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Volume 19, Number 7—July 2013
Volume 19, Number 7—July 2013 PDF Version [PDF - 6.83 MB - 155 pages]
Medscape CME Activity
Transmission of Streptococcus equi Subspecies zooepidemicus Infection from Horses to Humans PDF Version [PDF - 894 KB - 8 pages]S. Pelkonen et al.View SummaryView Abstract
This agent may cause severe illness in humans and should be considered an emerging zoonosis.
Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) is a zoonotic pathogen for persons in contact with horses. In horses, S. zooepidemicus is an opportunistic pathogen, but human infections associated with S. zooepidemicus are often severe. Within 6 months in 2011, 3 unrelated cases of severe, disseminated S. zooepidemicus infection occurred in men working with horses in eastern Finland. To clarify the pathogen’s epidemiology, we describe the clinical features of the infection in 3 patients and compare the S. zooepidemicus isolates from the human cases with S. zooepidemicus isolates from horses. The isolates were analyzed by using pulsed-field gel electrophoresis, multilocus sequence typing, and sequencing of the szP gene. Molecular typing methods showed that human and equine isolates were identical or closely related. These results emphasize that S. zooepidemicus transmitted from horses can lead to severe infections in humans. As leisure and professional equine sports continue to grow, this infection should be recognized as an emerging zoonosis.
Travel-associated Illness Trends and Clusters, 2000–2010
PDF Version [PDF - 1.41 MB - 9 pages]
K. Leder et al.View SummaryView Abstract
Enteric fever, dengue, and rabies are increasing; malaria is decreasing; and malaria, dengue, and enteric fever were detected in clusters.
Longitudinal data examining travel-associated illness patterns are lacking. To address this need and determine trends and clusters in travel-related illness, we examined data for 2000–2010, prospectively collected for 42,223 ill travelers by 18 GeoSentinel sites. The most common destinations from which ill travelers returned were sub-Saharan Africa (26%), Southeast Asia (17%), south-central Asia (15%), and South America (10%). The proportion who traveled for tourism decreased significantly, and the proportion who traveled to visit friends and relatives increased. Among travelers returning from malaria-endemic regions, the proportionate morbidity (PM) for malaria decreased; in contrast, the PM trends for enteric fever and dengue (excluding a 2002 peak) increased. Case clustering was detected for malaria (Africa 2000, 2007), dengue (Thailand 2002, India 2003), and enteric fever (Nepal 2009). This multisite longitudinal analysis highlights the utility of sentinel surveillance of travelers for contributing information on disease activity trends and an evidence base for travel medicine recommendations.
Quantifying Effect of Geographic Location on Epidemiology of Plasmodium vivax Malaria
PDF Version [PDF - 455 KB - 8 pages]
A. A. Lover and R. J. CokerView SummaryView Abstract
Regional variations should be considered in patient care, surveillance, and control programs.
Recent autochthonous transmission of Plasmodium vivax malaria in previously malaria-free temperate regions has generated renewed interest in the epidemiology of this disease. Accurate estimates of the incubation period and time to relapse are required for effective malaria surveillance; however, this information is currently lacking. By using historical data from experimental human infections with diverse P. vivax strains, survival analysis models were used to obtain quantitative estimates of the incubation period and time to first relapse for P. vivax malaria in broad geographic regions. Results show that Eurasian strains from temperate regions have longer incubation periods, and Western Hemisphere strains from tropical and temperate regions have longer times to relapse compared with Eastern Hemisphere strains. The diversity in these estimates of key epidemiologic parameters for P. vivax supports the need for elucidating local epidemiology to inform clinical follow-up and to build an evidence base toward global elimination of malaria.
Mutation in Spike Protein Cleavage Site and Pathogenesis of Feline Coronavirus
PDF Version [PDF - 663 KB - 8 pages]
B. N. Licitra et al.View SummaryView Abstract
Feline Coronavirus spike proteolytic requirement modifications may facilitate development of novel diagnostic and vaccine strategies against human strains.
Feline coronaviruses (FCoV) exist as 2 biotypes: feline enteric coronavirus (FECV) and feline infectious peritonitis virus (FIPV). FECV causes subclinical infections; FIPV causes feline infectious peritonitis (FIP), a systemic and fatal disease. It is thought that mutations in FECV enable infection of macrophages, causing FIP. However, the molecular basis for this biotype switch is unknown. We examined a furin cleavage site in the region between receptor-binding (S1) and fusion (S2) domains of the spike of serotype 1 FCoV. FECV sequences were compared with FIPV sequences. All FECVs had a conserved furin cleavage motif. For FIPV, there was a correlation with the disease and >1 substitution in the S1/S2 motif. Fluorogenic peptide assays confirmed that the substitutions modulate furin cleavage. We document a functionally relevant S1/S2 mutation that arises when FIP develops in a cat. These insights into FIP pathogenesis may be useful in development of diagnostic, prevention, and treatment measures against coronaviruses.
