CDC warns about drug-resistant Shigella bacteria, stomach bug deemed "serious public health threat" - CBS News

The Centers for Disease Control and Prevention says it is tracking a rise in stomach illnesses caused by infections with "extensively drug-resistant" bacteria that leave doctors with few antibiotic options to treat patients. The CDC warns it now poses a "serious public health threat."

Over the past few years, the CDC says there are signs the percentage of Shigella bacteria cases that are resistant to a broad swath of antibiotics has begun to climb steeply around the country. These strains can also spread their resistance genes to other stomach bugs.

Analyses of these bacteria, dubbed XDR Shigella, have shown resistance to all of the typically recommended frontline antibiotic treatments for bacteria: azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin. 

Outbreaks of Shigella bacteria often spread through contaminated food and water, via surfaces, or through sex. Symptoms of the disease it causes, a form of dysentery named shigellosis, include fever and diarrhea. 

Many shigellosis cases resolve with rest and hydration. But especially without treatment, more severe cases can result in hospitalizations and death. The bacteria is estimated to rank among the leading causes of death linked to diarrhea around the world.

The CDC's alert comes after a 2015 warning by the agency that multidrug-resistant Shigella had first begun to spread to the U.S. from Americans who had traveled abroad. 

The CDC says 5% of all Shigella isolates collected in 2022 were classified XDR, up from 1% in 2019. 

"Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission," the agency said in an alert Friday.

As recently as last month, authorities had warned of an outbreak of hundreds of shigellosis cases in travelers returning from resorts in Cabo Verde across the U.S. and Europe. Last year, the United Kingdom had also reported "an unusually high number" of XDR shigellosis around the country.

Some state and local health authorities in the U.S. have also warned of cases in recent months, urging people to wash their hands and take other steps to avoid getting sick.

"We typically see Shigella cases peak in the summer months and decline in the fall and winter. However, Shigella activity increased in Fall 2022, and we are now seeing some antibiotic-resistant cases, which are confirmed via antibiotic susceptibility testing," Brian Spencer, a spokesperson for Colorado's Department of Public Health and Environment, said in a statement.

This illustration made available by the Centers for Disease Control and Prevention shows the Shigella bacteria.  / AP

Spencer said cases have now slowed so far this year. However, authorities expect cases could again climb in the coming months. Colorado's cases have not been linked to the Cabo Verde outbreak.

"CDPHE identified several outbreaks and clusters of cases that were related to each other," Spencer said.

It is not clear what is driving the recent and out-of-season increases in drug-resistant Shigella infections. 

A CDC spokesperson did not respond to a request for comment about recent cases.

The agency's alert cites studies from 2012 and 2016 observing an increase in drug-resistant infections "particularly among people experiencing homelessness, international travelers, immunocompromised people, and MSM," using an acronym for men who have sex with men.

More about the increase is expected to be discussed Tuesday, when the agency plans to host a webinar for clinicians on the spread of XDR Shigella.

"Clinicians should understand the nuances of testing and managing infections, especially when treating patients from populations at increased risk of drug-resistant shigellosis including," the agency says.

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Alexander Tin

CBS News reporter covering public health and the pandemic.

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1. CDC warns public of rising drug-resistant bacteria  WKRC TV Cincinnati
2. CDC issues warning over an increase of drug-resistant bacteria  CNN
3. CDC warns of increase of drug-resistant bacteria Shigella  ABC News
4. CDC issues warning amid rise of drug-resistant bacteria  WSB Atlanta
5. CDC Issues Warning Over Rise of Drug-Resistant Bacteria  The Epoch Times
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Viruses in Cambodian bird flu cases identified as endemic clade - Reuters

Feb 26 (Reuters) - The viruses that infected two people in Cambodia with H5N1 avian influenza have been identified as an endemic clade of bird flu circulating in the country, the U.S. Centers for Disease Control and Prevention (CDC) said.

