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The use of natural compounds to prevent and treat infective diseases is increasing its importance, especially in the case of multidrug-resistant (MDR) microorganisms-mediated infections. The drug resistance phenomenon is today a global problem, so it is important to have available substances able to counteract MDR infections. Syzygium aromaticum (L.) Merr. & L.M. Perry (commonly called clove) is a spice characterized by several biological properties. Clove essential oil (EO) consists of numerous active molecules, being eugenol as the principal component; however, other compounds that synergize with each other are responsible for the biological properties of the EO. S. aromaticum is traditionally used for bowel and stomach disorders, cold and flu, oral hygiene, tooth decay, and for its analgesic action. Its EO has shown antioxidant, antimicrobial, anti-inflammatory, neuro-protective, anti-stress, anticancer, and anti-nociceptive activities. This review aims to investigate the role of E. S. aromaticum EO in the counteraction of MDR microorganisms responsible for human disorders, diseases, or infections, such as Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhi, Candida albicans, Giardia lamblia, Streptococcus mutans, Porphyromonas gingivalis, and Klebsiella pneumoniae. This study might orient clinical researchers on future therapeutic uses of S. aromaticum EO in the prevention and treatment of infectious diseases.
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Antiinfecciosos , Aceites Volátiles , Syzygium , Humanos , Aceite de Clavo , EugenolRESUMEN
Salmonella enterica is a bacterial pathogen known to cause gastrointestinal infections in diverse hosts, including humans and animals. Despite extensive knowledge of virulence mechanisms, understanding the factors driving host specificity remains limited. In this study, we performed a comprehensive pangenome-wide analysis of S. enterica to identify potential loci determining preference towards certain hosts. We used a dataset of high-quality genome assemblies grouped into 300 reference clusters with a special focus on four host groups: humans, pigs, cattle, and birds. The reconstructed pangenome was shown to be open and enriched with the accessory component implying high genetic diversity. Notably, phylogenetic inferences did not correspond to the distribution of affected hosts, as large compact phylogenetic groups were absent. By performing a pangenome-wide association study, we identified potential host specificity determinants. These included multiple genes encoding proteins involved in distinct infection stages, e.g., secretion systems, surface structures, transporters, transcription regulators, etc. We also identified antibiotic resistance loci in host-adapted strains. Functional annotation corroborated the results obtained with significant enrichments related to stress response, antibiotic resistance, ion transport, and surface or extracellular localization. We suggested categorizing the revealed specificity factors into three main groups: pathogenesis, resistance to antibiotics, and propagation of mobile genetic elements (MGEs).
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Salmonella enterica , Humanos , Animales , Bovinos , Porcinos , Salmonella enterica/genética , Especificidad del Huésped , Filogenia , Antibacterianos , Transporte IónicoRESUMEN
Campylobacter spp. are one of the most common causes of bacterial gastroenteritis in Canada and worldwide. Fluoroquinolones are often used to treat complicated human campylobacteriosis and strains of Campylobacter spp. resistant to these drugs are emerging along the food chain. A scoping review was conducted to summarise how human (fluoro)quinolone-resistant (FQR; quinolones including fluoroquinolones) Campylobacter spp. infections are characterised in the literature by describing how burden of illness (BOI) associated with FQR is measured and reported, describing the variability in reporting of study characteristics, and providing a narrative review of literature that compare BOI measures of FQR Campylobacter spp. infections to those with susceptible infections. The review identified 26 studies that yielded many case reports, a lack of recent literature and a lack of Canadian data. Studies reported 26 different BOI measures and the most common were hospitalisation, diarrhoea, fever and duration of illness. There were mixed results as BOI measures reported in literature were inconsistently defined and there were limited comparisons between resistant and susceptible infections. This presents a challenge when attempting to assess the magnitude of the BOI due to FQR Campylobacter spp., highlighting the need for more research in this area.
