Get Email Updates
To receive email updates about this page, enter your email address:
Volume 15, Number 4—April 2009
Volume 15, Number 4—April 2009 PDF Version [PDF - 7.33 MB - 175 pages]
The Amazon Region
The Status of Infectious Disease in the Amazon Region
PDF Version [PDF - 70 KB - 1 page]
P. L. Tauil
High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006
PDF Version [PDF - 413 KB - 7 pages]
G. Penna et al.View Abstract
In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001–2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region.
Human Febrile Illness Caused by Encephalomyocarditis Virus Infection, Peru
PDF Version [PDF - 356 KB - 7 pages]
M. Oberste et al.View Abstract
Etiologic studies of acute febrile disease were conducted in sites across South America, including Cusco and Iquitos, Peru. Patients’ clinical signs and symptoms were recorded, and acute- and convalescent-phase serum samples were obtained for serologic examination and virus isolation in Vero E6 and C6/36 cells. Virus isolated in Vero E6 cells was identified as encephalomyocarditis virus (EMCV) by electron microscopy and by subsequent molecular diagnostic testing of samples from 2 febrile patients with nausea, headache, and dyspnea. The virus was recovered from acute-phase serum samples from both case-patients and identified with cardiovirus-specific reverse transcription–PCR and sequencing. Serum samples from case-patient 1 showed cardiovirus antibody by immunoglobulin M ELISA (acute phase <8, convalescent phase >1,024) and by neutralization assay (acute phase <10, convalescent phase >1,280). Serum samples from case-patient 2 did not contain antibodies detectable by either assay. Detection of virus in serum strongly supports a role for EMCV in human infection and febrile illness.
Medscape CME Activity
Acute Conjunctivitis with Episcleritis and Anterior Uveitis Linked to Adiaspiromycosis and Freshwater Sponges, Amazon Region, Brazil, 2005 PDF Version [PDF - 350 KB - 7 pages]M. O. Mendes et al.View SummaryView Abstract
An epidemiologic investigation of an ocular disease outbreak among children was linked to the unusual fungus Emmonsia sp., an agent of adiaspiromycosis.
We conducted an epidemiologic investigation of an outbreak of ocular disease among children to determine whether the disease was linked to Emmonsia sp., a rarely-reported fungus and an agent of adiaspiromycosis. Using an unmatched case–control study design, we compared case-patients with asymptomatic controls randomly selected from the population. Scleral biopsies were analyzed microscopically. Of 5,084 children examined, 99 case-patients were identified; mean age (+1 SD) was 11.0 ± 4.4 years. Symptoms included photophobia (57%), ocular pain (42%), and blurred vision (40%). In the multivariate analysis, risk factors included diving in the Araguaia River (odds ratio 5.2; 95% confidence interval 2.4–12.0). Microscopy identified foreign bodies consistent with adiaconidia. This outbreak probably resulted from foreign-body–type reactions to adiaspiromycosis conidia after initial irritation caused by conjunctival contact with spicules of sponges in the river. Symptomatic children responded to corticosteroid treatment. Adiaspiromycosis is a preventable cause of ocular disease in the Amazon region.
Rapid Point-of-Care Diagnostic Test for Syphilis in High-Risk Populations, Manaus, Brazil
PDF Version [PDF - 235 KB - 3 pages]
M. Sabidó et al.View Abstract
We assessed the acceptability and operational suitability of a rapid point-of-care syphilis test and identified barriers to testing among high-risk groups and healthcare professionals in a sexually transmitted infections clinic in Manaus, Brazil. Use of this test could considerably alleviate the impact of syphilis in hard-to-reach populations in the Amazon region of Brazil.
Spatial Distribution of Leprosy in the Amazon Region of Brazil
PDF Version [PDF - 250 KB - 3 pages]
M. L. Penna et al.View Abstract
To detect areas with increased case-detection rates, we used spatial scan statistics to identify 5 of 10 clusters of leprosy in the Amazon region of Brazil. Despite increasing economic development, population growth, and road infrastructure, leprosy is endemic to this region, which is a source of case exportation to other parts of Brazil.
Oral Transmission of Chagas Disease by Consumption of Açaí Palm Fruit, Brazil
PDF Version [PDF - 230 KB - 3 pages]
A. A. Nóbrega et al.View Abstract
In 2006, a total of 178 cases of acute Chagas disease were reported from the Amazonian state of Pará, Brazil. Eleven occurred in Barcarena and were confirmed by visualization of parasites on blood smears. Using cohort and case–control studies, we implicated oral transmission by consumption of açaí palm fruit.
