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1.
Emerg Infect Dis ; 27(11): 2768-2775, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34670661

RESUMEN

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997-2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.


Asunto(s)
Anaplasmosis , Ehrlichiosis , Trasplante de Órganos , Anaplasmosis/epidemiología , Animales , Transfusión Sanguínea , Ehrlichiosis/epidemiología , Humanos , Trasplante de Órganos/efectos adversos , Receptores de Trasplantes , Estados Unidos/epidemiología
2.
MMWR Morb Mortal Wkly Rep ; 65(11): 293-4, 2016 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-27010506

RESUMEN

Since 1980, bison have injured more pedestrian visitors to Yellowstone National Park (Yellowstone) than any other animal (1). After the occurrence of 33 bison-related injuries during 1983-1985 (range = 10-13/year), the park implemented successful outreach campaigns (1) to reduce the average number of injuries to 0.8/year (range = 0-2/year) during 2010-2014 (unpublished data, National Park Service, September 2015). During May-July 2015, five injuries associated with bison encounters occurred (Table). Case reports were reviewed to evaluate circumstances surrounding these injuries to inform prevention.


Asunto(s)
Bison , Parques Recreativos , Peatones , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotograbar , Wyoming/epidemiología , Adulto Joven
3.
MMWR Morb Mortal Wkly Rep ; 65(11): 279-81, 2016 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-27010221

RESUMEN

Tuberculosis (TB) is a contagious bacterial disease of global concern. During 2013, an estimated nine million incident TB cases occurred worldwide (1). The majority (82%) were diagnosed in 22 countries, including South Africa and the Philippines, where annual incidence was 860 TB cases per 100,000 persons and 292 TB cases per 100,000 persons, respectively (1). The 2013 TB incidence in the United States was three cases per 100,000 persons (2). Under the Immigration and Nationality Act, TB screening is required for persons seeking permanent residence in the United States (i.e., immigrants and refugees), but it is not routinely required for nonimmigrants who are issued temporary visas for school or work (3). A portion of the U.S. tourism industry relies on temporary visa holders to accommodate seasonal and fluctuating demand for service personnel (4). This report describes three foreign-born persons holding temporary visas who had infectious TB while working at tourist destinations in the United States during 2012-2014. Multiple factors, including dormitory-style housing, transient work patterns, and diagnostic delays might have contributed to increased opportunity for TB transmission. Clinicians in seasonally driven tourist destinations should be aware of the potential for imported TB disease in foreign-born seasonal workers and promptly report suspected cases to health officials.


Asunto(s)
Empleo/estadística & datos numéricos , Personal Profesional Extranjero/estadística & datos numéricos , Industrias , Tuberculosis/diagnóstico , Adulto , Emigración e Inmigración/legislación & jurisprudencia , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo/legislación & jurisprudencia , Persona de Mediana Edad , Filipinas/etnología , Sudáfrica/etnología , Tuberculosis/epidemiología , Estados Unidos/epidemiología , Adulto Joven
4.
MMWR Morb Mortal Wkly Rep ; 65(11): 286-9, 2016 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-27023833

RESUMEN

Zika virus is an emerging mosquito-borne flavivirus. Recent outbreaks of Zika virus disease in the Pacific Islands and the Region of the Americas have identified new modes of transmission and clinical manifestations, including adverse pregnancy outcomes. However, data on the epidemiology and clinical findings of laboratory-confirmed Zika virus disease remain limited. During January 1, 2015-February 26, 2016, a total of 116 residents of 33 U.S. states and the District of Columbia had laboratory evidence of recent Zika virus infection based on testing performed at CDC. Cases include one congenital infection and 115 persons who reported recent travel to areas with active Zika virus transmission (n = 110) or sexual contact with such a traveler (n = 5). All 115 patients had clinical illness, with the most common signs and symptoms being rash (98%; n = 113), fever (82%; 94), and arthralgia (66%; 76). Health care providers should educate patients, particularly pregnant women, about the risks for, and measures to prevent, infection with Zika virus and other mosquito-borne viruses. Zika virus disease should be considered in patients with acute onset of fever, rash, arthralgia, or conjunctivitis, who traveled to areas with ongoing Zika virus transmission (http://www.cdc.gov/zika/geo/index.html) or who had unprotected sex with a person who traveled to one of those areas and developed compatible symptoms within 2 weeks of returning.


