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Publications (14)77.69 Total impact

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    ABSTRACT: In 1989, an outbreak of Q fever (C. burnetii infection) with 147 confirmed cases occurred in Solihull, West Midlands. Three patients developed cardiomyopathy in the subsequent 10 years. The cohort has been followed up with respect to the development of fatigue and, in this instance, cardiac effects after the original infection. To determine whether persisting fatigue after Q fever represented sub-clinical cardiomyopathy. Prospective follow-up study. All traceable subjects from the original outbreak, and community age-, sex- and smoking-matched controls, were studied. Questionnaires for idiopathic fatigue, 12-lead ECG, echocardiography, spirometry and shuttle walk distance were undertaken, and a subset with CDC-defined chronic fatigue syndrome had gated cardiac scans. Of the original cohort, 19 had died, three had emigrated and 10 were untraceable. Of the remaining 115, 108 responded to a mailed questionnaire and 87 were investigated further, of whom 85 provided complete data. Two developed aortic valve vegetations, one of whom died. Chronic fatigue syndrome was found in 20% of cases and 5.3% of controls (including those with co-morbidities), falling to 8.2% and 0 when excluding those with co-morbidities. There were no significant differences in ECG and echocardiographic investigations or shuttle-walk distance between those with fatigue and those without. Six of the seven patients with CFS had gated cardiac scans: all were within normal limits. These findings do not support the existence of a sub-clinical cardiomyopathy in the patients in this cohort who suffer from fatigue after acute Q fever, although endocarditis can occur after acute infection.
    QJM: monthly journal of the Association of Physicians 09/2002; 95(8):539-46. · 2.36 Impact Factor
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    ABSTRACT: Some patients exposed to Q fever (Coxiella burnetii infection) may develop chronic fatigue. To determine whether subjects involved in the West Midlands Q fever outbreak of 1989 had increased fatigue, compared to non-exposed controls, 10 years after exposure. Matched cohort study comparing cases to age-, sex- and smoking-history-matched controls not exposed to Q fever. A postal questionnaire was sent to subjects at home, followed by further assessment in hospital, including a physical examination and blood tests. Of 108 Q-exposed subjects, 70 (64.8%) had fatigue, 37 idiopathic chronic fatigue (ICF) (34.3%), vs. 29/80 (36.3%) and 12 (15.0%), respectively, in controls. In 77 matched pairs, fatigue was commoner in Q-exposed subjects than in controls: 50 (64.9%) vs. 27 (35.1%), p<0.0001. ICF was found in 25 (32.5%) of Q-exposed patients and 11(14.3%) of controls (p=0.01). There were 36 (46.8%) GHQ cases in Q-exposed subjects, vs. 18 (23.4%) controls (p=0.004). A matched analysis of those more intensively studied showed fatigue in 48 (66.7%) Q-exposed patients and 25 (34.7%) controls, (p<0.0001), ICF in 25 (34.7%) Q-exposed and 10 (13.9%) controls (p=0.004), and chronic fatigue syndrome (CFS) in 14 (19.4%) Q-exposed patients and three (4.2%) controls (p=0.003). Thirty-four (47.2%) Q-exposed patients were GHQ cases compared to 17 (23.6%) controls (p=0.004). Subjects who were exposed to Coxiella in 1989 had more fatigue than did controls, and some fulfilled the criteria for CFS. Whether this is due to ongoing antigen persistence or to the psychological effects of prolonged medical follow-up is uncertain.
    QJM: monthly journal of the Association of Physicians 08/2002; 95(8):527-38. · 2.36 Impact Factor
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    ABSTRACT: The largest outbreak of the zoonotic disease Q fever recorded in the United Kingdom (UK) occurred in Birmingham in 1989. One hundred and forty-seven cases were identified, 125 of whom were males, and 130 of whom were between 16 and 64 years of age. Fewer cases of Asian ethnic origin were observed than expected (p < 0.01), and more smokers (p < 0.005). A case control study (26 cases and 52 matched controls) produced no evidence that direct contact with animals or animal products had caused the outbreak. The epidemic curve suggested a point source exposure in the week beginning 10 April. The home addresses of cases were clustered in a rectangle 11 miles (18.3 km) north/south by 4 miles (6.7 km) east/ west, and attack rates became lower towards the north. Directly south of this area were farms engaged in outdoor lambing and calving, a potent source of coxiella spores. A retrospective computerised analysis showed that the geographical distribution of cases was associated with a source in this area (p < 0.00001). On 11 April, unusual southerly gales of up to 78 mph (130 km/h) were recorded. The probable cause of the outbreak was windborne spread of coxiella spores from farmland to the conurbation.
