Nose-Picking Can Spread Pneumonia

MedicalResearch.com Interview with:
"still picking her nose" by quinn norton is licensed under CC BY 2.0Dr Victoria Connor 

Clinical Research Fellow
Liverpool School of Tropical Medicine and Royal Liverpool Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pneumococcus is a bacteria which is very common and causes lots of different infections (pneumococcal disease). Infections can be non-invasive or invasive. Non-invasive diseases include middle ear infections, sinusitis and bronchitis. Invasive infections including chest infection (pneumonia), infections of brain and spinal cord (meningitis) and blood infections (sepsis).

Invasive pneumococcal infections is a major cause of death around the world and in the UK, is estimated that is responsible for 1.3 million deaths in children under 5 annually. Pneumococcal disease causes more deaths in low and middle income countries where approximately 90% of pneumonia deaths occur.

Pneumococcus also is commonly carried (colonises) the nose/throat of children and adults. This colonisation is important to understand as it is the main source of the bacterial transmission and is also the first step in pneumococcal infections.

The understanding of transmission of pneumococcus is currently poor. It is generally thought that transmission occurs through breathing in the respiratory sections of someone carrying pneumococcus in their nose which are infected with pneumococcus.

However more recently studies especially in mice have shown that there may be a role of hands or other objects as vehicles for the transmission of pneumococcus.

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Mandated Audit-and-Feedback Did Not Improve Hospital Hand Hygiene

MedicalResearch.com Interview with:
"Hand Washing" by Anthony Albright is licensed under CC BY-SA 2.0Dr. Daniel J. Livorsi, MD
Assistant Professor
INFECTIOUS DISEASE SPECIALIST
University of Iowa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the Joint Commission’s standards is that hospitals audit and provide feedback on hand hygiene compliance among healthcare workers. Audit-and-feedback is therefore commonly practiced in US hospitals, but the effective design and delivery of this intervention is poorly defined, particularly in relation to hand hygiene improvement.

We studied how 8 hospitals had implemented audit-and-feedback for hand hygiene improvement. We found that hospitals were encountering several barriers in their implementation of audit-and-feedback. Audit data on hand hygiene compliance was challenging to collect and was frequently questioned. The feedback of audit results did not motivate positive change. 

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Real World Treatment of Serious Infections with Ceftolozane/Tazobactam

MedicalResearch.com Interview with:

Thomas P. Lodise Jr., PharmD, PhD Clinical Pharmacist at the Stratton VA Medical Center in Albany, NY Albany College of Pharmacy and Health Sciences Albany, NY

Dr. Lodise

Thomas P. Lodise Jr., PharmD, PhD
Clinical Pharmacist at the Stratton
VA Medical Center in Albany, NY
Albany College of Pharmacy and Health Sciences
Albany, NY

MedicalResearch.com: What is the background for this study? How does Ceftolozane/Tazobactam differ from other antibiotics for serious Gram-negative infections including Pseudomonas aeruginosa?

Response: Treatment of patients with Gram-negative infections is increasingly difficult due to rising resistance to commonly used agents. Ceftolozane/tazobactam (C/T) is a potent anti-pseudomonal agent with broad Gram-negative coverage that is indicated for complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) and is currently being studied for ventilated nosocomial pneumonia. C/T differs from other antibiotics in terms of its potency against multi-drug resistant Pseudomonas aeruginosa, one of the most concerning and difficult-to-treat Gram-negative pathogens. This study evaluates C/T in a large database of US hospitals to better understand treatment patterns and associated outcomes.

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Bacterial Appendage Offers New Target To Combat Antibiotic Resistance

MedicalResearch.com Interview with:

David G. Thanassi, Ph.D. Professor and Interim Chair Department of Molecular Genetics & Microbiology Center for Infectious Diseases Stony Brook University Stony Brook, NY 11794-5222

Dr. Thanassi

David G. Thanassi, Ph.D.
Professor and Interim Chair
Department of Molecular Genetics & Microbiology
Center for Infectious Diseases
Stony Brook University
Stony Brook, NY 11794-5222

