skyla: October 2024

Wednesday, October 30, 2024

GPs advise not to ignore scabies symptoms

Scabies

People are being told not to ignore an itchy rash, with GPs in England reporting a spike in scabies - the highly infectious skin infestation.

The condition is caused by a mite which burrows under the skin to lay eggs and is spread through close physical contact, bedding and clothes.

It can spread quickly in places where people live closely together, such as universities and care homes, the Royal College of GPs (RCGP) said.

'Tiny red dots'

Some 3,689 cases were diagnosed in hospitals in England in the year to April – up from 2,128 the previous year, according to NHS figures.

The BBC has heard from people at five universities around the country, who spoke of multiple cases arising "out of nowhere" and whole houses having scabies.

One student said BBC "tiny red dots" along his wrist had begun spreading.

"One of my housemates came out to the house that she had scabies at the time as well. So then I was like, 'Okay, so do I'," he added.

More on this story

Another student told us he had been trying to get rid of it for "two to three months". When we asked how he thought he had caught it he said: "Probably a lot of sleeping together”.

Prof Hawthorne said: "We recognise that patients may be apprehensive to seek treatment given the social stigma that surrounds the condition, but it is important that they don’t ignore their symptoms as this could lead to them getting worse and risks transmitting the condition to other people."

Everyone infected needs to be treated at the same time with a cream or lotion from the pharmacy, doctors say.

Patients are also advised to wash their bedding and clothes on a high temperature.

Dr Alison George, a GP in the north of England who works in an emergency department, said many students come straight to A&E, but only after the disease has become worse.

"It can be really nasty. It is then really difficult to treat if you've got a really large area of the body covered in it."

Website: International Conference on Infectious Diseases.

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Tuesday, October 29, 2024

Mpox

Mpox

Mpox, previously known as monkeypox, is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. There are two distinct clades of the virus: clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb). In 2022–2023 a global outbreak of mpox was caused by the clade IIb strain.

Transmission

Mpox spreads from person to person mainly through close contact with someone who has mpox, including members of a household. Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth or mouth-to-skin contact (such as kissing), and it can also include being face-to-face with someone who has mpox (such as talking or breathing close to one another, which can generate infectious respiratory particles).

People with multiple sexual partners are at higher risk of acquiring mpox.

People can also contract mpox from contaminated objects such as clothing or linen, through needle injuries in health care, or in community settings such as tattoo parlours.

During pregnancy or birth, the virus may be passed to the baby. Contracting mpox during pregnancy can be dangerous for the fetus or newborn infant and can lead to loss of the pregnancy, stillbirth, death of the newborn, or complications for the parent.

Animal-to-human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses or eating animals. The animal reservoir of the monkeypox virus remains unknown and further studies are underway.

More research is needed on how mpox spreads during outbreaks in different settings and under different conditions.

Signs and symptoms

Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.

Common symptoms of mpox are:
rash
fever
sore throat
headache
muscle aches
back pain
low energy
swollen lymph nodes.

For some people, the first symptom of mpox is a rash, while others may have fever, muscle aches or sore throat first.

Diagnosis

Identifying mpox can be difficult because other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmitted infections, and medication-associated allergies. Someone with mpox may also have another sexually transmitted infection at the same time, such as syphilis or herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get care as early as possible and prevent severe illness and further spread.

The preferred laboratory test for mpox is detection of viral DNA by polymerase chain reaction (PCR). The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done using swabs of the throat or anus. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

HIV testing should be offered to adults with mpox, and children as appropriate. Diagnostic tests for other conditions should be considered where feasible, for example, varicella zoster virus (VZV), syphilis and herpes.

Treatment and vaccination

The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

Getting an mpox vaccine can help prevent infection (pre-exposure prophylaxis). It is recommended for people at high-risk of getting mpox, especially during an outbreak.

Groups that may be at high risk of mpox include: health and care workers at risk of exposure; people in the same household or close community as someone who has mpox, including children; people who have multiple sex partners, including men who have sex with men; and sex workers of any gender and their clients.

Website: International Conference on Infectious Diseases.

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Monday, October 28, 2024

Serious infections linked to dementia risk, study shows

Severe infections linked to brain atrophy and dementia

“The idea that infections can influence brain health for some people has been a no-brainer, especially those who themselves experienced infections,” said Keenan Walker, a tenure-track investigator and the director of the Multimodal Imaging of Neurodegenerative Disease Unit at the National Institute on Aging.

Even small infections can change the way we think and behave. More-severe infections can, in the short term, result in delirium, which may be associated with long-term cognitive problems, Walker said. “Big infection, big immune response — not good for the brain,” he said.

he hypothesis that infections may play a role in neurodegenerative diseases has been around, albeit more on the fringes, Walker said. That changed with the coronavirus pandemic and evidence of the lasting cognitive costs of long covid, which invigorated interest in the field.

In the current study, people with a history of infections also had changes to 260 immune-related proteins out of the 942 researchers tested from blood samples. A subset of 35 proteins was also associated with brain-volume changes. Some proteins seemed pathogenic and linked to reduced brain volume, while others were protective.

In general, infections were associated with increases in pathogenic proteins and decreases in protective ones.

