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At least two Canadians have been infected by a new superbug that defies treatment and could spread rapidly around the world, a leading Canadian medical microbiologist says.
Both Canadians, one in Alberta and one in B.C. infected by the antibiotic-resistant NDM-1 have recovered but, “we don’t know if the infection will come back,” Dr. Johann Pitout of the University of Calgary told the Star on Wednesday.
What scientists do know about this new discovery, reported Wednesday in http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/abstractThe LancetEND, is that it starts with a new gene, NDM-1, that secretes an enzyme that blocks almost all antibiotics from fighting certain bacteria, including the common E coli.
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The new superbug starts with a new gene, NDM-1, that secretes an enzyme that blocks almost all antibiotics from fighting certain bacteria, including the common E coli, pictured above.
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The superbugs “are potentially a major global health problem,” said study http://medicine.cf.ac.uk/en/person/tim-walsh/lead author Dr. Timothy Walsh of the University of Cardiff, WalesEND. “It is likely NDM-1 will spread worldwide.”
Indeed, since NDM-1 was first detected in 2008 in a handful of British and Indian cases, it’s jumped to 180 in India, Pakistan, Bangladesh and the U.K. in the study. That doesn’t include the Canadian or http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a5.htmthree U.S. cases reported in late June by the U.S. Centers for Disease ControlEND.
Their ages ranged from 4 to 66, and the reasons for hospitalization included bone-marrow transplants, dialysis, heart disease, pregnancy, traffic accidents, burns and cosmetic surgery.
All of the infections, including the Canadians and Americans, started with hospitalization in India or Pakistan, sometimes for cheaper or quicker elective surgery than was available in the West.
Pitout revealed the Alberta case.
Sylwia Gomes, spokesperson for the Public Health Agency of Canada, knew of the B.C. case reported in February “in a patient transferred from a hospital in India.”
“We've been aware of this situation for some time, and we've been closely monitoring it both in Canada and globally for the past year,” Dr. Howard Njoo, director general for the Centre for Communicable Diseases and Infection Control, told The Canadian Press.
“And as a result, with the patient being isolated and so on, there was no further spread of infection to anyone else in the hospital,” he said.
“The take-home message for the Canadian public is, if you travel to the subcontinent and you get admitted to hospital for whatever reason, medical or cosmetic surgery, and you come back and get sick, you should tell somebody you’ve been in hospital in India or Pakistan,” Pitout said.
Pitout, in a Commentary in The Lancet, goes one step further, suggesting screening and testing of anyone returning to Canada after medical procedures in India or Pakistan.
“If this emerging public health threat is ignored, sooner or later the medical community could be confronted with” untreatable antibody-resistant bacteria that trigger big increases in health-care costs, Pitout wrote.
The Lancet report is based on small numbers, said Yasmeen Sayeed of Surgical Tourism Canada, an agency that helps Canadians get connected with hospitals in India.
“We send about 40 patients every month to India and I haven't heard of any problems,” she said, adding that food-borne infections happen in that country, especially in the summer.
“We tell our patients to be very careful. . . only drink bottled water and even advice them to use it (bottled water) for brushing teeth.”
She added that their patients stay at high-end hotels.
Surgical Tourism Canada has its head office in Vancouver, but Sayeed said her clients are from across the country and go to India mostly for orthopedic procedures and weight-loss surgeries.
But lately, dozens of MS patients have travelled for the controversial Liberation treatment that is not available in Canada. The organization has a tie-up with two hospitals in India: Apollo and Fortis group. Patients go to the Indian cities of Chennai, Bangalore and New Delhi.
Chennai, a city in southern India, has been mentioned in the Lancet report. Sayeed said she knew that a couple of her clients got food-poisoning while in Bangalore for medical procedures but not in Chennai. However, she has asked doctors at these two hospital chains about precautions they are taking against the superbug.
“I've asked them if our patients should be concerned and what are they doing about it,” she said. “Of course, we take this very seriously. We don't want our patients to have any problems.”
NDM-1, the study found, has alarming potential to spread. The gene was found on DNA structures that can flip from one bacteria to another. Even worse, the bacteria are gram-negative, which are already highly resistant to antibiotics and for which no new drugs are being created, said Pitout.
The gene “is widespread,” said Pitout, “but we don’t know how common it is. We don’t know what the risk is of a patient getting it or how many E. coli in India have it.”
It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and produces an infection that is uncomfortable but not deadly.
“It’s unlikely to kill anybody,” he said.
Walsh and colleagues first discovered the gene in 2009 in bacteria taken from a Swedish patient who had been admitted to hospital in India. British health authorities issued a health alert in July 2009, about the rising toll of Britons infected by the superbug after “medical tourism.”
“The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed,” the authors wrote.
“It is disturbing, in context, to read calls in the popular press for U.K. patients to opt for corrective surgery in India with the aim of saving the National Health Service money,” the study concluded. “Such a proposal might ultimately cost the NHS substantially more than the short-term saving. The potential for wider international spread (is) clear and frightening.”
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