Articles from Emerging Infectious Diseases

Yellow fever, a zoonotic arboviral disease, has reemerged in Colombia, triggering a major outbreak in the country. During 2024 through mid-2025, a total of 132 human cases and 68 infections in nonhuman primates were confirmed, primarily in the department of Tolima, historically considered a low-risk area. We analyzed the historical and current epidemiology of yellow fever in Colombia, highlighting ecologic, social, and surveillance factors that contributed to the outbreak. Low vaccination coverage, insufficient epizootic and entomological surveillance, deforestation, habitat fragmentation, and limited application of One Health approaches have all exacerbated the situation. The high mortality rate of nonhuman primate species indicated a more profound ecologic crisis. Immediate, comprehensive measures, including mass vaccination, genomic surveillance, and integrated One Health frameworks, are urgently needed. Colombia’s experience underscores the need to reevaluate risk stratification and preparedness strategies across the Americas to prevent future yellow fever outbreaks in previously unaffected regions.

Human granulocytic anaplasmosis (HGA), caused by Anaplasma phagocytophilum transmitted through tick bites, remains poorly documented in France. We conducted a retrospective, multicenter study of cases in Alsace during 2012–2024, including 39 HGA episodes in 38 patients PCR positive for A. phagocytophilum. Most (63.2%) patients were men, median age was 60.5 years, and 76.3% lived in rural areas. A tick bite was reported in 61.6% of cases. Frequent symptoms included fever (97.4%), fatigue (61.5%), and headache (61.5%). Laboratory findings showed elevated C-reactive protein (100%), thrombocytopenia (94.9%), leukopenia (59.0%), and cytolysis (66.7%). One patient had secondary hemophagocytic lymphohistiocytosis. Most (87.2%) patients were hospitalized; none required intensive care unit admission. Doxycycline was administered in 29 cases, and all patients recovered. HGA should be considered in febrile patients with recent tick exposure and cytopenia. Although often benign, rare severe HGA forms can occur and justify increased clinical awareness, especially in A. phagocytophilum–endemic areas.

We describe 2 genetically unrelated outbreaks of Listeria monocytogenes infections (outbreak A and outbreak B) linked to packaged salads from 2 different firms that were investigated simultaneously in 2021. Combined, the outbreaks caused 30 illnesses, 27 hospitalizations, and 4 deaths over 8 years. Those investigations led to recalls of product from 2 different firms and highlight how L. monocytogenes contamination can persist for long periods and cause illnesses over many years. Outbreak A was investigated 3 times with illnesses occurring over 8 years, whereas illnesses in outbreak B occurred over 5 years. Both outbreaks illustrate the importance of routine and epidemiologically directed sampling by state partners, without which these outbreaks likely would have gone unsolved. The outbreaks were the second and third multistate outbreaks of listeriosis linked to packaged salads, providing further documentation of the potential for L. monocytogenes infections from consumption of contaminated packaged salads.

A previous study demonstrated noninferior efficacy of 4-month rifapentine/moxifloxacin regimen for tuberculosis (TB) treatment compared with the standard regimen. We analyzed pregnancy outcomes of women who became pregnant during the study. Among 740 women, 97 (13.1%) became pregnant. Of 102 pregnancies (in 97 participants), 30 (29.4%) participants were exposed to study drugs. Fetal loss was reported for 3/13 (23.1%) in the control regimen, 1/9 (11.1%) in the rifapentine/moxifloxacin regimen, and 1/8 (12.5%) in the rifapentine regimen. Among 21 live births in exposed pregnancies (7 in each arm), 1 infant with a congenital anomaly was reported in a participant on the rifapentine regimen. Among women receiving a short rifapentine/moxifloxacin regimen for tuberculosis who became pregnant, we observed no elevated rates of fetal losses or congenital anomalies.

