Michael H Merson

Interim Chair of the Department of Social and Behavioral Sciences

Clinical Professor of Global and Environmental Health

Professional overview

Michael Merson is Interim Chair of the Department of Social and Behavioral Sciences and a Clinical Professor of Global and Environmental Health at NYU. He also the William Joklik Emeritus Professor of Medicine and Global Health at Duke University, where he served as the founding director of the Duke Global Health Institute and as Vice President and Vice Provost for Global Affairs. His current research is focused on policy issues related to the response to pandemics, evaluating the rollout of Paxlovid in low-income countries and on ways to regain trust in public health.

Prior to NYU, he joined the faculty at Yale University as its first Dean of Public Health. Before entering academia, between 1980 and 1995, Dr. Merson served as director of the World Health Organization (WHO) programs on Diarrheal Diseases and Acute Respiratory Infections, and subsequently the WHO Global Program on AIDS. He has authored over 150 articles, is the senior editor of a leading global health textbook “Global Health: Disease, Programs, Systems, and Policies” and lead author of The AIDS Pandemic: Searching for a Global Response on the history of the global response to AIDS. He has served in advisory capacities for UNAIDS, WHO, the Global Fund to Fight AIDS, TB and Malaria, World Bank, World Economic Forum, Bill & Melinda Gates Foundation, and was an advisor to various private sector entities on the COVID-19 pandemic. He has two honorary degrees and is a member of the National Academy of Medicine.

Education

B.A., 1966, cum laude, Amherst College, Amherst, Massachusetts

M.D., 1970, summa cum laude, SUNY, Health Sciences Center at Brooklyn, New York

Honors and awards

Consortium of Universities for Global Health (CUGH) Distinguished Leadership Award (2018)

Duke Medical Alumni Association Distinguished Faculty Award (2017)

Master Teacher Award in Preventive Medicine, Downstate Medical Center (2010)

Outstanding Contribution to the Campaign Against HIV/AIDS, Russian Association Against AIDS (2000)

Connecticut Health Commissioner’s AIDS Leadership Award (1998)

Connecticut Health Commissioner’s AIDS Leadership Award (1997)

Frank Babbott Alumni Award (1995)

Surgeon General's Exemplary Service Medal (1993)

Commendation Medal, US Public Health Service; (1986)

Arthur S. Flemming Award for Outstanding Federal Service (1983)

Commendation Medal, US Public Health Service (1975)

Publications

Publications

Disease Caused by a Marine Vibrio : Clinical Characteristics and Epidemiology

Blake, P. A., Merson, M. H., Weaver, R. E., Hollis, D. G., & Heublein, P. C. (n.d.).

Publication year

1979

Journal title

New England Journal of Medicine

Volume

300

Issue

1

Page(s)

1-5

10.1056/NEJM197901043000101

Abstract

Abstract

We studied the clinical characteristics and epidemiology of disease associated with a rare, unnamed halophilic lactose-fermenting Vibrio species in 39 persons from whom the organism had been isolated. Two distinct clinical presentations were seen. In the first, the illness began with septicemia, often within 24 hours after raw oysters had been eaten; 18 of 24 such patients had pre-existing hepatic disease, and 11 of the 24 died. In the second, there was a wound infection after exposure to seawater or an injury incurred during the handling of crabs; none of these persons had pre-existing hepatic disease, and one of 15 died. Most cases (85 per cent) occurred during relatively warm months (May to October) in men (90 per cent) 40 or more years of age (95 per cent). This Vibrio species is a pathogen and should be considered in the differential diagnosis of septicemia with secondary skin lesions and of wound infections after exposure to seawater. (N Engl J Med 300:1–5, 1979) RECENTLY, Hollis et al. described the laboratory characteristics of an as yet unnamed halophilic Vibrio species.1 This Vibrio has been shown by deoxyribonucleic acid reassociation experiments to be a single species distinct from two other halophilic species, Vibrio parahaemolyticus and V. alginolyticus2; it can be distinguished from them biochemically by several reactions, including the fermentation of lactose (Table 1). This lactose-positive (L+) Vibrio is remarkable in that isolates from human beings have been from blood and infected tissue rather than from stool. In this report, we describe the clinical and epidemiologic characteristics of 39 illnesses associated with isolation of.

