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Volume 12, Number 8—August 2006
Volume 12, Number 8—August 2006 PDF Version [PDF - 5.37 MB - 131 pages]
Invasive Enterobacter sakazakii Disease in Infants
PDF Version [PDF - 87 KB - 5 pages]
A. Bowen and C. R. BradenView Abstract
Enterobacter sakazakii kills 40%–80% of infected infants and has been associated with powdered formula. We analyzed 46 cases of invasive infant E. sakazakii infection to define risk factors and guide prevention and treatment. Twelve infants had bacteremia, 33 had meningitis, and 1 had a urinary tract infection. Compared with infants with isolated bacteremia, infants with meningitis had greater birthweight (2,454 g vs. 850 g, p = 0.002) and gestational age (37 weeks vs. 27.8 weeks, p = 0.02), and infection developed at a younger age (6 days vs. 35 days, p<0.001). Among meningitis patients, 11 (33%) had seizures, 7 (21%) had brain abscess, and 14 (42%) died. Twenty-four (92%) of 26 infants with feeding patterns specified were fed powdered formula. Formula samples associated with 15 (68%) of 22 cases yielded E. sakazakii; in 13 cases, clinical and formula strains were indistinguishable. Further clarification of clinical risk factors and improved powdered formula safety is needed.
Venezuelan Equine Encephalitis Virus Transmission and Effect on Pathogenesis
PDF Version [PDF - 233 KB - 7 pages]
D. R. Smith et al.View Abstract
Quantifying the dose of an arbovirus transmitted by mosquitoes is essential for designing pathogenesis studies simulating natural infection of vertebrates. Titration of saliva collected in vitro from infected mosquitoes may not accurately estimate titers transmitted during blood feeding, and infection by needle injection may affect vertebrate pathogenesis. We compared the amount of Venezuelan equine encephalitis virus collected from the saliva of Aedes taeniorhynchus to the amount injected into a mouse during blood feeding. Less virus was transmitted by mosquitoes in vivo (geometric mean 11 PFU) than was found for comparable times of salivation in vitro (mean saliva titer 74 PFU). We also observed slightly lower early and late viremia titers in mice that were needle injected with 8 PFU, which represents the low end of the in vivo transmission range. No differences in survival were detected, regardless of the dose or infection route.
Bat-transmitted Human Rabies Outbreaks, Brazilian Amazon
E. da Rosa et al.View Abstract
We describe 2 bat-transmitted outbreaks in remote, rural areas of Portel and Viseu Municipalities, Pará State, northern Brazil. Central nervous system specimens were taken after patients' deaths and underwent immunofluorescent assay and histopathologic examination for rabies antigens; also, specimens were injected intracerebrally into suckling mice in an attempt to isolate the virus. Strains obtained were antigenically and genetically characterized. Twenty-one persons died due to paralytic rabies in the 2 municipalities. Ten rabies virus strains were isolated from human specimens; 2 other cases were diagnosed by histopathologic examination. Isolates were antigenically characterized as Desmodus rotundus variant 3 (AgV3). DNA sequencing of 6 strains showed that they were genetically close to D. rotundus–related strains isolated in Brazil. The genetic results were similar to those obtained by using monoclonal antibodies and support the conclusion that the isolates studied belong to the same rabies cycle, the virus variants found in the vampire bat D. rotundus.
Streptococcus suis Sequence Type 7 Outbreak, Sichuan, China
PDF Version [PDF - 192 KB - 6 pages]
C. Ye et al.View Abstract
An outbreak of Streptococcus suis serotype 2 emerged in the summer of 2005 in Sichuan Province, and sporadic infections occurred in 4 additional provinces of China. In total, 99 S. suis strains were isolated and analyzed in this study: 88 isolates from human patients and 11 from diseased pigs. We defined 98 of 99 isolates as pulse type I by using pulsed-field gel electrophoresis analysis of SmaI-digested chromosomal DNA. Furthermore, multilocus sequence typing classified 97 of 98 members of the pulse type I in the same sequence type (ST), ST-7. Isolates of ST-7 were more toxic to peripheral blood mononuclear cells than ST-1 strains. S. suis ST-7, the causative agent, was a single-locus variant of ST-1 with increased virulence. These findings strongly suggest that ST-7 is an emerging, highly virulent S. suis clone that caused the largest S. suis outbreak ever described.
