Arbovirus surveillance in South Carolina, 1996-98.

Arboviruses isolated and identified from mosquitoes in South Carolina (USA) are described, including new state records for eastern equine encephalitis virus (EEE), St. Louis encephalitis virus (SLE), Flanders virus, Tensaw virus (TEN), and a variant of Jamestown Canyon virus (JC). Mosquitoes were collected at 52 locations in 30 of 46 South Carolina counties beginning in June 1996, and ending in October 1998, and tested for arboviruses. Of 1,329 mosquito pools tested by virus isolation (85,806 mosquitoes representing 34 mosquito species or complexes), 15 pools were positive. Virus isolations included EEE from 1 pool each of Anopheles crucians complex and Culex erraticus; a variant of JC from 1 pool of An. crucians complex; a California serogroup virus from 1 pool of Aedes atlanticus/tormentor; TEN from 5 pools of An. crucians complex and 1 pool each of Culex salinarius and Psorophora ciliata; Flanders virus from 1 pool of Culiseta melanura; and Potosi virus from 1 pool each of Aedes vexans, Coquillettidia perturbans, and Psorophora columbiae. Of 300 mosquito pools tested by antigen-capture assay for EEE and SLE (14,303 mosquitoes representing 16 mosquito species or complexes), 21 were positive for EEE and I was positive for SLE. Positive EEE mosquito pools by antigen-capture assay included An. crucians complex (14 pools), Anopheles punctipennis (1 pool), Anopheles quadrimaculatus (1 pool), Cq. perturbans (4 pools), and Cs. melanura (1 pool). One pool of Cx. salinarius was positive for SLE by antigen-capture assay. Arbovirus-positive mosquito pools were identified from 12 South Carolina counties, all located in the Atlantic Coastal Plain, and from 4 of 8 Carolina bays surveyed.

Bat rabies in South Carolina, 1970-90.

This retrospective study examines the geographic and temporal distribution of bat species submitted for rabies testing in South Carolina (USA) from 1970 to 1990. Histories of human or animal exposures to rabid and nonrabid bats submitted during this time period were compared. Two hundred and thirty-one bats were found to be rabid from the 2,657 bats submitted over this 20 yr period. The two species most frequently submitted for testing were Lasiurus borealis with 785 specimens (30% of the total) and Nycticeius humeralis with 607 specimens (22% of the total). Lasiurus borealis also had the highest prevalence of rabies (18%) while N. humeralis had the lowest prevalence (3%). Fifty-one percent (1,259) of the bats received for testing were submitted from June through August. The majority (54%) of rabid bats were received from August through October.

Correlates of hepatotoxicity and antituberculosis therapy in South Carolina.

This study revealed that 20-30 percent of TB patients who were taking antituberculosis therapy developed elevated liver function tests. Half of the elevation in liver enzyme values occurred within the first two months of treatment. No statistically significant differences between sex, race and liver toxicity was found in this study. The time from initiation of treatment for TB to development of hepatotoxicity was shorter for females and whites. Physicians and public health workers should monitor the liver function tests of TB patients who are taking antituberculosis treatment. Recommendations for monitoring hepatotoxicity vary depending on the age of the patients. For patients less than 35 years old, monthly symptom review for jaundice, acholic stools, fever, anorexia, nausea and vomiting, may be adequate. For older patients, liver function tests are recommended monthly or every one to two months.

Comparison of individuals receiving anonymous and confidential testing for HIV.

We assessed the magnitude, demographics, seroprevalence, and reasons for site selection among South Carolina residents who chose to be tested in bordering states offering anonymous testing for human immunodeficiency virus (HIV). Residents tested from July 1990 through July 1991 at selected HIV testing sites in bordering states were surveyed and HIV test results were recorded. Of the 75 residents tested at these sites, 66 (88%) were white, 44 (59%) were male, and 9 (12.3%) of the 73 whose test results were recorded were HIV infected. During the same period, 57,137 individuals were HIV tested in-state by the state health department, of which 1,752 (3.1%) were positive. Residents tested outside the state were more likely to be HIV infected, male, and white than individuals tested within the state. Our findings suggest that although large numbers of South Carolinians are not HIV tested anonymously in other states, those tested anonymously out of state have a different demographic and risk profile than those tested confidentially in state.

HIV seroprevalence and reasons for refusing and accepting HIV testing.

