Hyperthermia Danger

During the summer, it is important for everyone, especially older adults and people with chronic medical conditions, to be aware of the dangers of hyperthermia. The National Institute on Aging (NIA), part of the NIH, has some tips to help mitigate some of the dangers.

Hyperthermia is an abnormally high body temperature caused by a failure of the heat-regulating mechanisms in the body to deal with the heat coming from the environment. Heat stroke, heat syncope (sudden dizziness after prolonged exposure to the heat), heat cramps, heat exhaustion and heat fatigue are common forms of hyperthermia. People can be at increased risk for these conditions, depending on the combination of outside temperature, their general health and individual lifestyle.

Older people, particularly those with chronic medical conditions, should stay indoors, preferably with air conditioning or at least a fan and air circulation, on hot and humid days, especially when an air pollution alert is in effect. Living in housing without air conditioning, not drinking enough fluids, not understanding how to respond to the weather conditions, lack of mobility and access to transportation, overdressing and visiting overcrowded places are all lifestyle factors that can increase the risk for hyperthermia.

People without air conditioners should go to places that do have air conditioning, such as senior centers, shopping malls, movie theaters and libraries. Cooling centers, which may be set up by local public health agencies, religious groups and social service organizations in many communities, are another option.

The risk for hyperthermia may increase from:

• Age-related changes to the skin such as poor blood circulation and inefficient sweat glands

• Alcohol use
• Being substantially overweight or underweight
• Dehydration
• Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever
• High blood pressure or other health conditions that require changes in diet. For example, people on salt-restricted diets may be at increased risk. However, salt pills should not be used without first consulting a physician.
• Reduced perspiration,caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs
• Use of multiple medications. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and is unable to control its temperature. Heat stroke occurs when someone’s body temperature increases significantly (above 104 degrees Fahrenheit) and shows symptoms of the following: strong rapid pulse, lack of sweating, dry flushed skin, mental status changes (like combativeness or confusion), staggering, faintness or coma. Seek immediate emergency medical attention for a person with any of these symptoms, especially an older adult.

If you suspect someone is suffering from a heat-related illness:

• Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge the person to lie down.
• If you suspect heat stroke, call 911.
• Apply a cold, wet cloth to the wrists, neck, armpits and/or groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
• Help the individual to bathe or sponge off with cool water.
• If the person can swallow safely, offer fluids such as water or fruit and vegetable juices, but avoid alcohol and caffeine.

The Low Income Home Energy Assistance Program (LIHEAP) within the Administration for Children and Families in the U.S. Department of Health and Human Services helps eligible households pay for home cooling and heating costs. People interested in applying for assistance should contact their local or state LIHEAP agency or go to http://www.acf.hhs.gov/programs/ocs/liheap .

7/2/14 Health News: RESEARCHERS FIND SALMONELLA’S ACHILLES’ HEEL ♦ MEDIUM-RARE BURGERS: A RISKY ♦ AMA SEEKS BAN ON ANTIBIOTIC USE ON FARMS FOR GROWTH PROMOTION

RESEARCHERS COMBINE ‘LUCK AND GUESSWORK’ TO FIND SALMONELLA’S ACHILLES’ HEEL

A sugar and amino acid compound called fructose-asparagine never previously recognized as a nutrient for any organism is the stuff that makes Salmonella grow and it could be key to the pathogen’s demise. Brian Ahmer, associate professor of microbial infection and immunity at The Ohio State University, says the nutrient may be the Achilles’ heel... Continue Reading

MEDIUM-RARE BURGERS: A RISKY CULINARY COMEBACK

For those in the food industry, the Jack in the Box E. coli outbreak of 1993 is known as the single event that convinced burger joints across the country to raise their internal cooking temperature by 15 degrees. In that outbreak, hamburgers sold at Jack in the Box franchises predominantly in Washington state sickened more... Continue Reading

AMA SEEKS BAN ON ANTIBIOTIC USE ON FARMS FOR GROWTH PROMOTION

The American Medical Association (AMA) is calling for federal action to ban antibiotic use in food animals for growth promotion purposes so as to slow the development of antibiotic-resistant bacteria. “Use drives resistance and overuse drives resistance to happen even faster,” said David Wallinga, a physician on the Keep Antibiotics Working steering committee. There is... Continue Reading

