Epidemiology of infectious syphilis at a tertiary hospital.

In 19 of 20 patients in whom the correct diagnosis of primary or secondary syphilis was not obvious initially, a positive routine admission VDRL test result was the first indication of the correct diagnosis. A retrospective study during a one-month period to correlate hospital admissions by clinical service with required routine admission serologic tests for syphilis disclosed an overall compliance rate of only 37.1% (range, 94.6% to 8.0%). Of the 38 patients who did have a positive admission VDRL test result, 55.3% were falsely positive. The false-positive rate was slightly higher for weakly reactive titers than it was for higher titers. The routine serologic testing program uncovered 129 and 116 new cases of syphilis during 1976 and 1977, respectively. The decision to continue the routine admission VDRL screening program was made because the consequences of an incorrect diagnosis could be very great for an individual patient.

Infectious syphilis mimicking neoplastic disease.

Five patients who were initially evaluated for malignant neoplasm actually had infectious syphillis (one primary, two secondaries, two secondaries with persistence of primary). Two patients were considered for radical surgery and one for extensive radiation and/or chemotherapy. In four patients an elevated routine admission VDRL was the first indication of the correct diagnosis. Dark-field examination is the most important laboratory test in the diagnosis of primary syphillis; VDRL and FTA-ABS are most important in confirming secondary syphillis. Penicillin remains the drug of choice for therapy. At a time when the incidence of sexually transmitted diseases is increasing, it is extremely important to develop adequate educational programs for medical students and physicians.

Antibody to Varicella-Zoster virus in parturient women and their offspring during the first year of life.

A nursery outbreak of varicella is reported. Serum from 200 parturient women and 131 of their offspring were studied for antibody to varicella-zoster (V-Z) virus to analyze their immunity to varicella. Antibody titers were measured by the sensitive fluorescent antibody to membrane antigen (FAMA) technique. It was found that approximately 5% to 16% of women of child-bearing age in New York City are susceptible to varicella. Women from Puerto Rico or other subtropical and tropical areas are more likely to be susceptible (16%) than others (5%). Infants born to mothers with detectable V-Z FAMA titers almost always had detectable V-Z antibody at birth. In serial serum specimens obtained from 67 initially seropositive babies during the first year of life, it was found that by 6 months of age most infants were no longer passively protected against varicella. These observations may explain why varicella is not uncommonly observed in young babies.

Nosocomial ringworm in a neonatal intensive care unit: a nurse and her cat.

An outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.

Varicella vaccination for healthcare workers at a university hospital: an analysis of costs and benefits.

OBJECTIVE: To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine. DESIGN: Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster. SETTING: A 988-bed tertiary-care university hospital. RESULTS: In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care. CONCLUSIONS: Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees.

Outbreak in a New York City teaching hospital burn center caused by the Iberian epidemic clone of MRSA.

During an 18-month period in a burn center (January 1995 through June 1996), 109 single-patient MRSA isolates were identified and 102 isolates (94%) were available for DNA fingerprinting. Ninety-nine isolates (97%) carried the mecA polymorph I and Tn554 type E. Pulsed-field electrophoresis (PFGE) identified 8 patterns, of which 60 isolates were of pattern F2. The I:E:F clonal type and a stable drug multidrug resistant phenotype (sensitivity only to trimethoprim/sulfamethoxazole and vancomycin) indicated that these isolates were closely related to the Iberian clone of MRSA, which is widely spread in Europe. The initial source of I:E:F isolates was sputum 49%, blood 23%, wound 16%, urine 7%, and intravascular catheter tip 5%. Fifty-four percent of patients had smoke inhalation injury, and 51/53 required intubation or tracheostomy. Forty-three isolates were considered invasive (positive blood culture). The overall mortality was 30%. Despite infection control measures, the I:E:F clone continued to be recovered from patients during the 18 months of study. This outbreak is the first known report of the Iberian MRSA clone in the United States.

The clerkship in public health: a positive experience.

Cornell University Medical College's required third-year clerkship in public health offers a unique educational experience well received by faculty and students. Within a two-week period, a combination of field trips, seminars, lectures, required reading, and a research paper enables students to gain familiarity with a broad range of issues by placing them in situations exposing them to relevant problems and solutions. Nearly all students find some aspect of either the field trips or seminars provocative. Some are motivated to plan follow-up electives. A similar course using local resources could be offered elsewhere.

