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Industrial farming practices in the U.S. are one of my pet peeves, from an environmental and health standpoint, as well as my “foodie” sensibilities.
Freshly laid, unfertilized farm eggs actually keep best unwashed until they are cracked, & will keep at room temperature for weeks. An egg, even unfertilized, is alive, exchanging air through the shell & living off yolk nutrients. Think about it, they are designed to be living incubators for a chick. They will slowly dehydrate & lose quality, but they will live and remain edible for a long time. (How do they tell if an egg is unfertilized?)
Americans – Why do you keep refrigerating your eggs? nicely summarizes the interesting & little-advertised facts about how American industrial farming practice requires us to scrub, chlorine wash, & refrigerate eggs at 40F, so as to reduce the risk of Salmonellosis and other infections. In Europe, less industrialized farming practices & vaccination of poultry against Salmonella has dramatically reduced this problem. Washing eggs is illegal, & they are kept at 70F to reduce condensation that might promote bacteria. Kept dry at this temperature, the coating on the egg from laying protects them from dehydration & bacterial entry for a long time on store shelves.
Unfortunately, in the U.S. even backyard flocks have been contaminated with Salmonella & are usually unvaccinated, so the risk is not so low. I keep my farm eggs unwashed but refrigerated to retard bacteria (wash before use, of course). I love eggs from pasture-raised chickens & ducks; they’re richly flavored & higher in omega-3 fatty acids & antioxidants from their naturally “buggy” diets. Discard any egg if it’s slimy, discolored, has an odor (it shouldn’t at all), or has new powdery spots on it.
My esteemed colleague, clinician, researcher and FL native Dr. Anthony Cannella speaks tomorrow morning at the University of Florida Emerging Pathogens Institute Seminar Series in Gainseville, discussing the links between individual immune response and development of disease, which may either protect, or promote an uncontrolled and lethal manifestation of disease. Dr. Cannella has been studying human T-cell (Th1) and humeral responses in pathogens like Brucella and Coccidioides for the past several years, and I believe he’s onto something critical.
Antimicrobials are not the answer. There are only so many metabolic pathways to chemically block in living organisms, and far more ways for them to evolve resistance. Sometimes even as simple as waking a sleeping gene archived from an ancestor that armed itself against a similar defense raised by plants of eons past. The antibiotic pipeline has gone dry, with little more than a few “me-too” drugs in development at best.
For a long time, I’ve believed that the next step in the evolution of medicine and the battle against infection, lies in unlocking the secrets of immunity. How does that one person at work who never gets a flu shot and never gets sick get away with it? While a woman in her 20′s dies of influenza within a week? How does one person arrive at the ER dying of sepsis from a Staphyloccal cellulitis, while a nursing home resident tolerates repeated bacteremias without so much as a leukocytosis? Why do so many children get away with swimming with Naegleria every year, but a few succumb? Is it just the particular strain of pathogen? The volume of invader? The person? Or all of it?
What causes an immune system to respond so aggressively that it kills its owner? How do we harness it? Can we? Should we? Dr. Cannella is doggedly on the hunt, and I am grateful. Follow him on Twitter @apc_md, and go see him speak if ever you can. He’s one of those scientists you can actually understand, and he loves Medicine and people. A really cool person, you’ll like him.
Fight the good fight, Doc.
Research has shown that prescription and over the counter drugs are present in our nation’s water supplies. Antibiotics in the waste stream and sewage systems are a significant source of resistant bacteria in our environment and can kill beneficial microbes. Many other drugs have more than one effect, including hormonal and toxic effects in animals and plants.
Water is one of the few vital elements without which we cannot survive. H2O does not break down. All of the water on the planet today is the same that has existed since the beginning of Earth. Please do your part to keep our water supplies pure and healthy.
DO NOT flush expired or unwanted prescription and over-the-counter drugs down the toilet or drain, unless the label or accompanying patient information specifically instructs you to do so. To dispose of prescription and over-the-counter drugs, call your city or county government’s household trash and recycling service and ask if a drug take-back program is available in your community. Some counties hold household hazardous waste collection days, where prescription and over-the-counter drugs are accepted at a central location for proper disposal.
If you don’t have a take-back program near you, here is the next best way to dispose of medications in household trash:
1. Take your prescription drugs out of their original containers.
3. Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.
2. Mix drugs with an undesirable substance, such as cat litter or used coffee grounds (You don’t want animals or even children swallowing them!).
4. Conceal or remove any personal information, including Rx number, on the empty containers by covering it with permanent marker or duct tape, or by scratching it off (Labels contain a lot of personal information that you may prefer to keep private).
