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Differences in the clinical presentations of ZIKV infection which are occurring in different parts of the world might be an obstacle to setting a case definition that is good for use in all areas.

A True Case Definition of Zika Virus Infection Should Still Be Pursued in Arbovirus Co-Transmission Areas

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

At MADID 2025, William R. Mikesell presented data Showing 20% vs. 16% treatment failure rates in doxycycline and minocycline groups.

A multi-hospital retrospective cohort study conducted across Indiana University Health (IU Health) hospitals has found no significant differences in treatment outcomes between doxycycline and minocycline for managing bone and joint infections. The study, presented at MADID 2025, by William R. Mikesell, PharmD, PGY2 infectious diseases pharmacy resident at Indiana University Health, builds on the foundation laid by the OVIVA trial, which established oral antibiotics as a noninferior alternative to intravenous therapy for these infections.

The study included adult patients treated between January 1, 2016, and August 1, 2024, who received either doxycycline (n=41) or minocycline (n=38) for a minimum of two weeks of a planned six-week antibiotic course. Patients receiving additional antibiotics for unrelated infections, as well as pregnant or incarcerated patients, were excluded.

The primary endpoint was treatment failure, defined as any of the following: emergency department visit or hospital readmission for bone or joint infection, antibiotic change due to resistance, presence of a draining sinus tract or frank purulence near the bone or prosthesis, positive repeat tissue culture, or biopsy evidence of infection. Secondary outcomes included adverse effects, need for extended therapy, and early discontinuation of treatment.

Treatment failure occurred in 20% of doxycycline-treated patients and 16% of those treated with minocycline, a difference that was not statistically significant. The most common infection sites included the foot, followed by the leg, knee, hand, arm, hip, and pelvis. Staphylococcus aureus—both methicillin-resistant (MRSA) and methicillin-susceptible strains—and coagulase-negative Staphylococcus species were the predominant pathogens. Secondary outcomes such as adverse event rates, additional antibiotic duration, and early therapy discontinuation were also similar across both groups.

William R. Mikesell explained the motivation behind the study, stating, “The study originally came up because our providers at University Hospital—which treats more immunocompromised patients—prefer to use minocycline for their bone and joint infections. This is in contrast to Methodist Hospital, where they preferred doxycycline.” He added, “Some of the providers at University wanted us to look into this because they believe minocycline is a better treatment option over doxycycline. There’s research out there suggesting that doxycycline induces its own resistance in MRSA isolates—specifically if they have the TetM ribosomal protection proteins. So, they elected to use minocycline over doxycycline.”

When asked if any patient subgroups or infection sites showed a preference for one antibiotic, Mikesell said, “Overall, the research showed there was no statistical difference between the two groups. Minocycline did have less treatment failure, which we defined similarly to the AVIVA trial. That included things like if they were readmitted, if they had frank pus, repeat bacteria isolates from the sample, or any radiologic findings showing that the infection was still present.” He noted, “There wasn’t a statistically significant difference. However, there were more MRSA isolates in the minocycline group. So, I think if there were more patients in the study—and if the study was conducted over a longer period of time—there could potentially be a difference.”

Addressing future directions, Mikesell emphasized the need for prospective studies: “Well, our study was retrospective in nature. Being a resident, there’s only so much time you have. Also, our study only included a 90-day follow-up. The AVIVA trial did a full year of follow-up. I think if there were more prospective trials looking at PO antibiotic options for bone and joint infections—designed similarly to the AVIVA trial—that would be perfect.”

These findings suggest comparable clinical effectiveness between doxycycline and minocycline as oral step-down therapies for bone and joint infections, reinforcing the flexibility clinicians have when tailoring treatment. However, larger, prospective trials are needed to validate these retrospective findings and to further explore resistance patterns and optimal antibiotic selection in diverse patient populations.