Carbapenem Resistance in Klebsiella pneumoniae Not Detected by Automated Susceptibility Testing
PDF Version [PDF - 105 KB - 5 pages]
F. C. Tenover et al.View Abstract
Detecting β-lactamase–mediated carbapenem resistance among Klebsiella pneumoniae isolates and other Enterobacteriaceae is an emerging problem. In this study, 15 blaKPC-positive Klebsiella pneumoniae that showed discrepant results for imipenem and meropenem from 4 New York City hospitals were characterized by isoelectric focusing; broth microdilution (BMD); disk diffusion (DD); and MicroScan, Phoenix, Sensititre, VITEK, and VITEK 2 automated systems. All 15 isolates were either intermediate or resistant to imipenem and meropenem by BMD; 1 was susceptible to imipenem by DD. MicroScan and Phoenix reported 1 (6.7%) and 2 (13.3%) isolates, respectively, as imipenem susceptible. VITEK and VITEK 2 reported 10 (67%) and 5 (33%) isolates, respectively, as imipenem susceptible. By Sensititre, 13 (87%) isolates were susceptible to imipenem, and 12 (80%) were susceptible to meropenem. The VITEK 2 Advanced Expert System changed 2 imipenem MIC results from >16 μg/mL to <2 μg/mL but kept the interpretation as resistant. The recognition of carbapenem-resistant K. pneumoniae continues to challenge automated susceptibility systems.
VEB-1 Extended-Spectrum β-lactamase–producing Acinetobacter baumannii, France
PDF Version [PDF - 394 KB - 9 pages]
T. Naas et al.View Abstract
VEB-1 extended-spectrum β-lactamase–producing Acinetobacter baumannii was responsible for an outbreak in hospitals in France. A national alert was triggered in September 2003 when 4 hospitals reported clusters of A. baumannii infection with similar susceptibility profiles. Case definitions and laboratory guidelines were disseminated, and prospective surveillance was implemented; strains were sent to a single laboratory for characterization and typing. From April 2003 through June 2004, 53 hospitals reported 290 cases of A. baumannii infection or colonization; 275 isolates were blaVEB-1-positive and clonally related. Cases were first reported in 5 districts of northern France, then in 10 other districts in 4 regions. Within a region, interhospital spread was associated with patient transfer. In northern France, investigation and control measures led to a reduction of reported cases after January 2004. The national alert enabled early control of new clusters, demonstrating the usefulness of early warning about antimicrobial drug resistance.
Macrolide Resistance in Adults with Bacteremic Pneumococcal Pneumonia
PDF Version [PDF - 177 KB - 8 pages]
J. P. Metlay et al.View Abstract
We conducted a case-control study of adults with bacteremic pneumococcal pneumonia to identify factors associated with macrolide resistance. Study participants were identified through population-based surveillance in a 5-county region surrounding Philadelphia. Forty-three hospitals contributed 444 patients, who were interviewed by telephone regarding potential risk factors. In multivariable analyses, prior exposure to a macrolide antimicrobial agent (odds ratio [OR] 2.8), prior flu vaccination (OR 2.0), and Hispanic ethnicity (OR 4.1) were independently associated with an increased probability of macrolide resistance, and a history of stroke was independently associated with a decreased probability of macrolide resistance (OR 0.2). Fifty-five percent of patients with macrolide-resistant infections reported no antimicrobial drug exposure in the preceding 6 months. Among patients who reported taking antimicrobial agents in the 6 months preceding infection, failure to complete the course of prescribed drugs was associated with an increased probability of macrolide resistance (OR 3.4).
Antibody Response to Pneumocystis jirovecii
PDF Version [PDF - 228 KB - 8 pages]
K. R. Daly et al.View Abstract
We conducted a prospective pilot study of the serologic responses to overlapping recombinant fragments of the Pneumocystis jirovecii major surface glycoprotein (Msg) in HIV-infected patients with pneumonia due to P. jirovecii and other causes. Similar baseline geometric mean antibody levels to the fragments measured by an ELISA were found in both groups. Serum antibodies to MsgC in P. jirovecii patients rose to a peak level 3–4 weeks (p<0.001) after recovery from pneumocystosis; baseline CD4+ count >50 cells/μL and first episode of pneumocystosis were the principal host factors associated with this rise (both p<0.001). Thus, MsgC shows promise as a serologic reagent and should be tested further in clinical and epidemiologic studies.
Virulent Epidemics and Scope of Healthcare Workers' Duty of Care
PDF Version [PDF - 132 KB - 4 pages]
D. K. SokolView Abstract
The phrase "duty of care" is, at best, too vague and, at worst, ethically dangerous. The nature and scope of the duty need to be determined, and conflicting duties must be recognized and acknowledged. Duty of care is neither fixed nor absolute but heavily dependent on context. The normal risk level of the working environment, the healthcare worker's specialty, the likely harm and benefits of treatment, and the competing obligations deriving from the worker's multiple roles will all influence the limits of the duty of care. As experts anticipate the arrival of an avian influenza pandemic in humans, discussion of this matter is urgently needed.
