Jan Dyer

Hotel pools and hot tubs are breeding grounds for waterborne bacteria—and they can be deadly. Between 2000 and 2014, germs spread through treated recreational water caused at least 27,219 illnesses and 8 deaths.

According to a CDC study, efforts to prevent outbreaks have had mixed results. The number of Legionella-related respiratory disease outbreaks increased over time, while Pseudomonas-related skin infection outbreaks declined and Cryptosporidium-related diarrheal disease outbreaks leveled off.

Legionella, which can cause severe pneumonia and flulike symptoms, was responsible for 16% of outbreaks. Another 13% was due to Pseudomonas, which can cause “hot tub rash” and swimmer’s ear. When a pool, hot tub, or water playground isn’t cleaned properly, bacteria grow and form “biofilm” on wet surfaces, ideal growing grounds for bacteria like Legionella and Pseudomonas. It’s harder for disinfectants to kill these bacteria when they are protected by biofilm, the CDC says.

The worst offender was Cryptosporidium, which caused 58% of the outbreaks and 89% of the illnesses. “Swallowing just a mouthful of water with Crypto in it can make otherwise healthy kids and adults sick for weeks,” said Michele Hlavsa, RN, MPH, chief of the CDC’s Healthy Swimming Program. Chlorine can’t kill Cryptosporidium quickly, she cautions. The best way to avoid it is to keep it out of the water in the first place. That means keeping anyone (usually young children) with stomach problems or diarrhea out of the pool. 

Other CDC tips:

• Check the inspection scores for pools, hot tubs, and water playgrounds.
• Use a test strip from a pool supply store to check the pH and bromine or free chlorine levels.
• Don’t swallow pool water.
• Take kids on regular bathroom breaks; change diapers in the diaper-changing area, away from the water.

Hotel pools and hot tubs are breeding grounds for waterborne bacteria—and they can be deadly. Between 2000 and 2014, germs spread through treated recreational water caused at least 27,219 illnesses and 8 deaths.

According to a CDC study, efforts to prevent outbreaks have had mixed results. The number of Legionella-related respiratory disease outbreaks increased over time, while Pseudomonas-related skin infection outbreaks declined and Cryptosporidium-related diarrheal disease outbreaks leveled off.

Legionella, which can cause severe pneumonia and flulike symptoms, was responsible for 16% of outbreaks. Another 13% was due to Pseudomonas, which can cause “hot tub rash” and swimmer’s ear. When a pool, hot tub, or water playground isn’t cleaned properly, bacteria grow and form “biofilm” on wet surfaces, ideal growing grounds for bacteria like Legionella and Pseudomonas. It’s harder for disinfectants to kill these bacteria when they are protected by biofilm, the CDC says.

The worst offender was Cryptosporidium, which caused 58% of the outbreaks and 89% of the illnesses. “Swallowing just a mouthful of water with Crypto in it can make otherwise healthy kids and adults sick for weeks,” said Michele Hlavsa, RN, MPH, chief of the CDC’s Healthy Swimming Program. Chlorine can’t kill Cryptosporidium quickly, she cautions. The best way to avoid it is to keep it out of the water in the first place. That means keeping anyone (usually young children) with stomach problems or diarrhea out of the pool. 

Other CDC tips:

• Check the inspection scores for pools, hot tubs, and water playgrounds.
• Use a test strip from a pool supply store to check the pH and bromine or free chlorine levels.
• Don’t swallow pool water.
• Take kids on regular bathroom breaks; change diapers in the diaper-changing area, away from the water.

Hotel pools and hot tubs are breeding grounds for waterborne bacteria—and they can be deadly. Between 2000 and 2014, germs spread through treated recreational water caused at least 27,219 illnesses and 8 deaths.

According to a CDC study, efforts to prevent outbreaks have had mixed results. The number of Legionella-related respiratory disease outbreaks increased over time, while Pseudomonas-related skin infection outbreaks declined and Cryptosporidium-related diarrheal disease outbreaks leveled off.

Legionella, which can cause severe pneumonia and flulike symptoms, was responsible for 16% of outbreaks. Another 13% was due to Pseudomonas, which can cause “hot tub rash” and swimmer’s ear. When a pool, hot tub, or water playground isn’t cleaned properly, bacteria grow and form “biofilm” on wet surfaces, ideal growing grounds for bacteria like Legionella and Pseudomonas. It’s harder for disinfectants to kill these bacteria when they are protected by biofilm, the CDC says.

The worst offender was Cryptosporidium, which caused 58% of the outbreaks and 89% of the illnesses. “Swallowing just a mouthful of water with Crypto in it can make otherwise healthy kids and adults sick for weeks,” said Michele Hlavsa, RN, MPH, chief of the CDC’s Healthy Swimming Program. Chlorine can’t kill Cryptosporidium quickly, she cautions. The best way to avoid it is to keep it out of the water in the first place. That means keeping anyone (usually young children) with stomach problems or diarrhea out of the pool. 

Other CDC tips:

• Check the inspection scores for pools, hot tubs, and water playgrounds.
• Use a test strip from a pool supply store to check the pH and bromine or free chlorine levels.
• Don’t swallow pool water.
• Take kids on regular bathroom breaks; change diapers in the diaper-changing area, away from the water.

Falls have long been a major hazard for older adults—accounting for the largest percentage of deaths from unintentional injuries. Each year, about 1 in 4 older adults in the US reports falling, and an estimated 3 million emergency department visits every year are related to falls.

