Clinical Infectious Diseases, Feb 2018

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CID Donald Kaye 0 Section Editor 0 0 Legionnaires Sickens 12 in California , Including 9 at Disneyland , USA 13 November 2017 (Reuters [Dan Whitcomb])-Disneyland has shut down and decontaminated 2 cooling towers following an outbreak of Legionnaires disease that sickened 12 people, 9 of them guests or employees at the theme park in Anaheim, county health officials said. One of the 3 cases of the respiratory illness not linked to Disneyland was fatal in an individual who had additional health issues, said Jessica Good of the Orange County Health Care Agency. The chief medical officer for Walt Disney Parks and Resorts, Pamela Hymel, said in a written statement that after learning of the Legionnaires cases, park officials ordered the cooling towers treated with chemicals to destroy the bacteria and shut them down. Cooling towers provide cold water for various uses at Disneyland and give off a vapor or mist that could have carried the Legionella bacteria. Disneyland, which opened in 1955 and attracts tens of thousands of visitors a day, is owned by The Walt Disney Company. There was no information on the condition of the remaining 11 victims, due to patient confidentiality laws. Good said an investigation of Legionnaires cluster discovered that the 12 people sickened by the serious lung disease had traveled to, lived in, or worked in Anaheim during the month of September. Ten of the victims, who ranged in age from 52 to 94, were hospitalized. Older people and those with health issues are particularly at risk. According to the Orange County health agency, Legionella is becoming more common in the United States and in Orange County, where 55 cases have been reported through October 2017, compared with 53 for all of 2016 and 33 in 2015. - Editorial comment: For the record there is possible transmission of Legionella from person to person (Correia et al. N Engl J Med. 2016; 374:497). As of November 15, the number of cases has risen to 15 with 2 deaths. The number of cases of legionellosis in any area is undoubtedly understated. The most commonly used test to diagnose legionellosis is the urinary antigen test, which only identifies L. pneumophila serogroup 1 and which is not sent routinely for patients with pneumonia, especially mild or ambulatory pneumonia. Cultures and polymerase chain reaction (PCR) are not done except in the sickest patients. The outbreak at Disneyland might be much larger than detected, considering the attendance nationally and internationally, with people getting sick after returning to their home state or country. This is unlike the outbreaks in hospitals and nursing homes where the scope of the outbreak is obvious. Genotyping to make sure all of the strains are the same with comparison with the strain(s) in the cooling towers would be useful. Nationally, the number of cases of legionellosis has increased over 4-fold since 2000. This could be due in part to better diagnosis and reporting. Biotech Firms Race to Recruit Good Bugs in War on Cancer 14 November 2017 (Reuters [Ben Hirschler])—Biotech companies are competing to develop medicines using “bugs as drugs” to fight cancer, building on the latest scientific findings that patients with high levels of good gut bacteria are more likely to respond to modern immunotherapy. Certain bacteria seem to help in cancer by priming immune cells and smoothing the path for immunotherapy drugs known as PD-1 drugs that work by taking the brakes off the immune system. Seres Therapeutics hopes to become the first company to leverage this discovery through a collaboration with the MD Anderson Cancer Center in Texas and the Parker Institute for Cancer Immunotherapy that will see its microbe medicine tested in a clinical trial. MD Anderson scientists were among 2 groups of cancer researchers who reported on the benefits of good gut microbes in the journal Science earlier this month. The work underscores the importance of the microbiome which has been linked to everything from digestive disorders to depression. Seres Chief Executive Roger Pomerantz told Reuters the aim was to start the randomized, placebo-controlled clinical trial in metastatic melanoma in 2018, evaluating the impact of giving a newly developed Seres microbiome drug alongside a PD-1 therapy. There are currently 2 approved PD-1 drugs, Merck & Co’s Keytruda or BristolMyers Squibb’s Opdivo, but Pomerantz declined to say which would be used. Seres, which is backed by Swiss food giant Nestle, became the first microbiome drug developer to go public in June 2015, but it suffered a setback last year when its leading drug candidate failed in a trial against Clostridium difficile. Other companies are competing hard. Like Seres, some are also eyeing the new opportunity in cancer, as microbiome science moves beyond the initial focus on gastrointestinal conditions like C. difficile, ulcerative colitis, and inflammatory