Severe Acquired Toxoplasmosis Caused by Wild Cycle of Toxoplasma gondii, French Guiana
PDF Version [PDF - 224 KB - 3 pages]
B. Carme et al.View Abstract
From 1998 through 2006, 44 cases of severe primary toxoplasmosis were observed in French Guiana in immunocompetent adults. Toxoplasma gondii isolates exhibited an atypical multilocus genotype. Severe disease in humans may result from poor host adaptation to neotropical zoonotic strains of T. gondii circulating in a forest-based cycle.
Links between Climate, Malaria, and Wetlands in the Amazon Basin
PDF Version [PDF - 696 KB - 4 pages]
S. H. Olson et al.View Abstract
Climate changes are altering patterns of temperature and precipitation, potentially affecting regions of malaria transmission. We show that areas of the Amazon Basin with few wetlands show a variable relationship between precipitation and malaria, while areas with extensive wetlands show a negative relationship with malaria incidence.
Seroprevalence of Kaposi Sarcoma–associated Herpesvirus and Other Serologic Markers in the Brazilian Amazon
PDF Version [PDF - 377 KB - 5 pages]
M. C. Nascimento et al.View Abstract
To determine the presence of Kaposi sarcoma–associated herpesvirus (KSHV) and other serologic markers, we tested serum specimens of 339 Amerindians, 181 rural non-Amerindians, and 1,133 urban blood donors (13 Amerindians) in the Brazilian Amazon. High KSHV seroprevalence in children and inverse association with herpes simplex virus type 2 indicates predominant nonsexual transmission among Amerindians.
Concurrent Dengue and Malaria in Cayenne Hospital, French Guiana
PDF Version [PDF - 310 KB - 4 pages]
B. Carme et al.View Abstract
Dengue–malaria co-infection reports are scarce. Of 1,723 consecutive febrile patients in Cayenne Hospital, 238 had dengue (174 early dengue fever cases) and 393 had malaria (371 acute malaria); 17 had both. Diagnosis of 1 of these 2 infections should not rule out testing for the other infection.
Lobomycosis in Inshore and Estuarine Dolphins
PDF Version [PDF - 167 KB - 2 pages]
A. E. Paniz-Mondolfi and L. Sander-Hoffmann
Variations in Leprosy Manifestations among HIV-Positive Patients, Manaus, Brazil
PDF Version [PDF - 166 KB - 2 pages]
C. Talhari et al.
Suspected Brazilian Purpuric Fever, Brazilian Amazon Region
PDF Version [PDF - 132 KB - 2 pages]
E. A. Santana-Porto et al.
Hepatitis C Virus in Blood Donors, Brazil
PDF Version [PDF - 157 KB - 3 pages]
K. L. Torres et al.
Leishmaniasis in Chaparé, Bolivia
PDF Version [PDF - 189 KB - 3 pages]
E. Rojas et al.
Volume 15, Number 4—April 2009 - Continued
Experimental Infection of Potential Reservoir Hosts with Venezuelan Equine Encephalitis Virus, Mexico
PDF Version [PDF - 348 KB - 7 pages]
E. R. Deardorff et al.View Abstract
In 1993, an outbreak of encephalitis among 125 affected equids in coastal Chiapas, Mexico, resulted in a 50% case-fatality rate. The outbreak was attributed to Venezuelan equine encephalitis virus (VEEV) subtype IE, not previously associated with equine disease and death. To better understand the ecology of this VEEV strain in Chiapas, we experimentally infected 5 species of wild rodents and evaluated their competence as reservoir and amplifying hosts. Rodents from 1 species (Baiomys musculus) showed signs of disease and died by day 8 postinoculation. Rodents from the 4 other species (Liomys salvini, Oligoryzomys fulvescens, Oryzomys couesi, and Sigmodon hispidus) became viremic but survived and developed neutralizing antibodies, indicating that multiple species may contribute to VEEV maintenance. By infecting numerous rodent species and producing adequate viremia, VEEV may increase its chances of long-term persistence in nature and could increase risk for establishment in disease-endemic areas and amplification outside the disease-endemic range.
Exotic Small Mammals as Potential Reservoirs of Zoonotic Bartonella spp.
