{"paper_id":"f799b8ed-00eb-4898-b293-4d3e5346c510","body_text":"LETTERS\nsymptom onset, increased during the \nsymptomatic period (as shown by \nhigher titers on day 10), peaked by day \n30 (2 weeks after recovery), then de-\nclined slowly over several years. Zaire \nebolavirus IgG remained detectable, \noften at high levels, >11 years after \nthe infection.\nThese long-lasting IgG antibody \nresponses found in 20 survivors of 3 \ndifferent Zaire ebolavirus outbreaks \nrule out the hypothesis that low Ebola \nvirus (and Marburg virus) seropreva-\nlence rates found in epidemic regions \nof Africa are due to rapid loss of spe-\ncific IgG. Whether this immunity is \nsufficient to protect from recurrent in-\nfection remains undetermined. These \nfindings show that IgG ELISA is suit-\nable for epidemiologic and epizootio -\nlogic investigations of Ebola and that \nZaire ebolavirus IgG is an excellent \nindicator of Zaire ebolavirus circula -\ntion in humans.\nNadia Wauquier,\n1  \nPierre Becquart,1  \nClélia Gasquet,  \nand Eric M. Leroy\nAuthors\t affiliations:\t Centre\t International\t\nde\t Recherches\t Médicales\t de\t Franceville,\t\nFranceville,\t Gabon\t (N.\t Wauquier,\t P\t Bec-\nquart,\t C\t Gasquet);\t Institut\t de\t Recherche\t\npour\t le\t Développement\t UMR190,\t Mar-\nseille,\t France\t (P .\tBecquart,\t C.\t Gasquet,\t\nE.M.\tLeroy)\nDOI:\t10.3201/eid1507.090402\nReferences\n  1.  Georges AJ, Leroy EM, Renaut AA, \nTevi Benissan C, Nabias RJ, Trinh Ngoc \nM, et al. Ebola hemorrhagic fever out-\nbreaks in Gabon, 1994–1997: epidemio -\nlogic and health control issues. J Infect \nDis. 1999;179(Suppl 1):S65–75. DOI: \n10.1086/514290\n  2.  Leroy EM, Rouquet P, Formenty P, \nSouquière S, Kilbourne A, Froment J-M, \net al. Multiple Ebola virus transmission \nevents and rapid decline of central African \nwildlife. Science. 2004;303:387–90. DOI: \n10.1126/science.1092528\n  3.  Walsh PD, Abernethy KA, Bermejo M, \nBeyers R, De Wachter P, Ella Akou M, \net al. Catastrophic ape decline in western \nequatorial Africa. Nature. 2003;422:611–4. \nDOI: 10.1038/nature01566\n  4.  Bermejo M, Rodriguez-Teijeiro JD, Illera \nG, Barroso A, Vila C, Walsh PD. Ebola \noutbreak killed 5000 gorillas. Science. \n2006;314:1564. DOI: 10.1126/science.  \n1133105\n  5.  Rowe AK, Bertolli J, Khan AS, Makunu \nR, Muyembe-Tamfum JJ, Bressler D, et \nal. Clinical, virologic, and immunologic \nfollow-up of convalescent Ebola hemor -\nrhagic fever patients and their household \ncontacts, Kikwit, Democratic Republic of \nthe Congo. J Infect Dis. 1999;179(Suppl \n1):S28–35. DOI: 10.1086/514318\n  6.  Ksiazek TG, Rollin PE, Williams AJ, \nBressler DS, Martin ML, Swanepoel R, et \nal. Clinical virology of Ebola hemorrhagic \nfever (EHF): virus, virus antigen, and IgG \nand IgM antibody findings among EHF \npatients in Kikwit, Democratic Republic  \nof the Congo, 1995. J Infect Dis. 1999; \n179(Suppl 1):S177–87. DOI: 10.1086/  \n514321\n  7.  Ksiazek TG, West CP, Rollin PE, Jahrling \nPB, Peters CJ. ELISA for the detection \nof antibodies to Ebola viruses. J Infect \nDis. 1999;179(Suppl 1):S192–8. DOI: \n10.1086/514313\n  8.  Heffernan RT, Pambo B, Hatchett RJ, \nLeman PA, Swanepoel R, Ryder RW. \nLow seroprevalence of IgG antibodies to \nEbola virus in an epidemic zone: Ogooue-\nIvindo region, northeastern Gabon, 1997. \nJ Infect Dis. 2005;191:964–8. DOI: 10. \n1086/427994\n  9.  Bausch DG, Borchert M, Grein T, Roth \nC, Swanepoel R, Libande ML, et al. Risk \nfactors for Marburg hemorrhagic fever, \nDemocratic Republic of the Congo. Emerg \nInfect Dis. 2003;9:1531–7.\n10.  Borchert M, Mulangu S, Swanepoel \nR, Tshomba A, Afounde A, Kulidri A, \net al. Pygmy populations seronegative \nfor Marburg virus. Emerg Infect Dis. \n2005;11:174–7.