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pathogenic bacteria such as Escherichia coli use hair-like surface appendages termed pili to colonize tissues within the host and initiate infection.  Together with our collaborators – the group of Huilin Li at the Van Andel Research Institute – we used an advanced imaging technique termed cryo-electron microscopy to determine snapshots of bacterial pili as they are being assembled.  The pili we studied are critical for uropathogenic strains of E. coli to colonize the urinary tract and cause urinary tract infections.  Our work revealed a new stage in the pilus assembly process and new details about how these structures are built on the bacterial surface.   Continue reading

New Antibiotic Combination IMI/REL Can Treat Resistant Infection With Less Kidney Toxicity

MedicalResearch.com Interview with:

Michelle Hoffman Brown Associate Principal Scientist at Merck Merck

Michelle Brown

Michelle Hoffman Brown
Associate Principal Scientist
Merck

MedicalResearch.com: What is the background for this study? What are the kidney risks of using colistin to treat carbapenem-resistant bacterial infections?

Response: Gram-negative pathogens are responsible for half of all healthcare-associated infections and their ability to resist traditional antibiotics makes them more dangerous for seriously ill patients in a healthcare setting. The need for new approaches to treat these pathogens is essential and this trial aimed to evaluate the efficacy and safety of imipenem/relebactam (IMI/REL) for the treatment of these challenging infections.

Nephrotoxicity is a common complication of colistin-based therapy and is the potential adverse experience of greatest concern to prescribing clinicians, limiting its use to treat carbapenem-resistant bacterial infections. Relebactam is a novel β-lactamase inhibitor that restores imipenem activity against many imipenem-non-susceptible strains of Gram-negative pathogens. In the Phase 3 RESTORE-IMI 1 study (NCT02452047), IMI/REL was shown to be as effective as, but better tolerated than, colistin plus imipenem, including as demonstrated by a lower incidence of treatment-emergent nephrotoxicity (prespecified secondary endpoint). This analysis looked at additional renal safety data from the RESTORE-IMI 1 trial.  Continue reading

Hospital Sinks a Trap For Bad Bacteria

MedicalResearch.com Interview with:
MedicalResearch.com Interview with: Gili Regev-Yochay, MD, Lead author Director of the Infection Prevention & Control Unit Sheba Medical Center Tel HaShomer, Israel.   MedicalResearch.com: What is the background for this study?  Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens).  Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak.    MedicalResearch.com: What are the main findings?   Response: The outbreak source were the sink-traps in nearly all the patient rooms, which were contaminated with this same bacteria. Once we understood that this was the source we took two measures:  1) Sink decontamination efforts, including intensive chlorine washes of the drainage and water system, replacement of all sink-traps, acetic acid treatment and more, all these efforts were only partially and only temporarily successful. So that even today, after a year of such efforts and a period in which we didn't have any patients with this infection, the drainage system is still contaminated with these bugs and they grow in the sink-traps and can be found in the sink outlets.  2) The second measure we took was an educational intervention, where we engaged the ICU team through workshops to the issue of the contaminated sinks and together enforced strict "sink-use guidelines" (sinks are to be used ONLY for hand washing, prohibiting placement of any materials near the sinks, etc.). Using these two measure the outbreak was fully contained.  To date, nearly 1.5 years since the last outbreak case, we did not have any further infections in our ICU patients with this bug.  MedicalResearch.com: What should readers take away from your report?  Response: Sink-traps and drainage systems can be a major source of CPE transmission.  While traditionally CPE outbreaks were attributed to patient-to patient transmission, the environment and particularly water and drainage system appears to play a major role.  MedicalResearch.com: What recommendations do you have for future research as a result of this work?   Response: There is urgent need to find a technological solution for drainage system contaminations.  While some have suggested to get rid of sinks in ICU this is probably not realistic in the era of emerging Clostridium infections (where washing hands, and not only alcohol rubs are needed).   Citation:  Gili Regev-Yochay, Gill Smollan, Ilana Tal, Nani Pinas Zade, Yael Haviv, Valery Nudelman, Ohad Gal-Mor, Hanaa Jaber, Eyal Zimlichman, Nati Keller, Galia Rahav. Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit. Infection Control & Hospital Epidemiology, 2018; 1 DOI: 1017/ice.2018.235    <span class="last-modified-timestamp">Oct 6, 2018 @ 7:25 pm</span>          The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Gili Regev-Yochay, MD
, Lead author
Director of the Infection Prevention & Control Unit
Sheba Medical Center
Tel HaShomer, Israel. 