Mikesell W, Wrin J. Doxycycline vs. minocycline for the treatment of bone and joint infections. Abstract 94 OR FRS. MAD-ID Meeting. May 28–31, 2025. Orlando, FL.

At MAD-ID 2025, William R Mikesell, PharmD, presented data showing 20% vs 16% treatment failure rates in doxycycline and minocycline groups.

Conferences

No Significant Difference Between Doxycycline and Minocycline for Bone and Joint Infections

Andrew Handel, MD, discusses prevention, how to remove ticks, and the burden of Lyme disease in certain populations. 

‘Tis the Season: Addressing Tick-Borne Illnesses

With the warm weather brings the return of people being outside and the possibility of contracting tick-borne diseases. According to the Centers for Disease Control and Prevention (CDC), more than 89,000 cases of Lyme disease were reported in 2023 by state health departments and the District of Columbia. However, these numbers come from routine national surveillance and may underrepresent the actual burden. 

CDC also estimates that approximately 476,000 people in the US are diagnosed with Lyme disease each year using other data collection methods. This number likely includes patients who are treated based on clinical suspicion but do not actually have Lyme disease, according to the federal agency.

 provides critical insights into the emergence of babesiosis—another tick-borne illness—in the Mid-Atlantic region. Babesiosis can be more severe than Lyme disease, and can become a life-threatening disease for the elderly. 

With this possibility, it is important for clinicians and the general public to consider tick-safety when outside in areas where they live.

“Ticks tend to live on tall grasses and brush in forested areas, so if you go out and you hiking and you know you're going to be in exposed areas where ticks like to live, you want to make sure to stay in the middle of that path, far away from the sides where the ticks are hanging out on the tall grass waiting to grab onto you,” Andrew Handel, MD, said. 

Handel is a pediatric infectious diseases physician at Stony Brook Children's Hospital and at Stony Brook’s Regional Tick-Borne Disease Center in Hampton Bays, NY

 which is the first and only dedicated tick clinic in the Northeast. The center offers tick removal, diagnosis, and treatment. It can test for tick-borne illnesses as well as counsel patients on tick bite prevention and tick identification.

Handel explains that along with trying to stay clear of areas where the ticks live, there are several other strategies to stay tick-free. These include:

Wear light-colored, long-sleeve shirts and pants to make ticks more identifiable.

Tuck your pants into your socks so the ticks don't have access to your skin

Perform routine tick checks when coming from the outdoors or nightly tick checks

Check unexpected and common places on your body for ticks. Ticks love to hide in the beltline, behind the ears, hairline, and in skin folds

If outdoors for an extensive time, consider treating clothes with permethrin, which kills ticks on contact

Put your clothes in the dryer for 10 minutes on high heat to kill any ticks

Handel says it is important to check for ticks after being out in nature, and for those who live in endemic areas such as the northeastern part of the US. In these latter areas it is a good habit to get into even when just out in the yard. He offers some guidance on checking for them.

“You want to really inspect all of your skin, head to toe, looking for any small ticks—many of them look like just the size of poppy seeds. Areas that are really important to check are behind the ears, along the beltline, and in skin folds,” Handel said. “Ticks really like to get into the skin folds, so whether that's in the armpit or the groin, and hide there, making it difficult to find them. And any areas that have hair you want to search really well there too, because again, the ticks have a way of getting underneath the hair and making it really difficult to find. So if you're not thorough, you might miss one.”

In terms of pulling ticks off, Handel says there is a very specific method.

“With your tweezers, you're going to grab them as close to the skin as possible, right at the head of the tick, where it's biting, and just firmly pull it upward. You don't want to twist it. You don't want to grab the belly and squeeze it. That can actually make it more likely that you end up with a tick-borne infection,” Handel said. “So you're going to take the tick, remove it very gently with the tweezers and put it in a sterile container, or a sealed container." He says by holding onto the tick it can be identified, which can be understood if it is a potential carrier of Lyme disease, for example. 

