The role of immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents

Article Abstract:

Persons infected with human immunodeficiency virus (HIV, which causes AIDS) appear to be at high risk for pneumococcal disease. Failure of the humoral immune system, important in immunity to pneumococcal disease, and the progressive loss of cell-mediated immunity occur in HIV-infected patients. The extent of involvement, the clinical course of infection, and the serotypes of pneumococcal bacteria most frequently encountered have not been widely studied in this vulnerable population. (Serotypes are combinations of foreign antigens.) To evaluate the risk of pneumococcal disease in these patients and develop methods of prevention, the authors conducted a retrospective review of male and female patients with pneumococcal bacteremia, based on medical records of 10 San Francisco hospitals from 1983 to 1987. (Bacteremia involves bacteria in the blood and may be life-threatening.) HIV seropositivity, an indication of HIV infection, was reviewed for patients between 20 and 55 years of age. A total of 294 cases (62 women and 232 men) conformed to the study parameters. Pneumococcal bacteremia resulted from pneumonia, meningitis, peritonitis, otitis media, pericarditis, septic arthritis, and sinusitis. At the time of diagnosis, 32 patients had AIDS; 43 were HIV-positive, but did not have AIDS; and 12 HIV-positive patients developed AIDS following pneumococcal bacteremia. The most common pneumococcal serotypes identified are among those included in the currently available pneumococcal vaccine. Further, these serotypes were identified in 82 percent of HIV-infected patients, and 90 percent of non-HIV patients. These findings indicate that, if the current pneumococcal vaccine is effective in HIV-positive patients, it may provide them with significant protection against pneumococcal disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Physiological aspects, Pneumococcal vaccine, Pneumococcal vaccines, HIV infection, HIV infections, Bacteremia, Streptococcus pneumoniae

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Foodborne disease outbreaks in nursing homes, 1975 through 1987

Article Abstract:

In 1986 almost one and a half million Americans were cared for in nursing homes. Most of these patients are frail elderly persons who are at serious risk of illness and death from foodborne diseases that may occur in such settings. The proportion of deaths (case-fatality ratio, or CFR) for foodborne illness among nursing home residents is 10 times higher than for the general population. Data from the Centers for Disease Control (CDC) from 1975 through 1987 were reviewed to determine the scope of the problem and to prevent future occurrences. During this period, 26 states reported 115 outbreaks of foodborne disease in nursing homes. The outbreaks ranged in size from six to 173 persons becoming ill. In total, 4,944 persons were affected; 213 were hospitalized, and 51 died. The cause was found in fewer than half of these cases. When a cause was identified, Salmonella was the bacterium responsible in more than half of the cases, and accounted for 81 percent of the deaths. Staphylococcus and Escherichia coli were also found to be common causes of illness. These outbreaks represent only a small proportion of the true number of foodborne illnesses in nursing homes because reporting is not mandatory. Only cases that are investigated by local or state health departments are likely to be reported to the CDC. The difficulties of diagnosis of foodborne illness among debilitated, often disoriented patients are discussed. Prevention and control measures are outlined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Communicable diseases, Foodborne diseases, Nursing homes

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