Diarrheal and respiratory disease aboard the hospital ship, USNS-Mercy T-AH 19, during Operation Desert Shield.

Diarrhea and respiratory disease were common problems among ground troops deployed to the Middle East during Operation Desert Shield. In order to determine the prevalence and impact of diarrheal and upper respiratory disease among shipboard personnel during this period, an epidemiologic survey was conducted on the hospital ship, USNS Mercy T-AH 19. An episode of acute diarrhea was reported by 46% of the surveyed population, and 79% reported upper respiratory symptoms. Six percent of personnel were temporarily unable to perform scheduled duties due to gastrointestinal symptoms and 7% due to respiratory symptoms. Officers were at increased risk of experiencing an episode of diarrhea, and female crew members more often reported respiratory complaints. Improved strategies to prevent diarrhea and respiratory disease among shipboard personnel are needed.

Norfloxacin compared to trimethoprim/sulfamethoxazole for the treatment of travelers' diarrhea among U.S. military personnel deployed to South America and West Africa.

A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.

The return of acute rheumatic fever in young adults.

The incidence of acute rheumatic fever (ARF) in the United States has been steadily declining for three decades, and by the mid-1980s had virtually disappeared. In the past 3 years, however, several scattered outbreaks have occurred among US schoolchildren, and there is speculation that ARF will again become a major public health problem in North America. We report a clustering of 10 cases of ARF in young men undergoing basic training at a recruit camp in San Diego, Calif. This was the first such outbreak in two decades among US military personnel and the largest reported series of ARF cases among adults in more than a decade in the United States. Adult-onset ARF was not benign in our patients. The rate of carditis (3 of 10 patients) was similar to that in older studies of adults with ARF. All patients in our series suffered severe polyarthritis, anemia, and fever, but only 60% gave any history of preceding pharyngitis. Rheumatic fever must again be suspected in adults, as well as children, who present with polyarthritis.

Randomized, double-blind trial of 1- versus 4-hour amphotericin B infusion durations.

We conducted a randomized, double-blind trial of 1- versus 4-h infusions of amphotericin B to determine whether there was any difference in infusion-related toxicity. A total of 128 maintenance infusions in 12 patients were studied; 62 were randomized to 1-h infusions (group A) and 66 were randomized to 4-h infusions (group B). We found no significant differences between patients in groups A and B in mean temperature, pulse, or systolic or diastolic blood pressure measured during the infusions. At a significant level of 0.05, the power to detect a mean difference in temperature of 2 degrees C, a pulse difference of 20 beats per min, a decrease in diastolic blood pressure of 10 mm Hg, or a decrease in systolic blood pressure of 20 mm Hg was 0.95. Rigors and chills were noted in 15 of 62 (24.1%) infusions in group A patients and 12 of 66 (18.1%) infusions in group B patients (P = 0.40). Meperidine was required because of severe persistent rigors in 6 of 62 (9.6%) infusions in group A patients and 6 of 66 (8.9%) infusions in group B patients (P = 0.91). An increase in temperature was noted in five (8%) of the group A infusions and seven (10.6%) of the group B infusions (P = 0.63). The mean time to onset of rigors, an increase in temperature, and an increase in pulse occurred significantly earlier in group A than in group B patients (P = 0.02 for all comparisons). We conclude that there is no difference in the incidence or severity of the infusion-related toxicity of amphotericin B with a 1-h infusion rate compared with a 4-h infusion rate. However, the onset of infusion-related toxicity occurs significantly earlier with a 1-h infusion.

Epidemiology of human rabies post-exposure prophylaxis at the US Naval Facility, Subic Bay, Philippines.

Data collected during 1984 from an active animal rabies surveillance system and human rabies post-exposure prophylaxis program at the US Naval Hospital, Subic Bay Naval Facility, Philippines revealed that potential rabies exposure, most commonly from dog bites or scratches, was reported for 311 US military and civilian personnel and four Filipino employees working on the facility. Seventy-nine persons (25 per cent) required complete post-exposure prophylaxis. Brain tissue from two captured dogs implicated in attacks was subsequently found to be positive for rabies antigen on fluorescent antibody testing.