At least four species or types of coccidia live in the intestine, and one species grows in the liver. In some cases, patches of epithelium die and slough away from the intestinal wall. Treatment has only a tempo rary effect during the early stages of intestinal coccidiosis, but it may be useful in controlling outbreaks. Intestinal coccidia develop a tolerance to the drug if used continuously, so Figure 15. Eimeria stiedae, the one spe cies that multiplies in the liver, is considered to be the most patho genic coccidium of rabbits. Infections lasting more than 16 days can be recognized by white circular nodules on the liver (Figure 15). In moderate infections, there is no mortality, but disfigurement of the liver makes it unmarketable; hence this type of coccidiosis always is of economic significance. These lesions vary from cortical scarring with multiple small, indented, gray areas on the surface to Archival Copy. The disease can be controlled by providing good sanitation and preventing contamination of food and water by urine. It usually is done at necropsy by observing histo pathologic lesions typical of the disease. Recently, several diag nostic tests have been developed that will help with the diagnosis in live rabbits. These tests may be helpful in antemortem diagnosis and also in screening rabbits to point out possible carriers or infected animals. The disease probably is more common than reported, as antibody tests on rabbit herds have shown that as many as 50 percent of clini cally normal rabbits have been exposed. In the acute form, the rabbit develops anorexia, fever, lethargy, and (in a few days) cen tral nervous symptoms ranging from ataxia or posterior paraly sis to generalized convulsions. Cats can shed the parasite in their stool and thereby contaminate stored rabbit feed; then the contami nated feed is ingested by rabbits. The parasitic organ ism often is found with the aid of a microscope in these necrotic foci. In the chronic form, there may be microscopic lesions but no apparent gross lesions, and organisms often are confined to the central nervous system. Diagnosis of toxoplasmosis generally is accomplished at necropsy by observation of his tologic lesions and organisms. Cats, the primary carrier of this organism, should be kept out of rabbitries or at least away from feed storage areas. The pinworm, Passalurus ambiguus, is a very common parasite of domestic rabbits, but it does not affect other animals or people. These parasites are spread from ani mal to animal by ingesting feed and water contaminated by the droppings of infected animals. It has a head with four suckers with which the worm attaches to the lining of the intestine. Rabbits acquire these tapeworms by ingesting contam inated feed and water containing tapeworm segments and eggs from the feces of dogs. The young larvae then are released from the eggs, penetrate the digestive tract, and migrate to the liver. They migrate within the liver, leaving white streaks behind, then leave the liver and enter the abdominal cavity. Vitamin A deficiency Lowgrade vitamin A defi ciency adversely affects the reproductive performance of females, often before other signs are noted. Hydrocephalus is caused by low maternal blood levels of vitamin A throughout the Nutritional diseases Pregnancy toxemia Also known as "ketosis," this disease is a toxemia of pregnancy that is most common in first litter females. When maternal blood levels fall below 20 micro grams (ug) per 100 ml serum, hydrocephalus appears in a large percentage of the young. Com mercial diets, in general, supply adequate levels of vitamin A; however, the vitamin does dete riorate after prolonged storage of alfalfa hay. Vitamin E deficiency Infant mortality, character ized by death of entire litters at 3 to 10 days of age without clinical signs prior to death, has been associated with vitamin E deficiency. Alfalfa hay is a suitable source of vitamin E in commercial rations, and 89 mg/100 grams (g) feed is adequate.
