Early Release

Perspective

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

  Chagas disease, caused by Trypanosoma cruzi parasites, is considered endemic to 21 countries in the Americas, excluding the United States. However, increasing evidence of T. cruzi parasites in the United States in triatomine insects, domestic animals, wildlife, and humans challenges that nonendemic label. Several triatomine species are common in the southern United States, where they transmit T. cruzi and invade human dwellings. Wildlife, captive animals, and companion animals, especially dogs, are commonly infected with T. cruzi parasites in this region and serve as reservoirs. Autochthonous human cases have been reported in 8 states, most notably in Texas. Labeling the United States as non–Chagas disease–endemic perpetuates low awareness and underreporting. Classification of Chagas disease as endemic, in particular as hypoendemic, to the United States could improve surveillance, research, and public health responses. Acknowledging the endemicity of Chagas disease in the United States is crucial for achieving global health goals.

Research

• Detection of Multiple Nosocomial Trichosporon asahii Transmission Events via Microsatellite Typing Assay, South America
  E. C. Francisco et al. View Abstract

  The fungus Trichosporon asahii has emerged as a cause of nosocomial infections, particularly in immunocompromised patients. Given its rising prevalence, information on its genetic diversity and transmission dynamics is urgently needed. We developed a microsatellite typing tool to investigate the genetic relatedness of T. asahii isolates. We selected 6 microsatellite markers from nanopore long-read sequencing of the T. asahii type-strain CBS 2479. We applied those markers to 111 clinical and environmental isolates; microsatellite typing showed high variability among isolates (11–37 alleles per marker) and identified 71 genotypes with strong discriminatory power (Simpson index of 0.9793). We applied the microsatellite typing method to T. asahii isolates from South America and identified multiple nosocomial transmission events from hospitals in Brazil, including clusters spanning more than a decade. The panel we developed offers high reproducibility and specificity, making it an effective tool for tracking outbreaks and determining the public health effects of T. asahii infections.

• Sporothrix brasiliensis Treatment Failure without Initial Elevated Itraconazole MICs in Felids at Border of Brazil
  C. do Prado et al. View Abstract

  Cat-transmitted sporotrichosis caused by Sporothrix brasiliensis is an emerging zoonosis in Latin America. Because treatment of feline sporotrichosis is often not effective, we sought to determine whether treatment failure results from S. brasiliensis strains that have existing elevated MICs for itraconazole, the primary treatment for this disease. During 2021–2023 at the triple border region of Brazil, Paraguay, and Argentina, 108 S. brasiliensis strains were isolated from felines before antifungal treatment. The main clinical manifestation was cutaneous disseminated sporotrichosis (61%), which was the only form resulting in sporotrichosis-induced deaths (61%). We conducted antifungal susceptibility testing for 9 antifungal compounds, evaluating for both mycelial and yeast phases. MIC levels were low for most antifungal agents but were higher in the mycelial phase than in the yeast phase, especially for voriconazole and isavuconazole. We conclude that the varying clinical manifestations of sporotrichosis and large differences in mortality rates were not caused by elevated itraconazole MICs.

• 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. View Abstract

  Lyme disease is the most common vectorborne disease in the United States. Evidence suggests that persons from racial and ethnic minority groups experience more severe disease. We used a claims-based algorithm on data from 16 jurisdictions with high Lyme disease incidence to identify cases among 4 populations: Medicaid beneficiaries <18 and >19 years of age, and Medicare fee-for-service beneficiaries <65 and >65 years of age. We calculated the prevalence of disseminated disease, hospitalization, and other clinical and epidemiologic parameters by race and ethnicity. We found that non-White persons were more likely than White persons to be female, hospitalized at diagnosis, diagnosed outside of primary care, diagnosed outside of the peak months for Lyme disease transmission, and have disseminated disease. Those data illustrate differences in Lyme disease by race and ethnicity and suggest possible differences across other sociodemographic characteristics. Additional prevention methods are needed to reduce differences in Lyme disease recognition and severity.

• Increased Incidence of Candida auris Colonization in Early COVID-19 Pandemic, Orange County, California, USA
  A. H. Dratch et al. View Abstract

  Candida auris transmission surged in long-term acute-care hospitals (LTACHs) in Orange County, California, USA, during the COVID-19 pandemic. This study describes the effect of COVID-19 on C. auris transmission by estimating the probability of patient colonization in LTACHs across 5 epidemiologic time periods. Patients had the highest probability of developing new skin colonization during the first COVID-19 wave, with a cumulative incidence of 22.5% (95% CI 18.5­–26.6) after a 30-day stay. Once the initial COVID-19 waves abated, a reduction in cumulative incidence of C. auris colonization was observed concurrently with persistent high prevalence, indicating that within-facility transmission can be reduced with proper infection prevention and control practices. Admission screenings and point prevalence surveys provided a wealth of data that guided public health recommendations and supported the objectives of both public health professionals and LTACHs for monitoring facility transmission dynamics and guiding decision making.

• Severe Group A Streptococcus Infection among Children, France, 2022–2024
  M. Colomina et al.
• Insights into Infant Strongyloidiasis, Papua New Guinea
  H. Zhao et al. View Abstract

  The human-infecting parasite Strongyloides fuelleborni subspecies kellyi has been reported from the island of New Guinea. We analyzed fecal DNA extracts (n = 164) from 19 infants in Papua New Guinea by using Strongyloides real-time PCR and undertook metabarcoding of cox1 and 18S rRNA hypervariable regions I and IV loci. Eight infants were infected with Strongyloides spp.; 7 were infected with S. fuelleborni subsp. fuelleborni and 1 with a Strongyloides sp. previously misattributed to S. fuelleborni subsp. kellyi. Phylogenetic and haplotyping analyses indicated S. fuelleborni in Papua New Guinea belongs to the Indochina subclade of S. fuelleborni subsp. fuelleborni and is not a unique subspecies. We report molecular evidence of S. fuelleborni subsp. fuelleborni infection in humans in the Pacific. Our findings also demonstrate the potential co-existence of an undescribed human-infecting Strongyloides sp. on the island of New Guinea, indicating a need for renewed clinical and epidemiologic investigations into infant strongyloidiasis.

• 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. View Abstract

  Piroplasmid parasites such as Theileria luwenshuni protozoa pose a global threat to both animal and human health. However, human theileriosis remains underexplored compared to infections caused by Plasmodium and Babesia species parasites. We investigated potential hemoparasite infections among 1,721 persons with fever, anemia, or both in Yunnan Province, China. Molecular detection identified 13 cases positive for T. luwenshuni protozoa, of which 5 patients were further confirmed by Western blot antibody analysis. We also identified 6 babesiosis cases, 3 infections with B. microti and 3 with novel Babesia spp. Subsequent vector and host investigations in the vicinity of the index cases revealed T. luwenshuni protozoa in 1 tick and 53 livestock animals. Of note, 3.3% combined vector-host samples tested positive for genetically diverse Babesia species. Our findings highlight the endemic circulation of T. luwenshuni and Babesia spp. parasites in southwest China, underscoring their importance as emerging public health concerns.

• 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. View Abstract

  In 2022, a Sudan Ebola virus outbreak was confirmed in Uganda. Within 1 month of the outbreak’s onset, we developed an individual-based modeling platform to estimate the unfolding outbreak’s burden of cases and deaths, as well as its duration, using different scenarios. Modeled projections were within the range of observed cases.

• Emergence of Autochthonous Leishmania (Mundinia) martiniquensis Infections in Horses, Czech Republic and Austria, 2019–2023
  D. Modrý et al. View Abstract

  We report 4 cases of equine cutaneous leishmaniasis caused by Leishmania martiniquensis in Czech Republic and Austria, outside the known endemic range of leishmaniases. The parasite should be considered as a potential cause of cutaneous lesions in horses; the risk for zoonotic transmission to immunocompromised humans is anticipated throughout central Europe.

• Rapidly Progressing Melioidosis Outbreak in City Center Zoo, Hong Kong, 2024
  C. J. Brackman et al. View Abstract

  In October 2024, twelve primates from 4 species died of sepsis at the Hong Kong Zoological and Botanical Gardens. Postmortem examinations and microbiological analyses confirmed Burkholderia pseudomallei infection. Phylogenetic analysis revealed a clonal sequence type 46 strain with minimal variation, signifying a single source. This outbreak highlights melioidosis risk in zoo settings.

• Related Melioidosis Cases with Unknown Exposure Source, Georgia, USA, 1983–2024
  S. Brennan et al. View Abstract

  We identified 4 cases of presumptive autochthonous melioidosis during 1983–2024 in Georgia, USA. Epidemiologic investigation identified no recent international travel before illness; all cases were geographically linked, and 3 patients became ill after a severe weather event. Bioinformatic analyses revealed Burkholderia pseudomallei genome sequences were highly related, suggesting a shared exposure.

• 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. View Abstract

  We performed molecular characterization of Orientia tsutsugamushi on DNA sequences from 5 patients from Bhutan with scrub typhus. In the 56 kDa gene, all isolates aligned with those from other Asia countries, including Nepal, India, Thailand, and Taiwan. High serum IgM titers correlated with PCR positivity in acutely ill patients.

• Imported Malaria and Congenital Acquisition in Infant, Portugal, 2024
  I. Lopes et al. View Abstract

  Plasmodium falciparum infection was diagnosed in a 3-month-old baby in Portugal by optical microscopy. The mother had had malaria in Angola 13 months earlier, before she emigrated to Portugal. She remained asymptomatic throughout and after pregnancy. We confirmed the diagnosis of an imported malaria case and congenital transmission using molecular techniques.

• Novel Henipavirus, Salt Gully Virus, Isolated from Pteropid Bats, Australia
  J. Barr et al. View Abstract

  We describe isolation and characterization of a novel henipavirus, designated Salt Gully virus, from the urine of pteropid bats in Australia. We noted the virus to be most closely related to Angavokely virus, not reliant on ephrin receptors for cell entry, and of unknown risk for human disease.

• Detection of Rat Lungworm (Angiostrongylus cantonensis) in Rats and Gastropods, Italy
  D. Pandian et al. View Abstract

  The emerging zoonotic nematode Angiostrongylus cantonensis causes severe neural angiostrongyliasis in both humans and animals. The parasite has been reported in Spain. We detected A. cantonensis in rats and gastropods from the Campania region, southern Italy, demonstrating its broad distribution on the southern coast of Europe.

Research Letters

• Linezolid and Meropenem for Nocardia otitidiscaviarum Actinomycetoma, India
  K. Sardana et al. View Abstract

  Treatment of actinomycotic mycetoma with joint involvement is challenging. We present a patient in India with mycetoma who reached complete cure and remission after linezolid and meropenem treatment with a 2-year follow-up. Clinicians should use advances in drug regimens according to subspecies variations of Nocardia and regional drug susceptibility patterns to guide therapy.

• 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.

• Characterization of Emerging Human Dirofilaria repens Infections, Estonia, 2023
  K. Nõupuu et al. View Abstract

  Mosquitoborne diseases are a growing threat to public health worldwide. Human dirofilariasis, caused by the nematode Dirofilaria repens and transmitted by mosquitoes from various genera, has recently expanded into new areas of Europe. In this article, we report molecularly confirmed autochthonous human D. repens infections in Estonia.

• 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. View Abstract

  The rat lungworm, Angiostrongylus cantonensis, is an invasive, zoonotic parasite that can cause severe disease in humans. We collected A. cantonensis larvae from 2 host species, invasive apple and mystery snails, from bodies of water in Georgia, USA. Recreational water users should avoid ingesting potentially infected hosts, aquatic vegetation, and water.

• Subarachnoid Neurocysticercosis Caused by Larval-Stage Taenia crassiceps Tapeworm, Slovenia
  B. Šoba et al. View Abstract

  We present a case of subarachnoid neurocysticercosis caused by Taenia crassiceps in an elderly woman in Slovenia with no underlying disease or immunosuppressive treatment. The parasite was identified by 12S rDNA PCR and sequencing. Despite prolonged therapy with albendazole and praziquantel, the disease recurred after treatment was discontinued.