According to the CDC, things are getting worse. Overall, deaths due to falls among older adults increased 31% from 2007- 2016, a rate of 3% per year. The rate increased in every demographic category except among American Indians/Alaska Natives, with the largest increase (4%) among people aged ≥ 85 years. Nationwide, nearly 30,000 older adults died from fall-related causes in 2016.

But falls are not an inevitable part of aging, the CDC reminds. Advanced age is a well-known independent risk factor; other risk factors include reduced activity, chronic conditions (including incontinence), prescription medications (which may act synergistically on the central nervous system), and changes in gait and balance. The CDC says health care providers can address the problem by asking patients about falls, assessing gait and balance, reviewing medications, and prescribing interventions such as strength and balance exercises or physical therapy.

Initiatives such as CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) can help with risk assessment, patient education, and interventions (https://www.cdc.gov/steadi).

Falls have long been a major hazard for older adults—accounting for the largest percentage of deaths from unintentional injuries. Each year, about 1 in 4 older adults in the US reports falling, and an estimated 3 million emergency department visits every year are related to falls.

According to the CDC, things are getting worse. Overall, deaths due to falls among older adults increased 31% from 2007- 2016, a rate of 3% per year. The rate increased in every demographic category except among American Indians/Alaska Natives, with the largest increase (4%) among people aged ≥ 85 years. Nationwide, nearly 30,000 older adults died from fall-related causes in 2016.

But falls are not an inevitable part of aging, the CDC reminds. Advanced age is a well-known independent risk factor; other risk factors include reduced activity, chronic conditions (including incontinence), prescription medications (which may act synergistically on the central nervous system), and changes in gait and balance. The CDC says health care providers can address the problem by asking patients about falls, assessing gait and balance, reviewing medications, and prescribing interventions such as strength and balance exercises or physical therapy.

Initiatives such as CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) can help with risk assessment, patient education, and interventions (https://www.cdc.gov/steadi).

Falls have long been a major hazard for older adults—accounting for the largest percentage of deaths from unintentional injuries. Each year, about 1 in 4 older adults in the US reports falling, and an estimated 3 million emergency department visits every year are related to falls.

According to the CDC, things are getting worse. Overall, deaths due to falls among older adults increased 31% from 2007- 2016, a rate of 3% per year. The rate increased in every demographic category except among American Indians/Alaska Natives, with the largest increase (4%) among people aged ≥ 85 years. Nationwide, nearly 30,000 older adults died from fall-related causes in 2016.

But falls are not an inevitable part of aging, the CDC reminds. Advanced age is a well-known independent risk factor; other risk factors include reduced activity, chronic conditions (including incontinence), prescription medications (which may act synergistically on the central nervous system), and changes in gait and balance. The CDC says health care providers can address the problem by asking patients about falls, assessing gait and balance, reviewing medications, and prescribing interventions such as strength and balance exercises or physical therapy.

Initiatives such as CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) can help with risk assessment, patient education, and interventions (https://www.cdc.gov/steadi).

A cost-effective community program at Pennsylvania State University helped most participants change their behavior and significantly improve their HbA_1c and blood pressure, according to a report in Preventing Chronic Disease.

The researchers for the extension program, Dining with Diabetes, collected data on 2,738 adults with type 2 diabetes or prediabetes and adult family members without diabetes. The program consisted of 4 weekly 2-hour classes and a follow-up class conducted 3 months later. The classes included hands-on food preparation, food tastings, and physical activity.

At the follow-up class, participants who completed the program had significant improvements in diabetes-related biomarkers. A greater percentage said they were confident they could keep their diabetes under control, compared with the number at baseline (67% v 58%). At baseline, most participants were adhering to medications; the researchers found no significant change in adherence.

Participants also increased the number of days per week on which they exercised for ≥ 20 minutes (from 2.9 to 3.4 days), and slightly increased the number of days on which they ate a variety of fruits and vegetables.

Nearly half of participants with baseline and follow-up measurements had a drop in HbA_1c. At follow-up, 21% had a reduction large enough to lower their diabetes status. The changes translated to a 5.9% decrease in HbA_1c for 27% of those who had uncontrolled diabetes at baseline. More than half (59%) had a drop in blood pressure, including 60% of those with uncontrolled diabetes.

The program, which was free to participants, cost Penn State Extension $407 per person. The researchers estimate that extending the program to half of the 1.3 million people with diabetes in Pennsylvania would save the state approximately $195 million at 1 year.

A cost-effective community program at Pennsylvania State University helped most participants change their behavior and significantly improve their HbA_1c and blood pressure, according to a report in Preventing Chronic Disease.

The researchers for the extension program, Dining with Diabetes, collected data on 2,738 adults with type 2 diabetes or prediabetes and adult family members without diabetes. The program consisted of 4 weekly 2-hour classes and a follow-up class conducted 3 months later. The classes included hands-on food preparation, food tastings, and physical activity.

At the follow-up class, participants who completed the program had significant improvements in diabetes-related biomarkers. A greater percentage said they were confident they could keep their diabetes under control, compared with the number at baseline (67% v 58%). At baseline, most participants were adhering to medications; the researchers found no significant change in adherence.

Participants also increased the number of days per week on which they exercised for ≥ 20 minutes (from 2.9 to 3.4 days), and slightly increased the number of days on which they ate a variety of fruits and vegetables.

Nearly half of participants with baseline and follow-up measurements had a drop in HbA_1c. At follow-up, 21% had a reduction large enough to lower their diabetes status. The changes translated to a 5.9% decrease in HbA_1c for 27% of those who had uncontrolled diabetes at baseline. More than half (59%) had a drop in blood pressure, including 60% of those with uncontrolled diabetes.

