Category: Infection

Increased heat tolerance in fungi with pathogenic potential due to global warming could bring new fungal diseases. The field of infectious diseases is unique in medicine because it routinely faces new and unexpected syndromes and illnesses. For example, HIV, SARS-CoV, Candida auris and SARS-CoV-2 all emerged in human populations, causing diseases that were previously unknown to medicine. The two major sources of new infectious diseases are likely zoonosis, which refers to the acquisition of infections from non-human hosts, and the environment. Evidence suggests that human infection with HIV, SARS-CoV and SARS-CoV-2 is a result of zoonosis via other mammalian hosts, whereas C. auris is an environmental fungus that has recently emerged as a major human fungal pathogen. 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support Fig. 1: Experimental infection of rabbits and mice provides evidence for a role of temperature in protecting against fungal infection, conferred by endothermy and adaptive immunity. References Fisher, M. C. et al. mBio 11, e00449–20 (2020). PubMed PubMed Central Google Scholar Robert, V. A. & Casadevall, A. J. Infect. Dis. 200, 1623–1626 (2009). Article PubMed Google Scholar Bergman, A. & Casadevall, A. mBio 1, e00212–10 (2010). Article PubMed PubMed Central Google Scholar Casadevall, A. PLoS Pathog. 8, e1002808 (2012). Article CAS PubMed PubMed Central Google Scholar Perfect, J. R., Lang, S. D. & Durack, D. T. Am. J. Pathol. 101, 177–194 (1980). CAS PubMed PubMed Central Google Scholar Meteyer, C. U. et al. J. Wildl. Dis. 47, 618–626 (2011). Article PubMed Google Scholar Rowley, J. J. & Alford, R. A. Sci. Rep. 3, 1515 (2013). Article CAS PubMed PubMed Central Google Scholar de Crecy, E. et al. BMC Biotechnol. 9, 74 (2009). Article PubMed PubMed Central Google Scholar Huang, C. J. et al. Mol. Biol. Evol. 35, 1823–1839 (2018). CAS PubMed Google Scholar Mead, H. L. et al. J. Fungi 6, 366 (2020). Article Google Scholar Robert, V., Cardinali, G. & Casadevall, A. 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Ethics declarations Competing interests The author declares no competing interests. Peer review Peer review information Nature Microbiology thanks Asiya Gusa and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Rights and permissions Reprints and Permissions About this article Cite this article Casadevall, A. Global warming could drive the emergence of new fungal pathogens. Nat Microbiol (2023). https://doi.org/10.1038/s41564-023-01512-w Download citation Published: 29 November 2023 DOI: https://doi.org/10.1038/s41564-023-01512-w Share this article Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

What’s new: China’s population of seniors living with HIV more than doubled from 2015 to 2019 and had a higher rate of new diagnoses than in the U.S. or Europe, a recent study showed. The number of people 60 or older with newly reported HIV infections shot up to 37,275 from 17,451 over those five years, according to a study published in the Chinese Journal of Epidemiology on Nov. 17. While that number fell over the next three years, it remained elevated at just over 27,000 last year. Register to read this article for free. Register

Ross is a nurse and co-president of a nurses’ union. Thomason is an industrial hygienist. Earlier this month, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) voted unanimously to approve its draft infection control guidelines and send it to the CDC for review. This extremely influential document, which was last updated 16 years ago, will be referenced by hospitals and other healthcare facilities to set their infection control policies. However, we’re concerned that the draft offers minimal recommendations to the CDC, and even worse, incorrectly treats surgical masks as respiratory protection. This unscientific guidance puts the U.S. in a weak position to protect patients and staff from currently circulating viruses and will leave us behind the curve in battling future pandemics. One of the biggest issues is with the new “air” category for pathogen transmission. The category includes three levels of precautions based on the transmissibility of a respiratory pathogen: “routine,” “special,” or “extended.” The guidance states that “routine” air precautions — the lowest level — are to be used with “common, often endemic, respiratory pathogens that spread predominantly over short distances.” But any delineation of endemic versus pandemic pathogens is arbitrary because the transmission mode of an aerosol-transmissible pathogen remains the same, so protections should also remain the same. (Note the draft guidelines don’t refer to “pandemic pathogens”; the “special” guidelines refer to “new