[Health] The Infectious Diseases Thread

[Isgrimnur]

CBS

Health officials say a deadly outbreak of listeria has been linked to raw milk from an organic farm in Pennsylvania.

The illnesses happened in 2014 but it took investigators until now to determine the cause. Two patients got sick from the bacteria, one in California and one in Florida, and the patient in Florida died.

The U.S. Centers for Disease Control and Prevention reported Friday that the outbreak had been traced to unpasteurized raw milk produced by Miller's Organic Farm in Bird-In-Hand, Pennsylvania.

In January, the FDA found listeria in samples of raw chocolate milk produced by the same company, and said genetic testing confirmed it was closely related to the strain that sent the two patients to the hospital in 2014.

Amos Miller, the owner of Miller's Organic Farm, said the company operates as a private membership club and only supplies milk and other farm-grown products to members. It does not distribute to retail stores or other outlets.

Miller told CBS News the company is still selling raw milk and is not aware of any health problems. "I don't know that it was proved it's on the farm here," he said. "We hope and pray for the best."

[Jeff V]

Yeah, because prayer is the nemesis of listeria bacteria.

I thought it was illegal to sell raw milk.

[Smoove_B]

I thought it was illegal to sell raw milk.

The specific laws vary by state. What you cannot do is sell raw milk and transport it across state lines - that's a federal raid.

[Ralph-Wiggum]

In Florida, you're allowed to sell raw milk as long as you specify that it is meant for pet but not human consumption. Of course, at farmer's markets they will have a sign saying that right next to the person giving out free samples....

[Z-Corn]

I had to buy a share of a cow and pay for monthly room and board to get my raw milk. It only took me getting violently ill with Campylobacter jejuni to cancel my "membership".


Full disclosure, I actually had to get sick with it twice in six weeks before I quit. Raw milk is delicious!

[Isgrimnur]

Zika

Men who know they've probably been infected with the mosquito-borne Zika virus should not have sex without a condom for six months, according to new federal health guidelines released Friday.

Numerous cases of sexually transmitted Zika infection -- which is thought to cause severe birth defects in some cases -- have been confirmed in the United States, said officials at the U.S. Centers for Disease Control and Prevention.
...
The goal of the latest CDC guidelines is to give doctors the best advice possible to share with their patients about pregnancy planning and sex, Jamieson added. However, they are are based on the best evidence to date, and not on a definitive understanding of Zika, she noted.
...
A team led by CDC investigator Alexandra Oster notes that, as of March 18, there are now "six confirmed cases of sexual transmission in the United States associated with this outbreak."

Just how long might the Zika virus linger in semen? According to the report, semen collected from one man still showed signs of the virus 62 days after he began to exhibit fever linked to Zika infection.
...
The latest guidelines also recommend that women who know they've been infected, have no symptoms but have recently been to a Zika-endemic area, or think they might have been exposed via sex, should wait at least eight weeks before trying to get pregnant.

[Isgrimnur]

It's official!

There's no longer any doubt that the Zika virus causes birth defects, federal health officials said Wednesday.
...
But study after study has shown the virus gets into the developing fetus's brain, killing brain cells, stopping it from growing and, often, killing the fetus. And it seems to do so at all stages of pregnancy, not just in the first trimester, as most other viruses do.

Aaaand, it's local:

Denton County Public Health confirmed the first case of the Zika virus in a country resident on Tuesday.

Health officials say it was an imported case. The female patient traveled internationally to a country with active transmission in late January.

Any word yet on local mosquito transmission?

[Isgrimnur]

Congrats to one of our own!

[HepC]-related deaths reached an all-time high in 2014, the Centers for Disease Control and Prevention announced Wednesday, surpassing total combined deaths from 60 other infectious diseases including HIV, pneumococcal disease and tuberculosis. The increase occurred despite recent advances in medications that can cure most infections within three months.

[Isgrimnur]

Oh, and my BIL is currently on IV antibiotics and getting a spinal tap to address long-term untreated syphilis. Filtered reports through family indicate that he's going to get to be well known by all of the governmental health agencies. So there's that.

[Smoove_B]

Wait...like secondary or tertiary syphilis? Because if he tertiary syphilis...yeah, he's going to be...a profile I'll enjoy reading about in the MMWR. Depending on the details, he might even be (indirectly) added to my class.

