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Volume 18, Number 3—March 2012
Volume 18, Number 3—March 2012 PDF Version [PDF - 5.64 MB - 187 pages]
Occurrence, Transmission, and Zoonotic Potential of Chronic Wasting Disease
PDF Version [PDF - 350 KB - 8 pages]
S. E. Saunders et al.View SummaryView Abstract
This disease continues to emerge in cervids in the United States and Canada.
Chronic wasting disease (CWD) is a fatal, transmissible prion disease that affects captive and free-ranging deer, elk, and moose. Although the zoonotic potential of CWD is considered low, identification of multiple CWD strains and the potential for agent evolution upon serial passage hinders a definitive conclusion. Surveillance for CWD in free-ranging populations has documented a continual geographic spread of the disease throughout North America. CWD prions are shed from clinically and preclinically affected hosts, and CWD transmission is mediated at least in part by the environment, perhaps by soil. Much remains unknown, including the sites and mechanisms of prion uptake in the naive host. There are no therapeutics or effective eradication measures for CWD-endemic populations. Continued surveillance and research of CWD and its effects on cervid ecosystems is vital for controlling the long-term consequences of this emerging disease.
Foodborne and Waterborne Infections in Elderly Community and Long-Term Care Facility Residents, Victoria, Australia
PDF Version [PDF - 333 KB - 8 pages]
M. D. Kirk et al.View SummaryView Abstract
LTCF residents had lower or similar rates of these infections, except salmonellosis, than community residents.
We calculated rates of foodborne and waterborne infections reported to the health department in Victoria, Australia, during 2000–2009 for elderly residents of long-term care facilities (LTCFs) and the community. We used negative binomial regression to estimate incidence rate ratios, adjusting for age, sex, and reporting period. We analyzed 8,277 infections in elderly persons. Rates of campylobacteriosis, legionellosis, listeriosis, toxigenic Escherichia coli infections, and shigellosis were higher in community residents, and rates of Salmonella infection were higher in LTCF residents. Each year, 61.7 Campylobacter infections were reported per 100,000 LTCF residents, compared with 97.6 per 100,000 community residents. LTCF residents were at higher risk for S. enterica serotype Typhimurium associated with outbreaks. Rates of foodborne infections (except salmonellosis) were similar to or lower for LTCF residents than for community residents. These findings may indicate that food preparation practices in LTCFs are safer than those used by elderly persons in the community.
Medscape CME Activity
Nonpasteurized Dairy Products, Disease Outbreaks, and State Laws—United States, 1993–2006 PDF Version [PDF - 268 KB - 7 pages]A. J. Langer et al.View SummaryView Abstract
Most dairy-associated outbreaks occurred in states that permitted sale of these products.
Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993–2006. We found 121 outbreaks for which the product’s pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product–associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number (≈150× greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered.
Medscape CME Activity
Community-associated Clostridium difficile Infections, Monroe County, New York, USA PDF Version [PDF - 314 KB - 9 pages]G. Dumyati et al.View SummaryView Abstract
Judicious use of antimicrobial drugs will reduce infections.
We conducted active sentinel surveillance in Monroe County, New York, USA, to compare incidence of community-associated Clostridium difficile infections (CA-CDIs) with that of health care–associated infections (HA-CDIs) and identify exposure and strain type differences between CA and HA cases. Patients positive for C. difficile toxin and with no documented health care exposure in the previous 12 weeks were defined as possible CA case-patients. Patients with onset in a health care setting or recent health care exposure were defined as HA case-patients. Eighteen percent of CDIs were CA; 76% were in persons who reported antimicrobial drug use in the 12 weeks before CDI diagnosis. Strain type distribution was similar between CA and HA cases; North American pulsed-field 1 was the primary strain (31% CA, 42% HA; p = 0.34). CA-CDI is an emergent disease affecting patients recently exposed to antimicrobial drugs. Community strains are similar to those found in health care settings.
