Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak--Auglaize County, Ohio, USA.

The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99·9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121·7, 95% confidence interval 27·4-∞) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak.

Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium.

BACKGROUND: Encephalitis continues to result in substantial morbidity and mortality worldwide. Advances in diagnosis and management have been limited, in part, by a lack of consensus on case definitions, standardized diagnostic approaches, and priorities for research. METHODS: In March 2012, the International Encephalitis Consortium, a committee begun in 2010 with members worldwide, held a meeting in Atlanta to discuss recent advances in encephalitis and to set priorities for future study. RESULTS: We present a consensus document that proposes a standardized case definition and diagnostic guidelines for evaluation of adults and children with suspected encephalitis. In addition, areas of research priority, including host genetics and selected emerging infections, are discussed. CONCLUSIONS: We anticipate that this document, representing a synthesis of our discussions and supported by literature, will serve as a practical aid to clinicians evaluating patients with suspected encephalitis and will identify key areas and approaches to advance our knowledge of encephalitis.

Chest disease presenting as an acute abdomen.

Four patients with primary disease in the chest are discussed, each coming to laparotomy. The final postoperative diagnoses were empyema, pulmonary tuberculosis, pulmonary embolism and bacterial endocarditis. These cases well illustrate the real risk of confusing an acute chest condition with an acute abdomen.

Rotatory subluxation of the scaphoid.

Rotatory subluxation of the scaphoid is an uncommon abnormality which is not widely understood. It can be difficult to diagnose and, if incorrectly managed, can lead to a severe and disabling radio-carpal arthritis. While complicating many forms of wrist trauma, its place in the lunate-perilunate dislocation spectrum being especially important, the abnormality may occur in the absence of trauma, such as with rheumatoid arthritis; its association with Kienböck's disease is documented in this paper. The mechanisms underlying the subluxation are discussed and the importance of early diagnosis is stressed. Eight cases of rotatory subluxation of the scaphoid are reported to illustrate the presentations, symptomatology and complexities of diagnosis.

Blastomycosis: diagnostic difficulties.

In five cases of blastomycosis, invasive procedures were required before the diagnosis was established; these included thoracotomy in two cases and craniotomy in a third case. Radiologic signs in blastomycosis are nonspecific, and the presentations of the disease may be protean and unusual. Certain factors and radiologic appearances should alert the physician and radiologist to the diagnosis.

Congenital absence of the kidney: problems in diagnosis and management.

We describe 6 patients with congenital absence of 1 kidney that has been confirmed surgically. These cases illustrate the thesis that renal agenesis can modify the presentation and the management of urinary tract disease, and include the only published account of carcinoma of the ureter draining a single kidney. The place of cystoscopy, isotopic studies, ultrasonography, computerized tomography, arteriography and renal venography is described briefly. The frequent difficulty in establishing a definite diagnosis of renal agenesis is emphasized and the indications for the investigation of possible cases of renal agenesis are reviewed.

The radiology of gastric reduction surgery for obesity.

The results of 181 gastric reduction operations for obesity, performed over a 3-year period, are reported. The indications for such surgery are presented and the results are briefly discussed. The broad surgical details of gastroplasty and of stapling procedures, the advantages of the latter and the newer trends in this field are described. The early and late complications are documented, illustrated and discussed. The important role of the radiologist in diagnosing these complications, especially in the acute post-operative period, is stressed.