Leptospirosis among patients presenting with dengue-like illness in Puerto Rico.

Leptospirosis is difficult to distinguish from dengue fever without laboratory confirmation. Sporadic cases/clusters of leptospirosis occur in Puerto Rico, but surveillance is passive and laboratory confirmation is rare. We tested for leptospirosis using an IgM ELISA on sera testing negative for dengue virus IgM antibody and conducted a case-control study assessing risk factors for leptospirosis, comparing clinical/laboratory findings between leptospirosis (case-patients) and dengue patients (controls). Among 730 dengue-negative sera, 36 (5%) were positive for leptospirosis. We performed post mortem testing for leptospirosis on 12 available specimens from suspected dengue-related fatalities; 10 (83%) tested positive. Among these 10 fatal cases, pulmonary hemorrhage and renal failure were the most common causes of death. We enrolled 42 case-patients and 84 controls. Jaundice, elevated BUN, hyperbilirubinemia, anemia, and leukocytosis were associated with leptospirosis (p < .01 for all). Male sex, walking in puddles, rural habitation, and owning horses were independently associated with leptospirosis. Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment.

An outbreak of acute bartonellosis (Oroya fever) in the Urubamba region of Peru, 1998.

During May 1998, we conducted a case-control study of 357 participants from 60 households during an outbreak of acute bartonellosis in the Urubamba Valley, Peru, a region not previously considered endemic for this disease. Blood and insect specimens were collected and environmental assessments were done. Case-patients (n = 22) were defined by fever, anemia, and intra-erythrocytic coccobacilli seen in thin smears. Most case-patients were children (median age = 6.5 years). Case-patients more frequently reported sand fly bites than individuals of neighboring households (odds ratio [OR] = 5.8, 95% confidence interval [CI] = 1.2-39.2), or members from randomly selected households > or = 5 km away (OR = 8.5, 95% CI = 1.7-57.9). Bartonella bacilliformis isolated from blood was confirmed by nucleotide sequencing (citrate synthase [g/tA], 338 basepairs). Using bacterial isolation (n = 141) as the standard, sensitivity, specificity, and positive predictive value of thin smears were 36%, 96%, and 44%, respectively. Patients with clinical syndromes compatible with bartonellosis should be treated with appropriate antibiotics regardless of thin-smear results.

Importancia de la Lutzomia peruensis en la transmisión de la enfermedad de Carrión en el Valle Sagrado de los incas. Urubamba Cusco, Perú / Importance of Lutzomyia peruensis in the transmission of the Carrionïs disease in the Incaïs Sacred Valley. Urubamba Cusco, Peru

En el valle Sagrado de los Incas (Valle del Río Urubamba) encontramos una sola de Lutzomyia, nos referimos a la Lutzomyia suele compartir su habitat con el vector de la enfermedad de Carrión, la Lutzomyia verrucarum. Los aspectos entomológicos fueron levados a cabo, en Mayo de 1998. Las colectas entomológicas se realizaron utilizando trampas de luz CDC toda la noche y en capturas diurnas en las viviendas.Se muestra la importancia de Lutzomyia peruensis incriminándola epidemiológicamente y se detectó Bartonella bacilliformis mediante PCR y haciendo secuenciamiento de ADN. Se presenta también la estimación del riesgo entomólogico de transmisión de bartonelosis por Lutzomyia peruensis, mediante el índice de inoculación de Bartonella bacilliformis

Clinicopathologic review of twelve children with nephropathy, Wilms tumor, and genital abnormalities (Drash syndrome).

The clinicopathologic and radiologic features of 12 children with complete and incomplete forms of Drash syndrome are reported. Their common denominator was a nephropathy. Four had the full triad, consisting of nephropathy, Wilms tumor, and genital abnormalities; five had nephropathy and genital abnormalities, and three had nephropathy and Wilms tumor. Of the 11 children who had proteinuria, eight had the nephrotic syndrome. Of the 10 whose condition progressed to end-stage renal failure, seven were less than 3 years of age. The histologic features of Wilms tumor were favorable in all seven children, and the tumor was bilateral in three. Of the nine patients who had genital abnormalities, eight had 46,XY karyotype and either ambiguous genitalia (six patients) or normal female phenotype (two). One other patient had a normal 46,XX female karyotype and phenotype but had both müllerian and wolffian structures and a streak ovary. Nine patients had a distinct pelvicaliceal abnormality not previously reported as a feature of this syndrome. Other congenital abnormalities were aniridia, mental retardation, deafness, nystagmus, and cleft palate. This syndrome must be considered in any infant with unexplained nephropathy, particularly in young phenotypic female infants and in those children with ambiguous genitalia or Wilms tumor with an early presentation.

The dental health of 12-year-old children in Dominica: a report of a survey using WHO methods.

As part of the process of assisting in the planning of a primary dental health care system in the Commonwealth of Dominica, we conducted a survey of mostly 12-year-old children. The purpose of the survey was to assess the oral health status and identify the needs for treatment and prevention. Secondary purposes included training Dominican dental auxiliaries and assistants to collect epidemiologic data and to use the findings to compare oral health status by region and previous coverage by the auxiliaries. The sample was obtained from schools throughout the country. Examinations were conducted according to standard WHO methods, using mirrors and explorers. The findings were recorded on prepared forms and the data were processed in Toronto using microcomputers. We found 31% of children to be caries-free and the mean DMFT score to be 2.5 (95% CI 2.2-2.7). Only 8% of lesions had been treated. No differences were observed by region but in areas covered by dental auxiliaries, children had fewer decayed teeth, fewer DMFT and higher F/DMFT ratios. Only 17% scored 0 on the CPITN index and 63% scored 2, meaning they had calculus. Debris was 3.6 times more likely to be found among those with gingival bleeding or calculus compared to those with periodontal health. Single surface restorations made up 82% of the estimated 2.0 caries treatment services required. The survey findings will allow planners to design specific preventive and treatment programs to meet Dominica's needs.