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Articles from Emerging Infectious Diseases

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Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit [PDF - 1.20 MB - 7 pages]
G. Desoubeaux et al.

Microsporidiosis is a fungal infection that generally causes digestive disorders, especially in immunocompromised hosts. Over a 4-day period in January 2018, 3 patients with hematologic malignancies who were admitted to the hematology unit of a hospital in France received diagnoses of Enterocytozoon bieneusi microsporidiosis. This unusually high incidence was investigated by sequence analysis at the internal transcribed spacer rDNA locus and then by 3 microsatellites and 1 minisatellite for multilocus genotyping. The 3 isolates had many sequence similarities and belonged to a new genotype closely related to genotype C. In addition, multilocus genotyping showed high genetic distances with all the other strains collected from epidemiologically unrelated persons; none of these strains belonged to the new genotype. These data confirm the epidemiologic link among the 3 patients and support a common source of infection.

EID Desoubeaux G, Nourrisson C, Moniot M, De Kyvon M, Bonnin V, De La Bretonniére M, et al. Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit. Emerg Infect Dis. 2019;25(9):1625-1631. https://dx.doi.org/10.3201/eid2509.190311
AMA Desoubeaux G, Nourrisson C, Moniot M, et al. Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit. Emerging Infectious Diseases. 2019;25(9):1625-1631. doi:10.3201/eid2509.190311.
APA Desoubeaux, G., Nourrisson, C., Moniot, M., De Kyvon, M., Bonnin, V., De La Bretonniére, M....Poirier, P. (2019). Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit. Emerging Infectious Diseases, 25(9), 1625-1631. https://dx.doi.org/10.3201/eid2509.190311.

Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal [PDF - 913 KB - 6 pages]
M. Aires-de-Sousa et al.

We aimed to provide updated epidemiologic data on carbapenem-resistant Klebsiella pneumoniae in Portugal by characterizing all isolates (N = 46) recovered during 2013–2018 in a 123-bed hospital in Lisbon. We identified blaKPC-3 (n = 36), blaOXA-181 (n = 9), and blaGES-5 (n = 8) carbapenemase genes and observed co-occurrence of blaKPC-3 and blaGES-5 in 7 isolates. A single GES-5–producing isolate co-produced the extended-spectrum β-lactamase BEL-1; both corresponding genes were co-located on the same ColE1-like plasmid. The blaOXA-181 gene was always located on an IncX3 plasmid, whereas blaKPC-3 was carried on IncN, IncFII, IncFIB, and IncFIIA plasmid types. The 46 isolates were distributed into 13 pulsotypes and 9 sequence types. All isolates remained susceptible to ceftazidime/avibactam, but some exhibited reduced antimicrobial susceptibility (MIC = 3 mg/L).

EID Aires-de-Sousa M, Ortiz de la Rosa J, Gonçalves M, Pereira A, Nordmann P, Poirel L. Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal. Emerg Infect Dis. 2019;25(9):1632-1638. https://dx.doi.org/10.3201/eid2509.190656
AMA Aires-de-Sousa M, Ortiz de la Rosa J, Gonçalves M, et al. Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal. Emerging Infectious Diseases. 2019;25(9):1632-1638. doi:10.3201/eid2509.190656.
APA Aires-de-Sousa, M., Ortiz de la Rosa, J., Gonçalves, M., Pereira, A., Nordmann, P., & Poirel, L. (2019). Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal. Emerging Infectious Diseases, 25(9), 1632-1638. https://dx.doi.org/10.3201/eid2509.190656.

Medscape CME Activity
Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions [PDF - 748 KB - 9 pages]
A. Ganesan et al.

To evaluate a classification system to support clinical decisions for treatment of contaminated deep wounds at risk for an invasive fungal infection (IFI), we studied 246 US service members (413 wounds) injured in Afghanistan (2009–2014) who had laboratory evidence of fungal infection. A total of 143 wounds with persistent necrosis and laboratory evidence were classified as IFI; 120 wounds not meeting IFI criteria were classified as high suspicion (patients had localized infection signs/symptoms and had received antifungal medication for >10 days), and 150 were classified as low suspicion (failed to meet these criteria). IFI patients received more blood than other patients and had more severe injuries than patients in the low-suspicion group. Fungi of the order Mucorales were more frequently isolated from IFI (39%) and high-suspicion (21%) wounds than from low-suspicion (9%) wounds. Wounds that did not require immediate antifungal therapy lacked necrosis and localized signs/symptoms of infection and contained fungi from orders other than Mucorales.

EID Ganesan A, Shaikh F, Bradley W, Blyth DM, Bennett D, Petfield JL, et al. Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions. Emerg Infect Dis. 2019;25(9):1639-1647. https://dx.doi.org/10.3201/eid2509.190168
AMA Ganesan A, Shaikh F, Bradley W, et al. Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions. Emerging Infectious Diseases. 2019;25(9):1639-1647. doi:10.3201/eid2509.190168.
APA Ganesan, A., Shaikh, F., Bradley, W., Blyth, D. M., Bennett, D., Petfield, J. L....Tribble, D. R. (2019). Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions. Emerging Infectious Diseases, 25(9), 1639-1647. https://dx.doi.org/10.3201/eid2509.190168.

Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum [PDF - 1.13 MB - 5 pages]
P. Nookeu et al.

Mycobacterium haemophilum is a nontuberculous mycobacterium that can infect immunocompromised patients. Because of special conditions required for its culture, this bacterium is rarely reported and there are scarce data for long-term outcomes. We conducted a retrospective study at Siriraj Hospital, Bangkok, Thailand, during January 2012–September 2017. We studied 21 patients for which HIV infection was the most common concurrent condition. The most common organ involvement was skin and soft tissue (60%). Combination therapy with macrolides and fluoroquinolones resulted in a 60% cure rate for cutaneous infection; adding rifampin as a third drug for more severe cases resulted in modest (66%) cure rate. Efficacy of medical therapy in cutaneous, musculoskeletal, and ocular diseases was 80%, 50%, and 50%, respectively. All patients with central nervous system involvement showed treatment failures. Infections with M. haemophilum in HIV-infected patients were more likely to have central nervous system involvement and tended to have disseminated infections and less favorable outcomes.

