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Articles from Emerging Infectious Diseases

Synopses

Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India [PDF - 2.42 MB - 10 pages]
L. Saikia et al.

During March 13–June 23, 2018, anthrax-like cutaneous lesions attributed to the Bacillus cereus group of organisms developed in 12 newborns in India. We traced the source of infection to the healthcare kits used for newborn care. We used multilocus sequence typing to characterize the 19 selected strains from various sources in hospital settings, including the healthcare kits. This analysis revealed the existence of a genetically diverse population comprising mostly new sequence types. Phylogenetic analysis clustered most strains into the previously defined clade I, composed primarily of pathogenic bacilli. We suggest that the synergistic interaction of nonhemolytic enterotoxin and sphingomyelinase might have a role in the development of cutaneous lesions. The infection was controlled by removing the healthcare kits and by implementing an ideal housekeeping program. All the newborns recovered after treatment with ciprofloxacin and amikacin.

EID Saikia L, Gogoi N, Das P, Sarmah A, Punam K, Mahanta B, et al. Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India. Emerg Infect Dis. 2019;25(7):1261-1270. https://dx.doi.org/10.3201/eid2507.181493
AMA Saikia L, Gogoi N, Das P, et al. Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India. Emerging Infectious Diseases. 2019;25(7):1261-1270. doi:10.3201/eid2507.181493.
APA Saikia, L., Gogoi, N., Das, P., Sarmah, A., Punam, K., Mahanta, B....Bora, R. (2019). Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India. Emerging Infectious Diseases, 25(7), 1261-1270. https://dx.doi.org/10.3201/eid2507.181493.

Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015 [PDF - 572 KB - 8 pages]
M. Walters et al.

Pseudomonas aeruginosa is intrinsically resistant to many antimicrobial drugs, making carbapenems crucial in clinical management. During July–October 2015 in the United States, we piloted laboratory-based surveillance for carbapenem-resistant P. aeruginosa (CRPA) at sentinel facilities in Georgia, New Mexico, Oregon, and Tennessee, and population-based surveillance in Monroe County, NY. An incident case was the first P. aeruginosa isolate resistant to antipseudomonal carbapenems from a patient in a 30-day period from any source except the nares, rectum or perirectal area, or feces. We found 294 incident cases among 274 patients. Cases were most commonly identified from respiratory sites (120/294; 40.8%) and urine (111/294; 37.8%); most (223/280; 79.6%) occurred in patients with healthcare facility inpatient stays in the prior year. Genes encoding carbapenemases were identified in 3 (2.3%) of 129 isolates tested. The burden of CRPA was high at facilities under surveillance, but carbapenemase-producing CRPA were rare.

EID Walters M, Grass JE, Bulens SN, Hancock EB, Phipps EC, Muleta D, et al. Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015. Emerg Infect Dis. 2019;25(7):1281-1288. https://dx.doi.org/10.3201/eid2507.181200
AMA Walters M, Grass JE, Bulens SN, et al. Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015. Emerging Infectious Diseases. 2019;25(7):1281-1288. doi:10.3201/eid2507.181200.
APA Walters, M., Grass, J. E., Bulens, S. N., Hancock, E. B., Phipps, E. C., Muleta, D....Kallen, A. (2019). Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015. Emerging Infectious Diseases, 25(7), 1281-1288. https://dx.doi.org/10.3201/eid2507.181200.

Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China [PDF - 588 KB - 8 pages]
F. Huang et al.

The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before–after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.

EID Huang F, van den Hof S, Qu Y, Li Y, Zhang H, Wang L, et al. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China. Emerg Infect Dis. 2019;25(7):1289-1296. https://dx.doi.org/10.3201/eid2507.181417
AMA Huang F, van den Hof S, Qu Y, et al. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China. Emerging Infectious Diseases. 2019;25(7):1289-1296. doi:10.3201/eid2507.181417.
APA Huang, F., van den Hof, S., Qu, Y., Li, Y., Zhang, H., Wang, L....Cobelens, F. (2019). Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China. Emerging Infectious Diseases, 25(7), 1289-1296. https://dx.doi.org/10.3201/eid2507.181417.

Medscape CME Activity
Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013 [PDF - 969 KB - 10 pages]
S. K. Brode et al.

Surveys suggest that clinicians diverge from guidelines when treating Mycobacterium avium complex (MAC) pulmonary disease (PD). To determine prescribing patterns, we conducted a cohort study of adults >66 years of age in Ontario, Canada, with MAC or Mycobacterium xenopi PD during 2001–2013. Using linked laboratory and health administrative databases, we studied the first treatment episode (>60 continuous days of >1 of a macrolide, ethambutol, rifamycin, fluoroquinolone, linezolid, inhaled amikacin, or, for M. xenopi, isoniazid). Treatment was prescribed for 24% MAC and 15% of M. xenopi PD patients. Most commonly prescribed was the recommended combination of macrolide, ethambutol, and rifamycin, for 47% of MAC and 36% of M. xenopi PD patients. Among MAC PD patients, 20% received macrolide monotherapy and 33% received regimens associated with emergent macrolide resistance. Although the most commonly prescribed regimen was guidelines-recommended, many regimens prescribed for MAC PD were associated with emergent macrolide resistance.

EID Brode SK, Chung H, Campitelli MA, Kwong JC, Marchand-Austin A, Winthrop KL, et al. Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013. Emerg Infect Dis. 2019;25(7):1271-1280. https://dx.doi.org/10.3201/eid2507.181817
AMA Brode SK, Chung H, Campitelli MA, et al. Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013. Emerging Infectious Diseases. 2019;25(7):1271-1280. doi:10.3201/eid2507.181817.
APA Brode, S. K., Chung, H., Campitelli, M. A., Kwong, J. C., Marchand-Austin, A., Winthrop, K. L....Marras, T. K. (2019). Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013. Emerging Infectious Diseases, 25(7), 1271-1280. https://dx.doi.org/10.3201/eid2507.181817.
Research

Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017 [PDF - 6.85 MB - 7 pages]
L. Martens et al.

