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The electron signals from the field ionization of two closely-spaced Rydberg states of \mbox{rubidium-85} are separated using quantum control. In selective field ionization, the state distribution of a collection of Rydberg atoms is measured by ionizing the atoms with a ramped electric field. Generally, atoms in higher energy states ionize at lower fields, so ionized electrons which are detected earlier in time can be correlated with higher energy Rydberg states. However, the resolution of this technique is limited by the Stark effect. As the electric field is increased, the electron encounters numerous avoided Stark level crossings which split the amplitude among many states, thus broadening the time-resolved ionization signal. Previously, a genetic algorithm has been used to control the signal shape of a single Rydberg state. The present work extends this technique to separate the signals from the $34s$ and $33p$ states of rubidium-85, which are overlapped when using a simple field ramp as in selective field ionization.

Individuals with methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) can be simultaneously colonized with MRSA on multiple body sites. Using whole genome sequencing (WGS), the intrahost relatedness of MRSA colonization and infection isolates was investigated.In the context of a prospective case-control study of SSTI, we analyzed colonization and infection isolates from US Army Infantry trainees with purulent infection due to MRSA. At the time of clinical presentation for SSTI, culture swabs were obtained from the infection site, as well as from the patient's nasal, oral, inguinal, and perianal regions. S. aureus culture and susceptibility was performed by standard methods. DNA from MRSA isolates was extracted and libraries were produced. Sequences were generated on an Illumina MiSeq, sequence reads were assembled, and single nucleotide variant (SNV) data were analyzed.Of 74 trainees with MRSA SSTI, 19 (25.7%) were colonized with MRSA. Ten (52.6%) were colonized on more than one body site. Colonization frequency by anatomic site was as follows: inguinal region (33%), nasal region (30%), perianal region (22%), and oral region (14%). A total of 36 MRSA colonization isolates were characterized. The intrahost median number of SNVs between infection and colonization isolates was 17. Among trainees with recurrent MRSA SSTI, limited intrahost diversity suggests that persistent colonization is a major contributor to recurrence risk.Among military trainees with MRSA SSTI, genomic characterization of infection and colonization isolates revealed a high degree of strain relatedness. Single acquisition events may account for MRSA colonization and infection in this population.

The adsorption and subsequent electrooxidative polymerization of ferriprotoporphyrin IX chloride (hemin; FePPCl) was investigated on highly ordered pyrolytic graphite, glassy carbon, and polycrystalline Pt electrodes using electrochemical atomic force microscopy, first-principles calculations, and cyclic voltammetry. Hemin was shown to readily adsorb to all three surfaces; however, it was more continuous over the carbon surfaces compared to the Pt surface. This disparity in adsorption appears to be a major contributing factor to differences observed between the electrodes following hemin electropolymerization. Despite differences in roughness and morphology, hemin polymerized as a continuous layer over each electrode surface. Periodic density functional theory calculations were used to model FePP (without Cl) on both the Pt(111) and graphite surfaces using the vdW-DF-optPBE functional to account for the dispersion interactions. Our calculations suggest that the FePP molecule chemisorbs to the Pt surface while at the same time exhibiting intramolecular hydrogen bonding between the carboxylic acid groups, which are extended away from the surface. In contrast to FePP-Pt chemisorption, FePP was found to physisorb to graphite. The preferred spin state upon adsorption was found to be S = 2 on Pt(111), whereas on graphite, the high and intermediate spin states were nearly isoenergetic. Additionally, gas-phase calculations suggest that much of the surface roughness observed microscopically for the polymerized porphyrin layer may originate from the nonparallel stacking of porphyrin molecules, which interact with each other by forming four intermolecular hydrogen bonds and through dispersion interactions between the stacked porphyrin rings. Regardless of polymer thickness, the underlying electrode appears to be able to participate in at least some redox processes. This was observed for the hemin-polymerized Pt electrode using the 2H

Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions.

During the 4-year surveillance period, there were 282,571 incident cases of skin and soft tissue infection (SSTI) among active component U.S. military members diagnosed in inpatient or outpatient settings, corresponding to an overall incidence of 558.2 per 10,000 person-years (p-yrs). An additional 10,904 cases occurred in theater of operations (460.0 per 10,000 p-yrs). Approximately half (49.4%) were classified as "other SSTI" (e.g., folliculitis, impetigo); 45.9% were cellulitis/abscess; 4.6% were carbuncles/furuncles; and 0.1% were erysipelas. Annual incidence rates declined by 46.6% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit trainee status, and junior enlisted rank. During the surveillance period, 238,924 service members were treated for SSTIs in outpatient or inpatient settings, which accounted for 395,361 medical encounters and 19,213 hospital bed days. The history of operational significance of skin infections in the military, the high healthcare costs associated with evaluating and treating skin infections, and the risk of infections by antibiotic-resistant organisms highlight the importance of prevention, early diagnosis, and definitive treatment of skin infections, particularly in high-risk settings such as new recruit/basic training populations.

The bioreduction of N-oxide compounds is the basis for the mode of action of a number of biologically active molecules. These compounds are thought to act by forming a reactive oxygen species through an intracellular reduction and subsequent redox cycling process within the organism. With these results in mind, the preliminary investigation into the electrochemical reduction of the benzisoxazole 2-oxide ring system was undertaken, with the thought that this class of compounds would reduce in a similar fashion to other N-oxide heterocycles. The electrochemical reduction of 3-phenyl-1,2-benzisoxazole 2-oxide on boron-doped diamond was studied using cyclic and square wave voltammetry as well as controlled potential electrolysis and HPLC for qualitative identification of the reaction products. It was found that the reduction proceeded with an initial quasi-reversible one-electron reduction followed by the very fast cleavage of either the endocyclic or exocyclic N–O bond. Subsequent electron transfer and protonation resulted in an overall two-electron reduction and formation of the 2-hydroxyaryl oxime and benzisoxazole. These results are analogous to those observed in the electrochemical reduction of other heterocyclic N-oxides albeit the reduction of the benzisoxazole N-oxides takes place at a more negative potential. However, these encouraging results warrant further investigation into the reduction potential of substituted benzisoxazole N-oxides as well as to elucidate and characterize the nature of the intermediate species involved. Copyright © 2014 John Wiley & Sons, Ltd.

