Epidemic keratoconjunctivitis in a chronic care facility: risk factors and measures for control.

OBJECTIVE: To study patterns of transmission of epidemic keratoconjunctivitis (EKC) in a chronic care facility and to assess control measures and prevent future outbreaks in this setting. DESIGN: A retrospective cohort study. SETTING: A 120-bed, four-unit, skilled nursing facility. PATIENTS: Residents and employees of the above facility. INTERVENTIONS: Increased frequency of cleaning; use of bleach disinfectant; universal precautions in handling eye secretions from residents with conjunctivitis; cohorting residents by unit; suspension of new admissions; closure of common gathering areas. MEASUREMENTS: Resident demographics; possible risk factors for infection among residents (including mobility, underlying illness, medications, involvement in social activity, level of confusion) and among employees (including co-morbid illnesses and eye conditions, exposures to persons with conjunctivitis, visits to eye care specialists, use of contact lenses or glasses); testing of conjunctival specimens from symptomatic persons for viral and bacterial agents. RESULTS: Of 95 residents on three chronic care units, 47 (attack rate 49%) had onset of eye symptoms consistent with EKC between September 14 and December 7, 1990. Thirty-eight (81%) of these had onset following the onset of symptoms in a resident with dementia who, despite habitual eye-rubbing and wandering into other residents' rooms, was not isolated or restricted in any way. Attack rates were higher (though not statistically significant) among more mobile residents (60% for ambulatory residents) and among those considered by staff to be confused (56%). Rapid antigen detection and culture confirmed adenovirus type 37 as the etiologic agent. CONCLUSIONS: Transmission of infection with adenovirus type 37 was successfully interrupted following strict infection control, suspension of new admissions, cohorting of residents by unit, and change to a disinfectant that inactivates adenovirus. Recognition of conjunctivitis as an appropriate reason for restricting movement of an infected resident may have prevented extensive viral transmission in this outbreak.

Cases from the aerospace medicine resident teaching file. Case #59. A case of "unbearable" gremlinenteritis.

A flight surgeon presents with severe diarrhea of sudden onset. The unusual cause could be traced to sorbitol, a common sweetener that is widely available and could easily affect many aviators. The symptoms are exacerbated in the aerospace environment and close investigation of the dietary history may be the only clue to this elusive diagnosis.

Bioelectrical impedance in the Air Force Weight Management Program.

Thousands of active-duty soldiers undergo weight evaluations each year and are subjected to disciplinary action if they fail to comply with established weight standards. This regulation consumes scarce available resources by requiring medical appointments. This study focuses on the use of bioelectrical impedance to determine body fat. It compared the physician's assistants with technicians for correlation of body fat percentage determinations. The correlation was r = .939 (p less than .0151) between the two groups. The use of technicians to determine body fat percentages using bioelectrical impedance appears to be a reasonable way to recover thousands of lost medical appointment slots.

Enhancing military primary care research.

Military primary care resident research training varies widely among internal medicine, pediatrics, and family practice programs. The level of resident physician participation in clinical investigations appears to be less than 30% in the federal physician training system. This paper reviews the current research activity in the Army, Navy, and Air Force primary care programs. It also reports on the results of a research training workshop and offers strategies to enhance resident involvement in clinical investigations.

The photic sneeze reflex as a risk factor to combat pilots.

The tendency to sneeze upon exposure to bright light is autosomal dominant and affects 18-35% of the population. This uncontrolled sneezing may represent a danger to pilots during flight. Testing was conducted using Ditric narrow band (+/- 10 nm) interference filters. Wavelengths at 430, 532, and 560 nm were tested with a GE 500-W photoflood BCA #1 bulb at constant intensity. Subsequent testing of military and civilian aviation goggles and sunglasses was conducted using a Digikrom 240 monochromator. Repeated testing with interference filters in a clinical setting showed no effect on sneezing in a susceptible subject. The photic sneeze reflex does not appear to be mediated by specific wavelengths of light, but rather by the change in light intensity. This could trigger an unexpected sneezing episode during critical periods of flight. This is an unrecognized and previously unreported danger to fixed-wing and rotary aircraft pilots.

Pseudomonas folliculitis from a health club whirlpool.

In public whirlpools, low disinfectant levels and inadequate monitoring are clearly a public health concern. Implementing guidelines published by the Centers for Disease Control seems to be the most reasonable approach to preventing dermatitis in persons who use these facilities. Physicians should be on the alert for well-demarcated rashes that may be associated with improperly maintained whirlpools.

'Halloween diarrhea'. An unexpected trick of sorbitol-containing candy.

When a patient with severe diarrhea and flatulence is afebrile and the results of physical examination are negative, a food source should be suspected as the cause of the problem. Careful scrutiny of the patient's diet and a high index of suspicion may implicate the artificial sweetener sorbitol. Exclusion of sorbitol from the patient's diet is recommended in these cases before embarking on an extensive clinical investigation.