Volume 18, Number 6—June 2012
Volume 18, Number 6—June 2012 PDF Version [PDF - 4.51 MB - 147 pages]
Medscape CME Activity
Iatrogenic Creutzfeldt-Jakob Disease, Final Assessment PDF Version [PDF - 291 KB - 7 pages]P. Brown et al.View SummaryView Abstract
The book on iatrogenic Creutzfeldt-Jakob disease (CJD) in humans is almost closed. This form of CJD transmission via medical misadventures was first detected in 1974. Today, only occasional CJD cases with exceptionally long incubation periods still appear. The main sources of the largest outbreaks were tissues from human cadavers with unsuspected CJD that were used for dura mater grafts and growth hormone extracts. A few additional cases resulted from neurosurgical instrument contamination, corneal grafts, gonadotrophic hormone, and secondary infections from blood transfusions. Although the final solution to the problem of iatrogenic CJD is still not available (a laboratory test to identify potential donors who harbor the infectious agent), certain other measures have worked well: applying special sterilization of penetrating surgical instruments, reducing the infectious potential of donor blood and tissue, and excluding donors known to have higher than normal risk for CJD.
The era of iatrogenic Creutzfeldt-Jakob disease (CJD) has nearly closed; only occasional cases with exceptionally long incubation periods are still appearing. The principal sources of these outbreaks are contaminated growth hormone (226 cases) and dura mater grafts (228 cases) derived from human cadavers with undiagnosed CJD infections; a small number of additional cases are caused by neurosurgical instrument contamination, corneal grafts, gonadotrophic hormone, and secondary infection with variant CJD transmitted by transfusion of blood products. No new sources of disease have been identified, and current practices, which combine improved recognition of potentially infected persons with new disinfection methods for fragile surgical instruments and biological products, should continue to minimize the risk for iatrogenic disease until a blood screening test for the detection of preclinical infection is validated for human use.
Medscape CME Activity
Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producing Enterobacteriaceae and Infection after Liver Transplant, France PDF Version [PDF - 385 KB - 9 pages]F. Bert et al.View SummaryView Abstract
Bacterial infection after liver transplant is fairly common, mostly because liver transplant patients are severely ill and the surgery is very complex. Adding to the seriousness of this situation is that some bacteria are resistant to many antimicrobial drugs. However, treating all infections as drug resistant would lead to even more drug resistance, so only patients at highest risk should receive the most powerful drugs. But who is at highest risk? A recent study in France screened fecal samples of liver transplant candidates and found that post-operative infections were most likely for those patients who already had certain bacteria in their feces before surgery. Thus, fecal screening for those multiresistant bacteria should be considered for all liver transplant candidates so that if post-operative infection develops, those at high risk can receive the most specific drugs right away.
Extended-spectrum β-lactamase–producing Enterobacteriaceae isolates (ESBLE) are emerging pathogens that confer resistance to antimicrobial drugs. We conducted a 10-year study in France (January 2001–April 2010) to investigate the incidence of and risk factors for ESBLE infections after liver transplant. Of 710 transplant patients screened preoperatively for ESBLE fecal carriage, 5.5% had ESBLE infection develop within 4 months after surgery; patients with pretransplant ESBLE fecal carriage were more likely to have infection develop than were noncarriers. Typing showed extensive genetic diversity, with a large predominance of CTX-M enzymes. Independent predictors of ESBLE infection were pretransplant fecal carriage, Model for End Stage Liver Disease score >25, and return to surgery. Our results indicate that the influx of preoperatively acquired ESBLE isolates into the hospital outweighs cross-transmission in the epidemiology of ESBLE infections after liver transplant. Transplant candidates should be systematically screened for carriage, and posttransplant infection in carriers should be treated with carbapenems.
Medscape CME Activity
Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus, Connecticut, USA, 2001–2010 PDF Version [PDF - 270 KB - 8 pages]J. L. Hadler et al.View SummaryView Abstract
Decreases in health care–related isolates accounted for all reductions in MRSA during 2007–2010.
