Clinical Infectious Diseases最新文献

{"title":"FDG-PET/CT Demonstrates Superior Detection of Multiorgan Involvement in Paracoccidioidomycosis Compared With Conventional Staging.","authors":"Pricila G Cunha, Maria Emilia Seren Takahashi, Raquel S B Stucchi, Mariana Paixão Ribeiro, Thiago F Souza, Carmino Antonio de Souza, Barbara Juarez Amorim, Maria Luiza Moretti, Plinio Trabasso, Celso Dario Ramos","doi":"10.1093/cid/ciag372","DOIUrl":"10.1093/cid/ciag372","url":null,"abstract":"<p><strong>Background: </strong>Paracoccidioidomycosis (PCM) is a neglected systemic mycosis in which accurate staging is critical but challenging with conventional methods. This study evaluated 18F-FDG PET/CT compared with standard evaluation for PCM staging and assessed its impact on disease severity classification.</p><p><strong>Methods: </strong>Thirty-four patients with confirmed PCM (treatment-naïve or with suspected treatment failure) underwent conventional staging and whole-body 18F-FDG PET/CT. Disease severity was classified as mild, moderate, or severe. PET/CT images were analyzed qualitatively and quantitatively (SUVmax, TMLV, TLG).</p><p><strong>Results: </strong>PET/CT detected more than twice as many lesions as conventional evaluation (150 vs 62; mean 4.4 ± 1.6 vs 1.8 ± 0.9 affected organ systems per patient), with statistically significant superiority for lymph node, pulmonary, and adrenal involvement (McNemar's test, P < .05). PET/CT reclassified 97% of patients as multifocal versus 59% by conventional staging and produced a significant unidirectional shift toward higher severity-the proportion classified as severe increased from 70.6% to 91.2% (P = .016). Patients with suspected treatment failure showed significantly lower TMLV and TLG than treatment-naïve patients (P < .05). Quantitative PET parameters correlated with serological titers and inflammatory markers (P < .05), and PET/CT detected four times as many sites as gallium-67 scintigraphy.</p><p><strong>Conclusions: </strong>18F-FDG PET/CT systematically reveals greater disease burden than conventional evaluation in PCM, reclassifying most patients toward higher severity with direct implications for treatment duration and follow-up. Where available, it should be considered an important complementary modality for initial disease assessment.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e515-e525"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Measles Outbreak in Texas School Districts: A Modeling Study.","authors":"Martial L Ndeffo-Mbah, Sina Mokhtar","doi":"10.1093/cid/ciag314","DOIUrl":"10.1093/cid/ciag314","url":null,"abstract":"<p><p>We developed a measles transmission model for K-12 public schools in Texas at the school-district-level. We found that, between 2025 and 2030, districts in West Texas are most at risk for measles outbreaks, while districts in large metropolitan areas would likely see the largest number of cases in an outbreak.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e661-e663"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza A and B Viral Shedding in Adults Immunized With Live Attenuated Influenza Vaccine.","authors":"Brandon M Tower, Cindy M Liu, David J Diemert, Sydney G Nelson, Chelsea E Ware, Juan E Salazar, Tony Pham, Reed M Leventis, Katherine E Rose, Annie L S Roberts, Nathan O Weber, Edward H Sung, Maliha Aziz, Ryan M Troyer, Daniel E Park","doi":"10.1093/cid/ciag294","DOIUrl":"10.1093/cid/ciag294","url":null,"abstract":"<p><strong>Background: </strong>Live attenuated influenza vaccine (LAIV) induces mucosal immunity through limited viral replication in the upper respiratory tract, but postvaccination viral shedding dynamics and their clinical correlates remain incompletely characterized.</p><p><strong>Methods: </strong>We evaluated 283 healthy adults (108 in 2023-2024, 175 during the 2024-2025 influenza seasons) following intranasal LAIV administration. Nasal swabs were collected on post-LAIV days 1, 2-4, and 5-7 to quantify influenza A and B RNA by RT-PCR. Viral detection, shedding duration and burden, clearance kinetics, and probability of detection were compared across seasons, vaccine strain compositions (quadrivalent vs trivalent), and host factors. Respiratory symptoms were assessed.</p><p><strong>Results: </strong>Early viral shedding was frequent: influenza A or B RNA was detected in 86.9% of participants on day 1, with codetection in 52.7%. Probability of detection declined from 92% on day 1% to 9% on day 7. Influenza B had longer shedding duration (median, 2.0 vs 1.0 days; P < .001) and higher shedding burden (4.2 vs 4.0 log10 RNA copies/mL; P < .001). Three clearance profiles-rapid (clearance ≤4 days), moderate (5-7 days), and slow (≥7 days)-were identified. Profiles were consistent across seasons but influenza B was disproportionately represented in slower-clearance groups (P < .001). Total viral burden (P < .01) and shedding duration (P = .01) were associated with total symptom burden.