Journal of Clinical Microbiology最新文献

{"title":"Perfect vs practical: utilizing hematology thin smears for the diagnosis of <i>Plasmodium</i> and <i>Babesia</i>.","authors":"Neil Anderson","doi":"10.1128/jcm.00644-25","DOIUrl":"https://doi.org/10.1128/jcm.00644-25","url":null,"abstract":"<p><p>In the manuscript entitled \"Hematology Thin Smears Perform Equally to Parasitology Thick and Thin Blood Smears for the Diagnosis of <i>Plasmodium</i> and <i>Babesia</i> in a Low-Prevalence Setting,\" the investigators demonstrate that traditional hematology smears (HS) review can have comparable performance to formal blood parasite smears (PS) review. The authors quote a 93.3% sensitivity in comparison to thick smears. This increases to 100% considering only new diagnoses. The implications are that HS can be utilized as a practical and rapid alternative to PS. For clinical laboratories that are limited to only HS capabilities, these findings suggest that they may be able to be less reliant on reference laboratory PS testing, allowing for more rapid diagnosis and management. Even in clinical laboratories that offer both tests, the findings suggest a reassessment of how both HS and PS fit into the diagnostic process for blood parasites. Familiarity with the pros and cons of both approaches allows them to be employed in a way that maximizes patient care impact.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0064425"},"PeriodicalIF":6.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter evaluation of blood culture contamination and blood cultures practices in US acute care hospitals: time for standardization.","authors":"Valeria Fabre, Yea-Jen Hsu, Karen C Carroll, Aaron M Milstone, Alejandra B Salinas, Lilian M Abbo, Chris Bower, Jennifer Berry, Sarah Boyd, Kathleen O Degnan, Pragya Dhaubhadel, Daniel J Diekema, Marci Dress, Baevin Feeser, Mark Fisher, Cynthia Flynn, Bradley A Ford, Erin B Gettler, Laurel J Glasser, Jessica Howard-Anderson, J Kristie Johnson, Sara M Karaba, Justin J Kim, Alyssa Kubischta, Benjamin M Landrum, Marvin Martinez, Amy J Mathers, Leonard Mermel, Rebekah W Moehring, John C O'Horo, Dana E Pepe, S Sonia Qasba, Barry Rittmann, Evan D Robinson, Guillermo Rodríguez-Nava, Rossana Rosa, Jonathan H Ryder, Jorge L Salinas, Aditya Shah, Gregory M Schrank, Mark Shelly, Emily S Spivak, Kathleen O Stewart, Thomas R Talbot, Trevor C Van Schooneveld, Anastasia Wasylyshyn, Avinash Gadala, Zunaira Virk, Sara E Cosgrove","doi":"10.1128/jcm.00530-25","DOIUrl":"https://doi.org/10.1128/jcm.00530-25","url":null,"abstract":"<p><p>Clinical and Laboratory Standards Institute (CLSI) recommends a blood culture contamination (BCC) threshold of <3%, with ≤1% considered optimal. However, there is not a standardized definition of BCC, and the effect of multiple definitions on BCC rates or what definitions laboratories use remain unknown. We surveyed 52 hospitals and analyzed 362,078 blood cultures (BCx) collected 1 September 2019 to 31 August 2021 from 62 intensive care units (ICUs) and 231 wards from 48 of these hospitals. We calculated and compared BCC rates using the College of American Pathologists (CAP) or CLSI criteria (both utilize a limited number of skin commensals to define BCC) and the comprehensive National Healthcare Safety Network (NHSN) commensal list. We characterized factors associated with BCC and related outcomes (central-line associated bloodstream infection [CLABSI] and vancomycin use). BCC, BCx positivity, and single BCx rates were monitored by 100%, 39%, and 21% of hospitals, respectively. Hospitals used CAP (65%), CLSI (17%), and NHSN (17%) criteria to define BCC. Mean BCC rate by CAP (CAP-BCC) was 1.38% for ICUs and 0.96% for wards. BCC rates remained similar by CLSI criteria but increased when using NHSN list. Sharing BCC data outside of the laboratory, measuring additional BCx quality indicators, and limiting central catheter-drawn BCx were associated with lower BCC rates. BCC was associated with higher CLABSI rates in ICUs. This study demonstrated variability in laboratory practices and opportunities to