Volume 14, Number 9—September 2008
Volume 14, Number 9—September 2008 PDF Version [PDF - 14.39 MB - 171 pages]
Underreported Threat of Multidrug-Resistant Tuberculosis in Africa
PDF Version [PDF - 185 KB - 8 pages]
Y. Ben Amor et al.View Abstract
Multidrug-resistant tuberculosis (MDR TB) in Africa may be more prevalent than previously appreciated. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programs. We gathered estimates of MDR TB rates for 39 of 46 countries in Africa. The relationship between MDR TB rates and independent factors was analyzed by using correlation and linear regression models. Our findings indicate that drug resistance surveys in Africa are critically needed. MDR TB rates must be assessed in countries without these surveys. In countries that have conducted a drug resistance survey, a new survey will determine evolution of drug resistance rates. We found no correlation between high MDR rates and TB incidence, HIV/TB co-infection rates, or year of introduction of rifampin. Results show that the retreatment failure rate was the most predictive indicator for MDR TB. Current category II drug regimens may increase MDR TB.
Preventing and Controlling Emerging and Reemerging Transmissible Diseases in the Homeless
PDF Version [PDF - 1.55 MB - 7 pages]
S. Badiaga et al.View SummaryView Abstract
Appropriate street- or shelter-based interventions for targeted populations are most effective.
Homelessness is an increasing public health problem. Because of poor living conditions and limited access to healthcare systems, homeless persons are exposed to many communicable infections. We summarize the intervention measures reported to be efficient for the control and the prevention of common transmissible infections among homeless populations. Evidence suggests that appropriate street- or shelter-based interventions for targeted populations are the most efficient methods. Depending on the populations targeted, these interventions may include education, free condom distribution, syringe and needle prescription programs, chest radiography screening for tuberculosis, directly observed therapy for tuberculosis treatment, improvement of personal clothing and bedding hygiene, and widespread use of ivermectin for scabies and body louse infestation. Systematic vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diphtheria is strongly recommended. National public health programs specific to homeless populations are required.
Questions on Mediterranean Spotted Fever a Century after Its Discovery
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C. Rovery et al.View Abstract
Mediterranean spotted fever (MSF) was first described in 1910. Twenty years later, it was recognized as a rickettsial disease transmitted by the brown dog tick. In contrast to Rocky Mountain spotted fever (RMSF), MSF was thought to be a benign disease; however, the first severe case that resulted in death was reported in France in the 1980s. We have noted important changes in the epidemiology of MSF in the last 10 years, with emergence and reemergence of MSF in several countries. Advanced molecular tools have allowed Rickettsia conorii conorii to be classified as a subspecies of R. conorii. New clinical features, such as multiple eschars, have been recently reported. Moreover, MSF has become more severe than RMSF; the mortality rate was as high as 32% in Portugal in 1997. Whether Rhipicephalus sanguineus is the only vector and reservoir for R. conorii conorii is a question not yet answered.
Regulatory Systems for Prevention and Control of Rabies, Japan
PDF Version [PDF - 111 KB - 7 pages]
H. Takahashi-Omoe et al.View Abstract
Japan is one of the few rabies-free countries. Although 3 imported cases of human rabies were seen in 1970 and 2006, no other cases have been reported for ≈50 years. The elimination of rabies in Japan is attributed to not only its geographic isolation but also to effective prevention and control measures, such as registration and vaccination of domestic dogs, required quarantine of susceptible imported animals, and national plans of action based on scientific research. Countermeasures against rabies have been upgraded; an improved management system for domestic dogs under the amended Enforcement Regulations of the Rabies Prevention Law has been in effect since April 2007. The latest regulatory systems for preventing and controlling rabies provide an effective model for elimination of the disease worldwide.
