Study finds high level of inappropriate testing for fungal disease
A study conducted at a large teaching hospital in Tokyo found that most tests used to diagnose invasive fungal disease were inappropriate, Japanese researchers reported yesterday in Open Forum Infectious Diseases.
The retrospective study, conducted at University of Tokyo Hospital, looked at data on patients who underwent testing with three different types of non–culture-based fungal assays (NCBFAs): beta-D glucan (BDG), galactomannan antigen (GMA), or cryptococcal antigen (CRAG). Testing was deemed appropriate if the clinical presentation was compatible with a fungal infection and there was a predisposing host factor at the time of ordering. The researchers also examined factors that increased risk of inappropriate NCBFA use.
A total of 1,159 patients underwent testing with either serum BDG, GMA, or CRAG tests during the study period. Among the 470 patients included in the analysis, roughly 80% of NCBFAs conducted were deemed inappropriate. Nearly 17% of patients underwent three separate unnecessary NCBFAs simultaneously.
Ordering by transplant medicine physicians, repetitions of the test, the absence of predisposing factors for fungal infections, and the absence of recommendations from infectious diseases (ID) consultants were associated with an increased risk of inappropriate NCBFA use.
The study authors say that while avoidable fungal testing doesn't get as much attention as inappropriate urine cultures or Clostridioides difficile testing, the results suggest fungal diagnostic stewardship is needed to prevent unnecessary cascades of care in patients at low risk of fungal infection.
"Our findings suggest that stewardship efforts engaging transplant physicians, clinical decision support tools to guide ordering practices, and involvement of ID physicians as stewards may be important strategies to improve fungal testing practices," they wrote.
Dec 6 Open Forum Infect Dis abstract
CDC keeps threat assessment moderate for H5N6 avian flu
The US Centers for Disease Control and Prevention (CDC) last week updated its risk assessment for H5N6 avian flu, which follows a concerning doubling of human cases in China this year. Last month the agency announced that a new risk assessment was under way.
In an update of its Influenza Risk Assessment Tool (IRAT), the CDC said that, for its latest assessment, it looked at a recent virus from Sichuan province. It put the risk of potential emergence as a pandemic-capable virus at 5.3, which is in the middle range of the moderate risk category and a little higher than for the 2015 version of the H5N6 virus. For public health impact, it put the risk at 6.3, also in the moderate range, which was a little lower than earlier virus.
The CDC said sequence data from the latest sample shows that H5N6 is still adapted to poultry, with no evidence of increase adaptation to mammals or increased transmissibility. Earlier recommended candidate vaccine viruses are expected to be effective against the H5N6 viruses that are currently circulating in China. Also, the CDC said its recent analysis suggests the viruses are susceptible to current recommended antiviral medications.
It notes that the H5N6 clade that has caused human illnesses has only been reported in birds in four Asian countries.
Since 2014, 52 human infections have been reported, all but 1 in China. Earlier this year, Laos reported a case. So far this year, 26 human cases have been reported, with most involving contact with poultry or poultry environments. Most cases were severe, and 9 people died from their infections.
Dec 2 CDC IRAT update
Nov 2 CIDRAP News scan
CDC ends probe of Salmonella outbreak tied to fish after 115 cases
The CDC yesterday said its investigation of a Salmonella Thompson outbreak tied to fish sold by a Denver company is over after 115 cases in 15 states —with 13 more cases and 1 additional state than when the outbreak was first reported 2 months ago.
Twenty people were hospitalized, and there were no deaths recorded in this outbreak linked to seafood products from Northeast Seafood Products of Denver. Illness-onset dates ranged from May 11 to Oct 16, and 93 of the case-patients were Colorado residents.
Among 81 people interviewed, 67 (83%) reported eating seafood, including raw seafood in sushi and cooked seafood, the CDC said. Sick people ranged in age from less than 1 to 85 years, with a median age of 39, and 53% were female.
"Sick people reported eating a variety of raw and cooked seafood from restaurants and grocery stores. Investigators identified Northeast Seafood Products as a common supplier and found the outbreak strain in the company’s production facility," the CDC said.
Northeast Seafood Products recalled several fish products on Oct 8.
Dec 6 CDC update
French lab worker dies from CJD; lab moratorium extended
A retired French lab worker who had worked with prions and was diagnosed as having Creutzfeldt-Jakob disease (CJD) has now died, and a moratorium on prion research in France has been extended, according to a French media report cited by ProMED Mail, the online reporting system of the International Society for Infectious Diseases.
An investigation is still under way to determine if the woman was exposed to prions during her work. It's not known if her CJD infection is related to her work or some other cause, such as sporadic or genetic.
The woman had worked at the National Research Institute for Agriculture, Food and Environment lab in Toulouse, and reports of her illness surfaced in July.
Her death marks the second involving a French lab worker from CJD. In 2019, a 33-year-old lab technician died after pricking her thumb while conducting an experiment on prion-infected mice.
According to the media reports, the research moratorium has been extended 2 more months.
Dec 6 ProMED Mail post
Jul 28 CIDRAP News scan