Hjordis M. Foy

Microbial causes of neonatal conjunctivitis

We assessed the microbial causes of neonatal conjunctivitis by comparing 55 infants with purulent conjunctivitis and 60 healthy control infants. A mean of >5 leukocytes per 1000× microscopic field was seen in Gram-stained smears obtained from the more inflamed eye in 77% of 30 untreated patients but none of 57 controls. Pathogens isolated more often from untreated patients than from controls included Haemophilus spp. (17% vs 2%, P=0.01). Staphylococcus aureus (17% vs 2%, P=0.01). Chlamydia trachomatis (14% vs 0%, P=0.01), enterococci (8% vs 0%, P=0.05), and Streptococcus pneumoniae (11% vs 2%, P=0.06). One or more of these pathogens were isolated from the conjunctivae in 58% of patients and 5% of controls (P

Adenovirus Type 3 Epidemic Associated with Intermittent Chlorination of a Swimming Pool

A sharp outbreak of pharyngoconjunctival fever due to adenovirus type 3 occurred in two swimming teams shortly alter exposure to unchlorinated water. Children swimming in the chlorinated water suffered no similar illness. The attack rate was 65% and 67% for each team, Attempts to isolate the virus from the water after the outbreak failed. In ten of 19 affected families, transmission to other family members was demonstrated; the secondary attack rate for children was 63%, for adults 19%. The majority of infected children suffered fever, pharyngitis, and conjunctivitis; symptoms in adults were milder, with conjunctivitis predominating. Diarrhea was more common among children infected at home. The median incubation period for swimmers was estimated at seven days; the median case-to-case interval in the families was 11 days.

Vaginal douching and the risk of tubal pregnancy

To explore the possible association between vaginal douching and tubal pregnancy, we interviewed 273 women who were diagnosed with tubal pregnancy at Group Health Cooperative between September 31, 1981 and October 1, 1986. Their responses were compared with responses of a random sample of 722 female members of Group Health Cooperative who were assumed to be at risk of becoming pregnant at the time the cases conceived. After adjusting for differences between cases and controls with regard to other measured risk factors, we found a modest increase in risk associated with having douched more than two times per year in the past (RR = 1.3, 95% CI: 0.9–1.8). Among women who had more than one sexual partner during their lifetime, however, the risk for those who had douched more than twice per year was somewhat higher (RR = 1.6, 95% CI: 1.1–2.3). There was an indication that women who had been exposed to Chlamydia trachomatis, as indicated by elevated antibody titers, may further increase their risk for tubal pregnancy by douching (RR = 2.4, 95% CI: 0.8–7.3). The associations found in other studies between douching and pelvic inflammatory disease, and between pelvic inflammatory disease and subsequent tubal pregnancy, argue that a relation between douching and tubal pregnancy might be anticipated. Our results offer further support for this hypothesis

Isolation of Mycoplasma hominis, T-strains, and cytomegalovirus from the cervix of pregnant women

Abstract Mycoplasma hominis was isolated from 37 of 199 cervical cultures from women attending the prenatal clinic at the University Hospital in Seattle. The isolation rate was higher among Negroes (32 per cent), than among Caucasians (16 per cent). T-strains were isolated from 56 per cent of the pregnant Caucasian women and 75 per cent of the pregnant Negro women. Nearly all (92 per cent) of those who carried M. hominis also carried T-strains. No adverse effect of pregnancy or on the infant from the presence of either M. hominis or T-strains was observed. Both organisms were transmitted to infants of positive mothers (M. hominis to 2 of 11 such infants and T-strains to 4 of 15 such infants). Cytomegalovirus (CMV) was isolated from cervical cultures of 5 of 140 pregnant women. Congenital cytomegalovirus disease or transmission to the infant was not seen in any of these 5 patients. On the other hand, the presence of CMV in the cervix was associated with lower than average birth weight.

Isolation of mycoplasmas and bacteria from the blood of postpartum women

Mycoplasmas and/or bacteria were recovered from the blood cultures of 26 (20.8%) of 125 febrile postpartum women. Genital mycoplasmas were recovered from 16 (12.8%) of the 125 febrile women and from none of 60 afebrile postpartum women (p less than 0.005). The presence of mycoplasmaemia was associated with a young age, primigravidity, and nulliparity. The isolation of organisms from the blood was also associated with fever during labor, internal monitor use, and a cesarean delivery.

