Friday, December 31, 2010

Planning on taking an exotic vacation?

So you have been saving your money and vacation time from work to take that once in a lifetime vacation. Maybe it’s an African safari, maybe a trip down the Amazon River, somewhere where you’ll bring back fantastic stories, pictures and video. The trip will make you the envy of friends and family alike. The one thing you definitely don’t want to bring back home is some deadly, exotic disease, the type you’ve read about but never thought it could happen to you.

The list of diseases out there is long, but to give an idea what you’ll be facing here’s an example: malaria, yellow fever, dysentery, sleeping sickness and rabies. Fortunately you can prepare yourself by taking some very important steps.

The first thing you should do is see your physician, health department or travel medicine clinic. Discuss with them your destination and they will know what preventive measures you’ll need.

The first thing is vaccinations. Some vaccines are recommended and some are required to travel to certain areas. Your health care provider can determine this. Depending on where you’re heading, you may need yellow fever (a required vaccine), Hepatitis A, and meningitis are some of the most common.

Also make sure your routine vaccinations are up to date. Diseases like diphtheria, though uncommon in the United States, are relatively common in some parts of the world. If traveling with small children or pregnant women there may be special requirements, so ensure your doctor is aware of these travelers.

If you are traveling to a malaria endemic area, it may be wise to start malaria prophylaxis prior to going. Again, certain areas of the world have drug-resistant strains, so the medication given will differ based on that fact. Other preventive measures you can take to prevent malaria and other mosquito-borne diseases are using insecticide-treated bed nets when you sleep and using a mosquito repellant that contains DEET. Check with your health care provider for any additional recommendations.

For measures like vaccines and other medications, you should see your health care provider 4 to 6 weeks prior to traveling. This will give the vaccinations a chance the produce the necessary antibody for your body to fight the infection.

Another issue when traveling overseas is the quality of the water. The area you travel may not have chlorinated water and a public health system like you are used to here. Some steps you can take to prevent “traveler’s diarrhea” are to avoid drinking untreated water or boil or treat the water with iodine/chlorine tablets. Also do not use ice in your drinks; it may be made from contaminated water. Avoid salads or other unpeeled fruits and vegetables. In addition, make sure all meats are cooked thoroughly.

In certain areas of the world dangerous parasites like Schistosomes are rampant. You usually get this parasite from swimming or doing other recreational activities in contaminated fresh water. There is not a vaccine or prophylactic medication, so if you’re in one of these areas, avoid fresh water. You cannot tell if the water is contaminated, so just don’t go in it.

Many developing nations have problems with stray animals and rabies is an issue so you should definitely make sure your children avoid getting near or petting strange animals.

Other things you should consider are the availability of health care at your destination. Consider travelers health insurance for care you may require or if medical treatment is not available, for evacuation to another country for the required medical care.

This article is far from exhaustive as far as infectious hazards and preventive measures available so I recommend visiting the CDC’s Travel Health Site for more details. One last thing before you head out on your thrilling excursion, check the U.S. State Department’s Travel advisories. Other issues may be going on that you should be aware of; civil unrest, war, kidnappings, is some examples.

I know it’s a cliché, but knowledge is power. Arming yourself with good information can protect you or your family from a dangerous disease or even death. Have a happy and safe trip.


The Schistosomiasis Control Initiative’s next target: cysticercosis

The Schistosomiasis Control Initiative (SCI), an arm of the Imperial College London, has been instrumental in fighting neglected tropical diseases (NTD) like schistosomiasis and soil-transmitted nematodes in sub-Sahara Africa, has received funding to fight another parasitic problem-- cysticercosis.

According to an SCI news release, they have received $1.5 million from the Bill and Melinda Gates Foundation to work on control of the pork tapeworm in poor African communities.

The SCI has done much in the distribution of the anti-parasitic drug, praziquantel in Africa for the treatment of schistosomiasis, so it makes sense that they do the same with cysticercosis which is also treated with the drug. However, as they point out in the news release, “although cysticercosis is easily treated using this drug, some reports have suggested that high doses, like those used to treat schistosomiasis, can increase the risk and severity of seizures in people who have cysts within the brain. However, the risk of side effects when administering the drug in communities where schistosomiasis and cysticercosis coexist has not been assessed systematically.”

Cysticercosis, a serious disease caused by ingestion of the eggs of the Taenia solium tapeworm, is prevalent in poor, rural pig raising communities and is a cause of neurological problems like epilepsy and worse. In fact, according to the SCI news release, 14 percent of all epilepsy cases in Tanzania are caused by this parasite.

The risk of fatal toxic shock with medical abortions

The risk of fatal septic shock and the use of abortion-inducing drugs are very low (much less than one case per 100,000 medical abortions), however a risk is present.

There have been 8 reported cases of clostridial toxic shock in medical abortions due to two organisms, Clostridium sordellii and Clostridium perfringens since 2000.

It is quite rare; however it is an almost surely fatal condition that can occur after the use of mifepristone and misoprostol to end pregnancies. These serious infections can occur after miscarriages also.

Clostridium sordellii is an anaerobic spore-forming gram positive bacilli which is found in the environment in soil and in the gastrointestinal tract of both humans and animals.

Healthy women may have Clostridium sordellii and other clostridial species as normal inhabitants of the vagina. Clostridial vaginal colonization following abortion has been observed in up to 29 percent of women. The organism may gain entry to the uterus via the cervix during spontaneous or induced abortion and even childbirth.

Symptoms of clostridial toxic shock include abdominal cramping, vomiting, diarrhea, hypotension, tachycardia, leukocytosis, sepsis, acute renal failure and disseminated intravascular coagulation. The infection carries a very high fatality rate.

Clostridial toxic shock syndrome has also seen in intravenous drug users (black tar heroin) and very rarely with receiving contaminated tissue allografts.

Wednesday, December 29, 2010

The little known raccoon roundworm

Recently the New York City Department of Health reported two devastating infections in children in Brooklyn. One child, a newborn, as of this writing, has severe permanent brain damage. The other, a teenager, has loss of vision in one eye. What caused such severe, devastating disease in these children? It’s called Baylisascaris procyonis, the raccoon roundworm.

Baylisascaris procyonis is a roundworm found in the small intestines of raccoons. They excrete the eggs of this parasite in their feces. The eggs can survive in the environment for years under favorable conditions. There can be millions of eggs shed by the raccoon, with high densities in the feces and the soil surrounding it.

The raccoon roundworm is pretty indiscriminate in what animals it can infect; rabbits, woodchucks, squirrels, and birds amongst others. Many times these animals get infected by getting the eggs in their fur and ingest the eggs during grooming.

Humans also get infected by accidentally ingesting eggs from the environment, from raccoon feces, contaminated water or fomites. Raccoons typically defecate in favored areas called latrines. Common latrines include the bases of trees, raised forks of trees, fallen logs, rooftops, woodpiles and decks.

In animals and humans, the eggs hatch in the intestine and the larvae migrate through the body. The three most common disease manifestations are larval migrations through the tissues, to the eyes (blindness) and the central nervous system (brain damage). Young children and persons with pica, (an abnormal desire to eat strange things like dirt) and those who are exposed to areas where raccoons defecate are most likely to get infected.

Treatment for this parasite is generally ineffective in preventing death. If the treatment is started early enough, it could kill the larva before it enters the central nervous system.

B. procyonis is found in both urban and rural environments. The prevalence varies on geographic area. It is most common in northern areas of the United States and decreases in the southern states, where it is rare or absent in raccoons in the Deep South.

How can you prevent this potentially life-threatening infection? According to the Centers of Disease Control and Prevention the following steps should be followed:

• Avoid direct contact with raccoons — especially their feces. Do not keep, feed, or adopt raccoons as pets! Raccoons are wild animals.

• Discourage raccoons from living in and around your home or parks by

-preventing access to food

-closing off access to attics and basements

-keeping sand boxes covered at all times, (becomes a latrine)

-removing fish ponds — they eat the fish and drink the water

-eliminating all water sources

-removing bird feeders

-keeping trash containers tightly closed

-clearing brush so raccoons are not likely to make a den on your property

• Stay away from areas and materials that might be contaminated by raccoon feces. Raccoons typically defecate at the base of or in raised forks of trees, or on raised horizontal surfaces such as fallen logs, stumps, or large rocks. Raccoon feces also can be found on woodpiles, decks, rooftops, and in attics, garages, and haylofts. Feces usually are dark and tubular, have a pungent odor (usually worse than dog or cat feces), and often contain undigested seeds or other food items.

• To eliminate eggs, raccoon feces and material contaminated with raccoon feces should be removed carefully and burned, buried, or sent to a landfill. Care should be taken to avoid contaminating hands and clothes. Treat decks, patios, and other surfaces with boiling water or a propane flame-gun. (Exercise proper precautions!) Newly deposited eggs take at least 2-4 weeks to become infective. Prompt removal and destruction of raccoon feces will reduce risk for exposure and possible infection.

This disease is considered uncommon in humans, but it is probably more common than documented. The number of infected raccoons and the increased likelihood humans come into contact with raccoons and their feces makes me believe it may be more prevalent than thought.


Staph food poisoning outbreaks linked to Illinois bakery

The Illinois Department of Public Health (IDPH) issued a news release yesterday warning the public about contaminated bakery goods from a Lincolnwood, Illinois bakery.

Outbreaks of staphylococcal food poisoning have afflicted about 100 people and have been linked to bakery goods from Rolf’s Patisserie.

According to the news release, pastry products from Rolf’s Patisserie were dessert items at four recent outbreaks at various events. Rolf’s is a wholesale and retail sales bakery.

In cooperation with the IDPH, Rolf’s has temporarily closed for the investigation; in addition, they voluntarily recalled all bakery products made after November 1st.

Staphylococcal food intoxication, it’s not an infection, is caused by several of the enterotoxins of Staphylococcus aureus. These toxins are heat-stable and cannot be killed by cooking.

People typically get this usually abrupt food poisoning through eating a food stuff that contains the staphylococcal enterotoxin, especially foods that come in contact with food handler’s hands, either without subsequent cooking or inadequate heating or refrigeration.

Foods most commonly implicated are pastries, custards, salad dressings, sandwiches and meat products. When these foods remain at room temperature for a period (usually a several hours) prior to consumption, the staph bacteria are allowed to multiply and produce the toxin.

The time between eating the offending food product and the onset of symptoms is short, from 30 minutes to 8 hours.

This intoxication presents itself quickly with sometimes violent onset; severe cramps, nausea, vomiting and often accompanied by diarrhea. The illness typically lasts a day or two. Serious complications and deaths are rare.

In an outbreak setting like this, recovery of large amounts Staphylococcus aureus or detection of enterotoxin from the implicated food confirms the diagnosis.

Prevention of staphylococcal food poisoning requires:

•Food handlers must be educated about strict food hygiene, temperature control, handwashing, and sanitation.
•Also the dangers of working with exposed skin, nose or eye infections.
•Those workers with boils, lesions, or abscesses must be temporarily excluded from food handling duties.
•Reduction in food handling time, from initial preparation to service, to a minimum of 4 hours at room temperature. Also proper temperature control must be observed when storing food either hot or cold.

Monday, December 27, 2010

Sexually transmitted infections in children rise sharply in Australia’s NT

Numbers from the Northern Territory government show an alarming trend with sexually transmitted infections (STI) among children.

In children ages 10 to 14, there was a 30 percent increase in STIs in the first six months of 2010 as compared to the same period a year before.

In the children in this age group, there were 30 cases of gonorrhea, 35 cases of chlamydia and 34 of trichomoniasis.

And in children under the age of ten, the numbers may even be more disturbing. The number of cases of STIs doubled from January to June 2010 as compared to the same time the previous year.

According to the government figures, there were 9 cases of chlamydia and four cases of trichomoniasis in children under the age of ten.

Read more about these 3 STIs below:

Trichomonas: the sexually transmitted parasite

Syphilis: a reemerging issue in Florida

Gonorrhea: the "clap" making a comeback


Al Qaeda considered biowarfare via the salad bar

This is according to initial reports from CBS News. The Department of Homeland Security (DHS) has confirmed that Al Qaeda in the Arabian Peninsula was at least considering poisoning salad bars in hotels and restaurants.

The DHS goes on to say that based on the information they had, the terror group was looking at the possibility of placing the serious poisons ricin and cyanide into certain food supplies like restaurant salad bars.

The CBS report says the unnamed source was credible, however DHS officials did not believe the planning for such a devious tactic was in any advanced stage.

US officials did however downplay the Al Qaeda group’s ability to carry out such an act.

But such a terrorist ploy is relatively simple and has been done before in this country. More than a quarter of a century ago in The Dalles, Oregon, this is exactly what was done by the cult the Rajneeshees, in an effort to influence elections in Wasco County.

The cult reportedly either contaminated the salads or the salad dressing with the bacterium salmonella, causing hundreds to get sick.

Read more about that case at: “25 years ago: bioterrorism at the salad bar”

Friday, December 24, 2010

What you need to know about rabies

What is rabies and how do you get it?

Rabies is an acute viral infection that is transmitted to humans or other mammals usually through the saliva from a bite of an infected animal. It is also rarely contracted through breaks in the skin or contact with mucous membranes. It has been suggested that airborne transmission is possible in caves where there are heavy concentrations of bats.

What types of animals are considered high risk for having the virus?

According to the Control of Communicable Diseases Manual, all mammals are susceptible to rabies. Raccoons, skunks, foxes, bats, dogs, coyotes and cats are the likely suspects. Other animals like otters and ferrets are also high risk. Mammals like rabbits, squirrels, rodents and opossums are rarely infected.

How do infected animals appear?

They can appear very aggressive, attacking for no reason. Some may act very tame. They may looks like they are foaming at the mouth or drooling because they cannot swallow their saliva. Sometimes the animal may stagger (this can also be seen in distemper). Not long after this point they will die. Most animals can transmit rabies days before showing symptoms.

What type of symptoms will it cause in humans?

Initially, like in many diseases, the symptoms are non-specific; fever, headache and malaise. This may last several days. At the site of the bite there may be some pain and discomfort. Symptoms then progress to more severe: confusion, delirium, abnormal behavior and hallucinations. If it gets this far, the disease is nearly 100% fatal.

Now you know about the symptoms of rabies, you know which animals are most likely to be at risk for having this deadly virus and how these animals may or may not act. The next step is understanding prevention.

Now you know about the symptoms of rabies, you know which animals are most likely to be at risk for having this deadly virus and how these animals may or may not act. The next step is understanding prevention.

The following recommendations can help protect your family and pets from rabies:

• Make sure you have your dogs, cats and ferrets vaccinated against rabies, and to follow your veterinarian’s instructions for revaccination.

• If you have a farm or ranch, ensure your horses and cattle are also vaccinated.

• Avoid contact with wild animals, never feed wild or stray animals

• Do not leave your pet’s food outside. Keep lids on garbage cans.

• If you have a pet door, ensure that it can be closed at night (skunks are notorious for coming into homes this way).

• Do not allow your pets to run free. Follow leash laws.

• If your animal is attacked by a wild, stray or unvaccinated animal, DO NOT examine your pet for injuries without wearing gloves. Wash your pet with soap and water to remove saliva from the attacking animal. Do not let your animal come into contact with other animals or people until the situation can be dealt with by Animal Control or the County Health Department.

You are always vigilant and try to avoid wild animals and unknown dogs and cats. However, one day you are out with the kids or walking the dogs and out of nowhere you are attacked by crazed dog. You beat it away but it takes a nasty bite out of you. What should you do?

First, clean the wound well with soap and water for 5-10 minutes. This will help reduce the chance of getting other bacterial infections and some studies show it can reduce the likelihood of getting rabies.

Next, get good description of the animal for Animal Control so it can be picked up for quarantine or rabies testing.

Go see your family physician or the emergency room. Though technically not a medical emergency, it is important to seek medical attention quickly so proper, timely treatment is given.

If you have to shoot or otherwise kill the animal, take care not to damage the head. The brain will be required for rabies testing.

Your doctor will evaluate the type of exposure (bite, scratch), and the type of animal that you had contact with. If post-exposure treatment is required it will likely be a combination of Rabies Immune Globulin (RIG) and Rabies vaccine. The RIG is given in one dose. RIG is basically pre-formed antibody that will provide immediate protection until you respond to the vaccine. The vaccine will help your body produce antibody to the virus, but this takes some time.

According to the CDC, the RIG should, if possible, be given around the wound itself. Any remaining RIG should be given intramuscularly away from the bite. Rabies vaccine is not like the old days, 20 shots in the stomach; instead it is 5 shots in the shoulder area.

Keeping your eyes open and keeping informed is the best way to prevent this deadly disease.

Researchers say ribavirin can be used for prophylaxis against Lassa

According to a study by researchers from the Tulane School of Public Health and Tropical Medicine, oral ribavirin is recommended for post exposure prophylaxis (PEP) after high risk exposure, such as contaminated needlesticks, to the Lassa virus.

According to the head researcher of the study, Dr. Daniel G. Bausch, the recommendation is based on a thorough literature review and plus much experience with the virus.

The conclusion the authors of the study come to does however contradict both World Health Organization’s (WHO) and the Centers for Disease Control and Prevention’s (CDC) who say there is no evidence to support the conclusion that the antiviral should be used for this purpose.

The study authors say that most doctors who see people at high risk of developing Lassa fever after becoming exposed to the virus would consider prescribing ribavirin for prophylaxis. They also go on to say that “these guidelines may also serve for PEP for other hemorrhagic fever-causing viruses like Junin, Machupo, Guanarito, Sabiá, Flexal and Crimean-Congo hemorrhagic fever.”

According to the CDC, Lassa fever is an acute viral illness that occurs in West Africa. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne.

Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease.

The animal host of Lassa virus is a rodent known as the "multimammate rat" of the genus Mastomys.

Humans get infected with Lassa through aerosol or direct contact with excreta from the rodent. Laboratory infections do occur primarily through contaminated needles.

The symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis.

Ribavirin is an antiviral drug used to treat a variety of viral infections alone (RSV) or in conjunction with other drugs (hepatitis C). It interferes with the RNA metabolism required for viral replication.

It's not a worm: it's a fungus among us

I can’t count how many times I’ve been asked over the years; I have ringworm on my arm, what kind of worm causes this? Ringworm infection is in fact caused by a group of fungi known as the Dermatophytes. This group of fungi cause infection limited to the keratinized layers of skin, hair and nails.Ringworm is also known as tinea infections or dermatophytosis of a particular part of the body; scalp, feet, etc.

The fungi that cause ringworm can be transmitted from person to person, from animal to person, from the environment and from inanimate objects like combs and shower stalls that are contaminated with the fungus.

I will briefly describe some of the most common sites for ringworm infection, how it’s transmitted and how it can be prevented.

• Tinea capitis: this is ringworm of the scalp (see picture below) but can also include eyebrows and eyelashes. This is primarily found in children. Common things you may see are scaly patches of temporary baldness. Infected hairs can become brittle and easily break off. It is transmitted by direct contact with skin, or contact with items that may contain infected hairs like the backs of chairs, combs, and brushes. Hats and clothing that have infected hairs from humans or animals can also be a source of infection. Check children and pets for signs of disease. Avoid contact with infected pets or people. Treated with oral anti-fungals.

Tinea corporis: ringworm of the body that appears as a flat, ring shaped spreading lesion with a red outer edge that may be dry or moist. Transmission is by either contact with human or animal lesions or contaminated shower stalls, benches and floors. It can be prevented by laundering towels and clothing, keeping showers and floors clean with disinfectants. This class of ringworm is also the cause of “jock itch” in the groin area.

Tinea pedis: this is ringworm of the feet or more commonly known as “athlete’s foot”. This form of ringworm is recognized by scaling and cracking of the skin, especially between the toes. This infection is transmitted primarily in contaminated shower stalls and floors and associated articles used by infected people. It can be prevented by strict personal hygiene, drying between toes after bathing, wearing flip-flops when using public showers and wearing cotton socks to help absorb sweat.

If you believe you or your child has ringworm infection, see your physician. Most times it can be presumptively diagnosed on symptoms and appearance. Confirmation is based on microscopic exam and culture of skin scraping, hairs or nail clippings. Most types can be easily treated with either topical or oral anti-fungals. Infected pets should also be treated.

So if you got little ones that play closely with the dog and cat or an older child that plays a contact sport, it’s good to be aware of the fungus among us.


A thorny situation: Fungal hazard in gardens called Sporothrix

April showers bring May flowers, and many of us will be working in the garden trying to beautify our yards. Gardening seems like it is a pretty safe pastime, however there are numerous hazards that can be encountered in the garden. You could come across a snake, hurt your back, get sunburn or get inoculated with a pathogenic fungus?

