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Campylobacter is a gram-negative, microaerophilic, flagellated, helical bacterium (1). Campylobacter infection, or campylobacteriosis, is the most common bacterial cause of diarrhea in the United States, producing [approximately equal to]1.5 million [...]

In 1985, the orthobunyavirus Fort Sherman virus (FSV) was discovered in a US soldier with acute febrile disease who was based in a jungle warfare training center in Panama (1). [...]

Native and invasive tick species pose serious public health concerns in the United States, particularly in northeastern states. Recent and rapid expansion of the lone star tick (Amblyomma americanum) into [...]

SARS-CoV-2 was initially reported in 2019 in China and spread rapidly worldwide, causing the COVID-19 pandemic in humans. Since the pandemic unfolded, the role of animals as amplifying or reservoir [...]

Babesiosis is caused by intraerythrocytic protozoa from the genus Babesia. First reported in 1957 (1), babesiosis is now described worldwide. Babesia infecting humans come from 4 clades (2): 3 clades [...]

On May 9, 2024, the Pan American Health Organization reported 5,193 cases of Oropouche fever (also called Oropouche virus disease) in Bolivia, Brazil, Colombia, and Peru and sent an alert [...]

Circoviruses are an emerging group of DNA viruses with largely unknown pathogenicity in humans (2,2). The best-studied circovirus is porcine circovirus 2, which causes hepatitis in pigs, among other diseases [...]

In England, after the July 2022 peak in the mpox outbreak (1), which affected primarily gay, bisexual, and other men who have sex with men (GBMSM), cases declined and remained [...]

West Nile virus (WNV) is a flavivirus within the family Flaviviridae. Since WNV was identified in New York, USA, in 1999, it has become the leading cause of arboviral disease [...]

Mpox is a zoonotic viral infectious disease first identified in humans in the Democratic Republic of the Congo (DRC) in 1970 (1). Monkeypox virus (MPXV) is endemic to forested regions [...]

Lyme disease, caused primarily by infection with Borrelia burgdorferi, is the most frequently reported vectorborne disease in the United States, accounting for >75% of reported tickborne diseases (1). B. burgdorferi [...]

Lyme disease is the most reported vectorborne disease affecting humans in Canada, and incidence continues to increase (1). In eastern North America, the blacklegged tick (Ixodes scapularis) is the primary [...]

A large outbreak of monkeypox virus (MPXV) clade I (previously known as the Congo-Basin clade) infections has been ongoing in the Democratic Republic of the Congo (DRC) since the autumn [...]

Pasteurella spp. can cause fatal zoonotic infections in humans (2,2). Pasteurella spp., which are nonmotile, facultatively anaerobic bacteria, form the oral and gastrointestinal flora of many animals including companion and [...]

PURPOSE Chest pain frequently poses a diagnostic challenge for general practitioners (GPs). Utilizing risk stratification tools might help GPs to rule out acute coronary syndrome (ACS) and make appropriate referral decisions. We conducted a systematic review of studies evaluating risk stratification tools for chest pain in primary care settings, both with and without troponin assays. Our aims were to assess the performance of tools for ruling out ACS and to provide a comprehensive review of the current evidence. METHODS We searched PubMed and Embase for articles up to October 9, 2023 concerning adult patients with acute chest pain in primary care settings, for whom risk stratification tools (clinical decision rules [CDRs] and/or single biomarker tests) were used. To identify eligible studies, a combination of active learning and backward snowballing was applied. Screening, data extraction, and quality assessment (following the Quality Assessment of Diagnostic Accuracy Studies-2 tool) were performed independently by 2 researchers. RESULTS Of the 1,204 studies screened, 14 were included in the final review. Nine studies validated 7 different CDRs without troponin. Sensitivities ranged from 75.0% to 97.0%, and negative predictive values (NPV) ranged from 82.4% to 99.7%. None of the CDRs outperformed the unaided judgment of GP's. Five studies reported on strategies using troponin measurements. Studies using high-sensitivity troponin showed highest diagnostic accuracy with sensitivity 83.3% to 100% and NPV 98.8% to 100%. CONCLUSION Clinical decision rules without troponin and the use of conventional troponin showed insufficient sensitivity to rule out ACS in primary care and are not recommended as standalone tools. High-sensitivity troponin strategies are promising, but studies are limited. Further prospective validation in primary care is needed before implementation. Key words: acute coronary syndrome; chest pain; clinical decision rules; primary health care; troponin, https://doi.org/10.1370/afm.3141 INTRODUCTION Chest pain often poses a diagnostic challenge for general practitioners (GPs). While chest pain is the hallmark symptom of acute coronary syndrome (ACS), it is often caused by [...]

