Infectious Diseases Pathology Branch

West Long Branch, United States

Infectious Diseases Pathology Branch

West Long Branch, United States

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Brondfield M.N.,University of California at San Francisco | Reid M.J.A.,University of California at San Francisco | Rutishauser R.L.,University of California at San Francisco | Cope J.R.,Centers for Disease Control and Prevention | And 9 more authors.
Transplant Infectious Disease | Year: 2017

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


Doker T.J.,Centers for Disease Control and Prevention | Sharp T.M.,Centers for Disease Control and Prevention | Perez-Padilla J.,Centers for Disease Control and Prevention | Benoit T.J.,Centers for Disease Control and Prevention | And 14 more authors.
Clinical Infectious Diseases | Year: 2015

Background. Melioidosis results from infection with Burkholderia pseudomallei and is associated with case-fatality rates up to 40%. Early diagnosis and treatment with appropriate antimicrobials can improve survival rates. Fatal and nonfatal melioidosis cases were identified in Puerto Rico in 2010 and 2012, respectively, which prompted contact investigations to identify risk factors for infection and evaluate endemicity. Methods. Questionnaires were administered and serum specimens were collected from coworkers, neighborhood contacts within 250 m of both patients' residences, and injection drug user (IDU) contacts of the 2012 patient. Serum specimens were tested for evidence of prior exposure to B. pseudomallei by indirect hemagglutination assay. Neighborhood seropositivity results guided soil sampling to isolate B. pseudomallei. Results. Serum specimens were collected from contacts of the 2010 (n = 51) and 2012 (n = 60) patients, respectively. No coworkers had detectable anti-B. pseudomallei antibody, whereas seropositive results among neighborhood contacts was 5% (n = 2) for the 2010 patient and 23% (n = 12) for the 2012 patient, as well as 2 of 3 IDU contacts for the 2012 case. Factors significantly associated with seropositivity were having skin wounds, sores, or ulcers (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.2-17.8) and IDU (OR, 18.0; 95% CI, 1.6-194.0). Burkholderia pseudomallei was isolated from soil collected in the neighborhood of the 2012 patient. Conclusions. Taken together, isolation of B. pseudomallei from a soil sample and high seropositivity among patient contacts suggest at least regional endemicity of melioidosis in Puerto Rico. Increased awareness of melioidosis is needed to enable early case identification and early initiation of appropriate antimicrobial therapy. © 2014 The Author.


Fanfair R.N.,Mycotic Diseases Branch | Benedict K.,Mycotic Diseases Branch | Bennett S.D.,Mycotic Diseases Branch | Lo Y.-C.,Epidemic Intelligence Service | And 17 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Mucormycosis is a fungal infection caused by environmentally acquired molds. We investigated a cluster of cases of cutaneous mucormycosis among persons injured during the May 22, 2011, tornado in Joplin, Missouri. METHODS: We defined a case as a soft-tissue infection in a person injured during the tornado, with evidence of a mucormycete on culture or immunohistochemical testing plus DNA sequencing. We conducted a case-control study by reviewing medical records and conducting interviews with case patients and hospitalized controls. DNA sequencing and whole-genome sequencing were performed on clinical specimens to identify species and assess strain-level differences, respectively. RESULTS: A total of 13 case patients were identified, 5 of whom (38%) died. The patients had a median of 5 wounds (range, 1 to 7); 11 patients (85%) had at least one fracture, 9 (69%) had blunt trauma, and 5 (38%) had penetrating trauma. All case patients had been located in the zone that sustained the most severe damage during the tornado. On multivariate analysis, infection was associated with penetrating trauma (adjusted odds ratio for case patients vs. controls, 8.8; 95% confidence interval [CI], 1.1 to 69.2) and an increased number of wounds (adjusted odds ratio, 2.0 for each additional wound; 95% CI, 1.2 to 3.2). Sequencing of the D1-D2 region of the 28S ribosomal DNA yielded Apophysomyces trapeziformis in all 13 case patients. Whole-genome sequencing showed that the apophysomyces isolates were four separate strains. CONCLUSIONS: We report a cluster of cases of cutaneous mucormycosis among Joplin tornado survivors that were associated with substantial morbidity and mortality. Increased awareness of fungi as a cause of necrotizing soft-tissue infections after a natural disaster is warranted. Copyright © 2012 Massachusetts Medical Society.


