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Volume 20, Number 3—March 2014

Volume 20, Number 3—March 2014   PDF Version [PDF - 10.61 MB - 183 pages]


  • Medscape CME Activity
    Invasive Fungal Infections after Natural Disasters PDF Version [PDF - 539 KB - 7 pages]
    K. Benedict and B. J. Park
    View Summary

    Fungal infections in persons affected by natural disasters are a potentially overlooked public health problem.

       View Abstract

    The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed.

    Length: 1:04


  • High-level Relatedness among Mycobacterium abscessus subsp. massiliense Strains from Widely Separated Outbreaks PDF Version [PDF - 460 KB - 8 pages]
    H. Tettelin et al.
    View Summary

    Identifying M. abscessus to the subspecies level will help delineate clusters with higher transmissibility.

       View Abstract

    Three recently sequenced strains isolated from patients during an outbreak of Mycobacterium abscessus subsp. massiliense infections at a cystic fibrosis center in the United States were compared with 6 strains from an outbreak at a cystic fibrosis center in the United Kingdom and worldwide strains. Strains from the 2 cystic fibrosis outbreaks showed high-level relatedness with each other and major-level relatedness with strains that caused soft tissue infections during an epidemic in Brazil. We identified unique single-nucleotide polymorphisms in cystic fibrosis and soft tissue outbreak strains, separate single-nucleotide polymorphisms only in cystic fibrosis outbreak strains, and unique genomic traits for each subset of isolates. Our findings highlight the necessity of identifying M. abscessus to the subspecies level and screening all cystic fibrosis isolates for relatedness to these outbreak strains. We propose 2 diagnostic strategies that use partial sequencing of rpoB and secA1 genes and a multilocus sequence typing protocol.

    Length: 1:26
  • Comparison of Imported Plasmodium ovale curtisi and P. ovale wallikeri Infections among Patients in Spain, 2005–2011 PDF Version [PDF - 480 KB - 8 pages]
    G. Rojo-Marcos et al.
    View Summary

    P. ovale wallikeri infection caused more severe thrombocytopenia than did P. ovale curtisi infection.

       View Abstract

    Sequencing data from Plasmodium ovale genotypes co-circulating in multiple countries support the hypothesis that P. ovale curtisi and P. ovale wallikeri are 2 separate species. We conducted a multicenter, retrospective, comparative study in Spain of 21 patients who had imported P. ovale curtisi infections and 14 who had imported P. ovale wallikeri infections confirmed by PCR and gene sequencing during June 2005–December 2011. The only significant finding was more severe thrombocytopenia among patients with P. ovale wallikeri infection than among those with P. ovale curtisi infection (p = 0.031). However, we also found nonsignificant trends showing that patients with P. ovale wallikeri infection had shorter time from arrival in Spain to onset of symptoms, lower level of albumin, higher median maximum core temperature, and more markers of hemolysis than did those with P. ovale curtisi infection. Larger, prospective studies are needed to confirm these findings.

    Length: 1:27
  • Medscape CME Activity
    Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis, Thailand, 2004–2008 PDF Version [PDF - 522 KB - 9 pages]
    E. Lam et al.
    View Summary

    In selected areas, test results were rarely used for management of MDR TB.

       View Abstract

    In 2004, routine use of culture and drug-susceptibility testing (DST) was implemented for persons in 5 Thailand provinces with a diagnosis of tuberculosis (TB). To determine if DST results were being used to guide treatment, we conducted a retrospective chart review for patients with rifampin-resistant or multidrug-resistant (MDR) TB during 2004–2008. A total of 208 patients were identified. Median time from clinical sample collection to physician review of DST results was 114 days. Only 5.8% of patients with MDR TB were empirically prescribed an appropriate regimen; an additional 31.3% received an appropriate regimen after DST results were reviewed. Most patients with rifampin -resistant or MDR TB had successful treatment outcomes. Patients with HIV co-infection and patients who were unmarried or had received category II treatment before DST results were reviewed had less successful outcomes. Overall, review of available DST results was delayed, and results were rarely used to improve treatment.

    Length: 1:33
  • Hendra Virus Vaccine, a One Health Approach to Protecting Horse, Human, and Environmental Health PDF Version [PDF - 416 KB - 8 pages]
    D. Middleton et al.
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    This vaccine for horses could also protect veterinarians who treat horses.

       View Abstract

    In recent years, the emergence of several highly pathogenic zoonotic diseases in humans has led to a renewed emphasis on the interconnectedness of human, animal, and environmental health, otherwise known as One Health. For example, Hendra virus (HeV), a zoonotic paramyxovirus, was discovered in 1994, and since then, infections have occurred in 7 humans, each of whom had a strong epidemiologic link to similarly affected horses. As a consequence of these outbreaks, eradication of bat populations was discussed, despite their crucial environmental roles in pollination and reduction of the insect population. We describe the development and evaluation of a vaccine for horses with the potential for breaking the chain of HeV transmission from bats to horses to humans, thereby protecting horse, human, and environmental health. The HeV vaccine for horses is a key example of a One Health approach to the control of human disease.