• Pediatric Case Report and Overview of Autochthonous Tick-Borne Encephalitis, Belgium
  J. De Langhe et al. View Abstract

  Prevalence of tick-borne encephalitis (TBE) is increasing in much of Europe. In May 2024, an autochthonous pediatric case of TBE was diagnosed in a 6-year-old girl in Belgium. Clinicians should recognize the symptoms and signs of TBE infections and consider this disease in patients with unexplained neurologic symptoms, regardless of travel history.

• Human Babesiosis Caused by Babesia venatorum, Russia, 2024
  O. P. Zelya et al. View Abstract

  We report a case of acute babesiosis in a splenectomized 63-year-old man in Siberia, Russia. We confirmed the causative agent, Babesia venatorum, by PCR. Our study demonstrated a change in the structure of the parasite population, from single parasite invasion of erythrocytes to multioccupancy, without an increase in parasitemia level.

• Zoonotic Rat Lungworm Angiostrongylus cantonensis in Black Rats, Houston, Texas, 2024
  D. A. Sierra et al. View Abstract

  The Angiostrongylus cantonensis rat lungworm is a zoonotic nematode that infects several rat species. This nematode causes eosinophilic meningitis and meningoencephalitis in humans and other accidental hosts. We found a 20% prevalence of A. cantonensis lungworms in black rats from a zoo facility in Houston, Texas, USA.

Letters

• Nosocomial Transmission of Plasmodium falciparum Malaria, Spain, 2024
  M. Romero et al.
• Nosocomial Transmission of Plasmodium falciparum Malaria, Spain, 2024
  J. L. Gómez Perales et al.

Etymologia

• Apicoplast [ā′-pik-ō-plast]
  H. Shankar et al.

About the Cover

• While Man Deliberates, Malaria Rules
  D. O. Freedman

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.
• Comparative Epidemiology of Salmonella Paratyphi A and Salmonella Typhi Causing Enteric Fever, Bangladesh, 2018–2020
  S. A. Rahman et al.
• Prolonged Monkeypox Virus Infections, California, USA, May 2022–August 2024
  S. H. Schildhauer et al.
• Differences in COVID-19 Fatality Rates among Ethnic Groups, Hawaii, USA, 2020–2022
  G. Devendra et al.
• Effects of human seasonal influenza vaccines on highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in ferrets
  X. Sun et al.

Dispatches

• Escherichia coli ST131:H22 in Parrots from Illegal Pet Trade, Brazil, 2024
  V. P. Rocha et al.
• Detection of Mpox in Wastewater Solids at Wastewater Treatment Plants, United States
  A. B. Boehm et al.
• Hypervirulent Klebsiella pneumoniae as a cause of lethal pneumocephalus in Europe
  N. Gläser et al.
• Genomic Investigation of Increased Gonococcal Infections, Minnesota, USA, 2024
  D. Evans et al.
• Emergence and Polyclonal Dissemination of bla_NDM-7–Carrying InX3 Plasmid in Enterobacter cloacae Complex, France, 2021–2023
  I. Rezzoug et al.
• Antimicrobial-Resistant Clonal Complex 11 Neisseria meningitidis–Associated Urethritis Cluster, Thailand
  J. C. Cartee et al.
• Detection of Extended-Spectrum β-lactamase–Producing Klebsiella pneumoniae in Human and Food Samples, Switzerland, 2018–2019
  L. Aguilar-Bultet et al.

Research Letters

• Disseminated Blastomycosis Mimicking Tuberculosis, China
  C. Guo et al.
• Angiostrongylus cantonensis in Definitive and Intermediate Hosts, Madagascar, 2023
  L. A. Maminirina et al.
• Cutaneous Coccidioidomycosis Mimicking Rosacea in Immunosuppressed Patient, Arizona, USA, 2024
  S. Obagi et al.

Research Letter

• Two Cases of Autochthonous West Nile Virus Encephalitis, Paris, France, 2025
  N. Hassold-Rugolino et al. View Abstract

  We report 2 cases of febrile lymphocytic meningitis with encephalitis in patients in France. One patient had not traveled outside Paris; the other had traveled to eastern France. Laboratory findings revealed acute West Nile virus infection. The cases occurred days apart, raising concern the virus has spread further in France.