Move Over MRSA, C. difficile is Here

30 04 2010

Clostridium difficile, or C. difficile, is a tough bacterium that’s been around a long time and has always been more prevalent in hospitals and healthcare facilities than MRSA.

It plagues those who are older, or immunocompromised, or have a serious illness. However, those on simple antibiotics can also be at risk.

A new strain of C. difficile has been detected and it is more drug-resistant, more virulent, and more deadly than other, older strains.

C. difficile can be transmitted in feces, so anything that comes into contact with feces in or out of a healthcare setting can readily spread the bacterium. This includes any surface, or standard objects such as rectal thermometers, commodes, bathing tubs, or table tops. It also includes healthcare professionals with contaminated hands or clothing.

C. difficile can be recurring. The germ creates spores which remain dormant on surfaces for weeks or months at a time. If we touch the contaminated surface and eat something without washing our hands, we might just “eat” C. difficile.

Testing procedures include various kinds of stool testing, an examination of the colon, or a CT scan.

There’s no specific test that differentiates between the various C. difficile strains, including the more virulent, drug-resistant strain.

Common symptoms include watery diarrhea, fever, nausea, abdominal pain and lack of appetite.

Complications from C. difficile may result in a torn colon or perforated bowel, PMC colitis, sepsis, and death.

Treatment might be as simple as stopping an antibiotic, or changing to a different one, but sometimes the infection is so bad that patients will try a fecal transplant. And you have to read about this, even if just for the “eeeewww” factor.

Alcohol-based hand sanitizers are effective in cutting back MRSA infections, but for C. difficile, good old fashioned handwashing with soap and water works better.

MRSA and C. difficile are in our communities as well as in our hospitals, and they’re not the only superbugs defeating the antibiotics we have.

Scientists are trying to stay a step ahead by developing more and better drugs to defeat these stubborn and drug-resistant microbes.

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Cryptococcus: One Scary Microbe

28 04 2010
NIOSH N95 mask

NIOSH N95 mask, courtesy Gruscana on Flickr

Cryptococcus gattii is all over the news. This dangerous fungus is making its way down the coast from British Columbia, through Washington and Oregon, and soon into California.

Now comes the really scary part.  When that fungus hit Oregon, it changed. There’s now a new strain of this fungus that’s even more deadly to humans and animals than the one that originated in B.C.

The fungus doesn’t spread person to person—you breathe it in while outdoors.  Symptoms may not start for months, it’s hard to diagnose, and if not caught in time, it’s difficult to treat.

There’s no vaccine and there’s little one can do to prevent infection.

Not much good news, but the scientists are working on it.

We talked with a man from the state of Washington who’s still recovering from his infection. This is his story, as he shared it with us:

Around August 2008, I was doing some work on my house, and I started coughing and feeling short of breath. I went to urgent care at Group Health where they took an X-ray and said I had pneumonia. They put me on IV antibiotics. Each treatment lasted about an hour and a half, and I had 11 treatments over about two and a half weeks’ time, but I wasn’t getting better.

The doctors did more X-rays and could see that my left lung was clouded. They gave me a test for gastroesophageal reflux and did a scan with dye, and finally said they thought I had cancer. I was then admitted to the hospital where I had a bronchoscopy. The pulmonologist said my lung had nodules, like cancer, but the samples they took came back negative. The doctors really couldn’t figure out what was wrong with me!

I then saw an infectious disease doctor, who was more familiar with symptoms like mine because of his work with AIDS patients. He asked what I’d been doing lately, and I said I thought maybe I’d inhaled some dust from mowing my yard, which has bird feeders in it, or from cutting limbs off trees. I’ve never worn a mask for any work I’ve done around my place.

They sent my tissue samples to the University of Washington and that is when they determined I had Cryptococcus. I was in the hospital nine days total. They also did a spinal tap to be sure the Cryptococcus was not causing meningitis.

I started on fluconazale, 400mg daily, but it wasn’t working so they increased it to 600mg. I have to take it for three years—this summer, I’ll complete my second year of it. I’m now down to about 200mg/day. At first, I had to go in every month so they could do X-rays and blood tests.

My lungs are pretty clear now, but the Cryptococcus is still in my blood. Fortunately, the amount of it drops by half about every time I get tested. I only have to go in about every 6 months now.

They told me if I had not started treatments when I did, I would have lived only another six to nine  days.

When you have Cryptococcus, the coughing is terrible—you just can’t stop. I couldn’t have conversations with people, it was so bad at times. I’d wake up in the night a lot and cough stuff up. The first month was especially bad this way—you gag a lot. Drinking orange juice helped me—I’m not sure why, but I’d carry it with me everywhere so that I could at least carry on a conversation.