Ocozocoautla de Espinosa Virus and Hemorrhagic Fever, Mexico
PDF Version [PDF - 225 KB - 5 pages]
M. Cajimat et al.View SummaryView Abstract
This novel virus is related to arenaviruses that cause hemorrhagic fever.
Arenavirus RNA was isolated from Mexican deer mice (Peromyscus mexicanus) captured near the site of a 1967 epidemic of hemorrhagic fever in southern Mexico. Analyses of nucleotide and amino acid sequence data indicated that the deer mice were infected with a novel Tacaribe serocomplex virus (proposed name Ocozocoautla de Espinosa virus), which is phylogenetically closely related to Tacaribe serocomplex viruses that cause hemorrhagic fever in humans in South America.
Causes of Pneumonia Epizootics among Bighorn Sheep, Western United States, 2008–2010
PDF Version [PDF - 296 KB - 9 pages]
T. E. Besser et al.View SummaryView Abstract
Mycoplasma ovipneumoniae is a primary pathogen.
Epizootic pneumonia of bighorn sheep is a devastating disease of uncertain etiology. To help clarify the etiology, we used culture and culture-independent methods to compare the prevalence of the bacterial respiratory pathogens Mannheimia haemolytica, Bibersteinia trehalosi, Pasteurella multocida, and Mycoplasma ovipneumoniae in lung tissue from 44 bighorn sheep from herds affected by 8 outbreaks in the western United States. M. ovipneumoniae, the only agent detected at significantly higher prevalence in animals from outbreaks (95%) than in animals from unaffected healthy populations (0%), was the most consistently detected agent and the only agent that exhibited single strain types within each outbreak. The other respiratory pathogens were frequently but inconsistently detected, as were several obligate anaerobic bacterial species, all of which might represent secondary or opportunistic infections that could contribute to disease severity. These data provide evidence that M. ovipneumoniae plays a primary role in the etiology of epizootic pneumonia of bighorn sheep.
Chicken as Reservoir for Extraintestinal Pathogenic Escherichia coli in Humans, Canada
PDF Version [PDF - 166 KB - 7 pages]
C. Bergeron et al.View SummaryView Abstract
Urinary tract infections can be difficult and expensive to treat. Most (85%) are caused by bacteria called E. coli. Historically, doctors have believed that these urinary tract E. coli came from the patient’s own intestines. But recently, Canadian researchers discovered that not only can these E. coli come from outside the patient’s intestines, they can actually come from outside the patient: from food. After comparing the genetic makeup of E. coli from human urinary tract infections with E. coli from retail meat (chicken, beef, and pork), they concluded that chickens are a likely source of E. coli and that the infections probably come directly from the chickens themselves, not from human contamination during food processing. Therefore, prevention of E. coli urinary tract infections in people might need to start on chicken farms.
We previously described how retail meat, particularly chicken, might be a reservoir for extraintestinal pathogenic Escherichia coli (ExPEC) causing urinary tract infections (UTIs) in humans. To rule out retail beef and pork as potential reservoirs, we tested 320 additional E. coli isolates from these meats. Isolates from beef and pork were significantly less likely than those from chicken to be genetically related to isolates from humans with UTIs. We then tested whether the reservoir for ExPEC in humans could be food animals themselves by comparing geographically and temporally matched E. coli isolates from 475 humans with UTIs and from cecal contents of 349 slaughtered animals. We found genetic similarities between E. coli from animals in abattoirs, principally chickens, and ExPEC causing UTIs in humans. ExPEC transmission from food animals could be responsible for human infections, and chickens are the most probable reservoir.
A Systematic Approach for Discovering Novel, Clinically Relevant Bacteria
PDF Version [PDF - 310 KB - 9 pages]
R. Schlaberg et al.View SummaryView Abstract
We identified 95 isolates from novel taxa that may have clinical relevance.
