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Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn Medscape CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Medscape CME for physicians. The activities listed below have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Volume 21—2015

Volume 21, Number 12—December 2015

image of the 'Thumbnail' version of the Volume 21, Number 12—December 2015 cover of the CDC's EID journal
Medscape CME Activity
Life-Threatening Sochi Virus Infections, Russia PDF Version [PDF - 558 KB - 5 pages]
D. H. Kruger et al.
    View Abstract

Sochi virus was recently identified as a new hantavirus genotype carried by the Black Sea field mouse, Apodemus ponticus. We evaluated 62 patients in Russia with Sochi virus infection. Most clinical cases were severe, and the case-fatality rate was as high as 14.5%.

    Cite This Article
EID Kruger DH, Tkachenko EA, Morozov VG, Yunicheva YV, Pilikova OM, Malkin G, et al. Life-Threatening Sochi Virus Infections, Russia. Emerg Infect Dis. 2015;21(12):2204-2208. https://dx.doi.org/10.3201/eid2112.150891
AMA Kruger DH, Tkachenko EA, Morozov VG, et al. Life-Threatening Sochi Virus Infections, Russia. Emerging Infectious Diseases. 2015;21(12):2204-2208. doi:10.3201/eid2112.150891.
APA Kruger, D. H., Tkachenko, E. A., Morozov, V. G., Yunicheva, Y. V., Pilikova, O. M., Malkin, G....Dzagurova, T. K. (2015). Life-Threatening Sochi Virus Infections, Russia. Emerging Infectious Diseases, 21(12), 2204-2208. https://dx.doi.org/10.3201/eid2112.150891.
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Volume 21, Number 11—November 2015

image of the 'Thumbnail' version of the Volume 21, Number 11—November 2015 cover of the CDC's EID journal
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Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA PDF Version [PDF - 940 KB - 9 pages]
D. Jung et al.
View Summary

Potentially resistant bloodstream isolates and increasing use of echinocandins create a need for institutional surveillance for candidemia in cancer patients.

    View Abstract

Many uncommon Candida species that cause bloodstream infections (BSIs) are not well-characterized. We investigated the epidemiology, antifungal use, susceptibility patterns, and factors associated with all-cause death among cancer patients in whom uncommon Candida spp. BSIs were diagnosed at a cancer treatment center during January 1998–September 2013. Of 1,395 Candida bloodstream isolates, 79 from 68 patients were uncommon Candida spp. The incidence density of uncommon Candida spp. BSIs and their proportion to all candidemia episodes substantively increased during the study period, and the rise was associated with increasing use of echinocandin antifungal drugs. Thirty-seven patients had breakthrough infections during therapy or prophylaxis with various systemic antifungal drugs for >7 consecutive days; 21 were receiving an echinocandin. C. kefyr (82%), and C. lusitaniae (21%) isolates frequently showed caspofungin MICs above the epidemiologic cutoff values. These findings support the need for institutional surveillance for uncommon Candida spp. among cancer patients.

    Cite This Article
EID Jung D, Farmakiotis D, Jiang Y, Tarrand JJ, Kontoyiannis DP. Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerg Infect Dis. 2015;21(11):1942-1950. https://dx.doi.org/10.3201/eid2111.150404
AMA Jung D, Farmakiotis D, Jiang Y, et al. Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerging Infectious Diseases. 2015;21(11):1942-1950. doi:10.3201/eid2111.150404.
APA Jung, D., Farmakiotis, D., Jiang, Y., Tarrand, J. J., & Kontoyiannis, D. P. (2015). Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerging Infectious Diseases, 21(11), 1942-1950. https://dx.doi.org/10.3201/eid2111.150404.
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Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E PDF Version [PDF - 1.18 MB - 7 pages]
H. Perrin et al.
View Summary

Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for hepatitis E virus infection.

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Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.

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EID Perrin H, Cintas P, Abravanel F, Gérolami R, d'Alteroche L, Raynal J, et al. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerg Infect Dis. 2015;21(11):1928-1934. https://dx.doi.org/10.3201/eid2111.141789
AMA Perrin H, Cintas P, Abravanel F, et al. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerging Infectious Diseases. 2015;21(11):1928-1934. doi:10.3201/eid2111.141789.
APA Perrin, H., Cintas, P., Abravanel, F., Gérolami, R., d'Alteroche, L., Raynal, J....Peron, J. (2015). Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerging Infectious Diseases, 21(11), 1928-1934. https://dx.doi.org/10.3201/eid2111.141789.
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Volume 21, Number 10—October 2015

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Invasive Disease Caused by Nontypeable Haemophilus influenzae PDF Version [PDF - 517 KB - 8 pages]
J. D. Langereis and M. I. de Jonge
View Summary

These infections are emerging worldwide, especially in young children and the elderly.

