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Emerging Infectious Diseases journal
Guillain-Barré Syndrome and Healthcare Needs during Zika Virus Transmission, Puerto Rico, 2016 E. Dirlikov et al. January 2017
Prolonged Detection of Zika Virus in Vaginal Secretions and Whole Blood K. O. Murray et al. January 2017
Persistent Zika Virus Detection in Semen in a Traveler Returning to the United Kingdom from Brazil, 2016 K. M. Gaskell et al. January 2017
Volume 22, Number 11—November 2016 PDF Version [PDF - 7.42 MB - 176 pages]
Medscape CME Activity
Transmission of Babesia microti Parasites by Solid Organ Transplantation PDF Version [PDF - 1.12 MB - 8 pages]M. B. Brennan et al.View SummaryView Abstract
Infection with this parasite should be included in differential diagnosis of fever and anemia after blood transfusion or organ transplantation.
Babesia microti, an intraerythrocytic parasite, is tickborne in nature. In contrast to transmission by blood transfusion, which has been well documented, transmission associated with solid organ transplantation has not been reported. We describe parasitologically confirmed cases of babesiosis diagnosed ≈8 weeks posttransplantation in 2 recipients of renal allografts from an organ donor who was multiply transfused on the day he died from traumatic injuries. The organ donor and recipients had no identified risk factors for tickborne infection. Antibodies against B. microti parasites were not detected by serologic testing of archived pretransplant specimens. However, 1 of the organ donor’s blood donors was seropositive when tested postdonation and had risk factors for tick exposure. The organ donor probably served as a conduit of Babesia parasites from the seropositive blood donor to both kidney recipients. Babesiosis should be included in the differential diagnosis of unexplained fever and hemolytic anemia after blood transfusion or organ transplantation.
Immune Responses to Invasive Group B Streptococcal Disease in Adults
PDF Version [PDF - 1.00 MB - 7 pages]
M. S. Edwards et al.View SummaryView Abstract
Antibodies to capsular polysaccharides and pilus proteins develop in recovering adults.
Immunization of nonpregnant adults could help prevent invasive group B Streptococcus (GBS) infections, but adult immune responses have not been investigated. We defined capsular polysaccharide (CPS) and pilus island (PI) surface antigen distribution and expression and immune responses to GBS infection in nonpregnant adults. Prospective surveillance from 7 hospitals in Houston, Texas, USA, identified 102 adults with GBS bacteremia; 43% had skin/soft tissue infection, 16% bacteremia without focus, and 12% osteomyelitis. CPS-specific IgG was determined by ELISA and pilus-specific IgG by multiplex immunoassay. CPS types were Ia (24.5%), Ib (12.7%), II (9.8%), III (16.7%), IV (13.7%), and V (12.7%); 9.8% were nontypeable by serologic methods. Pili, expressed by 89%, were most often PI-2a. CPS and pilus-specific IgG increased during convalescence among patients with strains expressing CPS or PI. All GBS expressed CPS or PI; 79% expressed both. Increased antibodies to CPS and PI during recovery suggests that GBS bacteremia in adults is potentially vaccine preventable.
Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014–2015
PDF Version [PDF - 2.49 MB - 9 pages]
A. Mirand et al.View SummaryView Abstract
Outbreaks can be detected by syndromic surveillance, rapid enterovirus testing, and genotyping.
The clinical impact of enteroviruses associated with hand, foot and mouth disease (HFMD) is unknown outside Asia, and the prevalence of enterovirus A71 (EV-A71) in particular might be underestimated. To investigate the prevalence of enterovirus serotypes and the clinical presentations associated with HFMD in France, we conducted prospective ambulatory clinic–based surveillance of children during April 2014–March 2015. Throat or buccal swabs were collected from children with HFMD and tested for the enterovirus genome. Physical examinations were recorded on a standardized form. An enterovirus infection was detected in 523 (79.3%) of 659 children tested. Two epidemic waves occurred, dominated by coxsackievirus (CV) A6, which was detected in 53.9% of enterovirus-infected children. CV-A6 was more frequently related to atypical HFMD manifestations (eruptions extended to limbs and face). Early awareness and documentation of HFMD outbreaks can be achieved by syndromic surveillance of HFMD by ambulatory pediatricians and rapid enterovirus testing and genotyping.
Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil
PDF Version [PDF - 981 KB - 6 pages]
C. Barcellos et al.View SummaryView Abstract
Neurologic manifestations of Zika infection must be adequately recognized and treated; our study methods can be used for monitoring and warning systems.
Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008–February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.
