A Woman Just Died From an Infection No U.S. Antibiotics Could Beat

A superbug that resisted all available bacteria kills a woman in Reno, Nevada.


The woman from Washoe, Nevada was in her 70s and had an infection in her hip. She’d contracted it in a hospital in India after fracturing her leg. Doctors in Reno attempted to tame her infection, trying every antibiotic they had. 26 in all. None of them worked, not even colistin, their last line of defense. The woman died.

The CDC’s report on her case, issued January 13, is sending a chill through the medical world: They’ve been worried for years about the appearance of a superbug that beats all of our antibiotics. Is this what happened here? It turns out that maybe she could have been saved using an antibiotic called fosfomycin not approved in the U.S. for treating the kind of infection she had. Even so, her case has troubling implications.

Post-mortem testing of the woman’s bacteria revealed that something new is going on. Previous infections that have been resistant to treatment with colistin have had a single critical gene, MCR-1. This woman’s bacteria didn’t have this gene, so there’s some previously undiscovered mechanism at work.

MCR-1 was first found in E.coli (NIAID)

Even prior to this, the protective firewall provided by colistin has been cracking. The drug was discovered in 1949 but went largely unused for a long time due to its harmful effect on the kidneys. It came to prominence as a last-line drug after bacteria strains showed signs of developing resistance to other key antibiotics — colistin had been so infrequently used meant that bacteria hadn’t yet had the chance to develop resistance to it.

But those days are apparently over. Colistin has become a popular, inexpensive additive to animal feed as both an antibiotic and also a way to quickly add muscle to animals. Agricultural demand for the drug reached 11,942 tons per year in 2015, and is expected to reach 16,500 tones by 2022. (73% of it is used in Asia, and 28.7% in Europe.) And the MCR-1 gene is now found in livestock and humans, suggesting that colistin’s days as a super-antibacterial are numbered.

 

One of the scariest aspects of the MCR-1 gene, by the way, is that it doesn’t live in a bacteria’s chromosome. Instead, it’s contained in a plasmid, a small, unattached bit of DNA. What’s worrisome about this is that, being independent, it can attach to any bacteria, thus making it resistant to colistin. The danger is that an MCR-1 plasmid, having been consumed in pork or chicken, attaches to some other bacteria it encounters in your gut. This is clearly already happening in patients carrying the MCR-1 gene. And it may a lethal recipe for the evolution of pan-resistant bacteria. 

Fosfomycin, the antibiotic to which the woman’s bacteria showed some reaction post-mortem, is another old drug for which little resistance has yet been developed. It’s approved in the U.S. for treatment of urinary-tract infections, but not for intravenous use in fighting infections. Some wonder if and when the U.S. FDA will widen its availability for use.

As for the woman in Nevada, she was, thankfully, kept well-isolated from other patients and staff. Samples taken from the hospital have so far shown no sign of her bacteria anywhere, so a deadly outbreak seems to have been avoided. For now.

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New fossils suggest human ancestors evolved in Europe, not Africa

Experts argue the jaws of an ancient European ape reveal a key human ancestor.

Surprising Science
  • The jaw bones of an 8-million-year-old ape were discovered at Nikiti, Greece, in the '90s.
  • Researchers speculate it could be a previously unknown species and one of humanity's earliest evolutionary ancestors.
  • These fossils may change how we view the evolution of our species.

Homo sapiens have been on earth for 200,000 years — give or take a few ten-thousand-year stretches. Much of that time is shrouded in the fog of prehistory. What we do know has been pieced together by deciphering the fossil record through the principles of evolutionary theory. Yet new discoveries contain the potential to refashion that knowledge and lead scientists to new, previously unconsidered conclusions.

A set of 8-million-year-old teeth may have done just that. Researchers recently inspected the upper and lower jaw of an ancient European ape. Their conclusions suggest that humanity's forebearers may have arisen in Europe before migrating to Africa, potentially upending a scientific consensus that has stood since Darwin's day.