Mycoplasma genitalium infections of the urogenital tract are usually treated with azithromycin; however, for the past several years, rates of azithromycin treatment failure have increased. To document the occurrence and frequency of macrolide resistance–mediating mutations (MRMMs) in M. genitalium infections, we collected 894 M. genitalium–positive samples during April 2014–December 2017 and retrospectively tested them for MRMMs. We designated 67 samples collected within 6 weeks after a positive result as test-of-cure samples; of these, 60 were MRMM positive. Among the remaining 827 samples, the rate of MRMM positivity rose from 22.7% in 2014 and 22.3% in 2015 to 44.4% in 2016 but decreased to 39.7% in 2017. Because of these high rates of MRMMs in M. genitalium infections, we recommend that clinicians perform tests of cure after treatment and that researchers further explore the clinical consequences of this infection.

EID Martens L, Kuster S, de Vos W, Kersten M, Berkhout H, Hagen F. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017. Emerg Infect Dis. 2019;25(7):1297-1303. https://dx.doi.org/10.3201/eid2507.181556
AMA Martens L, Kuster S, de Vos W, et al. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017. Emerging Infectious Diseases. 2019;25(7):1297-1303. doi:10.3201/eid2507.181556.
APA Martens, L., Kuster, S., de Vos, W., Kersten, M., Berkhout, H., & Hagen, F. (2019). Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017. Emerging Infectious Diseases, 25(7), 1297-1303. https://dx.doi.org/10.3201/eid2507.181556.

Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus [PDF - 6.89 MB - 10 pages]
J. Fuchs et al.

Bourbon virus (BRBV) is a recently discovered tick-transmitted viral pathogen that is prevalent in the Midwest and southern United States. Since 2014, zoonotic BRBV infections have been verified in several human cases of severe febrile illness, occasionally with fatal outcomes, indicating a possible public health threat. We analyzed the pathology of BRBV infection in mice and found a high sensitivity of the virus to the host interferon system. Infected standard laboratory mice did not show clinical signs or virus replication. However, in mice carrying defects in the type I and type II interferon system, the virus grew to high titers and caused severe pathology. In cell culture, BRBV was blocked by antiviral agents like ribavirin and favipiravir (T705). Our data suggest that persons having severe BRBV infection might have a deficiency in their innate immunity and could benefit from an already approved antiviral treatment.

EID Fuchs J, Straub T, Seidl M, Kochs G. Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus. Emerg Infect Dis. 2019;25(7):1304-1313. https://dx.doi.org/10.3201/eid2507.181062
AMA Fuchs J, Straub T, Seidl M, et al. Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus. Emerging Infectious Diseases. 2019;25(7):1304-1313. doi:10.3201/eid2507.181062.
APA Fuchs, J., Straub, T., Seidl, M., & Kochs, G. (2019). Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus. Emerging Infectious Diseases, 25(7), 1304-1313. https://dx.doi.org/10.3201/eid2507.181062.

Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis [PDF - 1.08 MB - 6 pages]
F. S. Nascimento et al.

Cyclosporiasis is an infection caused by Cyclospora cayetanensis, which is acquired by consumption of contaminated fresh food or water. In the United States, cases of cyclosporiasis are often associated with foodborne outbreaks linked to imported fresh produce or travel to disease-endemic countries. Epidemiologic investigation has been the primary method for linking outbreak cases. A molecular typing marker that can identify genetically related samples would be helpful in tracking outbreaks. We evaluated the mitochondrial junction region as a potential genotyping marker. We tested stool samples from 134 laboratory-confirmed cases in the United States by using PCR and Sanger sequencing. All but 2 samples were successfully typed and divided into 14 sequence types. Typing results were identical among samples within each epidemiologically defined case cluster for 7 of 10 clusters. These findings suggest that this marker can distinguish between distinct case clusters and might be helpful during cyclosporiasis outbreak investigations.

EID Nascimento FS, Barta JR, Whale J, Hofstetter JN, Casillas S, Barratt J, et al. Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis. Emerg Infect Dis. 2019;25(7):1314-1319. https://dx.doi.org/10.3201/eid2507.181447
AMA Nascimento FS, Barta JR, Whale J, et al. Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis. Emerging Infectious Diseases. 2019;25(7):1314-1319. doi:10.3201/eid2507.181447.
APA Nascimento, F. S., Barta, J. R., Whale, J., Hofstetter, J. N., Casillas, S., Barratt, J....Qvarnstrom, Y. (2019). Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis. Emerging Infectious Diseases, 25(7), 1314-1319. https://dx.doi.org/10.3201/eid2507.181447.

Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom [PDF - 1.93 MB - 10 pages]
B. S. Lopes et al.

We examined whole-genome–sequenced Campylobacter jejuni and C. coli from 2012–2015 isolated from birds and human stool samples in North East Scotland for the presence of antimicrobial resistance genes. We found that sequence type (ST) 5136 (clonal complex 464) was the most prevalent multidrug-resistant strain of C. jejuni exclusively associated with poultry host reservoirs and recovered from human cases of campylobacteriosis. Tetracycline resistance in ST5136 isolates was due to a tet(O/32/O) mosaic gene, ampicillin resistance was conferred by G → T transversion in the −10 promoter region of blaOXA-193, fluoroquinolone resistance was due to C257T change in gyrA, and aminoglycoside resistance was conferred by aac. Whole-genome analysis showed that the strain ST5136 evolved from ST464. The nationwide emergence of ST5136 was probably due to stepwise acquisition of antimicrobial resistance genes selected by high use of β-lactam, tetracycline, fluoroquinolone, and aminoglycoside classes of drugs in the poultry industry.

EID Lopes BS, Strachan N, Ramjee M, Thomson A, MacRae M, Shaw S, et al. Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom. Emerg Infect Dis. 2019;25(7):1320-1329. https://dx.doi.org/10.3201/eid2507.181572
AMA Lopes BS, Strachan N, Ramjee M, et al. Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom. Emerging Infectious Diseases. 2019;25(7):1320-1329. doi:10.3201/eid2507.181572.
APA Lopes, B. S., Strachan, N., Ramjee, M., Thomson, A., MacRae, M., Shaw, S....Forbes, K. J. (2019). Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom. Emerging Infectious Diseases, 25(7), 1320-1329. https://dx.doi.org/10.3201/eid2507.181572.

High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015–2018 [PDF - 1.81 MB - 9 pages]
B. Yakubu et al.

