Category: Infection

With the Bioethics Unit of the Indian Council of Medical Research (ICMR) placing a consensus policy statement on Controlled Human Infection Studies (CHIS) for comments, India has taken the first step in clearing the deck for such studies to be undertaken here. CHIS, also called human challenge studies, where healthy volunteers are intentionally exposed to a disease-causing microbe in a highly controlled and monitored environment, has been carried out for hundreds of years, an example being the yellow fever study in the early 1900s to establish that mosquitoes transmit the virus. Typically, a less virulent strain of the microbe is used to study less deadly diseases that have proven drugs for treatment. They are more often undertaken on a small number of volunteers to understand the various facets of infection and disease, and, occasionally, to accelerate the development process of a medical intervention. When used as part of vaccine development, these studies are initiated only when safety and immune responses of the candidate vaccines are known through early phases of clinical testing. Importantly, human challenge studies are not done as an alternative to phase-3 efficacy trials, but to help select the best candidate for testing in a conventional phase-3 clinical trial. Phase-3 clinical trials that follow human challenge studies often require fewer volunteers, speeding up the development process. In the last 50 years, CHIS studies have been carried out with thousands to accelerate vaccine development against typhoid and cholera. During the COVID-19 pandemic, the Imperial College London used 36 volunteers to study facets of the SARS-CoV-2 infection. In 2020, the World Health Organization approved using CHIS for accelerating COVID-19 vaccine development. There are several ethical challenges with human challenge studies, which require well-trained and robust systems in place. While collaborations with institutions and scientists well versed in conducting such studies are a must, navigating the ethical minefield is a challenge. Several clinical trials, including those by or involving the ICMR, have been mired in ethical violations, such as the Human papillomavirus (HPV) vaccine trial in Andhra Pradesh, in 2010. The ethical challenges while conducting CHIS are of a higher magnitude, the scope for misuse vast, and the repercussions severe. There is potential for exploitation, given the monetary dimension involving volunteers. If it becomes a reality, India should use CHIS only to study diseases with safe and effective treatment. Using CHIS to study novel microbes/disease with limited medical intervention should wait till Indian scientists gain expertise, and robust institutional structures and mechanisms are in place. COMMents SHARE Copy link Email Facebook Twitter Telegram LinkedIn WhatsApp Reddit Related Topics disease / ethics / medical research / prescription drugs / health treatment / Coronavirus / India / United Kingdom / vaccines

Jul 25, 2023, 5:13pmUpdated 12h ago Authorities are urging tri-state residents to take precautions to prevent rabies infections in people and pets. Rabies is a deadly disease caused by a virus that attacks the central nervous system. It can be transmitted from infected mammals to humans and other mammals. While rabies is rare in humans, precautions should still be taken by avoiding contact with wild animals and ensuring that pets are vaccinated. Rabies is most commonly seen in wild animals, such as raccoons, skunks, foxes, deer, groundhogs, coyotes and bats, according to the New York state Department of Health. Any mammal can be infected, including household pets like dogs and cats and other domestic animals such as horses and livestock. HOW IT IS TRANSMITTED The virus is transmitted by infected animals through their saliva and can infect people and animals through a bite or if the saliva gets into the eyes, nose, mouth or a break in the skin. WHAT TO DO IF YOU ARE EXPOSED People who are exposed to rabies should wash the bite or exposure area thoroughly with soap and water and immediately seek medical attention. Treatment for rabies should be administered as soon as possible after exposure. Treatment includes a dose of human rabies immune globulin and four doses of rabies vaccine administered over a two-week period. Exposure to a rabid animal does not always result in rabies. Rabies can be prevented if treatment is initiated promptly following an exposure. If a rabies exposure is not treated and a person develops clinical signs of rabies, the disease almost always results in death. PRECAUTIONS TO AVOID THE RISK OF RABIES INFECTIONS Don’t feed, touch or adopt wild animals, stray dogs or feral cats. Report all animal bites or contact with wild animals to the local county health department. If possible, do not let any animal escape that has possibly exposed someone to rabies. Be sure pet dogs, cats and ferrets, as well as horses and other livestock animals are up to date on their rabies vaccinations. Vaccination protects pets if they are exposed to rabid animals. Pets too young to be vaccinated should only be allowed outside under direct observation. Keep