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Louisiana Morbidity Report Louisiana Morbidity Report Offi ce of Public Health - Infectious Disease Epidemiology Section P.O. Box 60630, New Orleans, LA 70160 - Phone: (504) 568-8313 http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2037 Infectious Disease Epidemiology Main Webpage BOBBY JINDAL BRUCE D. GREENSTEIN GOVERNOR http://www.infectiousdisease.dhh.louisiana.gov SECRETARY March-April 2012 Volume 23 Number 2 Third Case* of Granulomatous Amebic Encephalitis Louisiana, 2011-2012 Susanne Straif-Bourgeois PhD MPH A 67 year-old male presented to an emergency department with patient’s residency and adjacent nursery. All water samples were complaints of dizziness, ataxia, nausea, vomiting and fever. He found to be negative. However, two of the soil samples, one from was transferred to another hospital, where the brain MRI revealed the work station and one from the greenhouse, were tested positive two to three ring-enhanced lesions. A brain biopsy sent to the Cen- for Balamuthia mandrillaris by PCR. (Figure) ters for Disease Control and Prevention (CDC) tested positive for Balamuthia mandrillaris by polymerase chain reaction (PCR). The Figure: Greenhouse With Positive Soil Sample- Region 5 – Louisiana, 2011-2012 patient was treated with miltefosine (a treatment normally used for visceral Leishmaniasis and a new investigational drug for amebic encephalitis), but the patient’s health declined and he died after 40 days of hospitalization. Photo Courtesy The patient, who had immigrated to the U.S. in 1979, had a his- of Steven Joubert tory of sinusitis and chronic kidney disease, but seemed to be im- munocompetent. He lived in Central Louisiana, where he owned a plant nursery for the past fi ve years. After notifi cation from the CDC about the Granulomatous Amebic Encephalitis (GAE) di- agnosis, staff from the Infectious Disease Epidemiology Section (IDES) and Department of Health and Hospital Region 5** of- fi ce collected environmental samples (water and soil) from the * Louisiana Morbidity Reports – Sept./Oct., 2011- Vol. 22 No. 5 and Balamuthia is the third and latest discovered genera of free- Nov./Dec., 2011 vol. 22 No. 6 living ameba, which can cause GAE in humans and animals. Bala- ** Map of Regions on Page 7 muthia mandrillaris was fi rst isolated in 1986 from a mandrill ba- boon that had died of encephalitis in a U.S. zoo. In 1991, the fi rst Contents human infection of Balamuthia was diagnosed; since then more than 200 cases worldwide have been identifi ed. In the U.S., at least Third Case of Granulomatous Amebic Encephalitis 70 cases have been diagnosed to date, with more cases occurring in warmer climates. Louisiana, 2011-2012 .....................................................................1 The incubation period ranges usually from weeks to months Considerable Increase in Methamphetamine Events but can be two years or longer. Prognosis is very poor if diagnosis occurs after the amebae have invaded the brain; the case fatality Louisiana, 2011 ..............................................................................2 rate is greater than 95%. Both healthy and immunocompromised Hospital Emergency Department Syndromic Surveillance - Mardi people can develop the disease. Exposure to soil as in gardening, playing with dirt or inhaling dirt increases the risk for this fatal Gras - Metro New Orleans - February, 2012 ..................................4 infection. Haff Disease - Louisiana, 2012 ...........................................................5 It is most likely that Balamuthia enters the body when soil con- taining these free living amebas gets into contact with skin wounds Strategic National Stockpile Exercise - Louisiana, 2012 ....................6 or cuts, or when dust containing these amebas is inhaled. Unlike Naegleria fowleri, which has a preference for invasion of the cen- Announcements - World Hepatitis Testing Day; Updates: IDES tral nervous system (CNS) via the olfactory nerves, it is suggested Webpages: Disease in Wildlife .......................................................6 (Continued on Page 5) LA Morbidity Rep., Mar.