Volume 19, Number 10—October 2013
Volume 19, Number 10—October 2013 PDF Version [PDF - 10.76 MB - 167 pages]
Chagas Disease and Breast-feeding
PDF Version [PDF - 394 KB - 6 pages]
F. F. Norman and R. López-VélezView SummaryView Abstract
Mothers with this disease should continue breast-feeding unless they are experiencing the acute phase, reactivated disease, or bleeding nipples.
Chagas disease (infection by the protozoan Trypanosoma cruzi) is a major parasitic disease of the Americas and one of the main neglected tropical diseases. Although various routes of transmission are recognized, the risk for transmission of the infection through breast-feeding has not clearly been established. We reviewed the literature on transmission of T. cruzi through breast-feeding to provide breast-feeding mothers with Chagas disease with medical guidance. Although data from animal studies and human studies are scarce, we do not recommend that mothers with Chagas disease discontinue breast-feeding, unless they are experiencing the acute phase of the disease, reactivated disease resulting from immunosuppression, or bleeding nipples. In these cases, thermal treatment of milk before feeding the infant may be considered.
Medscape CME Activity
Increased Incidence of Invasive Fusariosis with Cutaneous Portal of Entry, Brazil PDF Version [PDF - 561 KB - 6 pages]M. Nucci et al.View SummaryView Abstract
Most cases of infection with Fusarium spp. fungi involved primary skin lesions.
Invasive fusariosis (IF) is an infection with Fusarium spp. fungi that primarily affects patients with hematologic malignancies and hematopoietic cell transplant recipients. A cutaneous portal of entry is occasionally reported. We reviewed all cases of IF in Brazil during 2000–2010, divided into 2 periods: 2000–2005 (period 1) and 2006–2010 (period 2). We calculated incidence rates of IF and of superficial infections with Fusarium spp. fungi identified in patients at a dermatology outpatient unit. IF incidence for periods 1 and 2 was 0.86 cases versus 10.23 cases per 1,000 admissions (p<0.001), respectively; superficial fusarial infection incidence was 7.23 versus 16.26 positive cultures per 1,000 superficial cultures (p<0.001), respectively. Of 21 cases of IF, 14 showed a primary cutaneous portal of entry. Further studies are needed to identify reservoirs of these fungi in the community and to implement preventive measures for patients at risk.
Genetic Recombination and Cryptosporidium hominis Virulent Subtype IbA10G2
PDF Version [PDF - 657 KB - 10 pages]
N. Li et al.View SummaryView Abstract
Genetic analyses will increase understanding of evolution and spread of virulent subtypes.
Little is known about the emergence and spread of virulent subtypes of Cryptosporidium hominis, the predominant species responsible for human cryptosporidiosis. We conducted sequence analyses of 32 genetic loci of 53 C. hominis specimens isolated from a longitudinally followed cohort of children living in a small community. We identified by linkage disequilibrium and recombination analyses only limited genetic recombination, which occurred exclusively within the 60-kDa glycoprotein gene subtype IbA10G2, a predominant subtype for outbreaks in industrialized nations and a virulent subtype in the study community. Intensive transmission of virulent subtype IbA10G2 in the study area might have resulted in genetic recombination with other subtypes. Moreover, we identified selection for IbA10G2 at a 129-kb region around the 60-kDa glycoprotein gene in chromosome 6. These findings improve our understanding of the origin and evolution of C. hominis subtypes and the spread of virulent subtypes.
Emergence of Vaccine-derived Polioviruses, Democratic Republic of Congo, 2004–2011
PDF Version [PDF - 665 KB - 7 pages]
N. Gumede et al.View SummaryView Abstract
These viruses can emerge independently where immunity to poliovirus is inadequate.