Sequencing of the 16S rRNA gene (16S) is a reference method for bacterial identification. Its expanded use has led to increased recognition of novel bacterial species. In most clinical laboratories, novel species are infrequently encountered, and their pathogenic potential is often difficult to assess. We reviewed partial 16S sequences from >26,000 clinical isolates, analyzed during February 2006–June 2010, and identified 673 that have <99% sequence identity with valid reference sequences and are thus possibly novel species. Of these 673 isolates, 111 may represent novel genera (<95% identity). Isolates from 95 novel taxa were recovered from multiple patients, indicating possible clinical relevance. Most repeatedly encountered novel taxa belonged to the genera Nocardia (14 novel taxa, 42 isolates) and Actinomyces (12 novel taxa, 52 isolates). This systematic approach for recognition of novel species with potential diagnostic or therapeutic relevance provides a basis for epidemiologic surveys and improvement of sequence databases and may lead to identification of new clinical entities.
Seroprevalence of Antibodies against Taenia solium Cysticerci among Refugees Resettled in United States
PDF Version [PDF - 342 KB - 8 pages]
S. E. O’Neal et al.View SummaryView Abstract
Cysticercosis is an infection caused by a pork tapeworm that creates cysts in different areas of the human body. Sometimes, these parasites can get into the infected patient’s brain and lead to epilepsy or other neurologic disorders. Cysticercosis is most common in developing countries that have poor sanitation and where pigs feed on human waste; however, cases in the United States are increasing. A recent study found that many refugees who settle in the United States, including those from Burma, Laos, Burundi, and Bhutan, have been infected with the tapeworm. The occurrence of cysticercosis among these groups has clinical and public health implications because US physicians might not be familiar with this disease and its symptoms. Cysticercosis should be suspected in refugees who have seizures, headache, or other unexplained neurologic symptoms. Physicians should also be aware that treatment for intestinal parasites, routinely given to refugees before they leave their homeland, can cause serious neurologic reactions in those already infected with the tapeworm.
Neurocysticercosis (NCC) is a disease caused by central nervous system infection by the larval stage of the pork tapeworm, Taenia solium. In developing countries, NCC is a leading cause of adult-onset epilepsy. Case reports of NCC are increasing among refugees resettled to the United States and other nations, but the underlying prevalence among refugee groups is unknown. We tested stored serum samples from the Centers for Disease Control and Prevention Migrant Serum Bank for antibodies against T. solium cysts by using the enzyme-linked immunoelectrotransfer blot. Seroprevalence was high among all 4 populations tested: refugees from Burma (23.2%), Lao People’s Democratic Republic (18.3%), Bhutan (22.8%), and Burundi (25.8%). Clinicians caring for refugee populations should suspect NCC in patients with seizure, chronic headache, or unexplained neurologic manifestations. Improved understanding of the prevalence of epilepsy and other associated diseases among refugees could guide recommendations for their evaluation and treatment before, during, and after resettlement.
Pathogenic Potential to Humans of Bovine Escherichia coli O26, Scotland
PDF Version [PDF - 737 KB - 10 pages]
M. E. Chase-Topping et al.View SummaryView Abstract
This pathogen may be the next Shiga toxin–producing E. coli of concern.
Escherichia coli O26 and O157 have similar overall prevalences in cattle in Scotland, but in humans, Shiga toxin–producing E. coli O26 infections are fewer and clinically less severe than E. coli O157 infections. To investigate this discrepancy, we genotyped E. coli O26 isolates from cattle and humans in Scotland and continental Europe. The genetic background of some strains from Scotland was closely related to that of strains causing severe infections in Europe. Nonmetric multidimensional scaling found an association between hemolytic uremic syndrome (HUS) and multilocus sequence type 21 strains and confirmed the role of stx2 in severe human disease. Although the prevalences of E. coli O26 and O157 on cattle farms in Scotland are equivalent, prevalence of more virulent strains is low, reducing human infection risk. However, new data on E. coli O26–associated HUS in humans highlight the need for surveillance of non-O157 enterohemorrhagic E. coli and for understanding stx2 phage acquisition.
Lineage-specific Virulence Determinants of Haemophilus influenzae Biogroup aegyptius
PDF Version [PDF - 317 KB - 9 pages]
F. R. Strouts et al.View SummaryView Abstract
Novel adhesions, including trimeric autotransporters, might contribute to virulence.
