Objective: Toxoplasmosis may follow consumption of undercooked meat containing Toxoplasma gondii cysts. Lamb is considered to pose the highest risk for contamination across meats. Red meat is often served undercooked, yet there are no current data on T. gondii contamination of Australian sourced and retailed lamb. We sought to address this gap in public health knowledge.
Methods: Lamb mincemeat was purchased at the supermarket counter three times weekly for six months. T. gondii was detected by real‐time polymerase chain reaction (PCR) of DNA extracted from the meat following homogenisation. Purchases were also tested for common foodborne bacterial pathogens.
Results: Conservative interpretation of PCR testing (i.e. parasite DNA detected in three of four tests) gave a probability of 43% (95% confidence interval, 32%–54%) that lamb mincemeat was contaminated with T. gondii. None of the purchases were contaminated with Campylobacter jejuni, Salmonella species or S. enterica serovar Typhimurium, indicating sanitary meat processing.
Conclusions: Australian lamb is commonly contaminated with T. gondii. Future studies should be directed at testing a range of red meats and meat cuts.
Implications for public health: Consuming undercooked Australian lamb has potential to result in toxoplasmosis. There may be value in health education around this risk.
Lamb as a potential source of toxoplasma gondii infection for Australians
December 2019
Australian and New Zealand Journal of Public Health
The U.S. Centers for Disease Control reports in Morbidity and Mortality Weekly Report that on December 18, 2018, a man aged 87 years was evaluated in a hospital emergency department in Flushing, New York, for right lower abdominal quadrant pain. Evaluation included a computed tomography scan, which showed acute appendicitis with multiple abscesses measuring ≤3 cm. The patient was admitted, a percutaneous drain was placed, and 5 mL of an opaque jelly-like substance was aspirated and sent for culture and testing for antimicrobial sensitivities.
Gram stain of the culture revealed gram-negative rods, and culture revealed monomicrobial 1–2-mm yellowish-brown mucoid colonies.† Sequencing of the isolate’s 16S ribosomal RNA revealed >99.8% homology with Shewanella haliotis strain DW01 in the GenBank database. Antimicrobial susceptibility testing indicated that the isolate was susceptible to aminoglycosides, fluoroquinolones, certain penicillins, and broad-spectrum cephalosporins. Biochemical tests were performed to characterize isolate.
Phylogenetic analysis indicates that S. haliotis strain DW01 is the most recent ancestor of this clinical isolate. This is the first documented case of a S. haliotis appendix infection.
S. haliotis is an emerging human pathogen, first isolated from abalone gut microflora in 2007 (1). The geographic distribution of human infections caused by S. haliotis is concentrated in Asia, with most reports coming from China, Japan, South Korea, and Thailand (2). No cases of S. haliotis human infections had been reported in the World Health Organization’s Region of the Americas.
The patient was treated empirically with intravenous piperacillin-tazobactam while in the hospital and was discharged with a prescription for oral amoxicillin-clavulanic acid. At a follow-up visit 13 days later, he was recovering well. Empiric treatment of Shewanella spp. can be challenging; limited and varying antibiotic susceptibility profiles have been reported (2,3). This patient’s isolate was susceptible to several classes of antimicrobials, but resistance to certain antibiotics has been observed in this isolate and others (2). In a case series of 16 patients from Martinique, Shewanella spp. sensitivities to piperacillin-tazobactam and amoxicillin-clavulanic acid were reported to be 98% and 75%, respectively (3).
Risk factors for or potential vectors of Shewanella spp. infections are unidentified in up to 40%–50% of cases (4). S. haliotis is ecologically distributed in marine environments, including broad contamination of cultivated shellfish. Although infection following consumption of seafood is seldom reported (5), consumption of raw seafood could be an important vehicle for foodborne illnesses and outbreaks. This patient reported consuming raw salmon 10 days before becoming ill but had no other marine exposures or exposure to ill contacts. The time from potential exposure to onset of abdominal pain in this patient is consistent with that reported in the literature on Shewanella spp. (3–49 days). The epidemiologic exposure history supports the link between raw fish consumption and infection.
No other organisms were isolated in this patient; in the Martinique case series of Shewanella spp., one half of infections were monomicrobial as well (3). This case highlights the importance of preventing seafood-associated infections and the need to consider rare human pathogens in elderly or immunocompromised, marine-exposed populations, as well as persons who might consume at-risk food that might have been imported from outside the United States and persons who might have been infected outside the United States when traveling.