Rethinking humanity's origin story

The frontispiece of Thomas Huxley's Evidence as to Man's Place in Nature (1863) sketched by natural history artist Benjamin Waterhouse Hawkins. (Photo: Wikimedia Commons)

As reported in New Scientist, the 8- to 9-million-year-old hominin jaw bones were found at Nikiti, northern Greece, in the '90s. Scientists originally pegged the chompers as belonging to a member of Ouranopithecus, an genus of extinct Eurasian ape.

David Begun, an anthropologist at the University of Toronto, and his team recently reexamined the jaw bones. They argue that the original identification was incorrect. Based on the fossil's hominin-like canines and premolar roots, they identify that the ape belongs to a previously unknown proto-hominin.

The researchers hypothesize that these proto-hominins were the evolutionary ancestors of another European great ape Graecopithecus, which the same team tentatively identified as an early hominin in 2017. Graecopithecus lived in south-east Europe 7.2 million years ago. If the premise is correct, these hominins would have migrated to Africa 7 million years ago, after undergoing much of their evolutionary development in Europe.

Begun points out that south-east Europe was once occupied by the ancestors of animals like the giraffe and rhino, too. "It's widely agreed that this was the found fauna of most of what we see in Africa today," he told New Scientists. "If the antelopes and giraffes could get into Africa 7 million years ago, why not the apes?"

He recently outlined this idea at a conference of the American Association of Physical Anthropologists.

It's worth noting that Begun has made similar hypotheses before. Writing for the Journal of Human Evolution in 2002, Begun and Elmar Heizmann of the Natural history Museum of Stuttgart discussed a great ape fossil found in Germany that they argued could be the ancestor (broadly speaking) of all living great apes and humans.

"Found in Germany 20 years ago, this specimen is about 16.5 million years old, some 1.5 million years older than similar species from East Africa," Begun said in a statement then. "It suggests that the great ape and human lineage first appeared in Eurasia and not Africa."

Migrating out of Africa

In the Descent of Man, Charles Darwin proposed that hominins descended out of Africa. Considering the relatively few fossils available at the time, it is a testament to Darwin's astuteness that his hypothesis remains the leading theory.

Since Darwin's time, we have unearthed many more fossils and discovered new evidence in genetics. As such, our African-origin story has undergone many updates and revisions since 1871. Today, it has splintered into two theories: the "out of Africa" theory and the "multi-regional" theory.

The out of Africa theory suggests that the cradle of all humanity was Africa. Homo sapiens evolved exclusively and recently on that continent. At some point in prehistory, our ancestors migrated from Africa to Eurasia and replaced other subspecies of the genus Homo, such as Neanderthals. This is the dominant theory among scientists, and current evidence seems to support it best — though, say that in some circles and be prepared for a late-night debate that goes well past last call.

The multi-regional theory suggests that humans evolved in parallel across various regions. According to this model, the hominins Homo erectus left Africa to settle across Eurasia and (maybe) Australia. These disparate populations eventually evolved into modern humans thanks to a helping dollop of gene flow.

Of course, there are the broad strokes of very nuanced models, and we're leaving a lot of discussion out. There is, for example, a debate as to whether African Homo erectus fossils should be considered alongside Asian ones or should be labeled as a different subspecies, Homo ergaster.

Proponents of the out-of-Africa model aren't sure whether non-African humans descended from a single migration out of Africa or at least two major waves of migration followed by a lot of interbreeding.

Did we head east or south of Eden?

Not all anthropologists agree with Begun and his team's conclusions. As noted by New Scientist, it is possible that the Nikiti ape is not related to hominins at all. It may have evolved similar features independently, developing teeth to eat similar foods or chew in a similar manner as early hominins.

Ultimately, Nikiti ape alone doesn't offer enough evidence to upend the out of Africa model, which is supported by a more robust fossil record and DNA evidence. But additional evidence may be uncovered to lend further credence to Begun's hypothesis or lead us to yet unconsidered ideas about humanity's evolution.