The impact of zidovudine use in HIV-infected pregnant women on vertical transmission of HIV in Mississippi.

In February 1994, results of a large placebo-controlled trial of zidovudine (ZDV) use during pregnancy (ACTG 076) showed a dramatic reduction in vertical transmission of HIV. In August 1994, the Public Health Service (PHS) recommended routine ZDV use in HIV infected pregnant women and their neonates for the prevention of vertical transmission. We retrospectively reviewed vertical transmission rates of HIV in Mississippi from 1/1/90 to 8/30/94 before the PHS guidelines were released and from 9/1/94 to 12/31/97 after the PHS guidelines were released. We also reviewed data on ZDV use in HIV infected pregnant women and their neonates from 9/1/94 to 12/31/97. Antenatal, intrapartum and neonatal ZDV use increased from 61%, 59% and 73% respectively to 79%, 77% and 92% respectively. After 9/1/94, vertical transmission rates fell by 44%. Zidovudine use during pregnancy has increased in Mississippi since release of the PHS guidelines resulting in a dramatic decline in vertical transmission rates.

An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection.

In 1994, an apparent outbreak of atypical genital ulcers was noted by clinicians at the sexually transmitted disease clinic in Jackson, Mississippi. Of 143 patients with ulcers tested with a multiplex polymerase chain reaction (PCR) assay, 56 (39%) were positive for Haemophilus ducreyi, 44 (31%) for herpes simplex virus, and 27 (19%) for Treponema pallidum; 12 (8%) were positive for > 1 organism. Of 136 patients tested for human immunodeficiency virus (HIV) by serology, 14 (10%) were HIV-seropositive, compared with none of 200 patients without ulcers (P < .001). HIV-1 DNA was detected by PCR in ulcers of 6 (50%) of 12 HIV-positive patients. Multivariate analysis indicated that men with chancroid were significantly more likely than male patients without ulcers to report sex with a crack cocaine user, exchange of money or drugs for sex, and multiple sex partners. The strong association between genital ulcers and HIV infection in this population highlights the urgency of preventing genital ulcers in the southern United States.

Endemic blastomycosis in Mississippi: epidemiological and clinical studies.

In order to clarify the epidemiology and clinical spectrum of endemic blastomycosis, we reviewed the charts of 326 culture and/or histologically proven cases of blastomycosis in Mississippi from 1979 to 1988. Cases were dispersed throughout the state, but counties in central and south-central Mississippi reported 63% of all blastomycosis cases. The average annual incidence rate was 1.3 cases per 100,000 population. The majority of cases were in men (male to female ratio 1.7:1), and most patients were aged in their third through seventh decades (82%). Outdoor occupations were noted for only 28.9% of cases. Cases occurred throughout the year with no significant seasonal peak. Although 55% saw a physician within 7 days of onset of illness, 29% presented after 1 month. Despite early presentation, diagnosis was often delayed for more than 1 month (43.3%). Single organs were involved in 82.8% of cases. For all cases, organ systems involved included lungs (91.4%), skin (18.1%), bone (4.3%), genitourinary system (1.8%), and central nervous system (1.2%). The presence of skin or bone disease was associated with multiorgan involvement. Thirty-three patients died (11.5%), 6 of whom received no therapy. Patients who died were significantly older than those who survived. A successful outcome without relapse was noted in 86.5% of amphotericin B-treated patients and in 81.7% of ketoconazole-treated patients. The relapse rate for ketoconazole-treated patients was higher than for amphotericin B-treated patients (14% and 3.9% respectively).

No evidence of increase in birth defects and health problems among children born to Persian Gulf War Veterans in Mississippi.

The Department of Veterans' Affairs, Jackson, Mississippi, and the Mississippi State Department of Health conducted a collaborative investigation of an apparent increase in the numbers of birth defects and other health problems among children born to veterans of two Mississippi National Guard units who had served in the Persian Gulf War. The medical records of all children conceived by and born to veterans of the two units after deployment were reviewed; observed numbers of birth defects and other health problems were compared with expected numbers using rates from birth defect surveillance systems and previous surveys. The total number of all types of birth defects was not greater than expected, but whether the number of specific birth defects was greater than expected could not be determined. The frequency of premature birth, low birth weight, and other health problems appeared similar to that in the general population.

Vibrio vulnificus wound infections from the Mississippi Gulf coastal waters: June to August 1993.

Vibrio vulnificus, part of the normal marine flora of the Gulf of Mexico, is being increasingly recognized as an important human pathogen. V vulnificus contamination of superficial wounds can cause a severe, rapidly progressive, necrotizing cellulitis with bullous skin lesions that may require surgical debridement and is occasionally fatal. We summarize information about six cases of V vulnificus wound infection reported to the Mississippi State Department of Health from June to August 1993. Five of the six patients required hospitalization for intravenous antibiotic treatment and, in two cases, surgery. Two patients died from septicemia, despite aggressive antibiotic treatment; both had preexisting medical conditions that could have contributed to immune compromise and fulminant infection. This report underscores the virulence of this organism and the need for awareness by both the clinician and diagnostic laboratory personnel when dealing with superficial wounds occupationally or recreationally exposed to seawater.

James Parkinson. On child abuse and other things.

James Parkinson, a general physician, was interested in all facets of medical care, and wrote two books for the lay public that contained comments on diverse things. He may have been one of the first physicians to publicly describe child abuse. Some of his advice to the public was of a neurologic nature, and included directions on the diagnosis and treatment of pseudoseizures, epilepsy, drowning, and stroke.