Articles from Emerging Infectious Diseases

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.

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.

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.

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 stercoralis nematode 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.

Blastomyces urine antigen testing is a sensitive blastomycosis diagnostic method, but its utility for active case identification during outbreaks is unknown. We evaluated urine antigen testing for identifying blastomycosis cases during a 2023 outbreak at a Michigan, USA, paper mill and assessed demographic and clinical factors associated with test positivity. Approximately 2 months after the outbreak was recognized, we collected work and health information for 603 employees; 95% (n = 578) underwent urine antigen testing and 9% (n = 52) tested positive, including 25 previously undetected cases. Blastomycosis-like symptoms were associated with test positivity (p<0.001), but 10% of employees with positive results were asymptomatic. Recent hospitalization for blastomycosis was associated with test positivity (p = 0.02) and higher antigen levels. Further research into urine antigen testing is needed clarify its suitability for detecting mild and asymptomatic infections during outbreak investigations. Urine antigen testing had high acceptability among employees and effectively identified additional cases.

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.

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.

After a steady decline in tuberculosis (TB) during 2010–2019, the United States reported a sharp drop in 2020 and increases during 2021–2023. We assessed whether TB cases during 2020–2023 differed from what was expected in the absence of the COVID-19 pandemic. Using data from the Centers for Disease Control and Prevention National TB Surveillance System and Electronic Disease Notification system, we constructed Poisson regression models to predict frequencies of TB cases, persons receiving TB diagnosis within 1 year of arrival, and persons for whom postarrival TB follow-up was recommended on the basis of 2010–2019 trends. We observed lower than predicted TB cases (7,170 observed, 8,822 predicted), persons receiving diagnosis within 1 year of arrival (208 observed, 259 predicted), and persons with class B TB (4,827 observed, 7,169 predicted) in 2020. Migration changes and COVID-19–related factors likely contributed to the decrease in TB in 2020 and increases during 2021–2023.

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.

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.

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).

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.

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 adverse events, 126/477 (26%) required regimen change, and 83% of patients completed therapy. Home-based adverse event monitoring can help improve tuberculosis treatment adherence.

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.

Entamoeba moshkovskii is historically considered nonpathogenic. We report a case of severe extraintestinal infection in a patient from eastern India who had abdominal pain, fever, weight loss, anemia, and a splenic abscess. Molecular analysis confirmed E. moshkovskii as the causative agent. This case highlights this parasite’s potential to cause severe illness.

We provide evidence for natural Hendra virus infections and associated serology in a cohort of Australian black flying foxes (Pteropus alecto) transferred from Queensland to the Australian Centre for Disease Preparedness in Victoria, Australia. This study supports the likelihood that flying foxes undergo cycles of infection and reinfection and possibly recrudescence.

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.

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.

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.

We evaluated human Crimean-Congo hemorrhagic fever virus (CCHFV) seroprevalence in hunter-gatherer populations of northeastern Democratic Republic of the Congo. We tested blood from 300 participants for CCHFV antibodies; 4% were CCHFV-positive. CCHFV likely has been circulating undetected in the country, indicating the need for a more robust surveillance system.

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.

We report a case of a cutaneous infection in an immunocompetent person in China caused by an uncharacterized Mycobacterium strain. The patient isolate was identified as a novel species by whole-genome sequencing. We propose Mycobacterium nanjing sp. nov. as the name for this new species.

We report a cutaneous infection caused by Paraconiothyrium cyclothyrioides, a rare environmental mold, in a lung transplant recipient in Georgia, USA. The infection resolved with posaconazole after substantial diagnostic delays and related side effects. This case underscores the need for improved clinical awareness, diagnostic testing, treatments, and surveillance for such infections.

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.

We describe 2 plant-associated posttraumatic Kosakonia infections in Argentina. Facing biochemical and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry limitations, we used whole-genome sequencing to successfully identify K. cowanii and K. oryzae as the causative agents. Our data highlight the crucial role of genomics in correctly identifying these underestimated emerging pathogens.

