Early Release

Synopsis

• Stenotrophomonas maltophilia Bloodstream Infection Outbreak in Acute Care Hospital, California, USA, 2022–2023
  S. M. Khan et al. View Abstract

  Stenotrophomonas maltophilia is an opportunistic bacterial pathogen found in healthcare settings. During May 2022–September 2023, an acute care hospital in northern California, USA, identified 13 S. maltophilia bloodstream infections among intensive care unit patients. Whole-genome sequencing showed the isolates were highly related. We identified risk factors for infection by conducting a matched case–control study, targeted assessment of infection prevention and control practices, and laboratory testing of suspected environmental reservoirs. Among 13 case-patients and 39 control-patients, patients exposed to iodinated contrast (odds ratio [OR] 12.0; 95% CI 2.1–∞), injectable propofol (OR 12.2; 95% CI 1.5–101.4), or fentanyl (OR 9.2; 95% CI 1.8–∞) had increased odds of S. maltophilia bloodstream infection. Although we did not have culture confirmation of a source, we suspect S. maltophilia was transmitted by exposure to nonsterile water from a common source. We recommended infection prevention and control practices to reduce risk for contamination from nonsterile water.

Research

• Environmental and Phylogenetic Investigations of Aspergillus flavus Outbreak Linked to Contaminated Building Materials, Denmark, 2025
  A. Gewecke et al. View Abstract

  An Aspergillus flavus outbreak occurred in a tertiary hospital in Denmark. We compared environmental sampling methods, investigated the outbreak through short tandem-repeat genotyping, STRAfla, and analyzed isolate phylogeny using whole-genome sequencing. Paired sampling revealed that air sampling underestimated A. flavus burden (8 CFU/81 air samples vs. 585 CFU/81 surface samples), and culturing at 37°C was superior to 25°C (risk ratio 1.77; p<0.001). STRAfla (n = 145) confirmed clonality of the outbreak isolates. Active growth was identified in a kitchen inside the affected ward. Genetically related isolates were also found in the Department of Clinical Microbiology and in 4 unrelated wood-based building materials from retailers in Denmark. Phylogenetic analyses of 167 isolates supported introduction of A. flavus from building materials. We hypothesize that water damage enabled germination of dormant spores in precontaminated wood-based products. Our findings highlight a risk factor for outbreaks and should inform future hospital construction and infection prevention strategies.

• Lymphocytic Choriomeningitis Virus Seroprevalence among Urban Pregnant Women and Newborns, Philadelphia, Pennsylvania, USA, 2021
  D. D. Flannery et al. View Abstract

  Lymphocytic choriomeningitis virus (LCMV) is a globally distributed rodentborne pathogen that can cause severe congenital infections. We conducted a retrospective cross-sectional seroepidemiologic study using remnant serum samples from pregnant women and newborns at 2 hospitals in Philadelphia, Pennsylvania, USA. We tested samples for LCMV IgG and IgM in 3 phases: a high-risk group determined by neighborhood deprivation index scores, a random sample of all birthing women, and a group with prenatally diagnosed neurologic malformations. We found LCMV IgG seroprevalence was 2.4% among 700 high-risk and 2.7% among 300 randomly selected pregnant women. Seroprevalence varied by hospital site, maternal race or ethnicity, and neighborhood deprivation level. All seropositive maternal samples were IgM-negative. Thirty-seven pregnant women carrying fetuses with neurologic malformations were seronegative. Our findings highlight the risk for LCMV exposure in urban settings and emphasize the need for pregnant women to avoid contact with rodents to prevent this rare but serious congenital infection.

• Genetically Similar High-Risk Strains of Carbapenemase-Producing Enterobacterales in Humans and Companion Animals, United States
  L. Xiaoli et al. View Abstract

  To elucidate the zoonotic potential of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) in US companion animals (i.e., dogs and cats), we queried the National Center for Biotechnology Pathogen Detection database to identify One Health clusters containing CP-CRE isolates from companion animals and humans. The 11 One Health clusters we found included most (69% [169/246]) publicly available CP-CRE sequences from US companion animals and were from 8 internationally disseminated, high-risk sequence types from 3 bacterial species (Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae). All clustered isolates had New Delhi metallo-β-lactamase–family carbapenemases, and most (92%) carried the bla_NDM-5 allele. The One Health clusters included several closely related subclusters with geographically linked isolates from both humans and companion animals. Those results suggest that CP-CRE is an emerging One Health issue and that direct or indirect transmission of CP-CRE is occurring between humans and companion animals in the United States.

• Strongyloides Genetic Diversity among Humans, Dogs, and Nonhuman Primates, Central African Republic, 2016–2022
  E. Nosková et al. View Abstract

  Strongyloides stercoralis roundworm infection occurs in ≈600 million persons worldwide and is listed by the World Health Organization as a neglected tropical disease. Understanding zoonotic potential is critical, especially in areas where humans, domestic animals, and wildlife interact. We explored cross-species sharing of Strongyloides roundworms by analyzing fecal samples from humans, dogs, and nonhuman primates in the Dzanga-Sangha Protected Areas, Central African Republic. We detected positive samples by quantitative PCR and assessed genetic diversity through amplification of the 18S rRNA HVR-IV region and cox1, followed by high-throughput sequencing. Strongyloides prevalence was high in humans, dogs, and gorillas. S. stercoralis haplotype A roundworm dominated in humans but appeared in dogs and apes, whereas S. fuelleborni roundworm was present in all hosts. Shared species and haplotypes indicated zoonotic transmission. Our findings highlight the need for molecular surveillance and emphasize the role of dogs and nonhuman primates as reservoirs, complicating efforts to control infections in human populations.

• Projected Effects of Changing Global Tuberculosis Epidemiology on Mycobacterium tuberculosis Prevalence and Immunoreactivity, 2024–2050
  M. Machado et al. View Abstract

  We assessed how evolving global tuberculosis (TB) trends might influence Mycobacterium tuberculosis immunoreactivity and TB risk among persons immigrating to low-incidence countries. We projected annual risk for infection (ARI) in 168 countries for 2024–2050, focusing on China, India, the Philippines, and Vietnam. We applied projections to the age profile of immigrants to 4 low-incidence countries to estimate changes in M. tuberculosis immunoreactivity prevalence and TB risk under status quo and accelerated ARI decline scenarios. In the status quo 2024 estimate, M. tuberculosis immunoreactivity prevalence ranged from 14.7% in China to 40.1% in the Philippines, declining to 5.8% in China and 23.0% in the Philippines by 2050; TB risk also declined. Accelerated ARI reductions yielded greater relative decreases in disease risk than immunoreactivity prevalence. Declining global TB incidence could reduce M. tuberculosis immunoreactivity and disease risk among immigrant populations, which could inform cost–benefit analyses for future TB screening strategies in low-incidence settings.

• Seroincidence Rate of Typhoidal Salmonella in Children, Kenya, 2017–2018
  A. Khan et al. View Abstract

  Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi, results in high rates of illness and death globally. The lack of reliable diagnostic assays limits surveillance, leading to major gaps in understanding the population-level burden in low- and middle-income countries. We applied a novel serologic tool measuring IgG responses to hemolysin E to assess typhoidal Salmonella infection rates in children from 4 communities: 2 in western Kenya (Kisumu and Chulaimbo) and 2 in coastal Kenya (Ukunda and Msambweni). We found a substantially higher enteric fever seroincidence rate in coastal Kenya (37/100 person-years) than in western Kenya (3.6/100 person-years). We found a higher seroincidence rate in households with nonpiped water and lower incomes and in neighborhoods with higher population density. Our findings contribute to Kenya's limited enteric fever surveillance data, especially in the coastal regions. Such information underscores the need for public health interventions, such as typhoid conjugate vaccine introduction, in Kenya.

• Blastomyces antigen testing in urine for active case identification during a blastomycosis outbreak
  A. W. O’Connor et al.
• Tuberculosis before and during COVID-19 Pandemic, United States, 2010–2023
  P. I. Feng et al.

Policy Review

• Rethinking Leptospirosis Prevention, the Philippines
  R. V. Labana View Abstract

  Leptospirosis, the disease caused by infection with Leptospira spp. bacteria, remains a recurring public health challenge in the Philippines, particularly during monsoon floods and typhoon seasons. Despite responsive measures, such as Code White Alerts, standardized treatment protocols, and postflood prophylaxis, cases and associated deaths persist, emphasizing the limitations of reactive strategies. Structural challenges in flood control, urban sanitation, and rodent management hinder long-term prevention. This policy review applies a systems thinking approach to integrate national programs with community-led interventions, recognizing the interlinked roles of environmental management, behavioral change, and grassroots surveillance. Low-cost, context-sensitive actions, such as community drainage clearing, shared protective gear, local rodent-proofing, and barangay-level reporting, can address immediate risks while reinforcing structural initiatives. Embedding those actions within a feedback loop between local actions and national policies fosters resilience, reduces disease incidence, and shifts the paradigm from reactive response to sustainable prevention.

