Monday, January 24, 2011

The microscopic concerns of the Australian flooding

Heavy rains such as that which is happening in parts of Australia can cause tragic, 24-hour a day news-worthy events like mudslides and drownings.

Or even the most unusual things can occur. The reports coming out of the Queensland flooding have described such bizarre occurrences such as sharks swimming the streets near Brisbane and crocodiles in the northern areas.

But the issue of infectious diseases in cases of torrential rains and flooding are not nearly as sensational, but they can affect large numbers of people for extended periods of time.

The risk of contamination of drinking water is small in an industrialized country like Australia, but the risk still remains. And of course, the floodwaters could be a main source of diarrheal diseases that the people of Queensland should be aware.

Floodwaters can contain a plethora of microbial organisms that can cause some very unpleasant symptoms. Bacterial contaminants such as E. coli and protozoan parasites like Giardia and Cryptosporidium are all causes of diarrheal diseases.

Giardiais a protozoan parasite that lives in the intestine of infected humans and animals (in particular, beavers and domestics animals like cats and dogs). It is found in the environment on surfaces (where it can survive for long periods of time), water and food that has been contaminated with the feces from an infected person or animal.

Cryptosporidiumis a protozoan parasite of both medical and veterinary importance. 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.

In addition, another infectious disease issue that goes hand-in-hand with flooding like this is the increase in mosquito borne diseases. The issue of more standing water after flooding like this results in more mosquito breeding areas.

Mosquito borne viruses such as Ross River virus are already endemic in coastal areas of Australia, could become an even worse issue as a result of the flooding.

Ross River virus infection can be transmitted to humans by the bite of an infected mosquito. It generally results in a self-limiting flu-like non-fatal illness, but it can cause long-term joint pain and fatigue.

A variety of mosquito species can transmit RRV, biting day and/or night.

There is no vaccine and no specific treatment for Ross River virus infection, but treatment of symptoms can reduce discomfort.

Medical treatment is aimed at easing joint pains and swelling, and minimizing fatigue and lethargy.

Alaska starts "expedited partner therapy" in an effort to control STDs

With sexually transmitted infections rising at alarming levels, especially gonorrhea, in the state of Alaska, state health officials are going to try to curb the epidemic with a new approach to STD control.

In recent years, Alaska has gone from being ranked in the mid-20s nationally in cases of gonorrhea (GC) to being ranked #9. In addition, Alaska ranks only behind Mississippi in chlamydia (CT) infections nationally.

Expedited partner therapy (EPT) is the treatment of sex partners of patients diagnosed with Chlamydia and/or gonorrhea infection by providing prescriptions or medications for the patient’s partner(s) without the health care provider first examining the partner.

The Centers for Disease Control and Prevention (CDC) says, based on scientific studies, a useful option to get partners of infected individuals treated.

The Alaska Department of Public Health is actively encouraging physicians and other health care providers to take up the practice, when appropriate.

According to an investigation by the state, it was concluded that:

1) EPT is an acceptable partner management tool for the prevention and control of CT and GC in Alaska; and 2) EPT may be a particularly effective partner management tool for specific Alaska populations (e.g., patients unwilling or unable to participate in timely partner services), for specific geographic areas where partners services are not available, and when program resources may need to be redirected (e.g., during outbreak response or due to budget changes).

Here is the “Suggested Components of EPT Protocols, Policies, and Standing Orders for Alaska Healthcare Providers”:

EPT drug regimens: - Partners exposed to CT only:

Azithromycin 1 g orally in a single dose

- Partners exposed to GC only or both GC and CT:
Cefixime 400 mg orally in a single dose PLUS Azithromycin 1 g orally in a single dose

  •  Limit EPT to the number of known sex partners identified in the previous 60 days (or most recent sex partner if none in the previous 60 days).
Provide written materials to accompany EPT medication(s) that include the following information:

- An overview of CT and GC, including signs and symptoms of illness;

- A recommendation to seek medical care if the person receiving medication is experiencing symptoms;

- A list of local health care resources;

- Potential adverse reactions to the medication(s);

- A telephone number to report adverse reactions to the medication(s); and

- Counseling on abstinence until 7 days after treatment and 7 days after partners have been treated.

• Document in the index patient’s medical record the number (but not names) of partners who are being provided with EPT.

Sunday, January 23, 2011

New recommendations for Tdap vaccine use published in MMWR

The country as a whole a saw skyrocketing number of cases of pertussis (whooping cough) last year indicating that pertussis is not well controlled in the United States and the booster vaccine called Tdap (tetanus-diphtheria-acellular pertussis) is not being used as widely as it should be.

The October 2010 recommendations from the Advisory Committee on Immunization Practices (ACIP) were published in the January 14, 2011 edition of the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR).

The three updated recommendations are as follows:

1. The use of Tdap regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine.Adults and adolescents may be given Tdap regardless of when the last tetanus-diphtheria (Td) shot was given. Previously, a minimum interval of five years was recommended between the last Td and a Tdap. Recent data indicates that it is safe to give the Tdap sooner than two years after the tetanus shot. No waiting is necessary to get a pertussis shot.

2. The use of Tdap in certain adults aged 65 years and older.Seniors who work with young children should get Tdap. Tdap should be given to adults 65 years of age and older who have contact with infants younger than 12 months, and Tdap may be given to adults 65 and older needing a tetanus booster if they haven't already received the Tdap.

