One-third of the annual cases of listeriosis in the United States occur during pregnancy and can lead to miscarriage or stillbirth, premature delivery, or infection of the newborn. Previous risk assessments completed by the Food and Drug Administration/the Food Safety Inspection Service of the U.S. Department of Agriculture/the Centers for Disease Control and Prevention (FDA/USDA/CDC) and Food and Agricultural Organization/the World Health Organization (FAO/WHO) were based on dose-response data from mice. Recent animal studies using nonhuman primates and guinea pigs have both estimated LD(50)s of approximately 10(7) Listeria monocytogenes colony forming units (cfu). The FAO/WHO estimated a human LD(50) of 1.9 x 10(6) cfu based on data from a pregnant woman consuming contaminated soft cheese. We reevaluated risk based on dose-response curves from pregnant rhesus monkeys and guinea pigs. Using standard risk assessment methodology including hazard identification, exposure assessment, hazard characterization, and risk characterization, risk was calculated based on the new dose-response information. To compare models, we looked at mortality rate per serving at predicted doses ranging from 10(-4) to 10(12) L. monocytogenes cfu. Based on a serving of 10(6) L. monocytogenes cfu, the primate model predicts a death rate of 5.9 x 10(-1) compared to the FDA/USDA/CDC (fig. IV-12) predicted rate of 1.3 x 10(-7). Based on the guinea pig and primate models, the mortality rate calculated by the FDA/USDA/CDC is underestimated for this susceptible population.

ABSTRACTEnterococci are used to evaluate recreational-water quality and health risks in marine environments. In addition to their occurrence in feces of warm blooded animals, they are also common epiphytes. We investigated the contribution of plankton- or particle-associated enterococci in estuarine and coastal water. Seven water and size-fractionated plankton samples were collected monthly between April 2008 and January 2009 in the tidal reaches of the Skidaway River (Georgia, USA). Each size fraction, along with filtered (<30 μm) and bulk estuarine water, was processed according to U.S. Environmental Protection Agency method 1600. Presumptive enterococci were selected and species were identified using carbon substrate utilization patterns. The highest average densities occurred within the 30-, 63-, 105-, and 150-μm size fractions, which also represented the majority (>99%) of the particles within the sampled water. Particle-associated enterococci accounted for as little as 1% of enterococci in bulk water in April to as much as 95% in July.Enterococcus faecaliswas the most commonly isolated species from both water and plankton and represented 31% (16/51) and 35% (6/17) of the identifiedEnterococcusspecies from water and plankton, respectively.Enterococcus casseliflavusrepresented 29% of the selected isolates from plankton and 16% from water. BothE. faecalisandE. casseliflavuswere able to survive and grow in plankton suspensions significantly longer than in artificial seawater.Enterococcusspp. may be highly concentrated in plankton and associated particles, especially during summer and fall months. These findings could have implications for the effectiveness of enterococci as an indicator of coastal water quality, especially in particle-rich environments.

Aims:  Pathogenic Vibrio spp., including V. cholerae and V. vulnificus, are commonly found along the estuaries of the south‐east United States; however, it is often difficult to recover these species directly from environmental samples. Pre‐enrichment assays are commonly used to improve the detection of pathogenic vibrios from environmental sources. Here, we evaluated a novel enrichment procedure using freshly collected and autoclaved natural estuarine water amended with 1% peptone (designated as estuarine peptone water, EPW) and compared it to traditional alkaline peptone water (APW) for detection by PCR of V. cholerae and V. vulnificus. Methods and Results:  Of the 50 samples collected in total, V. cholerae DNA was detected in APW 10% of the time and in EPW 40% of the time. Likewise, the cholera toxin gene (ctxA) was detected in 4 vs 18% of the samples using APW and EPW, respectively. Conversely, APW showed improved recovery for V. vulnificus relative to EPW with respective detection frequencies of 46 and 20%. Results showed similar patterns across different sample types (water and plankton). Conclusions:  While enrichment in traditional APW was adequate for the recovery of Vibrio vulnificius, use of sterile estuarine water amended with peptone significantly improved the detection of V. cholerae and the virulence gene ctxA from estuarine sources.

Osteopathic medical students and residents are comfortable with typing; they are exposed to and would prefer using an electronic form of entry for medical documentation. These results support a conversion from written postencounter notes to keyboard data entry of notes on the COMLEX-USA Level 2-PE.