Best of luck to him...here's hoping he's given good meds.

[Isgrimnur]

Wife says its tertiary.

[Smoove_B]

Whoa, that's rare. Well, at least it was. I know rates of primary and secondary syphilis have been slowly rising, so I guess it's not a surprise that tertiary cases should also increase....but usually secondary sends people to the doctor because you typically show visible signs and symptoms. You think you have the flu and a full body rash. Surprise! It's syphilis. The organism that causes it is one of my favorites (is that too nerdy?). It's a spirochete -- shaped like a corkscrew. It slowly drills it's way into your skin. Cousin to the bacteria that causes Lyme (same type).

Seriously though, glad they caught it. I have to believe he will absolutely be answering a lot of questions for doctors and researchers.

[stessier]

What makes something secondary or tertiary? It's not something I want to google at work.

[Isgrimnur]

Wiki (NSFW)

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%).
...
Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere.

Neurosyphilis refers to an infection involving the central nervous system. It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and tabes dorsalis.
...
Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complication is syphilitic aortitis, which may result in aneurysm formation.

What sent him to the hospital was trouble with his vision, high ocular pressure. He also has reported issues with memory and his work, screwing up a number of tasks and even not having memories of a 4-hour meeting.

[Smoove_B]

So...primary is when you're initially infected. Syphilis causes a small, painless sore to appear at the point of entry. So depending on exactly what you were up to when transmission occurred, it could be on the underside of your fishing tackle or internal. It's not uncommon for this sore to go completely unnoticed, in particularly when you also realize it could be anywhere from a week to 90 days when that sore actually appears.

If you do nothing, the bacteria hangs out inside your body for anywhere from 1-6 months, at which point it comes back with a vengeance. It causes a rash across your entire body, sometimes spreading to the palms of your hands and the soles of your feet. Having a rash there is quite rare so that's a good "tell" that something is definitely wrong. Usually it's at this point that the person goes to the doctor thinking they had an allergic reaction to something or they have hives or chicken pox. However, after some tests the doctors figure out that no, something sexual you did months ago is what caused this rash. At this point, you get antibiotics and you're on your way.

If you don't go to the doctor when your body has the rash -or- if for reasons unknown you only have a very mild rash, the bacteria ramps up again and now starts causing all kinds of additional systemic problems to your organs. This is tertiary syphilis and it's absolutely life threatening. It will actually consume skin, muscle and eventually bone. When you're not at work, there are some excellent photos of the damage syphilis can do by way of human skulls. STIs are no joke, kids - wear a condom! I'm available for parties. Mention the Overlords and get a discount.

Regardless, this really loses some of the "zing" when it's not on a giant projector screen, so you'll have to take my word for it.

But this isn't what you really wanted to know about. It's the antibiotic resistant gonorrhea that's probably more concerning.

[coopasonic]

Just another excellent reason to avoid human contact.

[Isgrimnur]

You've posted plenty of times about your sexually transmitted budget drains, including pictures.

[Kraken]

And here I thought it meant he got it from a toilet seat.

[coopasonic]

You've posted plenty of times about your sexually transmitted budget drains, including pictures.

It's lesson I continue to learn.

[Jeff V]

And here I thought it meant he got it from a toilet seat.

You know it when your balls feel like a pair of maracas.

[Isgrimnur]

BIL has neurological complications. Will be on IV penicillin for two weeks, and will apparently be under treatment for the next two years. And the county will get to pick up the tab when his insurance runs out.

[Max Peck]

1st US case of germ resistant to last resort drug

For the first time, a U.S. patient has been infected with bacteria resistant to an antibiotic used as a last resort treatment, scientists said Thursday. The patient - a 49-year-old woman in Pennsylvania - has recovered. But health officials fear that if the resistance spreads to other bacteria, the country may soon see supergerms impervious to all known antibiotics. "It is the end of the road for antibiotics unless we act urgently," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said during an appearance in Washington. Other countries have already seen multi-drug resistant superbugs that no antibiotic can fight. So far, the United States has not. But this sets the stage for that development, CDC officials said.