Pneumococcal Serotypes before and after Introduction of Conjugate Vaccines, United States, 1999–2011
PDF Version [PDF - 506 KB - 10 pages]
S. S. Richter et al.View SummaryView Abstract
Monitoring of serotypes causing disease provides insight into pathogenesis and vaccine composition.
Serotyping data for pneumococci causing invasive and noninvasive disease in 2008–2009 and 2010–2011 from >43 US centers were compared with data from preconjugate vaccine (1999–2000) and postconjugate vaccine (2004–2005) periods. Prevalence of 7-valent pneumococcal conjugate vaccine serotypes decreased from 64% of invasive and 50% of noninvasive isolates in 1999–2000 to 3.8% and 4.2%, respectively, in 2010–2011. Increases in serotype 19A stopped after introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. Prevalences of other predominant serotypes included in or related to PCV13 (3, 6C, 7F) also remained similar for 2008–2009 and 2010–2011. The only major serotype that increased from 2008–2009 to 2010–2011 was nonvaccine serotype 35B. These data show that introduction of the 7-valent vaccine has dramatically decreased prevalence of its serotypes and that addition of serotypes in PCV13 could provide coverage of 39% of isolates that continue to cause disease.
Influence of Pneumococcal Vaccines and Respiratory Syncytial Virus on Alveolar Pneumonia, Israel
PDF Version [PDF - 991 KB - 8 pages]
D. M. Weinberger et al.View SummaryView Abstract
Year-to-year fluctuations in RSV bias estimates of vaccine impact in young children in the first few years after vaccine introduction.
Postlicensure surveillance of pneumonia incidence can be used to estimate whether pneumococcal conjugate vaccines (PCVs) affect incidence. We used Poisson regression models that control for baseline seasonality to determine the impact of PCVs and the possible effects of variations in virus activity in Israel on these surveillance estimates. PCV was associated with significant declines in radiologically confirmed alveolar pneumonia (RCAP) among patients <6 months, 6–17 months, and 18–35 months of age (–31% [95% CI –51% to –15%], –41% [95% CI –52 to –32%], and –34% [95% CI –42% to –25%], respectively). Respiratory syncytial virus (RSV) activity was associated with strong increases in RCAP incidence, with up to 44% of cases attributable to RSV among infants <6 months of age and lower but significant impacts in older children. Seasonal variations, particularly in RSV activity, masked the impact of 7-valent PCVs, especially for young children in the first 2 years after vaccine introduction.
Avian Metapneumovirus Subgroup C Infection in Chickens, China
PDF Version [PDF - 302 KB - 3 pages]
L. Wei et al.View Abstract
Avian metapneumovirus causes acute respiratory tract infection and reductions in egg production in various avian species. We isolated and characterized an increasingly prevalent avian metapneumovirus subgroup C strain from meat-type commercial chickens with severe respiratory signs in China. Culling of infected flocks could lead to economic consequences.
Human Alveolar Echinococcosis in Kyrgyzstan
PDF Version [PDF - 329 KB - 3 pages]
J. Usubalieva et al.View Abstract
Human echinococcosis is a reportable disease in Kyrgyzstan. Between 1995 and 2011, human alveolar echinococcosis increased from <3 cases per year to >60 cases per year. The origins of this epidemic, which started in 2004, may be linked to the socioeconomic changes that followed the dissolution of the former Soviet Union.
Molecular Epidemiologic Source Tracking of Orally Transmitted Chagas Disease, Venezuela
PDF Version [PDF - 492 KB - 4 pages]
M. Segovia et al.View Abstract
Oral outbreaks of Chagas disease are increasingly reported in Latin America. The transitory presence of Trypanosoma cruzi parasites within contaminated foods, and the rapid consumption of those foods, precludes precise identification of outbreak origin. We report source attribution for 2 peri-urban oral outbreaks of Chagas disease in Venezuela via high resolution microsatellite typing.
Unique Clone of Coxiella burnetii Causing Severe Q Fever, French Guiana
PDF Version [PDF - 364 KB - 3 pages]
A. Mahamat et al.View Abstract
Acute Q fever is an emergent and severe disease in French Guiana. We obtained 5 Coxiella burnetii isolates from samples of patients from Cayenne and found an epidemic clone circulating in Cayenne. This clone has caused pneumonia and endocarditis and seems to be more virulent than previously described strains.
Babesia microti Infection, Eastern Pennsylvania, USA
PDF Version [PDF - 380 KB - 3 pages]
M. E. Acosta et al.View Abstract
Infection with Babesia microti has not been well-described in eastern Pennsylvania, USA, despite the vector of this organism being prevalent. We report 3 cases of babesiosis in eastern Pennsylvania in persons without recent travel outside the region or history of blood transfusions, suggesting emergence of this infection.
