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Biomedical subjects

C M Nolan

Publications and source records attributed to C M Nolan.

At least 73 records · Page 4Linked to original sources
PubMed1987

Campylobacter jejuni enteritis associated with raw goat's milk.

During a three-week period in July 1983, six cases of Campylobacter jejuni enteritis in King County, Washington were associated with a dairy that produced raw goat's milk. Four patients consumed the dairy's milk, and the other two patients comprised an employee of the dairy and her infant son. Two case-control studies confirmed that, at the time the cases occurred, consumption of the dairy's milk was a risk factor for C. jejuni enteritis in King County. C. jejuni was isolated from the intestinal tract of three of the dairy's goats. Two of the three isolates, as well as those from five of the patients (all of those tested), were Lior serotype 36. That serotype was not encountered among 14 other C. jejuni isolates from King County during the period of the outbreak, including three isolates from goats at another inspected dairy. The study shows that raw goat's milk may transmit C. jejuni infection from animals to humans, as other investigators have shown for unpasteurized cow's milk.

Adolescent↗
PubMed1986

Active tuberculosis after isoniazid chemoprophylaxis of Southeast Asian refugees.

The outcome of isoniazid chemoprophylaxis for tuberculosis was assessed in refugees from Southeast Asia. From July 1979 through June 1982, 2,795 tuberculin-positive refugees were prescribed isoniazid chemoprophylaxis at the time of their resettlement in King County, Washington. Through December 1983, 19 cases of active tuberculosis had arisen in those refugees. The annual incidence varied between 2.04 and 2.86 cases per 1,000 receiving treatment during the 4 yr after initiation of chemoprophylaxis (cumulative incidence, 9.66 per 1,000). Seven of the cases of tuberculosis occurring after isoniazid chemoprophylaxis were pulmonary, 1 was pulmonary and extrapulmonary (lymphatic), and 11 were extrapulmonary alone (lymphatic, 6 cases; pleural, 4 cases; soft tissue, 1 case). Fifteen of the 19 cases were culture positive, among which 8 M. tuberculosis isolates were susceptible to isoniazid and 7 were resistant. A case-control analysis showed that poor compliance, defined as taking isoniazid for 3 months or less, was associated with a sixfold increase in risk for subsequent isoniazid-susceptible tuberculosis but with no increased risk for subsequent isoniazid-resistant disease. Thus, active tuberculosis continued to occur with a low but relatively constant incidence after prescription of isoniazid chemoprophylaxis to Southeast Asian refugees. In this setting, poor compliance with chemoprophylaxis predisposed to isoniazid-susceptible, but not to isoniazid-resistant tuberculosis. There is a need to improve the approach to prevention of tuberculosis in Southeast Asian refugees.

Adolescent↗
PubMed1986

A survey of Campylobacter and other bacterial contaminants of pre-market chicken and retail poultry and meats, King County, Washington.

As part of a larger study to determine the flow of Campylobacter and Salmonella from food animals to humans during 1982-83, 1,936 swabs were collected for bacteriologic study from pre-market chickens, retail poultry, and other retail meats as well as from equipment and work surfaces used to process such foods. Of the 297 samples collected in a poultry processing plant, 56.6 per cent were positive for Campylobacter jejuni/coli (CJC), as were 23.1 per cent of the 862 retail chicken, and 17.2 per cent of the 29 retail game hen samples. CJC was found infrequently in retail turkey, pork, and beef samples. Contamination of retail and pre-market chicken with CJC appeared to increase as the week progressed, and in pre-market chicken, later in the day. Less than 5 per cent of the retail samples of poultry, beef, and pork were found to contain Yersinia or Salmonella. However, Salmonella was cultured from 14.8 per cent of the swabs taken from the processing plant with 68 per cent of 44 Salmonellas being isolated concurrently with CJC. Tetracycline resistance which was plasmid-mediated was the most common antibiotic resistance observed, and was carried by 23.8 per cent of all CJC isolates. Overall, 38.8 per cent of all CJC isolates were resistant to ampicillin, erythromycin, streptomycin, or tetracycline, either singly or in combination.