or emerging” respiratory pathogens for which “effective treatments aren’t available.”) At the “routine” level, HICPAC recommends that masks be worn – but the committee indicates that surgical masks can be used, and healthcare workers may “choose voluntarily” to wear a higher level of protection. At this “routine” level, HICPAC recommends that masks be worn — but they indicate that surgical masks can be used, and healthcare workers may “choose voluntarily” to wear a higher level of protection. Why is HICPAC suggesting that surgical masks offer sufficient respiratory protection? The FDA, the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, and even the CDC have indicated that surgical masks do not offer respiratory protection, especially against aerosol particles. These masks are loose fitting and do not filter the air breathed in by the wearer. HICPAC’s “flexible” guidance will result in inadequate protection for healthcare workers. Follow the Science Nurses are scientists. We follow the precautionary principle, which means we do not wait for proof of harm before taking action to protect people’s health. In other words, we should use the highest level of protections when confronted with a novel virus, and ground these decisions in the evidence: numerous studies show that COVID is spread primarily via aerosol transmission. HICPAC members claim that this part of the guidance is written to be “pathogen agnostic,” and a second part on infection control protocols for individual pathogens — including viruses like COVID-19 — is expected to be completed next year. But approving the “pathogen agnostic” guidance leaves us unprotected. Part of the issue stems from the lack of frontline healthcare workers, unions, or patients on the committee. As a result, we are at risk. We feel betrayed by the institutions that are supposed to safeguard our health. HICPAC’s vote lets us know that nurses and other healthcare workers are expendable to our employers — despite the staffing crisis. The message to us: We are not heroes. We are disposable. Flashbacks to Early COVID “We’re following CDC guidance,” was the answer many registered nurses got in 2020 when we were given a surgical mask instead of an N95 respirator or told to reuse single-use disposable N95s, forcing nurses to risk their lives to care for patients. In April 2020, RNs at Providence Saint John’s Health Center in Santa Monica, California were suspended when they refused to go into COVID patient rooms without an N95. That same month, Celia Yap-Banago, RN, who worked in the cardiac telemetry unit at Research Medical Center in Kansas City, Missouri, died because she contracted COVID at work after her employer failed to screen a patient with active COVID symptoms and did not give her an N95. She had previously raised concerns about the lack of personal protective equipment (PPE) at her hospital. Her employer had allegedly moved PPE from all units to one floor of the hospital so it was not available on her unit, which was not “supposed to” have COVID patients. Back then, the CDC gave healthcare employers flexibility to conduct their own risk assessment. Employers were following the CDC’s crisis and contingency standards that said a surgical mask was acceptable. The result was an enormous number of avoidable COVID infections and tragic deaths among healthcare workers at a time when their care was so desperately needed. We Need Stronger Guidance The committee’s new recommendations propose to give employers the same kind of flexibility that we’ve seen lead to needless illness and death. The draft guidance lets employers decide whether to implement the recommendations based on their own risk assessment. If the CDC approves the draft, it will lead to unnecessary infections, deaths, and long-term health consequences from a wide range of pathogens, including COVID, influenza, and RSV. After nearly 4 years of living with the COVID pandemic, we have all learned hard lessons about PPE and how healthcare employers often focus on the bottom line rather than protecting healthcare workers and patients. What healthcare workers need is more protection, guided by clear and specific guidance for employers. The updated infection control guidance must follow the science. We urge the CDC to reject HICPAC’s guidelines and create a new draft. Input from a broad range of stakeholders must be included: frontline nurses, other healthcare workers who will be implementing the infection control guidance, healthcare worker unions, and experts in infection prevention, ventilation engineering, respiratory protection, and industrial hygienists who have previously been excluded and ignored in HICPAC’s process. It’s time to revise, and it’s time to get the science right. Jean Ross, RN, is a nurse and a president of National Nurses United, the largest union