I’ve had to build my stamina back up slowly. I feel I’m at about 90 percent now. My lungs have some scarring that will always be there, but they do expect that the Cryptococcus will clear my system.

My advice to others is to wear a mask! If you have any doubts at all, wear one. Whenever I mow, or do anything around the bird feeders, or go into the barn area, I wear a mask. This also helps protect against other diseases transmitted in bat and rodent droppings. You have to get the kind with a filter. I use NIOSH N95, and after I use a mask, I throw it out.

I feel very cautious now. We recently had a friend in the hospital with MRSA, and I didn’t visit her because of that. I wonder about people working in the poultry or forestry industries. I hope they are wearing masks.

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Germs – It’s a Symbiotic Thing

26 04 2010

We have 100 trillion microbes in and on our bodies. Most of these little critters don’t affect us—no harm, no foul.  Some germs even help out with digestion and other functions, and some cause illness.

Despite the fact that we’re walking bags of bugs, we don’t want to think about it and we definitely don’t want to get more germs, at least not the disease-causing kind.

Photo courtesy "bmann"

To prevent disease and general yuckiness in the home and elsewhere, we are a sponge-and-cleaner wielding people. Some of us more than others. (That’s right, Mom, I’m talking about you.)

We can’t keep our homes and offices germ-free, nor should we.  We have a symbiotic relationship with the germs in our world that requires a delicate balance of healthy intimacy to maintain.

But, we don’t want pathogenic germs to get the upper hand.  They’re the germs capable of causing disease.

Being clean and tidy helps keep the nasty numbers down, but germs will always be with us. Our bodies fight pathogens off all day long as we go about our business.

And when we actually do get around to cleaning, we tend to focus on obvious trouble spots (bathrooms, kitchens) while ignoring places we don’t typically think of as germ hot zones. We’re talking about our offices, our phones, our keyboards.

Dr. Charles Gerba, a professor of microbiology at The University of Arizona at Tucson, has done a lot of research on viruses and bacteria in offices.

His work reveals startling facts. For instance, the germiest place in any type of office is something you use every day. “The phone is typically the dirtiest piece of equipment in an office because it goes straight to your mouth, and you never clean or disinfect it,” says Gerba.

Right behind phones are desks, which often pull double-duty as restaurant tables, and keyboards, which are tricky to clean and good at collecting things like dirt, hair, food particles, dust and bacteria. Many of us like to grab a bite while catching up on email, but studies may make you rethink that: keyboards are usually much germier than toilet seats.

Things get complicated if many people share a computer. This is bad news if you absent-mindedly bite your nails or touch your nose or eyes while working.

Women’s offices tend to have more germs in them, as women tend to bring in and take out more items like bags and purses, which can carry germs that get transferred to office equipment.

However, men’s wallets are often found to be germier than women’s purses.

So, how can you protect yourself at work without turning into a worrywart? In an interview with Entrepreneur, Gerba suggested you:

  • Wipe down your desk and surrounding items with a disinfecting wipe once a week.
  • Keep a hand sanitizer at your desk and use it throughout the day.
  • If you tend to eat at your desk on a regular basis, think again–this behavior is inviting bacteria to grow at your fingertips.
  • Wash coffee mugs and glasses on a regular basis.
  • If you’re sick, don’t go to work.

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PubMed: Obtaining Full-Text Journal Articles

23 04 2010

In our previous PubMed articles, we discussed finding free articles online and conducting more effective searches. In this PubMed post, we discuss ways to get full text articles that are not free online.

Visit Your Libraries

Local Library

Check with your local library to see if they have the journal in question, or if they can get it in for you. This may be your only recourse for getting full articles at no cost, even if you have to wait awhile to get the journal.

Nearest Medical Library

If your local library doesn’t have or cannot get the journal or article you want, contact your nearest medical library. Call the National Network of Libraries of Medicine at 800-338-7657 or visit their website to locate your nearest library. (You can’t call this number to get help finding information, but they can help you locate a library.)

Order Online Through PubMed

Loansome Doc

PubMed is primarily for medical students and professionals, which is why it provides a service called Loansome Doc that enables you to 1) find medical libraries in your state serving the general public, and 2) easily and conveniently order journal articles through PubMed.

When viewing an article’s abstract, clicking on the “Send To” link opens a box from which you can select “Order.” Clicking the “Order articles” button will direct you to enter your Loansome Doc login information.