Those exposed are primarily limited to people who have had close, regular contact with the infected person, such as time spent together in a living space or classroom. It is important to identify as many of those contacts as possible through a contact investigation. Once those contacts have been determined, the college should provide the health department with the list of names and locating information so it can arrange for those individuals to receive testing to determine if they have been infected during their contact with the student. For example, all students who attended class in a small classroom with a highly infectious student may need to be tested. Students, their parents, faculty and the local community will all have a need for information. Preparing press kits containing basic information about tuberculosis will help educate those reporters who are covering the story. Identify one campus spokesperson to address questions about how the college is handling the situation and develop talking points for the spokesperson. It is advisable to leave the medical-related questions to the local health department to answer. Colleges can use these as a template for developing their own material specific to their situation. Basic information about tuberculosis can be found in the "Patient Education" section of this manual. Much of the information in this section can be adapted for dissemination to different audiences. Once the local health department has provided the college with documentation that the student is non-contagious and adhering to treatment, the student may return to class and may continue with coursework as long as treatment is maintained. If at any time the health department notifies the college that the student is not adhering to treatment, the student will not be allowed to continue enrollment at the college. It is recommended the college spokesperson defer medical questions regarding tuberculosis to the local health department. While the details will vary with every case of active tuberculosis disease, below are some basic talking points the college spokesperson can use when communicating with the media, students, faculty and the local community. This section addresses those expenses and provides guidance to colleges on ways to handle them. Implications for colleges the primary financial expense colleges will incur is in staff resources. A certain amount of staff time will need to be dedicated each academic term to assessing screening forms returned by incoming students new to the college. For students who are identified as at-risk for tuberculosis, staff time also will need to be allotted to guiding and tracking those students through the process of getting tested and, if necessary, treated. The staff time necessary to ensure the policy is appropriately implemented will likely be split between different areas of campus. For instance, the initial assessment of screening forms might be done by a staff person in the admissions or registration department. Colleges who have implemented a tuberculosis policy on their campus have found that they were able to do so with existing staff by sharing the implementation responsibilities among several staff members. Of course every college will be different, but as an example, the University of Missouri-Columbia used the equivalent of less than one staff person to fully implement its tuberculosis policy on its campus of 27,000 students. Implications for students For colleges that enforce student visa requirements for international students to have health insurance, the financial implications to students will be few, if any, because most insurance plans will cover the costs associated with testing for tuberculosis and treatment medications. While medical costs will vary in different parts of the country, in general, students can expect the following costs associated with testing and treating tuberculosis. If the local health department does not offer these reduced cost services, seek its assistance in finding other area providers that might. Thereareseveralcompaniesthatfocus on offering insurance to college students, with some of them insuring only international students. It is highly recommended that campuses coordinate closely with health departments before developing a surveillance system. Surveillance data needed for evaluation, at a minimum, should include the following: · · · · · · · · Numberofstudentstested Numberofstudentsevaluated(includestudentscompletingtuberculinskintestsorbloodtestsplusstudentswith positive tuberculin skin tests or blood tests who complete chest x-rays and physical exams) Numberofcasesofactivetuberculosisdisease Numberofcasesoflatenttuberculosisinfection Numberofstudentseligiblefortreatment Numberofstudentsstartingtreatment Numberofstudentscompletingtreatment Iftreatmentnotcompleted,citereason(adverseevent,patientchosenottocomplete,etc. In addition, the data may generate the desire for further study, such as evaluating the reasons or barriers to initiating treatment or completion of treatment.
The anthrax strain that the cult was using was likely a harmless strain used in animal vaccines. Molecular analysis revealed that the B anthracis isolates were similar to the Sterne 34F2 strain, the strain of anthrax used in animal vaccines. Dispersal of this type of anthrax (regarded as nonpathogenic for immunocompetent individuals) had little possibility to cause harm. The viscosity of the suspension was also problematic for successful aerosolization. B anthracis cultures were also obtained and grown into a slurry for use as a biological weapon. This cult may have investigated the use of C burnetii (the bacteria that causes Q fever) and toxic mushrooms. In 1992 a 48 Epidemiology of Biowarfare and Bioterrorism effectiveness is doubtful; reports indicate it repeatedly broke down. However, if the Aum Shinrikyo had obtained a different strain of B anthracis, the intended effects may have been more successful, which may have led the cult to use a biological agent in the Tokyo subway system. Its failures with biological agents led the group to use sarin, a chemical nerve agent. Lessons Learned: Both health and law enforcement officials should be aware of the possibility for use of more than one biological agent or a combination of agents. The Aum Shinrikyo knew that it could effectively use sarin from experience with an earlier release in the Matsumoto area of Tokyo in 1994. Another lesson learned is the importance of environmental sample collection and proper storage. The emerging discipline of forensic molecular biology proved the occurrence of an anthrax release by analysis of archived samples 8 years after the incident. This strain of shigella is uncommon and, before this outbreak, had last been reported as the source of an outbreak in the United States in 1983. A 13th individual became ill from eating pastries brought home by one of the laboratory workers; this individual also had stool cultures positive for S dysenteriae type 2. Five patients were treated in hospital emergency departments and released, four were hospitalized, but no deaths resulted. The supervisor was away from the office when the email was sent, and the break room could only be accessed using a numeric security code. The muffins and pastries had been commercially prepared, yet there were no other cases in the community outside the hospital laboratory. The ill persons reported eating a pastry between 7:15 am and 1:30 pm on October 29. Diarrhea onset for the ill laboratory workers occurred between 9:00 pm that day and 4:00 am on November 1. The mean incubation period until diarrhea onset was 25 hours and was preceded by nausea, abdominal discomfort, and bloating. No increased risk for illness was found from eating food from the break room refrigerator or drinking any beverage, eating in the hospital cafeteria, or attending social gatherings during the time of exposure to the pathogen. An examination of the hospital laboratory storage freezer revealed tampering of reference cultures of S dysenteriae type 2. The stored reference cultures had each contained 25 porous beads that were impregnated with microorganisms. The S dysenteriae type 2 vial contained at that time only 19 beads, and laboratory records indicated that the vial had not been used. S dysenteriae type 2 was isolated in virtually pure culture from the muffin specimen, and the same organism was isolated from the stools of eight laboratory worker patients. Pulsed-field gel electrophoresis revealed that the reference culture isolates were indistinguishable from those obtained from a contaminated muffin and the collected stool cultures, but differed from two nonoutbreak S dysenteriae type 2 isolates obtained from other Texas counties during that time. No research with this microorganism had been conducted at the hospital; therefore, laboratory technicians were not at risk of infection through laboratory error.