Doxycycline and the traveller

Merson, M. H. (n.d.).

Publication year

1979

Journal title

Gastroenterology

Volume

76

Issue

6

Page(s)

1485-1488

10.1016/0016-5085(79)90420-7

Abstract

Abstract

~

Relationship between enterotoxin production and serotype in enterotoxigenic Escherichia coli

Merson, M. H., Ørskov, F., Ørskov, I., Sack, R. B., Huq, I., & Koster, F. T. (n.d.).

Publication year

1979

Journal title

Unknown Journal

Volume

23

Issue

2

Page(s)

325-329

10.1128/iai.23.2.325-329.1979

Abstract

Abstract

The authors examined the relationship between serotype and enterotoxin production in 109 enterotoxigenic E. coli strains isolated from 109 patients with severe cholera-like diarrhea in Dacca, Bangladesh. Of 69 strains producing both heat-labile and heat-stable toxins, 59 (86%) belonged to the one of four O serogroups, and 56 (81%) of these strains belonged to one of six O:K:H serotypes. In contrast, 34 strains producing only heat-stable toxin were distributed among 15 O serogroups, and six strains producing only heat-labile toxin were distributed among six O serogroups. Twelve strains producing heat-labile and heat-stable toxins and five strains producing heat-stable toxin were found which had the same serotype (O78:K-:H12) and biotype. It appears that at least in one geographic setting E. coli strains producing both heat-labile and heat-stable toxins are more restricted in their O groups and O:K:H serotypes than E. coli that produce only heat-stable toxin and that certain serobiotypes may commonly include strains which produce both toxin types.

Solid-phase microtiter radioimmunoassay blocking test for detection of antibodies to Escherichia coli heat-labile enterotoxin

Merson, M. H., Greenberg, H. B., Levine, M. M., Merson, M. H., Sack, R. B., Sack, D. A., Valdesuso, J. R., Nalin, D., Hoover, D., Chanock, R. M., & Kapikian, A. Z. (n.d.).

Publication year

1979

Journal title

Journal of Clinical Microbiology

Volume

9

Issue

1

Page(s)

60-64

Abstract

Abstract

The development of a solid-phase microtiter radioimmunoassay blocking test to detect serum antibody to Escherichia coli heat-labile enterotoxin is described. The assay is easy to perform and quantitate, and it is sensitive and specific.

Use of colony pools for diagnosis of enterotoxigenic Escherichia coli diarrhea

Merson, M. H., Merson, M. H., Sack, R. B., Kibriya, A. K., Al-Mahmood, A., Adamed, Q. S., & Huq, I. (n.d.).

Publication year

1979

Journal title

Journal of Clinical Microbiology

Volume

9

Issue

4

Page(s)

493-497

Abstract

Abstract

~

Fecal steroids in diarrhea. II. Travellers' diarrhea

Merson, M. H., Huang, C. T., Udall, J. N., Merson, M., & Nichols, B. L. (n.d.).

Publication year

1978

Journal title

American Journal of Clinical Nutrition

Volume

31

Issue

4

Page(s)

626-632

10.1093/ajcn/31.4.626

Abstract

Abstract

Fecal bile acid and neutral sterol patterns of five healthy adult volunteers from the United States who contracted travellers' diarrhea in Mexico City in 1974 were studied. The only pathogen in four of these patients was the heat-stable-only enterotoxin producing strain of Escherichia coli. Stool culture for pathogens was negative in the fifth subject. Bacterial 7α-dehydroxylation of cholic and chenodeoxycholic acids was not altered in diarrhea associated with toxigenic E. coli heat-stable, although total concentrations of bile acids in the feces in mg/g of feces (wet weight) were decreased during the diarrheal episode (1.3 ± 0.2 versus 3.3 ± 0.4 in controls, P < 0.02). Consistent with findings on bile acids, no significant changes in the production of coprostanol from cholesterol were observed. Although total concentrations of cholesterol metabolites, in milligrams per grams of feces (wet weight), were reduced in diarrhea, the difference was not significant statistically (2.2 ± 0.9 versus 5.4 ± 0.8 in controls, P > 0.05). There was an apparent increase in bacterial alteration of fecal steroids in the subject who showed no pathogens in stool culture, despite a decrease in total steroid concentrations of a magnitude similar to those observed in diarrhea associated with E. coli heat-stable. The production of coprostanol was correlated with 7α-dehydroxylation of cholic acid (r = 0.829, P < 0.001) and chenodeoxycholic acid (r = 0.749, P < 0.001). The results from this study are in striking contrast to the changes in gastrointestinal steroid metabolism previously observed in acute shigellosis.

