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Volume 17, Number 10—October 2011
Volume 17, Number 10—October 2011 PDF Version [PDF - 6.59 MB - 207 pages]
Global Spread of Carbapenemase-producing Enterobacteriaceae
PDF Version [PDF - 766 KB - 8 pages]
P. Nordmann et al.View SummaryView Abstract
These resistance traits have been identified among nosocomial and community-acquired infections.
Carbapenemases increasingly have been reported in Enterobacteriaceae in the past 10 years. Klebsiella pneumoniae carbapenemases have been reported in the United States and then worldwide, with a marked endemicity at least in the United States and Greece. Metallo-enzymes (Verona integron–encoded metallo-β-lactamase, IMP) also have been reported worldwide, with a higher prevalence in southern Europe and Asia. Carbapenemases of the oxacillinase-48 type have been identified mostly in Mediterranean and European countries and in India. Recent identification of New Delhi metallo-β-lactamase-1 producers, originally in the United Kingdom, India, and Pakistan and now worldwide, is worrisome. Detection of infected patients and carriers with carbapenemase producers is necessary for prevention of their spread. Identification of the carbapenemase genes relies mostly on molecular techniques, whereas detection of carriers is possible by using screening culture media. This strategy may help prevent development of nosocomial outbreaks caused by carbapenemase producers, particularly K. pneumoniae.
Plasmodium knowlesi Malaria in Humans and Macaques, Thailand
PDF Version [PDF - 319 KB - 8 pages]
S. Jongwutiwes et al.View SummaryView Abstract
This parasite may be transmitted from macaques to humans.
Naturally acquired human infections with Plasmodium knowlesi are endemic to Southeast Asia. To determine the prevalence of P. knowlesi malaria in malaria-endemic areas of Thailand, we analyzed genetic characteristics of P. knowlesi circulating among naturally infected macaques and humans. This study in 2008–2009 and retrospective analysis of malaria species in human blood samples obtained in 1996 from 1 of these areas showed that P. knowlesi accounted for 0.67% and 0.48% of human malaria cases, respectively, indicating that this simian parasite is not a newly emergent human pathogen in Thailand. Sequence analysis of the complete merozoite surface protein 1 gene of P. knowlesi from 10 human and 5 macaque blood samples showed considerable genetic diversity among isolates. The sequence from 1 patient was identical with that from a pig-tailed macaque living in the same locality, suggesting cross-transmission of P. knowlesi from naturally infected macaques to humans.
Oseltamivir-Resistant Pandemic (H1N1) 2009 Virus Infection in England and Scotland, 2009–2010
PDF Version [PDF - 222 KB - 9 pages]
L. Calatayud et al.View SummaryView Abstract
Monitoring of antiviral resistance is strongly recommended for immunocompromised patients.
Oseltamivir has been widely used for pandemic (H1N1) 2009 virus infection, and by April 30, 2010, a total of 285 resistant cases were reported worldwide, including 45 in the United Kingdom. To determine risk factors for emergence of oseltamivir resistance and severe infection, a case–control study was conducted in the United Kingdom. Study participants were hospitalized in England or Scotland during January 4, 2009–April 30, 2010. Controls had confirmed oseltamivir-sensitive pandemic (H1N1) 2009 virus infections, and case-patients had confirmed oseltamivir-resistant infections. Of 28 case-patients with available information, 21 (75%) were immunocompromised; 31 of 33 case-patients (94%) received antiviral drugs before a sample was obtained. After adjusting for confounders, case-patients remained significantly more likely than controls to be immunocompromised and at higher risk for showing development of respiratory complications. Selective drug pressure likely explains the development of oseltamivir resistance, especially among immunocompromised patients. Monitoring of antiviral resistance is strongly recommended in this group.