Saturday, October 26, 2024

Antimicrobial resistance

Antimicrobial resistance

Overview

Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.

A global concern

Antimicrobial medicines are the cornerstone of modern medicine. The emergence and spread of drug-resistant pathogens threatens our ability to treat common infections and to perform life-saving procedures including cancer chemotherapy and caesarean section, hip replacements, organ transplantation and other surgeries.

In addition, drug-resistant infections impact the health of animals and plants, reduce productivity in farms, and threaten food security.

AMR has significant costs for both health systems and national economies overall. For example, it creates need for more expensive and intensive care, affects productivity of patients or their caregivers through prolonged hospital stays, and harms agricultural productivity.

AMR is a problem for all countries at all income levels. Its spread does not recognize country borders. Contributing factors include lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in homes, healthcare facilities and farms; poor access to quality and affordable vaccines, diagnostics and medicines; lack of awareness and knowledge; and lack of enforcement of relevant legislation. People living in low-resource settings and vulnerable populations are especially impacted by both the drivers and consequences of AMR.

What is the present situation?

Drug-resistance in bacteria

The global rise in antibiotic resistance poses a significant threat, diminishing the efficacy of common antibiotics against widespread bacterial infections. The 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report highlights alarming resistance rates among prevalent bacterial pathogens. Median reported rates in 76 countries of 42% for third-generation cephalosporin-resistant E. coli and 35% for methicillin-resistant Staphylococcus aureus are a major concern. For urinary tract infections caused by E. coli, 1 in 5 cases exhibited reduced susceptibility to standard antibiotics like ampicillin, co-trimoxazole, and fluoroquinolones in 2020. This is making it harder to effectively treat common infections.

Klebsiella pneumoniae, a common intestinal bacterium, also showed elevated resistance levels against critical antibiotics. Increased levels of resistance potentially lead to heightened utilization of last-resort drugs like carbapenems, for which resistance is in turn being observed across multiple regions. As the effectiveness of these last-resort drugs is compromised, the risks increase of infections that cannot be treated. Projections by the Organization for Economic Cooperation and Development (OECD) indicate an anticipated twofold surge in resistance to last-resort antibiotics by 2035, compared to 2005 levels, underscoring the urgent need for robust antimicrobial stewardship practices and enhanced surveillance coverage worldwide.

Drug resistance in fungi

As drug-resistant fungal infections increase, WHO is monitoring their magnitude and public health impact. Fungal infections can be difficult to treat, including due to drug-drug interactions for patients with other infections (e.g. HIV). The emergence and spread of multi-drug resistant Candida auris, an invasive fungal infection, is of particular concern. Development of WHO’s Fungal Priority Pathogens List (see below) included a comprehensive review of fungal infections and drug-resistant fungi globally.

Drug resistance in HIV, tuberculosis and malaria

HIV drug resistance (HIVDR) is caused by changes in the HIV genome that affect the ability of antiretroviral (ARV) drugs to block the replication of the virus. HIVDR can either be transmitted at the time of infection or acquired because of inadequate adherence to treatment or drug-drug interactions. HIVDR can lead to increased HIV infections and HIV-associated morbidity and mortality. WHO recommends that countries routinely implement HIVDR surveys to inform the selection of optimal ARV drug regimens for HIV prevention and treatment.

Tuberculosis (TB) is a major contributor to antimicrobial resistance. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the two most effective first-line TB drugs. MDR-TB is treatable and curable by using second-line drugs, but these medicines are expensive and toxic, and in some cases more extensive drug resistance can develop. TB caused by bacteria that do not respond to the most effective second-line TB drugs can leave patients with very limited treatment options. MDR-TB is therefore a public health crisis and threat to health security. Only about 2 in 5 people with drug resistant TB accessed treatment in 2022.

The emergence of drug-resistant parasites is a major threat to malaria control. Artemisinin-based combination therapies (ACTs) are the recommended first-line treatment for uncomplicated Plasmodium falciparum malaria and are used by most malaria endemic countries. Emergence of partial resistance to artemisinin and/or partner drugs in ACTs makes selecting the right treatment more challenging and requires close monitoring. In the Greater Mekong Subregion, partial resistance to artemisinin or a partner drug has been confirmed in several countries since 2001. In the WHO Eastern Mediterranean Region, resistance to a partner drug, sulfadoxine-pyrimethamine, led in some countries to treatment failure requiring a change to another ACT. In Africa, mutations linked to artemisinin partial resistance have been observed in several countries. ACTs that have been tested remain efficacious, but further spread of resistance could be a major public health challenge and improved surveillance is vital.

Drug resistance in neglected tropical diseases (NTDs)

The emergence of drug resistance against medicines for neglected tropical diseases (NTDs) is a significant threat to programmes to control, eliminate and eradicate NTDs, which especially affect vulnerable and marginalized populations. Resistance has been reported in leprosy medicines (dapsone, rifampicine and clofazimine) in several countries, in several anti-helminthics (while resistance has so far only been observed in use in animals, which is a serious concern for the veterinary sector, some of these medicines are also used in humans), in medicines used to treat human African trypanosomiasis (melarsoprol) and leishmaniasis (pentavalent antimonials, miltefosine), and others. It is important to monitor resistance and drug efficacy, put in place strategies to delay or curb resistance, and strengthen the pipeline of second-line medicines for NTDs. For example, WHO provides guidance for surveillance of resistance for the global leprosy elimination programme, and support to control distribution and monitor the standardized use, safety and efficacy of medicines, including donated medicines, in NTD programmes.

