Human Yersinia enterocolitica infections in Wisconsin. Clinical, laboratory and epidemiologic features

Yersinia enterocolitica has been sought in stool and blood culture specimens by the Wisconsin State Laboratory of Hygiene (SLH) since 1973. Clinical information on symptoms, duration of illness, and use of antibiotics for 41 persons with Y. enterocolitica infections from January 1, 1979, to September 30, 1980, was obtained by telephone interviews. Diarrhea and abdominal pain were the most common symptoms of the ill persons; extraintestinal symptoms were infrequently reported. Ten infected persons (24 percent) had no illness. Review of a 10 percent sample of all stool specimens cultured at the SLH from June 20, 1977, to June 20, 1979, revealed that Salmonella was the most commonly isolated enteric pathogen (15.4 percent) followed by Shigella (2.0 percent) and Y. enterocolitica (0.7 percent). Several different biotypes and serotypes of Y. enterocolitica were associated with illness. Y. enterocolitica isolates were uniformly susceptible to a wide variety of antibiotics, and most isolates were resistant to ampicillin. Epidemiologic studies showed that persons with Y. enterocolitica infections were more likely to live in rural counties than were all persons sending stool samples or those having Salmonella infections; underlying illness was identified as a risk factor for infection.

Clinical characteristics of infant botulism in the United States: a study of the non-California cases

We reviewed the clinical features of 99 cases of infant botulism reported to the Centers for Disease Control from states other than California for the period 1976 to 1980. There were no toxin-specific differences in the distribution of ages at onset or sex of the cases. For 76 (76%) patients for whom data were available the most common presenting symptoms were poor feeding (43%) and constipation (24%). Weak suck, poor head control, floppiness, weakness in extremities, difficulty swallowing, altered cry and constipation were reported in over three-fourths of the infants for whom data were available. Loss of facial expression, extraocular muscle paralysis, dilated pupils and depression of deep tendon reflexes occurred significantly more frequently among infants with type B botulism than among those with type A botulism. Ventilatory assistance was required for 61% of infants receiving aminoglycosides after the onset of weakness compared to only 26% of those infants not receiving aminoglycosides (P = 0.01). Infant botulism presents a characteristic clinical picture and should be suspected when an infant presents with weakness.

Enzyme-linked immunosorbent assay for detection of Salmonella typhi Vi antigen in urine from typhoid patients

Because typhoid fever continues to be a major cause of illness in many developing countries, there is a clear need for a sensitive and specific test that will permit rapid laboratory diagnosis of the disease. An enzyme-linked immunosorbent assay (ELISA) has recently been developed and tested, both in the laboratory and in a clinical situation, for its ability to detect Vi antigen in urine. The ELISA was capable of detecting as little as 1 ng of purified Vi antigen per ml in urine, compared with 100 ng/ml detectable by a previously tested coagglutination method. It could also detect antigen in urine diluted as much as 1:1,024 in normal urine. In tests of urine specimens from six stool culture-positive persons in a small typhoid outbreak in the United States, the ELISA detected antigen in specimens from four of the six patients. The ELISA also proved to be specific, giving no false-positive results for specimens from 50 persons who did not have typhoid fever. The apparent high sensitivity and specificity of this ELISA make it a promising test for rapid diagnosis of typhoid fever.

From pedialyte to popsicles: a look at oral rehydration therapy used in the United States and Canada

To obtain information on the attitudes and practices concerning oral rehydration therapy in the United States and Canada, a questionnaire was sent to the chairmen of departments of pediatrics of 142 medical colleges. Some form of oral fluid therapy for treatment of diarrheal dehydration is used by the institutions of all 128 survey respondents. The most commonly used fluids, commercial sugar-electrolyte solutions (89%), clear liquids (78%), and fruit juices (58%) have very different compositions and concentrations of ingredients. Oral therapy is based on a specific written protocol at 30% of the institutions and is used most frequently to treat outpatients with mild dehydration. To determine a uniform and optimal approach to oral fluid treatment for diarrhea, comparative clinical trials are needed to assess which fluid compositions and concentrations are most effective in preventing dehydration and in treating dehydration once it has occurred.

Home-administered oral therapy for diarrhoea: a laboratory study of safety and efficacy

Serum electrolytes were measured for persons treated for diarrhoea at home with prepackaged or locally available sugar and salt oral rehydration therapy (ORT) solutions and for persons with diarrhoea who received no ORT but were treated according to local customs. No detrimental effect was found for persons treated with ORT at home; no significant difference was found in the frequency at which members of the groups had hypernatraemia. The rates of hyponatraemia and hypokalaemia were significantly lower for persons who took estimated appropriate volumes of ORT than for those who took less than appropriate volumes or for persons treated according to local customs without ORT. These laboratory results indicate that ORT administered in rural homes in Bangladesh was safe and effective under the conditions of our study.