Articles from Emerging Infectious Diseases

We used whole-genome sequencing data to investigate historical Listeria monocytogenes clinical (n = 1,046) and nonclinical (n = 1,325) isolates from New York, USA. Applying a threshold of <20 single-nucleotide polymorphism differences for single-linkage clustering, 321 clinical isolates clustered into 85 clusters ranging from 2–33 isolates per cluster. Fourteen clusters included isolates with outbreak codes (4 clusters with New York codes and 10 with multistate codes). Three New York outbreak codes were assigned to isolates that were genetically highly related and from cases <2 months apart. Fifteen clusters included isolates that were obtained >10 years apart; 33 clusters included isolates from the same or contiguous counties. Seventeen clusters included food and environmental isolates highly related to clinical isolates. These findings suggest that some listeriosis clusters can be local and span a long period, demonstrating the importance of investigating small, localized listeriosis cases with closely related isolates, even over long timeframes.

Murine typhus, a fleaborne disease caused by the bacterium Rickettsia typhi, is found throughout temperate and tropical regions of the world. Transmission of R. typhi to humans involves several species of fleas, and most infections result from direct inoculation of R. typhi–infected flea feces into abrasions in the skin. We describe the transmission of R. typhi from an organ donor in Texas, USA, to 2 kidney transplant recipients. The donor and 1 recipient died from the infection. The occurrence of R. typhi transmission via transplantation is a harbinger for the reemergence of murine typhus in some of the most densely populated metropolitan areas of the United States. Our findings reinforce the need to improve healthcare provider and public awareness of this life-threatening but treatable infection.

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.

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.

Enteric fever remains a public health challenge. We analyzed data from a cluster-randomized Vi-tetanus toxoid conjugate vaccine trial to compare the epidemiology between Salmonella enterica serovars Paratyphi A, which causes paratyphoid fever, and Typhi, which causes typhoid fever. The overall incidence rate of paratyphoid fever was 27 (95% CI 23–32)/100,000 person-years (PY) and of typhoid fever was 216 (95% CI 198–236)/100,000 PY. We observed the highest incidence for both diseases in children 2–4 years of age: 72 (95% CI 41–117)/100,000 PY for paratyphoid and 887 (95% CI 715–1,088)/100,000 PY for typhoid. Lack of private toilets and safe drinking water were associated with both diseases. Prevalence of multidrug resistance was significantly higher in Salmonella Typhi (20.2%) than in Salmonella Paratyphi A (0.8%) (p<0.001). Our data suggest that integrated control measures targeting water, sanitation, and hygiene measures and bivalent vaccine targeting both pathogens are promising strategies to control both diseases.

Monkeypox virus (MPXV) infection typically lasts 14–28 days. Prolonged MPXV infection, in which symptoms or test positivity last >28 days, has been documented but not fully characterized. We used the California Department of Public Health (California, USA) mpox registry to compare prolonged (>28 days) and nonprolonged (<28 days) mpox cases by demographics, HIV status, and JYNNEOS vaccination status. Of 6,469 cases, 82 (1.3%) were prolonged. Persons with prolonged MPXV infections were more likely to be Black or African American (prolonged, 20.7%, vs. nonprolonged, 11.6%) and to have HIV (prolonged, 61.0%, vs. nonprolonged, 39.9%). Among persons with HIV, prolonged infections were more likely among those with lower (<200) CD4 counts (prolonged, 10.0%, vs. nonprolonged, 3.9%) or not engaged in HIV care (prolonged, 46.0%, vs. nonprolonged, 18.1%). No prolonged infections occurred in persons who received 2 JYNNEOS vaccine doses. Groups disproportionately affected by prolonged mpox should be prioritized for mpox vaccine education and outreach.

