Melioidosis: A Greater Threat Than Previously Suspected?

Burkholderia pseudomallei

Accepted Manuscript. Pending final edits. Microbes and Infection from Institut Pasteur and Elsevier Please cite this article as: E.A. Kelser, Melioidosis: A Greater Threat Than Previously Suspected?, Microbes and Infection (2016), doi: 10.1016/j.micinf.2016.07.001. Abstract Research released in 2016 shows that the global burden of Burkholderia pseudomallei infection is probably much higher than previously suspected. Better testing and reporting are needed if we are to detect outbreaks and diminish deadly delays in treatment. Worldwide, researchers need support for vaccine development, particularly for public health vaccines to protect people and animals in endemic areas. Because melioidosis can infect so many species, collaboration and communication between human and veterinary medicine experts will be key to tracking, treating and preventing B. pseudomallei infections. Melioidosis: A Greater Threat Than Previously Suspected? Infection with Burkholderia pseudomallei may be more common and deadly than we think. Melioidosis is often thought of as a tropical disease affecting people […]

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Meet dengue’s cousin, Zika

Aedes aegypti. James Gathany, 2006. CDC.

Microbes and Infection Volume 18, Issue 3, March 2016, Pages 163–166 Editorial Published by Elsevier Masson SAS for Institut Pasteur, Paris. All rights reserved. For original link with citations, go here.) It’s too early to know how alarmed we should be about the spread of Zika virus (ZIKV). The good news is that ZIKV currently presents as a relatively mild and self-limiting illness, with low hospitalization rates. The bad news is that ZIKV is spreading rapidly worldwide, is challenging to diagnose, and may have effects following the illness including autoimmune diseases like Guillain-Barré syndrome (GBS), other neurological disorders and birth defects. The World Health Organization (WHO) has warned its Member States that ZIKV has the potential to place an additional burden on local health systems and recommends development of ZIKV testing capabilities and public education campaigns for prevention of ZIKV. 1. About ZIKV ZIKV is a mosquito-borne ssRNA flavivirus of […]

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Lessons from Ebola: Failure of the International Health Regulations

WHO IHR infographic

One year ago this month, the United States was fully in the throes of terror about Ebola.  Thomas Eric Duncan had arrived from Liberia in September 2014 and died in a Dallas hospital on October 8, 2014. News coverage from West Africa showed healthcare workers in full isolation garb, overflowing hospitals and bodies in the streets. Continuous transmission was ongoing in Guinea, Sierra Leone and Liberia, with warnings of exponential increase. To date, over 28,000 cases have affected Guinea, Sierra Leone and Liberia with over 11,000 deaths; 36 cases have affected 7 other countries. History of the Outbreak Public health officials have determined that the outbreak probably began in Guinea in December 2013, when an 18 month-old in Meliandou, Guinea was infected, possibly by a bat.  The outbreak circulated within and outside that community, misdiagnosed as cholera and Lassa for about 3 months.  The previous outbreaks of Ebola had been […]

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Why one case of measles is a public health emergency

Measles child

When studying for my Certification in Infection Control exam, a review question was “One case of this disease is a public health emergency.”  The correct answer was “measles” (Rubeola).  Not so for chicken pox or pertussis or rubella, so why measles?  I could find no succinct answer to the question, and I had never once dealt with measles in over 10 years of nursing in pediatrics, family medicine, infection control, or public health. In mid-December of 2014, an infected traveler visited Disneyland while contagious. For the next 4 months, health departments in southern CA (including the one where I work) would be overrun with measles cases, suspect cases, and case investigations, and I would come to better understand the emergent nature of measles. Why is one case of measles a public health emergency? The short answer is threefold:  Measles can cause significant illness and death, is highly contagious, and we […]

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CDC asks for States’ help on antibiotic resistance

Coordinated effort pic

As infections become more drug-resistant and harder to treat, prevention is key.   Good hospital infection control and improved antibiotic use have been important aspects of this effort, but the U.S. Centers for Disease Control and Prevention (CDC) added two new elements to the public discussion last week– better communication during interfacility transfer,  and involvement of the Local Health Department. These recommendations coincided with the release of a study August 4 in the CDC’s Morbidity and Mortality Weekly Report (MMWR), in which the authors argue that one of the most effective means of prevention is better communication about patients known to be infected or colonized during transfer to other facilities.   The authors go on to propose that this coordinated effort may need to be led by State Health Departments, not by individual facilities and healthcare systems. “If you’re a hospital doing a great job but the hospital down the street isn’t, […]

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“C. Diff” Infections– 5 Important Things to Know

Clostridium difficile. U.S. Centers for Disease Control and Prevention.

Clostridium difficile (aka. “C. diff”) is a spore-forming bacteria that’s very hard to kill.  As C. diff becomes increasingly worrisome for hospital patients and infectious disease experts, what does the general public need to know? 1. C. diff infections are becoming more common and more severe.  A recent study funded by the United States Centers for Disease Control and Prevention (CDC) estimated that there are 453,000 infections in the United States per year and 29,300 deaths within 30 days after the initial diagnosis.  The infection will recur in an average of 20% of people infected.  Almost half of the infections occur in people under 65, but more than 90% of the deaths occur in people 65 and older. When the United States Centers for Disease Control and Prevention (CDC) issued its major report Antibiotic resistance threats in the United States, 2013, there were only 3 bacteria concerning enough to be […]

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Is less effective pertussis vaccine the “new normal”?

Baby with Pertussis, CDC.

The numbers for 2014 are still coming in, but it’s already clear that California had more confirmed cases of pertussis (“whooping cough”) in 2014 than in any year since 1945. These numbers are not just about low vaccination rates; these numbers  also tell the story of vaccine failure, what California public health officials warn may be the “new normal.”  What is Pertussis? Pertussis (aka. “whooping cough”) is caused by a bacteria named Bordetella pertussis, but similar cough illnesses can be caused by other Bordetella species. The disease has 3 stages — a catarrhal stage, a paroxysmal stage, and a convalescent stage. If caught early, the symptoms and communicability can be lessened with a course of antibiotics. If not caught early, the germ makes a toxin (pertussis toxin, and some researchers also suspect a second “cough toxin”) that can lead to a person coughing, often violently, for weeks or months.  After 3 […]

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More Bad News About Shigella

Shigella sonnei PHIL image, 2014.

What is Shigella (and Why Should You Care)? Shigella infections (aka. shigellosis) kill approximately 700,000 people a year, mostly in developing countries. An important cause of what was traditionally called “bacterial dysentery,” the World Health Organization (WHO) calls shigellosis “the most important cause of bloody diarrhea worldwide,” with at least 80 million illnesses every year. Shigellosis is highly contagious (Ingesting as few as 10 bacteria can transmit infection.) and also highly prone to drug resistance, making the more severe infections that require antibiotics increasingly difficult to treat.  As with all drug resistance, overuse of antibiotics is making the problem worse. Shigellosis spreads quickly in group settings like childcare facilities, military units, and homeless shelters. In an attempt to limit the spread of disease, local health departments are often guided by state laws to ban infected people from working as food handlers, healthcare workers, or childcare providers until the infected person […]

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