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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.

Volume 27—2021

Volume 27, Number 5—May 2021

Cover of issue Volume 27, Number 5—May 2021

Medscape CME Activity
Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018 [PDF - 1.54 MB - 6 pages]
W. He et al.

During 2013–2018, antimicrobial drugs were prescribed for 6.8% of cases of acute gastroenteritis encountered in general practice in Australia, including 35.7% of Salmonella infections and 54.1% of Campylobacter infections. During that time, prescriptions for acute gastroenteritis decreased by 2.0%. Managing infectious gastroenteritis in general practice will require greater antimicrobial stewardship.

EID He W, Kirk MD, Hall J, Liu B. Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerg Infect Dis. 2021;27(5):1462-1467. https://doi.org/10.3201/eid2705.203692
AMA He W, Kirk MD, Hall J, et al. Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerging Infectious Diseases. 2021;27(5):1462-1467. doi:10.3201/eid2705.203692.
APA He, W., Kirk, M. D., Hall, J., & Liu, B. (2021). Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerging Infectious Diseases, 27(5), 1462-1467. https://doi.org/10.3201/eid2705.203692.

Medscape CME Activity
Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy [PDF - 2.70 MB - 11 pages]
M. Rossi et al.

Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) has been endemic in Italy since 2013. In a multicenter cohort study, we investigated various aspects of KPC-Kp among patients, including 15-day mortality rates and delays in adequate therapy. Most (77%) KPC-Kp strains were sequence type (ST) ST512 or ST307. During 2017, KPC-Kp prevalence was 3.26 cases/1,000 hospitalized patients. Cumulative incidence of KPC-Kp acquired >48 hours after hospital admission was 0.68% but varied widely between centers. Among patients with mild infections and noninfected colonized patients, 15-day mortality rates were comparable, but rates were much higher among patients with severe infections. Delays of >4 days in receiving adequate therapy more frequently occurred among patients with mild infections than those with severe infections, and delays were less common for patients with known previous KPC-Kp colonization. Italy urgently needs a concerted surveillance system to control the spread of KPC-Kp.

EID Rossi M, Chatenoud L, Gona F, Sala I, Nattino G, D'Antonio A, et al. Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerg Infect Dis. 2021;27(5):1416-1426. https://doi.org/10.3201/eid2705.203662
AMA Rossi M, Chatenoud L, Gona F, et al. Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerging Infectious Diseases. 2021;27(5):1416-1426. doi:10.3201/eid2705.203662.
APA Rossi, M., Chatenoud, L., Gona, F., Sala, I., Nattino, G., D'Antonio, A....Gori, A. (2021). Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerging Infectious Diseases, 27(5), 1416-1426. https://doi.org/10.3201/eid2705.203662.

Volume 27, Number 4—April 2021

Cover of issue Volume 27, Number 4—April 2021

Medscape CME Activity
Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018 [PDF - 1.18 MB - 9 pages]
M. Markowicz et al.

The aim of this prospective study was to assess the risk for tickborne infections after a tick bite. A total of 489 persons bitten by 1,295 ticks were assessed for occurrence of infections with Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia spp., Babesia spp., Candidatus Neoehrlichia mikurensis, and relapsing fever borreliae. B. burgdorferi s.l. infection was found in 25 (5.1%) participants, of whom 15 had erythema migrans. Eleven (2.3%) participants were positive by PCR for Candidatus N. mikurensis. One asymptomatic participant infected with B. miyamotoi was identified. Full engorgement of the tick (odds ratio 9.52) and confirmation of B. burgdorferi s.l. in the tick by PCR (odds ratio 4.39) increased the risk for infection. Rickettsia helvetica was highly abundant in ticks but not pathogenic to humans. Knowledge about the outcome of tick bites is crucial because infections with emerging pathogens might be underestimated because of limited laboratory facilities.

EID Markowicz M, Schötta A, Höss D, Kundi M, Schray C, Stockinger H, et al. Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerg Infect Dis. 2021;27(4):1048-1056. https://doi.org/10.3201/eid2704.203366
AMA Markowicz M, Schötta A, Höss D, et al. Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerging Infectious Diseases. 2021;27(4):1048-1056. doi:10.3201/eid2704.203366.
APA Markowicz, M., Schötta, A., Höss, D., Kundi, M., Schray, C., Stockinger, H....Stanek, G. (2021). Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerging Infectious Diseases, 27(4), 1048-1056. https://doi.org/10.3201/eid2704.203366.

Medscape CME Activity
Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019 [PDF - 1.14 MB - 8 pages]
E. M. Rabold et al.

Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country.

EID Rabold EM, Ali H, Fernandez D, Knuth M, Schenkel K, Asghar R, et al. Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerg Infect Dis. 2021;27(4):1039-1047. https://doi.org/10.3201/eid2704.204205
AMA Rabold EM, Ali H, Fernandez D, et al. Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerging Infectious Diseases. 2021;27(4):1039-1047. doi:10.3201/eid2704.204205.
APA Rabold, E. M., Ali, H., Fernandez, D., Knuth, M., Schenkel, K., Asghar, R....Morgan, O. (2021). Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerging Infectious Diseases, 27(4), 1039-1047. https://doi.org/10.3201/eid2704.204205.

