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Issue Cover for Volume 5, Number 2—April 1999

Volume 5, Number 2—April 1999

[PDF - 4.18 MB - 130 pages]

Perspective

International Editors:Emerging Infectious Diseases—United Kingdom [PDF - 173 KB - 6 pages]
D. Walford and N. Noah
EID Walford D, Noah N. International Editors:Emerging Infectious Diseases—United Kingdom. Emerg Infect Dis. 1999;5(2):189-194. https://dx.doi.org/10.3201/eid0502.990201
AMA Walford D, Noah N. International Editors:Emerging Infectious Diseases—United Kingdom. Emerging Infectious Diseases. 1999;5(2):189-194. doi:10.3201/eid0502.990201.
APA Walford, D., & Noah, N. (1999). International Editors:Emerging Infectious Diseases—United Kingdom. Emerging Infectious Diseases, 5(2), 189-194. https://dx.doi.org/10.3201/eid0502.990201.

The Next Influenza Pandemic: Lessons from Hong Kong, 1997 [PDF - 68 KB - 9 pages]
R. Snacken et al.

The 1997 Hong Kong outbreak of an avian influenzalike virus, with 18 proven human cases, many severe or fatal, highlighted the challenges of novel influenza viruses. Lessons from this episode can improve international and national planning for influenza pandemics in seven areas: expanded international commitment to first responses to pandemic threats; surveillance for influenza in key densely populated areas with large live-animal markets; new, economical diagnostic tests not based on eggs; contingency procedures for diagnostic work with highly pathogenic viruses where biocontainment laboratories do not exist; ability of health facilities in developing nations to communicate electronically, nationally and internationally; licenses for new vaccine production methods; and improved equity in supply of pharmaceutical products, as well as availability of basic health services, during a global influenza crisis. The Hong Kong epidemic also underscores the need for national committees and country-specific pandemic plans.

EID Snacken R, Kendal AP, Haaheim LR, Wood JM. The Next Influenza Pandemic: Lessons from Hong Kong, 1997. Emerg Infect Dis. 1999;5(2):195-203. https://dx.doi.org/10.3201/eid0502.990202
AMA Snacken R, Kendal AP, Haaheim LR, et al. The Next Influenza Pandemic: Lessons from Hong Kong, 1997. Emerging Infectious Diseases. 1999;5(2):195-203. doi:10.3201/eid0502.990202.
APA Snacken, R., Kendal, A. P., Haaheim, L. R., & Wood, J. M. (1999). The Next Influenza Pandemic: Lessons from Hong Kong, 1997. Emerging Infectious Diseases, 5(2), 195-203. https://dx.doi.org/10.3201/eid0502.990202.

Disparity in the Natural Cycles of Borrelia burgdorferi and the Agent of Human Granulocytic Ehrlichiosis [PDF - 60 KB - 5 pages]
M. L. Levin et al.

We studied the prevalence of Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis (HGE) among questing nymphal and adult Ixodes scapularis ticks of the same generation and the infectivity of wild white-footed mice for ticks feeding on them. The prevalence of B. burgdorferi infection in host-seeking ticks increased less than twofold from nymphal (31% to 33%) to adult (52% to 56%) stage, and 52% of white-footed mice were infected. Prevalence of the agent of HGE increased 4.5- to 10.6-fold from nymphal (1.5% to 1.8%) to adult stage (7.6% to 19.0%), while only 18% of mice were infectious to ticks. B. burgdorferi infection was more common in mouse-fed ticks than in ticks collected from vegetation, whereas the agent of HGE was half as common in mouse-fed ticks as in ticks collected from vegetation. The different prevalence in nature of these pathogens in ticks suggests that their maintenance cycles are also different.

EID Levin ML, des Vignes F, Fish D. Disparity in the Natural Cycles of Borrelia burgdorferi and the Agent of Human Granulocytic Ehrlichiosis. Emerg Infect Dis. 1999;5(2):204-208. https://dx.doi.org/10.3201/eid0502.990203
AMA Levin ML, des Vignes F, Fish D. Disparity in the Natural Cycles of Borrelia burgdorferi and the Agent of Human Granulocytic Ehrlichiosis. Emerging Infectious Diseases. 1999;5(2):204-208. doi:10.3201/eid0502.990203.
APA Levin, M. L., des Vignes, F., & Fish, D. (1999). Disparity in the Natural Cycles of Borrelia burgdorferi and the Agent of Human Granulocytic Ehrlichiosis. Emerging Infectious Diseases, 5(2), 204-208. https://dx.doi.org/10.3201/eid0502.990203.
Synopses

Malaria Reemergence in the Peruvian Amazon Region [PDF - 325 KB - 7 pages]
J. A. Guarda et al.

Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate than P. vivax infection in the last 3 years, became the dominant Plasmodium infection in the highest transmission areas in the 1997 rainy season. The vector Anopheles darlingi has also increased during this epidemic in Loreto. Moreover, chloroquine and pyrimethamine-sulfadoxine drug-resistant P. falciparum strains have emerged, which require development of efficacious focal drug treatment schemes.