An emergent clone of Haemophilus influenzae biogroup aegyptius (Hae) is responsible for outbreaks of Brazilian purpuric fever (BPF). First recorded in Brazil in 1984, the so-called BPF clone of Hae caused a fulminant disease that started with conjunctivitis but developed into septicemic shock; mortality rates were as high as 70%. To identify virulence determinants, we conducted a pan-genomic analysis. Sequencing of the genomes of the BPF clone strain F3031 and a noninvasive conjunctivitis strain, F3047, and comparison of these sequences with 5 other complete H. influenzae genomes showed that >77% of the F3031 genome is shared among all H. influenzae strains. Delineation of the Hae accessory genome enabled characterization of 163 predicted protein-coding genes; identified differences in established autotransporter adhesins; and revealed a suite of novel adhesins unique to Hae, including novel trimeric autotransporter adhesins and 4 new fimbrial operons. These novel adhesins might play a critical role in host–pathogen interactions.
Using Genotyping and Geospatial Scanning to Estimate Recent Mycobacterium tuberculosis Transmission, United States
PDF Version [PDF - 174 KB - 8 pages]
P. K. Moonan et al.View SummaryView Abstract
These tools may enable direction of resources to populations with high transmission rates.
To determine the proportion of reported tuberculosis (TB) cases due to recent transmission in the United States, we conducted a cross-sectional study to examine culture-positive TB cases with complete genotype results (spoligotyping and 12-locus mycobacterial interspersed repetitive unit–variable-number tandem repeat typing) reported during January 2005–December 2009. Recently transmitted cases were defined as cases with matching results reported within statistically significant geospatial zones (identified by a spatial span statistic within a sliding 3-year window). Approximately 1 in 4 TB cases reported in the United States may be attributed to recent transmission. Groups at greatest risk for recent transmission appear to be men, persons born in the United States, members of a minority race or ethnic group, persons who abuse substances, and the homeless. Understanding transmission dynamics and establishing strategies for rapidly detecting recent transmission among these populations are essential for TB elimination in the United States.
Poultry Culling and Campylobacteriosis Reduction among Humans, the Netherlands
PDF Version [PDF - 167 KB - 3 pages]
I. Friesema et al.View Abstract
In the Netherlands in 2003, an outbreak of avian influenza in poultry resulted in extensive culling, especially of layer hens. Concurrently, human campylobacteriosis cases decreased, particularly in the culling area. These observations raise the hypothesis that Campylobacter spp. dissemination from poultry farms or slaughterhouses might contribute to human campylobacteriosis.
Novel Orthobunyavirus in Cattle, Europe, 2011
PDF Version [PDF - 296 KB - 4 pages]
B. Hoffmann et al.View Abstract
In 2011, an unidentified disease in cattle was reported in Germany and the Netherlands. Clinical signs included fever, decreased milk production, and diarrhea. Metagenomic analysis identified a novel orthobunyavirus, which subsequently was isolated from blood of affected animals. Surveillance was initiated to test malformed newborn animals in the affected region.
Escherichia coli O104:H4 Infections and International Travel
PDF Version [PDF - 204 KB - 4 pages]
D. C. Alexander et al.View Abstract
We analyzed travel-associated clinical isolates of Escherichia coli O104:H4, including 1 from the 2011 German outbreak and 1 from a patient who returned from the Philippines in 2010, by genome sequencing and optical mapping. Despite extensive genomic similarity between these strains, key differences included the distribution of toxin and antimicrobial drug–resistance determinants.
Laboratory Practices and Incidence of Non-O157 Shiga Toxin–producing Escherichia coli Infections
PDF Version [PDF - 215 KB - 3 pages]
K. A. Stigi et al.View Abstract
We surveyed laboratories in Washington State, USA, and found that increased use of Shiga toxin assays correlated with increased reported incidence of non-O157 Shiga toxin–producing Escherichia coli (STEC) infections during 2005–2010. Despite increased assay use, only half of processed stool specimens underwent Shiga toxin testing during 2010, suggesting substantial underdetection of non-O157 STEC infections.