 CONGRESSWOMEN PROPOSE SOLUTION TO ISSUE OF PATHOGENS AS ADULTERANTS

Reps. Rosa DeLauro (D-CT) and Louise Slaughter (D-NY) are introducing a bill in the House of Representatives that would give the Department of Agriculture’s Food Safety and Inspection Service (FSIS) the authority to declare any foodborne pathogen an adulterant and recall contaminated products. The “Pathogen Reduction and Testing Reform Act” amends the Federal Meat Inspection... Continue Reading

Antibiotic Resistance in Foodborne Germs is an Ongoing Threat

Antibiotic resistance in foodborne germs, an ongoing public health threat, showed both positive and troubling trends, according to data tracked by the Centers for Disease Control and Prevention in 2012. Each year, antibiotic-resistant infections from foodborne germs cause an estimated 430,000 illnesses in the United States. Multi-drug resistant Salmonella, from food and other sources, causes about 100,000 illnesses in the United States each year.

The most recent data showed that multi-drug resistant Salmonella decreased during the past 10 years and resistance to two important groups of drugs – cephalosporins and fluoroquinolones – remained low in 2012. However, in Salmonella typhi, the germ that causes typhoid fever, resistance to quinolone drugs increased to 68 percent in 2012, raising concerns that one of the common treatments for typhoid fever may not work in many cases.

About 1 in 5 Salmonella Heidelberg infections was resistant to ceftriaxone, a cephalapsorin drug. This is the same Salmonella serotype that has been linked to recent outbreaks associated with poultry. Ceftriaxone resistance is a problem because it makes severe Salmonella infections harder to treat, especially in children.

The data are part of the latest report of the National Antimicrobial Resistance Monitoring System (NARMS), a tri-agency surveillance system that has tracked antibiotic resistance in humans (CDC), retail meats (Food and Drug Administration), and food animals (U.S. Department of Agriculture) since 1996.  The report from CDC NARMS compares resistance levels in human samples in 2012 to a baseline period of 2003-2007.

“Our latest data show some progress in reducing resistance among some germs that make people sick but unfortunately we’re also seeing greater resistance in some pathogens, like certain types of Salmonella,” said Robert Tauxe, M.D., M.P.H, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. “Infections with antibiotic-resistant germs are often more severe. These data will help doctors prescribe treatments that work and to help CDC and our public health partners identify and stop outbreaks caused by resistant germs faster and protect people’s health.”

Among the other findings in the 2012 report:

• Campylobacter resistance to ciprofloxacin remained at 25 percent, despite FDA’s 2005 withdrawal of its approval for the use of enrofloxacin in poultry. Ciprofloxacin and enrofloxacin are both in the fluoroquinolone class of drugs.
• Shigella resistance to ciprofloxacin (2 percent) and azithromycin (4 percent) is growing. However, no Shigella strains were resistant to both drugs.
• Although fluoroquinolone resistance remained low in 2012, Salmonella enteritidis – the most common Salmonella type – accounted for 50 percent of infections resistant to the fluoroquinolone drug nalidixic acid, which is used in laboratory testing for resistance. Resistance to nalidixic acid relates to decreased susceptibility to ciprofloxacin, a widely used fluoroquinolone drug. Other work shows that many of the nalidixic acid resistant Salmonella enteritidis infections are acquired during travel abroad.

The report introduces a new method for interpreting Campylobacter data and includes links to online interactive graphs where users can choose an organism and an antibiotic and see the “bug-drug” trends from year-to-year in NARMS.

CDC NARMS monitors antibiotic resistance among clinical isolates of six types of common foodborne germs reported from all 50 states. In 2012, NARMS tested over 5,000 isolates for antibiotic resistance. By comparing results in 2012 with the baseline period of 2003-2007, NARMS provides important information on whether foodborne germs are gaining or losing resistance.

Where Are The Hot Spots For Antibiotic Resistance?

In July, CDC will roll out a new way every hospital in the country can track and control drug resistant bacteria.CDC already operates the National Healthcare Safety Network (NHSN), with more than 12,000 health care facilities participating.  Now we are implementing a breakthrough program that will take control of drug resistance to the next level – the Antibiotic Use and Resistance (AUR) reporting module.  The module is fully automated, capturing antibiotic prescriptions and drug susceptibility test results electronically.

