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Volume 11, Number 11—November 2005

Volume 11, Number 11—November 2005   PDF Version [PDF - 6.32 MB - 163 pages]


  • Emergence of Toscana Virus in Europe PDF Version [PDF - 216 KB - 7 pages]
    R. N. Charrel et al.
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    In southern Europe, Toscana virus is one of the three leading causes of aseptic meningitis.

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    Toscana virus (TOSV) is an arthropodborne virus first identified in 1971 from the sandfly Phlebotomus perniciosus in central Italy. Many case reports in travelers and clinical research and epidemiologic studies conducted around the Mediterranean region have shown that TOSV has a tropism for the central nervous system (CNS) and is a major cause of meningitis and encephalitis in countries in which it circulates. In central Italy, TOSV is the most frequent cause of meningitis from May to October, far exceeding enteroviruses. In other northern Mediterranean countries, TOSV is among the 3 most prevalent viruses associated with meningitis during the warm seasons. Therefore, TOSV must be considered an emerging pathogen. Here, we review the epidemiology of TOSV in Europe and determine questions that should be addressed in future studies. Despite increasing evidence of its major role in medicine as an emerging cause of CNS infections, TOSV remains an unstudied pathogen, and few physicians are aware of its potential to cause CNS infections.


  • Highly Pathogenic Avian Influenza H5N1, Thailand, 2004 PDF Version [PDF - 662 KB - 9 pages]
    T. Tiensin et al.
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    Early detection and control curtail outbreaks.

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    In January 2004, highly pathogenic avian influenza (HPAI) virus of the H5N1 subtype was first confirmed in poultry and humans in Thailand. Control measures, e.g., culling poultry flocks, restricting poultry movement, and improving hygiene, were implemented. Poultry populations in 1,417 villages in 60 of 76 provinces were affected in 2004. A total of 83% of infected flocks confirmed by laboratories were backyard chickens (56%) or ducks (27%). Outbreaks were concentrated in the Central, the southern part of the Northern, and Eastern Regions of Thailand, which are wetlands, water reservoirs, and dense poultry areas. More than 62 million birds were either killed by HPAI viruses or culled. H5N1 virus from poultry caused 17 human cases and 12 deaths in Thailand; a number of domestic cats, captive tigers, and leopards also died of the H5N1 virus. In 2005, the epidemic is ongoing in Thailand.

  • Coltiviruses and Seadornaviruses in North America, Europe, and Asia PDF Version [PDF - 223 KB - 7 pages]
    H. Attoui et al.
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    Neurotropic virus disease is often misdiagnosed as Japanese encephalitis.

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    Coltiviruses are tickborne viruses of the genus Coltivirus. The type species, Colorado tick fever virus (from North America), has been isolated from patients with flulike syndromes, meningitis, encephalitis, and other severe complications. Another coltivirus, Eyach virus, has been isolated from ticks in France and Germany and incriminated in febrile illnesses and neurologic syndromes. Seadornaviruses are endemic in Southeast Asia, particularly Indonesia and China. The prototype virus of the genus, Banna virus (BAV), has been isolated from many mosquito species, humans with encephalitis, pigs, and cattle. Two other seadornaviruses, Kadipiro and Liao Ning, were isolated only from mosquitoes. The epidemiology of seadornaviruses remains poorly documented. Evidence suggests that BAV is responsible for encephalitis in humans. Infection with BAV may be underreported because it circulates in regions with a high incidence of Japanese encephalitis and could be misdiagnosed as this disease.


  • Cervical Human Papillomavirus Screening among Older Women PDF Version [PDF - 83 KB - 6 pages]
    M. J. Grainge et al.
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    HPV-negative women >50 years of age still require cervical screening.

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    Rates of acquisition and clearance of cervical human papillomavirus (HPV) during a 3-year period in women 51 years of age were compared with rates in younger women to provide data on cervical screening for women >50 years of age. Paired, cytologically negative, archived cervical smears taken 3 years apart from 710 women in Nottingham, United Kingdom, were retrieved and tested for HPV infection with polymerase chain reaction (PCR) with GP5+/6+ primers. Seventy-one (21.3%) of 333 women 51 years of age who were HPV negative at baseline were positive 3 years later. This percentage was higher than the corresponding acquisition rates among women 21 (15.2%), 31 (14.1%), and 41 (13.3%) years of age, although these differences were not significant. This retrospective study shows that HPV-negative women >50 years of age can acquire HPV and, therefore, require cervical screening.

