Volume 7, Number 1—February 2001
Volume 7, Number 1—February 2001 PDF Version [PDF - 2.69 MB - 173 pages]
Emerging Infectious Diseases in Russia, 1990-1999
PDF Version [PDF - 60 KB - 5 pages]
S. V. Netesov and J. L. Conrad
Bovine Spongiform Encephalopathy and Variant Creutzfeldt-Jakob Disease: Background, Evolution, and Current Concerns
PDF Version [PDF - 129 KB - 11 pages]
P. Brown et al.View Abstract
The epidemic of bovine spongiform encephalopathy in the United Kingdom, which began in 1986 and has affected nearly 200,000 cattle, is waning to a conclusion, but leaves in its wake an outbreak of human Creutzfeldt-Jakob disease, most probably resulting from the consumption of beef products contaminated by central nervous system tissue. Although averaging only 10-15 cases a year since its first appearance in 1994, its future magnitude and geographic distribution (in countries that have imported infected British cattle or cattle products, or have endogenous BSE) cannot yet be predicted. The possibility that large numbers of apparently healthy persons might be incubating the disease raises concerns about iatrogenic transmissions through instrumentation (surgery and medical diagnostic procedures) and blood and organ donations. Government agencies in many countries continue to implement new measures to minimize this risk.of this rickettsia makes it available for use in serologic tests to determine its clinical spectrum, prevalence, and distribution.
Pesticides and Public Health: Integrated Methods of Mosquito Management
PDF Version [PDF - 55 KB - 7 pages]
R. I. RoseView Abstract
Pesticides have a role in public health as part of sustainable integrated mosquito management. Other components of such management include surveillance, source reduction or prevention, biological control, repellents, traps, and pesticide-resistance management. We assess the future use of mosquito control pesticides in view of niche markets, incentives for new product development, Environmental Protection Agency registration, the Food Quality Protection Act, and improved pest management strategies for mosquito control.
Quinolone and Macrolide Resistance in Campylobacter jejuni and C. coli: Resistance Mechanisms and Trends in Human Isolates
PDF Version [PDF - 106 KB - 11 pages]
J. Engberg et al.View Abstract
The incidence of human Campylobacter jejuni and C. coli infections has increased markedly in many parts of the world in the last decade as has the number of quinolone-resistant and, to a lesser extent, macrolide-resistant Campylobacter strains causing infections. We review macrolide and quinolone resistance in Campylobacter and track resistance trends in human clinical isolates in relation to use of these agents in food animals. Susceptibility data suggest that erythromycin and other macrolides should remain the drugs of choice in most regions, with systematic surveillance and control measures maintained, but fluoroquinolones may now be of limited use in the empiric treatment of Campylobacter infections in many regions.
Geographic Subdivision of the Range of the Malaria Parasite, Plasmodium vivax
PDF Version [PDF - 173 KB - 8 pages]
J. Li et al.View Abstract
We examined geographically distinct isolates of Plasmodium vivax and categorized them according to developmental success in Anopheles albimanus. We found that parasites from Central America and Colombia form a group distinct from those of Asia. New World isolates have a distinct chromosomal translocation and an episomal variation in the open reading fram (ORF) 470 DNA sequence that distinguishes them from the other isolates tested. Old World types of P. vivax were introduced into the Americas, and a remnant of this lineage remains in P. simium. It is indistinguishable from Old World P. vivax to the extent determinable by using our encoded markers and the examination of its developmental pattern in mosquitoes. The cohesive characteristics that separate types of P. vivax are predictors of range and potential for transmission and hence require taxonomic distinction.
Transferable Plasmid-Mediated Resistance to Streptomycin in Clinical Isolate of Yersinia pestis
PDF Version [PDF - 101 KB - 6 pages]
A. Guiyoule et al.View Abstract
Plasmid-mediated high-level resistance to multiple antibiotics was reported in a clinical isolate of Yersinia pestis in Madagascar in 1997. We describe a second Y. pestis strain with high-level resistance to streptomycin, isolated from a human case of bubonic plague in Madagascar. The resistance determinants were carried by a self-transferable plasmid that could conjugate at high frequencies to other Y. pestis isolates. The plasmid and the host bacterium were different from those previously associated with multiple-drug resistance, indicating that acquisition of resistance plasmids is occurring in this bacterial species. Emergence of resistance to streptomycin in Y. pestis represents a critical public health problem since this antibiotic is used as the first-line treatment against plague in many countries.
