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PERSON-TO-PERSON SPREAD OF SALMONELLA TYPHIMURIUM
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HBsAg and ALT levels in patients with CAHB.
Chain of Salmonella transmission.
prednylidene/kg bodyweight/day and 1’ 30 mg azathioprine/kg bodyweight/day. Chronic aggressive hepatitis was diagnosed according to histological criteria. Patients were seen once a month for seven months after the abrupt withdrawal of treatment. HBsAg was measured quantitatively by Laurell immunoelectrophoresis, and HBeAg titres were measured by EIA. The figure shows the mean values of HBsAg and alanine transaminase (ALT) recorded during the last year that patients were on therapy compared with the mean values of samples taken during the fourth to seventh months after therapy was stopped. HBeAg had disappeared from the serum in 5 out of 11 HBeAg positive patients. We suggest that rapid withdrawal of immunosuppressive therapy in some patients with HBeAg positive CAHB may initiate a host response resulting in the elimination of HBeAg and improvement of
usually introduced into human communities by contaminated animal flesh, eggs, and milk, not by human carriers.4 Further definition of the epidemiological pattern, including consideration of possible zoonotic factors, could assist in the prevention of similar outbreaks. The number of reported cases of salmonella infection is increasing in England and Wales, but in only
clinical and biochemical abnormalities. Moreover, the beneficial effects of corticosteroids in patients with HBeAg negative CAHB appear doubtful. Abteilung für Gastroenterologie und Hepatologie, Zentrum Innere Medizin, Medizinische Hochschule, Hannover,
West Germany
R. MULLER I. VIDO F. W. SCHMIDT
PERSON-TO-PERSON SPREAD OF SALMONELLA TYPHIMURIUM
SiR,—Dr Palmer and colleagues (April 18, p.881) suggest personspread in their investigation of an outbreak of Salmonella typhimurium gastroenteritis. However, such transmission does not usually occur, even in settings considered highly conducive to crossinfection.’ Although such transmission was alleged in one study of to-person
outbreak on an Indian reservation,2higher rates of illness were demonstrated when contacts of cases were compared with contacts of controls.3 It appears that a major effort was expended in sampling all the catering staff, but all their stool cultures were negative, as were all the environmental surface cultures. There is little discussion of the possible chain of salmonella transmission (see figure). This is important since salmonella food poisoning is really a zoonosis. It is an
not
SA, Aserkoff B, Brachman PS. Epidemic salmonellosis in hospitals and five year review. N Engl Med 1968; 279: 674-78. J Loewenstein MS An outbreak of salmonellosis propagated by person-to-person transmission on an Indian reservation Am J Epidemiol 1975; 102: 257-62. Horwitz MA, Pollard RA, Merson MH, Martin SM. A large outbreak of foodborne salmonellosis on the Navajo Nation Indian Reservation: Epidemiology and secondary transmission. Am J Publ Health 1977; 67: 1071-76.
1. Schroeder
institutions: a
2. 3.
17% of outbreaks in 1979
was
Boundary Health District, Surrey, British Columbia V3W 1J1,
the vehicle of infection
Canada
reported.5
T. JOHNSTONE
BIZARRE PERCEPTUAL DISORDER OF EXTREMITIES IN PATIENTS TAKING VERAPAMIL
SIR,-Over the past thirty months we have prescribed oral verapamil (classified as "emergency" drug treatment in Canada) for 124 patients. 3 patients have complained of unusual perceptual symptoms, described as painful coldness and numbness or bursting feelings, especially in the legs. Case1 A
60-year-old woman with hypertrophic obstructive cardiomyopathy characterised by chest pains, palpitations, lightheadedness, fainting spells, tiredness, and exertional dyspnoea, had not responded to propranolol. A septal myectomy had led to improvement but a year later she relapsed, and cardiac catheterisation revealed a recurrence in outflow tract gradient, which was halved after intravenous propranolol. Despite increasing doses of oral propranolol, she did not improve and she was weaned off this drug. For a few days she complained of coldness and found the weight of her spectacles on her nose troublesome. With her informed consent she was given oral verapamil and at first had a promising remission. Her symptoms then returned and persisted despite verapamil doses increased to 240 mg three times daily. About 5 months after the start of verapamil therapy a new group of symptoms began to dominate-namely, a severe, painful cold sensation associated with numbness in her face, jaws, gums, hands, legs, and feet. She found it difficult to walk and tended to fall about, and her legs had become restless at night, interfering with sleep. Anorexia developed. These symptoms were ascribed to her cardiac problem but her previous symptoms had improved and the cardiac cardiovascular signs had not altered. Propranolol had no effect and 4. Howie J. The pattern of communicable diseases in the UK and abroad. Br Med J 1976. ii: 217-19. 5. Anon. Food poisoning and salmonella surveillance in England and Wales 1979. Br Med J 1980, 281: 1360-61.
