Michigan reports fatal Elizabethkingia case

Michigan health officials today announced a fatal Elizabethkingia anopheles bloodstream infection matching an ongoing outbreak in Wisconsin, according to a statement. The patient was an older adult with underlying health conditions from western Michigan, the Michigan Department of Health and Human Services (MDHHS) said.

Eden Wells, MD, MPH, said the test results were confirmed by the Centers for Disease Control and Prevention on Mar 11 and added that the MDHHS has notified state health providers about the importance of early recognition.

Wisconsin health officials first announced the outbreak in early March, and so far they have detected 54 cases. Seventeen of the patients died, but it's not clear if the deaths were caused by the bacterial infection.

So far the source of the bacteria in the sick patients isn't known. E anopheles, which can be present in the soil and other environmental sources, is multidrug-resistant, but the Wisconsin strain is susceptible to fluoroquinolones, rifampin, trimethoprim/sufamethoxazole, and minocycline. The opportunistic organism typically affects people who are immune-compromised or have other underlying health conditions.
Mar 17 MDHHS statement
Mar 16 Wisconsin update
Mar 11 CIDRAP News scan "Wisconsin notes more bloodstream infections in Elizabethkingia outbreak"

Germany reports first locally acquired Lassa fever case

A funeral home worker from Germany's Alzey-Worms district has been hospitalized in isolation after testing positive for Lassa virus, according to a report yesterday from Der Spiegel and the ProMed Mail, the news service of the International Society for Infectious Diseases.

The patient had contact with the body of an American nurse who worked with Lassa fever patients in Togo and died at Cologne University Hospital on Feb 26. The nurse's infection was not diagnosed until Mar 9 after the body had been transported to the town of Alzey.

The funeral home employee, who is being treated in Frankfurt University Hospital's special isolation unit, tested positive for Lassa virus on Mar 15 after an initial negative test on Mar 10. He or she denied having contact with the deceased's bodily fluids, and the report does not say whether the patient is symptomatic.

The infection is Germany's first locally acquired case of Lassa fever, which can cause hemorrhagic fever and infects 100,000 to 300,000 people in West Africa each year. The patient's family members have also been hospitalized as a precaution, the report said.
Mar 16 ProMed Mail report

Europe proposes interventions to prevent TB in vulnerable groups

Tuberculosis (TB) elimination strategies in Europe must increase access to screening and treatment for vulnerable populations, including migrants and refugees, according to two reports today from the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC).

Though tuberculosis incidence in Europe decreased by 4.3% from 2010 to 2014, 340,000 Europeans were diagnosed as having the disease in 2014 (37 cases per 100,000 population). Incidence was as high as 788 cases per 100,000 among the homeless, the ECDC said. about one fourth of all global multidrug-resistant TB cases in 2014 occurred in Europe.

The WHO and ECDC recommend targeting screening and treatment programs to those at greatest risk of drug-resistant disease, including refugees and migrants from countries where TB infections are widespread, homeless people, substance abusers, and prisoners.

Interventions recommended by the ECDC include mobile unit outreach, financial and material incentives for screening and treatment, coordination with social service agencies, flexible strategies for directly observed treatment, and education to reduce stigma. The agency cited successes with programs that promoted video-observed treatment via smartphones in the United Kingdom and among health workers in the Romani community in Slovakia.

Other recommendations addressed the need to ensure access to medical care and reduce fears of deportation and stigma among Europe's growing migrant and refugee population. "TB screening must never be used as a reason to reject a refugee or a migrant," the WHO said.
Mar 17 WHO press release
Mar 17 ECDC policy briefing