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Medscape CME Activity

Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn CME credit. In support of improving patient care, these activities have been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CME credit is available for one year after publication.

Active CME Articles


Expires 3/18/2025
Medscape CME Activity
Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022 [PDF - 1.82 MB - 11 pages]
T. J. Doyle et al.

In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March–­June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

EID Doyle TJ, Gumke M, Stanek D, Moore J, Buck B, Locksmith T, et al. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. Emerg Infect Dis. 2024;30(4):634-643. https://doi.org/10.3201/eid3004.231392
AMA Doyle TJ, Gumke M, Stanek D, et al. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. Emerging Infectious Diseases. 2024;30(4):634-643. doi:10.3201/eid3004.231392.
APA Doyle, T. J., Gumke, M., Stanek, D., Moore, J., Buck, B., Locksmith, T....Chacreton, D. (2024). Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. Emerging Infectious Diseases, 30(4), 634-643. https://doi.org/10.3201/eid3004.231392.

Expires 2/23/2025
Medscape CME Activity
Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection [PDF - 1004 KB - 9 pages]
P. Machado et al.

Disseminated leishmaniasis (DL) is an emergent severe disease manifesting with multiple lesions. To determine the relationship between immune response and clinical and therapeutic outcomes, we studied 101 DL and 101 cutaneous leishmaniasis (CL) cases and determined cytokines and chemokines in supernatants of mononuclear cells stimulated with leishmania antigen. Patients were treated with meglumine antimoniate (20 mg/kg) for 20 days (CL) or 30 days (DL); 19 DL patients were instead treated with amphotericin B, miltefosine, or miltefosine and meglumine antimoniate. High levels of chemokine ligand 9 were associated with more severe DL. The cure rate for meglumine antimoniate was low for both DL (44%) and CL (60%), but healing time was longer in DL (p = 0.003). The lowest cure rate (22%) was found in DL patients with >100 lesions. However, meglumine antimoniate/miltefosine treatment cured all DL patients who received it; therefore, that combination should be considered as first choice therapy.

EID Machado P, Lago A, Cardoso TM, Magalhaes A, Carvalho LP, Lago T, et al. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerg Infect Dis. 2024;30(3):510-518. https://doi.org/10.3201/eid3003.230786
AMA Machado P, Lago A, Cardoso TM, et al. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerging Infectious Diseases. 2024;30(3):510-518. doi:10.3201/eid3003.230786.
APA Machado, P., Lago, A., Cardoso, T. M., Magalhaes, A., Carvalho, L. P., Lago, T....Carvalho, E. M. (2024). Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerging Infectious Diseases, 30(3), 510-518. https://doi.org/10.3201/eid3003.230786.

Expires 2/22/2025
Medscape CME Activity
Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe [PDF - 2.15 MB - 10 pages]
J. Brizuela et al.

Streptococcus suis, a zoonotic bacterial pathogen circulated through swine, can cause severe infections in humans. Because human S. suis infections are not notifiable in most countries, incidence is underestimated. We aimed to increase insight into the molecular epidemiology of human S. suis infections in Europe. To procure data, we surveyed 7 reference laboratories and performed a systematic review of the scientific literature. We identified 236 cases of human S. suis infection from those sources and an additional 87 by scanning gray literature. We performed whole-genome sequencing to type 46 zoonotic S. suis isolates and combined them with 28 publicly available genomes in a core-genome phylogeny. Clonal complex (CC) 1 isolates accounted for 87% of typed human infections; CC20, CC25, CC87, and CC94 also caused infections. Emergence of diverse zoonotic clades and notable severity of illness in humans support classifying S. suis infection as a notifiable condition.

EID Brizuela J, Roodsant TJ, Hasnoe Q, van der Putten B, Kozakova J, Slotved H, et al. Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. Emerg Infect Dis. 2024;30(3):413-422. https://doi.org/10.3201/eid3003.230348
AMA Brizuela J, Roodsant TJ, Hasnoe Q, et al. Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. Emerging Infectious Diseases. 2024;30(3):413-422. doi:10.3201/eid3003.230348.
APA Brizuela, J., Roodsant, T. J., Hasnoe, Q., van der Putten, B., Kozakova, J., Slotved, H....Schultsz, C. (2024). Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. Emerging Infectious Diseases, 30(3), 413-422. https://doi.org/10.3201/eid3003.230348.

