Emerging Infectious Diseases journal

Synopses

• Medscape CME Activity
  Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA PDF Version [PDF - 965 KB - 8 pages]
  R. Fitzhenry et al.
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  Surveillance will determine whether a new law regulating cooling towers reduces the incidence of Legionnaires’ disease.

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  The incidence of Legionnaires’ disease in the United States has been increasing since 2000. Outbreaks and clusters are associated with decorative, recreational, domestic, and industrial water systems, with the largest outbreaks being caused by cooling towers. Since 2006, 6 community-associated Legionnaires’ disease outbreaks have occurred in New York City, resulting in 213 cases and 18 deaths. Three outbreaks occurred in 2015, including the largest on record (138 cases). Three outbreaks were linked to cooling towers by molecular comparison of human and environmental Legionella isolates, and the sources for the other 3 outbreaks were undetermined. The evolution of investigation methods and lessons learned from these outbreaks prompted enactment of a new comprehensive law governing the operation and maintenance of New York City cooling towers. Ongoing surveillance and program evaluation will determine if enforcement of the new cooling tower law reduces Legionnaires’ disease incidence in New York City.

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  EID	Fitzhenry R, Weiss D, Cimini D, Balter S, Boyd C, Alleyne L, et al. Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerg Infect Dis. 2017;23(11):1776. https://dx.doi.org/10.3201/eid2311.161584
  AMA	Fitzhenry R, Weiss D, Cimini D, et al. Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerging Infectious Diseases. 2017;23(11):1776. doi:10.3201/eid2311.161584.
  APA	Fitzhenry, R., Weiss, D., Cimini, D., Balter, S., Boyd, C., Alleyne, L....Varma, J. K. (2017). Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerging Infectious Diseases, 23(11), 1776. https://dx.doi.org/10.3201/eid2311.161584.

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• Medscape CME Activity
  Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015 PDF Version [PDF - 981 KB - 7 pages]
  M. Escobar et al.
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  Personnel in charge of obstetric populations should watch for cases of chikungunya virus‒induced sepsis with hypoperfusion and organ dysfunction.

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  In 2015 in Colombia, 60 pregnant women were hospitalized with chikungunya virus infections confirmed by reverse transcription PCR. Nine of these women required admission to the intensive care unit because of sepsis with hypoperfusion and organ dysfunction; these women met the criteria for severe acute maternal morbidity. No deaths occurred. Fifteen women delivered during acute infection; some received tocolytics to delay delivery until after the febrile episode and prevent possible vertical transmission. As recommended by a pediatric neonatologist, 12 neonates were hospitalized to rule out vertical transmission; no clinical findings suggestive of neonatal chikungunya virus infection were observed. With 36 women (60%), follow-up was performed 1 year after acute viremia; 13 patients had arthralgia in >2 joints (a relapse of infection). Despite disease severity, pregnant women with chikungunya should be treated in high-complexity obstetric units to rule out adverse outcomes. These women should also be followed up to treat potential relapses.

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  EID	Escobar M, Nieto AJ, Loaiza-Osorio S, Barona JS, Rosso F. Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015. Emerg Infect Dis. 2017;23(11):1777-1783. https://dx.doi.org/10.3201/eid2311.170480
  AMA	Escobar M, Nieto AJ, Loaiza-Osorio S, et al. Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015. Emerging Infectious Diseases. 2017;23(11):1777-1783. doi:10.3201/eid2311.170480.
  APA	Escobar, M., Nieto, A. J., Loaiza-Osorio, S., Barona, J. S., & Rosso, F. (2017). Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015. Emerging Infectious Diseases, 23(11), 1777-1783. https://dx.doi.org/10.3201/eid2311.170480.

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Research

• Legionnaires’ Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015 PDF Version [PDF - 1.73 MB - 8 pages]
  P. Lapierre et al.
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  During the summer of 2015, New York, New York, USA, had one of the largest and deadliest outbreaks of Legionnaires’ disease in the history of the United States. A total of 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx. Analysis of environmental samples and clinical isolates showed that sporadic cases of legionellosis before, during, and after the outbreak could be traced to a slowly evolving, single-ancestor strain. Detection of an ostensibly virulent Legionella strain endemic to the Bronx community suggests potential risk for future cases of legionellosis in the area. The genetic homogeneity of the Legionella population in this area might complicate investigations and interpretations of future outbreaks of Legionnaires’ disease.

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  EID	Lapierre P, Nazarian E, Zhu Y, Wroblewski D, Saylors A, Passaretti T, et al. Legionnaires’ Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015. Emerg Infect Dis. 2017;23(11):1784-1791. https://dx.doi.org/10.3201/eid2311.170308
  AMA	Lapierre P, Nazarian E, Zhu Y, et al. Legionnaires’ Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015. Emerging Infectious Diseases. 2017;23(11):1784-1791. doi:10.3201/eid2311.170308.
  APA	Lapierre, P., Nazarian, E., Zhu, Y., Wroblewski, D., Saylors, A., Passaretti, T....Musser, K. A. (2017). Legionnaires’ Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015. Emerging Infectious Diseases, 23(11), 1784-1791. https://dx.doi.org/10.3201/eid2311.170308.

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• Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections PDF Version [PDF - 1.15 MB - 8 pages]
  S. Oza et al.
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  Rapidly identifying likely Ebola patients is difficult because of a broad case definition, overlap of symptoms with common illnesses, and lack of rapid diagnostics. However, rapid identification is critical for care and containment of contagion. We analyzed retrospective data from 252 Ebola-positive and 172 Ebola-negative patients at a Sierra Leone Ebola treatment center to develop easy-to-use risk scores, based on symptoms and laboratory tests (if available), to stratify triaged patients by their likelihood of having Ebola infection. Headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis comprised the symptom-based score. The laboratory-based score also included creatinine, creatine kinase, alanine aminotransferase, and total bilirubin. This risk score correctly identified 92% of Ebola-positive patients as high risk for infection; both scores correctly classified >70% of Ebola-negative patients as low or medium risk. Clinicians can use these risk scores to gauge the likelihood of triaged patients having Ebola while awaiting laboratory confirmation.

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  EID	Oza S, Sesay AA, Russell NJ, Wing K, Boufkhed S, Vandi L, et al. Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerg Infect Dis. 2017;23(11):1792-1799. https://dx.doi.org/10.3201/eid2311.170171
  AMA	Oza S, Sesay AA, Russell NJ, et al. Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases. 2017;23(11):1792-1799. doi:10.3201/eid2311.170171.
  APA	Oza, S., Sesay, A. A., Russell, N. J., Wing, K., Boufkhed, S., Vandi, L....Checchi, F. (2017). Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases, 23(11), 1792-1799. https://dx.doi.org/10.3201/eid2311.170171.

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• Drug-Resistant Tuberculosis among Children, China, 2006–2015 PDF Version [PDF - 780 KB - 6 pages]
  N. Tao et al.
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  Microbial drug resistance has become a major public health concern worldwide. To acquire epidemiologic data on drug-resistant tuberculosis (DR TB) among children, a major cause of illness and death for this population, we conducted a retrospective study of 2006–2015 data from 36 TB prevention and control institutions in Shandong Province, China. A total of 14,223 new TB cases, among which children (<18 years of age) accounted for only 5.5%, were caused by culture-confirmed Mycobacterium tuberculosis. Among children with TB, 18.9% had DR TB and 6.9% had multidrug-resistant TB. Over the past decade, the percentage of DR TB; multidrug-resistant TB; and overall first-line drug resistance for isoniazid, rifampin, ethambutol, and streptomycin among children increased significantly (at least 12%). Understanding the long-term trends of DR TB among children can shed light on the performance of TB control programs, thereby contributing to global TB control.

