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HICNet Medical News Digest      Sat, 24 Jun 1995        Volume 08 : Issue 25

Today's Topics:

  [MMWR] Unexplained Illness Among Persian Gulf War Veterans in an Air
  Blasting Away Dental Cavities
  Smoking Hinders Healing After Periodontal Treatment
  National Cancer Institute CancerNet Update 6/1/95
  Cryptosporidiosis

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Date: Tue, 20 Jun 1995 14:07:52 -0400 (EDT)
From: BUHLE@MSCF.MED.UPENN.EDU
To: hicnews
Subject: [MMWR] Unexplained Illness Among Persian Gulf War Veterans in an Air
Message-Id: <01HRXJW5XSFI000BOP@mail.med.upenn.edu>

        Unexplained Illness Among Persian Gulf War Veterans in an Air
      National Guard Unit: Preliminary Report -- August 1990-March 1995

     In November 1994, the U.S. Department of Veterans' Affairs
(VA), the Department of Defense (DoD), and the Pennsylvania
Department of Health requested that CDC investigate a report of
unexplained illnesses among members of an Air National Guard (ANG)
unit in south-central Pennsylvania (Unit A) who were veterans of
the Persian Gulf War (PGW) (August 1990-June 1991). These veterans
had been evaluated at a local VA medical center for symptoms that
included recurrent rash, diarrhea, and fatigue. A three-stage
investigation was planned to 1) verify and characterize signs and
symptoms in PGW veterans attending the VA medical center; 2)
determine whether the prevalence of symptoms was higher among
members of Unit A than among members of other units deployed to the
PGW and, if so, whether the increased prevalence was associated
with PGW deployment; and 3) characterize the illness and identify
associated risk factors. This report presents preliminary findings
from stages 1 and 2 (stage 3 is in progress).
Stage 1
     In December 1994, a team of CDC medical epidemiologists
visited the VA medical center, conducted standardized interviews
and performed standardized physical examinations of 59 PGW veterans
reported to be symptomatic, and reviewed medical records. Of the 59
veterans, 26 were selected from the health registry that had been
established for PGW veterans who reported symptoms believed to be
related to service in the Persian Gulf, and 14 were selected as
typical cases by the physician who reported the illnesses to VA;
the remaining 19 were listed on the registry but had not yet been
evaluated at the VA medical center to determine whether they were
eligible to be on the registry. In addition, 40 primary-care
physicians and 16 regional hospitals in south-central Pennsylvania
were surveyed; the survey did not identify additional PGW veterans
with any health complaints.
     The median age of the 59 persons was 39 years (range: 23-59
years), and 53 (90%) were male. All were enlisted personnel: 30
(51%) had been assigned to Unit A during the PGW and the remainder
were in other Air Force units and military branches; 48 (81%) had
been in the military for greater than or equal to 10 years; 16
(27%) had served greater than or equal to 5 years on active duty;
and 19 (32%) had been deployed for greater than or equal to 2 tours
to the PGW theater. At the time of the survey, 89% were employed in
addition to their ANG work.
     The most frequently reported symptoms considered "moderate" or
"severe" were fatigue (61%), joint pain (51%), nasal or sinus
congestion (51%), diarrhea (44%), joint stiffness (44%),
unrefreshing sleep (42%), excessive gas (i.e., flatulence,
bloating, and gastrointestinal distress) (41%), "difficulty
remembering" (41%), muscle pains (41%), headaches (39%), abdominal
pain (36%), general weakness (34%), and impaired concentration
(34%). The two symptoms identified as "most bothersome" were
fatigue (27%) and diarrhea (14%). Patients reported that their
symptoms began during or 2-3 months after departure from the
Persian Gulf, and all reported that several symptoms persisted
greater than or equal to 6 months. No consistent abnormalities were
identified among the participants on standardized physical
examination or by review of medical records and accompanying
laboratory tests performed at the VA medical center. After the war,
one participant had viscerotropic leishmaniasis diagnosed and
treated.
Stage 2
     From January through March 1995, members of Unit A and three
comparison units (units B, C, and D) were surveyed to determine the
prevalence of selected symptoms identified in stage 1 and to
examine the relation between reported symptoms and PGW service.
Comparison units were chosen for similarity in mission
responsibility to Unit A and were located in Pennsylvania and
another state. Units B and C (both reserve units) were surveyed
during routine monthly training sessions, and Unit D (an active
duty unit) was surveyed immediately after the Unit C survey. All
personnel on each base at the time of the survey were asked to
participate, regardless of health status or participation in the
PGW, by anonymously completing a questionnaire describing the
frequency, duration, and severity of 35 symptoms most commonly
