Man had hundreds of tapeworms in brain, chest after eating undercooked pork

Alexandria Hein of Fox News reports a 43-year-old man in China who was suffering from seizures and loss of consciousness went to the doctor after his symptoms persisted for several weeks, only to discover that he had hundreds of tapeworms in his brain and chest, reports say.

The patient, identified as Zhu Zhongfa, allegedly had eaten undercooked pork, which was contaminated with Taenia solium, a parasitic tapeworm.

“Different patients respond [differently] to the infection depending on where the parasites occupy,” Dr. Huang Jianrong, Zhongfa’s doctor at Affiliated Hospital of Zhejiang University School of Medicine, told AsiaWire. “In this case, he had seizures and lost consciousness, but others with cysts in their lungs might cough a lot.”

Jianrong explained that the larvae entered Zhongfa’s body through the digestive system and traveled upward through his bloodstream. He was officially diagnosed with cysticercosis and neurocysticercosis, and given an antiparasitic drug and other medications to protect his organs from further damage, according to AsiaWire.

Jianrong said his patient is doing well after one week, but the long-term effects from the massive infestation are unclear.

The Centers for Disease Control and Prevention (CDC) recommends cooking meat at a safe temperature and using a food thermometer in an effort to avoid taeniasis. Humans are the only hosts for Taenia tapeworms, and pass tapeworm segments and eggs in feces which contaminate the soil in areas where sanitation is poor. The eggs survive in a moist environment for days to months, and cows and pigs become infected after feeding in the contaminated areas.

Once inside the animal, the eggs hatch in the intestine and migrate to the muscle where it develops into cysticerci, which can survive for several years. This infects humans when they eat contaminated raw or undercooked beef or pork, according to the CDC.

Food Safety Talk 199: Possum Droppers

Don and Ben start the episode talking about kimchi fermentation and all the cabbage that needed to be washed and salted. The conversation went towards collaborations with fun people that might seem a bit unnatural to outsiders. The guys talk about a few outbreaks including two pathogenic E. coli ones linked to Romaine lettuce and Hep A in blackberries. They then do some listener feedback on foreign objects, bad cleaning and sanitizing machines and chitterlings. Also, bacteria is everywhere.

Food safety recalls are always either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early.
– Dr. Paul Mead

Food Safety Talk 199: Possum Droppers can be found on iTunes, Overcast or at foodsafetytalk.com

Show notes so you can follow along at home:

Rabbits can be risky: Chinese hunter diagnosed with bubonic plague after eating wild hare

My father’s family is Welsh, Newport, got the shit bombed out of them when he was an infant, and rabbit was a common meat.

Twenty-eight people in northern China have been quarantined after a hunter was diagnosed with bubonic plague on Saturday.

Chinese officials believe the unidentified male became infected after handling and eating a wild hare on Nov. 5 in the Inner Mongolia, according to state news site XinhuaNet

As a precaution, officials quarantined the people who had since come in contact with the man. None of them have exhibited fever or other symptoms of the plague, infamous for the Black Death pandemic during the Middle Ages. 

Two cases of pneumonic plague, a highly contagious form of the disease, were confirmed in China by local health officials last week. The two patients, who also were from Inner Mongolia, were diagnosed in Beijing and are currently being treated for the condition in the Chaoyang District. 

No epidemiological association has been found between the two cases, according to officials.

The plague is caused by Yersinia pestis — a common bacteria carried by rats, rabbits and squirrels, according to the U.S. Center for Disease Control and Prevention. Humans can contract the bubonic plague when bitten by infected fleas. Handling infected animals directly also can cause infection.

A tale of two antimicrobial resistance reports

I’ll leave the summary of two antimicrobial resistance reports to my friend and hockey colleague (and he’s a professor/veterinarian) Scott Weese of the Worms & Germs Blog (he’s the semi-bald dude behind me in this 15-year-old pic; I’m the goalie; too many pucks to the head):

 Two reports came out this week, both detailing the scourge of antibiotic resistance.

In Canada, the Canadian Council of Academies released “When antibiotics fail: the expert panel on the potential socio-economic impacts of antimicrobial resistance in Canada.

Not to be outdone, the CDC released Antibiotic Resistance Threats in the United States, 2019.

They’re both comprehensive, with a combined >400 pages explaining that this is a big problem.

I’m not going try to summarize the reports. I’ll just pick out a few interesting tidbits.