Plasmodium vivax malaria requires a 2-week course of primaquine (PQ) for radical cure. Evidence suggests that the hepatic isoenzyme cytochrome P450 2D6 (CYP2D6) is the key enzyme required to convert PQ into its active metabolite.CYP2D6 genotypes and phenotypes of 550 service personnel were determined, and the pharmacokinetics (PK) of a 30-mg oral dose of PQ was measured in 45 volunteers. Blood and urine samples were collected, with PQ and metabolites were measured using ultraperformance liquid chromatography with mass spectrometry.Seventy-six CYP2D6 genotypes were characterized for 530 service personnel. Of the 515 personnel for whom a single phenotype was predicted, 58% had a normal metabolizer (NM) phenotype, 35% had an intermediate metabolizer (IM) phenotype, 5% had a poor metabolizer (PM) phenotype, and 2% had an ultrametabolizer phenotype. The median PQ area under the concentration time curve from 0 to ∞ was lower for the NM phenotype as compared to the IM or PM phenotypes. The novel 5,6-ortho-quinone was detected in urine but not plasma from all personnel with the NM phenotype.The plasma PK profile suggests PQ metabolism is decreased in personnel with the IM or PM phenotypes as compared to those with the NM phenotype. The finding of 5,6-ortho-quinone, the stable surrogate for the unstable 5-hydroxyprimaquine metabolite, almost exclusively in personnel with the NM phenotype, compared with sporadic or no production in those with the IM or PM phenotypes, provides further evidence for the role of CYP2D6 in radical cure.NCT02960568.

Background Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTIs) are common among military recruits. Identifying which strains are responsible for SSTI and understanding the underlying transmission dynamics is critical to developing appropriate interventions for this high-risk population. Methods A cohort study of US Army Infantry trainees at Fort Benning, GA (June and September 2015). Participants from two training Companies were screened for colonization on multiple anatomic sites throughout the 14-week cycle as well as the time of clinical infection. MRSA+ samples were sequenced with Illumina HiSeq. Multi-locus sequence type (MLST) and virulence genes were identified in silico. Single nucleotide polymorphism (SNP) distances between soldiers’ bacteria were compared with assessing for potential transmission. Results Of 383 soldiers enrolled, 84 (22%) were colonized with MRSA during the study. Forty-two of 84 had a single positive colonization sample, of which 76% were from anatomical sites other than the nares (36% oropharyngeal, 26% perianal, 14% inguinal). Twelve trainees had MRSA SSTI during training (50% had colonization detected prior to or at infection). All were PFGE-type US300 (ST8) and were lukS/lukF-positive. SNP-based phylogenetic analyses and epidemiologic data indicate that most MRSA positives at baseline were due to unique importations from various community origins, suggesting that the ongoing MRSA epidemic is not due to a single endemic strain circulating on base. Following importation, extensive transmission then occurred, with multiple STs implicated. Transmission appeared restricted to within Companies, and predominantly within platoons. Conclusion Frequent colonization at baseline suggests a need for extensive MRSA screening and decolonization upon arrival to base, followed by ongoing infection control measures throughout training to prevent recolonization/infection. As multiple anatomical sites appear to play a role in transmission of MRSA, this may have important implications for screening protocols and control both in community and hospital-based settings. Disclosures All authors: No reported disclosures.

Background Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of skin and soft-tissue infection (SSTI). MSSA genomic epidemiology data are limited. We used whole-genome sequencing (WGS) to examine MSSA strain diversity among military trainees, a group known to be at high risk for S. aureus infection and carriage. Methods From July 2012 to December 2014, we conducted a prospective SSTI case–control study among US Army trainees at Fort Benning, GA. Thereafter, we identified MSSA SSTI clusters within select military training classes and performed WGS on clinical and colonizing isolates. We analyzed epidemiologic, clinical, genomic, and phylogenetic data in order to evaluate MSSA strain diversity and patterns of disease transmission. Results A total of 67 SSTI cases from 15 training classes were identified. The median (range) number of cases per class was 4 (3–10). Cases presented for care after a median of 39 (6–101) days of training. Of the 67 cases, 42 (63%) were colonized with MSSA at ≥1 anatomic site. A total of 78 MSSA colonizing isolates were identified at the time trainees presented for clinical care; colonizing isolates were found in the nares (37%), throat (31%), inguinal region (21%), and perianal region (12%). Multilocus sequence typing (MLST) assigned 128 (88%) isolates to 20 known types and 17 isolates to novel types. Among clinical isolates, 60 (90%) were assigned to known types. Sequence Type (ST) 8 was the most frequent type, accounting for 45% and 35% of clinical and colonizing isolates, respectively. The phylogenetic tree of isolates revealed seven major clusters, some of which were composed of a diversity of training classes, specimen types, and STs. These major clusters were further segregated into 15 sub-clusters where there was considerable diversity in intrahost variation. Conclusion Genomic characterization of MSSA infection and colonization isolates among congregate military trainees revealed a broad diversity of strains. There was a clear clonal origin and dissemination of MSSA isolates among close contacts within the ST-8 cluster but this transmission pattern was less apparent for MSSAs from other STs. Disclosures All Authors: No reported Disclosures.

Background Immunization with genetically engineered, attenuated malaria parasites (GAP) that arrest during liver infection confers sterile protection in mouse malaria models. A first generation Plasmodium falciparum GAP ( Pf p52 − /p36 − GAP) was previously generated by deletion of two pre-erythrocytic stage-expressed genes (P52 and P36) in the NF54 strain. Methods A first-in-human, proof-of-concept, safety and immunogenicity clinical trial in six human volunteers was conducted. Exposure consisted of delivery of Pf p52 − /p36 − GAP sporozoites via infected Anopheles mosquito bite with a five-bite/volunteer exposure followed by an approximately 200-bite exposure/volunteer one month later. Results The exposures were well tolerated with mild to moderate local and systemic reactions. All volunteers remained blood stage negative after low dose exposure. Five volunteers remained blood stage negative after high dose exposure. One volunteer developed peripheral parasitemia twelve days after high dose exposure. Together the findings indicate that Pf p52 − /p36 − GAP was severely but not completely attenuated. All six volunteers developed antibodies to CSP. Furthermore, IFN-γ responses to whole sporozoites and multiple antigens were elicited in 5 of 6 volunteers, with both CD4 and CD8 cell cytokine production detected. Conclusion Severe attenuation and favorable immune responses following administration of a first generation Pf p52 − /p36 − GAP suggests that further development of live-attenuated strains using genetic engineering should be pursued.

