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Volume 4, Number 4—December 1998

Volume 4, Number 4—December 1998   PDF Version [PDF - 10.56 MB - 186 pages]


  • International Editors: Emerging Infectious Diseases—South Africa PDF Version [PDF - 114 KB - 4 pages]
    K. P. Klugman
  • Quasispecies Structure and Persistence of RNA Viruses PDF Version [PDF - 78 KB - 7 pages]
    E. Domingo et al.
       View Abstract

    Viral quasispecies are closely related (but nonidentical) mutant and recombinant viral genomes subjected to continuous genetic variation, competition, and selection. Quasispecies structure and dynamics of replicating RNA enable virus populations to persist in their hosts and cause disease. We review mechanisms of viral persistence in cells, organisms, and populations of organisms and suggest that the critical interplay between host and viral influences (including in some cases the quasispecies organization) is the main driving force for long-term survival of viruses in nature.

  • Ecologic Studies of Rodent Reservoirs: Their Relevance for Human Health PDF Version [PDF - 139 KB - 9 pages]
    J. N. Mills and J. E. Childs
       View Abstract

    Within the past few years, the number of "new" human diseases associated with small-mammal reservoirs has increased dramatically, stimulating renewed interest in reservoir ecology research. A consistent, integrative approach to such research allows direct comparisons between studies, contributes to the efficient use of resources and data, and increases investigator safety. We outline steps directed toward understanding vertebrate host ecology as it relates to human disease and illustrate the relevance of each step by using examples from studies of hosts associated with rodent-borne hemorrhagic fever viruses.

  • Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease PDF Version [PDF - 117 KB - 12 pages]
    C. R. Vitek and M. Wharton
       View Abstract

    The massive reemergence of diphtheria in the Newly Independent States of the former Soviet Union marked the first large-scale diphtheria epidemic in industrialized countries in 3 decades. Factors contributing to the epidemic included a large population of susceptible adults; decreased childhood immunization, which compromised what had been a well-established childhood vaccination program; suboptimal socioeconomic conditions; and high population movement. The role of a change in the predominant circulating strains of Corynebacterium diphtheriae in this epidemic remains uncertain. Massive, well-coordinated international assistance and unprecedented efforts to vaccinate adults were needed to control the epidemic.


  • Cell-to-Cell Signaling and Pseudomonas aeruginosa Infections PDF Version [PDF - 174 KB - 10 pages]
    C. Van Delden and B. H. Iglewski
       View Abstract

    Pseudomonas aeruginosa is a bacterium responsible for severe nosocomial infections, life-threatening infections in immunocompromised persons, and chronic infections in cystic fibrosis patients. The bacterium's virulence depends on a large number of cell-associated and extracellular factors. Cell-to-cell signaling systems control the expression and allow a coordinated, cell-density–dependent production of many extracellular virulence factors. We discuss the possible role of cell-to-cell signaling in the pathogenesis of P. aeruginosa infections and present a rationale for targeting cell-to-cell signaling systems in the development of new therapeutic approaches.

  • Rotavirus PDF Version [PDF - 356 KB - 10 pages]
    U. D. Parashar et al.
       View Abstract

    Rotavirus, the most common diarrheal pathogen in children worldwide, causes approximately one third of diarrhea-associated hospitalizations and 800,000 deaths per year. Because natural infection reduces the incidence and severity of subsequent episodes, rotavirus diarrhea might be controlled through vaccination. Serotype-specific immunity may play a role in protection from disease. Tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) (which contains a rhesus rotavirus with serotype G3 specificity and reassortant rhesus-human rotaviruses with G1, G2, and G4 specificity) provides coverage against the four common serotypes of human rotavirus. In clinical trials in industrialized countries, RRV-TV conferred 49% to 68% protection against any rotavirus diarrhea and 61% to 100% protection against severe disease. This vaccine was licensed by the U.S. Food and Drug Administration on August 31, 1998, and should be cost-effective in reducing diarrheal diseases in industrialized countries. The vaccine's efficacy and cost-effectiveness in developing countries should be evaluated.

