Volume 15, Number 7—July 2009
Volume 15, Number 7—July 2009 PDF Version [PDF - 9.93 MB - 159 pages]
Medscape CME Activity
Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006 PDF Version [PDF - 691 KB - 7 pages]A. S. Chapman et al.View Abstract
In February 2006, a diagnosis of sylvatic epidemic typhus in a counselor at a wilderness camp in Pennsylvania prompted a retrospective investigation. From January 2004 through January 2006, 3 more cases were identified. All had been counselors at the camp and had experienced febrile illness with myalgia, chills, and sweats; 2 had been hospitalized. All patients had slept in the same cabin and reported having seen and heard flying squirrels inside the wall adjacent to their bed. Serum from each patient had evidence of infection with Rickettsia prowazekii. Analysis of blood and tissue from 14 southern flying squirrels trapped in the woodlands around the cabin indicated that 71% were infected with R. prowazekii. Education and control measures to exclude flying squirrels from housing are essential to reduce the likelihood of sylvatic epidemic typhus.
Increased Host Species Diversity and Decreased Prevalence of Sin Nombre Virus
PDF Version [PDF - 569 KB - 7 pages]
L. J. Dizney and L. A. RuedasView Abstract
Emerging outbreaks of zoonotic diseases are affecting humans at an alarming rate. Until the ecological factors associated with zoonoses are better understood, disease emergence will continue. For Lyme disease, disease suppression has been demonstrated by a dilution effect, whereby increasing species diversity decreases disease prevalence in host populations. To test the dilution effect in another disease, we examined 17 ecological variables associated with prevalence of the directly transmitted Sin Nombre virus (genus Hantavirus, etiologic agent of hantavirus pulmonary syndrome) in its wildlife host, the deer mouse (Peromyscus maniculatus). Only species diversity was statistically linked to infection prevalence: as species diversity decreased, infection prevalence increased. The increase was moderate, but prevalence increased exponentially at low levels of diversity, a phenomenon described as zoonotic release. The results suggest that species diversity affects disease emergence.
Spatial and Temporal Dynamics of Lymphocytic Choriomeningitis Virus in Wild Rodents, Northern Italy
PDF Version [PDF - 680 KB - 7 pages]
V. Tagliapietra et al.View Abstract
We determined the prevalence of infection with lymphocytic choriomeningitis virus (LCMV) among small mammals in northern Italy and analyzed long-term dynamics of LCMV in a rodent population in the province of Trento. LCMV is circulating among the most widespread and common wild rodent species in this area (Apodemus flavicollis, Myodes glareolus, and Microtus arvalis); overall prevalence is 6.8%. During 2000–2006, intensive monitoring of LCMV in a population of yellow-necked mice (A. flavicollis) showed a positive correlation between prevalence of infection and rodent density. At the individual level, weight and sex appeared to correlate with antibody prevalence, which suggests that horizontal transmission of LCMV occurs principally among heavier, older males and occurs during fighting. Isolation and genetic characterization of this virus will be the crucial next steps for a better understanding of its ecology.
Tick-borne Relapsing Fever and Borrelia hermsii, Los Angeles County, California, USA
PDF Version [PDF - 529 KB - 6 pages]
T. G. Schwan et al.View Abstract
The primary cause of tick-borne relapsing fever in western North America is Borrelia hermsii, a rodent-associated spirochete transmitted by the fast-feeding soft tick Ornithodoros hermsi. We describe a patient who had an illness consistent with relapsing fever after exposure in the mountains near Los Angeles, California, USA. The patient’s convalescent-phase serum was seropositive for B. hermsii but negative for several other vector-borne bacterial pathogens. Investigations at the exposure site showed the presence of O. hermsi ticks infected with B. hermsii and the presence of rodents that were seropositive for the spirochete. We determined that this tick-borne disease is endemic to the San Gabriel Mountains near the greater Los Angeles metropolitan area.