MedicalResearch.com: What is the background for this study?

Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens).  Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak.

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Therapy Dogs Can Spread MRSA in Hospitals—But Shampooing Can Help

MedicalResearch.com Interview with:

Courtesy of Kathryn Dalton, VMD MPH

Courtesy of Kathryn Dalton, VMD MPH

Kathryn Dalton, VMD MPH
AKC CHF Fellow
PhD Student, Davis Lab
Environmental Health and Engineering
Johns Hopkins Bloomberg School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Animal-assisted interventions (or AAI for short) have become increasing popular in hospitals for the emotional and physical benefits they bring to patients. But there is a risk that these therapy dogs could potential spread infectious germs, including MRSA (methicillin-resistantStaphylococcus aureus), to patients.

Our study found that therapy dogs can spread MRSA to patients, and children who had more contact with the therapy dog were at higher risk of getting MRSA. But, we used a new cleaning protocol on the dog with an anti-septic shampoo before the visit and anti-septic wipes during the visit. Patients who had more contact with the dog did not have a higher risk of MRSA when the dog was giving this new cleaning protocol, which made the AAI therapy visits safer for the patients. In addition, the patients’ emotional and physical benefits we observed were not changed by using this dog cleaning protocol.       Continue reading

Puppies From Commercial Dog Industry Source of Multistate Diarrhea Infections

MedicalResearch.com Interview with:
"Siberian Husky Puppies 2013-05-25" by Jeffrey Beall is licensed under CC BY 2.0Mark Laughlin, DVM

Veterinary Medical Officer
CDC

MedicalResearch.com: What is the background for this study?

How common are Campylobacter infections?  How does a Campylobacter infection typically present? 

Response: Campylobacter is one of the most common causes of diarrheal illness in the United States, causing an estimated 1.3 million illnesses each year. Most people with Campylobacter infection usually have diarrhea (often bloody), fever, and abdominal cramps. The diarrhea may be accompanied by nausea and vomiting. These symptoms usually start within 2 to 5 days after exposure and last about a week.

Most illnesses from Campylobacter likely occur due to eating raw or undercooked poultry, or from eating something that touched raw or undercooked poultry. Some illnesses can occur from contact with contaminated water, contact with animals, or from drinking raw (unpasteurized) milk.

Since 2009, 13 outbreaks of human Campylobacter infections linked to contact with dogs have been reported to CDC. These outbreaks account for a reported 47 illnesses and 2 hospitalizations.

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SMARTPHONE, M.D. : A NEW APP TO DIAGNOSE URINARY TRACT INFECTIONS

MedicalResearch.com Interview with:
SMARTPHONE, M.D. A NEW APP TO DIAGNOSE URINARY TRACT INFECTIONS Michael J. Mahan PhD
Professor, Microbiology and Molecular Genetics
Dept of Molecular, Cellular, and Developmental Biology
University of California, Santa Barbara, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Urinary tract infections (UTIs) cause nearly 10 million doctor visits each year in the United States. Women are much more likely to have a UTI than men, and are particularly harmful to pregnant women and can cause miscarriage. Thus, there is a medical need for rapid, low-cost, on-site testing — particularly in resource-limited settings.

We developed a new app that enables a smartphone to identify (ID) bacteria causing UTIs in just one hour — a fraction of the time and cost of clinical diagnostics.

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Inhaled Steroids Associated With Increased Risk of Atypical Mycobacterial Infections

MedicalResearch.com Interview with:

Stephen J Ruoss MD Professor, Stanford University, Medicine, Division of Pulmonary and Cfritical Care Medicine Stanford, California

Dr. Ruoss

Stephen J Ruoss MD
Professor, Stanford University, Medicine,
Division of Pulmonary and Cfritical Care Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by an atypical mycobacterial infection? 

Response: Our interest in undertaking this study stems from three important clinical observations and issues.

First, the use of inhaled steroid medications for a broad variety of respiratory complaints and diseases is increasing, including in clinical circumstances where there isn’t much strong supportive evidence for benefit to patients from using inhaled steroids.

The second observation is that steroids can and do alter immune system responses, and can increase the risk for some infections. There are already data from studying patients on inhaled steroids where the incidence of bacterial respiratory infections has increased, supporting the concerns for infection risk from inhaled steroids.

