Pasteurella multocida infections: Report of 34 cases and review of the literature

Pasteurella multocida, a small gram-negative coccobacillus, is part of the normal oral flora of many animals, including the cat and dog. P. multocida is a major pathogen in wound infections due to animal bites and can cause cellutitis, abscess, osteomyelitis, septic arthritis, or a variety of other infectious syndromes (Table 1). Over the years, P. multocida has been the subject of a number of short general reviews (74, 80, 91, 96, 158). More recently, reviews have focused on selected aspects of P. multocida infection including meningitis (44), empyema (112), spontaneous bacterial peritonitis (160), bone and joint infections (56), and septicemia (111). A large series of cases with a comprehensive review, however, has not been published. We therefore report here 34 cases from the Massachusetts General Hospital and review the English literature

Personalizing Breast Cancer Screening Based on Polygenic Risk and Family History

_Background:_ We assessed the clinical utility of a first-degree breast cancer family history and polygenic risk score (PRS) to inform screening decisions among women aged 30-50 years. _Methods:_ Two established breast cancer models evaluated digital mammography screening strategies in the 1985 US birth cohort by risk groups defined by family history and PRS based on 313 single nucleotide polymorphisms. Strategies varied in initiation age and interval. The benefits and harms were compared with those seen with 3 established screening guidelines. _Results:_ Women with a breast cancer family history who initiated biennial screening at age 40 years had a 36% increase in life-years gained and 20% more breast cancer deaths averted, but 21% more overdiagnoses and 63% more false positives. Screening tailored to PRS vs biennial screening from50 to 74 years had smaller positive effects on life-years gained and breast cancer deaths averted but also smaller increases in overdiagnoses and false positives. Combined use of family history and PRS vs biennial screening from 50 to 74 years had the greatest increase in life-years gained and breast cancer deaths averted. _Conclusions:_ Our results suggest that breast cancer family history and PRS could guide screening decisions before age 50 years among women at increased risk for breast cancer but expected increases in overdiagnoses and false positives should be expected

Cryptosporidiosis in Immunocompetent Patients

The intestinal protozoan cryptosporidium is known to cause diarrhea in immunocompromised patients, but few cases have been reported in detail in immunocompetent persons. During a 12-month period, we identified cryptosporidium in the stools of 43 immunocompetent patients. The numbers of cases were increased in those under 4 years old and in those from 30 to 39 years old. Of 30 index cases, 23 (77 per cent) were diagnosed in the late summer or the fall. Fifteen of the 43 patients (35 per cent) had other gastrointestinal pathogens, of which only Giardia lamblia was statistically associated with cryptosporidium. In the 28 patients in whom other gastrointestinal pathogens were not identified, the clinical manifestations were predominantly watery, nonbloody diarrhea and, less commonly, abdominal discomfort, anorexia, fever, nausea, and weight loss. The infection was self-limited in all 43 patients. Clustering of cases occurred in a day-care center and in two families. These clinical observations confirm worldwide findings and suggest that cryptosporidium is a relatively common nonviral cause of self-limited diarrhea in immunocompetent persons in the northeastern United States. (N Engl J Med 1985; 312:1278–82.)

An Association between Cryptosporidium and Giardia in Stool

To the Editor: Cryptosporidium species have recently been recognized as a cause of gastrointestinal disease in both immunocompromised and immunocompetent persons.1 2 Since February 1, 1983, all stool specimens submitted to our Clinical Parasitology Laboratory for ova and parasite examination have been screened for cryptosporidium by a modified acid-fast method.3 We wish to report an association between the presence of cryptosporidium and Giardia lamblia in stool. As of November 1, 1983, cryptosporidium had been identified in stool specimens from 33 of 1290 patients (2.6 per cent). For five patients, positive findings were verified by Sheather's sugar-flotation method.4 Five of the 33

Development of significantly improved catalysts for coal liquefaction and upgrading of coal extracts. Quarterly progress report No. 7, April 1-June 30, 1983

A series of twenty-five experimental bead catalysts were tested for coal liquefaction activity in batch screening trials. Six factors relating to support preparation and composition, molybdenum, nickel, and cobalt levels, and additives, were varied according to a statistical design. Molybdenum (MoO/sub 3/) and NiO/CoO promotor levels were found to correlate most closely with coal conversion and sulfur removal. Support composition and additive variables had detrimental effects only at particular levels. Batch testing with coal extracts was initiated. Runs were done to gain experience in processing extracts as well as to develop satisfactory work-up procedures. Results of baseline runs are given. Surface characterization of experimental bead catalysts continued. X-ray photoelectron and electron microprobe techniques were used. Results are compared to activity test data. 9 references, 6 figures, 12 tables