An outbreak of <Emphasis Type="Italic">Salmonella</Emphasis> Enteritidis phage type 34a infection associated with a Chinese restaurant in Suffolk,United Kingdom

Background

On 30^th July 2002, the Suffolk Communicable Disease Control Team received notifications of gastrointestinal illness due to Salmonella Enteritidis in subjects who had eaten food from a Chinese restaurant on 27^th July. An Outbreak Control Team was formed resulting in extensive epidemiological, microbiological and environmental investigations.

Methods

Attempts were made to contact everybody who ate food from the restaurant on 27^th July and a standard case definition was adopted. Using a pre-designed proforma information was gathered from both sick and well subjects. Food specific attack rates were calculated and two-tailed Fisher's exact test was used to test the difference between type of food consumed and the health status. Using a retrospective cohort design univariate Relative Risks and 95% Confidence Intervals were calculated for specific food items.

Results

Data was gathered on 52 people of whom 38 developed gastrointestinal symptoms; 16 male and 22 female. The mean age was 27 years. The mean incubation period was 30 hours with a range of 6 to 90 hours. Food attack rates were significantly higher for egg, special and chicken fried rice. Relative risk and the Confidence interval for these food items were 1.97 (1.11–3.48), 1.56 (1.23–1.97) and 1.48 (1.20–1.83) respectively. Interviews with the chef revealed that many eggs were used in the preparation of egg-fried rice, which was left at room temperature for seven hours and was used in the preparation of the other two rice dishes. Of the 31 submitted stool specimens 28 tested positive for S Enteritidis phage type 34a and one for S Enteritidis phage type 4.

Conclusion

In the absence of left over food available for microbiological examination, epidemiological investigation strongly suggested the eggs used in the preparation of the egg-fried rice as the vehicle for this outbreak. This investigation highlights the importance of safe practices in cooking and handling of eggs in restaurants.

     

Prevalence of <Emphasis Type="Italic">Chlamydia trachomatis</Emphasis>infection among women in a Middle Eastern community

Background  

Common vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates.     

Factor XIII deficiency: a rare cause of repeated abortions

Factor XIII deficiency is a rare cause of early abortion. The obstetrical outcome of four pregnancies in two women with factor XIII deficiency is reported. Both women were treated with substitution therapy using locally-prepared cryoprecipitate. The outcome in these two women demonstrated the need for substitution therapy in early pregnancy leading to an increased chance of obstetrical success.     

Chronic microsporidial stromal keratitis in an immunocompetent, non-contact lens wearer

An 82-year-old healthy man with unilateral chronic stromal keratitis, initially diagnosed to have viral keratitis and refractory to medical therapy, showed numerous oval, microsporidial organisms, measuring 4-5 m in length in the corneal biopsy. Penetrating keratoplasty, followed by treatment with systemic albendazole and topical propamidine isethionate resulted in resolution of the infection. Electron microscopy of the keratoplasty specimen demonstrated sporoblasts with diplokaryotic nuclei and multiple coils of the filament. The light and electron microscopic features were consistent with microsporidial keratitis.     

Ligneous Conjunctivitis: A Clinicopathologic Study of 3 Cases

The clinical, histopathologic features, and treatment outcomes in 3 patients with ligneous conjunctivitis are described. Bilateral, idiopathic membranes occurred in the palpebral conjunctiva in 2 patients. In 1 patient, unilateral conjunctival changes occurred in the bulbar conjunctiva, at the site of pterygium excision. Treatment included topical hyaluronidase, chymotrypsin, heparin, and cyclosporine and surgical excision with limited or no success. In one patient, conjunctival autografting from the normal fellow eye resulted in pseudomembrane formation at the donor site in the previously unaffected eye. Histopathological evaluation of excised membranes revealed the presence of amorphous eosinophilic hyaline material and chronic inflammatory cells. Immunohistochemical study revealed a predominance of T-lymphocytes. This case series confirms the recalcitrant clinical course of ligneous conjunctivitis. Conventional treatment modalities described in literature were not useful in the management of this condition. Surgical manipulation of the unaffected fellow eye in patients with unilateral disease can result in pathologic conjunctival changes, and is best avoided. This revised version was published online in July 2006 with corrections to the Cover Date.     

Concomitant adenoma and hybrid carcinoma of salivary gland type arising in Bartholin's gland.

We report a unique case of a salivary gland type of "hybrid carcinoma" arising within a Bartholin's gland adenoma. The tumor was characterized by large areas of an epithelial-myoepithelial carcinoma similar to that of the salivary gland with a peripheral infiltrative pattern of an adenoid cystic carcinoma (ACC).     

An observational, prospective study exploring the use of heart rate variability as a predictor of clinical outcomes in pre-hospital ambulance patients

OBJECTIVE: To explore the use of pre-hospital heart rate variability (HRV) as a predictor of clinical outcomes such as hospital admission, intensive care unit (ICU) admission and mortality. We also implemented an automated pre-analysis signal processing algorithm and multiple principal component analysis (PCA) for outcomes. MATERIALS AND METHODS: We conducted a prospective observational clinical study at an emergency medical services (EMS) system in a medium sized urban setting in the United States. Electrocardiogram (ECG) data was obtained from a sample of 45 ambulance patients conveyed to a tertiary hospital, monitored with a LIFEPAK12 defibrillator/monitor. After extracting the data, filtering for noise reduction and isolating non-sinus beats, various HRV parameters were computed. These included time domain, frequency domain and geometric parameters. PCA was performed on the hospital outcomes for these patients. RESULTS: We used a combination of HRV parameters, age and vital signs such as respiratory rate, SpO(2) and Glasgow coma score (GCS) in a PCA analysis. For predicting admission to ICU, sensitivity was 100%, specificity was 48.6%, and negative predictive value (NPV) was 100%; for predicting admission to hospital, sensitivity was 78.9%, specificity was 85.7%, and NPV was 75.0%; for predicting death, sensitivity was 50.0%, specificity was 100%, and NPV was 97.4%. There was also a significant correlation of several HRV parameters with length of hospital stay. CONCLUSIONS: With signal processing techniques, it is feasible to filter and analyze ambulance ECG data for HRV. We found a combination of HRV parameters and traditional 'vital signs' to have an association with clinical outcomes in pre-hospital patients. This may have potential as a triage tool for ambulance patients.