optimize BCx stewardship.IMPORTANCEBlood culture contamination (BCC) is associated with patient harm and unnecessary use of healthcare resources. BCC thresholds have been established; however, multiple BCC definitions exist. There is limited data on how BCC rates differ depending on the BCC definition used, what definitions laboratories most commonly use, or their approach to other blood cultures (BCx) quality indicators such as single rates or BCx positivity. A cross-sectional multicenter survey and analysis of BCx data from intensive care unit and wards revealed that most laboratories did not track single BCx or BCx positivity rates and that there was variability in how BCC was defined. Additionally, BCC rates were influenced by the definition used. BCC was associated with increased central-line associated bloodstream infection rates.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0053025"},"PeriodicalIF":6.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation and characterization of avian metapneumovirus subtypes A and B associated with the 2024 disease outbreaks among poultry in the USA.","authors":"Jianqiang Zhang, Liying Tian, Jaime Dittman, Baoqing Guo, Kay Kimpston-Burkgren, Erin Kalkwarf, Eman Gadu, Phillip Gauger, Mohamed El-Gazzar, Yuko Sato","doi":"10.1128/jcm.00333-25","DOIUrl":"https://doi.org/10.1128/jcm.00333-25","url":null,"abstract":"<p><p>Avian metapneumovirus (aMPV) is currently classified into four subtypes (aMPV-A, -B, -C, and -D). In late 2023 and early 2024, aMPV-A and aMPV-B were detected in US poultry for the first time, causing significant economic losses. This study analyzed aMPV RT-PCR data from 2,204 samples (1,158 turkey, 936 chicken, and 110 other breeds) submitted to a US veterinary diagnostic laboratory between January and November 2024. A higher percentage of turkey samples (51.04%) tested PCR-positive for aMPV-A and/or aMPV-B compared to chicken samples (15.6%), with aMPV-A showing an overall higher positive rate than aMPV-B, although the positive rates varied by state. Additionally, four aMPV-A and three aMPV-B isolates were successfully recovered from clinical samples using primary chicken embryo lung and/or fibroblast cells. Two aMPV-A isolates (USA/IA55601-6/2024 and USA/IA56509-5/2024) and two aMPV-B isolates (USA/NC20487-GA/2024 and USA/NC23734-GA/2024) were adapted to grow efficiently in a Vero cell line, reaching titers of ~10⁴-10⁶ TCID₅₀/mL between passages 4 and 10 for aMPV-A and between passages 1 and 10 for aMPV-B. Whole genome sequencing of the two aMPV-A and two aMPV-B isolates at different passages revealed that the viruses progressively acquired several nucleotide changes, some of which led to amino acid substitutions in different viral proteins during 10 passages in cell culture. Comparative analysis with 46 aMPV-A, -B, -C, and -D GenBank sequences showed that US aMPV-A and aMPV-B strains were genetically closely related within their subtypes. These cell culture-adapted US aMPV-A and aMPV-B isolates provide valuable tools for further characterization of aMPV and vaccine development.</p><p><strong>Importance: </strong>Avian metapneumovirus (aMPV) subtypes A and B were first detected in US poultry in late 2023 and early 2024, rapidly spreading nationwide and posing a significant threat to the industry. This study analyzed RT-PCR data from 2,204 clinical samples (January to November 2024) to determine aMPV-A and aMPV-B detection rates across poultry species, age groups, and states, providing insights into their epidemiology in the USA. Modified live vaccines are urgently needed to control aMPV but are hindered by the lack of US isolates growing efficiently in cell culture. We successfully isolated aMPV-A and aMPV-B in primary chicken embryo cells and adapted them to a Vero cell line. Their infectious titers and genetic stability were characterized over serial passages. These US aMPV-A and aMPV-B cell culture isolates provide valuable tools for studying pathogenesis, determining virus infectious doses, evaluating disinfectants and antivirals, and developing vaccines.