Expires 1/23/2025
Medscape CME Activity
Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021 [PDF - 2.24 MB - 10 pages]
J. Justman et al.

During January–August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons >2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.

EID Justman J, Skalland T, Moore A, Amos CI, Marzinke MA, Zangeneh SZ, et al. Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. Emerg Infect Dis. 2024;30(2):245-254. https://doi.org/10.3201/eid3002.230863
AMA Justman J, Skalland T, Moore A, et al. Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. Emerging Infectious Diseases. 2024;30(2):245-254. doi:10.3201/eid3002.230863.
APA Justman, J., Skalland, T., Moore, A., Amos, C. I., Marzinke, M. A., Zangeneh, S. Z....Ahmed, S. (2024). Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. Emerging Infectious Diseases, 30(2), 245-254. https://doi.org/10.3201/eid3002.230863.

Expires 1/22/2025
Medscape CME Activity
Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France [PDF - 1.68 MB - 10 pages]
J. Demonchy et al.

Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002­–­­2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.

EID Demonchy J, Biard L, Clere-Jehl R, Wallet F, Mokart D, Moreau A, et al. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerg Infect Dis. 2024;30(2):215-224. https://doi.org/10.3201/eid3002.231221
AMA Demonchy J, Biard L, Clere-Jehl R, et al. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerging Infectious Diseases. 2024;30(2):215-224. doi:10.3201/eid3002.231221.
APA Demonchy, J., Biard, L., Clere-Jehl, R., Wallet, F., Mokart, D., Moreau, A....Zafrani, L. (2024). Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerging Infectious Diseases, 30(2), 215-224. https://doi.org/10.3201/eid3002.231221.

Expires 12/21/2024
Medscape CME Activity
Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates [PDF - 1.35 MB - 9 pages]
C. Malaure et al.

Using whole-genome sequencing, we characterized Escherichia coli strains causing early-onset sepsis (EOS) in 32 neonatal cases from a 2019–2021 prospective multicenter study in France and compared them to E. coli strains collected from vaginal swab specimens from women in third-trimester gestation. We observed no major differences in phylogenetic groups or virulence profiles between the 2 collections. However, sequence type (ST) analysis showed the presence of 6/32 (19%) ST1193 strains causing EOS, the same frequency as in the highly virulent clonal group ST95. Three ST1193 strains caused meningitis, and 3 harbored extended-spectrum β-lactamase. No ST1193 strains were isolated from vaginal swab specimens. Emerging ST1193 appears to be highly prevalent, virulent, and antimicrobial resistant in neonates. However, the physiopathology of EOS caused by ST1193 has not yet been elucidated. Clinicians should be aware of the possible presence of E. coli ST1193 in prenatal and neonatal contexts and provide appropriate monitoring and treatment.

EID Malaure C, Geslain G, Birgy A, Bidet P, Poilane I, Allain M, et al. Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. Emerg Infect Dis. 2024;30(1):20-28. https://doi.org/10.3201/eid3001.230851
AMA Malaure C, Geslain G, Birgy A, et al. Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. Emerging Infectious Diseases. 2024;30(1):20-28. doi:10.3201/eid3001.230851.
APA Malaure, C., Geslain, G., Birgy, A., Bidet, P., Poilane, I., Allain, M....Bonacorsi, S. (2024). Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. Emerging Infectious Diseases, 30(1), 20-28. https://doi.org/10.3201/eid3001.230851.

Expires 12/19/2024
Medscape CME Activity
Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections [PDF - 1.54 MB - 5 pages]
S. Roth et al.

We describe detection of the previously rarely reported gram-positive bacterium Auritidibacter ignavus in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and A. ignavus detected in microbiologic swab specimens. A correct identification of A. ignavus in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify A. ignavus and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy.

EID Roth S, Linxweiler M, Rehner J, Schmartz G, Becker SL, Kühn J. Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. Emerg Infect Dis. 2024;30(1):8-12. https://doi.org/10.3201/eid3001.230385
AMA Roth S, Linxweiler M, Rehner J, et al. Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. Emerging Infectious Diseases. 2024;30(1):8-12. doi:10.3201/eid3001.230385.
APA Roth, S., Linxweiler, M., Rehner, J., Schmartz, G., Becker, S. L., & Kühn, J. (2024). Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. Emerging Infectious Diseases, 30(1), 8-12. https://doi.org/10.3201/eid3001.230385.

