Volume 17, Number 5—May 2011
Volume 17, Number 5—May 2011 PDF Version [PDF - 6.16 MB - 199 pages]
PDF Version [PDF - 31 KB - 2 pages]
R. Rosenberg and C. Ben BeardView Abstract
Infections with vector-borne pathogens are a major source of emerging diseases. The ability of vectors to bridge spatial and ecologic gaps between animals and humans increases opportunities for emergence. Small adaptations of a pathogen to a vector can have profound effects on the rate of transmission to humans.
Intravenous Artesunate for Severe Malaria in Travelers, Europe
PDF Version [PDF - 294 KB - 7 pages]
T. Zoller et al.View Abstract
Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained hemolysis occurred after reduction of parasitemia levels. Five patients required a blood transfusion. Patients with posttreatment hemolysis had received higher doses of IV artesunate than patients without hemolysis. IV artesunate was an effective alternative to quinine for treatment of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure.
Medscape CME Activity
Lessons Learned about Pneumonic Plague Diagnosis from 2 Outbreaks, Democratic Republic of the Congo PDF Version [PDF - 245 KB - 7 pages]E. Bertherat et al.View Abstract
Pneumonic plague is a highly transmissible infectious disease for which fatality rates can be high if untreated; it is considered extremely lethal. Without prompt diagnosis and treatment, disease management can be problematic. In the Democratic Republic of the Congo, 2 outbreaks of pneumonic plague occurred during 2005 and 2006. In 2005, because of limitations in laboratory capabilities, etiology was confirmed only through retrospective serologic studies. This prompted modifications in diagnostic strategies, resulting in isolation of Yersinia pestis during the second outbreak. Results from these outbreaks demonstrate the utility of a rapid diagnostic test detecting F1 antigen for initial diagnosis and public health management, as well as the need for specialized sampling kits and trained personnel for quality specimen collection and appropriate specimen handling and preservation for plague confirmation and Y. pestis isolation. Efficient frontline management and a streamlined diagnostic strategy are essential for confirming plague, especially in remote areas.
Evolution of New Genotype of West Nile Virus in North America
PDF Version [PDF - 497 KB - 9 pages]
A. R. McMullen et al.View Abstract
Previous studies of North American isolates of West Nile virus (WNV) during 1999–2005 suggested that the virus had reached genetic homeostasis in North America. However, genomic sequencing of WNV isolates from Harris County, Texas, during 2002–2009 suggests that this is not the case. Three new genetic groups have been identified in Texas since 2005. Spread of the southwestern US genotype (SW/WN03) from the Arizona/Colorado/northern Mexico region to California, Illinois, New Mexico, New York, North Dakota, and the Texas Gulf Coast demonstrates continued evolution of WNV. Thus, WNV continues to evolve in North America, as demonstrated by selection of this new genotype. Continued surveillance of the virus is essential as it continues to evolve in the New World.
Transstadial Transmission of Francisella tularensis holarctica in Mosquitoes, Sweden
PDF Version [PDF - 625 KB - 6 pages]
J. O. Lundström et al.View Abstract
In Sweden, human cases of tularemia caused by Francisella tularensis holarctica are assumed to be transmitted by mosquitoes, but how mosquito vectors acquire and transmit the bacterium is not clear. To determine how transmission of this bacterium occurs, mosquito larvae were collected in an area where tularemia is endemic, brought to the laboratory, and reared to adults in their original pond water. Screening of adult mosquitoes by real-time PCR demonstrated F. tularensis lpnA sequences in 14 of the 48 mosquito pools tested; lpnA sequences were demonstrated in 6 of 9 identified mosquito species. Further analysis confirmed the presence of F. tularensis holarctica–specific 30-bp deletion region sequences (FtM19inDel) in water from breeding containers and in 3 mosquito species (Aedes sticticus, Ae. vexans, and Ae. punctor) known to take blood from humans. Our results suggest that the mosquitoes that transmit F. tularensis holarctica during tularemia outbreaks acquire the bacterium already as larvae.