PubMed | Centers for Disease Control and Prevention, Epidemic Intelligence Service, University of California at San Francisco, Washington Hospital Healthcare System and Infectious Diseases Pathology Branch
Type: | Journal: Transplant infectious disease : an official journal of the Transplantation Society | Year: 2017

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection. This article is protected by copyright. All rights reserved.


PubMed | Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Puerto Rico Institute of Forensic science, Infectious Diseases Pathology Branch and 2 more.
Type: Journal Article | Journal: PLoS neglected tropical diseases | Year: 2016

Dengue is a leading cause of morbidity throughout the tropics; however, accurate population-based estimates of mortality rates are not available.We established the Enhanced Fatal Acute Febrile Illness Surveillance System (EFASS) to estimate dengue mortality rates in Puerto Rico. Healthcare professionals submitted serum and tissue specimens from patients who died from a dengue-like acute febrile illness, and death certificates were reviewed to identify additional cases. Specimens were tested for markers of dengue virus (DENV) infection by molecular, immunologic, and immunohistochemical methods, and were also tested for West Nile virus, Leptospira spp., and other pathogens based on histopathologic findings. Medical records were reviewed and clinical data abstracted. A total of 311 deaths were identified, of which 58 (19%) were DENV laboratory-positive. Dengue mortality rates were 1.05 per 100,000 population in 2010, 0.16 in 2011 and 0.36 in 2012. Dengue mortality was highest among adults 19-64 years and seniors 65 years (1.17 and 1.66 deaths per 100,000, respectively). Other pathogens identified included 34 Leptospira spp. cases and one case of Burkholderia pseudomallei and Neisseria meningitidis.EFASS showed that dengue mortality rates among adults were higher than reported for influenza, and identified a leptospirosis outbreak and index cases of melioidosis and meningitis.


PubMed | Centers for Disease Control and Prevention, Médecins Sans Frontières, Ministry of Health, Viral Special Pathogens Branch. and 2 more.
Type: Journal Article | Journal: The Journal of infectious diseases | Year: 2016

Here we describe clinicopathologic features of Ebola virus disease in pregnancy. One woman infected with Sudan virus in Gulu, Uganda, in 2000 had a stillbirth and survived, and another woman infected with Bundibugyo virus had a live birth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemical analysis, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malarial parasite pigment-laden macrophages. These data suggest that trophoblast infection may be a mechanism of transplacental ebolavirus transmission.


PubMed | Infectious Diseases Pathology Branch., Centers for Disease Control and Prevention and Emory University
Type: Case Reports | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2014

Melioidosis results from infection with Burkholderia pseudomallei and is associated with case-fatality rates up to 40%. Early diagnosis and treatment with appropriate antimicrobials can improve survival rates. Fatal and nonfatal melioidosis cases were identified in Puerto Rico in 2010 and 2012, respectively, which prompted contact investigations to identify risk factors for infection and evaluate endemicity.Questionnaires were administered and serum specimens were collected from coworkers, neighborhood contacts within 250 m of both patients residences, and injection drug user (IDU) contacts of the 2012 patient. Serum specimens were tested for evidence of prior exposure to B. pseudomallei by indirect hemagglutination assay. Neighborhood seropositivity results guided soil sampling to isolate B. pseudomallei.Serum specimens were collected from contacts of the 2010 (n = 51) and 2012 (n = 60) patients, respectively. No coworkers had detectable anti-B. pseudomallei antibody, whereas seropositive results among neighborhood contacts was 5% (n = 2) for the 2010 patient and 23% (n = 12) for the 2012 patient, as well as 2 of 3 IDU contacts for the 2012 case. Factors significantly associated with seropositivity were having skin wounds, sores, or ulcers (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.2-17.8) and IDU (OR, 18.0; 95% CI, 1.6-194.0). Burkholderia pseudomallei was isolated from soil collected in the neighborhood of the 2012 patient.Taken together, isolation of B. pseudomallei from a soil sample and high seropositivity among patient contacts suggest at least regional endemicity of melioidosis in Puerto Rico. Increased awareness of melioidosis is needed to enable early case identification and early initiation of appropriate antimicrobial therapy.


