Minnesota Department of Health (MDH) Bug Bytes
February 20, 2002
Vol. 3: No. 3
An issue of unusual and rare cases:
1. Unusual Influenza Strain
Our neighbor to the east, the Wisconsin Division of Public Health and the Wisconsin State Laboratory of Hygiene, and CDC, has identified an unusual influenza virus isolated from a 6 month old Outagamie County resident. The child became ill in early December and has recovered.
The evolution of this virus, which has been named influenza A/Wisconsin/12/2001 (H1N2), appears to have resulted from the combination or reassortment of the genes of the currently circulating A/New Caledonia (H1N1) and the A/Moscow (H3N2) strains of influenza A. This process of reassortment of influenza viruses occurs naturally and the appearance of influenza A (H1N2) viruses have been reported previously in China in 1988-1989 without further spread. On February 6, 2002, the World Health Organization reported the recent identification of influenza A (H1N2) viruses in human specimens from England, Israel and Egypt.
The current influenza vaccine is expected to provide good protection against this influenza A (H1N2) virus, because the current influenza vaccine contains strains with H1 protein (the A/New Caledonia-like strain) and N2 protein (the A/Moscow-like strain) that are similar to those in the new strain. Although this unusual event may well be focal and limited, at this time it is uncertain whether this virus will persist and circulate.
A large supply of influenza vaccine is still available at this time and it's still not too late to be vaccinated.
2. Rare Form of Neonatal Meningitis
On February 8 we received a call from an ICP reporting meningitis in a 4 day old hospitalized neonate of 36 weeks gestation. Enterobacter sakazakii was isolated from CSF and blood. The baby expired.
E. sakazakii is a rare and severe cause of neonatal meningitis. Individual cases, outbreaks of disease, and clusters of colonized infants have been associated with contaminated powdered infant milk formulas. E. sakazakii has been isolated from these powdered formulas which are sold as non-sterile products.
We are investigating the source of infection for this infant and are asking for reports of E. sakazakii infection in neonates in 2001 or 2002 to date.
3. Pigbel and Fondue
On February 3, two restaurant diners enjoyed a self-service fondue of chicken and shrimp (both items were brought to the table raw for cooking by the patrons) and several non-meat items. They noted that the heated oil did not seem as hot as on previous occasions, and the meat took a lot longer to cook than usual. The next day, one of the patrons, a previously healthy 56-year old female, fell critically ill with a necrotizing enteritis and a perforated bowel. She was hospitalized and underwent resection of the jejunum. The suspect cause is Clostridium perfringens, based on culture of this organism from abdominal fluid and the presence of "sheets" of gram-positive rods on the mucosal surface of the resected jejunum.
Enteritis necroticans is a severe often fatal necrotizing disease of the small intestine. It was first described in Germany and Denmark after WWII in patients who had eaten large meals after having been starved for a long time. In the early 1960's it was described in Papua, New Guinea among natives after large feasts of pig lasting 3 or 4 days. There it was termed pigbel in the native dialect. The causative agent is Clostridium perfringens and it is particularly associated with type C (there are 5 types, A to E) that produces the Beta toxin. We are currently typing the Clostridium that has been cultured from peritoneal fluid from the case.
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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