  • Cryptococcus gattii in AIDS Patients, Southern California PDF Version [PDF - 255 KB - 7 pages]
    S. Chaturvedi et al.
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    A molecular analysis of pheromone genes showed a notable prevalence of Cryptococcus gattii isolates from AIDS patients in southern California.

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    Cryptococcus isolates from AIDS patients in southern California were characterized by molecular analyses. Pheromone MFα1 and MFa1 gene fragments were polymerase chain reaction–amplified with fluorescently labeled primers and analyzed by capillary electrophoresis (CE) on DNA analyzer. CE–fragment-length analyses (CE-FLAs) and CE–single-strand conformation polymorphisms (CE-SSCPs) were used to determine Cryptococcus gattii (Cg), C. neoformans (Cn) varieties neoformans (CnVN) and grubii (CnVG), mating types, and hybrids. Corroborative tests carried out in parallel included growth on specialized media and serotyping with a commercial kit. All 276 clinical strains tested as haploid MATα by CE-FLA. CE-SSCP analyses of MFα1 showed 219 (79.3%) CnVG, 23 (8.3%) CnVN, and 34 (12.3%) Cg isolates. CE-FLA and CE-SSCP are promising tools for high-throughput screening of Cryptococcus isolates. The high prevalence of Cg was noteworthy, in view of its sporadic reports from AIDS patients in North America and its recent emergence as a primary pathogen on Vancouver Island, Canada.

  • Rift Valley Fever in Small Ruminants, Senegal, 2003 PDF Version [PDF - 225 KB - 8 pages]
    V. Chevalier et al.
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    Serologic incidence was estimated at 2.9%.

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    During the 2003 rainy season, the clinical and serologic incidence of Rift Valley fever was assessed in small ruminant herds living around temporary ponds located in the semi-arid region of the Ferlo, Senegal. No outbreak was detected by the surveillance system. Serologic incidence was estimated at 2.9% (95% confidence interval 1.0–8.7) and occurred in 5 of 7 ponds with large variations in the observed incidence rate (0%–20.3%). The location of ponds in the Ferlo Valley and small ponds were correlated with higher serologic incidence (p = 0.0005 and p = 0.005, respectively). Rift Valley fever surveillance should be improved to allow early detection of virus activity. Ruminant vaccination programs should be prepared to confront the foreseeable higher risks for future epidemics of this disease.

  • Toscana Virus in Spain PDF Version [PDF - 214 KB - 7 pages]
    S. Sanbonmatsu-Gámez et al.
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    At least 2 virus lineages are circulating in the Mediterranean basin.

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    Toscana virus (TOSV, Phlebovirus, family Bunyaviridae) infection is one of the most prevalent arboviruses in Spain. Within the objectives of a multidisciplinary network, a study on the epidemiology of TOSV was conducted in Granada, in southern Spain. The overall seroprevalence rate was 24.9%, significantly increasing with age. TOSV was detected in 3 of 103 sandfly pools by viral culture or reverse transcription–polymerase chain reaction from a region of the L gene. Nucleotide sequence homology was 99%–100% in TOSV from vectors and patients and 80%–81% compared to the Italian strain ISS Phl.3. Sequencing of the N gene of TOSV isolates from patients and vectors indicated 87%–88% and 100% homology at the nucleotide and amino acid levels, respectively, compared to the Italian strain. These findings demonstrate the circulation of at least 2 different lineages of TOSV in the Mediterranean basin, the Italian lineage and the Spanish lineage.

  • Tickborne Pathogen Detection, Western Siberia, Russia PDF Version [PDF - 275 KB - 8 pages]
    V. A. Rar et al.
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    Ixodes and Dermacentor ticks harbor Borrelia, Anaplasma/Ehrlichia, Bartonella, and Babesia species.

