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Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn Medscape CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Medscape CME for physicians. The activities listed below have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Volume 20—2014

Volume 20, Number 12—December 2014

image of the 'Thumbnail' version of the Volume 20, Number 12—December 2014 cover of the CDC's EID journal
Medscape CME Activity
Seroconversion for Infectious Pathogens among UK Military Personnel Deployed to Afghanistan, 2008–2011 PDF Version [PDF - 567 KB - 8 pages]
E. Newman et al.
View Summary

Many exposures, and potentially infections, are unreported.

    View Abstract

Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008–2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.

    Cite This Article
EID Newman E, Johnstone P, Bridge H, Wright D, Jameson L, Bosworth A, et al. Seroconversion for Infectious Pathogens among UK Military Personnel Deployed to Afghanistan, 2008–2011. Emerg Infect Dis. 2014;20(12):2015-2022. https://dx.doi.org/10.3201/eid2012.131830
AMA Newman E, Johnstone P, Bridge H, et al. Seroconversion for Infectious Pathogens among UK Military Personnel Deployed to Afghanistan, 2008–2011. Emerging Infectious Diseases. 2014;20(12):2015-2022. doi:10.3201/eid2012.131830.
APA Newman, E., Johnstone, P., Bridge, H., Wright, D., Jameson, L., Bosworth, A....Hewson, R. (2014). Seroconversion for Infectious Pathogens among UK Military Personnel Deployed to Afghanistan, 2008–2011. Emerging Infectious Diseases, 20(12), 2015-2022. https://dx.doi.org/10.3201/eid2012.131830.
Medscape CME Activity
Bacterial Pathogens Associated with Hidradenitis Suppurativa, France PDF Version [PDF - 609 KB - 9 pages]
H. Guet-Revillet et al.
View Summary

Staphylococcus lugdunensis and anaerobic actinomycetes are associated with this skin infection.

    View Abstract

Hidradenitis suppurativa (HS) is a skin disease characterized by recurrent nodules or abscesses and chronic suppurating lesions. In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment. Recently, prolonged antimicrobial treatments were shown to improve or resolve HS lesions. We prospectively studied the microbiology of 102 HS lesions sampled from 82 patients using prolonged bacterial cultures and bacterial metagenomics on 6 samples. Staphylococcus lugdunensis was cultured as a unique or predominant isolate from 58% of HS nodules and abscesses, and a polymicrobial anaerobic microflora comprising strict anaerobes, milleri group streptococci, and actinomycetes was found in 24% of abscesses or nodules and in 87% of chronic suppurating lesions. These data show that bacteria known to cause soft tissue and skin infections are associated with HS lesions. Whether these pathogens are the cause of the lesions or are secondary infectious agents, these findings support targeted antimicrobial treatment of HS.

    Cite This Article
EID Guet-Revillet H, Coignard-Biehler H, Jais J, Quesne G, Frapy E, Poirée S, et al. Bacterial Pathogens Associated with Hidradenitis Suppurativa, France. Emerg Infect Dis. 2014;20(12):1990-1998. https://dx.doi.org/10.3201/eid2012.140064
AMA Guet-Revillet H, Coignard-Biehler H, Jais J, et al. Bacterial Pathogens Associated with Hidradenitis Suppurativa, France. Emerging Infectious Diseases. 2014;20(12):1990-1998. doi:10.3201/eid2012.140064.
APA Guet-Revillet, H., Coignard-Biehler, H., Jais, J., Quesne, G., Frapy, E., Poirée, S....Join-Lambert, O. (2014). Bacterial Pathogens Associated with Hidradenitis Suppurativa, France. Emerging Infectious Diseases, 20(12), 1990-1998. https://dx.doi.org/10.3201/eid2012.140064.

