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Issue Cover for Volume 24, Number 8—August 2018

Volume 24, Number 8—August 2018

[PDF - 10.16 MB - 216 pages]

Synopses

Brucellosis in Dogs and Public Health Risk [PDF - 633 KB - 6 pages]
M. E. Hensel et al.

Brucella canis infects dogs and humans. In dogs, it can cause reproductive failure; in humans, it can cause fever, chills, malaise, peripheral lymphadenomegaly, and splenomegaly. B. canis infection in dogs is underrecognized. After evaluating serologic data, transmission patterns, and regulations in the context of brucellosis in dogs as an underrecognized zoonosis, we concluded that brucellosis in dogs remains endemic to many parts of the world and will probably remain a threat to human health and animal welfare unless stronger intervention measures are implemented. A first step for limiting disease spread would be implementation of mandatory testing of dogs before interstate or international movement.

EID Hensel ME, Negron M, Arenas-Gamboa AM. Brucellosis in Dogs and Public Health Risk. Emerg Infect Dis. 2018;24(8):1401-1406. https://dx.doi.org/10.3201/eid2408.171171
AMA Hensel ME, Negron M, Arenas-Gamboa AM. Brucellosis in Dogs and Public Health Risk. Emerging Infectious Diseases. 2018;24(8):1401-1406. doi:10.3201/eid2408.171171.
APA Hensel, M. E., Negron, M., & Arenas-Gamboa, A. M. (2018). Brucellosis in Dogs and Public Health Risk. Emerging Infectious Diseases, 24(8), 1401-1406. https://dx.doi.org/10.3201/eid2408.171171.

Abnormal Helminth Egg Development, Strange Morphology, and the Identification of Intestinal Helminth Infections [PDF - 2.48 MB - 5 pages]
S. Sapp et al.

Occasionally, abnormal forms of parasitic helminth eggs are detected during routine diagnostics. This finding can prove problematic in diagnosis because morphologic analysis based on tightly defined measurements is the primary method used to identify the infecting species and molecular confirmation of species is not always feasible. We describe instances of malformed nematode eggs (primarily from members of the superfamily Ascaridoidea) from human clinical practice and experimental trials on animals. On the basis of our observations and historical literature, we propose that unusual development and morphology of nematode and trematode eggs are associated with early infection. Further observational studies and experimentation are needed to identify additional factors that might cause abnormalities in egg morphology and production. Abnormal egg morphology can be observed early in the course of infection and can confound accurate diagnosis of intestinal helminthiases.

EID Sapp S, Yabsley MJ, Bradbury RS. Abnormal Helminth Egg Development, Strange Morphology, and the Identification of Intestinal Helminth Infections. Emerg Infect Dis. 2018;24(8):1407-1411. https://dx.doi.org/10.3201/eid2408.180560
AMA Sapp S, Yabsley MJ, Bradbury RS. Abnormal Helminth Egg Development, Strange Morphology, and the Identification of Intestinal Helminth Infections. Emerging Infectious Diseases. 2018;24(8):1407-1411. doi:10.3201/eid2408.180560.
APA Sapp, S., Yabsley, M. J., & Bradbury, R. S. (2018). Abnormal Helminth Egg Development, Strange Morphology, and the Identification of Intestinal Helminth Infections. Emerging Infectious Diseases, 24(8), 1407-1411. https://dx.doi.org/10.3201/eid2408.180560.

Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone [PDF - 1.74 MB - 10 pages]
P. J. Howlett et al.

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for specialist neurologic evaluation, ophthalmologic examination, and psychiatric assessment. Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke.

EID Howlett PJ, Walder AR, Lisk DR, Fitzgerald F, Sevalie S, Lado M, et al. Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone. Emerg Infect Dis. 2018;24(8):1412-1421. https://dx.doi.org/10.3201/eid2408.171367
AMA Howlett PJ, Walder AR, Lisk DR, et al. Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone. Emerging Infectious Diseases. 2018;24(8):1412-1421. doi:10.3201/eid2408.171367.
APA Howlett, P. J., Walder, A. R., Lisk, D. R., Fitzgerald, F., Sevalie, S., Lado, M....Scott, J. T. (2018). Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone. Emerging Infectious Diseases, 24(8), 1412-1421. https://dx.doi.org/10.3201/eid2408.171367.

Medscape CME Activity
Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome [PDF - 891 KB - 6 pages]
N. S. Rajapakse et al.

Since the first identification of neonatal microcephaly cases associated with congenital Zika virus infection in Brazil in 2015, a distinctive constellation of clinical features of congenital Zika syndrome has been described. Fetal brain disruption sequence is hypothesized to underlie the devastating effects of the virus on the central nervous system. However, little is known about the effects of congenital Zika virus infection on the peripheral nervous system. We describe a series of 4 cases of right unilateral diaphragmatic paralysis in infants with congenital Zika syndrome suggesting peripheral nervous system involvement and Zika virus as a unique congenital infectious cause of this finding. All the patients described also had arthrogryposis (including talipes equinovarus) and died from complications related to progressive respiratory failure.

EID Rajapakse NS, Ellsworth K, Liesman RM, Ho M, Henry N, Theel ES, et al. Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome. Emerg Infect Dis. 2018;24(8):1422-1427. https://dx.doi.org/10.3201/eid2408.180057
AMA Rajapakse NS, Ellsworth K, Liesman RM, et al. Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome. Emerging Infectious Diseases. 2018;24(8):1422-1427. doi:10.3201/eid2408.180057.
APA Rajapakse, N. S., Ellsworth, K., Liesman, R. M., Ho, M., Henry, N., Theel, E. S....Meneses, J. (2018). Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome. Emerging Infectious Diseases, 24(8), 1422-1427. https://dx.doi.org/10.3201/eid2408.180057.

Medscape CME Activity
Epidemiology of Diphyllobothrium nihonkaiense Diphyllobothriasis, Japan, 2001–2016 [PDF - 1.15 MB - 7 pages]
H. Ikuno et al.

We report 958 cases of cestodiasis occurring in Japan during 2001–2016. The predominant pathogen was Diphyllobothrium nihonkaiense tapeworm (n = 825), which caused 86.1% of all cases. The other cestode species involved were Taenia spp. (10.3%), Diplogonoporus balaenopterae (3.3%), and Spirometra spp. (0.2%). We estimated D. nihonkaiense diphyllobothriasis incidence as 52 cases/year. We observed a predominance of cases during March–July, coinciding with the cherry salmon and immature chum salmon fishing season, but cases were present year-round, suggesting that other fish could be involved in transmission to humans. Because of increased salmon trade, increased tourism in Japan, and lack of awareness of the risks associated with eating raw fish, cases of D. nihonkaiense diphyllobothriasis are expected to rise. Therefore, information regarding these concerning parasitic infections and warnings of the potential risks associated with these infections must be disseminated to consumers, food producers, restaurant owners, physicians, and travelers.

EID Ikuno H, Akao S, Yamasaki H. Epidemiology of Diphyllobothrium nihonkaiense Diphyllobothriasis, Japan, 2001–2016. Emerg Infect Dis. 2018;24(8):1428-1434. https://dx.doi.org/10.3201/eid2408.171454
AMA Ikuno H, Akao S, Yamasaki H. Epidemiology of Diphyllobothrium nihonkaiense Diphyllobothriasis, Japan, 2001–2016. Emerging Infectious Diseases. 2018;24(8):1428-1434. doi:10.3201/eid2408.171454.
APA Ikuno, H., Akao, S., & Yamasaki, H. (2018). Epidemiology of Diphyllobothrium nihonkaiense Diphyllobothriasis, Japan, 2001–2016. Emerging Infectious Diseases, 24(8), 1428-1434. https://dx.doi.org/10.3201/eid2408.171454.
Research

Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam [PDF - 1.50 MB - 9 pages]
N. Phan et al.

