Lit Review Mar #2
Disclaimer: this compilation of synopses have been collected from multiple sources, including Mark Crislip's Puscast, Journal Watch Infectious Diseases, Medscape Infectious Diseases, CDC MMWR, AMA Morning Rounds, ProMED Mail, Journal of Clinical Microbiology, Antimicrobial Agents and Chemotherapy, Clinical Infectious Diseases, and more. I chose these articles based on their relevance to clinical microbiology and would be of interest to my fellows, and some other pieces that I found amusing to read. All credit goes to these original contributors. I'm just a messenger :).
Leading Photo by slon_dot_pics from Pexels
Tuberculosis — United States, 2017
World TB Day: 3/24/18!
9,093 new cases in the US in 2017
Incidence rate decreased 2%/year, total cases decreased from 1.8%
Rate is too slow: we need 3.9% to achieve TB elimination in 2100
Of course CA reported the most cases among all states, but HI beat us on the incidence rate (5.2 vs 8.1%)
Preliminary Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006–2017
FoodNet: tracks lab confirmed infection caused by 9 pathogens
Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, Yersinia
Side note: NARMS – FDA and USDA, tracks resistance in 5 organisms
Campylobacter, , Shiga toxin-producing Escherichia coli O157, Shigella, Salmonella (both typhoidal and non-typhoidal, Vibrio except cholera
CIDT becoming more popular: seeing increase in case number in some pathogens that could be missed in culture: Yersinia, Vibrio, non-O157 STEC
Cases of Salmonella detected by CIDT increased a lot, and seems like most cases were positive in reflex culture
Overall case number did not decrease: although some serotypes associated with poultry or beef decreased (due to new USDA measures), other serotypes replaced them
Overall STEC increased, but probably due to non-O157 (which should increase as more labs use CIDT), O157 was hypothesized to decrease due to reduced incidence of HUS in children (since most HUS cases are caused by O157)
Fatal Yellow Fever in Travelers to Brazil, 2018
10 cases of YF in travelers to Brazil reported to ProMED (Program for Monitoring Emerging Diseases – an internet based outbreak reporting system) since Jan 2018
None had been vaccinated
4 deaths
Vaccine: all eligible persons aged ≥9 months traveling to many areas in Brazil, including São Paulo and Rio de Janeiro (especially Ilha Grande), at least 10 days before traveling
Notes from the Field: False-Negative Hepatitis B Surface Antigen Test Results in a Hemodialysis Patient — Nebraska, 2017
2010: dialysis patient with unknown immunity, got HBV vaccines before starting dialysis, tested negative for HBsAg and positive for anti-HBs
2016: admitted for other stuff, positive for HBsAg
All this time had not been under protocol for HBV positive patient in dialysis center
Confirmed by VL
Found sG145R mutation in S gene
Some older generations of FDA-approved kits did not detect this mutant
Anti-HBs not effective
Notes from the Field: Assessing Rabies Risk After a Mass Bat Exposure at a Research Facility in a National Park — Wyoming, 2017
August 2017: 20 local public health nurses exposed to bats and bat excrements while staying overnight at a national park research facility
Huge effort in identifying people who had been in the facility over the summer
Notes: rabies can spread via bites, scratches, mucous membrane contact with saliva, most US cases associated with bats - 75% of become ill within 3 months
Multistate Outbreak of Salmonella Infections Linked to Kratom
Kratom: plant consumed for its stimulant effects and as an opioid substitute
Native to Thailand, Malaysia, Indonesia, and Papua New Guinea
Outbreak in 35 states involving 87 people (as of 3/15/18), 27 hospitalized, no death
Most patients consumed powder form that they purchased from retail locations and online
Epi data suggested kratom product as likely to be involved, but no common brands or suppliers
Where were these grown????
