An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with "conv... more An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with "conventional therapy" (chloramphenicol 100 mg/kg/day, doxycycline 4 mg/kg/day, trimethoprim 10 mg/kg/day, and sulphamethoxazole 50 mg/kg/day) in the treatment of severe melioidosis. A paired restricted sequential trial designed to detect a reduction in mortality from 80 to 40% in culture-positive patients surviving greater than 48 hours was stopped after 22 months. Of the 161 patients entered into the study, 65 had bacteriologically confirmed melioidosis and 54 of these were septicaemic. Ceftazidime treatment was associated with a 50% (95% CI 19-81%) lower overall mortality than conventional treatment (74% vs 37%; p = 0.009) and should now become the treatment of choice for severe melioidosis.
Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many... more Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. Methodology/Principal findings We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was iso...
Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumo... more Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases. We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls. Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5...
Communicable disease and public health / PHLS, 2002
The largest outbreak of cryptosporidiosis reported in the United Kingdom, involving 575 confirmed... more The largest outbreak of cryptosporidiosis reported in the United Kingdom, involving 575 confirmed cases (of which 474 met an agreed case definition), occurred in the county of Devon during August and September of 1995. The descriptive epidemiology supports the hypothesis that the outbreak was associated with the consumption of cold tap water in the area served by a particular water treatment works. Cryptosporidium oocysts were detected in treated water samples at the time of the outbreak. Although the epidemiological analysis provided strong circumstantial evidence of a waterborne outbreak, the data were not recorded in a manner that made them admissible in criminal proceedings taken by the Drinking Water Inspectorate against the water company involved. The need to carry out an analytical study in conjunction with the identification and characterisation of the pathogen in the drinking water and the practicalities of agreeing criteria for lifting a 'boil water' notice are dis...
Tropical Medicine & International Health, 1998
The constancy of strain genotypes of multiple isolates of Burkholderia pseudomallei from 13 patie... more The constancy of strain genotypes of multiple isolates of Burkholderia pseudomallei from 13 patients with melioidosis was examined by BamHI ribotyping and pulsed‐field gel electrophoresis (PFGE) of XbaI digests of DNA. Seven of 8 patients with single episodes of melioidosis each yielded genetically identical isolates and only one of five patients with recurrent episodes was infected with a new strain clearly distinct from the original primary strain. Variation was observed in PFGE patterns of primary and relapse isolates of another patient but this was insufficient to define genetically distinct strains. We conclude that most patients with single or multiple episodes of melioidosis retain a single strain.
SUMMARYIntroduction of pneumococcal conjugate and polysaccharide vaccines into the United Kingdom... more SUMMARYIntroduction of pneumococcal conjugate and polysaccharide vaccines into the United Kingdom's routine immunization programmes is expected to change the epidemiology of invasive pneumococcal disease (IPD). We have documented the epidemiology of IPD in an English region (South West) with high-quality surveillance data before these programmes were established. We analysed data on isolates of Streptococcus pneumoniae from blood and CSF between 1996 and 2005 from microbiology laboratories in the South West that were reported and/or referred for serotyping to the Health Protection Agency Centre for Infections. The mean annual incidence of IPD increased from 11·2/100 000 in 1996 to 13·6/100 000 in 2005 (P<0·04). After adjusting for annual blood-culture sampling rates in hospitals serving the same catchment populations, an increase in annual incidence of IPD was no longer observed (P=1·0). Variation in overall incidence between laboratories could also be explained by variation ...
An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with &quot;conv... more An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with &quot;conventional therapy&quot; (chloramphenicol 100 mg/kg/day, doxycycline 4 mg/kg/day, trimethoprim 10 mg/kg/day, and sulphamethoxazole 50 mg/kg/day) in the treatment of severe melioidosis. A paired restricted sequential trial designed to detect a reduction in mortality from 80 to 40% in culture-positive patients surviving greater than 48 hours was stopped after 22 months. Of the 161 patients entered into the study, 65 had bacteriologically confirmed melioidosis and 54 of these were septicaemic. Ceftazidime treatment was associated with a 50% (95% CI 19-81%) lower overall mortality than conventional treatment (74% vs 37%; p = 0.009) and should now become the treatment of choice for severe melioidosis.
Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many... more Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. Methodology/Principal findings We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was iso...
Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumo... more Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases. We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls. Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5...
Communicable disease and public health / PHLS, 2002
The largest outbreak of cryptosporidiosis reported in the United Kingdom, involving 575 confirmed... more The largest outbreak of cryptosporidiosis reported in the United Kingdom, involving 575 confirmed cases (of which 474 met an agreed case definition), occurred in the county of Devon during August and September of 1995. The descriptive epidemiology supports the hypothesis that the outbreak was associated with the consumption of cold tap water in the area served by a particular water treatment works. Cryptosporidium oocysts were detected in treated water samples at the time of the outbreak. Although the epidemiological analysis provided strong circumstantial evidence of a waterborne outbreak, the data were not recorded in a manner that made them admissible in criminal proceedings taken by the Drinking Water Inspectorate against the water company involved. The need to carry out an analytical study in conjunction with the identification and characterisation of the pathogen in the drinking water and the practicalities of agreeing criteria for lifting a 'boil water' notice are dis...
Tropical Medicine & International Health, 1998
The constancy of strain genotypes of multiple isolates of Burkholderia pseudomallei from 13 patie... more The constancy of strain genotypes of multiple isolates of Burkholderia pseudomallei from 13 patients with melioidosis was examined by BamHI ribotyping and pulsed‐field gel electrophoresis (PFGE) of XbaI digests of DNA. Seven of 8 patients with single episodes of melioidosis each yielded genetically identical isolates and only one of five patients with recurrent episodes was infected with a new strain clearly distinct from the original primary strain. Variation was observed in PFGE patterns of primary and relapse isolates of another patient but this was insufficient to define genetically distinct strains. We conclude that most patients with single or multiple episodes of melioidosis retain a single strain.
SUMMARYIntroduction of pneumococcal conjugate and polysaccharide vaccines into the United Kingdom... more SUMMARYIntroduction of pneumococcal conjugate and polysaccharide vaccines into the United Kingdom's routine immunization programmes is expected to change the epidemiology of invasive pneumococcal disease (IPD). We have documented the epidemiology of IPD in an English region (South West) with high-quality surveillance data before these programmes were established. We analysed data on isolates of Streptococcus pneumoniae from blood and CSF between 1996 and 2005 from microbiology laboratories in the South West that were reported and/or referred for serotyping to the Health Protection Agency Centre for Infections. The mean annual incidence of IPD increased from 11·2/100 000 in 1996 to 13·6/100 000 in 2005 (P<0·04). After adjusting for annual blood-culture sampling rates in hospitals serving the same catchment populations, an increase in annual incidence of IPD was no longer observed (P=1·0). Variation in overall incidence between laboratories could also be explained by variation ...
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