mentioned during the stage 1 investigation and a general health
history. In addition, personnel who had been deployed to the
Persian Gulf were asked about possible exposures (e.g., geography
[location of service], duties [combat or support], medical and
other procedures [e.g., vaccinations, dental work], outdoor
activities [sports, recreation, mission-related], and food and
water sources).
     A total of 3927 personnel participated in the survey. Response
rates varied by unit: 63% (677 of 1083) in Unit A, 36% (540 of
1520) in Unit B, 74% (843 of 1141) in Unit C, and 78% (1867 of
2407) in Unit D. The distribution of demographic characteristics
and deployment status of the study participants was similar to the
distribution of these variables in the population of each unit.
     In all units, the prevalence of each of 13 chronic (lasting
greater than or equal to 6 months) symptoms was significantly
greater (p less than 0.05) among persons deployed to the PGW than
among those not deployed (Table 1). The prevalences of five symptom
categories--chronic diarrhea, other gastrointestinal complaints
(gas, bloating, cramps, or abdominal pain), difficulty remembering
or concentrating, "trouble finding words," and fatigue--were
significantly greater (p less than 0.03) among deployed personnel
from Unit A than among deployed personnel from each of the other
units. Symptom prevalences among nondeployed personnel were similar
in all units.
Reported by: KW Kizer, MD, Dept of Veterans' Affairs. S Joseph, MD,
Dept of Defense. M Moll, MD, JT Rankin, DVM, State Epidemiologist,
Pennsylvania Dept of Health. Div of Viral and Rickettsial Diseases,
National Center for Infectious Diseases; National Center for
Environmental Health, CDC.
Editorial Note: Approximately 700,000 U.S. troops (active duty,
reserve, and National Guard) were deployed to the Persian Gulf
region during operations Desert Shield and Desert Storm from August
1990 through June 1991. Previous assessments of the health status
of PGW veterans have been based on analysis of health registries
established by VA and DoD to rapidly identify and report illnesses
among PGW veterans (1). Through March 1995, approximately 43,000
and 16,000 PGW veterans had enrolled in the VA and the DoD
registries, respectively. Efforts have not identified a specific
etiology or biologic explanation for these illnesses, nor have
specific diseases or syndromes been identified.
     The preliminary findings of this investigation are subject to
at least two limitations. First, the stage 2 data on symptom
prevalence reflect self-reported information that was not evaluated
by physical examination and laboratory tests. However, standardized
physical examinations and review of VA laboratory test results from
patients in stage 1 did not reveal consistent abnormalities.
Second, participation rates for the stage 2 survey varied widely;
because persons with symptoms may have been more likely to
participate, the prevalence of reported health conditions may have
been overestimated.
     The preliminary findings presented in this report indicate
that some chronic symptoms were reported more commonly by PGW
veterans than by nondeployed PGW-era service personnel. Potential
explanations for the higher prevalence of symptoms among deployed
personnel--and the increased prevalence among deployed personnel
from Unit A--may include factors specific to the Persian Gulf
region (e.g., environmental, toxic, and infectious exposures);
factors related to military service and combat (e.g., exposure to
toxic agents and combat-related stress); characteristics associated
with the general population (e.g., stress-related disorders,
age-related effects, or other poorly defined chronic illnesses);
and factors especially specific to Unit A (e.g., increased local
concern and media attention about illnesses related to PGW service
when compared with other units). The stage 3 case-control study,
which is in progress, will assess risk factors in ill and healthy
PGW veterans from Unit A.
     Mechanisms have been established to rapidly identify and treat
PGW veterans with health problems. All PGW veterans with health
problems are encouraged to obtain an evaluation at their local VA
medical center or military treatment facility. Veterans can be
referred for further evaluation at specialized referral centers
established by VA and DoD.
     PGW veterans and their eligible family members can register
for medical examination and treatment by calling toll-free
telephone numbers (VA: [800] 749-9387; DoD: [800] 796-9699). DoD
has established a separate toll-free number ([800] 472-6719) for
PGW veterans to report details of incidents they believe may be
associated with a medical problem experienced since returning from
the Persian Gulf and for health-care providers with questions about
illnesses possibly related to service in the PGW.
Reference
1. Institute of Medicine. Health consequences of service during the
Persian Gulf War: initial findings and recommendations for
immediate action. Washington, DC: National Academy Press, 1995.