Global Escherichia coli Sequence Type 131 Clade with blaCTX-M-27 Gene
PDF Version [PDF - 5.82 MB - 8 pages]
Y. Matsumura et al.View SummaryView Abstract
Increased extended-spectrum β-lactamase–producing E. coli in Japan resulted mainly from a clade containing this gene.
The Escherichia coli sequence type (ST) 131 C2/H30Rx clade with the blaCTX-M-15 gene had been most responsible for the global dissemination of extended-spectrum β-lactamase (ESBL)–producing E. coli. ST131 C1/H30R with blaCTX-M-27 emerged among ESBL-producing E. coli in Japan during the late 2000s. To investigate the possible expansion of a single clade, we performed whole-genome sequencing for 43 Japan and 10 global ST131 isolates with blaCTX-M-27 (n = 16), blaCTX-M-14 (n = 16), blaCTX-M-15 (n = 13), and others (n = 8). We also included 8 ST131 genomes available in public databases. Core genome-based analysis of 61 isolates showed that ST131 with blaCTX-M-27 from 5 countries formed a distinct cluster within the C1/H30R clade, named C1-M27 clade. Accessory genome analysis identified a unique prophage-like region, supporting C1-M27 as a distinct clade. Our findings indicate that the increase of ESBL-producing E. coli in Japan is due mainly to emergence of the C1-M27 clade.
Medscape CME Activity
Multidrug-Resistant Corynebacterium striatum Associated with Increased Use of Parenteral Antimicrobial Drugs PDF Version [PDF - 2.32 MB - 7 pages]W. O. Hahn et al.View SummaryView Abstract
Device-related infections with this pathogen frequently require prolonged parenteral therapy.
Corynebacterium striatum is an emerging multidrug-resistant bacteria. We retrospectively identified 179 isolates in a clinical database. Clinical relevance, in vitro susceptibility, and length of parenteral antimicrobial drug use were obtained from patient records. For patients with hardware- or device-associated infections, those with C. striatum infections were matched with patients infected with coagulase-negative staphylococci for case–control analysis. A total of 87 (71%) of 121 isolates were resistant to all oral antimicrobial drugs tested, including penicillin, tetracycline, clindamycin, erythromycin, and ciprofloxacin. When isolated from hardware or devices, C. striatum was pathogenic in 38 (87%) of 44 cases. Patients with hardware-associated C. striatum infections received parenteral antimicrobial drugs longer than patients with hardware-associated coagulase-negative staphylococci infections (mean ± SD 69 ± 5 days vs. 25 ± 4 days; p<0.001). C. striatum commonly shows resistance to antimicrobial drugs with oral bioavailability and is associated with increased use of parenteral antimicrobial drugs.
Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel
PDF Version [PDF - 495 KB - 6 pages]
B. M. Alraddadi et al.View SummaryView Abstract
Infections occurred exclusively among personnel who had close contact with MERS-CoV patients.
Healthcare settings can amplify transmission of Middle East respiratory syndrome coronavirus (MERS-CoV), but knowledge gaps about the epidemiology of transmission remain. We conducted a retrospective cohort study among healthcare personnel in hospital units that treated MERS-CoV patients. Participants were interviewed about exposures to MERS-CoV patients, use of personal protective equipment, and signs and symptoms of illness after exposure. Infection status was determined by the presence of antibodies against MERS-CoV. To assess risk factors, we compared infected and uninfected participants. Healthcare personnel caring for MERS-CoV patients were at high risk for infection, but infection most often resulted in a relatively mild illness that might be unrecognized. In the healthcare personnel cohort reported here, infections occurred exclusively among those who had close contact with MERS-CoV patients.
Epidemiology of La Crosse Virus Emergence, Appalachia Region, United States
PDF Version [PDF - 1.50 MB - 9 pages]
S. Bewick et al.View SummaryView Abstract
Emergence may involve invasive mosquitoes other than Asian tiger mosquitoes, climate change, and changes in wildlife densities.
La Crosse encephalitis is a viral disease that has emerged in new locations across the Appalachian region of the United States. Conventional wisdom suggests that ongoing emergence of La Crosse virus (LACV) could stem from the invasive Asian tiger (Aedes albopictus) mosquito. Efforts to prove this, however, are complicated by the numerous transmission routes and species interactions involved in LACV dynamics. To analyze LACV transmission by Asian tiger mosquitoes, we constructed epidemiologic models. These models accurately predict empirical infection rates. They do not, however, support the hypothesis that Asian tiger mosquitoes are responsible for the recent emergence of LACV at new foci. Consequently, we conclude that other factors, including different invasive mosquitoes, changes in climate variables, or changes in wildlife densities, should be considered as alternative explanations for recent increases in La Crosse encephalitis.
