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1.
Ann Rheum Dis ; 67(12): 1689-96, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18272671

ABSTRACT

OBJECTIVE: To describe the epidemiology and clinical spectrum of reactive arthritis (ReA) following culture-confirmed infection with bacterial enteric pathogens in a population-based study in the USA. METHODS: We conducted telephone interviews of persons age>1 year with culture confirmed Campylobacter, Escherichia coli O157, Salmonella, Shigella and Yersinia infections reported to FoodNet (http://www.cdc.gov/FoodNet/) in Minnesota, USA and Oregon, USA between 2002 and 2004. SUBJECTS: with new onset joint pain, joint swelling, back pain, heel pain and morning stiffness lasting >or=3 days within 8 weeks of culture (possible ReA) were invited to complete a detailed questionnaire and physical examination. RESULTS: A total of 6379 culture-confirmed infections were reported; 70% completed screening interviews. Of these, 575 (13%) developed possible ReA; incidence was highest following Campylobacter (2.1/100,000) and Salmonella (1.4/100,000) infections. Risk was greater for females (relative risk (RR) 1.5, 95% CI, 1.3 to 1.7), adults (RR 2.5, 95% CI, 2.0 to 3.1) and subjects with severe acute illness (eg, fever, chills, headache, persistent diarrhoea). Risk was not associated with antibiotic use or human leukocyte antigen (HLA)-B27. A total of 54 (66%) of 82 subjects examined had confirmed ReA. Enthesitis was the most frequent finding; arthritis was less common. The estimated incidence of ReA following culture-confirmed Campylobacter, E coli O157, Salmonella, Shigella and Yersinia infections in Oregon was 0.6-3.1 cases/100,000. CONCLUSIONS: This is the first population-based study of ReA following infections due to bacterial enteric pathogens in the USA. These data will help determine the burden of illness due to these pathogens and inform clinicians about potential sequelae of these infections.


Subject(s)
Arthritis, Reactive/epidemiology , Enterobacteriaceae Infections/epidemiology , Acute Disease , Adolescent , Adult , Age Distribution , Arthritis, Reactive/microbiology , Campylobacter Infections/epidemiology , Child , Child, Preschool , Epidemiologic Methods , Female , Humans , Infant , Male , Minnesota/epidemiology , Oregon/epidemiology , Physical Examination/methods , Prohibitins , Salmonella Infections/epidemiology , Sex Distribution , Young Adult
2.
Epidemiol Infect ; 122(3): 409-16, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10459643

ABSTRACT

Lack of reliable data about street vendors, who are difficult to survey, has hampered efforts to improve the safety of street-vended food. A two-phase method for sampling vendors, surveying first in areas of concentrated vending activity identified by local authorities and second in randomly selected areas, was developed and implemented in two Guatemalan cities where street-vended food had been implicated in cholera transmission. In a 4-day survey in Escuintla, 59 vendors (42 from phase 1, 17 from phase 2) were interviewed. They demonstrated good knowledge of food safety and cholera but unsafe practices, implying that more effective, practical training was needed. In a 6-day survey in Guatemala City, 78 vendors (77 from phase 1, 1 from phase 2) were interviewed. Sixty-eight (87 %) vendors stored water, usually in wide-mouthed vessels prone to contamination; this led to a field test of a new system for safe water storage. Useful information for public health planning and intervention can be gathered rapidly with this new method for surveying street vendors.


Subject(s)
Cholera/prevention & control , Epidemiologic Methods , Food Inspection , Food Services/standards , Adolescent , Adult , Aged , Beverages/standards , Cholera/epidemiology , Female , Food Inspection/methods , Guatemala/epidemiology , Health Knowledge, Attitudes, Practice , Humans , Interviews as Topic , Male , Middle Aged , Risk Factors , Sampling Studies , Surveys and Questionnaires , Water Supply/standards
3.
Arch Intern Med ; 158(6): 633-8, 1998 Mar 23.
Article in English | MEDLINE | ID: mdl-9521228

