To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.
Nested case-control study, matched by service, length of stay, date of admission, and ...presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.
Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.
Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.
Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p less than .01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/H2-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.
Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality. The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.
Epidemiological studies were conducted in Mexico to assess the health risks associated with restricted crop irrigation using raw and treated wastewaters. Experimental studies were done in northeast ...Brazil and Leeds, in which Ascaris lumbricoides contamination of lettuces spray-irrigated with raw wastewater and waste stabilization pond effluents containing different helminthological qualities was determined (Brazil); and Ascaridia galli infection was monitored in immunosuppressed chickens fed lettuces spray-irrigated with water containing different A. galli egg numbers (Leeds). The results indicate that the WHO guideline quality of ≤ 1 egg per litre protects crop consumers, but not necessarily fieldworkers and their families especially children. This is particularly the case when wastewater treatment systems are not stable, when recontamination of the partially treated wastewater with small quantities of raw wastewater may occur, and when wild vegetables are harvested and consumed. In such cases a stricter guideline quality of ≤ 0.5 egg per litre may be required.
Although antibodies to the lipopolysaccharide antigens of Shigella have been demonstrated in human milk, such antibodies do not explain the putative protective effect of breast-feeding against ...symptomatic Shigella infection. Shigella species do not share related lipopolysaccharides, but they do possess closely related virulence plasmids that code for the proteins essential for cell invasion. We therefore sought to determine the frequency, amount, and duration of excretion of human milk antibodies to these shared virulence plasmid-associated antigens in populations of different rates of Shigella infection frequency (Mexico City, high; Houston, low). Such antibodies were present in the milk of virtually all the Mexican women but also were present in a large proportion of milk samples from the women living in Houston. The amounts of these antibodies were highest in colostrum but after 2 weeks of lactation fell to stable levels. The frequency and persistence of these antibodies in the milk of the women from Houston suggest that the memory and drive for secretion of these antibodies is extremely long lived.
The clinical features and diagnostic evaluation of six patients affected by prolymphocytic leukemia (PLL), are described. Some of the cases deviate from a relatively uniform and aggressive clinical ...course of the disease entity. An actuarial survival analysis of 60 cases gathered from the literature and the authors' experience indicate that the cases showing the most prolongated evolution may reach 30% of the total. The different aggressiveness in the clinical course of these patients does not depend on the efficiency of the therapies applied. The percentage of prolymphocytes (PL) in peripheral blood throughout the clinical course was variable and not depending on the treatments used. This fact, in conjunction with (1) the presence of cellular types deviated from the typical PL and detected both at optical and ultrastructural levels and (2) the existence of cases of PL with minimal splenomegaly and leukocyte counts of less than 50 × 109/liter, could lead to an underdiagnosis of PLL and hinder the actual cognition of the natural medical history of the disease.
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BFBNIB, FZAB, GIS, IJS, KILJ, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
A polymerase chain reaction (PCR) assay for the rapid identification of
Mycobacterium tuberculosis, based on amplification of the IS6110 insertion sequences, was tested in paraffin-embedded tissue ...from 64 biopsy samples with either positive or negative cultures for
Mycobacterium tuberculosis. The utility of this PCR assay in the diagnosis of tuberculosis among patients with hepatic granulomas (HGs) was then tested by examining 43 liver biopsy samples. They were classified as either having definitive or probable tuberculosis or as being of nontuberculous origin, on the basis of clinical and microbiologic data and on their response to antituberculous treatment. PCR was 100% sensitive in the diagnosis of culture-positive
M. tuberculosis infection in the lymph node, lung, and liver. The sensitivity of the PCR in the diagnosis of HG of definitive tuberculous origin was 58%, and the specificity was 96%. PCR is a valuable test for the demonstration of mycobacterial DNA in tissues. Although it is not highly sensitive, the DNA amplification method may also be more sensitive than culture in the diagnosis of
M. tuberculosis-associated HG.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
To describe an outbreak of Salmonella gastroenteritis among employees of the National Institute of Nutrition (INNSZ) of Mexico City during July, 1994.
Employees who developed diarrhea or fever ...associated with gastrointestinal symptoms starting on July 14th were included for study as well as 50 healthy controls. A questionnaire was applied to all, and they also provided a stool sample, along with other 80 asymptomatic people (included the kitchen workers) in whom only stool culture was done.
Ninety-seven employees that ate regularly at the Hospital's cafeteria were affected by the outbreak, and 67 of them (69%) could be evaluated. Most of them were nurses (34%), and handymen (27%). Most common symptoms were abdominal pain (97%), diarrhea (95%), nausea (91%), and fever (89%). Cultures from suspicious food items were all negative, but stool cultures from 10/70 cases were positive for Salmonella enteritidis vs. 0/133 in the controls. The ten S. enteritidis isolates resulted identical either by serotyping and by rapid amplified polymorphic DNA (RAPD) analysis. Cultures from all kitchen employees were negative for S. enteritidis. Breakfast meal on July 14th was associated with the development of gastroenteritis (61/67 cases vs 26/50 controls, p < 0.001), and particularly with an egg-covered meat plate (61/62 vs 13/26 controls, p < 0.0001).
This outbreak was probably caused by eggs contaminated with Salmonella, since no one of the kitchen personnel was found to be an asymptomatic carrier, and the implicated recipe allows for inappropriate cooking. Recommendations to improve cooking procedures must be added to the usual regulations to diminish the frequency of foodborne disease outbreaks in hospitals.
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