Outbreak News Today reports that since the last report on the Cryptosporidium outbreak in Sweden about two weeks ago, health officials say the number of reported cases has decreased in recent weeks.
While cases are declining, the number of cases reported per week remains slightly higher compared to the same period in previous years. To date, some 400 Cryptosporidium cases have been recorded.
Most cases have been reported from Stockholm, Östergötland, Västra Götaland, Halland, Jönköping and Uppsala.
The Public Health Authority analyzes samples from the cases to determine what type of cryptosporidium they have become ill from. Of the 202 samples analyzed so far, 93 have been shown to belong to subtype (A) and 58 belong to subtype B of Cryptosporidium parvum. In addition to this subtype, a number of different subtypes have been detected.
The fact that different subtypes are seen indicates that there are different sources of infection for the cases reported during the fall. From the survey studies it was shown that cases with subtype A have drunk to a greater extent pre-purchased freshly squeezed fruit and vegetable drinks that are no longer on the market when the shelf life is short. The majority (almost 80%) of cases with subtype A were reported to have fallen ill.
The U.S. Centers for Disease Control reports on October 25, 2018, at 2:15 a.m., a woman aged 30 years and her mother, aged 55 years, both of Egyptian descent, arrived at an emergency department in New Jersey in hypotensive shock after 16 hours of abdominal pain, vomiting, and diarrhea. The daughter also reported blurry vision and double vision (diplopia), shortness of breath, chest pain, and difficulty speaking. She appeared lethargic and had ophthalmoplegia and bilateral ptosis. Both women were admitted to the hospital. The mother improved after fluid resuscitation, but the daughter required vasopressor support in the intensive care unit. Although the mother did not have evidence of cranial nerve involvement on admission, during the next 24 hours, she developed dysphagia and autonomic dysfunction with syncope and orthostasis and was transferred to the intensive care unit as her symptoms progressively worsened similar to those of her daughter.
Two days before admission, both women had eaten fesikh, a traditional Egyptian fish dish of uneviscerated gray mullet that is fermented and salt-cured. Fesikh has been linked to foodborne botulism, including a large type E outbreak in Egypt in 1993 (1). The Egyptian Ministry of Health has since issued public health warnings regarding fesikh before Sham el-Nessim, the Egyptian holiday commemorating the beginning of spring, during which fesikh is commonly prepared and eaten.* Foodborne botulism outbreaks associated with fesikh and similar uneviscerated salt-cured fish have also occurred in North America (2); two outbreaks occurred among persons of Egyptian descent in New Jersey in 1992 (3) and 2005 (4).
Botulism, a paralytic illness caused by botulinum neurotoxin (BoNT), was suspected because of the reported exposure to fesikh along with symptoms of ophthalmoplegia, bilateral ptosis, dysarthria, and autonomic dysfunction. Per New Jersey Reporting Regulations (NJAC 8:57),† these suspected illnesses were immediately reported to the New Jersey Department of Health. After consultation with CDC, heptavalent botulism antitoxin was released by CDC and administered to both patients within approximately 24 hours of arrival at the hospital. The daughter’s symptoms improved, and she was weaned off vasopressors. Both patients survived following intensive care for 2 days and total hospitalization of 7 days each.
CDC tested serum obtained before antitoxin administration. Serum from the daughter tested positive for BoNT type E by the BoNT Endopep-MS assay (5); the mother’s serum tested negative. A leftover sample of the consumed fesikh also tested positive for BoNT type E and Clostridium botulinum type E.
Interviews conducted by the Communicable Disease Service at the New Jersey Department of Health revealed that two fresh mullets purchased by the patients’ neighbor at a local Asian market were used to prepare the fesikh. The mother salt-cured and fermented the mullet, leaving the fish uneviscerated and wrapped in plastic in the kitchen for 20 days at ambient temperature. The mother confirmed that she previously used the same method of preparation in Egypt with no deviation in techniques or steps.
