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By Carol A. Kemper, MD, FACP
Source: Terramocci R, et al. Infection. 2001;29:93-95.
Having all but vanished for years, Diphyllobothrium latum is re-emerging in Lake Como, Italy. Recently, the tapeworm infection was found in 6 people, 3 of whom lived in the Lake Como area and 3 of whom had been vacationing in the area. All 6 had eaten raw or smoked perch filets. Perch fished from the subalpine lake region on the Italian-Swiss border were found to contain larval forms of the tapeworm, although the Swiss shores of Lake Como and Lugano appear to be clear of the parasite.
During the last 30 years, there have been only sporadic reports of human D latum infection, all of which came from the Northern lakes area of Italy, southern Switzerland and France. However, in the distant past, Lakes Como, Grada, Iseo, and Maggiora were considered endemic for the parasite. The parasitic infection subsequently dwindled, probably as the result of the die-off of its major intermediate host—perch—from excessive pollution of Italian lakes and streams. Re-emergence of the parasite may be attributed to improvement in pollution levels, as well as consumption of raw or undercooked fish filets, especially in Chinese cuisine.
Source: ProMED-mail post, August 9, 2001; firstname.lastname@example.org.
Vibrio vulnificus infection has resulted in the deaths of 5 Latino men in Los Angeles County this summer. All 5 were in their 40s and 50s and all had underlying liver disease. Two of the men had purchased raw oysters from street vendors, and 2 had reportedly ordered raw oysters in a restaurant (1 in ceviche). It is not known how the fifth man contracted the infection. It is believed that the 5 men ingested raw oysters shipped from the Gulf Coast, where the warm salty waters, especially in the summer months, are conducive to the growth of the bacterium. In contrast, oysters from the Northern Pacific coast do not represent a risk, as they come from much colder waters.
In people with healthy immune systems and no underlying disease, V vulnificus may cause a self-limited gastroenteritis. However, in those with liver disease, cancer, AIDS, or other immune suppressive illness, it frequently results in fatal infection with bacteremia, septic shock, bullous skin lesions, and necrotic extremities. Increased public awareness and additional safety measures could prevent this infection. Raw oysters from the Gulf should be avoided, especially during the summer months, unless they have been pasteurized or frozen.
Source: ProMED-mail posts, August 17 and August 21, 2001. email@example.com.
An elderly female resident of Atlanta, Ga, died of West Nile Virus (WNV) infection on August 11, representing the first fatality from WNV in the United States this year. She had been admitted to Grady Memorial Hospital with meningoecephalitis 12 days earlier. Although physicians had been placed on alert for WNV, the infection was confirmed by the CDC after her death. She was a resident of an elderly housing unit in downtown Atlanta and had not traveled outside of the county.
Moving down the eastern seaboard this summer, WNV has become a significant problem in the Southeast, especially in Georgia and Florida. Numerous birds in both states have been found infected, as well as 28 horses and 3 sentinel chickens. No other deaths from WNV have occurred this summer, although in addition to this case in Georgia, infection has been confirmed in 4 persons from Florida and 1 from Staten Island, New York.
Source: Millar MR, et al. J Antimicrob Chemother. 2001;47:605-610.
Careful screening of healthy British children has found that many harbor resistant bacteria in oropharyngeal secretions and stools, even though many had not been exposed to antibiotics. Bacterial cultures were performed on mouthwashes obtained from 539 children aged 7-8 years. In 105 children for whom this information was available, none had received tetracycline, chloramphenicol, or third-generation cephalosporins within the past year. While only 17 children (3.2%) were found to be infected with Group B beta-hemolytic streptococci (1 of which was resistant to tetracycline), S aureus was found in 200 (37%) of the specimens. Two percent of these were methicillin resistant.
Hemophilus spp. were isolated from 72% of samples, 17% of which were resistant to ampicillin and 13% were resistant to erythromycin. Branhamella catarrhalis was isolated from 74% of specimens, 8% of which were erythromcyin resistant and 4% were tetracycline resistant. Interestingly, 17 of 335 (5.1%) children tested for resistant gram-negative bacteria in stool specimens had isolates resistant to third generation cephalosporins. Six of these isolates produced extended spectrum beta-lactamases. In addition, 11% of gram-negative bacteria isolated in stools had high-level resistance to chloramphenicol. Even healthy children without recent exposure to antibacterials frequently carry organisms with broad antibacterial resistance.