Little Pink Houses and MERS in Indiana

The just revealed news of an imported MERS (Middle East Respiratory Syndrome) case in Indiana--the first in the US--is not surprising. 

MERS has been simmering for 2 years and importations have occurred to several countries, including the UK. 

In this case, an infected healthcare worker (not surprisingly) traveled from Riyadh to London and on to Chicago. The patient then boarded a bus to Indiana.  

Although MERS has a case fatality rate of 30%, this patient appears to be not critically ill. Important actions in the coming days will include searching for secondary cases.

This case illustrates 2 important things:

1. It's a small world and infections on one side of the globe can appear on the other with no border restriction string enough to stop it. 

2. Astute clinicians are crucial. From what I've read, the patient's travel history tipped off physicians who ordered the appropriate tests. 

MERS occurring in the US was something that was expected and planned for--remember 8 SARS cases occurred in the US as well.

To Catch a Virus You Need A Special Mitt

I just finished the book To Catch a Virus. This book is focused on the developments in diagnostic virology that have shaped the way modern medicine confronts viral infections. What is most attractive about this book is that it details the discovery in a chronological fashion stressing the conceptual links between discoveries. For example, the development of PCR testing is handled in a manner in which one is able to see the progression from Oswald Avery to Kary Mullis without difficulty. Additionally, the book stresses the inductions made by various investigators providing a treasure trove of material for historians and philosophers of science. I highly recommend the book.

Why are Lice and Scabies Scarier than MRSA, C.diff, and VRE?

In the realm of hospital infection control there is a constant struggle to raise compliance rates with contact precautions. These measures are instituted when a patient harbors an organism that poses a transmission risk that is deemed to pose too great a threat to others in the hospital. MRSA, VRE, and C.diff are the big three but other conditions such as active tuberculosis and influenza also require isolation precautions. 

In most of these cases, contact precautions are considered burdensome and often result in less healthcare contact with such patients as healthcare providers eschew donning the gown and gloves required to comply with hospital regulation. 

However, 2 pathogens unequivocally prompt full compliance and when you see doctors and nurses meticulously ensuring their personal protective equipment is being worn appropriately you can be sure one of these two pathogens are present. 

It's not MDR-TB or measles that merits such mindfulness, but lice and scabies! 

It strikes me as paradoxical that such minor and easily treated pathogens strike fear in the heart of healthcare providers at such a momentous scale. 

Maybe a continual epidemic of lice, co-infected those with MRSA, C.diff, and VRE, is all that's needed to ensure compliance with infection control.

It's Elementary, Anthrax is Not Contagious

I like detective stories and detective work. That's why I love infectious diseases so much. Sherlock Holmes is probably the most famous literary detective archetype of all time and I enjoy reading Sir Arthur Conan Doyle's (who, by the way, was a physician) tales of his and Dr. Watson's adventures.

In that same vein, I enjoy watching the CBS program Elementary which portrays a modern day NYC-set version of Holmes and Dr. Watson. Last week's episode, which I was especially looking forward to, was focused on a death of a man from anthrax and the subsequent threat of its use in a mass casualty setting. 

One glaring factual inaccuracy, however, detracted from my viewing pleasure: on two occasions anthrax was mentioned in connection with quarantine. 

Quarantine, a measure that is scarcely used, is the exclusive province of communicable (i.e. contagious) diseases.

Anthrax is not contagious and the mistaken belief by the public that it is can pose problems during actual events, hampering response and needlessly causing unwarranted panic.

For example, as a medical student doing an ER rotation in New York City during October 2001, at the height of the Amerithrax attacks, I was "locked" down in an ED in which someone exposed to white powder presented. Predictably, no one would believe the medical student (albeit one that was a burgeoning ID physician) that anthrax was not communicable.

Anthrax does a lot of bad things to people but it doesn't spread between them. 

Spring Cleaning: An Opportunity to Inhale Rodent Urine

When I travel, I really enjoy reading local newspapers in order to get an idea of the issues that affect an area. Usually, these issues have little to do with infectious diseases but yesterday I came across an article regarding hantavirus in Utah. 

Hantavirus is a potentially lethal disease that came to public awareness after a large outbreak in 1993 in the Four Corners region. It also caused an outbreak at Yosemite in recent years.

Hantavirus is contracted via the inhalation of rodent urine and droppings (it happens more commonly than you might imagine) and it is no surprising that the change in season coincides with cases.  Spring cleaning of sheds and other areas stirs up these substances allowing them to be inhaled. 

The lesson: be careful when spring cleaning.