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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 24—2018

Volume 24, Number 5—May 2018

image of the 'Thumbnail' version of the Volume 24, Number 5—May 2018 cover of the CDC's EID journal
Medscape CME Activity
Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel PDF Version [PDF - 980 KB - 6 pages]
R. Cohen et al.
View Summary

Genetic sequencing should be used to confirm cases because purpura fulminans is a rare finding.

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We report a series of 5 case-patients who had Israeli spotted fever, of whom 2 had purpura fulminans and died. Four case-patients were given a diagnosis on the basis of PCR of skin biopsy specimens 3–4 days after treatment with doxycycline; 1 case-patient was given a diagnosis on the basis of seroconversion. Rickettsia spp. from the 2 case-patients who died were sequenced and identified as Rickettsia conorii subsp. israelensis. Purpura fulminans has been described in association with R. rickettsii and R. indica, but rarely with R. conorii subsp. israelensis.

    Cite This Article
EID Cohen R, Babushkin F, Shapiro M, Uda M, Atiya-Nasagi Y, Klein D, et al. Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel. Emerg Infect Dis. 2018;24(5):835-840. https://dx.doi.org/10.3201/eid2405.171992
AMA Cohen R, Babushkin F, Shapiro M, et al. Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel. Emerging Infectious Diseases. 2018;24(5):835-840. doi:10.3201/eid2405.171992.
APA Cohen, R., Babushkin, F., Shapiro, M., Uda, M., Atiya-Nasagi, Y., Klein, D....Finn, T. (2018). Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel. Emerging Infectious Diseases, 24(5), 835-840. https://dx.doi.org/10.3201/eid2405.171992.
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Surveillance for Mosquitoborne Transmission of Zika Virus, New York City, NY, USA, 2016 PDF Version [PDF - 955 KB - 8 pages]
A. Wahnich et al.
View Summary

Sentinel, enhanced passive, and syndromic surveillance in 2016 did not identify any evidence of transmission.

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A large number of imported cases of Zika virus infection and the potential for transmission by Aedes albopictus mosquitoes prompted the New York City Department of Health and Mental Hygiene to conduct sentinel, enhanced passive, and syndromic surveillance for locally acquired mosquitoborne Zika virus infections in New York City, NY, USA, during June–October 2016. Suspected case-patients were those >5 years of age without a travel history or sexual exposure who had >3 compatible signs/symptoms (arthralgia, fever, conjunctivitis, or rash). We identified 15 suspected cases and tested urine samples for Zika virus by using real-time reverse transcription PCR; all results were negative. We identified 308 emergency department visits for Zika-like illness, 40,073 visits for fever, and 17 unique spatiotemporal clusters of visits for fever. We identified no evidence of local transmission. Our experience offers possible surveillance tools for jurisdictions concerned about local mosquitoborne Zika virus or other arboviral transmission.

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EID Wahnich A, Clark S, Bloch D, Kubinson H, Hrusa G, Liu D, et al. Surveillance for Mosquitoborne Transmission of Zika Virus, New York City, NY, USA, 2016. Emerg Infect Dis. 2018;24(5):827-834. https://dx.doi.org/10.3201/eid2405.170764
AMA Wahnich A, Clark S, Bloch D, et al. Surveillance for Mosquitoborne Transmission of Zika Virus, New York City, NY, USA, 2016. Emerging Infectious Diseases. 2018;24(5):827-834. doi:10.3201/eid2405.170764.
APA Wahnich, A., Clark, S., Bloch, D., Kubinson, H., Hrusa, G., Liu, D....Conners, E. E. (2018). Surveillance for Mosquitoborne Transmission of Zika Virus, New York City, NY, USA, 2016. Emerging Infectious Diseases, 24(5), 827-834. https://dx.doi.org/10.3201/eid2405.170764.
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Volume 24, Number 4—April 2018

image of the 'Thumbnail' version of the Volume 24, Number 4—April 2018 cover of the CDC's EID journal
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Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA PDF Version [PDF - 1.37 MB - 7 pages]
N. Poowanawittayakom et al.
View Summary

Drug users were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement.

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The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s–1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons >14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis.

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EID Poowanawittayakom N, Dutta A, Stock S, Touray S, Ellison RT, Levitz SM, et al. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerg Infect Dis. 2018;24(4):631-637. https://dx.doi.org/10.3201/eid2404.171807
AMA Poowanawittayakom N, Dutta A, Stock S, et al. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerging Infectious Diseases. 2018;24(4):631-637. doi:10.3201/eid2404.171807.
APA Poowanawittayakom, N., Dutta, A., Stock, S., Touray, S., Ellison, R. T., & Levitz, S. M. (2018). Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerging Infectious Diseases, 24(4), 631-637. https://dx.doi.org/10.3201/eid2404.171807.
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Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh PDF Version [PDF - 1.98 MB - 8 pages]
H. W. Kingston et al.
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Scrub and murine typhus are common, treatable causes of undifferentiated febrile illnesses in hospitalized patients.

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We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence–confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.