EID Guarda JA, Asayag CR, Witzig R. Malaria Reemergence in the Peruvian Amazon Region. Emerg Infect Dis. 1999;5(2):209-215. https://dx.doi.org/10.3201/eid0502.990204
AMA Guarda JA, Asayag CR, Witzig R. Malaria Reemergence in the Peruvian Amazon Region. Emerging Infectious Diseases. 1999;5(2):209-215. doi:10.3201/eid0502.990204.
APA Guarda, J. A., Asayag, C. R., & Witzig, R. (1999). Malaria Reemergence in the Peruvian Amazon Region. Emerging Infectious Diseases, 5(2), 209-215. https://dx.doi.org/10.3201/eid0502.990204.

Enteropathogenic E. coli, Salmonella, and Shigella: Masters of Host Cell Cytoskeletal Exploitation [PDF - 808 KB - 8 pages]
D. L. Goosney et al.

Bacterial pathogens have evolved numerous strategies to exploit their host's cellular processes so that they can survive and persist. Often, a bacterium must adhere very tightly to the cells and mediate its effects extracellularly, or it must find a way to invade the host's cells and survive intracellularly. In either case, the pathogen hijacks the host's cytoskeleton. The cytoskeleton provides a flexible framework for the cell and is involved in mediating numerous cellular functions, from cell shape and structure to programmed cell death. Altering the host cytoskeleton is crucial for mediating pathogen adherence, invasion, and intracellular locomotion. We highlight recent advances in the pathogenesis of enteropathogenic Escherichia coli, Salmonella Typhimurium, and Shigella flexneri. Each illustrates how bacterial pathogens can exert dramatic effects on the host cytoskeleton.

EID Goosney DL, Knoechel DG, Finlay BB. Enteropathogenic E. coli, Salmonella, and Shigella: Masters of Host Cell Cytoskeletal Exploitation. Emerg Infect Dis. 1999;5(2):216-223. https://dx.doi.org/10.3201/eid0502.990205
AMA Goosney DL, Knoechel DG, Finlay BB. Enteropathogenic E. coli, Salmonella, and Shigella: Masters of Host Cell Cytoskeletal Exploitation. Emerging Infectious Diseases. 1999;5(2):216-223. doi:10.3201/eid0502.990205.
APA Goosney, D. L., Knoechel, D. G., & Finlay, B. B. (1999). Enteropathogenic E. coli, Salmonella, and Shigella: Masters of Host Cell Cytoskeletal Exploitation. Emerging Infectious Diseases, 5(2), 216-223. https://dx.doi.org/10.3201/eid0502.990205.

Bacterial Toxins: Friends or Foes? [PDF - 717 KB - 11 pages]
C. K. Schmitt et al.

Many emerging and reemerging bacterial pathogens synthesize toxins that serve as primary virulence factors. We highlight seven bacterial toxins produced by well-established or newly emergent pathogenic microbes. These toxins, which affect eukaryotic cells by a variety of means, include Staphylococcus aureus α-toxin, Shiga toxin, cytotoxic necrotizing factor type 1, Escherichia coli heat-stable toxin, botulinum and tetanus neurotoxins, and S. aureus toxic-shock syndrome toxin. For each, we discuss the information available on its synthesis and structure, mode of action, and contribution to virulence. We also review the role certain toxins have played in unraveling signal pathways in eukaryotic cells and summarize the beneficial uses of toxins and toxoids. Our intent is to illustrate the importance of the analysis of bacterial toxins to both basic and applied sciences.

EID Schmitt CK, Meysick KC, O'Brien AD. Bacterial Toxins: Friends or Foes?. Emerg Infect Dis. 1999;5(2):224-234. https://dx.doi.org/10.3201/eid0502.990206
AMA Schmitt CK, Meysick KC, O'Brien AD. Bacterial Toxins: Friends or Foes?. Emerging Infectious Diseases. 1999;5(2):224-234. doi:10.3201/eid0502.990206.
APA Schmitt, C. K., Meysick, K. C., & O'Brien, A. D. (1999). Bacterial Toxins: Friends or Foes?. Emerging Infectious Diseases, 5(2), 224-234. https://dx.doi.org/10.3201/eid0502.990206.

Clonal Differences among Erythromycin-Resistant Streptococcus pyogenes in Spain
E. Perez-Trallero et al.

The aim of this study was to determine whether the high levels of erythromycin resistance in Streptococcus pyogenes found in Spain are due to the introduction and spread of one or more clones. Phenotypic and genotypic techniques were used to characterize all erythromycin-resistant S. pyogenes (ErR) isolated in Gipuzkoa, Spain, in the last 10 years and 128 ErR isolated in Vitoria and Madrid during 1996. Of 437 ErR, 97% had the M phenotype; all 283 of the strains studied had the mefA determinant of resistance. After biotyping, T serotyping, emm typing, and genotyping, four major clones were detected. Clones B (biotype I, type T4, emm4, pulsed-field gel electrophoresis [PFGE] II) and D (biotype V, type T8.25, emm75, PFGE IV) comprised 78.8% of all ErR. The resistance of S. pyogenes to erythromycin was mainly due to an efflux mechanism of resistance (M phenotype); few clones were responsible for it.

