113 sick with Campylobacter from Petland puppies

The U.S. Centers for Disease Control, several states, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) investigated a multistate outbreak of multidrug-resistant Campylobacter infections. Epidemiologic and laboratory evidence indicated that contact with puppies sold through Petland stores were a likely source of this outbreak. This outbreak investigation is over. Illnesses could continue to occur because people may be unaware of the risk of Campylobacter infections from puppies and dogs.

Cute puppies

A total of 113 people with laboratory-confirmed infections or symptoms consistent with Campylobacter infection were linked to this outbreak. Illnesses were reported from 17 states. Illnesses started on dates ranging from January 12, 2016 to January 7, 2018. Ill people ranged in age from less than 1 year to 86, with a median age of 27. Sixty-three percent of ill people were female. Of 103 people with available information, 23 (22%) were hospitalized. No deaths were reported. Whole genome sequencing (WGS) showed that isolates from people infected with Campylobacter were closely related genetically. This close genetic relationship means that people in this outbreak were more likely to share a common source of infection.

Campylobacter bacteria isolated from clinical samples from people sickened in this outbreak were resistant to commonly recommended, first-line antibiotics. This means it may be difficult to treat these infections with the antibiotics usually prescribed for Campylobacter infections. Antibiotic resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients. Using WGS, we identified multiple antimicrobial resistance genes and mutations in most isolates from 38 ill people and 10 puppies in this outbreak. This finding matched results from standard antibiotic susceptibility testing methods used by CDC’s National Antimicrobial Resistance Monitoring System laboratory on isolates from five ill people and seven puppies in this outbreak. The 12 isolates tested by standard methods were resistant to azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline. In addition, 10 were resistant to gentamicin, and 2 were resistant to florfenicol.

In interviews, ill people answered questions about the foods they ate and any animal contact in the week before they became ill. Ninety-nine percent of people reported contact with a puppy in the week before illness started, and 87% reported they had contact with a puppy from Petland stores, or had contact with a person who became sick after contact with a puppy from a Petland store. Twenty-five ill people worked at Petland stores.

During the investigation, officials collected samples from pet store puppies for laboratory testing and identified the outbreak strain of Campylobacter in the samples. WGS showed that the Campylobacter isolates from sick people in this outbreak and isolates from pet store puppies were closely related genetically, providing additional evidence that people got sick from contact with pet store puppies.

Ill people reported contact with different breeds of puppies at different store locations in several states. The investigation did not identify a common breeder where puppies infected with the outbreak strain of Campylobacter originated. Puppies in this outbreak may have become infected at various points along the distribution chain when they had contact with infected puppies from other breeders or distributors during transport to pet store locations. Enhanced infection prevention measures throughout the distribution chain may help reduce the spread of Campylobacter infections among puppies.

This multidrug-resistant outbreak highlights the need for responsible use of antibiotics in pets. Education about best practices for Campylobacter disease prevention, diarrhea management in puppies, and responsible antibiotic use is essential throughout the distribution chain to help prevent the emergence and spread of antibiotic resistance. Pet owners should be aware that any puppy or dog, regardless of where it is purchased or adopted, may carry germs like Campylobacterthat can make people sick. Always wash your hands thoroughly with soap and water right after touching puppies and dogs or after picking up their poop. Work with your veterinarian to keep your animal healthy to prevent disease. More information about how to prevent illness when handling puppies and dogs is available for pet owners.

Fish-linked botulism in Nigeria

I’ve chronicled my fear of botulism many times before. I still can stuff, but I really pay attention to what I’m doing.

Dried fish and botulism seem to go together. Five bot cases in Germany and Spain were linked to dried fish in 2016.

There were 90 illnesses and nine deaths in 2017 from foodborne botulism in Ukraine. That’s a lot. Fish were a factor in many of these illnesses.

According to Outbreak News Daily, two unlucky Nigerians have died from botulism after consuming fish.

Three family members contracted suspected foodborne botulism, resulting in the deaths of the father and mother, according to the  the Nigerian Centres for Disease Control (NCDC). Fish appears to be the common food source.