We report a case of Mycobacterium riyadhense pulmonary disease in a patient who relocated from Saudi Arabia to Japan. Epidemiologic data and whole-genome analyses of the isolated strains suggested that the infection might have been acquired in Saudi Arabia and persisted, rather than a recent local acquisition in Japan.

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 antimicrobial resistosome is important for future infection treatment considerations.

Pregnant migrant women face increased tuberculosis vulnerability. We queried clinicians in Europe on Mycobacterium tuberculosis infection screening and management among pregnant migrants. Fewer than half reported routinely performing screening, and diagnostic and preventive practices varied widely. Those responses highlight substantial heterogeneity and uncertainty in current M. tuberculosis infection screening practices.

Histoplasmosis remains a neglected yet deadly fungal infection, disproportionately affecting persons living with HIV/AIDS and other immunocompromised populations in endemic regions. Despite the World Health Organization’s designation of Histoplasma as a high-priority pathogen, the disease remains underdiagnosed and excluded from national surveillance systems, resulting in delayed treatment and high death rates. To coordinate a global response, the International Society for Human and Animal Mycology convened a Histoplasmosis Working Group during its 2025 congress in Brazil. Experts engaged in structured discussions across 5 domains: awareness, research, diagnostics and treatment, capacity building, and fungal biology. The group highlighted persistent diagnostic delays, underuse of antigen testing, and poor access to liposomal amphotericin B and itraconazole. Innovations such as lateral flow assays and molecular tools were discussed, alongside the need for biobanks and validated diagnostic algorithms. A global 90–90–90 target for histoplasmosis by 2030 was proposed to improve diagnosis, treatment, and survival.

Blastomyces urine antigen testing is a sensitive blastomycosis diagnostic method, but its utility for active case identification during outbreaks is unknown. We evaluated urine antigen testing for identifying blastomycosis cases during a 2023 outbreak at a Michigan, USA, paper mill and assessed demographic and clinical factors associated with test positivity. Approximately 2 months after the outbreak was recognized, we collected work and health information for 603 employees; 95% (n = 578) underwent urine antigen testing and 9% (n = 52) tested positive, including 25 previously undetected cases. Blastomycosis-like symptoms were associated with test positivity (p<0.001), but 10% of employees with positive results were asymptomatic. Recent hospitalization for blastomycosis was associated with test positivity (p = 0.02) and higher antigen levels. Further research into urine antigen testing is needed clarify its suitability for detecting mild and asymptomatic infections during outbreak investigations. Urine antigen testing had high acceptability among employees and effectively identified additional cases.

Reports of ocular manifestations of Lyme disease (LD) are uncommon, and signs and symptoms may be overlooked by physicians. We conducted a retrospective case series of ocular LD reported during 1988–2025. Among 27 published reports in PubMed, we noted that, in 38 cases, the most common ocular manifestation was uveitis, representing 45% of cases, followed by optic neuritis and cranial nerve palsies (including trochlear and abducens). Not all cases met Centers for Disease Control and Prevention surveillance guidelines for LD, given that some case reports were published before the current guidelines. Cases that provided microbiologic proof were 2 anterior uveitis cases, 1 case of anterior uveitis with abducens’s nerve palsy, 1 case of intermediate uveitis, and 1 case of intranuclear ophthalmoplegia. Ocular LD can have a broad variety of manifestations; therefore, physicians should be aware of those manifestations and obtain microbiologic proof for a more definitive diagnosis and epidemiologic value when possible.

