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Clinical Infectious Diseases | 2012

Primary Amebic Meningoencephalitis Deaths Associated With Sinus Irrigation Using Contaminated Tap Water

Jonathan S. Yoder; Susanne Straif-Bourgeois; Sharon L. Roy; Thomas A. Moore; Govinda S. Visvesvara; Raoult Ratard; Vincent R. Hill; Jon D. Wilson; Andrea J. Linscott; Ron Crager; Natalia A. Kozak; Rama Sriram; Jothikumar Narayanan; Bonnie Mull; Amy M. Kahler; Chandra Schneeberger; Alexandre J. da Silva; Mahendra Poudel; Katherine Baumgarten; Lihua Xiao; Michael J. Beach

BACKGROUND Naegleria fowleri is a climate-sensitive, thermophilic ameba found in the environment, including warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In 2011, 2 adults died in Louisiana hospitals of infectious meningoencephalitis after brief illnesses. METHODS Clinical and environmental testing and case investigations were initiated to determine the cause of death and to identify the exposures. RESULTS Both patients had diagnoses of PAM. Their only reported water exposures were tap water used for household activities, including regular sinus irrigation with neti pots. Water samples, tap swab samples, and neti pots were collected from both households and tested; N. fowleri were identified in water samples from both homes. CONCLUSIONS These are the first reported PAM cases in the United States associated with the presence of N. fowleri in household plumbing served by treated municipal water supplies and the first reports of PAM potentially associated with the use of a nasal irrigation device. These cases occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Virginia. These infections introduce an additional consideration for physicians recommending nasal irrigation and demonstrate the importance of using appropriate water (distilled, boiled, filtered) for nasal irrigation. Furthermore, the changing epidemiology of PAM highlights the importance of raising awareness about this disease among physicians treating persons showing meningitislike symptoms.


Disaster Medicine and Public Health Preparedness | 2008

Chronic Disease and Related Conditions at Emergency Treatment Facilities in the New Orleans Area After Hurricane Katrina

Andrea J. Sharma; Edward C. Weiss; Stacy Young; Kevin U. Stephens; Raoult Ratard; Susanne Straif-Bourgeois; Theresa Sokol; Peter Vranken; Carol Rubin

BACKGROUND Disaster preparations usually focus on preventing injury and infectious disease. However, people with chronic disease and related conditions (CDRCs), including obstetric/gynecological conditions, may be vulnerable to disruptions caused by disasters. METHODS We used surveillance data collected after Hurricane Katrina to characterize the burden of visits for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency treatment facilities completed a standardized questionnaire for injury and illness surveillance from September 8 through October 22, 2005. RESULTS Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1% for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease (12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus 10.9% of those with non-CDRCs and 3.8% of those with injury. CONCLUSIONS Our data illustrate the importance of including CDRCs as a part of emergency response planning.


Emerging Infectious Diseases | 2014

Fungal endophthalmitis associated with compounded products.

Christina A. Mikosz; Rachel M. Smith; Moon Kim; Clara Tyson; Ellen H. Lee; Eleanor Adams; Susanne Straif-Bourgeois; Rick Sowadsky; Shannon Arroyo; Yoran Grant-Greene; Julie Duran; Yvonne Vasquez; Byron F. Robinson; Julie R. Harris; Shawn R. Lockhart; Thomas J. Török; Laurene Mascola; Benjamin J. Park

Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck’s Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.


American Journal of Public Health | 2007

Household water disinfection in Hurricane-affected communities of Louisiana: implications for disaster preparedness for the general public

Pavani K. Ram; Elizabeth Blanton; Debra Klinghoffer; Mary E. Platek; Janet Piper; Susanne Straif-Bourgeois; Matthew R. Bonner; Eric D. Mintz

OBJECTIVES Thousands of Louisiana residents were asked to boil water because of widespread disruptions in electricity and natural gas services after Hurricane Rita. We sought to assess awareness of boil water orders and familiarity with household water disinfection techniques other than boiling. METHODS We conducted a cross-sectional survey in randomly selected mobile home communities in Louisiana. RESULTS We interviewed 196 respondents from 8 communities, which had boil water orders instituted. Of 97 who were home while communities were still under orders to boil water, 30 (31%) were aware of the orders and, of those, 24 (80%) said the orders were active while they were living at home; of the 24, 10 (42%) reported boiling water. Overall, 163 (83%) respondents were aware of a method of water disinfection at the household level: boiling (78%), chlorination (27%), and filtration (25%); 87% had a container of chlorine bleach at home. CONCLUSIONS Few hurricane-affected respondents were aware of boil water orders and of alternate water disinfection techniques. Most had access to chlorine and could have practiced household chlorination if disruption in natural gas and electricity made boiling impossible.


Archive | 2005

Infectious Disease Epidemiology

Susanne Straif-Bourgeois; Raoult Ratard

The following chapter intends to give the reader an overview of the current field of applied infectious disease epidemiology. Prevention of disease by breaking the chain of transmission has traditionally been the main purpose of infectious disease epidemiology. While this goal remains the same, the picture of infectious diseases is changing. New pathogens are identified and already known disease agents are changing their behavior. The world population is aging; more people develop underlying disease conditions and are therefore more susceptible to certain infectious diseases or have long term sequelae after being infected.


The Journal of the Louisiana State Medical Society | 2005

Surveillance for West Nile virus cases in Louisiana 2001-2004.

Michaels; Balsamo Ga; Kukreja M; Anderson C; Susanne Straif-Bourgeois; Talati G; Raoult Ratard


The Journal of the Louisiana State Medical Society | 2007

Vibrio Infections in Louisiana: Twenty-Five Years of Surveillance 1980-2005

Annu Thomas; Susanne Straif-Bourgeois; Theresa Sokol; Raoult Ratard


The Journal of the Louisiana State Medical Society | 2006

Hurricane Katrina's impact on infectious disease surveillance.

Susanne Straif-Bourgeois; Theresa Sokol; Balsamo G; Hall S; Weed N; Krishna N; Thomas A; Michaels S; Islam Z; Raoult Ratard


The Journal of the Louisiana State Medical Society | 2005

Hepatitis C infection in Louisiana.

Theresa Sokol; Lewis Be; Susanne Straif-Bourgeois; Talati G; Raoult Ratard


The Ochsner journal | 2003

West Nile Epidemic in Louisiana in 2002

Gary Balsamo; Sarah Michaels; Theresa Sokol; Karen Lees; Mona Mehta; Susanne Straif-Bourgeois; Stacy Hall; Nevin Krishna; Gita Talati; Raoult Ratard

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Raoult Ratard

Louisiana Department of Health and Hospitals

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Theresa Sokol

Louisiana Department of Health and Hospitals

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Alexandre J. da Silva

Centers for Disease Control and Prevention

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Amy M. Kahler

Centers for Disease Control and Prevention

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Bonnie Mull

Centers for Disease Control and Prevention

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Chandra Schneeberger

Centers for Disease Control and Prevention

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Govinda S. Visvesvara

United States Department of Health and Human Services

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Jon D. Wilson

Louisiana State University

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Jonathan S. Yoder

Centers for Disease Control and Prevention

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