Forest Fragmentation as Cause of Bacterial Transmission among Nonhuman Primates, Humans, and Livestock, Uganda
PDF Version [PDF - 197 KB - 8 pages]
T. L. Goldberg et al.View Abstract
We conducted a prospective study of bacterial transmission among humans, nonhuman primates (primates hereafter), and livestock in western Uganda. Humans living near forest fragments harbored Escherichia coli bacteria that were ≈75% more similar to bacteria from primates in those fragments than to bacteria from primates in nearby undisturbed forests. Genetic similarity between human/livestock and primate bacteria increased ≈3-fold as anthropogenic disturbance within forest fragments increased from moderate to high. Bacteria harbored by humans and livestock were approximately twice as similar to those of red-tailed guenons, which habitually enter human settlements to raid crops, than to bacteria of other primate species. Tending livestock, experiencing gastrointestinal symptoms, and residing near a disturbed forest fragment increased genetic similarity between a participant’s bacteria and those of nearby primates. Forest fragmentation, anthropogenic disturbance within fragments, primate ecology, and human behavior all influence bidirectional, interspecific bacterial transmission. Targeted interventions on any of these levels should reduce disease transmission and emergence.
Pigs as Source of Methicillin-Resistant Staphylococcus aureus CC398 Infections in Humans, Denmark
PDF Version [PDF - 282 KB - 7 pages]
H. C. Lewis et al.View Abstract
An emerging subtype of methicillin-resistant Staphylococcus aureus (MRSA), clonal complex (CC) 398, is associated with animals, particularly pigs. We conducted a matched case–control and a case–case study comparing 21 CC398 case-patients with 2 controls randomly selected from the Danish Civil Registry and 2 case-patients infected with MRSA other than CC398. On farms of case-patients, animals were examined for MRSA. Thirteen case-patients reported pig exposure. Living or working on farms with animals was an independent risk factor for CC398 in the case–control (matched odds ratio [MOR] 35.4, 95% confidence interval [CI] 2.7–469.8) and the case–case study (MOR 14.5, 95%CI 2.7–76.7). History of hospitalization was associated with an increased risk only in the case–control study (MOR 11.4, 95% CI 1.4–94.8). A total of 23 of 50 pigs on 4 of 5 farms were positive for CC398. Our results, corroborated by microbiologic testing, demonstrate that pigs are a source of CC398 in Denmark.
Pediatric Parapneumonic Empyema, Spain
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I. Obando et al.View Abstract
Pediatric parapneumonic empyema (PPE) has been increasing in several countries including Spain. Streptococcus pneumoniae is a major PPE pathogen; however, antimicrobial pretreatment before pleural fluid (PF) sampling frequently results in negative diagnostic cultures, thus greatly underestimating the contribution of pneumococci, especially pneumococci susceptible to antimicrobial agents, to PPE. The study aim was to identify the serotypes and genotypes that cause PPE by using molecular diagnostics and relate these data to disease incidence and severity. A total of 208 children with PPE were prospectively enrolled; blood and PF samples were collected. Pneumococci were detected in 79% of culture-positive and 84% of culture-negative samples. All pneumococci were genotyped by multilocus sequence typing. Serotypes were determined for 111 PPE cases; 48% were serotype 1, of 3 major genotypes previously circulating in Spain. Variance in patient complication rates was statistically significant by serotype. The recent PPE increase is principally due to nonvaccine serotypes, especially the highly invasive serotype 1.
Circulation of 3 Lineages of a Novel Saffold Cardiovirus in Humans
PDF Version [PDF - 251 KB - 8 pages]
J. Drexler et al.View Abstract
Cardioviruses cause serious disease, mainly in rodents, including diabetes, myocarditis, encephalomyelitis, and multiple sclerosis–like disseminated encephalomyelitis. Recently, a human virus isolate obtained 25 years ago, termed Saffold virus, was sequenced and classified as a cardiovirus. We conducted systematic molecular screening for Saffold-like viruses in 844 fecal samples from patients with gastroenteritis from Germany and Brazil, across all age groups. Six cardioviruses were identified in patients <6 years of age. Viral loads were 283,305–5,044,412,175 copies/g of stool. Co-infections occurred in 4 of 6 children. No evidence for outbreak-like epidemic patterns was found. Phylogenetic analysis identified 3 distinct genetic lineages. Viral protein 1 amino acids were 67.9%–77.7% identical and had a distance of at least 39.4% from known cardioviruses. Because closely related strains were found on 2 continents, global distribution in humans is suspected. Saffold-like viruses may be the first human cardiovirus species to be identified.