ORAL HYDRATION IN ROTAVIRUS DIARRHŒA : A DOUBLE BLIND COMPARISON OF SUCROSE WITH GLUCOSE ELECTROLYTE SOLUTION

Sack, D. A., Eusof, A., Merson, M. H., Black, R. E., Chowdhury, A. M., Akbar Ali, M., Islam, S., & Brown, K. H. (n.d.).

Publication year

1978

Journal title

The Lancet

Volume

312

Issue

8084

Page(s)

280-283

10.1016/S0140-6736(78)91687-2

Abstract

Abstract

Of 57 male children, aged 5 months to 21/2 years with rotavirus diarrhœa, 28 were given oral therapy with sucrose electrolyte solution and 29 were given glucose electrolyte solution in a randomised double-blind trial. All were rehydrated and remained so on oral therapy alone. These patients were compared with 44 children, also with rotavirus, who were treated only with intravenous hydration. The oral therapy and intravenous therapy groups did not differ clinically in the rate of rehydration or the rate of purging. Vomiting did not prevent the giving of oral therapy during hospital admission. Bangladeshi children with rotavirus diarrhœa have a defect of carbohydrate digestion but this defect does not prevent the use of a sugar electrolyte solution for oral hydration.

A large outbreak of foodborne salmonellosis on the Navajo Nation Indian Reservation, epidemiology and secondary transmission

Merson, M. H., Horwitz, M. A., Pollard, R. A., Merson, M. H., & Martin, S. M. (n.d.).

Publication year

1977

Journal title

American journal of public health

Volume

67

Issue

11

Page(s)

1071-1076

10.2105/AJPH.67.11.1071

Abstract

Abstract

In September 1974, the largest outbreak of foodborne salmonellosis ever reported to the Center for Disease Control - affecting an estimated 3,400 persons - occurred on the Navajo Nation Indian Reservation. The responsible agent was Salmonella newport and the vehicle of transmission was potato salad served to an estimated 11,000 persons at a free barbecue. The cooked ingredients of the potato salad had been stored for up to 16 hours at improper holding temperatures. The magnitude of the outbreak allowed the authors to study secondary transmission by calculating the rates of diarrheal illness during the 2 weeks following the outbreak in persons who did not attend the barbecue and by examining the results of stool cultures obtained after the outbreak. They found no secondary transmission. The authors conclude that a health official should monitor food preparation and service at large social gatherings and that person-to-person transmission of salmonellosis probably does not normally occur even in settings considered highly conductive to cross-infection.

An evaluation of penicillin prophylaxis during an outbreak of foodborne streptococcal pharyngitis

Ryder, R. W., Lawrence, D. N., Nitzkin, J. L., Feeley, J. C., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

American Journal of Epidemiology

Volume

106

Issue

2

Page(s)

139-144

10.1093/oxfordjournals.aje.a112443

Abstract

Abstract

Ryder, R. W. (CDC, Atlanta, GA 30333), D. N. Lawrence, J. L. Nitzkin, J. C. Feeley and M. H. Merson. An evaluation of penicillin prophylaxis during an outbreak of foodborne ttreptococcal pharyngitis. Am J Epidemiol 106:139-144, 1977.Between August 16 and 21, 1974, an outbreak of β-hemolytic group A M-9 T-9 streptococcal pharyngitis affected 49% of a randomly selected group of inmates at a jail in southern Florida. Food-specific attack rates incriminated improperly stored egg salad served at lunch on August 16 as the vehicle of transmission. By August 20, 290 symptomatic inmates had been placed on penicillin or erythromycin; on that day fewer than 5% of throat cultures from 400 allegedly non-penicillin-allergic largely asymptomatic inmates, cultured just before penicillin prophylaxis, were positive for the epidemic strain. At the time prophylaxis was given, secondary transmission had accounted for only 3% of cases. No non-suppurative sequelae were observed but 5% of inmates who received penicillin prophylaxis experienced an adverse reaction to the drug. Although widespread penicillin prophylaxis during outbreaks of group A β-hemolytic streptococcal pharyngitis will likely prevent transmission of these organisms, prompt treatment of all symptomatic cases may be equally as effective in controlling adult institutional foodborne outbreaks of streptococcal pharyngitis and will likely minimize the number of adverse reactions to penicillin which may be seen.