The cases reported last week had raised concerns they were caused by a new strain of H5N1, clade 2.3.4.4b, which emerged in 2020 and has caused record numbers of deaths among wild birds and domestic poultry in recent months.

But work so far suggests this is not the case.

Preliminary genetic sequencing carried out in Cambodia led its health ministry to identify the viruses as H5 clade 2.3.2.1c, which has circulated in Cambodia among birds and poultry for many years and has sporadically caused infections in people, the CDC said in a statement on Saturday.

"Yes, this is an older clade of avian influenza that had been circulating around the region for a number of years and while it has caused human infections in the past, it has not been seen to cause human-to-human transmission. However, that doesn't mean that the threat is any less," said Erik Karlsson, director of the National Influenza Center of Cambodia and acting head of virology at the Institut Pasteur du Cambodge, which sequenced the virus.

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He added that the response needed to be coordinated and swift to prevent any further spread and to limit exposure to any common source.

An investigation into the source and to detect any additional cases is ongoing, the CDC said, adding that so far there had been no indication of person-to-person spread.

Cambodia tested at least 12 people for the H5N1 strain last week, after an 11-year-old girl died from the virus in the first known transmission to humans in the country in nearly a decade.

The victim's father, who was part of a group the girl had been in contact with in a province east of the capital Phnom Penh, tested positive for the virus but did not exhibit any symptoms, Cambodia's Health Minister Mam Bunheng had said in a statement on Friday.

Only the girl's case has been sequenced and the father's case is still being worked on, Karlsson said.

The World Health Organization said it is working with Cambodian authorities following the cases, describing the situation as worrying due to the recent rise in cases in birds and mammals.

Reporting by Juby Babu in Bengaluru; additional reporting by Jennifer Rigby in London; editing by Barbara Lewis

Our Standards: The Thomson Reuters Trust Principles.

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CDC issues warning over an increase of drug-resistant bacteria - CNN

CNN  — 

The US Centers for Disease Control and Prevention has issued a health advisory to warn the public of an increase of a drug-resistant bacteria called Shigella.

There are limited antimicrobial treatments available for these particular drug-resistant strains of Shigella and it’s also easily transmissible, warned the CDC in the Friday advisory. It’s also able to spread antimicrobial resistance genes to other bacteria that infect the intestines.

Shigella infections known as shigellosis can cause a fever, abdominal cramping, tenesmus and diarrhea that is bloody.

The bacteria can be spread by a fecal-oral route, person-to-person contact, and contaminated food and water.

While typically shigellosis affects young children, the CDC says it has started to see more of the antimicrobial-resistant infections in adult populations – especially in men who have sex with men, people experiencing homelessness, international travelers and people living with HIV.

Jean Lee, a PhD student at Melbourne's Doherty Institute, displays the superbug Staphylcocus epidermidis on an agar plate in Melbourne on September 4, 2018. - A superbug resistant to all known antibiotics that can cause "severe" infections or even death is spreading undetected through hospital wards across the world, scientists in Australia warned on September 3. Researchers at the University of Melbourne discovered three variants of the multidrug-resistant bug in samples from 10 countries, including strains in Europe that cannot be tamed by any drug currently on the market. (Photo by William WEST / AFP) (Photo credit should read WILLIAM WEST/AFP via Getty Images)

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Climate change is contributing to the rise of superbugs, new UN report says

“Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission,” the advisory said.

The CDC says patients will recover from shigellosis without any antimicrobial treatment and it can be managed with oral hydration, but for those who are infected with the drug-resistant strains there are no recommendations for treatment if symptoms become more severe.

The percentage of infections from drug-resistant strains of the bacteria increased from zero in 2015 to 5% in 2022, according to the CDC.

Nationwide, there are nearly 3 million antimicrobial-resistant infections each year, and more than 35,000 people die as a result, according to the CDC.