The mass migration that occurred during 2009–2013 and after the insurgency in northeastern Nigeria could have increased malaria incidence and Plasmodium falciparum genetic diversity in North Central Nigeria. To determine P. falciparum sequence diversity in this region, we screened 282 samples collected in regional clinics during 2015–2018 for Plasmodium spp. and, with positive samples, determined P. falciparum infection complexity and allele diversity using PCR. Of 34 P. falciparum–positive samples, 39 msp1, 31 msp2, and 13 glurp alleles were detected, and 88% of infections were polyclonal. We identified trimorphic and dimorphic allele combinations in a high percentage of samples, indicative of a high infection complexity in the study population. High genetic diversity is a catalyst for the evolution of drug-resistant alleles. Improved measures (e.g., better drug quality, diagnostics) are needed to control P. falciparum transmission and reduce the potential for the emergence of drug resistance in Nigeria.

EID Yakubu B, Longdet I, Horsefield T, Davou D, Obishakin E. High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015–2018. Emerg Infect Dis. 2019;25(7):1330-1338. https://dx.doi.org/10.3201/eid2507.181614
AMA Yakubu B, Longdet I, Horsefield T, et al. High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015–2018. Emerging Infectious Diseases. 2019;25(7):1330-1338. doi:10.3201/eid2507.181614.
APA Yakubu, B., Longdet, I., Horsefield, T., Davou, D., & Obishakin, E. (2019). High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015–2018. Emerging Infectious Diseases, 25(7), 1330-1338. https://dx.doi.org/10.3201/eid2507.181614.

Medscape CME Activity
Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016 [PDF - 866 KB - 8 pages]
P. A. Armstrong et al.

Candida auris is an emerging multidrug-resistant fungus that causes hospital-associated outbreaks of invasive infections with high death rates. During 2015–2016, health authorities in Colombia detected an outbreak of C. auris. We conducted an investigation to characterize the epidemiology, transmission mechanisms, and reservoirs of this organism. We investigated 4 hospitals with confirmed cases of C. auris candidemia in 3 cities in Colombia. We abstracted medical records and collected swabs from contemporaneously hospitalized patients to assess for skin colonization. We identified 40 cases; median patient age was 23 years (IQR 4 months–56 years). Twelve (30%) patients were <1 year of age, and 24 (60%) were male. The 30-day mortality was 43%. Cases clustered in time and location; axilla and groin were the most commonly colonized sites. Temporal and spatial clustering of cases and skin colonization suggest person-to-person transmission of C. auris. These cases highlight the importance of adherence to infection control recommendations.

EID Armstrong PA, Rivera SM, Escandon P, Caceres DH, Chow N, Stuckey MJ, et al. Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016. Emerg Infect Dis. 2019;25(7):1339-1346. https://dx.doi.org/10.3201/eid2507.180491
AMA Armstrong PA, Rivera SM, Escandon P, et al. Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016. Emerging Infectious Diseases. 2019;25(7):1339-1346. doi:10.3201/eid2507.180491.
APA Armstrong, P. A., Rivera, S. M., Escandon, P., Caceres, D. H., Chow, N., Stuckey, M. J....Pacheco, O. (2019). Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016. Emerging Infectious Diseases, 25(7), 1339-1346. https://dx.doi.org/10.3201/eid2507.180491.

Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands [PDF - 450 KB - 7 pages]
S. E. Schoustra et al.

Azole resistance is a major concern for treatment of infections with Aspergillus fumigatus. Environmental resistance selection is a main route for Aspergillus spp. to acquire azole resistance. We investigated the presence of environmental hotspots for resistance selection in the Netherlands on the basis of the ability of A. fumigatus to grow and reproduce in the presence of azole fungicide residues. We identified 3 hotspots: flower bulb waste, green waste material, and wood chippings. We recovered azole-resistant A. fumigatus from these sites; all fungi contained cyp51A tandem repeat–mediated resistance mechanisms identical to those found in clinical isolates. Tebuconazole, epoxiconazole, and prothioconazole were the most frequently found fungicide residues. Stockpiles of plant waste contained the highest levels of azole-resistant A. fumigatus, and active aerobic composting reduced Aspergillus colony counts. Preventing plant waste stockpiling or creating unfavorable conditions for A. fumigatus to grow in stockpiles might reduce environmental resistance burden.

EID Schoustra SE, Debets A, Rijs A, Zhang J, Snelders E, Leendertse PC, et al. Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands. Emerg Infect Dis. 2019;25(7):1347-1353. https://dx.doi.org/10.3201/eid2507.181625
AMA Schoustra SE, Debets A, Rijs A, et al. Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands. Emerging Infectious Diseases. 2019;25(7):1347-1353. doi:10.3201/eid2507.181625.
APA Schoustra, S. E., Debets, A., Rijs, A., Zhang, J., Snelders, E., Leendertse, P. C....Verweij, P. E. (2019). Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands. Emerging Infectious Diseases, 25(7), 1347-1353. https://dx.doi.org/10.3201/eid2507.181625.

Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013 [PDF - 758 KB - 9 pages]
S. Ly et al.

We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5–30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1–capture ELISA. We used multivariable Poisson regressions to explore links between participants’ DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.

EID Ly S, Fortas C, Duong V, Benmarhnia T, Sakuntabhai A, Paul R, et al. Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013. Emerg Infect Dis. 2019;25(7):1354-1362. https://dx.doi.org/10.3201/eid2507.181794
AMA Ly S, Fortas C, Duong V, et al. Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013. Emerging Infectious Diseases. 2019;25(7):1354-1362. doi:10.3201/eid2507.181794.
APA Ly, S., Fortas, C., Duong, V., Benmarhnia, T., Sakuntabhai, A., Paul, R....Tarantola, A. (2019). Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013. Emerging Infectious Diseases, 25(7), 1354-1362. https://dx.doi.org/10.3201/eid2507.181794.
Historical Review

Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era [PDF - 2.45 MB - 7 pages]
A. S. Bandyopadhyay et al.