Volume 20, Number 11—November 2014

image of the 'Thumbnail' version of the Volume 20, Number 11—November 2014 cover of the CDC's EID journal
Medscape CME Activity
Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011 PDF Version [PDF - 596 KB - 8 pages]
A. Farnham et al.
View Summary

Living in low-income areas and working in certain occupations may increase risk.

    View Abstract

Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.

    Cite This Article
EID Farnham A, Alleyne L, Cimini D, Balter S. Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011. Emerg Infect Dis. 2014;20(11):1795-1802. https://dx.doi.org/10.3201/eid2011.131872
AMA Farnham A, Alleyne L, Cimini D, et al. Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011. Emerging Infectious Diseases. 2014;20(11):1795-1802. doi:10.3201/eid2011.131872.
APA Farnham, A., Alleyne, L., Cimini, D., & Balter, S. (2014). Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011. Emerging Infectious Diseases, 20(11), 1795-1802. https://dx.doi.org/10.3201/eid2011.131872.
Medscape CME Activity
Blastomycosis Mortality Rates, United States, 1990–2010 PDF Version [PDF - 421 KB - 6 pages]
D. Khuu et al.
View Summary

Risks for illness and death caused by the Blastomyces dermatitidis fungus are affected by demographic, geographic, and behavioral factors.

    View Abstract

Blastomycosis is a potentially fatal fungal infection endemic to parts of North America. We used national multiple-cause-of-death data and census population estimates for 1990–2010 to calculate age-adjusted mortality rates and rate ratios (RRs). We modeled trends over time using Poisson regression. Death occurred more often among older persons (RR 2.11, 95% confidence limit [CL] 1.76, 2.53 for those 75–84 years of age vs. 55–64 years), men (RR 2.43, 95% CL 2.19, 2.70), Native Americans (RR 4.13, 95% CL 3.86, 4.42 vs. whites), and blacks (RR 1.86, 95% CL 1.73, 2.01 vs. whites), in notably younger persons of Asian origin (mean = 41.6 years vs. 64.2 years for whites); and in the South (RR 18.15, 95% CL 11.63, 28.34 vs. West) and Midwest (RR 23.10, 95% CL14.78, 36.12 vs. West). In regions where blastomycosis is endemic, we recommend that the diagnosis be considered in patients with pulmonary disease and that it be a reportable disease.

    Cite This Article
EID Khuu D, Shafir S, Bristow B, Sorvillo FJ. Blastomycosis Mortality Rates, United States, 1990–2010. Emerg Infect Dis. 2014;20(11):1789-1794. https://dx.doi.org/10.3201/eid2011.131175
AMA Khuu D, Shafir S, Bristow B, et al. Blastomycosis Mortality Rates, United States, 1990–2010. Emerging Infectious Diseases. 2014;20(11):1789-1794. doi:10.3201/eid2011.131175.
APA Khuu, D., Shafir, S., Bristow, B., & Sorvillo, F. J. (2014). Blastomycosis Mortality Rates, United States, 1990–2010. Emerging Infectious Diseases, 20(11), 1789-1794. https://dx.doi.org/10.3201/eid2011.131175.

Volume 20, Number 10—October 2014

image of the 'Thumbnail' version of the Volume 20, Number 10—October 2014 cover of the CDC's EID journal
Medscape CME Activity
Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011 PDF Version [PDF - 683 KB - 8 pages]
H. L. Wright et al.
View Summary

Device removal seems to be vital to successful therapy.

    View Abstract

Laparoscopic gastric banding is a common bariatric procedure worldwide. Rapidly growing mycobacteria are environmental organisms increasingly seen as pathogens, often in infected prosthetic material. We report 18 cases of infection associated with laparoscopic gastric banding caused by Mycobacterium fortuitum and M. abscessus in Australia during 2005–2011. We identified cases by reviewing positive cultures at the Queensland state reference laboratory or through correspondence with clinicians, and we obtained clinical and epidemiologic data. Eleven cases of M. fortuitum and 7 cases of M. abscessus infection were identified. The port was thought to be the primary site of infection in 10 of these cases. Complications included peritonitis, band erosion, and chronic ulceration at the port site. Rapidly growing mycobacteria can infect both port and band and can occur as either an early perioperative or late infection. Combination antimicrobial therapy is used on the basis of in vitro susceptibilities. Device removal seems to be vital to successful therapy.

