Quick Update: Recent Reports on MMWR (December 2018 - January 2019)
https://www.therecoveryvillage.com/heroin-addiction/black-tar-heroin-effects/#gref
Black Tar Heroin With a Side of Botulism
January 4, 2019 / 67(5152);1415–1418
September 29–October 6, 2017 in County of San Diego
Two patients with suspected wound botulism and a history of using black tar heroin
Baseline only one a year
Typical signs and symptoms: muscle weakness, difficulty swallowing, blurred vision, drooping eyelids, slurred speech, difficulty breathing, loss of facial expression, or descending paralysis
By April 2018: identified 9 patients, all hospitalized and one died
All 9 with history of injected drugs
7 used black tar heroin
6 practiced “skin popping”
Skin popping: injection of drugs into the skin with goal of achieving slower absorption, decreased risk of overdose, and easier administration than IV
All treated with heptavalent botulism antitoxin (BAT)
What public health labs can do per LRN (check with your jurisdiction)
Specimens to submit: serum, stool, gastric aspirate, tissue, environmental or food, culture isolates
What we do
Mouse bioassay
Culture and enrichment followed by PCR to detect toxin gene
More sensitive technologies being developed at the CDC
Forearm with round, depressed, hyperpigmented papules and plaques (arrows) indicative of skin popping
Human Rabies
January 4, 2019 / 67(5152);1410–1414
May 2017: Virginia Department of Health was notified regarding a patient with suspected rabies
History of dog bite 6 weeks before symptom onset while traveling in India
CDC confirmed that rabies virus from patient was the same as circulating dog strain in India
9th rabies death in US since 2008
Post-exposure prophylaxis in healthcare workers was very costly
Lesson: International travelers should consult with travel health specialists and get vaccinated when suggested
How we test for rabies: DFA on specimens (animals, humans), PCR is being launched by the CDC
A significant subset of bats we tests are positive for rabies: don’t hang out with them!
Mycobacteria chimaera in the OR
January 4, 2019 / 67(5152);1428–1429
Mycobacteria chimaera: member of MAC group, challenging to diagnose since infection develops very, very slowly
December 2016: a hospital in Los Angeles County, California (home!) reported two Mycobacterium avium complex infections, later identified as Mycobacterium chimaera, in patients with a recent history (<5 years) of cardiopulmonary bypass surgery
Both procedures used Sorin Stöckert 3T (Sorin Group, Munich, Germany) heater-cooler unit brand (currently LivaNova PLC, London, United Kingdom), which have been linked to outbreaks of M. chimaera infections among patients with similar surgical histories in Europe and the United States
https://www.somatechnology.com/Heater-Cooler-Systems/Sorin-Stockert-3T.aspx
Don’t Get Unlawfully Marketed Stem Cell Injections!
December 21, 2018 / 67(50);1397–1399
Background: the FDA ONLY granted approval to umbilical cord blood-derived stem cells ONLY for hematopoietic and immunologic reconstitution
There is also no validated process for sterilization of these cells so manufacturers need to be SUPER CLEAN
September 2018: Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients
All had received injections or infusions of non-FDA–approved umbilical cord blood-derived stem cell products processed and distributed by a private company for other than hematopoietic or immunologic reconstitution at an outpatient clinic
E. cloacae had identical PFGE patterns
Also in September 2018: Florida Department of Health received notification of Escherichia coli, Enterococcus faecalis, and Proteus mirabilis joint infections in four patients
All had received injections of these same products at an orthopedic clinic during also for other than hematopoietic or immunologic reconstitution. SURPRISE!
More cases in TX, FL, AZ presenting as bloodstream infections, joint infections, and epidural abscesses
Cultures of unopened vials demonstrated presence of these bugs
Suggesting pre-distribution contamination
Conjunctivitis After a Visit to an Eye Clinic
December 7, 2018 / 67(48);1347–1349
June 2017: Los Angeles County Department of Public Health (home, again!) was notified of seven patients seen at an eye care clinic earlier that month and developed epidemic keratoconjunctivitis
Contagious, severe form of viral conjunctivitis
Identified 17 patients with EKC (15 patients and 2 household contacts)
Found deficiencies!
Improper disinfection of tonometers (70% isopropanol wipes instead of soaking in chlorine or ethanol)
Improper use of eye drop administration among multiple patients (touching eyes or surrounding areas)
Human adenovirus (HAdV) type D53 (HAdV-53) identified from patient specimens
First report of EKC outbreak caused by HAdV-53