family pets indoors at night. Don’t leave them outside unattended or let them roam free. Teach children not to touch any animal they do not know and to tell an adult immediately if they are bitten by any animal. Keep property free of stored bird seed or other foods to avoid attracting wild animals. Also, feed pets indoors and cap garbage cans. Cover any openings to the attic, basement, porch or garage and cap chimneys with screens. Bring children and pets indoors and alert neighbors who are outside if wild animals enter the property. If you find animals living in or around parts of your home, consult a nuisance wildlife control expert about removing them. The local health department should be contacted if a bat is found inside the house. They will advise on what to do with the bat. Pet owners should contact the local health department or a veterinarian if their pet has been in a fight with another animal. A rabies booster vaccination may be needed. Share this story

Multiple sinus infections led to a life-altering situation for San Jose martial arts instructor, Natasha Gunther Santana, 26, who had to undergo a craniotomy to remove half of her skull following the spread of infection to her brain. The healthy mom had experienced five sinus infections in 2021 that were previously treatable with antibiotics. However, the persistent symptoms of vomiting, severe migraines, and uncharacteristic mood changes suggested the medication was no longer effective for the most recent infection. @natasha_santana97 This is the story on how I lost half my skull 😌 (don’t worry I’ll get it back soon) #tbi #traumaticbraininjury #brainsurgery #braininjury #sinusinfection #sinussurgery #sinuses #brain #craniotomy #craniectomy #skullremoval #stanford #speechtherapy #hospitallife #skull #badluck #viral #fyp #surgery #surgerycheck #surgeryrecovery #tbisurvivor #tbiawareness #fyp ♬ original sound – Natasha Alyena Santana It was discovered that Santana had a mutated gene that impeded the production of a protein responsible for initiating an immune response to foreign invaders, according to the Daily Mail. Consequently, the inability of antibiotics to fight the infection led to its spread to her brain, requiring the removal of a large part of her skull. Following the craniotomy in December 2021, Santana faced various post-surgery challenges, including a seizure, deep vein thrombosis, and the need to learn how to walk and talk again through intense therapy. After several months of recovery, Santana finally returned to teaching martial arts. Sharing her story on TikTok, Santana warned others with recurrent sinus infections to seek medical help from an ENT (ear, nose, and throat) specialist, rather than relying solely on primary care doctors. By consulting an ENT, individuals may be able to better address sinus infections before they lead to life-threatening complications, such as Santana’s ordeal. The development of a brain abscess following persistent sinus infections has been linked to the body’s ability to adapt to certain antibiotic medications. Frequent antibiotic use may cause the infection to become resistant to the medication, leading to chronic or recurrent sinus infections. If left untreated, the infection may affect the thin bones separating the sinuses from the brain, eventually entering the brain and causing tissue inflammation that requires urgent surgical removal.

Weekly COVID-19 hospitalizations have risen by more than 10% across the country, according to new data published by the Centers for Disease Control and Prevention, marking the largest percent increase in this key indicator of the virus since December. At least 7,109 admissions of patients diagnosed with COVID-19 were reported for the week of July 15 nationwide, the CDC said late Monday, up from 6,444 during the week before. Another important hospital metric has also been trending up in recent weeks: an average of 0.73% of the past week’s emergency room visits had COVID-19 as of July 21, up from 0.49% through June 21. The new figures come after months of largely slowing COVID-19 trends nationwide since the last wave of infections over the winter. “COVID-19 indicators, including hospital admissions, emergency department visits, test positivity, and wastewater levels, are increasing nationally,” the CDC said in an update posted to its data tracker dated July 24, 2023. Only one part of the country did not record more hospitalizations last week compared to the week prior: the Midwestern region spanning Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin. For now, hospitalizations remain far below the levels recorded at this time last year nationwide. July 2022 peaked at more than 44,000 weekly hospitalizations and 5% of emergency room visits with COVID-19 during a summer surge that strained many hospitals. Projections have differed over what the coming months will hold. An ensemble of academic and federal modelers said last month that the “main period of COVID-19 activity is expected to occur in late fall and early winter over the next 2 years, with median peak incidence between November and mid-January.” They cautioned that there were considerable differences