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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 23—2017

Volume 23, Number 4—April 2017

image of the 'Thumbnail' version of the Volume 23, Number 4—April 2017 cover of the CDC's EID journal
Medscape CME Activity
Neurologic Complications of Influenza B Virus Infection in Adults, Romania PDF Version [PDF - 1.08 MB - 8 pages]
C. P. Popescu et al.
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Infection with this virus should be considered as an etiologic factor for encephalitis.

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We characterized influenza B virus–related neurologic manifestations in an unusually high number of hospitalized adults at a tertiary care facility in Romania during the 2014–15 influenza epidemic season. Of 32 patients with a confirmed laboratory diagnosis of influenza B virus infection, neurologic complications developed in 7 adults (median age 31 years). These complications were clinically diagnosed as confirmed encephalitis (4 patients), possible encephalitis (2 patients), and cerebellar ataxia (1 patient). Two of the patients died. Virus sequencing identified influenza virus B (Yam)-lineage clade 3, which is representative of the B/Phuket/3073/2013 strain, in 4 patients. None of the patients had been vaccinated against influenza. These results suggest that influenza B virus can cause a severe clinical course and should be considered as an etiologic factor for encephalitis.

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EID Popescu CP, Florescu SA, Lupulescu E, Zaharia M, Tardei G, Lazar M, et al. Neurologic Complications of Influenza B Virus Infection in Adults, Romania. Emerg Infect Dis. 2017;23(4):574-581. https://dx.doi.org/10.3201/eid2304.161317
AMA Popescu CP, Florescu SA, Lupulescu E, et al. Neurologic Complications of Influenza B Virus Infection in Adults, Romania. Emerging Infectious Diseases. 2017;23(4):574-581. doi:10.3201/eid2304.161317.
APA Popescu, C. P., Florescu, S. A., Lupulescu, E., Zaharia, M., Tardei, G., Lazar, M....Ruta, S. M. (2017). Neurologic Complications of Influenza B Virus Infection in Adults, Romania. Emerging Infectious Diseases, 23(4), 574-581. https://dx.doi.org/10.3201/eid2304.161317.
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Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation PDF Version [PDF - 741 KB - 7 pages]
M. A. Foster et al.
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Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to healthcare workers.

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Although transmission of hepatitis A virus (HAV) through blood transfusion has been documented, transmission through organ transplantation has not been reported. In August 2015, state health officials in Texas, USA, were notified of 2 home health nurses with HAV infection whose only common exposure was a child who had undergone multi–visceral organ transplantation 9 months earlier. Specimens from the nurses, organ donor, and all organ recipients were tested and medical records reviewed to determine a possible infection source. Identical HAV RNA sequences were detected from the serum of both nurses and the organ donor, as well as from the multi–visceral organ recipient’s serum and feces; this recipient’s posttransplant liver and intestine biopsy specimens also had detectable virus. The other organ recipients tested negative for HAV RNA. Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers.

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EID Foster MA, Weil LM, Jin S, Johnson T, Hayden-Mixson TR, Khudyakov Y, et al. Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation. Emerg Infect Dis. 2017;23(4):590-596. https://dx.doi.org/10.3201/eid2304.161532
AMA Foster MA, Weil LM, Jin S, et al. Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation. Emerging Infectious Diseases. 2017;23(4):590-596. doi:10.3201/eid2304.161532.
APA Foster, M. A., Weil, L. M., Jin, S., Johnson, T., Hayden-Mixson, T. R., Khudyakov, Y....Moorman, A. C. (2017). Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation. Emerging Infectious Diseases, 23(4), 590-596. https://dx.doi.org/10.3201/eid2304.161532.
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Volume 23, Number 3—March 2017

image of the 'Thumbnail' version of the Volume 23, Number 3—March 2017 cover of the CDC's EID journal
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Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis PDF Version [PDF - 2.02 MB - 9 pages]
R. M. Smith et al.
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Encephalitozoon cuniculi was transmitted from an infected donor to 3 solid organ recipients, 1 of whom died.

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In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.

