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Biomedical subjects

A C England

Publications and source records attributed to A C England.

At least 19 recordsLinked to original sources
PubMed1996

Outbreak of serogroup C meningococcal disease associated with campus bar patronage.

Between February 1991 and April 1992, eight undergraduates at a US residential university and one at a nearby 2-year college contracted serogroup C meningococcal disease. A case-control investigation with 20 controls per case, oropharyngeal carriage surveys, and multilocus enzyme electrophoresis (MEE) of serogroup C isolates were used to identify factors contributing to the outbreak. All eight sterile-site isolates from cases were closely related by MEE and were similar (though not identical) to the strain associated with the 1991-1992 epidemic of meningococcal disease in eastern Canada. Disease was associated with cigarette smoking (p = 0.012), recent patronage of campus-area bars (p = 0.034), estimated amount of time spent in campus-area bars (p = 0.0003), and, especially, recent patronage of one specific bar, bar A (p = 0.0006; odds ratio = 23.1, 95% confidence interval 3.0-571.5). In carriage surveys, 1,528 throat cultures taken from (primarily student) noncases yielded only five (0.3%) strains that were identical by MEE to those from cases. Two of these were found among 22 cultures obtained from bar A employees in spring 1992. Some cases in this outbreak may have followed transmission of the epidemic strain in bar A. Campus bar environments may facilitate the spread of meningococcal disease among teenagers and young adults.

Adolescent↗
PubMed1995

Meningococcal carriage, alcohol consumption, and campus bar patronage in a serogroup C meningococcal disease outbreak.

Community outbreaks of serogroup C invasive meningococcal disease are increasing in North America (L. H. Harrison, JAMA 273:419-421, 1995; L. A. Jackson, A. Schuchat, M. W. Reeves, and J. D. Wenger, JAMA 273:382-389, 1995; C. M. Whalen, J. C. Hockin, A. Ryan, and F. Ashton, JAMA 273:390-394). In a recent 15-month university outbreak, disease was linked to patronage of a specific campus-area bar, suggesting that aspects of a campus bar environment might promote meningococcal transmission (P. B. Imrey, L. A. Jackson, P. H. Ludwinski, et al., Am. J. Epidemiol., in press). To investigate this hypothesis, oropharyngeal carriage results from samples taken from 867 university health service clients and 85 campus-area bar employees during the last 3 months of the outbreak were analyzed to determine factors correlated with carriage of any strain of Neisseria meningitidis. Results were validated with data from samples from 344 health center clients and 211 campus bar employees taken 8 months after the last outbreak case. Recent alcohol consumption (adjusted prevalence odds ratio = 3.8 for > 15 versus 0 drinks in last week [P = 0.0012]) and campus bar patronage (adjusted odds ratio = 1.9 for any versus no patronage in last 2 weeks [P = 0.0122]) showed separate effects in both univariate and multiple logistic regression analyses of data from the 1992 health center clients. Prevalence of meningococcal carriage among 1992 campus bar workers was 3.8 times that among health center clients; this prevalence ratio was roughly 2.5 after adjustment for alcohol consumption and bar patronage. Recent antibiotic usage was protective (prevalence odds ratio = 0.3) among health center clients and bar workers. These findings were generally supported by the validation samples. If alcohol consumption and other aspects of the campus bar environment facilitate transmission of and/or colonization by N. meningitidis, then the introduction of a highly pathogenic substrain into the campus bar environment may provide an unusual opportunity for invasive meningococcal disease within a campus community.

Adolescent↗
PubMed1983

A winter outbreak of acute histoplasmosis in northern Michigan.

In January 1980, an outbreak of 138 cases of acute pulmonary disease occurred among employees of a Michigan limestone quarry. The source of exposure was a vessel repair building (relative risk = 5.8) and the time of exposure was January 10 (relative risk = 2.4). Work activities associated with the specific place and time suggested exposure to a pulley which had been stored in a ring-billed gull nesting area as the cause of illness. Histoplasma capsulatum was recovered from the nesting area, the pulley, and the sputum of several patients. Early serologic testing confirmed the diagnosis of acute pulmonary histoplasmosis.

Animals↗
PubMed1982

Failure of Legionella pneumophila sensitivities to predict culture results from disinfectant-treated air-conditioning cooling towers.

The disinfection of cooling towers based on manufacturers' treatment protocols, as employed in units installed at various public gathering places in Dallas, Tex. (hotels, municipal auditorium), and at the city health department, was evaluated for effectiveness in controlling Legionella pneumophila and compared with previous laboratory studies. In specimens collected in September and December, 1978, L. pneumophila was isolated from 2 of 4 specimens from untreated cooling towers, 2 of 4 specimens from towers treated with agents deemed ineffective in earlier laboratory tests, 6 of 11 specimens from towers treated with putatively effective agents, and 0 of 4 specimens from towers treated with an agent unknown efficacy. These results suggest the need for further studies to identify biocidal agents effective in eliminating L. pneumophila from air-conditioning cooling towers.

Air Conditioning↗
PubMed1982

Preventing severe heat injury in runners: suggestions from the 1979 Peachtree Road Race experience.

