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Man's bug bite led to flesh-eating bacteria infection

23 Oct 2018

Posted by John D. Stellberger

A scanning electron micrograph image of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. MRSA can be a cause of "flesh-eating" bacterial infections.
Credit: National Institute of Allergy and Infectious Diseases (NIAID)

What started as a simple bug bite on a young man's knee soon turned life-threatening when the itchy bump developed into an infection with "flesh-eating" bacteria, according to a new report of the case.

The 21-year-old man went to the emergency room after his right knee became swollen and painful, and he had trouble walking, according to the report, published in the November issue of the American Journal of Emergency Medicine. He told doctors that he had not injured his knee, but that he had gotten a bug bite there three days earlier.

"I was really surprised to see that this otherwise young and healthy guy could barely walk," said Dr. Jacqueline Paulis, an emergency-medicine physician at New York University School of Medicine, who treated the patient and is the lead author of the report. (Paulis treated the patient at a different New York City hospital before working at NYU.) 

A scanning electron micrograph image of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. MRSA can be a cause of "flesh-eating" bacterial infections.

What started as a simple bug bite on a young man's knee soon turned life-threatening when the itchy bump developed into an infection with "flesh-eating" bacteria, according to a new report of the case.

The 21-year-old man went to the emergency room after his right knee became swollen and painful, and he had trouble walking, according to the report, published in the November issue of the American Journal of Emergency Medicine. He told doctors that he had not injured his knee, but that he had gotten a bug bite there three days earlier.

"I was really surprised to see that this otherwise young and healthy guy could barely walk," said Dr. Jacqueline Paulis, an emergency-medicine physician at New York University School of Medicine, who treated the patient and is the lead author of the report. (Paulis treated the patient at a different New York City hospital before working at NYU.)

An exam revealed that he had a bump on his knee that was discharging pus, and tissue in the area had started to die, or become necrotic. He also could not move his knee joint, which "raises a lot of red flags for doctors that there's something deeper going on," such as an infection, Paulis told Live Science. The patient also felt sharp pains in his chest when breathing, and he started having flu-like symptoms a day before arriving in the ER.

An X-ray of his knee showed that there was air underneath his skin tissue, which can be a sign of a "flesh-eating" bacterial infection, known medically as necrotizing fasciitis. (Air gets under the tissues because some species of bacteria that cause necrotizing fasciitis produce gas.)

Necrotizing fasciitis is a rare but serious infection of the tissue just under the skin, as well as connective tissue, that spreads quickly in the body and can result in the loss of limbs and even death.

There are several types of bacteria that can cause necrotizing fasciitis, including group A Streptococcus (group A strep), Klebsiella, Clostridium, Escherichia coli and Staphylococcus aureus, according to the Centers for Disease Control and Prevention (CDC). Most commonly, people get necrotizing fasciitis when the bacteria enter the body through breaks in the skin, including cuts and scrapes, burns and surgical wounds, the CDC says.

But bacteria may also enter the body through insect bites. If a person scratches a bite hard enough, they can break open the skin, allowing bacteria to enter, Paulis said.

However, when this happens, "usually our bodies and immune systems are healthy enough to contain that and mitigate it," Paulis said. In very rare cases, necrotizing fasciitis can develop, but this is usually seen in people with other risk factors for the disease, such as older age, diabetes or kidney disease.

Paulis said she doesn't know why the patient developed necrotizing fasciitis when he had no other risks factors for it. "He was the epitome of health, 21 and young," Paulis said. It was also unclear what type of insect bit the man, the report said. But the man's blood and wound site tested positive for the bacteria methicillin-resistant Staphylococcus aureus (MRSA), which caused his infection.

Tests also revealed that the man's infection had caused him to develop yet another rare complication — a "septic" pulmonary embolism. This is a clot containing bacteria that travels from the site of the infection to the lungs, where it blocks blood flow and causes abscesses.

Paulis said one reason she decided to publish the case was to make doctors aware that the combination of skin and lung symptoms could indicate an infection along with a septic pulmonary embolism — a rare disease combination that she has seen only a few times in her career. "I think we should have it on our radars as emergency physicians," Paulis said.