Asunto(s)
Brotes de Enfermedades , Viaje , Infección por el Virus Zika/diagnóstico , Virus Zika/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Estados Unidos/epidemiología , Adulto Joven , Infección por el Virus Zika/epidemiología
6.
MMWR Morb Mortal Wkly Rep ; 64(26): 714-8, 2015 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-26158352

RESUMEN

As of July 1, 2015, Guinea, Liberia, and Sierra Leone have reported a total of 27,443 confirmed, probable, and suspected Ebola virus disease (Ebola) cases and 11,220 deaths. Guinea and Sierra Leone have yet to interrupt transmission of Ebola virus. In January, 2016, Liberia successfully achieved Ebola transmission-free status, with no new Ebola cases occurring during a 42-day period; however, new Ebola cases were reported beginning June 29, 2015. Local cultural practices and beliefs have posed challenges to disease control, and therefore, targeted, timely health messages are needed to address practices and misperceptions that might hinder efforts to stop the spread of Ebola. As early as September 2014, Ebola spread to most counties in Liberia. To assess Ebola-related knowledge, attitudes, and practices (KAP) in the community, CDC epidemiologists who were deployed to the counties (field team), carried out a survey conducted by local trained interviewers. The survey was conducted in September and October 2014 in five counties in Liberia with varying cumulative incidence of Ebola cases. Survey results indicated several findings. First, basic awareness of Ebola was high across all surveyed populations (median correct responses = 16 of 17 questions on knowledge of Ebola transmission; range = 2-17). Second, knowledge and understanding of Ebola symptoms were incomplete (e.g., 61% of respondents said they would know if they had Ebola symptoms). Finally, certain fears about the disease were present: >90% of respondents indicated a fear of Ebola patients, >40% a fear of cured patients, and >50% a fear of treatment units (expressions of this last fear were greater in counties with lower Ebola incidence). This survey, which was conducted at a time when case counts were rapidly increasing in Liberia, indicated limited knowledge of Ebola symptoms and widespread fear of Ebola treatment units despite awareness of communication messages. Continued efforts are needed to address cultural practices and beliefs to interrupt Ebola transmission.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Fiebre Hemorrágica Ebola , Características de la Residencia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Recolección de Datos , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/psicología , Fiebre Hemorrágica Ebola/terapia , Humanos , Liberia/epidemiología , Masculino , Persona de Mediana Edad , Adulto Joven
7.
Front Vet Sci ; 11: 1393296, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38774910

RESUMEN

Coxiella burnetii is a bacterial pathogen capable of causing serious disease in humans and abortions in goats. Infected goats can shed C. burnetii through urine, feces, and parturient byproducts, which can lead to infections in humans when the bacteria are inhaled. Goats are important C. burnetii reservoirs as evidenced by goat-related outbreaks across the world. To better understand the current landscape of C. burnetii infection in the domestic goat population, 4,121 vaginal swabs from 388 operations across the United States were analyzed for the presence of C. burnetii by IS1111 PCR as part of the United States Department of Agriculture, Animal Plant Health Inspection Service, Veterinary Services' National Animal Health Monitoring System Goats 2019 Study. In total, 1.5% (61/4121) of swabs representing 10.3% (40/388) (weighted estimate of 7.8, 95% CI 4.4-13.5) of operations were positive for C. burnetii DNA. The quantity of C. burnetii on positive swabs was low with an average Ct of 37.9. Factors associated with greater odds of testing positive included suspected Q fever in the herd in the previous 3 years, the presence of wild deer or elk on the operation, and the utilization of hormones for estrus synchronization. Factors associated with reduced odds of testing positive include the presence of kittens and treatment of herds with high tannin concentrate plants, diatomaceous earth, and tetrahydropyrimidines. In vitro analysis demonstrated an inhibitory effect of the tetrahydropyrimidine, pyrantel pamoate, on the growth of C. burnetii in axenic media as low as 1 µg per mL. The final multivariable logistic regression modeling identified the presence of wild predators on the operation or adjacent property (OR = 9.0, 95% CI 1.3-61.6, p value = 0.0248) as a risk factor for C. burnetii infection.

