Note that "nosocomial" used below is an adjective meaning: "originating in hospital"
example: a nosocomial disease
[ETYMOLOGY: 19th Century: New Latin nosocomialis, via Late Latin from Greek, from nosokomos one that tends the sick, from nosos (see noso-) + komein to tend])
Sustained Transmission of Nosocomial Legionnaires Disease -- Arizona and OhioMore: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047639.htmIn 1996, two hospitals reported sustained transmission of nosocomial Legionnaires disease (LD). The hot water distribution systems in each hospital were implicated as the sources of infection. This report summarizes investigations in these two hospitals by hospital personnel, state and local health officials, and CDC and efforts to control transmission. Arizona, 1987-1996
In 1996, eight cases of nosocomial LD were diagnosed among cardiac and bone marrow transplant patients at hospital X. Possible nosocomial LD was first reported at hospital X in 1979, but no source had been identified. Intensified surveillance for nosocomial LD was initiated after the first three case-patients were identified in 1996.
A case of definite nosocomial LD in a hospital X patient was defined as respiratory illness with a new infiltrate on chest roentgenogram occurring after greater than or equal to 10 days of continuous hospitalization for a nonpneumonia illness and laboratory confirmation of legionellae infection by at least one of the following: 1) isolation of legionellae from tissue or respiratory secretions, 2) detection of Legionella pneumophila serogroup 1 (Lp-1) antigens in urine by radioimmunoassay or enzyme immunoassay, or 3) a fourfold rise in Legionella serogroup-specific antibody titer to greater than or equal to 128 between acute- and convalescent-phase serum specimens. Possible nosocomial LD was defined as onset of respiratory symptoms of LD after 2-9 days of continuous hospitalization (the incubation period for LD is usually 2-10 days).
and:
Legionnaires Disease Associated with a Whirlpool Spa Display -- Virginia, September- October, 1996From: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047291.htmContaminated whirlpool spas have been reported as a source of legionellosis. This report describes the preliminary findings of an ongoing investigation by the Virginia Department of Health (VDH) and CDC of a recent outbreak of Legionnaires disease in Virginia, which implicated a whirlpool spa display at a retail store as the source of infection.
On October 15, 1996, a district health department in southwestern Virginia contacted the Office of Epidemiology, VDH, about a hospital (hospital A) report that 15 patients had been admitted during October 12-13 with unexplained pneumonia. On October 21, another hospital (hospital B), located approximately 15 miles from hospital A, reported its pneumonia census to be higher than expected for the first 2 weeks of October. On October 23, the district health department was informed about three area residents with legionellosis (with Legionella pneumophila serogroup 1 {Lp1} antigen detected in urine); one was a patient at hospital A, and two were patients at hospitals outside the jurisdiction of the health department.
Unusual huh?
We used to think that we could eventually fully understand medicine and health issues, but it now appears that won't ever be true. New illnesses with new causes will continue to arise.
This SARS thing is fascinating, simply because it demonstrates what we don't know. Why are some people "super-infectors"? Is the virus unstable and mutating into less deadly forms in secondary and tertiary infections? What role do bacteria play into the mix?
How the heck did it get into humans in the first place? Will it burn out like Ebola? Or is it likely to become an even more deadly illness than the Spanish Flu?
None of those questions have reliable answers tonight, and while the total number of people infected worldwide are miniscule, it all comes down to the question of whether we can stop it, or at least contain it, before it has the chance to kill millions.
It's already had an economic impact far beyond its mortality numbers. Cathay Airlines is in severe trouble. The economic fallout on Hong Kong is growing, and it's not an insignificant part of the global economy.
Perhaps the hype is far worse than the actual impact of the illness will be. But maybe not. It's the uncertainty that's killing us more than the illness tonight.