Day: July 1, 2024

A Maryland resident was hospitalized with malaria after contracting the disease locally — a first in more than 40 years, Maryland Department of Health officials said Friday. Malaria is caused by a parasite transmitted through mosquito bites. The Health Department did not say precisely where the patient was exposed to malaria, but officials said the person lives in the National Capital Region, which includes Prince George’s, Montgomery, Charles and Frederick counties. The patient, who was not identified by age or gender, has been discharged and sent home to recover, officials said. “Malaria can be very dangerous and even fatal if it is not treated, but early treatment reduces the chances of complications,” Deputy Secretary for Public Health Services Nilesh Kalyanaraman said in a statement. “We urge the public to take precautions against mosquito bites, and if you develop symptoms after traveling abroad, seek urgent medical care.” Locally contracted malaria cases have also been reported in Florida and Texas this year for the first time in decades, raising concerns that the disease could return to areas where it has long been considered eradicated. Malaria was declared “eliminated” in the United States in 1951, and the World Health Organization designated the country “malaria free” in 1970. Some scientists have warned that rising temperatures caused by climate change may help spread malaria by expanding the mosquito’s natural territory, something a recent study showed is already happening in parts of Africa. Climate change may make it easier for mosquitoes to spread malaria The locally transmitted case in Maryland reported Friday came from a different strain of parasite than the recent cases in Florida and Texas, a Health Department official said. The Maryland case was caused by a parasite called P. falciparum, while the cases in Florida and Texas came from a parasite called P. vivax. Share this articleShare People can prevent mosquito bites by using an insect repellent that contains DEET, wearing loosefitting, long-sleeved clothing, closing windows and doors or covering them with screens, and emptying standing water at least once a week to prevent mosquitoes from laying eggs. Malaria symptoms typically appear seven to 30 days after a bite from an infectious mosquito, the state Health Department said. Patients may develop fever, chills, headache, body aches and fatigue. Anyone experiencing those symptoms who may have been exposed to malaria should seek urgent medical care, officials said. Maryland typically reports about 200 travel-related cases of malaria each year, and there are more than 2,000 cases reported in the United States annually, but for decades all of those cases occurred in people who had recently visited areas of the world where the disease is more common. What to know about malaria after rare cases are found in Florida, Texas Maryland has long been home to the Anopheles mosquito, which can spread the parasite that causes malaria from person to person. David Blythe, director of the Maryland Department of Health’s Infectious Disease Epidemiology and Outbreak Response Bureau, said the state had eradicated locally contracted infections because of mosquito control efforts that significantly reduced the public’s exposure to the Anopheles mosquito. Blythe said one way malaria could be reintroduced to Maryland is by someone who contracted the parasite in another country and brought it back to the state. If a local mosquito bit that person in Maryland and then bit a second person, it could spread the parasite. Travelers who know they could be exposed to malaria-spreading mosquitoes in another country can get preventive drugs from their physician to reduce the chances that they contract the disease and spread it to others.

If the COVID-19 pandemic has done one thing, it’s made us all more familiar with some of the important players in the immune system. Antibodies, B cells, and T cells are among the best known parts of the body’s response to a virus like SARS-CoV-2, but they don’t act alone. In a paper published on August 18 in the journal Cell, scientists report that innate immune cells—a critical part of the immune system activated to battle COVID-19—remain altered for at least a year after infection. The finding suggests that these cells may play a role in some of the lingering symptoms associated with Long COVID, although more studies are needed to confirm that connection. The innate immune system is the body’s first line of defense, made up of general pathogen-fighting cells that are designed to recognize and fight off all kinds of pathogens, including bacteria, viruses, fungi, and parasites in a non-specific way. (B cells and T cells, in contrast, are more customized to remember and recognize specific pathogens, and only those pathogens.) Steven Josefowicz, an associate professor of pathology and laboratory medicine at Weill Cornell Medical College, and his colleagues found, however, that even innate immune cells retain some memory of fighting SARS-CoV-2 after a severe infection. This recall, and the response it generates, can last for at least a year after