Western Australia (WA) has experienced a resurgence of congenital syphilis. Appropriate microbiology testing of the neonate is recommended to confirm infection, including syphilis immunoglobulin M (IgM), rapid plasma reagin (RPR) paired with a maternal sample, and polymerase chain reaction (PCR) on placenta and nasal swabs. We examined the performance of microbiology tests in confirmed congenital syphilis cases and the adherence to testing recommendations in those assessed as high risk. We reviewed the microbiology results of confirmed congenital syphilis cases in WA between 1 January 2018 and 31 December 2023. In addition, microbiology testing of neonates from metropolitan Perth identified as being at a high risk of congenital syphilis between 1 January 2021 and 31 October 2023 was reviewed. Eighteen congenital syphilis cases were identified; data were unavailable for a case born interstate. Of the 17 included cases, the case fatality rate was 35% (6/17; five stillbirths and one perinatal death). Placenta tissue PCR was positive in all stillbirths. Of the 12 live births, 83% were symptomatic at delivery. Perinatal testing was performed in 11 live births (11/12); IgM was detected in 55% (6/ 11). Placenta tissue PCR was positive in 88% (7/8 tested). Nasal swab PCR was positive in 57% (4/7 tested). There were 22 neonates classified as being at a high risk for congenital syphilis infection; all had IgM and RPR testing. Syphilis PCR was performed on placenta tissue samples in 64% (14/22) and on nasal swabs in 64% (14/ 22) of cases. Comprehensive microbiological testing, including syphilis IgM and placenta tissue PCR, is required to confirm congenital syphilis infection. Continuous evaluation of testing will be crucial for individual case detection and monitoring of the ongoing outbreak. Given the risk of incomplete specimen collection, our data support the adoption of a risk-based approach for neonates at risk of congenital syphilis, with management guided by maternal serology and treatment history.

Cutaneous leishmanasis (CL) is the most common form of leishmaniasis. The lesions are typically painless and can self-resolve. Chronic cases occur, particularly in immunocompromised patients. This report describes the treatment of a paediatric patient with refractory cutaneous leishmaniasis. Treatment of CL in children requires consideration of drug dosing, palatability, ethics of utilising treatments with limited supporting evidence and the potential long-term side effects. An immunocompetent 13-year-old girl presented with non-healing ulcer on her face following migration from Pakistan in 2018. The lesion had persisted despite previous empiric treatment with intra-lesional sodium stibogluconate. Biopsy was performed and Leishmaniasis tropica identified by PCR. Response to topical paromomycin was poor. There was partial resolution with oral miltefosine 50 mg BD for 28 days. Re-ulceration occurred within 6 weeks of cessation. The use of liposomal amphotericin was precluded by initial anaphylaxis; desensitisation was unsuccessful. Miltefosine was restarted at a higher dose of 50 mg TDS combined with fluconazole 300 mg daily. Again there was partial response but diminished compared to previous. After 3 months, fluconazole was replaced with allopurinol 200 mg TDS for 30 days. The lesion remained static. Topical GM-CSF was subsequently added for 3 weeks, with marginal improvement. Finally, photodynamic therapy was initiated in December 2019.

The Little Bighorn River is the primary source of water for water treatment plants serving the local Crow Agency population, and has special significance in the spiritual and ceremonial life of the Crow tribe. Unfortunately, the watershed suffers from impaired water quality, with high counts of fecal coliform bacteria routinely measured during run-off events. A metagenomic analysis was carried out to identify potential pathogens in the river water. The Oxford Nanopore MinION platform was used to sequence DNA in near real time to identify both uncultured and a coliform-enriched culture of microbes collected from a popular summer swimming area of the Little Bighorn River. Sequences were analyzed using CosmosID bioinformatics and, in agreement with previous studies, enterohemorrhagic and enteropathogenic Escherichia coli and other E. coli pathotypes were identified. Noteworthy was detection and identification of enteroaggregative E. coli O104:H4 and Vibrio cholerae serotype O1 El Tor, however, cholera toxin genes were not identified. Other pathogenic microbes, as well as virulence genes and antimicrobial resistance markers, were also identified and characterized by metagenomic analyses. It is concluded that metagenomics provides a useful and potentially routine tool for identifying in an in-depth manner microbial contamination of waterways and, thereby, protecting public health.