A recent report by the United Nations said roughly 5 million deaths worldwide were associated with antimicrobial resistance in 2019 and the annual toll is expected to increase to 10 million by 2050 if steps are not taken to stop the spread of antimicrobial resistance.

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Human Bird Flu Cases Investigated in Cambodia - The New York Times

Cambodian officials placed posters in Prey Veng village to warn against the dangers of bird flu.Cambodia Ministry of Health, via Associated Press

Cambodia has reported two cases of bird flu infection in people, a father and daughter in a village in Prey Veng Province. The 11-year-old girl died earlier this week.

The cases, the first reported in Cambodia since 2014, raised fears that the virus had acquired the ability to spread among people and may trigger another pandemic. But the World Health Organization said on Friday that 11 contacts of the girl, four of whom have flulike symptoms, had tested negative for infection with the H5N1 flu virus.

The 49-year-old father who has tested positive was not showing any symptoms, according to the Health Ministry. The W.H.O. is working closely with the Cambodian government to determine whether the father and daughter both caught the virus from direct contact with infected birds — the most likely possibility — or whether they infected each other.

Experts noted that there had been hundreds of sporadic cases of H5N1 infection in people since the virus was first identified and that there was no evidence that it had become adapted to humans.

Transmission among people is “very, very rare, versus a common source of infection,” said Richard Webby, a bird flu expert at St. Jude Children’s Research Hospital in Memphis and an adviser to the W.H.O.

But people should take care to avoid contact with wild birds that may be infected, Dr. Webby said.

“The risks from this virus to your average person on the street right now is very low, but it’s not zero,” he said. “And that’s primarily because there’s just so many more infected birds around right now.”

Snow geese in the Middle Creek Wildlife Management Area near Kleinfeltersville, Pa. The virus has taken a heavy toll on wild birds.Jim Lo Scalzo/EPA, via Shutterstock

Bird flu, or avian influenza, is a group of flu viruses that are primarily adapted to birds. The particular virus in these new cases, called H5N1, was first identified in 1996 in geese in China, and in people in Hong Kong in 1997.

Since then, there have been nearly a thousand cases in people in 21 countries, but a vast majority have resulted from prolonged, direct contact with birds. H5N1 does not yet seem to have adapted to spread efficiently among people.

“At the end of the day, this is a continuum of the same outbreak that started back in 1996,” said Dr. Malik Peiris, chief of virology at the University of Hong Kong, who has helped oversee responses to several bird flu outbreaks in Southeast Asia. “Really, it never went away.”

H5N1 is typically carried by aquatic birds, such as ducks, that can transmit the virus to domestic poultry via feces, saliva or other secretions.

The current version of the virus has been unusually widespread, causing the largest ever bird outbreaks in Europe and in the United States, affecting 58 million farmed birds in the latter. It is now considered endemic in several countries in Asia and Europe, according to Dr. Webby.

The virus has taken a heavy toll on wild birds too, triggering mass die-offs, and it has been spilling over into mammals, especially scavengers, like foxes, that might feed on infected carcasses.

Experts have been closely monitoring H5N1 since an outbreak on a mink farm in Spain last October suggested it could spread efficiently among some mammals.Mads Claus Rasmussen/Agence France-Presse — Getty Images

Any reports of infection in people warrant investigation to confirm that H5N1 has not yet adapted itself to human-to-human transmission. There have been six other cases of H5N1 reported in people since September, according to the W.H.O. The death of the 11-year-old girl this week is Cambodia’s first bird flu death since 2014.

Experts have been closely monitoring H5N1, especially since an outbreak on a Spanish mink farm in October suggested that the virus could spread efficiently among some mammals. Samples of the virus isolated from the mink carried a genetic mutation that is known to help flu replicate better in mammals.

No human infections were detected. But a mink-adapted version of the virus might be one step closer to efficient transmission among people.