For more information on how to dispose of medications, including which can or should be flushed, visit FDA’s Disposal of Unused Medicines: What You Should Know.
Or for more information on protecting water supplies, go to www.epa.gov/ppcp/ or call the Safe Drinking Water Hotline at 800-426-4791.
Stay thirsty, my friends,
People forget we’re just a fraction of this planet’s ecosystem. Vibrio is *natural* throughout warm Gulf salt waters, yet it mostly only threatens people with immune impairment, liver disease & iron overload conditions. Diseases and disease vectors are adapting to warming climates & expanding their habitats all over the globe. Expect more Northern cases as the range of warm climate microbes shifts (Ecologist Richard Ostki discusses the arguments fir & against this statement here).
Get straight facts on Vibrio at CDC’s page on Vibrio vulnificus.
Get more on the role of climate change in communicable diseases at Climate change influences infectious diseases both in the Arctic and the tropics: joining the dots at Global Health Action.
Expect the unexpected,
Chagas disease is an insidious parasitosis caused by Trypanosoma cruzi.
T. cruzi is transmitted while a Triatomid bug bites and sucks the blood of a host. It defecates as it feeds; irritation and inflammation prompts the rubbing of feces carrying live parasites into the wound. It will also infect any mucosal tissue, such as a nearby eye or mouth, as when the bite occurs near an eye, Romaña’s sign. Or when swallowed in juices made from tropical fruit that may be contaminated with insect droppings. It may also be transmitted from mother to baby during pregnancy.
Long endemic to Central and South America, it has slowly crept north with human development and spread of its insect vector’s preferred habitat, mud and thatch homes, rodents and dogs. T.cruzi has been found in Triatomid bugs in California, Arizona, and New Mexico in recent years. And interestingly, it has recently caused foodborne outbreaks related to guava juice, sugar cane juice, and especially acai fruit, which is popular in Brazil and the U.S. for its anti-oxidant properties. Acai palm is a common host plant for Triatomid bugs in the Amazon, and T. cruzi has been shown to survive storage and freezing for some time. That may give some pause to those consuming it for health benefits, but any imported juices must demonstrate compliance with FDA Hazard Analysis and Critical Control Point (HACCP) regulations before being admitted to the U.S., and failure to comply with any aspect means automatic detention. (And if you’re wondering now whether the growth in acai consumption in recent years has expanded the habitat range for T. cruzi’s vector, you will be happy to know that the Brazilian government has prioritized sustainable and environmentally responsible development over capitalism, by carefully controlling acai agriculture. Only 1 million hectares of land is authorized to grow acai commercially.)
Temperate regions have historically been a barrier to this parasite in North America. Climate change, however, may cause further northern encroachments of Triatomid bugs and its habitat. Increasing travel and trade may bring new hosts.
Most people who are infected develop no or mild flu-like symptoms. Only decades later do 20-30% of these develop heart, gastrointestinal, and neurologic dysfunction that must be treated symptomatically. Anti-trypanosomal drugs do not help beyond the early stages, and then only to reduce severe symptoms, not to kill the parasites. Those who develop suppressed immunity, such as HIV/AIDS or after organ or bone marrow transplantation, may reactivate dormant parasites and develop life-threatening meningoencephalitis, myocarditis (inflamed heart muscle), and other organs. Chagas is difficult to accurately test for with blood work, and unlikely to show up in blood smears in chronic phases (except in reactivation disease), so making the diagnosis is often only detected in the U.S. when a donor’s blood is permanently rejected for donation because of a positive EIA antibody screen for Trypanosoma cruzi. Polymerase chain reaction (PCR) assays are very unreliable.
Pest management and housing improvement is key to stopping human transmission in areas where Triatomid bugs and T. cruzi may co-exist. Screening of pregnant women occurs in endemic countries, but it may be reasonable to start doing so in the U.S. in selected areas or cases of travel exposure, and experts are in fact weighing the options.
“Perseverance” was my son Philip’s most defining trait, and he was always proud of a certificate he was given for it by his second grade teacher. I keep that certificate in prominent view, because, in life and in death, he taught me to survive.
Now and then I like to recognize and share stories about survivors. It reminds us all of how fragile life and our expectations are, and yet how it’s possible to overcome terrible events and to live purposefully, meaningfully, and even joyously despite, or even because of, a “new normal”.
