Hipsters beware: Rare tickborne disease found in Austin-area caves

This has nothing to do with food, but is so cool because of the bugs involved – and that they prey on Austin, Texas, hipsters who sleep in caves.

A rare tickborne disease commonly associated with sleeping in rustic mountain cabins has shown up in caves around Austin, Texas, potentially placing cave workers and the public at risk for infection.

According to researchers, three people working in caves in the Austin area were diagnosed with tickborne relapsing fever (TBRF) last year, and two more tested positive for antibodies against the Borrelia bacteria that cause the disease.

The infections were identified by Austin Public Health (APH) and occurred mostly in people who had given guided cave tours, according to Stephanie B. Campbell, DVM, MPH, CDC Epidemic Intelligence Service officer, and colleagues.

Campbell summarized an investigation into the infections during a presentation at the annual EIS conference in Atlanta. She told Infectious Disease News that TBRF has been documented before in Texas caves, though it is unclear whether it has ever been reported in Austin-area caves.

The disease is rare, generally occurring in people who are bitten during the night by Ornithodoros ticks while sleeping in rodent-infested cabins or other rustic buildings where rodents have built nests, according to the CDC. The soft-bodied ticks — different from hard-body ticks like the ones that cause Lyme disease — live among rodents, feeding on them as they sleep. Tick and animal species were not collected as part of the investigation, so the report by Campbell and colleagues did not include which ticks may have been involved and what animals they were feeding on. But Campbell said O. parkeri ticks are found in Texas.

Campbell SB, et al. Evaluating the risk of tickborne relapsing fever among occupational cavers — Austin, TX, 2017. Presented at: Epidemic Intelligence Service conference; April 16-19, 2018; Atlanta.

Disease outbreak at Texas cat café leads to kitty quarantine, investigation

I was walking Ted the Wonder Dog the other morning — which I try to do every day but often fail because I’m human, dammit, and Ted would rather sleep beside me all day, and then party at 2 a.m. — and we passed the new cat café in Annerley, Brisbane.

I never had indoor cats until the townhouse rules in Brisbane forced us so. Same with the tiny dog. Now we have our own inner city million-dollar property (in Monopoly money) the cats go in and out, and the dog won’t shut-up.

Cuteness overload was supposed to be the number one item on the menu at San Antonio’s first cat cafe, but now the owner is facing an investigation from local authorities.

City of San Antonio Animal Care Services seized two cats last week and ordered the remaining 54 cats in the 1,000-square-foot San Antonio Cat Cafe to be quarantined from the public on Monday, according to WOAI.

“You are not going to get the sick cats better in that environment and unfortunately you are likely to spread those ailments to the other animals that are currently healthy,” Shannon Sims, the assistant director of Animal Care Services, told the station.

The ailments that he’s talking about allegedly include ringworm and FIP, a viral disease that tends to attack the cells of the intestinal wall and is usually fatal in domestic cats, according to WebMD. Animal Care Services spokeswoman Lisa Norwood told KENS that the investigation thus far had revealed that up to three dozen cats that did not have rabies shots and that sick cats were often mixed with healthy cats.

Leah Taylor, a former cafe employee, who is studying to become a veterinary technician, told KENS she filed a complaint against owner Casey Steuart with Animal Care Services after witnessing four cats die there during her four months on the job.

“A lot of the cat care wasn’t maintained,” Taylor told KENS. “There were animals that should have been on medicine. There were animals that needed to see a vet for medical attention that weren’t tended to. There was a lot of ringworm and upper respiratory, which is very contagious not only to people but also to other animals.”

Cas Moskwa, another former Cat Cafe employee, posted a series of photos on Facebook Sunday, detailing what she called “the reality of the cafe and the poor state it currently is in.” She claimed that Steuart waited for weeks at a time before taking sick cats there to a veterinarian and left at least one sick and dying cat, named Decoy, out in the public lounge during his last agonizing days.

Her post includes photos of cats with crusted eyes and allegations that Steuart brought in a cat infected with ringworm into the facility’s kitten coop, resulting in three different litters becoming infected. She said in a separate post that a cat she took home from the cafe was one of them that had been infected.

According to KSAT, though, Steuart disputes the reports from Moskwa and other former employees, blaming “a lack of communication and misinterpretations.” She specifically disputed the reports of ringworm, a skin infection that can be transmitted to humans, in the cafe.