We examined trends in incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in Connecticut, with emphasis on 2007–2010, after legislation required reporting of hospital infections. A case was defined as isolation of MRSA from normally sterile body sites, classified after medical record review as hospital onset (HO), community onset, health care–associated community onset (HACO), or community-associated (CA). Blood isolates collected during 2005–2010 were typed and categorized as community- or health care–related strains. During 2001–2010, a total of 8,758 cases were reported (58% HACO, 31% HO, and 11% CA), and MRSA incidence decreased (p<0.05) for HACO and HO, but increased for CA. Significant 3- to 4-year period trends were decreases in all MRSA (–18.8%), HACO (–12.8%), HO (–33.2%), and CA (–12.7%) infections during 2007–2010, and an increase in CA infections during 2004–2006. Decreases in health care–related isolates accounted for all reductions. Hospital infections reporting may have catalyzed the decreases.
Molecular Epidemiology of Geographically Dispersed Vibrio cholerae, Kenya, January 2009–May 2010
PDF Version [PDF - 329 KB - 7 pages]
A. Mohamed et al.View SummaryView Abstract
Isolates represent multiple genetic lineages, a finding consistent with multiple emergences from endemic reservoirs.
Numerous outbreaks of cholera have occurred in Kenya since 1971. To more fully understand the epidemiology of cholera in Kenya, we analyzed the genetic relationships among 170 Vibrio cholerae O1 isolates at 5 loci containing variable tandem repeats. The isolates were collected during January 2009–May 2010 from various geographic areas throughout the country. The isolates grouped genetically into 5 clonal complexes, each comprising a series of genotypes that differed by an allelic change at a single locus. No obvious correlation between the geographic locations of the isolates and their genotypes was observed. Nevertheless, geographic differentiation of the clonal complexes occurred. Our analyses showed that multiple genetic lineages of V. cholerae were simultaneously infecting persons in Kenya. This finding is consistent with the simultaneous emergence of multiple distinct genetic lineages of V. cholerae from endemic environmental reservoirs rather than recent introduction and spread by travelers.
Community Survey after Rabies Outbreaks, Flagstaff, Arizona, USA
PDF Version [PDF - 226 KB - 7 pages]
A. M. McCollum et al.View SummaryView Abstract
Educational outreach should inform the public about dangers of translocation of wild animals and general aspects of rabies.
Flagstaff, Arizona, USA, experienced notable outbreaks of rabies caused by a bat rabies virus variant in carnivore species in 2001, 2004, 2005, 2008, and 2009. The most recent epizootic involved transmission among skunk and fox populations and human exposures. Multiple, wide-ranging control efforts and health communications outreach were instituted in 2009, including a household survey given to community members. Although the Flagstaff community is knowledgeable about rabies and the ongoing outbreaks in general, gaps in knowledge about routes of exposure and potential hosts remain. Future educational efforts should include messages on the dangers of animal translocation and a focus on veterinarians and physicians as valuable sources for outreach. These results will be useful to communities experiencing rabies outbreaks as well as those at current risk.
Trichomonas vaginalis Antimicrobial Drug Resistance in 6 US Cities, STD Surveillance Network, 2009–2010
PDF Version [PDF - 333 KB - 5 pages]
R. D. Kirkcaldy et al.View SummaryView Abstract
Such isolates should undergo drug susceptibility testing periodically to detect emerging resistance.
Nitroimidazoles (metronidazole and tinidazole) are the only recommended drugs for treating Trichomonas vaginalis infection, and previous samples that assessed resistance of such isolates have been limited in geographic scope. We assessed the prevalence of in vitro aerobic metronidazole and tinidazole resistance among T. vaginalis isolates from multiple geographic sites in the United States. Swab specimens were obtained from women who underwent routine pelvic examinations at sexually transmitted disease clinics in 6 US cities. Cultured T. vaginalis isolates were tested for nitroimidazole resistance (aerobic minimum lethal concentration [MLC] >50 µg/mL). Of 538 T. vaginalis isolates, 23 (4.3%) exhibited low-level in vitro metronidazole resistance (minimum lethal concentrations 50–100 µg/mL). No isolates exhibited moderate- to high-level metronidazole resistance or tinidazole resistance. Results highlight the possibility that reliance on a single class of antimicrobial drugs for treating T. vaginalis infections may heighten vulnerability to emergence of resistance. Thus, novel treatment options are needed.
Virulence Potential of Fusogenic Orthoreoviruses
PDF Version [PDF - 301 KB - 5 pages]
A. H. Wong et al.View SummaryView Abstract
Virus evolution should be monitored because frequent reassortment, which contributes to virus diversity, creates the potential for more severe infections.