3. The use of Tdap in undervaccinated children aged 7 through 10 years.Tdap may be given to children 7 to 10 years of age who have not completed the recommended DTaP series or who have never received a primary series of tetanus, diphtheria and pertussis. This recommendation closes a gap in coverage for children of that age group with those factors.

Whooping cough or pertussis is caused by the bacteria, Bordetella pertussis. This vaccine-preventable disease is spread through direct contact with respiratory discharges via the airborne route. Pertussis goes through a series of stages in the infected person; initially a irritating cough followed by repeated, violent coughing. The disease gets its nickname by coughing without inhaling air giving the characteristic high-pitched whoop. Certain populations may not have the typical whoop like infants and adults.

It is highly communicable, especially in very early stages and the beginning of coughing episodes, for approximately the first 2 weeks. Then the communicability gradually decreases and at 3 weeks it is negligible, though the cough my last for months.

This is a very serious disease that can be fatal, though this is not common. Complications to pertussis include hypoxia, seizures and pneumonia. Most deaths occur in infants under 6 months who have not completed primary immunizations.

Half of children who survive bacterial meningitis have long-tern complications

This is according to a study by Dr. Aruna Chandran of Johns Hopkins University, et al, published in the current issue of the Pediatric Infectious Disease Journal.

In a comprehensive, systematic literature review, researchers examined articles which included children between the ages of 1 month and <18 years at the time of diagnoses of meningitis.

Of the 1,443 childhood survivor’s of bacterial meningitis, 49.2% (705) reportedly had one or more long-term sequelae.

A majority of the 705 children reporting long-term complications were behavioral and/or intellectual disorders. This was followed by hearing problems and neurological deficits in that order.

The behavior and intellectual disorders seen in the study included cognitive impairment, behavioral problems and attention deficit hyperactivity disorder.

According to Dr. Chandran, “subtle neurologic deficits, such as impaired school performance, behavioral problems, and attention deficit disorder, may not be appreciated initially and may continue to affect survivors for many years.”

Differences in types of long-term complications among children were seen with different bacterial causes of meningitis (meningococcal, etc). However, the specific causative bacteria were confirmed in just over one-fourth of the children studied.

Dr. Chandran and her fellow researchers believe that the full impact of these long-term complications should be an important consideration in making recommendations for the use of vaccines against common bacterial causes of meningitis.

Saturday, January 22, 2011

Philippines human rabies death shows the importance of post-exposure prophylaxis

A 38-year-old Iloilo woman has died as a result of rabies last week to be the first recorded cases in the area in 2011.

The tragic thing is her death could have been prevented with rabies post-exposure prophylaxis.

According to the Visayan news site, Panay News, the mother of three and her sister from Barangay Botong, Badiangan were bitten by a 3-month-old puppy last June 22, 2010. The sister received the rabies vaccine series after she was bitten, but the victim refused treatment.

Estifania Gigare, provincial rabies coordinator for Iloilo said the following about the victim:

"She hesitated to seek medication right after she was bitten. Even before she died, she denied having rabies."

The woman started complaining of body aches at the beginning of the year, which was followed in the following days by severe pain in her right leg and difficulty swallowing. When she was brought to Federico Roman Tirador Sr. Memorial District Hospital, she was suffering from aerophobia and hydrophobia.

The woman’s father, husband and children who may have also been exposed to the rabies virus were given rabies immunoglobulin and vaccine.

Even Iloilo Gov. Arthur Defensor Sr. chimed in saying:

“People bitten by dogs and other animals must not hesitate in seeking early medical treatment from the nearest hospital. If patients cannot afford the medication, there are many government agencies that can help them."

Badiangan is a town of 22,000+ people in the Iloilo province, Philippines.

A plan to control Artemisinin-resistant malaria

It wasn’t long ago when people were saying that combination treatments with Artemisinin would be the future for eradicating the deadly parasite from the African continent.

As a matter of fact, the use of Artemisinin combination therapy (ACT) and insecticide treated bed nets is given credit for saving over 700,000 lives in Africa from 2000 to 2010.

Then ACT resistance was seen on the Cambodia-Thailand border. A 2008 study in the New England Journal of Medicine demonstrated the drug was losing its potency in the region and a fear that it may spread worldwide has grown.

Artemisinin, the antimalarial drug is extracted from the plant Artemisia annua (wormwood).

Artemisinin combination therapy is where a patient takes both a fast-acting and a slow-acting drug to kill the malaria parasite. Before the parasite would be killed in 24 to 36 hours; it is now taking up to 120 hours to kill the parasite.

If the resistance was to spread, there are no new drugs to take the place of ACT.

It is suspected that the artemisinin resistance appeared in the Cambodia-Thailand area because of a long history of rampant and indiscriminate artemisinin monotherapy and counterfeit drugs.

There is some precedent in the Thai-Cambodia border region as far as antimalarial resistance. This is where chloroquine resistance was first seen also.

The World Health Organization (WHO) in response to this serious issue has released a new action plan. According to Dr. Margaret Chan, WHO Director-General:

“The usefulness of our most potent weapon in treating malaria is now under threat. The new plan takes advantage of an unprecedented opportunity in the history of malaria control - to stop the emergence of drug resistance at its source and prevent further international spread."

In an effort to prevent malaria rates from soaring again, The Global Plan for Artemisinin Resistance Containment was developed by the WHO Global Malaria Programme with funding from the Bill and Melinda Gates Foundation and expertise from the Roll Back Malaria Partnership.