Molecular Epidemiology of Oropouche Virus, Brazil
PDF Version [PDF - 360 KB - 7 pages]
H. B. Vasconcelos et al.View Abstract
Oropouche virus (OROV) is the causative agent of Oropouche fever, an urban febrile arboviral disease widespread in South America, with >30 epidemics reported in Brazil and other Latin American countries during 1960–2009. To describe the molecular epidemiology of OROV, we analyzed the entire N gene sequences (small RNA) of 66 strains and 35 partial Gn (medium RNA) and large RNA gene sequences. Distinct patterns of OROV strain clustered according to N, Gn, and large gene sequences, which suggests that each RNA segment had a different evolutionary history and that the classification in genotypes must consider the genetic information for all genetic segments. Finally, time-scale analysis based on the N gene showed that OROV emerged in Brazil ≈223 years ago and that genotype I (based on N gene data) was responsible for the emergence of all other genotypes and for virus dispersal.
Medscape CME Activity
Severe Imported Plasmodium falciparum Malaria, France, 1996–2003 PDF Version [PDF - 206 KB - 7 pages]E. Seringe et al.View SummaryView Abstract
All travelers should receive pretravel advice on risk factors and antimalarial chemoprophylaxis.asdf
Little is known about severe imported Plasmodium falciparum malaria in industrialized countries where the disease is not endemic because most studies have been case reports or have included <200 patients. To identify factors independently associated with the severity of P. falciparum, we conducted a retrospective study using surveillance data obtained from 21,888 P. falciparum patients in France during 1996–2003; 832 were classified as having severe malaria. The global case-fatality rate was 0.4% and the rate of severe malaria was ≈3.8%. Factors independently associated with severe imported P. falciparum malaria were older age, European origin, travel to eastern Africa, absence of chemoprophylaxis, initial visit to a general practitioner, time to diagnosis of 4 to 12 days, and diagnosis during the fall–winter season. Pretravel advice should take into account these factors and promote the use of antimalarial chemoprophylaxis for every traveler, with a particular focus on nonimmune travelers and elderly persons.
Plasmodium knowlesi Malaria in Children
PDF Version [PDF - 233 KB - 7 pages]
B. E. Barber et al.View Abstract
Plasmodium knowlesi can cause severe malaria in adults; however, descriptions of clinical disease in children are lacking. We reviewed case records of children (age <15 years) with a malaria diagnosis at Kudat District Hospital, serving a largely deforested area of Sabah, Malaysia, during January–November 2009. Sixteen children with PCR-confirmed P. knowlesi monoinfection were compared with 14 children with P. falciparum monoinfection diagnosed by microscopy or PCR. Four children with knowlesi malaria had a hemoglobin level at admission of <10.0 g/dL (minimum lowest level 6.4 g/dL). Minimum level platelet counts were lower in knowlesi than in falciparum malaria (median 76,500/µL vs. 156,000/μL; p = 0.01). Most (81%) children with P. knowlesi malaria received chloroquine and primaquine; median parasite clearance time was 2 days (range 1–5 days). P. knowlesi is the most common cause of childhood malaria in Kudat. Although infection is generally uncomplicated, anemia is common and thrombocytopenia universal. Transmission dynamics in this region require additional investigation.
Travel-related Dengue Virus Infection, the Netherlands, 2006–2007
PDF Version [PDF - 227 KB - 8 pages]
G. G. Baaten et al.View Abstract
To assess the incidence of and risk factors for clinical and subclinical dengue virus (DENV) infection, we prospectively studied 1,207 adult short-term travelers from the Netherlands to dengue-endemic areas. Participants donated blood samples for serologic testing before and after travel. Blood samples were tested for antibodies against DENV. Seroconversion occurred in 14 (1.2%) travelers at risk. The incidence rate was 14.6 per 1,000 person-months. The incidence rate was significantly higher for travel during the rainy months. Dengue-like illness occurred in 5 of the 14 travelers who seroconverted. Seroconversion was significantly related to fever, retro-orbital pain, myalgia, arthralgia, and skin rash. The risk for DENV infection for short-term travelers to dengue-endemic areas is substantial. The incidence rate for this study is comparable with that in 2 other serology-based prospective studies conducted in the 1990s.
