Early Release

Perspective

• Limitations of Global Lens in Neisseria gonorrhoeae Antimicrobial Resistance Surveillance
  S. J. van Hal et al.

Synopses

• Cerebrospinal Fluid Findings among Patients with Anaplasmosis and Central Nervous Involvement, Minnesota and Wisconsin, USA
  I. Dumic et al.
• Group A Streptococcus Disease Outbreak Associated with Large Congregate Shelter, Chicago, Illinois, USA, October 2023–January 2024
  K. Toews et al. View Abstract

  Chicago Department of Public Health identified 3 pediatric patients hospitalized with group A Streptococcus (GAS) disease during October 26–November 3, 2023, in a large congregate family migrant shelter in Chicago, Illinois, USA. One patient had invasive GAS infection; 2 had peritonsillar abscesses requiring drainage. Despite infection control measures, GAS pharyngitis cases continued through November 13. Chicago Department of Public Health coordinated clinical partners to perform rapid antigen detection testing and throat cultures for residents and staff with pharyngitis symptoms. During November 20, 2023–January 3, 2024, a total of 428 symptomatic persons were evaluated; 166 tested positive for GAS. Among persons with GAS pharyngitis, median age was 12 years (range 0–45 years); 54.2% were women and girls. Common symptoms included sore throat (87.3%) and fever (63.3%). One pediatric resident death caused by invasive GAS was confirmed postmortem. This response highlights outbreak challenges in large congregate shelters housing children.

• Outcomes of Hospitalized and Critically Ill Adults with Murine Typhus, Galveston, Texas, USA, 2019–2023
  M. Pickich et al.
• Emergence of Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae with Penicillin-Binding Protein 3 Insertions, Taiwan, 2021
  T. Long et al. View Abstract

  Carbapenem-resistant Enterobacterales (CRE) are a major global health threat with limited treatment options. Aztreonam/avibactam is a promising therapy against metallo-β-lactamase (MBL)–producing and other CRE, but emerging resistance threatens its effectiveness. Insertions in penicillin-binding protein 3 (PBP3), which are well described in Escherichia coli, are linked to reduced aztreonam/avibactam susceptibility but remain poorly characterized in Klebsiella pneumoniae. We report clinical K. pneumoniae carbapenemase–producing K. pneumoniae sequence type 11 isolates carrying a novel PBP3 YRIT insertion, conferring reduced susceptibility to aztreonam/avibactam and ceftazidime/avibactam. Functional and genetic studies suggest that the PBP3 insertion impairs β-lactam binding and, in combination with bla_KPC-2 and other β-lactamases, contributes to reduced susceptibility. Those findings demonstrate the emergence of a PBP3 insertion in a high-risk K. pneumoniae clone, underscoring the expansion of this resistance mechanism and the critical need for genomic surveillance and novel therapeutics to identify and treat such infections.

• Public Health Response to Toxigenic Respiratory Diphtheria Outbreaks at Correctional Facility, South Africa, 2023–2025
  M. Jose et al. View Abstract

  Since 2023, there have been 3 outbreaks of toxigenic respiratory diphtheria at a correctional facility in Cape Town, South Africa. The first outbreak in October 2023 included 1 fatal case and 8 asymptomatic carriers testing positive for Corynebacterium diphtheriae. In December 2024, the second outbreak resulted in 1 case and 12 asymptomatic carriers. A third outbreak in February 2025, occurring 6 weeks after the second, resulted in 1 case and 14 asymptomatic carriers among inmates and staff. Contact tracing, antimicrobial prophylaxis, and vaccination campaigns were conducted with each outbreak. We outline public health responses to the 3 outbreaks and highlight key barriers and enablers for effective control in a highly mobile, densely populated correctional setting. Effective outbreak response in correctional facilities requires intersectoral collaboration and the development of adult vaccination guidelines for staff and inmates to prevent future vaccine-preventable disease outbreaks.

Research

• Characteristics of Plausible Source Cases Responsible for Recent Mycobacterium tuberculosis Transmission, United States, 2018–2022
  S. Kammerer et al. View Abstract

  Tuberculosis (TB) outbreaks in the United States can cause substantial illness. Using surveillance and genotyping data, we applied a plausible source–case algorithm to identify TB cases reported during 2018–2020 responsible for secondary cases attributed to recent Mycobacterium tuberculosis transmission during 2020–2022. We used mixed models and a machine learning workflow to assess sociodemographic, clinical, and social risk factors associated with plausible sources. In mixed models, sputum smear positivity, cavitary disease, race/ethnicity other than non-Hispanic White or non-Hispanic Asian, age <65 years, US birth, and homelessness were associated with plausible sources. An adaptive boosting model achieved an area under the receiver operating characteristic curve of 0.81 on test data. Transmission was heterogeneous; 8.1% of sources linked to 3–15 secondary cases accounted for 24.9% of transmission events. Focusing case management and contact investigations on cases with the characteristics we identified could reduce M. tuberculosis transmission and improve TB prevention.

