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Volume 17, Number 2—February 2011
Volume 17, Number 2—February 2011 PDF Version [PDF - 8.87 MB - 174 pages]
Medscape CME Activity
Zoonoses in the Bedroom PDF Version [PDF - 145 KB - 6 pages]B. B. Chomel and B. SunView Abstract
In most industrialized countries, pets are becoming an integral part of households, sharing human lifestyles, bedrooms, and beds. The estimated percentage of pet owners who allow dogs and cats on their beds is 14%–62%. However, public health risks, including increased emergence of zoonoses, may be associated with such practices.
Medscape CME Activity
Hepatitis E Virus and Neurologic Disorders PDF Version [PDF - 244 KB - 7 pages]N. Kamar et al.View Abstract
Information about the spectrum of disease caused by hepatitis E virus (HEV) genotype 3 is emerging. During 2004–2009, at 2 hospitals in the United Kingdom and France, among 126 patients with locally acquired acute and chronic HEV genotype 3 infection, neurologic complications developed in 7 (5.5%): inflammatory polyradiculopathy (n = 3), Guillain-Barré syndrome (n = 1), bilateral brachial neuritis (n = 1), encephalitis (n = 1), and ataxia/proximal myopathy (n = 1). Three cases occurred in nonimmunocompromised patients with acute HEV infection, and 4 were in immunocompromised patients with chronic HEV infection. HEV RNA was detected in cerebrospinal fluid of all 4 patients with chronic HEV infection but not in that of 2 patients with acute HEV infection. Neurologic outcomes were complete resolution (n = 3), improvement with residual neurologic deficit (n = 3), and no improvement (n = 1). Neurologic disorders are an emerging extrahepatic manifestation of HEV infection.
Human Infections with Non-O157 Shiga Toxin–producing Escherichia coli, Switzerland, 2000–2009
PDF Version [PDF - 161 KB - 6 pages]
U. Käppeli et al.View Abstract
We characterized 97 non-O157 Shiga toxin (stx)–producing Escherichia coli strains isolated from human patients during 2000–2009 from the national reference laboratory in Switzerland. These strains belonged to 40 O:H serotypes; 4 serotypes (O26:H11/H–, O103:H2, O121:H19, and O145:H28/H–) accounted for 46.4% of the strains. Nonbloody diarrhea was reported by 23.2% of the patients, bloody diarrhea by 56.8%. Hemolytic uremic syndrome developed in 40.0% of patients; serotype O26:H11/H– was most often associated with this syndrome. Forty-five (46.4%) strains carried stx2 genes only, 36 strains (37.1%) carried stx1, and 16 (16.5%) strains carried stx1 and stx2. Genes encoding enterohemolysin and intimin were detected in 75.3% and 70.1% of the strains, respectively. Resistance to >1 antimicrobial agent was present in 25 isolates. High genetic diversity within strains indicates that non-O157 stx–producing E. coli infections in Switzerland most often occurred as single cases.
Severe Cases of Pandemic (H1N1) 2009 in Children, Germany
PDF Version [PDF - 167 KB - 7 pages]
M. Altmann et al.View Abstract
In a hospital-based observational study in Germany, we investigated children admitted to pediatric intensive care units and deaths caused by confirmed pandemic (H1N1) 2009 to identify risk factors and outcomes in critically ill children. Ninety-three children were eligible for our study, including 9 with hospital-acquired infections. Seventy-five percent had underlying chronic medical conditions; neurodevelopmental disorders were most prevalent (57%). The proportion of patients having >1 risk factor increased with age in years (odds ratio 1.21, p = 0.007). Of 15 deaths, 11 occurred in a pediatric intensive care unit (case-fatality rate 12%, 95% confidence interval 6%–21%). Only 9% of the children had been vaccinated against pandemic (H1N1) 2009; all survived. Our results stress the role of underlying risk factors, especially neurodevelopmental disorders, and the need for improving preventive measures to reduce severe disease and adverse outcomes of pandemic (H1N1) 2009 in children.