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EID Smith RM, Muehlenbachs A, Schaenmann J, Baxi S, Koo S, Blau D, et al. Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis. Emerg Infect Dis. 2017;23(3):387-395. https://dx.doi.org/10.3201/eid2303.161580
AMA Smith RM, Muehlenbachs A, Schaenmann J, et al. Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis. Emerging Infectious Diseases. 2017;23(3):387-395. doi:10.3201/eid2303.161580.
APA Smith, R. M., Muehlenbachs, A., Schaenmann, J., Baxi, S., Koo, S., Blau, D....Zaki, S. R. (2017). Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis. Emerging Infectious Diseases, 23(3), 387-395. https://dx.doi.org/10.3201/eid2303.161580.
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Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014 PDF Version [PDF - 3.41 MB - 10 pages]
J. A. Davidson et al.
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Despite slightly increased cases in these areas, human infection with this cattle pathogen remains rare.

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Despite control efforts, Mycobacterium bovis incidence among cattle remains high in parts of England, Wales, and Northern Ireland, attracting political and public health interest in potential spread from animals to humans. To determine incidence among humans and to identify associated factors, we conducted a retrospective cohort analysis of human M. bovis cases in England, Wales, and Northern Ireland during 2002–2014. We identified 357 cases and observed increased annual case numbers (from 17 to 35) and rates. Most patients were >65 years of age and born in the United Kingdom. The median age of UK-born patients decreased over time. For 74% of patients, exposure to risk factors accounting for M. bovis acquisition, most frequently consumption of unpasteurized milk, was known. Despite the small increase in case numbers and reduction in patient age, M. bovis infection of humans in England, Wales, and Northern Ireland remains rare.

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EID Davidson JA, Loutet MG, O’Connor C, Kearns C, Smith R, Lalor MK, et al. Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014. Emerg Infect Dis. 2017;23(3):377-386. https://dx.doi.org/10.3201/eid2303.161408
AMA Davidson JA, Loutet MG, O’Connor C, et al. Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014. Emerging Infectious Diseases. 2017;23(3):377-386. doi:10.3201/eid2303.161408.
APA Davidson, J. A., Loutet, M. G., O’Connor, C., Kearns, C., Smith, R., Lalor, M. K....Zenner, D. (2017). Epidemiology of Mycobacterium bovis Disease in Humans in England, Wales, and Northern Ireland, 2002–2014. Emerging Infectious Diseases, 23(3), 377-386. https://dx.doi.org/10.3201/eid2303.161408.
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Volume 23, Number 2—February 2017

image of the 'Thumbnail' version of the Volume 23, Number 2—February 2017 cover of the CDC's EID journal
Medscape CME Activity
Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel PDF Version [PDF - 2.69 MB - 9 pages]
R. Ben-Ami et al.
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Clinical features and experimentally deduced virulence indicate that C. auris has the greater lethal potential.

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Candida auris and C. haemulonii are closely related, multidrug-resistant emerging fungal pathogens that are not readily distinguishable with phenotypic assays. We studied C. auris and C. haemulonii clinical isolates from 2 hospitals in central Israel. C. auris was isolated in 5 patients with nosocomial bloodstream infection, and C. haemulonii was found as a colonizer of leg wounds at a peripheral vascular disease clinic. Liberal use of topical miconazole and close contact among patients were implicated in C. haemulonii transmission. C. auris exhibited higher thermotolerance, virulence in a mouse infection model, and ATP-dependent drug efflux activity than C. haemulonii. Comparison of ribosomal DNA sequences found that C. auris strains from Israel were phylogenetically distinct from isolates from East Asia, South Africa and Kuwait, whereas C. haemulonii strains from different countries were closely interrelated. Our findings highlight the pathogenicity of C. auris and underscore the need to limit its spread.