EID Nookeu P, Angkasekwinai N, Foongladda S, Phoompoung P. Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum. Emerg Infect Dis. 2019;25(9):1648-1652. https://dx.doi.org/10.3201/eid2509.190430
AMA Nookeu P, Angkasekwinai N, Foongladda S, et al. Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum. Emerging Infectious Diseases. 2019;25(9):1648-1652. doi:10.3201/eid2509.190430.
APA Nookeu, P., Angkasekwinai, N., Foongladda, S., & Phoompoung, P. (2019). Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum. Emerging Infectious Diseases, 25(9), 1648-1652. https://dx.doi.org/10.3201/eid2509.190430.
Research

Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA [PDF - 1.00 MB - 7 pages]
V. J. Oakes et al.

Theileria orientalis Ikeda genotype is a parasite that causes a disease in cattle that results in major economic issues in Asia, New Zealand, and Australia. The parasite is transmitted by Haemaphysalis longicornis ticks, which have recently been reported in numerous states throughout the eastern United States. Concurrently, cattle in Virginia showed clinical signs consistent with a hemoprotozoan infection. We used amplicons specific for the major piroplasm surface protein and small subunit rDNA of piroplasms to test blood samples from the cattle by PCR. Bidirectional Sanger sequencing showed sequences with 100% identity with T. orientalis Ikeda genotype 2 sequences. We detected the parasite in 3 unrelated herds and from various animals sampled at 2 time points. Although other benign T. orientalis genotypes are endemic to the United States, detection of T. orientalis Ikeda genotype might represent a risk for the cattle industry in Virginia.

EID Oakes VJ, Yabsley MJ, Schwartz D, LeRoith T, Bissett C, Broaddus C, et al. Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA. Emerg Infect Dis. 2019;25(9):1653-1659. https://dx.doi.org/10.3201/eid2509.190088
AMA Oakes VJ, Yabsley MJ, Schwartz D, et al. Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA. Emerging Infectious Diseases. 2019;25(9):1653-1659. doi:10.3201/eid2509.190088.
APA Oakes, V. J., Yabsley, M. J., Schwartz, D., LeRoith, T., Bissett, C., Broaddus, C....Lahmers, K. K. (2019). Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA. Emerging Infectious Diseases, 25(9), 1653-1659. https://dx.doi.org/10.3201/eid2509.190088.

Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018 [PDF - 626 KB - 8 pages]
B. M. Berenger et al.

In July 2018, a case of Neisseria gonorrhoeae associated with ceftriaxone treatment failure was identified in Alberta, Canada. We identified the isolate and nucleic acid amplification testing (NAAT) specimen as the ceftriaxone-resistant strain multilocus sequence type 1903/NG-MAST 3435/NG-STAR 233, originally identified in Japan (FC428), with the same penA 60.001 mosaic allele and genetic resistance determinants. Core single-nucleotide variant (SNV) analysis identified 13 SNVs between this isolate and FC428. Culture-independent surveillance by PCR for the A311V mutation in the penA allele and N. gonorrhoeae multiantigen sequence typing directly from NAAT transport media positive for N. gonorrhoeae by NAAT did not detect spread of the strain. We identified multiple sequence types not previously detected in Alberta by routine surveillance. This case demonstrates the benefit of using culture-independent methods to enhance detection, public health investigations, and surveillance to address this global threat.

EID Berenger BM, Demczuk W, Gratrix J, Pabbaraju K, Smyczek P, Martin I. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018. Emerg Infect Dis. 2019;25(9):1660-1667. https://dx.doi.org/10.3201/eid2509.190407
AMA Berenger BM, Demczuk W, Gratrix J, et al. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018. Emerging Infectious Diseases. 2019;25(9):1660-1667. doi:10.3201/eid2509.190407.
APA Berenger, B. M., Demczuk, W., Gratrix, J., Pabbaraju, K., Smyczek, P., & Martin, I. (2019). Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018. Emerging Infectious Diseases, 25(9), 1660-1667. https://dx.doi.org/10.3201/eid2509.190407.

Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017 [PDF - 985 KB - 8 pages]
P. Chen et al.

Candida tropicalis is the leading cause of non–C. albicans candidemia in tropical Asia and Latin America. We evaluated isolates from 344 patients with an initial episode of C. tropicalis candidemia. We found that 58 (16.9%) patients were infected by fluconazole-nonsusceptible (FNS) C. tropicalis with cross resistance to itraconazole, voriconazole, and posaconazole; 55.2% (32/58) of patients were azole-naive. Multilocus sequence typing analysis revealed FNS isolates were genetically closely related, but we did not see time- or place-clustering. Among the diploid sequence types (DSTs), we noted DST225, which has been reported from fruit in Taiwan and hospitals in Beijing, China, as well as DST376 and DST505–7, which also were reported from hospitals in Shanghai, China. Our findings suggest cross-boundary expansion of FNS C. tropicalis and highlight the importance of active surveillance of clinical isolates to detect dissemination of this pathogen and explore potential sources in the community.

EID Chen P, Chuang Y, Wu U, Sun H, Wang J, Sheng W, et al. Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017. Emerg Infect Dis. 2019;25(9):1668-1675. https://dx.doi.org/10.3201/eid2509.190520
AMA Chen P, Chuang Y, Wu U, et al. Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017. Emerging Infectious Diseases. 2019;25(9):1668-1675. doi:10.3201/eid2509.190520.
APA Chen, P., Chuang, Y., Wu, U., Sun, H., Wang, J., Sheng, W....Chang, S. (2019). Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017. Emerging Infectious Diseases, 25(9), 1668-1675. https://dx.doi.org/10.3201/eid2509.190520.

Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018 [PDF - 1.32 MB - 7 pages]
P. Uprety et al.

Acute flaccid myelitis (AFM) is a polio-like disease that results in paralysis in previously healthy persons. Although the definitive cause of AFM remains unconfirmed, enterovirus D68 (EV-D68) is suspected based on 2014 data demonstrating an increase in AFM cases concomitant with an EV-D68 outbreak. We examined the prevalence in children and the molecular evolution of EV-D68 for 2009–2018 in Philadelphia, Pennsylvania, USA. We detected widespread EV-D68 circulation in 2009, rare detections in 2010 and 2011, and then biennial circulation, only in even years, during 2012–2018. Prevalence of EV-D68 significantly correlated with AFM cases during this period. Finally, whole-genome sequencing revealed early detection of the B1 clade in 2009 and continued evolution of the B3 clade from 2016 to 2018. These data reinforce the need to improve surveillance programs for nonpolio enterovirus to identify possible AFM triggers and predict disease prevalence to better prepare for future outbreaks.