Risk Factors for Cryptococcus gattii Infection, British Columbia, Canada
PDF Version [PDF - 139 KB - 7 pages]
L. MacDougall et al.View Abstract
To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii–infected persons compared with the general population, we conducted a sex-matched case−control study on a subset of case-patients in British Columbia (1999–2001). Exposures and underlying medical conditions among all case-patients (1999–2007) were also compared with results of provincial population–based surveys and studies. In case−control analyses, oral steroids (matched odds ratio [MOR] 8.11, 95% confidence interval [CI] 1.74–37.80), pneumonia (MOR 2.71, 95% CI 1.05–6.98), and other lung conditions (MOR 3.21, 95% CI 1.08–9.52) were associated with infection. In population comparisons, case-patients were more likely to be >50 years of age (p<0.001), current smokers (p<0.001), infected with HIV (p<0.001), or have a history of invasive cancer (p<0.001). Although C. gattii is commonly believed to infect persons with apparently healthy immune systems, several immunosuppressive and pulmonary conditions seem to be risk factors.
Possible Increased Pathogenicity of Pandemic (H1N1) 2009 Influenza Virus upon Reassortment
PDF Version [PDF - 502 KB - 9 pages]
E. J. Schrauwen et al.View Abstract
Since emergence of the pandemic (H1N1) 2009 virus in April 2009, three influenza A viruses—seasonal (H3N2), seasonal (H1N1), and pandemic (H1N1) 2009—have circulated in humans. Genetic reassortment between these viruses could result in enhanced pathogenicity. We compared 4 reassortant viruses with favorable in vitro replication properties with the wild-type pandemic (H1N1) 2009 virus with respect to replication kinetics in vitro and pathogenicity and transmission in ferrets. Pandemic (H1N1) 2009 viruses containing basic polymerase 2 alone or in combination with acidic polymerase of seasonal (H1N1) virus were attenuated in ferrets. In contrast, pandemic (H1N1) 2009 with neuraminidase of seasonal (H3N2) virus resulted in increased virus replication and more severe pulmonary lesions. The data show that pandemic (H1N1) 2009 virus has the potential to reassort with seasonal influenza viruses, which may result in increased pathogenicity while it maintains the capacity of transmission through aerosols or respiratory droplets.
Common Reservoirs for Penicillium marneffei Infection in Humans and Rodents, China
PDF Version [PDF - 167 KB - 6 pages]
C. Cao et al.View Abstract
Human penicilliosis marneffei is an emerging infectious disease caused by the fungus Penicillium marneffei. High prevalence of infection among bamboo rats of the genera Rhizomys and Cannomys suggest that these rodents are a key facet of the P. marneffei life cycle. We trapped bamboo rats during June 2004–July 2005 across Guangxi Province, China, and demonstrated 100% prevalence of infection. Multilocus genotypes show that P. marneffei isolates from humans are similar to those infecting rats and are in some cases identical. Comparison of our dataset with genotypes recovered from sites across Southeast Asia shows that the overriding component of genetic structure in P. marneffei is spatial, with humans containing a greater diversity of genotypes than rodents. Humans and bamboo rats are sampling an as-yet undiscovered common reservoir of infection, or bamboo rats are a vector for human infections by acting as amplifiers of infectious dispersal stages.
Phocine Distemper Virus in Seals, East Coast, United States, 2006
PDF Version [PDF - 245 KB - 6 pages]
J. P. Earle et al.View Abstract
In 2006 and 2007, elevated numbers of deaths among seals, constituting an unusual mortality event, occurred off the coasts of Maine and Massachusetts, United States. We isolated a virus from seal tissue and confirmed it as phocine distemper virus (PDV). We compared the viral hemagglutinin, phosphoprotein, and fusion (F) and matrix (M) protein gene sequences with those of viruses from the 1988 and 2002 PDV epizootics. The virus showed highest similarity with a PDV 1988 Netherlands virus, which raises the possibility that the 2006 isolate from the United States might have emerged independently from 2002 PDVs and that multiple lineages of PDV might be circulating among enzootically infected North American seals. Evidence from comparison of sequences derived from different tissues suggested that mutations in the F and M genes occur in brain tissue that are not present in lung, liver, or blood, which suggests virus persistence in the central nervous system.
Leptospirosis in Hawaii, USA, 1999–2008
PDF Version [PDF - 118 KB - 6 pages]
A. R. Katz et al.View Abstract
Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999–2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.