Humans Infected with Relapsing Fever Spirochete Borrelia miyamotoi, Russia
PDF Version [PDF - 410 KB - 8 pages]
A. E. Platonov et al.View SummaryView Abstract
Borreliae bacteria cause rash and flu-like illnesses, including Lyme disease, and relapsing fever. Recently, a new type of Borrelia (Borrelia miyamotoi) was found to cause relapsing fever in persons in Russia. Because the ticks that carry this new type of bacteria are found around the world (including the tick that transmits Lyme disease and babesiosis) the infection could become widespread. Disease caused by this new Borrelia species may cause repeated bouts of fever and is costly in terms of medical bills and lost wages. Although effective treatment is available, diagnosis and treatment are complicated by lack of awareness of this infection, limited availability of diagnostic tests, and nonspecific symptoms.
Borrelia miyamotoi is distantly related to B. burgdorferi and transmitted by the same hard-body tick species. We report 46 cases of B. miyamotoi infection in humans and compare the frequency and clinical manifestations of this infection with those caused by B. garinii and B. burgdorferi infection. All 46 patients lived in Russia and had influenza-like illness with fever as high as 39.5°C; relapsing febrile illness occurred in 5 (11%) and erythema migrans in 4 (9%). In Russia, the rate of B. miyamotoi infection in Ixodes persulcatus ticks was 1%–16%, similar to rates in I. ricinus ticks in western Europe and I. scapularis ticks in the United States. B. miyamotoi infection may cause relapsing fever and Lyme disease–like symptoms throughout the Holarctic region of the world because of the widespread prevalence of this pathogen in its ixodid tick vectors.
Pandemic (H1N1) 2009 among Quarantined Close Contacts, Beijing, People’s Republic of China
PDF Version [PDF - 196 KB - 7 pages]
X. Pang et al.View SummaryView Abstract
The attack rate was low, and having contact with an ill household member and younger age were the major risk factors.
We estimated the attack rate of pandemic (H1N1) 2009 and assessed risk factors for infection among close contacts quarantined in Beijing, People’s Republic of China. The first 613 confirmed cases detected between May 16 and September 15, 2009, were investigated; 7,099 close contacts were located and quarantined. The attack rate of confirmed infection in close contacts was 2.4% overall, ranging from 0.9% among aircraft passengers to >5% among household members. Risk factors for infection among close contacts were younger age, being a household member of an index case-patient, exposure during the index case-patient’s symptomatic phase, and longer exposure. Among close contacts with positive test results at the start of quarantine, 17.2% had subclinical infection. Having contact with a household member and younger age were the major risk factors for acquiring pandemic (H1N1) 2009 influenza virus infection. One person in 6 with confirmed pandemic (H1N1) 2009 was asymptomatic.
Multidrug-Resistant Tuberculosis, People’s Republic of China, 2007–2009
PDF Version [PDF - 313 KB - 8 pages]
G. X. He et al.View SummaryView Abstract
Early detection, effective treatment, and infection control measures are needed to reduce transmission.
We conducted a case–control study to investigate risk factors for multidrug-resistant tuberculosis (MDR TB) in the People’s Republic of China. Genotyping analysis was used to estimate the percentage of cases from recent transmission among 100 MDR TB case-patients hospitalized during April 2007–July 2009. Molecular subtyping of isolates showed that 41% of MDR TB strains clustered. Beijing genotype was found in 94% of the MDR TB isolates and 79% of the pan-susceptible isolates. In multivariate analysis, MDR TB was independently associated with Beijing genotype, retreatment for TB, symptoms lasting >3 months before first evaluation at the hospital, lack of health insurance, and being a farmer (vs. being a student). MDR TB was associated with Beijing genotype and lower socioeconomic status. A large percentage of MDR TB cases seemed to result from recent transmission. Early detection, effective treatment, and infection control measures for MDR TB are needed to reduce transmission.
Bacterial Causes of Empyema in Children, Australia, 2007–2009
PDF Version [PDF - 265 KB - 7 pages]
R. E. Strachan et al.View SummaryView Abstract
Most infections were caused by non–7-valent pneumococcal conjugate vaccine serotypes.