    Cite This Article
EID Wright HL, Thomson RM, Reid AB, Carter R, Bartley PB, Newton P, et al. Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011. Emerg Infect Dis. 2014;20(10):1612-1619. https://dx.doi.org/10.3201/eid2010.140077
AMA Wright HL, Thomson RM, Reid AB, et al. Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011. Emerging Infectious Diseases. 2014;20(10):1612-1619. doi:10.3201/eid2010.140077.
APA Wright, H. L., Thomson, R. M., Reid, A. B., Carter, R., Bartley, P. B., Newton, P....Coulter, C. (2014). Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011. Emerging Infectious Diseases, 20(10), 1612-1619. https://dx.doi.org/10.3201/eid2010.140077.
Medscape CME Activity
Risk Factors for Human Lice and Bartonellosis among the Homeless, San Francisco, California, USA PDF Version [PDF - 521 KB - 7 pages]
D. L. Bonilla et al.
View Summary

Results suggest that body lice disproportionately affect certain demographic groups and those who sleep outdoors.

    View Abstract

Homeless persons in San Francisco, California, USA, have been shown to have head and body lice infestations and Bartonella quintana infections. We surveyed a self-selected population of homeless persons in San Francisco to assess infestations of head and body lice, risks of having body lice, and presence of B. quintana in lice. A total of 203 persons who reported itching were surveyed during 2008–2010 and 2012: 60 (30%) had body lice, 10 (4.9%) had head lice, and 6 (3.0%) had both. B. quintana was detected in 10 (15.9%) of 63 body lice pools and in 6 (37.5%) of 16 head lice pools. Variables significantly associated (p<0.05) with having body lice in this homeless population included male sex, African–American ethnicity, and sleeping outdoors. Our study findings suggest that specific segments of the homeless population would benefit from information on preventing body lice infestations and louseborne diseases.

    Cite This Article
EID Bonilla DL, Cole-Porse C, Kjemtrup AM, Osikowicz LM, Kosoy MY. Risk Factors for Human Lice and Bartonellosis among the Homeless, San Francisco, California, USA. Emerg Infect Dis. 2014;20(10):1645-1651. https://dx.doi.org/10.3201/eid2010.131655
AMA Bonilla DL, Cole-Porse C, Kjemtrup AM, et al. Risk Factors for Human Lice and Bartonellosis among the Homeless, San Francisco, California, USA. Emerging Infectious Diseases. 2014;20(10):1645-1651. doi:10.3201/eid2010.131655.
APA Bonilla, D. L., Cole-Porse, C., Kjemtrup, A. M., Osikowicz, L. M., & Kosoy, M. Y. (2014). Risk Factors for Human Lice and Bartonellosis among the Homeless, San Francisco, California, USA. Emerging Infectious Diseases, 20(10), 1645-1651. https://dx.doi.org/10.3201/eid2010.131655.

Volume 20, Number 9—September 2014

image of the 'Thumbnail' version of the Volume 20, Number 9—September 2014 cover of the CDC's EID journal
Medscape CME Activity
Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010 PDF Version [PDF - 736 KB - 12 pages]
M. Booth et al.
View Summary

Patients who died had an increased sequential organ failure assessment score and need for vasopressors.