8.
Zoonoses Public Health ; 69(2): 73-82, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34626097

RESUMEN

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii and can manifest in an acute or chronic form. Many persons with acute Q fever are asymptomatic, but some develop a febrile illness, pneumonia or hepatitis. Chronic infections are rare and occur in less than 5% of persons exposed. Forms of chronic Q fever include endocarditis, infection of vascular grafts or aneurysms, osteomyelitis and osteoarthritis. Acute and chronic Q fever are nationally notifiable diseases, and presented here are the incidence, demographics and distribution of acute and chronic Q fever in the United States during 2008-2017. We summarized passive surveillance data from the Centers for Disease Control and Prevention's (CDC) National Notifiable Diseases Surveillance System (NNDSS) and supplemental case report forms (CRFs). Health departments reported 1,109 cases of acute Q fever and 272 chronic Q fever cases to NNDSS during this period. The 10-year average annual incidence for acute Q fever was 0.36 cases per million persons, and the average annual incidence for chronic Q fever was 0.09. Males accounted for nearly 75% of both acute and chronic Q fever cases. Average annual incidence was highest among persons aged 60-69 years for both acute and chronic Q fever (0.70 cases per million persons and 0.25, respectively). As reported through CRFs, many Q fever cases did not have a known exposure to C. burnetii; 60% (n = 380) of acute Q fever cases did not report exposure to animals in the 2 months before symptom onset. Almost 90% (n = 558) did not report exposure to unpasteurized milk. Only 40% (n = 247) of persons with reported Q fever were employed in high-risk occupations. Even though Q fever is a rare disease in the United States, incidence doubled from 2008 to 2017.


Asunto(s)
Coxiella burnetii , Fiebre Q , Animales , Incidencia , Masculino , Fiebre Q/epidemiología , Fiebre Q/microbiología , Fiebre Q/veterinaria , Estados Unidos/epidemiología , Zoonosis
9.
J Am Vet Med Assoc ; 260(7): 780-788, 2022 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-35175930

RESUMEN

OBJECTIVE: To understand large animal veterinarians' knowledge of select zoonotic diseases that cause livestock abortions and identify barriers to using personal protective equipment (PPE). SAMPLE: A convenience sample of 469 veterinarians currently working with livestock. PROCEDURES: We sent an electronic survey invitation to large animal veterinarians through various veterinary organizations. Respondents answered questions addressing knowledge and prior experience with select abortion-associated zoonotic diseases, resources available for infection control, attitudes and barriers to PPE use, and demographics. RESULTS: Median participant age was 49 years (range, 22 to 82 years), and 54% (235/438) were male. Half of veterinarians (185/348) were contacted 5 or fewer times per year to consult on livestock abortions. No veterinarians surveyed answered all questions on zoonotic disease transmission correctly. Personal protective equipment access varied, from 99% (289/290) having access to gloves to 20% (59/290) having access to respirators. Concerns for spreading disease to other animals (136/289 [47%]) and to other humans (108/287 [38%]) ranked as the most common reported motivators for PPE use. Reported barriers to PPE use among survey participants were the inconvenience of taking PPE into the field (101/286 [35%]) and the inconvenience of wearing PPE (97/286 [34%]). Access to PPE was not correlated with PPE use. CLINICAL RELEVANCE: Surveyed veterinarians had limited knowledge of transmission of select abortion-associated zoonotic diseases. Incomplete understanding might lead to inappropriate PPE selection, preventable disease exposure, or missed opportunities for client education. Inconvenience was a primary reason PPE was not used.


Asunto(s)
Salud Laboral , Veterinarios , Animales , Femenino , Humanos , Masculino , Conocimientos, Actitudes y Práctica en Salud , Ganado , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Zoonosis/prevención & control
10.
Curr Infect Dis Rep ; 22(4)2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-34135692

RESUMEN

PURPOSE OF REVIEW: The non-specific presentation of acute Q fever makes it difficult to diagnose in children, but untreated Q fever can result in chronic infections that have severe complications. RECENT FINDINGS: Pediatric Q fever cases continue to be infrequently reported in the literature, and primarily document cases of persistent infections with Coxiella burnetii. Standardized treatment protocols for chronic Q fever in children still do not exist. Doxycycline and hydroxychloroquine are the treatment combination most utilized by healthcare providers to treat Q fever endocarditis or osteomyelitis in children, but a variety of other antibiotic combinations have been reported with varying results. The use of adjunctive therapies, such as such as interferon gamma, has produced mixed outcomes. SUMMARY: The true impact of Coxiella burnetii on the health of children remains unknown; long-term longitudinal follow-up of children with acute or chronic Q fever has not been reported. Both the acute and chronic forms of Q fever are underreported and underdiagnosed. Healthcare providers should consider Q fever in pediatric patients with culture-negative endocarditis or osteomyelitis.