The program, which was free to participants, cost Penn State Extension $407 per person. The researchers estimate that extending the program to half of the 1.3 million people with diabetes in Pennsylvania would save the state approximately $195 million at 1 year.

A cost-effective community program at Pennsylvania State University helped most participants change their behavior and significantly improve their HbA_1c and blood pressure, according to a report in Preventing Chronic Disease.

The researchers for the extension program, Dining with Diabetes, collected data on 2,738 adults with type 2 diabetes or prediabetes and adult family members without diabetes. The program consisted of 4 weekly 2-hour classes and a follow-up class conducted 3 months later. The classes included hands-on food preparation, food tastings, and physical activity.

At the follow-up class, participants who completed the program had significant improvements in diabetes-related biomarkers. A greater percentage said they were confident they could keep their diabetes under control, compared with the number at baseline (67% v 58%). At baseline, most participants were adhering to medications; the researchers found no significant change in adherence.

Participants also increased the number of days per week on which they exercised for ≥ 20 minutes (from 2.9 to 3.4 days), and slightly increased the number of days on which they ate a variety of fruits and vegetables.

Nearly half of participants with baseline and follow-up measurements had a drop in HbA_1c. At follow-up, 21% had a reduction large enough to lower their diabetes status. The changes translated to a 5.9% decrease in HbA_1c for 27% of those who had uncontrolled diabetes at baseline. More than half (59%) had a drop in blood pressure, including 60% of those with uncontrolled diabetes.

The program, which was free to participants, cost Penn State Extension $407 per person. The researchers estimate that extending the program to half of the 1.3 million people with diabetes in Pennsylvania would save the state approximately $195 million at 1 year.

Many things can reactivate chronic hepatitis B virus (HBV) infection—withdrawal of antiviral therapy, pregnancy, and chemotherapy, to name a few. So when a patient with stable chronic HBV virus presented with significant hepatitis flare, clinicians from Beth Israel Deaconess Medical Center in Boston, Massachusetts, had a long list to check.

They first ruled out drug-associated hepatotoxicity and screened the patient for common causes of acute hepatitis. Beyond the HBV, the patient did not have other significant medical conditions, had not had close contact with anyone ill, and was not pregnant. Tests were negative for cytomegalovirus, Epstein-Barr syndrome, HIV, hepatitis A, C, and D. The patient tested negative for both antihepatitis E virus (HEV) IgM and IgG in a visit about 9 months before.

However, she reported regularly consuming pork, including a recent barbecue meal. Thus, the clinicians focused on HEV serology, which confirmed that she had an acute HEV infection.

Pigs act as a “natural reservoir” for HEV; contaminated meats and direct contact with animals are the most common causes of HEV human infection in industrialized countries. Recent data reveal the prevalence of HEV antibodies in the US is about 6%, illustrating that it is not as uncommon as it was thought to be. Although there was no direct evidence to confirm the source of her infection, it seemed likely due to the pork consumption.

The patient was started on tenofovir but stopped it 4 months later because she felt well. After a subsequent flare, “repeated counseling” persuaded the patient to start on entecavir, with successful viral suppression.

Hepatitis E superinfection on chronic HBV can contribute to significant morbidity and mortality, the clinicians say, particularly in patients with cirrhosis. Concurrent infection with another viral hepatitis should be considered in both immunodeficient and immunocompetent patients with chronic HBV reactivation.

Source:

Aslam A, Susheela A, Iriana S, Chan SS, Lau D. BMJ Case Rep. 2018;2018. pii: bcr-2017-223616.
doi: 10.1136/bcr-2017-223616.

Many things can reactivate chronic hepatitis B virus (HBV) infection—withdrawal of antiviral therapy, pregnancy, and chemotherapy, to name a few. So when a patient with stable chronic HBV virus presented with significant hepatitis flare, clinicians from Beth Israel Deaconess Medical Center in Boston, Massachusetts, had a long list to check.

They first ruled out drug-associated hepatotoxicity and screened the patient for common causes of acute hepatitis. Beyond the HBV, the patient did not have other significant medical conditions, had not had close contact with anyone ill, and was not pregnant. Tests were negative for cytomegalovirus, Epstein-Barr syndrome, HIV, hepatitis A, C, and D. The patient tested negative for both antihepatitis E virus (HEV) IgM and IgG in a visit about 9 months before.

However, she reported regularly consuming pork, including a recent barbecue meal. Thus, the clinicians focused on HEV serology, which confirmed that she had an acute HEV infection.

Pigs act as a “natural reservoir” for HEV; contaminated meats and direct contact with animals are the most common causes of HEV human infection in industrialized countries. Recent data reveal the prevalence of HEV antibodies in the US is about 6%, illustrating that it is not as uncommon as it was thought to be. Although there was no direct evidence to confirm the source of her infection, it seemed likely due to the pork consumption.

The patient was started on tenofovir but stopped it 4 months later because she felt well. After a subsequent flare, “repeated counseling” persuaded the patient to start on entecavir, with successful viral suppression.

Hepatitis E superinfection on chronic HBV can contribute to significant morbidity and mortality, the clinicians say, particularly in patients with cirrhosis. Concurrent infection with another viral hepatitis should be considered in both immunodeficient and immunocompetent patients with chronic HBV reactivation.

Source:

Aslam A, Susheela A, Iriana S, Chan SS, Lau D. BMJ Case Rep. 2018;2018. pii: bcr-2017-223616.
doi: 10.1136/bcr-2017-223616.

