Early Release

Perspective

• Chagas Disease, an Endemic Disease in the United States
  N. L. Beatty et al.

Research

• Detection of Multiple Nosocomial Trichosporon asahii Transmission Events via Microsatellite Typing Assay, South America
  E. C. Francisco et al.
• Epidemiology of Sporothrix brasiliensis in Felids at Border of Brazil—Treatment Failure without Initial Elevated Itraconazole MICs
  C. do Prado et al.
• Drivers of Crimean-Congo Hemorrhagic Fever in Natural Host and Effects of Control Measures, Bulgaria
  G. Limon et al. View Abstract

  Crimean-Congo hemorrhagic fever (CCHF) is an emerging tickborne disease and a World Health Organization priority. Although humans are accidental hosts, infection can lead to hemorrhagic fever with a high fatality rate. Domestic animals play a critical role in disease transmission, but infected animals do not show clinical signs and viremia is short; thus, CCHF virus (CCHFV) infections can remain unobserved. During 2017–2019, we conducted 2 sequential observational studies followed by a multisite randomized controlled trial to determine spatial-temporal patterns and quantify drivers for CCHFV exposure in a natural host (sheep) in a CCHF-endemic area of Bulgaria. We found high-risk areas embedded in endemic regions. Animal characteristics were not correlated with seropositivity; however, a seasonality effect was observed, suggesting sampling time was a potential confounder. Force of infection varied across farms and over time. CCHFV transmission heterogeneity among farms is driven by preventive measures used to reduce exposure to ticks.

• Rickettsioses in Uganda: An Underrecognized Cause of Hospitalization Due to Febrile Illness
  P. W. Blair et al.
• Differences in Lyme Disease Diagnosis among Medicaid and Medicare Beneficiaries, United States, 2016–2021
  L. Gould et al.
• Surge in cumulative incidence of Candida auris skin colonization early in the COVID-19 Pandemic
  A. H. Dratch et al.
• Severe Group A Streptococcus Infection among Children, France, 2022–2024
  M. Colomina et al.
• New insights into infant strongyloidiasis in Papua New Guinea
  H. Zhao et al.
• Epidemiology of Chikungunya Hospitalizations, Brazil, 2014–2024
  V. Pedí et al. View Abstract

  We describe 7,421 chikungunya hospitalizations in Brazil covered by the country’s unified health system during 2014–2024. Most (43.2%) hospitalizations occurred in 2016 and 2017, reaching 0.72 (95% CI 0.69–0.76) hospitalizations/100,000 population in 2016. Hospitalizations were more frequent among persons who were female (55.8%), identifying as brown or black (63.5%), and 1–19 years of age (31.4%). Intensive care unit admissions occurred in 1.4% of cases, predominantly among children <5 and adults >85 years of age. The overall in-hospital case-fatality rate was 1.1%, which increased substantially with age, reaching 11.5% among patients >90 years of age and 14.1% among men 85–89 years of age. Patients admitted to the intensive care unit had a case-fatality rate of 21.1%. The total cost of chikungunya hospitalizations was US $560,746 (US $76.26 per patient). Our findings provide insights for surveillance of the most severe chikungunya cases.

• Theileria luwenshuni and Novel Babesia spp. Infections in Humans, Yunnan Province, China
  R. Xiang et al.
• Attachment Patterns of Avian Influenza H5 Clade 2.3.4.4b Virus in Respiratory Tracts of Marine Mammals, North Atlantic Ocean
  S. N. Ayudhya et al. View Abstract

  Highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infections have caused substantial mortality events in marine mammals in recent years. We hypothesized that the high number of infections and disease severity could be related to cell tropism in respiratory tracts. Therefore, we examined the attachment pattern of an H5N1 clade 2.3.4.4b virus (H5²⁰²²) as a measure for cell tropism in the respiratory tracts of harbor seals, gray seals, harbor porpoises, and bottlenose dolphins and compared it with an H5N1 clade 2.1.3.2 virus (H5²⁰⁰⁵) and a human seasonal H3N2 virus using virus histochemistry. Both H5 viruses attached abundantly to olfactory and respiratory mucosa in the upper respiratory tract of both seal species. H5²⁰²² attached more abundantly than H5²⁰⁰⁵ to epithelial cells in the lower respiratory tract of all species. The observed attachment possibly explains the susceptibility of marine mammal species for recent H5N1 viruses and the observed development of severe disease.