And the third issue is that steroids can more specifically alter immune system function that helps combat mycobacterial infections, and this means that the risk for, and incidence of mycobacterial infections could be increased in patients treated with inhaled steroids. The best known mycobacterial infection is of course tuberculosis, but there are other mycobacteria, called nontuberculous mycobacterial (or atypical mycobacterial) that are broadly found in the environment, and some of those nontuberculous mycobacteria (NTM) can cause lung infections.

So our hypothesis was that the use of inhaled steroids might be associated with an increased frequency of NTM infections, and we designed the study to explore that hypothesis. Continue reading

First Trial Compares Treatment Options For Serious Infections Caused by ESBL-Producers

MedicalResearch.com Interview with:

Patrick Harris FRACP Staff Specialist Microbiology | Pathology Queensland | Health Support Queensland Postdoctoral Research Fellow University of Queensland, UQ Centre for Clinical Research (Paterson Group)

Dr. Harris

Patrick Harris FRACP
Staff Specialist
Microbiology | Pathology Queensland | Health Support Queensland
Postdoctoral Research Fellow
University of Queensland, UQ Centre for Clinical Research (Paterson Group

MedicalResearch.com: What is the background for this study?

Response: Increasingly, common bacterial pathogens such as E. coli or Klebsiella have acquired genes known as extended-spectrum beta-lactamases (ESBLs), which mediate resistance to many of our most important antibiotics. Despite their clinical importance, we have limited information derived from randomised clinical trials on the best antibiotic treatments for life-threatening infections caused by these ESBL-producers.

We aimed to compare two readily available antibiotics, meropenem (a carbapenem drug, as the “standard of care”) and piperacillin-tazobactam (which may be an alternative to meropenem). Many ESBL-producing bacteria test susceptible to piperacillin-tazobactam in the laboratory, yet clinical efficacy has been uncertain.  Some observational studies have suggested that piperacillin-tazobactam may be effective against ESBL-producers, but the data have been contradictory.  The theory has been that piperacillin-tazobactam may be less likely to select for resistance to carbapenems – which, when it occurs, can result in infection with bacteria that are almost untreatable.

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Q Fever Patients Must Be Followed To Avoid Cardiac Complications

MedicalResearch.com Interview with:

Sheep tick - vector for Coxiella burnetii, the cause of the disease known as Q fever CDC image

Sheep tick – vector for Coxiella burnetii, the cause of the disease known as Q fever CDC image

Pr. Didier Raoult
Directeur de l’IHU Méditerranée-Infection
Marseille 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This work represents the sum of data accumulated over several decades of studies on Q fever.

Our reference center contacts each of the physicians in charge and ensures patient follow-up, which allows obtaining data, that is not comparable to those used automatically in databanks. Four people exclusively dedicated their time to manage these specific data on Q fever.

The main data confirm the need to perform a cardiac ultrasound for all patients with Q fever and acute endocarditis (to detect valvulopathy) and to give a prophylactic treatment to avoid fixation on the heart in patients with valvulopathy.

This work helps clarify the evolution of Q fever by eliminating the term of chronic Q fever, which is based on non-clinical elements, and defining persistent Q fever for which there is an identifiable focus of infection.

Furthermore, this work makes it possible to recommend systematic detection of antiphospholipid antibodies in order to limit the risk of thrombosis and the risk of cardiac fixation.

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CDC: Multiple States Report Salmonella Infections From Backyard Poultry

MedicalResearch.com Interview with:

https://www.cdc.gov/salmonella/backyard-flocks-06-18/index.html

Dr. Megin Nichols

Dr. Megin Nichols DVM, MPH, DACVPM
Lead , Enteric Zoonoses Activity
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
CDC Veterinarian

MedicalResearch.com: What is the background for this announcement?

Response: Each year, CDC and multiple states investigate several multistate outbreaks of Salmonella infections linked to contact with live poultry in backyard flocks. Seventy outbreaks of Salmonella infections have been linked to contact with poultry in backyard flocks since 2000.

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Treatment and Prevention of HIV Infection Recommendations Updated

MedicalResearch.com Interview with:

Michael S. Saag, MD Professor,Division of Infectious Diseases UAB

Dr. Saag

Michael S. Saag, MD
Professor,Division of Infectious Diseases
UAB

MedicalResearch.com: What is the background for this study? What are the main findings? 

