Medicine in Maryland, 1634-1900/Medical reforms in Maryland (1848-76).
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Mycobacterium abscessus infections are frequently drug resistant and can cause severe disease, particularly among vulnerable populations in healthcare settings. In June 2024, a cluster of M. abscessus infection cases was reported at a hospital in Maryland, USA. An investigation involving hospital infection prevention staff, the Maryland Department of Health, the Centers for Disease Control and Prevention, and the Wadsworth Laboratory of the New York State Department of Health included initiation of mitigation efforts such as tap water use restrictions, point-of-use water filters, hospitalwide water flushing, and staff education regarding sink safety. Whole-genome sequencing of patient and environmental isolates, coupled with epidemiologic data, revealed a strong association (0-24 single-nucleotide polymorphism differences) between environmental and patient samples, indicating that infections were likely a result of patient exposure to M. abscessus. Ensuring initiation of mitigation initiatives likely prevented additional patient infections. Although effective in this investigation, not all mitigation strategies are equal or sustainable.
An epidemic of acute prolonged febrile respiratory disease affecting nine of 19 workers on a Maryland State bridge maintenance crew was diagnosed as histoplasmosis by serologic testing in all and by isolation of the organism in one. In our investigation, it was revealed that work on a particular bridge was associated with disease. Culture of bat guano from the site two months later revealed H. capsulatum. Four previously uninfected epidemiologic investigators also became ill with histoplasmosis following collection of soil and bat guano. This outbreak reveals that bats and bat guano are a source of histoplasmosis, suggests that only brief exposure is necessary for acute infection and reemphasizes that histoplasmosis is not confined to the midwestern states.
Deaths associated with strokes from 1963 to 1975 among 36,860 adult residents of Washington County, Maryland, were studied in relation to the hardness of drinking water at home, assessed on the basis of 1,569 water samples taken during this period. There was no satisfactory evidence that water hardness was related to stroke mortality. Age was a strongly related factor. There was little or no association with sex, marital status, socio-economic status as reflected by education or housing, smoking history, or frequency of church attendance.
Twelve of 43 pregnant little brown bats (Myotis lucifugus) collected at Montpelier Barn, Laurel, Maryland, gave birth to dead young. Eleven of these 12 dead neonates were abnormally small. Most of the stillbirths were attributable to unknown reproductive difficulties associated with first pregnancies, but four may have been due to high concentrations of polychlorinated biphenyls (PCB) in the newborn. Residues of the PCB, DDE, and oxychlordane crossed the placenta at similar rates.
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In 1972 in Baltimore, a peak of 7,436 reported animal bites (8/1,000 population) was reached. The bite rate for the most susceptible age group (5-14) was 19 per 1,000 population. By 1976, only 5,092 bites were reported, 5.8 per 1,000 total population, and 12.3 per 1,000 population 5-14 years of age. The decline in the number and rates of animal bites is believed due in large measure to the actions taken by the Bureau of Animal Control: education and publicity, increased fees and penalties, and enforcement of the new laws and regulations.
Experimental studies were conducted to assess the susceptibility of white-tailed deer (Odocoileus virginianus), gray squirrels (Sciurus carolinensis), and cottontail rabbits (Sylvilagus floridanus) to Jamestown Canyon (JC) and/or Keystone (KEY) virus infection. Viremia occurred in 5 of 6 deer inoculated with JC virus; however, all deer developed KEY virus neutralizing antibody. Based on the observation that antibody elicited by primary infection of deer with either KEY or JC virus exhibited partial heterologous neutralization in vitro, cross-challenge experiments were performed in these animals. Keystone virus failed to infect deer 30 days post primary JC virus infection; however, deer became infected when challenged with KEY virus 80 days after the initial JC virus infection as indicated by a substantial increase in antibody titer. Similarly, JC virus failed to produce viremia in immune animals infected with KEY virus 80 days previously, although 2 of the 3 animals challenged had serological evidence of infection. Three field-collected cottontail rabbits with no evidence of KEY antibody were readily susceptible to KEY virus infection and developed viremias of 1-4 days' duration; rabbits with KEY virus antibody did not develop viremia upon KEY virus challenge. Eight antibody-negative field-collected gray squirrels became viremic following injection with KEY virus; however, a comparable group of squirrels did not become viremic when injected with JC virus.
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