    View Abstract

In Scotland, the 2009 outbreak of Bacillus anthracis infection among persons who inject drugs resulted in a 28% death rate. To compare nonsurvivors and survivors, we obtained data on 11 nonsurvivors and 16 survivors. Time from B. anthracis exposure to symptoms or hospitalization and skin and limb findings at presentation did not differ between nonsurvivors and survivors. Proportionately more nonsurvivors had histories of excessive alcohol use (p = 0.05) and required vasopressors and/or mechanical ventilation (p<0.01 for each individually). Nonsurvivors also had higher sequential organ failure assessment scores (mean + SEM) (7.3 + 0.9 vs. 1.2 + 0.4, p<0.0001). Antibacterial drug administration, surgery, and anthrax polyclonal immune globulin treatments did not differ between nonsurvivors and survivors. Of the 14 patients who required vasopressors during hospitalization, 11 died. Sequential organ failure assessment score or vasopressor requirement during hospitalization might identify patients with injectional anthrax for whom limited adjunctive therapies might be beneficial.

    Cite This Article
EID Booth M, Donaldson L, Cui X, Sun J, Cole S, Dailsey S, et al. Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010. Emerg Infect Dis. 2014;20(9):1452-1463. https://dx.doi.org/10.3201/eid2009.131481
AMA Booth M, Donaldson L, Cui X, et al. Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010. Emerging Infectious Diseases. 2014;20(9):1452-1463. doi:10.3201/eid2009.131481.
APA Booth, M., Donaldson, L., Cui, X., Sun, J., Cole, S., Dailsey, S....Eichacker, P. Q. (2014). Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010. Emerging Infectious Diseases, 20(9), 1452-1463. https://dx.doi.org/10.3201/eid2009.131481.
Medscape CME Activity
Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France PDF Version [PDF - 517 KB - 8 pages]
A. Roux et al.
View Summary

Immunosuppressed patients without AIDS had longer time to treatment and a higher rate of death than did patients with AIDS.

    View Abstract

Pneumocystis jirovecii pneumonia (PCP) in patients without AIDS is increasingly common. We conducted a prospective cohort study of consecutive patients with proven PCP; of 544 patients, 223 (41%) had AIDS (AIDS patients) and 321 (59%) had other immunosuppressive disorders (non-AIDS patients). Fewer AIDS than non-AIDS patients required intensive care or ventilation, and the rate of hospital deaths—17.4% overall—was significantly lower for AIDS versus non-AIDS patients (4% vs. 27%; p<0.0001). Multivariable analysis showed the odds of hospital death increased with older age, receipt of allogeneic bone marrow transplant, immediate use of oxygen, need for mechanical ventilation, and longer time to treatment; HIV-positive status or receipt of a solid organ transplant decreased odds for death. PCP is more often fatal in non-AIDS patients, but time to diagnosis affects survival and is longer for non-AIDS patients. Clinicians must maintain a high index of suspicion for PCP in immunocompromised patients who do not have AIDS.

    Cite This Article
EID Roux A, Canet E, Valade S, Gangneux-Robert F, Hamane S, Lafabrie A, et al. Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France. Emerg Infect Dis. 2014;20(9):1490-1497. https://dx.doi.org/10.3201/eid2009.131668
AMA Roux A, Canet E, Valade S, et al. Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France. Emerging Infectious Diseases. 2014;20(9):1490-1497. doi:10.3201/eid2009.131668.
APA Roux, A., Canet, E., Valade, S., Gangneux-Robert, F., Hamane, S., Lafabrie, A....Azoulay, É. (2014). Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France. Emerging Infectious Diseases, 20(9), 1490-1497. https://dx.doi.org/10.3201/eid2009.131668.

Volume 20, Number 8—August 2014

image of the 'Thumbnail' version of the Volume 20, Number 8—August 2014 cover of the CDC's EID journal
Medscape CME Activity
Leptospirosis-Associated Hospitalizations, United States, 1998–2009 PDF Version [PDF - 394 KB - 7 pages]
R. M. Traxler et al.
View Summary

Average cost and duration of hospitalizations were significantly greater than for other infectious diseases.

    View Abstract

A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998–2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease–associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.