The plan consists of the following 5 steps to contain and prevent artemisinin resistance:

Stop the spread of resistant parasites. A fully funded and implemented malaria control agenda would address many of the needs for the containment and prevention of artemisinin resistance. Additional funding will be needed to stop the spread of resistant parasites in areas where there is evidence of artemisinin resistance. The global plan estimates that it will cost an additional US$10-20 per person in areas of confirmed resistance along the Cambodia-Thailand border and US$8-10 per person in the at-risk locations within the Greater Mekong area.
Increase monitoring and surveillance for artemisinin resistance. WHO estimated in 2010 that only 31 of the 75 countries that should be conducting routine testing of the efficacy of artemisinin-based combination therapies actually did so. There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance.
Improve access to malaria diagnostic testing and use artemisinin-based combination therapies only to combat malaria. These therapies are frequently used to treat causes of fever other than malaria, which can increase the risk of resistance. To reduce the number of patients who do not have malaria taking the therapies, WHO recommends diagnostic testing of all suspected malaria cases before treatment.
Invest in artemisinin resistance-related research. There is an urgent need to develop more rapid techniques for detecting resistant parasites, and to develop new classes of antimalarial medicines to eventually replace the artemisinin-based combination therapies.
Motivate action and mobilize resources. The success of the global plan will depend on a well coordinated and adequately funded response from many stakeholders at global, regional and national levels.
The plan is being implemented to prevent what happened years ago with the spread of chloroquine resistance worldwide. According to Professor Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership:

"Despite clear evidence that chloroquine resistance was progressively spreading from Southeast Asia to sub-Saharan Africa, no global containment strategy was prepared or adopted. As a result, malaria mortality was increasing worldwide, with hundreds of thousands of additional deaths occurring every year, particularly in sub-Saharan Africa."

Researcher calls skin bacteria an under-recognized pathogen

An organism which is commonly considered “normal skin flora” may not be as harmless as previously thought.

Professor Peter Lambert from Aston University in Birmingham, England, attributes the bacterium, Propionibacterium acnes to post-surgical infections including those of the brain and even suggests a link between the bacteria and cancer.

Prof. Lambert said the following in an interview in MyHealthNewsDaily:

“While the bacterium is generally considered harmless, more attention should be paid to its role as a potential pathogen.”

"Generally, we tend to disregard this organism, because we think it's a harmless organism. So if we see it, we don’t report it, we should take more notice of this and say it could be causing infection."

And Prof. Lambert is not alone. According to Christopher Vinnard, an infectious-disease researcher at the University of Pennsylvania School of Medicine:

"We're recognizing more recently that, in fact, there are distinct clinical syndromes that are associated with infections with P. acnes as an actual pathogen and not simply a contaminant."

Dr. Vinnard goes on to discuss a study where he links the bacteria to the formation of a brain abscess post- neurosurgery.

As far as P. acnes role in cancer, Prof. Lambert says some studies suggest a link between the anaerobic bug and prostate cancer. He goes on to say that P. acnes have been found growing inside cells of the prostate gland and the inflammation that could occur could cause cells to turn cancerous.

Propionibacterium acnes is an anaerobic, (albeit aerotolerant) gram-positive bacilli normally found on the skin. It is associated with inflammatory processes in acne. Being part of the skin flora, it is typically considered to be contaminant when found in other sites. However, it has been cited as a cause of more serious infections such as brain abscesses, osteomyelitis, endocarditis, infections of prosthetic devices and dental infections.

Tuesday, January 18, 2011

Monkeypox claims 5 lives in Bikoro territory, Congo

According to a report in Radio Okapi, the monkeypox virus has infected 114 people in the Bikoro health zone of the Équateur province, Democratic Republic of the Congo. 5 people have perished due the viral infection.
Équateur is one of the 25 provinces in the Democratic Republic of the Congo. The capital of Équateur Province is the city of Mbandaka.

Monkeypox is a relatively rare virus found primarily in central and western Africa. The disease is caused by Monkeypox virus. It is closely related to the smallpox virus (variola), the virus used in the smallpox vaccine (vaccinia), and the cowpox virus.

Infection with monkeypox is not as serious as its cousin, smallpox, however human deaths have been attributed to monkeypox.

According to the CDC, the symptoms of monkeypox are as follows: About 12 days after people are infected with the virus, they will get a fever, headache, muscle aches, and backache; their lymph nodes will swell; and they will feel tired. One to 3 days (or longer) after the fever starts, they will get a rash. This rash develops into raised bumps filled with fluid and often starts on the face and spreads, but it can start on other parts of the body too. The bumps go through several stages before they get crusty, scab over, and fall off. The illness usually lasts for 2 to 4 weeks.

People at risk for monkeypox are those who get bitten by an infected animal or if you have contact with the animal’s rash, blood or body fluids. It can also be transmitted person to person through respiratory or direct contact and contact with contaminated bedding or clothing.

There is no specific treatment for monkeypox.

Monday, January 17, 2011

Canadian company initiates recall of alcohol swabs due to possible Bacillus

In a Health Canada information release, the Shandex Sales Group has started a voluntary recall of alcohol swabs due to potential contamination with the bacterium, Bacillus cereus.

The alcohol swabs are used to clean injection sites in medical procedures.

The swabs being recalled come in boxes of either 100 or 200 under the brand names Life Brand, Equate, Personelle, Rexall, Exact, Remedy Rx and Uniprix.