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The incidence of severe Haemophilus influenza infections, such as sepsis and meningitis, has declined substantially since the introduction of the H. influenzae serotype b vaccine. However, the H. influenzae type b vaccine fails to protect against nontypeable H. influenzae strains, which have become increasingly frequent causes of invasive disease, especially among children and the elderly. We summarize recent literature supporting the emergence of invasive nontypeable H. influenzae and describe mechanisms that may explain its increasing prevalence over the past 2 decades.

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EID Langereis JD, de Jonge MI. Invasive Disease Caused by Nontypeable Haemophilus influenzae. Emerg Infect Dis. 2015;21(10):1711-1718. https://dx.doi.org/10.3201/eid2110.150004
AMA Langereis JD, de Jonge MI. Invasive Disease Caused by Nontypeable Haemophilus influenzae. Emerging Infectious Diseases. 2015;21(10):1711-1718. doi:10.3201/eid2110.150004.
APA Langereis, J. D., & de Jonge, M. I. (2015). Invasive Disease Caused by Nontypeable Haemophilus influenzae. Emerging Infectious Diseases, 21(10), 1711-1718. https://dx.doi.org/10.3201/eid2110.150004.
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Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013 PDF Version [PDF - 396 KB - 6 pages]
S. Vallabhaneni et al.
View Summary

Use of short-term steroids was a risk factor for infection.

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We investigated an unusual cluster of 6 patients with Cryptococcus neoformans infection at a community hospital in Arkansas during April–December 2013, to determine source of infection. Four patients had bloodstream infection and 2 had respiratory infection; 3 infections occurred within a 10-day period. Five patients had been admitted to the intensive care unit (ICU) with diagnoses other than cryptococcosis; none had HIV infection, and 1 patient had a history of organ transplantation. We then conducted a retrospective cohort study of all patients admitted to the ICU during April–December 2013 to determine risk factors for cryptococcosis. Four patients with C. neoformans infection had received a short course of steroids; this short-term use was associated with increased risk for cryptococcosis (rate ratio 19.1; 95% CI 2.1–170.0; p<0.01). Although long-term use of steroids is a known risk factor for cryptococcosis, the relationship between short-term steroid use and disease warrants further study

    Cite This Article
EID Vallabhaneni S, Haselow D, Lloyd S, Lockhart SR, Moulton-Meissner H, Lester L, et al. Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013. Emerg Infect Dis. 2015;21(10):1719-1724. https://dx.doi.org/10.3201/eid2110.150249
AMA Vallabhaneni S, Haselow D, Lloyd S, et al. Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013. Emerging Infectious Diseases. 2015;21(10):1719-1724. doi:10.3201/eid2110.150249.
APA Vallabhaneni, S., Haselow, D., Lloyd, S., Lockhart, S. R., Moulton-Meissner, H., Lester, L....Harris, J. R. (2015). Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013. Emerging Infectious Diseases, 21(10), 1719-1724. https://dx.doi.org/10.3201/eid2110.150249.
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Volume 21, Number 9—September 2015

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Mycobacterium abscessus Complex Infections in Humans PDF Version [PDF - 1.25 MB - 9 pages]
M. Lee et al.
View Summary

New treatments, rapid and inexpensive identification methods, and measures to contain nosocomial transmission and outbreaks are urgently needed.

    View Abstract

Mycobacterium abscessus complex comprises a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria that are responsible for a wide spectrum of skin and soft tissue diseases, central nervous system infections, bacteremia, and ocular and other infections. M. abscessus complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. The 2 major subspecies, M. abscessus subsp. abscessus and M. abscessus subsp. massiliense, have different erm(41) gene patterns. This gene provides intrinsic resistance to macrolides, so the different patterns lead to different treatment outcomes. M. abscessus complex outbreaks associated with cosmetic procedures and nosocomial transmissions are not uncommon. Clarithromycin, amikacin, and cefoxitin are the current antimicrobial drugs of choice for treatment. However, new treatment regimens are urgently needed, as are rapid and inexpensive identification methods and measures to contain nosocomial transmission and outbreaks.