11.
Zoonoses Public Health ; 67(3): 291-299, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31984654

RESUMEN

Typhus group rickettsioses (TGRs) are vector-borne diseases that include murine typhus (Rickettsia typhi) and epidemic typhus (R. prowazekii). Twentieth-century public health interventions led to dramatic decreases in incidence; little is known about the contemporary TGR prevalence because neither disease is nationally notifiable. We summarized administrative claims data in a commercially insured population to examine trends in TGR medical encounters. We analysed data from 2003 to 2016 IBM® MarketScan® Commercial Databases to identify persons with inpatient or outpatient visits with an International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification TGR-specific code. We summarized epidemiologic characteristics associated with incident diagnosis. We identified 1,799 patients diagnosed with a TGR. Patients resided in 46 states, and most were female (n = 1,019/1,799; 56.6%); the median age was 42 years (range: 0-64 years). Epidemic typhus (n = 931/1,799; 51.8%) was the most common TGRs, followed by murine typhus (n = 722/1,799; 40.1%). The majority of TGR patients were diagnosed in an outpatient setting (n = 1,725/1,799; 95.9%); among hospitalized patients, the majority received a murine typhus diagnosis (n = 67/74; 90.5%). TGRs are rarely diagnosed diseases. More patients were diagnosed with epidemic than murine typhus, even though R. prowazekii transmission requires body louse or flying squirrel exposure. Patients from all geographic regions were diagnosed with murine and epidemic typhus, despite historically recognized ranges for these diseases. The epidemiologic misalignment of insurance claims data versus historic TGRs data highlights the challenges of finding appropriate alternative data sources to serve as a proxy when national surveillance data do not exist.


Asunto(s)
Rickettsiaceae/clasificación , Tifus Endémico Transmitido por Pulgas/microbiología , Tifus Epidémico Transmitido por Piojos/epidemiología , Tifus Epidémico Transmitido por Piojos/microbiología , Adolescente , Adulto , Niño , Preescolar , Bases de Datos como Asunto , Femenino , Humanos , Lactante , Formulario de Reclamación de Seguro , Seguro de Salud , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores de Tiempo , Tifus Endémico Transmitido por Pulgas/epidemiología , Estados Unidos , Adulto Joven
12.
Traffic Inj Prev ; 20(1): 58-63, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30644778

RESUMEN

OBJECTIVES: Nationally, animal-motor vehicle crashes (AVCs) account for 4.4% of all types of motor vehicle crashes (MVCs). AVCs are a safety risk for drivers and animals and many National Park Service (NPS) units (e.g., national park, national monument, or national parkway) have known AVC risk factors, including rural locations and substantial animal densities. We sought to describe conditions and circumstances involving AVCs to guide traffic and wildlife management for prevention of AVCs in select NPS units. METHODS: We conducted an analysis using NPS law enforcement MVC data. An MVC is a collision involving an in-transit motor vehicle that occurred or began on a public roadway. An AVC is characterized as a collision between a motor vehicle and an animal. A non-AVC is a crash between a motor vehicle and any object other than an animal or noncollision event (e.g., rollover crash). The final data for analysis included 54,068 records from 51 NPS units during 1990-2013. Counts and proportions were calculated for categorical variables and medians and ranges were calculated for continuous variables. We used Pearson's chi-square to compare circumstances of AVCs and non-AVCs. Data were compiled at the park regional level; NPS parks are assigned to 1 of 7 regions based on the park's location. RESULTS: AVCs accounted for 10.4% (5,643 of 54,068) of all MVCs from 51 NPS units. The Northeast (2,021 of 5,643; 35.8%) and Intermountain (1,180 of 5,643; 20.9%) regions had the largest percentage of the total AVC burden. November was the peak month for AVCs across all regions (881 of 5,643; 15.6%); however, seasonality varied by park geographic regions. The highest counts of AVCs were reported during fall for the National Capital, Northeast/Southeast, and Northeast regions; winter for the Southeast region; and summer for Intermountain and Pacific West regions. CONCLUSIONS: AVCs represent a public health and wildlife safety concern for NPS units. AVCs in select NPS units were approximately 2-fold higher than the national percentage for AVCs. The peak season for AVCs varied by NPS region. Knowledge of region-specific seasonality patterns for AVCs can help NPS staff develop mitigation strategies for use primarily during peak AVC months. Improving AVC data collection might provide NPS with a more complete understanding of risk factors and seasonal trends for specific NPS units. By collecting information concerning the animal species hit, park managers can better understand the impacts of AVC to wildlife population health.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Animales Salvajes/lesiones , Vehículos a Motor/estadística & datos numéricos , Parques Recreativos , Animales , Humanos , Aplicación de la Ley , Registros , Factores de Riesgo , Población Rural/estadística & datos numéricos , Estaciones del Año , Estados Unidos
13.
Vector Borne Zoonotic Dis ; 19(5): 316-322, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30508402

