Sunday, July 29, 2012

Foreign media disclose hepatitis numbers on World Hepatitis Day 2012


Hepatitis B virions  Image/CDC

With the observation of World Hepatitis Day 2012 on Saturday, July 28, media outlets globally wrote about the incredibly large numbers of people infected with the liver viruses in their own countries.
The Pakistani news source, The News International reported Saturday that 12 million people are infected in Pakistan according to the World Health Organization (WHO). In fact the paper says the country is facing an epidemic of the viral disease.
Nationally, a prevalence of 4.9% is seen with hepatitis C and 2.4% with hepatitis B nationally.
The major causes for the high numbers in Pakistan are due to frequent use of therapeutic injections, re-use of syringes, inappropriate sterilization practices and poor hospital waste management.
Pakistan’s neighbor to the east, India reports that viral hepatitis claims around 250,000 lives annually in the country.
According to a report in the Daily Pioneer Saturday, about 10 million Indians are anti-HCV positive and 5 million of them may be viremic. Of these, nearly 25 per cent, which is over 1 million of the population, may develop chronic liver disease within two decades and 1 per cent to 4 per cent of them may develop liver cancer.
The Southeast Asian country of Vietnam is also dealing with an extraordinary burden of hepatitis.
Saigon Giai Phong, the Vietnamese Communist Party newspaper reports an estimated eight million people are infected with hepatitis B or C virus and liver cancer is the second leading cause of death in men.
Injection drug users in the country have a very high prevalence of the hepatitis C virus reported to be over 98 percent.
On the African continent, Nigerian media reports 19 million people are affected by hepatitis B.
Associate Professor and Consultant Gastroenterologist at the Lagos University Teaching Hospital (LUTH), Dr. Funmilayo Lesi, a member of SGHIN, said hepatitis B is a common disease in Nigeria that affects at least 19 million or one in eight Nigerians. She called on Nigerians to take steps to prevent the disease, as there are vaccines to prevent its occurrence.
This year’s theme for World Hepatitis Day 2012 is “It’s closer than you think”.
The Global Dispatch reported in an article about World Hepatitis Day that approximately 500 million people worldwide are living with either hepatitis B or hepatitis C. This represents 1 in 12
people, yet awareness remains inexplicably low. If left untreated and unmanaged, hepatitis B or C can lead to advanced liver scarring (cirrhosis) and other complications, including liver cancer or liver failure. Together, hepatitis B and C kill approximately one million people every year.
According to the CDC, Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.
Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.
The best way to prevent Hepatitis B is by getting vaccinated.
Hepatitis C is a contagious liver disease that results from infection with hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with hepatitis C virus enters the body of someone who is not infected. Hepatitis C can also be transmitted through sexual contact.
Hepatitis C can be either "acute" or "chronic". Acute hepatitis C virus infection is a short-term illness that occurs within the 1st 6 months after someone is exposed to hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic hepatitis C is a serious disease than can result in long-term health problems, or even death. There is no vaccine for hepatitis C.
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Saturday, July 28, 2012