EID Perez-Trallero E, Marimón JM, Montes M, Orden B, de Pablos M. Clonal Differences among Erythromycin-Resistant Streptococcus pyogenes in Spain. Emerg Infect Dis. 1999;5(2):235-240. https://dx.doi.org/10.3201/eid0502.990207
AMA Perez-Trallero E, Marimón JM, Montes M, et al. Clonal Differences among Erythromycin-Resistant Streptococcus pyogenes in Spain. Emerging Infectious Diseases. 1999;5(2):235-240. doi:10.3201/eid0502.990207.
APA Perez-Trallero, E., Marimón, J. M., Montes, M., Orden, B., & de Pablos, M. (1999). Clonal Differences among Erythromycin-Resistant Streptococcus pyogenes in Spain. Emerging Infectious Diseases, 5(2), 235-240. https://dx.doi.org/10.3201/eid0502.990207.

Air Evacuation under High-Level Biosafety Containment: The Aeromedical Isolation Team [PDF - 227 KB - 6 pages]
G. W. Christopher and E. M. Eitzen

Military contingency operations in tropical environments and potential use of biological weapons by adversaries may place troops at risk for potentially lethal contagious infections (e.g., viral hemorrhagic fevers, plague, and zoonotic poxvirus infections). Diagnosis and treatment of such infections would be expedited by evacuating a limited number of patients to a facility with containment laboratories. To safely evacuate such patients by military aircraft and minimize the risk for transmission to air crews, caregivers, and civilians, the U.S. Army Medical Research Institute of Infectious Diseases maintains an aeromedical isolation team. This rapid response team, which has worldwide airlift capability designed to evacuate and manage patients under high-level containment, also offers a portable containment laboratory, limited environmental decontamination, and specialized consultative expertise. This article also examines technical aspects of the team's equipment, training, capabilities, and deployments.

EID Christopher GW, Eitzen EM. Air Evacuation under High-Level Biosafety Containment: The Aeromedical Isolation Team. Emerg Infect Dis. 1999;5(2):241-246. https://dx.doi.org/10.3201/eid0502.990208
AMA Christopher GW, Eitzen EM. Air Evacuation under High-Level Biosafety Containment: The Aeromedical Isolation Team. Emerging Infectious Diseases. 1999;5(2):241-246. doi:10.3201/eid0502.990208.
APA Christopher, G. W., & Eitzen, E. M. (1999). Air Evacuation under High-Level Biosafety Containment: The Aeromedical Isolation Team. Emerging Infectious Diseases, 5(2), 241-246. https://dx.doi.org/10.3201/eid0502.990208.

emm Typing and Validation of Provisional M Types for Group A Streptococci [PDF - 77 KB - 7 pages]
R. Facklam et al.

This report discusses the following issues related to typing of group A streptococci (GAS): The development and use of the 5' emm variable region sequencing (emm typing) in relation to the existing serologic typing system; the designation of emm types in relation to M types; a system for validation of new emm types; criteria for validation of provisional M types to new M-types; a list of reference type cultures for each of the M-type or emm-type strains of GAS; the results of the first culture exchange program for a quality control testing system among the national and World Health Organization collaborating centers for streptococci; and dissemination of new approaches to typing of GAS to the international streptococcal community.

EID Facklam R, Beall B, Efstratiou A, Fischetti V, Johnson D, Kaplan E, et al. emm Typing and Validation of Provisional M Types for Group A Streptococci. Emerg Infect Dis. 1999;5(2):247-253. https://dx.doi.org/10.3201/eid0502.990209
AMA Facklam R, Beall B, Efstratiou A, et al. emm Typing and Validation of Provisional M Types for Group A Streptococci. Emerging Infectious Diseases. 1999;5(2):247-253. doi:10.3201/eid0502.990209.
APA Facklam, R., Beall, B., Efstratiou, A., Fischetti, V., Johnson, D., Kaplan, E....Tyrrell, G. (1999). emm Typing and Validation of Provisional M Types for Group A Streptococci. Emerging Infectious Diseases, 5(2), 247-253. https://dx.doi.org/10.3201/eid0502.990209.
Research

Rapid Molecular Genetic Subtyping of Serotype M1 Group A Streptococcus Strains [PDF - 258 KB - 10 pages]
N. Hoe et al.

Serotype M1 group A Streptococcus, the most common cause of invasive disease in many case series, generally have resisted extensive molecular subtyping by standard techniques (e.g., multilocus enzyme electrophoresis, pulsed-field gel electrophoresis). We used automated sequencing of the sic gene encoding streptococcal inhibitor of complement and of a region of the chromosome with direct repeat sequences to unambiguously differentiate 30 M1 isolates recovered from 28 patients in Texas with invasive disease episodes temporally clustered and thought to represent an outbreak. Sequencing of the emm gene was less useful for M1 strain differentiation, and restriction fragment length polymorphism analysis with IS1548 or IS1562 as Southern hybridization probes did not provide epidemiologically useful subtyping information. Sequence polymorphism in the direct repeat region of the chromosome and IS1548 profiling data support the hypothesis that M1 organisms have two main evolutionary lineages marked by the presence or absence of the speA2 allele encoding streptococcal pyrogenic exotoxin A2.