infection. The new paper has important implications for understanding how the immune system—even the less bespoke parts that aren’t targeting specific bacteria or viruses—is changed by infections. Understanding these alterations could also shed light on why some people continue to experience long-term symptoms after encountering SARS-CoV-2, says Josefowicz. He and his team focused on the parent cells of innate immune cells—stem cells in the bone marrow that continuously replenish the supply of these immune cells. Since most of these stem cells reside in the bone marrow, the easiest way to access them is through a bone marrow aspiration, a painful and invasive procedure in which doctors puncture a portion of the hip bone to reach the marrow. A small number of these stem cells, however, circulate in the blood, and Josefowicz conducted studies to not only extract and enrich their numbers from blood samples, but to confirm that they represent the same stem cells found in the marrow. That allowed him to study these cells from patients who were admitted to the ICU with severe COVID-19 infections by collecting their blood, rather than obtaining bone marrow biopsies. By analyzing those stem cells, “what’s clear is that the immune system is fundamentally changed after a severe infection like COVID-19,” he says. These cells contain genetic changes that alter which genes they express, skewing them toward generating more inflammatory factors. The change lasts for at least a year following a severe COVID-19 infection, which is how long Josefowicz studied cells from a few dozen patients. Since these stem cells are responsible for producing more copies of innate immune cells, the changes in the genes they express are carried over to the new generations of cells they make. When he studied the cells in a dish, Josefowicz found that they’re capable of producing higher levels of inflammatory factors and are more likely to migrate—which, in a human body, means they can spread their inflammatory effects to other tissues. In animal models, these hyper responsive cells preferentially gravitate toward the lungs, brain, and heart, some of the organs most heavily affected by Long COVID. The higher levels of inflammatory factors may be a response to the intense effect of a severe SARS-CoV-2 infection. “Severe COVID-19 could look to the immune system like the beginning of a chronic infection,” says Josefowicz, “and since the immune system is having trouble clearing this particular pathogen, it’s pulling out all the stops to give itself a better chance of dealing with the virus.” Whether this memory of COVID-19 is contributing to Long COVID isn’t clear yet, but the research could inspire additional studies to better understand how viruses like SARS-CoV-2 affect the immune system, both in the short and long term. “This is the beginning of a very long story that will hopefully open up our understanding of how viral infections, and in particular COVID-19, are different from a cold,” says Dr. Lindsay Lief, director of the medical ICU and post ICU recovery clinic at Weill Cornell New York Presbyterian Hospital and one of the co-authors of the paper. “We need to understand how infections change the immune system to impact not just what symptoms you experience, but how you respond to your next infection or your next vaccination.” The pandemic provided the scientists with a unique opportunity to study how the immune system changes in response to a virus, since so many people were infected at the same time, and there were no vaccines to confound the immune response. All of the blood samples came from participants who were admitted to the ICU in the spring of 2020 with severe COVID-19 infections, before vaccines were available. Because the participants’ health records during their ICU stay were available, the researchers could look at any treatments they were given, and they found a potentially useful clue about one intervention that could mitigate how much the immune system was altered. People who received drugs to block IL6, which causes inflammation and increases in response to an infection, seemed to show lower levels of innate immune cells that were prone to producing inflammatory factors. While the drug did not have much effect in improving people’s severe COVID-19 symptoms while in the ICU, the study suggests it might have suppressed some of the gene expression changes in the innate immune stem cells. That in turn could reduce the chances of Long COVID-like symptoms from developing in these people, although more studies are needed to confirm that theory. “What we hope now is that others will use our approaches to link these types of changes to different clinical outcomes and disease states,” says Josefowicz. “Since these blood cells are