    Length: 1:13
  • Possible Role of Songbirds and Parakeets in Transmission of Influenza A(H7N9) Virus to Humans PDF Version [PDF - 405 KB - 6 pages]
    J. C. Jones et al.
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    These birds may be intermediate hosts and facilitate transmission and dissemination of subtype H7N9.

       View Abstract

    Avian-origin influenza A(H7N9) recently emerged in China, causing severe human disease. Several subtype H7N9 isolates contain influenza genes previously identified in viruses from finch-like birds. Because wild and domestic songbirds interact with humans and poultry, we investigated the susceptibility and transmissibility of subtype H7N9 in these species. Finches, sparrows, and parakeets supported replication of a human subtype H7N9 isolate, shed high titers through the oropharyngeal route, and showed few disease signs. Virus was shed into water troughs, and several contact animals seroconverted, although they shed little virus. Our study demonstrates that a human isolate can replicate in and be shed by such songbirds and parakeets into their environment. This finding has implications for these birds’ potential as intermediate hosts with the ability to facilitate transmission and dissemination of A(H7N9) virus.

    Length: 1:21
  • Neisseria meningitidis Serogroup W, Burkina Faso, 2012 PDF Version [PDF - 576 KB - 6 pages]
    J. R. MacNeil et al.
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    Reported increases raised questions about whether these cases were a natural increase in disease or the result of serogroup replacement after meningococcal serogroup A conjugate vaccine introduction.

       View Abstract

    In 2010, Burkina Faso became the first country to introduce meningococcal serogroup A conjugate vaccine (PsA-TT). During 2012, Burkina Faso reported increases in Neisseria meningitidis serogroup W, raising questions about whether these cases were a natural increase in disease or resulted from serogroup replacement after PsA-TT introduction. We analyzed national surveillance data to describe the epidemiology of serogroup W and genotyped 61 serogroup W isolates. In 2012, a total of 5,807 meningitis cases were reported through enhanced surveillance, of which 2,353 (41%) were laboratory confirmed. The predominant organism identified was N. meningitidis serogroup W (62%), and all serogroup W isolates characterized belonged to clonal complex 11. Although additional years of data are needed before we can understand the epidemiology of serogroup W after PsA–TT introduction, these data suggest that serogroup W will remain a major cause of sporadic disease and has epidemic potential, underscoring the need to maintain high-quality case-based meningitis surveillance after PsA–TT introduction.

    Length: 1:40
  • Monitoring Water Sources for Environmental Reservoirs of Toxigenic Vibrio cholerae O1, Haiti PDF Version [PDF - 620 KB - 8 pages]
    M. T. Alam et al.
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    The presence of toxigenic V. cholerae O1 in environmental reservoirs are confirmed in Haiti

       View Abstract

    An epidemic of cholera infections was documented in Haiti for the first time in more than 100 years during October 2010. Cases have continued to occur, raising the question of whether the microorganism has established environmental reservoirs in Haiti. We monitored 14 environmental sites near the towns of Gressier and Leogane during April 2012–March 2013. Toxigenic Vibrio cholerae O1 El Tor biotype strains were isolated from 3 (1.7%) of 179 water samples; nontoxigenic O1 V. cholerae was isolated from an additional 3 samples. All samples containing V. cholerae O1 also contained non-O1 V. cholerae. V. cholerae O1 was isolated only when water temperatures were ≥31°C. Our data substantiate the presence of toxigenic V. cholerae O1 in the aquatic environment in Haiti. These isolations may reflect establishment of long-term environmental reservoirs in Haiti, which may complicate eradication of cholera from this coastal country.

    Length: 1:33
  • Hantavirus Infections among Overnight Visitors to Yosemite National Park, California, USA, 2012 PDF Version [PDF - 516 KB - 8 pages]
    J. J. Núñez et al.
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    A rare hantavirus outbreak reaffirms the need for control of deer mice and public awareness of the risks posed by contact with them.

       View Abstract

    In summer 2012, an outbreak of hantavirus infections occurred among overnight visitors to Yosemite National Park in California, USA. An investigation encompassing clinical, epidemiologic, laboratory, and environmental factors identified 10 cases among residents of 3 states. Eight case-patients experienced hantavirus pulmonary syndrome, of whom 5 required intensive care with ventilatory support and 3 died. Staying overnight in a signature tent cabin (9 case-patients) was significantly associated with becoming infected with hantavirus (p<0.001). Rodent nests and tunnels were observed in the foam insulation of the cabin walls. Rodent trapping in the implicated area resulted in high trap success rate (51%), and antibodies reactive to Sin Nombre virus were detected in 10 (14%) of 73 captured deer mice. All signature tent cabins were closed and subsequently dismantled. Continuous public awareness and rodent control and exclusion are key measures in minimizing the risk for hantavirus infection in areas inhabited by deer mice.