-Apr., 2012, Vol 23, No.2 Considerable Increase in Methamphetamine Events Louisiana, 2011 William “Clay” Trachtman, M.S.; Xiaoping Nie, Ph.D; Syed Atif Ahsan, MPH; Allison N. Koehler, MPH Background substance events and entering the information into an online data- The Louisiana Toxic Substance Incidents Program (LaTSIP) is base based on criteria set up by the National Toxic Substance In- designed to protect people from harm caused by spills and leaks of cidents Program (NTSIP). Currently, LaTSIP has fi ve major data toxic substances. The program is funded by the Centers for Disease sources: Control and Prevention/Agency for Toxic Substances and Disease • Louisiana State Police Registry and modeled partially after the Louisiana Hazardous • National Response Center Substance Emergency Events Surveillance Program (LaHSEES) • Department of Transportation (2000-2009), the program that LaTSIP was designed to replace. • Louisiana Poison Control Center LaTSIP collects information about chemical spills and maintains • Media it in a centralized database. Trends in data can then be analyzed to Data from these sources (as well as others) are entered into the develop approaches to minimize risk to public health. database. Meth lab events that happened from 2009 to 2011 were The chemical byproducts of methamphetamine (meth) produc- examined. In order for a meth lab event to qualify for inclusion in tion represent a signifi cant health risk; the number of meth labo- the LaTSIP database (or the previous LaHSEES database), the lab ratories in Louisiana has been increasing. A defi nition posted on must be active when discovered and require a clean-up. the web for the City of Lakewood, Colorado Police Department is the following: “Methamphetamine is an illegal stimulant that can Results / Discussion be injected, smoked, ingested or snorted. Ingredients are obtained Over the past three years, qualifying meth lab events have gone legally and then are "cooked" to form the fi nished product. Make- up signifi cantly (Figure 1). shift meth laboratories have been found in homes, motel rooms, Figure 1: Meth Events - Louisiana, 2009-2011 apartments and motor vehicles. These clandestine meth labs are very dangerous. Flammable chemicals are used in the manufactur- 90 ing process, and fi res are not uncommon. Poisonous gas is created 80 during the process, and toxic chemicals are used, created and dis- 70 carded during manufacturing.” 60 In 2006, LaHSEES observed a drastic decrease in the raw 50 number of meth lab events in Louisiana compared to numbers 40 in 2004 and 2005. This decline coincided with the enactment of the Louisiana law, Senate Bill 24, which went into effect August 30 15, 2005. This bill required all dealers of anhydrous ammonia (a Number of Events 20 critical component in meth production), to inspect their customers' 10 tanks and receptacles, and to place an inspection sticker of autho- 0 rization on the tank or receptacle. The bill also created the crime LaHSEES 2009 LaTSIP 2010 LaTSIP 2011* of unauthorized possession of anhydrous ammonia. In addition, Collecting Database pharmacies and other retail establishments were restricted in the In 2009, only seven meth events qualifi ed for inclusion in amount of pseudoephedrine, ephedrine, or phenylpropanolamine, the LaHSEES/NTSIP database. This number jumped up to 47 in (also required for meth production), that could be sold to a single customer. Louisiana Morbidity Report Louisiana further restricted access to meth ingredients on July Volume 23 Number 2 March - April 2012 2, 2009, by enacting a bill into law that required pseudoephedrine drugs (commonly found in cold medication and the main ingredi- The Louisiana Morbidity Report is published bimonthly by the Infectious ant in the production of meth), to only be sold by licensed pharma- Disease Epidemiology Section of the Department of Health and Hospitals Offi ce of Public Health to inform physicians, nurses, and public health cies. In addition, the pharmacies must enter the sale information professionals about disease trends and patterns in Louisiana. Address cor- into a new central computer monitoring system that is accessible respondence to Louisiana Morbidity Report, Infectious Disease Epidemiology by law enforcement. Section, Louisiana Department of Health and Hospitals, P.O. Box 60630, New Although both of these laws helped to initially decrease the Orleans, LA 70160. number of meth labs in the state, over the past three years, LaTSIP Assistant Secretary, OPH J.T. Lane has recorded a dramatic increase in the number of meth lab events that qualify for inclusion in its database. State Epidemiologist Raoult Ratard, MD MPH Methods Editors Susanne Straif-Bourgeois, PhD MPH Theresa Sokol, MPH LaTSIP surveillance consists of staff collecting data on toxic Rosemarie Robertson, BS MT(C) CNMT 2 LA Morbidity Rep., Mar.-Apr., 2012, Vol 23, No.2 2010, and 81 in 2011 (2011 data is not fi nalized) for a total of 135 by the media of meth lab events during the last few years. An at- qualifying events over three years. In reality, the number of meth tempt was made by LaTSIP to get EPIC data through the Freedom labs is higher than these numbers, as only a small percentage of of Information Act; however, there has been no response as of the meth lab events actually qualify for inclusion into the LaHSEES/ writing of this article. LaTSIP database. Unfortunately for Louisiana, the increase in meth lab events Following are several of many
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