As these biopsies are performed under direct observation, fragments of suspect lesions can be sampled using biopsy forceps. During the surgical intervention a sample can sometimes be examined immediately in order to decide on the next step. Methods Cytological techniques · Material sampled by biopsy of tissue specimens After biopsy of tissues such as lymph nodes, a smear is made by spreading the sample on a slide. In general, smear examinations of aspirated fluid have a lower diagnostic yield than smears of tissue. Bacteriological and histological techniques for biopsied samples these techniques are only possible if there is at least one tissue fragment in the specimen. Bacteriological techniques Bacteriological examination is always more definitive than histological techniques and must take priority, where possible, where specimens are limited and bacteriological services are available. It is very important, where such services are available, that surgeons be reminded not to place the suspect specimens in fixing agents such as formol, as these prevent any cultures from being obtained. Slants are then treated with haematoxylin and eosin stains for histological examination. Other slants are stained using Ziehl-Neelsen or auramine, then examined for tuberculous bacilli. Practical point: On biopsy, at least two fragments are collected: one is put into saline and sent to the mycobacteriology laboratory for culture, while the other is put into a fixing agent for histology. Macroscopic aspects Caseum, or necrotizing granulomata, is specific to tuberculosis. If it is recent, it has a yellowish white, cheesy texture; on ageing it becomes greyish and chalky. When caseating material is obtained (from aspiration of an abscess or fistulation of a lymph node), tuberculosis is the first diagnosis that comes to mind. Certain lesions can be observed on clinical examination of a patient: · · Ulcerations on the surface of the skin or the mucous membranes are irregularly draining sinuses with raised edges, containing necrotizing granuloma. Fistulas and sinuses form in the absence of natural drainage (adenitis, cold abscess). These granuloma can be of different sizes: from miliary granulation of less than 1 mm diameter to tuberculoma which can reach up to 20 mm in diameter. On examination of a sample excised during surgery or autopsy any of these lesions can be observed. Dissection of the sample (lung, kidney) can sometimes reveal tuberculous cavities, which present in the form of cavities filled or covered with caseating granuloma. Several types of macroscopic lesion are generally present on a single excised sample. Nevertheless, however clear the diagnosis seems to be, the examination must be completed by microscopic examination of tissue segments after specific staining. Microscopic aspects the involvement of an organ by tuberculosis is associated with an inflammatory reaction at the affected site. The inflammation occurs in three successive stages that can be simultaneous - acute, subacute and chronic - and that have different histological aspects. The acute phase Infection by the tubercle bacillus first leads to a rapid, nonspecific inflammatory reaction manifested by exudative lesions that are not particularly specific to tuberculosis. The focus of the inflammation is the site of a sero-fibrous exudate with numerous macrophages in the centre. At this stage the bacillus can be observed at the centre of this site of inflammation. The subacute phase Lysis of the bacilli liberates the phospholipids from their capsule, provoking a specific tissue reaction and the formation of follicles, "Koлster follicles" (Appendix 5). Two kinds of follicular lesions can be observed: · - the epithelioid giant cell follicle A rounded focus containing: numerous epithelioid cells. These are monocytes with an egg-shaped centre, abundant cytoplasm and indistinct cytoplasmic edges. These are large cells with abundant cytoplasm, indistinct edges and multiple centres arranged in the shape of a crown or a horseshoe. It is common to "granulomata": tuberculous leprosy, sarcoidosis and connective tissue diseases. The chronic phase the fibrous follicle: the tuberculous follicle gradually develops into a fibrous follicle. Collagenous fibres invade the tuberculous focus, which is enclosed in a fibrous shell with fibroblasts and lymphocytes, forming a fibro-caseating follicle that is then transformed into a fully fibrous follicle.