If the version of H5N1 identified in Cambodia were found to be closer to the one seen in Spain than to those in previous Asian outbreaks, scientists would be concerned, Dr. Peiris said. “It is important to try to understand exactly what has gone on” in Cambodia, he added.

The W.H.O. is “updating a bank of vaccine candidate viruses that are suitable for manufacturing, should it be needed,” the agency said in a statement. W.H.O. is also providing antiviral drugs from an available stockpile.

Peruvian officials examined a dead sea lion, which they feared had died of bird flu./EPA, via Shutterstock

Genetic analysis can reveal whether H5N1 has acquired mutations that help it spread among people.

“That should give us a good hint as to whether or not the virus has really jumped one step further,” said Dr. Shayan Sharif, an avian immunologist at the Ontario Veterinary College at the University of Guelph in Canada.

But it will be more difficult to determine how the two family members were infected in Cambodia. That’s because H5N1 samples from the father and daughter are likely to be nearly identical regardless of whether the virus was acquired from a person or from the same infected birds, Dr. Webby said.

“If both of them were infected from the same set of chickens, they are going to be infected with very similar viruses,” he said. It may be more informative for scientists to chart the path of the virus by examining the nature of the contact among infected people.

Caged chickens at a farm in Buenos Aires.Mariana Nedelcu/Reuters

The virus poses the biggest risk to people who are in direct contact with birds, such as poultry farmers. Security measures on farms and poultry processing plants, including the use of personal protective equipment by workers, can help reduce the risks of infection.

To contain local outbreaks, infected flocks are generally culled and farms are put under quarantine. But the virus is now so widespread in birds that experts are beginning to consider whether broader measures, such as the vaccination of poultry, might be needed.

Vaccination has not traditionally been used to control avian influenza in poultry in the United States or Europe. But officials are rethinking that stance, and trials of bird flu vaccines are underway.

“I don’t really think that we should panic at the moment,” Dr. Sharif said. But “as we see all of these various different bits and pieces of the puzzle coming together,” he said, “I believe we need to get really seriously ready for an emergency.”

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An elite Bronze Age man had brain surgery more than 3,000 years ago - CNN

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CNN  — 

When archaeologists uncovered the burial site of two brothers who lived during the 15th century BC in Israel, they were surprised to discover that one of them had brain surgery shortly before he died.

The finding marks the earliest example of trephination, a type of cranial surgery, found in the ancient Near East.

Trephination, also known as trepanation, involves cutting a hole in the skull — and there are examples of the medical procedure dating back thousands of years.

The remains of the brothers, who lived during the Bronze Age between 1550 BC and 1450 BC, were found during an excavation of a tomb in the ancient city of Tel Megiddo.

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Medieval grave reveals rare 'coffin birth' and neurosurgery

The older brother, estimated to be between 20 and 40 years old, had angular notched trephination. His scalp was cut and then a sharp, beveled-edge instrument was used to make four intersecting lines on the frontal bone of the skull that made a 30-millimeter (1.2-inch) square-shaped hole.

A study detailing the findings published Wednesday in the journal PLOS ONE.

“We have evidence that trephination has been this universal, widespread type of surgery for thousands of years,” said study author Rachel Kalisher in a statement. She is a doctoral candidate at Brown University’s Joukowsky Institute for Archaeology and the Ancient World in Providence, Rhode Island.

“But in the Near East, we don’t see it so often — there are only about a dozen examples of trephination in this entire region. My hope is that adding more examples to the scholarly record will deepen our field’s understanding of medical care and cultural dynamics in ancient cities in this area.”

Skull pieces removed during the surgery were included in the brother's grave.

Oddly enough, the bone pieces removed from the skull were included in the grave — but it wasn’t the only unusual discovery made about the brothers as researchers studied their bones.

Bronze Age brothers

The city of Tel Megiddo was part of the Via Maris 4,000 years ago. This crucial land route connected Egypt, Syria, Mesopotamia and Anatolia, according to study coauthor Israel Finkelstein, director of the University of Haifa’s School of Archaeology and Maritime Cultures.

