National notes

47 Infectious Diseases Newsletter

England: Diphtheria occurred in a hospital for mentally subnormal adults. Sera from 211 staff members were assayed for antitoxin titers; 86 had < 0.01 units/ml. Seventy-nine were immunized with low dose Td (iLfu d and 10Lfu T). Seroconversion occurred in 70% with a single dose; higher rates occurred in younger adults. Local reactions occurred in 43%; 13% had moderately severe local "reactions with systemic symptoms. 9 Coincidentally, tetanus antitoxin seroconversion occurred in 59% of single dose recipients. They recommend antitoxin screening before immunization, a single dose booster for those < 45 years old and two doses for those older. Brit Med J 286:624, 19.83 South Africa: ~'Sandyk and Brennan report three cases of rapidly fatal encephalopathy caused by Shigella flexneri in 9-, 10-, and ll-year-old children. Abdominal and intestinal symptoms were minimal and no fluid-electrolyte imbalances were present. Necrosis of segments of the brain occurred in all three patients; pontine hemorrhage and demyelination occurred in one. The authors suggest their experience supports the neurotoxic effect of shigella. Arch Dis Child 58:70, 1983 Bangladesh: Virulent cholera resurfaced in 1982. "Classical" V. cholera replaced E1 Tot within 3 months, resulted in severe illness, and accounted for 90% of cases. News Release, International Centre for Diarrhoeal Disease, March 19, 1983 Greece: Neonatal tetanus occurred in Greece in 1966-1977. Survivors (38) of this disease suffered neurologic sequelae (4 patients) but no deficits in growth or development from 5 to 12 years later. Anoxia during the disease probably accounts for the sequelae. The 38 survivors were among 50 of 73 original patients; 23 died (31,5%)~acutely and 12 survivors were not assessed. Arch Dis Child 58:68, 1983

NATIONAL NOTES Colorado: Weinstein, et al analyzed 500 episodes of bacteremia and fungemia in adults during an almost two-year period. True bacteremia was associated with the isolation of facultative and anaerobic gram-negative bacilli, fungi, and grampositive cocci (except for S. viridans and S. epidermidis). False positives were associated with gram-positive bacilli. Two positive cultures confirmed the diagnosis in 99%+ of episodes. Most common pathogens were E. coli, S. aureus,

9

S. pneumoniae, M. pneumoniae, and P. aeurignosa. Two-thirds of episodes were nosocomial; polymicrobial septicemia occurred most often in surgical or transplant patients. Bacteria came from the gastrointestinal, genitourinary, and respiratory tracts but in one-third of instances, no source was found. Therapy was appropriate in > 90% when sensitivity data was known. Half of the deaths (42% of 500 episodes) were due to infection. Death was greatest in transplant patients; least in obstetrics-gynecology patients. Enterococcal, facultative gram-negative, fungal, polymicrobial and nosocomial sepsis had the highest mortality rate. Shock, leukopenia, and predisposing diseases also were associated with increased mortality. Body temperature was inversely related to death. Seven variables influenced outcome: (i) specific organism; (2) blood pressure; (3) body temperature; (4) primary focus; (5) place of acquisition; (6) age; and (7) predisposing factors. Rev Infect Dis 5:35-53 and 54-70, 1983 Centers for Disease Control: Of 642 outbreaks of acute gastroenteritis, 54 were due to Norwalk-like virus infection; 23% of outbreaks were water-borne, 4% food-borne, 67% nursing home; 60% summer camp, and 28% on cruise ships. Amer J Publ Health 72:1329, 1982 Yale University: Of 136 children with fever or respiratory symptoms, 19% had pneumonia by roentgenologic criteria. The best predictor of pneumonia was tachypnea; cluster of pulmonary findings (distress, tales, decreased breath sounds, tachypnea) also was predictive. Had these criteria been used, 30% fewer roentgenograms would have been obtained. Clin Pediatr 21:730, 1983 United States: After M. tuberculosis, M. avium complex, M. fortuitum, M. kansasii; and'M, scrofulaceum were isolated in that order in 1980; 35% of all isolates were nontuberculous mycobacteria. The South Atlantic region continues to predominate although California leads all states in isolates of M. avium complex (933) with Florida reporting 822. Details of the geographic distribution are given. J Infect Dis 146:829, 1982 Wisconsin: Maki et al decided that contamination of inanimate surfaces (furniture, faucets and sink drains) and of air and water contribute negligibly to nosocomial infections. They base their conclusion on similar patient illnesses in two hospitals disparate in physical configuration and in profile and level of environmental microbial contamination. Nevertheless, they still encourage sanitary and cleanliness measures to pro-

by Elsevier Science Publish'ihg Co., Inc.