Polioviruses isolated from 70 acute flaccid paralysis patients from the Democratic Republic of Congo (DRC) during 2004–2011 were characterized and found to be vaccine-derived type 2 polioviruses (VDPV2s). Partial genomic sequencing of the isolates revealed nucleotide sequence divergence of up to 3.5% in the viral protein 1 capsid region of the viral genome relative to the Sabin vaccine strain. Genetic analysis identified at least 7 circulating lineages localized to specific geographic regions. Multiple independent events of VDPV2 emergence occurred throughout DRC during this 7-year period. During 2010–2011, VDPV2 circulation in eastern DRC occurred in an area distinct from that of wild poliovirus circulation, whereas VDPV2 circulation in the southwestern part of DRC (in Kasai Occidental) occurred within the larger region of wild poliovirus circulation.
Coccidioidomycosis-associated Hospitalizations, California, USA, 2000–2011
PDF Version [PDF - 469 KB - 8 pages]
G. Sondermeyer et al.View SummaryView Abstract
These hospitalizations significantly increased and were costly.
In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000–2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.
Immunogenic Mycobacterium africanum Strains Associated with Ongoing Transmission in The Gambia
PDF Version [PDF - 458 KB - 7 pages]
F. Gehre et al.View SummaryView Abstract
Immunogenicity of these strains is correlated with successful spread within the human host population.
In West Africa, Mycobacterium tuberculosis strains co-circulate with M. africanum, and both pathogens cause pulmonary tuberculosis in humans. Given recent findings that M. tuberculosis T-cell epitopes are hyperconserved, we hypothesized that more immunogenic strains have increased capacity to spread within the human host population. We investigated the relationship between the composition of the mycobacterial population in The Gambia, as measured by spoligotype analysis, and the immunogenicity of these strains as measured by purified protein derivative–induced interferon-γ release in ELISPOT assays of peripheral blood mononuclear cells. We found a positive correlation between strains with superior spreading capacity and their relative immunogenicity. Although our observation is true for M. tuberculosis and M. africanum strains, the association was especially pronounced in 1 M. africanum sublineage, characterized by spoligotype shared international type 181, which is responsible for 20% of all tuberculosis cases in the region and therefore poses a major public health threat in The Gambia.
Plasmodium vivax Malaria during Pregnancy, Bolivia
PDF Version [PDF - 386 KB - 7 pages]
L. Brutus et al.View SummaryView Abstract
Infections during pregnancy are associated with serious adverse outcomes.
Plasmodium vivax is a major cause of illness in areas with low transmission of malaria in Latin America, Asia, and the Horn of Africa. However, pregnancy-associated malaria remains poorly characterized in such areas. Using a hospital-based survey of women giving birth and an antenatal survey, we assessed the prevalence rates of Plasmodium spp. infections in pregnant women in Bolivia, and evaluated the consequences of malaria during pregnancy on the health of mothers and newborns. P. vivax infection was detected in 7.9% of pregnant women attending antenatal visits, and placental infection occurred in 2.8% of deliveries; these rates did not vary with parity. Forty-two percent of all P. vivax malaria episodes were symptomatic. P. vivax–infected pregnant women were frequently anemic (6.5%) and delivered babies of reduced birthweight. P. vivax infections during pregnancy are clearly associated with serious adverse outcomes and should be considered in prevention strategies of pregnancy-associated malaria.
Antibody Responses against Pneumocystis jirovecii in Health Care Workers Over Time
PDF Version [PDF - 649 KB - 8 pages]
S. Fong et al.View SummaryView Abstract
Nosocomial transmission of Pneumocystis is possible, and antibodies in health care workers may serve as key indicators of exposure.
In a previous cross-sectional study, we showed that clinical staff working in a hospital had significantly higher antibody levels than nonclinical staff to Pneumocystis jirovecii. We conducted a longitudinal study, described here, to determine whether occupation and self-reported exposure to a patient with P. jirovecii pneumonia were associated with antibody levels to P. jirovecii over time. Baseline and quarterly serum specimens were collected and analyzed by using an ELISA that targeted different variants of the Pneumocystis major surface glycoprotein (MsgA, MsgB, MsgC1, MsgC3, MsgC8, and MsgC9). Clinical staff had significantly higher estimated geometric mean antibody levels against MsgC1 and MsgC8 than did nonclinical staff over time. Significant differences were observed when we compared the change in antibody levels to the different MsgC variants for staff who were and were not exposed to P. jirovecii pneumonia–infected patients. MsgC variants may serve as indicators of exposure to P. jirovecii in immunocompetent persons.