between models within the group, with some teams projecting an additional smaller peak elsewhere in the year. In the U.S., 2021 saw larger peaks in August and December, driven by the Delta and Omicron variants, respectively. In 2022, hospitalizations peaked at similar levels in July and January, driven by different descendants of the original Omicron variants. Variants and vaccines Unlike previous waves, no single variant has yet emerged this summer to dominate infections nationwide. Instead, the CDC’s current projections estimate that a mix of descendants from the XBB variant that first drove infections last winter are now competing around the country. Largest among these XBB subvariants are infections grouped as the XBB.1.16, XBB.1.9.1, XBB.2.3, XBB.1.6 or EG.5 strains, which each make up between 10% and 15% of infections nationwide. Experts had previously singled out EG.5 as one of the fastest-growing lineages worldwide. EG.5 is a descendant of the XBB.1.9.2 variant, with an additional mutation that might be helping it outcompete other strains. It comes as health authorities have been racing to prepare for a new round of COVID-19 vaccinations this fall. Updated vaccines are expected to be available by late September, the CDC said earlier this month, after the FDA requested that drugmakers begin producing new formulations targeting these kinds of XBB strains. Government distribution of current supplies is due to wind down next week in advance of the update, which will also mark the switchover to a traditional commercial market for vaccines. However, the CDC says current supplies of shots will still be shipped until September for “exceptional” situations. “While many individuals may wait to receive a COVID-19 vaccine until the updated version is released, as it is expected to provide more robust protection against currently circulating variants, certain individuals may need or desire a COVID-19 vaccine prior to the anticipated release of the updated vaccine in the fall,” the agency said.

Abstract Background Nonhygienic products for managing menstruation are reported to cause reproductive tract infections. Menstrual cups are a potential solution. We assessed whether menstrual cups would reduce bacterial vaginosis (BV), vaginal microbiome (VMB), and sexually transmitted infections (STIs) as studies have not evaluated this. Methods and findings A cluster randomized controlled trial was performed in 96 Kenyan secondary schools, randomized (1:1:1:1) to control, menstrual cup, cash transfer, or menstrual cup plus cash transfer. This substudy assessing the impact of menstrual cups on BV, VMB, and STIs, included 6 schools from the control (3) and menstrual cup only (3) groups, both receiving BV and STI testing and treatment at each visit. Self-collected vaginal swabs were used to measure VMB (16S rRNA gene amplicon sequencing), BV (Nugent score), and STIs. STIs were a composite of Chlamydia trachomatis and Neisseria gonorrhoeae (nucleic acid amplification test) and Trichomonas vaginalis (rapid immunochromatographic assay). Participants were not masked and were followed for 30 months. The primary outcome was diagnosis of BV; secondary outcomes were VMB and STIs. Intention-to-treat blinded analyses used mixed effects generalized linear regressions, with random effects term for school. The study was conducted between May 2, 2018, and February 7, 2021. A total of 436 participants were included: 213 cup, 223 control. There were 289 BV diagnoses: 162 among control participants and 127 among intervention participants (odds ratio 0.76 [95% CI 0.59 to 0.98]; p = 0.038). The occurrence of Lactobacillus crispatus–dominated VMB was higher among cup group participants (odds ratio 1.37 [95% CI 1.06 to 1.75]), as was the mean relative abundance of L. crispatus (3.95% [95% CI 1.92 to 5.99]). There was no effect of intervention on STIs (relative risk 0.82 [95% CI 0.50 to 1.35]). The primary limitations of this study were insufficient power for subgroup analyses, and generalizability of findings to nonschool and other global settings. Conclusions Menstrual cups with BV and STI testing and treatment benefitted adolescent schoolgirls through lower occurrence of BV and higher L. crispatus compared with only BV and STI testing and treatment during the 30 months of a cluster randomized menstrual cup intervention. Author summary Why was this study done? Many girls in low- and middle-income countries are unable to adequately manage their menses and can suffer reproductive tract infections resulting from use of inappropriate materials. Reusable menstrual cups are medical grade silicone bell-shaped chambers that are inserted into the vagina to capture menstrual blood. Menstrual cups are safe and have not been associated with changes in vaginal pH or microflora. It is not known whether menstrual cups could lead to improvements in reproductive tract health. What did the researchers do and find? We assessed the impact of menstrual cups on the vaginal microbiome (VMB), bacterial vaginosis (BV), and sexually transmitted infections (STIs) in 436 secondary schoolgirls in western Kenya. During the 30-month cluster randomized controlled