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Medscape CME Activity

Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn CME credit. In support of improving patient care, these activities have been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CME credit is available for one year after publication.

Active CME Articles


Expires 6/17/2023
Medscape CME Activity
Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States [PDF - 498 KB - 8 pages]
A. Irish et al.

We combined American Community Survey data with age-specific Trypanosoma cruzi prevalence derived from US surveys and World Health Organization reports to yield estimates of Chagas disease in the United States, which we mapped at the local level. In addition, we used blood donor data to estimate the relative prevalence of autochthonous T. cruzi infection. Our estimates indicate that 288,000 infected persons, including 57,000 Chagas cardiomyopathy patients and 43,000 infected reproductive-age women, currently live in the United States; 22–108 congenital infections occur annually. We estimated ≈10,000 prevalent cases of locally acquired T. cruzi infection. Mapping shows marked geographic heterogeneity of T. cruzi prevalence and illness. Reliable demographic and geographic data are key to guiding prevention and management of Chagas disease. Population-based surveys in high prevalence areas could improve the evidence base for future estimates. Knowledge of the demographics and geographic distribution of affected persons may aid practitioners in recognizing Chagas disease.

EID Irish A, Whitman JD, Clark EH, Marcus R, Bern C. Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States. Emerg Infect Dis. 2022;28(7):1313-1320. https://doi.org/10.3201/eid2807.212221
AMA Irish A, Whitman JD, Clark EH, et al. Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States. Emerging Infectious Diseases. 2022;28(7):1313-1320. doi:10.3201/eid2807.212221.
APA Irish, A., Whitman, J. D., Clark, E. H., Marcus, R., & Bern, C. (2022). Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States. Emerging Infectious Diseases, 28(7), 1313-1320. https://doi.org/10.3201/eid2807.212221.

Expires 6/16/2023
Medscape CME Activity
Natural History of and Dynamic Changes in Clinical Manifestation, Serology, and Treatment of Brucellosis, China [PDF - 1.63 MB - 6 pages]
H. Wang et al.

Serum agglutination test plus exposure history were used to diagnose most cases of human brucellosis in 2 China provinces. After appropriate treatment, 13.3% of acute brucellosis cases progressed to chronic disease; arthritis was an early predictor. Seropositivity can persist after symptoms disappear, which might cause physicians to subjectively extend therapeutic regimens.

EID Wang H, Liu H, Zhang Q, Lu X, Li D, Zhang H, et al. Natural History of and Dynamic Changes in Clinical Manifestation, Serology, and Treatment of Brucellosis, China. Emerg Infect Dis. 2022;28(7):1460-1465. https://doi.org/10.3201/eid2807.211766
AMA Wang H, Liu H, Zhang Q, et al. Natural History of and Dynamic Changes in Clinical Manifestation, Serology, and Treatment of Brucellosis, China. Emerging Infectious Diseases. 2022;28(7):1460-1465. doi:10.3201/eid2807.211766.
APA Wang, H., Liu, H., Zhang, Q., Lu, X., Li, D., Zhang, H....Zhang, W. (2022). Natural History of and Dynamic Changes in Clinical Manifestation, Serology, and Treatment of Brucellosis, China. Emerging Infectious Diseases, 28(7), 1460-1465. https://doi.org/10.3201/eid2807.211766.

Expires 5/23/2023
Medscape CME Activity
Antimicrobial-Resistant Shigella spp. in San Diego, California, USA, 2017–2020 [PDF - 1.11 MB - 7 pages]
T. Gaufin et al.

Annually, Shigella spp. cause ≈188 million cases of diarrheal disease globally, including 500,000 cases in the United States; rates of antimicrobial resistance are increasing. To determine antimicrobial resistance and risk factors in San Diego, California, USA, we retrospectively reviewed cases of diarrheal disease caused by Shigella flexneri and S. sonnei diagnosed during 2017–2020. Of 128 evaluable cases, S. flexneri was slightly more common than S. sonnei; most cases were in persons who were gay or bisexual cisgender men, were living with HIV, were unhoused, or used methamphetamines. Overall, rates of resistance to azithromycin, fluoroquinolones, ampicillin, and trimethoprim/sulfamethoxazole (TMP/SMX) were comparable to the most recent national data reported from the Centers for Disease Control and Prevention; 55% of isolates were resistant to azithromycin, 23% to fluoroquinolones, 70% to ampicillin, and 83% to TMP/SMX. The rates that we found for TMP/SMX were slightly higher than those in national data.