  • An update of prior recommendations made by the IAS-USA, which have been updated every 2 years since 1996
  • Cover ARVs for prevention and treatment of HIV infection
  • Developed by an international panel of 16 volunteer experts in HIV research and patient care appointed by the IAS–USA
    • Members receive no compensation and do not participate in industry promotional activities while on the panel
  • Primarily for clinicians in highly resourced settings; however, principles are universally applicable
  • Reviewed data published or presented from September 2016 through June 2018
  • Rated on strength of recommendation and quality of evidence

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Non-Invasive Liquid Biopsy Can Detect Deep Seated Infections

MedicalResearch.com Interview with:

David K. Hong, M.D. VP Medical Affairs and Clinical Development at Karius

Dr. Hong


David K. Hong, M.D.

VP Medical Affairs and Clinical Development at Karius

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Invasive fungal infections (IFI) are a cause of significant mortality and morbidity in immunocompromised patients. The diagnosis of IFIs is challenging, and often requires an invasive biopsy in order to identify the causal pathogen. There is a need for non-invasive methods of fungal identification to help guide targeted anti-fungal therapy.

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CDC Reports Salmonella Reading Outbreak: Urges Food Preparation Precautions

MedicalResearch.com Interview with:
wash-hands-well . CDC wellAaron E. Glatt, MD, FACP, FIDSA, FSHEA

Chairman, Department of Medicine & Hospital Epidemiologist
South Nassau Communities Hospital
Clinical Professor of Medicine
Icahn School of Medicine at Mount Sinai
Oceanside, NY 11572 

MedicalResearch.com: What is the background for the CDC alert regarding a multistate outbreak of multidrug-resistant Salmonella Reading infections linked to raw turkey products?   Is this Salmonella strain different or more dangerous than other Salmonella food poisoning outbreaks? 

Response: The CDC has reported that as of yesterday, there have been 90 people infected with Salmonella Reading from 26 states. No deaths have been reported, but 40 patients to date required hospitalization. There was a previous outbreak of S. Reading in 2016 related to contaminated alfalfa sprouts, but this organism is not that much different nor is it more virulent than many other salmonella strains.  Continue reading

Biomarker Procalcitonin Offered Limited Benefit Over Clinical Judgement In Antibiotic Prescribing Patterns

MedicalResearch.com Interview with:

David T. Huang, MD, MPH Associate Professor, Critical Care Medicine, Emergency Medicine, Clinical and Translational Science Director, MACRO (Multidisciplinary Acute Care Research Organization) Director, CRISMA Administrative Core (Clinical Research, Investigation, and Systems Modeling of Acute illness) University of Pittsburgh

Dr. David Huang

David T. Huang, MD, MPH
Associate Professor, Critical Care Medicine, Emergency Medicine, Clinical and Translational Science
Director, MACRO (Multidisciplinary Acute Care Research Organization)
Director, CRISMA Administrative Core (Clinical Research, Investigation, and Systems Modeling of Acute illness)
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: The overuse of antibiotics has become a serious threat to global public health, causing antibiotic resistance and increasing health care costs. Physicians have long known that antibiotics are usually unnecessary for acute bronchitis and for some other cases of lower respiratory tract infections, and that antibiotics treat only bacterial infections, not viral. But in daily practice, many physicians often prescribe them.

Previous research had reported that using a biomarker blood test and following an antibiotic guideline tied to the test results could reduce antibiotic use in lower respiratory tract infections. In February 2017, the U.S. Food and Drug Administration approved the biomarker test that measures procalcitonin – a peptide that typically increases in bacterial infections, but not viral.

We conducted the Procalcitonin Antibiotic Consensus Trial (ProACT) trial to evaluate whether a procalcitonin antibiotic prescribing guideline, implemented for the treatment of suspected lower respiratory tract infection with reproducible strategies, would result in less exposure to antibiotics than usual care, without a significantly higher rate of adverse events.

The ProACT trial involved 14 predominately urban academic hospitals. We enrolled 1,656 adult patients who presented to the hospital emergency department and were initially diagnosed with a lower respiratory tract infection. All the patients were tested for their procalcitonin levels, but the results were shared only with the physicians of the patients randomly assigned to procalcitonin-guided antibiotic prescription.