trial, BV and VMB composition were assessed every 6 months, and STIs (gonorrhea, chlamydia, and trichomoniasis) were assessed annually, with testing and treatment for BV and STIs for intervention and control participants regardless of symptoms. Among the intervention group, in crude analyses, the occurrence of BV was 24% lower than control participants, while the proportion of Lactobacillus crispatus–dominated community state type was 37% higher. What do these findings mean? Other studies have found that menstrual cups are a safe and cost-effective tool for menstrual hygiene management. These results provide evidence they can promote an optimal VMB and reduce BV for adolescent girls. Further research should investigate the constitution of the VMB and incidence of BV and STIs in different age groups and populations using menstrual cups. Citation: Mehta SD, Zulaika G, Agingu W, Nyothach E, Bhaumik R, Green SJ, et al. (2023) Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial. PLoS Med 20(7): e1004258. https://doi.org/10.1371/journal.pmed.1004258 Academic Editor: Sarah J. Stock, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, UNITED KINGDOM Received: November 4, 2022; Accepted: June 7, 2023; Published: July 25, 2023 Copyright: © 2023 Mehta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Raw sequence data (FASTQ files) were deposited in the National Center for Biotechnology Information (NCBI) Sequence Read Archive (SRA), under BioProject identifier PRJNA746243. This study was conducted with approval from the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SERU), which requires that data be released from any KEMRI-based Kenyan studies (including de-identified data) only after their written approval for additional analyses. In accordance, data for this study will be available upon request, after obtaining written approval for the proposed analysis from the KEMRI SERU. Their application forms and guidelines can be accessed at https://www.kemri.org/seru-overview. To request these data, please contact the KEMRI SERU at [email protected]. Funding: This study was supported by the National Institutes of Health Eunice Shriver National Institute of Child Health and Human Development (R01-HD093780 to SDM), and the Joint Global Health Trials Initiative (UK-Medical Research Council/ Department for International Development/ Wellcome Trust/Department of Health and Social Care; MR/N006046/1 to PPH). The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: BIOM, biological observation matrix; BV, bacterial vaginosis; CaCHe, Cups and Community Health; CCT, conditional cash transfer; COVID-19, Coronavirus Disease 2019; CST, community state type; CT, Chlamydia trachomatis; GLMM, generalized linear mixed model; GRC, Genome Research Core; HDSS, health and demographic surveillance system; ITT, intention to treat; MHM, menstrual hygiene management; NG, Neisseria gonorrhoeae; OR, odds ratio; RR, relative risk; SES, socioeconomic status; SSA, sub-Saharan Africa; STI, sexually transmitted infection; TV, Trichomonas vaginalis; VALENCIA, VAginaL community state typE Nearest CentroId classifier; VMB, vaginal microbiome; WASH, water,

<!– –> Cases of conjunctivitis and other eye infections are on the rise in Delhi (representational) New Delhi: Schools in Delhi have reported rising cases of eye infections lasting for three to four days on average, with some sending at least 10 to 12 children showing symptoms back home every day to check the spread of the contagion. Cases of conjunctivitis and other eye infections are on the rise in Delhi, with many doctors cautioning that they are “highly contagious” and proper hygiene behaviour needs to be maintained to check their spread. St Mary’s school principal Annie Koshi said that children who are suffering from eye infections are mostly from class 4 to class 7 and that, they are recovering within three to four days. “Students are recovering and coming back for classes in three to four days,” Ms Koshi told PTI. “However, we have been sending at least 10 to 12 students back home each day due to this. There are no cases of typhoid or any other diseases in St Mary’s school yet,” she added. Students suffering from eye infections have been asked by schools not to come to classes until they have completely recovered. They are also being sensitised by their respective principals and teachers, the president of Delhi State Public School Management Association, RC Jain said. Principal of ITL Public School Sudha Acharya said cases are more prominent amongst the children in the primary section. “Students with eye infection have been missing school for 2-3 days but for typhoid and stomach infection, students are taking medical leave of at least a week. We are taking all possible precautionary measures,” Ms Acharya said. Neeru Vijh of Government Girls Senior Secondary School in Vasundhara Enclave said that more than 10 per cent of the students have been suffering from eye infections in their school. “We are sensitising our students. Teachers are talking about this before beginning their lecture. Even though there are no cases of typhoid in our school, we get our water tanks cleaned from time