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Emerging Infectious Diseases journal
Guinea Worm (Dracunculus medinensis) Infection in a Wild-Caught Frog, Chad M. L. Eberhard et al. November 2016
Resurgence of Yellow Fever in Angola, 2015–2016 A. A. Grobbelaar et al. October 2016
Volume 22, Number 9—September 2016 PDF Version [PDF - 42.68 MB - 184 pages]
Medscape CME Activity
Treatment Outcomes for Patients with Extensively Drug-Resistant Tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa PDF Version [PDF - 582 KB - 8 pages]C. L. Kvasnovsky et al.View SummaryView Abstract
Results underscore the need for timely and adequate treatment for tuberculosis and HIV/AIDS.
We analyzed data for a retrospective cohort of patients treated for extensively drug-resistant tuberculosis in 2 provinces in South Africa and compared predictors of treatment outcome in HIV-positive patients who received or had not received antiretroviral drugs with those for HIV-negative patients. Overall, 220 (62.0%) of 355 patients were HIV positive. After 2 years, 34 (10.3%) of 330 patients with a known HIV status and known outcome had a favorable outcome. Multivariate analysis showed that predictors of favorable outcome were negative results for acid-fast bacilli by sputum microscopy at start of treatment and weight >50 kg. HIV-positive patients were more likely to have an unfavorable outcome. The strongest predictor of unfavorable outcome was weight <50 kg. Overall outcomes were poor. HIV status was not a predictor of favorable outcome, but HIV-positive patients were more likely to have an unfavorable outcome. These results underscore the need for timely and adequate treatment for tuberculosis and HIV infection.
Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015
PDF Version [PDF - 515 KB - 8 pages]
Y. Haaskjold et al.View SummaryView Abstract
Awareness of risk factors for death could help identify patients in need of more intensive medical support.
The 2013–2016 outbreak of Ebola virus disease (EVD) in West Africa infected >28,000 people, including >11,000 who died, and disrupted social life in the region. We retrospectively studied clinical signs and symptoms and risk factors for fatal outcome among 31 Ebola virus–positive patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the outbreak. Significant predictors for death were shorter time from symptom onset to admission, male sex, high viral load on initial laboratory testing, severe pain, diarrhea, bloody feces, and development of other bleeding manifestations during hospitalization. These risk factors for death could be used to identify patients in need of more intensive medical support. The lack of fever in as many as one third of EVD cases may have implications for temperature-screening practices and case definitions.
Travel- and Community-Based Transmission of Multidrug-Resistant Shigella sonnei Lineage among International Orthodox Jewish Communities
PDF Version [PDF - 986 KB - 9 pages]
K. S. Baker et al.View SummaryView Abstract
Shigellosis trends in these communities provide insight into global movement of drug-resistant Enterobacteriaceae.
Shigellae are sensitive indicator species for studying trends in the international transmission of antimicrobial-resistant Enterobacteriaceae. Orthodox Jewish communities (OJCs) are a known risk group for shigellosis; Shigella sonnei is cyclically epidemic in OJCs in Israel, and sporadic outbreaks occur in OJCs elsewhere. We generated whole-genome sequences for 437 isolates of S. sonnei from OJCs and non-OJCs collected over 22 years in Europe (the United Kingdom, France, and Belgium), the United States, Canada, and Israel and analyzed these within a known global genomic context. Through phylogenetic and genomic analysis, we showed that strains from outbreaks in OJCs outside of Israel are distinct from strains in the general population and relate to a single multidrug-resistant sublineage of S. sonnei that prevails in Israel. Further Bayesian phylogenetic analysis showed that this strain emerged approximately 30 years ago, demonstrating the speed at which antimicrobial drug–resistant pathogens can spread widely through geographically dispersed, but internationally connected, communities.
Feasibility of Using Convalescent Plasma Immunotherapy for MERS-CoV Infection, Saudi Arabia
PDF Version [PDF - 1.17 MB - 8 pages]
Y. M. Arabi et al.View SummaryView Abstract
Efficacy testing will be challenging because of the small pool of donors with sufficiently high antibody titers.
