Updated guidance from the CDC on Zika, candidemia infections in patients with C. difficile infections, and more topics made up our Top 5 articles for the month of October 2017.
#5: Nearly 10% of Americans with Candidemia have Clostridium difficile Co-infection
A survey of Americans hospitalized for treatment of candidemia has revealed the presence of Clostridium difficile (C. difficile) co-infection in almost 10% of the cases.
Infections caused by C. difficile and Candida species are important healthcare-associated infections. A multistate survey carried out in 2014 by the US Centers for Disease Control and Prevention (CDC) reported C. difficile and Candida in 61 of 504 (12.1%) and 32 of 504 (6.3%) infections, with C. difficile responsible for 70% of all recorded gastrointestinal infections and Candida responsible for 22% of all bloodstream infections. Both infections carry a high mortality rate.
The root of Candida-C. difficile co-infections is antibiotic pressure. Disruption of the gut flora can lead to decreased immunity, which promotes colonization by Candida and the presence of the microbe in the blood (candidemia). C. difficile can also take advantage of the altered gut flora to establish an infection. The 2 infections often occur separately, but they can co-exist. How often that occurs is unclear.
#4: Threat of Zika Virus Still Looms in Southern States
On October 12, 2017, the Florida Department of Health (DOH) confirmed a case of locally-transmitted Zika virus in the state. This new case adds to the growing total of travel-related and undetermined cases in Florida, bringing the grand total to 188 statewide cases. The Manatee County case is believed to be an isolated case and the Centers for Disease Control and Prevention (CDC) state there is no evidence to support active and ongoing transmission of the Zika virus.
According to the Florida DOH, this case involves a couple who had traveled to Cuba. One partner acquired the Zika virus in Cuba and returned home. Once home, a mosquito bit the infected partner and then bit the uninfected partner, transferring the virus to the other partner.
This incident underscores the need for individuals who have traveled to Zika-endemic areas to take the necessary steps to avoid being bitten by mosquitoes for at least 3 weeks when they return to the United States, according to the Florida DOH. This will help stave off the chance of spreading the virus to the community and an individual’s loved ones and friends. Precautions should be made on a personal level and in the environment. The mosquitoes that transmit the Zika virus can breed in as little as a teaspoon of water, and so the Florida DOH is reminding residents to “drain all sources of standing water to keep mosquitoes from multiplying.” In addition, residents and visitors should remain vigilant about using insect repellent throughout the day and night to prevent bites.
#3: Herpes Simplex Virus 2 and HIV—What's the Connection?
Although international health organizations often focus on the nearly 37 million people worldwide who live with HIV, another sexually transmitted disease—herpes simplex 2 (HSV-2), the main cause of genital herpes, is a far more common condition. According to the World Health Organization, as of 2012, there were 417 million people globally between the ages of 15 and 49 with HSV-2, many of them, like most with HIV, reside in sub-Saharan Africa. And while HSV-2 on its own is not fatal, having the condition makes an individual more likely to contract HIV, just as having HIV raises a person’s risk of HSV-2.
This symbiosis and what it means for a vulnerable population was behind a British team’s effort to document the risk of HIV acquisition in people infected with HSV-2. Scientists at the University of Bristol and Imperial College London delved into multiple studies conducted between 2003 and 2017, mostly in Africa, that examined the connection between these 2 chronic infections. They found that individuals with HSV-2 had a decidedly higher risk of acquiring HIV than those without HSV-2. This risk was nearly tripled among the general population and doubled for people in high-risk categories, such as women engaged in sex work, men who frequent sex workers, and men who have sex with men. And when the data was analyzed to separate out individuals who had acquired HSV-2 after the study began versus those who had been infected with it earlier, the team found that the risk of contracting HIV was 5 times greater in the general population.
#2: CDC Issues Updated Guidance for Infants Born to Mothers with Possible Zika Infection During Pregnancy
Today, October 19, 2017, in a new Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention (CDC) released updated interim clinical guidance designed to help healthcare providers as they care for infants who were born to mothers with potential Zika virus infection while pregnant.
In August 2017, the CDC, in collaboration with the American Academy of Pediatrics as well as the American College of Obstetricians and Gynecologists, hosted a meeting where clinical experts presented emerging evidence in the realm of Zika virus. These presentations focused on the diagnosis, evaluation, and management of infants with potential congenital Zika virus. The evidence presented was used to inform the updated guidance.
Despite the fact that Zika virus cases are down compared with this time last year, cases continue to spring up in other countries across the world and in the United States, which serves as a reminder: Zika is still a big public health threat, especially to pregnant women and their unborn children.
#1: Rare Infectious Disease Spreading in Puerto Rico: Public Health Watch Report
Federal assistance for Puerto Rico in the aftermath of Hurricane Maria may not be around “forever,” but an infectious component of the storm's impact on the US territory may linger.
According to reports in multiple media outlets, including the Washington Post, clinicians on the storm-ravaged island have already identified at least 10 cases of leptospirosis, a water-borne infection. Given that as many as one-third of Puerto Rico's residents still do not have running water—some 4 weeks after Maria touched down—it is expected that more cases of the bacterial disease will emerge as residents have been forced to stand in line for access to communal water supplies. Leptospirosis is also spread via dogs and cats, livestock, and rodents—relevant considering a report by the SunshineStateNews.com, which suggests that garbage collection has not resumed on much of the island and that there have been sightings of dead animals in the streets in some areas.
All of which makes Puerto Rico a potential ground zero for a major outbreak of an infectious disease, experts say.