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Infecciones por Campylobacter , Campylobacter jejuni , Campylobacter , Quinolonas , Humanos , Quinolonas/farmacología , Quinolonas/uso terapéutico , Canadá/epidemiología , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/microbiología , Fluoroquinolonas/farmacología , Fluoroquinolonas/uso terapéutico , Costo de Enfermedad , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia BacterianaRESUMEN
Corynespora cassiicola is a common plant pathogen responsible for leaf-spotting diseases in the tropical and subtropical areas. C. cassiicola seldom causes human infections. Here we describe a case of subcutaneous phaeohyphomycosis caused by C. cassiicola in a 76-year-old Chinese man, who presented to our hospital with a purulent discharge and painful sensation on his right leg. Skin biopsy revealed an abscess, and culture confirmed C. cassiicola to be the causative agent. The result was further identified by sequence analysis of the internal transcribed spacer region. The patient was successfully treated with systemic voriconazole and wound debridement: the lesion disappeared after 20 days.
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Ascomicetos , Feohifomicosis , Masculino , Humanos , Anciano , Feohifomicosis/tratamiento farmacológicoRESUMEN
During 2004-2020 in total 18 anisakid larvae (Nematoda) were sent in to the Laboratory of Parasitology at Keldur for investigation and species identification. Fourteen had temporarily lived within the human body and were alive when detected, three were noticed alive in food just before being consumed, one larva was found dead. Pseudoterranova decipiens was found í 16 instances (89%), Anisakis simplex in two (11%). The one Anisakis case was a wriggling larva detected in the diaper of a baby that was believed to have ingested the larva with undercooked fish three days earlier in the kindergarten. In the other case a dead larva was found entangled in fish chew, spit out by a baby being fed with boiled haddock. Pseudoterranova larvae in humans (n=13) were most frequently detected in the mouth (11 persons). In one instance winding movements of larva in vomit of a baby attracted the attention of the mother, in another case a person detected tickling movements of a larva when cleaning the anal area after defecation. Length of the 13 Pseudoterranova larvae varied between 30 and 47 mm. They were believed to have lived in their hosts from one up to nine days. Nine larvae had already developed to the L4, stage, four were still in the L3 stage. Cod was the most frequently mentioned source of infection (5 of 14 cases), two persons regarded catfish to be the culprit, one named both fish species. In one case either sushi or plaice was believed to be the infection source, one person presumably got the larva participating in a sushi feast. In four cases the fish source remained unknown. Most often the larva was consumed in private homes, three persons believed to have gotten the larva when dining in a restaurant, a harbour worker got the worm when eating raw fish and the same baby got a larva on two different occasions in the kindergarten.
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Anisakiasis , Anisakis , Ascaridoidea , Animales , Anisakiasis/diagnóstico , Humanos , Islandia , LarvaRESUMEN
BACKGROUND: In Southeast Asia, Plasmodium knowlesi, a parasite of long-tailed macaques (Macaca fascicularis), is an important cause of human malaria. Plasmodium cynomolgi also commonly infects these monkeys, but only one naturally acquired symptomatic human case has been reported previously. METHODS: Malariometric studies involving 5422 subjects (aged 6 months to 65 years) were conducted in 23 villages in Pailin and Battambang, western Cambodia. Parasite detection and genotyping was conducted on blood samples, using high-volume quantitative PCR (uPCR). RESULTS: Asymptomatic malaria parasite infections were detected in 1361 of 14732 samples (9.2%). Asymptomatic infections with nonhuman primate malaria parasites were found in 21 individuals living close to forested areas; P. cynomolgi was found in 11, P. knowlesi was found in 8, and P. vivax and P. cynomolgi were both found in 2. Only 2 subjects were female, and 14 were men aged 20-40 years. Geometric mean parasite densities were 3604 parasites/mL in P. cynomolgi infections and 52488 parasites/mL in P. knowlesi infections. All P. cynomolgi isolates had wild-type dihydrofolate reductase genes, in contrast to the very high prevalence of mutations in the human malaria parasites. Asymptomatic reappearance of P. cynomolgi occurred in 2 subjects 3 months after the first infection. CONCLUSIONS: Asymptomatic naturally acquired P. cynomolgi and P. knowlesi infections can both occur in humans. CLINICAL TRIALS REGISTRATION: NCT01872702.