We explored the feasibility of collecting convalescent plasma for passive immunotherapy of Middle East respiratory syndrome coronavirus (MERS-CoV) infection by using ELISA to screen serum samples from 443 potential plasma donors: 196 patients with suspected or laboratory-confirmed MERS-CoV infection, 230 healthcare workers, and 17 household contacts exposed to MERS-CoV. ELISA-reactive samples were further tested by indirect fluorescent antibody and microneutralization assays. Of the 443 tested samples, 12 (2.7%) had a reactive ELISA result, and 9 of the 12 had reactive indirect fluorescent antibody and microneutralization assay titers. Undertaking clinical trials of convalescent plasma for passive immunotherapy of MERS-CoV infection may be feasible, but such trials would be challenging because of the small pool of potential donors with sufficiently high antibody titers. Alternative strategies to identify convalescent plasma donors with adequate antibody titers should be explored, including the sampling of serum from patients with more severe disease and sampling at earlier points during illness.
Prediction of Protection against Asian Enterovirus 71 Outbreak Strains by Cross-neutralizing Capacity of Serum from Dutch Donors, The Netherlands
PDF Version [PDF - 1.04 MB - 8 pages]
S. van der Sanden et al.View SummaryView Abstract
Herd immunity induced by locally circulating strains could provide protection against introduction of new strains.
Outbreaks of human enterovirus 71 (EV-71) in Asia are related to high illness and death rates among children. To gain insight into the potential threat for the population of Europe, we determined the neutralizing activity in intravenous immunoglobulin (IVIg) batches and individual serum samples from donors in the Netherlands against EV-71 strains isolated in Europe and in Asia. All IVIg batches and 41%, 79%, and 65% of serum samples from children ≤5 years of age, women of childbearing age, and HIV-positive men, respectively, showed high neutralizing activity against a Dutch C1 strain, confirming widespread circulation of EV-71 in the Netherlands. Asian B3–4 and C4 strains were efficiently cross-neutralized, predicting possible protection against extensive circulation and associated outbreaks of those types in Europe. However, C2 and C5 strains that had few mutations in the capsid region consistently escaped neutralization, emphasizing the importance of monitoring antigenic diversity among circulating EV-71 strains.
Staphylococcus aureus Regulatory RNAs as Potential Biomarkers for Bloodstream Infections
PDF Version [PDF - 1.57 MB - 9 pages]
V. Bordeau et al.View SummaryView Abstract
These RNAs predict disease severity and provide targets for therapeutic approaches.
Staphylococcus aureus is a commensal bacterium and pathogen. Identifying biomarkers for the transition from colonization to disease caused by this organism would be useful. Several S. aureus small RNAs (sRNAs) regulate virulence. We investigated presence and expression of 8 sRNAs in 83 S. aureus strains from 42 patients with sepsis or septic shock and 41 asymptomatic colonized carriers. Small pathogenicity island sRNAs sprB and sprC were clade specific. Six sRNAs had variable expression not correlated with clinical status. Expression of RNAIII was lower in strains from septic shock patients than in strains from colonized patients. When RNAIII was associated with expression of sprD, colonizing strains could be discriminated from strains in patients with bloodstream infections, including patients with sepsis and septic shock. Isolates associated with colonization might have sRNAs with target expression different from those of disease isolates. Monitoring expression of RNAIII and sprD could help determine severity of bloodstream infections.
Ebola Virus Disease, Democratic Republic of the Congo, 2014
PDF Version [PDF - 606 KB - 10 pages]
C. Nanclares et al.View SummaryView Abstract
Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.
During July–November 2014, the Democratic Republic of the Congo underwent its seventh Ebola virus disease (EVD) outbreak. The etiologic agent was Zaire Ebola virus; 66 cases were reported (overall case-fatality rate 74.2%). Through a retrospective observational study of confirmed EVD in 25 patients admitted to either of 2 Ebola treatment centers, we described clinical features and investigated correlates associated with death. Clinical features were mainly generic. At admission, 76% of patients had >1 gastrointestinal symptom and 28% >1 hemorrhagic symptom. The case-fatality rate in this group was 48% and was higher for female patients (67%). Cox regression analysis correlated death with initial low cycle threshold, indicating high viral load. Cycle threshold was a robust predictor of death, as were fever, hiccups, diarrhea, dyspnea, dehydration, disorientation, hematemesis, bloody feces during hospitalization, and anorexia in recent medical history. Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.
Medscape CME Activity
Use of Testing for West Nile Virus and Other Arboviruses PDF Version [PDF - 510 KB - 7 pages]J. Vanichanan et al.View SummaryView Abstract
For patients with meningitis and encephalitis, testing for these viruses is underutilized.
