4th person in US mysteriously stricken with deadly bacteria from South Asia | Hacker News Reader

4th person in US mysteriously stricken with deadly bacteria from South Asia

arstechnica.com

120 points_Microft41 comments

> "Currently, CDC believes the most likely cause is an imported product (such as a food or drink, personal care or cleaning products or medicine) or an ingredient in one of those types of products," the agency said in a statement.

In case anyone was curious and didn't want to read the article.

Also, though:

> So far, the CDC has collected and tested more than 100 samples of products, soil, and water from the four patients' homes, but none has turned up positive for B. pseudomallei. The agency noted that tracking down a source of B. pseudomallei can sometimes be difficult as the bacteria can take two to three weeks to develop into an infection, broadening the window of possible exposure times and testing patients' memories.

While scary, is this really newsworthy? We're surrounded by bacteria that can be dangerous, but usually isn't.

Five years ago, my dad was admitted to the hospital because he contracted cryptococcus neoformans[1]. The thing is, that bacteria is everywhere. It's just that most people's bodies are able to easily fight it off. Most of the time, when someone becomes infected it is due to low immunity (HIV/AIDS patients and transplant patients, for example) He is neither of them. It turns out, there is a tiny percentage of the population that becomes infected and nobody knows why.

It was scary. Until they finally did a biopsy of his brain they were convinced he had cancer, they just didn't know what form. After the biopsy they were able to easily treat it with a common, over the counter medication they give women for yeast infections.

The bacteria had done enough damage that they had to install a permanent ventricular shunt (basically, a subdural tube that goes from his brain to his stomach to act as an overflow for cerebral fluid his body can no longer properly process in the brain) People die from cryptococcal meningitis like he had. My dad's neurosurgeon even told me that my dad was days away from death, had they not figured out what the problem was when they did.

Still, no news outlets reported on it. So I can't help but wonder, again, the newsworthiness of this mysterious deadly bacteria other than Ars Technica is joining all other media companies in trying to drum up revenue by needlessly scaring people.

1: https://www.cdc.gov/fungal/cdc-and-fungal/cryptococcal-menin...

> While scary, is this really newsworthy?

It is because the strains were genetically linked yet cover a vast disconnected geographic area.

Something is bringing the bacteria in, and they're trying to find it.

In addition, when something like this appears you want medical workers to be thinking about it as an option and adjust their Bayesian probabilities.

The standard "When you hear hoofbeats, think horses not zebras" is fine unless the circus just came to town. At which point, horses is still more likely, but zebras are no longer out of the question.

I work on the genetics and genomics of Cryptococcus, and actually it can often be quite tricky to treat as common azoles (most likely what your dad was treated with) are often ineffective (they tend to be fungistatic instead of fungicidal). Had the azoles not worked they would likely have moved on to using Amphotericin B which is a pretty nasty drug, though much more effective on Crypto. Systemic fungal infection in general are pretty difficult to deal with because fungal cell biology and physiology is not all that dissimilar to ours (on the grand scale of things).

How interesting. Thank you!

Key point from the article- it doesn’t generally spread from person to person

B. pseudomallei is not considered to be transmitted via air or respiratory droplets in non-laboratory settings. Person-to-person transmission risk is considered extremely low as there have only been a few documented cases of person-to-person transmission; contact of damaged skin with polluted soil or water is the most frequent route for natural infection. Healthcare personnel are generally not at risk if they follow standard precautions. However, laboratory personnel are at increased risk because some lab procedures may aerosolize particles and release B. pseudomallei into the air. Laboratory personnel can reduce their risk of exposure by following good laboratory practices.3 Laboratory staff who may have been exposed to B. pseudomallei should refer to existing CDC guidance.

https://emergency.cdc.gov/han/2021/han00448.asp

https://twitter.com/mims/statuses/1217043229427761152?ref_sr...

This isn't the Chinese authorities reporting on this bacteria though.

Also key: All four are known to have had contact. It's not random.

Sure? The article says that the cases are "connected", but not that the individuals have been in contact. (It could have been that they happened to use the same contaminated product.)