Mariia Zotova/Getty Images Three people have died in New York and Connecticut after coming into contact with the Vibrio vulnificus bacteria, which can cause a rare but severe infection, according to health officials. In Connecticut, two people who died likely got the Vibrio vulnificus infection (vibriosis) after swimming in salt or brackish water in the Long Island Sound with open wounds. A third person in the state, who was hospitalized but has not died, was infected after eating raw oysters from an out-of-state establishment. The death in New York’s Suffolk County is still being investigated to determine where the bacteria was encountered, according to a news release from the state’s department of health. Health officials in both states are now warning residents and providers to be aware of the possibility of vibriosis, and to swim in seawater and eat raw seafood with caution. “While rare, the vibrio bacteria has unfortunately made it to this region and can be extraordinarily dangerous,” New York Governor Kathy Hochul said in a news release. “As we investigate further, it is critical that all New Yorkers stay vigilant and take responsible precautions to keep themselves and their loved ones safe, including protecting open wounds from seawater and for those with compromised immune systems, avoiding raw or undercooked shellfish which may carry the bacteria.” Here’s what to know about vibriosis, and how best to protect yourself. Vibriosis is a bacterial infection caused by several species of Vibrio bacteria. In these recent cases, Vibrio vulnificus bacteria is the culprit. It’s estimated that vibriosis causes 800,000 illnesses and 100 deaths in the U.S. each year, and results from people consuming raw or undercooked seafood, or exposing an open wound to seawater. Most infections occur when the weather is warm—between May and October. Though most people who are immunocompetent will have a mild case of vibriosis,Vibrio vulnificus bacteria in particular can cause life-threatening wound infections that can lead to necrotizing fasciitis, which is why it’s commonly referred to as a “flesh-eating bacteria,” according to William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine. The Centers for Disease Control and Prevention report that people with Vibrio vulnificus infections often require intensive care or limb amputations. An estimated 1 in 5 people with the infection die, often with a day or two. Though anyone can get vibriosis through a wound or via eating raw seafood, there are some people who may be more likely to get an infection and have it turn severe, including people who have a weakened immune system, liver disease, or are taking medication to lower stomach acid levels. How a Vibrio vulnificus infection presents depends on how it was acquired—whether it was through eating raw or undercooked oysters or shellfish, or if the bacteria gets into an open wound, according to Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security. If it’s ingested, people can expect to have some gastrointestinal symptoms that typically start within 24 hours of eating the contaminated food and can last approximately three days. Those symptoms include: Watery diarrhea Abdominal cramping Nausea and vomiting Fever and chills Vibrio vulnificus infections can also cause more severe illness when ingested, leading to bloodstream infections and severe blistering skin lesions. If Vibrio vulnificus gets into an open wound, it can cause a life-threatening infection that can spread throughout the entire body. The symptoms of a wound infected by the Vibrio vulnificus bacteria include: Fever Redness Pain Swelling Warmth Discoloration Discharge (leaking fluids from the wound) People are typically diagnosed with vibriosis if Vibrio bacteria are found in their wound, blood, or stool. People with a gastrointestinal case of vibriosis may not need any treatment other than supportive care; in more severe cases, infections are treated with antibiotics, and potentially amputation to remove dead or infected tissue. Since you can get vibriosis from raw or undercooked seafood—particularly raw oysters and shellfish—the only way to fully cook seafood to kill the bacteria. (The CDC notes that neither hot sauce nor lemon will kill Vibrio bacteria; drinking alcohol while eating oysters won’t kill it either). You also can’t tell if an oyster or other seafood contains the harmful bacteria just by look, smell, or taste. People who are healthy or immunocompetent may be able to eat oysters without much of a risk, but some people are much more likely to get an infection or severe complication, including people who: Have liver disease, cancer, diabetes, HIV, or thalassemia (an inherited blood disorder) Receive immune-suppressing therapy Take medicine to decrease stomach acid levels Have had recent stomach surgery Regarding wound infections from Vibrio vulnificus, the best way to reduce your chances is to stay out of saltwater or brackish water (a mix of fresh and saltwater) if you have any kind of open wound, which includes recent piercings, tattoos, or surgeries. You can also get a Vibrio wound infection if it comes into contact with raw or undercooked seafood or its juices. “If you’re immunocompromised and have a new injury that hasn’t healed, stay out of the water,” Dr. Schaffner said. “This is the time to relax in the sun instead.” If you must go into saltwater or brackish water with an open wound, you should cover with a waterproof bandage, and then wash wounds and cuts thoroughly with soap and water after any potential contact.