EID Uprety P, Curtis D, Elkan M, Fink J, Rajagopalan R, Zhao C, et al. Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018. Emerg Infect Dis. 2019;25(9):1676-1682. https://dx.doi.org/10.3201/eid2509.190468
AMA Uprety P, Curtis D, Elkan M, et al. Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018. Emerging Infectious Diseases. 2019;25(9):1676-1682. doi:10.3201/eid2509.190468.
APA Uprety, P., Curtis, D., Elkan, M., Fink, J., Rajagopalan, R., Zhao, C....Graf, E. H. (2019). Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018. Emerging Infectious Diseases, 25(9), 1676-1682. https://dx.doi.org/10.3201/eid2509.190468.

Medscape CME Activity
Risk for Clostridiodes difficile Infection among Older Adults with Cancer [PDF - 922 KB - 7 pages]
M. Kamboj et al.

To assess whether risk for Clostridiodes difficile infection (CDI) is higher among older adults with cancer, we conducted a retrospective cohort study with a nested case–control analysis using population-based Surveillance, Epidemiology, and End Results–Medicare linked data for 2011. Among 93,566 Medicare beneficiaries, incident CDI and odds for acquiring CDI were higher among patients with than without cancer. Specifically, risk was significantly higher for those who had liquid tumors and higher for those who had recently diagnosed solid tumors and distant metastasis. These findings were independent of prior healthcare-associated exposure. This population-based assessment can be used to identify targets for prevention of CDI.

EID Kamboj M, Gennarelli RL, Brite J, Sepkowitz K, Lipitz-Snyderman A. Risk for Clostridiodes difficile Infection among Older Adults with Cancer. Emerg Infect Dis. 2019;25(9):1683-1689. https://dx.doi.org/10.3201/eid2509.181142
AMA Kamboj M, Gennarelli RL, Brite J, et al. Risk for Clostridiodes difficile Infection among Older Adults with Cancer. Emerging Infectious Diseases. 2019;25(9):1683-1689. doi:10.3201/eid2509.181142.
APA Kamboj, M., Gennarelli, R. L., Brite, J., Sepkowitz, K., & Lipitz-Snyderman, A. (2019). Risk for Clostridiodes difficile Infection among Older Adults with Cancer. Emerging Infectious Diseases, 25(9), 1683-1689. https://dx.doi.org/10.3201/eid2509.181142.

Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand [PDF - 2.68 MB - 8 pages]
L. Ford et al.

We used phylogenomic and risk factor data on isolates of Salmonella enterica serovars Mississippi and Typhimurium definitive type 160 (DT160) collected from human, animal, and environmental sources to elucidate their epidemiology and disease reservoirs in Australia and New Zealand. Sequence data suggested wild birds as a likely reservoir for DT160; animal and environmental sources varied more for Salmonella Mississippi than for Salmonella Typhimurium. Australia and New Zealand isolates sat in distinct clades for both serovars; the median single-nucleotide polymorphism distance for DT160 was 29 (range 8–66) and for Salmonella Mississippi, 619 (range 565–737). Phylogenomic data identified plausible sources of human infection from wildlife and environmental reservoirs and provided evidence supporting New Zealand–acquired DT160 in a group of travelers returning to Australia. Wider use of real-time whole-genome sequencing in new locations and for other serovars may identify sources and routes of transmission, thereby aiding prevention and control.

EID Ford L, Ingle D, Glass K, Veitch M, Williamson DA, Harlock M, et al. Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand. Emerg Infect Dis. 2019;25(9):1690-1697. https://dx.doi.org/10.3201/eid2509.181811
AMA Ford L, Ingle D, Glass K, et al. Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand. Emerging Infectious Diseases. 2019;25(9):1690-1697. doi:10.3201/eid2509.181811.
APA Ford, L., Ingle, D., Glass, K., Veitch, M., Williamson, D. A., Harlock, M....Kirk, M. D. (2019). Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand. Emerging Infectious Diseases, 25(9), 1690-1697. https://dx.doi.org/10.3201/eid2509.181811.

Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017 [PDF - 2.00 MB - 10 pages]
E. van Schalkwyk et al.

Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016–2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2–86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8–2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.

EID van Schalkwyk E, Mpembe RS, Thomas J, Shuping L, Ismail H, Lowman W, et al. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017. Emerg Infect Dis. 2019;25(9):1698-1707. https://dx.doi.org/10.3201/eid2509.190040
AMA van Schalkwyk E, Mpembe RS, Thomas J, et al. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017. Emerging Infectious Diseases. 2019;25(9):1698-1707. doi:10.3201/eid2509.190040.
APA van Schalkwyk, E., Mpembe, R. S., Thomas, J., Shuping, L., Ismail, H., Lowman, W....Govender, N. P. (2019). Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017. Emerging Infectious Diseases, 25(9), 1698-1707. https://dx.doi.org/10.3201/eid2509.190040.

Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016 [PDF - 2.43 MB - 11 pages]
G. Oligbu et al.

We describe the effects of the 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugate vaccines on pneumococcal meningitis in England and Wales during July 1, 2000–June 30, 2016. Overall, 84,473 laboratory-confirmed invasive pneumococcal disease cases, including 4,160 (4.9%) cases with meningitis, occurred. PCV7 implementation in 2006 did not lower overall pneumococcal meningitis incidence because of replacement with non–PCV7-type meningitis incidence. Replacement with PCV13 in 2010, however, led to a 48% reduction in pneumococcal meningitis incidence by 2015–16. The overall case-fatality rate was 17.5%: 10.7% among patients <5 years of age, 17.3% among patients 5–64 years of age, and 31.9% among patients >65 years of age. Serotype 8 was associated with increased odds of death (adjusted odds ratio 2.9, 95% CI 1.8–4.7). In England and Wales, an effect on pneumococcal meningitis was observed only after PCV13 implementation. Further studies are needed to assess pneumococcal meningitis caused by the replacing serotypes.