Dicyano-ferriprotoporphyrin supported on Pt microelectrodes was investigated as a possible electrocatalytic material capable of selectively oxidizing the gasotransmitter H 2 S over interfering gasotransmitters CO and NO. The modified microelectrodes were able to detect H 2 S concentrations as low as 50 nM at a potential of 0.15 V vs . Ag/AgCl and demonstrated a 100–1000× higher sensitivity toward H 2 S than CO and NO, respectively. However, H 2 S detection was affected by the presence of CO and NO due, at least in part, to imperfect coverage of the underlying Pt microelectrode by the electrocatalyst. Incomplete CN − coordination and questionable stability of the porphyrin layer are also discussed as possible causes of CO and NO interference. Work is on-going to alleviate these limitations in order to fully develop the material into a practical electrocatalyst capable of selective H 2 S oxidation.

While it is evident that nasal colonization with S. aureus increases the likelihood of SSTI, there is a significant lack of information regarding the contribution of extranasal colonization to the overall risk of a subsequent SSTI. Furthermore, the impact of S. aureus colonization on bacterial community composition outside the nasal microbiota is unclear. Thus, this report represents the first investigation that utilized both culture and high-throughput sequencing techniques to analyze microbial dysbiosis at multiple body sites of healthy and diseased/colonized individuals. The results described here may be useful in the design of future methodologies to treat and prevent SSTIs., Skin and soft tissue infections (SSTIs) are common in the general population, with increased prevalence among military trainees. Previous research has revealed numerous nasal microbial signatures that correlate with SSTI development and Staphylococcus aureus colonization. Thus, we hypothesized that the ecology of the inguinal, oropharynx, and perianal regions may also be altered in response to SSTI and/or S. aureus colonization. We collected body site samples from 46 military trainees with purulent abscess (SSTI group) as well as from 66 asymptomatic controls (non-SSTI group). We also collected abscess cavity samples to assess the microbial composition of these infections. Samples were analyzed by culture, and the microbial communities were characterized by high-throughput sequencing. We found that the nasal, inguinal, and perianal regions were similar in microbial composition and significantly differed from the oropharynx. We also observed differences in Anaerococcus and Streptococcus abundance between the SSTI and non-SSTI groups for the nasal and oropharyngeal regions, respectively. Furthermore, we detected community membership differences between the SSTI and non-SSTI groups for the nasal and inguinal sites. Compared to that of the other regions, the microbial compositions of the nares of S. aureus carriers and noncarriers were dramatically different; we noted an inverse correlation between the presence of Corynebacterium and the presence of Staphylococcus in the nares. This correlation was also observed for the inguinal region. Culture analysis revealed elevated methicillin-resistant S. aureus (MRSA) colonization levels for the SSTI group in the nasal and inguinal body sites. Together, these data suggest significant microbial variability in patients with SSTI as well as between S. aureus carriers and noncarriers. IMPORTANCE While it is evident that nasal colonization with S. aureus increases the likelihood of SSTI, there is a significant lack of information regarding the contribution of extranasal colonization to the overall risk of a subsequent SSTI. Furthermore, the impact of S. aureus colonization on bacterial community composition outside the nasal microbiota is unclear. Thus, this report represents the first investigation that utilized both culture and high-throughput sequencing techniques to analyze microbial dysbiosis at multiple body sites of healthy and diseased/colonized individuals. The results described here may be useful in the design of future methodologies to treat and prevent SSTIs.

User testing, a method of assessing website usability, can be a cost-effective and easily administered process to collect information about a website's effectiveness. A user experience (UX) team at an academic health sciences library has employed user testing for over three years to help refine the library's home page. Test methodology used in-person testers using the "think aloud" method to complete tasks on the home page. Review of test results revealed problem areas of the design and redesign; further testing was effective in refining the page. User testing has proved to be a valuable method to engage users and provide feedback to continually improve the library's home page.

Electrofishing was used in 30 Florida lakes to monitor fish communities over an 8-year period. Six 10-minute electrofishing transects were used annually per lake to estimate the catch per unit effort (CPUE, gm/hr) total fish, sport fish, and each individual fish species. A variance components analysis using CPUE as the dependent variable and lake, year within lake, and transect within year and lake as independent variables showed that in almost every case transect accounted for more than 50% of the variance in CPUE. The estimated variance from this sampling effort showed that the average number of electrofishing transects needed to estimate total fish and sport fish CPUE within 20% of the mean at a confidence of 95% would have to double and triple current effort, respectively. Lake trophic status, estimated with chlorophyll concentrations, was also monitored and showed a direct positive relation with total fish and sport fish, even with low sampling effort, providing a general ability to estimate...

Electrodeposited Fe(III) meso-Tetra(4-carboxyphenyl) porphyrin with cyanide ligands coordinated to the central iron ion is being investigated as a possible material capable of selectively oxidizing H2S in the presence of CO and NO in physiologically relevant solutions. Preliminary results suggest this to be a very attractive material as it oxidizes H2S at low potentials while exhibiting minimal activity towards both CO and NO. However certain results suggest that the Fe may not be completely coordinated with cyanide ligands. This may explain the limitations of the material at elevated H2S concentrations and imperfect selectivity over the interfering gases. Additionally, a cathodic-post run treatment is suggested in order to maintain the electrochemical activity of the porphyrin-modified electrode surface by stripping any S0 that deposits on the electrode surface during the H2S oxidation.

