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Published on Leave a comment on The Kennedy Era

Readers of past postings know I try to avoid politics in this blog. Today's post represents a complete failure to achieve that goal. I have followed RFK Jr.'s statements and writings about vaccines and public health for many years. His brand of pseudo-science is incomprehensible to me and anyone who understands biology and scientific methodology. His confirmation as HHS Secretary last week marks a sea change in the American health system; although he spouts some worthwhile targets to improve public health, in his new position he poses a grave public health threat for infectious diseases in particular. Regardless of any specific vaccine or other policies he might introduce, his mere confirmation as HHS Secretary may serve to further normalize anti-vax sentiment and likely will increase rates of vaccine refusal. Welcome to the new Dark Ages, though I doubt it will last several centuries like the last one. More on this later.

The Global Watch

A number of things to be aware of globally, though none immediately troublesome for the US.

Marburg Outbreak in Tanzania

This outbreak of a viral hemorrhagic fever disease (similar to Ebola) was declared about a month ago. Ten cases (2 confirmed, 8 suspected) have been identified, all fatal. Now, the 281 contacts of those 10 cases have passed the 21-day incubation period and remain well, very reassuring. However, WHO still rates the risk at the national level as high, given that the locale, Kangera, is a major regional transportation hub to other countries. Risk for global spread is still low.

Ebola (Sudan virus) Outbreak in Uganda

AfricaCDC reports that the vaccine trial is underway now in 7 of the 8 planned sites. Disease activity seems relatively stable, though the weekly reports tend to lag with last update posted from February 10.

PPE for VHF

With every viral hemorrhagic fever outbreak, healthcare providers comprise a prominent number of infected individuals. This occurred even in the US when 2 American nurse providers were infected during the 2014 importation from travelers. It's a good time to remember precautions to prevent VHF spread in healthcare settings, also a bit confusing since different guidelines apply according to whether the suspected patient is clinically stable or unstable. Front line providers need to contact their friendly local ID or infection control practitioner for help as soon as a suspected VHF case is encountered. Remember to obtain a good travel history.

mpox

In WHO's February 13 situation report, clade Ib mpox remains primarily in the DRC, Rwanda, and Uganda. MMWR just reported confirmation of a case of Ib infection in California from November 2024, in a traveler returning from east Africa. More on MMWR later.

Measles Again!

No surprise, but we have new outbreaks in the US, presumptively heavily related to cases in unvaccinated persons who were old enough to have received 2 doses of MMR vaccine.

A February 14 update from the Texas Department of State Health Services lists a total of 48 cases in the South Plains region, with age distribution of 13 cases in 0-4 year-olds, 29 in school-aged children (5-17 yo), 5 18 and older, and 1 with age unknown. Digging through the data from their spreadsheet links, MMR coverage in 2023-24 in the Seminole ISD (apparently the epicenter of the outbreak) is an appallingly low 82%. In Gaines County, home of 42 of the outbreak cases, the rate of "Conscientious Exemptions" for vaccine administration for children rose from 7.45% in 2013-14 to 17.62% in 2023-24. Even the earlier rate is super-high. Gaines County is the red box below.

The CDC measles page is updated only monthly, perhaps not frequently enough given the current situation. And, speaking of the CDC ...

Interesting Week Ahead for the CDC

I'll be watching closely this week. MMWR seems to be back, but with fewer topics per issue. I looked at the 2024 content, and only about 10% of the weekly publications had less than 4 topics. Both issues following the "publication pause" had only 2 articles each.

More telling, the Advisory Council on Immunization Practices is scheduled to meet on February 26-28. The draft agenda was released on January 19, and I'll be interested to see if the topics change. Currently on the schedule are votes on meningococcal, chikungunya, and influenza vaccines plus further discussion on maternal and pediatric RSV vaccines on Wednesday. These are not particularly high profile targets for the anti-vaccination lobby or for anti-DEI issues. However, part of the discussion process for vaccines at ACIP meetings has been an "Evidence to Recommendations" portion that normally includes a section on equity. I wonder whether this will change. Thursday's draft agenda includes perhaps more controversial subjects of HPV and mpox vaccines, due the relationship of these infections to spread via sexual contact in different high risk groups. Thursday's discussion also touches on pneumococcal and adult RSV vaccines, plus a 5-minute blurb on Lyme disease vaccination that I'm wondering about. The meeting wraps up Friday morning with discussions on covid (!) and CMV vaccines. I hope to attend much of the meetings and I'll report back next week.

