H5N1

Ebola outbreak brings to light an unforeseen impact of tsetse control on sleeping sickness transmission in Guinea

Via bioRxiv, another reminder that Ebola didn't hurt only its own victims: Ebola outbreak brings to light an unforeseen impact of tsetse control on sleeping sickness transmission in Guinea. The abstract:

In addition to the thousands of deaths due the unprecedented ebola outbreak that stroke West Africa (2014-2016), national health systems in affected countries were deeply challenged impacting a number of diseases control programs. 

Here we describe the case of Human African Trypanosomiasis (HAT), a deadly neglected tropical disease due to a trypanosome transmitted by tsetse flies for which no vaccine or chemoprophylaxis exists. Data are presented for the disease focus of Boffa in Guinea where a pilot elimination project combining medical screening and vector control was launched in 2012. 

During ebola, HAT active screening activities were postponed and passive surveillance also was progressively impaired. However, tsetse control using small insecticide impregnated targets could be maintained. The over two years disruption of screening activities led to a dramatic increase of HAT prevalence, from 0.7% in 2013 (21/2885) to 2% (69/3448) in 2016, reaching epidemic levels (>5%) in some villages. 

In deep contrast, control levels reached in 2013 (0.1%; 7/6564) were maintained in areas covered with impregnated targets as no cases were found in 2016 (0/799). 

In Boffa, ebola has thus incidentally provided a unique framework to challenge current HAT control strategies. A first lesson is that the screen and treat strategy is fragile as rapid bursts of the disease may occur in case of disruption. A second lesson is that vector control reducing human-tsetse contacts, even implemented alone, is effective in providing a good level of protection against infection. 

This advocates for a greater attention being paid to tsetse control in thinking the 2020 HAT elimination strategies in Africa.

Did Cro-Magnon 1 have neurofibromatosis type 1?

Credit: Charlier et al.

This really doesn't have much to do with infectious diseases and the politics of public health, but it's a lovely example of what modern medical technology can do. Via The Lancet: Did Cro-Magnon 1 have neurofibromatosis type 1? Click or tap through for links to the appendix and footnotes.

The Cro-Magnon 1 skeleton corresponds to a 28 000 BCE Homo sapiens male individual that was discovered in 1868 in a rock shelter in Les Eyzies, France. Since its discovery, various diagnoses have been proposed with regards to a round polycyclic osteolytic lesion on the right frontal bone, measuring 37 mm x 27 mm (appendix): post-mortem alteration due to the soil, rickets, actinomycosis, and Langerhans cell histiocytosis. 

Recently, we did a medical CT scan, followed by a micro CT scan, on the lesion. The results showed the exact bone aspect of the pathological zone and peripheral limits (figure A): a limited resorption of the external cortical bone, of granular aspect, without peripheral sclerosis in the internal table, which excludes a malignant transformation. This aspect agrees with the radiological morphology of a subcutaneous schwannoma with progressive bone erosion in the context of neurofibromatosis type 1, as confirmed by biomedical literature and direct comparison with palaeopathological reference collections (for example, skull 101 of the Tessier collection, in Amiens, France). 

Additionally, an asymmetry of the size of the internal auditory meatus is visible after a micro CT scan examination and three-dimensional reconstruction of the Cro-Magnon 1 skull (appendix), which could be related to the development of an acoustic neurinoma (a schwannoma). Examination of other nerve foramina at the level of the skull base did not show any anomaly. Although acoustic neurinomas are more frequent in neurofibromatosis type 2, they have also been reported in type 1. Cases of internal auditory meatus enlargement in neurofibromatosis type 1 have also been described without any associated acoustic nerve tumour, with the cause of the enlargement being related to bone dystrophy (bony dysplasia) or dural ectasia. 

According to this retrospective diagnosis, a new facial reconstruction of this individual can be proposed, featuring the macroscopic aspect of the disease. A further analysis of the rest of the skeleton might be of interest to search for other bone lesions with characteristics of low growth rate.

India: As mercury rises, a 'dengue-like fever' has Delhi doctors worried

Via India Today: As mercury rises, a 'dengue-like fever' has Delhi doctors worried. Excerpt:

With the sudden increase in temperature, patients suffering from dengue like fever has become a major concern for the doctors these days. Doctors have called it a 'wake up call' for Delhiites before sweltering summer of May and June. 

In just a couple of days, the cases of viral fever presenting dengue like symptoms, allergies, respiratory illnesses, tuberculosis, pneumonia, jaundice and gastrointestinal disease has risen up to 30 percent, said city's leading health experts. This year, doctors say that they can see a change in the pattern of diseases being reported with early onset of summers and hence, people should be extra alert. 

On Friday, with 36 degree Celsius[96.8ºF], the city was welcomed to a hot and sweltering day. It is important to note that the season for vector-borne diseases begins in mid-July and generally lasts till November-end. However, health experts have warned that this year mosquito borne cases have started to come up early.  