Excretion of Transmissible Spongiform Encephalopathy Infectivity in Urine
PDF Version [PDF - 319 KB - 7 pages]
L. Gregori et al.View Abstract
The route of transmission of most naturally acquired transmissible spongiform encephalopathy (TSE) infections remains speculative. To investigate urine as a potential source of TSE exposure, we used a sensitive method for detection and quantitation of TSE infectivity. Pooled urine collected from 22 hamsters showing clinical signs of 263K scrapie contained 3.8 ± 0.9 infectious doses/mL of infectivity. Titration of homogenates of kidneys and urinary bladders from the same animals gave concentrations 20,000-fold greater. Histologic and immunohistochemical examination of these same tissues showed no indications of inflammatory or other pathologic changes except for occasional deposits of disease-associated prion protein in kidneys. Although the source of TSE infectivity in urine remains unresolved, these results establish that TSE infectivity is excreted in urine and may thereby play a role in the horizontal transmission of natural TSEs. The results also indicate potential risk for TSE transmission from human urine–derived hormones and other medicines.
Spatial Analysis of Tuberculosis Cases in Migrants and Permanent Residents, Beijing, 2000–2006
PDF Version [PDF - 419 KB - 7 pages]
Z. Jia et al.View Abstract
To determine the role of the migrant population in the transmission of tuberculosis (TB), we investigated the distribution and magnitude of TB in permanent residents and migrant populations of Beijing, People’s Republic of China, from 2000 through 2006. An exploratory spatial data analysis was applied to detect the “hot spots” of TB among the 2 populations. Results, using the data obtained from 2004–2006, showed that people who migrated from the western, middle, and eastern zones of China had a significantly higher risk of having TB than did permanent residents. These findings indicate that population fluctuations have affected the rate of TB prevalence in Beijing, and interventions to control TB should include the migrant population.
Bluetongue Virus Serotype 8 Reemergence in Germany, 2007 and 2008
PDF Version [PDF - 293 KB - 3 pages]
B. Hoffmann et al.View Abstract
Reemerging bluetongue virus serotype 8 (BTV-8) in Germany was detected first in May 2007 in a sentinel cow and in February 2008 in an export heifer. Reemergence was confirmed by retesting the samples, experimental inoculation, fingerprinting analysis, and virus isolation. Overwintering of BTV-8 and continuous low-level infections are assumed.
Ecoepidemiology of Cutaneous Leishmaniasis Outbreak, Israel
PDF Version [PDF - 385 KB - 3 pages]
S. R. Singer et al.View Abstract
A total of 161 cases of cutaneous leishmaniasis caused by Leishmania tropica occurred in the Jerusalem district during 2004–2005; 127 (79%) cases were in a town just outside Jerusalem. Environmental models suggest that in the context of global warming, this outbreak has the potential to extend into Jerusalem.
Highly Pathogenic Avian Influenza Virus (H5N1) Isolated from Whooper Swans, Japan
PDF Version [PDF - 271 KB - 3 pages]
Y. Uchida et al.View Abstract
On April 21, 2008, four whooper swans were found dead at Lake Towada, Akita prefecture, Japan. Highly pathogenic avian influenza virus of the H5N1 subtype was isolated from specimens of the affected birds. The hemagglutinin (HA) gene of the isolate belongs to clade 2.3.2 in the HA phylogenetic tree.
Neurobrucellosis in Stranded Dolphins, Costa Rica
PDF Version [PDF - 329 KB - 4 pages]
G. Hernández-Mora et al.View Abstract
Ten striped dolphins, Stenella coeruleoalba, stranded along the Costa Rican Pacific coast, had meningoencephalitis and antibodies against Brucella spp. Brucella ceti was isolated from cerebrospinal fluid of 6 dolphins and 1 fetus. S. coeruleoalba constitutes a highly susceptible host and a potential reservoir for B. ceti transmission.