The man was treated with intravenous antibiotics and surgery to remove dead tissue in his infected knee. He recovered fully and was able to leave the hospital after a few weeks, Paulis said.


Rats Suddenly Surge in Boston Suburbs

22 Oct 2018

Posted by John D. Stellberger

The suburbs have long beckoned certain city dwellers — recent college grads in search of cheaper rent, young families wanting more space — but another kind of urbanite is now discovering paradise among the green lawns and leafy streets beyond Boston.

And it’s not better schools they’re after.

We’re talking about rats. Long a scourge of densely populated cities like Boston, rats have suddenly scurried into the consciousness of Boston’s suburbanites. The loathed little beasts have infested neighborhoods, startled residents, and flummoxed local authorities charged with getting rid of them.

In Belmont, officials closed a popular children’s park twice in a recent five-month period because of rat infestations. In Peabody, rat problems are now a standing issue on the board of health’s monthly agenda.

“We’ve been visited,” confirms Reading Town Manager Bob LeLacheur Jr., who recently informed residents at a meeting of the town’s select board that money was no concern when it comes to battling a boom in the rat population. (And that was before one showed up on his driveway.)

Rich Cyr, lead technician from B & B Pest Control, baited rat traps (left) with peanut butter at a home in Marblehead and held a dead rat (right) found at a home in Lynn.Aram Boghosian for The Boston Globe

Just how bad has it gotten? Over the summer, the city of Waltham declared a public health emergency.

“We had reports of 25 to 30 rats playing in puddles,” the director of the board of health told the Waltham City Council in August. The council, apparently unnerved, quickly approved $15,000 to address the problem.

To be sure, Boston remains a rat capital; in one review of 2015 census data, the city ranked as the second most rat- and mouse-infested city in the United States.

But exploding rat populations in smaller cities and towns have confounded experts, who say it’s happening around the country and even the world.

Theories regarding the causes include the possibility that growing suburban populations, along with a corresponding growth in garbage dumpsters and other public receptacles, have provided an abundant source of food. Some have also speculated that smaller cities and towns, being both budget conscious and unaccustomed to rat infestations, may have skimped on eradication efforts in the past, allowing small problems to turn into much bigger ones.

Another worry on the minds of many experts, though, is climate. Increasingly mild winters could be allowing rats to reproduce more often, with devastating results. Rats have a gestation period of only a few weeks and litters that can number up to 14. Those baby rats are then ready to reproduce a little more than a month after birth.

“You take one pregnant rat and you come back in one year, and all of the descendants of that one pregnant rat will have become 15,000 to 18,000 rats,” says Bobby Corrigan, a scientist in urban rodentology who travels the world — including to Boston — to study the creatures.

Once established in a community, rodents can be tricky to get rid of, in part because it requires a concerted effort to cut off their supply of food and shelter.

“The problem with rats is you can have them in a neighborhood, and five people are doing their due diligence, and a couple bad seeds can delay the elimination process,” says John Bozarjian, owner of Lynn-based B&B Pest Control, which serves Greater Boston.

As complaints about rats in suburban towns have piled up, local officials have launched a number of efforts: facilitating inspections of residential properties, increasing dumpster inspections and trash pickups, and, in the case of Peabody, filming a 30-minute public-access program dedicated to rat prevention.

Rich Cyr found evidence of rat activity in a crawl space under a home in Marblehead.Aram Boghosian for The Boston Globe

For a while, the town of Belmont went so far as to enact a “carry in, carry out” strategy at town parks, in which trash barrels were removed and guests required to carry out any trash they’d brought with them.

In Newton, the occasional rat sighting is nothing new, says Deborah Youngblood, commissioner of health and human services for the city. But after a run of complaints in recent months, the city has put on a full-court press in rat prevention.

Officials this summer began handing out a rat-related brochure to everyone stopping by town hall to pick up building permits, and a letter will soon go out to local restaurants detailing ways to discourage rats. The town has also launched a Web page dedicated exclusively to rats, where residents can report sightings and find basic information on preventative measures.

