Search PubMed⌕ Search

Biomedical subjects

L Mascola

Publications and source records attributed to L Mascola.

At least 55 records · Page 3Linked to original sources
PubMed1993

Measles in pregnancy: a descriptive study of 58 cases.

OBJECTIVE: To describe the effects of measles in pregnancy using a large case series. METHODS: Pregnant women with measles were identified by county health department records, and their hospital and clinic records were reviewed. When available, records for the infants of case patients were also reviewed. RESULTS: Fifty-eight pregnant women with measles were identified. Thirty-five (60%) were hospitalized for measles, 15 (26%) were diagnosed with pneumonia, and two (3%) died of measles complications. Excluding three induced abortions, 18 pregnancies (31%) ended prematurely; five were spontaneous abortions and 13 were preterm deliveries. All but two of the 18 pregnancies that terminated early did so within 14 days of rash onset. Two term infants were born with minor congenital anomalies, but their mothers had measles late in the third trimester. No newborns were diagnosed with congenital measles. CONCLUSIONS: The incidence of death and other complications from measles during pregnancy may be higher than expected for age-comparable, nonpregnant women. Measles in pregnancy may lead to high rates of fetal loss and prematurity, especially in the first 2 weeks after the onset of rash.

Abortion, Spontaneous↗
PubMed1993

Screening for HIV and hepatitis B virus in Los Angeles County prenatal clinics: a demonstration project.

A project designed to pilot voluntary screening for HIV antibody and hepatitis B virus antigen (HBsAg) in women using Los Angeles County Department of Health Services prenatal clinics is described. The purpose of the study was to demonstrate that HIV testing could be integrated into an existing prenatal health care system with minimal disruption. In an 8-month period, 9,069 women entered the project; 76% accepted HIV antibody testing. The rate of HIV antibody seropositivity was 144 per 100,000 (10 per 6,943), and the rate of HBsAg seropositivity was 253 per 100,000 (23 per 9,103). No difference in test acceptance rates was found using a sign-off versus a sign-on HIV antibody consent form although potential confounders were not controlled. Only five of the eight HIV antibody-positive women (63%) and eight of the 20 HBsAg-positive women (40%) who were interviewed reported behaviors considered high risk for HIV or HBsAg infection.

Adult↗
PubMed1992

Resurgence of congenital rubella syndrome in the 1990s. Report on missed opportunities and failed prevention policies among women of childbearing age.

OBJECTIVE: To assess previous missed opportunities for rubella screening and vaccination of women delivering infants with congenital rubella syndrome and to discuss prevention strategies. DESIGN: Descriptive analysis of data collected through interviews and review of medical records. POPULATION STUDIED: Twenty-one women who delivered infants with congenital rubella syndrome in four Southern California counties from January 1, 1990, through January 8, 1991. RESULTS: Twelve (57%) of the women had a total of 22 known missed opportunities for rubella screening or vaccination. Of the 22 missed opportunities, three (14%) were missed screenings at the time of marriage, two (9%) were missed screenings during previous pregnancies, five (23%) were missed screenings during induced abortions, and 12 (55%) were missed opportunities for vaccination postpartum or after induced abortions. Nine (43%) of the women had no known missed opportunities for rubella screening or vaccination. Of 12 women educated in California, only four (33%) were subject to the 1982 California school rubella immunization requirement. CONCLUSIONS: Congenital rubella syndrome could have been prevented in more than half of the infants born to these women if missed opportunities for rubella testing and/or vaccination had not occurred. Because premarital rubella testing and school immunization requirements do not ensure that all women of childbearing age are immune to rubella, physicians and hospitals should establish procedures for postpartum rubella vaccination of susceptible women. Family planning and abortion clinics should implement routine rubella testing and follow-up vaccination of susceptible women.

California↗
PubMed1992

Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. The Listeria Study Group.

