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1.
J Food Prot ; 84(6): 962-972, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428741

RESUMO

ABSTRACT: Scombrotoxin fish poisoning (SFP) is caused by the ingestion of certain fish species with elevated concentrations of histamine due to decomposition. In fall 2019, the U.S. Food and Drug Administration (FDA) was notified of 51 SFP cases including two hospitalizations from 11 states through the FDA consumer complaint system or directly from state partners. A case patient was defined as an individual who experienced a histamine-type reaction after consumption of tuna imported from Vietnam and an illness onset between 14 August and 24 November 2019. A traceback investigation was initiated at 19 points of service to identify a common tuna source. The FDA and state partners collected 34 product samples throughout the distribution chain, including from a case patient's home, points of service, distributors, and the port of entry. Samples were analyzed for histamine by sensory evaluation and/or chemical testing. Case patients reported exposure to tuna imported from Vietnam. The traceback investigation identified two Vietnamese manufacturers as the sources of the tuna. Twenty-nine samples were confirmed as decomposed by sensory evaluation and/or were positive for elevated histamine concentrations by chemical testing. Both Vietnamese companies were placed on an import alert. Seven U.S. companies and one Vietnamese company initiated voluntary recalls. The FDA released public communication naming the U.S. importers to help suppliers and distributors identify the product and effectuate the foreign company's recall. This SFP outbreak investigation highlights the complexities of the federal outbreak response, specifically related to imported food. Cultural considerations regarding imported foods should be addressed during outbreak responses when timing is critical. Collaboration with countries where confidentiality agreements are not in place can limit information sharing and the speed of public health responses.


Assuntos
Doenças Transmitidas por Alimentos , Atum , Animais , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Histamina , Humanos , Toxinas Marinhas , Estados Unidos/epidemiologia , Vietnã/epidemiologia
2.
J Food Prot ; : 1821-1831, 2017 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-28981373

RESUMO

From 1998 to 2008, produce-related illness outbreaks accounted for roughly one-half of reported foodborne outbreaks in the United States. In 2013, Mexico accounted for approximately 50 and 30% of the monetary value of all vegetables and fruits, respectively, imported into the United States. We used historical import data to examine the correlation between the port of entry for five implicated produce vehicles from five multistate outbreaks and the geospatial and temporal distribution of illnesses in the corresponding outbreaks in the United States. For comparison, we analyzed the geospatial and temporal distribution of cases from two U.S. multistate outbreaks associated with domestically grown produce. The geospatial distribution of illnesses in the two outbreaks linked to domestic produce differed from that of the import-related produce outbreaks. The results of our pilot study suggest that geospatial distribution of early-onset cases may be used to identify ports of entry for produce likely to be responsible for causing multistate outbreaks in the United States and that targeted sampling of produce items from these ports of entry may expedite identification of an outbreak vehicle.

3.
Foodborne Pathog Dis ; 14(12): 701-710, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28926300

RESUMO

BACKGROUND: Foodborne disease data collected during outbreak investigations are used to estimate the percentage of foodborne illnesses attributable to specific food categories. Current food categories do not reflect whether or how the food has been processed and exclude many multiple-ingredient foods. MATERIALS AND METHODS: Representatives from three federal agencies worked collaboratively in the Interagency Food Safety Analytics Collaboration (IFSAC) to develop a hierarchical scheme for categorizing foods implicated in outbreaks, which accounts for the type of processing and provides more specific food categories for regulatory purposes. IFSAC also developed standard assumptions for assigning foods to specific food categories, including some multiple-ingredient foods. The number and percentage of outbreaks assignable to each level of the hierarchy were summarized. RESULTS: The IFSAC scheme is a five-level hierarchy for categorizing implicated foods with increasingly specific subcategories at each level, resulting in a total of 234 food categories. Subcategories allow distinguishing features of implicated foods to be reported, such as pasteurized versus unpasteurized fluid milk, shell eggs versus liquid egg products, ready-to-eat versus raw meats, and five different varieties of fruit categories. Twenty-four aggregate food categories contained a sufficient number of outbreaks for source attribution analyses. Among 9791 outbreaks reported from 1998 to 2014 with an identified food vehicle, 4607 (47%) were assignable to food categories using this scheme. Among these, 4218 (92%) were assigned to one of the 24 aggregate food categories, and 840 (18%) were assigned to the most specific category possible. CONCLUSIONS: Updates to the food categorization scheme and new methods for assigning implicated foods to specific food categories can help increase the number of outbreaks attributed to a single food category. The increased specificity of food categories in this scheme may help improve source attribution analyses, eventually leading to improved foodborne illness source attribution estimates and enhanced food safety and regulatory efforts.


