The clinical features and microbiological characteristics of 315 patients with definite or possible infective endocarditis (IE) from January 1995 to December 2003 were evaluated. There were 187 males and 128 females with a mean age of 51 years (range, 1 month to 92 years). Ninety-three patients (30%) had a diagnosis of valvular heart disease and 24 (8%) had received prosthetic valve replacement. Blood culture was negative in 62 patients (20%). Staphylococci (91 patients, 32%), including methicillin-susceptible Staphylococcus aureus (15%), methicillin-resistant S. aureus (11%), and coagulase-negative staphylococci (6%), were the most commonly encountered pathogens followed by viridans group streptococci (77 patients, 24%). Eight patients (25%) had various neurological, renal, embolic, and cardiac complications. Patients with neurological complications [odds ratio (OR) 8·175, P<0·001], nosocomial IE (OR 6·661, P<0·001), underlying malignancy (OR 4·993, P<0·001), elevated serum creatinine level (OR 3·132, P=0·001), or elevated WBC count (>15000/mm3) (OR 2·537, P=0·007) were at significantly increased risk of mortality. This study found mortality from IE was associated with several factors, among which neurological complications were the most hazardous. Patients with more than one risk factor had poorer prognosis. These results suggest the need for more aggressive management in patients with IE when multiple risk factors for mortality are identified.

In August 2002 an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5–6 August 2002. The estimated primary attack rate was 9·97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16·49%). The town and its surroundings were served by two water systems, A and B. The cases had consumed water provided by system A (attack rate 164 cases/1000 population). Microbiological analysis of water from system A did not show the presence of coliform bacteria or shigella. This shigellosis outbreak was the largest reported in Spain. The impact of the epidemic was probably greater than the incidence detected.

Pulsed-field gel electrophoresis (PFGE) is commonly used in molecular epidemiology. However, this technique has never been used in studying intra-family spread of enteric diseases in Bangladesh. Our objective was to evaluate the intra-familial transmission of shigella infection using PFGE. Children of either sex, less than 10 years old, who were family contacts of shigella-infected index cases were the study population. PFGE was applied if the same serotypes/sub-serotypes of shigella were isolated from both the index case and the family contact children. In total, 227 index cases were studied. Shigella was isolated from 61 (27%) contact children on day 1 of enrolment, among which Shigella flexneri (41%) and S. boydii (41%) were dominant, followed by S. dysenteriae (10%), S. sonnei (3%), and shigella-like organisms (5%). Seventeen (28%) of the asymptomatic infections in contact children were caused by the same serotype of shigella as that found in the index case. The intra-familial shigella transmission rate was 8% (17/227). Of the 227 contact children, eight (4%) developed diarrhoea during a 10-day follow-up and shigella was isolated from five (2%) of these children, and three of them (S. flexneri 3a, 1b, and 3a) were identical to the strains from their respective index cases. Compared to children without asymptomatic carriage of shigella (2/166), the risk (odds ratio) of developing diarrhoea for the children with asymptomatic carriage of shigella identical to their cases (3/17) was 9·0 (95% CI 1·5–49·0, P=0·01). The attributable risk for symptomatic shigella infection by intra-familial transmission was 50%. Results of this study demonstrated that intra-familial transmission of shigella carries a higher risk for diarrhoea.

We conducted a case-control study to assess risk factors for typhoid fever in Diyarbakir, Turkey, a region where transmission of Salmonella typhi is endemic. We prospectively identified febrile patients from Diyarbakir and the surrounding area who were admitted to hospital. Cases were defined as patients who had S. typhi isolated from at least one blood culture. Sixty-four cases with blood culture-confirmed S. typhi were identified between May 2001 and May 2003. In total, 128 age- and sex-matched controls selected from neighbourhoods as cases were enrolled. We hypothesized that consumption of raw vegetables contaminated with sewage would be associated with an increased risk of typhoid fever. Conditional logistic regression modelling revealed that living in a crowded household (OR 3·31, 95% CI 1·58–6·92, P=0·002), eating cig kofte (a traditional raw food) (OR 5·29, 95% CI 2·20–12·69, P=0·000) and lettuce salad (OR 3·55, 95% CI 1·52–8·28, P=0·003) in the 15 days prior to symptoms onset was independently associated with typhoid fever. We conclude that living in a crowded household and consumption of raw vegetables outside the home increase the risk of typhoid fever in this region.

