August 2018
EMERGING
INFECTIOUS DISEASES®
Highlights: Emerging Infectious Diseases, Vol. 24, No. 8, August 2018
The articles of interest summarized below will appear in the August 2018 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. The articles are embargoed until July 11, 2018, at Noon Eastern Time.
Important Note: Not all articles that EID publishes represent work done at CDC or by CDC staff. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC in the EID journal”). Opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated.
1. Brucellosis in Dogs and Public Health Risk, Martha E. Hensel et al.
Brucellosis is a disease caused by Brucella bacteria of several species. Different species tend to infect different animals. B. abortus infects domestic livestock (cattle, bison, and elk); B. melitensis, goats and sheep; B. ovis, sheep; and B. suis, caribou and pigs. Some Brucella species infect certain marine mammals. Most humans who get brucellosis get it from dairy animals or dairy products (like raw milk, yogurt, cheese). Another species, B. canis, infects dogs and humans. In dogs, it can cause reproductive failure; in humans, it can cause fever, chills, malaise, and enlarged lymph nodes and spleen. People can acquire B. canis infection through direct contact with infected dogs or their reproductive or blood products. Laboratory personnel, veterinarians, and animal caretakers are at increased risk for exposure. Human infection with B. canis has been thought to occur infrequently; however, this assumption may stem from lack of requirements that cases be reported and lack of diagnostic tests specific for B. canis (for dogs and humans). A recent study that evaluated blood samples, transmission of B. canis, and reporting requirements determined that brucellosis occurs in dogs in many parts of the world. The researchers concluded that without stronger intervention measures, brucellosis will probably remain an underrecognized threat to human health and animal welfare. They believe that improved (more specific) diagnostic tests for humans and dogs will help inform policies to prevent the spread of disease and that a good first step would be implementation of mandatory testing of dogs before they are shipped between states or countries.
Contact: Martha Hensel, Texas A&M University, phone: (678) 372-6278; email: mhensel@cvm.tamu.edu.
2. Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015, Elise M. O’Connell et al.
Hookworms can infect animals and people (nearly half a million people worldwide are infected). A growing concern is resistance to treatment, resulting from use of just one class of drug in both human and veterinary medicine. Infection can be acquired through the skin (e.g., walking barefoot on contaminated soil) or inadvertent ingestion of hookworm-contaminated feces. Typically, people have most commonly been infected with two species of hookworm (Necator americanus and Ancylostoma duodenale). However, a survey of US-bound refugees from Myanmar revealed a high level of infection with only one of these two species (N. americanus) and a lower level of infection with another species, Ancylostoma ceylanicum, which also infects dogs and cats. While the N. americanus hookworms were not cured as easily as expected with the mainstay drug used for treatment (although they did not contain the resistant mutation seen in similar worms in veterinary medicine), the A. ceylanicum hookworms were more easily treated. The researchers concluded that human infection with A. ceylanicum hookworms might be more common than previously recognized and recommend surveying the level of A. ceylanicum hookworm infection among local cat and dog populations to determine the extent of their contribution to human infection.
Contact: National Institute of Allergy and Infectious Diseases, Office of Communications (301) 402-1663.
3. Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone, Patrick J. Howlett et al.
Surviving Ebola virus infection is challenging enough, but the struggle doesn’t stop there. A suspicion that some survivors experience nervous system problems was confirmed by a recent study. Of 361 survivors of the 2014–16 Ebola epidemic in Sierra Leone, 35 were identified as experiencing neurologic sequelae, including migraines, strokes, sensory deficits, and psychiatric disorders (e.g., depression or anxiety). The most severely affected patients experienced blindness, deafness, localized weakness, and cognitive dysfunction. The disability and mental health problems that follow Ebola virus infection indicate a need to train specialists in affected regions so they can provide support for these survivors.
Contact: University of Liverpool, Liverpool, L69 3BX, United Kingdom, Phone: +44 (0)151 794 8356, Email: Simon.Wood@liverpool.ac.uk.
4. Enhanced Surveillance for Coccidioidomycosis, 14 US States, 2016,, Kaitlin Benedict et al.
Coccidioidomycosis (also known as Valley fever) is an infection caused by inhalation of the soil-dwelling fungus Coccidioides. About 40% of infections result in symptoms, which typically are flu-like symptoms, such as fever, cough, and body aches. A small proportion of patients have severe, often life-threatening disease affecting the lungs and other parts of the body. In the United States, most cases occur in people who live in Arizona and California. Because much remains unknown about its epidemiology in other states, researchers conducted surveillance in 14 U.S. states in 2016 by identifying cases and interviewing patients about their demographic characteristics, symptoms, and exposures. They found that delays in diagnosis, unnecessary use of antibacterial drugs, and prolonged illness occurred frequently. They also found that most patients reported travel to areas where Coccidioides lives. The researchers argue that greater awareness nationwide among clinicians and the public about coccidioidomycosis is required to minimize delays in diagnosis and appropriate treatment.
Contact: CDC Media Relations, phone: 404-639-3286 or email: media@cdc.gov.
5. Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions,, Marcelo A. Barria et al.
Chronic wasting disease (CWD) is a contagious and fatal neurodegenerative disease and a serious animal health issue for deer and elk in North America. It might also be a public health issue. The recent discovery of CWD among free-ranging reindeer and moose in Europe prompted a group of researchers to revisit the unresolved issue of whether CWD can spread from animals to humans, as can bovine spongiform encephalopathy (so-called mad cow disease). Both diseases are caused by prions, misfolded protein particles that are detected in the neural tissue of infected animals. The researchers, funded by the Department of Health and Social Care and the Government of Scotland, found that CWD prions from cervids (e.g., elk, white-tailed deer, and reindeer) in North America can convert the human brain prion protein in a test tube into the disease-associated form but that the efficiency of conversion is affected by variation in the cervid and human prion protein genes. Given the similarity of North American cervids to those in Europe, the researchers underscore the need for a more comprehensive and thorough assessment of whether CWD can cross the species barrier and infect humans.
Contact: Marcelo A. Barria, National CJD Research and Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, UK; phone: +44 (0)131 537 1980 or email: Marcelo.Barria@ed.ac.uk.
6. Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome,, Nipunie S. Rajapakse et al.
Since the onset of the Zika virus outbreak in Brazil in 2015, multiple publications have described the devastating central nervous system [brain and spinal cord] effects of congenital Zika virus infection (when the infection is present at birth). However, to learn more about the possible effects of congenital Zika virus infection on the peripheral nervous system (about which much less is known than effects on the central nervous system), researchers have described four infants with congenital Zika syndrome who suffered from paralysis of the diaphragm (the set of muscles used to breath in and out) associated with dysfunction of the phrenic nerve. This paralysis suggests that the peripheral nervous system may be involved and that Zika virus is the cause. All four patients also had arthrogryposis (a congenital joint contracture deriving from Greek, literally meaning “curving of joints”) and died from complications related to progressive respiratory failure. This unique association of clinical findings and Zika virus infection has not been described for other congenital infections. The presence of paralysis of the diaphragm might represent a risk for early death among infants born with congenital Zika syndrome.
Contact:Kelley Luckstein, Mayo Clinic; phone: 507-284-5005 or email: newsbureau@mayo.edu.
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