With this module, we’ll be able to create the first antibiotic prescribing index. This index will help benchmark antibiotic use across health care facilities for the first time, allowing facilities to compare their data with similar facilities. It will help facilities and local and state health departments as well as CDC to  identify hot spots within a city or a region.

We’ll be able to answer the questions: Which facilities are prescribing more antibiotics? How many types of resistant bacteria and fungi are they seeing? Do prescribing practices predict the number of resistant infections and outbreaks a facility will face?  Ultimately with this information, we’ll be able to both improve prescribing practices and identify and stop outbreaks in a way we have never done before.

This will help deploy supportive and evidence-based interventions at each facility as well as at regional levels to help stop spread among various facilities.

The need for a comprehensive system to collect local, regional, and national data on antibiotic resistance is more critical than ever. The system now exists, and we need quick and widespread uptake.

Rapid and full implementation of this system is supported through the proposed increase of $14 million contained in CDC’s 2015 budget request to Congress.

With the requested funding increase in future years, CDC would look to develop web-based tools and provider apps so physicians will gain access to facility- and community-specific data via NHSN on the most effective empiric antibiotic for the patient in front of them. For example, a physician in a burn unit treating a patient with a possible staph infection will know what antibiotics that particular microbe is likely susceptible TO and which ones are likely to be most effective.

Instead of broad-spectrum antibiotics being the default choice, as is often the case now, doctors will see recommendations for targeted narrow-spectrum antibiotics that are more likely to be effective and less likely to lead to potentially deadly infections such as C. difficile.

In addition to improving patient care, this information has an economic impact. Health care facilities that have evaluated their prescribing and resistance patterns and instituted effective antibiotic stewardship programs have saved money by reducing the amount of antibiotics they need to purchase and reducing complications, thus reducing their facility-specific cost of treatment.

There’s a great deal of interest in the development of new antibiotics, and some discussion of fast-tracking development of new antibiotics for limited populations. With the new electronic module, we’ll be able to track the use of almost any antibiotic to improve prescribing and prolong the life of new antibiotics as well as those currently in use.  The new module can also contribute to research adverse events related to newly approved antibiotics.

These changes won’t happen overnight, and all of this data won’t be available immediately upon the launch of the module. But with expanded investment, within five years, we should be able to make a real difference and save thousands of live

Risks of Feeding Raw Foods to Your Pets

Dogs and cats aren't exempt from the dangers of foodborne illness. To minimize risk, FDA suggests consumers carefully consider the risks of feeding a raw pet food to their pets.

Food poisoning isn't only a human problem: our four-legged friends are also at risk if they eat foods that are contaminated with disease-causing bacteria. Two of these bacteria—Salmonella and Listeria monocytogenes — are particularly dangerous to both pets and humans. Here is one way to avoid them—and why.

Knowing the Risk to Your Pet

Raw pet food consists primarily of meat, bones, and organs that haven’t been cooked, and therefore are more likely than cooked food to contain organisms that can make your dog or cat sick, says William J. Burkholder, DVM, PhD, Veterinary Medical Officer in the Food and Drug Administration’s (FDA’s) Division of Animal Feeds. Moreover, raw food can make you sick as well if you don’t handle it properly. FDA does not believe feeding raw pet foods to animals is consistent with the goal of protecting the public from significant health risks.

The agency therefore recommends cooking of raw meat and poultry to kill harmful bacteria like Salmonella and Listeria monocytogenes before you give the food to your pets. And as always, when working with food, you should follow FDA’s instructions on how to handle it safely.

Salmonella bacteria are commonly found in such foods as raw or undercooked meat, poultry, eggs and egg products. Salmonella can also contaminate raw or unpasteurized milk and other dairy products, as well as raw fruits and vegetables.

Burkholder says people who choose a raw diet for their pets often point out that feral dogs and cats catch prey and eat it raw. “That’s true,” he adds, “but we don’t know how many of these animals get sick or die as a result of doing that. Since sick feral animals are rarely taken to a veterinarian when they’re ill, there’s no way to collect that information.”

