(CNN) — The bump on a young California girl’s hand was mysterious — and growing. It wasn’t until she had seen two doctors and undergone a biopsy that her family realized the cause: The child had gotten in the way of a hungry iguana with a sweet tooth, resulting in what may be the first documented infection of a rare bacterial infection in a human from an iguana bite.
The girl, Lena Mars, is featured in a scientific presentation on the case that will be given at the European Congress of Clinical Microbiology and Infectious Diseases in April. She is still recovering at her family’s home in San Jose, California after the unexpected ordeal, which started on a vacation in March 2022.
Mars and her parents, Julian and Luisa, had taken a trip to Costa Rica. While enjoying one of the country’s many beautiful beaches, the girl’s parents gave her a snack. But it turns out that she wasn’t the only one who was hungry: A wild iguana popped up as the girl ate her cake by the water.
Iguanas are common in Costa Rica. They’re harmless herbivores, known mostly for sunning themselves under trees and eating fruits and leaves, but experts say this animal must have developed a sweet tooth.
The iguana ran up to the girl and bit her on the back of her left middle finger, causing her to loosen her grip on the cake. The reptile then ran off with the snack, but it did leave something else behind.
Dr. Jordan Mah, an author of the presentation and an expert in medical microbiology, worked on the lab testing for the case as a part of the Department of Pathology at Stanford University. Mah said the girl’s parents probably weren’t thinking about the bite when they took her to a doctor because of the bump on her hand.
“I think when they went to get medical attention for the bump initially, the bite kind of slipped their mind because they didn’t see it as a potential exposure, because it just healed. And it was only later on during the course of treatment, as it got worse, that it kind of jogged their memory and they brought it to the doctor’s attention,” he said.
Mah says the Mars had been immediately responsive after the iguana encounter. The wound looked superficial, but they took the girl to a local clinic, where staffers disinfected the wound with alcohol and gave her five days worth of antibiotics.
The wound appeared to have cleared up in about two weeks. It was only five months later, when her parents noticed a dime-size bump on the girl’s hand in the same spot, that they thought they should take her to another doctor. The girl told them it didn’t hurt, and there were no other symptoms.
Her pediatrician thought the bump might be a harmless cyst and told her parents to keep an eye it. But when the bump continued to grow and began causing mild pain, her parents took the girl to an orthopedist, who suggested a biopsy.
In November, the doctor removed the 2-centimeter mass. Scientists took a closer look at the growth in the lab and discovered that the child had a rare infection with Mycobacterium marinum, a non-tuberculous mycobacterium that more commonly causes a tuberculosis-like illness in fish.
It’s ubiquitous in fresh and salt water but rarely infects humans. Typically, when humans are infected, it’s after a wound has been exposed to the bacteria in water. Most people who get these infections develop a rash that may spread in a spherical pattern. It may develop a nodule with pus or turn into an ulcer.
Most antibiotics alone don’t typically work on these kinds of infections, so doctors started the girl on rifampin, an antimicrobial, and clarithromycin, an antibiotic often used for skin infections. The infection responded well to the treatment.
“Typically, with these infections, because they take a very long time to grow and they’re a little bit more fastidious, you need to treat them for a longer period of time, sometimes several months,” Mah said. “So she’s doing better. I wouldn’t say 100%, but she’s doing a lot better than she was initially.”
Mah believes this is the first time a human has gotten this kind of infection from an iguana bite. He wanted to present the case to warn clinicians of the possibility.
Growing M. marinum in the lab required a lower temperature than most bacteria. This particular bacteria likes to grow at about 82 to 86 degrees Fahrenheit. Most bacteria are cultured around 95 to 98.6 degrees, so the diagnostics were slightly different. With lizards and iguanas having lower body temperatures than humans, Mah said, they may be the perfect hosts for this kind of bacteria.
“There is we know a lot about animal bites and bacteria, infections, following, let’s say, dogs or cats, but there really isn’t much for lizards, let alone iguana,” he said. “I don’t think people should be afraid, but doctors should be aware of the possibility.”
Iguanas that were native to South and Central America and Mexico have become an invasive species in South Florida, Hawaii, Texas and Puerto Rico, so people may have more encounters with them. But experts who work with iguanas say they are usually pretty harmless, so there is no reason to be afraid of them.
Anna Meyer, operations manager at Iguanaland, Florida’s largest reptile zoo, said the behavior of the one in this case is not typical.
“Typically, they will go about their day and not want to bother anyone or be bothered by anyone. But like any wildlife, if they start associating people with food, they’re going to risk coming closer,” Meyer said. In this case, other tourists in Costa Rica might have fed the wild iguana until it became habituated to people and developed certain expectations of them.
“That’s an animal who’s just become accustomed to people providing it with food,” Meyer said. It probably realized it could get a “higher-value food” from the toddler without much danger to itself.
The lesson here, she said, is that no one should feed wildlife, because it makes the animal think that stealing food from a child is, well, like taking candy from a baby.
“There’s more calories in cake than in a mango or leaves,” she said.
The Mars family said their daughter is still recovering from her wound, and they praised her for the spirit with which she has handled the whole experience.
“Our daughter, Lena, just celebrated her 4th birthday and is still recovering from the surgery in November. The wound is just closing, and the whole healing process has taken more strength than the bite itself,” the family said in a statement. “Lena is the bravest child we can imagine, and she is handling the situation pretty well. She definitely remembers the bite and knows that the bacteria came from the iguana. She will probably never forget the experience, but we hope that someday we can all laugh about what happened.”
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