Dispatches

• Rapid Interventions to Limit Outbreak of Invasive Streptococcus pneumoniae in Correctional Facility, North Carolina, USA, 2024
  C. D. Gowler et al. View Abstract

  A Streptococcus pneumoniae serotype 4 outbreak in a North Carolina correctional facility resulted in 14 cases (8 suspected, 1 probable, and 5 confirmed). After implementation of movement restrictions and vaccination with 23-valent pneumococcal polysaccharide vaccine, new cases ceased. Serotype 4 presence in this setting raises challenges for an effective vaccination strategy.

• Emerging Endemic Area for Blastomycosis, New York, USA, 2000–2024
  L. E. Ramirez et al. View Abstract

  Blastomycosis is not yet considered endemic in upstate New York, USA; however, cases have increased during the past decade. We performed a retrospective study of 54 laboratory-confirmed cases reported during 2000–2024. Our results demonstrate an increase in incidence over time, indicating that this region represents an emerging endemic area.

• Tuberculosis after TB Preventive Therapy in Persons Living with HIV Recently Initiating Antiretroviral Therapy, Mozambique
  L. Templin et al. View Abstract

  We investigated tuberculosis (TB) diagnoses among persons living with HIV recently initiated on antiretroviral therapy in Mozambique during 2021–2024 (N = 341,844). TB diagnosis rates were lower among those who completed TB preventive therapy (3.1/1,000 person-years) compared with those who had an incomplete course (11.0/1,000 person-years) or did not start (21.6/1,000 person-years).

• Optimal Specimens and Lesions for Mpox Diagnosis Using Real-Time PCR, South Korea
  D. Kim et al. View Abstract

  We analyzed 612 specimens from 135 patients with monkeypox virus clade IIb in South Korea by using real-time PCR. Crusted and anogenital skin lesions and rectal swab specimens demonstrated the highest positivity rates. Viral loads varied by lesion type, anatomic site, and time since symptom onset, supporting our specimen selection for clade IIb detection.

• Life-threatening extraintestinal infection caused by Entamoeba moshkovskii in eastern India
  S. Sardar et al.
• Home-Based Monitoring of Treatment-Related Adverse Events during Drug-Resistant Tuberculosis Treatment, India, 2020–2024
  M. Ahson et al. View Abstract

  We investigated home-based outreach and point-of-care diagnostic tools for monitoring adverse events among persons treated for drug-resistant tuberculosis in Dharavi, India. Of 974 persons treated, 518 (53%) reported 1,410 events, 126/477 (26%) required regimen change, and 83% of patients completed therapy. Home-based adverse event monitoring can help improve tuberculosis treatment adherence.

• Natural Hendra Virus Infections in Captive Australian Black Flying Foxes, Queensland
  V. Boyd et al.

Research Letters

• Detecting Influenza A(H5N1) Viruses through Severe Acute Respiratory Infection Surveillance, Cambodia
  W. W. Davis et al. View Abstract

  Of 19 human cases of avian influenza A(H5N1) virus infection detected during January 2023–March 2025 in Cambodia, 12 (63%) were detected directly by surveillance for severe acute respiratory infection (SARI) or indirectly by testing ill close contacts. SARI surveillance can supplement other surveillance sources for identifying H5N1 cases.

• Oestrus ovis Nasal Myiasis with Pupation in Human Host, Greece, October 2025
  I. P. Kioulos et al. View Abstract

  We report a case of human Oestrus ovis nasal myiasis in Greece, in which pupation occurred within the human host. Ten larvae in various stages of development and 1 puparium were expelled or extracted from the patient’s maxillary sinus. Diagnosis was confirmed through morphologic identification and by PCR, followed by DNA sequencing.

• Costs of Extrapulmonary Nontuberculous Mycobacteria Disease, Denmark, 2005–2017
  V. Dahl et al. View Abstract

  We estimated the direct and indirect costs associated with extrapulmonary nontuberculous mycobacteria (ENTM) disease in Denmark during 2005–2017. ENTM disease was associated with substantially higher healthcare costs, lower employment income, and increased public benefits before, around, and after diagnosis. Our findings highlight the substantial socioeconomic burden associated with ENTM disease.

• Crimean-Congo Hemorrhagic Fever Virus Seroprevalence among Hunter-Gatherers, Northeastern DRC
  D. M. Kasumba et al.
• Mycobacterium nanjing sp. nov., a Novel Slowly Growing Mycobacterium Isolated from Cutaneous Infection in China
  Y. Zou et al.
• Mycobacterium riyadhense Pulmonary Disease after Relocation from Saudi Arabia, Japan
  T. Ozawa et al.
• Occupational Transmission of Extensively Drug-Resistant Tuberculosis, France
  C. Poignon et al. View Abstract

  We report occupational transmission of extensively drug-resistant tuberculosis (TB) to a healthcare worker in France receiving tumor necrosis factor α inhibitor therapy. Despite airborne precautions, the healthcare worker contracted TB working in a high-risk unit. This case underscores that immunocompromised healthcare workers should not be assigned to frontline TB care in high-risk settings.