WGS and PFGE on patient isolates confirmed outbreak caused by Salmonella I 4,[5],12:b:- , Salmonella Javiana, Salmonella Okatie, Salmonella Thompson, some of these were found on in both kratom product and ill people
Behaviors, movements, and transmission of droplet-mediated respiratory diseases during transcontinental airline flights
Study sponsored by Boeing
Study team of 10 flew on 20 transcontinental flights (about 6 hours) and recorded behavior of passengers to calculate contact time between passengers and crew
One passenger coughed moderately during flight
Built a model of infection: an infected passenger in different locations in coach, and an infected crew member
Used transmission rate in plane from a 1977 report of transmission of flu-like illness while on a tarmac for 4.5 hrs
Assumed a droplet transmission of viruses
One infected passenger will infect two additional people at the most
A sick crew member will infect 4.6 more people
Collected 229 environmental samples, all neg for respiratory viruses
So they said that it would be unlikely to spread infection beyond 1 m from sick person
I don’t exactly know why but I’m not buying it
Prior Chlamydia Infection and Doubled Risk for Ovarian Cancer
Two independent case-control studies reported association bentween presence of Pgp3 antibodies (antigen is highly immunogenic, indicative of Chlamydia exposure) and 43-60% increased risk of ovarian cancer
Such increased risk not seen in a bunch of other pathogens (Mycoplasma genitalium, HSV-2, HPV, polyomavirus, HBV, HCV, EBV, CMV (they couldn’t reliably test exposure to NGC)
Is it safe to go back into the water? A systematic review and meta-analysis of the risk of acquiring infections from recreational exposure to seawater
Meta-analysis looking at coastal water all over the world (USA, UK, Australia, NZ, Spain and one Denmark, Greece, Mexico, Norway, Turkey
People exposed to seawater in various ways were 86 percent more likely to get sick (ear, GI)
Quality Improvement to Demonstrate the Lack of Reliability of the Human Papillomavirus mRNA Assay to Identify Women With Latent Human Papillomavirus Infections
Screening strategy for CA cervix
21-29 cytology alone every 3 years
30-65 cytology alone every 3 years or cytology+HPV every 5 years
PCR increases sensitivity for precancer lesions
PCR more sensitive to adenocarcinoma which is more serious
>65 may stop screening if adequate prior screening
Negative cytology x3 or Negative cyto+HPV x2 within 10 years, with the most recent within 5 years
No prior history of cervical cancer, CIN 2/3 in the prior 20 years
FDA approved HPV testing only as screening among 25-65
10% of patients will have persistent infection, fluctuating between latent and active
Active lesions will cause damage but not latent, may switch
HPV DNA test doesn’t tell you whether it’s an active or latent infection
E6/E7 mRNA-based HPV test detects only active infections
Hoping that detecting only active infection in individuals with HPV positive only will prevent unnecessary follow up and treatment in women having HPV but in latent infection
68% had positive DNA followed by negative mRNA
69.6% of these women had follow-up management altered as a result of a neg Mrna test
38.1% of these women actually had history of abnormal pap or cancer within 5 years
26.8% of these women actually had abnormal colposcopy
Should not be used as a primary screening tool!
Human Factors Risk Analyses of a Doffing Protocol for Ebola-Level Personal Protective Equipment: Mapping Errors to Contamination
Interesting paper for risk of self-contamination while doffing EVD PPE
Most mistakes during hand hygiene and PAPR removal
FoodBorne Outbreak of Group G Streptococcal Pharyngitis in a School Dormitory in Osaka, Japan
GGS include Streptococcus dysgalactiae subsp. equisimilis and Streptococcus dysgalactiae subsp. dysgalactiae
September 2017: 140 students (18-31yo) in a dorm in Japan developed pharyngitis
Streptococcus dysgalactiae subsp. equisimilis isolated from patient, broccoli salad, and a cook, same PFGE type
Served in caferia
Mean progression time 44.9 hrs
Isolate also found in cooked rice but at low level
Cook ate but did not make the salad – not source
Organism from rice cross-contaminated to broccoli
That's all for now. Bug Hunters, may the odds be ever in your favor.