    Cite This Article
EID Lee M, Sheng W, Hung C, Yu C, Lee L, Hsueh P, et al. Mycobacterium abscessus Complex Infections in Humans. Emerg Infect Dis. 2015;21(9):1638-1646. https://dx.doi.org/10.3201/eid2109.141634
AMA Lee M, Sheng W, Hung C, et al. Mycobacterium abscessus Complex Infections in Humans. Emerging Infectious Diseases. 2015;21(9):1638-1646. doi:10.3201/eid2109.141634.
APA Lee, M., Sheng, W., Hung, C., Yu, C., Lee, L., & Hsueh, P. (2015). Mycobacterium abscessus Complex Infections in Humans. Emerging Infectious Diseases, 21(9), 1638-1646. https://dx.doi.org/10.3201/eid2109.141634.
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Encephalitis Surveillance through the Emerging Infections Program, 1997–2010 PDF Version [PDF - 471 KB - 6 pages]
K. C. Bloch and C. A. Glaser
View Summary

A 3-state syndromic surveillance system documented reduction and emergence of neurologic infectious diseases.

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Encephalitis is a devastating illness that commonly causes neurologic disability and has a case fatality rate >5% in the United States. An etiologic agent is identified in <50% of cases, making diagnosis challenging. The Centers for Disease Control and Prevention Emerging Infections Program (EIP) Encephalitis Project established syndromic surveillance for encephalitis in New York, California, and Tennessee, with the primary goal of increased identification of causative agents and secondary goals of improvements in treatment and outcome. The project represents the largest cohort of patients with encephalitis studied to date and has influenced case definition and diagnostic evaluation of this condition. Results of this project have provided insight into well-established causal pathogens and identified newer causes of infectious and autoimmune encephalitis. The recognition of a possible relationship between enterovirus D68 and acute flaccid paralysis with myelitis underscores the need for ongoing vigilance for emerging causes of neurologic disease.

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EID Bloch KC, Glaser CA. Encephalitis Surveillance through the Emerging Infections Program, 1997–2010. Emerg Infect Dis. 2015;21(9):1562-1567. https://dx.doi.org/10.3201/eid2109.150295
AMA Bloch KC, Glaser CA. Encephalitis Surveillance through the Emerging Infections Program, 1997–2010. Emerging Infectious Diseases. 2015;21(9):1562-1567. doi:10.3201/eid2109.150295.
APA Bloch, K. C., & Glaser, C. A. (2015). Encephalitis Surveillance through the Emerging Infections Program, 1997–2010. Emerging Infectious Diseases, 21(9), 1562-1567. https://dx.doi.org/10.3201/eid2109.150295.
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Volume 21, Number 8—August 2015

image of the 'Thumbnail' version of the Volume 21, Number 8—August 2015 cover of the CDC's EID journal
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Escherichia coli O157 Outbreaks in the United States, 2003–2012 PDF Version [PDF - 1.58 MB - 9 pages]
K. E. Heiman et al.
View Summary

Beef and leafy vegetables were the most common sources of these outbreaks.

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Infections with the Shiga toxin–producing bacterium Escherichia coli O157 can cause severe illness and death. We summarized reported outbreaks of E. coli O157 infections in the United States during 2003–2012, including demographic characteristics of patients and epidemiologic findings by transmission mode and food category. We identified 390 outbreaks, which included 4,928 illnesses, 1,272 hospitalizations, and 33 deaths. Transmission was through food (255 outbreaks, 65%), person-to-person contact (39, 10%), indirect or direct contact with animals (39, 10%), and water (15, 4%); 42 (11%) had a different or unknown mode of transmission. Beef and leafy vegetables, combined, were the source of >25% of all reported E. coli outbreaks and of >40% of related illnesses. Outbreaks attributed to foods generally consumed raw caused higher hospitalization rates than those attributed to foods generally consumed cooked (35% vs. 28%). Most (87%) waterborne E. coli outbreaks occurred in states bordering the Mississippi River.

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EID Heiman KE, Mody RK, Johnson SD, Griffin PM, Gould L. Escherichia coli O157 Outbreaks in the United States, 2003–2012. Emerg Infect Dis. 2015;21(8):1293-1301. https://dx.doi.org/10.3201/eid2108.141364
AMA Heiman KE, Mody RK, Johnson SD, et al. Escherichia coli O157 Outbreaks in the United States, 2003–2012. Emerging Infectious Diseases. 2015;21(8):1293-1301. doi:10.3201/eid2108.141364.
APA Heiman, K. E., Mody, R. K., Johnson, S. D., Griffin, P. M., & Gould, L. (2015). Escherichia coli O157 Outbreaks in the United States, 2003–2012. Emerging Infectious Diseases, 21(8), 1293-1301. https://dx.doi.org/10.3201/eid2108.141364.
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Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013 PDF Version [PDF - 1.43 MB - 8 pages]
M. M. Kratz et al.
View Summary

Questions about how to protect this at-risk population deserve careful consideration.

