Fwd: [graffis-l] NEW, VERY DANGEROUS BUG FROM IRAQ AND AFGHANISTAN... NOW HERE!

[Guest guest]

>Acinetobacter baumannii in Iraq, Afghanistan and here

>Posted by: " Mark Graffis " mgraffis mgraffis

>Sun Mar 2, 2008 7:06 pm (PST)

>Excellent article, just the sort of thing I like going to the list.

>has a history of strange behavior. I'll forward it

>

>-

>V.

>Mark Graffis

>Sunday, March 02, 2008 10:16 PM

>Failing posts . . .

>

>Hi Mark,

>

>I sent this to your List a little over a week ago and it never posted. I

>tried posting again about a little while ago, and it didn't post either.

>If you'd just rather I didn't, no prob. OTOH, maybe you'd want to know

>they're not posting. If you want, I'll try them again later.

>

>Peace,

>V.

>

>Fri, 22 Feb 2008 19:31:19 -0500

>graffis-l

> " V. " <veedot

>Acinetobacter baumannii in Iraq, Afghanistan and here . . .

>

>Acinetobacter baumannii in Iraq

>Coming to a hospital near you

>

>Multiple and Extremely Drug Resistant

>Acinetobacter baumannii

>

>To report cases or check the list of infected civilian hospitals please

>click here

>http://leishmaniasis.us/Mapping.html

>

>http://www.acinetobacterbaumannii.org/

>~~~

>

>Insurgents in the Bloodstream

>Proceedings | Capt. Chas Henry (Ret.) | February 22, 2008

>

> " It's why I lost my leg, so it sucks. "

>

>The assessment, from a 22-year-old Marine toughing out physical therapy on

>two prosthetic limbs, is laconic, matter-of-fact. Sgt. David Emery lost

>one leg in February 2007 when a suicide bomber assaulted the checkpoint

>near Haditha, Iraq, where he and fellow Marines stood guard. Military

>surgeons were forced to remove his remaining leg when it became infected

>with acinetobacter baumannii-a strain of highly resistant bacteria that

>since U.S. forces began fighting in Iraq and Afghanistan has threatened

>the lives, limbs, and organs of hundreds wounded in combat.

>

> " They could have saved it, " says Emery. " They had a rod in it, but then

>the bacteria was in too bad and my white blood cell count was up to

>89,000-and they told my mom on a Friday that they had to take it. "

>

>Emery's mother recalls that the hazard was not confined to her son's limbs.

>

> " He ended up getting it in his stomach, " says Connie Emery, " and they

>tried to close his stomach back up, but when they did, the stitches ended

>up pulling away because the infection was taking over. "

>

>An Army infectious disease physician says the germ has spread rapidly

>since the wars in Afghanistan and Iraq began. " Prior to the war, we were

>seeing one to two cases of acinetobacter infection per year, " remembers

>Lt. Col. Kimberly Moran, deputy director for tropical public health at the

>Uniformed Services University of the Health Sciences in Bethesda, Maryland.

>

> " Now that's much different. We've had hundreds of positive cultures over

>the last four years. "

>

>And the toll has been serious, observes Army Col. Glenn Wortmann, acting

>chief of infectious disease at Walter Reed Army Medical Center in

>Washington, D.C. " Of the infectious disease problems that have come out of

>the conflict, " notes Dr. Wortmann, " it is the most important complication

>we've seen. "

>

>Most striking about the problem is that men and women wounded in combat

>have acquired the bacteria in the very hospitals where aggressive surgery

>has, in many cases, saved their lives. " The outbreak, " acknowledges a

>Defense Department fact sheet, " appears to have started during the care of

>patients (both U.S. military and non-U.S.) in the combat support hospitals

>of Iraq and Afghanistan. "

>

> " They go to what's called 'far forward' surgical outfits where the main

>concern is keeping them alive, " explains Dr. Rox Anderson of Harvard

>Medical School, " and in the process there's not a hundred percent of the

>[anti-contamination] controls. Despite a great effort by the military

>medical people, there's a high risk of infection anyway. "

>

>Once established at frontline surgical sites, the bacteria began

> " traveling with patients or on patients, " says Dr. Moran, " from Iraq all

>the way back to Walter Reed, with stops along the way through the

>evacuation chain and getting into our hospitals. " There, she adds, " it was

>spread from patient to patient through various means, just being on

>surfaces and having one person come in a room after another person has left. "

>

>Most evidence of the bacteria has been confirmed at military hospitals in

>Germany, the Washington, D.C., area, and Texas -- though cases have also

>been confirmed on board the hospital ship USNS Comfort and at Tripler Army

>Medical Center in Hawaii.

>

>(As Proceedings went to press, the Baltimore Sun reported an outbreak of

>acinetobacter baumannii infections at the University of Maryland Medical

>Center.)