48 Infectious Diseases Newsletter

tect immunocompromised patients. N Engl J Med 307:1562, 1982 Chicago: Herman and colleagues, in an important report, tell us that two children allergic to egg white protein (ovalbumin) had a generalized anaphylactic reaction to live measles virus vaccine (LMVV) which is prepared in chick embryo tissue culture and supposedly devoid of egg proteins. Specific IgE which reacted 'with ovalbumin-antigens in LMVV was present in their sera. Twenty-four children who were egg white sensitive by skin test but had had no reactions to ingested eggs were skin test negative to LMVV, had no detectable specific serum IgE to LMVV components and underwent immunization safely. Six patients with severe ovalbumin allergy (manffested clinically on ingestion of egg white) had positive skin tests to LMVV, specific IgE antimeasles vaccine antibody and were immunized safely by incremental injections of LMVV (0.05 ml increments every 20 minutes). The authors suggest: (i) screening of all egg-sensitive individuals with prior reactions to egg by skin test to LMVV; and (2) desensitization method of LMVV administration. J Pediatr 102:196, 1983 Centers for Disease Control: Hepatitis A can be epidemic in day care centers affecting staff and parents of attendees. During a 21 month period in Phoenix, each time a single case of hepatitis occurred in a day care center, all attendees and staff were given immune globulin. This program was oarried out in 91 centers and resulted in a reduction in transmission from 7.3 cases/nontreated center to 6.0 cases/treated center. Cases ceased in the center within two weeks of IG administration and in households within six weeks. Cases of hepatitis in the entire community decreased 75% and new outbreaks by 77%. The authors suggest that the community decrease occurred because of a reduction in tertiary transmission from day care center foci. JAMA 249:48, 1983 RESEARCH NOTES T-cells in measles and varicella: T-lymphocyte subpopulations were studied in 8 patients (12 to 29 years old) with acute measles and in 6 patients (ages 23 to 36 years) with acute varicella. Monoclonal antibody against Leu 2a and Leu 3a antigens were used to sort out suppressor (Ts) from helper (Th) cells. During the acute phases of both diseases, PHA responses were suppressed as was PPD induced lymphocyte proliferation in most tested. In muscles, T lymphocytopenia occurred but the ratio of Ts/Th did not change. In varicella, Ts (Leu 2a cells) were increased both in percentage and in

absolute number. Further, the Ts subset appeared activated. Mononuclear cells from the varicella patients could suppress PHA responsiveness in autologous convalescent tests. The mechanism in varicella appears to differ from that operative in measles. Infect Immun 39:29, 1983 Prophylaxis of ABE: Rats were rendered bacteremic after placement of a transaortic catheter. This model of bacterial endocarditis was used to test the prophylactic capacity of clindamycin, erythromycin, and doxycycline. All three protected against endocarditis but only clindamycin did so against three pathogens at blood levels achievable in humans after oral administration. Concentrations far less than the MBC for streptococci were effective. Since serum was n o t b a c t e r i c i d a l at time of challenge, the antibiotic effect was not dependent on bacterial killing. The authors speculate that inhibition of bacterial adherence may be responsible. J Infect Dis 146:806, 1982 Varicella Vaccine: Arbeter et al report that healthy children were given the KMeC strain of live, attenuated varicella vaccine (LVV). All seroconverted (43 children) with either 40th passage or 50th passage LVV. All developed cell mediated immune (CMI) responses. Mild papular skin lesions occurred in 31% of the 40th passage and 6% of the 50th passage vaccine. They conclude that 50th passage LVV is the candidate vaccine for use in patients with leukemia. Pediatr 71:307, 1983 Influenza in Turkeys: Type A (HINI) swine influenza-like viruses have been isolated from turkeys in the United States. These agents are closely related to those endemic in pigs as determined by antibody, RNA and replication characteristics. A laboratory worker came down with typical "flu" from infection with one of the isolates. Hinshaw and colleagues hypothesize that turkeys may be a source for human disease and one reservoir in nature in addition to the pig. Science 220:206, 1983 CSF Lactate: Patients with meningitis (109 adults and children) were examined for CSF lactate levels as a possible early index of bacterial etiology. Elevated lactate was correlated with leucocytes in the CSF. A positive predictive value for bacterial meningitis was 31% (reversing its value somewhat). Elevated lactate occurred in patients with infections other than the CNS, in head trauma, subarachnoid hemorrhage and alcoholic seizures. The authors conclude it is of no value in the diagnosis of bacterial meningitis. Arch Intern Med 143:85, 1983

9 1983 by Elsevier Science Publishing Co., Inc.