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Malaria/parasitología , Plasmodium cynomolgi/aislamiento & purificación , Plasmodium knowlesi/aislamiento & purificación , Adolescente , Adulto , Anciano , Animales , Enfermedades Asintomáticas/epidemiología , Cambodia/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Genotipo , Técnicas de Genotipaje , Humanos , Lactante , Malaria/epidemiología , Masculino , Persona de Mediana Edad , Carga de Parásitos , Plasmodium cynomolgi/clasificación , Plasmodium cynomolgi/genética , Plasmodium knowlesi/clasificación , Plasmodium knowlesi/genética , Plasmodium vivax/clasificación , Plasmodium vivax/genética , Plasmodium vivax/aislamiento & purificación , Prevalencia , Reacción en Cadena en Tiempo Real de la Polimerasa , Adulto JovenRESUMEN
BACKGROUND: Salmonella enterica subsp. diarizonae (IIIb) is frequently isolated from the environment, cold-blooded reptiles, sheep and humans; however only a few studies describe the isolation of this subspecies from invasive human infections. The factors contributing to this unusual behavior are currently unknown. RESULTS: We report here the genome features of two diarizonae strains, SBO13 and SBO27, isolated from endocervical tissue collected post-abortion and from cerebrospinal fluid of a newborn child, respectively, in the city of Santa Cruz, Bolivia. Although isolated six years apart, SBO27 in 2008 and SBO13 in 2014, both strains belong to the same sequence type 1256 (ST1256) and show a high degree of genome conservation sharing more than 99% of their genes, including the conservation of a ~ 10 kb plasmid. A prominent feature of the two genomes is the presence of 24 genomic islands (GIs), in addition to 10 complete Salmonella pathogenicity islands (SPI) and fragments of SPI-7, a pathogenicity island first reported in the human-adapted serovar Typhi. Some of the GIs identified in SBO13 and SBO27 harbor genes putatively encoding auto-transporters involved in adhesion, lipopolysaccharide modifying enzymes, putative toxins, pili-related proteins, efflux pumps, and several putative membrane cation transport related-genes, among others. These two Bolivian isolates also share genes encoding the type-III secretion system effector proteins SseK2, SseK3 and SlrP with other diarizonae sequence types (ST) mainly-associated with infections in humans. The sseK2, sseK3 and slrP genes were either absent or showing frameshift mutations in a significant proportion of genomes from environmental diarizonae isolates. CONCLUSIONS: The comparative genomic study of two diarizonae strains isolated in Bolivia from human patients uncovered the presence of many genes putatively related to virulence. The statistically-significant acquisition of a unique combination of these functions by diarizonae strains isolated from humans may have impacted the ability of these isolates to successfully infect the human host.
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Genoma Bacteriano , Infecciones por Salmonella/genética , Salmonella enterica/genética , Salmonella enterica/aislamiento & purificación , Factores de Virulencia/genética , Virulencia , Adulto , Femenino , Islas Genómicas , Genómica , Humanos , Recién Nacido , Filogenia , Infecciones por Salmonella/microbiología , Salmonella enterica/patogenicidad , Adulto JovenRESUMEN
To detect changes in human-to-human transmission of influenza A(H7N9) virus, we analyzed characteristics of 40 clusters of case-patients during 5 epidemics in China in 2013-2017. Similarities in number and size of clusters and proportion of clusters with probable human-to-human transmission across all epidemics suggest no change in human-to-human transmission risk.
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Epidemias , Subtipo H7N9 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/transmisión , Análisis por Conglomerados , Humanos , Gripe Humana/virología , Estudios RetrospectivosRESUMEN
Infection with Usutu virus (USUV) has been recently associated with neurologic disorders, such as encephalitis or meningoencephalitis, in humans. These findings indicate that USUV is a potential health threat. We report an acute human infection with USUV in France putatively associated with a clinical diagnosis of idiopathic facial paralysis.