EID Gaufin T, Blumenthal J, Ramirez-Sanchez C, Mehta S, Pride DT, Fierer J, et al. Antimicrobial-Resistant Shigella spp. in San Diego, California, USA, 2017–2020. Emerg Infect Dis. 2022;28(6):1110-1116. https://doi.org/10.3201/eid2806.220131
AMA Gaufin T, Blumenthal J, Ramirez-Sanchez C, et al. Antimicrobial-Resistant Shigella spp. in San Diego, California, USA, 2017–2020. Emerging Infectious Diseases. 2022;28(6):1110-1116. doi:10.3201/eid2806.220131.
APA Gaufin, T., Blumenthal, J., Ramirez-Sanchez, C., Mehta, S., Pride, D. T., Fierer, J....Jenks, J. D. (2022). Antimicrobial-Resistant Shigella spp. in San Diego, California, USA, 2017–2020. Emerging Infectious Diseases, 28(6), 1110-1116. https://doi.org/10.3201/eid2806.220131.

Expires 5/20/2023
Medscape CME Activity
Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA [PDF - 724 KB - 10 pages]
F. A. Ramadan et al.

Demographic and clinical indicators have been described to support identification of coccidioidomycosis; however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected coccidioidomycosis in emergency departments and inpatient units in Coccidioides-endemic regions. We aimed to develop a predictive model among participants with suspected coccidioidomycosis. We applied a least absolute shrinkage and selection operator to specific coccidioidomycosis predictors and developed univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a statistically significant predictive feature of coccidioidomycosis in both inpatient and outpatient settings. Our multivariable outpatient model also identified rash (adjusted odds ratio 9.74 [95% CI 1.03–92.24]; p = 0.047) as a predictor. Our results suggest preliminary support for developing a coccidioidomycosis prediction model for use in clinical settings.

EID Ramadan FA, Ellingson KD, Canales RA, Bedrick EJ, Galgiani JN, Donovan FM. Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA. Emerg Infect Dis. 2022;28(6):1091-1100. https://doi.org/10.3201/eid2806.212311
AMA Ramadan FA, Ellingson KD, Canales RA, et al. Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA. Emerging Infectious Diseases. 2022;28(6):1091-1100. doi:10.3201/eid2806.212311.
APA Ramadan, F. A., Ellingson, K. D., Canales, R. A., Bedrick, E. J., Galgiani, J. N., & Donovan, F. M. (2022). Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA. Emerging Infectious Diseases, 28(6), 1091-1100. https://doi.org/10.3201/eid2806.212311.

Expires 4/18/2023
Medscape CME Activity
Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019 [PDF - 854 KB - 9 pages]
L. E. Nabarro et al.

Healthcare-associated invasive group A Streptococcus (iGAS) outbreaks are common worldwide, but only England has reported outbreaks associated with home healthcare (HHC). We describe 10 outbreaks during 2018–2019 in England. A total of 96 iGAS cases (range 2–39 per outbreak) and 28 deaths (case-fatality rate 29%) occurred. Outbreak duration ranged from 3–517 days; median time between sequential cases was 20.5 days (range 1–225 days). Outbreak identification was difficult, but emm typing and whole-genome sequencing improved detection. Network analyses indicated multiple potential transmission routes. Screening of 366 HHC workers from 9 outbreaks identified group A Streptococcus carriage in just 1 worker. Outbreak control required multiple interventions, including improved infection control, equipment decontamination, and antimicrobial prophylaxis for staff. Transmission routes and effective interventions are not yet clear, and iGAS outbreaks likely are underrecognized. To improve patient safety and reduce deaths, public health agencies should be aware of HHC-associated iGAS.

EID Nabarro LE, Brown CS, Balasegaram S, Decraene V, Elston J, Kapadia S, et al. Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019. Emerg Infect Dis. 2022;28(5):915-923. https://doi.org/10.3201/eid2805.211497
AMA Nabarro LE, Brown CS, Balasegaram S, et al. Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019. Emerging Infectious Diseases. 2022;28(5):915-923. doi:10.3201/eid2805.211497.
APA Nabarro, L. E., Brown, C. S., Balasegaram, S., Decraene, V., Elston, J., Kapadia, S....Lamagni, T. (2022). Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019. Emerging Infectious Diseases, 28(5), 915-923. https://doi.org/10.3201/eid2805.211497.

Expires 4/15/2023
Medscape CME Activity
Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017 [PDF - 520 KB - 8 pages]
G. Peirano et al.