From the CCA report (Canada):

According to their modelling, first-line antimicrobials (those most commonly used to treat routine infections) helped save at least 17,000 lives in 2018 while generating $6.1 billion in economic activity in Canada. “This contribution is at risk because the number of effective antimicrobials are running out.”

Antimicrobial resistance was estimated to reduce Canada’s GDP by $2 billion in 2018. That’s only going to get worse unless we get our act together. It’s estimated that by 2050, if resistance rates remain unchanged, the impact will be $13 billion per year. If rates continue to increase, that stretches to $21 billion. Remember, that’s just for Canada, a relatively small country from a population standpoint.

Healthcare costs due to resistance (e.g. drugs, increased length of stay in hospital) accounted for $1.4 billion in 2018.  But remember that people who die from resistant infections can actually cost less. If I get a serious resistant infection and die quickly, my healthcare costs are pretty low since I didn’t get prolonged care. All that to say that dollar costs alone don’t capture all the human aspects. Regardless, this cost will likely increase to $20-40 billion per year by 2050.

In terms of human health, resistant infections were estimated to contribute to 14,000 deaths in Canada in 2018, with 5,400 of those directly attributable to the resistant infection (i.e. those deaths would not have occurred if the bug was susceptible to first line drugs). That makes resistance a leading killer, and it’s only going to get worse.

I’ll stop there. The document has a lot of good information and it’s worth reading if you’re interested in the topic.  They also provided a handy 2-page “infographic” summary if you can’t quite stomach the complete 268-page report (also see image below).

From the CDC report (US):

The document’s dedication says a lot. “This report is dedicated to the 48,700 families who lose a loved one each year to antibiotic resistance or Clostridioides difficile, and the countless healthcare providers, public health experts, innovators, and others who are fighting back with everything they have.”

The forward has some great messages too:

To  stop antibiotic resistance, our nation must:

Stop referring to a coming post-antibiotic era—it’s already here. You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy. The time for action is now and we can be part of the solution.

Stop playing the blame game. Each person, industry, and country can affect the development of antibiotic resistance. We each have a role to play and should be held accountable to make meaningful progress against this threat.

Stop relying only on new antibiotics that are slow getting to market and that, sadly, these germs will one day render ineffective. We need to adopt aggressive strategies that keep the germs away and infections from occurring in the first place.

Stop believing that antibiotic resistance is a problem “over there” in someone else’s hospital, state, or country—and not in our own backyard. Antibiotic resistance has been found in every U.S. state and in every country across the globe. There is no safe place from antibiotic resistance, but everyone can take action against it. Take action where you can, from handwashing to improving antibiotic use.

Some might say it’s alarmist. However, I don’t think it’s alarmist when someone really should be raising the alarm. We need to talk about it more, not less. We need to get people (including the general public, healthcare workers, farmers, veterinarians, policymakers) on board, to realize it’s a big issue that needs to be addressed now. “Short term pain for long-term gain” certainly applies here. We can keep delaying and the numbers will keep going up, or we can invest in solutions.

The numbers are scary but specific numbers don’t really matter in many ways. “Lots” is all we should have to know to get motivated. However, decision-makers like numbers, so these numbers hopefully will be useful to show the impact and potential benefits of investing in this problem, and motivate them to put money into antimicrobial stewardship. Saving lives should be enough, but that often doesn’t cut it. Antibiotic resistance doesn’t have a good marketing campaign. Everyone knows why people were wearing pink last month and why there are some pretty dodgy moustaches this month. Those are important issues, for sure. However, considering the overall impact, antibiotic stewardship needs to get more people behind it if we’re going to effect change.

Raw is risky: Eating raw pig liver from Singapore market may increase risk of hepatitis E

Danielle Ann of Alvinology reports researchers at the Singapore General Hospital have found definite similarities between the virus strains of Hepatitis E virus or (HEV) in pig liver and human liver.

This means that ingesting raw pork liver could mean you’re ingesting a strain of HEV that’s similar enough to human HEV that it could cause you get infected.

The same report said that people who have contracted HEV has risen steadily over the years. While the researchers could not say if the ingestion of raw pig liver is the main cause of the rise in cases, many local dishes feature this ingredient and do not cook the meat thoroughly.

The same report said that you can acquire the disease from eating contaminated food or substances. Ingesting water that is laced with the disease or accidentally drinking water that has trace amounts of faeces. Eating raw or half-cooked meat that is infected can also transmit the virus to you.

Raw is risky: Eating raw pig liver from Singapore market may increase risk of hepatitis E

Danielle Ann of Alvinology reports researchers at the Singapore General Hospital have found definite similarities between the virus strains of Hepatitis E virus or (HEV) in pig liver and human liver.

