Faculty Bibliography

Nigeria, with 259 polio cases, now accounts for 77 percent of polio cases in the world, and health officials are awaiting findings from tests on an additional 85 paralyzed children. The polio virus has also spread from Nigeria, particularly from Kano, in the northern part of the country, to 10 formerly polio- free countries elsewhere in Africa. 'Today, Kano state in northern Nigeria is the only endemic area in the world where polio immunization is not taking place,' said Dr. David Heymann, who directs the agency's polio eradication program

The donor was not suspected of having rabies at his death, which doctors attributed to a stroke, the Centers for Disease Control and Prevention said yesterday. It was not until this week, after a pathologist in Dallas who was puzzled about the deaths asked the federal agency for help, that the connection was made, Dr. Artun Srinivasan, a C.D.C. physician said in a telephone interview. Dr. Mitchell L. Cohen, an expert on infectious diseases at the center, said in a telephone news conference that tests performed on Wednesday in Atlanta identified a strain of the rabies virus commonly found among bats in all four patients. It is not known when or where the donor was exposed to rabies. A year can pass from when a person is bitten by a rabid animal or exposed to a bat before rabies develops. There is no effective therapy for rabies, which is usually fatal. But injections of two types of immunizations can prevent rabies if they are given soon after exposure. So health officials at the disease control centers and in four states, Alabama, Arkansas, Oklahoma and Texas, are seeking to identify quickly anyone who had contact with the four patients to determine who needs immunizations. People exposed to patients' saliva are those most likely to need treatment

Nigeria, with 259 polio cases, now accounts for 77 percent of all polio cases in the world, and health officials are awaiting findings from tests on an additional 85 paralyzed children. The polio virus has also spread from Nigeria, particularly from Kano, in the northern part of the country, to 10 polio-free countries elsewhere on the continent. Kano officials stopped polio immunizations last August when political and religious leaders there claimed that the polio vaccine could make girls infertile. W.H.O. officials say that repeated independent testing of the vaccine have refuted such claims. Dr. [David L. Heymann] said that Kano's governor, Ibrahim Shekarau, told him that he was satisfied the vaccine was safe. Since May, Mr. Shekarau has repeatedly pledged to resume vaccinations. W.H.O. and the United Nations Children's Fund, Unicef, have sent additional workers and have taken other ''extraordinary measures'' to help Nigeria, Dr. Heymann said. Last Saturday, Kano officials began training immunization workers. But in a number of telephone conversations with W.H.O. officials before and since then, Mr. Shekarau has refused to set a date for resumption of polio immunizations

Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem because treatment is complicated, cure rates are well below those for drug-susceptible tuberculosis (TB), and patients may remain infectious for months or years, despite receiving the best available therapy. To gain a better understanding of MDR-TB, we characterized serial isolates recovered from 13 human immunodeficiency virus-negative patients with MDR-TB, by use of IS6110 restriction fragment-length polymorphism analysis, spacer oligonucleotide genotyping (i.e., 'spoligotyping'), and sequencing of rpoB, katG, mabA-inhA (including promoter), pncA, embB, rpsL, rrs, and gyrA. For all 13 patients, chronic MDR-TB was caused by a single strain of Mycobacterium tuberculosis; 8 (62%) of the 13 strains identified as the cause of MDR-TB belonged to the W-Beijing family. The sputum-derived isolates of 4 (31%) of the 13 patients had acquired additional drug-resistance mutations during the study. In these 4 patients, heterogeneous populations of bacilli with different resistance mutations, as well as mixtures of drug-susceptible and drug-resistant genotypes, were observed. This genetic heterogeneity may require treatment targeted at both drug-resistant and drug-susceptible phenotypes

To characterize methicillin-resistant Staphylococcus aureus (MRSA) strains circulating in the community, we identified predictors of isolating community MRSA and genotyped a sample of MRSA collected from a community-based, high-risk population. Computerized databases of the Community Health Network of San Francisco and the Clinical Microbiology Laboratory were searched electronically for the years 1992-1999 to identify community-onset infections caused by MRSA. Sequential analyses were performed to identify predictors of MRSA strains. The majority (58%) of infections were caused by strains traceable to the hospital or to long-term care facilities. Injection drug use was associated with infections that were not associated with health care settings. Genotypes for 20 of 35 MRSA isolates recovered from injection drug users did not match any of >600 genotypes of clinical isolates. In a nonoutbreak setting, the hospital was the main source of community MRSA; however, the presence of genetically distinct and diverse MRSA strains indicates MRSA strains now also originate from the community

Community methicillin-resistant Staphylococcus aureus (CMRSA) strains are being isolated with increasing frequency around the world. In Western Australia CMRSA are endemic in geographically remote communities and have been found to belong to five different contour-clamped homogeneous electric field (CHEF) electrophoretic patterns. Representatives of each of these CHEF patterns have been compared to CMRSA representative of CHEF patterns from other Australian states and New Zealand. With one exception, all of the isolates were nonmultiresistant and were not resistant to many antimicrobial agents other than the beta-lactams. With one exception, which is not believed to be a CMRSA, all of the isolates harbored a beta-lactamase plasmid. Erythromycin resistance was associated with a 2-kb plasmid. One of the beta-lactamase plasmids was found to be able to acquire additional resistance determinants to become a multiple resistance plasmid. There were 10 multilocus sequence types belonging to eight distantly related clonal complexes of S. aureus. One new sequence type was found. Although most of the CMRSA harbored the type IVa SCCmec, a type IV structural variant was found and two new SCCmec types were identified. Protein A gene (spa) typing revealed two new spa types and, with two exceptions, corresponded to multilocus sequence typing. In contrast to other reports on CMRSA, most of the CMRSA strains studied here did not contain the Panton-Valentine leukocidin genes. The results also demonstrate that nonmultiresistant hospital strains such as UK EMRSA-15 may be able to circulate in the community and could be mistaken for CMRSA based on their resistance profiles

The use of quinolones in the treatment of non-serious community-acquired methicillin-resistant Staphylococcus aureus is discussed. The new C8-modified quinolones may be suitable for such treatment but controlled trials should be carried out to ensure that the pharmacokinetics are such that there is little risk of resistance developing

Mr. 'Enrand' came to me with depression, weight gain, high cholesterol and elevated blood pressure. Each of these abnormalities was mild, but they were likely to get worse if left untreated. Eight months after relinquishing my control, I took Enrand's blood pressure and discovered it was back to normal without medication. The scale indicated that he had lost 30 pounds during that time. His cholesterol was back below 200. Now he was sleeping through the night without Valium. Now that Enrand had passed through his midlife crisis and the crippling anxiety accompanying it, I realized that he'd been doing the doctoring. He'd learned to treat -- not illness -- but the fear that ran through the heart of it