Common hand warts in athletes: association with trauma to the hand.

Forty-nine members of a university track team and 80 members of the crew team were surveyed about warts on their hands. They were also questioned about the nature and extent of their exercise, the types of equipment they used, and whether they wore protective gloves. Common hand warts were significantly more prevalent in members of the crew team than in members of the track team (25% v 10%; p < .05). Although both groups lifted weights regularly, the crew team members were less likely to use protective gloves; they sustained additional trauma to their hands from almost daily exercise on rowing machines and river practice. College health providers should question patients with hand warts about types of athletic activity and should suggest that they protect their hands by wearing weight-lifter's gloves.

Infections associated with pets.

Dogs, cats, rodents, reptiles and birds can transmit numerous diseases. Some are localized infections resulting from bites, scratches or other skin contact. Occasionally, a minor scratch or bite can lead to more serious infection, such as cat-scratch disease. Under certain circumstances, serious gastrointestinal, respiratory or multisystem illness can develop. Accurate diagnosis and identification of the pet source are necessary to prevent further transmission.

Group C beta-hemolytic streptococci causing pharyngitis and scarlet fever.

After a young woman had scarlet fever associated with group C beta-hemolytic streptococcal pharyngitis, we reviewed all cases of pharyngitis treated at a student health clinic during that semester. From 541 cases of pharyngitis, 34 cultures yielded group C Streptococcus. The patients who harbored group C organisms were similar to the patients with group A streptococcal pharyngitis in the presence of fever, exudate, and cervical adenopathy. The severity of symptoms and the demonstration of scarlet fever developing from infection with this organism supports antibiotic treatment of patients with group C streptococcal pharyngitis.

Multicenter, double-blind, placebo-controlled trial of terfenadine in seasonal allergic rhinitis and conjunctivitis.

A multiclinic, double-blind, parallel and controlled study was conducted in the 1982 spring pollen season to evaluate and compare the effects of terfenadine, 60 mg bid with those of chlorpheniramine 4 mg tid and placebo for a treatment period of seven days in patients with seasonal allergic rhinitis and conjunctivitis. Of a total of 397 patients enrolled in the seven study centers, 345 patients were accepted for evaluation of efficacy and 393 patients for safety. The results show that based on the physicians' assessment of the overall efficacy, terfenadine was significantly superior to placebo and comparable to chlorpheniramine in the relief of allergic symptoms, with moderate to complete relief being observed in 60% (68/113) of the terfenadine-treated patients, in 60% (71/119) of the chlorpheniramine-treated patients, and in 30% (34/119) of the placebo-treated patients. The daily evaluation of severity of symptoms by the patients show that the effect of terfenadine and chlorpheniramine was evident on the first day after entry, reached a peak on the second day after entry, and persisted thereafter. Side effects were minor and infrequent in all treatment groups. There was no statistically significant difference in the incidence of sedation between the terfenadine (7.6%) and placebo (2.4%) groups whereas the incidence of sedation with chlorpheniramine (19%) was significantly higher. In conclusion, terfenadine is as effective as chlorpheniramine in the treatment of symptoms of seasonal allergic rhinitis and conjunctivitis with an incidence of sedation not significantly different from that with placebo and significantly less than with chlorpheniramine.

Current management of fungal enteritis.

Fungal infections of the gastrointestinal tract have risen to higher levels of prevalence in the past decade. Major factors accounting for this increase are social changes, such as the increased ease and frequency of travel, which exposes the individual to environmental conditions that may result in fungal infection; increasing use of antibiotic and hormonal medications by otherwise healthy persons; and improved therapy for other diseases, such as polychemotherapy of cancer with its immunosuppressive effects. Both noninvasive and invasive fungal disease of the intestinal tract in otherwise healthy individuals can be successfully treated. The invasive fungal infections in patients with severe prior underlying disease are often first diagnosed postmortem, but improvement in serologic techniques now offers a possibility of earlier diagnosis and therapeutic intervention.

Efficacy of undecylenic acid-zinc undecylenate powder in culture positive tinea pedis.

One hundred fifty-one patients with tinea pedis participated in a double-blind study to assess the efficacy and safety of a powder containing undecylenic acid 2% and zinc undecylenate 20% versus a placebo powder. Patients were assigned to apply twice-daily applications of either active powder or placebo for a period of 4 weeks. Trichophyton rubrum or Trichophyton mentagrophytes were isolated from pretreatment cultures of 85 patients. Of these, 88% treated with active powder had negative cultures after 4 weeks compared with 17% of those treated with placebo powder (p less than 0.001). Fungus was identified in potassium hydroxide (KOH) treated skin scrapings of all 151 patients before treatment. Of those treated with active powder, 80% were KOH negative after 4 weeks compared with 49% of those treated with placebow powder (p = 0.001). Erythema and scaling were significantly improved by therapy with active powder, as were subjective evaluations of itching and burning. There were no side-effects or adverse reactions to undecylenic acid and its zinc salt.

Group B beta-hemolytic streptococci causing pharyngitis.