PubMed Loansome Doc

Ordering option for Loansome Doc

Registration for Loansome Doc is free; you only pay when you order an article. To sign up for Loansome Doc, visit the Loansome Doc signup page.  The first step will help you locate a medical library near you. You will need to contact the medical library of your choice to get signed up with them.

If you are not a healthcare provider or student, the medical library will consider you an “unaffiliated user.” Each library will have different criteria regarding unaffiliated users, pricing, and document delivery formats (hardcopy vs. electronic, e.g.).

LinkOut

If you click on an article’s title in your PubMed search results, you can click “LinkOut” at the bottom of the abstract to see online sources providing full text. You do not need a Loansome Doc account for these, but you may have to set up an account on the website of the online source to place an order.

PubMed - LinkOut

Viewing options for ordering under LinkOut

So to sum up:

  • Try your local library or visit a medical library (if you have one close to you).
  • If you are planning to order articles on a relatively frequent basis, sign up for Loansome Doc so you can place all your orders from within PubMed.
  • If you are planning to order articles relatively infrequently, try ordering from a LinkOut service.




Kids Come to Work and Speak Up

22 04 2010

(We welcome two guest bloggers today: Paloma, age 10, writes about handwashing, and Paris, age 14, writes about Earth Day.)

 

Handwashing is important because if you don’t wash your hands, then you will probably get sick.

You can also spread your germs and make other people sick. For example, if you were to eat a slice of pie with a friend and you or your friend didn’t wash your hands, then you and your friend could be putting your germs into the other person’s mouth.

Everyone should wash their hands after eating a meal and before and after playing outside but if you don’t have soap and water around you it’s always good to keep hand sanitizer with you!=)

Just as the health of our bodies is important, so is the health of our Earth.

Today I want to talk to you about our Earth’s oceans and why it is important to keep them clean.  It is important to keep our oceans clean because they make up about 70% of our planet.

Throwing plastic into our oceans can harm the animals like seals that are curious and get tangled up in plastic and die from suffocation. Another good reason why we should properly throw away our trash is because sea turtles will eat the plastic sandwich bags and they will get caught in their throats or digestive system.

Plus, it just makes our oceans look dirty and we want a clean looking ocean not one that’s filled with tons of trash. So, please make sure your trash ends up in the trash cans or recycle.

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Meningitis: A College Memory You Don’t Want

21 04 2010

Going away to school is a lifechanging experience. For many students, four years disappear into a haze of studying, working, and partying with their classmates. It’s a chaotic time where everything is shared: space, feelings, clothes, cars, and germs.

When a meningitis outbreak shows up in the news, it’s a good bet that it showed up at a school. Any shared spaces like schools, dorms, or barracks where crowds of young adults converge are favorite territories for bacteria and viruses to spread.

Meningitis, a serious but rare infection, is an inflammation of the membranes covering the brain and spinal cord. It affects about 1,500 Americans each year.

Meningitis is commonly mistaken for the flu in its early stages, and therefore left untreated. When this happens, it can do a lot of damage within hours, sometimes causing confusion, seizures, and brain damage. Survivors are often left with amputated limbs—permanent reminders of their experience.

So what does meningitis act like and why are colleges a prime environment for it?

Most meningitis patients complain of excruciating headaches, unyielding fevers, nausea, and vomiting. Sound like just a bad case of the flu? More telling are other symptoms, which include stiffness and pain in the neck (due to the swelling around the spinal cord and brain), sensitivity to light, numbness or loss of sensation in limbs, rashes, mental confusion, and convulsions and seizures.

Most at risk are college students. Busy, exhausted, and stressed students often have lowered immune systems. A wide variety of lifestyles and health choices create a melting pot of germs, especially when bathrooms and eating areas are shared. Meningitis is spread through contact with an infected person’s bodily fluid: a shared cigarette or drink, a kiss, a cough. It’s possible to carry a germ that causes meningitis and never be sick, while unknowingly passing it on to someone else. There are lots of ways to spread it.

Many such infections could be prevented with vaccination. Some schools are now requiring proof of vaccination; others only provide information about meningitis. Before heading off to college, make sure you’re protected and know what the warning signs are. Parents, if you’re reading this, make sure your son or daughter is protected before they leave you.  It could be the most important going-away gift you give your child.

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Flu Season Roundup and the Importance of Annual Vaccination

19 04 2010

By Laura Scott, Executive Director of Families Fighting Flu

If you are like most parents, you’ve had a lot of questions this flu season, like: What exactly is the flu? Why do we need to get vaccinated against the flu every year? If my child or I received the H1N1 flu vaccine this year, do we need to get vaccinated again next season?