Reemergence of Chikungunya Virus in Bo, Sierra Leone
PDF Version [PDF - 760 KB - 3 pages]
R. Ansumana et al.View Abstract
We diagnosed 400 possible IgM-positive cases of chikungunya virus in Bo, Sierra Leone, during July 2012–January 2013 by using lateral flow immunoassays. Cases detected likely represent only a small fraction of total cases. Further laboratory testing is required to confirm this outbreak and characterize the virus.
Novel Bartonella Agent as Cause of Verruga Peruana
PDF Version [PDF - 513 KB - 4 pages]
D. L. Blazes et al.View Abstract
While studying chronic verruga peruana infections in Peru from 2003, we isolated a novel Bartonella agent, which we propose be named Candidatus Bartonella ancashi. This case reveals the inherent weakness of relying solely on clinical syndromes for diagnosis and underscores the need for a new diagnostic paradigm in developing settings.
Schmallenberg Virus among Female Lambs, Belgium, 2012
PDF Version [PDF - 297 KB - 3 pages]
F. Claine et al.View Abstract
Reemergence of Schmallenberg virus (SBV) occurred among lambs (n = 50) in a sheep flock in Belgium between mid-July and mid-October 2012. Bimonthly assessment by quantitative reverse transcription PCR and seroneutralization demonstrated that 100% of lambs were infected. Viremia duration may be longer in naturally infected than in experimentally infected animals.
Psychrobacter arenosus Bacteremia after Blood Transfusion, France
PDF Version [PDF - 312 KB - 3 pages]
Y. Caspar et al.View Abstract
We report a case of transfusion-associated bacteremia caused by Psychrobacter arenosus. This psychrotolerant bacterium was previously isolated in 2004 from coastal sea ice and sediments in the Sea of Japan, but not from humans. P. arenosus should be considered a psychrotolerant bacterial species that can cause transfusion-transmitted bacterial infections.
Ciprofloxacin-Resistant Campylobacter spp. in Retail Chicken, Western Canada
PDF Version [PDF - 465 KB - 4 pages]
A. Agunos et al.View Abstract
During 2005–2010, the Canadian Integrated Program for Antimicrobial Resistance Surveillance identified increased prevalence of ciprofloxacin (a fluoroquinolone) resistance among Campylobacter isolates from retail chicken in British Columbia (4%–17%) and Saskatchewan (6%–11%), Canada. Fluoroquinolones are critically important to human medicine and are not labeled for use in poultry in Canada.
Asynchronous Onset of Clinical Disease in BSE-Infected Macaques
PDF Version [PDF - 358 KB - 3 pages]
J. Montag et al.View Abstract
To estimate the effect of the variability of prion disease onset on primary bovine spongiform encephalopathy transmission to humans, we studied 6 cynomolgus macaques. The preclinical incubation period was significantly prolonged in 2 animals, implying that onset of variant Creutzfeldt-Jacob disease in humans could be more diverse than previously expected.
Prevalence of Nontuberculous Mycobacteria in Cystic Fibrosis Clinics, United Kingdom, 2009
PDF Version [PDF - 296 KB - 3 pages]
P. Seddon et al.View Abstract
Incidence of pulmonary infection with nontuberculous mycobacteria (NTM) is increasing among persons with cystic fibrosis (CF). We assessed prevalence and management in CF centers in the United Kingdom and found 5.0% of 3,805 adults and 3.3% of 3,317 children had recently been diagnosed with NTM. Of those, 44% of adults and 47% of children received treatment.
Reducing Visceral Leishmaniasis by Insecticide Impregnation of Bed-Nets, Bangladesh
PDF Version [PDF - 411 KB - 4 pages]
D. Mondal et al.View Abstract
The effect of insecticide-treated materials on reducing visceral leishmaniasis (VL) is disputable. In Bangladesh, we evaluated the effect of a community-based intervention with insecticide impregnation of existing bed-nets in reducing VL incidence. This intervention reduced VL by 66.5%. Widespread bed-net impregnation with slow-release insecticide may control VL in Bangladesh.
Genetic Variants of Orientia tsutsugamushi in Domestic Rodents, Northern China
PDF Version [PDF - 345 KB - 3 pages]
M. Zhang et al.View Abstract
We screened Orientia tsutsugamushi from 385 domestic rodents and 19 humans with scrub typhus in rural Tai’an District, Shandong Province, a new scrub typhus epidemic area in northern China. Sequence analysis identified 7 genotypes in the rodents, of which 2 were also identified in the humans.