Tel Megiddo controlled part of this trade route, making it a wealthy and cosmopolitan city full of palaces, temples and fortifications.

“It’s hard to overstate Megiddo’s cultural and economic importance in the late Bronze Age,” Finkelstein said.

The tomb was found in an area adjacent to a late Bronze Age palace in Tel Megiddo, leading researchers to believe the two men were either high-ranking elite members of society or perhaps even royals. DNA testing revealed the two were related and likely brothers.

The men were buried with Cypriot pottery, food and other valuable possessions similar to those found in other local high-status tombs.

Cow skull. 3D reconstruction of the cow skull showing internally and externally the hole produced by trepanation. Bar corresponds to 10 cm.

Fernando Ramirez Rozzi/Nature

Skull surgery was performed on this Stone Age cow, study says

And in life, both brothers were severely ill. Their skeletons are marked by signs of disease, including extensive lesions suggesting chronic, debilitating conditions. But both were able to survive for many years despite their ailments.

“These brothers were obviously living with some pretty intense pathological circumstances that, in this time, would have been tough to endure without wealth and status,” Kalisher said. “If you’re elite, maybe you don’t have to work as much. If you’re elite, maybe you can eat a special diet. If you’re elite, maybe you’re able to survive a severe illness longer because you have access to care.”

The younger brother died in his teens or early 20s, likely succumbing to an infectious disease like tuberculosis or leprosy.

The older brother had an extra molar, so he might have experienced a genetic condition like Cleidocranial dysplasia that impacts teeth and bones, according to the researchers.

The researchers can’t tell why the older brother required trephination. The practice was used to relieve pressure in the skull or treat symptoms of epilepsy and sinusitis. Ancient Mesopotamian texts also suggest that the operation might have been “curative to supernatural or otherworldly conditions,” Kalisher said.

An ancient surgeon in Peru likely used a sharp tool to carefully groove the perfect circles in this Incan skull. Healed bone around the edge of the holes indicates the patient was alive during the surgery and likely survived. Scholars can't explain the purpose behind the mysterious, multiple openings.

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Were mystery holes in skulls an ancient aspirin?

“The skeletal evidence tells us that this individual endured illness for a prolonged time, which, assuming it was left untreated, likely progressed,” Kalisher said. “This elite individual was privileged enough to endure infection for a long time, and also had a high-level cranial operation, which leads us to posit that the trephination was done in direct response to a declining state.”

Regardless of why the older brother had the surgery, he died within days or hours afterward, based on the lack of bone healing researchers noted during their analysis.

Cracking ancient medical cases

Many questions remain after studying the bones of the two brothers, Kalisher said.

While the skeletal evidence suggests the brothers had leprosy, more research is needed to make a clear determination. If the analysis reveals bacterial DNA that aligns with leprosy, the brothers may have experienced one of the earliest documented cases of the disease.

“Leprosy can spread within family units, not just because of the close proximity but also because your susceptibility to the disease is influenced by your genetic landscape,” Kalisher said.

Kalisher is also puzzled as to why the skull pieces removed from the older brother were included in his burial. Only two other examples of this have been found in the past, in England and Peru.

Courtesy of Simon Burchell

How Stone Age blades are still cutting it in modern surgery

“In our study, we consider if the excised bone pieces were reinserted into the head because the practitioner thought it would facilitate healing,” Kalisher said. “But, I also come back to the medicinal/magical dichotomy we impose on the past. It is possible that the excised bones also held some other, non-medical purpose, leading to its inclusion with the individual. It is simply unknowable to us. So for now, this mystery remains unsolved.”

There are larger questions about ancient trephination researchers want to answer, like why some were made using analog drills to create round holes, while others are square or triangular.

But in regards to the brothers, it’s clear that the two men were not considered outcasts or “othered” because of their health issues. People close to the brothers cared for them and made sure they were laid to rest with proper burial traditions, the researchers said.

