Archive for January 4, 2013

Steroids as adjuvant treatment of sore throat in acute bacterial pharyngitis.

Can Fam Physician. 2012 Jan;58(1):52-4.

Schams SC, Goldman RD.


BC Children’s Hospital, Department of Pediatrics, Room K4-226, Ambulatory Care Bldg, 4480 Oak St, Vancouver, BC V6H 3V4, Canada.


QUESTION: I see many children suffering from sore throat and acute pharyngitis. Some adult studies describe faster pain relief when sore throat is treated with steroids. Would a single dose of a steroid, as an anti-inflammatory agent, provide accelerated pain relief for sore throat in children?

ANSWER: A single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) leads to significantly (P < .05) faster onset of pain relief and shorter suffering, especially in children with severe or exudative group A β-hemolytic streptococcus-positive acute pharyngitis.


January 4, 2013 at 8:11 pm

Epidemiology of foodborne norovirus outbreaks, United States, 2001-2008.

Emerg Infect Dis. 2012 Oct;18(10):1566-73.

Hall AJ, Eisenbart VG, Etingüe AL, Gould LH, Lopman BA, Parashar UD.


Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.


Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 2001-2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish.


January 4, 2013 at 8:09 pm

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact – United States, 2009-2010.

MMWR Surveill Summ. 2012 Dec 14;61(9):1-12.

Wikswo ME, Hall AJ; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.


Problem/Condition: Approximately 179 million cases of acute gastroenteritis (AGE) occur in the United States each year, and outbreaks of AGE are a substantial public health problem. Although CDC has conducted national surveillance for waterborne and foodborne AGE outbreaks since 1971 and 1973, respectively, no national surveillance existed for AGE outbreaks resulting primarily from person-to-person transmission before implementation of the National Outbreak Reporting System (NORS) in 2009.

Reporting Period: 2009-2010.

Description of System: NORS is a national surveillance system launched in 2009 to support the reporting of all waterborne outbreaks and enteric disease outbreaks from foodborne, person-to-person, animal contact, environmental, and unknown modes of transmission. State and local public health agencies in the 50 U.S. states, the District of Columbia, five U.S. territories, and three Freely Associated States report these outbreaks to CDC via NORS using a standardized online data entry system. Data are collected on general outbreak characteristics (e.g., dates, number of illnesses, and locations), demographic characteristics of cases (e.g., age and sex), symptoms, case outcomes, and laboratory testing information and results. Only outbreaks reported in NORS with a primary mode of transmission of person-to-person contact are included in this report.

Results: During 2009-2010, a total of 2,259 person-to-person AGE outbreaks were reported in NORS from 42 states and the District of Columbia. These outbreaks resulted in 81,491 reported illnesses, 1,339 hospitalizations, and 136 deaths. No etiology was reported in approximately 40% (n = 840) of outbreaks. Of the remaining 1,419 outbreaks with a reported etiology, 1,270 (89%) were either suspected or confirmed to be caused solely by norovirus. Other reported etiologies included Shigella (n = 86), Salmonella (n = 16), Shiga toxin-producing Escherichia coli (STEC) (n = 11), and rotavirus (n = 10). Most (82%) of the 1,723 outbreaks caused by norovirus or an unknown etiology occurred during the winter months, and outbreaks caused by Shigella or another suspected or confirmed etiology most often occurred during the spring or summer months (62%, N = 53 and 60%, N = 38, respectively). A setting was reported for 1,187 (53%) of total outbreaks. Among these reported settings, nursing homes and other long-term-care facilities were most common (80%), followed by childcare centers (6%), hospitals (5%), and schools (5%).

Interpretation: NORS provides the first national data on AGE outbreaks spread primarily through person-to-person transmission and describes the frequency of this mode of transmission. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic characteristics, likely accounts for a substantial portion of the reported outbreaks of unknown etiology. In the United States, sporadic and outbreak-associated norovirus causes an estimated 800 deaths and 70,000 hospitalizations annually, which could increase by an additional 50% during epidemic years. During 2009-2010, norovirus outbreaks accounted for the majority of deaths and health-care visits in person-to-person AGE outbreaks reported to NORS.

Public Health Action: Prevention and control of person-to-person AGE outbreaks depend primarily on appropriate hand hygiene and isolation of ill persons. NORS surveillance data can help identify the etiologic agents, settings, and populations most often involved in AGE outbreaks resulting primarily from person-to-person transmission and guide development of targeted interventions to avert these outbreaks or mitigate the spread of infection. Surveillance for person-to-person AGE outbreaks via NORS also might be important in clarifying the epidemiology and role of certain pathogens (e.g., STEC) that have been traditionally considered foodborne but can also be transmitted person-to-person. As ongoing improvements and enhancements to NORS are introduced, participation in NORS has the potential to increase, allowing for improved estimation of epidemic person-to-person AGE and its relative importance among other modes of transmission.


Peripheral synovitis, 2 consecutive ASO determinations, a tuberculin skin test, and chest radiography may be sufficient to diagnose EN



January 4, 2013 at 8:08 pm

ERYTHEMA NODOSUM – Etiologic and Predictive Factors in a Defined Population

ARTHRITIS & RHEUMATISM March 2000 V.43 N.3 P.584-592




Carlos Garcı´a-Porru´a, MD, PhD, Miguel A. Gonza´lez-Gay,

MD, PhD, Manuel Va´zquez-Caruncho, MD, Luis Lo´pez-Lazaro, MD,

PhD, Mercedes Lueiro, MD, Maria L. Ferna´ndez, MD, Javier AlvarezFerreira, MD: Hospital Xeral-Calde, Lugo, Spain; Ramo´n M. Pujol,

MD, PhD: Hospital Santa Creu i San Pau, Barcelona, Spain.

Address reprint requests to Miguel A. Gonza´lez-Gay, MD, PhD, Rheumatology Division, Hospital Xeral-Calde, c) Dr. Ochoa s/n, 27004 Lugo, Spain

Objective. To examine the frequency and features of erythema nodosum (EN), establish disease associations, and identify the optimal set of predictors for the occurrence of secondary EN.

Methods. We performed a retrospective study of an unselected population of patients 14 years and older with biopsy-proven EN diagnosed at a referral hospital between 1988 and 1997. Patients were classified as having either idiopathic EN or EN secondary to other diseases if the skin nodules occurred in the context of a well-defined disease, or if there was a precipitating event in close temporal proximity to the onset of EN.

Results. One hundred six patients (82 women) were diagnosed as having biopsy-proven EN. At the time of diagnosis, no precipitating events or underlying diseases were identified in 36.8% of patients. Sarcoidosis and nonstreptococcal upper respiratory tract infections (URI) were the most common conditions associated with secondary EN. Only 1 of 35 patients with an initial diagnosis of idiopathic EN and a followup of at least 1 year was finally diagnosed as having secondary EN. The best predictive model of secondary EN included an abnormal results on a chest radiograph, a previous history of nonstreptococcal URI, and a significant change in antistreptolysin O (ASO) titer in 2 consecutive determinations performed in a 2–4-week interval. Also, the presence of peripheral synovitis, a positive tuberculin skin test, and a history of diarrhea suggested the presence of secondary EN. This model showed high sensitivity and specificity.

Conclusion. Idiopathic EN is common. A basic procedure including careful medical history-taking, a physical examination for peripheral synovitis, 2 consecutive ASO determinations, a tuberculin skin test, and chest radiography may be sufficient to diagnose EN



January 4, 2013 at 8:04 pm


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