An increase in the incidence of empyema worldwide could be related to invasive pneumococcal disease caused by emergent nonvaccine replacement serotypes. To determine bacterial pathogens and pneumococcal serotypes that cause empyema in children in Australia, we conducted a 2-year study of 174 children with empyema. Blood and pleural fluid samples were cultured, and pleural fluid was tested by PCR. Thirty-two (21.0%) of 152 blood and 53 (33.1%) of 160 pleural fluid cultures were positive for bacteria; Streptococcus pneumoniae was the most common organism identified. PCR identified S. pneumoniae in 74 (51.7%) and other bacteria in 19 (13.1%) of 145 pleural fluid specimens. Of 53 samples in which S. pneumoniae serotypes were identified, 2 (3.8%) had vaccine-related and 51 (96.2%) had nonvaccine serotypes; 19A (n = 20; 36.4%), 3 (n = 18; 32.7%), and 1 (n = 8; 14.5%) were the most common. High proportions of nonvaccine serotypes suggest the need to broaden vaccine coverage.
Medscape CME Activity
Clinical Implications of Azole Resistance in Aspergillus fumigatus, the Netherlands, 2007–2009 PDF Version [PDF - 279 KB - 9 pages]J. van der Linden et al.View SummaryView Abstract
Antifungal drug resistance is associated with high death rates among patients with invasive aspergillosis.
The prevalence and spread of azole resistance in clinical Aspergillus fumigatus isolates in the Netherlands are currently unknown. Therefore, we performed a prospective nationwide multicenter surveillance study to determine the effects of resistance on patient management strategies and public health. From June 2007 through January 2009, all clinical Aspergillus spp. isolates were screened for itraconazole resistance. In total, 2,062 isolates from 1,385 patients were screened; the prevalence of itraconazole resistance in A. fumigatus in our patient cohort was 5.3% (range 0.8%–9.5%). Patients with a hematologic or oncologic disease were more likely to harbor an azole-resistant isolate than were other patient groups (p<0.05). Most patients (64.0%) from whom a resistant isolate was identified were azole naive, and the case-fatality rate of patients with azole-resistant invasive aspergillosis was 88.0%. Our study found that multiazole resistance in A. fumigatus is widespread in the Netherlands and is associated with a high death rate for patients with invasive aspergillosis.
Medscape CME Activity
Invasive Non-Aspergillus Mold Infections in Transplant Recipients, United States, 2001–2006 PDF Version [PDF - 297 KB - 10 pages]B. J. Park et al.View SummaryView Abstract
Non–Aspergillus infections increased substantially during the surveillance period.
Recent reports describe increasing incidence of non-Aspergillus mold infections in hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. To investigate the epidemiology of infections with Mucorales, Fusarium spp., and Scedosporium spp. molds, we analyzed data from the Transplant-Associated Infection Surveillance Network, 23 transplant centers that conducted prospective surveillance for invasive fungal infections during 2001–2006. We identified 169 infections (105 Mucorales, 37 Fusarium spp., and 27 Scedosporium spp.) in 169 patients; 124 (73.4%) were in HCT recipients, and 45 (26.6%) were in SOT recipients. The crude 90-day mortality rate was 56.6%. The 12-month mucormycosis cumulative incidence was 0.29% for HCT and 0.07% for SOT. Mucormycosis incidence among HCT recipients varied widely, from 0.08% to 0.69%, with higher incidence in cohorts receiving transplants during 2003 and 2004. Non-Aspergillus mold infections continue to be associated with high mortality rates. The incidence of mucormycosis in HCT recipients increased substantially during the surveillance period.
Rickettsia honei Infection in Human, Nepal, 2009
PDF Version [PDF - 188 KB - 3 pages]
H. Murphy et al.View Abstract
We report a case of Rickettsia honei infection in a human in Nepal. The patient had severe illness and many clinical features typical of Flinders Island spotted fever. Diagnosis was confirmed by indirect immunofluorescent assay with serum and molecular biological techniques. Flinders Island spotted fever may be an endemic rickettsiosis in Nepal.
Outbreak of West Nile Virus Infection in Greece, 2010
PDF Version [PDF - 387 KB - 5 pages]
K. Danis et al.View Abstract
During 2010, an outbreak of West Nile virus infection occurred in Greece. A total of 197 patients with neuroinvasive disease were reported, of whom 33 (17%) died. Advanced age and a history of heart disease were independently associated with death, emphasizing the need for prevention of this infection in persons with these risk factors.