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  EID	Tao N, He X, Zhang X, Liu Y, Yu C, Li H, et al. Drug-Resistant Tuberculosis among Children, China, 2006–2015. Emerg Infect Dis. 2017;23(11):1800-1805. https://dx.doi.org/10.3201/eid2311.170234
  AMA	Tao N, He X, Zhang X, et al. Drug-Resistant Tuberculosis among Children, China, 2006–2015. Emerging Infectious Diseases. 2017;23(11):1800-1805. doi:10.3201/eid2311.170234.
  APA	Tao, N., He, X., Zhang, X., Liu, Y., Yu, C., & Li, H. (2017). Drug-Resistant Tuberculosis among Children, China, 2006–2015. Emerging Infectious Diseases, 23(11), 1800-1805. https://dx.doi.org/10.3201/eid2311.170234.

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• Airborne Transmission of Highly Pathogenic Influenza Virus during Processing of Infected Poultry PDF Version [PDF - 2.00 MB - 9 pages]
  K. Bertran et al.
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  Exposure to infected poultry is a suspected cause of avian influenza (H5N1) virus infections in humans. We detected infectious droplets and aerosols during laboratory-simulated processing of asymptomatic chickens infected with human- (clades 1 and 2.2.1) and avian- (clades 1.1, 2.2, and 2.1) origin H5N1 viruses. We detected fewer airborne infectious particles in simulated processing of infected ducks. Influenza virus–naive chickens and ferrets exposed to the air space in which virus-infected chickens were processed became infected and died, suggesting that the slaughter of infected chickens is an efficient source of airborne virus that can infect birds and mammals. We did not detect consistent infections in ducks and ferrets exposed to the air space in which virus-infected ducks were processed. Our results support the hypothesis that airborne transmission of HPAI viruses can occur among poultry and from poultry to humans during home or live-poultry market slaughter of infected poultry.

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  EID	Bertran K, Balzli C, Kwon Y, Tumpey TM, Clark A, Swayne DE, et al. Airborne Transmission of Highly Pathogenic Influenza Virus during Processing of Infected Poultry. Emerg Infect Dis. 2017;23(11):1806-1814. https://dx.doi.org/10.3201/eid2311.170672
  AMA	Bertran K, Balzli C, Kwon Y, et al. Airborne Transmission of Highly Pathogenic Influenza Virus during Processing of Infected Poultry. Emerging Infectious Diseases. 2017;23(11):1806-1814. doi:10.3201/eid2311.170672.
  APA	Bertran, K., Balzli, C., Kwon, Y., Tumpey, T. M., Clark, A., & Swayne, D. E. (2017). Airborne Transmission of Highly Pathogenic Influenza Virus during Processing of Infected Poultry. Emerging Infectious Diseases, 23(11), 1806-1814. https://dx.doi.org/10.3201/eid2311.170672.

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• Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003–2013 PDF Version [PDF - 2.63 MB - 11 pages]
  M. Goto et al.
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  Bacteremia caused by gram-negative bacteria is associated with serious illness and death, and emergence of antimicrobial drug resistance in these bacteria is a major concern. Using national microbiology and patient data for 2003–2013 from the US Veterans Health Administration, we characterized nonsusceptibility trends of community-acquired, community-onset; healthcare-associated, community-onset; and hospital-onset bacteremia for selected gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter spp.). For 47,746 episodes of bacteremia, the incidence rate was 6.37 episodes/10,000 person-years for community-onset bacteremia and 4.53 episodes/10,000 patient-days for hospital-onset bacteremia. For Klebsiella spp., P. aeruginosa, and Acinetobacter spp., we observed a decreasing proportion of nonsusceptibility across nearly all antimicrobial drug classes for patients with healthcare exposure; trends for community-acquired, community-onset isolates were stable or increasing. The role of infection control and antimicrobial stewardship efforts in inpatient settings in the decrease in drug resistance rates for hospital-onset isolates needs to be determined.

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  EID	Goto M, McDanel JS, Jones MM, Livorsi DJ, Ohl ME, Beck BF, et al. Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003–2013. Emerg Infect Dis. 2017;23(11):1815-1825. https://dx.doi.org/10.3201/eid2311.161214
  AMA	Goto M, McDanel JS, Jones MM, et al. Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003–2013. Emerging Infectious Diseases. 2017;23(11):1815-1825. doi:10.3201/eid2311.161214.
  APA	Goto, M., McDanel, J. S., Jones, M. M., Livorsi, D. J., Ohl, M. E., Beck, B. F....Perencevich, E. N. (2017). Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003–2013. Emerging Infectious Diseases, 23(11), 1815-1825. https://dx.doi.org/10.3201/eid2311.161214.

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• Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016 PDF Version [PDF - 2.95 MB - 8 pages]
  J. B. Slifirski et al.
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  Data on the likelihood of Mycoplasma genitalium infection in sexual contacts, particularly for men who have sex with men (MSM), are needed to form an evidence base for guidelines. We conducted a cross-sectional analysis of patients attending a sexual health clinic in Melbourne, Victoria, Australia, during 2008–2016. We calculated the proportion of contacts with M. genitalium infection and determined factors associated with infection. Among those patients reporting sexual contact with an M. genitalium–infected person, 48.2% of women, 31.0% of heterosexual men, and 41.7% of MSM were infected. Among heterosexual contacts, women were twice as likely to be infected; among MSM, rectal infection was more common than urethral infection; and among persons within heterosexual partnerships, concordance of infection was high. High positivity among female and MSM contacts and high concordance in heterosexual partnerships provide some justification for presumptive treatment; however, clinicians should consider antimicrobial drug resistance and toxicity of quinolones.

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  EID	Slifirski JB, Vodstrcil LA, Fairley CK, Ong JJ, Chow E, Chen MY, et al. Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016. Emerg Infect Dis. 2017;23(11):1826-1833. https://dx.doi.org/10.3201/eid2311.170998
  AMA	Slifirski JB, Vodstrcil LA, Fairley CK, et al. Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016. Emerging Infectious Diseases. 2017;23(11):1826-1833. doi:10.3201/eid2311.170998.
  APA	Slifirski, J. B., Vodstrcil, L. A., Fairley, C. K., Ong, J. J., Chow, E., Chen, M. Y....Bradshaw, C. S. (2017). Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016. Emerging Infectious Diseases, 23(11), 1826-1833. https://dx.doi.org/10.3201/eid2311.170998.

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• Retrospective Observational Study of Atypical Winter Respiratory Illness Season Using Real-Time Syndromic Surveillance, England, 2014–15 PDF Version [PDF - 1.17 MB - 9 pages]
  S. Smith et al.
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  During winter 2014–15, England experienced severe strains on acute health services. We investigated whether syndromic surveillance could contribute to understanding of the unusually high level of healthcare needs. We compared trends for several respiratory syndromic indicators from that winter to historical baselines. Cumulative and mean incidence rates were compared by winter and age group. All-age influenza-like illness was at expected levels; however, severe asthma and pneumonia levels were above those expected. Across several respiratory indicators, cumulative incidence rates during 2014–15 were similar to those of previous years, but higher for older persons; we saw increased rates of acute respiratory disease, including influenza like illness, severe asthma, and pneumonia, in the 65–74- and >75-year age groups. Age group–specific statistical algorithms may provide insights into the burden on health services and improve early warning in future winters.

