Volume 16, Number 9—September 2010
Volume 16, Number 9—September 2010 PDF Version [PDF - 6.48 MB - 179 pages]
Medscape CME Activity
Recurrent Granulibacter bethesdensis Infections and Chronic Granulomatous Disease PDF Version [PDF - 418 KB - 8 pages]D. E. Greenberg et al.View Abstract
Chronic granulomatous disease (CGD) is characterized by frequent infections, most of which are curable. Granulibacter bethesdensis is an emerging pathogen in patients with CGD that causes fever and necrotizing lymphadenitis. However, unlike typical CGD organisms, this organism can cause relapse after clinical quiescence. To better define whether infections were newly acquired or recrudesced, we use comparative bacterial genomic hybridization to characterize 11 isolates obtained from 5 patients with CGD from North and Central America. Genomic typing showed that 3 patients had recurrent infection months to years after apparent clinical cure. Two patients were infected with the same strain as previously isolated, and 1 was infected with a genetically distinct strain. This organism is multidrug resistant, and therapy required surgery and combination antimicrobial drugs, including long-term ceftriaxone. G. bethesdensis causes necrotizing lymphadenitis in CGD, which may recur or relapse.
Long-Term Health Risks for Children and Young Adults after Infective Gastroenteritis
PDF Version [PDF - 251 KB - 8 pages]
R. E. Moorin et al.View Abstract
To quantify the risk and types of sequelae attributable to prior enteric infections, we undertook a population-based retrospective cohort study using linked administrative records. The risk for first-time hospitalization for sequelae was modeled by using Cox proportional regression analysis controlling for other health and sociodemographic factors. We identified a significant increase of 64% in the rate of first-time hospitalization for sequelae for persons with prior enteric infections: 52% for intragastrointestinal sequelae and 63% for extragastrointestinal sequelae compared with first-time hospitalization for those without prior infection. Extragastrointestinal sequelae occurred predominantly during the first 5 years after first-time enteric infection. In contrast, most intragastrointestinal sequelae occurred >10 years later. Infective gastroenteritis during childhood or adolescence increases the risk for first-time hospitalization for intragastrointestinal and extragastrointestinal disease over the 2 decades after first-time enteric infection, highlighting the importance of identifying ways of reducing the incidence of such infections.
Trends in Hospitalizations for Peptic Ulcer Disease, United States, 1998–2005
PDF Version [PDF - 342 KB - 9 pages]
L. B. Feinstein et al.View Abstract
Infection with Helicobacter pylori increases the risk for peptic ulcer disease (PUD) and its complications. To determine whether hospitalization rates for PUD have declined since antimicrobial drugs to eradicate H. pylori became available, we examined 1998–2005 hospitalization records (using the Nationwide Inpatient Sample) in which the primary discharge diagnosis was PUD. Hospitalizations for which the diagnosis was H. pylori infection were also considered. The age-adjusted hospitalization rate for PUD decreased 21% from 71.1/100,000 population (95% confidence interval [CI] 68.9–73.4) in 1998 to 56.5/100,000 in 2005 (95% CI 54.6–58.3). The hospitalization rate for PUD was highest for adults >65 years of age and was higher for men than for women. The age-adjusted rate was lowest for whites and declined for all racial/ethnic groups, except Hispanics. The age-adjusted H. pylori hospitalization rate also decreased. The decrease in PUD hospitalization rates suggests that the incidence of complications caused by H. pylori infection has declined.
Worldwide Diversity of Klebsiella pneumoniae That Produce β-Lactamase bla Gene
PDF Version [PDF - 379 KB - 8 pages]
G. Cuzon et al.View Abstract
Klebsiella pneumoniae isolates that produce carbapenemases (KPCs) are rapidly disseminating worldwide. To determine their genetic background, we investigated 16 blaKPC-2-harboring K. pneumoniae isolates from 5 countries. The isolates were multidrug resistant, possessed the blaKPC-2 gene, and differed by additional β-lactamase content. They harbored a naturally chromosome-encoded bla gene (blaSHV-1 [12.5%], blaSHV-11 [68.7%], or blaOKP-A/B [18.8%]) and several acquired and plasmid-encoded genes (blaTEM-1 [81.3%], blaCTX-M-2 [31.3%], blaCTX-M-12 [12.5%], blaCTX-M-15 [18.7%], and blaOXA-9 [37.5%]). The blaKPC-2 gene was always associated with 1 of the Tn4401 isoforms (a, b, or c). Tn4401 was inserted on different-sized plasmids that belonged to different incompatibility groups. Several blaKPC-containing K. pneumoniae clones were found: 9 different pulsotypes with 1 major (sequence type 258) and 7 minor distinct allelic profiles. Different clones harboring different plasmids but having identical genetic structure, Tn4401, could be at the origin of the worldwide spread of this emerging resistance gene.