This week's New England Journal of Medicine included a Perspective written by 3 former editors-in-chief of MMWR plus a former director for one of CDC's Centers. It was entitled "The Consequences of Silencing the 'Voice of CDC.'" Clearly the authors carry some implicit bias in favor of the CDC, but the article was enlightening. They repeated the reports I heard that the February 6 issue suppressed a discussion on H5N1 influenza (may have related to spread between cats and humans), which is concerning. I was interested to learn a bit of history: MMWR first appeared in 1961, during my lifetime but in a period when my interests fell more along the lines of Tinkertoys and butterflies. Currently I am one of 147,000 electronic subscribers to MMWR. CDC shares titles and brief summaries of reports with the Office of the Assistant Secretary for Public Affairs at HHS to alert them of content, but the authors were not aware of any time the reports had been altered or censored by the executive branch.

The authors went on to mention how rapid publication in MMWR helped public health management, citing the initial descriptions of what was eventually AIDS, outbreaks of foodborne illness related to hamburger contaminated with E. coli O157:H7, and anthrax related to intentional distribution of anthrax spores. I was a practicing pediatric ID physician during all of these outbreaks and still remember reading MMWR and changing my practice to account for new disease situations.

In addition to the evolving VHF situation in Africa mentioned previously, we need ongoing high-level surveillance for avian flu and for the large outbreak of tuberculosis in Kansas. With regard to the former, we did hear some information in MMWR this week: new serologic evidence of H5N1 infection in veterinarians providing care for cattle but with no known link to infected herds, suggesting more widespread cow infection than has been detected so far.

As an aside, since I do most of the grocery shopping in my household, I discovered the USDA has egg market reports. If you need some distraction from hand-wringing, you can track how many 30-dozen egg cases are moving around in your region each weekday!

WRIS

I'm thinking I don't need to tell any front line healthcare provider that influenza season is in full swing and is the one prominent player in our winter respiratory infection season at the moment.

More concerning is that illness severity is quite high.

Virtually all circulating strains are influenza A, and avian flu is not contributing to this with still just a handful of human cases detected in the US. Not too late to vaccinate.

My Test Grade Was 3

Please pardon my error last week in inviting readers to take the "How Ignorant Am I?" online quiz, not realizing it required subscription access. The quiz itself is based on a 1950 publication by statistician and weather forecaster Glenn W. Brier, updated in the Nature article you probably can't access. Briefly, the new quiz consists of 5 questions covering percentage of water in human body parts, timing of publication of genetic theories, planet size, number of atoms in common molecules, and melting points of precious metals; in short, scientifically based but nothing recently discovered. The kicker to the quiz is that it's not just whether you provide the correct answer, but that you quantify your confidence in the answer you provided. The scoring system is weighted such that failure (getting the wrong answer but thinking you are correct) is punished more severely than rewarding success (just getting the right answer). Here's the scoring interpretation: "If you ended up with a negative total, you did worse than a complete ignoramus who just answered 5 to every question" [5 indicates you had no idea which answer was correct, resulting in a score of zero if you answered 5 for all questions]. "People who actually know a lot, or are extremely lucky, get higher scores." (The highest possible score, getting all answers correct and being absolute certain of your answers, is 125.). So, my score of 3 isn't great, with a consolation prize that "Those with an awareness of their own doubts ... might end up with a small positive score." The main point of the quiz was " ... to train forecasters to be less over-confident, and have insight into their own thought processes." Applies to weather forecasters and possibly to healthcare providers as well!

Published on Leave a comment on Super Bowl LIX

All of Taylor Swift's minions, along with much of the world, know that today is another Super Bowl event. This time the site is New Orleans, which brings to mind the recent FDA warning about norovirus contamination of oysters from Louisiana harvest area 3. If you're like me, you had to know exactly where this is.

The Superdome is sort of like a cruise ship. I wonder what a Super Bowl norovirus outbreak would look like, but hoping I don't find out.

More Measles to Start the Year

It looks like we have 2 measles clusters already this year, 1 in Gaines County, Texas, and the other in Fulton Country, Georgia. According to news reports, both are associated with unvaccinated children who were old enough to have been vaccinated. The CDC has incomplete information as of February 6, and I note that they have decreased the frequency of measles updates to monthly as of this year. The national tally is 14 cases so far, from Alaska, Georgia, New York City, Rhode Island, and Texas.
Six of the 14 cases were hospitalized.

And, speaking of the CDC ....

