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Lit Review and Outbreak Updates (6/9/18)

June 10, 2018

 

 

 

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 :).

 

 

CDC outbreak updates!!!

 

  • Multistate Outbreak of Salmonella Adelaide Infections Linked to Pre-Cut Melon

    • As of 6/8/18: 60 cases in 5 states (Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, and Ohio)

    • Fresh cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products produced at the Caito Foods facility in Indianapolis, Indiana

    • May be sold in clear, plastic clamshell containers at Costco, Jay C, Kroger, Payless, Owen’s, Sprouts, Trader Joe’s, Walgreens, Walmart, and Whole Foods/Amazon

  • Salmonella outbreak linked to exposure to live poultry

    • As of 6/8/18: 124 cases in 36 states, no death yet

    • Salmonella Seftenberg, Salmonella Montevideo, Salmonella Infantis, Salmonella Enteritidis, Salmonella Indiana, and Salmonella Litchfield

  • Update on Multistate Outbreak of Salmonella Braenderup Infections Linked to Rose Acre Farms Shell Eggs

    • As of 5/10/18: 35 cases in 9 states

    • Throw away those eggs!

    • Could be marketed under other names: Coburn Farms, Country Daybreak, Food Lion, Glenview, Great Value, Nelms, Publix, Sunshine Farms, and Sunups

  • Update of Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce

    • As of 6/1/18: 197 cases in 35 states with 5 deaths from HUS

    • Unlikely that contaminated produce is still around

 

Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who Inject Drugs — Six Sites, 2005–2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a2.htm?s_cid=mm6722a2_w

 

  • The CDC assessed the effects of the opioid epidemic on invasive methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005–2016

  • IVDUs: 16.3 times more likely to develop invasive MRSA infections than others

  • Invasive MRSA from injecting drugs increased from 4.1% of invasive MRSA cases to 9.2% (2011–2016), mostly associated with non-sterile drug injections

  • Common complications: endocarditis, osteomyelitis, skin and soft tissue infection

 

Update: Influenza Activity in the United States During the 2017–18 Season and Composition of the 2018–19 Influenza Vaccine

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a4.htm?s_cid=mm6722a4_w

 

  • A rough year, with A(H3N2) being a predominant strain

    • Hemagglutination inhibition for these H3N2s doesn’t work very well so need to use focus reduction assay

  • PHLs tested 98,446 specimens during October 1, 2017–May 19, 2018; 53,790

    • 54.6% positive for flu

  • How does CDC detect potential genetic drift?

    • PHLs submitted specimens to National Influenza Reference Centers (CA, NY, WI state labs to be characterized sequencing and antigenic characterization

    • Most H3N2s inhibited by antisera raised from A/Michigan/15/2014 strain, which was part of vaccine in the past year, but less than half inhibited by A/Hong Kong/4801/2014 antisera (this was also a component of vaccine)

      • More (77%) were inhibited by antisera against A/Singapore/INFIMH-16–0019/2016, which will be in 2018-2019 vaccine!

    • No resistance to oseltamivir and zanamivir detected

  • 2018-2019 vaccine components

    • A/Michigan/45/2015 A(H1N1)pdm09-like

    • A/Singapore/INFIMH-16–0019/2016 A(H3N2)-like

    • B/Colorado/06/2017-like (B/Victoria lineage)

    • B/Phuket/3073/2013-like (B/Yamagata lineage) (only in quadrivalent vaccines)

 

Update: ACIP Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) — United States, 2018–19 Influenza Season

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a5.htm?s_cid=mm6722a5_w

 

  • LAIV used to be not very effective against A(H1N1)pdm09-like viruses, but should work well with a new virus (A/Slovenia/2903/2015)

  • 2018–19 U.S. influenza season: any licensed, age-appropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV4

    • LAIV4 is an option for those for whom it is otherwise appropriate. No preference is expressed for any influenza vaccine product

 

Notes from the Field: Cyclosporiasis Cases Associated with Dining at a Mediterranean-Style Restaurant Chain — Texas, 2017

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a5.htm?s_cid=mm6721a5_w

 

  • 22 patients who dined at one of four locations of chain

  • Odds ratio highest for green onions, but no solid association

 

Notes from the Field: Verona Integron-Encoded Metallo-Beta-Lactamase–Producing Pseudomonas aeruginosa Outbreak in a Long-Term Acute Care Hospital — Orange County, Florida, 2017

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a6.htm?s_cid=mm6721a6_w

 

  • July 2017: one patient identified at a long-term acute care hospital (LTACH) in Orange County, Florida

  • Subsequent screening of rectal swabs revealed 6 more patients colonized

  • PCR to detect gene available in all 50 states through ARLN

 

Effect of Dermatology Consultation on Outcomes for Patients With Presumed Cellulitis: A Randomized Clinical Trial

https://jamanetwork.com/journals/jamadermatology/article-abstract/2672582

 

  • Looked at 175 patients

  • Patients who had dermatology consultation received shorter course of antibiotics with better clinical improvement

  • Roughly a third of all cases were misdiagnosed

 

New Molecular Method for Detection of Candidemia, but Don’t Forget the Blood Cultures

https://academic.oup.com/cid/article-abstract/66/11/1687/4846896?redirectedFrom=fulltext

 

  • T2 system: detection of 5 common species of Candida (C. albicans, C. tropicalis, C. glabrata, C. krusei, C. parapsilosis) using PCR with magnetic resonance that detects the amplified DNA hybridized to iron-decorated nanoparticles

  • Pretty good system, but:

    • Won’t recover organism

    • Won’t detect other Candida spp. Including C. auris

    • Patients often have concomitant bacteremia

  • Implementation can be a tall order

    • Worth it or not? Depends upon incidence of candidemia and high-risk groups of patients in each institution

 

What’s New in the Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2017 Update – A Clinical Practice Guideline?

https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf

 

  • Jwatch has a really good summary

  • Key point

    • PrEP is recommended in MSM, heterosexual individuals, and people who use injected drugs with high risk of HIV infection

    • TDF/FTC is the ONLY recommended regimen for PrEP

    • Should still screen for HBSAg – stopping TDF in people with chronic HBV could result in disease flare up

  • Changes

    • HIV Ab/Ag combo tests are recommended over any FDA approved test

    • MSM or individuals with history of STDs, high risk should get tested every 3 months instead of 6

    • HCV testing is recommended

 

Pneumococcal Community-Acquired Pneumonia Detected by Serotype-Specific Urinary Antigen Detection Assays

https://academic.oup.com/cid/article/66/10/1504/4682634

 

  • Strep pneumo CAP can be challenging to diagnose with conventional culture

  • Novel serotype-specific urinary antigen detection (SSUAD)

  • Although can only detect 13 serotypes, the test helped diagnose significantly more cases, with 82% relative increase in detection

 

Interferon-γ Release Assay Performance for Tuberculosis in Childhood

http://pediatrics.aappublications.org/content/141/6/e20173918?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

 

  • 778 cases of TB in patients 18 yr or younger in CA registry

  • Sensitivity of IGRA compared to TST in 5-18-yo: 96%  vs 83% - should be test of choice

  • Both sensitivity and specificity dropped in children aged <2 years: 80%cvs 87%

  • That's all for now. Bug Hunters, may the odds be ever in your favor. 

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

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