Medscape CME Activity
Cryptococcus gattii Infections in Multiple States Outside the US Pacific Northwest PDF Version [PDF - 891 KB - 7 pages]J. R. Harris et al.View SummaryView Abstract
The organism might be endemic outside the outbreak-affected areas.
Clonal VGII subtypes (outbreak strains) of Cryptococcus gattii have caused an outbreak in the US Pacific Northwest since 2004. Outbreak-associated infections occur equally in male and female patients (median age 56 years) and usually cause pulmonary disease in persons with underlying medical conditions. Since 2009, a total of 25 C. gattii infections, 23 (92%) caused by non–outbreak strain C. gattii, have been reported from 8 non–Pacific Northwest states. Sixteen (64%) patients were previously healthy, and 21 (84%) were male; median age was 43 years (range 15–83 years). Ten patients who provided information reported no past-year travel to areas where C. gattii is known to be endemic. Nineteen (76%) patients had central nervous system infections; 6 (24%) died. C. gattii infection in persons without exposure to known disease-endemic areas suggests possible endemicity in the United States outside the outbreak-affected region; these infections appear to differ in clinical and demographic characteristics from outbreak-associated C. gattii. Clinicians outside the outbreak-affected areas should be aware of locally acquired C. gattii infection and its varied signs and symptoms.
Rickettsia slovaca Infection in Humans, Portugal
PDF Version [PDF - 307 KB - 3 pages]
R. de Sousa et al.View Abstract
Fifteen years after the initial detection of Rickettsia slovaca in ticks in Portugal, 3 autochthonous cases of R. slovaca infection were diagnosed in humans. All patients had an eschar on the scalp and lymphadenopathy; 2 patients had facial edema. R. slovaca infection was confirmed by serologic testing, culture, and PCR.
Reassortant Avian Influenza A(H5N1) Viruses with H9N2-PB1 Gene in Poultry, Bangladesh
PDF Version [PDF - 798 KB - 5 pages]
I. Monne et al.View Abstract
Bangladesh has reported a high number of outbreaks of highly pathogenic avian influenza (HPAI) (H5N1) in poultry. We identified a natural reassortant HPAI (H5N1) virus containing a H9N2-PB1 gene in poultry in Bangladesh. Our findings highlight the risks for prolonged co-circulation of avian influenza viruses and the need to monitor their evolution.
Evolution of Influenza A Virus H7 and N9 Subtypes, Eastern Asia
PDF Version [PDF - 821 KB - 4 pages]
C. Lebarbenchon et al.View Abstract
Influenza A viruses are a threat to poultry and human health. We investigated evolution of influenza A virus H7 and N9 subtypes in wild and domestic birds. Influenza A(H7N9) virus probably emerged after a long silent circulation in live poultry markets in eastern Asia.
Variant Human T-cell Lymphotropic Virus Type 1c and Adult T-cell Leukemia, Australia
PDF Version [PDF - 1.27 MB - 3 pages]
L. Einsiedel et al.View Abstract
Human T-cell lymphotropic virus type 1 is endemic to central Australia among Indigenous Australians. However, virologic and clinical aspects of infection remain poorly understood. No attempt has been made to control transmission to indigenous children. We report 3 fatal cases of adult T-cell leukemia/lymphoma caused by human T-cell lymphotropic virus type 1 Australo-Melanesian subtype c.
Transition in the Cause of Fever from Malaria to Dengue, Northwestern Ecuador, 1990–2011
PDF Version [PDF - 479 KB - 4 pages]
S. G. Cifuentes et al.View Abstract
In tropical areas, the predominant cause of fever has historically been malaria. However by 2011, among febrile patients in northwestern Ecuador, dengue was identified in 42% and malaria in none. This finding suggests a transition in the cause of fever from malaria to other illnesses, such as dengue.