Nested Polymerase Chain Reaction for Amplification of the Cryptosporidium Oocyst Wall Protein Gene
PDF Version [PDF - 63 KB - 8 pages]
S. Pedraza-Díaz et al.View Abstract
We developed a sensitive nested polymerase chain reaction (PCR) procedure for the Cryptosporidium oocyst wall protein (COWP) gene. Amplification and genotyping were successful in 95.2% of 1,680 fecal samples, 77.6% by the unnested and 17.6% by the nested COWP procedure. The COWP gene was amplified from 2,128 fecal samples: 71 from livestock animals and 2,057 from humans. This series included 706 cases from seven drinking water-associated outbreaks and 51 cases from five swimming pool-associated outbreaks, as well as 1,300 sporadic cases.
Preoperative Drug Dispensing as Predictor of Surgical Site Infection
PDF Version [PDF - 85 KB - 9 pages]
K. S. Kaye et al.View Abstract
The system used by the National Nosocomial Infection Surveillance (NNIS) program to measure risk of surgical site infection uses a score of >3 on the American Society of Anesthesiologists (ASA)-physical status scale as a measure of underlying illness. The chronic disease score measures health status as a function of age, sex, and 29 chronic diseases, inferred from dispensing of prescription drugs. We studied the relationship between the chronic disease score and surgical site infection and whether the score can supplement the NNIS risk index. In a retrospective comparison of 191 patients with surgical site infection and 378 uninfected controls, the chronic disease score and ASA score were highly correlated. The chronic disease score improved prediction of infection by the NNIS risk index and augmented the ASA score for risk adjustment.
Lack of Evidence of Endogenous Avian Leukosis Virus and Endogenous Avian Retrovirus Transmission to Measles Mumps Rubella Vaccine Recipients
PDF Version [PDF - 135 KB - 7 pages]
A. I. Hussain et al.View Abstract
The identification of endogenous avian leukosis virus (ALV) and endogenous avian retrovirus (EAV) in chick cell-derived measles and mumps vaccines in current use has raised concern about transmission of these retroviruses to vaccine recipients. We used serologic and molecular methods to analyze specimens from 206 recipients of measles, mumps, and rubella vaccine for evidence of infection with ALV and EAV. A Western blot assay for detecting antibodies to endogenous ALV was developed and validated. All serum samples were negative for antibodies to endogenous ALV by Western blot analysis. Peripheral blood lymphocyte samples from 100 vaccinees were further tested by polymerase chain reaction for both ALV and EAV proviral sequences; all were negative. Matching serum samples were tested by reverse transcriptase polymerase chain reaction for ALV and EAV RNA, and all 100 samples were negative, providing no evidence of viremia. These findings do not indicate the presence of either ALV or EAV infection in MMR vaccine recipients and provide support for current immunization policies.
A Flea-Associated Rickettsia Pathogenic for Humans
PDF Version [PDF - 207 KB - 9 pages]
D. Raoult et al.View Abstract
A rickettsia named the ELB agent, or "Rickettsia felis," was identified by molecular biology techniques in American fleas in 1990 and later in four patients from Texas and Mexico. We attempted to isolate this rickettsia from infected fleas at various temperatures and conditions. A representative isolate of the ELB agent, the Marseille strain, was characterized and used to develop a microimmunofluorescence test that detected reactive antibodies in human sera. The ELB agent was isolated from 19 of 20 groups of PCR-proven infected fleas. The microimmunofluorescence results provided serologic evidence of infection by the ELB agent in four patients with fever and rash in France (2) and Brazil (2), supporting the pathogenic role of this rickettsia. Our successful isolation of this rickettsia makes it available for use in serologic tests to determine its clinical spectrum, prevalence, and distribution.
Gastroenteritis in Sentinel General Practices, the Netherlands
PDF Version [PDF - 75 KB - 10 pages]
M. A. de Wit et al.View Abstract
From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroenteritis (cases) and an equal number of patients visiting for nongastrointestinal symptoms (controls) were invited to participate in a case-control study. The incidence of gastroenteritis was 79.7 per 10,000 person years. Campylobacter was detected most frequently (10% of cases), followed by Giardia lamblia (5%), rotavirus (5%), Norwalk-like viruses (5%) and Salmonella (4%). Our study found that in the Netherlands (population 15.6 million), an estimated 128,000 persons each year consult their general practitioner for gastroenteritis, slightly less than in a comparable study in 1992 to 1993. A pathogen could be detected in almost 40% of patients (bacteria 16%, viruses 15%, parasites 8%).