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  EID	Smith S, Morbey R, Pebody RG, Hughes TC, de Lusignan S, Yeates F, et al. Retrospective Observational Study of Atypical Winter Respiratory Illness Season Using Real-Time Syndromic Surveillance, England, 2014–15. Emerg Infect Dis. 2017;23(11):1834-1842. https://dx.doi.org/10.3201/eid2311.161632
  AMA	Smith S, Morbey R, Pebody RG, et al. Retrospective Observational Study of Atypical Winter Respiratory Illness Season Using Real-Time Syndromic Surveillance, England, 2014–15. Emerging Infectious Diseases. 2017;23(11):1834-1842. doi:10.3201/eid2311.161632.
  APA	Smith, S., Morbey, R., Pebody, R. G., Hughes, T. C., de Lusignan, S., Yeates, F....Elliot, A. J. (2017). Retrospective Observational Study of Atypical Winter Respiratory Illness Season Using Real-Time Syndromic Surveillance, England, 2014–15. Emerging Infectious Diseases, 23(11), 1834-1842. https://dx.doi.org/10.3201/eid2311.161632.

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• Weather-Dependent Risk for Legionnaires’ Disease, United States PDF Version [PDF - 1.94 MB - 9 pages]
  J. E. Simmering et al.
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  Using the Nationwide Inpatient Sample and US weather data, we estimated the probability of community-acquired pneumonia (CAP) being diagnosed as Legionnaires’ disease (LD). LD risk increases when weather is warm and humid. With warm weather, we found a dose-response relationship between relative humidity and the odds for LD. When the mean temperature was 60°–80°F with high humidity (>80.0%), the odds for CAP being diagnosed with LD were 3.1 times higher than with lower levels of humidity (<50.0%). Thus, in some regions (e.g., the Southwest), LD is rarely the cause of hospitalizations. In other regions and seasons (e.g., the mid-Atlantic in summer), LD is much more common. Thus, suspicion for LD should increase when weather is warm and humid. However, when weather is cold, dry, or extremely hot, empirically treating all CAP patients for LD might contribute to excessive antimicrobial drug use at a population level.

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  EID	Simmering JE, Polgreen LA, Hornick DB, Sewell DK, Polgreen PM. Weather-Dependent Risk for Legionnaires’ Disease, United States. Emerg Infect Dis. 2017;23(11):1843-1851. https://dx.doi.org/10.3201/eid2311.170137
  AMA	Simmering JE, Polgreen LA, Hornick DB, et al. Weather-Dependent Risk for Legionnaires’ Disease, United States. Emerging Infectious Diseases. 2017;23(11):1843-1851. doi:10.3201/eid2311.170137.
  APA	Simmering, J. E., Polgreen, L. A., Hornick, D. B., Sewell, D. K., & Polgreen, P. M. (2017). Weather-Dependent Risk for Legionnaires’ Disease, United States. Emerging Infectious Diseases, 23(11), 1843-1851. https://dx.doi.org/10.3201/eid2311.170137.

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Dispatches

• Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016–2017 PDF Version [PDF - 2.67 MB - 4 pages]
  K. Kwok et al.
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  A new recombinant norovirus GII.P16-GII.2 outnumbered pandemic GII.4 as the predominant GII genotype in the winter of 2016–2017 in Hong Kong, China. Half of hospitalized case-patients were older children and adults, including 13 young adults. This emergent norovirus targets a wider age population compared with circulating pandemic GII.4 strains.

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  EID	Kwok K, Niendorf S, Lee N, Hung T, Chan L, Jacobsen S, et al. Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016–2017. Emerg Infect Dis. 2017;23(11):1852-1855. https://dx.doi.org/10.3201/eid2311.170561
  AMA	Kwok K, Niendorf S, Lee N, et al. Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016–2017. Emerging Infectious Diseases. 2017;23(11):1852-1855. doi:10.3201/eid2311.170561.
  APA	Kwok, K., Niendorf, S., Lee, N., Hung, T., Chan, L., Jacobsen, S....Chan, M. (2017). Increased Detection of Emergent Recombinant Norovirus GII.P16-GII.2 Strains in Young Adults, Hong Kong, China, 2016–2017. Emerging Infectious Diseases, 23(11), 1852-1855. https://dx.doi.org/10.3201/eid2311.170561.

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• Emergence of Bordetella holmesii as a Causative Agent of Whooping Cough, Barcelona, Spain PDF Version [PDF - 1.40 MB - 4 pages]
  A. Mir-Cros et al.
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  We describe the detection of Bordetella holmesii as a cause of whooping cough in Spain. Prevalence was 3.9% in 2015, doubling to 8.8% in 2016. This emergence raises concern regarding the contribution of B. holmesii to the reemergence of whooping cough and the effectiveness of the pertussis vaccine.

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  EID	Mir-Cros A, Codina G, Martín-Gómez M, Fàbrega A, Martínez X, Jané M, et al. Emergence of Bordetella holmesii as a Causative Agent of Whooping Cough, Barcelona, Spain. Emerg Infect Dis. 2017;23(11):1856-1859. https://dx.doi.org/10.3201/eid2311.170960
  AMA	Mir-Cros A, Codina G, Martín-Gómez M, et al. Emergence of Bordetella holmesii as a Causative Agent of Whooping Cough, Barcelona, Spain. Emerging Infectious Diseases. 2017;23(11):1856-1859. doi:10.3201/eid2311.170960.
  APA	Mir-Cros, A., Codina, G., Martín-Gómez, M., Fàbrega, A., Martínez, X., Jané, M....González-López, J. (2017). Emergence of Bordetella holmesii as a Causative Agent of Whooping Cough, Barcelona, Spain. Emerging Infectious Diseases, 23(11), 1856-1859. https://dx.doi.org/10.3201/eid2311.170960.

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• Highly Pathogenic Avian Influenza A(H7N9) Virus, Tennessee, USA, March 2017 PDF Version [PDF - 1.15 MB - 4 pages]
  D. Lee et al.
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  In March 2017, highly pathogenic avian influenza A(H7N9) was detected at 2 poultry farms in Tennessee, USA. Surveillance data and genetic analyses indicated multiple introductions of low pathogenicity avian influenza virus before mutation to high pathogenicity and interfarm transmission. Poultry surveillance should continue because low pathogenicity viruses circulate and spill over into commercial poultry.

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  EID	Lee D, Torchetti MK, Killian M, Berhane Y, Swayne DE. Highly Pathogenic Avian Influenza A(H7N9) Virus, Tennessee, USA, March 2017. Emerg Infect Dis. 2017;23(11):1860-1863. https://dx.doi.org/10.3201/eid2311.171013
  AMA	Lee D, Torchetti MK, Killian M, et al. Highly Pathogenic Avian Influenza A(H7N9) Virus, Tennessee, USA, March 2017. Emerging Infectious Diseases. 2017;23(11):1860-1863. doi:10.3201/eid2311.171013.
  APA	Lee, D., Torchetti, M. K., Killian, M., Berhane, Y., & Swayne, D. E. (2017). Highly Pathogenic Avian Influenza A(H7N9) Virus, Tennessee, USA, March 2017. Emerging Infectious Diseases, 23(11), 1860-1863. https://dx.doi.org/10.3201/eid2311.171013.

