Volume 19, Number 5—May 2013
Volume 19, Number 5—May 2013 PDF Version [PDF - 7.91 MB - 156 pages]
Medscape CME Activity
Transmission of Mycobacterium tuberculosis Beijing Strains, Alberta, Canada, 1991–2007D. Langlois-Klassen et al.View SummaryView Abstract
Transmission of Beijing strains posed no more of a public health threat than did non-Beijing strains.
Beijing strains are speculated to have a selective advantage over other Mycobacterium tuberculosis strains because of increased transmissibility and virulence. In Alberta, a province of Canada that receives a large number of immigrants, we conducted a population-based study to determine whether Beijing strains were associated with increased transmission leading to disease compared with non-Beijing strains. Beijing strains accounted for 258 (19%) of 1,379 pulmonary tuberculosis cases in 1991–2007; overall, 21% of Beijing cases and 37% of non-Beijing cases were associated with transmission clusters. Beijing index cases had significantly fewer secondary cases within 2 years than did non-Beijing cases, but this difference disappeared after adjustment for demographic characteristics, infectiousness, and M. tuberculosis lineage. In a province that has effective tuberculosis control, transmission of Beijing strains posed no more of a public health threat than did non-Beijing strains.
Foodborne Transmission of Bovine Spongiform Encephalopathy to Nonhuman Primates
PDF Version [PDF - 2.71 MB - 9 pages]
E. Holznagel et al.View SummaryView Abstract
A single oral dose infected all macaques, and multiple doses prolonged incubation times.
Risk for human exposure to bovine spongiform encephalopathy (BSE)–inducing agent was estimated in a nonhuman primate model. To determine attack rates, incubation times, and molecular signatures, we orally exposed 18 macaques to 1 high dose of brain material from cattle with BSE. Several macaques were euthanized at regular intervals starting at 1 year postinoculation, and others were observed until clinical signs developed. Among those who received ≥5 g BSE-inducing agent, attack rates were 100% and prions could be detected in peripheral tissues from 1 year postinoculation onward. The overall median incubation time was 4.6 years (3.7–5.3). However, for 3 macaques orally exposed on multiple occasions, incubation periods were at least 7–10 years. Before clinical signs were noted, we detected a non-type 2B signature, indicating the existence of atypical prion protein during the incubation period. This finding could affect diagnosis of variant Creutzfeldt-Jakob disease in humans and might be relevant for retrospective studies of positive tonsillectomy or appendectomy specimens because time of infection is unknown.
Populations at Risk for Alveolar Echinococcosis, France
PDF Version [PDF - 2.89 MB - 8 pages]
M. Piarroux et al.View Abstract
During 1982–2007, alveolar echinococcosis (AE) was diagnosed in 407 patients in France, a country previously known to register half of all European patients. To better define high-risk groups in France, we conducted a national registry-based study to identify areas where persons were at risk and spatial clusters of cases. We interviewed 180 AE patients about their way of life and compared responses to those of 517 controls. We found that almost all AE patients lived in 22 départements in eastern and central France (relative risk 78.63, 95% CI 52.84–117.02). Classification and regression tree analysis showed that the main risk factor was living in AE-endemic areas. There, most at-risk populations lived in rural settings (odds ratio [OR] 66.67, 95% CI 6.21–464.51 for farmers and OR 6.98, 95% CI 2.88–18.25 for other persons) or gardened in nonrural settings (OR 4.30, 95% CI 1.82–10.91). These findings can help sensitization campaigns focus on specific groups.
World Health Organization International Standard to Harmonize Assays for Detection of Hepatitis E Virus RNA
PDF Version [PDF - 939 KB - 7 pages]
S. A. Baylis et al.View Abstract
Nucleic acid amplification technique–based assays are a primary method for the detection of acute hepatitis E virus (HEV) infection, but assay sensitivity can vary widely. To improve interlaboratory results for the detection and quantification of HEV RNA, a candidate World Health Organization (WHO) International Standard (IS) strain was evaluated in a collaborative study involving 23 laboratories from 10 countries. The IS, code number 6329/10, was formulated by using a genotype 3a HEV strain from a blood donation, diluted in pooled human plasma and lyophilized. A Japanese national standard, representing a genotype 3b HEV strain, was prepared and evaluated in parallel. The potencies of the standards were determined by qualitative and quantitative assays. Assay variability was substantially reduced when HEV RNA concentrations were expressed relative to the IS. Thus, WHO has established 6329/10 as the IS for HEV RNA, with a unitage of 250,000 International Units per milliliter.