• Wickerhamomyces anomalus Fungemia during Healthcare-Associated Outbreak, Pereira, Colombia, 2025
  K. M. Ordoñez et al.
• Outbreak of Wickerhamomyces anomalus (formerly Candida pelliculosa) Bloodstream Infections, Venezuela, 2022–2023
  M. Franco et al.
• Association of Frailty and Frailty Trajectory with Risk for Respiratory Infectious Diseases
  J. Yang et al.
• In Vitro Antifungal Susceptibility of 1,178 Clinical Feline Sporothrix schenckii Complex Isolates, Thailand, 2023–2025
  C. Yurayart et al.
• Role of Households with Children in the Community Spread of Multi-Drug Resistant Enterobacterales
  B. Breeze et al.
• Identification of a novel recombinant human adenovirus genotype B117 from two pediatric community-acquired pneumonia cases in China
  J. Wang et al.
• National Surveillance of Enterovirus D68 Upsurge, France, 2024
  M. Jeannoël et al.
• Antimicrobial-Resistant Gonorrhea of Public Health Concern, Australia, 2022–2024
  L. Walker et al.

Dispatches

• Emergence of Ceftriaxone-Resistant Neisseria gonorrhoeae penA-60–Carrying Strains, Thailand, 2025
  R. Kittiyaowamarn et al. View Abstract

  We report 5 gonorrhea cases caused by ceftriaxone-resistant penA–60-carrying Neisseria gonorrhoeae bacteria during January–April 2025 in Thailand, successfully cured by ceftriaxone therapy. Most patients had prior over-the-counter antimicrobial drug exposure. Ceftriaxone-resistant gonococcal strains are spreading in Thailand, and strengthened gonorrhea and resistance surveillance and effective antimicrobial stewardship programs are needed.

• Yellow Fever Virus Surveillance in Callithrix spp. Marmosets during Epizootic Outbreak, Brazil, 2024–2025
  M. L. Siconelli et al.
• Adverse Outcomes of Travel-Related Cosmetic Procedures, 2014–2024
  K. McNamara et al.
• Therapeutic Challenges in Case of Trichophyton indotineae Dermatophytosis, Singapore, 2025
  T. Foo et al. View Abstract

  Trichophyton indotineae is an emerging dermatophyte frequently associated with terbinafine resistance. We report a case of recalcitrant T. indotineae infection in Singapore with limited response despite prolonged azole therapy, which only resolved after combination therapy with anidulafungin and itraconazole. This case highlights therapeutic challenges and need for improved diagnostics in T. indotineae infections.

• Suspected Sexual Transmission of Dermatophilosis among Men Who Have Sex with Men, Barcelona, Spain, 2025–2026
  V. Descalzo et al. View Abstract

  Dermatophilosis is considered a zoonotic infection. We report 9 cases among men who have sex with men in Barcelona, Spain, during December 2025–March 2026. Whole-genome sequencing revealed highly related isolates forming a distinct lineage within the genus Dermatophilus. Epidemiologic and clinical features of the cases support human-to-human transmission via sexual contact.

• Suspected Sexual Transmission of Dermatophilosis among Men Who Have Sex with Men, Lyon and Paris, France, 2025–2026
  M. Degreze et al. View Abstract

  We report a genomically linked cluster of 9 Dermatophilus congolensis cutaneous infections diagnosed within 2 months among men who have sex with men in Lyon and Paris, France, 2025–2026. Genomic similarity and shared sexual exposures strongly suggest interhuman sexual transmission of this zoonotic bacterium.

• Placental Vascular Pathology Associated with Congenital Lymphocytic Choriomeningitis Virus Infection, Philadelphia, Pennsylvania, USA
  A. Abraham et al. View Abstract

  Congenital lymphocytic choriomeningitis virus (LCMV) infection is associated with major neurologic malformations and fetal demise. We report 2 cases of probable congenital LCMV infection and chorioretinitis, cerebral ventriculomegaly, and placental histopathology in Philadelphia, Pennsylvania, USA. Clinicians who suspect congenital LCMV infection should screen for chorioretinitis, LCMV antibodies, and evidence of placental pathology.

