We conducted prospective, active population-based surveillance for candidemia (defined as any Candida species isolated from blood) in Atlanta and San Francisco (total population, 5.34 million) during ...1992–1993. The average annual incidence of candidemia at both sites was 8 per 100,000 population. The highest incidence (75 per 100,000) occurred among infants ⩽1 year old. In 19% of patients, candidemia developed prior to or on the day of admission. Underlying medical conditions included cancer (26%), abdominal surgery (14%), diabetes mellitus (13%), and human immunodeficiency virus infection (10%). In 47% of cases, species of Candida other than Candida albicans were isolated, most commonly Candida parapsilosis, Candida glabrata, and Candida tropicalis. Antifungal susceptibility testing of 394 isolates revealed minimal levels of azole resistance among C. albicans, C. tropicalis, and C. parapsilosis. These data document the substantial burden of candidemia and its changing epidemiology. Continued surveillance will be important to monitor the epidemiology of candidemia and to detect emergence of resistance to azoles.
CONTEXT Recent increases in infectious disease mortality and
concern about emerging infections warrant an examination of longer-term
trends. OBJECTIVE To describe trends in infectious disease ...mortality in
the United States during the 20th century. DESIGN AND SETTING Descriptive study of infectious disease
mortality in the United States. Deaths due to infectious diseases from
1900 to 1996 were tallied by using mortality tables. Trends in
age-specific infectious disease mortality were examined by using
age-specific death rates for 9 common infectious causes of death. SUBJECTS Persons who died in the United States between 1900 and
1996. MAIN OUTCOME MEASURES Crude and age-adjusted mortality rates. RESULTS Infectious disease mortality declined during the first 8
decades of the 20th century from 797 deaths per 100,000 in 1900
to 36 deaths per 100,000 in 1980. From 1981 to 1995, the
mortality rate increased to a peak of 63 deaths per 100,000 in
1995 and declined to 59 deaths per 100,000 in 1996. The decline
was interrupted by a sharp spike in mortality caused by the 1918
influenza epidemic. From 1938 to 1952, the decline was particularly
rapid, with mortality decreasing 8.2% per year. Pneumonia and
influenza were responsible for the largest number of infectious disease
deaths throughout the century. Tuberculosis caused almost as many
deaths as pneumonia and influenza early in the century, but
tuberculosis mortality dropped off sharply after 1945. Infectious
disease mortality increased in the 1980s and early 1990s in persons
aged 25 years and older and was mainly due to the emergence of the
acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and,
to a lesser degree, to increases in pneumonia and influenza deaths
among persons aged 65 years and older. There was considerable
year-to-year variability in infectious disease mortality, especially
for the youngest and oldest age groups. CONCLUSIONS Although most of the 20th century has been marked by
declining infectious disease mortality, substantial year-to-year
variation as well as recent increases emphasize the dynamic nature
of infectious diseases and the need for preparedness to address
them.
Cotton leaf curl disease (CLCuD) is a major constraint to cotton production in Pakistan. Infectious clones of the monopartite begomovirus cotton leaf curl virus (CLCuV), associated with diseased ...cotton, are unable to induce typical symptoms in host plants. We have identified and isolated a single-stranded DNA molecule approximately 1350 nucleotides in length which, when coinoculated with the begomovirus to cotton, induces symptoms typical of CLCuD, including vein swelling, vein darkening, leaf curling, and enations. This molecule (termed DNA β) requires the begomovirus for replication and encapsidation. The CLCuV/DNA 1/DNA β complex, together with a similar complex previously identified in Ageratum conyzoides, represent members of an entirely new type of infectious, disease-causing agents. The implications of this finding to our understanding of the evolution of new disease-causing agents are discussed.
Population-based active laboratory surveillance for invasive mycotic infections was conducted during 1992 and 1993 in three California counties: Alameda, Contra Costa, and San Francisco (population, ...2.94 million). The cumulative incidence of invasive mycotic infections was 178.3 per million per year. Invasive mycoses were most commonly caused by Candida (72.8 per million per year), Cryptococcus (65.5), Coccidioides (15.3), Aspergillus (12.4), and Histoplasma (7.1). The clinical significance of other, less common fungi was determined by detailed chart review. The cumulative incidence was determined for zygomycosis (1.7 per million per year), hyalohyphomycosis (1.2), and phaeohyphomycosis (1.0). The most common underlying conditions were human immunodeficiency virus infection (47.4%), nonhematologic malignancy (14.7%), diabetes mellitus (9.9%), and chronic lung disease (9.3%). This represents the first population-based epidemiological assessment of invasive mycoses in the United States.
CONTEXT Rabies postexposure prophylaxis (RPEP) treatments and associated costs
have increased in the United States. The extent to which RPEP use is consistent
with guidelines is not well understood. ...OBJECTIVE To characterize animal contacts and determine the frequency and factors
associated with inappropriate RPEP use. DESIGN, SETTING, AND PATIENTS Prospective case series study of patients presenting with an animal
exposure–related complaint from July 1996 to September 1998 at 11 university-affiliated,
urban emergency departments (the Emergency ID Net). MAIN OUTCOME MEASURES Exposure type, circumstances, and RPEP use (appropriateness defined
by local public health departments). RESULTS Of 2030 exposures, 1635 (81%) were to dogs; 268 (13%) to cats; 88 (4%)
to rodents/rabbits; 10 (0.5%) to raccoons; 5 (0.2%) to bats; and 24 (1.2%)
to other animals. Among those exposed, 136 (6.7%) received RPEP after dog
(95), cat (21), raccoon (8), bat (4), or other animal (8) exposures. Use of
RPEP varied by site (range, 0%-27.7% of exposures), with most frequent use
reported at sites in the eastern United States. Management was considered
appropriate in 1857 exposures (91.5%). Use of RPEP was considered inappropriate
in 54 cases (40% of those in which it was given), owing to factors including
animal availability for observation and exposure in a low-endemicity area.