Symptoms: the adverse reaction induced by grayanotoxins includes nausea and vomiting; dizziness; weakness; mental confusion or impaired consciousness; excessive perspiration and/or salivation, cloudy or blurred vision; chest pain or compression; paresthesias in the extremities or perioral area shortly after the toxic honey is ingested. Because grayanotoxins are metabolized and excreted rapidly, patients typically feel better and experience an alleviation of grayanotoxin induced symptoms along with a return to normal cardiac function, as seen in measures such as heart and blood pressure, within a relatively brief duration. Pathway / mechanism: the responses of skeletal and heart muscle, peripheral nerves, and the central nervous system are related to effects of grayanotoxin on the cell membrane. It may be more likely in springtime, because honey produced during this season tends to have a higher concentration of grayanotoxin than does honey from other seasons. In contrast, the pooling of massive quantities of honey during commercial processing generally serves to dilute the amount of any toxic substance. So-called "mad honey" may be distinguished by its brown color, linden-flower smell and bitter taste, along with the sharp, burning sensation it may cause in the throat. Sources Grayanotoxin poisoning most commonly results from ingestion of grayanotoxin-contaminated honey, although it may result from ingestion of components of the plants in the Ericaceж family or their use as a tea. This includes the mountain laurel (Kalmia latifolia) and sheep laurel (Kalmia angustifolia), which probably are the other most important sources of the toxin. Diagnosis Diagnosis is by the evaluation of characteristic signs and symptoms of grayanotoxin intoxication, along with the assessment of recent consumption behavior and choices of the patient. Atrioventricular block induced by mad-honey intoxication: Confirmation of diagnosis by pollen analysis. Occurrence and analysis in honey and a comparison of toxicities in mice, Food Cosmet. Hypotension, bradycardia and syncope caused by honey poisoning, Resuscitation 68: 405408. The role of this compound in defense against plant pests and pathogens has been established. Disease For Consumers: A Snapshot Beans are a great deal, nutritionwise and costwise but be sure to cook your kidney beans well. Onset: Usually begins with extreme nausea and vomiting within 1 to 3 hours of ingestion of the product, with diarrhea developing later within that timeframe. Duration: Recovery usually is rapid, within 3 to 4 hours after onset of symptoms, and spontaneous, although some cases have required hospitalization. Reports of this syndrome in the United States are anecdotal and have not been formally published. Sources Phytohaemagglutinin, the presumed toxic agent, is found in many species of beans, but is in highest concentration in red kidney beans (Phaseolus vulgaris). Raw kidney beans contain from 20,000 to 70,000 hau, while fully cooked beans contain from 200 to 400 hau. White kidney beans, another variety of Phaseolus vulgaris, contain about one-third the amount of toxin as the red variety; broad beans (Vicia faba) contain 5% to 10% the amount that red kidney beans contain. However, Bender and Readi found that boiling the beans for 10 minutes (100°C) completely destroyed the toxin. Consumers should boil the beans for at least 30 minutes to ensure that the product reaches sufficient temperature, for a sufficient amount of time, to completely destroy the toxin. Studies of casseroles cooked in slow cookers revealed that the food often reached internal temperatures of only 75°C or less, which is inadequate for destruction of the toxin. Other possible causes, such as Bacillus cereus, staphylococcal food poisoning, and chemical toxicity, must first be eliminated. If beans were a component of the suspect meal, analysis is quite simple, based on hemagglutination of red blood cells (hau). Infective Dose Information Most chapters include a statement on the infective dose necessary to cause disease. Estimated annual number of domestically acquired foodborne illnesses, hospitalizations, and deaths due to 31 pathogens and unspecified agents transmitted through food, United States Foodborne Estimated annual % % Estimated annual % Estimated annual agents number of illnesses number of number of deaths (90% (90% credible hospitalizations (90% credible interval) interval) credible interval) 31 known 9. Factors that Affect Microbial Growth in Food Bacteriological Analytical Manual Food is a chemically complex matrix.