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Blefaroptosis/etiología , Parálisis Facial/etiología , Infecciones por Flavivirus/epidemiología , Infecciones por Flavivirus/virología , Flavivirus/aislamiento & purificación , Corticoesteroides/uso terapéutico , Adulto , Antivirales/uso terapéutico , Flavivirus/genética , Infecciones por Flavivirus/complicaciones , Infecciones por Flavivirus/tratamiento farmacológico , Francia/epidemiología , Humanos , Masculino , Filogenia , ARN Viral/aislamiento & purificación , Valaciclovir/uso terapéuticoRESUMEN
Campylobacter jejuni, a major cause of bacterial foodborne illnesses, is considered highly susceptible to environmental stresses. In this study, we extensively investigated the stress tolerance of 121 clinical strains of C. jejuni against 5 stress conditions (aerobic stress, disinfectant exposure, freeze-thaw, heat treatment, and osmotic stress) that this pathogenic bacterium might encounter during foodborne transmission to humans. In contrast to our current perception about high stress sensitivity of C. jejuni, a number of clinical strains of C. jejuni were highly tolerant to multiple stresses. We performed population genetics analysis by using comparative genomic fingerprinting and showed that multistress-tolerant strains of C. jejuni constituted distinct clades. The comparative genomic fingerprinting subtypes belonging to multistress-tolerant clades were more frequently implicated in human infections than those in stress-sensitive clades. We identified unique stress-tolerant C. jejuni clones and showed the role of stress tolerance in human campylobacteriosis.
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Adaptación Biológica , Infecciones por Campylobacter/microbiología , Campylobacter jejuni/fisiología , Estrés Fisiológico , Animales , Pollos , Microbiología Ambiental , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Humanos , Viabilidad Microbiana , Concentración Osmolar , TemperaturaRESUMEN
Human infections with Salmonella enterica serovar Napoli are uncommon in Europe. However, these infections represented 5.9% of salmonellosis cases in Italy during 2014-2015. The source of infection is unknown. We analyzed surveillance data and compared strain genetic similarities and found that contaminated vegetables and surface water are probable sources of human infection.
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Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/microbiología , Infecciones por Salmonella/epidemiología , Infecciones por Salmonella/microbiología , Salmonella enterica/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedades Transmisibles Emergentes/historia , Femenino , Variación Genética , Historia del Siglo XXI , Humanos , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Filogenia , Infecciones por Salmonella/historia , Salmonella enterica/clasificación , Adulto JovenRESUMEN
Transmission of Paracoccidioides spp. fungi to humans is usually related to manipulation of soil. Rural workers are the most affected group. We report an outbreak of paracoccidioidomycosis after deforestation and massive earth removal during construction of a highway in Rio de Janeiro, Brazil. Extensive environmental disturbances might be involved in fungal transmission.
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Brotes de Enfermedades , Paracoccidioides/aislamiento & purificación , Paracoccidioidomicosis/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Niño , Femenino , Humanos , Incidencia , Masculino , Paracoccidioidomicosis/microbiología , Adulto JovenRESUMEN
BACKGROUND: A large number (n = 460) of A(H7N9) human infections have been reported in China from March 2013 through December 2014, and H7N9 outbreaks in humans became an emerging issue for China health, which have caused numerous disease outbreaks in domestic poultry and wild bird populations, and threatened human health severely. The aims of this study were to investigate the directional trend of the epidemic and to identify the significant presence of spatial-temporal clustering of influenza A(H7N9) human cases between March 2013 and December 2014. METHODS: Three distinct epidemic phases of A(H7N9) human infections were identified in this study. In each phase, standard deviational ellipse analysis was conducted to examine the directional trend of disease spreading, and retrospective space-time permutation scan statistic was then used to identify the spatio-temporal cluster patterns of H7N9 outbreaks in humans. RESULTS: The ever-changing location and the increasing size of the three identified standard deviational ellipses showed that the epidemic moved from east to southeast coast, and hence to some central regions, with a future epidemiological trend of continue dispersing to more central regions of China, and a few new human cases might also appear in parts of the western China. Furthermore, A(H7N9) human infections were clustering in space and time in the first two phases with five significant spatio-temporal clusters (p < 0.05), but there was no significant cluster identified in phase III. CONCLUSIONS: There was a new epidemiologic pattern that the decrease in significant spatio-temporal cluster of A(H7N9) human infections was accompanied with an obvious spatial expansion of the outbreaks during the study period, and identification of the spatio-temporal patterns of the epidemic can provide valuable insights for better understanding the spreading dynamics of the disease in China.
