Alan B. Bloch

Recovery of hepatitis A virus from a water supply responsible for a common source outbreak of hepatitis A.

An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis A. Well water samples were collected 3 months after illness onset in the index case and 28 days after illness onset in the last trailer park resident. Hepatitis A virus antigen (HAVAg) was detected in the samples by enzyme immunoassay from three of the five cell lines following two 30-day passages and from a fourth cell line following a third passage of 21 days.

Predictors of survival in HIV-infected tuberculosis patients

ObjectiveTo ascertain predictors of survival in HIV-infected tuberculosis (TB) patients. DesignRetrospective cohort study. SettingNew York City public hospital. PatientsFifty-four consecutive HIV-seropositive patients with newly diagnosed TB and no other AIDS-defining illnesses. Main outcome measuresCD4+ T-lymphocyte counts, completion of anti-TB therapy, repeat hospitalizations with TB, and survival. ResultsForty-five (84%) of the 54 patients died a median of 15 months after TB diagnosis (range, 1–80 months), five (9%) were alive after a median of 81 months (range, 75–84 months), and four (7%) were lost to follow-up after a median of 42 months (range, 30–66 months). In univariate analyses, disseminated TB, intrathoracic adenopathy, oral candidiasis and CD4 count depletion were each associated with decreased survival. In a multivariate analysis, CD4 count depletion was the only independent predictor of decreased survival. Repeat hospitalization with TB occurred in 10 out of 15 patients who did not complete anti-TB therapy compared with one out of 21 patients who completed anti-TB therapy (P < 0.001). ConclusionThe clinical presentation of TB and CD4 count at TB diagnosis are each predictive of survival in HIV-seropositive TB patients. The CD4 count is the only independent predictor of survival.