Reassortant Cache Valley Virus Associated With Acute Febrile, Nonneurologic Illness, Missouri.

An adult male from Missouri sought care for fever, fatigue, and gastrointestinal symptoms. He had leukopenia and thrombocytopenia and was treated for a presumed tickborne illness. His condition deteriorated with respiratory and renal failure, lactic acidosis, and hypotension. Next-generation sequencing and phylogenetic analysis identified a reassortant Cache Valley virus.

First human rabies case in Missouri in 50 years causes death in outdoorsman.

This report describes the first case of human rabies in Missouri in 50 years that resulted in a patient fatality. Current rabies epidemiology, treatment and management of exposures, and the signs and symptoms and treatment of human rabies is discussed.

ORF virus infection in children: clinical characteristics, transmission, diagnostic methods, and future therapeutics.

Orf virus leads to self-limited, subacute cutaneous infections in children who have occupational or recreational contact with infected small ruminants. Breaches in the integument and contact with animals recently vaccinated for orf may be important risk factors in transmission. Common childhood behaviors are likely important factors in the provocation of significant contact (ie, bites) or in unusual lesion location (eg, facial lesions). Clinician recognition is important in distinguishing orf infection from life-threatening cutaneous zoonoses. Recently developed molecular techniques provide diagnostic precision and newer topical therapeutics may hasten healing.

Diagnosis of West Nile virus infection in horses.

The North American West Nile virus (WNV) epizootic, which began in 1999, has caused significant morbidity and mortality in horses. Because experimental infection has failed to consistently produce encephalitis in inoculated horses, investigation of naturally occurring cases was used to optimize strategies for diagnosis of this disease. Although WNV RNA could be detected by reverse transcriptase-polymerase chain reaction (RT-PCR) performed on whole blood collected from both clinically affected horses and unaffected herdmates, the diagnostic sensitivity of this approach was low compared with IgM-capture enzyme-linked immunosorbent assay. In addition, it was observed that 18.5% of herdmates of clinically ill horses seroconverted to WNV yet exhibited no overt clinical signs of WNV encephalitis. West Nile viral RNA was detected in neural tissue of 46 of 64 dead horses that were suspected of having WNV encephalitis. Some of these animals were IgM negative or had not been tested serologically. A primary cause of death other than WNV encephalitis was identified in 15 of the 64 cases, whereas the final diagnosis for 3 of these cases remains unresolved. Quantitative RT-PCR analysis of neural tissue from WNV RNA-positive horses demonstrated that the medulla contained the highest mean concentration of viral RNA and that WNV RNA could be detected in samples extracted from formalin-fixed neural tissue. A comparison of WNV RT-PCR amplification strategies found that nested RT-PCR improved diagnostic sensitivity only slightly over a single round of amplification and that a quantitative (TaqMan) assay had sensitivity and specificity that were equivalent to those of nested amplification.

An Investigation of a Cluster of Parapoxvirus Cases in Missouri, Feb-May 2006: Epidemiologic, Clinical and Molecular Aspects.

In the spring of 2006, four human cases of parapoxvirus infections in Missouri residents were reported to the Centers for Disease Control and Prevention (CDC), two of which were initially diagnosed as cutaneous anthrax. This investigation was conducted to determine the level of recognition of zoonotic parapoxvirus infections and prevention measures, the degree to which veterinarians may be consulted on human infections and what forces were behind this perceived increase in reported infections. Interviews were conducted and clinical and environmental sampling was performed. Swab and scab specimens were analyzed by real-time polymerase chain reaction (PCR), whereas serum specimens were evaluated for parapoxvirus antibodies. Three case patients were found to have fed ill juvenile animals without using gloves. Forty-six percent of veterinarians reported having been consulted regarding suspected human orf infections. Orf virus DNA was detected from five of 25 asymptomatic sheep. Analysis of extracellular envelope gene sequences indicated that sheep and goat isolates clustered in a species-preferential fashion. Parapoxvirus infections are common in Missouri ruminants and their handlers. Infected persons often do not seek medical care; some may seek advice from veterinarians rather than physicians. The initial perception of increased incidence in Missouri may have arisen from a reporting artifact stemming from heightened concern about anthrax. Asymptomatic parapoxvirus infections in livestock may be common and further investigation warranted.