Oct. 21, 2011 -- Frequent hand washing will keep those nasty bugs at bay, right? Not if you’re using a public bathroom. Paper dispensers, hand dryers, door handles -- all the things you touch after scrubbing -- are contaminated with all sorts of menacing microbes, sometimes too many to count.
"We documented extensive bacterial contamination of high‐touch environmental sites in 22 public restrooms and aircraft," says researcher Lennox Archibald, MD, PhD, of the College of Medicine, University of Florida, in Gainesville.
Translation: Bathrooms in restaurants, resorts, hospitals, and even libraries are crawling with bugs that can cause everything from diarrhea to wound infections.
"You can go paranoid thinking about it," Archibald tells WebMD.
There's been virtually no research into how many bacteria, and how many different types of bacteria, lie in wait in public restrooms, he says.
So from December 2010 through February 2011, his team descended on restrooms inside four commercial aircraft and 18 public places, including a mall, a hospital, offices, a lecture hall, a conference center, department stores, restaurants, an airport, and a resort.
They swabbed and cultured what Archibald calls "high-touch" areas -- faucets, paper dispenser levers, and doorknobs and handles.
The researchers hit the microorganism jackpot. They recovered staph, which can cause everything from boils to antibiotic-resistant infections. They found E. coli. They cultured Enterococcus, a fecal bug that can cause urinary tract infections and wound infections. And more.
Cultures of high‐touch sites in three hospital restrooms yielded seven bugs that are responsible for two‐thirds of hospital‐associated infections.
The findings were presented at the annual meeting of the Infectious Diseases Society of America (IDSA) in Boston.
For Archibald, one solution is to hold it in. "I only use bathrooms on very long-distance flights," he says.
For those times when you have to go, carry paper towels or tissues to protect your hands after washing, he says.
William Schaffner, MD, chair of IDSA's immunization work group and head of preventive medicine at Vanderbilt University Medical Center in Nashville, has a more bug-friendly viewpoint.
Some bacteria boost our immune system, he tells WebMD.
"We don't live in a sterile world," Schaffner says. "You don't want to obsess. On the other hand, you want to be hygienic," he says.
His tip: Carry a little vial of hand sanitizer where ever you go.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
Sept. 29, 2011 -- Are you at risk from listeria, the deadly bacteria now in the news?
The death toll is rising in the ongoing outbreak from contaminated cantaloupe. It's now the largest outbreak of food-borne illness in more than a decade.
Suddenly the spotlight is on listeria. What is it? Where is it found? Who's at risk? What can we do about it? What are the symptoms of listeriosis, and how is it treated? Here's WebMD's FAQ.
Listeria monocytogenes leads a double life. It's commonly found in the environment, where it feeds on decaying plant matter. It's found in soil, animal feed, groundwater, and sewage. It can also be carried in the guts of cattle and poultry.
But when listeria gets into humans, it changes form. It becomes a bacterial parasite that lives inside -- and feeds on -- human cells. The disease caused by listeria is called listeriosis.
Because it's spread from cell to cell, it avoids the antibody arm of the immune system. Fortunately, the human cell-mediated immune system usually is very good at seeking out and destroying listeria-infected cells.
People with lowered cell-mediated immunity -- the elderly, cancer patients, people taking immunity-suppressing drugs, and pregnant women -- are particularly vulnerable to listeriosis.
By far the most common way people get listeriosis is by eating foods contaminated with listeria.
However, newborns can be directly infected during birth. For every 100,000 U.S. births, there are 8.6 neonatal infections. Listeriosis is one of the most common causes of neonatal meningitis.
"Listeria is a very uncommon cause of illness," Patricia Griffin, MD, chief of the CDC's enteric disease epidemiology branch, tells WebMD.
That said, mild gastrointestinal illness from listeria probably is quite common. Listeriosis -- when listeria escapes the gut and invades the bloodstream -- is rare. The CDC now estimates there are only about 800 listeriosis cases a year in the U.S.
