The Hawaii pneumococcal disease initiative.
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Aged↗
Biomedical subjects
J S Spika
Publications and source records attributed to J S Spika.
Antimicrobial resistance of pneumococci in children with acute lower respiratory tract infection in Pakistan.
87 strains of Streptococcus pneumoniae isolated during three winter seasons (1986-89) from the blood of children with acute lower respiratory tract infection (ALRI) in Pakistan were serotyped and tested for susceptibility to a range of antimicrobial agents. 97% of isolates were resistant to at least one antimicrobial drug. 62% had decreased susceptibility to co-trimoxazole (trimethoprim/sulphamethoxazole) (31% were fully resistant) and 39% were resistant to chloramphenicol. All isolates were susceptible to erythromycin, cefaclor, cephalothin, ceftriaxone, cefuroxime, rifampicin, vancomycin, and clindamycin. 29% of isolates were neither vaccine types nor vaccine-related types. Serotype distribution and antimicrobial susceptibility varied significantly during the three winter seasons. No single serotype was found in all three winters. The findings highlight the need for surveillance of antimicrobial resistance and serotype distribution of S pneumoniae in developing countries as a guide both to the choice of agent for treatment of pneumococcal infections, especially ALRI, and to the formulation of new pneumococcal conjugate vaccines for use in young children.
Child, Preschool↗
Nosocomial Legionnaires' disease and use of medication nebulizers.
Guidelines for the prevention of nosocomial pneumonia specify that only sterile fluids should be used for aerosol therapy; however, this recommendation may not be uniformly followed. Thirteen patients with nosocomial pneumonia due to Legionella pneumophila serogroup 3 (Lp3) were identified at a community hospital in the period from 1984 through 1988; 12 patients (92%) had chronic obstructive pulmonary disease; and 9 patients (69%) died. An epidemiologic investigation suggested that the use of nebulizers to deliver medication was associated with acquiring legionnaires' disease. The hospital potable water system was contaminated with Lp3, and a survey indicated that tap water was commonly used to wash medication nebulizers. Lp3 in respirable-size droplets was isolated from aerosols generated by a nebulizer containing Lp3 at one-tenth the concentration found in the hospital potable water. These findings support the recommendation that only sterile fluids be used for filling or cleaning respiratory care equipment and suggest that this guideline is not universally followed.
Administration, Inhalation↗
Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group.
The increasing number of Streptococcus pneumoniae isolates identified as relatively or fully resistant to penicillin or fully resistant to other antimicrobials in the United States supports the need to monitor for this resistance. Thus, 5459 S. pneumoniae isolates submitted to the Centers for Disease Control in 1979-1987 by 35 hospitals in a hospital-based pneumococcal surveillance system were evaluated. The MIC to penicillin or ampicillin was greater than or equal to 0.1 micrograms/ml for 274 (5%) isolates; 1 had an MIC of 4.0 micrograms/ml to penicillin. Seventeen (0.3%) were resistant to erythromycin (MIC, greater than or equal to 8 micrograms/ml), 157 (2.9%) were resistant to tetracycline (MIC, greater than or equal to 16 micrograms/ml), and 34 (0.6%) were resistant to sulfamethoxazole/trimethoprim (MIC, greater than or equal to 76 and 4 micrograms/ml). Isolates relatively resistant to penicillin represented 1.8% of isolates in 1979, 8% in 1982, and 3.6% in 1987. Sixty-five multiply resistant isolates were identified. Pneumococci from the southwestern United States (region 4) were more likely to be relatively resistant to penicillin. Using logistic regression analysis, serotypes 14 and 19A, isolates from region 4, and isolates from middle ear fluid were associated with penicillin resistance (P less than or equal to .008, chi 2. These data confirm that antimicrobial resistance among pneumococcal isolates remained at low levels in the United States through 1987.
Age Factors↗
Culture-confirmed pneumonia due to Chlamydia pneumoniae.