The Global Polio Eradication Initiative continues to make progress toward the eradication target. Indigenous wild poliovirus (WPV) type 2 was last detected in 1999, WPV type 3 was last detected in 2012, and over the past 2 years WPV type 1 has been detected only in parts of 2 countries (Afghanistan and Pakistan). Once the eradication of poliomyelitis is achieved, infectious and potentially infectious poliovirus materials retained in laboratories, vaccine production sites, and other storage facilities will continue to pose a risk for poliovirus reintroduction into communities. The recent breach in containment of WPV type 2 in an inactivated poliovirus vaccine manufacturing site in the Netherlands prompted this review, which summarizes information on facility-associated release of polioviruses into communities reported over >8 decades. Successful polio eradication requires the management of poliovirus containment posteradication to prevent the consequences of the reestablishment of poliovirus transmission.

EID Bandyopadhyay AS, Singh H, Fournier-Caruana J, Modlin JF, Wenger J, Partridge J, et al. Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era. Emerg Infect Dis. 2019;25(7):1363-1369. https://dx.doi.org/10.3201/eid2507.181703
AMA Bandyopadhyay AS, Singh H, Fournier-Caruana J, et al. Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era. Emerging Infectious Diseases. 2019;25(7):1363-1369. doi:10.3201/eid2507.181703.
APA Bandyopadhyay, A. S., Singh, H., Fournier-Caruana, J., Modlin, J. F., Wenger, J., Partridge, J....Zaffran, M. J. (2019). Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era. Emerging Infectious Diseases, 25(7), 1363-1369. https://dx.doi.org/10.3201/eid2507.181703.
Dispatches

Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene [PDF - 1.16 MB - 3 pages]
A. Multani et al.

We report a case of chagasic encephalitis diagnosed by 28S rRNA sequencing. The diagnosis of chagasic encephalitis is challenging, given the broad differential diagnosis for central nervous system lesions in immunocompromised patients and low sensitivity of traditional diagnostics. Sequencing should be part of the diagnostic armamentarium for potential chagasic encephalitis.

EID Multani A, Meer A, Smith DS, Kheraj MN, Plowey ED, Blackburn BG. Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene. Emerg Infect Dis. 2019;25(7):1370-1372. https://dx.doi.org/10.3201/eid2507.180285
AMA Multani A, Meer A, Smith DS, et al. Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene. Emerging Infectious Diseases. 2019;25(7):1370-1372. doi:10.3201/eid2507.180285.
APA Multani, A., Meer, A., Smith, D. S., Kheraj, M. N., Plowey, E. D., & Blackburn, B. G. (2019). Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene. Emerging Infectious Diseases, 25(7), 1370-1372. https://dx.doi.org/10.3201/eid2507.180285.

Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018 [PDF - 2.65 MB - 4 pages]
V. J. Cornelisse et al.

We describe a sexual network consisting of 1 nonbinary-gendered participant and 2 male and 4 female participants in Australia, 2018. Six of 7 participants had oropharyngeal gonorrhea in the absence of urogenital gonorrhea. This observation supports a new paradigm of gonorrhea transmission in which oropharyngeal gonorrhea can be transmitted through tongue kissing.

EID Cornelisse VJ, Bradshaw CS, Chow E, Williamson DA, Fairley CK. Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018. Emerg Infect Dis. 2019;25(7):1373-1376. https://dx.doi.org/10.3201/eid2507.181561
AMA Cornelisse VJ, Bradshaw CS, Chow E, et al. Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018. Emerging Infectious Diseases. 2019;25(7):1373-1376. doi:10.3201/eid2507.181561.
APA Cornelisse, V. J., Bradshaw, C. S., Chow, E., Williamson, D. A., & Fairley, C. K. (2019). Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018. Emerging Infectious Diseases, 25(7), 1373-1376. https://dx.doi.org/10.3201/eid2507.181561.

Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis [PDF - 988 KB - 3 pages]
B. L. Arruda et al.

Salmonella enterica serotype I 4,[5],12:i:- has been increasingly isolated from swine. However, its pathogenic potential is not well characterized. Analysis of swine cases confirmed a strong positive association between isolation of I 4,[5],12:i:- and lesions of enteric salmonellosis and suggested a similar pathogenic potential as that for Salmonella Typhimurium.

EID Arruda BL, Burrough ER, Schwartz KJ. Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis. Emerg Infect Dis. 2019;25(7):1377-1379. https://dx.doi.org/10.3201/eid2507.181453
AMA Arruda BL, Burrough ER, Schwartz KJ. Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis. Emerging Infectious Diseases. 2019;25(7):1377-1379. doi:10.3201/eid2507.181453.
APA Arruda, B. L., Burrough, E. R., & Schwartz, K. J. (2019). Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis. Emerging Infectious Diseases, 25(7), 1377-1379. https://dx.doi.org/10.3201/eid2507.181453.

Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers [PDF - 1.12 MB - 4 pages]
C. Langelier et al.

We used metagenomic next-generation sequencing to longitudinally assess the gut microbiota and antimicrobial resistomes of international travelers to clarify global exchange of resistant organisms. Travel resulted in an increase in antimicrobial resistance genes and a greater proportion of Escherichia species within gut microbial communities without impacting diversity.

EID Langelier C, Graves M, Kalantar K, Caldera S, Durrant R, Fisher M, et al. Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers. Emerg Infect Dis. 2019;25(7):1380-1383. https://dx.doi.org/10.3201/eid2507.181492
AMA Langelier C, Graves M, Kalantar K, et al. Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers. Emerging Infectious Diseases. 2019;25(7):1380-1383. doi:10.3201/eid2507.181492.
APA Langelier, C., Graves, M., Kalantar, K., Caldera, S., Durrant, R., Fisher, M....Leung, D. T. (2019). Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers. Emerging Infectious Diseases, 25(7), 1380-1383. https://dx.doi.org/10.3201/eid2507.181492.

Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018 [PDF - 1.90 MB - 5 pages]
R. Elling et al.

In 2018, a cluster of pediatric human parechovirus (HPeV) infections in 2 neighboring German hospitals was detected. Viral protein 1 sequence analysis demonstrated co-circulation of different HPeV-3 sublineages and of HPeV-1 and -5 strains, thereby excluding a nosocomial outbreak. Our findings underline the need for HPeV diagnostics and sequence analysis for outbreak investigations.