EID Hoe N, Nakashima K, Grigsby D, Pan X, Dou SJ, Naidich S, et al. Rapid Molecular Genetic Subtyping of Serotype M1 Group A Streptococcus Strains. Emerg Infect Dis. 1999;5(2):254-263. https://dx.doi.org/10.3201/eid0502.990210
AMA Hoe N, Nakashima K, Grigsby D, et al. Rapid Molecular Genetic Subtyping of Serotype M1 Group A Streptococcus Strains. Emerging Infectious Diseases. 1999;5(2):254-263. doi:10.3201/eid0502.990210.
APA Hoe, N., Nakashima, K., Grigsby, D., Pan, X., Dou, S. J., Naidich, S....Musser, J. M. (1999). Rapid Molecular Genetic Subtyping of Serotype M1 Group A Streptococcus Strains. Emerging Infectious Diseases, 5(2), 254-263. https://dx.doi.org/10.3201/eid0502.990210.
Dispatches

Gnathostomosis, an Emerging Foodborne Zoonotic Disease in Acapulco, Mexico [PDF - 53 KB - 3 pages]
N. Rojas-Molina et al.

Between 1993 and 1997, 98 gnathostomosis cases were clinically identified in Acapulco, Mexico. Intermittent cutaneous migratory swellings were the commonest manifestation. Larvae were identified in 26 cases, while in 72, final diagnosis was made on the basis of epidemiologic data, food habits, and positive enzyme-linked immunosorbent assay and Western blot results.

EID Rojas-Molina N, Pedraza-Sanchez S, Torres-Bibiano B, Meza-Martinez H, Escobar-Gutierrez A. Gnathostomosis, an Emerging Foodborne Zoonotic Disease in Acapulco, Mexico. Emerg Infect Dis. 1999;5(2):264-266. https://dx.doi.org/10.3201/eid0502.990211
AMA Rojas-Molina N, Pedraza-Sanchez S, Torres-Bibiano B, et al. Gnathostomosis, an Emerging Foodborne Zoonotic Disease in Acapulco, Mexico. Emerging Infectious Diseases. 1999;5(2):264-266. doi:10.3201/eid0502.990211.
APA Rojas-Molina, N., Pedraza-Sanchez, S., Torres-Bibiano, B., Meza-Martinez, H., & Escobar-Gutierrez, A. (1999). Gnathostomosis, an Emerging Foodborne Zoonotic Disease in Acapulco, Mexico. Emerging Infectious Diseases, 5(2), 264-266. https://dx.doi.org/10.3201/eid0502.990211.

Acute Hemorrhagic Conjunctivitis Due to Enterovirus 70 in India [PDF - 86 KB - 3 pages]
R. Maitreyi et al.

An outbreak of acute hemorrhagic conjunctivitis occurred in Delhi, India, during August and September 1996. The etiologic agent was confirmed as enterovirus type 70 by a modified centrifugation-enhanced culture method followed by immunofluorescence and neutralization tests. After nearly a decade, this virus is reemerging as a cause of acute hemorrhagic conjunctivitis in India.

EID Maitreyi R, Dar L, Muthukumar A, Vajpayee M, Vajpayee R, Seth P, et al. Acute Hemorrhagic Conjunctivitis Due to Enterovirus 70 in India. Emerg Infect Dis. 1999;5(2):267-269. https://dx.doi.org/10.3201/eid0502.990212
AMA Maitreyi R, Dar L, Muthukumar A, et al. Acute Hemorrhagic Conjunctivitis Due to Enterovirus 70 in India. Emerging Infectious Diseases. 1999;5(2):267-269. doi:10.3201/eid0502.990212.
APA Maitreyi, R., Dar, L., Muthukumar, A., Vajpayee, M., Vajpayee, R., Seth, P....Broor, S. (1999). Acute Hemorrhagic Conjunctivitis Due to Enterovirus 70 in India. Emerging Infectious Diseases, 5(2), 267-269. https://dx.doi.org/10.3201/eid0502.990212.

Mycobacterium sp. as a Possible Cause of Hypersensitivity Pneumonitis in Machine Workers [PDF - 70 KB - 5 pages]
B. G. Shelton et al.

Hypersensitivity pneumonitis (HP) in workers exposed to metal removal fluids (MRFs) is increasing. This study supports the hypothesis that aerosolized mycobacteria colonizing the MRFs likely cause the disease. Three case studies of HP outbreaks among metal workers showed potentially high exposures to a rare and newly proposed Mycobacterium species. Retrospective review of samples submitted to our laboratory showed an association between presence of mycobacteria and HP.

