At the Centers for Disease Control (CDC) and Prevention web site, look for case

Question

At the Centers for Disease Control (CDC) and Prevention web site, look for case reports or case studies about a bacterial, fungal, viral and parasite (protozoan or helminth) infection, reported in the Morbidity and Mortality Weekly Reports (MMWR). Briefly summarize each case report in your own words, showing the type of infection, source of infection, identity of the pathogen (s), how the case was investigated and managed and the conclusions reached. Provide the citations for the four case reports. The case studies should be current; no older than 4 years.

Students need to provide detail regarding the cases and in the other responses. Students will need to read 3-4 cases before selecting which one to focus on for each pathogen. In each case study, it needs to be clear who was infected. Each student will select 4 cases. One for bacteria, fungi, virus and a parasite. A total of four cases.

For each case, describe who was infected, where the infection was acquired, how the infection was diagnosed, what tests were used and how the patient was managed and treated. Surveys and epidemiological reports are not case studies. In addition, the cases should be from MMWR.

Explanation / Answer

1) Measles case study (Bacterial infection):

On May 25, 2016, a detainee at a U.S. Immigration and Customs Enforcement (ICE) detention center in Arizona had been hospitalized with fever and a generalized maculopapular rash. He was confirmed to have measles by real-time polymerase chain reaction (rPCR). A second case of measles in a staff member was confirmed by rPCR the next day. Epidemiologic investigations was conducted by local and state health departments and they identified 31 total cases of measles in 22 detainees and nine staff members, with rash onsets occurring May 6–June 26. Outbreak control measures consisted of administration of measles-mumps-rubella (MMR) vaccine to 1,424 detainees housed at the facility during May 29–31 and isolation of the detainee patient and any additional detainee patients identified during their remaining infectious period (until 4 days after rash onset). The epidemiological team recommended implementing measles control policies for detention similar to those recommended in health care facilities.

Reference: Venkat H, Kassem AM, Su C, et al. Notes from the Field: Measles Outbreak at a United States Immigration and Customs Enforcement Facility Arizona, May–June 2016. MMWR Morb Mortal Wkly Rep 2017;66:543–544.

2) Powassan virus disease:

In early November 2016, a healthy male infant aged 5 months from eastern Connecticut developed fever and vomiting. Right-sided facial twitching began over the next several days, and progressed to seizures.He was admitted to the hospital for evaluation and management of his seizures. There was no travel history; however, the parents reported that 2 weeks earlier, the infant had been bitten by a tick most likely carried into the home on a family member’s clothing. The CSF sample obtained on admission was positive for POWV immunoglobulin M, with a POWV-specific neutralizing antibody titer of 32. POWV is a tickborne flavivirus, similar to tickborne encephalitis virus, transmitted by Ixodes scapularis, I. cookei, and I. marxi ticks. Clinical presentations of POWV infection range from a febrile illness to severe neurologic disease, with death occurring in approximately 10% of reported cases. The child’s seizures were controlled with anticonvulsant therapy with fosphenytoin and levetiracetam, and he was discharged home after 7 days on oral levetiracetam.

Reference: Tutolo JW, Staples JE, Sosa L, Bennett N. Notes from the Field: Powassan Virus Disease in an Infant - Connecticut, 2016. MMWR Morb Mortal Wkly Rep 2017;66:408–409.

3) Fungal disease:

Seven C. auris cases occurring during May 2013–August 2016 were reported to CDC (one in 2013, one in 2015, and five in 2016). Six of seven cases were identified through retrospective review of microbiology records from reporting hospitals and reference laboratories. Cases were reported from four states: Illinois (n = 2, single hospital), Maryland (n = 1), New Jersey (n = 1), and New York (n = 3, three different hospitals). Recent travel outside the United Stated was documented for only one patient: the 2013 New York patient had been transferred less than 1 week earlier from a hospital in the Middle East. Five patients had C. auris initially isolated from blood, one from urine, and one from the external ear canal.

Reference: Vallabhaneni S, Kallen A, Tsay S, et al. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus — United States, May 2013–August 2016. MMWR Morb Mortal Wkly Rep 2016;65:1234–1237.

4) Protozoal infection:

This report provides preliminary data about 22 cases of Cutaneous Lieshmaniasis (CL) in military personnel deployed during 2002--2003 to three countries in Southwest/Central Asia (Afghanistan, Iraq, and Kuwait). When evaluated, the 22 patients had a median of three (range: one to nine) skin lesions, which ranged from 3 mm to 40 mm in diameter. Higher proportions of the lesions were located on the upper (39%) or lower (32%) extremities than on the trunk/back (16%) or face/neck (13%). Typically, the lesions were painless, had enlarged slowly, and ultimately had central ulceration, often covered with eschar and surrounded by an erythematous, indurated border (Figure 2). Regional lymph nodes (e.g., epitrochlear, axillary, and inguinal), if palpable, usually were <1 cm in diameter. None of the patients had systemic symptoms. In 17 (77%) of the 22 cases, parasites were noted on light-microscopic examination of tissue. Of the 19 patients who had tissue cultured for parasites, 14 (74%) had positive cultures, of which 13 (93%) had sufficient organisms for species identification by isoenzyme electrophoresis. All nine of the 13 patients whose cultures had been tested as of October 20, 2003, were infected with Leishmania major. Therefore, U.S. health-care providers should consider the possibility of CL in persons with chronic skin lesions who were deployed to Southwest/Central Asia.

Reference: Albright G. Cutaneous Leishmaniasis in U.S. Military Personnel --- Southwest/Central Asia, 2002--2003. October 24, 2003 / 52(42);1009-1012.

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