Full-Genome Deep Sequencing and Phylogenetic Analysis of Novel Human Betacoronavirus
PDF Version [PDF - 1.06 MB - 9 pages]
M. Cotten et al.View Abstract
A novel betacoronavirus associated with lethal respiratory and renal complications was recently identified in patients from several countries in the Middle East. We report the deep genome sequencing of the virus directly from a patient’s sputum sample. Our high-throughput sequencing yielded a substantial depth of genome sequence assembly and showed the minority viral variants in the specimen. Detailed phylogenetic analysis of the virus genome (England/Qatar/2012) revealed its close relationship to European bat coronaviruses circulating among the bat species of the Vespertilionidae family. Molecular clock analysis showed that the 2 human infections of this betacoronavirus in June 2012 (EMC/2012) and September 2012 (England/Qatar/2012) share a common virus ancestor most likely considerably before early 2012, suggesting the human diversity is the result of multiple zoonotic events.
Targeting Surveillance for Zoonotic Virus Discovery
PDF Version [PDF - 5.30 MB - 5 pages]
J. Levinson et al.View Abstract
We analyzed a database of mammal–virus associations to ask whether surveillance targeting diseased animals is the best strategy to identify potentially zoonotic pathogens. Although a mixed healthy and diseased animal surveillance strategy is generally best, surveillance of apparently healthy animals would likely maximize zoonotic virus discovery potential for bats and rodents.
Changes in Severity of Influenza A(H1N1)pdm09 Infection from Pandemic to First Postpandemic Season, Germany
PDF Version [PDF - 723 KB - 8 pages]
N. Lehners et al.View Abstract
We studied risk factors for a severe clinical outcome in hospitalized patients with laboratory-confirmed influenza A(H1N1)pdm09 infection at the University Hospital Heidelberg in the pandemic and first postpandemic seasons. We identified 102 patients in 2009–10 and 76 in 2010–11. The proportion of severely diseased patients dramatically increased from 14% in 2009–10 to 46% in 2010–11 as did the mortality rate (5%–12%). Patients in the first postpandemic season were significantly older (38 vs. 18 years) and more frequently had underlying medical conditions (75% vs. 51%). Overall, 50 patients (28%) had a severe clinical outcome, resulting in 14 deaths. Multivariate analysis showed that older male patients with chronic lung disease were at increased risk for a severe clinical outcome. In summary, the proportion of patients with severe disease and fatal cases increased in the postpandemic season. Therefore, patients with suspected infections should be promptly identified and receive early treatment.
Severe Fever with Thrombocytopenia Syndrome Virus among Domesticated Animals, China
PDF Version [PDF - 1.93 MB - 8 pages]
G. Niu et al.View SummaryView Abstract
Domesticated animals may play a role in the transmission cycles of this novel bunyavirus.
To investigate the infections of severe fever with thrombocytopenia syndrome virus (SFTSV) in domesticated animals, we sampled a total of 3,039 animals in 2 counties in Shandong Province, People’s Republic of China, from April to November 2011. SFTSV-specific antibodies were detected in 328 (69.5%) of 472 sheep, 509 (60.5%) of 842 cattle, 136 (37.9%) of 359 dogs, 26 (3.1%) of 839 pigs, and 250 (47.4%) of 527 chickens. SFTSV RNA was detected in all sampled animal species, but the prevalence was low, ranging from 1.7% to 5.3%. A cohort study in 38 sheep was conducted to determine when seroconversion to SFTSV occured. SFTSVs were isolated from sheep, cattle, and dogs and shared >95% sequence homology with human isolates from the same disease-endemic regions. These findings demonstrate that natural infections of SFTSV occur in several domesticated animal hosts in disease-endemic areas and that the virus has a wide host range.
Campylobacter coli Outbreak in Men Who Have Sex with Men, Quebec, Canada, 2010–2011
PDF Version [PDF - 1.29 MB - 4 pages]
C. Gaudreau et al.View Abstract
During September 2010–November 2011, a cluster of erythromycin-susceptible, tetracycline- and ciprofloxacin-resistant Campylobacter coli pulsovar 1 infections was documented, involving 10 case-patients, in Montreal, Quebec, Canada. The findings suggested sexual transmission of an enteric infection among men who have sex with men.
Delayed Diagnosis of Chronic Q Fever and Cardiac Valve Surgery
PDF Version [PDF - 755 KB - 3 pages]
L. M. Kampschreur et al.View Abstract
Untreated chronic Q fever causes a high number of complications and deaths. We present cases of chronic Q fever that were not diagnosed until after the patients underwent cardiac valve surgery. In epidemic areas, Q fever screening of valve surgery patients secures early initiation of treatment and can prevent illness and death.
