Minnesota Department of Health (MDH) Bug Bytes
January 2, 2001
Vol. 2: No. 1
1. Human Botulism in Minnesota, December 2000
We have our first reported botulism case in Minnesota since 1998. A 65-year old female from eastern Minnesota developed respiratory failure after a gastrointestinal illness lasting 1-2 days. After she was put on a ventilator, it was noted that she had loss of motor function. The consulting neurologist contacted us and botulism antitoxin was obtained from CDC. The patient is recovering. Culture and mouse assay test results were consistent with botulism. The investigation of possible sources is ongoing. Botulism can be of three types: foodborne, wound, and intestinal (both infant and adult). While these three forms may differ slightly, botulism cases typically present with an acute symmetric descending flaccid paralysis. Cranial nerve symptoms (such as drooping eyelids, double vision, difficulty swallowing, and slurred speech) are generally prominent and may be the earliest symptoms of botulism. Specimens for diagnostic testing include serum, feces, vomitus, gastric contents and suspect foods. In wound botulism, debrided tissue or swab samples from wounds may be added. Both specimen culture and toxin testing are done here at MDH. We may also facilitate the procurement of antitoxin from CDC. If you have questions, contact us at (612) 676-5414.
2. Venomous Spiders in Minnesota? In early December, a Twin Cities resident bought a houseplant at a local nursery. Upon arriving home, a spider was discovered and subsequently captured on the plant. While the spider did not bite anyone, the family called us to confirm their suspicion that it may be one of the widow species. The spider was submitted to the University of Minnesota Entomology Department, and they confirmed that the spider was a brown widow (Latrodectus geometricus). This species is one of five widow species (all venomous to humans) found in North America. Brown widows are found throughout the world in tropical areas, and introduced populations have been documented in Florida. We learned that the nursery had received plant shipments from Florida. Nursery staff found no additional brown widows during a thorough inspection after this spider was found. The primary venomous spiders in the United States are the widows and the brown recluse spider. None of these species are regularly found in Minnesota. People bitten by black widows (or other widow species) usually feel pain at the time of the bite, and develop slight erythema at the bite site. Within an hour, severe muscle cramps and spasms (especially in the abdominal area) are commonly reported. Bite victims often experience other symptoms such as anxiety, weakness, profuse sweating, and nausea. Young children and the elderly are at greatest risk for significant complications, and untreated cases can be fatal. Brown recluse bites are usually painless, but within a few hours a blue-gray macular halo often appears around the bite site. This may progress into ulcerated sores (with extensive necrosis) up to several centimeters in diameter. Systemic reactions and fatalities are rare. In Minnesota, common sac spiders can bite humans, resulting in smaller ulcerated sores that are often confused with brown recluse bites.
3. Resistant Pneumococci in the News
In this week's New England Journal of Medicine there is an article about pneumococcal resistance (N Eng J Med 2000; 343:26, 1917-24). Our own Catherine Lexau is one of the coauthors. Nationally, 24% of invasive pneumococcal isolates were non-susceptible to penicillin in 1998. In addition, resistance to other classes of antimicrobials is substantial; 14% of isolates were non-susceptible to three or more antimicrobial classes. In Minnesota, the percentage of pneumococcal isolates that were non-susceptible to three or more antimicrobials increased from 6% in 1995 to 18% in 1999. Unfortunately, most of these multiple-resistant pneumococcal isolates are penicillin-resistant as well. Detailed information about pneumococcal resistance in Minnesota can be found at the MDH Pneumococcal Disease Website. Data for this study came from the Active Bacterial Core Surveillance program of CDC. This surveillance program is part of CDC's Emerging Infections Program, in which several state health departments, including MDH, receive supplemental funding to perform enhanced population-based surveillance for several important reportable pathogens and conditions. Ultimately, the Minnesota data for this study came from infection control practitioners and laboratories from around the state. This is an example of your efforts being transformed into national directives. Thanks. Speaking of antibiotic resistance, this month's Disease Control Newsletter (DCN) is about antimicrobial resistance and antimicrobial prescribing in Minnesota and the US. If you do not receive DCN, you can access it on our Disease Control Newsletter website.
4. E. coli O157:H7 Outbreak Update
Total number of confirmed cases in Minnesota is 38. Two of these are confirmed HUS cases; 2 additional HUS cases are epi-linked but are not confirmed as E. coli O157:H7.
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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