Experimental Infection of Amblyomma aureolatum Ticks with Rickettsia rickettsii
PDF Version [PDF - 223 KB - 6 pages]
M. B. Labruna et al.View Abstract
We experimentally infected Amblyomma aureolatum ticks with the bacterium Rickettsia rickettsii, the etiologic agent of Rocky Mountain spotted fever (RMSF). These ticks are a vector for RMSF in Brazil. R. rickettsii was efficiently conserved by both transstadial maintenance and vertical (transovarial) transmission to 100% of the ticks through 4 laboratory generations. However, lower reproductive performance and survival of infected females was attributed to R. rickettsii infection. Therefore, because of the high susceptibility of A. aureolatum ticks to R. rickettsii infection, the deleterious effect that the bacterium causes in these ticks may contribute to the low infection rates (<1%) usually reported among field populations of A. aureolatum ticks in RMSF-endemic areas of Brazil. Because the number of infected ticks would gradually decrease after each generation, it seems unlikely that A. aureolatum ticks could sustain R. rickettsii infection over multiple successive generations solely by vertical transmission.
Genotypic Profile of Streptococcus suis Serotype 2 and Clinical Features of Infection in Humans, Thailand
PDF Version [PDF - 453 KB - 8 pages]
A. Kerdsin et al.View Abstract
To examine associations between clinical features of Streptococcus suis serotype 2 infections in humans in Thailand and genotypic profiles of isolates, we conducted a retrospective study during 2006–2008. Of 165 patients for whom bacterial cultures of blood, cerebrospinal fluid, or both were positive for S. suis serotype 2, the major multilocus sequence types (STs) found were ST1 (62.4%) and ST104 (25.5%); the latter is unique to Thailand. Clinical features were examined for 158 patients. Infections were sporadic; case-fatality rate for adults was 9.5%, primarily in northern Thailand. Disease incidence peaked during the rainy season. Disease was classified as meningitis (58.9%) or nonmeningitis (41.1%, and included sepsis [35.4%] and others [5.7%]). Although ST1 strains were significantly associated with the meningitis category (p<0.0001), ST104 strains were significantly associated with the nonmeningitis category (p<0.0001). The ST1 and ST104 strains are capable of causing sepsis, but only the ST1 strains commonly cause meningitis.
Babesiosis in Lower Hudson Valley, New York, USA
PDF Version [PDF - 258 KB - 5 pages]
J. T. Joseph et al.View Abstract
Although Lyme disease has been endemic to parts of the Lower Hudson Valley of New York, United States, for >2 decades, babesiosis has emerged there only since 2001. The number of Lower Hudson Valley residents in whom babesiosis was diagnosed increased 20-fold, from 6 to 119 cases per year during 2001–2008, compared with an ≈1.6-fold increase for the rest of New York. During 2002–2009, a total of 19 patients with babesiosis were hospitalized on 22 occasions at the regional tertiary care center. Concurrent conditions included advanced age, malignancies, splenectomy, and AIDS. Two patients acquired the infection from blood transfusions and 1 from perinatal exposure, rather than from a tick bite. One patient died. Clinicians should consider babesiosis in persons with fever and hemolytic anemia who have had tick exposure or have received blood products.
Experimental Oral Transmission of Atypical Scrapie to Sheep
PDF Version [PDF - 543 KB - 7 pages]
M. M. Simmons et al.View Abstract
To investigate the possibility of oral transmission of atypical scrapie in sheep and determine the distribution of infectivity in the animals’ peripheral tissues, we challenged neonatal lambs orally with atypical scrapie; they were then killed at 12 or 24 months. Screening test results were negative for disease-specific prion protein in all but 2 recipients; they had positive results for examination of brain, but negative for peripheral tissues. Infectivity of brain, distal ileum, and spleen from all animals was assessed in mouse bioassays; positive results were obtained from tissues that had negative results on screening. These findings demonstrate that atypical scrapie can be transmitted orally and indicate that it has the potential for natural transmission and iatrogenic spread through animal feed. Detection of infectivity in tissues negative by current surveillance methods indicates that diagnostic sensitivity is suboptimal for atypical scrapie, and potentially infectious material may be able to pass into the human food chain.
