Human listeriosis in Britain, 1967-85, a summary of 722 cases. 2. Listeriosis in non-pregnant individuals, a changing pattern of infection and seasonal incidence

Clinical information was collected on 722 cases of Listeria monocytogenes infections in humans occurring in Britain between 1967 and 1985. This series comprised 34% (248 cases) associated with pregnancy and 66% (474 cases) in non-pregnant adults and juveniles. The cases not associated with pregnancy comprised: 76% in patients with severe underlying illness (of which 34% had central nervous system infections, and 42% bacteraemia without involvement of the central nervous system); 21% in previously healthy individuals (of whom 18% had meningitis); and 3% in patients without bacteraemia or involvement of the central nervous system. Cases occurred most often in male patients over 40 years of age. The overall mortality was 44%. Overall, the pattern of infection has altered to a disease of higher incidence, affecting most often susceptible non-pregnant individuals and the unborn. An annual increase in incidence of listeriosis occurred in the autumn in all categories of patients.     

Smoking during pregnancy, 1967-80.

Data from two national samples of live births to married mothers (the 1967 and 1980 National Natality Surveys) were used to document changes in smoking during pregnancy. Smoking among married teenagers remained essentially constant between 1967 and 1980. For married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 40 to 25 per cent among Whites and 33 to 23 per cent among Blacks. There were striking differences in the magnitude of the decrease by educational attainment. Among the White married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 48 to 43 per cent for those with less than 12 years education and from 34 to 11 per cent for those with 16 or more years education.     

The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group

To determine the morbidity and mortality due to listeriosis in the United States, the authors undertook an active surveillance project in 1986 to identify all cases in which Listeria monocytogenes was isolated from cultures of ordinarily sterile sites in a population of 34 million persons. The authors estimated that at least 1,700 cases of listeriosis and 450 deaths occurred in the United States in 1986; 27% of these cases occurred in pregnant women, with 22% of perinatal cases resulting in stillbirths or neonatal deaths. The risk of listeriosis in adults (0.5 per 100,000 population) was similar in all regions studied; the incidence of perinatal listeriosis was three times higher in Los Angeles County, California, than in the other areas (24.3/100,000 live births vs. 7.8/100,000 live births). Geographic variation may have resulted from underdiagnosis of perinatal listeriosis in five of the study areas. Multilocus electrophoretic enzyme typing was useful for elucidating the molecular epidemiology of L. monocytogenes; perinatal listeriosis was significantly associated with one group of related strains. Multilocus electrophoretic enzyme typing also identified three clusters representing possible common-source outbreaks. These findings document the substantial morbidity due to listeriosis in the United States; to the extent that sporadic listeriosis is foodborne, this morbidity could be reduced by appropriate preventive measures, particularly in persons known to be at increased risk of infection.     

Mortality during influenza epidemics in the United States, 1967-1978.

Excess deaths due to pneumonia and influenza and excess deaths for all causes were estimated using a time-series analysis for each of the eight influenza epidemics in the United States that occurred between 1967-1978. The effects of different analytic methods and different methods of structuring data are compared. Future directions for estimating the impact of influenza on mortality include a combination of regression techniques and multiple time-series analyses of surveillance data.     

Estimates of pregnancies and pregnancy rates for the United States, 1976-85.

After increasing by 9 per cent in the period 1976-80 in the United States, pregnancy rates declined by 4 per cent between 1980 and 1984 (from 111.9 to 107.3 pregnancies per 1,000 women aged 15-44 years). Between 1984 and 1985, the rate rose by less than 1 per cent to 108.2. More detailed data by age and race, available only through 1983, indicate that the decline in the 1980-83 period was not shared by all age groups. For example, pregnancy rates continued to increase for women in their thirties, and teenage pregnancy remained substantially the same. In 1983, 61 per cent of all pregnancies ended in live birth, 26 per cent in induced abortion, and 13 per cent in fetal loss. Pregnancy rates in that year were two-thirds higher for women of races other than White than for White women, and pregnancies of other-than-White women were more likely to terminate as an induced abortion or fetal loss. However, White teenagers and teenagers of other races were about equally likely to have their pregnancy end in induced abortion or fetal loss.     

Administration of iodized oil during pregnancy: a summary of the published evidence.

This brief review of the available studies confirms that the administration of iodized oil before or during pregnancy prevents endemic cretinism and brain damage by correcting iodine deficiency and thyroid function in pregnant women, fetuses, neonates, infants and children. The potential benefits derived from using iodized oil immediately before or during pregnancy greatly outweigh the potential risks in areas of moderate and severe prevalence of iodine-deficiency disorders, where iodized salt is not yet available.     

Genital flora during pregnancy and colonization of the newborn

A longitudinal study of the cervical and vaginal microflora of 131 pregnant women showed a similar range of organisms at first visit (up to 16 weeks), at 28 weeks and at 36 weeks of pregnancy. Twenty different groups or genera of microorganisms were recovered, predominantly lactobacilli. There was a fall in the isolation rate of organisms in the mothers 6 to 8 weeks after delivery. Lactobacilli and yeasts including Candida albicans were recovered less frequently whereas the incidence of Escherichia coli and group B streptococci increased.

Infants born to these mothers were swabbed within 24 hours of delivery and yielded organisms from the umbilicus, ear and mouth in 24%, 33% and 38% of cases respectively. Alpha haemolytic streptococci and Staphylococcus aureus were the predominant organisms. Sixteen different groups or genera were isolated.

The isolation rates in non-pregnant women attending a `well-women' clinic were similar to those in the postnatal mothers; few women of 60 years or more were colonized.

     

妊娠合并败血症19例分析

目的:探讨妊娠合并败血症的特点及高危因素。方法:回顾性分析2004年1月～2006年7月间产科住院病人中发生妊娠合并败血症的相关资料。结果:2004年1月～2006年7月间发生19例共20次妊娠合并败血症(其中1例发生两次败血症),发生率为0.20%,以革兰阴性细菌败血症为主,致病菌中不动杆菌占首位,其中鲁氏不动杆菌4株,鲍曼氏不动杆菌2株;妊娠期发生败血症的高危因素为先兆早产、前置胎盘、胎膜早破。结论:妊娠期败血症以革兰阴性细菌败血症为主,致病菌主要为条件致病菌;孕期应加强监测,积极处理高危因素,降低感染发生率;根据微生物学培养结果选择敏感抗生素,必要时终止妊娠,可有效地治疗败血症,取得良好结局。     

妊娠合并亚临床甲状腺功能减退症1053例临床分析

目的：研究亚临床甲状腺功能减退（ SCH）对孕期并发症及妊娠结局的影响。方法选取经甲状腺功能筛查诊断为SCH的孕妇1053例（ SCH组）,正常孕妇3899例（对照组）,比较各组TSH、FT4、TPOAb,孕期并发症及妊娠结局情况。结果SCH组的TSH水平及TPOAb阳性率均高于对照组（t＝39．001,P＜0．01;χ2＝40．753,P＜0．01）。 SCH组的早产率及新生儿窒息率高于对照组（χ2＝8．638,P＜0．05;χ2＝22．209,P＜0．01）,SCH组新生儿低出生体重率高于对照组,但无统计学意义（χ2＝2．323,P＞0．05）。结论 SCH是孕期常见病,可能与流产、早产等妊娠不良结局的发生相关,应重视妊娠妇女的SCH筛查。