PDF Version [PDF - 267 KB - 7 pages]
K. Inoue et al.View Abstract
To evaluate the risk for emerging human infections caused by zoonotic Bartonella spp. from exotic small mammals, we investigated the prevalence of Bartonella spp. in 546 small mammals (28 species) that had been imported into Japan as pets from Asia, North America, Europe, and the Middle and Near East. We obtained 407 Bartonella isolates and characterized them by molecular phylogenetic analysis of the citrate synthase gene, gltA. The animals examined carried 4 zoonotic Bartonella spp. that cause human endocarditis and neuroretinitis and 6 novel Bartonella spp. at a high prevalence (26.0%, 142/546). We conclude that exotic small mammals potentially serve as reservoirs of several zoonotic Bartonella spp.
Enhancing Time-Series Detection Algorithms for Automated Biosurveillance
PDF Version [PDF - 287 KB - 7 pages]
J. I. Tokars et al.View Abstract
BioSense is a US national system that uses data from health information systems for automated disease surveillance. We studied 4 time-series algorithm modifications designed to improve sensitivity for detecting artificially added data. To test these modified algorithms, we used reports of daily syndrome visits from 308 Department of Defense (DoD) facilities and 340 hospital emergency departments (EDs). At a constant alert rate of 1%, sensitivity was improved for both datasets by using a minimum standard deviation (SD) of 1.0, a 14–28 day baseline duration for calculating mean and SD, and an adjustment for total clinic visits as a surrogate denominator. Stratifying baseline days into weekdays versus weekends to account for day-of-week effects increased sensitivity for the DoD data but not for the ED data. These enhanced methods may increase sensitivity without increasing the alert rate and may improve the ability to detect outbreaks by using automated surveillance system data.
Animal Reservoir Hosts and Fish-borne Zoonotic Trematode Infections on Fish Farms, Vietnam
PDF Version [PDF - 1.32 MB - 7 pages]
N. T. Anh et al.View Abstract
Fish-borne zoonotic trematodes (FZT) pose a risk to human food safety and health and may cause substantial economic losses in the aquaculture industry. In Nghe An Province, Vietnam, low prevalence of FZT for fish farmers but high prevalence for fish indicate that reservoir hosts other than humans may play a role in sustaining transmission. To determine whether domestic animals may be reservoir hosts, we assessed prevalence and species composition of FZT infections in dogs, cats, and pigs in a fish-farming community in Vietnam. Feces from 35 cats, 80 dogs, and 114 pigs contained small trematode eggs at 48.6%, 35.0%, and 14.4%, respectively; 7 species of adult FZT were recovered from these hosts. These results, combined with data from previous investigations in this community, imply that domestic animals serve as reservoir hosts for FZT and therefore must be included in any control programs to prevent FZT infection in humans.
Novel Type of Streptococcus pneumoniae Causing Multidrug-Resistant Acute Otitis Media in Children
PDF Version [PDF - 210 KB - 5 pages]
Q. Xu et al.View Abstract
After our recent discovery of a Streptococcus pneumoniae 19A “superbug” (Legacy strain) that is resistant to all Food and Drug Administration–approved antimicrobial drugs for treatment of acute otitis media (AOM) in children, other S. pneumoniae isolates from children with AOM were characterized by multilocus sequence typing (MLST). Among 40 isolates studied, 16 (40%) were serotype 19A, and 9 (23%) were resistant to multiple antimicrobial drugs. Two others had unreported sequence types (STs) that expressed the 19A capsule, and 8 (88%) of the 9 multidrug-resistant strains were serotype 19A, including the Legacy strain with the new ST-2722. In genetic relatedness, ST-2722 belonged to a cluster of reported strains of S. pneumoniae in which all strains had 6 of the same alleles as ST-156. The multidrug-resistant strains related to ST-156 expressed different capsular serotypes: 9V, 14, 11A, 15C, and 19F.
Oseltamivir-Resistant Influenza Virus A (H1N1), Europe, 2007–08 Season
PDF Version [PDF - 396 KB - 9 pages]
A. Meijer et al.View Abstract
In Europe, the 2007–08 winter season was dominated by influenza virus A (H1N1) circulation through week 7, followed by influenza B virus from week 8 onward. Oseltamivir-resistant influenza viruses A (H1N1) (ORVs) with H275Y mutation in the neuraminidase emerged independently of drug use. By country, the proportion of ORVs ranged from 0% to 68%, with the highest proportion in Norway. The average weighted prevalence of ORVs across Europe increased gradually over time, from near 0 in week 40 of 2007 to 56% in week 19 of 2008 (mean 20%). Neuraminidase genes of ORVs possessing the H275Y substitution formed a homogeneous subgroup closely related to, but distinguishable from, those of oseltamivir-sensitive influenza viruses A (H1N1). Minor variants of ORVs emerged independently, indicating multiclonal ORVs. Overall, the clinical effect of ORVs in Europe, measured by influenza-like illness or acute respiratory infection, was unremarkable and consistent with normal seasonal activity.
