CHINA (GUANGDONG) – RICE CONTAMINATED WITH AFLOTOXIN
The Ministry of Health in China has issued a nationwide warning concerning contaminated rice produced at some factories in south China’s Guangdong Province. Officials seized 308 tons of moldy rice that had been bleached, polished, and had mineral oil added to it to make it look normal. The contaminated rice, which contained excessive amounts of the carcinogen aflatoxin B1, could pose serious health risks to consumers. The Ministry urged health authorities to conduct strict inspections of rice sold on the market.
[PROMED 8/8/01]

JAPAN – BOY DIES OF E. COLI INFECTION
A five–year old boy died on August 1 as a result of infection with E. coli 0157:H7. Eight of the boy’s pre–school classmates also became ill. The state health center examined all 184 children and 48 staff members at the school, and detected the bacteria in two other students. Health officials with the Nara state government did not release further details, and it is not clear how the children became infected.
[ASSOCIATED PRESS 8/1/01]

CANADA (BRITISH COLUMBIA) – MULTI–DRUG RESISTANT HIV CASES
Doctors at St. Paul’s Hospital in Vancouver, B.C. have seen about six cases of multi–drug
resistant HIV in the past year, raising concerns that this may signal a new epidemic of resistant strains of HIV. While it is not uncommon for patients to develop a form of resistance to some of the drugs they are taking, there have only been a few reported cases worldwide where patients are newly infected with a type of HIV that is resistant to all three classes of antiretroviral drugs. Resistance develops when patients are not able to fully adhere to the strict regimens needed to effectively suppress the virus. Missing occasional doses increases the likelihood that the virus will develop resistance, which is subsequently passed on when the virus is transmitted to others. Current therapies for HIV patients typically involve two of the three classes of antiretrovirals. Patients infected with a multi–drug resistant strain are less likely to respond to different
combinations of the drugs. Doctors at St. Paul’s who recently treated two patients infected with multi–drug resistant HIV stated that in both cases, the virus spread very rapidly within a few months. It is not currently clear whether these strains are more aggressive than those that have been reported in other parts of the world.
[THE VANCOUVER SUN 8/9/01]

CHILE – OUTBREAK OF RESPIRATORY SYNCYTIAL VIRUS
The Chilean capital, Santiago, is experiencing its worst outbreak of respiratory syncytial virus (RSV) infection. RSV is the most common cause of bronchiolitis and pneumonia among children one year of age. The infection has primarily occurred in the city’s poor, who have been particularly affected by the recent heavy rains and freezing temperatures. Authorities have requested military and police hospitals to provide overflow beds and oxygen supplies for infected patients.
[PROMED 8/4/01]

UNITED STATES – LINEZOLID RESISTANT MRSA CASE
An 85–year–old patient undergoing peritoneal dialysis was found to be infected with a strain of methicillin–resistant Staphylococcus aureus (MRSA) that was also resistant to the new antibiotic linezolid. MRSA infections are serious problems in many hospitals, and vancomycin has often been used to treat the infection. Linezolid has recently served as an alternative to vancomycin. The patient received linezolid over a three week period because of intolerance to vancomycin, but linezolid was discontinued upon identification of a resistant isolate recovered from the patient’s peritoneal dialysis fluid. Although linezolid resistance has been encountered when treating vancomycin–resistant enterococci (VRE), no instances of resistance have been reported among clinical isolates of S. aureus. In this case, no other linezolid–resistant S. aureus isolates were recovered from other patients at the institution. A possible explanation for the unexpected finding may be the emergence of resistance to linezolid in a previously undetected susceptible clone that was co–infecting the patient.
[LANCET 2001;358:207פ PROMED 7/30/01]
Ed. Note: The presence of a resistance to Linezolid is worrisome. Linezolid (Zyvox) is a
new class of antibiotic called oxazolidinone and should be reserved for use against
resistant gram positive bacteria such as Staphylococcus aureus.

RUSSIA – CHOLERA OUTBREAK
At least 52 people have been diagnosed with cholera in the city of Kazan, the capital of the central Russian region of Tatarstan. A 40–year–old man died of the infection, andover 200 people have been hospitalized as a result of the outbreak. The outbreak beganin late July when three teenagers became sick after swimming in a contaminated reservoir on the outskirts of the city. The infection spread rapidly, however, it appears to be contained within the city of Kazan. Following the outbreak, authorities in Kazan added more chlorine to the city’s drinking water and sewage drains, and increased street cleaning and garbage removal efforts. Over 900 doctors and medical workers have been involved in combating the outbreak. More than 500 ponds and reservoirs in Kazan were tested for cholera, but the bacteria was only found in the reservoir that initiated the outbreak. Health authorities have increased monitoring of the water supply in cities located up– and down–river from Kazan.
[REUTERS 8/7/01; ASSOCIATED PRESS 7/31/01]