Dr. Jim Collins

Cases

Case: Severe Acute Respiratory Syndrome and its etiology

Beijing was everely affected by SARS, and SARS-associated coronavirus was been confirmed as its cause. However, clinical and experimental evidence implicates the possibility of co-infection. In a recent report, reovirus was isolated from throat swabs of SARS patients, including the first case in Beijing and her mother. Identification with the electron microscopy revealed the characteristic features of reovirus. Now, 24 of 38 samples from other SARS cases have been found to have the reovirus, which appears to be a unique reovirus (orthoreovirus). Preliminary animal experiment showed that inoculation of the reovirus in mice caused death with atypical pneumonia. Nevertheless the association of reovirus with SARS outbreak requires further investigation. How would you investigate this???

Case: Explain the spread of disease:

From the World Health Association Surveillance Report for OIE List A Diseases: Foot and Mouth Disease. FMD in Kuwait --An outbreak of FMD occurred in late January/early February among Friesian cattle kept in an intensive dairy farm. Kuwait has endemic FMD and reported at least six outbreaks of FMD during the year.

Case: Why can’t Rabies be controlled in wildlife?

BBC International Reports Text of report by Russian Mayak radio

Russian Mayak radio reported several days ago that a sick fox had bitten 2 people in the streets of Ivanovo. To date, there are already 25 people across the region who have received similar bites, while, by comparison, last year in the whole of Russia, there were 22 such cases, 15 of whom died. The problem of last year's high mortality rate, according to sanitary inspectors, lies in the negligence of the victims, who have failed to turn to a doctor for help in time. The negligence also shows itself in the fact that not everyone is aware that foxes infected with rabies don't behave like dogs or cats at all. They approach people fearlessly, something a healthy fox would never do.

Case: Explain the spread of WNV to over 20 states; if horses are dying, is there a risk to humans?

Equine Cases of West Nile Virus Infection
There were 738 cases of clinical West Nile virus (WNV) infection reported in horses from 130 counties in 20 States. Of the 738 reported, 651 cases were verified through diagnostic testing at the National Veterinary Services Laboratories of USDA-APHIS. Of those, 640 were classified as confirmed cases and 11 as probable cases. Of 470 horses for which an outcome has been reported, 156 (33.2 percent (WOW) died or were euthanized.

Case: Explain Influenza virus virulence, spread, risk (if any) to humans:

Avian flu toll tops 2 million birds - February

The number of turkeys and chickens affected by an avian influenza outbreak in Virginia has topped 2 million. The Virginia Department of Agriculture and Consumer Services said 83 flocks with a total of 2.04 million birds have tested positive for the disease. During the current outbreak, 1.4 million affected birds have been destroyed or slaughtered for market so far, leaving another 700,000 to face the same fate. Since the virus was first detected at a farm in Rockingham County, it has spread to Shenandoah, Augusta, Page and Greene counties.

Case: What can be done?

Eastern Europe's HIV, TB Crisis Threatens Rest of Continent

HIV infections and tuberculosis are rising rapidly in the former Eastern Bloc, and unless action is taken to fight the infections, all of Europe is at risk of a major health crisis, according to the Red Cross and Red Crescent Conference. While Africa and Asia have the highest number of AIDS cases, the former Eastern Bloc has the fastest growth rate. Some 30,000 people die each year from tuberculosis in Russia, which in 2000 had a rate of 90.7 cases per 100,000 people, double the European average. And this could spell problems for Western Europe, which is being flooded with impoverished East Europeans migrating to Western Europe to seek jobs. Europe is standing in front of a creeping crisis with millions of people under threat of death from the rapidly rising number of HIV infections combined with tuberculosis.

Case: Measles: Mexico from the USA?

A person had an onset of measles on 13 April in Mexico. The patient visited Texas on April 10^th. A question arose about the possible exposure of the person to measles in Houston or Dallas, Texas, USA. But during this year Texas has had only one case of measles in an adoptee exposed in China with an onset on 14 Feb. They did not have any cases of measles in the previous year, and in the year before that Texas had 7 cases of which 6 were directly related to international travel.

The incubation period for measles from exposure to rash onset averages 14 days (range 7-18 days). The incubation period from exposure to prodromal illness is 10-12 days with the prodrome usually lasting 2-4 days. Is it possible that this person contracted measles in Texas and carried it to Mexico?

Case: Are you prepared to explain why we are not at risk from this case?

First case of vCJD in the US

A 22-year-old British woman living in Florida is believed to have a brain illness linked to mad cow disease, the first known case in the United States, health officials declared recently.

- An official from the Centers for Disease Control and Prevention emphasized there was every reason to suspect that she represented no risk to others in the US.

- Officials with the Florida Department of Health emphasized that there is no reason to suspect cattle in the United States have the cow version, bovine spongiform encephalopathy

- A state Health Department spokesman has reassured the public that there is no evidence to suggest her illness poses a threat to anyone else or the agriculture industry.

Case: THIS is where Hanta comes from:

Hantavirus Pulmonary Syndrome – Vermont

A 61-year-old previously healthy Vermont resident was hospitalized with respiratory failure requiring ventilation, profound hypoxemia, and low blood pressure. Subsequent chest radiographs revealed bilateral edema consistent with acute respiratory distress syndrome ARDS. During the 2 months preceding hospitalization the patient had cleaned a mouse nest from a woodpile, observed mice in the basement, and trapped 2 mice under the kitchen counters. During an onsite investigation conducted by the Vermont Department of Health, mice droppings were observed under the kitchen counter and in the cellar. The wildlife services program of the U.S.D.A. trapped rodents near patient's house: 46 rodents were captured, including 6 deer mice, 13 white-footed mice, 21 woodland jumping mice, one meadow jumping mouse, four chipmunks, and one vole. These rodents were tested serologically at CDC for hantavirus antibodies and 2 of 5 deer mice were positive; all other rodents were negative.