HICN243 News Part 2/3 
Author Message
 HICN243 News Part 2/3

--- begin part 2 of 3 cut here ---
Public Health Service and CDC,  have  developed  comprehensive  plans  for  an
emergency medical/ public health response to a catastrophic earthquake.  These
plans established state  and  federal  support  mechanisms  to  enhance  local
governments'  ability to respond.  This support includes the National Disaster
Medical System;  coordination  of  procurement  and  distribution  of  medical
supplies;  provision  of  medical  personnel,  equipment,  and  public  health
services;  and, if necessary,  establishment of field hospitals and evacuation
of casualties.
    Following the earthquake,  initial reports indicate that local medical and
public health resources were generally adequate.  State and federal assistance
was  provided as needed;  however,  the catastrophic earthquake response plans
were not activated.  Local,  state,  and federal agencies  are  reviewing  the
response  to  this  event;  the  California  Department  of Health Services is
investigating additional public health aspects of  the  earthquake,  including
cause-specific morbidity and mortality,  public preparedness, and the adequacy
of emergency response.

References

1.  Department of Finance.  Population  estimates  of  California  cities  and
counties: January 1, 1988-January 1, 1989.  Sacramento: Department of Finance,
1989. (Report 89 E-1).

2. Parrish RG, Ing R. Medical examiner and coroner jurisdictions in the United
States.  Colorado Springs,  Colorado:  American Academy of Forensic  Sciences,
1988.

3.  California Department of Conservation, Division of Mines and Geology.  How
earthquakes are measured. Calif Geol 1979;32(Feb.):35-7.

4. Stratton J.  Earthquakes.  In: Gregg MB, ed.  Public health consequences of
disasters.  Atlanta: US Department of Health and Human Services, Public Health
Service (in press).

5. CDC. Deaths associated with Hurricane Hugo--Puerto Rico.  MMWR 1989;38:680-
2.

6.  CDC.  Medical examiner/coroner reports of deaths associated with Hurricane
Hugo--South Carolina. MMWR 1989;38:754,759-62.

7. Hansen GC. San Francisco numbers game. Calif Geol 1987;40(Dec.):271-4.

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Volume  2, Number 43                                      November 20, 1989

           Elemental Mercury Vapor Poisoning -- North Carolina, 1988

    In July 1988,  the  Environmental  Epidemiology  Section,  North  Carolina
Department of Environment, Health, and Natural Resources (DEHNR), investigated
chronic  mercury  poisoning diagnosed in a 3-year-old boy from North Carolina.
The patient's clinical manifestations included  hypersalivation,  myalgia  and
tremor  in  the  hands,  myalgia  and  weakness  in  both  lower  extremities,
diaphoresis, irritability, insomnia, and anorexia.  Analysis of a random urine
sample  detected  a  mercury  level  of 160 ug/L (normal:  less than 25 ug/L).
Results of 24-hour urine specimens for mercury collected from both the patient
and his parents were:  patient, 360 ug/L;  mother, 230 ug/L;  and father,  145
ug/L.
    Although  the  family reported no known mercury exposures,  in April 1988,
they had moved into a house  whose  previous  owner  had  collected  elemental
mercury.  Several  containers  of  mercury  reportedly had been spilled in the
house during the previous owner's occupancy.  As a result of the determination
that  the  house  was the probable source of exposure,  the family temporarily
relocated.
    In July 1988,  DEHNR conducted an extensive investigation of the house.  A
mercury  vapor  analyzer detected a mercury concentration of 20 ug/m3-60 ug/m3
in five rooms and two bathrooms.  The average  mercury  concentration  in  the
patient's  bedroom  was  55 ug/m3 (range:  30 ug/m3-140 ug/m3).  In the vacuum
cleaner filter bag,  the mercury concentration for air exceeded the  range  of
the  analyzer  (1000 ug/m3).  A dust sample from the vacuum cleaner bag had an
elemental  mercury  concentration  of  4400  ppm,   and  carpet  samples   had
concentrations of 0.8 ppm-638 ppm.
    Urine  mercury  screening was carried out for two children of the previous
occupant and for seven  persons  who  had  frequently  visited  them  The  two
children  had  urine  mercury  levels of 98 ug/L and 49 ug/L;  the seven other
persons had levels less than 25 ug/L.
    Corrective measures included removal of the  carpets,  decontamination  of
the house (i.e., several cleanings of floors, walls, and solid surfaces with a
product containing a metallic-mercury-sulphide-converting powder,  a chelating
compound,  and a dispersing agent),  and application of a polyurethane coating
to  all  floor  surfaces.  Subsequent  analysis  indicated  that  the  mercury
concentration was less than 1 ug/m3 throughout the house.
    Over a 2-month period, the urine mercury levels of the family decreased to
normal.  The patient,  who had  been  treated  with  penicillamine,  recovered
without neurologic sequelae. In August 1988, the family returned to the house.
Because  the patient's parents and the children of the previous owner remained
asymptomatic, they were not treated.