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    Ixodes persulcatus (n = 125) and Dermacentor reticulatus (n = 84) ticks from Western Siberia, Russia, were tested for infection with Borrelia, Anaplasma/Ehrlichia, Bartonella, and Babesia spp. by using nested polymerase chain reaction assays with subsequent sequencing. I. persulcatus ticks were infected with Borrelia burgdorferi sensu lato (37.6% ± 4.3% [standard deviation]), Anaplasma phagocytophilum (2.4% ± 1.4%), Ehrlichia muris (8.8% ± 2.5%), and Bartonella spp. (37.6% ± 4.3%). D. reticulatus ticks contained DNA of B. burgdorferi sensu lato (3.6% ± 2.0%), Bartonella spp. (21.4% ± 4.5%), and Babesia canis canis (3.6% ± 2.0%). Borrelia garinii, Borrelia afzelii, and their mixed infections were observed among I. persulcatus, whereas B. garinii NT29 DNA was seen in samples from D. reticulatus. Among the I. persulcatus ticks studied, no Babesia spp. were observed, whereas B. canis canis was the single subspecies found in D. reticulatus.

  • Norovirus Outbreaks from Drinking Water PDF Version [PDF - 139 KB - 6 pages]
    L. Maunula et al.
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    Norovirus contamination calls for viral monitoring of drinking water.

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    As part of an intensified monitoring program for foodborne disease outbreaks in Finland, waterborne outbreaks were investigated for viruses. The diagnostic procedure included analysis of patients' stool samples by electron microscopy and reverse transcription–polymerase chain reaction (RT-PCR) for noroviruses and astroviruses. When these test results were positive for a virus, the water sample was analyzed. Virus concentration was based on positively charged filters from 1-L samples. Of the total 41 waterborne outbreaks reported during the observation period (1998–2003), samples from 28 outbreaks were available for analysis. As judged by RT-PCR results from patient samples, noroviruses caused 18 outbreaks. In 10 outbreaks, the water sample also yielded a norovirus. In all but 1 instance, the amplicon sequence was identical to that recovered from the patients. The ubiquity of waterborne norovirus outbreaks calls for measures to monitor water for viruses.

  • Typing African Relapsing Fever Spirochetes PDF Version [PDF - 198 KB - 8 pages]
    J. Scott et al.
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    Sequencing distinguished relapsing fever from other borrelial species but not B. duttonii from B. recurrentis.

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    Relapsing fever Borrelia spp. challenge microbiologic typing because they possess segmented genomes that maintain essential genes on large linear plasmids. Antigenic variation further complicates typing. Intergenic spacer (IGS, between 16S–23S genes) heterogeneity provides resolution among Lyme disease–associated and some relapsing fever spirochetes. We used an IGS fragment for typing East African relapsing fever Borrelia spp. Borrelia recurrentis and their louse vectors showed 2 sequence types, while 4 B. duttonii and their tick vectors had 4 types. IGS typing was unable to discriminate between the tick- and louseborne forms of disease. B. crocidurae, also present in Africa, was clearly resolved from the B. recurrentis/B. duttonii complex. IGS analysis of ticks showed relapsing fever Borrelia spp. and a unique clade, distant from those associated with relapsing fever, possibly equivalent to a novel species in ticks from this region. Clinical significance of this spirochete is undetermined.

  • Neutralizing Antibody Response and SARS Severity PDF Version [PDF - 351 KB - 8 pages]
    M. Ho et al.
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    Antibody response correlates with severity of infection.

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    Using the Taiwan nationwide laboratory-confirmed severe acute respiratory syndrome (SARS) database, we analyzed neutralizing antibody in relation to clinical outcomes. With a linear mixed model, neutralizing antibody titer was shown to peak between week 5 and week 8 after onset and to decline thereafter, with a half-life of 6.4 weeks. Patients with a longer illness showed a lower neutralizing antibody response than patients with a shorter illness duration (p = 0.008). When early responders were compared with most patients, who seroconverted on and after week 3 of illness, the small proportion (17.4%) of early responders (antibody detectable within 2 weeks) had a higher death rate (29.6% vs. 7.8%) (Fisher exact test, p = 0.004), had a shorter survival time of <2 weeks (Fisher exact test, p = 0.013), and were more likely to be > 60 years of age (Fisher exact test, p = 0.01). Our findings have implications for understanding the pathogenesis of SARS and for SARS vaccine research and development.



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