Symptoms of salmonellosis in animals include:

• Vomiting
• Diarrhea (which may be bloody)
• Fever
• Loss of appetite
• Decreased activity level

Listeria bacteria are commonly found in uncooked meats, vegetables and unpasteurized milk and soft cheeses. Unlike most bacteria, Listeria like cold temperatures and can grow and spread in the refrigerator. So if you refrigerate Listeria-contaminated food, the germs not only multiply at the cool temperature, they could contaminate your refrigerator and spread to other foods there, increasing the likelihood that you and your family members would be exposed to Listeria and get sick.

Symptoms of listeriosis in animals include:

• Nausea
• Diarrhea
• Fever
• Neurological disease can happen in a small percentage of situations

Raw Foods Can Also Affect Human Health

Consumers also run the risk of getting sick if they handle contaminated pet foods and accidentally transfer the bacteria to their mouths.

“If you’re going to handle raw foods, you need to pay particular attention to good hygienic practices,” Burkholder says. “Wash your hands and anything else that comes into contact with the product with hot, soapy water for at least 20 seconds.”

Feeding raw food to a pet also increases the risk of contaminating food contact surfaces and other places.

“Even if the dog or cat doesn't get sick, they can become carriers of Salmonella and transfer the bacteria to their surroundings, and then people can get the disease from contact with the infected environment,” Burkholder says.

Once Salmonella gets established in the pet’s gastrointestinal tract, the animal can shed the bacteria when it has a bowel movement, and the contamination will continue to spread.

Symptoms of Salmonella and Listeria Infection in Humans

Salmonella infection (salmonellosis) symptoms in humans include:

• Fever
• Nausea
• Vomiting
• Diarrhea (which may be bloody)
• Stomach pain
• More rarely: entry of Salmonella into bloodstream from intestines, followed by spread to joints, arteries, heart, soft tissues, and other areas of body

Symptoms associated with salmonellosis most often begin 12 hours to 3 days after ingestion of the bacteria and can last 4 to 7 days without treatment. All consumers are at risk for contracting salmonella from contaminated foods, but pregnant women, children under five, the elderly and those with weak immune systems are at risk of developing severe symptoms.

Compared to salmonellosis and other foodborne illnesses, infection with Listeria monocytogenes (listeriosis) is rare, but has serious and potentially fatal risks.

Listeria can infect multiple locations in the body:

• The brain
• Membranes surrounding the brain and spinal cord
• Gastrointestinal tract
• Bloodstream

Symptoms associated with listeriosis begin 11 to 70 days after coming in contact with the bacteria, with a mean (or average) of 31 days, and they can last up to a few weeks. Listeriosis occurs almost exclusively in pregnant women and their fetuses, newborns, the elderly and those with weak immune systems. Listeriosis can cause life-threatening infection in a fetus and newborns, as well as in persons with weakened immune systems, although the infection can often be treated with antibiotics.

“Feeding raw foods to pets increases the risk that both the pet and the people around the pet will encounter bacteria that cause foodborne illness, particularly if the products are not carefully handled and fed,” Burkholder says. “This is certainly one factor that should be considered when selecting diets for your pet

Lead in Kids’ Blood Linked with Behavioral and Emotional Problems

Lead in kids’ blood linked with behavioral and emotional problems

Emotional and behavioral problems show up even with low exposure to lead, and as blood lead levels increase in children, so do the problems, according to research funded by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health. The results were published online June 30 in the journal JAMA Pediatrics.

“This research focused on lower blood lead levels than most other studies and adds more evidence that there is no safe lead level”

—Kimberly Gray, Ph.D

Health Scientist Administrator, National Institute of Environmental Health Sciences (NIEHS)

“This research focused on lower blood lead levels than most other studies and adds more evidence that there is no safe lead level,” explained NIEHS Health Scientist Administrator Kimberly Gray, Ph.D. “It is important to continue to study lead exposure in children around the world, and to fully understand short-term and long-term behavioral changes across developmental milestones. It is well-documented that lead exposure lowers the IQ of children.”

Blood lead concentrations measured in more than 1,300 preschool children in China were associated with increased risk of behavioral and emotional problems, such as being anxious, depressed, or aggressive. The average blood lead level in the children was 6.4 micrograms per deciliter.

While many studies to date have examined health effects at or above 10 micrograms per deciliter, this study focused on lower levels. The CDC now uses a reference level of 5 micrograms per deciliter, to identify children with blood lead levels that are much higher than normal, and recommends educating parents on reducing sources of lead in their environment and continued monitoring of blood lead levels.

