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Since November, more than 50 people have been sickened and at least 18 have died in an Elizabethkingia outbreak that is affecting residents of Wisconsin and Michigan. While not a lot is known about this sickness at this time, it is important that healthcare professionals stay up-to-date on what is being learned so that they can identify and effectively treat potential outbreaks in their areas.
Elizabethkingia is a rather mysterious bacterium that was named after CDC bacteriologist Elizabeth O. King, who discovered and identified the first species of this genus in the 1950’s. The bacteria that is responsible for the current U.S. outbreak is Elizabethkingia anopheles, a strain that was isolated from the Anopheles mosquito in 2011.
This gram-negative bacterium is more hardy that most bacteria. In his Medscape article, Deadly Midwest Outbreak of Elizabethkingia, Dr. John McQuinston, PhD reports that, “it can survive in temperatures up to 42°C [107.6°F], is resistant to chorine, and can survive in alcohol. It’s also resistant to many commonly prescribed antibiotics.
Julia Belluz of Vox Science and Health reports that this bacteria is actually quite common. It can be found in water, soil, and is often carried by insects. Fortunately, it rarely causes any adverse reactions in humans. It seems only to affect the ill and elderly. In fact, according to Belluz, in the recent outbreak, nearly all of the affected patients were over the age of 65, and all had compromised immune systems due to at least one underlying health problem.
According to Dr. Shicheng Chen, a microbiologist at Michigan State University, in the cases of the outbreaks in Michigan and Wisconsin, the source of the infection is still unknown. This is largely due to the fact that researchers are not yet certain how, exactly, this bacteria is spread. They current theory is that it is transmitted through contaminated water or when patients come in contact with it in hospitals.
The Wisconsin Department of Health is currently working with the CDC to try to determine the cause of this recent outbreak. “As part of the outbreak investigation activities, DPH and the Centers for Disease Control and Prevention (CDC) are conducting site visits and collecting environmental samples from both private residences and health care facilities. CDC is also assisting Wisconsin with testing of samples from a variety of potential sources, including health care products, water sources and the environment. To date, none of these have been found to be a source of the bacteria.”
Those affected with this bacterium typically show symptoms of septicemia, which can be deadly if not caught early and treated with the appropriate antibiotics. In addition to symptoms of sepsis and septic shock, some infected patients may present with respiratory and lung infections, difficulty breathing, chills, cellulitis, or even rashes and swelling of the skin.
According to Dr. McQuinston, because this bacteria is so rare, it is often hard to recognize and diagnose. He writes that it has “a clinical presentation resembling many other more likely etiologies [so it] may not be among the top candidates for a potential cause of bloodstream infections.” He advises that, “clinicians who have patients with underlying health issues and bloodstream infections of unknown etiology should consider Elizabethkingia as a possible cause.”
Though it is resistant to many types of antibiotics, the CDC reports that Elizabethkingia can be treated effectively with certain antibiotics including: fluoroquinolones, rifampin, minocycline, and trimethoprim/sulfamethoxazole. The CDC recommends combination treatment when possible. Dr. McQuinston states that, “For best results, treatment should be selected based on antimicrobial susceptibility testing results for each suspected case.”
To learn more about Elizabethkingia bacterial infections, you can read about it at Medscape, the CDC, Vox Science and Health, or the Wisconsin Department of Health.