Risk Factors for Human Infection with Puumala Virus, Southwestern Germany
PDF Version [PDF - 605 KB - 8 pages]
A. C. Schwarz et al.View Abstract
Puumala virus, which causes nephropathia epidemica (NE), is the most prevalent hantavirus in Germany; bank voles serve as the main reservoir. During 2001–2007, most NE cases reported from Germany occurred in the southwestern state of Baden-Württemberg. We investigated the influence of bank vole habitats (beech forest, seed plants), vole food supply (beechnut mast), climate factors (winter and spring temperatures), and human population density on spatial and temporal occurrence of NE cases in Baden-Württemberg. Using Poisson-regression analyses, we found that all these factors influenced disease incidence. Furthermore, an independent trend of increasing incidence predicted that incidence will nearly double each year. The regression model explained 75% of the annual variation in NE incidence. The results suggest that environmental drivers lead to increasing incidence of NE infections in the southern part or even other parts of Germany.
Invasions by Eurasian Avian Influenza Virus H6 Genes and Replacement of Its North American Clade
PDF Version [PDF - 548 KB - 6 pages]
H. zu Dohna et al.View Abstract
The spread of highly pathogenic avian influenza virus (AIV) (H5N1) underlines the potential for global AIV movement through birds. The phylogenies of AIV genes from avian hosts usually separate into Eurasian and North American clades, reflecting limited bird migration between the hemispheres. However, mounting evidence that some H6 sequences from North America cluster with Eurasian subtype H6 sequences calls the strict hemispheric divide into question. We conducted a comprehensive phylogenetic analysis of the extent and timing of cross-hemisphere movements by the H6 gene. Results suggested that Eurasian H6 subtype has invaded North America several times, with the first invasions occurring 10 years before the first detection of invading isolates. The members of the North American clade decreased from 100% in the 1980s to 20% in the 2000s among H6 isolates from North America. Unraveling the reasons for this large-scale gene movement between hemispheres might identify drivers of global AIV circulation.
Multiple Origins of Foot-and-Mouth Disease Virus Serotype Asia 1 Outbreaks, 2003–2007
PDF Version [PDF - 597 KB - 6 pages]
J. Valarcher et al.View Abstract
We investigated the molecular epidemiology of foot-and-mouth disease virus (FMDV) serotype Asia 1, which caused outbreaks of disease in Asia during 2003–2007. Since 2004, the region affected by outbreaks of this serotype has increased from disease-endemic countries in southern Asia (Afghanistan, India, Iran, Nepal, Pakistan) northward to encompass Kyrgyzstan, Tajikistan, Uzbekistan, several regions of the People’s Republic of China, Mongolia, Eastern Russia, and North Korea. Phylogenetic analysis of complete virus capsid protein 1 (VP1) gene sequences demonstrated that the FMDV isolates responsible for these outbreaks belonged to 6 groups within the Asia 1 serotype. Some contemporary strains were genetically closely related to isolates collected historically from the region as far back as 25 years ago. Our analyses also indicated that some viruses have spread large distances between countries in Asia within a short time.
Clusters of Multidrug-Resistant Mycobacterium tuberculosis Cases, Europe
PDF Version [PDF - 552 KB - 9 pages]
I. Devaux et al.View Abstract
Molecular surveillance of multidrug-resistant tuberculosis (MDR TB) was implemented in Europe as case reporting in 2005. For all new MDR TB cases detected from January 2003 through June 2007, countries reported case-based epidemiologic data and DNA fingerprint patterns of MDR TB strains when available. International clusters were detected and analyzed. From 2003 through mid-2007 in Europe, 2,494 cases of MDR TB were reported from 24 European countries. Epidemiologic and molecular data were linked for 593 (39%) cases, and 672 insertion sequence 6110 DNA fingerprint patterns were reported from 19 countries. Of these patterns, 288 (43%) belonged to 18 European clusters; 7 clusters (242/288 cases, 84%) were characterized by strains of the Beijing genotype family, including the largest cluster (175/288 cases, 61%). Both clustering and the Beijing genotype were associated with strains originating in eastern European countries. Molecular cluster detection contributes to identification of transmission profile, risk factors, and control measures.