Several severe respiratory virus infections that have emerged during the past decade originated in animals, including bats. In Indonesia, exposure to bats has been associated with increased risk of acquiring orthoreovirus infection. Although orthoreovirus infections are mild and self-limiting, we explored their potential for evolution into a more virulent form. We used conventional virus culture, electron microscopy, and molecular sequencing to isolate and identify orthoreoviruses from 3 patients in whom respiratory tract infection developed after travel to Indonesia. Virus characterization by plaque-reduction neutralization testing showed antigenic similarity, but sequencing of the small segment genes suggested virus reassortment, which could lead to increased virulence. Bats as a reservoir might contribute to virus evolution and genetic diversity, giving orthoreoviruses the potential to become more virulent. Evolution of this virus should be closely monitored so that prevention and control measures can be taken should it become more virulent.
Intrafamilial Circulation of Tropheryma whipplei, France
PDF Version [PDF - 283 KB - 7 pages]
F. Fenollar et al.View SummaryView Abstract
High prevalence within families might reflect a specific immune condition.
Tropheryma whipplei, which causes Whipple disease, has been detected in 4% of fecal samples from the general adult population of France. To identify T. whipplei within families, we conducted serologic and molecular studies, including genotyping, on saliva, feces, and serum from 74 relatives of 13 patients with classic Whipple disease, 5 with localized chronic T. whipplei infection, and 3 carriers. Seroprevalence was determined by Western blot and compared with 300 persons from the general population. We detected T. whipplei in 24 (38%) of 64 fecal samples and 7 (10%) of 70 saliva samples from relatives but found no difference between persons related by genetics and marriage. The same circulating genotype occurred significantly more often in families than in other persons. Seroprevalence was higher among relatives (23 [77%] of 30) than in the general population (143 [48%] of 300). The high prevalence of T. whipplei within families suggests intrafamilial circulation.
Human Gyrovirus DNA in Human Blood, Italy
PDF Version [PDF - 205 KB - 4 pages]
F. Maggi et al.View SummaryView Abstract
HGyV in blood suggests the infection might be systemic.
Human gyrovirus (HGyV) is a recent addition to the list of agents found in humans. Prevalence, biologic properties, and clinical associations of this novel virus are still incompletely understood. We used qualitative PCRs to detect HGyV in blood samples of 301 persons from Italy. HGyV genome was detected in 3 of 100 solid organ transplant recipients and in 1 HIV-infected person. The virus was not detected in plasma samples from healthy persons. Furthermore, during observation, persons for whom longitudinal plasma samples were obtained had transient and scattered presence of circulating HGyV. Sequencing of a 138-bp fragment showed nucleotide identity among all the HGyV isolates. These results show that HGyV can be present in the blood of infected persons. Additional studies are needed to investigate possible clinical implications.
Clostridium difficile Infection, Colorado and the Northwestern United States, 2007
PDF Version [PDF - 208 KB - 3 pages]
J. L. Kuntz et al.View Abstract
To determine the incidence of Clostridium difficile infection during 2007, we examined infection in adult inpatient and outpatient members of a managed-care organization. Incidence was 14.9 C. difficile infections per 10,000 patient-years. Extrapolating this rate to US adults, we estimate that 284,875 C. difficile infections occurred during 2007.
Severe Fever with Thrombocytopenia Syndrome Virus, Shandong Province, China
PDF Version [PDF - 303 KB - 3 pages]
L. Zhao et al.View Abstract
Severe fever with thrombocytopenia syndrome, which results in severe illness and has a high case-fatality rate, is caused by a novel bunyavirus, severe fever with thrombocytopenia syndrome virus. We found that samples from 2/237 (0.8%) healthy persons and 111/134 (83%) goats in Yiyuan County, Shandong Province, China, were seropositive for this virus.
Macrolide-Resistant Bordetella pertussis Infection in Newborn Girl, France
PDF Version [PDF - 277 KB - 3 pages]
S. Guillot et al.View Abstract
A macrolide antimicrobial drug was administered to a newborn with cough. On day 23 of hospitalization, macrolide-resistant Bordetella pertussis was isolated from nasopharyngeal aspirates. DNA sequencing and PCR–restriction fragment length polymorphism showed a 2047 A-to-G mutation in the 3 copies of the 23S rRNA gene. Monitoring for macrolide resistance is essential in infants <6 months of age.
