MMWR: The Dangers Of Dagging Hoggets

 

 

 

# 6000

 

Since 6,000 posts is a bit of a milestone, I’d hoped for something really special to blog about; a major scientific discovery, or some breaking flu news perhaps.

 

Alas, this has been a fairly slow news morning, so I’ll settle for something unusual instead.

 

If you’ve noticed some snickering going on among disease geeks over the past 24 hours, it may be due to a dispatch from the CDC’s MMWR yesterday that describes a rather unique route of infection by Campylobacter jejuni in a couple of ranch workers in Montana.

 

First a link and excerpt (emphasis mine), then I’ll return with some `historical perspective’.

 

Notes from the Field: Campylobacter jejuni Infections Associated with Sheep Castration — Wyoming, 2011

Weekly

December 9, 2011 / 60(48);1654-1654

On June 29, 2011, the Wyoming Department of Health was notified of two laboratory-confirmed cases of Campylobacter jejuni enteritis among persons working at a local sheep ranch. During June, two men had reported onset of symptoms compatible with campylobacteriosis. Both patients had diarrhea, and one also had abdominal cramps, fever, nausea, and vomiting. One patient was hospitalized for 1 day. Both patients recovered without sequelae.

 

During June, both patients had participated in a multiday event to castrate and dock tails of 1,600 lambs. Both men reported having used their teeth to castrate some of the lambs. Among the 12 persons who participated in the event, the patients are the only two known to have used their teeth to castrate lambs. During the multiday event, a few lambs reportedly had a mild diarrheal illness. Neither patient with laboratory-confirmed illness reported consumption of poultry or unpasteurized dairy products, which are common sources of exposure to C. jejuni (1). The patients resided in separate houses and did not share food or water; none of their contacts became ill.

 

(Continue . . .)

 

 

 

Ahem.  I’ll give you all a second to compose yourselves.

 

The practice of `dagging hoggets’ with one’s teeth, while not exactly sanitary (or palatable), is apparently one of long standing.

 

Errol Flynn, Hollywood’s swashbuckling leading man for more than two decades (1932-1959), grew up in Australia, and worked a variety of jobs as a young man.

 

One of them was at a sheep farm in the 1920s, and part of his job . . . you guessed it . . . was sheep castration.

 

The hard way.

 

Flynn delighted in relating the details of this procedure at fancy dinner parties and society functions once he had obtained fame and fortune, and included a graphic description in his autobiography  My Wicked, Wicked Ways.

A quote from his book (warning, a bit graphic) follows:

“All I had to do was stick my face into this gruesome mess and bite off the young sheep's testicles. Dag a hogget. I had good teeth. I put my nose into this awful-smelling mess, my teeth solidly around the balls of the six-month-old sheep, and took a bite while I held him upside down. My nose was in fur and ordure. I bit and spat out the product into a pile of what they called prairie oysters. We have them in America too: delicious to eat, but not delicious to remove. They said this was the most sanitary way to de-ball a sheep. After I was done, I passed the sheep onto the next man, who put a little coal tar on the same spot for purposes of cleansing and closing up the wound.

The sheep never let out a bleat.”

 

 

Somehow, between  E. coli infections, fecal implants, and now dagging hoggets, today’s AFD blogs have developed a bit of a theme.  

 

Purely unintentional, I assure you. Sometimes you just have to go where the stories lead you. 

 

Then you take a long, hot shower.

The Sonora/Arizona GBS Cluster

 

 

# 5694

 

 

Since the end of June the diligent newshounds on FluTrackers have been following reports of a growing number of `flaccid paralysis’ – sometimes described as Guillain-Barré Syndrome (GBS) – cases reported in Sonora Mexico and Southwestern Arizona.

 

The tracking thread, which as of today contains 35 – mostly Spanish-to-English translations - may be viewed here.

 

Those with good memories may recall that late last year another cluster of unexplained GBS-like cases occurred some 1500 miles to the south-east in Veracruz, Mexico.

 

I wrote about that outbreak twice (see Guillain-Barre Syndrome in Mexico, More On the Veracruz Paralysis Outbreak). Despite the detection of 38 cases, and several months of investigation, no definitive cause was determined.

 

Vaccines were eliminated from the suspect list, and the focus was on testing water, food, and environmental samples for toxins and bacterial contamination.

