Updates-By Carol A. Kemper, MD, FACP
Updates-By Carol A. Kemper, MD, FACP
E coli 0157 as a Zoonosis
Source: MMWR Morb Mortal Wkly Rep. 2001;50:293-297.
Outbreaks of Escherichia coli 0157:h7 have been previously reported in visitors of a petting zoo and a farm in the United Kingdom. Two similar outbreaks have now been reported in Pennsylvania and Washington, leading to 56 episodes of illness and 19 hospitalizations. During the first outbreak, which occurred in May 2000 in Washington, 5 people (aged 2-14 years) developed enteritis due to E coli 0157. The isolates had identical PFGE patterns. Further investigation revealed that 4 of the patients, as part of a class field trip, had visited a dairy farm. The fifth patient was a sibling of one of the case patients. The children were allowed to handle young poultry, rabbits, goats, and a calf. They then had lunch in a nearby field. Stool samples from 5 animals at the farm were negative for E coli 0157.
The second outbreak in November 2000 in Pennsylvania involved many more people: 51 people, ranging in age from 1 to 52 years (most were pre-school and school-aged children) developed a diarrheal illness within 10 days of visiting a dairy farm. Fifteen patients had either positive stool cultures or developed hemolytic-uremic syndrome. Visitors could eat and drink while petting various farm animals, including cattle, llamas, and a pig. A case-control study of visitors to the farm showed that direct contact with cattle, nail biting, and purchasing food from an outdoor concession stand were significant risk factors for the development of disease.
The CDC has since published guidelines for prevention of transmission of enteric pathogens at petting zoos and farms. Institution of good hand washing facilities with soap and water and distribution of instructional leaflets to visitors were effective at halting the outbreak at the first facility. Visitors to zoos and farms need to be counseled that various human pathogens, including Salmonella, Campylobacter, and E coli can be readily transmitted from animals to people. Activities with hand-to-mouth contact, such as eating, drinking, smoking, and using pacifiers should be discouraged while having contact with animals, and good hand washing should be reinforced. (How long is 15 seconds?).
Bad Business Deals Attributed to Mefloquine
Source: Torassa U. San Francisco Chronicle. April 8, 2001:T10.
Former us representative edward Mezvinsky (Iowa), who has been indicted on charges of fraud, is suing Hoffman-LaRoche, makers of mefloquine. Mezvinsky claims that his use of mefloquine exacerbated his underlying bipolar disorder, resulting in a series of bad business decisions that ultimately cost his investors millions of dollars and landed him in court. Mezvinsky is apparently only one of a number of people who have attempted to sue the manufacturer of mefloquine, claiming various untoward and unexpected neurologic and psychiatric effects (including suicide). This is the first time, however, that a criminal defendant has used the "Larium defense."
Magic Mushrooms and Mefloquine
Source: ISTM Physicians ([email protected]); March 19-20, 2001.
Physicians on the international Travel Medicine (ISTM) chat line reviewed a case of an 18-year-old student traveling in Southeast Asia and India as part of a class "project" who developed an acute reaction following an ingestion of raw "magic mushrooms" in Thailand. He presented several days later to a physician in Calcutta complaining of nausea, sweats, palpitations, and intermittent attacks of confusion, anxiety, and, according to friends, possible paranoia. He was also experiencing bad dreams.
He was also receiving mefloquine for malaria prophylaxis.
He consumed the mushrooms—also known as LSG/ecstasy mushrooms—and some possible marijuana, along with several friends, none of whom had a similar reaction. Such mushrooms have been popular with certain travelers looking for a "natural" (someone said the word—organic?) high since the 1960s and are apparently available at clubs and resorts in Southeast Asia.
Whether this young man’s symptoms were secondary to the mushrooms, the mefloquine, or both is uncertain. However, retrospective data suggest that up to 11.3% of travelers, none with previously identified psychiatric problems, report some kind of neuropsychiatric symptoms while receiving mefloquine, including sleep disturbances, vivid dreams, and fatigue in about one-half to frank depression in 0.5% (see Kemper CA. Infectious Disease Alert 2000;19:112). About 1.2% report prolonged symptoms lasting longer than 2 months.
Critics of these data argue that good prospective data identifying a significant risk of neuropsychiatric problems in persons receiving mefloquine is lacking. Mefloquine remains an important prophylactic antimalarial agent for many travelers. Since a major complaint of some patients appears to be a perception of a lack of adequate warning regarding potential side effects, travel medicine clinics may find a simple handout outlining potential problems helpful. It seems reasonable to add that patients should probably not take psychoactive substances with their mefloquine.
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