An Infected Wound as a Cause of Botulism in a 12-Year-Old Boy : Debridement, Medical Management, and Intensive Respiratory Support Resulted in Complete Recovery

Kennedy, T. L., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

Clinical Pediatrics

Volume

16

Issue

2

Page(s)

151-153

10.1177/000992287701600206

Abstract

Abstract

~

Cholera on Guam, 1974 : Epidemiologic findings and isolation of non-toxinogenic strains

Merson, M. H., Martin, W. T., Craig, J. P., Morris, G. K., Blake, P. A., Craun, G. F., Feeley, J. C., Camacho, J. C., & Gangarosa, E. J. (n.d.).

Publication year

1977

Journal title

American Journal of Epidemiology

Volume

105

Issue

4

Page(s)

349-361

10.1093/oxfordjournals.aje.a112393

Abstract

Abstract

In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains emptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of different V. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.

Ciguatera in Puerto Rico and the Virgin Islands

Payne, C. A., Payne, S. N., Hughes, J. M., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

New England Journal of Medicine

Volume

296

Issue

16

Page(s)

949-950

10.1056/NEJM197704212961628

Abstract

Abstract

To the Editor: The report of Hughes and Merson1 presented a concise résumé of the general problem of ciguatera (fish poisoning) and once again brought the topic to the clinical literature, where it is seldom seen. The major neurology and gastroenterology textbooks contain no reference to this entity, which was apparently known to the ancient Egyptians. The authors state, “Ninety per cent of outbreaks reported to the Center for Disease Control occurred in Hawaii and Florida.” This figure apparently represents deficiency in case reporting rather than the actual incidence of the problem. We became interested in ciguatera in mid-1975.

Coproexamination for Botulinal Toxin and Clostridium botulinum : A New Procedure for Laboratory Diagnosis of Botulism

Dowell, V. R., Hatheway, C. L., Lombard, G. L., McCroskey, L. M., Hughes, J. M., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

JAMA: The Journal of the American Medical Association

Volume

238

Issue

17

Page(s)

1829-1832

10.1001/jama.1977.03280180033021

Abstract

Abstract

Stool or serum specimens or both from 318 persons pertaining to 165 botulism investigations over a three-year period were examined. Botulinal toxin was detected in stools of 19 of 56 patients and in sera of 20 of 60 patients with clinical botulism; it was not detected in specimens from 246 persons with an illness other than botulism or well contacts of patients. Clostridium botulinum was identified in stools of 36 of 60 clinical botulism patients and in four of 27 asymptomatic contacts of patients with botulism victims, but not in stools of 65 persons not associated with confirmed botulism. When stool and serum samples were examined, confirmatory evidence was obtained for 72.9% of the botulism cases. Detection of botulinal toxin or C botulinum in the stool of a person should be considered evidence supporting the clinical diagnosis of botulism.

Enzyme-linked immunosorbent assay for detection of Escherichia coli heat-labile enterotoxin

Merson, M. H., Yolken, R. H., Greenberg, H. B., Merson, M. H., Sack, R. B., & Kapikian, A. Z. (n.d.).

Publication year

1977

Journal title

Journal of Clinical Microbiology

Volume

6

Issue

5

Page(s)

439-444

Abstract

Abstract

The development of an enzyme-linked immunosorbent assay (ELISA) for the detection of heat-labile Escherichia coli enterotoxin is described. The assay, which is based on the immunological similarity between Vibrio cholerae toxin and heat-labile E. coli enterotoxin, is similar in design to a radioimmunoassay but utilizes enzyme-labeled rather than radioactive isotope-labeled reagents. The ELISA system is as sensitive as both radioimmunoassay and the y-1 adrenal cell assay for the detection of heat-labile E. coli enterotoxin but requires neither radioactive reagents nor tissue culture techniques. The ELISA is easy to perform and is adaptable for use in small laboratories.