OBJECTIVE: To identify dietary risk factors for sporadic listeriosis. DESIGN: Case-control study with blinded telephone interviews. SETTING: Multistate population of 18 million persons, November 1988 through December 1990. PARTICIPANTS: One hundred sixty-five patients with culture-confirmed listeriosis and 376 control subjects matched for age, health care provider, and immunosuppressive condition. RESULTS: The annual incidence of invasive listeriosis was 7.4 cases per million population; 23% of the infections were fatal. Cases were more likely than matched controls to have eaten soft cheeses (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4 to 4.8; P = .002) or food purchased from store delicatessen counters (OR, 1.6; 95% CI, 1.0 to 2.5; P = .04); 32% of sporadic disease could be attributed to eating these foods. Sixty-nine percent of cases in men and nonpregnant women occurred in cancer patients, persons with the acquired immunodeficiency syndrome, organ transplant recipients, or those receiving corticosteroid therapy. Among these immunosuppressed patients, eating undercooked chicken also increased the risk of listeriosis (OR, 3.3; 95% CI, 1.2 to 9.2; P = .02). CONCLUSIONS: Foodborne transmission may account for a substantial portion of sporadic listeriosis. Prevention efforts should include dietary counseling of high-risk patients and continued monitoring of food production.

Case-Control Studies↗
PubMed1992

A survey of hospital infection control policies and employee measles cases during Los Angeles County's measles epidemic, 1987 to 1989.

BACKGROUND: Between December 1987 and December 1989, 74 adults employed in Los Angeles County acute care hospitals were found to have measles. To investigate measles infection control policies in Los Angeles County and to gain information on employee measles cases, two surveys were performed. METHODS: A survey of all infection control practitioners (N = 102) of acute care hospitals was conducted in July 1989. Reported employee measles cases were surveyed after initial case reports were reviewed. RESULTS: The survey of acute care hospitals revealed that only 17% had mandatory measles infection control policies requiring written proof of past measles vaccination, disease, or seropositivity. Only 4% of hospitals had policies affecting students or volunteers. A second survey of hospital employees with confirmed measles revealed that 46% (34/74) were working in hospitals without measles infection control policies, 43% (32/74) were born before 1957, and 31% (21/67) were working in jobs not traditionally considered to provide a high risk of measles exposure. One third of the sick employees were hospitalized. The standard of either birth date before 1957 or oral history of measles illness or vaccination would have classified 93% (39/42) of the employees with measles as immune. CONCLUSIONS: Effective infection control policies against measles and rubella should be adopted and enforced. Those policies should only allow written documentation as proof of measles immunity and should address all employees, regardless of age or job description.

Adult↗
PubMed1992

Swimming-associated cryptosporidiosis.

In July and August 1988, an outbreak of gastroenteritis affected 44 of 60 (73%) persons from 5 separate swimming groups who had used the same swimming pool in Los Angeles. Cryptosporidium was identified in 5 of 8 (63%) stool specimens, and the clinical picture was consistent with Cryptosporidium infection. Resistance of Cryptosporidium to chlorine, an inadequately maintained pool filtration system, repeated exposure to pool water, and possible continuing pool contamination may have contributed to ongoing transmission. Cryptosporidium should be considered a potential etiologic agent of gastroenteritis associated with recreational water use.

Adolescent↗
PubMed1992

Biologic, foster, and adoptive parents: care givers of children exposed perinatally to human immunodeficiency virus in the United States. The Pediatric Spectrum of Disease Clinical Consortium.

Children born to human immunodeficiency virus (HIV)-infected mothers often do not live with a biologic parent because of drug use, illness, or death of the mother. Public health officials need to know the number and proportion of children who will require care by someone other than a biologic parent (alternative care giver). The Pediatric Spectrum of Disease project, conducted in six different geographic regions in the United States, assesses issues specific to HIV in children. Among the information being collected in this study are data regarding the primary care giver. Of 1683 children born to HIV-infected mothers and enrolled through 1990, 55% (937) were living with a biologic parent, 10% (169) with another relative, 28% (455) were in foster care, 3% (55) had been adopted, and 4% (67) lived in group settings or with other care givers. In all locations and for all racial/ethnic groups, children of mothers who used intravenous drugs were more likely to be living with an alternative care giver than were children of mothers who had not used intravenous drugs (odds ratio 4.15). However, there were striking variations by study location (odds ratio range 1.4 to 7.2). The data suggest that maternal drug use may be the most important factor determining whether a child lives with a biologic parent and that there are also regional differences in alternative care placement.