Genome Analysis of Rift Valley Fever Virus, Mayotte
PDF Version [PDF - 199 KB - 3 pages]
C. Cêtre-Sossah et al.View Abstract
As further confirmation of a first human case of Rift Valley fever in 2007 in Comoros, we isolated Rift Valley fever virus in suspected human cases. These viruses are genetically closely linked to the 2006–2007 isolates from Kenya.
Prevalence of Rift Valley Fever among Ruminants, Mayotte
PDF Version [PDF - 554 KB - 4 pages]
C. Cêtre-Sossah et al.View Abstract
Rift Valley fever threatens human and animal health. After a human case was confirmed in Comoros in 2007, 4 serosurveys among ruminants in Mayotte suggested that Rift Valley fever virus had been circulating at low levels since 2004, although no clinical cases occurred in animals. Entomologic and ecologic studies will help determine outbreak potential.
Louping Ill in Goats, Spain, 2011
PDF Version [PDF - 431 KB - 3 pages]
A. Balseiro et al.View Abstract
Although louping ill affects mainly sheep, a 2011 outbreak in northern Spain occurred among goats. Histopathologic lesions and molecular genetics identified a new strain of louping ill virus, 94% identical to the strain from Britain. Surveillance is needed to minimize risk to domestic and wildlife species and humans.
Accuracy of ICD-10 Codes for Surveillance of Clostridium difficile Infections, France
PDF Version [PDF - 213 KB - 3 pages]
G. Jones et al.View Abstract
The sensitivity and specificity of surveillance for Clostridium difficile infections according to International Classification of Diseases, 10th revision, codes were compared with laboratory results as standard. Sensitivity was 35.6%; specificity was 99.9%. Concordance between the 2 methods was moderate. Surveillance based on ICD-10 codes underestimated the rate based on laboratory results.
Molecular Epidemiology of Laguna Negra Virus, Mato Grosso State, Brazil
PDF Version [PDF - 239 KB - 4 pages]
E. S. Travassos da Rosa et al.View Abstract
We associated Laguna Negra virus with hantavirus pulmonary syndrome in Mato Grosso State, Brazil, and a previously unidentified potential host, the Calomys callidus rodent. Genetic testing revealed homologous sequencing in specimens from 20 humans and 8 mice. Further epidemiologic studies may lead to control of HPS in Mato Grosso State.
Avian Influenza A (H5N1) Virus Antibodies in Poultry Cullers, South Korea, 2003–2004
PDF Version [PDF - 160 KB - 3 pages]
D. Kwon et al.View Abstract
Transmission of influenza (H5N1) virus from birds to humans is a serious public health threat. In South Korea, serologic investigation among 2,512 poultry workers exposed during December 2003–March 2004 to poultry with confirmed or suspected influenza (H5N1) virus infection found antibodies in 9. Frequency of bird-to-human transmission was low.
Bartonella vinsonii subsp. arupensis in Humans, Thailand
PDF Version [PDF - 202 KB - 3 pages]
Y. Bai et al.View Abstract
We identified Bartonella vinsonii subsp. arupensis in pre-enriched blood of 4 patients from Thailand. Nucleotide sequences for transfer-messenger RNA gene, citrate synthase gene, and the 16S–23S rRNA internal transcribed spacer were identical or closely related to those for the strain that has been considered pathogenic since initially isolated from a human in Wyoming, USA.
Immunodeficiency-associated Vaccine-Derived Poliovirus Type 3 in Infant, South Africa, 2011
PDF Version [PDF - 239 KB - 3 pages]
N. Gumede et al.View Abstract
Patients with primary immunodeficiency are prone to persistently excrete Sabin-like virus after administration of live-attenuated oral polio vaccine and have an increased risk for vaccine-derived paralytic polio. We report a case of type 3 immunodeficiency-associated vaccine-derived poliovirus in a child in South Africa who was born with X-linked immunodeficiency syndrome.
Rickettsia parkeri Infection in Domestic Dogs, Southern Louisiana, USA, 2011
PDF Version [PDF - 193 KB - 3 pages]
B. J. Grasperge et al.View Abstract
The association between companion animals and tick-borne rickettsial disease has long been recognized and can be essential to the emergence of rickettsioses. We tested whole blood from dogs in temporary shelters by using PCR for rickettsial infections. Of 93 dogs, 12 (13%) were positive for Rickettsia parkeri, an emerging tick-borne rickettsiosis.