RESUMEN

Introduction: Tularemia is a zoonotic infection caused by the highly infectious bacterium Francisella tularensis. Persons having outdoor professions are more likely than others to be exposed to F. tularensis through increased contact with arthropods, infected animals, and contaminated aerosols. Materials and Methods: After a tularemia epizootic during July and August 2015 at Devils Tower National Monument and an associated tularemia infection in a park employee, we assessed seroprevalence of F. tularensis antibodies, risk factors for F. tularensis seropositivity, and use of protective measures among park employees. Results: Seroprevalence among participating employees was 13% (3/23). Seropositive employees reported multiple risk factors for F. tularensis exposure through both job-related and recreational activities. Activities reported by more seropositive than seronegative employees included using a power blower (67% vs. 5%, p = 0.03), collecting animal carcasses (100% vs. 30%, p = 0.047), and hunting prairie dogs recreationally (67% vs. 5%, p = 0.03). Seropositive employees reported exposure to more ticks (median 30, range 25-35) than seronegative employees (median 6, range 0-25, p = 0.001). Most employees used protective measures (e.g., insect repellent) inconsistently but increased use after receiving educational materials. Conclusions: Educating and enabling at-risk employees to use protective measures consistently, both at work and during recreational activities, can reduce exposure during epizootics.


Asunto(s)
Francisella tularensis , Empleados de Gobierno , Parques Recreativos , Tularemia/epidemiología , Tularemia/microbiología , Adulto , Anticuerpos Antibacterianos/sangre , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Wyoming , Adulto Joven
14.
J Wildl Dis ; 55(4): 944-946, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30920904

RESUMEN

Tularemia is a bacterial zoonosis caused by Francisella tularensis. We conducted a serosurvey of black-tailed prairie dogs (Cynomys ludovicianus) in Devils Tower National Monument, Wyoming, US, following an epizootic in voles ( Microtus spp.) due to F. tularensis. Only 1 of 44 (2%) sampled prairie dogs was seropositive for F. tularensis, providing evidence of survival and potentially limited spread among free-ranging prairie dogs.


Asunto(s)
Francisella tularensis/aislamiento & purificación , Sciuridae/microbiología , Animales , Arvicolinae/microbiología , Wyoming/epidemiología , Zoonosis
15.
One Health ; 6: 1-6, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30069498

RESUMEN

Yellowstone National Park is home to the largest bison population on public land in the United States. Although Yellowstone regulations require visitors to remain at least 23 m from bison, since 1980, bison have injured more visitors to Yellowstone than any other animal. We examined a series of bison-related injuries at Yellowstone to evaluate the circumstances of these injuries and to identify common risk-enhancing behaviors that lead to injury. To do this, we analyzed narrative case incident records from law enforcement regarding bison-human encounters in Yellowstone during 2000-2015. Data regarding demographics, preencounter activities, number of persons involved, type of injury, and acknowledgement of appropriate viewing distance were extracted from the records. Bison encounters resulted in injury to 25 persons (21 visitors and 4 employees). Age range for injured persons was 7-68 years (median: 49 years), and 13 were female. All injuries occurred in areas of high visitor concentration. Mean visitor distance from bison before injury was 3.4 m (range: 0.3-6.1 m). Twenty persons (80%) actively approached bison before their injuries; 5 (20%) failed to retreat when bison approached. Fifteen persons (60%) were injured when in a group of ≥3 persons approaching bison. Twelve persons (48%) sustained injuries while photographing bison. Six persons (24%) acknowledged they were too close to bison. Education alone might not be sufficient to reduce bison-related injuries. Effective injury prevention campaigns for national parks require an understanding of the behaviors and motivations of persons who approach bison. Including behavioral science and behavior change techniques in bison injury prevention campaigns might reduce injuries at Yellowstone.

