Synopsis for July 28, 2006

The MMWR is embargoed until Thursday, 12 PM EST.

1. Multidrug Resistant Cual-Tropic HIV-1 Infection in an Antiretroviral-Naïve Man Who Had Sex with Men – New York City, 2004-2005
2. Heat-Related Deaths – United States, 1999-2003
3. Chagas Disease After Organ Transplantation – Los Angeles, CA 2006

Multidrug Resistant Cual-Tropic HIV-1 Infection in an Antiretroviral-Naïve Man Who Had Sex with Men – New York City, 2004-2005

This article describes the final results of the investigation of an unusual strain of HIV diagnosed in a New York City man in late 2004.  The strain was resistant to multiple drugs in three classes of HIV medications, and the patient experienced rapid progression of his infection to AIDS.  Because the patient reported multiple sexual partners prior to his diagnosis, the New York City Health Department immediately initiated efforts to identify and offer testing to his sexual contacts and to assess the prevalence of this strain in the New York City region.  The investigation identified three other patients with the same strain of HIV, all of whom engaged in similar high-risk behaviors at many of the same places during the same time periods as the index patient. All four men are currently clinically stable on complex treatment regimens.  Researchers were unable to determine if the rapid disease progression in the index patient was the result of the particular strain or other factors, and information was not sufficient to determine the rate of disease progression in the other patients.  These cases underscore the importance of HIV prevention. HIV remains incurable and can progress rapidly to life-threatening illness in some individuals.  Transmission of virus that is difficult to treat is increasing, and efforts to monitor the rate and types of transmitted resistance are critical to guide HIV treatment strategies.

Heat-Related Deaths – United States, 1999-2003

All heat-related illnesses and deaths are preventable.  By understanding the risks of heat related death and taking preventive measures, people can reduce their risk of heat-related death. 

 Most heat-related deaths occur during the summer months, when high ambient temperatures overcome the body’s natural ability to cope with heat. The elderly, very young children and persons with chronic medical conditions (especially cardiovascular disease) are at highest risk.  In this report CDC data were used to determine the number of deaths from 1999 to 2003 that were the result of exposure to excessive natural heat recorded as the underlying cause or hypothermia recorded as a contributing factor.  If exposure to extreme heat cannot be avoided, prevention measures should include reducing strenuous activities, frequently drinking water or nonalcoholic fluids and avoiding direct sun light.  Parents should never leave children alone in cars. Persons at risk for heat-related death should be frequently checked by caregivers to evaluate for symptoms of heat-related illness.

Chagas Disease After Organ Transplantation – Los Angeles, CA 2006

Medical personnel should be aware that Chagas disease is one of the possible infectious risks associated with organ transplantation. Additionally, physicians and laboratorians should maintain a high index of suspicion for T. cruzi infection in transplant and transfusion recipients who exhibit complications of an unknown etiology when more common sources have been excluded. 

Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease is endemic primarily in Latin America and has occurred following organ transplantation in both Latin America and the United States. This report describes two cases in the United States of T. cruzi infection associated with heart transplantation from two different donors. It is recommended that physicians and laboratorians maintain a high index of suspicion for T. cruzi infection in transplant and transfusion recipients who exhibit complications of an unknown etiology when more common sources have been excluded, so that treatment can begin promptly.

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