Tembusu Virus in Ducks, China
PDF Version [PDF - 284 KB - 3 pages]
Z. Cao et al.View Abstract
In China in 2010, a disease outbreak in egg-laying ducks was associated with a flavivirus. The virus was isolated and partially sequenced. The isolate exhibited 87%–91% identity with strains of Tembusu virus, a mosquito-borne flavivirus of the Ntaya virus group. These findings demonstrate emergence of Tembusu virus in ducks.
Novel Amdovirus in Gray Foxes
PDF Version [PDF - 241 KB - 3 pages]
L. Li et al.View Abstract
We used viral metagenomics to identify a novel parvovirus in tissues of a gray fox (Urocyon cinereoargenteus). Nearly full genome characterization and phylogenetic analyses showed this parvovirus (provisionally named gray fox amdovirus) to be distantly related to Aleutian mink disease virus, representing the second viral species in the Amdovirus genus.
Bacteremia and Antimicrobial Drug Resistance over Time, Ghana
PDF Version [PDF - 284 KB - 4 pages]
U. Groß et al.View Abstract
Bacterial distribution and antimicrobial drug resistance were monitored in patients with bacterial bloodstream infections in rural hospitals in Ghana. In 2001–2002 and in 2009, Salmonella enterica serovar Typhi was the most prevalent pathogen. Although most S. enterica serovar Typhi isolates were chloramphenicol resistant, all isolates tested were susceptible to ciprofloxacin.
Isolation and Phylogenetic Grouping of Equine Encephalosis Virus in Israel
PDF Version [PDF - 536 KB - 4 pages]
K. Aharonson-Raz et al.View Abstract
During 2008–2009 in Israel, equine encephalosis virus (EEV) caused febrile outbreaks in horses. Phylogenetic analysis of segment 10 of the virus strains showed that they form a new cluster; analysis of segment 2 showed ≈92% sequence identity to EEV-3, the reference isolate. Thus, the source of this emerging EEV remains uncertain.
Prevalence and Molecular Characterization of Cyclospora cayetanensis, Henan, China
PDF Version [PDF - 367 KB - 4 pages]
Y. Zhou et al.View Abstract
To determine prevalence of Cyclospora cayetanensis infection in Henan, China, we conducted a study of 11,554 hospital patients. Prevalence was 0.70% (95% confidence interval 0.70% ± 0.15%), with all age groups infected. Most cases were found in the summer. Minor sequence polymorphisms were observed in the 18S rRNA gene of 35 isolates characterized.
Yellow Fever Virus Vaccine–associated Deaths in Young Women
PDF Version [PDF - 164 KB - 3 pages]
S. J. SeligmanView Abstract
Yellow fever vaccine–associated viscerotropic disease is a rare sequela of live-attenuated virus vaccine. Elderly persons and persons who have had thymectomies have increased susceptibility. A review of published and other data suggested a higher than expected number of deaths from yellow fever vaccine–associated viscerotropic disease among women 19–34 years of age without known immunodeficiency.
Unexpected Rift Valley Fever Outbreak, Northern Mauritania
PDF Version [PDF - 281 KB - 3 pages]
A. B. El Mamy et al.View Abstract
During September–October 2010, an unprecedented outbreak of Rift Valley fever was reported in the northern Sahelian region of Mauritania after exceptionally heavy rainfall. Camels probably played a central role in the local amplification of the virus. We describe the main clinical signs (hemorrhagic fever, icterus, and nervous symptoms) observed during the outbreak.
Seroconversion to Pandemic (H1N1) 2009 Virus and Cross-Reactive Immunity to Other Swine Influenza Viruses
PDF Version [PDF - 289 KB - 3 pages]
R. Perera et al.View Abstract
To assess herd immunity to swine influenza viruses, we determined antibodies in 28 paired serum samples from participants in a prospective serologic cohort study in Hong Kong who had seroconverted to pandemic (H1N1) 2009 virus. Results indicated that infection with pandemic (H1N1) 2009 broadens cross-reactive immunity to other recent subtype H1 swine viruses.
