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C. Sivert, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.
Associate Professor, Edward Via College of Osteopathic Medicine
Potential for Q Fever Infection Among Travelers Returning from Iraq and the Netherlands. Biochemical stratagem for obligate parasitism of eukaryotic cells by Coxiella burnetii. Characterization of a Coxiella burnetii ftsZ mutant generated by Himar1 transposon mutagenesis. Alpha(v)beta(3) intergrin and bacterial lipopolysaccaride are involved in Coxiella burnetii-stimulated production of tumor necrosis factor by human monocytes. Coxiella burnetii induces reorganization of the actin cytoskeleton in human monocytes. Differential interaction with endocytic and exocytic pathways distinguish parasitophorous vacuoles of Coxiella burnetii and Chlamydia trachomatis. Coxiella burnetii inhabits a cholesterol-rich vacuole and influences cellular cholesterol metabolism. Maturation of the Coxiella burnetii parasitophorous vacuole requires bacterial protein synthesis but not replication. Sustained activation of Akt and Erk1/2 is required for Coxiella burnetii antiapoptotic activity. Stimulation of toll-like receptor 2 by Coxiella burnetii is required for macrophage production of pro-inflammatory cytokines and resistance to infection. Protein-tyrosine phosphatase activity of Coxiella burnetii that inhibits human neutrophils. Comparative genomics reveal extensive transposon-mediated genomic plasticity and diversity among potential effector proteins within the genus Coxiella. Turning a tiger into a house cat: using Legionella pneumophila to study Coxiella burnetii. Functional similarities between the icm/dot pathogenesis systems of Coxiella burnetii and Legionella pneumophila. Isolation from animal tissue and genetic transformation of Coxiella burnetii are facilitated by an improved axenic growth medium. The Coxiella burnetii Dot/Icm system creates a comfortable home through lysosomal renovation. Coxiella burnetii isolates cause genogroup-specific virulence in mouse and guinea pig models of acute Q fever. Air-borne transmission of Q fever: the role of parturition in the generation of infective aerosols. Q fever in California; recovery of Coxiella burnetii from naturally-infected air-borne dust. Q fever studies in Southern California; recovery of Rickettsia burnetii from raw milk. Seroepidemiology of Q fever in Nova Scotia: evidence for age dependent cohorts and geographical distribution. Upregulation of tumor necrosis factor alpha and interleukin-1 beta in Q fever endocarditis. Production of interleukin-10 and transforming growth factor beta by peripheral blood mononuclear cells in Q fever endocarditis. Evaluation of specificity of indirect enzyme-linked immunosorbent assay for diagnosis of human Q fever. Evaluation of the complement fixation and indirect immunofluorescence tests in the early diagnosis of primary Q fever. Humoral immune response to Q fever: enzyme-linked immunosorbent assay antibody response to Coxiella burnetii in experimentally infected guinea pigs. Development of a chloroform:methanol residue subunit of phase I Coxiella burnetti for the immunization of animals. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Serologic and skin-test response after Q fever vaccination by the intracutaneous route. Low-dose priming before vaccination with the phase I chloroformmethanol residue vaccine against Q fever enhances humoral and cellular immune responses to Coxiella burnetii. Acinetobacter species are environmentally hardy and difficult to eradicate from inanimate healthcare surfaces, but their relatively low virulence makes them poor candidates for weaponizing. In fact, even in the most severely war-wounded patients, Acinetobacter species infections are rarely fatal.
Intestinal anthrax may mimic acute gastroenteritis, acute abdomen with peritonitis (thus focal and rebound tenderness), or dysentery. Abdominal radiographic studies are non-specific, sometimes showing diffuse airfluid levels, bowel thickening, and peritoneal fluid. Surgical findings may include hemorrhagic mesenteric adenitis, serosanguinous to hemorrhagic ascites, bowel ulceration (usually ileum and cecum), edema, and necrosis. Notably absent in inhalational anthrax are upper respiratory symptoms (rhinorrhea, coryza, congestion) as one would see with influenza. Pneumonia generally does not occur; therefore, lung exam may be unrevealing and organisms are not typically seen in the sputum. White blood cell count is typically elevated only slightly at presentation (mean 9,800/microliter in 2001 cases) with a neutrophil predominance. Bacillus anthracis will be detectable even in the early phase of disease by routine blood culture and may even be seen on Gram stain of blood later in the course of the illness; however, even one or two doses of antibiotics will render blood (and other sites) sterile. Antibiotic choices must be adjusted for strain susceptibility patterns, and consultation with an infectious disease physician is imperative. Generally, ciprofloxacin or doxycycline use is avoided during pregnancy and in children due to safety concerns; however, a consensus group and the American Academy of Pediatrics have suggested that ciprofloxacin or doxycycline should still be used as first line therapy in lifethreatening anthrax disease until strain susceptibilities are known. Recommended treatment duration is at least 60 days, and should be changed to oral therapy as clinical condition improves. In the event of a mass-casualty situation intravenous antibiotics may not be available. The doses for ciprofloxacin are 500 mg po bid for adults, and 10-15 mg/kg po bid (up to 1 g/day) for children. The doses for doxycycline are 21 200 mg po initially then 100 mg po bid thereafter for adults (or children > 8 yr and > 45 kg), and 2. Supportive therapy for shock, fluid volume deficit, and adequacy of airway may be needed. Corticosteroids may be considered as adjunct therapy in patients with severe edema or meningitis, based upon experience in treating other bacterial diseases. Cutaneous anthrax Uncomplicated cutaneous anthrax disease should be treated initially with either ciprofloxacin (500 mg po bid for adults or 10-15 mg/kg/day divided bid (up to 1000 mg/day) for children) or doxycycline (100 mg po bid for adults, 5 mg/kg/day divided bid for children less than 8 yr (up to 200 mg/day)). If the strain proves to be penicillin susceptible, then the treatment may be switched