Active Bacterial Core Surveillance of the Emerging Infections Program Network
PDF Version [PDF - 74 KB - 8 pages]
A. Schuchat et al.View Abstract
Active Bacterial Core surveillance (ABCs) is a collaboration between the Centers for Disease Control and Prevention and several state health departments and universities participating in the Emerging Infections Program Network. ABCs conducts population-based active surveillance, collects isolates, and performs studies of invasive disease caused by Streptococcus pneumoniae, group A and group B Streptococcus, Neisseria meningitidis, and Haemophilus influenzae for a population of 17 to 30 million. These pathogens caused an estimated 97,000 invasive cases, resulting in 10,000 deaths in the United States in 1998. Incidence rates of these pathogens are described. During 1998, 25% of invasive pneumococcal infections in ABCs areas were not susceptible to penicillin, and 13.3% were not susceptible to three classes of antibiotics. In 1998, early-onset group B streptococcal disease had declined by 65% over the previous 6 years. More information on ABCs is available at www.cdc.gov/ncidod/dbmd/abcs. ABCs specimens will soon be available to researchers through an archive.
Emerging Chagas Disease: Trophic Network and Cycle of Transmission of Trypanosoma cruzi from Palm Trees in the Amazon
PDF Version [PDF - 240 KB - 13 pages]
A. Teixeira et al.View Abstract
A trophic network involving molds, invertebrates, and vertebrates, ancestrally adapted to the palm tree (Attalaea phalerata) microhabitat, maintains enzootic Trypanosoma cruzi infections in the Amazonian county Paço do Lumiar, state of Maranhão, Brazil. We assessed seropositivity for T. cruzi infections in the human population of the county, searched in palm trees for the triatomines that harbor these infections, and gathered demographic, environmental, and socioeconomic data. Rhodnius pictipes and R. neglectus in palm-tree frond clefts or in houses were infected with T. cruzi (57% and 41%, respectively). Human blood was found in 6.8% of R. pictipes in houses, and 9 of 10 wild Didelphis marsupialis had virulent T. cruzi infections. Increasing human population density, rain forest deforestation, and human predation of local fauna are risk factors for human T. cruzi infections.
Persistence and variability of Stenotrophomonas maltophilia in Cystic Fibrosis Patients, Madrid, 1991-1998
PDF Version [PDF - 140 KB - 10 pages]
S. Valdezate et al.View Abstract
During 1991 to 1998 at least one Stenotrophomonas maltophilia pulmonary infection was observed in 25 (24%) of 104 cystic fibrosis (CF) patients at the same unit of our hospital in Spain. Ribotyping and pulse-field gel electrophoresis (PFGE) characterization of 76 S. maltophilia isolates from these patients indicated an overall clonal incidence of 47.1%, reflecting new strains in 44% of patients with repeated positive cultures for S. maltophilia. Six patients with repeated episodes were persistently colonized (>6 months) with the same strain. S. maltophilia bacterial counts were higher (geometric mean, 2.9 x108 cfu/mL) in patients with repeated episodes than in those with a single episode (8.4 x104 cfu/mL, p<0.01). Single episodes of S. maltophilia occurred in patients <10 years of age (43% [6/14]), whereas chronic colonization occurred more frequently in older patients (>16 years of age).
Hospital Control and Multidrug-Resistant Pulmonary Tuberculosis in Female Patients, Lima, Peru
PDF Version [PDF - 54 KB - 5 pages]
F. F. Willingham et al.View Abstract
We examined the prevalence of tuberculosis (TB), rate of multidrug-resistant (MDR) TB, and characteristics of TB on a female general medicine ward in Peru. Of 250 patients, 40 (16%) were positive by sputum culture and 27 (11%) by smear, and 8 (3%) had MDRTB. Thirteen (33%) of 40 culture-positive patients had not been suspected of having TB on admission. Six (46%) of 13 patients whose TB was unsuspected on admission had MDRTB, compared with 2 (7%) of 27 suspected cases (p=0.009). Five (63%) of 8 MDRTB patients were smear positive and therefore highly infective. In developing countries, hospital control, a simple method of reducing the spread of MDRTB, is neglected.
