Michigan E. anophelis case related to outbreak in Wisconsin

An outbreak of rare bloodstream infections caused by Elizabethkingia anophelis that has sickened dozens of patients in Wisconsin since November has spread to neighboring Michigan, according to state health officials.

The Michigan Department of Health and Human Services (MDHHS) said a blood culture isolate taken from a patient who recently died in the western part of the state matched the outbreak of E. anophelis that has affected 12 counties in southeastern Wisconsin.

Eden V. Wells

According to the MDHHS, the deceased patient in Michigan was “an older adult” with underlying health conditions, which matches the description of a majority of the patients who were infected in Wisconsin.

Patients with compromised immune systems or serious underlying health conditions are at greater risk for illness associated with Elizabethkingia infections, which often are difficult to treat with antibiotics, according to the MDHHS.

Signs and symptoms of infection include fever, shortness of breath, chills and cellulitis.

“Michigan has worked closely with the CDC and Wisconsin health department to alert our provider community about the Wisconsin outbreak and to ensure early recognition of potential cases in our state,” Eden V. Wells, MD, MPH, chief medical executive of the MDHHS, said in a news release. “Timely diagnosis is key to ensuring patients receive appropriate treatment, and we will continue to provide updates and guidance as additional information becomes available.”

There were 54 cases of E. anophelis reported in Wisconsin as of March 17 — most of them in patients aged older than 65 years who have serious underlying health conditions, the Wisconsin Department of Health Services (WDHS) has said. It has not been determined if the deaths of 17 infected patients (median age, 77 years) were caused by the infection or other serious pre-existing health problems, Claire Yunker, WDHS spokeswoman, told Infectious Disease News.

Search for source ongoing

Elizabethkingia bacteria — named for Elizabeth O. King, a CDC bacteriologist who discovered it — are commonly found in the environment and has been detected in soil, river water and reservoirs, according to the MDHHS.

The MDHHS has joined Wisconsin state health officials and the CDC in an attempt to identify the source of the bacteria.

“We cast a really wide net and are looking at many possibilities including water, soil, medical products, food [and] the possible association to health care they may have received, but as of now we don’t know the cause,” Tom Skinner, CDC spokesman, told Infectious Disease News. “We’ll continue working as long as it takes unless we someday get to the end of a road and feel like we can’t go further. Sometimes we are unable to solve [it].”

The discovery of the Michigan case came after the MDHHS sent an alert on Feb. 8 asking health care providers and laboratories to review records for Elizabethkingia specimens identified since Jan. 1, 2014. On Feb. 29, MDHHS labs identified Elizabethkingia in a recently submitted blood sample and forwarded the isolate to the CDC for confirmation. The CDC notified the MDHHS on March 11 of the match to the Wisconsin cases.

The MDHHS urged health care providers and laboratories to continue reporting the isolation of Elizabethkingia to the agency and retain available isolates for confirmatory testing. – by Gerard Gallagher

Disclosures: Yunker is a spokeswoman for the Wisconsin Department of Health Services. Skinner is a spokesman for the CDC.