Trends in hospitalizations associated with gastroenteritis among adults in the United States, 1979-1995.
(25/2074)
Gastroenteritis (GE) is among the most common illnesses of humans but the burden of disease, its epidemiology, and the distribution of pathogens in adults have not been fully examined. This information is needed to plan prevention strategies particularly for high-risk groups. This study is a retrospective analysis of data from the National Hospital Discharge Survey for the years 1979 through 1995 which describes the disease burden and epidemiology of hospitalizations associated with GE among adults in the United States. Diarrhoea was listed as a diagnosis on an average of 452,000 hospital discharges per year representing 1.5% of all hospitalizations among adults. The annual number of GE hospitalizations has decreased by 20% from approximately 500,000 in 1979 to 400,000 in 1995. The aetiology of 78% of cases coded as GE was undetermined. Until the aetiology of disease can be better established, specific strategies for prevention cannot be developed. (+info)
Outbreaks of enterotoxigenic Escherichia coli infection in American adults: a clinical and epidemiologic profile.
(26/2074)
Because enterotoxigenic Escherichia coli (ETEC) is not identified by routine stool culture methods, ETEC outbreaks may go unrecognized, and opportunities for treatment and prevention may be missed. To improve recognition of adult ETEC outbreaks, we compared them with reported outbreaks of viral gastroenteritis. During 1975-95, we identified 14 ETEC outbreaks in the United States and 7 on cruise ships, caused by 17 different serotypes and affecting 5683 persons. Median symptom prevalences were: diarrhoea 99%, abdominal cramps 82%, nausea 49%, fever 22%, vomiting 14%. The median incubation period was 42 h, and for 8 of 10 outbreaks, the mean or median duration of illness was > 72 h (range 24-264). For 17 (81%) ETEC outbreaks, but for only 2 (8%) viral outbreaks, the prevalence of diarrhoea was > or = 2.5 times the prevalence of vomiting. ETEC outbreaks may be differentiated from viral gastroenteritis outbreaks by a diarrhoea-to-vomiting prevalence ratio of > or = 2.5 and a longer duration of illness. (+info)
Molecular typing methods to investigate transmission of Escherichia coli O157:H7 from cattle to humans.
(27/2074)
The utility of phage typing, pulsed-field gel electrophoresis (PFGE), and plasmid profile analysis was compared, to differentiate between Canadian Escherichia coli O157:H7 strains of human (n = 27) and cattle (n = 24) origin. The diversity indices for phage typing, plasmid analysis and PFGE were 0.85, 0.69 and 0.93, respectively. PFGE and phage typing were also applied to study the role of direct transmission of E. coli O157:H7 from cattle to humans on isolates collected from two separate farm outbreaks. PFGE showed that more than one E. coli O157:H7 strain with varying PFGE DNA subtype profiles, may be responsible for an outbreak, and that more than one E. coli O157:H7 subtype may be circulating on a particular farm at any one time. To our knowledge, this is one of the first reports where PFGE typing was used to verify the direct transmission of E. coli O157:H7 from cattle to humans. (+info)
Molecular epidemiological study on tetracycline resistance R plasmids in enterohaemorrhagic Escherichia coli O157:H7.
(28/2074)
Restriction patterns obtained with EcoRI and Southern hybridization were used for the differentiation of tetracycline-resistant (Tet(r)) R plasmids in enterobaemorrhagic Escherichia coli (EHEC) O157:H7 isolates from a mass outbreak at a kindergarten in Obihiro-City, Hokkaido, Japan, 1996. Two kinds of Tet(r) R plasmids of 50 and 95 kb were detected. The 50-kb plasmids were identical to each other, while the 93-kb plasmids were of three types that were very similar to each other. The tet genes of both 50- and 95-kb R plasmids were 100% identical to the tet gene of pSC101 and all plasmids hybridized to a probe for tet. Because food-origin O157 strains were sensitive to tetracycline, we concluded that such Tet(r) R-plasmids might transfer to drug-sensitive O157 strains in the infected individuals. (+info)
An international outbreak of Salmonella enteritidis associated with lasagne; lessons on the need for cross-national co-operation in investigating food-borne outbreaks.