Hantavirus Pulmonary Syndrome, Central Plateau, Southeastern, and Southern Brazil
PDF Version [PDF - 190 KB - 7 pages]
L. T. Figueiredo et al.View Abstract
Hantavirus pulmonary syndrome (HPS) is an increasing health problem in Brazil because of encroachment of sprawling urban, agricultural, and cattle-raising areas into habitats of subfamily Sigmodontinae rodents, which serve as hantavirus reservoirs. From 1993 through June 2007, a total of 884 cases of HPS were reported in Brazil (case-fatality rate 39%). To better understand this emerging disease, we collected 89 human serum samples and 68 rodent lung samples containing antibodies to hantavirus from a 2,500-km-wide area in Brazil. RNA was isolated from human samples and rodent tissues and subjected to reverse transcription–PCR. Partial sequences of nucleocapsid protein and glycoprotein genes from 22 human and 16 rodent sources indicated only Araraquara virus and Juquitiba virus lineages. The case-fatality rate of HPS was higher in the area with Araraquara virus. This virus, which may be the most virulent hantavirus in Brazil, was associated with areas that have had greater anthropogenic changes.
Rift Valley Fever, Mayotte, 2007–2008
PDF Version [PDF - 139 KB - 3 pages]
D. Sissoko et al.View Abstract
After the 2006–2007 epidemic wave of Rift Valley fever (RVF) in East Africa and its circulation in the Comoros, laboratory case-finding of RVF was conducted in Mayotte from September 2007 through May 2008. Ten recent human RVF cases were detected, which confirms the indigenous transmission of RFV virus in Mayotte.
High Prevalence of Spirochetosis in Cholera Patients, Bangladesh
PDF Version [PDF - 197 KB - 3 pages]
E. J. Nelson et al.View Abstract
The microbes that accompany the etiologic agent of cholera, Vibrio cholerae, are only now being defined. In this study, spirochetes from the genus Brachyspira were identified at high titers in more than one third of cholera patients in Bangladesh. Spirochetosis should now be tracked in the setting of cholera outbreaks.
Genetic Diversity of Toscana Virus
PDF Version [PDF - 356 KB - 4 pages]
X. Collao et al.View Abstract
Distribution of Toscana virus (TOSV) is evolving with climate change, and pathogenicity may be higher in nonexposed populations outside areas of current prevalence (Mediterranean Basin). To characterize genetic diversity of TOSV, we determined the coding sequences of isolates from Spain and France. TOSV is more diverse than other well-studied phleboviruses (e.g.,Rift Valley fever virus).
Co-infection with Pansensitive and Multidrug-Resistant Strains of Mycobacterium tuberculosis
PDF Version [PDF - 190 KB - 3 pages]
M. P. Mendez et al.View Abstract
We report a case of a 23-year-old HIV-negative man with multidrug-resistant Mycobacterium tuberculosis that became evident while he was being treated for M. tuberculosis that was sensitive to all first-line drugs. This case should alert clinicians to consider co-infection as a possible cause of recrudescent disease.
Enterovirus 71 Maternal Antibodies in Infants, Taiwan
PDF Version [PDF - 251 KB - 4 pages]
S. Luo et al.View Abstract
Enterovirus 71 (EV71) causes life-threatening disease outbreaks in young children in Asia. This cohort study was conducted to understand the dynamics of maternal EV71 antibodies in Taiwanese young infants. Approximately 50% of neonates had detectable EV71 neutralizing antibodies, which declined to almost undetectable levels by 6 months of age.
Correlation between Tick Density and Pathogen Endemicity, New Hampshire
PDF Version [PDF - 212 KB - 3 pages]
S. T. Walk et al.View Abstract
To assess the endemicity of tick-borne pathogens in New Hampshire, we surveyed adult tick vectors. Pathogens were more prevalent in areas of high tick density, suggesting a correlation between tick establishment and pathogen endemicity. Infection rates in ticks correlated with disease frequency in humans.
Lobomycosis in Offshore Bottlenose Dolphins (Tursiops truncatus), North Carolina
PDF Version [PDF - 205 KB - 3 pages]
D. S. Rotstein et al.View Abstract
Lacazia loboi, a cutaneous fungus, is found in humans and dolphins from transitional tropical (Florida) and tropical (South America) regions. We report 2 cases of lobomycosis in stranded bottlenose dolphins (Tursiops truncatus) and 1 case of lobomycosis-like disease in 1 free-swimming, pelagic, offshore bottlenose dolphin from North Carolina, where no cases have previously been observed.