Selection for the A₁₃₆R₁₅₄R₁₇₁ PRNP allele is known to curb classical scrapie in sheep, and we expected it to minimize the risk for classical bovine spongiform encephalopathy (c-BSE) propagation. We orally challenged newborn ARR/ARR and ARQ/ARQ lambs with ovine-passaged c-BSE. Contrary to our expectations, prion disease developed in all ARR/ARR lambs after markedly longer incubation times (≈50 months) than ARQ/ARQ controls (≈20 months). Tissue distribution of the abnormal isoform of prion protein (PrP) in clinically affected ARR/ARR sheep largely mirrored tissue distribution seen in ARQ/ARQ animals. Bioassays in bovine- and human-PrP transgenic mice showed that passage through ARR/ARR sheep did not increase the agent’s zoonotic potential. Transmission efficiency in human normal cellular isoform PrP-expressing mice remained similar to cattle c-BSE and lower than ARQ-passaged c-BSE. Our data reveal the limitations of breeding exclusively for ARR when the objective is to mitigate c-BSE risk and underscore the need to maintain specific-risk-material removal and surveillance programs.

Classical scrapie affects sheep and goats. To control prevalence in sheep, the European Union initiated breeding programs targeting resilient genotypes. Although certain goat polymorphisms, such as Q₂₂₂K, are linked to resistance, specific breeding programs have not been implemented. Hemizygous transgenic mice carrying the goat K₂₂₂ cellular prion protein (PrP) allele (K₂₂₂-Tg516) exhibited resistance to several classical scrapie isolates. We inoculated homozygous K₂₂₂-Tg516 and Q₂₂₂-Tg501 mice with various scrapie isolates. Homozygous K₂₂₂-Tg516 mice reached the end of their lifespan without exhibiting clinical signs; we observed brain proteinase K–resistant PrP accumulation in those mice that was lower than in Q₂₂₂-Tg501 mice. Histologically, K₂₂₂-Tg516 brains lacked prion-related lesions, except for the presence of few isolated scrapie PrP plaques in cases of isolates highly adapted to the K₂₂₂-PrP^C environment. Our findings caution against including that polymorphism in breeding programs, because it could lead to emergence of asymptomatic silent prion carriers of classical scrapie among goat populations.

Lassa virus (LASV) causes Lassa fever; mortality rates are higher in pregnant women, and fetal infection and death are possible. Sexual transmission after recovery from Lassa fever has occurred. Using virus strains that are lethal (Josiah) or nonlethal (NJ2015) in guinea pigs, we characterized LASV-associated pathology and reproductive tissue tropism in male and female animals. Uterus, ovary, and epididymis were the earliest and most affected tissues; perivascular lymphocytic inflammation was prominent at lethal timepoints and persisted in survivors after clinical disease. LASV-Josiah RNA was detected in reproductive tissues by 4 days postinfection (dpi). Virus localized by immunohistochemistry and in situ hybridization predominantly within vascular smooth muscle and interstitial mesenchymal cells and was widespread in reproductive tissues in lethal infections (12–25 dpi) but not detected in survivors (41–42 dpi). Using a physiologically relevant model, we describe reproductive tissue targets to further elucidate LASV infection and effects on reproductive health and virus transmission.

Genomic sequencing of reemerging highly pathogenic avian influenza A(H5N1) virus detected in Argentina in February 2025 revealed novel triple-reassortant viruses containing gene segments from Eurasian H5N1 and low pathogenicity viruses from South and North American lineages. Our findings highlight continued evolution and diversification of clade 2.3.4.4b H5N1 in the Americas.

We diagnosed neuroinvasive tularemia in a neonate in Utah who had culture-negative pleocytosis in cerebrospinal fluid, rim-enhancing lesions on brain magnetic resonance imaging, and blood microbial cell-free DNA Francisella tularensis detection. Maternal history, serologic testing, and Francisella sp. identified in the fallopian tube by immunohistochemistry and 16S rRNA gene PCR strongly support congenital infection.

A 62-year-old patient was hospitalized in Geneva, Switzerland, with an atypical manifestation of West Nile virus infection. Initially, he sought care for febrile diarrhea and vomiting; his condition deteriorated and hemophagocytic lymphohistiocytosis and meningoencephalitis developed. Corticosteroids improved his condition. We used high-throughput sequencing and ophthalmologic findings to diagnose West Nile virus.

