Early Release

Perspective

• Emerging Respiratory Virus Threats from Influenza D and Canine Coronavirus HuPn-2018
  G. C. Gray et al. View Abstract

  In 2009 and again in 2019, public health warnings were confirmed by the emergence, rapid widespread transmission, and lethality of novel influenza and coronaviruses. The world continues to suffer disease from these respiratory viruses. Two newly recognized emergent respiratory viruses, influenza D and canine coronavirus HuPn-2018, have been shown to have considerable potential for causing future human epidemics, but diagnostics and surveillance for the viruses are lacking. We reviewed data regarding influenza D virus and coronavirus canine coronavirus HuPn-2018. Those data strongly indicate that these viruses are major newly recognized threats. However, little is being done to respond to or prevent disease associated with these viruses, warranting the question of whether we will learn from previous pandemics.

Synopses

• Pulmonary Histoplasmosis, Taiwan, 1997–2024
  T. Kao et al. View Abstract

  Pulmonary histoplasmosis has traditionally been considered geographically restricted to disease-endemic regions. Taiwan, historically nonendemic, has recently witnessed rising infections. We conducted a retrospective study by reviewing adult patients in Taiwan who had pathologically confirmed pulmonary histoplasmosis during June 1997–December 2024. We analyzed 14 cases with lung involvement. Eight case-patients were male and 6 female; mean age was 56.6 years. Of note, 11 case-patients (78.6%) had no history of travel to histoplasmosis-endemic regions; 10 (71.4%) were immunocompetent. Left upper lobe involvement was most common (n = 4 [28.6%]), with nodular lesions predominating (n = 12 [85.7%]). Most (11 [78.6%]) patients received antifungal therapy, mostly with voriconazole. Outcomes were favorable; 1 (7.1%) patient died. Two additional case-patients without lung involvement exhibited similar demographics and clinical outcomes. Case identification rate has increased since 2015. This 27-year study documents the emergence of pulmonary histoplasmosis in Taiwan, emphasizing the need for heightened clinical suspicion in nonendemic regions.

• Case Series of Bacteremia Associated with Probiotic Use in Children after Cardiac Surgery, China
  X. Wang et al. View Abstract

  We examined probiotic-associated bacteremia in a cohort of postoperative pediatric cardiac surgery patients in China. Among 16,436 children who underwent cardiac surgery during 2019–2024, a total of 5,034 received probiotics; 6 developed bacteremia with probiotic strains (Bacillus subtilis, Bacillus licheniformis, Lacticaseibacillus rhamnosus). Three cases occurred in children who had not directly received probiotics, suggesting potential cross-contamination or catheter-related transmission. All 6 patients had complex congenital heart disease and central venous catheters; 5 underwent palliative surgery. Fever, elevated C-reactive protein and leukocytes, and use of respiratory support were common. Antibiotic therapy achieved blood-culture clearance in all; 1 death occurred because of underlying cardiac disease, not infection. Our findings conclude probiotic-associated bacteremia is rare and usually resolves with antibiotics; outcomes correlate more with cardiac complexity than bacteremia itself. Maintaining perioperative probiotic use and enhancing infection-control measures, specifically regarding central line care, are recommended to minimize the risk for probiotic-associated bacteremia in pediatric cardiosurgical patients.

• Two Cases of Q Fever in Pregnancy, including Management of the Newborn, Australia
  R. Silcock et al. View Abstract

  Optimal management of the birthing parent with Q fever in pregnancy and of the infant has not been established. Coxiella burnetii expresses a tropism for the placenta; resulting infection can potentially lead to spontaneous abortion and fetal demise. Although evidence around preventing transmission and infection in the peripartum and postpartum period is lacking, reports of healthy babies born to mothers with acute or chronic Q fever in pregnancy are increasing. Historically, many clinicians have recommended against breastfeeding in this setting because of a theoretical risk for bacterial transmission through breastmilk. We discuss 2 women in Australia who had Q fever in pregnancy, focusing on the peripartum period and infant management. Breastfeeding was encouraged in both cases. Both infants were born healthy and at term and have demonstrated no serologic or clinical evidence of Q fever infection in the first year of life.

