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This weeks Morbidity and Mortality Report describes the outbreak

of hemorrhagic gastroenteritis –from exposure to farm animals in display

barns at the North Carolina State Fair. This reinforces the danger of”Petting

Zoos” as a vehicle of transmission of E. coli.These animal petting “stations”

rarely have adequate handwashing facilities.AVOID.

Hello to everyone–Our first post of 2012.Check out a New York Times article of

December 27,2011 by Mark Bittman.Over the past several years multiple food borne

illness outbreaks have occurred involving a wide variety of foods –for example,

peanut butter, pot-pies, sprouts,ground turkey. Bittman’s article refers to a study

carried out in Phoenix Arizona.The research center studied 80 brands of ground

beef,pork,chicken and turkey.the findings are startling:

1.47% contained Staphylococcus aureus.

2. 52% were resistant to at least 3 classes of antibiotics

3.If you are buying pre-ground products there is at least a 25% chance that  you

may be consuming a drug resistant bacteria that may either immediately cause

disease or set up a colonization state and later a drug resistant infection.

Implications and thoughts regarding the above.

1.Never buy ground meat products that are not ground on site.

2.Always assume that vegetables , and meat products are contaminated with bacteria.

3.Practice good hand washing when dealing with the above and with decontamination \

of your work surface  and utensils.

4.The biggest factors driving this explosion of contaminated food are :

         a.Centralization of food processing into giant operations which supply

large portions of the country.

        b.Inappropriate use of antibiotics in Animal feed. 80% of the antibiotics

used in this country are used in animal feeds. A shocking and indefensible number.

Many researchers feel that the very high percentage of MRSA in

Mississippi can be traced in part to the very high utilization of  antibiotics in

the chicken industry.   Dr. Smith

A new study suggested that individuals experiencing an episode of shingles

were 3-4 times more likely to develop MS over the next several years. Another

reason to strongly consider obtaining Zostavax   Dr Smith

A huge new puzzling food borne epidemic involving of all things–cantaloupe.

We have seen Chicken pot pie and peanut related food epidemics in recent years.

Bean sprouts and different berries have also been informed in smaller outbreaks.

Listeria have usually been associated with cheese, and other food products.

Immune competent individuals usually have a mild illness.Pregnant individuals

and neonates as well as immune compromised individuals have the more serious

forms of illness and can develop blood poisoning and die.Call the center if you wish

us to send out a copy of CDC recent reports on the illness.

vaccine has an excellent track record as it is merely a more potent

version of the chicken pox vaccine used in millions of children. call us right away.

We hope to get more in very soon.   Dr .Smith

Business continues to be very brisk.The many different stories about travel risks

such as the resistant E.coli outbreak in Europe emphasize the importance of

education and risk minimimzation for foreign travel.The center is the only full service Travel  Travel Medicine  Clinic open 9-5 daily.Other advantages it offers:

1.Full information from CDC and WHO on any travel risks -updated daily by

nurse and physician

2.Yellow Fever Center.

3.On site physician at all times .Ability to write all needed prescriptions-not

usually available at Health Department Clinics.

4.Extremely nice facilities.

5.Parking lot very safe –unlikely to  be car-jacked while seeing the Travel

Medicine nurse.

6.24/7 availability of physician should any adverse reaction to immunizations

or problems on trip occur.Availability to se and evaluate individuals with post

trip problems.Not available at Health Department Clinics.

7.Physician founder with 30 years of experience in Travel Medicine

.Previously established 1 of first clinics in Midwest in Kansas City –still thriving

after 30 years.