16.
Am J Trop Med Hyg ; 99(1): 136-142, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29848404

RESUMEN

Spotted fever group rickettsioses (SFGRs), such as African tick bite fever (ATBF), are among the most commonly diagnosed diseases for ill travelers returning from southern Africa. We summarized demographic, clinical, and diagnostic features of imported SFGR cases in U.S. travelers returning from Africa who had laboratory specimens submitted to the Centers for Disease Control and Prevention. Diagnosis of SFGR was performed by indirect immunofluorescence antibody assay, immunohistochemical staining, polymerase chain reaction (PCR), or culture. Cases were defined as probable SFGR, confirmed SFGR, or confirmed ATBF. Clinical and epidemiological categorical variables were described as counts and proportions; continuous variables were described using geometric mean titers, median, and range. One hundred and twenty-seven patients satisfied laboratory criteria for confirmed or probable SFGR. Fever was the most common symptom (N = 88; 69%), followed by ≥ 1 eschars (N = 70; 55%). Paired serums were submitted for 36 patients (28%); 12 patients (33%) had nonreactive initial serum sample but converted to a titer ≥ 64 with the convalescent sample. Twenty-seven patients (21%) had infection with Rickettsia africae based on PCR analysis of eschar swab (N = 8) or biopsy (N = 23). Fifteen patients had eschar biopsy or swab samples and serum sample(s) submitted together; 9 (60%) had PCR-positive eschar results and nonreactive acute serology. Health-care providers should consider SFGR when evaluating patients for a febrile illness with eschar and compatible foreign travel history. Polymerase chain reaction testing of eschar biopsies or swabs provides a confirmed diagnosis in early stages of disease; eschar swabs or biopsies are an underutilized diagnostic technique.


Asunto(s)
Vectores Arácnidos/parasitología , Cicatriz/diagnóstico , Fiebre/diagnóstico , Rickettsiosis Exantemáticas/diagnóstico , Garrapatas/parasitología , Enfermedad Relacionada con los Viajes , Adolescente , Adulto , África/epidemiología , Anciano , Anciano de 80 o más Años , Animales , Biopsia , Niño , Cicatriz/epidemiología , Cicatriz/microbiología , Cicatriz/patología , Femenino , Fiebre/epidemiología , Fiebre/microbiología , Fiebre/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Rickettsia/aislamiento & purificación , Rickettsia/patogenicidad , Vigilancia de Guardia , Rickettsiosis Exantemáticas/epidemiología , Rickettsiosis Exantemáticas/patología , Rickettsiosis Exantemáticas/transmisión , Viaje , Estados Unidos/epidemiología
17.
Sci Rep ; 8(1): 16670, 2018 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-30420599

RESUMEN

Laboratory testing for Q fever (Coxiella burnetii) is essential for a differential diagnosis, yet little is known about Q fever diagnostic testing practices in the United States. We retrospectively analyzed Q fever immunoglobulin G (IgG) indirect immunofluorescence assay (IFA) testing data between 1/1/2012-10/31/2016 from ARUP, LabCorp, Mayo Medical Laboratories, and Quest Diagnostics. Data included IgG phase I and phase II titers, patient age and sex, and state and date of specimen collection. On average, 12,821 specimens were tested for Q fever annually by the participating laboratories. Of 64,106 total specimens, 84.1% tested negative for C. burnetii-specific antibodies. Positive titers ranged from 16 to 262,144 against both phase I and phase II antigens. Submission of specimens peaked during the summer months, and more specimens were submitted from the West North Central division. Testing occurred more frequently in males (53%) and increased with age. In conclusion, few U.S. Q fever cases are reported, despite large volumes of diagnostic specimens tested. Review of commercial laboratory data revealed a lack of paired serology samples and patterns of serology titers that differ from case reporting diagnostic criteria.