PubMed | Centers for Disease Control and Prevention, Infectious Diseases Pathology Branch and Health Science University
Type: Journal Article | Journal: The Journal of infectious diseases | Year: 2016

After chikungunya virus (CHIKV) transmission was detected in Puerto Rico in May 2014, multiple surveillance systems were used to describe epidemiologic trends and CHIKV-associated disease. Of 28 327 cases reported via passive surveillance, 6472 were tested for evidence of CHIKV infection, and results for 4399 (68%) were positive. Of 250 participants in household cluster investigations, 70 (28%) had evidence of recent CHIKV infection. Enhanced surveillance for chikungunya at 2 hospitals identified 1566 patients who tested positive for CHIKV, of whom 10.9% were hospitalized. Enhanced surveillance for fatal cases enabled identification of 31 cases in which CHIKV was detected in blood or tissue specimens. All surveillance systems detected a peak incidence of chikungunya in September 2014 and continued circulation in 2015. Concomitant surveillance for dengue demonstrated low incidence, which had decreased before CHIKV was introduced. Multifaceted chikungunya surveillance in Puerto Rico resolved gaps in traditional passive surveillance and enabled a holistic description of the spectrum of disease associated with CHIKV infection.


In the blood of a patient infected with Zika, researchers have found key proteins that could help them create medicines and vaccines to fight the rapidly spreading virus. A study published Wednesday in the journal Science Translational Medicine describes two antibodies that were able to “eliminate” samples of the Zika virus when tested in laboratory dishes. When the researchers gave either of the antibodies to mice that had been deliberately infected with Zika, the animals “were completely protected against ZIKV infection,” according to the study. Importantly, the antibodies did not seem to recognize strains of Dengue virus, a close relative of Zika. If these antibodies are developed into medicines, that feature could reduce the risk of inadvertently fueling the rise of a more dangerous strain of Dengue, the researchers noted. The antibodies were harvested from the blood of a patient in China who became ill in Venezuela. The report is the latest in a spate of research describing the inner workings of the Zika virus and the ways it does damage to pregnant women and their developing babies. In Wednesday’s edition of the New England Journal of Medicine, Brazilian public health officials reported the results of one of the first studies to systematically test women for Zika throughout their pregnancies and track the health of their babies. Working with UCLA pediatric infectious disease specialist Dr. Karin Nielsen-Saines, the Brazilians followed a group of 345 women throughout their pregnancies. Among them, 53% tested positive for Zika. The researchers examined the infants born to infected women and found that 46% of the babies had health problems, compared with 11% of the babies born to uninfected mothers. Among affected infants, 42% had “grossly abnormal clinical or brain imaging findings,” including some who had both. In addition, four of the infants were diagnosed with microcephaly. While researchers have long suspected that Zika infections early in pregnancy were most harmful to developing fetuses, the Brazilian study found that the trimester during which the women were infected did not matter much. Some 55% of pregnant women infected in their first trimester had poor pregnancy outcomes, as did 52% of those infected in their second trimester and 29% of those infected in their third trimester. These outcomes ranged from a baby’s small overall size — a result of fetal growth restriction — to fetal distress during birth. Abnormalities of the central nervous system were seen in fetuses infected as late as 39 weeks of gestation, the researchers said. A study that tracked Zika-infected pregnant women in the United States, meanwhile, offered more specific numbers on microcephaly and suggested that Zika infection early in pregnancy does pose the greatest risk. In an article in Wednesday’s edition of the journal JAMA, researchers found that 6% of Zika-infected pregnant women in the United States had a fetus or infant with evidence of a Zika-related birth defect. All of these women were infected during their first trimester, the study found. Among this group, 11% had a fetus or infant with a birth defect. Infants with microcephaly represented 4% of the 442 completed pregnancies that were tracked. Meanwhile, a report from the Centers for Disease Control and Prevention offers more fine-grained detail of Zika’s harm. It confirms the virus’ powerful attraction to the placenta and to developing brain tissue and shows that long after a pregnant woman has recovered from Zika infection’s mild symptoms, the virus is thriving inside placental tissue and a fetus’ developing brain. The study, published online Tuesday in the journal Emerging Infectious Disease, is the first to show Zika’s genetic material replicating in brain tissues of infants with microcephaly who later died, and in placentas of women who suffered pregnancy losses. Zika can continue to replicate in infants’ brains even after birth, said study lead author Julu Bhatnagar, who leads the molecular pathology team at the CDC’s Infectious Diseases Pathology Branch.  The virus’ persistence suggests that even apparently healthy babies born to mothers who were infected with Zika may not be out of the woods, and that babies born with microcephaly may experience ongoing brain damage from their mothers’ Zika infection. “We don’t know how long the virus can persist,” Bhatnagar said. “More studies are needed to fully understand how the virus can affect babies.” Follow me on Twitter @LATMelissaHealy and "like" Los Angeles Times Science & Health on Facebook. Teens are cutting back on drugs, alcohol, smoking and even electronic cigarettes, study finds Optimistic women are less likely to die prematurely of cancer or heart disease, study says Sorry, Pokemon Go addicts, playing the video game doesn’t count as a real workout