Asian American, Native Hawaiian, and Pacific Islander populations have been underrepresented in research on COVID-19 outcomes. We conducted a cross-sectional study of 5,494 electronic medical records of patients in a large tertiary care health system in the ethnically diverse state of Hawaii, USA. We compared fatality rates for hospitalized patients on the basis of race or ethnicity, age, vaccination status, and sequential organ failure assessment (SOFA) score at admission. Fatality rates varied between racial and ethnic groups but were associated with increasing age across all groups. Fatality rates were closely associated with increasing SOFA score and were inversely associated with the number of COVID-19 vaccinations received. We found that Asian and Pacific Islander groups experienced higher rates of in-hospital death and that death was strongly associated with increased age and SOFA score and with <1 COVID-19 vaccination. Clinicians should be aware of these outcomes when treating COVID-19 patients from these ethnic groups.

Highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b viruses have infected >1,000 herds of dairy cattle and hundreds of poultry flocks in the United States since the beginning of 2024. Seventy human cases have been reported during that period, mainly through occupational exposure. Although prior influenza A(H1N1)pdm09 virus infection has been shown to confer protection against influenza A(H5N1) clade 2.3.4.4b virus infection in the ferret model, it remains unclear if influenza vaccines, known to elicit a less potent and narrower cross-reactive immune response, can achieve a similar effect. In this article, we demonstrate that immunization with commercially available human seasonal influenza vaccines also confers partial protection against disease caused by H5N1 clade 2.3.4.4b virus in ferrets, which is partially associated with the presence of cross-reactive antibodies targeting H5N1 virus antigens.

Testing for spotted fever group rickettsioses (SFGR) and the criteria for identifying suspected patients are not routinely used in Kazakhstan. In 2019, we performed a cross-sectional study in 6 sentinel hospitals in the Pavlodar region. We tested 105 hospitalized patients with SFGR-like symptoms by using PCR or indirect immunofluorescence antibody assay and identified 62 cases of SFGR. Most (78%) cases of disease were caused by Rickettsia sibirica and R. raoultii. Cutaneous signs (eschar or rash) were found in 87% of SFGR patients; 79% had a rash, 48% had an eschar, and 13% had neither. Testing of suspected rickettsia cases resulted in a 27% increase in laboratory-detected SFGR over the mean of the previous 3 years (62 vs. 49). Broadening the case definition by including fever, headache, or myalgia and expanding routine testing for suspected cases of SFGR could contribute to improved case detection and earlier treatment.

Salmonella enterica serovar Muenchen emerged in Israel in 2018 and became a major public health threat. We aimed to determine the role of poultry in rising human cases, transmission routes within the broiler industry, and genetic similarity to Salmonella Muenchen found globally. We used whole-genome sequencing to compare Salmonella Muenchen isolates from poultry, food, and humans collected in Israel (2020–2023; n = 109) and globally (n = 125). Salmonella Muenchen sequence type 82 isolates from Israel harbored pESI plasmid, exhibited high genetic similarity between human and poultry sources, and closely resembled international pESI-positive strains; we found quinolone-resistance determinants in 58.6% of isolates. Salmonella Muenchen prevalence in commercial broiler flocks was 61.5% (95% CI 51.5%–71.5%); strains could not be traced to breeder flocks, but on-farm persistence existed. The clonal spread of Salmonella Muenchen in poultry contributes to increased incidence in humans. Horizontal transmission in broilers requires control measures to protect public health.

We report the detection of hemotropic mycoplasmas in 4 immunosuppressed pediatric patients in Spain: 2 solid organ transplant recipients, 1 hematopoietic stem cell transplant recipient, and 1 cancer patient. Sequences were 100% identical to a strain previously identified in Miniopterus schreibersii bats, which raises concerns about unnoticed zoonotic transmission.

We used a sensitive and specific PCR to detect monkeypox virus clade Ib DNA from >3,000 wastewater samples collected prospectively across the United States. Monkeypox virus clade Ib DNA was detected in 1 sample from a location with a confirmed case; it was not detected in locations with no confirmed cases.

We report a case of severe acute kidney injury in a patient in Germany infected with Seoul virus. Clinical and laboratory analysis linked the infection to a pet rat breeding facility in central Germany. Increased surveillance and a One Health approach are needed, given the rising popularity of pet rats.