    Cite This Article
EID Traxler RM, Callinan LS, Holman RC, Steiner C, Guerra MA. Leptospirosis-Associated Hospitalizations, United States, 1998–2009. Emerg Infect Dis. 2014;20(8):1273-1279. https://dx.doi.org/10.3201/eid2008.130450
AMA Traxler RM, Callinan LS, Holman RC, et al. Leptospirosis-Associated Hospitalizations, United States, 1998–2009. Emerging Infectious Diseases. 2014;20(8):1273-1279. doi:10.3201/eid2008.130450.
APA Traxler, R. M., Callinan, L. S., Holman, R. C., Steiner, C., & Guerra, M. A. (2014). Leptospirosis-Associated Hospitalizations, United States, 1998–2009. Emerging Infectious Diseases, 20(8), 1273-1279. https://dx.doi.org/10.3201/eid2008.130450.

Volume 20, Number 7—July 2014

image of the 'Thumbnail' version of the Volume 20, Number 7—July 2014 cover of the CDC's EID journal
Medscape CME Activity
Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK PDF Version [PDF - 449 KB - 8 pages]
A. Abbara et al.
View Summary

Serologic surveillance should be implemented to identify the prevalence of this disease in persons who inject drugs.

    View Abstract

Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009–2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012–13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community.

    Cite This Article
EID Abbara A, Brooks T, Taylor GP, Nolan M, Donaldson H, Manikon M, et al. Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK. Emerg Infect Dis. 2014;20(7):1115-1122. https://dx.doi.org/10.3201/eid2007.131764
AMA Abbara A, Brooks T, Taylor GP, et al. Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK. Emerging Infectious Diseases. 2014;20(7):1115-1122. doi:10.3201/eid2007.131764.
APA Abbara, A., Brooks, T., Taylor, G. P., Nolan, M., Donaldson, H., Manikon, M....Holmes, A. (2014). Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK. Emerging Infectious Diseases, 20(7), 1115-1122. https://dx.doi.org/10.3201/eid2007.131764.
Medscape CME Activity
Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012 PDF Version [PDF - 546 KB - 8 pages]
A. L. Cohen et al.
View Summary

Patient age and co-infections, but not disease severity, were associated with virus type and subtype.

    View Abstract

To determine clinical and epidemiologic differences between influenza caused by different virus types and subtypes, we identified patients and tested specimens. Patients were children and adults hospitalized with confirmed influenza and severe acute respiratory illness (SARI) identified through active, prospective, hospital-based surveillance from 2009–2012 in South Africa. Respiratory specimens were tested, typed, and subtyped for influenza virus by PCR. Of 16,005 SARI patients tested, 1,239 (8%) were positive for influenza virus. Patient age and co-infections varied according to virus type and subtype, but disease severity did not. Case-patients with influenza B were more likely than patients with influenza A to be HIV infected. A higher proportion of case-patients infected during the first wave of the 2009 influenza pandemic were 5–24 years of age (19%) than were patients infected during the second wave (9%). Although clinical differences exist, treatment recommendations do not differ according to subtype; prevention through vaccination is recommended.

    Cite This Article
EID Cohen AL, Hellferscee O, Pretorius M, Treurnicht F, Walaza S, Madhi S, et al. Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012. Emerg Infect Dis. 2014;20(7):1149-1156. https://dx.doi.org/10.3201/eid2007.131869
AMA Cohen AL, Hellferscee O, Pretorius M, et al. Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012. Emerging Infectious Diseases. 2014;20(7):1149-1156. doi:10.3201/eid2007.131869.
APA Cohen, A. L., Hellferscee, O., Pretorius, M., Treurnicht, F., Walaza, S., Madhi, S....Cohen, C. (2014). Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012. Emerging Infectious Diseases, 20(7), 1149-1156. https://dx.doi.org/10.3201/eid2007.131869.

