Joel N. Kuritsky

Sternal wound infections and endocarditis due to organisms of the Mycobacterium fortuitum complex

Excerpt Sternal wound infections after surgery occur in 0.5% to 6% of all patients requiring sternotomy incisions (1-4). Most infections have been due to staphylococci and aerobic gram-negative org...

Norwalk gastroenteritis : A community outbreak associated with bakery product consumption

From 23 to 26 August 1982, a gastrointestinal illness occurred among 129 of 248 (52%) persons interviewed who had attended four social events in the Minneapolis-St. Paul area. The median incubation period was 36 hours, and symptoms included diarrhea, nausea, headache, and vomiting. Findings of a food-specific questionnaire given to attendants of the four events confirmed that consumption of cake and frosting was significantly associated with development of the illness (odds ratio, 7.9 to 48.3; p = 0.006 to 0.00001). All cake items were purchased from a single bakery, where the employee who had prepared the frosting had had onset of diarrhea and vomiting on August 20. Given an approximate 60% attack rate among persons who ate frosted items, we estimate that 3000 outbreak-associated cases occurred. Serologic analysis confirmed that 17 of 25 ill persons had fourfold or greater rises in their antibody titer to Norwalk virus. Thus, foodborne transmission of Norwalk virus can result from contamination by a single foodhandler.

Acquired Immunodeficiency Syndrome Associated with Blood-Product Transfusions

A 53-year-old white man had fever, malaise, and dyspnea on exertion. His chest roentgenogram was normal, but pulmonary function tests showed impaired diffusion capacity and a gallium scan showed marked uptake in the lungs. Results of an open-lung biopsy documented Pneumocystis carinii pneumonia. Immunologic test results were consistent with the acquired immunodeficiency syndrome. The patient denied having homosexual contact or using intravenous drugs. Twenty-nine months before the diagnosis of pneumocystis pneumonia was made, the patient had had 16 transfusions of whole blood, platelets, and fresh-frozen plasma during coronary artery bypass surgery at another medical center. This patient is not a member of any currently recognized high-risk group and is believed to have contracted the acquired immunodeficiency syndrome from blood and blood-product transfusions.

The Risk of Subsequent Transmission of Hemophilus Influenzae Type B Disease among Children in Day Care

To determine the risk of Hemophilus influenzae type b disease among children attending day-care facilities who were exposed to a primary case of invasive hemophilus disease, we conducted a two-year (August 1982 through July 1984) statewide prospective study involving active surveillance for H. influenzae disease and a 60-day follow-up of the childrens day-care contacts. We identified 185 patients with primary invasive hemophilus type b disease who were under six years of age and who attended a total of 195 day-care facilities (centers or private homes). There were 4102 children in attendance at these day-care facilities when the primary cases occurred; 4034 (98 percent) were followed for 60 days or more after the onset of illness in the patients with primary disease. A total of 2612 children were considered classroom contacts of the patients with primary disease, because they were cared for in the same home or the same room in a larger facility, but they were not siblings of the index patients. Of these classroom contacts, 370 from 0 to 23 months of age and 716 from 24 to 47 months of age did not receive rifampin chemoprophylaxis. We could confirm no subsequent H. influenzae disease among contacts. Our results suggest that the risk of subsequent hemophilus disease in contacts of patients in day-care facilities is significantly lower than that previously reported for siblings and day-care contacts.

Fatal Hepatic Necrosis Due to Pyrimethamine-Sulfadoxine (Fansidar)

Pyrimethamine-sulfadoxine has been associated with severe and fatal cutaneous reactions as well as transient liver damage. We report the case of a patient who died of progressive hepatic failure caused by pyrimethamine-sulfadoxine administration. In addition, we summarize reports made to the Food and Drug Administration since 1982 that focus on hepatotoxic reactions to pyrimethamine-sulfadoxine. We suggest that fatal hepatic injury can occur after treatment with pyrimethamine-sulfadoxine and that physicians who prescribe the drug should be aware of this possibility.

An Outbreak of Acute Hemorrhagic Conjunctivitis in Central Minnesota

The only confirmed outbreak of acute hemorrhagic conjunctivitis in the continental United States during 1982 occurred in Brainerd, Minnesota. The disease first appeared in a 27-year-old woman during a trip to Tahiti. The patients two daughters (8 months old and 3 years old) developed mild conjunctivitis two days later. Although the symptoms of all three had completely resolved before they arrived in Brainerd, illness compatible with acute hemorrhagic conjunctivitis developed in five other individuals who shared a house with them there. Symptoms appeared within two days in four of the five and within three days in the fifth. All five had high neutralizing antibody titers to enterovirus 70 (1:128, 1:32, 1:32, 1:128, and 1:256) and one had high antibody titers to coxsackievirus A24 which may cause similar symptoms (less than 1:4 in all cases). The symptoms resolved without sequelae in all five patients within five days. These cases demonstrated that a person who is no longer symptomatic can still infect others and that an infected person can transmit enterovirus 70 for at least eight days after the onset of symptoms.

Streptokinase and the Guillain-Barré syndrome.

Excerpt To the editor: Evaluation of the reported association between streptokinase therapy and the Guillain-Barre syndrome (1, 2) brings to light problems encountered by the Food and Drug Administ...

RISK OF SECONDARY HAEMOPHILUS INFLUENZAE TYPE B |[lpar]|Hib|[rpar]| DISEASE IN DAY CARE

In 1982, the MDH initiated a statewide, prospective, active surveillance system for Hib disease. During the first year, we identified 219 cases among children ≤12 years of age. The median time of case report to MDH following onset of illness was 8.2 days. 80 cases (39%) occurred among children attending day care. Of 971 nonsibling-child day care contacts from the same room, 962 (99%) were followed for 60 days. 200 of the 962 (21%) received rifampin prophylaxis. No Hib cases occurred among this group or the 762 contact children who did not receive rifampin, including 137 <24 mos of age; and 269, 24 to 47 mos of age. The secondary attack rate for day care contacts <48 mos is lower (p=0.003) than that reported for household contacts of similar age in a national study. In the present study the distribution of outer membrane protein subtypes (OMP) was similar to that previously reported from 22 states. However, subtype 1H strains previously associated with an increased secondary attack rate in day care, were isolated more frequently from primary cases in day care than in non-day care (53% v. 32%, p=0.03). With the exception of day care, there was no relation between OMP subtypes and age, gender, onset of disease, or geographic residence of the case. Our data suggest that the risk of secondary Hib disease in day care is lower than that previously reported for family-sibling contacts. Further, the frequency of 1H strains among primary cases is higher than in non-day care population.