Rich Cyr entered a crawl space to place rat traps at a home in Marblehead.Aram Boghosian for The Boston Globe

I’ve definitely never talked about rats more,” says Youngblood.

In truth, says John D. Stellberger — president/entomologist of EHS Pest Services — mice probably pose a more significant health risk to humans, as, unlike rats, they often occupy homes or offices, scurrying across counter tops or feasting on desk crumbs.

But many people, he points out, can live with the occasional sight of a mouse.

Rats, on the other hand?

“There’s zero tolerance,” Stellberger says.

The good news is that, in at least some cases, the measures cities and towns are taking seem to be having an impact.

After twice closing Joey’s Park, the town of Belmont has instituted monthly checks of all its parks and keeps a pest control company on call for any issues that might arise.

“What we’re doing right now is working,” says Jay Marcotte, Belmont’s public works director. “Knock on wood.”

The bad news is that, while rat populations can be controlled with serious effort, the reality is rats are here to stay.

As Bozarjian put it, “There have been three mammals that have been surviving since the dawn of time: humans, mice, and rats.

“And they’re gonna be here till the end of time.”

To get rid of rats and rodents safely, contact EHS Pest.

Man dies of rare brain disorder after eating squirrel brains

16 Oct 2018

Posted by John D. Stellberger

EHS Pest Control, MA, RI

A man in New York developed an extremely rare and fatal brain disorder after he ate squirrel brains, according to a new report of the man's case.

In 2015, the 61-year-old man was brought to a hospital in Rochester, New York, after experiencing a decline in his thinking abilities and losing touch with reality, the report said. The man had also lost the ability to walk on his own.

An MRI of the man's head revealed a striking finding: The brain scan looked similar to those seen in people with variant Creutzfeldt-Jakob disease (vCJD), a fatal brain condition caused by infectious proteins called prions. Only a few hundred cases of vCJD have ever been reported, and most were tied to consumption of contaminated beef in the United Kingdom in the 1980s and 1990s. (In cows, vCJD is commonly called "mad cow disease.")

But in this case, the man had another dietary habit that could have raised his risk for vCJD: His family said he liked to hunt, and it was reported that he had eaten squirrel brains, said Dr. Tara Chen, a medical resident at Rochester Regional Health and lead author of the report. It's unclear if the man consumed the entire squirrel brain or just squirrel meat that was contaminated with parts of squirrel brain, Chen said. [27 Oddest Medical Cases]

Chen didn't treat the patient, but she uncovered the case while writing a report on suspected Creutzfeldt-Jakob disease cases seen at her hospital in the last five years.

The report was presented on Oct. 4 at IDWeek, a meeting of several organizations focused on infectious diseases.

A rare brain disorder

Creutzfeldt-Jakob disease (CJD) is a progressive neurological disorder that affects only about 1 in a million people each year worldwide, according to the National Institutes of Health (NIH). It's a "debilitating disease" that progresses quickly and usually results in death within one year of diagnosis, Chen told Live Science. There is no treatment or cure.

The disease results from prion proteins that fold abnormally, leading to lesions in the brain.

There are three forms of Creutzfeldt-Jakob disease (CJD): one that is inherited, one that comes from exposure to infected tissue from the brain or nervous system (this form includes vCJD), and one type that is "sporadic" and does not appear to have a genetic or environmental cause.

The sporadic type is the most common, responsible for 85 percent of cases, according to the NIH.

Because CJD is so rare, doctors at Rochester Regional Health were surprised when four suspected cases of the disease occurred at the hospital within a six-month period, from November of 2017 to April of 2018. That number is higher than expected based on the population of the Rochester area, which has about 1 million people, said study co-author Dr. John Hanna, also a medical resident at Rochester Regional Health.

This high number of suspected CJD cases prompted Chen, Hanna and colleagues to conduct a review of suspected CJD cases occurring at their hospital from 2013 to 2018. (Five cases were identified, but two of those five ultimately tested negative for CJD.)