• Ocular Lyme Disease
  J. Bellafiore et al.

Research

• Emergence of New Delhi Metallo-β-Lactamase 14–Producing Klebsiella pneumoniae Sequence Type 147 Clone in Spain and Outbreak in the Canary Islands
  P. Aja-Macaya et al. View Abstract

  The emergence of a high-risk New Delhi metallo-β-lactamase 14–producing Klebsiella pneumoniae sequence type 147 clone is of public health concern because of its rapid international spread. We report cross-border emergence and rapid dissemination of that clone in the Canary Islands, Spain, during 2023–2025. We analyzed 30 isolates recovered during 2023 in detail by reviewing clinical and epidemiologic data, conducting whole-genome sequencing to assess clonal relatedness and analyze resistomes, and performing antimicrobial susceptibility testing of novel therapeutic options through reference broth microdilution. The isolates formed a well-defined cluster, with minimal genomic distance and identical resistomes, confirming the local outbreak. Those clones were also closely related to other international New Delhi metallo-β-lactamase 14–producing K. pneumoniae sequence type 147 isolates, supporting the ongoing cross-border expansion of that clone. Aztreonam/avibactam was the most active therapeutic option (MICs <0.125 mg/L). Our findings highlight the need for close monitoring to prevent further dissemination of this clone.

• Reduced Emergency Department Visits and Hospitalizations in Infants after Universal Respiratory Syncytial Virus Immunization, Italy, 2024–25
  S. Villa et al. View Abstract

  During the 2024–25 winter season, a universal immunization campaign with nirsevimab was implemented in a region of Italy to prevent respiratory syncytial virus (RSV) infection among infants <12 months of age. We assessed its effects using regional syndromic surveillance data on emergency department visits (EDVs) and hospitalizations for lower respiratory tract infections and RSV infections. We estimated expected burden using an interrupted time series analysis, based on historical trends, and observed values with predictions. Children 1–5 years of age, not eligible for immunization, served as a comparison group. Among infants, EDVs for acute lower respiratory tract infections decreased by 42.7% and hospitalizations decreased by 46.5%, whereas EDVs for RSV infection decreased by 49.3% and hospitalizations decreased by 55.0%. No reductions were observed in children 1–5 years of age, confirming ongoing RSV circulation. Our findings support the effectiveness of universal nirsevimab immunization in reducing severe RSV-related outcomes among infants.

• Group A Streptococcus Meningitis, United States, 1997–2022
  P. A. Hawkins et al.
• Genomic Insights into Marburg Virus Strains from 2023 and 2025 Outbreaks in Kagera, Tanzania
  L. A. Mapunda et al. View Abstract

  Marburg virus (MARV) is the primary cause of Marburg virus disease (MVD), a severe hemorrhagic fever with a high case-fatality rate. The first reported MVD outbreak in Tanzania occurred in 2023, followed by a second outbreak in 2025, both within the Kagera region. During those MVD outbreaks, 174 suspected cases were identified; of those, 10 were laboratory confirmed. After complete genome assembly and bioinformatic analyses, we found the MARV strains of the 2023 and 2025 outbreaks to be closely related and clustered with MARV strains that caused outbreaks in Rwanda (2024) and Uganda (2014). The sequences from both MVD outbreaks in Tanzania showed >99.71% nucleotide identity, suggesting a possible single spillover event followed by limited human-to-human virus transmission. Further ecologic studies are essential to identify potential spillover events, but our findings indicate that closely related MARV strains circulate in Kagera, Tanzania, posing a risk for future outbreak recurrence.

