James M. Vergeront

Isolation of Blastomyces dermatitidis in Soil Associated with a Large Outbreak of Blastomycosis in Wisconsin

In investigating six cases of blastomycosis in two school groups that had separately visited an environmental camp in northern Wisconsin in June 1984, we identified a large outbreak of the disease and isolated Blastomyces dermatitidis from soil at a beaver pond near the camp. Of 89 elementary-school children and 10 adults from the two groups, 48 (51 percent) of the 95 evaluated in September had blastomycosis. Of the cases, 26 (54 percent) were symptomatic (the median incubation period was 45 days; range, 21 to 106 days). No cases were identified in 10 groups that visited the camp two weeks before or after these two groups. A review of camp itineraries, a questionnaire survey, and environmental investigation showed that blastomycosis occurred in two of four groups that visited a beaver pond and in none of eight groups that did not. Walking on the beaver lodge (P = 0.008) and picking up items from its soil (P = 0.05) were associated with illness. Cultures of soil from the beaver lodge and decomposed wood near the beaver dam yielded B. dermatitidis. We conclude that B. dermatitidis in the soil can be a reservoir for human infection.

Molecular Epidemiology of Antibiotic Resistance in Salmonella from Animals and Human Beings in the United States

We collected serotyped isolates of salmonella from reference laboratories in the United States, tested their susceptibility to antibiotics, and extracted plasmids from isolates that were resistant to a different combination of antibiotics from each of three serotypes. Restriction-endonuclease digestion showed that within each of the three groups, plasmid molecules from animal and human isolates were often identical or nearly identical. One serotype-plasmid combination appeared to be endemic in cattle in 20 states and infected 26 persons in two states. The human cases, which were not recognizably related except for their common plasmids, appeared to be clustered in time but geographically dispersed, like cases in previous outbreaks spread by food products. These findings suggest that resistance plasmids may be extensively shared between animal and human bacteria, and that spread of multiresistant strains of salmonella among animals and human beings, as observed in Britain, may have been undetected in the United States for lack of comparable surveillance.

An enterotoxin-like protein in Staphylococcus aureus strains from patients with toxic shock syndrome.

An enterotoxin-like protein, tentatively labeled enterotoxin F, was isolated from Staphylococcus aureus strains taken from patients with toxic shock syndrome. Antibodies specific for enterotoxin F were prepared in rabbits. Use of these antibodies showed that 130 (91.5%) of 142 S. aureus strains from patients with toxic shock syndrome produced enterotoxin F. Strains from toxic shock patients in eight other countries were identified as enterotoxin F producers. Only a small number of S. aureus strains from sources other than patients with toxic shock syndrome were found to produce enterotoxin F. Twenty-one of 111 controls had low antibody titers (less than 1:100) to enterotoxin F whereas 86 of 92 toxic shock patients had low acute phase antibody titers (less than 1:100) to enterotoxin F. Eight of 52 patients had serum conversion as shown by an increase in antibody titer to enterotoxin F in sera taken 21 to 60 days after onset of the illness. It may be possible to identify persons susceptible to toxic shock syndrome by measuring their antibody titer to enterotoxin F.

Toxic Shock Syndrome: Management and Long-Term Sequelae

Little information is available on the optimal management of toxic shock syndrome and on its sequelae. The most appropriate antibiotic treatment, the efficacy of colloid infusions, and the potential role of gamma globulin preparations have not yet been completely ascertained. Coagulase-positive staphylococci associated with toxic shock syndrome had minimal inhibitory concentrations of 0.06 microgram/mL or less to rifampin, 0.25 microgram/mL or less to gentamicin, and 0.50 microgram/mL or less to both nafcillin and clindamycin. In the 36 patients studied abnormal chest roentgenograms were commoner in those who had received albumin than in those who had not. Radioimmunoassay showed antibody titers to staphylococcal enterotoxin F, a marker protein in toxic shock syndrome, of 1:4000 or more for intravenous gamma globulin (12/15 lots) and 1:40 000 or more for intramuscular gamma globulin. Major sequelae of toxic shock syndrome include late-onset rash, compromised renal function, cyanotic extremities, and prolonged neuromuscular abnormalities.