Use of Primary Care Data for Detecting Impetigo Trends, United Kingdom, 1995–2010
PDF Version [PDF - 372 KB - 3 pages]
L. J. Shallcross et al.View Abstract
Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995–2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases.
Primary Multidrug-Resistant Mycobacterium tuberculosis in 2 Regions, Eastern Siberia, Russian Federation
PDF Version [PDF - 331 KB - 4 pages]
S. Zhdanova et al.View Abstract
Of 235 Mycobacterium tuberculosis isolates from patients who had not received tuberculosis treatment in the Irkutsk oblast and the Sakha Republic (Yakutia), eastern Siberia, 61 (26%) were multidrug resistant. A novel strain, S 256, clustered among these isolates and carried eis-related kanamycin resistance, indicating a need for locally informed diagnosis and treatment strategies.
Clonal Distribution and Virulence of Campylobacter jejuni Isolates in Blood
PDF Version [PDF - 354 KB - 3 pages]
B. Feodoroff et al.View Abstract
Campylobacter jejuni bacteria are highly diverse enteropathogens. Seventy-three C. jejuni isolates from blood collected in Finland were analyzed by multilocus sequence typing and serum resistance. Approximately half of the isolates belonged to the otherwise uncommon sequence type 677 clonal complex. Isolates of this clonal complex were more resistant than other isolates to human serum.
Melioidosis in Traveler from Africa to Spain
PDF Version [PDF - 481 KB - 4 pages]
M. I. Morosini et al.View Abstract
The worldwide epidemiology of melioidosis is changing. We describe a case of acute melioidosis in Spain in a patient who had traveled to Africa. A novel sequence type of Burkholderia pseudomallei was identified in this patient. Clinicians should be aware of the possibility of melioidosis in travelers returning from melioidosis-nonendemic regions.
Declining Influenza Vaccination Coverage among Nurses, Hong Kong, 2006–2012
PDF Version [PDF - 511 KB - 4 pages]
S. Lee et al.View Abstract
Seasonal influenza vaccination of nurses in Hong Kong fell from 57% in 2005 to 24% in 2012, paralleling concern for adverse reactions associated with vaccination. Decreased acceptance of vaccination was most prominent among nurses who had less work experience and more frequent contact with patients.
Hepatitis E Virus among Persons Who Inject Drugs, San Diego, California, USA, 2009–2010
PDF Version [PDF - 379 KB - 3 pages]
R. Mahajan et al.View Abstract
Data about prevalence of hepatitis E virus infection in persons who inject drugs are limited. Among 18–40-year-old persons who inject drugs in California, USA, prevalence of antibodies against hepatitis E virus was 2.7%. This prevalence was associated with age but not with homelessness, incarceration, or high-risk sexual behavior.
Persistent Human Cosavirus Infection in Lung Transplant Recipient, Italy
PDF Version [PDF - 402 KB - 3 pages]
G. Campanini et al.View Abstract
Human cosavirus is a novel picornavirus recently identified in feces from children in southern Asia. We report infection with human cosavirus in a patient in the Mediterranean area. The patient was an adult double lung transplant recipient who had chronic diarrhea associated with persistent infection with human cosavirus.
New Clonal Strain of Candida auris, Delhi, India
PDF Version [PDF - 727 KB - 4 pages]
A. Chowdhary et al.View Abstract
A new clonal strain of Candida auris is an emerging etiologic agent of fungemia in Delhi, India. In 12 patients in 2 hospitals, it was resistant to fluconazole and genotypically distinct from isolates from South Korea and Japan, as revealed by M13 and amplified fragment length polymorphism typing.
Subclinical Avian Influenza A(H5N1) Virus Infection in Human, Vietnam
PDF Version [PDF - 474 KB - 4 pages]
M. Le et al.View Abstract
Laboratory-confirmed cases of subclinical infection with avian influenza A(H5N1) virus in humans are rare, and the true number of these cases is unknown. We describe the identification of a laboratory-confirmed subclinical case in a woman during an influenza A(H5N1) contact investigation in northern Vietnam.