    Cite This Article
EID Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis. 2018;24(4):638-645. https://dx.doi.org/10.3201/eid2404.170190
AMA Kingston HW, Hossain M, Leopold S, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerging Infectious Diseases. 2018;24(4):638-645. doi:10.3201/eid2404.170190.
APA Kingston, H. W., Hossain, M., Leopold, S., Anantatat, T., Tanganuchitcharnchai, A., Sinha, I....Paris, D. H. (2018). Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerging Infectious Diseases, 24(4), 638-645. https://dx.doi.org/10.3201/eid2404.170190.
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Volume 24, Number 3—March 2018

image of the 'Thumbnail' version of the Volume 24, Number 3—March 2018 cover of the CDC's EID journal
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Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015 PDF Version [PDF - 3.00 MB - 11 pages]
J. Huang et al.
View Summary

Children who have received the enterovirus A71 vaccine are still at risk for disease with infections of enteroviruses of other serotypes.

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Using China’s national surveillance data on hand, foot and mouth disease (HFMD) for 2008–2015, we described the epidemiologic and virologic features of recurrent HFMD. A total of 398,010 patients had HFMD recurrence; 1,767 patients had 1,814 cases of recurrent laboratory-confirmed HFMD: 99 reinfections of enterovirus A71 (EV-A71) with EV-A71, 45 of coxsackievirus A16 (CV-A16) with CV-A16, 364 of other enteroviruses with other enteroviruses, 383 of EV-A71 with CV-A16 and CV-A16 with EV-A71, and 923 of EV-A71 or CV-A16 with other enteroviruses and other enteroviruses with EV-A71 or CV-A16. The probability of HFMD recurrence was 1.9% at 12 months, 3.3% at 24 months, 3.9% at 36 months, and 4.0% at 38.8 months after the primary episode. HFMD severity was not associated with recurrent episodes or time interval between episodes. Elucidation of the mechanism underlying HFMD recurrence with the same enterovirus serotype and confirmation that HFMD recurrence is not associated with disease severity is needed.

    Cite This Article
EID Huang J, Liao Q, Ooi M, Cowling BJ, Chang Z, Wu P, et al. Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015. Emerg Infect Dis. 2018;24(3):432-442. https://dx.doi.org/10.3201/eid2403.171303
AMA Huang J, Liao Q, Ooi M, et al. Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015. Emerging Infectious Diseases. 2018;24(3):432-442. doi:10.3201/eid2403.171303.
APA Huang, J., Liao, Q., Ooi, M., Cowling, B. J., Chang, Z., Wu, P....Wei, S. (2018). Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015. Emerging Infectious Diseases, 24(3), 432-442. https://dx.doi.org/10.3201/eid2403.171303.
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Volume 24, Number 2—February 2018

image of the 'Thumbnail' version of the Volume 24, Number 2—February 2018 cover of the CDC's EID journal
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Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France PDF Version [PDF - 1.24 MB - 9 pages]
B. Rossi et al.
View Summary

Europe might have an epidemic of infections with these bacteria similar to that in Asia in the early 2000s.

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Liver abscesses containing hypervirulent Klebsiella pneumoniae have emerged during the past 2 decades, originally in Southeast Asia and then worldwide. We hypothesized that hypervirulent K. pneumoniae might also be emerging in France. In a retrospective, monocentric, cohort study, we analyzed characteristics and outcomes for 199 consecutive patients in Paris, France, with liver abscesses during 2010−2015. We focused on 31 patients with abscesses containing K. pneumoniae. This bacterium was present in most (14/27, 52%) cryptogenic liver abscesses. Cryptogenic K. pneumoniae abscesses were more frequently community-acquired (p<0.00001) and monomicrobial (p = 0.008), less likely to involve cancer patients (p<0.01), and relapsed less often (p<0.01) than did noncryptogenic K. pneumoniae liver abscesses. K. pneumoniae isolates from cryptogenic abscesses belonged to either the K1 or K2 serotypes and had more virulence factors than noncryptogenic K. pneumoniae isolates. Hypervirulent K. pneumoniae are emerging as the main pathogen isolated from cryptogenic liver abscesses in the study area.

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EID Rossi B, Gasperini M, Leflon-Guibout V, Gioanni A, de Lastours V, Rossi G, et al. Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France. Emerg Infect Dis. 2018;24(2):221-229. https://dx.doi.org/10.3201/eid2402.170957
AMA Rossi B, Gasperini M, Leflon-Guibout V, et al. Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France. Emerging Infectious Diseases. 2018;24(2):221-229. doi:10.3201/eid2402.170957.
APA Rossi, B., Gasperini, M., Leflon-Guibout, V., Gioanni, A., de Lastours, V., Rossi, G....Lefort, A. (2018). Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France. Emerging Infectious Diseases, 24(2), 221-229. https://dx.doi.org/10.3201/eid2402.170957.
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Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom PDF Version [PDF - 763 KB - 9 pages]
H. Sharma et al.
View Summary

Nonmenstrual TSS is now more common, and better understanding will improve prevention interventions.

