Updates
Updates
Oral Gram Negatives: Transient Visitors
Source: Mobbs KJ, et al. Chest 1999; 115:1570-1575.
Oropharyngeal carriage of aerobic gram-negative bacilli (GNB) reportedly occurs in about 10-20% of individuals, although the figures are quite variable, and have been reported to be as high as 61% in semireclusive vegetarian monks (one wonders what they’re using for fertilizer). Any gram-negative rod (GNR) in the mouth (e.g., Klebsiella, Enterobacter) is considered a potential pathogen, but there have been few attempts to distinguish transient oral colonization from persistent carriage. A total of 120 individuals, including student volunteers, nurses, and laboratory personnel, submitted, within 48 hours of the other, two "rinse and gargle" specimens for culture using enriched broth. Quantitatively determined colony counts per mL of saliva using serial dilutions were compared between the groups. Isolation of the same organism from both specimens was indicative of carriage, whereas isolation of an aerobic GNR from a single specimen was considered transient acquisition.
Viridans streptococci, at concentrations of more than 1 ´ 106 cfu/mL, were isolated from the mouths of all participants. Transient acquisition of yeast was found in 22%, but persistent carriage occurred in only 5%. Staphylococcus aureus was isolated from 13% of subjects on one occasion, but was persistent in 5%. In contrast, transient acquisition of aerobic GNB was found in 36% of healthy volunteers, although persistent carriage was seen in only 6.6%. Serratia spp. was the predominant organism in persons with persistent carriage, whereas E. coli was more frequently a transient colonizer. Only low numbers (1 ´ 106 cfu/mL) of GNB were detected, on average, in people with transient colonization.
Interestingly, the students, who were generally younger than the other groups, had the highest rate of transient colonization (52%), but the lowest rate of persistent carriage (0%), whereas the older groups had similar frequency of carriage (7.5% and 12.5% for nurses and laboratory workers, respectively). In contrast to earlier studies, these data indicate that, although oropharyngeal exposure and transient colonization to gram-negative pathogens is common, most healthy individuals successfully clear these potential pathogens from their mouths. Progressive age, with the occurrence of more frequent dental and gingival disease, declining health, and smoking, may limit this natural immune function.
Cyberspace Sex!
Source: ProMED-mail post, August 25, 1999. www.healthnet.org.
Officials from the san francisco Public Health Department (SFPHD) report the first ever cyberspace cluster of an STD: seven cases of syphilis have been linked to an America Online Internet chat room, San Francisco Men for Men (SFM4M). It is estimated that 100 to 1000 similar such chat rooms are active in San Francisco, which have become an increasingly popular way to meet sex partners, many of whom are anonymous. Sex partners are often known only by their cybernet "handles," or nicknames, for which AOL was unlikely to provide to the SFPHD specific user names without a court order.
The seven men, five of whom were also HIV-infected, reported sexual contact with about 99 other individuals—including one man who had 47 partners. At a loss for how to contact these faceless and nameless individuals, and lacking the necessary cybersex language skills, the SFPHD was put in contact with the chairman of a worldwide online service in San Francisco, called Planet Out. Arrangements were made to post alerts and information about the outbreak whenever a user logged on to the site. In addition, volunteers were trained to enter chat rooms and make idle conversation about the outbreak. Through these mechanisms, about 35 men have been identified, 33 of whom have been screened for STDs. Another one-third of the sexual contacts are believed to have sought medical care from sources other than the PHD, while the remaining one-third may still be unaware of their exposure.
This outbreak occurred against a backdrop of increasingly unsafe sexual behaviors in the gay community in San Francisco. More than 500 new HIV infections were reported in San Francisco last year, although the incidence of syphilis has dropped significantly since the 1980s. The SFPHD and Planet Out have made clever use of the Internet to relay important public service information and safer sex messages. Perhaps other similar online services can be encouraged to provide more of these kinds of "ethnographic" prevention messages for targeting high-risk individuals, as gay men grow weary of the same safe sex messages and the misperception that HIV is no longer the threat it once was.
GiardiaVax for Dogs
Source: http://www.healthnet.org/programs/promed-hma/9904/msg00106.html
The u.s. department of agricul-ture has approved the use of a vaccine in dogs to prevent giardia infection (GiardiaVax). Giardia is estimated to infect 10-20% of dogs, especially those that are bred in larger kennels. Experts believe this poses a potential risk to pet owners and, because of its fecal-oral route transmission, smaller children in particular. The vaccine is presently manufactured by the Fort Dodge Animal Health—recommendations are to vaccinate all puppies at 8 weeks of age, with a booster 2-3 weeks later, and annually thereafter.
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