Website: International Conference on Infectious Diseases.

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Friday, October 25, 2024

Ants learned to farm fungi during a mass extinction

Ants learned to farm fungi during a mass extinction

We tend to think of agriculture as a human innovation. But insects beat us to it by millions of years. Various ant species cooperate with fungi, creating a home for them, providing them with nutrients, and harvesting them as food. This reaches the peak of sophistication in the leafcutter ants, which cut foliage and return it to feed their fungi, which in turn form specialized growths that are harvested for food. But other ant species cooperate with fungi—in some cases strains of fungus that are also found growing in their environment.

Genetic studies have shown that these symbiotic relationships are highly specific—a given ant species will often cooperate with just a single strain of fungus. A number of genes that appear to have evolved rapidly in response to strains of fungi take part in this cooperative relationship. But it has been less clear how the cooperation originally came about, partly because we don't have a good picture of what the undomesticated relatives of these fungi look like.
Now, a large international team of researchers has done a study that traces the relationships among a large collection of both fungi and ants, providing a clearer picture of how this form of agriculture evolved. And the history this study reveals suggests that the cooperation between ants and their crops began after the mass extinction that killed the dinosaurs, when little beyond fungi could thrive.

Tracing the farmers

One of the key features of this work is its exhaustiveness; it obtained DNA from 475 species of fungus and 276 species of ants. These include both the agricultural species and their close relatives who don't engage in this practice. In addition, the researchers studied over 2,000 genes from each of these species in order to estimate which species were most closely related to each other, and when these species split off from a common ancestor.

The use of that many genes is critical since some of these genes will likely have evolved rapidly in response to the altered conditions created by the adoption of agriculture. These genes likely have more mutations than would be expected based on the time between the present and when the species split off, making the split appear older than it actually is. By surveying a large number of genes, the effect of any outliers like this is much less likely to distort the analysis.

The researchers break the analysis down according to the kind of farming practiced by each ant species. Some of them farm yeast, others farm a group of species called coral fungi, and others engage in a more sophisticated form of agriculture involving fungi that are more adapted to this lifestyle. Leafcutter ants fall into this latter category. And, with a single exception (a group of leafcutters that aren't especially related to any of the rest), all of these groups cluster tightly together. All of these are embedded within a large group that opportunistically cooperates with fungi but don't specialize in growing a single species.

Both yeast and coral fungus farmers are closely related to each other, and each derives from a single ancestral species. The most sophisticated farming species also cluster together. Leafcutter species are interspersed with these (aside from that one exception).

On the fungus side, similar things were true. The yeast species that are farmed all cluster together. Same with the coral fungi, although there are two wild-living strains within that species cluster. The strains that are most adapted to farming form their own cluster, though they're all closely related to the yeast strains, with only a single wild-living strain separating them. Finally, all the species grown by leaf cutters are in a single cluster within this group.

Website: International Conference on Infectious Diseases.

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Wednesday, October 23, 2024

What is immunity debt – and is it really making kids sick?

What is immunity debt – and is it really making kids sick?

What is immunity debt?

In the early pandemic period, non-COVID illnesses fell in areas where people stayed home, avoided other people, washed their hands frequently, and took other steps to prevent themselves from being exposed to viruses.

Several viruses, like some strands of the flu, were totally wiped out during that time, but others simply came back once restrictions lifted and people began socialising more often – a phenomenon that some scientists refer to as an “immunity debt” that is still being paid off.

“Decreasing burdens on hospitals during the height of COVID, it was good to go in debt for that,” Dr Amesh Adalja, an infectious disease doctor and senior scholar at the Johns Hopkins Center for Health Security in the US, told Euronews Health.
Why is the phrase controversial?

The term “immunity debt” is sometimes used to suggest that natural infections are better for our immune systems than vaccines and that pandemic-era restrictions were ineffective because people still got sick later on.
Does immunity debt explain all increases in infections?

While the immunity debt dynamics hold true for many viruses, some of them may be seeing a resurgence due to reasons other than immunity debt.

For example, Adalja said that the rise in whooping cough cases, also known as pertussis, is likely cyclical.

How does immunity debt affect the public and hospitals?

In 2021, European paediatric societies called for strengthened childhood vaccination programmes to counter immunity debt, and since 2023, RSV vaccines have been available for pregnant women and older adults in the European Union. They rolled out this year in the UK.

“Vaccines are a great way of filling the gap in immune stimulation which was left by a reduced rate of virus circulation,” Openshaw said.

Notably, increases in illnesses caused by immunity debt – or cyclical surges – could pose a bigger problem for health systems if they are hit with too many patients at once.

Tuesday, October 22, 2024

Salmonella Infections in Children

Salmonella Infections in Children

Salmonella bacteria cause more than a million infections each year in the United States. Most often, people get sick after eating food contaminated with Salmonella. Their symptoms usually include diarrhea, fever and stomach cramps. Salmonella illness can sometimes be severe enough to require a hospital stay.