</p><p><strong>Conclusions: </strong>LAIV replication begins within 24 h and declines over the first week, with persistent shedding uncommon after day 7. Influenza B replicates more extensively and persists longer than influenza A. Symptom burden correlates with shedding duration and viral burden.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e611-e618"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Check Engine Light, Red Herring, or MacGuffin? Clinician-Level Correlations of the Antibiotic Utilization for Respiratory Conditions (AXR) Metric With Outpatient Antimicrobial Stewardship Metrics, Diagnostic Practices, and Prescription Characteristics.","authors":"Allan M Seibert, Adam L Hersh, Park Willis, Barbora Nelson, Joseph Bledsoe, Payal K Patel, Whitney Buckel, Jared A Olson, Nora Fino, Valoree Stanfield, Alyssa Y Castillo, Holly M Frost, Edward A Stenehjem","doi":"10.1093/cid/ciag255","DOIUrl":"10.1093/cid/ciag255","url":null,"abstract":"<p><strong>Background: </strong>The Healthcare Effectiveness Data and Information Set's antibiotic utilization for respiratory conditions (AXR) is a new, broad antibiotic prescribing metric. Higher AXR values indicate higher respiratory encounter prescribing rates. Relationships between clinician-level AXR and prescribing/diagnostic practices are unclear.</p><p><strong>Methods: </strong>This was a retrospective observational study of respiratory urgent care (UC) encounters across 32 UC centers in our health system, conducted from 1 July 2022 to 30 June 2025. Correlations between clinician-level AXR and prespecified outcomes (tier 3 prescribing, antibiotics for pharyngitis despite negative group A Streptococcus antigen testing, sinusitis/acute otitis media (AOM) treatment/diagnosis rates, narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy, and <7-day treatment duration for sinusitis/AOM in patients ≥2 years) were assessed using quartile-based logistic regression and weighted Spearman correlations.</p><p><strong>Results: </strong>Among 528 444 respiratory encounters, 37.1% (195 891) were associated with an antibiotic prescription; 303 clinicians were included. Clinicians in the highest AXR quartile (AXR quartile 4 [Q4]) were more likely to be in Q4 than in quartile 1 for the following: tier 3 prescribing (odds ratio, 15.38 [95% confidence interval, 5.58-42.39]), pharyngitis prescribing despite negative group A Streptococcus testing (11.16 [4.04-30.79]), and the treatment (8.95 [3.23-24.80]) or diagnosis (33.92 [11.14-103.27]) of sinusitis/AOM. AXR-Q4 clinicians were less likely to be in Q4 for narrow-spectrum antibiotic prescriptions excluding encounters with penicillin allergy (odds ratio, 0.36 [95% confidence interval, .17-.77]) and prescriptions of <7 days for sinusitis/AOM for patients ≥2 years old (0.25 [.11-.55]).</p><p><strong>Conclusions: </strong>In our UC network, high clinician-AXR was correlated with antibiotic prescription/diagnostic measures. AXR can serve as an efficient screening metric but should be paired with prescription/diagnosis-specific measures and prescription characteristics to guide outpatient stewardship efforts.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"351-361"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Nirsevimab on Antibiotic Use in Children Using Target Trial Emulation.","authors":"Mahaa M Ahmed, Torsten Joerger, Ziyi Wang, Yun Li, Jeffrey S Gerber","doi":"10.1093/cid/ciag406","DOIUrl":"10.1093/cid/ciag406","url":null,"abstract":"<p><strong>Background: </strong>Nirsevimab is a monoclonal antibody with demonstrated efficacy in preventing respiratory syncytial virus (RSV) infections in infants. Because acute respiratory tract infections (ARTIs), including viral infections, often lead to antibiotic prescribing, we aimed to determine the effectiveness of nirsevimab on antibiotic prescribing among infants with medically attended ARTIs.</p><p><strong>Methods: </strong>A primary care attendee cohort was established using electronic health record data from 32 diverse practices across a healthcare network to emulate a target trial comparing nirsevimab to no treatment among infants <8 months. Eligible infants were seen at a primary care practice within 14 days of life. Primary outcomes included time to first antibiotic prescription for (1) outpatient ARTIs, (2) outpatient encounters for bronchiolitis, and (3) RSV-related hospitalizations. Nirsevimab effectiveness was calculated as 1 minus the risk ratio for each primary outcome.</p><p><strong>Results: </strong>Among 15 341 patients who met inclusion criteria, 7413 received nirsevimab. Compared with no treatment, nirsevimab administration led to a 14.4% (95% CI: 7.8%, 20.6%) reduction in antibiotic prescribing for outpatient ARTIs, a 40.3% (95% CI: 25.1%, 52.5%) reduction in antibiotic prescribing for outpatient bronchiolitis, and a 69.4% (95% CI: 4.8%, 90.1%) reduction in antibiotic prescribing for RSV-related hospitalizations.