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Biomedical subjects

D W Fraser

Publications and source records attributed to D W Fraser.

At least 91 records · Page 5Linked to original sources
PubMed1979

Disseminated actinomycosis with spinal cord compression: report of two cases.

We studied two patients with vertebral actinomycosis and symptoms of spinal cord compression. Both patients had a chronic illness characterized by multiple draining skin lesions, weight loss, and progressive leg weakness. They responded to antibiotic therapy and corticosteroids without neurosurgical intervention. The patients were treated with antibiotics for 12 months, and remained well, without major neurologic disorder, for 2 years after stopping medication.

Actinomyces↗
PubMed1979

Legionnaires' disease: clinical features of the epidemic in Philadelphia.

A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems. Early in the illness, constitutional symptoms predominated. Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea. Physical examination showed few abnormalities other than rales. Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic. Chest radiograph showed patchy, often nodular, areas of consolidation. Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons. Twenty-six patients died. Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant.

Acute Kidney Injury↗
PubMed1979

Nosocomial Legionnaires' disease in Columbus, Ohio.

Three patients with severe pneumonia at a community hospital in Columbus, Ohio, were found to have Legionnaires' disease in late August 1977. A subsequent serologic survey of patients with pneumonia at this hospital identified three additional cases. Among patients with pneumonia, hospital exposure in the 2 weeks before onset of illness was significantly associated with Legionnaires' disease (P = 0.003). Serosurveys of hospital employees with a recent history of upper respiratory illness, healthy employees, and workers at the hospital construction site showed that one of 101, one of 107, and none of 114, respectively, has a single reciprocal titer of greater than or equal to 256 to the Legionnaires' disease (LD) bacterium. Serosurveys of patients with pneumonia at three control hospitals identified five additional patients with Legionnaires' disease, three of them with pneumonia that was apparently hospital acquired in a single renal transplant unit. A fourth patient from that unit without clinical illness had a fourfold rise in titer to LD bacterium.

Adult↗
PubMed1979

The Vermont epidemic of Legionnaires' disease.

Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.

Adolescent↗
PubMed1979

A major focus of Legionnaires' disease in Bloomington, Indiana.

Thirty-nine cases of Legionnaires' disease in a 16-month period were identified in visitors to and residents of Bloomington, Indiana. Thirty-five patients had spent at least one night at the Indiana Memorial Union in the 2 weeks before becoming ill. Five of 32 sporadic cases nationwide between 1 January and 31 March 1978 were retrospectively shown to be in persons who had recently visited the Union. The risk of acquiring Legionnaires' disease as a Union visitor was at least 17 times greater than that for Bloomington residents 20 years or older. Employees who had worked at the Union 5 years or longer were more likely to be seropositive than workers in other Bloomington hotels. Legionnaires' disease bacterium was isolated from five environmental sites in Bloomington. A cooling tower may have been involved in disease spread, but it was not the only source. Hypochlorite solution was added to cooling tower water as a precautionary measure; however, one case was confirmed in a man with Union exposure 9 days after hypochlorite treatment had begun.

Adult↗
PubMed1979

Sporadic community-acquired Legionnaires' disease in the United States. A case-control study.

One hundred patients with sporadic, community-acquired, serologically confirmed Legionnaires' disease were matched with control subjects known by the patients (acquaintance controls) and control subjects chosen from among patients with negative serodiagnostic tests for Legionnaires' disease (clinical controls). Each clinical control subject was also matched with an acquaintance control of his own. Legionnaires' disease patients had smoked more cigarettes, consumed more alcohol, and were more likely to have resided near excavation sites than acquaintance or clinical control subjects. Parallel differences between clinical controls and their acquaintances were not seen. Legionnaires' disease patients had traveled away from home for more time during the 2 weeks before onset of illness than had their acquaintances. The difference was of greater magnitude than that between clinical control subjects and their acquaintances. Legionnaires' disease patients were more likely to have resided near construction sites than clinical controls, and there were more construction workers among patients than among clinical control subjects.

Adult↗
PubMed1978

1974 outbreak of Legionnaires' Disease diagnosed in 1977. Clinical and epidemiological features.

An illness characterized by high fever and pneumonia struck 2.9% of a group of the Independent Order of Odd Fellows attending a convention held in Philadelphia, in September, 1974. The convention headquarters was the hotel where the American Legion met in July, 1976. The epidemiological, clinical, and laboratory characteristics of the illness were nearly identical to those of the disease in American legionnaires in 1976. Illness was significantly associated with attendance at one convention activity held on Monday morning, Sept. 16, 1974, in the grand ballroom of the hotel. A serological survey in February and March, 1977, showed that people who had attended the convention and became ill were more likely to have raised indirect fluorescent antibody titres than persons who had attended and remained well. The illness seen in Odd Fellows members in September, 1974, was caused by the legionnaire's disease organism.