Reported by:  EI Blair,  MD,  Dept of Pediatrics,  RE  Cross,  PhD,  Depts  of
Pathology  and  Medicine,  Univ  of North Carolina School of Medicine,  Chapel
Hill;  GM Stave, MD,  Duke Occupational Health Svc,  Duke Univ Medical Center,
Durham;  WW Hill Jr,  MPH,  J Smith,  Nash County Health Dept,  Nashville;  JI
Freeman, DVM, DL Newton, MSPH, WJ Pate, WA Williams, JN MacCormack, MD,  State
Epidemiologist,  North  Carolina  Dept  of  Environment,  Health,  and Natural
Resources.  Div of  Environmental  Hazards  and  Health  Effects,  Center  for
Environmental  Health  and  Injury  Control;  Div of Field Svcs,  Epidemiology
Program Office, CDC.

Editorial Note:  Reported cases of  nonoccupational  elemental  mercury  vapor
poisoning are relatively rare (1).  Acute cases usually result from inhalation
of high concentrations of mercury vapor,  which is produced when the metal  is

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heated  in  an enclosed space (1).  The North Carolina investigation and other
reported cases indicate that chronic elemental  mercury  vapor  poisoning  can
also occur in the home (2).
    In  this  report,  the  patient  developed many of the symptoms typical of
chronic elemental mercury vapor poisoning  (3).  In  addition,  the  patient's
urine  mercury  concentration was greater than 150 ug/L,  the level associated
with the earliest neurologic effects in {*filter*}s (4).  The 8-hour  time-weighted
average  air  concentration  of  elemental  mercury  vapor associated with the
earliest neurologic effects in {*filter*} workers has been estimated  at  50  ug/m3
(4).   This   concentration   was   detected  throughout  the  house;   higher
concentrations were recorded in the patient's bedroom.
    The concentrations of elemental mercury found in the  vacuum  cleaner  bag
dust  sample  and  the  carpet  samples indicate that the carpets were heavily
contaminated.  Vacuuming the mercury-contaminated carpet may have resulted  in
dispersal  of particles and vapor throughout the house.  Vaporization probably
increased with the spread of the mercury and the onset of warmer weather (5).
    The Environmental Protection Agency's suggested ambient air  concentration
for mercury is less than 1 ug/m3 (6).  Although this level exceeds those found
in pristine environments (6)--and presumably in  uncontaminated  homes--it  is
below  the accepted exposure concentrations for occupational settings (7).  In
addition,  a concentration of 1 ug/m3 has been considered an  obtainable  goal
for decontamination in other cases of residential mercury contamination (8).
    Elemental  mercury should not be stored in residences,  particularly those
with carpeted surfaces. If spilled, mercury should be removed before it can be
dispersed.  However, a contaminated carpet or rug should be vacuumed only with
a  specialized  industrial  mercury vacuum.  A contaminated carpet or rug that
cannot be adequately cleaned should be considered a  substantial  health  risk
and  removed  promptly.  If  necessary,  decontamination  procedures should be
undertaken to reduce the ambient mercury vapor concentration in the  house  to
less than 1 ug/m3.

References

1.  Sexton  DJ,  Powell  KE,  Liddle J,  et al.  A nonoccupational outbreak of
inorganic mercury vapor poisoning. Arch Environ Health 1978;33:186-91.