Monkey Malaria in a European Traveler Returning from Malaysia
PDF Version [PDF - 216 KB - 3 pages]
A. Kantele et al.View Abstract
In 2007, a Finnish traveler was infected in Peninsular Malaysia with Plasmodium knowlesi, a parasite that usually causes malaria in monkeys. P. knowlesi has established itself as the fifth Plasmodium species that can cause human malaria. The disease is potentially life-threatening in humans; clinicians and laboratory personnel should become more aware of this pathogen in travelers.
Mycobacterium haemophilum and Lymphadenitis in Immunocompetent Children, Israel
PDF Version [PDF - 153 KB - 3 pages]
Y. H. Cohen et al.View Abstract
The database of a major microbiology laboratory in Israel was searched to determine the prevalence of nontuberculous mycobacterial lymphadenitis in immunocompetent children. We observed a 4-fold increase in nontuberculous mycobacteria isolates during 1985–2006, which was attributable mainly to increased detection of Mycobacterium haemophilum starting in 1996.
Obligations to Report Outbreaks of Foodborne Disease under the International Health Regulations (2005)
PDF Version [PDF - 153 KB - 3 pages]
M. Kirk et al.View Abstract
Every year, Australia identifies 2–3 outbreaks associated with imported foods. To examine national authorities’ obligations under the International Health Regulations (2005), we reviewed outbreaks in 2001–2007 that implicated internationally distributed foods. Under these regulations, 6 (43%) of 14 outbreaks would have required notification to the World Health Organization.
Occurrence and Clinical Relevance of Mycobacterium chimaera sp. nov., Germany
PDF Version [PDF - 334 KB - 4 pages]
B. Schweickert et al.View Abstract
Retrospective molecular genetic analysis of 166 Mycobacterium intracellulare isolates showed that 143 (86%) strains could be assigned to Mycobacterium chimaera sp. nov. Of 97 patients from whom M. chimaera sp. nov. was isolated, only 3.3% exhibited mycobacterial lung disease, whereas all M. intracellulare isolates caused severe pulmonary infections.
Juquitiba-like Hantavirus from 2 Nonrelated Rodent Species, Uruguay
PDF Version [PDF - 390 KB - 5 pages]
A. Delfraro et al.View Abstract
Serologic and genetic analyses indicate that a Juquitiba-like hantavirus circulates in Maldonado, Uruguay. This virus is carried by 2 rodent species, Oligoryzomys nigripes and Oxymycterus nasutus. The same hantavirus in 2 nonrelated species can be explained by a spillover infection or a host-switching event.
Rabies Postexposure Prophylaxis, Marseille, France, 1994–2005
PDF Version [PDF - 128 KB - 3 pages]
P. Gautret et al.View Abstract
The administration of human rabies postexposure prophylaxis near Marseille (southern France) has changed since the eradication of terrestrial mammal rabies in 2001. Most injuries were associated with indigenous dogs; rabies vaccine was overprescribed. We suggest that the World Health Organization guidelines be adapted for countries free of terrestrial mammal rabies.
Host Range and Genetic Diversity of Arenaviruses in Rodents, United Kingdom
PDF Version [PDF - 171 KB - 4 pages]
K. R. Blasdell et al.View Abstract
During a study to extend our knowledge of the host range and genetic diversity of arenaviruses in Great Britain, 66 of 1,147 rodent blood samples tested for antibody, and 127 of 482 tested by PCR, were found positive. All sequences most closely resembled those of previously identified lymphocytic choriomeningitis virus.
Knowledge, Attitudes, and Practices regarding Avian Influenza (H5N1), Afghanistan
PDF Version [PDF - 220 KB - 3 pages]
T. Leslie et al.View Abstract
From February through April 2007, avian influenza (H5N1) was confirmed in poultry in 4 of 34 Afghan provinces. A survey conducted in 2 affected and 3 unaffected provinces found that greater knowledge about reducing exposure was associated with higher socioeconomic status, residence in affected provinces, and not owning backyard poultry.
Emergence and Spread of Chlamydia trachomatis Variant, Sweden
PDF Version [PDF - 288 KB - 4 pages]
B. Herrmann et al.View Abstract
A variant of Chlamydia trachomatis that had escaped detection by commonly used systems was discovered in Sweden in 2006. In a nationwide study, we found that it is now prevalent across Sweden, irrespective of the detection system used. Genetic analysis by multilocus sequence typing identified a predominant variant, suggesting recent emergence.