Many things can reactivate chronic hepatitis B virus (HBV) infection—withdrawal of antiviral therapy, pregnancy, and chemotherapy, to name a few. So when a patient with stable chronic HBV virus presented with significant hepatitis flare, clinicians from Beth Israel Deaconess Medical Center in Boston, Massachusetts, had a long list to check.

They first ruled out drug-associated hepatotoxicity and screened the patient for common causes of acute hepatitis. Beyond the HBV, the patient did not have other significant medical conditions, had not had close contact with anyone ill, and was not pregnant. Tests were negative for cytomegalovirus, Epstein-Barr syndrome, HIV, hepatitis A, C, and D. The patient tested negative for both antihepatitis E virus (HEV) IgM and IgG in a visit about 9 months before.

However, she reported regularly consuming pork, including a recent barbecue meal. Thus, the clinicians focused on HEV serology, which confirmed that she had an acute HEV infection.

Pigs act as a “natural reservoir” for HEV; contaminated meats and direct contact with animals are the most common causes of HEV human infection in industrialized countries. Recent data reveal the prevalence of HEV antibodies in the US is about 6%, illustrating that it is not as uncommon as it was thought to be. Although there was no direct evidence to confirm the source of her infection, it seemed likely due to the pork consumption.

The patient was started on tenofovir but stopped it 4 months later because she felt well. After a subsequent flare, “repeated counseling” persuaded the patient to start on entecavir, with successful viral suppression.

Hepatitis E superinfection on chronic HBV can contribute to significant morbidity and mortality, the clinicians say, particularly in patients with cirrhosis. Concurrent infection with another viral hepatitis should be considered in both immunodeficient and immunocompetent patients with chronic HBV reactivation.

Source:

Aslam A, Susheela A, Iriana S, Chan SS, Lau D. BMJ Case Rep. 2018;2018. pii: bcr-2017-223616.
doi: 10.1136/bcr-2017-223616.

Cryptococcal meningitis is one of the most common mycoses in patients with HIV/AIDS. In developed countries, mortality rates due to the disease hover around 9%—in poor and underdeveloped regions, the number leaps to 70%. Many of those deaths are related to lack of access and difficulty in administering amphotericin B and  flucytosine. That is the most effective standard treatment, but it is expensive and carries serious adverse effects, including nephrotoxicity, hepatotoxicity, and bone marrow suppression. Fluconazole, also commonly used, does not effectively clear fungal burden and is associated with clinical relapse.

More antifungals are desperately needed, but it takes billions of dollars to get a drug to market, and the process is slow. Where are the new antifungals to come from?  Maybe from other drugs?

Researchers have begun mining drug compound “libraries,” searching for existing drugs that can be repurposed. The drugs have already passed all the regulatory hurdles—it is just a matter of finding which ones could be turned to a new use. The antidepressant sertraline, for instance, has been found to be a potent antifungal that works synergistically with fluconazole and is now being repurposed for cryptococcal meningitis. 

Researchers from University of Technology Sydney screened the Screen-Well Enzo library of 640 compounds for candidates that phenotypically inhibited the growth of Cryptococcus deuterogattii. The search turned up promising results for the anthelminthic agent flubendazole, as well as the L-type calcium channel blockers nifedipine, nisoldipine, and felodipine. Flubendazole was very active against all pathogenic Cryptococcus species, and, importantly, was equally effective against isolates resistant to fluconazole. Nifedipine, nisoldipine and felodipine inhibited Cryptococcus. Nisoldipine was also effective against Candida, Saccharomyces and Aspergillus.

The researchers say flubendazole may be the best starting point for treating cryptococcal disease, both for its effectiveness and because research has not found serious adverse effects from antihelminthic treatment. Flubendazole interferes with normal cell growth as early as 3 hours posttreatment and continues to render treated Cryptococcus cells unviable. However, because flubendazole is formulated to treat gastrointestinal worms, it is not yet known whether it would be able to reach therapeutic concentrations in the brain required for an antifungal effect.

Overall, their findings, the researchers say, “validates repurposing as a rapid approach for finding new agents to treat neglected infectious diseases.”

Source:
Truong M, Monahan LG, Carter DA, Charles IG. PeerJ. 2018;6: e4761.
doi: 10.7717/peerj.4761

Cryptococcal meningitis is one of the most common mycoses in patients with HIV/AIDS. In developed countries, mortality rates due to the disease hover around 9%—in poor and underdeveloped regions, the number leaps to 70%. Many of those deaths are related to lack of access and difficulty in administering amphotericin B and  flucytosine. That is the most effective standard treatment, but it is expensive and carries serious adverse effects, including nephrotoxicity, hepatotoxicity, and bone marrow suppression. Fluconazole, also commonly used, does not effectively clear fungal burden and is associated with clinical relapse.

More antifungals are desperately needed, but it takes billions of dollars to get a drug to market, and the process is slow. Where are the new antifungals to come from?  Maybe from other drugs?

Researchers have begun mining drug compound “libraries,” searching for existing drugs that can be repurposed. The drugs have already passed all the regulatory hurdles—it is just a matter of finding which ones could be turned to a new use. The antidepressant sertraline, for instance, has been found to be a potent antifungal that works synergistically with fluconazole and is now being repurposed for cryptococcal meningitis. 