• Effect of Chloramine Disinfection of Community Water System on Legionnaires’ Disease Outbreak, Minnesota, USA, 2024
  M. E. Bledsoe et al. View Abstract

  The Minnesota Department of Health identified an outbreak of Legionnaires’ disease in a city in northern Minnesota, USA, in April 2023 that continued until chloramine disinfection of the community water system was implemented. Before chloramine disinfection was implemented, Legionella pneumophila was detected in 1 of 16 samples from the drinking water distribution system and in 5 of 10 premise plumbing samples using both cultivation-dependent (Legiolert) and cultivation-independent (digital PCR) assays in this independent investigation. Approximately 11 weeks after disinfection was implemented, all distribution system samples tested negative; however, 1 of 6 Legiolert-tested and 3 of 6 digital PCR–tested premise plumbing samples were positive. After 24 weeks of disinfection, all samples collected from the distribution system and premise plumbing tested negative. Our results show that a community water system supplied by groundwater supported substantial growth of L. pneumophila in premise plumbing and that chloramine disinfection halted the outbreak.

• Enhanced isolation and detection of SARS-CoV-2 in hospitalized patients undergoing antiviral therapy
  R. Perera et al.
• Detection of Novel Thermotolerant Tepidimonas sp. Bacteria in Human Respiratory Specimens, Hong Kong, China, 2024
  K. Chiu et al. View Abstract

  In patients with acute respiratory infections (ARIs), routine diagnostic tests often fail to identify the microbial cause; thus, many ARIs have undetermined etiology. We investigated potential involvement of thermotolerant bacteria in ARIs among patients in Hong Kong, China, by incubating blood agar inoculated with respiratory specimens at 50°C for 5 days. Among 7,257 specimens analyzed, 58 specimens from 57 patients grew thermotolerant bacteria not identified by other methods. We identified Tepidimonas spp. in 42 isolates, 3 of which appear to be a novel Tepidimonas species (tentatively Tepidimonas hongkongensis sp. nov). Genomic analysis revealed various virulence, resistance, and stress-related genomes in the 3 isolates. Tepidimonas spp. bacteria were predominantly isolated from patients with chronic lung disease and malignancies. We also detected T. hongkongensis in hospital water samples but at a lower percentage than in respiratory specimens, suggesting colonization potential. Clinical implications of T. hongkongensis remain unknown; continued surveillance could determine its role in ARIs.

• Clinical features of infections caused by newly emerging Trichosporon species
  M. Desnos-Ollivier et al.

Dispatches

• Sphingobacterium hotanense Infections in Immunocompromised Patients, United States
  K. Abu-Zeinah et al. View Abstract

  Sphingobacterium hotanense is a gram-negative bacillus identified in 2013 from soil samples that rarely causes infection in humans. We describe 2 cases of S. hotanense bacteremia secondary to skin and soft tissue infection in immunocompromised patients in Minnesota, USA, highlighting S. hotanense as a potential pathogen in immunocompromised hosts with environmental exposure.

• Dermacentor occidentalis Ticks and Link to Rickettsia lanei Infections, California, USA
  W. S. Probert et al. View Abstract

  Rickettsia lanei is a newly recognized spotted fever group rickettsial species that causes severe Rocky Mountain spotted fever–like illness. We used genome sequencing, enabled by hybridization capture-based target enrichment, to establish Dermacentor occidentalis ticks as the likely source of a human infection with R. lanei in California, USA.

• Evidence of Rat Hepatitis E Virus Circulation through Wastewater Surveillance, Central Argentina
  B. Filoni et al. View Abstract

  During 2023–2024, we detected rat hepatitis E virus in 67.7% of wastewater samples from central Argentina. This high level of detection opens new inquiries in the region, highlighting the need to investigate the virus in both animal reservoirs and humans, with a focus on hepatitis cases of unknown etiology.

