CLINICAL ISSUES :: INFECTIOUS DISEASES Record increase in STIs in CA


Sexually-transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have reached a never-before recorded high (a 45 percent increase in past five years) in California, particularly in Orange County, LA.16


Cuba, Thai-


land, and Belarus are presently doing a better job at control- ling syphilis. According to the CA Dept. of Public Health, this has led to an unprecedented surge in cases of congenital syphilis. The crisis has been blamed on the deterioration of the health infrastructure beginning in 2008 and budget slashes that occurred ten years ago that were never restored to their original level.16


Health officials have also coupled the rise of STIs with homelessness, poverty, substance abuse, and mental health problems. According to Dr. H. Bauer of the CA STD Control Branch, the Affordable Care Act has also funneled patients away from public health services toward primary care physi- cians, and this is not the most effective plan. Those who depended on public clinics for STI screening, etc. may not feel comfortable talking about it with their physicians or may have no physician at all.16


Thus, economics and gov-


ernment policy play a significant role in shifting patterns of infectious diseases. The sequelae include stillbirths, ectopic pregnancies, infertility, blindness, hearing loss, dementia and ultimately, vastly increased health costs—to mention a few.


Dangerous emerging mycotic infection Who can recall the last time a CDC advisory was issued


to report the isolation of a nosocomial mycotic infection? Candida auris has been growing in notoriety now for several years with a case count of 463 plus in the Fall of 2018. It is an emerging mycotic threat with grave consequences for three reasons: 1. Multidrug resistance; 2. It is difficult to identify and easy to mis-identify, leading to non-optimal treatment; and 3. It has caused serious outbreaks in healthcare facilities that have been difficult to eradicate.17


It has been reported to


be the cause of invasive infections (candidemia) with a high incidence of mortality (approaching 60 percent).18 Seventy cases of C. auris infections (seven invasive) occurred in the neurosciences intensive care unit of the Oxford University Hospitals, U.K., and all were associ- ated with use of reusable skin-surface axillary temperature probes.19


and environmental decontamination procedures for Can- dida auris at https://www.cdc.gov/fungal/candida-auris/c- auris-treatment.html and continues to update the site due to the insidiousness and potentially deadliness of this emerging mycotic infection.


The CDC maintains updates on the diagnosis, treatment,


Conclusion Although Nobel laureates accomplish amazing break- throughs in science and medicine, they are not neces- sarily gifted with foresight, as proven by Sir Frank M. Burnet. He apparently believed that infectious diseases were, in 1962, conquered things of the past. Louis Pasteur (1822-1895) who was possibly the greatest of all micro- biologists once said, “Gentlemen, it is the microbes that will have the last word.”20


and other numerous dangerous emerging and re-emerging pathogens have proved Pasteur to be correct and that laboratory managers should best remain at the ready.


16 MARCH 2019 MLO-ONLINE.COM


REFERENCES 1. Science News Magazine. 190:13, Dec. 24, 2016, p. 32. 2. Klain, Rod (White House Ebola Response Coordinator), Vox, Oct. 15, 2018.


3. “Flea-Borne Typhus Spreads Across L.A. Area, with at Least 57 Reported Cases.” CNN Wire, Oct. 8, 2018. 4. CDC Typhus Fevers: https://www.cdc.gov/typhus/murine/index.html


5. Vital Signs: Trends in Vectorborne Disease Cases- United States and Territories. 2004-2016; MMWR, May 4, 2018, Vol. 67, No. 17.


6. Butler, T. Capnocytophaga canimorsus: an emerging cause of sepsis, men- ingitis, and post-splenectomy infection after dog bites. Eur. J Clin. Microbiol. Infect. Dis. 2015 Jul:34(7):1271-80. doi: 10.1007/s10096-015-2360-7. Epub 2015 Apr 1.


7. Wisconsin boy’s mysterious illness may have been caused by dog lick. WISN News 12, Aug. 9, 2018. https://www.wisn.com/article/ wisconsin-liam-young-mysterious-illness-dog-lick-saliva/22688731


8. West S. Bacteria spread through dog saliva linked to S. Milwau- kee woman’s death. Milwaukee Journal Sentinel, Aug. 11, 2018. https://www.jsonline.com/story/news/local/milwukee/2018/08/11/ bacteria-dog-saliva-linked-death-wisconsin-woman/966203002/


9. Phillips K. The Shocking reason that this man’s legs and hands were amputated: A dog’s saliva. The Washington Post, July 31, 2018.


10. Marcus M.B. Woman’s pet dog gave her a life-threatening infec- tion. CBS News, June 30, 2016. https://www.cbsnews.com/news/ womans-pet-dog-gave-her-life-threatening-infection/


11. Wilson J. P., Kafetz K., Fink D. Lick of death: Capnocytophaga canimorsus is an important cause of sepsis in the elderly. BMJ Case Reports 2016; doi:10.1136/ bcr-2016-215450.


12. Prion disease update (02): United States (New York) Variant CJD Sus- pected, Squirrel Brain, Human Fatality, 2015, International Society for Infec- tious Diseases, promededr@promedmail.orghttps://outlook.office.com/ owa/?realm=uthsc.edu&exsvurl=1&ll-cc=1033&modurl=0&path=/mail/search


13. Berger J.R., Weisman E., Weisman, B. Creutzfeldt-Jakob Disease and eat- ing squirrel brains. The Lancet. August 30, 1997, DOI: https://doi.org/10.1016/S) 14)-6736(05)63333-8.


14. Monkeypox–UK (05): ex Nigeria, A ProMed-mail post, Oct. 2, 2018, International Society for Infectious Diseases, https://www.blackpoolgazette.co.uk/news/health/patients-offered-small- pox-vaccine-to-protect-against-potential-monkeypox -infection-1-9375758


15. Monkeypox–Israel: ex Nigeria, A ProMed-mail post, Oct. 12, 2018, International Society for Infectious Diseases, http://afludiary.blogspot.com/2018/10/israel-moh-confirms-imported- monkeypox.html


16. Weber C. STDs reach all-time high in California. Associated Press, USA Today, May 15, 2018.


17. Candida auris. https://www.cdc.gov/fungal/candida-auris/index.html


18. Larkin E., Hager C., Chandra J. The emerging pathogen Candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation. Antimicro. Agents & Chemother. May 2017, Vol. 61:5, 1-13, e02396-16.


19. Sheppard A., Madder H., Moir I. et al. A Candida auris outbreak and its control in an intensive care setting, N. Engl. J. Med. 2018; 379:1322-1331.


20. Louis Pasteur Quotes. https://www.azquotes.com/ author/11366-Louis_Pasteur


Linda L. Ross, MS, MLS (ASCP)cm SM, is a seasoned


Clinical Microbiologist, as well as, an award-winning teaching Associate Professor at the University of Tennessee Health Science Center’s (UTHSC), Department of Clinical Laboratory Science in Memphis, TN.


HIV/AIDS, the Ebola viruses,


Linda L. Williford Pifer, PhD, SM (ASCP), GS (ABB), is a Professor at UTHSC’s Department of Clinical Laboratory Science. She established the diagnostic virology lab at Le Bonheur Children’s Hospital in Memphis, TN.


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