Researchers from University of Technology Sydney screened the Screen-Well Enzo library of 640 compounds for candidates that phenotypically inhibited the growth of Cryptococcus deuterogattii. The search turned up promising results for the anthelminthic agent flubendazole, as well as the L-type calcium channel blockers nifedipine, nisoldipine, and felodipine. Flubendazole was very active against all pathogenic Cryptococcus species, and, importantly, was equally effective against isolates resistant to fluconazole. Nifedipine, nisoldipine and felodipine inhibited Cryptococcus. Nisoldipine was also effective against Candida, Saccharomyces and Aspergillus.

The researchers say flubendazole may be the best starting point for treating cryptococcal disease, both for its effectiveness and because research has not found serious adverse effects from antihelminthic treatment. Flubendazole interferes with normal cell growth as early as 3 hours posttreatment and continues to render treated Cryptococcus cells unviable. However, because flubendazole is formulated to treat gastrointestinal worms, it is not yet known whether it would be able to reach therapeutic concentrations in the brain required for an antifungal effect.

Overall, their findings, the researchers say, “validates repurposing as a rapid approach for finding new agents to treat neglected infectious diseases.”

Source:
Truong M, Monahan LG, Carter DA, Charles IG. PeerJ. 2018;6: e4761.
doi: 10.7717/peerj.4761

Cryptococcal meningitis is one of the most common mycoses in patients with HIV/AIDS. In developed countries, mortality rates due to the disease hover around 9%—in poor and underdeveloped regions, the number leaps to 70%. Many of those deaths are related to lack of access and difficulty in administering amphotericin B and  flucytosine. That is the most effective standard treatment, but it is expensive and carries serious adverse effects, including nephrotoxicity, hepatotoxicity, and bone marrow suppression. Fluconazole, also commonly used, does not effectively clear fungal burden and is associated with clinical relapse.

More antifungals are desperately needed, but it takes billions of dollars to get a drug to market, and the process is slow. Where are the new antifungals to come from?  Maybe from other drugs?

Researchers have begun mining drug compound “libraries,” searching for existing drugs that can be repurposed. The drugs have already passed all the regulatory hurdles—it is just a matter of finding which ones could be turned to a new use. The antidepressant sertraline, for instance, has been found to be a potent antifungal that works synergistically with fluconazole and is now being repurposed for cryptococcal meningitis. 

Researchers from University of Technology Sydney screened the Screen-Well Enzo library of 640 compounds for candidates that phenotypically inhibited the growth of Cryptococcus deuterogattii. The search turned up promising results for the anthelminthic agent flubendazole, as well as the L-type calcium channel blockers nifedipine, nisoldipine, and felodipine. Flubendazole was very active against all pathogenic Cryptococcus species, and, importantly, was equally effective against isolates resistant to fluconazole. Nifedipine, nisoldipine and felodipine inhibited Cryptococcus. Nisoldipine was also effective against Candida, Saccharomyces and Aspergillus.

The researchers say flubendazole may be the best starting point for treating cryptococcal disease, both for its effectiveness and because research has not found serious adverse effects from antihelminthic treatment. Flubendazole interferes with normal cell growth as early as 3 hours posttreatment and continues to render treated Cryptococcus cells unviable. However, because flubendazole is formulated to treat gastrointestinal worms, it is not yet known whether it would be able to reach therapeutic concentrations in the brain required for an antifungal effect.

Overall, their findings, the researchers say, “validates repurposing as a rapid approach for finding new agents to treat neglected infectious diseases.”

Source:
Truong M, Monahan LG, Carter DA, Charles IG. PeerJ. 2018;6: e4761.
doi: 10.7717/peerj.4761

A 26-year-old man presented to uroligy clinicians with right testicular pain and a right epididymal mass. It was a challenge to diagnose the cause—until he revealed some essential clues.

The differential diagnosis included testicular malignancy and lymphoma. However, tumor markers were within normal limits. Tests for HIV and syphilis were negative. The clinicians also considered granulomatous or chronic orchitis, but after treatment with nonsteroidal anti-inflammatory drugs, the pain and palpable epididymal mass had resolved. Then, follow-up testicular ultrasound images showed new diffuse heterogeneous hypoechoic lesions in the right testis.

The patient elected to have a right radical orchiectomy with sperm cryopreserved. He recovered well, and semen analysis did not show any abnormalities.

Pathology of the surgical specimen revealed necrotizing and nonnecrotizing granulomas. At this point, the patient recollected that he had developed cervical lymphadenopathy and oral ulcers several weeks after traveling to South America, 8 months before presenting with the testicular symptoms.

Combined with another clue—frequent exposure to cats during his South America trip—the patient’s symptoms now created a clearer picture. He had been diagnosed with toxoplasmosis at the time but had not received treatment because he was immunocompetent. The patient’s symptoms had resolved spontaneously, and he said he had  been in his usual health between then and when he developed the testicular pain.

Based on this new information, the clinicians conducted immunohistochemical tests, which revealed isolated cysts about 20 µm in diameter, confirming a diagnosis of testicular toxoplasmosis. They started him on systemic toxoplasmosis treatment; he has been in good health since.

The clinicians note that toxoplasmosis is highly prevalent, infecting up to 30% of the world’s population. Cat feces is one source of infection with Toxoplasma gondii, which is typically asymptomatic. In immunocompetent patients, it tends to present as an acute infection that is benign and self-limited.

Only a few cases of testicular toxoplasmosis have been reported in the literature, and all have been in immunocompromised patients. Because this patient was immunocompetent, the case is  unique, being the only one reported as yet. Given the immunocompetence, the clinicians say, the patient demonstrates the need for clinicians to have a high index of suspicion.

Source:
Wong V, Amarasekera C, Kundu S. BMJ Case Rep. 2018;2018. pii: bcr-2018-224962.