Animals↗
PubMed1986

The role of poultry and meats in the etiology of Campylobacter jejuni/coli enteritis.

To determine the role of meats as possible sources of infection leading to Campylobacter jejuni/coli (CJC) enteritis, 218 cases and 526 controls were selected from the King County Group Health Cooperative (GHC) population from April 1982 through September 1983. All subjects were interviewed regarding food consumption one week prior to case onset. Consumption of chicken and cornish game hen were both associated with more than a doubling of the risk of CJC enteritis: for chicken (relative risk = 2.4, 95% CI = 1.6-3.6), and for game hen, (RR = 3.3, 95% CI = 1.1-9.8). The consumption of raw or rare chicken was even more strongly associated (RR = 7.6, 95% CI = 2.1-27.6). Strains of CJC bearing R factors for tetracycline were equally as likely as tetracycline-susceptible strains to have been acquired from chicken and game hens. Processed turkey sandwich meats (RR = 1.7, 95% CI = 1.0-2.9) raw or rare fish (RR = 4.0, 95% CI = 1.1-14.5) and shellfish (RR = 1.5, 95% CI = 1.1-2.1) were the only other meats reported to have been eaten significantly (p less than .05) more often by cases than by controls. These data along with the results of bacteriologic sampling of meats from King County retail food markets during the same period suggest that ingestion of contaminated chicken is a primary source of CJC enteritis, contributing to approximately half of the cases.

Adolescent↗
PubMed1985

Community-wide surveillance of Campylobacter jejuni infection. Evaluation of a laboratory-based method.

Surveillance of infections due to Campylobacter jejuni is needed to further define the epidemiology of this disease in the U.S. We assessed one potential method of community-wide surveillance, a laboratory-based reporting network. Six microbiology laboratories that routinely culture fecal specimens for C. jejuni reported all isolates to Seattle-King County Health Department for an 18-month period. Further investigations on 476 cases reported from this broadly based network revealed that C. jejuni enteritis affected primarily children and young adults, occurred sporadically (with a summer-fall predominance), led to hospitalization in 13% of cases, was found negligibly in patients hospitalized or immunocompromised, and produced no fatalities. Comparative statistics showed that C. jejuni was reported more frequently than Salmonella and Shigella combined in individuals served by reporting laboratories. Because one participating laboratory was that of a 280,000-member health maintenance organization, it was possible to calculate age-specific incidence rates for bacterial enteric infections in that population. C. jejuni and Salmonella had high attack rates among 0-4 year-old children: 184 cases/100,000 enrollees per year and 126/100,000 per year, respectively. C. jejuni showed another peak at 20-29 years (108/100,000 per year) that was absent in salmonellosis. This study demonstrates that a laboratory-based reporting system is a feasible approach to community-wide C. jejuni surveillance.

Adolescent↗
PubMed1984

Vibrio parahaemolyticus gastroenteritis. An outbreak associated with raw oysters in the Pacific northwest.

During a 3-month period in the late summer and fall of 1981, six cases of gastroenteritis and one wound infection due to Vibrio parahaemolyticus were reported to public health agencies in Washington and Oregon. An investigation revealed that all of the gastroenteric illnesses were associated with eating raw oysters; that oysters eaten by five of the six patients were harvested at four divergent sites at Willapa Bay, Washington, a large commercial growing area; and that the V. parahaemolyticus isolates from those five patients were all Kanagawa positive, belonged to serotype 04:K12, and exhibited an atypical biochemical reaction, urea hydrolysis. No further cases linked to Willapa Bay oysters have been reported, and the infecting strain could not be found in sediment samples from the bay in February 1982. Thus, even though the origin of this self-limiting outbreak is obscure, the investigation demonstrated that the geographic distribution of V. parahaemolyticus infection in the United States includes the Pacific seacoast . Furthermore, oysters must be considered, along with crabs, shrimp, and lobster, as a vehicle of transmission of this infection in the United States.