Expires 11/17/2024
Medscape CME Activity
Invasive Nocardia Infections across Distinct Geographic Regions, United States [PDF - 1.33 MB - 9 pages]
S. Gupta et al.

We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.

EID Gupta S, Grant LM, Powers HR, Kimes KE, Hamdi A, Butterfield RJ, et al. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerg Infect Dis. 2023;29(12):2417-2425. https://doi.org/10.3201/eid2912.230673
AMA Gupta S, Grant LM, Powers HR, et al. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerging Infectious Diseases. 2023;29(12):2417-2425. doi:10.3201/eid2912.230673.
APA Gupta, S., Grant, L. M., Powers, H. R., Kimes, K. E., Hamdi, A., Butterfield, R. J....Vikram, H. R. (2023). Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerging Infectious Diseases, 29(12), 2417-2425. https://doi.org/10.3201/eid2912.230673.

Expires 11/15/2024
Medscape CME Activity
Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA [PDF - 1.55 MB - 9 pages]
D. Capone et al.

We collected stool from school-age children from 352 households living in the Black Belt region of Alabama, USA, where sanitation infrastructure is lacking. We used quantitative reverse transcription PCR to measure key pathogens in stool that may be associated with water and sanitation, as an indicator of exposure. We detected genes associated with >1 targets in 26% of specimens, most frequently Clostridioides difficile (6.6%), atypical enteropathogenic Escherichia coli (6.1%), and enteroaggregative E. coli (3.9%). We used generalized estimating equations to assess reported risk factors for detecting >1 pathogen in stool. We found no association between lack of sanitation and pathogen detection (adjusted risk ratio 0.95 [95% CI 0.55–1.7]) compared with specimens from children served by sewerage. However, we did observe an increased risk for pathogen detection among children living in homes with well water (adjusted risk ratio 1.7 [95% CI 1.1–2.5]) over those reporting water utility service.

EID Capone D, Bakare T, Barker T, Chatham A, Clark R, Copperthwaite L, et al. Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Emerg Infect Dis. 2023;29(12):2434-2442. https://doi.org/10.3201/eid2912.230780
AMA Capone D, Bakare T, Barker T, et al. Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Emerging Infectious Diseases. 2023;29(12):2434-2442. doi:10.3201/eid2912.230780.
APA Capone, D., Bakare, T., Barker, T., Chatham, A., Clark, R., Copperthwaite, L....Brown, J. (2023). Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Emerging Infectious Diseases, 29(12), 2434-2442. https://doi.org/10.3201/eid2912.230780.

Expires 10/17/2024
Medscape CME Activity
Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021 [PDF - 853 KB - 9 pages]
S. Zayet et al.

Campylobacter fetus accounts for 1% of Campylobacter spp. infections, but prevalence of bacteremia and risk for death are high. To determine clinical features of C. fetus infections and risks for death, we conducted a retrospective observational study of all adult inpatients with a confirmed C. fetus infection in Nord Franche-Comté Hospital, Trevenans, France, during January 2000–December 2021. Among 991 patients with isolated Campylobacter spp. strains, we identified 39 (4%) with culture-positive C. fetus infections, of which 33 had complete records and underwent further analysis; 21 had documented bacteremia and 12 did not. Secondary localizations were reported for 7 (33%) patients with C. fetus bacteremia, of which 5 exhibited a predilection for vascular infections (including 3 with mycotic aneurysm). Another 7 (33%) patients with C. fetus bacteremia died within 30 days. Significant risk factors associated with death within 30 days were dyspnea, quick sequential organ failure assessment score >2 at admission, and septic shock.

EID Zayet S, Klopfenstein T, Gendrin V, Vuillemenot J, Plantin J, Toko L, et al. Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. Emerg Infect Dis. 2023;29(11):2189-2197. https://doi.org/10.3201/eid2911.230598
AMA Zayet S, Klopfenstein T, Gendrin V, et al. Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. Emerging Infectious Diseases. 2023;29(11):2189-2197. doi:10.3201/eid2911.230598.
APA Zayet, S., Klopfenstein, T., Gendrin, V., Vuillemenot, J., Plantin, J., Toko, L....Royer, P. (2023). Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. Emerging Infectious Diseases, 29(11), 2189-2197. https://doi.org/10.3201/eid2911.230598.