The woman had gone to a military clinic in Pennsylvania last month and was treated for a urinary tract infection. Initial tests found she was infected with E. coli bacteria, a common variety of germ seen in the gut that often makes its way to the bladder. But the tests showed this E. coli was resistant to antibiotics commonly used first for such infections. She was successfully treated with another kind of antibiotic. But while she has recovered, further testing completed in the last week confirmed that the E. coli was carrying a gene for resistance against the drug colistin. Colistin is an old antibiotic. By the 1970s, doctors had mostly stopped using it because of its harsh side effects. But it was brought back as other antibiotics began losing their effectiveness. It's used against hard-to-treat bacteria that resist one of the last lines of defense, antibiotics called carbapenems. If those germs pick up the colistin-resistance gene, doctors may be out of treatment options, health officials say.

Health experts urge WHO to consider moving Rio Olympics

Health experts on Friday urged the World Health Organization to consider whether the Rio de Janeiro Olympics should be postponed or moved because of the Zika outbreak. The 150 experts - including former White House science adviser Dr. Philip Rubin - issued an open letter to the U.N. health agency, calling for the games to be delayed or relocated "in the name of public health." The letter cited recent scientific evidence that the Zika virus causes severe birth defects, most notably babies born with abnormally small heads. In adults, it can cause neurological problems, including a rare syndrome that can be fatal or result in temporary paralysis. The authors also noted that despite increased efforts to wipe out the mosquitoes that spread Zika, infections in Rio have gone up rather than down. Several public health academics have previously warned that having hundreds of thousands of people head to the Aug. 5-21 games in Brazil will inevitably lead to the births of more brain-damaged babies and speed up the virus' global spread. Most people infected by Zika suffer only minor symptoms including fever, a rash and muscle or joint pain.

I really hadn't considered the implications of having hundreds of thousands of people visiting ground zero for a virus with multiple transmission vectors.

[Isgrimnur]

And then returning to their home countries. What could go wrong?

[Max Peck]

And then returning to their home countries. What could go wrong?

I just had a flash of insight.

What is the one country that has the capability to weaponize a virus and may well not be participating in the Rio olympics!

Vlad, you magnificent bastard...

[Isgrimnur]

Shades of Rainbow Six.

[stessier]

1st US case of germ resistant to last resort drug

For the first time, a U.S. patient has been infected with bacteria resistant to an antibiotic used as a last resort treatment, scientists said Thursday. The patient - a 49-year-old woman in Pennsylvania - has recovered. But health officials fear that if the resistance spreads to other bacteria, the country may soon see supergerms impervious to all known antibiotics. "It is the end of the road for antibiotics unless we act urgently," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said during an appearance in Washington. Other countries have already seen multi-drug resistant superbugs that no antibiotic can fight. So far, the United States has not. But this sets the stage for that development, CDC officials said.

The woman had gone to a military clinic in Pennsylvania last month and was treated for a urinary tract infection. Initial tests found she was infected with E. coli bacteria, a common variety of germ seen in the gut that often makes its way to the bladder. But the tests showed this E. coli was resistant to antibiotics commonly used first for such infections. She was successfully treated with another kind of antibiotic. But while she has recovered, further testing completed in the last week confirmed that the E. coli was carrying a gene for resistance against the drug colistin. Colistin is an old antibiotic. By the 1970s, doctors had mostly stopped using it because of its harsh side effects. But it was brought back as other antibiotics began losing their effectiveness. It's used against hard-to-treat bacteria that resist one of the last lines of defense, antibiotics called carbapenems. If those germs pick up the colistin-resistance gene, doctors may be out of treatment options, health officials say.

I'm on mobile so can't link to it, but Ars has an article pointing out the errors in this reporting. It's not the first time this has happened. And colistin resistance already exists. We should definitely reconsider how we use antibiotics, but we're not all doomed. Yet.

[Max Peck]

1st US case of germ resistant to last resort drug

For the first time, a U.S. patient has been infected with bacteria resistant to an antibiotic used as a last resort treatment, scientists said Thursday. The patient - a 49-year-old woman in Pennsylvania - has recovered. But health officials fear that if the resistance spreads to other bacteria, the country may soon see supergerms impervious to all known antibiotics. "It is the end of the road for antibiotics unless we act urgently," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said during an appearance in Washington. Other countries have already seen multi-drug resistant superbugs that no antibiotic can fight. So far, the United States has not. But this sets the stage for that development, CDC officials said.

