Minnesota Department of Health (MDH) Bug Bytes
February 14, 2001
Vol. 2: No. 4
1. Sand Fleas, Jiggers, and Chigoes - Oh My!
Last week a pathologist asked for our assistance in identifying "apparent worm parts" removed from one of three skin lesions on the underside of the foot of a 19 year-old male college student returning from Argentina. The referring pathologist wondered if the "long, thin, apparent worm-like structure" extracted from the lesion represented Dracunculus medinensis (Guinea worm) or a related parasite. Upon examination, we determined the "worm" to be uncoiled uterus with eggs from the sand flea (also called jigger or chigoe), Tunga penetrans. This species is distributed throughout tropical America and Africa. The adult female burrows into the skin of humans and other mammals; at this time the flea is about 1 mm long. After mating, the female expands (with eggs) to the size of a pea. After eggs are laid and hatch, the larvae escape through a small skin aperture and develop on the ground. The presence of the sand flea in the skin often causes extreme itching, pain and often secondary infection. Tetanus and gangrene are occasional complications.
2. Td Product Shortage There is currently a significant nationwide shortage of tetanus and diphtheria toxoid (Td) - adult formulation. Information about this shortage was first communicated from CDC last November; however, it was anticipated to be only a short-term problem that would be resolved in early 2001. Since that time, Wyeth-Ayerst Laboratories has decided to discontinue their Td product. There now remains only one U.S. Td manufacturer - Aventis-Pasteur. Although Aventis-Pasteur has stepped up production, it appears that vaccine supplies will not be sufficient to meet the projected U.S. needs during 2001. As a result of this shortage, the Commissioner of Health has temporarily suspended the provision in the school immunization law that requires evidence of a Td booster given at or after 11 years of age. This suspension will be in effect for the remainder of the 2000-01 school year and for the next school year. Suspension of the post-secondary Td requirement is under advisement. MDH is assessing Td supplies throughout the state; we will be contacting ICPs to determine their current Td vaccine supply.
3. EIP ABCs Article
In the latest Emerging Infectious Diseases journal (available online at http://www.cdc.gov/ncidod/eid/ Attention: Non-MDH link) is an article describing the Emerging Infections Program Active Bacterial Core Surveillance (ABCs) program of which Bug Byte readers play such an important role. As stated in the article, "ABCs is a model of collaboration between public health and academia. The system provides reliable data that can be used to address critical public health concerns, improve understanding of emerging infections, and help prevent the consequences of these infections." Data highlights include the documentation of increasing drug resistance of Streptococcus pneumoniae, a decline in Group B streptococcal disease in infants, and the emergence of serogroup Y meningococci.
4. Foodborne Illness Primer for Physicians
The American Medical Association, FDA, USDA, and CDC have collaborated to produce "Diagnosis and Management of Foodborne Illnesses, A Primer for Physicians" available at http://www.cdc.gov/mmwr/. Attention: Non-MDH link We encourage you to review it and tell your primary care provider friends about it. Attached to the web site is a Continuing Medical Education program worth 3 credit hours. Diagnostic features and laboratory testing for various foodborne illnesses are well described. Patient scenarios and clinical vignettes are presented (check out what happens when the favorite Italian restaurant serves garlic-infused olive oil on the house salad!).
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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