Outbreak of West Nile Virus Infection, Volgograd Region, Russia, 1999
PDF Version [PDF - 63 KB - 5 pages]
A. E. Platonov et al.View Abstract
From July 25 to October 1, 1999, 826 patients were admitted to Volgograd Region, Russia, hospitals with acute aseptic meningoencephalitis, meningitis, or fever consistent with arboviral infection. Of 84 cases of meningoencephalitis, 40 were fatal. Fourteen brain specimens were positive in reverse transcriptase-polymerase chain reaction assays, confirming the presence of West Nile/Kunjin virus.
Rapid Identification of Corynebacterium diphtheriae Clonal Group Associated with Diphtheria Epidemic, Russian Federation
PDF Version [PDF - 85 KB - 4 pages]
S. Kombarova et al.View Abstract
We used 199 Corynebacterium diphtheriae isolated in 1995 to 1997 in Russia to evaluate the ability of random amplified polymorphic DNA (RAPD) to identify the unique clonal group that emerged there in 1990. Our data show that RAPD can reliably, reproducibly, and rapidly screen a large number of strains to identify the epidemic clonal group.
Shigella spp. Surveillance in Indonesia: the Emergence or Reemergence of S. dysenteriae
PDF Version [PDF - 49 KB - 4 pages]
D. Subekti et al.View Abstract
From June 1998 through November 1999, Shigella were isolated in 5% of samples from 3,848 children and adults with severe diarrheal illness in hospitals throughout Indonesia. S. dysenteriae has reemerged in Bali, Kalimantan, and Batam and was detected in Jakarta after a hiatus of 15 years.
Tracking Cryptosporidium parvum by Sequence Analysis of Small Double-Stranded RNA
PDF Version [PDF - 73 KB - 5 pages]
L. Xiao et al.View Abstract
We sequenced a 173-nucleotide fragment of the small double-stranded viruslike RNA of Cryptosporidium parvum isolates from 23 calves and 38 humans. Sequence diversity was detected at 17 sites. Isolates from the same outbreak had identical double-stranded RNA sequences, suggesting that this technique may be useful for tracking Cryptosporidium infection sources.
Pathologic Studies of Fatal Cases in Outbreak of Hand, Foot, and Mouth Disease, Taiwan
PDF Version [PDF - 59 KB - 3 pages]
W. Shieh et al.View Abstract
In 1998, an outbreak of enterovirus 71-associated hand, foot, and mouth disease occurred in Taiwan. Pathologic studies of two fatal cases with similar clinical features revealed two different causative agents, emphasizing the need for postmortem examinations and modern pathologic techniques in an outbreak investigation.
Disseminated Neocosmospora vasinfecta Infection in a Patient with Acute Nonlymphocytic Leukemia
PDF Version [PDF - 83 KB - 4 pages]
O. A. Cornely et al.View Abstract
We report Neocosmospora vasinfecta infection following chemotherapy for acute nonlymphocytic leukemia. N. vasinfecta, a plant pathogen, was identified by culture and genetic sequencing. Susceptibility testing revealed in vitro resistance for common antifungals.
Adventitious Viral Genomes in Vaccines but Not in Vaccinees
PDF Version [PDF - 38 KB - 2 pages]
R. A. Weiss
High-Level Ciprofloxacin Resistance in Neisseria gonorrhoeae: First Report from Israel
PDF Version [PDF - 40 KB - 2 pages]
M. Dan et al.
An Unusual Bacterium Causing a Brain Abscess
PDF Version [PDF - 40 KB - 2 pages]
D. N. Atapattu et al.
First Glycopeptide-Resistant Enterococcus faecium Isolate from Blood Culture in Ankara, Turkey
PDF Version [PDF - 40 KB - 3 pages]
A. Basustaoglu et al.
Antimicrobial-Drug Use and Methicillin-Resistant Staphylococcus aureus
PDF Version [PDF - 45 KB - 3 pages]
D. L. Monnet and N. Frimodt-Møller
Lack of Evidence for Cloramphenicol Resistance in Neisseria meningitidis, Africa
PDF Version [PDF - 41 KB - 2 pages]
M. C. Tondella et al.
Iron Loading and Disease Surveillance
PDF Version [PDF - 40 KB - 2 pages]
M. Reyes and G. Imperatore
About the Cover
Strengthening National Preparedness for Smallpox: an Update
PDF Version [PDF - 40 KB - 3 pages]
J. W. LeDuc and P. B. Jahrling
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