  • Chlamydia pneumoniae and Cardiovascular Disease PDF Version [PDF - 130 KB - 9 pages]
    L. A. Campbell et al.
       View Abstract

    Chlamydia pneumoniae is a ubiquitous pathogen that causes acute respiratory disease. The spectrum of C. pneumoniae infection has been extended to atherosclerosis and its clinical manifestations. Seroepidemiologic studies have associated C. pneumoniae antibody with coronary artery disease, myocardial infarction, carotid artery disease, and cerebrovascular disease. The association of C. pneumoniae with atherosclerosis is corroborated by the presence of the organism in atherosclerotic lesions throughout the arterial tree and the near absence of the organism in healthy arterial tissue. C. pneumoniae has also been isolated from coronary and carotid atheromatous plaques. To determine whether chronic infection plays a role in initiation or progression of disease, intervention studies in humans have been initiated, and animal models of C. pneumoniae infection have been developed. This review summarizes the evidence for the association and potential role of C. pneumoniae in cardiovascular disease.

  • Bacterial Symbiosis in Arthropods and the Control of Disease Transmission PDF Version [PDF - 197 KB - 12 pages]
    C. B. Beard et al.
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    Bacterial symbionts may be used as vehicles for expressing foreign genes in arthropods. Expression of selected genes can render an arthropod incapable of transmitting a second microorganism that is pathogenic for humans and is an alternative approach to the control of arthropod-borne diseases. We discuss the rationale for this alternative approach, its potential applications and limitations, and the regulatory concerns that may arise from its use in interrupting disease transmission in humans and animals.

  • Genetic Epidemiology of Infectious Diseases in Humans: Design of Population- Based Studies PDF Version [PDF - 106 KB - 11 pages]
    L. Abel and A. J. Dessein
       View Abstract

    The spread and clinical manifestations of an infection in human populations depend on a variety of factors, among them host genetics. Familial linkage studies used in genetic epidemiology to identify host genes test for nonrandom segregation of a trait with a few candidate chromosomal regions or any regions in the genome (genomewide search). When a clear major gene model can be inferred and reliable epidemiologic information is collected (e.g., in schistosomiasis), parametric linkage studies are used. When the genetic model cannot be defined (e.g., in leprosy and malaria), nonparametric linkage studies (e.g., sibling-pair studies) are recommended. Once evidence of linkage is obtained, the gene can be identified by polymorphisms strongly associated with the trait. When the tested polymorphism is in strong linkage disequilibrium with the disease allele or is the disease allele itself (e.g., in HIV infection and malaria), association studies can directly identify the disease gene. Finally, the role of the detected polymorphism in causing the trait is validated by functional studies.

  • Insecticide Resistance and Vector Control PDF Version [PDF - 134 KB - 9 pages]
    W. G. Brogdon and J. C. McAllister
       View Abstract

    Insecticide resistance has been a problem in all insect groups that serve as vectors of emerging diseases. Although mechanisms by which insecticides become less effective are similar across all vector taxa, each resistance problem is potentially unique and may involve a complex pattern of resistance foci. The main defense against resistance is close surveillance of the susceptibility of vector populations. We describe the mechanisms of insecticide resistance, as well as specific instances of resistance emergence worldwide, and discuss prospects for resistance management and priorities for detection and surveillance.


  • Mutators and Long-Term Molecular Evolution of Pathogenic Escherichia coli O157:H7 PDF Version [PDF - 56 KB - 3 pages]
    T. S. Whittam et al.
       View Abstract

    It has been proposed that an increased mutation rate (indicated by the frequency of hypermutable isolates) has facilitated the emergence of Escherichia coli O157:H7. Analysis of the divergence of 12 genes shows no evidence that the pathogen has undergone an unusually high rate of mutation and molecular evolution.

  • Increasing Hospitalization and Death Possibly Due to Clostridium difficile Diarrheal Disease PDF Version [PDF - 88 KB - 7 pages]
    F. Frost et al.
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    This study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and ill-defined enteric pathogens. Infant and young child hospitalization (but not death) rates in each category increased more than 50% during 1990 to 1994. Age-adjusted death and hospitalization rates due to enteric bacterial infections and hospitalizations due to enteric viral infections have increased since 1988. The increases in hospitalization and death rates from enteric bacterial infections were due to a more than eightfold increase in rates for specified enteric bacterial infections that were uncoded during this period (ICD9 00849). To identify bacterial agents responsible for most of these infections, hospital discharges and outpatient claims (coded with more detail after 1992) were examined for New Mexico's Lovelace Health Systems for 1993 to 1996. Of diseases due to uncoded enteric pathogens, 73% were due to Clostridium difficile infection. Also, 88% of Washington State death certificates (1985 to 1996) coded to unspecified enteric pathogen infections (ICD0084) listed C. difficile infection.