We investigated the cause of seasonal outbreaks of pediatric acute encephalitis-like syndrome associated with litchi harvests (May–July) in northern Vietnam since 2008. Nineteen cerebrospinal fluid samples were positive for human enterovirus B, and 8 blood samples were positive for hypoglycemic toxins present in litchi fruits. Patients who were positive for hypoglycemic toxins had shorter median times between disease onset and admission, more reports of seizures, more reports of hypoglycemia (glucose level <3 mmol/L), lower median numbers of leukocytes in cerebrospinal fluid, and higher median serum levels of alanine aminotransferase and aspartate transaminase than did patients who were positive for enteroviruses. We suggest that children with rapidly progressing acute encephalitis-like syndrome at the time of the litchi harvest have intoxication caused by hypoglycemic toxins, rather than viral encephalitis, as previously suspected. These children should be urgently treated for life-threatening hypoglycemia.

EID Phan N, Gouilh M, Paireau J, Phuong L, Cheval J, Ngu N, et al. Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerg Infect Dis. 2018;24(8):1435-1443. https://dx.doi.org/10.3201/eid2408.171004
AMA Phan N, Gouilh M, Paireau J, et al. Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerging Infectious Diseases. 2018;24(8):1435-1443. doi:10.3201/eid2408.171004.
APA Phan, N., Gouilh, M., Paireau, J., Phuong, L., Cheval, J., Ngu, N....Eloit, M. (2018). Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerging Infectious Diseases, 24(8), 1435-1443. https://dx.doi.org/10.3201/eid2408.171004.

Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016 [PDF - 1.08 MB - 10 pages]
K. Benedict et al.

Although coccidioidomycosis in Arizona and California has been well-characterized, much remains unknown about its epidemiology in states where it is not highly endemic. We conducted enhanced surveillance in 14 such states in 2016 by identifying cases according to the Council of State and Territorial Epidemiologists case definition and interviewing patients about their demographic characteristics, clinical features, and exposures. Among 186 patients, median time from seeking healthcare to diagnosis was 38 days (range 1–1,654 days); 70% had another condition diagnosed before coccidioidomycosis testing occurred (of whom 83% were prescribed antibacterial medications); 43% were hospitalized; and 29% had culture-positive coccidioidomycosis. Most (83%) patients from nonendemic states had traveled to a coccidioidomycosis-endemic area. Coccidioidomycosis can cause severe disease in residents of non–highly endemic states, a finding consistent with previous studies in Arizona, and less severe cases likely go undiagnosed or unreported. Improved coccidioidomycosis awareness in non–highly endemic areas is needed.

EID Benedict K, Ireland M, Weinberg MP, Gruninger RJ, Weigand J, Chen L, et al. Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016. Emerg Infect Dis. 2018;24(8):1444-1452. https://dx.doi.org/10.3201/eid2408.171595
AMA Benedict K, Ireland M, Weinberg MP, et al. Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016. Emerging Infectious Diseases. 2018;24(8):1444-1452. doi:10.3201/eid2408.171595.
APA Benedict, K., Ireland, M., Weinberg, M. P., Gruninger, R. J., Weigand, J., Chen, L....Jackson, B. R. (2018). Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016. Emerging Infectious Diseases, 24(8), 1444-1452. https://dx.doi.org/10.3201/eid2408.171595.

Human Norovirus Replication in Human Intestinal Enteroids as Model to Evaluate Virus Inactivation [PDF - 3.14 MB - 12 pages]
V. Costantini et al.

Human noroviruses are a leading cause of epidemic and endemic acute gastroenteritis worldwide and a leading cause of foodborne illness in the United States. Recently, human intestinal enteroids (HIEs) derived from human small intestinal tissue have been shown to support human norovirus replication. We implemented the HIE system in our laboratory and tested the effect of chlorine and alcohols on human norovirus infectivity. Successful replication was observed for 6 norovirus GII genotypes and was dependent on viral load and genotype of the inoculum. GII.4 viruses had higher replication levels than other genotypes. Regardless of concentration or exposure time, alcohols slightly reduced, but did not completely inactivate, human norovirus. In contrast, complete inactivation of the 3 GII.4 viruses occurred at concentrations as low as 50 ppm of chlorine. Taken together, our data confirm the successful replication of human noroviruses in HIEs and their utility as tools to study norovirus inactivation strategies.

EID Costantini V, Morantz EK, Browne H, Ettayebi K, Zeng X, Atmar RL, et al. Human Norovirus Replication in Human Intestinal Enteroids as Model to Evaluate Virus Inactivation. Emerg Infect Dis. 2018;24(8):1453-1464. https://dx.doi.org/10.3201/eid2408.180126
AMA Costantini V, Morantz EK, Browne H, et al. Human Norovirus Replication in Human Intestinal Enteroids as Model to Evaluate Virus Inactivation. Emerging Infectious Diseases. 2018;24(8):1453-1464. doi:10.3201/eid2408.180126.
APA Costantini, V., Morantz, E. K., Browne, H., Ettayebi, K., Zeng, X., Atmar, R. L....Vinjé, J. (2018). Human Norovirus Replication in Human Intestinal Enteroids as Model to Evaluate Virus Inactivation. Emerging Infectious Diseases, 24(8), 1453-1464. https://dx.doi.org/10.3201/eid2408.180126.

Clonal Expansion of Macrolide-Resistant Sequence Type 3 Mycoplasma pneumoniae, South Korea [PDF - 742 KB - 7 pages]
J. Lee et al.

To investigate the genetic background for the emergence of macrolide resistance, we characterized the genetic features of Mycoplasma pneumoniae using multilocus sequence typing. Of the 146 M. pneumoniae strains collected during the 5 consecutive outbreaks of M. pneumoniae pneumonia during 2000–2016 in South Korea, macrolide resistance increased from 0% in the first outbreak to 84.4% in the fifth. Among the 8 sequence types (STs) identified, ST3 (74.7%) was the most prevalent, followed by ST14 (15.1%). Macrolide-susceptible strains comprised 8 different STs, and all macrolide-resistant strains were ST3 (98.3%) except 1 with ST14. The proportion of macrolide-resistant strains in ST3 remained 2.2% (1/46) until the 2006–2007 outbreak and then markedly increased to 82.6% (19/23) during the 2010–2012 outbreak and 95.0% (38/40) during the 2014–2016 outbreak. The findings demonstrated that clonal expansion of ST3 M. pneumoniae was associated with the increase in macrolide resistance in South Korea.

EID Lee J, Lee J, Lee H, Ahn Y, Eun B, Cho E, et al. Clonal Expansion of Macrolide-Resistant Sequence Type 3 Mycoplasma pneumoniae, South Korea. Emerg Infect Dis. 2018;24(8):1465-1471. https://dx.doi.org/10.3201/eid2408.180081
AMA Lee J, Lee J, Lee H, et al. Clonal Expansion of Macrolide-Resistant Sequence Type 3 Mycoplasma pneumoniae, South Korea. Emerging Infectious Diseases. 2018;24(8):1465-1471. doi:10.3201/eid2408.180081.
APA Lee, J., Lee, J., Lee, H., Ahn, Y., Eun, B., Cho, E....Choi, E. (2018). Clonal Expansion of Macrolide-Resistant Sequence Type 3 Mycoplasma pneumoniae, South Korea. Emerging Infectious Diseases, 24(8), 1465-1471. https://dx.doi.org/10.3201/eid2408.180081.

Medscape CME Activity
Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015 [PDF - 1.27 MB - 10 pages]
E. M. O’Connell et al.