Who is most at risk from Salmonella?

Infections occur most often in infants and children younger than 4 years because their immune systems are still developing. Babies who are not breastfed are also more likely to get sick from Salmonella. Infants may be exposed to Salmonella if they eat contaminated food or come into contact with contaminated surfaces or sick family members.

Elderly people and those whose immune systems are weakened from certain medical conditions (such as diabetes, liver or kidney disease and cancer) or treatments also are at increased risk.
How does Salmonella spread?

Salmonella bacteria usually spread to humans by animal products such as poultry, beef, fish, eggs and dairy products. At times, though, other foods such as fruits, vegetables and bakery products have caused outbreaks. Most often, this happens when these foods were contaminated by contact with an animal product.

The bacteria can also be spread by drinking contaminated water. Salmonella outbreaks have been linked to infected pets such as backyard poultry, snakes, small turtles, lizards and other reptiles. And, it can spread by contact with contaminated pet food. Typhoid fever, which is also caused by Salmonella, is only spread through contact with an infected person or an item contaminated by an infected person.

Signs & symptoms of Salmonella infection

Salmonella bacteria are best known for being a cause of diarrhea. This type of illness, called gastroenteritis, typically happens after eating food that has been contaminated with Salmonella.

When your child has a Salmonella infection that causes gastroenteritis, they may have symptoms such as:

Diarrhea
Abdominal cramps and tenderness
Fever

While the overwhelming number of people with Salmonella infection have gastroenteritis, the bacteria also can cause a variety of other disorders, including:

Bacteria in the blood (bacteremia)
Inflammation of the membranes of the brain or spinal cord (meningitis)
Inflammation of the bone (osteomyelitis)

How to prevent Salmonella infection

Salmonella infections can often be prevented by practicing good hygiene techniques during food preparation, as well as regular hand washing. Be sure to thoroughly cook eggs, poultry and ground beef. Hands should always be washed after playing with pets, especially lizards and pet turtles.

If your child has a problem with their immune system: Avoid reptiles used as pets, such as lizards and snakes. Children with sickle cell anemia are at risk for Salmonella infection of the bones. Families of these children should avoid having reptiles and amphibians as pets.

If you plan travel to an area where typhoid exists: Make an appointment with your doctor (preferably 1-2 months before travel) to discuss vaccination against the infection. See Precautions for International Travel: Information for Parents.

Website: International Conference on Infectious Diseases.

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Monday, October 21, 2024

All you need to know about childhood vaccinations

All you need to know about childhood vaccinations

This is being driven by pandemic disruptions, conflict, displacement and increasing vaccine misinformation. As a result, some 25 million children globally are now missing out on life-saving vaccines every year, placing them at risk from devastating and entirely preventable diseases like measles and polio.

In South Africa, there are some 100,000 zero dose children – young children who have missed lifesaving childhood vaccinations.

In late 2022, South Africa recorded an outbreak of measles that threatens the health of children and adults across the country, particularly those who have missed childhood immunisations.

In South Africa, every new born baby should receive the free Road To Health booklet that provides parents and caregivers with crucial health care information for their child and a schedule to help keep track of routine clinic visits for check-ups and immunisation.

If you do not have a Road To Health booklet for your child, you can collect one at any health facility in South Africa, free of charge.

Vaccines are most effective when they are administered to children at the right age and with the recommended dosage as children are susceptible to certain diseases at certain ages. As an example, polio occurs most frequently in children below the age of 5. Because of this, polio vaccines are given to children of those ages to prevent harm caused by the disease. A child who isn't vaccinated or isn't vaccinated on time remains unprotected and has increased chances of getting seriously ill.

Website: International Conference on Infectious Diseases.

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Saturday, October 19, 2024

Check Your Fridge: More Than 4 Million Eggs Are Part of a Class 1 Recall by the FDA

Check Your Fridge: More Than 4 Million Eggs Are Part of a Class 1 Recall by the FDA

The Food and Drug Administration (FDA) has upgraded an ongoing egg recall to Class 1, its highest categorization, signaling the product may cause “serious adverse health consequences or death.”

On Sept. 6, the Centers for Disease Control and Prevention sent out the initial recall for eggs produced by Milo’s Poultry Farms LLC, based in Bonduel, Wisconsin, which stated that the eggs "have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems." The eggs, it added, were distributed in Wisconsin, Illinois, and Michigan through retail stores and food service distributors.

The initial recall noted that 65 people were infected with Salmonella linked to the eggs across nine states, including Wisconsin, Illinois, Michigan, Minnesota, Iowa, Virginia, Colorado, Utah, and California, including 24 hospitalizations.

However, on Sept. 30, the recall was upgraded to a Class 1. According to the Associated Press, in total the recall includes more than 345,417 dozen-cartons of eggs, totalling to roughly four million eggs. The CDC noted that the recall includes "all chicken egg types, such as cage-free or organic," along with "all cases and carton sizes," and all cases "labeled with 'Milo’s Poultry Farms' or 'Tony’s Fresh Market" of all expiration dates. Eggs from "M & E Family Farms" and "Happy Quackers Farm" duck eggs, both distributed by Milo's, are also impacted.