 

The Veracruz cluster dwindled in early 2011, and since then there have only been a few scattered cases of GBS in that region.

 

Since late last month Spanish Language newspapers in Sonora have been reporting on an unusual number of `flaccid paralysis’ cases and an elevated level of diarrheal diseases in their community.

 

Guillain-Barré Syndrome is an autoimmune disorder that causes muscle weakness ands sometimes paralysis. Most patients recover after a few weeks, although permanent nerve damage can remain.  On rare occasions, patients can die from the illness.

 

While all of the causes of GBS are not known, doctors do know that it often follows a bacterial or viral infection. 

 

This from the CDC’s Guillain-Barré syndrome (GBS)  Q&A page.

What causes GBS?

Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS.

People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

 

Late Wednesday afternoon the Yuma (Arizona) County Health Department issued a statement on the recent rise in diarrheal/Campylobacter cases and cluster of GBS-like cases in Southern Arizona and neighboring Sonora, Mexico.

Rare Condition Sparks Investigation

 

Posted Date: 7/13/2011 4:00 PM

Yuma County, Arizona, and San Luis, Sonora, have recently seen an increase in Campylobacter infection/acute diarrheal illness and Guillain-Barre’ Syndrome within their respective communities.

 

Campylobacter infection/acute diarrheal illness usually comes from a food or water source(s), and it causes diarrhea; sometimes with abdominal pain, and fever.

 

Campylobacter infection/acute diarrheal illness is one of the most common causes of diarrheal infection. Guillain-Barre’ Syndrome is a rare complication that can cause muscle weakness and sometimes paralysis. This condition is thought to be caused by an immune reaction response to a recent illness/infection.

 

The Yuma County Health District, along with the Arizona Department of Health Services, the Centers for Disease Control and Prevention (CDC) and Sonora health officials are working together to conduct an investigation into the source(s) of these health conditions.

 

“An investigation of this nature takes a lot of time and a lot of people. It’s like putting a puzzle together. You need all the pieces before you see the picture,” said Becky Brooks, Director of Yuma County Health District. “The response from all agencies has been great, and the expertise from each has certainly contributed to the investigation.”

 

Health officials from Arizona and Sonora have also conducted outreach and education and have asked physicians and hospitals to watch for the signs of GBS or Campylobacter infection and quickly contact their local health department with any possible cases.

 

It is important to note that GBS is not passed person to person and the best thing to do is to prevent gastrointestinal infections in the first place.

 

Good hand washing habits and safe food preparation go a long way to prevent common illnesses. Everyone should wash their hands thoroughly after using the bathroom, before and while they are cooking, and before eating.

 

Be sure to follow the four food safety tips: Clean, Separate, Cook, and Chill.

Clean: Wash hands, cutting boards, utensils, and countertops.
Separate: Keep raw meat, poultry, and seafood separate from ready-to-eat foods ( fruits, vegetables, food that do not require cooking).
Cook: Use a food thermometer to ensure that foods are cooked to a safe internal temperature: 145 F for whole meats (allowing the meat to rest for 3 minutes before carving or consuming), 160 F for ground meats, and 165 F for all poultry.
Chill: Keep your refrigerator below 40 F and refrigerate food that will spoil. Keep cold things cold and hot things hot.

• Seek medical care if you develop Gastrointestinal symptoms.
• Don’t prepare food for others if you have diarrhea or vomiting.
• Be especially careful preparing food for children, pregnant women, those in poor health and older adults.
• Washing your hands is the single most important thing you can do to prevent illness.

 

Since this release, the local media has picked up on the story.  A few examples include:

 

Mystery diarrhea outbreak in Yuma County, Mexico

Diarrhea Cases on the Rise, Yuma Health Officials Investigates

CDC investigating increase in illnesses in Yuma County

 

While fairly rare, GBS affects between 3,000 and 6,000 Americans every year.  Campylobacter infections, on the other hand, are very common, with an estimated 2.4 million cases in the U.S. every year.

 

This from the CDC’s  NCZVED information page on:

 

Campylobacter

What is campylobacteriosis?

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

 

(Continue . . .)

 

Although a campylobacter link has not yet been established, this GBS outbreak will  likely subside once the outbreak of diarrheal disease can be stemmed.

 

The newshounds on FluTrackers will continue to follow the story in the U.S. and Mexican press, and if anything unusual comes out of the CDC’s investigation, I’ll report on it here.