He also cautions people not to try other methods such as burning the tick off or putting petroleum jelly or an ointment on the spot where the tick is. He says this could also lead to tick-borne infections.

Lyme disease has a tendency to be in 2 populations: children of a certain age and seniors. “The first is in children, when they're around 5 to 9 years old. And then a second peak happens in older adults, generally starting around 60 years or older,” Handel said. “There's not definitive proof as to why it happens, but it seems to be exposure to the ticks.”



Stony Book has a free tick-borne disease helpline. For people interested in using it, they can call (631) 726-TICK (8425).


References
1. Lyme Disease Surveillance and Data. CDC. March 13, 2025. Accessed June 6, 2025. https://www.cdc.gov/lyme/data-research/facts-stats/index.html
2. Stromdahl EY, Feldman KA, Nadolny RM, et al. Emerging babesiosis in the mid-Atlantic: autochthonous human babesiosis cases and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) and Ixodes keiransi (Acari: Ixodidae) ticks from Delaware, Maryland, Virginia, West Virginia, and the District of Columbia, 2009 to 2024. 

. Published online April 22, 2025. doi:10.1093/jme/tjaf054

'Tis the Season: Addressing Tick-Borne Illnesses

Fungal infections present a significant global health threat due to rising antifungal resistance, yet few new antifungal drugs are in clinical development. This study evaluated five phytocannabinoids for antifungal activity against key fungal pathogens, focusing on the priority pathogen 

. Cannabidiol (CBD) and Cannabidivarin (CBDV) demonstrated broad fungicidal activity against 

 and other fungi, including dermatophytes causing common tinea infections. 

Both compounds inhibited biofilm formation and reduced virulence factors such as capsule size. Proteomic analyses indicated that CBD and CBDV disrupt fungal cell membranes, alter ergosterol biosynthesis, affect metabolic pathways, and selectively target mitochondrial proteins. In vivo testing using a 

 showed significantly improved survival following topical CBD treatment. These findings highlight phytocannabinoids, particularly CBD and CBDV, as promising candidates for novel antifungal therapies.

We recently conducted an email interview with associate professor Amy K Cain, ARC future fellow at the School of Natural Sciences, Macquarie University, to discuss her team’s promising research on the antifungal properties of phytocannabinoids, particularly CBD and CBDV, and their potential to address drug-resistant fungal infections such as 

Contagion: How do the antifungal effects of CBD and CBDV compare with existing standard antifungal treatments in terms of efficacy and safety?

Cain: Our study shows promising results compared to existing antifungals. For instance, phytocannabinoids demonstrated quicker antifungal effects against 

 than amphotericin B, a standard antifungal; most fungal cells were killed within 1 hour with CBD or CBDV, whereas amphotericin B requires around 4 hours to achieve similar effects. Additionally, CBD is already used clinically for conditions like epilepsy and pain management, and these uses have established an excellent safety profile, even with oral administration.

Contagion: Given that CBD and CBDV showed activity against biofilms and virulence factors in 

, what are the implications for treating difficult fungal infections, especially those resistant to current antifungal drugs?

Cain: We believe phytocannabinoids have strong potential for treating challenging fungal infections. Our data demonstrate their broad antifungal activity across multiple clinical strains of

, and we are currently investigating their effects on drug-resistant strains, which look promising so far.

Contagion: What are the next steps to translate these findings, especially the promising in vivo results in the Galleria mellonella model, into clinical trials or human treatments for fungal infections?

Cain: We have filed a patent based on these findings and are collaborating with commercial partners to advance the research toward clinical trials and eventual development of a patient-ready product.

This study identifies CBD and CBDV as effective antifungal agents against 

 and other fungal pathogens. Both compounds disrupt fungal cell function, inhibit biofilm formation, and reduce virulence factors. Early in vivo results suggest potential for clinical development, with ongoing efforts to advance toward human trials.

