BMJ  2003;326:1265 (7 June), doi:10.1136/bmj.326.7401.1265-a

Letter

Mortality associated with foodborne bacterial gastrointestinal infections

Case selection and clinical data are important

The first 150 words of the full text of this article appear below.

EDITOR—The article by Helms et al raises the importance of case selection and clinical data on the estimates of short and long term mortality from clinical illness.1 Clinicians' understanding of an illness entails identifying symptoms and signs, in relation to age, sex, and geography, the three variables for which the authors selected controls. But clinicians also decide on the necessity for diagnostic laboratory tests. Results deemed unlikely to influence patients' management or outcome affect the likelihood of investigation.2 Variations in laboratory testing protocols and methods affect what is detected and reported.3

Medical epidemiologists are aware that the infecting dose affects severity. In general, the larger the infecting dose, the more severe the illness and the more likely the patient is to present to a clinician,4 so that severe illnesses are more likely to be represented in those studied.

Medical microbiologists are aware, as acknowledged by the authors, that . . . [Full text of this article]

Sarah J O'Brien, head of gastrointestinal diseases division

Health Protection Agency, Communicable Disease Surveillance Centre, London NW9 5EQ sarah.o'brien@hpa.org.uk

Roger A Feldman, emeritus professor of clinical epidemiology

Barts and the London, Queen Mary School of Medicine and Dentistry, University of London E1 2AD


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Relevant Article

Short and long term mortality associated with foodborne bacterial gastrointestinal infections: registry based study • Commentary: matched cohorts can be useful
Morten Helms, Pernille Vastrup, Peter Gerner-Smidt, Kåre Mølbak, and Stephen Evans
BMJ 2003 326: 357. [Abstract] [Full Text] [PDF]

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