Expires 10/16/2024
Medscape CME Activity
Group A Streptococcus Primary Peritonitis in Children, New Zealand [PDF - 916 KB - 7 pages]
A. Taylor et al.

Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children’s Hospital, Auckland, New Zealand, during 2010–2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen.

EID Taylor A, Elliott BM, Atkinson J, Roberts S, Voss L, Best EJ, et al. Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerg Infect Dis. 2023;29(11):2203-2209. https://doi.org/10.3201/eid2911.230211
AMA Taylor A, Elliott BM, Atkinson J, et al. Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerging Infectious Diseases. 2023;29(11):2203-2209. doi:10.3201/eid2911.230211.
APA Taylor, A., Elliott, B. M., Atkinson, J., Roberts, S., Voss, L., Best, E. J....Webb, R. (2023). Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerging Infectious Diseases, 29(11), 2203-2209. https://doi.org/10.3201/eid2911.230211.

Expires 9/20/2024
Medscape CME Activity
Spike in Congenital Syphilis, Mississippi, USA, 2016–2022 [PDF - 1.31 MB - 8 pages]
M. Staneva et al.

In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.

EID Staneva M, Hobbs CV, Dobbs T. Spike in Congenital Syphilis, Mississippi, USA, 2016–2022. Emerg Infect Dis. 2023;29(10):1965-1972. https://doi.org/10.3201/eid2910.230421
AMA Staneva M, Hobbs CV, Dobbs T. Spike in Congenital Syphilis, Mississippi, USA, 2016–2022. Emerging Infectious Diseases. 2023;29(10):1965-1972. doi:10.3201/eid2910.230421.
APA Staneva, M., Hobbs, C. V., & Dobbs, T. (2023). Spike in Congenital Syphilis, Mississippi, USA, 2016–2022. Emerging Infectious Diseases, 29(10), 1965-1972. https://doi.org/10.3201/eid2910.230421.

Expires 9/14/2024
Medscape CME Activity
Serotype Distribution and Disease Severity in Adults Hospitalized with Streptococcus pneumoniae Infection, Bristol and Bath, UK, 2006‒2022 [PDF - 3.00 MB - 12 pages]
C. Hyams et al.

Ongoing surveillance after pneumococcal conjugate vaccination (PCV) deployment is essential to inform policy decisions and monitor serotype replacement. We report serotype and disease severity trends in 3,719 adults hospitalized for pneumococcal disease in Bristol and Bath, United Kingdom, during 2006–2022. Of those cases, 1,686 were invasive pneumococcal disease (IPD); 1,501 (89.0%) had a known serotype. IPD decreased during the early COVID-19 pandemic but during 2022 gradually returned to prepandemic levels. Disease severity changed throughout this period: CURB65 severity scores and inpatient deaths decreased and ICU admissions increased. PCV7 and PCV13 serotype IPD decreased from 2006–2009 to 2021–2022. However, residual PCV13 serotype IPD remained, representing 21.7% of 2021–2022 cases, indicating that major adult PCV serotype disease still occurs despite 17 years of pediatric PCV use. Percentages of serotype 3 and 8 IPD increased, and 19F and 19A reemerged. In 2020–2022, a total of 68.2% IPD cases were potentially covered by PCV20.

EID Hyams C, Challen R, Hettle D, Amin-Chowdhury Z, Grimes C, Ruffino G, et al. Serotype Distribution and Disease Severity in Adults Hospitalized with Streptococcus pneumoniae Infection, Bristol and Bath, UK, 2006‒2022. Emerg Infect Dis. 2023;29(10):1953-1964. https://doi.org/10.3201/eid2910.230519
AMA Hyams C, Challen R, Hettle D, et al. Serotype Distribution and Disease Severity in Adults Hospitalized with Streptococcus pneumoniae Infection, Bristol and Bath, UK, 2006‒2022. Emerging Infectious Diseases. 2023;29(10):1953-1964. doi:10.3201/eid2910.230519.
APA Hyams, C., Challen, R., Hettle, D., Amin-Chowdhury, Z., Grimes, C., Ruffino, G....Finn, A. (2023). Serotype Distribution and Disease Severity in Adults Hospitalized with Streptococcus pneumoniae Infection, Bristol and Bath, UK, 2006‒2022. Emerging Infectious Diseases, 29(10), 1953-1964. https://doi.org/10.3201/eid2910.230519.

