Is Citronella Safe for Dogs? A Veterinarian Provides Guidance

Puerto Rico Issues Public Health Emergency After Spike In Potentially Fatal Mosquito-borne Infections

The U.S. Territory of Puerto Rico has joined nearby islands in declaring a public health emergency after a spike in cases of dengue fever.

The health department reports there have been more than 540 cases so far this year, which is a 350% increase when compared to activity over the last five years.

"This year, dengue cases have exceeded historical figures. Teams have been working on the integrated plan for prevention and control in response to arboviruses, and we will expand the implemented response. It is important to note that the increase in cases has not only been reflected in Puerto Rico, but we have seen it throughout the Americas region," Mellado López, head of the Puerto Rico Department of Health, said in a statement.

The Mayo Clinic says dengue is a potentially life-threatening infection that is transmitted through mosquitoes.

Similar to Zeka, there are no known cures or vaccines for the virus, but symptoms can be treated with medication.

Symptoms of dengue fever include aches, nausea, vomiting, difficulty breathing, and fatigue.

The World Health Organization says the virus led to the deaths of more than 5,000 people around the world in 2023.

Puerto Rico has joined nearby islands in declaring a public health emergency after a spike in cases of dengue fever. REUTERS The Mayo Clinic says dengue is a potentially life-threatening infection that is transmitted through mosquitoes. REUTERS

Of the more than 3,000 types of insects, the Aedes aegypti mosquito is thought to be the primary spreader of dengue throughout the Americas.

"Wherever you have a significant number of mosquitoes and warm hot environments is where you see dengue transmission," Dr. Stacey Rizza, a Mayo Clinic infectious diseases specialist, told the Mayo Clinic News Network.

Jamaica, Curacao, Brazil, and many other territories and nations have issued emergencies over the stunning uptick in dengue.

The health department reports there have been more than 540 cases so far this year, which is a 350% increase when compared to activity over the last five years. FOX Weather Of the more than 3,000 types of insects, the Aedes aegypti mosquito (seen above) is thought to be the primary spreader of dengue throughout the Americas. AP

The WHO has warned the endemic is the fast-growing mosquito-borne illness worldwide and is likely a result of a changing climate, an El Niño pattern, human conflicts, and poor access to healthcare.

Start your day with all you need to know

Morning Report delivers the latest news, videos, photos and more.

Thanks for signing up!

NOAA satellite estimates show an increase in precipitation was observed across many of the Caribbean islands over the past winter, which can aid in increasing the mosquito population.

Heavy rainfall and warm temperatures can help increase breeding sites and lengthen the transmission season.

The WHO has warned the endemic is the fast-growing mosquito-borne illness worldwide and is likely a result of numerous effects such as changing climate, an El Niño pattern, human conflicts, and poor access to healthcare. REUTERS A dengue prevention kit is displayed during a health fair, after an increase in dengue fever cases. REUTERS

"Dengue has become a growing public health concern with approximately 4 billion people in 130 countries identified at risk of infection," the WHO said.

Health experts suggest an essential tactic in the fight against mosquitoes is as simple as removing stagnant water, applying bug spray, and wearing protective clothing.

WHO previously stated that transmission is cyclic and outbreaks last 3-4 years, but with a changing climate it is unclear if the virus will follow previous norms.

Are Deadly Strep Infections On The Rise? Here's What To Know

Japan has been experiencing a dramatic rise in cases of streptococcal toxic shock syndrome (STSS), according to the country's National Institute of Infectious Diseases (NIID) and as reported in the Japan Times.

In 2023, a record 941 cases of STSS were reported in Japan, outpacing the record 894 cases that occurred in 2019. So far this year, 517 cases have been documented in the country, with cases occurring in 45 of 47 of the country's prefectures.

This week, the Tokyo Metropolitan Government issued a warning to residents about the disease, as 88 cases have already occurred in the city since the beginning of the year -- more than half of last year's total number. Specific factors that are fueling the surge remain unknown. The mortality rate for STSS in Japan is 30%, according to the NIID.

Japan's health authorities are now urging people to take basic preventive measures to ward off infection with group A Streptococcus (GAS), the bacteria that causes STSS, such as hand-washing and appropriate wound care. Aside from STSS, GAS causes other invasive infections such as cellulitis, necrotizing fasciitis, and pneumonia.

Invasive GAS Infections in the U.S.

"We've had issues in the U.S. With this organism ... So we've been aware of this for some time now," George Diaz, MD, an infectious diseases specialist and division chief of medicine at Providence Regional Medical Center in Everett, Washington, told MedPage Today.

Diaz pointed to recent CDC data that showed a decrease in invasive GAS infections during the COVID-19 pandemic, most likely due to preventive measures, such as isolation and quarantining. "We believe there's a resurgence in cases after those sorts of measures have been relaxed," he said.

Overall, invasive GAS infections have been increasing in the U.S. Over the past decade, primarily in adults, and preliminary data from 2023 indicated that the number of invasive GAS infections reached a 20-year high. However, during the COVID pandemic, cases decreased by up to 25% compared with the years right before the pandemic, and infection numbers were especially low in children. In late 2022, that trend reversed, with invasive GAS infections increasing to levels higher than those seen in pre-pandemic years, particularly for children. In December 2022, the CDC issued a health advisory about recent increases in pediatric invasive GAS infections in multiple states.