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• Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas PDF Version [PDF - 1.63 MB - 3 pages]
  A. Virk et al.
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  We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Clinicians should consider this pathogen in the diagnosis of patients with symptoms of leprosy who have traveled to endemic areas.

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  EID	Virk A, Pritt B, Patel R, Uhl JR, Bezalel SA, Gibson LE, et al. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis. 2017;23(11):1864-1866. https://dx.doi.org/10.3201/eid2311.171104
  AMA	Virk A, Pritt B, Patel R, et al. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerging Infectious Diseases. 2017;23(11):1864-1866. doi:10.3201/eid2311.171104.
  APA	Virk, A., Pritt, B., Patel, R., Uhl, J. R., Bezalel, S. A., Gibson, L. E....Peters, M. S. (2017). Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerging Infectious Diseases, 23(11), 1864-1866. https://dx.doi.org/10.3201/eid2311.171104.

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• Lineage-Specific Real-Time RT-PCR for Yellow Fever Virus Outbreak Surveillance, Brazil PDF Version [PDF - 1.63 MB - 5 pages]
  C. Fischer et al.
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  The current yellow fever outbreak in Brazil prompted widespread yellow fever virus (YFV) vaccination campaigns, imposing a responsibility to distinguish between vaccine- and wild-type YFV-associated disease. We developed novel multiplex real-time reverse transcription PCRs that differentiate between vaccine and American wild-type YFV. We validated these highly specific and sensitive assays in an outbreak setting.

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  EID	Fischer C, Torres MC, Patel P, Moreira-Soto A, Gould EA, Charrel RN, et al. Lineage-Specific Real-Time RT-PCR for Yellow Fever Virus Outbreak Surveillance, Brazil. Emerg Infect Dis. 2017;23(11):1867-1871. https://dx.doi.org/10.3201/eid2311.171131
  AMA	Fischer C, Torres MC, Patel P, et al. Lineage-Specific Real-Time RT-PCR for Yellow Fever Virus Outbreak Surveillance, Brazil. Emerging Infectious Diseases. 2017;23(11):1867-1871. doi:10.3201/eid2311.171131.
  APA	Fischer, C., Torres, M. C., Patel, P., Moreira-Soto, A., Gould, E. A., Charrel, R. N....Drexler, J. (2017). Lineage-Specific Real-Time RT-PCR for Yellow Fever Virus Outbreak Surveillance, Brazil. Emerging Infectious Diseases, 23(11), 1867-1871. https://dx.doi.org/10.3201/eid2311.171131.

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• Phylogenetic Analysis of Klebsiella pneumoniae from Hospitalized Children, Pakistan PDF Version [PDF - 1.57 MB - 4 pages]
  H. Ejaz et al.
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  Klebsiella pneumoniae shows increasing emergence of multidrug-resistant lineages, including strains resistant to all available antimicrobial drugs. We conducted whole-genome sequencing of 178 highly drug-resistant isolates from a tertiary hospital in Lahore, Pakistan. Phylogenetic analyses to place these isolates into global context demonstrate the expansion of multiple independent lineages, including K. quasipneumoniae.

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  EID	Ejaz H, Wang N, Wilksch JJ, Page AJ, Cao H, Gujaran S, et al. Phylogenetic Analysis of Klebsiella pneumoniae from Hospitalized Children, Pakistan. Emerg Infect Dis. 2017;23(11):1872-1875. https://dx.doi.org/10.3201/eid2311.170833
  AMA	Ejaz H, Wang N, Wilksch JJ, et al. Phylogenetic Analysis of Klebsiella pneumoniae from Hospitalized Children, Pakistan. Emerging Infectious Diseases. 2017;23(11):1872-1875. doi:10.3201/eid2311.170833.
  APA	Ejaz, H., Wang, N., Wilksch, J. J., Page, A. J., Cao, H., Gujaran, S....Heinz, E. (2017). Phylogenetic Analysis of Klebsiella pneumoniae from Hospitalized Children, Pakistan. Emerging Infectious Diseases, 23(11), 1872-1875. https://dx.doi.org/10.3201/eid2311.170833.

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• Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia PDF Version [PDF - 1.75 MB - 4 pages]
  Á. A. Faccini-Martínez et al.
      View Abstract

  In 2015, we investigated Bartonella quintana and typhus group rickettsiae in body lice from homeless persons in Bogotá, Colombia. We found B. quintana–infected body lice and seroprevalence of this microorganism in 19% of homeless persons and typhus group rickettsiae in 56%. Public health professionals should start preemptive measures and active vector control.

      Cite This Article

  EID	Faccini-Martínez ÁA, Márquez AC, Bravo-Estupiñan DM, Calixto O, López-Castillo CA, Botero-García CA, et al. Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia. Emerg Infect Dis. 2017;23(11):1876-1879. https://dx.doi.org/10.3201/eid2311.170341
  AMA	Faccini-Martínez ÁA, Márquez AC, Bravo-Estupiñan DM, et al. Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia. Emerging Infectious Diseases. 2017;23(11):1876-1879. doi:10.3201/eid2311.170341.
  APA	Faccini-Martínez, Á. A., Márquez, A. C., Bravo-Estupiñan, D. M., Calixto, O., López-Castillo, C. A., Botero-García, C. A....Cuervo, C. (2017). Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia. Emerging Infectious Diseases, 23(11), 1876-1879. https://dx.doi.org/10.3201/eid2311.170341.

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• Street Cleaning Trucks as Potential Sources of Legionella pneumophila PDF Version [PDF - 538 KB - 3 pages]
  N. Valero et al.
      View Abstract

  In 2015, Legionnaires’ disease was diagnosed in a street cleaning worker. We found Legionella pneumophila serogroup 1 in the water and internal foam from the tanks of 2 trucks used by the worker during the incubation period. The internal foam was removed, and a Legionella prevention program was implemented.

      Cite This Article

  EID	Valero N, de Simón M, Gallés P, Izquierdo N, Arimon J, González R, et al. Street Cleaning Trucks as Potential Sources of Legionella pneumophila. Emerg Infect Dis. 2017;23(11):1880-1882. https://dx.doi.org/10.3201/eid2311.161390
  AMA	Valero N, de Simón M, Gallés P, et al. Street Cleaning Trucks as Potential Sources of Legionella pneumophila. Emerging Infectious Diseases. 2017;23(11):1880-1882. doi:10.3201/eid2311.161390.
  APA	Valero, N., de Simón, M., Gallés, P., Izquierdo, N., Arimon, J., González, R....Gómez, A. (2017). Street Cleaning Trucks as Potential Sources of Legionella pneumophila. Emerging Infectious Diseases, 23(11), 1880-1882. https://dx.doi.org/10.3201/eid2311.161390.

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• Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan PDF Version [PDF - 873 KB - 4 pages]
  Y. Fan et al.
      View Abstract

  The virulence of genotype I (GI) Japanese encephalitis virus (JEV) is under debate. We investigated differences in the virulence of GI and GIII JEV by calculating asymptomatic ratios based on serologic studies during GI- and GIII-JEV endemic periods. The results suggested equal virulence of GI and GIII JEV among humans.