Tethered capsule endomicroscopy (TCE) is an emerging screening technology that comprehensively obtains microstructural OCT images of the gastrointestinal (GI) tract in unsedated patients. To advance clinical adoption of this imaging technique, it will be important to validate TCE images with co-localized histology, the current diagnostic gold standard. One method for co-localizing OCT images with histology is image-targeted laser marking, which has previously been implemented using a driveshaft-based, balloon OCT catheter, deployed during endoscopy. In this paper, we present a TCE device that scans and targets the imaging beam using a low-cost stepper motor that is integrated inside the capsule. In combination with a 4-laser-diode, high power 1430/1450 nm marking laser system (800 mW on the sample and 1s pulse duration), this technology generated clearly visible marks, with a spatial targeting accuracy of better than 0.5 mm. A laser safety study was done on swine esophagus ex vivo, showing that these exposure parameters did not alter the submucosa, with a large, 4-5x safety margin. The technology was demonstrated in living human subjects and shown to be effective for co-localizing OCT TCE images to biopsies obtained during subsequent endoscopy.

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families' financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.

Private residences in rural areas with water systems that are not adequately regulated, monitored, and updated could have drinking water that poses a health risk. To investigate water quality on the Crow Reservation in Montana, water and biofilm samples were collected from 57 public buildings and private residences served by either treated municipal or individual groundwater well systems. Bacteriological quality was assessed including detection of fecal coliform bacteria and heterotrophic plate count (HPC) as well as three potentially pathogenic bacterial genera, Mycobacterium, Legionella, and Helicobacter. All three target genera were detected in drinking water systems on the Crow Reservation. Species detected included the opportunistic and frank pathogens Mycobacterium avium, Mycobacterium gordonae, Mycobacterium flavescens, Legionella pneumophila, and Helicobacter pylori. Additionally, there was an association between HPC bacteria and the presence of Mycobacterium and Legionella but not the presence of Helicobacter. This research has shown that groundwater and municipal drinking water systems on the Crow Reservation can harbor potential bacterial pathogens.

age of 33. ± 13.9 years for EoE patients and 38 ± 14.1 years in control subjects.Compared to controls, patients with active EoE showed significant thickening of the LP, MM, and SM (Fig. 1) (p<0.05, p<0.03, and p<0.001, respectively).Conclusion: In this study, we have demonstrated the ability of tethered capsule OCT endomicroscopy for assessing the detailed esophageal morphology EoE patients.Findings were consistent with those of prior EUS studies and provided additional information about individual layer thickening in EoE patients.Minimally invasive detection of sub-epithelial remodeling using capsule OCT may be important in identifying patients with increased risk of developing esophageal stenosis (stenotic phenotype) or other complications.Further studies are required to evaluate the relationship between sub-epithelial pathology and the response to treatment and severity of disease.

Waterborne diseases continue to take a heavy toll on the global community, with developing nations, and particularly young children carrying most of the burden of morbidity and mortality. Starting with the historical context, this article explores some of the reasons why this burden continues today, despite our advances in public health over the past century or so. While molecular biology has revolutionized our abilities to define the ecosystems and etiologies of waterborne pathogens, control remains elusive. Lack of basic hygiene and sanitation, and failing infrastructure, remain two of the greatest challenges in the global fight against waterborne disease. Emerging risks continue to be the specter of multiple drug resistance and the ease with which determinants of virulence appear to be transmitted between strains of pathogens, both within and outside the human host.

Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural impacts. As a result, both quantity and quality of culturally important subsistence resources are diminished, contributing to poor nutrition and obesity, and overall reductions in quality of life and life expectancy. Climate change is adding to these impacts on Native American communities, variably causing drought, increased flooding and forced relocation affecting tribal water resources, traditional foods, forests and forest resources, and tribal health. This article will highlight several extramural research projects supported by the United States Environmental Protection Agency (USEPA) Science to Achieve Results (STAR) tribal environmental research grants as a mechanism to address the environmental health inequities and disparities faced by tribal communities. The tribal research portfolio has focused on addressing tribal environmental health risks through community based participatory research. Specifically, the STAR research program was developed under the premise that tribal populations may be at an increased risk for environmentally-induced diseases as a result of unique subsistence and traditional practices of the tribes and Alaska Native villages, community activities, occupations and customs, and/or environmental releases that significantly and disproportionately impact tribal lands. Through a series of case studies, this article will demonstrate how grantees—tribal community leaders and members and academic collaborators—have been addressing these complex environmental concerns by developing capacity, expertise and tools through community-engaged research.