During 2012–2015, US-bound refugees living in Myanmar–Thailand border camps (n = 1,839) were surveyed for hookworm infection and treatment response by using quantitative PCR. Samples were collected at 3 time points: after each of 2 treatments with albendazole and after resettlement in the United States. Baseline prevalence of Necator americanus hookworm was 25.4%, Ancylostoma duodenale 0%, and Ancylostoma ceylanicum (a zoonosis) 5.4%. Compared with N. americanus prevalence, A. ceylanicum hookworm prevalence peaked in younger age groups, and blood eosinophil concentrations during A. ceylanicum infection were higher than those for N. americanus infection. Female sex was associated with a lower risk for either hookworm infection. Cure rates after 1 dose of albendazole were greater for A. ceylanicum (93.3%) than N. americanus (65.9%) hookworm (p<0.001). Lower N. americanus hookworm cure rates were unrelated to β-tubulin single-nucleotide polymorphisms at codons 200 or 167. A. ceylanicum hookworm infection might be more common in humans than previously recognized.

EID O’Connell EM, Mitchell T, Papaiakovou M, Pilotte N, Lee D, Weinberg M, et al. Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015. Emerg Infect Dis. 2018;24(8):1472-1481. https://dx.doi.org/10.3201/eid2408.180280
AMA O’Connell EM, Mitchell T, Papaiakovou M, et al. Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015. Emerging Infectious Diseases. 2018;24(8):1472-1481. doi:10.3201/eid2408.180280.
APA O’Connell, E. M., Mitchell, T., Papaiakovou, M., Pilotte, N., Lee, D., Weinberg, M....Nutman, T. B. (2018). Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015. Emerging Infectious Diseases, 24(8), 1472-1481. https://dx.doi.org/10.3201/eid2408.180280.

Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions [PDF - 1.51 MB - 8 pages]
M. A. Barria et al.

Chronic wasting disease (CWD) is a contagious and fatal neurodegenerative disease and a serious animal health issue for deer and elk in North America. The identification of the first cases of CWD among free-ranging reindeer and moose in Europe brings back into focus the unresolved issue of whether CWD can be zoonotic like bovine spongiform encephalopathy. We used a cell-free seeded protein misfolding assay to determine whether CWD prions from elk, white-tailed deer, and reindeer in North America can convert the human prion protein to the disease-associated form. We found that prions can convert, but the efficiency of conversion is affected by polymorphic variation in the cervid and human prion protein genes. In view of the similarity of reindeer, elk, and white-tailed deer in North America to reindeer, red deer, and roe deer, respectively, in Europe, a more comprehensive and thorough assessment of the zoonotic potential of CWD might be warranted.

EID Barria MA, Libori A, Mitchell G, Head MW. Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions. Emerg Infect Dis. 2018;24(8):1482-1489. https://dx.doi.org/10.3201/eid2408.161888
AMA Barria MA, Libori A, Mitchell G, et al. Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions. Emerging Infectious Diseases. 2018;24(8):1482-1489. doi:10.3201/eid2408.161888.
APA Barria, M. A., Libori, A., Mitchell, G., & Head, M. W. (2018). Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions. Emerging Infectious Diseases, 24(8), 1482-1489. https://dx.doi.org/10.3201/eid2408.161888.

Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India [PDF - 619 KB - 7 pages]
M. Alsan et al.

The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for community-acquired antimicrobial resistance (CA-AMR) in low-income settings have not been clearly elucidated. Our aim was to identify risk factors for CA-AMR with extended-spectrum β-lactamase (ESBL)–producing organisms among urban-dwelling women in India. We collected microbiological and survey data in an observational study of primigravidae women in a public hospital in Hyderabad, India. We analyzed the data using multivariate logistic and linear regression and found that 7% of 1,836 women had bacteriuria; 48% of isolates were ESBL-producing organisms. Women in the bottom 50th percentile of income distribution were more likely to have bacteriuria (adjusted odds ratio 1.44, 95% CI 0.99–2.10) and significantly more likely to have bacteriuria with ESBL-producing organisms (adjusted odds ratio 2.04, 95% CI 1.17–3.54). Nonparametric analyses demonstrated a negative relationship between the prevalence of ESBL and income.

EID Alsan M, Kammili N, Lakshmi J, Xing A, Khan A, Rani M, et al. Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India. Emerg Infect Dis. 2018;24(8):1490-1496. https://dx.doi.org/10.3201/eid2408.171030
AMA Alsan M, Kammili N, Lakshmi J, et al. Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India. Emerging Infectious Diseases. 2018;24(8):1490-1496. doi:10.3201/eid2408.171030.
APA Alsan, M., Kammili, N., Lakshmi, J., Xing, A., Khan, A., Rani, M....Owens, D. K. (2018). Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India. Emerging Infectious Diseases, 24(8), 1490-1496. https://dx.doi.org/10.3201/eid2408.171030.

Toxoplasmosis in Transplant Recipients, Europe, 2010–2014 [PDF - 527 KB - 8 pages]
F. Robert-Gangneux et al.

Transplantation activity is increasing, leading to a growing number of patients at risk for toxoplasmosis. We reviewed toxoplasmosis prevention practices, prevalence, and outcomes for hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT; heart, kidney, or liver) patients in Europe. We collected electronic data on the transplant population and prevention guidelines/regulations and clinical data on toxoplasmosis cases diagnosed during 2010–2014. Serologic pretransplant screening of allo-hematopoietic stem cell donors was performed in 80% of countries, screening of organ donors in 100%. SOT recipients were systematically screened in 6 countries. Targeted anti-Toxoplasma chemoprophylaxis was heterogeneous. A total of 87 toxoplasmosis cases were recorded (58 allo-HSCTs, 29 SOTs). The 6-month survival rate was lower among Toxoplasma-seropositive recipients and among allo-hematopoietic stem cell and liver recipients. Chemoprophylaxis improved outcomes for SOT recipients. Toxoplasmosis remains associated with high mortality rates among transplant recipients. Guidelines are urgently needed to standardize prophylactic regimens and optimize patient management.

EID Robert-Gangneux F, Meroni V, Dupont D, Botterel F, Garcia JM, Brenier-Pinchart M, et al. Toxoplasmosis in Transplant Recipients, Europe, 2010–2014. Emerg Infect Dis. 2018;24(8):1497-1504. https://dx.doi.org/10.3201/eid2408.180045
AMA Robert-Gangneux F, Meroni V, Dupont D, et al. Toxoplasmosis in Transplant Recipients, Europe, 2010–2014. Emerging Infectious Diseases. 2018;24(8):1497-1504. doi:10.3201/eid2408.180045.
APA Robert-Gangneux, F., Meroni, V., Dupont, D., Botterel, F., Garcia, J. M., Brenier-Pinchart, M....Manuel, O. (2018). Toxoplasmosis in Transplant Recipients, Europe, 2010–2014. Emerging Infectious Diseases, 24(8), 1497-1504. https://dx.doi.org/10.3201/eid2408.180045.

Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains [PDF - 5.00 MB - 11 pages]
R. Beyrouthy et al.

We investigated unusual carbapenemase-producing Enterobacter cloacae complex isolates (n = 8) in the novel sequence type (ST) 873, which caused nosocomial infections in 2 hospitals in France. Whole-genome sequence typing showed the 1-year persistence of the epidemic strain, which harbored a blaVIM-4 ST1-IncHI2 plasmid, in 1 health institution and 2 closely related strains harboring blaCTX-M-15 in the other. These isolates formed a new subgroup in the E. hormaechei metacluster, according to their hsp60 sequences and phylogenomic analysis. The average nucleotide identities, specific biochemical properties, and pangenomic and functional investigations of isolates suggested isolates of a novel species that had acquired genes associated with adhesion and mobility. The emergence of this novel Enterobacter phylogenetic lineage within hospitals should be closely monitored because of its ability to persist and spread.