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EID Ben-Ami R, Berman J, Novikov A, Bash E, Shachor-Meyouhas Y, Zakin S, et al. Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerg Infect Dis. 2017;23(2):195-203. https://dx.doi.org/10.3201/eid2302.161486
AMA Ben-Ami R, Berman J, Novikov A, et al. Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerging Infectious Diseases. 2017;23(2):195-203. doi:10.3201/eid2302.161486.
APA Ben-Ami, R., Berman, J., Novikov, A., Bash, E., Shachor-Meyouhas, Y., Zakin, S....Finn, T. (2017). Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel. Emerging Infectious Diseases, 23(2), 195-203. https://dx.doi.org/10.3201/eid2302.161486.
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Risk Factors for Disseminated Coccidioidomycosis, United States PDF Version [PDF - 464 KB - 4 pages]
C. D. Odio et al.
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Of 150,000 new coccidioidomycosis infections that occur annually in the United States, ≈1% disseminate; one third of those cases are fatal. Immunocompromised hosts have higher rates of dissemination. We identified 8 patients with disseminated coccidioidomycosis who had defects in the interleukin-12/interferon-γ and STAT3 axes, indicating that these are critical host defense pathways.

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EID Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerg Infect Dis. 2017;23(2):311. https://dx.doi.org/10.3201/eid2302.160505
AMA Odio CD, Marciano BE, Galgiani JN, et al. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerging Infectious Diseases. 2017;23(2):311. doi:10.3201/eid2302.160505.
APA Odio, C. D., Marciano, B. E., Galgiani, J. N., & Holland, S. M. (2017). Risk Factors for Disseminated Coccidioidomycosis, United States. Emerging Infectious Diseases, 23(2), 311. https://dx.doi.org/10.3201/eid2302.160505.
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Volume 23, Number 1—January 2017

image of the 'Thumbnail' version of the Volume 23, Number 1—January 2017 cover of the CDC's EID journal
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Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–2012 PDF Version [PDF - 1.77 MB - 7 pages]
S. Strollo et al.
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Highest hospitalization rates were for men ≥65 years of age, and rates decreased during 2005−2012.

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Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis–associated hospitalizations in the United States. We extracted data for 33 states for 2002–2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005–2012 for men (annual change –3.9%) and women (annual change –4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease.

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EID Strollo S, Lionakis MS, Adjemian J, Steiner CA, Prevots D. Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–2012. Emerg Infect Dis. 2017;23(1):7-13. https://dx.doi.org/10.3201/eid2301.161198
AMA Strollo S, Lionakis MS, Adjemian J, et al. Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–2012. Emerging Infectious Diseases. 2017;23(1):7-13. doi:10.3201/eid2301.161198.
APA Strollo, S., Lionakis, M. S., Adjemian, J., Steiner, C. A., & Prevots, D. (2017). Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–2012. Emerging Infectious Diseases, 23(1), 7-13. https://dx.doi.org/10.3201/eid2301.161198.
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Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010 PDF Version [PDF - 956 KB - 10 pages]
X. Cui et al.
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Differences between recipients and nonrecipients and the small number of higher risk patients confounded assessment.

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We studied anthrax immune globulin intravenous (AIG-IV) use from a 2009–2010 outbreak of Bacillus anthracis soft tissue infection in injection drug users in Scotland, UK, and we compared findings from 15 AIG-IV recipients with findings from 28 nonrecipients. Death rates did not differ significantly between recipients and nonrecipients (33% vs. 21%). However, whereas only 8 (27%) of 30 patients at low risk for death (admission sequential organ failure assessment score of 0–5) received AIG-IV, 7 (54%) of the 13 patients at high risk for death (sequential organ failure assessment score of 6–11) received treatment. AIG-IV recipients had surgery more often and, among survivors, had longer hospital stays than did nonrecipients. AIG-IV recipients were sicker than nonrecipients. This difference and the small number of higher risk patients confound assessment of AIG-IV effectiveness in this outbreak.

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EID Cui X, Nolen LD, Sun J, Booth M, Donaldson L, Quinn CP, et al. Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010. Emerg Infect Dis. 2017;23(1):56-65. https://dx.doi.org/10.3201/eid2301.160608
AMA Cui X, Nolen LD, Sun J, et al. Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010. Emerging Infectious Diseases. 2017;23(1):56-65. doi:10.3201/eid2301.160608.
APA Cui, X., Nolen, L. D., Sun, J., Booth, M., Donaldson, L., Quinn, C. P....Eichacker, P. Q. (2017). Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010. Emerging Infectious Diseases, 23(1), 56-65. https://dx.doi.org/10.3201/eid2301.160608.
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