EID Oligbu G, Collins S, Djennad A, Sheppard CL, Fry NK, Andrews NJ, et al. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016. Emerg Infect Dis. 2019;25(9):1708-1718. https://dx.doi.org/10.3201/eid2509.180747
AMA Oligbu G, Collins S, Djennad A, et al. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016. Emerging Infectious Diseases. 2019;25(9):1708-1718. doi:10.3201/eid2509.180747.
APA Oligbu, G., Collins, S., Djennad, A., Sheppard, C. L., Fry, N. K., Andrews, N. J....Ladhani, S. N. (2019). Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016. Emerging Infectious Diseases, 25(9), 1708-1718. https://dx.doi.org/10.3201/eid2509.180747.
Dispatches

Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017 [PDF - 2.50 MB - 4 pages]
H. Li et al.

During 2014–2017, we screened for Rickettsia japonica infection in Xinyang, China, and identified 20 cases. The major clinical manifestations of monoinfection were fever, asthenia, myalgia, rash, and anorexia; laboratory findings included thrombocytopenia and elevated hepatic aminotransferase concentrations. Physicians in China should consider R. japonica infection in at-risk patients.

EID Li H, Zhang P, Du J, Yang Z, Cui N, Xing B, et al. Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017. Emerg Infect Dis. 2019;25(9):1719-1722. https://dx.doi.org/10.3201/eid2509.171421
AMA Li H, Zhang P, Du J, et al. Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017. Emerging Infectious Diseases. 2019;25(9):1719-1722. doi:10.3201/eid2509.171421.
APA Li, H., Zhang, P., Du, J., Yang, Z., Cui, N., Xing, B....Liu, W. (2019). Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017. Emerging Infectious Diseases, 25(9), 1719-1722. https://dx.doi.org/10.3201/eid2509.171421.

Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato [PDF - 1.28 MB - 4 pages]
E. S. Acheson et al.

We compared 2 climate classification systems describing georeferenced environmental Cryptococcus gattii sensu lato isolations occurring during 1989–2016. Each system suggests the fungus was isolated in temperate climates before the 1999 outbreak on Vancouver Island, British Columbia, Canada. However, the Köppen-Geiger system is more precise and should be used to define climates where pathogens are detected.

EID Acheson ES, Galanis E, Bartlett K, Klinkenberg B. Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato. Emerg Infect Dis. 2019;25(9):1723-1726. https://dx.doi.org/10.3201/eid2509.181884
AMA Acheson ES, Galanis E, Bartlett K, et al. Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato. Emerging Infectious Diseases. 2019;25(9):1723-1726. doi:10.3201/eid2509.181884.
APA Acheson, E. S., Galanis, E., Bartlett, K., & Klinkenberg, B. (2019). Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato. Emerging Infectious Diseases, 25(9), 1723-1726. https://dx.doi.org/10.3201/eid2509.181884.

Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda [PDF - 929 KB - 3 pages]
A. I. Izimukwiye et al.

We report 4 recent cases of nasal rhinosporidiosis in Rwanda. All patients were boys or young men living in the same district (Gatsibo District, Eastern Province), suggesting a reservoir in the area. The recent reemergence of rhinosporidiosis in Rwanda might reflect increased availability of diagnostic services rather than emerging disease.

EID Izimukwiye AI, Mbarushimana D, Ndayisaba MC, Bigirimana V, Rugwizangoga B, Laga AC. Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda. Emerg Infect Dis. 2019;25(9):1727-1729. https://dx.doi.org/10.3201/eid2509.190021
AMA Izimukwiye AI, Mbarushimana D, Ndayisaba MC, et al. Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda. Emerging Infectious Diseases. 2019;25(9):1727-1729. doi:10.3201/eid2509.190021.
APA Izimukwiye, A. I., Mbarushimana, D., Ndayisaba, M. C., Bigirimana, V., Rugwizangoga, B., & Laga, A. C. (2019). Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda. Emerging Infectious Diseases, 25(9), 1727-1729. https://dx.doi.org/10.3201/eid2509.190021.

Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity [PDF - 1.04 MB - 6 pages]
M. Chan et al.

Tools to detect human norovirus infectivity have been lacking. Using human intestinal enteroid cultures inoculated with GII.Pe-GII.4 Sydney–infected fecal samples, we determined that a real-time reverse transcription PCR cycle threshold cutoff of 30 may indicate infectious norovirus. This finding could be used to help guide infection control.

EID Chan M, Cheung S, Mohammad KN, Chan J, Estes MK, Chan P. Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity. Emerg Infect Dis. 2019;25(9):1730-1735. https://dx.doi.org/10.3201/eid2509.190205
AMA Chan M, Cheung S, Mohammad KN, et al. Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity. Emerging Infectious Diseases. 2019;25(9):1730-1735. doi:10.3201/eid2509.190205.
APA Chan, M., Cheung, S., Mohammad, K. N., Chan, J., Estes, M. K., & Chan, P. (2019). Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity. Emerging Infectious Diseases, 25(9), 1730-1735. https://dx.doi.org/10.3201/eid2509.190205.

Vaccine Effectiveness against DS-1–Like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015 [PDF - 881 KB - 4 pages]
K. C. Jere et al.

Atypical DS-1–like G1P[8] rotaviruses emerged in 2013 in Malawi after rotavirus vaccine introduction. Vaccine effectiveness among infants hospitalized with acute DS-1–like G1P[8] rotavirus gastroenteritis was 85.6% (95% CI 34.4%–96.8%). These findings suggest that vaccine provides protection against these strains despite their emergence coinciding with vaccine introduction.

EID Jere KC, Bar-Zeev N, Chande A, Bennett A, Pollock L, Sanchez-Lopez PF, et al. Vaccine Effectiveness against DS-1–Like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015. Emerg Infect Dis. 2019;25(9):1734-1737. https://dx.doi.org/10.3201/eid2509.190258
AMA Jere KC, Bar-Zeev N, Chande A, et al. Vaccine Effectiveness against DS-1–Like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015. Emerging Infectious Diseases. 2019;25(9):1734-1737. doi:10.3201/eid2509.190258.
APA Jere, K. C., Bar-Zeev, N., Chande, A., Bennett, A., Pollock, L., Sanchez-Lopez, P. F....Cunliffe, N. A. (2019). Vaccine Effectiveness against DS-1–Like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015. Emerging Infectious Diseases, 25(9), 1734-1737. https://dx.doi.org/10.3201/eid2509.190258.

Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance [PDF - 1.86 MB - 4 pages]
E. Tkadlec et al.

Using long-term data on incidences of Lyme disease and tickborne encephalitis, we showed that the dynamics of both diseases in central Europe are predictable from rodent host densities and climate indices. Our approach offers a simple and effective tool to predict a tickborne disease risk 1 year in advance.

