The first case of chronic wasting disease (CWD) in Florida has been detected in a road-killed deer in Holmes County, boosting the number of affected states to 31 and prompting nearby states to take action.

Caused by infectious prions (misfolded proteins), CWD is a fatal neurodegenerative disease affecting cervids such as deer and elk. While CWD isn't known to infect humans, some experts fear it could jump species. 

CWD management zone established  

On June 15, the Florida Fish and Wildlife Conservation Commission (FWC) and the Florida Department of Agriculture and Consumer Services (FDACS) announced an emergency order and actions to protect against CWD spread in north Florida.

"As part of the plan, the FWC will collect samples from specific established zones to further assess the spread of the disease," FWC said in a news release. "The FWC has increased CWD monitoring and surveillance in the area and FDACS is prioritizing CWD testing from all samples collected from Holmes County."

Controlling the spread of CWD is difficult once it becomes established in a natural population.

The CWD management zone covers parts of Holmes, Jackson, and Washington counties. The FWC prohibits the export of whole-deer carcasses and high-risk parts, baiting or feeding deer, and the rehabilitation of injured or orphaned white-tailed deer. Holmes County is on the border with Alabama and lies close to Georgia, as well.

The FDACS is scrutinizing transportation permits for intrastate cervids to or from cervid farms within the zone, which are under quarantine.

"Controlling the spread of CWD is difficult once it becomes established in a natural population," the FWC wrote. "Because prions shed by infected deer persist in the environment, the best chance for controlling CWD is acting quickly."

Nearby states respond

Several nearby states reacted with their own announcements:

• The Alabama Department of Conversation and Natural Resources said in a statement that it will increase CWD sampling in the southeastern part of the state.
• The Georgia Department of Natural Resources issued a release saying that it will activate its CWD response protocol if it is detected in the state.
• The Tennessee Wildlife Resources Agency said it has halted the rehabilitation of white-tailed deer fawns, News Channel 5 Nashville reports.

A review and meta-analysis of studies on treatment outcomes for extensively drug-resistant tuberculosis (TB) found a success rate of only 44%, researchers reported yesterday in the Journal of Infection.

Among 5,056 studies published from 2005 to April 2023 that reported on treatment outcomes for extensively drug-resistant TB, researchers from Aarhus University Hospital in Denmark identified 94 eligible studies from 26 countries, involving 10,223 patients. The pooled proportion of cases treated successfully was 44.2% (95% confidence interval [CI], 38.3% to 50.3%), well below the World Health Organization (WHO) target success rate of 75%. For studies in which all successful and unsuccessful outcomes were completely stratified, the pooled success rate was only 26.9% (95% CI, 19.1% to 36.4%). A variety of sensitivity analyses produced similar estimates.

"These rates are very low, and this situation is comparable to the prognosis for patients affected by tuberculosis prior to the antibiotic era," the study authors wrote.

They note, however, that a slight improvement in treatment outcomes was observed after 2013, and that the 25 studies on outcomes for patients with pre-extensively drug-resistant TB found a pooled treatment success rate of 63.3%.

This situation is comparable to the prognosis for patients affected by tuberculosis prior to the antibiotic era.

More important, the review did not include any studies conducted since the introduction of the all-oral, shorter, and less toxic BPaL (bedaquiline, pretomanid, and linezolid) regimen with or without moxifloxacin, which has demonstrated treatment success rates of up to 90% in phase 3 trials. The WHO recommended this regimen for most patients with drug-resistant TB in May 2022.

"This newly introduced and recommended regimen gives hope for a new era of extensively drug-resistant tuberculosis treatment," the authors wrote.

Analysis of Neisseria gonorrhoeae isolates from three African countries found high resistance to ciprofloxacin and emerging resistance determinants for azithromycin, African researchers reported today in the Journal of Antimicrobial Chemotherapy.

For the study, the researchers conducted antibiotic susceptibility testing and whole-genome sequencing (WGS) on 433, 154, and 99 gonococcal isolates collected from men in Uganda, Malawi, and South Africa, respectively, from 2015 to 2020. Although the World Health Organization African Region has some of the highest prevalence of gonorrhea, there data are scarce on antimicrobial resistance (AMR) and on the evolution, molecular epidemiology, and presence of genetic AMR determinants in gonococcal isolates from the region.

Antibiotic susceptibility testing revealed that resistance to ciprofloxacin was high in all countries (57.1% of isolates in Malawi, 77.8% in South Africa, and 100% in Uganda were resistant), while all isolates were susceptible to ceftriaxone, cefixime, and spectinomycin, and 99.9% were susceptible to azithromycin.

WGS found that AMR determinants were common for ciprofloxacin, benzylpenicillin, and tetracycline but rare for ceftriaxone and azithromycin. A phylogenomic tree of the isolates from the three countries, along with 159 isolates from Kenya and 52 from Burkina Faso, showed that most belonged to the more antibiotic-susceptible lineage B (780 isolates) compared with the AMR lineage (141).

It is imperative to strengthen gonococcal AMR surveillance, ideally including genomics, in African countries.

The study authors note that while ciprofloxacin is no longer recommended for gonorrhea treatment in the three countries, the high prevalence of ciprofloxacin resistance is likely related to its continued empirical use for urethritis, along with the continued use of fluoroquinolones for other infections. And although susceptibility to ceftriaxone and azithromycin was high, the existence of AMR determinants to these antibiotics, which are recommended for gonorrhea treatment, is a concern.

"The high prevalence of resistance to ciprofloxacin (and empirical use continues), tetracycline and benzylpenicillin, and the emerging resistance determinants for azithromycin show that it is imperative to strengthen gonococcal AMR surveillance, ideally including genomics, in African countries," they wrote.