November 2014

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 20, No. 11, (November 2014)


The articles of interest summarized below will appear in the October 2014 issues of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature emerging pathogens. The articles are embargoed until October 15, 2014, at 12 p.m. EDT.

Note: Not all articles published in EID represent work done at CDC. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC”). The opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated.

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1. Drug-Resistant Candida glabrata Infection in Cancer Patients, Dimitrios Farmakiotis et al. 

Patients with cancer are at risk for fungal infection because of the indwelling medical devices, surgery, immune-suppressing drugs, or antibacterial drugs needed to treat the cancer-associated infections. One such infection is caused by the fungal organism Candida. The species that commonly infects cancer patients is Candida glabrata, which is becoming resistant to many antifungal drugs. An investigation into what is causing this emerging drug resistance identified several risk factors: previous exposure to an antifungal drug (cross-resistance), having a cancer of the blood, use of a breathing machine (ventilator), having too few monocytes (a type of white blood cell), and needing intravenous feeding. Some of these risk factors cannot be avoided, but one that can is overuse use of antifungal drugs (such as prescribing a drug not laboratory-proven to be needed). Thus, one key to preventing fungal infections in cancer patients is careful and appropriate use of antifungal drugs.


Dimitrios P. Kontoyiannis, MD, ScD
Frances King Black Endowed Professor
M.D. Anderson Medical Center, Houston, Texas

2. Seroprevalence of Norovirus Genogroup IV Antibodies among Humans, Italy, 2010–2011, Barbara Di Martino et al. 

The word “norovirus” often conjures up images of an outbreak among people in close quarters, such as on cruise ships. But noroviruses also infect animals, such as dogs and cats.  It was recently shown that noroviruses can be transmitted from humans to dogs. Is the reverse also possible?  According to a recent analysis of blood samples from humans in Italy, it might be. Although the blood samples most commonly contained the “human” norovirus genotype (IV.1), they also contained the “animal” genotype (IV.2). This finding indicates that the evolution of human and animal noroviruses is tightly intermingled, probably as a result of a long history of social interactions between humans and domesticated pets. Transmission of norovirus from animals to humans, should it occur, would have far-reaching consequences for human health and food safety.


Barbara Di Martino
Faculty of Veterinary Medicine
University of Teramo, Italy

3. Legionnaires’ Disease Incidence and Risk Factors, New York, New York, USA, 2002–2011, Andrea Farnham et al.

Legionnaires’ disease is on the rise; in New York City during 2002–2009, new cases increased by 230%. This bacterial disease is transmitted by inhaling contaminated water droplets. Known risk factors are underlying medical conditions (smoking, chronic obstructive pulmonary disease, diabetes, weakened immune system, age older than 50, receipt of a transplant or chemotherapy), travel, residence in a health care facility, and proximity to contaminated water in cooling towers, whirlpool spas, decorative fountains, and grocery produce misters. But can socioeconomic status or job also put a person at risk?  A recent study indicates that the answer might be yes. In New York City, most cases occurred in people who lived in high-poverty areas and/or worked in the fields of transportation, repair, protective services, cleaning, or construction.  If those associations are confirmed, cases could be reduced by better maintenance of cooling towers and water systems in buildings in these areas and by providing personal protective equipment for people who work at high-risk jobs.

Contact Sharon Balter via:

Press Office
New York City Department of Health and Mental Hygiene

4. Foodborne Illness, Australia, Circa 2000–Circa 2010, Martyn Kirk et al. and Sequelae Due to 5 Pathogens Acquired from Contaminated Food, Australia, Circa 2010, Laura Ford et al. 

Foodborne illness is a problem for many reasons.  Not only do patients, their employers, and the health care industry pay the price, but food businesses and entire industries can suffer as well. Even after patients have recovered from their illness, complications (sequelae) can occur, such as hemolytic-uremic syndrome, Guillain-Barré syndrome, irritable bowel syndrome, and reactive arthritis. Knowing the extent of the problem is helpful for those who create food safety policies and regulations, and knowing how the problem is changing over time tells them whether the policies and regulations are working. Thus, Australia recently updated its estimates of new foodborne illness cases (incidence), hospitalizations, deaths, and complications and compared them over a 10-year period. From 2000 to 2010, the number of all foodborne illnesses combined decreased, but the number of some individual illnesses (salmonellosis and campylobacteriosis) increased. In 2010, campylobacteriosis alone was responsible for 80% of all new cases of chronic sequelae following foodborne illness. Among illnesses that decreased over time were rotavirus infections and hepatitis A, reflecting successful vaccination programs.  All but 1 of the sequelae mentioned previously have increased during the past 10 years, corresponding directly with the increases in salmonellosis and campylobacteriosis. In Australia, additional focus on preventing campylobacteriosis might help reduce the overall burden of foodborne illnesses and their sequelae.

Contact (for both articles):

Martyn Kirk
National Centre for Epidemiology and Population Health
Research School of Population Health
The Australian National University, Canberra, Australia
+61 2 6125 5609
+61 4 2613 2181


5. Mycobacterium ulceransInfection Imported from Australia to Missouri, USA, 2012, Benjamin Stuart Thomas et al. 

Mycobacterium ulcerans infection (also called Buruli ulcer) is a localized infection of the skin and surrounding tissue; ulcers usually form on the arms or legs. This infection most commonly occurs in sub-Saharan Africa, but it also occurs in subtropical and nontropical regions such as Australia and Japan. It is rare in the United States. Most Buruli ulcers can be cured if detected and treated early. However, a condition that is extremely rare in a given country might escape diagnosis for a while, as happened for a patient in Missouri, USA. This patient, who had recently emigrated to the United States after living in Australia, had symptoms for about eight months before a correct diagnosis was made. It took more than year for his skin ulcers to be treated and healed. When diagnosing unusual or nonresponsive skin infections, doctors in the United States should consider their patients’ travel history and the possibility that they might have acquired their infection in another country.


Benjamin Stuart Thomas
Washington University School of Medicine, St. Louis, MO
Sarah George
Division of Infectious Diseases, Allergy, and Immunology
Saint Louis University and St. Louis VA Health Care System


Page last reviewed: September 9, 2014