EID Tkadlec E, Václavík T, Široký P. Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance. Emerg Infect Dis. 2019;25(9):1738-1741. https://dx.doi.org/10.3201/eid2509.190684
AMA Tkadlec E, Václavík T, Široký P. Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance. Emerging Infectious Diseases. 2019;25(9):1738-1741. doi:10.3201/eid2509.190684.
APA Tkadlec, E., Václavík, T., & Široký, P. (2019). Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance. Emerging Infectious Diseases, 25(9), 1738-1741. https://dx.doi.org/10.3201/eid2509.190684.

Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA [PDF - 367 KB - 3 pages]
R. Ginn et al.

We developed an electronic records methodology to programmatically estimate the date of first appearance of coccidioidomycosis symptoms in patients. We compared the diagnostic delay with overall healthcare utilization charges. Many patients (46%) had delays in diagnosis of >1 month. Billed healthcare charges before diagnosis increased with length of delay.

EID Ginn R, Mohty R, Bollmann K, Goodsell J, Mendez G, Bradley B, et al. Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA1. Emerg Infect Dis. 2019;25(9):1742-1744. https://dx.doi.org/10.3201/eid2509.190019
AMA Ginn R, Mohty R, Bollmann K, et al. Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA1. Emerging Infectious Diseases. 2019;25(9):1742-1744. doi:10.3201/eid2509.190019.
APA Ginn, R., Mohty, R., Bollmann, K., Goodsell, J., Mendez, G., Bradley, B....Galgiani, J. N. (2019). Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA1. Emerging Infectious Diseases, 25(9), 1742-1744. https://dx.doi.org/10.3201/eid2509.190019.

Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA [PDF - 436 KB - 3 pages]
F. M. Donovan et al.

Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.

EID Donovan FM, Wightman P, Zong Y, Gabe L, Majeed A, Ynosencio T, et al. Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA. Emerg Infect Dis. 2019;25(9):1745-1747. https://dx.doi.org/10.3201/eid2509.190023
AMA Donovan FM, Wightman P, Zong Y, et al. Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA. Emerging Infectious Diseases. 2019;25(9):1745-1747. doi:10.3201/eid2509.190023.
APA Donovan, F. M., Wightman, P., Zong, Y., Gabe, L., Majeed, A., Ynosencio, T....Galgiani, J. N. (2019). Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA. Emerging Infectious Diseases, 25(9), 1745-1747. https://dx.doi.org/10.3201/eid2509.190023.
Research Letters

Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure [PDF - 744 KB - 2 pages]
J. C. Howard et al.

Diaporthe phaseolorum is a fungal plant parasite that has rarely been described as causing invasive human disease. We report a case of human soft tissue infection with Diaporthe phaseolorum in a heart transplant patient with end-stage renal failure in New Zealand.

EID Howard JC, Chen K, Werno A, Metcalf S. Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure. Emerg Infect Dis. 2019;25(9):1748-1749. https://dx.doi.org/10.3201/eid2509.190768
AMA Howard JC, Chen K, Werno A, et al. Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure. Emerging Infectious Diseases. 2019;25(9):1748-1749. doi:10.3201/eid2509.190768.
APA Howard, J. C., Chen, K., Werno, A., & Metcalf, S. (2019). Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure. Emerging Infectious Diseases, 25(9), 1748-1749. https://dx.doi.org/10.3201/eid2509.190768.

Disseminated Emergomycosis in a Person with HIV Infection, Uganda [PDF - 993 KB - 2 pages]
I. Rooms et al.

We describe emergomycosis in a patient in Uganda with HIV infection. We tested a formalin-fixed, paraffin-embedded skin biopsy to identify Emergomyces pasteurianus or a closely related pathogen by sequencing broad-range fungal PCR amplicons. Results suggest that emergomycosis is more widespread and genetically diverse than previously documented. PCR on tissue blocks may help clarify emergomycosis epidemiology.

EID Rooms I, Mugisha P, Gambichler T, Hadaschik E, Esser S, Rath P, et al. Disseminated Emergomycosis in a Person with HIV Infection, Uganda. Emerg Infect Dis. 2019;25(9):1750-1751. https://dx.doi.org/10.3201/eid2509.181234
AMA Rooms I, Mugisha P, Gambichler T, et al. Disseminated Emergomycosis in a Person with HIV Infection, Uganda. Emerging Infectious Diseases. 2019;25(9):1750-1751. doi:10.3201/eid2509.181234.
APA Rooms, I., Mugisha, P., Gambichler, T., Hadaschik, E., Esser, S., Rath, P....Rickerts, V. (2019). Disseminated Emergomycosis in a Person with HIV Infection, Uganda. Emerging Infectious Diseases, 25(9), 1750-1751. https://dx.doi.org/10.3201/eid2509.181234.

Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013 [PDF - 353 KB - 2 pages]
K. C. Jackson et al.

Since its recent discovery, Bourbon virus has been isolated from a human and ticks. To assess exposure of potential vertebrate reservoirs, we assayed banked serum and plasma samples from wildlife and domestic animals in Missouri, USA, for Bourbon virus–neutralizing antibodies. We detected high seroprevalence in raccoons (50%) and white-tailed deer (86%).

EID Jackson KC, Gidlewski T, Root J, Bosco-Lauth AM, Lash R, Harmon JR, et al. Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013. Emerg Infect Dis. 2019;25(9):1752-1753. https://dx.doi.org/10.3201/eid2509.181902
AMA Jackson KC, Gidlewski T, Root J, et al. Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013. Emerging Infectious Diseases. 2019;25(9):1752-1753. doi:10.3201/eid2509.181902.
APA Jackson, K. C., Gidlewski, T., Root, J., Bosco-Lauth, A. M., Lash, R., Harmon, J. R....Komar, N. (2019). Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013. Emerging Infectious Diseases, 25(9), 1752-1753. https://dx.doi.org/10.3201/eid2509.181902.

Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015 [PDF - 594 KB - 4 pages]
M. Mateo et al.

Lassa fever has not been reported in Côte d’Ivoire. We performed a retrospective analysis of human serum samples collected in Côte d’Ivoire in the dry seasons (January–April) during 2015–2018. We identified a fatal human case of Lassa fever in the Bangolo District of western Côte d’Ivoire during 2015.