------------------------------

Date: Thu, 22 Jun 95 10:01:13 -0700
From: David Dodell <david@mailhost.smhsi.com>
To: hicnews
Subject: Blasting Away Dental Cavities
Message-Id: <199506221657.AA26285@asuvax.eas.asu.edu>

[Image]

FOR IMMEDIATE RELEASE: June 1995

CONTACT:
Susan Shaffer, Chris Martin
312/440-2806

DENTAL TECHNOLOGY "BLASTS" AWAY CAVITIES, A POSSIBLE ALTERNATIVE TO DENTAL
DRILL

In the June issue of the Journal of the American Dental Association (JADA),
researchers outline a dental technology that today is capable of "blasting
away" some areas of the tooth surface without using the dental drill,
affording dentists new opportunities in the diagnosis and treatment of tooth
decay.

The equipment, called "air-abrasive technology," uses minute alumina
particles almost too small to be seen with the naked eye that are carried to
the tooth by a stream of air. Because the particles spray away some areas of
the tooth at high speeds with no drilling sound, vibrations or need for
anesthesia, patients "view the service as extremely valuable," according to
lead study author Ronald E. Goldstein, DDS, clinical professor, Medical
College of Georgia, School of Dentistry, Augusta.

The technology is a conservative means of removing some portions of the
tooth, allowing the possibility of diagnosis of decay at the "earliest
possible moment," Dr. Goldstein said.

The American Dental Association (ADA) views the technology as one whose
primary value is for diagnosis. The dentist can use the short blasts of
alumina particles on suspicious-looking darkened areas in the pits and
fissures of the chewing surfaces of the back teeth, the areas where decay is
most often seen, especially among U.S. teens and children.

Dr. Goldstein also maintained that with the equipment the dentist can remove
stains and organic debris for the application of sealants (protective
plastic coatings) on the teeth and can also remove areas of early caries
(decay) for replacement with resin fillings.

Dr. Goldstein noted, however, that air-abrasion is "not well- suited for
removing all decay." Moist or soft dentin (the layer beneath the tooth
enamel) cannot effectively be removed with air- abrasion. Dr. Goldstein,
however, sees the technology as holding promise not only for diagnosis but
also for the treatment of pit- and-fissure decay.

Prices for air-abrasion the units range from about $8,000 to $17,000.

According to the ADA, the technology is certainly worth exploring, though
more studies are needed to determine its exact effectiveness in filling
teeth.



------------------------------

Date: Thu, 22 Jun 95 10:02:15 -0700
From: David Dodell <david@mailhost.smhsi.com>
To: hicnews
Subject: Smoking Hinders Healing After Periodontal Treatment
Message-Id: <199506221658.AA26302@asuvax.eas.asu.edu>

[Image]

FOR IMMEDIATE RELEASE: June 1995

CONTACT:
Susan Shaffer, Chris Martin
312/440-2806

NEW STUDY SHOWS SMOKING HINDERS HEALING AFTER PERIODONTAL TREATMENT

A recent study, highlighted in the June Journal of the American Dental
Association (JADA), shows that if you smoke you'll very likely experience
reduced healing compared to a non-smoker after dental treatment for
periodontal (advanced gum) disease. According to the American Dental
Association (ADA), periodontal disease in some form strikes three out of
four Americans over age 35, and more than half of all people over age 18
have at least an early stage of the disease.

Researchers at the University of Buffalo (UB), State University of New York,
tracked 55 smokers and 88 non-smokers with significant periodontitis and
assessed them before and three months after treatment to determine the
amount and rate of healing.

According to Sara G. Grossi, DDS, UB clinical assistant professor of Oral
Biology, "Although both groups had an equal amount of disease and received
the same treatment, the non-smokers healed far better than the smokers."

After treatment (which consisted of routine scaling and root planing), the
number of gum sites still prone to bleeding -- a usual sign of periodontal
disease -- had decreased by 20 percent in the non-smokers compared to only
12 percent in the smokers. The depth of periodontal pockets, the gaps
between the gum and the tooth that usually indicate the seriousness of
periodontal disease, also improved more in the non-smokers than in the
smokers. In addition, the bacteria that cause periodontal disease were
eliminated in the non-smokers after treatment, but were still present in the
smokers.

Commenting on the study findings, Grossi said that they have "profound
implications for the clinical management of periodontal disease. Smokers do
not respond as favorably to treatment as non-smokers do."

