First Mycobacterium abscessus Outbreak Associated With Recreational Water in the United States
Bibliographic record
Abstract
Background. Mycobacterium abscessus, a rapidly growing acid-fast bacterium naturally found in water, soil, and dust, is an opportunistic pathogen that causes rare infections of the skin and subcutaneous tissues. Outbreaks of skin infections related to recreational water exposure were identified in Canada in 2003, and in Italy 2009–2011, but no previous outbreaks associated with recreational water in the United States had been reported. In Idaho, February–May 2013, M. abscessus skin infections were diagnosed in 11 children. Methods. Clinical evaluation of children, mycobacterial culture and identification, and epidemiologic and environmental investigations were performed. Results. Affected children were aged 2–6 years; 9 (82%) were female. All were otherwise healthy with no diagnosed immunocompromising conditions. Most children presented with erythematous nodular lesions on their hands or feet. In some cases, initial symptoms were attributed to viral hand, foot, and mouth disease. Illness onsets occurred January–May 2013. One case was confirmed as M. abscessus group not chelonae by bacterial RNA polymerase β subunit (rpoB) gene sequencing, 2 were confirmed as M. abscessus/chelonae complex by 16S rDNA sequence analysis, and in 2 cases, acid-fast bacilli were detected in fixed skin biopsy or smear of exudate; 6 additional clinically-compatible cases shared epidemiologic risk factors. Epidemiologic investigation determined that the sole common exposure among cases was playing in a fitness facility's wading pool December 2012–April 2013. Environmental investigation found a worn rubber mat on the bottom of the pool at the slide exit and worn polyurethane decking suspected to have allowed colonization by M. abscessus. Swabs of the fountain strainer and slide ladder cultured positive for M. abscessus/chelonae with pulsed-field gel electrophoresis patterns related, but not identical to those of clinical isolates. Mycobacterium spp. were isolated from the pool water. The pool operator hyperchlorinated, drained, scrubbed, and disinfected the pool. The worn rubber mat was replaced. No associated cases were reported after environmental remediation. Conclusion. An outbreak of M. abscessus skin infections among children was associated with a wading pool and controlled by environmental remediation. This was the first such reported outbreak in the United States. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".