Invasive Illness with Salmonella Virchow Infection

Salmonella virchow infection in man is usually sporadic and is little known in Britain. We report an outbreak of 21 cases in the Manchester area. The source of infection was believed to be chickens bought at different shops. Symptoms were typhoidal or septicaemic.     

Outbreak of Food-poisoning Caused by Salmonella Virchow in Spit-roasted Chicken

Salmonella virchow food-poisoning acquired from eating chicken caused illness in at least 50 people who attended a tennis club function in Liverpool, and in many other people in the Merseyside area. In some cases the illness was severe, with positive blood cultures, and 35 people were admitted to hospital.The source of infection was a retail shop which received deep-frozen chickens already contaminated with S. virchow from a packing-station in Cheshire. These chickens were spit-roasted after inadequate thawing and subsequently handled under unhygienic conditions. The result was a massive build-up of salmonella contamination in the shop and in the chicken portions sold.S. virchow was isolated from over 160 patients and contacts in the Merseyside area during the outbreak and many continued to excrete the organism in the faeces after four months. Antibiotic treatment was not recomended because there was no evidence that it shortened the duration of excretion.A high rate of contamination of chickens from a packing-station by a salmonella type capable of causing serious disease in man is clearly a public health problem which cannot be ignored.The use of rotary spits for roasting chickens requires thorough investigation and appraisal, because as operated at present they evidently constitute a public health hazard.     

Salmonella Virchow in a Chicken-packing Station and Associated Rearing Units

In tracing the source of an outbreak of food-poisoning with Salmonella virchow a chicken-packing station and associated rearing farms were investigated. The serotype was found in chickens in 9 of the 14 rearing farms investigated and in the hatchery, but not in the breeding flocks supplying the hatchery. Several personnel on the farms were affected. The infection was most likely to have been introduced by contaminated feeding-stuffs.     

Infection with netilmicin resistant Serratia marcescens in a special care baby unit.

An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcescens occurred in a special care baby unit. S marcescens was isolated from a total of 13 babies; significant infection occurred in five, of whom two died. Epidemiological investigation failed to detect a common source but gastrointestinal colonisation of babies formed a prolonged and possibly important reservoir for infection. Containment proved difficult until the unit was closed to new admissions, and even then spread to a temporary unit ensued. O Serotyping and bacteriophage typing disclosed a single epidemic strain. This produced an aminoglycoside acetylating enzyme (AAC(6'')) conferring resistance to netilmicin and tobramycin and moderate resistance to amikacin. Use of gentamicin resulted in the isolation of serratia with increased resistance to all aminoglycosides, and, similarly, increased resistance to third generation cephalosporins emerged with their use.     

Babies with spina bifida treated without surgery: parents' views on home versus hospital care.

From 1971 to 1981, 98 babies born with meningomyelocoele at the North Staffordshire Hospital Centre''s district maternity hospital, were thought not suitable for surgery. Sixty three survived for more than one week. Over the period the hospital''s policy changed: initially all such babies were kept in hospital, but later parents were given the choice of taking their baby home for palliative and terminal care. In an attempt to determine parents'' views on the care of their baby the parents of 44 of the babies who survived to one week were traced in 1985-6, five to 14 years later; 80 of them were asked how they felt about the lives and deaths of their babies. Eighteen babies had been taken home, and they had lived longer than the 26 who had been cared for in hospital. Parents whose baby had remained in hospital were sadder than those who had taken their baby home when they looked back at their experiences, and they also considered that their baby''s life had been of poor quality. Most of those who had taken their baby home had a more positive view of their child''s life. The figures suggest that the bereavement process after a baby''s death is longer than has been thought, but despite residual sadness just over half of the parents interviewed thought that something positive had come out of their experience.     

Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report

Introduction

Until now, studies on paracetamol given intravenously have mainly been performed with the pro-drug propacetamol or with paracetamol in preterm babies above 32 weeks of gestation. Studies in these babies indicate that intravenous paracetamol is tolerated well, however studies on the efficacy of intravenous paracetamol are lacking. There are no pharmacokinetic data on the administration of multiple doses of paracetamol in preterm babies with a gestational age below 32 weeks.

