ABSTRACT
An outbreak of infection caused by a previously undescribed Gram-negative bacterium affected people attending a hot (37 degrees C) spring spa in France in 1987. Thirty-five case of pneumonia and two cases of meningitis occurred. None of these patients died. Attack rates were significantly higher for patients above 70 years old and for male patients. An epidemiological comparison of the 26 hospitalized cases with 52 matched controls suggests that spa treatment early on the first day (OR = 4.8) and attendance at the vapour baths (OR = 10.7) were significant risk factors for acquiring the infection. Person-to-person spread was not thought to have occurred. The same bacterium was isolated from the hot spring water. All strains studied shows a single rRNA gene restriction pattern. Epidemiological data indicated that the thermal water was the source of infection. This outbreak stresses the need for increased surveillance of infections in people attending hot spring spas.
Subject(s)
Disease Outbreaks , Gram-Negative Bacterial Infections/epidemiology , Meningitis, Bacterial/epidemiology , Pneumonia/epidemiology , Water Microbiology , Aged , Aged, 80 and over , Balneology , Case-Control Studies , DNA, Ribosomal/analysis , Female , France/epidemiology , Gram-Negative Bacteria/genetics , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/complications , Gram-Negative Bacterial Infections/microbiology , Health Resorts , Hot Temperature , Humans , Incidence , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/microbiology , Middle Aged , Pneumonia/complications , Pneumonia/microbiology , RNA, Ribosomal/genetics , Restriction Mapping , Rheumatic Diseases/complications , Rheumatic Diseases/therapyABSTRACT
An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis. We report 3 cases of Q fever endocarditis. In 2 of these patients endocarditis developed on cardiac valve prosthesis. The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory. A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis. It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures.
Subject(s)
Endocarditis, Subacute Bacterial/etiology , Q Fever/complications , Adult , Aged , Antibodies, Bacterial/analysis , Chronic Disease , Coxiella/immunology , Endocarditis, Subacute Bacterial/drug therapy , Female , Heart Valve Prosthesis/adverse effects , Humans , Male , Middle Aged , Q Fever/drug therapy , Q Fever/immunology , Tetracyclines/therapeutic useABSTRACT
Two cases of pulmonary embolism accompanied by syncope in patients with pre-existing left bundle branch block are reported. Contrary to classical descriptions, the syncopes in these two patients could not be ascribed to cardiovascular collapse, but several arguments (such as the clinical features of the syncope and its coexistence in one case with ECG evidence of complete atrio-ventricular dissociation) were in favour of a paroxysmal disorder of conduction. Right bundle branch block is known to be common in pulmonary embolism and may even be more frequent in patients with left bundle branch block. In such cases, sudden and transient arrest of conduction in the right bundle would complete the left bundle branch block, thus accounting for a paroxysmal atrio-ventricular block.