>

>The persistence of the outbreak has pushed it to momentous proportions. " I

>believe this is the largest in-hospital acinetobacter outbreak in

>history, " asserts Dr. Timothy Endy, a retired Army colonel now teaching

>infectious disease medicine at the State University of New York, Upstate

>Medical University. Endy battled the bacteria while attending to patients

>at Walter Reed.

>

>Researchers say they don't know exactly how acinetobacter baumannii first

>made its way into frontline treatment facilities. Early suspicions pointed

>to the possibility that the germs, mixed with soil, were blown deep into

>penetrating wounds. Some physicians speculated that bacteria residing in

>the combat zone had settled onto the skin of service members-lying dormant

>until open wounds allowed the bugs to create havoc. Small-sample testing,

>however, has indicated little or no evidence of problem-causing

>acinetobacter in Iraqi soil. And the only Iraq or Afghanistan veterans so

>far showing signs of acinetobacter colonization on their skin are those

>who have spent time in casualty treatment centers.

>

>Moreover, say scientists, nothing in the character of the outbreak would

>indicate that it originated as a result of intentional biological attack.

>

>The bug's dangerous effects were first noticed just weeks into the March

>2003 assault on Iraq. During April of that year, then-Lt. Cdr. Kyle

>Petersen, a Navy physician treating battle casualties on board the

>Comfort, observed a number of not-easily-explained patient deaths. He

>contacted fellow infectious disease specialists via online message boards,

>describing his American and Iraqi patients' symptoms-and, when they were

>eventually available, their lab results. The interaction helped rapidly

>identify the problem and initiated testing of frontline medical facilities.

>

> " There were bacteria, " recalls Moran, " acinetobacter bacteria, on hospital

>surfaces like in operating rooms, on ventilator machines, or on light

>surfaces or environmental control units. "

>

>At first glance, acinetobacter baumannii does not seem particularly

>fiendish. It is neither intensely virulent nor remarkably energetic. Its

>name, in fact, derives from the Greek word akinetos, meaning " unable to

>move. " But, as hundreds of those wounded in combat have learned, it

>exhibits one particularly troubling genius. Noteworthy even among

>better-known, more-feared microorganisms, it is able to steal resistance

>capabilities from other bacteria with which it comes into contact.

>

>In addition to agonizing over what treatment to use, physicians worry

>about when they should bring medications to bear. This is particularly

>difficult since tests to prove infection take days. So a doctor may have

>to wait up to 72 hours to learn if bacteria have colonized on a patient's

>skin or, more dangerously, insinuated themselves into a wound.

>

> " Is my patient infected, or just colonized? " asks Petersen, recalling the

>dilemma faced when suspecting that acinetobacter is threatening a patient.

> " If [the person's skin] is colonized and I over-treat him, I could damage

>his kidneys. If he's infected, and I ignore that and say he's colonized,

>he could die. "

>

> " The infection, if it goes on, " notes Anderson, " sometimes will lead to

>amputation, so these are tough choices. "

>

>Defense Department records-provided in response to a December 2007 query

>from Proceedings-indicate that from March 2003 to March 2005 acinetobacter

>infections attacked more than 250 patients at U.S. military healthcare

>facilities. As of June 2006, the same documents say, seven deaths had been

>linked to acinetobacter-related complications. The records did not contain

>figures for the bacteria's impact during the remainder of 2006 and 2007.

>

>While the majority of those fighting acinetobacter infection in military

>hospitals have been deployed to Iraq or Afghanistan, up to a third have

>not -- infants and the elderly among those apparently acquiring the

>bacteria in armed forces healthcare centers.

>

>Those hit hardest are typically the weakest of the weak. In the case of

>men and women hurt on the battlefield, observes Anderson, those with

> " complex wounds, combination of burns, blast injury, and lacerations. "

>

>Of the seven people the Defense Department acknowledges to have died

>because of acinetobacter-related complications, five were non-active duty

>patients being treated in the same hospital as infected service

>members-patients already weakened by such problems as organ failure,

>immune system deficiency, or multiple traumatic wounds.

>

>Two key issues seem behind the persistence of the outbreak. A number of

>infectious disease specialists point to difficulties in completely ridding

>hospital environments of acinetobacter. Doing so, they say, requires more

>stringent cleaning than that typically sufficient to kill other bacteria.

>Additionally, several express concern that policies on antibiotic use

>differ at commands and hospitals along the casualty evacuation chain.

>

>Sometimes trying to err on the side of caution, doctors on the frontline

>prescribe wide-spectrum antibiotics prior to determining if a patient is

>actually carrying acinetobacter. In the long term, this has created problems.