Whether listeria causes illness, Griffin says, depends on a combination of three things: a person's susceptibility, how much listeria a person has been infected with, and the virulence of the particular listeria strain.
Another thing that makes listeria dangerous is that it can survive for a long time, even at refrigerator temperatures.
"Listeria can live in microfilms," Griffin says. Microfilms are sticky mats of bacteria that don't easily wash away.
Microfilms may be one reason why listeria can survive and thrive for years in food processing plants.
But what makes Listeria most dangerous is that once it has entered the bloodstream, it gets into the lymph system and into the brain. Encephalitis and meningitis are major causes of death and disability in people with listeriosis.
Aug. 18, 2011 -- Brain-eating amoebas have killed three young Americans this summer.
What is this scary bug? How does it get to the brain? Where is it, and how can you avoid it? WebMD answers these and other questions.
Amoebas are single-celled organisms. The so-called brain-eating amoeba is a species discovered in 1965 and formally named Naegleria fowleri. Although first identified in Australia, this amoeba is believed to have evolved in the United States.
There are several species of naegleria, but only the N. fowleri species causes human disease.?
Like other amoebas, naegleria reproduce by cell division. When conditions are less than optimal, amoebas become inactive cysts. When conditions are favorable, the cysts turn into trophozoites -- their feeding form. These trophozoites can also temporarily grow tails that allow them to swim. In this tailed form they cannot eat, so they soon revert to the trophozoite stage.
Naegleria love warm temperatures and are able to survive in water as hot as 113 degrees Fahrenheit.
These amoebas can be found in warm places around the globe. They are found in:
Naegleria can't live in salt water and cannot survive in properly treated swimming pools or in treated municipal water.
Most cases of N. fowleri disease occur in Southern or Southwestern states. Over half of all infections have been in Florida and Texas. However, a recent case in Minnesota suggests either that the amoebas are more common in Northern states than previously known, or that they are spreading into these states.
The moniker "brain-eating amoeba" makes naegleria sound like tiny zombies wandering about looking for a way into your skull. But brains are accidental food for them, says Jonathan Yoder, MPH, who tracks the deadly amoeba for the CDC.
"It is normally eating bacteria in its natural environment, but for some reason it does use the brain as a food source when it gets into humans," Yoder tells WebMD.
If you were to drink a glass of water infested with naegleria, you would not get a brain infection. Infection occurs only after water (or perhaps dust) containing the amoeba gets into the nose.
This appears to happen most often when people are diving, water skiing, or performing water sports in which water is forced into the nose. However, infections have occurred in people who dunked their heads in hot springs or who used untreated tap water to cleanse their nostrils.
Studies suggest that N. fowleri amoebas are attracted to the chemicals that nerve cells use to communicate with one another. Once in the nose, the amoebas travel through the olfactory nerve into the frontal lobe of the brain.
June 3, 2011 -- Lawn-mowing safety precautions are essential to help reduce the thousands of injuries received every year by children and adolescents, five national medical organizations warn.
In 2010, about 253,000 people were treated for lawn-mower-related injuries; nearly 17,000 of those involved children under age 19, according to the U.S. Consumer Product Safety Commission.
And lawn mower injuries were up 3% in 2010 compared to 2009.
"Lawn mower injuries to children are easily preventable," says Keith Brandt, MD, president of the American Society for Reconstructive Microsurgery (ASRM), in a news release. "Children should remain inside the house or under direct supervision of another adult whenever a lawn mower is being used."
He says if another adult is not available to supervise, the person doing the cutting should "create a danger zone of 20 feet around the mower" and that the machine should be shut down if anyone gets within that distance.
Besides the American Society for Reconstructive Microsurgery, other organizations involved in issuing the warning include the American Society of Plastic Surgeons, American Society of Maxillofacial Surgeons, American Academy of Pediatrics, and American Academy of Orthopaedic Surgeons.