      Cite This Article

  EID	Fan Y, Lin J, Liao S, Chen J, Chen Y, Chiu H, et al. Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan. Emerg Infect Dis. 2017;23(11):1883-1886. https://dx.doi.org/10.3201/eid2311.161443
  AMA	Fan Y, Lin J, Liao S, et al. Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan. Emerging Infectious Diseases. 2017;23(11):1883-1886. doi:10.3201/eid2311.161443.
  APA	Fan, Y., Lin, J., Liao, S., Chen, J., Chen, Y., Chiu, H....Chiou, S. (2017). Virulence of Japanese Encephalitis Virus Genotypes I and III, Taiwan. Emerging Infectious Diseases, 23(11), 1883-1886. https://dx.doi.org/10.3201/eid2311.161443.

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• Polyclonal Pulmonary Tuberculosis Infections and Risk for Multidrug Resistance, Lima, Peru PDF Version [PDF - 813 KB - 4 pages]
  R. R. Nathavitharana et al.
      View Abstract

  Because within-host Mycobacterium tuberculosis diversity complicates diagnosis and treatment of tuberculosis (TB), we measured diversity prevalence and associated factors among 3,098 pulmonary TB patients in Lima, Peru. The 161 patients with polyclonal infection were more likely than the 115 with clonal or the 2,822 with simple infections to have multidrug-resistant TB.

      Cite This Article

  EID	Nathavitharana RR, Shi CX, Chindelevitch L, Calderon R, Zhang Z, Galea JT, et al. Polyclonal Pulmonary Tuberculosis Infections and Risk for Multidrug Resistance, Lima, Peru. Emerg Infect Dis. 2017;23(11):1887-1890. https://dx.doi.org/10.3201/eid2311.170077
  AMA	Nathavitharana RR, Shi CX, Chindelevitch L, et al. Polyclonal Pulmonary Tuberculosis Infections and Risk for Multidrug Resistance, Lima, Peru. Emerging Infectious Diseases. 2017;23(11):1887-1890. doi:10.3201/eid2311.170077.
  APA	Nathavitharana, R. R., Shi, C. X., Chindelevitch, L., Calderon, R., Zhang, Z., Galea, J. T....Cohen, T. (2017). Polyclonal Pulmonary Tuberculosis Infections and Risk for Multidrug Resistance, Lima, Peru. Emerging Infectious Diseases, 23(11), 1887-1890. https://dx.doi.org/10.3201/eid2311.170077.

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• Long-Term Viruria in Zika Virus–Infected Pregnant Women, Brazil, 2016 PDF Version [PDF - 365 KB - 3 pages]
  A. B. Terzian et al.
      View Abstract

  During the 2016 Zika virus outbreak in Brazil, we detected Zika virus RNA in urine samples collected from Zika virus–positive pregnant women during different stages of pregnancy. Women had positive and negative intervals of viruria; 3 newborns had adverse outcomes. Further research is needed to clarify the relationship between viruria and outcomes for newborns.

      Cite This Article

  EID	Terzian AB, Estofolete C, Alves da Silva R, Vaz-Oliani D, Oliani A, Brandão de Mattos C, et al. Long-Term Viruria in Zika Virus–Infected Pregnant Women, Brazil, 2016. Emerg Infect Dis. 2017;23(11):1891-1893. https://dx.doi.org/10.3201/eid2311.170078
  AMA	Terzian AB, Estofolete C, Alves da Silva R, et al. Long-Term Viruria in Zika Virus–Infected Pregnant Women, Brazil, 2016. Emerging Infectious Diseases. 2017;23(11):1891-1893. doi:10.3201/eid2311.170078.
  APA	Terzian, A. B., Estofolete, C., Alves da Silva, R., Vaz-Oliani, D., Oliani, A., Brandão de Mattos, C....Nogueira, M. L. (2017). Long-Term Viruria in Zika Virus–Infected Pregnant Women, Brazil, 2016. Emerging Infectious Diseases, 23(11), 1891-1893. https://dx.doi.org/10.3201/eid2311.170078.

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• Changing Demographics and Prevalence of Body Lice among Homeless Persons, Marseille, France PDF Version [PDF - 1.00 MB - 4 pages]
  T. Ly et al.
  View Summary

  Body Lice among Homeless Persons, France

      View Abstract

  The prevalence of body lice among 2,288 sheltered homeless persons in the city of Marseille during 2000–2017 was 12.2% and significantly decreased over time. We report a positive association between body lice infestations and older age, duration of stays in France for migrants, frequent consumption of alcohol, and tobacco smoking.

      Cite This Article

  EID	Ly T, Touré Y, Calloix C, Badiaga S, Raoult D, Tissot-Dupont H, et al. Changing Demographics and Prevalence of Body Lice among Homeless Persons, Marseille, France. Emerg Infect Dis. 2017;23(11):1894-1897. https://dx.doi.org/10.3201/eid2311.170516
  AMA	Ly T, Touré Y, Calloix C, et al. Changing Demographics and Prevalence of Body Lice among Homeless Persons, Marseille, France. Emerging Infectious Diseases. 2017;23(11):1894-1897. doi:10.3201/eid2311.170516.
  APA	Ly, T., Touré, Y., Calloix, C., Badiaga, S., Raoult, D., Tissot-Dupont, H....Gautret, P. (2017). Changing Demographics and Prevalence of Body Lice among Homeless Persons, Marseille, France. Emerging Infectious Diseases, 23(11), 1894-1897. https://dx.doi.org/10.3201/eid2311.170516.

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• Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada PDF Version [PDF - 842 KB - 4 pages]
  S. K. Brode et al.
      View Abstract

  In Ontario, Canada, during 1998–2010, nontuberculous mycobacteria (NTM) from pulmonary sites comprised 96% of species/patient combinations isolated; annual rates of isolation and cases increased steadily. NTM isolates from nonpulmonary sites comprised 4% of species/patient combinations; annual rates and cases were temporally stable. NTM increases were driven exclusively by pulmonary isolates and disease.

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  EID	Brode SK, Marchand-Austin A, Jamieson FB, Marras TK. Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada. Emerg Infect Dis. 2017;23(11):1898-1901. https://dx.doi.org/10.3201/eid2311.170959
  AMA	Brode SK, Marchand-Austin A, Jamieson FB, et al. Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada. Emerging Infectious Diseases. 2017;23(11):1898-1901. doi:10.3201/eid2311.170959.
  APA	Brode, S. K., Marchand-Austin, A., Jamieson, F. B., & Marras, T. K. (2017). Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada. Emerging Infectious Diseases, 23(11), 1898-1901. https://dx.doi.org/10.3201/eid2311.170959.

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• High-Level Fosfomycin Resistance in Vancomycin-Resistant Enterococcus faecium PDF Version [PDF - 492 KB - 3 pages]
  Y. Guo et al.
      View Abstract

  Of 890 vancomycin-resistant Enterococcus faecium isolates obtained by rectal screening from patients in Pittsburgh, Pennsylvania, USA, 4 had MICs >1,024 μg/mL for fosfomycin. These isolates had a Cys119Asp substitution in the active site of UDP-N-acetylglucosamine enolpyruvyl transferase. This substitution increased the fosfomycin MIC >4-fold and rendered this drug inactive in biochemical assays.

