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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 3/13/2021
Medscape CME Activity
Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016 [PDF - 2.68 MB - 10 pages]
E. A. Dykstra et al.

Tickborne diseases are rare in Washington, USA, and the ecology of these pathogens is poorly understood. We integrated surveillance data from humans and ticks to better describe their epidemiology and ecology. During 2011–2016, a total of 202 tickborne disease cases were reported in Washington residents. Of these, 68 (34%) were autochthonous, including cases of Lyme disease, Rocky Mountain spotted fever, tickborne relapsing fever, and tularemia. During May 2011–December 2016, we collected 977 host-seeking ticks, including Ixodes pacificus, I. angustus, I. spinipalpis, I. auritulus, Dermacentor andersoni, and D. variabilis ticks. The prevalence of Borrelia burgdorferi sensu stricto in I. pacificus ticks was 4.0%; of B. burgdorferi sensu lato, 3.8%; of B. miyamotoi, 4.4%; and of Anaplasma phagocytophilum, 1.9%. We did not detect Rickettsia rickettsii in either Dermacentor species. Case-patient histories and detection of pathogens in field-collected ticks indicate that several tickborne pathogens are endemic to Washington.

EID Dykstra EA, Oltean HN, Kangiser D, Marsden-Haug N, Rich SM, Xu G, et al. Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerg Infect Dis. 2020;26(4):648-657. https://dx.doi.org/10.3201/eid2604.191382
AMA Dykstra EA, Oltean HN, Kangiser D, et al. Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerging Infectious Diseases. 2020;26(4):648-657. doi:10.3201/eid2604.191382.
APA Dykstra, E. A., Oltean, H. N., Kangiser, D., Marsden-Haug, N., Rich, S. M., Xu, G....Eisen, R. J. (2020). Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerging Infectious Diseases, 26(4), 648-657. https://dx.doi.org/10.3201/eid2604.191382.

Expires 2/19/2021
Medscape CME Activity
Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017 [PDF - 1.51 MB - 8 pages]
M. Mukaigawara et al.

Clinical characteristics of disseminated strongyloidiasis, the severest form of strongyloidiasis, are not well described. We conducted a retrospective, consecutive chart review of patients with disseminated strongyloidiasis admitted to Okinawa Chubu Hospital in Okinawa, Japan, during January 1975–December 2017. The 70 patients were classified into 3 clinical phenotypes: dissemination (32 patients [45.7%]), occult dissemination with meningitis caused by enteric organisms (12 patients [17.1%]), and occult dissemination with culture-negative suppurative meningitis (26 patients [37.1%]). Associated mortality rates were 56.3%, 16.7%, and 11.5%, respectively, and sepsis occurred in 40.6%, 58.3%, and 11.5% of cases, respectively. Common symptoms included fever (52.9% of patients), headache (32.9%), and altered mental status (24.3%). Patients were treated with thiabendazole (before 2003) or ivermectin (after 2003). Our findings show that disseminated strongyloidiasis has clinical phenotypes in terms of severity and that identification of occult dissemination, a mild form with prominent neurologic manifestations, is lifesaving.

EID Mukaigawara M, Narita M, Shiiki S, Takayama Y, Takakura S, Kishaba T. Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017. Emerg Infect Dis. 2020;26(3):401-408. https://dx.doi.org/10.3201/eid2603.190571
AMA Mukaigawara M, Narita M, Shiiki S, et al. Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017. Emerging Infectious Diseases. 2020;26(3):401-408. doi:10.3201/eid2603.190571.
APA Mukaigawara, M., Narita, M., Shiiki, S., Takayama, Y., Takakura, S., & Kishaba, T. (2020). Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017. Emerging Infectious Diseases, 26(3), 401-408. https://dx.doi.org/10.3201/eid2603.190571.

Expires 2/19/2021
Medscape CME Activity
Epidemiology of Cryptosporidiosis, New York City, New York, USA, 1995–2018 [PDF - 1.22 MB - 11 pages]
L. Alleyne et al.

