উন্নত করার কিছু দেখছেন? একটি পরিবর্তন প্রস্তাব করুন।
Gonorrhea is a sexually transmitted infection that usually stays where it starts. Rarely, untreated, the bacterium Neisseria gonorrhoeae spreads through the bloodstream to distant parts of the body. This disseminated gonococcal infection usually shows up as arthritis, skin inflammation (dermatitis) or inflammation of the sheaths around tendons (tenosynovitis). In rare cases it causes infection of the heart's lining (endocarditis), meningitis, muscle inflammation (myositis) or bone infection (osteomyelitis).
On August 12, 2019, the Kalamazoo County Health and Community Services Department in Michigan was told of three people hospitalized with it.
The investigation
Because the infection is so rare, the cases were severe and more kept appearing, the county and the Michigan Department of Health and Human Services opened a joint investigation. They:
- issued health alerts and public notices;
- reviewed medical records and interviewed patients;
- tested the bacteria for antimicrobial resistance;
- had state and CDC laboratories sequence the whole genomes of the bacteria.
A review of about 27,000 gonorrhea cases in Michigan over the previous 18 months found no other cluster of disseminated infection in place or time.
Investigators defined a confirmed case as N. gonorrhoeae grown from a normally sterile site, such as blood, joint fluid or cerebrospinal fluid, and a probable case as a positive nucleic acid amplification test from a nonsterile site (the urethra, vagina, cervix, rectum or throat) together with signs or symptoms such as tenosynovitis or pain in several joints.
The patients
From August 12 to December 18, 2019, there were 13 confirmed and 3 probable cases. Fourteen of the 16 patients lived in Kalamazoo County and two in bordering southwest Michigan counties.
| Of 16 patients | Number |
|---|---|
| Male / female | 9 / 7 |
| Age, median (range) | 39 (16–52) |
| Homeless | 4 |
| Hospitalized | 15 |
| Treated with ceftriaxone by injection or infusion | 14 (seven for 4–6 weeks) |
| First signs | |
| Septic arthritis | 13 |
| Myositis | 4 |
| Tenosynovitis | 3 |
| Osteomyelitis | 2 |
| Mitral valve endocarditis (bacteria found in the blood) | 1 |
| Gonorrhea found elsewhere at the same time | 11 |
| Urogenital | 8 |
| Throat | 5 |
| Rectal | 1 |
| Reported drug use or a positive drug test | 13 |
| Methamphetamine | 10 |
| Marijuana | 6 |
| Opioids | 3 |
| Injection drug use | 3 |
What it means
How severe the illness was, how closely related the bacteria were, and how many patients reported using methamphetamine raise unusual questions about both the patients and the bacterium, and the investigators called for more study. Prompt diagnosis and treatment might prevent severe disease and complications. Outreach continued to find cases, alert clinicians, identify patients' partners and spread prevention messages widely; stronger surveillance, thorough investigation and continued partnerships, the authors wrote, remain crucial to finding and understanding such clusters quickly and limiting them.
Sources
Based on "Notes from the Field: Ongoing Cluster of Highly Related Disseminated Gonococcal Infections — Southwest Michigan, 2019," by William D. Nettleton and colleagues (Kalamazoo County Health and Community Services Department; Western Michigan University Homer Stryker M.D. School of Medicine; Michigan Department of Health and Human Services; CDC), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
লাইসেন্স: CC0 1.0 (পাবলিক ডোমেইন) · গৃহীত হয়েছে www.cdc.gov
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