Stories from Texas Medicine, February 2017

Typhoid Fever on the Half Shell - 02/16/2017

Protecting the public from communicable infectious disease outbreaks is one of the most important, and most challenging, functions of public health. Foodborne outbreaks are not uncommon, and they can be especially difficult. This true story of the epidemiologic investigation into a typhoid fever outbreak illustrates the critical importance of timely reporting by front-line clinicians, extensive interprofessional teamwork, and statewide coordination.

Prevention of Health Care-Associated Infections in an Era of Public Reporting - 02/16/2017

Health care-associated infections (HAIs) are a leading cause of wasted health care dollars, and prevention of HAIs is a quintessential pillar of patient safety and satisfaction. Catheter-associated urinary tract infections, central line-associated blood stream infections, ventilator-associated pneumonias, surgical site infections, and Clostridium difficile infections are the important HAIs seen in U.S. hospitals. C. difficile infections are an emerging threat to modern health care systems, attributed to antibiotic overuse and resistance. Combined payment bundle increases the pressure on hospitals to take ownership of hip and knee replacement surgery patients. Health care facilities are heavily penalized for HAIs by the Centers for Medicare & Medicaid Services, not to mention the potential for negative publicity with public reporting. The role of initiatives such as prevention bundles, decolonization, antibiotic stewardship, and no-touch disinfection are emerging, but proper hand hy...

Emerging Infectious Diseases, Animals, and Future Epidemics - 02/16/2017

Emerging and reemerging infections have become prevalent in the United States since the 1970s, causing illness, death, and fear among the public. The published literature was reviewed to offer a perspective on risk factors for disease acquisition and to allow a prediction of the next microbial assault after Ebola and Zika. Four well-integrated factors likely will contribute simultaneously: animals colonized or infected by pathogens capable of human transmission, microbes recurrently changing their virulence, a growing number of susceptible people, and climatic and environmental factors encouraging disease transmission. The next pathogen likely to emerge in an important way in the United States is a new mutant virus arising from a well-established RNA virus family. Standard public health principles, including monitoring general populations for disease, developing new reagents as pathogens arise, implementing control efforts such as effective antibiotic stewardship programs, and vaccine ...

The Growing Threat of Antimicrobial Resistance - 02/01/2017

The emergence and widespread dissemination of multidrug-resistant organisms is considered one of the three most important public health threats for humankind in the 21st century and jeopardizes the practice of modern medicine. Failure to tackle this problem in a comprehensive fashion could result in a dire post-antibiotic era, impairing the future development of treatments against important diseases, such as cancer, and transplant medicine, among others. Here, we provide a global perspective of the problem and describe some of the most important antibiotic-resistant organisms affecting the health of our patients. In addition, we discuss some of the ongoing efforts to deal with the antimicrobial resistance crisis.

Infectious Diseases: An Ethical Challenge for Physicians - 02/01/2017

Infectious diseases are different. Not only are there more of them than other types of disease, but also more is known about them. Of all human afflictions, those that can be cured are, for the most part, infectious diseases. The outstanding authors contributing to the Symposium on Infectious Diseases in Medicine provide a big-picture perspective relevant to physicians practicing in every specialty of medicine.

Can We Be Too Clean for Our Own Good? The Hygiene Hypothesis Reviewed - 02/01/2017

The hygiene hypothesis began as an attempt to explain the relatively rapid rise in atopic diseases. Strachan's early hypothesis regarding the role of family size and exposure to early childhood infections in the development of atopic diseases has clearly evolved to integrate the possible effects of hygiene, eradication of parasitic infections, immunizations, improvements in home heating and ventilation, dust mite exposure, breastfeeding duration, diet, parental smoking, pollution, and exposure to pets and farm animals. However, as most of our understanding at the current time still comes from observational and epidemiologic studies, further investigations are needed to help uncover which of these genetic and environmental factors are indeed the causes behind the increases in allergic rhinitis and asthma.