MMWR is Back ... Sort Of

After an unprecedented (isn't everything unprecedented these days?) 2 week hiatus, the Morbidity and Mortality Weekly Report Volume 73 number 3 appeared on February 6. Besides the delay, it was unusual in that it contained only 2 topics, both related to wildfires: PFAS levels in first responders to the 2023 Maui wildfire and emergency department use during the LA County wildfires. Not a thing about any infectious diseases, despite the fact we are in the midst of a heavy winter respiratory virus season. Presumably this is not the new normal, and I'm hoping we soon see a return to something resembling the old weekly MMWR.

WRIS

We do have some continuation of CDC data current enough for looking at our winter respiratory infection season. FluView is cooking along, and we can see that outpatient influenza-like illness is going strong.

Influenza hospitalizations are very high, similar to the 2017-18 flu season.

Mortality data lag actual cases, but we have already tallied 57 pediatric deaths this year, and I fear we'll top last year's number of 207. This past week we saw almost exclusively influenza A viruses, about evenly divided between H3N2 and H1N1pdm09 (the pandemic 2009 strain). Both are covered by the current vaccine.

Meanwhile, RSV season is mostly over, and we're still waiting to see if covid will spike this winter. Covid wastewater levels have been and remain high.

Avian Flu

Influenza A H5N1 continues to be widespread in the animal population. Probably the biggest news the past week is that the D.1.1 genotype, so far only present in birds, has now appeared in a dairy cattle herd in Nevada. Given how long H5N1 has been present in various animal populations in the US, this doesn't seem all that surprising to me. The main import is that the longer these strains hang around, the higher the chance for mutation or reassortment into a strain with the ability to infect and spread among humans.

Here's the February 6 USDA update on recent cattle cases; if you visit the site you can change the timeline and also look at alpaca or swine cases. I'm particularly watching the swine cases because that animal has the highest risk of developing a strain with greater ability to infect humans. (Only 1 pig has been known to be infected so far, in Oregon last October.) You can go to their main avian flu website to look at other animal populations.

Just to further confuse you, the official terminology for the predominantly bird strain is "highly pathogenic avian influenza (HPAI) H5N1 clade 2.3.4.4b, genotype D1.1," as opposed to the more common cattle strain of HPAI H5N1 clade 2.3.4.4b, genotype B3.13. Now you can bore your friends with this tidbit at tonight's Super Bowl party!

Infectious Disease Troubles in Africa

Two situations in Africa are looking increasingly concerning. The Democratic Republic of Congo is trying to deal with an mpox outbreak in the midst of widespread violence and war in the country. As we know from the song, war is good for absolutely nothing, and the DRC's ability to manage the mpox outbreak, already strained, is suffering.

The other African hotspot is in Uganda, experiencing an outbreak of Suban Ebola virus disease. Fortunately WHO is facilitating a candidate vaccine trial there which could be a breakthrough in controlling this particular virus. Mortality rates in prior outbreaks were 41-100% and are improved by availability of supportive care.

In the meantime, CDC's Health Alert Network issued an advisory for the Uganda outbreak, raising the travel precautions to a level 2 (practice enhanced precautions).

Does Probability Exist?

As I was trying to interpret the various weather predictions for icy roads in my area, I came across this great piece in Nature by David Spiegelhalter, an emeritus professor of statistics at the University of Cambridge, UK. It definitely appealed to the statistics nerd in me, but I think everyone, including people without a background in science, would learn from it. I especially enjoyed the "How ignorant am I?" quiz. You don't need any special background to take it, so try it out. Next week I'll reveal my score. [Note added: apparently I used my institutional access to see this article, it's not free content for everyone. My apologies to those who can't access it, I'll give more details about the quiz next week.]

What is the probability the Super Bowl will end in a tie? The rules don't allow that, so I guess it's as close to zero as you can get with any probability in this world.

BTW, Spiegelhalter's answer to whether probability exists was, "probably not - but it is useful to act as if it does." My kind of guy.

Published on Leave a comment on Hello Darkness

Earlier this morning, Punxsutawney Phil saw his shadow, guaranteeing 6 more weeks of winter darkness with about the same amount of scientific basis as what we might be facing with a darkened CDC and other federal agencies. The original executive order limiting information release from federal agencies was said to last until February 1, but a day later MMWR is still silent.

We have now missed 2 MMWR reports, and I haven't been able to find any update on when/if this valuable resource might reappear. FluView Interactive and other CDC sites have similar notices though apparently are publishing some updates, which I'll show in the WRIS section later. Meanwhile, the world goes on.