Assuntos
Surtos de Doenças , Contaminação de Alimentos , Alimentos/classificação , Doenças Transmitidas por Alimentos/epidemiologia , Laticínios/microbiologia , Ovos/microbiologia , Manipulação de Alimentos , Microbiologia de Alimentos , Inocuidade dos Alimentos , Frutas/microbiologia , Humanos , Carne/microbiologia , Pasteurização
4.
Clin Infect Dis ; 66(suppl_1): S92-S94, 2017 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-29293930

RESUMO

From 1976 to 2016, neurotoxigenic Clostridium baratii type F caused 18 (<0.5%) reported US infant botulism cases. Six cases occurred during 2012-2013; no common source was identified. Type F infant botulism mostly occurs in very young infants and typically presents more rapidly and severely than illness caused by types A and B botulinum neurotoxin.


Assuntos
Botulismo/epidemiologia , Clostridium botulinum tipo F , Doenças Raras/epidemiologia , Doenças Raras/microbiologia , Feminino , Humanos , Recém-Nascido , Masculino , Estados Unidos/epidemiologia
5.
Drug Test Anal ; 9(1): 68-74, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27367536

RESUMO

In September 2013, the Hawaii Department of Health (HDOH) was notified of seven adults who developed acute hepatitis after taking OxyELITE Pro™, a weight loss and sports dietary supplement. CDC assisted HDOH with their investigation, then conducted case-finding outside of Hawaii with FDA and the Department of Defense (DoD). We defined cases as acute hepatitis of unknown etiology that occurred from April 1, 2013, through December 5, 2013, following exposure to a weight loss or muscle-building dietary supplement, such as OxyELITE Pro™. We conducted case-finding through multiple sources, including data from poison centers (National Poison Data System [NPDS]) and FDA MedWatch. We identified 40 case-patients in 23 states and two military bases with acute hepatitis of unknown etiology and exposure to a weight loss or muscle building dietary supplement. Of 35 case-patients who reported their race, 15 (42.9%) reported white and 9 (25.7%) reported Asian. Commonly reported symptoms included jaundice, fatigue, and dark urine. Twenty-five (62.5%) case-patients reported taking OxyELITE Pro™. Of these 25 patients, 17 of 22 (77.3%) with available data were hospitalized and 1 received a liver transplant. NPDS and FDA MedWatch each captured seven (17.5%) case-patients. Improving the ability to search surveillance systems like NPDS and FDA MedWatch for individual and grouped dietary supplements, as well as coordinating case-finding with DoD, may benefit ongoing surveillance efforts and future outbreak responses involving adverse health effects from dietary supplements. This investigation highlights opportunities and challenges in using multiple sources to identify cases of suspected supplement associated adverse events. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.


Assuntos
Anabolizantes/toxicidade , Fármacos Antiobesidade/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Suplementos Nutricionais/toxicidade , Hepatite/etiologia , Fígado/efeitos dos fármacos , Adulto , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Induzida por Substâncias e Drogas/terapia , Feminino , Hepatite/patologia , Hepatite/terapia , Hospitalização , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
Emerg Infect Dis ; 22(12): 2113-2119, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27869595

RESUMO

The relationship between the number of ingested Listeria monocytogenes cells in food and the likelihood of developing listeriosis is not well understood. Data from an outbreak of listeriosis linked to milkshakes made from ice cream produced in 1 factory showed that contaminated products were distributed widely to the public without any reported cases, except for 4 cases of severe illness in persons who were highly susceptible. The ingestion of high doses of L. monocytogenes by these patients infected through milkshakes was unlikely if possible additional contamination associated with the preparation of the milkshake is ruled out. This outbreak illustrated that the vast majority of the population did not become ill after ingesting a low level of L. monocytogenes but raises the question of listeriosis cases in highly susceptible persons after distribution of low-level contaminated products that did not support the growth of this pathogen.