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Abstract To investigate the clinical and molecular characteristics and evolution of the Zika virus (ZIKV) in Thailand from March 2020 to March 2023. In all, 751 serum samples from hospitalized patients in Bangkok and the surrounding areas were screened for ZIKV using real-time RT-PCR. Demographic data and clinical variables were evaluated. Phylogenetic and molecular clock analysis determined the genetic relationships among the ZIKV strains, emergence timing, and their molecular characteristics. Among the 90 confirmed ZIKV cases, there were no significant differences in infection prevalence when comparing age groups and sexes. Rash was strongly associated with ZIKV infection. Our ZIKV Thai isolates were categorized into two distinct clades: one was related to strains from Myanmar, Vietnam, Oceania, and various countries in the Americas, and the other was closely related to previously circulating strains in Thailand, one of which shared a close relation to a neurovirulent ZIKV strain from Cambodia. Moreover, ZIKV Thai strains could be further classified into multiple sub-clades, each exhibiting specific mutations suggesting the genetic diversity among the circulating strains of ZIKV in Thailand. Understanding ZIKV epidemiology and genetic diversity is crucial for tracking the virus’s evolution and adapting prevention and control strategies. Introduction Zika virus (ZIKV) is a single-stranded RNA flavivirus primarily transmitted by the Aedes mosquitoes. It was first discovered in Uganda in 1947 and identified in Asia in 19661,2. Prior to 2007, only sporadic ZIKV infection cases with self-limiting or mild symptoms were documented in Africa and Asia3. In 2007, the first ZIKV outbreak occurred in Yap Islands, Micronesia, affecting 73% residents4. Subsequent outbreaks occurred in French Polynesia in 2013–2014, during which the association between ZIKV infection and Guillain–Barré syndrome was noted5,6. ZIKV was first identified in Brazil in 20157 and rapidly spread throughout the Americas8. Brazil experienced a dramatic rise in ZIKV-linked neonatal microcephaly cases, resulting in the declaration of a public health emergency of international concern by the WHO in early 2016 to establish a causal connection between ZIKV and congenital disabilities9. Since then, many countries have increased their focus on monitoring ZIKV infections. Before 2016, multiple lines of evidence indicated that ZIKV circulated at low levels, and sporadic cases were reported in Southeast Asian countries including Thailand for decades10. From 2016 to 2017, the number of ZIKV infection cases in Thailand dramatically increased by over 1500 cases; however, it remains unclear whether this rise was because of higher infection rates or increased awareness11. According to the Bureau of Epidemiology, Ministry of Public Health, Thailand, the morbidity rate in 2016 was 1.69 per 100,000 population. From 2019 to 2022, the morbidity rates of ZIKV in Thailand were < 0.5 yearly; the rates were 0.41, 0.36, 0.10, and 0.29 per 100,000 population, respectively12. From 2016 to 2022, the Bureau reported 234 confirmed cases of ZIKV in pregnant women. Among them, 11 patients experienced miscarriages, of which four were related to ZIKV infection. Furthermore, clinical surveillance of 2217 neonates with microcephaly revealed 15 cases of congenital Zika syndrome. While the ZIKV epidemic and its genetic characterization in the Americas are well documented, its presence and molecular epidemiology in Southeast Asia, particularly in Thailand, are areas of concern and ongoing investigation. Few studies have explored the molecular epidemiology of the Thai ZIKV strains. Hence, more research is required on the current genetic characterization and diversity of ZIKV strains in Thailand since the COVID-19 pandemic. This research aimed to comprehensively evaluate the ZIKV prevalence, clinical presentation, and genetic characteristics in Thailand from 2020 to 2023. Investigating the genetic diversity of the current ZIKV circulating in Thailand can help assess the risk of outbreaks and guide public health strategies and preparedness efforts. Results Demographic characteristics and clinical features Out of the 751 samples (Table 1), 12.0% (90/751; 56.7% female and 43.3% male) tested positive for ZIKV infection based on Zika viral RNA presence. There was no significant sex-related difference in ZIKV prevalence (p = 0.507). The median age of patients with confirmed ZIKV was 37 (IQR: 29–46) years (range: 1–71 years). Most patients were in the 36–45 years age group (32.2%), followed by 26–35 years (22.2%) and 46–55 years (13.3%). Prevalence was lower among participants aged ≤ 15 years (10%) and 16–25 years (10%). Age was not significantly associated with increased ZIKV infection (p = 0.187). The median duration from illness onset to Zika RNA diagnosis was 3.5 days (IQR: 3–5 days). Table 1 Demographic characteristics and clinical presentation of individuals according to ZIKV infection, Thailand (2020–2023) (N = 751).Full size table The common clinical symptoms among ZIKV patients included rash (83.1%), fever (71.2%), arthralgia (54.2%), myalgia (39%), and conjunctivitis (22%). Skin rash was strongly associated with ZIKV infection (odds ratio [OR] 19.89, p < 0.001), as were arthralgia (OR 2.63, p < 0.001), and conjunctivitis (OR 11.73, p < 0.001). There was no evidence of ZIKV-associated neurological complications. Next, we examined the correlation between age groups and clinical characteristics and found that only arthralgia or joint pain (p = 0.022) showed a significant association with age groups (Table 2). In addition, the percentage of ZIKV-positive samples in each study year was analyzed and showed that there were 4.67% (12/257) tested positive for ZIKV infection in March 2020-December 2020, 7.54% (8/109) in 2021, 17.5% (47/269) in 2022. Interestingly, 19.8% (23/116) tested positive for ZIKV in the first three months of 2023. Table 2 Clinical characteristics in different age groups of ZIKV-infected participants (N = 59).Full size table Genome sequence and phylogenetic analysis of ZIKV detected in Thailand during 2020–2023 We constructed a maximum likelihood phylogenetic tree and examined the nucleotide identity using complete coding sequences of ZIKV Thai strains of 2020–2023 from this study (n = 17) and additional sequences representing various strains sourced from the GenBank database. Our ZIKV Thai isolates belonged to the Asian lineage and could be classified into two clades: Southeast Asian (SEA) and Asian-American (AA). Out of the 17 ZIKV Thai isolates from 2020 to 2023 (Figs. 1 and 2), 11 were in the SEA clade, which includes strains from Thailand in 2016–2017 (98.5–99.4% sequence identity), Singapore in 2016 (99.0–99.4% sequence identity), and Cambodia in 2019 (98.8–99.5% sequence identity). Most of our SEA ZIKV strains

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A 39-year-old male was hospitalized for one month at an outside hospital with acute respiratory failure which required high flow oxygen supplementation. He was diagnosed with HIV with a CD4 cell count of 36 cells/µL. His risk factors included sex with men and women. Patient was not vaccinated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was also diagnosed with CMV DNAemia of 200,000 copies/mL in plasma and presumed Pneumocystis jirovecii (PJP) pneumonia given consistent imaging findings and a positive beta-D-glucan result. Sputum Pneumocystis Calcofluor white smear was negative, and the patient deferred bronchoscopy. He was treated for CMV DNAemia with intravenous ganciclovir for 3–4 weeks before transitioning to oral valganciclovir. He was also treated for PJP pneumonia with steroids and trimethoprim-sulfamethoxazole until developing hyperkalemia and transitioned to pentamidine to complete treatment. He was started on antiretroviral therapy (ART) with bictegravir/emtricitabine/tenofovir alafenamide. He was discharged on ART, valganciclovir, and prophylactic dapsone for PJP pneumonia prevention. Fig. 1 Coronal CT image shows bilateral peri-broncho-vascular nodules and ground glass opacities Full size image Four months after discharge from the outside hospital, the patient presented to the emergency department in the summer of 2022 with a dry cough for 3 weeks accompanied by intermittent fever, chills, night sweats, dysphagia, and diarrhea. He also had unintentional weight loss of 15 pounds over the last month. He had not been taking his medications for the last month and had been lost to follow up. Patient was raised in Mexico, but had no other recent travel, animal exposures, or current partners. On physical examination, his temperature was 37.8 C°, heart rate of 128 beats per minute, and a respiration rate of 26 breaths per minute with pulse oxygenation of 94%. The patient was diaphoretic but in no acute distress. Other findings were notable for oropharyngeal white patches, bilateral coarse breath sounds, and multiple flesh colored umbilicated papules on the left thorax. The exam was negative for hepatosplenomegaly or lymphadenopathy. On admission, chest x-ray revealed an ill-defined focal hazy opacity of the right lateral middle lung with a computerized tomography (CT) scan subsequently showing extensive areas of bilateral tree-in-bud infiltrate with scattered ground