We report a case of severe conjunctivitis in a traveler infected with a Philophthalmus lacrymosus eye fluke, probably acquired on the Galápagos Islands in Ecuador. This zoonotic parasite is endemic in Brazil and Venezuela, where it has been reported in birds and capybaras.

Poultry workers in Washington, USA, were infected with highly pathogenic avian influenza A(H5N1) virus and recovered. The viruses were clade 2.3.4.4b genotype D1.1, closely related to viruses causing poultry outbreaks. Continued surveillance and testing for influenza A(H5) clade 2.3.4.4b viruses remain essential for risk assessment and pandemic preparedness of zoonotic influenza viruses.

We report 5 patients in Bangladesh presumed to have Nipah virus infections after consuming raw date palm sap. PCR and serology for Nipah virus were negative, but high-throughput sequencing identified Pteropine orthoreovirus in archived throat swab samples and virus cultures. This batborne virus should be considered in differential diagnosis of Nipah-like illnesses.

Schistosomiasis is a globally prevalent parasitic infection, but pancreatic involvement is extremely rare. In this article, we report 4 cases of pancreatic schistosomiasis from endemic regions in China. The possible link between schistosomiasis and pancreatic malignancy deserves further study. These cases underscore the diagnostic challenge of pancreatic schistosomiasis.

We investigated macrolide resistance and P1 genotypes of Mycoplasma pneumoniae during the 2024–2025 outbreak in Hamilton, Ontario, Canada. Macrolide resistance remained stable at ≈10%–20%, but significant shifts in P1 genotype distribution and resistance rates in P1 types occurred, indicating notable changes in M. pneumoniae molecular epidemiology in Ontario since 2011–2012.

Our 2024 survey of eligible US healthcare workers found that 48% of unvaccinated healthcare workers are interested in receiving Ebola virus vaccine. The Advisory Committee on Immunization Practices recommended vaccination for healthcare workers at highest risk for occupational exposure to Zaire ebolavirus (Orthoebolavirus zairense). Addressing concerns identified by survey respondents might improve vaccine acceptance.

Phocine distemper virus caused epizootics of fatal pneumonia in North Sea harbor seals in 1988 and 2002. Two seals that stranded years later were infected with defective phocine distemper virus variants that caused severe encephalomyelitis. Old seal encephalitis resembled subacute sclerosing panencephalitis in humans and old dog encephalitis in canines.

Sporadic cases of trombiculiasis have been reported as causing neurologic signs in dogs. We report a cluster of trombiculiasis cases (outbreak) in the province of Noord-Holland, the Netherlands, associated with Neotrombicula autumnalis mite infestation. Veterinarians should consider N. autumnalis infestation in differential diagnoses for acute onset neurologic signs in dogs.

Sporadic cholera outbreaks continue to occur in Haiti. We used a novel space-time analysis to gain insight from limited government surveillance data. We identified concerning patterns of disease spread in areas known to be at high risk for epidemic cholera in and around the capital city of Port-au-Prince.

Using metatranscriptomics, we identified Trubanaman virus in cerebrospinal fluid from a severely immunocompromised man who died of encephalitis in Queensland, Australia. Virus sequences were related to orthobunyaviruses previously detected in mosquitoes in Australia. Testing for other causes yielded negative results, suggesting that Trubanaman virus was the cause of this fatal encephalitis case.

We report on a carbapenem-, extended spectrum β-lactam-, fluoroquinolone-, and tetracycline-resistant Salmonella enterica serovar Typhi strain in a patient returning to Germany from India. Considering the recent emergence of extensively drug-resistant Salmonella Typhi strains, further expansion of antibiotic resistance to carbapenems poses a serious threat for typhoid fever treatment.

Influenza D virus (IDV) is prevalent in cattle in China, and a risk for spillover to other species exists. We detected IDV antibodies in 6/315 of black donkeys in northern China, suggesting cattle-to-donkey transmission and demonstrating the expanding host range of IDV and the need for reassessment of cross-species transmission risks.