    View Abstract

In September 2012, the New York City Department of Health and Mental Hygiene identified an outbreak of Neisseria meningitidis serogroup C invasive meningococcal disease among men who have sex with men (MSM). Twenty-two case-patients and 7 deaths were identified during August 2010−February 2013. During this period, 7 cases in non-MSM were diagnosed. The slow-moving outbreak was linked to the use of websites and mobile phone applications that connect men with male sexual partners, which complicated the epidemiologic investigation and prevention efforts. We describe the outbreak and steps taken to interrupt transmission, including an innovative and wide-ranging outreach campaign that involved direct, internet-based, and media-based communications; free vaccination events; and engagement of community and government partners. We conclude by discussing the challenges of managing an outbreak affecting a discrete community of MSM and the benefits of using social networking technology to reach this at-risk population.

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EID Kratz MM, Weiss D, Ridpath A, Zucker JR, Geevarughese A, Rakeman JL, et al. Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013. Emerg Infect Dis. 2015;21(8):1386. https://dx.doi.org/10.3201/eid2108.141837
AMA Kratz MM, Weiss D, Ridpath A, et al. Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013. Emerging Infectious Diseases. 2015;21(8):1386. doi:10.3201/eid2108.141837.
APA Kratz, M. M., Weiss, D., Ridpath, A., Zucker, J. R., Geevarughese, A., Rakeman, J. L....Varma, J. K. (2015). Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013. Emerging Infectious Diseases, 21(8), 1386. https://dx.doi.org/10.3201/eid2108.141837.
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Volume 21, Number 7—July 2015

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Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors PDF Version [PDF - 919 KB - 6 pages]
J. Chan et al.
View Summary

Clinicians should be aware of these infections, especially in patients from disease-endemic regions.

    View Abstract

Infections with the fungus Talaromyces (formerly Penicillium) marneffei are rare in patients who do not have AIDS. We report disseminated T. marneffei infection in 4 hematology patients without AIDS who received targeted therapy with monoclonal antibodies against CD20 or kinase inhibitors during the past 2 years. Clinicians should be aware of this emerging complication, especially in patients from disease-endemic regions.

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EID Chan J, Chan T, Gill H, Lam F, Trendell-Smith NJ, Sridhar S, et al. Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors. Emerg Infect Dis. 2015;21(7):1101-1106. https://dx.doi.org/10.3201/eid2107.150138
AMA Chan J, Chan T, Gill H, et al. Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors. Emerging Infectious Diseases. 2015;21(7):1101-1106. doi:10.3201/eid2107.150138.
APA Chan, J., Chan, T., Gill, H., Lam, F., Trendell-Smith, N. J., Sridhar, S....Yuen, K. (2015). Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors. Emerging Infectious Diseases, 21(7), 1101-1106. https://dx.doi.org/10.3201/eid2107.150138.
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Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014 PDF Version [PDF - 1.85 MB - 9 pages]
G. Cumming et al.
View Summary

Syndromic surveillance was useful for outbreak monitoring, and public health response helped reduce hospitalization times.

    View Abstract

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.

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EID Cumming G, Khatami A, McMullan BJ, Musto J, Leung K, Nguyen O, et al. Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014. Emerg Infect Dis. 2015;21(7):1144-1152. https://dx.doi.org/10.3201/eid2107.141149
AMA Cumming G, Khatami A, McMullan BJ, et al. Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014. Emerging Infectious Diseases. 2015;21(7):1144-1152. doi:10.3201/eid2107.141149.
APA Cumming, G., Khatami, A., McMullan, B. J., Musto, J., Leung, K., Nguyen, O....Sheppeard, V. (2015). Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013–2014. Emerging Infectious Diseases, 21(7), 1144-1152. https://dx.doi.org/10.3201/eid2107.141149.
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Volume 21, Number 6—June 2015

image of the 'Thumbnail' version of the Volume 21, Number 6—June 2015 cover of the CDC's EID journal
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Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis PDF Version [PDF - 1.21 MB - 10 pages]
R. R. Kempker et al.
View Summary

Acquired drug resistance is common and an impediment to successful treatment outcomes.