  • Introduction of Aedes albopictus into a La Crosse Virus—Enzootic Site in Illinois PDF Version [PDF - 121 KB - 4 pages]
    U. Kitron et al.
       View Abstract

    In late summer and fall 1997, Aedes albopictus mosquitoes were found in Peoria, Illinois, a long recognized focus of La Crosse virus transmission. Larvae were found in tires and other artificial containers, biting adults were recovered, and eggs were collected in oviposition traps within a 25-ha area. One chipmunk trapped < 0.25 km from the infested area tested positive for neutralizing antibodies against La Crosse virus.

  • Mycobacterium canettii, the Smooth Variant of M. tuberculosis, Isolated from a Swiss Patient Exposed in Africa PDF Version [PDF - 228 KB - 4 pages]
    G. E. Pfyffer et al.
       View Abstract

    An exceptionally smooth and glossy morphotype of Mycobacterium tuberculosis complex was isolated from a 56-year-old Swiss patient with mesenteric tuberculosis. Direct 16S rRNA sequence analysis of the hypervariable signature gene regions revealed a 100% homology to the specific M. tuberculosis complex sequence. Spoligotyping and restriction fragment length polymorphism analyses using the insertion sequences IS6110 and IS1081 and the polymorphic GC-rich sequence as additional genetic markers identified the isolate as the novel taxon M. canettii. Like a Somali child with a similar case, this patient probably contracted the infection in Africa, which raises questions about the geographic distribution of M. canettii.

  • Human Infections with Shiga Toxin-Producing Escherichia coli Other Than Serogroup O157 in Germany PDF Version [PDF - 54 KB - 5 pages]
    L. Beutin et al.
       View Abstract

    We investigated different types of Shiga toxin-producing Escherichia coli (STEC) not belonging to serogroup O157 for their role as human pathogens. Non-O157 STEC isolated from 89 human patients in Germany were characterized according to serotypes, virulence markers, and association with human illness. EaeA-positive STEC were isolated from 54 (60.7%) of the patients and were frequently associated with severe diarrheal disease, hemolytic uremic syndrome, and young age. EaeA-negative STEC were found in 35 (39.3%) of the patients and were more associated with clinically uncomplicated cases and adult patients. For pediatric patients, a serotype-independent diagnosis of STEC is recommended.

  • New Orientia tsutsugamushi Strain from Scrub Typhus in Australia PDF Version [PDF - 78 KB - 4 pages]
    D. M. Odorico et al.
       View Abstract

    In a recent case of scrub typhus in Australia, Orientia tsutsugamushi isolated from the patient's blood was tested by sequence analysis of the 16S rDNA gene. The sequence showed a strain of O. tsutsugamushi that was quite different from the classic Karp, Kato, and Gilliam strains. The new strain has been designated Litchfield.

  • Streptococcus parasanguinis: New Pathogen Associated with Asymptomatic Mastitis in Sheep PDF Version [PDF - 61 KB - 3 pages]
    J. Fernández-Garayzábal et al.
       View Abstract

    We describe two unusual cases in sheep of subclinical mastitis caused by Streptococcus parasanguinis. This bacterium has been associated with the development of experimental endocarditis; its presence at relatively high concentrations in apparently healthy sheep milk may pose a health risk in persons with predisposing heart lesions.

  • Introduction of HIV-2 and Multiple HIV-1 Subtypes to Lebanon PDF Version [PDF - 105 KB - 8 pages]
    D. Pieniazek et al.
       View Abstract

    HIV genetic variability, phylogenetic relationships, and transmission dynamics were analyzed in 26 HIV-infected patients from Lebanon. Twenty-five specimens were identified as HIV-1 and one as HIV-2 subtype B. The 25 strains were classified into six env-C2-V3 HIV-1 subtypes: B (n = 10), A (n = 11), C (n = 1), D (n = 1), G (n = 1), and unclassifiable. Potential recombinants combining parts of viral regions from different subtypes Aenv/Dpol/Agag, Genv/Apol and the unclassifiable-subtypeenv/ unclassifiable-subtypepol/Agag were found in three patients. Epidemiologic analysis of travel histories and behavioral risks indicated that HIV-1 and HIV-2 subtypes reflected HIV strains prevalent in countries visited by patients or their sex partners. Spread of complex HIV-subtype distribution patterns to regions where HIV is not endemic may be more common than previously thought. Blood screening for both HIV-1 and HIV-2 in Lebanon is recommended to protect the blood supply. HIV subtype data provide information for vaccine development.