glass and consolidative opacities (Figs. 1, 2 and 3). Labs confirmed advanced HIV with CD4 of 6 cells/µL and a HIV viral load of > 800,000 copies/mL. He was found to be positive for SARS-CoV-2 by polymerase chain reaction (PCR). Plasma CMV PCR was elevated at 3.9 million copies/mL. Fig. 2 Axial CT image demonstrates nodules in peripheral aspects of right upper and left upper lobes Full size image Coronavirus disease 2019 (COVID-19) treatment was deferred as the patient presented with subacute symptoms for several weeks prior to arrival without initial hypoxemia. The patient was started on empiric typical and atypical bacterial pneumonia treatment with vancomycin, cefepime, and doxycycline. He also started PJP treatment with trimethoprim-sulfamethoxazole. Additionally, the patient was started on fluconazole for presumed Candida esophagitis. However, during his admission, the patient developed worsening oxygen requirements and persistent fevers. CT angiogram did not show evidence of pulmonary embolism. C-reactive protein was elevated at 1.7 mg/dL and ferritin was 4,003 ng/mL. Bronchoalveolar lavage (BAL) was performed including viral culture which was positive for CMV. SARS-CoV-2 specific testing was not performed on the BAL fluid, and it is not routinely recovered from the cell lines used for viral culture at the reference laboratory. AFB culture was also performed on the BAL which later grew Mycobacterium avium complex (MAC). Transbronchial biopsies taken demonstrated pneumonitis with numerous enlarged, virally infected cells with both cytoplasmic and large nuclear inclusions. These findings were diagnostic of CMV pneumonitis (Fig. 4). Immunostaining confirmed numerous, scattered positive cells for CMV (Fig. 4B and D) whereas stains for acid fast bacilli and fungi were negative. The patient was initiated on intravenous ganciclovir for CMV pneumonitis. Dilated ophthalmologic exam did not reveal retinitis. The patient’s fevers, dyspnea, and cough resolved over the next seven days, and he was transitioned to oral valganciclovir. Of note, the MAC isolated on BAL was not treated due to patient’s improvement on other therapy. Fig. 3 Axial CT image demonstrates nodules and consolidative opacities in right middle lobe and posterior left lung base Full size image Fig. 4 Histopathologic and immunohistochemical evaluation of transbronchial biopsy. A) Fragment of lung tissue with scattered enlarged cells (small arrowheads) with cytologic features diagnostic for CMV infection in a background of pneumonitis (100x magnification, H&E). B) Immunohistochemical confirmation using antibodies to CMV that are binding to enlarged cells (strong nuclear staining) scattered throughout the biopsy (100x magnification, CMV IHC). C) Multiple enlarged cells (arrowheads), some with characteristic nuclear inclusions in a background of reactive and inflamed lung parenchyma (400x magnification, H&E). D) CMV immunohistochemical staining with strong positivity in the nuclei and scattered positivity in the cytoplasm of the same cells (400x magnification, CMV IHC) Full size image The patient was prescribed a 21-day course of valganciclovir. At outpatient follow up, he reported doing well and was finishing his CMV therapy. On that visit, he was reinitiated on ART with abacavir/dolutegravir/lamivudine. He presented again 2 months after initial presentation with dyspnea and fevers, requiring readmission to the hospital. A repeat CT revealed resolution of the majority of nodular opacities and residual ground glass opacities (Fig. 5), but his CMV PCR showed a plasma level of 5 million copies/mL. Patient’s SARS-CoV-2 by PCR testing was persistently positive, which seemed to indicate inability to clear the virus versus a continued active infection. He was briefly treated with intravenous foscarnet given initial concern for ganciclovir resistance; however, the mutational analysis for ganciclovir, cidofovir, and foscarnet resistance was negative with codons 457–630 of UL97 gene and codons 393–1000 of UL54 gene sequencing. Repeat CD4 was < 10 cells/µL and HIV viral load was 6 million copies/mL concerning for non-adherence to ART. The patient was switched back to intravenous ganciclovir and then to oral valganciclovir with symptomatic improvement. Fig. 5 Coronal CT image obtained 3 months later with resolution of majority of the nodular opacities with