EID Shelton BG, Flanders WD, Morris GK. Mycobacterium sp. as a Possible Cause of Hypersensitivity Pneumonitis in Machine Workers. Emerg Infect Dis. 1999;5(2):270-273. https://dx.doi.org/10.3201/eid0502.990213
AMA Shelton BG, Flanders WD, Morris GK. Mycobacterium sp. as a Possible Cause of Hypersensitivity Pneumonitis in Machine Workers. Emerging Infectious Diseases. 1999;5(2):270-273. doi:10.3201/eid0502.990213.
APA Shelton, B. G., Flanders, W. D., & Morris, G. K. (1999). Mycobacterium sp. as a Possible Cause of Hypersensitivity Pneumonitis in Machine Workers. Emerging Infectious Diseases, 5(2), 270-273. https://dx.doi.org/10.3201/eid0502.990213.

Evaluating Diagnosis and Treatment of Oral and Esophageal Candidiasis in Ugandan AIDS Patients [PDF - 83 KB - 4 pages]
M. Ravera et al.

A randomized cross-over clinical and endoscopic evaluation of 85 Ugandan patients showed that esophageal candidiasis in AIDS patients with oral candidiasis could be managed without endoscopy and biopsies. Oral lesions, especially when accompanied by esophageal symptoms, were sufficient for diagnosis. Miconazole was more effective than nystatin in treating esophageal candidiasis and could be a valid alternative to more expensive azolic drugs in developing countries.

EID Ravera M, Reggiori A, Agliata AM, Rocco RP. Evaluating Diagnosis and Treatment of Oral and Esophageal Candidiasis in Ugandan AIDS Patients. Emerg Infect Dis. 1999;5(2):274-277. https://dx.doi.org/10.3201/eid0502.990214
AMA Ravera M, Reggiori A, Agliata AM, et al. Evaluating Diagnosis and Treatment of Oral and Esophageal Candidiasis in Ugandan AIDS Patients. Emerging Infectious Diseases. 1999;5(2):274-277. doi:10.3201/eid0502.990214.
APA Ravera, M., Reggiori, A., Agliata, A. M., & Rocco, R. P. (1999). Evaluating Diagnosis and Treatment of Oral and Esophageal Candidiasis in Ugandan AIDS Patients. Emerging Infectious Diseases, 5(2), 274-277. https://dx.doi.org/10.3201/eid0502.990214.

Neospora caninum Infection and Repeated Abortions in Humans [PDF - 162 KB - 3 pages]
E. Petersen et al.

To determine whether Neospora caninum, a parasite known to cause repeated abortions and stillbirths in cattle, also causes repeated abortions in humans, we retrospectively examined serum samples of 76 women with a history of abortions for evidence of N. caninum infection. No antibodies to the parasite were detected by enzyme-linked immunosorbent assay, immunofluorescence assay, or Western blot.

EID Petersen E, Lebech M, Jensen L, Lind P, Rask M, Bagger P, et al. Neospora caninum Infection and Repeated Abortions in Humans. Emerg Infect Dis. 1999;5(2):278-280. https://dx.doi.org/10.3201/eid0502.990215
AMA Petersen E, Lebech M, Jensen L, et al. Neospora caninum Infection and Repeated Abortions in Humans. Emerging Infectious Diseases. 1999;5(2):278-280. doi:10.3201/eid0502.990215.
APA Petersen, E., Lebech, M., Jensen, L., Lind, P., Rask, M., Bagger, P....Uggla, A. (1999). Neospora caninum Infection and Repeated Abortions in Humans. Emerging Infectious Diseases, 5(2), 278-280. https://dx.doi.org/10.3201/eid0502.990215.

Lack of Association between First Myocardial Infarction and Past Use of Erythromycin, Tetracycline, or Doxycycline [PDF - 63 KB - 4 pages]
L. A. Jackson et al.

To evaluate the association of prior treatment with antibiotics active against Chlamydia pneumoniae with the risk for incident myocardial infarction, we conducted a population-based case-control study. We found that use of erythromycin, tetracycline, or doxycycline during the previous 5 years was not associated with risk for first myocardial infarction. These results suggest little or no association between the use of these antibiotics and the risk for first myocardial infarction in the primary prevention setting.

EID Jackson LA, Smith NL, Heckbert SR, Grayston JT, Siscovick DS, Psaty BM. Lack of Association between First Myocardial Infarction and Past Use of Erythromycin, Tetracycline, or Doxycycline. Emerg Infect Dis. 1999;5(2):281-284. https://dx.doi.org/10.3201/eid0502.990216
AMA Jackson LA, Smith NL, Heckbert SR, et al. Lack of Association between First Myocardial Infarction and Past Use of Erythromycin, Tetracycline, or Doxycycline. Emerging Infectious Diseases. 1999;5(2):281-284. doi:10.3201/eid0502.990216.
APA Jackson, L. A., Smith, N. L., Heckbert, S. R., Grayston, J. T., Siscovick, D. S., & Psaty, B. M. (1999). Lack of Association between First Myocardial Infarction and Past Use of Erythromycin, Tetracycline, or Doxycycline. Emerging Infectious Diseases, 5(2), 281-284. https://dx.doi.org/10.3201/eid0502.990216.

An Epidemic of Bloody Diarrhea: Escherichia coli O157 Emerging in Cameroon? [PDF - 752 KB - 6 pages]
P. Cunin et al.