As for what consumers should do, the CDC shared that everyone should throw away any of the eggs they may have purchased that are a part of this recall. Additionally, it noted to "Wash items and surfaces that may have touched the recalled eggs using hot soapy water or a dishwasher" and call your healthcare provider if you or anyone in your household has Salmonella's severe symptoms. Those symptoms, it added, include. "Diarrhea and a fever higher than 102°F, diarrhea for more than three days that is not improving, bloody diarrhea, so much vomiting that you cannot keep liquids down, signs of dehydration, such as not peeing much, dry mouth and throat, or feeling dizzy when standing up."

The CDC added that these symptoms usually appear between six hours to six days after infection and that most people recover without treatment after four days to one week.

Website: International Conference on Infectious Diseases.

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Thursday, October 17, 2024

Study: Half of patients with sepsis die within 2 years

Half of people who develop blood poisoning, otherwise known as sepsis, are dead within a couple of years, a new study finds. Photo by Adobe Stock/HealthDay News

Half of people who develop blood poisoning, otherwise known as sepsis, are dead within a couple of years, a new study finds.

A little more than 50% of patients admitted to an ER with sepsis died within two years, Danish researchers report.

"We found that certain factors increased the risk of death after sepsis, including, not surprisingly, advanced age," said Finn Nielsen, a senior scientist of clinical epidemiology at Aarhus University Hospital in Denmark.

"Additionally, conditions such as dementia, heart disease, cancer and previous hospitalization with sepsis within the last six months before admission also elevated the risk of dying during a median follow-up period of two years," Nielsen added in a hospital news release.

Old age increased a person's risk of sepsis by 4% for every additional year of age, researchers found.

Further, a history of cancer more than doubled a person's risk of death, clogged arteries increased risk by 39%, and dementia increased risk by 90%, results show.

People with repeated bouts of sepsis also were 48% more likely to die, based on data from hospital patients previously admitted with sepsis within the past six months.

"We believe this knowledge is useful for both clinicians and researchers in the field of acute medicine," Nielsen said. "Recognizing that sepsis is a serious illness with high mortality is crucial."

However, larger studies are needed, given that this research was done at a single hospital, Nielsen noted.

"Similar but larger studies of sepsis-related outcomes need to be repeated across departments, regions and countries to obtain a comprehensive epidemiological picture of sepsis," Nielsen said.

Neilsen presented these findings at the European Society for Emergency Medicine's annual meeting in Copenhagen, Denmark.

"Sepsis is a serious and potentially fatal medical condition. The incidence of sepsis is increasing in several countries, yet so far, there has been limited, reliable information about long-term outcomes for patients who develop sepsis," Dr. Barbra Backus, chair of the society's abstract selection, said in a meeting news release.

"This study has shown certain risk factors that should alert clinicians to the risk of patients with sepsis at an increased risk of dying, so that they can monitor them and follow them up more closely," added Backus, an emergency physician in Rotterdam, the Netherlands, who was not involved in the research.

Findings presented at a medical meeting should be considered preliminary until published in a peer-reviewed article.

Website: International Conference on Infectious Diseases.

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Wednesday, October 16, 2024

Surge in malaria cases linked to aircraft-transported mosquitoes

Malaria

Malaria cases resulting from bites of mosquitoes transported by aircraft from areas where is common have increased, according to both a retrospective analysis in France and a systematic review of studies in Europe, which have been published in Eurosurveillance.

After malaria was eradicated in western Europe in the 1970s, most cases in the EU/EEA have been reported among travellers returning from countries where malaria is established. Of the 6,131 cases reported in the EU/EEA in 2022, 99% were travel related.

Locally-acquired infections are reported sporadically every year in western Europe.

These include introduced infections, which are transmitted by a local mosquito after it has bitten an infected returning traveller carrying plasmodia in their blood; induced cases, which are related to other means of transmission such as a healthcare-associated infection or mother-to-child transmission; and Odyssean malaria, which refers to cases resulting from the bite of an infected mosquito transported by aircraft, luggage or parcel from an endemic area.
Findings of systematic review of studies in Europe

The systematic review analysed studies in Europe indexed from 1969 to January 2024 in the MEDLINE, Embase and OpenGrey databases. Numbers were supplemented by a data call to EU/EEA and UK public health authorities launched in 2022.

Of the 145 cases described from nine countries, 105 were classified as airport malaria, 32 as luggage malaria, and eight as either type of malaria. Most cases were reported in France, Belgium, and Germany, and half resided or worked near or at an international airport. Case reports of airport and luggage malaria were found to be rising, with one third of cases reported over the last five years, even as air traffic declined during the COVID-19 pandemic.

People infected with malaria had a mean age of 37.9 years and were more likely to be male than female, at a ratio of 1.5:1. For the cases with a known outcome, 124 recovered and nine died. Patients that died were older on average, with a mean age of 57.2 years. Forty eight of 145 cases were epidemiologically linked to at least one other case.