Cryptosporidiosis is a parasitic diarrheal infection that is transmitted by the fecal–oral route. We assessed trends in incidence and demographic characteristics for the 3,984 cases diagnosed during 1995–2018 in New York City, New York, USA, and reported to the New York City Department of Health and Mental Hygiene. Reported cryptosporidiosis incidence decreased with HIV/AIDS treatment rollout in the mid-1990s, but the introduction of syndromic multiplex diagnostic panels in 2015 led to a major increase in incidence and to a shift in the demographic profile of reported patients. Incidence was highest among men 20–59 years of age, who consistently represented most (54%) reported patients. In addition, 30% of interviewed patients reported recent international travel. The burden of cryptosporidiosis in New York City is probably highest among men who have sex with men. Prevention messaging is warranted for men who have sex with men and their healthcare providers, as well as for international travelers.

EID Alleyne L, Fitzhenry R, Mergen KA, Espina N, Amoroso E, Cimini D, et al. Epidemiology of Cryptosporidiosis, New York City, New York, USA, 1995–2018. Emerg Infect Dis. 2020;26(3):409-419. https://dx.doi.org/10.3201/eid2603.190785
AMA Alleyne L, Fitzhenry R, Mergen KA, et al. Epidemiology of Cryptosporidiosis, New York City, New York, USA, 1995–2018. Emerging Infectious Diseases. 2020;26(3):409-419. doi:10.3201/eid2603.190785.
APA Alleyne, L., Fitzhenry, R., Mergen, K. A., Espina, N., Amoroso, E., Cimini, D....Thompson, C. N. (2020). Epidemiology of Cryptosporidiosis, New York City, New York, USA, 1995–2018. Emerging Infectious Diseases, 26(3), 409-419. https://dx.doi.org/10.3201/eid2603.190785.

Expires 2/12/2021
Medscape CME Activity
Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015–2017 [PDF - 941 KB - 8 pages]
M. P. Parikh et al.

Recently, Tennessee, USA, has seen an increase in the use of commonly injected drugs, such as heroin and fentanyl. Injection drug use (IDU) practices can lead to life-threatening methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and other serious diseases. We matched MRSA BSIs identified through the National Healthcare Safety Network to the Tennessee Hospital Discharge Data System to characterize the prevalence, demographics, and clinical characteristics associated with IDU in this disease population. Of the 7,646 MRSA BSIs identified during 2015–2017, we found that 1,839 (24.1%) were IDU-related. IDU-related BSIs increased by 118.9%; the greatest rise occurred among emergency department–onset infections (197.4%). IDU was more often associated with white, female, 18–49-year-old, and uninsured persons (p<0.001). We found >1 additional IDU-related diagnoses in 84.2% of IDU-related BSIs. Targeted harm reduction strategies for persons at high risk of IDU are necessary to reduce MRSA BSIs in acute care settings.

EID Parikh MP, Octaria R, Kainer MA. Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015–2017. Emerg Infect Dis. 2020;26(3):446-453. https://dx.doi.org/10.3201/eid2603.191408
AMA Parikh MP, Octaria R, Kainer MA. Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015–2017. Emerging Infectious Diseases. 2020;26(3):446-453. doi:10.3201/eid2603.191408.
APA Parikh, M. P., Octaria, R., & Kainer, M. A. (2020). Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015–2017. Emerging Infectious Diseases, 26(3), 446-453. https://dx.doi.org/10.3201/eid2603.191408.

Expires 1/16/2021
Medscape CME Activity
Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017 [PDF - 1.08 MB - 9 pages]
C. Delgado-Sanz et al.

We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010–2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.

EID Delgado-Sanz C, Mazagatos-Ateca C, Oliva J, Gherasim A, Larrauri A. Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerg Infect Dis. 2020;26(2):220-228. https://dx.doi.org/10.3201/eid2602.181732
AMA Delgado-Sanz C, Mazagatos-Ateca C, Oliva J, et al. Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerging Infectious Diseases. 2020;26(2):220-228. doi:10.3201/eid2602.181732.
APA Delgado-Sanz, C., Mazagatos-Ateca, C., Oliva, J., Gherasim, A., & Larrauri, A. (2020). Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerging Infectious Diseases, 26(2), 220-228. https://dx.doi.org/10.3201/eid2602.181732.

Expires 1/16/2021
Medscape CME Activity
Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States [PDF - 1.11 MB - 7 pages]
C. Gaulin et al.

We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22–December 4, 2018. Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.

