News Scan for May 03, 2018

Saudi MERS case
Chronic wasting and mineral licks
Salmonella in rattlesnake pills
Ebola and retinal lesions
Infection prevention guide

New MERS case reported in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) recorded a new case of MERS-CoV yesterday in Sakakah, a city in the northwestern corner of the country.

Officials diagnosed a 53-year-old Saudi man as having MERS-CoV (Middle East respiratory syndrome coronavirus) after he presented with symptoms of the virus. He is in stable condition, and the MOH said the source of his infection was "primary," meaning it is unlikely he contracted the virus from another person.

The new case brings Saudi Arabia's MERS-CoV total since 2012 to 1,837, including 744 deaths. Two people are still being treated for their infections.
May 2 Saudi MOH report


Mineral licks may play host to disease-causing prions

A study published yesterday in PLoS One shows that mineral deer licks in Wisconsin served as reservoirs for prions, potentially explaining the spread of chronic wasting disease (CWD) among American cervids.

To conduct the study, scientists took environmental samples (including soil and standing water) on and around 11 mineral deer licks in south-central Wisconsin in 2013. They detected CWD-causing prions in 9 of the 11 mineral licks, higher concentrations in water samples than soil samples. Further testing of fecal droppings from white-tailed deer confirmed the animals were depositing prions near the mineral licks.

"This finding suggests that mineral licks may serve as reservoirs of CWD prions that contribute to disease transmission to susceptible animals. Although the levels of CWD prions in the samples analyzed appears low, we note that the association of prions with clay minerals often present at mineral licks can dramatically enhance disease transmission via the oral route of exposure," the authors said.

CWD is a fatal neurodegenerative disease found in deer, moose, and elk in the United States, Canada, and Scandinavia.
May 2 PLoS One study


Tainted rattlesnake supplements renews CDC Salmonella warning

An investigation into a salmonellosis infection in a Texas resident in 2017 found Salmonella Oranienburg in a bottle of rattlesnake supplements from his or her home, and though advanced testing didn't match the product strain to the patient's illness, it was a close genetic match to a patient in Kansas who got sick after taking rattlesnake supplements. Researchers from the US Centers for Disease Control and Prevention (CDC) and their partners in Texas and Kansas reported their findings today in the latest edition of Morbidity and Mortality Weekly Report (MMWR).

Rattlesnake pills contain dehydrated and pulverized rattlesnake meat and are marketed without Food and Drug Administration approval for conditions such as cancer, HIV, and acne. They have been linked to Salmonella infections before, and the CDC warned about the risk of contamination—especially for people with underlying health conditions—in November when it announced the Kansas patient's illness.

During the initial investigation into the Kansas illness, the patient did not reveal taking rattlesnake pills when asked about vitamins and supplements. However, after whole-genome sequencing suggested a match between the pills from the Texas patient's home and the Kansas patient's illness, health officials reinterviewed the patient about less common supplements, the patient reported having traveled to Mexico and purchasing rattlesnake pills. The patient believed the pills were homemade and reported taking five of them. There were no more pills for testing.

No other Salmonella illnesses related to the strain found in the Kansas patient or the Texas supplement sample have been identified.

The report said reptiles and their meat have been known to carry Salmonella species and that most related human infections were from S arizonae. It noted that the Kansas case marks the first known human infection with Salmonella Oraneinburg.
May 4 MMWR report
Dec 19, 2017, CIDRAP News scan "CDC: Rattlesnake pills contained Salmonella"


Ebola causes retinal lesions, damage to photoreceptors

Survivors of Ebola virus disease (EVD) can have myriad lasting symptoms, including extensive vision and eye problems. A new study in JAMA Ophthalmology studied 14 survivors of the disease, with more than 80% of the patients exhibiting extensive retinal scarring.

Researchers used a number of tools, including swept-source optical coherence tomography (OCT), Humphrey visual field analysis, and spatial analysis to capture ophthalmological images of 27 eyes of survivors, who had a median age of 37 years. They documented 141 Ebola retinal lesions.

"A collapse of the overlying retinal structures was detected in larger lesions, corresponding visual field defects respected the horizontal raphe, and perilesional areas of dark without pressure (ellipsoid zone hyporeflectivity) accompanied 89% of lesions," the authors wrote. By using OCT, the authors were able to determine damage to the eye's photoreceptors for the first time.

The authors suggest that EVD survivors should undergo extensive vision and ocular testing; more ocular images of lesions will theoretically help explain Ebola pathogenesis in the eye.

Last year, researchers from the University of Liverpool were the first to establish that EVD survivors suffered from unique retina scarring. They published their study in Emerging Infectious Diseases.
May 3 JAMA Ophthalmol study
Jun 19, 2017, Emerg Infect Dis report


Group publishes infection prevention and control guide for clinics

A healthcare delivery shift from hospitals to outpatient clinics — along with an increasing number of procedures done in clinic settings — brings a greater risk of healthcare-related infections, which prompted a team from the University of Texas to publish the first step-by-step guide for improving infection prevention and control (IPC) practices in clinics. The report appears in the latest issue of Open Forum Infectious Diseases.

Earlier recommendations were broad or were issued in the wake of outbreaks and epidemics, and the new report offers a more proactive systemized approach, the authors said.

Many clinics don't have resources to launch a robust IPC program, so the group suggests focusing on high-priority areas such as injection safety, sterilization, and high-level disinfection.

The first step consists of pulling together a multidisciplinary oversight committee, then form an infection prevention team to get a handle on the scope of services performed and prioritize high-risk activities and areas using a standardized survey tool such as a CDC checklist.

Other steps covered in the report include education, hand hygiene, environment (cleaning, sterilization, and disinfection), injection safety, construction (eg, sinks, hand hygiene facilities), waiting room considerations, occupational health, and pandemic preparedness.

Glucose meters are cited as a high priority for disinfection standardization and training due to their historic link to bloodborne pathogen transmission.

Authors also address monitoring IPC compliance with survey tools and establishing regular staff communication procedures, such as a website that contains all the current policies, forms, health alerts, and resources.
May 1 Open Forum Infect Dis report
May 2 University of Texas Health Science Center at Houston press release

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