Assuntos
Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Sorvetes/microbiologia , Listeriose/epidemiologia , Listeriose/microbiologia , Idoso , Idoso de 80 Anos ou mais , Carga Bacteriana , Contaminação de Alimentos , Microbiologia de Alimentos , História do Século XXI , Humanos , Listeria monocytogenes , Listeriose/história , Listeriose/transmissão , Vigilância da População , Estados Unidos/epidemiologia
7.
Emerg Infect Dis ; 22(7): 1193-200, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27314510

RESUMO

Outbreak data have been used to estimate the proportion of illnesses attributable to different foods. Applying outbreak-based attribution estimates to nonoutbreak foodborne illnesses requires an assumption of similar exposure pathways for outbreak and sporadic illnesses. This assumption cannot be tested, but other comparisons can assess its veracity. Our study compares demographic, clinical, temporal, and geographic characteristics of outbreak and sporadic illnesses from Campylobacter, Escherichia coli O157, Listeria, and Salmonella bacteria ascertained by the Foodborne Diseases Active Surveillance Network (FoodNet). Differences among FoodNet sites in outbreak and sporadic illnesses might reflect differences in surveillance practices. For Campylobacter, Listeria, and Escherichia coli O157, outbreak and sporadic illnesses are similar for severity, sex, and age. For Salmonella, outbreak and sporadic illnesses are similar for severity and sex. Nevertheless, the percentage of outbreak illnesses in the youngest age category was lower. Therefore, we do not reject the assumption that outbreak and sporadic illnesses are similar.


Assuntos
Surtos de Doenças , Monitoramento Epidemiológico , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População/métodos , Campylobacter , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/microbiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli O157 , Humanos , Estudos Retrospectivos , Salmonella , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/microbiologia , Estados Unidos/epidemiologia
8.
J Food Prot ; 79(11): 1828-1832, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-28221903

RESUMO

A most-probable-number (MPN) method was used to enumerate Listeria monocytogenes in 2,320 commercial ice cream scoops manufactured on a production line that was implicated in a 2015 listeriosis outbreak in the United States. The analyzed samples were collected from seven lots produced in November 2014, December 2014, January 2015, and March 2015. L. monocytogenes was detected in 99% (2,307 of 2,320) of the tested samples (lower limit of detection, 0.03 MPN/g), 92% of which were contaminated at <20 MPN/g. The levels of L. monocytogenes in these samples had a geometric mean per lot of 0.15 to 7.1 MPN/g. The prevalence and enumeration data from an unprecedented large number of naturally contaminated ice cream products linked to a listeriosis outbreak provided a unique data set for further understanding the risk associated with L. monocytogenes contamination for highly susceptible populations.


Assuntos
Sorvetes , Listeria monocytogenes , Surtos de Doenças , Contaminação de Alimentos , Microbiologia de Alimentos , Listeriose , Prevalência , Estados Unidos
9.
Public Health Rep ; 130(5): 526-32, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26327730