The history of the recent severe tornado that struck Joplin Missouri on 5/22/11 is

well known. In the July 29,2011 MMWR–18 cases of a very unusual

severe skin infection -mucormycosis is described in Joplin residents. This

infection is usually seen only in Diabetics ,cancer patients or other

immunosuppressive conditions.13 confirmed cases ar described in the report.These

patients had all been injured in the tornado with an average of 4 wounds documented

in the ER medical charts.Medical management included surgical debridement

and removing of foreign body–wooden splinters were most common.2 of the

patients had Diabetes and none were considered immunocompromised. 10/13

required ICU admit and 5/13 (38%) died.The specific organism within the

order Mucormycete was Apophysomyces trapeziformis.This has been associated

with traumatic implantation of fungal spores.This is the first known cluster of this

fungal infection following a tornado.

In working up hundreds of consults

 since returning to Mississippi in 2002  I have

become aware of a poor but frequent medical practice widely used in

physician offices and ambulatory clinics. This is the combination of

an IM injection of an antibiotic  -usually Rocephin in high doses- 1 gram

combined with a potent steroid such as dexamethasone or Decadron.This is

spectacularly illogical and not to be found in any textbook or lecture or course. The

combination of a steroid and an antibiotic is rarely if ever indicated.

I.M. antibiotics are almost never indicated in ambulatory adults with the development of potent

well absorbed oral antibiotics.the only reasons for the use of an IM antibiotic

to an ID expert would seem to be the following:

      1.Nausea

      2.Some other reason that the GI tract cannot be used.

      3.An acute severe bacterial infection in which it is critical to get antibiotic

into the patient while they are being referred to a definitive treatment facility.

These situations are almost never seen in the charts  that I review.

There are many reasons not to use an I.M. antibiotic:

     1.They are more expensive –by an order of magnitude than oral agents.

     2.They are painful to administer.

     3.They may cause neuromuscular injury

     4.Because of the obesity of many of our patients–the drug may be injected into

fat deposits–perhaps causing fat necrosis.

It is my hope that :

1.I.M. antibiotics in office situations be restricted to the situations described above.

2.That if Rocephin is used a.Needle length be appropriate b.The dose be decreased

to 250 mg  a more appropriate dose.

3.That antibiotics never be combined with injectable steroids.There should

be no place in medicine for this as the only obvious purpose for the steroids is

to give the patient a “buzz”.

Hopefully payors will lead the way in producing the abandonment of this

most unfortunate and indefensible practice. Dr Smith

At the Center We continue to receive many communications regarding patients

and families with recurrent MRSA problems. Many are frustrated and the

experience with eradicating MRSA from a patient and a family has  been

difficult to impossible.Many of the questions to our Web site are from  a great

distance from Jackson. Thus, coming to see us may not be realistic. We have

developed a method to interact with patients and families who fall into this category.

I have dubbed this an Infectious Disease MRSA Advice Session. It is not a consult .

It can not be billed to your Medical Insurance carrier-though some of the things we tell you to do can be then ordered by your local physician. We have worked with hundreds

of families who have had MRSA problems with greater than a 95% success record.

The MRSA Advice session will be a direct 30 minute session with Dr. Smith initially via Telephone–Hopefully adding Skype and a visual component within 60 days.If you wish to

schedule such a session–you may contact us through the Web site via e-mail or

by calling the clinic. We will then send you a complete explanation as to how this

would work including all fees etc. No one in the country has more experience than

we do with proven MRSA eradication methods.    Dr Smith

The experimental antibiotic fidaxomicin won approval today from the FDA

Anti -Infective Drug Advisory committee for treatment of C. Difficile colitis.

This will almost certainly result in full approval by the FDA and subsequent

marketing of the drug for this condition.This will give us the second approved

drug to treat this very serious condition. Oral vancomycin is far too expensive and

suffers from a high relapse rate. I have had excellent results with Xifaxin(rifixamin)

dosed at 400-550 mg TID with no relapses. This regimen is about half the costs of

vancomycin. I no longer recommend or use Flagyl. It has never sought approval

and the response rate and relapse rate have dramatically decreased and increased

in recent years. Xifaxin has an ongoing study for C. diff which should definitley lead

to approval. The new drug fidaxomicin is a luminal antibiotic with minimal side

effects. It will be marketed under the name Dificid.    Dr S