• Detection of Avian Influenza H5–Specific Antibodies by Chemiluminescent Assays
  A. Márquez et al. View Abstract

  We evaluated 2 electrochemiluminescence serologic assays to detect avian influenza H5 antibodies. Both assays identified H5 antibodies from both serum and dried blood spots and had strong specificity and minimal cross-reactivity in human and avian samples. Such assays can support populationwide serologic surveys aimed at assessing population-level immunity.

• Disseminated Nocardia ignorata Infection with Splenic and Brain Involvement in Patient with Large B-Cell Lymphoma
  S. Elbaz et al. View Abstract

  A 79-year-old man in the United States with large B-cell lymphoma and chronic obstructive pulmonary disease had disseminated Nocardia ignorata infection involving the brain and spleen. Despite antimicrobial therapy, he died from complications. This rare manifestation highlights the need to consider Nocardia in immunocompromised patients with central nervous system and abdominal lesions.

• Presence or Emergence of Canine Leishmaniasis, Malawi
  B. Chikufenji et al.
• Detection of Oropouche and Punta Toro Virus Infections by Enhanced Surveillance, Panama, 2023–2024
  M. Chen-Germán et al. View Abstract

  Enhanced arboviral surveillance in Panama revealed an Oropouche virus case, 5 months before the 2025 national outbreak, in samples that tested negative for routinely screened arboviruses. Subsequent contact tracing identified an additional case of Punta Toro virus. Our findings highlight the importance of expanding diagnostic efforts to identify circulating arboviruses.

• Tularemia in New York State, USA, 1993–2023
  D. T. Gaber et al.

Research Letters

• Mycobacterium decipiens Infection in Patient Receiving Anti–TNF-α Therapy, France, 2024
  J. Destoop et al. View Abstract

  Mycobacterium decipiens is a newly identified species with high genomic similarity to M. tuberculosis. We report a cutaneous M. decipiens infection in a patient in France who had inflammatory bowel disease being treated with anti–tumor necrosis factor-α therapy. The infection was successfully treated with an oral antimicrobial regimen.

• Donor Screening Failure for Strongyloides stercoralis in Solid Organ Transplantation
  R. Kohan et al. View Abstract

  We report 2 cases of donor-derived Strongyloides stercoralis infection in renal transplant recipients. Despite initial negative serologic testing in donor samples, retrospective testing confirmed transmission. This report underscores the limitations of serologic screening, the need for targeted protocols in endemic-risk populations, and the importance of close posttransplant surveillance.

• Serologic Evidence of Exposure to Burkholderia pseudomallei, Nigeria
  J. Savelkoel et al. View Abstract

  Melioidosis is an underreported cause of community-acquired pneumonia and sepsis in Nigeria. We conducted a cross-sectional study using a Burkholderia pseudomallei protein microarray in 500 healthy participants from Nigeria. We observed a serologic response supportive of past exposure to the causative agent of melioidosis in 30% of study participants.

• Molecular Analysis of Emerging MT27 Macrolide-Resistant Bordetella pertussis, Kobe, Japan, 2025
  S. Komatsu et al. View Abstract

  We report the emergence and spread of multilocus variable-number tandem-repeat analysis type 27 (MT-27) macrolide-resistant Bordetella pertussis (MRBP) in Kobe, Japan, in 2025. Whole-genome sequencing revealed that MT27-MRBP did not originate from the widely circulating MT27 macrolide-sensitive B. pertussis in Japan but was closely related to MRBP in China.

• Fatal Ehrlichia muris eauclairensis Infection in Liver Transplant Recipient, Minnesota, USA
  S. Sahra et al. View Abstract

  Ehrlichia muris eauclairensis bacterial infections can manifest with atypical and severe symptoms in immunocompromised patients. We report a fatal case of severe ehrlichiosis caused by E. muris eauclairensis in a liver transplant recipient in Minnesota, USA. Healthcare providers must remain vigilant about tickborne infections in endemic regions, especially among immunocompromised patients.

