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Disclaimer: Ahead of print articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 25, Number 8—August 2019

  • Medscape CME Activity
    Zika Virus Infection in Pregnant Women, Yucatan, Mexico
    Y. Romer et al.

    We report demographic, epidemiologic, and clinical findings for a prospective cohort of pregnant women during the initial phase of Zika virus introduction into Yucatan, Mexico. We monitored 115 pregnant women for signs of active or recent Zika virus infection. The estimated cumulative incidence of Zika virus infection was 0.31 and the ratio of symptomatic to asymptomatic cases was 1.7 (range 1.3–4.0 depending on age group). Exanthema was the most sensitive clinical sign but also the least specific. Conjunctival hyperemia, joint edema, and exanthema were the combination of signs that had the highest specificity but low sensitivity. We did not find evidence of vertical transmission or fetal anomalies, likely because of the low number of pregnant women tested. We also did not find evidence of congenital disease. Our findings emphasize the limited predictive value of clinical features in areas where Zika virus cocirculates with other flaviviruses.

  • Multistate Outbreak of Listeriosis Associated with Packaged Leafy Green Salads, United States and Canada, 2015–2016
    J. L. Self et al.

    We investigated an outbreak of listeriosis detected by whole-genome multilocus sequence typing and associated with packaged leafy green salads. Nineteen cases were identified in the United States during July 5, 2015–January 31, 2016; isolates from case-patients were closely related (median difference 3 alleles, range 0–16 alleles). Of 16 case-patients interviewed, all reported salad consumption. Of 9 case-patients who recalled brand information, all reported brands processed at a common US facility. The Public Health Agency of Canada simultaneously investigated 14 cases of listeriosis associated with this outbreak. Isolates from the processing facility, packaged leafy green salads, and 9 case-patients from Canada were closely related to US clinical isolates (median difference 3 alleles, range 0–16 alleles). This investigation led to a recall of packaged leafy green salads made at the processing facility. Additional research is needed to identify best practices and effective policies to reduce the likelihood of Listeria monocytogenes contamination of fresh produce.

  • Pseudomonas poae–Associated Fatal Septic Transfusion Reaction, Peoria, Illinois, USA, 2017
    T. S. Woodring and J. J. Farrell

    In the United States, fatal transfusion-transmitted infections from red blood cell units are rare. Although this pattern mostly reflects how inhospitable refrigerated red blood cell units are to contaminant growth, fatalities caused by microorganisms that can grow at storage temperature (4°C), but not in standard clinical blood cultures at 37°C, are probably underestimated. We analyzed a fatal red blood cell transfusion in Peoria, Illinois, USA, that occurred in 2017. Samples from the patient’s whole blood and the red blood cell unit remained culture-negative during the investigation, despite direct visualization of gram-negative bacilli within the unit immediately after transfusion. We identified the bacteria as Pseudomonas poae, a nonpathogenic pseudomonad carrying multiple cold-shock domain protein genes, and confirmed its cold tolerance and inability to grow at 37°C. Our work indicates transfusion reaction workups need to include testing for psychrophilic organisms, which could explain the cause of other apparently culture-negative transfusion reactions.

  • Cross-Protection of Dengue Virus Infection against Congenital Zika Syndrome, Northeastern Brazil
    C. Pedroso et al.

    The Zika virus outbreak in Latin America resulted in congenital malformations, called congenital Zika syndrome (CZS). For unknown reasons, CZS incidence was highest in northeastern Brazil; one potential explanation is that dengue virus (DENV)–mediated immune enhancement may promote CZS development. In contrast, our analyses of historical DENV genomic data refuted the hypothesis that unique genome signatures for northeastern Brazil explain the uneven dispersion of CZS cases. To confirm our findings, we performed serotype-specific DENV neutralization tests in a case–control framework in northeastern Brazil among 29 Zika virus–seropositive mothers of neonates with CZS and 108 Zika virus–seropositive control mothers. Neutralization titers did not differ significantly between groups. In contrast, DENV seroprevalence and median number of neutralized serotypes were significantly lower among the mothers of neonates with CZS. Supported by model analyses, our results suggest that multitypic DENV infection may protect from, rather than enhance, development of CZS.

  • Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012–2014
    R. D. Savage et al.

    Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012–2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328–$6,868) but varied by disease (range $4,558–$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.