RESUMO

OBJECTIVE: Liver disease is a potential complication from using dietary supplements. This study investigated an outbreak of non-viral liver disease associated with the use of OxyELITE Pro(TM), a dietary supplement used for weight loss and/or muscle building. METHODS: Illness details were ascertained from MedWatch reports submitted to the U.S. Food and Drug Administration (FDA) describing consumers who ingested OxyELITE Pro alone or in combination with other dietary supplements. FDA's Forensic Chemistry Center analyzed samples of OxyELITE Pro. RESULTS: From February 2012 to February 2014, FDA received 114 reports of adverse events of all kinds involving consumers who ingested OxyELITE Pro. The onset of illness for the first report was December 2010 and for the last report was January 2014. Thirty-three states, two foreign nations, and Puerto Rico submitted reports. Fifty-five of the reports (48%) described liver disease in the absence of viral infection, gallbladder disease, autoimmune disease, or other known causes of liver damage. A total of 33 (60%) of these patients were hospitalized, and three underwent liver transplantation. In early 2013, OxyELITE Pro products entered the market with a formulation distinct from products sold previously. The new formulation replaced 1,3-dimethylamylamine with aegeline. However, the manufacturer failed to submit to FDA a required "new dietary ingredient" notice for the use of aegeline in OxyELITE Pro products. Laboratory analysis identified no drugs, poisons, pharmaceuticals, toxic metals, usnic acid, N-Nitroso-fenfluramine, pyrrolizidine alkaloids, aristocholic acid, or phenethylamines in the products. CONCLUSIONS: Vigilant surveillance is required for adverse events linked to the use of dietary supplements.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/legislação & jurisprudência , Amidas/envenenamento , Aminas/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Suplementos Nutricionais/envenenamento , Aprovação de Drogas/legislação & jurisprudência , Falência Hepática Aguda/induzido quimicamente , United States Food and Drug Administration/legislação & jurisprudência , Adulto , Fármacos Antiobesidade/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/cirurgia , Química Farmacêutica/legislação & jurisprudência , Surtos de Doenças/estatística & dados numéricos , Feminino , Hawaii/epidemiologia , Humanos , Falência Hepática Aguda/mortalidade , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Food Prot ; 78(8): 1428-33, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26219354

RESUMO

The present study was conducted to evaluate the level of food safety protection provided to consumers of Grade "A" milk and milk products in the United States by the National Conference on Interstate Milk Shipments (NCIMS) Grade "A" Milk Safety Program through its implementation and enforcement of the U.S. Grade "A" Pasteurized Milk Ordinance (PMO). The number of reported illnesses associated with Grade "A" milk and milk products in the United States was obtained from state and federal agencies and published articles. The consumption of Grade "A" milk and milk products in the United States was estimated from food consumption survey data for individuals. The level of food safety protection was measured quantitatively using the metric of annual illness attack rate. During a 15-year period (1999 through 2013), the estimated annual illness attack rate was 0.41 reported illnesses per 1 billion exposures (estimated using person-day intake data) or 0.52 reported illnesses per 1 billion lb (454 million kg) of Grade "A" milk and milk products consumed. Food safety protection provided to consumers of Grade "A" milk and milk products by the NCIMS through its implementation and enforcement of the PMO is important given the common consumption of Grade "A" milk and milk products in the United States.


Assuntos
Inocuidade dos Alimentos , Leite , Pasteurização/legislação & jurisprudência , Animais , Laticínios/análise , Laticínios/microbiologia , Surtos de Doenças , Contaminação de Alimentos/análise , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Leite/química , Leite/microbiologia , Infecções por Salmonella/epidemiologia , Estados Unidos/epidemiologia
11.
Risk Anal ; 35(6): 1125-39, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25557397

RESUMO

We present an economic welfare-based method to estimate the health costs associated with foodborne illness caused by known viruses, bacteria, parasites, allergens, two marine biotoxins, and unspecified agents. The method generates health costs measured in both quality-adjusted life years and in dollars. We calculate the reduction in quality-adjusted life days caused by the illness and add reductions in quality-adjusted life years from any secondary effects that are estimated to occur. For fatal cases, we calculate the life years lost due to premature death. We add direct medical expenses to the monetary costs as derived from estimates of willingness to pay to reduce health risks. In total, we estimate that foodborne illness represents an annual burden to society of approximately $36 billion, with an average identified illness estimated to reduce quality-adjusted life days by 0.84, which is monetized and included in the average cost burden per illness of $3,630.


