Epidemic Clostridium difficile Ribotype 027 in Chile

TO THE EDITOR: The increased severity of Clostridium difficile infection is primarily attributed to the appearance of an epidemic strain characterized as PCR ribotype 027 (1). The only report that identified epidemic C. difficile ribotype 027 in an American country outside of North America comes from Costa Rica, raising the possibility that strains 027 might also be present in other countries of Latin America (2). Several studies between 2001 and 2009 have been conducted in South American countries to detect the incidence of C. difficile infection in hospitalized patients, but they did not identify which C. difficile strains were causing these infections (3).     

Clostridium difficile infection, Colorado and the northwestern United States, 2007

To determine the incidence of Clostridium difficile infection during 2007, we examined infection in adult inpatient and outpatient members of a managed-care organization. Incidence was 14.9 C. difficile infections per 10,000 patient-years. Extrapolating this rate to US adults, we estimate that 284,875 C. difficile infections occurred during 2007.     

Mycoplasmosis in Ferrets

We report an outbreak of severe respiratory disease associated with a novel Mycoplasma species in ferrets. During 2009–2012, a respiratory disease characterized by nonproductive coughing affected ≈8,000 ferrets, 6–8 weeks of age, which had been imported from a breeding facility in Canada. Almost 95% became ill, but almost none died. Treatments temporarily decreased all clinical signs except cough. Postmortem examinations of euthanized ferrets revealed bronchointerstitial pneumonia with prominent hyperplasia of bronchiole-associated lymphoid tissue. Immunohistochemical analysis with polyclonal antibody against Mycoplasma bovis demonstrated intense staining along the bronchiolar brush border. Bronchoalveolar lavage samples from 12 affected ferrets yielded fast-growing, glucose-fermenting mycoplasmas. Nucleic acid sequence analysis of PCR-derived amplicons from portions of the 16S rDNA and RNA polymerase B genes failed to identify the mycoplasmas but showed that they were most similar to M. molare and M. lagogenitalium. These findings indicate a causal association between the novel Mycoplasma species and the newly recognized pulmonary disease.     

Intrafamilial circulation of Tropheryma whipplei, France

Tropheryma whipplei, which causes Whipple disease, has been detected in 4% of fecal samples from the general adult population of France. To identify T. whipplei within families, we conducted serologic and molecular studies, including genotyping, on saliva, feces, and serum from 74 relatives of 13 patients with classic Whipple disease, 5 with localized chronic T. whipplei infection, and 3 carriers. Seroprevalence was determined by Western blot and compared with 300 persons from the general population. We detected T. whipplei in 24 (38%) of 64 fecal samples and 7 (10%) of 70 saliva samples from relatives but found no difference between persons related by genetics and marriage. The same circulating genotype occurred significantly more often in families than in other persons. Seroprevalence was higher among relatives (23 [77%] of 30) than in the general population (143 [48%] of 300). The high prevalence of T. whipplei within families suggests intrafamilial circulation.     

Risk for Travel-associated Legionnaires’ Disease,Europe, 2009

Legionnaires’ disease is underreported in Europe; notification rates differ substantially among countries. Approximately 20% of reported cases are travel-associated. To assess the risk for travel-associated Legionnaires’ disease (TALD) associated with travel patterns in European countries, we retrieved TALD surveillance data for 2009 from the European Surveillance System, and tourism denominator data from the Statistical Office of the European Union. Risk (number cases reported/number nights spent) was calculated by travel country. In 2009, the network reported 607 cases among European travelers, possibly associated with 825 accommodation sites in European Union countries. The overall risk associated with travel abroad was 0.3 cases/million nights. We observed an increasing trend in risk from northwestern to southeastern Europe; Greece had the highest risk (1.7). Our findings underscore the need for countries with high TALD risks to improve prevention and control of legionellosis; and for countries with high TALD risks, but low notification rates of Legionnaires’ disease to improve diagnostics and reporting.     

Aeromonas spp. Bacteremia in Pregnant Women, Thailand-Myanmar Border, 2011

TO THE EDITOR: Aeromonas spp. bacteria cause a broad spectrum of human infections (1). Invasive infections can be associated with exposure to contaminated water and occur frequently in patients with underlying immunosuppression or trauma but only infrequently in pregnant women (2). During January-May 2011, Aeromonas spp. bacteremia was identified in 3 pregnant Myanmar women of Karen ethnicity, who sought care at migrant/refugee clinics on the Thailand-Myanmar border.     

Reservoir Competence of Vertebrate Hosts for Anaplasma phagocytophilum

Fourteen vertebrate species (10 mammals and 4 birds) were assessed for their ability to transmit Anaplasma phagocytophilum, the bacterium that causes human granulocytic anaplasmosis, to uninfected feeding ixodid ticks. Small mammals were most likely to infect ticks but all species assessed were capable of transmitting the bacterium, in contrast to previous findings.     

bla(OXA-181)-positive Klebsiella pneumoniae, Singapore

TO THE EDITOR: Nordmann et al. (1) raised concern over the global spread of carbapenemase-producing Enterobacteriaceae. In their article, they called attention to the oxacillinase-48 (OXA-48) type carbapenemases because bacteria that produce these enzymes do not have a distinctive antimicrobial drug susceptibility profile, and there is less awareness of this mechanism of carbapenem resistance. We report the recent isolation of bla(OXA-181)-positive Klebsiella pneumoniae from 2 patients from Bangladesh who were admitted to separate hospitals in Singapore within a short period of each other.     

PCR 检测在血液病患儿血流感染细菌谱分析中的应用

目的：探讨聚合酶链式反应（PCR）技术在分析血流感染细菌菌谱中的应用,为血液病患儿细菌性血流感染的流行病学调查提供新的思路。方法从西安市儿童医院血液内科收集80例疑似血流感染患儿的外周静脉血标本进行血培养,同时扩增并测序细菌16 S rDNA,对血培养和 PCR 结果进行比较。结果80例血液标本中7例细菌培养阳性,阳性率为8．8％;PCR 检测出16例阳性,阳性率为20．0％,二者差异有统计学意义（χ2＝5．82,P ＜0．05）;在16例 PCR 阳性标本中,革兰阳性菌占68．7％,其中表皮葡萄球菌最多[占31．3％（5/16）],革兰阴性菌占31．3％,以非发酵菌为主[占18．7％（3/16）]。结论16 S rDNA-PCR结合测序的方法可以很好地鉴定血流感染病原菌,可作为一种新的流行病学方法在临床应用;血液病儿童血流感染病原菌以革兰阳性球菌为主,尤以表皮葡萄球菌最常见。