EID Mateo M, Picard C, Sylla Y, Kamo E, Odegue D, Journeaux A, et al. Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015. Emerg Infect Dis. 2019;25(9):1753-1756. https://dx.doi.org/10.3201/eid2509.190239
AMA Mateo M, Picard C, Sylla Y, et al. Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015. Emerging Infectious Diseases. 2019;25(9):1753-1756. doi:10.3201/eid2509.190239.
APA Mateo, M., Picard, C., Sylla, Y., Kamo, E., Odegue, D., Journeaux, A....Dosso, M. (2019). Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015. Emerging Infectious Diseases, 25(9), 1753-1756. https://dx.doi.org/10.3201/eid2509.190239.

Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease [PDF - 410 KB - 3 pages]
S. Jing et al.

We identified a case of fatal acute respiratory disease from household transmission of human adenovirus type 55 (HAdV-55) in Anhui Province, China. Computed tomography showed severe pneumonia. Comparative genomic analysis of HAdV-55 indicated the virus possibly originated in Shanxi Province, China. More attention should be paid to highly contagious HAdV-55.

EID Jing S, Zhang J, Cao M, Liu M, Yan Y, Zhao S, et al. Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease. Emerg Infect Dis. 2019;25(9):1756-1758. https://dx.doi.org/10.3201/eid2509.181937
AMA Jing S, Zhang J, Cao M, et al. Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease. Emerging Infectious Diseases. 2019;25(9):1756-1758. doi:10.3201/eid2509.181937.
APA Jing, S., Zhang, J., Cao, M., Liu, M., Yan, Y., Zhao, S....Zhang, Q. (2019). Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease. Emerging Infectious Diseases, 25(9), 1756-1758. https://dx.doi.org/10.3201/eid2509.181937.

Worldwide Reduction in MERS Cases and Deaths since 2016 [PDF - 332 KB - 3 pages]
C. A. Donnelly et al.

Since 2012, Middle East respiratory syndrome (MERS) coronavirus has infected 2,442 persons worldwide. Case-based data analysis suggests that since 2016, as many as 1,465 cases and 293–520 deaths might have been averted. Efforts to reduce the global MERS threat are working, but countries must maintain vigilance to prevent further infections.

EID Donnelly CA, Malik MR, Elkholy A, Cauchemez S, Van Kerkhove MD. Worldwide Reduction in MERS Cases and Deaths since 2016. Emerg Infect Dis. 2019;25(9):1758-1760. https://dx.doi.org/10.3201/eid2509.190143
AMA Donnelly CA, Malik MR, Elkholy A, et al. Worldwide Reduction in MERS Cases and Deaths since 2016. Emerging Infectious Diseases. 2019;25(9):1758-1760. doi:10.3201/eid2509.190143.
APA Donnelly, C. A., Malik, M. R., Elkholy, A., Cauchemez, S., & Van Kerkhove, M. D. (2019). Worldwide Reduction in MERS Cases and Deaths since 2016. Emerging Infectious Diseases, 25(9), 1758-1760. https://dx.doi.org/10.3201/eid2509.190143.

Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone [PDF - 428 KB - 3 pages]
P. K. Singh and A. Jain

Resistance to second-line tuberculosis drugs for patients with multidrug-resistant tuberculosis has emerged globally and is a potential risk factor for unfavorable outcomes of shorter duration drug regimens. We assessed the proportion of patients eligible for a shorter drug regimen in Uttar Pradesh, India, which had the highest rate of multidrug-resistant tuberculosis in India.

EID Singh PK, Jain A. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone. Emerg Infect Dis. 2019;25(9):1760-1762. https://dx.doi.org/10.3201/eid2509.190105
AMA Singh PK, Jain A. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone. Emerging Infectious Diseases. 2019;25(9):1760-1762. doi:10.3201/eid2509.190105.
APA Singh, P. K., & Jain, A. (2019). Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone. Emerging Infectious Diseases, 25(9), 1760-1762. https://dx.doi.org/10.3201/eid2509.190105.

Candida auris in Germany and Previous Exposure to Foreign Healthcare [PDF - 928 KB - 3 pages]
A. Hamprecht et al.

The emerging yeast Candida auris has disseminated worldwide. We report on 7 cases identified in Germany during 2015–2017. In 6 of these cases, C. auris was isolated from patients previously hospitalized abroad. Whole-genome sequencing and epidemiologic analyses revealed that all patients in Germany were infected with different strains.

EID Hamprecht A, Barber AE, Mellinghoff SC, Thelen P, Walther G, Yu Y, et al. Candida auris in Germany and Previous Exposure to Foreign Healthcare. Emerg Infect Dis. 2019;25(9):1763-1765. https://dx.doi.org/10.3201/eid2509.190262
AMA Hamprecht A, Barber AE, Mellinghoff SC, et al. Candida auris in Germany and Previous Exposure to Foreign Healthcare. Emerging Infectious Diseases. 2019;25(9):1763-1765. doi:10.3201/eid2509.190262.
APA Hamprecht, A., Barber, A. E., Mellinghoff, S. C., Thelen, P., Walther, G., Yu, Y....Kurzai, O. (2019). Candida auris in Germany and Previous Exposure to Foreign Healthcare. Emerging Infectious Diseases, 25(9), 1763-1765. https://dx.doi.org/10.3201/eid2509.190262.

Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA [PDF - 594 KB - 4 pages]
L. Li et al.

Talaromyces marneffei and other Talaromyces species can cause opportunistic invasive fungal infections. We characterized clinical Talaromyces isolates from patients in California, USA, a non–Talaromyces-endemic area, by a multiphasic approach, including multigene phylogeny, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and phenotypic methods. We identified 10 potentially pathogenic Talaromyces isolates, 2 T. marneffei.

EID Li L, Chen K, Dhungana N, Jang Y, Chaturvedi V, Desmond E. Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA. Emerg Infect Dis. 2019;25(9):1765-1768. https://dx.doi.org/10.3201/eid2509.190380
AMA Li L, Chen K, Dhungana N, et al. Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA. Emerging Infectious Diseases. 2019;25(9):1765-1768. doi:10.3201/eid2509.190380.
APA Li, L., Chen, K., Dhungana, N., Jang, Y., Chaturvedi, V., & Desmond, E. (2019). Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA. Emerging Infectious Diseases, 25(9), 1765-1768. https://dx.doi.org/10.3201/eid2509.190380.

Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis [PDF - 355 KB - 2 pages]
S. M. Rudramurthy et al.

Parathyridaria percutanea is an emerging fungus causing subcutaneous phaeohyphomycoses in renal transplant recipients in India. We identified P. percutanea from a patient with subcutaneous phaeohyphomycosis. From our culture collection, we identified the same fungus from 4 similar patients. We found 5 cases previously described in literature.

EID Rudramurthy SM, Sharma M, Sethuraman N, Dutta P, Tarai B, Savio J, et al. Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis. Emerg Infect Dis. 2019;25(9):1768-1769. https://dx.doi.org/10.3201/eid2509.190383
AMA Rudramurthy SM, Sharma M, Sethuraman N, et al. Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis. Emerging Infectious Diseases. 2019;25(9):1768-1769. doi:10.3201/eid2509.190383.
APA Rudramurthy, S. M., Sharma, M., Sethuraman, N., Dutta, P., Tarai, B., Savio, J....Chakrabarti, A. (2019). Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis. Emerging Infectious Diseases, 25(9), 1768-1769. https://dx.doi.org/10.3201/eid2509.190383.

Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia [PDF - 405 KB - 2 pages]
C. L. Weitzman et al.

Cane toads, an invasive species in Australia, are resistant to fungal pathogens affecting frogs worldwide (Batrachochytrium dendrobatidis). From toad skin swabs, we detected higher proportions of bacteria with antifungal properties in Queensland, where toad and pathogen distributions overlap, than in other sites. This finding suggests that site-specific pathogen pressures help shape skin microbial communities.

EID Weitzman CL, Kaestli M, Gibb K, Brown GP, Shine R, Christian K. Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia. Emerg Infect Dis. 2019;25(9):1770-1771. https://dx.doi.org/10.3201/eid2509.190386
AMA Weitzman CL, Kaestli M, Gibb K, et al. Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia. Emerging Infectious Diseases. 2019;25(9):1770-1771. doi:10.3201/eid2509.190386.
APA Weitzman, C. L., Kaestli, M., Gibb, K., Brown, G. P., Shine, R., & Christian, K. (2019). Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia. Emerging Infectious Diseases, 25(9), 1770-1771. https://dx.doi.org/10.3201/eid2509.190386.

Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia [PDF - 429 KB - 2 pages]
S. P. Nowak et al.

We report a case of Plasmodium knowlesi malaria imported to central Europe from Southeast Asia. Laboratory suspicion of P. knowlesi infection was based on the presence of atypical developmental forms of the parasite in Giemsa-stained microscopic smears. We confirmed and documented the clinical diagnosis by molecular biology techniques.

EID Nowak SP, Zmora P, Pielok Ł, Kuszel Ł, Kierzek R, Stefaniak J, et al. Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia. Emerg Infect Dis. 2019;25(9):1772-1773. https://dx.doi.org/10.3201/eid2509.190445
AMA Nowak SP, Zmora P, Pielok Ł, et al. Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia. Emerging Infectious Diseases. 2019;25(9):1772-1773. doi:10.3201/eid2509.190445.
APA Nowak, S. P., Zmora, P., Pielok, Ł., Kuszel, Ł., Kierzek, R., Stefaniak, J....Paul, M. (2019). Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia. Emerging Infectious Diseases, 25(9), 1772-1773. https://dx.doi.org/10.3201/eid2509.190445.

Bombali Virus in Mops condylurus Bats, Guinea [PDF - 377 KB - 2 pages]
L. S. Karan et al.

In 2018, a previously unknown Ebola virus, Bombali virus, was discovered in Sierra Leone. We describe detection of Bombali virus in Guinea. We found viral RNA in internal organs of 3 Angolan free-tailed bats (Mops condylurus) trapped in the city of N’Zerekore and in a nearby village.

EID Karan LS, Makenov MT, Korneev MG, Sacko N, Boumbaly S, Yakovlev SA, et al. Bombali Virus in Mops condylurus Bats, Guinea. Emerg Infect Dis. 2019;25(9):1774-1775. https://dx.doi.org/10.3201/eid2509.190581
AMA Karan LS, Makenov MT, Korneev MG, et al. Bombali Virus in Mops condylurus Bats, Guinea. Emerging Infectious Diseases. 2019;25(9):1774-1775. doi:10.3201/eid2509.190581.
APA Karan, L. S., Makenov, M. T., Korneev, M. G., Sacko, N., Boumbaly, S., Yakovlev, S. A....Popova, A. Y. (2019). Bombali Virus in Mops condylurus Bats, Guinea. Emerging Infectious Diseases, 25(9), 1774-1775. https://dx.doi.org/10.3201/eid2509.190581.

Blastomycosis Misdiagnosed as Tuberculosis, India [PDF - 699 KB - 2 pages]
A. Kumar et al.

Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non–disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.

EID Kumar A, Kunoor A, Eapen M, Singh P, Chowdhary A. Blastomycosis Misdiagnosed as Tuberculosis, India. Emerg Infect Dis. 2019;25(9):1776-1777. https://dx.doi.org/10.3201/eid2509.190587
AMA Kumar A, Kunoor A, Eapen M, et al. Blastomycosis Misdiagnosed as Tuberculosis, India. Emerging Infectious Diseases. 2019;25(9):1776-1777. doi:10.3201/eid2509.190587.
APA Kumar, A., Kunoor, A., Eapen, M., Singh, P., & Chowdhary, A. (2019). Blastomycosis Misdiagnosed as Tuberculosis, India. Emerging Infectious Diseases, 25(9), 1776-1777. https://dx.doi.org/10.3201/eid2509.190587.

Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients [PDF - 432 KB - 2 pages]
A. Bellanger et al.

We present 2 fatal cases of invasive fungal disease with isavuconazole treatment failure in immunocompromised patients: one with a TR34-L98H azole–resistant Aspergillus fumigatus isolate and the other a RhizomucorA. fumigatus co-infection. Such patients probably require surveillance by galactomannan antigen detection and quantitative PCRs for A. fumigatus and Mucorales fungi.

