Cryptococcus gattii infection in solid organ transplant recipients: description of Oregon outbreak cases.

Cryptococcus gattii was recognized as an emerging infection in the Pacific Northwest in 2004. Out of 62 total infections in Oregon since the outbreak, 11 were in solid organ transplant (SOT) recipients. SOT recipients were more likely to have disseminated disease and higher mortality than normal hosts, who mostly had isolated mass lesions. The median time from transplantation to C. gattii diagnosis was 17.8 months. The primary sites of infection were lung (n = 4), central nervous system (n = 3), or both (n = 4). The Oregon-endemic strain, VGII (subtypes IIa and IIc) was present in 10 of 11 patients; the median fluconazole minimum inhibitory concentration (MIC) was 12 µg/mL (range 2-32 µg/mL) for this strain. We found C. gattii infection among organ transplant recipients was disseminated at diagnosis, had low cerebrospinal fluid cryptococcal antigen titers, and was associated with an elevated fluconazole MIC and high attributable mortality.

Pathology and viral antigen distribution of lethal pneumonia in domestic cats due to pandemic (H1N1) 2009 influenza A virus.

A novel swine-origin H1N1 influenza A virus has been identified as the cause of the 2009 influenza pandemic in humans. Since then, infections with the pandemic (H1N1) 2009 influenza virus have been documented in a number of animal species. The first known cases of lethal respiratory disease associated with pandemic (H1N1) 2009 influenza virus infection in house pets occurred in domestic cats in Oregon. A 10-year-old neutered domestic shorthair and an 8-year-old spayed domestic shorthair died shortly after developing severe respiratory disease. Grossly, lung lobes of both cats were diffusely firm and incompletely collapsed. Histologically, moderate to severe necrotizing to pyonecrotizing bronchointerstitial pneumonia was accompanied by serofibrinous exudation and hyaline membranes in the alveolar spaces. Influenza A virus was isolated from nasal secretions of the male cat and from lung homogenate of the female cat. Both isolates were confirmed as pandemic (H1N1) 2009 influenza virus by real-time reverse transcriptase polymerase chain reaction. With immunohistochemistry, influenza A viral antigen was demonstrated in bronchiolar epithelial cells, pneumocytes, and alveolar macrophages in pneumonic areas. The most likely sources of infection were people in the household with influenza-like illness or confirmed pandemic (H1N1) 2009 influenza. The 2 cases reported here provide, to the best of the authors' knowledge, the first description of the pathology and viral antigen distribution of lethal respiratory disease in domestic cats after natural pandemic (H1N1) 2009 influenza virus infection, probably transmitted from humans.

A nosocomial outbreak of fluoroquinolone-resistant salmonella infection.

BACKGROUND: Infection with fluoroquinolone-resistant strains of salmonella is rare, as is nosocomial salmonella infection. We describe the first recognized outbreak of fluoroquinolone-resistant salmonella infections in the United States, which occurred in two nursing homes and one hospital in Oregon. METHODS: We interviewed medical staff and reviewed patients' charts and death certificates. In Nursing Home A we conducted a case-control study. Patients were defined as residents of the nursing home from whom fluoroquinolone-resistant Salmonella enterica serotype Schwarzengrund was isolated between February 1996 and December 1998. Controls were residents with similar medical conditions whose cultures did not yield salmonella. We compared isolates using pulsed-field gel electrophoresis and sequence analysis. We reviewed pharmacy records to compare the use of fluoroquinolone among several nursing homes. RESULTS: Eleven patients with fluoroquinolone-resistant salmonellosis were identified at two nursing homes. The index patient had been hospitalized in the Philippines and had probably acquired the infection there. Transmission was probably direct (from patient to patient) or through contact with contaminated surfaces. Treatment with fluoroquinolones during the six months before a culture was obtained was associated with a significant risk of salmonella infection (4 of 5 patients had taken fluoroquinolones, as compared with 2 of 13 controls; odds ratio, 22.0; 95 percent confidence interval, 1.06 to 1177). The patients were not significantly more likely than the controls to have taken other antibiotics. More fluoroquinolones were used at Nursing Home A than at similar nursing homes in Oregon. The isolates from the outbreak had similar patterns on pulsed-field gel electrophoresis and the same gyrA mutations. The isolates from the outbreak were also similar to the only previous isolate of fluoroquinolone-resistant salmonella in the United States, which came from a patient in New York who had been transferred from a hospital in the Philippines. CONCLUSIONS: We describe a prolonged nosocomial outbreak of infection with fluoroquinolone-resistant S. enterica serotype Schwarzengrund. More such outbreaks are likely in institutional settings, particularly those in which there is heavy use of antimicrobial agents.