Health Canada and Shandex are working to monitor the recall and the company is requesting that wholesalers and retailers stop the sale of these items.

There are no adverse reactions to these products to date.

More on Bacillus cereus:

Bacillus cereus is an aerobic, spore-forming bacterium found in the soil and the environment worldwide. It commonly found in low levels in raw, dried and processed foods.

A well recognized and common cause of food poisoning worldwide, Bacillus cereus causes two types of toxins: a diarrheal type and a vomiting type.

The diarrheal type of this food borne illness is usually associated with meats, milk and vegetables. The onset for the disease is from 8-16 hours and it lasts 12 to 14 hours.

The vomiting type of this food poisoning is due to rice, grains, cereals and other starchy foods. The onset is quite rapid (30 minutes to 6 hours) and usually lasts a day or so. This type is frequently associated with outbreaks due to cooked rice held at room temperature.

This type of food borne illness is rarely fatal and cannot be transmitted from person to person.

Improper storage of food stuffs is the issue. Bacillus cereus spores can survive boiling and if the food, rice for example is stored at ambient temperature, the spores can germinate into toxin producing bacteria. Then the person eats the rice contaminated with the pre-formed toxin that causes the illness.

The vomiting type of toxin is also heat resistant, much like the enterotoxin that causes Staphylococcus aureus food poisoning, and cooking will not destroy the toxin.

To prevent B. cereus food poisoning the key is to thoroughly cook food and if you do not eat it immediately, hold it at 140°F or refrigerate promptly. Do not let the food cool slowly.

Saturday, January 15, 2011

CDC travel notice: Legionnaires’ disease in Cozumel

The US Centers for Disease Control and Prevention (CDC) has issued a travel notice today for US travelers going to Cozumel, Mexico.

There has been an ongoing outbreak of Legionnaires’ disease on the island of Cozumel at the following resorts: Regency Club Vacation Resort and Wyndham Cozumel Resort & Spa (formerly Reef Club Cozumel).

The CDC says there have been 9 confirmed cases of Legionnaires’ disease seen in both US tourists and tourists from the Netherlands that have stayed at the resorts.

The CDC recommends the following for US travelers:

Travelers at high risk of infection should consider staying at another resort or should avoid exposures to misty water at the Regency Club Vacation Resort and the Wyndham Cozumel Resort & Spa, especially showering. High risk groups include:
Current or former smokers
People aged 50 or older
People with any of the following chronic health conditions:
Chronic lung disease, such as COPD or emphysema
Weakened immune system that might be caused by cancer, organ transplant, or certain prescription drugs
Other chronic conditions, such as chronic kidney disease, asthma, heart disease, or liver disease
Rarely, people without any risk factors develop Legionnaires’ disease after exposure to Legionella.

Legionnaires’ disease gained national notoriety in 1976 when the Centers for Disease Control and Prevention (CDC) discovered it during an epidemic of pneumonia among American legion members at a convention in Philadelphia.

The causative organism is the bacteria, Legionella pneumophila. The legionella bacteria are found throughout nature, because of this most people become exposed to it but few develop symptoms.

The primary place in nature it’s found is water sources particularly at warmer temperatures; lakes, rivers and moist soil.

It is also found in man-made facilities (frequently the source of outbreaks) such as air-conditioning ducts and cooling towers, humidifiers, whirlpools and hospital equipment.

People get exposed through inhaling infectious aerosols from these water sources. There is no transmission from person to person.

The infection can appear in two clinical forms: Legionnaires’ disease and Pontiac fever.

Both conditions are typified by headache, fever, body aches and occasionally abdominal pain and diarrhea.

Legionnaires’ disease is the cause of pneumonia where a non productive cough is typical. Fatality rates of this form of the infection are around 15 % even with improvements in treatment.

Pontiac fever is a self limiting flu-like illness that does not progress to pneumonia or death. Diagnosis is usually made by typical symptoms in an outbreak setting.

Diagnosis of Legionnaires’ disease depends on identifying the bacteria in microbiological culture, detecting the antigen in urine samples or a fourfold increase in antibody titer.

Certain health conditions make you more susceptible to infection to include increasing age, smoking, chronic lung disease, malignancy and diabetes mellitus.

Legionnaires’ disease is treatable with antibiotics.

Kollywood actress Shobhana commits suicide:suffered from Chikungunya

The supporting actress who starred in such Indian films as ‘Sillunu Oru Kadhal’and the soap ‘Meendum Meendum Sirippu’ was found dead in her home in Kotturpuram.

The 31-year-old Shobhana was found hanging in her room by her mother this past Monday.

According to a report in the Times of India, Shobhana was suffering from Chikungunya fever which has been speculated to be a cause of her suicide. Because of her illness, she lost out on several roles in Tamil movies.

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. Chikungunya virus is a member of the genus Alphavirus, in the family Togaviridae. Chikungunya fever is diagnosed based on symptoms, physical findings (e.g., joint swelling), laboratory testing, and the possibility of exposure to infected mosquitoes. There is no specific treatment for chikungunya fever; care is based on symptoms. Chikungunya infection is not usually fatal.

Read about other mosquito-borne diseases below:

Suggested by the author:
Travel health: dengue fever
Travel health: malaria
Travel health: lymphatic filariasis
Travel health: yellow fever

Wednesday, January 12, 2011

Vibrio cholerae seen in Cebu town

According to a report in the Cebu Daily News, 5 people in Catmon town have tested positive for the bacterium, Vibrio cholerae.