Rabies postexposure prophylaxis was considered inappropriately withheld from
119 cases (6.3% of those not receiving RPEP), often because a domestic animal
was unavailable for observation or testing. CONCLUSION These results suggest that use of RPEP is often inappropriate. Greater
compliance with current guidelines would increase RPEP use. Physician education,
improved coordination with public health officials, and clarification of RPEP
guidelines could optimize use of this expensive resource.
To determine the incidence of cryptococcosis and its risk factors among human immunodeficiency virus (HIV)—infected persons, population-based active surveillance was conducted in four US areas ...(population, 12.5 million) during 1992–1994, and a case-control study was done. Of 1083 cases, 931 (86%) occurred in HIV-infected persons. The annual incidence of cryptococcosis per 1000 among persons living with AIDS ranged from 17 (San Francisco, 1994) to 66 (Atlanta, 1992) and decreased significantly in these cities during 1992–1994. Among non-HIV-infected persons, the annual incidence of cryptococcosis ranged from 0.2 to 0.9/100,000. Multivariate analysis of the case-control study (158 cases and 423 controls) revealed smoking and outdoor occupations to be significantly associated with an increased risk of cryptococcosis; receiving fluconazole within 3 months before enrollment was associated with a decreased risk for cryptococcosis. Further studies are needed to better describe persons with AIDS currently developing cryptococcosis in the era of highly active antiretroviral therapy.
Escherichia coli O157:H7 and other Shiga toxin—producing E. coli (STEC) infections have been associated with bloody diarrhea. The prevalence of enteropathogens among patients with bloody diarrhea was ...determined by a prospective study at 11 US emergency departments. Eligible patients had bloody stools, ⩾3 loose stool samples per 24-h period, and an illness lasting <7 days. Among 873 patients with 877 episodes of bloody diarrhea, stool samples for culture were obtained in 549 episodes (62.6%). Stool cultures were more frequently ordered for patients with fever, >10 stools/day, and visibly bloody stools than for patients without these findings. Enteropathogens were identified in 168 episodes (30.6%): Shigella (15.3%), Campylobacter (6.2%), Salmonella (5.8%), STEC (2.6%), and other (1.6%). Enteropathogens were isolated during 12.5% of episodes that physicians thought were due to a noninfectious cause. The prevalence of STEC infection varied by site from 0% to 6.2%. Hospital admissions resulted from 195 episodes (23.4%). These data support recommendations that stool samples be cultured for patients with acute bloody diarrhea.
The Emerging Infections Programs (EIPs), a population-based network involving 10 state health departments and the Centers for Disease Control and Prevention, complement and support local, regional, ...and national surveillance and research efforts. EIPs depend on collaboration between public health agencies and clinical and academic institutions to perform active, population-based surveillance for infectious diseases; conduct applied epidemiologic and laboratory research; implement and evaluate pilot prevention and intervention projects; and provide capacity for flexible public health response. Recent EIP work has included monitoring the impact of a new conjugate vaccine on the epidemiology of invasive pneumococcal disease, providing the evidence base used to derive new recommendations to prevent neonatal group B streptococcal disease, measuring the impact of foodborne diseases in the United States, and developing a systematic, integrated laboratory and epidemiologic method for syndrome-based surveillance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To describe the burden and trends in hospitalizations associated with infectious diseases among American Indian and Alaska Native (AI/AN) infants.
First-listed infectious disease hospitalizations and ...hospitalization rates among AI/AN infants and infants in the general US population from 1988-1999 were analyzed by using Indian Health Service/tribal hospital discharge data and the National Hospital Discharge Survey data, respectively.
Infectious disease hospitalizations accounted for 53% of all AI/AN infant hospitalizations and approximately 43% of all US infant hospitalizations during 1988-1999. The annual hospitalization rate for infectious diseases among AI/AN infants declined from 27,486 per 100,000 infants in 1988 to 14,178 per 100,000 infants in 1999. However, the rates for AI/AN infants within the Alaska, Southwest, and Northern Plains regions remained higher than that for the general US infant population at the end of the study period. Lower respiratory tract infection hospitalizations accounted for almost 75% of AI/AN infant infectious disease hospitalizations, and the lower respiratory tract infection hospitalization rate for AI/AN infants was twice that for US infants.
Although infectious disease hospitalization rates for AI/AN infants have declined, AI/AN infants continue to have a higher infectious disease burden than the general US infant population.
At least four Bacillus anthracis-containing envelopes destined for New York City and Washington, D.C. were processed at the Trenton Processing and Distribution Center (PDC) on September 18 and ...October 9, 2001. When cutaneous anthrax was confirmed in a Trenton postal worker, the PDC was closed. Four cutaneous and two inhalational anthrax cases were identified. Five patients were hospitalized; none died. Four were PDC employees; the others handled or received mail processed there. Onset dates occurred in two clusters following envelope processing at the PDC. The attack rate among the 170 employees present when the B. anthracis-containing letters were sorted on October 9 was 1.2%. Of 137 PDC environmental samples, 57 (42%) were positive. Five (10%) of 50 local post offices each yielded one positive sample. Cutaneous or inhalational anthrax developed in four postal employees at a facility where B. anthracis-containing letters were processed. Cross-contaminated mail or equipment was the likely source of infection in two other case-patients with cutaneous anthrax.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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