      Cite This Article

  EID	Guo Y, Tomich AD, McElheny CL, Cooper VS, Tait-Kamradt A, Wang M, et al. High-Level Fosfomycin Resistance in Vancomycin-Resistant Enterococcus faecium. Emerg Infect Dis. 2017;23(11):1902-1904. https://dx.doi.org/10.3201/eid2311.171130
  AMA	Guo Y, Tomich AD, McElheny CL, et al. High-Level Fosfomycin Resistance in Vancomycin-Resistant Enterococcus faecium. Emerging Infectious Diseases. 2017;23(11):1902-1904. doi:10.3201/eid2311.171130.
  APA	Guo, Y., Tomich, A. D., McElheny, C. L., Cooper, V. S., Tait-Kamradt, A., Wang, M....Doi, Y. (2017). High-Level Fosfomycin Resistance in Vancomycin-Resistant Enterococcus faecium. Emerging Infectious Diseases, 23(11), 1902-1904. https://dx.doi.org/10.3201/eid2311.171130.

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Commentaries

• Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice PDF Version [PDF - 2.55 MB - 3 pages]
  R. L. Berkelman and A. Pruden
          Cite This Article

  EID	Berkelman RL, Pruden A. Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice. Emerg Infect Dis. 2017;23(11):1905-1907. https://dx.doi.org/10.3201/eid2311.171429
  AMA	Berkelman RL, Pruden A. Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice. Emerging Infectious Diseases. 2017;23(11):1905-1907. doi:10.3201/eid2311.171429.
  APA	Berkelman, R. L., & Pruden, A. (2017). Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice. Emerging Infectious Diseases, 23(11), 1905-1907. https://dx.doi.org/10.3201/eid2311.171429.

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Research Letters

• Blood Culture–Negative Endocarditis, Morocco PDF Version [PDF - 314 KB - 2 pages]
  N. Boudebouch et al.
      View Abstract

  We investigated the microorganisms causing blood culture–negative endocarditis (BCNE) in Morocco. We tested 19 patients with BCNE by serologic methods, molecular methods, or both and identified Bartonella quintana, Staphylococcus aureus, Streptococcus equi, and Streptococcus oralis in 4 patients. These results highlight the role of these zoonotic agents in BCNE in Morocco.

      Cite This Article

  EID	Boudebouch N, Sarih M, Chakib A, Fadili S, Boumzebra D, Zouizra Z, et al. Blood Culture–Negative Endocarditis, Morocco. Emerg Infect Dis. 2017;23(11):1908-1909. https://dx.doi.org/10.3201/eid2311.161066
  AMA	Boudebouch N, Sarih M, Chakib A, et al. Blood Culture–Negative Endocarditis, Morocco. Emerging Infectious Diseases. 2017;23(11):1908-1909. doi:10.3201/eid2311.161066.
  APA	Boudebouch, N., Sarih, M., Chakib, A., Fadili, S., Boumzebra, D., Zouizra, Z....Fournier, P. (2017). Blood Culture–Negative Endocarditis, Morocco. Emerging Infectious Diseases, 23(11), 1908-1909. https://dx.doi.org/10.3201/eid2311.161066.

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• Zika Virus Persistence and Higher Viral Loads in Cutaneous Capillaries Than in Venous Blood PDF Version [PDF - 317 KB - 2 pages]
  S. Matheus et al.
      View Abstract

  We collected venous and capillary serum samples from 21 Zika virus‒infected patients on multiple days after symptom onset and found RNA load was higher and median duration of virus detection significantly longer in capillary than in venous blood. These findings raise questions about the role of the capillary compartment in virus transmission dynamics.

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  EID	Matheus S, de Laval F, Moua D, N’Guyen C, Martinez E, Rousset D, et al. Zika Virus Persistence and Higher Viral Loads in Cutaneous Capillaries Than in Venous Blood. Emerg Infect Dis. 2017;23(11):1910-1911. https://dx.doi.org/10.3201/eid2311.170337
  AMA	Matheus S, de Laval F, Moua D, et al. Zika Virus Persistence and Higher Viral Loads in Cutaneous Capillaries Than in Venous Blood. Emerging Infectious Diseases. 2017;23(11):1910-1911. doi:10.3201/eid2311.170337.
  APA	Matheus, S., de Laval, F., Moua, D., N’Guyen, C., Martinez, E., Rousset, D....Briolant, S. (2017). Zika Virus Persistence and Higher Viral Loads in Cutaneous Capillaries Than in Venous Blood. Emerging Infectious Diseases, 23(11), 1910-1911. https://dx.doi.org/10.3201/eid2311.170337.

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• Detection of Spotted Fever Group Rickettsia DNA by Deep Sequencing PDF Version [PDF - 331 KB - 3 pages]
  R. Graham et al.
      View Abstract

  After conventional molecular and serologic testing failed to diagnose the cause of illness, deep sequencing identified spotted fever group Rickettsia DNA in a patient’s blood sample. Sequences belonged to R. honei, the causative agent of Flinders Island spotted fever. Next-generation sequencing is proving to be a useful tool for clinical diagnostics.

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  EID	Graham R, Donohue S, McMahon J, Jennison AV. Detection of Spotted Fever Group Rickettsia DNA by Deep Sequencing. Emerg Infect Dis. 2017;23(11):1911-1913. https://dx.doi.org/10.3201/eid2311.170474
  AMA	Graham R, Donohue S, McMahon J, et al. Detection of Spotted Fever Group Rickettsia DNA by Deep Sequencing. Emerging Infectious Diseases. 2017;23(11):1911-1913. doi:10.3201/eid2311.170474.
  APA	Graham, R., Donohue, S., McMahon, J., & Jennison, A. V. (2017). Detection of Spotted Fever Group Rickettsia DNA by Deep Sequencing. Emerging Infectious Diseases, 23(11), 1911-1913. https://dx.doi.org/10.3201/eid2311.170474.

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• Chlamydia trachomatis Biovar L2 Infection in Women in South Africa PDF Version [PDF - 337 KB - 3 pages]
  R. Peters et al.
      View Abstract

  We detected Chlamydia trachomatis biovar L2 in vaginal swab specimens of 7 women with vaginal discharge in South Africa. Whole-genome sequencing directly from clinical specimens identified a closely related cluster of strains. The clinical role of this infection in the context of syndromic management should be clarified.

      Cite This Article

  EID	Peters R, Doyle R, Redelinghuys MJ, McIntyre JA, Verjans GM, Breuer J, et al. Chlamydia trachomatis Biovar L2 Infection in Women in South Africa. Emerg Infect Dis. 2017;23(11):1913-1915. https://dx.doi.org/10.3201/eid2311.170758
  AMA	Peters R, Doyle R, Redelinghuys MJ, et al. Chlamydia trachomatis Biovar L2 Infection in Women in South Africa. Emerging Infectious Diseases. 2017;23(11):1913-1915. doi:10.3201/eid2311.170758.
  APA	Peters, R., Doyle, R., Redelinghuys, M. J., McIntyre, J. A., Verjans, G. M., Breuer, J....Kock, M. M. (2017). Chlamydia trachomatis Biovar L2 Infection in Women in South Africa. Emerging Infectious Diseases, 23(11), 1913-1915. https://dx.doi.org/10.3201/eid2311.170758.

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• Unrecognized Dengue Virus Infections in Children, Western Kenya, 2014–2015 PDF Version [PDF - 733 KB - 3 pages]
  D. M. Vu et al.
      View Abstract

  We detected a cluster of dengue virus infections in children in Kenya during July 2014–June 2015. Most cases were serotype 1, but we detected all 4 serotypes, including co-infections with 2 serotypes. Our findings implicate dengue as a cause of febrile illness in this population and highlight a need for robust arbovirus surveillance.