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0033325"},"PeriodicalIF":6.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of plasma cell-free DNA PCR for non-invasive diagnosis of mucormycosis.","authors":"Jordan Mah, Anthony Lieu, Veronica Nicholas, Angel Moreno, Kanagavel Murugesan, Indre Budvytiene, Niaz Banaei","doi":"10.1128/jcm.00796-25","DOIUrl":"https://doi.org/10.1128/jcm.00796-25","url":null,"abstract":"<p><p>Diagnosis of mucormycosis poses a substantial challenge due to the lack of a non-invasive biomarker and limitations of conventional diagnostics using invasive specimens. The aim of this study was to characterize the performance of Mucorales plasma cell-free DNA (cfDNA) PCR in immunosuppressed and non-immunosuppressed patients with pulmonary, disseminated, and localized mucormycosis. Patients with Mucorales plasma cfDNA test results were retrospectively categorized as proven or probable for sensitivity analysis and as no Mucorales infection for specificity analysis. In total, 85 positive and 212 negative Mucorales plasma cfDNA test results in unique patients were included in this study. Per the expert definitions, 47 patients had proven or probable mucormycosis, and 171 did not have invasive Mucorales infection. The Mucorales plasma cfDNA PCR had an overall sensitivity and specificity of 85.1% (40/47, 95% CI, 71.7-93.8) and 92.9% (158/170, 95% CI, 88.0-96.3), respectively. The sensitivity was 92.1% (35/38, 95% CI, 78.6-98.3) and 55.6% (5/9, 95% CI, 21.2-86.3) in patients with and without immunosuppression, respectively, and 100% (14/14, 95% CI, 76.8-100), 89.5% (17/19, 95% CI, 66.9-98.7), and 64.3% (9/14, 95% CI, 35.1-87.2) in patients with disseminated, pulmonary, and localized mucormycosis, respectively. Mucorales plasma cfDNA PCR is a sensitive and specific non-invasive testing modality for the diagnosis of mucormycosis in immunosuppressed patients and those with pulmonary and disseminated infection.IMPORTANCEMucormycosis is an invasive mold infection associated with high morbidity and mortality. Early diagnosis and effective antifungal treatment are critical for improving clinical outcomes. However, diagnosis of mucormycosis is often delayed due to the lack of a non-invasive biomarker and insensitivity of culture and non-specificity of histopathology performed on invasive specimens. Mucorales plasma cell-free DNA (cfDNA) PCR is a novel testing modality that allows non-invasive diagnosis of mucormycosis. In the current study, we evaluated the clinical performance of a pre-analytically optimized Mucorales plasma cfDNA PCR in immunosuppressed and non-immunosuppressed patients with pulmonary, disseminated, and localized infections. We show that Mucorales plasma cfDNA PCR is highly sensitive and specific in immunosuppressed patients with pulmonary and disseminated infections. Thus, the Mucorales plasma cfDNA PCR represents an accurate diagnostic tool for non-invasive diagnosis of mucormycosis, which may enable early treatment and improved outcomes in immunosuppressed patients with mucormycosis.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0079625"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 LIAISON PLEX yeast blood culture assay for identifying 16 invasive fungal pathogens in blood cultures.","authors":"Christopher L Emery, Neelam Dhiman, Siu-Kei Chow, Gwyn Peterson, Paul Granato, Brian Bernier, Janet Farhang","doi":"10.1128/jcm.00362-25","DOIUrl":"10.1128/jcm.00362-25","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Fungi frequently cause potentially life-threatening bloodstream infections, particularly in immunocompromised and hospitalized individuals. Molecular methods can allow earlier pathogen identification for faster optimization of appropriate therapy. This multisite study evaluated the analytical and clinical performance of the automated multiplex LIAISON PLEX Yeast Blood Culture nucleic acid assay (Luminex Corporation, Northbrook, IL), which detects and identifies 14 &lt;i&gt;Candida&lt;/i&gt; and 2 &lt;i&gt;Cryptococcus&lt;/i&gt; pathogens from positive blood cultures. Samples