Niger Eliminates Onchocerciasis Transmission

WHO announced that Niger joined Colombia (2013), Ecuador (2014), Guatemala (2016) and Mexico (2015) in eliminating transmission of Onchocerca volvulus, the cause of "river blindness." This is a major achievement, and I hope that funding cuts don't hinder WHO's disease elimination programs significantly.

African Outbreaks with Worldwide Significance

Sudan Virus in Uganda

This virus is in the Ebola virus family, and now Uganda is facing a new outbreak mostly involving healthcare providers (so far). WHO is advising against instituting any travel advisories, but the US State Department has had a Level 3 travel advisory in place since October, 2024, unrelated to any infectious disease outbreaks. (I was interested to note that this State Department site had no disclaimers about revamping the web site.)

Many readers will remember how Ebola virus came to the US via international travel. Certainly this new outbreak is still low risk for international spread, but the possibility remains and reminds all of us how distant outbreaks can hit home.

mpox

A new report in NEJM nicely describes the ongoing mpox outbreak in the Democratic Republic of Congo and surrounding areas. As emphasized in the accompanying editorial, spread from household close contact is prominent, with children sometimes experiencing severe disease. Pediatric cases are further described in another report, and the accompanying editorial emphasizes the challenges in trying to manage the outbreak. If you really want to dig deep into the numbers, WHO has an update. International spread so far has been limited but could increase.

MIS-C Phenotypes

This article caught my eye, even though MIS-C is less of a concern in our current covid situation.

The figure below is complicated, but suffice to say the researchers identified 3 clinical clusters: respiratory (cluster 1 above), shock/cardiac (cluster 2), and mild disease (cluster 3).

WRIS

Winter respiratory infection season is in full swing. It's not exactly great timing to have confusion in CDC's information restrictions during what is likely the height of flu season, not to mention ongoing concerns about avian flu. Already we were dealing with less data after the pandemic ended, a reasonable plan given less urgency surrounding covid. However, I admit to being confused about what might be changing in other surveillance systems now, with nary a peep (pun intended) about how the new administration's executive orders affect disease surveillance.

For what it's worth, here's a little bit of what I can find. I'm guessing that nothing much had changed with data collection methods by January 25, the closing date for the numbers used below.

Total acute respiratory illness is high or very high in much of the country.

Influenza is the main driver.

The Sound of Silence

Paul Simon has criticized most of the early work of Simon and Garfunkel, but the song that begins with "Hello darkness, my old friend" apparently is an exception. He is quoted in a 2023 interview regarding The Sound of Silence, “Somehow that song has changed its meaning over the years. It’s different. That’s good luck for me that that happened, you know?” I agree.

People talking without speaking
People hearing without listening

Published on Leave a comment on Happy World Leprosy Day!

I'm not sure I'd put this in the same celebratory category as a new year's event (January 29 is Vietnamese new year and Chinese new year for 2025), but it is noteworthy. WHO publicizes this day, and it might surprise some in the US that we had 369 new US cases detected in 2023, including 4 children. Here's a global map:

Leprosy still is one of the most stigmatized diseases in the world, fed by rumor and superstition. WHO is a good source for factual information. Speaking of WHO ...

US Quits WHO - What Does This Mean?

Well, this executive order doesn't mean anything immediately, assuming the new administration doesn't somehow violate the agreement for giving a year's notice to WHO before leaving. The US is obligated to pay for 2025. I have no direct experience with WHO, but it is well-known to be a large bureaucracy with the usual ponderous systems that this brings. I did find some better information from one of the many information sources I read, this one written by epidemiologist Dr. Katelyn Jetelina. She previously worked at WHO in Geneva, and her January 23 post provides more insight into how the loss of US funding for WHO might impact world health. She documents many problems with the WHO, but also provides a stark look at what the loss of US funds could portend. The US is the largest donor to WHO.

I'm hoping cooler heads will prevail and this exit won't go through.

MMWR Disappears

I've been subscribing to CDC's Morbidity and Mortality Weekly Report for more than 40 years, way back to when the paper copy came to me in snail mail every week. The communications embargo for health information, detailed in a memo by the acting Secretary for HHS, put a hold until February 1 on federal agencies issuing any information that hasn't been reviewed by a presidential appointee. The memo does allow for exceptions that include critical information, again requiring some sort of political appointee approval.

The MMWR isn't particularly controversial in my mind. I read it every week, but I suspect most healthcare providers don't keep it on their nightstands, or whatever that equivalent is in today's digital world. As of now, the current issue is listed as January 16, with nothing about a January 23 edition. Presumably we will miss January 30 as well.