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To Avoid Leprosy, Stay Away from Armadillos!

MedicalResearch.com Interview with:

Nine-banded armadillo image credit: Dr. Richard Truman, USPHS, Public Domain (2014)John S. Spencer, Ph.D.
Colorado State University
Fort Collins, Colorado

MedicalResearch.com: What is the background for this study? Where can armadillos be found? What are the main findings? 

Response: The ancient disease leprosy, a disease causing skin lesions, nerve damage, disfigurement and disability, is caused by the bacterium Mycobacterium leprae, and is mainly spread by aerosol infection (coughing and sneezing) from human to human. It is rare in the United States (less than 200 cases on average per year), while it is endemic in Brazil, where over 25,000 new cases were diagnosed last year. In addition, zoonotic transmission of leprosy by nine-banded armadillos (Dasypus novemcintus, pictured at left) has been shown to occur in the southern United States, mainly in Texas, Louisiana and Florida.

Nine-banded armadillos originated from South America, and expanded their range from Mexico into Texas in the 1800’s, eventually spreading north and east throughout the gulf states. People in Brazil, particularly in rural areas, hunt and kill armadillos as a dietary source of protein. In the small town of Belterra in western Pará state in the Brazilian Amazon region, a survey of 146 residents showed that around 65% of people had some contact with armadillos, through hunting, preparing the meat for cooking, or by eating them. A group of individuals who ate armadillos most frequently (more than once per month and up to twice a week) had a significantly higher antibody titer towards the M. leprae-specific antigen PGL-I and an almost two-fold higher risk of being diagnosed with disease, a significant risk.   Continue reading

More Acorns = More Mice = More Lyme Disease

The white-footed mouse has been found to be a competent reservoir for the Lyme disease-causing spirochete, Borrelia burgdorferi – Wikipedia image

MedicalResearch.com Interview
Richard S. Ostfeld, PhD

Distinguished Senior Scientist
Cary Institute of Ecosystem Studies
Millbrook, NY 12545, USA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Lyme disease and other tick-borne infections occur in large portions of the eastern and Midwestern United States and adjacent Canada, and the geographic range is expanding rapidly, engulfing new communities every year.  Despite the observed increases in incidence rates and geographic range at the national level, considerable variation occurs across space and time, with persistent hot spots, colder spots, bad years, and not-as-bad years.  We undertook this long-term study (19 years) to ask what causes some places and years to be particularly risky and others not as risky, in terms of human exposure to tick-borne disease.  Because diagnosis and treatment of Lyme disease are problematic and highly controversial, and because no vaccines or effective tick-control methods are currently available, we hoped that understanding the causes of high risk would facilitate prevention of human exposure.

We found that, in the oak-dominated forests that pervade the Lyme-disease-endemic zone, acorn production in the autumn is a strong leading indicator of Lyme disease risk two summers later.  Acorn production is associated with marked population increases of white-footed mice and eastern chipmunks, which use abundant acorns as a key over-winter food source, leading to population growth the following year.  Dense summer populations of mice and chipmunks provide the local population of blacklegged ticks with abundant sources of blood-meal hosts.  These small rodents are more permissive of successful tick feeding (other hosts kill many ticks by grooming them as they attempt to feed), and they are also the primary natural reservoirs of infection with the microbial agents causing Lyme disease, anaplasmosis, and babesiosis.  Larval ticks emerging when rodents are highly abundant are highly likely to survive and acquire infection, molting the next year into infected nymph-stage ticks.  Bites from nymph-stage ticks are responsible for the great majority of tick-borne disease cases.  The one-year lag from acorns to rodent populations plus the one year lag from larval ticks biting rodents to nymphal ticks biting people together are responsible for the total two-year lag.