Relapse Associated with Active Disease Caused by Beijing Strain of Mycobacterium tuberculosis
PDF Version [PDF - 556 KB - 7 pages]
W. J. Burman et al.View Abstract
The role of microbial factors in outcomes of tuberculosis treatment has not been well studied. We performed a case–control study to evaluate the association between a Beijing strain and tuberculosis treatment outcomes. Isolates from patients with culture-positive treatment failure (n = 8) or relapse (n = 54) were compared with isolates from randomly selected controls (n = 296) by using spoligotyping. Patients with Beijing strains had a higher risk for relapse (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0–4.0, p = 0.04) but not for treatment failure. Adjustment for factors previously associated with relapse had little effect on the association between Beijing strains and relapse. Beijing strains were strongly associated with relapse among Asian–Pacific Islanders (OR 11, 95% CI 1.1–108, p = 0.04). Active disease caused by a Beijing strain was associated with increased risk for relapse, particularly among Asian–Pacific Islanders.
Frequency and Evolution of Azole Resistance in Aspergillus fumigatus Associated with Treatment Failure
PDF Version [PDF - 655 KB - 9 pages]
S. J. Howard et al.View Abstract
Azoles are the mainstay of oral therapy for aspergillosis. Azole resistance in Aspergillus has been reported infrequently. The first resistant isolate was detected in 1999 in Manchester, UK. In a clinical collection of 519 A. fumigatus isolates, the frequency of itraconazole resistance was 5%, a significant increase since 2004 (p<0.001). Of the 34 itraconazole-resistant isolates we studied, 65% (22) were cross-resistant to voriconazole and 74% (25) were cross-resistant to posaconazole. Thirteen of 14 evaluable patients in our study had prior azole exposure; 8 infections failed therapy (progressed), and 5 failed to improve (remained stable). Eighteen amino acid alterations were found in the target enzyme, Cyp51A, 4 of which were novel. A population genetic analysis of microsatellites showed the existence of resistant mutants that evolved from originally susceptible strains, different cyp51A mutations in the same strain, and microalterations in microsatellite repeat number. Azole resistance in A. fumigatus is an emerging problem and may develop during azole therapy.
Co-infections with Chikungunya Virus and Dengue Virus in Delhi, India
PDF Version [PDF - 408 KB - 4 pages]
H. S. Chahar et al.View Abstract
Aedes aegypti mosquitoes are common vectors for dengue virus and chikungunya virus. In areas where both viruses cocirculate, they can be transmitted together. During a dengue outbreak in Delhi in 2006, 17 of 69 serum samples were positive for chikungunya virus by reverse transcription–PCR; 6 samples were positive for both viruses.
Influenza Virus A (H1N1) in Giant Anteaters (Myrmecophaga tridactyla)
PDF Version [PDF - 560 KB - 3 pages]
S. Nofs et al.View Abstract
In February 2007, an outbreak of respiratory disease occurred in a group of giant anteaters (Myrmecophaga tridactyla) at the Nashville Zoo. Isolates from 2 affected animals were identified in March 2007 as a type A influenza virus related to human influenza subtype H1N1.
Intergenogroup Recombinant Sapovirus in Japan, 2007–2008
PDF Version [PDF - 590 KB - 4 pages]
W. Chanit et al.View Abstract
We investigated the incidence of sapovirus (SaV)–associated gastroenteritis in infants and children in Japan during 2007–2008 and characterized the diversity of SaV-positive strains. SaV was detected in 19 (4%) of 477 fecal specimens. The leading genogroup (79%, 15 cases) comprised intergenogroup recombinant SaVs (GII/GIV).
Lack of Macrolide Resistance in Chlamydia trachomatis after Mass Azithromycin Distributions for Trachoma
PDF Version [PDF - 455 KB - 3 pages]
K. C. Hong et al.View Abstract
We investigated antimicrobial drug resistance in ocular Chlamydia trachomatis 18 months after 4 biannual communitywide distributions of antimicrobial drugs in a region of Ethiopia where ocular strains of C. trachomatis are highly endemic. We found no significant differences in susceptibilities to azithromycin and doxycycline in 6 posttreatment and 4 pretreatment samples.
Genetically Diverse Coronaviruses in Wild Bird Populations of Northern England
PDF Version [PDF - 399 KB - 4 pages]
L. A. Hughes et al.View Abstract
Infectious bronchitis virus (IBV) causes a costly respiratory viral disease of chickens. The role of wild birds in the epidemiology of IBV is poorly understood. We detected diverse coronaviruses by PCR in wildfowl and wading birds in England. Sequence analysis showed some viruses to be related to IBV.