The Regional Epidemiology Surveillance Unit in Central Visayas (RESU-7) chief, Renan Cimafranca says the patients range in age from seven to 60. He goes on to say the water system may have caused the infection since it was contaminated after several days of rainfall.

Cimafranca advises Catmon residents to boil water before use.

Catmon is a 5th class municipality in the province of Cebu, Philippine. It is located 57 kilometers from the Cebu City.

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.

It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).

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.

The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infective. Some patients may become carriers of the organism which can last for months.

Cholera is diagnosed by growing the bacteria in culture. Treatment consists of replacement of fluids lost, intravenous replacement in severe cases. Doxycycline or tetracycline antibiotic therapy can shorten the course of severe disease.

Paper suggests NDM-1 started in India

Remember last summer when researchers in the UK made the assertion that the enzyme known as NDM-1 (New Delhi metallo-β-lactamase 1) came from India to Britain via patients that traveled to the Indian subcontinent for medical procedures?

The enzyme was named New Delhi metallo-β-lactamase 1 based on the location where it was first seen, like the names of many different microbes, chemicals and other discoveries.

A study published in the American Society for Microbiology journal, Antimicrobial Agents and Chemotherapy appears to back up the claims of the UK researchers.

The paper is a collaboration of authors from the United States, Australia and India who examined samples from over a dozen hospitals in India from 2006-7. Of the 39 isolates of Enterobacteriaceae (gram negative bacilli like E. coli and Klebsiella) that were carbapenem-resistant. Of these strains, 15 carried the blaNDM-1 gene. The bacterial isolates came from patients in hospitals in several Indian cities, including New Delhi.

Indian health officials have not been happy with the various research done on NDM-1 and the naming of the enzyme. Back in August they called the UK study a “sinister design” to destroy the Indian medical tourism industry.

Now in the Indian paper, The Hindu, Chennai-based infectious disease specialist Abdul Ghafur, say the link between the enzyme and New Delhi is “hypothetical and unproven”.

In a statement in The Hindu, Dr. Ghafur had the following to say:

The name of NDM-1 must be changed to remove the words ‘New Delhi,' as it would help in removing the stigma and result in better combined effort by all of the medical community in tackling antibiotic resistance. After all, science is for the benefit of humanity. This name change must be done as early as possible.''

Ghafur has suggested ‘Newly Derived or Newly Defined' as alternatives to identify the enzyme.

Sunday, January 9, 2011

Measles outbreak in Mindanao

At the same time the southern island provinces are dealing with flooding and landslides where more than a dozen people have died, the people of this region are also facing a measles outbreak.

According to health authorities in the Davao del Norte province in Mindanao, the outbreak has affected at least 30 people with at least 3 deaths due to the viral disease.

The towns hit by this current outbreak are Talaingod and Kapalong, both part of Davao del Norte province.

The torrential rains and subsequent landslides and flooding have kept medical assistance from reaching Talaingod where many of the people in the town are part of the Ata-Manobo tribe.

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.

CDC issues travel notice for Uganda due to yellow fever

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

An outbreak of yellow fever which started back in November has struck northern Uganda, the first such outbreak since the 1970s.

The Ugandan Ministry of Health is planning a mass vaccination campaign in the northern districts.

The CDC strongly advises:

US citizens residing and traveling in Uganda are advised to avoid travel to northern Uganda unless they have been vaccinated against yellow fever within the past 10 years. If you have been vaccinated recently, do not travel to northern Uganda for at least 10 days after receiving the vaccine since it takes 10 days for the vaccine to be effective.

As far as yellow fever vaccination:

•CDC recommends that all travelers 9 months of age and older traveling to Uganda receive yellow fever vaccination.
•Uganda requires yellow fever vaccination for travelers 1 year of age and older arriving from countries endemic for yellow fever.
•Talk to your doctor to make sure you do not have any medical conditions that might prevent you from receiving the vaccine. If the doctor advises you not to get the yellow fever vaccine because of medical reasons, you should not travel to Uganda at this time, especially the districts involved in this outbreak.

For more information concerning travel to Uganda, see “Health Information for Travelers to Uganda”

Saturday, January 8, 2011

Iowa health officials identify three influenza strains very early in the season

In an Iowa Department of Public Health (IDPH) news release from early December, health officials there say they have identified three different influenza strains already.

Health officials say it is very rare to see three strains this early in the flu season. IDPH Medical Director, Dr. Patricia Quinlisk had the following to say about the unusual occurrence:

“It is very rare for us to see three strains of influenza circulating this early in the season, usually; we’ll see only one or two strains at this point. This means, of course, that it’s possible for an individual to get influenza three times this year. The good news is that this year’s vaccine covers all three strains we’ve identified. Get one shot, dodge three bullets.”

And Dr. Quinlisk is absolutely correct. The 2010-2011 seasonal flu shot provides immunity to the following three strains of influenza: A/California/7/09 (H1N1)-like virus (pandemic (H1N1) 2009 influenza virus), A/Perth /16/2009 (H3N2)-like virus and the B/Brisbane/60/2008-like virus.

One thing is for sure, flu season is definitely here in many parts of the country.

New California pertussis immunization law takes effect in July

The state of California just went through its worst epidemic of pertussis in five decades with nearly 8,000 confirmed cases and 10 infant deaths last year; the new legislation signed by Governor Arnold Scharzenegger, is designed to protect the health of California’s children.