included 69 prospectively collected specimens, 63 pre-selected samples, and 829 contrived specimens. The assay demonstrated 100% positivity in detecting target fungal pathogens and 0% positivity in negative blood cultures. All 13 tested bottle/matrix types gave 100% detection of six evaluated pathogens. Limits of detection ranged from 7.77 × 10&lt;sup&gt;2&lt;/sup&gt; CFU/mL (&lt;i&gt;Candida famata&lt;/i&gt;) to 2.83 × 10&lt;sup&gt;5&lt;/sup&gt; CFU/mL (&lt;i&gt;Candida albicans&lt;/i&gt;). The assay identified five strains tested for each of the 16 target species, indicating good inclusivity. No cross-reactivity occurred with 40 bacterial strains. Cross-reactivity with 2 of 37 off-target fungi (&lt;i&gt;Candida&lt;/i&gt; [&lt;i&gt;Yarrowia&lt;/i&gt;] &lt;i&gt;deformans&lt;/i&gt; and &lt;i&gt;Candida pseudohaemulonii&lt;/i&gt;) was predicted by &lt;i&gt;in silico&lt;/i&gt; sequence analyses. Low concentrations of on-panel fungi were detectable alongside high concentrations of potential fungal and bacterial confounders. Reproducibility was 100% within-lab and 99.7% across sites. For combined prospective plus pre-selected specimens, sensitivity/positive percent agreement (PPA) was 100% for detected fungal pathogens, and specificity/negative percent agreement (NPA) was 97.6%‒100.0%. Common pathogens in prospective samples were &lt;i&gt;Candida glabrata&lt;/i&gt; (36%) and &lt;i&gt;C. albicans&lt;/i&gt; (25%). Contrived specimen PPA was 100%, and NPA was ≥99.6%. The LIAISON PLEX Yeast Blood Culture assay provides outstanding sensitivity and specificity for rapidly identifying and differentiating fungal pathogens in positive blood culture specimens.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Bloodstream fungal infections have serious risks of illness and death. Optimal treatment requires early pathogen identification so appropriate antifungal therapy can be immediately started. Blood culture is standard for confirming fungal infection but takes several days for results and may not provide detailed pathogen information. The LIAISON PLEX Yeast Blood Culture assay quickly analyzes fungus-positive blood cultures to identify 16 pathogenic fungi, including multiple &lt;i&gt;Candida&lt;/i&gt; spp. that are common causes of bloodstream infection. This study demonstrated a high degree of test accuracy and reliability in rapidly identifying the infective pathogen in blood cultures from 132 patients with demonstrated culture-positive fungal infections. Assay performance was confirmed in 829 contrived samples, whereby samples were spiked with different funga","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0036225"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The <i>Staphylococcus aureus</i> complex: implications for the clinical microbiology laboratory.","authors":"Austin Yan, Julianne V Kus, Nadia Sant","doi":"10.1128/jcm.01276-24","DOIUrl":"10.1128/jcm.01276-24","url":null,"abstract":"<p><p>In the last 15 years, advances in diagnostic microbiology have enabled more detailed characterization of human bacterial pathogens. These changes have led to the description of new species within the <i>Staphylococcus aureus</i> complex, including <i>S. aureus</i> subspecies <i>anaerobius</i>, <i>Staphylococcus argenteus</i>, and <i>Staphylococcus schweitzeri</i>. In this minireview, we discuss the history, epidemiology, microbiology, genomics, and clinical significance of the <i>S. aureus</i> complex and provide a guide for laboratories to reliably detect and differentiate these novel species.