• Concurrent Detection of Swine-Origin Influenza A(H1N1) Virus in Pigs and Farmer, Switzerland
  J. Steiner et al. View Abstract

  We report zoonotic transmission of Eurasian avian-like swine influenza A(H1N1) virus from pigs to a farmer. The pigs and farmer experienced influenza-like illness. Whole-genome sequencing revealed >99.9% isolate sequence identity between hosts. Our findings highlight the risk posed by enzootic swine influenza A virus and the need for genomic and epidemiologic surveillance.

• Burden of Hospitalization for Disseminated Coccidioidomycosis and Coccidioidal Meningitis, Texas, USA, 2016-2023
  C. H. Szeto et al.
• Caballeronia Bacteremia in Children with Cancer, United States
  H. L. Glasgow et al.
• Repeated Extraneous Introduction of Cholera, Thailand, 2007–2025
  K. Okada et al.

Photo Quiz

• Photo Quiz
  R. Gaynes

Research Letters

• Outbreak of Neisseria gonorrhoeae ST16676 among Disseminated Infections, Minnesota, USA, 2025
  D. Evans et al.
• Cutibacterium avidum in Post-Mastectomy Breast with Prior Silicone Injections
  S. Subramanian et al.

Letters

• Utility of Phenotypic and Genomic Analysis to Characterize Antimicrobial-Resistant Neisseria gonorrhoeae of Public Health Concern
  J. H. Melendez
• Increase in bla_NDM among Carbapenemase-Producing, Carbapenem-Resistant Enterobacterales, United States, 2016–2023
  U. Ansari et al.

Books and Media

• Dangerous Miracle: The Astonishing Rise and Looming Disaster of Antibiotics
  J. P. Mills
• Myriad, Microscopic and Marvelous: The World of Antoni van Leeuwenhoek
  J. H. Sogin

Etymologia

• Bacteria [bak-tēr′-ē-ә]
  H. Santos-Dutra et al.
• New Delhi metallo-β-lactamase 1 [nū del′ē mә-tal′ō bāt′ә lak′tә-mās wuhn]
  S. Chakraborty

Online Report

• Assessing evidence to guide primary prevention of Pathogen X
  I. Holmes et al.

Correction

• Correction: Vol. 32, No. 5

Synopsis

• Outbreak of Legionnaires’ Disease Linked to Newly Installed Residential Water Heaters, the Netherlands, 2023
  D. Reukers et al.

Research

• Clinical Predictors of Fatal Outcomes in Human Leptospirosis, Thailand, 2015–2024
  U. Limothai et al.
• Adeno-Associated Virus Type 2 and Human Adenovirus Species F Type 41 Co-infection Associated with Acute Severe Hepatitis in Children, California, USA
  R. Zhuo et al. View Abstract

  Since late 2021, clusters of acute severe hepatitis of unknown etiology in previously healthy children, including some requiring liver transplantation, have been reported worldwide. Co-infection with adeno-associated virus type 2 (AAV2) and human adenovirus species F type 41 (HAdV-F41) has been identified in most cases. Global incidence peaked in 2022, and pediatric liver failure involving co-infection with AAV2 and HAdV-F41 has remained rare in recent years. We report 2 cases of pediatric liver failure associated with AAV2 and HAdV-F41 in California, USA, in March 2024 and January 2025. The patients had high adenovirus loads (393,000 and 480,000 copies/mL), extended adenovirus viremia (2 and 3.5 months), and high AAV2 viral loads (1.3 and 1.0 × 10⁶ copies/mL). One patient required liver transplantation; both patients recovered. Our findings underscore the need for heightened physician awareness and expanded surveillance to identify and characterize new cases, improve understanding of underlying pathophysiology, clarify risk factors, and inform therapeutic strategies.

• Molecular Epidemiology of Scapular Skin Snips and Risk Factors for Mansonella streptocerca, Gabon
  C. Sicard et al.

Dispatches

• Nipah Virus Shedding in Urine from Fruit Bats, Sri Lanka, 2018–2019
  C. Kohl et al.
• Phormia regina as a Vector for Ignatzschineria spp. Bacteremia in People Experiencing Homelessness, Vancouver, Canada
  E. Finlayson-Trick et al.
• Trends in Congenital Syphilis Cases by Maternal Country of Birth, Spain, 2016–2024
  V. Hernando et al.

Online Report

• Inconsistent Strategies to Mitigate the Effects of Batrachochytrium salamandrivorans, Europe
  P. Böning et al.