EID Beyrouthy R, Barets M, Marion E, Dananché C, Dauwalder O, Robin F, et al. Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains. Emerg Infect Dis. 2018;24(8):1505-1515. https://dx.doi.org/10.3201/eid2408.180151
AMA Beyrouthy R, Barets M, Marion E, et al. Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains. Emerging Infectious Diseases. 2018;24(8):1505-1515. doi:10.3201/eid2408.180151.
APA Beyrouthy, R., Barets, M., Marion, E., Dananché, C., Dauwalder, O., Robin, F....Bonnet, R. (2018). Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains. Emerging Infectious Diseases, 24(8), 1505-1515. https://dx.doi.org/10.3201/eid2408.180151.
Dispatches

Therapeutic and Transmission-Blocking 
Efficacy of Dihydroartemisinin/Piperaquine and Chloroquine against Plasmodium vivax Malaria, Cambodia [PDF - 685 KB - 4 pages]
J. Popovici et al.

We assessed the efficacy of standard 3-day courses of chloroquine and dihydroartemisinin/piperaquine against Plasmodium vivax malaria. Compared with chloroquine, dihydroartemisinin/piperaquine was faster in clearing asexual P. vivax parasites and blocking human-to-mosquito transmission. This drug combination was also more effective in preventing potential recurrences for >2 months.

EID Popovici J, Vantaux A, Primault L, Samreth R, Piv E, Bin S, et al. Therapeutic and Transmission-Blocking 
Efficacy of Dihydroartemisinin/Piperaquine and Chloroquine against Plasmodium vivax Malaria, Cambodia. Emerg Infect Dis. 2018;24(8):1516-1519. https://dx.doi.org/10.3201/eid2408.170768
AMA Popovici J, Vantaux A, Primault L, et al. Therapeutic and Transmission-Blocking 
Efficacy of Dihydroartemisinin/Piperaquine and Chloroquine against Plasmodium vivax Malaria, Cambodia. Emerging Infectious Diseases. 2018;24(8):1516-1519. doi:10.3201/eid2408.170768.
APA Popovici, J., Vantaux, A., Primault, L., Samreth, R., Piv, E., Bin, S....Menard, D. (2018). Therapeutic and Transmission-Blocking 
Efficacy of Dihydroartemisinin/Piperaquine and Chloroquine against Plasmodium vivax Malaria, Cambodia. Emerging Infectious Diseases, 24(8), 1516-1519. https://dx.doi.org/10.3201/eid2408.170768.

Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016 [PDF - 1.53 MB - 4 pages]
N. Le-Viet et al.

We report a dual genotype Orientia tsutsugamushi infection in Vietnam in 2016. The patient had fever, rash, and an eschar. The Kawasaki genotype was identified in the eschar specimen and Karp genotype in the whole blood specimen. The genotype co-infection rate for scrub typhus is unknown and should be further evaluated.

EID Le-Viet N, Phan D, Le-Viet N, Trinh S, To M, Raoult D, et al. Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016. Emerg Infect Dis. 2018;24(8):1520-1523. https://dx.doi.org/10.3201/eid2408.171622
AMA Le-Viet N, Phan D, Le-Viet N, et al. Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016. Emerging Infectious Diseases. 2018;24(8):1520-1523. doi:10.3201/eid2408.171622.
APA Le-Viet, N., Phan, D., Le-Viet, N., Trinh, S., To, M., Raoult, D....Parola, P. (2018). Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016. Emerging Infectious Diseases, 24(8), 1520-1523. https://dx.doi.org/10.3201/eid2408.171622.

Hospitalized Patient as Source of Aspergillus fumigatus, 2015 [PDF - 1.83 MB - 4 pages]
B. Lemaire et al.

Hospital-acquired aspergillosis is usually associated with environmental contamination. In 2015, continuous monitoring of airborne fungi and multilocus variable-number tandem-repeat analysis identified the source of Aspergillus fumigatus as the airway of a patient. Therefore, patients colonized with Aspergillus spp. should be treated in airborne infection isolation rooms.

EID Lemaire B, Normand A, Forel J, Cassir N, Piarroux R, Ranque S. Hospitalized Patient as Source of Aspergillus fumigatus, 2015. Emerg Infect Dis. 2018;24(8):1524-1527. https://dx.doi.org/10.3201/eid2408.171865
AMA Lemaire B, Normand A, Forel J, et al. Hospitalized Patient as Source of Aspergillus fumigatus, 2015. Emerging Infectious Diseases. 2018;24(8):1524-1527. doi:10.3201/eid2408.171865.
APA Lemaire, B., Normand, A., Forel, J., Cassir, N., Piarroux, R., & Ranque, S. (2018). Hospitalized Patient as Source of Aspergillus fumigatus, 2015. Emerging Infectious Diseases, 24(8), 1524-1527. https://dx.doi.org/10.3201/eid2408.171865.

Anncaliia algerae Microsporidial Myositis, New South Wales, Australia [PDF - 2.57 MB - 4 pages]
G. Sutrave et al.

We describe the successful management of Anncaliia algerae microsporidial myositis in a man with graft versus host disease after hemopoietic stem cell transplantation. We also summarize clinical presentation and management approaches and discuss the importance of research into the acquisition of this infection and strategies for prevention.

EID Sutrave G, Maundrell A, Keighley C, Jennings Z, Brammah S, Wang M, et al. Anncaliia algerae Microsporidial Myositis, New South Wales, Australia. Emerg Infect Dis. 2018;24(8):1528-1531. https://dx.doi.org/10.3201/eid2408.172002
AMA Sutrave G, Maundrell A, Keighley C, et al. Anncaliia algerae Microsporidial Myositis, New South Wales, Australia. Emerging Infectious Diseases. 2018;24(8):1528-1531. doi:10.3201/eid2408.172002.
APA Sutrave, G., Maundrell, A., Keighley, C., Jennings, Z., Brammah, S., Wang, M....Watts, M. R. (2018). Anncaliia algerae Microsporidial Myositis, New South Wales, Australia. Emerging Infectious Diseases, 24(8), 1528-1531. https://dx.doi.org/10.3201/eid2408.172002.

Outbreak of Trichinella T9 Infections Associated with Consumption of Bear Meat, Japan [PDF - 1.23 MB - 4 pages]
K. Tada et al.

An outbreak of trichinellosis occurred in Japan in December 2016. All case-patients had eaten undercooked bear meat, from which Trichinella larvae were subsequently isolated. DNA sequencing analysis of the mitochondrial genes cytochrome c-oxidase subunit 1 and internal transcribed spacer 2 confirmed that Trichinella T9 had caused the outbreak.

EID Tada K, Suzuki H, Sato Y, Morishima Y, Nagano I, Ishioka H, et al. Outbreak of Trichinella T9 Infections Associated with Consumption of Bear Meat, Japan. Emerg Infect Dis. 2018;24(8):1532-1535. https://dx.doi.org/10.3201/eid2408.172117
AMA Tada K, Suzuki H, Sato Y, et al. Outbreak of Trichinella T9 Infections Associated with Consumption of Bear Meat, Japan. Emerging Infectious Diseases. 2018;24(8):1532-1535. doi:10.3201/eid2408.172117.
APA Tada, K., Suzuki, H., Sato, Y., Morishima, Y., Nagano, I., Ishioka, H....Gomi, H. (2018). Outbreak of Trichinella T9 Infections Associated with Consumption of Bear Meat, Japan. Emerging Infectious Diseases, 24(8), 1532-1535. https://dx.doi.org/10.3201/eid2408.172117.

Variation in Influenza B Virus Epidemiology by Lineage, China [PDF - 3.35 MB - 5 pages]
J. Yang et al.