Human and Canine Pulmonary Blastomycosis, North Carolina, 2001–2002
PDF Version [PDF - 182 KB - 3 pages]
P. MacDonald et al.View Abstract
We investigated a cluster of blastomycosis in 8 humans and 4 dogs in a rural North Carolina community. Delayed diagnosis, difficulty isolating Blastomyces dermatitidis in nature, and lack of a sensitive and specific test to assess exposure make outbreaks of this disease difficult to study.
West Nile Virus Epizootiology, Central Red River Valley, North Dakota and Minnesota, 2002–2005
PDF Version [PDF - 74 KB - 3 pages]
J. A. Bell et al.View Abstract
West Nile virus (WNV) epizootiology was monitored from 2002 through 2005 in the area surrounding Grand Forks, North Dakota. Mosquitoes were tested for infection, and birds were surveyed for antibodies. In 2003, WNV was epidemic; in 2004, cool temperatures precluded WNV amplification; and in 2005, immunity in passerines decreased, but did not preclude, WNV amplification.
O'nyong-nyong Virus, Chad
PDF Version [PDF - 125 KB - 3 pages]
M. Bessaud et al.View Abstract
We report the first laboratory-confirmed human infection with O'nyong-nyong virus in Chad. This virus was isolated from peripheral blood mononuclear cells of a patient with evidence of a seroconversion to a virus related to Chikungunya virus. Genome sequence was partly determined, and phylogenetic studies were conducted.
Human Bocavirus in French Children
PDF Version [PDF - 86 KB - 3 pages]
V. Foulongne et al.View Abstract
Human bocavirus (HBoV), a new member of the genus Bocavirus in the family Parvoviridae, has been recently associated with respiratory tract infections. We report the epidemiologic and clinical features observed from a 1-year retrospective study of HBoV infection in young children hospitalized with a respiratory tract infection.
Bocavirus Infection in Hospitalized Children, South Korea
PDF Version [PDF - 207 KB - 3 pages]
J. Chung et al.View Abstract
This study presents the first evidence of human bocavirus infection in South Korean children. The virus was detected in 27 (8.0%) of 336 tested specimens, including 17 (7.5%) of 225 virus-negative specimens, collected from children with acute lower respiratory tract infection.
Changing Pattern of Visceral Leishmaniasis, United Kingdom, 1985-2004
PDF Version [PDF - 95 KB - 3 pages]
A. Malik et al.View Abstract
A 20-year (1985–2004) retrospective review of 39 patients with imported visceral leishmaniasis found that tourism to Mediterranean countries and HIV infection were associated with visceral leishmaniasis. Diagnosis was often delayed. Treatment with liposomal amphotericin B has improved prognosis. Visceral leishmaniasis should be made a reportable disease.
Mental Status after West Nile Virus Infection
PDF Version [PDF - 121 KB - 3 pages]
K. Y. Haaland et al.View Abstract
Mental status after acute West Nile virus infection has not been examined objectively. We compared Telephone Interview for Cognitive Status scores of 116 patients with West Nile fever or West Nile neuroinvasive disease. Mental status was poorer and cognitive complaints more frequent with West Nile neuroinvasive disease (p = 0.005).
Human Metapneumovirus, Australia, 2001–2004
PDF Version [PDF - 212 KB - 4 pages]
T. P. Sloots et al.View Abstract
We examined 10,025 respiratory samples collected for 4 years (2001–2004) and found a 7.1% average annual incidence of human metapneumovirus. The epidemic peak of infection was late winter to spring, and genotyping showed a change in predominant viral genotype in 3 of the 4 years.
Community-acquired Methicillin-resistant Staphylococcus aureus in Children, Taiwan
PDF Version [PDF - 115 KB - 4 pages]
W. Lo et al.View Abstract
Highly virulent community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) is common worldwide. Using antimicrobial drug susceptibility testing, staphylococcal cassette chromosome mec typing, exotoxin profiling, and pulsed-field gel electrophoresis typing, we provide evidence that supports the relationship between nasal strains of PVL-positive MRSA and community-acquired disease.
Incubation Period of Hantavirus Cardiopulmonary Syndrome
PDF Version [PDF - 184 KB - 3 pages]
P. A. Vial et al.View Abstract
The potential incubation period from exposure to onset of symptoms was 7–39 days (median 18 days) in 20 patients with a defined period of exposure to Andes virus in a high-risk area. This period was 14–32 days (median 18 days) in 11 patients with exposure for <48 hours.