The woman had gone to a military clinic in Pennsylvania last month and was treated for a urinary tract infection. Initial tests found she was infected with E. coli bacteria, a common variety of germ seen in the gut that often makes its way to the bladder. But the tests showed this E. coli was resistant to antibiotics commonly used first for such infections. She was successfully treated with another kind of antibiotic. But while she has recovered, further testing completed in the last week confirmed that the E. coli was carrying a gene for resistance against the drug colistin. Colistin is an old antibiotic. By the 1970s, doctors had mostly stopped using it because of its harsh side effects. But it was brought back as other antibiotics began losing their effectiveness. It's used against hard-to-treat bacteria that resist one of the last lines of defense, antibiotics called carbapenems. If those germs pick up the colistin-resistance gene, doctors may be out of treatment options, health officials say.

I'm on mobile so can't link to it, but Ars has an article pointing out the errors in this reporting. It's not the first time this has happened. And colistin resistance already exists. We should definitely reconsider how we use antibiotics, but we're not all doomed. Yet.

I get the impression that you're reacting to the headline without reading the article, not even the quoted portion that you included in your reply. (Spoiler: It says pretty much what you describe about the Ars article, except that it is a reasonably factual account of the situation instead of a debunking of overly sensationalized reporting.) If it was just an "Oh noes, we be doomed!!!" article, I wouldn't have bothered with it.

[Max Peck]

Bureaucrats. Bureaucrats never change...

The World Health Organization (WHO) has played down concerns over the spread of the Zika virus, amid calls for the Rio Olympics in August to be postponed. Senior WHO official Bruce Aylward told the BBC that risk assessment plans were in place, and reiterated that there was no need to delay the Games. The mayor of Rio said disease-carrying mosquitoes were being eradicated. The officials were responding to an open letter by scientists saying it was "unethical" for the Games to go ahead. The letter also said the global health body should revisit its Zika guidance.
...
The International Olympic Committee (IOC) has said it sees no reason to delay or move the Games because of the mosquito-borne disease. Mr Aylward said that a call to postpone the Games could not be ruled out in the future, but added: "All the information available today... suggests that the games should definitely go ahead." He restated the WHO's warning that women who are pregnant or seek to get pregnant should not travel to the Zika zone or be exposed to returning partners who may have been infected. Postponing the games, at this stage, would only "compromise the huge investment that athletes and others have made in preparing for what should be a fantastic occasion."

So, as long as women who are (or ever will be) pregnant don't go, or are ever exposed to people who went (or were themselves exposed to people who were exposed to Zika), then everything will be just fine. Because the games are Really Important. Sounds legit, right?

[Blackhawk]

We're gonna need more yellow cubes.

[Isgrimnur]

US births

A woman infected with Zika virus gave birth to a child in New Jersey on Tuesday. The baby girl was born with an unusually small head associated with the mosquito-borne disease.

The mother is from Honduras and was in New Jersey visiting relatives. This is at least the second baby in the U.S. born with birth defects associated with Zika. In January, a child was born in Hawaii with microcephaly.
...
As of last month, the Centers for Disease Control and Prevention said close to 300 pregnant women in the U.S. and its territories had contracted the virus.

Hawaii case

The child’s mother had lived in Brazil in May last year and probably was infected by a mosquito then, early in her pregnancy, the health department said. The virus presumably reached the embryo and damaged its developing brain.

[Malificent]

We're gonna need more yellow cubes.

I see what you did there and I approve.

[Isgrimnur]

Not the alpacas!

Alpacas raised as hobby animals in Qatar tested positive last year for Middle East respiratory syndrome coronavirus, or MERS-CoV — the first livestock outside of dromedary camels found to be infected with the virus that causes deadly MERS in humans, according to a report.
...
Dromedary camels, common in the Middle East, are suspected of transmitting MERS-CoV to humans and playing a part in the recent MERS outbreak in the region. The majority of alpacas, a relative of camels, are found in South America, with around 88% of the world population living in Peru.

[Isgrimnur]

Zika

Ten pregnant women in Dallas County have preliminary tested positive for the Zika virus, the county health director said during a meeting Tuesday with the commissioner's court.

Dallas County Health and Human Services Directory Zachary Thompson said the Centers for Disease Control and Prevention recommends waiting until the women give birth to confirm the diagnosis by testing both the mother and her child.

Thompson told the Dallas County Commissioner's Court Tuesday morning that the women all contracted the virus while traveling internationally and that none of the infections were spread locally.