Reassortant Eurasian Avian-Like Influenza A(H1N1) Virus from a Severely Ill Child, Hunan Province, China, 2015
PDF Version [PDF - 2.38 MB - 7 pages]
W. Zhu et al.View SummaryView Abstract
Infectivity and virulence of this virus in mice are higher than for previous human-origin Eurasian avian–like viruses.
In 2015, a novel influenza A(H1N1) virus was isolated from a boy in China who had severe pneumonia. The virus was a genetic reassortant of Eurasian avian-like influenza A(H1N1) (EA-H1N1) virus. The hemagglutinin, neuraminidase, and matrix genes of the reassortant virus were highly similar to genes in EA-H1N1 swine influenza viruses, the polybasic 1 and 2, polymerase acidic, and nucleoprotein genes originated from influenza A(H1N1)pdm09 virus, and the nonstructural protein gene derived from classical swine influenza A(H1N1) (CS H1N1) virus. In a mouse model, the reassortant virus, termed influenza A/Hunan/42443/2015(H1N1) virus, showed higher infectivity and virulence than another human EA-H1N1 isolate, influenza A/Jiangsu/1/2011(H1N1) virus. In the respiratory tract of mice, virus replication by influenza A/Hunan/42443/2015(H1N1) virus was substantially higher than that by influenza A/Jiangsu/1/2011(H1N1) virus. Human-to-human transmission of influenza A/Hunan/42443/2015(H1N1) virus has not been detected; however, given the circulation of novel EA-H1N1 viruses in pigs, enhanced surveillance should be instituted among swine and humans.
Serotype IV Sequence Type 468 Group B Streptococcus Neonatal Invasive Disease, Minnesota, USA
PDF Version [PDF - 1.11 MB - 4 pages]
S. Teatero et al.View Abstract
To further understand the emergence of serotype IV group B Streptococcus (GBS) invasive disease, we used whole-genome sequencing to characterize 3 sequence type 468 strains isolated from neonates in Minnesota, USA. We found that strains of tetracycline-resistant sequence type 468 GBS have acquired virulence genes from a putative clonal complex 17 GBS donor by recombination.
Capsular Switching and Other Large-Scale Recombination Events in Invasive Sequence Type 1 Group B Streptococcus
PDF Version [PDF - 1.76 MB - 4 pages]
A. Neemuchwala et al.View Abstract
We report several cases of recombination events leading to capsular switching among sequence type (ST) 1 group B Streptococcus strains. These strains otherwise shared a common genome backbone with serotype V ST1 strains. However, the genomes of ST1 serotype V strains and those of serotypes VI, VII, and VIII strains differed substantially.
Changing Pattern of Chlamydia trachomatis Strains in Lymphogranuloma Venereum Outbreak, France, 2010–2015
PDF Version [PDF - 740 KB - 3 pages]
O. Peuchant et al.View Abstract
We describe a change in the molecular epidemiology of Chlamydia trachomatis strains involved in an outbreak of rectal lymphogranuloma venereum in France during January 2010–April 2015. Until 2012, the C. trachomatis L2b strain predominated; however, starting in 2013, most cases involved the L2 strain. We also identified 4 genetic L2b ompA variants.
ESBL-Producing and Macrolide-Resistant Shigella sonnei Infections among Men Who Have Sex with Men, England, 2015
PDF Version [PDF - 1.50 MB - 5 pages]
P. Mook et al.View Abstract
In England in 2015, Shigella sonnei isolates from men who have sex with men produced extended-spectrum β-lactamases and exhibited macrolide resistance. Whole-genome sequencing showed a close relationship among the isolates, which harbored a plasmid that was previously identified in a shigellosis outbreak among this population but has acquired a mobile element.
Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome
PDF Version [PDF - 1.00 MB - 4 pages]
A. Moura da Silva et al.View Abstract
We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.
Severe Fever with Thrombocytopenia Syndrome Complicated by Co-infection with Spotted Fever Group Rickettsiae, China
PDF Version [PDF - 1.56 MB - 4 pages]
Q. Lu et al.View Abstract
During 2013–2015 in central China, co-infection with spotted fever group rickettsiae was identified in 77 of 823 patients infected with severe fever with thrombocytopenia syndrome virus. Co-infection resulted in delayed recovery and increased risk for death, prompting clinical practices in the region to consider co-infection in patients with severe fever with thrombocytopenia syndrome.