Health officials confirm Ebola outbreak in Uganda, 14 dead


Photo/ CDC-Frederick MurphyCDC

After weeks of speculation as to the cause of more than a dozen deaths this month, Ugandan Health Ministry officials and representatives from the World Health Organization (WHO) confirmed that the deaths were caused by Ebola hemorrhagic fever.
According to an Al Jazeera report Saturday, "Laboratory investigations done at the Uganda Virus Research Institute have confirmed that the strange disease reported in Kibaale district is indeed Ebola hemorrhagic fever," the Ugandan government and WHO said in joint statement.
Health officials told reporters in Kampala that the 14 dead were among 20 reported with the disease. Two of the infected have been isolated for examination by researchers and health officials.
Government officials in Uganda are urging calm in light of the confirmed outbreak.
Ebola hemorrhagic fever was first recognized in 1976 and was named after a river in the Congo. It received a lot of popular attention thanks to the best-seller, “The Hot Zone”.
Infections with Ebola virus are acute. There is no carrier state. Because the natural reservoir of the virus is unknown, the manner in which the virus first appears in a human at the start of an outbreak has not been determined.
People can be exposed to Ebola virus from direct contact with the blood and/or secretions of an infected person. Thus, the virus is often spread through families and friends because they come in close contact with such secretions when caring for infected persons. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.
The incubation period for Ebola HF ranges from 2 to 21 days. The onset of illness is abrupt and is characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients.
The death rate for Ebola HF can be up to 90%. There is no standard treatment for Ebola HF.
Officials said now that they've verified Ebola in the area they can concentrate on controlling the disease. Ebola patients were being treated at the only major hospital in Kibaale, said Stephen Byaruhanga, the district's health secretary.
"Being a strange disease, we were shocked to learn that it was Ebola," Byaruhanga said. "Our only hope is that in the past when Ebola broke out in other parts of Uganda it was controlled."
The challenge, he said, was retaining the services of all the nurses and doctors who are being asked to risk their lives in order to look after the sick.
Approximately one year ago, the Uganda Health Ministry announced that the country was officially declared Ebola free after a confirmed case and fatality of a 12-year-old girl in the Luwero district.
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ZOLOFT could be useful in treating cryptococcal meningitis according to researchers


C. neoformans  Photo/CDC

A very commonly prescribed antidepressant could have an additional use in fighting life-threatening fungal infections according to researchers at Texas A&M University.

According to a Texas A&M news release last week, the paper, published in the journal Antimicrobial Agents and Chemotherapy is the result of a two-year investigation by Xiaorong Lin, assistant professor of biology, and Matthew S. Sachs, professor of biology, involving sertraline hydrocholoride (ZOLOFT) and its effects on Cryptococcus neoformans, the major causative agent of fungal meningitis -- specifically, cryptococcal meningitis, which claims more than half a million lives worldwide each year, according to a 2009 Center for Disease Control (CDC) report.

Dr. Lin, who participated in a previous study to determine if a variety of FDA-approved drugs contained any fungicidal properties, found that sertraline was particularly effective against the yeast, C. neoformans.

According to the release:

A follow-up investigation of sertraline in a mouse model of systemic cryptococcosis revealed that it combats infection similar to fluconazole, an antifungal drug used commonly since the early 1990s. Moreover, a drug combination of sertraline and fluconazole was found to work more efficiently than either drug alone.
Lin says that even though the infection ultimately proved fatal in the mice study, sertraline as a cryptoccol treatment still holds promise. Because sertraline reduced the overall fungal burden within the mice and also possesses the desirable ability to cross the blood-brain barrier as an antidepressant, there is still hope it can be altered to serve as a viable treatment option.
"The problem for many current antifungal drugs is that many cannot go to the brain, and it's very difficult for a lot of compounds to reach the brain in the first place," Lin says. "So, you run into the problem of not killing all the fungus or having a very low level of fungus still exist. The fact is, this antidepressant can cross the blood-brain barrier and can get into the tissue at high concentrations."

Dr. Sachs notes, "The point here is that if there is a drug that already exists, is known to be well-tolerated, and has alternative uses, that's a good thing. The billion dollars it would take to bring a drug to the market -- that's already done."

With further testing, the Texas A&M researchers hope to discover the appropriate concentration and dosage of sertraline to necessary to completely eradicate a cryptococcal infection.

According to the American Society of Health-System Pharmacists:

Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance.