2. Moutinho ME, Tompkins AL, Rowland TW, et al. Acute mercury vapor poisoning.
Am J Dis Child 1981;135:42-4.

3.  Grandjean P.  Diseases associated with metals.  In:  Last JM,  ed.  Public
health and preventive medicine. 12th ed. Connecticut: Appleton-Century-Crofts,
1986:587-615.

4.  WHO Study Group.  Recommended health-based limits in occupational exposure
to heavy metals.  Geneva:  World Health Organization, 1980.  (Technical report
series no. 647).

5.  Goldwater  LJ.  The  toxicology  of  inorganic  mercury.  Ann  NY Acad Sci
1957;65:498-503.

6. Environmental Protection Agency.  Background information on the development
of  national  emission  standards  for  hazardous  air  pollutants:  asbestos,
beryllium,   and  mercury.   Research  Triangle  Park,   North  Carolina:   US
Environmental Protection Agency, 1973; publication no.  APTD-1503.

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7.   Occupational   Safety  and  Health  Administration.   Air  contaminants--
permissible exposure limits (title  29,  Code  of  federal  regulations,  part
1910.1000).  Washington,  DC:  US Department of Labor, Occupational Safety and
Health Administration, 1989.

8.  Zirschky J, Witherell L.  Clean-up of mercury contamination of thermometer
workers' homes. Am Ind Hyg Assoc J 1987;37:311-4.

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Volume  2, Number 43                                      November 20, 1989

                Current   Trends   Pap   Smear   Screening  --
               Behavi{*filter*}Risk Factor Surveillance System, 1988

    Data from the 1988 Behavi{*filter*}Risk Factor Surveillance System (BRFSS) were
used to characterize knowledge and prevalence of use of the Papanicolaou (Pap)
smear--a  primary screening test for cervical cancer--among women in 15 states
and the District of Columbia.  The 16 participating health  departments*  used
standard   questions   and  methods  to  conduct  monthly  random-digit-dialed
telephone interviews of {*filter*}s greater than or equal to 18 years of  age  (1).
Respondents  were asked whether they knew about Pap smear tests,  whether they
had ever had a Pap smear, and how long it had been since their last test.
    The sample for this analysis included 8741  black  women  and  white  non-
Hispanic  women aged greater than or equal to 18 years who had not undergone a
hysterectomy.  Almost all (99.8%) women interviewed knew of the Pap smear, and
98.8%  had  had  at least one such test.  The frequency of Pap smear screening
varied by age, income level,  and race (Table 1).  Women aged 18-39 years were
1.6  times  more likely to have had a Pap smear within the preceding year than
were women aged greater than or equal to 60 years.  Also,  75% of  women  with
incomes  greater  than or equal to $20,000 reported having had the test within
the preceding year, compared with 65% of women with incomes less than $10,000.
    For all age groups combined, a higher percentage of black women (82%;  95%
CI  plus  or  minus  3.5)  than  white  women (71%;  95% CI plus or minus 1.6)
reported receiving a Pap smear in the preceding  year.  These  differences  by
race  occurred  within  each  of  the eight geographic areas with a sufficient
number of black respondents to allow race-specific comparisons.

Reported by: The following BRFSS coordinators:  L Parker, California;  M Rivo,
District of Columbia;  B Steiner, Illinois; K Bramblett, Kentucky; R Schwartz,
Maine; A Weinstein, Maryland;  R Thurber, Nebraska;  K Zaso, New Hampshire;  L
Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; N Hann,
Oklahoma;  D Lackland, South Carolina;  K Tollestrup, Washington;  R Anderson,
West {*filter*}ia;  M  Soref,  Wisconsin.  Div  of  Chronic  Disease  Control  and
Community  Intervention  and  Office of Surveillance and Analysis,  Center for
Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:  In 1986,  approximately 5000 U.S.  women died  from  invasive
cervical  cancer,  a  disease  that  can  be  prevented by early detection and
treatment (2).  Incidence and mortality rates of invasive cervical cancer vary
by  socioeconomic  factors,   and  unequal  access  to  medical  services  may
contribute to delayed diagnosis and death (3-5).  The BRFSS finding that black
women are more likely than white women to have  had  a  recent  Pap  smear  is
consistent  with  data from the 1985 and 1987 National Health Interview Survey
(NHIS) (6,7), even though overall NHIS estimates of yearly Pap smear screening
frequency are lower than those produced by BRFSS (8).
    Although  National  Cancer  Institute  data  show  that  cervical   cancer
incidence  and  mortality  rates  increase  with age (9),  Pap smear screening
decreases with age. Therefore, improving cervical cancer screening among older
women should be emphasized.  The American Cancer Society recommends annual Pap
tests  beginning  with the onset of {*filter*} activity;  after three negative Pap
tests, less frequent tests may be recommended by the woman's physician (10).
    Despite higher rates of yearly Pap smears for black  women  in  1988,  the
age-adjusted  incidence rate for invasive cervical cancer for blacks was twice
that for whites in 1986,  the last year for which data are available (9);  the
age-adjusted  mortality  rate  for  cervical cancer that year was nearly three
times higher for blacks than for whites.  NHIS  data  show  black  women  have

