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Biomedical subjects

E R Alexander

Publications and source records attributed to E R Alexander.

123 records · Page 7Linked to original sources
PubMedDate not supplied

Where's the beef? The role of cross-contamination in 4 chain restaurant-associated outbreaks of Escherichia coli O157:H7 in the Pacific Northwest.

BACKGROUND: From March through August 1993, outbreaks of Escherichia coli O157:H7 occurred at 4 separate Oregon and Washington steak and salad bar restaurants affiliated with a single national chain. OBJECTIVE: To determine the cause of outbreaks of E coli O157:H7 at 4 chain restaurants. METHODS: Independent case-control studies were performed for each outbreak. Available E coli O157:H7 isolates were subtyped by pulse-field gel electrophoresis and by phage typing. RESULTS: Infection was not associated with beef consumption at any of the restaurants. Implicated foods varied by restaurant but all were items served at the salad bar. Among the salad bar items, no single item was implicated in all outbreaks, and no single item seemed to explain most of the cases at any individual restaurant. Molecular subtyping of bacterial isolates indicated that the first 2 outbreaks, which occurred concurrently, were caused by the same strain, the third outbreak was caused by a unique strain, and the fourth was multiclonal. CONCLUSIONS: Independent events of cross-contamination from beef within the restaurant kitchens, where meats and multiple salad bar items were prepared, were the likely cause of these outbreaks. Meat can be a source of E coli O157:H7 infection even if it is later cooked properly, underscoring the need for meticulous food handling at all stages of preparation.

Adolescent↗
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Role of Chlamydia trachomatis in perinatal infection.

The transmission of Chlamydia trachomatis from the infected cervix of a mother to the eye of an infant, with resultant inclusion conjunctivitis, was documented in humans and in primates 75 years ago by cytologic methods. With modern microbiologic methodology it is possible to quantitate this transmission. It is now known that 2%-24% (usually 7%-12%) of cervices are infected before delivery and that 18%-50% (usually 20%-25%) of infants born to culture-positive mothers develop conjunctivitis. In addition, nasopharyngeal infection occurs in 15%-20% of infants, and 3%-18% develop pneumonia due to C. trachomatis. Bronchiolitis and otitis media are less common infections. The consequence of rectal and vaginal colonization remains unknown, as does the significance of the increase in antibody titers against C. trachomatis throughout early childhood. Early studies suggesting that C. trachomatis was a prominent cause of postpartum endometritis and a cause of premature delivery have not been confirmed in larger prospective studies when mycoplasma species were simultaneously studied. A subset of mothers with active infection, as evidenced by IgM antibody against C. trachomatis, may have earlier delivery, but it is clear that evaluation of the contribution of C. trachomatis to maternal and fetal risk will require larger studies with evaluation of possible concurrent mycoplasmal infection.

Chlamydia Infections↗
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Are rectogenital chlamydial infections a marker of sexual abuse in children?

In order to examine the occurrence of chlamydial infection in sexually abused children, we cultured 51 abused children and 43 controls, 2 to 14.5 years of age. Only seven of the children were male. Chlamydia trachomatis was isolated from the vagina or rectum of two abused girls, 10 and 12 years of age, at their follow-up examination several weeks after the suspected abuse. C. trachomatis was also isolated from the vaginal culture of two controls and from the throat and rectum of another girl enrolled as a control. The two control children with vaginal infection were sisters, 7 and 10 years of age, who had been abused by their step-father 3 years previously. An antichlamydial immunoglobulin greater than or equal to 1:32 or a fourfold rise in the titer of immunoglobulin G was found in 13 of 49 (27%) abused children and 2 of 40 (5%) controls. This difference was statistically significant. The isolation of C. trachomatis from a rectogenital site was not limited to children with recent sexual abuse in this population. Serology may also be of limited use since serologic evidence of recent chlamydial infection was present in 5% of controls.

Adolescent↗
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Chlamydial pharyngitis?

Among 118 women who were sexual contacts of men with nongonococcal urethritis, the practice of fellatio correlated with symptoms of a sore throat. Oropharyngeal cultures for Chlamydia trachomatis were negative in all women, including 11 women who practiced fellatio and whose partners were known to have nongonococcal urethritis due to C. trachomatis. The study does not support a major role for C. trachomatis as a cause of sore throat in women who practice fellatio.

Chlamydia Infections↗
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Etiologies of postgonococcal urethritis in homosexual and heterosexual men: roles of Chlamydia trachomatis and Ureaplasma urealyticum.

Before treatment for urethral gonorrhea, Chlamydia trachomatis was isolated from 18% and Ureaplasma urealyticum from 37% of 121 men. C. trachomatis was recovered from none of 18 homosexual men who had gonorrhea and from 22 of 95 heterosexual men who had gonorrhea (P less than 0.05). After treatment with a penicillin, postgonococcal urethritis occurred significantly more often in heterosexual than in homosexual men (P less than 0.002). Postgonococcal urethritis developed in all men from whom C. trachomatis was isolated. Among men without U. urealyticum infection, postgonococcal urethritis was significantly associated with C. trachomatis infection (P less than 0.02). Among men without C. trachomatis infection, postgonococcal urethritis was less closely associated with U. urealyticum infection (0.1 greater than P greater than 0.05). Postgonococcal urethritis was least frequent among men who had neither C. trachomatis nor U. urealyticum infection.