Plasmodium knowlesi Infection in Humans, Cambodia, 2007–2010
PDF Version [PDF - 247 KB - 3 pages]
N. Khim et al.View Abstract
Two cases of Plasmodium knowlesi infection in humans were identified in Cambodia by 3 molecular detection assays and sequencing. This finding confirms the widespread distribution of P. knowlesi malaria in humans in Southeast Asia. Further wide-scale studies are required to assess the public health relevance of this zoonotic malaria parasite.
Equine Piroplasmosis Associated with Amblyomma cajennense Ticks, Texas, USA
PDF Version [PDF - 172 KB - 3 pages]
G. A. Scoles et al.View Abstract
We report an outbreak of equine piroplasmosis in southern Texas, USA, in 2009. Infection prevalence reached 100% in some areas (292 infected horses). Amblyomma cajennense was the predominant tick and experimentally transmitted Theileria equi to an uninfected horse. We suggest that transmission by this tick species played a role in this outbreak.
Timeliness of Surveillance during Outbreak of Shiga Toxin–producing Escherichia coli Infection, Germany, 2011
PDF Version [PDF - 202 KB - 4 pages]
M. Altmann et al.View Abstract
In the context of a large outbreak of Shiga toxin–producing Escherichia coli O104:H4 in Germany, we quantified the timeliness of the German surveillance system for hemolytic uremic syndrome and Shiga toxin–producing E. coli notifiable diseases during 2003–2011. Although reporting occurred faster than required by law, potential for improvement exists at all levels of the information chain.
Global Distribution of Shigella sonnei Clones
PDF Version [PDF - 213 KB - 3 pages]
I. Filliol-Toutain et al.View Abstract
To investigate global epidemiology of Shigella sonnei, we performed multilocus variable number tandem repeat analysis of 1,672 isolates obtained since 1943 from 50 countries on 5 continents and the Pacific region. Three major clonal groups were identified; 2 were globally spread. Type 18 and its derivatives have circulated worldwide in recent decades.
Drug-Resistant Tuberculosis, KwaZulu-Natal, South Africa, 2001–2007
PDF Version [PDF - 298 KB - 4 pages]
K. Wallengren et al.View Abstract
In Africa, incidence and prevalence of drug-resistant tuberculosis have been assumed to be low. However, investigation after a 2005 outbreak of extensively drug-resistant tuberculosis in KwaZulu-Natal Province, South Africa, found that the incidence rate for multidrug-resistant tuberculosis in KwaZulu-Natal was among the highest globally and would be higher if case-finding efforts were intensified.
Antimicrobial Ointments and Methicillin-Resistant Staphylococcus aureus USA300
PDF Version [PDF - 289 KB - 4 pages]
M. Suzuki et al.View SummaryView Abstract
Got a cut? Reach for the triple antimicrobial-drug ointment? Not so fast. In the United States, common use of over-the-counter triple antimicrobial-drug ointments may be leading to emergence of a new, antimicrobial-drug resistant MRSA strain. This resistant strain (USA300) is common in the United States, where these ointments are used often, but less common in Japan, where they are not used as often. This finding supports more cautious use of topical antimicrobial drugs.
We tested 259 methicillin-resistant Staphylococcus aureus isolates and 2 USA300 ATCC type strains for susceptibility to bacitracin and neomycin contained in over-the-counter antibacterial ointments. Resistance to both bacitracin and neomycin was found only in USA300. The use of over-the counter antimicrobial drugs may select for the USA300 clone.
Novel Arenavirus, Zambia
PDF Version [PDF - 274 KB - 4 pages]
A. Ishii et al.View Abstract
To investigate arenavirus in Zambia, we characterized virus from the kidneys of 5 arenavirus RNA–positive rodents (Mastomys natalensis) among 263 captured. Full-genome sequences of the viruses suggested that they were new strains similar to Lassa virus–related arenaviruses. Analyzing samples from additional rodents and other species can elucidate epizootiologic aspects of arenaviruses.