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Rates and risk factors for acquired drug resistance and association with outcomes among patients with multidrug-resistant tuberculosis (MDR TB) are not well defined. In an MDR TB cohort from the country of Georgia, drug susceptibility testing for second-line drugs (SLDs) was performed at baseline and every third month. Acquired resistance was defined as any SLD whose status changed from susceptible at baseline to resistant at follow-up. Among 141 patients, acquired resistance in Mycobacterium tuberculosis was observed in 19 (14%); prevalence was 9.1% for ofloxacin and 9.8% for capreomycin or kanamycin. Baseline cavitary disease and resistance to >6 drugs were associated with acquired resistance. Patients with M. tuberculosis that had acquired resistance were at significantly increased risk for poor treatment outcome compared with patients without these isolates (89% vs. 36%; p<0.01). Acquired resistance occurs commonly among patients with MDR TB and impedes successful treatment outcomes.

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EID Kempker RR, Kipiani M, Mirtskhulava V, Tukvadze N, Magee MJ, Blumberg HM, et al. Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis. Emerg Infect Dis. 2015;21(6):992-1001. https://dx.doi.org/10.3201/eid2106.141873
AMA Kempker RR, Kipiani M, Mirtskhulava V, et al. Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis. Emerging Infectious Diseases. 2015;21(6):992-1001. doi:10.3201/eid2106.141873.
APA Kempker, R. R., Kipiani, M., Mirtskhulava, V., Tukvadze, N., Magee, M. J., & Blumberg, H. M. (2015). Acquired Drug Resistance in Mycobacterium tuberculosis and Poor Outcomes among Patients with Multidrug-Resistant Tuberculosis. Emerging Infectious Diseases, 21(6), 992-1001. https://dx.doi.org/10.3201/eid2106.141873.
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Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013 PDF Version [PDF - 2.29 MB - 8 pages]
R. Smith et al.
View Summary

Public health response to the outbreak likely resulted fewer injections, cases, and deaths.

Deaths, Illnesses Averted in Meningitis Outbreak

    View Abstract

During 2012–2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients.

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EID Smith R, Derado G, Wise M, Harris JR, Chiller TM, Meltzer MI, et al. Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013. Emerg Infect Dis. 2015;21(6):933-940. https://dx.doi.org/10.3201/eid2106.141558
AMA Smith R, Derado G, Wise M, et al. Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013. Emerging Infectious Diseases. 2015;21(6):933-940. doi:10.3201/eid2106.141558.
APA Smith, R., Derado, G., Wise, M., Harris, J. R., Chiller, T. M., Meltzer, M. I....Park, B. (2015). Estimated Deaths and Illnesses Averted During Fungal Meningitis Outbreak Associated with Contaminated Steroid Injections, United States, 2012–2013. Emerging Infectious Diseases, 21(6), 933-940. https://dx.doi.org/10.3201/eid2106.141558.
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Volume 21, Number 5—May 2015

image of the 'Thumbnail' version of the Volume 21, Number 5—May 2015 cover of the CDC's EID journal
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Recent US Case of Variant Creutzfeldt-Jakob Disease—Global Implications PDF Version [PDF - 2.48 MB - 10 pages]
A. Maheshwari et al.
View Summary

A recently diagnosed case highlights the need for continued global surveillance.

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Variant Creutzfeldt-Jakob disease (vCJD) is a rare, fatal prion disease resulting from transmission to humans of the infectious agent of bovine spongiform encephalopathy. We describe the clinical presentation of a recent case of vCJD in the United States and provide an update on diagnostic testing. The location of this patient’s exposure is less clear than those in the 3 previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the United States more than a decade before illness onset. This case exemplifies the persistent risk for vCJD acquired in unsuspected geographic locations and highlights the need for continued global surveillance and awareness to prevent further dissemination of vCJD.

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EID Maheshwari A, Fischer M, Gambetti P, Parker A, Ram A, Soto C, et al. Recent US Case of Variant Creutzfeldt-Jakob Disease—Global Implications. Emerg Infect Dis. 2015;21(5):750-759. https://dx.doi.org/10.3201/eid2105.142017
AMA Maheshwari A, Fischer M, Gambetti P, et al. Recent US Case of Variant Creutzfeldt-Jakob Disease—Global Implications. Emerging Infectious Diseases. 2015;21(5):750-759. doi:10.3201/eid2105.142017.
APA Maheshwari, A., Fischer, M., Gambetti, P., Parker, A., Ram, A., Soto, C....Hussein, H. M. (2015). Recent US Case of Variant Creutzfeldt-Jakob Disease—Global Implications. Emerging Infectious Diseases, 21(5), 750-759. https://dx.doi.org/10.3201/eid2105.142017.
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Volume 21, Number 4—April 2015

image of the 'Thumbnail' version of the Volume 21, Number 4—April 2015 cover of the CDC's EID journal
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Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012 PDF Version [PDF - 1.98 MB - 9 pages]
P. Gautret et al.
View Summary

No demographic characteristics identified who might benefit most from pretravel counseling.

