LETTERSDromedaries are common in hot desert terrains of the ArabianPeninsula, the Middle East, Afghanistan, central Asia,India, and parts of Africa. Bactrian camels are found in coldersteppes of Mongolia, Central Asia, Pakistan, and Iran.Studies have demonstrated a high seroprevalence (>90%) ofMERS-CoV in adult (>5 years of age) dromedaries from theMiddle East and from northern, eastern, and parts of centralAfrica (6), but whether MERS-CoV circulates among Bactriancamels is unknown.To determine whether MERS-CoV is circulatingamong both species of camels, we studied apparentlyhealthy Bactrian camel herds in southern Mongolia duringNovember 24–30, 2014. We investigated 11 herds inUmnugovi Province (170 sampled animals) and 1 herdin the adjacent Dundgovi Province (30 sampled animals)(Table). A convenience sample was collected from eachherd; younger animals were oversampled. Serum and nasalswab samples were collected from each animal. Thenasal swab samples were placed in virus transport mediumand later tested by real-time PCR targeting openreadingframe 1a and upstream of envelope protein gene,as previously described (7); all samples were negative forMERS-CoV RNA. The serum samples were tested for thepresence of MERS-CoV antibody by using a validatedMERS-CoV (strain EMC) spike pseudoparticle neutralizationtest (8); no samples were positive, indicating alack of recent or past MERS-CoV infection. A randomsample of 5 serum samples each from camels in Umnugoviand Dundgovi Provinces was tested by using a microneutralizationtest against bovine coronavirus (BCoV)as previously described (8); all 10 samples were positive(titer range 1:20–1:640).The sampled animals included 127 camels >5 yearsof age from 12 herds across 2 provinces in southernMongolia. Thus, the negative test results indicate thatMERS-CoV is not circulating among Bactrian camels insouthern Mongolia. The seroprevalence of MERS-CoVamong adult dromedaries in the Middle East and Africais typically >90%, so the lack of any serologic reactivityin camels from Mongolia implies that MERS-CoVinfection does not infect Bactrian camels or that the geographicrange of the virus does not extend to northeasternAsia. In contrast, infection with a BCoV-like coronavirusseems ubiquitous in Bactrian camels, as it is indromedaries (7).Dipeptidyl peptidase-4 (DPP4; cluster of differentiation26) is the receptor for MERS-CoV. As deduced fromthe human DPP4–MERS-CoV spike protein structuralmodel, the differences in the amino acids in DPP4 moleculesof dromedary and Bactrian camel were found in 2small regions far from the binding interface of DDP4 andMERS spike protein (9). The 15 aa of DPP4 critical forbinding with MERS-CoV spike protein are conserved betweendromedaries and Bactrian camels. Definitive evidenceof susceptibility, or lack thereof, of Bactrian camelsto MERS-CoV can be established only by experimentalinfection of these animals.Even if Bactrian camels are susceptible to MERS-CoV infection, geographic separation may be an alternativeexplanation for the absence of MERS-CoV amongcamels in Mongolia. So far, Australia is the only countrywhere dromedaries appear to be free of MERS-CoV; however,as with dromedaries elsewhere, dromedaries in Australiaare infected by a BCoV-like virus (8). Dromedariesin Australia originated from Afghanistan; these camelswere shipped to Australia in the early part of the twentiethcentury to work on railroad construction projects.There are 2 plausible explanations for the lack of MERS-CoV in Australia: the small numbers of adult animals thatwere transported from Afghanistan to Australia might nothave been sufficient to introduce the virus into Australiaor the virus might have been absent from dromedariesin Afghanistan.Our study was limited by sample size and by thebreadth of the study area. Mongolia has 21 provinces and≈349,300 Bactrian camels, but we studied just 2 southernTable. Collection sites of nasal swab and serum specimens from Bactrian camels tested for Middle East respiratory syndromecoronavirus, southern Mongolia, November 2014Age, yHerd no.Province, district5 No. sampled/no. total in herd1 Umnugovi, Khankhongor 9 5 9 23/562 Umnugovi, Khankhongor 7 2 9 18/313 Umnugovi, Khankhongor 8 0 5 13/284 Umnugovi, Khankhongor 0 9 17 26/655 Umnugov, Bayan-Ovoo 0 7 8 15/276 Umnugovi, Bayan-Ovoo 0 1 16 17/707 Umnugovi, Bayan-Ovoo 0 0 4 4/98 Umnugovi, Bayan-Ovoo 0 2 9 11/339 Umnugovi, Bayan-Ovoo 0 0 10 10/5410 Umnugovi, Bayan-Ovoo 1 5 7 13/3611 Umnugovi, Bayan-Ovoo 0 8 12 20/2412 Dundgovi, Khuld 0 9 21 30/58Total 25 48 127 200/4911270 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015