According to the Centers for Disease Control and Prevention (CDC):

Cryptococcosis is an infection caused by fungi that belong to the genus Cryptococcus. There are over 30 different species of Cryptococcus, but two species – Cryptococcus neoformans and Cryptococcus gattii – cause nearly all cryptococcal infections in humans and animals. Although many people who develop cryptococcosis have weakened immune systems, some are previously healthy.
C. neoformans can be found in soil throughout the world. People at risk can become infected after inhaling microscopic, airborne fungal spores. Sometimes these spores cause symptoms of a lung infection, but other times there are no symptoms at all. In people with weakened immune systems, the fungus can spread to other parts of the body and cause serious disease.
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Friday, July 27, 2012

South Carolina boy dies from brain amoeba


Image/Dave Benbennick via Wikimedia Commons


A child from Sumter County, South Carolina has succumbed to a rare “brain-eating” amoebic infection according to health officials.
The S.C. Department of Health and Environmental Control (DHEC) announced Wednesday that laboratory results confirm that the unnamed boy died as a result of infection with the parasite, Naegleria fowleri.
DHEC Director Catherine Templeton said, “We are saddened to learn that this child was exposed to the deadly organism Naegleria fowleri. While this organism is present in many warm water lakes, rivers and streams in the South, infection in humans is extremely rare.Naegleria fowleri almost always results in death.
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 32 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.
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Monday, July 23, 2012

Cholera spikes in strife-torn North Kivu, Democratic Republic of Congo


Image/CIA

The security situation in the eastern Democratic Republic of Congo (DRC) province of North Kivu has been deteriorating for months because of armed conflict between various renegade soldier groups.
The fighting has resulted in the displacement of approximately 250,000 people from the area fleeing the violence in search of safety.
Health concerns have also risen in violence-ridden areas of the eastern DRC. According to a World Health Organization (WHO) Global Alert and Response (GAR) issued Monday, the DRC has reported a sharp increase in the number of cholera cases in the armed conflict area of North Kivu.
For the three weeks spanning June 11 to July 1, 368 new cases of cholera were reported.
Because of the lack of security in the area, there is a concern those stricken with cholera will have difficulty in accessing the health-care facilities and could increase the number of severe and fatal cases.
The WHO also reports the fear of the cholera spilling over the borders into neighboring countries Burundi, Rwanda, South Sudan and Uganda.
Médecins Sans Frontières (MSF) and its partners blame the outbreak on a lack of potable drinking water.
The GAR reports:
Patients are being treated with infusions and antibiotics as appropriate, at treatment centres. Interventions to control the epidemic that are being carried out include education and communication; management of cases; increased surveillance; hygiene and sanitation; and provision of safe drinking water.
WHO is working to support national authorities in response to the cholera outbreak and the broader humanitarian emergency resulting from conflict and population displacement.
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 be 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.
According to Wikipedia, North Kivu is a province bordering Lake Kivu in the eastern Democratic Republic of Congo. Its capital is Goma.
North Kivu borders the provinces of Orientale to the north and northwest, Maniema to the southwest, and South Kivu to the south. To the east, it borders the countries of Uganda and Rwanda.
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Saturday, July 21, 2012

CDC: 2012 whooping cough cases more than double last year


Dr. Anne Schuchat  Photo/CDC

A joint briefing between the Centers for Disease Control and Prevention (CDC) and the Washington State Health Secretary was presented Thursday, which detailed the data available on the current outbreak in the United States and the state of Washington in particular.
Dr. Anne Schuchat, Director for the National Center for Immunization and Respiratory Diseases at the CDC noted that nationwide, nearly 18,000 cases have been reported to CDC. That's more than twice as many cases as was seen during the same time in 2011.
She continues, “In fact, it's more than we had in each of the past five years. We may be on track for record high pertussis rates this year. We may need to go back to 1959 to find a year with as many cases reported by this time so far. So, there is a lot of pertussis out there and I think there may be more coming to a place near you.”
Dr. Schuchat also said that to date, the current 2012 outbreak has resulted in the deaths of nine babies.
“2010 was our last pertussis peak year nationally. We had over 27,000 reported cases that year and 27 deaths, 25 of which occurred in infants”, according to Schuchat.
Washington State Secretary of Health, Mary Selecky, who declared an epidemic in her state back in April, said that this year they are seeing the largest number of whooping cough cases in Washington since the early 1940s.
She said that when she declared the epidemic three months ago, there were 640 cases. As of Thursday, Selecky reports Washington has eclipsed 3,000 cases so far this year.
She exemplifies the magnitude of the problem, “Let me put that in perspective for you. Washington had just over 200 cases at this time last year in July of 2011.”
Both Schuchat and Selecky stressed the importance of vaccination, encouraging adults and pregnant women to get vaccinated. Schuchat said, “Pertussis vaccine remains the single most effective approach to prevent infection. It is critical to protect infants and others at high risk. I want to stress that unvaccinated children are at eight times higher risk of getting pertussis compared to children fully vaccinated.”
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Wednesday, July 18, 2012