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Volume  2, Number 43                                      November 20, 1989

increasingly used this screening since 1973 (60% of black women, compared with
64% of white women,  had had a Pap smear within the past 2 years in 1973 (6)),
so recent changes in screening by race may not be directly related to invasive
cervical cancer incidence and mortality patterns.
    Medical-care delivery to underserved  populations  may  be  an  especially
challenging problem,  since screening is only one of several key components to
prevention.  Other factors influencing incidence and mortality trends  include
prompt  notification  of  Pap smear results,  adequate patient follow-up,  and
appropriate treatment.  To reduce undetected progression to invasive  cervical
cancer,  comprehensive  examination  of  Pap smear screening,  follow-up,  and
treatment patterns is needed--especially for  minorities,  low-income  groups,
and older women (2).

References

 1.  Remington PL, Smith MY, Williamson DF, et al. Design, characteristics and
usefulness of state-based  behavi{*filter*} risk  factor  surveillance:  1981-1986.
Public Health Rep 1988;203:366-75.

 2.  CDC. Chronic disease reports: deaths from cervical cancer--United States,
1984-1986. MMWR 1989;38:650-4,659.

 3. Cuello C, Correa P, Haenzel W.  Socio-economic class differences in cancer
incidence in Cali, Colombia. Int J Cancer 1982;29:637-43.

 4.  Devesa SS,  Diamond EL.  Association of {*filter*} cancer and cervical cancer
incidence with income and education among whites and blacks. JNCI 1980;65:515-
28.

 5. Howard J. Avoidable mortality from cervical cancer: exploring the concept.
Soc Sci Med 1987;24:507-14.

 6. Makuc DM, Fried VM, Kleinman JC.  National trends in the use of preventive
health care by women. Am J Public Health 1989;79:21-6.

 7.  Thornberry OT, Wilson RW, Golden PM, NCHS.  Health promotion data for the
1990 objectives.  Rockville,  Maryland:  US Department  of  Health  and  Human
Services,  Public  Health Service,  1986.  (Advance data from vital and health
statistics; no. 126).

 8.  CDC.  Provisional estimates from the  National  Health  Interview  Survey
supplement  on  cancer  control--United  States,  January-March,  1987.   MMWR
1988;37:417-20,425.

 9. National Cancer Institute. Cancer statistics review, 1973-1986.  Bethesda,
Maryland:  US Department of Health and Human Services,  Public Health Service,
1989; NIH publication no. 89-2789.

10.  American  Cancer  Society.  Summary of current guidelines for the cancer-
related checkup: recommendations.  Atlanta: American Cancer Society, 1988; ACS
publication no. 3347.01-PE.

*California,  District  of  Columbia,  Illinois,  Kentucky,  Maine,  Maryland,
Nebraska, New Hampshire, New Mexico, New York, North Carolina, Oklahoma, South
Carolina, Washington, West {*filter*}ia, and Wisconsin.