CDC data from the last 5 years showed that approximately 14,000 to 25,000 cases of invasive GAS disease occurred each year in the U.S. And 1,500 to 2,300 people died annually from these infections. In contrast, several million cases of milder GAS-associated illnesses, such as strep throat, scarlet fever, and impetigo, occur annually in the U.S.

Diaz noted that the apparent spike in cases of STSS in Japan may be in part due to heightened vigilance in diagnosing the condition there. "It could be that what Japan is seeing is that they're being very careful about identifying these cases. And so they're seeing these high numbers, especially in mortality, versus in the U.S. Where we may not be quite as good as Japan in identifying and tracking these cases," he explained. It is not uncommon for milder forms of STSS to be underdiagnosed, he added.

STSS can result from invasive or noninvasive GAS infection, but typically occurs when bacteria enter through compromised skin or mucus membranes, with the main sites of entry being the vagina, pharynx, mucosa, and skin or soft tissue, and then spreads systemically and in the bloodstream. However, the route of entry remains unknown for up to 50% of cases.

Early symptoms of STSS include influenza-like symptoms, such as fever, myalgia, nausea, and vomiting. As the disease progresses, it is associated with soft tissue necrosis, as well as multi-organ involvement, including renal impairment, coagulopathies, liver involvement, and acute respiratory distress syndrome. Mortality rates from STSS range from 30% to 70%, even with aggressive antibiotic treatment and hospitalization.

STSS is more common in people ages 65 and older, those who have recently had surgery, and in people with diabetes or alcohol use disorder. GAS can be transmitted via droplets and contact with contaminated surfaces, but transmission can be reduced by standard infection control practices, including good hand hygiene and respiratory etiquette.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures

Diaz reported no conflicts of interest.

Please enable JavaScript to view the comments

Study: Dangerous Surgical Site Infections Can Be Reduced With Simple Prevention Protocol

A new study published in the American Journal of Infection Control demonstrates the use of a simple pre-surgical infection prevention protocol to prevent dangerous post-surgical infections. Researchers performed this investigation at the Soroka University Medical Center in Israel.

Surgical site infections (SSIs) are a type of health care-associated infection with deadly consequences for some patients. According to the latest data from the Centers for Disease Control and Prevention, there were more than 110,000 SSIs linked to inpatient surgeries in the U.S. In 2015. These infections lead to a high rate of morbidity and mortality, with a patient's estimated risk of death as much as 11 times higher than normal. SSIs also have a very high financial burden, with the average hospital stay extended by nearly 10 days and an estimated $20,000 in additional hospitalization costs per patient.

There are a number of recommended protocols to help prevent SSIs, but lack of patient compliance, high costs, and bacterial resistance can reduce their utility and effectiveness. In this new study, researchers aimed to evaluate the results of a protocol designed to reduce SSIs through a particular focus on the Staphylococcus aureus pathogen. The approach involved a pre-surgical intranasal application of povidone-iodine and skin antisepsis using chlorhexidine gluconate (CHG).

The study involved 688 adult patients who had hip or knee arthroplasty or spine surgery at Soroka University Medical Center between February 2018 and October 2021. Their outcomes were compared to a retrospective patient cohort from 2016 and 2017 treated before the povidone-iodine component of the protocol was implemented. Patient outcomes were tracked for 90 days after surgery.

Deploying this intervention prior to surgery helped to address a broad challenge in health care, that some 30% of the population is colonized with S. Aureus without exhibiting symptoms. The pre-surgical protocol successfully eradicated S. Aureus in nearly 40% of patients found to already harbor the pathogen.

This is particularly important for patient outcomes, as the researchers found that the presence of S. Aureus within the day following surgery was associated with a three-fold risk of developing an SSI. Overall, the study showed a significant decrease in severe SSIs among patients who received the newer protocol.

"Our study clearly shows that we can prevent surgical site infections and keep patients safer through the use of a simple pre-surgical nasal application of povidone-iodine in combination with standard CHG bathing," said Lisa Saidel-Odes, MD, Infectious Diseases specialist at Soroka University Medical Center and lead author of the paper. "We noted that the protocol is most effective in cases with little S. Aureus present and suggest that an additional application of the povidone-iodine might be needed for patients with greater nasal colonization."

Additional details from the study:

Of the 688 patients included, 28 developed an SSI in the 90-day study window. Patients with diabetes were at particularly increased risk for developing an SSI.

Patients were screened for S. Aureus prior to surgery. More than 16% were already colonized with either methicillin-sensitive or methicillin-resistant S. Aureus.

Of patients who developed SSIs, S. Aureus was not the only cause of infection. Eleven patients were infected with Enterobacterales.

"This study shows the power of applying widely available antiseptics to reduce SSIs and improve patient safety," said Tania Bubb, Ph.D., RN, CIC, FAPIC, 2024 APIC president. "The results are encouraging not only because the regimen is effective in reducing SSI, but also because it is simple to implement and avoids the risk of antibiotic resistance."

More information: Getting the Drop on Staphylococcus aureus: Semi-Quantitative Staphylococcus aureus Nasal Colony Reduction in Orthopedic Surgery Reduces Surgical Site Infection, American Journal of Infection Control (2024). DOI: 10.1016/j.Ajic.2024.02.014

Provided by Association for Professionals in Infection Control

Citation: Study: Dangerous surgical site infections can be reduced with simple prevention protocol (2024, March 28) retrieved 29 March 2024 from https://medicalxpress.Com/news/2024-03-dangerous-surgical-site-infections-simple.Html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

---