Faculty Bibliography

OBJECTIVE: To investigate suspected pseudo-outbreaks of Mycobacterium tuberculosis (MTB) during August 1994 and July 1995 among patients who did not have clinical findings consistent with tuberculosis. DESIGN: Retrospective and prospective surveys of all clinical and laboratory data using standard epidemiological tools and DNA fingerprinting. SETTING: A university-affiliated community hospital. PATIENTS: Those with positive MTB cultures during periods when we noted that the number of MTB positive cultures greatly outnumbered the usual monthly average (retrospective analysis, 1994) and patients with positive MTB cultures without clinical findings consistent with tuberculosis (prospective survey, 1995). RESULTS: Epidemiological and molecular studies revealed specimen cross-contamination in the laboratory due to a faulty exhaust hood. Improvement in laboratory ventilation and change of the implicated hood prevented further specimen contamination. CONCLUSIONS: The identification of positive MTB cultures from patients without clinical evidence of tuberculosis should be a signal to suspect laboratory contamination and implement control measures. These should include a thorough epidemiological investigation, DNA fingerprint analysis, and an environmental inspection

Back when John Glenn joined the astronaut corps, as the United States prepared for its first urgent forays into space, he and his fellow pilots took a notoriously dim view of the men in white, the doctors who could ground them for medical cause. But now that NASA is giving Glenn one last chance to show the 'right stuff' in space, he is enlisting the medical profession on his side: One rationale cited by the agency for Glenn's participation in the flight is the opportunity to carry out medical research on what will be the oldest human body to orbit the Earth so far. In pleading with NASA to allow him to fly aboard the space shuttle, Sen. Glenn, D-Ohio, tapped into some medical experts' interest in the parallels between the biological effects of aging and space travel

But now that NASA is giving Mr. Glenn one last chance to show the ''right stuff'' in space, he is enlisting the medical profession on his side: one rationale cited by the agency for Mr. Glenn's participation in the flight is the opportunity to carry out medical research on what will be the oldest human body to orbit the Earth so far. But whether information collected from a sole geriatric volunteer will be sufficient to be meaningful is controversial. In metabolism experiments for the shuttle flight, Mr. Glenn will swallow capsules containing one type of amino acid and receive intravenous injections of another. Then low-level X-ray studies will help detect any changes in lean body mass. Because amino acids are the building blocks of protein, the aim will be to relate any changes in hormonal levels with loss of protein and muscle atrophy in Mr. Glenn and, eventually, eight other crew members. For a sleep experiment, Mr. Glenn will swallow melatonin or placebo pills before retiring on four nights. He will also swallow a capsule containing a small thermometer to record core body temperature because that is a good indicator of biological rhythms. Devices attached to Mr. Glenn's scalp, chest and wrist during monitoring periods will record brain wave activity, breathing patterns and movements during sleep. Mr. Glenn will give samples of his blood and wastes as part of the research

As Thomas Rowe tested samples of the deadly ''bird flu'' strain of influenza virus in a high-security Federal laboratory here this week, a plastic shield protected his face, the air he breathed was filtered as it came through a hose from a battery-powered respirator, a blue gown shielded his body and booties covered his shoes. Mr. Rowe, a research biologist, wore two pairs of latex gloves as he handled samples containing infectious components of the ''bird flu'' virus, known as influenza A(H5N1), under a safety hood in the laboratory at the Centers for Disease Control and Prevention here. The hood above the laboratory bench is designed to reduce the risk that workers like Mr. Rowe will become accidentally infected, and the laboratory building is under negative pressure so that if a door is opened inadvertently, air will rush in, not out, to prevent the escape of dangerous microbes. The laboratory work is vital to the swift public health response to the threat of ''bird flu.'' It is needed to understand the virus at its most basic level, to develop tests to help doctors and health officials detect cases and to make a vaccine in case it is needed to help prevent large outbreaks of illness caused by A(H5N1)

Yet as late as this month, neither the U.S. government nor WHO had approved final plans to counter a pandemic, even as they helped the government of Hong Kong deal with a worrisome outbreak of 'bird flu.' 'It is astounding and atrocious that we haven't had more resources made available to us to get this thing done,' said Peter Patriarca, a Food and Drug Administration official who was the principal author of a recently completed U.S. draft plan on how to battle a flu pandemic. The hope is that the avian strain, known as A(H5N1), will peter out. But one fear is that the strain will adapt to allow easy human-to-human transmission. Another is that it will mix with one of the several human influenza strains now circulating to create yet another strain, one with the potential for producing a pandemic -- the term used when the disease strikes large numbers of people in a number of countries in a short time

Yet, surprisingly, neither the United States Government nor W.H.O. has approved final plans to counter a pandemic, even as they help the Government of Hong Kong deal with a worrisome outbreak of ''bird flu.'' That strain of influenza virus is the first to jump from birds to humans without going through other animals. The Government created a panel in 1993 to come up with a plan to deal with an influenza pandemic, and the latest draft, written last week, is being sent to Donna E. Shalala, the Secretary of Health and Human Services. Approval is expected quickly now that events in Hong Kong have heightened awareness, Government officials said. But they acknowledged that the Hong Kong outbreak had pointed up gaps in the draft, making further revisions likely. United States and W.H.O. officials interviewed expressed confidence in the thoroughness of their draft plans for a pandemic. But W.H.O. refused to release a copy of its draft. The American disease-control agency initially denied repeated requests for a copy of the nation's draft plan, but Dr. Peter A. Patriarca, an official of the Food and Drug Administration who is the principal author of the American drafts, released it over the weekend

A 'bird flu' strain of influenza virus has caused only 20 confirmed or suspected cases of human illness in Hong Kong, all since May, and has not been found elsewhere. Yet Hong Kong health officials are so worried about the virus that last Monday they began slaughtering all 1.2 million chickens in the territory. And virologists around the world have been burning the midnight oil for several weeks, studying the strain and attempting to make a vaccine for it

A 'bird flu' strain has caused only 20 confirmed or suspected cases of human illness in Hong Kong, all since May, and has not been found elsewhere. Yet Hong Kong health officials are so worried about the virus that they have slaughtered 1.3 million chickens in the territory. And virologists around the world have been burning the midnight oil for several weeks, studying the strain and attempting to make a vaccine for it. The main reason is the strain's novelty for humans. It has been seen only in poultry before, and the strain infecting humans is the same one that has killed thousands of chickens in Hong Kong. Scientists believe that the virus is transmitted when someone touches an infected person, not through the air - the usual way influenza spreads. But scientists are puzzled about exactly how the virus is transmitted. Whether the destruction of Hong Kong chickens will stop the transmission of the virus is an unanswered question. But as long as A(H5N1) infections continue to occur, no one can know where the Hong Kong outbreak will lead. For now, [Keiji Fukuda] said, 'there is clearly a great deal of concern that this virus could take hold and lead to a pandemic.'