Epidemiologic Assessment of the Relevance of the So-Called Enteropathogenic Serogroups of Escherichia coli in Diarrhea

Gangarosa, E. J., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

New England Journal of Medicine

Volume

296

Issue

21

Page(s)

1210-1213

10.1056/NEJM197705262962106

Abstract

Abstract

Since the early 1950's the concept has evolved that certain serogroups of Escherichia coli, commonly designated enteropathogenic, are like shigellae and salmonellae, inherent enteric pathogens. This view is so widely held that many clinicians regard diarrhea associated with these serogroups as a distinct clinical entity, and many large hospitals include, as diagnostic laboratory routine, a search for these serogroups in stools from patients, particularly infants, with diarrhea. In the light of knowledge obtained in the last 10 years about virulence plasmids and about mechanisms by which Esch. coli causes diarrhea, we attempt to evaluate this concept through a historical.

Escherichia coli Serotypes and Diarrhea

Gurwith, M., Hinde, D., Gangarosa, E. J., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

New England Journal of Medicine

Volume

297

Issue

9

Page(s)

510-511

10.1056/NEJM197709012970917

Abstract

Abstract

To the Editor: Gangarosa and Merson (N Engl J Med 296:1210, 1977) conclude that “routine serogrouping of Esch. coli in sporadic cases of diarrhea using commercial antiserums#x2026;is#x2026;useless.” They review studies relating Esch. coli of the traditional enteropathogenic serotypes (EPEC) to diarrhea. Seven of these reports, published from 1950 to 1961, form the entire epidemiologic evidence “refuting” the virulence of EPEC.1 2 3 4 5 6 7 We wonder whether the results of these studies, especially when their methods are scrutinized, support the conclusions drawn, and we question their relevance to serogrouping in 1977. In one study, transient and sometimes asymptomatic infection with EPEC was found in.

Food borne botulism in the United States, 1970 to 1975

Merson, M. H., Horwitz, M. A., Hughes, J. M., Merson, M. H., & Gangarosa, E. J. (n.d.).

Publication year

1977

Journal title

Journal of Infectious Diseases

Volume

136

Issue

1

Page(s)

153-159

10.1093/infdis/136.1.153

Abstract

Abstract

~

Foodborne disease outbreaks of chemical etiology in the United States, 1970-1974

Hughes, J. M., Horwitz, M. A., Merson, M. H., Barker, W. H., & Gangarosa, E. J. (n.d.).

Publication year

1977

Journal title

American Journal of Epidemiology

Volume

105

Issue

3

Page(s)

233-244

10.1093/oxfordjournals.aje.a112379

Abstract

Abstract

In the United States between 1970 and 1974 there was an increase each year both in the absolute number of foodborne disease outbreaks of chemical etiology reported to the Center for Disease Control and in the proportion of these outbreaks in the total reported foodborne disease outbreaks. Nearly half (48.9%) of these foodborne disease outbreaks of chemical origin were caused by toxic fish or shellfish. Of the rest, 16.5% were caused by poisonous mushrooms, 10.9% by heavy metal poisoning, 7.2% by excessive use in food of monosodium. glutamate (the etiologic agent of Chinese Restaurant Syndrome) and 16.5% by miscellaneous chemicals. Practices that contributed to the occurrence of these outbreaks included the inadvertent selection for consumption of toxic fish, shellfish, or mushrooms, storage of fish at improper temperatures, storage of acidic liquids in metal containers, and addition of excessive amounts of monosodium glutamate to foods. Commercially-processed foods were responsible for outbreaks of scombroid fish poisoning, shellfish poisoning, and heavy metal poisoning. Because outbreaks of chemical etiology due to contaminated commercial products do occur, prompt recognition and reporting of outbreaks to public health personnel are essential so that epidemiologic investigations can be conducted and effective control measures promptly initiated.