Assuntos
Efeitos Psicossociais da Doença , Doenças Transmitidas por Alimentos/economia , Pesquisa Empírica , Microbiologia de Alimentos , Humanos , Qualidade de Vida , Estados Unidos
12.
Expert Rev Anti Infect Ther ; 13(1): 69-80, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25399653

RESUMO

Since the introduction of sulfonamides in the late 1930s, selective pressure and the widespread dissemination of mobile genetic elements conferring antimicrobial resistance have forced clinicians to seek successive agents for the treatment of multidrug-resistant shigellosis. Over the decades, the principal antibiotics used to treat Shigella infections have included tetracycline, chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid. Presently, ciprofloxacin, azithromycin, and ceftriaxone serve as the mainstays of treatment, although growing evidence has documented decreased susceptibility or full resistance to these agents in some regions. With diminishing pharmaceutical options available, there is an enhanced need for preventive measures in the form of improved sanitation and hygiene standards, strict use of currently effective agents, and a safe and effective licensed vaccine.


Assuntos
Farmacorresistência Bacteriana Múltipla , Disenteria Bacilar/tratamento farmacológico , Shigella/efeitos dos fármacos , Antibacterianos/uso terapêutico , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Humanos
13.
Clin Infect Dis ; 58(9): e133-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24457344

RESUMO

From 2000 to 2012, Vibrio cholerae O1 and Shigella species isolates from urban Dhaka and rural Matlab were tested for resistance to all clinically relevant antibiotics in Bangladesh. Resistances in urban and rural Bangladesh tended to rise and fall together, especially a few years after the introduction of new resistance.


Assuntos
Antibacterianos/farmacologia , Resistência Microbiana a Medicamentos , Shigella/efeitos dos fármacos , Vibrio cholerae O1/efeitos dos fármacos , Bangladesh , Humanos , Testes de Sensibilidade Microbiana , População Rural , Shigella/isolamento & purificação , População Urbana , Vibrio cholerae O1/isolamento & purificação
14.
J Orthop Case Rep ; 4(1): 21-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-27298939

RESUMO

INTRODUCTION: Metallosis involving the knee joint most often results from metal-on-metal contact late in the life of a failing implant following polyethylene wear. We report a case of acute metallosis following knee arthroplasty in a previously healthy 59-year old male. CASE REPORT: In June 2011, the patient underwent left knee arthroplasty for severe osteoarthritis with necrosis and bone edema in the medial femoral condyle and tibial plateau. Nine months later, because of persistent pain and swelling in the joint, revision arthroplasty was undertaken along with partial synovectomy. Examination revealed pristine prosthetic implants in the absence of loose fragments of bone or glue. Synovial pathology exhibited marked chronic inflammation and hyperplasia with extensive finely granular foreign material resembling metallic debris. Laboratory analysis of synovium revealed a predominance of iron, the principal component of the saw blades. CONCLUSION: We hypothesize the patient experienced acute metallosis resulting from deposition of metallic fragments from three saw blades used during arthroplasty. We believe the increased density of the patient's bone that required use of multiple blades may have resulted, in part, from heavy lifting the patient partook in during the two years preceding arthroplasty.

15.
J Food Prot ; 76(6): 932-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23726186

RESUMO

Recalls of foods contaminated with pathogens help reduce the transmission of infectious diseases. Here, we summarize the number and nature of foods recalled as a result of microbiological contamination, classified by the U.S. Food and Drug Administration for the period 1 October 2002 through 30 September 2011. Microbiological contamination accounted for 1,395 (42%) of 3,360 recalls of food during this period. Nuts and edible seeds, followed by fishery-seafood products and spices, were the types of products most commonly recalled for microbiological contamination. Salmonella contamination accounted for the greatest number of food products recalled due to microbiological contamination, and was the pathogen most often linked to reported outbreaks involving recalled food products.


