We identified a large outbreak of rapidly growing mycobacterial infections among persons who had had footbaths and pedicures at one nail salon. Physicians should suspect this cause in patients with persistent furunculosis after exposure to whirlpool footbaths.

In 2000, an outbreak of Mycobacterium fortuitum furunculosis affected customers using whirlpool footbaths at a nail salon. We swabbed 30 footbaths in 18 nail salons from 5 California counties and found mycobacteria in 29 (97%); M. fortuitum was the most common. Mycobacteria may pose an infectious risk for pedicure customers.

A comparative analysis of the Bordetella pertussis, B. bronchiseptica, and B. parapertussis genome assemblies permitted the identification of regions with significant sequence divergence and the design of two new real-time PCR assays, BP283 and BP485, for the specific detection of B. pertussis. The performance characteristics of these two assays were evaluated and compared to those of culture and an existing real-time PCR assay targeting the repetitive element IS481. The testing of 324 nasopharyngeal specimens indicated that, compared to culture, the BP283 assay had a sensitivity and specificity of 100 and 96.8% and the BP485 assay had a sensitivity and specificity of 92.3 and 97.1%. Notably, B. holmesii was isolated from two specimens that were positive by the IS481 assay but negative by the BP283 and BP485 assays. These two assays represent an improvement in specificity over those of PCR assays targeting only IS481 and may be duplexed or used in conjunction with existing PCR assays to improve the molecular detection of B. pertussis.Bordetella pertussis, the causative agent of pertussis, or whooping cough, is reemerging as a significant respiratory pathogen in many parts of the world (2, 14, 26). In the United States, the number of pertussis cases has increased rapidly over the last several years (2). Explanations for this reemergence include waning herd immunity, the antigenic drift of B. pertussis strains away from the antigenic composition of vaccines, better pertussis awareness and reporting, and the increasing use of nucleic acid amplification tests for the laboratory detection of B. pertussis (3,16). Nucleic acid amplification tests, such as the PCR test, offer an improvement in sensitivity over that of culture for the diagnosis of pertussis (23). Unfortunately, there is no standardized PCR test available for B. pertussis detection by clinical microbiology laboratories. Among the previously described PCR assays for pertussis diagnosis, the most frequently utilized target sequence is that of IS481. Over 200 copies of this insertion element are found in the B. pertussis genome (18). This high copy number offers a significant advantage in analytical sensitivity for PCR assays utilizing this target compared to assays with single-copy target sequences (23). However, the enhanced sensitivities of assays targeting IS481 also make them more prone to give false-positive results through laboratory contamination. Moreover, assays detecting the IS481 target sequence also lack specificity, as IS481 elements are also found in B. holmesii and some B. bronchiseptica strains (21,22). Reports of respiratory disease outbreaks attributed to B. pertussis based on errant results of PCR tests targeting IS481 have prompted recommendations for the use of additional PCR targets for the confirmation of B. pertussis detection by PCR (2,5,7,11,19,20).In this study, we describe the identification of two new PCR target sequences through comparative genomics. Real-time PCR assays targeting these sequences were developed in simplex and d...

Campylobacter curvus is a rarely encountered Campylobacter species in human, animal, and environmental samples. During the course of two investigations, one involving a search for possible bacterial agents causing bloody gastroenteritis and a second concerning a small outbreak of Brainerd's diarrhea in northern California, 20 strains of C. curvus or C. curvus-like organisms were isolated by a microfiltration technique and prolonged incubation. The results suggest that C. curvus may be an underappreciated Campylobacter that may be involved in sporadic and outbreak cases of bloody or chronic diarrhea in humans.The genus Campylobacter consists of curved or S-shaped gram-negative, oxidase-positive microaerophilic bacilli with a respiratory type of metabolism (15). The genus has undergone several taxonomic revisions over the past decade, including the transfer of a number of species to either the genus Arcobacter or the genus Helicobacter (12). Sixteen species presently reside in the genus Campylobacter. Of these 16 species, Campylobacter jejuni, C. coli, and C. fetus are the major species of medical, public health, or veterinary interest involved in disease processes (12).Of the 13 remaining Campylobacter species, very little information regarding their pathogenicity is available, although some species, such as C. upsaliensis, C. hyointestinalis, and C. lari, have been associated with various infectious syndromes (1, 3, 13). Even less information about campylobacters such as C. curvus is available. Originally described in 1984 ("Wolinella curva") (14), only four strains of C. curvus were described in that report; two strains were associated with the oral cavity, one isolate was from blood, and the fourth was a clinical isolate of unknown origin. Since that initial report, few studies have reported on the isolation of C. curvus. C. curvus has been isolated from the stools of patients who subsequently presented with either Guillain-Barré or Fisher's syndrome, although no role in the development of these neurologic conditions could be associated with this species (8). In a 2000 study of more than 1,300 human stool specimens conducted to study the prevalence of campylobacters (other than C. jejuni and C. coli), only 3 of 48 campylobacters recovered were tentatively identified as C. curvus-like (4). A study from 2003 (11) reported that 320 consecutive liquid or semisolid fecal specimens submitted to a laboratory for enteric pathogen detection were culture negative for C. curvus, although one stool specimen was positive for C. curvus by 16S rRNA gene PCR. These cumulative results suggest that the frequency of C. curvus in the gastrointestinal tracts of symptomatic individuals is exceedingly low.Over a 4-year period, we have isolated 20 strains of C. curvus from two separate and distinct clinical settings, namely, from a hospital survey of infectious causes of bloody diarrhea and from an outbreak of Brainerd's diarrhea in northern California. These isolations serve as the basis of this report. MATERIALS AND METHODSSettings...