We used national sentinel surveillance data in China for 2005–2016 to examine the lineage-specific epidemiology of influenza B. Influenza B viruses circulated every year with relatively lower activity than influenza A. B/Yamagata was more frequently detected in adults than in children.

EID Yang J, Lau Y, Wu P, Feng L, Wang X, Chen T, et al. Variation in Influenza B Virus Epidemiology by Lineage, China. Emerg Infect Dis. 2018;24(8):1536-1540. https://dx.doi.org/10.3201/eid2408.180063
AMA Yang J, Lau Y, Wu P, et al. Variation in Influenza B Virus Epidemiology by Lineage, China. Emerging Infectious Diseases. 2018;24(8):1536-1540. doi:10.3201/eid2408.180063.
APA Yang, J., Lau, Y., Wu, P., Feng, L., Wang, X., Chen, T....Cowling, B. J. (2018). Variation in Influenza B Virus Epidemiology by Lineage, China. Emerging Infectious Diseases, 24(8), 1536-1540. https://dx.doi.org/10.3201/eid2408.180063.

Invasive Colonic Entamoebiasis in Wild Cane Toads, Australia [PDF - 1.21 MB - 3 pages]
C. M. Shilton et al.

We detected a disease syndrome in free-ranging Australian cane toads involving atypical behavior and emaciation that is associated with a previously undescribed Entamoeba sp. that infiltrates the colonic lining, causing it to slough. The organism may become seasonally pathogenic when toads are under hydric and nutritional stress.

EID Shilton CM, Šlapeta J, Shine R, Brown GP. Invasive Colonic Entamoebiasis in Wild Cane Toads, Australia. Emerg Infect Dis. 2018;24(8):1541-1543. https://dx.doi.org/10.3201/eid2408.180101
AMA Shilton CM, Šlapeta J, Shine R, et al. Invasive Colonic Entamoebiasis in Wild Cane Toads, Australia. Emerging Infectious Diseases. 2018;24(8):1541-1543. doi:10.3201/eid2408.180101.
APA Shilton, C. M., Šlapeta, J., Shine, R., & Brown, G. P. (2018). Invasive Colonic Entamoebiasis in Wild Cane Toads, Australia. Emerging Infectious Diseases, 24(8), 1541-1543. https://dx.doi.org/10.3201/eid2408.180101.

Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana [PDF - 981 KB - 4 pages]
N. Amoako et al.

We report new molecular evidence of locally acquired dengue virus infections in Ghana. We detected dengue viral RNA among children with suspected malaria by using a multipathogen real-time PCR. Subsequent sequence analysis revealed a close relationship with dengue virus serotype 2, which was implicated in a 2016 outbreak in Burkina Faso.

EID Amoako N, Duodu S, Dennis FE, Bonney J, Asante KP, Ameh J, et al. Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana. Emerg Infect Dis. 2018;24(8):1544-1547. https://dx.doi.org/10.3201/eid2408.180341
AMA Amoako N, Duodu S, Dennis FE, et al. Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana. Emerging Infectious Diseases. 2018;24(8):1544-1547. doi:10.3201/eid2408.180341.
APA Amoako, N., Duodu, S., Dennis, F. E., Bonney, J., Asante, K. P., Ameh, J....Awandare, G. A. (2018). Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana. Emerging Infectious Diseases, 24(8), 1544-1547. https://dx.doi.org/10.3201/eid2408.180341.

Death from Transfusion-Transmitted Anaplasmosis, New York, USA, 2017 [PDF - 890 KB - 3 pages]
R. Goel et al.

We report a death from transfusion-transmitted anaplasmosis in a 78-year-old man. The patient died of septic shock 2 weeks after a perioperative transfusion with erythrocytes harboring Anaplasma phagocytophilum. The patient’s blood specimens were positive for A. phagocytophilum DNA beginning 7 days after transfusion; serologic testing remained negative until death.

EID Goel R, Westblade LF, Kessler DA, Sfeir M, Slavinski S, Backenson B, et al. Death from Transfusion-Transmitted Anaplasmosis, New York, USA, 2017. Emerg Infect Dis. 2018;24(8):1548-1550. https://dx.doi.org/10.3201/eid2408.172048
AMA Goel R, Westblade LF, Kessler DA, et al. Death from Transfusion-Transmitted Anaplasmosis, New York, USA, 2017. Emerging Infectious Diseases. 2018;24(8):1548-1550. doi:10.3201/eid2408.172048.
APA Goel, R., Westblade, L. F., Kessler, D. A., Sfeir, M., Slavinski, S., Backenson, B....Cushing, M. M. (2018). Death from Transfusion-Transmitted Anaplasmosis, New York, USA, 2017. Emerging Infectious Diseases, 24(8), 1548-1550. https://dx.doi.org/10.3201/eid2408.172048.

Capillaria Ova and Diagnosis of Trichuris trichiura Infection in Humans by Kato-Katz Smear, Liberia [PDF - 1.66 MB - 4 pages]
K. Fischer et al.

We examined human stool samples from Liberia for soil-transmitted helminth ova by Kato-Katz smear and by quantitative PCR. Twenty-five samples were positive for Trichuris trichiura by smear but negative by quantitative PCR. Reexamination of samples showed that they contained Capillaria eggs that resemble T. trichiura in Kato-Katz smears.

EID Fischer K, Gankpala A, Gankpala L, Bolay FK, Curtis KC, Weil GJ, et al. Capillaria Ova and Diagnosis of Trichuris trichiura Infection in Humans by Kato-Katz Smear, Liberia. Emerg Infect Dis. 2018;24(8):1551-1554. https://dx.doi.org/10.3201/eid2408.180184
AMA Fischer K, Gankpala A, Gankpala L, et al. Capillaria Ova and Diagnosis of Trichuris trichiura Infection in Humans by Kato-Katz Smear, Liberia. Emerging Infectious Diseases. 2018;24(8):1551-1554. doi:10.3201/eid2408.180184.
APA Fischer, K., Gankpala, A., Gankpala, L., Bolay, F. K., Curtis, K. C., Weil, G. J....Fischer, P. U. (2018). Capillaria Ova and Diagnosis of Trichuris trichiura Infection in Humans by Kato-Katz Smear, Liberia. Emerging Infectious Diseases, 24(8), 1551-1554. https://dx.doi.org/10.3201/eid2408.180184.

Coxiella burnetii Endocarditis and Meningitis, California, USA, 2017 [PDF - 897 KB - 3 pages]
L. Allan-Blitz et al.

The epidemiology of Coxiella burnetii infection in the United States is not well characterized. We report a case-patient with C. burnetii endocarditis and meningitis. Infection was diagnosed by detecting high serologic titers for C. burnetii and confirmed by sequencing of C. burnetii 16S rRNA isolated from resected valvular tissue and PCR of cerebrospinal fluid.

EID Allan-Blitz L, Sakona A, Wallace WD, Klausner JD. Coxiella burnetii Endocarditis and Meningitis, California, USA, 2017. Emerg Infect Dis. 2018;24(8):1555-1557. https://dx.doi.org/10.3201/eid2408.180249
AMA Allan-Blitz L, Sakona A, Wallace WD, et al. Coxiella burnetii Endocarditis and Meningitis, California, USA, 2017. Emerging Infectious Diseases. 2018;24(8):1555-1557. doi:10.3201/eid2408.180249.
APA Allan-Blitz, L., Sakona, A., Wallace, W. D., & Klausner, J. D. (2018). Coxiella burnetii Endocarditis and Meningitis, California, USA, 2017. Emerging Infectious Diseases, 24(8), 1555-1557. https://dx.doi.org/10.3201/eid2408.180249.