“Young children are particularly vulnerable to the toxic effects of lead, because lead can affect children's developing nerves and brains,” said senior author Jianghong Liu, Ph.D., from the University of Pennsylvania School of Nursing, Philadelphia.

Lead is a naturally occurring toxic metal, but sources of lead exposure are often due to human activities, including burning fossil fuels, mining, and manufacturing. In the United States, lead exposure usually comes from lead-containing products, such as paint, caulking, and pipe solder, in older homes. In China, lead exposure is more often related to air pollution.

“The sources of lead exposure may explain why concentrations of lead are different,” explained Liu. “In China, we found that blood lead concentrations increased with age in preschool children. In the United States, however, blood lead concentrations increase with age in children up to 2-3 years old and then decline.”

For the study, the researchers analyzed one blood sample taken from each child between the ages of 3-5. Behavioral problems were assessed at age 6 using standardized questionnaires. The questionnaires were filled out by the children’s teachers and parents, which the authors noted is both a strength and limitation. “The study used scores from two sources, but the ratings do not provide a clinical diagnostic measure of behavioral problems,” said Liu.

U.S. studies have reported that lead exposure causes what psychologists call externalizing behavior problems, such as aggressiveness and bullying, which may lead to truancy and even jail time as children get older. In this study, children with higher blood lead levels had internalizing problems, such as anxiety and depression, as well as some externalizing problems. Though not addressed in this study, Liu said these differences could be explained by cultural, genetic, or environmental variations, or research gaps.

The authors emphasized, “Continuing monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.”

Reducing The Spread of Drug Resistance in Bacteria

Scientists deciphered the structure and mechanism of a protein that bacteria need to spread the genes for antibiotic resistance. The findings could enable the development of novel drugs to combat multidrug-resistant bacteria.

An atomic force microscopy image shows a 4-part complex of the protein RepA (bright mounds) bound "handcuffing" 2 thread-like strands of DNA plasmid. Credit: University of Nebraska Medical Center Nanoimaging Core Facility.

Antibiotics disrupt bacteria’s ability to grow and replicate. Microbes that are resistant to antibiotics are a growing public health problem. Some bacteria, including strains of Staphylococcus aureus (Staph), have become extremely difficult to treat because the microbes are able to survive different antibiotics. Decades of widespread use have encouraged the spread of bacteria with resistance to multiple antibiotics.

Genes that confer drug resistance can be passed between bacteria on small circular DNA molecules called plasmids. Plasmids copy themselves separately from the bacterial chromosome by using the host bacterium’s DNA replication machinery. Past studies have found that most plasmids carrying drug-resistant genes in S. aureus encode a highly conserved protein called RepA that’s part of the complex needed to begin plasmid replication.

A team at Duke University Medical Center led by Dr. Maria Schumacher and colleagues at the University of Sydney in Australia investigated the structure and mechanism of RepA. Results appeared online on June 9, 2014, in Proceedings of the National Academy of Sciences.

RepA has 3 main domains: a highly conserved N-terminal domain (NTD) that binds DNA, a long and variable linker region, and a C-terminal domain (CTD) that interacts with other proteins involved in replication. The scientists used a technique called X-ray crystallography to determine the structure of the NTD and CTD. They found that NTDs were configured to form dimers and tetramers with themselves.

Next, the scientists studied how the NTD associates with DNA. They determined that RepA binds along interon boxes—sites where plasmid replication begins—next to each other. This side-by-side configuration is associated with DNA melting, the opening up of the double-stranded DNA molecule and one of the initial steps of replication.

Modeling suggested that 2 separate DNA strands are linked together by NTD tetramers. To take a closer look at the molecular level, the scientists used a technique called atomic force microscopy. The results confirmed that NTD tetramers stick together to “handcuff” 2 DNA plasmids together.

Plasmids left to replicate uncontrolled can harm host cells by overburdening the cells’ metabolism. The handcuffing structure suggests a molecular mechanism for controlling how many plasmid copies can be made in the bacterium; the bridging structure can hinder plasmid replication by preventing the initiation of replication.

“If plasmids can’t replicate, they go away,” Schumacher says. These results give new molecular insight into how to design drugs to target RepA and prevent multidrug resistant Staph from spreading resistance genes.