NDM-1 Affected Superbugs: Spreading Tentacles From South Asia?


Eight people in Canada are reportedly affected by bacterial infection involving NDM-1 now, a steep jump from three confirmed cases barely three months ago, according to Public Health Agency.

Four of these cases have been reported from British Columbia, two from Ontario, one from Alberta and one from Quebec, informed Dr. Michael Mulvey, head of the Antimicrobial Resistance and Nosocomial Infections wing at the federal agency.

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Two of the eight, a 76 year old woman from British Columbia whose case has found a mention in the journal of Emerging Infectious Diseases, and a patient from Quebec whose age and sex have not been reported, have died. However, according to Dr. Mulvey, their death was not a direct result of NDM-1 infection. The woman from British Columbia died due to a complication of sepsis while the patient from Quebec succumbed to cancer. The remaining six have since recovered.

While officials assure there is no cause for alarm, the infectious disease specialists and other doctors have to take note of the increasing number of cases, one of which was reported just the last week.

What is NDM-1?

NDM-1, or New Delhi Metallo-beta-lactamase-1, is a type of enzyme that has somehow entered several types of common disease causing bacteria, including some E. coli strains. It has made these bacteria sort of superbugs - resistant to most, or all, antibiotics, and has rendered the treatment of the disease very difficult. The name New Delhi comes from the capital of India, one of the NDM hotspot countries.

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From where is it spreading?

Dr. Mulvey from Winnipeg said that they are highlighting the fact that the cases are not just confined to Canada; many other countries are now reporting cases of NDM-1 infection. The US has witnessed it and so have many European countries, Australia, Hong Kong, Taiwan and Japan. What's more, he said that many of these cases have been linked to South Asian countries, especially India, Pakistan and Bangladesh.

These are initial cases. They have been noticed in these countries only sporadically and have not spread to any great extent in any of these. Yet, Mulvey noted the rise of superbug infections in the UK and they are becoming more pervasive in countries of South Asia, like India.

Of the eight persons affected in Canada, at least five had visited India or Pakistan. Four of them had spent time in the hospitals of those countries, and one had at least some contact with the healthcare system there.

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The B.C. woman stayed in the northern India for more than 3 months. She developed acute and persistent diarrhea and was hospitalized. Later, apart from diarrhea, she was treated for hypertension, congestive heart failure as well as urinary tract infection.

Usual antibiotics didn't improve her condition which continued to worsen. In February, she was taken to Vancouver and hospitalized there. However, the condition continued to deteriorate leading to ultimate death.

Tests revealed that she was infected with Klebsiella pneumonia and some E. coli strains. Both of these were found to contain the enzyme NDM-1. Mulvey, chief author of the report which was published in the journal of the US Center for Disease Control, said that the B.C. woman was prone to illness.

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How real is the threat to us?

According to Dr. Linda Hoang, a medical microbiologist at the laboratory of British Columbia Centre for Disease Control, Canadians needn't worry about NDM-1 outbreak as there is no evidence of spread of infection either within the hospitals or in the community here.

This is not to say that these superbugs can't spread here; it's just that because of our general hygiene and infection control practices we have not witnessed the spread, and possibly have prevented it, said Hoang from Vancouver.

She also said that there may still be cases that haven't yet been identified. However, she added, if they were extensive we would have seen a spread by now in our hospitals and out-patient facilities; but we haven't.

If the spread does occur, asserts Mulvey, it would be a serious threat as the infections are difficult to treat with existing antibiotics and there are no new antibiotics in the process of development that can effectively fight these superbugs.

Medical practitioners wouldn't like to see cases beginning to spread in hospitals here. That would be the first indication of a possible problem. However, infection control practices in Canada are quite good and have successfully kept other multidrug-resistant organism infections, like MRSA, fairly low in comparison with other countries.

Bacterial infections involving NDM-1 are not yet reportable in Canada, which means that doctors here are not required to inform the federal and provincial health authorities about the cases. However, the Nosocomial Infection Surveillance in Canada, that involves 50 sentinel hospitals across the length and breadth of the country, has been monitoring cases involving organisms with NDM-1, since September 2009, according to Mulvey.

Hoang advises Canadians visiting other countries, especially those that have reported a high number of cases of superbug infection, to see their doctors after they return, if they have any illnesses continuing from the trip.

And the number of these countries is expanding, as suggested by the CDC journal.

Recent cases elsewhere

In another report, two cases of NDM-1 superbug infection have been reported from Austria. The first is of a 30-year old man who suffered injuries after a motorcycle accident when he was visiting Pakistan and India and received initial treatment there. Later, he had to spend five months undergoing various treatments in Austria before fully recovering.

The second case is of a 14-year old boy from Kosovo. He underwent an appendix removal surgery in Kosovo and had been suffering from abdominal abscesses ever since. He was admitted to an Austrian hospital in April and has been there since then. Significantly, he had not visited any of the countries known to be NDM-1 hotspots.

The boy's case suggests that the NDM-1 affected superbugs might be spreading within the hospitals, or in the communities, even outside Indian subcontinent. What's more, the emergence of infections can lead to the transfer of the enzyme from one to other strains of various bacteria which would be a serious threat indeed.

Instant action is required to prevent the spread of NDM-1 enzyme to various bacteria and thereby avert a worldwide health problem.


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