She also told the San Antonio Express News that three cats did die at the cafe, but none from neglect. One, she said, was 17 years old.

Raw is risky: Brucellosis from unpasteurized milk in Texas

In July 2017, the Texas Department of State Health Services (DSHS) Region 2/3 office reported a human case of brucellosis associated with the consumption of raw (unpasteurized) cow’s milk purchased from a dairy in Paradise, Texas. CDC’s Bacterial Special Pathogens Branch (BSPB) confirmed the isolate as Brucella abortus vaccine strain RB51 (RB51).

Brucellosis is a zoonotic bacterial disease that affects humans and many animal species. In humans, the disease is characterized by fever and nonspecific influenza-like symptoms that frequently include myalgia, arthralgia, and night sweats. Without appropriate treatment, brucellosis can become chronic, and life-threatening complications can arise. Human brucellosis transmitted by cattle was once common in the United States. Control strategies have focused on elimination of brucellosis through vaccination and surveillance of cattle herds, in addition to milk pasteurization. Because of these measures, domestically acquired human cases are now rare (1).

RB51, a live-attenuated vaccine used to prevent B. abortus infection in cattle, has been documented to cause human disease, most commonly through occupational exposures such as needle sticks (2). Importantly, unlike wild strains of B. abortus, RB51 does not stimulate an antibody response detectable by routine serological assays, requiring culture for confirmation. Additionally, RB51 is resistant to rifampin, a common treatment choice for human brucellosis (2,3). This case represents the first documented instance of human brucellosis caused by RB51 through consumption of raw milk acquired in the United States.

Following isolation of RB51 from the patient’s blood, bulk milk tank samples from the farm tested positive for RB51 by polymerase chain reaction and bacterial culture. Culture of individual milk samples from all 43 cows in the herd identified two RB51 culture-positive cows. Subsequent whole genome sequencing indicated genetic relatedness between the cow and human isolate.

In Texas, farm sales of raw milk products to the public are legal with a “Grade ‘A’ Raw for Retail” license, regulated by the DSHS Milk and Dairy Group. By the end of August, through correspondence with the dairy, DSHS had identified approximately 800 persons who might have visited the farm during June 1–August 7. On September 1, Texas DSHS and BSPB began notification calls to these households, recommending that all exposed persons (i.e., those who consumed raw milk products from the farm during June 1–August 7) seek medical attention and begin 3 weeks of postexposure prophylaxis, even if asymptomatic (4).

Contact information was available for 582 households. The notification was issued successfully to 397 (68.2%) households. Among these notified households, 324 (81.6%) identified at least one exposed household member. Contacted persons referred 34 additional potentially exposed households, including households from seven other states.* A nationwide press release and Health Alert Network Health Advisory were issued in September to facilitate further identification of exposed persons (5).

To date, there are no other confirmed cases associated with this investigation. CDC and Texas DSHS continue measures to increase awareness among health care providers and the public regarding unique challenges associated with treatment and diagnosis of RB51 in humans and the risks of consuming raw milk.

Notes from the Field: Brucella abortus vaccine strain RB51 infection and exposures associated with raw milk consumption

09.mar.18

CDC

Caitlin Cossaboom

https://www.cdc.gov/mmwr/volumes/67/wr/mm6709a4.htm?s_cid=mm6709a4_w

Tex-Mex theft: $1.2M in stolen fajitas prompts employee’s arrest at Texas juvie center

This ranks up there with the great maple syrup theft in Canada a couple of years ago.

Josh Hafner of USA Today reports a Texas juvenile center employee confessed to stealing shipments of fajitas over nine years, a district attorney said, a theft totaling $1.2 million.

The Tex-Mex mystery unfolded on Aug. 7 when an 800-pound delivery of fajitas arrived at the Cameron County Juvenile Justice Department in San Benito, The Brownsville Herald reported, about 10 miles north of the Mexico border.

There was only one problem, a kitchen staffer told the delivery driver: The department didn’t serve fajitas. That’s when the driver said he had been delivering fajitas to the center for nearly a decade, District Attorney Luis V. Saenz said.

“If it wasn’t so serious, you’d think it was a Saturday Night Live skit,” Saenz told the Herald. “But this is the real thing.”

The kitchen staffer told her supervisor about the call, and the missing piece fell into place: Gilberto Escamilla, a department employee, had taken that day off. When confronted at work the next day, he confessed to stealing fajitas for the past nine years, Saenz told the newspaper.