Case presentation

We present a case series of nine Caucasian preterm babies, six boys and three girls, with a mean gestational age of 28.6 weeks (range 25.9 to 31.6 weeks). Case one, a girl with a gestational age of 25 weeks and six days, presented with necrotizing enterocolitis. In the second case, a female baby with a gestational age of 26 weeks and two days presented with hematoma. In case three, a female baby with a gestation of 26 weeks and one day developed intraventricular hemorrhage. In case four, a male baby with a gestational age of 31 weeks and four days presented with pain after vacuum delivery. Case five, a female baby born after a gestation of 29 weeks and six days presented with hematoma. In case six, a male baby with a gestation of 30 weeks and six days presented with hematoma. In case seven, a male baby, born with a gestational age of 30 weeks and six days, presented with caput succedaneum and hematoma. In case eight, a male baby, born after a gestation of 28 weeks and four days, developed abdominal distention. Case nine, a female baby, born with a gestational age of 27 weeks and three days presented with hematoma. These babies were treated with intravenous paracetamol 15 mg/kg every six hours. Serum concentrations and aspartate transaminase were determined after prolonged administration. Pain scores were assessed using the Premature Infant Pain Profile.

Conclusion

Paracetamol serum concentrations ranged from 8 to 64 mg/L after eight to 12 doses of intravenous paracetamol. Adequate analgesia was obtained in seven babies. During paracetamol therapy the median serum level of aspartate transaminase was 20 U/L (range 12 to 186 U/L). This case series indicates that prolonged intravenous administration of paracetamol in preterm babies with a gestational age of less than 32 weeks is tolerated well in the first days after birth. However, in the absence of proper pharmacokinetic data in this age group we cannot advocate the use of paracetamol intravenously.     

Development of bacterial and bifidobacterial communities in feces of newborn babies

Microbial 16S rDNA from babies' fecal samples were amplified by PCR, and analysed by denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. PCR-DGGE profiles were used to follow in time the colonization of the intestine by bacteria. Four healthy babies, one baby who received antibiotics and their parents participated to the present study to determine the extent to which administration of antibiotics can modify the bacterial colonization of neonatal human gut and verify the influence of parental factors on the formation of the fecal bacterial community. In the healthy babies, Escherichia coli or bacteria belonging to Clostridium spp. were the initial colonizers rapidly followed by Bifidobacterium, Bacteroides, Clostridium, Streptococcus, Enterococcus and Actinomyces. Bifidobacterium species appeared already after five days in the breast-fed babies while there was a delay in the baby who received a formula based diet during only one day after birth. In each baby two or three bifidobacterial species including B. infantis were found. The observed variations in species were not associated with the feeding changes. The comparison of DGGE profiles of the babies and their parents patterns showed bands with equal migration suggesting a vertical transmission determined by genetic and environmental factors. The brief appearance of pioneer bacteria determined as being E. coli and Enterococcus spp. in the profile from the baby under antibiotic therapy, was succeeded by a small stable community consisting of Ruminococcus species. No Bifidobacterium sequences were detectable in this antibiotic-treated baby in spite of a partly breast-milk diet.     

Nosocomial Diarrhoea in the Elderly Due to Enterotoxigenic Clostridium perfringens

To diagnose sporadic diarrhoea due to Clostridium perfringens infection, faecal specimens from elderly patients were examined directly for C. perfringens enterotoxin using reverse passive latex agglutination assay, and then cultured for this organism. C. perfringens isolates from those samples were grouped by slide agglutination and by pulsed-field gel electrophoresis (PFGE). Fifty of the 60 isolates agglutinated with newly raised antiserum WX2 and 38 shared the same genomic PFGE pattern. Characteristics of the epidemics and experimental data suggest that the diarrhoea was caused by a nosocomial spread of C. perfringens, and not by a food-borne outbreak.     

Nosocomial transmission of group B streptococci.

The acquisition of group B streptococci by babies in a special-care baby unit and two postnatal wards was investigated over a six-month period using serology and phage typing. Sixty-three culture-positive babies were identified in the postnatal wards, one-third of whom had been born to mothers who were not carrying the organism in the genital tract or anorectal area during labour. A non-maternal source was identified for 14 of these 21 infants: either colonised mothers and babies in the same ward or, on one occasion, a member of the hospital staff. In the special-care baby unit, however, only one instance of nosocomial acquisition of group B streptococci was recorded despite a high prevalence of colonisation in the staff on the unit and the presence of heavily colonised babies. The results of this survey suggest that although sepsis caused by group B streptococci may be the result of nosocomial transmission, this may be prevented by careful attention to hygiene.     