    View Abstract

Among travelers, rabies cases are rare, but animal bites are relatively common. To determine which travelers are at highest risk for rabies, we studied 2,697 travelers receiving care for animal-related exposures and requiring rabies postexposure prophylaxis at GeoSentinel clinics during 1997–2012. No specific demographic characteristics differentiated these travelers from other travelers seeking medical care, making it challenging to identify travelers who might benefit from reinforced pretravel rabies prevention counseling. Median travel duration was short for these travelers: 15 days for those seeking care after completion of travel and 20 days for those seeking care during travel. This finding contradicts the view that preexposure rabies vaccine recommendations should be partly based on longer travel durations. Over half of exposures occurred in Thailand, Indonesia, Nepal, China, and India. International travelers to rabies-endemic regions, particularly Asia, should be informed about potential rabies exposure and benefits of pretravel vaccination, regardless of demographics or length of stay.

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EID Gautret P, Harvey K, Pandey P, Lim P, Leder K, Piyaphanee W, et al. Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012. Emerg Infect Dis. 2015;21(4):569-577. https://dx.doi.org/10.3201/eid2104.141479
AMA Gautret P, Harvey K, Pandey P, et al. Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012. Emerging Infectious Diseases. 2015;21(4):569-577. doi:10.3201/eid2104.141479.
APA Gautret, P., Harvey, K., Pandey, P., Lim, P., Leder, K., Piyaphanee, W....Parola, P. (2015). Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012. Emerging Infectious Diseases, 21(4), 569-577. https://dx.doi.org/10.3201/eid2104.141479.
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Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–2009 PDF Version [PDF - 1.14 MB - 9 pages]
C. Cohen et al.
View Summary

Mortality rates were higher among HIV-positive persons and older persons who had influenza.

Deaths Associated with Respiratory Viruses in HIV-Prevalent Area

    View Abstract

We estimated deaths attributable to influenza and respiratory syncytial virus (RSV) among persons >5 years of age in South Africa during 1998–2009 by applying regression models to monthly deaths and laboratory surveillance data. Rates were expressed per 100,000 person-years. The mean annual number of seasonal influenza–associated deaths was 9,093 (rate 21.6). Persons >65 years of age and HIV-positive persons accounted for 50% (n = 4,552) and 28% (n = 2,564) of overall seasonal influenza-associated deaths, respectively. In 2009, we estimated 4,113 (rate 9.2) influenza A(H1N1)pdm09–associated deaths. The mean of annual RSV-associated deaths during the study period was 511 (rate 1.2); no RSV-associated deaths were estimated in persons >45 years of age. Our findings support the recommendation for influenza vaccination of older persons and HIV-positive persons. Surveillance for RSV should be strengthened to clarify the public health implications and severity of illness associated with RSV infection in South Africa.

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EID Cohen C, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, et al. Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091. Emerg Infect Dis. 2015;21(4):600-608. https://dx.doi.org/10.3201/eid2104.141033
AMA Cohen C, Walaza S, Viboud C, et al. Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091. Emerging Infectious Diseases. 2015;21(4):600-608. doi:10.3201/eid2104.141033.
APA Cohen, C., Walaza, S., Viboud, C., Cohen, A. L., Madhi, S. A., Venter, M....Tempia, S. (2015). Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091. Emerging Infectious Diseases, 21(4), 600-608. https://dx.doi.org/10.3201/eid2104.141033.
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Volume 21, Number 3—March 2015

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Epidemiology of Human Mycobacterium bovis Disease, California, USA, 2003–2011 PDF Version [PDF - 528 KB - 9 pages]
M. Gallivan et al.
View Summary

Disease was associated with the Hispanic binational population and immunosuppressive conditions, including diabetes.

