Infection Prevention Updates
How Doctors Diagnosed A Woman's Eye Infection Linked To Bacteria In Eyedrops
How a rare type of bacteria infected and ultimately blinded Nancy Montz's left eye was a head-scratcher for Dr. Morgan Morelli, a physician who specializes in infectious diseases.
The Ohio woman had been infected with Pseudomonas aeruginosa, a bacterium resistant to most antibiotics. Morelli, chief fellow in the division of infectious diseases and HIV medicine at the University Hospitals Cleveland Medical Center, had never seen this kind of bacteria in an eye.
In fact, the particular kind of highly drug-resistant bacterium had never been reported in the United States.
"We were racking our heads trying to figure out how this happened," she said.
Montz, 72, of Perry, did not wear contacts — a common route for bacteria to enter the eyes. Last November, in chilly northeastern Ohio, she certainly hadn't been swimming in any nearby lakes, another potential source of unusual bacteria.
"We thought that this was just some sort of freak accident," Morelli said. "We had no idea that this case was going to be linked to a global manufacturing issue."
It took several months to confirm that Montz's infection had come from a contaminated bottle of EzriCare artificial tears, a product since linked to dozens of similar eye infections nationwide.
Details of Montz's case were published Thursday in Antimicrobial Agents and Chemotherapy, a journal of the American Society for Microbiology.
As of March 14, at least 68 people in 16 states had been diagnosed with such eye infections, according to the Centers for Disease Control and Prevention.
EzriCare Artificial Tears.Courtesy Kim Harrison Eight patients, like Montz, lost vision in at least one eye. Four people had to have their eyeballs surgically removed. Three have died.
EzriCare Artificial Tears, as well as Delsam Pharma's Artificial Eye Ointment, were recalled in February. The products had been manufactured by Global Pharma Healthcare in India and sold mostly online.
The CDC expects more cases will be identified and plans to update its investigation into the cases in the coming weeks, a spokesperson said. The agency confirmed to NBC News that Montz is one of 68 patients so far in its ongoing investigation.
Montz's infection was advanced when it was diagnosed, and she is unlikely to see out of that eye again.
She first realized something was wrong when she woke up with an unusual smear of yellow discharge on her pillow. Her left eye was cloudy and she had trouble seeing out of it.
The eye was "real funky looking," Montz said. She couldn't feel any pain or soreness, however, because a prior health problem had numbed the entire left side of her face, including her left eye.
Her husband encouraged her to see a doctor, who prescribed antibiotics.
But the drugs, which almost always take care of eye infections, didn't work. Within 48 hours, her eye became much worse. That's when Morelli got involved.
Her team ultimately found the bacteria that had infected Montz's eye was also in the bottle of EzriCare artificial tears she'd ordered through Amazon.
"She probably scratched the left eye with the eyedropper accidentally and didn't realize it because she had no feeling," Morelli hypothesized. "That allowed the infection to enter the eye much more easily and quickly in that eye before it ever affected the right one."
Morelli recommended several ways to reduce the risk of any type of eye infection:
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Erika EdwardsBacteria: Radioactive Elements Replace Essential Rare Earth Metals
A team led by LMU chemist Lena Daumann has demonstrated for the first time that bacteria can use certain radioactive elements to sustain their metabolism.
As well as being a useful material in all kinds of key technologies, lanthanides are important for bacteria, which use the rare earth metals in their metabolism. It turns out, however, that they are not as irreplaceable as previously thought, as an international and interdisciplinary team led by Professor Lena Daumann from the Department of Chemistry at LMU has demonstrated: Certain bacteria can use the radioactive elements americium and curium instead of the lanthanides -- and even prefer them sometimes.
Bacteria that use lanthanides are widespread in the environment. They belong to the so-called methylotrophs, which can use methanol or methane as carbon and energy sources. To do this, they take up lanthanides and incorporate them into an important metabolic enzyme, a lanthanide-dependent methanol dehydrogenase. The elements americium and curium, members of the radioactive actinides, are very similar to the lanthanides when it comes to key chemical properties such as size and charge. "And so we asked ourselves whether the bacteria can use actinides instead of their essential lanthanides," says Daumann.