India: man has tapeworm larvae removed from 'voice box'


Photo/CDC

An Indian man who suddenly suffered with severe pain in the throat and a loss of voice, was diagnosed with an unusual parasitic condition.
In a Times of India (TOI) report Tuesday, it is reported that upon examination at the Columbia Asia Hospital in Hebbal, physicians discovered a mass in his “voice box” caused by a cysticerci from the pork tapewormTaenia solium.
Dr. Santosh S. Consultant ENT, Head and Neck Surgeon at Columbia Asia Hospital said of the case, "What made the treatment challenging was the fact that the worm was lodged right in his voice box. He underwent a surgery last week; where by a team of specialists removed the worm after a 2-hours long procedure."
The patient is recovering well after the surgery. Astonished, the patient noted, “I was quite taken aback by the diagnosis, I never thought that my condition was a result of a tapeworm in my vocal cords."
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 escapes 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.
The larval stage of the tapeworm, or cysticercus, occurs the vast majority of the time (>85%) in the brain or eyes. However, they may migrate to other areas such as the liver, heart and striated muscles.
The case reported in the TOI above, is quite rare but oral cysticercosis is not unheard of. Cases of cysticercosis have been reported from the facetongue and vocal cords.
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.
Depending on the site of the cysticercosis, treatment may involve medications to kill the parasites (antiparasitic treatments such as albendazole or praziquantel), powerful anti-inflammatories (steroids) to reduce swelling and surgery to remove the infected area.
Prevention of cysticercosis includes adequate cooking of meat and washing fruits and vegetables 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.
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Monday, July 16, 2012

Experts encourage screening West Nile patients for kidney disease

From a Baylor College of Medicine news release July 12:


Researchers from Baylor College of Medicine, Texas Children's Hospital and The University of Texas Health Science Center at Houston advise physicians to screen patients for kidney disease if they have a history of infection with West Nile virus.
In a study of 139 patients infected with West Nile virus in the Houston-area, researchers from the three institutions found indications of varying degrees of kidney disease in 40 percent of those who had the mosquito-borne illness. Their findings appear online in the journal PLoS ONE.

Progression of disease

"We are in the process of researching the relationship between West Nile virus infection and kidney disease, but this study now allows us to understand the prevalence and progression of kidney disease in those previously infected with West Nile virus," said Dr. Kristy Murray, associate professor of pediatrics ­ tropical medicine at BCM and Texas Children's, and senior author of the paper and principal investigator of the West Nile virus research program.
West Nile disease results from the bite of an infected mosquito. It causes fever, headache and body aches. In its most severe form, it can cause high fever, neck stiffness, stupor, coma, tremors, convulsions, muscle weakness and paralysis. In severe cases, it can cause encephalitis or inflammation of the brain and its sufferers may have to be hospitalized. While it is known that those with the most severe form of the disease can suffer long-term nerve and brain problems, long-term kidney problems have not been identified before, said Murray. Murray and Melissa Nolan, the first author of the paper, are with the National School of Tropical Medicine at BCM.

