Tularemia in the Southeastern Swiss Alps at 1,700 m above sea level.

A 37-year-old man presented with a 4-day history of nonbloody diarrhea, fever, chills, productive cough, vomiting, and more recent sore throat. He worked for the municipality in a village in the Swiss Alps near St. Moritz. Examination showed fever (40 °C), hypotension, tachycardia, tachypnea, decreased oxygen saturation (90 % at room air), and bibasilar crackles and wheezing. Chest radiography and computed tomography scan showed an infiltrate in the left upper lung lobe. He responded to empiric therapy with imipenem for 5 days. After the imipenem was stopped, the bacteriology laboratory reported that 2/2 blood cultures showed growth of Francisella tularensis. He had recurrence of fever and diarrhea. He was treated with ciprofloxacin (500 mg twice daily, oral, for 14 days) and symptoms resolved. Further testing confirmed that the isolate was F. tularensis (subspecies holarctica) belonging to the subclade B.FTNF002-00 (Western European cluster). This case may alert physicians that tularemia may occur in high-altitude regions such as the Swiss Alps

Determinants of private well water testing in Maine

Objectives: Describe sociodemographic characteristics associated with ever testing well water using data from the 2014-2017 Maine Behavioral Risk Factor Surveillance System (BRFSS) (n= 12,152).https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1005/thumbnail.jp

Epidemic Spread of a Single Clone of Methicillin-Resistant Staphylococcus aureus among Injection Drug Users in Zurich, Switzerland

We describe an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among injection drug users (IDUs). From August 1994 through December 1999, we registered 31 IDUs with MRSA infections (12 with soft-tissue infection, 7 with pneumonia [fatal in 1], 7 with endocarditis [fatal in 1], 2 with osteomyelitis, 2 with septic arthritis, and 1 with ulcerative tonsillitis), with a marked increase in the number of IDUs registered during 1998 and 1999. Of 31 patients, 15 (48%) were infected with human immunodeficiency virus. A point-prevalence study among IDUs who frequented outpatient facilities in Zurich revealed an MRSA carriage rate of 10.3% (range, 0%-28.6%) in various facilities. In all but 1 case, pulsed-field gel electrophoresis banding patterns of isolates obtained from these patients were indistinguishable from isolates of the initial 31 IDUs registered. Risk factors for MRSA carriage were disability and prior hospitalization in a hospice. In summary, MRSA became endemic in IDUs in Zurich as a result of the spread of a single clone. This clone caused major morbidity and was responsible for a lethal outcome in 2 case

Blood Lead Levels and Serum Insulin-Like Growth Factor 1 Concentrations in Peripubertal Boys

Background: Childhood lead exposure has been associated with growth delay. However, the association between blood lead levels (BLLs) and insulin-like growth factor 1 (IGF-1) has not been characterized in a large cohort with low-level lead exposure. Methods: We recruited 394 boys 8–9 years of age from an industrial Russian town in 2003–2005 and followed them annually thereafter. We used linear regression models to estimate the association of baseline BLLs with serum IGF-1 concentration at two follow-up visits (ages 10–11 and 12–13 years), adjusting for demographic and socioeconomic covariates. Results: At study entry, median BLL was 3 μg/dL (range, < 0.5–31 μg/dL), most boys (86%) were prepubertal, and mean ± SD height and BMI z-scores were 0.14 ± 1.0 and –0.2 ± 1.3, respectively. After adjustment for covariates, the mean follow-up IGF-1 concentration was 29.2 ng/mL lower (95% CI: –43.8, –14.5) for boys with high versus low BLL (≥ 5 μg/dL or < 5 μg/dL); this difference persisted after further adjustment for pubertal status. The association of BLL with IGF-1 was stronger for mid-pubertal than prepubertal boys (p = 0.04). Relative to boys with BLLs < 2 μg/dL, adjusted mean IGF-1 concentrations decreased by 12.8 ng/mL (95% CI: –29.9, 4.4) for boys with BLLs of 3–4 μg/dL; 34.5 ng/mL (95% CI: –53.1, –16.0) for BLLs 5–9 μg/dL; and 60.4 ng/mL (95% CI: –90.9, –29.9) for BLLs ≥ 10 μg/dL. Conclusions: In peripubertal boys with low-level lead exposure, higher BLLs were associated with lower serum IGF-1. Inhibition of the hypothalamic–pituitary–growth axis may be one possible pathway by which lead exposure leads to growth delay

Plasma concentrations of per- and polyfluoroalkyl substances and body composition from mid-childhood to early adolescence

BACKGROUND • Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation. Prior studies have found positive, inverse, and null associations of PFAS concentrations with adiposity among children and adolescents. Few studies have examined associations of PFAS concentrations with changes in body composition longitudinally. No study has examined the association of PFAS plasma concentrations with lean mass.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1038/thumbnail.jp

Air Pollution Exposure and Abnormal Glucose Tolerance during Pregnancy: The Project Viva Cohort

