CCMS Medicine Winter 2017 - 10

www.CHESTERCMS.org

Figure 2: Possible Signs & Symptoms of Post-Cardio-pulmonary Bypass NTM Infection

fatigue
dyspnea
nausea
vomiting
fever

muscle pain
joint pain
nonspecific pain
abdominal pain
persistent cough

Important considerations for the present situation:
1. Both the CDC and FDA have published information
and alerts for healthcare providers about these potentiallycontaminated HCDs on their respective websites.
2. Clinicians or patients with questions should contact CDC
Information at 800-CDC-INFO (800-232-4636) or at https://
wwwn.cdc.gov/contactus/Form.
3. Worthwhile sources: https://www.cdc.gov/HAI/outbreaks/
heater-cooler.html, http://www.fda.gov/MedicalDevices/
Products and MedicalProcedures/Cdiovasculardevices/heatercoolerdevices/ucm520191
The Swiss investigators made preliminary recommendations
for health care providers to prevent future nosocomial M. chimera
infections, including: (1.) ensure strict separation of contaminated
HCDs from the air of critical medical areas; (2.) educate clinicians
on the risks for, and dangers associated with, M. chimera; (3.)
screen patients who had open heart surgery, heart transplantation,
or those who were exposed to ventricular assist devices and
demonstrate prolonged and unexpected fevers.
In addition, on November 30th, the FDA subsequently put
out a whole list of general preventive measures, as well as specific
measures regarding the use of the LivaNova PLC Stockert 3-T

10 C H E S T E R C O U N T Y M e d i c i n e | W I N T E R 2 0 1 7

cough with blood
night sweats
weight loss
redness, heat, or pus at the surgical site

Heater-Cooler System. That list is quite long and cannot be
included here due to space limitations, so be sure to visit the above
websites for all that information.
Finally, in addition to the historical allusions at the beginning
of this article, the situation also brings to mind the 1959 seminal
publication, Diseases of Medical Progress (R.H. Moser; Charles
C. Thomas, Publisher) and the earlier paper by that same author
(NEJM, 9/27/56). Dr. Moser summed up the issue very neatly,
stating, "I feel that the subject of induced disease should be one of
continuing and dynamic interest to all practitioners of medicine.
It is mandatory that we continue to be alert to the subtle hazards
of each drug and procedure we employ, since we are adequately
propagandized regarding the apparent and well-published benefits.
We must be prepared to assume the great responsibility that
attends the remarkable therapeutic armamentarium now at our
command." And, in one prophetic caveat, he concluded, "It is a
reasonable assumption that the number of unreported observations
exceed by far those which manage to find their way into the
literature."
Dr. Maher is a long-time member of the CCMS Board.
He is a retired physician and the former Director of the
Chester County Health Department.

http://chestercms.org/index.html https://wwwn.cdc.gov/dcs/ContactUs/Form https://wwwn.cdc.gov/dcs/ContactUs/Form https://www.cdc.gov/HAI/outbreaks/ http://www.fda.gov/MedicalDevices/

Table of Contents for the Digital Edition of CCMS Medicine Winter 2017