Aged↗
PubMed1978

Disease control programs in the United States. Control of streptococcal and poststreptococcal disease.

Programs administered by health departments and heart associations for control of streptococcal and poststreptococcal disease differ greatly from state to state. The year 1974 was used as a representative year when studying the variety of state policies and programs regarding surveillance of streptococcal disease, primary and secondary prevention of rheumatic fever, and prevention of poststreptococcal glomerulonephritis. A uniform national policy for streptococcal control is desirable but should be based on evidence not now available concerning the impact of various elements of control programs on morbidity and mortality.

Carrier State↗
PubMed1978

Antibiotic treatment of guinea-pigs infected with agent of Legionnaires' disease.

Erythromycin and rifampicin (rifampin) were able to prevent death of guineapigs given intraperitoneal injections of the agent causing legionnaires' disease. Penicillin, chloramphenicol, tetracycline, and gentamicin showed no significant effect. On the basis of clinical experience and experimental observations, erythromycin is recommended for patients suspected to have legionnaires' disease. Combined therapy with erythromycin and rifampicin may be justified in patients with confirmed legionnaires' disease who are not responding to erythromycin alone or as part of a controlled antibiotic trial among suspected cases during an outbreak of legionnaires' disease.

Administration, Oral↗
PubMed1978

Hemophilus influenzae type b disease in a day-care center. Report of an outbreak.

Four episodes of serious Hemophilus influenzae type b infection occurred in three children attending a day-care center. This was 100 times the expected annual total. The pharyngeal carriage rate of Hib was 60% for siblings of patients, 20% for adult household contacts, and 5% for well children at the center. No carriers were found in control populations. Escherichia coli K100, which cross-reacts serologically with Hib, was found in rectal swabs of 20% of family contacts of patients and 3.5% of well children at the center. It was recovered from two of seven persons who carried Hib in the pharynx and two of 75 who did not (P = 0.035), suggesting that carriage of one organism may facilitate carriage of the other. In a randomized prospective trial with 85 patient contact, Hib carriage was eradicated in all of four carriers given ampicillin and in all of three given rifampin. There were no statistically significant differences in the rate of adverse reactions in the two treatment groups. No further cases were reported.

Ampicillin↗
PubMed1978

Listeria monocytogenes infection in neonates: Investigation of an epidemic.

From March 10 through October 29, 1975, Listeria monocytogenes infection occurred in seven neonates born at a 401-bed general hospital in Greenville, S.C. In the preceding 19 months, there had been only one case. Six of the seven isolates from the infected infants were of serotype JB. Risk of listeriosis in neonates was associated with being born to mothers of low socioeconomic status and being born to mothers who had had vaginitis during pregnancy. Nosocomial transmission of L. monocytogenes appeared unlikely, but the source of the infection is unknown. Of the media used in this study for isolation of L. monocytogenes from mixed cultures, McBride's agar and McBride's agar with nalidixic acid were most useful.

Cross Infection↗
PubMed1978

An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium.

In January 1977 an unsolved outbreak of infection at St. Elizabeth's Hospital (Washington, D.C.) that occurred in 1965 was linked with Legionnaires' disease. The link was made by fluorescent antibody testing with the bacterium isolated from tissues of persons with Legionnaires' disease in the 1976 outbreak in Philadelphia. In July and August 1965, an epidemic of severe respiratory disease characterized by abrupt onset of high fever, weakness, malaise, and nonproductive cough, frequently accompanied by radiographic evidence of pneumonia, affected at least 81 patients at St. Elizabeth's Hospital, a general psychiatric hospital. Fourteen (17%) of the affected patients died. Intensive epidemiologic and laboratory investigations in 1965 did not determine the etiology. The etiologic organism may have become airborne from sites of soil excavation.

Air Microbiology↗
PubMed1978

Delayed hypersensitivity reactions in patients with Mycobacterium chelonei and Mycobacterium fortuitum infections.

Delayed hypersensitivity reactions to skin test antigens prepared from rapidly growing mycobacteria were measured in patients with postoperative wound infections due to Mycobacterium chelonei and M. fortuitum. Sixteen of 19 patients with M. chelonei infection had more than 10 mm of induration to the M. chelonei purified protein derivative antigen (PPD-CG) and were significantly more likely to react to PPD-CG than patients or hospital personnel who had no evidence of infection. All but one patient had more induration with PPD-CG than with the antigen prepared from M. fortuitum (PPD-F). Three of 4 patients with M. fortuitum infection had greater than or equal to 9mm of induration with PPD-F and were significantly more likely than noninfected patients to react to PPD-F. Three of the 4 patients also had at least as much induration with PPD-F as with PPD-CG. In an outbreak of infections due to M. chelonei, testing with PPD-CG may be useful epidemiologically. Although the data are less clearly defined for PPD-F, testing with this antigen may be of value in an outbreak caused by M. fortuitum.

Adult↗