Expires 8/18/2024
Medscape CME Activity
Characteristics of Hard Tick Relapsing Fever Caused by Borrelia miyamotoi, United States, 2013–2019 [PDF - 1.14 MB - 11 pages]
D. W. McCormick et al.

Borrelia miyamotoi, transmitted by Ixodes spp. ticks, was recognized as an agent of hard tick relapsing fever in the United States in 2013. Nine state health departments in the Northeast and Midwest have conducted public health surveillance for this emerging condition by using a shared, working surveillance case definition. During 2013–2019, a total of 300 cases were identified through surveillance; 166 (55%) were classified as confirmed and 134 (45%) as possible. Median age of case-patients was 52 years (range 1–86 years); 52% were male. Most cases (70%) occurred during June–September, with a peak in August. Fever and headache were common symptoms; 28% of case-patients reported recurring fevers, 55% had arthralgia, and 16% had a rash. Thirteen percent of patients were hospitalized, and no deaths were reported. Ongoing surveillance will improve understanding of the incidence and clinical severity of this emerging disease.

EID McCormick DW, Brown CM, Bjork J, Cervantes K, Esponda-Morrison B, Garrett J, et al. Characteristics of Hard Tick Relapsing Fever Caused by Borrelia miyamotoi, United States, 2013–2019. Emerg Infect Dis. 2023;29(9):1719-1729. https://doi.org/10.3201/eid2909.221912
AMA McCormick DW, Brown CM, Bjork J, et al. Characteristics of Hard Tick Relapsing Fever Caused by Borrelia miyamotoi, United States, 2013–2019. Emerging Infectious Diseases. 2023;29(9):1719-1729. doi:10.3201/eid2909.221912.
APA McCormick, D. W., Brown, C. M., Bjork, J., Cervantes, K., Esponda-Morrison, B., Garrett, J....Kugeler, K. J. (2023). Characteristics of Hard Tick Relapsing Fever Caused by Borrelia miyamotoi, United States, 2013–2019. Emerging Infectious Diseases, 29(9), 1719-1729. https://doi.org/10.3201/eid2909.221912.

Expires 8/15/2024
Medscape CME Activity
Foodborne Botulism, Canada, 2006–2021 [PDF - 858 KB - 8 pages]
R. A. Harris et al.

During 2006–2021, Canada had 55 laboratory-confirmed outbreaks of foodborne botulism, involving 67 cases. The mean annual incidence was 0.01 case/100,000 population. Foodborne botulism in Indigenous communities accounted for 46% of all cases, which is down from 85% of all cases during 1990–2005. Among all cases, 52% were caused by botulinum neurotoxin type E, but types A (24%), B (16%), F (3%), and AB (1%) also occurred; 3% were caused by undetermined serotypes. Four outbreaks resulted from commercial products, including a 2006 international outbreak caused by carrot juice. Hospital data indicated that 78% of patients were transferred to special care units and 70% required mechanical ventilation; 7 deaths were reported. Botulinum neurotoxin type A was associated with much longer hospital stays and more time spent in special care than types B or E. Foodborne botulism often is misdiagnosed. Increased clinician awareness can improve diagnosis, which can aid epidemiologic investigations and patient treatment.

EID Harris RA, Tchao C, Prystajecky N, Weedmark K, Tcholakov Y, Lefebvre M, et al. Foodborne Botulism, Canada, 2006–2021. Emerg Infect Dis. 2023;29(9):1730-1737. https://doi.org/10.3201/eid2909.230409
AMA Harris RA, Tchao C, Prystajecky N, et al. Foodborne Botulism, Canada, 2006–2021. Emerging Infectious Diseases. 2023;29(9):1730-1737. doi:10.3201/eid2909.230409.
APA Harris, R. A., Tchao, C., Prystajecky, N., Weedmark, K., Tcholakov, Y., Lefebvre, M....Austin, J. W. (2023). Foodborne Botulism, Canada, 2006–2021. Emerging Infectious Diseases, 29(9), 1730-1737. https://doi.org/10.3201/eid2909.230409.