Group A Streptococcus (GAS) causes a variety of diseases in humans but is not widely appreciated as a cause of meningitis. During 1997–2022, ten sites participating in the Active Bacterial Core Surveillance network in the United States identified GAS meningitis cases. We calculated annual incidence and case-fatality rates (CFRs) for 320 of those cases and determined antimicrobial resistance by whole-genome sequencing. Annual incidence of GAS meningitis ranged from 0.02 to 0.07 cases/100,000 persons. Children <1 year of age had the highest average annual incidence, 0.23 cases/100,000 children. GAS meningitis had a higher CFR (19.4%) than meningitis caused by group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae. Clindamycin resistance among GAS meningitis isolates increased from 3.2% during 1997–2002 to 17.7% during 2018–2022. Clinicians should be aware that meningitis is an uncommon but severe manifestation of invasive GAS and has a higher CFR than more established meningitis etiologies.

A previous study demonstrated noninferior efficacy of 4-month rifapentine/moxifloxacin regimen for tuberculosis (TB) treatment compared with the standard regimen. We analyzed pregnancy outcomes of women who became pregnant during the study. Among 740 women, 97 (13.1%) became pregnant. Of 102 pregnancies (in 97 participants), 30 (29.4%) participants were exposed to study drugs. Fetal loss was reported for 3/13 (23.1%) in the control regimen, 1/9 (11.1%) in the rifapentine/moxifloxacin regimen, and 1/8 (12.5%) in the rifapentine regimen. Among 21 live births in exposed pregnancies (7 in each arm), 1 infant with a congenital anomaly was reported in a participant on the rifapentine regimen. Among women receiving a short rifapentine/moxifloxacin regimen for tuberculosis who became pregnant, we observed no elevated rates of fetal losses or congenital anomalies.

Haematospirillum jordaniae was first identified as a human pathogen in 2016. In this article, we describe 4 patients who had H. jordaniae infections identified in 2020 and who had temporally and spatially linked environmental exposures. Three of the 4 patients reported leg injuries while participating in recreational river water activities in south-central Pennsylvania, USA. In 2024, we detected H. jordaniae in river samples collected at locations identified during patient interviews. All patients sought emergency department services for clinical assessment; however, the causative bacterial isolate was not initially identified. H. jordaniae was identified as the bacterial cause months after patient treatment and discharge. Although H. jordaniae infections are considered rare, the true occurrence is unknown. Additional information about the organism’s ecology and environmental seasonality could guide public health messaging and increase awareness among healthcare providers.

Reptile-associated outbreaks of human Salmonella infections are increasing in Canada, coinciding with a rise in the popularity of reptiles as pets. We conducted a retrospective analysis of surveillance data for human Salmonella case-patients in Ontario during 2015–2022. We compared serotypes and reptile types for those reporting domestic reptile or amphibian exposure with veterinary Salmonella isolates reported during the same period. Case-patients commonly reported contact with reptile types from which Salmonella was most frequently isolated. Some serotypes from human case-patients were closely associated with contact with specific reptile types, including Salmonella Paratyphi B biovar Java (Salmonella Paratyphi B variant L (+) tartrate +) with snakes, Salmonella Agbeni with turtles, and Salmonella Cotham, Salmonella Chester, and Salmonella Tennessee with bearded dragons. Salmonella was most likely to be reported from reptiles fed a carnivorous diet. Education of reptile owners could help promote proper veterinary care and reduce transmission of zoonotic infections.

Candida bloodstream infections, and their increasing antifungal resistance, are a global concern. In this cross-sectional study, we analyzed 2,443 culture-confirmed candidemia cases reported in South Africa during 2012–2017 to assess the effect of previous antifungal exposure on nonsusceptible Candida infection. We classified cases by species resistance profile and patient’s antifungal use within 14 days before infection. We found that 48% of cases were caused by nonsusceptible species, and 20% of patients had prior antifungal exposure, mainly to fluconazole. In patients >90 days of age, prior antifungal use was significantly associated with nonsusceptible Candida bloodstream infection (adjusted OR 2.02, 95% CI 1.43–2.87; p<0.001), with species-specific effects. No such association was found in neonates and young infants, for whom hospital transmission appeared more influential. Our findings underscore the need for targeted antifungal stewardship and enhanced infection prevention to mitigate antifungal resistance in South Africa.

