Human nanophyetiasis: transmission by handling naturally infected coho salmon (Oncorhynchus kisutch)

Article Abstract:

The parasitic trematode (flatworm) known as Nanophyetus salmincola salmincola (NSS) has been transmitted to man by eating raw, incompletely cooked, or cold smoked salmon fishes. This study reports the first US case of infection with NSS due to handling naturally infected coho salmon. The patient worked in a research project of NSS epidemiology. His duties involved removing a portion of the salmon kidney, softening the tissue, and examining it for the presence of NSS metacercariae (the encysted stage of a trematode). Laboratory work was conducted without the benefit of protective gloves. One month after the initiation of the study, the patient complained of flu-like symptoms, including diarrhea, nausea, and abdominal pain. The identification of the NSS bipolar egg in the patient's stool and eosinophilia (an elevated number of eosinophils, a type of white blood cell) confirmed the diagnosis of hand-to-mouth transmission of the parasite. The patient did not eat fish for several months prior to his illness and never ate raw or cold smoked fish. He responded favorably to therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Disease transmission, Identification and classification, Parasites, Salmon, Diseases and pests, Life cycles (Biology), Worms, Intestinal and parasitic, Helminths, Parasitic diseases

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Diagnostic test ordering in the evaluation of febrile children: physician and environmental factors

Article Abstract:

Information gathered in a medical history or physical examination has an effect on diagnostic test ordering in children. However, there was been little investigation of whether nonpatient factors, such as type of physician and health care setting, can alter the intensity and approach to the ordering of diagnostic tests. 6,191 consecutive outpatient visits by nonadmitted febrile children under the age of 18 to the emergency department over an 8-month period were studied. It was found that patients evaluated by hospital-based subspecialists had a greater likelihood of undergoing tests than patients who were evaluated by community-based physicians. Physicians with less experience were more likely to order tests than more experienced ones. The season of the year and the experience and training of the attending staff affect test ordering, which has important implications for patients and families, clinical training, and supervision and health costs.

Evaluation, Fever in children, Childhood fever, Medical personnel and patient, Medical personnel-patient relations

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