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1.
Epidemiol Infect ; 127(2): 359-63, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11693515

ABSTRACT

An outbreak of trichinellosis that occurred in the United Kingdom is described. Members of four households consumed pork salami from northern Serbia, the Federal Republic of Yugoslavia. Eight cases of trichinellosis occurred. Clinical and laboratory features of the cases were typical with myalgia (7 cases), fever (6), headache (5), periorbital oedema (4), non-specific ST/T wave changes on electrocardiogram (3), Trichinella antibodies (6), eosinophilia (7) and raised serum creatine kinase (3). All recovered. Trichinella larvae were detected in the salami. During pre-travel counselling, travellers should be advised about possible risk from cured pork products which have been produced locally in Trichinella endemic areas.


Subject(s)
Disease Outbreaks , Food Parasitology , Meat/parasitology , Trichinella spiralis/isolation & purification , Trichinellosis/epidemiology , Adult , Animals , Child , Female , Humans , Male , Swine , United Kingdom/epidemiology
2.
J Infect ; 41(2): 184-7, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11023769

ABSTRACT

OBJECTIVES: We report the cases of two patients, brother and sister, both with pulmonary tuberculosis. Both patients complied poorly with treatment. One developed multi-drug resistant disease, whilst the other did not. We aimed to show that the two infecting strains were the same, and then to compare the fitness of the resistant strain to that of the sensitive strain. METHODS: The isolates were typed by RFLP. The fitness of the multi-drug resistant tuberculosis strain was determined by calculating the ratio of generation produced by the drug-resistant and a drug-susceptible strain in a mixed culture. The number of bacteria present in this broth culture was estimated using the Miles and Misra technique. The number of drug-resistant bacteria present was determined by inoculating aliquots of broth onto Middlebrook 7H10 agar with 5mg/l rifampicin. RESULTS: The infecting strain of Mycobacterium tuberculosis was shown to be the same on RFLP typing in both cases. It was found that the multi-drug resistant organism had decreased fitness compared to the sensitive organism. CONCLUSION: The decreased relative fitness of the resistant strain implies a physiologic cal cost for the development of drug resistance.


Subject(s)
Antitubercular Agents/therapeutic use , Mycobacterium tuberculosis/physiology , Tuberculosis, Multidrug-Resistant , Tuberculosis, Pulmonary/microbiology , Bacterial Typing Techniques , Fatal Outcome , Female , Humans , Male , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Patient Compliance , Polymorphism, Restriction Fragment Length , Tuberculosis, Pulmonary/drug therapy
3.
Clin Immunol Immunopathol ; 87(1): 60-7, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9576011

ABSTRACT

Surface and intracellular immunologic and apoptotic markers and functional lymphocyte assays after stimulation with anti-CD3/anti-CD28 antibodies or phytohemagglutinin (PHA) were studied in 44 patients fulfilling the Oxford criteria for chronic fatigue syndrome (CFS). Results were then correlated to scores for the Short Form-36 health questionnaire (SF-36), which assesses eight aspects of patient's well-being, and for the general health questionnaire (GHQ), which detects current psychiatric disorder. Patients had significantly increased mean fluorescence intensity readings of HLA-DR in CD4 and CD8 cells (P < 0.05). Expression of the costimulatory receptor CD28 in CD8 cells was significantly reduced, and the apoptosis repressor ratio of bcl-2/bax in both CD4 and CD8 was increased in patients (P < 0.05). Patients with increased HLA-DR expression had significantly lower SF-36 total scores, worse body pains, and poorer general health perception and physical functioning scores. Increased spontaneous lymphocyte proliferation was associated with poor general health perception. PHA proliferative responses were lower in patients with poor emotional and mental health scores, and the anti-CD3/anti-CD28 response was low in those with low general health perception scores. Higher spontaneous proliferation and reduced PHA responses correlated with higher GHQ scores. Similarly, GHQ scores were significantly higher, indicating worse mental health, in those with lower total SF-36 scores and worse general and mental health scores in the SF-36 questionnaire. Finally, higher expression of the costimulatory molecule CD28 correlated with higher total SF-36 scores, general health perception and social functioning scores, and with lower role limitation due to physical health. The increased expression of class II antigens and the reduced expression of the costimulatory receptor CD28, which is a marker of terminally differentiated cells, lend further support to the concept of immunoactivation of T-lymphocytes in CFS and may be consistent with the notion of a viral etiopathogenesis in the illness. We report, for the first time, increased expression of the apoptosis repressor protein bcl-2, which may contribute to enhanced survival of activated lymphocytes. Using the SF-36 health assessment questionnaire and the GHQ, we demonstrated changes in different immunological parameters, each of which correlated with particular aspects of disease symptomatology.


