Clustering of cases of mycobacterium fortuitum infection investigated by molecular typing

Organisms of the Mycobacterium fortuitum complex are recognized, but uncommon, causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M.fortuitum was isolated from 20 patients over a 15-month period, with an apparent clustering of isolates of M.fortuitum occurring from January to March 1994. The molecular epidemiology of this clustering was investigated using an arbitrary primer-polymerase chain reaction method (AP-PCR). Twenty-two isolates were studied and yielded 14 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates of M.fortuitum recovered during the six-weeks period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was located from specimens from all seven patients. The source of the cluster of isolates of M.fortuitum is uncertain. We can find no epidemiological link upon which to suppose an episode of cross-infection within the hospital environment. Therefore it seems likely that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M.fortuitum observed in this study (AU)

A geo-spatial analysis of health care in Barbados (1982) - abstract

In Barbados, the overall picture of health care is quite bright, with a population per medical practioner of 1,100 and a population per hospital bed of 400. However, an analysis of the location of the medical facilities and practitioners reveals that there is much disparity in the availability of health care. Places like St. Lucy and St. Joseph as well as parts of St. Philip are at a marked disadvantage, having no medical practioner in residence, and are somewhat removed from the nearest available medical service. This was confirmed, using three established tecniques in spatial analysis (AU)

Shelters from the storm : A note on the geography of hurricane shelters in Barbados, 1982

Barbados, a small island of 166 square miles in the Caribbean, with a population of 246,416 persons, has a total of 177 emergency shelters with a known capacity of 20,623 persons. The average shelter capacity is 117 persons and the total known shelter capacity represents 8.4

of the population. The spatial arrangement of the grade I shelters, as seen relative to the 1980 population census map by grouped enumeration districts, reveals that there are many areas and persons, who, in time of emergency, will not be able to avail themselves to the protection of a shelter (AU)

The medical geography of clinical leptospirosis in Barbados 1976 to 1982

This study examines the inter-relationship of the factors: host, agent and human activity in producing clinical leptospirosis in Barbados from 1976 through 1982. These inter-relationships are examined at 2 levels: the macro (parish) and the micro (district) levels. At the macro level the factors of rainfall, drainage and involvement in agriculture were found to have significant associations with the average morbidity pattern. When plotted relative to rainfall, 71.8 percent of the cases occurred in locations and months of above average rainfall. When plotted relative to drainage, 91.3 percent of the cases occurred in areas below 250 ft., where clay infilling in watercourses produced flood-prone environments, or in areas above 250 ft. which were within 220 yd. of watercourses. The net result is that rainfall and drainage combined accounted for 98.5 percent of cases at this level. The Rainfall-Agricultural Involvement multiple regression model explained 60 percent of the variation in parish morbidity over the time period. These factors, however, did not adequately explain micro-level patterns of morbidity. To understand these, human activity was examined. This analysis utilized an adaptation of 2 methodologies - the 24 hr. Recall Technique and Water Contact Studies. These were used to determine exposure to the physical environment, and its relation to the pattern of morbidity. For this examination 2 areas were studied - St. Philip South-West, a high morbidity area with more cases than could be explained by the moisture factor alone, and St. James East, with fewer. Exposure to the physical environment was found to vary according to location, sex and the pattern of human activity. These all had strong associations with morbidity. The micro-level study revealed that there are 2 distinct spheres of exposure - the home and the work environments - and there tends to be little overlap in these 2 spheres. The study also revealed that there was a spatial variation in the nature of contact with the environment which may be an important consideration in explaining the micro-level pattern of morbidity. (AU)