Wild Boars as Hosts of Human-Pathogenic Anaplasma phagocytophilum Variants
PDF Version [PDF - 327 KB - 4 pages]
J. Michalik et al.View SummaryView Abstract
European boars could be used as sentinel animals to detect A. phagocytophilum strains that cause human infections.
To investigate the potential of wild boars to host Anaplasma phagocytophilum, we analyzed bacterial 16S rRNA and ank genes. DNA sequencing identified several A. phagocytophilum variants, including a predominance of strains known to cause human disease. Boars are thus hosts for A. phagocytophilum, notably, strains associated with human granulocytic anaplasmosis.
Local Transmission of Imported Endemic Syphilis, Canada, 2011
PDF Version [PDF - 166 KB - 3 pages]
S. Fanella et al.View Abstract
Endemic (nonvenereal) syphilis is relatively common in nonindustrialized regions of the world. We describe a case of local transmission in Canada and review tools available for confirming a diagnosis. Improved molecular tools and global clinical awareness are needed to recognize cases of endemic syphilis imported to areas where it is not normally seen.
Schmallenberg Virus in Calf Born at Term with Porencephaly, Belgium
PDF Version [PDF - 278 KB - 2 pages]
M. Garigliany et al.
Zoonotic Disease Pathogens in Fish Used for Pedicure
PDF Version [PDF - 205 KB - 3 pages]
D. W. Verner-Jeffreys et al.View Summary
“Doctor” fish might not be such good doctors after all. These fish are used for the increasingly popular spa treatment called fish pedicures. During these sessions, spa patrons immerse their feet in water, allowing the live fish to feed on dead skin, mainly for cosmetic reasons. However, examinations of doctor fish destined for these spas found that they can carry harmful bacteria. Thus, although reports of human infection after fish pedicures are few, there may be some risks. Spa patrons who have underlying medical conditions (such as diabetes, immunosuppression, or even simple breaks in the skin) are already discouraged from taking such treatments. However, spas that offer fish pedicures should also consider using only disease-free fish reared in controlled facilities under high standards of husbandry and welfare.
Rickettsia conorii Indian Tick Typhus Strain and R. slovaca in Humans, Sicily
PDF Version [PDF - 199 KB - 3 pages]
A. Torina et al.
Detection of European Strain of Echinococcus multilocularis in North America
PDF Version [PDF - 211 KB - 3 pages]
E. J. Jenkins et al.
Recognition and Diagnosis of Cryptococcus gattii Infections in the United States
PDF Version [PDF - 231 KB - 4 pages]
S. Iverson et al.
Coccidioidal Endophthalmitis in Immunocompetent Person, California, USA
PDF Version [PDF - 218 KB - 2 pages]
M. Cheng et al.
Human MRSA Isolates with Novel Genetic Homolog, Germany
PDF Version [PDF - 173 KB - 3 pages]
A. Kriegeskorte et al.
ESBL-Positive Enterobacteria Isolates in Drinking Water
PDF Version [PDF - 166 KB - 2 pages]
H. De Boeck et al.
Novel Chlamydiaceae Disease in Captive Salamanders
PDF Version [PDF - 240 KB - 3 pages]
A. Martel et al.
Novel Variant of Beilong Paramyxovirus in Rats, China
PDF Version [PDF - 174 KB - 3 pages]
P. Woo et al.
Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant
PDF Version [PDF - 183 KB - 3 pages]
E. Stanford et al.
African Swine Fever Virus Strain Georgia 2007/1 in Ornithodoros erraticus Ticks
PDF Version [PDF - 199 KB - 3 pages]
A. V. Diaz et al.
Apparent Triclabendazole-Resistant Human Fasciola hepatica Infection, the Netherlands
PDF Version [PDF - 178 KB - 2 pages]
A. Winkelhagen et al.
Hepatitis E Virus Infection in Sheltered Homeless Persons, France
PDF Version [PDF - 256 KB - 2 pages]
S. Larrat et al.
Possibility of Leishmaniasis Transmission in Jura, France
PDF Version [PDF - 158 KB - 1 page]
M. Kasbari et al.
PDF Version [PDF - 183 KB - 2 pages]
L. B. Schonberger and R. B. Schonberger
Books and Media
About the Cover
- Page created: October 19, 2012
- Page last updated: October 19, 2012
- Page last reviewed: October 19, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)