US tularemia cases now top 100

Cases of tularemia in four US states have reached at least 104 for 2015, according to federal and state officials.

The Centers for Disease Control and Prevention (CDC) said in today's Morbidity and Mortality Weekly Report (MMWR) that Colorado has reported 43 cases, Nebraska 21, South Dakota 20, and Wyoming 16, for 100 total cases. South Dakota, however, in its most recent infectious disease summary, which covers the year through September, reported 24 tularemia cases, which brings the total to 104.

That compares with about 125 in the entire previous decade, the CDC said in the MMWR report.

Patients range in age from 10 months to 89 years, with a median of 56 years, the CDC said. Seventy-four of them are male. The most common clinical presentations of the disease were respiratory disease (the pneumonic form, in 26 patients), skin lesions with lymph node involvement (the ulceroglandular form, 26), and a general febrile illness (typhoidal form, 25).

Of the patients, 48 were hospitalized, and 1 death was reported, in an 85-year-old man. Possible exposure routes included animal contact (in 51 patients), environmental aerosolizing activities (49), and arthropod bites (34). Forty-one patients reported two or more possible exposures.

The CDC says healthcare professionals in the affected regions should be aware of the disease in those at risk.

The authors write that the cause for the increase in cases is unclear, adding, "Possible explanations might be contributing factors, including increased rainfall promoting vegetation growth, pathogen survival, and increased rodent and rabbit populations. Increased awareness and testing since tularemia was reinstated as a nationally notifiable disease in January 2000 is also a possible explanation."
Dec 4 MMWR report
September South Dakota infectious disease summary

Eight Guillain-Barre cases noted in French Polynesia chikungunya outbreak

French Polynesian and French scientists, writing in Eurosurveillance yesterday, reported a cluster of the neurologic condition Guillain-Barre syndrome (GBS) in nine patients who had chikungunya during a recent outbreak in French Polynesia.

The patients were admitted to a tertiary hospital for GBS symptoms at some point from November 2014 through February 2015. The island experienced an outbreak of about 66,000 chikungunya cases from October 2014 through March 2015.

The patients ranged in age from 37 to 77 years, with a median age of 48. Six of the patients were men. Two patients had hypertension, and a third had hypertension plus diabetes. The rest did not have preexisting conditions.

Weakness and paralysis progressed from the lower to upper limbs in eight patients, while the ninth had only facial involvement. Four required intensive care. Hospital stays averaged 8 days (range, 3 to 40). All the patients had serologic evidence of past dengue infection, while eight had antibodies to Zika virus.

The authors wrote, "GBS had already been associated with several arboviral diseases including chikungunya virus infections, but a cluster as we reported here had never been described."
Dec 3 Eurosurveillance report

Newly identified mcr-1 resistance gene found in Denmark

Just 2 weeks after a highly worrying resistance gene called mcr-1 was first identified in China, Danish researchers report that it has existed in their country since at least 2012.

After Chinese researchers reported their findings Nov 18 in The Lancet Infectious Diseases, mcr-1 whole-genome sequencing data were made available to other investigators. And researchers from the Danish National Food Institute, Technical University of Denmark (DTU), and Statens Serum Institut used a computer program that quickly maps a bacterium's DNA to identify the gene among bacterial data stored in a Danish database, according to a DTU press release yesterday.

They found mcr-1 in Escherichia coli samples from a patient who had a blood infection in 2015, as well as in five food samples that have been imported from 2012 through 2014. "All the bacteria are multiresistant [extended spectrum beta-lactamase] bacteria containing the mcr-1 gene, which can further complicate treatment," according to the release.

A STAT story yesterday said the patient was a man who had not traveled outside Denmark, and the food samples are poultry imported from Germany.
Dec 3 DTU press release
Dec 3 STAT story
Nov 20 CIDRAP News scan on findings in China

Chipotle E coli outbreak grows by 7 cases, 3 states

An outbreak of Escherichia coli infections linked to Chipotle restaurants has grown by 7 cases and 3 states, to 52 cases and 9 states, the CDC said today in an update.

Illinois, Pennsylvania, and Maryland each reported a case since the previous CDC update, on Nov 20, to join the list of affected states. Washington has had the most cases, with 27, followed by Oregon, 13; California and Ohio, 3 each; and Minnesota, 2. New York had previously reported a case.

Of the 7 new illnesses, 2 began in October and 5 in November, the CDC said. Of the 3 most recent cases reported in November, only one patient, whose illness started on Nov 10, reported eating at Chipotle Mexican Grill the week before illness onset. Among all patients, illnesses began from Oct 19 to Nov 13.

Patients range in age from 1 year to 94, with a median age of 21 years, and 59% are female. Twenty people (38%) reported being hospitalized, but there have been no reports of hemolytic uremic syndrome—a potentially deadly kidney complication—and no deaths.

Of the patients, 47 (90%) reported eating at a Chipotle before getting sick, the CDC said. Officials are still probing what food might be causing the illnesses.
Dec 4 CDC update

WHO details 3 MERS cases in Saudi Arabia

The World Health Organization (WHO) today provided new details on three MERS-CoV patients that have already been confirmed by Saudi officials, two of whom died.

The cases were reported to the WHO by Saudi Arabia's Ministry of Health (MOH) from Nov 2 through Nov 27. They bring the number of lab-confirmed cases of MERS-CoV (Middle East respiratory syndrome coronavirus) reported to the WHO to 1,621, including at least 584 deaths.

The first patient was a 70-year-old man in Riyadh who developed symptoms on Oct 28 and was hospitalized on Oct 30. He tested positive for the virus on Nov 11 and died the same day. He owned camels, had frequent contact with them, and drank raw camel milk, all of which are considered MERS risk factors.

The second patient was a 50-year-old woman in Afif, about halfway between Riyadh and Mecca. She first had symptoms on Oct 30 and was hospitalized the next day. She tested positive on Nov 1 and died on Nov 4. She had preexisting conditions but no known risk factors before getting sick.

The third patient is a 47-year-old male foreigner in Al-Kharj who became sick on Nov 4. He tested positive for MERS-CoV on Nov 12 and is still in critical condition. He has comorbidities and had contact with another MERS patient before becoming ill.

For the third day in a row, the Saudi MOH reported no new MERS-CoV cases, keeping the country at 1,278 cases and 549 deaths.
Dec 4 WHO update
Dec 4 MOH statement