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In the 1970s investigations generated a remarkable amount of information on the viruses responsible for acute gastroenteritis. The two viruses responsible for most cases occur in epidemiologically distinct clinical forms. Although occasionally epidemic, rotavirus infections are usually sporadic and primarily affect infants and young children. This illness is characterized by severe diarrhea commonly lasting five to eight days and frequently associated with upper respiratory tract symptoms, fever, and vomiting. The Norwalk agent and Norwalk-like viruses are characteristically epidemic and responsible for community-wide outbreaks of gastroenteritis among all ages. The disease this agent produces usually lasts 24 to 48 hours and is characterized by various combinations of vomiting, diarrhea, nausea, headache, and low-grade fever.
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PMID:Viral diseases: infections of the gastrointestinal tract. 629 Jan 33

In June 1977 an outbreak of acute gastroenteritis affected 103 students and teachers at an elementary school in Ohio. The illness typically lasted 24 hours or less and was characterized by vomiting (86%) and cramping (70%), but more than half of the persons involved also reported having nausea, diarrhea, and headache. Similar illness frequently followed in household members (29%) of families with primary cases. Investigation revealed that 70% of the children and teachers who swam in a pool at an all day outing June 1 (4 classrooms) and 55% of those who swam during a similar outing June 2 (2 classrooms) had the onset of acute illness from 12--48 hours later. None of the children who attended the outings but did not swim had a similar illness. The evidence suggested that the primary outbreak was caused by contaminated water in the pool and that person-to-person spread of illness followed. Results of a microbiologic study of pool water were negative for bacterial and viral pathogens. Throat washings, stool specimens, and paired blood samples studied for evidence of pathogens were negative initially, but subsequent serologic studies suggested that infection by Norwalk virus was the cause of the outbreak. The pool chlorinator which was inadvertently unconnected at the time of the school visits was reconnected and an underground leak in the water supply pipes was corrected. No more cases were reported after the pool was drained, cleaned, and reopened.
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PMID:An outbreak of Norwalk gastroenteritis associated with swimming in a pool and secondary person-to-person transmission. 629 5

A patient reported that she developed various shock-like symptoms upon intake of alcohol, acetylsalicylic acid, or after injection of contrast medium. After provocation with alcohol applied orally and following endoscopy flush, tachycardia, and a severe headache followed immediately by painful diarrhea were observed. According to our diagnosis the patient had urticaria pigmentosa involving the bone marrow and an enlarged liver and spleen, respectively. The suspected intestinal mastocytosis was confirmed histologically by a biopsy from the jejunum. It was concluded that the symptoms were the result of a direct activation of the accumulated intestinal mast cells. The differential diagnosis of mastocytosis as opposed to allergic gastroenteritis, sprue, and carcinoid is discussed.
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PMID:[Mastocytosis simulating a food allergy]. 686 85

Clinical and epidemiologic characteristics of disease associated with a newly described nonhalophilic Vibrio species, Vibrio mimicus, were identified by studying isolates from 21 patients referred to the Centers for Disease Control between 1977 and 1981. Two isolates were from the ears of patients with otitis who had recently been exposed to seawater. Nineteen isolates were from stool samples; these patients generally had diarrhea, nausea, vomiting, and abdominal cramps, with fever, headache, and bloody diarrhea occurring in fewer than half. Persons with diarrhea were more likely than age- and sex-matched controls to have eaten raw oysters (p = 0.013). Although most cases were sporadic, three were associated with a single outbreak. Only two isolates produced toxin found by enzyme-linked immunosorbent assay or the Y-1 adrenal cell assay for heat-labile toxin, and none produced heat-stable toxin found by the infant mouse assay. Vibrio mimicus should be considered in the differential diagnosis of acute gastroenteritis occurring after recent ingestion of seafood (especially raw oysters) and in acute otitis after exposure to seawater.
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PMID:Disease from infection with Vibrio mimicus, a newly recognized Vibrio species. 688 69

Clinical and epidemiologic characteristics of disease associated with a newly described nonhalophilic Vibrio species, Vibrio mimicus, were identified by studying isolates from 21 patients referred to the Centers for Disease Control between 1977 and 1981. Two isolates were from the ears of patients with otitis who had recently been exposed to seawater. Nineteen isolates were from stool samples; these patients generally had diarrhea, nausea, vomiting, and abdominal cramps, with fever, headache, and bloody diarrhea occurring in fewer than half. Persons with diarrhea were more likely than age- and sex-matched controls to have eaten raw oysters (p = 0.013). Although most cases were sporadic, three were associated with a single outbreak. Only two isolates produced toxin found by enzyme-linked immunosorbent assay or the Y-1 adrenal cell assay for heat-labile toxin, and none produced heat-stable toxin found by the infant mouse assay. Vibrio mimicus should be considered in the differential diagnosis of acute gastroenteritis occurring after recent ingestion of seafood (especially raw oysters) and in acute otitis after exposure to seawater.
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PMID:Disease from infection with Vibrio mimicus, a newly recognized Vibrio species. Clinical characteristics and edipemiology. 688 70