Expires 7/21/2024
Medscape CME Activity
Clinical Characteristics of Corynebacterium ulcerans Infection, Japan [PDF - 2.06 MB - 11 pages]
A. Yamamoto et al.

Corynebacterium ulcerans is a closely related bacterium to the diphtheria bacterium C. diphtheriae, and some C. ulcerans strains produce toxins that are similar to diphtheria toxin. C. ulcerans is widely distributed in the environment and is considered one of the most harmful pathogens to livestock and wildlife. Infection with C. ulcerans can cause respiratory or nonrespiratory symptoms in patients. Recently, the microorganism has been increasingly recognized as an emerging zoonotic agent of diphtheria-like illness in Japan. To clarify the overall clinical characteristics, treatment-related factors, and outcomes of C. ulcerans infection, we analyzed 34 cases of C. ulcerans that occurred in Japan during 2001–2020. During 2010–2020, the incidence rate of C. ulcerans infection increased markedly, and the overall mortality rate was 5.9%. It is recommended that adults be vaccinated with diphtheria toxoid vaccine to prevent the spread of this infection.

EID Yamamoto A, Hifumi T, Ato M, Iwaki M, Senoh M, Hatanaka A, et al. Clinical Characteristics of Corynebacterium ulcerans Infection, Japan. Emerg Infect Dis. 2023;29(8):1505-1515. https://doi.org/10.3201/eid2908.220058
AMA Yamamoto A, Hifumi T, Ato M, et al. Clinical Characteristics of Corynebacterium ulcerans Infection, Japan. Emerging Infectious Diseases. 2023;29(8):1505-1515. doi:10.3201/eid2908.220058.
APA Yamamoto, A., Hifumi, T., Ato, M., Iwaki, M., Senoh, M., Hatanaka, A....Takahashi, M. (2023). Clinical Characteristics of Corynebacterium ulcerans Infection, Japan. Emerging Infectious Diseases, 29(8), 1505-1515. https://doi.org/10.3201/eid2908.220058.

Expires 7/14/2024
Medscape CME Activity
Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum [PDF - 1.07 MB - 8 pages]
K. Shapiro et al.

Mycolicibacterium neoaurum is a rapidly growing mycobacterium and an emerging cause of human infections. M. neoaurum infections are uncommon but likely underreported, and our understanding of the disease spectrum and optimum management is incomplete. We summarize demographic and clinical characteristics of a case of catheter-related M. neoaurum bacteremia in a child with leukemia and those of 36 previously reported episodes of M. neoaurum infection. Most infections occurred in young to middle-aged adults with serious underlying medical conditions and commonly involved medical devices. Overall, infections were not associated with severe illness or death. In contrast to other mycobacteria species, M. neoaurum was generally susceptible to multiple antimicrobial drugs and responded promptly to treatment, and infections were associated with good outcomes after relatively short therapy duration and device removal. Delays in identification and susceptibility testing were common. We recommend using combination antimicrobial drug therapy and removal of infected devices to eradicate infection.

EID Shapiro K, Cross SJ, Morton TH, Inaba H, Holland A, Fasipe FR, et al. Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum. Emerg Infect Dis. 2023;29(8):1516-1523. https://doi.org/10.3201/eid2908.230007
AMA Shapiro K, Cross SJ, Morton TH, et al. Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum. Emerging Infectious Diseases. 2023;29(8):1516-1523. doi:10.3201/eid2908.230007.
APA Shapiro, K., Cross, S. J., Morton, T. H., Inaba, H., Holland, A., Fasipe, F. R....Adderson, E. E. (2023). Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum. Emerging Infectious Diseases, 29(8), 1516-1523. https://doi.org/10.3201/eid2908.230007.

Expires 6/20/2024
Medscape CME Activity
Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus [PDF - 3.76 MB - 10 pages]
S. M. Rudramurthy et al.

We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02–0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03–16], itraconazole [0.03–16], posaconazole [0.03–8], and isavuconazole [0.03–16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus.