  • Natural Vertical Transmission of Zika Virus in Larval Aedes aegypti Populations, Morelos, Mexico
    M. Izquierdo-Suzán et al.

    We characterized natural vertical transmission of Zika virus in pools of Aedes aegypti larvae hatched from eggs collected in Jojutla, Morelos, Mexico. Of the 151 pools analyzed, 17 tested positive for Zika virus RNA; infectious Zika virus was successfully isolated from 1 of the larvae pools (31N) in C6/36 cells. Real-time quantitative PCR and indirect immunofluorescence assays confirmed the identity of the isolate, named Zika virus isolate 31N; plaque assays in Vero cells demonstrated the isolate’s infectivity in a mammalian cell line. We obtained the complete genome of Zika virus isolate 31N by next-generation sequencing and identified 3 single-nucleotide variants specific to Zika virus isolate 31N using the meta-CATS tool. These results demonstrate the occurrence of natural vertical transmission of Zika virus in wild Ae. aegypti mosquitoes and suggest that this transmission mode could aid in the spread and maintenance of Zika virus in nature.

  • Retrospective Cohort Study of Lassa Fever in Pregnancy, Southern Nigeria
    S. Okogbenin et al.
  • Congenital Syphilis as a Measure of Maternal and Child Healthcare, Brazil
    M. Bezerra et al.

    Syphilis is a sexually transmitted infection that has direct adverse effects on maternal and infant health through vertical Treponema pallidum transmission during early pregnancy. We evaluated congenital syphilis as a predictor of the quality of basic maternal and child healthcare in Brazil during 2010–2015. We investigated case rates and correlations with epidemiologic and socioeconomic indicators. We observed rising congenital syphilis incidence rates and increasing syphilis-associated perinatal and infant mortality rates in all regions. Case rates were highest in the Northeast, Southeast, and South, and congenital syphilis infant mortality rates were highest in the Northeast and Southeast. We observed correlations between congenital syphilis rates and infant death, spontaneous abortion (miscarriage), and stillbirth rates. We also noted correlations between rates of stillbirth caused by syphilis and inadequate prenatal care. Our study suggests gaps in basic healthcare for pregnant women and indicates the urgent need for measures to increase early diagnosis and appropriate treatment.

  • 17DD Yellow Fever Revaccination and Heightened Long-Term Immunity in Populations of Disease-Endemic Areas, Brazil
    O. Martins-Filho et al.

    We evaluated the duration of neutralizing antibodies and the status of 17DD vaccine–specific T- and B-cell memory following primary and revaccination regimens for yellow fever (YF) in Brazil. We observed progressive decline of plaque-reduction neutralization test (PRNT) seropositivity and of the levels of effector memory CD4+ and CD8+ T cells, as well as interferon-γ+CD8+ T cells, 10 years after primary vaccination. Revaccination restored PRNT seropositivity as well as the levels of effector memory CD4+, CD8+, and interferon-γ+CD8+ T cells. Moreover, secondary or multiple vaccinations guarantee long-term persistence of PRNT positivity and cell-mediated memory 10 years after booster vaccination. These findings support the relevance of booster doses to heighten the 17DD-YF–specific immune response to guarantee the long-term persistence of memory components. Secondary or multiple vaccinations improved the correlates of protection triggered by 17DD-YF primary vaccination, indicating that booster regimens are needed to achieve efficient immunity in areas with high risk for virus transmission.

Historical Review
  • Lessons Learned from Dengue Surveillance and Research, Puerto Rico, 1899–2013
    T. M. Sharp et al.

    Dengue was first reported in Puerto Rico in 1899 and sporadically thereafter. Following outbreaks in 1963 and 1969, the Centers for Disease Control and Prevention has worked closely with the Puerto Rico Department of Health to monitor and reduce the public health burden of dengue. During that time, evolving epidemiologic scenarios have provided opportunities to establish, improve, and expand disease surveillance and interventional research projects. These initiatives have enriched the tools available to the global public health community to understand and combat dengue, including diagnostic tests, methods for disease and vector surveillance, and vector control techniques. Our review serves as a guide to organizations seeking to establish dengue surveillance and research programs by highlighting accomplishments, challenges, and lessons learned during more than a century of dengue surveillance and research conducted in Puerto Rico.