Dinh H, Fernandes KE, Erpf PE, et al. Uncovering the antifungal potential of Cannabidiol and Cannabidivarin. PLoS Negl Trop Dis. 2025;19(6):e0013081. Published 2025 Jun 5. doi:10.1371/journal.pntd.0013081

Q&A with Amy Cain discusses cannabidiol and cannabidivarin’s effects on fungal biofilms and drug-resistant strains.

Phytocannabinoids Demonstrate Fungicidal Activity and Inhibit Fungal Virulence Factors

Logan Brock, PharmD, presents UF Health Shands data at MAD-ID 2025 showing limited diagnostic yield from routine fungal cultures and delayed results compared to standard methods.

A retrospective analysis from UF Health Shands Hospital questions the clinical value of routinely ordering fungal blood cultures alongside standard blood cultures during initial sepsis evaluations. The findings, presented by Logan Brock, PharmD, at MAD-ID 2025, show that fungal blood cultures rarely provide additional diagnostic information and take longer to yield results.

The single-center study reviewed 2,073 adult inpatient encounters from January 1, 2023, to December 31, 2024, in which fungal and standard blood cultures were collected within 24 hours of each other. Of those, 96.9% showed no growth in either type of culture. Among the 64 pairs that did show growth, only 8 (12.5%) fungal cultures were positive when standard cultures were negative. Conversely, 30 (46.9%) standard cultures identified fungal pathogens that fungal cultures missed. Both cultures were positive in 26 (40.6%) cases. 

 species accounted for 93.8% of all fungal isolates.

Median time-to-positivity was significantly longer for fungal cultures (48 hours; IQR: 41–93) than for standard cultures (33 hours; IQR: 28–43; 

 < 0.001). All-cause in-hospital and 30-day mortality rates were 17.4% and 16.4%, respectively.

“Paired fungal blood cultures infrequently identified fungal pathogens not detected by standard blood cultures and had a longer time-to-positivity,” the authors concluded.

Logan Brock, a PGY-2 infectious diseases pharmacy resident at UF Health Shands, said the study originated from concerns raised by an ICU pharmacist, “One of our ICU pharmacists reached out to us because she was seeing an increase in fungal blood cultures being ordered at our hospital. So, us and the ID stewardship department did a little digging with her, and we confirmed that there were actually a lot of fungal blood cultures being ordered. Anecdotally, we weren’t seeing a lot of fungal growth from these fungal blood cultures. Even in the cases where they did grow, the standard blood cultures were also growing the fungus. So, we wanted to take a closer look at our hospital’s fungal blood culture ordering and see if they’re providing any utility—or perhaps not.”

While no formal restrictions have been implemented yet, Brock says discussions are underway, “Full disclosure—at my hospital, we haven’t decided how we’re going to restrict fungal blood cultures based on the results of this study. There are a lot of key stakeholders that will have to get engaged—ID physicians, ICU doctors who are ordering the fungal blood cultures.”

He noted that one possible model could mirror how the hospital managed anaerobic blood culture bottles during a supply shortage, “Some ideas we’ve been talking about are doing something similar to what we did with our anaerobic blood culture bottles during the shortage… so that any people or teams who wanted to order anaerobic bottles had to request them from the micro lab—and usually had to show that they had some indication for them, like intra-abdominal infections… I can see doing something similar for fungal blood cultures.”

Despite the low yield overall, Brock emphasized that fungal blood cultures may still be valuable in select high-risk patients. He shared one case in which they led to a meaningful therapeutic adjustment.

“Yeah, so there was actually one case in particular where fungal blood cultures provided a really big benefit, I would say. This was a 73-year-old patient who came in septic. He had a bowel perforation, so he was started on fungal coverage. Predictably and appropriately, standard blood cultures were drawn, fungal blood cultures were drawn, and the standard blood cultures grew a couple of bacteria—

“The fungal blood culture did actually grow a 

 ended up being 32, which is susceptible dose-dependent. It is susceptible, but it’s right at the breakpoint for susceptible—so it’s a very high MIC.