Speaking to MAIL TODAY, Dr Sanjeev Bagai, vice-chairman and director of Mainpal Hospital (Dwarka) said, "From a couple of days, viral fever cases we are witnessing at the OPD are representing dengue like symptoms. Patients are having rashes over their body with high grade fever complaining nausea, vomiting and allergies. If the fever persist for more than two days, they should see a doctor at early and do not rely on self medication at all." 

"Since last two weeks, lots of patients are complaining summer related health illness and it has risen up to 25 to 30 per cent. Cases of gastrointestinal diseases such as typhoid, food poisoning, diarrhea and viral fever have started to increase. Strangely, these viral fevers have similarity with dengue fever. There should be more intake of water to keep the body hydrated," said Dr SP Boytra, Chairman of Internal Medicine department at Sir Ganga Ram Hospital.

A new class of synthetic retinoid antibiotics effective against bacterial persisters

Via Nature: A new class of synthetic retinoid antibiotics effective against bacterial persisters. The abstract:

A challenge in the treatment of Staphylococcus aureus infections is the high prevalence of methicillin-resistant S. aureus (MRSA) strains and the formation of non-growing, dormant ‘persister’ subpopulations that exhibit high levels of tolerance to antibiotics and have a role in chronic or recurrent infections. As conventional antibiotics are not effective in the treatment of infections caused by such bacteria, novel antibacterial therapeutics are urgently required. 

Here we used a Caenorhabditis elegans–MRSA infection screen to identify two synthetic retinoids, CD437 and CD1530, which kill both growing and persister MRSA cells by disrupting lipid bilayers. CD437 and CD1530 exhibit high killing rates, synergism with gentamicin, and a low probability of resistance selection. All-atom molecular dynamics simulations demonstrated that the ability of retinoids to penetrate and embed in lipid bilayers correlates with their bactericidal ability. An analogue of CD437 was found to retain anti-persister activity and show an improved cytotoxicity profile. 

Both CD437 and this analogue, alone or in combination with gentamicin, exhibit considerable efficacy in a mouse model of chronic MRSA infection. With further development and optimization, synthetic retinoids have the potential to become a new class of antimicrobials for the treatment of Gram-positive bacterial infections that are currently difficult to cure.

See also this report in The Guardian on the study.

Finland: Vole fever season approaches; spring cleaners advised to take care

Via Yle Uutiset: Vole fever season approaches, spring cleaners advised to take care. As if it weren't bad enough that taxes on Finnish summer cottages have tripled since 2000, hantavirus is a threat. Excerpt:

Reliable figures about the vole population in Finland this spring will only be available once the snow melts, but health authorities are warning residents of central and western areas in particular to take precautions against contracting vole fever this spring. 

Vole fever is an illness caused by a strain of the hanta virus known as the Puumala virus, after a small village in Finland. Only the bank vole (Myodes glareolus) carries it. Found throughout the Nordics, the infection is known as myyräkuume in Finnish, sorkfeber in Swedish, and musepest in Norwegian. 

Experts say that numbers of voles, also known as field mice, are actually down in Finland this year, with negligible amounts expected to survive the winter in the south and east. Populations of the virus-carrying voles surge every few years, with peak seasons followed by a plummet because many of the rodents end up dying from the virus they carry. 

"They are not exceptionally abundant right now," says Finland's Natural Resources Centre researcher Otso Huitu. 

He nevertheless advises spring cleaners of summer cottages and storage buildings to take care when cleaning up after the winter season, as up to two-thirds of the vole population could be carrying the Puumala virus. Droppings can spread the virus for up to two months in cold buildings like wood storage sheds, for example. 

"Even just one vole can create a considerable amount of waste," Huitu says.

‘Our greatest fear’: Highly drug-resistant gonorrhea confirmed by health officials

Via The Washington Post: ‘Our greatest fear’: Highly drug-resistant gonorrhea confirmed by health officials. Excerpt and then a comment:

A super-resistant strain of gonorrhea has been reported in the United Kingdom following warnings from global public health officials that the common sexually transmitted disease is becoming more difficult to treat.  

Health officials in England said it is the first time that a case of gonorrhea could not be treated successfully with antibiotics that are commonly used to cure it. 

Earlier this year, a man, who was not named, sought treatment there for symptoms that he developed about a month after he had sexual contact with a woman in Southeast Asia, according to a case report from Public Health England. The bacterial infection was treated with two antibiotics, azithromycin and ceftriaxone, but subsequent tests still came back positive for the disease, the officials said.

“This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics,” Gwenda Hughes, who leads the sexually transmitted infection section at Public Health England, said Wednesday in a statement. 

Gonorrhea, which is caused by the bacterium, Neisseria gonorrhoeae, is one of the most common sexually transmitted diseases around the world.  

Each year, there are an estimated 78 million cases across the globe — about 820,000 of which are reported in the United States, according to data from the Centers for Disease Control and Prevention and the World Health Organization. 