By using motion-sensitive cameras set in over 100 sites over two years, we were also able to ask whether the local community of mammal predators can affect human risk of exposure.  We found that sites with a diverse assemblage of predators, especially foxes, bobcats, and opossums, were associated with reduced tick infection prevalence with the agents of Lyme disease, anaplasmosis, and babesiosis.  When these predators were absent, which sometimes occurred when coyotes displaced them, infection prevalence was significantly higher.  Infection prevalence was also lower in sites within extensive, unbroken forest, and higher in sites with small forest remnants.  Taken together, we determined that an understanding of the food webs within which ticks and pathogens dwell can strongly facilitate the ability to predict when and where risk will be high.  Acorns exert what ecologists call a “bottom-up” effect, whereas the predators enforce “top-down” control.  We found that the ticks were remarkably resilient to most weather-related factors.  However, when winter-spring weather was particularly warm and dry, tick abundance the following summer was reduced.  Cold winters did not kill off the ticks. 

MedicalResearch.com: What should readers take away from your report?

Response: The ecology of tick-borne disease is incredibly complex, but still we can find big signals amongst the noise and predict risk with a good degree of confidence.  Predicting times and places of enhanced risk is particularly important given the frustrations within the public health community and the public at large over the slow pace of progress in improving diagnostic capabilities and treatments.  We are still relying fundamentally on individual efforts to prevent exposure using various self-protections, such as repellents, tick-checks, protective clothing and the like.  Targeting these efforts to times and places where risk is particularly high should help protect public health. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Long-term monitoring of tick populations is crucial for evaluating the importance of ecological variables, like wildlife abundance and weather, in determining risk of human exposure.  In addition, the longer we monitor these variables the more likely we are to see extreme events, which might play outsized roles.  Intensive monitoring like this is also crucial for detecting invasions by other species of tick that are important to public health. For instance, we expect lone star ticks to invade our area from the south, with unpredictable consequences for blacklegged ticks and human health.  We are also concerned about potential invasions by non-native ticks, like the long-horned tick that was recently detected in several eastern and Midwestern states to our south. 

No disclosures 

Citation:

Richard S. Ostfeld, Taal Levi, Felicia Keesing, Kelly Oggenfuss, Charles D. Canham. Tick-borne disease risk in a forest food web. Ecology, 2018; 99 (7): 1562 DOI: 1002/ecy.2386

 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Biomarker Can Identify Aggressive Form of Bacteria Klebsiella pneumoniae

MedicalResearch.com Interview with:

This blood agar plate (BAP) grew colonies of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria- CDC image

This blood agar plate (BAP) grew colonies of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria- CDC image

Thomas A Russo, MD, CM
The Departments of Medicine, and Microbiology and Immunology
The Witebsky Center for Microbial Pathogenesis
University at Buffalo-State University of New York, and the
Veterans Administration Western New York Healthcare System
Buffalo, New York

MedicalResearch.com: What is the background for this study? What is Klebsiella pneumoniae?

Response: K. pneumoniae is an important bacterial pathogen that cause a number of different infections. Presently, two pathotypes exist that behave very differently.

Classical K. pneumoniae, which is most common in North America and Europe primarily causes infections in the healthcare setting, usually in patients with co-morbidities. Also, it is becoming increasingly antimicrobial resistant, making treatment challenging.

Hypervirulent K. pneumoniae, which is more common in the Asian Pacific Rim,  can cause infections in otherwise healthy individuals, often causes infection in multiple sites, and these sites are usually not infected by classical K. pneumonia, such as the eye, brain, and aggressive soft-tissue infection (necrotizing fasciitis). Hypervirulent K. pneumonia strains are also becoming antimicrobial resistant, albeit at a slower rate than classical K. pneumoniae at this time.

There are some differences how infections due to these two pathotypes are managed. It would also be ideal to track the prevalence and relative antimicrobial resistance of these two pathotypes, but up until now this could not be reliably done because there was not a validated test that could differentiate them. The goal of this study was to identify biomarkers that could accurately differentiate classical from hypervirulent K. pneumoniae.  Continue reading

Coding Changes Limited Penalty Impact From CMS Hospital-Acquired Conditions Policy

MedicalResearch.com Interview with:

Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health

Dr. Calderwood

Michael S. Calderwood, MD, MPH, FIDSA
Regional Hospital Epidemiologist
Assistant Professor of Medicine
Infectious Disease & International Health

MedicalResearch.com: What is the background for this study?  

Response: Prior work by Lee et al. (N Engl J Med 2012;367:1428–1437) found that the 2008 CMS Hospital-Acquired Conditions (HAC) policy did not impact already declining national rates of central line-associated bloodstream infections (CLABSIs) or catheter-associated urinary tract infections (CAUTIs). We studied why this policy did not have its intended impact by looking at coding practices and the impact of the policy on the diagnosis-related group (DRG) assignment for Medicare hospitalizations. The DRG assignment determines reimbursement for inpatient hospitalizations.