Sporothrix schenckii is a fungus that grows well in soil and other decaying vegetation. It is particularly associated with sphagnum moss (peat), hay, lumber and rose bushes, hence the nickname, “rose-gardener’s disease”.

It usually enters the skin through minor trauma like a thorn or splinter. It can less commonly be inhaled and cause pulmonary infection. Typically lesions will be found on the hands or forearms. The appearance of a small, painless red bump may present itself after several weeks. It may look like an insect bite or a boil and eventually ulcerates. It can spread via the lymph nodes up the arm or leg.

Disseminated infections of the disease may be seen (lungs or central nervous system) but that is usually restricted to those with an impaired immune system. In addition, alcoholics seem particularly prone to this infection.

The infection will not resolve itself and you will need to see your physician for appropriate treatment. Diagnosis is based on submitting a sample, usually a biopsy or swab, to a laboratory for a fungal culture. There are several anti-fungal medications available for treatment.

How can you prevent this disease? The use of gloves and wearing long sleeves will help prevent abrasions. Particular care should be taken if you have a compromised immune system, not only for Sporothrix, but several other infectious agents that could be present in your garden. Stay posted for info on these in future articles.

Happy gardening.

Want to cool off? Before you jump in that lake, beware of amoebas

Before you take the kids and try to cool off this summer at the lake in your town, you should know about Naegleria fowleri. This relatively rare, pathogenic amoeba is found in warm or hot freshwater like lakes, rivers and hot springs. It is also possible to get it from dirty unchlorinated or under-chlorinated swimming pools. This parasite is found worldwide and in the United States, it is found in mainly in the southern-tier states, including Florida. There were 6 cases reported to the CDC in 2007, 3 being reported from Florida.

How do you get this microscopic creature and what exactly does it do to you? People typically get it by swimming, jumping or playing in freshwater and get the water up their nose. From there the parasite travels to the brain and spinal cord and necrotizes or basically eats brain tissue. The disease is known as primary amoebic meningoencephalitis (PAM) and it has a very rapid progression. Typical symptoms may start after a day or two; headache, fever, nausea and vomiting. Later symptoms may include seizures, irrational behavior, hallucinations and finally coma and death. The course of the disease typically last about a week. Because the symptoms are very similar to bacterial meningitis, PAM may not even be considered in the diagnosis.

Fortunately, it’s a pretty rare disease, with only approximately 30 cases in the past decade. Unfortunately, treatment is usually unsuccessful with only a handful of people surviving infection.

You should always assume there is some risk when swimming in freshwater. The location and number of amoeba present in a body of water varies from time to time. The Centers of Disease Control and Prevention recommends these four steps to reduce your risk of infection:

• Avoid water-related activities in bodies of warm freshwater, hot springs, and thermally-polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.

Thursday, December 23, 2010

United Kingdom releases report on Travelers’ diarrhea

The United Kingdom's Health Protection Agency (HPA) has released a comprehensive report on the wheres and what’s of travelers’ diarrhea (TD).

The 22 page report entitled, “Foreign travel-associated illness: a focus on travelers’ diarrhea” discusses data sources, findings, etiological agents and countries of risk for travelers. In addition, it includes some preventive measures that are applicable to all foreign travelers.

Here I would like to summarize some of the most interesting findings in the report:

•Of the 24,000+ laboratory-confirmed cases of travelers’ diarrhea reported from 2004-2008, the vast majority were bacterial causes. The true number is likely much higher.
•Approximately half of the cases were due to non-typhoidal Salmonella spp.
•Campylobacter represented a quarter of the cases, while Shigella was at 14%
•Of the parasitic causes of TD, Giardia was the highest accounting for 6% of total laboratory-confirmed cases.
•The risk of acquiring TD when traveling from a high income country to a low income country has been reported to be as high as 60% depending on the destination.
•High risk zones for catching TD were in Africa, Latin America, the Middle East and most of Asia.
•The top 5 countries where UK travelers went and acquired TD were: Egypt, Turkey, Thailand, India and Spain.
•Worldwide, the risk of getting a laboratory-confirmed TD is 8 for every 100,000 visits. The highest by region was traveling to the Indian subcontinent where there were 60 cases for 100,000 visits.
•E.coli was not listed in the report for a variety of reasons.

The end of the report offers some common sense though important prevention advice for travelers. It closes with…

‘Boil it, cook it, peel it, or forget it!’

Wednesday, December 22, 2010

Kroger recalls pet food due to aflatoxin

The grocery store chain Kroger has recalled several pet food products that may have been distributed to more than a dozen states.

Kroger issued the recall press release yesterday and the different brand names affected by the recall include Pet Pride, Old Yeller and Kroger Value brands (see press release for specific product information and locations).

The pet food is being recalled because they may contain aflatoxins. According to a statement from Kroger:

"If your pet shows any symptoms of illness, including sluggishness or lethargy combined with a reluctance to eat, yellowish tint to the eyes and/or gums, and severe or bloody diarrhea, please consult your veterinarian immediately"

This mycotoxin (aflatoxin) is a natural toxin produced as a secondary metabolite to certain strains of the fungus Aspergillus, in particular Aspergillus flavus and Aspergillus parasiticus.

The toxin is then excreted onto plants or pre-processed foods, some intended for human consumption.

Aflatoxins are contaminants of foods intended for people or animals as a result of fungal contamination. The most common foods implicated are cereals like corn, wheat and rice, oilseeds like peanuts and sunflower, and spices. However, the toxin can affect a very wide range of food stuffs.

Aflatoxin poisoning can be broken down into acute and chronic disease depending on the amount of toxin ingested. When people (or animals) ingest aflatoxin contaminated foods, the liver is the main target for disease.

There is a direct link between aflatoxin poisoning and liver cancer. Liver cancer or hepatocellular carcinoma is an important public health concern in many parts of the world due to aflatoxin.

Customers who have purchased the products can return them for a refund.

Tuesday, December 21, 2010

Measles acquired at Taize, France

I previously wrote about the risk of infectious diseases at large mass gatherings about a month prior to the annual Muslim pilgrimage to Mecca called the Hajj. Respiratory acquired diseases like tuberculosis, influenza and meningitis are a common issue at gatherings such as this.

So to piggy-back on that, in Germany, numerous cases of measles were identified in unvaccinated pilgrims who went to the ecumenical Christian gathering at Taize, France.

At least 13 primary cases of measles, all in young, unvaccinated people ages 9-32 were either clinically or laboratory confirmed.

This just underscores the importance of vaccinating non-immune young people and the risks of imported and long-distance spread of infectious diseases.

Taize is one of the most important sites of Christian pilgrimage where thousands of young Protestants and Catholics join for communal work and study.

Measles or rubeola, is an acute highly communicable viral disease that is characterized by Koplik spots in the cheek or tongue very early in the disease. A couple of days later a red blotchy rash appears first on the face, and then spreads, lasting 4-7 days. Other symptoms include fever, cough and red watery eyes. The patient may be contagious from four days prior to the rash appearance to four days after rash appearance.

The disease is more severe in infants and adults. Complications from measles which is reported in up to 20% of people infected include; seizures, pneumonia, deafness and encephalitis.

