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Twenty volunteers were inoculated with various doses of human serum containing Phlebotomus fever virus (Sicilian type) to determine their clinical and serologic responses as well as the human infectious dose50 of the virus. All infected subjects developed fever which varied in duration from 6 to 74 hours. The most common symptoms during sandfly fever were headache, anorexia, myalgia, photophobia, low back and retro-orbital pain. Infected individuals developed a marked leukopenia characterized by an initial lymphopenia followed by protracted neutropenia. Little complement fixing antibody was detected in convalescent sera but most subjects developed significant rises in hemagglutination inhibiting antibodies. All infected subjects developed specific neutralizing antibodies with titers ranging from 1:40 to 1:2,560. Of the three serologic tests performed, the plaque reduction neutralization method appears to be the most sensitive test for detecting antibodies to Phlebotomus fever viruses.
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PMID:Clinical and serologic responses of volunteers infected with phlebotomus fever virus (Sicilian type). 18 Aug 44

Serum hepatitis is a dreaded risk in connection with regular dialysis treatment (RDT). Liver damage, however, can be cuased by other diseases, such as infection with cytomegalovirus (CMV). Two cases in our artificial kidney unit revealed signs of liver damage with increased liver enzyme activity. Case 1, a woman, was on RDT after an unsuccessful renal transplantation, and Case 2, a man, belonged to the staff. Serum hepatitis was initially suspected in both cases, but repeated examinations of the sera revealed no hepatitis B antigen or antibodies (HbAg and HbAb). Later on, both showed a significant increase in antibodies in complement fixations reaction (CF) to CMV-antigen. CMV could be isolated from urine in Case 2. Case 1 had been bilaterally nephrectomized. The symptoms (tiredness, muscle pain and headache) and the course of the disease were mild in both cases and liver enzymes became normal within 1-2 weeks. Twenty out of 31 examined patients and staff had antibodies in CF to CMV-antigen, but in none was there any significant increase. The source of infection may have been transfusion of fresh blood in Case 1, but in Case 2 no particular source could be suspected. Thus, in liver damage CMV-infection may be an etiological alternative. In routine work at artficial kidney unite patients and personnel are regularly examined in respect of bilirubin, liver enzymes, HbAg and HbAb in serum. We recommend also examination of serum for antibodies in CF to CMV-antigen. Until a firm differential diagnosis has been established the patient should be isolated and the dialysis equipments used only by that patient.
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PMID:Cytomegalovirus hepatitis in an artificial kidney unit. 18 60

During 1973 and 1974, we looked for cases of Colorado tick fever throughout Colorado; 228 cases were identified. Although 90% of the patients reported exposure to ticks before illness, only 52% were aware of an actual tick bite. Typical symptoms of fever, myalgia, and headache were common, but gastrointestinal symptoms were also prominent in 20% of the patients. Twenty percent were hospitalized; no deaths or permanent sequelae were noted. Persistent viremia (greater than or equal to 4 weeks) was found in about half of the cases; this finding was not associated with the occurrence of prolonged symptoms (greater than or equal to 3 weeks), which were also reported in half of the cases. One patient became reinfected with the virus. Increasing tourism in endemic areas and the frequent occurrence of prolonged or biphasic illnesses provide the potential for patients with Colorado tick fever to seek medical care anywhere in the United States.
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PMID:Colorado tick fever: clinical, epidemiologic, and laboratory aspects of 228 cases in Colorado in 1973-1974. 20 40

An epidemic of coxsackievirus B2 infections occured at a boys summer camp. The resulting illness was characterized by malaise, headache, muscle pain, and high fever that persisted for four to six days. The boy in the index case arrived at the camp the first day of the season. The attack rate was 89% among campers and 47% among counselors. The spread of infections appeared to be on a person-to-person basis and in a disorderly fashion. Unusual features of the epidemic included the high attack rate, restriction of infection to the camp residents, and evidence of prolonged pharyngeal viral shedding. Conditions at camps are ripe for similar epidemic and the potential problem is greater than is generally realized.
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PMID:Coxsackievirus B epidemic at a boys' camp. 22 33

A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems. Early in the illness, constitutional symptoms predominated. Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea. Physical examination showed few abnormalities other than rales. Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic. Chest radiograph showed patchy, often nodular, areas of consolidation. Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons. Twenty-six patients died. Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant.
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PMID:Legionnaires' disease: clinical features of the epidemic in Philadelphia. 43 27