  • Artyfechinostomum sufrartyfex Trematode Infections in Children, Bihar, India
    Y. K. Prasad et al.

    Eating raw or insufficiently cooked mollusks is a known risk factor for human echinostomiasis. We confirmed identification of Artyfechinostomum sufrartyfex trematodes as the causative agent of disease among 170 children in northern Bihar, India. We also identified the snail Pila globosa as a potential source of infections in the study area.

  • Wild-Type Yellow Fever Virus RNA in Cerebrospinal Fluid of Child
    P. Marinho et al.

    We report a 3-year-old child who was hospitalized because of severe manifestations of the central nervous system. The child died after 6 days of hospitalization. Analysis of postmortem cerebrospinal fluid showed the presence of yellow fever virus RNA. Nucleotide sequencing confirmed that the virus was wild-type yellow fever virus.

  • Emergent Invasive Group A Streptococcus dysgalactiae subsp. Equisimilis, United States, 2015–2018
    S. Chochua et al.

    The term group A Streptococcus is considered synonymous for the species Streptococcus pyogenes. We describe an emergent invasive S. dysgalactiae subspecies equisimilis lineage that obtained the group A antigen through a single ancestral recombination event between a group C S. dysgalactiae subsp. equisimilis strain and group A S. pyogenes strain.

  • Case Series Study of Melioidosis, Colombia
    J. Y. Rodríguez et al.

    We report 7 cases of melioidosis in Colombia and comparision of 4 commercial systems for identifying Burkholderia pseudomallei. Phoenix systems were not a definitive method for identifying B. pseudomallei. For accurate identification, we recommend including this bacterium in the library databases of matrix-assisted laser desorption/ionization mass spectrometry systems in Latin America.

  • Lethal Encephalitis in Seals with Japanese Encephalitis Virus Infection, China, 2017
    X. Li et al.

    We isolated Japanese encephalitis virus (JEV) from brain samples of 2 seals with lethal encephalitis at Weihai Aquarium, Weihai, China, in 2017. We confirmed our findings by immunohistochemical staining and electron microscopy. Phylogenetic analysis showed this virus was genotype I. Our findings suggest that JEV might disseminate though infected zoo animals.

  • Marburgvirus in Egyptian Fruit Bats, Zambia
    M. Kajihara et al.

    We detected Marburg virus genome in Egyptian fruit bats (Rousettus aegyptiacus) captured in Zambia in September 2018. The virus was closely related phylogenetically to the viruses that previously caused Marburg outbreaks in the Democratic Republic of the Congo. This finding demonstrates that Zambia is at risk for Marburg virus disease.

  • Kaposi Sarcoma in Mantled Guereza
    A. Grewer et al.

    We identified a novel Kaposi’s sarcoma herpesvirus–related rhadinovirus (Colobine gammaherpesvirus 1) in a mantled guereza (Colobus guereza kikuyensis). The animal had multiple oral tumors characterized by proliferation of latent nuclear antigen 1–positive spindle cells and was not co-infected with immunosuppressive simian viruses, suggesting that it had Kaposi sarcoma caused by this novel rhadinovirus.

  • Evaluating Temperature Sensitivity of Vesicular Stomatitis Virus–Based Vaccines
    D. R. Stein et al.

    Use of the vesicular stomatitis virus (VSV)–based Ebola virus vaccine during outbreaks and the potential use of a similar VSV-based Lassa virus vaccine has raised questions about the vaccines’ stability should the cold chain fail. We demonstrated that current cold chain condition might tolerate significant variances without affecting efficacy.

  • Novel Virus Related to Kaposi’s Sarcoma–Associated Herpesvirus from Colobus Monkey
    A. Dhingra et al.

    We determined the complete genome sequence of a virus isolated from a mantled guereza that died of primary effusion lymphoma. The virus is closely related to Kaposi’s sarcoma–associated herpesvirus (KSHV) but lacks some genes implicated in KSHV pathogenesis. This finding may help determine how KSHV causes primary effusion lymphoma in humans.

  • Underreporting of Fatal Congenital Zika Syndrome, Mexico, 2016–2017
    V. M. Cardenas et al.

    To determine completeness of fatal congenital Zika syndrome reporting in Mexico, we examined data from the Mexican National Institute of Statistics and Geography. We found that an estimated 50% more infants died from microcephaly attributable to congenital Zika syndrome during 2016–2017 than were reported by the existing surveillance system.