Sexually transmitted infections clinics in Bangkok, Thailand, reported increasing numbers of men with Neisseria meningitidis–associated urethritis during 2017–2023. Genomic analysis indicated global expansion of the nongroupable clonal complex 11 N. meningitidis urethritis clade. Continued global surveillance is needed to monitor the spread of antimicrobial-resistant N. meningitidis with urethral adaptability.

Among 3,367 New Delhi metallo-β-lactamase–producing Enterobacterales isolates collected in France during 2021–2023, we found the bla_NDM-7 gene systematically localized on 2 closely related InX3 plasmids known to harbor antimicrobial resistance and virulence factors. Enhanced surveillance to monitor spread of antimicrobial resistance is needed among New Delhi metallo-β-lactamase–producing Enterobacterales.

This article summarizes a genomic investigation of a 4-fold increase in disseminated gonococcal infections in Minnesota, USA, in 2024. We detected the emergence of a Neisseria gonorrhoeae strain of a rarely observed sequence type, which carries a porB1a allele previously associated with disseminated disease and lacks a gonococcal genetic island.

We report a fatal case of pneumocephalus in Germany caused by hypervirulent Klebsiella pneumoniae sequence type 23, confirmed by using clinical, histopathologic, and genomic analyses. The patient reported no travel history, suggesting local emergence. This unusual case reveals an unclear pathogen prevalence and demonstrates the need for increased awareness of global spread.

Baylisascaris procyonis, an emerging zoonotic parasite, causes clinically significant visceral, ophthalmologic, and neurologic disease in humans. We screened raccoons (n = 46) collected from central and southern Mississippi for B. procyonis by necropsy (13.0% prevalence) and droplet digital PCR of feces (26.7% prevalence). Further surveillance to determine raccoon infection rates throughout Mississippi is indicated.

We describe a cluster of genetically related extended-spectrum β-lactamase–producing Klebsiella pneumoniae sequence type 14 recovered from human clinical samples and an alfalfa-cress sample collected by systematic food sampling in Basel, Switzerland. Our findings suggest food could represent a reservoir contributing to spread of extended-spectrum β-lactamase–producing Enterobacterales.

We investigated Bordetella holmesii and Bordetella pertussis in 935 suspected pertussis cases in northern India (2019–2023) using PCR and serology. B. holmesii showed increased prevalence in pertussis cases, particularly in older children, highlighting its emerging role and the need for ongoing surveillance and adjusted prevention strategies.

Escherichia coli sequence type 131:H:22 is a consequential lineage of extraintestinal pathogenic E. coli, associated with human pyelonephritis and sepsis. We report the transmission of avian pathogenic E. coli in a parrot rehabilitation center in Brazil and the presence of a high-risk zoonotic lineage of extraintestinal pathogenic E. coli sequence type 131-H22.

We report human infections with Necator gorillae and Strongyloides fuelleborni, zoonotic helminths from nonhuman primates, in Gabon. We also detected a cryptic Ancylostoma species helminth. Infections occurred in settings of localized deforestation and environmental degradation, which increase human–animal contact. Surveillance to clarify the extent of human infections is needed.

We report possible intraoperative transmission of Brucella melitensis in Slovenia, likely caused by aerosolized particles during wound irrigation. Whole-genome multilocus sequence typing revealed that isolates from the patient and the surgeon belonged to the same transmission cluster, differing by 1 allele. Our findings raise awareness of occupational risks faced by orthopedic surgeons.

An immunocompromised patient in Arizona, USA, experienced cutaneous coccidioidomycosis mimicking rosacea-like dermatitis; she was receiving vandetanib therapy. Histopathology confirmed the diagnosis despite inconclusive serologic results. Lesions resolved with fluconazole treatment, but blue-gray hyperpigmentation persisted, likely linked to vandetanib. This case highlights diagnostic challenges in endemic fungal infections and rare drug-associated hyperpigmentation.