When you are through with the core module and sure that you have understood it proceed to read the satellite module corresponding to your profession or interest. Note: You may refer to the list of glossary (unit5) and abbreviations (unit 6) at the end of the module for terms that are not clear. All patients with chronic cough lasting three or more weeks should be suspected as probable cases of pulmonary tuberculosis. Write the most important and practical laboratory test to diagnose pulmonary tuberculosis? A patient is said to be treatment failure if she / he still remains sputum positive after two months of treatment. Spitting into cans and finally disposing by burning To cover the mouth when coughing and/or sneezing. What is the ideal living /sleeping/ space (area) recommended for adult person to prevent overcrowding? You must collect and examine two sputum smear samples from every pulmonary tuberculosis suspect. The protracted schedule of its treatment consumes the meager health resources and poses difficulties to properly comply to the treatment regimens. At present the benefits of early diagnosis and treatment are also being challenged by the emergence of drug resistant mycobacterium strains. Although pulmonary tuberculosis is one of the most contagious disease, it is preventable and treatable. Therefore, understanding the basic principles of prevention and treatment and designing applicable control strategy play a great role in the reduction of morbidity and mortality in the country. Upon completion of the module, the reader will be able to: 2 3 4 Define the causative agent, pathogenesis and clinical features of the disease. Recognize the importance of appropriate treatment of cases in the prevention of drug resistance. She visited a health station in her village for the above complaints and was given injections for a week, but the symptoms worsened. Her husband died six months back, who never appeared to health institution for his chronic cough. There were five children living with her, the youngest being one year old and the others six, four, three and two years old. As of her statement, the youngest child, Ali had cough and fever since the last 15 days. The family lived in a village 70Km away from Alemaya with no electricity and clean water supply. She used to lead the family life by selling fruits and vegetables after the death of her husband. Their two goats and one cow spend the night in the same tukul and the house served as a kitchen. Every year three million people die from tuberculosis, mostly in developing countries where it kills one in five adults. The number of new pulmonary tuberculosis cases world-wide is expected to increase from around seven million in 1990 to over ten million by 2000. It also causes unprecedented levels of infection and deaths among women and girls. Furthermore, it was the first cause of hospital death, constituting 27% of all patients who died in hospitals. Risk factors which are identified to be important for development of the disease are: Poor nutritional status/poverty. Miscellaneous: Hormonal therapy, diabetes mellitus (three to four times increase of risk), alcoholism, silicosis, etc. The disease is transmitted by means of invisible droplet nuclei containing the organisms that have left the reservoir during breathing, sneezing or coughing. Transmission generally occurs indoors where droplet nuclei can stay in the air for long time. Occasionally it can also be caused by Mycobacterium bovis and Mycobacterium african but of much less magnitude.
These actions require careful evaluation of bird movement patterns and of the avian cholera disease cycle. Movement of birds infected with avian cholera from one geographic location to another site is seldom desirable. The environmental impact of such measures must be evaluated and appropriate approvals must be obtained before these actions are undertaken. A more useful approach may be to enhance the quality of the wetland in a way that reduces the survival of P. Hazing with aircraft has been successfully used to move whooping cranes away from a major outbreak of avian cholera. During an avian cholera outbreak in South Dakota, a large refuge area was temporarily created to hold infected snow geese in an area by closing it to hunting. At the same time, a much larger population of snow geese about 10 miles away was moved out of the area to prevent transmission of the disease into that population. Vaccination and postexposure treatment of waterfowl have both been successfully used to combat avian cholera in Canada goose propagation flocks. This product has been used for several years with good results in a giant Canada goose propagation flock that has a great deal of contact with free-flying wild waterfowl and field outbreaks of avian cholera. Before use of the bacterin, this flock of Canada geese suffered an outbreak of avian cholera and was successfully treated with intramuscular infections of 50 milligrams of oxytetracycline followed by a 30-day regimen of 500 grams of tetracycline per ton of feed. Vaccine use in these instances was in association with studies to evaluate avian cholera impacts on survival rates rather than to control disease in those subpopulations. Endangered species can be trapped and immunized if the degree of risk warrants this action. Live vaccines should not be used for migratory birds without adequate safety testing. Human Health Considerations Avian cholera is not considered a high risk disease for humans because of differences in species susceptibility