We describe the global molecular epidemiology of 229 carbapenemase-producing Escherichia coli in 36 countries during 2015–2017. Common carbapenemases were oxacillinase (OXA) 181 (23%), New Delhi metallo-β-lactamase (NDM) 5 (20%), OXA-48 (17%), Klebsiella pneumoniae carbapenemase 2 (15%), and NDM-1 (10%). We identified 5 dominant sequence types (STs); 4 were global (ST410, ST131, ST167, and ST405), and 1 (ST1284) was limited to Turkey. OXA-181 was frequent in Jordan (because of the ST410-B4/H24RxC subclade) and Turkey (because of ST1284). We found nearly identical IncX3-blaOXA-181 plasmids among 11 STs from 12 countries. NDM-5 was frequent in Egypt, Thailand (linked with ST410-B4/H24RxC and ST167-B subclades), and Vietnam (because of ST448). OXA-48 was common in Turkey (linked with ST11260). Global K. pneumoniae carbapenemases were linked with ST131 C1/H30 subclade and NDM-1 with various STs. The global carbapenemase E. coli population is dominated by diverse STs with different characteristics and varied geographic distributions, requiring ongoing genomic surveillance.

EID Peirano G, Chen L, Nobrega D, Finn TJ, Kreiswirth BN, DeVinney R, et al. Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017. Emerg Infect Dis. 2022;28(5):924-931. https://doi.org/10.3201/eid2805.212535
AMA Peirano G, Chen L, Nobrega D, et al. Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017. Emerging Infectious Diseases. 2022;28(5):924-931. doi:10.3201/eid2805.212535.
APA Peirano, G., Chen, L., Nobrega, D., Finn, T. J., Kreiswirth, B. N., DeVinney, R....Pitout, J. (2022). Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017. Emerging Infectious Diseases, 28(5), 924-931. https://doi.org/10.3201/eid2805.212535.

Expires 3/22/2023
Medscape CME Activity
Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis [PDF - 2.53 MB - 11 pages]
K. Ogrinc et al.

Lyme neuroborreliosis (LNB) in Europe may manifest with painful meningoradiculoneuritis (also known as Bannwarth syndrome) or lymphocytic meningitis with or without cranial neuritis (peripheral facial palsy). We assessed host immune responses and the prevalence of TLR1 (toll-like receptor 1)–1805GG polymorphism to gain insights into the pathophysiology of these conditions. Regardless of LNB manifestation, most mediators associated with innate and adaptive immune responses were concentrated in cerebrospinal fluid; serum levels were unremarkable. When stratified by specific clinical manifestation, patients with meningoradiculoneuritis had higher levels of B-cell chemoattractants CXC motif chemokine ligand (CXCL) 12 and CXCL13 and T-cell–associated mediators CXCL9, CXCL10, and interleukin 17, compared with those without radicular pain. Moreover, these patients had a higher frequency of TLR1–1805GG polymorphism and more constitutional symptoms. These findings demonstrate that meningoradiculoneuritis is a distinct clinical entity with unique immune and genetic pathophysiology, providing new considerations for the study of LNB and borrelial meningoradiculitis.

EID Ogrinc K, Hernández SA, Korva M, Bogovič P, Rojko T, Lusa L, et al. Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerg Infect Dis. 2022;28(4):766-776. https://doi.org/10.3201/eid2804.211831
AMA Ogrinc K, Hernández SA, Korva M, et al. Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerging Infectious Diseases. 2022;28(4):766-776. doi:10.3201/eid2804.211831.
APA Ogrinc, K., Hernández, S. A., Korva, M., Bogovič, P., Rojko, T., Lusa, L....Strle, K. (2022). Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerging Infectious Diseases, 28(4), 766-776. https://doi.org/10.3201/eid2804.211831.

Expires 3/17/2023
Medscape CME Activity
Shewanella spp. Bloodstream Infections in Queensland, Australia [PDF - 1.07 MB - 6 pages]
K. B. Laupland et al.

The epidemiology of bloodstream infections caused by Shewanella spp. is not well defined. Our objective was to define the incidence and determinants of Shewanella spp. bloodstream infections by using population-based surveillance in Queensland, Australia during 2000‒2019. The incidence was 1.0 cases/1 million persons annually and was highest during summer and in the tropical Torres and Cape region. Older persons and male patients were at highest risk. At least 1 concurrent condition was documented in 75% of case-patients, and 30-day all cause case-fatality rate was 15%. Aging populations in warm climates might expect an increasing burden of these infections.

EID Laupland KB, Stewart AG, Edwards F, Paterson DL, Coulter S, Heney C, et al. Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerg Infect Dis. 2022;28(4):701-706. https://doi.org/10.3201/eid2804.212193
AMA Laupland KB, Stewart AG, Edwards F, et al. Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerging Infectious Diseases. 2022;28(4):701-706. doi:10.3201/eid2804.212193.
APA Laupland, K. B., Stewart, A. G., Edwards, F., Paterson, D. L., Coulter, S., Heney, C....Harris, P. (2022). Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerging Infectious Diseases, 28(4), 701-706. https://doi.org/10.3201/eid2804.212193.

