PAHO reports 3,100 new cases, mostly in the Caribbean

The Pan American Health Organization (PAHO) late last week reported 3,100 new suspected or confirmed chikungunya cases, bringing the total in the Americas this year to 250,726.

The previous two reports noted increases of 617 and 32,492 cases, respectively. Brazil, which logged more than 30,000 new cases in the previous report, did not report updated numbers to PAHO for the most recent report, dated Aug 19.

Almost all the new cases in last week's report came from a slew of Caribbean islands reporting for the first time in 2016. Leading the pack was Aruba, with 704 cases, and Trinidad and Tobago, with 590. Dominica and Jamaica were next, with 271 and 205, respectively. As with the previous report, many countries have not reported on their chikungunya status for many weeks.

The chikungunya outbreak began in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas. Since then PAHO has recorded 2,130,693 cases.
Aug 19 PAHO update


Ohio reports Cryptosporidum surge linked to recreational water

Three Ohio counties are reporting a spike in Cryptosporidium cases over the past 2 weeks, with a large number of cases linked to exposures at various local recreational water facilities, Food Safety News (FSN) reported on Aug 19.

So far, 209 cases have been reported in Columbus, Franklin, and Delaware counties in the central part of the state.

Jose Rodriguez, a spokesman for Columbus Public Health, told FSN that the 209 cases surpass the number of cases from the past 4 years combined. Just 8 days earlier the agency reported only 93 cases. Rodriguez added that the outbreak isn't tied to any one location and that a number of patients had multiple exposures at different facilities.

Cryptosporidium outbreaks, caused by microscopic parasites, can be cyclical, and Rodriguez said a similar outbreak in 2008 led to nearly 500 cases. Several public pools were temporarily closed for "hyperchlorination" to eliminate the parasite.

The parasite is a leading cause of waterborne disease outbreaks linked to recreational water in the United States, according to background information from the Centers for Disease Control and Prevention (CDC). The hallmark of cryptosporidiosis is watery diarrhea that lasts 1 to 2 weeks. Some groups are vulnerable to serious illness, including young children, pregnant women, and those who have weakened immune systems.
Aug 19 FSN story
Aug 18 Columbus Public Health press release

CDC Cryptosporidum background


Researchers report antibiotic resistant E coli in French drinking water

A team of French researchers today reported the detection of antibiotic resistant Escherichia coli in French drinking water supplies.

In a study published in Antimicrobial Agents and Chemotherapy, the researchers described finding a single E coli isolate containing an extended-spectrum beta lactamase (ESBL) gene similar to those previously found in humans and animals. The isolate was found among drinking water samples from 28 water supply systems located throughout France, taken from where water enters the distribution system. The locations were chosen because of multiple water quality failures.

E coli was found in all the samples, but six isolates from six different water supplies were found to be resistant to at least one antimicrobial. Sequencing indicated that the isolate that was resistant to several antimicrobials harbored an ESBL-carrying plasmid. ESBLs are resistant to many penicillin and cephalosporin antibiotics.

While resistance-carrying genes have been detected in drinking water in low-income nations with poor sanitation and unregulated antibiotic use, the researchers said their study is likely the first report of an ESBL-producing bacterium in drinking water in a high-income country. Although the water supply where the isolate was found has been repaired, and the isolate would probably not have been pathogenic to humans, the concern is that the reservoir for antibiotic resistance is expanding.

"All potential reservoirs—human, animal, and environmental—are now contaminated by extended spectrum beta-lactamases," said Marisa Haenni, PhD, senior scientist with the Agency for Food, Environmental, and Occupational Health & Safety in Lyon, France, in a news release from the American Society for Microbiology (ASM), which publishes the journal.

"Though this contamination strongly varies, depending on the studied reservoir and country, no one is protected from the sporadic presence of ESBLs in places that should be free of this resistant bacterium."
Aug 22 Antimicrob Agents Chemother abstract
Aug 22 ASM news release


Salmonella in Africa temporally linked to HIV epidemic

Scientists who described the genetic sequencing of a highly invasive form of non-typhoidal Salmonella (iNTS) causing an epidemic in sub-Saharan Africa said in Nature Genetics today that infection with this strain can be deadly and may be linked to HIV and resistant to several antibiotics.

Infection with iNTS most often occurs in children suffering from malnutrition and in HIV-infected adults, and is surpassing Salmonella Typhi in many parts sub-Saharan Africa as the most likely cause of salmonellosis. A nonspecific fever that masquerades as malaria is the hallmark of infection, which is rarely accompanied by diarrhea. About 22% to 45% of infections can be deadly.

The authors of the study collected 129 samples of invasive Salmonella Typhimurium isolates from Malawi, Kenya, Mozambique, Uganda, the Democratic Republic of Congo, Nigeria, and Mali. They found that iNTS is composed of only two "highly conserved" lineages, unlike Salmonella Typhimurium isolates associated with gastroenteritis, which come from varied lineages.

The researchers said most sub-Saharan invasive Salmonella Typhimurium cases emerged independently from 52 to 35 years ago, about the same time HIV emerged as an epidemic in Africa. The temporal link could explain why iNTS is more severe in HIV patients.

"HIV increases susceptibility to iNTS infections, and this form of bacteremia is an AIDS-defining opportunistic infection in adults… host immune status has a critical role in determining the outcome of Salmonella infections," the authors wrote.
Aug 22 Nat Genet study

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