Cercarial Dermatitis Transmitted by Exotic Marine Snail
PDF Version [PDF - 417 KB - 9 pages]
S. V. Brant et al.View Abstract
Cercarial dermatitis (swimmer’s itch) is caused by the penetration of human skin by cercariae of schistosome parasites that develop in and are released from snail hosts. Cercarial dermatitis is frequently acquired in freshwater habitats, and less commonly in marine or estuarine waters. To investigate reports of a dermatitis outbreak in San Francisco Bay, California, we surveyed local snails for schistosome infections during 2005–2008. We found schistosomes only in Haminoea japonica, an Asian snail first reported in San Francisco Bay in 1999. Genetic markers place this schistosome within a large clade of avian schistosomes, but do not match any species for which there are genetic data. It is the second known schistosome species to cause dermatitis in western North American coastal waters; these species are transmitted by exotic snails. Introduction of exotic hosts can support unexpected emergence of an unknown parasite with serious medical or veterinary implications.
All-Cause Mortality during First Wave of Pandemic (H1N1) 2009, New South Wales, Australia, 2009
PDF Version [PDF - 202 KB - 7 pages]
D. J. Muscatello et al.View Abstract
In temperate countries, death rates increase in winter, but influenza epidemics often cause greater increases. The death rate time series that occurs without epidemic influenza can be called a seasonal baseline. Differentiating observed death rates from the seasonally oscillating baseline provides estimated influenza-associated death rates. During 2003–2009 in New South Wales, Australia, we used a Serfling approach with robust regression to estimate age-specific weekly baseline all-cause death rates. Total differences between weekly observed and baseline rates during May–September provided annual estimates of influenza-associated death rates. In 2009, which included our first wave of pandemic (H1N1) 2009, the all-age death rate was 6.0 (95% confidence interval 3.1–8.9) per 100,000 persons lower than baseline. In persons >80 years of age, it was 131.6 (95% confidence interval 126.2–137.1) per 100,000 lower. This estimate is consistent with a pandemic virus causing mild illness in most persons infected and sparing older persons.
Medscape CME Activity
Illicit Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia PDF Version [PDF - 269 KB - 9 pages]K. M. Kreisel et al.View Abstract
To assess the association of illicit drug use and USA300 methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, a multicenter study was conducted at 4 Veterans Affairs medical centers during 2004–2008. The study showed that users of illicit drugs were more likely to have USA300 MRSA bacteremia (in contrast to bacteremia caused by other S. aureus strains) than were patients who did not use illicit drugs (adjusted relative risk 3.0; 95% confidence interval 1.9–4.4). The association of illicit drug use with USA300 MRSA bacteremia decreased over time (p = 0.23 for trend). Notably, the proportion of patients with USA300 MRSA bacteremia who did not use illicit drugs increased over time. This finding suggests that this strain has spread from users of illicit drugs to other populations.
Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza, Western Australia, 2009
PDF Version [PDF - 266 KB - 8 pages]
D. Carcione et al.View Abstract
We compared confirmed pandemic (H1N1) 2009 influenza and seasonal influenza diagnosed in Western Australia during the 2009 influenza season. From 3,178 eligible reports, 984 pandemic and 356 seasonal influenza patients were selected; 871 (88.5%) and 288 (80.9%) were interviewed, respectively. Patients in both groups reported a median of 6 of 11 symptoms; the difference between groups in the proportion reporting any given symptom was <10%. Fewer than half the patients in both groups had >1 underlying condition, and only diabetes was associated with pandemic (H1N1) 2009 influenza (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.5). A total of 129 (14.8%) persons with pandemic (H1N1) 2009 and 36 (12.5%) persons with seasonal influenza were hospitalized (p = 0.22). After controlling for age, we found that patient hospitalization was associated with pandemic (H1N1) 2009 influenza (OR 1.5; 95% CI 1.1–2.1). Contemporaneous pandemic and seasonal influenza infections were substantially similar in terms of patients’ symptoms, risk factors, and proportion hospitalized.
