Heat susceptibility of bacterial enteropathogens. Implications for the prevention of travelers' diarrhea

The heat susceptibility of four bacterial enteropathogens in foods and water was studied to develop effective recommendations for travelers to regions where diarrheal diseases are important health problems. All enteropathogens tested survived well in foods stored at refrigerator temperature (4 degrees C), room temperature (25 degrees C), and 50 degrees C, which is too hot to touch. Tap water had to be heated above 65 degrees C to reliably kill all bacterial enteropathogens. At 13 of the 14 tourist-oriented hotels in four countries, water from the hot water tap did not reach temperatures of 65 degrees C. The implications of this study are that food and water that are too hot to touch may still be contaminated with bacterial enteropathogens. Travelers should be advised that food, water, or beverages are safe only if they have been brought to boiling or near-boiling temperatures prior to consumption.     

Candida-associated diarrhea in hospitalized patients

Ten hospitalized patients with severe diarrhea associated with intestinal Candida overgrowth are reported. Candida-associated diarrhea is predominantly of the secretory type, characterized by frequent watery stools, usually without blood, mucus, tenesmus, or abdominal pain. The patients were elderly, malnourished, and critically ill, or suffered from chronic debilitating illness. Their hospital stays were prolonged, and the majority were being treated with multiple antibiotics or chemotherapeutic agents. Diarrhea often led to dehydration, prerenal azotemia, hyperchloremic metabolic acidosis, and electrolyte imbalance. Stool culture most frequently isolated Cand. albicans in association with decreased normal flora. Colonoscopy showed no evidence of colitis. Diagnosis was made based on the absence of diarrhea-producing medications, the continuation of diarrhea despite fasting, the exclusion of other infections, inflammatory conditions and other causes of secretory diarrhea, and a dramatic response to a short course of nystatin.     

Prevalence of rotavirus diarrhea among outpatients and hospitalized patients: a comparison

The prevalence of rotavirus diarrhea was compared in two settings, among children attending outpatient clinics and those hospitalized (inpatients) at Pune, India. A total of 489 and 628 fecal specimens were collected during October 1993 to September 1996 from outpatients and inpatients respectively. Overall occurrence of rotavirus diarrhea was more among hospitalized children. Using the stratification on the variable age, it is shown that age is indeed a confounding variable. The important finding of the study was, in < or = 6 months age group, it was observed that the occurrence of rotavirus diarrhea was more in the outpatients (30.26%) than among the inpatients (10.11%). Children of this age group are likely to be partially protected by maternal antibodies. The effect of seasonality and sex distribution did not differ in the two settings. It was found that G2 serotype was the major cause of diarrhea among the outpatients.     

Incidence of sepsis in hospitalized patients

In recent years, several epidemiological studies have helped expand our knowledge of the incidence of sepsis at the intensive care unit (ICU) and population levels. However, more data are needed from developing countries. Overall, even with a lack of standardized definitions—particularly of sepsis-associated organ dysfunction, hypoperfusion or hypotension, and septic-induced cardiovascular failure despite adequate fluid resuscitation—the incidence of sepsis seems higher in Brazil, the United Kingdom, and Portugal. In the future, in order to better identify patients that need early ICU admission, aggressive care, and new therapies, we must develop and apply better instruments for definition and risk stratification, especially for evaluating the risk of progressing from sepsis to severe sepsis and septic shock.     

Spectrum of hemoglobinopathies in Orissa, India

Five hundred and 20 cases (279 males; 241 females), referred for anemia, with a wide age range, from different parts of the state of Orissa, India, were investigated to evaluate the extent of the prevalence of hemoglobinopathies (sickle cell disorders and thalassemias) by analyzing the associated hemoglobin (Hb) profiles, Hb genotypes, as well as the clinical and hematological parameters. We found sickle cell trait (Hb AS) in 131 cases (62 males; 69 females), homozygous sickle cell anemia in 49 cases (34 males; 15 females) and Hb S-beta thalassemia (S-beta-thal) in 17 cases (nine males; eight females). There were also 46 cases (32 males; 14 females) of beta-thal major, 103 cases (51 males; 52 females) of beta-thal trait, six cases (four males; two females) of Hb E trait [beta26(B8)Glu-->Lys; GAG-->AAG], and 17 cases (12 males; five females) of Hb E-beta-thal (E-beta-thal). A large proportion of these anomalies were found among the general caste people rather than among the tribal population which constitutes 22% of the total population in this state. Hb E was found mainly in higher castes like Khandayat and Karan, residing in the coastal region of Orissa. This study provides comprehensive data on the spectrum of hemoglobinopathies in this state.     