Chlamydia Infections↗
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Eradication of Chlamydia trachomatis from the urethras of men with nongonococcal urethritis by treatment with amoxicillin.

Twenty men with nongonococcal urethritis were treated orally with amoxicillin (750 mg three times daily for 10 days). One man had herpes simplex virus infection of the urethra. Chlamydia trachomatis was isolated from the urethras of six (32) of the remaining men. Urethral specimens cultured for C. trachomatis became negative during amoxicillin therapy for all six men and remained negative for all five men who were followed for 24-48 days. Amoxicillin did not eradicate Ureaplasma urealyticum from any of 13 colonized men. Nongonococcal urethritis persisted or recurred at greater than or equal to 14 days after initiation of treatment in one of five men with, and ten of twelve men without initial C. trachomatis infection (P = 0.06). Since multiple-dose penicillin regimens are used for the treatment of acute pelvic inflammatory disease and epididymitis, which are frequently caused by C trachomatis, the apparent efficacy of high-dose amoxicillin therapy for chlamydial urethritis in this study is of interest. However, until the results of further study of the efficacy of multiple-dose penicillin regimens for infections due to C. trachomatis are known, tetracyclines remain the treatment of choice for the majority of such complications.

Amoxicillin↗
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The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population.

The epidemiology of cervical infection with Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum among a group of pregnant American Indian women was investigated. The prevalences of these microorganisms were 24-30% for C. trachomatis, 50% for M. hominis, and 80% for U. urealyticum. These rates are unusually high for an unselected sample. Infection with C. trachomatis was correlated with younger age but not with primigravidity or educational level. Neither M. hominis nor U. urealyticum infection was correlated with younger age, primigravidity, or level of education. The possible consequences of the increased prevalences of C. trachomatis, M. hominis, and U. urealyticum in this group of American Indians are of concern and are being investigated.

Chlamydia Infections↗
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Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: evidence of core-group transmitters and the impact of illicit antibiotics.

In 1985, 2,455 cases of infection due to penicillinase-producing Neisseria gonorrhoeae were reported from Dade County, Florida. These cases represent the largest concentration of PPNG infections reported to date in the United States. A zip code-based geographic analysis of morbidity caused by gonorrhea and PPNG identified a core area where the percentage of all gonorrhea cases due to PPNG was 31-36%. This percentage decreased in a radial pattern outward from the central core. A prospective study of patients presenting to the Dade County central clinic with gonorrhea found that men infected with PPNG were more likely to have medicated themselves with illicit antibiotics than were patients infected with penicillin-sensitive N. gonorrhoeae (odds ratio, 3.6; 95% confidence interval, 1.9-6.8). Of all self-medicated patients, 42% obtained antibiotics via illicit over-the-counter purchase at pharmacies in the hyperendemic area. In contrast to previous reports, PPNG infection was not associated with either narcotic- or prostitution-related activities. The results show that PPNG is endemic in Dade County and is arrayed in a core distribution. Antibiotic abuse may have played an important role in the Miami epidemic and in the establishment of PPNG as an endemic strain.

Adolescent↗
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National surveillance for neonatal herpes simplex virus infections.

To explore the magnitude and descriptive epidemiology of neonatal herpes simplex virus (HSV) infection, the Centers for Disease Control (CDC) conducted an 18-month hospital-based surveillance study in which 184 cases were reported. Only 22% of mothers had a history of genital HSV infection and only 9% had genital lesions at the time of delivery. Cesarean delivery initiated prior to membrane rupture failed to prevent infection in 15 cases. These data confirm previous observations that most mothers of infected neonates have no history of genital HSV and are asymptomatic at delivery. Furthermore this study suggests that intrauterine infection may be an important route of transmission and underscores the limitations of current prevention strategy.

Adolescent↗
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The impact of sexually transmitted diseases on minority populations.

Sexually transmitted diseases (STD) are more prevalent among some minority populations in the United States than they are among the white majority. Primary and secondary syphilis occurs 45 times as often among non-Hispanic blacks as among non-Hispanic whites and 13 times as often among Hispanics as among non-Hispanic whites, according to morbidity reports received in 1988 by the Centers for Disease Control. Gonorrhea is reported more commonly among some minorities, with 1988 rates per 100,000 population being 54 for whites, 1,801 for blacks, and 201 for Hispanics. The reasons for the higher incidence of STD among some minorities are unknown. Data on racial differences in behavior and disease susceptibility are meager and do not account for the observed differences. Poverty, which is more common among some minorities than among the white majority, is closely associated with the prevalence of STD and may be a link between membership in a minority population and an increased risk.

Acquired Immunodeficiency Syndrome↗
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Ophthalmia neonatorum associated with maternal chlamydial infections.

An unselected sample of 142 pregnant women had a single cervical culture for C trachomatis at 36 to 40 weeks' gestation. Of these women, 18 (12.7%) had positive cultures, and their infants were followed in postoperative fashion. Of these 18 infants, eight (44%) developed ophthalmia neonatorum. A combination of cultures and conjunctival smears for Giemsa staining and fluorescent-antibody examination for infected cells confirmed the diagnosis in 70% of the infants with conjunctivitis. However, 12 of 18 infants has serum antibodies against genital strain chlamydial antigens at 1 year of age, indicating that a majority of the infants were infected. Four of the infants had superior micropannus at 1 year of age; however, none of the infants had active conjunctivitis nor corneal or conjunctival scars.

Antibodies↗