The event descriptions of the two fatalities is provided by the World Health Organization (WHO):

The woman, a 47 year-old, presented to King’s Care Hospital, Abuja, on 7 January 2018, with vomiting, fever, sudden blurring of vision, generalized body weakness, dysphagia and odynophagia, and left ptosis. She was semi-conscious. She was initially diagnosed with ischaemic heart disease, with esophageal stricture and central retinal vein thrombosis. However, her neurological symptoms worsened rapidly, progressing to complete bilateral ptosis, paralysis of her respiratory muscles, and respiratory failure. She was referred approximately 24 hours after admission and died in transit.

Her 49 year-old husband presented to the same hospital with nausea, dizziness, vomiting, progressive dysarthria, odynophagia and partial ptosis. He was transferred to Zenith Medical and Kidney Centre, where his symptoms worsened. He suffered progressive respiratory failure, which required a tracheostomy and ventilation, and died on 15 January 2018.

Their 15-year-old daughter also developed symptoms and was hospitalized as of last week.

All three cases had eaten fish at home in the previous 24 hours. Two further children, who stayed in the same house, are currently in Lagos and are being monitored remotely. A third child is in Karu, but monitoring has been hampered by uncooperative relatives.

 

In memorandum: Wisconsin epidemiologist Jeffrey Davis identified Milwaukee’s Cryptosporidium outbreak

I was a new doctoral student when cryptosporidiosis sickened over 400,000 people and killed 69 in Wisconsin in the spring of 1993.

I had recently started the Food Safety Network, which was bringing daily updates to scientists and public health folks who usually had to wait 6 months for the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly to arrive.

It may seem trivial now, but it was a big deal in its day.

Lotsa posers and copycats over the years, so we went to barfblog.com.

Later that year, cryptosporidiosis would sicken hundreds in Kitchener-Waterloo, where I was living with my young family.

Somehow, I was speaking about this to our home-renovator-contractor-and-therapist yesterday while he unplugged our kitchen faucet.

And then I got this.

Meg Jones of the Milwaukee Journal Sentinel writes that as doctors’ offices filled with Milwaukeeans suffering from a mysterious illness in 1993, Mayor John Norquist called a meeting with state and local officials.

Norquist asked state epidemiologist Jeffrey Davis whether he would drink a glass of Milwaukee’s water and when Davis said he would not, Norquist issued a massive boil water advisory that affected more than 1 million residents.

With decades of work in public health, Davis was the perfect person to figure out a little-known parasite cryptosporidiosis could be the culprit that sickened more than 400,000 people.

As state epidemiologist for the past four decades, Davis was Wisconsin’s doctor.

He was a medical sleuth who figured out the connection between toxic shock syndrome and tampons and helped determine the infectious agent transmitted by ticks that causes Lyme disease. 

Davis, 72, died of pneumonia in Madison Jan. 16.

“Jeff’s knowledge of the literature helped identify the (Cryptosporidium) outbreak earlier. Cryptosporidiosis at that point was a pretty rare pathogen,” said State Public Health Veterinarian James Kazmierczak.

Knowing about a similar waterborne outbreak elsewhere in the U.S., Davis asked to see data on water quality in Milwaukee and noticed a spike in turbidity at the same time that people began to get sick. At the time, city water supplies were not tested for Cryptosporidium.

“Because of Jeff’s knowledge of what happened earlier with cryptosporidiosis, that became the leading suspect,” said Kazmierczak.

Davis grew up in Whitefish Bay and earned an undergraduate degree in chemistry in 1967 at University of Wisconsin-Madison and his medical degree in 1971 at the University of Chicago. He did his internship and residency in pediatrics in Florida and from 1973 to 1975 worked for the U.S. Centers for Disease Control and the South Carolina Department of Health.

After a stint at Duke University Medical Center, he returned to Wisconsin in 1978 as state epidemiologist and chief of the division of acute and communicable diseases. In 1991, his job title changed to chief medical officer and state epidemiologist for communicable diseases.