Officers later searching his home found fajitas in the refrigerator. Escamilla made bail following his firing and arrest, but a trail of invoices and vouchers led investigators to the shockingly spicy conclusion: Escamilla’s fajitas fraud totaled $1,251,578, per the Herald.

“He would literally, on the day he ordered them, deliver them to customers he had already lined up,” Saenz said.

Texas Environmental Health Association and Austin

There are exactly five cities I could live in. Portland, Madison, Toronto, Raleigh.

And Austin.

I grew up in one of these, and currently live in another.

The only problem with Austin is a lack of hockey. 

Today I gave a talk to the Texas Environmental Health Association about a bunch of food safety stuff. Got to catch up with old friends and tell folks about some of the fun things we’re working on.

Also got to eat some brisket, listen to good music and drink some Texas beer.

Good times.

Not Paradise: Brucellosis linked to raw milk consumption in Texas

The Texas Department of State Health Services reports in the course of diagnosing the cause of fever, muscle and joint pain, and fatigue in a Texas resident, blood culture results revealed that the patient was infected with Brucella. Through investigation by DSHS, the most probable source of the infection was determined to be raw cow’s milk which the person had been consuming. The source of the milk was K-Bar Dairy, a licensed raw milk dairy in Paradise, Texas.

DSHS is concerned that other people who consumed raw milk from K-Bar Dairy may also have been exposed to Brucella and became infected. Brucellosis may cause short-term and long-term disease. Without specific testing, this disease may elude correct diagnosis, and without appropriate antibiotic therapy, illness may persist.

Health care providers should consider Brucellosis among differential diagnoses when a patient presents with a clinically-compatible constellation of signs and symptoms. The patient should be asked about risk factors for Brucellosis. A key question affecting the level of suspicion of Brucellosis in this scenario is the patient’s consumption of raw milk or raw milk products from K-Bar Dairy in Paradise Texas in Wise County since June 1, 2017. These individuals are considered to be at high risk of contracting brucellosis. Consumers are advised not to consume any raw milk or raw milk products from K-Bar Dairy that are still in their possession and to discard it.

At this time, it is uncertain how long Brucella may have been present in the raw milk from this dairy. Testing is ongoing in an attempt to answer that question. If a patient seeks consultation because they consumed raw milk or raw milk products from this dairy between January and June, 2017 they should be advised to be watchful for signs of chronic Brucellosis and clinically evaluated as appropriate.

Benefit for 7-year-old Texas girl with E. coli set for August

Alexis Dominguez of KXII Fox News 12 reports a 7-year-old Tioga girl has spent the last month recovering in a Dallas hospital after getting E. coli.

Emorie Clayton, 7, from Tioga has been in the pediatric intensive care unit at Children’s Hospital in Dallas for nearly a month.

Austin Lewter, Emorie’s uncle says she is recovering after she was infected with E. coli, which attacked her intestines, her digestive system and her kidneys.

“She’s had several surgeries and procedures now but the biggest one actually removed 70% of her colon.”

Emorie’s family says doctors are unsure how she got E. coli and may never even know what caused it.

But during the family’s difficult time, friends and family have come together to help pay for their medical bills.

“There’s stories like this everywhere and when people want to do good, when people need to do good, when people need to come together, they do.”

Lewter says they are several events for the month of August being planned by community members.

“The 12th of August, here in Whitesboro, we’re planning an all-day benefit event. All the proceeds will go to her medical expenses.”

Food safety is not simple

Winnipeg, Manitoba, Canada correspondent, Rob Mancini, writes:

I’ve been told many times from various sources that Mancini’s always a cheerful guy, you can’t upset him… this is only because I find happiness with my family. I have an amazing wife and 2 incredible kids (6 years old and 19 months), all healthy.  What more can I ask for: nothing.

But when I read stories of kids dying from hemolytic uremic syndrome due to an E. coli infection, in particular when it could have been prevented, I get mad.

“We can’t hold him. We can’t love on him. All we can do is just stand at the bedside,” Lindsey Montgomery, Huston’s mom, told WFAA.

Heartbreaking.

Fox News reports A 2-year-old boy is on life support after contracting an E. coli infection from an unknown source while on vacation in Oklahoma with his family. Landon Huston, of Ennis, Texas, was experiencing stomach virus-like symptoms when a fecal sample tested positive for E. coli, WFAA reported.