A 26-year-old man presented to uroligy clinicians with right testicular pain and a right epididymal mass. It was a challenge to diagnose the cause—until he revealed some essential clues.

The differential diagnosis included testicular malignancy and lymphoma. However, tumor markers were within normal limits. Tests for HIV and syphilis were negative. The clinicians also considered granulomatous or chronic orchitis, but after treatment with nonsteroidal anti-inflammatory drugs, the pain and palpable epididymal mass had resolved. Then, follow-up testicular ultrasound images showed new diffuse heterogeneous hypoechoic lesions in the right testis.

The patient elected to have a right radical orchiectomy with sperm cryopreserved. He recovered well, and semen analysis did not show any abnormalities.

Pathology of the surgical specimen revealed necrotizing and nonnecrotizing granulomas. At this point, the patient recollected that he had developed cervical lymphadenopathy and oral ulcers several weeks after traveling to South America, 8 months before presenting with the testicular symptoms.

Combined with another clue—frequent exposure to cats during his South America trip—the patient’s symptoms now created a clearer picture. He had been diagnosed with toxoplasmosis at the time but had not received treatment because he was immunocompetent. The patient’s symptoms had resolved spontaneously, and he said he had  been in his usual health between then and when he developed the testicular pain.

Based on this new information, the clinicians conducted immunohistochemical tests, which revealed isolated cysts about 20 µm in diameter, confirming a diagnosis of testicular toxoplasmosis. They started him on systemic toxoplasmosis treatment; he has been in good health since.

The clinicians note that toxoplasmosis is highly prevalent, infecting up to 30% of the world’s population. Cat feces is one source of infection with Toxoplasma gondii, which is typically asymptomatic. In immunocompetent patients, it tends to present as an acute infection that is benign and self-limited.

Only a few cases of testicular toxoplasmosis have been reported in the literature, and all have been in immunocompromised patients. Because this patient was immunocompetent, the case is  unique, being the only one reported as yet. Given the immunocompetence, the clinicians say, the patient demonstrates the need for clinicians to have a high index of suspicion.

Source:
Wong V, Amarasekera C, Kundu S. BMJ Case Rep. 2018;2018. pii: bcr-2018-224962.

A 26-year-old man presented to uroligy clinicians with right testicular pain and a right epididymal mass. It was a challenge to diagnose the cause—until he revealed some essential clues.

The differential diagnosis included testicular malignancy and lymphoma. However, tumor markers were within normal limits. Tests for HIV and syphilis were negative. The clinicians also considered granulomatous or chronic orchitis, but after treatment with nonsteroidal anti-inflammatory drugs, the pain and palpable epididymal mass had resolved. Then, follow-up testicular ultrasound images showed new diffuse heterogeneous hypoechoic lesions in the right testis.

The patient elected to have a right radical orchiectomy with sperm cryopreserved. He recovered well, and semen analysis did not show any abnormalities.

Pathology of the surgical specimen revealed necrotizing and nonnecrotizing granulomas. At this point, the patient recollected that he had developed cervical lymphadenopathy and oral ulcers several weeks after traveling to South America, 8 months before presenting with the testicular symptoms.

Combined with another clue—frequent exposure to cats during his South America trip—the patient’s symptoms now created a clearer picture. He had been diagnosed with toxoplasmosis at the time but had not received treatment because he was immunocompetent. The patient’s symptoms had resolved spontaneously, and he said he had  been in his usual health between then and when he developed the testicular pain.

Based on this new information, the clinicians conducted immunohistochemical tests, which revealed isolated cysts about 20 µm in diameter, confirming a diagnosis of testicular toxoplasmosis. They started him on systemic toxoplasmosis treatment; he has been in good health since.

The clinicians note that toxoplasmosis is highly prevalent, infecting up to 30% of the world’s population. Cat feces is one source of infection with Toxoplasma gondii, which is typically asymptomatic. In immunocompetent patients, it tends to present as an acute infection that is benign and self-limited.

Only a few cases of testicular toxoplasmosis have been reported in the literature, and all have been in immunocompromised patients. Because this patient was immunocompetent, the case is  unique, being the only one reported as yet. Given the immunocompetence, the clinicians say, the patient demonstrates the need for clinicians to have a high index of suspicion.

Source:
Wong V, Amarasekera C, Kundu S. BMJ Case Rep. 2018;2018. pii: bcr-2018-224962.

The estimated prevalence of autism spectrum disorder (ASD) is higher than previously recorded, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network. Between 2000- 2014, the prevalence increased from 6.7 to 16.8 per 1,000 children, a jump of about 150%.

Autism and Developmental Disabilities Monitoring is a surveillance system that estimates the prevalence of autism spectrum disorder among children aged 8 years who live within 11 sites (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Autism and Developmental Disabilities Monitoring does not depend on family or practitioner reporting to determine ASD case status. Instead, staff conduct surveillance in a 2-phase process: reviewing children’s evaluation records from data sources in the community (including “developmental assessments completed by a wide range of health and education providers”), and compiling them into a comprehensive record that is then reviewed by ≤ 1 experienced clinicians.

Certain characteristics remained similar in 2014 compared with earlier surveillance years, ADDM researchers say. For instance, the median age of earliest known ASD diagnosis was 52 months in 2014, compared with close to 53 months in previous years.