to amoxicillin (500 mg po tid for adults or 80 mg po divided tid (up to 1500 mg/day) for children). If the exposure is known to have been due to contact with infected livestock or their products, then 7-10 days of antibiotics may suffice. If systemic illness accompanies cutaneous anthrax, then intravenous antibiotics should be administered as per the inhalational anthrax recommendations discussed above. Documentation of clinical experience in treating oropharyngeal and intestinal anthrax is limited. Supportive care to include fluid, shock, and airway management should be anticipated. For oropharyngeal anthrax, airway compromise is a significant risk, and consideration should be given for the early administration of corticosteroids to reduce the development of airway edema. If despite medical therapy, airway compromise develops, early airway control with intubation should be considered. No specific guidance exists for drainage of ascites in patients with intestinal anthrax. However, large fluid collections could at a minimum compromise respiration and consideration should be given to therapeutic (and potentially diagnostic) paracentesis. Standard precautions are recommended for patient care in all forms of anthrax disease. There are no data to suggest direct personto-person spread from any form of anthrax disease. However, for patients with systemic anthrax disease, especially before antibiotic initiation, invasive procedures, autopsy, or embalming of remains could potentially lead to the generation of infectious droplets; thus, such procedures should be avoided when possible. After an invasive procedure or autopsy, the instruments and materials 22 used should be autoclaved or incinerated, and the immediate environment where the procedure took place should be thoroughly disinfected with a sporicidal agent. Iodine can be used, but must be used at disinfectant strengths, as antiseptic-strength iodophors are not usually sporicidal.
The Indian Public Health system is not geared to meet the need of close followup and monitoring that the use of Depo requires. However, Net-en, another contraceptive with equally disturbing side-effects, is being introduced in the official family welfare programme in "such places where adequate facilities for followup and counselling are available" (affidavit filed by Ministry of Health and Family Welfare on August 18, 2000 in the Supreme Court of India in the matter of Stree Shakti Sanghatana and Others versus the Union of India and Others). MarketingofDrugs 205 the Thalidomide Children and the Law the thalidomide babies have grown up. Some 8,000 mothers who took the drug bore deformed children, 400 or so in Britain. Many people must long ago have assumed that society had paid its debt to the children and the parents; few can fail to recall the wave of compassion and anger that followed their birth. Yet even now the bulk of the compensation claims in Britain are not settled, and the peculiar agony of this saga is that no one should feel a sense of relief that at last a settlement may be in sight. No money can ever compensate for being a limbless trunk, but at least a generous compensation can give the glimmer of a normal life. One thinks also of the parents who for so long have had added to their sorrows the anxieties of protracted litigation. Distillers agreed to pay 40 per cent of the assessment if the allegations of negligence were withdrawn. Clearly, if the full sum was judged "sufficient" to compensate the victims, the 40 per cent must be judged 60 per cent insufficient to human need at the time, to say nothing of the effects of future inflation. Even the full sum exposes the crudeness of the rule-of-thumb assessments of the law. As the Law Commissioners say, the legal method of fixing damages lacks any mathematical actuarial, statistical or other scientific basis. What is stopping the Government immediately bringing in an Act to make evidence of this kind crucial? It is appreciated that Distillers have always denied negligence and that if the cases were pursued, the children might end up with nothing. But at the end of the day what is to be paid in settlement is the decision of Distillers, and they should offer much, much more to every one of the thalidomide victims. It may be argued that Distillers have a duty to their shareholders and that, having taken account of skilled legal advice, the terms are just. Without in any way surrendering on negligence, Distillers could and should think again. Compassion after disaster requires a state insurance scheme for compensation, as some have long advocated for personal injury cases. But even the wisest reform will be a sham if society does not now insist on justice for the victims of an enduring tragedy. Quoted in "Changing Era of Social Responsibility and Corporate Ethics in Indian Pharmaceutical Industry" by Indurkar at <. The website says: "The United States Food and Drug Administration estimates that counterfeits make up more than 10% of the global medicines market and are present in both industrialized and developing countries. It is estimated that up to 25% of the medicines consumed in poor countries are counterfeit or substandard. Trade in these medicines is more prevalent in countries with weak drug regulation control and enforcement, scarcity and/or erratic supply of basic medicines, unregulated markets and unaffordable prices. However, one of the most counterfeited drugs today is Viagra, which is sold extensively via the Internet in industrialized countries. The Influence of the Pharmaceutical Industry, Volume I, Report, together with formal minutes. The Truth About the Drug Companies: How they deceive us and what they do about it. Stanley Adams was an executive who did what he felt was right by alerting the European Commission to cartelisation and anti-competitive practices by Swiss-based pharmaceutical giant Hoffmann-La Roche. The Commission fined Hoffmann for abuse of its dominant position in the bulk vitamin market but during antitrust proceedings disclosed information that enabled Hoffmann to identify Adams, who was consequently arrested and convicted for unauthorised disclosure under Swiss law. Adams successfully sought damages from the Commission, which was held by the European Court to have failed its obligation "not to disclose information of the kind covered by the obligation of professional secrecy, in particular information about undertakings, their business relations or their cost components.
