August 2021

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 27, No. 8, Month 2021

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. EID requests that, when possible, you include a live link to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Ahead of Print section of the EID website at

The articles of interest summarized below will appear in the August 2021 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until July 14, 2021, at 12 p.m. EDT.

1.  Fungemia and other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements, Juha Rannikko et al.

Probiotics are live microorganisms intended to provide health benefits when consumed. One probiotic is the yeast Saccharomyces boulardii, and its use has been associated with fungemia (fungal/yeast infection of the blood). In US hospitals, S. boulardii probiotics are commonly given, especially to elderly patients. To explore the association between taking S. boulardii as a probiotic and development of a Saccharomyces fungemia, researchers examined medical records from 5 hospitals in Finland during 2009–2018. They found that among 46 patients with Saccharomyces fungemia, at least 20 (43%) were taking S. boulardii probiotic. S. boulardii probiotics are thus not recommended for patients at risk for fungemia (e.g., those who have indwelling catheters, are immunocompromised, are critically ill, or whose gastrointestinal tract integrity might be compromised).

Contact: Juha Rannikko, Tampere University Hospital, Tampere, Finland; email:

2.  Comparison of Lyme Disease in the United States and Europe, Adriana R. Marques et al.

Lyme disease is common in many areas of the United States and Europe. In both locations, the causative bacteria, spirochetes of the Borrelia burgdorferi sensu lato complex (genus Borreliella), are transmitted by Ixodes ticks. Despite those similarities, there are some differences in the clinical signs and symptoms of Lyme disease between these regions. The 2 species responsible for most infections in Europe (B. afzelii and B. garinii) are not found in the United States, where most infections are caused by B. burgdorferi. Erythema migrans (the characteristic skin lesion of Lyme disease, usually an expanding, round or oval red patch, sometimes having a bull’s-eye pattern) is more commonly associated with other symptoms (such as fatigue, fever, muscle and/ or joint pains) in the United States than it is in Europe, and certain other skin conditions associated with Lyme disease in Europe do not occur at all in the United States. The typical neurologic sign of early Lyme neuroborreliosis in the United States is facial paralysis (facial nerve palsy); whereas in Europe, it is painful nerve root inflammation (radiculitis). Lyme arthritis (joint inflammation) is more common in the United States. It is likely, but not yet proven, that the clinical differences in Lyme disease between the 2 geographic regions are associated with variation in disease-producing power (virulence) between the different species of Lyme borrelia, and it will be important to study how the specific factors associated with the etiologic agents contribute to these differences.

Contact: NIAID Communications Office. Media email: Media phone: 301-402-1663

3.  Plague Transmission from Corpses and Carcasses, Sophie Jullien et al.

Plague is an ancient disease that has killed millions of people, including one third of the population of Europe during the “Black Death” pandemic in the 14th century. Plague remains a threat in many parts of the world and has been categorized by the World Health Organization as a reemerging disease. Knowing whether human corpses can transmit plague can help subject matter experts develop policies for handling the bodies of those who have died from the disease. Researchers analyzed the scientific literature to evaluate risk for transmitting Yersinia pestis bacteria, the causative agent of plague, from human corpses and animal carcasses. Because they could not find direct evidence of transmission, they hypothesized about possible transmission pathways and assessed the potential for transmission. They examined 3 potential sources of infection: body fluids of living plague patients; infected corpses and carcasses; and body fluids of infected corpses. They concluded that pneumonic plague (a form of plague that primarily infects the lungs) can be transmitted by intensive handling of the corpse or carcass, presumably through inhaling respiratory droplets, and that bubonic plague (named for the swollen lymph nodes or “buboes” that sometimes accompany infection) can be transmitted by blood-to-blood contact with the body fluids of a corpse or carcass. These findings can help subject matter experts develop precautions for healthcare workers, veterinarians, and any persons who are tasked with handling the bodies of persons or animals that died from plague.

Contact: Paul Garner, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine

Sophie Jullien, Institute of Global Health, University of Barcelona, Spain; email:

4.  Epidemiology and Spatial Emergence of Anaplasmosis, New York, USA, 2010‒2018, Alexis Russell et al.

Anaplasmosis is an emerging tickborne disease caused by Anaplasma phagocytophilum bacterium. Initially called human granulocytic ehrlichiosis, human infection with A. phagocytophilum was first described in 1994 in patients from Minnesota and Wisconsin. Now referred to as human granulocytic anaplasmosis or simply anaplasmosis, this infection is characterized by a flu-like illness marked by fever, fatigue, muscle aches, and headache. Although severe complications and death do occur in rare instances, most patients recover fully after treatment with antibiotics. Because New York State has experienced a recent increase in cases, researchers analyzed human case surveillance and tick surveillance data collected by the New York State Department of Health to better understand patterns of disease emergence. A spatial analysis showed an expanding hot spot of anaplasmosis in the Capital District Region surrounding Albany, where prevalence of the disease increased >8-fold during 2010–2018. The prevalence of A. phagocytophilum bacteria increased greatly within tick populations in the Capital District Region over the same period. Those results indicate that anaplasmosis is rapidly emerging in a geographically focused area of New York State. Further assessments of anaplasmosis epidemiology over time and geography will help pinpoint populations at highest risk and anticipate when and where the disease will spread in the future, enabling public health experts to target prevention efforts toward those populations who might benefit the most.

Contact: The NYS Department of Health, Public Affairs Group, or 518-474-7354


Page last reviewed: July 14, 2021