(29/2074)
We investigated an outbreak of Salmonella enteritidis involving at least 19 British tourists returning from one hotel in another European country. A retrospective cohort study of 47 hotel guests identified lasagne as the most likely vehicle of transmission (RR 11.5; 95% CI 3.0-44.1; P < 0.0001). However, difficulties in information exchange and lack of formal mechanisms to agree on the aims of the cross-national investigation hampered efficient management of the outbreak. The factors leading to contamination of the food vehicle were not identified and therefore specific action to prevent reoccurrence could not be taken. There is need to develop protocols for cross-national investigations of outbreaks in Europe which should include specifying objectives, roles and responsibilities of investigators and control agencies, with formal reporting of the outcome of the investigation. (+info)
Phage typing of Campylobacter jejuni and Campylobacter coli and its use as an adjunct to serotyping.
(30/2074)
Campylobacter is the most commonly reported cause of gastro-intestinal infection in England and Wales, with over 50,000 reported cases in 1997. The majority of human campylobacter isolates in England and Wales are C. jejuni (c. 90%) with most of the remainder being C. coli. We describe the use of phage typing as an extension to serotyping for more detailed characterization within these two species. The scheme was piloted during a study of 2407 C. jejuni and 182 C. coli strains isolated in Wales between April 1996 and March 1997. Fifty-seven C. jejuni phage types were identified, with the ten most prevalent phage types accounting for 60% of isolates tested; 16% of isolates were untypable. The most common phage type was PT 1 which represented c. 20% of isolates. A further 7% of isolates reacted with the phages but did not conform to a designated type (RDNC). Only 12 phage types were identified among C. coli, with the two most common types, PT 2 and PT 7 accounting for 75.2% of isolates. When used in conjunction with serotyping, the ability of phage typing to identify between 6 and 29 subtypes within each of the predominant HS types has enabled a further level of discrimination to be achieved that enhances the epidemiological typing of C. jejuni and C. coli. (+info)
Use of complementary treatment by those hospitalised with acute illness.
(31/2074)
AIM: To determine the frequency of use of complementary treatment and measure its impact on clinical outcomes in a hospitalised general paediatric population. METHODS: A population based random sample of children admitted to the general paediatric service at a metropolitan children's hospital in Auckland, New Zealand from February to July 1998. Children with asthma, pneumonia, bronchiolitis, gastroenteritis, or fever were eligible. Data collected by personal interview with parents and by review of the medical records of these children. RESULTS: 251 of 511 eligible children admitted during the study period were enrolled. Forty four children (18%) had received complementary treatment during the hospitalising illness. Most children (77%) had been seen in primary care before hospitalisation. The proportion that were seen in primary care and the number of primary care visits before hospitalisation did not vary with receipt of complementary treatment. The proportion of children who were prescribed medications before hospitalisation was significantly greater for those who had received complementary treatment compared with those who had not (59% v 39%). There was no significant difference between users and non-users of complementary treatment in the severity of the illness at presentation, investigations performed, treatment administered, or length of inpatient stay. CONCLUSION: A substantial proportion of children hospitalised with acute medical illnesses have received complementary treatment. Alternative health care is used as an adjunct rather than an alternative to conventional health care. Receipt of complementary treatment has no significant effect on clinical outcomes for children hospitalised with common acute medical illnesses. (+info)
Ganglioside GM(1a) on the cell surface is involved in the infection by human rotavirus KUN and MO strains.
(32/2074)
Rotavirus is the most common cause of severe gastroenteritis in infants and children worldwide. The cell attachment of most animal rotaviruses, which belong to the neuraminidase-sensitive strains, requires sialic acid residues on the host cell membranes. On the other hand, most human rotaviruses are classified as neuraminidase-insensitive strains. The involvement of gangliosides on the host cell surface in human rotavirus infection was investigated by immunostaining analysis of target cells, and by assaying the neutralization of infection by rotavirus and the blocking of target cellular receptors. In host cells (MA104 cells) pretreated with Arthrobacter ureafaciens neuraminidase, which were still infected by human rotaviruses (KUN and MO strains), GM(3) was hydrolyzed markedly by the neuraminidase, while GM(1a) was not hydrolyzed at all. Infection by the rotaviruses was strongly inhibited by exogenous ganglioside GM(1a), but not GA(1). Infection was also inhibited by pretreatment of the MA104 cells with cholera toxin B-subunit, which specifically blocked ganglioside GM(1a) on the plasma membrane. The treatment of MA104 cells with the endoglycoceramidase attenuated human rotavirus infection. From these findings, we concluded that GM(1a) on the plasma membrane of the host cells was involved in the infection by human rotavirus KUN and MO strains. (+info)