But public health officials said it is becoming more and more resistant to drugs. 

Teodora Wi, medical officer of human reproduction at WHO, said in a news release last year that the bacteria that cause gonorrhea are highly intelligent, explaining that “every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.” 

It's not certain how the patient in England contracted the super-resistant strain. Although he had contact with a woman in Asia, he also had one female partner in the United Kingdom, according to the recent report from Public Health England. She avoided infection. 

Following treatment, a throat swab revealed that the man's infection was still present.  

The patient was then treated intravenously with another antibiotic called ertapenem, and preliminary tests show that the medication may be working. 

He will be tested again next month.

As Maryn McKenna pointed out in a recent tweet, all the attention has been paid to this man—not to the woman he had sex with in Asia, or to her other possible contacts. But I hope that Public Health England, ECDC, and WHO are working hard to trace that woman and her contacts.

South Africa: Bologna blamed in worst listeria outbreak in history

Via The New York Times: Bologna Blamed in Worst Listeria Outbreak in History. Excerpt:

The world’s largest known listeria outbreak has spread throughout South Africa for 15 months, killing 189 people. Health officials believe they have identified the source: bologna. 

Since January last year, 982 confirmed cases of listeriosis had been recorded, the National Institute for Communicable Diseases in South Africa reported on Thursday. The infection, caused by food that has been contaminated with the bacterium Listeria monocytogenes, is often lethal.  

A cluster of gastroenteritis cases among toddlers in a Johannesburg hospital this January led authorities to the sandwich meat in a day care center’s refrigerator — and in turn, to a meat production facility in the northern city of Polokwane. There, officials said they detected traces of LST6, the listeria strain identified in 91 percent of the outbreak’s cases.

The South African meat processor, Enterprise Foods, issued a recall of some of its processed products in early March. Food safety experts at the World Health Organization plan to review the company’s exports to 15 countries across Africa, many of which lack reliable disease surveillance systems and diagnostic tools. Namibia recently reported one listeriosis case; its link to South Africa’s outbreak is uncertain.  

Tiger Brands, the parent company of Enterprise Foods, did not respond to requests for comment.

The highly processed meat, locally called “polony,” is known for its fluorescent artificial color. It is often consumed in low-income communities and sold by street vendors, making distribution difficult to track.  

Listeriosis has an incubation period of up to 70 days, so additional cases are expected to emerge. Because officials determined that 9 percent of the cases involved a different strain of listeria, there may be multiple outbreaks. 

Doctors in South Africa were not required to report cases of listeriosis to the Ministry of Health until last December. Patient records were vague and often lacked the contact information for follow-up, said Dr. Peter K. Ben Embarek, a food safety expert at the W.H.O.  

“Many didn’t even know to be asking patients about the meat,” said Dr. Louise Ivers, an associate global health professor at Harvard. “Surveillance is a critical but neglected piece of health systems,” Dr. Ivers said. “Without the resources and lab infrastructure, countries are left reacting: reacting to cholera, reacting to Ebola, reacting to listeria.”

Yemen: 1,085,305 cholera cases as of March 30

WHO's Cholera Response Dashboard reports 1,085,305 cases and 2,270 deaths as of March 30. That is an increase of 580 cases and two deaths in 48 hours.

Canada: Mumps cases confirmed in the North West Territories for first time in 23 years

Thanks to FluTrackers for alerting me to this CBC News report: Mumps cases confirmed in the N.W.T. for 1st time in 23 years.  Excerpt:

The N.W.T.'s chief public health officer confirmed the first new cases of the mumps in the territory in 23 years.  

Dr. Andre Corriveau issued a health advisory warning on Thursday that the acute, infectious virus may be circulating in some communities. 

There are two cases confirmed and at least two other cases are being investigated, Corriveau said.  

Those individuals recently attended hand games, providing the virus with an opportunity to spread to other communities in the territory. 

"There are many people from communities across the North [at hand games]," Corriveau explained. 

"We wanted to make sure all our healthcare workers are alerted to this and the general public can be mindful that the venue might have been a source of exposure for this illness."

Nigeria: MSF sets up cholera treatment centre in Bauchi, admits 243 patients in 10 days

Via Vanguard: Cholera: MSF sets up treatment centre in Bauchi, admits 243 patients in 10 days. Excerpt:

ABUJA – Doctors Without Borders, also known as Médecins Sans Frontières (MSF), has set up a cholera treatment center in the Abubakar Tafawa Balewa University Teaching Hospital Bauchi to manage the rising number of cases in the state.  

The 70-bed capacity treatment center, which was established on 19th March, 2018, has admitted 243 cholera patients within its first 10 days of operation.  

While 183 patients have been successfully treated and discharged, three deaths were recorded in the facility. 

Vanguard reports that no fewer than 560 cholera cases have been reported in Bauchi state since the beginning of the outbreak in February this year.