  • Emergence of a Novel Recombinant Norovirus GII.P16-GII.12 Strain Causing Gastroenteritis, Alberta, Canada
    K. Pabbaraju et al.

    We identified a novel recombinant GII.P16-GII.12 norovirus associated with epidemic and endemic gastroenteritis during March 1, 2018–February 12, 2019, in Alberta, Canada. GII.12 viruses have not been detected in Alberta since 2000. Comparing the full genome of this strain to previously published sequences revealed this virus to be a novel recombinant strain.

  • Efficacy of High-Dose Albendazole with Ivermectin for Treating Imported Loiasis, Imported to Italy
    F. Gobbi et al.

    We describe the outcomes of 16 cases of imported loiasis in Italy. Patients had microfilaremia <20,000/mL and were treated with high-dose albendazole for 28 days and a single dose of ivermectin. This combination might be an effective treatment option in nonendemic areas, when diethylcarbamazine, the drug of choice, is not available.

  • Sustained Low-Level Transmission of Zika and Chikungunya Viruses after Emergence in the Fiji Islands
    M. Kama et al.

    Zika and chikungunya viruses were first detected in Fiji in 2015. Examining surveillance, phylogenetic, and serologic data, we found evidence of low-level transmission of Zika and chikungunya viruses during 2013–2017, in contrast to the major outbreaks caused by closely related virus strains in other Pacific Island countries.

Research Letters
  • Polio-like Manifestation of Powassan Virus Infection with Anterior Horn Cell Involvement, Canada
    C. Picheca et al.

    Evidence of spinal cord involvement in Powassan virus infection is largely limited to mouse models. We report a case of a polio-like illness caused by Powassan virus infection in a 62-year-old man in Canada. Magnetic resonance imaging showed T2 hyperintensities in the anterior horns of the cervical spinal cord.

  • Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China
    Z. Chen et al.

    Whether Mycobacterium leprae transmits from placenta to fetus remains unknown. We describe the case of a pregnant women with untreated histoid leproma. Although her newborn was healthy, laboratory examination revealed intact M. leprae present in the placenta, suggesting that the placental barrier might prevent vertical dissemination of M. leprae.

  • Erwinia billingiae as Unusual Cause of Septic Arthritis, France, 2017
    I. Bonnet et al.

    In 2017 in France, we treated a patient with knee septic arthritis caused by Erwinia billingiae after trauma involving a palm tree. This rare pathogen could only be identified through 16S rRNA gene sequencing. For bacterial infections after injuries with plants, 16S rRNA gene sequencing might be required for species identification.

  • Bejel, a Nonvenereal Treponematosis, among Men Who Have Sex with Men, Japan
    T. Kawahata et al.

    Bejel, an endemic treponematosis caused by infection with Treponema pallidum subspecies endemicum, has not been reported in eastern Asia and the Pacific region. We report local spread of bejel among men who have sex with men in Japan. Spread was complicated by venereal syphilis.

  • Chikungunya Fever Outbreak, Zhejiang Province, China, 2017
    J. Pan et al.

    We report a disease outbreak caused by chikungunya virus in Zhejiang Province, China, in August 2017. Phylogenic analysis indicated that this virus belonged to the Indian Ocean clade of the East/Central/South African genotype and was imported by a traveler returning from Bangladesh.

  • No Evidence for Role of Cutavirus in Malignant Melanoma
    U. Wieland et al.

    Cutavirus was previously found in cutaneous melanoma. We detected cutavirus DNA in only 2/185 melanoma biopsies and in 0/52 melanoma metastases from patients in Germany. Viral DNA was localized in the upper epidermal layers. Swab specimens from healthy skin were cutavirus positive for 3.8% (9/237) of immunocompetent and 17.1% (35/205) of HIV-positive men.

  • Early Questing by Lone Star Tick Larvae, New York and Massachusetts, USA, 2018
    S. R. Telford et al.

    Subtropical lone star tick larvae typically emerge in late summer. We found clusters of host-seeking lone star tick larvae during early June 2018 in New York and Massachusetts, USA. Invasion and persistence of this tick in more northern locations may have been promoted by adaptation to an accelerated life cycle.

  • Intrafamily Transmission of Monkeypox Virus, Central African Republic, 2018
    C. Besombes et al.