• lsaC and Tandem lsaE-lnuB Resistance Genes in Invasive Group A Streptococcus
  B. Beall et al. View Abstract

  Among >16,500 recently recovered invasive Streptococcus pyogenes isolates, we detected 9 independent acquisitions of lsaC or tandem lsaE-lnuB genes, which are known to confer resistance to pleuromutilins and clindamycin. Continued awareness of the evolving S, pyogenes resistosome is important for future infection treatment considerations.

• Indeterminant Interferon-γ Release Assays in Refugee Children with Splenomegaly, Uganda, 2020–2023
  C. R. Phares et al. View Abstract

  We observed a novel association between splenomegaly and indeterminate interferon-γ release assays in refugee children 5–14 years of age in Uganda. Those demonstrating splenomegaly were 4 times more likely to have indeterminate results. Among refugee children 2–4 years of age, >10% had indeterminate results even without splenomegaly.

• Cutaneous Paraconiothyrium cyclothyrioides Infection in Lung Transplant Recipient
  C. Mackey et al.

Emerging Infection Networks Letter

• Query into Tuberculosis Infection Screening and Management among Pregnant Migrants, Europe, 2025
  F. Puviani et al.

Another Dimension

• Everything is Tuberculosis: A Portrait of Connection
  N. M. M’ikanatha

Online Report

• New 2030 Global Target for Histoplasmosis
  A. C. Pasqualotto et al.

Correction

• Correction: Vol. 32, No. 1

About the Cover

• Romanticism at the Edge of Death
  T. Chorba

Synopses

• Pediatric Meningoencephalitis Cluster Caused by Snowshoe Hare Virus, Whistler, British Columbia, Canada, 2024
  F. Ali et al.
• Circulation Patterns, Genetic Diversity, and Public Health Implications of Enterovirus D68, Europe, 2014–2024
  C. Andrés et al.

Research

• Enhanced Detection of Coccidioides spp. Fungi from Environmental Samples Using Droplet Digital PCR
  J. Segovia-Mota et al.
• Hemolytic Uremic Syndrome Outbreak in Adults and Shiga Toxin–Producing Escherichia coli Negative for Locus of Enterocyte Effacement, France, 2025
  J. de Larminat et al.
• Dengue Incidence, Seroprevalence, and Expansion Factors from Active Surveillance, Brazil, 2016–2021
  E. de Barros et al.
• Confirming ERVEBO Vaccination via Vector Immunity Detection to Support Ebola Virus Surveillance in Endemic Countries
  E. Karaaslan et al.
• Respirable Aerosol Production and Reduction of Avian Influenza Transmission Risk during Chicken Processing, Bangladesh
  N. Rimi et al.
• Evaluation of Effectiveness of Autocidal Gravid Ovitraps for Preventing Zika Virus Infection, Puerto Rico
  Z. J. Madewell et al.
• Seroprevalence of Crimean-Congo Hemorrhagic Fever Virus Infection in Humans and Domestic Ruminants, Democratic Republic of the Congo
  B. Lombe et al.
• Geographically Distinct Circulation of Genotype II and III St. Louis Encephalitis Virus, Texas, USA, 2009–2024
  A. R. Kneubehl et al.
• Accelerated Increase in Candidozyma (Candida) auris Bloodstream Infections during COVID-19 Pandemic, South Africa
  H. Ismail et al.

Dispatches

• Chronic Wasting Disease in Farmed Cervids, South Korea, 2001–2024
  Y. Choi et al.
• Panton-Valentine Leukocidin–Encoding CC398 Methicillin-Resistant Staphylococcus aureus, the Netherlands, 2023–2024
  P. van Schelven et al.
• Outbreak of Dengue Virus Serotype 3, Republic of the Marshall Islands, 2019–2021
  T. M. León et al.
• Rapid Spread of Recombinant African Swine Fever Virus Genotypes I and II, Vietnam, 2023–2024
  Y. Kim et al.

Research Letters

• Rickettsia lanei Rickettsiosis, Oregon, USA, 2025
  S. G. Ladd-Wilson et al. View Abstract

  Using metagenomic sequencing, we identified a patient infected with Rickettsia lanei who was initially diagnosed with Rocky Mountain spotted fever (RMSF), a clinically similar disease caused by infection with R. rickettsii. Our investigation highlights the importance of clinical, epidemiologic, and laboratory partnerships to leverage the discovery of novel pathogens.

• Seroepidemiologic Study of Oropouche Virus, Amazonas State, Brazil, 2015–2016
  J. Forato et al.