Adult↗
PubMed1983

Campylobacter jejuni enteritis: efficacy of antimicrobial and antimotility drugs.

We analyzed retrospectively the illnesses of 82 patients with Campylobacter jejuni enteritis to ascertain the efficacy of antimicrobials and drugs that inhibit gastrointestinal motility. Forty-four patients were treated with only supportive measures consisting of diet modification and fluids; 22 others received an antimotility agent for at least 48 h; the remaining 16 were given an antimicrobial at or near the time of therapeutic intervention. The three groups were similar in terms of severity of symptoms and signs. There was a greater need for secondary antimicrobial therapy because of static or worsening illness in the group treated with antimotility agents (8/22, 36%) than in the others (4/44,9%; 2/16, 13%: p less than 0.02). Furthermore, six patients treated initially and 10 treated secondarily with erythromycin or tetracycline had illnesses of shorter duration than did untreated controls paired by age, sex, length and severity of symptoms and signs, hematochezia, and antimotility therapy (p less than 0.05). Thus treatment of C. jejuni enteritis with erythromycin or a tetracycline shortened the illness, but antimotility agents impeded the resolution of the infection.

Adolescent↗
PubMed1982

Persistent neuropsychological sequelae of toxic shock syndrome.

Twelve women, aged 16 to 29 years, were interviewed and examined for possible neuropsychological sequelae 2 to 12 months after they recovered from toxic shock syndrome. Six of the 12 women had symptoms such as difficulty concentrating, headache, recent memory lapses, inability to compute, and loss of other higher integrative functions. Eight patients were found to have electroencephalographic abnormalities. All six symptomatic patients but no asymptomatic patients had abnormal neurologic findings. Abnormalities such as impaired memory and calculation and poorly sustained concentration were found in five of six symptomatic patients but in no asymptomatic patient. Six control subjects, all asymptomatic women aged 17 to 29 years, were interviewed and examined 2 to 12 months after they recovered from postpartum endometritis; these subjects were normal in all parameters tested. A direct effect of the staphylococcal toxin on the central nervous system may be the cause of these sequelae.

Adolescent↗
PubMed1981

Vi serology in the detection of typhoid carriers.

A new haemagglutination assay for Vi antibodies was evaluated in searches for symptom-free carriers of Salmonella typhi associated with sporadic cases of typhoid fever. The assay differs from previous ones in that a purified (instead of crude) Vi antigen from Citrobacter was used to sensitise the red blood cells. In ten sporadic outbreaks of typhoid stool culture identified seven enteric carriers of S. typhi among the patients' families or other close contacts. All seven carriers had Vi antibodies in titres ranging from 1:40 to 1:2560. Moreover, among thirty-seven stool-culture-negative contacts of patients, only one had Vi antibodies, in a titre of 1:10. Thus, the new assay for Vi antibodies was as sensitive and as specific as faecal culture in detecting symptom-free typhoid carriers. It could become a convenient screening test.

Adolescent↗
PubMed1981

Cefotaxime treatment of pelvic inflammatory disease.

We studied cefotaxime in the treatment of gonococcal and nongonococcal pelvic inflammatory disease. Cefotaxime was uniformly effective against gonococcal pelvic inflammatory disease. However, 4 of 11 patients with nongonococcal pelvic inflammatory disease had a suboptimal response.

Bacteria↗
PubMed1981

Purified Clostridium difficile cytotoxin stimulates guanylate cyclase activity and inhibits adenylate cyclase activity.