She added that "these treatments also were very conservative. With more
complicated periodontal treatments, such as surgery, the problems will be
compounded."

The ADA warns that people who smoke or chew tobacco are at much greater risk
for periodontal diseases and tend to have them more severely than non-users
of tobacco. If you smoke you are also at increased risk for oral cancer,
which causes almost 9,000 deaths annually and is diagnosed in 30,000 persons
each year.



------------------------------

Date: Sat, 24 Jun 95 15:19:44 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: National Cancer Institute CancerNet Update 6/1/95
Message-ID: <LFy87c1w165w@stat.com>

            +----------------------------------------------+
            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |
            +----------------------------------------------+
                    |  CancerNet@icicc.nci.nih.gov  |
                    +-------------------------------+


Changes to CancerNet, June 1995



CancerNet was updated on June 1, 1995.

PDQ Statements
--------------

The following PDQ statements were added or updated in CancerNet with the June
update (see the file Monthly PDQ Changes -- cn-405001 for detailed information
on the changes in each statement).


New Statements:

Two new supportive care statements were added:

Delirium (cn-305472)
Transitional care planning (cn-305471)


Changed Statements:

Changed treatment statements for physicians:

Adult Acute Myeloid Leukemia (cn-101029)
Adult Hodgkin's Disease (cn-100003)
Bladder Cancer (cn-101206)
Breast Cancer  (cn-100013)
Childhood Acute Lymphocytic Leukemia (cn-100026)
Childhood Non-Hodgkin's Lymphoma (cn-100915)
Chronic Myelogenous Leukemia (cn-101031)
Colon Cancer (cn-100008)
Hairy Cell Leukemia (cn-101651)
Neuroblastoma (cn-100530)
Nonsmall Cell Lung Cancer (cn-100039)
Pancreatic Cancer (exocrine) (cn-100046)
Plasma Cell Neoplasm (cn-100281)
Prostate Cancer (cn-101229)
Rectal Cancer (cn-100076)
Renal Cell Cancer (cn-101070)
Small Cell Lung Cancer (cn-100040)
Wilms' Tumor (cn-100719)


Changed treatment statements for patients:

Adult Acute Lymphocytic Leukemia (cn-201024)
Adult Acute Myeloid Leukemia (cn-201029)
Adult Brain Cancer (cn-201143)
Adult Hodgkin's Disease (cn-200003)
Adult Non-Hodgkin's Lymphoma (cn-200066)
Breast Cancer  (cn-200013)
Childhood Acute Myeloid Leukemia (cn-201081)
Childhood Hodgkin's Disease (cn-203043)
Childhood Non-Hodgkin's Lymphoma (cn-200915)
Cutaneous T-cell Lymphoma (cn-200098)
Nonsmall Cell Lung Cancer (cn-200039)
Prostate Cancer (cn-201229)
Renal Cell Cancer (cn-201070)
Small Cell Lung Cancer (cn-200040)


Changed supportive care statements:

Fever, Chills, and Sweats (cn-302327)
Pruritus (cn-300609)


Changed cancer screening and prevention statements:

Screening for Ovarian Cancer (cn-305145)
Screening for Prostate Cancer (cn-304727)
Screening for Testicular Cancer (cn-304729)

Prevention of Cervical Cancer (cn-304734)
Prevention of Colorectal Cancer (cn-304731)


Changed drug information statements:
None.


Changed other PDQ information:
None.


Changed CancerNet News
----------------------
The following news bulletins were added:

Ad Hoc Working Group on the NCI Intramural Program: Report to the NCAB
     (cn-400087) [This bulletin was added on May 19, 1995, in advance of the
     June update.]
Mammography Facility Locator Service Opens (cn-400088)
Robert Gallo Resigns from NCI (cn-400089)

The following news bulletins were changed:

PDQ Distributors (cn-400003)
NCI High Priority Clinical Trials (cn-400007)
PDQ Literature Citations (cn-400013)
Redistribution of CancerNet and CancerNet Availability (cn-400030)
How to Access NCI Information Resources -- U.S. Residents (cn-400035)
How to Access NCI Information Resources -- International (cn-400036)
PDQ User Guide for the National Library of Medicine's MEDLARS System, Part 1
     (Sections 1-4, What is PDQ, Connecting, Basics of Using PDQ, Search
     Cancer Information Summaries) (cn-400050)
FDA's Mammography Quality Standards Act Takes Effect (cn-400075)
NIH Awarded Broad Gene Therapy Patent (cn-400080)
NCI Surgical Oncology Branch Trials (cn-400081)
NCI-Designated Cancer Centers Public Affairs Network (cn-400085)