Plasmodium vivax is the major cause of malaria outside sub-Saharan Africa and inflicts debilitating morbidity and consequent economic impacts in developing countries. In order to produce a P. vivax vaccine for global use, we have previously reported the development of a novel chimeric recombinant protein, VMP001, based on the circumsporozoite protein (CSP) of P. vivax . Very few adjuvant formulations are currently available for human use. Our interest is to evaluate second-generation vaccine formulations to identify novel combinations of adjuvants capable of inducing strong, long-lasting immune responses. In this study rhesus monkeys were immunized intramuscularly three times with VMP001 in combination with a stable emulsion (SE) or a synthetic Toll-like receptor 4 (TLR4) agonist (glucopyranosyl lipid A [GLA]) in SE (GLA-SE). Sera and peripheral blood mononuclear cells (PBMCs) were tested for the presence of antigen-specific humoral and cellular responses, respectively. All groups of monkeys generated high titers of anti- P. vivax IgG antibodies, as detected by enzyme-linked immunosorbent assays (ELISAs) and immunofluorescence assays. In addition, all groups generated a cellular immune response characterized by antigen-specific CD4 + T cells secreting predominantly interleukin-2 (IL-2) and lesser amounts of tumor necrosis factor (TNF). We conclude that the combination of VMP001 and GLA-SE is safe and immunogenic in monkeys and may serve as a potential second-generation vaccine candidate against P. vivax malaria.

A vanadium pentoxide (V 2 O 5 ) film was electrodeposited onto the end of a PtIr wire ( d = 125 μm) via potential cycling in order to preliminarily assess its viability as a prospective material for in vivo H 2 S monitoring. The deposited oxide film exhibited catalytic activity towards the oxidation of H 2 S in a physiologically relevant pH buffer solution, which resulted in a large increase in peak current compared to that exhibited by the bare PtIr surface. The modified electrode exhibited a linear response over a total sulfide concentration range of 0.5–15 μM. The catalytic activity of the V 2 O 5 -modified wire towards the oxidation of upper physiological levels of NO and CO, two gaseous interferences found in vivo , was investigated using amperometry. While the electrode demonstrated some activity towards NO, it exhibited significant activity towards CO in the potential region of interest. However, the response towards NO and CO was much slower than the response towards H 2 S and the linear range remained unchanged despite the presence of the interfering gases.

Background Skin and soft-tissue infections (SSTI) are common among military recruits, and some experience recurrent SSTI (two infections ≥30 days apart) during training. We used whole-genome sequencing (WGS) to assess the relatedness of strains from recurrent S. aureus SSTI cases and their close contacts. Methods From 2010 to 2014, we prospectively identified SSTI cases among US Army Infantry trainees (Fort Benning, GA), obtaining infection swabs at the time of presentation for all SSTIs and multiple anatomic site colonization swabs at the time of presentation for the first infection. Thereafter, we selected cases of recurrent S. aureus SSTI with phenotypically concordant paired isolates (e.g., MRSA-MRSA). We also selected concordant colonization isolates from recurrent cases as well as concordant infection isolates from SSTI cases in the same training class as the recurrent case. Isolates were characterized by WGS. The number of single nucleotide polymorphism (SNP) differences between isolates was calculated. Phylogenetic trees were constructed to identify patterns of intra- vs. extra-host S. aureus acquisition among cases of recurrent infection. Results We identified 23 cases of recurrent S. aureus SSTI with concordant infection isolates (18 MRSA). The median (range) pairwise SNP difference for intrahost infection isolates was 15 (0–3,768); 12 (0–348), MRSA and 310 (3–3,768), MSSA. Nine (39%) were colonized with a concordant strain (5 MRSA), yielding 14 colonization isolates (7 MRSA). The median pairwise SNP difference between intrahost colonization and recurrent infection isolates was 57 (2–3,582); 5 (2–3,582), MRSA and 167 (2–313), MSSA. Infection isolates from 33 proximal cases (27 MRSA) were identified. The median pairwise SNP difference between recurrent infection isolates and that of a proximal case was 24 (1–531); 20 (1–216), MRSA and 307 (286–531), MSSA. Variant analysis showed no difference between the number of putative high impact SNPs between infection (μ = 11, σ = 20) and colonization (μ = 19, σ = 42) isolates. Conclusion WGS of S. aureus from recurrent SSTI suggests patterns of intra-host reinfection as well as intra-host acquisition/infection. Targeted decolonization may prevent recurrent S. aureus SSTI. Disclosures All authors: No reported disclosures.

Significantly higher mortality has been demonstrated in patients who suffer severe burns complicated by Klebsiella pneumoniae bacteremia. The specific virulence mechanisms associated with this organism in this population are unclear.Our study assessed the impact of the mechanism of antibiotic resistance, strain clonality, and other host factors on morbidity and mortality. All patients with thermal burns infected with K pneumoniae between January 1, 2004 and July 1, 2008 were included in the analysis.Ninety-one patients had 111 episodes of K pneumoniae infections, with 59 isolates among the 91 patients producing extended spectrum beta-lactamase (ESBL). Patients with ESBL-producing strains were slightly younger, had higher Injury Severity Scores (ISS), and higher percent full thickness burns. Those who survived to discharge were younger (p0.001), had less burned surface area (p = 0.013), had fewer ventilator days (p = 0.016), and fewer infections with ESBL-producing isolates (p = 0.042). Logistic regression revealed that an infection with ESBL-producing K pneumoniae during the hospital stay was the factor most predictive of death, with a nearly 4-fold increased odds of dying. However, survival duration analysis of the population with and without ESBL-producing K pneumoniae using Kaplan-Meier technique showed no significant difference in the populations. Cox regression proportional hazards model revealed that only age (p = 0.01) and ventilator days (por = 0.01) were associated with time to death. No specific clonality of the strains tested or ESBL production resistance genes were associated with mortality or ESBL production.These results suggest that infections caused by ESBL-producing K pneumoniae are predictive of death when occurring in an older, more badly burned population.

Malaria's global impact is expansive and includes the extremes of the healthcare system ranging from international travelers returning to nonendemic regions with tertiary referral medical care to residents in hyperendemic regions without access to medical care. Implementation of prompt and accurate diagnosis is needed to curb the expanding global impact of malaria associated with ever-increasing antimalarial drug resistance. Traditionally, malaria is diagnosed using clinical criteria and/or light microscopy even though both strategies are clearly inadequate in many healthcare settings. Hand held immunochromatographic rapid diagnostic tests (RDTs) have been recognized as an ideal alternative method for diagnosing malaria. Numerous malaria RDTs have been developed and are widely available; however, an assortment of issues related to these products have become apparent. This review provides a summary of RDT including effectiveness and strategies to select the ideal RDT in varying healthcare settings.