Medscape CME Activity
Blastomycosis Surveillance in 5 States, United States, 1987–2018 [PDF - 1.79 MB - 8 pages]
K. Benedict et al.

Blastomycosis is caused by inhalation of Blastomyces spp. fungi. Limited data are available on the incidence and geographic range of blastomycosis in the United States. To better characterize its epidemiologic features, we analyzed combined surveillance data from the 5 states in which blastomycosis is reportable: Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin. Surveillance identified 4,441 cases during 1987–2018, a mean of 192 cases per year. The mean annual incidence was <1 case/100,000 population in most areas but >20 cases/100,000 population in some northern counties of Wisconsin. Median patient age was 46 years, 2,892 (65%) patients were male, 1,662 (57%) were hospitalized, and 278 (8%) died. The median time from symptom onset to diagnosis was 33 days. The severity of illness and diagnostic delays suggest that surveillance underestimates the true number of cases. More in-depth surveillance in additional states could elucidate blastomycosis incidence and inform efforts to increase awareness.

EID Benedict K, Gibbons-Burgener S, Kocharian A, Ireland M, Rothfeldt L, Christophe N, et al. Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerg Infect Dis. 2021;27(4):999-1006. https://doi.org/10.3201/eid2704.204078
AMA Benedict K, Gibbons-Burgener S, Kocharian A, et al. Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerging Infectious Diseases. 2021;27(4):999-1006. doi:10.3201/eid2704.204078.
APA Benedict, K., Gibbons-Burgener, S., Kocharian, A., Ireland, M., Rothfeldt, L., Christophe, N....Jackson, B. R. (2021). Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerging Infectious Diseases, 27(4), 999-1006. https://doi.org/10.3201/eid2704.204078.

Volume 27, Number 3—March 2021

Cover of issue Volume 27, Number 3—March 2021

Medscape CME Activity
Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018 [PDF - 730 KB - 10 pages]
E. Won et al.

We investigated the clinical outcomes and molecular mechanisms of fluconazole-resistant (FR) Candida glabrata bloodstream infections. Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p<0.05). For patients with FR isolates, appropriate antifungal therapy was the only independent protective factor associated with 30-day (hazard ratio 0.304) and 90-day (hazard ratio 0.310) mortality. Sequencing of pleiotropic drug-resistance transcription factor revealed that 1–2 additional Pdr1p amino acid substitutions (except genotype-specific Pdr1p amino acid substitutions) occurred in 98.5% of FR isolates but in only 0.9% of fluconazole-susceptible dose-dependent isolates. These results highlight the high mortality rate of patients infected with FR C. glabrata BSI isolates harboring Pdr1p mutations.

EID Won E, Choi MJ, Kim M, Yong D, Lee W, Uh Y, et al. Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerg Infect Dis. 2021;27(3):779-788. https://doi.org/10.3201/eid2703.203482
AMA Won E, Choi MJ, Kim M, et al. Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerging Infectious Diseases. 2021;27(3):779-788. doi:10.3201/eid2703.203482.
APA Won, E., Choi, M. J., Kim, M., Yong, D., Lee, W., Uh, Y....Shin, J. (2021). Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerging Infectious Diseases, 27(3), 779-788. https://doi.org/10.3201/eid2703.203482.

Medscape CME Activity
Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan [PDF - 698 KB - 8 pages]
A. A. Malik et al.

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.

EID Malik AA, Gandhi NR, Lash TL, Cranmer LM, Omer SB, Ahmed JF, et al. Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerg Infect Dis. 2021;27(3):805-812. https://doi.org/10.3201/eid2703.203916
AMA Malik AA, Gandhi NR, Lash TL, et al. Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerging Infectious Diseases. 2021;27(3):805-812. doi:10.3201/eid2703.203916.
APA Malik, A. A., Gandhi, N. R., Lash, T. L., Cranmer, L. M., Omer, S. B., Ahmed, J. F....Becerra, M. C. (2021). Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerging Infectious Diseases, 27(3), 805-812. https://doi.org/10.3201/eid2703.203916.

Volume 27, Number 2—February 2021

Cover of issue Volume 27, Number 2—February 2021

Medscape CME Activity
Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018 [PDF - 2.56 MB - 12 pages]
A. Benavides-Lara et al.