The following news bulletins were deleted:

Electromagnetic Field Exposure and Cancer Studies at NCI (cn-400082) [This
     news item is replaced by NCI Fact sheet cn-600346 (please see below)]
Data from Swedish Study of Tamoxifen Published: Possible GI Risk Noted
     (cn-400086) [This news item is replaced by NCI Fact sheet cn-600347
     (please see below)]


Publications
------------
No NCI publications were added or changed.


NCI Fact Sheets
---------------
The following fact sheets were added:

Questions and Answers About PDQ (cn-600022)
Electromagnetic Field Exposure and Cancer Studies at NCI (cn-600346) [This NCI
     fact sheet replaces news item cn-400082 (please see above)]
Data from Swedish Study of Tamoxifen Published: Possible GI Risk Noted
     (cn-600347) [This NCI fact sheet replaces news item cn-400086 (please
     see above)]
Questions and Answers About Soft Tissue Sarcomas (cn-600612)

The following fact sheets were changed:

The National Cancer Institute Cancer Centers Program (cn-600012)
NCI's Clinical Trials Cooperative Group Program (cn-600014)
Referral Information for the BCPT (complete list) (cn-400021)
BCPT Referral (partial list) -- Alabama to Georgia (cn-400022)
Questions and Answers: The Breast Cancer Prevention Trial (cn-600041)
Chemoprevention (cn-600042)
Referral Information for the PCPT (complete list) (cn-400090)
PCPT Referral (partial list) -- Alabama to Georgia (cn-400091)
The National Cancer Institute's SEER Cancer Statistics Review (cn-600110)
International Cancer Information Services (cn-600299)


The following fact sheets were deleted:

Collaborative Study of Extremely-Low-Frequency Electromagnetic Field Exposure
     and Childhood Leukemia (cn-600035)
Antineoplastons/Dr. Stanislaw Burzynski (cn-600091)

CANCERLIT Citations and Abstracts:
----------------------------------
Two new CANCERLIT citation and abstract topics were added:
Intraocular melanoma (cn-7__170)
Retinoblastoma (cn-7__175)

The CANCERLIT citations and abstracts for June will be available on June 7,
1995.



Instructions:

To request the CancerNet Instructions and Contents List, send a
mail message, and in the body of the message,  enter HELP.  Address
the mail message to:

          cancernet@icicc.nci.nih.gov

To request the modified statements, follow the above directions,
and in the body of the mail message, enter the statement code.
When requesting more than one statement, enter each code on a
separate line.

CancerNet statements are also available in Spanish. To request the
Instructions and Contents List in Spanish, enter SPANISH in the
body of the mail message. If you would like to request the statements
in Spanish, substitute the prefix "cs-" in front of the number
(e.g., cs-100022) to receive the statement on anal cancer in Spanish .
All of the physician and patient statements are available in Spanish.
News items that are available in Spanish have a # next to the statement
title. Although both the English and Spanish are updated at the same
time each month, the Spanish statements do not reflect the changes made
in the English statements until the following month to allow time for
translation . If you are interested in requesting CancerNet statements
or news articles in Spanish, it is suggested that you request an updated
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If you are redistributing the PDQ information you retrieve from
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the information from CancerNet, request the news article, Redistribution
of Cancernet (cn-400030) , to find out about conditions that apply when
redistributing the information.  This article also has information on
other sites providing access to CancerNet information.

Please send comments or questions to:

Cheryl Burg
NCI International Cancer Information Center
Internet: cheryl@icicc.nci.nih.gov



------------------------------

Date: Sat, 24 Jun 95 15:20:32 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: Cryptosporidiosis
Message-ID: <Xgy87c2w165w@stat.com>

F A C T   S H E E T
*******************************************
Centers for Disease Control and Prevention
June 19, 1995


CRYPTOSPORIDIOSIS (krip-to-spo-rid-e-o-sis)

What is cryptosporidiosis?
Cryptosporidiosis is a disease caused by the parasite
Cryptosporidium parvum, which as late as 1976 was not known to
cause disease in humans. Until 1993, when over 400,000 people in
Milwaukee, Wisconsin, became ill with diarrhea after drinking water
contaminated with the parasite, few people had heard of either
cryptosporidiosis or the single-celled intestinal protozoon that
causes it.