Since 1996 Salmonella Typhimurium DT104 salmonellosis has increased in The Netherlands. This prompted a case-control study of risk factors for salmonellosis to inform transmission routes for this phage type. Cases were laboratory-confirmed patients with a Salmonella infection and controls were selected from population registries by frequency matching for age, sex, degree of urbanization and season. Cases and controls received a questionnaire on risk factors. Of the 1171 cases, 573 (49%) responded: 245 S. Enteritidis and 232 S. Typhimurium cases (both DT104 and non-DT104), of which 58 were DT104. Of the 10250 controls, 3409 (33%) responded. Use of H2 antagonists [odds ratio (OR) 4·4, 95% CI 1·6–12·2] and proton pump inhibitors (OR 4·2, 95% CI 2·2–7·9), consumption of raw eggs (OR 3·1, 95% CI 1·3–7·4) and products containing raw eggs (OR 1·8, 95% CI 1·1–3·0) were associated with endemic S. Enteritidis infection. Risk factors for endemic S. Typhimurium infection were use of proton pump inhibitors (OR 8·3, 95% CI 4·3–15·9), occupational exposure to raw meat (OR 3·0, 95% CI 1·1–7·9), playing in a sandbox (for children aged 4–12 years) (OR 2·4, 95% CI 1·6–3·7), consumption of undercooked meat (OR 2·2, 95% CI 1·1–4·1) and use of antibiotics (OR 1·9, 95% CI 1·0–3·4). Use of proton pump inhibitors (OR 11·2, 95% CI 3·9–31·9) and playing in a sandbox (OR 4·4, 95% CI 1·8–10·7) were the only risk factors for S. Typhimurium DT104 salmonellosis. This study confirms known risk factors for salmonellosis. However, playing in a sandbox was a predominant new risk factor for S. Typhimurium salmonellosis in children [population attributable risk (PAR) 14%], and especially for S. Typhimurium DT104 (PAR 32%).

This study examined the prevalence of the intestinal spirochaetes Brachyspira aalborgi and Brachyspira pilosicoli in different Western Australian (WA) populations. Faecal samples included 287 from rural patients with gastrointestinal symptoms, comprising 142 from non-Aboriginal and 145 from Aboriginal people; 227 from recent healthy migrants to WA from developing countries; and 90 from healthy non-Aboriginal individuals living in Perth, WA. DNA was extracted from faeces, and subjected to PCR assays for both species. B. pilosicoli-positive individuals were confined to the rural Aboriginal (14·5%) and migrant (15·0%) groups. B. aalborgi was detected at a lower but similar prevalence in all four groups: rural non-Aboriginals, 5·6%; rural Aboriginals, 6·9%; migrants, 7·9%; controls, 5·6%. In migrants and Aborigines, the presence of B. pilosicoli and B. aalborgi was associated (P<0·001), suggesting that colonization by B. pilosicoli may be facilitated by colonization with B. aalborgi. Amongst the Aboriginal patients, logistic regression identified both spirochaete species as being associated with chronic diarrhoea, failure to thrive and being underweight. Both species may have pathogenic potential, but B. aalborgi appears more host-adapted than the opportunistic B. pilosicoli.

