Listeriosis in the United States

78 Infectious Diseases Newsletter 7(10) October 1988 peated isolations often serve as a stimulus to become more aggressive in efforts to establish the diagnosis of invasive aspergillosis. The occurrence of invasive aspergiUosis is favored by concomitant treatment with glucosteroids, cytotoxic agents, and broadly active antimicrobics; acute leukemia; and severe neutropenia. However, invasive aspergillosis has been reported to occur in a previously healthy host as a rare occurrence. Our patient was initially thought to be without predisposing factors until bilateral adrenal hyperplasia was discovered at autopsy. The presence of Aspergillis spp. in the first sputum that was cultured may have reflected her hypercorticoid state, and the broad-

spectrum antibacterial treatment she was given may not have been a primary predisposing factor. Our patient may illustrate occult Cushing's disease as an underlying process setting the stage for the occurrence of invasive aspergillosis. Moreover, our experience emphasizes the probable significance of serial isolations of Aspergillis spp. in specimens obtained from the lower respiratory tract of a patient with pneumonia who does not respond to antibacterial therapy.

the diagnosis of invasive pulmonary aspergiUosis. J Clin Microbiot 11:370376, 1980 Rinaldi MG: Invasive aspcrgillosis. Rev Infect Dis 5:1061-1076, 1983 Treger JR, Visscher DW, Bartlett MS, et al: Diagnosis of pulmonary infection caused by Aspergillus: Usefulness of respiratory cultures. J Inf Dis 152:572576, 1985 Yu VL, Muder RR, Poorsattas A: Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergiUosis. Results from a three-year prospective study. Am J Med 81:2-49-254, 1986

Bibliography Nalesnik MA, Myerowitz RL, Jenkins R, et al: Significance of Aspergillis species isolated from respiratory secretions in

Joseph Koo, M.D. Division of lnfectious and Immunologic Diseases University of California Davis Medical Center Sacramento, California

COMMENTS ON CURRENT PUBLICATIONS

Brown KH, Gastanaduy AS, Saavedra JM, et al: Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr 112:191-200, 1988. In a randomized clinical trial, the effects of re-introduction of four lactose free formulas were evaluated during diarrhea afflicting 128 non-malnourisbed children between 3 and 36 months of age. Following rehydration, continued oral feeding with a casein, sucrose, and vegetable oil diet during the early phase of therapy yielded improved nutritional results as measured by net apparent absorption of nitrogen, fat, carbohydrates, and total energy; retention of nitrogen; and increments in body weight, arm circumference, and skin-fold thickness. Comment Millions of episodes of diarrhea occur weekly in children throughout the

world. These episodes often result in dehydration and death, or contribute to secondary malnutrition among survivors. When an infant develops diarrhea and dehydration, the initial thrust of therapy should be toward rehydration with fluid and electrolyte solutions. Dietary therapy should then be reinstituted to prevent the development of malnutrition. Children who are refed immediately after rehydration generally have a greater fecal output than those who are treated intravenously; however, early refeeding should be continued unless the increased fecal production is clinically significant. In this study the rates of therapeutic failure ranged from 2.9%-10%, with a trend toward increasing rates of failure with greater dietary intake. In the majority of children with diarrhea, appropriate dietary reinstitution will be beaeficial, but failures will occur. Individual children need to be monitored during © 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/$0.00 + 2.20

their course of rehydmtion and refeeding. LKP []

Ciesielski CA, Hightower AW, Parsons SK, et al: Listeriosis in the United States: 1980-1982. Arch Int Med 148:1416-1419, 1988. Using information from the Professional Activity Study of the Comission on Professional and Hospital Activities (a nonprofit, nongovernmental hospital discharge data system representing 22%-23% of all shortterm, non-federal hospitals in the United States) the magnitude of the public health problem posed by listedosis was evaluated. Patientswith discharge diagnoses of listeriosis during the period 1980-1982 were included, comprising 27%-29% of all