WU Polyomavirus in Patients Infected with HIV or Hepatitis C Virus, Connecticut, USA, 2007
PDF Version [PDF - 435 KB - 3 pages]
M. A. Miller et al.View Abstract
WU polyomavirus (WUPyV) was detected in 10 (8.3%) of 121 HIV-positive plasma specimens, 0 (0%) of 120 HIV-negative serum specimens, and 2 (2.5%) of 79 hepatitis C virus (HCV)–positive serum specimens. KI polyomavirus was not detected in HIV-positive plasma or HCV-positive serum specimens. HIV-infected persons may be susceptible to systemic WUPyV infection.
Methicillin-Resistant Staphylococcus aureus ST398 in Swine Farm Personnel, Belgium
PDF Version [PDF - 499 KB - 4 pages]
O. Denis et al.View Abstract
We assessed methicillin-resistant Staphylococcus aureus (MRSA) in persons on 49 swine farms in Belgium. Surveys showed that 48 (37.8%) persons carried MRSA ST398 and 1 (0.8%) had concurrent skin infection. Risk factors for carriage were MRSA carriage by pigs, regular contact with pigs and companion animals, and use of protective clothing.
Eczema Herpeticum and Clinical Criteria for Investigating Smallpox
PDF Version [PDF - 543 KB - 3 pages]
D. A. Boyd et al.View Abstract
Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, our patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox.
Rickettsia slovaca and R. raoultii in Tick-borne Rickettsioses
PDF Version [PDF - 472 KB - 4 pages]
P. Parola et al.View Abstract
Tick-borne lymphadenopathy (TIBOLA), also called Dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL), is defined as the association of a tick bite, an inoculation eschar on the scalp, and cervical adenopathies. We identified the etiologic agent for 65% of 86 patients with TIBOLA/DEBONEL as either Rickettsia slovaca (49/86, 57%) or R. raoultii (7/86, 8%).
Latent Tuberculosis and Active Tuberculosis Disease Rates among the Homeless, New York, New York, USA, 1992–2006
PDF Version [PDF - 417 KB - 3 pages]
J. M. McAdam et al.View Abstract
We conducted a retrospective study to examine trends in latent tuberculosis infection (LTBI) and TB disease rates among homeless persons in shelters in New York, NY, 1992–2006. Although TB case rates fell from 1,502/100,000 population to 0, a 31% LTBI rate in 2006 shows the value of identifying and treating TB in the homeless.
Chinese-like Strain of Porcine Epidemic Diarrhea Virus, Thailand
PDF Version [PDF - 494 KB - 4 pages]
S. Puranaveja et al.View Abstract
Since late 2007, several outbreaks of porcine epidemic diarrhea virus (PEDV) infection have emerged in Thailand. Phylogenetic analysis places all Thai PEDV isolates during the outbreaks in the same clade as the Chinese strain JS-2004-2. This new genotype PEDV is prevailing and currently causing sporadic outbreaks in Thailand.
Epidemiology of Human T-cell Lymphotropic Virus Type 1 Infection in Blood Donors, Israel
PDF Version [PDF - 424 KB - 3 pages]
S. Stienlauf et al.View Abstract
The prevalence of infection with human T-cell lymphotropic virus type 1 (HTLV-1) in blood donors from Israel is 1 infection/100,000 persons. In donors originating from Eastern Europe, the Middle East, and Latin America, prevalences are 7.7, 14.6, and 20.4, respectively. HTLV-1 prevalence may be high outside areas where HTLV-1 previously was known to be endemic.
Recurrent Lymphocytic Meningitis Positive for Herpes Simplex Virus Type 2
PDF Version [PDF - 512 KB - 4 pages]
K. Kallio-Laine et al.View Abstract
We found the prevalence of recurrent lymphocytic meningitis associated with herpes simplex virus type 2 (HSV-2) was 2.2/100,000 population in Finland during 1996–2006, higher than previous estimates. PCR was most sensitive in detecting HSV-2 DNA from cerebrospinal fluid if the sample was taken 2–5 days after symptom onset.
