Wednesday 10 November 2010

Communicating microbiology to non specialist audiences

Got this from a Tweet by Cesar Sanchez (@TwistedBacteria), really good article by the excellent Bernard Dixon, perhaps we should all take note!

http://www.microbemagazine.org/index.php/11-2010-animalcules-and-forum

Hmm this link seems to be broken, works if you type it into the URL bar - strange!!

Try the magazine home page and navigate from there - sorry....

Anthrax Heroin – it is still here.

Following reports from Scotland in January and May 2010 about the presence of Bacillus anthracis, the causative agent of anthrax in Heroin, the BBC website reports the death of a drug user in Kent. According to the Health Protection Agency this represents the fifth case of a person becoming ill via this route. The case was described as ‘sad’ by Dr Mathi Chandrakumar from the Kent Health Protection Unit, who added that the risk of person to person spread of this disease, in this particular circumstance was extremely unlikely. Infection with Anthrax is now recognised as one of a number of risks facing intravenous drug users.
Importantly those at risk are advised that people should be vigilant for the symptoms of Anthrax infection. These include swelling and redness around the injection site, general feeling of being unwell such as a raised temperature, chills or a severe headache and breathing difficulties. On a positive note if identified early the infection can often be treated successfully with antibiotics, this can be life saving – but early recognition is the key.
I would completely agree with this assessment. The route of infection in these cases is clear and based around a very specific action. It is completely different to the situation experienced by people who are involved with the processing of hides. In the case of an intravenous drug user, where the heroin appears to be contaminated, the organism is likely to be introduced directly into the bloodstream where vegetative organisms can grow and spores germinate.

Cholera is not respecting national boundaries!

According to the ProMed Mail site, first reports of suspected cases of cholera are appearing in the Dominican Republic. Reports indicate that a 43 year old man in the Dominican Republic is being treated in Barahona University hospital. The patient is thought to be a business man who has recently returned from Haiti and he represents the third suspected case, if confirmed, in the Dominican Republic.
The situation continues to develop.

Tuesday 9 November 2010

Has Cholera reached Port au Prince?


It would appear that cholera has reached the Haitian capital of Port au Prince. It has been reported on the Sky News website and via Reuters that the first isolated cases have been seen in the city. It is reported that a young child of 3 years has the disease and that he had not left the city for the past year. It is reported that he is currently being treated in hospital for dehydration, vomiting and diarrhoea.
Suggestions are currently that Hurricane Tomas may have contributed to the appearance o0f the disease in the capital due to the increased flow of the Artibonite river which burst its banks at the weekend. This is one of the suspected sources of the infection. The fear voiced by Health Authorities is that the disease could now infiltrate the various camps inside the capital. A further 100 suspected cases of cholera in city residents are currently being investigated.

Monday 8 November 2010

Latest Shooting Up report has an HIV focus and is published on the HPA Website.


The latest instalment of the annual Shooting up report has been published by the Health protection agency (HPA) and is focussed on HIV infection
The report starts with a timely reminder of the list of bacteria and viruses that are particularly important when considering intravenous drug abusers (IVDA), these include, Clostridium botulinum, Grp A streptococci and potentially community acquired MRSA as well as viral agents such as HIV and Hepatitis C.
The report states that the prevalence of HIV amongst IVDU is quite low with rates of 4.1% in London and 0.6% in Scotland and are at a level 1.5% across the UK. It was also noted HIV prevalence in IVDU has increase from 0.7 to 1.5% in the last decade returning to levels seen in the early 1990s. On a personal note I wonder if we have lost the momentum in getting the message across to the public at large?

Returning to the report there has been an increase in the uptake of HIV testing with up to three quarters of IVDUs report having had a test and about a third of IVDU patients still not aware of their status.  A large proportion of HIV positive IVDU patients are involved with specialist treatment services.

A number of IVDU patients report being infected with Hepatitis C (numbers equated to about a half of patients), whereas around a sixth presented with Hepatitis B infection. Bacterial infections such as sores or abscess were reported in approximately one patient in three. On a more positive note needle and syringe sharing appears to have generally fallen but still almost one in five patients reported the sharing of either syringes or needles.
  
One thing the report highlights is a continued need for education and investigation into sharing of needles and paraphernalia that increases the risk of the patient to potentially serious infections that may well be life threatening. We need to maintain and develop surveillance to inform decisions that feed into UK policy making.

More detail can be seen on the HPA Website (http://www.hpa.org.uk/hpr/archives/2010/news4410.htm#idus09)

The Changing situation in Haiti.

It is reported on ProMed Mail this week that the death toll in Haiti, associated with cholera has risen to 442 cases, with 105 new cases being reported since the 30th October. This represents a 40% increase in new cases. The health authority in Haiti reports a further 1978 people were admitted to hospital which gives a total number of cases at circa 6742.