Probable Locally Acquired Babesia divergens–Like Infection in Woman, Michigan, USA [PDF - 558 KB - 3 pages]
E. Herc et al.

We report an asplenic patient who was infected with Babesia divergens–like/MO-1. The clinical course was complicated by multiorgan failure that required intubation and dialysis. The patient recovered after an exchange transfusion and antimicrobial drug therapy. Physicians should be alert for additional cases, particularly in asplenic persons.

EID Herc E, Pritt B, Huizenga T, Douce R, Hysell M, Newton D, et al. Probable Locally Acquired Babesia divergens–Like Infection in Woman, Michigan, USA. Emerg Infect Dis. 2018;24(8):1558-1560. https://dx.doi.org/10.3201/eid2408.180309
AMA Herc E, Pritt B, Huizenga T, et al. Probable Locally Acquired Babesia divergens–Like Infection in Woman, Michigan, USA. Emerging Infectious Diseases. 2018;24(8):1558-1560. doi:10.3201/eid2408.180309.
APA Herc, E., Pritt, B., Huizenga, T., Douce, R., Hysell, M., Newton, D....Kaul, D. R. (2018). Probable Locally Acquired Babesia divergens–Like Infection in Woman, Michigan, USA. Emerging Infectious Diseases, 24(8), 1558-1560. https://dx.doi.org/10.3201/eid2408.180309.

Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab [PDF - 583 KB - 4 pages]
D. Nolfi-Donegan et al.

Patients receiving eculizumab have an increased risk for meningococcal disease, but most reported cases are attributable to encapsulated meningococcal strains. We describe a case in which a nongroupable meningococcal strain, which rarely causes disease in healthy persons, caused fatal disease in an eculizumab recipient despite meningococcal vaccination.

EID Nolfi-Donegan D, Konar M, Vianzon V, MacNeil J, Cooper J, Lurie P, et al. Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab. Emerg Infect Dis. 2018;24(8):1561-1564. https://dx.doi.org/10.3201/eid2408.180228
AMA Nolfi-Donegan D, Konar M, Vianzon V, et al. Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab. Emerging Infectious Diseases. 2018;24(8):1561-1564. doi:10.3201/eid2408.180228.
APA Nolfi-Donegan, D., Konar, M., Vianzon, V., MacNeil, J., Cooper, J., Lurie, P....McNamara, L. (2018). Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab. Emerging Infectious Diseases, 24(8), 1561-1564. https://dx.doi.org/10.3201/eid2408.180228.

Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore [PDF - 1.23 MB - 4 pages]
G. Yan et al.

Dengue virus and Zika virus coexist in tropical regions in Asia where healthcare resources are limited; differentiating the 2 viruses is challenging. We showed in a case–control discovery cohort, and replicated in a validation cohort, that the diagnostic indices of conjunctivitis, platelet count, and monocyte count reliably distinguished between these viruses.

EID Yan G, Pang L, Cook AR, Ho HJ, Win M, Khoo A, et al. Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore. Emerg Infect Dis. 2018;24(8):1565-1568. https://dx.doi.org/10.3201/eid2408.171883
AMA Yan G, Pang L, Cook AR, et al. Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore. Emerging Infectious Diseases. 2018;24(8):1565-1568. doi:10.3201/eid2408.171883.
APA Yan, G., Pang, L., Cook, A. R., Ho, H. J., Win, M., Khoo, A....Chai, L. (2018). Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore. Emerging Infectious Diseases, 24(8), 1565-1568. https://dx.doi.org/10.3201/eid2408.171883.

Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso [PDF - 1.76 MB - 4 pages]
S. Zida et al.

Patients in Burkina Faso who sought medical attention for febrile jaundice were tested for leptospirosis. We confirmed leptospirosis in 27 (3.46%) of 781 patients: 23 (2.94%) tested positive using serologic assays and 4 (0.51%) using LipL32 PCR. We further presumed leptospirosis in 16 (2.82%) IgM-positive specimens.

EID Zida S, Kania D, Sotto A, Brun M, Picardeau M, Castéra J, et al. Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso. Emerg Infect Dis. 2018;24(8):1569-1572. https://dx.doi.org/10.3201/eid2408.170436
AMA Zida S, Kania D, Sotto A, et al. Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso. Emerging Infectious Diseases. 2018;24(8):1569-1572. doi:10.3201/eid2408.170436.
APA Zida, S., Kania, D., Sotto, A., Brun, M., Picardeau, M., Castéra, J....Tuaillon, E. (2018). Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso. Emerging Infectious Diseases, 24(8), 1569-1572. https://dx.doi.org/10.3201/eid2408.170436.

Direct Detection of penA Gene Associated with Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Strain by Using PCR [PDF - 459 KB - 3 pages]
D. M. Whiley et al.

The ceftriaxone-resistant Neisseria gonorrhoeae FC428 clone was first observed in Japan in 2015, and in 2017, it was documented in Denmark, Canada, and Australia. Here, we describe a PCR for direct detection of the penA gene associated with this strain that can be used to enhance surveillance activities.

EID Whiley DM, Mhango L, Jennison AV, Nimmo G, Lahra MM. Direct Detection of penA Gene Associated with Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Strain by Using PCR. Emerg Infect Dis. 2018;24(8):1573-1575. https://dx.doi.org/10.3201/eid2408.180295
AMA Whiley DM, Mhango L, Jennison AV, et al. Direct Detection of penA Gene Associated with Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Strain by Using PCR. Emerging Infectious Diseases. 2018;24(8):1573-1575. doi:10.3201/eid2408.180295.
APA Whiley, D. M., Mhango, L., Jennison, A. V., Nimmo, G., & Lahra, M. M. (2018). Direct Detection of penA Gene Associated with Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Strain by Using PCR. Emerging Infectious Diseases, 24(8), 1573-1575. https://dx.doi.org/10.3201/eid2408.180295.
Research Letters

Identification of Peste des Petits Ruminants Virus, Georgia, 2016 [PDF - 481 KB - 3 pages]
M. Donduashvili et al.

A phylogenetic analysis of samples taken from reported outbreaks of peste des petits ruminants virus (PPRV) in Georgia revealed a closer relationship to viruses from northern and eastern Africa than to viruses from countries closer to Georgia. This finding has crucial implications for the control of PPRV in the region.

EID Donduashvili M, Goginashvili K, Toklikishvili N, Tigilauri T, Gelashvili L, Avaliani L, et al. Identification of Peste des Petits Ruminants Virus, Georgia, 2016. Emerg Infect Dis. 2018;24(8):1576-1578. https://dx.doi.org/10.3201/eid2408.170334
AMA Donduashvili M, Goginashvili K, Toklikishvili N, et al. Identification of Peste des Petits Ruminants Virus, Georgia, 2016. Emerging Infectious Diseases. 2018;24(8):1576-1578. doi:10.3201/eid2408.170334.
APA Donduashvili, M., Goginashvili, K., Toklikishvili, N., Tigilauri, T., Gelashvili, L., Avaliani, L....Dundon, W. G. (2018). Identification of Peste des Petits Ruminants Virus, Georgia, 2016. Emerging Infectious Diseases, 24(8), 1576-1578. https://dx.doi.org/10.3201/eid2408.170334.

Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru [PDF - 667 KB - 3 pages]
D. Juarez et al.

While studying respiratory infections in Peru, we identified Venezuelan equine encephalitis virus (VEEV) in a nasopharyngeal swab, indicating that this alphavirus can be present in human respiratory secretions. Because VEEV may be infectious when aerosolized, our finding is relevant for the management of VEEV-infected patients and for VEEV transmission studies.