Highly Pathogenic Avian Influenza (H5N1) Outbreaks in Wild Birds and Poultry, South Korea
PDF Version [PDF - 561 KB - 4 pages]
H. Kim et al.View Abstract
Highly pathogenic avian influenza (H5N1) among wild birds emerged simultaneously with outbreaks in domestic poultry in South Korea during November 2010–May 2011. Phylogenetic analysis showed that these viruses belonged to clade 2.3.2, as did viruses found in Mongolia, the People’s Republic of China, and Russia in 2009 and 2010.
Culturing Stool Specimens for Campylobacter spp., Pennsylvania, USA
PDF Version [PDF - 196 KB - 4 pages]
N. M. M’ikanatha et al.View Abstract
In 2010, we surveyed 176 clinical laboratories in Pennsylvania regarding stool specimen testing practices for enteropathogens, including Campylobacter spp. Most (96.3%) routinely test for Campylobacter spp. In 17 (15.7%), a stool antigen test is the sole method for diagnosis. We recommend that laboratory practice guidelines for Campylobacter spp. testing be developed.
Clinical Significance of Escherichia albertii
PDF Version [PDF - 315 KB - 5 pages]
T. Ooka et al.View Abstract
Discriminating Escherichia albertii from other Enterobacteriaceae is difficult. Systematic analyses showed that E. albertii represents a substantial portion of strains currently identified as eae-positive Escherichia coli and includes Shiga toxin 2f–producing strains. Because E. albertii possesses the eae gene, many strains might have been misidentified as enterohemorrhagic or enteropathogenic E. coli.
Chikungunya Outbreak in Guangdong Province, China, 2010
PDF Version [PDF - 129 KB - 3 pages]
D. Wu et al.View Abstract
A disease outbreak with dengue-like symptoms was reported in Guangdong Province, China, in October 2010. Testing results confirmed that the pathogen causing the outbreak was chikungunya virus. Phylogenic analysis indicated that this virus was a member of the Indian Ocean clade of the East/Center/South African subgroup of chikungunya virus.
Drug-Resistant Tuberculosis in Zhejiang Province, China, 1999–2008
PDF Version [PDF - 94 KB - 3 pages]
X. Wang et al.View Abstract
To evaluate levels and trends in drug-resistant tuberculosis (TB) in Zhejiang Province, China, we conducted 1 survey in each of 3 years (1999, 2004, and 2008). We found that <5% of new cases were multidrug-resistant TB. The prevalence of multidrug-resistant TB has not increased in new or re-treated cases in this province.
Southeast Asian Foot-and-Mouth Disease Viruses in Eastern Asia
PDF Version [PDF - 186 KB - 3 pages]
N. J. Knowles et al.View Abstract
Foot-and-mouth disease (FMD) outbreaks recently affected 2 countries (Japan and South Korea) in eastern Asia that were free of FMD without vaccination. Analysis of viral protein 1 nucleotide sequences indicated that FMD serotype A and O viruses that caused these outbreaks originated in mainland Southeast Asia to which these viruses are endemic.
Hepatitis E Virus Infection in HIV-infected Persons
PDF Version [PDF - 218 KB - 5 pages]
N. F. Crum-Cianflone et al.View Abstract
To determine whether hepatitis E virus (HEV) is a cause of hepatitis among HIV-infected persons, we evaluated 1985–2009 data for US military beneficiaries. Evidence of acute or prior HEV infection was detected for 7 (4%) and 5 (3%) of 194 HIV-infected persons, respectively. HEV might be a cause of acute hepatitis among HIV-infected persons.
