The objectives of this research study are: 1. To probe into the widespread period of severe acute respiratory syndrome. 2. To study on this highly contagious and rapid spread of this new kind of disease At the time when nearby emergency department of medical center breaks out a suspicion of nasocomial infection. First, our emergency department immediately formed a strict fever screening station. After comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever station between the central and southern medical institution. The research period was from May 15, 2003to July 15, 2003. Our research targets made by the emergency fever station were around 3730 patients with a random selection of 300 cases. This research uses the structure of fever screening measurement questionnaires to gather information and then adapted the EP1-INFO 10.0 version of statistical analysis. The results of the research are as follows: 1. Chief complaint of sore throat (38.3%) and fever (17%) fitted to the clinical symptoms of SARS. In relation to SARS before and after the spread of the disease, there are still other complaints such as the gastrointestinal system (18.7%) and cardiovascular disease (16.7%) that showed no obvious difference. 2. During the period of emergency fever screening station, an additional 50% of manpower are being arranged to screen probable or non-probable affected cases. (from the 300 randomly selected cases) 3. There are no obvious difference showed after comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever center between the central and southern medical institution. 4. After tallying the number of doctors and nurses participated in screening procedure and number of non-medical staff developed similar symptoms to SARS, we can see the result of total number of medical staff from the emergency fever screening station that can successfully control the spread and prevention of the disease, making it the standard and model in the prevention and control of other communicable disease in the future. Key words: Severe acute respiratory syndrome, fever screening station, emergency room, emergency task force

Rift Valley Fever Virus is a plebovirus that causes epidemics and epizootics in sub-Saharan African countries but has expanded to Egypt and the Arabian Peninsula. The laboratory rat (Rattus norvegicus) is susceptible to RVFV and has been shown to manifest the characteristic responses of humans and livestock. The rat has frequently been used as a model to study RVFV pathogenesis. Several strains have been infected and some found to be resistant to hepatic disease while others were not. This resistance was found to be associated with a dominant gene inherited in Mendelian fashion. The congenic rat strain WF.LEW and several substrains of the parental strains were used to try and locate the resistance gene. Microsatellites and single nucleotide polymorphisms were used to characterize the genomes of various rat substrains in an attempt to map the gene. Breeding and viral challenge experiments were used to further characterize the strains and assign a location to the resistance gene. The LEW/SsNHsd rats showed approximately 37% genomic difference as compared with LEW/MolTac rats, and 8% difference as compared with LEW/Crl rats. WF/NHsd rats demonstrated a difference of approximately 8% as compared with WF/CrCrl rats. Genotyping of the congenic WF.LEW revealed Lewis markers on RNO3 and RNO9. Subsequent backcross experiments and viral challenge experiments assigned the resistance gene to the distal end of RNO3.