Huston was taken to Children’s Medical Center Dallas where doctors discovered the infection had progressed to Hemolytic Uremic Syndrome (HUS), an abnormal destruction of red blood cells that leads to kidney failure, WFAA reported.

Huston underwent the first of two surgeries on June 14 and has had a blood transfusion. He was placed on life support after doctors discovered fluid in his lungs, a post on the family’s GoFundMe page said.

The Texas Department of Health Services is investigating any potential source of the bacteria. E. coli can be found in the environment, foods, and intestines of people and animals, according to the Centers for Disease Control and Prevention (CDC).

“Most parents like us had no idea, you know, the dangers of something like this,” Montgomery told WFAA. “And it’s everywhere. E. coli is something that’s everywhere.”

While most strains of the bacteria are harmless, others can cause diarrhea, urinary tract infections, respiratory illness and pneumonia. About 5-10 percent of patients who contract E. coli will develop (HUS), which could present as decreased frequency of urination, feeling tired and losing color in cheeks and inside the lower eyelids. Patients can recover in a few weeks but others may suffer permanent damage or die.

“I have faith he’s going to come out on top,” John Huston, the toddler’s dad, told WFAA.

I’ve taught many food safety courses and have lectured on the importance of food safety to many. I’ve used different techniques in teaching, heavily based on behavioral science amongst other antics, to stress the importance of certain food safety principles. Even did a TV show on the subject.  All of this doesn’t matter if your inherent belief system is contrary to the information provided.  Need to be compelling and understand how human behavior operates. At times I wish I know more psychology but it’s never too late.

Food safety is not simple, it is hard and anyone who says otherwise is clueless.

I always try to share personal stories and current relevant food safety stories in an attempt to connect with my audience or readers and gauge their interest. Doug taught me this and it works.

 

Handwashing is never enough: Texas family says sons infected with E. coli at petting zoo

An Azle family wants to warn others after both their young boys were hospitalized with E. coli earlier this year.

“It’s awful. You can’t do anything but just sit there and watch your child hurt,” Emily Miller told WFAA.

Miller’s sons Brayden, 7, and Dylan, 5, were both diagnosed with an E. coli infection, and Dylan’s case impacted his kidneys. Miller said he required dialysis, and he was hospitalized for 27 days, including several nights in the ICU.

“It’s such a crazy thought that this could happen,” Miller said.

She was surprised by the intensity of the illness, but also by where her boys may have come into contact with E. coli. She said doctors believe they were likely contaminated while the family was visiting a petting zoo.

“I wasn’t aware that you could get it from animals and livestock,” Miller said.

She took the boys to the petting zoo back in January, and four days later her oldest was in the hospital.

Both brothers are now doing well, though Dylan is still on blood pressure medicine due to the illness, Miller said.

The Centers for Disease Control says petting zoos do pose risks, as livestock can carry E. coli bacteria. The CDC’s advice is to wash hands with soap and water immediately after being near animals, whether you touch them or not.

The CDC also says that soap and water is more effective than instant hand sanitizers, and if sanitizers are the only option, go ahead and use them but follow up with soap and water as soon as possible.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

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2-year-old on life support in Texas after contracting E. coli

An Ennis family says the CDC is investigating after their 2-year-old was exposed to a dangerous strain of E.coli.

Landon Huston is now on life support at Children’s Medical Center Dallas.

“He’s usually up, rambunctious, running around,” said his mother, Lindsey Montgomery. “I’m ready for my little boy to be back.”

The family took a trip to Oklahoma two weeks ago, cooling down in a hotel pool and at a natural spring.

“I’d never heard of people swimming and get E. oli,” said his father, John Huston.

Unfortunately, many, many people have been identified as getting sick with Shiga-toxin producing E. coli from swimming, water parks, or water supplies.

“Three, four days later, Landon’s got fever, diarrhea, really sick,” said Montgomery.

But by the time a test confirmed E.coli, his kidneys were shutting down. Montgomery said the CDC interviewed her trying to determine the source of the infection.

“They asked me where he had been, what food he had ate, any restaurants,” she said.

Dr. Jeffrey Kahn, Children’s Health Chief of Pediatric Infections Diseases, said it’s normal for a case like this to trigger a public health investigation.

“That suggests that there’s some contamination somewhere. It’s usually water or food and typically that means it’s not just one individual who’s been exposed,” he said.