Consumer acceptance of irradiated meat and poultry in the United States.

Food manufacturers in the United States are currently allowed to irradiate raw meat and poultry to control microbial pathogens and began marketing irradiated beef products in mid-2000. Consumers can reduce their risk of foodborne illness by substituting irradiated meat and poultry for nonirradiated products, particularly if they are more susceptible to foodborne illness. The objective of this study was to identify the individual characteristics associated with willingness to buy irradiated meat and poultry, with a focus on five risk factors for foodborne illness: unsafe food handling and consumption behavior, young and old age, and compromised immune status. A logistic regression model of willingness to buy irradiated meat or poultry was estimated using data from the 1998-1999 FoodNet Population Survey, a single-stage random-digit dialing telephone survey conducted in seven sites covering 11% of the U.S. population. Nearly one-half (49.8%) of the 10,780 adult respondents were willing to buy irradiated meat or poultry. After adjusting for other factors, consumer acceptance of these products was associated with male gender, greater education, higher household income, food irradiation knowledge, household exposure to raw meat and poultry, consumption of animal flesh, and geographic location. However, there was no difference in consumer acceptance by any of the foodborne illness risk factors. It is unclear why persons at increased risk of foodborne illness were not more willing to buy irradiated products, which could reduce the hazards they faced from handling or undercooking raw meat or poultry contaminated by microbial pathogens.

Rabies in a vaccinated wolf-dog hybrid.

In March 1993, an 11-month-old neutered male wolf-dog hybrid with a 5-day history of progressive neurologic signs was determined to have rabies. The animal was currently vaccinated for rabies with a USDA-approved canine rabies vaccine. One month prior to becoming ill, the animal was observed carrying a dead skunk in its enclosure in a rabies-endemic foothills region of northern California. The diagnosis was made by direct fluorescent antibody testing and confirmed by use of polymerase chain reaction methods when attempts to isolate rabies virus failed. Seven people required rabies postexposure prophylactic treatment. No rabies vaccine is currently licensed for use in wild animals or in wild-domestic animal hybrids in the United States. A documented case of rabies in a wolf-dog hybrid vaccinated with a USDA-approved canine rabies vaccine underscores the public safety issues faced by veterinarians caring for wild-domestic animal hybrids.

Changing trends in the epidemiology of human brucellosis in California from 1973 to 1992: a shift toward foodborne transmission.

From 1973 through 1992, 426 cases of human brucellosis were reported in California, of which 98% were laboratory confirmed. Brucella melitensis was identified in 185 cases (78.7% of the bacteriologically typed cases). Hispanics accounted for 81% of the cases from 1983 to 1992 compared with 65% during the previous decade (P < .01). The population-adjusted average annual incidence was higher in Hispanics, especially in children and teenagers, compared with non-Hispanic whites and African Americans. Slaughterhouse cases decreased from 25% during 1973-1982 to < 3% during the following decade. Changes in case distribution were characterized by a decreasing incidence in the Central Valley and an increasing incidence in the San Francisco Bay area and the southern Coast Range. Hispanics were more likely to report being infected by consumption of milk and cheese in Mexico during 1983-1992 than during the previous 10 years (relative risk, 1.45). Between 1973 and 1992, human brucellosis in California evolved from an occupational to a foodborne illness.