    View Abstract

We conducted a retrospective review of California tuberculosis (TB) registry and genotyping data to evaluate trends, analyze epidemiologic differences between adult and child case-patients with Mycobacterium bovis disease, and identify risk factors for M. bovis disease. The percentage of TB cases attributable to M. bovis increased from 3.4% (80/2,384) in 2003 to 5.4% (98/1,808) in 2011 (p = 0.002). All (6/6) child case-patients with M. bovis disease during 2010–2011 had >1 parent/guardian who was born in Mexico, compared with 38% (22/58) of child case-patients with M. tuberculosis disease (p = 0.005). Multivariate analysis of TB case-patients showed Hispanic ethnicity, extrapulmonary disease, diabetes, and immunosuppressive conditions, excluding HIV co-infection, were independently associated with M. bovis disease. Prevention efforts should focus on Hispanic binational families and adults with immunosuppressive conditions. Collection of additional risk factors in the national TB surveillance system and expansion of whole-genome sequencing should be considered.

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EID Gallivan M, Shah N, Flood J. Epidemiology of Human Mycobacterium bovis Disease, California, USA, 2003–2011. Emerg Infect Dis. 2015;21(3):435-443. https://dx.doi.org/10.3201/eid2103.141539
AMA Gallivan M, Shah N, Flood J. Epidemiology of Human Mycobacterium bovis Disease, California, USA, 2003–2011. Emerging Infectious Diseases. 2015;21(3):435-443. doi:10.3201/eid2103.141539.
APA Gallivan, M., Shah, N., & Flood, J. (2015). Epidemiology of Human Mycobacterium bovis Disease, California, USA, 2003–2011. Emerging Infectious Diseases, 21(3), 435-443. https://dx.doi.org/10.3201/eid2103.141539.
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Volume 21, Number 2—February 2015

image of the 'Thumbnail' version of the Volume 21, Number 2—February 2015 cover of the CDC's EID journal
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Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005 PDF Version [PDF - 565 KB - 10 pages]
S. J. Olsen et al.
View Summary

Although many causes were identified, most remain unknown.

    View Abstract

Acute encephalitis is a severe neurologic syndrome. Determining etiology from among ≈100 possible agents is difficult. To identify infectious etiologies of encephalitis in Thailand, we conducted surveillance in 7 hospitals during July 2003–August 2005 and selected patients with acute onset of brain dysfunction with fever or hypothermia and with abnormalities seen on neuroimages or electroencephalograms or with cerebrospinal fluid pleocytosis. Blood and cerebrospinal fluid were tested for >30 pathogens. Among 149 case-patients, median age was 12 (range 0–83) years, 84 (56%) were male, and 15 (10%) died. Etiology was confirmed or probable for 54 (36%) and possible or unknown for 95 (64%). Among confirmed or probable etiologies, the leading pathogens were Japanese encephalitis virus, enteroviruses, and Orientia tsutsugamushi. No samples were positive for chikungunya, Nipah, or West Nile viruses; Bartonella henselae; or malaria parasites. Although a broad range of infectious agents was identified, the etiology of most cases remains unknown.

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EID Olsen SJ, Campbell AP, Supawat K, Liamsuwan S, Chotpitayasunondh T, Laptikulthum S, et al. Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005. Emerg Infect Dis. 2015;21(2):280-289. https://dx.doi.org/10.3201/eid2102.140291
AMA Olsen SJ, Campbell AP, Supawat K, et al. Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005. Emerging Infectious Diseases. 2015;21(2):280-289. doi:10.3201/eid2102.140291.
APA Olsen, S. J., Campbell, A. P., Supawat, K., Liamsuwan, S., Chotpitayasunondh, T., Laptikulthum, S....Dowell, S. F. (2015). Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005. Emerging Infectious Diseases, 21(2), 280-289. https://dx.doi.org/10.3201/eid2102.140291.
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pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection, South Korea, 2000–2011 PDF Version [PDF - 535 KB - 6 pages]
N. Yun et al.
View Summary

Initial pH level at hospital admission was the most accurate and simple predictor of death.

    View Abstract

Vibrio vulnificus infection can progress to necrotizing fasciitis and death. To improve the likelihood of patient survival, an early prognosis of patient outcome is clinically important for emergency/trauma department doctors. To identify an accurate and simple predictor for death among V. vulnificus–infected persons, we reviewed clinical data for 34 patients at a hospital in South Korea during 2000–2011; of the patients, 16 (47%) died and 18 (53%) survived. For nonsurvivors, median time from hospital admission to death was 15 h (range 4–70). For predicting death, the areas under the receiver operating characteristic curves of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and initial pH were 0.746 and 0.972, respectively (p = 0.005). An optimal cutoff pH of <7.35 had a sensitivity of 100% and specificity of 83%. Compared with the APACHE II score, the initial arterial blood pH level in V. vulnificus-infected patients was a more accurate predictive marker for death.