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Zusammenfassung Katharina Regina Winkler Hämatologisch-immunologische Verlaufsuntersuchungen bei Kühen mit Gebärparese Medizinische Tierklinik der Veterinärmedizinischen Fakultät der Universität Leipzig Eingereicht im September 2014 100 Seiten, 41 Abbildungen, 13 Tabellen, 282 Literaturangaben, 17 Seiten Anhang Schlüsselwörter: Gebärparese, Stoffwechsel, Glucocorticoide, Endotoxin, Blutbild Problemstellung: Der Mineralstoffwechsel unterliegt immunologischen Einflüssen. Vitamin-D3 ist essentiell für die Antigen- und Zytokinsynthesen in den Blutzellen. Die Osteoblastenreifung wird durch Zytokine beeinflusst. Das tangiert die Gebärparese (GP) und erschließt potentiell prophylaktische sowie therapeutische Ansätze. Zielstellung: Es wurde geprüft, ob a) es Mineralstoffunterschiede bei der GP-Diagnose und im Verlauf zu früheren Studien gibt, b) die Parameter Endotoxin (ET), anti-Lipid A-IgG-Titer (ALA-IgG-Titer) und Haptoglobin (Hp) sowie Leuko- und Erythrogramme gesicherte Beziehungen zur GP sowie zu Mineralstoffen und immunologischen Parametern haben, c) die Therapie bei GP durch Glucocorticoide verbessert werden kann und d) Jungkühe mehr Geburtsstress und Belastungen des Ca-Pi-K-Stoffwechsels haben. Versuchsanordnung: Untersucht wurden 111 HF-Kühe bzw. Jungkühe: 21 GP-Kühe mit Grundbehandlung, 22 GP-Kühe mit zusätzlicher Dexamethason-21-iso-ni-cotinat-Therapie (Dexa-IN), 40 gesunde Kontrollkühe (KG) und 28 gesunde Jungkühe. Laborkontrollen erfolgten bei den GP-Kühen vor der Therapie, bei den KG 1 - 3 Tage post partum (d p. p.) sowie 1 d und 14 d nach dem Therapiedatum. Analysiert wurden neben Stoffwechselparametern Endotoxin (LAL-Test), ALA-IgG-Titer, Haptoglobin sowie das Leuko- und Erythrogramm. Ergebnisse: Die Erstbehandlung war bei 47 % ohne und 67 % mit Dexa-IN-Therapie erfolgreich; die Heilungsrate betrug 74 bzw. 82 %, d. h., die Dexa-IN-Therapie verbesserte das Behandlungsergebnis bei GP ohne Nebenwirkungen. 69,8 % der GP-Kühe hatten eine kombinierte Hypokalz- und Hypophosphatämie. 24 Stunden nach Beginn der Therapie waren beide Mineralstoffe in den GP-Gruppen wieder physiologisch. 11,6 % der GP-Kühe und 10,7 % der Jungkühe hatten eine Hypophosphatämie. Das ist offensichtlich eine Folge des Kalbestresses in diesen Gruppen. Die Mg-, Na- und Cl-Konzentrationen waren in allen Gruppen physiologisch. Mg korrelierte negativ mit Ca und Pi (p<0,01). Die K-Konzentrationen waren in den GP-Gruppen einen d p. p. signifikant niedriger als in den KG. Sie korrelierten mit Ca- und Pi in den GP-Gruppen mit 0,42 bis 0,48 (p<0,01). Auf stärkere Stresseinflüsse auf K wiesen Korrelationen zu Glucose, Bilirubin, eosinophile und basophile Granulozyten sowie Lymphozyten hin. Die Fe-Konzentrationen der GP- und KG-Kühe waren physiologisch. Fe korrelierte mit ALA-IgG-Titer gesichert negativ. Die ET-Konzentrationen ließen nur schwache Beziehungen zur GP erkennen, wie rET:Ca=-0,17 (p<0,05). ET korrelierte mit den ALA-IgG-Titern gesichert positiv (Dexa-IN-Gruppe). Die ALA-IgG-Titer differierten bei den Kühen nicht gesichert, sie korrelierten nicht mit Ca, aber mit Pi und mit der Mehrzahl der klinisch-chemischen und hämatologischen Parameter. Das zeigt die Entzündungseinflüsse auf den Pi-Stoffwechsel mit der Förderung von Hypophosphatämien. Die Hp-Konzentrationen streuten stark und waren in allen Gruppen am Diagnose- und noch mehr am Folgetag erhöht (p>0,05). Bei Jungkühen wies der höhere Anstieg auf stärkeren Kalbestress hin. Die Leukozytenzahl war am GP-Diagnosetag erhöht (Leukozytose; p>0,05) und sank zum Folgetag in den Normbereich ab. In der Dexa-IN-Gruppe war der Abfall am stärksten (p<0,05). Die Leukozytenzahl korrelierte gesichert negativ mit den ALA-IgG-Titer sowie in den GP-Gruppen mit den Pi- sowie Ca-Konzentrationen, ebenso die neutrophilen Granulozyten. Eosinophile, basophile Granulozyten sowie Lymphozyten sanken p. p. ab (p<0,05) und korrelierten gesichert mit Ca und Pi. Die GP-Kühe hatten am Diagnosetag eine Monozytose (p<0,05). Die Monozyten korrelierten mit den ALA-IgG-Titern, mit dem Pi und dem Ca gesichert negativ. Sie hatten die engsten Beziehungen zum Entzündungsgeschehen sowie den Pi- und Ca-Konzentrationen. Die CK-Aktivitäten waren am Diagnose- und am Folgetag gegenüber der KG signifikant erhöht. Mit Ca korrelierte die CK in allen Kuh-Gruppen gesichert negativ, mit Pi nur in der GP-Gruppe ohne Dexa-IN. Die CK stand in enger gesicherter Beziehung zu Entzündungsindikatoren. Hämoglobin war in den GP-Gruppen am Diagnosetag signifikant, der Hämatokrit und die Erythrozytenzahlen tendenziell gesteigert. Schlussfolgerungen: Die Studie zeigt bei GP-Kühen vielfältige Beziehungen des Ca-Pi-K-Stoffwechsels zu Entzündungsindikatoren und legt ursächliche Einflüsse nahe, besonders zu ALA-IgG-Titern und Monozyten. Sie können Ursachen für Hypophosphat- und Hypokalämie sein. Zusätzliche Dexa-IN-Therapie verbessert das Behandlungsergebnis.

