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.