Morning MEDtalks with Dr K K Aggarwal

New Delhi, July 25, 2018 :

Around the globe

Cyclospora update: The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. As of July 19, 2018, health officials say a total of 163 lab-confirmed cases of Cyclospora infection were reported in people who ate salads from McDonald’s restaurants in 10 states, including Missouri.
Cyclospora cayetanensis is a food and waterborne parasitic cause of diarrheal illness in children and adults. Humans are the only natural hosts. It is most frequently reported in Latin America, the Indian subcontinent, and Southeast Asia.
Risk factors for infection in endemic areas include contaminated water, food or soil, poor sanitation and low socioeconomic status.
Oocysts of C. cayetanensis passed in the stool are shed in a noninfective form and require several days before they become infectious, so person-to-person transmission is not likely. A low infectious dose (10 to 100 organisms) is probably sufficient for infection.
The infection is characterized by anorexia, nausea, flatulence, fatigue, abdominal cramping, diarrhea, low-grade fever, and weight loss. In watery diarrhea with pain, think of microspore.
In endemic areas, asymptomatic infections are more frequent, although more severe clinical symptoms occur in young children and older adults. The median incubation period is about seven days.
In stool microscopy, oocysts can be detected by modified acid-fast staining of stool, in which oocysts appear light pink to deep purple (diameter 8 to 10 microns).
It is important to distinguish the Cyclospora oocysts from those of Cryptosporidium, which are also acid fast but smaller (diameter 5 microns).
Treatment is trimethoprim-sulfamethoxazole one double-strength 160 mg/800 mg tablet orally twice daily for 7 to 10 days.

CDC launches first vision and eye health surveillance system in the US

CDC has developed the first Vision and Eye Health Surveillance System (VEHSS) in the US in collaboration with the National Opinion Research Center (NORC). VEHSS is designed to help health care professionals, researchers, policymakers, and state health departments better understand the scope of vision loss, eye disorders, and eye care services in the United States. Visitors to the site can search for information about eye conditions and diseases at the state and national levels. They also can use the system to:

Identify and collect existing data on residents’ vision and eye health.
Create case definitions to analyze data consistently across sources.
Analyze data to estimate:
- Prevalence of eye disorders and disabilities
- Use of eye health services
- Health disparities in visual health treatment and outcomes

First guidelines for clinical evaluation of Alzheimer’s disease and other dementias

The Alzheimer’s Association has developed the first guidelines for clinical evaluation of Alzheimer’s disease and other dementias for Primary and Specialty Care, which were previewed at the Alzheimer’s Association International Conference (AAIC) 2018 in Chicago. Key recommendations include:

All middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation.
History should be obtained not only from the patient but also from someone who knows the patient well to:
- Establish the presence and characteristics of any substantial changes, to categorize the cognitive behavioral syndrome.
- Investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses.
- Appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care and support.
Concerns should not be dismissed as “normal aging” without a proper assessment.
Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (e.g., family member or confidant).

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI