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EMERGING INFECTIOUS DISEASES Volume 4 • Number 4 October–December 1998

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EMERGING INFECTIOUS DISEASES Volume 4 • Number 4 October–December 1998 Contents EMERGING INFECTIOUS DISEASES Volume 4 Number 4 OctoberDecember 1998 International EditorsUpdate Synopses Emerging Infectious DiseasesSouth Africa 517 Cell-to-Cell Signaling and Pseudomonas 551 K.P. Klugman aeruginosa Infections C. Van Delden and B.H. Iglewski Rotavirus 561 U.D. Parashar, J.S. Bresee, J.R. Gentsch, and R.I. Glass Chlamydia pneumoniae and 571 Cardiovascular Disease L.A. Campbell, C.C. Kuo, and J.T. Grayston Bacterial Symbiosis in Arthropods and the 581 Control of Disease Transmission C.B. Beard, R.V. Durvasula, and F.F. Richards Genetic Epidemiology of Infectious Diseases in 593 Humans: Design of Population-Based Studies L. Abel and A.J. Dessein Insecticide Resistance and Vector Control 605 W.G. Brogdon and J.C. McAllister Dispatches Mutators and Long-Term Molecular Evolution 615 of Pathogenic Escherichia coli O157:H7 T.S. Whittam, S.D. Reid, and R.K. Selander Increasing Hospitalization and Death Possibly 619 Due to Clostridium difficile Diarrheal Disease F. Frost, G.F. Craun, and R.L. Calderon Introduction of Aedes albopictus into a 627 La Crosse VirusEnzootic Site in Illinois U. Kitron, J. Swanson, M. Crandell, P.J. Sullivan, J. Anderson, R. Garro, L.D. Haramis, and P.R. Grimstad Mycobacterium canettii, the Smooth 631 Variant of M. tuberculosis, Isolated from a Swiss Patient Exposed in Africa G.E. Pfyffer, R. Auckenthaler, J.D.A. van Embden, and Above: Three Women (1998) by Ezekiel Madiba, Mabopane, D. van Soolingen South Africa. Human Infections with Shiga Toxin- 635 (Used with permission of the artist.) Producing Escherichia coli Other Than Serogroup O157 in Germany Perspectives L. Beutin, S. Zimmermann, and K. Gleier Quasispecies Structure and Persistence of 521 New Orientia tsutsugamushi Strain from 641 RNA Viruses Scrub Typhus in Australia E. Domingo, E. Baranowski, C.M. Ruiz-Jarabo, D.M. Odorico, S.R. Graves, B. Currie, J. Catmull, A.M. Martín-Hernández, J.C. Sáiz, and C. Escarmís Z. Nack, S. Ellis, L. Wang, and D.J. Miller Ecologic Studies of Rodent Reservoirs: 529 Streptococcus parasanguinis: New Pathogen 645 Their Relevance for Human Health Associated with Asymptomatic Mastitis in Sheep J.N. Mills and J.E. Childs J.F. Fernández-Garayzábal, E. Fernández, A. Las Heras, Diphtheria in the Former Soviet Union: 539 C. Pascual, M.D. Collins, and L. Domínguez Reemergence of a Pandemic Disease C.R. Vitek and M. Wharton Cover: When spider webs unite, they can tie up a lion. Adapted from the Red Cross African American HIV/AIDS Program poster series with permission. Copyright April 1992 (revised March 1997). Contents EMERGING INFECTIOUS DISEASES Volume 4 Number 4 OctoberDecember 1998 Introduction of HIV-2 and Multiple HIV-1 649 Can the Military Contribute to Global 704 Subtypes to Lebanon Surveillance and Control of Infectious Diseases? D. Pieniazek, J. Baggs, D.J. Hu, G.M. Matar, A.M. R. D’Amelio and D.L. Heymann Abdelnoor, J.E. Mokhbat, M. Uwaydah, A.R. Bizri, Dual Infection with Ehrlichia chaffeensis and 705 C.A. Ramos, L.M. Janini, A. Tanuri, C. Fridlund, C. Schable, L. Heyndrickx, M.A. Rayfield, and W. Heneine a Spotted Fever Group Rickettsia: A Case Report Sporadic STEC O157 Infection: Secondary 657 A.J. Sulzer Household Transmission inWales Dual Infection with Ehrlichia chaffeensis and 706 S.M. Parry and R.L. Salmon a Spotted Fever Group Rickettsia: A Case Ehrlichia Infection in Italy 663 ReportReply to Dr. Sulzer M. Nuti, D.A. Serafini, D. Bassetti, A. Ghionni, D.J. Sexton and D.H. Walker F. Russino, P. Rombolà, G. Macri, and E. Lillini Reemergence of Plasmodium vivax 707 Salmonella Enteritidis PT6: Another 667 Malaria in the Republic of Korea Egg-Associated Salmonellosis? P.S. Brachman M.R. Evans, W. Lane, and C.D. Ribeiro Paratyphoid Fever 707 Reemergence of Epidemic Malaria in 671 M.R. Wallace the Highlands of Western Kenya Hospitalizations after the Gulf War 707 M.A. Malakooti, K. Biomndo, and G.D. Shanks K.M. Leisure, N.L. Nicolson, and G.L. Nicolson Murine Typhus in Travelers Returning 677 Hospitalizations after the Gulf WarReply 707 from Indonesia to K.M. Leisure et al. P. Parola, D. Vogelaers, C. Roure, F. Janbon, and D. Raoult J.D. Knoke and G.C. Gray Differentiating Human from Animal 681 Isolates of Cryptosporidium parvum Book Review I.M. Sulaiman, L. Xiao, C. Yang, L. Escalante, A. Moore, C.B. Beard, M.J. Arrowood, and A.A. Lal HIV Nursing and Symptom Management 710 An Outbreak of Hantavirus Pulmonary 687 A.C. Moorman Syndrome, Chile, 1997 J. Toro, J.D. Vega, A.S. Khan, J.N. Mills, P. Padula, News and Notes W. Terry, Z. Yadón, R. Valderrama, B.A. Ellis, C. Pavletic, Overseas Medical Laboratory Conference 711 R. Cerda, S. Zaki, S. Wun-Ju, R. Meyer, M. Tapia, C. Mansilla, M. Baro, J.A. Vergara, M. Concha, G. Calderon, D. Enria, C.J. Peters, and T.G. Ksiazek Commentaries Host Genetics of Infectious Diseases: 695 Old and New Approaches Converge A.V.S. Hill Does Restricted Distribution Limit Access 698 and Coverage of Yellow Fever Vaccine in the United States? T.P. Monath, J.A. Giesberg, and E. G. Fierros Letters Aedes aegypti in Tucson, Arizona 703 T.M. Fink, B. Hau, B.L. Baird, S. Palmer, S. Kaplan, F.B. Ramberg, D.G. Mead, and H. Hagedorn Rotavirus particles visualized by electron microscopy in stool filtrate from child with acute gastroenteritis. Photo courtesy of Dr. Charles D. Humphrey, CDC. Update International Editors update Emerging Infectious Diseases—South Africa Keith P. Klugman The South African Institute for Medical Research Johannesburg, South Africa Dr. Klugman, director of the main a major cause of illness and death in South African Institute for Medi- South Africa. The medical infrastructure is cal Research and and its Pneu- good in major cities, primary health care is mococcal Diseases Research Unit, is professor of microbiology and expanding in rural areas, and modern chair of the School of Pathology, diagnostic facilities are reasonably widely University of the Witwatersrand. available. Urban areas have a mixture of He has broad interests and infectious disease problems encountered in experience in bacterial infec- tions and works with WHO developing as well as industrialized countries, committees and advisory groups and in the tropical environment of the on acute respiratory infections, northeast, malaria and other vector-borne meningitis, pneumonia, vaccine, diseases persist. and drug management. Infectious diseases re- An aerial view of Chris Hani Baragwanath Hospital, with 3,000 inpatients the largest hospital in the world Soweto, South Africa. Multiple-drug resistant pneumococci were found here in 1978. Address for correspondence: K.P. Klugman, The South African Institute for Medical Research, Johannesburg, South Africa; fax: 27-11-489-9012; e-mail: [email protected]. Vol. 4, No. 4, OctoberDecember 1998517 Emerging Infectious Diseases Update Emerging Infectious Disease Surveillance The reason for the contrast between the low National surveillance of emerging infections incidence of betalactamase-producing H. influenzae in South Africa is in its infancy. A number of and the high incidence of penicillin resistance in infectious diseases are notifiable, but no formal the pneumococcus is not known. laboratory-based surveillance system is in place to confirm diagnoses or to subtype microorgan- Neisseria meningitidis isms for epidemiology purposes. I have Over the past few years, the distribution of summarized infectious disease trends in South meningococcal serogroups has been fairly even Africa, with special emphasis on the antimicro- between groups A, B, and C. An epidemic in Cape bial resistance patterns of locally circulating Town of group B in the 1980s provided an microorganisms. opportunity to attempt to use an outer membrane protein vaccine, but the epidemic Bacterial Diseases ceased before enough cases could be enrolled in the vaccine trial. An epidemic of group A Streptococcus pneumoniae meningococcal meningitis is ongoing in the Fully resistant and multiple-drug resistant countries immediately to the north of South pneumococci were discovered in South Africa in Africa, particularly in Mozambique, and an 1978. The pattern of emergence of pneumococcal increasing number of group A strains are being resistance in South Africa has been somewhat identified, largely in adult refugees from different from that observed in Western Europe Mozambique. These group A strains have been (and more recently in the United States). In typed by the World Health Organization those countries, the emergence of resistance was Meningococcal Reference Center in Oslo, explosive and associated with a limited number Norway, and represent a unique South African of clones, particularly of serotype 23F and 6B, clone. The epidemic clone associated with the Haj which are associated with multidrug resistance (III-1) in the 1980s was, however, discovered for and high-level penicillin resistance. The highly the first time in South Africa in 1997. resistant strains initially isolated in South Africa belonged largely to serotype 19A and for some as Staphylococcus aureus yet unexplained reason, remain rare. Antimicro- The incidence of methicillin-resistant S. bial resistance to penicillin in the pneumococcus aureus in South Africa is alarming, with up to in South Africa has reached very high levels 50% of nosocomial isolates being methicillin- (approximately 45% in young children), but most resistant. No vancomycin-intermediate S. aureus of this resistance is caused by a large number of strains as have been reported in the United intermediately penicillin-resistant strains rather States and Japan have been identified in than a limited number of clones found South Africa to date. The incidence of internationally. Antibiotic resistance differs in methicillin resistance among S. epidermidis the public versus private health-care sectors of strains in hospitals is, as expected, even South Africa. The most important difference may higher. be the relative scarcity of macrolide resistance among strains of pneumococci in public Enterococcus hospitals, where these drugs are less often used.
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