“Based on those results, we switched him from fluconazole to our echinocandin at our hospital, micafungin, which I think was a much better therapy. Their white count came down, they improved, and I think without using fungal blood cultures there, we might not have known they had a fungal infection at all.” The findings support targeted, rather than routine, use of fungal blood cultures, especially in patients without clear risk factors for invasive fungal disease

Brock L, DeSear K, Engeleit A, Gurram P, Vuong L. Under the Microscope: The (Over)Utilization of Fungal Blood Cultures. Abstract 46 OR FRS. MAD-ID Meeting. May 28–31, 2025. Orlando, FL.

Logan Brock, PharmD, presents data at MAD-ID, showing limited diagnostic yield from routine fungal cultures and delayed results compared with standard methods.

Rethinking Fungal Blood Cultures in Sepsis Workups

VOWST Shows Consistent Safety Profile for rCDI Patients with Comorbidities

At the 2025 MAD-ID meeting, Dianne Nguyen, MD, head of medical affairs for the pharmaceutical division at Nestlé Health Science, presented new data demonstrating the consistent safety profile of VOWST™ (fecal microbiota spores, live–brpk) in adults with recurrent 

 infection (rCDI), including those with significant comorbid conditions.

The findings come from an integrated analysis of two Phase 3 trials: the randomized, double-blind, placebo-controlled ECOSPOR III study (n=182) and the open-label, single-arm ECOSPOR IV study (n=263). In both trials, VOWST was administered orally as four capsules daily for three consecutive days following the completion of antibacterial treatment.

“This integrated analysis helps us better understand the product's safety and how it looks in this particularly more vulnerable patient population,” Nguyen said.

Among the 349 participants who received VOWST, 51% (n=178) had comorbid conditions such as renal impairment/failure, diabetes, cardiac disease, or were immunocompromised/immunosuppressed (IC/IS). Despite these underlying conditions, safety findings remained favorable.

In patients with renal impairment/failure, TEAEs occurred in 80%, serious TEAEs in 35%, and adverse events of special interest (TEAESIs) in 26%.

Those with diabetes experienced TEAEs at 70%, serious TEAEs at 20%, and TEAESIs at 9%.

Among those with cardiac disease, respective rates were 75%, 27%, and 12%.

The IC/IS subgroup showed rates of 77%, 20%, and 14%.

By comparison, placebo-treated participants in ECOSPOR III experienced even higher rates in several categories, for example, 100% of renal impairment patients reported TEAEs and 57% had serious TEAEs.

“First of all, patients with comorbidities—especially those with multiple—are more likely to experience treatment-emergent adverse events regardless of whether they received active treatment or placebo,” Nguyen explained. “That’s not surprising. But what we observed is that among those who did receive VOWST, the safety profile was consistent regardless of comorbidity status. That’s very encouraging.”

Importantly, no serious adverse events were attributed to VOWST, and no patients discontinued the study due to treatment-related side effects. TEAEs leading to death were infrequent across all subgroups and in the overall integrated population.

Looking ahead, Nguyen noted that while no formal controlled trials are planned in these high-risk groups, real-world studies are already underway. “We’re doing some work right now looking at clinical experience in these patient populations,” she said. “That’s going to give us more information about groups who may have been underrepresented in our clinical trials.”

She added that broader awareness of VOWST’s tolerability could support its use in routine care, “I’m looking forward to getting more information out there to really better describe how this particular product looks in terms of its effectiveness in a routine clinical setting.”

Sims M, Stevens R, Nguyen D, Pullman J, Berenson C. Safety of fecal microbiota spores, live-brpk (formerly SER-109) in participants with recurrent 

At MAD-ID, Dianne Nguyen, MD, shares Phase 3 data showing consistent tolerability of the microbiome therapy across high-risk patient populations

José Mauro Peralta, PhD

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