Expires 2/17/2023
Medscape CME Activity
Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA [PDF - 984 KB - 9 pages]
R. A. Livingston et al.

Enterovirus D68 (EV-D68) causes severe respiratory illness outbreaks among children, particularly those with asthma. We previously detected neutralizing antibodies against the predominant EV-D68 B1 clade in the 2014 outbreak in serum collected before the outbreak (2012–2013) from persons 24 months to 85 years of age. We recently detected neutralizing antibodies to the 2014 B1, B2, and D clade viruses in serum collected after the 2014 outbreak (April–May 2017) from 300 children 6 months to 18 years of age. B1 virus neutralizing antibodies were found in 100% of patients, even children born after 2014; B2 in 84.6%, and D in 99.6%. In 2017, titers increased with patient age and were higher than titers in 2012–2013 from comparably aged children. Rate of seronegativity was highest (15.3%) for B2 virus. Multivariate analysis revealed an association between asthma and higher titers against B2 and D viruses. EV-D68 seems to have circulated during 2014–2017.

EID Livingston RA, Harrison CJ, Selvarangan R. Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerg Infect Dis. 2022;28(3):539-547. https://doi.org/10.3201/eid2803.211467
AMA Livingston RA, Harrison CJ, Selvarangan R. Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases. 2022;28(3):539-547. doi:10.3201/eid2803.211467.
APA Livingston, R. A., Harrison, C. J., & Selvarangan, R. (2022). Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases, 28(3), 539-547. https://doi.org/10.3201/eid2803.211467.

Expires 2/17/2023
Medscape CME Activity
Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018 [PDF - 3.45 MB - 12 pages]
A. E. Barskey et al.

Reported Legionnaires’ disease (LD) cases began increasing in the United States in 2003 after relatively stable numbers for >10 years; reasons for the rise are unclear. We compared epidemiologic patterns associated with cases reported to the Centers for Disease Control and Prevention before and during the rise. The age-standardized average incidence was 0.48 cases/100,000 population during 1992–2002 compared with 2.71 cases/100,000 in 2018. Reported LD incidence increased in nearly every demographic, but increases tended to be larger in demographic groups with higher incidence. During both periods, the largest number of cases occurred among White persons, but the highest incidence was in Black or African American persons. Incidence and increases in incidence were generally largest in the East North Central, Middle Atlantic, and New England divisions. Seasonality was more pronounced during 2003–2018, especially in the Northeast and Midwest. Rising incidence was most notably associated with increasing racial disparities, geographic focus, and seasonality.

EID Barskey AE, Derado G, Edens C. Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerg Infect Dis. 2022;28(3):527-538. https://doi.org/10.3201/eid2803.211435
AMA Barskey AE, Derado G, Edens C. Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerging Infectious Diseases. 2022;28(3):527-538. doi:10.3201/eid2803.211435.
APA Barskey, A. E., Derado, G., & Edens, C. (2022). Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerging Infectious Diseases, 28(3), 527-538. https://doi.org/10.3201/eid2803.211435.

Expires 1/21/2023
Medscape CME Activity
Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement [PDF - 2.09 MB - 11 pages]
P. Bogovič et al.

Information on febrile illness caused by tick-borne encephalitis virus (TBEV) without central nervous system involvement is limited. We characterized 98 patients who had TBEV RNA in their blood but no central nervous system involvement at the time of evaluation. Median duration of illness was 7 days; 37 (38%) patients were hospitalized. The most frequent findings were malaise or fatigue (98%), fever (97%), headache (86%), and myalgias (54%); common laboratory findings were leukopenia (88%), thrombocytopenia (59%), and abnormal liver test results (63%). During the illness, blood leukocyte counts tended to improve, whereas thrombocytopenia and liver enzymes tended to deteriorate. At the time of positive PCR findings, 0/98 patients had serum IgG TBEV and 7 serum IgM TBEV; all patients later seroconverted. Viral RNA load was higher in patients with more severe illness but did not differ substantially in relation to several other factors. Illness progressed to tick-borne encephalitis in 84% of patients within 18 days after defervescence.