Syphilis: clinical manifestations, diagnosis, and treatment.

Clinical manifestations of primary, secondary, congenital, and late syphilis are described. Darkfield examination is the most important laboratory method for diagnosis of primary syphilis. The VDRL and FTA-ABS are the most common serologic tests used for diagnosis and follow-up. Penicillin remains the treatment of choice in nonallergenic patients.

Syphilis and other sexually transmitted diseases.

As early syphilis becomes more uncommon in the community, it will present frequently to the tertiary hospital as a diagnostic problem. Twenty patients with classic signs and symptoms of primary and secondary syphilis in whom the correct diagnosis was initially missed are presented. The importance of a routine admission Venereal Disease Research Laboratory test (VDRL) in making the correct diagnosis is emphasized. The laboratory techniques for diagnosing syphilis and recommended treatment schedules are presented. Clinical manifestations of herpes progenitalis, problems with pregnancy and association with cervical carcinoma are also presented. Enteric diseases (hepatitis, shigellosis, giardiasis and amebiasis) as sexually transmitted diseases in homosexual men are summarized.

Serratia marcescens contamination of feline whole blood in a hospital blood bank.

During a 7-month period, 29 units of feline whole blood in a hospital blood bank were confirmed, and 2 units were suspected, to be contaminated with Serratia marcescens. An investigation of the outbreak identified S marcescens in a jar of alcohol-soaked cotton balls and in a bag of saline solution used during venipuncture. Fifteen of the contaminated units were administered to 14 cats, and 6 of the 14 developed clinical signs of a transfusion reaction. The most common sign was vomiting; 4 cats died. The report underscores the importance of using aseptic techniques during collection of blood for transfusion and of thoroughly investigating any transfusion reaction.

Bacteriologic contamination in an air-fluidized bed.

An air-fluidized bed was found to be a potential bacteriologic hazard when used by heavily infected burned patients. Even after following the manufacturer's protocol for eliminating bacteria from the bed and for cleaning the filter sheet, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus fecalis, Escherichia coli, and Serratia marcescens were recovered. Use of the bed was suspended until an effective disinfecting procedure was developed for the filter sheet and weekly removal of solid materials from the bed was instituted.

[Acquired immune deficiency syndrome (AIDS)]. / Das Erworbene Immundefizienz-Syndrom (AIDS).

Acquired immune deficiency syndrome (AIDS) is a new disease caused almost certainly by a transmissible agent, which is most likely a retrovirus termed HTLV-III. The disease is mainly spread by sexual, especially homosexual contact. Blood-borne transmission is another recognized form of spreading of the disease; it seems, however, that the disease is not readily spread via casual, non-sexual, or other than blood-borne routes. Although the disease is still concentrated in the major metropolitan areas of the United States, it is now increasingly observed in several countries throughout the world. The basic characteristic of the disease is a profound dysregulation of the immune system as proved by a qualitative and quantitative defect of helper T-lymphocytes as well as by B-cell hyperactivity. Clinical manifestations are those of severe and life-threatening opportunistic infections and unusual neoplasms, particularly Kaposi's sarcoma. The mortality is extremely high and may well approach 100%. Therapeutic efforts include the treatment of opportunistic infections and the search for agents which may reconstitute immunologic competence.

Streptococcal pyoderma of the penis following fellatio.

Gonococcal pharyngitis has been correlated with fellatio in both heterosexual females and homosexual males. This report describes another complication of fellatio, group A beta-eaemolytic streptococcal pyroderma on the penis after exposure to a male who probably had pharyngitis. the erythematous, purulent lesions should be cultured. After the organism has been identified, adequate treatment with either a long-acting parenteral penicillin or a 10-day course of oral penicillin is important in order to prevent the possible life-threatening complication of post-streptococcal glomerulonephritis.

The role of surgery in primary syphilis of the anus.

Surgery has no role in the treatment of primary (infectious) syphilis of the anorectum. In this paper, we describe four patients who presented directly to the surgeon complaining of localized anal lesions. In three patients, the chancre was excised and in one patient the correct diagnosis was made prior to surgery. Rectal pain, which we attributed to secondary infection, was the chief complaint in three patients. Two patients also complained of tender lymphadenopathy. Darkfield examination is the most important diagnostic technique and penicillin remains the drug of choice. When treating diseases of the anorectum, the surgeon must maintain a high index of suspicion and a constant awareness of the manifold presentations of primary syphilis.