Pleasant Odors and Congruency: Effects on Approach Behavior

Ninety subjects between the ages of 18 and 35 viewed 24 slideswhen the testing room was scented with no odor or one of twopleasant scents (baby powder or chocolate). Six slides wereof babies, six were of chocolate items and 12 were control slidesof pine trees or the Orient. In pilot testing the chocolateslides were rated as being congruent with the chocolate scentand incongruent with the baby powder scent; the baby slideswere rated as being congruent with the baby powder scent andincongruent with the chocolate scent. Subjects viewed the slidesat their own pace while a computer recorded how long each slidewas viewed. During a second viewing, subjects rated the slidesand answered questions about their own mood and health. Congruencydid not play a role in the findings. Pleasant odors had certaineffects compared to no odor (i.e. longer looking time, bettermood and lower hunger ratings), while other effects were relatedto specific odors (i.e. arousal was highest in the chocolatecondition and there were fewer health symptoms reported in thebaby powder condition). These findings suggest that pleasantodors may have some general effects due to their hedonic value,while associations individuals have with particular pleasantodors may influence other variables. Chem. Senses 20: 479–487,1995.     

Uptake,Outcomes, and Costs of Antenatal,Well-Baby,and Prevention of Mother-to-Child Transmission of HIV Services under Routine Care Conditions in Zambia

Background

Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT) in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A.

Methods

We enrolled 99 HIV-infected/HIV-exposed (index) mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison) mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider’s perspective.

Results

Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART) based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included.

Conclusions

HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in increased service delivery costs in the short term.     

Unexpected Conservation of the X-Linked Color Vision Gene in Nocturnal Prosimians: Evidence from Two Bush Babies

Bush babies have had a long history of nocturnal life and it would be interesting to know whether their color vision genes have become degenerate. Therefore, we used PCR techniques to sequence the X-linked pigment gene of two of these nocturnal prosimians: Galago senegalensis and Otolemur garnettii. Southern hybridization of genomic DNA of G. senegalensis showed a single X-linked pigment gene. Interestingly, the deduced pigment sequences of the two bush babies are identical. By comparing the X-linked pigments of bush baby, human, squirrel monkey, and marmoset, 38 variable positions were identified. At those positions that may cause a spectral shift, the bush baby pigment has identical or biochemically similar residues to those of the marmoset cone pigment with a spectral peak of 543 nm. This result is consistent with the estimate of 544–545 nm for the spectral peak of the X-linked pigment of Otolemur crassicaudatus, which is closely related to Otolemur garnettii. The neighbor-joining tree of mammalian X-linked pigments showed a significantly shorter branch in the bush baby lineage than in other primate lineages. A relative rate test showed that the nonsynonymous substitution rate of the bush baby X-linked pigment gene is about three times slower than that of the human red pigment gene, though the synonymous substitution rates of the two genes are similar. The slower nonsynonymous rate in the bush baby lineage suggests that the bush baby X-linked pigment gene is under functional constraints, in spite of its nocturnal life. Two radical changes at positions in the intradiskal surface next to the sixth transmembrane domain were observed in the X-linked cone pigment of bush babies but not in other primates. They are changes from Ala to Ser and from Asn to His, which are similar in function to the corresponding residues in rhodopsins. These two changes may be of importance for dim light sensitivity, which is consistent with our proposal that the evolution of the bush baby X-linked pigment gene is under selective pressure. In addition, the 2.5% divergence in introns 2 and 5 of the X-linked pigment gene between the two bush babies supports their classification into two separate genera. Received: 30 November 1996 / Accepted: 17 June 1997     

‘Agonistic buffering’ in the wild barbary macaque,Macaca sylvana L.

Barbary apes are known to exhibit male care of babies at various locations, but only in the Middle Atlas mountains of Morocco has it been reported that a baby may be used in male-male interactions, apparently reducing the likelihood of aggression. The present study was made in order to discover if the behavior was characteristic of other groups reproductively isolated from the Atlas population. Male-male interactions involving a baby were observed in two groups and are described in detail; their friendly nature supports the hypothesis that the presence of a baby reduces the likelihood of aggression. We did not, however, see the active use of babies in this context which has been described for the Atlas population.     

Should we abandon Kielland's forceps?

To assess the risks associated with the use of Kielland''s forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.5%) were delivered with Kielland''s forceps. There was no difference in early neonatal outcome (as judged by Apgar scores, intubations, and admission to the special care baby unit) between these babies and those delivered normally or by non-rotational forceps, but a higher proportion of the 127 (10.7%) delivered by emergency caesarean section were compromised. Of the 1517 multigravid patients, only 57 (3.8%) underwent instrumental delivery, 15 (1.0%) by Kielland''s forceps. Among these babies, also, the outcome was no worse than for those delivered normally, but the babies delivered by caesarean section showed a greatly increased incidence of low Apgar scores, intubations, and admission to the special care baby unit. There were no stillbirths or neonatal deaths among babies delivered by Kielland''s forceps, nor were there any cases of severe birth trauma or of obvious neonatal morbidity.     