Pediatric Pneumococcal Serotypes in 4 European Countries
PDF Version [PDF - 765 KB - 12 pages]
G. Hanquet et al.View Abstract
After heptavalent pneumococcal conjugate vaccine (PCV7) was marketed in France, Spain, Belgium, and England and Wales (United Kingdom), invasive disease from non-PCV7 serotypes (NVT) increased. Adjusted serotype-specific incidences among children <15 years of age were compared between 1999–2002 (prevaccine) and 2005–2006 (postmarketing). Vaccine coverage increased to ≈32%–48% in France, Spain, and Belgium but remained <1% in England and Wales. Serotype 1 incidence rose in all age groups and countries (incidence rate ratio [IRR] 1.3–4.2; p<0.004), independently of PCV7 use, but incidence of serotypes 7F and 19A increased most in France, Spain, and Belgium (IRR 1.9–16.9 in children <5 years; p<0.001), where PCV7 coverage was greater. Vaccine-induced replacement of PCV7 serotypes possibly contributed to NVT increases, as did secular trends. New vaccines targeting these serotypes are available, but serotype dynamics needs further exploration that accounts for underreporting and prevaccine trends.
Influenza in Refugees on the Thailand–Myanmar Border, May–October 2009
PDF Version [PDF - 271 KB - 7 pages]
P. Turner et al.View Abstract
We describe the epidemiology of influenza virus infections in refugees in a camp in rural Southeast Asia during May–October 2009, the first 6 months after identification of pandemic (H1N1) 2009 in Thailand. Influenza A viruses were detected in 20% of patients who had influenza-like illness and in 23% of those who had clinical pneumonia. Seasonal influenza A (H1N1) was the predominant virus circulating during weeks 26–33 (June 25–August 29) and was subsequently replaced by the pandemic strain. A review of passive surveillance for acute respiratory infection did not show an increase in acute respiratory tract infection incidence associated with the arrival of pandemic (H1N1) 2009 in the camp.
Legionellosis Outbreak Associated with Asphalt Paving Machine, Spain, 2009
PDF Version [PDF - 284 KB - 7 pages]
M. Coscollá et al.View Abstract
From 1999 through 2005 in Alcoi, Spain, incidence of legionellosis was continually high. Over the next 4 years, incidence was lower, but an increase in July 2009 led health authorities to declare an epidemic outbreak. A molecular epidemiology investigation showed that the allelic profiles for all Legionella pneumophila samples from the 2009 outbreak patients were the same, thus pointing to a common genetic origin for their infections, and that they were identical to that of the organism that had caused the previous outbreaks. Spatial-temporal and sequence-based typing analyses indicated a milling machine used in street asphalt repaving and its water tank as the most likely sources. As opposed to other machines used for street cleaning, the responsible milling machine used water from a natural spring. When the operation of this machine was prohibited and cleaning measures were adopted, infections ceased.
Determinants of Multidrug-Resistant Tuberculosis Clusters, California, USA, 2004–2007
PDF Version [PDF - 215 KB - 7 pages]
J. Z. Metcalfe et al.View Abstract
Laboratory and epidemiologic evidence suggests that pathogen-specific factors may affect multidrug-resistant (MDR) tuberculosis (TB) transmission and pathogenesis. To identify demographic and clinical characteristics of MDR TB case clustering and to estimate the effect of specific isoniazid resistance–conferring mutations and strain lineage on genotypic clustering, we conducted a population-based cohort study of all MDR TB cases reported in California from January 1, 2004, through December 31, 2007. Of 8,899 incident culture-positive cases for which drug susceptibility information was available, 141 (2%) were MDR. Of 123 (87%) strains with genotype data, 25 (20%) were aggregated in 8 clusters; 113 (92%) of all MDR TB cases and 21 (84%) of clustered MDR TB cases occurred among foreign-born patients. In multivariate analysis, the katG S315T mutation (odds ratio 11.2, 95% confidence interval 2.2–∞; p = 0.004), but not strain lineage, was independently associated with case clustering.
