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1953 Maryland outbreak
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'''1953 Maryland outbreak''': In July, 1953, a sudden [[Epidemic myalgic encephalomyelitis|outbreak]] of a polio-like infection occurred in the student nurses at Chestnut Lodge Hospital, a private, psychiatric hospital in Rockville, Maryland, near Washington, DC.<ref name="Shelokov, 1957">{{Cite journal | last1 = Shelokov | first1 = Alexis | author-link1 = Alexis Shelokov | last2 = Habel | first2 = Karl | author-link2 = Karl Habel | last3 = Verder | first3 = Elizabeth | author-link3 = Elizabeth Verder | last4 = Welsh | first4 = William | author-link4 = William Welsh | title = Epidemic Neuromyasthenia — An Outbreak of Poliomyelitis-like Illness in Student Nurses | journal = New England Journal of Medicine | volume = | issue = 257 | page = 345-355 | date =August 1957| doi = 10.1056/NEJM195708222570801}}</ref> The Montgomery County Health Department, the Maryland State Health Department, [[National Institute of Allergy and Infectious Diseases]], and Georgetown University School of Medicine were involved in deciphering the outbreak. == Symptoms == [[File:Distribution of symptoms during the 1953 Rockville, Maryland outbreak.png|thumb|Distribution of symptoms during the 1953 Rockville, Maryland outbreak<ref name="Shelokov, 1957" />]] The investigators authored an article for the ''New England Journal of Medicine'' and noted the following core symptoms<ref name="Shelokov, 1957" />: * localized muscular weakness ([[paresis]]) * [[Neck stiffness|stiffness of the neck]] and [[Back stiffness|back]] * [[headache]] * [[diarrhea]] * temperature elevation and instability of [[body temperature]] The outbreak was deemed to resemble other [[list of outbreaks|outbreaks]] of poliomyelitis-like illnesses in hospitals around the same time, including the [[1934 Los Angeles atypical polio outbreak|Los Angeles County Hospital in 1934]]. [[Epidemic neuromyasthenia]] became the final diagnosis.<ref name="Shelokov, 1957" /> Often a minor illness characterized by [[Flu-like symptoms|flu-like malaise]], [[Myalgia|achiness]] and low-grade [[fever]] proceeded by several days to up to two weeks the development of a full-blown symptom complex (i.e., involving muscle weakness and partial [[paralysis]]). If the prodromal period persisted, symptoms might include diarrhea, [[nausea]] and [[vomiting]] and in some cases, severe [[respiratory illness]]es.<ref name="Shelokov, 1957" /> Additional symptoms included [[sore throat]], [[postural headache]], [[abdominal pain]], [[menstrual irregularities]], and [[Eye pain|pain on eye]] motion.<ref name="Shelokov, 1957" /> == Findings == * [[Lumbar puncture]]s were done on 25 of the cases and all 25 were negative for [[cerebrospinal fluid]] involvement. Eight lumbar punctures were repeated and all of those were negative, also.<ref name="McEvedy, 1970">{{Cite journal | last1 = McEvedy | first1 = Colin | author-link1 = Colin McEvedy | last2 = Beard | first2 = A.W. | author-link2 = William Beard | title = Concept of Benign Myalgic Encephalomyelitis | journal = [[British Medical Journal]] | volume = 1970 | issue = 1 | page = 11-15 | date = 1970 | pmid = 5411596 | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1700895/}}</ref> * [[Paresis|Muscle weakness]] was confirmed in half of cases via quantitative muscular-testing procedures<ref name="Shelokov, 1957" /> * From several of the patients, the Bethesda-Ballerup paracolon organism was isolated. It was believed that this organism may have triggered the disease in the same manner as an infection of poliomyelitis virus precipitated other early epidemics.