Abstract. Melioidosis is a bacterial infection caused by Burkholderia pseudomallei, a gram-negative saprophytic bacillus. Cases occur sporadically in the Americas with an increasing number of cases observed among people with no travel history to endemic countries. To better understand the incidence of the disease in the Americas, we reviewed the literature, including unpublished cases reported to the Centers for Disease Control and Prevention. Of 120 identified human cases, occurring between 1947 and June 2015, 95 cases (79%) were likely acquired in the Americas; the mortality rate was 39%. Burkholderia pseudomallei appears to be widespread in South, Central, and North America.

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.

Abstract. A fatal case of melioidosis was diagnosed in Ohio one month after culture results were initially reported as a Bacillus species. To identify a source of infection and assess risk in patient contacts, we abstracted patient charts; interviewed physicians and contacts; genetically characterized the isolate; performed a Burkholderia pseudomallei antibody indirect hemagglutination assay on household contacts and pets to assess seropositivity; and collected household plant, soil, liquid, and insect samples for culturing and real-time polymerase chain reaction testing. Family members and pets tested were seronegative for B. pseudomallei. Environmental samples were negative by real-time polymerase chain reaction and culture. Although the patient never traveled internationally, the isolate genotype was consistent with an isolate that originated in Southeast Asia. This investigation identified the fifth reported locally acquired non-laboratory melioidosis case in the contiguous United States. Physicians and laboratories should be aware of this potentially emerging disease and refer positive cultures to a Laboratory Response Network laboratory.

Human anthrax cases reported in the country of Georgia increased 75% from 2011 (n = 81) to 2012 (n = 142). This increase prompted a case-control investigation using 67 culture- or PCR-confirmed cases and 134 controls matched by residence and gender to investigate risk factor(s) for infection during the month before case onset. Independent predictors most strongly associated with disease in the multivariable modelling were slaughtering animals [odds ratio (OR) 7·3, 95% confidence interval (CI) 2·9-18·1, P 1 km; 15 (12%) of 125 had sick livestock; and 11 (9%) of 128 respondents reported finding dead livestock. We recommend joint public health and veterinary anthrax case investigations to identify areas of increased risk for livestock anthrax outbreaks, annual anthrax vaccination of livestock in those areas, and public awareness education.

Lymphoma has been reported in a variety of avian species, including those in the order Galliformes (chickens, turkeys, etc.), Columbiformes (pigeons, doves, etc.), Psittaciformes (macaws, parrots, etc.), and Passeriformes (jays, cardinals, et~.).I-~ Lymphomas in gallinaceous birds are associated with herpesvirus or retroviral infections.The lesion distribution, age of onset, and histologic morphology varies with the type of virus and species of gallinaceous bird affe~ted.~ A viral etiology has not been shown in other avian species. Lymphoma has only been reported in one ratite, a 3-year-old female ostrich (Struthio camelus).6 This manuscript describes lymphoma with a leukemic blood picture in an emu (Dromaius novaehollandiae).A 2-year-old female emu was presented with a 5-week history of weight loss and anorexia after fighting with her breeding partner. Initial examination revealed extreme emaciation and lethargy-The remaining nine birds in the flock were healthy. Whole blood in EDTA anticoagulant and serum were submitted for a complete blood cell (CBC) count and biochemical profile, respectively. Minimal treatment, consisting of intramuscular injection of B vitamin complex, was performed. Initial hematological and biochemical data are presented in Tables 1 and 2. The emu had a severe anemia with a packed cell volume (PCV) of 16.5%. Although EDTA anticoagulant causes hemolysis of erythrocytes in some avian specie^,^ the emu plasma was not grossly hemolyzed. Examination of the blood film revealed a lack of polychromasia, indicative of a nonregenerative anemia, and mild decrease in thrombocytes. A marked lymphocytic leukocytosis, with greater than 50% immature lymphocytes, also was observed ( Fig. 1).The bird was hypoalbuminemic (1.9 gldl) using the bromcresol green (BCG) dye-binding assay. Falsely low albumin concentrations have been observed in chicken and duck sera measured by the BCG assay as compared to serum protein electrophoresis values.* However, similar albumin values were obtained with both the BCG assay and serum protein electrophoresis of the emu serum (1.9 and 1.85 g/dl, respectively). Serum globulin concentration, determined as the difference between serum protein and serum albumin concentrations, was normal at 2.2 g/dl. Serum cholesterol and uric acid concentrations were mildly elevated. Lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) activities also were elevated.The emu was mildly hypoglycemic and severely hyperkalemic.The emu showed no clinical improvement on follow-up examination approximately 2 weeks later. The bird was extremely emaciated, anoretic, and in sternal recumbency. It showed little response to manipulation and jugular venipuncture. Whole blood in EDTA anticoagulant and serum again were submitted for a CBC count and biochemical profile, respectively (Tables 1 & 2).The PCV had decreased to 11 Soh with little evidence of erythrocyte regeneration on the blood film.The total white blood cell (WBC) count had decreased from 11 2,55O/~l to 29,5821 PI. However, immature lym...