The organizations state in a news release that many injuries related to lawn mowers require a team of doctors from various specialties to treat and repair. Often, they say, patients must go through painful reconstructive operations for months or years to restore form and function.
The groups issued the following tips to reduce injuries:
Lawn mowers can cause serious eye injuries. The American Academy of Pediatrics says children near lawn mowers that are in operation should wear polycarbonate protective eyewear.
"Every year at this time, it is common to see children operating or playing around lawn mowers in unsafe ways," says O. Marion Burton, MD, FAAP, president of the American Academy of Pediatrics. "We want parents and kids to be more aware of precautions to take so that injuries can be prevented."
Steven Buchman, MD, president of the American Society of Maxillofacial Surgeons, says a significant number of "devastating injuries" occur to children and adults that can be life-changing events.
Phillip Haeck, MD, president of the American Society of Plastic Surgeons, says he has seen "broken and dislocated bones, deep cuts, missing fingers and toes, limb amputations, burns, and eye injuries" caused by lawn mowers.
May 19, 2011 -- A large number of people who have problems with their eyesight don't visit eye doctors because of the cost or because they don't have health insurance that covers eye care, a CDC survey shows.
The survey shows that others don't get regular eye exams because they don't think they have eye problems, or for a variety of other reasons, such as having to travel too far to see doctors or specialists or having no transportation to get to their offices.
In a study involving 11,503 adults aged 40 and over who were considered to have moderate-to-severe visual impairment, 39.8% said they had skipped seeking care in the past year because of costs or lack of insurance.
Almost 35% said they didn't seek eyesight care because they felt they didn't need it, while 4.5% said they could not get an appointment.
The percentage of those citing cost or lack of insurance was greater among adults between 40 and 64 at 42.8%, compared to 23.3% of people 65 and older, according to the CDC's Morbidity and Mortality Weekly Report for May 20.
The CDC analyzed data from 21 states taking part in Behavioral Risk Factor Surveillance System surveys that covered the period between 2006 and 2009.
Survey participants were asked to state the last time they had their eyes examined. Those who said their last eye exam was over one year ago were asked about the main reason for not seeing an eye care professional.
The participants were considered visually impaired if they said they had trouble recognizing a friend across the street or difficulty reading newspapers, magazines, recipes, menus, or numbers on telephones.
The report says the percentage of people 65 and over saying they had no need to go to an eye doctor was 43.8% compared to 32.9% in the 40- to 64-year-old age group. And 41.7% of men said they had no need for eye care, compared to 28.7% of women.
CDC researchers said 36.9% of people who reported no age-related eye disease reported no need to go to eye doctors compared with those who reported age-related eye disease (28.2%).
The reasons survey participants gave for failing to seek eye care varied by age, sex, presence of eye disease, state the person lived in, race, ethnicity, and education level.
"The large proportion of persons aged 65 and over reporting no need as their main reason for not seeking care is of concern because this population has the highest prevalence of visual impairment," the CDC report says. "A possible reason for this is that older adults might regard impairment as a normal part of aging."
The researchers note that previous studies have indicated that many people often aren't aware they have eye health needs because of the lack of attention given to the subject by primary care providers.
May 2, 2011 -- The first study to look at the use of herbal supplements or medicinal teas in babies finds that about 9% of moms report using these remedies in infants under a year old.
The study, which is based on a nationwide survey of new mothers conducted by the CDC and the FDA, found that moms who used herbal supplements themselves were nearly four times more likely to give them to their babies than moms who didn’t use them previously.
Hispanic women were more likely than African-Americans or whites to give herbal supplements to their babies.
And the more weeks a mom breastfed her infant, the more likely she was to give the infant an herbal supplement or tea, the study found.
Study researchers think the connection to breastfeeding may offer a window into beliefs about these kinds of preparations.