In the United States, the most commonly diagnosed arboviral disease is West Nile virus (WNV) infection. Diagnosis is made by detecting WNV IgG or viral genomic sequences in serum or cerebrospinal fluid. To determine frequency of this testing in WNV-endemic areas, we examined the proportion of tests ordered for patients with meningitis and encephalitis at 9 hospitals in Houston, Texas, USA. We identified 751 patients (567 adults, 184 children), among whom 390 (52%) experienced illness onset during WNV season (June–October). WNV testing was ordered for 281 (37%) of the 751; results indicated acute infection for 32 (11%). Characteristics associated with WNV testing were acute focal neurologic deficits; older age; magnetic resonance imaging; empirically prescribed antiviral therapy; worse clinical outcomes: and concomitant testing for mycobacterial, fungal, or other viral infections. Testing for WNV is underutilized, and testing of patients with more severe disease raises the possibility of diagnostic bias in epidemiologic studies.
Medscape CME Activity
Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase–Producing Escherichia coli Infections in Patients with Pyelonephritis, United States PDF Version [PDF - 908 KB - 10 pages]D. A. Talan et al.View SummaryView Abstract
Prevalence of fluoroquinolone resistance now exceeds treatment guideline thresholds for alternative antimicrobial drug strategies.
For 2013–2014, we prospectively identified US adults with flank pain, temperature >38.0°C, and a diagnosis of acute pyelonephritis, confirmed by culture. Cultures from 453 (86.9%) of 521 patients grew Escherichia coli. Among E. coli isolates from 272 patients with uncomplicated pyelonephritis and 181 with complicated pyelonephritis, prevalence of fluoroquinolone resistance across study sites was 6.3% (range by site 0.0%–23.1%) and 19.9% (0.0%–50.0%), respectively; prevalence of extended-spectrum β-lactamase (ESBL) production was 2.6% (0.0%–8.3%) and 12.2% (0.0%–17.2%), respectively. Ten (34.5%) of 29 patients with ESBL infection reported no exposure to antimicrobial drugs, healthcare, or travel. Of the 29 patients with ESBL infection and 53 with fluoroquinolone-resistant infection, 22 (75.9%) and 24 (45.3%), respectively, were initially treated with in vitro inactive antimicrobial drugs. Prevalence of fluoroquinolone resistance exceeds treatment guideline thresholds for alternative antimicrobial drug strategies, and community-acquired ESBL-producing E. coli infection has emerged in some US communities.
Enterohemorrhagic Escherichia coli Hybrid Pathotype O80:H2 as a New Therapeutic Challenge
PDF Version [PDF - 1.14 MB - 9 pages]
N. Soysal et al.View SummaryView Abstract
This emerging clonal group harbors the extraintestinal virulence–associated plasmid pS88 and can induce invasive infections and death.
We describe the epidemiology, clinical features, and molecular characterization of enterohemorrhagic Escherichia coli (EHEC) infections caused by the singular hybrid pathotype O80:H2, and we examine the influence of antibiotics on Shiga toxin production. In France, during 2005–2014, a total of 54 patients were infected with EHEC O80:H2; 91% had hemolytic uremic syndrome. Two patients had invasive infections, and 2 died. All strains carried stx2 (variants stx2a, 2c, or 2d); the rare intimin gene (eae-ξ); and at least 4 genes characteristic of pS88, a plasmid associated with extraintestinal virulence. Similar strains were found in Spain. All isolates belonged to the same clonal group. At subinhibitory concentrations, azithromycin decreased Shiga toxin production significantly, ciprofloxacin increased it substantially, and ceftriaxone had no major effect. Antibiotic combinations that included azithromycin also were tested. EHEC O80:H2, which can induce hemolytic uremic syndrome complicated by bacteremia, is emerging in France. However, azithromycin might effectively combat these infections.
Elevated Risk for Antimicrobial Drug–Resistant Shigella Infection among Men Who Have Sex with Men, United States, 2011–2015
PDF Version [PDF - 494 KB - 4 pages]
A. Bowen et al.View SummaryView Abstract
These men were 3–77 times more likely than other persons to have shigellae resistant to >1 key drugs.
Shigella spp. cause ≈500,000 illnesses in the United States annually, and resistance to ciprofloxacin, ceftriaxone, and azithromycin is emerging. We investigated associations between transmission route and antimicrobial resistance among US shigellosis clusters reported during 2011–2015. Of 32 clusters, 9 were caused by shigellae resistant to ciprofloxacin (3 clusters), ceftriaxone (2 clusters), or azithromycin (7 clusters); 3 clusters were resistant to >1 of these drugs. We observed resistance to any of these drugs in all 7 clusters among men who have sex with men (MSM) but in only 2 of the other 25 clusters (p<0.001). Azithromycin resistance was more common among MSM-associated clusters than other clusters (86% vs. 4% of clusters; p<0.001). For adults with suspected shigellosis, clinicians should culture feces; obtain sex histories; discuss shigellosis prevention; and choose treatment, when needed, according to antimicrobial drug susceptibility. Public health interviews for enteric illnesses should encompass sex practices; health messaging for MSM must include shigellosis prevention.
