The as yet unexplained cluster of Elizabethkingia anophelis cases in Wisconsin (and 1 in Michigan) that we've been following for the past 7 weeks took another turn a week ago when the Illinois DOH Confirmed An Elizabethkingia Infection In Local Resident.
Today, the Illlinois State Department of Health issued a press release announcing they have now detected 10 additional cases, 6 in patients that have died.
Last week's case apparently matched the strain reported in both Wisconsin and Michigan, while the 10 newly announced cases are reportedly a different strain of Elizabethkingia anophelis.
The exact time frame for these cases isn't immediately clear, as they were detected by going back over old cases, but some may go back a year or longer. First the press release, then the state's information page.
Because of the Elizabethkingia outbreak in Wisconsin, IDPH sent alerts to Illinois hospitals and laboratories in early February and again in March requesting that they report all cases of Elizabethkingia going as far back as January 1, 2014. Additionally, IDPH requested that facilities save any remaining specimens for possible testing.
IDPH sent the specimens it received to the Centers for Disease Control and Prevention (CDC) for testing, which resulted in the confirmation of these 10 cases. Six of those individuals have died; however, IDPH is unable to determine if Elizabethkingia was the cause of death because many of those individuals had underlying health conditions. As part of its testing, the CDC previously identified a case of Elizabethkingia that matches the strain in the Wisconsin outbreak. Earlier this month, IDPH reported that one case in Illinois related to the Wisconsin strain.
“Although this strain of Elizabethkingia is different than the one seen in the Wisconsin outbreak, our investigatory methods remain the same and we continue to work with the CDC and our local health departments to investigate this cluster of cases and develop ways to prevent additional infections,” said IDPH Director Nirav D. Shah, M.D., J.D.
Health officials continue to collect case histories and other information to try to find a connection among these individuals. Previously, health providers were not required to report individual cases of Elizabethkingia, so it is difficult to determine the degree and kind of exposure that results in illness. For the same reason, it is difficult to estimate how many cases of illness actually occur each year.
Elizabethkingia bacteria are commonly found in the environment, but do not typically cause human illness. The majority of the infections identified to date in Illinois have been bloodstream infections and in patients who are over age 65.
To help prevent illness due to various types of bacteria, implement good health practices, wash your hands frequently, and make sure your health care providers do the same.SPRINGFIELD – The Illinois Department of Public Health (IDPH) announced today recent test results show 10 Illinois residents have been diagnosed with infections caused by a strain of Elizabethkingia anophelis that is different from the outbreak in Wisconsin.
The Illinois DOH has posted the following webpage as well:
10 Illinois residents have been diagnosed with infections caused by a strain of Elizabethkingia anophelis that is different from the outbreak in Wisconsin
*Please note that numbers are provisional and may be subject to change.
Elizabethkingia bacteria are rarely reported to cause illness in humans. Symptoms among people diagnosed with Elizabethkingia infection can include fever, shortness of breath, chills or cellulitis. Confirmation of the illness requires a laboratory test.
IDPH is currently investigating a cluster of bacterial infections caused by Elizabethkingia anophelis. The majority of patients acquiring these infections are over 65 years old, and all patients have a history of at least one underlying serious illness.
To date, Wisconsin is reporting 59 confirmed cases, including 18 deaths; Michigan is reporting one confirmed case, including one death. Illinois has one case matching the strain found in Wisconsin. The remaining 10 cases in the current cluster are of a different strain.
At this time, the source of these infections is still unknown. IDPH is working with the Centers for Disease Control and Prevention (CDC) and the Wisconsin and Michigan Departments of Public Health to conduct a comprehensive investigation which includes:
- Interviewing patients with Elizabethkingia anophelis infection and/or their families to gather information about activities and exposures related to healthcare products, food, water, restaurants, and other community settings
- Obtaining environmental and product samples from facilities that have treated patients with Elizabethkingia anophelis infections
- Conducting a review of medical records
- Obtaining nose and throat swabs from individuals receiving care on the same units in health care facilities as a patient with a confirmed Elizabethkingia anophelis to determine if they are carrying the bacteria
- Obtaining nose and throat swabs from household contacts of patients with confirmed cases to identify if there may have been exposure in their household environment
- Performing a “social network” analysis to examine any commonalities shared between patients including health care facilities or shared locations or activities in the community
The genus Elizabethkingia includes not only E. Anophelis , but also E. meningoseptica, E. miricola, and E. endophytica. Most cases in the literature have involved HAI's (Hospital Acquired Infections), and community outbreaks are rare.
- In 2012 an outbreak at a London hospital infected 30 patients (see EID Journal Waterborne Elizabethkingia meningoseptica in Adult Critical Care) with infection associated with water sources in the critical care unit.
- Another outbreak, also in 2012, reported in the Indian Journal of Critical Care (see Elizabethkingia meningoseptica: Emerging nosocomial pathogen in bedside hemodialysis patients) isolated this organism in the hospital unit's handwash sink and water supply.
- In 2013 4 patients on ventilators were infected in India (see Elizabethkingia Meningoseptica Outbreak in Intensive Care Unit),
To date, despite intensive state and CDC epidemiological investigations, no source or common exposure for these infections has been found.