    Monkeypox is a rare viral zoonotic disease; primary infections are reported from remote forest areas of Central and West Africa. We report an investigation of a monkeypox outbreak in Lobaye, in southwest region of Central African Republic, in October 2018.

  • Zoonotic Virus Seroprevalence among Bank Voles, Poland, 2002–2010
    M. Grzybek et al.

    Bank voles in Poland are reservoirs of zoonotic viruses. To determine seroprevalence of hantavirus, arenavirus, and cowpox virus and factors affecting seroprevalence, we screened for antibodies against these viruses over 9 years. Cowpox virus was most prevalent and affected by extrinsic and intrinsic factors. Long-term and multisite surveillance is crucial.

  • Prolonged Zika Virus RNA Detection in Semen of Immunosuppressed Patient
    C. Petridou et al.

    Zika virus RNA has been detected in semen samples collected <370 days after symptom onset. We report unusual persistence of Zika virus RNA in semen, confirmed by sequencing at 515 days after symptom onset and detectable for >900 days, in a patient with immunosuppression.

  • Molecular Genotyping of Hepatitis A Virus, California, USA, 2017–2018
    W. S. Probert et al.

    We implemented subgenomic and whole-genome sequencing to support the investigation of a large hepatitis A virus outbreak among persons experiencing homelessness, users of illicit drugs, or both in California, USA, during 2017–2018. Genotyping data helped confirm case-patients, track chains of transmission, and monitor the effectiveness of public health control measures.

  • Feast of Sacrifice and Orf, Milan, Italy, 2015–2018
    S. Veraldi et al.

    Orf (ecthyma contagiosum) is an infection of the skin caused by a DNA virus belonging to the genus Parapoxvirus. We recently observed 7 cases of orf in Muslim men living in the metropolitan area of Milan, Italy, who acquired the infection after the Feast of Sacrifice.

  • Crimean-Congo Hemorrhagic Fever, Herat Province, Afghanistan, 2017
    A. Niazi et al.

    We studied the clinical and epidemiologic features of an outbreak of Crimean-Congo hemorrhagic fever in Herat Province, Afghanistan. The study comprised 63 patients hospitalized in 2017. The overall case-fatality rate was 22.2%; fatal outcome was significantly associated with a negative IgM test result, longer prothrombin time, and nausea.

  • Multidrug-Resistant Klebsiella pneumoniae ST307 in Traveler Returning from Puerto Rico to Dominican Republic
    R. Rojas et al.

    We report blaKPC-2-harboring carbapenem-resistant Klebsiella pneumoniae in an emerging sequence type 307 lineage in a traveler returning from Puerto Rico to the Dominican Republic. Phylogenetic analyses indicate regional dissemination of this highly drug-resistant clone across the Americas, underscoring the need for adequate surveillance and infection control efforts to prevent further spread.

  • Recombinant GII.Pe-GII.4 Norovirus, Thailand, 2017–2018
    W. Chuchaona et al.

    During June 2017–December 2018, norovirus was responsible for 10.9% of acute gastroenteritis cases in Thailand. Genogroup I (GI) was found in 14% of samples, of which 12 were co-infected with genogroup II (GII). In 35.8% of samples, GII.Pe-GII.4 Sydney predominated. Diverse recombinant strains of GI and GII norovirus co-circulated year-round.

  • Sneathia amnii and Maternal Chorioamnionitis and Stillbirth, Mozambique
    P. Vitorino et al.

    We report a case of Sneathia amnii as the causative agent of maternal chorioamnionitis and congenital pneumonia resulting in a late fetal death in Mozambique, with strong supportive postmortem molecular and histopathological confirmation. This rare, fastidious gram-negative coccobacillus has been reported to infrequently cause abortions, stillbirths, and neonatal infections.

In Memoriam
About the Cover


Volume 25, Number 9—September 2019

  • Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum
    P. Nookeu et al.
  • Genotyping Method for Potential Common Source of Enterocytozoon bieneusi Microsporidia Infection in Hematology Unit
    G. Desoubeaux et al.
  • Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal
    M. Aires-de-Sousa et al.
  • Classification of Invasive Fungal Infections to Support Wound Treatment Decisions
    A. Ganesan et al.
  • Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA
    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.