EID Bogovič P, Kastrin A, Lotrič-Furlan S, Ogrinc K, Županc T, Korva M, et al. Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement. Emerg Infect Dis. 2022;28(2):291-301. https://doi.org/10.3201/eid2802.211661
AMA Bogovič P, Kastrin A, Lotrič-Furlan S, et al. Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement. Emerging Infectious Diseases. 2022;28(2):291-301. doi:10.3201/eid2802.211661.
APA Bogovič, P., Kastrin, A., Lotrič-Furlan, S., Ogrinc, K., Županc, T., Korva, M....Strle, F. (2022). Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement. Emerging Infectious Diseases, 28(2), 291-301. https://doi.org/10.3201/eid2802.211661.

Expires 1/20/2023
Medscape CME Activity
Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016 [PDF - 995 KB - 9 pages]
E. M. Bloch et al.

Babesia spp. are tickborne parasites that cause the clinical infection babesiosis, which has an increasing incidence in the United States. We performed an analysis of hospitalizations in the United States during 2010–2016 in which babesiosis was listed as a diagnosis. We used the National Inpatient Sample database to characterize the epidemiology of Babesia–associated admissions, reflecting severe Babesia-related disease. Over a 7-year period, a total of 7,818 hospitalizations listed babesiosis as a primary or secondary admitting diagnosis. Hospitalizations were seasonal (71.2% occurred during June–August) and situated overwhelmingly in the Northeast and Midwest. The patients were predominantly male and of advanced age, which is consistent with the expected epidemiology. Despite a higher severity of illness in more than (58.5%), the mortality rate was low (1.6%). Comparison with state reporting data suggests that the number of hospitalized persons with babesiosis increased modestly during the observation period.

EID Bloch EM, Day JR, Krause PJ, Kjemtrup A, O’Brien SF, Tobian A, et al. Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016. Emerg Infect Dis. 2022;28(2):354-362. https://doi.org/10.3201/eid2802.210213
AMA Bloch EM, Day JR, Krause PJ, et al. Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016. Emerging Infectious Diseases. 2022;28(2):354-362. doi:10.3201/eid2802.210213.
APA Bloch, E. M., Day, J. R., Krause, P. J., Kjemtrup, A., O’Brien, S. F., Tobian, A....Goel, R. (2022). Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016. Emerging Infectious Diseases, 28(2), 354-362. https://doi.org/10.3201/eid2802.210213.

Expires 12/17/2022
Medscape CME Activity
Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007–2020 [PDF - 1.83 MB - 6 pages]
C. Kaeuffer et al.

Rare fungal pathogens are emerging as agents of invasive fungal infections. We analyzed 13 cases of fungal infections caused by Kazachstania (Arxiozyma) spp. in Strasbourg University Hospital, Strasbourg, France. Among the cases, 4 patients had proven fungal disease (3 cases of invasive fungal disease and 1 mucocutaneous infection) and 9 were colonized by Kazachstania (Arxiozyma) spp. Candida albicans was also isolated from 11 of the 13 patients. None of the patients with proven invasive fungal disease met host criteria, but most had underlying diseases. All strains were identified as K. telluris by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and 3 were confirmed as K. bovina by internal transcribed spacer sequencing. For all tested strains, the MICs for fluconazole were >2 μg/mL. Emergence of this rare fungal infection might be explained by the increasing number of patients with immunocompromised conditions and gastroesophageal diseases.

EID Kaeuffer C, Baldacini M, Ruge T, Ruch Y, Zhu Y, De Cian M, et al. Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007–2020. Emerg Infect Dis. 2022;28(1):29-34. https://doi.org/10.3201/eid2801.211543
AMA Kaeuffer C, Baldacini M, Ruge T, et al. Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007–2020. Emerging Infectious Diseases. 2022;28(1):29-34. doi:10.3201/eid2801.211543.
APA Kaeuffer, C., Baldacini, M., Ruge, T., Ruch, Y., Zhu, Y., De Cian, M....Danion, F. (2022). Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007–2020. Emerging Infectious Diseases, 28(1), 29-34. https://doi.org/10.3201/eid2801.211543.

Expires 12/14/2022
Medscape CME Activity
Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018 [PDF - 1.54 MB - 9 pages]
L. J. Walker et al.

Since 2012, the United States has reported a distinct syndrome of acute flaccid paralysis (AFP) with anterior myelitis, predominantly in children. This polio-like syndrome was termed acute flaccid myelitis (AFM). Australia routinely conducts AFP surveillance to exclude poliomyelitis. We reviewed 915 AFP cases in Australia for children <15 years of age during 2000‒2018 and reclassified a subset to AFM by using the US Council of State and Territorial Epidemiologists case definition. We confirmed 37 AFM cases by using magnetic resonance imaging findings and 4 probable AFM cases on the basis of cerebrospinal fluid pleocytosis. Nonpolio enteroviruses were detected in 33% of AFM cases from which stool samples were tested. Average annual AFM incidence was 0.07 cases/100,000 person-years in children <15 years of age. AFM occurred sporadically in Australia before 2010 but regularly since then, indicating sustained, albeit rare, clinical manifestation in children. The AFP surveillance system in Australia is well-positioned to identify future AFM cases.

