LETTERS

Douglas Marthaler, Infect Dis. 2014;20:917–9d http://dx.doi. in addition to a loss of appetite, pro- Laura Bruner, James Collins, org/10.3201/eid2005.140195 gressive anemia, and, especially, and Kurt Rossow blood eosinophilia, a sign which, as in Address for correspondence: Douglas Author affiliations: University of Minnesota humans, indicates that the infestation Marthaler, Veterinary Diagnostic Laboratory, Veterinary Diagnostic Laboratory, Saint is recent. Under natural conditions, the College of Veterinary Medicine, University of Paul, Minnesota, USA (D. Marthaler, J. disease is believed to be mainly sub- Minnesota, 1333 Gortner Ave, Saint Paul, MN Collins, K. Rossow); and Swine Vet Center, clinical and chronic. It should be not- 55108, USA; email: [email protected] Saint Peter, Minnesota, USA (L. Bruner) ed that the acute form of the disease is more common in sheep (5). With re- DOI: http://dx.doi.org/10.3201/eid2012.140908 gard to lesions, the disease is closer to intestinal (caused by References S. mansoni) than to urinary schistoso- 1. Stevenson GW, Hoang H, Schwartz KJ, miasis. The lesions are characterized Burrough ER, Sun D, Madson D, et al. by the formation of gray-white granu- Emergence of porcine epidemic diarrhea lomas ³5 mmin diameter, or by pol- virus in the United States: clinical signs, Schistosomiasis lesions, and viral genomic sequences. yps, and intestinal hemorrhaging due J Vet Diagn Invest. 2013;25:649–54d in Cattle in to bleeding of the granulomas formed http://dx.doi.org/10.1177/104063871 Corsica, France during migration of the parasite’s eggs 3501675 to the intestinal lumen. In the liver, 2. Vlasova AN, Marthaler D, Wang Q, Culhane MR, Rossow KD, Rovira A, et To the Editor: The origin of the granulomas may also be observed, al. Distinct characteristics and complex human cases of urinary schistosomia- as well as fibrosis of the portal vein. evolution of PEDV, North America, May sis observed in France was recently Hepatomegaly and cirrhosis may also 2013–February 2014. Emerg Infect Dis. be present. These lesions are caused 2014;20:1620–8. identified (1,2). None of these patients 3. Pensaert MB, de Bouck P. A new corona- had traveled to a disease-endemic by adult parasites in the mesenteric virus-like particle associated with diarrhea area, but all had vacationed in Corsica vessels and the portal vein. in swine. Arch Virol. 1978;58:243–7d and had swum in the Cavu River, near The presence of truncatus http://dx.doi.org/10.1007/BF01317606 contortus (Michaud) (Mollusca, Gas- 4. Song D, Park B. Porcine epidemic diar- Porto-Vecchio in southern Corsica. rhoea virus: a comprehensive review of The letter by Berry et al. to Emerging tropoda, Hygrophila) snails was men- molecular epidemiology, diagnosis, and Infectious Diseases (2) reminded us tioned as early as 1832, and the spe- vaccines. Virus Genes. 2012;44:167–75d that bovine schistosomiasis had been cies was formally identified in 1922 http://dx.doi.org/10.1007/s11262-012- in Corsica. Since that time it has been 0713-1 reported in Corsica in the past, up 5. Luo Y, Zhang J, Deng X, Ye Y, Liao M, through the 1960s, in the same area. assumed that this mollusc could be a Fan H. Complete genome sequence of In cattle, bovis has potential intermediate for human a highly prevalent isolate of porcine been found in Africa and the Middle (6) or bovine (3,7) schistosomiasis. epidemic diarrhea virus in South China. In 1963, Gretillat studied bovine J Virol. 2012;86:9551d http://dx.doi.org/ East (Iraq, Israel), as well as in the 10.1128/JVI.01455-12 Mediterranean Basin, especially in schistosomiasis in Corsica (8). Inves- 6. Fan H, Zhang J, Ye Y, Tong T, Xie K, Sicily and Sardinia in Italy, and Cor- tigations of Bulinus snails were con- Liao M. Complete genome sequence of a sica, France, where cases were report- ducted solely in the southern part of novel porcine epidemic diarrhea virus in the island, in the area where Brumpt south China. J Virol. 