Catch early

"An estimated two million Americans have been infected with West Nile, and we advise physicians to screen them for potential kidney disease, because if you catch it early, then the person can be monitored and treated should the disease progress," said Nolan, senior research coordinator at BCM and Texas Children's.
Researchers collected blood and urine samples from the 139 West Nile patients in the study and asked them general questions about their symptoms and health. They then followed up with the patients every six months from the study's starting dates in April ­- Nov. 2010.
The researchers found that 10 percent of the patients had test results consistent with stage three or greater chronic kidney disease and 30 percent had results consistent with stages one or two.

Five stages

Chronic kidney disease is divided into five stages. The first two are milder forms of disease and stage three is a moderate form. Stage four and five are the more severe forms that are usually irreversible and can result in dialysis or kidney transplantation.
"Stage three is a tipping point where patients either recover or progress onto later stages," said Nolan. "However, since there are no symptoms of kidney disease until later stages, many people are not aware that they have it."
Researchers also found that traditional risk factors associated with kidney disease, such as diabetes, hypertension, and older age, were not statistically associated with kidney disease in the study participants. The one thing they did find significant was that those with more severe West Nile infections were at higher risk for kidney disease.

Take precautions

"Our next steps are going to be to understand that relationship between infection and kidney disease," said Murray. "We believe we now have good evidence towards an association. There are many long-term and serious health effects related to infection with this virus, and we want to strongly encourage people of all ages to take precautions against mosquito bites."
Others who took part in the study include Amber S. Podoll, Katherine M. Akers and Kevin W. Finkel with the UTHealth Medical School and Anne M. Hause with The University of Texas School of Public Health, which is a part of UTHealth.
Funding for this study came from the Gillson Longenbaugh Foundation and the National Institutes of Health.
The full report can be found at the journal PLoS ONE.



Sunday, July 15, 2012

Smoking may lead to increased risk of viral hepatitis reinfection post-liver transplant according to study


Photo/CDC

Transplant recipients who smoke or have smoked increase their risk of viral hepatitis reinfection following liver transplantation according to a new study by researchers at McGill University.

The Canadian researcher conclude, based on their finding that tobacco in cigarettes may adversely affect immune system response in patients transplanted for viral hepatitis.

The study is published in the July issue of the journal Liver Transplantation.


Analysis of demographic characteristics and post-transplantation complications was performed on data from primary liver transplant recipients over a 14-year period. Using data from the McGill University Health Centre (MUHC) Liver Transplant database, the team identified 444 patients who received liver transplants between 1990 and 2004, of which 63 were repeat transplants. The mean age of liver recipients was 55 years and 66% were male with a mean body mass index (BMI) of 27.
Results show that 23% of transplant recipients were active or ex-smokers and 78% were non-smokers. Of those who ever smoked, 78% were male and 88% were Caucasian. The cause of liver disease was likely to be alcohol related in 29% of smokers or ex-smokers compared to 16% non-smokers. Researchers estimated the median survival time for smokers following transplantation was just over 13 years.
Further analysis shows that the recurrent viral hepatitis-free survival time was less than one year for smokers and close to five years for non-smokers. The team found that patient survival, and time to biliary complications, first rejection and depression post-transplantation was not linked to smoking status. However, recurrent viral hepatitis-free survival was strongly associated with smoking.

McGill University’s, Dr. Mamatha Bhat explains, “Our findings suggest that recurrence of viral hepatitis may be more frequent among liver transplant recipients who are active or former smokers. Encouraging preoperative smoking cessation may be beneficial in improving patient outcomes following transplantation.” 

Researchers are by no means suggesting denial of liver transplant in smokers; only suggest that transplant specialists be more vigilant in monitoring for complications in those candidates who continue to smoke. 

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Saturday, July 14, 2012

West Nile Virus reappears in Greece


Culex tarsalis mosquito Photo/CDC

For the first time since the 2011 West Nile Virus (WNV) outbreak that killed nine out of the 101 people infected, the Greek Centre for Disease Control and Prevention (Keelpno) reports the reappearance of the mosquito borne virus in the Athens area.