“He loved being a sleuth and medical detective, leading investigations of all sorts, from toxic shock syndrome to Legionnaires’ outbreaks, to the Cryptosporidium water supply outbreak, which was huge,” said his wife Roseanne Clark.

“He really was passionate about trying to figure out the source to reduce the impact on as many people as possible. He cared about the health of the people of Wisconsin.”

Questions: Why do your eardrums move when your eyes move?

I figured I was just getting old.

My hearing has been getting worse, bad enough that I finally went to the doctor on Tuesday.

She, along with a nurse, managed to extract two quarter-sized pieces of what looked like fungal felt, one from each ear. She prescribed some antibiotics to see if the swelling would go down.

My hearing and balance improved immediately.

Which prompted a question that Ed Yong of The Atlantic has ventured to answer: Why do eardrums move when your eyeballs move?

As your eyes flitted right, both eardrums bulged to the left, one inward and one outward. They then bounced back and forth a few times, before coming to a halt. When you looked left, they bulged to the right, and oscillated again.

These wobbles happen every time you move your eyes, whether or not there’s external noise. The bigger the movement, the bigger the wobble. But no one knows why they happen. And until Jennifer Groh, from Duke University, discovered them, no one even knew that they happened at all.

Groh has long been interested in how the brain connects information from our eyes and ears. In a loud party, for example, we automatically read the lips of our conversational partners to interpret any unintelligible sounds. For that to work, the brain has to align visual and auditory information in space, so it knows that those sounds are coming from those lips. And that’s easier said than done, because our ears are obviously fixed on our heads but our eyes are constantly moving. They flit all over the space in front of us, roughly three times a second. Every such movement changes the spatial relationships between what we see and what we hear. So how does the brain unite those streams of information? And where?

“Historically, people have thought that information enters the ear and the eye separately, and that eventually it’s combined,” says Nina Kraus from Northwestern University. But Groh’s experiment, she says, suggests that this act of combination happens much earlier. The eardrum, after all, is responsible for converting vibrations in the air around us into vibrations in the liquid within our heads. It’s where hearing effectively begins. And if it wobbles as our eyes shift, then this suggests that vision might affect hearing “at the earliest possible point,” says Kraus.

Kurtis Gruters and David Murphy, two members of Groh’s team, detected the wobbling eardrums in the simplest possible way. They stuck microphones in the ears of several volunteers, and asked them to look at different targets. As their eyes moved, so did their eardrums. Like actual tiny drums, these vibrating membranes created small sounds, which the microphones could detect. That’s how the team showed that the eardrum oscillations match the direction and strength of the eyes’ movements.

They also found that the eardrums start to wobble about 10 milliseconds before the eyes. This suggest that the ears aren’t reacting to what’s happening in the eyes. Instead, Groh says, “the brain is saying: I am about to move the eyes; ears, get ready.”

Barbara Shinn-Cunningham, from Boston University, also studies the neuroscience of hearing, and she is more circumspect. “It is a very interesting and previously unknown phenomenon, which may turn out to be incredibly important,” she says, “But so far, there is no evidence it is. We just don’t yet know why it happens or what it means.”

Salmon sushi: 5.6′ tapeworm excreted by California man

Raw can be risky.

Including raw fish used to make sushi, especially if it is not frozen at sea.

Following up my chat with daughter Sorenne while strolling around Noumea, New Caledonia last week, a Fresno man with a daily sushi habit had a 5.5-foot tapeworm lodged in his intestines. He pulled it out himself, wrapped it around a cardboard toilet paper tube and carried the creature into Fresno’s Community Regional Medical Center.

Michelle Robertson, a San Francisco Gate staff writer, reports that Kenny Banh was the lucky doc on shift at the time. He recounted his experience on a recent episode of the podcast “This Won’t Hurt A Bit.”

Banh said the patient complained of “bloody diarrhea” and expressed a desire to get treated for tapeworms.