• Localized Outbreak of Macrolide-Resistant Pertussis in Infants, Japan, March–May 2025
  T. Obara et al.

Online Report

• Integrating Prevention and Response at the Crossroads of Henipavirus Preparedness, Hendra@30 Conference, 2024
  K. Halpin et al. View Abstract

  Diseases caused by henipaviruses, exemplified by Hendra virus and Nipah virus, pose a serious risk to public health because of their epidemic potential and high case-fatality rates and the paucity of medical countermeasures to mitigate them. In December 2024, a group of 150 scientists from 16 countries convened in Geelong, Victoria, Australia, to mark the 30th anniversary of the discovery of Hendra virus. The Hendra@30 conference built upon its predecessor conference held in 2019 in Singapore, Nipah@20, by expanding its program across broader disciplines and integrating sessions on human sociology and disease ecology into the main scientific discussions. We describe key highlights from Hendra@30 and reflect on 4 key elements that have advanced henipavirus research and medical countermeasures research and development. We propose that integrating bat ecology into henipavirus research blueprints will enable development of ecologic countermeasures that prevent spillover and will complement existing preparedness and response efforts with evidence-based prevention strategies.

About the Cover

• Nocardia and the Death of Raphael (1520)
  P. Charlier et al.

Perspective

• Life-Threatening SARS-CoV-2–Associated Encephalopathy and Multiorgan Failure in Children, Asia and Oceania, 2022–2024
  M. Kasai et al.

Research

• Predictors of Fatal Outcomes among Hospitalized Pediatric Rocky Mountain Spotted Fever Patients, Sonora, Mexico, 2004–2024
  S. Bellman et al.
• Leptotrombidium imphalum as Vector for Scrub Typhus in Human Settlements, India, 2022–2023
  C. S. Devamani et al.
• Pathogenesis of Pulmonary Complications in Fatal Yellow Fever, Brazil, 2017–2019
  A. N. Duarte-Neto et al.
• Environmental and Phylogenetic Investigations of Aspergillus flavus Outbreak Linked to Contaminated Building Materials, Denmark, 2025
  A. Gewecke et al.

Dispatches

• Retail Milk Monitoring of Influenza A(H5N1) in Dairy Cattle, United States, 2024–25
  N. N. Tarbuck et al.
• Genomic Analysis of Doxycycline Resistance–Associated 16S rRNA Mutations in Treponema pallidum subsp. pallidum
  G. S. Long et al.
• Donor-Derived West Nile Virus Infection in Kidney Recipients, France
  A. Truffot et al.
• Characteristics and Transmission Dynamics among Global Travel-Related Mpox Cases Caused by Clade Ib Monkeypox Virus
  H. Laurenson-Schafer et al.
• Measles Outbreak Driven by Nosocomial Transmission, Armenia, February–July 2023
  K. Palayan et al.
• Desulfovibrio Bacteremia in Patients with Abdominal Infections, Japan, 2020–2025
  N. Watanabe et al.
• Rabies Reemergence, Central Europe, 2022–2024
  E. Robardet et al.

Research Letters

• Airport Malaria Cluster in Certified Malaria-Free Country, Libya, 2024
  A. M. Alarbi et al.
• Severe Respiratory Diphtheria-Like Illness Caused by Toxigenic Corynebacterium ulcerans
  R. Helleren et al.
• Monkeypox Virus Antibodies in Healthy Persons after Vaccination, United Kingdom
  V. H. Sheridan et al.
• Invasive Pneumococcal Disease among Childbearing-Age Women, United States, 2007–2023
  N. Prasad et al.
• Serologic Investigation of Influenza D Virus in Cats and Dogs, Europe
  C. Trombetta et al.

Letter

• Candida auris Testing by the Antimicrobial Resistance Laboratory Network, United States, 2022–2023
  J. E. Laury et al.

Etymologia

• Mumps [muhmps]
  S. Mohan and A. Khan