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0127624"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-fungal pathogens detected by broad-range fungal polymerase chain reaction.","authors":"Sonya Ahuja, Joshua A Lieberman","doi":"10.1128/jcm.00087-25","DOIUrl":"10.1128/jcm.00087-25","url":null,"abstract":"","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0008725"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance evaluation of a commercial multiplex pathogen panel for the diagnosis of pediatric joint infections.","authors":"Lawson Copley, Gina Lee, Mary Villani, Naureen Tareen, Laura M Filkins","doi":"10.1128/jcm.00278-25","DOIUrl":"10.1128/jcm.00278-25","url":null,"abstract":"<p><p>This study evaluates the performance of the BIOFIRE Joint Infection (JI) Panel compared to joint fluid culture and/or 16S rRNA PCR, followed by Sanger sequencing (16S PCR/S) for the diagnosis of joint infections in pediatric patients. An on-panel organism was detected by standard-of-care joint (SOCj) studies (joint fluid culture with or without 16S PCR/S, as ordered by the treating physician) in 29/65 samples (44.6%), and the same organism was detected by the BIOFIRE JI panel in all samples. The cumulative positive percent agreement in the detection of on-panel genus or species-level targets by the BIOFIRE JI panel was 100% (36/36), 100% (25/25), and 100% (27/27), and the negative percent agreement was 99.7% (1,974/1,979), 99.2% (1,974/1,990), and 99.7% (1,303/1,307) compared to detection by SOCj, joint fluid culture only, or 16S PCR/S only, respectively. The potential clinical impact of employing the BIOFIRE JI panel was predicted by retrospective adjudication using a study-specific rubric. We predicted that 27.7% (18/65) of BIOFIRE JI panel results could have had a positive impact on patient care. One case (1.5%) was predicted to potentially have a negative impact, and three cases (4.6%) were adjudicated to have an unknown impact. All organisms detected by 16S PCR/S, but not by culture, were also detected by the BIOFIRE JI panel during this study.</p><p><strong>Importance: </strong>The BIOFIRE JI Panel has been limitedly evaluated in pediatric patients. Our study shows a strong agreement between the BIOFIRE JI panel and culture and/or 16S rRNA PCR with Sanger sequencing for the detection of the most common pathogenic causes of joint infection in children. The faster time to results of the BIOFIRE JI panel has the potential to guide optimal treatment faster than conventional methods.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0027825"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced genomic surveillance of enteroviruses reveals a surge in enterovirus D68 cases, the Johns Hopkins health system, Maryland, 2024.","authors":"Amary Fall, Julie M Norton, Omar Abdullah, Andrew Pekosz, Eili Klein, Heba H Mostafa","doi":"10.1128/jcm.00469-25","DOIUrl":"10.1128/jcm.00469-25","url":null,"abstract":"<p><p>This study reports increased Enterovirus D68 (EV-D68) circulation in 2024, re-establishing its biennial circulation cycle after its interruption during the COVID-19 pandemic. A total of 1,395 respiratory and cerebrospinal fluid (CSF) samples, positive for rhinovirus/enterovirus, collected from January to November 2024 were screened. EV-D68 was the predominant enterovirus detected (72.6% of EV-positive samples), with cases peaking in October, consistent with historical seasonal patterns. Demographically, children under 5 years were predominantly infected with EV-D68 (41.6% of cases). Phylogenetic analysis revealed the co-circulation of two EV-D68 subclades: B3 (71%) and A2 (29%). Subclade B3 was primarily associated with pediatric infections (median age: 5 years), while A2 was more common in adults (median age: 42 years). Comparative genomic analysis of the 2024 B3 genomes, along with genomes from 2018 and 2022, identified the emergence of four amino acid substitutions, including three in nonstructural proteins (3C: I597V; 3D: I950V, T2173A) and one in the structural protein VP2 (T145S). The six positive enterovirus CSF samples diagnosed in 2024 included six different types: EV-D68, E9, E30, E18, CV-A9, and CV-B1. Notably, the 2024 EV-D68 outbreak did not coincide with a reported increase in acute flaccid myelitis (AFM) cases. This study highlights the importance of EV-D68 genomic surveillance for monitoring EV-D68 evolution, given its association with severe respiratory disease and neurological complications. Enhanced surveillance is also critical for the early detection of the emergence of enteroviruses, such as EV-C105, identified in this