EID Gaulin C, Ramsay D, Thivierge K, Tataryn J, Courville A, Martin C, et al. Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerg Infect Dis. 2020;26(2):199-205. https://dx.doi.org/10.3201/eid2602.191218
AMA Gaulin C, Ramsay D, Thivierge K, et al. Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerging Infectious Diseases. 2020;26(2):199-205. doi:10.3201/eid2602.191218.
APA Gaulin, C., Ramsay, D., Thivierge, K., Tataryn, J., Courville, A., Martin, C....Dion, R. (2020). Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerging Infectious Diseases, 26(2), 199-205. https://dx.doi.org/10.3201/eid2602.191218.

Expires 1/15/2021
Medscape CME Activity
Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018 [PDF - 671 KB - 3 pages]
N. McLaren et al.

Observed peaks of acute flaccid myelitis (AFM) cases have occurred biennially since 2014 in the United States. We aimed to determine if AFM etiology differed between peak and nonpeak years, considering that clinical features of AFM differ by virus etiology. We compared clinical and laboratory characteristics of AFM cases that occurred during peak (2016 and 2018, n = 366) and nonpeak (2015 and 2017, n = 50) years. AFM patients in peak years were younger (5.2 years) than those in nonpeak years (8.3 years). A higher percentage of patients in peak years than nonpeak years had pleocytosis (86% vs. 60%), upper extremity involvement (33% vs. 16%), and an illness preceding limb weakness (90% vs. 62%) and were positive for enterovirus or rhinovirus RNA (38% vs. 16%). Enterovirus D68 infection was associated with AFM only in peak years. Our findings suggest AFM etiology differs between peak and nonpeak years.

EID McLaren N, Lopez A, Kidd S, Zhang JX, Nix W, Link-Gelles R, et al. Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerg Infect Dis. 2020;26(2):212-219. https://dx.doi.org/10.3201/eid2602.191453
AMA McLaren N, Lopez A, Kidd S, et al. Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerging Infectious Diseases. 2020;26(2):212-219. doi:10.3201/eid2602.191453.
APA McLaren, N., Lopez, A., Kidd, S., Zhang, J. X., Nix, W., Link-Gelles, R....Routh, J. A. (2020). Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerging Infectious Diseases, 26(2), 212-219. https://dx.doi.org/10.3201/eid2602.191453.

Expires 12/18/2020
Medscape CME Activity
Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018 [PDF - 625 KB - 8 pages]
F. Ahmed et al.

We assessed determinants of work attendance during the first 3 days after onset of acute respiratory illness (ARI) among workers 19–64 years of age who had medically attended ARI or influenza during the 2017–2018 influenza season. The total number of days worked included days worked at the usual workplace and days teleworked. Access to paid leave was associated with fewer days worked overall and at the usual workplace during illness. Participants who indicated that employees were discouraged from coming to work with influenza-like symptoms were less likely to attend their usual workplace. Compared with workers without a telework option, those with telework access worked more days during illness overall, but there was no difference in days worked at the usual workplace. Both paid leave benefits and business practices that actively encourage employees to stay home while sick are necessary to reduce the transmission of ARI and influenza in workplaces.

EID Ahmed F, Kim S, Nowalk M, King JP, VanWormer JJ, Gaglani M, et al. Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018. Emerg Infect Dis. 2020;26(1):26-33. https://dx.doi.org/10.3201/eid2601.190743
AMA Ahmed F, Kim S, Nowalk M, et al. Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018. Emerging Infectious Diseases. 2020;26(1):26-33. doi:10.3201/eid2601.190743.
APA Ahmed, F., Kim, S., Nowalk, M., King, J. P., VanWormer, J. J., Gaglani, M....Uzicanin, A. (2020). Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018. Emerging Infectious Diseases, 26(1), 26-33. https://dx.doi.org/10.3201/eid2601.190743.

Expires 11/15/2020
Medscape CME Activity
Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017 [PDF - 982 KB - 8 pages]
N. Susilawathi et al.