> CDC investigators determined that all four cases are connected and they suspect a so-far-unknown imported product may be to blame.

reading comprehension : 1 tenfourwookie : 0

I'm wrong. It does not say this.

Where have you heard that before?

Do you actually have reason to doubt it here? Because cynical skepticism isn't a helpful alternative to genuinely doing our best to understand and correcting course when better data is available.

Also, just to flog that old dead horse for the umpteenth time: Nobody said that "COVID-19 does not spread from person to person". What the WHO reported, on January 14 2020, at the very beginning of the pandemic when very little was known, was that "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission".

If you read that tweet and conclude that the WHO says that there is no human-to-human transmission, then you have a problem with reading comprehension.

WHO was largely denying the possibility of airborne transmission as late as July 2020.

https://academic.oup.com/cid/article/71/9/2311/5867798

Yes, there are things to criticise the WHO for (the initial advice against masks, and the delayed acknowledgment of aerosol/airborne transmission you allude to). But that often misrepresented tweet is not one of them I'd say.

My original comment pertained to a general pattern of communication from public health agencies-- I believe you were the first to bring up that tweet.

But if you want to explore the topic, by 14 January 2020 the virus had been sequenced for over a week, and its status as a beta-coronavirus with substantial sequence similarity to SARS established. Even if the sentence "preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission" was true, rather than merely asserted by Chinese authorities (as now seems more likely) it's just not a terribly pertinent thing to report if you're trying to be Gricean about it. It was one instance of a pattern of minimization from public health agencies that persisted even after it was clear that SARS-CoV-2 had global reach: https://lessonsfromthecrisis.substack.com/p/things-can-get-r...

It was early in the pandemic and very little was known, so issuing a statement that says “…no clear evidence of human to human transmission” was irresponsible. There was no clear evidence against human to human transmission either.

Simply saying nothing about it or we don’t know yet would have been better than that statement which guides a non pedantic reader, which are common outside of HN, to believing that human to human transmission was unlikely.

It's simply a matter of applying a prior: when I hear an organization's claim, I consider the base rate at which past claims have proven trustworthy, adjusting for whether past errors were honest mistakes, noble lies, culpable failures to apply medieval-peasant-tier common sense, the fruit of transparently ulterior motives, and so on. I sure hope they're right in this case but it's not clear why in particular I should think so.

What do you do?

I consider all my priors, not just a single one about the source.

I'm not saying you should reflexively believe the opposite of what any given source reports, just bear in mind the track records.

It'd be great to see more investment in antibiotics, and we need world governments to lead the charge. It'd be even better to see our current drug prohibition regime pivot from recreational drugs to antibiotics. Development of new, fantastic antibiotics is only a matter of time and money. We as a species have the capabilities, we just need to make the move.

Investment is a problem because ABX aren't profitable relative to other opportunities (in biotech / pharma, think cancer or Hep C). ABX cure, rather than treat, which means you have a single revenue event rather than recurring (chronic) revenues. Even in that space, Hep C was way more profitable. And if you're successful with ABX in a public health sense, the number of new cases generally goes down. Compare to a cancer drug, or a urinary incontinence drug, where that doesn't happen. There have been precious few new ABX developed in recent years. One is daptomycin ("Cubicin" in American marketing-speak). It was a few tens of thousands per course of treatment when it came out, pitched (and approved) as a narrow treatment for a very few indications, because that's how you have to sneak a new antibiotic through the system these days--you won't command high enough prices otherwise. It is, in fact, a broad-spectrum drug and I'm sure it's used off-label.

I think what we need to do to fix this is recognize it is a public health problem that the market is not forward-looking enough to fix, and use government power to fix it. We could do this by subsidizing the cost of pushing a new molecule through the FDA. Or we could, you know, fix the FDA and make their review processes more utilitarian and less costly...but that's bigger fish. There are limited government programs trying to do this at the moment.

A lot of the reason we see new, ABX-resistant strains in SE Asia is unrestrained use of our better drugs, which are cheap in generic form (ciprofloxacin, for example). We should be regulating ABX use with the fervor we now reserve for so many low-harm recreational substances. Perhaps we could just pivot that whole industry rather than taking them apart...