The complexity of rickettsial serodiagnostics during acute illness has limited clinical characterization in Africa. We used archived samples from sepsis (n = 259) and acute febrile illness (n = 70) cohorts in Uganda to identify spotted fever and typhus group rickettsiae by using immunofluorescence assay and clinically validated rRNA reverse transcription PCR (RT-PCR). Among 329 participants, 10.0% had rickettsial infections (n = 33; n = 20 identified with immunofluorescence assay and n = 13 by RT-PCR). Serum rRNA RT-PCR was 75.0% (95% CI 42.8–94.5%) sensitive and 91.2% (95% CI 85.8–95.1%) specific. Thrombocytopenia was more common among patients with rickettsial infections than with other nonmalarial infections (adjusted odds ratio 3.7; p = 0.003). No participants were on a tetracycline antimicrobial drug at admission. rRNA RT-PCR is a promising diagnostic strategy for identifying acute rickettsial infections. Doxycycline should be included in empiric antimicrobial drug regimens for nonmalarial febrile illness in this region.

Prevalence of emerging fungal infections is increasing, particularly among immunocompromised persons, children, and older persons. We report 108 cases of Scheffersomyces spartinae infection in pediatric patients from Karachi and other cities in Pakistan, of which 107 were identified from blood cultures. Cultures were initially misidentified as Clavispora lusitaniae by a biochemical assay before speciation as S. spartinae by whole-genome sequencing. All isolates were from children <12 years of age, and >69% were from children <1 month of age. Isolates were genetically distinct across regions of Pakistan; however, genetic diversity was low in isolates from patients in Karachi and nearby Nawabshah and had median differences of just 9 pairwise nucleotide variants. This study demonstrates S. spartinae is a potentially emerging pathogen in neonates and young infants in Pakistan. The findings highlight the limitations of phenotypic identification for detecting emerging fungal infections and underscore the value of molecular identification approaches.

Mpox was first identified against the backdrop of the smallpox eradication campaign. Monkeypox virus (MPXV), the causative agent of mpox, has been maintained in animal reservoirs in the forested regions of West and Central Africa as 2 distinct clades; clade I has historically caused more severe infection in Central Africa than clade II, historically found in West Africa. However, rapid reemergence and spread of both MPXV clades through novel routes of transmission have challenged the known characteristics of mpox. We summarize mpox demographic distribution, clinical severity, and case-fatality rates attributed to genetically distinct MPXV subclades and focus on MPXV clade Ib, the more recently identified subclade. Broad worldwide assistance will be necessary to halt the spread of both MPXV clades within mpox endemic and nonendemic regions to prevent future outbreaks.

Talaromycosis is a life-threatening fungal disease that primarily affects immunocompromised persons in Southeast Asia. We conducted a multicenter, case–control study recruiting participants with advanced HIV disease in Vietnam; 205 case-patients with culture-confirmed talaromycosis were matched to 405 control-patients by age, sex, and CD4 count. Occupational exposure to tropical plants (odds ratio [OR] 1.73 [95% CI 1.10–2.73]; p = 0.017) and to farmed animals (OR 2.07 [95% CI 1.20–3.55]; p = 0.009) were independent risk factors for talaromycosis. Talaromycosis risk was higher in participants from highland regions than in persons from lowland regions (p<0.05). Participants from lowland regions who had lived or traveled to highland regions had a higher risk for talaromycosis (OR 3.15 [95% CI 1.49–6.64]; p = 0.003). This study confirms the epidemiologic correlation between talaromycosis and soil exposure and demonstrates an epidemiologic link between talaromycosis and residence in or travel to highland regions of Vietnam.