EID Walker LJ, Thorley BR, Morris A, Elliott EJ, Saul N, Britton PN. Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018. Emerg Infect Dis. 2022;28(1):20-28. https://doi.org/10.3201/eid2801.211690
AMA Walker LJ, Thorley BR, Morris A, et al. Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018. Emerging Infectious Diseases. 2022;28(1):20-28. doi:10.3201/eid2801.211690.
APA Walker, L. J., Thorley, B. R., Morris, A., Elliott, E. J., Saul, N., & Britton, P. N. (2022). Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018. Emerging Infectious Diseases, 28(1), 20-28. https://doi.org/10.3201/eid2801.211690.

Expires 11/18/2022
Medscape CME Activity
Trends in Incidence and Clinical Outcomes of Clostridioides difficile Infection, Hong Kong [PDF - 1.31 MB - 9 pages]
C. Guo et al.

We conducted a territorywide survey to investigate the epidemiology, risk factors, and clinical outcomes of Clostridioides difficile infection (CDI) among hospitalized patients in Hong Kong. A total of 17,105 cases of CDI were identified, of which 15,717 (91.9%) were healthcare-associated and 1,025 (6.0%) were community-associated. Although CDI incidence increased substantially from 2006 to 2017, it plateaued in 2018 and 2019. The 30-day mortality rates decreased from 20.1% in 2015 to 16.8% in 2019, whereas the 60-day recurrence rates remained constant at ≈11% during the study period. Cross-correlation statistic showed significant correlations between incidence trend and overall antimicrobial drug use (r = 0.865, p<0.001), which has decreased as a result of an antibiotic stewardship program initiated in 2017. Our data suggest a turning point in C. difficile epidemiology that could be related to the changing pattern of antimicrobial drug use.

EID Guo C, Kwong T, Mak J, Zhang L, Lui G, Wong G, et al. Trends in Incidence and Clinical Outcomes of Clostridioides difficile Infection, Hong Kong. Emerg Infect Dis. 2021;27(12):3036-3044. https://doi.org/10.3201/eid2712.203769
AMA Guo C, Kwong T, Mak J, et al. Trends in Incidence and Clinical Outcomes of Clostridioides difficile Infection, Hong Kong. Emerging Infectious Diseases. 2021;27(12):3036-3044. doi:10.3201/eid2712.203769.
APA Guo, C., Kwong, T., Mak, J., Zhang, L., Lui, G., Wong, G....Wong, S. H. (2021). Trends in Incidence and Clinical Outcomes of Clostridioides difficile Infection, Hong Kong. Emerging Infectious Diseases, 27(12), 3036-3044. https://doi.org/10.3201/eid2712.203769.

Expires 11/17/2022
Medscape CME Activity
Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014–2020 [PDF - 998 KB - 7 pages]
R. Yamamuro et al.

To determine differences in clinical characteristics of patients with bacteremia caused by Corynebacterium striatum, C. jeikeium, and other species of Corynebacterium, we retrospectively reviewed medical records of patients in Japan who had Corynebacterium bacteremia during January 2014–May 2020. Of the 115 records evaluated, 60 (52%) were cases of true bacteremia and 55 (48%) were cases of contamination. Proportions of true bacteremia cases caused by C. striatum (70%) and by C. jeikeium (71%) were significantly higher than those caused by other species of Corynebacterium (9%). These 2 organisms were commonly detected in blood cultures of patients with hematologic malignancies and neutropenia. The mortality rates at 90 days were 34% (C. striatum), 30% (C. jeikeium), and 0 (other species). Given the high mortality rates, assessing true bacteremia when C. striatum or C. jeikeium is detected in blood cultures, especially in patients with hematologic malignancy, is warranted.

EID Yamamuro R, Hosokawa N, Otsuka Y, Osawa R. Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014–2020. Emerg Infect Dis. 2021;27(12):2981-2987. https://doi.org/10.3201/eid2712.210473
AMA Yamamuro R, Hosokawa N, Otsuka Y, et al. Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014–2020. Emerging Infectious Diseases. 2021;27(12):2981-2987. doi:10.3201/eid2712.210473.
APA Yamamuro, R., Hosokawa, N., Otsuka, Y., & Osawa, R. (2021). Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014–2020. Emerging Infectious Diseases, 27(12), 2981-2987. https://doi.org/10.3201/eid2712.210473.