Volume 20, Number 6—June 2014

image of the 'Thumbnail' version of the Volume 20, Number 6—June 2014 cover of the CDC's EID journal
Medscape CME Activity
Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark PDF Version [PDF - 417 KB - 7 pages]
S. Nielsen et al.
View Summary

Complications were identified in only 9 pregnancies during 2007–2011.

    View Abstract

A high risk for obstetric complications has been reported among women infected with Coxiella burnetii, the causative agent of Q fever, but recent studies have failed to confirm these findings. We reviewed national data collected in Denmark during 2007–2011 and found 19 pregnancies in 12 women during which the mother had a positive or equivocal test for antibodies to C. burnetii (IgM phase I and II titers >64, IgG phase I and II titers >128). Of these 12 women, 4 experienced obstetric complications (miscarriage, preterm delivery, infant small for gestational age, oligohydramnion, fetal growth restriction, or perinatal death); these complications occurred in 9 pregnancies (47% of the 19 total pregnancies identified). Our findings suggest an association between Q fever and adverse pregnancy outcomes, but complications were identified in only 9 pregnancies during the study’s 5-year period, indicating that the overall risk is low.

    Cite This Article
EID Nielsen S, Mølbak K, Henriksen T, Krogfelt K, Larsen C, Villumsen S, et al. Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark. Emerg Infect Dis. 2014;20(6):925-931. https://dx.doi.org/10.3201/eid2006.130584
AMA Nielsen S, Mølbak K, Henriksen T, et al. Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark. Emerging Infectious Diseases. 2014;20(6):925-931. doi:10.3201/eid2006.130584.
APA Nielsen, S., Mølbak, K., Henriksen, T., Krogfelt, K., Larsen, C., & Villumsen, S. (2014). Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark. Emerging Infectious Diseases, 20(6), 925-931. https://dx.doi.org/10.3201/eid2006.130584.

Volume 20, Number 5—May 2014

image of the 'Thumbnail' version of the Volume 20, Number 5—May 2014 cover of the CDC's EID journal
Medscape CME Activity
Outbreaks of Kingella kingae Infections in Daycare Facilities PDF Version [PDF - 501 KB - 8 pages]
P. Yagupsky
View Summary

Improved methods for identifying infected children and carriers are needed to adequately investigate outbreaks of K. kingae.

    View Abstract

During the past decade, transmission of the bacterium Kingella kingae has caused clusters of serious infections, including osteomyelitis, septic arthritis, bacteremia, endocarditis, and meningitis, among children in daycare centers in the United States, France, and Israel. These events have been characterized by high attack rates of disease and prevalence of the invasive strain among asymptomatic classmates of the respective index patients, suggesting that the causative organisms benefitted from enhanced colonization fitness, high transmissibility, and high virulence. After prophylactic antibacterial drugs were administered to close contacts of infected children, no further cases of disease were detected in the facilities, although test results showed that some children still carried the bacterium. Increased awareness of this public health problem and use of improved culture methods and sensitive nucleic acid amplification assays for detecting infected children and respiratory carriers are needed to identify and adequately investigate outbreaks of K. kingae disease.

    Cite This Article
EID Yagupsky P. Outbreaks of Kingella kingae Infections in Daycare Facilities. Emerg Infect Dis. 2014;20(5):746-753. https://dx.doi.org/10.3201/eid2005.131633
AMA Yagupsky P. Outbreaks of Kingella kingae Infections in Daycare Facilities. Emerging Infectious Diseases. 2014;20(5):746-753. doi:10.3201/eid2005.131633.
APA Yagupsky, P. (2014). Outbreaks of Kingella kingae Infections in Daycare Facilities. Emerging Infectious Diseases, 20(5), 746-753. https://dx.doi.org/10.3201/eid2005.131633.