to time,” Ms Vijh told PTI. Experts underline the need to carry hand sanitisers, while noting that there has been a 50 per cent surge in conjunctivitis cases in OPDs. Sharing numbers, Dr Soveeta Rath, Paediatric Ophthalmology, Strabismus, and Neuro-Ophthalmology, Dr Shroff’s Charity Eye Hospital, in Delhi, said they have observed a notable surge of 50 per cent in conjunctivitis cases in their OPDs. “Particularly affecting children and teenagers, these cases typically present with symptoms like redness, watery eyes, discharge, and a foreign body sensation in the eyes. “It is necessary to maintain hygiene, especially for kids who are going to school. Each kid should have a separate towel and napkin. They should avoid touching contaminated surfaces or their eyes, as the conjunctivitis virus can spread through contact,” she said. It is important that kids sanitise their hands after touching any surface and keep hand sanitisers with them, she added. Delhi government-run hospitals are “on alert”, especially related to cases of conjunctivitis, fungal infections and vector-borne diseases, Health Minister Saurabh Bharadwaj said on Tuesday. (Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.) Featured Video Of The Day Katrina Kaif-Vicky Kaushal Smile As Paparazzi Says “Lovely Jodi” To Them

Infections can present with many different symptoms, and one common symptom is wasting, which involves the loss of fat and in extreme cases lean muscle as well. Researchers in the lab of Salk Institute professor Janelle Ayres, PhD, have now found that that in mice, wasting response to infection by the parasite Trypanosoma brucei—the causative agent of sleeping sickness—occurs in two phases, each regulated by different immune cells. Their study results showed that during T. brucei infection, it is CD4+ T cells that play a role in the development of sickness-induced anorexia and fat wasting, while CD8+ T cells are linked with cachexia. The findings also suggested that while fat loss did not benefit the fight against infection, muscle loss did—a surprising clue that some wasting may help manage illness. The study results might help to inform the future development of more effective therapeutics that spare people from wasting, as well as increase understanding of how wasting influences survival and morbidity across infections, cancers, chronic illnesses, and other disorders. “We often make assumptions that conditions like wasting are bad, since they often coincide with higher mortality rates,” said Ayres, Salk Institute Legacy Chair and head of the Molecular and Systems Physiology Laboratory. “But if instead we ask, what is the purpose of wasting? We can find surprising and insightful answers that can help us understand the human response to infection and how we can optimize that response.” Ayers is senior author of the team’s published paper in Cell Reports, which is titled “CD4+ T cells regulate sickness-induced anorexia and fat wasting during a chronic parasitic infection.” Infections cause reprogramming of host metabolic processes, the authors explained, and clinically, the most obvious metabolic response to infection is energy stores wasting. Cachexia is what the team describes as “an extreme catabolic state,” and is characterized by unintentional weight loss and muscle loss, which can include fat loss. Wasting in which there is only fat loss is known as adipose tissue wasting. However, the team continued, “Whether cachexia or adipose tissue wasting serves functional roles during infections remains unknown, but they are both typically viewed as maladaptive consequences of host-pathogen interactions.” Defending the body from an invading pathogen takes a lot of energy, and will require what the investigators describe as “trade-offs with other biological functions.” Prior studies have suggested that this immune-related energy consumption has wasting as an unfortunate side effect. Ayres and team were curious to know whether wasting could be beneficial, and not just a side effect. Trypanosoma brucei parasites (dark blue) among mouse blood cells (light blue and white). [Salk Institute] T cells are immune cells that are relatively slow to respond to infections, but when they do respond, they adapt to fight the particular infection. Ayres was interested to know whether it was these T cells causing wasting. If T cells are responsible for the condition, that would indicate wasting is not simply an unproductive side effect of energy-hungry immune cells. Of particular interest to the researchers were CD4+ and CD8+ T cells. CD4+ T cells lead the fight against infection and can promote the activity of CD8+ T cells, which can kill invaders and cancerous cells. The two T cell types often work together, so the team hypothesized their role in wasting may be a cooperative effort, too. “A better understanding of the roles of CD4+ and CD8+ T cells in regulating energy stores and how this relates to their functions in host defense is necessary,” they pointed out. To work out the association between CD4+ and CD8+ T cells and wasting, the researchers studied infection with the parasite T. brucei, which resides in fat and can block the adaptive