Tourist boom in India spreads stealthy germs

Bloomberg

Smallpox, syphilis, plague, cholera – some of the planet’s most notorious scourges dramatically expanded their reach thanks to unsuspecting travelers. With a record 3.77 billion air passengers worldwide last year, new disease-causing microbes have never traversed the planet faster.
The recent case in Reno, Nevada of a woman who died from a rare bacterial infection is a tragic reminder. She picked up a variant of a germ called Klebsiella pneumoniae, probably while she was treated in India for a leg fracture and hip infection, Washoe County health authorities said last week. Tests found the bacterium was resistant to 26 antibiotics. In fact, no available drug could stop it from poisoning her bloodstream weeks after she was admitted to the hospital in Nevada.
“There are lots of studies that show that being in India does put you at risk for these infections,” said Ramanan Laxminarayan, a New Delhi-based director for the Center for Disease Dynamics, Economics & Policy in Washington.
India carries one of the highest health-care burdens from antibiotic-resistant bacteria in the world. Sepsis caused by drug-defying germs kills more than 58,000 newborns in India, according to Laxminarayan. The overuse of antimicrobial medicines, and the lack of toilets and clean water, helps propagate and spread the mutant microbes in the environment.
The Indian government is trying to counter that. The direct sale of antibiotics to the public was prohibited in March 2014 to halt excessive, unnecessary use. Later the same year, Prime Minister Narendra Modi began a program to wipe out open defecation within five years as part of a nationwide “Clean India” campaign.
India is predicted to be the world’s third-biggest air travel market by 2035. Since Pitout noted the infection link, the South Asian nation has
come up as the country from where travelers are most likely to return with digestive tracts colonized by ESBL-producing bacteria in at least eight studies by research groups from Australia to New York City. Recent studies show antimicrobial resistance is a growing worldwide problem, with an especially high incidence in countries in South Asia, Southeast Asia, China, and some areas in southern Europe, such as Greece, said Lindsay Grayson, head of infectious diseases at the Austin Hospital in Melbourne.
“The extent of the spread of these organisms and the size of the problem is still being defined,” Grayson said in a phone interview from Geneva, where he is assisting WHO formulate clinical guidelines to control the spread. “In Australia, we have increasing concerns about travelers, such as businessmen, who have recently returned from China who are about to undergo surgical procedures. They should undergo fecal screening to see if they have acquired similarly resistant organisms that could later affect their health care.”
The bacterium that killed the woman in Nevada resisted carbapenem as well as colistin. It was fortified with a gene dubbed NDM — short for New Delhi metallo-beta-lactamase, a reference to the city where a Swedish man was hospitalized in 2007 with an infection that couldn’t be stopped by carbapenem or any commonly prescribed antibiotic treatment.
The gene is now found in bacteria worldwide, including in the U.S., making it impossible to prove whether or not the Nevada patient, who was in her 70s, picked it up during her extended visit to India, said Laxminarayan at the Center for Disease Dynamics, Economics & Policy. Even still, it’s plausible that India was the source. “Carbapenem-resistance is rife in India — both in the community and in hospitals,” he said.