According to an AFP report Friday, Since July 7, three 60 year-olds, one 40 year-old and an 18 year-old man have been diagnosed with the mosquito-borne disease.

While the first victims were successfully treated, the latest three had been hospitalised for symptoms "affecting the central nervous system," Keelpno added.

First discovered in Uganda in 1937, West Nile virus is a mosquito-borne disease that can cause encephalitis, a brain inflammation.

According to the Centers for Disease Control and Prevention (CDC), approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.

Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

There is no specific treatment for WNV infection.

WNV is indigenous to Africa, Asia, Europe and Australia.

Friday, July 13, 2012

University of California researchers use beneficial fungus to protect pistachios from aflatoxin


Public domain photo/Koyaaanis Qatsi 

Researchers from the University of California’s Kearney Agricultural Research and Extension Center have come up with a way to protect the state’s pistachio crop from aflatoxin by using another, beneficial fungus.

According to a news release Friday, after 11 years of research, Kearney scientists discovered how to expose pistachio trees to the spores of a beneficial fungus (Aspergillus flavus 36 (AF36)) that displaces the aflatoxin-producing Aspergillus spp. This is the first time this process has ever been done in tree crops.

UC Davis plant pathologist Themis Michailides says the results have been great. “The reduction in aflatoxin contaminated nuts has been up to 45 percent. We anticipate higher reduction with application of the beneficial fungus for multiple years and on larger acreage.”

The Kearney process received approval by both the US Environmental Protection Agency and the California Department of Pesticide Regulation earlier this year.

The 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. 

Aflatoxin poisoning can be broken up 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. 

Foods most commonly affected by aflatoxins (from the USDA’s Food Safety Research Information Office):

• Cereals (maize, corn, sorghum, pearl millet, rice, wheat)

• Oilseeds (peanut, soybean, sunflower, cotton)

• Spices (chillies, black pepper, coriander, turmeric, ginger)

• Tree nuts (almonds, pistachio, walnuts, coconut)

• Dried fruits (sultanas, figs)

• Cocoa beans 

According to the news release:

Aflatoxin was discovered in the 1960s when a flock of turkeys in England died after eating contaminated feed. Aflatoxin is produced by certain strains of the fungus Aspergillus flavus, which is commonly found in soil and decaying vegetation. Aflatoxin is a resilient foe. Roasting nuts does not destroy the toxin. Other crops, such as corn and cottonseed used as animal feed, can be treated with ammonia to reduce aflatoxin, however ammonia treatment is not possible for human food, such as tree nut crops.
All shipments of pistachios are tested for aflatoxins, and are rejected in Europe if contamination exceeds 10 parts per billion and in the United States if shipments have more than 15 parts per billion.
The use of beneficial fungi to fight aflatoxin was first investigated by Peter Cotty, a research plant pathologist in the School of Plant Sciences at the University of Arizona. Cotty’s research focuses on reducing aflatoxin presence in corn and cottonseed. Michailides and his colleague Mark Doster, staff research associate in the Michailides lab at Kearney, found that Aspergillus flavus 36 (AF36) can be introduced into an orchard by inoculating “dead” wheat seeds and then dispersing the seeds on the orchard floor. Dew and soil moisture spur the development of harmless spores that colonize pistachios and prevent colonization by toxigenic fungus strains.

What’s next for Kearney scientists? Almonds and figs they say.


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Cambodia ‘mystery illness’ investigation over: the conclusions