Newswise — Nov. 29, 2023 –The COVID-19 pandemic hampered progress in fighting tuberculosis infections worldwide. Diverted funds meant that one of the world’s leading infectious killers caused 1.3 million deaths in 2022. TB is also the leading cause of death among those with HIV /AIDS worldwide. In 2022, 167,000 people died of HIV-associated TB. This World AIDS Day, the Forum of International Respiratory Societies (FIRS), of which the American Thoracic Society is a founding member, calls on governments, health advocates, and non-government organizations to strengthen their response to AIDS and TB. This collaborative effort is necessary to help realize the World Health Organization’s goal of ending the AIDS epidemic by 2030. “People with latent TB who are living with HIV should have access to TB prevention therapy,” said American Thoracic Society (ATS) President M. Patricia Rivera, MD, ATSF. “Studies show that this therapy can reduce the chances of dying from TB and AIDS by nearly 40 percent.” ATS began in 1905 as the National Association for the Study and Prevention of Tuberculosis. Today, the ATS and other FIRS members, representing the world’s leading respiratory societies, are working to improve lung health globally. In the developing world, TB is often the first sign a person has HIV. Yet, about half of the people living with HIV and tuberculosis are unaware of their co-infection and, therefore, not receiving appropriate care that could prevent not only serious illness but death, according to WHO. Shortly after AIDS emerged, it fueled a global resurgence of TB that continues in many low- and middle-income countries. In 2022, the WHO reported that the largest number of new TB cases were in WHO’s Southeast Asia Region (46 percent), followed by the African Region (23 percent) and the Western Pacific (18 percent). According to the Centers for Disease Control and Prevention, HIV infection is the greatest risk factor for progressing from latent to active TB. HIV increases the risk of other infectious respiratory diseases, including Pneumocystis jirovecii pneumonia and bacterial pneumonia, both of which can be life threatening. Education, prevention strategies, and new medicines, particularly antiretroviral therapies, have reduced the number of AIDS-related deaths by 69 percent since the peak in 2004. Still, the WHO estimates that in 2022, an estimated 39 million people were living with AIDS, 1.5 million of them children. FIRS believes a global response to HIV/AIDS can be strengthened by: Increasing awareness of the continuing global threat of HIV-related disease and its link to TB and other respiratory diseases. Improving the health outcomes of people living with HIV through patient care and research into better prevention, early diagnosis, and effective treatment strategies for both HIV and TB, including rapid diagnosis and treatment for multidrug-resistant TB that is harder to cure. Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programs and increasing the early use of antiretroviral therapy. Improving HIV education in at-risk communities to reduce the incidence of new HIV infections. Reducing HIV-related health disparities and inequities. “The good news is that antiretroviral therapies work, and TB is preventable and curable,” Dr. Rivera said. “These two facts, along with the millions of lives that we can save, should be motivation enough to ensure that these medical advances are available to everyone.”

Please join us on Wednesday, November 29th, 2023 from 2:00 pm-3:00 pm CET What is this survey: A WHO multi-level global survey on the implementation of the minimum requirements for IPC at both the national and health care facility levels using assessment tools accessible online via the WHO IPC Portal. What are the objectives of this survey: To offer countries the opportunity to assess their current implementation status of the WHO minimum requirements for IPC programmes at the national and facility level through the WHO IPC Portal and gather their results and guidance from WHO to make improvement plans. To gather a baseline situational analysis of the implementation of the IPC minimum requirements at the national and facility levels to enable tracking of some indicators included in the monitoring framework of the global action plan 2024-2030 on IPC, and compare it with other available assessments, when appropriate. For more information on the survey itself, please visit the IPC global survey page. Alternatively, join us for this special seminar and learn more how you can get involved and how this can contribute towards your IPC implementation journey! The webinar will be held in English, with simultaneous interpretation available in French, Spanish and Russian. Please note that the participants must register to receive their individual webinar link and password for the session. This will be sent by RAMOS, Aimee Louise, DIRECTLY TO YOUR EMAIL. Check your Spam or Junk Mail if you do not receive the webinar link in your Inbox. Please contact [email protected] with questions.

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