Streptococcus suis is an emerging agent of zoonotic bacterial meningitis in Asia. We describe the epidemiology of S. suis cases and clinical signs and microbiological findings in persons with meningitis in Bali, Indonesia, using patient data and bacterial cultures of cerebrospinal fluid collected during 2014–2017. We conducted microbiological assays using the fully automatic VITEK 2 COMPACT system. We amplified and sequenced gene fragments of glutamate dehydrogenase and recombination/repair protein and conducted PCR serotyping to confirm some serotypes. Of 71 cases, 44 were confirmed as S. suis; 29 isolates were serotype 2. The average patient age was 48.1 years, and 89% of patients were male. Seventy-seven percent of patients with confirmed cases recovered without complications; 11% recovered with septic shock, 7% with deafness, and 2% with deafness and arthritis. The case-fatality rate was 11%. Awareness of S. suis infection risk must be increased in health promotion activities in Bali.

EID Susilawathi N, Tarini N, Fatmawati N, Mayura P, Suryapraba A, Subrata M, et al. Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017. Emerg Infect Dis. 2019;25(12):2235-2242. https://dx.doi.org/10.3201/eid2512.181709
AMA Susilawathi N, Tarini N, Fatmawati N, et al. Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017. Emerging Infectious Diseases. 2019;25(12):2235-2242. doi:10.3201/eid2512.181709.
APA Susilawathi, N., Tarini, N., Fatmawati, N., Mayura, P., Suryapraba, A., Subrata, M....Mahardika, G. (2019). Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017. Emerging Infectious Diseases, 25(12), 2235-2242. https://dx.doi.org/10.3201/eid2512.181709.

Expires 11/14/2020
Medscape CME Activity
Seroprevalence and Risk Factors Possibly Associated with Emerging Zoonotic Vaccinia Virus in a Farming Community, Colombia [PDF - 467 KB - 8 pages]
A. Styczynski et al.

In 2014, vaccinia virus (VACV) infections were identified among farmworkers in Caquetá Department, Colombia; additional cases were identified in Cundinamarca Department in 2015. VACV, an orthopoxvirus (OPXV) used in the smallpox vaccine, has caused sporadic bovine and human outbreaks in countries such as Brazil and India. In response to the emergence of this disease in Colombia, we surveyed and collected blood from 134 farmworkers and household members from 56 farms in Cundinamarca Department. We tested serum samples for OPXV antibodies and correlated risk factors with seropositivity by using multivariate analyses. Fifty-two percent of farmworkers had OPXV antibodies; this percentage decreased to 31% when we excluded persons who would have been eligible for smallpox vaccination. The major risk factors for seropositivity were municipality, age, smallpox vaccination scar, duration of time working on a farm, and animals having vaccinia-like lesions. This investigation provides evidence for possible emergence of VACV as a zoonosis in South America.

EID Styczynski A, Burgado J, Walteros D, Usme-Ciro J, Laiton K, Farias A, et al. Seroprevalence and Risk Factors Possibly Associated with Emerging Zoonotic Vaccinia Virus in a Farming Community, Colombia. Emerg Infect Dis. 2019;25(12):2169-2176. https://dx.doi.org/10.3201/eid2512.181114
AMA Styczynski A, Burgado J, Walteros D, et al. Seroprevalence and Risk Factors Possibly Associated with Emerging Zoonotic Vaccinia Virus in a Farming Community, Colombia. Emerging Infectious Diseases. 2019;25(12):2169-2176. doi:10.3201/eid2512.181114.
APA Styczynski, A., Burgado, J., Walteros, D., Usme-Ciro, J., Laiton, K., Farias, A....Petersen, B. (2019). Seroprevalence and Risk Factors Possibly Associated with Emerging Zoonotic Vaccinia Virus in a Farming Community, Colombia. Emerging Infectious Diseases, 25(12), 2169-2176. https://dx.doi.org/10.3201/eid2512.181114.

Expires 10/15/2020
Medscape CME Activity
Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease [PDF - 1004 KB - 10 pages]
J. W. Gnann et al.

West Nile Virus (WNV) can result in clinically severe neurologic disease. There is no treatment for WNV infection, but administration of anti-WNV polyclonal human antibody has demonstrated efficacy in animal models. We compared Omr-IgG-am, an immunoglobulin product with high titers of anti-WNV antibody, with intravenous immunoglobulin (IVIG) and normal saline to assess safety and efficacy in patients with WNV neuroinvasive disease as part of a phase I/II, randomized, double-blind, multicenter study in North America. During 2003–2006, a total of 62 hospitalized patients were randomized to receive Omr-IgG-am, standard IVIG, or normal saline (3:1:1). The primary endpoint was medication safety. Secondary endpoints were morbidity and mortality, measured using 4 standardized assessments of cognitive and functional status. The death rate in the study population was 12.9%. No significant differences were found between groups receiving Omr-IgG-am compared with IVIG or saline for either the safety or efficacy endpoints.