bowel disease. Vedanta Biosciences, another US biotech firm that is an affiliate of PureTech NEWS • CID 2018:66 (15 February) • i Health, plans to file for approval to start a clinical trial in immuno-oncology in 2018, whereas Synlogic is also working on experimental cancer therapies. French biotech company Enterome, meanwhile, is working with BristolMyers on microbiome-derived diagnostic tests and potential drugs to use with the US drugmaker’s immunotherapy medicines. Advocates argue that microbiome medicine offers a smart way to both tone down the immune system response— useful for conditions like rheumatoid arthritis and allergies—or ramp it up, which is needed for the body to fight back against cancer. The first wave of microbiome drugs rely on fecal microbiota transplantation (FMT), or samples of microbes distilled from human feces, delivered either as a capsule or by enema. But companies are also working on synthetically fermented versions. Copyright © 2017 Reuters Limited. All rights reserved. Could Giant Rats Help Fight Tuberculosis in Major Cities? 15 November 2017 (Reuters [Heba Kanso])—Giant rats are probably not the first thing that come to mind to tackle tuberculosis, but scientists hope their sniffing skills will speed up efforts to detect the deadly disease in major cities around the world. African giant pouched rats, trained by Belgian charity APOPO, are known for sniffing out landmines in countries from Angola to Cambodia and for detecting tuberculosis cases in East Africa. Over the next few years, APOPO plans to fight tuberculosis at the source by launching TB-detection rat facilities in major cities of 30 high-risk countries including Vietnam, India, and Nigeria. The rats learn to recognize the presence of tuberculosis in samples of mucus that is coughed up from the patient’s lower airways. In Tanzania, people in communities where tuberculosis is most common, including in prisons, often fail to show up for screening because of a lack of money or awareness, placing a huge burden on health authorities, health experts said. The APOPO has seen the TB detection rate increase by 40% in clinics it has worked with in Tanzania and Mozambique, according to James Pursey, APOPO spokesman, who said that using rats to screen did not negate the need for proper diagnostic testing. Although a technician may take 4 days to detect a case of tuberculosis, a trained rat can screen 100 samples in 20 minutes, and a rat screening costs as little as 20 US cents, APOPO said. Copyright © 2017 Reuters Limited. All rights reserved. Editorial comment: The rats have a sensitivity of 75% compared with culture and 82% compared with the Xpert MTB/ RIF PCR assay but only 41% specificity (Mulder et  al. Int J Tuberc Lung Dis 21:1127, 2017). Stop Using Antibiotics in Healthy Animals, WHO Urges Farmers 7 November 2017 (Reuters [Kate Kelland and Tom Polansek])—The World Health Organization (WHO) urged farmers to stop using antibiotics to promote growth and prevent disease in healthy animals because the practice fuels dangerous drug-resistant superbug infections in people. Describing a lack of effective antibiotics for humans as “a security threat” on a par with “a sudden and deadly disease outbreak,” WHO Director-General Tedros Adhanom Ghebreyesus said “strong and sustained action across all sectors” was vital to turn back the tide of resistance and “keep the world safe.” The WHO “strongly recommends an overall reduction in the use of all classes of medically important antibiotics in food-producing animals, including complete restriction of these antibiotics for growth promotion and disease prevention without diagnosis,” the United Nations agency said in a statement. Any use of antibiotics promotes the development and spread of so-called superbugs—multi-drug-resistant infections that can evade the medicines designed to kill them. According to the WHO’s statement, in some countries, around 80% of total consumption of medically important antibiotics is in the animal sector. They are largely used in healthy animals to stop them getting sick and to speed up their growth. The WHO said such use should be halted completely. In sick animals, it added, wherever possible, tests should first be conducted to determine the most effective and prudent antibiotic to treat their specific infection. Some countries have already taken action to reduce the use of antibiotics in food-producing animals. The European Union has since 2006 banned the use of the drugs for growth promotion. Consumers are also driving a demand for meat raised without routine use of antibiotics, with some major food chains adopting “antibiotic-free” policies for meat supplies. The WHO said alternatives to using antibiotics for disease prevention in animals include improving hygiene and farming practices, and making better use of vaccines.

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News, Clinical Infectious Diseases, 2018, i-ii, DOI: 10.1093/cid/cix1065