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Subtipo H7N9 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Análisis Espacio-Temporal , Animales , Aves , China/epidemiología , Análisis por Conglomerados , Brotes de Enfermedades , Humanos , Subtipo H7N9 del Virus de la Influenza A/clasificación , Gripe Aviar/patología , Gripe Aviar/virología , Gripe Humana/patología , Gripe Humana/virología , Filogenia , Estudios RetrospectivosRESUMEN
The aims of the present study were to isolate and identify clinical and environmental strains of Aeromonas spp. by means of biochemical tests and the automated method VITEK 2 and to investigate the presence of the virulence genes cytotoxic enterotoxin (act), hemolysin (asa-1), and type III secretion system (ascV), and also the in vitro antimicrobial susceptibility of the strains. From the clinical isolates, 19 Aeromonas hydrophila, 3 Aeromonas veronii bv. sobria, and 1 Aeromonas caviae were identified, while from the environmental strains, 11 A. hydrophila, 22 A. veronii bv. sobria, 1 A. veronii bv. veronii, and 1 A. caviae were recovered. The gene act was detected in 69.5% of clinical isolates, asa-1 in 8.6%, and ascV in 34.7%. In the environmental strains, the detection rates were 51.4%, 45.7%, and 54.2% for the genes act, asa-1, and ascV, respectively. Resistance to amoxicillin-clavulanate and piperacillin-tazobactam was observed in 15 and 3 clinical strains, respectively, and resistance to ceftazidime, meropenem, imipenem, ciprofloxacin, and trimethoprim-sulfamethoxazole was observed in 1 strain for each drug. Resistance to amoxicillin-clavulanate and piperacillin-tazobactam was detected in 17 and 1 environmental strain, respectively. Higher resistance percentages were observed in clinical strains, but environmental strains also showed this phenomenon and presented a higher detection rate of virulence genes. Thus, it is important to monitor the antimicrobial susceptibility and pathogenic potential of the environmental isolates.
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Aeromonas/patogenicidad , Microbiología Ambiental , Aeromonas/efectos de los fármacos , Aeromonas/genética , Brasil , Farmacorresistencia Bacteriana , Humanos , Pruebas de Sensibilidad Microbiana , Virulencia/genéticaRESUMEN
We used molecular methods to identify Rickettsia raoultii infections in 2 persons in China. These persons had localized rashes around sites of tick bites. R. raoultii DNA was detected in 4% of Dermacentor silvarum ticks collected in the same area of China and in 1 feeding tick detached from 1 patient.
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Infecciones por Rickettsia/microbiología , Rickettsia/clasificación , Rickettsia/genética , Adulto , Anciano , Anticuerpos Antibacterianos/inmunología , Proteínas Bacterianas/genética , Humanos , Masculino , Filogenia , Rickettsia/inmunología , Infecciones por Rickettsia/diagnóstico , Infecciones por Rickettsia/transmisión , Mordeduras de Garrapatas/microbiologíaRESUMEN
The genus Edwardsiella, previously residing in the family Enterobacteriaceae and now a member of the family Hafniaceae, is currently composed of five species, although the taxonomy of this genus is still unsettled. The genus can primarily be divided into two pathogenic groups: E. tarda strains are responsible for almost all human infections, and two other species (E. ictaluri, E. piscicida) cause diseases in fish. Human infections predominate in subtropical habitats of the world and in specific geospatial regions with gastrointestinal disease, bloodborne infections, and wound infections, the most common clinical presentations in decreasing order. Gastroenteritis can present in many different forms and mimic other intestinal disturbances. Chronic gastroenteritis is not uncommon. Septicemia is primarily found in persons with comorbid conditions including malignancies and liver disease. Mortality rates range from 9% to 28%. Most human infections are linked to one of several risk factors associated with freshwater or marine environments such as seafood consumption. In contrast, edwardsiellosis in fish is caused by two other species, in particular E. ictaluri. Both E. ictaluri and E. piscicida can cause massive outbreaks of disease in aquaculture systems worldwide, including enteric septicemia in channel catfish and tilapia. Collectively, these species are increasingly being recognized as important pathogens in clinical and veterinary medicine. This article highlights and provides a current perspective on the taxonomy, microbiology, epidemiology, and pathogenicity of this increasingly important group.
