Infectious Disease Blog

I had the privilege of chatting with Dr. Michael Barza on Friday about what’s going on in the field of infectious diseases. Barza is the Chief of Medicine and Program Director for Internal Medicine at Caritas Carney Hospital and also Vice Chairman for Operations and Associate Chief of Medicine at New England Medical Center, both of which are in Boston, Mass. Barza also serves as the Deputy Editor of the journal Clinical Infectious Diseases.  

Click below to hear the interview.

Interview with Dr. Michael Barza

Here’s the transcript:

Christina Zdanowicz: How long have you been working in the field of infectious disease and what specifically is your specialty?

Dr. Michael Barza: For 40 years. At least I began my fellowship in 1968 at New England Medical Center. And my specialty is probably antibiotics, pneumonia, fevers of unknown origin. Those would be my main areas of interest.

CZ: What’s you affiliation with the Clinical Infectious Diseases journal?

MB: I’m the deputy editor of that journal. My main duty is to take the first look at virtually all of the unsolicited manuscripts, which is most of the manuscripts – about 2,500 a year. I take the first look at those and decide if I think we should be interested in sending them out for review or declining them without review.

CZ: What is the exact scope or what are some of the topics in that journal?

MB: It’s very broad reaching. It covers all aspects of infectious disease ranging from hospital epidemiology to immunization practices to infections by virtually any kind of pathogen: viruses, bacteria, fungi, parasites. As well as sometimes dealing with issues of ethics, of efficiency of consultations of sort of general topics like that. So, virtually all aspects of infectious disease but the emphasis is upon clinical infectious diseases, not so much in basic research, or if its basic research, it must be something applicable more or less now.

CZ: What are some of the hot topics relating to infectious diseases that the journal has been publishing about more recently? 

MB: In terms of viruses, influenza, both influenza A and B that we have in this country already as well as H5N1. Influenza has been a big topic. Other viral infections, of course HIV is always an important topic. Lately, we’ve actually had quite a few studies of treatment issues in HIV in developing countries – Africa, southeast Asia and so on.

In terms of bacterial infections, the biggest issue is probably been MRSA, which is an acronym for Methicillin-resistant Staphylococcus aureus. We’ve also had quite a bit on resistant bacteria, especially resistant Gram-negative bacteria, especially in intensive care units and elsewhere in hospitals, multi-resistant organisms, which have been an increasing problem in mot countries. Sticking with bacteria, tuberculosis continues to be a major killer and in particular now, there’s been a great deal of concern about multi-drug resistant tuberculosis. So called XDR, extended drug resistant TB. These organisms are actually resistant to virtually every antimicrobial that we can throw at them.

Then, a number of parasitic infections, malaria continues to be a major killer and cause of morbidity in a lot of countries, so we continue to have an interest in trials of new anti-malarial agents. 

CZ: And anything coming up in the new issue of the journal that is really groundbreaking or something that the community will really latch onto?

MB: Well, I haven’t looked yet at what’s on. I see these things usually several weeks in advance and I can’t remember what’s on for the next issue. I don’t remember anything that’s earth shattering. There is, in a few weeks, we’re going to have expedited publication, which we hardly ever do, of an article describing a kind of outbreak of a kind of E. coli in the United Kingdom. A kind of E. coli infection that can sometimes cause serious damage to the kidneys, it’s called the hemolytic uremic syndrome. In fact that manuscript is going to be the basis of an inquiry by some judicial commission in the United Kingdom. So we have been considering releasing that in expedited form.           

CZ: That sounds like something really explosive potentially if it’s going to a judicial committee. 

MB: It does have public health implications in part because mostly because there’s some evidence that these infections could be transmitted from child to child, I guess from adult to child too, or vice versa, but there have been some cases of transmission, so they want to alert the public that if one child has some of these symptoms, they should be kept separate from other children. So, I think that, in part, will be the subject of the inquiry. 

The Centers for Disease Control and Prevention is warning doctors to be vigilant as we enter the peak of flu season. Especially since a large increase was reported in the number of U.S. children who died last year from the flu while fighting off staph infections, according to the Atlanta Journal-Constitution.

Last week, the CDC sent out the warning about children who may have fallen prey to the flu and staph. According to the AP, as posted on Demopolis Live:

“Last year, the CDC learned of 73 children who died from flu, and 44 percent of them had a bacterial co-infection — mostly staph. Compared to earlier years, that’s a five-fold increase in staph piggybacking on kids’ flu.”

Of the 22 children that died from the flu last year also had staph, according to the same Atlanta Journal-Constitution article. Fifteen of those children actually had MRSA, or methicillin-resistant Staphylococcus aureus. Click on my recent post about the latest MRSA developments to read more.

There have also been an increased number of staph pneumonia cases reported in children who have the flu. According to the Atlanta Journal-Constitution article:

“When I was trained as a doctor and an infectious disease specialist, we basically never saw staph pneumonia. … Now we see staph pneumonia all the time,” said Dr. Jonathan McCullers, a researcher who studies the interaction between influenza and bacteria like staph at St. Jude Children’s Research Hospital in Memphis.

The CDC has the following suggestions for parents wishing to keep their kids flu-free during flu season:

• Cover their nose and mouth with a tissue when they cough or sneeze—have them throw the tissue away after they use it.
• Wash their hands often with soap and water, especially after they cough or sneeze. If water is not near, use an alcohol-based hand cleaner.
• Remind them to not to touch their eyes, nose, or mouth. Germs often spread this way

A doctor’s worst nightmare is coming true. An even more drug-resistant strain of Methicillin-resistant Staphylococcus aureus, commonly known as MRSA, is emerging in the United States. The strain is an altered version of USA 300, the most common form of community-acquired MRSA in the U.S.

Four treatments formerly effective against USA 300 are now largely unresponsive. These drugs are: clindamycin, ciproflaxcin, tetracycline and mupirocin.

According to the Chicago Tribune, a recent study found the strain of MRSA:

“ … primarily in urban gay communities in San Francisco and Boston, though anecdotal reports indicate it has also been seen in Chicago, New York, Los Angeles and Philadelphia.”

Researchers worry the strain will spread further. Some experts suggest the microbe will adapt and become resistant to more antibiotics.

While the study suggests the more drug-resistant strain of MRSA has been found in gay men, About.com’s Infectious Disease blogger Anna Spector says not to worry:

“But have no fear, all the hype is based on one article published by scientists who studied gay men from two populations. And keep in mind that many previously healthy people get MRSA, so men who have sex with men should not be the only ones targeted in the media.”