In eighteenth- and nineteenth-century Britain, a bacterial infection which we now know to be caused primarily by a streptococcus, was killing women in childbirth at an alarming rate. The disease, called puerperal, or childbed, fever, was being transmitted primarily from doctor to patient by a doctor’s unwashed hands and filthy, contaminated clothing and linens. Despite this evident and, in retrospect, obvious vector, the doctors of this period never discovered how to prevent their patients from dying a gruesome and painful death. Many physicians wrote extensive accounts of the illness but often ended their works in despair, unable to find the cause. Much of the historical literature blames this befuddlement on personality traits of the physicians, arguing that egos and professional hostilities prevented the kind of cooperation that could have led to progress. This study attempts to show that this failure was not a product of personalities but of the modern physicians’ assumptions and logic. The assumptions were the stillpowerful, but often unnoticed, dictates about the human body handed down from ancient Greek medicine. The logical errors were a product of pre-scientific notions of definition, explanation, and evidence. The author argues that it was not a lack of data that thwarted the physicians, but a series of these intellectual roadblocks that prevented them from understanding and extended the terror of puerperal fever for another two centuries.

West Nile virus affected nearly 2,000 people in Texas in 2012, killing 89. Neither state and local public health institutions nor the medical community were well prepared for the unprecedented outbreak. The virus is carried by mosquitoes and can cause paralysis and other neurological damage. Other diseases carried by insect vectors, like dengue fever, are poised to resurge or emerge in Texas. Suspected effects of climate change, like warmer winters, may contribute to the prevalence of such diseases and frequency of outbreaks. Adequate surveillance of human cases of these diseases is crucial to the public health response, but is hampered by a low level of diagnosis and reporting throughout the state and spotty vector surveillance by local entities. / text

Francisella tularensis is a zoonotic bacterium that must exist in diverse environments ranging from arthropod vectors to mammalian hosts. To better understand how genes are regulated in these different environments, a transcriptional response- regulator gene (genome locus FTL0552) was deleted in F. tularensis live vaccine strain (LVS). The FTL0552 deletion mutant exhibited slightly reduced rates of extracellular growth but was unable to replicate or survive in mouse macrophages and was avirulent in the mouse model using either BALB/c or C57BL/6 mice. Mice infected with the FTL0552 mutant produced reduced levels of inflammatory cytokines, exhibited reduced histopathology and cleared the bacteria quicker than mice infected with LVS. Mice that survived infection with the FTL0552 mutant were afforded partial protection when challenged with a lethal dose of the virulent Schu S4 strain (4 of 10 survivors, day 21 post infection) when compared to naïve mice (0 of 10 survivors by day 7 post infection). Microarray experiments indicate that 148 genes are regulated in the FTL0552 mutant. Most of the genes are down regulated, indicating that FTL0552 controls transcription of genes in a positive manner. The list of down regulated genes includes genes located within the Francisella Pathogenicity Island (FPI) that are essential for intracellular survival and virulence of Francisella tularensis. Furthermore, a mutant in FTL0552 or the comparable locus in Schu S4 (FTT1557c) may be an alternative candidate vaccine for tularemia.

Coccidioidomycosis (Valley Fever) is an environmentally-mediated respiratory disease caused by the inhalation of airborne spores from the fungi Coccidioides spp. The fungi reside in arid and semi-arid soils of the Americas. The disease has increased epidemically in Arizona and other areas within the last two decades. Despite this increase, the ecology of the fungi remains obscure, and environmental antecedents of the disease are largely unstudied. Two sources of soil disturbance, hypothesized to affect soil ecology and initiate spore dissemination, are investigated. Nocturnal desert rodents interact substantially with the soil substrate. Rodents are hypothesized to act as a reservoir of coccidioidomycosis, a mediator of soil properties, and a disseminator of fungal spores. Rodent distributions are poorly mapped for the study area. We build automated multi-linear regression models and decision tree models for ten rodent species using rodent trapping data from the Organ Pipe Cactus National Monument (ORPI) in southwest Arizona with a combination of surface temperature, a vegetation index and its texture, and a suite of topographic rasters. Surface temperature, derived from Landsat TM thermal images, is the most widely selected predictive variable in both automated methods. Construction-related soil disturbance (e.g. road construction, trenching, land stripping, and earthmoving) is a significant source of fugitive dust, which decreases air quality and may carry soil pathogens. Annual differencing of Landsat Thematic Mapper (TM) mid-infrared images is used to create change images, and thresholded change areas are associated with coordinates of local dust inspections. The output metric identifies source areas of soil disturbance, and it estimates the annual amount of dust-producing surface area for eastern Pima County spanning 1994 through 2009. Spatially explicit construction-related soil disturbance and rodent abundance data are compared with coccidioidomycosis incidence data using rank order correlation and regression methods. Construction-related soil disturbance correlates strongly with annual county-wide incidence. It also correlates with Tucson periphery incidence aggregated to zip codes. Abundance values for the desert pocket mouse (Chaetodipus penicillatus), derived from a soil-adjusted vegetation index, aspect (northing) and thermal radiance, correlate with total study period incidence aggregated to zip code.

The goal of this dissertation is to characterize the distribution and determinants of coccidioidomycosis in greater Tucson, Arizona, using landscape ecology and complex survey methods to control for environmental factors that affect <italic>Coccidioides</italic> exposure. Notifiable coccidioidomycosis cases reported to the health department in Arizona have dramatically increased since 1997 and indicate a potential epidemic of unknown causes. Epidemic determination is confounded by concurrent changes in notifiable disease reporting-compliance, misdiagnosis, and changing demographics of susceptible populations. A stratified, two-stage, address-based telephone survey of greater Tucson, Arizona, was conducted in 2002 and 2003. Subjects were recruited from direct marketing data by census block groups and landscape strata as determined using a geographic information system (GIS). Subjects were interviewed about potential risk factors. Address-level state health department notifiable-disease surveillance data were compared with self-reported survey data to estimate the true disease frequency.Comparing state surveillance data with the survey data, no coccidioidomycosis epidemic was detectable from 1992 to 2006 after adjusting surveillance data for reporting compliance. State health department surveillance reported only 20% of the probable reportable cases in 2001.Utilizing survey data and geographic coding, it was observed that spatial and temporal disease frequency was highly variable at the census block-group scale and indicates that localized soil disturbance events are a major group-level risk factor. Poststratification by 2000 census demographic data adjusted for selection bias into the survey and response rate. Being Hispanic showed similar odds ratio of self-reporting coccidioidomycosis diagnosis as of being non-Hispanic White race-ethnicity when controlled by other risk factors. Cigarette smoking in the home and having a home located in the low Hispanic foothills and low Hispanic riparian strata were associated with elevated risk of odds ratios for coccidioidomycosis. Sample stratification by landscape and demographics controlled for differential classification of susceptibility and exposures between strata.Clustered, address-based telephone surveys provide a feasible and valid method to recruit populations from address-based lists by using a GIS to design a survey and population survey statistical methods for the analysis. Notifiable coccidioidomycosis case surveillance can be improved by including reporting compliance in the analysis. Pathogen exposures and host susceptibility are important predictable group-level determinants of coccidioidomycosis that were controlled by stratified sampling using a landscape ecology approach.

This dissertation examines the experience of those involved in the typhoid fever outbreak at Camp Thomas, Chickamauga National Military Park, Georgia between April and August 1898. Among American volunteer soliders in the Spanish-American War, those stationed at this camp suffered the highest number of typhoid cases and deaths from typhoid. Treatments of the war have referred to the outbreak and some studies have examined it as part of wider subjects, but none from the standpoint of those involved, commanders, doctors, civilians, officers and enlisted men. The mobilized soldiers represented numerous states and reflected the disease experience of civilian society. The study considers the mobilization process, the disease outbreak and the aftermath.