Pandemic (H1N1) 2009 Encephalitis in Woman, Taiwan
PDF Version [PDF - 186 KB - 3 pages]
A. Cheng et al.View Abstract
We report an unusual case of pandemic (H1N1) 2009–related encephalitis in an immunocompetent woman. Although rare cases of pandemic (H1N1) 2009 associated with encephalitis have been reported previously, in this patient, direct viral invasion of the central nervous system was shown by simultaneous detection of viral RNA and pleocytosis.
Household Transmission of Pandemic (H1N1) 2009 Virus, Taiwan
PDF Version [PDF - 263 KB - 4 pages]
L. Chang et al.View Abstract
During August–November 2009, to investigate disease transmission within households in Taiwan, we recruited 87 pandemic (H1N1) 2009 patients and their household members. Overall, pandemic (H1N1) 2009 virus was transmitted to 60 (27%) of 223 household contacts. Transmission was 4× higher to children than to adults (61% vs. 15%; p<0.001).
Group B Streptococcus and HIV Infection in Pregnant Women, Malawi, 2008–2010
PDF Version [PDF - 167 KB - 4 pages]
K. J. Gray et al.View Abstract
To determine whether an association exists between group B streptococcus carriage and HIV infection, we recruited 1,857 pregnant women (21.7% HIV positive) from Queen Elizabeth Central Hospital, Blantyre, Malawi. Overall, group B streptococcus carriage was 21.2% and did not differ by HIV status. However, carriage was increased among HIV-positive women with higher CD4 counts.
Incidence Rate for Hantavirus Infections without Pulmonary Syndrome, Panama
PDF Version [PDF - 230 KB - 4 pages]
B. Armien et al.View Abstract
During 2001–2007, to determine incidence of all hantavirus infections, including those without pulmonary syndrome, in western Panama, we conducted 11 communitywide surveys. Among 1,129 persons, antibody prevalence was 16.5%–60.4%. Repeat surveys of 476 found that patients who seroconverted outnumbered patients with hantavirus pulmonary syndrome by 14 to 1.
Crimean-Congo Hemorrhagic Fever, Afghanistan, 2009
PDF Version [PDF - 132 KB - 2 pages]
M. L. Mustafa et al.View Abstract
In response to an outbreak of Crimean-Congo hemorrhagic fever in western Afghanistan, we measured immunoglobulin G seroprevalence among household members and their animals. Seroprevalence was 11.2% and 75.0% in humans (n = 330) and livestock (n = 132), respectively. Persons with frequent exposure to cattle had an elevated risk of being immunoglobulin G positive.
Extensively Drug-Resistant Tuberculosis in Women, KwaZulu-Natal, South Africa
PDF Version [PDF - 185 KB - 4 pages]
M. R. O’Donnell et al.View Abstract
To determine whether women in KwaZulu-Natal, South Africa, with drug-resistant tuberculosis (TB) were more likely than men to have extensively drug-resistant TB, we reviewed 4,514 adults admitted during 2003–2008 for drug-resistant TB. Female sex independently predicted extensively drug-resistant TB, even after we controlled for HIV infection. This association needs further study.
Clostridium difficile Infection in Outpatients, Maryland and Connecticut, USA, 2002–2007
PDF Version [PDF - 321 KB - 4 pages]
J. M. Hirshon et al.View SummaryView Abstract
Infection with Clostridium difficile (C. diff) causes diarrhea in hospitalized patients, usually when antimicrobial-drug treatment disrupts their normal intestinal balance. Recently, concerns have been raised that this infection is increasing in the community, outside hospitals. This study found that most outpatients either had a known risk factor (other medical condition, recent hospitalization, antimicrobial-drug treatment) or were also infected with other diarrhea-causing bacteria. This finding tempers concern that C. diff infections are becoming common in the community among outpatients with no risk factors.
Clostridium difficile, the most commonly recognized diarrheagenic pathogen among hospitalized persons, can cause outpatient diarrhea. Of 1,091 outpatients with diarrhea, we found 43 (3.9%) who were positive for C. difficile toxin. Only 7 had no recognized risk factors, and 3 had neither risk factors nor co-infection with another enteric pathogen.
