Varicella outbreaks in Army recruits from Puerto Rico: varicella susceptibility in a population from the tropics
Article Abstract:
From October 1986 to November 1987, two outbreaks of varicella zoster infection occurred at the Defense Language Institute in San Antonio, Texas. The virus, which causes both chickenpox and herpes zoster (shingles), results in about 3 million cases of chickenpox each year in the US, 90 percent of which occur in children ranging from one to 14 years old. In the first outbreak, the attack rate was 30 percent, which was estimated to involve 71 percent of susceptible individuals. A total of 105 recruits became infected, but there were no serious complications. Adults are at higher risk than children for complications from chicken pox, which include encephalitis and pneumonia. The rate of encephalitis resulting from varicella-zoster is eight times greater in adults than children, and the death rate is 25 times greater in adults. In general, military organizations provide group housing facilities which facilitate the efficient spread of airborne infection. Serologic testing was instituted to determine the proportion of susceptible individuals. The students at the Defense Language Institute were largely from Puerto Rico, and it was determined that only 58 percent of the students from Puerto Rico had antibodies against the varicella-zoster virus, a rate that is considerably lower when compared with individuals from other tropical countries. The rate of immunity within the continental US is virtually 100 percent in individuals above the age of 15. The reason for the increased susceptibility of the Puerto Rican recruits is not known. However, it seems clear that the varicella-zoster vaccine, which has been developed primarily for children, may prove to be useful in adults from highly susceptible populations. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1990
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Occult coiled drinking straw aspiration
Article Abstract:
The accidental inhalation of foreign bodies into the airways of the lungs is common, and the affected person may be totally unaware of his condition. The foreign body may cause a bloody cough, chest pain, or may cause an infection (pneumonia) where the ingested body has become lodged. Substances typically ingested include chicken and fish bones, fruits, candy, pins, teeth, gum, and stomach contents. Most cases of foreign body inhalation occur in children who have inhaled seeds or nuts. A recent case describes a 23-year-old man who was referred to the Pulmonary Disease Service at Fitzsimons Army Medical Center for evaluation of a right lung pneumonia of seven months duration. Diagnostic imaging techniques indicated an infection of the right lung that responded when treated with drugs that kill bacteria, but would then reoccur. Flexible fiber-optic bronchoscopy of the area revealed a large amount of inflammation and irritation. Fiber-optic bronchoscopy is a procedure in which a fine tube-like structure is passed into the lung and allows for the direct visualization and sampling of lung tissue. Samples revealed the presence of a large lesion that contained dead tissue and obstructed the airways, but which did not contain fungus. Rigid bronchoscopy uses a harder tube-like structure to examine the lungs, and allowed the physicians to clamp and remove the lesion. Upon removing the lesion they discovered it was a coiled plastic drinking straw. The patient later admitted that he would chew on drinking straws for hours after drinking a beverage. This is a unique case of foreign body inhalation and demonstrates the potential hazards of chewing on straws. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Heart and Lung
Subject: Health
ISSN: 0147-9563
Year: 1990
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Pulmonary embolism associated with the act of defecation
Article Abstract:
Pulmonary embolism occurs when a blood clot travels to the blood vessels in the lungs, where it becomes lodged and blocks the normal flow of blood. It is the most common cause of preventable death. Out of an estimated 500,000 cases of pulmonary embolism each year, 10 percent are fatal. Pulmonary embolism occurs in patients with blood clot disorders such as deep vein thrombosis. This condition most commonly affects the legs, were it causes blood clots to form inside of the blood vessels. It is treated with drugs, such as heparin, that prevent blood clots from forming. This type of treatment has been shown to reduce the formation of blood clots and the incidence of death from pulmonary embolism. This article describes the case reports of two patients who developed pulmonary embolisms after defecating (having a bowel movement). Both patients fainted when they tried to stand after defecating. It was not until after several diagnostic tests were performed that it was discovered that the patients had pulmonary embolisms. Squatting on the toilet may help to dislodge blood clots in the legs and thighs. When the medical records of 138 patients with pulmonary embolism were reviewed, nine cases associated with defecating were identified. Risk factors for this condition include recent surgery, a prior history of blood clot formation, cardiopulmonary disease, and diabetes. Patients with blood clots can be treated with stool softeners and instructed on how to minimize the force of abdominal muscle contractions and internal pressure during defection to reduce the risk of pulmonary embolism. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Heart and Lung
Subject: Health
ISSN: 0147-9563
Year: 1991
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