  • Impact of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis in England and Wales, 2000–2016
    G. Oligbu et al.
  • Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017
    E. van Schalkwyk et al.
  • Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018
    P. Uprety et al.
  • Risk for Clostridiodes difficile Infection among Older Adults with Cancer
    M. Kamboj et al.
  • Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018
    B. M. Berenger et al.
  • Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA
    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.

  • Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda
    A. I. Izimukwiye et al.
  • Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance
    E. Tkadlec et al.
  • Rickettsia japonica Infections in Humans, China, 2014–2017
    H. Li et al.
  • Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit
    A. Chamieh et al.
  • Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA
    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.

  • Climate Classification System–Based Determination of Location of Cryptococcus gattii Emergence
    E. S. Acheson et al.
  • Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity
    M. Chan et al.
  • Vaccine Effectiveness Against DS-1–like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015
    K. C. Jere et al.
Research Letters
  • Candida auris in Germany and Previous Exposure to Foreign Healthcare
    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.

  • Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015
    M. Mateo et al.
  • Disseminated Emergomycosis in a Person with HIV Infection from Uganda: Molecular Identification of Emergomyces pasteurianus or a Close Relative from a Pathology Block
    I. Rooms et al.
  • Fatal Cases of Invasive Fungal Disease after Isavuconazole Treatment Failure, France
    A. Bellanger et al.
  • Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019
    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.

  • Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia
    S. P. Nowak et al.
  • Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand
    L. Ford et al.
  • Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA
    L. Li et al.
  • Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia
    C. L. Weitzman et al.
  • Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease
    S. Jing et al.
  • Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure
    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.

  • Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013
    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%).

  • Bombali Virus in Mops condylurus Bats, Guinea
    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.

  • Potential Fifth Clade of Candida auris, Iran, 2018
    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.

  • Worldwide Reduction in MERS Cases and Deaths since 2016
    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.

  • Blastomycosis Misdiagnosed as Tuberculosis, India
    A. Kumar et al.
  • Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis
    S. M. Rudramurthy et al.
Books and Media
  • Infections of Leisure, Fifth Edition
    K. Fullerton
Online Report
  • Implementation and Evaluation of Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers
    S. Barkati et al.


Volume 25, Number 10—October 2019

  • Global Epidemiology of Diphtheria, 2000–2017
    K. Clarke et al.
  • Economic Burden of West Nile Virus Disease, Québec, Canada, 2012–2013
    N. Ouhoummane et al.
  • Invasive Group A Streptococcus, Group B Streptococcus, and S. pneumoniae Infection among Adults Experiencing Homelessness, Alaska, 2002–2015
    E. Mosites et al.
  • Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir
    V. P. Mishin et al.

    Baloxavir showed broad-spectrum in vitro replication inhibition of 4 types of influenza viruses (90% effective concentration range 1.2–98.3 nmol/L); susceptibility pattern was influenza A ˃ B ˃ C ˃ D. This drug also inhibited influenza A viruses of avian and swine origin, including viruses that have pandemic potential and those resistant to neuraminidase inhibitors.

  • Powassan Virus, Increasingly Recognized Cause of Encephalitis in Northern United States
    J. Allgaier et al.
  • Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017
    I. Guendel et al.
  • Characterization of Highly Pathogenic Avian Influenza Virus H5N6 and H5N5 Clade Reassortants, Germany, 2017–18
    A. Pohlmann et al.
Research Letters
  • Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission
    L. Zhou et al.

    We estimated the incubation period and serial interval for human-to-human–transmitted avian influenza A(H7N9) virus infection using case-patient clusters from epidemics in China during 2013–2017. The median incubation period was 4 days and serial interval 9 days. China’s 10-day monitoring period for close contacts of case-patients should detect most secondary infections.

  • Emergence of Influenza A(H7N4) Virus, Cambodia
    D. Vijaykrishna et al.

    Active surveillance in high-risk sites in Cambodia has identified multiple low-pathogenicity influenza A(H7) viruses, mainly in ducks. None fall within the A/Anhui/1/2013(H7N9) lineage; however, some A(H7) viruses from 2018 show temporal and phylogenetic similarity to the H7N4 virus that caused a nonfatal infection in Jiangsu Province, China, in December 2017.

  • Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018
    A. van Schalkwyk and M. Romito
  • Geospatial Variation in Rotavirus Vaccination Coverage in Infants, United States, 2010–2017
    M. Rogers et al.


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