Asunto(s)
Técnica del Anticuerpo Fluorescente/métodos , Fiebre Q/sangre , Pruebas Serológicas/métodos , Adolescente , Adulto , Anticuerpos Antibacterianos/inmunología , Anticuerpos Antibacterianos/metabolismo , Coxiella burnetii/inmunología , Coxiella burnetii/patogenicidad , Femenino , Humanos , Inmunoglobulina G/metabolismo , Masculino , Persona de Mediana Edad , Fiebre Q/inmunología , Estudios Retrospectivos , Estados Unidos , Adulto Joven
18.
J Med Entomol ; 54(3): 742-751, 2017 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-28028138

RESUMEN

Tick-borne pathogens transmitted by Ixodes scapularis Say (Acari: Ixodidae), also known as the deer tick or blacklegged tick, are increasing in incidence and geographic distribution in the United States. We examined the risk of tick-borne disease exposure in 9 national parks across six Northeastern and Mid-Atlantic States and the District of Columbia in 2014 and 2015. To assess the recreational risk to park visitors, we sampled for ticks along frequently used trails and calculated the density of I. scapularis nymphs (DON) and the density of infected nymphs (DIN). We determined the nymphal infection prevalence of I. scapularis with a suite of tick-borne pathogens including Borrelia burgdorferi, Borrelia miyamotoi, Anaplasma phagocytophilum, and Babesia microti. Ixodes scapularis nymphs were found in all national park units; DON ranged from 0.40 to 13.73 nymphs per 100 m2. Borrelia burgdorferi, the causative agent of Lyme disease, was found at all sites where I. scapularis was documented; DIN with B. burgdorferi ranged from 0.06 to 5.71 nymphs per 100 m2. Borrelia miyamotoi and A. phagocytophilum were documented at 60% and 70% of the parks, respectively, while Ba. microti occurred at just 20% of the parks. Ixodes scapularis is well established across much of the Northeastern and Mid-Atlantic States, and our results are generally consistent with previous studies conducted near the areas we sampled. Newly established I. scapularis populations were documented in two locations: Washington, D.C. (Rock Creek Park) and Greene County, Virginia (Shenandoah National Park). This research demonstrates the potential risk of tick-borne pathogen exposure in national parks and can be used to educate park visitors about the importance of preventative actions to minimize tick exposure.


Asunto(s)
Anaplasma phagocytophilum/aislamiento & purificación , Babesia microti/aislamiento & purificación , Borrelia/aislamiento & purificación , Ixodes/microbiología , Ixodes/parasitología , Animales , Borrelia burgdorferi/aislamiento & purificación , Ixodes/crecimiento & desarrollo , Ninfa/crecimiento & desarrollo , Ninfa/microbiología , Ninfa/parasitología , Parques Recreativos , Estados Unidos
19.
Travel Med Infect Dis ; 14(5): 475-480, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27597388

RESUMEN

BACKGROUND: In June 2014, the mosquito-borne chikungunya virus (CHIKV) emerged in the U.S. Virgin Islands (USVI), a location where tourists comprise the majority of the population during peak season (January-April). Limited information is available concerning visitors' CHIKV awareness and prevention measures. METHODS: We surveyed a convenience sample of Virgin Islands National Park visitors aged ≥18 years. Respondents completed a questionnaire assessing CHIKV knowledge, attitudes, and practices; health information-seeking practices; and demographics. RESULTS: Of 783 persons contacted, 443 (57%) completed the survey. Fewer than half (208/441 [47%]) were aware of CHIKV. During trip preparation, 28% of respondents (126/443) investigated USVI-specific health concerns. Compared with persons unaware of CHIKV, CHIKV-aware persons were more likely to apply insect repellent (134/207 [65%] versus 111/231 [48%]; p < 0.001), wear long-sleeves and long pants (84/203 [41%] versus 57/227 [25%]; p < 0.001), and wear insect repellent-treated clothing (36/204 [18%] versus 22/227 [10%]; p = 0.02). CONCLUSIONS: The majority of visitors surveyed did not research destination-related health concerns and were unaware of CHIKV. However, CHIKV awareness was associated with using multiple prevention measures to reduce disease risk. These findings underscore the importance of providing tourists with disease education upon destination arrival.


Asunto(s)
Fiebre Chikungunya/prevención & control , Fiebre Chikungunya/virología , Conocimientos, Actitudes y Práctica en Salud , Parques Recreativos , Viaje , Adulto , Animales , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/transmisión , Virus Chikungunya/fisiología , Culicidae/virología , Femenino , Humanos , Insectos Vectores/virología , Masculino , Encuestas y Cuestionarios , Islas Virgenes de los Estados Unidos/epidemiología , Adulto Joven
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