Human Infections with New Subspecies of Campylobacter fetus
PDF Version [PDF - 367 KB - 3 pages]
M. E. Patrick et al.View Abstract
Campylobacter fetus subsp. testudinum subsp. nov. is a newly proposed subspecies of C. fetus with markers of reptile origin. We summarize epidemiologic information for 9 humans infected with this bacterium. All cases were in men, most of whom were of Asian origin. Infection might have been related to exposure to Asian foods or reptiles.
Chikungunya Fever Outbreak, Bhutan, 2012
PDF Version [PDF - 465 KB - 4 pages]
S. Wangchuk et al.View Abstract
In 2012, chikungunya virus (CHIKV) was reported for the first time in Bhutan. IgM ELISA results were positive for 36/210 patient samples; PCR was positive for 32/81. Phylogenetic analyses confirmed that Bhutan CHIKV belongs to the East/Central/South African genotype. Appropriate responses to future outbreaks require a system of surveillance and improved laboratory capacity.
Safe Pseudovirus-based Assay for Neutralization Antibodies against Influenza A(H7N9) Virus
PDF Version [PDF - 369 KB - 2 pages]
C. Qiu et al.View Abstract
Serologic studies are urgently needed to assist in understanding an outbreak of influenza A(H7N9) virus. However, a biosafety level 3 laboratory is required for conventional serologic assays with live lethal virus. We describe a safe pseudovirus–based neutralization assay with preliminary assessment using subtype H7N9–infected samples and controls.
Think Fungus—Prevention and Control of Fungal Infections
PDF Version [PDF - 744 KB - 2 pages]
M. E. Brandt and B. J. Park
Leptotrichia trevisanii Sepsis after Bone Marrow Transplantation
PDF Version [PDF - 247 KB - 2 pages]
J. M. Schrimsher et al.
Clinical Profile of Children with Norovirus Disease in Rotavirus Vaccine Era
PDF Version [PDF - 287 KB - 3 pages]
M. E. Wikswo et al.
Leprosy in Pregnant Woman, United States
PDF Version [PDF - 251 KB - 2 pages]
A. C. Gimovsky and C. J. Macri
Haemophilus parahaemolyticus Septic Shock after Aspiration Pneumonia, France
PDF Version [PDF - 256 KB - 2 pages]
A. Le Floch et al.
Mycobacterium iranicum Infection in HIV-infected Patient, Iran
PDF Version [PDF - 246 KB - 2 pages]
A. Hashemi-Shahraki et al.
Close Relative of Human Middle East Respiratory Syndrome Coronavirus in Bat, South Africa
PDF Version [PDF - 430 KB - 3 pages]
N. Ithete et al.
Multidrug-Resistant Escherichia coli Bacteremia
PDF Version [PDF - 288 KB - 3 pages]
F. Alhashash et al.
Transmission of Schmallenberg Virus during Winter, Germany
PDF Version [PDF - 293 KB - 3 pages]
K. Wernike et al.
Recurrent Bordetella holmesii Bacteremia and Nasal Carriage in a Patient Receiving Rituximab
PDF Version [PDF - 286 KB - 3 pages]
L. Nguyen et al.
Rickettsia africae in Amblyomma variegatum Ticks, Uganda and Nigeria
PDF Version [PDF - 301 KB - 3 pages]
V. Lorusso et al.
Ongoing Measles Outbreak in Orthodox Jewish Community, London, UK
PDF Version [PDF - 613 KB - 3 pages]
V. Baugh et al.
Human Infection with Eurasian Avian-like Influenza A(H1N1) Virus, China
PDF Version [PDF - 301 KB - 3 pages]
D. Wang et al.
Novel Bat Coronaviruses, Brazil and Mexico
PDF Version [PDF - 315 KB - 3 pages]
L. Góes et al.
Vibrio cholerae O1 El Tor and O139 Bengal Strains Carrying ctxB, Bangladesh
PDF Version [PDF - 434 KB - 3 pages]
S. M. Rashed et al.
About the Cover
- Page created: February 03, 2014
- Page last updated: February 03, 2014
- Page last reviewed: February 03, 2014
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)