Antibiotic-associated pseudomembranous colitis has been linked with Clostridium difficile toxin. We examined the effect of toxins from four strains of C. difficile isolated from patients with pseudomembranous colitis on colonic adenylate (EC 4.6.1.1) and guanylate cyclase (EC 4.6.1.2) activities. Partially purified toxins had a cytotoxic effect on hamster fibroblasts in culture at a concentration of 10 ng/ml. Likewise, these toxins enhanced colonic guanylate cyclase activity two- to threefold, with the maximal stimulation being at 10 ng/ml. These toxins also enhanced guanylate cyclase activity in ileum, cecum, and duodenum. Both the cytotoxic activity on hamster fibroblasts and the enhancement of hamster guanylate cyclase activity were inhibited by antiserum to C. difficile toxin. These same toxins inhibited adenylate cyclase activity at a 100-ng/ml concentration, but had no effect at 10 ng/ml. They also had no effect at any concentration on colonic Na+-K+ adenosine triphosphatase. To be sure that the findings were not due to a contaminant, a purified C. difficile cytotoxin was used, and the same findings were found with the pure cytotoxin (at a 100-fold-lower concentration). The data suggest that activation of guanylate cyclase may be a factor in the pathogenesis of antimicrobial-associated pseudomembranous colitis.

Adenylyl Cyclase Inhibitors↗
PubMed1981

Infective endocarditis and mitral prolapse: a comparison with other types of endocarditis.

We compared clinical features, response to therapy, and outcome of infective endocarditis in ten patients with mitral valve prolapse and 23 patients with endocarditis involving other types of left-sided valvular lesions. Signs of endocarditis were more subtle in patients with mitral valve prolapse, and antimicrobial therapy was instituted later in those patients. Nevertheless, nine of ten patients with mitral valve prolapse and endocarditis responded optimally to antimicrobials; only five of 23 patients with other types of endocarditis responded similarly. Four patients with mitral valve prolapse experienced increasing valvular dysfunction during the year after treatment of endocarditis; one died. We conclude that endocarditis in patients with mitral valve prolapse is more responsive to antimicrobial therapy even though recognition of the infection often is delayed. However, mitral valve prolapse endocarditis is not a benign infection, because progressive valvular dysfunction is a frequent sequel.

Adolescent↗
PubMed1980

A study of cephalothin and desacetylcephalothin in cerebrospinal fluid in therapy for experimental pneumococcal meningitis.

One explanation for the failure of cephalothin to cure patients with bacterial meningitis is that desacetylcephalothin, as in vivo metabolite that has less antibacterial activity than the parent drug, penetrates more efficiently into cerebrospinal fluid (CSF); In experimental pneumococcal meningitis in rabbits, the peak levels of cephalothin and desacetylcephalothin in CSF after an intramuscular injection of 250 mg of cephalothin/kg were, respectively, 1.43 +/- 4.9 microgram/ml (2.8% of peak serum level) and 1.69 +/- 0.57 microgram/ml (2.2% of peak serum level). The observed half-life of desacetylcephalothin in CSF (3.32/hr) was longer (P less than 0.01) than that of cephalothin (0.72/hr). Choroid plexuses isolated from the lateral cerebral ventricles of rabbits with meningitis took up cephalothin in vitro more avidly than desacetylcephalothin (P less than 0.05), and metabolism of cephalothin to desacetylcephalothin by isolated choroid plexuses was demonstrated directly. Thus, intrathecal metabolism of cephalothin by the choroid plexus may contribute to the unsatisfactory performance of cephalothin in bacterial meningitis.

Animals↗
PubMed1980

Vancomycin penetration into CSF during treatment of patients receiving hemodialysis.

Penetration of vancomycin into CSF was determined during therapy with the regimens recently used to treat staphylococcal infections in patients receiving hemodialysis: 1 gm weekly or 750 mg twice weekly. During three episodes in two patients with proved or suspected central nervous system infection, CSF levels of vancomycin ranged from < 0.5 to 1.54 microgram/ml; in only two of six CSF specimens did the antibiotic level exceed its in vitro inhibitory concentration for the infecting organism. Thus, the vancomycin hemodialysis regimens may provide marginal to subtherapeutic CSF drug levels.

Adult↗
PubMed1980

Identification of Salmonella typhi in faecal specimens by an antiserum-agar method.