Expires 10/13/2022
Medscape CME Activity
Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States [PDF - 1.10 MB - 8 pages]
S. J. Mowla et al.

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997–2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.

EID Mowla SJ, Drexler NA, Cherry CC, Annambholta PD, Kracalik IT, Basavaraju SV. Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerg Infect Dis. 2021;27(11):2768-2775. https://doi.org/10.3201/eid2711.211127
AMA Mowla SJ, Drexler NA, Cherry CC, et al. Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerging Infectious Diseases. 2021;27(11):2768-2775. doi:10.3201/eid2711.211127.
APA Mowla, S. J., Drexler, N. A., Cherry, C. C., Annambholta, P. D., Kracalik, I. T., & Basavaraju, S. V. (2021). Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerging Infectious Diseases, 27(11), 2768-2775. https://doi.org/10.3201/eid2711.211127.

Expires 9/20/2022
Medscape CME Activity
Relapsing Fever Infection Manifesting as Aseptic Meningitis, Texas, USA [PDF - 2.81 MB - 5 pages]
L. Ellis et al.

Tickborne relapsing fever spirochetes are an overlooked cause of disease around the globe. We report a case of tickborne relapsing fever in a patient in Texas, USA, who had a single febrile episode and gastrointestinal and neurologic symptoms. Immunoblot analysis using recombinant Borrelia immunogenic protein A implicated Borrelia turicatae as the causative agent.

EID Ellis L, Curtis MW, Gunter SM, Lopez JE. Relapsing Fever Infection Manifesting as Aseptic Meningitis, Texas, USA. Emerg Infect Dis. 2021;27(10):2681-2685. https://doi.org/10.3201/eid2710.210189
AMA Ellis L, Curtis MW, Gunter SM, et al. Relapsing Fever Infection Manifesting as Aseptic Meningitis, Texas, USA. Emerging Infectious Diseases. 2021;27(10):2681-2685. doi:10.3201/eid2710.210189.
APA Ellis, L., Curtis, M. W., Gunter, S. M., & Lopez, J. E. (2021). Relapsing Fever Infection Manifesting as Aseptic Meningitis, Texas, USA. Emerging Infectious Diseases, 27(10), 2681-2685. https://doi.org/10.3201/eid2710.210189.

Expires 9/17/2022
Medscape CME Activity
Recurrence of Human Babesiosis Caused by Reinfection [PDF - 721 KB - 4 pages]
J. Ho et al.

Babesiosis developed in a 62-year-old immunocompetent physician, who had an uneventful recovery after receiving atovaquone and azithromycin. Three years later, babesiosis developed again, and he was again successfully given treatment. Clinical and laboratory evidence were highly supportive of Babesia reinfection. Healthcare professionals should be aware that reinfection might occur in babesiosis.

EID Ho J, Carey E, Carey DE, Krause PJ. Recurrence of Human Babesiosis Caused by Reinfection. Emerg Infect Dis. 2021;27(10):2658-2661. https://doi.org/10.3201/eid2710.211240
AMA Ho J, Carey E, Carey DE, et al. Recurrence of Human Babesiosis Caused by Reinfection. Emerging Infectious Diseases. 2021;27(10):2658-2661. doi:10.3201/eid2710.211240.
APA Ho, J., Carey, E., Carey, D. E., & Krause, P. J. (2021). Recurrence of Human Babesiosis Caused by Reinfection. Emerging Infectious Diseases, 27(10), 2658-2661. https://doi.org/10.3201/eid2710.211240.

Expires 9/15/2022
Medscape CME Activity
Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018 [PDF - 2.78 MB - 10 pages]
K. Kontula et al.

We evaluated the incidence, outcomes, and causative agents of bloodstream infections (BSI) in Finland during 2004–2018 by using data from the national registries. We identified a total of 173,715 BSIs; annual incidence increased from 150 to 309 cases/100,000 population. BSI incidence rose most sharply among persons >80 years of age. The 1-month case-fatality rate decreased from 13.0% to 12.6%, but the 1-month all-cause mortality rate rose from 20 to 39 deaths/100,000 population. BSIs caused by Escherichia coli increased from 26% to 30% of all BSIs. BSIs caused by multidrug-resistant microbes rose from 0.4% to 2.8%, mostly caused by extended-spectrum β-lactamase-producing E. coli. We observed an increase in community-acquired BSIs, from 67% to 78%. The proportion of patients with severe underlying conditions rose from 14% to 23%. Additional public health and healthcare prevention efforts are needed to curb the increasing trend in community-acquired BSIs and antimicrobial drug–resistant E. coli.