\nAddress for correspondence: Eric M. Leroy, \nCentre International de Recherches Médicales \nde Franceville, BP 769, Franceville, Gabon; \nemail: eric.leroy@ird.fr\nVaribaculum  \ncambriense  \nInfections in Hong \nKong, China, 2006 \nTo the Editor: Varibaculum cam-\nbriense is an anaerobic, gram-posi-\ntive, diphtheroid bacterium that was \ndescribed by Hall et al. in 2003 (1). \nBiochemical testing, electrophoretic \nanalysis of whole-cell proteins, and \nphylogenetic analysis of 16S rRNA \ngene sequences showed that V. cam-\nbriense is related to but distinct from \nActinomyces spp. and related taxa, \nincluding the genera Actinobaculum, \nArcanobacterium, and Mobiluncus.\nAlthough its natural habitat re-\nmains unknown, V. cambriense has \nbeen isolated from intrauterine de-\nvices and human vagina and abscess \nspecimens (2). Commercial systems, \nsuch as analytical profile index (API) \nRapid ID 32 Strep and Coryne kits \n(bioMérieux, Marcy l’Etoile, France), \nused in differentiation of novel bacte -\nria provide biochemical profiles useful \nfor identification of V. cambriense (1). \nHowever, the absence of data on this \norganism in manufacturers’ databases \nhas hampered recognition of V. cam-\nbriense in routine clinical laboratories. \nWe report 4 cases of V. cambriense in-\nfection and show that this bacterium is \na potential pathogen in skin and soft \ntissue infections.\nIn 2006, four isolates of gram-\npositive curved bacilli that grew on \nColumbia agar with 5% horse blood \nunder anaerobic conditions were re-\nferred by 2 regional hospitals in Hong \nKong to our laboratory for identifica -\ntion. These isolates originated from \nthe abscess specimens of 4 patients.\nPatient 1 was a 45-year-old wom-\nan with a right ovarian chocolate cyst \nand endometriosis who had undergone \nlaparotomy, right salpingo-oophorec -\ntomy, and lysis of adhesions in 2001. \nSince then, she had a recurrent abscess \nover the umbilical scar that was treat -\ned conservatively. Culture of pus from \n\t Emerging\tInfectious\tDiseases\t•\twww.cdc.gov/eid\t•\tVol.\t15,\tNo.\t7,\tJuly\t2009\t 1137 \n1These\t authors\t contributed\t equally\t to\t this\t\narticle.\nAll material published in Emerging \nInfectious Diseases is in the public \ndomain and may be used and reprinted \nwithout special permission; proper \ncitation, however, is required.\n\nLETTERS\nthe umbilical scar grew an unidenti -\nfied gram-positive bacillus (M124). \nHistologic analysis of umbilical tissue \nshowed acute suppurative inflamma -\ntory cells and microabscess formation. \nThe patient refused follow-up and \nno antimicrobial drug treatment was \ngiven.\nPatient 2 was a 25-year-old man \nwho had a history of excision of mul-\ntiple sebaceous cysts in the groin, and \nbuttock pain and swelling for 4 days. \nHe had no previous trauma and was \nafebrile. An abscess was incised and \ndrained. Culture of tissue obtained \ngrew an unidentified gram-positive ba-\ncillus (M397) and a Peptostreptococ-\ncus spp. The infection later subsided \nwithout antimicrobial drug treatment.\nPatient 3 was a 34-year-old man \nwith a lump in the left groin that had \nbeen present for 1 year. He was hos-\npitalized with erythema and increased \nswelling of the lesion. An abscess was \ndiagnosed, incised, and drained. Gram \nstaining of pus showed numerous \nleukocytes and gram-positive bacilli. \nCulture yielded an unidentified gram-\npositive bacillus (M380). He was \ntreated with ampicillin and cloxacillin, \nand the wound healed.\nPatient 4 was a 55-year-old wom-\nan with an abscess on her back. She \nhad a 3-year history of seronegative \nrheumatoid arthritis but was not re-\nceiving immunosuppressant therapy. \nThe abscess was drained, and gram \nstaining of pus showed numerous leu-\nkocytes and gram-positive cocci and \nbacilli. Culture yielded Peptostrepto-\ncoccus spp. and an unidentified gram-\npositive bacillus (M398). The abscess \nhealed without antimicrobial drug \ntreatment.