Cerebrospinal fluid analysis in children with seizures.

Cerebrospinal fluid (CSF) examinations of 212 children aged two to 24 months with idiopathic nonfebrile seizures, complex febrile seizures, or status epilepticus, who had a lumbar puncture within 24 hours of the convulsion, were reviewed to determine whether an idiopathic convulsion can result in CSF abnormalities. Children with complex febrile seizures had a median CSF white blood cell count of 1 cell/mm3 (range 0–19 cells/mm3) and a median CSF polymorphonuclear (PMN) cell count of 0 cells/mm3 (range 0–8 cells/mm3). The CSF white blood cell (WBC) count was elevated above the upper limit of normal of 5 cells/mm3 in 9.8% and the absolute number of polymorphonuclear cells was more than 0 cells/mm3 in 26.2% of the complex febrile seizure subjects. Values at the 95th percentile were calculated; a total of 8 WBC/mm3, 4 PMN/mm3, protein of 73 mg/dl and glucose of 119 mg/dl determined the 95th percentile CSF values for the patients with complex febrile seizures. Patients with nonfebrile seizures or with status epilepticus had similar findings. We conclude that complex febrile, idiopathic nonfebrile convulsions or status epilepticus may affect CSF findings in children: CSF with >20 WBC/mm3 or >10 PMN/mm3 should not be attributed to seizures.

Outbreak of anthrax in Thailand.

An outbreak of anthrax occurred among 14 persons exposed to the meat of two water buffalo which had died from anthrax, in two neighbouring villages in the northeastern region of Thailand. All but one case had typical eschars or blisters. Three had eaten raw meat; one of them died from gastric anthrax with severe haematemesis. All the others were successfully treated with penicillin. The incubation period varied between two and 11 days. Sporadic outbreaks of human and animal anthrax still occur in Southeast Asia.

RISES IN TITERS OF ANTIBODY TO HUMAN CORONA VIRUSES OC43 AND 229E IN SEATTLE FAMILIES DURING 1975–1979

Abstract Sequential serum specimens were obtained every four months during 1975–1979 from 44 children and adults of 10 Seattle families. The 419 specimens were tested for antibody to human coronaviruses OC43 and 229E by enzyme-linked immunosorbent assay (ELISA). Antibody titers were found to increase with age, and titers as well as frequency of rises were greater for OC43 than for 229E virus in all age groups. Significant antibody rises were most frequent in specimens bracketing the winter interval, but some also occurred in the spring-summer and summer-fall intervals. Concurrent significant antibody rises to OC43 virus in different members of the same family were observed in 15 instances, to 229E virus in seven instances, and to OC43 virus in some members and 229E virus in others in eight instances. Significant antibody rises to OC43 or 229E virus indicating reinfections were frequently observed throughout the three-year period but were always separated by at least two four-month intervals. Concurrent significant antibody rises to both 229E and OC43 viruses were seen only in three persons. Finally, the frequency of significant antibody rises in children, about one per person-year, was almost three times higher than in adults.

Enhancing student practicum opportunities: the outbreak investigation option.

An outbreak investigation practicum option for graduate students at the University of Washington School of Public Health and Community Medicine has three goals of education, scientific investigation, and exposure to operations of public health agencies. Over a six-year period, 48 students performed 40 outbreak investigations in collaboration with adjunct faculty based in local public health agencies. An outbreak investigation practicum at Yale University had similar goals, but the rapid-response team approach there generally involved one regular faculty member and a team of graduate students. In either program, the level of faculty involvement necessary for outbreak investigations is sustainable only if the faculty value public health practice as part of the schools mission. Since public health students need to acquire many practical skills, a short outbreak investigation practicum experience should not be viewed in isolation, but rather should be one of a variety of practicum offerings available to students at schools of public health.

Mycoplasma pneumoniae and Other Human Mycoplasmas

Mycoplasmas are small pliable pleomorph bacteria lacking cell walls. They were first called pleuropneumonialike organisms (PPLOs) for the disease they caused in cattle. The first human isolation of a mycoplasma, probably Mycoplasma hominis, was made from a Bartilin’s gland in 1937. However, their role as human parasites did not become recognized until the 1950s. They belong to the order Mycoplasmatales, family Mycoplasmataceae, and class Mollicutes.(1)