Locally-acquired malaria over nearly three decades in France

Similar trends were observed in a retrospective analysis of surveillance and case investigation data in France on locally acquired malaria from 1995 to 2022. Cases were classified by the most likely mode of transmission, using a classification derived from the European Centre for Disease Prevention and Control (ECDC). A descriptive analysis was also conducted to identify spatial and temporal patterns of cases.

Researchers found a total of 117 locally acquired malaria cases reported in European France. They also found that locally acquired infections remained constant overall, with more Odyssean cases being reported since 2011. Fifty one of the 117 cases identified were categorised as Odyssean, 36 as induced, 27 as cryptic (where the investigation was inconclusive), and three as introduced.

Most cases were among males with a median age of 34.5 years. Half of patients were born in an country in Africa where malaria is common, and the other half were born in France. More than half of cases were reported in the region Île-de-France. 102 were admitted to hospital, and seven patients died. Among patients with locally-acquired malaria, severe cases and death was more frequent than in imported cases.

Public health implications

To tackle the risk of Odyssean malaria, researchers of the retrospective analysis in France advised the strict enforcement of disinsectisation of aircrafts. To improve treatment, they also recommended that physicians consider the possibility of locally-acquired malaria for patients with an unexplained fever early, even if there is no travel history.

Authors of the systematic review highlighted the need for more structured surveillance of malaria cases in Europe, including a standardised case definition. They also recommended the implementation of prevention measures and to assess the effectiveness and compliance for measures currently in place.

Website: International Conference on Infectious Diseases.

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Tuesday, October 15, 2024

Blood Poisoning

Blood Poisoning

What is blood poisoning?

Blood poisoning (sepsis) has nothing to do with poison. Instead, it’s primary cause is the presence of germs, which enter your bloodstream from an infection elsewhere in your body. This can happen through wounds, burns, cuts, and scrapes. Bacteria can come from something as simple as a sinus infection. Although blood poisoning is often a result of a bacterial infection, even a COVID-19 viral infection can lead to sepsis as well as influenza and fungal infections. Any of these situations can lead to blood poisoning.

Untreated infection in the bloodstream can trigger sepsis. Sepsis is the body’s life-threatening response to a bacterial infection and is often a medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Bacterial infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Both blood poisoning requires immediate treatment. This is to prevent sepsis from infecting major organs, like the lungs, kidneys, and heart. Sepsis is unpredictable, aggressive, and progresses rapidly.

Anyone can get blood poisoning, but the risk is higher for:

Infants and young children (especially under 1 year of age)
Older people (65 years of age or older)
People who have a weakened immune system
People who have chronic medical conditions, including diabetes, cancer, and AIDS
People who have just had surgery
Symptoms of blood poisoning

The symptoms of blood poisoning are similar to symptoms of a cold or the flu and may include:

Chills, shivering
Sudden fever (moderate to high temperature)
Fast heartbeat
Rapid breathing
Heart palpitations (heart skips a beat or seems to flutter)
Low energy (more in children)
Irritability (more in children)

Additional symptoms that indicate sepsis, include:

Confusion or disorientation
Extreme pain or discomfort
Shortness of breath
Clammy or sweaty skin

If you recently had surgery or a wound that could be infected, take these symptoms seriously. They could signal blood poisoning. If you have any of these symptoms, call your doctor right away.

What causes blood poisoning?

Blood poisoning is most often caused by a bacterial infection entering your bloodstream. However, it also can be cause by some viral infections, such as COVID-19, influenza, and fungal infections. Bacteria can enter your bloodstream in multiple ways, including daily activities, such as brushing your teeth too vigorously. A simple dental cleaning can cause bacteria to enter your bloodstream. This is true if you have certain risk factors. Risk factors include prior knee or hip replacement. It’s difficult for your body to clear bacteria around prosthetic devices. In dental visits, your dentist will have you take antibiotics before your appointment to prevent infection. Bacteria can enter your bloodstream through a scraped knee or other wound. Urinary tract infections are a common source of blood poisoning. Even a sinus infection can cause bacteria to enter your bloodstream.

Your immune system will eliminate small amounts of germs. When this doesn’t happen, it can cause blood poisoning. Too many germs can enter your bloodstream at once. Your immune system can’t keep up. This causes blood poisoning.

How is blood poisoning diagnosed?

Blood poisoning is diagnosed by examining a blood sample to find bacteria in the blood. Also, doctors check the number of white blood cells in the sample. If you suspect you have blood poisoning, call your doctor right away. Your doctor will examine you and order blood tests, if necessary.

If bacteria are in your blood, your doctor will identify the type of bacteria. If you have a cut or other wound on your body, your doctor may swab that area to collect bacteria.

Can blood poisoning be prevented or avoided?

To lower your risk of blood poisoning:Take care of cuts and open wounds. Don’t let them become infected. Keep them clean. Treat them with antiseptic medicine or as directed by your doctor.
Get flu and pneumonia vaccines.
Don’t ignore a toothache. A tooth infection can cause blood poisoning. See your dentist before it becomes a bigger problem.
See your doctor for sinus and ear infections.
Be aware that infection can occur following surgery or a medical treatment.