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In test, zaps to spine help 2 stroke survivors move arms - ABC News

WASHINGTON -- A stroke left Heather Rendulic with little use of her left hand and arm, putting certain everyday tasks like tying shoes or cutting foods out of reach.

“I live one-handed in a two-handed world and you don’t realize how many things you need two hands for until you only have one good one,” the Pittsburgh woman told The Associated Press.

So Rendulic volunteered for a first-of-its-kind experiment: Researchers implanted a device that zaps her spinal cord in spots that control hand and arm motion. When they switched it on, she could grasp and manipulate objects — moving a soup can, opening a lock and by the end of the four-week study, cutting her own steak.

It’s not a cure — the improvements ended after scientists removed the temporary implant — and the pilot study included only Rendulic and one other stroke survivor. But the preliminary results, published Monday, mark a step toward one day restoring mobility for this extremely common type of paralysis.

“They’re not just getting flickers of movement. They’re getting something important,” said Dr. Jason Carmel, a Columbia University neurologist who wasn’t involved with the new experiment but also studies ways to recover upper-limb function. “It’s a very exciting proof of concept.”

Nearly 800,000 people in the U.S. alone suffer a stroke each year. Even after months of rehabilitation, well over half are left with permanently impaired arm and hand function that can range from muscle weakness to paralysis.

Experiments by multiple research groups have found that implanting electrodes to stimulate the lower spine shows promise for restoring leg and foot movement to people paralyzed after a spinal cord injury — some have even taken steps.

But upper-limb paralysis has gotten little attention and is inherently more challenging. The brain must signal multiple nerves that control how the shoulder lifts, the wrist turns and the hand flexes. Stroke damage makes it harder for those messages to get through.

“People still retain some of this connection, they’re just not enough to enable movement,” said University of Pittsburgh assistant professor Marco Capogrosso, who led the new research with colleagues at Carnegie Mellon University. “These messages are weaker than normal.”

His idea: Stimulate a pathway of related nerve cells so they're better able to sense and pick up the brain’s weak signal.

“We’re not bypassing their control. We’re enhancing their capabilities to move their own arm,” he said.

Researchers turned to implants the size of spaghetti strands that already are used to stimulate the spine for chronic pain treatment. The implants carry electrodes that are placed on the surface of the spinal cord to deliver pulses of electricity to the targeted nerve cells — which for hand and arm control are in the spine’s neck region.

Rendulic and a second, more severely impaired volunteer could move better as soon as the stimulator was switched on — and by the study’s end showed improved muscle strength, dexterity and range of motion, researchers reported Monday in the journal Nature Medicine. Surprisingly, both participants retained some improvement for about a month after the implants were removed.

Rendulic, now 33, was performing some fine-motor tasks for the first time since suffering a stroke in her 20s. That unusually young stroke, caused by weak blood vessels that bled inside her brain, initially paralyzed her entire left side. She learned to walk again but — with the exception of those four weeks with spinal stimulation — cannot fully open her left hand or completely raise that arm.

“You feel like there’s a barrier between your brain and your arm,” Rendulic said. But with the stimulation on, “I could immediately sense that, like, oh my arm and hand are still there.”

Two other researchers who helped pioneer experiments stimulating the lower limbs of people with spinal cord injuries say it’s logical to now try the technology for stroke.

While bigger and longer studies are needed, the new results “are really promising,” said Mayo Clinic assistant professor Peter Grahn.

Scientists have learned from research with lower limbs that "it may not matter where that injury occurs, if it’s something in the brain or it’s a spinal cord injury,” added University of Louisville professor Susan Harkema. “Targeting the human spinal cord circuitry has a lot of potential.”

With National Institutes of Health funding, Capogrosso is studying the approach in a few more stroke survivors. The researchers also have formed a company to further develop the technology.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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