However, male-to-female prevalence changed slightly, from 4.5:1 to 4:1, driven by a greater relative increase in ASD prevalence among girls since 2012. Autism and Developmental Disabilities Monitoring  also points to a trend that begun in 2002 of a decrease in the ratios of white to black children and white to Hispanic children. Historically, ADDM researchers say, estimates have been 20% to 30% higher among white children compared with black children and 50% to 70% higher compared with Hispanic children. In 2014, those numbers dropped to 7% (the lowest difference ever observed by ADDM) and 22%, respectively.

Implementation of the new DSM-5 case definition had little effect on the overall number of children identified with ASD in 2014, ADDM researchers say.

The estimated prevalence of autism spectrum disorder (ASD) is higher than previously recorded, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network. Between 2000- 2014, the prevalence increased from 6.7 to 16.8 per 1,000 children, a jump of about 150%.

Autism and Developmental Disabilities Monitoring is a surveillance system that estimates the prevalence of autism spectrum disorder among children aged 8 years who live within 11 sites (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Autism and Developmental Disabilities Monitoring does not depend on family or practitioner reporting to determine ASD case status. Instead, staff conduct surveillance in a 2-phase process: reviewing children’s evaluation records from data sources in the community (including “developmental assessments completed by a wide range of health and education providers”), and compiling them into a comprehensive record that is then reviewed by ≤ 1 experienced clinicians.

Certain characteristics remained similar in 2014 compared with earlier surveillance years, ADDM researchers say. For instance, the median age of earliest known ASD diagnosis was 52 months in 2014, compared with close to 53 months in previous years.

However, male-to-female prevalence changed slightly, from 4.5:1 to 4:1, driven by a greater relative increase in ASD prevalence among girls since 2012. Autism and Developmental Disabilities Monitoring  also points to a trend that begun in 2002 of a decrease in the ratios of white to black children and white to Hispanic children. Historically, ADDM researchers say, estimates have been 20% to 30% higher among white children compared with black children and 50% to 70% higher compared with Hispanic children. In 2014, those numbers dropped to 7% (the lowest difference ever observed by ADDM) and 22%, respectively.

Implementation of the new DSM-5 case definition had little effect on the overall number of children identified with ASD in 2014, ADDM researchers say.

The estimated prevalence of autism spectrum disorder (ASD) is higher than previously recorded, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network. Between 2000- 2014, the prevalence increased from 6.7 to 16.8 per 1,000 children, a jump of about 150%.

Autism and Developmental Disabilities Monitoring is a surveillance system that estimates the prevalence of autism spectrum disorder among children aged 8 years who live within 11 sites (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). Autism and Developmental Disabilities Monitoring does not depend on family or practitioner reporting to determine ASD case status. Instead, staff conduct surveillance in a 2-phase process: reviewing children’s evaluation records from data sources in the community (including “developmental assessments completed by a wide range of health and education providers”), and compiling them into a comprehensive record that is then reviewed by ≤ 1 experienced clinicians.

Certain characteristics remained similar in 2014 compared with earlier surveillance years, ADDM researchers say. For instance, the median age of earliest known ASD diagnosis was 52 months in 2014, compared with close to 53 months in previous years.

However, male-to-female prevalence changed slightly, from 4.5:1 to 4:1, driven by a greater relative increase in ASD prevalence among girls since 2012. Autism and Developmental Disabilities Monitoring  also points to a trend that begun in 2002 of a decrease in the ratios of white to black children and white to Hispanic children. Historically, ADDM researchers say, estimates have been 20% to 30% higher among white children compared with black children and 50% to 70% higher compared with Hispanic children. In 2014, those numbers dropped to 7% (the lowest difference ever observed by ADDM) and 22%, respectively.

Implementation of the new DSM-5 case definition had little effect on the overall number of children identified with ASD in 2014, ADDM researchers say.

Researchers from RAND Corp. compared performance between each VA facility and 3 corresponding non-VA settings with similar geographic settings, size, and complexity of care, using recent data on patient safety, mortality and readmission, inpatient and outpatient effectiveness, and patient-centered care.

VA hospitals performed on average the same as or significantly better than the non-VA hospitals on all 6 measures of inpatient safety, all 3 inpatient mortality measures, and 12 inpatient effectiveness measures. VA facilities also performed significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures. Compared with Medicare HMOs, the VA did significantly better on 14 measures and did not differ on 2.

However, the VA performance was worse than the non-VA hospitals on 3 readmission measures and 2 effectiveness measures. For example, VA inpatient performance was significantly lower on the patient experience measure for pain management.

The researchers saw “high variation” across VA facilities in performance on some quality measures, although they note that variation was even greater among non-VA hospitals. “The variation among VA health facilities shows that veterans in some areas are not receiving the same high-quality care that other VA facilities are able to provide,” said Carrie Farmer, a co-author of the study.

Researchers from RAND Corp. compared performance between each VA facility and 3 corresponding non-VA settings with similar geographic settings, size, and complexity of care, using recent data on patient safety, mortality and readmission, inpatient and outpatient effectiveness, and patient-centered care.

VA hospitals performed on average the same as or significantly better than the non-VA hospitals on all 6 measures of inpatient safety, all 3 inpatient mortality measures, and 12 inpatient effectiveness measures. VA facilities also performed significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures. Compared with Medicare HMOs, the VA did significantly better on 14 measures and did not differ on 2.

However, the VA performance was worse than the non-VA hospitals on 3 readmission measures and 2 effectiveness measures. For example, VA inpatient performance was significantly lower on the patient experience measure for pain management.

The researchers saw “high variation” across VA facilities in performance on some quality measures, although they note that variation was even greater among non-VA hospitals. “The variation among VA health facilities shows that veterans in some areas are not receiving the same high-quality care that other VA facilities are able to provide,” said Carrie Farmer, a co-author of the study.