High proportion of isosporiasis among HIV-infected patients with diarrhea in southern India

We investigated 245 diarrheal stool specimens from HIV-positive subjects between January 2003 and December 2006 to determine the etiological role of coproparasites. Parasitic etiology was observed in 91 (37.1%) cases. Isospora belli (26.1%) was the most common parasite followed by Entameba histolytica/dispar (3.3%), Cryptosporidium spp. (2.9%), Giardia intestinalis (1.6%), and Strongyloides stercoralis (1.2%). Interesting trends of significant increase in the number of cases of I. belli and decline in Cryptosporidium spp. were observed during the study period.     

Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure

OBJECTIVES: The goal of this study was to determine the prevalence of worsening renal function (WRF) among hospitalized heart failure (HF) patients, clinical predictors of WRF, and hospital outcomes associated with WRF. BACKGROUND: Impaired renal function is associated with poor outcomes among chronic HF patients. METHODS: Chart reviews were performed on 1,004 consecutive patients admitted for a primary diagnosis of HF from 11 geographically diverse hospitals. Cox regression model analysis was used to identify independent predictors for WRF, defined as a rise in serum creatinine of >0.3 mg/dl (26.5 micromol/l). Bivariate analysis was used to determine associations of development of WRF with outcomes (in-hospital death, in-hospital complications, and length of stay). RESULTS: Among 1,004 HF patients studied, WRF developed in 27%. In the majority of cases, WRF occurred within three days of admission. History of HF or diabetes mellitus, admission creatinine > or =1.5 mg/dl (132.6 micromol/l), and systolic blood pressure >160 mm Hg were independently associated with higher risk of WRF. A point score based on these characteristics and their relative risk ratios predicted those at risk for WRF. Hospital deaths (adjusted risk ratio [ARR] 7.5; 95% confidence intervals [CI] 2.9, 19.3), complications (ARR 2.1; CI 1.5, 3.0), and length of hospitalizations >10 days (ARR 3.2, CI 2.2, 4.9) were greater among patients with WRF. CONCLUSIONS: Worsening renal function occurs frequently among hospitalized HF patients and is associated with significantly worse outcomes. Clinical characteristics available at hospital admission can be used to identify patients at increased risk for developing WRF.     

Prevalence of Campylobacter jejuni and enteric bacterial pathogens among hospitalized HIV infected versus non-HIV infected patients with diarrhoea in southern India

A prevalence study on Campylobacter jejuni and other enteric bacterial pathogens was carried out in 200 HIV infected and 200 non-HIV infected subjects with diarrhoeal symptoms at an AIDS Hospital in southern India. Diarrhoeal specimens were inoculated onto standard culture media as well as onto Columbia and Campylobacter blood agar media for C. jejuni isolation. All the C. jejuni isolates were tested for antimicrobial susceptibility using Kirby-Bauer's method. A significant difference in recovery rates was observed between the 2 groups in relation to C. jejuni (p < or = 0.02; 95% CI 5.5 (1-10) and Shigella spp. (p < or = 0.02; 95% CI 6.5 (1-12). 21 isolates of Shigella spp., 16 C. jejuni, 5 Salmonella typhi, 3 Arcobacter spp., 3 Yersinia enterocolitica, and 2 Aeromonas hydrophila were recovered from the HIV infected cases. All the C. jejuni isolates were sensitive to ciprofloxacin whereas 1 strain was resistant to nalidixic acid. Interestingly, all the 29 Shigella spp. (21 from HIV and 8 from non-HIV cases) were resistant to erythromycin and most were resistant to many other antibiotics used. Our observations underline the need for epidemiological investigations to screen C. jejuni and Shigella spp. in HIV infected subjects with diarrhoea and analyse their antibiograms periodically to minimize disease burden in HIV/AIDS.     

Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis

BACKGROUND AND AIM: Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis. METHODS: All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded. RESULTS: A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin. CONCLUSION: Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.     