Blood poisoning treatment

The treatment of blood poisoning often involves admission to a hospital’s intensive care unit (ICU) for those who are very sick. This is so that your doctor can give you antibiotics and other medicines intravenously and closely monitor your organ systems. Fast treatment is important. Blood poisoning can become a more serious case of sepsis. Sepsis is life-threatening. It damages vital organs. When blood poisoning is caught early and doesn’t do any serious damage, you can then be switched to oral antibiotics that you can take at home. These are usually in pill form.

Living with blood poisoning

Many people fully recover from blood poisoning. However, untreated blood poisoning or catching it too late can worsen is serious sepsis. When you have sepsis, damage to major organs may be irreversible. For example, kidney damage could lead to lifelong dialysis. Once you have had blood poisoning, you’re at higher risk for developing infections in the future.

Website: International Conference on Infectious Diseases.

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Monday, October 14, 2024

HAIs: Reports and Data

HAIs: Reports and Data

Key points

1. Although significant progress has been made in preventing some healthcare-associated infection types, there is much more work to be done.
2. CDC publishes data reports to help track progress and target areas that need assistance.

3. The data come from two complementary HAI surveillance systems, the National Healthcare Safety Network (NHSN) and the Emerging Infections Program Healthcare-Associated Infections – Community Interface (EIP HAIC).

From the National and State Healthcare-Associated Infections Progress Report

1. At the national level, among acute care hospitals there were significant decreases observed for VAE (19%), MRSA (16%), CAUTI (12%), CLABSI (9%) and CDI (3%) between 2021 and 2022. No significant changes were observed for SSI-COLO and SSI-HYST between 2021 and 2022.
2. Highlights of 2022 state performance compared to the 2015 national baseline SIR of 1 from acute care hospitals:50 states performed better on at least two infection types
8 states performed worse on at least two infection types

From the HAI Hospital Prevalence Survey

1. On any given day, about 1 in 31 hospital patients has at least one healthcare-associated infection. Patients in the 2015 HAI Hospital Prevalence survey were at least 16% less likely than patients in the 2011 survey to have an HAI.3% of hospitalized patients in the 2015 survey had one or more HAI.
2. There were an estimated 687,000 HAIs in U.S. acute care hospitals in 2015. About 72,000 hospital patients with HAIs died during their hospitalizations.

Antibiotic Resistance & Patient Safety Portal

The Antibiotic Resistance & Patient Safety Portal (AR&PSP) is an interactive web-based application that was created to innovatively display data collected through CDC's National Healthcare Safety Network (NHSN) and other sources. It offers enhanced data visualizations through 4 main components:

1. Antibiotic Resistance– with data from NHSN and the AR Lab Network

2. Antibiotic Use and Stewardship – with data from NHSN (Antibiotic Stewardship) and Xponent database from Quintiles IMS (Antibiotic Use)
3. Healthcare-Associated Infections – data display for the National and State Healthcare-Associated Infections Progress Report
4. Geographic Location – for the nation and a state, view HAI data, AR data, and Antibiotic Stewardship data together on one page

Website: International Conference on Infectious Diseases.

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Saturday, October 12, 2024

Tuberculosis

Tuberculosis

Overview

Tuberculosis (TB) is an infectious disease that most often affects the lungs and is caused by a type of bacteria. It spreads through the air when infected people cough, sneeze or spit.

Tuberculosis is preventable and curable.

About a quarter of the global population is estimated to have been infected with TB bacteria. About 5–10% of people infected with TB will eventually get symptoms and develop TB disease.

Those who are infected but not (yet) ill with the disease cannot transmit it. TB disease is usually treated with antibiotics and can be fatal without treatment.

In certain countries, the Bacille Calmette-Guérin (BCG) vaccine is given to babies or small children to prevent TB. The vaccine prevents TB outside of the lungs but not in the lungs.

Symptoms

People with latent TB infection don’t feel sick and aren’t contagious. Only a small proportion of people who get infected with TB will get TB disease and symptoms. Babies and children are at higher risk.

Certain conditions can increase a person’s risk for tuberculosis disease:diabetes (high blood sugar)
weakened immune system (for example, HIV or AIDS)
being malnourished
tobacco use.

Unlike TB infection, when a person gets TB disease, they will have symptoms. These may be mild for many months, so it is easy to spread TB to others without knowing it.

Common symptoms of TB:prolonged cough (sometimes with blood)
chest pain
weakness
fatigue
weight loss
fever
night sweats.

The symptoms people get depend on where in the body TB becomes active. While TB usually affects the lungs, it also affects the kidneys, brain, spine and skin.

Prevention

Follow these steps to help prevent tuberculosis infection and spread:Seek medical attention if you have symptoms like prolonged cough, fever and unexplained weight loss as early treatment for TB can help stop the spread of disease and improve your chances of recovery.
Get tested for TB infection if you are at increased risk, such as if you have HIV or are in contact with people who have TB in your household or your workplace.
If prescribed treatment to prevent TB, complete the full course.
If you have TB, practice good hygiene when coughing, including avoiding contact with other people and wearing a mask, covering your mouth and nose when coughing or sneezing, and disposing of sputum and used tissues properly.

Special measures like respirators and ventilation are important to reduce infection in healthcare and other institutions.
Diagnosis

WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB.

Rapid diagnostic tests recommended by WHO include the Xpert MTB/RIF Ultra and Truenat assays. These tests have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB.