Researchers from RAND Corp. compared performance between each VA facility and 3 corresponding non-VA settings with similar geographic settings, size, and complexity of care, using recent data on patient safety, mortality and readmission, inpatient and outpatient effectiveness, and patient-centered care.

VA hospitals performed on average the same as or significantly better than the non-VA hospitals on all 6 measures of inpatient safety, all 3 inpatient mortality measures, and 12 inpatient effectiveness measures. VA facilities also performed significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures. Compared with Medicare HMOs, the VA did significantly better on 14 measures and did not differ on 2.

However, the VA performance was worse than the non-VA hospitals on 3 readmission measures and 2 effectiveness measures. For example, VA inpatient performance was significantly lower on the patient experience measure for pain management.

The researchers saw “high variation” across VA facilities in performance on some quality measures, although they note that variation was even greater among non-VA hospitals. “The variation among VA health facilities shows that veterans in some areas are not receiving the same high-quality care that other VA facilities are able to provide,” said Carrie Farmer, a co-author of the study.

People with mental and/or substance abuse disorders are more than twice as likely to smoke cigarettes as people without those disorders, and are more likely to die of a smoking-related illness than from a behavioral health condition. Yet many people are not screened for tobacco use in behavioral health facilities. According to the Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA), in 2016, only half of mental health treatment facilities and 64% of substance abuse treatment facilities reported screening patients for tobacco use.

Even fewer facilities provide counseling and treatments. Only 38% of mental health facilities offer tobacco cessation counseling, 25% offer nicotine replacement therapy (NRT), and 22% offer non-nicotine cessation medications. Of substance abuse treatment facilities, 47% offer tobacco cessation counseling, 26% offer NRT, and 20% offer non-nicotine cessation medications. Oklahoma and New York had the highest percentage of programs. 

On the other hand, 49% of mental health and 33% of substance abuse treatment facilities now have smoke-free campuses in the 50 states, Washington DC, and Puerto Rico. That number varies by state, ranging from 20% of mental health facilities in Idaho to 78% in Oklahoma, and 10% of substance abuse treatment facilities in Idaho to 83% in New York.

Practical steps can boost the availability of smoking cessation screening and programs. The CDC recommends integrating screening and treatment protocols into workflows and electronic health record systems. The CDC also advises providing outreach to behavioral health providers who reinforce the message that patients can benefit from evidence-based cessation treatment.

The report is based on data from the 2016 National Mental Health Services Survey and the 2016 National Survey of Substance Abuse Treatment Services.

People with mental and/or substance abuse disorders are more than twice as likely to smoke cigarettes as people without those disorders, and are more likely to die of a smoking-related illness than from a behavioral health condition. Yet many people are not screened for tobacco use in behavioral health facilities. According to the Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA), in 2016, only half of mental health treatment facilities and 64% of substance abuse treatment facilities reported screening patients for tobacco use.

Even fewer facilities provide counseling and treatments. Only 38% of mental health facilities offer tobacco cessation counseling, 25% offer nicotine replacement therapy (NRT), and 22% offer non-nicotine cessation medications. Of substance abuse treatment facilities, 47% offer tobacco cessation counseling, 26% offer NRT, and 20% offer non-nicotine cessation medications. Oklahoma and New York had the highest percentage of programs. 

On the other hand, 49% of mental health and 33% of substance abuse treatment facilities now have smoke-free campuses in the 50 states, Washington DC, and Puerto Rico. That number varies by state, ranging from 20% of mental health facilities in Idaho to 78% in Oklahoma, and 10% of substance abuse treatment facilities in Idaho to 83% in New York.

Practical steps can boost the availability of smoking cessation screening and programs. The CDC recommends integrating screening and treatment protocols into workflows and electronic health record systems. The CDC also advises providing outreach to behavioral health providers who reinforce the message that patients can benefit from evidence-based cessation treatment.

The report is based on data from the 2016 National Mental Health Services Survey and the 2016 National Survey of Substance Abuse Treatment Services.

People with mental and/or substance abuse disorders are more than twice as likely to smoke cigarettes as people without those disorders, and are more likely to die of a smoking-related illness than from a behavioral health condition. Yet many people are not screened for tobacco use in behavioral health facilities. According to the Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA), in 2016, only half of mental health treatment facilities and 64% of substance abuse treatment facilities reported screening patients for tobacco use.

Even fewer facilities provide counseling and treatments. Only 38% of mental health facilities offer tobacco cessation counseling, 25% offer nicotine replacement therapy (NRT), and 22% offer non-nicotine cessation medications. Of substance abuse treatment facilities, 47% offer tobacco cessation counseling, 26% offer NRT, and 20% offer non-nicotine cessation medications. Oklahoma and New York had the highest percentage of programs. 

On the other hand, 49% of mental health and 33% of substance abuse treatment facilities now have smoke-free campuses in the 50 states, Washington DC, and Puerto Rico. That number varies by state, ranging from 20% of mental health facilities in Idaho to 78% in Oklahoma, and 10% of substance abuse treatment facilities in Idaho to 83% in New York.

Practical steps can boost the availability of smoking cessation screening and programs. The CDC recommends integrating screening and treatment protocols into workflows and electronic health record systems. The CDC also advises providing outreach to behavioral health providers who reinforce the message that patients can benefit from evidence-based cessation treatment.

The report is based on data from the 2016 National Mental Health Services Survey and the 2016 National Survey of Substance Abuse Treatment Services.