Concurrent Chikungunya and Dengue Virus Infections during Simultaneous Outbreaks, Gabon, 2007
PDF Version [PDF - 211 KB - 3 pages]
E. M. Leroy et al.View Abstract
An outbreak of febrile illness occurred in Gabon in 2007, with 20,000 suspected cases. Chikungunya or dengue-2 virus infections were identified in 321 patients; 8 patients had documented co-infections. Aedes albopictus was identified as the principal vector for the transmission of both viruses.
Gnathostomiasis Acquired by British Tourists in Botswana
PDF Version [PDF - 304 KB - 4 pages]
J. S. Herman et al.View Abstract
Infection with Gnathostoma spinigerum has been generally confined to Southeast Asia and Central and South America. However, gnathostomiasis was recently found in British tourists who had visited Botswana. Consequently, travel to Africa should now be considered a risk factor for gnathostomiasis.
Skin and Soft Tissue Infections (Patera Foot) in Immigrants, Spain
PDF Version [PDF - 219 KB - 3 pages]
H. Ternavasio-de la Vega et al.View Abstract
An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats (pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis.
Congenital Transmission of Chagas Disease in Latin American Immigrants in Switzerland
PDF Version [PDF - 176 KB - 3 pages]
Y. Jackson et al.View Abstract
International migration has changed the epidemiologic patterns of Chagas disease. Recently, 2 cases of Chagas disease transmitted from Latin American women to their newborns were diagnosed in Geneva, Switzerland. A retrospective study to detect Chagas disease showed a prevalence of 9.7% among 72 Latin American women tested during pregnancy in Switzerland.
Isolation of Genotype V St. Louis Encephalitis Virus in Florida
PDF Version [PDF - 158 KB - 3 pages]
C. L. Ottendorfer et al.View Abstract
We isolated and characterized St. Louis encephalitis virus (SLEV) from cloacal swabs of naturally exposed adult sentinel chickens in 2006. Phylogenetic analysis of SLEV strains isolated in Florida indicated that Brazilian SLEV circulated in 1972 and 2006; lineages were VA and VB.
Chagasic Cardiomyopathy in Immigrants from Latin America to Spain
PDF Version [PDF - 68 KB - 2 pages]
A. Pérez de Ayala et al.
Spotted Fever Group Rickettsia sp. Closely Related to R. japonica, Thailand
PDF Version [PDF - 114 KB - 2 pages]
N. Takada et al.
Segniliparus rugosus Infection, Australia
PDF Version [PDF - 79 KB - 3 pages]
T. Hansen et al.
Multigenotype Q Fever Outbreak, the Netherlands
PDF Version [PDF - 65 KB - 2 pages]
C. H. Klaassen et al.
Correlation between Buruli Ulcer and Vector-borne Notifiable Diseases, Victoria, Australia
PDF Version [PDF - 67 KB - 2 pages]
P. D. Johnson and C. J. Lavender
Avian Influenza Risk Perception among Poultry Workers, Nigeria
PDF Version [PDF - 69 KB - 2 pages]
F. O. Fasina et al.
Mycobacterium avium subsp. hominissuis Infection in a Pet Parrot
PDF Version [PDF - 80 KB - 3 pages]
E. J. Shitaye et al.
Mycobacterium colombiense and Pseudotuberculous Lymphadenopathy
PDF Version [PDF - 80 KB - 2 pages]
K. Vuorenmaa et al.
Leptospira noguchii and Human and Animal Leptospirosis, Southern Brazil
PDF Version [PDF - 112 KB - 3 pages]
É. F. Silva et al.
Aquaculture and Florfenicol Resistance in Salmonella enterica Serovar Typhimurium DT104
PDF Version [PDF - 120 KB - 2 pages]
F. C. Cabello
Lethal Bluetongue Virus Serotype 1 Infection in Llamas
PDF Version [PDF - 122 KB - 3 pages]
G. Meyer et al.
About the Cover
Peer Reviewed Report Available Online OnlyInternational Course on Emerging Viruses in the Amazon RegionA. L. Gomes et al.
News and Notes
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.
Get Email Updates
To receive email updates about this page, enter your email address:
- Page created: June 07, 2012
- Page last updated: June 07, 2012
- Page last reviewed: June 07, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)