Top Infectious Disease News of the Week—June 30, 2019

#5: Dozens Sickened With Salmonella After Eating Papayas

The US Centers for Disease Control and Prevention (CDC) is warning consumers in several states to dispose of whole, fresh papayas imported from Mexico following the detection of a multistate outbreak of Salmonella Uganda.

As of June 26, 2019, 62 individuals have been infected with the outbreak strain across 8 states. Whole genome sequencing analysis of 40 isolates predicted resistance to both streptomycin and sulfisoxazole. The CDC notes that this resistance will not affect the choice of antibiotics used to treat most people. Testing of 3 clinical isolates via CDC’s National Antimicrobial Resistance Monitoring System is currently underway.

Onset of illness dates range from January 14, 2019, to June 8, 2019. There has been an increase in the number of documented cases since April.

Read more about the Salmonella outbreak.

#4: 1 Child Dead in Cluster of E coli Cases Linked to San Diego County Fair

A young child has died after contracting Shiga-toxin producing E coli after coming into contact with animals at a petting zoo while attending the San Diego County Fair. The young boy, who was 2 years-old, was hospitalized for his illness and later died on June 24, 2019, from a complication of the disease.

The County of San Diego Health and Human Services Agency (HHSA) issued a news release on June 28, 2019, announcing that a total of 4 children have been diagnosed with Shiga-toxin producing E coli. The 3 other children did not require hospitalization, but all visited the fair between June 8 and June 15, 2019, and had contact with the petting zoo animals or other animals onsite. The fair officials have closed public access to all animal areas, including the petting zoo, as a precaution.

HHSA is working alongside the County Department of Environmental Health to investigate the cluster of infections. As part of the epidemiological investigation the health officials inspected food facilities that the children visited at the fair but did not find any link to the E coli cluster.

Read more about the E coli cluster in San Diego.

#3: Investigators Discover Antibody Capable of Inhibiting Multiple Strains of Norovirus

A team of investigators has made a key discovery that could make a vaccine for the norovirus a reality.

A study published in the journal Immunity describes how a research team discovered an antibody that is capable of broadly inhibiting several strains of pandemic norovirus.

“In order to design an effective vaccine for norovirus, scientists needed to identify a neutralizing antibody that could work against many strains of the virus, as well as strains that will circulate in the future,” Ralph Baric, PhD, an author on the study, said in a press release. “This information can now be used to build better human vaccines.”

Read more about the antibody discovery.

#2: Sounding Off: Dr. Drew on How LA's Homeless Problem Is a Public Health Emergency

Drew Pinsky, MD, cannot understand how the situation on the Pacific Coast, and Los Angeles, in particular, is being tolerated.

“It’s beyond anything that is sustainable or rational or morally allowable,” he said of the humanitarian crisis that’s driving a rise in infectious diseases there.

Contagion® recently spoke with Pinsky, an internist, addiction medicine specialist, and prominent media personality, about the situation out West, what contributing factors are at play, and how health care providers can help.

Read our full Q&A with Dr. Drew.

#1: Pan-resistant, Currently Untreatable Gram-Negative Infections Come Closer to Home

The global emergence of antimicrobial resistance among gram-negative (GN) species is a major public health concern. This year the US Centers for Disease Control and Prevention reported multiple cases of pan drug-resistant (PDR) Pseudomonas aeruginosa originating from a bariatric surgery clinic in Tijuana, Mexico, prompting the agency to issue travel warnings. Organisms were isolated from 10 patients across 2 states, and effective therapeutic options were very limited. As pan-resistant infections have become a reality, clinicians face an increasing dilemma with how to treat multidrug-resistant strains.

The first US case of pan-resistant bacteria was reported by McGann et al, which identified an Escherichia coli strain isolated from a urine culture in which both mcr-1 and bla_CTX-M were present on a novel IncF plasmid, resulting in resistance to both colistin and β-lactamase.

A 2016 case of pan-resistant Klebsiella pneumoniae was documented in the US in a woman who had recently arrived from India and was admitted to a Nevada hospital with SIRS. A K pneumoniae strain isolated from her hip abscess was shown to be resistant to all 26 antimicrobials tested, including B-lactams, colistin, and aminoglycosides (Table). Tigecycline demonstrated intermediate activity against this strain, but the patient died from septic shock within 1 month.³ Whole genome sequencing of the isolate revealed a 5.4Mb chromosome and 3 plasmids belonging to multi-locus sequence strain (ST)15, and 4 β-lactamase genes: 2 chromosomal extended-spectrum β-lactamase (ESBL) (bla _CTX-M-15 and bla _SVH-28) and 2 plasmid borne elements (the carbapenemase bla _NDM-1 and class C B-lactamase bla _CMY-6.). Genetically conferring resistance to all tested β-lactams and β-lactamase inhibitors.

Read more about the emergence of these pathogens.