PURPOSE HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence. METHODS We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries. The incidence rate was calculated as the number of infections per 100 person-months, with evaluation of the STIs overall and individually. We used marginal structural models to account for time-varying confounding and quantitative bias analysis to evaluate the sensitivity of estimates to nondifferential outcome misclassification. RESULTS Participating GBM were followed up for a total of 1,623.5 person-months. Overall, 70 participants (13.1%) took PrEP during the study period. Relative to no uptake, PrEP uptake was associated with an increased incidence rate of gonorrhea (incidence rate ratio = 4.00; 95% CI, 1.67-9.58), but not of chlamydia or syphilis, and not of any bacterial STI overall. Accounting for misclassification, the median incidence rate ratio for gonorrhea was 2.36 (95% simulation interval, 1.08-5.06). CONCLUSIONS We observed an increased incidence rate of gonorrhea associated with PrEP uptake among Ontarian GBM that was robust to misclassification. Although our findings support current guidelines for integrating gonorrhea screening with PrEP services, additional research should consider the long-term impact of PrEP among this population. Key words: bacterial sexually transmitted infections; STIs; pre-exposure prophylaxis; PrEP; HIV; gay, bisexual, and men who have sex with men; sexual and gender minorities; health risk behaviors; prevention; marginal structural models; quantitative bias analysis; risk compensation; vulnerable populations Submitted September 25, 2023; submitted, revised, June 6, 2024; accepted June 7, 2024., https://doi.org/10.1370/afm.3152 Annals Early Access article INTRODUCTION Bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis, have increased since 2010, with cases of gonorrhea and syphilis commonly reported among men [...]

Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use. We conducted a survey (n = 564) between January 2020 to June 2021 in public and private primary care clinics in Texas to study the prevalence and predictors of patients' antibiotic expectations for common symptoms/illnesses. We surveyed Black patients (33%) and Hispanic/Latine patients (47%), and over 93% expected to receive an antibiotic for at least 1 of the 5 pre-defined symptoms/illnesses. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu than private clinic patients. Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (odds ratio [OR] = 1.6; 95% CI, 1.1-2.4) and cold/flu symptoms (OR = 2.9; 95% CI, 2.0-4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. Future antibiotic stewardship interventions should tailor patient education materials to include information on antibiotic risks and guidance on appropriate antibiotic indications. Key words: antibiotic use; antimicrobial stewardship; primary care; antibiotic risks; patient expectations, https://doi.org/10.1370/afm.3161 INTRODUCTION Patients often receive antibiotic prescriptions to treat common viral symptoms/ illnesses, such as respiratory tract infection, (1-6) cold/flu, (7,8) and diarrhea, (9,10) despite guidelines recommending against these practices. [...]

PURPOSE We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care. METHODS This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/[m.sup.2]) with a weight-related comorbidity or had obesity (body mass index [greater than or equal to] 30 kg/[m.sup.2]). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat. RESULTS We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non- Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P =.48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration. CONCLUSIONS The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification. Key words: obesity; overweight; comorbidity; health coaching; motivation; self-management; primary care; lifestyle; goal setting; diet; weight loss; physical activity; veterans; ethnic and racial minorities; vulnerable populations; barriers; practice-based research; health informatics, https://doi.org/10.1370/afm.3150 INTRODUCTION Obesity is a serious global public health problem. (1,2) Veterans and racial and ethnic minority groups experience considerable disparities in obesity rates (2-4) and are thus at higher [...]