Between November 1997 and April 20, 1998, bloody diarrhea sickened 298 persons in Cameroon. Laboratory investigation of the epidemic (case-fatality rate, 16.4%) documented amoebiasis in one of three patients and three types of pathogens: multidrug-resistant Shigella dysenteriae type 1, S. boydii, and enterohemorrhagic Escherichia coli. We report the first isolation of E. coli O157:H7 in Cameroon and the second series of cases in the Central African region.

EID Cunin P, Tedjouka E, Germani Y, Ncharre C, Bercion R, Morvan J, et al. An Epidemic of Bloody Diarrhea: Escherichia coli O157 Emerging in Cameroon?. Emerg Infect Dis. 1999;5(2):285-290. https://dx.doi.org/10.3201/eid0502.990217
AMA Cunin P, Tedjouka E, Germani Y, et al. An Epidemic of Bloody Diarrhea: Escherichia coli O157 Emerging in Cameroon?. Emerging Infectious Diseases. 1999;5(2):285-290. doi:10.3201/eid0502.990217.
APA Cunin, P., Tedjouka, E., Germani, Y., Ncharre, C., Bercion, R., Morvan, J....Martin, P. (1999). An Epidemic of Bloody Diarrhea: Escherichia coli O157 Emerging in Cameroon?. Emerging Infectious Diseases, 5(2), 285-290. https://dx.doi.org/10.3201/eid0502.990217.

Genospecies Diversity of Lyme Disease Spirochetes in Rodent Reservoirs [PDF - 71 KB - 6 pages]
D. Richter et al.

To determine whether particular Borrelia burgdorferi s.l. genospecies associate solely with rodent reservoir hosts, we compared the genospecies prevalence in questing nymphal Ixodes ticks with that in xenodiagnostic ticks that had fed as larvae on rodents captured in the same site. No genospecies was more prevalent in rodent-fed ticks than in questing ticks. The three main spirochete genospecies, therefore, share common rodent hosts.

EID Richter D, Endepols S, Ohlenbusch A, Eiffert H, Spielman A, Matuschka F. Genospecies Diversity of Lyme Disease Spirochetes in Rodent Reservoirs. Emerg Infect Dis. 1999;5(2):291-296. https://dx.doi.org/10.3201/eid0502.990218
AMA Richter D, Endepols S, Ohlenbusch A, et al. Genospecies Diversity of Lyme Disease Spirochetes in Rodent Reservoirs. Emerging Infectious Diseases. 1999;5(2):291-296. doi:10.3201/eid0502.990218.
APA Richter, D., Endepols, S., Ohlenbusch, A., Eiffert, H., Spielman, A., & Matuschka, F. (1999). Genospecies Diversity of Lyme Disease Spirochetes in Rodent Reservoirs. Emerging Infectious Diseases, 5(2), 291-296. https://dx.doi.org/10.3201/eid0502.990218.
Commentaries

Preparing for Pandemic Influenza: The Need for Enhanced Surveillance [PDF - 50 KB - 3 pages]
K. F. Gensheimer et al.
EID Gensheimer KF, Fukuda K, Brammer L, Cox NJ, Patriarca PA, Strikas RA. Preparing for Pandemic Influenza: The Need for Enhanced Surveillance. Emerg Infect Dis. 1999;5(2):297-299. https://dx.doi.org/10.3201/eid0502.990219
AMA Gensheimer KF, Fukuda K, Brammer L, et al. Preparing for Pandemic Influenza: The Need for Enhanced Surveillance. Emerging Infectious Diseases. 1999;5(2):297-299. doi:10.3201/eid0502.990219.
APA Gensheimer, K. F., Fukuda, K., Brammer, L., Cox, N. J., Patriarca, P. A., & Strikas, R. A. (1999). Preparing for Pandemic Influenza: The Need for Enhanced Surveillance. Emerging Infectious Diseases, 5(2), 297-299. https://dx.doi.org/10.3201/eid0502.990219.
Letters

An Outbreak of Gastroenteritis in Japan due to Escherichia coli O166 [PDF - 57 KB - 1 page]
Y. Nishikawa et al.
EID Nishikawa Y, Ogasawara J, Helander A, Haruki K. An Outbreak of Gastroenteritis in Japan due to Escherichia coli O166. Emerg Infect Dis. 1999;5(2):300. https://dx.doi.org/10.3201/eid0502.990220
AMA Nishikawa Y, Ogasawara J, Helander A, et al. An Outbreak of Gastroenteritis in Japan due to Escherichia coli O166. Emerging Infectious Diseases. 1999;5(2):300. doi:10.3201/eid0502.990220.
APA Nishikawa, Y., Ogasawara, J., Helander, A., & Haruki, K. (1999). An Outbreak of Gastroenteritis in Japan due to Escherichia coli O166. Emerging Infectious Diseases, 5(2), 300. https://dx.doi.org/10.3201/eid0502.990220.