EID Juarez D, Guevara C, Wiley M, Torre A, Palacios G, Halsey ES, et al. Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru. Emerg Infect Dis. 2018;24(8):1578-1580. https://dx.doi.org/10.3201/eid2408.171274
AMA Juarez D, Guevara C, Wiley M, et al. Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru. Emerging Infectious Diseases. 2018;24(8):1578-1580. doi:10.3201/eid2408.171274.
APA Juarez, D., Guevara, C., Wiley, M., Torre, A., Palacios, G., Halsey, E. S....Leguia, M. (2018). Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru. Emerging Infectious Diseases, 24(8), 1578-1580. https://dx.doi.org/10.3201/eid2408.171274.

Plasmodium ovale wallikeri in Western Lowland Gorillas and Humans, Central African Republic [PDF - 771 KB - 3 pages]
M. I. Mapua et al.

Human malaria parasites have rarely been reported from free-ranging great apes. Our study confirms the presence of the human malaria parasite Plasmodium ovale wallikeri in western lowland gorillas and humans in Dzanga Sangha Protected Areas, Central African Republic, and discusses implications for malaria epidemiology.

EID Mapua MI, Fuehrer H, Petrželková KJ, Todd A, Noedl H, Qablan MA, et al. Plasmodium ovale wallikeri in Western Lowland Gorillas and Humans, Central African Republic. Emerg Infect Dis. 2018;24(8):1581-1583. https://dx.doi.org/10.3201/eid2408.180010
AMA Mapua MI, Fuehrer H, Petrželková KJ, et al. Plasmodium ovale wallikeri in Western Lowland Gorillas and Humans, Central African Republic. Emerging Infectious Diseases. 2018;24(8):1581-1583. doi:10.3201/eid2408.180010.
APA Mapua, M. I., Fuehrer, H., Petrželková, K. J., Todd, A., Noedl, H., Qablan, M. A....Modrý, D. (2018). Plasmodium ovale wallikeri in Western Lowland Gorillas and Humans, Central African Republic. Emerging Infectious Diseases, 24(8), 1581-1583. https://dx.doi.org/10.3201/eid2408.180010.

Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010–2012 [PDF - 320 KB - 2 pages]
D. L. Williams et al.

Skin biopsies from US leprosy patients were tested for mutations associated with drug resistance. Dapsone resistance was found in 4 of 6 biopsies from American Samoa patients. No resistance was observed in patients from other origins. The high rate of dapsone resistance in patients from American Samoa warrants further investigation.

EID Williams DL, Araujo S, Stryjewska BM, Scollard D. Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010–2012. Emerg Infect Dis. 2018;24(8):1584-1585. https://dx.doi.org/10.3201/eid2408.180033
AMA Williams DL, Araujo S, Stryjewska BM, et al. Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010–2012. Emerging Infectious Diseases. 2018;24(8):1584-1585. doi:10.3201/eid2408.180033.
APA Williams, D. L., Araujo, S., Stryjewska, B. M., & Scollard, D. (2018). Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010–2012. Emerging Infectious Diseases, 24(8), 1584-1585. https://dx.doi.org/10.3201/eid2408.180033.

Autochthonous Hepatitis E during Pregnancy, France [PDF - 564 KB - 2 pages]
E. Bouthry et al.

Acute hepatitis E virus infections occurred during the third trimester in 2 pregnant women in France who sought treatment with nonspecific symptoms or asymptomatic elevation of liver enzymes. Infection cleared quickly in both women. We detected no hepatitis E RNA in 1 newborn’s feces at 3 weeks of age.

EID Bouthry E, Benachi A, Vivanti AJ, Letamendia E, Vauloup-Fellous C, Roque-Afonso A. Autochthonous Hepatitis E during Pregnancy, France. Emerg Infect Dis. 2018;24(8):1586-1587. https://dx.doi.org/10.3201/eid2408.180105
AMA Bouthry E, Benachi A, Vivanti AJ, et al. Autochthonous Hepatitis E during Pregnancy, France. Emerging Infectious Diseases. 2018;24(8):1586-1587. doi:10.3201/eid2408.180105.
APA Bouthry, E., Benachi, A., Vivanti, A. J., Letamendia, E., Vauloup-Fellous, C., & Roque-Afonso, A. (2018). Autochthonous Hepatitis E during Pregnancy, France. Emerging Infectious Diseases, 24(8), 1586-1587. https://dx.doi.org/10.3201/eid2408.180105.

Misdiagnosis of Babesiosis as Malaria, Equatorial Guinea, 2014 [PDF - 379 KB - 2 pages]
M. Arsuaga et al.

We report a case of babesiosis, caused by Babesia microti, in a missionary who worked in Equatorial Guinea but also visited rural Spain. The initial diagnosis, based on clinical features and microscopy, was malaria. The patient’s recovery was delayed until she received appropriate treatment for babesiosis.

EID Arsuaga M, González L, Padial E, Dinkessa A, Sevilla E, Trigo E, et al. Misdiagnosis of Babesiosis as Malaria, Equatorial Guinea, 2014. Emerg Infect Dis. 2018;24(8):1588-1589. https://dx.doi.org/10.3201/eid2408.180180
AMA Arsuaga M, González L, Padial E, et al. Misdiagnosis of Babesiosis as Malaria, Equatorial Guinea, 2014. Emerging Infectious Diseases. 2018;24(8):1588-1589. doi:10.3201/eid2408.180180.
APA Arsuaga, M., González, L., Padial, E., Dinkessa, A., Sevilla, E., Trigo, E....Montero, E. (2018). Misdiagnosis of Babesiosis as Malaria, Equatorial Guinea, 2014. Emerging Infectious Diseases, 24(8), 1588-1589. https://dx.doi.org/10.3201/eid2408.180180.

Paenibacillus assamensis in Joint Fluid of Man with Suspected Tularemia, China [PDF - 608 KB - 3 pages]
E. Zhang et al.

Paenibacillus assamensis is a bacterium usually found in warm springs. We detected P. assamensis in a man with suspected tularemia. The strain isolated from the man’s knee joint fluid was identified as P. assamensis after analysis of a homologous sequence of the 16S rRNA gene.

EID Zhang E, Lu H, Liu Q, Tang Z, Li D, Jiang L, et al. Paenibacillus assamensis in Joint Fluid of Man with Suspected Tularemia, China. Emerg Infect Dis. 2018;24(8):1589-1591. https://dx.doi.org/10.3201/eid2408.180260
AMA Zhang E, Lu H, Liu Q, et al. Paenibacillus assamensis in Joint Fluid of Man with Suspected Tularemia, China. Emerging Infectious Diseases. 2018;24(8):1589-1591. doi:10.3201/eid2408.180260.
APA Zhang, E., Lu, H., Liu, Q., Tang, Z., Li, D., Jiang, L....Wang, Y. (2018). Paenibacillus assamensis in Joint Fluid of Man with Suspected Tularemia, China. Emerging Infectious Diseases, 24(8), 1589-1591. https://dx.doi.org/10.3201/eid2408.180260.

Plasmodium falciparum Plasmepsin 2 Duplications, West Africa [PDF - 417 KB - 3 pages]
J. Inoue et al.

Dihydroartemisinin/piperaquine (DHA/PPQ) is increasingly deployed as an antimalaria drug in Africa. We report the detection in Mali of Plasmodium falciparum infections carrying plasmepsin 2 duplications (associated with piperaquine resistance) in 7/65 recurrent infections within 2 months after DHA/PPQ treatment. These findings raise concerns about the long-term efficacy of DHA/PPQ treatment in Africa.

