17 August, 2010

Spotlight News of the Week

NDM-1: Foreshadowing World’s Next Superbug?
This week saw numerous news stories on a possible new superbug, NDM-1. The first NDM-1 associated death was reportedly a Belgian man who was infected in Pakistan after surgery for a car accident injury. In recent years, rising medical costs in Western countries such as the US and Britain have driven patients seeking more affordable care and procedures to developing countries like India and Pakistan, a phenomenon now known as “medical tourism.” Since December of 2009, bacteria with resistance to nearly all known antibiotics have been found in British, Australian, Canadian, American and Dutch patients who had previously sought care in India. These bacteria contained a gene producing resistance to even the most powerful class of antibiotics (carbapenems). The gene was named New Delhi Metallo-beta-lactamase (NDM-1) after the city where it was believed to have originated. A study published in The Lancet in early August found NDM-1-carrying bacteria to be common in hospitals in India, Bangladesh and Pakistan and even more prevalent among the local community, where it can spread easily through contaminated water. A backlash against the news coverage has taken two forms: scientific and political. Some scientists are concerned that the media hype suggests NDM-1 is a spectacular concern even though other antibiotic resistance infections are also very troubling. Politicians and medical tourism advocates in India have suggested the report is an attack on a budding industry. The Lancet is one of the oldest and most prestigious medical journals in the world.

The most common carriers of NDM-1 are gram-negative E. coli and K. pneumoniae which cause urinary and respiratory infections and can potentially transfer the gene to other infectious gram-negative bacteria. As the focus has traditionally been on development of antibiotics against gram-positive bacteria such as MRSA, it is worrisome to consider how global travel can potentially propagate resistance to a multitude of disease-causing bacteria around the world with no effective treatments on the horizon.

Additional News Highlights:

Dengue in Florida:
Florida’s Broward County Health Department announced a confirmed case of Dengue in a woman who had not left the county for weeks. Broward County is now only the second location in the US to document a locally acquired case (Key West has seen 53 cases this year). For decades, almost all dengue cases in the 48 continental US states acquired the disease during international travel or visits to more tropical US locations (e.g. Puerto Rico and the US Virgin Islands). The identification of this locally acquired case means that a mosquito in Broward County was carrying Dengue and transmitted to the confirmed case. Therefore, other residents in the county are likely at risk as well..

West Nile Virus in British Colombia and Greece:
Since its first appearance in North America in 1999, West Nile virus has steadily spread outward from the initial cases in the New York area. This week, it was identified in a dead crow for the first time in British Colombia. West Nile Virus has been seen historically in Europe but it has been far less common in recent years. Therefore, Greece’s announcement of 32 cases and at least 2 deaths has concerned its neighbors. Approximately 80% of people who are infected show no signs of illness, but in rare cases (about 1 in 150) severe and potentially fatal illness can occur.

Typhoid Fever in the United States:
A rare outbreak of Typhoid Fever in the United States has been linked to frozen Mamey (a reddish tropical fruit also known as zapote or sapote) used to make fruit smoothies. Epidemiological evidence has pointed the Centers for Disease Control to Goya Foods, Inc. who have since recalled packages of the frozen fruit product. Seven cases of Salmonella Typhi have been confirmed to date (3 in California and 4 in Nevada).

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