</p><p><strong>Conclusions: </strong>Nirsevimab administration in primary care reduced antibiotic use for ARTIs in both ambulatory and inpatient settings.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e487-e494"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematospermia in a Returning Traveler.","authors":"Isaie J Reuling, Michèle van Vugt, Caspar J Hodiamont","doi":"10.1093/cid/ciag237","DOIUrl":"https://doi.org/10.1093/cid/ciag237","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"83 3","pages":"e664-e666"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the Urinary Myco\u0000 MEIA Aspergillus\u0000 Assay as an Aid to Diagnose Invasive Aspergillosis","authors":"Irina Baburina,Kieren A Marr,Yuri Vanbiervliet,Nitipong Permpalung,Chiung-Yu Huang,Robina Aerts,Patricia X Marques,Andrew F Shorr,M Hong Nguyen,Binghua Hao,John R Wingard,Johan Maertens,Sean X Zhang","doi":"10.1093/cid/ciag522","DOIUrl":"https://doi.org/10.1093/cid/ciag522","url":null,"abstract":"Abstract Background Invasive aspergillosis (IA) is difficult to diagnose, contributing to poor clinical outcomes and unnecessary antifungal therapies. The MycoMEIA Aspergillus assay (MycoMEIA), which detects Aspergillus glycans in urine, does not require invasive specimens. We report data that supported regulatory approval. Methods A case-control study and prospective cohort study were conducted to evaluate MycoMEIA as an aid to diagnose IA. Performance was assessed using consensus criteria of “proven” or “probable” IA and controls. Additional analyses evaluated positivity in “possible” IA, agreement with serum galactomannan (GM EIA), cross-reactivity, and timing of positivity relative to clinical diagnosis. Reproducibility was assessed across three laboratories. Results In brief, 469 urine samples from 50 IA cases and 240 controls demonstrated MycoMEIA 92% (95% CI 80.8–97.8) sensitivity and 87.6% (95% CI 82.8–91.8) specificity. All cases with positive serum GM EIA were positive by MycoMEIA. Urine testing identified 19/24 (79.2%) IA cases diagnosed by bronchoalveolar lavage (BAL) but negative by serum GM EIA and provided lead-time positivity of 5 days (range −21 to +14) before clinical diagnosis. Prospective testing confirmed a specificity of 89.7% (95% CI 75.8–97.1) and identified IA in 28/102 (27.5%) people with suspected “possible” IA. Some cross-reactivity was observed with other Ascomycetes fungi. Results were reproducible across sites. Conclusions MycoMEIA shows strong performance as an aid to diagnose IA. Its high sensitivity and negative predictive value may help reduce unnecessary empirical antifungals. Further studies are needed to define its role in screening and broader patient populations.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"33 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Much Ado About Macrolides: Revisiting Empiric Atypical Coverage in Nonsevere Community-acquired Pneumonia.","authors":"Whitney Hartlage, Priya Nori","doi":"10.1093/cid/ciag223","DOIUrl":"10.1093/cid/ciag223","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"493-494"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Phases of Clostridioides difficile Infection (CDI) in the United States: The History and Epidemiology of CDI From 1935 to Present.","authors":"Om B Kar, Daniel E Freedberg","doi":"10.1093/cid/ciag363","DOIUrl":"10.1093/cid/ciag363","url":null,"abstract":"<p><p>This review combines historical reports and surveillance data to contextualize Clostridioides difficile infection (CDI) in the United States as a phased epidemic, currently in the deceleration phase. C. difficile was first isolated in 1935. During a prolonged emergence phase, the organism attracted limited clinical attention. In 1978, C. difficile was established as the cause of antibiotic-associated pseudomembranous colitis and from 1978 to a peak in 2010, CDI was in an acceleration phase characterized by fluoroquinolone-resistant, toxin-overproducing strains, large hospital outbreaks, and incidence rates over 150 per 100 000 population. Beginning around 2010, CDI incidence decreased, with a shift from healthcare-associated to community-acquired CDI. Changes in diagnostics complicate incidence comparison between phases; only recently is it apparent that CDI has entered a deceleration phase characterized by infectious reservoirs and possible increases in immunity. It may behoove us to prepare for a different kind of CDI: community-based and insidious rather than hospital-predominant and explosive.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"401-407"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing Course.","authors":"Koray K Demir, Matthew P Cheng, Joanna Nelson","doi":"10.1093/cid/ciaf720","DOIUrl":"10.1093/cid/ciaf720","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"339-344"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}