Assuntos
Contaminação de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Recall e Retirada de Produto , Surtos de Doenças , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/prevenção & controle , Humanos , Nozes , Especiarias , Estados Unidos , United States Food and Drug Administration
16.
ISRN Microbiol ; 2013: 213915, 2013 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-24455398

RESUMO

We determined the frequency of multidrug resistant (MDR) infections with Shigella spp. and Vibrio cholerae O1 at an urban (Dhaka) and rural (Matlab) hospital in Bangladesh. We also compared sociodemographic and clinical features of patients with MDR infections to those with antibiotic-susceptible infections at both sites. Analyses were conducted using surveillance data from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), for the years 2000-2012. Compared to patients with antibiotic-susceptible for Shigella infections, those in Dhaka with MDR shigellosis were more likely to experience diarrhea for >24 hours, while, in Matlab, they were more likely to stay inhospital >24 hours. For MDR shigellosis, Dhaka patients were more likely than those in Matlab to have dehydration, stool frequency >10/day, and diarrheal duration >24 hours. Patients with MDR Vibrio cholerae O1 infections in Dhaka were more likely than those in Matlab to experience dehydration and stool frequency >10/day. Thus, patients with MDR shigellosis and Vibrio cholerae O1 infection exhibited features suggesting more severe illness than those with antibiotic-susceptible infections. Moreover, Dhaka patients with MDR shigellosis and Vibrio cholerae O1 infections exhibited features indicating more severe illness than patients in Matlab.

18.
J Pediatr ; 161(2): 354-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22575248

RESUMO

Adverse event reports submitted to the US Food and Drug Administration suggested a possible association between necrotizing enterocolitis and ingestion of a commercial feed thickener by premature infants. Review in 2011 of 22 cases with exposure revealed a distinct illness pattern.


Assuntos
Enterocolite Necrosante/induzido quimicamente , Aditivos Alimentares/efeitos adversos , Doenças do Prematuro/induzido quimicamente , Polissacarídeos Bacterianos/efeitos adversos , Transtornos de Deglutição/terapia , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/microbiologia , Refluxo Gastroesofágico/terapia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/terapia , Leite Humano
19.
ISRN Microbiol ; 2012: 654819, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23762755

RESUMO

Using data from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) from 1996 to 2001, we compared the clinical features of diarrhea in patients with stool specimens yielding only A. hydrophila (189 patients; 1.4% of 13,970 patients screened) or P. shigelloides (253 patients) compared to patients with sole V. cholerae non-O1 infection (99 patients) or V. parahaemolyticus infection (126 patients). Patients exhibited similar frequencies of fever (temperature >37.8°C), stools characterized as watery, and stools containing visible mucus. Dehydration was observed more often among patients with V. parahaemolyticus or V. cholerae non-O1 infection. Compared to patients infected with V. parahaemolyticus, those with A. hydrophila, P. shigelloides, or V. cholerae non-O1 infection were less likely to report visible blood in the stool and, on microscopic examination, less likely to exhibit stool red blood cell and white blood cell counts exceeding 20 cells per high power field. The proportion of patients reporting subjective cure at the time of discharge was significantly smaller for those infected with V. parahaemolyticus. These findings suggest that A. hydrophila and P. shigelloides produce diarrheal disease that is less severe than that resulting from infection with V. cholerae non-O1 or V. parahaemolyticus.

20.
Pediatr Infect Dis J ; 30(5): 428-30, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21346685

RESUMO

We used the Pediatric Health Information System (PHIS) administrative database to compare the incidence of childhood tuberculosis at Children's National Medical Center (CNMC) in Washington, DC, with national rates and evaluated PHIS as an epidemiologic tool. The incidence rate of tuberculosis at CNMC was approximately twice that of the national PHIS rate (incidence rate ratio, 1.9; 95% confidence interval 1.4-2.5). Of the 51 cases listed by PHIS as tuberculosis at CNMC between 2003 and 2007, 41 represented active tuberculosis validated by internal chart review, with a positive predictive value of 80%.


Assuntos
Bases de Dados Factuais , Tuberculose/epidemiologia , Adolescente , Criança , Pré-Escolar , Coleta de Dados/métodos , District of Columbia/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Adulto Jovem
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