    Length: 1:31
  • Coxiella burnetii Seroprevalence and Risk for Humans on Dairy Cattle Farms, the Netherlands, 2010–2011 PDF Version [PDF - 445 KB - 9 pages]
    B. Schimmer et al.
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    Transmission to humans can be reduced by using protective clothing and eliminating birds and vermin from stables.

       View Abstract

    Q fever, caused by Coxiella burnetii, is a recognized occupational infection in persons who have regular contact with ruminants. We determined C. burnetii seroprevalence in residents living or working on dairy cattle farms with >50 adult cows and identified risk factors for seropositivity. Serum samples from farm residents, including employees, were tested for C. burnetii IgG and IgM; seroprevalence was 72.1% overall and 87.2%, 54.5%, and 44.2% among farmers, spouses, and children, respectively. Risk factors included farm location in southern region, larger herd size, farm employment, birds in stable, contact with pigs, and indirect contact with rats or mice. Protective factors included automatic milking of cows and fully compliant use of gloves during and around calving. We recommend strengthening general biosecurity measures, such as consistent use of personal protective equipment (e.g., boots, clothing, gloves) by farm staff and avoidance of birds and vermin in stables.

    Length: 1:34
  • Minimal Diversity of Drug-Resistant Mycobacterium tuberculosis Strains, South Africa PDF Version [PDF - 455 KB - 8 pages]
    N. R. Gandhi et al.
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    Although diverse strains are present in South Africa, only a few strains cause most drug-resistant TB.

       View Abstract

    Multidrug- (MDR) and extensively drug-resistant tuberculosis (XDR TB) are commonly associated with Beijing strains. However, in KwaZulu-Natal, South Africa, which has among the highest incidence and mortality for MDR and XDR TB, data suggest that non-Beijing strains are driving the epidemic. We conducted a retrospective study to characterize the strain prevalence among drug-susceptible, MDR, and XDR TB cases and determine associations between strain type and survival. Among 297 isolates from 2005–2006, 49 spoligotype patterns were found. Predominant strains were Beijing (ST1) among drug-susceptible isolates (27%), S/Quebec (ST34) in MDR TB (34%) and LAM4/KZN (ST60) in XDR TB (89%). More than 90% of patients were HIV co-infected. MDR TB and XDR TB were independently associated with mortality, but TB strain type was not. We conclude that, although Beijing strain was common among drug-susceptible TB, other strains predominated among MDR TB and XDR TB cases. Drug-resistance was a stronger predictor of survival than strain type.

    Length: 1:50

Historical Review

  • Drought and Epidemic Typhus, Central Mexico, 1655–1918 PDF Version [PDF - 606 KB - 6 pages]
    J. N. Burns et al.
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    Climate data suggest that drought was a factor in several major typhus epidemics.

       View Abstract

    Epidemic typhus is an infectious disease caused by the bacterium Rickettsia prowazekii and transmitted by body lice (Pediculus humanus corporis). This disease occurs where conditions are crowded and unsanitary. This disease accompanied war, famine, and poverty for centuries. Historical and proxy climate data indicate that drought was a major factor in the development of typhus epidemics in Mexico during 1655–1918. Evidence was found for 22 large typhus epidemics in central Mexico, and tree-ring chronologies were used to reconstruct moisture levels over central Mexico for the past 500 years. Below-average tree growth, reconstructed drought, and low crop yields occurred during 19 of these 22 typhus epidemics. Historical documents describe how drought created large numbers of environmental refugees that fled the famine-stricken countryside for food relief in towns. These refugees often ended up in improvised shelters in which crowding encouraged conditions necessary for spread of typhus.

Policy Review

  • Surveillance for Antimicrobial Drug Resistance in Under-Resourced Countries PDF Version [PDF - 469 KB - 8 pages]
    G. Vernet et al.
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    New programs can be improved by drawing on lessons from previous successful efforts.

       View Abstract

    Antimicrobial drug resistance is usually not monitored in under-resourced countries because they lack surveillance networks, laboratory capacity, and appropriate diagnostics. This accelerating problem accounts for substantial number of excess deaths, especially among infants. Infections particularly affected by antimicrobial drug resistance include tuberculosis, malaria, severe acute respiratory infections, and sepsis caused by gram-negative bacteria. Nonetheless, mapping antimicrobial drug resistance is feasible in under-resourced countries, and lessons can be learned from previous successful efforts. Specimen shipping conditions, data standardization, absence of contamination, and adequate diagnostics must be ensured. As a first step toward solving this problem, we propose that a road map be created at the international level to strengthen antimicrobial resistance surveillance in under-resourced countries. This effort should include a research agenda; a map of existing networks and recommendations to unite them; and a communication plan for national, regional, and international organizations and funding agencies.

    Length: 1:26



Books and Media

In Memoriam

About the Cover