My good friend, colleague, and co-editor of Gompf’s ID Pearls 2.0, John Toney MD, nearly lost his daughter, Sarah, to a horrific highway accident in May. It’s been long months of surgeries, anguish, frustration, and labor to arrive at this point, but Sarah is now back at Marshall University studying Pharmacy with what she now calls her “pharm-ily”, the friends and mentors who supported her through what must have seemed an unspeakably endless summer.
Please trace her journey at MU Pharmacy Student Returns.
Then stop for a moment and reflect on the everyday blessings in your life. They add up. I promise.
In an unprecedented era where corporations are People, and Big Ag can hobble and gag the FDA, the facts are stark. Stop the antibiotic hemorrhage now, or bleed us all to death.
It starts with human prescribers, but it cannot end there. Over 80% of antibiotics are used by industrial farming operations in food animals (!) . Pork production may well be the worst offender, with 95% of antibiotics used being the same types used in humans; but even different, the antibiotics share the same class or resistance mechanism as those used to treat people. All drugs, antibiotics included, are eventually excreted into the soil, downstream water, or wastewater systems. There they can accumulate, they can change the natural flora in the environment and cause resistance in bacteria otherwise never exposed to antibiotics, or even alter a microbial population in ways that impact other systems down the line, eventually leading right back to us.
CDC has published its exhaustive and sobering review, Antibiotic Resistance Threats in the United States, 2013, and breaks down what we can expect in the decade to come and what we–ALL OF US–need to do to stop the runaway train.
In today’s press release, CDC Director Dr. Tom Frieden discusses the seriousness and reality of antibiotic resistance and offers
“Four Core Actions to Fight Antibiotic Resistance:
- To combat this serious health threat, CDC has identified four core actions critical to halting resistance:
- Preventing Infections, Preventing the Spread of Resistance: Avoiding infections reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop. Drug-resistant infections can be prevented by immunization, infection prevention actions in healthcare settings, safe food preparation and handling, and general hand washing.
- Tracking: CDC gathers data on antibiotic-resistant infections, causes of infections, and whether there are particular reasons (risk factors) that cause some people to get a resistant infection. With that information, experts can develop strategies to prevent those infections and prevent the resistant bacteria from spreading.
- Improving Antibiotic Use/Stewardship: Perhaps the most important action needed to greatly slow the development and spread of antibiotic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary. The commitment to always use antibiotics appropriately and safely —only when they are needed to treat disease – and to choose the right antibiotics and to administer them in the right way in every case is known as antibiotic stewardship.
- Developing Drugs and Diagnostic Tests: Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not completely stopped. Therefore, new antibiotics always will be needed to keep up with resistant bacteria, as will new tests to track the development of resistance.”
I cannot agree more.
A good deal of the developing world wishes they had access to things like city-treated water or pasteurized milk. Tap water in this country is overwhelmingly safe, to the extent that most of us take a tall cool drink from the faucet very much for granted.
We live intricately connected to our fellow creatures, most especially our hidden microbial world, bound in a delicate and wonderful balance. We cannot (and should not) sterilize everything we put into or on our bodies, because most microbes are necessary to our immune-strengthening microbiome. We can only reduce the number of potentially harmful microbes in our water or reduce our exposures. People need to be more aware of this fact in the same way that we all know lightning strikes rarely, yet we know not to stand outside near a tree in a storm.
One of the balances that have been debated in recent years is the proper temperature for water heaters in buildings and homes. On the one hand, children and the elderly are at high risk for serious scalds from water that is over 120 degrees Fahrenheit at the tap. On the other, Legionella is a serious threat to an increasingly older population, to those who receive chemotherapy or immunosuppressing agents for an ever-increasing number of conditions, and to those with chronic lung disease due to smoking or asthma (which itself is on the rise, along with the population of aging tobacco smokers). Legionella grows in water under 140 degrees Fahrenheit. It can cause life-threatening pneumonia and is inhaled in tiny aerosols created by shower heads, sprayers, fountains, and faucets. It is difficult to diagnose, and often is not detected, so additional antibiotics are routinely given to patients admitted with pneumonia. (This results in more people exposed to antibiotics, which itself is a snowballing problem for another post.)
In our growing population of elderly with chronic lung conditions, Mycobacterium-other-than-TB can be a serious problem (MOTT: so named because they are relatives of Mycobacterium tuberculosis that are not contagious; also known as “atypical Mycobacteria”) . MOTT often causes respiratory symptoms similar to TB—slow progressive lung destruction, loss of weight, and disability. Several species of MOTT may cause lung disease, and most require several combinations of antibiotics for to 2 to 3 years or more; some of the drugs may cause side effects, or the patient’s MOTT species may become resistant to them. MOTT may cause widespread infection in those with advanced HIV disease. MOTT may be acquired from the soil, natural fresh water, and treated water, including plumbing where warm water may aerosolize into the air, such as shower heads and hot tubs.