This means that ingesting raw pork liver could mean you’re ingesting a strain of HEV that’s similar enough to human HEV that it could cause you get infected.

The same report said that people who have contracted HEV has risen steadily over the years. While the researchers could not say if the ingestion of raw pig liver is the main cause of the rise in cases, many local dishes feature this ingredient and do not cook the meat thoroughly.

The same report said that you can acquire the disease from eating contaminated food or substances. Ingesting water that is laced with the disease or accidentally drinking water that has trace amounts of faeces. Eating raw or half-cooked meat that is infected can also transmit the virus to you.

TB in deer hunters

For a country that still proclaims, we enjoy the safest food supply in the world in U.S. Department of Agriculture missives, when we’ve been arguing reduced risk is a better message for 25 years and that there are so many countries with the self-proclaimed title of safest food in the world they can’t all be right – it’s alarming that Mycobacterium bovis has been transmitted from deer to a human.

Hello zoonoses.

Deer hunting season in Ontario (that’s in Canada) begins about today.

I never had any interest.

Not a Bambi thing, just thought it was boring.

My dad went a few times but I’m not sure if he enjoyed it or not.

Whatever.

The U.S. Centers for Disease Control reports that in May 2017, the Michigan Department of Health and Human Services was notified of a case of pulmonary tuberculosis caused by Mycobacterium bovis in a man aged 77 years. The patient had rheumatoid arthritis and was taking 5 mg prednisone daily; he had no history of travel to countries with endemic tuberculosis, no known exposure to persons with tuberculosis, and no history of consumption of unpasteurized milk. He resided in the northeastern Lower Peninsula of Michigan, which has a low incidence of human tuberculosis but does have an enzootic focus of M. bovis in free-ranging deer (Odocoileus virginianus). The area includes a four-county region where the majority of M. bovis–positive deer in Michigan have been found.

Statewide surveillance for M. bovis via hunter-harvested deer head submission has been ongoing since 1995; in 2017, 1.4% of deer tested from this four-county region were culture-positive for M. bovis, compared with 0.05% of deer tested elsewhere in Michigan. The patient had regularly hunted and field-dressed deer in the area during the past 20 years. Two earlier hunting-related human infections with M. bovis were reported in Michigan in 2002 and 2004. In each case, the patients had signs and symptoms of active disease and required medical treatment.

Whole-genome sequencing of the patient’s respiratory isolate was performed at the National Veterinary Services Laboratories in Ames, Iowa. The isolate was compared against an extensive M. bovis library, including approximately 900 wildlife and cattle isolates obtained since 1993 and human isolates from the state health department. This 2017 isolate had accumulated one single nucleotide polymorphism compared with a 2007 deer isolate, suggesting that the patient was exposed to a circulating strain of M. bovis at some point through his hunting activities and had reactivation of infection as pulmonary disease in 2017.

Whole-genome sequencing also was performed on archived specimens from two hunting-related human M. bovis infections diagnosed in 2002 (pulmonary) and 2004 (cutaneous) that were epidemiologically and genotypically linked to deer (3). The 2002 human isolate had accumulated one single nucleotide polymorphism since sharing an ancestral genotype isolated from several deer in Alpena County, Michigan, as early as 1997; the 2004 human isolate shared an identical genotype with a grossly lesioned deer harvested by the patient in Alcona County, Michigan, confirming that his infection resulted from a finger injury sustained during field-dressing. The 2002 and 2017 cases of pulmonary disease might have occurred following those patients’ inhalation of aerosols during removal of diseased viscera while field-dressing deer carcasses.

In Michigan, deer serve as maintenance and reservoir hosts for M. bovis, and transmission to other species has been documented. Since 1998, 73 infected cattle herds have been identified in Michigan, resulting in increased testing and restricted movement of cattle outside the four-county zone. Transmission to humans also occurs, as demonstrated by the three cases described in this report; however, the risk for transmission is understudied.

Similar to Mycobacterium tuberculosis, exposure to M. bovis can lead to latent or active infection, with risk for eventual reactivation of latent disease, especially in immunocompromised hosts. To prevent exposure to M. bovis and other diseases, hunters are encouraged to use personal protective equipment while field-dressing deer. In addition, hunters in Michigan who submit deer heads that test positive for M. bovis might be at higher risk for infection, and targeted screening for tuberculosis could be performed. Close collaboration between human and animal health sectors is essential for containing this zoonotic infection.