EID Inoue J, Silva M, Fofana B, Sanogo K, Mårtensson A, Sagara I, et al. Plasmodium falciparum Plasmepsin 2 Duplications, West Africa. Emerg Infect Dis. 2018;24(8):1591-1593. https://dx.doi.org/10.3201/eid2408.180370
AMA Inoue J, Silva M, Fofana B, et al. Plasmodium falciparum Plasmepsin 2 Duplications, West Africa. Emerging Infectious Diseases. 2018;24(8):1591-1593. doi:10.3201/eid2408.180370.
APA Inoue, J., Silva, M., Fofana, B., Sanogo, K., Mårtensson, A., Sagara, I....Gil, J. (2018). Plasmodium falciparum Plasmepsin 2 Duplications, West Africa. Emerging Infectious Diseases, 24(8), 1591-1593. https://dx.doi.org/10.3201/eid2408.180370.

Progressive Multifocal Leukoencephalopathy after Treatment with Nivolumab [PDF - 606 KB - 3 pages]
M. Martinot et al.

Progressive multifocal leukoencephalopathy (PML) is increasingly being reported in patients undergoing immunotherapy. We report a case of progressive multifocal leukoencephalopathy after treatment with nivolumab, a PD-1 blocker that is used to restore impaired T-cell responses in patients with cancer and infections. Data for 4 other cases were obtained from pharmacovigilance databases.

EID Martinot M, Ahle G, Petrosyan I, Martinez C, Gorun DM, Mohseni-Zadeh M, et al. Progressive Multifocal Leukoencephalopathy after Treatment with Nivolumab. Emerg Infect Dis. 2018;24(8):1594-1596. https://dx.doi.org/10.3201/eid2408.180460
AMA Martinot M, Ahle G, Petrosyan I, et al. Progressive Multifocal Leukoencephalopathy after Treatment with Nivolumab. Emerging Infectious Diseases. 2018;24(8):1594-1596. doi:10.3201/eid2408.180460.
APA Martinot, M., Ahle, G., Petrosyan, I., Martinez, C., Gorun, D. M., Mohseni-Zadeh, M....Tebacher-Alt, M. (2018). Progressive Multifocal Leukoencephalopathy after Treatment with Nivolumab. Emerging Infectious Diseases, 24(8), 1594-1596. https://dx.doi.org/10.3201/eid2408.180460.

Isolation of Candida auris from Ear of Otherwise Healthy Patient, Austria, 2018 [PDF - 319 KB - 2 pages]
S. Pekard-Amenitsch et al.

The emerging pathogen Candida auris is isolated mostly from hospitalized patients and often shows multidrug resistance. We report on the isolation of this yeast in Austria from an outpatient’s auditory canal. The isolate showed good susceptibility against antifungals except for echinocandins; the patient was treated successfully with topical administration of nystatin.

EID Pekard-Amenitsch S, Schriebl A, Posawetz W, Willinger B, Kölli B, Buzina W. Isolation of Candida auris from Ear of Otherwise Healthy Patient, Austria, 2018. Emerg Infect Dis. 2018;24(8):1596-1597. https://dx.doi.org/10.3201/eid2408.180495
AMA Pekard-Amenitsch S, Schriebl A, Posawetz W, et al. Isolation of Candida auris from Ear of Otherwise Healthy Patient, Austria, 2018. Emerging Infectious Diseases. 2018;24(8):1596-1597. doi:10.3201/eid2408.180495.
APA Pekard-Amenitsch, S., Schriebl, A., Posawetz, W., Willinger, B., Kölli, B., & Buzina, W. (2018). Isolation of Candida auris from Ear of Otherwise Healthy Patient, Austria, 2018. Emerging Infectious Diseases, 24(8), 1596-1597. https://dx.doi.org/10.3201/eid2408.180495.

Phylogeny of Yellow Fever Virus, Uganda, 2016 [PDF - 384 KB - 2 pages]
H. R. Hughes et al.

In April 2016, a yellow fever outbreak was detected in Uganda. Removal of contaminating ribosomal RNA in a clinical sample improved the sensitivity of next-generation sequencing. Molecular analyses determined the Uganda yellow fever outbreak was distinct from the concurrent yellow fever outbreak in Angola, improving our understanding of yellow fever epidemiology.

EID Hughes HR, Kayiwa J, Mossel EC, Lutwama J, Staples J, Lambert AJ. Phylogeny of Yellow Fever Virus, Uganda, 2016. Emerg Infect Dis. 2018;24(8):1598-1599. https://dx.doi.org/10.3201/eid2408.180588
AMA Hughes HR, Kayiwa J, Mossel EC, et al. Phylogeny of Yellow Fever Virus, Uganda, 2016. Emerging Infectious Diseases. 2018;24(8):1598-1599. doi:10.3201/eid2408.180588.
APA Hughes, H. R., Kayiwa, J., Mossel, E. C., Lutwama, J., Staples, J., & Lambert, A. J. (2018). Phylogeny of Yellow Fever Virus, Uganda, 2016. Emerging Infectious Diseases, 24(8), 1598-1599. https://dx.doi.org/10.3201/eid2408.180588.
Letters

Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK [PDF - 337 KB - 2 pages]
J. Depaquit et al.
EID Depaquit J, Kaltenbach ML, Gay F. Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerg Infect Dis. 2018;24(8):1599-1600. https://dx.doi.org/10.3201/eid2408.172147
AMA Depaquit J, Kaltenbach ML, Gay F. Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerging Infectious Diseases. 2018;24(8):1599-1600. doi:10.3201/eid2408.172147.
APA Depaquit, J., Kaltenbach, M. L., & Gay, F. (2018). Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerging Infectious Diseases, 24(8), 1599-1600. https://dx.doi.org/10.3201/eid2408.172147.

Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK [PDF - 655 KB - 2 pages]
S. Leelayoova et al.
EID Leelayoova S, Siripattanapipong S, Mungthin M. Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerg Infect Dis. 2018;24(8):1600-1601. https://dx.doi.org/10.3201/eid2408.180192
AMA Leelayoova S, Siripattanapipong S, Mungthin M. Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerging Infectious Diseases. 2018;24(8):1600-1601. doi:10.3201/eid2408.180192.
APA Leelayoova, S., Siripattanapipong, S., & Mungthin, M. (2018). Visceral Leishmaniasis in Traveler to Guyana Caused by Leishmania siamensis, London, UK. Emerging Infectious Diseases, 24(8), 1600-1601. https://dx.doi.org/10.3201/eid2408.180192.
About the Cover

A Worm’s Eye View [PDF - 2.42 MB - 2 pages]
B. Breedlove and R. Bradbury
EID Breedlove B, Bradbury R. A Worm’s Eye View. Emerg Infect Dis. 2018;24(8):1602-1603. https://dx.doi.org/10.3201/eid2408.ac2408
AMA Breedlove B, Bradbury R. A Worm’s Eye View. Emerging Infectious Diseases. 2018;24(8):1602-1603. doi:10.3201/eid2408.ac2408.
APA Breedlove, B., & Bradbury, R. (2018). A Worm’s Eye View. Emerging Infectious Diseases, 24(8), 1602-1603. https://dx.doi.org/10.3201/eid2408.ac2408.
Etymologia

Etymologia: Antimony [PDF - 593 KB - 1 page]
M. D. Walker
EID Walker MD. Etymologia: Antimony. Emerg Infect Dis. 2018;24(8):1601. https://dx.doi.org/10.3201/eid2408.et2408
AMA Walker MD. Etymologia: Antimony. Emerging Infectious Diseases. 2018;24(8):1601. doi:10.3201/eid2408.et2408.
APA Walker, M. D. (2018). Etymologia: Antimony. Emerging Infectious Diseases, 24(8), 1601. https://dx.doi.org/10.3201/eid2408.et2408.
Online Reports

Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings [PDF - 2.72 MB - 13 pages]
D. W. Denning et al.

Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.

Page created: July 18, 2018
Page updated: July 18, 2018
Page reviewed: July 18, 2018
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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