An antiserum-agar technique was evaluated as a method for detecting Salmonella typhi in faeces. Thirty-one laboratory strains of S. typhi produced immunoprecipitate haloes during overnight growth on SS agar and blood-agar-base infusion agar (BAB) containing donkey antiserum to a vaccine strain of S. typhi. Other salmonella species sharing O serogroup antigens with S. typhi also produced haloes when streaked in pure culture on SS-antiserum agar but not on BAB-antiserum agar. One hundred and forty-one consecutive faecal specimens were cultured on SS-antiserum agar. Results with this method were concordant with those of established isolation techniques on specimens from six of seven suspected carriers of S. typhi. Ten other salmonellas were isolated from the faecal specimens but only S. javiana, like S. typhi a serogroup-D organism, yielded false-positive haloes on antiserum agar. The antiserum-agar technique offers promise as a means of screening for S. typhi in faecal cultures.

Agar↗
PubMed1980

Enzyme immunoassay of the capsular polysaccharide of Streptococcus pneumoniae type III in cerebrospinal fluid in experimental meningitis.

An enzyme immunoassay (EIA) for the capsular polysaccharide of Streptococcus pneumoniae type III was developed and applied to the measurement of this antigen in cerebrospinal fluid (CSF) in an experimental model of pneumococcal meningitis. EIA was performed by a single-antibody sandwich technique in which the globulin fraction of pneumococcal type-specific antiserum (antiserum-globulin) was used to coat the solid phase before antigen attachment and to conjugate with the labelling enzyme, horseradish peroxidase. Under optimum assay conditions EIA detected purified pneumococcal type-III capsular polysaccharide in concentrations as low as 0.15 ng/ml in aqueous buffer. Assayed by EIA, the mean concentration of type-III capsular polysaccharide in CSF of rabbits with pneumococcal meningitis increased exponentially from 24 h to 96nh of infection (range 13.9 ng/ml--62 500 ng/ml). Effective antimicrobial therapy of rabbits with meningitis was associated with a rapid decrease in the CSF concentration of the capsular antigen, although it was still detected in concentration in the range 1--10 ng/ml in 100% of animals treated for 4 days. Thus EIA provides a quantitative and extremely sensitive method of measuring type-III pneumococcal capsular polysaccharide in CSF.

Animals↗
PubMed1980

Evaluation of a new assay for Vi antibody in chronic carriers of Salmonella typhi.

The assay for serum antibody to the Salmonella typhi capsular polysaccharide (Vi) antigen has recently been revised because of the availability of a purified, highly polymerized Vi antigen. We compared this revised Vi antibody assay to the traditional one for potential usefulness in the surveillance of chronic enteric carriers of S. typhi. The purified Vi antigen of Citrobacter freundii was incorporated into a passive hemagglutination assay for serum Vi antibody; the standard Vi antibody assay was also a hemagglutination assay that employed as the Vi antigen a crude extract of Citrobacter (Ballerup O group 29). As determined by the revised assay, Vi antibody was found in the sera of 22 (71%) of 31 current typhoid carriers, none of 6 resolved carriers, and none of 22 control subjects. According to the traditional assay, Vi antibody was present in 23 of those current carriers (74%), 1 of the resolved carriers (17%), and 4 of the control subjects (18%). The rate of false-positive Vi antibody tests among resolved carriers and control subjects was less with the revised assay (P < 0.05). Successful antimicrobial therapy resulted in a reversion to seronegativity within 1 year in 8 of 10 Vipositive carriers according to the revised assay, but in only 3 of 11 according to the standard assay (P < 0.05). During a 2-year period of observation, 15 (94%) of 16 current typhoid carriers had at least one positive purified Vi antibody test; among 12 of those patients with Vi titers of 1:40 or greater, 9 (75%) were continuously Vi positive. Thus, the revised Vi antibody assay is more specific and no less sensitive than the standard assay for the condition of current enteric carriage of S. typhi. This serological test could be of value in the surveillance of typhoid carriers by public health agencies.

Aged↗