It's the meat industry that's by far the worst offender in antibiotics, and they've got too much money to do anything about without an awful lot of screaming.

I don't think they use cutting-edge stuff, do they?

Research more antibiotics? Let's understand what the current ones do before we introduce new ones.

> Symptoms can span localized pain or swelling, fever, ulceration, abscess, cough, chest pain, high fever, headache, anorexia, respiratory distress, abdominal discomfort, joint pain, disorientation, weight loss, stomach or chest pain, muscle or joint pain, and seizures, the CDC notes.

This is the first time I've heard of a bacteria causing anorexia or for that matter the first time I've seen anything (apart from possibly genetics) being a direct cause of anorexia

So in this sense they mean a lack of appetite, essentially. As I understand it, what most people think of as anorexia (purposely starving yourself) would be referred to anorexia nervosa.

https://en.wikipedia.org/wiki/Anorexia_(symptom)

Quote: Anorexia is a symptom, not a diagnosis. When a healthcare provider states that a patient has anorexia, they are simply referring to a decreased appetite. This means that the provider must find and treat the underlying cause of the anorexia. Anorexia is not to be confused with the mental health disorder anorexia nervosa. Because the terms are often used interchangeably, a provider must clarify to a patient to which they are referring as to avoid confusion. Anyone can manifest with anorexia regardless of their gender, age, or weight.

As long we have a global economy where goods and consumption move faster than the signals (?) they give off, we're going to be subject to "invasive species" such as this. Add in antibiotic resistance and another collision of natural forces is in the making.

Widespread antibiotic resistance would be a serious turning point for the global economy and the current way of life

It doesn't help that MANY doctors are complete morons and give out antibiotics for "suspected" infection.

The amount of times I had to refuse an antibiotic has been insane. There was a time I had some abdominal pain, got diagnosed with inflammation of the colon.....googled the name doctor said(cant recall now) but the information I found was that antibiotics are completely useless for it. In the end it was a muscle strain lol.

FDA/CDC needs to step in and really crack down on antibiotic usage. If I could report the doctors I would. Documents should be reviewed and warnings issued.

Conversely: my wife is a Nurse Practitioner and, when she was practicing family medicine, the number of times she had to refuse people antibiotics for what was obviously not bacterial (muscle strain, viral infection, etc...) was insane. She complained about it regularly.

I agree that the FDA and CDC need to crack down on antibiotic usage. They should also provide better education as to when antibiotics are appropriate.

If you can legally write a script and don't know that antibiotics aren't for virus you shouldn't be allowed to write scripts.

We don't need a crackdown. We need medical professionals to put their education to use.

I don't think it is a matter of the provider not knowing that antibiotics aren't for viral infections. They have patient after patient after patient coming in demanding to get an antibiotic. At some point, many of those providers give up and give in. I'm proud of my wife for not being one of them.

So "Do no harm" no longer applies? Maybe the answer is a class action suit a la opioids?

https://www.ajtmh.org/view/journals/tpmd/71/3/article-p360.x...

> South Asia is the southern region of Asia, which is defined in both geographical and ethno-cultural terms. The region consists of the countries of Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka and the Maldives.

~Wikipedia

Burkholderia pseudomallei could be used as a bio-weapon.

Burkholderia mallei which is closely related has been used as a bio-weapon on US soil.

"B. mallei was intentionally used to infect animals and humans during World War I. The Germans used B. mallei to infect animals that were being sent from neutral countries to the Allies with glanders."

"In 1914, a member of the German army named Anton Dilger, an American-educated surgeon, was sent home to live with his parents in Virginia after a nervous breakdown. He brought strains of Bacillus anthracis and B mallei and set up a laboratory with his brother’s help to grow the organisms in a private home in Chevy Chase, Maryland."

It's interesting that they think this is from South Asia given Burkholderia pseudomallei is in Mexico and maybe the USA and you'd expect it was from dirty fresh produce. I guess genetics don't lie.

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