Seven patients, aged 12 to 19 years, had atypical measles. Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain. The characteristic rash was erythematous, maculopapular, and progressed frequently to vesicular, petechial, or purpuric lesions. It initially involved palms and soles with subsequent spread to proximal extremities and the trunk, sparing the face. Six of six chest roentgenograms showed infiltrates. Findings not previously described in atypical measles included liver enzyme elevations, thrombocytopenia, disseminated intravascular coagulation, possible transmission among three siblings, and suspected cardiac involvement. Measles complement fixation titers compatible with recent infection were seen in all patients. All patients had previously received killed measles vaccine. A substantial number of persons who are older adolescents or young adults may be at risk of developing atypical measles.
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PMID:Atypical measles in adolescents and young adults. 44 83

A jet airliner with 54 persons aboard was delayed on the ground for three hours because of engine failure during a takeoff attempt. Most passengers stayed on the airplane during the delay. Within 72 hours, 72 per cent of the passengers became ill with symptoms of cough, fever, fatigue, headache, sore throat and myalgia. One passenger, the apparent index case, was ill on the airplane, and the clinical attack rate among the others varied with the amount of time spent aboard. Virus antigenically similar to A/Texas/1/77(H3N2) was isolated from 8 of 31 passengers cultured, and 20 of 22 ill persons tested had serologic evidence of infection with this virus. The airplane ventilation system was inoperative during the delay and this may account for the high attack rate.
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PMID:An outbreak of influenza aboard a commercial airliner. 46 58

Eight patients with atypical pneumonia caused by the Legionnaires' disease organism were seen during the spring and summer of 1977. Two died of the acute illness. All patients were febrile and presented with symptoms of acute respiratory infection. Other symptoms included malaise, anorexia, chills, myalgia, and headache. Severe hypoxemia was a striking feature. Conventional methods to determine the etiology of these pneumonias were unsuccessful but subsequent serological studies confirmed the diagnosis of Legionnaires' disease. Seven patients were treated with beta-lactam antibiotics alone or with an aminoglycoside and all failed to respond. Six were subsequently treated with erythromycin and five who received this drug for at least 48 hours were markedly improved within this time period. We believe that erythromycin is effective in the treatment of Legionnaires' disease.
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PMID:Case report. Clinical manifestations and treatment of Legionnaires' disease. 46 49

Arteriitis temporalis, a disease that was largely unknown in the early fifties, has gained importance in recent years. In the past ten years 32 patients suffering from arteriitis temporalis were diagnosed and treated both in the eye hospital and in the rheumatic-cardiological hospital of the Berlin-Buch Municipal Hospital. The following clinical findings were essential for the diagnosis: advanced or old age of the patient, massive headache in the temporal and/or occipital regions, myalgia primarily in the shoulders and the neck that responded relatively poorly to treatment, reduced eyesight, loss of weight and decrease in vitality. Extremely high BSR, an increased amount of alpha-2 and an increased level of alkaline phosphatase were most important among the laboratory findings. Corticosteroids have proved to be the medicine of choice for treating this condition.
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PMID:[Arteriitis temporalis--a major disease developing in advance age (author's transl)]. 55 43

In July 1968, an explosive epidemic of acute febrile illness occurred at a county health department facility in Pontiac, Michigan. Illness characterized principally by fever, headache, myalgia, and malaise affected at least 144 persons, including 95 of 100 persons employed in the health department building. The mean incubation period was approximately 36 hours. Illness was self-limited, generally lasting from two to five days. Secondary cases did not occur in family contacts and second attacks did not consistently follow re-exposure in the building. A defective air-conditioning system was implicated as the source and mechanism of spread of the causative factor. However, extensive laboratory and environmental investigations failed to identify the etiologic agent. Since these investigations a bacterium similar to or identical with the agent responsible for Legionnaires' Disease has been isolated from guinea pigs exposed to the Pontiac health department building in 1968 as well as from guinea pigs exposed to water from the evaporative condenser. Paired sera from 32 cases of Pontiac Fever showed seroconversion or diagnostic rises in antibody titers to this bacterium.
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PMID:Pontiac fever. An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects. 62 97


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