A simple approach for expanding metalloporphyrins as electrocatalytic materials is introduced. This new method involves the direct electropolymerization of an electrically conducting layer of ferriprotoporphyrin followed by a metal-substitution reaction executed by soaking the electrode in an aqueous metal-salt solution. This process exchanges the iron center of the surface-bound protoporphyrin with the metal ion of the salt solution. X-ray photoelectron spectroscopy and electrochemical methods confirm that this new metal is incorporated into the surface-bound porphyrin structure and alters the electrochemical properties of the electrode. This simple electrode modification process may expand the use of metalloporphyrins for electrocatalytic applications. © 2013 The Electrochemical Society. [DOI: 10.1149/2.005310eel] All rights reserved.

Questions: 1. What are this patient’s most striking clinical and laboratory findings? 2. How do you explain this patient’s most striking clinical and laboratory findings? 3. What is this patient’s most likely diagnosis? 4. What are the common laboratory methods for establishing HIV infection? 5. What laboratory and clinical findings define this patient’s disease? 6. What factors can cause a false negative HIV antibody test? 7. What is the “window period” for HIV antibody detection? 8. What is a useful diagnostic algorithm for laboratory screening for HIV infection? 9. What laboratory test(s) should be used to follow known HIV positive patients? 10. At what CD4 level are patients tested and/or treated prophylactically for Pneumocystis carinii pneumonia (PCP)?

Background Military trainees are known to be at increased risk for S. aureus colonization and skin and soft-tissue infections (SSTI). The longitudinal epidemiology of S. aureus colonization in this high-risk population is not well understood. Methods A longitudinal cohort study of colonization and SSTI was conducted among Army trainees at Fort Benning, GA from 6/2015 to 11/2016. In total, four companies (~200 trainees/company) were enrolled. Each subject was swabbed at four body sites at five time points (days 0, 14, 28, 56, and 90) to assess S. aureus colonization status. Specimens were processed by standard methods. S. aureus isolates underwent antibiotic susceptibility testing and molecular characterization, including PCR and pulsed-field gel electrophoresis. Results Three-hundred forty-three subjects from two companies were enrolled in year one. At baseline, 70% were colonized with S. aureus in at least one site. Overall S. aureus/methicillin-resistant S. aureus (MRSA) colonization was highest in the oropharynx (60%/7%), followed by the nose (32%/3%), and the inguinal (11%/1%), and peri-anal (10%; 1%) regions. The prevalence of colonization in at least one body site was generally consistent throughout the training period: day 14 – 63%/9%; day 28 – 71%/10%; day 56 – 64%/11%; and day 90 – 62%/8%. MRSA were largely USA300 (54%) and USA800 (36%). The oropharynx was the most frequently colonized site (range, 29%-60%). Among those not nasally colonized at baseline, 54%/8% acquired S. aureus/MRSA in the nose by day 90. Sixty-nine (20%) subjects were persistently colonized in the nares (>80% cultures) throughout training while 108 (32%) subjects remained nasal colonization-negative at every time point. Conclusion Military trainees experience a prolonged and intense exposure to S. aureus, as evidenced by a high colonization prevalence and colonization of multiple body sites over the duration of the training period. Effective decolonization strategies are needed to reduce the colonization burden of S. aureus, decrease transmission rates, and thereby reduce the risk of SSTI in the military training setting. Disclosures All authors: No reported disclosures.

Background Tafenoquine (TQ) is an 8-aminoquinoline (8AQ) that has been tested in several Phase II and Phase III clinical studies and is currently in late stage development as an anti-malarial prophylactic agent. NPC-1161B is a promising 8AQ in late preclinical development. It has recently been reported that the 8AQ drug primaquine requires metabolic activation by CYP 2D6 for efficacy in humans and in mice, highlighting the importance of pharmacogenomics in the target population when administering primaquine. A logical follow-up study was to determine whether CYP 2D activation is required for other compounds in the 8AQ structural class. Methods In the present study, the anti-malarial activities of NPC-1161B and TQ were assessed against luciferase expressing Plasmodium berghei in CYP 2D knock-out mice in comparison with normal C57BL/6 mice (WT) and with humanized/CYP 2D6 knock-in mice by monitoring luminescence with an in vivo imaging system. These experiments were designed to determine the direct effects of CYP 2D metabolic activation on the anti-malarial efficacy of NPC-1161B and TQ. Results NPC-1161B and TQ exhibited no anti-malarial activity in CYP 2D knock-out mice when dosed at their ED100 values (1 mg/kg and 3 mg/kg, respectively) established in WT mice. TQ anti-malarial activity was partially restored in humanized/CYP 2D6 knock-in mice when tested at two times its ED100. Conclusions The results reported here strongly suggest that metabolism of NPC-1161B and TQ by the CYP 2D enzyme class is essential for their anti-malarial activity. Furthermore, these results may provide a possible explanation for therapeutic failures for patients who do not respond to 8AQ treatment for relapsing malaria. Because CYP 2D6 is highly polymorphic, variable expression of this enzyme in humans represents a significant pharmacogenomic liability for 8AQs which require CYP 2D metabolic activation for efficacy, particularly for large-scale prophylaxis and eradication campaigns.

Background The FMP2.1/AS02A candidate malaria vaccine was tested in a Phase 2 study in Mali. Based on results from the first eight months of follow-up, the vaccine appeared well-tolerated and immunogenic. It had no significant efficacy based on the primary endpoint, clinical malaria, but marginal efficacy against clinical malaria in secondary analyses, and high allele-specific efficacy. Extended follow-up was conducted to evaluate extended safety, immunogenicity and efficacy. Methods A randomized, double-blinded trial of safety, immunogenicity and efficacy of the candidate Plasmodium falciparum apical membrane antigen 1 (AMA1) vaccine FMP2.1/AS02A was conducted in Bandiagara, Mali. Children aged 1–6 years were randomized in a 1∶1 ratio to receive FMP2.1/AS02A or control rabies vaccine on days 0, 30 and 60. Using active and passive surveillance, clinical malaria and adverse events as well as antibodies against P. falciparum AMA1 were monitored for 24 months after the first vaccination, spanning two malaria seasons. Findings 400 children were enrolled. Serious adverse events occurred in nine participants in the FMP2.1/AS02A group and three in the control group; none was considered related to study vaccination. After two years, anti-AMA1 immune responses remained significantly higher in the FMP2.1/AS02A group than in the control group. For the entire 24-month follow-up period, vaccine efficacy was 7.6% (p = 0.51) against first clinical malaria episodes and 9.9% (p = 0.19) against all malaria episodes. For the final 16-month follow-up period, vaccine efficacy was 0.9% (p = 0.98) against all malaria episodes. Allele-specific efficacy seen in the first malaria season did not extend into the second season of follow-up. Interpretation Allele-specific vaccine efficacy was not sustained in the second malaria season, despite continued high levels of anti-AMA1 antibodies. This study presents an opportunity to evaluate correlates of partial protection against clinical malaria that waned during the second malaria season. Trial Registration Clinicaltrials.gov NCT00460525 NCT00460525

