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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 9—September 2019

  • Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum
    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. 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.

  • Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit
    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.

  • Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Hospital, Portugal
    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).

  • Classification of Trauma-Associated 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.

  • Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016
    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.

  • Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017
    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.

  • Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018
    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.

  • 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.

    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.

  • Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand
    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.

  • Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017
    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.

  • Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA
    R. Ginn et al.
  • Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda
    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.

  • Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance
    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.

  • Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017
    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.

  • 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 Temperate Climate Detection of Cryptococcus gattii sensu lato
    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.

  • Use of Human Intestinal Enteroids to Detect 
Human Norovirus Infectivity
    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.

  • Vaccine Effectiveness Against DS-1–like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015
    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.

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.

    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.

  • Disseminated Emergomycosis in a Person with HIV Infection, Uganda
    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.

  • Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients
    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.

  • 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.

    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.

  • Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA
    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.

  • Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia
    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.

  • Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease
    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.

  • 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.

    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.

  • Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis
    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.

  • Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone
    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.

Books and Media
About the Cover
Online Report
  • Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers
    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.


Volume 25, Number 10—October 2019

  • Global Epidemiology of Diphtheria, 2000–2017
    K. Clarke et al.
  • Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeast Australia, 2016–2017
    W. Liu et al.
  • Emergence and Containment of Canine Influenza Virus H3N2, Ontario, Canada, 2017–2018
    J. Weese et al.
  • Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults
    A. Dernoncourt et al.
  • Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015
    M. D. Van Kerkhove et al.

    To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

  • Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016
    S. Kamiyama 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.
  • Early Diagnosis of Tularemia with Flow Cytometry, Czech Republic, 2003–2015
    A. Chrdle et al.
  • Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China
    Y. Hu et al.
  • Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections
    N. Okba et al.

    Middle East respiratory syndrome coronavirus (MERS-CoV) infections in humans can cause asymptomatic to fatal lower respiratory lung disease. Despite posing a probable risk for virus transmission, asymptomatic to mild infections can go unnoticed; a lack of seroconversion among some PCR-confirmed cases has been reported. We found that a MERS-CoV spike S1 protein–based ELISA, routinely used in surveillance studies, showed low sensitivity in detecting infections among PCR-confirmed patients with mild clinical symptoms and cross-reactivity of human coronavirus OC43–positive serum samples. Using in-house S1 ELISA and protein microarray, we demonstrate that most PCR-confirmed MERS-CoV case-patients with mild infections seroconverted; nonetheless, some of these samples did not have detectable levels of virus-neutralizing antibodies. The use of a sensitive and specific serologic S1-based assay can be instrumental in the accurate estimation of MERS-CoV prevalence.

  • Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus
    R. Harvey et al.

    Middle East respiratory syndrome coronavirus (MERS-CoV) was detected in humans in 2012. Since then, sporadic outbreaks with primary transmission through dromedary camels to humans and outbreaks in healthcare settings have shown that MERS-CoV continues to pose a threat to human health. Several serologic assays for MERS-CoV have been developed globally. We describe a collaborative study to investigate the comparability of serologic assays for MERS-CoV and assess any benefit associated with the introduction of a standard reference reagent for MERS-CoV serology. Our study findings indicate that, when possible, laboratories should use a testing algorithm including >2 tests to ensure correct diagnosis of MERS-CoV. We also demonstrate that the use of a reference reagent greatly improves the agreement between assays, enabling more consistent and therefore more meaningful comparisons between results.

  • Serologic Evidence of Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia
    M. Wille et al.
  • VAR2CSA Serologic Testing to Detect Plasmodium falciparum Transmission Patterns
    A. Fonseca et al.
  • Sporotrichosis in the Highlands of Madagascar, 2013–2017
    T. Rasamoelina et al.
  • Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines
    K. O. Murray 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.
  • Borrelia miyamotoi Meningitis, Sweden
    A. J. Henningsson et al.
  • Bidirectional Human-Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018
    A. Chastagner et al.
  • New Exposure Location of Hantavirus Pulmonary Syndrome Case, California, 2018
    A. M. Kjemtrup et al.
  • Tickborne Encephalitis in Auvergne Rhône-Alpes Region, France, 2017–2018
    E. Botelho-Nevers et al.
  • Factoring Prior Treatment into Tuberculosis Prevalence Estimates, United States, 2011–2012
    L. A. Vonnahme et al.
  • Plasmodium cynomolgi as Cause of Malaria in a Tourist in Southeast Asia, 2018
    G. N. Hartmeyer et al.
  • Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico
    R. R. Hemme et al.
  • Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018
    R. Bai et al.
  • Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit
    A. Chamieh 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.
  • Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS
    S. M. Michienzi et al.
  • Mycobacterium marseillense Infection in Human Skin, China, 2018
    B. Xie et al.
  • Lassa Virus in Pygmy Mice, Benin, West Africa, 2016–2017
    A. Yadouleton et al.

    Lassa virus has been identified in 3 pygmy mice, Mus baoulei, in central Benin. The glycoprotein and nucleoprotein sequences cluster with the Togo strain. These mice may be a new reservoir for Lassa virus in Ghana, Togo, and Benin.

  • Pulmonary Infection caused by Mycobacterium canariasense in a Suspected Tuberculosis Patient, Iran
    F. Sakhaee et al.
  • Databases for Research and Development
    M. G. Head
  • Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission
    C. E. Styles et al.
Books and Media
  • Flu Hunter: Unlocking the Secrets of a Virus
    R. G. Webster


Volume 25, Number 11—November 2019

  • Vaccine-Derived Poliovirus Infection among Patients with Primary Immunodeficiency and Impact of Patient Screening on Disease Outcomes, Iran
    M. Shaghaghi et al.
  • Rare Detection of Bordetella pertussis Pertactin-Deficient Strains in Argentina
    F. Carriquiriborde et al.
  • Clinical and Molecular Epidemiology of Invasive Group B Streptococcus Disease among Infants, China
    W. Ji et al.
  • Mansonella ozzardi Infection in the Amazon Region, Ecuador
    M. Calvopina et al.
  • Human-to-Human Transmission of Influenza A(H3N2) Virus with Reduced Susceptibility to Baloxavir, Japan, February 2019
    E. Takashita et al.
  • Preventing Sexual Transmission of Zika Virus Infection During Pregnancy, Puerto, Rico, USA, 2016
    B. Salvesen von Essen et al.
Research Letters
  • Endemicity of Yaws Shown by Treponema pallidum Antibodies in Nonhuman Primates, Kenya
    D. M. Zimmerman et al.
  • Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017–2018
    A. Hakawi et al.

    We characterized exposures and demographics of Middle East respiratory syndrome coronavirus cases reported to the Saudi Arabia Ministry of Health during July 1–October 31, 2017, and June 1–September 16, 2018. Molecular characterization of available specimens showed that lineage 5 predominated among circulating viruses during these periods.

  • Unavailability of Injectable Antimicrobial Drugs to Treat Gonorrhea and Syphilis, United States, 2016
    W. S. Pearson et al.
  • Mutation and Diversity of Diphtheria Toxin in Corynebacterium ulcerans
    K. Otsuji et al.
  • Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014
    L. Amoureux et al.
  • Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017
    M. Adelantado et al.


Volume 25, Number 12—December 2019

Research Letter
  • Multistate Psittacosis Outbreak at Chicken Slaughter Plants, Virginia and Georgia, USA, 2018
    K. A. Shaw et al.


The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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