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Volume  2, Number 43                                      November 20, 1989

    Urine Testing for Drug Use Among Male Arrestees -- United States, 1989

    Since 1986,  the Drug  Use  Forecasting  (DUF)  program  of  the  National
Institute  of  Justice  (NIJ)  has  monitored drug use among recently arrested
persons in selected cities.  Every  3  months,  DUF  staff  obtain  voluntary,
anonymous  urine  specimens from a sample of arrestees in booking facilities.*
The findings in this report reflect drug use  among  male  arrestees  from  14
cities during January-March 1989.
    Urine   specimens   were   screened   by  Enzyme  Multiplied  Immune  Test
(EMIT(TM))** for  the  following  {*filter*}  and/or  their  metabolites:  opiates,
{*filter*},    phencyclidine   (PCP),    {*filter*},    amphetamines,   methadone,
barbiturates,  propoxyphene,  benzodiazepine,   and  methaqualone.   Specimens
positive  for  amphetamines  were  tested  by  gas chromatography to eliminate
false-positive  reactions  by  related  {*filter*},  such  as  ephedrine.  Positive
screening tests for other {*filter*} were not confirmed.
    Preference for enrollment in the program was given to persons charged with
serious  nondrug-related offenses.  Attempts were made to limit the percentage
of participants charged with sale or possession of {*filter*} to less than or equal
to 25%. Persons charged with traffic offenses or vagrancy were excluded.
    Each arrestee  was  asked  to  participate  in  a  brief,  anonymous,  and
confidential  interview  regarding drug use,  drug-treatment history,  needle-
sharing behaviors,  and availability of new {*filter*} "on the  street."  Following
the  interview,  the  arrestee  was  asked  to  provide  a urine specimen.  Of
arrestees contacted,  greater than or equal to 90% agreed to  be  interviewed;
80%-96% of those interviewed provided a urine specimen (Table 1).
    Urine  tests  were  positive for {*filter*} most commonly in arrestees in New
York (76%), Philadelphia (74%), and the District of Columbia (65%),  and least
likely  in  the  smaller  cities  of  Indianapolis (26%) and San Antonio (24%)
(Figure 1).  In nine of the 14 cities,  less than 10%  of  the  arrestees  had
positive  urine  tests  for opiates.  Eighty-one percent of persons who tested
positive for opiates also tested positive for  {*filter*}.  In  five  cities,  no
arrestee had a positive test for amphetamines,  and the percentage of positive
tests was greater than 7% in only one city, San Diego (35%).
    Drug injection at some time during their lives was reported by 15%-38%  of
the  male  arrestees in each city (Table 2).  {*filter*} and {*filter*} were the most
frequently reported injected {*filter*}.  In 10 of the 14 cities,  {*filter*} was more
frequently reported to be injected than {*filter*}.  In eight cities, injection of
amphetamines was reported by greater than or equal to 40% of the arrestees who
injected  {*filter*}.  In  11  cities,  greater  than  or equal to 20% of injectors
reported sharing needles.

Reported by:  ED Wish, PhD, JA O'Neil,  MA,  National Institute of Justice.  R
Stevens, Cleveland State Univ, Ohio. P McMillan, Dallas County Sheriff's Dept,
Texas.  T Mieczkowski,  Wayne State Univ,  Detroit.  P Galloway, Marion County
Justice Agency,  Indianapolis.  C Burnett,  Univ of Missouri,  Kansas City;  S
Decker,  Univ  of  Missouri,  St.  Louis.  W  Hunter,  Orleans Parish Criminal
Sheriff's Dept, New Orleans.  T Miller, Narcotic and Drug Research,  Inc,  New
York. J Shanahan, Philadelphia Police Dept.  R Rian, Treatment Alternatives to
Street  Crime of Phoenix,  Arizona.  P Clem,  Treatment Alternatives to Street
Crime of Portland, Oregon.  S Soto, Youth Div, City of San Antonio,  Texas.  S
Pennell,  San  Diego  Assoc  of  Governments,  San Diego.  K Boyer,  J Carver,
District of Columbia Pretrial Services  Agency.  National  Institute  on  Drug
Abuse,  {*filter*},  Drug Abuse, and Mental Health Administration.  Office of the
Director, Center for Prevention Svcs, CDC.

