Possible Airborne Person-to-Person Transmission of Mycobacterium bovis - Nebraska 2014-2015.

Mycobacterium bovis, one of several mycobacteria of the M. tuberculosis complex, is a global zoonotic pathogen that primarily infects cattle. Humans become infected by consuming unpasteurized dairy products from infected cows; possible person-to-person airborne transmission has also been reported. In April 2014, a man in Nebraska who was born in Mexico was determined to have extensive pulmonary tuberculosis (TB) caused by M. bovis after experiencing approximately 3 months of cough and fever. Four months later, a U.S.-born Hispanic girl from a nearby town who had been ill for 4-5 months was also determined to have pulmonary TB caused by M. bovis. The only social connection between the two patients was attendance at the same church, and no common dietary exposure was identified. Both patients had pulmonary cavities on radiography and acid-fast bacilli (AFB) on sputum-smear microscopy, indicators of being contagious. Whole-genome sequencing results of the isolates were nearly indistinguishable. Initial examination of 181 contacts determined that 39 (22%) had latent infection: 10 (42%) of 24 who had close exposure to either patient, 28 (28%) of 100 who were exposed to one or both patients in church, and one (2%) of 57 exposed to the second patient at a school. Latent infection was diagnosed in six contacts on follow-up examination, 2 months after an initial negative test result, for an overall latent infection rate of 25%. No infected contacts recalled consuming unpasteurized dairy products, and none had active TB disease at the initial or secondary examination. Persons who have M. bovis TB should be asked about consumption of unpasteurized dairy products, and contact investigations should follow the same guidance as for M. tuberculosis TB.

Patterns of youths' glycemic control with insulin pump therapy.

Youths with type 1 diabetes mellitus may decide to use insulin pump therapy. Limited information describes youths' glycemic control with insulin pump therapy. A repeated-measures design guided data collection at five points from one month before insulin pump therapy through 12 months with insulin pump therapy. The research question was, "How do youths' hemoglobin A(1c) (HbA(1c)) values change with insulin pump therapy?" Glycemic control target was 7.6% HbA(1c) value. Thirty youths (9 to 18 years old) had at least 4 HbA(1c) values. Nineteen youths who achieved glycemic control had three different patterns during 12 months of insulin pump therapy. Eleven youths who did not achieve glycemic control had two different patterns. Multiple factors can influence a youth's glycemic control. Uncontrolled blood glucose levels increase the individual's risk for developing type 1 diabetes complications. Youths and health care providers need to work as a team to identify factors affecting the youth's glycemic control and discuss changes.