Campylobacter fetus ss. jejuni has recently been recognized as a very common cause of gastroenteritis. Symptoms of Campylobacter gastroenteritis include fever, diarrhea, abdominal pain, myalgia and headache. Bloody diarrhea occurs in about 50 percent of patients. This organism is now being isolated more frequently than Salmonella or Shigella in cases of diarrhea. Acute colitis mimicking Crohn's disease or ulcerative colitis on proctoscopic examination and on barium enema x-ray has been described. The drug of choice for therapy is erythromycin.
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PMID:Campylobacter Gastroenteritis. 705 19

Approximately 3000 people in Bennington, Vermont, 19% of the population, had a diarrheal illness during the first and second weeks of June 1978. Persons affected reported abdominal cramps (86%), diarrhea (82%), malaise (73%), and headache (47%). The mean duration of illness was 4.6 days. The illness was associated with drinking unboiled water from the town water system. Investigation showed that the entire water system was probably contaminated and the source of contamination was the main unfiltered water source. Bolles Brook. Campylobacter fetus subspecies jejuni was cultured from 15 of 42 rectal swabs obtained from persons who had been ill, but not from swabs obtained from 23 persons who served as controls. No environmental samples of water and no specimens from wild or domestic animals were positive for Campylobacter. This appears to be the first waterborne outbreak of gastroenteritis associated with C. fetus subspecies jejuni.
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PMID:Campylobacter enteritis associated with contaminated water. 705 90

Non-typhoid salmonellosis remains a common infective illness. We studied 77 consecutively admitted children aged 1 month to 15 years in order to determine frequency of antecedents, the strain of the isolated organisms, clinical findings, frequency of complications and the adequacy of management. The presentation and severity of the illness were compared between younger than two and older children. Salmonella typhimurium was isolated in 65% of the cases. Two thirds of the tested strains were multiresistant to antibiotics. Non-typhoid salmonellosis usually occurred in the form of acute gastroenteritis: in only 4% of the cases it presented as pyrexia of unknown origin without gastrointestinal symptoms. 30% of the cases had been exposed to one or more antimicrobial agents within four weeks before the date of their stool culture. Only 30% had been breast fed. Previously diagnosed cow's milk protein intolerance resulted to be present in 14% of the less than two years old children (p < 0.02). Abdominal pain and headache were found more frequently in older children (p < 0.02). Protein C reactive values were significantly higher in this age group (p < 0.05). 25% of the children were mildly or moderately dehydrated. Hypernatremia was uncommon. 31% of the cases were treated with antibiotics: the antimicrobial treated children presented diarrhoea for longer period (p < 0.05) and they remained admitted for longer time (p < 0.00).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinico-epidemiological observations of 77 pediatric cases of infection with non-typhi salmonellae]. 807 87

A 50 year-old female ingested 10 seeds from the pods of the Wisteria plant due to curiosity and the perception that they were edible beans. Subsequent toxic effects included headache, gastroenteritis, hematemesis, dizziness, confusion, diaphoresis, and a syncopal episode. She continued to feel tired and complained of being dizzy 5 to 7 days after the ingestion. Despite the abundant references in the literature supporting the toxicity of this plant and the cases cited by Lampe and McCann (1), a literature search identified only one additional case report involving two youths in Italy who ingested at least 5-6 seeds each (2). The three events were sufficiently similar in the onset of the gastrointestinal symptoms and the effects on the central nervous system as to characterize a Wisteria syndrome.
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PMID:Wisteria toxicity. 843 6

The costs for diagnostic workup in the medical emergency room were analyzed for 1000 consecutive patients in the course of a cost analysis program. Next to demographic data, the complaints leading to admission, all diagnostic procedures and tests as well as the final diagnosis were recorded. According to cumulated tariffs of individual services, the total cost for the 1000 patients amounted to Sfr. 303000. Medical, laboratory and technical services each amounted to one third of this sum. The cost of Sfr. 303 per patient compared rather well with those of Sfr. 350 for the average initial consultation at the outpatient clinic. The three symptoms thoracic or abdominal pain and headache covered 50% of the reasons for admission. The five most common diagnoses were: common cold, chest wall tenderness, gastroenteritis, headache and acute upper respiratory tract infection. The most cost-intensive workup was performed for nausea and vomiting and abdominal or thoracic pain. Technical procedures such as chest films and upper panendoscopy were responsible for high costs. Assessment of costs according to symptoms and final diagnosis, respectively, yielded almost identical results. In both cases, minimal and maximal costs varied by a factor of 20 or more.
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PMID:[Costs of diagnosis in emergency room consultations]. 896 20


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