I'm not so worried about this now, I'm sure we'd hear if we need to take any urgent action with bird flu or other emergency, but I am concerned about whether political censorship will affect the credibility of this information in the long run. I can still remember the chaos early in 2020 and the insistence by some of the value of hydroxychloroquine, ivermectin, and even bleach as effective treatments.

And, speaking of avian flu ...

Avian Flu Update (without CDC)

The Infectious Diseases Society of America broadcast a bird flu webinar, usually done in conjunction with CDC, but this time CDC wasn't mentioned in the title and none of the speakers had CDC appointments. I was able to attend the session in its entirety, and the recording and slides are available to everyone. In spite of the official CDC absence, the speakers were bona fide experts, and I learned several things.

The molecular difference between highly pathogenic avian influenza and low (not lowly) pathogenic strains (slide 6):

Recent global spread of HPAI by wild birds (slide 11):

Spread to dairy cows facilitated by excellent replication in mammary glands and transmission among cows mainly via milking machines (slide 16):

Experience in California suggests that conjunctival swabs may have higher yield of H5N1 than nasopharyngeal swabs (slide 37):

Remember that conjunctivitis is common (80%) in current human cases of H5N1 but is not a prominent feature of seasonal influenza.

Sequencing of strains from human cases in California suggest that the human cases arose by independent cattle-to-human infection events (slide 40), explained by the red dots below appearing in separate phylogenetic trees:

Also some discussion ensued about various testing options. The short version is that none of the tests are approved for conjunctival specimens, and the sensitivity of various tests to identify influenza A H5 is uncertain. Also unknown is whether testing costs in commercial labs would be covered by various insurance plans.

The penultimate presentation was by Bethany Boggess Alcauter, PhD, from the National Center for Farmworker Health. She provided a unique perspective that enlightened me greatly. It starts with slide 72. It was very clear that farmworkers have difficult jobs with little labor protections (below is slides 75-78):

One can easily imagine how tough it is to monitor and manage infections in these workers who now have the added burden of being more targeted for deportation.

A final presentation by Dr. Richard Webby from St. Jude Children's Research Hospital summed up in slides 86 and 87 the current understanding of H5N1 evolution and how difficult it will be to predict the future:

Antibiotics Can't Beat Cold Steel for Appendicitis

Moving away from various pandemic and political concerns for a moment, a new randomized controlled trial suggests that medical therapy alone is inferior to appendectomy (aka appendicectomy in the article) for management of uncomplicated appendicitis in children 5-16 years of age. This was a multinational study at 11 sites (2 in the US) that enrolled a little over 900 children with suspected non-perforated appendicitis.

Prior studies have suggested antibiotic therapy alone is an acceptable management pathway, and I suspect we haven't heard the last on this issue. For now I'd go with surgical intervention as the better alternative.

WRIS

With the muzzle on federal authorities releasing new data, I was interested to see what my usual information sites had available to me this week to monitor winter respiratory viral infection activity. I'm happy to report that the CDC's Respiratory Illnesses Data Channel was updated on Friday as per usual.

The NREVSS Dashboard also was updated (the cutoff date is January 17, but this diagram has additional data compared to last week's report).

I'm not subscribing to any crystal ball methods for predicting how WRIS will progress; I've seen some intimations that covid will be mild this winter, but I worry that some folks are trying to fit covid into a seasonal virus pattern which so far we've learned is not true.

Any bets on whether we'll see MMWR this week?

Happy Year of the Snake! Sức khỏe dồi dào

https://chus.vn/year-of-the-snake/

Published on Leave a comment on Tick Tock

I have little to no use for social media although I do understand that many in the US see TikTok as a valuable source of entertainment and income. When I had a blog with the AAP I was "forced" to sign up for a Facebook account but never used it. I already spend a lot of time tracking new data from multiple, more reliable, sources. Do I sound like a typical boomer?

The darkening of US TikTok access, presumably to be restored in a day, is but one of many striking events this coming week. I'll be watching closely to see what happens with our public health infrastructure and pandemic preparedness over the coming months and years.

Avian Influenza

Six months ago, or even 3 months ago, I never would have thought I'd be discussing the H5N1 situation so prominently. Although we still have no evidence of human-to-human transmission, which would be a game-changer, looking at how our leaders respond to this potential threat is a bellwether for our public health infrastructure will protect us going forward.

Here's the current status:

Our public health infrastructure has given us some important steps in the past week.