Background: In a prior study, a DNA prime / adenovirus boost vaccine (DNA/Ad) expressing P. falciparum circumsporozoite protein (CSP) and apical membrane antigen-1 (AMA1) (NMRC-M3V-D/Ad-PfCA Vaccine) induced 27% protection against controlled human malaria infection (CHMI). To investigate the contribution of DNA priming, we tested the efficacy of adenovirus vaccine alone (NMRC-M3V-Ad-PfCA ) in a Phase 1 clinical trial. Methodology/Principal Findings: The regimen was a single intramuscular injection with two non-replicating human serotype 5 adenovectors encoding CSP and AMA1, respectively. One x 1010 particle units of each construct were combined prior to administration. The regimen was safe and well-tolerated. Four weeks later, 18 study subjects received P. falciparum CHMI administered by mosquito bite. None were fully protected although one showed delayed onset of parasitemia. Antibody responses were low, with geometric mean CSP ELISA titer of 381 (range < 50–1626) and AMA1 ELISA of 4.95 µg/mL (range 0.2–38). Summed ex vivo IFN-γ ELISpot responses to overlapping peptides were robust, with geometric mean spot forming cells/million peripheral blood mononuclear cells [sfc/m] for CSP of 273 (range 38–2550) and for AMA1 of 1303 (range 435–4594). CD4+ and CD8+ T cell IFN-γ responses to CSP were positive by flow cytometry in 25% and 56% of the research subjects, respectively, and to AMA1 in 94% and 100%, respectively. Significance: In contrast to DNA/Ad, Ad alone did not protect against CHMI despite inducing broad, cell-mediated immunity, indicating that DNA priming is required for protection by the adenovirus-vectored vaccine. ClinicalTrials.gov Identifier: NCT00392015.

Varicella-zoster virus (VZV) infections have declined in many industrialized countries due to vaccination with the attenuated Oka strain virus. Rare cases of severe, disseminated vaccine-strain VZV infection have occurred in the immunocompromised, although rarely in HIV-infected persons. We describe a man with previously-undiagnosed human immunodeficiency virus (HIV) infection who received VZV vaccination and subsequently presented to a combat hospital in Afghanistan with disseminated varicella, respiratory failure, and sepsis. The patient recovered with ventilator and hemodynamic support, intravenous acyclovir, and empiric antibiotic therapy. DNA sequencing detected Oka strain virus from patient blood specimens. Although safe in most populations, the VZV vaccine may cause life-threatening disease in immunocompromised patients. Improved detection of HIV infection may be useful in preventing such cases.

We have designed a pre-erythrocytic vaccine candidate based on the Plasmodium vivax circumsporozoite (CSV) protein, which includes its N- and C-terminal parts and a truncated region containing repeat sequences from both the VK210 and the VK247 P. vivax subtypes. Two versions of this vaccine candidate were made: a soluble recombinant protein expressed in Escherichia coli, designated VMP001 and a particulate antigen expressed in Saccharomyces cerevisiae, designated CSV-S,S. The latter is composed of CSV-S, a fusion protein between VMP001 and hepatitis B surface antigen (HBsAg), and free HBsAg co-expressed in yeast and self-assembling into mixed particles. Both antigen versions, adjuvanted with AS01, were shown to be immunogenic in rhesus monkeys. CSV-S,S/AS01 induced higher levels of VMP001-specific antibodies than did VMP001/AS01. Antibody responses against the N- and C-terminal regions of CSV and the VK210 repeat motif were of a similar magnitude following immunization with either the soluble or the particulate antigen. However, antibodies against the AGDR region, a potentially protective B cell epitope, were only detected after immunization with CSV-S,S. Analysis of the induced CD4(+) T cells highlighted different cytokine profiles depending on the antigen form. These results warrant further clinical evaluation of these two vaccine candidates to assess the added value of a particulate versus soluble form of CSV, in terms of both immunogenicity and protective efficacy.

Background The development of an asexual blood stage vaccine against Plasmodium falciparum malaria based on the major merozoite surface protein-1 (MSP1) antigen is founded on the protective efficacy observed in preclinical studies and induction of invasion and growth inhibitory antibody responses. The 42 kDa C-terminus of MSP1 has been developed as the recombinant protein vaccine antigen, and the 3D7 allotype, formulated with the Adjuvant System AS02A, has been evaluated extensively in human clinical trials. In preclinical rabbit studies, the FVO allele of MSP142 has been shown to have improved immunogenicity over the 3D7 allele, in terms of antibody titres as well as growth inhibitory activity of antibodies against both the heterologous 3D7 and homologous FVO parasites. Methods Two Phase 1 clinical studies were conducted to examine the safety, reactogenicity and immunogenicity of the FVO allele of MSP142 in the adjuvant system AS01 administered intramuscularly at 0-, 1-, and 2-months: one in the USA and, after evaluation of safety data results, one in Western Kenya. The US study was an open-label, dose escalation study of 10 and 50 μg doses of MSP142 in 26 adults, while the Kenya study, evaluating 30 volunteers, was a double-blind, randomized study of only the 50 μg dose with a rabies vaccine comparator. Results In these studies it was demonstrated that this vaccine formulation has an acceptable safety profile and is immunogenic in malaria-naïve and malaria-experienced populations. High titres of anti-MSP1 antibodies were induced in both study populations, although there was a limited number of volunteers whose serum demonstrated significant inhibition of blood-stage parasites as measured by growth inhibition assay. In the US volunteers, the antibodies generated exhibited better cross-reactivity to heterologous MSP1 alleles than a MSP1-based vaccine (3D7 allele) previously tested at both study sites. Conclusions Given that the primary effector mechanism for blood stage vaccine targets is humoral, the antibody responses demonstrated to this vaccine candidate, both quantitative (total antibody titres) and qualitative (functional antibodies inhibiting parasite growth) warrant further consideration of its application in endemic settings. Trial registrations Clinical Trials NCT00666380

