What Should You Know About Elizabethkingia Infections?

This infection is being found in Wisconsin

Three more things to know about Elizabethkingia infections.

Please go here to learn the basics.

Where Is It Found?

Oftentimes when an outbreak of a rare bacterial pathogen occurs, cases can be traced to one facility, and then to one common source. Outbreaks of more common bacteria may be more diffuse. They may be commonly found, but only in certain situations lead to human infections. Such infections may be associated with a particular risk factor, like say a medical device that is not properly sterilized, in the multiple places where the bacteria is found.

 

So it is interesting that these cases have not all occured in one facility. The Wisconsin cases have been found in 11 counties: Columbia, Dane, Dodge, Fond du Lac, Jefferson, Milwaukee, Ozaukee, Racine, Sauk, Washington, and Waukesha.

How Does It Spread?

Well, that's not clear yet. The CDC reports it is investigating "healthcare products, water sources, and the environment". For it to be in so many places, there's not just one small, local source, but something commonly found in multiple locations.

There have been, in the past, infections related to person-to-person spread. That is to say, infections have occurred through childbirth in infants. But mother-to-child transmission is not occurring here (all patients are much older).

The bacteria is found in a variety of locations in the environment around the world. In fact, it appears the Elizabethkingia genus is "ubiquitous" in nature. It may be the bacteria is more commonly present than realized, but usually does not have a "vehicle" through which to contact and infect people.

The bacteria likely only causes notable infections in those with impaired immune systems, so an outbreak would require the presence of a) bacteria, b) a risk factor for introducing infection, and c) the at-risk (immune compromised) population.

Elsewhere, the specific bacteria, Elizabethkingia anophelis, is found in the gut of a mosquito that transmits malaria – Anopholes gambiae (and Anopheles stephensi).

Although there are Anopheles mosquitoes in Wisconsin, they are a different type (which are not so active in the winter cold and do not transmit malaria to us). Other Elizabethkingia species have been found in the roots of some trees, in soil, in water, and other environmental sources.

It's possible that an environmental source initially inoculated the infection into the hospital environment. I some locations, this could have been from a mosquito; in Wisconsin it's not clear what the source might have initially been. But it appears the amplification – or further spread of the bacteria which then leads to human infections – has been through healthcare. Health facilities often amplify and spread infections.

In fact, a similar Elizabethkingia species, E. meningoseptica, has been known to spread and amplify in hospitals or health facilities (like dialysis units) with shared environments or medical equipment. The bacterial resistance to antibiotics may allow it to persist. The bacteria is in fact described as, at times, ubiquitous in hospital environments.

 In the past the contamination has been found to be due to shared items like sinks. This might be related to the water source, but sinks can also be contaminated when a sink intended for hand hygiene sinks is used inappropriately for cleaning of supplies and disposing of secretions, which was associated with at least one hospital outbreak. Stopping this outbreak may be about getting down to the basics of Infection Prevention and Control.

We Are Only Just Getting to Know About This Bacteria

There is not much known about the bacteria or how it manifests.

Cases of Elizabethkingia anophelis were reported, in the past, as cases of meningitis in neonates recently in Hong Kong, the Central African Republic – and the first case where the name came from identified in 1959 by a microbiologist, Elizabeth King, in the US. Cases of other Elizabethkingia species have also been reported in infants, but additionally in other patients, who like infants, do not have strong immune systems, like immunocompromised patients. These have included patients such as a lung transplant recipient, as well as others with cancer, diabetes, and kidney problems.

Those with weakened immune systems from other comorbidities and possibly age may be more at risk, as may have been seen in Wisconsin.

There are currently 11 articles on Pubmed. This is not many.

Sometimes novel diseases have been there longer than we thought. Not all infections are diagnosed. Not all diagnoses are specific. As we begin to specifically diagnose more and more infections – around the world – we begin to see a fuller picture of bacterial ecology. It's likely other infections with this bacteria have been undiagnosed in the past, but Wisconsin is clearly having a novel outbreak, as infections were well tracked well before this outbreak. It's a reminder that we need to study as many bacteria – and viruses, and fungi, and parasites – as we can, to be prepared for whatever comes our way.

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