News Scan for Aug 23, 2016

Hepatitis found in scallops
Fecal transplant trial
Meningitis C in Niger
Bagpipe lung
Experimental Ebola drug

Scallops test positive for hepatitis A as Hawaii outbreak grows

Food and Drug Administration (FDA) tests on scallops implicated in Hawaii's hepatitis A outbreak yielded positive results on two samples, according to an update yesterday from the agency on the investigation.

Also, the number of people sickened in the outbreak continues to grow, with 206 cases now reported as of Aug 17. The total reflects an increase of 38 since the last update from the Hawaii Department of Health (HDOH). The most recent illness onset was Aug 9, and 51 patients have been hospitalized, according to the HDOH.

The FDA said it and its investigation partners notified Sea Port Products Corp that its frozen bay scallops are the likely source of the illnesses and that the company voluntarily recalled three lots of its product on Aug 18. They were distributed to California, Hawaii, and Nevada.

The trace-back investigation had revealed that the imported scallops were supplied to certain Genki Sushi outlets in Hawaii where people sickened in the outbreak had eaten.
Aug 22 FDA investigation update
Aug 17 HDOH


Fecal microbiota transplantation proves effective in clinical trial

The results of a new clinical trial indicate that fecal microbiota transplantation (FMT) using stools from healthy donors is an effective treatment for patients with recurrent Clostridium difficile infections (CDIs).

In the randomized, controlled, double-blind clinical trial, 46 CDI patients at academic hospitals in Rhode Island and New York received FMT, with 22 patients being treated with stool from a healthy donor and a control group of 24 patients being treated with a placebo—their own stool. All of the patients had experienced at least three occurrences of CDI and been previously treated with vancomycin. The primary end point was the resolution of diarrhea over 8 weeks.

In a finding that was consistent with observational studies, 91% of the patients (20 of 22) who received donor FMT were cured of CDI during the course of treatment, while 63% of the patients (15 of 24) who received their own stool were cured. Donor FMT also restored the normal microbial community structure, while microbial diversity did not improve in the control group.

But the researchers were surprised to find a difference in cure rates among the control groups at the two different sites. In New York, 9 out 10 patients who received their own stool were cured, compared with only 6 of the 14 in Rhode Island. The study authors suggested one reason for the difference could be that many of the New York patients had experienced more recurrences of CDI, had waited for long periods before consultation, and had received longer courses of vancomycin and other antibiotics before entering the study. Therefore, some of the patients could have been cured before enrollment.

The study was published today in the Annals of Internal Medicine.
Aug 23 Ann Intern Med

Novel meningitis C strain linked to 2015 epidemic in Niger

An analysis of a large Neisseria meningitidis C outbreak in Niger in 2015 was the largest of its kind so far involving the subtype and was caused by a novel strain, researchers from Niger reported today, along with their colleagues from the World Health Organization and the US Centers for Disease Control and Prevention.

The epidemic came in the wake of the 2010 rollout of a new vaccine against meningitis serogroup A in Niger, which has been credited with decreasing epidemics involving that strain in Africa's "meningitis belt" countries. The investigators reported their findings today in The Lancet Infectious Diseases.

The novel meningitis C strain was first detected in local outbreaks in Nigeria in 2013.

Niger's meningitis C outbreak included 9,367 suspected cases, 549 of them fatal, the team found in their analysis of surveillance data. Over a third of cerebrospinal specimens were positive for a bacterial pathogen, nearly 72% of them meningitis C. Whole-genome sequencing of 77 isolates identified the ST-10217 strain.

In an accompanying editorial, Susanne Jacobsson, PhD, from Orebro University in Sweden and the country's pathogenic Neisseria reference lab, wrote that Niger's epidemic shows a need for a continued focus on meningitis in Africa and shows the importance of surveillance for all serogroups and the need for research on new affordable multivalent vaccines to stop epidemics on the continent.
Aug 23 Lancet Infect Dis abstract
Aug 23 Lancet Infect Dis


Highland hazard: Bagpipe causes fatal lung disease

In a study in Thorax, researchers yesterday described a death caused by "bagpipe lung" and warn players of wind instruments that their music makers could be harboring dangerous mold and other fungi. 

The scientists described a 61-year-old man who died from hypersensitivity pneumonitis. The chronic condition occurs when the immune system reacts to an inhaled environmental antigen. For 7 years, the man was treated for a dry cough and breathlessness with immunosuppressant drugs, but his conditioned worsened and he eventually died from acute respiratory distress syndrome.

During his illness, doctors looked for an environmental trigger for his lung condition, eventually finding it in the mold and other fungi living in the reeds, neck, and bag of the bagpipe the man played daily. Samples from the bagpipe showed growth of Paecilomyces variotti, Rhodotorula mucilaginosa, Trichosporon mucoides and Exophiala dermatitidis. Though not proven conclusively, the researchers say the man's clinical presentation and absence of other triggers makes the bagpipe the likely culprit.

"This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of [hypersensitivity pneumonitis]," the authors wrote.
Aug 22 Thorax study
Aug 22 BMJ
press release


Drug shows promise in monkeys against Sudan Ebola virus

An experimental gene-silencing drug worked well against the Sudan strain of Ebola virus in rhesus macaques, according to a study yesterday in Nature Microbiology.

Canadian and US scientists experimentally infected 25 monkeys with the Sudan strain of the virus, which is not the strain responsible for the massive Ebola outbreak in West Africa from 2013 to 2015. They then began treating 20 of the animals from 1 to 5 days after infection.

Treatment with an RNA interference therapeutic comprising small interfering RNA (siRNA) resulted in up to 100% survival, even when it was initiated when the macaques had fever, viremia, and signs of Ebola virus disease. The drug also effectively controlled viral load.

The authors wrote, "Mirroring clinical findings, a correlation between high viral loads and fatal outcome was observed, emphasizing the importance of stratifying efficacy according to viral load."
Aug 22 Nat Microbiol abstract

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