The investigation into the outbreak of the previously undiagnosed disease, which affected 78 children in Cambodia and killed at least 54, has concluded according to the Cambodia Ministry of Health (MoH) and the World Health Organization (WHO).
In a Joint Statement from the MoH and WHO Thursday, investigators into the outbreak, which began in April, conclude that a severe form of hand, foot and mouth disease (HFMD), enterovirus 71, was the cause in the majority of cases reported to the Ministry of Health.
In addition, investigators discovered that a good number of the children were treated with steroids at some point during their illness, which only exacerbated their condition and made it worse.
Laboratory tests, a thorough medical records review, active follow-up with the affected families and evaluation of the data from the national surveillance system were all significant facets of the investigation.
According to the statement:
Samples from a total of 31 patients were obtained and tested for a number of pathogens by Institut Pasteur du Cambodge. Most of these samples tested positive for enterovirus 71 (EV-71) which causes HFMD. A small proportion of samples also tested positive for other pathogens including Haemophilus Influenzae type B and Streptococcus suis. It was not possible to test all the patients as some of them died before appropriate samples could be taken.
A total of 78 cases were identified. These included the initial 62 cases reported by Kantha Bopha hospital, and cases reported from other hospitals. Of these, the investigation focused on 61 cases that fitted a specific criteria (the case definition), and of which 54 had died, mostly children under the age of three.
The following actions have been instituted: reporting all cases of HFMD to the MoH, enhanced surveillance and the development of guidelines and training of medical personnel in the management of all forms of HFMD.
EV-71 has been implicated in HFMD outbreaks in Southeast Asia over the several years.
According to the WHO, in the first six months of this year alone, 356 people in China and 33 in Vietnam have died from the hand, foot and mouth disease.
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Thursday, July 12, 2012

FDA ok’s BD Diagnostics MRSA molecular test


Photo/CDC

A quick and accurate result to determine if a patient is colonized with methicillin-resistantStaphylococcus aureus (MRSA) is critical in reducing transmission of the organism in a health care environment where patients are often vulnerable to such infections.
BD Diagnostics announced in a press release Monday, it received FDA clearance to market the BD MAX™ MRSA molecular test in the United States. The assay is performed on the fully-automated BD MAX™ System and is designed to rapidly and accurately identify patients colonized with MRSA.
Tom Polen, President, BD Diagnostics – Diagnostic Systems said, “The BD MAX MRSA assay is an easy-to-use, cost-effective method to identify patients colonized with this deadly superbug, which may support better outcomes for the patient and a safer hospital environment. FDA clearance of the BD MAX MRSA test gives our customers a new level of automation to optimize MRSA surveillance testing.”
The Centers for Disease Control and Prevention (CDC) says MRSA is now common in both health care and community settings. However, patients in healthcare facilities have weakened immune systems and undergo procedures (such as surgery) or have catheters inserted into the skin that make it easier for MRSA to get into the body.
When patients get MRSA in healthcare facilities, the infections tend to be severe. Common infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.
In addition, there is a dollar cost associated with MRSA. According to the Institute for Healthcare Improvement, the total cost burden to the U.S. healthcare system from MRSA infections is estimated at more than $2.5 billion annually.
The BD MAX MRSA assay is the second test cleared this year by the FDA on the BD MAX System.
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 ineffective 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.
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Tuesday, July 10, 2012

Denmark reports first case of IV drug-related anthrax


An intravenous drug user who injected heroinhas died from an anthrax infection in a Copenhagen hospital over the weekend, becoming the first such case in Denmark.
According to an Associated Press report Monday, the Denmark Health Ministry says a 55-year-old drug addict died Sunday from ananthrax infection believed to be from contaminated heroin.
According to a ProMed-mail posting, an infectious disease consultant from the university hospital Rigshospitalet, Copenhagen says blood cultures on the HCV and HIV-positive IV drug user revealed the presence of the bacterium, Bacillus anthracis. Although the patient was treated with antibiotics, he eventually died from an irreparable shock.
Danish health officials report that terrorism is not suspected and that the infection cannot be passed person-to-person.
In late June, German officials also reported two fatal cases linked through exposure to heroin contaminated by Bacillus anthracis. Authorities there say the same batch of heroin in the 2009/2010 outbreak in Scotland, which left ten people dead, may be linked to the new German cases.
Swedish health officials also issued a warning Monday to the “thousands” of heroin users in the country. According to Dr. Håkan Ringberg, an infectious disease doctor with Smittskydd Skåne, "We're advising users not to take heroin intravenously."
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Friday, July 6, 2012

