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S B Werner

Publications and source records attributed to S B Werner.

At least 37 records · Page 2Linked to original sources
PubMed1996

Invasive group A streptococcal infections in children with varicella in Southern California.

OBJECTIVE: To describe demographic and clinical features of invasive group A streptococcal (GAS) infections in children with varicella in Southern California in early 1994. METHODS: From hospitals of Los Angeles and Orange Counties, children with invasive GAS infections after varicella between January 1 and April 8, 1994, were identified by hospital infection control nurses. Medical records of patients were reviewed, and any available GAS isolate was further tested. RESULTS: Twenty-four cases were identified; 54% were male, 50% were Hispanic and the median age was 3 years (range, 0.5 to 8). Four cases died before hospitalization. The other 20 were hospitalized for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1 with concomitant epiglottitis), 2 with myositis/necrotizing fasciitis, 2 with pneumonia and 2 with bacteremia without apparent source. Five had evidence of multiorgan involvement including two patients fulfilling criteria of streptococcal toxic shock-like syndrome. Of 19 patients with blood cultures, 10 (53%) had GAS bacteremia. Onset of GAS infection was suggested, as a median, on Day 4 of varicella, with fever, vomiting and localized swelling being commonly reported. The mean maximum temperature on the day of admission was 39.4 degrees C (102.9 degrees F). Four GAS isolates were M1T1 and one was M3T3. Five isolates produced streptococcal pyrogenic exotoxins A and B. CONCLUSIONS: Invasive GAS disease, including streptococcal toxic shock-like syndrome, is a serious complication of varicella. Physicians should be alert for the complication of GAS when fever and localized swelling or signs of cellulitis develop 3 days or more after the onset of varicella. Widespread use of varicella vaccine may decrease invasive GAS infections in this setting.

Bacteremia↗
PubMed1996

A new route of transmission for Escherichia coli: infection from dry fermented salami.

OBJECTIVES: This study evaluated the production of dry fermented salami associated with an outbreak of Escherichia coli O157.H7 infection in Washington State and California. METHODS: Facility inspections, review of plant monitoring data, food handler interviews, and microbiological testing of salami products were conducted. RESULTS: Production methods complied with federal requirements and industry-developed good manufacturing practices. No evidence suggested that postprocessing contamination occurred. Calculations suggested that the infectious dose was smaller than 50 E. coli O157:H7 bacteria. CONCLUSIONS: Dry fermented salami can serve as a vehicle of transmission for O157:H7 strains. Our investigation and prior laboratory studies suggest that E. coli O157:H7 can survive currently accepted processing methods.

Adult↗
PubMed1996

Epidemic Salmonella enteritidis infection in Los Angeles County, California. The predominance of phage type 4.

Between April and July 1994, 501 cases of Salmonella enteritidis infection were reported in Los Angeles County, California, nearly 5 times the number reported between April and July 1993; of these, 422 (84%) were sporadic (not related to known outbreaks). A case-control study was done to determine risk factors for sporadic illness; the distribution of S enteritidis phage types was evaluated. Case-patients (n = 58) were county residents older than 1 year with culture-confirmed S enteritidis infection in August 1994. One to two acquaintance controls (n = 98) were matched to each case by age, sex, and race. Two risk factors-eating raw or undercooked eggs (matched odds ratio [MOR] = 6.6; 95% confidence interval [CI] = 1.9, 23.0) and eating in restaurants (MOR = 4.9; 95% CI = 1.2, 19.4) in the 3 days before the onset of illness-remained significant in the conditional logistic regression model. Of 16 randomly selected S enteritidis case-isolates, 15 (94%) were phage type 4. The reasons for the regional predominance of phage type 4, an S enteritidis subtype recently associated with large and destructive increases in salmonellosis among poultry and humans in Britain and much of Europe, are unclear. To minimize human S enteritidis infection, food service workers need frequent training in the proper handling of raw foods, eggs should be kept refrigerated during distribution and storage, and eggs should be cooked until the yolk is firm, particularly for persons at the greatest risk for serious illness: pregnant women, elderly persons, and those with compromised immune systems. Clinicians should obtain stool specimens for culture from patients who present with diarrhea and fever or bloody diarrhea or who are possibly part of an outbreak.

Adolescent↗
PubMed1996

Effect of dexamethasone on osseointegration: a preliminary experimental study.

The peri-implant reparative process is one of the factors involved in osseointegration. Local and systemic factors may contribute to the peri-implant micro-environment. The aim of this study was to assess the effect of dexamethasone (DXM) on the first stages of the post-implantation reparative process using a quantitative osseointegration experimental model previously developed at our laboratory. A titanium laminar implant was inserted into the right tibiae of nine male Wistar rats under ether anesthesia, following a technique we previously described. Six rats received 120 micrograms/kg/day i.p. doses of DXM (Decadron Sidus, Argentina) for 14 days pre-implantation and 14 days post-implantation. The remaining three (controls) were injected with an equivalent volume of saline. On day 14 post-implantation, all animals were killed, and their tibiae were resected, radiographed, and processed before being embedded in methylmethacrylate. Microscopic observation and histomorphometric studies were performed. Results show that, in this experimental model, the extension of osteogenic peri-implant response was greater in DXM-treated animals than in controls. Thus, our laminar implant test may prove useful to study the effects of corticosteroids on the osseointegration process.