  • The FDA announced that cat and dog food manufacturers "consider H5N1 in food safety plans." The wording isn't clear to me, considering something is not the same as a requirement, but wording later in the document suggests it is requiring manufacturers to reassess how their unpasteurized raw products could place pets and their owners at risk for H5N1; transmission to pets from such products has been documented already. The webpage also contains a useful list of publications.
  • CDC issued a new advisory asking hospitals to accelerate subtyping of influenza A infections in hospitalized patients, particularly for these with severe illness where the high viral loads increase the possibility of mutation and recombination events that could increase virulence and transmissibility. This shouldn't be too difficult for hospitals - many multiplex test platforms include testing for influenza A H1 and H3, the seasonal strains, so a patient testing positive for influenza A and negative for H1 and H3 needs prompt followup to test for H5. H5 testing is not as widely available and would require help from public health labs. This advisory is very timely and important particularly as we see co-circulation of seasonal influenza with avian influenza.
  • CDC also reiterated their guidance for use of combination therapy (oseltamivir plus baloxavir) for some human infections with H5N1, mainly for immunocompromised patients but also to be considered for hospitalized patients.

All of this surveillance requires resources (i.e. money); let's hope the new administration recognizes that. As an aside, I noted that the UK is embarking on a large pandemic response exercise as preparation for future outbreaks.

Protect Your Hispanic Patients

OK, one more semi-political comment and then I'll get off my soap box. Dr. Danielle Ofri, a primary care doctor in NYC, wrote a nice opinion piece in the NY Times last week (requires subscription or a free account to read). With the uncertain threats of coming deportations, she notes that "fear alone can keep patients from seeking care." Not only is this harmful for individual patients and families, it will be incredibly expensive if individuals delay healthcare visits and we are faced with treating illnesses at a later stage in disease. One state (sadly, my place of birth) requires public hospitals to ask about US residence status, a rather chilling deterrent to seeking care, but patients are not required to answer. Dr. Ofri recommends those providers making the latter point clear first, before asking the question.

Consequences of in utero Zika Infection

A new article from investigators in Brazil found that children born to mothers infected with Zika virus during pregnancy demonstrated increased rates of neurodevelopmental delay even when they did not have evidence of the congenital Zika syndrome. The risk was significantly higher for infants born to mothers infected during the first trimester of pregnancy.

More on CWD

Last week I mentioned chronic wasting disease spreading in cervids in the US, with a tongue-in-cheek (pun intended) caution about eating venison; cooking does not inactive prion-mediated disease. Now comes a new report from Norway showing CWD prion detection in muscle tissue from moose, red deer, and reindeer. Pass on cervid meat ingestion in Scandinavia!

New Vaccine Education Resource for Clinicians

Well, maybe not so new, but I just found out it's available to anyone. The Pediatric Infectious Disease Society Foundation has a large number of educational modules available to all who register. Check it out if you're interested.

WRIS

Our winter respiratory infection season plods along. I've been somewhat amused with news reports about surges in human metapneumovirus infections, which of course happens every winter. However, no one is mentioning the common cold coronavirus infections (HCOV) that are just a common now as HMPV. Here's a quick look at percent positive tests nationally, also searchable by region. HCOV is a little higher than HMPV; I guess HCOV is the Rodney Dangerfield of winter respiratory viruses.

My Bucket Lists

I have many bucket lists, none of them in writing, but this past week a new report brought to mind the bucket list I'm most ashamed of. It's my infectious diseases bucket list, a mental listing of infections I hope to see during my lifetime. It's shameful because it requires someone to be sick in order for me to cross off a list item. One of the biggies on the list is seal finger. I'm guessing most readers have never heard of it.

Researchers in Denmark and Australia reported a rather severe episode of seal finger caused by Mycoplasma phocimorsus associated with a cat scratch. This 54-year-old Danish woman developed tendinous panaritium (I had to look that up, it's basically a paronychia/whitlow/felon with contiguous spread) several days following a cat scratch, but then it progressed to very extensive infection requiring multiple extensive surgical procedures. I don't think it's a misprint in the article that stated she developed all this in 2013; likely the delay in reporting depended on new methodology. The authors seem to be the same team that originally discovered in 2023 that this organism was associated with seal finger. The unusual element in the current case report is its association with a cat scratch, I think only reported a couple times previously. The authors of the current report state that their patient's isolate appears to be a different Mycoplasma species than what was detected in the other 2 reports.

Courtesy of BBC News. The Royal Society for the Prevention of Cruelty to Animals recommends observing seals from a distance of no less than 100 meters.

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