According to a California Department of Public Health (CDPH) news release:

Beginning July 1, 2011, all students entering 7th through 12th grades in both public and private schools will be required to show proof of a Tdap (Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine)booster shot before starting school. This requirement applies to all public and private schools.

California’s parents are being urged not to wait for the new fall school year to get their kids vaccinated, since there will be no grace period and the regulations will be strictly enforced. CDPH recommends that parents have their adolescent children vaccinated now in order to protect them against pertussis and to meet the 2011-12 school requirements. Parents should be aware that the protection from childhood immunization to pertussis wears off, and adolescents may be at risk to the highly contagious disease without a booster.

Whooping cough or pertussis is caused by the bacteria, Bordetella pertussis. This vaccine-preventable disease is spread through direct contact with respiratory discharges via the airborne route. Pertussis goes through a series of stages in the infected person; initially a irritating cough followed by repeated, violent coughing. The disease gets its nickname by coughing without inhaling air giving the characteristic high-pitched whoop. Certain populations may not have the typical whoop like infants and adults.

It is highly communicable, especially in very early stages and the beginning of coughing episodes, for approximately the first 2 weeks. Then the communicability gradually decreases and at 3 weeks it is negligible, though the cough my last for months.

This is a very serious disease that can be fatal, though this is not common. Complications to pertussis include hypoxia, seizures and pneumonia. Most deaths occur in infants under 6 months who have not completed primary immunizations.

Pertussis is an endemic disease found worldwide. In this country, according to the CDC, outbreaks occur every 3-5 years. Prior to last year’s epidemic, they say the last epidemic of pertussis in the United States was in 2005.

Those that are not immunized are susceptible to this disease. Young infants and school aged children (who are frequently the source of infection for younger siblings) are at greatest risk.

For more information, visit the CDPH Immunization Branch website

Thursday, January 6, 2011

Philippines DOH prohibits “public viewing” of bodies due to infectious diseases

An administrative order (2010-033) issued by the Philippines Department of Health (DOH) in December has placed new restrictions on open viewing of remains if the individual died of certain “dangerous communicable diseases”.

The order explicitly says:

The remains shall be placed in a plastic cadaver bag or other durable, airtight container at the point of death and a biohazard tag attached, provided, that, this container shall not be opened for viewing or any other purpose prior to burial or cremation.

The list of infectious diseases already included meningococcemia, HIV-AIDS, viral hemorrhagic fevers, yellow fever and plague. Now the DOH has added 5 additional dangerous communicable diseases: Severe Acute Respiratory Syndrome (SARS), Hepatitis B and C, rabies, invasive group A streptococcal infections, and transmissible spongiform encephalopathies (TSE) such as mad cow disease and Creutzfeldt-Jakob Disease.

The order does recognize that certain of these diseases are not found in the Philippines:

It is recognized that viral hemorrhagic fever, yellow fever, plague and SARS are not found in the Philippines at this time but they may be brought in at any time by travelers.

Researchers get funding for Leishmania braziliensis study in Brazil

A team of researchers from the University of Pennsylvania School of Veterinary Medicine, the University of Maryland College of Computer, Mathematical, and Natural Sciences and the Federal University of Bahia in Brazil have received funding from the National Institutes of Health (NIH) for a 5-year study of human infection with Leishmania braziliensis.

The study will take place in Corte de Pedra, Brazil with a budget of $2.75 million. Mucocutaneous leishmaniasis is endemic in Brazil.

The objective of the study is for the development of new treatments for leishmaniasis.

Leishmaniasis is not a single disease, but a group of syndromes due to a variety of species of this parasite. The affect different populations and are related to a characteristic vector, the sandfly.

The disease can range from asymptomatic infections to those causing significant illness and death. Disease can appear on a spectrum from a single skin ulcer to destructive lesions of the face to terminal organ disease.

Mucocutaneous leishmaniasis or espundia is caused by Leishmania braziliensis. 90% of all mucocutaneous leishmaniasis cases occur in Bolivia, Peru and Brazil. “Espundia has also been described as “white leprosy”.

In mucocutaneous leishmaniasis, the disease typically starts out with an initial skin lesion, that slowly but spontaneously heals, chronic ulcers appear after months or years on the skin, mouth and nose, with destruction of underlying tissue. Tissue destruction with disfigurement can be very severe.

The treatment for mucocutaneous leishmaniasis requires systemic drugs. See the Medical Letter for details.

Wednesday, January 5, 2011

Singapore announces recall of health products due to Burkholderia cepacia

A month after the Singaporean Health Sciences Authority (HSA) announced the recall of OralGuard Antiseptic-Antiplaque Mouthwash, three more health and hygiene products are being voluntarily recalled by the manufacturing companies.

The three products being recalled are:

•“Care Wipes” by Tai Sun Paper Products Pte Ltd (Singapore)
•“Trihexid Chlorhexidine 0.2% Mouth Rinse” by Trident Pharm Pte Ltd
•“Pearlie White Fluorinze Fluoride Mouth Rinse” by Corlison Pte Ltd
All of the above products have had batches of the product contaminated with the bacteria, Burkholderia cepacia.

According to the HSA news release, “Care Wipes” is a disposable skin cleansing wipe. “Trihexid Chlorhexidine 0.2% Mouth Rinse” is labeled for use in the prevention of bad breath, tooth and gum diseases, reduction of plaque build-up, mouth ulcers and oral care following surgery. “Pearlie White Fluorinze Fluoride Mouth Rinse” is labeled to help kill bacteria that cause bad breath, plaque and gum problems, relieve tooth sensitivity, prevent tooth decay, strengthen tooth enamel and freshen breath.