During a period of 3 years, 1998–2000, 1047 faecal swabs from Black-headed gulls were sampled at one location in Southern Sweden. Salmonella spp. was found in 28 individuals (2·7%) and the dominating serotype found was S. Typhimurium (83%). Twenty-five per cent of the Salmonella-infected gulls were later recaptured and re-sampled. We found that Salmonella infection in Black-headed gulls was of short duration, and that infection in this bird species was predominantly expressed as carriage without disease manifestations. All S. Typhimurium isolates were subjected to antibiotic resistance profiling and molecular characterization by pulsed-field gel electrophoresis and IS200 polymerase chain reaction. The S. Typhimurium gull isolates were compared to human and domestic animal isolates of the same serotype and phage type. We found genetic relatedness of S. Typhimurium DT195 isolates from gulls, domestic animals and humans, indicating that Black-headed gulls might play a role in the spread of S. Typhimurium in Sweden.

The chemotactic response of Vibrio cholerae O1 towards the mucilaginous sheath of Anabaena sp. was investigated by capillary tube method using a virulent strain of V. cholerae O1, El Tor, Ogawa (3083-T) and its isogenic mutant (HAP-1-T) that lacks the hap gene, which codes for mucinase (HA/protease). Homogenates of Anabaena sp. and purified mucin were used in this study as chemoattractants. Results showed 5·7% bacterial accumulation of wild-type V. cholerae O1 towards 4% homogenates of Anabaena sp. whereas, its mutant (hap−) showed 2·9% accumulation after 90 min. The higher percentage of attraction of wild-type V. cholerae O1 than the mutant (hap−) towards mucin and the homogenates of Anabaena sp. might be due to the activity of mucinase. These results indicate the role of mucinase in the chemotactic motility of V. cholerae O1 towards Anabaena sp.

Mass gatherings are believed to increase the transmission of infectious diseases although surveillance systems have shown a low impact. The Catholic Jubilee was held in Rome, Italy in 2000. We conducted a case-control study to analyse the risk factors of giardiasis among residents. All diseases reported to the laboratory surveillance system from January 2000 to May 2001 were compared with hospital controls concurrently selected in the same season as cases and frequency-matched for age and birth country. Fifty-two cases (44·1%) and 72 controls were enrolled. In the multivariable analysis factors associated with giardiasis among adults were: travelling abroad (OR 24·2, P>0·01), exposure to surface water (OR 4·80, P=0·05), high educational level (OR 3·8, P=0·03). Having a maid from a high-prevalence country was independently associated (OR 2·3) although not statistically significant. This is the only exposure that changed during the Jubilee.

To determine factors associated with fetal growth, preterm delivery and stillbirth in an area of high malaria transmission in Southern Malawi, a cross-sectional study of pregnant women attending and delivering at two study hospitals was undertaken. A total of 243 (17·3%) babies were preterm and 54 (3·7%) stillborn. Intra-uterine growth retardation (IUGR) occurred in 285 (20·3%), of whom 109 (38·2%) were low birthweight and 26 (9·1%) preterm. Factors associated with IUGR were maternal short stature [adjusted odds ratio (AOR) 1·6, 95% confidence interval (CI) 1·0–2·5]; primigravidae (AOR 1·9, 95% CI 1·4–2·7); placental or peripheral malaria at delivery (AOR 1·4, 95% CI 1·0–1·9) and maternal anaemia at recruitment (Hb <8 g/dl) (AOR 1·9, 95% CI 1·3–2·7). Increasing parasite density in the placenta was associated with both IUGR (P=0·008) and prematurity (P=0·02). Factors associated with disproportionate fetal growth were maternal malnutrition [mid-upper arm circumference (MUAC) <23 cm, AOR 1·9, 95% CI 1·0–3·7] and primigravidae (AOR 1·8, 95% CI 1·0–3·1). Preterm delivery and stillbirth were associated with <5 antenatal care visits (AOR 2·2, 95% CI 1·3–3·7 and AOR 3·1, 95% CI 1·4–7·0 respectively) and stillbirth with a positive Venereal Disease Research Laboratory (VDRL) test (AOR 4·7, 95% CI 1·5–14·8). Interventions to reduce poor pregnancy outcomes must reduce the burden of malaria in pregnancy, improve antenatal care and maternal malnutrition.