The characteristics and mortality of outpatient acquired pneumonia

Merson, M. H., Moore, M. A., Merson, M. H., Charache, P., & Shepard, R. H. (n.d.).

Publication year

1977

Journal title

Johns Hopkins Medical Journal

Volume

140

Issue

1

Page(s)

9-14

Abstract

Abstract

One hundred fifty four cases of pneumonia occurring over a 6 month period were analyzed. Population characteristics admission diagnoses, causative pathogens, frequency of associated illnesses, antibiotic usage and mortality were evaluated. Despite population characteristics known to predispose to a poor clinical outcome, the mortlity was low, probably because of rapid institution of a single, appropriate antibiotic.

The Safety of Eating Shellfish

Hughes, J. M., Merson, M. H., & Gangarosa, E. J. (n.d.).

Publication year

1977

Journal title

JAMA: The Journal of the American Medical Association

Volume

237

Issue

18

Page(s)

1980-1981

10.1001/jama.1977.03270450070031

Abstract

Abstract

~

Type a botulism from commercially canned beef stew

Blake, P. A., Horwitz, M. A., Hopkins, L., Lombard, G. L., McCroan, J. E., Prucha, J. C., & Merson, M. H. (n.d.).

Publication year

1977

Journal title

Southern Medical Journal

Volume

70

Issue

1

Page(s)

5-7

10.1097/00007611-197701000-00004

Abstract

Abstract

Two of three persons who ate lunch together became ill with symptoms characteristic of botulism. One died before botulism was suspected and before specimens could be collected for laboratory testing, but a serum specimen from the other patient, who survived, yielded botulinal toxin, type A. The third person remained asymptomatic, but Clostridium botulinum type A was cultured from his stool. The three persons had shared two canned foods: home-canned green beans and commercially canned beef stew. The green beans were initially assumed to be the cause of the outbreak. However, the empty stew can was recovered from the garbage, and washings from the can yielded C botulinum, type A, and its toxin.

Diagnostic value of indirect hemagglutination in the seroepidemiology of Shigella infections

Merson, M. H., Patton, C. M., Gangarosa, E. J., Weissman, J. B., Merson, M. H., & Morris, G. K. (n.d.).

Publication year

1976

Journal title

Journal of Clinical Microbiology

Volume

3

Issue

2

Page(s)

143-148

Abstract

Abstract

To evaluate the usefulness of the indirect hemagglutination (HA) test in the epidemiological investigation of shigellosis, single serum specimens were tested from 50 patients with Shigella dysenteriae 1 (Shiga bacillus) infections, 103 asymptomatic contacts of these cases, 267 adult and 100 student control, and serum specimens collected during two outbreaks caused by S. sonnei and one outbreak due to S. flexneri 6. In patients with S. dysenteriae 1, 74% demonstrated titers of ≥ 1:40, with 50% showing titers of ≥ 1:60, whereas in the controls 10.4% had titers of ≥ 1:40 and only 0.3% had titers of ≥ 1:60. IHA titers in serum specimens collected from patients with S. sonnei and S. flexneri 6 were too low to be considered diagnostic for individual patients, but were useful in analysis of group results. Groups of ill individuals yielded titers significantly higher than non ill groups; however, titers from ill groups were usually less than 1:40. The IHA test for S. dysenteriae 1 antibodies serves as a valuable adjunct to the diagnosis of Shiga bacillus dysentery. In the laboratory, an IHA titer of 1:40 or 1:80 is a 'borderline positive.' Shiga bacillus dysentery is strongly indicated when IHA titers are ≥ 1:60.

ENTEROTOXIGENIC ESCHERICHIA COLI AND REOVIRUS-LIKE AGENT IN RURAL BANGLADESH

Ryder, R. W., Sack, D. A., Kapikian, A. Z., Mclaughlin, J. C., Chakraborty, J., Mizanur Rahman, A. S., Merson, M. H., & Wells, J. G. (n.d.).