Possible Outbreak of Streptomycin-Resistant Mycobacterium tuberculosis Beijing in Benin
PDF Version [PDF - 430 KB - 3 pages]
D. Affolabi et al.View Abstract
Using geographic information system and molecular tools, we characterized a possible outbreak of tuberculosis caused by Mycobacterium tuberculosis Beijing strain in 17 patients in Cotonou, Benin, during July 2005–October 2006. Most patients lived or worked in the same area and frequented the same local drinking bar. The isolates were streptomycin resistant.
Rickettsia felis Infection in Man, France
PDF Version [PDF - 398 KB - 2 pages]
A. Renvoisé et al.
Rapid Increase of Scrub Typhus, South Korea, 2001–2006
PDF Version [PDF - 435 KB - 3 pages]
S. Kweon et al.
Fatal Algaemia in Patient with Chronic Lymphocytic Leukemia
PDF Version [PDF - 389 KB - 2 pages]
P. Lanotte et al.
Arcanobacterium pyogenes Sepsis in Farmer, Brazil
PDF Version [PDF - 348 KB - 2 pages]
C. E. Levy et al.
Reactivation of Bovine Tuberculosis in Patient Treated with Infliximab, Switzerland
PDF Version [PDF - 349 KB - 2 pages]
M. Nager et al.
Chitinophaga terrae Bacteremia in Human
PDF Version [PDF - 417 KB - 2 pages]
L. Crémet et al.
Immunoglobulin G in Ebola Outbreak Survivors, Gabon
PDF Version [PDF - 370 KB - 2 pages]
N. Wauquier et al.
Varibaculum cambriense Infections in Hong Kong, China, 2006
PDF Version [PDF - 393 KB - 3 pages]
Y. Chu et al.
Outbreaks of Hemotrophic Mycoplasma Infections in China
PDF Version [PDF - 337 KB - 2 pages]
Z. Hu et al.
Sensitivity of Andes Hantavirus to Antiviral Effect of Human Saliva
PDF Version [PDF - 372 KB - 3 pages]
J. Hardestam et al.
Spread of Cantagalo Virus to Northern Brazil
PDF Version [PDF - 343 KB - 2 pages]
M. L. Medaglia et al.
Acanthamoeba spp. in Urine of Critically Ill Patients
PDF Version [PDF - 372 KB - 3 pages]
L. C. Santos et al.
Ranavirus Outbreak in North American Bullfrogs (Rana catesbeiana), Japan, 2008
PDF Version [PDF - 344 KB - 2 pages]
Y. Une et al.
Maternal Antibody Transfer in Yellow-legged Gulls
PDF Version [PDF - 342 KB - 3 pages]
J. M. Pearce-Duvet et al.
Bartonella rochalimae and Other Bartonella spp. in Fleas, Chile
PDF Version [PDF - 432 KB - 3 pages]
L. Pérez-Martínez et al.
Prevalence of Human Bocavirus in Human Tonsils and Adenoids
PDF Version [PDF - 343 KB - 2 pages]
N. Clément et al.
Books and Media
Emerging Infections in Asia
PDF Version [PDF - 327 KB - 1 page]
L. H. Phong
War and Disease: Biomedical Research on Malaria in the Twentieth Century
PDF Version [PDF - 417 KB - 1 page]
About the Cover
Peer Reviewed Report Available Online OnlyPotential Impact of a 2-Person Security Rule on BioSafety Level 4 Laboratory WorkersJ. W. LeDuc et al.View SummaryView Abstract
Directors of all major BioSafety Level 4 (BSL-4) laboratories in the United States met in 2008 to review the current status of biocontainment laboratory operations and to discuss the potential impact of a proposed 2-person security rule on maximum-containment laboratory operations. Special attention was paid to the value and risks that would result from a requirement that 2 persons be physically present in the laboratory at all times. A consensus emerged indicating that a video monitoring system represents a more efficient, economical standard; provides greater assurance that pathogens are properly manipulated; and offers an increased margin of employee safety and institutional security. The 2-person security rule (1 to work and 1 to observe) may decrease compliance with dual responsibilities of safety and security by placing undue pressure on the person being observed to quickly finish the work, and by placing the observer in the containment environment unnecessarily.
Peer Reviewed Report Available Online OnlyMeeting on Establishment of Consortium to Study Invasive Salmonelloses in Sub-Saharan AfricaJ. D. Clemens
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