79 Infectious Diseases Newsletter 7(10) October 1988 discharges from such hospitals in the United States. There were 660 patients. By year, there were 234 in 1980; 212 in 1981; 214 in 1982. The male/female ratio was 304/356. Meningitis was the clinical form of the infection in 317 (48%), with 107 (33.8%) < 1 month; 12 (3.8%) 1 month-15 years; 19 (6.0%) 16-39 years; and 179 (56.5%) 40 years. The overall case fatality rate was 19.1%; the death rate increased with age, exceeding 30% in patients ~> 60 years in age. Pregnancy or the neonatal state was present in 219 (33.2%) cases, while other underlying illnesses [malignancies (122), diabetes mellitus (77), chronic hepatic (39) or renal (40) disease, collagen vascular disease (18), and organ transplantation (19)] were noted in 315 (47.7%) patients. That is, in 126 (19.0%) patients no predisposing, noninfectious disease was reported. It was estimated that 800 cases of listeriosis occur each year in the United States, causing at least 150 deaths per year.

Continent With proof that humans (excepting premature and neonatal infants) are infected with Listeria monocytogenes primarily through ingestion of food contaminated with the organism, many states now require the reporting of listeriosis. Also, in view of the evidence of foodborne transmission, listeriosis has become a disease of public health interest. The data reported by Ciesielski et al represent a most welcome, first compilation of information on the occurrence of listeriosis in the United States. PDH []

Cochi SL, Preblud SR, Orenstein, WA: Prospectus on the relative resurgence of memps in the United States. Amer J Dis Child 142:499507, 1988.

Live mumps virus vaccine was licensed in the United States in December, 1967. In 1985, an all time low of approximately 3,000 cases of mumps was reported, representing a 98% decrease from the 152,000 cases reported in 1968, the year mumps became a nationally notifiable disease. Since 1986, there has been a relative resurgence of mumps in the United States, with numerous outbreaks in older school age children on college campuses and in other young adult populations. The authors examined the reasons for this resurgence by reviewing the history of recommendations for use of mumps immunization, the historical pattern of mumps vaccine use in the United States, and data documenting the changing epidemiology of mumps in the United States. They found that the relative resurgence of mumps in the United States is chiefly due to failure to vaccinate all susceptible persons, especially those who are now between 10 and 19 years of age. Post-licensure field evaluations of mumps vaccine effectiveness have not demonstrated waning vaccine-induced immunity.

Comment In the United States, there is a relatively underimmunized cohort of persons born between 1967 and 1977 who grew up during the period when the risk of exposure to mumps was rapidly declining. The authors provide evidence to support their view that this is a result of failure to vaccinate susceptible persons, and not the result of vaccine failures. The effectiveness of mumps immunization school laws in decreasing mumps incidence has been consistently demonstrated. Future policy emphasis should include enforcing existing laws requiring vaccination against mumps, extending present laws to be comprehensive for kindergarten through grade 12, and considering the introduction of laws requiring vaccination for all students in kindergarten through grade 12 in states without an © 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/$0.00 + 2.20

existing law. All older school age children and those entering college should have been vaccinated against mumps. The recommendation of the American College Health Association that all college health programs require documentation of previous mumps disease or vaccination before entering school should be followed. LKP []

Schwartz B, A1-Ruwais A, A'ashi J, Broome CV, Al-Tabarque A, Fontaine RE, Hightower AW, Music SI: Comparative efficacy of ceftriaxone and rifampin in eradicating pharyngeal carriage of group A Neisseria meningitMis. Lancet 1:1239-1242, 1988.

In 1987 a large outbreak of group A meningococcal meningitis occurred among Moslem pilgrims to Mecca. Because of the many problems encountered in administering rifampin prophylaxis to family members or close contacts, a comparison of ceftriaxone and rifampin prophylaxis was undertaken in Jeddah, Saudi Arabia (72 km from Mecca). Either ceftriaxone (single IM dose of 250 mg for adults, 125 mg for children < 15 yrs) or rifampin (600 nag, PO, 12hourly, for 2 days for adults, 10 mg/kg body wt, 12-hourly for 2 days for children) was given to 347 contacts of patients whose cerebrospinal fluid (CSF) or blood yielded Neisseria meningitidis, or who had purulent CSF. One-third of preprophylaxis orpharyngeal swabs from contacts yielded Neisseria spp. [carriage rates pre-prophylaxis were higher (42%) in the ceftriaxone group than in the rifampin group (24%) because of inclusion of a large group of workers exposed in a compound]. Otherwise the groups were comparable in age, sex,