That's when the doctors came across the case tied to squirrel brains. Tests indicated that this was a "probable" case of vCJD because of the MRI finding and a test that showed specific proteins in the patient's cerebrospinal fluid, which often indicate the disease.

However, CJD can be confirmed only with a test of brain tissue on autopsy at death. Although the patient passed away after his diagnosis, Chen and colleagues are working to obtain access to his medical records to see if CJD was confirmed at autopsy. If so, such a confirmation would be highly unusual; only four confirmed cases of vCJD have ever been reported in the United States, according to the Centers for Disease Control and Prevention.

The review of the five cases revealed a concerning finding: Diagnosis of the condition was often delayed; in one case, about two weeks passed before doctors suspected that a patient had CJD. In that case, the patient, a 65-year-old woman, had undergone plasmapheresis, a blood-filtering procedure, and a gynecological surgery before her diagnosis.

Quick diagnosis of CJD is important, because infectious prions could contaminate equipment used on patients with the disease, and this might transmit the condition to others if the equipment is not properly cleaned.

Diagnosis may be delayed, in part, because CJD is rare and is not "on the tip of the physician's mind" when assessing a patient, Hanna told Live Science. In addition, once doctors suspect CJD and order a cerebrospinal fluid test, it typically takes around two weeks to get the test results.

The report highlights the need for doctors to keep CJD diagnosis in mind and for hospitals to have "policies for infection control when it comes to CJD," Hanna said.

For squirrel control, contact EHS Pest.

Source: Live Science

Southern CA Dealing with New Breed of Mosquito and They're on the Move

10 Oct 2018

Posted by John D. Stellberger

They’re tiny. They’re hungry. And they’re invading the city.

An invasive mosquito species called the Aedes is spreading at an alarming rate throughout Southern California, causing concern over possible disease outbreaks in the near future.

Known as the “ankle biter,” the Aedes has been making its home in Southern California over the last several years.

In Long Beach, the non-native species was first detected last year in the northwest corner of the city. This season they’re everywhere.

“They’ve colonized all the ZIP codes,” said Lamar Rush, a supervisor for the Long Beach Health Department’s Vector Control Program. “It started with a few calls last year, and this year it’s just exploded.”

Los Angeles County so far has seen two types of Aedes: the Asian Tiger Mosquito, native to Southeast Asia, and the Yellow Fever Mosquito, native to Africa. Both are found throughout the world.

And they’re troubling for many reasons.

While the region’s native Culex mosquito mainly feeds on birds, the Aedes prefers people, making them particularly aggressive.

They usually bite around the legs and ankles and feed during the day, whereas the Culex is nocturnal.

“They’re tiny so most people don’t even notice them until it’s too late,” Rush said. “Their bites are very itchy.”

There’s also the breeding habits.

The Cluex prefers to lay her eggs in clustered rafts on standing water. If you dump out the water, the eggs will dry up and die.

The Aedes attaches her eggs to a wall and covers them with a protective seal. If the water source dries up, the eggs can survive for years until they’re reactivated.

She only needs a tiny amount of space and water.

Office plants, flowerpots or even a discarded bottle cap with sprinkler water will do, said Susanne Kluh, the scientific and technical services director for the Greater Los Angeles County Vector Control District, which oversees mosquito abatement in East Long Beach.

“We can’t even begin to describe what kind of a problem this poses,” she said.

Kluh said the problem began about two years ago and has been getting “exponentially worse.” In 2014, they would trap about five Aedes mosquitos a week in the county. Now they’re logging around 40 a night.

The county hotline to report mosquito bites is receiving about 1,400 calls each month, compared to around 150 calls in previous years, she added.

“The only good news is that they haven’t currently transmitted any diseases and they don’t fly very far,” Kluh said.

But if the problem persists, she said, Southern California could have an outbreak of diseases never before seen in the region.

The Aedes can transmit Dengue fever, Zika and yellow fever, while the Culex can only carry West Nile virus. The area will get some relief when breeding season ends this month, but Kluh said she’s expecting another record mosquito season next year.

