Monthly Archives: July 2016

Do You Know That Illness May Lurk in Blood Supply

An uncommon, but potentially fatal, tick-borne illness may be creeping into the U.S. blood supply and doctors need to develop a way to spot it, researchers report.

Babesiosis is a parasitic infection that is transmitted through a tick bite or during a blood transfusion. Symptoms range from mild flu-like symptoms to severe difficulty with breathing, organ damage and death. People with compromised immune systems are most at risk for fatal babesiosis infection.

The first tick-borne case of babesiosis was documented in Massachusetts in 1969, and the first known transfusion-related infection occurred in 1979. Since then, there have been 159 transfusion-associated babesiosis cases reported in the United States, according to a study published in the Sept. 6 issue of the Annals of Internal Medicine.

There is no approved screening test for blood donors, and many people have no symptoms so they don’t even realize they are infected when they donate blood.

Study author Dr. Barbara Herwaldt, a medical epidemiologist at U.S. Centers for Disease Control and Prevention, called the threat “uncommon, but important.”

Transfusion-related cases know no boundaries. “Most tick-borne cases of babesiosis occur during the warm months and have only been seen within seven states in Northeast and Midwest,” she said. “Transfusion-related infection can occur in all four seasons and, in theory, could occur anywhere,” she said. “Blood donors travel and blood components are shipped across state lines.”

The U.S. Food and Drug Administration is currently working on ways to keep babesia out of the blood supply, but until that occurs doctors must put babesiosis on their radar screen, particularly if someone has unexplained fever or a certain type of anemia known as hemolytic anemia (low red blood cell count). These are the blood cells where the parasite takes up residence during babesiosis infection.

“Consider the diagnosis and then order the appropriate test,” Herwaldt said. Diagnosis involves looking at droplets of blood under a microscope. “Babesiosis is treatable with antibiotics that are commonly and readily available.”

“Babesia infection is on the rise and is potentially fatal, especially for immune-compromised and older people,” said Philip Tierno, director of clinical microbiology and immunology at New York University Langone Medical Center in New York City. “This is an important consideration in terms of testing on blood supply.”

Time is of the essence, he said. The best option right now is for blood banks to look at a droplet of a donor’s blood under a microscope. They may not be able to tell what is tainting the blood, but they will know it is tainted, he explained.

“They would be able to tell that the red cells may be parasitized by something, and that the blood needs to be further checked in microbiology lab,” he said. “This is the best option right now in light of increase in numbers of cases.”

Babesiosis in the U.S. blood supply “is something to be reckoned with, and by the time that anyone develops a test that is simple enough to be used by blood banks, it will be too late,” he said. Excluding people with a history of babesiosis infection from the blood donor pool won’t work because most people don’t know they have it.

People who are receiving blood transfusions may be especially vulnerable to babesiosis, he said.

Prevention also has a role in keeping infection out of the blood supply in the first place, he said. “Keep away from ticks,” Tierno said. “The same ticks that can give you Lyme disease and other types of tick-borne illness can give you babesiosis.”

When you go outdoors during tick season, wear protective clothing and use an insect repellent, he added.

What is the benefit of drink apple juice

Mehmet Oz, MD, the Columbia University thoracic surgeon who gained fame first in books and more recently with his syndicated television show, has run afoul of the Food and Drug Administration with his report about levels of arsenic in popular brands of apple juice.

The FDA called the report “irresponsible and misleading” and another TV doc, ABC’s Richard Besser, MD, accused Oz of fear-mongering.

In a recent episode of The Dr. Oz Show, Oz reported that five brands of apple juice — Minute Maid, Apple & Eve, Mott’s, Juicy Juice, and Gerber — all contained some level of arsenic and suggested that this was a cause for concern.

The show used an independent laboratory, EMSL Analytical, to test dozens of samples from three U.S. cities to compare the level of arsenic in the juices to the Environmental Protection Agency’s safe standard for drinking water, less than 10 parts per billion.

At least one sample for four of the five brands — excluding Minute Maid — came in above that threshold. The highest level measured was in Gerber apple juice, at 36 ppb.

The segment earned a stiff rebuke from representatives of government, industry, and academia for causing unnecessary alarm, even before it aired.

The criticism centered primarily on Oz’s testing methods, which provided a level of total arsenic in the juices. The results do not provide a breakdown of the levels of the two forms of arsenic — organic and inorganic.