Animals↗
PubMed1995

Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse.

From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting > 165 min (11/15 vs. 20/45; odds ratio [OR], 5.0; 95% confidence interval [CI], 1.5-16.3) or exposure to first scrub nurse A (15/15 vs. 22/45; OR, infinity; 95% CI, 2.5, infinity). Molecular typing of 5 case-patient C. albicans isolates revealed a common strain. Nurse A had a history of recurrent vaginal infections responding to topical antifungal agents; however, cultures of multiple samples from nurse A, beginning 3 weeks after the last infected patient's surgery, failed to yield C. albicans. Following her voluntary transfer from cardiac surgery, no additional infections of case-patients were detected. This study demonstrates the utility of combining epidemiologic methods and molecular typing in investigating C. albicans infection clusters and suggests that a common exogenous source can be responsible for C. albicans surgical wound infections.

Aged↗
PubMed1994

Hantavirus pulmonary syndrome in California: report of two cases and investigation.

We report two cases of hantavirus pulmonary syndrome that were probably acquired in California. Genetic analysis of tissue specimens from one of the patients revealed that the virus isolated is a variant of the strain (Sin Nombre virus) identified in the outbreak of hantavirus pulmonary syndrome that occurred in the Four Corners region of the southwestern United States in 1993. In addition to presenting the clinical features of the two cases, we discuss the possible risk factors for infection.

Adult↗
PubMed1993

Wound botulism in a patient with a tooth abscess: case report and review.

We describe a case of wound botulism associated with a tooth abscess in a 5-year-old boy. We reviewed the literature and reports to the Centers for Disease Control and Prevention (Atlanta) of laboratory-confirmed cases of wound botulism. From 1943 through 1990, 47 cases were reported. Type A botulinus toxin was identified in 32 cases, type B in 13, types A and B in 1, and an unknown type in 1. Botulism was associated with wounds from trauma, use of injectable drugs, and surgery. Sinusitis after use of intranasal cocaine has also been associated with botulism. Treatment for wound botulism includes prompt debridement of the wound for eliminating anaerobic conditions, intensive care, and treatment with antitoxin.

Botulinum Toxins↗
PubMed1992

Epidemiology of Aeromonas infections in California.

In May 1988, California became the first state to make aeromonas infection a reportable condition, thereby permitting the first population-based study of the epidemiology of infection caused by Aeromonas organisms. Case investigations were carried out on 219 of the 280 patients whose infections were reported during the first year of notification. The overall incidence rate for Aeromonas isolation was 10.6 cases per 1 million population. The gastrointestinal tract was the most commonly reported site from which Aeromonas was isolated (81%), with wounds being the next most common source (9%). Five (2%) of the 219 patients died; all five had serious underlying medical conditions apart from aeromonas infection. No common-source enteric outbreaks were reported. The high rate of gastrointestinal symptoms and isolation of organisms from medically vulnerable patients and the fact that other bacterial enteric pathogens were rarely isolated from symptomatic patients support evidence from previous studies that Aeromonas is an enteric pathogen. The evidence from these case reports in California suggests that aeromonas infections are not an important public health problem and are largely nonpreventable. Thus, public health surveillance is not necessary and mandatory reporting has been discontinued.

Adolescent↗
PubMed1990

Outbreak of Pontiac fever due to Legionella anisa.

An outbreak of Pontiac fever occurred among 34 of 56 people attending conferences at a hotel in Santa Clara County, California, in 1988. Two groups had an acute febrile upper respiratory illness, with a mean attack rate of 82% and a mean incubation period of 56 hours. Symptoms resolved spontaneously within 5 days. Legionella anisa, which had not previously been associated with outbreaks of Pontiac fever or legionnaires' disease, was isolated from a decorative fountain in the hotel lobby. In addition, 5 of 8 pairs of serum samples from cases showed a more than fourfold rise in antibody titre to the L anisa recovered from the fountain. 42% of hotel employees had titres greater than or equal to 256 against L anisa, whereas none of 48 serum samples from matched controls had titres greater than or equal to 128. The findings raise concern about water treatment protocols for extent of disease that might be caused by exposure to aerosols containing L anisa and other Legionella species.

Acute Disease↗
PubMed1990

Risk factors associated with a school-related outbreak of serogroup C meningococcal disease.

An outbreak of Neisseria meningitidis sero-group C disease occurred in four eighth grade students and in a younger sibling of another eighth grade student attending an intermediate school (seventh and eighth grades) in Santa Clara County, CA. Four cases had onset within 3 days in January, 1989, with the fifth case occurring approximately 10 days later. A case-control study was performed to determine risk factors associated with serogroup C meningococcal infection (disease or carriage) in this eighth grade class. Students were more likely to be infected if they had had a preceding viral-like respiratory illness characterized by fever (odds ratio (OR) 5.3, P = 0.03) or cough (OR 5.1, P = 0.048). A ski trip (OR 6.3, P = 0.01) and a poster-making session for a school dance (OR 3.7, P = 0.08) were identified as possible settings for a common exposure. Spending time with two specific students during lunchtime or outside of school was associated with an increased risk of infection (OR 7.0, P = 0.054; OR 5.8, P = 0.04).