Courtesy Retrofuturs

Influenza (or “the flu”) is often mistaken for the common cold.  But, the flu is not a bad cold or a stomach bug.  Rather, it’s a serious virus that claims the lives of nearly 100 children younger than five years of age in the U.S. annually, and more than 20,000 children under the age of five are hospitalized every year.

Since April 2009, the CDC has received reports of 337 laboratory-confirmed pediatric deaths from influenza.  However, unlike seasonal influenza where younger children under the age of five are typically most affected, 71 percent of this season’s pediatric deaths from H1N1 influenza occurred in school-age children, ages five to 17 years.

Annual vaccination is the single best way to help prevent illness and death caused by influenza in people of all age groups.  As of the end of February 2010, between 72 and 81 million people—more than 30 percent of children and nearly 20 percent of adults—were reported as being vaccinated against H1N1 in the U.S.  That’s good, but not good enough.  In order to help slow and ultimately stop the spread of the virus, more people, especially children, need to get vaccinated.

This year, we’ve seen H1N1’s path of destruction across the globe, and it continues to be the dominant strain of influenza.  In fact, more than 213 countries and territories have reported laboratory-confirmed cases of H1N1, resulting in more than 17,700 deaths worldwide.  Although this number is less than what we typically see in an average flu season in the U.S. (36,000 deaths), it is still a large number, representing lives lost to a vaccine-preventable illness.

It’s important to understand why people need to get an annual flu vaccination. Most years, the strains of flu virus that spread throughout the world change genetically.  When that happens, the previous year’s flu vaccine may not be effective.

Therefore, every February, the Vaccines and Related Biological Products Advisory Committee advises the Food and Drug Administration on which flu strains to include in the next season’s vaccine.

The selection of the flu strains is made early in the year. This gives flu manufacturers time to make enough vaccine for the upcoming flu season.  The manufacturers need a good length of time to produce the vaccines because it takes a while to grow vaccines in eggs, which is currently the only licensed method for making flu vaccines.

It is worth noting that the 2009 H1N1 strain was a separate vaccine this flu season because the pandemic strain didn’t rear its ugly head until last April, which by then was too late to be included in the seasonal vaccine.

Each year, the vaccine is comprised of three different strains to help protect people against the most common types of influenza viruses circulating around the world for that particular year.  Flu vaccines typically contain two “A” strains and one “B” strain.

Based on global surveillance data and the World Health Organization’s recommendation, the following three strains will be included in the flu vaccines (shot form and nasal spray) for the 2010-2011 U.S. season:

  • an A/California/7/09 (H1N1)-like virus
  • an A/Perth /16/2009 (H3N2)-like virus
  • a B/Brisbane/60/2008-like virus

The 2009 H1N1 strain that people got vaccinated against this season will be in next flu season’s vaccine.  But, even if you got vaccinated against the H1N1 strain, you still need to get vaccinated again next season because now that strain will be part of the seasonal flu vaccine, which includes two other strains of flu virus.

So, what will next flu season bring in the way of disease?  Generally, we can gauge what the U.S. flu season will be like next season from looking at flu trends in the Southern Hemisphere, where the winter flu season starts in April or May.  Based on what we’re seeing right now, I expect that H1N1 will continue to be the dominating strain during the 2010-2011 flu season in the U.S.  In fact, until a large majority of the population gets vaccinated, the strain is likely to continue to circulate on a global scale.  Once enough immunity has been built over the next several years, the virus will begin to act more like a seasonal strain.

Now for the question of who should get vaccinated against the flu each year.

Just this past February, the CDC’s Advisory Committee on Immunization Practices voted for universal influenza vaccination, which means everyone 6 months and older should get vaccinated against the flu starting with the 2010-2011 flu season.  The important thing to remember is, in order to safeguard our children from this serious virus, everyone must do their part by getting vaccinated, because prevention from the flu is only as good as the number of people who actually get vaccinated.

To drive awareness about the seriousness of influenza and the importance of getting an annual vaccination, Families Fighting Flu (FFF) leads educational campaigns, including its most recent campaign called Be a Flu Free Family, which was launched in January during National Influenza Vaccination Week.  The multi-pronged campaign included:

  • An original animation, which provides a six-year-old boy’s perspective on why it’s important for his whole family to be vaccinated against the flu, as well as a fun downloadable coloring book with scenes from the animation to help parents talk to their kids about how to stay protected against the flu
  • Audio and video podcasts with Families Fighting Flu members
  • A WebEx for media with the U.S. Department of Health and Human Services and the CDC

For more information on influenza and FFF, visit www.familiesfightingflu.org.

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