Undetected Multidrug-Resistant Tuberculosis Amplified by First-line Therapy in Mixed Infection
PDF Version [PDF - 411 KB - 4 pages]
S. M. Hingley-Wilson et al.View Abstract
Infections with >1 Mycobacterium tuberculosis strain(s) are underrecognized. We show, in vitro and in vivo, how first-line treatment conferred a competitive growth advantage to amplify a multidrug-resistant M. tuberculosis strain in a patient with mixed infection. Diagnostic techniques that identify mixed tubercle bacilli populations are needed to curb the spread of multidrug resistance.
Clinical Findings for Early Human Cases of Influenza A(H7N9) Virus Infection, Shanghai, China
PDF Version [PDF - 540 KB - 5 pages]
S. Lu et al.View Abstract
A novel strain of influenza A(H7N9) virus has emerged in China and is causing mild to severe clinical symptoms in infected humans. Some case-patients have died. To further knowledge of this virus, we report the characteristics and clinical histories of 4 early case-patients.
Multidrug-Resistant Atypical Variants of Shigella flexneri in China
PDF Version [PDF - 968 KB - 4 pages]
S. Qiu et al.View Abstract
We identified 3 atypical Shigella flexneri varieties in China, including 92 strains with multidrug resistance, distinct pulse types, and a novel sequence type. Atypical varieties were prevalent mainly in developed regions, and 1 variant has become the dominant Shigella spp. serotype in China. Improved surveillance will help guide the prevention and control of shigellosis.
MDR TB Transmission, Singapore
PDF Version [PDF - 300 KB - 2 pages]
C. Chee et al.
Human Infection with Marten Tapeworm
PDF Version [PDF - 332 KB - 3 pages]
P. Eberwein et al.
Campylobacter jejuni in Hospitalized Patients with Diarrhea, Kolkata, India
PDF Version [PDF - 295 KB - 2 pages]
P. Mukherjee et al.
Verona Integron–encoded Metallo-β-Lactamase 1 in Enterobacteria, Ontario, Canada
PDF Version [PDF - 336 KB - 3 pages]
N. Tijet et al.
Novel Bat-borne Hantavirus, Vietnam
PDF Version [PDF - 330 KB - 3 pages]
S. Arai et al.
Possible Cause of Liver Failure in Patient with Dengue Shock Syndrome
PDF Version [PDF - 276 KB - 3 pages]
A. Khongphatthanayothin et al.
Spotted Fever Group Rickettsiae in Questing Ticks, Central Spain
PDF Version [PDF - 319 KB - 3 pages]
I. G. Fernández de Mera et al.
Neonatal Granulicatella elegans Bacteremia, London, UK
PDF Version [PDF - 267 KB - 2 pages]
L. Quartermain et al.
Bartonella Species in Raccoons and Feral Cats, Georgia, USA
PDF Version [PDF - 288 KB - 2 pages]
J. Hwang and N. L. Gottdenker
Rifampin-Resistant Mycobacterium bovis BCG–Induced Disease in HIV-Infected Infant, Vietnam
PDF Version [PDF - 269 KB - 3 pages]
D. Hong et al.
Bulleidia extructa Periprosthetic Hip Joint Infection, United States
PDF Version [PDF - 262 KB - 2 pages]
B. Kloesel et al.
Tick-borne Encephalitis Virus, Zealand, Denmark, 2011
PDF Version [PDF - 333 KB - 3 pages]
A. Fomsgaard et al.
Usutu Virus in Migratory Song Thrushes, Spain
PDF Version [PDF - 323 KB - 3 pages]
U. Höfle et al.
Rickettsia aeschlimannii Infection in a Man, Greece
PDF Version [PDF - 268 KB - 2 pages]
A. Germanakis et al.
Antibodies against Rift Valley Fever Virus in Cattle, Mozambique
PDF Version [PDF - 270 KB - 3 pages]
N. Lagerqvist et al.
Avian Influenza A(H7N9) Virus Infections, Shanghai, China
PDF Version [PDF - 360 KB - 3 pages]
Z. Mei et al.
Books and Media
About the Cover
Peer Reviewed Report Available Online OnlyInfluence of Humans on Evolution and Mobilization of Environmental Antibiotic ResistomeW. H. Gaze et al.View Abstract
The clinical failure of antimicrobial drugs that were previously effective in controlling infectious disease is a tragedy of increasing magnitude that gravely affects human health. This resistance by pathogens is often the endpoint of an evolutionary process that began billions of years ago in non–disease-causing microorganisms. This environmental resistome, its mobilization, and the conditions that facilitate its entry into human pathogens are at the heart of the current public health crisis in antibiotic resistance. Understanding the origins, evolution, and mechanisms of transfer of resistance elements is vital to our ability to adequately address this public health issue.
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 03, 2013
- Page last updated: July 03, 2013
- Page last reviewed: July 03, 2013
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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