Wrestler R-Truth hospitalized with convulsions due to walking pneumonia

The professional wrestling website,, has reported that R-Truth, real name Ronnie Aaron Killings, was rushed to the hospital with convulsions as a result of a bout of walking pneumonia.

“WWE Superstar R-Truth is currently suffering with walking pneumonia which caused him to break out into convulsions last week reports The Wrestling Observer Newsletter. The RAW Superstar was rushed to hospital and was told quick acting colleagues may have saved his life after it was reveled oxygen was not reaching his brain, had he been on his own things might have been very different. It is being reported that Truth has been suffering from travel fatigue of late.”

What is walking pneumonia?

Walking pneumonia is a very common type of respiratory illness, with an estimated 2 million cases annually in the United States, caused by Mycoplasma pneumoniae. The mycoplasmas are the smallest known free-living bacteria and are unique because they lack a cell wall.

“Walking pneumonia” is an atypical pneumonia and gets its name from the fact that people infected can usually go through their day doing the things they normally do, unlike the more severe, traditional types of pneumonia.

Mycoplasma pneumoniae is found worldwide and can be seen in epidemics like in military populations. Outbreaks also occur in schools and households. It typically infects people age 40 and younger. Some studies suggest that this organism causes up to 50% of all pneumonias.

People get infected likely through droplet inhalation (by respiratory means) and direct contact with infected people.

Symptoms of “walking pneumonia” are gradual in onset. Headache, malaise, fever, cough, sore throat and shortness of breath are some common symptoms. Ear and eye pain, and a rash are sometimes experienced.

In more severe cases, the pneumonia may progress from one lobe to the other. Hemolytic anemia, serious pneumonia and central nervous system complications like encephalitis are rare but can occur.

Most cases of Mycoplasmapneumoniae are self-limiting and do not require antibiotic treatment. However, without antibiotic treatment, you may feel sick for a month or more. Because Mycoplasma pneumoniae lacks a cell wall, it cannot be treated with penicillins. To shorten the course of illness or for more serious infections, effective treatments are erythromycin, clarithromycin and azithromycin.

Monday, December 20, 2010

Baywatch star Donna D’Errico hospitalized with MRSA

Former Baywatch star and playmate Donna D’Errico has reportedly been hospitalized with an infection with the antibiotic-resistant bacterium, MRSA.

It has been reported that D’Errico picked up the bug while visiting a relative at a hospital ICU.

It is unclear how serious her infection is, but according to her Facebook page she wrote the following: "Prayer request - this time for me - a serious medical issue has arisen. Thank you for any and all prayers." She is expected to remain in the hospital for at least 1-2 more days.

Staphylococcus aureus is a bacterium found colonizing (without causing infection) the skin and nose in one quarter to one third of people.

Methicillin –resistant Staphylococcus aureus (MRSA) is a highly resistant type in which beta-lactam antibiotics (penicillins and cephalosporins) are useless in treatment.

What was once restricted to hospital infections, MRSA is becoming increasingly common in community acquired infections.

MRSA is primarily spread person to person via close skin contact, through cuts and abrasions and poor hygiene.

MRSA was first seen in the United Kingdom in 1961. Today there are approximately a million cases seen in the U.S. annually.

For MRSA prevention recommendations see the link from the CDC

Sunday, December 19, 2010

Hillsborough County, Florida reports an increase in Shigella cases

The Hillsborough County Health Department (HCHD) in Tampa, Florida sent out letters to health care providers yesterday warning them of an increase in Shigella cases in the county.

They report that there have been 40 cases confirmed since the beginning of October. Hillsborough County has not seen numbers like this since 2005.

The vast majority of cases (75%) have been seen in person’s ages 0-18. There have not however been any reported outbreaks of the gastrointestinal infection in child care centers or schools to date.

The typical symptoms to look for are:

•Watery (occasionally bloody) diarrhea
•Abdominal cramps/pain
•Duration of illness: 3-7 days

The HCHD is also reporting a significant increase in Norovirus infections in the county and state and since some of the symptoms between Shigella and Norovirus overlap, they suggest that health care providers consider testing for both agents.

Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. Most cases of Shigella are mild, however severe complications can occur. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.

More severe complications may include dehydration, convulsions in children, Reiter's syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.

This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor; day care centers are a great example where objects like bathroom faucet handles, doorknobs, or toys can easily get contaminated.

It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those that are primarily responsible for transmission are those that fail to wash their hands thoroughly after defecation. Thorough handwashing is the key in preventing the spread of shigellosis.

Because Shigella is resistant to stomach acid, a person can get infected with as little as 10 organisms.

After getting infected; symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection till approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.

Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.

Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic will be effective.

Saturday, December 18, 2010

The hygiene hypothesis and the use of hookworms to prevent allergic reactions

More and more people have subscribed to David Stractan’s theory known as the hygiene hypothesis, and now a small but growing number of people suffering from certain illnesses have taken hold of helminthic therapy to cure there ills.

Stractan describes the hygiene hypothesis by essentially saying that people in the West in particular, because of good sanitation, vaccines and hygiene are not exposed to certain infectious microorganisms (bacteria, viruses and parasites) in childhood that make them more susceptible to allergies and autoimmune diseases.

In contrast, proponents of this theory say that many countries in Africa, South America and Asia do not have high levels of these type of diseases and disorders because they are exposed to parasites, probiotics and other gut flora.

A treatment/therapy not approved in the United States for allergies and autoimmune/immune issues like eczema, hay fever, inflammatory bowel disease and a host of others is called helminthic therapy.

How does it work?

According to University of Iowa gastroenterologist, David Elliot, MD, the helminth, or roundworm (most often used types are hookworms and whipworm) when attacked by the human immune system, the worms send out a protective “cocktail” of chemicals that calms down the immune response. Because of this slowed immune response, it appears that allergic reactions and inflammatory diseases happen less often.

Is there a danger in purposely infecting yourself with these parasites?

One company out of Europe, Autoimmune Therapies, says there is little to no danger from small, therapeutic doses of hookworm or whipworm.

On the website for Autoimmune Therapies, they even quote the US Centers for Disease Control and Prevention (CDC) where they advise against doctors treating light infections with these parasites.

Owner Jasper Lawrence also goes on to say that this therapy is well tolerated and maintaining a healthy diet while using hookworms poses no risk.

In addition, because of the specific life cycles of Necator americanus (hookworm) and Trichuris trichuria (whipworm), the initial dose you take will be all the parasite you’ll get since they will not reproduce and increase in numbers.

Lawrence also goes on to say side effects are minor; maybe an itch where the hookworm enters and a day or two of mild diarrhea.

Of course there are critics of this “therapy” who say that deliberate infection with helminthes “makes absolutely no sense at all” and that it’s based on “flawed reasoning”.