徐州地区感染性腹泻病人中致病性弧菌的分布研究

目的了解徐州地区感染性腹泻中致病性弧菌的分布情况,掌握其流行规律,为致病性弧菌引起的感染性腹泻提供科学的控制和防治依据。方法用常规分离培养方法检测感染性腹泻粪便或肛拭子标本2674例。结果共检出致病性弧菌10个种类,518株,总检出率为19.37%。结论致病性弧菌是引起本地区感染性腹泻的主要病原菌之一,种类分布繁多。应加强对致病性弧菌的动态监测。     

Monitoring the chloroquine sensitivity of Plasmodium vivax from Calcutta and Orissa,India

Chloroquine-resistant Plasmodium vivax malaria was first reported in India in 1995. This report led to the round-the-year monitoring, in Calcutta (West Bengal) and Mayurbhanj district (northern Orissa), of the in-vivo sensitivity of local P. vivax to chloroquine (CQ). Between January 1998 and December 2001, 800 cases with microscopically confirmed P. vivax malaria were enrolled in the study. Each was given CQ in the regimen recommended both by the Government of India and the World Health Organization (i.e. a total of 25 mg/kg, over 3 days). Only six cases, of the 480 who completed the scheduled 28 days of follow-up, failed to clear their parasitaemias by day 5. Even these six cases had only low-level parasitaemias on day 5, and all were aparasitaemic by day 7. In the study area, despite the wide-spread abuse of CQ and the increasingly frequent reports of CQ-resistant P. falciparum, CQ appears to remain an effective drug in the treatment of P. vivax.     

Pressure sores among hospitalized patients

A cross-sectional survey was done to determine the prevalence of pressure sores in hospitalized patients and the factors associated with having a pressure sore in the hospital. Among 634 adult patients, 30 (4.7%; 3.1% to 6.3%, 95% confidence interval) had a pressure sore and 78 (12.3%; 9.8% to 14.8%) were at risk for a pressure sore because they had been confined to a bed or chair for at least 1 week. Comparing these two groups of patients, we found that fecal incontinence, diarrhea, fractures, urinary catheter use, decreased weight, dementia, and hypoalbuminemia were associated with having pressure sores (p less than or equal to 0.05). Using logistic regression analysis, hypoalbuminemia, fecal incontinence, and fractures remained significantly and independently associated with having a pressure sore (odds ratios = 3.0, 3.1, and 5.2, respectively; p less than or equal to 0.05). Our findings suggest that 17% (14% to 20%) of hospitalized patients have pressure sores or are at risk for them, and that hypoalbuminemia, fecal incontinence, and fractures may identify bedridden patients at greatest risk.     

Incidence of type-2 diabetes among industrial Workers in Kerala,India

Kerala is the most advanced Indian state in epidemiological transition and has the highest type 2 diabetes prevalence. However, data on incidence of diabetes in Kerala are limited. We studied the incidence of diabetes and pre-diabetes among industrial workers. We measured fasting plasma glucose (FPG) among 326 workers (mean age 51 years, men 76 %) from two major industries in Kerala in the years 2009 and 2011 using standard protocol. Individuals with FPG ≥126 mg/dl or on medications for diabetes were considered to have diabetes mellitus, FPG ≥100 mg/dl and ≤125/dl mg as pre-diabetic, and FPG <100 mg/dl as normal. Among the 326 workers, 26.1 % (95 % CI 21.6–31.1) were diabetic, 32.8 % (CI 28.7–37.2) were pre-diabetic, and the remaining 41.1 % were having normal FPG at baseline. At year two, 13.3 % of the 241 workers who were either normal or had pre-diabetes at baseline developed diabetes providing an incidence rate of 6.65 % per year. Among the 134 workers with normal FPG at baseline 28.4 % progressed to pre-diabetes, 5.2 % developed diabetes, and among the 107 pre-diabetics, 23.4 % developed diabetes at year two. The odds of progressing to diabetes from pre-diabetes were five times higher compared to those from normal FPG (OR 5.53; CI 2.28–13.37). Progression to pre-diabetes and diabetes occurred at a very fast rate in this population indicating the need for preventive measures to slow down this fast progression.     

Anaemia in acute, Plasmodium falciparum malaria in children from Orissa state, India.

