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Early Release

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Issues Available

Volume 29, Number 7—July 2023

  • Nationwide Outbreak of Candida auris Infections Driven by COVID-19 Hospitalizations, Israel, 2021–2022
    R. Biran et al.

    We report an outbreak of Candida auris across multiple healthcare facilities in Israel. For the period of May 2014–May 2022, a total of 209 patients with C. auris infection or colonization were identified. The C. auris incidence rate increased 30-fold in 2021 (p = 0.00015), corresponding in time with surges of COVID-19–related hospitalization. Multilocus sequence typing revealed hospital-level outbreaks with distinct clones. A clade III clone, imported into Israel in 2016, accounted for 48.8% of typed isolates after January 2021 and was more frequently resistant to fluconazole (100% vs. 63%; p = 0.00017) and voriconazole (74% vs. 5.2%; p<0.0001) than were non–clade III isolates. A total of 23% of patients had COVID-19, and 78% received mechanical ventilation. At the hospital level, outbreaks initially involved mechanically ventilated patients in specialized COVID-19 units and then spread sequentially to ventilated non–COVID-19 patients and nonventilated patients.

  • Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis
    I. S. Schwartz et al.

    Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.

  • Clinical and Mycologic Characteristics of Emerging Mucormycosis Agent Rhizopus homothallicus
    S. M. Rudramurthy et al.
  • Rising Incidence of Sporothrix brasiliensis Infections, 2011–2022, Curitiba, Brazil
    R. C. Cognialli et al.
  • Trajectory and Demographic Correlates of Antibodies to SARS-CoV-2 Nucleocapsid in Recently Infected Blood Donors, United States
    J. M. Haynes et al.

    We evaluated antibodies to the nucleocapsid protein of SARS-CoV-2 in a large cohort of blood donors in the United States who were recently infected with the virus. Antibodies to the nucleocapsid protein of SARS-CoV-2 indicate previous infection but are subject to waning, potentially affecting epidemiologic studies. We longitudinally evaluated a cohort of 19,323 blood donors who had evidence of recent infection by using a widely available serologic test to determine the dynamics of such waning. We analyzed overall sample-to-cutoff values for 48,330 donations (average 2.5 donations/person) that had an average observation period of 102 days. The observed peak sample-to-cutoff value varied widely, but the waning rate was consistent across the range, with a half-life of 122 days. Within the cohort, only 0.75% of persons became seronegative. Factors predictive of higher peak values and longer time to seroreversion included increasing age, male sex, higher body mass index, and non-Caucasian race.

  • Triplex ELISA for Assessing Durability of Taenia solium Seropositivity after Neurocysticercosis Cure
    N. L. Tang et al.

    Neurocysticercosis prevalence estimates often are based on serosurveys. However, assessments of Taenia solium seropositivity durability in patients with various neurocysticercosis types are lacking. We optimized a triplex serologic ELISA by using synthetic GP50, T24H, and Ts18var3 antigens for T. solium. We used that assay to test sequential serologic responses over several years after neurocysticercosis cure in 46 patients, 9 each with parenchymal or ventricular neurocysticercosis and 28 with subarachnoid disease. Triplex results were concordant with 98% of positive and 100% of negative enzyme-linked immunoelectrotransfer blots. Eight years after neurocysticercosis cure, 11.1% of patients with parenchymal, 47.3% with subarachnoid, and 41.7% with ventricular disease were still seropositive. Median time to seroreversion after cure in this cohort in a T. solium nonendemic area was 2 years for parenchymal disease, 4 years for ventricular disease, and 8 years for subarachnoid disease. Our findings can inform epidemiologic models that rely on serosurveys to estimate disease burden.

  • Sensitivity to Neutralizing Antibodies and Resistance to Type I Interferons in SARS-CoV-2 R.1 Lineage Variants, Canada
    R. Jacob et al.
  • Effect of Norovirus Inoculum Dose on Virus Kinetics, Shedding, and Symptoms
    Y. Ge et al.