EID Kontula K, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerg Infect Dis. 2021;27(10):2560-2569. https://doi.org/10.3201/eid2710.204826
AMA Kontula K, Skogberg K, Ollgren J, et al. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerging Infectious Diseases. 2021;27(10):2560-2569. doi:10.3201/eid2710.204826.
APA Kontula, K., Skogberg, K., Ollgren, J., Järvinen, A., & Lyytikäinen, O. (2021). Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerging Infectious Diseases, 27(10), 2560-2569. https://doi.org/10.3201/eid2710.204826.

Expires 8/16/2022
Medscape CME Activity
Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy [PDF - 1.04 MB - 9 pages]
A. Berardi et al.

We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.

EID Berardi A, Spada C, Creti R, Auriti C, Gambini L, Rizzo V, et al. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis. 2021;27(9):2279-2287. https://doi.org/10.3201/eid2709.210049
AMA Berardi A, Spada C, Creti R, et al. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerging Infectious Diseases. 2021;27(9):2279-2287. doi:10.3201/eid2709.210049.
APA Berardi, A., Spada, C., Creti, R., Auriti, C., Gambini, L., Rizzo, V....Lugli, L. (2021). Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerging Infectious Diseases, 27(9), 2279-2287. https://doi.org/10.3201/eid2709.210049.

Expires 7/21/2022
Medscape CME Activity
Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019 [PDF - 3.33 MB - 10 pages]
S. C. Brown et al.

During 3 weeks in 2019, 4 human cases of Eastern equine encephalitis (EEE) were diagnosed at a single hospital in Connecticut, USA. The cases coincided with notable shifts in vector–host infection patterns in the northeastern United States and signified a striking change in EEE incidence. All 4 cases were geographically clustered, rapidly progressive, and neurologically devastating. Diagnostic tests conducted by a national commercial reference laboratory revealed initial granulocytic cerebrospinal fluid pleocytosis and false-negative antibody results. EEE virus infection was diagnosed only after patient samples were retested by the arbovirus laboratory of the Centers for Disease Control and Prevention in Fort Collins, Colorado, USA. The crucial diagnostic challenges, clinical findings, and epidemiologic patterns revealed in this outbreak can inform future public health and clinical practice.

EID Brown SC, Cormier J, Tuan J, Lier AJ, McGuone D, Armstrong PM, et al. Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019. Emerg Infect Dis. 2021;27(8):2042-2051. https://doi.org/10.3201/eid2708.203730
AMA Brown SC, Cormier J, Tuan J, et al. Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019. Emerging Infectious Diseases. 2021;27(8):2042-2051. doi:10.3201/eid2708.203730.
APA Brown, S. C., Cormier, J., Tuan, J., Lier, A. J., McGuone, D., Armstrong, P. M....Gobeske, K. T. (2021). Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019. Emerging Infectious Diseases, 27(8), 2042-2051. https://doi.org/10.3201/eid2708.203730.

Expires 7/14/2022
Medscape CME Activity
Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements [PDF - 848 KB - 7 pages]
J. Rannikko et al.

Because of widespread use of probiotics, their safety must be guaranteed. We assessed use of Saccharomyces boulardii probiotic yeast from medical records for patients who had Saccharomyces fungemia or other clinical Saccharomyces culture findings. We evaluated all Saccharomyces sp. findings at 5 university hospitals in Finland during 2009–2018. We found 46 patients who had Saccharomyces fungemia; at least 20 (43%) were using S. boulardii probiotic. Compared with a control group that had bacteremia or candidemia, the odds ratio for use of an S. boulardii probiotic was 14 (95% CI 4–44). Of 1,153 nonblood culture findings, the history for 125 patients was checked; at least 24 (19%) were using the probiotic (odds ratio 10, 95% CI 3–32). This study adds to published fungemia cases linked to use of S. boulardii probiotic and sheds light on the scale of nonblood Saccharomyces culture findings that are also linked to use of this probiotic.

EID Rannikko J, Holmberg V, Karppelin M, Arvola P, Huttunen R, Mattila E, et al. Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements. Emerg Infect Dis. 2021;27(8):2043-2051. https://doi.org/10.3201/eid2708.210018
AMA Rannikko J, Holmberg V, Karppelin M, et al. Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements. Emerging Infectious Diseases. 2021;27(8):2043-2051. doi:10.3201/eid2708.210018.
APA Rannikko, J., Holmberg, V., Karppelin, M., Arvola, P., Huttunen, R., Mattila, E....Hohenthal, U. (2021). Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements. Emerging Infectious Diseases, 27(8), 2043-2051. https://doi.org/10.3201/eid2708.210018.

CME Articles by Volume

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