“I get asked this a lot,” the doctor said. “Truthfully, a lot of times I don’t think they have it.”

This man had it, which he proved to Banh by opening a plastic grocery bag and pulling out the worm-wrapped toilet paper tube.

Banh then asked some questions, starting with: “That came out of your bottom?”

“Yes.”

According to the doctor’s retelling, the patient was using the restroom when he noticed what looked like a piece of intestine hanging out of his body.

 “He grabs it, and he pulls on it, and it keeps coming out,” Banh recounted. He then picks the thing up, “looks at it, and what does it do? It starts moving.”

That’s when the man realized he had a tapeworm stuck in his insides. He headed to the emergency room shortly thereafter, where Banh treated him with an anthelmintic, a single-treatment deworming medication used on humans and dogs alike.

Banh also took it upon himself to measure the specimen on the floor of the hospital. It stretched a whopping 5 feet, 6 inches — “my height,” noted the doctor.

Tapeworms can be contracted in a variety of ways, but Banh said his patient hadn’t traveled out of the country or engaged in any out-of-the-ordinary behavior. The man also professed his love of sushi, specifically raw salmon sashimi, which he confessed to eating daily.

Fresno is located an ample 150 miles from coastline and is not exactly famed for its sushi. The Centers for Disease Control and Prevention warned last February that the rise in popularity of raw fish consumption has likely spurred

The story has attracted attention all over the world, as these things tend to do, says Peter Olson, a tapeworm expert and a researcher at the Natural History Museum’s life sciences department, who was quoted as telling The Guardian, “because they’re gross”. The worm, he says, was “almost certainly something called the broad fish tapeworm … salmon is one of the main ways you would pick it up, if you don’t cook the meat.” The life of the broad fish tapeworm involves more than one host. “A typical life cycle might include a bear that feeds on salmon, then defecates back into the river. The larvae would be passed into the environment and, in the case of an aquatic life cycle like this, it would be eaten by something like a copepod, a little crustacean. When that copepod is eaten by a fish, it would transform into a larval tapeworm and that’s what is being transmitted to a human in this case. That would go to the intestine and grow into this giant worm.”

(On one of our first dates, over 12 years ago – same age as barfblog.com — Amy tried to serve me grilled salmon. I whipped out my trusty tip-sensitive digital thermometer and noted a 98F reading, and said, no way. Cook it.)

The tapeworm is a monstrous and impressive creation. It has a segmented body, with male and female reproductive organs in each segment, so it is capable of self-fertilisation. It does not have a head as such – its “head” is only useful for holding on to its host’s gut, rather than for “eating” (it absorbs nutrients through its skin). In many cases, you would not know you were infected. You might spot bits of tapeworm segment in your stool – small, pale, rice-like bits – or experience stomach pain or vomiting.

Again, 11 sick: Blame the consumer Hong Kong edition

The Centre for Health Protection (CHP) of the Department of Health is today (January 19) investigating an outbreak of food poisoning affecting 11 persons, and reminded the public to maintain personal, food and environmental hygiene to prevent food-borne diseases.

The patients, comprising one man and 10 women aged 63 to 76, developed abdominal pain, nausea, vomiting, diarrhoea and fever about 12 to 26 hours after having lunch at a restaurant at Lau Fau Shan in Yuen Long on January 7.

Five of them sought medical attention, of whom one required hospitalisation but was discharged upon treatment. The stool specimen of that patient tested positive for Vibrio parahaemolyticus. All affected persons are now in stable condition.

Carnival cruises: Couple’s honeymoon ruined by poop shower

My parents are taking a well-earned respite from the cold of Canada and embarked on a cruise from Florida the other day.

Hopefully it’s better than the one described below.

A couple from Missouri says their honeymoon cruise was ruined by sewage spewing from a shower drain, leaving them to celebrate amid the smell of “poop” inside their cabin.

Christine Parker and John Shoemaker, of St. Louis, detailed their foul experience in November aboard the Carnival Triumph in an interview with the Miami Herald, claiming unsanitary conditions on the 14-deck, 893-foot mega-ship turned what should have been a celebration into a potential health scare.