Cotton Rats and House Sparrows as Hosts for North and South American Strains of Eastern Equine Encephalitis Virus
PDF Version [PDF - 439 KB - 8 pages]
N. C. Arrigo et al.View Abstract
Eastern equine encephalitis virus (EEEV; family Togaviridae, genus Alphavirus) is an arbovirus that causes severe disease in humans in North America and in equids throughout the Americas. The enzootic transmission cycle of EEEV in North America involves passerine birds and the ornithophilic mosquito vector, Culiseta melanura, in freshwater swamp habitats. However, the ecology of EEEV in South America is not well understood. Culex (Melanoconion) spp. mosquitoes are considered the principal vectors in Central and South America; however, a primary vertebrate host for EEEV in South America has not yet been identified. Therefore, to further assess the reservoir host potential of wild rodents and wild birds, we compared the infection dynamics of North American and South American EEEV in cotton rats (Sigmodon hispidus) and house sparrows (Passer domesticus). Our findings suggested that each species has the potential to serve as amplification hosts for North and South America EEEVs.
Typhoid Fever and Invasive Nontyphoid Salmonellosis, Malawi and South Africa
PDF Version [PDF - 344 KB - 4 pages]
N. A. Feasey et al.View Abstract
To determine the prevalence of invasive nontyphoid salmonellosis and typhoid fever in Malawi and South Africa, we compared case frequency and patient age distribution. Invasive nontyphoid salmonellosis showed a clear bimodal age distribution; the infection developed in women at a younger age than in men. Case frequency for typhoid fever was lower than for salmonellosis.
KI and WU Polyomaviruses and CD4+ Cell Counts in HIV-1–infected Patients, Italy
PDF Version [PDF - 316 KB - 4 pages]
M. Babakir-Mina et al.View Abstract
To investigate an association between KI and WU polyomavirus (KIPyV and WUPyV) infections and CD4+ cell counts, we tested HIV-1–positive patients and blood donors. No association was found between cell counts and virus infections in HIV-1–positive patients. Frequency of KIPyV infection was similar for both groups. WUPyV was more frequent in HIV-1–positive patients.
Increasing Incidence of Mucormycosis in University Hospital, Belgium
PDF Version [PDF - 135 KB - 3 pages]
V. Saegeman et al.View Abstract
To determine why incidence of mucormycosis infections was increasing in a large university hospital in Belgium, we examined case data from 2000–2009. We found the increase was not related to voriconazole use but most probably to an increase in high-risk patients, particularly those with underlying hematologic malignancies.
Extensively Drug-Resistant Tuberculosis, Pakistan
PDF Version [PDF - 136 KB - 3 pages]
R. Hasan et al.View Abstract
Frequency of extensively drug-resistant tuberculosis in Pakistan increased from 1.5% in 2006 to 4.5% in 2009 (p<0.01). To understand the epidemiology, we genotyped selected strains by using spoligotyping, mycobacterial interspersed repetitive units–variable number of tandem repeats, and IS6110 restriction fragment length polymorphism analysis.
Tuberculosis Acquired Outside of Households, Rural Vietnam
PDF Version [PDF - 132 KB - 3 pages]
T. N. Buu et al.View Abstract
Using population-based data from rural Vietnam, we assessed tuberculosis (TB) transmission within and outside of households. Eighty-three percent of persons with recent household TB were infected by different strains of Mycobacterium tuberculosis than were their household members. This result argues against the effectiveness of active TB case finding among household members.
Co-infections with Plasmodium knowlesi and Other Malaria Parasites, Myanmar
PDF Version [PDF - 242 KB - 3 pages]
N. Jiang et al.View Abstract
To determine the frequency of co-infections with Plasmodium species in southern Myanmar, we investigated the prevalence of P. knowlesi. More than 20% of patients with malaria had P. knowlesi infection, which occurred predominantly as a co-infection with either P. falciparum or P. vivax.
Human Herpesvirus 8 Genotype E in Patients with Kaposi Sarcoma, Peru
PDF Version [PDF - 382 KB - 4 pages]
O. Cassar et al.View Abstract
To determine human herpesvirus 8 (HHV-8) K1 genotypes in patients with Kaposi sarcoma (KS) from Peru, we characterized HHV-8 in 25 KS biopsy samples. Our findings of 8 A, 1 B, 14 C, and 2 E subtypes showed high HHV-8 diversity in these patients and association between E genotype and KS development.