Volume 20, Number 4—April 2014

image of the 'Thumbnail' version of the Volume 20, Number 4—April 2014 cover of the CDC's EID journal
Medscape CME Activity
Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009 PDF Version [PDF - 669 KB - 9 pages]
R. S. Barlow et al.
View Summary

Providers should evaluate patient travel history and bacterial serotype when considering antimicrobial therapy.

    View Abstract

To evaluate trends in and risk factors for acquisition of antimicrobial-drug resistant nontyphoidal Salmonella infections, we searched Oregon surveillance data for 2004–2009 for all culture-confirmed cases of salmonellosis. We defined clinically important resistance (CIR) as decreased susceptibility to ampicillin, ceftriaxone, ciprofloxacin, gentamicin, or trimethoprim/sulfamethoxazole. Of 2,153 cases, 2,127 (99%) nontyphoidal Salmonella isolates were obtained from a specific source (e.g., feces, urine, blood, or other normally sterile tissue) and had been tested for drug susceptibility. Among these, 347 (16%) isolates had CIR. The odds of acquiring CIR infection significantly increased each year. Hospitalization was more likely for patients with than without CIR infections. Among patients with isolates that had been tested, we analyzed data from 1,813 (84%) who were interviewed. Travel to eastern or Southeast Asia was associated with increased CIR. Isolates associated with outbreaks were less likely to have CIR. Future surveillance activities should evaluate resistance with respect to international travel.

    Cite This Article
EID Barlow RS, DeBess EE, Winthrop KL, Lapidus JA, Vega R, Cieslak PR, et al. Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009. Emerg Infect Dis. 2014;20(4):603-611. https://dx.doi.org/10.3201/eid2004.131063
AMA Barlow RS, DeBess EE, Winthrop KL, et al. Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009. Emerging Infectious Diseases. 2014;20(4):603-611. doi:10.3201/eid2004.131063.
APA Barlow, R. S., DeBess, E. E., Winthrop, K. L., Lapidus, J. A., Vega, R., & Cieslak, P. R. (2014). Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009. Emerging Infectious Diseases, 20(4), 603-611. https://dx.doi.org/10.3201/eid2004.131063.

Volume 20, Number 3—March 2014

image of the 'Thumbnail' version of the Volume 20, Number 3—March 2014 cover of the CDC's EID journal
Medscape CME Activity
Invasive Fungal Infections after Natural Disasters PDF Version [PDF - 539 KB - 7 pages]
K. Benedict and B. J. Park
View Summary

Fungal infections in persons affected by natural disasters are a potentially overlooked public health problem.

    View Abstract

The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed.

Length: 1:04
    Cite This Article
EID Benedict K, Park BJ. Invasive Fungal Infections after Natural Disasters. Emerg Infect Dis. 2014;20(3):349-355. https://dx.doi.org/10.3201/eid2003.131230
AMA Benedict K, Park BJ. Invasive Fungal Infections after Natural Disasters. Emerging Infectious Diseases. 2014;20(3):349-355. doi:10.3201/eid2003.131230.
APA Benedict, K., & Park, B. J. (2014). Invasive Fungal Infections after Natural Disasters. Emerging Infectious Diseases, 20(3), 349-355. https://dx.doi.org/10.3201/eid2003.131230.
Medscape CME Activity
Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008 PDF Version [PDF - 522 KB - 9 pages]
E. Lam et al.
View Summary

In selected areas, test results were rarely used for management of MDR TB.

    View Abstract

In 2004, routine use of culture and drug-susceptibility testing (DST) was implemented for persons in 5 Thailand provinces with a diagnosis of tuberculosis (TB). To determine if DST results were being used to guide treatment, we conducted a retrospective chart review for patients with rifampin-resistant or multidrug-resistant (MDR) TB during 2004–2008. A total of 208 patients were identified. Median time from clinical sample collection to physician review of DST results was 114 days. Only 5.8% of patients with MDR TB were empirically prescribed an appropriate regimen; an additional 31.3% received an appropriate regimen after DST results were reviewed. Most patients with rifampin -resistant or MDR TB had successful treatment outcomes. Patients with HIV co-infection and patients who were unmarried or had received category II treatment before DST results were reviewed had less successful outcomes. Overall, review of available DST results was delayed, and results were rarely used to improve treatment.