Notes from the Field: Zoonotic mycobacterium bovis disease in deer hunters—Michigan, 2002-2017

James Sunstrum, MD1; Adenike S hoyinka, MD2; Laura E. Power, MD2,3; Daniel Maxwell, DO4; Mary Grace Stobierski, DVM5; Kim Signs, DVM5; Jennifer L. Sidge, DVM, PhD5; Daniel J. O’Brien, DVM, PhD6; Suelee Robbe-Austerman, DVM, PhD7; Peter Davidson, PhD5

https://www.cdc.gov/mmwr/volumes/68/wr/mm6837a3.htm

North Carolina man dies from Vibrio lined to undercooked seafood

 The North Carolina Department of Health and Human Services has confirmed man from Cary died from Vibrio vulnificus, apparently linked to raw oysters.

The Center for Disease Control says it is impossible to tell that an oyster is bad by looking at it.

“An oyster that contains harmful bacteria doesn’t look, smell, or even taste different from any other oyster,” the CDC’s website says.

Most Vibrio infections can be prevented by ensuring your seafood is thoroughly cooked, especially oysters.

84 raspberry pickers stricken with leptospirosis in Australia, 2018

In 2018, an outbreak of leptospirosis was identified among raspberry workers from a mixed‐berry farm in New South Wales, Australia. Initial testing had not revealed a cause, but eventually leptospirosis was detected via polymerase chain reaction (PCR). Further serological testing detected Leptospira borgpetersenii serovar Arborea, of which rodents are the predominant reservoir. Leptospirosis is rare in Australia, with outbreaks usually related to flooding. We conducted an investigation to identify risk factors for infection, to inform control measures.

Cases were detected through laboratory notifications, hospital‐based syndromic surveillance, awareness‐raising among farm employees and clinician alerts. Confirmed cases had a four‐fold rise in antibody titre or single titre ≥400 on microscopic agglutination test, and a positive IgM. Probable cases had a positive Leptospira PCR or IgM, and possible cases had a clinically compatible illness. We conducted a case–control study among raspberry workers on the farm and compared reported exposures between cases and seronegative controls. We assessed environmental risks on‐site and tested rodents for leptospirosis.

We identified 84 cases over a 5‐month period (50 confirmed, 19 probable and 15 possible). Compared with controls, cases were less likely to wear gloves and more recently employed. Cases also more commonly reported always having scratched hands, likely from the thorns on raspberry plants. We observed evidence of rodent activity around raspberry plants and three of thirteen trapped mice tested positive for Leptospira Arborea. Control measures included enhanced glove use, doxycycline prophylaxis and rodent control.

This is the largest known outbreak of leptospirosis in Australia. Workers were likely exposed through scratches inflicted during harvesting, which became contaminated with environmental leptospires from mice. Leptospirosis should be considered an occupational risk for raspberry workers, requiring protective measures. Chemoprophylaxis may assist in controlling outbreaks. PCR assists in the early diagnosis and detection of leptospirosis and should be included in surveillance case definitions.

Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018

Zoonoses and Public Health

Anthea L. Katelaris, Keira Glasgow, Kerryn Lawrence, Paul Corben, Anthony Zheng, Suhasini Sumithra, John Turahui, Janet Terry, Debra van den Berg, Daneeta Hennessy, Stacey Kane, Scott B. Craig, Ellena Heading, Mary‐Anne Burns, Hanisah L. Corner, Vicky Sheppeard, Jeremy McAnulty

 https://doi.org/10.1111/zph.12652

https://onlinelibrary.wiley.com/doi/abs/10.1111/zph.12652

Raw is risky: Two more deaths from brucellosis in Africa

The current human brucellosis epidemic in Ath Mansour has again
claimed new victims. These are 2 citizens of Ath Vouali, hospitalized
Wednesday [28 Aug 2019] at the EPH Kaci Yahia M’Chedallah. The
affected subjects are a 40-year-old father and his 15-month-old son.
Met in the halls of the hospital, the father indicated that he and his
family have consumed raw milk from the farmer whose goats were
infected almost 2 months ago.

After these 2 new victims, 6 cases of human brucellosis have been
detected since last week [18-24 Aug 2019] in this commune and
hospitalized at M’Chedallah hospital. In this context, we learned that
a Daira commission, composed of a member of the APC executive of Ath
Mansour, the subdivisionary of agriculture of Ahnif, a member of the
prevention of the Ahnif EPSP and the M’Chedallah Civil Protection
Unit, was set up on the instructions of the Daira Chief.’