Next-Generation Sequencing of Coccidioides immitis Isolated during Cluster Investigation
PDF Version [PDF - 704 KB - 6 pages]
D. M. Engelthaler et al.View Abstract
Next-generation sequencing enables use of whole-genome sequence typing (WGST) as a viable and discriminatory tool for genotyping and molecular epidemiologic analysis. We used WGST to confirm the linkage of a cluster of Coccidioides immitis isolates from 3 patients who received organ transplants from a single donor who later had positive test results for coccidioidomycosis. Isolates from the 3 patients were nearly genetically identical (a total of 3 single-nucleotide polymorphisms identified among them), thereby demonstrating direct descent of the 3 isolates from an original isolate. We used WGST to demonstrate the genotypic relatedness of C. immitis isolates that were also epidemiologically linked. Thus, WGST offers unique benefits to public health for investigation of clusters considered to be linked to a single source.
Arbovirus Prevalence in Mosquitoes, Kenya
PDF Version [PDF - 446 KB - 9 pages]
A. D. LaBeaud et al.View Abstract
Few studies have investigated the many mosquito species that harbor arboviruses in Kenya. During the 2006–2007 Rift Valley fever outbreak in North Eastern Province, Kenya, exophilic mosquitoes were collected from homesteads within 2 affected areas: Gumarey (rural) and Sogan-Godud (urban). Mosquitoes (n = 920) were pooled by trap location and tested for Rift Valley fever virus and West Nile virus. The most common mosquitoes trapped belonged to the genus Culex (75%). Of 105 mosquito pools tested, 22% were positive for Rift Valley fever virus, 18% were positive for West Nile virus, and 3% were positive for both. Estimated mosquito minimum infection rates did not differ between locations. Our data demonstrate the local abundance of mosquitoes that could propagate arboviral infections in Kenya and the high prevalence of vector arbovirus positivity during a Rift Valley fever outbreak.
New Delhi Metallo-β-Lactamase from Traveler Returning to Canada
PDF Version [PDF - 214 KB - 3 pages]
G. Peirano et al.View Abstract
An Escherichia coli isolate with New Delhi metallo-β-lactamase was isolated from a patient with pyelonephritis and prostatitis who returned to Canada after recent hospitalization in India. The patient was successfully treated with ertapenem and fosfomycin. This patient highlights the role of international travel in the spread of antimicrobial drug resistance and blaNDM-1.
School Closures and Student Contact Patterns
PDF Version [PDF - 201 KB - 3 pages]
C. Jackson et al.View Abstract
To determine how school closure for pandemic (H1N1) 2009 affected students’ contact patterns, we conducted a retrospective questionnaire survey at a UK school 2 weeks after the school reopened. School closure was associated with a 65% reduction in the mean total number of contacts for each student.
Unusual Transmission of Plasmodium falciparum, Bordeaux, France, 2009
PDF Version [PDF - 178 KB - 3 pages]
M. Vareil et al.View Abstract
Plasmodium falciparum malaria is usually transmitted by mosquitoes. We report 2 cases in France transmitted by other modes: occupational blood exposure and blood transfusion. Even where malaria is not endemic, it should be considered as a cause of unexplained acute fever.
Transmission of Armillifer armillatus Ova at Snake Farm, The Gambia, West Africa
PDF Version [PDF - 364 KB - 4 pages]
D. Tappe et al.View Abstract
Visceral pentastomiasis caused by Armillifer armillatus larvae was diagnosed in 2 dogs in The Gambia. Parasites were subjected to PCR; phylogenetic analysis confirmed relatedness with branchiurans/crustaceans. Our investigation highlights transmission of infective A. armillatus ova to dogs and, by serologic evidence, also to 1 human, demonstrating a public health concern.
Characteristics of Patients with Oseltamivir-Resistant Pandemic (H1N1) 2009, United States
PDF Version [PDF - 132 KB - 3 pages]
S. B. Graitcer et al.View Abstract
During April 2009–June 2010, thirty-seven (0.5%) of 6,740 pandemic (H1N1) 2009 viruses submitted to a US surveillance system were oseltamivir resistant. Most patients with oseltamivir-resistant infections were severely immunocompromised (76%) and had received oseltamivir before specimen collection (89%). No evidence was found for community circulation of resistant viruses; only 4 (unlinked) patients had no oseltamivir exposure.
Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan
PDF Version [PDF - 221 KB - 4 pages]
S. Shakoor et al.View Abstract
We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.
Alert System to Detect Possible School-based Outbreaks of Influenza-like Illness
PDF Version [PDF - 52 KB - 3 pages]
P. Mann et al.View Abstract
To evaluate the usefulness of school absentee data in identifying outbreaks as part of syndromic surveillance, we examined data collected from public schools in Miami-Dade County, Florida, USA. An innovative automated alert system captured information about school-specific absenteeism to detect and provide real-time notification of possible outbreaks of influenza-like illness.
New Avian Influenza Virus (H5N1) in Wild Birds, Qinghai, China
PDF Version [PDF - 263 KB - 3 pages]
Y. Li et al.View Abstract
Highly pathogenic avian influenza virus (H5N1) (QH09) was isolated from dead wild birds (3 species) in Qinghai, China, during May–June 2009. Phylogenetic and antigenic analyses showed that QH09 was clearly distinguishable from classical clade 2.2 viruses and belonged to clade 2.3.2.
Blastomycosis in Man after Kinkajou Bite
PDF Version [PDF - 272 KB - 3 pages]
J. R. Harris et al.View Abstract
We report transmission of Blastomyces dermatitidis fungal infection from a pet kinkajou to a man. When treating a patient with a recalcitrant infection and a history of an animal bite, early and complete animal necropsy and consideration of nonbacterial etiologies are needed.
Novel HIV-1 Recombinant Forms in Antenatal Cohort, Montreal, Quebec, Canada
PDF Version [PDF - 519 KB - 4 pages]
M. Quesnel-Vallières et al.View Abstract
Near full-length genomes of 4 unclassified HIV-1 variants infecting patients enrolled in an antenatal cohort in Canada were obtained by sequencing. All 4 variants showed original recombination profiles, including A1/A2/J, A1/D, and A1/G/J/CRF11_cpx structures. Identification of these variants highlights the growing prevalence of unique recombinant forms of HIV-1 in North America.
Eschar-associated Spotted Fever Rickettsiosis, Bahia, Brazil
PDF Version [PDF - 357 KB - 4 pages]
N. Silva et al.View Abstract
In Brazil, Brazilian spotted fever was once considered the only tick-borne rickettsial disease. We report eschar-associated rickettsial disease that occurred after a tick bite. The etiologic agent is most related to Rickettsia parkeri, R. africae, and R. sibirica and probably widely distributed from São Paulo to Bahia in the Atlantic Forest.
Pandemic (H1N1) 2009–associated Pneumonia in Children, Japan
PDF Version [PDF - 330 KB - 4 pages]
M. Hasegawa et al.View Abstract
To describe clinical aspects of pandemic (H1N1) 2009 virus–associated pneumonia in children, we studied 80 such children, including 17 (21%) with complications, who were admitted to 5 hospitals in Japan during August–November 2009 after a mean of 2.9 symptomatic days. All enrolled patients recovered (median hospitalization 6 days). Timely access to hospitals may have contributed to favorable outcomes.
Oseltamivir-Resistant Pandemic (H1N1) 2009 Virus, Mexico
PDF Version [PDF - 330 KB - 4 pages]
J. E. Ramirez-Gonzalez et al.View Abstract
During May 2009–April 2010, we analyzed 692 samples of pandemic (H1N1) 2009 virus from patients in Mexico. We detected the H275Y substitution of the neuraminidase gene in a specimen from an infant with pandemic (H1N1) 2009 who was treated with oseltamivir. This virus was susceptible to zanamivir and resistant to adamantanes and oseltamivir.
Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza Viral Loads, Singapore
PDF Version [PDF - 380 KB - 14 pages]
C. K. Lee et al.View Abstract
Mean viral loads for patients with pandemic (H1N1) 2009 were ≈1 log10 times lower than those for patients with seasonal influenza within the first week after symptom onset. Neither pandemic nor seasonal influenza viral loads correlated with clinical severity of illness. No correlation was found between viral loads and concurrent illness.