2012;86:10248–9d ed as early as 1929 by Emile Brumpt http://dx.doi.org/10.1128/JVI.01589-12 (3,4). In addition, certain Schistosoma had described their presence 30 years 7. Marthaler D, Jiang Y, Otterson T, blood fluke species, especially S. hae- earlier. Bulinus snails were identified Goyal S, Rossow K, Collins J. Complete matobium and S. bovis, can share the in 4 rivers, the Rizzanese, Baraci, genome sequence of porcine epidemic Ortolo and Spartano, especially in diarrhea virus strain USA/Colorado/ same definitive hosts (humans or ani- 2013 from the United States. Genome mals) and the same intermediate hosts, residual ponds of waterways some- Announc. 2013;1: http://dx.doi.org/10. i.e., Bulinus contortus snails. Cattle, times quite close to the sea. At 2 sites, 1128/genomeA.00555-13 sheep and goats, horses, wild rumi- unidentifiable cercaria larvae were 8. Jung K, Wang Q, Scheuer KA, Lu Z, revealed through dissection (5 of 70 Zhang Y, Saif LJ. Pathology of US nants and rodents can all be definitive porcine epidemic diarrhea virus strain hosts of S. bovis. Bulinus snails in the Rizzanese, 26 of PC21A in gnotobiotic pigs. Emerg In cattle, the clinical manifesta- 50 in the Baraci). As part of the same Infect Dis. 2014;20:662–5d http://dx.doi. tions of infestation are poorly docu- study, slaughterhouse examination of org/10.3201/eid2004.131685 15 cattle from regions where Bulinus 9. Wang L, Byrum B, Zhang Y. New mented. In experimental , in- variant of porcine epidemic diarrhea termittent diarrhea has been observed, snails had been discovered revealed virus, united states, 2014. Emerg sometimes containing blood or mucus, adult Schistosoma in the mesenteric

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 12, December 2014 2163 LETTERS and vesical veins, as well as in the 2. Berry A, Moné H, Iriart X, Mouahid order mammals (1). Although emmon- liver and the portal system. G, Abbo O, Boissier J, et al. Schistoso- sia rarely infect humans, the fungi can miasis haematobium, Corsica, France In a more comprehensive study [letter]. Emerg Infect Dis. 2014;20:1595–7. cause localized granulomatous pul- (9), Bulinus snails were found in all http://dx.doi.org/10.3201/eid2009.140928. monary disease (adiaspiromycosis) in of Corsica’s coastal rivers, except for 3. Brumpt E. Cycle évolutif du Schistosoma immunocompetent persons (1–4). Be- those in the northwestern-most part of bovis (Bilharzia crassa); infection spon- fore 2013, no association was known tanée de Bulinus contortus en Corse C.-R. the island. However, of the 55 bod- Acad. Sci. 1929;CLXXXXI:879. between emmonsia and HIV, and there ies of water where Bulinus snails were 4. Brumpt E. Cycle évolutif complet de was no indication that emmonsia were found, only 1 contained gastropods Schistosoma bovis. Infection naturelle en endemic to sub-Saharan Africa. with Schistosoma cercariae, and re- Corse et infection expérimentale de Buli- In 2013 a novel Emmonsia sp. nus contortus. Ann Parasitol Hum Comp. sults of a search for blood flukes in 220 1930;VIII:17–50. that is closely related to E. pasteuriana small rodents (known for being sus- 5. Pandey VS, Ziam H. Helminthoses cir- was described. The fungus caused dis- ceptible to S. bovis and captured near culatoires. In: Lefèvre P-C, Blancou J, seminated disease in 13 HIV-infected bodies of water where Bulinus snails Charmette R, editors. Principales mala- persons in South Africa (12 in Cape dies infectieuses et parasitaires du bétail, had been observed) were negative. Europe et régions chaudes. Paris: Tec & Town, 1 in Bloemfontein) (5). Two We have found no