As a Microbiologist and a Public Health professional, it can be challenging to stay on top new and emerging microbes, and it’s even more challenging as a dad to read about these microorganisms and not seal my 16 month old away in a sterile room. In microbiology we are often aware of a specific microbe for decades and consider it nothing to worry about – and then there’s an outbreak of strange symptoms and the public health community works tirelessly to discover the cause is that microbe we thought was nothing to worry about. This is what’s happening right now in Wisconsin and Michigan with Elizabethkingia anophelis, which has sickened 57 people, killing 19 since November 1, 2015.
Before I go on, it’s important to know that Elizabethkingia is a genus of bacteria with at least four strains that we know of. One of these strains, Elizabethkingia meningoseptica, is known to cause meningitis among premature infants in the NICU. This is *not* the strain of Elizabethkingia causing the current outbreaks in Wisconsin and Michigan. The strain causing the current outbreak is Elizabethkingia anophelis. Most media have referred to the bacteria simply as Elizabethkingia, leaving out the species name, which has caused some concern among parents familiar with its reputation in the NICU. For the rest of this post when I use the name Elizabethkingia I’m referring to the strain causing the Wisconsin and Michigan outbreaks.
Elizabethkingia anophelis is a bacterium found naturally in the environment in soil and water, and in the gut of the Anopheles mosquito. This is where this species of Elizabethkingia gets its name. The anopheles mosquito is the mosquito most of us are familiar with, and it’s also the one that spreads tropical diseases like Zika, malaria and yellow fever. To be clear these tropical diseases are in no way related to the outbreaks of Elizabethkingia in Wisconsin and Michigan.
Symptoms of Elizabethkingia can include fever, shortness of breath, chills or cellulitis (a swelling or redness of the skin). Elizabethkingia is typically resistant to antibiotics but the strain found in Wisconsin and Michigan can be treated with a combination of antibiotics. Therefore, early detection of symptoms and seeking immediate medical intervention is key when infection is suspected.
Elizabethkingia is what we call “opportunistic,” which means it takes advantage of hosts with an already weakened immune systems. An opportunistic pathogen doesn’t typically cause an illness in a host with a normal, healthy immune system. Because Elizabethkingia is widely distributed in the environment it most frequently affects cats that spend time outdoors. We have known for sometime that Elizabethkingia is also an opportunistic pathogen in humans, but there hasn’t been an outbreak similar in scale to what’s currently happening. Statistically speaking the current outbreak is small, but in terms of previous outbreaks of Elizabethkingia, it is large. In the past we’ve seen very small pockets of outbreaks that have tended to be unconnected, so an outbreak of this scale in a relatively contained geographic area is something that has public health officials’ Spidey senses tingling.
As public health officials work to spread evidence-based information about this illness, there is the opportunity for panic and unintentional misinformation. As I mentioned before, some reports have confused which species of Elizabethkingia is causing the current outbreak, causing parents to panic. As a parent myself, outbreaks like these are a cause for concern. Children, as we know, are among the most vulnerable among us when it comes to infectious disease.
A relief to some parents will be that there is no evidence that this species of Elizabethkingia is transmitted from human-to-human, and the majority of those affected by this outbreak have been over the age of 65 and with underlying medical conditions. But that doesn’t necessarily mean that children aren’t at risk. Many parents in Wisconsin and Michigan want to know what they can do to ensure their child is safe from an Elizabethkingia infection and why this outbreak emerged from almost nowhere. Unfortunately we don’t yet have an answer as to why this outbreak has happened. Officials from the CDC and the Wisconsin Department of Health have looked into multiple potential sources including food, water, hospital environments and pharmaceuticals, but so far nothing has turned up. To help identify the source and control the outbreak the governor of Wisconsin just announced they have brought on nine new public health officials.
What is important to recognize as we see the emergence and initial cases evolve is that we are learning what this disease can do and until we know more and we have all of the facts, calm and patience should be the guiding principle and vigilance should always be maintained. This is not always easy to do when there is potential for our children to be exposed, especially in the early phases of these initial cases where we don’t know the source of infection. No matter the age of your child, you know them, their disposition, tendencies, likes and dislikes. Whenever there is any deviation from these norms, we become concerned and with any outward signs we immediately seek medical help without even thinking. This is what I mean by being vigilant and remaining attentive to any possible changes that can alert you to any issues. Illnesses due to Elizabethkingia are still occurring and as we learn more from the ongoing investigation, we hope to bring you additional information as soon as it becomes available.