Early Release

Perspective

• Limitations of Global Surveillance for Neisseria gonorrhoeae Antimicrobial Resistance
  S. J. van Hal et al. View Abstract

  Neisseria gonorrhoeae bacteria cause ≈82 million infections annually worldwide. As antimicrobial resistance (AMR) accelerates, the actual prevalence of antimicrobial-resistant infections remains obscured because of fragmented, heterogeneous, and often absent surveillance systems. The efficacy of ceftriaxone, widely used as first-line therapy, is increasingly threatened by the expansion of strains harboring the mosaic penA 60.001 allele, first documented in 2015 and now recognized globally as the dominant determinant of AMR. Our systematic search of the published literature identified 212 such isolates; nearly half were detected after 2022 in England and Australia, and epidemiologic data frequently linked acquisition of infection to the Asia-Pacific region. The substantially higher case numbers reported in those countries reflect the strength of their gonococcal AMR surveillance systems and more timely public data sharing. Our findings suggest that underreporting of the actual prevalence of ceftriaxone resistance is likely and that the opportunity for action is limited.

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. View Abstract

  We explored the association between frailty and respiratory infectious diseases (RIDs) through a large cohort of 423,691 participants in the UK Biobank. Participants without baseline RIDs were assessed by physical frailty and frailty index. A total of 16,848 participants had repeated assessments. We divided participants into nonfrail, prefrail, and frail groups and categorized frailty changes as alleviation, maintenance, or aggravation. We estimated risk for RIDs, including influenza, pneumonia, and other acute lower respiratory infections. Compared with nonfrailty, prefrailty and frailty increased RID risk 1.32–2.29 times. Each 0.1-point increase in frailty index per year raised RID risk by 47%; each 1-point increase in physical frailty per year increased risk by 26%. Frailty worsening (e.g., aggravation of prefrailty) amplified risk by 2.31–4.16 times. Partial frailty improvement did not fully eliminate risk. Frailty is a modifiable, dynamic risk factor, underscoring the need for early frailty identification and intervention to reduce RIDs in high-risk populations.

• In Vitro Antifungal Drug Susceptibility of Feline Sporothrix schenckii Complex Isolates, Thailand, 2023–2025
  C. Yurayart et al. View Abstract

  Feline sporotrichosis is a public health concern because it is a zoonotic illness and has a prolonged treatment time. We report laboratory-confirmed cases of feline Sporothrix schenckii complex infection submitted to a laboratory in Thailand during 2023–2025 and evaluate their in vitro antifungal drug susceptibility profiles for amphotericin B, itraconazole, posaconazole, voriconazole, ketoconazole, fluconazole, and flucytosine. A total of 1,178 S. schenckii complex isolates were identified. Overall, 368 isolates did not show reduced susceptibility. We observed single-drug reduced susceptibility to amphotericin B (60 isolates), posaconazole (41 isolates), voriconazole (9 isolates), and terbinafine (4 isolates). We observed a reduced susceptibility to itraconazole in 687 isolates: 321 single-drug, 270 co-reduced, and 96 multidrug-reduced isolates. An increasing number of feline sporotrichosis cases and escalating reduced susceptibility to itraconazole underscore the need for continued surveillance and susceptibility testing to support management in complex cases.

• Role of Households with Children in Community Spread of Multidrug-Resistant Enterobacterales, St. Louis, Missouri, USA
  B. Breeze et al. View Abstract

  Community-acquired multidrug-resistant (MDR) Enterobacterales bacteria are an increasing public health concern, yet whether households play a role in community spread remains unclear. We investigated 150 households with children in St. Louis, Missouri, USA, for MDR Enterobacterales. We cultured swab specimens from household members and environmental surfaces for identification and antimicrobial susceptibility testing. We also performed whole-genome sequencing in the 53 (35%) households where >1 MDR Enterobacterales species were recovered. Enterobacter hormaechei predominated, followed by Klebsiella pneumoniae and Pantoea species. Whole-genome sequencing revealed closely related strains shared between persons and environmental surfaces, suggesting potential intra-household transmission. We identified >1 horizontal gene transfer event between Enterobacterales genera within a household. On multivariable analysis, households that had children attending daycare, a member with an ADHD diagnosis, and dog ownership were associated with increased odds of household MDR Enterobacterales colonization. Households likely serve as major contributors in acquisition and community spread of MDR Enterobacterales.