EID Gnann JW, Agrawal A, Hart J, Buitrago M, Carson P, Hanfelt-Goade D, et al. Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease. Emerg Infect Dis. 2019;25(11):2064-2073. https://dx.doi.org/10.3201/eid2511.190537
AMA Gnann JW, Agrawal A, Hart J, et al. Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease. Emerging Infectious Diseases. 2019;25(11):2064-2073. doi:10.3201/eid2511.190537.
APA Gnann, J. W., Agrawal, A., Hart, J., Buitrago, M., Carson, P., Hanfelt-Goade, D....Whitley, R. J. (2019). Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease. Emerging Infectious Diseases, 25(11), 2064-2073. https://dx.doi.org/10.3201/eid2511.190537.

Expires 9/12/2020
Medscape CME Activity
Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults [PDF - 928 KB - 10 pages]
A. Dernoncourt et al.

We conducted a retrospective study on all cases of pneumococcal septic arthritis (SA) in patients >18 years of age reported to the Picardie Regional Pneumococcal Network in France during 2005–2016. Among 1,062 cases of invasive pneumococcal disease, we observed 16 (1.5%) SA cases. Although SA is uncommon in adult patients, the prevalence of pneumococcal SA in the Picardie region increased from 0.69% during 2005–2010 to 2.47% during 2011–2016 after introduction of the pneumococcal 13-valent conjugate vaccine. We highlight the emergence of SA cases caused by the 23B serotype, which is not covered in the vaccine.

EID Dernoncourt A, El Samad Y, Schmidt J, Emond J, Gouraud C, Brocard A, et al. Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerg Infect Dis. 2019;25(10):1824-1833. https://dx.doi.org/10.3201/eid2510.181695
AMA Dernoncourt A, El Samad Y, Schmidt J, et al. Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerging Infectious Diseases. 2019;25(10):1824-1833. doi:10.3201/eid2510.181695.
APA Dernoncourt, A., El Samad, Y., Schmidt, J., Emond, J., Gouraud, C., Brocard, A....Hamdad, F. (2019). Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerging Infectious Diseases, 25(10), 1824-1833. https://dx.doi.org/10.3201/eid2510.181695.

Expires 9/12/2020
Medscape CME Activity
Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 [PDF - 530 KB - 7 pages]
S. Kamiyama et al.

Edwardsiella tarda is primarily associated with gastrointestinal disease, but an increasing number of cases involving extraintestinal disease, especially E. tarda bacteremia, have been reported. Using clinical information of E. tarda bacteremia patients identified during January 2005–December 2016 in Japan, we characterized the clinical epidemiology of E. tarda bacteremia. A total of 182,668 sets of blood cultures were obtained during the study period; 40 (0.02%) sets from 26 patients were positive for E. tarda. The most common clinical manifestations were hepatobiliary infection, including cholangitis, liver abscess, and cholecystitis. Overall 30-day mortality for E. tarda bacteremia was 12%, and overall 90-day mortality was 27%. The incidence of E. tarda infection did not vary by season. We more frequently observed hepatobiliary infection in patients with E. tarda bacteremia than in patients with nonbacteremic E. tarda infections. E. tarda bacteremia is a rare entity that is not associated with high rates of death.

EID Kamiyama S, Kuriyama A, Hashimoto T. Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerg Infect Dis. 2019;25(10):1817-1823. https://dx.doi.org/10.3201/eid2510.180518
AMA Kamiyama S, Kuriyama A, Hashimoto T. Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerging Infectious Diseases. 2019;25(10):1817-1823. doi:10.3201/eid2510.180518.
APA Kamiyama, S., Kuriyama, A., & Hashimoto, T. (2019). Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerging Infectious Diseases, 25(10), 1817-1823. https://dx.doi.org/10.3201/eid2510.180518.

