Chronic herpes gestationis and antiphospholipid antibody syndrome successfully treated with cyclophosphamide.

Herpes gestationis shares many features with other bullous diseases, especially bullous pemphigoid. Treatments of benefit in bullous pemphigoid may also be effective for herpes gestationis. Cyclophosphamide, azathioprine, and other immunosuppressive agents have been used successfully in refractory cases of bullous pemphigoid. We describe a patient with severe and persistent herpes gestationis in the postpartum period and the antiphospholipid antibody syndrome, both of which were refractory to high-dose corticosteroid therapy. Treatment with pulsed-dose intravenous cyclophosphamide produced an excellent clinical response.

Public health implications regarding the epidemiology and microbiology of public whirlpools.

High temperature bathing in hot tubs, spas and whirlpools poses four potential public health concerns: injury/death, disease transmission, possible teratogenic effects, and congestive heart failure or dysrhythmias for individuals with cardiac problems. Health departments need criteria before initiating environmental and epidemiologic investigations. These criteria must include severity of the disease and number of individuals possibly exposed. In addition, public health officials are obligated to define the magnitude of the problem, inform affected individuals and institute appropriate control measures. Optional information should be collected during an environmental and epidemiologic investigation to clarify the mechanisms of disease transmission and design control measures. The public health response to improving hot water bathing safety and sanitation should be directed at primary prevention. Educational efforts would be directed toward whirlpool operators, users and the medical community. Included should be a review of regulations addressing the construction and operation of public spas and whirlpools.

Survey of health department-based environmental epidemiology programs.

A survey of state epidemiologists in all 50 states and New York City was conducted between October 1982 and January 1983 to determine which states had existing programs in environmental epidemiology. We identified 29 environmental epidemiology programs with at least one full-time state-funded staff member. The most common areas of responsibility included investigations of indoor air pollution (96 per cent), exposures to toxic or hazardous substances (93 per cent), and pesticide exposures (93 per cent).

Isolation of Salmonella enteritidis, serotype Horsham, from three American Indian Tribes.

Salmonella enteritidis, serotype Horsham, identified rarely worldwide, was isolated from the stools of six American Indians with gastroenteritis. The patients were from separate tribes located in three geographically distinct villages. Although significant contact was demonstrated between ill individuals within two tribes, no common source for the organism has been identified.