Bat-associated Rabies Virus in Skunks
PDF Version [PDF - 187 KB - 4 pages]
M. J. Leslie et al.View Abstract
Rabies was undetected in terrestrial wildlife of northern Arizona until 2001, when rabies was diagnosed in 19 rabid skunks in Flagstaff. Laboratory analyses showed causative rabies viruses associated with bats, which indicated cross-species transmission of unprecedented magnitude. Public health infrastructure must be maintained to address emerging zoonotic diseases.
Fecal Viral Load and Norovirus-associated Gastroenteritis
PDF Version [PDF - 88 KB - 3 pages]
M. Chan et al.View Abstract
We report the median cDNA viral load of norovirus genogroup II is >100-fold higher than that of genogroup I in the fecal specimens of patients with norovirus-associated gastroenteritis. We speculate that increased cDNA viral load accounts for the higher transmissibility of genogroup II strains through the fecal-oral route.
Rickettsia felis in Xenopsylla cheopis, Java, Indonesia
PDF Version [PDF - 74 KB - 3 pages]
J. Jiang et al.View Abstract
Rickettsia typhi and R. felis, etiologic agents of murine typhus and fleaborne spotted fever, respectively, were detected in Oriental rat fleas (Xenopsylla cheopis) collected from rodents and shrews in Java, Indonesia. We describe the first evidence of R. felis in Indonesia and naturally occurring R. felis in Oriental rat fleas.
Avian Influenza among Waterfowl Hunters and Wildlife Professionals
PDF Version [PDF - 92 KB - 3 pages]
J. S. Gill et al.View Abstract
We report serologic evidence of avian influenza infection in 1 duck hunter and 2 wildlife professionals with extensive histories of wild waterfowl and game bird exposure. Two laboratory methods showed evidence of past infection with influenza A/H11N9, a less common virus strain in wild ducks, in these 3 persons.
OFFLU Network on Avian Influenza
PDF Version [PDF - 112 KB - 2 pages]
S. EdwardsView Abstract
OFFLU is the name of the network of avian influenza expertise inaugurated jointly in 2005 by the Food and Agriculture Organization of the United Nations and the World Organisation for Animal Health. Achievements and constraints to date and plans for the future are described.
Salmonella Typhimurium DT104, Italy
PDF Version [PDF - 22 KB - 1 page]
A. Cawthorne et al.
Echovirus 13 Aseptic Meningitis, Brazil
PDF Version [PDF - 32 KB - 3 pages]
C. I. Kmetzsch et al.
Nonsteroidal Antiinflammatory Drugs and Group A Streptococcal Infection
PDF Version [PDF - 17 KB - 1 page]
D. M. Aronoff and Z. D. Mulla
Detecting Clostridium botulinum
PDF Version [PDF - 18 KB - 1 page]
J. Karner and F. Allerberger
Echinococcus multilocularis in Dogs, Japan
PDF Version [PDF - 47 KB - 3 pages]
Y. Morishima et al.
New World Hantavirus in Humans, French Guiana
PDF Version [PDF - 36 KB - 2 pages]
S. Matheus et al.
Qinghai-like H5N1 from Domestic Cats, Northern Iraq
PDF Version [PDF - 53 KB - 3 pages]
S. L. Yingst et al.
Classifying Escherichia coli
PDF Version [PDF - 50 KB - 3 pages]
D. M. Girão et al.
Toscana Virus RNA in Sergentomyia minuta Flies
PDF Version [PDF - 79 KB - 2 pages]
R. Charrel et al.
Rat-bite Fever, Canada
PDF Version [PDF - 27 KB - 2 pages]
M. E. Schachter et al.
Cutaneous Injury and Vibrio vulnificus Infection
PDF Version [PDF - 28 KB - 2 pages]
P. Chung et al.
Neorickettsia helminthoeca in Dog, Brazil
PDF Version [PDF - 89 KB - 3 pages]
S. A. Headley et al.
Books and Media
Mycobacterium bovis Infection in Animals and Humans, 2nd Edition
PDF Version [PDF - 16 KB - 1 page]
M. V. Palmer
Evolution of Microbial Pathogens
PDF Version [PDF - 21 KB - 2 pages]
About the Cover
Peer Reviewed Report Available Online OnlyPathogenesis of Verocytotoxin/Shiga Toxin–producing Escherichia coli InfectionA. Caprioli et al.
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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- Page created: December 09, 2011
- Page last updated: December 09, 2011
- Page last reviewed: December 09, 2011
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