These cases illustrate the importance of early recognition and treatment of botulism. Botulism can be fatal, typically from respiratory failure, and treatment delays can result in increased mortality and worsened overall outcomes (6). These cases also highlight the role of uneviscerated, salt-cured fish dishes as potential vehicles for foodborne botulism. C. botulinum spores are ubiquitous in marine environments, and traditional methods of home preparation for these dishes might support conditions that are favorable for toxin production (i.e. anaerobic conditions) (2). Neither of these patients had previously heard of botulism. Risk communication via public awareness campaigns, as has been conducted by the Egyptian Ministry of Health to discourage fesikh consumption, might be indicated in the United States; engagement with Egyptian communities in the United States might provide insights into additional prevention strategies to decrease the risk for foodborne botulism from fesikh and other uneviscerated, salt-cured fish products.
I warn people about fresh basil, but they just call me crazy, although I’m the one with the PhD in food stuff.
The U.S. Centers for Disease Control reported at the end of Sept there were 241 confirmed cases in 5 states and was linked to fresh basil from Siga Logistics de RL de CV of Morelos, Mexico.
This outbreak appears to be over.
Sorry it takes me longer to report these things, but I don’t get paid and my brain drifts.
Alexandria Hein of Fox News reports a 43-year-old man in China who was suffering from seizures and loss of consciousness went to the doctor after his symptoms persisted for several weeks, only to discover that he had hundreds of tapeworms in his brain and chest, reports say.
The patient, identified as Zhu Zhongfa, allegedly had eaten undercooked pork, which was contaminated with Taenia solium, a parasitic tapeworm.
“Different patients respond [differently] to the infection depending on where the parasites occupy,” Dr. Huang Jianrong, Zhongfa’s doctor at Affiliated Hospital of Zhejiang University School of Medicine, told AsiaWire. “In this case, he had seizures and lost consciousness, but others with cysts in their lungs might cough a lot.”
Jianrong explained that the larvae entered Zhongfa’s body through the digestive system and traveled upward through his bloodstream. He was officially diagnosed with cysticercosis and neurocysticercosis, and given an antiparasitic drug and other medications to protect his organs from further damage, according to AsiaWire.
Jianrong said his patient is doing well after one week, but the long-term effects from the massive infestation are unclear.
The Centers for Disease Control and Prevention (CDC) recommends cooking meat at a safe temperature and using a food thermometer in an effort to avoid taeniasis. Humans are the only hosts for Taenia tapeworms, and pass tapeworm segments and eggs in feces which contaminate the soil in areas where sanitation is poor. The eggs survive in a moist environment for days to months, and cows and pigs become infected after feeding in the contaminated areas.
Once inside the animal, the eggs hatch in the intestine and migrate to the muscle where it develops into cysticerci, which can survive for several years. This infects humans when they eat contaminated raw or undercooked beef or pork, according to the CDC.
Don and Ben start the episode talking about kimchi fermentation and all the cabbage that needed to be washed and salted. The conversation went towards collaborations with fun people that might seem a bit unnatural to outsiders. The guys talk about a few outbreaks including two pathogenic E. coli ones linked to Romaine lettuce and Hep A in blackberries. They then do some listener feedback on foreign objects, bad cleaning and sanitizing machines and chitterlings. Also, bacteria is everywhere.
Food safety recalls are always either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early.
– Dr. Paul Mead
Chinese officials believe the unidentified male became infected after handling and eating a wild hare on Nov. 5 in the Inner Mongolia, according to state news site XinhuaNet.
As a precaution, officials quarantined the people who had since come in contact with the man. None of them have exhibited fever or other symptoms of the plague, infamous for the Black Death pandemic during the Middle Ages.
Two cases of pneumonic plague, a highly contagious form of the disease, were confirmed in China by local health officials last week. The two patients, who also were from Inner Mongolia, were diagnosed in Beijing and are currently being treated for the condition in the Chaoyang District.
No epidemiological association has been found between the two cases, according to officials.
The plague is caused by Yersinia pestis — a common bacteria carried by rats, rabbits and squirrels, according to the U.S. Center for Disease Control and Prevention. Humans can contract the bubonic plague when bitten by infected fleas. Handling infected animals directly also can cause infection.
I’ll leave the summary of two antimicrobial resistance reports to my friend and hockey colleague (and he’s a professor/veterinarian) Scott Weese of the Worms & Germs Blog (he’s the semi-bald dude behind me in this 15-year-old pic; I’m the goalie; too many pucks to the head):
Two reports came out this week, both detailing the scourge of antibiotic resistance.
They’re both comprehensive, with a combined >400 pages explaining that this is a big problem.
I’m not going try to summarize the reports. I’ll just pick out a few interesting tidbits.