    The effect of norovirus dose on outcomes such as virus shedding and symptoms after initial infection is not well understood. We performed a secondary analysis of a human challenge study by using Bayesian mixed-effects models. As the dose increased from 4.8 to 4,800 reverse transcription PCR units, the total amount of shed virus in feces increased from 4.5 × 1011 to 3.4 × 1012 genomic equivalent copies; in vomit, virus increased from 6.4 × 105 to 3.0 × 107 genomic equivalent copies. Onset time of viral shedding in feces decreased from 1.4 to 0.8 days, and time of peak viral shedding decreased from 2.3 to 1.5 days. Time to symptom onset decreased from 1.5 to 0.8 days. One type of symptom score increased. An increase in norovirus dose was associated with more rapid shedding and symptom onset and possibly increased severity. However, the effect on virus load and shedding was inconclusive.

  • Long-term Epidemiology and Evolution of Swine Influenza Viruses, Vietnam
    J. Cheung et al.
  • Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014
    M. E. Gerdes et al.

    More than 7.15 million cases of domestically acquired infectious waterborne illnesses occurred in the United States in 2014, causing 120,000 hospitalizations and 6,600 deaths. We estimated disease incidence for 17 pathogens according to recreational, drinking, and nonrecreational nondrinking (NRND) water exposure routes by using previously published estimates. In 2014, a total of 5.61 million (95% credible interval [CrI] 2.97–9.00 million) illnesses were linked to recreational water, 1.13 million (95% CrI 255,000–3.54 million) to drinking water, and 407,000 (95% CrI 72,800–1.29 million) to NRND water. Recreational water exposure was responsible for 36%, drinking water for 40%, and NRND water for 24% of hospitalizations from waterborne illnesses. Most direct costs were associated with pathogens found in biofilms. Estimating disease burden by water exposure route helps direct prevention activities. For each exposure route, water management programs are needed to control biofilm-associated pathogen growth; public health programs are needed to prevent biofilm-associated diseases.

  • Highly Pathogenic Avian Influenza Virus (H5N1) Clade Introduced by Wild Birds, China, 2021
    J. Tian et al.

    Highly pathogenic avian influenza (HPAI) subtype H5N1 clade virus has spread globally, causing unprecedented large-scale avian influenza outbreaks since 2020. In 2021, we isolated 17 highly pathogenic avian influenza H5N1 viruses from wild birds in China. To determine virus origin, we genetically analyzed 1,529 clade H5N1 viruses reported globally since October 2020 and found that they formed 35 genotypes. The 17 viruses belonged to genotypes G07, which originated from eastern Asia, and G10, which originated from Russia. The viruses were moderately pathogenic in mice but were highly lethal in ducks. The viruses were in the same antigenic cluster as the current vaccine strain (H5-Re14) used in China. In chickens, the H5/H7 trivalent vaccine provided complete protection against clade H5N1 virus challenge. Our data indicate that vaccination is an effective strategy for preventing and controlling the globally prevalent clade H5N1 virus.

  • Systematic Review of Hansen Disease Attributed to Mycobacterium lepromatosis
    S. M. Collin et al.

    In 2008, bacilli from 2 Hansen disease (leprosy) cases were identified as a new species, Mycobacterium lepromatosis. We conducted a systematic review of studies investigating M. lepromatosis as a cause of HD. Twenty-one case reports described 27 patients with PCR–confirmed M. lepromatosis infection (6 dual M. leprae/M. lepromatosis): 10 case-patients in the United States (7 originally from Mexico), 6 in Mexico, 3 in the Dominican Republic, 2 each in Singapore and Myanmar, and 1 each in Indonesia, Paraguay, Cuba, and Canada. Twelve specimen surveys reported 1,098 PCR–positive findings from 1,428 specimens, including M. lepromatosis in 44.9% (133/296) from Mexico, 3.8% (5/133) in Colombia, 12.5% (10/80) in Brazil, and 0.9% (2/224) from the Asia-Pacific region. Biases toward investigating M. lepromatosis as an agent in cases of diffuse lepromatous leprosy or from Mesoamerica precluded conclusions about clinicopathologic manifestations and geographic distribution. Current multidrug treatments seem effective for this infection.

  • Pulmonary Nontuberculous Mycobacteria, Ontario, Canada, 2020
    T. K. Marras et al.

    We measured annual prevalence of microbiologically defined nontuberculous mycobacterial lung disease in Ontario, Canada. Mycobacterium avium prevalence was 13 cases/100,000 persons in 2020, a 2.5-fold increase from 2010, indicating a large increase in true M. avium lung disease. During the same period, M. xenopi decreased nearly 50%, to 0.84 cases/100,000 persons.

  • Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020–December 2021
    J. Gold et al.

    Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019–2021. During 2020–2021, patients hospitalized with COVID-19–associated fungal infections had higher (48.5%) in-hospital mortality rates than those with non–COVID-19–associated fungal infections (12.3%). Improved fungal disease surveillance is needed, particularly during respiratory virus pandemics.

  • Sexually Transmitted Trichophyton mentagrophytes Genotype VII Infection among Men Who Have Sex with Men
    A. Jabet et al.

    Transmission of dermatophytes, especially Trichophyton mentagrophytes genotype VII, during sexual intercourse has been recently reported. We report 13 such cases in France. All patients were male; 12 were men who have sex with men. Our findings suggest sexual transmission of this pathogen within a specific population, men who have sex with men.

  • Lumpy Skin Disease Virus Infection in Free-Ranging Indian Gazelles (Gazella bennettii), Rajasthan, India
    S. Sudhakar et al.

    Near a zoo in Bikaner, India, 2 free-ranging Indian gazelles (Gazella bennettii) displayed nodular skin lesions. Molecular testing revealed lumpy skin disease virus (LSDV) infection. Subsequent genome analyses revealed LSDV wild-type strain of Middle Eastern lineage. Evidence of natural LSDV infection in wild gazelles in this area indicates a broadening host range.

  • Tuberculosis among Non–US-Born Persons and Persons >60 Years of Age, United States, 2019–2020
    R. Woodruff and R. Miramontes
  • Evolutionary Formation and Distribution of Puumala Virus Genome Variants, Russia
    E. Blinova et al.

    We analyzed Puumala virus (PUUV) sequences collected from bank voles from different regions of Russia. Phylogenetic analysis revealed PUUV reassortments in areas with the highest hemorrhagic fever with renal syndrome incidence, indicating reassortment might contribute to pathogenic properties of PUUV. Continued surveillance is needed to assess PUUV pathogenicity in Russia.

  • Cutaneous Pythiosis in 2 Dogs, Italy
    A. Peano et al.
  • Estimates of Serial Interval and Reproduction Number of Sudan Virus, Uganda, August–November 2022
    V. Marziano et al.

    We estimated the mean serial interval for Sudan virus in Uganda to be 11.7 days (95 CI% 8.2–15.8 days). Estimates for the 2022 outbreak indicate a mean basic reproduction number of 2.4–2.7 (95% CI 1.7–3.5). Estimated net reproduction numbers across districts suggest a marked spatial heterogeneity.

  • Nonnegligible Seroprevalence and Predictors of Murine Typhus, Japan
    T. Aita et al.

    To elucidate the epidemiology of murine typhus, which is infrequently reported in Japan, we conducted a cross-sectional study involving 2,382 residents of rickettsiosis-endemic areas in Honshu Island during August–November 2020. Rickettsia typhi seroprevalence rate was higher than that of Orientia tsutsugamushi, indicating that murine typhus is a neglected disease.

  • Spotted Fever and Typhus Group Rickettsiae in Dogs and Humans, Northeastern Mexico
    R. Palacios-Santana et al.
  • Candida vulturna Outbreak Caused by Cluster of Multidrug-Resistant Strains, China
    H. Du et al.
  • Nannizzia polymorpha as Rare Cause of Skin Dermatophytosis
    P. Sun et al.

    Nannizzia polymorpha is a dermatophyte that rarely infects humans. We describe 2 case-patients from Asia who had an inflammatory type of tinea capitis and tinea manuum caused by infection with this fungus. The diagnosis was confirmed on the basis of the morphologic and molecular characteristics of the microorganism.

  • Detecting, Quantifying, and Isolating Monkeypox Virus in Suspected Cases
    M. Argüelles et al.
  • Fatal Invasive Mold Infections after Transplantation of Organs Recovered from Drowned Donors, United States, 2011–2021
    K. Wu et al.

    Drowned organ donors can be exposed to environmental molds through the aspiration of water; transplantation of exposed organs can cause invasive mold infections in recipients. We describe 4 rapidly fatal cases of potentially donor-derived invasive mold infections in the United States, highlighting the importance of maintaining clinical suspicion for these infections in transplant recipients.

Research Letters
  • Long-Term SARS-CoV-2 Antibody Seroprevalence in Blood Donors, Italy
    M. Ferrari et al.