    Communicable disease and public health / PHLS 09/1998; 1(3):180-7.
  • T C Boswell, K J Nye, E G Smith
    Journal of Hospital Infection 06/1998; 39(1):78-9. · 2.86 Impact Factor
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    ABSTRACT: In 1989, 147 individuals in the West Midlands, UK, were infected with Q fever. Five years later, following anecdotal reports of fatigue, we used a questionnaire-based case-control study to determine the prevalence of chronic fatigue syndrome symptoms in this group. Replies from 71 patients were compared with those from 142 age- and sex-matched controls. Increased sweating (52.9% vs. 31.6%, p = 0.006), breathlessness (50.7% vs. 30.6%, p = 0.006), blurred vision (34.3% vs. 17.8%, p = 0.016) and undue tiredness (68.7% vs. 51.5%, p = 0.03) were found in controls compared to cases. These findings were similar to those in Australian abbatoir workers occupationally exposed to Q fever. CDC criteria for chronic fatigue syndrome were fulfilled by 42.3% of cases and 26% of controls. Using visual analogue scores, symptoms were more severe in cases than in controls. Our findings support the existence of a chronic fatigue state following acute Q fever, in a group of patients exposed just once to the organism, and in circumstances free of such confounding factors as lawsuits over compensation.
    QJM: monthly journal of the Association of Physicians 03/1998; 91(2):105-23. · 2.36 Impact Factor
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    ABSTRACT: Antibiotic resistance of 1515 consecutive laboratory isolates of Streptococcus pneumoniae between 1989 and 1994 was analyzed. Overall, 39 (2.6%) isolates were resistant to penicillin, 102 (6.7%) resistant to erythromycin and 52 (3.4%) resistant to tetracycline. There was a higher proportion of penicillin resistant isolates from sterile sites compared with "non-sterile sites" (5% vs. 2.2%; P < 0.02). This same pattern occurred with erythromycin (12.5% vs. 5.6%; P < 0.001). From 1989-90 to 1993-94 the penicillin resistance rate increased from 0.8% to 8% and the erythromycin from 5.7% to 8.4%, whereas the tetracycline resistance rate fell from 3.7% to 2.8%. The increase in resistance to penicillin largely occurred in the final 12 months of this study period. One hundred and fifty isolates (9.9%) were serotyped, including isolates from sterile sites and those with penicillin resistance. The commonest serotypes of penicillin-sensitive pneumococci were 14, 19, 9 and 6. The majority of penicillin-resistant pneumococci (PRP) were of serotype 9 (64%) followed by 6, 23 and 19. Overall 95% of these isolates were of serotypes represented in the 23-valent pneumococcal polysaccharide vaccine (Pneumovax II). PRP were more likely to have resistance to erythromycin (23%) or tetracycline (23%) compared to penicillin-sensitive pneumococci (6% and 3% respectively). Most of the PRP were isolated from patients aged over 50 years including 11 isolates from blood cultures of patients with pneumonia or septicaemia. There was a possible epidemiological association between four patients with PRP but surveillance cultures of hospital contacts revealed no extra cases. These results show a worrying increase in infections due to PRP which has implications for clinical and laboratory staff in the diagnosis and treatment of serious pneumococcal infections.