“We didn’t have a good honeymoon,” Parker told the newspaper. “People expect you to come back so excited and we have been fighting with the Carnival staff and smelling poop in our room. We were exhausted and angry.”

To make matters even worse, Parker claimed crew members aboard the ship acted as if black sewage reeking of fecal matter was no big deal.

For her troubles, Parker said Carnival offered her a $300 credit to be used on the ship and 15 percent off her next cruise with the company — which she doesn’t intend to book anytime soon.

The ship, which arrived back in south Florida on Nov. 11, was later given a failing grade by inspectors from the Centers for Disease Control and Prevention’s Vessel Sanitation Program.

Two other Carnival Cruise Line ships — the Breeze and the Vista, the company’s newest vessel — failed similar inspections in December, bringing the company’s tally to three failed inspections within two months, according to the Herald.

A Miami-based maritime attorney told the newspaper that failed inspections on cruise ships typically occur roughly two or three times per year, making the rash of poor grades a rarity.

Chabeli Herrera of the Miami Herald reports that aboard the Carnival Vista, Carnival Cruise Line’s newest ship, crew members hid trolleys of potentially hazardous food, equipment and dirty dishware from sanitation inspectors.

Fruit flies were found by the buffet and in a Parmesan cheese container. Crew failed to appropriately document illnesses on board.

On the Carnival Breeze, another of the Doral-based line’s newest vessels, machinery was found to be corroded or not functioning properly. About 25 garbage bins overflowing with waste were found by inspectors near an area where food was handled.

These violations and dozens of others landed both ships failing grades from the Centers for Disease Control and Prevention’s Vessel Sanitation Program, which routinely inspects cruise ships in an effort to control the spread of gastrointestinal illnesses. Ships must score 86 points or higher, out of 100, to pass.

But December’s reports follow another Carnival failure reported in November aboard the Carnival Triumph, bringing Carnival’s tally to three failed inspections in the past two months.

‘Something will always be somebody’s last meal’ Does it have to be today?

My favorite food safety fairytale is along the lines of, we’ve always produced food this way and no one has ever gotten sick.

Because bugs don’t change, food don’t change, people don’t change.

Raw oysters, the renowned aphrodhsiac, is especially prone to fairytale hyperbole.

Delayna Earley of the Island Packet in South Carolina, writes, who doesn’t love a good oyster roast?

“I’ve been doing this all my life and we’ve never had a case of anyone dying from eating an oyster,” Larry Toomer, owner of the Bluffton Oyster Co., said. “We know where our oysters came from because we harvest them, refrigerate them ourselves and then cook them shortly after.”

Toomer says that there is always a risk when consuming any raw food, but the oysters that are harvested off the coast of the Low country typically don’t have bacteria due cleansing nature of the tidal waters they grow in.

“Something will always be somebody’s last meal,” Toomer says. “If you’re immune system is not up to snuff you shouldn’t eat anything raw, whether that is an oyster, or burger or any other type of meat, but something is going to set you off if you’re already sick. But other than that, we shouldn’t worry too much.”

Seek and ye shall find: Citrobacter in pre-cut veggies in a German hospital sickened 76

A foodborne outbreak of VIM carbapenemase-expressing Citrobacter freundii (CPC) occurred between February and June 2016 at a major university hospital in Germany.

An explosive increase of CPC isolated from rectal swabs of patients during weekly routine screening led to the declaration of an outbreak. A hospital-wide prevalence screening was initiated as well as screening of all patients on admission and before transfer to another ward, and canteen staff, patient rooms, medical and kitchen inventory and food. Swabs were streaked out on selective plates. All CPC isolates were analysed by mass spectrometry and selected isolates by whole-genome sequencing.