Spiroplasma ixodetis has been reported to cause the rare combination of cataract and uveitis in infants. Through a retrospective analysis of available literature and additional unpublished cases, we identified 28 eyes from 18 infants from 8 countries in Europe with cataracts and intraocular inflammation. The cataracts were bilateral in 55.6%, unilateral in 44.4%, and progressive in 46.4% of patients. Granulomatous anterior uveitis was found in all infants. Presence of S. ixodetis was supported by PCR (positive in 89.3% of eyes tested), transmission electron microscopy (positive in 90% of eyes tested), or culture of aspirated lens material (positive in 87.5% of eyes tested). Treatment with macrolide antimicrobial drugs, corticosteroids, and lensectomy appeared to be effective. Two patients had a recurrence of the uveitis after lens extraction and needed prolonged treatment. To increase awareness of S. ixodetis, we suggest its inclusion with the organisms of the TORCH acronym.

During 2007–2020, we conducted a cross-sectional prevalence study among patients with acute undifferentiated febrile illness to describe the burden and long-term epidemiology of rickettsioses in Cambodia. Serum samples were collected from 10,243 participants, along with epidemiologic data, information on clinical symptoms, demographic characteristics, and risk factors. A total of 802 (7.8%) participants met the definition for acute rickettsial infection after ruling out malaria, influenza, dengue, and chikungunya; 557 (5.4%) cases were typhus, 154 (1.5%) spotted fever, and 136 (1.3%) scrub typhus. Overall seroprevalence was 18.1% (1,857/10,243). Increased age, residence in urban settings, and recent travel to forests were significantly associated with rickettsial infection. Symptoms significantly associated with infection included rash, vomiting, and skin lesions. Our results confirm the underlying burden of rickettsioses and associated risk factors in Cambodia and highlight the need for accessible diagnostics and clinical guidance that consider rickettsioses when treating persons with acute undifferentiated febrile illness.

Invasive aspergillosis (IA) caused by Aspergillus flavus remains poorly described. We retrospectively analyzed 54 cases of IA caused by A. flavus reported in France during 2012–2018. Among cases, underlying IA risk factors were malignancy, solid organ transplantation, and diabetes. Most (87%, 47/54) infections were localized, of which 33 were pleuropulmonary and 13 were ear-nose-throat (ENT) infection sites. Malignancy (70% [23/33]) and solid organ transplantation (21% [7/33]) were the main risk factors in localized pulmonary infections, and diabetes mellitus was associated with localized ENT involvement (61.5%, [8/13]). Fungal co-infections were frequent in pulmonary (36%, 12/33) but not ENT IA (0 cases). Antifungal monotherapy was prescribed in 45/50 (90%) cases, mainly voriconazole (67%, 30/45). All-cause 30-day case-fatality rates were 39.2% and 90-day rates were 47.1%, and rates varied according to risk factor, IA site, and fungal co-infections. Clinicians should remain vigilant for A. flavus and consider it in the differential diagnosis for IA.

Risk factors for developing bloodstream infections (BSIs) caused by Aerococcus bacteria remain insufficiently examined. In this nationwide case–control study in Sweden, 19 of 23 clinical microbiological laboratories identified patients who had aerococcal BSIs during 2012–2016. We compared each of those index patients with 4 controls matched for age, sex, and county of residence. Overall, 588 episodes of aerococcal BSI occurred over 39.6 million person-years, corresponding to an average incidence of 1.48/100,000 person-years (95% CI 1.37–1.60/100,000 person-years). Most infections developed in men >65 years of age. Aerococcal BSI was associated with neurologic (adjusted odds ratio 2.89 [95% CI 2.26–3.70]) and urologic (adjusted odds ratio 2.15 [95% CI 1.72—2.68]) conditions and previous hospitalization or infection treatment. Our findings support the previously observed predilection for aerococcal BSIs developing in elderly men with urinary tract disorders. Awareness of Aerococcus spp. in patients, especially elderly men, will be needed to manage invasive infections.