To use a direct quote from the ProMed Mail website: “The WHO warned last week that the outbreak is far from over and Haiti should prepare for the "worst-case scenario", cholera in the capital.”

Saturday 6 November 2010

A Fantastic Meeting to attend in January 2011 with the Society for Applied Microbiology.

Wednesday 12 January.
Royal Society, Carlton House Terrace, London
Tea, coffee and registration  
Chair: Geoff Hanlon
10.30-11.15 The Denver Russell Memorial Lecture. Propionibacterium acnes: an emerging pathogen Peter Lambert, Aston University.

11.15-11.50 The gut flora and probiotics George McFarlane, University of Dundee 11.50-12.25 An overview of the past 40 years in anaerobic microbiology
Mike Wren, UCH  

12.25-13.30 Lunch

Session A: Probiotics
Chair: Martin Adams  
13.30 -14.05 Probiotics and the elderly Ian Rowland, University of Reading 
14.05- 14.40 Prebiotics Bob Rastall, University of Reading  

14.40-15.00 Tea and coffee 

15.00-15.35 Probiotics. prebiotics and neonates Christine Edwards, University of Glasgow 
15.35-16.10 Veterinary use of probiotics Roberto La Ragione, VLA  
16.10-16.45 Safety of probiotics Kevin Whelan, King's College London

Session B: Anaerobic microbiology
Chair: Mark Fielder 
13.30-14.05 State of the art regarding clostridia Ian Poxton, University of Edinburgh 14.05-14.40 The exploitation of beneficial anaerobic microorganisms Nigel Minton, University of Nottingham  

14.40-15.00 Tea and coffee  

15.00-15.35 Anaerobes in compex polymicrobial diseases  M. J. Woodward, Veterinary Laboratories Agency  
15.35-16.10 An overview of identification of anaerobes, including latest developments
Val Hall, Anaerobe Reference Laboratory, NPHS Microbiology Cardiff 
 16.10-16.45 Oral anaerobes: Peter Mullany, Eastman Dental Institute

Event organiser's contact details: Society for Applied Microbiology (www.sfam.org.uk)
Tel: +44 (0)1234 761752    +44 (0)1234 761752      
Fax: +44 (0)1234 328330 
Email: meetings@sfam.org.uk

Rates of TB highest for 30 years.



According to the Health Protection Agency (HPA) in the UK there were 9040 news cases of Tuberculosis infection in 2009 which the highest figure since 9266 cases were reported in England and Wales in 1979, they also report that multi-resistant cases, resistant to the first line drug treatment has doubled. Figures from the HPA show that there were around 206 in 2000 and now show circa 390 cases in 2009, it is revealed that within these figures strains resistant to multiple antibiotics (MDR cases, multiple drug resistance) is still low at 1.2% but has risen over the last decade. What we have also seen is a rise of multidrug resistant cases from 28 in 2000 to 56 in 2009.

One of the problems with TB infection is that the symptoms can often take sometime to manifest in the patient. Once identified treatment can also take some time. It is likely that infection will be treated for around six months and often with two or three drugs simultaneously. The MDR cases may take even longer to respond and be treated for around eighteen months or longer and the treatment can be complicated.

It is worth noting that if TB is caught early it is treatable and we need to remain vigilant for cases and the potential sources of the infection remembering that some of the groups that need helps and should be monitored are perhaps in so called hard to reach populations

I agree with and echo the word of Dr Paul Cosford from the HPA as reported on the Reuters website from where I took the following quote
“TB is sadly not a disease of the past and the figures today serve as an important reality check,"

Influenza H1H1 Swine Flu shows activity.

The influenza A H1N1 virus has claimed a vicitm at the begining of the new 'flu season'. A eight year old ochid in Lurgan  Nothern Ireland has, sadly, succumbed to the virus and this was reported in the last week. The child was apparently at a school for children with severe learning disabilities.A spokesperson from the Health Protection Agency said that the death was reminder of the fact that flu infections can causes very severe complications in those patients with underlying health conditions and that vaccinations against flu are strongly reccomended for vulnerable people of all ages.

The annual flu vaccination covers a range of the most likely flu variants that are predicted to be circulating and following the pandemic of 2009 the H1N1 swine flu strain is covered by this years annual vaccine. As the spokesperson from the PHA sayas, as reported by the BBC website, "We would advise all those who are eligible for flu immunisation to make sure they get it as soon as possible."  I totally agree!

The re-emergence of Influenza A H1N1 is not a surprise and follows the expect natural cycle of flu infection, how many more cases we will see and how many will result in fatalities is quite difficult to accurately predict, but rest assured the Department of Health are watching and monitoring.

Another case was also reported in NI last week but this case was in an adult male and not linked to the fatal case.

Tuesday 2 November 2010

TRIM21 a molecule with real application potential!