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Volume  2, Number 43                                      November 20, 1989

Editorial Note: In 1987, 3,460,960, persons--or 1.9% of the {*filter*} population--
were supervised by the correctional system in the United States (1).  In 1988,
there  were  13.8  million  arrests in the United States (2).  The DUF program
permits objective measurement of recent drug use among  a  sample  of  persons
arrested  in  selected  U.S.  cities.  Urine tests for {*filter*},  opiates,  and
amphetamines give positive results for as long as 3 days, 2 days,  and 2 days,
respectively,  after  the  last use of the {*filter*} (3).  Therefore,  DUF results
measure drug use only for the 2-3 days before arrest. Because some persons who
are charged with drug offenses are excluded from  participation  (even  though
they  are  more  likely  to be test-positive at the time of arrest),  DUF data
probably underestimate actual drug use among arrestees.
    The prevalence of recent {*filter*} use (greater than or equal to 50%)  among
arrestees  in  seven  of the 14 cities is striking.  DUF reports for 1984-1986
documented the increasing proportion of arrestees testing positive for {*filter*}
in that period (4,5).  For 1987-1989,  DUF data for New Orleans indicate  that
the  near  doubling  of  positive  urine  tests  for  {*filter*}  coincided  with
substantial increases in reported use of crack (NIJ, unpublished data).
    Because conditions in booking facilities make systematic  random  sampling
difficult,  convenience  samples  were taken with preferences given to persons
charged with serious  nondrug-related  offenses.  Screening  for  {*filter*}  and
opiates  was  based  on  the  EMIT(TM),  which can yield a positive result for
opiates after a variety of legal medicines (e.g.,  cough medicines  containing
codeine  or  dextromethorphan)  and foods containing poppy seeds are consumed.
Because positive screens were not confirmed, the rates of opiate positives may
overestimate  the  use  of  {*filter*}  and  other  illegally  used  opiates.  The
reliability of the opiate findings is supported by the fact that most (81%) of
arrestees  with positive opiate tests also had positive {*filter*} tests.  False-
positive screening tests for {*filter*} are unlikely.
    At least two aspects of the procedures used by interviewers in  recruiting
participants  in  the booking facilities may limit the generalizability of the
DUF findings.  First,  the  participants  are  not  a  random  sample  of  the
arrestees. Second, the findings could be biased if selection methods increased
the  likelihood  of  selecting  persons  who  had  recently  used  {*filter*} or if
arrestees who had recently used  {*filter*}  were  more  likely  to  give  a  urine
specimen.
    The  finding that greater than or equal to 20% of the drug injectors in 11
cities reported sharing needles indicates that a substantial proportion of the
arrestees engage in behaviors that put them at increased risk for transmission
of human immunodeficiency virus (HIV) and other {*filter*}borne infections (6).
    Previous studies have identified the criminal justice  system  as  a  good
setting for promoting HIV/acquired immunodeficiency syndrome (AIDS) prevention
programs among intravenous-drug users (7).  In the 1989 DUF study,  47%-95% of
needle-sharing arrestees reported changing their injection  practices  because
of  concern about AIDS (8).  Therefore,  provision of counseling and education
for arrestees should help prevent the transmission of HIV and  other  {*filter*}ly
transmitted diseases in this high-risk population.

References

1.  US Department of Justice.  Probation and parole 1987.  Washington, DC:  US
Department of Justice, Bureau of Justice Statistics, 1988.

2.  Federal Bureau of Investigation.  Uniform crime  reports  for  the  United
States.   Washington,  DC:   US  Department  of  Justice,  Federal  Bureau  of
Investigation, 1988.

Health InfoCom Network News                                             Page 19
Volume  2, Number 43                                      November 20, 1989

3.  Council on Scientific Affairs.  Scientific issues in  drug  testing.  JAMA
1987;257:3110-4.

4.  Wish  ED.  Drug  use  forecasting:  New York 1984-1986--research in action
report. Washington, DC: National Institute of Justice, 1987.

5. Wish ED, O'Neil J.  {*filter*} use in arrestees: refining measures of national
trends by sampling the criminal population--trends in {*filter*} use.  Rockville,
Maryland:  {*filter*},  Drug Abuse,  and Mental Health  Administration,  National
Institute on Drug Abuse (in press). (NIDA research monograph).

6.   CDC.   Update:   acquired   immunodeficiency   syndrome  associated  with
intravenous-drug use-- United States, 1988. MMWR 1989;38:165-70.