EID Bellanger A, Berceanu A, Scherer E, Desbrosses Y, Daguindau E, Rocchi S, et al. Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients. Emerg Infect Dis. 2019;25(9):1778-1779. https://dx.doi.org/10.3201/eid2509.190598
AMA Bellanger A, Berceanu A, Scherer E, et al. Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients. Emerging Infectious Diseases. 2019;25(9):1778-1779. doi:10.3201/eid2509.190598.
APA Bellanger, A., Berceanu, A., Scherer, E., Desbrosses, Y., Daguindau, E., Rocchi, S....Millon, L. (2019). Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients. Emerging Infectious Diseases, 25(9), 1778-1779. https://dx.doi.org/10.3201/eid2509.190598.

Potential Fifth Clade of Candida auris, Iran, 2018 [PDF - 672 KB - 2 pages]
N. A. Chow et al.

Four major clades of Candida auris have been described, and all infections have clustered in these 4 clades. We identified an isolate representative of a potential fifth clade, separated from the other clades by >200,000 single-nucleotide polymorphisms, in a patient in Iran who had never traveled outside the country.

EID Chow NA, de Groot T, Badali H, Abastabar M, Chiller TM, Meis JF. Potential Fifth Clade of Candida auris, Iran, 2018. Emerg Infect Dis. 2019;25(9):1780-1781. https://dx.doi.org/10.3201/eid2509.190686
AMA Chow NA, de Groot T, Badali H, et al. Potential Fifth Clade of Candida auris, Iran, 2018. Emerging Infectious Diseases. 2019;25(9):1780-1781. doi:10.3201/eid2509.190686.
APA Chow, N. A., de Groot, T., Badali, H., Abastabar, M., Chiller, T. M., & Meis, J. F. (2019). Potential Fifth Clade of Candida auris, Iran, 2018. Emerging Infectious Diseases, 25(9), 1780-1781. https://dx.doi.org/10.3201/eid2509.190686.

Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019 [PDF - 1.55 MB - 3 pages]
K. Okada et al.

The largest outbreak of dengue fever in Tanzania is ongoing. Dengue virus type 1 was diagnosed in a traveler who returned from Tanzania to Japan. In phylogenetic analysis, the detected strain was close to the Singapore 2015 strain, providing a valuable clue for investigating the dengue outbreak in Tanzania.

EID Okada K, Morita R, Egawa K, Hirai Y, Kaida A, Shirano M, et al. Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019. Emerg Infect Dis. 2019;25(9):1782-1784. https://dx.doi.org/10.3201/eid2509.190814
AMA Okada K, Morita R, Egawa K, et al. Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019. Emerging Infectious Diseases. 2019;25(9):1782-1784. doi:10.3201/eid2509.190814.
APA Okada, K., Morita, R., Egawa, K., Hirai, Y., Kaida, A., Shirano, M....Yamamoto, S. P. (2019). Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019. Emerging Infectious Diseases, 25(9), 1782-1784. https://dx.doi.org/10.3201/eid2509.190814.
Books and Media

Infections of Leisure, Fifth Edition [PDF - 402 KB - 1 page]
K. Fullerton
EID Fullerton K. Infections of Leisure, Fifth Edition. Emerg Infect Dis. 2019;25(9):1785. https://dx.doi.org/10.3201/eid2509.190634
AMA Fullerton K. Infections of Leisure, Fifth Edition. Emerging Infectious Diseases. 2019;25(9):1785. doi:10.3201/eid2509.190634.
APA Fullerton, K. (2019). Infections of Leisure, Fifth Edition. Emerging Infectious Diseases, 25(9), 1785. https://dx.doi.org/10.3201/eid2509.190634.
About the Cover

Beatrix Potter, Author, Naturalist, Mycologist [PDF - 711 KB - 2 pages]
B. Breedlove
EID Breedlove B. Beatrix Potter, Author, Naturalist, Mycologist. Emerg Infect Dis. 2019;25(9):1786-1787. https://dx.doi.org/10.3201/eid2509.ac2509
AMA Breedlove B. Beatrix Potter, Author, Naturalist, Mycologist. Emerging Infectious Diseases. 2019;25(9):1786-1787. doi:10.3201/eid2509.ac2509.
APA Breedlove, B. (2019). Beatrix Potter, Author, Naturalist, Mycologist. Emerging Infectious Diseases, 25(9), 1786-1787. https://dx.doi.org/10.3201/eid2509.ac2509.
Etymologia

Etymologia: Sporothrix schenckii [PDF - 698 KB - 1 page]
F. P. Sellera and C. E. Larsson
EID Sellera FP, Larsson CE. Etymologia: Sporothrix schenckii. Emerg Infect Dis. 2019;25(9):1631. https://dx.doi.org/10.3201/eid2509.et2509
AMA Sellera FP, Larsson CE. Etymologia: Sporothrix schenckii. Emerging Infectious Diseases. 2019;25(9):1631. doi:10.3201/eid2509.et2509.
APA Sellera, F. P., & Larsson, C. E. (2019). Etymologia: Sporothrix schenckii. Emerging Infectious Diseases, 25(9), 1631. https://dx.doi.org/10.3201/eid2509.et2509.
Online Reports

Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers [PDF - 1.19 MB - 6 pages]
S. Barkati et al.

Macaque-related injuries among primate workers can lead to a potentially fatal B virus encephalomyelitis. We describe a decision tool for evaluating the need for antiviral postexposure prophylaxis and provide a retrospective review of the injuries assessed in our center after its implementation in 2010. Among the injuries studied (n = 251), 40.6% were categorized as high-risk (prophylaxis recommended), 44.2% moderate-risk (consider prophylaxis), and 15.1% low-risk (prophylaxis not recommended). Ten percent of low-risk and 98% of high-risk injuries received prophylaxis (p<0.001). Compared with using universal postexposure prophylaxis, using a decision tool can lead to a standardization of practice and a reduction in prescriptions for antiviral medication.

EID Barkati S, Taher H, Beauchamp E, Yansouni CP, Ward BJ, Libman MD. Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers. Emerg Infect Dis. 2019;25(9):1-6. https://dx.doi.org/10.3201/eid2509.190045
AMA Barkati S, Taher H, Beauchamp E, et al. Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers. Emerging Infectious Diseases. 2019;25(9):1-6. doi:10.3201/eid2509.190045.
APA Barkati, S., Taher, H., Beauchamp, E., Yansouni, C. P., Ward, B. J., & Libman, M. D. (2019). Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers. Emerging Infectious Diseases, 25(9), 1-6. https://dx.doi.org/10.3201/eid2509.190045.
Page created: August 21, 2019
Page updated: August 21, 2019
Page reviewed: August 21, 2019
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