Borrelia miyamotoi–Associated Neuroborreliosis in Immunocompromised Person
PDF Version [PDF - 644 KB - 4 pages]
K. Boden et al.View Abstract
Borrelia miyamotoi is a newly recognized human pathogen in the relapsing fever group of spirochetes. We investigated a case of B. miyamotoi infection of the central nervous system resembling B. burgdorferi–induced Lyme neuroborreliosis and determined that this emergent agent of central nervous system infection can be diagnosed with existing methods.
Persistent Bacillus cereus Bacteremia in 3 Persons Who Inject Drugs, San Diego, California, USA
PDF Version [PDF - 1.45 MB - 3 pages]
G. Schaefer et al.View Abstract
Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones.
Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002–2011
PDF Version [PDF - 660 KB - 4 pages]
B. A. Wuerth et al.View Abstract
Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus.
Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices
PDF Version [PDF - 477 KB - 3 pages]
E. E. Sickbert-Bennett et al.View Abstract
Improving hand hygiene from high to very high compliance has not been documented to decrease healthcare-associated infections. We conducted longitudinal analyses during 2013–2015 in an 853-bed hospital and observed a significantly increased hand hygiene compliance rate (p<0.001) and a significantly decreased healthcare-associated infection rate (p = 0.0066).
Nosocomial Outbreak of Parechovirus 3 Infection among Newborns, Austria, 2014
PDF Version [PDF - 2.06 MB - 4 pages]
V. Strenger et al.View Abstract
In 2014, sepsis-like illness affected 9 full-term newborns in 1 hospital in Austria. Although results of initial microbiological testing were negative, electron microscopy identified picornavirus. Archived serum samples and feces obtained after discharge were positive by PCR for human parechovirus 3. This infection should be included in differential diagnoses of sepsis-like illness in newborns.
Large-Scale Survey for Tickborne Bacteria, Khammouan Province, Laos
PDF Version [PDF - 693 KB - 5 pages]
A. J. Taylor et al.View Abstract
We screened 768 tick pools containing 6,962 ticks from Khammouan Province, Laos, by using quantitative real-time PCR and identified Rickettsia spp., Ehrlichia spp., and Borrelia spp. Sequencing of Rickettsia spp.–positive and Borrelia spp.–positive pools provided evidence for distinct genotypes. Our results identified bacteria with human disease potential in ticks in Laos.
Multidrug-Resistant Shigella Infections in Patients with Diarrhea, Cambodia, 2014–2015
PDF Version [PDF - 1.58 MB - 4 pages]
K. Poramathikul et al.View Abstract
We observed multidrug resistance in 10 (91%) of 11 Shigella isolates from a diarrheal surveillance study in Cambodia. One isolate was resistant to fluoroquinolones and cephalosporins and showed decreased susceptibility to azithromycin. We found mutations in gyrA, parC, β-lactamase, and mphA genes. Multidrug resistance increases concern about shigellosis treatment options.
Contact Tracing for Imported Case of Middle East Respiratory Syndrome, China, 2015
PDF Version [PDF - 336 KB - 3 pages]
M. Kang et al.View Abstract
Confirmation of an imported case of infection with Middle East respiratory syndrome coronavirus in China triggered intensive contact tracing and mandatory monitoring. Using a hotline and surveillance video footage was effective for tracing all 110 identified contacts. Contact monitoring detected no secondary transmission of infection in China.
Mutation in West Nile Virus Structural Protein prM during Human Infection
PDF Version [PDF - 378 KB - 3 pages]
Y. Lustig et al.View Abstract
A mutation leading to substitution of a key amino acid in the prM protein of West Nile virus (WNV) occurred during persistent infection of an immunocompetent patient. WNV RNA persisted in the patient’s urine and serum in the presence of low-level neutralizing antibodies. This case demonstrates active replication of WNV during persistent infection.
Multidrug-Resistant Escherichia coli in Bovine Animals, Europe
PDF Version [PDF - 555 KB - 3 pages]
E. Brennan et al.View Abstract
Of 150 Escherichia coli strains we cultured from specimens taken from cattle in Europe, 3 had elevated MICs against colistin. We assessed all 3 strains for the presence of the plasmid-mediated mcr-1 gene and identified 1 isolate as mcr-1–positive and co-resistant to β-lactam, florfenicol, and fluoroquinolone antimicrobial compounds.
Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014–2015
PDF Version [PDF - 391 KB - 3 pages]
K. A. Lindblade et al.View Abstract
Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.
Changing Diagnostic Methods and Increased Detection of Verotoxigenic Escherichia coli, Ireland
PDF Version [PDF - 342 KB - 2 pages]
T. Rice et al.View Abstract
The recent paradigm shift in infectious disease diagnosis from culture-based to molecular-based approaches is exemplified in the findings of a national study assessing the detection of verotoxigenic Escherichia coli infections in Ireland. The methodologic changes have been accompanied by a dramatic increase in detections of non-O157 verotoxigenic E. coli serotypes.
Multidrug-Resistant Campylobacter coli in Men Who Have Sex with Men, Quebec, Canada, 2015
PDF Version [PDF - 521 KB - 3 pages]
C. Gaudreau et al.
Local Persistence of Novel MRSA Lineage after Hospital Ward Outbreak, Cambridge, UK, 2011–2013
PDF Version [PDF - 406 KB - 2 pages]
M. S. Toleman et al.
Community-Acquired Clostridium difficile Infection, Queensland, Australia
PDF Version [PDF - 357 KB - 3 pages]
L. Furuya-Kanamori et al.
Biological Warfare in the 17th Century
PDF Version [PDF - 317 KB - 2 pages]
Bifidobacterium longum Subspecies infantis Bacteremia in 3 Extremely Preterm Infants Receiving Probiotics
PDF Version [PDF - 491 KB - 3 pages]
E. Esaiassen et al.
Multidrug-Resistant Staphylococcus aureus, India, 2013–2015
PDF Version [PDF - 457 KB - 2 pages]
Colistin-Resistant Enterobacteriaceae Carrying the mcr-1 Gene among Patients in Hong Kong
PDF Version [PDF - 406 KB - 3 pages]
S. Wong et al.
Cryptococcus gattii Meningitis Complicated by Listeria monocytogenes Infection
PDF Version [PDF - 342 KB - 3 pages]
R. G. Deiss et al.
Melioidosis in Travelers Returning from Vietnam to France
PDF Version [PDF - 313 KB - 3 pages]
J. Gauthier et al.
mcr-1–Positive Colistin-Resistant Escherichia coli in Traveler Returning to Canada from China
PDF Version [PDF - 496 KB - 3 pages]
M. Payne et al.
Carbapenem-Resistant Enterobacter spp. in Retail Seafood Imported from Southeast Asia to Canada
PDF Version [PDF - 377 KB - 3 pages]
N. Janecko et al.
Fluoroquinolone-Resistant Mycoplasma genitalium, Southwestern France
PDF Version [PDF - 371 KB - 3 pages]
C. Le Roy et al.
Possible Transmission of mcr-1–Harboring Escherichia coli between Companion Animals and Human
PDF Version [PDF - 355 KB - 3 pages]
X. Zhang et al.
Acetobacter indonesiensis Bacteremia in Child with Metachromatic Leukodystrophy
PDF Version [PDF - 321 KB - 3 pages]
R. Kohlmann et al.
Autochthonous Chikungunya Fever in Traveler Returning to Japan from Cuba
PDF Version [PDF - 350 KB - 3 pages]
M. Tsuboi et al.
Inactivation and Environmental Stability of Zika Virus
PDF Version [PDF - 485 KB - 3 pages]
J. A. Müller et al.
ESBL-Producing Strain of Hypervirulent Klebsiella pneumoniae K2, France
PDF Version [PDF - 298 KB - 2 pages]
L. Surgers et al.
Specificity of Dengue NS1 Antigen in Differential Diagnosis of Dengue and Zika Virus Infection
PDF Version [PDF - 351 KB - 3 pages]
S. Matheus et al.
Vibrio cholerae O1 Imported from Iraq to Kuwait, 2015
PDF Version [PDF - 554 KB - 2 pages]
A. Mukhopadhyay et al.
Chromosomal Locations of mcr-1 and bla in Fluoroquinolone-Resistant Escherichia coli ST410
PDF Version [PDF - 452 KB - 3 pages]
L. Falgenhauer et al.
About the Cover
Proceedings of First Histoplasmosis in the Americas and the Caribbean Meeting, Paramaribo, Suriname, December 4–6, 2015
M. Nacher and A. Adenis
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- Page created: August 23, 2016
- Page last updated: August 23, 2016
- Page last reviewed: August 23, 2016
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