Vibrio cholerae Outbreak in Italy [PDF - 62 KB - 1 page]
L. C. d'Oro et al.
EID d'Oro LC, Merlo E, Ariano E, Silvestri MG, Ceraminiello A, Negri E, et al. Vibrio cholerae Outbreak in Italy. Emerg Infect Dis. 1999;5(2):300-301. https://dx.doi.org/10.3201/eid0502.990221
AMA d'Oro LC, Merlo E, Ariano E, et al. Vibrio cholerae Outbreak in Italy. Emerging Infectious Diseases. 1999;5(2):300-301. doi:10.3201/eid0502.990221.
APA d'Oro, L. C., Merlo, E., Ariano, E., Silvestri, M. G., Ceraminiello, A., Negri, E....La Vecchia, C. (1999). Vibrio cholerae Outbreak in Italy. Emerging Infectious Diseases, 5(2), 300-301. https://dx.doi.org/10.3201/eid0502.990221.

Shiga Toxin–Producing Escherichia coli O157:H7 in Japan [PDF - 59 KB - 2 pages]
J. Terajima et al.
EID Terajima J, Izumiya H, Wada A, Tamura K, Watanabe H. Shiga Toxin–Producing Escherichia coli O157:H7 in Japan. Emerg Infect Dis. 1999;5(2):301-302. https://dx.doi.org/10.3201/eid0502.990222
AMA Terajima J, Izumiya H, Wada A, et al. Shiga Toxin–Producing Escherichia coli O157:H7 in Japan. Emerging Infectious Diseases. 1999;5(2):301-302. doi:10.3201/eid0502.990222.
APA Terajima, J., Izumiya, H., Wada, A., Tamura, K., & Watanabe, H. (1999). Shiga Toxin–Producing Escherichia coli O157:H7 in Japan. Emerging Infectious Diseases, 5(2), 301-302. https://dx.doi.org/10.3201/eid0502.990222.

Streptococcus pyogenes Erythromycin Resistance in Italy [PDF - 61 KB - 2 pages]
M. Bassetti et al.
EID Bassetti M, Mantero E, Gatti G, Di Biagio A, Dante B. Streptococcus pyogenes Erythromycin Resistance in Italy. Emerg Infect Dis. 1999;5(2):302-303. https://dx.doi.org/10.3201/eid0502.990223
AMA Bassetti M, Mantero E, Gatti G, et al. Streptococcus pyogenes Erythromycin Resistance in Italy. Emerging Infectious Diseases. 1999;5(2):302-303. doi:10.3201/eid0502.990223.
APA Bassetti, M., Mantero, E., Gatti, G., Di Biagio, A., & Dante, B. (1999). Streptococcus pyogenes Erythromycin Resistance in Italy. Emerging Infectious Diseases, 5(2), 302-303. https://dx.doi.org/10.3201/eid0502.990223.

Estimated Incidence of Clostridium difficile Infection [PDF - 61 KB - 2 pages]
F. Frost et al.
EID Frost F, Hurley JS, Petersen HV, Casciano RN. Estimated Incidence of Clostridium difficile Infection. Emerg Infect Dis. 1999;5(2):303-304. https://dx.doi.org/10.3201/eid0502.990224
AMA Frost F, Hurley JS, Petersen HV, et al. Estimated Incidence of Clostridium difficile Infection. Emerging Infectious Diseases. 1999;5(2):303-304. doi:10.3201/eid0502.990224.
APA Frost, F., Hurley, J. S., Petersen, H. V., & Casciano, R. N. (1999). Estimated Incidence of Clostridium difficile Infection. Emerging Infectious Diseases, 5(2), 303-304. https://dx.doi.org/10.3201/eid0502.990224.

Diphtheria in Eastern Nepal [PDF - 61 KB - 2 pages]
H. Srinivasa et al.
EID Srinivasa H, Parija S, Upadhyaya M. Diphtheria in Eastern Nepal. Emerg Infect Dis. 1999;5(2):304-305. https://dx.doi.org/10.3201/eid0502.990225
AMA Srinivasa H, Parija S, Upadhyaya M. Diphtheria in Eastern Nepal. Emerging Infectious Diseases. 1999;5(2):304-305. doi:10.3201/eid0502.990225.
APA Srinivasa, H., Parija, S., & Upadhyaya, M. (1999). Diphtheria in Eastern Nepal. Emerging Infectious Diseases, 5(2), 304-305. https://dx.doi.org/10.3201/eid0502.990225.

Commercial Use of Burkholderia cepacia [PDF - 61 KB - 2 pages]
J. J. LiPuma and E. Mahenthiralingam
EID LiPuma JJ, Mahenthiralingam E. Commercial Use of Burkholderia cepacia. Emerg Infect Dis. 1999;5(2):305-306. https://dx.doi.org/10.3201/eid0502.990226
AMA LiPuma JJ, Mahenthiralingam E. Commercial Use of Burkholderia cepacia. Emerging Infectious Diseases. 1999;5(2):305-306. doi:10.3201/eid0502.990226.
APA LiPuma, J. J., & Mahenthiralingam, E. (1999). Commercial Use of Burkholderia cepacia. Emerging Infectious Diseases, 5(2), 305-306. https://dx.doi.org/10.3201/eid0502.990226.