However, there are those who swear by it. Here are a couple of comments from another web site:

“My first dose of 35 hookworms greatly improved my multiple chemical sensitivity symptoms (rash, irritability, and restless leg syndrome) and my asthma. I have high hopes that my second dose (of 35 more) will bring further improvements. Dr. Hotez’s arguments against helminthic therapy make no sense: he says helminthic therapy is dangerous because helminths are dangerous in the wild. But the dangers in the wild are the result of hundreds or thousands of worms in each person, compared to the dozens of worms in helminthic therapy. And the worms cannot reproduce in the body (they must live part of their life cycle in the soil) so there is NO danger of over-dosing, or of passing on the worms (because toilets eliminate the soil portion of the life cycle and end the spread of worms.)”

“I was also able to achieve remission from Crohn’s after getting hookworms and whipworms.”

I am not here to support or oppose helminthic therapy, just reporting that it’s out there and there has been some research done on it. You need to do your own research and judge for yourself.

Friday, December 17, 2010

Argentina sees unusual cases of cysticercosis

Four cases of cysticercosis have been detected by the Infectious Diseases, Neurology and Pediatric Service at the Adolfo Margara Local Hospital in Trelew with several other cases suspected and still under observation.

The infected people, 2 adults and 2 eight year old children are all foreign born. One girl was admitted with seizures and a CT scan revealed parasitic cysts in the brain (neurocysticercosis).

Cysticercosis is not endemic in this region of the country.

Dr. Juan Carlos Villalba suspects the infections are related to fresh fruits and vegetables since those infected belong to families that work the fields in rural areas where fruits and vegetables are grown and flood irrigation is used.

The drugs used to treat cysticercosis are not available in Argentina.

What is the pork tapeworm?

Taenia solium is a tapeworm that people get from eating raw or undercooked “measly pork”. The pork meat has cysticerci (the larval stage) which in the human intestine mature to an adult tapeworm. Here the tapeworm attaches to the intestine and produces thousands of eggs.

Does the pork tapeworm cause disease while in the intestine?

Most people are asymptomatic and only become aware of the tapeworm by noticing segments of the worm in their feces. Symptoms of infection, if any, are general: nausea, intestinal upset, vague abdominal symptoms such as hunger pains, diarrhea and/or constipation, or chronic indigestion.

What is cysticercosis?

Human cysticercosis occurs either by the direct transfer of Taenia solium eggs from the feces of people harboring an adult worm to their own mouth (autoinfection) or to the mouth of another individual, or indirectly by ingestion of food or water contaminated with the eggs. When the person ingests the eggs, the embryo escape from the shell and penetrates the intestinal wall, gets into the blood vessels, where they spread to muscle, or more seriously, the eyes, heart or brain.

How serious is cysticercosis?

The severity of cystercercosis depends on which organs are infected and the number of cysticerci. An infection consisting of a few small cysticerci in the liver or muscles would likely result in no obvious disease and go unnoticed. Those that form in voluntary muscle tend to be asymptomatic, but may cause some pain. On the other hand, a few cysticerci, if located in a particularly "sensitive" area of the body, might result in irreparable damage. For instance, a cysticercus in the eye might lead to blindness, or a cysticercus in the brain (neurocysticercosis) could lead to traumatic neurological damage, epileptic seizures or brain swelling that can kill.

Is this a problem in the United States?

This condition is relatively common in Mexico and large parts of Central America. It is seen most frequently in the Southwest U.S., but can be seen in other parts of the country. It is most frequently associated with immigrants to this country.

How long after infection do symptoms of cysticercosis appear?

It may be as short as a few weeks or up to 10 years or more.

Is it treatable?

It can be treated with anti-parasitic drugs like praziquantel and steroid therapy to control brain swelling. Occasionally surgical intervention may be required to relieve symptoms.

How do you prevent this disease?

In the U.S., laws have been passed that requires meat inspection for cysticerci prior to meat being put on the market of human consumption.

Adequate cooking of meat destroys the tapeworm larvae and will prevent infection by tapeworm. Freezing meat to -5C for 4 days, -15C for 3 days, or -24C for 1 day kills the larvae as well.

Good hygiene and hand washing after using the toilet will prevent self-infection in a person already infected with tapeworms in addition to contamination of foodstuffs by human feces.

Thursday, December 16, 2010

Cebu, Philippines town facing typhoid outbreak

The town of Alegria on the Visayan island of Cebu is experiencing an outbreak of typhoid fever which has affected over 200 people so far.

A medical team from the Department of Health went to the town of 20,000 with medical supplies including antibiotics to assist in the outbreak.

Though not all cases have been laboratory confirmed, according to Dr. Cristina Giango, chief of the Integrated Provincial Health Office (IPHO) in Cebu province said there were 221 cases of probable typhoid fever.

Dr Giango goes on to say that though the situation is “alarming”, the IPHO and DOH have taken measures to stop the spread of the disease.

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Wednesday, December 15, 2010

Human Streptococcus suis infections from eating raw pork

Out of Thailand, the Information Center for Emerging Infectious Diseases at Chulalongkorn University has reported 3 additional cases of human Streptococcus suis infection in the southeast Asian nation. There have been a couple dozen cases in Phetchabun province this year with 5 fatalities.

The reported source of the infections was a Laotian and Thai meat salad called “Larb” or “Lu Mu”. The salads in these cases were made with raw pork and raw pork blood.

Dr. Sirichai Phataranuthaphon, director of Lampang Provincial Health Office, warns the public not to eat raw meat such as that in the offending dishes because of the risk of potentially life-threatening infection.

Human Streptococcus suis infection is a zoonotic infection associated with pigs. The infection can be fatal particularly if the specific strain produces certain toxins. S. suis infection can manifest itself in meningitis, toxic shock and endocarditis.

Proper cooking of pork meat or porcine organs eliminates the risk of infection with Streptococcus suis. The infection in humans is not only seen in those who consume raw pork, but also in those who slaughter and prepare the meals.

It does not appear to be transmitted from person to person.

Tuesday, December 14, 2010

Using nuclear technology to prevent African sleeping sickness

The International Atomic Energy Agency (IAEA), the international organization probably best known for its non-proliferation mandate, also does some work to help combat one of the most deadly diseases known.

African sleeping sickness affects as many as 500,000 people, 80 percent of whom eventually die, and kills 3 million livestock every year causing more than $4 billion in economic losses annually.

The vector that spreads the deadly parasite is the very aggressive tsetse fly. It is said that in parts of Africa where the landscape is fertile, the tsetse fly has created a “green desert”.

The development of vaccines for humans or animals against sleeping sickness has been futile because once the parasite makes its way into the bloodstream they are able to change the outer protein coat they wear into at least 1000 variants. Drugs that prevent the onset of sleeping sickness and the drugs available to treat it are highly toxic or difficult to administer.

So what does the IAEA have to do with preventing African sleeping sickness?

It is using nuclear technologies to sterilize the tsetse fly vector. The principle of the Sterile Insect Technique (SIT) is that fertile insects are unable to produce normal offspring when they have mated with a sexually sterile partner. Insects can be sterilized by treating them with mutagenic agents (e.g. gamma rays). Such individuals, partially or totally sterile, are released into a native insect population. The greater the ratio of sterile to native insects, the greater the chance of a rapid population suppression.