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New formulations of Amphotericin-B (Am-B), the most popular therapeutic drug for many human infections such as parasitic and fungal pathogens, are safe, economical, and effective in the world. Several newly designed carrier systems for Am-B can also be considered orally with sufficient gastrointestinal permeability and good solubility. However, the clinical application of several new formulations of Am-B with organ cytotoxicity, low bioavailability, high costs, and technical problems have caused some issues. Therefore, more attention and scientific design are required to progress safe and effective drug delivery systems. Currently, the application of nano-based technology and nanomaterials in the advancement of drug delivery systems exhibits promising outcomes to cure many human systemic infections. Designing novel drug delivery systems including solid lipid nanostructured materials, lipo-polymersomes, drug conjugates and microneedles, liposomes, polymer and protein-based nanostructured materials, dendrimers, emulsions, mixed micelles, polymeric micelles, cyclodextrins, nanocapsules, and nanocochleate for Am-B has many advantages to reducing several related issues. The unique properties of nanostructured particles such as proper morphology, small size, surface coatings, and, electrical charge, permit scientists to design new nanocomposite materials against microorganisms for application in various human diseases. These features have made these nanoparticles an ideal candidate for drug delivery systems in clinical approaches to cure a number of human disorders and currently, several therapeutic nanostructured material formulations are under different stages of clinical tests. Hence, this scientific paper mainly discussed the advances in new formulations of Am-B for the treatment of human systemic infections and related clinical tests.
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Leishmaniasis , Micosis , Nanopartículas , Humanos , Anfotericina B/uso terapéutico , Micelas , Sistemas de Liberación de Medicamentos , Micosis/tratamiento farmacológico , Leishmaniasis/tratamiento farmacológico , Polímeros/uso terapéuticoRESUMEN
Yokenella regensburgei is a Gram-negative rod part of the Enterobacteriaceae family (order Enterobacterales) and a rare cause of human infections. Although improved diagnostic methods have led to an increase in reports of this elusive pathogen, information remains limited. In order to provide a better understanding of this bacterium, we developed the first comprehensive review of its biology, biochemical profile, antimicrobial resistance pattern, virulence factors, natural reservoir and involvement in various veterinary and human infections. Human infections with this bacterium are scarcely reported, most probably due to constraints regarding its identification and biochemical similarities to Hafnia alvei. Multiple systematic searches revealed 23 cases of human infection, with a seemingly worldwide distribution, mostly in middle-aged or elderly male patients, often associated with immunosuppression. To date, Y. regensburgei has been reported in skin and soft tissue infections, bacteremia and sepsis, osteoarticular infections and in others such as urinary tract and digestive infections. The unique ability of Y. regensburgei to degrade polystyrene presents a novel and promising avenue for addressing plastic pollution in the near future. However, large-scale applications of this bacterium will undoubtedly increase human exposure, highlighting the necessity for comprehensive research into its role in human and veterinary infections, pathogenicity and antibiotic resistance.
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We investigated 4 related human cases of cowpox virus infection reported in France during 2011. Three patients were infected by the same strain, probably transmitted by imported pet rats, and the fourth patient was infected by another strain. The 2 strains were genetically related to viruses previously isolated from humans with cowpox infection in Europe.
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Virus de la Viruela Vacuna/clasificación , Virus de la Viruela Vacuna/genética , Viruela Vacuna/epidemiología , Adulto , Animales , Línea Celular , Niño , Viruela Vacuna/transmisión , Virus de la Viruela Vacuna/aislamiento & purificación , Femenino , Francia/epidemiología , Genoma Viral , Humanos , Masculino , Datos de Secuencia Molecular , Filogenia , RatasRESUMEN
Campylobacter fetus subsp. testudinum subsp. nov. is a newly proposed subspecies of C. fetus with markers of reptile origin. We summarize epidemiologic information for 9 humans infected with this bacterium. All cases were in men, most of whom were of Asian origin. Infection might have been related to exposure to Asian foods or reptiles.