Guinea Worm (Dracunculus medinensis) Infection in a Wild-Caught Frog, Chad
PDF Version [PDF - 938 KB - 2 pages]
M. L. Eberhard et al.View Abstract
A third-stage (infective) larva of Dracunculus medinensis, the causative agent of Guinea worm disease, was recovered from a wild-caught Phrynobatrachus francisci frog in Chad. Although green frogs (Lithobates clamitans) have been experimentally infected with D. medinensis worms, our findings prove that frogs can serve as natural paratenic hosts.
Dog-Mediated Human Rabies Death, Haiti, 2016
PDF Version [PDF - 969 KB - 3 pages]
R. M. Wallace et al.View Abstract
Haiti has experienced numerous barriers to rabies control over the past decades and is one of the remaining Western Hemisphere countries to report dog-mediated human rabies deaths. We describe the circumstances surrounding a reported human rabies death in 2016 as well as barriers to treatment and surveillance reporting.
Staphylococcus aureus Colonization and Long-Term Risk for Death, United States
PDF Version [PDF - 823 KB - 4 pages]
A. Mendy et al.View Abstract
To examine the association of colonization by Staphylococcus aureus and general population mortality, we followed 10,598 adults for 8.5 years on average. Methicillin-susceptible S. aureus colonization was not associated with death. Methicillin-resistant S. aureus carriage predicted death in a crude analysis but not after adjustment for socioeconomic status and co-morbidities.
Group B Streptococcus Serotype III Sequence Type 283 Bacteremia Associated with Consumption of Raw Fish, Singapore
PDF Version [PDF - 860 KB - 4 pages]
S. Tan et al.View Abstract
We conducted a retrospective study of 40 case-patients and 58 controls as part of a nationwide investigation of a group B Streptococcus outbreak in Singapore in 2015. Eating a Chinese-style raw fish dish (yusheng) was a major risk factor for bacteremia, particularly caused by serotype III sequence type 283.
Group B Streptococcus Sequence Type 283 Disease Linked to Consumption of Raw Fish, Singapore
PDF Version [PDF - 533 KB - 4 pages]
P. Rajendram et al.View Abstract
An outbreak of invasive group B Streptococcus (GBS) disease occurred in Singapore in mid-2015. We conducted a case–control study of 22 adults with invasive GBS infections during June 21–November 21, 2015. Consumption of raw fish was strongly associated with invasive sequence type 283 infections, but not with non–sequence type 283 infections.
Novel Levofloxacin-Resistant Multidrug-Resistant Streptococcus pneumoniae Serotype 11A Isolates, South Korea
PDF Version [PDF - 386 KB - 3 pages]
M. Park et al.View Abstract
Of 608 Streptococcus pneumoniae clinical strains isolated at a hospital in South Korea during 2009–2014, sixteen (2.6%) were identified as levofloxacin resistant. The predominant serotype was 11A (9 isolates). Two novel sequence types of multidrug-resistant S. pneumoniae with serotype 11A were identified, indicating continuous diversification of resistant strains.
Imported Chikungunya Virus Strains, Taiwan, 2006–2014
PDF Version [PDF - 1.12 MB - 4 pages]
C. Yang et al.View Abstract
We identified 78 imported chikungunya cases in Taiwan during 2006–2014. Sixty-six (84.6%) cases were initially suspected to be dengue, which indicates the necessity for laboratory diagnostics in differentiation between dengue and chikungunya. Results also emphasize the need for active surveillance of febrile illness at points of entry.
Neutralizing Antibodies to Severe Fever with Thrombocytopenia Syndrome Virus 4 Years after Hospitalization, China
PDF Version [PDF - 1.82 MB - 3 pages]
Y. Huang et al.View Abstract
Severe fever with thrombocytopenia syndrome is an emerging hemorrhagic fever disease in eastern Asia, caused by a tickborne bunyavirus. Of 25 patients hospitalized with this disease in China, 100% produced and maintained neutralizing antibodies to severe fever with thrombocytopenia syndrome virus for the study period of 4 years.
Increased Community-Associated Infections Caused by Panton-Valentine Leukocidin–Negative MRSA, Shanghai, 2005–2014
PDF Version [PDF - 1.22 MB - 4 pages]
M. Li et al.View Abstract
During 2005–2014, community-associated methicillin-resistant Staphylococcus aureus infections increased in Shanghai, China. Most infections were caused by sequence type 59 S. aureus that lacked Panton-Valentine leukocidin. This finding challenges the notion that Panton-Valentine leukocidin is necessary for epidemiologic success of community-associated methicillin-resistant S. aureus.
