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MMWR Morb Mortal Wkly Rep ; 68(33): 713-717, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31437141


In September 2018, CDC identified Salmonella enterica serotype Newport (Newport) infections that were multidrug resistant (MDR), with decreased susceptibility to azithromycin, a recommended oral treatment agent. Until 2017, decreased susceptibility to azithromycin had occurred in fewer than 0.5% of Salmonella isolates from U.S. residents. This report summarizes the investigation of a multistate MDR Salmonella outbreak conducted by CDC, state and local health departments, and the U.S. Department of Agriculture's Food Safety and Inspection Service. During June 2018-March 2019, 255 cases of infection with the outbreak strain were identified in 32 states; 43% of patients (89 of 206 with information on travel) reported recent travel to Mexico. Infections were linked to consumption of soft cheese obtained in Mexico and beef obtained in the United States. Consumers should avoid eating soft cheese that could be made from unpasteurized milk, regardless of the source of the cheese. When preparing beef, a food thermometer should be used to ensure that appropriate cooking temperatures are reached. When antibiotic treatment is needed for a patient, clinicians should choose antibiotics based on susceptibility testing wherever possible.

Azitromicina/farmacologia , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queijo/microbiologia , Criança , Pré-Escolar , Feminino , Microbiologia de Alimentos , Humanos , Lactente , Masculino , México , Pessoa de Meia-Idade , Carne Vermelha/microbiologia , Salmonella/genética , Intoxicação Alimentar por Salmonella/tratamento farmacológico , Doença Relacionada a Viagens , Estados Unidos/epidemiologia , Adulto Jovem
Clin Infect Dis ; 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31247064


BACKGROUND: Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, four California residents, from two adjacent counties, were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California. METHODS: We interviewed suspected botulism patients and their families, inspected the suspect establishment and collected suspect food, and tested patient sera, stool, and gastric aspirates by mouse bioassay for BoNT and/or culture for C. botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives by direct mouse bioassay and culture, and performed whole genome sequencing on food and clinical isolates. RESULTS: In April-May 2017, ten patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; seven required mechanical ventilation, and one died. Of nine patients with available information, all visited Gas Station X before illness onset where eight reported consuming a commercial nacho cheese sauce. BoNT/A and/or BoNT/A-producing Clostridiumbotulinum were detected from each patient and leftover cheese sauce. C. botulinum isolates from four patients were closely related to cheese sauce isolates by whole genome high quality single nucleotide polymorphism analysis. No other botulism cases associated with this nacho cheese sauce were reported elsewhere in the United States. CONCLUSIONS: This large foodborne botulism outbreak in California was caused by consumption of commercial nacho cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the source of the outbreak. The cheese sauce was likely locally contaminated although the mechanism is unclear.

MMWR Morb Mortal Wkly Rep ; 67(15): 443-446, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29672479


In January 2017, CDC identified a cluster of Salmonella enterica serotype Newport infections with isolates sharing an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern, JJPX01.0010 (pattern 10), through PulseNet, the national molecular subtyping network for foodborne disease surveillance. This report summarizes the investigation by CDC, state and local health and agriculture departments, and the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) and discusses the possible role of dairy cows as a reservoir for strains of Salmonella that persistently cause human illness. This investigation combined epidemiologic and whole genome sequencing (WGS) data to link the outbreak to contaminated ground beef; dairy cows were hypothesized to be the ultimate source of Salmonella contamination.

Surtos de Doenças , Carne/microbiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bovinos , Criança , Pré-Escolar , Feminino , Microbiologia de Alimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Salmonella enterica/genética , Salmonella enterica/isolamento & purificação , Estados Unidos/epidemiologia , Adulto Jovem
Transplantation ; 97(9): 881-9, 2014 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-24827763


We describe four solid-organ transplant recipients with donor-derived West Nile virus (WNV) infection (encephalitis 3, asymptomatic 1) from a common donor residing in a region of increased WNV activity. All four transplant recipients had molecular evidence of WNV infection in their serum and/or cerebrospinal fluid (CSF) by reverse transcription polymerase chain reaction (RT-PCR) testing. Serum from the organ donor was positive for WNV IgM but negative for WNV RNA, whereas his lymph node and spleen tissues tested positive for WNV by RT-PCR. Combination therapy included intravenous immunoglobulin (4 cases), interferon (3 cases), fresh frozen plasma with WNV IgG (2 cases), and ribavirin (1 case). Two of the four transplant recipients survived.Review of the 20 published cases of organ-derived WNV infection found that this infection is associated with a high incidence of neuroinvasive disease (70%) and severe morbidity and mortality (30%). Median time to onset of symptomatic WNV infection was 13 days after transplantation (range 5-37 days). Initial unexplained fever unresponsive to antibiotic therapy followed by rapid onset of neurologic deficits was the most common clinical presentation. Confirmation of infection was made by testing serum and CSF for both WNV RNA by RT-PCR and WNV IgM by serological assays. Treatment usually included supportive care, reduction of immunosuppression, and frequent intravenous immunoglobulin. The often negative results for WNV by current RT-PCR and serological assays and the absence of clinical signs of acute infection in donors contribute to the sporadic occurrence of donor-derived WNV infection. Potential organ donors should be assessed for unexplained fever and neurological symptoms, particularly if they reside in areas of increased WNV activity.

Transplante de Órgãos/efeitos adversos , Doadores de Tecidos , Febre do Nilo Ocidental/complicações , Anticorpos Antivirais/sangue , Humanos , Imunoglobulina M/imunologia , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Transplante de Pulmão/efeitos adversos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Baço/patologia , Febre do Nilo Ocidental/sangue , Febre do Nilo Ocidental/líquido cefalorraquidiano , Febre do Nilo Ocidental/terapia , Vírus do Nilo Ocidental