FDA approves CMV viral load test for managing organ transplant patients


Cytomegalovirus (CMV) is one of the herpesviruses. More than half of people in the United States are infected with the generally harmless virus by the time they are 40 years old.
However, the lifelong infection CMV may cause severe and occasionally life-threatening disease in immunocompromised persons, such as organ and bone marrow transplant recipients, cancer patients, patients receiving immunosuppressive drugs, and HIV-infected patients.
According to a Roche Molecular Diagnostics media release Thursday, the fully automated COBAS® AmpliPrep / COBAS® TaqMan® CMV Test is the first FDA-approved laboratory test for use in quantifying CMV DNA in human plasma specimens. Physicians use CMV DNA viral load information from the test to help manage patients who have been diagnosed with CMV disease, specifically patients whose immune system has been suppressed for solid organ transplantation.
Paul Brown, Ph.D., head of Roche Molecular Diagnostics says, “With this test, laboratories now have an FDA-approved option for standardized and automated CMV viral load testing that improves the laboratory’s workflow. It provides physicians with clinically useful information to aid in the management of solid organ transplant patients with CMV disease.”
CMV is the most common and important viral infection in solid organ transplant (SOT) recipients. The virus can be transmitted through the donor organ, resulting in CMV infection and leading to the development of CMV disease, or can occur by reactivation of the virus in transplant recipients with previous CMV infection. CMV disease in transplant recipients may be similar to infectious mononucleosis with fever, malaise and mild laboratory abnormalities, or can be more serious with involvement of the lung or gastrointestinal tract.
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Monday, July 2, 2012

Nearly one-third of the planet is affected by roundworms: WHO

Ascaris adult worms Photo/CDC

The parasitic roundworms, also known as soil-transmitted helminths are a huge problem, impairing children physically, nutritionally and cognitively worldwide.

The parasites, transmitted to people through contaminated soil include the giant intestinal roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and the hookworms (Necator americanus and Ancylostoma duodenale).

According to a World Health Organization (WHO) Fact Sheet released Friday:

Approximately two billion people, or almost 29% of the world’s population are infected with soil-transmitted helminth infections worldwide. Soil-transmitted helminth infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and east Asia.

Over 270 million preschool-age children and over 600 million school-age children live in areas where these parasites are intensively transmitted, and are in need of treatment and preventive interventions.

Some of the soil-transmitted helminths (Ascaris and Trichuris) are transmitted by eggs that are passed in the feces of infected people. The worms produce thousands of eggs daily inside the infected individual, and without proper sanitation facilities, the eggs are excreted in the feces wherever the person chooses to defecate.

This makes people, particularly children vulnerable to infection via contaminated soil, water or fruits and vegetables.

In the case of hookworms, the eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin. People become infected with hookworm primarily by walking barefoot on the contaminated soil.

Illness depends on the worm burden. The more worms, the more serious the symptoms.

The WHO says  the heavier infections can cause a range of symptoms including intestinal manifestations (diarrhea, abdominal pain), general malaise and weakness, and impaired cognitive and physical development. Hookworms cause chronic intestinal blood loss that can result in anemia.

The worms can also have a detrimental nutritional effect because the worms feed on blood and other nutrients in the host and they can cause a loss of appetite and diarrhea.

  • The WHO’s strategy for control of these parasites include:   periodic drug treatment (deworming) without previous individual diagnosis to all at-risk people living in endemic areas. Treatment should be given once a year when the prevalence of soil-transmitted helminth infections in the community is over 20%, and twice a year when the prevalence of soil-transmitted helminth infections in the community is over 50%.
  • health and hygiene education reduces transmission and reinfection by encouraging healthy behaviors
  •  provision of adequate sanitation is also important but not always possible in resource-poor settings.

Albendazole (400 mg) and mebendazole (500 mg) are the WHO-recommended medicines; they are effective, cheap and have few side effects.

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