In heated confrontation aired on ABC’s Good Morning America, Besser not only blasted reporting of only the total arsenic numbers but also charged that relying on a single lab to test for arsenic fell far short of scientific standards. Oz, however, refused to back down and maintained that he acted responsibly.

According to the FDA, arsenic is found in the environment in both forms, either as a result of natural processes or the result of contamination from human activities. In the U.S., some pesticides used up until 1970 contained arsenic.

The organic form of arsenic is “essentially harmless,” according to the FDA. The inorganic form can cause problems at high levels or with a long period of exposure.

In a letter sent to The Dr. Oz Show before the segment aired, Don Zink, PhD, senior science adviser in the FDA’s Center for Food Safety and Applied Nutrition, wrote, “The FDA believes that it would be irresponsible and misleading for The Dr. Oz Show to suggest that apple juice contains unsafe amounts of arsenic based solely on tests for total arsenic.”

The FDA said it has been testing for arsenic in apple juice for several years. The juice is first screened with a test for total arsenic because it is rapid, accurate, and cost-effective, according to Zink. Only when the total level of arsenic is greater than 23 ppb does the agency employ the more complex inorganic arsenic test.

“The vast majority of samples we have tested for total arsenic have less than 23 ppb,” Zink noted.

In a second letter to the show, Zink informed the producers that the FDA had performed its own testing on samples of apple juice from the same lot that yielded the highest level of arsenic in Dr. Oz’s investigation. All of the results ranged from 2 ppb to 6 ppb.

“In short,” Zink wrote, “the results of the tests cited above do not indicate that apple juice contains unsafe amounts of arsenic.”

In an email to ABC News and MedPage Today, Aaron Barchowsky, PhD, a professor in the department of environmental and occupational health at the University of Pittsburgh, said that he agrees with the FDA’s conclusion.

“It is the inorganic form of arsenic in the environment that is toxic, and measuring total arsenic is not informative,” he wrote. “I support the comments by the FDA and agree that the Oz show analysis is incomplete and probably misleading.”

On its website, the FDA said that it has a standard for an unsafe level of arsenic in water but not in apple juice for two main reasons — the consumption of water is much greater and most of the arsenic in water is the unsafe inorganic form, whereas in fruit juice, most of the arsenic is the organic form.

Henry Miller, MD, a fellow at the Hoover Institution at Stanford University and formerly the founding director of the FDA’s Office of Biotechnology, criticized Oz for failing to provide evidence that the levels of arsenic found in the apple juice were dangerous.

Things that you should now before tattoo

An investigation into skin lesions that two people developed after getting tattoos has concluded that both were infected with a bacteria not previously linked to the practice.

The infections involved Mycobacterium haemophilum, which usually only strikes individuals whose immune system are compromised. In this instance, however, the patients, both from Seattle, developed rashing despite the fact that both had normal immune systems, a report on the investigation found.

“Two people developed chronic skin infections after receiving tattoos at the same parlor,” explained study lead author Dr. Meagan K. Kay from the U.S. Centers for Disease Control and Prevention. “The patrons were thought to have been exposed through use of tap water during rinsing and diluting of inks.”

Kay, an epidemic intelligence service officer with the CDC, and her team report their findings in the September issue of the CDC’s journal Emerging Infectious Diseases.

The authors pointed out that tattooing is not considered a sterile procedure, is not regulated at the federal level and can be risky. And while the specific inks and colorings (pigments) commonly used to apply tattoos are regulated by the U.S. Food and Drug Administration, the rules usually apply only when cosmetics or color additives are involved.

The latest concern about associated infection risk arose in 2009 when a 44-year-old man and a 35-year-old man sought care for skin infections that had developed at the site of tattoos acquired at a facility in the Seattle region.

Lesion cultures and lab testing revealed that M. haemophilum was the culprit in the case of the first patient. Skin evaluations and patient interviews led the researchers to conclude that the second man most probably also suffered from the same sort of bacterial infection, although they technically classified his situation as a “suspected case.”

A follow-up investigation of the tattoo parlor revealed that municipal water had been used to dilute the ink during the tattooing process.

Water is considered to be a source for M. haemophilum. And though the facility was cleared of any safety violations, and no M. haemophilum bacteria was found in analyzed water samples, the tattoo operators were told to use sterile water for all future tattoo applications.

“It is important to remember that tattooing is not a sterile procedure and infections can occur after tattoo receipt,” Kay said. “Measures should be taken by tattoo artists to prevent infections, including proper training, use of sterile equipment, and maintaining a clean facility. Use of tap water during any part of the tattoo procedure should be avoided,” she explained.