From December 1986 to March 1987 an outbreak of Listeria monocytogenes infection occurred in the Philadelphia metropolitan area. A patient-control study showed patients were more likely than controls to have had an ill family member and to have used antidiarrheal medication during the month before their illness. Diet histories showed patients were significantly more likely to have eaten ice cream or salami than were controls, and to have shopped at one grocery store chain. Subtyping of L. monocytogenes isolates of patients showed no predominant strain, and cultures of food products eaten by patients were negative except for Brie cheese eaten by one patient. With no predominant strain of L. monocytogenes in the patients, a common source for this outbreak is unlikely. Thus, the identified risk factors may have been associated with carriage of L. monocytogenes and a coinfecting organism may have precipitated disseminated disease. Possible cofactors should be considered in investigations of future outbreaks of listeriosis.
Personnel of inner-city emergency departments (EDs), which are frequently the only source of medical care for many patients, may be in a unique position to detect human immunodeficiency virus (HIV) infection earlier than personnel at other recommended screening sites. To assist development of ED-based screening strategies for HIV infection, we undertook a serosurvey of HIV infection in adult patients attending an ED during a 6-week period in 1992 using an identity-unlinked technique and compared our findings with data collected similarly in 1988. Of 1,606 patients, 183 (11.4%) were HIV-positive, compared with 6.0% in 1988. Seroprevalence rates of HIV infection among patients only at risk of heterosexual transmission increased more than fourfold (7% to 30.3%). CD4+ cell counts were higher in those patients with undiagnosed HIV infection than in those with known HIV infection. Targeting minority patients aged 25-44 years, intravenous drug users, and those patients at heterosexual risk would have identified 87% of patients with new HIV infection, while requiring screening of 41% of the study sample. Targeted voluntary screening programs in certain EDs would likely detect significant numbers of new early HIV infections.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.