PURPOSE The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients. METHODS This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors. RESULTS A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P CONCLUSIONS The DIG IT was more effective than controls (receiving usual care). Twofold improvement in the BP readings and ASCVD scores in medically underserved patients were achieved with DIG IT. Key words: digital health; hypertension; patient care team; vulnerable population, https://doi.org/10.1370/afm.3151 INTRODUCTION Medically underserved populations are 40% more likely to have hypertension and 3 times more likely to die from heart diseases due to uncontrolled high blood pressure (BP). (1,2) [...]

BACKGROUND For many patients with post-COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient's perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID. METHODS A phenomenological approach guided this analysis. Using purposive sampling, we conducted semistructured interviews with English-speaking, adult primary care patients describing symptoms of long COVID. We deidentified and transcribed the recorded interviews. Transcripts were analyzed using inductive qualitative content analysis. RESULTS This article reports results from 19 interviews (53% female, mean age = 54 years). Patients expected their primary care practitioners (PCPs) to be knowledgeable about long COVID, attentive to their individual condition, and to engage in collaborative processes for treatment. Patients described 2 areas of experiences. First, interactions with clinicians were perceived as positive when clinicians were honest and validating, and negative when patients felt dismissed or discouraged. Second, patients described challenges navigating the fragmented US health care system when coordinating care, treatment and testing, and payment. CONCLUSION Primary care patients' experiences seeking care for long COVID are incongruent with their expectations. Patients must overcome barriers at each level of the health care system and are frustrated by the constant challenges. PCPs and other health care professionals might increase congruence with expectations and experiences through listening, validating, and advocating for patients with long COVID. Key words: primary care issues; long COVID; COVID-19; qualitative methods; patient perspective, https://doi.org/10.1370/afm.3145 Annals Early Access article BACKGROUND Post-COVID-19 conditions (PCC), or 'long COVID,' is an imminent public health emergency. Long COVID has already contributed to an estimated 3,500 American deaths, resulted [...]

To monitor COVID-19 epidemic spread, the World Health Organization tracked worldwide incidence by relying on notification data of laboratory-confirmed cases (1). In Germany, public health and social measures (PHSM), such [...]

Human babesiosis is a tickborne disease caused by protozoans that infect red blood cells. Immunocompromised persons and those who have undergone splenectomies are at risk for severe illness (2). Most [...]

Gastroenteritis is one of the most common infectious diseases, characterized by rapid onset of diarrhea with or without nausea, vomiting, fever, and abdominal pain (1,2). Enteric viruses and bacteria are [...]

Western equine encephalitis virus (WEEV) is a mosquitoborne alphavirus that causes central nervous system (CNS) infection in humans and equids in the United States, Canada, and the southern cone of [...]

Human mpox is a zoonotic disease caused by 2 distinct clades (I and II) of the monkeypox virus (MPXV) (1). Clade I primarily affects children and adolescents in Central Africa, [...]

SARS-CoV-2 and influenza have caused substantial health threats. SARS-CoV-2 had caused >0.7 billion reported cases and 6.9 million deaths globally by May 2023, when the World Health Organization (WHO) declared [...]

In 2012, Anopheles stephensi, a primary malaria vector in South Asia, was detected in Djibouti, a country in Africa that was approaching malaria preelimination status (1). Unlike typical malaria vectors [...]

Streptococcus dysgalactiae subspecies equsimilis (SDSE) is a [beta]-hemolytic Streptococcus species mainly expressing Lancefield antigens C or G (1). The incidence of SDSE bacteremia has been increasing, and SDSE has surpassed [...]