      Cite This Article

  EID	Vu DM, Mutai N, Heath CJ, Vulule JM, Mutuku FM, Ndenga BA, et al. Unrecognized Dengue Virus Infections in Children, Western Kenya, 2014–2015. Emerg Infect Dis. 2017;23(11):1915-1917. https://dx.doi.org/10.3201/eid2311.170807
  AMA	Vu DM, Mutai N, Heath CJ, et al. Unrecognized Dengue Virus Infections in Children, Western Kenya, 2014–2015. Emerging Infectious Diseases. 2017;23(11):1915-1917. doi:10.3201/eid2311.170807.
  APA	Vu, D. M., Mutai, N., Heath, C. J., Vulule, J. M., Mutuku, F. M., Ndenga, B. A....LaBeaud, A. (2017). Unrecognized Dengue Virus Infections in Children, Western Kenya, 2014–2015. Emerging Infectious Diseases, 23(11), 1915-1917. https://dx.doi.org/10.3201/eid2311.170807.

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• Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil PDF Version [PDF - 1.34 MB - 3 pages]
  A. C. do Valle et al.
      View Abstract

  Transmission of Paracoccidioides spp. fungi to humans is usually related to manipulation of soil. Rural workers are the most affected group. We report an outbreak of paracoccidioidomycosis after deforestation and massive earth removal during construction of a highway in Rio de Janeiro, Brazil. Extensive environmental disturbances might be involved in fungal transmission.

      Cite This Article

  EID	do Valle AC, Marques de Macedo P, Almeida-Paes R, Romão AR, Lazéra M, Wanke B, et al. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerg Infect Dis. 2017;23(11):1917-1919. https://dx.doi.org/10.3201/eid2311.170934
  AMA	do Valle AC, Marques de Macedo P, Almeida-Paes R, et al. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerging Infectious Diseases. 2017;23(11):1917-1919. doi:10.3201/eid2311.170934.
  APA	do Valle, A. C., Marques de Macedo, P., Almeida-Paes, R., Romão, A. R., Lazéra, M., & Wanke, B. (2017). Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerging Infectious Diseases, 23(11), 1917-1919. https://dx.doi.org/10.3201/eid2311.170934.

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• Mycobacterium shimoidei, a Rare Pulmonary Pathogen, Queensland, Australia PDF Version [PDF - 375 KB - 4 pages]
  T. M. Baird et al.
      View Abstract

  Nontuberculous mycobacteria are human pathogens with increasing incidence and prevalence worldwide. Mycobacterium shimoidei is a rare cause of pulmonary disease, with only 15 cases previously reported. This series documents an additional 23 cases of M. shimoidei from Queensland, Australia, and highlights the pathogenicity and clinical role of this species.

      Cite This Article

  EID	Baird TM, Carter R, Eather G, Thomson R. Mycobacterium shimoidei, a Rare Pulmonary Pathogen, Queensland, Australia. Emerg Infect Dis. 2017;23(11):1919-1922. https://dx.doi.org/10.3201/eid2311.170999
  AMA	Baird TM, Carter R, Eather G, et al. Mycobacterium shimoidei, a Rare Pulmonary Pathogen, Queensland, Australia. Emerging Infectious Diseases. 2017;23(11):1919-1922. doi:10.3201/eid2311.170999.
  APA	Baird, T. M., Carter, R., Eather, G., & Thomson, R. (2017). Mycobacterium shimoidei, a Rare Pulmonary Pathogen, Queensland, Australia. Emerging Infectious Diseases, 23(11), 1919-1922. https://dx.doi.org/10.3201/eid2311.170999.

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• The Breadth of Viruses in Human Semen PDF Version [PDF - 352 KB - 3 pages]
  A. P. Salam and P. W. Horby
      View Abstract

  Zika virus RNA is frequently detected in the semen of men after Zika virus infection. To learn more about persistence of viruses in genital fluids, we searched PubMed for relevant articles. We found evidence that 27 viruses, across a broad range of virus families, can be found in human semen.

      Cite This Article

  EID	Salam AP, Horby PW. The Breadth of Viruses in Human Semen. Emerg Infect Dis. 2017;23(11):1922-1924. https://dx.doi.org/10.3201/eid2311.171049
  AMA	Salam AP, Horby PW. The Breadth of Viruses in Human Semen. Emerging Infectious Diseases. 2017;23(11):1922-1924. doi:10.3201/eid2311.171049.
  APA	Salam, A. P., & Horby, P. W. (2017). The Breadth of Viruses in Human Semen. Emerging Infectious Diseases, 23(11), 1922-1924. https://dx.doi.org/10.3201/eid2311.171049.

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• Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India PDF Version [PDF - 336 KB - 2 pages]
  R. Chaudhry et al.
      View Abstract

  Proactive environmental surveillance for Legionella pneumophila in hospitals that treat immunocompromised patients is a useful strategy for preventing nosocomial Legionnaires’ disease. We report the presence of L. pneumophila serogroup 1 in 15.2% of the water systems of our tertiary healthcare center, which should prompt health officials to formulate mitigation policies.

      Cite This Article

  EID	Chaudhry R, Sreenath K, Arvind V, Vinayaraj E, Tanu S. Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India. Emerg Infect Dis. 2017;23(11):1924-1925. https://dx.doi.org/10.3201/eid2311.171071
  AMA	Chaudhry R, Sreenath K, Arvind V, et al. Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India. Emerging Infectious Diseases. 2017;23(11):1924-1925. doi:10.3201/eid2311.171071.
  APA	Chaudhry, R., Sreenath, K., Arvind, V., Vinayaraj, E., & Tanu, S. (2017). Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India. Emerging Infectious Diseases, 23(11), 1924-1925. https://dx.doi.org/10.3201/eid2311.171071.

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• Outbreak of Zika Virus Infections, Dominica, 2016 PDF Version [PDF - 341 KB - 2 pages]
  S. J. Ryan et al.
      View Abstract

  In February 2016, the World Health Organization declared the pandemic of Zika virus a public health emergency. On March 4, 2016, Dominica reported its first autochthonous Zika virus disease case; subsequently, 1,263 cases were reported. We describe the outbreak through November 2016, when the last known case was reported.

      Cite This Article

  EID	Ryan SJ, Carlson CJ, Stewart-Ibarra AM, Borbor-Cordova MJ, Romero MM, Cox S, et al. Outbreak of Zika Virus Infections, Dominica, 2016. Emerg Infect Dis. 2017;23(11):1926-1927. https://dx.doi.org/10.3201/eid2311.171140
  AMA	Ryan SJ, Carlson CJ, Stewart-Ibarra AM, et al. Outbreak of Zika Virus Infections, Dominica, 2016. Emerging Infectious Diseases. 2017;23(11):1926-1927. doi:10.3201/eid2311.171140.
  APA	Ryan, S. J., Carlson, C. J., Stewart-Ibarra, A. M., Borbor-Cordova, M. J., Romero, M. M., Cox, S....Ahmed, S. (2017). Outbreak of Zika Virus Infections, Dominica, 2016. Emerging Infectious Diseases, 23(11), 1926-1927. https://dx.doi.org/10.3201/eid2311.171140.