    Journal of Infection 07/1996; 33(1):17-22. · 4.07 Impact Factor
  • J G Ayres, E G Smith, Nicole Flint
    The Lancet 05/1996; 347(9006):978-9. · 39.21 Impact Factor
  • T C Boswell, E G Smith, J G Ayres
    Journal of Hospital Infection 08/1995; 30(3):233-5. · 2.86 Impact Factor
  • T C Boswell, K J Nye, E G Smith
    Journal of Antimicrobial Chemotherapy 12/1994; 34(5):844-5. · 5.34 Impact Factor
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    ABSTRACT: Of 147 patients with acute Q fever diagnosed during a major outbreak in Birmingham, England, in early summer 1989, 41 provided sets of sera which allowed us to make a detailed analysis of the primary humoral immune response. Antibody titers specific for Coxiella burnetii were measured by the complement fixation test and by an immunoglobulin M (IgM)- and IgG-specific indirect immunofluorescence test. The relative avidity of specific IgGs was determined by the indirect immunofluorescence test with and without treatment of antigen-antibody complexes with 8 M urea. The IgG subclass responses after primary infection and their avidities were also determined for a limited number of paired serum specimens. Specific IgM titers persisted for more than 6 months in the majority of cases and were therefore not a sufficient criterion for the diagnosis of recent infection. However, for serial samples the antibody titer ratios (IgG/IgM) and the ratios (IgG titer with treatment/IgG titer without treatment) that indicated relative avidity changed significantly, depending on the time postinfection. Within the IgG class, the C. burnetii-specific antibody response over time was almost exclusively represented by subclass 1 molecules, which thus showed affinity maturation.
    Journal of Clinical Microbiology 09/1992; 30(8):1958-67. · 4.07 Impact Factor
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    ABSTRACT: Enterococcus (Streptococcus) faecalis expresses three species-specific surface protein antigens of molecular weights 73,000, 40,000, and 37,000. On Western blotting (immunoblotting), they were detected strongly by immunoglobulin G (IgG) in sera from patients with E. faecalis endocarditis, but not in sera from patients with other E. faecalis infections or with endocarditis due to other streptococci. We developed an enzyme-linked immunosorbent assay system to measure IgG, IgM, and IgA levels to these antigens and evaluated its potential as a serodiagnostic test for E. faecalis endocarditis. The test correctly diagnosed E. faecalis endocarditis in 15 of 16 cases. Of 10 cases of endocarditis due to other streptococci and 10 E. faecalis infections other than endocarditis, 9 and 8, respectively, gave negative results. The test should prove particularly useful in culture-negative cases, for which choice of appropriate antibiotic therapy for E. faecalis endocarditis is vital.
    Journal of Clinical Microbiology 03/1990; 28(2):195-200. · 4.07 Impact Factor
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    ABSTRACT: We describe a method for the serodiagnosis of Streptococcus faecalis in infective endocarditis which could be of value in culture-negative cases. Serum-grown cells of S. faecalis produced three major characteristic protein antigens (73,000, 40,000, and 37,000 molecular weight) which were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of solubilized whole cells. After electrophoretic transfer to a nitrocellulose membrane, these antigens were visualized by probing with serum from patients with endocarditis caused by S. faecalis. Serum from patients with endocarditis caused by other organisms did not react with the S. faecalis-specific antigens. This procedure should facilitate positive early diagnosis of S. faecalis endocarditis or establish its absence in culture-negative cases.
    Journal of Clinical Microbiology 03/1987; 25(2):211-5. · 4.07 Impact Factor
  • Journal of Infection 12/1986; 13(3):309-11. · 4.07 Impact Factor
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    ABSTRACT: Imipenem (N-formimidoyl thienamycin) is a new carbapenem beta-lactam antibiotic with a broad antibacterial spectrum. Forty-five patients were treated with either 500 or 1,000 mg of imipenem/cilastatin four times daily, the duration varying according to clinical response. The diagnoses were urinary tract infection, 10 patients; septicemia, six; intraabdominal sepsis, six; pneumonia, six (two cases of Legionnaires' disease); skin and soft tissue infection, four; and other diagnoses, 13. Of the 32 clinically assessable patients, 17 were cured, nine improved, three died, and three were withdrawn from the trial. Of 21 patients who were microbiologically assessable, 13 were cured. In six cases of complicated urinary tract infection, the organism--which had been eradicated from the urine during treatment--reappeared after completion of antibiotic therapy. Two patients developed adverse clinical reactions that were thought to be drug-related (drug-induced fever and nausea plus vomiting, respectively). Both patients had mildly abnormal results in liver function tests, and one developed a positive direct Coombs' test. Fifty-seven percent of the patients developed some degree of phlebitis, which was moderate to severe in 19%. In this study imipenem/cilastatin proved to be a highly effective agent for the treatment of a variety of serious bacterial infections.
    Reviews of infectious diseases 07/1985; 7 Suppl 3:S490-5.