Severe Fever with Thrombocytopenia Syndrome in Patients Suspected of Having Scrub Typhus
PDF Version [PDF - 1.37 MB - 4 pages]
Y. Wi et al.View Abstract
To determine prevalence of severe fever with thrombocytopenia syndrome in South Korea, we examined serum samples from patients with fever and insect bite history in scrub typhus–endemic areas. During the 2013 scrub typhus season, prevalence of this syndrome among patients suspected of having scrub typhus was high (23.0%), suggesting possible co-infection.
Nasopharyngeal Pneumococcal Density and Evolution of Acute Respiratory Illnesses in Young Children, Peru, 2009–2011
PDF Version [PDF - 424 KB - 4 pages]
R. R. Fan et al.View Abstract
We examined nasopharyngeal pneumococcal colonization density patterns surrounding acute respiratory illnesses (ARI) in young children in Peru. Pneumococcal densities were dynamic, gradually increasing leading up to an ARI, peaking during the ARI, and decreasing after the ARI. Rhinovirus co-infection was associated with higher pneumococcal densities.
Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015
PDF Version [PDF - 766 KB - 3 pages]
J. Lednicky et al.View Abstract
Mayaro virus has been associated with small outbreaks in northern South America. We isolated this virus from a child with acute febrile illness in rural Haiti, confirming its role as a cause of mosquitoborne illness in the Caribbean region. The clinical presentation can mimic that of chikungunya, dengue, and Zika virus infections.
Co-infections with Chikungunya and Dengue Viruses, Guatemala, 2015
PDF Version [PDF - 839 KB - 3 pages]
T. Edwards et al.View Abstract
We screened serum samples referred to the national reference laboratory in Guatemala that were positive for chikungunya or dengue viruses in June 2015. Co-infection with both viruses was detected by reverse transcription PCR in 46 (32%) of 144 samples. Specimens should be tested for both arboviruses to detect co-infections.
Early Mention of the Term Epidemiology
PDF Version [PDF - 272 KB - 1 page]
Marseillevirus in the Pharynx of a Patient with Neurologic Disorders
PDF Version [PDF - 949 KB - 3 pages]
S. Aherfi et al.
Lack of Mimivirus Detection in Patients with Respiratory Disease, China
PDF Version [PDF - 305 KB - 2 pages]
X. Zhang et al.
Severe Pneumonia Associated with Adenovirus Type 55 Infection, France, 2014
PDF Version [PDF - 457 KB - 3 pages]
J. Lafolie et al.
Spotted Fever Group Rickettsia in the Pampa Biome, Brazil, 2015–2016
PDF Version [PDF - 1.13 MB - 3 pages]
B. Weck et al.
Shigella flexneri with Ciprofloxacin Resistance and Reduced Azithromycin Susceptibility, Canada, 2015
PDF Version [PDF - 397 KB - 3 pages]
C. Gaudreau et al.
HIV/Hepatitis C Virus Co-infection among Adults Beginning Antiretroviral Therapy, Malawi
PDF Version [PDF - 349 KB - 3 pages]
M. Demir et al.
Exposures among MERS Case-Patients, Saudi Arabia, January–February 2016
PDF Version [PDF - 317 KB - 3 pages]
R. F. Alhakeem et al.
Leishmania major Cutaneous Leishmaniasis in 3 Travelers Returning from Israel to the Netherlands
PDF Version [PDF - 372 KB - 3 pages]
J. S. Kuilder et al.
Molecular Evidence of Oysters as Vehicle of Norovirus GII.P17-GII.17
PDF Version [PDF - 297 KB - 2 pages]
L. Rasmussen et al.
Recent Chikungunya Virus Infection in 2 Travelers Returning from Mogadishu, Somalia, to Italy, 2016
PDF Version [PDF - 359 KB - 3 pages]
L. Zammarchi et al.
Meningococcal Disease in US Military Personnel before and after Adoption of Conjugate Vaccine
PDF Version [PDF - 507 KB - 2 pages]
M. D. Decker
Travel-Associated Vibrio cholerae O1 El Tor, Russia
PDF Version [PDF - 520 KB]
K. V. Kuleshov et al.
Books and Media
Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti
PDF Version [PDF - 681 KB - 2 pages]
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- Page created: October 19, 2016
- Page last updated: October 19, 2016
- Page last reviewed: October 19, 2016
- Centers for Disease Control and Prevention,
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