immune response, which includes T cells. This represented an ideal infection to address questions about fat wasting and how T cells mediate that process. “… we utilized a T. brucei-mouse infection model to investigate the role of the adaptive immune response in adipose tissue wasting and cachexia and to determine what function these catabolic responses have for host defense,” they commented. Using this model, the team investigated the role of CD4+ and CD8+ T cells during T. brucei infection in mice, and also assessed how removal of CD4+ and CD8+ T cells changed the longevity, mortality rates, parasite symptoms, and parasitic burden in infected animals. From left: Janelle Ayres, Siva Varanasi, Karina Sanchez, Samuel Redford, and Natalia Thorup. [Salk Institute] The studies showed that in T. brucei infected mice, CD4+ T cells acted first and initiated the process of fat wasting. Afterward, but completely independently of fat wasting, CD8+ T cells initiated the process of muscle wasting. “We find that the wasting response occurs in two phases, with the first stage involving fat wasting caused by CD4+ T cell-induced anorexia and a second anorexia-independent cachectic stage that is dependent on CD8+ T cells,” the investigators wrote. “We demonstrate that CD4+ T cells are drivers of adipose tissue wasting in response to T. brucei infection. We further demonstrate that CD4+ T cells are required for the induction of the sickness-induced anorexic response.” Interestingly, CD4+ T cell-induced fat wasting had no impact on the ability of the mice to fight T. brucei or to survive infection. The CD8+ T cell-induced muscle wasting, however— and contrary to traditional assumptions about wasting – helped the mice fight T. brucei and survive the infection. “Fat wasting has no impact on host antibody-mediated resistance defenses or survival, while later-stage muscle wasting contributes to disease-tolerance defenses,” the team further noted. “Thus, at least in a murine model of T. brucei infection, adipose tissue wasting serves no apparent beneficial function for the host or the pathogen, while cachexia may contribute to host disease-tolerance defenses.” “Our discoveries were so surprising that there were times I wondered if we did something wrong,” said first author Samuel Redford, PhD, a current visiting researcher and former graduate student in Ayres’ lab. “We had striking results that mice with fully functioning immune systems and mice without CD4+ T cells

An uptick in hospital-associated infections (HAI) has triggered questions about whether healthcare institutions in the state of Kerala are becoming a hotbed of antimicrobial resistance (AMR). A report on AMR, released by the state Health Department on 2 August, has set off concerns in this regard. Going by the data from the Kerala Antimicrobial Resistance Surveillance Network’s (KARS NET) Annual Report 2023, AMR is increasing in the state. And so is HAI. It is feared that the state has waged a losing battle against drug resistance as it overlooked HAI in its AMR strategy. What is hospital-associated infection (HAI)? According to the World Health Organisation (WHO), HAI is an infection occurring in a patient during the process of care in a hospital or other healthcare facilities that was not present or incubating at the time of admission. As HAI might result in prolonged hospital stays, misuse and overuse of antimicrobials (medicines used to prevent and treat infections) is also high. Increased resistance of micro-organisms like bacteria, viruses, fungi, and parasites to the antimicrobials could thereby increase the risk of disease spread, severe illness, and even death. According to the United States Centers for Disease Control and Prevention (CDC), HAIs comprise a range of infections like central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections. Also Read: Why is IMA cautioning against use of antibiotics? Reasons for concern Trends of ESBL evidence from KARS NET over four years. (Supplied) As per the KARS NET Annual Report 2023, extended-spectrum beta-lactamases (ESBL) production as well as carbapenem resistance (CR) has been increasing over the years. It came to this conclusion after analysing the trend over the last four years, from 2018 to 2022. ESBLs are enzymes produced by Enterobacterales, a large order of different types of bacteria (germs) that commonly cause infections both in healthcare settings, and in communities. ESBLs can break down and destroy some commonly used antibiotics, including penicillin and cephalosporin, thereby making such drugs ineffective for treating infections. The most worrying trend is the CR, as carbapenems — considered as last-resort antibiotics — are used for the treatment of infections caused by multidrug-resistant microbes. Trends of Carbapenem resistance–evidence from KARS-NET over four years. (Supplied) The report tracked CR against four groups of bacteria: Acinetobacter (that can cause infections in the blood, urinary tract, and lungs, or wounds in other parts of the body) E. coli (strains that can cause illnesses like urinary tract infections) Klebsiella (causing HAI-like pneumonia, bloodstream infections, and