Satellite-based remote sensing of marine microorganisms has become a useful tool in predicting human health risks associated with these microscopic targets. Early applications were focused on harmful algal blooms, but more recently methods have been developed to interrogate the ocean for bacteria. As satellite-based sensors have become more sophisticated and our ability to interpret information derived from these sensors has advanced, we have progressed from merely making fascinating pictures from space to developing process models with predictive capability. Our understanding of the role of marine microorganisms in primary production and global elemental cycles has been vastly improved as has our ability to use the combination of remote sensing data and models to provide early warning systems for disease outbreaks. This manuscript will discuss current approaches to monitoring cyanobacteria and vibrios, their activity and response to environmental drivers, and will also suggest future directions.

Water pollution is a major threat to children worldwide with diarrhea being the principal health consequence of water contamination; the global burden of morbidity and mortality from waterborne diarrhea is vast. Children are disproportionately affected. Many other diseases are also related to water, including certain vector-borne diseases like malaria, and malnutrition. Water-related malnutrition is the consequence of repeated episodes of diarrhea and lack of water for food production. Most of the global burden of waterborne and water-related diseases could be prevented through basic sanitation, hygiene, and the provision of clean water. Water scarcity is a problem in many areas of the world today and is anticipated to increase in the years ahead with increasing global population and changes in climate that will likely decrease the availability of water. Water scarcity may likely exacerbate the burden of waterborne disease and threaten food security and increased conflict in the world’s major river basins.

Advances in water and wastewater treatment in the twentieth century have transformed public health worldwide. However, as a number of World Health Organization and American Academy of Microbiology expert reports have clearly shown, we are still a long way from guaranteeing safe drinking water even in the most developed nations. This chapter attempts to identify major knowledge gaps and summarize at least some of the priorities for the future provision of safe drinking water. Obviously, the major benefits to human health are through basic hygiene and sanitation practices — still much needed areas for public health intervention in many parts of the world. However, this chapter will emphasize more research-oriented needs and priorities. These include the need for a better understanding of biofilms and their control, improvements in risk assessment methodologies, the emergence of new disease, the balance between pathogens and disinfection-by-products, and the future promise of rapidly developing technologies.

It is a pleasure to review an academic textbook that is as timely as Mark Shirtliff and Jeff Leid's contribution to the subject. What immediately strikes me is how little is conclusively known about bacterial-biofilm infections, and yet how rapidly the subject is progressing. This book leaves you with no doubt of the importance of bioflms in device-related infections. Even in diagnoses of aseptic loosening, there is a strong argument for an infectious basis, at least in some of the cases. In a subject that is changing so rapidly and in which effective therapies are still ill-defined, we can only hope that the editors and authors will be willing to update their work often—possibly online. Diagnosis of vascular graft infections with antibodies against staphylococcal slime antigensLate-onset infections of synthetic vascular grafts (LO-SVGIs) are generally caused by staphylococci that produce a slime polysaccharide and grow as a biofilm on the graft surface. We developed an ELISA to detect serum antibodies against staphylococcal slime polysaccharide antigens (SSPA). Patients with an ongoing staphylococcal LO-SVGI had greater titres of IgM antibodies against SSPA than did patients in other groups. Antibody titres of 0·40 ELISA units (EU) or more, or 0·35 EU or more detected 97% and 100% of staphylococcal LO-SVGIs, respectively, 0% and 2% titre/unit false-positive results. Full-Text PDF

This chapter contains sections titled: Introduction Diversity of microorganisms Microbial biofilms Diagnosis and confirmation Material degradation processes Preventive measures Conclusions References

This chapter contains sections titled: Introduction Applications of polymeric materials Microbial biofilms on polymers Degradation processes Mechanisms of degradation Degradation methodology Plasticizers Use of biocides Biodegradation and health Conclusions References

It is clear from recent literature reviews, from American Academy of Microbiology Reports and from WHO expert meetings, that we are a long way from guaranteeing safe drinking water even in the most developed nations. This chapter attempts to identify major knowledge gaps and summarize at least some of the needs and priorities for the future provision of safe drinking water. Obviously, the major benefits to human health are through basic hygiene and sanitation practices -still much needed areas for public health intervention in many parts of the world. However, this chapter will emphasize more research-oriented needs and priorities. These include the need for a better understanding of biofilms and their control, improvements in risk assessment methodologies, the emergence of new disease, the balance between pathogens and disinfection-by-products, and the future promise of rapidly developing technologies.