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Volume 19, Number 7—July 2013

CME ACTIVITY

Transmission of Streptococcus equi Subspecies zooepidemicus Infection from Horses to Humans

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title:
Transmission of Streptococcus equi Subspecies zooepidemicus Infection
from Horses to Human

CME Questions

1. You are seeing a 50-year-old male who works as a horse trainer. The patient has a 2-week history of malaise, back and neck pain, and fever. He had thought he had the flu, but his wife noticed that he was confused and lethargic this morning and brought him to the doctor’s office.

You consider whether this patient might have an infection with Streptococcus equi zooepidemicus. S. zooepidemicus was associated with all of the following sites of infection in the current case series EXCEPT:

A. Throat

B. Joint

C. Soft tissue

D. Central nervous system/meningitis

2. What should you consider regarding the clinical course of patients with S. zooepidemicus infection in the current study?

A. None of the patients had recent exposure to horses

B. All patients died of the infection

C. There was broad antimicrobial resistance of S. zooepidemicus isolates

D. All patients had objective findings of systemic inflammation

3. The patient is admitted to hospital, and his blood culture grows S. zooepidemicus. What should you consider regarding the transmission of this infection?

A. S. zooepidemicus is only found in horses and humans

B. Half of the horses found to harbor S. zooepidemicus in the current study were sick

C. Two patients in the current study were infected with the same strain of S. zooepidemicus despite living over 100 km from each other

D. All 3 patients in the current study were infected with the same strain of S. zooepidemicus

4. As you treat this patient, what should you consider regarding molecular findings from the current study?

A. Gene sequencing failed to connect human with equine isolates

B. Pulsed-field gel electrophoresis profiles were similar for the same strain of S. zooepidemicus

C. All multilocus sequence typing (MLST) sequence types correlated to known sequences of S. zooepidemicus

D. One strain was similar on MLST to a strain associated with a previous disease outbreak

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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