Adenovirus-associated Deaths in US Military during Postvaccination Period, 1999–2010
PDF Version [PDF - 138 KB - 3 pages]
R. N. Potter et al.View SummaryView Abstract
For about 50 years, adenovirus has been a major cause of serious respiratory illness in US active duty military members, particularly at basic training camps. During 1971–1999, a vaccine program successfully lowered the number of illnesses and deaths from adenovirus infection. However, a recent study has shown that since the program ended, the number of deaths might be creeping back up. A new program, which uses second-generation adenovirus vaccines approved in 2011, is expected to again lower the number of illnesses and deaths caused by adenovirus.
Adenoviruses are frequent causes of respiratory disease in the US military population. A successful immunization program against adenovirus types 4 and 7 was terminated in 1999. Review of records in the Mortality Surveillance Division, Armed Forces Medical Examiner System, identified 8 deaths attributed to adenovirus infections in service members during 1999–2010.
Epsilonproteobacteria in Humans, New Zealand
PDF Version [PDF - 144 KB - 3 pages]
A. J. Cornelius et al.View Abstract
Using PCR–denaturing gradient gel electrophoresis, we examined 49 fecal samples from healthy volunteers and 128 diarrhea specimens to assess the distribution of Epsilonproteobacteria that might be routinely overlooked. Our results suggest that certain taxa that are not routinely examined for could account for a proportion of diarrhea of previously unknown etiology.
Nonculture Diagnostic Tests for Enteric Diseases
PDF Version [PDF - 72 KB - 2 pages]
T. F. Jones and P. Gerner-Smidt
Escherichia coli Producing CMY-2 β-Lactamase in Retail Chicken, Pittsburgh, Pennsylvania, USA
PDF Version [PDF - 154 KB - 2 pages]
Y. Park et al.
Ilheus Virus Infection in Human, Bolivia
PDF Version [PDF - 165 KB - 3 pages]
E. A. Venegas et al.
Shared Human/Rabbit Ligands for Rabbit Hemorrhagic Disease Virus
PDF Version [PDF - 140 KB - 2 pages]
K. Nyström et al.
Antimicrobial Drug Resistance in Peru
PDF Version [PDF - 139 KB - 2 pages]
C. García et al.
Fatal Measles without Rash in Immunocompetent Adult, France
PDF Version [PDF - 154 KB - 3 pages]
J. Lupo et al.
Carbapenemase-producing Acinetobacter spp. in Cattle, France
PDF Version [PDF - 172 KB - 3 pages]
L. Poirel et al.
Aedes albopictus Mosquitoes, Yucatan Peninsula, Mexico
PDF Version [PDF - 231 KB - 3 pages]
J. Salomón-Grajales et al.
Prevalence of Nontuberculous Mycobacteria Infection, China, 2004–2009
PDF Version [PDF - 153 KB - 2 pages]
H. Jing et al.
Travelers as Sentinels for Chikungunya Fever, Brazil
PDF Version [PDF - 162 KB - 2 pages]
T. Chaves et al.
Enhanced Surveillance for White-Nose Syndrome in Bats
PDF Version [PDF - 150 KB - 3 pages]
A. Griggs et al.
NDM-1–producing Klebsiella pneumoniae, Croatia
PDF Version [PDF - 156 KB - 3 pages]
A. Mazzariol et al.
Adherence to Oseltamivir Guidelines during Influenza Pandemic, the Netherlands
PDF Version [PDF - 142 KB - 2 pages]
E. H. Fietjé et al.
Serologic Evidence of Nipah Virus Infection in Bats, Vietnam
PDF Version [PDF - 129 KB - 2 pages]
F. Hasebe et al.
Discordance in Mycobacterium tuberculosis Rifampin Susceptibility
PDF Version [PDF - 154 KB - 3 pages]
A. S. Kalokhe et al.
High Incidence of Group B Streptococcal Infection in Infants Born to HIV-Infected Mothers
PDF Version [PDF - 152 KB - 2 pages]
T. Goetghebuer et al.
Etymology of Cholera
PDF Version [PDF - 138 KB - 1 page]
A. A. Kousoulis
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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- Page created: July 10, 2012
- Page last updated: July 10, 2012
- Page last reviewed: July 10, 2012
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