Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content

Volume 5, Number 2—April 1999

Volume 5, Number 2—April 1999   PDF Version [PDF - 4.18 MB - 130 pages]


  • International Editors:Emerging Infectious Diseases—United Kingdom PDF Version [PDF - 173 KB - 6 pages]
    D. Walford and N. Noah
  • The Next Influenza Pandemic: Lessons from Hong Kong, 1997 PDF Version [PDF - 68 KB - 9 pages]
    R. Snacken et al.
        View Abstract

    The 1997 Hong Kong outbreak of an avian influenzalike virus, with 18 proven human cases, many severe or fatal, highlighted the challenges of novel influenza viruses. Lessons from this episode can improve international and national planning for influenza pandemics in seven areas: expanded international commitment to first responses to pandemic threats; surveillance for influenza in key densely populated areas with large live-animal markets; new, economical diagnostic tests not based on eggs; contingency procedures for diagnostic work with highly pathogenic viruses where biocontainment laboratories do not exist; ability of health facilities in developing nations to communicate electronically, nationally and internationally; licenses for new vaccine production methods; and improved equity in supply of pharmaceutical products, as well as availability of basic health services, during a global influenza crisis. The Hong Kong epidemic also underscores the need for national committees and country-specific pandemic plans.

  • Disparity in the Natural Cycles of Borrelia burgdorferi and the Agent of Human Granulocytic Ehrlichiosis PDF Version [PDF - 60 KB - 5 pages]
    M. L. Levin et al.
        View Abstract

    We studied the prevalence of Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis (HGE) among questing nymphal and adult Ixodes scapularis ticks of the same generation and the infectivity of wild white-footed mice for ticks feeding on them. The prevalence of B. burgdorferi infection in host-seeking ticks increased less than twofold from nymphal (31% to 33%) to adult (52% to 56%) stage, and 52% of white-footed mice were infected. Prevalence of the agent of HGE increased 4.5- to 10.6-fold from nymphal (1.5% to 1.8%) to adult stage (7.6% to 19.0%), while only 18% of mice were infectious to ticks. B. burgdorferi infection was more common in mouse-fed ticks than in ticks collected from vegetation, whereas the agent of HGE was half as common in mouse-fed ticks as in ticks collected from vegetation. The different prevalence in nature of these pathogens in ticks suggests that their maintenance cycles are also different.


  • Malaria Reemergence in the Peruvian Amazon Region PDF Version [PDF - 325 KB - 7 pages]
    J. A. Guarda et al.
        View Abstract

    Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate than P. vivax infection in the last 3 years, became the dominant Plasmodium infection in the highest transmission areas in the 1997 rainy season. The vector Anopheles darlingi has also increased during this epidemic in Loreto. Moreover, chloroquine and pyrimethamine-sulfadoxine drug-resistant P. falciparum strains have emerged, which require development of efficacious focal drug treatment schemes.

  • Enteropathogenic E. coli, Salmonella, and Shigella: Masters of Host Cell Cytoskeletal Exploitation PDF Version [PDF - 808 KB - 8 pages]
    D. L. Goosney et al.
        View Abstract

    Bacterial pathogens have evolved numerous strategies to exploit their host's cellular processes so that they can survive and persist. Often, a bacterium must adhere very tightly to the cells and mediate its effects extracellularly, or it must find a way to invade the host's cells and survive intracellularly. In either case, the pathogen hijacks the host's cytoskeleton. The cytoskeleton provides a flexible framework for the cell and is involved in mediating numerous cellular functions, from cell shape and structure to programmed cell death. Altering the host cytoskeleton is crucial for mediating pathogen adherence, invasion, and intracellular locomotion. We highlight recent advances in the pathogenesis of enteropathogenic Escherichia coli, Salmonella Typhimurium, and Shigella flexneri. Each illustrates how bacterial pathogens can exert dramatic effects on the host cytoskeleton.

  • Bacterial Toxins: Friends or Foes? PDF Version [PDF - 717 KB - 11 pages]
    C. K. Schmitt et al.
        View Abstract

    Many emerging and reemerging bacterial pathogens synthesize toxins that serve as primary virulence factors. We highlight seven bacterial toxins produced by well-established or newly emergent pathogenic microbes. These toxins, which affect eukaryotic cells by a variety of means, include Staphylococcus aureus α-toxin, Shiga toxin, cytotoxic necrotizing factor type 1, Escherichia coli heat-stable toxin, botulinum and tetanus neurotoxins, and S. aureus toxic-shock syndrome toxin. For each, we discuss the information available on its synthesis and structure, mode of action, and contribution to virulence. We also review the role certain toxins have played in unraveling signal pathways in eukaryotic cells and summarize the beneficial uses of toxins and toxoids. Our intent is to illustrate the importance of the analysis of bacterial toxins to both basic and applied sciences.