Since the Milwaukee outbreak, concern about the safety of drinking
water in the United States has increased, and new attention has
been focused on determining and reducing the risk for
cryptosporidiosis from community and municipal water supplies.

How is cryptosporidiosis spread?
Cryptosporidiosis is spread by putting something in the mouth that
has been contaminated with the stool of an infected person or
animal. In this way, people swallow the Cryptosporidium parasite,
which is too small to be seen with the naked eye. A person can
become infected by drinking contaminated water or eating raw or
undercooked food contaminated with Cryptosporidium oocysts (an
egg-like form of the parasite that is the infectious stage); direct
contact with the droppings of infected animals or stool of infected
humans; or hand-to-mouth transfer of oocysts from surfaces that may
have become contaminated with microscopic amounts of stool from an
infected person or animal.

What are the symptoms of cryptosporidiosis?
Two to ten days after infection by the parasite, symptoms may
appear. Although some persons may not have symptoms, others have
watery diarrhea, headache, abdominal cramps, nausea, vomiting, and
low- grade fever. These symptoms may lead to weight loss and
dehydration.

In otherwise healthy persons, these symptoms usually last 1 to 2
weeks, at which time the immune system is able to stop the
infection. In persons with suppressed immune systems, such as
persons who have AIDS or recently have had an organ or bone marrow
transplant, the infection may continue and become life-threatening.

What should you do if you suspect that you have
cryptosporidiosis?
See your physician. Since the routine stool examination used for
most parasites usually fails to detect Cryptosporidium, a stool
specimen should be examined using stains/tests available especially
for this parasite. It is important for persons with a poorly
functioning immune system to seek medical attention early in the
course of their disease.

What is the treatment for cryptosporidiosis?
No safe and effective cure is available for cryptosporidiosis.
People who have normal immune systems improve without taking
antibiotic or antiparasitic medications.
The treatment recommended for this diarrheal illness is to drink
plenty of fluids and to get extra rest. Physicians may prescribe
medication to slow the diarrhea during recovery.

Who is at risk?
Persons at increased risk for cryptosporidiosis include child care
workers; diaper-aged children who attend child care centers;
persons exposed to human feces by sexual contact; and caregivers
who might come in direct contact with feces while caring for a
person infected with cryptosporidiosis at home or in a medical
facility. Once infected, persons with suppressed immune systems,
such as cancer chemotherapy patients, are at risk for severe
disease.

How can you prevent cryptosporidiosis?

Avoid water or food that may be contaminated.

Wash hands after using the toilet and before handling food.

If you work in a child care center where you change diapers, be
sure to wash your hands thoroughly with plenty of soap and warm
water after every diaper change, even if you wear gloves.

During communitywide outbreaks caused by contaminated drinking
water, boil drinking water for 1 minute to kill the Cryptosporidium
parasite. Allow water to cool before drinking it.

HIV-infected persons should avoid drinking water directly from
lakes or rivers; avoid unpasteurized milk or milk products; avoid
exposure to calves and lambs and places where these animals are
raised; wash hands after contact with pets; and wash hands after
gardening or other contact with soil. Because any sexual activity
that brings a person in contact with the feces of an infected
partner greatly increases the risk for cryptosporidiosis,
HIV-infected persons and AIDS patients should follow gsafer sexg
guidelines and avoid sexual practices that may result in contact
with feces.

If you are a caregiver of cryptosporidiosis patients, wash hands
after bathing patients, emptying bedpans, changing soiled linen, or
otherwise coming in contact with the stools of patients.

If you have cryptosporidiosis, wash your hands often to prevent
spreading the disease to other members of your household.

For more information on cryptosporidiosis, see the following
sources:

Cordell RL, Addiss DG. Cryptosporidiosis in child care settings: a
review of the literature and recommendations for prevention and
control. Pediatr Infect Dis J. 1994;13(4):310-17.

Dubey JP, Speer CA, Fayer R. Cryptosporidiosis of man and animals.
Boston: CRC Press, 1990.

LeChevallier MW, Norton WD, Lee RG. Giardia and Cryptosporidium
spp. in filtered drinking water supplies. Appl Environ Microbiol
1991;57(9):2617-21.

MacKenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson
DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB, Davis JP. A massive
outbreak in Milwaukee of Cryptosporidium infection transmitted
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End of HICNet Medical News Digest V08 Issue #25
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Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135