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Ornamental Bromeliad Plants Contribute to Zika-Carrying Mosquitoes

MedicalResearch.com Interview with:
“Bromeliad” by Selena N. B. H. is licensed under CC BY 2.0André Wilke, Ph.D.
Post Doctoral Associate
Division of Environment & Public Health
Department of Public Health Sciences
University of Miami Miller School of Medicine
Clinical Research Building
Miami, Florida 33136

MedicalResearch.com: What is the background for this study?

Response: As vector-borne diseases pose an increasing public health threat to communities in South Florida and elsewhere, a new study led by public health researchers at the University of Miami Miller School of Medicine has revealed that ornamental bromeliad plants contribute to breeding of the Aedes aegypti mosquito—a key culprit for the Zika outbreak that hit Miami-Dade County and other areas of Florida and the Americas in 2016.

In addition to Zika, bites from the Aedes aegypti mosquito can cause dengue, yellow fever and chikungunya. Zika has been linked to microcephaly and other birth defects in unborn babies when pregnant women contract the disease. The family of diseases linked to the Aedes aegypti can cause other severe symptoms. Yellow fever can be fatal.

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What Causes Failures in Personal Protective Equipment Use in Hospitals?

MedicalResearch.com Interview with:

Sarah L. Krein, PhD, RN Research Career Scientist VA Ann Arbor Healthcare System Ann Arbor, MI 

Sarah L. Krein, PhD, RN
Research Career Scientist
VA Ann Arbor Healthcare System
Ann Arbor, MI

MedicalResearch.com: What is the background for this study?

Response: We conducted this study to better understand the challenges faced by health care personnel when trying to follow transmission based precaution practices while providing care for hospitalized patients.  We already know from other studies that there are breaches in practice but our team was interested in better understanding why and how those breaches (or failures) occur so we can develop better strategies to ensure the safety of patients and health care personnel.

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What Do We Find Disgusting? and Why?

MedicalResearch.com Interview with:
rat- wikipedia imageMícheál de Barra, PhD

Lecturer in Psychology
Brunel University London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Disgust has been called the “intuitive microbiologist”  – it tracks the sources of infection in our environment. But so far, there has been little attempt to link the sources of disgust to the sources of infectious disease in a comprehensive way. So we developed a method for developing stimuli based on a random sample illness.

We basically asked ourselves what the kinds of cues that might be associated with that kind of disease risk and asked people to rate disgust responses. The main motive for this was to contribute to a debate in the literature about if there are “kinds of disgust” and if so, how many. I results were a little ambiguous there I’m afraid.

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Widely Use Antibacterial in Hand Sanitizers and Toothpaste Can Attack Biofilms

MedicalResearch.com Interview with:

Christopher M. Waters PhD Departments of Microbiology and Molecular Genetics BEACON Center for The Study of Evolution in Actio Michigan State University East Lansing, MI 

Dr. Waters

Christopher M. Waters PhD
Departments of Microbiology and Molecular Genetics
BEACON Center for The Study of Evolution in Actio
Michigan State University
East Lansing, MI 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research really centers on understanding and targeting bacterial biofilms. These are multicellular communities of bacteria encased in a slimy matrix that protects them from the immune system and antibiotic treatment during infections. One of the most common types of biofilm infections is in the lungs of cystic fibrosis by the bacterium Pseudomonas aeruginosa. CF patients can become chronically colonized by P. aeruginosa, and antibiotics are not able to clear these infections.

Our idea was can we find other molecules that make antibiotics more effective at killing biofilms? To this end, we screened about 6,000 compounds for those that would make tobramycin more effective at killing P. aeruginosa biofilms, and one of the best hits we found was the antimicrobial triclosan that has been widely used for decades in hand sanitizers, soaps, and tooth paste. Although neither triclosan nor tobramycin can kill biofilms alone, the combination is 100X more effective against virtually every P. aeruginosa strain tested. It also worked against other bacteria that commonly infect cystic fibrosis lungs such as Staphylococcus aureus and Burkholderia cenocepacia.

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