Lancet: UK Ciprofloxacin-Resistant Campylobacteriosis

 

 

# 5133

 

 

 

Yesterday Maryn McKenna wrote in her Superbug blog  News break: FDA estimates US livestock get 29 million pounds of antibiotics per year. 

 

If you haven’t already read it, you should.  You should also check out today’s blog from Maryn,  “Pig MRSA”: New human infections in France.

I’ll wait.

 

Today, a somewhat related correspondence appears in The Lancet on the rise of Ciprofloxacin-resistant campylobacterial infections in the UK.  Cipro is a 2nd generation fluoroquinolone antibiotic.

 

The article (registration required for access):

 

 

Ciprofloxacin-resistant campylobacteriosis in the UK

Alison J Cody, Lorraine Clarke, Ian CJW Bowler, Kate E Dingle

Preview | Full Text | PDF

 

 

The authors state that between 1995 and 2008, the percentage of campylobacter isolates cultured at the John Radcliffe Hospital, Oxford, UK that were cipro resistant has risen from 7% to 37.5%. 

The incidence of erythromycin resistance, meanwhile, have remained basically unchanged at under 2.5%.

 

Although its use in poultry was banned in the United States in 2005, there are still about a half dozen fluoroquinolones authorized for veterinary use (cite NOAH) in the UK on cattle, pigs, chickens, turkeys, dogs, cats and other pet animals.

While normally individual animals are treated, entire flocks of turkeys and chickens may be treated with fluoroquinolones placed in their water supply for short periods of time under the direction of a licensed veterinarian.

 

 

The authors conclude that: government regulation of the poultry industry is necessary, since increasing numbers of ciprofloxacin-resistant isolates from human beings, most of which originate in poultry, imply a link to the veterinary use of fluoroquinolones

 

 

This article is actually a follow-up to a study printed last August The Lancet, called:

 

The growing UK epidemic of human campylobacteriosis

Original Text

Norval JC Strachan a, Ken J Forbes b

Campylobacter spp are the largest cause of bacterial gastroenteritis in the developed world. 1 The 2009 reporting rates for Scotland 2 and England/Wales 3 show more than 64 000 cases, representing year-on-year rises of 30% and 14%, respectively. Because there is substantial under-reporting, 4 the actual number of cases is likely to be closer to 450 000. Further, about 10% of reported cases are hospitalised. The sequelae of this disease not only include severe stomach cramps and diarrhoea but also, in up ...

 

 

Fortunately, although widespread (millions of cases are estimated each year in the United States) and misery inducing, campylobacteriosis is usually a self-limiting illness.

 

Only in severe cases are antibiotics required.

 

This from the CDC’s National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) factsheet.

 

What is campylobacteriosis?

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

 

How common is Campylobacter?

Campylobacter is one of the most common causes of diarrheal illness in the United States. The vast majority of cases occur as isolated, sporadic events, not as part of recognized outbreaks. Active surveillance through FoodNet indicates that about 13 cases are diagnosed each year for each 100,000 persons in the population. Many more cases go undiagnosed or unreported, and campylobacteriosis is estimated to affect over 2.4 million persons every year, or 0.8% of the population.

(Continue . . .)

 

 

If most campylobacter infections don’t require antibiotic treatment, you may be wondering why regulating the use of fluoroquinolones in agriculture is looked upon as such a big deal? 

 

Well, obviously, some people can become very ill and do require antibiotics when infected with campylobacter.  More than 100 deaths a year are attributed to that bacteria in the US alone.

 

But, ciprofloxacin resistant campylobacter isn’t the only adverse result from using these types of antibiotics on livestock. It is just a fairly easily observed one.

 

Due to continued use (and frequently, misuse) around the world, other bacteria, like E. coli, C. Difficile and salmonella are also developing resistance to fluoroquinolones.

 

And these antibiotics end up in our food, and our environment, inviting even more bacterial resistance to develop.

 

Our victories over bacterial infections using modern antibiotics have rightfully been described as a miracle of modern science.

 

But improper stewardship of our dwindling arsenal of effective antimicrobial agents threatens to cripple our ability to treat many serious infections. 

 

For more information on the prudent use of antibiotics, you may wish to revisit:

 

Eurosurveillance On Antimicrobial Resistance

ECDC/EMEA: Joint Report On Resistant Bacteria

Carbapenemases Rising