The pandemic of Salmonella enteritidis phage type 4 reaches Utah: a complex investigation confirms the need for continuing rigorous control measures.

In 1995, Salmonella Enteritidis (SE) cases in the state of Utah increased fivefold. Isolates were identified as phage type 4 (PT4). Risk factors and sources of infection were investigated in two case-control studies, a traceback of implicated foods, and environmental testing. Forty-three patients with sporadic infections and 86 controls were included in a case-control study of risk factors for infection. A follow-up case-control study of 25 case and 19 control restaurants patronized by case and control patients examined risks associated with restaurant practices. In the first case-control study, restaurant dining was associated with illness (P = 0.002). In the follow-up case-control study, case restaurants were likelier to use > 2000 eggs per week (P < 0.02), to pool eggs (P < 0.05), and to use eggs from cooperative 'A' (P < 0.009). Eggs implicated in separately investigated SE PT4 outbreaks were traced to cooperative 'A', and SE PT4 was cultured from one of the cooperative's five local farms. We conclude that SE PT4 transmitted by infected eggs from a single farm caused a fivefold increase in human infections in Utah.

Comparison of sorbitol MacConkey agar and a two-step method which utilizes enzyme-linked immunosorbent assay toxin testing and a chromogenic agar to detect and isolate enterohemorrhagic Escherichia coli.

Enterohemorrhagic Escherichia coli (EHEC) and specifically serotype O157:H7 are a significant cause of hemorrhagic gastrointestinal disease and the hemolytic uremic syndrome. Methods currently used in clinical microbiology labs, such as sorbitol-MacConkey (SMAC) agar, reliably detect only O157:H7. We have evaluated a two-step method that has the potential to identify and isolate all EHEC serotypes, including serotype O157:H7. This method utilizes a chromogenic selective-differential medium for the isolation of E. coli together with an enzyme-linked immunosorbent assay (ELISA) that detects the Shiga-like toxins Stx1 and Stx2. Both are commercially available and usable in a wide range of clinical microbiology laboratories. Compared to a Vero cell cytotoxic assay, SMAC had sensitivities of 23.5% for the identification of all EHEC serotypes and of 50.0% for the identification of O157:H7 alone. The two-step method had sensitivities of 76.5 and 100%, respectively. The ELISA alone had a sensitivity of 82.4% in the detection of Stx1 and Stx2. The specificity was 100% in all cases. Overall, 14 EHEC isolates were obtained: 8 (58%) O157:H7, 2 (14%) O26, 2 (14%) O111:NM, 1 (7%) O103:H2, and 1 (7%) O121:H19. All but one were isolated during the months of May to September. The two-step method was found to be considerably more expensive than SMAC for both positive and negative samples.

Performance characteristics of the Gen-Probe Probe Competition Assay used as a supplementary test for the Gen-Probe PACE 2 and 2C assays for detection of Chlamydia trachomatis.

The performance characteristics of the Gen-Probe Probe Competition Assay (PCA) used in conjunction with the Gen-Probe PACE 2 and 2C direct detection assays for Chlamydia trachomatis were examined. Data collected by five public health laboratories by using the Gen-Probe PACE 2 were pooled and analyzed. Of 25,081 endocervical and male urethral specimens tested by the PACE 2 assay, 773 were tested by PCA. Of 334 specimens initially positive by the PACE 2 assay with an initial PACE 2 result of greater than 2,000 relative light units (RLU), 333 (99.7%) were positive by PCA while 242 of 339 (71.4%) specimens with an initial result between the cutoff and 2,000 RLU were positive by PCA, and 35 of 100 (35%) specimens with initial results between 200 RLU and the cutoff were positive by PCA. An additional 10,938 specimens were tested by the PACE 2C assay. Of these, positive PCA results were obtained for 187 of 188 (99.5%) specimens with initial results of greater than 2,000 RLU, 99 of 163 (60.7%) of specimens in the range of cutoff to 2,000 RLU, and 12 of 100 (12%) in the range of 200 RLU to the cutoff. These results indicate that specimens greater than 2,000 RLU do not require a supplemental test and that additional positive results can be obtained by testing specimens with an initial result below the cutoff.