other docu- Doc Editions Lavoisier; 2003. p. 1485–99. additional cases of disseminated em- mentation on bovine schistosomiasis 6. Dollfus PH. Sur la présence en France et monsiosis caused by this novel species in Corsica between 1966 and the pres- en Corse du Bullinus contortus (Michaud), were identified in HIV-uninfected per- hôte intermédiaire de Schistosoma hæma- ent time. Has this disease disappeared tobium (Bilharz): note préliminaire. Bull sons (1 immunocompetent, the other since the 1960s? Is it still present as an Soc Pathol Exot. 1922;15:208–12. immunosuppressed for renal trans- enzootic disease with silent transmis- 7. Arfaa F, Massoud J, Chu KY. Suscepti- plantation) in Cape Town (6). Because sion? It should be noted that the disease bility of Portuguese Bulinus contortus to these cases clustered geographically, it Iranian strains of Schistosoma haematobi- produces few or no clinical signs and um and S. bovis. Bull World Health Organ. was suggested that this novel Emmon- that slaughterhouse detection requires 1967;37:165–6. sia sp. occupies a microenvironment dissection of the circulatory system of 8. Gretillat S. Epidémiologie de certaines around Cape Town (7). We report 3 the abdominal cavity. In any case, the affections à trématodes des animaux do- additional cases of disseminated em- mestiques en Corse (bilharziose bovine discovery of human cases of schisto- et distomatose bovine et ovine). Ann Para- monsiosis from Johannesburg, South somiasis proves that a human–Bulinus sitol Hum Comp. 1963;38:471–81. Africa, 403 km from Bloemfontein parasitic cycle exists in Corsica, and 9. Doby J-M, Rault S, Deblock S, Chabaud A. and 1,400 km from Cape Town. All therefore an –Bulinus cycle may Bulins et bilharzioses en Corse. Réparti- patients were HIV-infected and re- tion, fréquence et biologie de “Bulinus exist as well. For the sake of scientific truncates” [in French]. Annal. Parasitol. ported no travel to Bloemfontein or interest, an investigation into the pres- 1966;4:337–49. Cape Town. ence of S. bovis in in Cor- The 3 patients were admitted to sica would be worthwhile. Moreover, Address for correspondence: Paul M.V. Martin, Helen Joseph Hospital between Au- the fact that both Schistosoma species Anses - Lab de Lyon, 31, ave Tony Garnier, Lyon gust 2012 and August 2014; all pa- use the same intermediate host, Bulinus 69009, France; email: [email protected] tients were male and had CD4 counts contortus snails, could cause problems of ≤5 cells/µL at admission. Patient 1 with differential diagnosis. had never received antiretroviral thera- py; patients 2 and 3 had defaulted anti- Didier Calavas and retroviral treatment for several months Paul M.V. Martin before admission. All patients had Author affiliation: Agence Nationale de disseminated skin rash, pneumonia, Sécurité Sanitaire, Lyon Laboratory, anemia, and substantial weight loss; Lyon, France HIV-Associated chest radiographs suggested pulmo- DOI: http://dx.doi.org/10.3201/eid2012.141474 Disseminated nary tuberculosis. The rash appeared Emmonsiosis, as disseminated hyperpigmented scaly References papules and plaques (online Techni- Johannesburg, cal Appendix Figure 1, http://wwwnc. 1. Holtfreter MC, Moné H, Müller-Stöver I, South Africa cdc.gov/EID/article/20/12/14-0902- Mouahid G, Richter J. Schistosoma haemato- Techapp1.pdf). Patients 1 and 2 also bium infections acquired in Corsica, France, August 2013. Euro Surveill. 2014;19:20821 To the Editor: Emmonsia spp., had diarrhea and exhibited delirium. http://www.eurosurveillance.org/View dimorphic fungi found worldwide, Laboratory investigations for pa- Article.aspx?ArticleId=20821. cause disease mainly among lower- tient 1 showed normocytic anemia,

2164 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 12, December 2014