Now the researchers have demonstrated that this is actually the case. They carried out an in-vivo study of two methylotrophic bacterial strains in collaboration with the Helmholtz Center in Dresden-Rossendorf (HZDR). "We fed the microbes various elements and showed that they incorporate americium and curium and grow just as well with these elements," explains Daumann. It is important that the actinides have the same oxidation state and are of a similar size to the lanthanides normally used, so that they fit in the active center of methanol dehydrogenase. Additional in-vitro studies with isolated methanol dehydrogenase also demonstrate that the enzyme works with the actinides and exhibits similar activities.
"We could thus show for the first time that organisms can use these radioactive elements for life processes," emphasizes Daumann. When the bacteria were offered a mixture of various lanthanides and actinides, they even preferred americium and curium ahead of some lanthanides. The ability of the bacteria to incorporate radioactive actinides is also interesting with respect to potential applications: "Methylotrophic bacteria could potentially be used in bioremediation or in the separation and recycling of lanthanides and actinides. Such difficult-to-separate mixtures are often found in spent nuclear fuel," says Daumann.
Bitten By An Iguana? You Could Get A Rare Bacterial Infection, New Study Says
Iguanas, those pesky green critters that come out in full force during the summer months in South Florida, are more than just a nuisance. They also pose health risks.
While touching an iguana or its feces can cause salmonella, a new Centers of Disease Control & Prevention report links an iguana's bite to a rare bacterial infection called mycobacterium marinum.
The discovery came after a 3-year-old girl from California and her family had taken a trip to Costa Rica. While eating cake on the beach, an iguana snapped it out of her left hand and bit her. The girl was immediately taken to a local clinic and found to have a superficial bite for which doctors gave her a five-day course of oral amoxicillin. But five months later, a cyst appeared.
After it was removed and biopsied, scientists took a closer look at the growth in the lab and discovered that the child had a rare infection caused by the bite. That type of infection usually infects humans only after a wound has been exposed to the bacteria in water.
Most antibiotics alone don't typically work on mycobacterium marinum, so doctors put the girl on rifampin, an antimicrobial, and clarithromycin, an antibiotic often used for skin infections. A report shows the infection responded well to the treatment.
Out of control iguanas infesting South Florida
Dr. Jordan Mah, the author of the report that will appear in the June 2023 issue of Emerging Infectious Diseases, CDC's monthly peer-reviewed public health journal, said it's not unusual for it to take a few months for a growth to surface. Usually mycobacterium marinum is assoiated with snake bites, he said.
"The course this pathogen takes with this infection happens over a period of time," said Mah, an expert in medical microbiology who worked at the lab that tested the cyst as a part of the Department of Pathology at Stanford University.
"I think the key thing is not to feed these animals so they don't get used to associating humans with food," he said. "I am pretty sure people on the beach fed him and it led to him biting the child to get food."
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Iguanas, particularly the green ones plentiful in South Florida, are herbivores and feed on foliage, flowers and fruit. Some will eat animal material such as insects, lizards, and other small animals, nesting birds and eggs.
Tom Portuallo, owner of Iguana Control, said South Floridians are seeing more iguanas than usual for this type of year because of the unusually warm winter.
Portuallo, in the iguana removal business for 14 years, said he hasn't heard of anyone getting bitten by an iguana. "They are not designed to kill prey and are more apt to run away than towards you," he said.
He has, however, seen dogs get sick from licking iguana feces and children get sick from touching iguana droppings.
Iguana killers: Hunts around South Florida backyards become a tourist attraction
Wherever they bask in the sun, iguanas leave behind their droppings almost as large as dog poop. Since lawns and pool decks are favorite places, it's easy to accidentally come in to contact with their bacteria-filled droppings.
Portuallo says iguanas cannot be relocated. His company will kill the iguanas and repurpose them into fish chum.
Mah said Floridians shouldn't worry about getting salmonella or mycobacerium marinum from an iguana who swims in their pool. "It is chlorinated, so that should kill organisms. Even in a fresh water lake or river, you would need a cut for organisms to get in."
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodma@sunsentinel.Com.
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