• Identification of a novel recombinant human adenovirus genotype B117 from two pediatric community-acquired pneumonia cases in China
  J. Wang et al.
• Antimicrobial-Resistant Neisseria gonorrhoeae of Public Health Concern, New South Wales, Australia, 2022–2024
  L. J. Walker et al. View Abstract

  Antimicrobial-resistant Neisseria gonorrhoeae poses a serious public health threat. In Australia, N. gonorrhoeae isolates with ceftriaxone MICs >0.125 mg/L or azithromycin MICs >256 mg/L required follow-up by public health officials. Odds of culture-positive notifications meeting those criteria increased from 2017–2019 (n = 11) to 2022–2024 (n = 94) (odds ratio 8.58 [95% CI 4.81–17.0]). Local acquisition was frequent (78.7%). Isolates with decreased ceftriaxone susceptibility were more common in female and heterosexual patients than were isolates with high-level azithromycin resistance. We identified 9 genomically linked clusters (<15 single-nucleotide polymorphisms), 3 with sizable clonal expansion. Initial test of cure was negative for 81/94 (86.2%) 2022–2024 cases; of the rest, 9 cases had no follow-up visits, 2 were reinfected, and 2 failed initial treatment. Improving follow-up and reporting of treatment failure would strengthen case management protocols. Culture-based diagnostics remain essential to detect antimicrobial resistance, inform surveillance, and curb the rising resistance trend.

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 Introductions of Cholera, Thailand, 2007–2025
  K. Okada et al. View Abstract

  Genomic analyses identified 4 seventh pandemic Vibrio cholerae El Tor clades in Thailand (2007–2025). Closely related to other South Asian strains, the clades reveal that repeated cross-border introductions, rather than local persistence, drive outbreaks. Our findings highlight the importance of genomic surveillance for monitoring transmission and informing regional control strategies.

Photo Quiz

• Photo Quiz
  R. Gaynes

Research Letters

• Neisseria gonorrhoeae Sequence Type 16676 in Disseminated Infections, Minnesota, USA, 2025
  D. Evans et al. View Abstract

  We summarize an outbreak investigation of Neisseria gonorrhoeae sequence type 16676 associated with disseminated gonococcal infections in Minnesota, USA, in 2025. This strain emerged rapidly, carried a plasmid with a tetracycline resistance gene, and encoded a porB1a allele. Prospective genomic surveillance enabled detection and epidemiologic investigation of this outbreak.

• 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.
• National Surveillance of Enterovirus D68 Upsurge, France, 2024
  M. Jeannoël et al.
• Prognostic Value of PCR Cycle Threshold in Crimean-Congo Hemorrhagic Fever, Iraq, 2022–2023
  R. I. Khaleel et al.

Dispatches

• Nipah Virus Shedding in Urine from Fruit Bats, Sri Lanka, 2018–2019
  C. Kohl et al.
• Phormia regina Fly as Vector for Ignatzschineria spp. Bacteremia in Persons Experiencing Homelessness, Canada, 2025
  E. Finlayson-Trick et al. View Abstract

  Ignatzschineria spp. bacteria are emerging pathogens whose vectors historically have not been clearly identified. We used molecular methods to establish a relationship between the black blow fly (Phormia regina) and human Ignatzschineria bacteremia in persons experiencing homelessness in Vancouver, British Columbia, Canada, validating a novel transmission pathway in a vulnerable urban population.

• Trends in Congenital Syphilis Cases by Maternal Country of Birth, Spain, 2016–2024
  V. Hernando et al.
• Vascularized Iris Mass as Sentinel Manifestation of Syphilis in Patient with HIV Infection, Spain, 2025
  M. Caminal-Caramés et al.
• Cluster of Human Tanapox Cases in Wildlife Reserve, South Africa, 2024
  M. Birkhead et al.
• Cat Scratch Disease Associated with Acute Hearing Loss
  M. Yakubovsky et al.

Online Report

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

Research

• Implementation and Early Outcomes of Laboratory Proficiency Testing Program for National Wastewater Surveillance System, USA, 2024
  H. Dutcher et al.

Dispatch

• Camel Prion Disease, Tataouine, Tunisia, 2019–2021
  A. Amara et al.