Here’s our weekly round-up of what illnesses are spreading the most in Metro Detroit communities, according to our local doctors and hospitals. Wayne County — Bee stings, infected bug bites, hand foot & mouth disease, seasonal allergies, asthma flare-ups, strep throat, COVID Dr. Kevin Dazy — Pediatrician, Children’s Hospital of Michigan “We continue to see kids with croup and hand-foot-mouth symptoms of rash and mouth sores. Once hand-foot-mouth starts going around, we expect the numbers of kids with the virus to grow. Right now, though, all thoughts are on back-to-school. Parents should be working on getting their kids updated on vaccines to ensure their children are protected against preventable disease. We see too many families who deal with these preventable diseases when their child is hospitalized or dealing with issues that were completely avoidable saying, ‘I wish I would have gotten those vaccinations.’ Now’s the time. “ Dr. Tiffany Widner — Pediatrician, Children’s Hospital of Michigan “We are seeing allergic reactions to bug bites, hand foot mouth, viral infections including viral URIs (cold symptoms) and contact dermatitis from environmental exposures (the name for rashes that can be associated with things like poison ivy, grasses, etc). We also are still seeing a lot of allergy and asthma complaints. In terms of back to school, I would recommend that parents turn their school forms in to their physicians as soon as possible, if they haven’t done it already. Also keep in mind that we are unable to complete forms if the child hasn’t been seen in the past year. Parents should consider the COVID19 vaccine as numbers are creeping up, and children in school will be at risk for contracting the illness. Also, remember the flu vaccine will be coming out next month. And now is the time to start putting all of the children back on a regular sleep schedule prior to the start of school.” Oakland County — Bee stings, infected bug bites, summer rashes, hand foot and mouth disease, seasonal allergies, asthma flare-ups, COVID, ear infections Dr. Steven McGraw — Chair of Emergency Medicine, Ascension Providence Hospital, Southfield Campus “I’m still seeing LOTS of bee stings. Some are rather serious and if people are allergic, make certain to have epi-pens available. Bees and wasps get aggressive during this time of year. I’m seeing some patients with COVID-19. It’s still lower than before, but coming back.” Dr. Jennifer Stevenson — Division Head, Fairlane Emergency Department Senior Staff Physician Department of Emergency Medicine Henry Ford Hospital, Fairlane “The number of strep cases continues to blow my mind! We’re also definitely seeing an uptick in COVID-19 cases. Generally speaking, those who are younger without medical problems are faring well. We have seen an increase in COVID-19 hospital admissions in those with co-morbidities. In addition, there’s been some hand-foot-mouth in the community. We’re also seeing a lot of allergic reactions. I think the bees get a little feisty this time of year. Those who are allergic should be sure to have their epi pens on hand!” Sarah Rauner — Pediatric nurse practitioner, Emergency Center, Corewell Health’s Beaumont Hospital, Troy “We are continuing to see some summer time rashes and bug bites that can become infected. Hand foot and mouth disease has made an appearance as well. Less vomiting and diarrhea lately however COVID has picked up a little bit. Keep washing your hands in preparation for the fall and school!” Dr. Susan Bork — Director of Operations, Emergency Center, Corewell Health’s Beaumont Hospital, Royal Oak “We are seeing an uptick in gastroenteritis cases with symptoms of vomiting and diarrhea, as well as sore throats and hand, foot and mouth infections. There has been a slight increase in mild COVID cases and no major changes in allergies.” Caroline Morris, PA-C — Henry Ford-GoHealth Urgent Care Centers “Presently we are seeing an increase in flu-like symptoms that are neither the flu or COVID-19, but rather a really bad cold (rhinovirus). We are still seeing an increase in COVID-19 cases currently that seem to present with fatigue cough and sore throat. We’re also seeing a lot of sporting injuries that include dislocated fingers, wrist, hand, knee and ankle injuries.” Dr. Rena Daiza — Primary Care Physician, Henry Ford Medical Center Bloomfield Twp. “With the weather changes this week, I am seeing a lot of allergies and asthma flares. Asthma can often overlap symptoms with upper respiratory illnesses, so people should be sure to test for respiratory illnesses like COVID-19. An upper respiratory illness should be suspected if usual remedies for asthma and allergies are not helping symptoms.” Emergency Department at Henry Ford West Bloomfield Hospital “I am seeing a lot of a lot of pain complaints (abdominal, flank and headache). We have had some allergic reactions from bees and peanut butter allergies. Falls and shortness of breath are also some of the top complaints.” Washtenaw County — Sore throats, COVID, infected bug bites, summer rashes Monroe County — Stomach viruses, sore throats, pink eye, swimmer’s ear Macomb County — Bee stings, infected bug bites, poison ivy, seasonal allergies, eye infections, sore throats Dr. Matthew Steck — Emergency physician at McLaren Macomb “There has been a noticeable increase in the prevalence of water incidents, including injuries and near-drowning, prompting the ER to urge extra caution when in and around water. Across all ages and patient populations, various orthopedic and soft tissue injuries continue to be the most common reason to seek care in the emergency and trauma center. Following a brief uptick in viral infections causing upper respiratory infections and a lingering cough, those cases have tapered off. Though an increase in cases has been reported on, there has not been a significant increase in the prevalence of COVID-19 diagnoses. “ Livingston County — Increase in rabies treatment due to bat exposures