Subject(s)
Fatigue Syndrome, Chronic/immunology , Lymphocyte Subsets/immunology , Adult , CD28 Antigens/metabolism , Fatigue Syndrome, Chronic/diagnosis , Female , Humans , Immunophenotyping , Interferon-alpha/therapeutic use , Lymphocyte Activation , Male , Middle Aged , Proto-Oncogene Proteins/metabolism , Proto-Oncogene Proteins c-bcl-2/metabolism , Surveys and Questionnaires , bcl-2-Associated X Protein , fas Receptor/metabolism
5.
Epidemiol Infect ; 112(1): 63-7, 1994 Feb.
Article in English | MEDLINE | ID: mdl-8119365

ABSTRACT

One hundred and eighty-one stool specimens from patients with various types of diarrhoea (135 patients) or from non-diarrhoeal controls (23 acute medical patients, 23 inflammatory bowel disease in remission) were investigated using a colony-blot DNA hybridization assay for the presence of Verocytotoxin-producing (VTEC), enteroaggregative (EAggEC) and diffusely adherent (DAEC) Escherichia coli. Twelve patients had probe-positive EAggEC in the stool and 8 of these had diarrhoea, 6 following recent travel. Eight patients had DAEC, 7 of whom had travellers' diarrhoea. Six of 10 (60%) travellers with gastroenteritis, but without a recognized enteric pathogen, were positive for EAggEC (4) or DAEC (2). Five of 10 (50%) travellers with gastroenteritis related to a recognized enteric pathogen also had DAEC identified in their stool. Of the 23 acute medical control patients 11 had been abroad, 4 of these were immigrants and had EAggEC. VTEC were not found and, with one exception, immunoassays for antibodies to E. coli O 157 and O 2 lipopolysaccharides were negative.


Subject(s)
Diarrhea/microbiology , Escherichia coli Infections/microbiology , Escherichia coli/pathogenicity , Adult , Antibodies, Bacterial/blood , Bacterial Adhesion , Bacterial Toxins/biosynthesis , Escherichia coli/immunology , Escherichia coli/metabolism , Feces/microbiology , Female , Gastroenteritis/microbiology , Humans , Lipopolysaccharides/immunology , Male , Prospective Studies , Shiga Toxin 1 , Travel
7.
Dig Dis ; 11(4-5): 288-97, 1993.
Article in English | MEDLINE | ID: mdl-8222309

ABSTRACT

Current knowledge of Escherichia coli strains responsible for bowel infections, including the more recently defined entero- hemorrhagic and entero-adherent types, is reviewed.


Subject(s)
Diarrhea/microbiology , Enterotoxins , Escherichia coli Infections/microbiology , Escherichia coli , Gastroenteritis/microbiology , Escherichia coli/classification , Escherichia coli/pathogenicity , Escherichia coli Infections/transmission , Humans
8.
Commun Dis Rep CDR Rev ; 3(2): R28-31, 1993 Jan 29.
Article in English | MEDLINE | ID: mdl-7693142

ABSTRACT

Fifty-one patients with malaria were admitted to the Coppetts Wood Unit of the Royal Free Hospital in 1991. The majority had taken either no prophylaxis or a suboptimal regimen. This was especially evident among patients from ethnic minorities. The most common clinical feature of malaria is fever, which may present months and occasionally years after exposure which can lead to failure or delay in the diagnosis. Doctors should stress the need for travellers to endemic areas to take prophylaxis as well as mosquito avoidance measures. All patients for whom a diagnosis of malaria is considered should be referred for a same-day diagnostic test, preferably to a centre with appropriate expertise in tropical medicine.