Evidence of Tungiasis in Pre-Hispanic America
PDF Version [PDF - 666 KB - 8 pages]
V. Maco et al.View Abstract
Ancient parasites of the genus Tunga originated in America and, during the first half of the 19th century, were transported to the Eastern Hemisphere on transatlantic voyages. Although they were first documented by Spanish chroniclers after the arrival of Columbus, little is known about their presence in pre-Hispanic America. To evaluate the antiquity of tungiasis in America, we assessed several kinds of early documentation, including written evidence and pre-Incan earthenware reproductions. We identified 17 written documents and 4 anthropomorphic figures, of which 3 originated from the Chimu culture and 1 from the Maranga culture. Tungiasis has been endemic to Peru for at least 14 centuries. We also identified a pottery fragment during this study. This fragment is the fourth representation of tungiasis in pre-Hispanic America identified and provides explicit evidence of disease endemicity in ancient Peru.
Human Intraocular Filariasis Caused by Dirofilaria sp. Nematode, Brazil
PDF Version [PDF - 455 KB - 4 pages]
D. Otranto et al.View Abstract
A case of human intraocular dirofilariasis is reported from northern Brazil. The nematode was morphologically and phylogenetically related to Dirofilaria immitis but distinct from reference sequences, including those of D. immitis infesting dogs in the same area. A zoonotic Dirofilaria species infesting wild mammals in Brazil and its implications are discussed.
Human Intraocular Filariasis Caused by Pelecitus sp. Nematode, Brazil
PDF Version [PDF - 230 KB - 3 pages]
O. Bain et al.View Abstract
A male nematode was extracted from iris fibers of a man from the Brazilian Amazon region. This nematode belonged to the genus Pelecitus but was distinct from the 16 known species in this genus. Similarities with Pelecitus spp. from neotropical birds suggested an avian origin for this species.
Linguatula serrata Tongue Worm in Human Eye, Austria
PDF Version [PDF - 196 KB - 3 pages]
M. Koehsler et al.View Abstract
Linguatula serrata, the so-called tongue worm, is a worm-like, bloodsucking parasite belonging to the Pentastomida group. Infections with L. serrata tongue worms are rare in Europe. We describe a case of ocular linguatulosis in central Europe and provide molecular data on L. serrata tongue worms.
Rickettsia rickettsii Transmission by a Lone Star Tick, North Carolina
PDF Version [PDF - 210 KB - 3 pages]
E. B. Breitschwerdt et al.View Abstract
Only indirect or circumstantial evidence has been published to support transmission of Rickettsia rickettsii by Amblyomma americanum (lone star) ticks in North America. This study provides molecular evidence that A. americanum ticks can function, although most likely infrequently, as vectors of Rocky Mountain spotted fever for humans.
Tick-Borne Encephalitis Virus, Kyrgyzstan
PDF Version [PDF - 304 KB - 4 pages]
B. J. Briggs et al.View Abstract
Tick-borne encephalitis virus (TBEV) is an emerging pathogen in Europe and Asia. We investigated TBEV in Kyrgyzstan by collecting small mammals and ticks from diverse localities and analyzing them for evidence of TBEV infection. We found TBEV circulating in Kyrgyzstan much farther south and at higher altitudes than previously reported.
Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA
PDF Version [PDF - 102 KB - 3 pages]
B. D. Foy et al.View Abstract
Clinical and serologic evidence indicate that 2 American scientists contracted Zika virus infections while working in Senegal in 2008. One of the scientists transmitted this arbovirus to his wife after his return home. Direct contact is implicated as the transmission route, most likely as a sexually transmitted infection.
Tick-Borne Relapsing Fever Borreliosis, Rural Senegal
PDF Version [PDF - 301 KB - 3 pages]
P. Parola et al.View Abstract
Detecting spirochetes remains challenging in cases of African tick-borne relapsing fever. Using real-time PCR specific for the 16S rRNA Borrelia gene, we found 27 (13%) of 206 samples from febrile patients in rural Senegal to be positive, whereas thick blood smear examinations conducted at dispensaries identified only 4 (2%) as positive.
Novel Bluetongue Virus Serotype from Kuwait
PDF Version [PDF - 333 KB - 4 pages]
S. Maan et al.View Abstract
Sheep and goats sampled in Kuwait during February 2010 were seropositive for bluetongue virus (BTV). BTV isolate KUW2010/02, from 1 of only 2 sheep that also tested positive for BTV by real-time reverse transcription–PCR, caused mild clinical signs in sheep. Nucleotide sequencing identified KUW2010/02 as a novel BTV serotype.