Collagen defects in lethal perinatal osteogenesis imperfecta.

Quantitative and qualitative abnormalities of collagen were observed in tissues and fibroblast cultures from 17 consecutive cases of lethal perinatal osteogenesis imperfecta (OI). The content of type I collagen was reduced in OI dermis and bone and the content of type III collagen was also reduced in the dermis. Normal bone contained 99.3% type I and 0.7% type V collagen whereas OI bone contained a lower proportion of type I, a greater proportion of type V and a significant amount of type III collagen. The type III and V collagens appeared to be structurally normal. In contrast, abnormal type I collagen chains, which migrated slowly on electrophoresis, were observed in all babies with OI. Cultured fibroblasts from five babies produced a mixture of normal and abnormal type I collagens; the abnormal collagen was not secreted in two cases and was slowly secreted in the others. Fibroblasts from 12 babies produced only abnormal type I collagens and they were also secreted slowly. The slower electrophoretic migration of the abnormal chains was due to enzymic overmodification of the lysine residues. The distribution of the cyanogen bromide peptides containing the overmodified residues was used to localize the underlying structural abnormalities to three regions of the type I procollagen chains. These regions included the carboxy-propeptide of the pro alpha 1(I)-chain, the helical alpha 1(I) CB7 peptide and the helical alpha 1(I) CB8 and CB3 peptides. In one baby a basic charge mutation was observed in the alpha 1(I) CB7 peptide and in another baby a basic charge mutation was observed in the alpha 1(I) CB8 peptide. The primary defects in lethal perinatal OI appear to reside in the type I collagen chains. Type III and V collagens did not appear to compensate for the deficiency of type I collagen in the tissues.     

Intraperitoneal Fluid Infusion in Children with Gastroenteritis

In a study of 91 babies with dehydration as a result of gastroenteritis the intraperitoneal route was found to be safe and effective in those with mild or moderate dehydration, but not in those who were severely dehydrated. The fluids found to be most effective in the intraperitoneal technique were normal saline with 28 mEq of potassium chloride per litre, or for hypertonically dehydrated babies half-strength Darrow''s solution. This technique can be carried out by a nurse working single-handed if the baby is premedicated with promazine.     

The detection of Salmonella in skimmed milk powder enrichments using conventional methods and immunomagnetic separation

Skimmed milk powders were spiked with one of three Salmonella serovars and incubated in buffered peptone water for 24 h. No false-negative results were obtained by immunomagnetic separation (IMS), compared to seven for selenite cysteine, one for Müller-Kauffmann tetrathionate and two for Rappaport-Vassiliadis enrichment broths. Salmonella virchow was detected and enumerated during the pre-enrichment incubation by IMS and indirect conductance techniques. The Salm. virchow cell number did not increase after 12 h incubation and remained at 3 times 10⁶ cfu ml^-1. IMS was able to capture Salm. virchow cells at cell numbers ca 50 ml^-1 in the presence of a 1000 greater number of non-salmonella cells.     

Conjugated and unconjugated bilirubins in humans and rhesus monkeys. Structural identity of bilirubins from biles and meconiums of newborn humans and rhesus monkeys.

1. Bilirubin-IXalpha monoglucuronide was the predominant bilirubin in biles and meconiums of newborn humans and rhesus monkeys. Rhesus-monkey baby biles contained slightly more diglucuronide than did human baby biles. 2. Bilrubin-IXalpha glucoside, bilirubin-IXalpha xyloside and bilirubin-IXbeta were also constituents of human and rhesus-monkey baby biles and meconiums. Bilirubin-IXalpha glucuronide glucoside was present in human and rhesus-monkey baby biles but not in meconiums. The identity of the bilirubins was confirmed by u.v.-visible and mass spectroscopy of the azodipyrroles obtained by treating the bilirubins with diazotized ethyl anthranilate. The resulting azodipyrroles were identical with the corresponding azodipyrroles obtained from human adult biles and also from reduced isomers of biliverdin. 3. Bilirubin-IXbeta was present in much higher proportions in the extracts of meconiums than in the extracts of biles from the same babies. 4. Oxidation of bilirubins to biliverdins occurs in utero to a small but undetermined extent. The resulting green pigments were present in meconiums collected from the lower small and large intestines of newborn babies and rhesus monkeys. 5. Butanol extracted most of the bilirubins present in biles. This modified method proved to be quick and easy. Little hydrolysis of bilirubins took place during extraction or separation by t.l.c.