“It may be because many people think of herbal supplements as more natural, and breastfeeding may be something people think of as more natural, so they kind of go together for that reason,” says Sara B. Fein, PhD, a consumer science specialist with the FDA.
The jury is still out, however, on whether the use of herbal supplements in infants is a cause for concern.
Guidelines recommend that babies get nothing but breast milk or formula for at least the first six months of life, with vitamins and medicines as needed.
Experts point out that there are few studies on the safety or effectiveness of dietary supplements in children, and even fewer in infants.
“Infants are not just small adults,” says Fein. “They have a different metabolism. They have organs that are growing rapidly, and there are special concerns with almost anything with infants.”
Supplements and teas are less stringently regulated by the FDA than drugs. They have been found in some cases to have been contaminated with heavy metals, bacteria, or other pathogens.
But, says pediatrician Kathi J. Kemper, MD, “We don’t see babies flooding emergency rooms because they’ve gotten toxic amounts of some herbal tea.” Kemper is a chair of the Center for Integrative Medicine at the Wake Forest University School of Medicine.
Overall, Kemper thinks the study is significant simply because it takes stock of how often and for what ailments people use herbals in babies.
“I think it’s a really important contribution because it tells us a lot more than we knew before about the prevalence of using herbals and teas in babies,” says Kemper, who was not involved in the study.
For the study, researchers surveyed around 3,000 pregnant women before their babies were born and then at regular intervals during the baby’s first year.
All the women were at least 18 years old. The study over-represented women who were older, white, middle-class, and well educated.
The mothers were asked if their babies were given any herbal or botanical preparation or tea within the last two weeks. Moms were instructed not to count skin creams or any kind of supplement they were taking that might have been passed through breast milk.
Moms were also asked about their own herbal supplement use, as well as socioeconomic and lifestyle factors.
Overall, one out of 11 moms reported giving supplements and teas to their infants. Compared to women who didn’t use herbs, mothers were more likely to turn to botanicals if they only had one child, were older, had more education, higher incomes, or were married.
The four most common reasons mothers reported giving herbal supplements or teas to their babies were fussiness, digestive problems, colic, and to help with sleep.
The most frequently used preparations were gripe water (which may contain ginger and fennel), teething tablets, chamomile, and unspecified teas.
Less commonly, but significantly, Fein says, were the wide variety of supplements reported in the “other” category: chrysanthemum tea, clove oil, astragalus, comfrey, elderberry tea, flaxseed oil, garlic oil, goldenseal extract, grape extract, horehound tea, lemon tea, orange oil, orange tea, red raspberry tea, rosemary leaf tea, sambucol, slippery elm, and white oak bark.
“There’s just this huge variety of things that were being given to infants,” Fein says. “This is one reason that we recommend that pediatricians be aware that possibly a larger percentage of their patients than they might think might be receiving these substances.”
“They might interact with medicines or have an effect on the body,” she says.
The study is published in Pediatrics.
April 28, 2011 -- Poultry contaminated with campylobacter bacteria is the leading cause of food-borne illness in the U.S, according to a new report that ranks the top 10 riskiest food-bacteria combinations.
Poultry with campylobacter bacteria sickens more than 600,000 people a year, leading to costs of about of $1.3 billion, according to the report by University of Florida Emerging Pathogens Institute in Gainesville.
Next up on the list is toxoplasma in pork, followed by listeria in deli meats, salmonella in poultry, and listeria in dairy products. Salmonella actually appears four times on the list in combination with produce, eggs, and complex foods in addition to poultry.
Taken together, the top 10 riskiest combinations cost more than $8 billion in medical care, sick days, and care for any lasting complications each year.
Most people think of food-borne illness as causing gastrointestinal upset such as diarrhea and vomiting, but these combinations can sometimes cause more severe symptoms. For example, campylobacter bacteria can infrequently also cause paralysis and neuromuscular problems, and E. coli O157:H7 can sometimes lead to severe kidney damage. This strain of E. coli is usually found in contaminated beef or produce.