After Zika virus (ZIKV) infection in Costa Rica was confirmed in January 2016, the national surveillance system was enhanced to monitor associated birth defects. To characterize the ZIKV outbreak among live-born infants during March 2016–March 2018, we conducted a descriptive analysis. Prevalence of ZIKV-associated birth defects was 15.3 cases/100,000 live births. Among 22 infants with ZIKV-associated birth defects, 11 were designated as confirmed (positive for ZIKV) and 11 were designated as probable cases (negative for ZIKV or not tested, but mother was expsed to ZIKV during pregnancy). A total of 91% had microcephaly (head circumference >2 SDs below mean for age and sex), 64% severe microcephaly (head circumference >3 SDs below mean for age and sex), 95% neurodevelopmental abnormalities, 82% brain anomalies, 41% eye abnormalities, and 9% hearing loss. Monitoring children for >1 year can increase identification of ZIKV-associated abnormalities in addition to microcephaly.

EID Benavides-Lara A, la Paz Barboza-Arguello Md, González-Elizondo M, Hernández-deMezerville M, Brenes-Chacón H, Ramírez-Rojas M, et al. Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerg Infect Dis. 2021;27(2):360-371. https://doi.org/10.3201/eid2702.202047
AMA Benavides-Lara A, la Paz Barboza-Arguello Md, González-Elizondo M, et al. Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerging Infectious Diseases. 2021;27(2):360-371. doi:10.3201/eid2702.202047.
APA Benavides-Lara, A., la Paz Barboza-Arguello, M. d., González-Elizondo, M., Hernández-deMezerville, M., Brenes-Chacón, H., Ramírez-Rojas, M....Soriano-Fallas, A. (2021). Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerging Infectious Diseases, 27(2), 360-371. https://doi.org/10.3201/eid2702.202047.

Medscape CME Activity
Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018 [PDF - 1.48 MB - 13 pages]
V. Joste et al.

We retrospectively analyzed epidemiologic, clinical, and biologic characteristics of 368 Plasmodium ovale wallikeri and 309 P. ovale curtisi infections treated in France during January 2013–December 2018. P. ovale wallikeri infections displayed deeper thrombocytopenia and shorter latency periods. Despite similar clinical manifestations, P. ovale wallikeri–infected patients were more frequently treated with artemisinin-based combination therapy. Although the difference was not statistically significant, P. ovale wallikeri–infected patients were 5 times more frequently hospitalized in intensive care or intermediate care and had a higher proportion of severe thrombocytopenia than P. ovale curtisi–infected patients. Rapid diagnostic tests that detect aldolase were more efficient than those detecting Plasmodium lactate dehydrogenase. Sequence analysis of the potra gene from 90 P. ovale isolates reveals an insufficient polymorphism for relapse typing.

EID Joste V, Bailly J, Hubert V, Pauc C, Gendrot M, Guillochon E, et al. Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerg Infect Dis. 2021;27(2):372-384. https://doi.org/10.3201/eid2702.202143
AMA Joste V, Bailly J, Hubert V, et al. Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerging Infectious Diseases. 2021;27(2):372-384. doi:10.3201/eid2702.202143.
APA Joste, V., Bailly, J., Hubert, V., Pauc, C., Gendrot, M., Guillochon, E....Houzé, S. (2021). Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerging Infectious Diseases, 27(2), 372-384. https://doi.org/10.3201/eid2702.202143.

Volume 27, Number 1—January 2021

Cover of issue Volume 27, Number 1—January 2021

Medscape CME Activity
Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015 [PDF - 565 KB - 10 pages]
E. Pérez-Nadales et al.

Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000–2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000–2009 to 0.22 cases per 100,000 admissions in 2010–2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.

EID Pérez-Nadales E, Alastruey-Izquierdo A, Linares-Sicilia M, Soto-Debrán J, Abdala E, García-Rodríguez J, et al. Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerg Infect Dis. 2021;27(1):24-36. https://doi.org/10.3201/eid2701.190782
AMA Pérez-Nadales E, Alastruey-Izquierdo A, Linares-Sicilia M, et al. Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerging Infectious Diseases. 2021;27(1):24-36. doi:10.3201/eid2701.190782.
APA Pérez-Nadales, E., Alastruey-Izquierdo, A., Linares-Sicilia, M., Soto-Debrán, J., Abdala, E., García-Rodríguez, J....Nucci, M. (2021). Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerging Infectious Diseases, 27(1), 24-36. https://doi.org/10.3201/eid2701.190782.

Medscape CME Activity
Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018 [PDF - 1.75 MB - 11 pages]
J. Bennett et al.

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000–2018 and RHD mortality rates during 2000–2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0–14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9–27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9–3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2–5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3–14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1–13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.

EID Bennett J, Zhang J, Leung W, Jack S, Oliver J, Webb R, et al. Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerg Infect Dis. 2021;27(1):36-46. https://doi.org/10.3201/eid2701.191791
AMA Bennett J, Zhang J, Leung W, et al. Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerging Infectious Diseases. 2021;27(1):36-46. doi:10.3201/eid2701.191791.
APA Bennett, J., Zhang, J., Leung, W., Jack, S., Oliver, J., Webb, R....Baker, M. G. (2021). Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerging Infectious Diseases, 27(1), 36-46. https://doi.org/10.3201/eid2701.191791.

CME Articles by Volume

Page created: November 13, 2020
Page updated: April 26, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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