Adolescent↗
PubMed1984

Primary plague pneumonia contracted from a domestic cat at South Lake Tahoe, Calif.

Primary plague pneumonia occurred in a 47-year-old South Lake Tahoe woman shortly after face-to-face exposure to her plague pneumonia-infected cat. Both died. Field investigation revealed a recent plague epizootic in squirrels and chipmunks around the patient's home. Control measures included active surveillance and chemoprophylaxis of 197 contacts to the victim, a community alert on methods of self- and pet protection, and application of insecticide to reduce rodent flea populations. No secondary cases occurred.

Animals↗
PubMed1984

Effect of patent ductus arteriosus on lower extremity blood flow velocity patterns in preterm infants.

We used a 20-MHz, range-gated, pulsed Doppler device to measure noninvasively femoral artery blood flow velocity patterns in 24 preterm infants with patent ductus arteriosus (PDA). Mean spatial flow velocity and its temporal average were recorded by illumination of the entire flow stream. Peak systolic forward flow velocity (Vs), peak diastolic retrograde flow velocity (VD), mean flow velocity (Vf), and the peak to peak-mean velocity ratio, (VS-VD)/Vf, were determined serially in each patient. The changes in the femoral flow velocity pattern preceded or coincided with other evidence of ductal left to right shunting. Prior to PDA closure, (VS-VD)/Vf averaged 14.1 and Vf averaged 4.4 cm/sec; after ductal closure, (VS-VD)/Vf fell to 3.7 (P less than .001) and Vf rose to 9.1 cm/sec, more than twice the preclosure value (P less than .001). Large diastolic reverse flow velocity vectors and low mean velocity correlated with large left to right PDA shunts estimated from other methods of assessment. The noninvasive femoral artery Doppler approach detects patency of the ductus early in life, reflects left to right shunting in diastole, and emphasizes the impact of the PDA on systemic blood flow.

Blood Flow Velocity↗
PubMed1982

A sensitive analytical apparatus for measuring hydrogen production rates. II. Application to studies in human infants.

We estimated hydrogen (H2) production by determining simultaneously the end-tidal concentration (ETH2) and the direct pulmonary excretion rate (VeH2) in normal-sized, healthy, term and preterm neonates between 2 days and 7 weeks of life who were receiving all their calories enterally as breast milk or a proprietary formula. We found that there was no peak or pattern in H2 production during the first 3 postprandial hours (mean VeH2 = 1.00 +/- 0.97 SD ml/kg/h; mean ETH2 = 40.3 +/- 33.1 SD ppm). Frequently, there was marked short-term variability of the ETH2 in a given infant (coefficient of variation = 13.4% +/- 18.7%). H2 production was elevated in normal neonates without signs of malabsorption. We found that VeH2 correlated with ETH2 using both nasopharyngeal catheter (r = 0.63; p less than 0.001) and nasal prong (r = 0.71; p less than 0.001) collection techniques. We conclude that breath hydrogen determinations in neonates are not readily comparable to similar studies in older patients. Longitudinal studies of individual infants may reveal changes in breath H2 excretion of sufficient magnitude to be distinguishable from moment-to-moment variations, and correlatable with certain intercurrent clinical problems affecting intestinal H2 production or pulmonary H2 excretion. However, interpretation of breath H2 determinations in human infants will be difficult.

Breath Tests↗
PubMed1982

Legionellosis--the 1980 San Francisco outbreak.

During the first half of March 1980, an unseasonal outbreak of legionellosis, which involved at least 14 of approximately 1,000 workers, occurred in a 6-month-old office building in San Francisco. An epidemiologic investigation revealed that persons 50 yr of age and older were at increased risk of disease. The outbreak was temporally associated with operation of the building's air conditioning system. In addition, Legionella pneumophila Serogroups 1, 4, and 6 were identified in water samples taken from a rooftop air conditioning cooling tower located directly across the street from an area of recent excavation.

Adult↗
PubMed1979

Association between raw milk and human Salmonella dublin infection.

Between 1971 and 1975 the mean annual incidence of human Salmonella dublin infection in California increased more than five-fold. Investigation of the increase showed an association with exposure to raw milk in 44 out of 113 cases. Of these 44 patients, 35 had used certified raw milk from a single dairy. Faecal swabs confirmed S dublin infection in the dairy herd and the milk, and so a pasteurisation order was issued. S dublin appears to be an unusually invasive and life-threatening salmonella serotype: 65% of isolations were obtained from non-faecal specimens (mainly blood cultures), 89 patients (80%) were admitted to hospital and 22 patients died. Almost three-quarters of the patients were aged 20 or over, and half had serious underlying diseases, particularly leukaemias and lymphomas. Five patients presented with infected vascular lesions that included aneurysms with abscesses and infections of previous arterial graft sites. The public's increasing desire for a "health food" such as raw milk should be tempered with an appreciation of its attendant risk to health.

Adolescent↗