His research focuses on the molecular epidemiology of viruses, virus interactions with their hosts, and innovative pathogen detection methods. Immunogenicity of an inactivated Rift Valley fever vaccine in humans: a 12-year experience. Field evaluation of formalin inactivated Kyasanur forest disease virus tissue culture vaccine in three districts of Karnataka state. Crimean-Congo hemorrhagic fever in eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. Please give us your new address (in the box) and print the number of your old mailing label here Emerging Infectious Diseases · Nataro* scherichia coli is both the most abundant facultative commensal of the human gastrointestinal tract and the most common bacterial cause of human diarrhea (1). Had it incidentally acquired only fragments or incomplete packages of virulence-associated genes? This communication also illustrates 2 principles that should be recognized more generally with regard to diarrheogenic E. Thus, once definitive evidence is presented that a particular strain is pathogenic, the challenge is to determine the genotypic or phenotypic fingerprints that permit extrapolation to other strains. Diarrheal epidemiology studies today are able to identify a likely etiologic agent for most patients, in contrast to studies of 20 years ago, because of improved diagnostic tests and the identification of new pathogens, but the task is not finished. Additional studies are needed in many places to refine our understanding of putative and emerging pathogens and to determine their full epidemiologic roles. Potential study participants are recruited at the conclusion of rolling risk factor survey interviews, similar to the Behavioral Risk Factor Surveillance System. A "control bank" allows investigators to rapidly obtain contact details for appropriately matched controls because age and sex of all household members are recorded in a database. This bank of 14,024 potential controls was used in 4 casecontrol studies of sporadic salmonellosis and campylobacteriosis. This system avoided randomly dialing thousands of households to enroll controls in young age groups. The control bank was used for 3 years after initial collection, although many jurisdictions update banks annually. Programming questionnaires can delay investigations, which makes paper-based collection better in small outbreaks (4). Consumer attitudes and behaviours-key risk factors in an outbreak of Salmonella typhimurium phage type 12 infection sourced to chicken nuggets. Biases and efficiencies associated with two different control sources in a case-control study of Salmonella typhimurium phage type 12 infection. Frequency of infectious gastrointestinal illness in Australia, 2002: regional, seasonal and demographic variation. We acknowledge that a "bank" of these readily accessible controls could permit more rapid recruitment of participants in numerous age strata and obviate the need for extensive random digit dialing to recruit an adequate agematched control population in many investigations. Nevertheless, in most epidemiologic investigations, controls need to be selected from the same geographic area as the case-patients, and even in large telephone surveys, the number of respondents in any 697 Emerging Infectious Diseases · This would make it difficult to recruit enough controls within the small areas affected by most outbreaks, particularly within specific age strata. A control bank may therefore be more practical for use in large communitywide outbreaks, outbreaks that occur over large regions. A concern in such programs is the potential for unintended spread of the vaccine virus (vaccinia) from the primary vaccinee to contacts who may be at the greatest risk of having adverse reactions resulting from secondary transmission (2,3). Contact spread of the live attenuated vaccinia virus is considered the predominant method of secondary transmission. The conventional methods of preventing a secondary transmission event in the household of a smallpox vaccine recipient include the use of bandages and long sleeves to limit direct contact with the lesion and immediate hand-washing when contact occurs (4). Several recent reports have measured the presence of vaccinia virus on the dressings or hands of vaccinated persons; however, the recovery of vaccinia virus in the environment has not been evaluated after vaccination in a controlled setting (57). We present the first reported attempt to recover live vaccinia virus from the homes of recently vaccinated persons. We hypothesized that live vaccinia virus shed from the skin reaction could not be recovered in the natural environment, and as a result, constitutes a limited risk for contact transmission. Three hundred eighty-seven environmental swab samples were collected on 3 different study days from 43 persons (mean age 24 years) with major cutaneous reactions. On postvaccination days 7, 10, and 15, a sterile Calgiswab type 2 applicator (Harwood Products Co.