BACKGROUND AND OBJECTIVES: We sought to evaluate the HIV seropositivity of patients who refused or accepted human immunodeficiency virus (HIV) testing in a South Carolina sexually transmitted diseases (STD) clinic, and the patients' reasons for refusing or accepting testing. STUDY DESIGN: A serologic and self-administered survey done Jan. 9 through June 1, 1989. For those who refused HIV testing, a routine syphilis serology sample was tested blindly for HIV. RESULTS: Of 1,929 patients in the study, 398 (21%) refused HIV testing. HIV test refusers were 2.2 times more likely to be HIV antibody positive than HIV test acceptors (3.0% versus 1.4%, prevalence ratio = 2.2, CI95 1.1-4.4), with this difference mainly occurring among males. Seven of eight patients reporting that they refused testing because they were HIV positive were found to be HIV negative. The principal reason indicated for test refusal was not feeling at risk for HIV infection. The principal reasons indicated for test acceptance were wanting to know the results for their own health status and wishing to prevent spread of the virus to partners. CONCLUSION: We conclude that: (1) a higher seropositivity exists among HIV test refusers than acceptors; (2) patient reporting HIV seropositivity should be viewed with caution; (3) many STD patients deny their risk for HIV; and (4) STD patients are concerned about transmission of HIV to their partners.

A large outbreak of gastroenteritis caused by diarrheal toxin-producing Bacillus cereus.

An outbreak of diarrhea occurred after a university field day. Of 643 attendees who returned mailed questionnaires, 139 (22%) reported illness. Persons who ate barbecued pork, which was unrefrigerated for 18 h after cooking, were five times more likely to become ill than those who did not eat pork (26% vs. 5%; relative risk, 5.4; 95% confidence interval, 1.4-20.9). A leftover pork sample grew a Bacillus cereus isolate, > 10(5) cfu/g, that produced diarrheal toxin. Thirty-four percent of ill persons noted onset of illness outside the 6- to 24-h incubation period traditionally ascribed to B. cereus-mediated diarrhea, and an unusually high percentage (23%) noted fever. B. cereus may cause a wider spectrum of disease than previously described.

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.

Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T-cell type.

A 62-year-old male with a 20-year history of diabetes and three-year history of adult T-cell lymphocytic leukemia developed a systemic infection with Dactylaria gallopava. At autopsy the fungus was found in the brain, lungs, liver, spleen, and kidney. The organism has caused disease in chickens and turkey poults and has been found in chicken litter, hot springs, and the effluent of a thermonuclear reactor. This report documents the second human infection and the first case of disseminated human dactylariosis.

Human immunodeficiency virus: seroprevalence in parturients in rural South Carolina.

To establish the prevalence of human immunodeficiency virus (HIV) in the population of childbearing women in a rural South Carolina community, a blinded seroprevalence survey was conducted using all cord blood samples collected during a one-year period at a signal hospital. There were 1,811 live births (57% white, 43% black) during that period. Of the 1,365 samples collected and tested, six (0.44%) were HIV-positive by enzyme-linked immunosorbent assay, and three (0.22%) were confirmed by Western blot analysis. Based on these percentages, we estimate that there are approximately 80 HIV-infected women of childbearing age among the 180,000 residents of our health district. Although the seroprevalence of HIV in our parturients is low, it is somewhat higher than that reported from other rural areas. We therefore recommend counseling and voluntary blood testing for HIV antibodies, with informed consent, for all pregnant women living within our health district.

Candida lusitaniae septicemia in a patient on extended home intravenous hyperalimentation.

This is a report of the successful therapy of a case of Candida lusitaniae septicemia in a patient with short bowel syndrome who had been on home intravenous hyperalimentation for approximately 3 months when the infection developed. C. lusitaniae was isolated from multiple blood cultures taken over the course of 2 days.

Influenza A/Philippines/2/82 outbreak in a nursing home: limitations of influenza vaccination in the aged.

The failure of the 1982-1983 influenza vaccine to protect elderly NHCU residents from clinical infection with influenza A/Philippines/2/82 resulted primarily from antigenic drift of the epidemic strain, inasmuch as the attack rates in the vaccinated and nonvaccinated patients were not significantly different. This experience supports the decision to replace A/Bangkok/1/79 with A/Philippines/2/82 virus antigen in the 1983-1984 influenza vaccine.

Observation of Paragonimus westermani eggs in sputum after digestion for mycobacteria culture.

Pulmonary paragonimiasis was diagnosed by the observation of Paragonimus westermani eggs on smears of sputum concentrated for the detection of mycobacteria and on the culture plates. The eggs were distorted but recognizable.

Naturally acquired rabies in an eastern chipmunk (Tamias striatus).

Rabies in an Eastern chipmunk was detected by fluorescent-antibody testing and mouse inoculation. The results were independently confirmed, and the virus was recovered from tissue culture.

Naturally acquired rabies in an eastern wood rat (Neotoma floridana).

Rabies in an eastern wood rat was detected by fluorescent antibody testing and mouse inoculation. The results were independently confirmed.