A tuberculin skin test (TST) or interferongamma release assay (IGRA) can be used to identity people with infection.

Diagnosing multidrug-resistant and other resistant forms of TB (see multidrug-resistant TB section below) as well as HIV-associated TB can be complex and expensive.

Tuberculosis is particularly difficult to diagnose in children.

Treatment

Tuberculosis disease is treated with antibiotics. Treatment is recommended for both TB infection and disease.

The most common antibiotics used are:isoniazid
rifampin
pyrazinamide
ethambutol
streptomycin.

To be effective, these medications need to be taken daily for 4–6 months. It is dangerous to stop the medications early or without medical advice. This can allow TB that is still alive to become resistant to the drugs.

Tuberculosis that doesn’t respond to standard drugs is called drug-resistant TB and requires more toxic treatment with different medicines.

Website: International Conference on Infectious Diseases.

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Wednesday, October 9, 2024

Plant compound used in traditional medicine may help fight tuberculosis

Plant compound used in traditional medicine may help fight tuberculosis

UNIVERSITY PARK, Pa. — A compound found in African wormwood — a plant used medicinally for thousands of years to treat many types of illness — could be effective against tuberculosis, according to a new study that is available online and will be published in the October edition of the Journal of Ethnopharmacology.

The team, co-led by Penn State researchers, found that the chemical compound, an O-methylflavone, can kill the mycobacteria that causes tuberculosis in both its active state and its slower, hypoxic state, which the mycobacteria enters when it is stressed.

Bacteria in this state are much harder to destroy and make infections more difficult to clear, according to co-corresponding author Joshua Kellogg, assistant professor of veterinary and biomedical sciences in the College of Agricultural Sciences.

While the findings are preliminary, Kellogg said the work is a promising first step in finding new therapies against tuberculosis.

“Now that we’ve isolated this compound, we can move forward with examining and experimenting with its structure to see if we can improve its activity and make it even more effective against tuberculosis,” he said. “We’re also still studying the plant itself to see if we can identify additional molecules that might be able to kill this mycobacterium.”

Tuberculosis — caused by the bacteria Mycobacterium tuberculosis, or Mtb — is one of the world's leading killers among infectious diseases, according to the Centers for Disease Control and Prevention. There are about 10 million cases a year globally, with approximately 1.5 million of those being fatal.

While effective therapies exist for TB, the researchers said there are several factors that make the disease difficult to treat. A standard course of antibiotics lasts six months, and if a patient contracts a drug-resistant strain of the bacteria, it stretches to two years, making treatment costly and time consuming.

Additionally, the bacteria can take two forms in the body, including one that is significantly harder to kill.

“There’s a ‘normal’ microbial bacterial form, in which it’s replicating and growing, but when it gets stressed — when drugs or the immune system is attacking it — it goes into a pseudo-hibernation state, where it shuts down a lot of its cellular processes until it perceives that the threat has passed,” Kellogg said. “This makes it really hard to kill those hibernating cells, so we were really keen to look at potential new chemicals or molecules that are capable of attacking this hibernation state.”

Multiple species of the Artemisia plant have been used in traditional medicine for centuries, the researchers said, including African wormwood, which has been used to treat cough and fever. Recent studies in Africa have suggested that the plant also has clinical benefits in treating TB.

“When we look at the raw plant extract that has hundreds of molecules in it, it’s pretty good at killing TB,” Kellogg said. “Our question was: There seems to be something in the plant that's really effective — what is it?”

For their study, the researchers took raw extract of the African wormwood plant and separated it into “fractions” — versions of the extract that have been separated into simpler chemical profiles. They then tested each of the fractions against Mtb, noting whether they were effective or ineffective against the bacteria. At the same time, they created a chemical profile of all of the tested fractions.

“We also used machine learning to model how the changes in chemistry correlated with the changes in activity that we saw,” Kellogg said. “This allowed us to narrow our focus to two fractions that were really active.”

From these, the researchers identified and tested a compound that effectively killed the bacteria in the pathogen’s active and inactive states, which the researchers said is significant and rare to see in TB treatments. Further testing in a human cell model showed that it had minimal toxicity.

Kellogg said the findings have the potential to open new avenues for developing new, improved therapeutics.

“While the potency of this compound is too low to use directly as an anti-Mtb treatment, it may still be able to serve as the foundation for designing more potent drugs,” he said. “Furthermore, there appear to be other, similar chemicals in African wormwood that may also have the same type of properties.”

The researchers said that in the future, more studies are needed to continue exploring the potential for using African wormwood for treating TB.

Co-authors from Penn State are R. Teal Jordan, research technologist and lab manager in veterinary and biomedical sciences, and Xiaoling Chen, graduate student in pathobiology. Also co-authors on the paper were Scarlet Shell, Maria Natalia Alonso, Junpei Xiao, Juan Hilario Cafiero, Trevor Bush, Melissa Towler and Pamela Weathers, all at Worcester Polytechnic Institute.

The National Institutes of Health's National Institute for Allergies and Infectious Disease and the U.S. Department of Agriculture's National Institute of Food and Agriculture helped support this work.

Website: International Conference on Infectious Diseases.

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