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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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6711a2.htm?s_cid=mm6711a2_e

  • 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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6711a3.htm?s_cid=mm6711a3_e

  • 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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6711e1.htm?s_cid=mm6711e1_e

  • 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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a6.htm?s_cid=mm6710a6_e

  • 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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a7.htm?s_cid=mm6710a7_e

  • 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

https://www.cdc.gov/salmonella/kratom-02-18/index.html

  • 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

http://www.pnas.org/content/early/2018/03/13/1711611115

  • 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

https://www.medscape.com/viewarticle/894204

  • 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

https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyx281/4911079

  • 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

https://journals.lww.com/greenjournal/Abstract/publishahead/Quality_Improvement_to_Demonstrate_the_Lack_of.98121.aspx

  • 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

https://obgyn.mcw.edu/wp-content/uploads/King_Kathy-Cervical-Cancer-Screening-2016-NEW-FullPageNotes.pdf

  • 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

http://europepmc.org/abstract/med/29471368

  • 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

http://jcm.asm.org/content/early/2018/02/23/JCM.01884-17.abstract

  • 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.

PEERA HEMARAJATA, M.D., PH.D., D(ABMM)

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