Thursday, March 24, 2016

Wisconsin DOH Elizabethkingia Update - March 23rd


The medical mystery in Wisconsin continues with their unprecedented, and at least partially community acquired Elizabethkingia outbreak (see earlier reports here, here and here), with cases coming from 13 different counties.

Some of these cases are reportedly nursing home patients, or had recent contact with a medical facility, but apparently not all (cite)

In a normal year Wisconsin might expect to see 1 or 2 cases, so how so many have come to be infected remains unknown, although both state and CDC disease detectives are on the ground and looking for answers.

The latest update adds 5 cases since last week, although only 52 cases are laboratory confirmed.


Elizabethkingia are bacteria that are rarely reported to cause illness in humans, and are uncommon colonizers of the respiratory tract.

The signs and symptoms of illness that can result from exposure to the bacteria can include fever, shortness of breath, chills or cellulitis. Confirmation of the illness requires a laboratory test.

Wisconsin 2016 Elizabethkingia anophelis outbreak

The Wisconsin Department of Health Services (DHS), Division of Public Health (DPH) is currently investigating an outbreak of bloodstream infections caused by Elizabethkingia.

The majority of patients acquiring this infection are over the age of 65, and all patients have a history of at least one underlying serious illness.

At this time, the source of these infections is unknown and the Department is working diligently to contain this outbreak.

As part of the outbreak investigation activities, DPH and the Centers for Disease Control and Prevention (CDC) are conducting site visits and collecting environmental samples from both private residences and health care facilities. CDC is also assisting Wisconsin with testing of samples from a variety of potential sources, including health care products, water sources and the environment. To date, none of these have been found to be a source of the bacteria.

The Department has alerted health care providers, infection preventionists and laboratories statewide and provided information as well as treatment guidance for this outbreak. After that initial guidance was sent, there has been a rapid identification of cases and healthcare providers have been able to treat and improve outcomes for patients.


Affected counties include Columbia, Dane, Dodge, Fond du Lac, Jefferson, Milwaukee, Ozaukee, Racine, Sauk, Sheboygan, Washington, Waukesha, and Winnebago.

*This investigation is ongoing. Case counts may change as additional illnesses are identified and more cases are laboratory confirmed.
**These are cases that tested positive for Elizabethkingia, but will never be confirmed as the same strain of Elizabethkingia anophelis because the outbreak specimens are no longer available to test.

The Wisconsin Division of Public Health (DPH) continues to receive reports of bloodstream infections caused by a bacterium of the genus Elizabethkingia. Elizabethkingia are opportunistic pathogens preferentially causing illness among immune compromised individuals or patients with underlying medical conditions, and are associated with high mortality. Therefore, early detection and treatment with an effective antibiotic regimen is important to increase the probability of good outcomes.

The index of suspicion for Elizabethkingia infections should be high among patients with multiple co-morbid conditions, particularly malignancy, diabetes mellitus, chronic renal disease or end-stage renal disease on dialysis, alcohol dependence, alcoholic cirrhosis, immune-compromising conditions or immunosuppressive treatment. 

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