Treatment of Tularemia in Patient with Chronic Graft-versus-Host Disease
PDF Version [PDF - 2.59 MB - 3 pages]
J. Weile et al.View Abstract
We describe a case of human tularemia caused by Francisella tularensis subsp. holarctica in a stem cell transplant recipient with chronic graft-versus-host disease who was receiving levofloxacin prophylaxis. The infection was characterized by pneumonia with septic complications. The patient was successfully treated with doxycycline.
Scrub Typhus Outbreak, Northern Thailand, 2006–2007
PDF Version [PDF - 1.97 MB - 4 pages]
W. Rodkvamtook et al.View Abstract
During a scrub typhus outbreak investigation in Thailand, 4 isolates of O. tsutsugamushi were obtained and established in culture. Phylogenetic analysis based on the 56-kDa type-specific antigen gene demonstrated that the isolates fell into 4 genetic clusters, 3 of which had been previously reported and 1 that represents a new genotype.
Detecting Rickettsia parkeri Infection from Eschar Swab Specimens
PDF Version [PDF - 1.18 MB - 3 pages]
T. Myers et al.View Abstract
The typical clinical presentation of several spotted fever group Rickettsia infections includes eschars. Clinical diagnosis of the condition is usually made by analysis of blood samples. We describe a more sensitive, noninvasive means of obtaining a sample for diagnosis by using an eschar swab specimen from patients infected with Rickettsia parkeri.
Contaminated Ventilator Air Flow Sensor Linked to Bacillus cereus Colonization of Newborns
PDF Version [PDF - 760 KB - 3 pages]
G. Turabelidze et al.View Abstract
We investigated Bacillus cereus–positive tracheal aspirates from infants on ventilators in a neonatal intensive care unit. Multilocus sequence typing determined a genetic match between strains isolated from samples from a case-patient and from the air flow sensor in the ventilator. Changing the sterilization method for sensors to steam autoclaving stopped transmission.
Mapping Environmental Suitability for Malaria Transmission, Greece
PDF Version [PDF - 1.20 MB - 3 pages]
B. Sudre et al.View Abstract
During 2009–2012, Greece experienced a resurgence of domestic malaria transmission. To help guide malaria response efforts, we used spatial modeling to characterize environmental signatures of areas suitable for transmission. Nonlinear discriminant analysis indicated that sea-level altitude and land-surface temperature parameters are predictive in this regard.
Implications of Dengue Outbreaks for Blood Supply, Australia
PDF Version [PDF - 356 KB - 3 pages]
H. M. Faddy et al.View Abstract
Dengue outbreaks have increased in size and frequency in Australia, and transfusion-transmitted dengue poses a risk to transfusion safety. Using whole blood samples collected during the large 2008–2009 dengue epidemic, we estimated the risk for a dengue-infectious blood donation as ≈1 in 7,146 (range 2,218–50,021).
Novel Molecular Type of Clostridium difficile in Neonatal Pigs, Western Australia
PDF Version [PDF - 589 KB - 3 pages]
M. M. Squire et al.View Abstract
Clostridium difficile causes neonatal enteritis in piglets; strains of PCR ribotype 078 are most commonly identified. We investigated C. difficile prevalence in piglets in Australia and isolated a novel strain with a unique pathogenicity locus. In a mouse infection model, this strain produced more weight loss than did a ribotype 078 strain.
Novel Lyssavirus in Bat, Spain
PDF Version [PDF - 578 KB - 3 pages]
N. Ceballos et al.View Abstract
A new tentative lyssavirus, Lleida bat lyssavirus, was found in a bent-winged bat (Miniopterus schreibersii) in Spain. It does not belong to phylogroups I or II, and it seems to be more closely related to the West Causasian bat virus, and especially to the Ikoma lyssavirus.
Borrelia recurrentis in Head Lice, Ethiopia
PDF Version [PDF - 1.10 MB - 3 pages]
A. Boutellis et al.View Abstract
Since the 1800s, the only known vector of Borrelia recurrentis has been the body louse. In 2011, we found B. recurrentis DNA in 23% of head lice from patients with louse-borne relapsing fever in Ethiopia. Whether head lice can transmit these bacteria from one person to another remains to be determined.
Tuberculosis Exposure among Evacuees at a Shelter after Earthquake, Japan, 2011
PDF Version [PDF - 478 KB - 3 pages]
H. Kanamori et al.View Abstract
Tuberculosis was diagnosed in a person who had stayed in a shelter after the 2011 Great East Japan Earthquake. A contact investigation showed that the prevalence of latent tuberculosis infection among other evacuees at the shelter was 20%. Our report underscores the importance of tuberculosis prevention and control after natural disasters.