Two varieties of African sleeping sickness exist: one primarily in East Africa caused by the parasite Trypanosoma brucei rhodesiense. T.B. rhodesiense produces an acute infection that will usually cause severe illness and death in weeks to months.

The other species is Trypanosoma brucei gambiense. This parasite is found in West and Central Africa. However, the 2 species are showing some geographic overlap.

This infection progresses more slowly and may require months to years for disease to occur.

Both types of sleeping sickness are caused by the bite of a tse tse fly. These vicious little bugs depend on blood meals for its nutrients. It gets the blood from mammals including humans. The tse tse fly has a very painful bite and you will certainly remember getting bit.

When taking a blood meal, the fly injects the parasite into the skin. From here the parasite is carried to the lymphatic system and eventually the bloodstream.

They go through stages in the body and eventually end up in the spinal fluid if appropriate, timely treatment is given. The treatment options for sleeping sicknessdepends on which stage the disease is in, blood stage or CNS stage. Treatment should begin as soon as possible.

Diagnosis of African sleeping sickness is based on finding the parasite in blood, spinal fluid or lymph node aspirates.

Monday, December 13, 2010

Overexposure to antibacterial soaps and the impact on the immune system (podcast)

According to a study by the University of Michigan School of Public Health, young people who are overly exposed to certain chemicals found in antibacterial soaps, toothpastes and plastics may have immune systems that are not functioning properly.

The two chemicals looked at, Triclosan and Bisphenol A (BPA) which are found in numerous products which are considered endocrine-disrupting compounds (EDCs), which are thought to negatively impact human health by mimicking or affecting hormones.

For people under 18, too much triclosan can have an impact on our exposure to micro-organisms that are beneficial for development of the immune system. In addition, they found that young people with higher levels of triclosan were more likely to report diagnosis of allergies and hay fever.

According to Allison Aiello, associate professor at the U-M School of Public Health and principal investigator on the study, “as an antimicrobial agent found in many household products, triclosan may play a role in changing the micro-organisms to which we are exposed in such a way that our immune system development in childhood is affected.”

She goes on to say, “it is possible that a person can be too clean for their own good."

The study also illustrates that the timing of the exposure to BPA (at what age) and perhaps the quantity and length of time we are exposed to BPA may be affecting the immune system response.

Here they compared urinary BPA with cytomegalovirus (CMV) antibody levels and it appears that age matters. In people 18 or older, higher amounts of BPA were associated with higher CMV levels, but in people younger than 18 the reverse was true.

So the question remains, could we be too clean for our own good? More work needs to be done.

The paper, "The Impact of Bisphenol A and Triclosan on Immune Parameters in the U.S. Population," appears online in Environmental Health Perspectives

Listen to the podcast here

Sunday, December 12, 2010

Bird flu in the news

In Dakahlia governorate, Egypt, a 30 year old man has died at the al-Sadr hospital in Zagazig due to suspected avian influenza. He is the 12th person to die of bird flu in Egypt this year, and the 38th fatality since 2006.

The man was one of 5 suspected cases of avian influenza being treated at this time.

In Indonesia, they have a confirmed case of H5N1 avian influenza in a 21 year old admitted to the Hasan Sadikin Hospital in Bandung.

The patient was in the ICU and now is steadily improving to the point that assisted respiration has been terminated.

H5N1 avian influenza follows an unusually aggressive clinical course, with rapid deterioration and high fatality. The clinical disease follows this course: high fever (38C), diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. Difficulty in breathing develops around five days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody.

Doctors have observed respiratory failure three to five days after symptom onset. Another common feature is multi-organ dysfunction.

Thursday, December 9, 2010

“Patient Zeta”, Derrick Burts discusses condom use and STIs

The once unknown porn actor who contracted HIV known only as “Patient Zeta” has come out as 24 year old Derrick Burts. And now Mr. Burts wants some changes in the porn industry to protect actors from sexually transmitted infections (STI).

Burts, star of both straight and gay porn contracted HIV over a month ago says he wishes he knew more about the risks of getting STIs. He is now an advocate of mandatory condom use in all pornographic movies.

Burts says, “It is very dangerous. It should be required that you wear a condom on the set." In addition to catching HIV, Burts also revealed contracting Chlamydia, gonorrhea and herpes in the months prior to his HIV revelation.

So, how effective is condom use in preventing sexually transmitted infections?

Though not a perfect preventive measure, they do significantly reduce the chance of transmission. The National Institutes of Health says condom use reduces the risk of contracting the virus by 85%.

Strict, consistent condom use is also very effective against Chlamydia and gonorrhea. However, certain STIs like herpes and human papilloma virus can still be spread if the condom does not cover all infected skin. These viruses are spread via skin to skin contact.

Wednesday, December 8, 2010

Delhi, India: polio virus detected in city’s sewage

Health officials in Delhi were alarmed by the finding of polio virus in the city sewage during routine sewage surveillance last spring. Samples have been sent to the World Health Organization for further study. Surveillance samples taken since April have not been positive for the virus.

There have been no human cases of polio in Delhi in 2010. But according to Dr. C.M. Khanijo, chief of the polio cell in Delhi, “Polio spreads through fecal-oral route and can be found in fecal particles present in sewage. So, even when no human cases are reported, sampling from the environment can alert health authorities.”

According to professor of community medicine Dr. Bir Singh, the detection of polio virus in sewage indicated that the virus had not been eradicated completely, and it could be a potential source of infection to those who have not been immunized.

India is only one of four countries who had not succeeded in interrupting transmission of polio; Afghanistan, Nigeria and Pakistan are the others.

Polio is caused by the poliovirus types 1, 2 and 3. All three types cause paralysis, with wild poliovirus type 1 being isolated from paralysis cases most often.

This viral infection is primarily spread from person to person through the fecal-oral route. However, in places where sanitation is very good, transmission though throat secretions may be considered more important.

Polio is recognized in about 1 percent of infections by flaccid paralysis, while over 90 percent of infections are unapparent.

Paralysis of poliomyelitis is usually asymmetric and the site of paralysis depends on the location of nerve cell destruction on the spinal cord or brain stem. Legs are affected more often than the arms. Paralysis of the respiration can be life threatening.

Prevention of polio is through immunization, either through the live oral poliovirus vaccine (OPV) or the inactivated poliovirus vaccine (IPV).

Midland, Texas health officials warn public about increased Shigella cases

Midland Health Department Manager, Sal Garcia reports that since October, they have seen 53 cases of the bacterial disease. This is 10 times the number of cases that is seen in a typical October.

Garcia said they informed the medical community about the surge in cases after it saw a spike starting in late August. After cases failed to decline, though, they decided this week to alert citizens and ask for their help in squelching the infection from spreading.

What is Shigellosis?

It is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.

It can cause bacillary dysentery because of the invasive ability of the organism that may result ulcerations and abscesses of the intestines.

It rarely spreads to the bloodstream.

More severe complications may include convulsions in children, Reiter's syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.

This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor: prisons, day care centers and refugee camps are three examples.

It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those that are primarily responsible for transmission are those that fail to wash their hands thoroughly after defecation.