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• Autochthonous Leprosy without Armadillo Exposure, Eastern United States PDF Version [PDF - 293 KB - 1 page]
  T. Rendini and W. Levis
      View Abstract

  Autochthonous leprosy has been reported in New York City, where there are no wild armadillos. Recent autochthonous cases also have been reported in Georgia and Florida and blamed on armadillos, including cases with no known armadillo exposure. International migration needs to be considered as a cause of autochthonous leprosy.

      Cite This Article

  EID	Rendini T, Levis W. Autochthonous Leprosy without Armadillo Exposure, Eastern United States. Emerg Infect Dis. 2017;23(11):1928. https://dx.doi.org/10.3201/eid2311.171145
  AMA	Rendini T, Levis W. Autochthonous Leprosy without Armadillo Exposure, Eastern United States. Emerging Infectious Diseases. 2017;23(11):1928. doi:10.3201/eid2311.171145.
  APA	Rendini, T., & Levis, W. (2017). Autochthonous Leprosy without Armadillo Exposure, Eastern United States. Emerging Infectious Diseases, 23(11), 1928. https://dx.doi.org/10.3201/eid2311.171145.

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• Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio’s Phenomenon, Peru PDF Version [PDF - 716 KB - 2 pages]
  C. Ramal et al.
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  Diffuse multibacillary leprosy of Lucio and Latapí is mainly reported in Mexico and Central America. We report a case in a 65-year-old man in Peru. He also had Lucio’s phenomenon, characterized by vascular thrombosis and invasion of blood vessel walls by leprosy bacilli, causing extensive skin ulcers.

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  EID	Ramal C, Casapia M, Marin J, Celis JC, Baldeon J, Vilcarromero S, et al. Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio’s Phenomenon, Peru. Emerg Infect Dis. 2017;23(11):1929-1930. https://dx.doi.org/10.3201/eid2311.171228
  AMA	Ramal C, Casapia M, Marin J, et al. Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio’s Phenomenon, Peru. Emerging Infectious Diseases. 2017;23(11):1929-1930. doi:10.3201/eid2311.171228.
  APA	Ramal, C., Casapia, M., Marin, J., Celis, J. C., Baldeon, J., Vilcarromero, S....Legua, P. (2017). Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio’s Phenomenon, Peru. Emerging Infectious Diseases, 23(11), 1929-1930. https://dx.doi.org/10.3201/eid2311.171228.

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• Dengue Virus Type 2 in Travelers Returning to Japan from Sri Lanka, 2017 PDF Version [PDF - 584 KB - 3 pages]
  S. Kutsuna
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  In June 2017, dengue virus type 2 infection was diagnosed in 2 travelers returned to Japan from Sri Lanka, where the country’s largest dengue fever outbreak is ongoing. Travelers, especially those previously affected by dengue fever, should take measures to avoid mosquito bites.

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  EID	Kutsuna S. Dengue Virus Type 2 in Travelers Returning to Japan from Sri Lanka, 2017. Emerg Infect Dis. 2017;23(11):1931-1933. https://dx.doi.org/10.3201/eid2311.171293
  AMA	Kutsuna S. Dengue Virus Type 2 in Travelers Returning to Japan from Sri Lanka, 2017. Emerging Infectious Diseases. 2017;23(11):1931-1933. doi:10.3201/eid2311.171293.
  APA	Kutsuna, S. (2017). Dengue Virus Type 2 in Travelers Returning to Japan from Sri Lanka, 2017. Emerging Infectious Diseases, 23(11), 1931-1933. https://dx.doi.org/10.3201/eid2311.171293.

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Books and Media

• The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic PDF Version [PDF - 477 KB - 1 page]
  K. Hamilton
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  EID	Hamilton K. The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic. Emerg Infect Dis. 2017;23(11):1934. https://dx.doi.org/10.3201/eid2311.171206
  AMA	Hamilton K. The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic. Emerging Infectious Diseases. 2017;23(11):1934. doi:10.3201/eid2311.171206.
  APA	Hamilton, K. (2017). The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic. Emerging Infectious Diseases, 23(11), 1934. https://dx.doi.org/10.3201/eid2311.171206.

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• Ebola: Profile of a Killer Virus PDF Version [PDF - 518 KB - 2 pages]
  S. S. Morse
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  EID	Morse SS. Ebola: Profile of a Killer Virus. Emerg Infect Dis. 2017;23(11):1934-1935. https://dx.doi.org/10.3201/eid2311.171207
  AMA	Morse SS. Ebola: Profile of a Killer Virus. Emerging Infectious Diseases. 2017;23(11):1934-1935. doi:10.3201/eid2311.171207.
  APA	Morse, S. S. (2017). Ebola: Profile of a Killer Virus. Emerging Infectious Diseases, 23(11), 1934-1935. https://dx.doi.org/10.3201/eid2311.171207.

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About the Cover

• Visions of Matchstick Men and Icons of Industrialization PDF Version [PDF - 2.11 MB - 2 pages]
  B. Breedlove
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  EID	Breedlove B. Visions of Matchstick Men and Icons of Industrialization. Emerg Infect Dis. 2017;23(11):1936-1937. https://dx.doi.org/10.3201/eid2311.AC2311
  AMA	Breedlove B. Visions of Matchstick Men and Icons of Industrialization. Emerging Infectious Diseases. 2017;23(11):1936-1937. doi:10.3201/eid2311.AC2311.
  APA	Breedlove, B. (2017). Visions of Matchstick Men and Icons of Industrialization. Emerging Infectious Diseases, 23(11), 1936-1937. https://dx.doi.org/10.3201/eid2311.AC2311.

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Etymologia

• Etymologia: Legionella pneumophila PDF Version [PDF - 650 KB - 1 page]
  R. Henry
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  EID	Henry R. Etymologia: Legionella pneumophila. Emerg Infect Dis. 2017;23(11):1851. https://dx.doi.org/10.3201/eid2311.ET2311
  AMA	Henry R. Etymologia: Legionella pneumophila. Emerging Infectious Diseases. 2017;23(11):1851. doi:10.3201/eid2311.ET2311.
  APA	Henry, R. (2017). Etymologia: Legionella pneumophila. Emerging Infectious Diseases, 23(11), 1851. https://dx.doi.org/10.3201/eid2311.ET2311.

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Conference Summaries

• Evidence-Based Options for Controlling Respiratory Virus Transmission
  B. J. Cowling et al.
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Corrections

• Correction: Vol. 23, No. 9 PDF Version [PDF - 253 KB - 1 page]
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  EID	Correction: Vol. 23, No. 9. Emerg Infect Dis. 2017;23(11):1937. https://dx.doi.org/10.3201/eid2311.C12311
  AMA	Correction: Vol. 23, No. 9. Emerging Infectious Diseases. 2017;23(11):1937. doi:10.3201/eid2311.C12311.
  APA	(2017). Correction: Vol. 23, No. 9. Emerging Infectious Diseases, 23(11), 1937. https://dx.doi.org/10.3201/eid2311.C12311.

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• Correction: Vol. 23, No. 9 PDF Version [PDF - 253 KB - 1 page]
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  EID	Correction: Vol. 23, No. 9. Emerg Infect Dis. 2017;23(11):1937. https://dx.doi.org/10.3201/eid2311.C22311
  AMA	Correction: Vol. 23, No. 9. Emerging Infectious Diseases. 2017;23(11):1937. doi:10.3201/eid2311.C22311.
  APA	(2017). Correction: Vol. 23, No. 9. Emerging Infectious Diseases, 23(11), 1937. https://dx.doi.org/10.3201/eid2311.C22311.

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