Expires 9/11/2020
Medscape CME Activity
Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 [PDF - 1.00 MB - 8 pages]
E. Mosites et al.

The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002–2015. We used data from the Centers for Disease Control and Prevention’s Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group.

EID Mosites E, Zulz T, Bruden D, Nolen L, Frick A, Castrodale L, et al. Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerg Infect Dis. 2019;25(10):1903-1910. https://dx.doi.org/10.3201/eid2510.181408
AMA Mosites E, Zulz T, Bruden D, et al. Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerging Infectious Diseases. 2019;25(10):1903-1910. doi:10.3201/eid2510.181408.
APA Mosites, E., Zulz, T., Bruden, D., Nolen, L., Frick, A., Castrodale, L....Bruce, M. G. (2019). Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerging Infectious Diseases, 25(10), 1903-1910. https://dx.doi.org/10.3201/eid2510.181408.

Expires 8/20/2020
Medscape CME Activity
Risk for Clostridioides difficile Infection among Older Adults with Cancer [PDF - 821 KB - 7 pages]
M. Kamboj et al.

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

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

Expires 8/20/2020
Medscape CME Activity
Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions [PDF - 748 KB - 9 pages]
A. Ganesan et al.

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

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

Expires 7/15/2020
Medscape CME Activity
Zika Virus Infection in Pregnant Women, Yucatan, Mexico [PDF - 1.23 MB - 8 pages]
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.

EID Romer Y, Valadez-Gonzalez N, Contreras-Capetillo S, Manrique-Saide P, Vazquez-Prokopec G, Pavia-Ruz N. Zika Virus Infection in Pregnant Women, Yucatan, Mexico. Emerg Infect Dis. 2019;25(8):1452-1460. https://dx.doi.org/10.3201/eid2508.180915
AMA Romer Y, Valadez-Gonzalez N, Contreras-Capetillo S, et al. Zika Virus Infection in Pregnant Women, Yucatan, Mexico. Emerging Infectious Diseases. 2019;25(8):1452-1460. doi:10.3201/eid2508.180915.
APA Romer, Y., Valadez-Gonzalez, N., Contreras-Capetillo, S., Manrique-Saide, P., Vazquez-Prokopec, G., & Pavia-Ruz, N. (2019). Zika Virus Infection in Pregnant Women, Yucatan, Mexico. Emerging Infectious Diseases, 25(8), 1452-1460. https://dx.doi.org/10.3201/eid2508.180915.

Expires 6/17/2020
Medscape CME Activity
Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013 [PDF - 969 KB - 10 pages]
S. K. Brode et al.

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

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

Expires 6/13/2020
Medscape CME Activity
Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016 [PDF - 866 KB - 8 pages]
P. A. Armstrong et al.

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

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

Expires 5/19/2020
Medscape CME Activity
Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018 [PDF - 1.90 MB - 9 pages]
E. A. Ilori et al.

Lassa fever (LF) is endemic to Nigeria, where the disease causes substantial rates of illness and death. In this article, we report an analysis of the epidemiologic and clinical aspects of the LF outbreak that occurred in Nigeria during January 1–May 6, 2018. A total of 1,893 cases were reported; 423 were laboratory-confirmed cases, among which 106 deaths were recorded (case-fatality rate 25.1%). Among all confirmed cases, 37 occurred in healthcare workers. The secondary attack rate among 5,001 contacts was 0.56%. Most (80.6%) confirmed cases were reported from 3 states (Edo, Ondo, and Ebonyi). Fatal outcomes were significantly associated with being elderly; no administration of ribavirin; and the presence of a cough, hemorrhaging, and unconsciousness. The findings in this study should lead to further LF research and provide guidance to those preparing to respond to future outbreaks.

EID Ilori EA, Furuse Y, Ipadeola OB, Dan-Nwafor CC, Abubakar A, Womi-Eteng OE, et al. Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018. Emerg Infect Dis. 2019;25(6):1066-1074. https://dx.doi.org/10.3201/eid2506.181035
AMA Ilori EA, Furuse Y, Ipadeola OB, et al. Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018. Emerging Infectious Diseases. 2019;25(6):1066-1074. doi:10.3201/eid2506.181035.
APA Ilori, E. A., Furuse, Y., Ipadeola, O. B., Dan-Nwafor, C. C., Abubakar, A., Womi-Eteng, O. E....Ihekweazu, C. (2019). Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018. Emerging Infectious Diseases, 25(6), 1066-1074. https://dx.doi.org/10.3201/eid2506.181035.