The severity of anaemia associated with acute, Plasmodium falciparum malaria and the extent to which haemolysis, bone-marrow suppression, and pre-existent iron deficiency contribute to the anaemia were assessed in 102 Indian children aged 2-12 years. Blood haemoglobin (Hb), plasma unconjugated bilirubin and haptoglobin, serum iron and transferrin concentrations and transferrin saturation, red cell morphology and reticulocyte response were investigated in the patients and in 50 control children. Twenty-three patients with severe anaemia (< 70 g Hb/litre) were investigated further, by bone-marrow biopsy followed by iron staining of sections or touch smears of the biopsy material. There was evidence of haemolysis in the malaria cases: in the peripheral blood smears and the significantly higher plasma concentrations of unconjugated bilirubin, lower plasma concentrations of haptoglobin and lower blood concentrations of Hb than those seen in the controls. Haemoglobin concentration correlated directly with haptoglobin (r = 0.489; P < 0.001) and inversely with unconjugated bilirubin in malaria patients (r = -0.526; P < 0.001) but not in controls (r = -0.140 and -0.061, respectively). Parasitaemia (parasites/microliter) was not significantly correlated with Hb, haptoglobin or unconjugated bilirubin. Compared with the earlier samples, follow-up samples from the patients, collected 2 weeks after discharge from hospital and antimalarial therapy, showed significant increase in Hb, haematocrit, haptoglobin and decreases in both total and unconjugated bilirubin. There was evidence of hypercellularity and mild-moderate erythroid hyperplasia, mainly of normoblastic maturation with adequate reticulocyte response, in the bone-marrow samples from the cases of severe anaemia; dyserythropoiesis was only noticed in one case and no stainable iron was detectable in 17 of the 23 cases. These observations indicate that haemolysis is the prime cause of the anaemia seen in acute falciparum malaria, although destruction of parasitised erythrocytes is not the sole cause of the haemolytic process. Bone-marrow suppression appears to have an insignificant role but pre-existent iron deficiency aggravates the severity of the anaemia.     

Incidence of venous thromboembolism in patients hospitalized with cancer

Background

There are sparse data on the frequency of venous thromboembolism in patients with various types of cancer. We sought to determine the incidence and relative risk of venous thromboembolism, pulmonary embolism, and deep venous thrombosis in patients with malignancies.

Subjects and methods

The number of patients discharged with a diagnostic code for 19 types of malignancies, pulmonary embolism or deep venous thrombosis from 1979 through 1999 was obtained from the National Hospital Discharge Survey. Patients studied were men and women of all ages and races.

Results

In patients with any of the 19 malignancies studied, 827 000 of 40 787 000 (2.0%) had venous thromboembolism, which was twice the incidence in patients without these malignancies, 6 854 000 of 662 309 000 (1.0 %). The highest incidence of venous thromboembolism was in patients with carcinoma of the pancreas, 51 000 of 1 176 000 (4.3%), and the lowest incidences were in patients with carcinoma of the bladder and carcinoma of the lip, oral cavity or pharynx. The overall incidences of pulmonary embolism and deep venous thrombosis were also twice the rates in noncancer patients. Incidences with cancer were not age dependent. The incidence of venous thromboembolism in patients with cancer began to increase in the late 1980s.

Conclusion

Patients with cancer had twice the incidence of venous thromboembolism, pulmonary embolism and deep venous thrombosis as patients without cancer. The incidence of venous thromboembolism, pulmonary embolism and deep venous thrombosis associated with cancer differed according to the type of cancer, was comparable in elderly and younger patients, and increased in the late 1980s and 1990s.     

Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada

BACKGROUND: Stroke is a leading cause of death and disability, and poses a significant burden of care for those who survive. OBJECTIVES: To estimate the incidence of hospitalization for stroke and describe the impact of age, sex and comorbidity on in-hospital mortality, length of stay and readmission rates. METHODS: Health insurance numbers were used to link acute care hospitalizations across Canada in 1999/2000 for stroke patients with no discharges for a stroke within the preceding five years. Patients were followed up for one year from the date of their initial admission. RESULTS: The numbers of men (15,367) and women (16,740) in the study were similar. The incidence of all types of stroke (International Classification of Diseases, ninth revision, codes 430, 431 and 434/436) for hospitalized men and women was 14.4 per 10,000, with a 15-fold rise from 8.7 for the age group of 45 to 64 years to 131.9 per 10,000 for the age group 80 years and older. For the index episode, stroke patients spent an average of 21.0 days in the hospital, and 18.2% died in the hospital within 28 days. Of those who survived the first episode, 10.3% were readmitted to the hospital within one year with a recurrent stroke, and overall 37.1% were readmitted for any cause (including stroke). Among these stroke patients, hypertension was codiagnosed in 35%; diabetes in 17%; arrhythmia in 15%; ischemic heart disease in 13.6%; and congestive heart failure in 5%. CONCLUSIONS: Hospital records linked by patient identification can produce more accurate national estimates of patients hospitalized with stroke than any current countrywide surveillance system.