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Staphylococcal toxic shock syndrome (TSS) was originally described in menstruating women and linked to TSS toxin 1 (TSST-1)–producing Staphylococcus aureus. Using UK national surveillance data, we ascertained clinical, molecular and superantigenic characteristics of TSS cases. Average annual TSS incidence was 0.07/100,000 population. Patients with nonmenstrual TSS were younger than those with menstrual TSS but had the same mortality rate. Children <16 years of age accounted for 39% of TSS cases, most caused by burns and skin and soft tissue infections. Nonmenstrual TSS is now more common than menstrual TSS in the UK, although both types are strongly associated with the tst+ clonal complex (CC) 30 methicillin-sensitive S. aureus lineage, which accounted for 49.4% of all TSS and produced more TSST-1 and superantigen bioactivity than did tst+ CC30 methicillin-resistant S. aureus strains. Better understanding of this MSSA lineage and infections in children could focus interventions to prevent TSS in the future.

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EID Sharma H, Smith D, Turner CE, Game L, Pichon B, Hope R, et al. Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerg Infect Dis. 2018;24(2):258-266. https://dx.doi.org/10.3201/eid2402.170606
AMA Sharma H, Smith D, Turner CE, et al. Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerging Infectious Diseases. 2018;24(2):258-266. doi:10.3201/eid2402.170606.
APA Sharma, H., Smith, D., Turner, C. E., Game, L., Pichon, B., Hope, R....Sriskandan, S. (2018). Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerging Infectious Diseases, 24(2), 258-266. https://dx.doi.org/10.3201/eid2402.170606.
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Volume 24, Number 1—January 2018

image of the 'Thumbnail' version of the Volume 24, Number 1—January 2018 cover of the CDC's EID journal
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Zika Virus Testing and Outcomes during Pregnancy, Florida, USA, 2016 PDF Version [PDF - 824 KB - 8 pages]
C. Shiu et al.
    View Abstract

Zika virus infection during pregnancy can lead to congenital Zika syndrome. Implementation of screening programs and interpretation of test results can be particularly challenging during ongoing local mosquitoborne transmission. We conducted a retrospective chart review of 2,327 pregnant women screened for Zika virus in Miami–Dade County, Florida, USA, during 2016. Of these, 86 had laboratory evidence of Zika virus infection; we describe 2 infants with probable congenital Zika syndrome. Delays in receipt of laboratory test results (median 42 days) occurred during the first month of local transmission. Odds of screening positive for Zika virus were higher for women without health insurance or who did not speak English. Our findings indicate the increase in screening for Zika virus can overwhelm hospital and public health systems, resulting in delayed receipt of results of screening and confirmatory tests and the potential to miss cases or delay diagnoses.

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EID Shiu C, Starker R, Kwal J, Bartlett M, Crane A, Greissman S, et al. Zika Virus Testing and Outcomes during Pregnancy, Florida, USA, 2016. Emerg Infect Dis. 2018;24(1):1-8. https://dx.doi.org/10.3201/eid2401.170979
AMA Shiu C, Starker R, Kwal J, et al. Zika Virus Testing and Outcomes during Pregnancy, Florida, USA, 2016. Emerging Infectious Diseases. 2018;24(1):1-8. doi:10.3201/eid2401.170979.
APA Shiu, C., Starker, R., Kwal, J., Bartlett, M., Crane, A., Greissman, S....Curry, C. L. (2018). Zika Virus Testing and Outcomes during Pregnancy, Florida, USA, 2016. Emerging Infectious Diseases, 24(1), 1-8. https://dx.doi.org/10.3201/eid2401.170979.
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Recognition of Azole-Resistant Aspergillosis by Physicians Specializing in Infectious Diseases, United States PDF Version [PDF - 417 KB - 3 pages]
T. A. Walker et al.
View Summary

Of 709 physicians, 348 were familiar with azole-resistant Aspergillus fumigatus; of those treating case-patients, 21% lacked access to susceptibility testing.

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Infections caused by pan–azole-resistant Aspergillus fumigatus strains have emerged in Europe and recently in the United States. Physicians specializing in infectious diseases reported observing pan–azole-resistant infections and low rates of susceptibility testing, suggesting the need for wider-scale testing.

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EID Walker TA, Lockhart SR, Beekmann SE, Polgreen PM, Santibanez S, Mody RK, et al. Recognition of Azole-Resistant Aspergillosis by Physicians Specializing in Infectious Diseases, United States. Emerg Infect Dis. 2018;24(1):111-113. https://dx.doi.org/10.3201/eid2401.170971
AMA Walker TA, Lockhart SR, Beekmann SE, et al. Recognition of Azole-Resistant Aspergillosis by Physicians Specializing in Infectious Diseases, United States. Emerging Infectious Diseases. 2018;24(1):111-113. doi:10.3201/eid2401.170971.
APA Walker, T. A., Lockhart, S. R., Beekmann, S. E., Polgreen, P. M., Santibanez, S., Mody, R. K....Jackson, B. R. (2018). Recognition of Azole-Resistant Aspergillosis by Physicians Specializing in Infectious Diseases, United States. Emerging Infectious Diseases, 24(1), 111-113. https://dx.doi.org/10.3201/eid2401.170971.
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