\nThe 4 unidentified gram-positive \nbacilli from these patients were ini-\ntially characterized by using the API \nRapid ID 32 Strep and Coryne kits. \nDoubtful identifications at various \nconfidence levels were obtained, in-\ncluding Corynebacterium diphtheriae \nvar. mitis or var. belfanti, Gardner-\nella vaginalis, Streptococcus mitis, \nS. oralis, Gemella morbillorum, and \nAerococcus urinae. Sequencing of full \nlength 16S rRNA genes suggested that \nthe isolates were V. cambriense; Gen-\nBank BLAST (http://blast.ncbi.nlm.\nnih.gov/Blast.cgi) results showed V. \ncambriense type strain CCUG 44998\nT \nsequence as the best match (identities \n98%–99%) (3).\nBiochemical reactions of the \nstrains were similar to those of CCUG \n44998\nT (1). All 4 isolates grew poorly \nin air and 5% CO2, were catalase nega-\ntive, did not hydrolyse esculin or gela-\ntin, or reduce nitrates. The 4 isolates \ndid not ferment most of the carbo-\n1138\t Emerging\tInfectious\tDiseases\t•\twww.cdc.gov/eid\t•\tVol.\t15,\tNo.\t7,\tJuly\t2009\nTable. Characteristics and test results for 4 isolates of unknown bacteria, Hong Kong, China, 2006* \nIsolate  \nCharacteristic \nVaribaculum \ncambriense type \nstrain CCUG 44998\nT\nM124 M397 M380  M398 \nHospital  B B A A \nPatient sex/age, y  F/45 M/25 M/34 F/55 \nDate referred/isolated  2006 May  2006 Dec 2006 Dec 2006 Dec \nAPI test code      \n Rapid ID32 Strep  00100010100 00102010100 02122001100 00002011100 \n Coryne  1010321 1410321 1010721 1010321 \nAcid production from      \n Glucose + + + + + \n Lactose – – – – – \n Maltose V – (+) – (+)  + + \n Melibiose – – – – – \n Pullulan – – – – – \n Raffinose – – – – – \n Ribose V + + + – (+) \n Sucrose V + + + + \n Trehalose V – – + – \n MBDG – – – – – \nHydrolysis of hippurate V + + – + \nProduction of      \nĮ-galactosidase – – – + – \nȕ-galactosidase V – – (+) – – \nĮ-glucosidase + – (+) – (+) – (+) – (+) \n Alkaline phosphatase – – – – – \n APPA V – + + + \nGenBank accession no.†  FJ169866 FJ169867 FJ169868 FJ169869 \nIdentity to type strain CCUG 44998\nT\n, %  99 98 99 99 \n*API, analytical profile index; V, variable; MBDG, methyl-ȕ-D-glucopyranoside; APPA, alanyl-phenylalanyl-proline arylamidase. Test \nresults were obtained by using the API Rapid ID32 Strep kit (bioMérieux, Marcy l’Etoile, France). Results in parentheses were obtained \nby using the API Coryne kit (bioMérieux). \n†For 16S rRNA gene sequence. \n\nLETTERS\nhydrates in the 2 API kits, except for \nribose, maltose, glucose, and sucrose. \nDiscrepancies in results between the 2 \ntest kits were seen with ribose in 1 iso-\nlate (M398) and maltose in 2 isolates \n(M124 and M397). One isolate (M380) \ndid not hydrolyze hippurate but pro-\nduced acid from trehalose and xylose. \nThis isolate was also α-galactosidase \npositive, a result different from that \nof the type strain. All 4 isolates were \nα-glucosidase positive and 3 were ala-\nnyl-phenyl-alanyl-proline arylamidase \npositive. Some of the biochemical re-\nactions for the 4 isolates, including \nall tests for delineating V. cambriense \nfrom other catalase-negative Actino-\nmyces spp. (1), are summarized in the \nTable.\nWe report the isolation of V. cam-\nbriense from 4 patients with purulent \nskin and soft tissue infections. Our \nfindings contribute to understanding \nof the clinical and pathogenic po-\ntential of this anaerobic bacterium. \nGram-positive diphtheroid organisms \nfrom wound specimens are occasion -\nally considered to be skin commensal \norganisms. Clinical microbiologists \nshould be aware of this organism and \nthe current inadequacy of commercial \nsystems for its identification. We have \nshown that 16S rRNA gene sequenc-\ning is a useful alternative to gas–liquid \nchromatographic analyses of cell wall \nfatty acids or metabolic products for \nidentification of anaerobic gram-pos-\nitive bacilli.\nYiu-Wai Chu, Chi-Ho Wong, \nMan-Yu Chu, Cara P.F. Cheung, \nTerence K.M. Cheung,  \nCindy Tse, Wei-Kwang Luk,  \nand Janice Y.C. Lo\nAuthor\t affiliations:\t Centre\t for\t Health\t Pro-\ntection,\t Hong\t Kong,\t People’s\t Republic\t of\t\nChina\t(Y .-W.\tChu,\tC.-H.\tWong,\tM.-Y .\tChu,\t\nC.P .F .\tCheung,\tT .K.M.\tCheung,\tJ.Y .C.\tLo);\t\nKwong\tWah\tHospital,\tHong\tKong\t(C.