Background: Exposure to fine particulate matter (PM with diameter ≤ 2.5 μm; PM2.5) has been linked to type 2 diabetes mellitus, but associations with hyperglycemia in pregnancy have not been well studied. Methods: We studied Boston, Massachusetts–area pregnant women without known diabetes. We identified impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) during pregnancy from clinical glucose tolerance tests at median 28.1 weeks gestation. We used residential addresses to estimate second-trimester PM2.5 and black carbon exposure via a central monitoring site and spatiotemporal models. We estimated residential traffic density and roadway proximity as surrogates for exposure to traffic-related air pollution. We performed multinomial logistic regression analyses adjusted for sociodemographic covariates, and used multiple imputation to account for missing data. Results: Of 2,093 women, 65 (3%) had IGT and 118 (6%) had GDM. Second-trimester spatiotemporal exposures ranged from 8.5 to 15.9 μg/m3 for PM2.5 and from 0.1 to 1.7 μg/m3 for black carbon. Traffic density was 0–30,860 vehicles/day × length of road (kilometers) within 100 m; 281 (13%) women lived ≤ 200 m from a major road. The prevalence of IGT was elevated in the highest (vs. lowest) quartile of exposure to spatiotemporal PM2.5 [odds ratio (OR) = 2.63; 95% CI: 1.15, 6.01] and traffic density (OR = 2.66; 95% CI: 1.24, 5.71). IGT also was positively associated with other exposure measures, although associations were not statistically significant. No pollutant exposures were positively associated with GDM. Conclusions: Greater exposure to PM2.5 and other traffic-related pollutants during pregnancy was associated with IGT but not GDM. Air pollution may contribute to abnormal glycemia in pregnancy. Citation: Fleisch AF, Gold DR, Rifas-Shiman SL, Koutrakis P, Schwartz JD, Kloog I, Melly S, Coull BA, Zanobetti A, Gillman MW, Oken E. 2014. Air pollution exposure and abnormal glucose tolerance during pregnancy: the Project Viva Cohort. Environ Health Perspect 122:378–383; http://dx.doi.org/10.1289/ehp.130706

Dietary Patterns and PFAS Plasma Concentrations in Childhood: Project Viva, USA

Children who adhered to a dietary pattern of primarily packaged foods and fish had higher plasma concentrations of select PFAS, reflective of food intake and/or correlated lifestyle factors.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1011/thumbnail.jp

Effects of Barnacle Encrustation on the Swimming Behaviour, Energetics, Morphometry, and Drag Coefficient of the Scallop Chlamys Hastata

Barnacle encrustation negatively influenced every aspect of swimming in the scallop Chlamys hastata measured in this study. Scallops swam significantly longer, travelled further and attained greater elevation once epibiotic barnacles had been removed. Shell morphometry of barnacle-encrusted scallops was similar to shells of unencrusted scallops. Specifically, shell length was positively allometric with shell height and shell mass was negatively allometric. However, adductor muscle mass scaled isometrically to shell height, in contrast to unencrusted scallops. In the laboratory, the drag coefficient (Cd) of barnacle-encrusted scallops decreased after barnacle removal, in contrast to sponge-encrusted scallops in which no decrease in Cd was detected when the sponge was removed from the scallop\u27s valves. Furthermore, scallops swimming with barnacle encrustation required more energy than did unencrusted scallops. Although there was no significant difference in aerobic energy expenditure between swimming barnacle-encrusted and unencrusted scallops, differences in anaerobic energy expenditure were detected. Specifically, barnacle-encrusted scallops required more arginine phosphate than unencrusted scallops to swim to exhaustion although octopine levels were similar. Thus, barnacle encrustation dramatically decreased a scallop\u27s ability to swim, partly by increasing the drag coefficient experienced by the scallop and the energy required for swimming

Effects of Barnacle Encrustation on the Swimming Behaviour, Energetics, Morphometry, and Drag Coefficient of the Scallop Chlamys Hastata

Barnacle encrustation negatively influenced every aspect of swimming in the scallop Chlamys hastata measured in this study. Scallops swam significantly longer, travelled further and attained greater elevation once epibiotic barnacles had been removed. Shell morphometry of barnacle-encrusted scallops was similar to shells of unencrusted scallops. Specifically, shell length was positively allometric with shell height and shell mass was negatively allometric. However, adductor muscle mass scaled isometrically to shell height, in contrast to unencrusted scallops. In the laboratory, the drag coefficient (Cd) of barnacle-encrusted scallops decreased after barnacle removal, in contrast to sponge-encrusted scallops in which no decrease in Cd was detected when the sponge was removed from the scallop\u27s valves. Furthermore, scallops swimming with barnacle encrustation required more energy than did unencrusted scallops. Although there was no significant difference in aerobic energy expenditure between swimming barnacle-encrusted and unencrusted scallops, differences in anaerobic energy expenditure were detected. Specifically, barnacle-encrusted scallops required more arginine phosphate than unencrusted scallops to swim to exhaustion although octopine levels were similar. Thus, barnacle encrustation dramatically decreased a scallop\u27s ability to swim, partly by increasing the drag coefficient experienced by the scallop and the energy required for swimming