Recently, a 3rd case of Naegleria fowleri meningoencephalitis was reported in Louisiana in which the organism was traced to the household’s plumbing. It is believed to have been acquired via hose water used to flood a slip-and-sliding-type water toy; the 2 prior were acquired via sinus irrigations with unboiled tap water. There have been prior cases in Arizona due to untreated ground water provided by a private water company. Australia has experienced Naegleria infections related to public water systems, and Pakistan has reported tap water-related meningitis cases. The Louisiana cases are the first to reveal Naegleria in the plumbing of households receiving treated city water in the U.S.; city water tested positive for this microbe earlier this week. Looking back, there is also data that amoeba species themselves may make MOTT organisms in pipes more infective and capable of greater tissue invasion—after the amoebae ingest them (!).
CDC is using the Australian model in dealing with this emerging problem as climate change makes the unexpected commonplace.
While our public health systems evolve new responses to deal with changes in our human ecosystems, there are common sense things we can do to mimimize our own risks, most especially those of us with chronic lung disease or impaired immune systems, or those of us with children:
- Keep home water heaters at 120 degrees Fahrenheit maximum. Higher temperatures are a high risk for scald burns in homes where children visit or live, and for the elderly or disabled. Naegleria fowleri does not survive past 120 degrees F.
- For those with chronic lung disease: Once a month, turn the water heater to 140 degrees Fahrenheit for 12 hours; run two or three faucets at hottest temperature for 10 minutes. Repeat this process throughout the home until all the faucets and shower heads have been flushed with 140 degree water.
- Have home plumbing systems hyper-chlorinated once every 3-4 months and any time the plumbing system is repaired.
- Always use boiled tap water, or distilled or sterile water, for sinus rinsing (as with neti pots) or ritual nasal cleansing (such as the Islamic practice of wudu).
- Never sniff tap water into the nose while bathing, showering, or washing the face. Teach children to keep the head above water in the tub and never suck water up the nose.
- Don’t allow children to play unsupervised with hoses or sprinklers. Teach them not to drink from hoses and to keep them away from the face.
- Avoid water toys like slip-and-slides and inflatable water slides that use hose water, where it may be difficult to avoid water going up the nose.
- Consider adding a few capfuls of bleach to baby pools filled with a hose (just enough to smell the bleach). Clean and dry baby pools between use.
- If you need to top off the water in your swimming pool with tap water, place the hose directly into the skimmer box and ensure that the filter is running. Do not top off by placing the hose in the body of the pool.
- Think about your own uses of tap and hose water, and how you can keep healthy.
- Quit smoking tobacco products and/or unfiltered marijuana cigarettes, including water pipes or hookah.
For more information, visit:
- CDC’s Naegleria fowleri and Public Drinking Water Systems
- CDC’s Legionella Fast Facts & People At Risk
- Atypical Mycobacteria Nontuberculous Mycobacteria, Mycobacteria other than tuberculosis [MOTT]
Another little one was lost to Naegleria fowleri this summer, owing to a slip & slide at a friend’s house. A memory from our childhoods. It hits home how the importance of clean water is so central to our lives, and yet so often taken for granted.
We live in microbial soup. Most of it is harmless and in fact, necessary, to our immune system’s health. But the balance is delicate, and we are only a small part of the greater network.
Chlorine is an important and highly effective disinfectant. But most people do not realize that it’s a volatile element; it can interact with many elements in the environment; it can evaporate within a day or two from a quart of tap water set on a counter, and it evaporates faster when warm. So water in pipes & hoses can be warm & underchlorinated by the time it reaches and sits in homes. And pipes themselves may develop tiny cracks and leaks, and become coated with a slimy “biofilm” of bacteria and other organisms–excellent food sources for protozoa, which may even become more virulent in contact with them. We can keep water heaters at 120 degrees F & run the taps for several minutes every week if we have kids (this can lower other microbes, too, in homes of people with low immunity). We can avoid drinking or getting hose water up the nose & add a little bleach to a baby pool. Home filtration is not very satisfactory; the filters remove chlorine as well as impurities, and microbes in pipes can grow in the stored water and filter itself.
But how should cities treat our water as climate changes?
Public health officials–and the public–should be thinking and thinking ahead. Our support for the CDC’s Waterborne Disease Prevention Branch is more critical than ever in its role of keeping our nation’s water supplies and activities safe and fun for the challenging years to come.