Contains fulltext : 118242.pdf (Publisher’s version ) (Open Access) BACKGROUND: Gene-based vaccination using prime/boost regimens protects animals and humans against malaria, inducing cell-mediated responses that in animal models target liver stage malaria parasites. We tested a DNA prime/adenovirus boost malaria vaccine in a Phase 1 clinical trial with controlled human malaria infection. METHODOLOGY/PRINCIPAL FINDINGS: The vaccine regimen was three monthly doses of two DNA plasmids (DNA) followed four months later by a single boost with two non-replicating human serotype 5 adenovirus vectors (Ad). The constructs encoded genes expressing P. falciparum circumsporozoite protein (CSP) and apical membrane antigen-1 (AMA1). The regimen was safe and well-tolerated, with mostly mild adverse events that occurred at the site of injection. Only one AE (diarrhea), possibly related to immunization, was severe (Grade 3), preventing daily activities. Four weeks after the Ad boost, 15 study subjects were challenged with P. falciparum sporozoites by mosquito bite, and four (27%) were sterilely protected. Antibody responses by ELISA rose after Ad boost but were low (CSP geometric mean titer 210, range 44-817; AMA1 geometric mean micrograms/milliliter 11.9, range 1.5-102) and were not associated with protection. Ex vivo IFN-gamma ELISpot responses after Ad boost were modest (CSP geometric mean spot forming cells/million peripheral blood mononuclear cells 86, range 13-408; AMA1 348, range 88-1270) and were highest in three protected subjects. ELISpot responses to AMA1 were significantly associated with protection (p = 0.019). Flow cytometry identified predominant IFN-gamma mono-secreting CD8+ T cell responses in three protected subjects. No subjects with high pre-existing anti-Ad5 neutralizing antibodies were protected but the association was not statistically significant. SIGNIFICANCE: The DNA/Ad regimen provided the highest sterile immunity achieved against malaria following immunization with a gene-based subunit vaccine (27%). Protection was associated with cell-mediated immunity to AMA1, with CSP probably contributing. Substituting a low seroprevalence vector for Ad5 and supplementing CSP/AMA1 with additional antigens may improve protection. TRIAL REGISTRATION: ClinicalTrials.govNCT00870987.

Circumsporozoite protein (CSP) of Plasmodium falciparum is a protective human malaria vaccine candidate. There is an urgent need for models that can rapidly down-select novel CSP-based vaccine candidates. In the present study, the mouse-mosquito transmission cycle of a transgenic Plasmodium berghei malaria parasite stably expressing a functional full-length P. falciparum CSP was optimized to consistently produce infective sporozoites for protection studies. A minimal sporozoite challenge dose was established, and protection was defined as the absence of blood-stage parasites 14 days after intravenous challenge. The specificity of protection was confirmed by vaccinating mice with multiple CSP constructs of differing lengths and compositions. Constructs that induced high NANP repeat-specific antibody titers in enzyme-linked immunosorbent assays were protective, and the degree of protection was dependent on the antigen dose. There was a positive correlation between antibody avidity and protection. The antibodies in the protected mice recognized the native CSP on the parasites and showed sporozoite invasion inhibitory activity. Passive transfer of anti-CSP antibodies into naive mice also induced protection. Thus, we have demonstrated the utility of a mouse efficacy model to down-select human CSP-based vaccine formulations.

In late 2010, the Claude Moore Health Sciences Library (CMHSL) launched an experimental implementation of quick response (QR) codes with the goal of determining whether certain services could be delivered more efficiently with this method. A QR code is a “specific matrix barcode (or two-dimensional code) that is readable by dedicated QR barcode readers and camera telephones. The code consists of black modules arranged in a square pattern on a white background. The information encoded may be text, [uniform resource locator] URL, or other data” [1]. Dating back to 1994 when they were created by Japan's Denso-Wave Corporation [2], QR codes have not only migrated into everyday life in many parts of Asia, but global use in advertising is experiencing exponential growth [3]. The 2009 Horizon Report classified QR codes as a key trend in the four-to-five-year category, specifically citing education as a primary area of use [4]. Some libraries, such as the library at the University of Bath, were avid adopters of the technology and utilized QR codes in the library catalog, making it possible to save information about a book in order to locate it on the shelf and to link students to an MP3 audio tour of the library [5]. Ramsden and Jordan write that, despite owning smart phones with the capability to read QR codes, student awareness of the technology remains very low. However, they point out that the potential for the technology to emerge further into student awareness is encouraging [5]. CMHSL believed that younger people would have the most familiarity with QR codes, with students being a prime demographic, and this supposition is supported by a survey conducted by the University of Bath across four different universities [6].

Plasmodium vivax is the major cause of malaria outside of sub-Saharan Africa and causes morbidity and results in significant economic impact in developing countries. In order to produce a P. vivax vaccine for global use, we have previously reported the development of VMP001, based on the circumsporozoite protein (CSP) of P. vivax . Our interest is to evaluate second-generation vaccine formulations to identify novel combinations of adjuvants capable of inducing strong, long-lasting immune responses. In this study, groups of C57BL/6J mice were immunized subcutaneously three times with VMP001 emulsified with synthetic TLR4 (GLA) or TLR7/8 (R848) agonist in stable emulsion (SE), a combination of the TLR4 and TLR7/8 agonists, or SE alone. Sera and splenocytes were tested for the presence of antigen-specific humoral and cellular responses, respectively. All groups of mice generated high titers of anti- P. vivax IgG antibodies as detected by ELISA and immunofluorescence assay. GLA-SE promoted a shift in the antibody response to a Th1 profile, as demonstrated by the change in IgG2c/IgG1 ratio. In addition, GLA-SE induced a strong cellular immune response characterized by multi-functional, antigen-specific CD4 + T cells secreting IL-2, TNF and IFN-γ. In contrast, mice immunized with SE or R848-SE produced low numbers of antigen-specific CD4 + T cells, and these T cells secreted IL-2 and TNF, but not IFN-γ. Finally, R848-SE did not enhance the immune response compared to GLA-SE alone. Based on these results, we conclude that the combination of VMP001 and GLA-SE is highly immunogenic in mice and may serve as a potential second-generation vaccine candidate against vivax malaria.

