Deborah L. Martin

Cholera on a Gulf Coast Oil Rig

A single case of severe diarrhea on a floating Texas oil rig was followed two days later by what proved to be the largest outbreak of cholera in the United States in over a century. After isolation of toxigenic Vibrio cholerae El Tor Inaba of the typical United States phage type from the index patients stool, the ensuing investigation detected 14 additional cases of cholera and one asymptomatic infection serologically. Infection was associated with eating rice on the oil rig on a particular day (P = 0.03) when an open valve permitted the rigs drinking-water system to be contaminated by canal water containing sewage (including that from the index patient) discharged from the rig. The rice had been rinsed in the contaminated water after cooking, and before being served it had been maintained at a temperature that allows V. cholerae 01 to multiply. Toxigenic V. cholerae 01 is persisting in the United States, and large common-source outbreaks of cholera can occur if proper sanitation is not maintained.

An outbreak of shigellosis associated with the consumption of raw oysters

We describe an outbreak of Shigella sonnei infection among 24 persons who had eaten raw oysters in restaurants in southeastern Texas within five days before the onset of symptoms. The oysters in all eight restaurants were supplied by the same dealer, but examination of a routine water sample collected six days before the probable time of contamination showed the waters where the oysters were harvested to be free of fecal contamination, making widespread sewage contamination unlikely. The suspect oysters were traced to a single boat. Stool swabs from that boats oyster harvesters allowed the identification of one asymptomatic carrier who had a strain of S. sonnei (determined by colicin typing, plasmid analysis, and testing for susceptibility to antibiotics) that was similar to or the same as that infecting the patients. Although the source of this mans infection was unknown, he reported having eaten no oysters. Investigation revealed that 5-gallon (19-liter) pails were used as toilets aboard the oyster boats. Sewage collected in these pails was often dumped overboard into the harvesting area. We conclude that this outbreak of S. sonnei resulted from poor sanitary procedures that probably allowed stool from a carrier to contaminate oysters either just before or after they were taken aboard the boat.

A Mysterious Cluster of Deaths and Cardiopulmonary Arrests in a Pediatric Intensive Care Unit

Abstract In the period April 1981 through June 1982, there was an unusual increase in the number of deaths and cardiopulmonary arrests in the pediatric intensive care unit at a large medical center hospital in San Antonio, Texas. During this period, 34 of 42 deaths (81 per cent) occurred in the evening work shift, as compared with 36 of 106 (34 per cent) during the previous four years (P<0.0001). Reviews of records of patients revealed no association between death in this 15-month epidemic period and a variety of demographic, historical, medical, and admission characteristics; medical or surgical procedures; or the severity of illness. The findings of a blinded clinical consultant support the conclusion that the increase in deaths and cardiopulmonary arrests could not be explained on the basis of the clinical status of the patients, and the consultant concluded that during the epidemic period, there were more deaths and cardiopulmonary arrests that were either unexpected in timing or inconsistent with the...

A cluster of true appendicitis cases

A cluster of cases of appendicitis occurred primarily in school-age boys in a small Texas town. The expected rate of appendicitis is 1.5 cases per 1,000 persons, or about 1 case per month in that town. However, in the spring of 1984, 13 cases, 10 in school-age boys, occurred. In eight of these patients, the initial onset of abdominal pain occurred over a 15 day period. A case controlled study of school-age patients indicated that sweets in the diet and consumption of local farm eggs may have been associated with the appendicitis. We hypothesize that a group of young male patients who were susceptible to appendicitis because of the high sugar content of their diets were exposed to a bacterium or virus that precipitated this outbreak of appendicitis.

Cholera on the Texas Gulf Coast

Cholera is being increasingly recognized in the Gulf Coast region. This report describes two cholera cases of classic clinical presentation. Both cases were caused by toxigenic Vibrio cholerae, one of an 01 serotype and one of a non-01 serotype. Vibrio cholerae was also isolated from the home environments of both patients. These findings indicate that cholera continues to be detected on the Gulf Coast, that non-01 V cholerae infections may be clinically indistinguishable from V cholerae 01 infections, and that both 01 and non-01 V cholerae strains are capable of survival in Gulf Coast environments.

Clinical and laboratory features of an outbreak of Vibrio cholerae O1 infections in the united states

A point source outbreak of Vibrio cholerae O1 El Tor Inaba infections occurred aboard an oil rig south of Port Arthur, Texas, in September 1981. Sixteen crew members had V. cholerae O1 infections as determined by serology or stool specimens; 15 were symptomatic. The high percentage of symptomatic infections was attributed in part to the ingestion of a large number of V. cholerae O1 organisms by susceptible individuals. Symptoms included diarrheal stools (100%), weakness (60%), abdominal cramps (53%), nausea (40%), and vomiting (27%). Only one of the three patients who sought medical attention was diagnosed by his physician as having cholera. Physicians who treat patients who live near or travel to the Gulf Coast should consider cholera in patients with watery stools. If cholera is suspected, laboratories should use thiosulfate-citrate-bile salts-sucrose (TCBS) agar in addition to routine enteric media for processing stool specimens.