7.  CDC.  Coordinated community programs for HIV prevention among intravenous-
drug users --California, Massachusetts. MMWR 1989;38:369-74.

8.  Wish ED, O'Neil J, Baldau V. Lost opportunity to combat AIDS: drug abusers
in the criminal justice system--AIDS and IV drug users.  Rockville,  Maryland:
{*filter*},  Drug Abuse,  and Mental Health Administration, National Institute on
Drug Abuse (in press). (NIDA research monograph).

*The DUF system is presently operating in 22 cities.  For further  information
on  DUF  contact  Dr.  Eric Wish,  National Institute of Justice,  633 Indiana
Avenue, N.W., Washington, DC 20531; telephone (202) 272-6127.

**Use of trade names is for identification only and does not imply endor{*filter*}t
by the Public Health Service or  the  U.S.  Department  of  Health  and  Human
Services.

Health InfoCom Network News                                             Page 20
Volume  2, Number 43                                      November 20, 1989

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
                                  Dental News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

            {*filter*}SECONDARY SYPHILIS IN AIDS PATIENT. A CASE REPORT.
        By B. Martinez and A. Silva. School of Dentistry, U. of Chile.
                              School of Dentistry
                             Universidad de Chile
                               Santiago - Chile
                        Casilla 1414 - Correo Central.

Syphilis has been described as a common previous infection  in  Aids  patients
with  and without {*filter*}manifestations (1,2) but it has not been described {*filter*}
syphilitic lesions in theses patients (3).  We have seen  recently  a  Chilean
with Aids and {*filter*}syphilitic lesions that is the syubject of this report.

                                 CASE REPORT.

A  29-yr-old  male  was  referred  because  caries  in some teeth.  During the
clinical examination he reported that had Aids, and presented Kaposi's Sarcoma
in the skin of the arms,  legs and trunk.  At the {*filter*}examination were  noted
two lesions on the left margin of the tongue,  slightly raise,  with irregular
border, fissures and grayish-white surface, and another smallest behind,  both
were  painless  and  also presented erosion on the mucosa of upper lip.  These
lesions appeared one week before the examination  and  the  patient  gave  not
importance  because they did not cause discomfort,  and he refused a biopsy of
theses lesions. He had bilateral submandibular lymph nodes.  Due to economical
problems the patient delayed 2 months the serologic  tests,  but  during  this
time  he  was  controlled  and  we noted that the anterior ulcer of the tongue
decreased in size, but appeared another in the left buccal mucosa.

Previously the patient had presented  fever,  diarrhea,  and  in  Spain  where
probably he contracted Aids, was treated before the first symptoms of Aids, of
{*filter*}  syphilis,  four or five years previously.  At the time of the initial
examination a smear for candida of the tongue's ulcers was negative  and  also
the  darkfield examination for treponema.  But the VDRL (1:2) and FTA-abs were
reactive and one week later the patient was started on benzatine penicillin  G
(2.4  million  units),  one  injection  per week for four weeks.  All the {*filter*}
lesions disappeared three days after the first  injection,  but  simultaeously
the patient presented Kaposi's Sarcoma of hard palate.

                                   DISCUSION

We  think  that  this  patient  presented  some  special aspects.  First,  the
secondary syphilitic lesions in the {*filter*}mucosa appeared 4-5 years  after  the
primary  {*filter*}  lesions.  According  to the literature (4),  most syphilitic
patients have the secondary lesions 9 to 90 days, average of three weeks after
the onset of the chancre. Probably in this immunedeficiency the time is longer
or the clinical manifestations of syphilitic lesions  are  different.  Second,
this is the first case of {*filter*}syphilitc secondary lesions in an Aids patient.
{*filter*} ulcers  are not uncommon in Aids,  and Schulten et al.  (5),  in 75 Aids
Dutch patients reported 4% with ulcers of unknown etiology; also, Phelan et al
(6),  similarly found 3% of ulcers with uncertain cause that were negative  in
virus cultures. We suggest that all patients with this type of ulcers, that do

Health InfoCom Network News                                             Page 21
Volume  2, Number 43                                      November 20, 1989

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