Pandemic (H1N1) 2009, Abu Dhabi, United Arab Emirates, May 2009–March 2010
PDF Version [PDF - 269 KB - 4 pages]
G. Khan et al.View Abstract
To ascertain characteristics of pandemic (H1N1) 2009 virus infection, we reviewed medical records for all suspected or confirmed cases reported in Abu Dhabi during May 2009–March 2010. Overall case-fatality rate was 1.4/100,000 population. Most patients who died had ≥1 risk factor, and female decedents were considerably younger than male decedents.
Usefulness of Published PCR Primers in Detecting Human Rhinovirus Infection
PDF Version [PDF - 248 KB - 3 pages]
C. E. Faux et al.View Abstract
We conducted a preliminary comparison of the relative sensitivity of a cross-section of published human rhinovirus (HRV)–specific PCR primer pairs, varying the oligonucleotides and annealing temperature. None of the pairs could detect all HRVs in 2 panels of genotyped clinical specimens; >1 PCR is required for accurate description of HRV epidemiology.
Surveillance for West Nile Virus in Dead Wild Birds, South Korea, 2005–2008
PDF Version [PDF - 300 KB - 3 pages]
J. Yeh et al.View Abstract
To investigate the possibility of West Nile virus (WNV) introduction into South Korea, the National Veterinary Research and Quarantine Service has conducted nationwide surveillance of WNV activity in dead wild birds since 2005. Surveillance conducted during 2005–2008 found no evidence of WNV activity.
Hantavirus Infection in Istanbul, Turkey
PDF Version [PDF - 144 KB - 2 pages]
O. Oncul et al.
Maternal–Fetal Transmission of Cryptococcus gattii in Harbor Porpoise
PDF Version [PDF - 143 KB - 2 pages]
S. A. Norman et al.
New Delhi Metallo-β-Lactamase, Ontario, Canada
PDF Version [PDF - 153 KB - 2 pages]
N. Tijet et al.
Genetic Detection of Dobrava/Belgrade Virus, Bulgaria
PDF Version [PDF - 164 KB - 2 pages]
A. Papa and I. Christova
A226V Strains of Chikungunya Virus, Réunion Island, 2010
PDF Version [PDF - 157 KB - 3 pages]
E. D’Ortenzio et al.
Segniliparus rugosus–associated Bronchiolitis in California Sea Lion
PDF Version [PDF - 170 KB - 2 pages]
R. H. Evans
Orbiviruses in Rusa Deer, Mauritius, 2007
PDF Version [PDF - 173 KB - 2 pages]
F. Jori et al.
No Xenotropic Murine Leukemia Virus–related Virus Detected in Fibromyalgia Patients
PDF Version [PDF - 237 KB - 2 pages]
J. Luczkowiak et al.
Clonal Spread of Streptococcus pyogenes emm44 among Homeless Persons, Rennes, France
PDF Version [PDF - 281 KB - 3 pages]
A. Cady et al.
Surface Layer Protein A Variant of Clostridium difficile PCR-Ribotype 027
PDF Version [PDF - 171 KB - 3 pages]
P. Spigaglia et al.
Introduction of Japanese Encephalitis Virus Genotype I, India
PDF Version [PDF - 192 KB - 3 pages]
P. V. Fulmali et al.
Dengue Virus Serotype 3 Subtype III, Zhejiang Province, China
PDF Version [PDF - 209 KB - 3 pages]
J. Sun et al.
European Subtype Tick-borne Encephalitis Virus in Ixodes persulcatus Ticks
PDF Version [PDF - 162 KB - 3 pages]
A. E. Jääskeläinen et al.
Rickettsia aeschlimannii in Hyalomma marginatum Ticks, Germany
PDF Version [PDF - 137 KB - 2 pages]
L. Rumer et al.
Dogs as Reservoirs for Leishmania braziliensis
PDF Version [PDF - 126 KB - 2 pages]
Pandemic (H1N1) 2009 and HIV Co-infection
PDF Version [PDF - 119 KB - 1 page]
D. T. Kuhar and D. K. Henderson
Books and Media
Bacterial Population Genetics in Infectious Disease
PDF Version [PDF - 189 KB - 2 pages]
Avian Influenza: Science, Policy and Politics
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- Page created: September 09, 2011
- Page last updated: September 09, 2011
- Page last reviewed: September 09, 2011
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