Burkholderia cepacia is a gram negative bacterium that is normally found in the environment (soil, water and plants). It is can be seen in the hospital environment because of its ability to survive on or in medical devices and disinfectants.

It is not typically an issue for healthy people; however it can colonize the respiratory tract and cause life-threatening infection in people with cystic fibrosis or chronic granulomatous disease.

B. cepacia has been implicated in non-fatal infections of other sites like the urinary tract.

People usually get infected or colonized by direct contact with contaminated medical solutions, foods, disinfectants and respiratory equipments. Person-to-person transmission has also been documented.

B. cepacia is resistant to many common antibiotics.

This is not the only recall of a product recently due to B. cepacia. You may remember earlier in 2010, there was a recall of Tylenol products due to B. cepacia contamination at a Johnson & Johnson plant.

Syphilis spikes in Alberta, Canada- health officials looking for solutions

The sexually transmitted infection which was barely heard about anymore a few short years ago is rearing its head in places all over the globe. Here on this web site, I’ve discussed that dramatic increase in cases of the disease from China to North Carolina to Florida.

Now it is being reported in the Global Saskatoon that the Canadian province of Alberta is facing an epidemic of syphilis in numbers that are clearly troubling.

According to the report, in 1999, there were 2 cases of the spirochete infection in the province. Now a decade later, Alberta has reported 267 cases in 2009 and the outbreak shows no sign of slowing.

According to Dr. James Talbot, Deputy Medical Officer for Alberta says this tends to happen with 15 to 35 year olds, since they are more likely to take risks such as having sex with people they don’t know.

Another, perhaps more disturbing number is how many babies were born with syphilis in 2009. In Alberta there were 7 cases while the rest of the country had just one case.

Of course, health officials are looking for a way to curb the outbreak. One idea is to require restaurants and bars to place condom dispensers in the restrooms. This requirement would be tied to getting a liquor license for the establishment.

Other ideas being tossed around include advertisement campaigns, working with anonymous internet sites and prostitutes.

This is not the first time a location tried to something unusual in an effort to put the brakes on the spread of syphilis. Last year in Forsyth County, NC, health officials were giving out Wal-Mart Gift Cards to entice people to get tested for the sexually transmitted infection.

Syphilis is a sexually transmitted infection (STI) caused by the bacterium, Treponema pallidum. The most common way to get syphilis is by having sexual contact (oral, genital or anal) with an infected person. The secondary lesions are also infective and contact with them could transmit the bacteria.

If syphilis is left untreated the bacteria will damage the heart, eyes, brain, bones, joints and central nervous system. This can happen decades after the initial infection. This can result in blindness, deafness, memory loss, heart disease and death. Neurosyphilis is one of the most severe signs of this stage.

It can also be transmitted from an infected mother to her baby (congenital transmission). It can also be transmitted through blood transfusion, though extremely rare because of testing of donors.

Untreated syphilis during pregnancy, especially early syphilis, can lead to stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities. Congenital syphilis (CS) can be prevented by early detection of maternal infection and treatment at least 30 days before delivery.

Syphilis is treated easily and inexpensively with one shot of penicillin.

See the news report:

Monday, January 3, 2011

Toxoplasmosis in the immunocompromised

Toxoplasmosis is a protozoan parasite that’s found worldwide. According to the Centers of Disease Control and Prevention (CDC) there are approximately 23% of adults and adolescents infected with the parasite. They also mention that in certain populations around the world the prevalence may be as high as 95%. It is believed that the infection is acquired throughout life.

For the person with a healthy immune system who picks up this parasite, Toxoplasma gondii, the symptoms are mild or totally asymptomatic and the acute infection passes unnoticed. The immune system keeps the parasite in check in the tissues. If at a later time the immune system is compromised, the disease can be reactivated.

This parasite infects almost all warm-blooded animals, but the domestic cat is the final host. Cats may excrete millions of these parasites in their feces on a daily basis. Cats usually pick up this organism through eating mice, rats, birds and by grooming themselves.

There are several conditions in which the organism Toxoplasma can cause lethal infection; people with AIDS, cancer patients on chemotherapy and transplacentally transmitted between mother and child are the main groups of patients most at risk. Serious disease manifestations may include brain abscesses, eye infections and pneumonia.

In the pregnant woman, the risk is if she gets a primary (new) infection during her pregnancy. The infection may be passed to the unborn child with devastating outcomes.

In the 2007 AIDS statistics, it shows that Florida is third both in new cases (3,961) and cumulative (109,524) in the country. Our own counties of Hillsborough and Pinellas are in the top seven for number of cases in the state. So based on these numbers alone, this disease is something to be aware of, and to understand the prevention of this potentially deadly disease amongst our own population.

Human infection with Toxoplasma typically occur by one of the following routes; eating undercooked or raw meat, changing cat litter boxes and getting exposed to cat feces while gardening or other activities.

For high risk groups like those mentioned above, the CDC recommends the following to prevent infection with Toxoplasma:

• Thoroughly cook food to the appropriate time and temperature.
• Wash fruits and vegetables.
• Wash cutting boards, utensils, and hands after handling raw or uncooked foods.
• Wear gloves during gardening, wash hands well afterwards.
• Do not feed your cat’s raw or undercooked meats.Change the litter box daily if you own a cat. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat's feces. If you are pregnant or immunocompromised:
• Avoid changing the litter box altogether if possible. Use gloves or get a friend or family member to do it.
• Keep cats indoors.