EID Rudramurthy SM, Singh S, Kanaujia R, Chaudhary H, Muthu V, Panda N, et al. Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus. Emerg Infect Dis. 2023;29(7):1313-1322. https://doi.org/10.3201/eid2907.221491
AMA Rudramurthy SM, Singh S, Kanaujia R, et al. Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus. Emerging Infectious Diseases. 2023;29(7):1313-1322. doi:10.3201/eid2907.221491.
APA Rudramurthy, S. M., Singh, S., Kanaujia, R., Chaudhary, H., Muthu, V., Panda, N....Chakrabarti, A. (2023). Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus. Emerging Infectious Diseases, 29(7), 1313-1322. https://doi.org/10.3201/eid2907.221491.

Expires 6/16/2024
Medscape CME Activity
Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022 [PDF - 2.87 MB - 10 pages]
R. Cognialli et al.

Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis. We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011–May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visit-years in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019–2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed.

EID Cognialli R, Cáceres DH, Bastos F, Cavassin FB, Lustosa B, Vicente VA, et al. Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022. Emerg Infect Dis. 2023;29(7):1330-1339. https://doi.org/10.3201/eid2907.230155
AMA Cognialli R, Cáceres DH, Bastos F, et al. Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022. Emerging Infectious Diseases. 2023;29(7):1330-1339. doi:10.3201/eid2907.230155.
APA Cognialli, R., Cáceres, D. H., Bastos, F., Cavassin, F. B., Lustosa, B., Vicente, V. A....Queiroz-Telles, F. (2023). Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011–2022. Emerging Infectious Diseases, 29(7), 1330-1339. https://doi.org/10.3201/eid2907.230155.

Expires 5/19/2024
Medscape CME Activity
Neurologic Complications of Babesiosis, United States, 2011–2021 [PDF - 998 KB - 9 pages]
S. Locke et al.

Babesiosis is a globally distributed parasitic infection caused by intraerythrocytic protozoa. The full spectrum of neurologic symptoms, the underlying neuropathophysiology, and neurologic risk factors are poorly understood. Our study sought to describe the type and frequency of neurologic complications of babesiosis in a group of hospitalized patients and assess risk factors that might predispose patients to neurologic complications. We reviewed medical records of adult patients who were admitted to Yale-New Haven Hospital, New Haven, Connecticut, USA, during January 2011–October 2021 with laboratory-confirmed babesiosis. More than half of the 163 patients experienced >1 neurologic symptoms during their hospital admissions. The most frequent symptoms were headache, confusion/delirium, and impaired consciousness. Neurologic symptoms were associated with high-grade parasitemia, renal failure, and history of diabetes mellitus. Clinicians working in endemic areas should recognize the range of symptoms associated with babesiosis, including neurologic.

EID Locke S, O’Bryan J, Zubair AS, Rethana M, Moffarah A, Krause PJ, et al. Neurologic Complications of Babesiosis, United States, 2011–2021. Emerg Infect Dis. 2023;29(6):1128-1135. https://doi.org/10.3201/eid2906.221890
AMA Locke S, O’Bryan J, Zubair AS, et al. Neurologic Complications of Babesiosis, United States, 2011–2021. Emerging Infectious Diseases. 2023;29(6):1128-1135. doi:10.3201/eid2906.221890.
APA Locke, S., O’Bryan, J., Zubair, A. S., Rethana, M., Moffarah, A., Krause, P. J....Farhadian, S. F. (2023). Neurologic Complications of Babesiosis, United States, 2011–2021. Emerging Infectious Diseases, 29(6), 1128-1135. https://doi.org/10.3201/eid2906.221890.

Expires 5/18/2024
Medscape CME Activity
Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection [PDF - 1005 KB - 10 pages]
L. Ponderand et al.

Tularemia is a zoonotic infection caused by Francisella tularensis. Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica–related prosthetic joint infection that occurred in France during 2016–2019. We also reviewed relevant literature and found only 5 other cases of Francisella-related prosthetic joint infections worldwide, which we summarized. Among those 8 patients, clinical symptoms appeared 7 days to 19 years after the joint placement and were nonspecific to tularemia. Although positive cultures are typically obtained in only 10% of tularemia cases, strains grew in all 8 of the patients. F. tularensis was initially identified in 2 patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; molecular methods were used for 6 patients. Surgical treatment in conjunction with long-term antimicrobial treatment resulted in favorable outcomes; no relapses were seen after 6 months of follow-up.

