News Scan for Jun 13, 2019

Salmonella tied to live poultry
Cutaneous anthrax in Italy
Favipiravir for Bourbon virus

Salmonella outbreak tied to live poultry swells to 279 cases in 41 states

The Centers for Disease Control and Prevention (CDC) today confirmed 227 new cases of Salmonella infection tied to backyard poultry such as chicks and ducklings, swelling the outbreak to 279 cases in 41 states.

Forty people have required hospitalization for their illnesses. When the CDC first reported this outbreak on May 16, it involved only 52 cases in 21 states. In interviews, 118 (77%) of 153 case-patients reported recent contact with chicks or ducklings. "People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries," the CDC said.

Illness-onset dates range from Jan 1 to May 24, and patients range in age from less than 1 year to 92 years, with a median age of 25. No deaths have been reported.

Ohio has the most cases, with 32, followed by Tennessee and Texas (26 each), Pennsylvania (18), and Virginia (16).

Outbreak strains are Salmonella Agona, Anatum, Braenderup, Infantis, Montevideo, and Newport. Officials have identified one of these strains in samples collected from backyard poultry in Ohio, the CDC said.

The outbreak is the latest in a series of Salmonella outbreaks tied to live poultry, the most recent of which happened last year and eventually affected at least 334 people, 56 of whom were hospitalized.

The CDC recommends a variety of steps to prevent disease for poultry owners, stores, and mail-order hatcheries.
Jun 13 CDC update


Italian researchers detail pair of related cutaneous anthrax infections

Researchers from Italy detailed two epidemiologically linked cutaneous Bacillus anthracis infections, in patients who had both been exposed to the blood of a cow that died from the disease at a farm near Rome in 2017. The group reported the findings today in the latest issue of Eurosurveillance.

The first patient was a 50-year-old male veterinarian who developed an eschar and lesion after contaminating his hand while removing a glove after inspecting a cow that died from digestive hemorrhage. When four more cows died at the farm and were confirmed as having anthrax, the patient sought specialist care and was hospitalized for treatment. He received intravenous ciprofloxacin and was discharged 4 days later with a prescription for oral ciprofloxacin.

Meanwhile, the second patient—a male farm worker in his 40s—sought care at a different city near Rome for several lesions on his arm and was admitted the same day to a hospital for treatment of ulcerated and necrotizing skin symptoms and upper-extremity edema.

He initially didn't report any exposure to sick animals, but had worked on a horse farm bordering the one where the cows had died from anthrax. Upon further questioning by his clinical team, the man remembers that he had been exposed to the blood of the dead cow that was evaluated by the first patient, the veterinarian. He was treated with intravenous ciprofloxacin and was discharged 2 weeks later.

Researchers said the two cases highlight the importance of a concerted One Health response between clinicians and veterinarians, the healthcare system and public health officials. They also note that anthrax should be included in the differential diagnosis of skin lesions, especially during dry seasons where B anthracis has been detected before.
Jun 13 Eurosurveill report


Mouse findings show favipiravir as potential Bourbon virus treatment

Experiments on mice suggest the antiviral drug favipiravir might be a useful treatment for deadly tickborne Bourbon virus infections. Researchers based at Washington University School of Medicine published their findings today in PLOS Pathogens.

Bourbon virus was first identified in Bourbon County, Kansas, in 2014, and of the handful of human cases that have been detected, most have been fatal. There are no treatments or vaccines for the disease.

According to a press release from the school, given that Bourbon virus is a distant relative of influenza, researchers have been examining if any current or candidate drugs for flu could be used to treat Bourbon virus. They narrowed the list to favipiravir, because it inhibits a protein that the virus needs to multiply. Favipiravir is approved in Japan but hasn't yet been cleared by US regulators.

For the study, they experimentally infected mice, then treated them with favipiravir or placebo. Of those treated within a day of infection, all given the antiviral at the time of infection or within 1 day after survived without becoming visibly sick, while all of the placebo-treated mice died. Mice who got favipiravir 3 days after infection when they showed signs of infection recovered.

Jacco Boon, PhD, assistant professor of medicine and the study's first author, said in the press release, "Up until now, doctors have not had any way to treat Bourbon virus. We’ve found something that works, at least in mice, and it suggests that antivirals for flu are a good place to start looking for a treatment for Bourbon."
Jun 13 PLOS Pathog abstract
Jun 13 Washington University School of Medicine press release

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