\tT se);\t\nand\tT seung\tKwan\t O\t Hospital,\t Hong\t Kong\t\n(W.-K.\tLuk)\nDOI:\t10.3201/eid1507.081291\nReferences\n  1.  Hall V , Collins MD, Lawson PA, Hutson \nRA, Falsen E, Inganas E, et al. Character-\nization of some Actinomyces-like isolates \nfrom human clinical sources: description \nof Varibaculum cambriensis gen. nov., \nsp. nov. J Clin Microbiol. 2003;41:640–4. \nDOI: 10.1128/JCM.41.2.640-644.2003\n  2.  Verhelst R. Characterization of the vaginal \nmicroflora [dissertation]. Ghent (the Neth-\nerlands): University of Ghent; 2006.\n  3.  Edwards U, Rogall T, Blocker H, Emde \nM, Bottger EC. Isolation and direct com-\nplete nucleotide determination of entire \ngenes. Characterization of a gene coding \nfor 16S ribosomal RNA. Nucleic Acids \nRes. 1989;17:7843–53. DOI: 10.1093/\nnar/17.19.7843\nAddress for correspondence: Yiu-Wai Chu, \nPublic Health Laboratory Centre, 382 Nam \nCheong St, Kowloon, Hong Kong Special \nAdministrative Region, People’s Republic of \nChina; email: alf@dh.gov.hk\nOutbreaks of  \nHemotrophic  \nMycoplasma  \nInfections in China\nTo the Editor: Infections caused \nby hemotrophic mycoplasmas (for -\nmerly called eperythrozoonoses) in \nanimals and humans have been emerg-\ning in the People’s Republic of China \nin recent years. To date, 6 hemotrophic \nMycoplasma spp. have been identified \nin rodents and mammals (1 ). M. suis \nfrom pigs, M. wenyonii from cattle, \nand M. ovis from sheep have been con-\nfirmed; the human pathogen, which \nis most frequently observed in China, \nhas not been genetically identified (2). \nHowever, the zoonotic potential of the \nbacteria is evident because the disease \nis more prevalent in farmers and veter-\ninary doctors, who have frequent close \ncontact with domestic animals, than \nin other persons (2 ). Vertical trans-\nmission from mother to fetus has also \nbeen confirmed (2). In animals, espe-\ncially in piglets, the disease is charac-\nterized by febrile acute anemia, jaun-\ndice, and eventual death resulting from \nconcurrent infection with other mi-\ncrobes (3–6). Infected humans may be  \nasymptomatic or have various clinical \nsigns, including acute fever, anemia, \nand severe hemolytic jaundice, espe-\ncially in infected neonates. Pregnant \nwomen and newborns were reported to \nbe more vulnerable to the disease than \nothers and to show more severe clini-\ncal signs after infection (2).\nWe conducted an epidemiologic \ninvestigation of hemotrophic myco-\nplasma infections in China by review-\ning all reported cases and outbreaks \nfor 1994–2007. Clinical cases for >6 \nanimal species (including pigs, cows, \ngoats, horses, foxes, chickens, and hu-\nmans) were reported during the period \n(Table). The number of reported cases \nvaried from year to year. Human infec-\ntions were confirmed by clinical and \nlaboratory methods (2). We reinvesti -\ngated blood samples of >600 pigs with \nprevious diagnoses of mycoplasma in-\nfection accompanied by clinical signs \nof fever and jaundice. Slides were \nmade and stained in Giemsa-staining \nsolution. We used light microscopy to \nlook for the presence of M. suis on the \nerythrocyte surface. We also used flu-\norescence microscopy to look for the \nmicrobes by mixing a drop of infected \nblood with acridine orange solution \n(0.1 mg/mL). The microbes bound to \nred blood cells were examined with a \nconfocal microscope. Positive cases \nwere further confirmed by PCR us-\ning primers of the small subunit RNA \ngene sequences. All samples were \nPCR positive, but PCR sensitivity is \nhigher than sensitivity of acridine or -\nange staining, which is higher than \nsensitivity of Geimsa staining.\nHemotrophic mycoplasma infec-\ntion is still a neglected zoonotic disease, \nwhich poses a threat to public health \nand the animal industry, especially in \nChina (2,7). The prevalence of the dis-\n\t Emerging\tInfectious\tDiseases\t•\twww.cdc.gov/eid\t•\tVol.\t15,\tNo.\t7,\tJuly\t2009\t 1139","source_license":"CC-BY-4.0","license_restricted":false}