  • Sporadic STEC O157 Infection: Secondary Household Transmission in Wales PDF Version [PDF - 71 KB - 5 pages]
    S. M. Parry and R. L. Salmon
       View Abstract

    We conducted a study to quantify and characterize household transmission of Shiga toxin (Vero cytotoxin)– producing Escherichia coli O157 (STEC O157) following sporadic infection in Wales. Through total population surveillance, we identified 83 index case-patients and their household contacts. We screened fecal samples submitted from household contacts for STEC O157 and calculated the household transmission rate for sporadic STEC O157 infection to be 4% to 15%. Household contacts in groups at high risk (particularly children under 5 years of age) present a risk of spreading the infection in the wider community.

  • Ehrlichia Infection in Italy PDF Version [PDF - 72 KB - 3 pages]
    M. Nuti et al.
       View Abstract

    Immunoglobulin M seroconversion to Ehrlichia chaffeensis was documented in U.S. citizens bitten by ticks in Sardinia. Seven cases of suspected ehrlichiosis in local residents were not confirmed by laboratory tests. In Alpine areas antibodies to E. phagocytophila were detected in persons at high risk, i.e., foresters (8.6%) and hunters (5.5%), and in controls (l.5%). Of 153 persons bitten by ticks, only one was Ehrlichia antibody-positive after 6 months.

  • Salmonella Enteritidis PT6: Another Egg-Associated Salmonellosis? PDF Version [PDF - 60 KB - 3 pages]
    M. R. Evans et al.
       View Abstract

    Salmonella Enteritidis phage type 6 (PT6) increased dramatically in the United Kingdom during 1997. The sharp rise suggests that PT6 contamination has spread rapidly throughout a basic food commodity; however, the source and food vehicle remain unknown. We present evidence from three outbreaks suggesting a possibile link between PT6 and eggs. Poor documentation of the egg supply network continues to pose problems for public health investigators. Thorough investigation of all future PT6 outbreaks and case-control studies of sporadic infections are needed to confirm the etiology of PT6 infection.

  • Reemergence of Epidemic Malaria in the Highlands of Western Kenya PDF Version [PDF - 229 KB - 6 pages]
    M. A. Malakooti et al.
       View Abstract

    Hospital records (1990-1997) of a tea company in the Kericho district, western Kenya, showed malaria epidemics almost annually from May to July, with an annual attack rate of 50%, 857 hospitalizations per 100,000 per year, and 42 deaths per 100,000 per year; 32% of deaths in hospitalized patients were caused by malaria. A questionnaire survey (June 1997) of 244 patients hospitalized for malaria showed that only 8% had traveled to an area with known malaria transmission 30 days before diagnosis. The increasing malaria incidence may be due to drug resistance.

  • Murine Typhus in Travelers Returning from Indonesia PDF Version [PDF - 126 KB - 4 pages]
    P. Parola et al.
       View Abstract

    We report the first three documented cases of murine typhus imported into Europe from Indonesia, discuss clues for the diagnosis of the disease, and urge that murine fever be considered in the diagnosis of febrile disease in travelers.

  • Differentiating Human from Animal Isolates of Cryptosporidium parvum PDF Version [PDF - 72 KB - 5 pages]
    I. M. Sulaiman et al.
       View Abstract

    We analyzed 92 Cryptosporidium parvum isolates from humans and animals by a polymerase chain reaction/restriction fragment length polymorphism method based on the thrombospondin-related anonymous protein 2 gene sequence. Used as a molecular marker, this method can differentiate between the two genotypes of C. parvum and elucidate the transmission of infection to humans.

  • An Outbreak of Hantavirus Pulmonary Syndrome, Chile, 1997 PDF Version [PDF - 207 KB - 8 pages]
    J. Toro et al.
       View Abstract

    An outbreak of 25 cases of Andes virus-associated hantavirus pulmonary syndrome (HPS) was recognized in southern Chile from July 1997 through January 1998. In addition to the HPS patients, three persons with mild hantaviral disease and one person with asymptomatic acute infection were identified. Epidemiologic studies suggested person-to-person transmission in two of three family clusters. Ecologic studies showed very high densities of several species of sigmodontine rodents in the area.



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