Spotted Fever Group Rickettsiae in Ticks, Germany
PDF Version [PDF - 214 KB - 3 pages]
C. Silaghi et al.View Abstract
To explore increased risk for human Rickettsia spp. infection in Germany, we investigated recreational areas and renatured brown coal surface-mining sites (also used for recreation) for the presence of spotted fever group rickettsiae in ticks. R. raoultii (56.7%), R. slovaca (13.3%), and R. helvetica (>13.4%) were detected in the respective tick species.
Bartonella spp. in Feral Pigs, Southeastern United States
PDF Version [PDF - 230 KB - 3 pages]
A. W. Beard et al.View Abstract
In conjunction with efforts to assess pathogen exposure in feral pigs from the southeastern United States, we amplified Bartonella henselae, B. koehlerae, and B. vinsonii subsp. berkhoffii from blood samples. Feral pigs may represent a zoonotic risk for hunters or butchers and pose a potential threat to domesticated livestock.
Rickettsia parkeri in Gulf Coast Ticks, Southeastern Virginia, USA
PDF Version [PDF - 150 KB - 3 pages]
C. L. Wright et al.View Abstract
We report evidence that Amblyomma maculatum tick populations are well established in southeastern Virginia. We found that 43.1% of the adult Gulf Coast ticks collected in the summer of 2010 carried Rickettsia parkeri, suggesting that persons living in or visiting southeastern Virginia are at risk for infection with this pathogen.
Multitarget Test for Emerging Lyme Disease and Anaplasmosis in a Serosurvey of Dogs, Maine, USA
PDF Version [PDF - 243 KB - 3 pages]
P. W. Rand et al.View Abstract
To determine if the range of deer ticks in Maine had expanded, we conducted a multitarget serosurvey of domestic dogs (Canis lupus familiaris) in 2007. An extension of exposure to Borrelia burgdorferi to the northern border and local transmission of Anaplasma phagocytophilum throughout southern areas was found.
Phylogenetic Analysis of West Nile Virus Isolates, Italy, 2008–2009
PDF Version [PDF - 345 KB - 4 pages]
G. Rossini et al.View Abstract
To determine the lineage of West Nile virus that caused outbreaks in Italy in 2008 and 2009, several West Nile virus strains were isolated from human specimens and sequenced. On the basis of phylogenetic analyses, the strains isolated constitute a distinct group within the western Mediterranean cluster.
Genomic Characterization of Nipah Virus, West Bengal, India
PDF Version [PDF - 173 KB - 3 pages]
V. A. Arankalle et al.View Abstract
An intrafamilial outbreak in West Bengal, India, involving 5 deaths and person-to-person transmission was attributed to Nipah virus. Full-genome sequence of Nipah virus (18,252 nt) amplified from lung tissue showed 99.2% nt and 99.8% aa identity with the Bangladesh-2004 isolate, suggesting a common source of the virus.
Chikungunya Virus, Southeastern France
PDF Version [PDF - 230 KB - 4 pages]
M. Grandadam et al.View Abstract
In September 2010, autochthonous transmission of chikungunya virus was recorded in southeastern France, where the Aedes albopictus mosquito vector is present. Sequence analysis of the viral genomes of imported and autochthonous isolates indicated new features for the potential emergence and spread of the virus in Europe.
Upward Trend in Dengue Incidence among Hospitalized Patients, United States
PDF Version [PDF - 59 KB - 3 pages]
J. A. Streit et al.View Abstract
International travel and a global expansion of dengue fever have the potential to increase the incidence of dengue in the United States. We conducted a retrospective cohort analysis of trends in dengue among hospitalized patients by using the National Inpatient Sample (2000–2007); the number of cases more than tripled (p<0.0001).
Detection and Phylogenetic Characterization of Human Hepatitis E Virus Strains, Czech Republic
PDF Version [PDF - 217 KB - 3 pages]
P. Vasickova et al.View Abstract
To determine the origin of hepatitis E virus in the Czech Republic, we analyzed patient clinical samples. Five isolates of genotypes 3e, 3f, and 3g were obtained. Their genetic relatedness with Czech strains from domestic pigs and wild boars and patient recollections suggest an autochthonous source likely linked to consumption of contaminated pork.