From the CCA report (Canada):
According to their modelling, first-line antimicrobials (those most commonly used to treat routine infections) helped save at least 17,000 lives in 2018 while generating $6.1 billion in economic activity in Canada. “This contribution is at risk because the number of effective antimicrobials are running out.”
Antimicrobial resistance was estimated to reduce Canada’s GDP by $2 billion in 2018. That’s only going to get worse unless we get our act together. It’s estimated that by 2050, if resistance rates remain unchanged, the impact will be $13 billion per year. If rates continue to increase, that stretches to $21 billion. Remember, that’s just for Canada, a relatively small country from a population standpoint.
Healthcare costs due to resistance (e.g. drugs, increased length of stay in hospital) accounted for $1.4 billion in 2018. But remember that people who die from resistant infections can actually cost less. If I get a serious resistant infection and die quickly, my healthcare costs are pretty low since I didn’t get prolonged care. All that to say that dollar costs alone don’t capture all the human aspects. Regardless, this cost will likely increase to $20-40 billion per year by 2050.
In terms of human health, resistant infections were estimated to contribute to 14,000 deaths in Canada in 2018, with 5,400 of those directly attributable to the resistant infection (i.e. those deaths would not have occurred if the bug was susceptible to first line drugs). That makes resistance a leading killer, and it’s only going to get worse.
The document’s dedication says a lot. “This report is dedicated to the 48,700 families who lose a loved one each year to antibiotic resistance or Clostridioides difficile, and the countless healthcare providers, public health experts, innovators, and others who are fighting back with everything they have.”
The forward has some great messages too:
To stop antibiotic resistance, our nation must:
Stop referring to a coming post-antibiotic era—it’s already here. You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy. The time for action is now and we can be part of the solution.
Stop playing the blame game. Each person, industry, and country can affect the development of antibiotic resistance. We each have a role to play and should be held accountable to make meaningful progress against this threat.
Stop relying only on new antibiotics that are slow getting to market and that, sadly, these germs will one day render ineffective. We need to adopt aggressive strategies that keep the germs away and infections from occurring in the first place.
Stop believing that antibiotic resistance is a problem “over there” in someone else’s hospital, state, or country—and not in our own backyard. Antibiotic resistance has been found in every U.S. state and in every country across the globe. There is no safe place from antibiotic resistance, but everyone can take action against it. Take action where you can, from handwashing to improving antibiotic use.
Some might say it’s alarmist. However, I don’t think it’s alarmist when someone really should be raising the alarm. We need to talk about it more, not less. We need to get people (including the general public, healthcare workers, farmers, veterinarians, policymakers) on board, to realize it’s a big issue that needs to be addressed now. “Short term pain for long-term gain” certainly applies here. We can keep delaying and the numbers will keep going up, or we can invest in solutions.
The numbers are scary but specific numbers don’t really matter in many ways. “Lots” is all we should have to know to get motivated. However, decision-makers like numbers, so these numbers hopefully will be useful to show the impact and potential benefits of investing in this problem, and motivate them to put money into antimicrobial stewardship. Saving lives should be enough, but that often doesn’t cut it. Antibiotic resistance doesn’t have a good marketing campaign. Everyone knows why people were wearing pink last month and why there are some pretty dodgy moustaches this month. Those are important issues, for sure. However, considering the overall impact, antibiotic stewardship needs to get more people behind it if we’re going to effect change.
Danielle Ann of Alvinology reports researchers at the Singapore General Hospital have found definite similarities between the virus strains of Hepatitis E virus or (HEV) in pig liver and human liver.
This means that ingesting raw pork liver could mean you’re ingesting a strain of HEV that’s similar enough to human HEV that it could cause you get infected.
The same report said that people who have contracted HEV has risen steadily over the years. While the researchers could not say if the ingestion of raw pig liver is the main cause of the rise in cases, many local dishes feature this ingredient and do not cook the meat thoroughly.
The same report said that you can acquire the disease from eating contaminated food or substances. Ingesting water that is laced with the disease or accidentally drinking water that has trace amounts of faeces. Eating raw or half-cooked meat that is infected can also transmit the virus to you.
Methods: Lamb mincemeat was purchased at the supermarket counter three times weekly for six months. T. gondii was detected by real‐time polymerase chain reaction (PCR) of DNA extracted from the meat following homogenisation. Purchases were also tested for common foodborne bacterial pathogens.