“There are pathogens in food, but I don’t think it as an epidemic,” says study author Michael Batz, head of the food safety program of the University of Florida Emerging Pathogens Institute. ?“The vast majority of meals don’t lead to illness, so danger is not lurking in every corner. But there is a real risk and it is one we can do something about it.”
“Food-borne illness is essentially preventable,” he says.
“The young, old, pregnant, and people who have chronic illness are certainly at higher risk,” he says.
Pregnant women, for example, are extremely susceptible to listeria in deli meats and soft cheeses and toxoplasma found in pork and beef. “The rates of pregnant women who are aware of this risk are low,” he says. “The new report should serve to remind pregnant women to avoid deli meats and soft cheeses.”
Phillip Tierno, PhD, director of clinical microbiology and diagnostic immunology at the New York University Langone Medical Center, agrees that food-borne illnesses are largely preventable.
Toxoplasma gondii, which appears on the list, is usually associated with cat litter but can also be found in raw or undercooked meat. “You don’t have to eat raw meat,” he says. “On a personal level, the most important thing you can do is cook your food. Cooking and heat can kill many pathogens.”
Food handling is also an important way to protect yourself from food-borne illness, Tierno says. “Even after you tell people be careful of cross contamination, they don’t do it. To effectively clean up, you need a good disinfecting solution and you should not mix meat and vegetable cutting boards.”
Also, toss uneaten cold cuts after a few days. “Listeria loves the cold,” he says.
While seafood does not make the new list, sushi is risky business, Tierno says.
“It is not mentioned here because more people get ill with salmonella from eggs and chicken carcasses,” he says. But “a good sushi man can protect against parasites, but he can’t eliminate the bacteria, so cooking is important.”
April 28, 2011 -- A Medscape/WebMD survey of 15,794 U.S. doctors finds that orthopaedic surgeons and radiologists make the most money, while pediatricians and primary care doctors trail the pack.
It's not really a surprise that specialists make the most money:
That's just what most of these specialists make. Some individuals make a lot more. For example, about 17% of dermatologists report earning $500,000 a year or more.
At the other end of the scale are primary care doctors and pediatricians, who log in at about $159,000 a year average income. Only about one in 100 primary care providers reports making more than $500,000 a year, while 18% had a 2010 income of $100,000 or less.
As in most other fields, men are more highly paid than women. Male specialists pull down a median $225,000 while female specialists take in a median $160,000 a year. The same thing goes for primary care doctors: Men report a median $170,000 annual income while women earn a median $140,000 a year.
The survey offers some hints about why female doctors earn less. Women report spending more time with each patient and report seeing fewer patients each week than male doctors do.
Are doctors being paid a fair amount? Doctors are pretty evenly split on the question. Just over half of specialists, and just under half of primary care doctors, say they are fairly compensated.
If the salaries of doctors seem high to you, consider this: Many doctors work very long hours. Two things eat up doctors' time: Actually treating patients and paperwork.
Anesthesiologists, cardiologists, gastroenterologists, surgeons, and urologists spend an average 46 to 50 hours a week seeing patients. About 42% of all doctors see 50 to 99 patients a week, while about 30% see 100 to 149 patients weekly.
Then there's the paperwork. About one in five oncologists, surgeons, and cardiologists report spending 20 or more hours a week on paperwork and other non-patient activities such as billing issues, supervision, and office meetings. So do 17% of primary care doctors.
Perhaps the most interesting question in the Medscape Physician Compensation Survey is whether, given the chance to do it all over again, they would choose to become doctors.
Instead of a career in medicine, one doctor would have switched to a job as "an assassin -- of insurance company executives." Another would have been a Zamboni driver.
But an overwhelming 69% of doctors said they would once again choose a medical career. However, 12% said they definitely would not. Among the top alternative career choices are business, law, and education.