Our goal is to develop a vaccine that sustainably prevents Plasmodium falciparum (Pf) malaria in ≥80% of recipients. Pf sporozoites (PfSPZ) administered by mosquito bites are the only immunogens shown to induce such protection in humans. Such protection is thought to be mediated by CD8+ T cells in the liver that secrete interferon-γ (IFN-γ). We report that purified irradiated PfSPZ administered to 80 volunteers by needle inoculation in the skin was safe, but suboptimally immunogenic and protective. Animal studies demonstrated that intravenous immunization was critical for inducing a high frequency of PfSPZ-specific CD8+, IFN-γ–producing T cells in the liver (nonhuman primates, mice) and conferring protection (mice). Our results suggest that intravenous administration of this vaccine will lead to the prevention of infection with Pf malaria. The efficacy of a sporozoite-based malaria vaccine is tested in humans, nonhuman primates, and mice. The efficacy of a sporozoite-based malaria vaccine is tested in humans, nonhuman primates, and mice.

A paraneoplastic syndrome associated with anti-N-methyl-D-asparate (NMDA) receptors can initially present as a neurologic or psychiatric disturbance. Removal of the tumor is usually curative, and the syndrome is associated with the presence, rather than the history, of tumor. We present a case in which a 25-year-old, Hispanic woman presented with seizures, memory loss, and unusual behavioral changes. The woman had a teratoma removed 2 months earlier. Because of the time course, a paraneoplastic syndrome was initially considered unlikely. Brain imaging, electroencephalography (EEG) and neurologic work-up were negative. The patient was treated for a suspected somatoform disorder and psychosis. Based on the clinical picture, the working diagnosis was changed to delirium due to paraneoplastic limbic encephalitis. A course of intravenous immunoglobins (IVIg), and high dose steroids was administered. The patient's symptoms improved, and she was discharged home. After discharge, studies came back positive for antibodies against NR1/NR2 of the NMDA receptor.

Fourteen Enterobacteriaceae isolates with ertapenem MIC2 mg/mL were analyzed to identify mechanisms of resistance. All isolates produced extended-spectrum beta-lactamase or AmpC beta-lactamase with variable, but decreased, expression of outer membrane proteins. One Enterobacter cloacae produced derepressed AmpC beta-lactamase, 1 Escherichia coli expressed plasmid-mediated AmpC beta-lactamase, and 1 E. cloacae produced a carbapenemase.

Malaria's global impact is expansive and includes the extremes of the healthcare system ranging from international travelers returning to nonendemic regions with tertiary referral medical care to residents in hyperendemic regions without access to medical care. Implementation of prompt and accurate diagnosis is needed to curb the expanding global impact of malaria associated with ever-increasing antimalarial drug resistance. Traditionally, malaria is diagnosed using clinical criteria and/or light microscopy even though both strategies are clearly inadequate in many healthcare settings. Hand held immunochromatographic rapid diagnostic tests (RDTs) have been recognized as an ideal alternative method for diagnosing malaria. Numerous malaria RDTs have been developed and are widely available; however, an assortment of issues related to these products have become apparent. This review provides a summary of RDT including effectiveness and strategies to select the ideal RDT in varying healthcare settings.

Carbapenemases are among the newest resistance mechanisms to emerge in some gram-negative bacteria. We describe bacteremia in a critically ill liver transplant recipient infected with KPC-2-producing Enterobacter cloacae and Pseudomonas putida . Although this enzyme has been previously described in Enterobacter spp., this is the first report of KPC carbapenemase in P. putida .

The patient is a single, white man with no personal or family history of psychosis. He had an unremarkable developmental history and, other than a childhood diagnosis of attention-deficit hyperactivity disorder, which resolved, no previous contacts with mental health professionals. He was in good physical condition, and there was no history of drug or alcohol abuse. At the age of 18, the patient enrolled in the U.S. Marine Corps and was considered to be an outstanding recruit. Forty-five days into training, he suffered a heat injury during a training hike on a warm day. The patient’s temperature in the field was recorded as 104 F. He was flown via helicopter to the nearest emergency room, where he was hydrated, intubated, and given a head CT scan, which showed no acute intracranial process. The patient was hospitalized for 4 days, at which point he was considered to be recovered. Approximately 4 days after returning to military training, the patient had mental-status changes. He endorsed the delusion that he was personally responsible for the unsatisfactory performances of other recruits. He expressed paranoia about his doctors and the media, whom he believed were communicating with him through the TV and newspaper. He endorsed visual hallucination of the floor moving in waves, and command auditory hallucinations. He was admitted to inpatient psychiatric care and started on 1 mg of risperidone. An MRI scan of the brain and neurological assessment were found to be unremarkable. Symptoms improved but did not resolve during hospitalization. When symptoms persisted beyond 1 month, the patient was diagnosed with schizophreniform disorder.

An elderly patient with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was treated sequentially with vancomycin plus rifampin then daptomycin plus gentamicin. The MRSA strain developed diminished susceptibility to vancomycin (MIC increase and tolerance), daptomycin, and gentamicin, and resistance to rifampin during therapy.

Primaquine is used to eradicate the hepatic or hypnozoite form of Plasmodium vivax that may lead to relapse of infection. Host genetic factors may play a role in the activity of primaquine therapy.

This is the first report of blue autofluorescence as a useful characteristic in the microscopic detection of Toxoplasma gondii, Hammondia hammondi, Hammondia heydorni, Neospora caninum, Besnoitia darlingi, and Sarcocystis neurona oocysts or sporocysts. This autofluorescence is of sufficient intensity and duration to allow identification of these oocysts from complex microscopic sample backgrounds. As with the autofluorescence of related coccidia, the oocysts glow pale blue when illuminated with an ultraviolet (UV) light source and viewed with the correct UV excitation and emission filter set.