Extrapulmonary nontuberculous mycobacteria (NTM) infection potentially affects any organ; lymph nodes, skin, and soft tissue are the most commonly affected (1,2). The severity of disease varies considerably from uncomplicated lymphadenitis [...]

BACKGROUND: Organophosphate esters (OPEs) are flame retardants and plasticizers used in consumer products. OPEs are found ubiquitously throughout the environment with high concentrations in indoor house dust. Exposure to individual OPEs is associated with immune dysfunction, particularly in macrophages. However, OPEs exist as complex mixtures and the effects of environmentally relevant mixtures on the immune system have not been investigated. OBJECTIVES: The objectives of this study were to evaluate the toxicity of an environmentally relevant mixture of OPEs that models Canadian house dust on macrophages using phenotypic and functional assessments in vitro. METHODS: High-content live-cell fluorescent imaging for phenotypic biomarkers of toxicity in THP-1 macrophages treated with the OPE mixture was undertaken. We used confocal microscopy and cholesterol analysis to validate and expand on the observed OPE-induced lipid phenotype. Then, we used flow cytometry and live-cell imaging to conduct functional tests and uncover mechanisms of OPE-induced phagocytic suppression. Finally, we validated our THP-1 findings in human primary peripheral blood mononuclear cells (hPBMC) derived macrophages. RESULTS: Exposure to non-cytotoxic dilutions of the OPE mixture resulted in higher oxidative stress and disrupted lysosome and lipid homeostasis in THP-1 and primary macrophages. We further observed that phagocytosis of apoptotic cells in THP-1 and primary macrophages was lower in OPEexposed cells vs. controls. In THP-1 macrophages, phagocytosis of both Gram-positive and Gram-negative bacteria was also lower in OPE-exposed cells vs. controls. Additionally, the OPE mixture altered the expression of phagocytic receptors linked to the recognition of phosphatidylserine and pathogen-associated molecular patterns. DISCUSSION: The results of this in vitro study suggested that exposure to an environmentally relevant mixture of OPEs resulted in higher lipid retention in macrophages and poor efferocytic response. These effects could translate to enhanced foam cell generation resulting in higher cardiovascular mortality. Furthermore, bacterial phagocytosis was lower in OPE-exposed macrophages in an in vitro setting, which may indicate the potential for reduced bacterial clearance in models of infections. Taken together, our data provide strong evidence that mixtures of OPEs can influence the biology of macrophages and offer new mechanistic insights into the impact of OPE mixtures on the immune system. https://doi.org/10.1289/EHP13869, Introduction Manufacturers use organophosphate esters (OPEs), the most prominent class of flame retardants,in consumer and commercial products to prevent or reduce the spread of fire. (1,2) The use of OPEs [...]

BACKGROUND: While it is well-established that exposure to dampness or mold in homes negatively affects physical health, the association with mental health remains less well evidenced. As plausible psychosocial and biological pathways exist between dampness and mold exposure and poor mental health, a review of evidence is required. OBJECTIVE: This State-of-the-Science review sought to assess what is known about the mental health effects of dampness or mold exposure and identify gaps in the literature and priorities for further research. METHODS: A comprehensive search of electronic databases (MEDLINE, Embase, PsycInfo, Global Health, Web of Science, and Scopus) was conducted to identify relevant studies published from 2003 to 2023. Eligible studies included observational study designs such as cohort and crosssectional studies. Target studies for review assessed the effect of dampness and/or mold on mental health outcomes. RESULTS: Of the 1,169 records retrieved, 19 studies met the inclusion criteria. The available evidence described positive associations between residential dampness/mold exposure and poor mental health. In adults, associations were observed for outcomes such as depression, stress, and anxiety, while for children, associations were observed for emotional symptoms and emotional dysregulation. DISCUSSION: Identified studies generally reported associations between exposure to dampness/mold in the home and poorer mental and emotional health. Given the methodological limitations present in the current evidence base, it is recommended that more research be conducted. https://doi.org/10.1289/EHP14341, Introduction The World Health Organization (WHO) guidelines on indoor air quality emphasize that mold exposure poses a significant risk to human health. (1) The prevalence of mold growth in dwellings [...]