Publication year

1976

Journal title

The Lancet

Volume

307

Issue

7961

Page(s)

659-663

10.1016/S0140-6736(76)92776-8

Abstract

Abstract

48 patients admitted to a rural Bangladesh hospital with dehydration secondary to diarrhœa were examined for infection caused by reovirus-like agent (R.L.A.) or enterotoxigenic Escherichia coli (E.T.E.C.). The diagnosis of R.L.A. infection was established by electron microscopy of stool filtrates and by a fourfold or greater rise in serum complement-fixing antibodies to the Nebraska calf diarrhœa virus. Evidence of infection by heat-labile-toxin (L.T.)-producing E.T.E.C. was sought by stool culture and serological testing using the adrenal-cell tissue-culture system. Infection by heat-stable-toxin (S.T.)-producing E.T.E.C. was sought by stool culture using the infant mouse test. 12 patients, all less than two years old, had evidence of R.L.A. infection, accounting for illness in 55% of the 22 patients who were less than two years old. None of these 22 children had evidence of E.T.E.C. infection. R.L.A. diarrhœa lasted five to six days, often led to serious dehydration, and was associated with vomiting and fever. 11 cases of E.T.E.C. diarrhœa were detected, accounting for 56% of the cases of diarrhœa in the 18 patients who were more than ten years old. Diarrhœa caused by E.T.E.C. was sudden in onset, shorter in duration, and caused pronounced dehydration. In a community survey E.T.E.C. was isolated with equal frequency in the stools of control and case family members. The data suggest that E.T.E.C. is a common cause of adult diarrhœa in Bangladesh, while R.L.A. is a common cause of diarrhœa in children.

Fish and Shellfish Poisoning

Hughes, J. M., & Merson, M. H. (n.d.).

Publication year

1976

Journal title

New England Journal of Medicine

Volume

295

Issue

20

Page(s)

1117-1120

10.1056/NEJM197611112952006

Abstract

Abstract

Vertebrate fish containing toxins capable of causing human illness are divided into three categories based on the location of the toxin.1 Ichthyosarcotoxic fish contain toxin in their musculature, viscera, skin or mucus and are responsible for most cases of fish poisoning. Ichthyo-otoxic fish have toxin in their gonads, and ichthyohemotoxic fish contain toxin in their blood; poisoning due to these fish is relatively rare. Of the nine types of ichthyosarcotoxism, ciguatera, scombroid and puffer-fish poisoning (tetrodotoxism) are the most common worldwide. Shellfish may cause paralysis (paralytic shellfish poisoning) if they contain toxin derived from the dinoflagellates Gonyaulax catenella or Go.

Laboratory investigation of diarrhea in travelers to Mexico : Evaluation of methods for detecting enterotoxigenic Echerichia coli

Merson, M. H., Morris, G. K., Merson, M. H., Sack, D. A., Wells, J. G., Martin, W. T., Dewitt, W. E., Feeley, J. C., Sack, R. B., & Bessudo, D. M. (n.d.).

Publication year

1976

Journal title

Journal of Clinical Microbiology

Volume

3

Issue

5

Page(s)

486-495

Abstract

Abstract

A laboratory investigation was conducted on cultures collected from travelers before, during, and after a trip to Mexico to characterize the etiology of traveler's diarrhea. Four laboratory methods for detecting enterotoxigenicity of Escherichia coli were evaluated: the infant mouse assay, the Chinese hamster ovary (CHO) cell assay, the Y1 adrenal cell assay, and the rabbit ileal loop. Although a number of common enteric pathogens were identified as a cause of traveler's diarrhea, including six serotypes of Salmonella, two serotypes of Shigella, Vibrio parahaemolyticus, Giardia lamblia, and Entamoeba histolytica, enterotoxigenic Escherichia coli was most commonly isolated. Strains were identified that produced only heat labile enterotoxin (LT), only heat stable enterotoxin (ST), or both LT and ST. The infant mouse assay yielded results falling into two distinct groups, providing a clear separation of positive and negative cultures. The CHO assay also formed two groups, with positive cultures producing 11% or more of the elongated cells. There was good agreement between the CHO and the Y1 adrenal cell assays for detection of LT. The adrenal cell system for detection of LT was more suitable than the CHO assay for processing large numbers of specimens because of the miniculture modification of this method utilized in this study. The infant mouse method was a simple and reliable method for detecting ST.