Diagnosis of infection caused by Chlamydia pneumoniae, a newly recognized respiratory pathogen, has proved difficult. Between July 1987 and April 1988, culture and serologic tests for C. pneumoniae were done on specimens from 49 patients with pneumonia seen at an Atlanta hospital emergency room. Cultures from 3 patients (6%) grew C. pneumoniae. Genus-specific Chlamydia complement fixation titers and microimmunofluorescence titers for C. pneumoniae were suggestive of acute infection in all 3 culture-positive patients. Three other patients had evidence of acute disease by published criteria for antibody titers. Most studies of C. pneumonia have not had culture-proven cases; the 6% rate of positive cultures in this study support the role of C. pneumoniae as a cause of pneumonia. More widespread availability of simplified culture systems for C. pneumoniae is needed. Caution should be used when interpreting serologic tests in the absence of culture confirmation.
Adolescent↗
An outbreak of surgical-wound infections due to group A streptococcus carried on the scalp.
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Adolescent↗
Outbreak of Mycobacterium chelonae infection associated with use of jet injectors.
Between January 1 and May 15, 1988, foot infections due to Mycobacterium chelonae subspecies abscessus were diagnosed in eight persons who had undergone invasive procedures at a podiatry office. A cohort study was performed to evaluate risk factors for disease. Persons who underwent procedures before 10:30 AM were more likely to have developed infection than those with procedures after that time (relative risk, 5.6). In addition, procedures involving any of the second through fourth toes were more likely to have resulted in infection than procedures involving only the first and/or fifth toes (relative risk, 4.4). Persons with 0, 1, or 2 risk factors had attack rates of 5%, 14%, and 60%, respectively. Mycobacterium chelonae subspecies abscessus organisms of the same antimicrobial resistance pattern as the patients' strains were cultured from distilled water in a reusable, nonsterilized container. A jet injector used to administer lidocaine was held between procedures in a mixture of the distilled water and a disinfectant as recommended by the manufacturer. Inoculation of patients with mycobacteria by the jet injector may have only occurred early in the day due to slow killing of the bacteria by the disinfectant. The outbreak emphasizes the pathogenicity of this water-associated organism and the need for high-level disinfection of jet injectors.
Abscess↗
Association of shower use with Legionnaires' disease. Possible role of amoebae.
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Adult↗
Vancomycin-resistant Pediococcus acidilactici: nine cases of bacteremia.
Pediococci, vancomycin-resistant gram-positive cocci, have been isolated from human specimens, but an association with clinical illness has not been established. Clinical and epidemiologic data were obtained on nine patients who had Pediococcus acidilactici isolated from blood. Patients were eight elderly adults with complicated medical problems and one infant with congenital jejunoileal atresia. Seven patients were hospitalized before P. acidilactici was isolated. Eight had received multiple antibiotics; however, only two had received vancomycin. In all cases there was a delay in correct bacterial identification, and the significance of the isolate was uncertain. There was no clearly identified syndrome associated with P. acidilactici bacteremia. All eight adults had fever and six had pneumonia potentially attributable to other causes. The findings underscore the importance of proper identification of vancomycin-resistant gram-positive cocci. P. acidilactici may be an opportunistic pathogen in severely compromised hosts; however, further observations are necessary to clarify its role in human disease.
Aged↗
Role of air sampling in investigation of an outbreak of legionnaires' disease associated with exposure to aerosols from an evaporative condenser.
Epidemiologic studies have suggested that legionnaires' disease can be transmitted to susceptible hosts by contaminated aerosolized water from cooling towers and evaporative condensers; however, epidemic strains of Legionella have not been isolated by air sampling at such sites during epidemiologic investigations. An outbreak of legionnaires' disease occurred at a retirement hotel; Legionella pneumophila serogroup 1 was isolated from an evaporative condenser and from potable water. A case-control study showed that the only significant exposure risk was in area A. L. pneumophila serogroup 1 was isolated during air sampling near the evaporative condenser exhaust site, the air conditioning intake vent, and an air vent in area A, but not in shower stalls. Monoclonal antibody subtype patterns of L. pneumophila serogroup 1 isolates from patients matched those from the evaporative condenser but not from shower water. Air sampling and monoclonal antibody subtyping results support epidemiologic evidence that the evaporative condenser was the source of this outbreak.
Aerosols↗
The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents.