Archaea are a group of single-celled microorganisms with distinct characteristics, and constitute 1 of the 3 domains of life, along with bacteria and eukarya. Although they were thought to live [...]

The recommendations of the Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC) are based on discussions during a virtual meeting of IVIR-AC on 26 February-1 March 2024. (1) Four sessions [...]

Undernutrition adversely affects the cognitive and physical development of preschool children especially in arid and semi-arid areas, with far reaching effects up to adulthood. School feeding programmes are perceived as safety measures to improve children's health. The study assessed the contribution of school lunch feeding programmes in improving the micronutrients intake of preschool children in Kilifi County, Kenya. This quasi experimental study involved 288 children from ten Early Childhood Education Development (ECED) centers and their parents/guardians. Five of the centers had a government sponsored school lunch programme (Lunch programme group) and the other five centers had no lunch programme (Non programme group). Data collected included types of food, frequency and quantity consumed by the children using 24 hours' recall method and Individual Dietary Diversity Score (IDDS). The micronutrients intake was assessed through Recommended Dietary Adequacy (RDA) using NutriSurvey 2007 Program and 2009 WHO guidelines. The SPSS version 24 and SAS version 9.4 statistical software were used in data management and analysis. Inferential statistics including Chi-square, correlation and regression were used to evaluate the contribution of the feeding programme to the micronutrient intake. The threshold for statistical significance for all analysis was set at p Key words: Dietary diversity, Micronutrient deficiency, preschoolers, recommended dietary adequacy, INTRODUCTION Acute malnutrition has persisted for a long time in Kenya's Arid and Semi-Arid (ASAL) regions, mainly among children below five years of age. According to the 2022 Kenya Demographic [...]

Lyme disease, caused by infection with the bacterium Borrelia burgdorferi, is the most common vectorborne illness in the United States and is steadily affecting an expanding area of the country [...]

Before the Omicron variant emerged, 6 months of age have been recommended to receive COVID-19 vaccines in Japan, where mRNA vaccines (Pfizer-BioNTech, https://www.pfizer.com; Moderna, https://www. modernatx.com) are predominantly used. Seroepidemiologic [...]

In July 2018, after 60 years of endemic circulation in European wild rabbits (Oryctolagus cuniculus), myxoma virus (MYXV) jumped to the Iberian hare (Lepus granatensis) (1). This species jump resulted [...]

Infection caused by highly pathogenic avian influenza viruses (HPAIVs) have caused major economic losses in the poultry industry and pose a serious threat to public health. The A/goose/ Guangdong/1/1996 (gs/GD) [...]

The zoonotic hookworm Ancylostoma ceylanicum infects canids, felids, and humans in tropical regions of the world (2,2). Heavy infections may cause iron-deficiency anemia and bloody diarrhea as a result of [...]

In 1926, A.C. Chandler described "a new schistosome infection of man" based on the presence of distinctive terminal spined schistosome eggs from 2 human fecal samples collected in Krishnanagar, West [...]

Streptococcus agalactiae (group B Streptococcus [GBS]) is a major pathogen of humans, cattle, aquatic species, and camels (2-4). GBS has been detected in pork but has not been associated with [...]

From early 2013 through October 2017, a total of 5 outbreaks of avian influenza A(H7N9) virus infection occurred, resulting in 616 human deaths (1). In particular, the fifth wave of [...]

Medscape CME Activity In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation [...]

Recognizing the key role early detection plays in interrupting further tuberculosis (TB) transmission, the World Health Organization (WHO) has emphasized the need for global investment in that area. In line [...]

Scedosporium spp. and Lomentospora prolificans are non-Aspergillus filamentous fungi causing increasingly recognized invasive fungal disease (IFD) in both immunocompromised and immunocompetent patients (2,2). Scedosporium spp. comprise S. apiospermum complex species, [...]