Crack Cocaine and Infectious Tuberculosis
PDF Version [PDF - 346 KB - 4 pages]
A. Story et al.View Abstract
We hypothesize that crack cocaine is independently associated with smear-positive tuberculosis (TB). In a case–control study of TB in London, 19 (86%) of 22 crack cocaine users with pulmonary TB were smear positive compared with 302 (36%) of 833 non–drug users. Respiratory damage caused by crack cocaine may predispose drug users to infectivity.
Human Case of Swine Influenza A (H1N1) Triple Reassortant Virus Infection, Wisconsin
PDF Version [PDF - 193 KB - 3 pages]
A. P. Newman et al.View Abstract
Zoonotic infections with swine influenza A viruses are reported sporadically. Triple reassortant swine influenza viruses have been isolated from pigs in the United States since 1998. We report a human case of upper respiratory illness associated with swine influenza A (H1N1) triple reassortant virus infection that occurred during 2005 following exposure to freshly killed pigs.
Diagnostic Challenges of Central Nervous System Tuberculosis
PDF Version [PDF - 158 KB - 3 pages]
L. J. Christie et al.View Abstract
Central nervous system tuberculosis (TB) was identified in 20 cases of unexplained encephalitis referred to the California Encephalitis Project. Atypical features (encephalitic symptoms, rapid onset, age) and diagnostic challenges (insensitive cerebrospinal fluid [CSF] TB PCR result, elevated CSF glucose levels in patients with diabetes, negative result for tuberculin skin test) complicated diagnosis.
Tularemia in a Park, Philadelphia, Pennsylvania
PDF Version [PDF - 140 KB - 2 pages]
J. R. Sinclair et al.
Genotyping of Orientia tsutsugamushi from Humans with Scrub Typhus, Laos
PDF Version [PDF - 142 KB - 3 pages]
P. Parola et al.
Clindamycin-Resistant Clone of Clostridium difficile PCR Ribotype 027, Europe
PDF Version [PDF - 179 KB - 3 pages]
D. Drudy et al.
Increasing Incidence of Clostridium difficile-associated Disease, Singapore
PDF Version [PDF - 154 KB - 3 pages]
P. Lim et al.
West Nile Virus in Golden Eagles, Spain, 2007
PDF Version [PDF - 160 KB - 3 pages]
M. A. Jiménez-Clavero et al.
Merkel Cell Polyomavirus and Merkel Cell Carcinoma, France
PDF Version [PDF - 160 KB - 3 pages]
V. Foulongne et al.
Worldwide Prevalence of Head Lice
PDF Version [PDF - 155 KB - 2 pages]
M. E. Falagas et al.
Texas Isolates Closely Related to Bacillus anthracis Ames
PDF Version [PDF - 196 KB - 3 pages]
L. J. Kenefic et al.
Bluetongue in Eurasian Lynx
PDF Version [PDF - 152 KB - 3 pages]
T. P. Jauniaux et al.
Indigenous Dengue Fever, Buenos Aires, Argentina
PDF Version [PDF - 136 KB - 2 pages]
M. Natiello et al.
Naegleria fowleri in Well Water
PDF Version [PDF - 153 KB - 3 pages]
B. Blair et al.
Popular and Scientific Attitudes Regarding Pandemic Influenza
PDF Version [PDF - 146 KB - 2 pages]
Books and Media
Food-Borne Parasitic Zoonoses: Fish and Plant-Borne Parasites (World Class Parasites)
F. J. Sorvillo
Epidemiologic Principles and Food Safety
PDF Version [PDF - 407 KB - 2 pages]
T. F. Jones
About the Cover
“How Comes It, Rocinante, You’re so Lean?” “I’m Underfed, with Overwork I’m Worn”
PDF Version [PDF - 151 KB - 2 pages]
- Page created: October 02, 2012
- Page last updated: October 02, 2012
- Page last reviewed: October 02, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)