Synopsis for March 11, 2005

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Inadvertent Use of Bicillin C-R to Treat Syphilis Infection ― Los Angeles, California, 1999-2004
2. Transmission of Hepatitis B Virus Among Persons Undergoing Blood Glucose Monitoring in Long-Term-Care Facilities ― Mississippi, North Carolina, and Los Angeles County, California, 2003-2004
3. Salmonellosis Associated with Pet Turtles ― Wisconsin and Wyoming, 2004
4. Lead Poisoning Associated with Use of Litargirio ― Rhode Island, 2003

Inadvertent Use of Bicillin C-R to Treat Syphilis Infection ― Los Angeles, California, 1999-2004

A 2004 CDC investigation documented the largest known occurrence of the inadvertent use of the wrong formulation of penicillin to treat syphilis.

Between 1999 and 2004, nearly 700 patients at a Los Angeles clinic were treated with Bicillin C-R, which contains just half the CDC-recommended dose of penicillin for syphilis treatment found in Bicillin L-A. Clinic staff attempted to contact, retest and retreat all patients who were initially mistreated. Of those who were originally diagnosed with syphilis, nearly 60 percent were retreated with Bicillin L-A; one had previously diagnosed neurosyphilis. About 42 percent of the contacts of those diagnosed with syphilis were retested, 78 percent of whom showed no evidence of ever having had syphilis. No single factor led to the use of Bicillin C-R. Both formulations had very similar names and packaging, and in late 1998, the clinic received a shipment of Bicillin C-R in lieu of Bicillin L-A. Due to this investigation the FDA and the manufacturer of Bicillin C-R recently announced new changes in packaging, including bold warning labels stating that it should not be used for syphilis treatment. While the health consequences appeared limited in this situation, effective treatment of syphilis is essential for controlling this disease.

Transmission of Hepatitis B Virus Among Persons Undergoing Blood Glucose Monitoring in Long-Term-Care Facilities ― Mississippi, North Carolina, and Los Angeles County, California, 2003-2004

Hepatitis B and other bloodborne diseases can be transmitted when diabetes care supplies and equipment are shared.

CDC and health department investigators report that outbreaks of hepatitis B occurred among diabetic patients who received routine fingersticks in long-term care facilities in Mississippi, California and North Carolina. The outbreaks were attributed to diabetes care supplies that were contaminated by blood from fingersticks. To prevent transmission of infections between patients, equipment and supplies used to measure blood glucose levels should be restricted to individual use. Healthcare providers in long-term care facilities, such as nursing homes, should also make certain that fingersticks are limited to individual use to ensure good diabetes care. Based on the results from these and other investigations, CDC has made specific recommendations for preventing transmission of bloodborne diseases such as hepatitis B among residents of long-term care facilities.

Salmonellosis Associated with Pet Turtles ― Wisconsin and Wyoming, 2004

Public health officials and the general public need to be aware of the continued sale of small turtles despite the FDA ban.

They must also be aware of the risk of human disease associated with contact of reptiles and their environment. Turtles and other reptiles are a potential source of human salmonellosis. In 1975, the U.S. Food and Drug Administration banned sales of small turtles to prevent human infection. Recently however, several states, including Wisconsin and Wyoming, have reported illegal small turtle sales from vendors and pet stores. At least five human cases of salmonellosis are linked to such turtles. This report describes the investigation into those cases. The results underscore the need for health and environmental officials to prevent illegal distribution of small turtles and consider patient contact with reptiles when investigating salmonellosis cases. It also highlights the need for continued risk education for pet store staff and the general public regarding the risk of human salmonellosis from contact with reptiles.

Lead Poisoning Associated with Use of Litargirio ― Rhode Island, 2003

Although deteriorated leaded paint in older housing remains the main source of childhood lead exposures, other sources should be considered, particularly when a child’s elevated BLL does not respond to remediation of residential lead paint hazards.

Lead can damage the neurologic, hematologic, and renal systems. Deteriorated leaded paint in older housing remains the most common source of lead exposure for children in the United States; however, other lead sources increasingly are recognized, particularly among certain racial/ethnic populations. In 2003, the Rhode Island Department of Health recognized litargirio (known as litharge or lead monoxide) as a potential source of lead exposure for Hispanic children. This report summarizes a case investigation of elevated blood lead levels (BLLs >10 µg/dL) associated with litargirio use among two siblings in Rhode Island, the public health action taken, and a survey of parents/guardians in three pediatric clinics in Providence to assess litargirio use. Findings underscore the importance of follow-up of elevated BLLs and thorough investigation to identify all lead sources.

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