As the COVID-19 pandemic waned, Mycoplasma pneumoniae reemerged in the pediatric population in Ohio, USA. The rate of macrolide-resistant M. pneumoniae fluctuated by month, ranging from 0 to 8.7%, and mirrored the azithromycin prescribing rate. Real-time surveillance for macrolide-resistant M. pneumoniae provides accurate information for management of children with these infections.

Rabies is transmissible through transplantation. Wild mammal bites or scratches carry a high risk for rabies, but their frequency among organ donors is unknown. During 2024, an estimated 12 (95% CI 7–20; 0.07%) of 16,989 deceased US donors had high-risk exposures. Identifying such exposures can mitigate rabies transmission to transplant recipients.

Treatment of respiratory diphtheria requires prompt administration of equine diphtheria antitoxin (DAT) to neutralize circulating toxin. We conducted surveys of key procurement agencies and manufacturers currently engaged in DAT manufacturing or procurement, along with key informant interviews with developers of monoclonal antibodies. Our findings indicate that prices and availability of DAT vary and that prediction of demand is challenging for both manufacturers and procurement agencies. Substantial concerns were raised over the inability to obtain enough DAT to respond to increasing global outbreaks. Monoclonal antibody developers noted financial challenges in advancing their clinical and manufacturing progress.

A previous study demonstrated noninferior efficacy of 4-month rifapentine/moxifloxacin regimen for tuberculosis (TB) treatment compared with the standard regimen. We analyzed pregnancy outcomes of women who became pregnant during the study. Among 740 women, 97 (13.1%) became pregnant. Of 102 pregnancies (in 97 participants), 30 (29.4%) participants were exposed to study drugs. Fetal loss was reported for 3/13 (23.1%) in the control regimen, 1/9 (11.1%) in the rifapentine/moxifloxacin regimen, and 1/8 (12.5%) in the rifapentine regimen. Among 21 live births in exposed pregnancies (7 in each arm), 1 infant with a congenital anomaly was reported in a participant on the rifapentine regimen. Among women receiving a short rifapentine/moxifloxacin regimen for tuberculosis who became pregnant, we observed no elevated rates of fetal losses or congenital anomalies.

Haematospirillum jordaniae was first identified as a human pathogen in 2016. In this article, we describe 4 patients who had H. jordaniae infections identified in 2020 and who had temporally and spatially linked environmental exposures. Three of the 4 patients reported leg injuries while participating in recreational river water activities in south-central Pennsylvania, USA. In 2024, we detected H. jordaniae in river samples collected at locations identified during patient interviews. All patients sought emergency department services for clinical assessment; however, the causative bacterial isolate was not initially identified. H. jordaniae was identified as the bacterial cause months after patient treatment and discharge. Although H. jordaniae infections are considered rare, the true occurrence is unknown. Additional information about the organism’s ecology and environmental seasonality could guide public health messaging and increase awareness among healthcare providers.

Reptile-associated outbreaks of human Salmonella infections are increasing in Canada, coinciding with a rise in the popularity of reptiles as pets. We conducted a retrospective analysis of surveillance data for human Salmonella case-patients in Ontario during 2015–2022. We compared serotypes and reptile types for those reporting domestic reptile or amphibian exposure with veterinary Salmonella isolates reported during the same period. Case-patients commonly reported contact with reptile types from which Salmonella was most frequently isolated. Some serotypes from human case-patients were closely associated with contact with specific reptile types, including Salmonella Paratyphi B biovar Java (Salmonella Paratyphi B variant L (+) tartrate +) with snakes, Salmonella Agbeni with turtles, and Salmonella Cotham, Salmonella Chester, and Salmonella Tennessee with bearded dragons. Salmonella was most likely to be reported from reptiles fed a carnivorous diet. Education of reptile owners could help promote proper veterinary care and reduce transmission of zoonotic infections.

