News Scan for Nov 21, 2017

News brief

Animal Zika studies shed light on transmission, paralysis complications

Experiments in guinea pigs to explore possible routes of Zika transmission found that infected animals can pass the virus to healthy cagemates, perhaps through tears or saliva, researchers from China reported today in Nature Communications.

Zika transmission through sexual contact has been clearly established, but much less is known about other routes of human-to-human spread. The case of a US man from Utah who contracted the virus in 2016 after caring for his sick father has confounded researchers.

In the new report, the study team first confirmed that guinea pigs were susceptible to Zika infection after subcutaneous injection. Then when they place infected animals in cages with healthy animals, all of the uninfected animals readily developed viremia at levels similar to the experimentally infected animals. After just 1 day, Zika RNA was found in blood, saliva, and tears.

Researchers compared two Zika strains, one from 2010 in Cambodia and the other from 2016 in Venezuela. Response in guinea pigs to the earlier strain was slightly attenuated.

Another round of experiments showed that guinea pigs can be infected with Zika through intranasal inoculation, with virus found in several tissues, including the brain and parotid glands. In experiments with macaques, the team found that the animals can efficiently contract Zika after intranasal and intragastric inoculation.

The authors concluded that more evidence from animal models and clinical settings are needed to tease out close contact routes of transmission from other known routes.
Nov 21 Nat Commun abstract

In other Zika research developments, researchers from Yale University yesterday reported that the immune response to Zika, rather than the virus itself, may be responsible for some of the neurologic complications of the disease such as Guillain-Barre syndrome. They reported their findings in Nature Microbiology. Based on experiments with mice engineered to be susceptible to the disease, the investigators found that when Zika spread through blood to the brain, it triggered a flood of CD8 T immune cells, which have the capacity to limit nerve cell infection but can also trigger Zika-related paralysis.
Nov 20 Nat Microbiol abstract
Nov 20 Yale University press release

Nigeria confirms 4 more monkeypox cases but notes slowdown

The Nigerian Centre for Disease Control (NCDC) confirmed four more monkeypox cases but said the number of suspected cases has declined over the last 3 weeks. There are now 42 confirmed and 146 suspected cases reported since outbreak began in October.

All confirmed cases have been found in the 10 southernmost states of Nigeria. A total of 22 states have reported suspected cases.

The report said 9 of 12 swabs that were negative for monkeypox were positive for chickenpox.

So far there have been no deaths attributed to monkeypox, a rare virus closely related to smallpox. This outbreak, however, is Nigeria's largest to date. More men than women have been infected, and most patients have been between 21 and 30 years of age.

The NCDC said they will be taking a One Health approach to monitoring the outbreak. Humans contract monkeypox from infected animals.
Nov 19 NCDC update

Stewardship / Resistance Scan for Nov 21, 2017

News brief

US cases of Candida auris continue to climb

The number of reported Candida auris infections in the United States has risen to 157, according to the most recent case count from the Centers for Disease Control and Prevention (CDC).

As of Oct 31, the multidrug-resistant (MDR) fungus has been identified in healthcare facilities in 10 states, with New York (102) and New Jersey (33) reporting the most cases. Cases have also been reported in California (1), Connecticut (1), Florida (2), Illinois (9), Indiana (1), Maryland (1), Massachusetts (6), and Oklahoma (1).

The case count, which rose from 126 in September, reflects the number of laboratory-confirmed C auris infections. The CDC also reports that 29 patients have probable infections and 212 people have been found to be colonized with the pathogen. Colonized patients were identified by targeted screening in four states with clinical cases.

In patients with compromised immune systems, C auris can cause serious invasive infections affecting the bloodstream, heart, brain, ear, and bones. The CDC estimates that more than 1 in 3 patients with an invasive C auris infection die, and reports from other countries estimate mortality rates as high as 50%.
Nov 17 CDC case count update

Italian telemedicine consultation reduces antibiotic use, MDR bacteria

A telemedicine-based infectious disease consultation service at an Italian pediatric cardiac hospital helped reduce antibiotic use, overall antibiotic costs, and the selection of MDR bacteria, researchers report in the Italian Journal of Pediatrics.

The remote stewardship program, which was started in January 2015 after a cluster of pneumonia patients were admitted to the intensive care unit (ICU), consisted of a biweekly videoconference discussion of all clinical cases admitted to the hospital and a review of antibiotic strategies for each patient. Additional consultation with specialists was also available via telemedicine. The main topics discussed during the meetings were monitoring and managing of MDR Enterobacteriaceae, antibiotic prophylaxis protocols in surgery, and the difference between empirical and definitive therapy.

To measure the impact of the program on antibiotic appropriateness, costs, incidence of nosocomial infections, and incidence of isolation of MDR bacteria, the researchers compared the period immediately before the intervention (January 2014 through March 2015) to the post-intervention period (March 2015 through March 2016).

There were 683 patients in the pre-intervention period and 531 patients in the post-intervention period. The rate of hospital infections in the ICU per 1,000/person days decreased from 9.5 in the pre-intervention period to 6.1 in the post-intervention period, a difference that was not statistically significant. The rate of MDR isolation decreased from 104 to 79 per 1,000/person days, a reduction of 25%. In addition, the overall cost of antibiotics fell from €25,000 to €15,000, and average antibiotic packages consumed per admission fell from 9 to 6.7.

"In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients," the authors write. "The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety."
Nov 17 Ital J Pediatr letter to the editor