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EID Yun N, Kim D, Lee J, Han M. pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection, South Korea, 2000–2011. Emerg Infect Dis. 2015;21(2):259-264. https://dx.doi.org/10.3201/eid2102.131249
AMA Yun N, Kim D, Lee J, et al. pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection, South Korea, 2000–2011. Emerging Infectious Diseases. 2015;21(2):259-264. doi:10.3201/eid2102.131249.
APA Yun, N., Kim, D., Lee, J., & Han, M. (2015). pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection, South Korea, 2000–2011. Emerging Infectious Diseases, 21(2), 259-264. https://dx.doi.org/10.3201/eid2102.131249.
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Volume 21, Number 1—January 2015

image of the 'Thumbnail' version of the Volume 21, Number 1—January 2015 cover of the CDC's EID journal
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Epidemiology of Human Plague in the United States, 1900–2012 PDF Version [PDF - 999 KB - 7 pages]
K. J. Kugeler et al.
View Summary

Epidemiologic changes reflect shifts in the populations at risk, the advent of effective therapy, and improved detection methods.

    View Abstract

We summarize the characteristics of 1,006 cases of human plague occurring in the United States over 113 years, beginning with the first documented case in 1900. Three distinct eras can be identified on the basis of the frequency, nature, and geographic distribution of cases. During 1900–1925, outbreaks were common but were restricted to populous port cities. During 1926–1964, the geographic range of disease expanded rapidly, while the total number of reported cases fell. During 1965–2012, sporadic cases occurred annually, primarily in the rural Southwest. Clinical and demographic features of human illness have shifted over time as the disease has moved from crowded cities to the rural West. These shifts reflect changes in the populations at risk, the advent of antibiotics, and improved detection of more clinically indistinct forms of infection. Overall, the emergence of human plague in the United States parallels observed patterns of introduction of exotic plants and animals.

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EID Kugeler KJ, Staples J, Hinckley A, Gage KL, Mead PS. Epidemiology of Human Plague in the United States, 1900–2012. Emerg Infect Dis. 2015;21(1):16-22. https://dx.doi.org/10.3201/eid2101.140564
AMA Kugeler KJ, Staples J, Hinckley A, et al. Epidemiology of Human Plague in the United States, 1900–2012. Emerging Infectious Diseases. 2015;21(1):16-22. doi:10.3201/eid2101.140564.
APA Kugeler, K. J., Staples, J., Hinckley, A., Gage, K. L., & Mead, P. S. (2015). Epidemiology of Human Plague in the United States, 1900–2012. Emerging Infectious Diseases, 21(1), 16-22. https://dx.doi.org/10.3201/eid2101.140564.
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Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany PDF Version [PDF - 763 KB - 8 pages]
J. Latus et al.
View Summary

The consequences of associated hematuria may be long-lasting, and hantavirus IgG is detectable years after acute infection.

    View Abstract

Human infection with Puumala virus (PUUV), the most common hantavirus in Central Europe, causes nephropathia epidemica (NE), a disease characterized by acute kidney injury and thrombocytopenia. To determine the clinical phenotype of hantavirus-infected patients and their long-term outcome and humoral immunity to PUUV, we conducted a cross-sectional prospective survey of 456 patients in Germany with clinically and serologically confirmed hantavirus-associated NE during 2001–2012. Prominent clinical findings during acute NE were fever and back/limb pain, and 88% of the patients had acute kidney injury. At follow-up (7–35 mo), all patients had detectable hantavirus-specific IgG; 8.5% had persistent IgM; 25% had hematuria; 23% had hypertension (new diagnosis for 67%); and 7% had proteinuria. NE-associated hypertension and proteinuria do not appear to have long-term consequences, but NE-associated hematuria may. All patients in this study had hantavirus-specific IgG up to years after the infection.

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EID Latus J, Schwab M, Tacconelli E, Pieper F, Wegener D, Dippon J, et al. Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany. Emerg Infect Dis. 2015;21(1):76-83. https://dx.doi.org/10.3201/eid2101.140861
AMA Latus J, Schwab M, Tacconelli E, et al. Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany. Emerging Infectious Diseases. 2015;21(1):76-83. doi:10.3201/eid2101.140861.
APA Latus, J., Schwab, M., Tacconelli, E., Pieper, F., Wegener, D., Dippon, J....Braun, N. (2015). Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany. Emerging Infectious Diseases, 21(1), 76-83. https://dx.doi.org/10.3201/eid2101.140861.
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