<ref name="Parish, 1978">{{Cite journal | last1 = Parish | first1 = J.G. | author-link1 = Gordon Parish| title = Early outbreaks of 'epidemic neuromyasthenia'| journal = Postgraduate Medical Journal | volume = 54 | issue = 637 | page = 711-717 | date = November 1978 | pmid = 370810| url = http://www.ncbi.nlm.nih.gov/pubmed/370810 }}</ref> * Hemoglobin determinations, erythrocyte counts, sedimentation rates and urinalyses were within normal limits * Tendency toward [[lymphocytosis]] in the acute phase * All [[infectious disease testing]] (including tests for a range of [[Enterovirus|enteroviruses]]) was negative == Epidemiology == Fifty cases were documented: 48 females and 2 males, of which 47 of the cases were in the student nurse population.<ref name="McEvedy, 1970" /> A second outbreak occurred two and a half months after the first major group of cases, during which 7 cases appeared in a newly introduced student-nurse population. No toxic agent was found. ==Course & prognosis == Patients often experienced an "early and misleading improvement"<ref name="Shelokov, 1957" /> only to enter a chronic state of "prolonged debility," suffering relapses with [[exertion]], damp and cold weather or onset of [[Menstrual cycle|menstrual periods]]. == Controversy == In 1970, this outbreak was one of fifteen mentioned in a paper by psychiatrists [[Colin McEvedy]] and [[A. W. Beard]], who wanted to rename all fifteen outbreaks as [[mass hysteria]] or myalgia nervosa.<ref name="McEvedy, 1970" /> The psychiatrists were criticized by patients and researchers, such as Dr. [[Melvin Ramsay]] who was directly involved in the 1955 [[Royal Free Hospital outbreak]]. [[Colin McEvedy|McEvedy]] admitted to Dr. [[Byron Hyde]], when invited to discuss his theory, that he did not examine any patients and undertook only the most cursory examination of medical records.<ref name="Hooper, 2007">{{Cite journal | last1 = Hooper | first1 = Malcolm | author-link1 = Malcolm Hooper | title = Myalgic encephalomyelitis: a review with emphasis on key findings in biomedical research | journal = Journal of Clinical Pathology | volume = 60 | issue = 5 | page = 466–471 | date = May 2007| doi = 10.1136/jcp.2006.042408}}</ref> In 1994, [[Nathaniel Briggs|Nathaniel C. Briggs]] and [[Paul Levine|Paul H. Levine]], from the Viral Epidemiology Branch, Epidemiology and Biostatistics Program of the [[National Institutes of Health]], wrote a review comparing twelve [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|outbreaks]] referred to as [[chronic fatigue syndrome]], [[epidemic neuromyasthenia]], and [[myalgic encephalomyelitis]]. They grouped the outbreaks into four levels of increasing neurological involvement, ranked I-IV. The 1953 Maryland outbreak was rated as level III, which meant that they found "objective paresis with cutaneous sensory as well as affective and cognitive neuropsychological changes." The researchers noted that: "'unusual fatigability' was a cardinal symptom. Twelve (46%) of 26 patients reexamined 3-5 months after onset were symptomatic and 'several had to be on part-time duty with periods of daytime bed rest'" and patients experienced "frequent recrudescensces [increased severity of a disease after a remission] particularly associated with exertion."<ref name="Briggs, 1994">{{Cite journal | last1 = Briggs | first1 = Nathaniel C. | author-link1 = Nathaniel Briggs | last2 = Levine | first2 = Paul H. | author-link2 = Paul Levine| title = A Comparative Review of Systemic and Neurological Symptomatology in 12 Outbreaks Collectively Described as Chronic Fatigue Syndrome, Epidemic Neuromyasthenia, and Myalgic Encephalomyelitis| journal = Clinical Infectious Diseases | volume = 1994 | issue = Suppl 1 | page = S32-42 | date = 1994 | pmid = 8148451 | doi =10.1093/clinids/18.Supplement_1.S32}}</ref> == See also== *[[Epidemic myalgic encephalomyelitis]] *[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks]] ==Learn more== ==References== {{Reflist}} [[Category:History]] [[Category:Outbreaks]] [[Category:Outbreaks in the 1950s]] [[Category:Outbreaks in the United States of America]]
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