    We evaluated SARS-CoV-2 antibody response in voluntary blood donors in Italy at different timepoints. Immediately after lockdown easing, 908/25,657 donors (3.5%) had low IgG titers against nucleocapsid. In the next 2 years, titers increased despite few COVID-19 symptoms. On multivariate analysis, allergic rhinitis was associated with reduced risk for symptomatic COVID-19.

  • Novel Highly Pathogenic Avian Influenza A(H5N1) Clade Virus in Wild Birds, South Korea
    S. Lee et al.

    We isolated 5 highly pathogenic avian influenza A(H5N1) clade viruses from wild waterfowl feces in South Korea during November 2022. Whole-genome sequencing and phylogenetic analysis revealed novel genotypes produced by reassortment with Eurasian low pathogenicity avian influenza viruses. Enhanced surveillance will be required to improve prevention and control strategies.

  • Mycobacterium angelicum Infection in Urinary Tract, French Polynesia
    M. Keita et al.
  • Reemergence of Dengue Virus Serotype 3, Brazil, 2023
    F. Naveca et al.

    We characterized 3 autochthonous dengue virus serotype 3 cases and 1 imported case from 2 states in the North and South Regions of Brazil, 15 years after Brazil's last outbreak involving this serotype. We also identified a new Asian lineage recently introduced into the Americas, raising concerns about future outbreaks.

  • Candida auris‒Associated Hospitalizations, United States, 2017–2022
    K. Benedict et al.

    Using a large US hospital database, we reviewed 192 Candida auris‒associated hospitalizations during 2017–2022, including 38 (20%) C. auris bloodstream infections. Hospitalizations involved extensive concurrent conditions and healthcare use; estimated crude mortality rate was 34%. These findings underscore the continued need for public health surveillance and C. auris containment efforts.

  • Extensively Drug-Resistant Shigella flexneri 2a, California, USA, 2022
    J. Caldera et al.

    In Los Angeles, California, USA, persistent, refractory shigellosis was diagnosed in an immunocompetent man who has sex with men. Whole-genome sequencing augmented phenotypic antimicrobial susceptibility testing to comprehensively profile bacterial drug resistance and appropriately guide therapy and clear the infection.

  • Isolation of Elizabethkingia spp. from Diagnostic Specimens from Dogs and Cats, USA, 2019–2021
    J. Weese et al.
  • Low Susceptibility of Pigs against Experimental Infection with PAIV H5N1, Clade
    A. Graaf et al.
Books and Media
Online Report
  • Epidemiology of Pathogens Listed as Potential Bioterrorism Agents, the Netherlands, 2009‒2019
    J. Broertjes et al.


Volume 29, Number 8—August 2023

  • Clinical Characteristics of Corynebacterium ulcerans Infection, Japan
    A. Yamamoto et al.
  • Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum
    K. Shapiro et al.
  • Waterborne Infectious Diseases Associated with Exposure to Tropical Cyclonic Storms, United States
    V. D. Lynch and J. Shaman
  • Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan
    B. Yoo et al.
  • Prospecting for Zoonotic Pathogens by Using Targeted DNA Enrichment
    E. E. Enabulele et al.
  • Emerging Corynebacterium diphtheriae Species Complex Infections, Réunion Island, France, 2015–2020
    T. Garrigos et al.
  • Chromosome-Borne CTX-M-65 Extended-Spectrum β-Lactamase–Producing Salmonella enterica Serovar Infantis, Taiwan
    Y. Liao et al.
  • Multidrug Resistant Shigella sonnei Bacteremia among Persons Experiencing Homelessness, Vancouver, British Columbia, Canada
    A. Stefanovic et al.
  • Human Fecal Carriage of Streptococcus agalactiae ST283, Thailand
    T. Barkham et al.
Research Letters
  • Soft Tissue Infection of Immunocompetent Man with Cat-Derived Globicatella Species
    N. K. Jones et al.
  • Fatal Meningitis from Shiga Toxin–Producing Escherichia coli in 2 Full-Term Neonates, France
    G. Geslain et al.
  • Case of Extensively Drug-Resistant Shigella sonnei Infection, United States
    H. Choia et al.
  • Infected Aneurysm Caused by Desulfovibrio desulfuricans Infection
    T. Fujihara et al.
  • Longitudinal Association of COVID-19 Hospitalization and Death with Online Search for Loss of Smell or Taste
    D. Toomre et al.
  • Rio Negro Virus Infection, Bolivia, 2021
    R. Mafayle et al.


The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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