meningitis) Pseudomonas (causing infections in the blood, lungs, or other parts of the body after surgery) It also traced the prevalence of Methicillin-resistant Staphylococcus aureus or MRSA (an infection in which Staphylococcus bacteria that causes a range of diseases including sepsis becomes resistant to Methicillin) and Vancomycin-resistant Enterococci or VRE (an infection in which Enterococci bacteria becomes resistant to Vancomycin) in the state from 2018 to 2022. Trends of MRSA and VRE–evidence from KARS NET over four years. (Supplied) As per the report, the apparent decrease in MRSA in 2021 may be attributed to the non-uniformity in data from some centres in the initial months of 2021, owing to the subsequent waves of the pandemic in the state and the majority of centres being Covid care centres. VRE rates have also increased over the last three years. However, the report also cited a limitation as the data mostly represents tertiary care centres and it may not be representative of the community. Also Read: Study finds prevalence of antibiotic resistance in rural Karnataka Other findings The KARS-NET report that covers the AMR data from 1 January to 31 December, 2022, was a result of information compiled from 23 surveillance laboratories spread across 11 districts in the state. Data of patients checked for priority pathogens. (Supplied) The data from 27,604 patients were analysed. Of these, 51 percent (13,962) were female patients and 49 percent (13,443) were male patients. Out of the 27,604 isolates, 49 percent (13,523) were in-patients (IPD), 35 percent (9,704) were out-patients (OPD), 13 percent (3,561) were patients admitted to the intensive care unit (ICU), and the remaining (816) of unknown origin. As per the report, the most isolated pathogen from IPDs and OPDs was E. coli, followed by Klebsiella. In IPD patients, it was 37 percent (5,004) and 26 percent (3,477), respectively. While in the case of OPD patients, it was 45 percent (4,360) and 22 percent (2,112). In ICU facilities, Klebsiella was the most isolated pathogen at 31 percent (1,102), followed by E. coli at 29 percent (1,019). Antibiotic resistance profile of Escherichia coli. (Supplied) The highest resistance to Carbapenem was observed in Klebsiella isolated from blood, that is 43 percent, compared to the other specimen types, while CR observed in E. coli isolates from blood was up to 10 percent. The highlight of the KARS-NET Report was for the first-time network sites submitted AMR surveillance data of 41 Salmonella enterica serovar Typhi and Paratyphi (bacteria causing enteric fever). It came out with the finding that such bacteria achieved low resistance to first-line antibiotics like ciprofloxacin, ampicillin, and chloramphenicol. Also Read: India bans 14 fixed-dose combination medicines used for cough, infections Healthcare institutions and community’s role Dr Aravind R, Convener of Kerala Antibiotic Resistance Strategic Action Plan’s (KARSAP) working committee, told South First that staff accountability and behavioural change are the prerequisites to fight AMR. “Healthcare institutions, as well as the community, must give due importance to infection prevention and control (IPC),” said Dr Aravind. Location-wise distribution of isolates. (Supplied) Take the case of E. coli. These bacteria can cause disease when they make a toxin called Shiga toxin. But it can be prevented by practicing proper hygiene, especially good handwashing, said Dr Aravind. “Washing fruits and vegetables well under running water, cooking meats thoroughly, avoiding cross-contamination and others are some steps that a common man can take to prevent E. coli,” he added. He stated, “It can’t be presumed that ESBL

DEAR DR. ROACH: My mom had a throat and palate infection that was treated in 2017, and about two weeks later, she had a heart attack. In 2023, she had pneumonia, and was briefly hospitalized and treated, but again about two weeks later, she had another heart attack. We asked her cardiologist if there is a relationship between either the infections themselves or the treatment of infections and heart attacks, but he was not aware of any. This seems too unlikely to be a coincidence. What is your experience on this? — A.C.S. ANSWER: A heart attack happens when the demand for blood from the heart is greater than the ability of the blood vessels can provide. In practice, this almost always means that there are blockages in the blood vessels. However, an increase in the workload of the heart, such as strenuous exercise or an infection (fever tends to increase heart rate, and the blood flow from the heart usually increases with serious infection), can be what leads a person to have a heart attack. It’s possible that this is what happened with your mom. The timing of two weeks after the event is longer than expected, but it’s possible. Whether from chronic infection or inflammatory conditions like rheumatoid arthritis, inflammation in the blood increases the risk of heart disease in the long term, so if there is a connection, and it’s not just coincidental, that would be the most likely cause. DEAR DR. ROACH: You wrote about the dangers of testosterone