News Article | November 5, 2015
Site: news.yahoo.com

A Colombian man's lung tumors turned out to have an extremely unusual cause: The rapidly growing masses weren't actually made of human cells, but were from a tapeworm living inside him, according to a report of the case. This is the first known report of a person becoming sick from cancer cells that developed in a parasite, the researchers said. "We were amazed when we found this new type of disease — tapeworms growing inside a person, essentially getting cancer, that spreads to the person, causing tumors," said study researcher Dr. Atis Muehlenbachs, a staff pathologist at the Centers for Disease Control and Prevention's Infectious Diseases Pathology Branch (IDPB). The man had HIV, which weakens the immune system and likely played a role in allowing the development of the parasite cancer, the researchers said. Although the man's case is probably a rare one, the researchers noted that both tapeworms and HIV affect millions of people worldwide, "so there may be more cases that are unrecognized," Muehlenbachs said. [10 Deadly Diseases That Hopped Across Species] The 41-year-old man first went to doctors in Colombia after experiencing a fever, cough and weight loss for several months. The man had been diagnosed with HIV more than 10 years earlier, but was not taking his medications. A CT scan showed tumors in his lung and lymph nodes, but biopsies of these tumors revealed bizarre cells, leading Colombian doctors to contact the CDC for assistance in diagnosing the man. The cells, when examined under a microscope, acted like cancer cells — they multiplied quickly and crowded together. But the cells didn't appear to be human, they were 10 times smaller than human cancer cells. After a number of tests, the researchers found DNA from a type of tapeworm called H. nana in the man's tumor. This result was surprising, the researchers said, because the cells did not look at all like tissue from a tapeworm. But further tests confirmed that the cells were indeed from H. nana. The researchers hypothesized that, because the man had HIV, the tapeworm kept growing in the body, unchecked by the immune system. Eventually, mutations developed in the tapeworm's cells that turned the cells cancerous. The patient died just 72 hours after researchers determined that the tumors were caused by H. nana. H. nana is the most common tapeworm in humans, infecting up to 75 million people worldwide at any given time. If researchers do find other cases like the Colombian man's, it's not clear what type of treatment would help. Drugs that treat tapeworm infections may not be able to treat cancer cells from tapeworms, the researchers said. But it's possible that human cancer treatment might also work against parasite cancer cells. The study is published in today's (Nov. 5) issue of the New England Journal of Medicine. Copyright 2015 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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