Adoption↗
PubMed1991

CD4 T-lymphocyte counts and Pneumocystis carinii pneumonia in pediatric HIV infection.

The relationship between CD4 T-lymphocyte counts and infection with the human immunodeficiency virus (HIV) is retrospectively investigated for 266 HIV-infected and uninfected children who were born to infected women, including 39 with Pneumocystis carinii pneumonia (PCP), in a population-based surveillance study. Of 21 perinatally HIV-infected children with PCP only 10 (48%) had CD4 T-lymphocyte counts that were less than 500 x 10(6) cells/L (500 cells/mm3), compared with all 18 who were infected via blood transfusions or clotting factors. Among 68 children who were 1 year or younger, 18 (90%) of 20 PCP cases had CD4 T-lymphocyte counts that were less than 1500 x 10(6) cells/L (1500 cells/mm3) compared with only five (10%) of 48 children who did not have the acquired immunodeficiency syndrome (odds ratio, 77.4; 95% confidence interval, 19.7 to 313.4). The mean CD4 T-lymphocyte count was lower for the 39 PCP cases when compared with the 188 children who were at different stages of HIV infection and did not have the acquired immunodeficiency syndrome (AIDS) independent of age. The majority of perinatally HIV-infected children with PCP were 6 months or younger and 50% were previously unknown to be infected. Thus, HIV-positive children should be identified early and followed closely. CD4 T-lymphocyte counts may be useful in monitoring HIV-positive children and determining when to begin PCP prophylaxis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group.

To determine the morbidity and mortality due to listeriosis in the United States, the authors undertook an active surveillance project in 1986 to identify all cases in which Listeria monocytogenes was isolated from cultures of ordinarily sterile sites in a population of 34 million persons. The authors estimated that at least 1,700 cases of listeriosis and 450 deaths occurred in the United States in 1986; 27% of these cases occurred in pregnant women, with 22% of perinatal cases resulting in stillbirths or neonatal deaths. The risk of listeriosis in adults (0.5 per 100,000 population) was similar in all regions studied; the incidence of perinatal listeriosis was three times higher in Los Angeles County, California, than in the other areas (24.3/100,000 live births vs. 7.8/100,000 live births). Geographic variation may have resulted from underdiagnosis of perinatal listeriosis in five of the study areas. Multilocus electrophoretic enzyme typing was useful for elucidating the molecular epidemiology of L. monocytogenes; perinatal listeriosis was significantly associated with one group of related strains. Multilocus electrophoretic enzyme typing also identified three clusters representing possible common-source outbreaks. These findings document the substantial morbidity due to listeriosis in the United States; to the extent that sporadic listeriosis is foodborne, this morbidity could be reduced by appropriate preventive measures, particularly in persons known to be at increased risk of infection.

Adult↗
PubMed1991

Fatal listeria meningitis in an immunocompromised infant: therapeutic implications.

Infection with Listeria monocytogenes is rare in infants and children. Listeriosis has been made a notifiable condition in the State of California since 1985. From January 1985 to December 1990, only seven cases of listeriosis have been reported in children less than or equal to 13 years of age. This brief report summarises the features of a fatal case of listeria meningitis in an immunocompromised 4-month-old infant, discusses diagnostic and therapeutic implications, and describes the other six cases.

Anti-Bacterial Agents↗
PubMed1990

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↗
PubMed1990

The effects of case definition in maternal screening and reporting criteria on rates of congenital syphilis.

Reports of congenital syphilis in 1987 were reviewed to determine how new national guidelines for defining congenital syphilis would influence reported rates in Los Angeles County. After reviewing all reported reactive serologic tests for syphilis, we found 166 additional cases, resulting in a 426 percent increase in the 1987 reported rate of congenital syphilis. Rates of congenital syphilis are dependent upon surveillance practices, screening policies, and case definition.

Female↗