“I’m afraid I don’t have much hope that it’s going to be any better,” she said.

Here are tips to prevent mosquito breeding around the home:

  • Empty any containers filled with water in and around the home.
  • Clean and scrub bird baths and pet water bowls at least once a week.
  • Dump water from potted plant saucers.
  • Clean and chlorinate swimming pools, and drain water from pool covers.
  • Limit the watering of lawns and outdoor plants.

For effective mosquito control, contact EHS Pest.

North Carolina Car Infested with Ants

09 Oct 2018

Posted by John D. Stellberger

A North Carolina family returned from a three-day trip to find the car they had parked at Charlotte Douglas International Airport had been broken into. Not by crooks, but by hundreds, maybe even thousands of ants. 

Caroline Tedder Hacker wrote on the airport’s Facebook page that they were in the engine compartment and all over the cabin. On the two-hour drive home to Greensboro, some were crawling on her 11-year-old.

Hacker told WCNC that they found a colony that had been built under the hood near the windshield.

The airport confirmed that similar incidents have happened in the past, and said that it regularly treats the area, but that it is a sporadic issue in the parking lot, which is next to a wet, grassy space where ants sometimes surface due to the weather and time of year.

“It just made me really irritated, because it’s happened to other people, just feels like it shouldn’t have happened, if it happened to other people,” Hacker told WCNC. Watch out for anthills where you park, keep your car clear of any food or crumbs and get it washed thoroughly to help prevent this type of infestation.

The airport has agreed to pay for the $200 cleaning charge the Hackers incurred, and also waive the parking fee.

The family has not said if they will be pursuing further compensation.

Looking for an effective ant colony removal, contact EHS Pest.

Typhus reaches 'epidemic levels' in parts of Los Angeles area

08 Oct 2018

Posted by John D. Stellberger

LOS ANGELES — Health officials on Friday reported a typhus outbreak in Los Angeles County and say it has reached "epidemic levels" in the city of Pasadena.

Twenty cases have been reported in Pasadena, mostly in the last two months, health officials told NBC News, noting that a normal year would typically only see five infections. The city of Long Beach, California, has 12 cases so far in 2018 — double the normal annual number, said Emily Holman, the city's infectious disease response coordinator.

The number of cases in the rest of the county since July is nine, which counts as an "outbreak," Los Angeles County Department of Public Health officials said in a statement. Pasadena and Long Beach have their own health departments even though they exist within the county.

“The Pasadena Public Health Department is reporting epidemic levels of typhus fever this year," read a statement from that city on Friday.

The official source of the outbreak is said to be fleas from domestic and wild animals.

"Infection happens when the feces from infected fleas are rubbed into cuts or scrapes in the skin or rubbed into the eyes," the county health department states on its website.

Some experts, however, say the true culprit is the inhumane conditions the county's expanding homeless population lives in.

"All of the cases have a history of living or working in the downtown Los Angeles area," a county health spokeswoman said via email.

Andy Bales, the CEO of the Union Rescue Mission, which has nearly 1,400 beds for those fleeing or avoiding downtown's Dickensian streets, said, "The conditions on Skid Row are ripe for even more serious issues than this."

In 2014, Bales had a leg amputated after he was exposed to flesh-eating bacteria downtown.

The office of Mayor Eric Garcetti said it is on the case.

"We're deploying every available resource to help control and stop this outbreak," mayoral spokesman Alex Comisar said via email. "The City and County have formed a dedicated task force through our Unified Homelessness Response Center to keep Angelenos safe, and ensure everyone gets the treatment they need as quickly as possible."

EHS Pest - Dog Flea

Typhus or typhus fever is a flea-borne infectious disease that can cause high fever, headache, chills, and body aches, rashes and in rare cases, meningitis and death. (It is not the same as typhoid fever, which is caused by a different kind of bacteria and is usually spread by consuming contaminated food and water.)

Health officials in Pasadena are blaming the outbreak on a warm summer and fall and human interaction with animals in neighborhoods that have an "interface" with wildlife in canyons and the Angeles National Forest. They say the disease has nothing to do with homelessness in their high-income city.

