News Scan for Apr 22, 2016

Pet-related MCR-1 spread
Salmonella outbreak over
US measles death
Plague in cats
Malaria and transfusions

Tests find evidence for MCR-1 transmission between pets and people

Pet dogs and cats can be colonized with the MCR-1 antibiotic-resistance gene and pass it to people, Chinese researchers reported yesterday in a letter to Emerging Infectious Diseases. Their findings came from an investigation into MCR-1–harboring Escherichia coli isolates from three men hospitalized in a Guangzhou facility's urology ward toward the end of 2015.

After learning that one of the men worked in a pet shop, researchers collected fecal samples from dogs and cats at the store. Of 39 samples from dogs, 4 were positive on polymerase chain reaction testing for MCR-1, and of 14 samples from cats, 2 were positive. Further tests showed that all six of the positive samples were resistant to colistin, polymyxin B, cephalosporin, gentamicin, and ciprofloxacin.

Genetic sequencing suggested that one of the human strains was related to four of the isolates from dogs, which suggests possible MCR-1 transmission between dogs and the patient.

The researchers said the findings hint that aside from food animals and humans, companion animals may be a reservoir of colistin-resistant E coli, adding more complexity to the evolution of MCR-1 in the community.

Another Chinese team first described the MCR-1 gene, which confers resistance to the last-line antibiotic colistin, in November. In the wake of that finding, scientists in several countries have found the gene, sometimes alongside other resistance genes, after examining their sample collections.
Apr 21 Emerg Infect Dis letter


CDC declares Salmonella outbreak tied to supplement over after 33 cases

A multistate outbreak of Salmonella Virchow infections linked to a nutritional supplement powder has grown by 6 cases in a month, to 33, but is now considered over, the Centers for Disease Control and Prevention (CDC) said today.

"This outbreak investigation is over," the agency said in a statement. "However, the recalled Garden of Life RAW Meal Organic Shake & Meal products have a long shelf life and may still be in people's homes."

The number of affected states since the CDC's previous update on Mar 23 grew by 3, to 23. And among 27 patients with available information, 6 required hospitalization, which is 1 more than reported previously. Minnesota and Utah reported the most cases, 3 each.

Illness-onset dates vary from Dec 5, 2015, to Mar 18. Patients range in age from less than a year to 84, with a median age of 35, and are split about evenly by sex.

Garden of Life, of Palm Beach Gardens, Fla., recalled several lots of RAW Meal shakes and meal products on Jan 29, and then expanded the recall on Feb 12. Of 30 outbreak patients interviewed, 28 said they had consumed powdered supplements or meal replacement powders in the week before they fell ill, and 27 specifically mentioned RAW Meal products made by the company.
Apr 21 CDC statement


New details disclosed in first US measles death since 2003

A patient from Port Angeles, Wash., who in April 2015 became the first US measles fatality in 12 years was identified by the Seattle Times yesterday as a 28-year-old womanwho had a rare chronic condition.

Catherine J. Montantes never developed a rash, and the infection was detected only on autopsy, the story said. Her identity was not released at the tme of her death.

Montantes was likely one of more than 30 people exposed to the virus at Lower Elwha Health Clinic on Jan 29, 2015, after possible contact with a 52-year-old man who may have exposed a total of 149 people to measles. She fell ill 6 weeks after the clinic visit, was hospitalized on Mar 26, and died of measles virus giant-cell pneumonia on Apr 8, 2015.

Montantes suffered from dermatomyositis, a rare condition that causes muscle inflammation and weakness. Treatment requires the use of medication that suppresses the immune system, the Times said.

Montantes' mother said she was immunized against measles as a child. Speaking of immunocompromised people, the CDC's Manisha Patel, MD, said, "Even if they're vaccinated, they may still be susceptible."

The woman's death highlights the importance of universal measles vaccination as a way to protect people who are especially vulnerable to infection, the Times said. In 2015, 189 people were infected with measles nationally, with 11 cases diagnosed in Washington. Four cases in the United States have been confirmed this year.
Apr 21 Seattle Times article
Related Jul 6, 2015,
CIDRAP News item


Plague diagnosed in 3 Wyoming cats

The Wyoming Department of Health (WDH) yesterday confirmed plague infections in three Park County cats.

All three cats lived in Cody, Wyo., in the vicinity of South Fork Road. Veterinarians confirmed the plague diagnoses between Apr 12 and Apr 20, the WDH said. The agency didn’t say whether the cats survived.

"Plague is a serious bacterial infection that can be deadly for pets and for people if not treated promptly with antibiotics," said Karl Musgrave, DVM, MPH, Wyoming state public health veterinarian. Cats and dogs can contract Yersinia pestis, the bacterium that causes plague, from flea-infested rodents and transmit the disease to people, though only six people have been diagnosed with plague in Wyoming, where Y pestis is pervasive, since 1978.

Symptoms of plague in animals include enlarged lymph nodes, swelling in the head and neck area, fever, chills, lack of energy, cough, vomiting, diarrhea, and dehydration. Plague symptoms in people are similar, with the addition of extreme exhaustion, headache, difficulty breathing, and abdominal pain.

Preventive methods include avoiding contact with rodents, using flea repellent, and seeking treatment of animals displaying concerning symptoms, the WDH said.
Apr 21 WDH press release


Technique for removing malaria parasites from blood shows promise

A technology for reducing parasites in blood may aid in reducing malaria cases transmitted by transfusions, according to a study yesterday in The Lancet.

Researchers from the the United Kingdom and Ghana evaluated the effectiveness of the Mirasol system by using it to treat whole blood transfused to 214 anemic patients at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from Mar 12 to Nov 7, 2014. Mirasol uses ultraviolet light and riboflavin to reduce parasite counts in blood.

Approximately half of Ghanaian blood donations have detectable levels of Plasmodium falciparum, the parasite that most commonly causes malaria in the region, and 14% to 28% of transfusion recipients in Ghana become infected, the authors said.

Of 214 patients who completed the African Investigation of the Mirasol System (AIMS) trial, 107 received Mirasol-treated blood transfusions, and the remainder received untreated blood. One-quarter of all transfusions contained malaria parasites. Malaria was transmitted to 1 of 28 people (4%) exposed to parasites from Mirasol-treated blood and to 8 of 37 (22%) patients exposed to parasites in untreated blood, the authors said.

The group receiving Mirasol-treated blood had fewer allergic reactions (5%) than the untreated group (8%), possibly because the technique inactivates white blood cells. Thirteen deaths occurred during the study, though the authors attributed deaths to severe pre-existing illnesses and not to transfusion effects.

Parasite reduction technologies for blood transfusions could lead to lower cases and costs related to malaria in sub-Saharan Africa, the authors said.
Apr 21 The Lancet study

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