Group B beta-hemolytic streptococci were isolated from the throats of 49 of 1,110 patients who had pharyngitis. Compared with patients whose throat cultures were negative for beta-hemolytic streptococci, those harboring group B were more likely to have enlarged tonsils (P less than 0.001), exudate (P less than 0.02), and tender enlarged anterior cervical lymph nodes (P less than 0.01). Group B should not necessarily be dismissed as a nonpathogen when identified in the pharynx of patients with exudative pharyngitis; laboratories which report beta-hemolytic streptococcal isolates from the pharynx only as group A or non-group A should be encouraged to perform definitive group identification of all beta-hemolytic isolates to further evaluate the role of other streptococcal groups as the causative agents for pharyngitis.

Snake-to-human transmission of Aeromonas (Pl) shigelloides resulting in gastroenteritis.

A healthy young man developed acute gastroenteritis after handling an infected bao constrictor. The animal died after contracting "mouth-rot disease", a progressive ulcerative stomatitis of snakes charactistically caused a Aeromonas species. Stool cultures from the patient yielded a heavy growth of Aeromonas (Plesiomonas) shigelloides but no other enteric pathogens. Treatment wit sulfamethoxazole-trimethoprim resulted in rapid relief of clinical symptoms. Aeromonas species are not considered part of the normal human fecal flora and gastroenteritis due to this organism is rare. Furthermore, this case appears to represent a new zoonosis: human Aeromonas (Plasiomonas) gastroenteritis derived from contact with an infected animal host.

Decreased T cell levels in patients with warts.

Thymus-derived lymphocyte (T cell) levels were determined in 72 healthy patients who had viral warts, in 21 healthy patients who had been cured of warts from one to 15 years previously, and in 35 age-matched normal controls who had no history of warts. The mean percentage of lymphocytes that formed rosettes with sheep erythrocytes was less in patients with warts and patients previously cured of warts than in normal controls (P less than .001 and P less than .001, respectively). The number of total T cells/cu mm was decreased in untreated patients with warts (P less than .01) but was normal in patients cured of warts for more than one year. In addition, the morphology of the rosettes in the two patient groups differed from the controls; 32% had small numbers of sheep erythrocytes bound loosely to T cells compared with a rosette of numerous erythrocytes closely adherent to the T cell in 91% of the controls. The results suggest a defect of cellular immunity in many healthy patients with warts.

Venereal causes of cytomegalovirus mononucleosis.

Cytomegalovirus (CMV) mononucleosis developed in two men after sexual contact with a woman who had had a similar but medically unverified illness several months before. The CMV was cultured from the woman's urine and cervix. Evidence of recent infection with CMV was also found in a new sexual contact of one of the men. However, roommates of the infected patients remained well, and serologic evidence of CMV infection failed to develop. This small outbreak suggests that CMV may be acquired as a venereal infection that sometimes progresses to the mononucleosis syndrome.

Predictors of the duration of infectious mononucleosis.

The clinical course of infectious mononucleosis was monitored in 122 patients to determine predictors of duration of illness. Gastrointestinal symptoms and palatal petechiae were associated with a prolonged recovery period. Multiple regression analysis of quantitative data identified the number of days from onset of symptoms to diagnosis as the only statistically significant indicator. Liver enzymes, white blood cell count, percentage atypical lymphocytes and heterophil titer had no prognostic value for the length of illness.

Rubella: pattern of outbreak in a university.

During the spring term of 1975, rubella was diagnosed in 23 students at Georgetown University in Washington, DC. The cases were concentrated among students from the School of Foreign Service and their close contacts; outbreaks did not appear in other divisions of the university. Rubella immunization of susceptible female college personnel is recommended.

How frequent is bacterial superinfection of the pharynx in infectious mononucleosis? Observations on incidence, recognition, and management with antibiotics.

Throat cultures from 133 patients with infectious mononucleosis were compared with cultures from 2,881 patients who were seen during the same period because of pharyngitis. Less than 3 per cent of the cultures from each group contained Group A beta hemolytic streptococci. The inflamed pharynx and necrotic tonsils of infectious mononucleosis are seldom subject to bacterial superinfection, either initially or during the course of the illness. There is no indication for routine use of antibiotics when infectious mononucleosis is diagnosed. Should, however, a throat culture indicate presence of a bacterial pathogen, any appropriate antibiotic except ampicillin may be used without increasing the incidence of skin rash.

Diarrhoea caused by Candida.

Candida proliferation in the gastrointestinal tract was responsible for diarrhoea in six patients. Their common presentation was multiple loose or watery bowel movements, without blood or mucus but sometimes associated with abdominal cramps, and lasting as long as 3 months. Yeast cells were most easily identified by direct microscopic examination of stool specimens. Symptoms disappeared in all patients after 3 to 4 days of oral nystatin therapy.

Abuse of antibiotics. A study of patients attending a university clinic.

Self-treatment with antibiotics was evaluated among patients at a university health service in an 18-month period. Sixty-two students ingested antibiotics, usually tetracycline (40%) or penicillin (21%), for varying intervals before seeking medical care. Respiratory symptoms were the most common reason (40%). The most frequent drug source was residual medication obtained by prescription from a private physician for a prior illness (43%). Although self-therapy was of short duration, the negative bacteriologic cultures obtained on our evaluation in all but four patients challenged precise diagnosis. The findings indicate that inappropriate use of antibiotics by patients would be curtailed by prescribing only the exact amount needed for a given illness and by emphasizing the need for completion of the course of therapy.