to Avian Cholera 91 different strains of P. Processing of carcasses associated with avian cholera die-offs should be done outdoors or in other areas with adequate ventilation. Other types of Mycobacterium rarely cause tuberculosis in most avian species; however, parrots, macaws, and other large perching birds are susceptible to human and bovine types of tuberculosis bacilli. Avian tuberculosis generally is transmitted by direct contact with infected birds, ingestion of contaminated feed and water, or contact with a contaminated environment. Pigs Mink Rabbits Sheep Species Affected All avian species are susceptible to infection by M. Recent molecular studies with a limited number of isolates from birds, humans, and other mammals clearly indicated that M. Chronic infections exist in some captive nene goose flocks, making these flocks unsuitable donors to supplement the wild population of this endangered species. In free-ranging wild birds, avian tuberculosis is found most often in species that live in close association with domestic stock (sparrows and starlings) and in scavengers (crows and gulls). A decade-long study of nearly 12,000 wild birds necropsied in the Netherlands disclosed that 0. The disease is most commonly found in the North Temperate Zone, and, within the United States, the highest infection rates in poultry are in the North Central States. Distribution of this disease in free-ranging wild birds is inferred from birds submitted for necropsy; however, the sampling underrepresents both the geographic distribution and the frequency of infection for individual species. Avian tuberculosis likely exists in small numbers of free-ranging wild birds wherever there are major bird concentrations. The chronic nature of this disease guarantees its presence yearround for both wild and captive birds. Wastewater sites are often closed to hunting, thereby serving as refuge areas, and warm water discharges to these sites maintain open water in subfreezing temperatures, thus inviting ready use by waterfowl. Environmental conditions can greatly affect the susceptibility of birds to tuberculosis and the prevalence of tuberculosis in captive birds. Other birds have died of avian tuberculosis without any obvious clinical signs or external lesions. Advanced disease and clinical signs are seen most often in adult birds because of the chronic, insidious nature of the disease.
Or will increasingly advanced bioterrorists or rogue nations be able to create the ultimate weapons though genetic engineering? Meeting these challenges will require continued research with a multidisciplinary approach, using the expertise of physicians and veterinarians trained in public health, microbiologists, pathologists, ecologists, vector biologists, and public health officials, both military and civilian. Surveillance for waterborne-disease outbreaks associated with drinking waterUnited States, 20012002. Surveillance for waterborne-disease outbreaks associated with recreational waterUnited States, 20012002. Occurrence and distribution of Vibrio cholerae in the coastal environment of Peru. Vaba, Haiza, Kholera, Foklune or Cholera: in any language still the disease of seven pandemics. Development and validation of a detection system for wild-type Vibrio cholerae in genetically modified cholera vaccine. Legionnaires disease associated with a whirlpool spa display-Virginia, SeptemberOctober, 1996. The hospital water supply as a source of nosocomial infections: a plea for action. Legionella: from environmental habitats to disease pathology, detection and control. Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Legionella micdadei. A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant. Legionella-like amebal pathogens-phylogenetic status and possible role in respiratory disease. Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations. A survey of Campylobacter and other bacterial contaminants of pre-market chicken and retail poultry and meats, King County, Washington. The role of poultry and meats in the etiology of Campylobacter jejuni/coli enteritis. The extent of surface contamination of retailed chickens with Campylobacter jejuni serogroups. Campylobacter jejuni cytolethal distending toxin causes a G2-phase cell cycle block. Double-blind placebo-controlled trial of erythromycin in the treatment of clinical Campylobacter infection. The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli. Grain feeding and the dissemination of acid-resistant Escherichia coli from cattle. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Antibodies of patients with Lyme disease to components of the Ixodes dammini spirochete. Epidemiologic and diagnostic studies of patients with suspected early Lyme disease, Missouri, 19901993. Detection of Borrelia lonestari in Amblyomma americanum (Acari: Ixodidae) from Tennessee. Detection of Borrelia lonestari, putative agent of southern tick-associated rash illness, in white-tailed deer (Odocoileus virginianus) from the southeastern United States. Identification of an uncultivable Borrelia species in the hard tick Amblyomma americanum: possible agent of a Lyme disease-like illness. First culture isolation of Borrelia lonestari, putative agent of southern tickassociated rash illness. Vector interactions and molecular adaptations of Lyme disease and relapsing fever spirochetes associated with transmission by ticks. Ciprofloxacin-resistant Salmonella enterica Typhimurium and Choleraesuis from pigs to humans, Taiwan.
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