Medical Literary Messenger Spring 2014 Published

The Spring 2014 issue of the Medical Literary Messenger, which I oversee as the Editor-in-Chief, has been published.

You may download it via the website here.

I am very proud of the work of our contributors and of the editorial team. 

I hope that you will find the latest issues engaging, reflective and touching.

Illness in Travelers Returned from Brazil- Implications for the 2014 FIFA World Cup

A came across this article in Clinical Infectious Diseases that deals with both infectious diseases and football (soccer). Naturally, I was thrilled.

In this retrospective review the most common travel-related illnesses were dermatologic conditions (40%), diarrheal syndromes (25%), and febrile systemic illness (19%). The most common specific dermatologic diagnoses were cutaneous larva migrans, myiasis, and tungiasis. Dengue and malaria, predominantly Plasmodium vivax, were the most frequently identified specific causes of fever and the most common reasons for hospitalization after travel. 

Cutaneous larva migrans should be no surprise, given that Brazilian beaches are teeming with hookworms. In one report, 30 % of beach sand sampled from Alto Beach in Brazil contained the larvae of the dog and cat hookworms. Beach sand is also a hazard stateside, as summarized in this past blog of mine.

I am not suggesting that one attend the World Cup exclusively for the matches and then return immediately to the hotel. Some common sense precautions may help, such as wearing flip flops and  lying on beach recliners to minimize direct contact with beach sand. Hand hygiene and travel appropriate vaccinations would also help to prevent other ailments.

It is World Cup Time. Olé! 

Fecal Transplantation- A Huge Step Forward

I have been silent on the blog for a bit. I am back!

Last week, I performed a fecal microbiota transplant (FMT) for refractory C.difficile infection. My colleague at VCU, Dr. Michael Edmond, is truly a leader in this important treatment, as suggested here.

A major barrier to FMT is obtainment of the donor stool. Enter Open Biome, a non-profit organization that provides hospitals with screened, banked frozen stool for administration.

Although barriers to FMTs remain, including a paltry reimbursement, the availability of donor stool is a huge step forward.

The Emergence of Antibiotic Resistance

I am back on the ID consult service so it is bound to be a busy week. 

As I was perusing the NY Times yesterday, I came across this editorial on the rise of antibiotic resistance. The opinion piece highlights the looming crisis in antimicrobial resistance. Noted are the following points:

• Antibiotics are overused, not only by physicians but also in agriculture
• Carbapenem resistance is on the growth- a harbinger of significant resistance across various antibiotic classes
• There is little financial incentive for pharmaceutical companies to develop and market new antibiotic classes

A more detailed report on antibiotic resistance by the World Health Organization can be found here.

I do not mean to sound alarmist but the emergence of antibiotic resistance is the public health threat of the times.

Patient Hand Hygiene at Home Predicts hand Hygiene in the Hospital

Here is a concise communication published in Infection Control and Hospital Epidemiology on hand hygiene. This article has an interesting spin, specifically, that patient hand hygiene at home predicts hand hygiene in the hospital.

Hand hygiene in the hospital decreased compared to that at home, and home practices were strongly associated with hospital practices. So, if patients reported regular hand hygiene at home, they were also more likely to wash their hands in the hospital, albeit less frequently than at home. Being bed bound and being unable to access hand sanitizer may play a role in decreased patient hand hygiene.

If patients are expected to remind staff to wash their hands, they must first believe in hand hygiene, both at home and in the hospital.