  • Clonal Differences among Erythromycin-Resistant Streptococcus pyogenes in Spain
    E. Perez-Trallero et al.
        View Abstract

    The aim of this study was to determine whether the high levels of erythromycin resistance in Streptococcus pyogenes found in Spain are due to the introduction and spread of one or more clones. Phenotypic and genotypic techniques were used to characterize all erythromycin-resistant S. pyogenes (ErR) isolated in Gipuzkoa, Spain, in the last 10 years and 128 ErR isolated in Vitoria and Madrid during 1996. Of 437 ErR, 97% had the M phenotype; all 283 of the strains studied had the mefA determinant of resistance. After biotyping, T serotyping, emm typing, and genotyping, four major clones were detected. Clones B (biotype I, type T4, emm4, pulsed-field gel electrophoresis [PFGE] II) and D (biotype V, type T8.25, emm75, PFGE IV) comprised 78.8% of all ErR. The resistance of S. pyogenes to erythromycin was mainly due to an efflux mechanism of resistance (M phenotype); few clones were responsible for it.

  • Air Evacuation under High-Level Biosafety Containment: The Aeromedical Isolation Team PDF Version [PDF - 227 KB - 6 pages]
    G. W. Christopher and E. M. Eitzen
        View Abstract

    Military contingency operations in tropical environments and potential use of biological weapons by adversaries may place troops at risk for potentially lethal contagious infections (e.g., viral hemorrhagic fevers, plague, and zoonotic poxvirus infections). Diagnosis and treatment of such infections would be expedited by evacuating a limited number of patients to a facility with containment laboratories. To safely evacuate such patients by military aircraft and minimize the risk for transmission to air crews, caregivers, and civilians, the U.S. Army Medical Research Institute of Infectious Diseases maintains an aeromedical isolation team. This rapid response team, which has worldwide airlift capability designed to evacuate and manage patients under high-level containment, also offers a portable containment laboratory, limited environmental decontamination, and specialized consultative expertise. This article also examines technical aspects of the team's equipment, training, capabilities, and deployments.

  • emm Typing and Validation of Provisional M Types for Group A Streptococci PDF Version [PDF - 77 KB - 7 pages]
    R. Facklam et al.
        View Abstract

    This report discusses the following issues related to typing of group A streptococci (GAS): The development and use of the 5' emm variable region sequencing (emm typing) in relation to the existing serologic typing system; the designation of emm types in relation to M types; a system for validation of new emm types; criteria for validation of provisional M types to new M-types; a list of reference type cultures for each of the M-type or emm-type strains of GAS; the results of the first culture exchange program for a quality control testing system among the national and World Health Organization collaborating centers for streptococci; and dissemination of new approaches to typing of GAS to the international streptococcal community.


  • Rapid Molecular Genetic Subtyping of Serotype M1 Group A Streptococcus Strains PDF Version [PDF - 258 KB - 10 pages]
    N. Hoe et al.
        View Abstract

    Serotype M1 group A Streptococcus, the most common cause of invasive disease in many case series, generally have resisted extensive molecular subtyping by standard techniques (e.g., multilocus enzyme electrophoresis, pulsed-field gel electrophoresis). We used automated sequencing of the sic gene encoding streptococcal inhibitor of complement and of a region of the chromosome with direct repeat sequences to unambiguously differentiate 30 M1 isolates recovered from 28 patients in Texas with invasive disease episodes temporally clustered and thought to represent an outbreak. Sequencing of the emm gene was less useful for M1 strain differentiation, and restriction fragment length polymorphism analysis with IS1548 or IS1562 as Southern hybridization probes did not provide epidemiologically useful subtyping information. Sequence polymorphism in the direct repeat region of the chromosome and IS1548 profiling data support the hypothesis that M1 organisms have two main evolutionary lineages marked by the presence or absence of the speA2 allele encoding streptococcal pyrogenic exotoxin A2.




About the Cover