Length: 1:33
    Cite This Article
EID Lam E, Nateniyom S, Whitehead S, Anuwatnonthakate A, Monkongdee P, Kanphukiew A, et al. Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008. Emerg Infect Dis. 2014;20(3):408-416. https://dx.doi.org/10.3201/eid2003.130951
AMA Lam E, Nateniyom S, Whitehead S, et al. Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008. Emerging Infectious Diseases. 2014;20(3):408-416. doi:10.3201/eid2003.130951.
APA Lam, E., Nateniyom, S., Whitehead, S., Anuwatnonthakate, A., Monkongdee, P., Kanphukiew, A....Podewils, L. (2014). Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008. Emerging Infectious Diseases, 20(3), 408-416. https://dx.doi.org/10.3201/eid2003.130951.

Volume 20, Number 2—February 2014

image of the 'Thumbnail' version of the Volume 20, Number 2—February 2014 cover of the CDC's EID journal
Peer Reviewed Report Available Online Only
Medscape CME Activity
Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults
K. A. Hendricks et al.
    View Abstract

The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.

   
Peer Reviewed Report Available Online Only
Medscape CME Activity
Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women PDF Version [PDF - 776 KB - 6 pages]
D. Meaney-Delman et al.
View Summary

Clinical recommendations for the prevention and treatment of anthrax among pregnant women are updated.

    View Abstract

In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.

   

Volume 20, Number 1—January 2014

image of the 'Thumbnail' version of the Volume 20, Number 1—January 2014 cover of the CDC's EID journal
Medscape CME Activity
Raw Milk Consumption among Patients with Non–Outbreak-related Enteric Infections, Minnesota, USA, 2001–2010 PDF Version [PDF - 580 KB - 7 pages]
T. J. Robinson et al.
View Summary

The risk for illness associated with raw milk consumption is far greater than previously realized.

    View Abstract

Raw milk has frequently been identified as the source of foodborne illness outbreaks; however, the number of illnesses ascertained as part of documented outbreaks likely represents a small proportion of the actual number of illnesses associated with this food product. Analysis of routine surveillance data involving illnesses caused by enteric pathogens that were reportable in Minnesota during 2001–2010 revealed that 3.7% of patients with sporadic, domestically acquired enteric infections had reported raw milk consumption during their exposure period. Children were disproportionately affected, and 76% of those <5 years of age were served raw milk from their own or a relative’s farm. Severe illness was noted, including hemolytic uremic syndrome among 21% of Escherichia coli O157–infected patients reporting raw milk consumption, and 1 death was reported. Raw milk consumers, potential consumers, and policy makers who might consider relaxing regulations regarding raw milk sales should be educated regarding illnesses associated with raw milk consumption.

    Cite This Article
EID Robinson TJ, Scheftel JM, Smith KE. Raw Milk Consumption among Patients with Non–Outbreak-related Enteric Infections, Minnesota, USA, 2001–2010. Emerg Infect Dis. 2014;20(1):38-44. https://dx.doi.org/10.3201/eid2001.120920
AMA Robinson TJ, Scheftel JM, Smith KE. Raw Milk Consumption among Patients with Non–Outbreak-related Enteric Infections, Minnesota, USA, 2001–2010. Emerging Infectious Diseases. 2014;20(1):38-44. doi:10.3201/eid2001.120920.
APA Robinson, T. J., Scheftel, J. M., & Smith, K. E. (2014). Raw Milk Consumption among Patients with Non–Outbreak-related Enteric Infections, Minnesota, USA, 2001–2010. Emerging Infectious Diseases, 20(1), 38-44. https://dx.doi.org/10.3201/eid2001.120920.

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