Genetic Analysis of Primaquine Tolerance in a Patient with Relapsing Vivax Malaria
PDF Version [PDF - 2.06 MB - 4 pages]
A. Bright et al.View Abstract
Patients with Plasmodium vivax malaria are treated with primaquine to prevent relapse infections. We report primaquine failure in a patient with 3 relapses without any possibility of re-infection. Using whole genome sequencing of the relapsing parasite isolates, we identified single nucleotide variants as candidate molecular markers of resistance.
Tick-borne Encephalitis Associated with Consumption of Raw Goat Milk, Slovenia, 2012
PDF Version [PDF - 1.01 MB - 3 pages]
N. Hudopisk et al.View Abstract
Tick-borne encephalitis (TBE) developed in 3 persons in Slovenia who drank raw milk; a fourth person, who had been vaccinated against TBE, remained healthy. TBE virus RNA was detected in serum and milk of the source goat. Persons in TBE-endemic areas should be encouraged to drink only boiled/pasteurized milk and to be vaccinated.
Zombies—A Pop Culture Resource for Public Health Awareness
PDF Version [PDF - 424 KB - 5 pages]
M. Nasiruddin et al.View Abstract
Sitting at his laboratory bench, a scientist adds mutation after mutation to a strand of rabies virus RNA, unaware that in a few short days, an outbreak of this very mutation would destroy society as we know it. It could be called “Zombie Rabies,” a moniker befitting of the next Hollywood blockbuster—or, in this case, a representation of the debate over whether a zombie apocalypse, manufactured by genetically modifying one or more diseases like rabies, could be more than just fiction. Fear of the unknown has long been a psychological driving force for curiosity, and the concept of a zombie apocalypse has become popular in modern society. This article explores the utility of zombies to capitalize on the benefits of spreading public health awareness through the use of relatable popular culture tools and scientific explanations for fictional phenomena.
Plasmodium falciparum with Multidrug Resistance 1 Gene Duplications, Senegal
PDF Version [PDF - 290 KB - 2 pages]
A. Pascual et al.
Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease
PDF Version [PDF - 789 KB - 3 pages]
S. E. Schutzer et al.
Brucellosis in Guangdong Province, People’s Republic of China, 2005–2010
PDF Version [PDF - 353 KB - 2 pages]
J. Chen et al.
Cutaneous Mycobacterium shigaense Infection in Immunocompetent Woman, China
PDF Version [PDF - 1.30 MB - 2 pages]
P. Cui et al.
Infectious Disease Surveillance by Medical Examiners and Coroners
PDF Version [PDF - 288 KB - 2 pages]
D. M. Blau et al.
Multidrug-Resistant Acinetobacter baumannii Clone, France
PDF Version [PDF - 428 KB - 2 pages]
R. A. Bonnin et al.
Genomic Analysis of Salmonella enterica Serovar Typhimurium Definitive Phage Type 104
PDF Version [PDF - 455 KB - 3 pages]
H. Izumiya et al.
Single Genotype of Anaplasma phagocytophilum Identified from Ticks, Camargue, France
PDF Version [PDF - 649 KB - 3 pages]
A. Chastagner et al.
West Nile Virus Lineage 2 Strain in Greece, 2012
PDF Version [PDF - 413 KB - 3 pages]
S. C. Chaintoutis et al.
Reindeer Warble Fly–associated Human Myiasis, Scandinavia
PDF Version [PDF - 345 KB - 3 pages]
B. Kan et al.
Azole-Resistant Aspergillus fumigatus, Iran
PDF Version [PDF - 337 KB - 3 pages]
S. Seyedmousavi et al.
Search for Possible Additional Reservoirs for Human Q Fever, the Netherlands
PDF Version [PDF - 442 KB - 2 pages]
H. Roest et al.
Scalp Eschar and Neck Lymphadenopathy Caused by Rickettsia massiliae
PDF Version [PDF - 573 KB - 2 pages]
A. Cascio et al.
Mycobacterium tuberculosis Complex in Remains of 18th–19th Century Slaves, Brazil
PDF Version [PDF - 348 KB - 3 pages]
L. H. Jaeger et al.
Treatment of Listeriosis in First Trimester of Pregnancy
PDF Version [PDF - 358 KB - 3 pages]
B. T. Chan et al.
In Memoriam: Alexander I. Klimov (1943–2013)
PDF Version [PDF - 470 KB - 1 page]
In Memoriam: Susumu Hotta (1918–2011)
PDF Version [PDF - 700 KB - 2 pages]
E. Konishi and G. Kuno
About the Cover
- Page created: May 06, 2013
- Page last updated: May 06, 2013
- Page last reviewed: May 06, 2013
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)