Because Shigella is resistant to gastric acid, a person can get infected with as little as 10 organisms.

After getting infected symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection till approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.

Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.

Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic will be effective.

Monday, December 6, 2010

Fear of vaccines is breaking down herd immunity

This is according to a presentation by Paul A. Offit, MD at the 23rdAnnual Infectious Diseases in Children symposium held in Philadelphia last month.

Offit, the Chief of Infectious Diseases and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia notes that a fear of vaccines and a anti-vaccine movement in the US has resulted in a breakdown of herd immunity and significant outbreaks of vaccine-preventable childhood diseases in this country.

As the fear of vaccines increases, more and more people will become susceptible to these vaccine-preventable diseases.

He discussed the historical timeline of the fear of vaccines beginning with yellow fever in the 1940s up to the 1982 documentary, “DPT: Vaccine Roulette”. This one hour film gave rise to groups such as Dissatified Parents Together and others. In addition, the book by Barbara Loe Fisher, “DPT: A Shot in the Dark” added to this fear (see video to the left).

Offit says that the different viewpoints should be acknowledged but different strategies must be employed to highlight the importance of immunization against these vaccine-preventable diseases.

With the introduction of every new vaccine comes the concern of new adverse events whether it is autism, SIDS, seizures, diabetes and strokes depending on the vaccine.

But with all this fear we are seeing as Offit describes as the tipping point where there is a critical breakdown in herd immunity as evidenced in recent epidemics in measles, mumps and now the most recent 2010 pertussis outbreaks.

According to Offit, physicians need to educate parents on the importance of vaccinations of their children. He goes on to say, “You can argue that one should simply do the best you can to get your patients vaccinated. Be passionate. It’s OK to comfort parents with the science of vaccines, but frame that in an emotional and passionate way.”

Saturday, December 4, 2010

Jacksonville woman infected with falciparum malaria

A 31 year old Jacksonville woman with no history of international travel has been diagnosed with the most serious form of malaria, Plasmodium falciparum.

The Duval County Health Department’s Epidemiology department is currently trying to determine if the infection was acquired in the local area.

All of the 111 cases of malaria reported so far this year have been considered imported cases. If this case is proven to be locally acquired, it will be the first such case in Duval County in a decade.

It would be considered unusual to have a locally acquired case of falciparum malaria because of such stringent mosquito control in the county and the state as a whole.

However, seeing single cases in countries like the United States can happen if climatic conditions are favorable, an asymptomatic human carrier is available and the appropriate vector is present.

According to the Centers for Disease Control and Prevention (CDC), about 1,300 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from malaria-risk areas, many from sub-Saharan Africa and South Asia.

Human malaria is considered a tropical disease, but some cases happen outside the tropics. Most cases are found in Southeast Asia, China, India, and Africa, parts of the Middle East, Mexico, Central and South America.

For malaria to occur you must have the following; a susceptible population, malaria carriers and the right mosquito vector (the female Anopheles mosquito).

The disease may manifest itself after an incubation of days to months. Once the parasites build up in the blood, symptoms are non-specific; fever, chills, body aches, diarrhea and vomiting. At this point the only way to confirm is finding the parasites in blood. These early stages resemble many other febrile diseases.

Paroxysms (due to rupture and release of the parasite and metabolic products into the system), happen every 48-72 hours depending on the species.

There is a cold stage which leads to teeth chattering, shaking chills followed by a hot stage (fever) where temperatures may reach 106°F. Convulsions may develop particularly in children.

Untreated P. falciparum (the life-threatening species) can lead to severe malaria. Severe malaria is characterized by cerebral malaria, severe anemia, renal filure (black water fever), respiratory distress and bleeding disorders and shock.

Prompt treatment for falciparum malaria is essential because death from cerebral complications may occur.

Friday, December 3, 2010

CDC issues travel notice for Dominican Republic because of cholera

The Centers for Disease Control and Prevention (CDC) issued a travel notice today for US travelers going to the Dominican Republic.

It has been reported that since November 16th, Dominican Republic health officials have confirmed several cases of cholera in the country. The Dominican Republic is on the island of Hispaniola next to cholera plagued Haiti.

Currently the CDC and US State Department have not issued any travel warnings for the country and say the risk of cholera is still low. However, caution should still be exercised.

The CDC advises travelers to follow 5 simple steps to prevent cholera:

1.Drink and use safe water
2.Wash your hands often with soap and safe water
3.Use toilets; do not defecate in any body of water
4.Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables
5.Clean up safely—in the kitchen and in places where the family bathes and washes clothes
Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.

The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.

Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.

Read more details about the CDC recommendations

Thursday, December 2, 2010

Cryptosporidium outbreak in Sweden causes more than 2000 to get sick

The intestinal parasite, Cryptosporidium has caused more than 2000 people in the Swedish town of Ostersund to become ill. The citizens contracted the parasite through the municipal water supply.

Some believe the contamination of the water supply may be a case of criminal negligence and an investigation is underway.

One person who believes this is Environmental prosecutor Christer B. Jarlas. Jarlas said He said he has reason to believe that the contamination was due to carelessness by one or several individuals who didn't have control of their operations.

The city of 50,000 is under a boil water advisory which may last for a few weeks.

Cryptosporidium is a protozoan parasite of both medical and veterinary importance. There are two species associated with human infection; Cryptosporidium parvum and C. hominis.

Infection with Cryptosporidium represents a wide range of severity from asymptomatic infections to life-threatening diarrhea. Asymptomatic infections are a likely source of infection for other people.

The diarrhea is profuse and watery and is associated with abdominal cramps. In immunologically healthy people symptoms may come and go and is typically cleared in less than a month.

In people who cannot clear the parasite (HIV), the infection can be prolonged and can lead to death.

Infection with Cryptosporidium is typically transmitted by the fecal-oral route; fecally contaminated water or food and person-to-person contact.

There have been several outbreaks of Cryptosporidiosis seen worldwide with most being associated with recreational water, day care centers and drinking water contamination. The most notorious is the outbreak in Milwaukee in 1993 where 400,000 people got infected through the water plants filtration system.

Wednesday, December 1, 2010

President Obama orders bioethics commission to investigate syphilis study

Remember the discovery of the clearly unethical sexually transmitted infections inoculation studies which happened in the 1940s (maybe better known as the Guatemalan syphilis study)?

This was the US Public Health Service “study” to determinethe prophylactic capabilities of penicillin. These studies were done on Guatemalan soldiers and prisoners.

In light of Dr. Susan Reverby’s findings, the President of the United States has ordered Dr. Amy Gutmann, Chair of the Presidential Commission for the Study of Bioethical Issues to look into a couple of areas of concern.

First, wanting to be assured that current rules for research participants protect people from harm or unethical treatment, he has asked Gutmann to do a thorough review of human subject’s protection to determine if Federal regulations and international standards adequately guard the health and well-being of participants in scientific studies, both here and abroad, supported by the Federal Government.

Second, Mr. Obama asked Dr. Gutmann to oversee a thorough fact-finding investigation into the specifics of the U.S. Public Health Service Sexually Transmitted Diseases Inoculation Study.