Of an estimated 17632 participants of the 1979 Peachtree Road Race, a 10-km race held at 0800 on 4 July in Atlanta, Georgia, 29 had severe heat injury (collapse with altered mental status and rectal temperature of 39.7 degrees C or greater); all 29 recovered promptly. The temperature was 24.0 degrees C; the relative humidity, 83%; and the wet bulb-globe index, 23.0 degrees C. Compared with unaffected participants matched by age, sex, and predicted finishing time, case-runners were taller, had slower best recent 1.6-km and 10-km times, had run less in June, were more likely to achieve 89% of estimated maximum aerobic capacity during the race, less often splashed with water, were more likely to have underestimated their predicted finishing times based on their best recent 10-km times, and were more likely to live in Georgia. Height, sprinkler use, and underestimating predicted finishing times were each significant in the presence of the others. These observations suggest that participants of similar races, particularly those taller than 179.2 cm, should splash with water at least twice and base their predicted finishing times on their best recent 10-km times; adherence to these recommendations by runners at risk should reduce their severe heat injury risk at least 8.1 times.

Athletic Injuries↗
PubMed1981

Sporadic and epidemic nosocomial legionellosis in the United States. Epidemiologic features.

As of April 30, 1980, 83 nosocomial cases of sporadic legionellosis had been reported to the Centers for Disease Control (CDC). In all 83 cases the patients had pneumonia; the median age of the patients was 56.5 years. All but one patient were hospitalized at the time of onset. Of 71 patients for whom the outcome is known, 22 (31 percent) died of causes directly attributed to their infection. Eleven patients had end-stage renal disease, 28 were receiving systemic immunosuppressive medications, 17 had cancer, 12 had chronic bronchitis or emphysema, 29 were smokers, and four had diabetes mellitus. Risks of acquiring nosocomial sporadic legionellosis for patients with these conditions relative to the general United States population = 340, 26, 11, 3.7, 1.9 and 1.3, respectively. These risk factors are similar to those identified for sporadic community-acquired legionellosis and for epidemic nosocomial legionellosis. Methods for preventing nosocomial legionellosis are not known, but comparing Legionella to other water-associated organisms which have been spread from medical devices to cause pneumonia may be fruitful.

Adult↗
PubMed1981

Effect of free fatty acids on protein binding of antimicrobial agents.

The effect of free fatty acids (FFAs) on the binding of antibiotics to human serum proteins was studied by addition of palmitic acid to albumin solutions and normal pooled serum. FFA reduced the binding of dicloxacillin, cefamandole, and sulfamethoxazole at molar ratios of FFA to albumin of greater than 2.0. In contrast, FFA enhanced the binding of benzylpenicillin, cephalothin, and cefoxitin at physiologic molar ratios of FFA to albumin. Elevated levels of FFAs induced in vivo by heparin produced similar results with dicloxacillin and benzylpenicillin. Addition of FFA to serum, but not to albumin, reduced the binding of clindamycin and trimethoprim. That the binding of these drugs was much lower in albumin than in serum suggested the presence in serum of another antibiotic-binding protein and that FFAs can modulate binding to this protein. Binding of chloramphenicol was unaffected by FFAs. The possible clinical significance of the changes in protein binding due to FFAs is discussed.

Anti-Bacterial Agents↗
PubMed1981

Sporadic legionellosis in the United States: the first thousand cases.

As of 30 September 1979, 1005 confirmed cases of sporadic legionellosis caused by Legionella pneumophila serogroups 1 to 4 in U.S. residents had been reported to the Centers for Disease Control; 19% were fatal. All but 2% of the 1005 cases were associated with pneumonia documented by chest radiograph. About 75% of the cases occurred in June through October. The risk of acquiring sporadic legionellosis was increased among males and persons 50 years or older; persons with renal disease necessitating dialysis or transplantation, with chronic bronchitis or emphysema, with diabetes mellitus, and with cancer (10 selected sites or types); persons who smoke; and persons being treated with immunosuppressive drugs. Increasing age and chronic bronchitis or emphysema were associated with increased risk of death. The sensitivity of culturing L. pneumophila from specimens positive by direct immunofluorescence was estimated to be 45%. The distribution of serogroups 1, 2, 3, and 4 of L. pneumophila in 57 fresh, not previously examined direct fluorescent antibody-positive specimens was 84%, 11%, 4%, and 2%, respectively; all 26 strains isolated from these specimens were of one of these four serogroups.

Adolescent↗
PubMed1981

Legionellosis.

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Agglutination Tests↗
PubMed1978

Enzymuria as a marker of renal injury and disease: studies of N-acetyl-beta-glucosaminidase in the general population and in patients with renal disease.

Urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) was shown to be reproducible in random urine specimens when expressed as the ratio of NAG to milligrams of urinary creatinine. The enzyme/creatinine ratio in 815 healthy people was relatively constant throughout childhood and adult life except for the first two years after birth and in individuals 56 years or greater. High ratios in the young children may be explained by low urinary creatinine excretion probably related to small body mass and reduced glomerular filtration rate at this age. The ratio was increased in adult uremic patients and children and adults with a variety of neurologic and obstructive lesions of the voiding mechanism. The presence of bacteriuria did not appear to increase the ratio. Significant enzymuria (greater than 2 SD above the mean for age and sex) was detected in 38 of 81 children with well-characterized renal disease. Among patients with predominantly glomerular disorders there was a close relationship between activity of the disease and enzymuria. In patients with tubulointerstitial disease enzymuria was frequent even in the absence of proteinuria. One of the highest enzyme/creatinine ratios was observed in a child with cystinosis. These studies indicate that NAG enzymuria is a sensitive indicator of activity of renal disease and may prove to be a suitable screening test for significant renal disease or injury in childhood.

Acetylglucosaminidase↗