replacement in men over 70 in your column a few months ago. Could you please describe the dangers of this again? My husband is 73 and injects testosterone every 10 days or so. He’s not feeling too well overall, but he doesn’t know why. He’s been to the cardiologist, but the studies came back fine. He says he feels nerves in his stomach and a bit of shortness of breath. He’s also tired and without much energy. — E.D. ANSWER: There are clear dangers with excess testosterone use, especially in older men. Some men use very high doses of testosterone or other androgens for muscle building, and this can cause heart damage, blood clots and stroke. I strongly do not recommend doing this, but it is generally used illicitly. By contrast, for men in whom testosterone therapy is given appropriately, the dangers are quite small, and in most men, the benefits outweigh the risks. Men should have a clear reason to receive testosterone therapy, such as having low bone density, low libido, loss of body hair, or development of breast tissue, in addition to repeatedly low testosterone levels (including a level taken between 8 a.m. and 10 a.m. when testosterone levels are highest). In these men, the goal is to stabilize the testosterone level, and the risks of the catastrophic outcomes listed above appear to be very small, or even zero. Testosterone levels should also be measured during therapy. I can’t speculate on the cause behind your husband’s symptoms. Nonspecific symptoms, such as low energy, can be caused by low testosterone, but unless there are more specific symptoms of low testosterone, I generally do not recommend testosterone replacement. Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].

Scientists have estimated that the global incidence of Brucella infections is much higher than previously believed. Findings suggest that at least 1.6 to 2.1 million new cases of human brucellosis occur every year. This differs significantly from one of the most cited references, which predicts an incidence of 500,000 new cases yearly. Brucellosis is a bacterial disease that affects livestock and humans. In humans, the disease causes fever, sweats, fatigue, and malaise. People are normally exposed to Brucella by consuming unpasteurized milk products or handling contaminated animal tissues. Most human cases come from regions with highly dense at-risk populations. The number of new human brucellosis cases annually remains unclear despite previous attempts to identify the impact of the disease, according to a study in the journal Emerging Infectious Diseases. Risk by regionResearchers produced estimates using animal and human brucellosis data from the World Organization of Animal Health (WOAH) and human population data reported to the World Bank. Data was from 2014 to 2018. They used three statistical models and considered missing information. Disease misdiagnosis and under diagnosis were not considered in the models. Because the team had more complete data for livestock than human disease, at both global and regional levels, they used livestock data as the basis to estimate disease incidence. A total of 144 countries and 3.2 billion people were considered at risk. Models indicated Africa and Asia have most of the global risk and cases, although areas within the Americas and Europe remain of concern. Countries not endemic for the disease record cases resulting from travel and trade of raw milk products across national borders. “Among countries in Africa, inadequate or non-existent public and animal health programs perpetuate the status quo. This uncontrolled disease situation, accompanied by rapid population growth and increased demand for animal products, provides an unfortunate outlook for the future of brucellosis control across this entire region,” said researchers. “Although risk is spread across the entire Asia region, the primary hotspot occurs in the Middle East. This increased risk is likely the result of having close contact with small ruminants and consuming their raw milk products.” French situationMeanwhile, Santé publique France has revealed 40 cases of brucellosis were declared in 2022 in 12 regions. Of these, 38 were imported infections linked mainly to travel to Algeria but also to nations including Turkey, Tunisia, and Djibouti. One person fell sick after consuming a cheese from Lebanon. For the two non-imported cases, one was a former slaughterhouse employee who started work before the elimination of brucellosis in farms. The other patient could not be contacted. The number of cases returned to 2019 levels, in line with the resumption of travel to countries considered endemic, as COVID-19 pandemic restrictions were lifted. In 2020 and 2021, about 20 cases were recorded each year. A total of 34 strains belonged to Brucella melitensis, one to Brucella abortus and another was not characterized. Symptom onset dates for cases reported in 2022 ranged from December 2018 to November 2022. Fifteen cases were female. Patients were aged 5 to 91 with a median of 55 years old, including two children under 16 years old. Two cases were pregnant women. (To sign up for a free subscription to Food Safety News, click here.)