In a follow-up to a report last week about a large outbreak of Elizabethkingia anophelis  in southeastern and southern Wisconsin, The Wisconsin Department of Health Services (DHS) has reported an additional four cases of the bloodstream infection, bringing the outbreak total to 48.

Wisconsin map/National Atlas of the United States
Wisconsin map/National Atlas of the United States

While 18 patients who tested positive for the Elizabethkingia infection in this outbreak have died, it has not been determined if the cause is the bacterial infection, or the patients’ other serious health conditions, or both.

One additional county reported case(s) bringing the total to 12–Case patients reside in Columbia, Dane, Dodge, Fond du Lac, Jefferson, Milwaukee, Ozaukee, Racine, Sauk, Sheboygan, Washington and Waukesha counties.

Health officials say the majority of patients acquiring this infection are over the age of 65, and all patients have a history of at least one underlying serious illness.

At this time, the source of these infections is unknown and the Department is working diligently to contain this outbreak.

It was reported last week that the Center for Disease Control and Prevention (CDC) saw the outbreak as “very worrisome” as typically there are 5-10 cases per state, per year, so this outbreak is quite large.

Elizabethkingia are opportunistic pathogens preferentially causing illness among immune-compromised individuals or patients with underlying medical conditions, and infection is associated with high mortality. Therefore, early detection and treatment with an effective antibiotic regimen is important to increase the probability of good outcomes.

The index of suspicion for Elizabethkingia infections should be high among patients with multiple co-morbid conditions, particularly malignancy, diabetes mellitus, chronic renal disease or end-stage renal disease on dialysis, alcohol dependence, alcoholic cirrhosis, immune compromising conditions or immunosuppressive treatment.