VP1 sequences were determined for poliovirus type 1 isolates obtained over a 189-day period from a poliomyelitis patient with common variable immunodeficiency syndrome (a defect in antibody formation). The isolate from the first sample, taken 11 days after onset of paralysis, contained two poliovirus populations, differing from the Sabin 1 vaccine strain by ∼10%, differing from diverse type 1 wild polioviruses by 19 to 24%, and differing from each other by 5.5% of nucleotides. Specimens taken after day 11 appeared to contain only one major poliovirus population. Evolution of VP1 sequences at synonymous third-codon positions occurred at an overall rate of ∼3.4% per year over the 189-day period. Assuming this rate to be constant throughout the period of infection, the infection was calculated to have started ∼9.3 years earlier. This estimate is about the time (6.9 years earlier) the patient received his last oral poliovirus vaccine dose, approximately 2 years before the diagnosis of immunodeficiency. These findings may have important implications for the strategy to eliminate poliovirus immunization after global polio eradication.

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BRONCHIECTASIS Original Research Bronchiectasis is an uncommon, but potentially serious condition related to abnormal widening of the airway passages. Recurrent lung infections; foreign objects in the airways; and defective lung clearance mechanisms, such as the inability to properly clear mucus, can lead to bronchiectasis. 1,2 Symptoms of bronchiectasis include, but are not limited to, hemoptysis, chronic cough, sputum production, and shortness of breath. [2][3][4] Bronchiectasis treatment is aimed at minimizing further damage to the airways through infl ammation reduction, infection Background: Bronchiectasis is a potentially serious condition characterized by permanent and abnormal widening of the airways, the prevalence of which is not well described. We sought to describe the trends, associated conditions, and risk factors for bronchiectasis among adults aged Ն 65 years. Methods: A 5% sample of the Medicare outpatient claims database was analyzed for bronchiectasis trends among benefi ciaries aged Ն 65 years from 2000 to 2007. Bronchiectasis was identifi ed using International Classifi cation of Diseases, Ninth Revision, Clinical Modifi cation claim diagnosis codes for acquired bronchiectasis. Period prevalence was used to describe sex-and race/ethnicityspecifi c rates, and annual prevalence was used to describe trends and age-specifi c rates. We estimated trends using Poisson regression and odds of bronchiectasis using multivariate logistic regression.

To identify clinical and therapeutic features of pulmonary nontuberculous mycobacterial (PNTM) disease, we conducted a retrospective analysis of patients referred to the Brazilian reference center, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, who received a diagnosis of PNTM during 1993–2011 with at least 1 respiratory culture positive for NTM. Associated conditions included bronchiectasis (21.8%), chronic obstructive pulmonary disease (20.7%), cardiovascular disease (15.5%), AIDS (9.8%), diabetes (9.8%), and hepatitis C (4.6%).Two patients had Hansen disease; 1 had Marfan syndrome. Four mycobacterial species comprised 85.6% of NTM infections: Mycobacterium kansasii, 59 cases (33.9%); M. avium complex, 53 (30.4%); M. abscessus, 23 (13.2%); and M. fortuitum, 14 (8.0%). A total of 42 (24.1%) cases were associated with rapidly growing mycobacteria. In countries with a high prevalence of tuberculosis, PNTM is likely misdiagnosed as tuberculosis, thus showing the need for improved capacity to diagnose mycobacterial disease as well as greater awareness of PNTM disease prevalence.

The prevalence of helminth and tuberculosis infections is high in South India, whereas Bacille-Calmette-Guerin (BCG) vaccine efficacy is low. Our aim was to determine whether concurrent helminth infection alters the ability to mount a delayed-type hypersensitivity response to tuberculin. In a cross-sectional study in southern India, individuals 6-65 years of age were screened for intestinal helminths, circulating filarial antigenemia, tuberculin reactivity, active tuberculosis, and history of BCG vaccination; 54% were purified protein derivative (PPD) positive, 32% had intestinal helminth infection, 9% were circulating filarial antigen positive, and 0.5% had culture-confirmed active tuberculosis. Only age and BCG vaccination were significantly associated with PPD reactivity; however, BCG vaccination was associated with a lower prevalence of hookworm infection relative to those without prior BCG vaccination. Neither intestinal helminth infection nor filarial infection was associated with diminished frequencies of PPD positivity. Our findings suggest that preceding helminth infection does not influence significantly the delayed-type hypersensitivity response to tuberculin.

Background Invasive candidiasis (IC) is a growing concern among US healthcare facilities. A large-scale study evaluating incidence and trends of IC in the US by species and body site is needed to understand the distribution of infection. Methods An electronic medical record database was used to calculate incidence and trends of IC in the US by species and infection site from 2009-2017. Hospital incidence was calculated using total unique inpatient hospitalizations in hospitals reporting at least one Candida case as the denominator. IC incidence trends were assessed using generalized estimating equations with an exchangeable correlation structure to fit Poisson regression models, controlling for changes in hospital characteristics and case mix over time. Results Candida albicans remains the leading cause of IC in the US, followed by C. glabrata. The overall incidence of IC was 90/100,000 patients, which did not change significantly over time. There were no changes in species-specific incidence, apart from the other Candida species group which increased 7.2% annually. While there was no change in candidemia from 2009-2017, abdominal and non-abdominal sterile site IC increased significantly. Conclusions Non-bloodstream IC is increasing in the US. Understanding the epidemiology of IC should facilitate improved management of infected patients.

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To estimate age-specific incidences and assess the national morbidity and mortality burden for Guillain-Barre syndrome (GBS) in the United States, a national hospital discharge database compiled by the Commission on Professional and Hospital Activities (CPHA) and national death certificate data reported to the National Vital Statistics System were reviewed. During 1985-1991, 10,453 patients with GBS were discharged from CPHA-participating hospitals (estimated annual incidence, 3.0/100,000 population). The age-specific incidence of GBS increased with age from 1.5/100,000 in persons <15 years old to 8.6/100,000 in persons 70-79 years old. The total estimated number of GBS-related deaths from 1985 through 1990 was 3770 (95% confidence interval, 3506-4034), for an average of 628 GBS deaths per year. These rates suggest that the proposed national surveillance system for acute flaccid paralysis should capture at a minimum the 796 GBS cases in persons <15 years old. GBS remains a significant health burden among older adults in the United States, with a marked increase in risk after age 40.