Dispatches

• CYP2D6 Genotype and Primaquine Treatment in Patients with Malaria, Venezuela
  C. Pacheco et al. View Abstract

  We determined CYP2D6*4 and CYP2D6* genotypes and metabolizer phenotypes in 96 patients with suspected malaria in Venezuela and found intermediate or poor metabolizer phenotypes in ≈25% of cases. Nine of 44 malaria patients had Plasmodium vivax recurrence. Public health authorities should evaluate the benefits of increasing total doses of primaquine for treatment.

• Modeling Case Burden and Duration of Sudan Ebola Virus Disease Outbreak in Uganda, 2022
  D. Bisanzio et al.
• Emergence of Autochthonous Leishmania (Mundinia) martiniquensis Infections in Horses, Czech Republic and Austria, 2019–2023
  D. Modrý et al.
• Rapidly Progressing Melioidosis Outbreak in City Center Zoo, Hong Kong, 2024
  C. J. Brackman et al.
• Melioidosis cases with highly related Burkholderia pseudomallei whole genome sequences among 4 people with unknown exposure source, Georgia, USA, 1983–2024
  S. Brennan et al.
• Gastric Submucosal Tumor in Patient Infected with Dioctophyme renale Roundworm, South Korea, 2024
  D. Kim et al. View Abstract

  We describe a case of a gastric submucosal tumor in a patient in South Korea infected with Dioctophyme renale roundworm. The patient had a history of consuming raw freshwater fish. Molecular and morphologic analyses confirmed D. renale Infection. Genetic testing should be used to diagnose rare parasitic infections with unusual clinical manifestations.

• Genetic Characterization of Orientia tsutsugamushi, Bhutan, 2015
  T. Tshokey et al.
• Imported Malaria and Congenital Acquisition in Infant, Portugal
  I. Lopes et al.
• Novel Henipavirus, Salt Gully Virus, Isolated from Pteropid Bats, Australia
  J. Barr et al.

Research Letters

• Linezolid and Meropenem for Nocardia otitidiscaviarum Actinomycetoma
  K. Sardana et al.
• New World Screwworm Infestation in Wild Mountain Tapirs, Central Andes Mountains, Colombia
  J. Cepeda-Duque et al. View Abstract

  We describe New World screwworm (Cochliomyia hominivorax) infestation in 2 injured mountain tapirs (Tapirus pinchaque) from a protected area in the Central Andes, Colombia. Screwworms were not a known threat to mountain tapirs. Community outreach is needed to raise awareness on effects of this parasite on humans, domestic animals, and wildlife.

• Clinical and Molecular Characterization of Emerging Human Dirofilaria repens Infections, Estonia, 2023
  K. Nõupuu et al.
• Monkeypox Virus Clade IIa Infections, Liberia, 2023–2024
  D. Nyan et al. View Abstract

  We performed monkeypox virus genome sequencing on clinical samples from Liberia, yielding 5 clade IIa genomes. Our analysis found no evidence of sustained human-to-human transmission, suggesting independent zoonotic spillovers from a diverse viral lineage. Public health officials should continue monitoring and sequencing efforts to identify emerging monkeypox virus lineages.

• Detection of Rat Lungworms in Invasive Mollusks, Georgia, USA, 2024
  T. J. Achatz et al.
• Subarachnoid Neurocysticercosis Caused by Larval-Stage Taenia crassiceps Tapeworm, Slovenia
  B. Šoba et al.
• Pediatric Case Report and Overview of Autochthonous Tick-Borne Encephalitis, Belgium
  J. De Langhe et al.
• Human Babesiosis Caused by Babesia venatorum, Russia, 2024
  O. P. Zelya et al.

Etymologia

• Apicoplast [ə-pikʹ-ō-plast]
  H. Shankar et al.

Research

• Spotted Fever Group Rickettsioses among Hospitalized Patients and Circulation of Rickettsia in Ticks, Kazakhstan, 2019s
  Y. V. Bumburidi et al.
• Reptile Exposure among Human Salmonellosis Cases and Salmonella Serotypes Isolated from Reptiles, Ontario, Canada, 2015–2022
  K. Paphitis et al.
• Recent Systemic Antifungal Exposure and Nonsusceptible Candida in Hospitalized Patients, South Africa, 2012–2017
  C. Rabault et al.