Quantitative assessment of Naegleria fowleri and Escherichia coli concentrations within a Texas reservoir.

Previous presence/absence studies have indicated a correlation between the presence of the pathogenic amoeba Naegleria fowleri and the presence of bacteria, such as the fecal indicator Escherichia coli, in environmental surface waters. The objective of this study was to use quantitative real-time polymerase chain reaction (qPCR) methodologies to measure N. fowleri and E. coli concentrations within a Texas reservoir in late summer, and to determine if concentrations of N. fowleri and E. coli were statistically correlated. N. fowleri was detected in water samples from 67% of the reservoir sites tested, with concentrations ranging up to an estimated 26 CE (cell equivalents)/100 mL. E. coli was detected in water samples from 60% of the reservoir sites tested, with concentrations ranging up to 427 CE/100 mL. In this study, E. coli concentrations were not indicative of N. fowleri concentrations.

Treatment of adult hypophosphatasia with teriparatide.

OBJECTIVE: To describe the effects of 24 months of teriparatide therapy in an adult with hypophosphatasia, which thus far has no established medical treatment. METHODS: A 75-year-old woman with hypophosphatasia was treated with ergocalciferol and calcium supplements for 2 years. She had sustained multiple spontaneous and low-trauma fractures since she was 10 years old. Baseline biochemical values (and reference ranges) were as follows: serum total alkaline phosphatase ranged from 14 to 17 U/L (30 to 110), bone-specific alkaline phosphatase (BSALP) was 5 U/L (14 to 43), serum phosphorus was elevated at 5.4 mg/dL (2.6 to 4.4), and pyridoxal 5'-phosphate was high at 250 ng/mL (5 to 30). At baseline, she had mild secondary hyperparathyroidism (intact parathyroid hormone, 76 pg/mL; reference range, 10 to 65), which was corrected by the calcium supplementation and vitamin D therapy. Dual-energy x-ray absorptiometry (DXA) scanning in 2003 showed L1-L4 bone mineral density (BMD) of 0.786 g/cm2, T score of -3.3, and Z score of -1.7; DXA also showed femoral neck BMD of 0.740 g/cm2, T score of -2.5, and Z score of -0.5. During walking, the patient sustained a low-trauma fracture in a metatarsal. Teriparatide, synthetic parathyroid hormone(1-34), in a dosage of 20 microg subcutaneously was given daily from April 2004 until June 2006. RESULTS: After about 1.5 years of teriparatide therapy, BSALP reached the lower end of the reference range at 16 U/L, and after 24 months of continuous teriparatide treatment, both serum total alkaline phosphatase and BSALP normalized at 30 U/L and 18 U/L, respectively. Pyridoxal 5'-phosphate declined from a baseline of 250 to 188 ng/mL after 17 months of treatment. Urinary N-telopeptide increased from a baseline of <6 to 19 after 17 months and to 70 bone collagen equivalents/mmol creatinine after 24 months of anabolic therapy. Repeated DXA scanning showed a substantial improvement in lumbar spine BMD and stability in hip BMD. The patient experienced no clinical fractures or adverse events during teriparatide therapy. CONCLUSION: In one woman with adult hypophosphatasia, 2 years of teriparatide treatment improved biochemical markers of bone remodeling and increased skeletal mineralization. Teriparatide may prove to be a viable treatment for adult hypophosphatasia; thus, this intervention warrants further evaluation.

Secondary osteoporosis: a review of the recent evidence.

OBJECTIVE: To review several causes of secondary osteoporosis as well as screening recommendations for underlying disorders. METHODS: We conducted a review of the literature on many of the causes of osteoporosis that have been published during the past 15 years, focusing on those sources available from 2000 through the present. Indeed, more than two-thirds of the articles that we reviewed were printed during the past 6 years. These reports examined secondary osteoporosis in general, as well as many of the specific causes. RESULTS: Secondary osteoporosis occurs in almost two-thirds of men, more than half of premenopausal and perimenopausal women, and about one-fifth of postmenopausal women. Its causes are vast, and they include hypogonadism, medications, hyperthyroidism, vitamin D deficiency, primary hyperparathyroidism, solid organ transplantation, gastrointestinal diseases, hematologic diseases, Cushing's syndrome, and idiopathic hypercalciuria. These causes have their own pathogenesis, epidemiologic features, and effect on the skeleton. CONCLUSION: The causes of secondary osteoporosis are numerous, and an understanding of their characteristics with respect to bone density and potential fracture risk is essential in the management of osteoporosis. A heightened awareness of the possibility of their existence is necessary to provide optimal care.