Subject(s)
Malaria/diagnosis , Travel , Adolescent , Adult , Child , Female , Humans , Malaria/epidemiology , Male , Middle Aged , United Kingdom/epidemiology
10.
Postgrad Med J ; 67(793): 1013-4, 1991 Nov.
Article in English | MEDLINE | ID: mdl-1775408

ABSTRACT

Two cases of scarlet fever are described, both following super-infection of chickenpox. Enterotoxin B and C producing staphylococci were the only pathogens identified. The role of staphylococcal and streptococcal toxins in the pathogenesis of scarlet fever and toxic shock syndrome is discussed.


Subject(s)
Chickenpox/complications , Enterotoxins/biosynthesis , Scarlet Fever/complications , Staphylococcus aureus/metabolism , Child , Child, Preschool , Conjunctivitis, Bacterial/etiology , Female , Humans , Male , Scarlet Fever/microbiology , Shock, Septic/microbiology
11.
CDR (Lond Engl Rev) ; 1(12): R134-6, 1991 Nov 08.
Article in English | MEDLINE | ID: mdl-1669755

ABSTRACT

The clinical presentation of tuberculosis in children can take many forms. This paper describes six cases seen within a 12-month period at a regional department of infectious and tropical diseases. Three of the cases had meningeal disease, two had pulmonary infection and one had miliary disease. They illustrate the difficulties of accurate diagnosis and its importance in choosing the most effective treatment. Guidelines are provided on the management of childhood tuberculosis.


Subject(s)
Tuberculosis, Pulmonary/diagnosis , Tuberculosis/diagnosis , Adolescent , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Drug Therapy, Combination , Female , Humans , Infant , Male , Microbial Sensitivity Tests , Tuberculosis/drug therapy , Tuberculosis/prevention & control , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/prevention & control
13.
J Hosp Infect ; 18(4): 279-92, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1682366

ABSTRACT

The incidence of methicillin-resistant Staphylococcus aureus in England and Wales was monitored by a weekly reporting scheme from early 1986 to March 1990. Potential coverage was approximately two-thirds of hospital beds. Reporting centres fell from a peak of 210 in 1986 to a low of 101 centres early in 1989 with later recovery. There were 2367 positive reports in 1986, 2174 in 1987, 1700 in 1988, 1701 in 1989 and 632 in the first quarter of 1990. Colonizations outnumbered infections by 2:1. There were marked regional differences: North-East Thames was dominant in 1986 and 1987, and then declined; South-East Thames showed a dramatic increase in 1988 which continued. Other regions showed less significant changes but there were continuing problems in the South-Western Region and in the West Midlands. Some of these changes were related to the decline of EMRSA-1, possibly due to the introduction of effective control measures, and to the emergence of EMRSA-3 in South-East Thames and its spread to Wessex.


Subject(s)
Methicillin Resistance , Population Surveillance , Staphylococcal Infections/epidemiology , Staphylococcus aureus/classification , Bacteriophage Typing , Disease Outbreaks/statistics & numerical data , England/epidemiology , Hospital Bed Capacity , Humans , Incidence , Residence Characteristics , Staphylococcal Infections/microbiology , Staphylococcal Infections/mortality , Wales/epidemiology
15.
BMJ ; 302(6780): 828-9, 1991 Apr 06.
Article in English | MEDLINE | ID: mdl-2025706
20.
BMJ ; 298(6678): 960, 1989 Apr 08.
Article in English | MEDLINE | ID: mdl-2497874
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