Barriers to Creutzfeldt-Jakob Disease Autopsies, California

Creutzfeldt-Jakob disease (CJD) surveillance relies on autopsy and neuropathologic evaluation. The 1990–2000 CJD autopsy rate in California was 21%. Most neurologists were comfortable diagnosing CJD (83%), but few pathologists felt comfortable diagnosing CJD (35%) or performing autopsy (29%). Addressing obstacles to autopsy is necessary to improve CJD surveillance

Acute Encephalitis Hospitalizations, California, 1990–1999: Unrecognized Arboviral Encephalitis?

Epidemiologic features of hospitalized patients provide little evidence of unrecognized arboviral encephalitis

Epidemic Leptospirosis Associated with Pulmonary Hemorrhage—Nicaragua, 1995

In October 1995, epidemic “hemorrhagic fever,” without jaundice or renal manifestations, was reported in rural Nicaragua following heavy flooding; 2259 residents were evaluated for nonmalarial febrile illnesses (cumulative incidence, 6.1%) and 15 (0.7%) died with pulmonary hemorrhage. A case-control study found that case-patients were more likely than controls to have ever walked in creeks (matched odds ratio [MOR], 15.0; 95% confidence interval [CI], 1.7–132.3), have household rodents (MOR, 10.4; 95% CI, 1.1–97.1), or own dogs with titers ≥ 400 to Leptospira species (MOR, 23.4; 95% CI, 3.6–`). Twenty-six of 51 case-patients had serologic or postmortem evidence of acute leptospirosis. Leptospira species were isolated from case-patients and potential animal reservoirs. This leptospirosis epidemic likely resulted from exposure to flood waters contaminated by urine from infected animals, particularly dogs. Leptospirosis should be included in the differential diagnosis for nonmalarial febrile illness, particularly during periods of flooding or when pulmonary hemorrhage occurs

Reply to Shah, J.S.; Ramasamy, R. Target Antigens in Western and Line Immunoblots for Supporting the Diagnosis of Lyme Disease. Comment on “Porwancher et al. Immunoblot Criteria for Diagnosis of Lyme Disease: A Comparison of CDC Criteria to Alternative Interpretive Approaches. <i>Pathogens</i> 2023, <i>12</i>, 1282”

We are writing in response to comments made by Shah and Ramasamy [...

Important emerging bacterial zoonotic infections affecting the immunocompromised

The immunocompromised are at particular risk for infection with zoonotic diseases. Persons can be temporarily immunocompromised due to pregnancy or developmental stage (i.e. infants); longer-term or permanent states of immunosuppression can occur as a result of immunosuppressive treatment following cancer or organ transplant, or from infectious diseases, such as AIDS. The focus of this review article is on emerging bacterial zoonotic diseases that are of particular concern among the immunocompromised. Factors that affect disease emergence can include factors such as human demographics and behavior; technology and industry; economic development and land use; international travel and commerce; microbial adaptation and change; and breakdown of public health measures. The immunocompromised need to take precautions when engaging in seemingly normal activities such as food preparation; caring for companion animals; and recreational or occupational activities. The immunocompromised are not only more susceptible to infection, but often suffer more serious sequelae as a result of infection. This review article provides an overview of the major foodborne, respiratory, and vector-borne bacterial pathogens that affect the immunocompromised. The major categories of immunodeficiency are described. In addition, measures that can be taken to prevent infection, including the role of health education, are discussed