Is your hot water hot enough?

There's an interesting paper in the March issue of Emerging Infectious Diseases that examines water cultures from homes of patients with nontuberculous mycobacterial infections (full text here). This paper caught my eye because it's our perception at VCU that we're seeing more patients with pulmonary atypical mycobacterial infections. Curiously, we rarely see Legionella, another waterborne pathogen.

In this study, water samples were obtained from 31 NTM-infected patients' homes from across the US. 59% of the homes had NTMs found in the water, and 46% had matching species. Of note, patients whose hot water temperature was <125° were two-fold more likely to have contaminated water than those whose water was >130°. The author recommends that patients at risk of NTM infections (slender elderly persons and cystic fibrosis heterozygotes), crank up the heat on their hot water tanks.

Kikuchi Disease Causative Agent?

I know this is a stretch beyond infection prevention, but I am fascinated by diseases with unknown causes and perhaps biased to think many have infectious etiologies. I spent 6 years on the USDA's National Advisory Committee on Microbiological Criteria for Foods (NACMCF). During the last several years on the Committee I was on a subcommittee charged with the "Assessment of the Food Safety Importance of Mycobacterium avium subspecies paratuberculosis (MAP)." MAP is associated with Johne's Disease in livestock and we looked at whether MAP could be transmitted to humans via food and what methods are available to eliminate MAP from the food supply. We were not specifically charged with looking at MAP as a human pathogen, although Johne's in cattle is clinically similar to inflammatory bowel disease in humans. In fact MAP has been linked to Crohn's disease in humans. So I guess this post is turning into an infection prevention one, just not hospital infection prevention...

Anyway, Kikuchi disease is a rare disease with clinical features of diffuse lymphadenopathy and fever and 4:1 female predominance. It is often confused with lymphoma. The etiology is unknown but has been linked to EBV, HHV-6, HHV-8, Yersinia and toxoplasma. In a new case report in Pediatrics, authors in the UK discuss a case in a 15-year old boy associated with Pasteurella multocida bacteremia. I found it fascinating. The patient did well on antibiotics, especially considering that P. multocida bacteremia carries a 30% mortality rate.