Some really interesting research has been recently published examining how the immune system can interact with host cells. It was previously thought that antibodies could not enter cells and attack intracellular parasites such as viruses, however research published today indicates the contrary! Fantastic! Work published by the MRC group in Cambridge shows that antibodies are indeed able to move into cells and ‘tackle’ viruses that have already infected the host. It is thought that the antibody is internalised with the virus and the presence of this antibody triggers a response. Whilst this process will not work on all viral infections it certainly changes and enhances our previous knowledge greatly. Whilst at a relatively early stage the work does offer some promise for treatment of some viral infections in the future.

The work centres around the TRIM21 protein, it appears that once the antibody has entered the cell a response is initiated mediated by TRIM21 which effectively routes the viral particle into a pathway designed to remove and destroy unwanted material. It is thought that this process happens fairly rapidly and may well have an effect before the viral agent has had an opportunity to have much of a pathogenic effect. Excitingly, it appears that increasing the concentration of TRIM21 increases the efficacy of the process, and this is what might have great potential in terms of treatment. We already have a number of antibacterial agents but surprisingly few anti-virals, an opinion also held by one of the researchers at the MRC in Cambridge, Dr Leo James.

It is worth remembering that there are a great number of people killed by viral infections every year, estimates suggest that there are almost twice as many deaths than those attributed to cancer. As if to affirm that fact they remain the most difficult of infections to treat.

A timely and promising story further affirming the chant that Science is vital! (http://scienceisvital.org.uk/)

Monday 1 November 2010

Cholera outbreak in Haiti 2010

The current situation with regard to the cholera outbreak  in Haiti is that over 4100 people are currently infected and around 300 people have died as a result of the infection. At present the infection is continuing to spread with the possibility that the capital Port-au-Prince will see cases very soon. There are as of Wednesday a further 174 suspected cases reported. The main focus for the authorities is now control, with the supply of clean water and good sanitation a priority as these are the main routes for the spread of the disease. From a treatment perspective it is now vital to have enough IV fluids available and enough treatment centres to be able to support the people who are already unwell. It would appear that the strain of cholera currently active in Haiti appears to be the 01 strain according o reports.
So what is cholera?
Cholera is an acute diarrhoeal disease caused by a bacterium called Vibrio cholerae that gets into the body by eating or drinking contaminated food or water. One of the problems is that quite a high percentage of people do not actually get infected by the disease but do shed the organism back into the environment. This is a potentially important source of the infection and one of the reasons why this type of infection is so prevalent after a situation that causes the disruption of safe water supplies and sewage disposal. Up the 80% of affected people can generally be supported and treated with oral rehydration salts quite successfully. Help that can be immediately dispensed to the population would include information on hand washing and its value, proper control of sewage and waste material along with the boiling of water of use of chemical treatments for potentially potable water including the use of chlorine tablets. It should also be remember that food should be eaten only after being cooked or at least peeled. Again remembering that washing of non cooked food should also be carried out only in water that has been treated and stored correctly to prevent contamination.

Why has this occurred now ?
This is a difficult question to answer definitively. It might be due to recent changes in temperature and salinity in the local rivers that have made infection possible. This situation can also be made possible if an algal bloom is present, common when temperatures rise. It has been known for sometime that cholera to be carried by some algae and copepods which can then be ingested by the human host in water and possibly initiating an infection. This has been recognised as an established route of infection in the marine environments around Bangladesh and a similar chain of events may account for the current outbreak in Haiti.

One interesting piece from the NPR Health blog examines the possibility that the non Haitian strain of cholera that is active in the region might have been bought in by peace keepers from other countries. It should be noted, as reported in the blog, that the UN have tested peacekeepers and have not found the organism present.
Authorities now need to keep vigilant to see where the infection develops next.

Whats going on with Swine Flu (Influenza H1N1)

On the 27th October 2010 it was reported that data had emerged showing that there were 70 children and teenagers killed as a result of the recent influenza A H1N1, swine flu. Prof Liam Donaldsons team showed that children from certain ethnic backgrounds were more affected than those of other groups, although the reason why is still unclear and indeed was an unexpected finding. The report also found that patients with pre-existing conditions such as neurological conditions were also at risk.
We are aware that the virus is likely to undergo changes and remerge in the coming flu season, how it will behave is still uncertain as we cannot predict accurately what genetic changes may occur. It is generally thought that H1N1 is likely to appear as the seasonal flu during this season but we will have to wait and see.

As the pandemic virus proved to be a lot less deadly than first feared, criticism has been made of the government’s response. It has been suggested that there might have been financial savings to have been made if a more measured response had been made. This is an unfair criticism on the whole as we did not know how the pandemic would develop so it was difficult to predict the perfect response. Two key things are clear, the first is that the full blown plan that was put into place played an important role in saving life and secondly, children especially those in vulnerable groups should be vaccinated against swine flu in the light of this report.