Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease - United States.

The term "chronic Lyme disease" is used by some health care providers as a diagnosis for various constitutional, musculoskeletal, and neuropsychiatric symptoms (1,2). Patients with a diagnosis of chronic Lyme disease have been provided a wide range of medications as treatment, including long courses of intravenous (IV) antibiotics (3,4). Studies have not shown that such treatments lead to substantial long-term improvement for patients, and they can be harmful (1,5). This report describes cases of septic shock, osteomyelitis, Clostridium difficile colitis, and paraspinal abscess resulting from treatments for chronic Lyme disease. Patients, clinicians, and public health practitioners should be aware that treatments for chronic Lyme disease can carry serious risks

Francisella tularensis: an arthropod-borne pathogen

Arthropod transmission of tularemia occurs throughout the northern hemisphere. Few pathogens show the adaptability of Francisella tularensis to such a wide array of arthropod vectors. Nonetheless, arthropod transmission of F. tularensis was last actively investigated in the first half of the 20th century. This review will focus on arthropod transmission to humans with respect to vector species, modes of transmission, geographic differences and F. tularensis subspecies and clades

Ecological Niche Modeling of Francisella tularensis Subspecies and Clades in the United States

Two subspecies of Francisella tularensis are recognized: F. tularensis subsp. tularensis (type A) and F. tularensis subsp. holartica (type B). Type A has been subdivided further into A1a, A1b, and A2, which differ geographically and clinically. The aim of this work was to determine whether or not differences among subspecies and clades translate into distinct ecological niches. We used 223 isolates from humans and wildlife representing all six genotypes (type A, B, A1, A2, A1a, or A1b). Ecological-niche models were built independently for each genotype, using the genetic algorithm for rule-set prediction. The resulting models were compared using a non-parametric multivariate analysis-of-variance method. A1 and A2 are ecologically distinct, supporting the previously observed geographic division, whereas ecological niches for types A and B overlapped notably but A1a and A1b displayed no appreciable differences in their ecological niches

A new strategy for waterborne disease prevention

In many parts of the developing world, drinking water is collected from unsafe sources and is further contaminated during storage in household vessels. We have developed a simple, inexpensive system for point-of-use disinfection and storage of water which has 3 elements: for disinfection, a sodium hypochlorite solution produced from water and salt using appropriate technology; for safe storage, a 20-litre plastic vessel with a narrow mouth, lid, and spigot (referred to hereafter as the special vessel); and community education to ensure proper use of this system and to teach populations about the association between contaminated water and disease (Mintz, 1995). A field test of this system in El Alto, Bolivia, demonstrated a high level of acceptance among impoverished Aymara Indian families (Quick, 1996). Stored water in households that used the system had lower levels of contamination with E. coli than water in households that used their traditional storage systems. A second field test among vendors in the markets of Guatemala City, Guatemala, showed that there were lower levels of contamination with fecal coliform bacteria in samples of stored water and beverages from vendors using this system than from vendors not using this system (Sobel, 1997). Two field trials have been conducted in the past 3 years to test the effectiveness of this system in preventing diarrhea and its sustainability on a large scale

Multiple Francisella tularensis Subspecies and Clades, Tularemia Outbreak, Utah

In July 2007, a deer fly–associated outbreak of tularemia occurred in Utah. Human infections were caused by 2 clades (A1 and A2) of Francisella tularensis subsp. tularensis. Lagomorph carcasses from the area yielded evidence of infection with A1 and A2, as well as F. tularensis subsp. holarctica. These findings indicate that multiple subspecies and clades can cause disease in a localized outbreak of tularemia

Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies.

<p><b>Background</b>: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke.</p> <p><b>Objective</b>: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke.</p> <p><b>Methods</b>: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses.</p> <p><b>Results</b>: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of <i>>30</i> and <i>>60 min</i> (p = 0.001 and p = 0.004, respectively). Regression models explained 11–19% of the variance in total sedentary time and time in prolonged sedentary bouts.</p> <p><b>Conclusion</b>: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.</p

Web-based Investigation of Multistate Salmonellosis Outbreak

We investigated a large outbreak of Salmonella enterica serotype Javiana among attendees of the 2002 U.S. Transplant Games, including 1,500 organ transplant recipients. Web-based survey methods identified pre-diced tomatoes as the source of this outbreak, which highlights the utility of such investigative tools to cope with the changing epidemiology of foodborne diseases

Landscape and Residential Variables Associated with Plague-Endemic Villages in the West Nile Region of Uganda

Plague, caused by the bacteria Yersinia pestis , is a severe, often fatal disease. This study focuses on the plagueendemic West Nile region of Uganda, where limited information is available regarding environmental and behavioral risk factors associated with plague infection. We conducted observational surveys of 10 randomly selected huts within historically classified case and control villages (four each) two times during the dry season of 2006 ( N = 78 case huts and N = 80 control huts), which immediately preceded a large plague outbreak. By coupling a previously published landscape-level statistical model of plague risk with this observational survey, we were able to identify potential residence-based risk factors for plague associated with huts within historic case or control villages (e.g., distance to neighboring homestead and presence of pigs near the home) and huts within areas previously predicted as elevated risk or low risk (e.g., corn and other annual crops grown near the home, water storage in the home, and processed commercial foods stored in the home). The identified variables are consistent with current ecologic theories on plague transmission dynamics. This preliminary study serves as a foundation for future case control studies in the area

Normal Globular Cluster Systems in Massive Low Surface Brightness Galaxies

We present the results of a study of the globular cluster systems of 6 massive spiral galaxies, originally cataloged as low surface brightness galaxies but here shown to span a wide range of central surface brightness values, including two intermediate to low surface brightness galaxies. We used the Advanced Camera for Surveys on board HST to obtain photometry in the F475W and F775W bands and select sources with photometric and morphological properties consistent with those of globular clusters. A total of 206 candidates were identified in our target galaxies. From a direct comparison with the Galactic globular cluster system we derive specific frequency values for each galaxy that are in the expected range for late-type galaxies. We show that the globular cluster candidates in all galaxies have properties consistent with globular cluster systems of previously studied galaxies in terms of luminosity, sizes and color. We establish the presence of globular clusters in the two intermediate to low surface brightness galaxies in our sample and show that their properties do not have any significant deviation from the behavior observed in the other sample galaxies. Our results are broadly consistent with a scenario in which low surface brightness galaxies follow roughly the same evolutionary history as normal (i.e. high surface) brightness galaxies except at a much lower rate, but require the presence of an initial period of star formation intense enough to allow the formation of massive star clusters.Comment: 14 pages, 6 figures. AJ accepte