Candida bloodstream infections, and their increasing antifungal resistance, are a global concern. In this cross-sectional study, we analyzed 2,443 culture-confirmed candidemia cases reported in South Africa during 2012–2017 to assess the effect of previous antifungal exposure on nonsusceptible Candida infection. We classified cases by species resistance profile and patient’s antifungal use within 14 days before infection. We found that 48% of cases were caused by nonsusceptible species, and 20% of patients had prior antifungal exposure, mainly to fluconazole. In patients >90 days of age, prior antifungal use was significantly associated with nonsusceptible Candida bloodstream infection (adjusted OR 2.02, 95% CI 1.43–2.87; p<0.001), with species-specific effects. No such association was found in neonates and young infants, for whom hospital transmission appeared more influential. Our findings underscore the need for targeted antifungal stewardship and enhanced infection prevention to mitigate antifungal resistance in South Africa.

The complexity of rickettsial serodiagnostics during acute illness has limited clinical characterization in Africa. We used archived samples from sepsis (n = 259) and acute febrile illness (n = 70) cohorts in Uganda to identify spotted fever and typhus group rickettsiae by using immunofluorescence assay and clinically validated rRNA reverse transcription PCR (RT-PCR). Among 329 participants, 10.0% had rickettsial infections (n = 33; n = 20 identified with immunofluorescence assay and n = 13 by RT-PCR). Serum rRNA RT-PCR was 75.0% (95% CI 42.8–94.5%) sensitive and 91.2% (95% CI 85.8–95.1%) specific. Thrombocytopenia was more common among patients with rickettsial infections than with other nonmalarial infections (adjusted odds ratio 3.7; p = 0.003). No participants were on a tetracycline antimicrobial drug at admission. rRNA RT-PCR is a promising diagnostic strategy for identifying acute rickettsial infections. Doxycycline should be included in empiric antimicrobial drug regimens for nonmalarial febrile illness in this region.

Prevalence of emerging fungal infections is increasing, particularly among immunocompromised persons, children, and older persons. We report 108 cases of Scheffersomyces spartinae infection in pediatric patients from Karachi and other cities in Pakistan, of which 107 were identified from blood cultures. Cultures were initially misidentified as Clavispora lusitaniae by a biochemical assay before speciation as S. spartinae by whole-genome sequencing. All isolates were from children <12 years of age, and >69% were from children <1 month of age. Isolates were genetically distinct across regions of Pakistan; however, genetic diversity was low in isolates from patients in Karachi and nearby Nawabshah and had median differences of just 9 pairwise nucleotide variants. This study demonstrates S. spartinae is a potentially emerging pathogen in neonates and young infants in Pakistan. The findings highlight the limitations of phenotypic identification for detecting emerging fungal infections and underscore the value of molecular identification approaches.

Mpox was first identified against the backdrop of the smallpox eradication campaign. Monkeypox virus (MPXV), the causative agent of mpox, has been maintained in animal reservoirs in the forested regions of West and Central Africa as 2 distinct clades; clade I has historically caused more severe infection in Central Africa than clade II, historically found in West Africa. However, rapid reemergence and spread of both MPXV clades through novel routes of transmission have challenged the known characteristics of mpox. We summarize mpox demographic distribution, clinical severity, and case-fatality rates attributed to genetically distinct MPXV subclades and focus on MPXV clade Ib, the more recently identified subclade. Broad worldwide assistance will be necessary to halt the spread of both MPXV clades within mpox endemic and nonendemic regions to prevent future outbreaks.

Talaromycosis is a life-threatening fungal disease that primarily affects immunocompromised persons in Southeast Asia. We conducted a multicenter, case–control study recruiting participants with advanced HIV disease in Vietnam; 205 case-patients with culture-confirmed talaromycosis were matched to 405 control-patients by age, sex, and CD4 count. Occupational exposure to tropical plants (odds ratio [OR] 1.73 [95% CI 1.10–2.73]; p = 0.017) and to farmed animals (OR 2.07 [95% CI 1.20–3.55]; p = 0.009) were independent risk factors for talaromycosis. Talaromycosis risk was higher in participants from highland regions than in persons from lowland regions (p<0.05). Participants from lowland regions who had lived or traveled to highland regions had a higher risk for talaromycosis (OR 3.15 [95% CI 1.49–6.64]; p = 0.003). This study confirms the epidemiologic correlation between talaromycosis and soil exposure and demonstrates an epidemiologic link between talaromycosis and residence in or travel to highland regions of Vietnam.

