Eugene J. Gangarosa

Clinical Features of Types A and B Food-borne Botulism

Medical records of 55 patients with type A and type B food-borne botulism reported to the Centers for Disease Control during 2 years were reviewed to assess the clinical features and severity of illness, diagnostic test results, nature of complications, amd causes of death. Some patients had features not usually associated with botulism including paresthesia (14%), asymmetric extremely weakness (17%), asymmetric ptosis (8%), slightly elevated cerebrospinal fluid protein values (14%), and positive responses to edrophonium chloride(26%). Several observation suggest that type A was more severe than type B disease. Although the case-fatality ratio was not significantly greater, patients with type A disease saw a physician earlier in the course of illness, were more likely to need ventilatory support, and were hospitalized longer. Patients who died were older than those who survived. Deaths within the first 2 weeks resulted from failure to recognized the severity of the disease or from pulmonary or systemic infection whereas the three late deaths were related to respirator malfunction.

Non-cholera vibrio infections in the United States. Clinical, epidemiologic, and laboratory features.

Non-cholera vibrios are organisms that are biochemically indistinguishable from Vibrio cholerae but do not agglutinate in vibrio 0 group 1 antiserum. Since 1972 there has been a dramatic increase in the number of these organisms referred to the Center for Disease Control for identification. Clinical, epidemiologic, and laboratory data were analyzed for 26 of 28 patients with isolates identified between January 1972 and March 1975. Thirteen (50%) of the isolates were obtained from feces of patients who had an acute diarrheal illness; no other pathogens were isolated from their feces, and all patients survived. Four (15%) patients had non-cholera vibrios isolated from other gastrointestinal or biliary tract sites; none of these patients had acute illness definitely attributable to non-cholera vibrios. Nine (35%) patients had non-cholera vibrios isolated from other tissues and body fluids; four deaths occurred in this group. Patients with acute diarrhea frequently had a history of recent shellfish ingestion or foreign travel, whereas some patients with systemic non-cholera vibrio infection had a history of recent occupational or recreational exposure to salt water.

Epidemic diarrhea at Crater Lake from enterotoxigenic Escherichia coli. A large waterborne outbreak.

In June and July 1975, Gastrointestinal illness occurred in more than 200 staff members and 2000 visitors to an American national park. In was characterized by prolonged diarrhea, cramps, nausea, and vomiting, lasted a median duration of 8 days, and was significantly associated with consumption of park water (P less than 0.001), which had been contaminated by raw sewage. Enterotoxigenic Escherichia coli serotype 06:K15:H16 was isolated from 20 of 49 ill park residents and from the parks water supply, but not from 71 residents who had never been ill or had been well for at least 4 days. No other bacterial, viral, or parasitic pathogens were isolated from ill or well persons. This outbreak is the first waterborne epidemic of diarrheal illness shown to be due to enterotoxigenic. E. coli, and this study documents one mode of transmission of this pathogen. This investigation also suggests the relative insensitivity of current methods for identifying persons infected with this organism, either by the culturing of randomly selected isolates or by measuring serologic responses.

Benzalkonium chloride as a source of infection.

BENZALKONIUM chloride is widely used as a germicide in clinical medicine. When used correctly it is an agent of proved effectiveness, but its misuse can result in severe and even fatal infections.1...

CHOLERA IN PORTUGAL, 1974 II. TRANSMISSION BY BOTTLED MINERAL WATER

During a cholera epidemic, Vibrio cholerae was isolated from two springs which supplied mineral water to a spa and to a commercial water bottling plant. Epidemiologic investigation found that cholera attack rates were 10-fold greater among visitors to the spa than among non-visitors. A subsequent matched-pair case-control study which excluded persons who had visted the spa showed that a history of consumption of the bottled non-carbonated water was significantly more common among bacteriologically confirmed cholera cases than among paired controls.

Epidemiologic assessment of the relevance of the so-called enteropathogenic serogroups of Escherichia coli in diarrhea.

Since the early 1950s the concept has evolved that certain serogroups of Escherichia coli, commonly designated enteropathogenic, are like shigellae and salmonellae, inherent enteric pathogens. Thi...

Shigellosis in custodial institutions

Thirty-four high-risk children admitted to an institution with endemic Shigella flexneri 2a disease were given either streptomycin-dependent S. flexneri 2a or S. sonnei oral vaccine. Fourteen vaccinees in each group remained under surveillance for more than 12 months and one sonnei vaccinee for more than six months. There was no difference in attack rate for S. flexneri 2a diarrhea between the flexneri and sonnei vaccinees (9/14 vs. 9/15). All cases of symptomatic dysentery occurred within nine months after vaccination; despite clinical immunity thereafter, episodic asymptomatic excretion of shigella was observed in 10 of 28 children. The level of immunity induced by streptomycin-dependent S. flexneri 2a oral vaccine was insufficient to prevent disease in this institutional setting.

ACUTE RENAL FAILURE IN ASIATIC CHOLERA: CLINICOPATHOLOGIC CORRELATIONS WITH ACUTE TUBULAR NECROSIS AND HYPOKALEMIC NEPHROPATHY

Excerpt Progressive uremia has long been recognized as a late and often fatal complication of Asiatic cholera. In 1921, anuria in cholera was attributed by Rogers1to a fall in blood pressure leadin...

Foodborne Disease Outbreaks Traced to Poultry, United States, 1966–1974

To determine the epidemiologic characteristics of foodborne disease outbreaks traced to poultry, we reviewed records of all 352 such outbreaks reported to the Center for Disease Control 1966–1974; 217 (62%) outbreaks were traced to turkey, 129 (37%) to chicken, 5 (1%) to both turkey and chicken, and 1 (0.3%) to cornish hen. Outbreaks from poultry accounted for 12% of all foodborne disease outbreaks reported from 1966 through 1974, but the number and percentage has been decreasing since 1969; these outbreaks involved 30,606 cases of gastrointestinal illness (20% of all cases of foodborne disease) and 14 deaths. Food-service establishments were responsible for mishandling the food in 79% of outbreaks, homes in 19%, and food-processing establishments in 2%. In 85% of the outbreaks, the food-handling error was storage of food at improper holding temperatures. In outbreaks reported 1972–1974 in which an etiologic agent was indentified, Salmonella spp. were responsible for 44%, Clostridium perfringens for 26%, ...

A Simple Technique for Obtaining a Colon Biopsy Specimen per Rectum

Summary The Crosby capsule can be modified for colon biopsy per rectum by securing the instrument to a long flexible rectal tube with strips of adhesive plaster. This biopsy method is simple, rapid, safe, and well tolerated by patients. Specimens thus obtained are ideal for histologic study.