In total, 76 mostly unrelated cases in different wards were identified. The CPC was isolated from retained samples of prepared vegetable salads and puddings and from a mixing machine used to prepare them only after an overnight culture. The immediate ban on serving potential source food resulted in a sharp decline and finally disappearance of novel cases. Repeated testing of pre-sliced vegetables showed a high degree of contamination with C. freundii without a carbapenemase, indicating a possible source.

This report demonstrates that an explosive increase in carbapenemase-expressing Enterobacteriaceae contamination may be caused by a foodborne source, and suggests that pre-sliced vegetables have to be taken into account as a putative pathogen repository. It also underlines the importance of appropriate cooling, transport, re-heating and distribution of meals and indicates that probing of non-organic surfaces is limited by low sensitivity, which may be increased by additional overnight cultivation in appropriate media.

A nosocomial foodborne outbreak of a VIM carbapenemase-expressing Citrobacter freundii

15 January 2018

Clinical Infectious Diseases, https://doi.org/10.1093/cid/ciy034

Mathias Pletz, Antje Wollny, Ute-Heike Dobermann, Jurgen Rodel, Svetlana Neubauer, Claudia Stein, Christian Brandt, Anita Hartung, Alexander Mellmann, Sabine Edel, Vladimir Patchev, Oliwia Makarewicz, Jens Maschmann

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy034/4809943?redirectedFrom=PDF

‘Disease from outer space’ States confront the spread of CWD in deer

In March, 1996, the UK government confirmed what had been known for years: bovine spongiform encephalopathy (or mad cow disease) was killing humans in the UK.

The various forms of transmissible encephalopathies have different names according to the species – scrapie in sheep, feline spongiform encephalopathy in cats, Creutzfeldt-Jacob disease in humans, chronic wasting disease in deer and elk.

But they’re all the same affliction, caused by infectious proteins, or prions.

I haven’t been following the CWD outbreak in deer, but it seems to be where BSE was about 1993: There’s this mysterious new disease no one ever thoughts would cross over to humans, but now, maybe?

Jim Robbins of the New York Times writes that, as darkness closed in, one hunter after another stopped at this newly opened game check station, deer carcasses loaded in the beds of their pickups.

They had been given licenses for a special hunt, and others would follow. Jessica Goosmann, a wildlife technician with Montana’s Fish, Wildlife & Parks Department, stepped outside to greet them, reaching for the neck of each freshly killed deer to cut an incision and remove a lymph node for testing.

On the edge of this south-central Montana village, where deer hunting is a way of life, the game check station has become the front line of the state’s efforts to stop the spread of a deadly infection known as chronic wasting disease.

It has ravaged deer herds throughout the United States and Canada and forced the killing of thousands of infected animals in 24 states and three Canadian provinces. It has also been found in Norway and South Korea. With the disease widespread in Wyoming, the Dakotas and the province of Alberta, Montana officials had been bracing for its emergence.

So in November, when biologists discovered it in six deer in this part of Montana and in another near the Canadian border, officials began setting up special hunts and stations for testing.

“It wasn’t a surprise that we found it,” said John Vore, game management bureau chief for the Montana Department of Fish, Wildlife & Parks. “It was a disappointment, but not a surprise.”

On Friday, the department announced that two more deer from this region, taken early in the special hunt, tested positive for the disease. Other test results are pending.

Chronic wasting disease is a contagious neurological disease that infects elk, deer, moose and caribou, and reduces their brains to a spongy consistency. Animals become emaciated, behave strangely and eventually die. It’s not known to be transferred to humans. Neither is it known to be spread from wild to domestic animals. There is no treatment, although a vaccine has been successful in tests in wild deer.

It is among a class of diseases known as transmissible spongiform encephalopathy, or TSE. Most experts believe the infectious agent is something called a prion, a misfolded cellular protein found in the nervous system and lymph tissue. The disease was first noted in captive deer in Colorado in the 1960s. The most closely related animal disease is scrapie in sheep.

“It’s a very unusual disease,” said Matthew Dunfee, an expert at the Wildlife Management Institute in Fort Collins, Co. and project director for the Chronic Wasting Disease Alliance. “Some experts say it’s a disease from outer space.”