Spiroplasma ixodetis has been reported to cause the rare combination of cataract and uveitis in infants. Through a retrospective analysis of available literature and additional unpublished cases, we identified 28 eyes from 18 infants from 8 countries in Europe with cataracts and intraocular inflammation. The cataracts were bilateral in 55.6%, unilateral in 44.4%, and progressive in 46.4% of patients. Granulomatous anterior uveitis was found in all infants. Presence of S. ixodetis was supported by PCR (positive in 89.3% of eyes tested), transmission electron microscopy (positive in 90% of eyes tested), or culture of aspirated lens material (positive in 87.5% of eyes tested). Treatment with macrolide antimicrobial drugs, corticosteroids, and lensectomy appeared to be effective. Two patients had a recurrence of the uveitis after lens extraction and needed prolonged treatment. To increase awareness of S. ixodetis, we suggest its inclusion with the organisms of the TORCH acronym.

During 2007–2020, we conducted a cross-sectional prevalence study among patients with acute undifferentiated febrile illness to describe the burden and long-term epidemiology of rickettsioses in Cambodia. Serum samples were collected from 10,243 participants, along with epidemiologic data, information on clinical symptoms, demographic characteristics, and risk factors. A total of 802 (7.8%) participants met the definition for acute rickettsial infection after ruling out malaria, influenza, dengue, and chikungunya; 557 (5.4%) cases were typhus, 154 (1.5%) spotted fever, and 136 (1.3%) scrub typhus. Overall seroprevalence was 18.1% (1,857/10,243). Increased age, residence in urban settings, and recent travel to forests were significantly associated with rickettsial infection. Symptoms significantly associated with infection included rash, vomiting, and skin lesions. Our results confirm the underlying burden of rickettsioses and associated risk factors in Cambodia and highlight the need for accessible diagnostics and clinical guidance that consider rickettsioses when treating persons with acute undifferentiated febrile illness.

Invasive aspergillosis (IA) caused by Aspergillus flavus remains poorly described. We retrospectively analyzed 54 cases of IA caused by A. flavus reported in France during 2012–2018. Among cases, underlying IA risk factors were malignancy, solid organ transplantation, and diabetes. Most (87%, 47/54) infections were localized, of which 33 were pleuropulmonary and 13 were ear-nose-throat (ENT) infection sites. Malignancy (70% [23/33]) and solid organ transplantation (21% [7/33]) were the main risk factors in localized pulmonary infections, and diabetes mellitus was associated with localized ENT involvement (61.5%, [8/13]). Fungal co-infections were frequent in pulmonary (36%, 12/33) but not ENT IA (0 cases). Antifungal monotherapy was prescribed in 45/50 (90%) cases, mainly voriconazole (67%, 30/45). All-cause 30-day case-fatality rates were 39.2% and 90-day rates were 47.1%, and rates varied according to risk factor, IA site, and fungal co-infections. Clinicians should remain vigilant for A. flavus and consider it in the differential diagnosis for IA.

Risk factors for developing bloodstream infections (BSIs) caused by Aerococcus bacteria remain insufficiently examined. In this nationwide case–control study in Sweden, 19 of 23 clinical microbiological laboratories identified patients who had aerococcal BSIs during 2012–2016. We compared each of those index patients with 4 controls matched for age, sex, and county of residence. Overall, 588 episodes of aerococcal BSI occurred over 39.6 million person-years, corresponding to an average incidence of 1.48/100,000 person-years (95% CI 1.37–1.60/100,000 person-years). Most infections developed in men >65 years of age. Aerococcal BSI was associated with neurologic (adjusted odds ratio 2.89 [95% CI 2.26–3.70]) and urologic (adjusted odds ratio 2.15 [95% CI 1.72—2.68]) conditions and previous hospitalization or infection treatment. Our findings support the previously observed predilection for aerococcal BSIs developing in elderly men with urinary tract disorders. Awareness of Aerococcus spp. in patients, especially elderly men, will be needed to manage invasive infections.