The Los Angeles County Department of Public Health spokeswoman said via email that officials are investigating the source of the typhus in downtown L.A. by searching specifically for "high concentrations of infected fleas and/or infected rats, feral cats and opossums."

Bales noted, "There are lots of rats on Skid Row, and there are lots of dogs that belong to homeless people."

In September the nonprofit research organization Economic Roundtable released an analysis that concluded the county has 102,955 homeless people — nearly double what government officials had previously reported.

"The numbers on the sidewalk have increased dramatically," said Alice Callaghan, founder of the Skid Row services organization Las Familias del Pueblo. "They're like refugee camps."

Contact EHS Pest to find out more about typhus fever and how to combat fleas in your home.

Exotic East Asian Longhorned Tick Bites First Human in Connecticut: Officials

03 Oct 2018

Posted by John D. Stellberger

The first evidence of human biting by the exotic east Asian longhorned tick has been reported, according to the Tick Testing Laboratory at the Connecticut Agricultural Experiment Station.

Officials said the resident who was bit lives in Fairfield County.

The longhorned tick is an invasive species that was initially discovered on a farm in New Jersey in 2017 and has since been found in eight other states, including Connecticut. It was most recently detected in Connecticut in July of 2018, officials said.

The newly discovered tick feeds on a wide variety of mammals including humans, but it is unclear how often, according to researchers.

Longhorned ticks have been found to carry several human pathogens in Asia, but officials said it is unclear if this tick will be capable of transmitting pathogens such as the ones that cause things like Lyme disease, Babesiosis, Anaplasmosis or Powassan virus.

"The identification of an Asian longhorned tick feeding on a state resident underscores the importance of our tick-testing program in helping to corroborate the capacity of this tick to bite humans outside of its native range. Going forward, it will be imperative to more fully assess the risk associated with this tick and its capacity to transmit local disease-causing pathogens," said Dr. Theodore Andreadis, the Director of the Connecticut Agricultural Experiment Station.

The Tick Testing Laboratory at the Connecticut Agricultural Experiment Station tests nearly 4,000 ticks for three human disease causing agents annually.

Contact EHS Pest to find out more about ticks and how to safely get rid of them.


Common Pests That Invade Homes in the Fall

01 Oct 2018

Posted by John D. Stellberger

EHS Pest Rodent Expert, MA, RI

When summer ends, some homeowners lower their guard regarding bugs, pests and other pests. Mosquitos and flies are less common, so we forget about the others. Some pests do go away as the cooler weather sets in, but Fall is still a season that allows pests to thrive and causes others to find refuge, food and shelter in your home.

Below are list of pests that can become a nuisance during Fall:

  • Rodents - Mice and rats are common fall home intruders because they need warmth and food to survive in cold temperatures. These rodents pose concerns because they carry diseases, chew on electrical cables, and ruin insulation. If you suspect mice or rat infestation in your home, contact professional pest experts right away.
  • Bed Bugs - Bedbugs can be prevalent especially during holidays when people are traveling for family gatherings. These hitchhikers can quickly latch on your suitcases, clothing and accessories. Bed bug bites cause unpleasant itchy blisters or patches that will take months to fade. To reduce the risk of taking home these pesky pests, first inspect hotel mattresses and keep your luggage off the carpeted floors. After travel, wash everything with hot water. Bedbugs are not easy to control, seek the help of a pest professional if you suspect a bedbug infestation in your home.
  • Ants - An ant infestation is also common during this season. Ants can cause food contamination and carpenter ants can damage your home. It is important to seal all holes and cracks in the foundation to prevent ants from entering. Make sure to keep food in airtight containers and don't store fire wood near the house.
  • Cockroaches - Roaches tend to survive during cold weathers and love to inhabit unsanitary places. Make sure you keep kitchen and bathrooms clean to prevent them from coming through pipes and drains.

Sanitation plays a major role in keeping these insects and rodents at bay. Keep your home clean and contact EHS Pest for preventative exterminator services.

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