Researchers describe outbreaks in Brazil, Pakistan and Malaysia

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Abstracts from a cancelled event have been issued on outbreaks in Brazil, Pakistan and Malaysia.

The conference abstracts were scheduled to be presented at the International Congress on Infectious Diseases in September 2020 in Kuala Lumpur, Malaysia, but the gathering was called off because of the coronavirus pandemic.

Studies in the International Journal of Infectious Diseases supplement involve E. coli O157, Staphylococcus aureus and Brucella.

The first study involves a deadly Shiga toxin-producing E. coli (STEC) O157:H7 outbreak with hemolytic uremic syndrome (HUS) cases in Brazil.

In March 2019, a gastroenteritis outbreak occurred in the day care center of Vila Velha-Brazil with a death from HUS. There were 24 reports of diarrhea, with most being children but a few employees were affected.

Infections reduced after the suspension of day care activities on March 26. The 2-year-old class had the highest attack rate. There were no infections in the 4-year-old class.

Bloody diarrhea was reported in five patients, nine had abdominal pain, eight mentioned vomiting and three evolved to HUS, with one death. STEC O157:H7 was detected in two children who had bloody diarrhea, one with HUS, and in the water tap reducer.

It is thought that E. coli was introduced into the center by an infected person, spreading the outbreak and maintained by person-to-person transmission.

“It was recommended to guide teachers and staff about how to prevent fecal-oral transmission diseases, and to monitor water quality in the day care center,” said researchers.

Staphylococcus aureus in rice
The second abstract is about an outbreak in Pakistan with consumption of contaminated rice as the most probable cause.

In March 2018, 15 students of a boarding school went to a hospital in Islamabad with complaints of nausea, vomiting, abdominal pain and diarrhea.

Out of 120 residents at the school, 47 developed symptoms. All of them were males with an age range of 8 to 14 years old.

Out of 57 students who ate rice, 47 developed illness. No other foods were found to be significantly associated with illness. The food was cooked a day earlier and stored before being donated to the school by a local restaurant. Staphylococcus aureus was isolated from rice samples.

Researchers said unhygienic storage and handling lead to contamination of the rice.

“In addition to the internal food safety checks, implementation of frequent handwashing and hygiene promotion operating procedures were recommended for the restaurant,” according to the abstract.

Brucella outbreaks
Lastly, scientists reported two outbreaks of eight Brucella infections between October 2018 and February 2019 in the Klang district of Malaysia.

Five confirmed and three probable infections were reported. Four patients had brucellosis after consuming unpasteurized goat’s milk from a goat farm while the other four were workers from a cattle farm. Of the patients, two were children aged 6 and 10 years old.

The mean duration from onset of symptoms to diagnosis was 45 days with the longest being 87 days. All patients required an average of 14 days in hospital but they recovered without long term problems.

From these two outbreaks, all patients had prolonged fever and non-specific symptoms with routine laboratory investigations being inconclusive. In both outbreaks, a positive epidemiological link to consuming unpasteurized , raw goat’s milk and handling cattle were the important clues to diagnosis, said researchers.

“Assessment of exposure risk to Brucella is prudent while taking history for all patients presenting with fever of unknown origin as it will lead to early diagnosis, early treatment and minimized risk of laboratory staff exposure,” they added.

Other research
Three other recent studies have been published describing outbreaks in India and the Philippines that involved Salmonella, Hepatitis A and suspected anthrax.

 

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