Tularemia, a zoonosis caused by Francisella tularensis, is endemic in Baden-Wuerttemberg, Germany. To determine tularemia epidemiology in this region, we characterized the genetic diversity of F. tularensis in human and animal isolates during 2012–2022 by using whole-genome sequencing, combined with human and veterinary surveillance data analysis. Human case numbers varied; most cases occurred in 2021 (n = 34). Arthropod bites were reported most in cases with information on animal exposure (45%, n = 43). Poisson regression confirmed a significant increase in human cases during the study period (p<0.001). No seasonal pattern was identified, but case numbers were lowest in winter. Human surveillance data often lacked exposure details. Positivity rates in animals were 5%–34%, increasing since 2017. Human isolates often clustered with hare-derived strains, although transmission routes often remain unclear. These findings emphasize the importance of combining genome sequencing with detailed epidemiologic tracing to identify infection sources and improve surveillance data.

A previous study demonstrated noninferior efficacy of 4-month rifapentine/moxifloxacin regimen for tuberculosis (TB) treatment compared with the standard regimen. We explored results among study participants with diabetes. Among 2,516 randomized participants, 181 (7.2%) had diabetes. Of 166 participants with diabetes in the microbiologically eligible analysis group, 26.3% (15/57) had unfavorable outcomes in the control regimen, 13.8% (8/58) in the rifapentine/moxifloxacin regimen, and 29.4% (15/51) in the rifapentine regimen. The difference in proportion of unfavorable outcomes between the control and rifapentine/moxifloxacin arms in the microbiologically eligible analysis group was –12.5% (95% CI –27.0% to 1.9%); the difference between the control and rifapentine arms was 3.1% (95% CI –13.8% to 20.0%). Safety outcomes were similar in the rifapentine/moxifloxacin regimen and control arms. Among participants with TB and diabetes, the rifapentine/moxifloxacin arm had fewest unfavorable outcomes and was safe. Our findings indicate that the rifapentine/moxifloxacin regimen can be used in persons with TB and diabetes.

Human ehrlichiosis is a potentially fatal tickborne disease caused by 3 species: Ehrlichia chaffeensis, E. ewingii, and E. muris eauclairensis. In the United States, 234 confirmed cases of E. ewingii ehrlichiosis were reported to the Centers for Disease Control and Prevention through the National Notifiable Diseases Surveillance System during 2013–2021; average annual incidence was 0.08 cases/1 million population. E. ewingii ehrlichiosis was reported more commonly among older, White, non-Hispanic, and male patients. Incidence and case counts generally increased yearly, except for 2020 and 2021. The highest number of cases were reported from Missouri and Arkansas. We report the geographic expansion of E. ewingii ehrlichiosis and the continued public health challenge of clarifying clinical manifestations of this infection. Clinician education will be essential to implement molecular assays to properly diagnose E. ewingii infection in patients and gain a better understanding of the epidemiology of this emerging disease.

A global increase in the incidence of invasive group A Streptococcus (iGAS) infections was observed after lifting of COVID-19 related restrictions in 2022, and type M1_UK dominated in many countries. After seasonal declines in iGAS incidence during the summer of 2023, simultaneous, rapid expansion of a previously rare emm type 3.93 was seen beginning in November, increasing to 20% of all cases in England and 60% of all cases in the Netherlands within 4 months. emm3.93 was associated with iGAS in children 6–17 years of age and with increased risk for pneumonia or pleural empyema and meningitis in both countries. No excess risk of death was identified for emm3.93 compared with other types. Genomic analysis of historic and contemporary emm3.93 isolates revealed the emergence of 3 new clades with a potentially advantageous genomic configuration. Our findings demonstrate the value of molecular surveillance, including long-read sequencing, in identifying clinical and public health threats.