Expires 5/17/2020
Medscape CME Activity
Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA [PDF - 578 KB - 7 pages]
N. Goldstein et al.

Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.

EID Goldstein N, St. Clair J, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis. 2019;25(6):1075-1083. https://dx.doi.org/10.3201/eid2506.181041
AMA Goldstein N, St. Clair J, Kasperbauer SH, et al. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerging Infectious Diseases. 2019;25(6):1075-1083. doi:10.3201/eid2506.181041.
APA Goldstein, N., St. Clair, J., Kasperbauer, S. H., Daley, C. L., & Lindeque, B. (2019). Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerging Infectious Diseases, 25(6), 1075-1083. https://dx.doi.org/10.3201/eid2506.181041.

Expires 4/17/2020
Medscape CME Activity
Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan [PDF - 2.53 MB - 8 pages]
R. Akamatsu et al.

Bacillus cereus is associated with foodborne illnesses characterized by vomiting and diarrhea. Although some B. cereus strains that cause severe extraintestinal infections and nosocomial infections are recognized as serious public health threats in healthcare settings, the genetic backgrounds of B. cereus strains causing such infections remain unknown. By conducting pulsed-field gel electrophoresis and multilocus sequence typing, we found that a novel sequence type (ST), newly registered as ST1420, was the dominant ST isolated from the cases of nosocomial infections that occurred in 3 locations in Japan in 2006, 2013, and 2016. Phylogenetic analysis showed that ST1420 strains belonged to the Cereus III lineage, which is much closer to the Anthracis lineage than to other Cereus lineages. Our results suggest that ST1420 is a prevalent ST in B. cereus strains that have caused recent nosocomial infections in Japan.

EID Akamatsu R, Suzuki M, Okinaka K, Sasahara T, Yamane K, Suzuki S, et al. Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerg Infect Dis. 2019;25(5):883-890. https://dx.doi.org/10.3201/eid2505.171890
AMA Akamatsu R, Suzuki M, Okinaka K, et al. Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerging Infectious Diseases. 2019;25(5):883-890. doi:10.3201/eid2505.171890.
APA Akamatsu, R., Suzuki, M., Okinaka, K., Sasahara, T., Yamane, K., Suzuki, S....Higashi, H. (2019). Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerging Infectious Diseases, 25(5), 883-890. https://dx.doi.org/10.3201/eid2505.171890.

Expires 4/12/2020
Medscape CME Activity
Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015 [PDF - 1.04 MB - 8 pages]
L. Thorlacius-Ussing et al.

Staphylococcus aureus bacteremia (SAB) is a major cause of illness and death worldwide. We analyzed temporal trends of SAB incidence and death in Denmark during 2008–2015. SAB incidence increased 48%, from 20.76 to 30.37 per 100,000 person-years, during this period (p<0.001). The largest change in incidence was observed for persons >80 years of age: a 90% increase in the SAB rate (p<0.001). After adjusting for demographic changes, annual rates increased 4.0% (95% CI 3.0–5.0) for persons <80 years of age, 8.4% (95% CI 7.0–11.0) for persons 80–89 years of age, and 13.0% (95% CI 9.0–17.5) for persons >90 years of age. The 30-day case-fatality rate remained stable at 24%; crude population death rates increased by 53% during 2008–2015 (p<0.001). Specific causes and mechanisms for this rapid increase in SAB incidence among the elderly population remain to be clarified.

EID Thorlacius-Ussing L, Sandholdt H, Larsen A, Petersen A, Benfield T. Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerg Infect Dis. 2019;25(5):875-882. https://dx.doi.org/10.3201/eid2505.181733
AMA Thorlacius-Ussing L, Sandholdt H, Larsen A, et al. Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerging Infectious Diseases. 2019;25(5):875-882. doi:10.3201/eid2505.181733.
APA Thorlacius-Ussing, L., Sandholdt, H., Larsen, A., Petersen, A., & Benfield, T. (2019). Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerging Infectious Diseases, 25(5), 875-882. https://dx.doi.org/10.3201/eid2505.181733.

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