EID Elling R, Böttcher S, du Bois F, Müller A, Prifert C, Weissbrich B, et al. Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018. Emerg Infect Dis. 2019;25(7):1384-1388. https://dx.doi.org/10.3201/eid2507.190257
AMA Elling R, Böttcher S, du Bois F, et al. Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018. Emerging Infectious Diseases. 2019;25(7):1384-1388. doi:10.3201/eid2507.190257.
APA Elling, R., Böttcher, S., du Bois, F., Müller, A., Prifert, C., Weissbrich, B....Panning, M. (2019). Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018. Emerging Infectious Diseases, 25(7), 1384-1388. https://dx.doi.org/10.3201/eid2507.190257.

Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA [PDF - 1011 KB - 5 pages]
K. Rizzo et al.

We analyzed antimicrobial susceptibility test results reported in healthcare-associated infections by California hospitals during 2014–2017. Approximately 3.2% of Enterobacteriaceae reported in healthcare-associated infections were resistant to carbapenems and 26.9% were resistant to cephalosporins. The proportion of cephalosporin-resistant Escherichia coli increased 7% (risk ratio 1.07, 95% CI 1.04–1.11) per year during 2014–2017.

EID Rizzo K, Horwich-Scholefield S, Epson E. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA. Emerg Infect Dis. 2019;25(7):1389-1393. https://dx.doi.org/10.3201/eid2507.181938
AMA Rizzo K, Horwich-Scholefield S, Epson E. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA. Emerging Infectious Diseases. 2019;25(7):1389-1393. doi:10.3201/eid2507.181938.
APA Rizzo, K., Horwich-Scholefield, S., & Epson, E. (2019). Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA. Emerging Infectious Diseases, 25(7), 1389-1393. https://dx.doi.org/10.3201/eid2507.181938.

Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting [PDF - 383 KB - 3 pages]
J. Voermans et al.

We evaluated the benefit of whole blood versus plasma to detect acute Zika virus infections. Comparison of Zika virus quantitative reverse transcription PCR results in single timepoint whole blood–plasma pairs from 227 patients with suspected Zika virus infection resulted in confirmation of 8 additional patients with Zika virus infection.

EID Voermans J, Pas, SD, van der Linden A, GeurtsvanKessel C, Koopmans M, van der Eijk A, et al. Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting. Emerg Infect Dis. 2019;25(7):1394-1396. https://dx.doi.org/10.3201/eid2507.182000
AMA Voermans J, Pas, SD, van der Linden A, et al. Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting. Emerging Infectious Diseases. 2019;25(7):1394-1396. doi:10.3201/eid2507.182000.
APA Voermans, J., Pas,, S. D., van der Linden, A., GeurtsvanKessel, C., Koopmans, M., van der Eijk, A....Reusken, C. (2019). Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting. Emerging Infectious Diseases, 25(7), 1394-1396. https://dx.doi.org/10.3201/eid2507.182000.

Dengue Outbreak during Ongoing Civil War, Taiz, Yemen [PDF - 621 KB - 4 pages]
K. A. Alghazali et al.

We identified dengue in ≈51% of patients given a clinical diagnosis of suspected dengue in Taiz, Yemen, during 2016. The cosmopolitan genotype of dengue virus type 2 was most common; viruses appeared to have originated in Saudi Arabia. Damage to public health infrastructure during the ongoing civil war might enable dengue to become endemic to Yemen.

EID Alghazali KA, Teoh B, Loong S, Sam S, Che-Mat-Seri N, Samsudin N, et al. Dengue Outbreak during Ongoing Civil War, Taiz, Yemen. Emerg Infect Dis. 2019;25(7):1397-1400. https://dx.doi.org/10.3201/eid2507.180046
AMA Alghazali KA, Teoh B, Loong S, et al. Dengue Outbreak during Ongoing Civil War, Taiz, Yemen. Emerging Infectious Diseases. 2019;25(7):1397-1400. doi:10.3201/eid2507.180046.
APA Alghazali, K. A., Teoh, B., Loong, S., Sam, S., Che-Mat-Seri, N., Samsudin, N....AbuBakar, S. (2019). Dengue Outbreak during Ongoing Civil War, Taiz, Yemen. Emerging Infectious Diseases, 25(7), 1397-1400. https://dx.doi.org/10.3201/eid2507.180046.

Nontuberculous Mycobacteria, Botswana, 2011–2014 [PDF - 1.20 MB - 3 pages]
B. Mbeha et al.

We documented a 6-fold increase in the frequency of nontuberculous mycobacteria isolated from clinical samples in Botswana during 2011–2014. Because antituberculosis treatment is often initiated only on the basis of acid-fast bacilli smear-positive microscopy results, some patients with nontuberculous mycobacterial infections might have received inappropriate treatment.

EID Mbeha B, Mine M, Motswaledi M, Dewar J. Nontuberculous Mycobacteria, Botswana, 2011–2014. Emerg Infect Dis. 2019;25(7):1401-1403. https://dx.doi.org/10.3201/eid2507.181440
AMA Mbeha B, Mine M, Motswaledi M, et al. Nontuberculous Mycobacteria, Botswana, 2011–2014. Emerging Infectious Diseases. 2019;25(7):1401-1403. doi:10.3201/eid2507.181440.
APA Mbeha, B., Mine, M., Motswaledi, M., & Dewar, J. (2019). Nontuberculous Mycobacteria, Botswana, 2011–2014. Emerging Infectious Diseases, 25(7), 1401-1403. https://dx.doi.org/10.3201/eid2507.181440.

Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak [PDF - 1.11 MB - 4 pages]
A. Fall et al.

To retrospectively investigate enterovirus D68 circulation in Senegal during the 2014 US outbreak, we retrieved specimens from 708 persons, mostly children, who had acute respiratory symptoms during September–December 2014. Enterovirus D68 was detected in 14 children (2.1%); most cases occurred in October. Phylogenetic analysis revealed that all strains clustered within subclade A1.

EID Fall A, Jallow M, Kebe O, Kiori D, Sy S, Goudiaby D, et al. Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak. Emerg Infect Dis. 2019;25(7):1404-1407. https://dx.doi.org/10.3201/eid2507.181441
AMA Fall A, Jallow M, Kebe O, et al. Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak. Emerging Infectious Diseases. 2019;25(7):1404-1407. doi:10.3201/eid2507.181441.
APA Fall, A., Jallow, M., Kebe, O., Kiori, D., Sy, S., Goudiaby, D....Dia, N. (2019). Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak. Emerging Infectious Diseases, 25(7), 1404-1407. https://dx.doi.org/10.3201/eid2507.181441.

Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA [PDF - 552 KB - 4 pages]
J. Boonyaratanakornkit et al.

Homelessness has not previously been identified as a risk factor for respiratory syncytial virus (RSV) infection. We conducted an observational study at an urban safety-net hospital in Washington, USA, during 2012–2017. Hospitalized adults with RSV were more likely to be homeless, and several clinical outcome measures were worse with RSV than with influenza.

EID Boonyaratanakornkit J, Ekici S, Magaret A, Gustafson K, Scott E, Haglund M, et al. Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA. Emerg Infect Dis. 2019;25(7):1408-1411. https://dx.doi.org/10.3201/eid2507.181261
AMA Boonyaratanakornkit J, Ekici S, Magaret A, et al. Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA. Emerging Infectious Diseases. 2019;25(7):1408-1411. doi:10.3201/eid2507.181261.
APA Boonyaratanakornkit, J., Ekici, S., Magaret, A., Gustafson, K., Scott, E., Haglund, M....Chu, H. Y. (2019). Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA. Emerging Infectious Diseases, 25(7), 1408-1411. https://dx.doi.org/10.3201/eid2507.181261.
Research Letters

Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017 [PDF - 352 KB - 3 pages]
J. Lin et al.

Using 16S rRNA and rpoB gene sequencing, we identified 6 patients infected with Elizabethkingia bruuniana treated at E-Da Hospital (Kaohsiung, Taiwan) during 2005–2017. We describe patient characteristics and the molecular characteristics of the E. bruuniana isolates, including their MICs. Larger-scale studies are needed for more robust characterization of this pathogen.

EID Lin J, Lai C, Yang C, Huang Y, Lin H. Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017. Emerg Infect Dis. 2019;25(7):1412-1414. https://dx.doi.org/10.3201/eid2507.180768
AMA Lin J, Lai C, Yang C, et al. Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017. Emerging Infectious Diseases. 2019;25(7):1412-1414. doi:10.3201/eid2507.180768.
APA Lin, J., Lai, C., Yang, C., Huang, Y., & Lin, H. (2019). Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017. Emerging Infectious Diseases, 25(7), 1412-1414. https://dx.doi.org/10.3201/eid2507.180768.

Human Enterovirus C105, China, 2017 [PDF - 444 KB - 3 pages]
M. Li et al.

We report a case of enterovirus C105 infection in an 11-year-old girl with lower respiratory tract symptoms that was identified through the Respiratory Virus Surveillance System, which covers 30 sentinel hospitals in all 16 districts of Beijing, China. The presence of this virus strain in China confirmed its geographically wide distribution.

EID Li M, Zhang T, Gong C, Li A, Luo M, Dong M, et al. Human Enterovirus C105, China, 2017. Emerg Infect Dis. 2019;25(7):1414-1416. https://dx.doi.org/10.3201/eid2507.180874
AMA Li M, Zhang T, Gong C, et al. Human Enterovirus C105, China, 2017. Emerging Infectious Diseases. 2019;25(7):1414-1416. doi:10.3201/eid2507.180874.
APA Li, M., Zhang, T., Gong, C., Li, A., Luo, M., Dong, M....Huang, F. (2019). Human Enterovirus C105, China, 2017. Emerging Infectious Diseases, 25(7), 1414-1416. https://dx.doi.org/10.3201/eid2507.180874.

Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans [PDF - 381 KB - 3 pages]
D. González et al.

The distribution of the chytrid fungus Batrachochytrium salamandrivorans continues to expand in Europe. During 2014–2018, we collected 1,135 samples from salamanders and newts in 6 countries in Europe. We identified 5 cases of B. salamandrivorans in a wild population in Spain but none in central Europe or the Balkan Peninsula.

EID González D, Baláž V, Solský M, Thumsová B, Kolenda K, Najbar A, et al. Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans. Emerg Infect Dis. 2019;25(7):1416-1418. https://dx.doi.org/10.3201/eid2507.181001
AMA González D, Baláž V, Solský M, et al. Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans. Emerging Infectious Diseases. 2019;25(7):1416-1418. doi:10.3201/eid2507.181001.
APA González, D., Baláž, V., Solský, M., Thumsová, B., Kolenda, K., Najbar, A....Vojar, J. (2019). Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans. Emerging Infectious Diseases, 25(7), 1416-1418. https://dx.doi.org/10.3201/eid2507.181001.

Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy [PDF - 579 KB - 3 pages]
E. Mancuso et al.

We detected Crimean-Congo hemorrhagic fever virus in a Hyalomma rufipes nymph collected from a whinchat (Saxicola rubetra) on the island of Ventotene in April 2017. Partial genome sequences suggest the virus originated in Africa. Detection of the genome of this virus in Italy confirms its potential dispersion through migratory birds.

EID Mancuso E, Toma L, Polci A, d’Alessio SG, Di Luca M, Orsini M, et al. Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy. Emerg Infect Dis. 2019;25(7):1418-1420. https://dx.doi.org/10.3201/eid2507.181345
AMA Mancuso E, Toma L, Polci A, et al. Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy. Emerging Infectious Diseases. 2019;25(7):1418-1420. doi:10.3201/eid2507.181345.
APA Mancuso, E., Toma, L., Polci, A., d’Alessio, S. G., Di Luca, M., Orsini, M....Monaco, F. (2019). Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy. Emerging Infectious Diseases, 25(7), 1418-1420. https://dx.doi.org/10.3201/eid2507.181345.

Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018 [PDF - 674 KB - 3 pages]
R. Hua et al.

We report a sheep infected with Echinococcus canadensis G8 tapeworm in China in 2018. This pathogen was previously detected in moose, elk, muskox, and mule deer in Europe and North America; our findings suggest a wider host range and geographic distribution. Surveillance for the G8 tapeworm should be conducted in China.

EID Hua R, Xie Y, Song H, Shi Y, Zhan J, Wu M, et al. Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018. Emerg Infect Dis. 2019;25(7):1420-1422. https://dx.doi.org/10.3201/eid2507.181585
AMA Hua R, Xie Y, Song H, et al. Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018. Emerging Infectious Diseases. 2019;25(7):1420-1422. doi:10.3201/eid2507.181585.
APA Hua, R., Xie, Y., Song, H., Shi, Y., Zhan, J., Wu, M....Yang, G. (2019). Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018. Emerging Infectious Diseases, 25(7), 1420-1422. https://dx.doi.org/10.3201/eid2507.181585.

Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain [PDF - 387 KB - 3 pages]
R. Rodríguez-Pastor et al.

We detected Francisella tularensis and Bartonella spp. in fleas parasitizing common voles (Microtus arvalis) from northwestern Spain; mean prevalence was 6.1% for F. tularensis and 51% for Bartonella spp. Contrasted vector–host associations in the prevalence of these bacteria suggest that fleas have distinct roles in the transmission cycle of each pathogen in nature.

EID Rodríguez-Pastor R, Mougeot F, Vidal M, Jado I, González-Martín-Niño RM, Escudero R, et al. Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain. Emerg Infect Dis. 2019;25(7):1423-1425. https://dx.doi.org/10.3201/eid2507.181646
AMA Rodríguez-Pastor R, Mougeot F, Vidal M, et al. Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain. Emerging Infectious Diseases. 2019;25(7):1423-1425. doi:10.3201/eid2507.181646.
APA Rodríguez-Pastor, R., Mougeot, F., Vidal, M., Jado, I., González-Martín-Niño, R. M., Escudero, R....Luque-Larena, J. (2019). Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain. Emerging Infectious Diseases, 25(7), 1423-1425. https://dx.doi.org/10.3201/eid2507.181646.

Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa [PDF - 543 KB - 3 pages]
R. L. Higgitt et al.

We screened African wild dogs (Lycaon pictus) in Kruger National Park, South Africa, for Mycobacterium bovis infection using an interferon-gamma release assay. We detected M. bovis sensitization in 20 of 21 packs; overall apparent infection prevalence was 83%. These animals experience high infection pressure, which may affect long-term survival and conservation strategies.

EID Higgitt RL, Louis van Schalkwyk O, de Klerk-Lorist L, Buss PE, Caldwell P, Rossouw L, et al. Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa. Emerg Infect Dis. 2019;25(7):1425-1427. https://dx.doi.org/10.3201/eid2507.181653
AMA Higgitt RL, Louis van Schalkwyk O, de Klerk-Lorist L, et al. Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa. Emerging Infectious Diseases. 2019;25(7):1425-1427. doi:10.3201/eid2507.181653.
APA Higgitt, R. L., Louis van Schalkwyk, O., de Klerk-Lorist, L., Buss, P. E., Caldwell, P., Rossouw, L....Miller, M. A. (2019). Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa. Emerging Infectious Diseases, 25(7), 1425-1427. https://dx.doi.org/10.3201/eid2507.181653.

Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China [PDF - 382 KB - 3 pages]
S. Chen et al.

In 2016, we identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in China. The strain genotype was identical to the resistant clone FC428 that originated in Japan. Enhanced international collaborative surveillance programs are crucial to track the transmission of the ceftriaxone-resistant clones.

EID Chen S, Han Y, Yuan L, Zhu X, Yin Y. Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China. Emerg Infect Dis. 2019;25(7):1427-1429. https://dx.doi.org/10.3201/eid2507.190172
AMA Chen S, Han Y, Yuan L, et al. Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China. Emerging Infectious Diseases. 2019;25(7):1427-1429. doi:10.3201/eid2507.190172.
APA Chen, S., Han, Y., Yuan, L., Zhu, X., & Yin, Y. (2019). Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China. Emerging Infectious Diseases, 25(7), 1427-1429. https://dx.doi.org/10.3201/eid2507.190172.

Disseminated Metacestode Versteria Species Infection in Woman, Pennsylvania, USA [PDF - 590 KB - 3 pages]
B. Lehman et al.

A patient in Pennsylvania, USA, with common variable immunodeficiency sought care for fever, cough, and abdominal pain. Imaging revealed lesions involving multiple organs. Liver resection demonstrated necrotizing granulomas, recognizable tegument, and calcareous corpuscles indicative of an invasive cestode infection. Sequencing revealed 98% identity to a Versteria species of cestode found in mink.

EID Lehman B, Leal SM, Procop GW, O’Connell E, Shaik J, Nash TE, et al. Disseminated Metacestode Versteria Species Infection in Woman, Pennsylvania, USA. Emerg Infect Dis. 2019;25(7):1429-1431. https://dx.doi.org/10.3201/eid2507.190223
AMA Lehman B, Leal SM, Procop GW, et al. Disseminated Metacestode Versteria Species Infection in Woman, Pennsylvania, USA. Emerging Infectious Diseases. 2019;25(7):1429-1431. doi:10.3201/eid2507.190223.
APA Lehman, B., Leal, S. M., Procop, G. W., O’Connell, E., Shaik, J., Nash, T. E....Banzon, J. (2019). Disseminated Metacestode Versteria Species Infection in Woman, Pennsylvania, USA. Emerging Infectious Diseases, 25(7), 1429-1431. https://dx.doi.org/10.3201/eid2507.190223.

Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa [PDF - 365 KB - 3 pages]
W. Takken and S. Lindsay

Malaria continues to be a major health threat in Africa, mainly in rural areas. Recently, the urban malaria vector Anopheles stephensi invaded Djibouti and Ethiopia, potentially spreading to other areas of Africa. Urgent action is needed to prevent urban malaria epidemics from emerging and causing a public health disaster.

EID Takken W, Lindsay S. Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa. Emerg Infect Dis. 2019;25(7):1431-1433. https://dx.doi.org/10.3201/eid2507.190301
AMA Takken W, Lindsay S. Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa. Emerging Infectious Diseases. 2019;25(7):1431-1433. doi:10.3201/eid2507.190301.
APA Takken, W., & Lindsay, S. (2019). Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa. Emerging Infectious Diseases, 25(7), 1431-1433. https://dx.doi.org/10.3201/eid2507.190301.

Outbreak of African Swine Fever, Vietnam, 2019 [PDF - 569 KB - 3 pages]
V. Le et al.

African swine fever is one of the most dangerous diseases of swine. We confirmed the 2019 outbreak in Vietnam by real-time reverse transcription PCR. The causative strain belonged to p72 genotype II and was 100% identical with viruses isolated in China (2018) and Georgia (2007). International prevention and control collaboration is needed.