Clinical and Epidemiologic Features of a Massive Waterborne Outbreak of Cryptosporidiosis in Persons With HIV Infection

During March and April 1993, a massive outbreak of Cryptosporidium infection resulted from contamination of the public water supply in Milwaukee, Wisconsin. The health impact of this outbreak in HIV-infected persons was unknown but was perceived as severe. We surveyed HIV-infected persons who resided in the greater Milwaukee area to examine the acute health impact of cryptosporidiosis on this population. Data from a random-digit dialing survey in the general population residing in the same area were used for comparison. The attack rate of watery diarrhea suggestive of cryptosporidiosis was lower in HIV-infected persons (32%) than in the general population (51%). There was no significant difference in attack rate in HIV-infected persons based on CD4+ T-lymphocyte count. In persons with watery diarrhea, HIV-infected persons were more likely to experience cough (42%), fever (52%), and dehydration (55%). In HIV-infected persons with watery diarrhea, persons with CD4+ T-lymphocyte counts <200/microl had longer duration of diarrhea and were more likely to seek medical attention and be hospitalized. During this massive waterborne outbreak, HIV-infected persons were not more likely to experience symptomatic Cryptosporidium infection than the general population. However, once infected, the duration and severity of illness was greater in HIV-infected persons, especially if the CD4+ T-lymphocyte count was <200/microl.

Possible Host-Defense Mechanisms in Toxic Shock Syndrome

Abstract Future research activity in toxic shock syndrome should provide further understanding of the ways different host-defense mechanisms are involved in toxic shock syndrome; such efforts must ...

Toxic shock syndrome: Relation to catamenial products, personal health and hygiene, and sexual practices

In 1980, the discovery of an association between vaginal tampon use and toxic shock syndrome affected the lifestyles of menstruating women and the catamenial products industry. It made both the general public and the medical community more aware of all aspects of menstruation. The relation between developing toxic shock syndrome and tampon use is unclear; tampon fluid capacity (absorbency) remains the best predictive measure of that risk. No unique aspect of tampon use other than absorbency seems to increase the risk of developing toxic shock syndrome, and numerous hygiene and medical history factors do not seem to play a role in the pathogenesis of the disease. Studies in Minnesota, Wisconsin, and Iowa indicate that 70% to 75% of women between the ages of 15 and 24, the group with the highest risk of developing menstrual toxic shock syndrome, continued to use tampons after news media attention in 1980 on the association of the syndrome with tampon use. This rate of use is higher than the rate found for the general population by recent tampon market research.

Tri-State Toxic Shock Syndrome Study: Evaluation of Case Definition and Prevention of Recurrence

Abstract The clinical and laboratory findings in 80 nonfatal cases of toxic shock syndrome were examined as part of the Tri-State Toxic-Shock Syndrome Study conducted by the state health department...

Toxic Shock Syndrome: A Critique of the 1980 Wisconsin Case-Control Study

Seven cases of toxic shock syndrome has been reported to the Wisconsin Division of Health by 6 January 1980; all seven cases were in female patients, six of whom had onset of illness during active menstruation. Through passive reporting of cases by physicians and patients themselves, a total of 38 patients with confirmed cases of toxic shock syndrome had been identified by the Division of Health by 30 June 1980. Thirty-five patients with menstrual toxic shock syndrome were each age-matched to three menstruating control subjects as part of a case-control study to identify potential risk factors associated with menstrual toxic shock syndrome. Statistically significant findings included increased tampon usage by patients as compared with controls, and fewer patients than controls were using any method of birth control. Numerous other health and hygiene variables were examined and found not to be statistically significant. We critically review the potential biases inherent to the study design. The conclusions and experience gained in this study were crucial to the designing of later case-control studies.

A Review of Toxic Shock Syndrome Surveillance in Wisconsin: The Effect of Media Publicity and Laboratory Services on Reporting of Illness

Abstract A review of case reports on toxic shock syndrome received by the Wisconsin Division of Health through 30 January 1981, with onset of illness before 1 January 1981, showed that media public...