>

> " I think antibiotic use is probably driving some of this, " suggests

>Petersen of the Comfort, " because when you keep people on prolonged

>antibiotics unnecessarily, it lets them be colonized with worse and worse

>bacteria. "

>

>In 2006, doctors at Walter Reed began successfully curbing acinetobacter

>infections using an antibiotic called imipenem. Soon thereafter, Endy

>recalls, frontline surgeons began using imipenem as a prophylactic

>antibiotic-infusing it into injured service members even when it was not

>clear the bacteria had colonized on the patients' skin or invaded their

>wounds. The result, he says: " We started to see increasing resistance to

>this antibiotic, resulting in the use of the more toxic drug, colistin. "

>

>Wortmann at Walter Reed understands the urge of frontline providers to

> " break out the big guns " right away, particularly when they know their

>facilities are contaminated with acinetobacter. But he counsels caregivers

>to first use antibiotics targeted toward more common bacteria, treating

>for acinetobacter only when tests show a patient has been colonized or

>infected. " When you give an antibiotic, " he says, " you'll kill most of the

>bacteria that's on that patient, but if a bacteria either is resistant to

>that antibiotic or is able to rapidly become resistant to that antibiotic,

>then it will grow because all the other bacteria have been killed off. "

>

>Researchers in military laboratories and elsewhere are exploring better

>means of fighting acinetobacter. Some are examining possible uses of

>radiation. At Harvard, Anderson is experimenting with a dye " painted " onto

>open wounds then activated with light. " Even the worst strains that are

>resistant to multiple antibiotics, " he says, " will succumb to the

>light-activated dye approach. "

>

>Policies on infection control and antibiotic use, meantime, remain

>essentially unchanged from those in place when the war began. " There are

>guidelines, " says Wortmann, " and sort of loose oversight of the practicing

>patterns of the physicians, but there is no one person that says, 'Doctor

>Jones in Baghdad, you must do this.' "

>

>Timothy Endy, the former Walter Reed physician, is among those who believe

>that, in some measure, there should be. He urges defense leaders to bring

>a more systematic approach to the fight-across military service lines and

>command structures-citing " lessons that should be learned from this

>outbreak but have not been implemented to my knowledge. "

>

>A key reform he feels necessary, and past due: creating the means for

>military services and the Department of Veterans Affairs to gather and

>share real-time information on antibiotic-resistant infections in medical

>centers.

>

>He also recommends application of unified policies on infection control

>and prophylactic use of antibiotics-and advocates that the service's most

>senior medical officers, employing a more global view than physicians at

>single points along casualty evacuation routes, be afforded authority to

>order clinical practice guidelines for infection control.

>

>Most important, he adds, in order for treatment rules to work more swiftly

>than fast-adapting bacteria, such guidelines must be " executed in the war

>theater without delay. "

>

>During 2004, the outbreak's worst point so far, some 30 percent of all

>patients returning from Iraq and Afghanistan tested positive for

>acinetobacter. Four years into the fight, up to 20 percent of those

>returning wounded still face biological onslaught by this bloodstream

>insurgent.

>

> " That's what really held me back, " says Marine Sergeant Emery. " That's why

>I was laid up in the hospital for so long. "

>

>Capt. Henry was a Marine public affairs officer. He now covers defense,

>intelligence, and homeland security for Washington, D.C., television

>outlets ABC7 and NewsChannel 8. This article first appeared in the

>February issue of Proceedings magazine.

>Sound Off...What do you think? Join the discussion.

>Copyright 2008 Proceedings. All opinions expressed in this article are the

>author's and do not necessarily reflect those of Military.com.

>http://www.military.com/features/0,15240,162552,00.html

>~~~

>

>The greatest obstacle to date in battling the spread of the Iraqi genotype

>Acinetobacter Baumannii is that there is no mandatory reporting of

>secondary infections from hospitals as you would with primary diseases. So

>without reliable reporting of actual infections then there is no reliable

>reporting data.

>

>Couple this with the Privacy Act of 1974 and the unwillingness of the

>military to divulge genomic information to civilian hospitals of this

>strain - well, you will have more unnecessary deaths.

>

><snip>

>

>http://www.acinetobacter.org/

>~~~

>

>http://www.google.com/search?as_q=Acinetobacter+baumannii & hl=en & num=100 & btnG=Go\

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>

>~~~

>--

>_

>/ \

>\ _______________________________/\ \

>\ \ \ \ \ \

>\ \ \©2008 veedot\ \ \

>\ \ \____________________________\_\ \

>\ \/_________________________________\

>\_/

> " What is the noble cause my son died for? "

>- Cindy Sheehan

>

>--

>_

>/ \

>\ _______________________________/\ \

>\ \ \ \ \ \

>\ \ \©2008 veedot\ \ \

>\ \ \____________________________\_\ \

>\ \/_________________________________\

>\_/

> " Neutrality helps the oppressor, never the victim. Silence encourages the

>tormentor, never the tormented. "

>- Elie Wiesel (09/30/1928 - )

 

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