HBsAg and ALT levels in patients with CAHB.
Chain of Salmonella transmission.
prednylidene/kg bodyweight/day and 1’ 30 mg azathioprine/kg bodyweight/day. Chronic aggressive hepatitis was diagnosed according to histological criteria. Patients were seen once a month for seven months after the abrupt withdrawal of treatment. HBsAg was measured quantitatively by Laurell immunoelectrophoresis, and HBeAg titres were measured by EIA. The figure shows the mean values of HBsAg and alanine transaminase (ALT) recorded during the last year that patients were on therapy compared with the mean values of samples taken during the fourth to seventh months after therapy was stopped. HBeAg had disappeared from the serum in 5 out of 11 HBeAg positive patients. We suggest that rapid withdrawal of immunosuppressive therapy in some patients with HBeAg positive CAHB may initiate a host response resulting in the elimination of HBeAg and improvement of
usually introduced into human communities by contaminated animal flesh, eggs, and milk, not by human carriers.4 Further definition of the epidemiological pattern, including consideration of possible zoonotic factors, could assist in the prevention of similar outbreaks. The number of reported cases of salmonella infection is increasing in England and Wales, but in only
clinical and biochemical abnormalities. Moreover, the beneficial effects of corticosteroids in patients with HBeAg negative CAHB appear doubtful. Abteilung für Gastroenterologie und Hepatologie, Zentrum Innere Medizin, Medizinische Hochschule, Hannover,
West Germany
R. MULLER I. VIDO F. W. SCHMIDT
PERSON-TO-PERSON SPREAD OF SALMONELLA TYPHIMURIUM
SiR,—Dr Palmer and colleagues (April 18, p.881) suggest personspread in their investigation of an outbreak of Salmonella typhimurium gastroenteritis. However, such transmission does not usually occur, even in settings considered highly conducive to crossinfection.’ Although such transmission was alleged in one study of to-person
outbreak on an Indian reservation,2higher rates of illness were demonstrated when contacts of cases were compared with contacts of controls.3 It appears that a major effort was expended in sampling all the catering staff, but all their stool cultures were negative, as were all the environmental surface cultures. There is little discussion of the possible chain of salmonella transmission (see figure). This is important since salmonella food poisoning is really a zoonosis. It is an
not
SA, Aserkoff B, Brachman PS. Epidemic salmonellosis in hospitals and five year review. N Engl Med 1968; 279: 674-78. J Loewenstein MS An outbreak of salmonellosis propagated by person-to-person transmission on an Indian reservation Am J Epidemiol 1975; 102: 257-62. Horwitz MA, Pollard RA, Merson MH, Martin SM. A large outbreak of foodborne salmonellosis on the Navajo Nation Indian Reservation: Epidemiology and secondary transmission. Am J Publ Health 1977; 67: 1071-76.
1. Schroeder
institutions: a
2. 3.
17% of outbreaks in 1979
was
Boundary Health District, Surrey, British Columbia V3W 1J1,
the vehicle of infection
Canada
reported.5
T. JOHNSTONE
BIZARRE PERCEPTUAL DISORDER OF EXTREMITIES IN PATIENTS TAKING VERAPAMIL
SIR,-Over the past thirty months we have prescribed oral verapamil (classified as "emergency" drug treatment in Canada) for 124 patients. 3 patients have complained of unusual perceptual symptoms, described as painful coldness and numbness or bursting feelings, especially in the legs. Case1 A
60-year-old woman with hypertrophic obstructive cardiomyopathy characterised by chest pains, palpitations, lightheadedness, fainting spells, tiredness, and exertional dyspnoea, had not responded to propranolol. A septal myectomy had led to improvement but a year later she relapsed, and cardiac catheterisation revealed a recurrence in outflow tract gradient, which was halved after intravenous propranolol. Despite increasing doses of oral propranolol, she did not improve and she was weaned off this drug. For a few days she complained of coldness and found the weight of her spectacles on her nose troublesome. With her informed consent she was given oral verapamil and at first had a promising remission. Her symptoms then returned and persisted despite verapamil doses increased to 240 mg three times daily. About 5 months after the start of verapamil therapy a new group of symptoms began to dominate-namely, a severe, painful cold sensation associated with numbness in her face, jaws, gums, hands, legs, and feet. She found it difficult to walk and tended to fall about, and her legs had become restless at night, interfering with sleep. Anorexia developed. These symptoms were ascribed to her cardiac problem but her previous symptoms had improved and the cardiac cardiovascular signs had not altered. Propranolol had no effect and 4. Howie J. The pattern of communicable diseases in the UK and abroad. Br Med J 1976. ii: 217-19. 5. Anon. Food poisoning and salmonella surveillance in England and Wales 1979. Br Med J 1980, 281: 1360-61.