EID Le V, Jeong D, Yoon S, Kwon H, Trinh T, Nguyen T, et al. Outbreak of African Swine Fever, Vietnam, 2019. Emerg Infect Dis. 2019;25(7):1433-1435. https://dx.doi.org/10.3201/eid2507.190303
AMA Le V, Jeong D, Yoon S, et al. Outbreak of African Swine Fever, Vietnam, 2019. Emerging Infectious Diseases. 2019;25(7):1433-1435. doi:10.3201/eid2507.190303.
APA Le, V., Jeong, D., Yoon, S., Kwon, H., Trinh, T., Nguyen, T....Song, D. (2019). Outbreak of African Swine Fever, Vietnam, 2019. Emerging Infectious Diseases, 25(7), 1433-1435. https://dx.doi.org/10.3201/eid2507.190303.

Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar [PDF - 392 KB - 3 pages]
W. Sohn et al.

We performed an epidemiologic survey of opisthorchiasis in Yangon, Myanmar. The fecal egg-positive rate of residents was 0.7%, and we recovered an adult fluke after chemotherapy and purging of an egg-positive resident. We detected Opisthorchis viverrini metacercariae in freshwater fish. We found the Yangon area to have low-grade endemicity of opisthorchiasis.

EID Sohn W, Jung B, Hong S, Lee K, Park J, Kim H, et al. Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar. Emerg Infect Dis. 2019;25(7):1435-1437. https://dx.doi.org/10.3201/eid2507.190495
AMA Sohn W, Jung B, Hong S, et al. Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar. Emerging Infectious Diseases. 2019;25(7):1435-1437. doi:10.3201/eid2507.190495.
APA Sohn, W., Jung, B., Hong, S., Lee, K., Park, J., Kim, H....Chai, J. (2019). Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar. Emerging Infectious Diseases, 25(7), 1435-1437. https://dx.doi.org/10.3201/eid2507.190495.
Letters

Nontoxigenic Corynebacterium diphtheriae Infections, Europe [PDF - 355 KB - 2 pages]
A. A. Zasada and M. Rzeczkowska
EID Zasada AA, Rzeczkowska M. Nontoxigenic Corynebacterium diphtheriae Infections, Europe. Emerg Infect Dis. 2019;25(7):1437-1438. https://dx.doi.org/10.3201/eid2507.180995
AMA Zasada AA, Rzeczkowska M. Nontoxigenic Corynebacterium diphtheriae Infections, Europe. Emerging Infectious Diseases. 2019;25(7):1437-1438. doi:10.3201/eid2507.180995.
APA Zasada, A. A., & Rzeczkowska, M. (2019). Nontoxigenic Corynebacterium diphtheriae Infections, Europe. Emerging Infectious Diseases, 25(7), 1437-1438. https://dx.doi.org/10.3201/eid2507.180995.

Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015 [PDF - 313 KB - 1 page]
M. Thomas et al.
EID Thomas M, Whyler N, Tomlin A, Tilyard M. Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015. Emerg Infect Dis. 2019;25(7):1438. https://dx.doi.org/10.3201/eid2507.181775
AMA Thomas M, Whyler N, Tomlin A, et al. Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015. Emerging Infectious Diseases. 2019;25(7):1438. doi:10.3201/eid2507.181775.
APA Thomas, M., Whyler, N., Tomlin, A., & Tilyard, M. (2019). Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015. Emerging Infectious Diseases, 25(7), 1438. https://dx.doi.org/10.3201/eid2507.181775.
Books and Media

Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease [PDF - 427 KB - 1 page]
S. Zlitni and A. S. Bhatt
EID Zlitni S, Bhatt AS. Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease. Emerg Infect Dis. 2019;25(7):1439. https://dx.doi.org/10.3201/eid2507.190582
AMA Zlitni S, Bhatt AS. Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease. Emerging Infectious Diseases. 2019;25(7):1439. doi:10.3201/eid2507.190582.
APA Zlitni, S., & Bhatt, A. S. (2019). Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease. Emerging Infectious Diseases, 25(7), 1439. https://dx.doi.org/10.3201/eid2507.190582.
About the Cover

Difficult Places, Unexpected Discoveries [PDF - 2.66 MB - 2 pages]
B. Breedlove and J. Weber
EID Breedlove B, Weber J. Difficult Places, Unexpected Discoveries. Emerg Infect Dis. 2019;25(7):1440-1441. https://dx.doi.org/10.3201/eid2507.ac2507
AMA Breedlove B, Weber J. Difficult Places, Unexpected Discoveries. Emerging Infectious Diseases. 2019;25(7):1440-1441. doi:10.3201/eid2507.ac2507.
APA Breedlove, B., & Weber, J. (2019). Difficult Places, Unexpected Discoveries. Emerging Infectious Diseases, 25(7), 1440-1441. https://dx.doi.org/10.3201/eid2507.ac2507.
Etymologia

Etymologia: Carbapenem [PDF - 366 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Carbapenem. Emerg Infect Dis. 2019;25(7):1393. https://dx.doi.org/10.3201/eid2507.et2507
AMA Henry R. Etymologia: Carbapenem. Emerging Infectious Diseases. 2019;25(7):1393. doi:10.3201/eid2507.et2507.
APA Henry, R. (2019). Etymologia: Carbapenem. Emerging Infectious Diseases, 25(7), 1393. https://dx.doi.org/10.3201/eid2507.et2507.
Online Reports

Ethical Considerations for Movement Mapping to Identify Disease Transmission Hotspots [PDF - 328 KB - 6 pages]
B. C. de Jong et al.

Traditional public health methods for detecting infectious disease transmission, such as contact tracing and molecular epidemiology, are time-consuming and costly. Information and communication technologies, such as global positioning systems, smartphones, and mobile phones, offer opportunities for novel approaches to identifying transmission hotspots. However, mapping the movements of potentially infected persons comes with ethical challenges. During an interdisciplinary meeting of researchers, ethicists, data security specialists, information and communication technology experts, epidemiologists, microbiologists, and others, we arrived at suggestions to mitigate the ethical concerns of movement mapping. These suggestions include a template Data Protection Impact Assessment that follows European Union General Data Protection Regulations.

Page created: June 18, 2019
Page updated: June 18, 2019
Page reviewed: June 18, 2019
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