LETTERSprovinces and a total of 200 camels. Umnogovi Provincehas the largest, and Dundgovi Province the fifth largest,camel population in the country (≈113,000 and ≈28,000animals, respectively). Further studies on the epidemiologyof MERS-CoV infection in dromedaries and Bactriancamels from central Asia, China, and Mongolia are warranted.The field work for this study was supported by a researchgrant from The University of Hong Kong; the laboratorytesting was supported by the National Institutes of Health,National Institute of Allergy and Infectious Diseases (contractN272201400006C).References1. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus ADME,Fouchier RAM. Isolation of a novel coronavirus from a man withpneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814–20.http://dx.doi.org/10.1056/NEJMoa12117212. World Health Organization. Middle East respiratory syndromecoronavirus (MERS-CoV): summary of current situation, literatureupdate and risk assessment–as of 5 February 2015 [cited 2015 Feb25]. http://www.who.int/csr/disease/coronavirus_infections/mers-5-february-2015.<strong>pdf</strong>?ua=13. Reusken CBEM, Haagmans BL, Müller MA, Gutierrez C,Godeke G-J, Meyer B, et al. Middle East respiratory syndromecoronavirus neutralising serum antibodies in dromedary camels: acomparative serological study. Lancet Infect Dis. 2013;13:859–66.http://dx.doi.org/10.1016/S1473-3099(13)70164-64. Chan RWY, Hemida MG, Kayali G, Chu DKW, Poon LLM,Alnaeem A, et al. Tropism and replication of Middle Eastrespiratory syndrome coronavirus from dromedary camels inthe human respiratory tract: an in-vitro and ex-vivo study.Lancet Respir Med. 2014;2:813–22. http://dx.doi.org/10.1016/S2213-2600(14)70158-45. Azhar EI, El-Kafrawy SA, Farraj SA, Hassan AM, Al-Saeed MS,Hashem AM, et al. Evidence for camel-to-human transmission ofMERS coronavirus. N Engl J Med. 2014;370:2499–505.http://dx.doi.org/10.1056/NEJMoa14015056. Reusken CBEM, Messadi L, Feyisa A, Ularamu H, Godeke G-J,Danmarwa A, et al. Geographic distribution of MERScoronavirus among dromedary camels, Africa. Emerg Infect Dis.2014;20:1370–4. http://dx.doi.org/10.3201/eid2008.1405907. Chu DKW, Poon LLM, Gomaa MM, Shehata MM,Perera RAPM, Abu Zeid D, et al. MERS coronaviruses indromedary camels, Egypt. Emerg Infect Dis. 2014;20:1049–53.http://dx.doi.org/10.3201/eid2006.1402998. Hemida MG, Perera RA, Al Jassim RA, Kayali G, Siu LY,Wang P, et al. Seroepidemiology of Middle East respiratorysyndrome (MERS) coronavirus in Saudi Arabia (1993) andAustralia (2014) and characterisation of assay specificity.Euro Surveill. 2014;19: pii 20828.9. Wang N, Shi X, Jiang L, Zhang S, Wang D, Tong P, et al.Structure of MERS-CoV spike receptor-binding domaincomplexed with human receptor DPP4. Cell Res. 2013;23:986–93.http://dx.doi.org/10.1038/cr.2013.92Address for correspondence: Malik Peiris, School of Public Health,The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong KongSpecial Administrative Region, China; email: malik@hku.hkOligella ureolyticaBacteremia in Elderly Woman,United StatesTristan Simmons, Eryn Fennelly, David LoughranAuthor affiliation: Philadelphia College of Osteopathic Medicine,Philadelphia, Pennsylvania, USADOI: http://dx.doi.org/10.3201/eid2107.150242To the Editor: Oligella ureolytica is an aerobic gramnegativecoccobacillus found as a commensal organism inhuman urinary tracts (1). Previously referred to as CDCGroup IVe, this bacterium is not commonly encounteredas a source of infection and is difficult to isolate by usingconventional laboratory procedures (2). The few cases ofpathogenic infection with O. ureolytica described in the literaturehave occurred in patients ranging in age from newbornto 89 years and from the varied locations of India,Turkey, Canada, and the United States (3–7). We report acase of O. ureolytica bacteremia in a patient in whom sepsiswas diagnosed and review the current literature on thisemerging pathogen.A 66-year-old woman sought treatment in our emergencydepartment for a fever of 100.7°F, femur fracture,and a right buttock stage III decubitus ulcer. She reportedhaving fallen 4 days earlier, after which she was unable towalk and spent 4 days laying in her own urine and feces.Blood tests revealed an elevated leukocyte count of 24.4× 10 9 cells/L (76% neutrophils, 2% bands), and urinalysisshowed trace leukocyte esterase, +3 bacteria, and 5–10 leukocytes.Chest radiograph and head computed tomographyimages were unremarkable. Her electrocardiogram showednonspecific ST wave changes. Samples from the patient’sblood, urine, and wounds were collected while the patientwas in the emergency department and were sent for culture.Wound cultures showed growth of Proteus mirabilisand Enterococcus spp. The urine culture grew >100,000CFU Escherichia coli. The first set of blood culturesgrew O. ureolytica in aerobic and anaerobic bottles, butanother set drawn 30 min later showed no growth. Theblood cultures were processed by using the Bact/Alert 3D(bioMérieux, Marcy l’Etoile, France) and Gram stained.Identification was from the Vitek 2 compact system (bio-Mérieux). The O. ureolytica sample was sensitive to amikacin,ampicillin/sulbactam, ceftazidime, ceftriaxone,gentamicin, imipenem, levofloxacin, nitrofurantoin, trimethoprim/sulfamethoxazole,and chloramphenicol. Noresistance was found.Because of the unique bacteremia, further diagnosticswere conducted. The results of chest, abdomen, and pelviccomputed tomography scans were unremarkable. 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