Human immunodeficiency virus (HIV) is an important risk factor for invasive pneumococcal disease, but information on clinical course and infecting serotypes is limited. To help develop strategies to reduce the morbidity due to invasive pneumococcal disease, episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records (November 1983-November 1987) at 10 San Francisco hospitals and, for patients 20-55 years old living in San Francisco, HIV antibody status was determined by review of medical records. Pneumococcal isolates from one hospital were serotyped. Of 294 patients with pneumococcal bacteremia identified, 32 (11%) had AIDS at the time pneumococcal bacteremia was diagnosed and another 43 (15%) were HIV-infected but did not have AIDS; 12 HIV-infected patients developed AIDS after the episode of pneumococcal bacteremia. The rate of pneumococcal bacteremia in AIDS patients was estimated to be 9.4/1000 patient-years. Serotypes of 27 (82%) of 33 pneumococcal isolates from HIV-infected patients and 107 (90%) from 119 patients without known HIV infection were among the 23 serotypes included in the currently available polysaccharide vaccine. The rate of pneumococcal bacteremia is approximately 100-fold greater in AIDS patients in San Francisco than rates reported before the AIDS epidemic, but more than half the episodes of pneumococcal bacteremia in HIV-infected patients occurred in patients without AIDS. Data on pneumococcal serotypes causing invasive disease in HIV-infected patients suggest that the current pneumococcal vaccine, if effective in this population, could provide significant protection against pneumococcal disease.
Acquired Immunodeficiency Syndrome↗
Pneumococcal bacteremia in Charleston County, South Carolina. A decade later.
Since nationwide surveillance for pneumococcal bacteremia in the United States is not done, community-based studies are useful alternative methods to monitor trends in this disease. Data on the incidence of pneumococcal bacteremia in Charleston County, South Carolina, from 1974 to 1976, have been used to support cost-effective pneumococcal vaccine programs for the elderly. We reevaluated the incidence of pneumococcal bacteremia in Charleston County in 1986 and 1987 to assess whether earlier estimates remained valid given changes in medical practice. During 1986 and 1987, overall annual incidence of pneumococcal bacteremia in Charleston County was 18.7 per 100,000 (95% confidence limits, 13.7 to 23.6 per 100,000), which represents a 2.3-fold increase over the earlier rate. The increase coincided with a 2.2-fold increase in the annual number of blood cultures processed at four Charleston County hospital laboratories from 1975 to 1987 despite only a 1.1-fold increase in the number of patients discharged from these hospitals. Annualized rates increased 2.3-fold for adults more than or equal to 65 years old to 53 per 100,000 and 4.6-fold for children less than 2 years old to 162 per 100,000. The case-fatality rate of bacteremic patients was 18%, compared with 21% in the earlier study. The case-fatality rate for adults more than or equal to 65 years of age was 44%. Ninety-one percent of adults 19 to 64 years old with bacteremia had underlying medical conditions for which pneumococcal vaccine is recommended; all persons 55 to 64 years old had at least one underlying condition. The marked increases in pneumococcal bacteremia rates detected are likely due to more routine culturing of blood from symptomatic patients with pneumococcal disease. These findings emphasize the need for effective programs promoting use of pneumococcal vaccine in high-risk groups, particularly those more than or equal to 65 years old, and the development of a more immunogenic vaccine for children less than 2 years old.
Adult↗
Pneumococcal vaccination. Controversies and opportunities.
The morbidity and mortality associated with pneumococcal infections are preventable in many high-risk individuals by immunization with 23-valent pneumococcal vaccine. While the clinical effectiveness of the current vaccine is less than ideal, use of the vaccine is cost effective. In spite of recommendations for pneumococcal vaccination of elderly and other high-risk persons, and federal reimbursement for vaccination Medicare enrollees, it was estimated in 1985 that only 10% to 15% of this target population was immunized. Strategies for immunizing high-risk individuals with pneumococcal vaccine need to involve physicians, public health professionals, health advocacy groups, and persons in the targeted populations.
Antibodies, Bacterial↗
Prevalence of Salmonella and multiple antimicrobial-resistant Salmonella in California dairies.
A cross-sectional survey was conducted on 75 randomly selected dairies in one California county. Salmonella was isolated from 12 (16%) dairies; S newport was isolated from 6 (8%). Chloramphenicol-resistant S newport and S dublin were isolated from 8 (10.7%) dairies. Dairies with Salmonella had higher average calf mortality rates (P = 0.064; odds ratio [OR], 3.8). Dairies with S newport had a greater than expected occurrence of illnesses in adult cows compared with dairies with no S newport (P = 0.048; OR, 6.7) or with no Salmonella serotypes isolated (P = 0.047; OR, 6.9). Dairies with chloramphenicol-resistant Salmonella were more likely to have used chloramphenicol during the preceding 18-month period compared with dairies with chloramphenicol-susceptible Salmonella or no Salmonella (P = 0.023; OR, 9.5).