EID Ponderand L, Guimard T, Lazaro E, Dupuy H, Peuchant O, Roch N, et al. Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection. Emerg Infect Dis. 2023;29(6):1117-1126. https://doi.org/10.3201/eid2906.221395
AMA Ponderand L, Guimard T, Lazaro E, et al. Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection. Emerging Infectious Diseases. 2023;29(6):1117-1126. doi:10.3201/eid2906.221395.
APA Ponderand, L., Guimard, T., Lazaro, E., Dupuy, H., Peuchant, O., Roch, N....Caspar, Y. (2023). Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection. Emerging Infectious Diseases, 29(6), 1117-1126. https://doi.org/10.3201/eid2906.221395.

Expires 4/14/2024
Medscape CME Activity
Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021 [PDF - 2.96 MB - 11 pages]
L. M. Powell et al.

Clindamycin and β-lactam antibiotics have been mainstays for treating invasive group A Streptococcus (iGAS) infection, yet such regimens might be limited for strains displaying MLSB phenotypes. We investigated 76 iGAS isolates from 66 patients in West Virginia, USA, during 2020–2021. We performed emm typing using Centers for Disease Control and Prevention guidelines and assessed resistance both genotypically and phenotypically. Median patient age was 42 (range 23–86) years. We found 76% of isolates were simultaneously resistant to erythromycin and clindamycin, including all emm92 and emm11 isolates. Macrolide resistance was conferred by the plasmid-borne ermT gene in all emm92 isolates and by chromosomally encoded ermA, ermB, and a single mefA in other emm types. Macrolide-resistant iGAS isolates were typically resistant to tetracycline and aminoglycosides. Vulnerability to infection was associated with socioeconomic status. Our results show a predominance of macrolide-resistant isolates and a shift in emm type distribution compared with historical reports.

EID Powell LM, Choi S, Chipman CE, Grund ME, LaSala P, Lukomski S. Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021. Emerg Infect Dis. 2023;29(5):897-907. https://doi.org/10.3201/eid2905.221421
AMA Powell LM, Choi S, Chipman CE, et al. Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021. Emerging Infectious Diseases. 2023;29(5):897-907. doi:10.3201/eid2905.221421.
APA Powell, L. M., Choi, S., Chipman, C. E., Grund, M. E., LaSala, P., & Lukomski, S. (2023). Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021. Emerging Infectious Diseases, 29(5), 897-907. https://doi.org/10.3201/eid2905.221421.

Expires 4/13/2024
Medscape CME Activity
Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020 [PDF - 1003 KB - 11 pages]
C. M. Okafor et al.

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015–2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2–8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11–2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23–4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

EID Okafor CM, Clogher P, Olson D, Niccolai L, Hadler J. Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020. Emerg Infect Dis. 2023;29(5):877-887. https://doi.org/10.3201/eid2905.221294
AMA Okafor CM, Clogher P, Olson D, et al. Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020. Emerging Infectious Diseases. 2023;29(5):877-887. doi:10.3201/eid2905.221294.
APA Okafor, C. M., Clogher, P., Olson, D., Niccolai, L., & Hadler, J. (2023). Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020. Emerging Infectious Diseases, 29(5), 877-887. https://doi.org/10.3201/eid2905.221294.

Expires 3/22/2024
Medscape CME Activity
Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients [PDF - 1.21 MB - 5 pages]
D. Stamos et al.

During the SARS-CoV-2 pandemic, few cases of Nocar­dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis­seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in­fection. We also summarize the literature for no­cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina­tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se­lect the optimal treatment for each patient.

EID Stamos D, Barajas-Ochoa A, Raybould JE. Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients. Emerg Infect Dis. 2023;29(4):696-700. https://doi.org/10.3201/eid2904.221439
AMA Stamos D, Barajas-Ochoa A, Raybould JE. Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients. Emerging Infectious Diseases. 2023;29(4):696-700. doi:10.3201/eid2904.221439.
APA Stamos, D., Barajas-Ochoa, A., & Raybould, J. E. (2023). Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients. Emerging Infectious Diseases, 29(4), 696-700. https://doi.org/10.3201/eid2904.221439.

CME Articles by Volume

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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