Tuberculosis Pulmonar/transmisión , Adulto , Instituciones de Atención Ambulatoria , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Notificación de Enfermedades , Femenino , Georgia/epidemiología , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Factores de Riesgo , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiologíaRESUMEN
OBJECTIVE: To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device. SETTING: Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia. PATIENTS: 123 consecutive patients who received a PAS-Port implantable venous access device between January 1 and June 30, 1995. DESIGN: Retrospective cohort study with follow-up > or = 1 year following device implantation. RESULTS: Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/1,000 device days). CONCLUSIONS: Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.
Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/etiología , Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/efectos adversos , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Adulto , Anciano , Anciano de 80 o más Años , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/terapia , Estudios de Cohortes , Contaminación de Equipos , Femenino , Georgia/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/terapia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We prospectively evaluated rates of tuberculin skin test (TST) conversion from July 1992 to June 1997 among house staff in the Emory University Affiliated Hospitals Training Program following implementation of expanded infection control measures for tuberculosis at Grady Memorial Hospital (Atlanta), which cares for approximately 200 patients with tuberculosis per year. Over 5 years, documented TST conversions occurred for 52 (2.4%) of 2,144 house staff. Conversion rates decreased after the first 6 months from 5.98 to 1.09 per 100 person-years worked over the next 4.5 years (P < .001). Multivariate analysis revealed that risk factors for TST conversion included graduation from a foreign medical school and being part of the house staff in the Department of Medicine; race or ethnicity, gender, and age were not risk factors. Over the last 4.5 years, the TST conversion rate among U.S. medical school graduate house staff (n = 1,928) was 0.72 per 100 person-years worked, and there was no significant difference in conversion rates between house staff in the Department of Medicine and house staff in other departments. In summary, TST seroconversion rates decreased significantly following full implementation of expanded infection control measures for tuberculosis and were low (< 1% per year) among U.S. medical school graduates despite their caring for large numbers of patients with tuberculosis at an inner-city public hospital.
Asunto(s)
Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Cuerpo Médico de Hospitales , Tuberculosis/transmisión , Femenino , Médicos Graduados Extranjeros , Georgia/epidemiología , Humanos , Incidencia , Masculino , Mycobacterium tuberculosis , Estudios Prospectivos , Factores de Riesgo , Prueba de Tuberculina , Tuberculosis/epidemiología , Tuberculosis/prevención & controlRESUMEN
Tuberculosis in the United States has become primarily an inner-city disease. We examined the epidemiology of culture-confirmed tuberculous meningitis among patients cared for at an urban public hospital in Atlanta. During an 11.5-year period (January 1984-June 1995) cerebrospinal fluid cultures for Mycobacterium tuberculosis were positive in 34 patients, accounting for 1.5% of all culture-confirmed tuberculosis cases. All patients were born in the United States, 31 (91%) were black, 16 (47%) of 34 were human immunodeficiency virus (HIV) seropositive, 9 (26.5%) were HIV seronegative, and 9 (26.5%) had an unknown HIV serostatus. No significant differences were seen in clinical presentation, cerebrospinal fluid, or other laboratory data between HIV seropositive and HIV seronegative/ unknown groups, except for a lower serum white blood cell count among HIV seropositive patients. Mortality was striking; 14 (41.2%) died because of tuberculous meningitis despite appropriate therapy initiated a mean of 3 days after admission. Six survivors had permanent neurologic sequelae. Univariate analysis of outcome was not statistically associated with any measured demographic, laboratory value, stage at presentation, treatment regimen, or HIV serostatus. Multivariate analysis of outcome using 13 independent variables also demonstrated no significant association between these variables and outcome, although a trend was seen for increased mortality for white people (P = 0.09) and increasing age (P = 0.09). Tuberculous meningitis among inner-city residents remains a devastating disease associated with high morbidity and mortality that has changed little during the past 4 decades. HIV infection does not change markedly the clinical presentation or the response to therapy.
Asunto(s)
Tuberculosis Meníngea/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Niño , Preescolar , Femenino , Estudios de Seguimiento , Georgia , Seronegatividad para VIH , Seropositividad para VIH/epidemiología , Hospitales con más de 500 Camas , Hospitales Urbanos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Análisis Multivariante , Grupos Raciales , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Meníngea/mortalidadRESUMEN
Five hundred fifty persons who worked with nonhuman primates (NHP) or with NHP material in 13 North American research institutions were surveyed for potential occupational exposures and tested for antibodies to simian immunodeficiency virus (SIV). Needlesticks and mucocutaneous exposures were reported more frequently among persons who handled SIV-negative or SIV-status-unknown (SIV-N/U) animals (36% and 35%) or who worked with SIV-N/U material in the laboratory (18% and 17%) than among persons who handled SIV-positive NHP (SIV-P) (9% and 4%) or worked with SIV-P material (6% and 8%). The risk for needlesticks when working with both SIV-N/U and SIV-P animals and the risk for mucocutaneous exposures from SIV-N/U animals increased with the number of years working with NHP. Persons who performed invasive tasks (e.g., obtaining blood samples, performing surgery/autopsies) were more likely than others to sustain needlesticks (adjusted OR = 3.55, 95%CI = 1.40-9.02). Two (0.4%) of 550 persons had antibodies to SIV. One appears to be infected with SIV, as previously reported. These data suggest that persons who work with NHP or with NHP material are at risk for occupational exposure to potentially infectious materials including SIV. Prevention strategies are needed to reduce the risk for needlesticks and mucocutaneous exposures around all NHP, and safety guidelines should emphasize prevention options for invasive tasks performed with animals.