Human Rabies in Israel [PDF - 64 KB - 3 pages]
D. David et al.
EID David D, Rupprecht CE, Smith J, Samina I, Perl S, Stram Y. Human Rabies in Israel. Emerg Infect Dis. 1999;5(2):306-308. https://dx.doi.org/10.3201/eid0502.990227
AMA David D, Rupprecht CE, Smith J, et al. Human Rabies in Israel. Emerging Infectious Diseases. 1999;5(2):306-308. doi:10.3201/eid0502.990227.
APA David, D., Rupprecht, C. E., Smith, J., Samina, I., Perl, S., & Stram, Y. (1999). Human Rabies in Israel. Emerging Infectious Diseases, 5(2), 306-308. https://dx.doi.org/10.3201/eid0502.990227.

Emerging Infections and Disease Emergence [PDF - 59 KB - 2 pages]
M. E. Wilson
EID Wilson ME. Emerging Infections and Disease Emergence. Emerg Infect Dis. 1999;5(2):308-309. https://dx.doi.org/10.3201/eid0502.990228
AMA Wilson ME. Emerging Infections and Disease Emergence. Emerging Infectious Diseases. 1999;5(2):308-309. doi:10.3201/eid0502.990228.
APA Wilson, M. E. (1999). Emerging Infections and Disease Emergence. Emerging Infectious Diseases, 5(2), 308-309. https://dx.doi.org/10.3201/eid0502.990228.

Malaria Control in South America [PDF - 60 KB - 2 pages]
P. C. Matteson
EID Matteson PC. Malaria Control in South America. Emerg Infect Dis. 1999;5(2):309-310. https://dx.doi.org/10.3201/eid0502.990229
AMA Matteson PC. Malaria Control in South America. Emerging Infectious Diseases. 1999;5(2):309-310. doi:10.3201/eid0502.990229.
APA Matteson, P. C. (1999). Malaria Control in South America. Emerging Infectious Diseases, 5(2), 309-310. https://dx.doi.org/10.3201/eid0502.990229.

Malaria Control in South America— Response to P.C. Matteson [PDF - 62 KB - 2 pages]
D. R. Roberts and L. L. Laughlin
EID Roberts DR, Laughlin LL. Malaria Control in South America— Response to P.C. Matteson. Emerg Infect Dis. 1999;5(2):310-311. https://dx.doi.org/10.3201/eid0502.990230
AMA Roberts DR, Laughlin LL. Malaria Control in South America— Response to P.C. Matteson. Emerging Infectious Diseases. 1999;5(2):310-311. doi:10.3201/eid0502.990230.
APA Roberts, D. R., & Laughlin, L. L. (1999). Malaria Control in South America— Response to P.C. Matteson. Emerging Infectious Diseases, 5(2), 310-311. https://dx.doi.org/10.3201/eid0502.990230.

On the Etiology of Tropical Epidemic Neuropathies [PDF - 61 KB - 2 pages]
J. de la Fuente and M. P. Rodríguez
EID de la Fuente J, Rodríguez MP. On the Etiology of Tropical Epidemic Neuropathies. Emerg Infect Dis. 1999;5(2):311-312. https://dx.doi.org/10.3201/eid0502.990231
AMA de la Fuente J, Rodríguez MP. On the Etiology of Tropical Epidemic Neuropathies. Emerging Infectious Diseases. 1999;5(2):311-312. doi:10.3201/eid0502.990231.
APA de la Fuente, J., & Rodríguez, M. P. (1999). On the Etiology of Tropical Epidemic Neuropathies. Emerging Infectious Diseases, 5(2), 311-312. https://dx.doi.org/10.3201/eid0502.990231.

Risk for Ebola Virus Infection in Côte d'Ivoire [PDF - 49 KB - 2 pages]
O. Kunii et al.
EID Kunii O, Formenty P, Diarra-Nama J, Nahounou N. Risk for Ebola Virus Infection in Côte d'Ivoire. Emerg Infect Dis. 1999;5(2):312-313. https://dx.doi.org/10.3201/eid0502.990232
AMA Kunii O, Formenty P, Diarra-Nama J, et al. Risk for Ebola Virus Infection in Côte d'Ivoire. Emerging Infectious Diseases. 1999;5(2):312-313. doi:10.3201/eid0502.990232.
APA Kunii, O., Formenty, P., Diarra-Nama, J., & Nahounou, N. (1999). Risk for Ebola Virus Infection in Côte d'Ivoire. Emerging Infectious Diseases, 5(2), 312-313. https://dx.doi.org/10.3201/eid0502.990232.
About the Cover

The Louse Hunt
Corrections

Erratum Vol. 5, No. 1 [PDF - 36 KB - 1 page]
EID Erratum Vol. 5, No. 1. Emerg Infect Dis. 1999;5(2):314. https://dx.doi.org/10.3201/eid0502.c10502
AMA Erratum Vol. 5, No. 1. Emerging Infectious Diseases. 1999;5(2):314. doi:10.3201/eid0502.c10502.
APA (1999). Erratum Vol. 5, No. 1. Emerging Infectious Diseases, 5(2), 314. https://dx.doi.org/10.3201/eid0502.c10502.
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