Calvin C. Linnemann

TRANSMISSION OF HERPES-SIMPLEX VIRUS TYPE 1 IN A NURSERY FOR THE NEWBORN IDENTIFICATION OF VIRAL ISOLATES BY D.N.A. "FINGERPRINTING"

The occurrence of herpes-simplex-virus type-1 infections in two newborn infants in a nursery within a one-month period suggested the possibility of transmission in the nursery. One infant may have been infected by his father, who had active herpes labialis at the time of the childs birth. The source of the second infants infection was not apparent. Viruses isolated from the two infants were fingerprinted by cleaving the virus-specific D.N.A. with several restriction endonucleases and comparing the electrophoretic patterns. Isolates from the two infants were identical and differed from other isolates from epidemiologically unrelated cases. This observation confirmed the possibility of transmission of herpes-simplex virus type 1 in the nursery, but did not define the mode of transmission. Type-1 infections are serious in neonates: one of the infants died and an oesophageal stricture developed in the other. The fingerprinting technique provides a useful epidemiological technique for tracing the transmission of herpes virus infections.

ASSOCIATION OF REYE'S SYNDROME WITH VIRAL INFECTION

Abstract From January to March, 1974, twenty-four cases of Reyes syndrome encephalopathy and fatty liver) were diagnosed in Cincinnati, Ohio. The epidemic coincided with an epidemic of influenza B, intermediate type. In eighteen of twenty-three cases (78%) in which viral studies were done, an acute viral infection was found in either the patient or a close contact with similar prodromal symptoms. Influenza-B infection was confirmed in twelve patients and twelve contacts, although influenza A, parainfluenza 1, adenovirus, and varicella-zoster virus infections also occurred. In four cases there was evidence of two different viruses infecting the patients or their contacts. Cellular immunity was studied in six cases and responses to phytohaemagglutinin and specific viral antigen were normal. This is the first epidemic of Reyes syndrome in which the association with viral infection has been confirmed in most patients by virological techniques. Impaired cellular immunity could not be implicated as the cause of the unusual reponse to infection.

Measles IgM response during reinfection of previously vaccinated children

Measles IgM antibody was found in the convalescent sera from five of seven childrenwith a primary measles infection, but in only two of seven previously vaccinated children with clinical measles, and in none of seven previously vaccinated children who were revaccinated with attenuated measles virus. Since specific IgM antibody is characteristic of a primary immune response to measles virus, the absence of IgM indicates that some children are experiencing a reinfection despite a primary antigenic stimulus by the vaccine.

The clinical presentations of Rocky Mountain spotted fever. Comments on recognition and management based on a study of 63 patients.

Rocky Mountain spotted fever continues to increase in the United States and the case-fatality ratio remains unchanged despite the availability of effective antibiotics. The apparent reason for the continuing deaths from this disease is the failure of physicians to consider the diagnosis in patients presenting with febrile exanthems in the late spring and summer months. A clinical diagnosis should be based on the history of tick exposure and the presence of fever and the typical exanthem. Serologic tests are useful mainly in retrospect. This article reviews the clinical experience with Rocky Mountain spotted fever in an endemic area in recent years and discusses problems in the diagnosis and management.

Febrile illness in early infancy associated with ECHO virus infection

Twenty-three infants less than six weeks of age with fever of 100.4 degrees F, or higher and no evidence of bacterial infection were seen at the Cincinnati General Hospital from July to December, 1971. Seventeen of these were admitted to the hospital; 15 were treated with penicillin and kanamycin for possible sepsis. Viral isolation was attempted on 21 of these infants, and ECHO viruses were isolated from 14 (66.7 per cent), compared to three (14.3 per cent) of 21 controls. Eleven of the 14 ECHO viruses isolated were type 4, and the other 3 were types 6, 11, and 25 respectively. Acute and convalescent serum was obtained from 11 of the 21 infants; seven had a fourfold rise in antibody to ECHO virus type 4. Most of the children had fever with irritability, six of the 23 had a fine maculopapular rash, and three had aseptic meningitis. This study suggests that ECHO viruses may be a significant cause of febrile illness in young infants during the summer and fall and may account for illnesses which lead to hospitalization as possible sepsis.

Prolonged Hospital Epidemic of Salmonellosis: Use of Trimethoprim-Sulfamethoxazole for Control

The occurrence of a foodborne outbreak of Salmonella drypool, an uncommon serotype, led to the recognition of hospital-acquired cases occurring over a 5-year period. In late 1981, a catered luncheon resulted in an epidemic of S. drypool, and in retrospect, cases were found to have been occurring in hospital patients from 1977 until 1981. Over the next 4 months, patients, employees, and 50% of the kitchen workers became infected, despite repeated culture surveys of the staff and removal of all infected workers. Food and environmental cultures failed to reveal the source of infection, but infected workers were observed to have multiple negative cultures over several months and then to become positive again. Closing of the kitchen for 2 weeks failed to stop the epidemic. Finally, all kitchen employees, both infected and uninfected, were treated with trimethoprim-sulfamethoxazole for 2 weeks. After treatment, no new kitchen workers became infected, although two workers who had had positive cultures earlier in the epidemic began to excrete S. drypool again, and the epidemic ended.

Poliovirus antibody in urban school children

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