Novel Hepatitis E Virus Genotype in Norway Rats, Germany
PDF Version [PDF - 330 KB - 4 pages]
R. Johne et al.View Abstract
Human hepatitis E virus infections may be caused by zoonotic transmission of virus genotypes 3 and 4. To determine whether rodents are a reservoir, we analyzed the complete nucleotide sequence of a hepatitis E–like virus from 2 Norway rats in Germany. The sequence suggests a separate genotype for this hepatotropic virus.
Exposure of Dentists to Mycobacterium tuberculosis, Ibadan, Nigeria
PDF Version [PDF - 168 KB - 3 pages]
S. I. Cadmus et al.View Abstract
To determine the prevalence of Mycobacterium tuberculosis infection among dental patients and to assess dentists’ risk for exposure, we conducted a study among dental patients at a large tertiary hospital in Nigeria, a country where tuberculosis is endemic. Ten (13%) of 78 sputum samples obtained were positive for M. tuberculosis.
Rhinovirus Outbreaks in Long-term Care Facilities, Ontario, Canada
PDF Version [PDF - 158 KB - 3 pages]
J. Longtin et al.View Abstract
Diagnostic difficulties may have led to underestimation of rhinovirus infections in long-term care facilities. Using surveillance data, we found that rhinovirus caused 59% (174/297) of respiratory outbreaks in these facilities during 6 months in 2009. Disease was sometimes severe. Molecular diagnostic testing can differentiate these outbreaks from other infections such as influenza.
Analysis of Avian Hepatitis E Virus from Chickens, China
PDF Version [PDF - 314 KB - 4 pages]
Q. Zhao et al.View Abstract
Avian hepatitis E virus (HEV) has been identified in chickens; however, only 4 complete or near-complete genomic sequences have been reported. We found that the near-complete genomic sequence of avian HEV in chickens from China shared the highest identity (98.3%) with avian HEV from Europe and belonged to avian HEV genotype 3.
Contact Lens Solution–associated Acanthamoeba and Fusarium Keratitis
PDF Version [PDF - 101 KB - 3 pages]
J. D. Bullock and R. E. Warwar
Austrian Syndrome Associated with Pandemic (H1N1) 2009 in Child
PDF Version [PDF - 105 KB - 3 pages]
W. Alhushki and C. Rongkavilit
Hospital Discharge Data for Guillain-Barré Syndrome and Influenza A (H1N1) Vaccine Adverse Events
PDF Version [PDF - 78 KB - 2 pages]
T. F. Jones et al.
Invasive Klebsiella pneumoniae Infections, California, USA
PDF Version [PDF - 135 KB - 2 pages]
R. McCabe et al.
Acute Cervical Lymphadenitis Caused by Mycobacterium florentinum
PDF Version [PDF - 122 KB - 2 pages]
S. S. Syed et al.
Family Outbreak of Shiga Toxin–producing Escherichia coli O123:H–, France, 2009
PDF Version [PDF - 122 KB - 3 pages]
L. A. King et al.
Toscana Virus Infection in American Traveler Returning from Sicily, 2009
PDF Version [PDF - 122 KB - 3 pages]
M. K. Kay et al.
Increase in Neisseria meningitidis Serogroup W135, Niger, 2010
PDF Version [PDF - 116 KB - 3 pages]
J. Collard et al.
Mobile Messaging as Surveillance Tool during Pandemic (H1N1) 2009, Mexico
PDF Version [PDF - 121 KB - 2 pages]
M. Lajous et al.
Rickettsia sibirica mongolitimonae in Traveler from Egypt
PDF Version [PDF - 84 KB - 2 pages]
C. Socolovschi et al.
New Infectious Diseases and Industrial Food Animal Production
PDF Version [PDF - 86 KB - 2 pages]
E. Silbergeld et al.
Books and Media
Antimicrobial Resistance: Beyond the Breakpoint
PDF Version [PDF - 76 KB - 1 page]
D. J. Pombo
Tuberculosis (Biographies of Disease)
PDF Version [PDF - 136 KB - 2 pages]
About the Cover
- Page created: August 31, 2011
- Page last updated: August 31, 2011
- Page last reviewed: May 26, 2012
- Centers for Disease Control and Prevention,
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