Genetic Characterization of West Nile Virus Lineage 2, Greece, 2010
PDF Version [PDF - 142 KB - 3 pages]
A. Papa et al.View Abstract
We conducted a complete genome analysis of a West Nile virus detected in Culex pipiens mosquitoes during a severe outbreak of human West Nile disease in Greece 2010. The virus showed closest genetic relationship to the lineage 2 strain that emerged in Hungary in 2004; increased virulence may be associated with amino acid substitution H249P.
The Crab Hole Mosquito Blues
PDF Version [PDF - 206 KB - 5 pages]
K. M. Johnson et al.View Abstract
Venezuelan equine encephalomyelitis (VEE) epizoodemics were reported at 6–10-year intervals in northern South America beginning in the 1920s. In 1937, epizootic VEE virus was isolated from infected horse brain and shown as distinct from the North American equine encephalomyelitis viruses. Subsequently, epizootic and sylvatic strains were isolated in distinct ecosystems; isolates were characterized serologically as epizootic subtype I, variants A/B and C; or sylvatic (enzootic) subtype I, variants D, E, and F, and subtypes II, III, and IV. In 1969, variant I-A/B virus was transported from a major outbreak in northern South America to the borders of El Salvador, Guatemala, and Honduras. This musical poem describes the history and ecology of VEE viruses and the epidemiology of an unprecedented 1969 movement of VEE viruses from South America to equids and humans in Central America from Costa Rica to Guatemala and Belize and in Mexico and the United States that continued until 1972.
Plasmodium vivax Seroprevalence in Bred Cynomolgus Monkeys, China
PDF Version [PDF - 136 KB - 2 pages]
H. Li et al.
Imported Dengue Virus Serotype 3, Yemen to Italy, 2010
PDF Version [PDF - 153 KB - 3 pages]
P. Ravanini et al.
Strongyloidiasis in Man 75 Years after Initial Exposure
PDF Version [PDF - 116 KB - 2 pages]
V. Prendki et al.
Anaplasma phagocytophilum Infection in Ticks, China–Russia Border
PDF Version [PDF - 135 KB - 3 pages]
J. Jiang et al.
Japanese Encephalitis, Tibet, China
PDF Version [PDF - 134 KB - 3 pages]
Y. Li et al.
Babesia sp. EU1 Infection in a Forest Reindeer, the Netherlands
PDF Version [PDF - 206 KB - 3 pages]
M. Kik et al.
Dengue Virus Serotype 4, Roraima State, Brazil
PDF Version [PDF - 156 KB - 3 pages]
J. G. Temporão et al.
Novel Phlebovirus in Febrile Child, Greece
PDF Version [PDF - 128 KB - 2 pages]
V. Anagnostou et al.
Seroprevalence of Toscana Virus in Blood Donors, France, 2007
PDF Version [PDF - 136 KB - 3 pages]
N. Brisbarre et al.
Quinine-Resistant Malaria in Traveler Returning from French Guiana, 2010
PDF Version [PDF - 126 KB - 3 pages]
L. Bertaux et al.
Kyasanur Forest Disease Virus Alkhurma Subtype in Ticks, Najran Province, Saudi Arabia
PDF Version [PDF - 159 KB - 3 pages]
M. Mahdi et al.
West Nile Virus Infection, Assam, India
PDF Version [PDF - 128 KB - 2 pages]
S. A. Khan et al.
Rare Rotavirus Strains in Children with Severe Diarrhea, Malaysia
PDF Version [PDF - 145 KB - 3 pages]
L. Ch’ng et al.
Avian Malaria Deaths in Parrots, Europe
PDF Version [PDF - 179 KB - 3 pages]
P. Olias et al.
Fatal Human Case of Western Equine Encephalitis, Uruguay
PDF Version [PDF - 180 KB - 3 pages]
A. Delfraro et al.
Widespread Availability of Artemisinin Monotherapy in the United States
PDF Version [PDF - 139 KB - 2 pages]
R. M. Rakita and U. Malhotra
Yersinia pestis DNA Sequences in Late Medieval Skeletal Finds, Bavaria
PDF Version [PDF - 196 KB - 3 pages]
T. Tran et al.
About the Cover
And therefore I have sailed the seas and come
To the holy city of Byzantium
PDF Version [PDF - 205 KB - 2 pages]
- Page created: January 18, 2012
- Page last updated: January 20, 2012
- Page last reviewed: January 20, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)