ABSTRACT

BACKGROUND: Typhoid fever is a potentially fatal illness common in the less industrialized world. In the United States, the majority of cases occur in travelers to other countries. METHODS: We reviewed surveillance forms submitted to the Centers for Disease Control and Prevention, Atlanta, Ga, for patients with culture-confirmed typhoid fever between 1985 and 1994. RESULTS: The Centers for Disease Control and Prevention received report forms for 2445 cases of typhoid fever. Median age of patients was 24 years (range, 0-89 years). Ten (0.4%) died. Seventy-two percent reported international travel within the 30 days before onset of illness. Six countries accounted for 80% of cases: Mexico (28%), India (25%), the Philippines (10%), Pakistan (8%), El Salvador (5%), and Haiti (4%). The percentage of cases associated with visiting Mexico decreased from 46% in 1985 to 23% in 1994, while the percentage of cases associated with visiting the Indian subcontinent increased from 25% in 1985 to 37% in 1994. The incidence of typhoid fever in US citizens traveling to the Indian subcontinent was at least 18 times higher than for any other geographic region. Complete data on antimicrobial susceptibility to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were reported for 330 (13%) Salmonella Typhi isolates. Isolates from 1990 to 1994 were more likely than isolates from 1985 to 1989 to be resistant to any of these antimicrobial agents (30% vs 12%; P<.001) and to be resistant to all 3 agents (12% vs 0.6%; P<.001). CONCLUSIONS: American travelers to less industrialized countries, especially those traveling to the Indian subcontinent, continue to be at risk for typhoid fever. Antimicrobial resistance has increased, and a quinolone or third-generation cephalosporin may be the best choice for empirical treatment of typhoid fever.


Subject(s)
Salmonella typhi/drug effects , Travel , Typhoid Fever/drug therapy , Typhoid Fever/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Drug Resistance, Microbial , Female , Humans , Incidence , Infant , Male , Middle Aged , United States/epidemiology
4.
J Infect Dis ; 175(6): 1527-30, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9180200

ABSTRACT

In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.


Subject(s)
Anti-Bacterial Agents/pharmacology , Diarrhea/microbiology , Dysentery, Bacillary/drug therapy , Shigella/drug effects , Shigella/isolation & purification , Animals , Anti-Bacterial Agents/therapeutic use , Bolivia , Campylobacter/isolation & purification , Campylobacter Infections/drug therapy , Campylobacter Infections/microbiology , Child, Preschool , Diarrhea/drug therapy , Diarrhea/parasitology , Drug Resistance, Microbial , Drug Resistance, Multiple , Dysentery, Amebic/drug therapy , Dysentery, Amebic/parasitology , Dysentery, Bacillary/microbiology , Empiricism , Entamoeba histolytica/isolation & purification , Feces/parasitology , Female , Humans , Infant , Male , Microbial Sensitivity Tests , Salmonella/isolation & purification , Salmonella Infections/drug therapy , Salmonella Infections/microbiology
5.
Ann Intern Med ; 125(7): 558-63, 1996 Oct 01.
Article in English | MEDLINE | ID: mdl-8815754

ABSTRACT

BACKGROUND: Although botulism is rare, recognition of a possible case of this illness represents a public health emergency. To prevent more cases, prompt investigation must be done to determine whether illness is linked to commercial product or restaurant. Botulism can masquerade as other illnesses, and seemingly unlikely foods can harbor botulinum toxin. OBJECTIVE: To confirm the diagnosis and determine the cause and extent of an outbreak of botulism associated with food served at a delicatessen. DESIGN: Retrospective cohort study of patrons of the delicatessen; laboratory analysis of food, serum samples, and stool samples; and traceback of implicated food. SETTING: Community in Georgia. PARTICIPANTS: Patrons of the delicatessen. MAIN OUTCOME MEASURES: Botulinum toxin in food, serum, or stool and Clostridium botulinum in food and stools. RESULTS: 8 of 52 patrons (15%) met the case definition for botulism. In 4 of the 8 patrons, and illness other than botulism was initially diagnosed. Five of the 8 were hospitalized, and 1 died. Stool cultures from 4 patrons yielded type AC. botulinum, and two serum samples contained botulinum toxin. All ill persons ate food from the delicatessen on 1 October 1993. Of the 22 persons who ate at the delicatessen that day, all 8 ill persons but none of the 14 well persons ate a potato stuffed with meat and cheese sauce. An open can of cheese sauce contained type A botulinum toxin and yielded C botulinum on culture. Cheese sauce experimentally inoculated with C botulinum spores became toxic after 8 days at a temperature of 22 degrees C (room temperature). CONCLUSIONS: A commercial, canned cheese caused a botulism outbreak. This product readily becomes toxic when contaminated by C botulinum spores and left at room temperature. Mild botulism caused by unusual vehicles may be misdiagnosed. Botulism should be included in the differential diagnosis of persons with signs or symptoms of acute cranial nerve dysfunction.


Subject(s)
Botulism/epidemiology , Cheese/microbiology , Clostridium botulinum/isolation & purification , Disease Outbreaks , Adult , Botulinum Toxins/analysis , Botulism/diagnosis , Diagnosis, Differential , Female , Georgia/epidemiology , Humans , Male , Middle Aged , Retrospective Studies
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