Jorge Lobo’s disease (JLD), caused by Paracoccidioides lobogeorgii, primarily affects inhabitants of the Amazon Forest. We report a 9-year-old boy in Brazil who had JLD diagnosed after a tick bite. The rarity of pediatric cases likely reflects surveillance gaps. Increased clinical awareness is crucial for early JLD detection and intervention, especially in endemic regions.

Prophylaxis for ophthalmia neonatorum remains in use despite decreased incidence of the condition. We report a breakthrough case of neonatal conjunctivitis in Japan caused by a levofloxacin-resistant Neisseria gonorrhoeae bacteria strain, co-infected with Chlamydia trachomatis bacteria. This case highlights failures in screening, prophylaxis, and treatment, underscoring the need to reassess prevention strategies.

Blastomycosis is endemic in central and southern North America but rare in China. It can mimic community-acquired pneumonia, tuberculosis, or cancer. We describe a patient who initially had tuberculosis diagnosed and later had blastomycosis diagnosed through metagenomic detection, which aided diagnosis and treatment. Clinicians should consider blastomycosis in differential diagnoses for respiratory diseases.

Crimean-Congo hemorrhagic fever virus is considered a public health risk in southwestern Europe. We surveyed serum samples from 667 European rabbits across Portugal, a rabbit species known to host immature Hyalomma lusitanicum ticks. We found low levels of virus antibodies (>1%), with a localized cluster reaching 5.77% in southern populations.

Purpureocillium lilacinum, a common environmental mold and bionematicide, can cause human infections. At a major US commercial laboratory during March 2019–February 2025, P. lilacinum culture rates increased; rates were highest in the South Atlantic and Pacific states. Nonculture-based diagnostic tools such as microscopy may help identify and confirm clinical infection earlier.

We assessed the prevalence of the rat lungworm, Angiostrongylus cantonensis, in rats and snails in Toamasina, Madagascar, using molecular techniques. Although no human cases of neuroangiostrongyliasis have been reported in Madagascar, the pathogen’s presence in definitive hosts (2.5%, 2/78) and intermediate hosts (26.9%, 35/130) reveals active circulation and potential zoonotic risk.

Melioidosis, caused by the highly lethal pathogen Burkholderia pseudomallei, is emerging in North and South America. We studied soil samples in Suriname to determine endemicity of Burkholderia species. B. thailandensis was isolated, but B. pseudomallei was not. A multidisciplinary approach could establish clinical and ecologic distribution of both Burholderia species in Suriname.

In 2022, we established a residual sample serosurveillance program in Ho Chi Minh City, Vietnam. During September 2022–April 2024, we found low measles antibody seroprevalence in children in the city’s western region, where a measles outbreak began in May 2024. Serosurveillance could be a useful tool for outbreak prediction and prevention.

Trichophyton mentagrophytes genotype VII (TMVII) is an emerging dermatophyte strain associated with sexual transmission among men who have sex with men. A hypothesis-generating query of US infectious diseases specialists found that 56% had heard of TMVII and 23% knew how to treat TMVII infections, underscoring a need for increased clinician education.

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.

Rickettsia sibirica mongolitimonae is an emerging cause of tickborne rickettsiosis. Since the bacterium was first documented as a human pathogen in 1996, a total of 69 patients with this infection have been reported in the literature. Because of the rising rate of R. sibirica mongolitimonae infection cases, we evaluated the epidemiologic and clinical features of 29 patients who had R. sibirica mongolitimonae infections confirmed during 2007–2024 at the Center for Rickettsiosis and Arthropod-Borne Diseases, the reference laboratory of San Pedro University Hospital–Center for Biomedical Research of La Rioja, Logroño, Spain. We also reviewed all cases published in the literature during 1996–2024, evaluating features of 94 cases of R. sibirica mongolitimonae infection (89 in Europe, 4 in Africa, and 1 in Asia). Clinicians should consider R. sibirica mongolitimonae as a potential causative agent of rickettsiosis, and doxycycline should be administered promptly to avoid clinical complications.