Animals↗
Risk factors for infant botulism in the United States.
To define risk factors for infant botulism, we performed a 2-year prospective case-control study of 68 laboratory-confirmed cases in infants living in the United States, outside of California. For each case patient, two control subjects were matched by date and hospital of birth or county birth records. By univariate analysis, breast-feeding (odds ratio = 2.9) and consumption of honey (odds ratio = 9.8) were associated with disease, but only 11 case patients (16%) had eaten honey. Decreased frequency of bowel movement (less than one per day for at least 2 months) was also associated with disease in infants 2 months of age and older (odds ratio = 5.2). Risk factors changed with the age of the patient at disease onset when analyzed by multivariate logistic regression methods. For infants less than 2 months old, living in a rural area or on a farm was the only significant risk factor (odds ratio = 6.4). For infants 2 months of age and older, breast-feeding (odds ratio = 3.8), less than one bowel movement per day for at least 2 months (odds ratio = 2.9), and ingestion of corn syrup (odds ratio = 5.2) were associated with disease. The severity of the disease was similar for breast- and bottle-fed infants. Clearly defined food exposures account for a minority of infant botulism cases. Preexisting host factors, such as intestinal flora and frequency of bowel movements, may be the most important risk factors for development of disease.
Botulism↗
Acute lower respiratory infections: a major cause of death in children in Bangladesh.
The importance of acute lower respiratory infections (ALRI) as a cause of death in children was estimated using systematically collected demographic data on the population of the Teknaf area of southern Bangladesh. Of 1349 children aged 1-59 months who died between 1 January 1982 and 31 December 1985, ALRI was diagnosed by verbal autopsy in 390 (29%) and was the leading cause of death. ALRI mortality rates were highest in the youngest age groups (136/1000 for those less than or equal to 5 months) and decreased in older children (16/1000 for those 3-4 years old). Half of all fatal ALRI cases occurred in children less than 6 months old. In older children, ALRI-associated deaths tended to occur during the months October to January, while deaths in infants tended to follow the seasonal birth pattern. Significant predisposing factors for fatal ALRI were malnutrition and measles, detected, respectively, in 18% and 8% of children who died from ALRI. This study emphasizes the importance of ALRI as a major cause of death in developing countries and suggests that interventions to reduce childhood mortality are needed and should be targeted to specific age groups at risk.
Acute Disease↗
Pneumococcal bacteremia in Hawaii: initial findings of a pneumococcal disease prevention project.
The Hawaii Department of Health (DOH) recently established a pneumococcal disease initiative to determine the scope of serious pneumococcal disease in residents of Hawaii and to investigate methods of increasing vaccine utilization in the State. The initial phase of the project involved a review of pneumococcal bacteremia at all 38 microbiology laboratories in Hawaii during 1986 and 1987. Two hundred twenty-two residents with bacteremia were identified. Eighty-six percent of adults had pneumonia as the primary source of bacteremia. In children greater than 5 years old, pneumonia was present in 24%, otitis media in 35%, and meningitis in 11%. Bacteremia with no apparent focus of infection was found in 30% of children. The overall annual incidence of pneumococcal bacteremia was 9/10(5) population. Rates were highest in children greater than 2 years old (103/10(5] and persons greater than or equal to 65 years old (22/10(5]. These are similar to rates reported from other populations in the United States during the 1970s and early 1980s, but are less than those detected in 2 more recent population-based studies. The overall case-fatality rate in our study was relatively low (16%); however, 35% of persons greater than or equal to 65 years old died. A record of previous pneumococcal vaccination was found in the medical records of only 2 (1%) patients. Our study confirms that pneumococcal bacteremia causes significant morbidity and mortality among elderly residents of Hawaii and suggests that vaccine coverage is very low among this high-risk population. Phase 2 of the initiative included surveys of Hawaii physicians and the public to ascertain attitudes toward pneumococcal immunization.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Legionellosis in cardiac transplant recipients: results of a nationwide survey.
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Heart Transplantation↗