study.IMPORTANCEEnteroviruses (EVs), a genus within the <i>Picornaviridae</i> family, are small, single-stranded RNA viruses linked to a wide spectrum of diseases, including neurological conditions. Despite their prevalence, they remain understudied. EV-D68 and EV-A71 have raised global public health concerns due to outbreaks of acute flaccid myelitis (AFM) and encephalomyelitis in North America and Europe. EVs exhibit high genetic variability, and viral evolution has been associated with changes in neurovirulence. Notably, EV-D68 epidemics in 2014, 2016, and 2018 coincided with spikes in AFM cases. However, AFM reports from 2019 to 2022 were low, even with a significant increase in EV-D68 infections in 2022. We developed an EV-D68 genomic surveillance workflow to investigate genotype associations with severe disease. Our previous work linked amino acid substitutions in 2018 strains to increased disease severity. This study analyzes EV-D68 evolution in 2024 and documents the return of its biennial circulation pattern following disruption during the COVID-19 pandemic.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0046925"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The utility of syndromic respiratory pathogen panels: the premise of flexible and customizable approaches.","authors":"Julie M Norton, Gaby Dashler, Eili Klein, Heba H Mostafa","doi":"10.1128/jcm.00313-25","DOIUrl":"10.1128/jcm.00313-25","url":null,"abstract":"<p><p>Extended respiratory panels have been limited to specific patient populations due to cost and inconclusive clinical utility. Customizing syndromic panels offers a way to balance clinical utility and available resources. In this study, we evaluated strategies and assessed the value of flexible, customized respiratory panels. A total of 200 specimens from symptomatic patients (December 2023 to September 2024), negative for SARS-CoV-2/Flu/RSV, were tested with the LIAISON PLEX Respiratory Flex Assay-an extended respiratory panel that offers flexibility in target selection. The study assessed additional diagnoses, correlations with institutional and state-wide pathogen prevalence, and whether customizable panels could optimize diagnostic yield. Sixty-two samples (31%) negative for SARS-CoV-2/Flu/RSV tested positive for other targets, primarily rhinovirus/enterovirus (60%), correlating with local and state prevalence. Weighted estimates for 18,373 symptomatic patients during the study period modeled a prevalence of 14.3% for rhinovirus/enterovirus, followed by HPIV-3, adenovirus, and coronavirus. During the study period, 6% of patients received the standard of care extended respiratory panel order after a negative SARS-CoV-2/Flu/RSV result, duplicating SARS-CoV-2/Flu/RSV testing. Leveraging a flexible feature could have resulted in an estimated staff time reduction of 5,545 minutes for a second swab collection and running a second test, in addition to the cost of running two different panels during a single encounter. Local respiratory pathogen prevalence data can guide target selection in customized panels. The inclusion of high-prevalence targets can increase the likelihood of diagnosis from 12% to nearly 30%. Flexibility in customizing targeted pathogen panels could enhance diagnostic value while conserving institutional resources.IMPORTANCERapid and accurate identification of pathogens causing respiratory tract infections can aid in guiding treatment decisions, reducing healthcare costs, and supporting real-time surveillance of infectious diseases within a community. Limitations of clinical utility beyond SARS-CoV-2/Flu/RSV are primarily driven by cost and the lack of specific treatment options. There is a need to balance clinical gaps with testing cost and diagnostic stewardship. In this study, we evaluated the utility of flexible, customized respiratory viral panels and reportable targets within a broader set of available targets in an extended respiratory panel.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0031325"},"PeriodicalIF":6.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}