Streptococcus pneumoniae infection is considered an uncommon cause of arthritis in adults. To determine the clinical and microbiological characteristics of pneumococcal septic arthritis, we retrospectively studied a large series of cases among adult patients during the 2010–2018 conjugate vaccine era in France. We identified 110 patients (56 women, 54 men; mean age 65 years), and cases included 82 native joint infections and 28 prosthetic joint infections. Most commonly affected were the knee (50/110) and hip (25/110). Concomitant pneumococcal infections were found in 37.2% (38/102) and bacteremia in 57.3% (55/96) of patients, and underlying conditions were noted for 81.4% (83/102). Mortality rate was 9.4% (8/85). The proportion of strains not susceptible to penicillin was 29.1% (32/110). Of the 55 serotyped strains, 31 (56.4%) were covered by standard pneumococcal vaccines; however, several nonvaccine serotypes (mainly 23B, 24F, and 15A) had emerged, for which susceptibility to β-lactams was low.

The Ebola virus disease (EVD) outbreak of 2013–2016 was large, leaving in its wake an estimated 17,000 survivors in West Africa. Uveitis is one of the most common ophthalmic manifestations of EVD, but long-term follow-up in the at-risk population is lacking. We conducted a retrospective cross-sectional study of 521 EVD survivors from Sierra Leone who underwent comprehensive ophthalmic examination a median of 1,289 days, or ≈3.5 years, after discharge from Ebola treatment units. The most common ophthalmic findings were cataracts (117 eyes, 11.2%), uveitis (86 eyes, 8.3%), dry eyes (81 eyes, 7.8%), and chorioretinal scar (68 eyes, 6.5%). EVD survivors with cataracts, uveitis, optic neuropathy, and corneal scar were more likely to have vision impairment, defined as Snellen visual acuity worse than 20/50. Results of our study highlight the need for ongoing vision care in EVD survivors.

Congregate homeless shelters are disproportionately affected by infectious disease outbreaks. We describe enterovirus epidemiology across 23 adult and family shelters in King County, Washington, USA, during October 2019–May 2021, by using repeated cross-sectional respiratory illness and environmental surveillance and viral genome sequencing. Among 3,281 participants >3 months of age, we identified coxsackievirus A21 (CVA21) in 39 adult residents (3.0% [95% CI 1.9%–4.8%] detection) across 7 shelters during October 2019–February 2020. We identified enterovirus D68 (EV-D68) in 5 adult residents in 2 shelters during October–November 2019. Of 812 environmental samples, 1 was EV-D68–positive and 5 were CVA21–positive. Other enteroviruses detected among residents, but not in environmental samples, included coxsackievirus A6/A4 in 3 children. No enteroviruses were detected during April 2020–May 2021. Phylogenetically clustered CVA21 and EV-D68 cases occurred in some shelters. Some shelters also hosted multiple CVA21 lineages.

Mycobacterium abscessus infection is challenging to treat. Extrapulmonary M. abscessus infections (EP-MAB) are less common than pulmonary M. abscessus infections. To evaluate treatment regimens, we retrospectively analyzed consecutive microbiologically confirmed EP-MAB cases diagnosed in France during 2012–2020. We studied 45 patients with EP-MAB, including 14 bone and joint infections, 10 skin and soft tissue infections, and 8 lymph node infections. Most (62%) patients had no reported immunodeficiency. In 27 patients, EP-MAB followed healthcare-associated (44%) or environmental (16%) injuries. Of the 45 isolates, 25 were subspecies abscessus, 10 bolletii, and 9 massiliense; 1 was unidentified. Cure was achieved for 36 (80%) patients who received a median antimicrobial regimen of 6 months; 22 (55%) also underwent surgery. Four patients died, and 5 were unavailable for follow-up. EP-MAB predominantly affects immunocompetent patients after an injury; outcomes are favorable. We propose a >6-month regimen of antimicrobial therapy with consideration for surgery and regular patient reassessment.