Seroprevalence of Baylisascaris procyonis Infection among Humans, Santa Barbara County, California, USA, 2014-2016.

Baylisascaris procyonis (raccoon roundworm) infection is common in raccoons and can cause devastating pathology in other animals, including humans. Limited information is available on the frequency of asymptomatic human infection. We tested 150 adults from California, USA, for B. procyonis antibodies; 11 were seropositive, suggesting that subclinical infection does occur.

Burnout Mediates the Association Between Workaholism and Substance Use: Findings from a French National Company.

To examine the mediation effect of burnout on the association between workaholism and tobacco and alcohol use. A total of 2199 workers from the French national electricity company fulfilled an online questionnaire. Smoking status, alcohol use disorder based on the Alcohol Use Disorders Identification Test-Consumption and workaholism based on the Work Addiction Risk Test were used as binary variables. Burnout was assessed as a continuous variable with the Copenhagen Burn-Out Inventory. Mediation analyses tested the direct effect of the associations between workaholism and each substance use, as well as the indirect effect passing through burnout, while adjusting for sociodemographic factors (gender, age, occupational grade and marital life), work stress using the effort-reward imbalance and overcommitment. When testing the mediation effect of burnout on the relation between workaholism and smoking, there was a significant direct effect of workaholism on smoking (Estimated effect of 0.27 [95% CI 0.01; 0.54]) and a significant indirect effect passing through burnout (Estimated effect of 0.09 [95% CI 0.02; 0.15]). When testing the mediation effect of burnout on the relation between workaholism and alcohol use, the direct effect of workaholism on alcohol use was not significant (Estimated effect of 0.21 [95% CI - 0.01; 0.44]) while the indirect effect passing through burnout was significant (Estimated effect of 0.10 [95% CI 0.04; 0.17]). Information and prevention regarding substance use should be reinforced among workers exposed to workaholism, especially if their workaholism led to a high level of burnout. Preventing the emergence of burnout among workaholics might have some benefits on their tobacco and alcohol use.

Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome.

We review Pneumocystis carinii pneumonia (PCP) in patients in the developing world (i.e., Africa, Asia, the Philippines, and Central and South America) who have acquired immunodeficiency disease (AIDS). During the first decade of the AIDS pandemic, PCP rarely occurred in African adults. More recent reports have noted that PCP comprises a significantly greater percentage of cases of pneumonia than it did in the past. This trend dramatically contrasts with that observed in industrialized nations, where a reduction in the number of cases of PCP has occurred as a result of the widespread use of primary P. carinii prophylaxis and highly active antiretroviral therapy. Throughout the developing world, the rate of coinfection with Mycobacterium tuberculosis and PCP is high, ranging from 25% to 80%. Initiation of treatment when PCP is in an advanced stage may account for the high mortality rates (20%-80%) associated with pediatric PCP in the developing world.

Chylothorax caused by Paragonimus westermani in a native Californian.

Paragonimiasis is a parasitic infection endemic in Asia but uncommon in the United States. It presents most frequently with cough and hemoptysis. Pleural effusions are common and can manifest occasionally as a pseudochylothorax, but a true chylothorax has, to our knowledge, never been reported. We report a case of a chylothorax from infection with Paragonimus westermani. The case is also unique because it occurred in a native Californian who had not traveled to Asia and was infected by eating raw crabs at a local sushi restaurant. The freshwater crabs had been imported from Asia.

West Nile encephalitis, status epilepticus and West Nile pneumonia in a renal transplant patient.

West Nile neuroinvasive disease (WNND) represents a small fraction of cases of West Nile Virus (WNV) infection. Organ transplantation is associated with increased risk of acquiring WNND. We report a patient with living-related renal transplantation who developed unusual manifestations of WNND. First, fatal status epilepticus unresponsive to pentobarbital ensued. Status epilepticus from WNV has been described very rarely in the medical literature. Second, this patient grew WNV on broncho-alveolar lavage samples. To our knowledge, this is the first case of culture positive West Nile pneumonia. Third, the finding in cerebrospinal fluid (CSF) of a negative West Nile immunoglobulin M (IgM) and a positive West Nile polymerase chain reaction is striking. It is consistent with a high-viral burden and impaired immune response. This finding raises questions about the appropriateness of relying on CSF IgM assays to rapidly diagnose WNV encephalitis in organ transplant patients, as has been recommended.

Increase in prevalence of Pneumocystis carinii mutations in patients with AIDS and P. carinii pneumonia, in the United States and China.

This study of Pneumocystis carinii dihydropteroate synthase (DHPS) mutations in patients with AIDS who have P. carinii pneumonia compares the change in the prevalence of such mutations in the United States, where sulfa-drug prophylaxis is widespread, to that in China, where it is infrequent. The DHPS gene from 145 US patients presenting during 1983-2001 and from 15 Chinese patients presenting during 1998-2001 was amplified by polymerase chain reaction and was sequenced. In the United States, 40% of patients had DHPS mutations; 38% received sulfa-drug prophylaxis. Mutation prevalence increased to 70% during 2000-2001, from 25% during 1994-1995 (P<.01). In China, 7% of patients had DHPS mutations; none received sulfa-drug prophylaxis. The prevalence of P. carinii DHPS mutations has markedly increased in the United States but remains low in China.