There is a large population of people that are at high risk if infected with this common parasite in our own cities and state. Being wise, judicious and careful can prevent a potentially fatal infection in the immunocompromised.


The loss of a parasitology legend: Dr. John H. Cross

When I read about the recent passing of Dr. John H. Cross of the Uniformed Services University of the Health Sciences (USUHS), it brought back some memories of the man and a course I took about two decades ago.

I don’t want to rehash his accomplishments (that can be found in this Washington Post article) but my short-lived experience under his tutelage.

In 1992, while I was still in the service, I had the opportunity to listen to Dr. Cross talk about a world of parasites that continues to keep me hooked to this day. This occurred at a course I took and assisted in at the USUHS which is located on the campus of the Bethesda Naval Hospital.

I was a military (NCOIC) microbiology supervisor at Andrews AFB in Maryland just down the beltway from the Bethesda Naval Hospital. One of the educational roles at the Andrews laboratory was the 1 year internship for USAF Clinical Laboratory Scientist/Medical Technology laboratory officers.

Here they rotated all the various departments of a clinical laboratory with one major exception; they learned clinical and diagnostic parasitology at USUHS with the medical students at the university.

I was asked by a superior at Andrews if I could go to the course also primarily to help med students in the use of a microscope, the identification of parasites and to generally assist in monitoring one of the several lab classrooms.

Because of this, I got to attend Dr. Cross’ class which was an absolute thrill.

I worked for 5 years prior to this in a bacteriology and parasitology lab while I was stationed in the Philippines in the 1980s where my passion for the subject was first planted and a great deal of experience and expertise was acquired.

But my passion for parasitology grew more after listening to Dr. Cross’ lectures in the course “Diagnostic Parasitology and Medical Zoology” which were hardly out of textbooks alone, but decades of being out in the tropics actually collecting samples, making discoveries, working with the locals of the host nation and getting infected himself numerous times.

As I listened to the lectures and the corresponding stories, all I could think was this was my dream job, and I imagined his stories, slides and photos of these decades of “real life” experience either got others excited as me or thoroughly repulsed them. But one thing is for certain, he held your attention with a teaching technique not often seen in the university setting.

Equally impressive was the laboratory experience where we learned numerous procedures which are just not utilized in clinical parasitology laboratories such as: the Stoll’s egg count, the Kato-Katz technique, the Harada-Mori technique for hookworms and the Knott’s technique for microfilariae. Honestly, this is just the short list.

Also incorporated in this fascinating course was a real “hands on” segment in medical entomology. We learned to speciate the different mosquitoes, ticks and a plethora of other critters.

Outside the student lab's area where very unique things were being done (remember this was 20 years ago) like the culturing of trypanosomes and other parasites, which up to that point, I didn’t know was possible.

To be a medical/graduate student specializing in tropical medicine at USUHS had to be a real treat with Dr. John Cross at the helm. The man knew parasites, he lived parasites and rhetorically he was “up to his elbows” in parasites. The way he knew how to present his encyclopedic knowledge of parasites was very special, and definitely not seen everyday.

Well, I passed the exams and got a certificate out of the course, but beyond that I learned so much that I might not otherwise get to experience. After I got out of the service and taught parasitology at my next job, I knowingly patterned my lectures after this amazing parasitologist and teacher.

The world of tropical medicine and parasitology has lost a true legend and his presence will be surely missed.

RIP Dr. John H. Cross (1925-2010)

Saturday, January 1, 2011

US strain of MRSA seen in the Isle of Man

According to a BBC report, a strain of Methicillin- Resistant Staphylococcus aureus (MRSA) that is common in the United States has been seen in a few cases on the British dependency, the Isle of Man.

The strain known as MRSA USA300 is a predominant strain of community-acquired MRSA infections in the US for the past decade or so is considered uncommon in the UK.

This strain of MRSA is common in skin and soft tissue infections, including outbreaks. People commonly infected are children in day care centers, athletes, military recruits, homosexual men, prisons and others who are otherwise healthy.

It has also been implicated in fatal, invasive disease such as sepsis, necrotizing pneumonia and osteomyelitis.

MRSA USA300 is historically not associated with health care-acquired infections; however it is being seen as an emerging problem in some health facilities in recent years.

This strain of MRSA, when seen outside the United States, is typically brought to the host country via international travel.

The USA types of strains of Staphylococcus aureus is based on a typing system established by the US Centers for Disease Control and Prevention.

The Isle of Man is a small island located in the Irish Sea between Great Britain and Ireland.

33 people die due to rabies in one Chinese province…in November alone!

The Chinese news site,, reports that in the Guangdong province alone, 33 people died from rabies, and that’s just in November!

The report goes on to say that the top 3 causes of death by infectious disease were AIDS (80), rabies (33) and tuberculosis (14) in the month of November.

The fact that rabies is the second highest cause of death among infectious diseases is quite alarming and points to real issues in the area of animal vaccination and post-exposure prophylaxis for people exposed to these animals.

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.

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.

It is likely the people who contracted rabies in the Guangdong province got infected through the bites of dogs and cats.

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.

Initially, like in many diseases, the symptoms of rabies 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.

If you are bit by an animal, 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.

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.

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.