CTX-M-15–producing Enteroaggregative Escherichia coli as Cause of Travelers’ Diarrhea
PDF Version [PDF - 322 KB - 4 pages]
E. Guiral et al.View Abstract
Travelers’ diarrhea is a major public health problem. From patients in whom diarrhea developed after travel to India, 5 enteroaggregative Escherichia coli strains carrying β-lactamase CTX-M-15 were identified; 3 belonged to clonal complex sequence type 38. This β-lactamase contributes to the multidrug resistance of enteroaggregative E. coli, thereby limiting therapeutic alternatives.
Placental Transmission of Human Parvovirus 4 in Newborns with Hydrops, Taiwan
PDF Version [PDF - 143 KB - 3 pages]
M. Chen et al.View Abstract
In studying the epidemiology of parvovirus 4 (PARV4) in Taiwan, we detected DNA in plasma of 3 mothers and their newborns with hydrops. In 1 additional case, only the mother had PARV4 DNA. Our findings demonstrate that PARV4 can be transmitted through the placenta.
Similarity of Shiga Toxin–producing Escherichia coli O104:H4 Strains from Italy and Germany
PDF Version [PDF - 153 KB - 2 pages]
G. Scavia et al.
Complicated Pandemic (H1N1) 2009 during Pregnancy, Taiwan
PDF Version [PDF - 152 KB - 3 pages]
W. Huang et al.
Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) in Children’s Hospital, Australia
PDF Version [PDF - 162 KB - 3 pages]
G. Khandaker et al.
Global Health Security in an Era of Global Health Threats
PDF Version [PDF - 150 KB - 2 pages]
S. B. Cáceres
Use of Workplace Absenteeism Surveillance Data for Outbreak Detection
PDF Version [PDF - 184 KB - 2 pages]
B. Paterson et al.
Zoonotic Ascariasis, United Kingdom
PDF Version [PDF - 200 KB - 3 pages]
R. P. Bendall et al.
Minority K65R Variants and Early Failure of Antiretroviral Therapy in HIV-1–infected Eritrean Immigrant
PDF Version [PDF - 232 KB - 3 pages]
V. Bansal et al.
Diagnosis of Rickettsioses from Eschar Swab Samples, Algeria
PDF Version [PDF - 157 KB - 2 pages]
N. Mouffok et al.
Livestock-associated Methicillin-Susceptible Staphylococcus aureus ST398 Infection in Woman, Colombia
PDF Version [PDF - 152 KB - 2 pages]
J. N. Jiménez et al.
Granulicatella adiacens and Early-Onset Sepsis in Neonate
PDF Version [PDF - 167 KB - 3 pages]
M. J. Bizzarro et al.
Lymphocytic Choriomeningitis with Severe Manifestations, Missouri, USA
PDF Version [PDF - 162 KB - 2 pages]
S. Folk et al.View Summary
Lymphocytic choriomeningitis virus is spread by rodents, particularly the common house mouse, and is found throughout the world. The virus, which usually causes mild illness with nonspecific symptoms, can at times cause severe disease. Two patients in Missouri, who reported seeing mice in their homes before becoming ill, came down with serious nervous system disease. Although both patients recovered, these cases provide a reminder of the potential severity of this virus. Patients with nervous system disease of unknown cause, especially those who have had contact with wild or pet rodents, should be tested for this virus.
Sporotrichosis Caused by Sporothrix mexicana, Portugal
PDF Version [PDF - 178 KB - 2 pages]
N. M. Dias et al.
Swinepox Virus Outbreak, Brazil, 2011
PDF Version [PDF - 171 KB - 3 pages]
M. L. Medaglia et al.
Plasmodium vivax Seroprevalence in Bred Cynomolgus Monkeys, China
PDF Version [PDF - 160 KB - 2 pages]
D. B. Elmore
Dengue Virus Serotype 4, Roraima State, Brazil
PDF Version [PDF - 197 KB - 3 pages]
P. O. Acosta et al.
Novel Hepatitis E Virus Genotype in Norway Rats, Germany
PDF Version [PDF - 273 KB - 3 pages]
W. Zhang et al.
Books and Media
Antibiotic Resistance: Understanding and Responding to an Emerging Crisis
PDF Version [PDF - 176 KB - 1 page]
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