To date, no Zika-infected mosquitoes have been found in Dallas County.

Mosquitoes in North Texas could become carriers if they bite a Zika infected person. Dr. Seema Yasmin, public health reporter for The Dallas Morning News, tweeted the risk of local outbreaks could increase as the number of people with the infection rises and as conditions improve for mosquitoes to breed.

[Isgrimnur]

North Carolina

An Ohio teenager died after contracting a suspected brain-eating amoeba infection while visiting the U.S. National Whitewater Center in Charlotte last week, according to health officials.

The 18-year-old female died shortly after returning from a church trip, during which she contracted Primary Amebic Meningoencephalitis, known as PAM, which is a severe brain infection caused by an amoeba called Naegleria fowleri, according to Mitzi Kline, Communication Director for Franklin County Public Health in Ohio.
...
"She travelled to North Carolina and this was her only water exposure during her trip, only water exposure during the incubation time period which is one to nine days," Kline said in a phone interview.

It was almost another reason for Smoove to hate Ohio.

[Blackhawk]

Brain eating amoeba? In North Carolina?

This explains much.

[Smoove_B]

Shit just got real.

First case of Female-to-Male Zika transmission recorded:

In the report, researchers found that a man, who was in his 20s and did not travel outside the United States during the year before his illness, contracted the virus after one instance of vaginal intercourse, without a condom, with a woman who had recently returned from a country where the virus is endemic.

Dr. Mary T. Bassett, New York City’s health commissioner, said that there were several factors in this case that might have raised the risk of infection: The man was uncircumcised, the woman was in the early stages of her illness when her viral load was high, and she was also at the beginning of her menstrual cycle.

[Doomboy]

Children of Men, folks, Children of Men.

[Isgrimnur]

Any sex

Any kind of sex can spread the Zika virus, federal health officials said Monday in updated guidance for pregnant women.

And doctors need to ask all pregnant women about any chance they could have been infected with Zika, either through sex, travel or via mosquito bite, the Centers for Disease Control and Prevention said in updated Zika guidelines.

Several recent new cases show that just about any kind of sexual contact can spread the virus, the CDC said. "Sexual exposure includes vaginal sex, anal sex, oral sex, or other activities that might expose a sex partner to genital secretions," it says in the new guidance.
...
CDC's been watching more than 400 known cases of Zika-affected pregnancies in the U.S., plus another 378 in U.S. territories such as Puerto Rico. Twelve babies have been born in the U.S. with Zika-related defects and another six pregnancies were miscarried or aborted because of severe defects.

So far, all the women were in Zika-affected areas when pregnant, but more and more cases of sexual transmission are turning up. Health experts can say they're sexually transmitted because Zika is not yet known to be spreading in the U.S. and they've found Zika in the semen of men and in other bodily fluids.

"As of July 20, 2016, 15 cases of Zika virus infection transmitted by sexual contact had been reported in the United States," the CDC report reads.

"Sexually transmitted Zika virus infection has also been reported in other countries. In published reports, the longest interval after symptom onset that sexual transmission from a man might have occurred was 32-41 days."

Evidence of Zika in semen has been found as long as three months after a man was infected.

[LawBeefaroni]

The first volunteer has received a dose of Inovio Pharmaceuticals' experimental vaccine to combat the Zika virus, the Plymouth meeting biotech company said Tuesday.

Inovio is developing its Zika vaccine with partner GeneOne Life Science in South Korea.

The U.S. Food and Drug Administration and Health Canada's Health Products and Food Branch have approved early-stage tests in 40 healthy adults, the company said.

The tests will be done in Philadelphia, Miami, and Quebec City, and will evaluate safety, tolerability, and immunogenicity of the vaccine against the mosquito-borne virus. Study results are expected this year.

[Smoove_B]

It's on - First locally acquired case of Zika in Florida confirmed:

An outbreak of the Zika virus has been confirmed in Florida, marking the first time the virus has been found to be transmitted via infected mosquitoes within the continental U.S.

The outbreak has infected at least four people, three men and one woman, through local transmission, Florida officials said today.

“This means Florida has become the first state in our nation to have local transmission of the Zika virus," Florida Gov. Rick Scott said today.

Scott said a small area in northern Miami that is about a square mile in size is the only area where the Zika virus is being transmitted from mosquitoes to people.

For anyone following this closely, it's not a surprise.