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This case report is the fourth documented case of Lyme-induced syndrome of inappro&shy;priate secretion of antidiuretic hormone (SIADH).  

Salt, Ticks, and Lyme: A Case of Lyme Neuroborreliosis Presenting as SIADH

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

TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discusses dihydrofolate reductase inhibitors (DHFRIs) as a novel approach to combat multidrug-resistant neisseria gonorrhoeae. 

A Group of Antimicrobial Compounds Show Novelty Action Against Gonorrhea 

Back in May, TAXIS Pharmaceuticals announced it had received a $2.9 million grant, to be awarded over 3 years, from the National Institute of Allergy and Infectious Diseases. This grant allows the company to further advance research and development for its dihydrofolate reductase inhibitors (DHFRIs) as a novel approach to combat multidrug-resistant gonorrhea (commonly referred to as supergonorrhea), a rapidly spreading, deadly, and highly resistant strain of 

TAXIS is a clinical-stage company developing new classes of therapies to treat multidrug-resistant bacterial infections. Their investigational drug candidates include efflux pump inhibitors, DHFRIs, and FtsZ inhibitors and aim to combat antimicrobial resistance.

One of their investigational compounds, TXA 15054, is in the very early stages of development, and TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discussed its novelty.

“TXA 15054 is from a compound series that targets bacterial DHFR…. Although DHFR is not a new target, it is important to remind the audience that trimethoprim, which is the only drug that targets DHFR, has absolutely no activity against gonorrhea. So our TXA 15054 and other compounds from that series target bacterial DHFR in a unique way, which is totally different from trimethoprim,” said Parhi in an interview with 

 at the recent American Society for Microbiology Microbe conference.

In terms of safety and tolerability, there are some benefits associated with this group of compounds. “TXA 15054 and other compounds found in this series do not actually bind to human DHFR, so it can have a very big implication in the adverse effects or toxicity for patients,” Parhi said.

This newer strain of this sexually transmitted infection (STI), also known as supergonorrhea, poses a public health challenge due to its resistance to the last line of an effective antibiotic, ceftriaxone. And the overall incidence rates of this STI are escalating worldwide. The World Health Organization (WHO) reports that in 2020, there were an estimated 82.4 million (range, 47.7 million-130.4 million) new gonorrhea cases among people aged 15 to 49 years worldwide, with a global incidence rate of 19 (range, 11-29) per 1000 women and 23 (range, 10-43) per 1000 men. Most cases were in the WHO African Region and Western Pacific Region.

Although this strain has been seen mostly outside the US, in 2023, 2 cases of this pathogen were confirmed in the US and identified by the Massachusetts Department of Public Health.

Massachusetts officials reported that clinicians were able to treat the patients successfully with ceftriaxone. However, this strain of the STI had reduced susceptibility to 5 antibiotic classes, including cephalosporins.

Parhi is optimistic his company will identify a specific agent to bring to the clinic. “I hope by the end of 2025 or mid-2026 we will be able to identify a preclinical candidate, and then within 6 months or so, we can identify a clinical candidate.... We are excited about this series of compounds,” he said.



References

1. TAXIS Pharmaceuticals announces $2.9 million NIH grant for its novel investigational therapeutic to combat antibiotic-resistant gonorrhea. Press release. TAXIS Pharmaceuticals. May 27, 2025. Accessed July 14, 2025.
https://www.prweb.com/releases/taxis-pharmaceuticals-receives-2-9-million-nih-grant-for-its-novel-investigational-therapeutic-to-combat-antibiotic-resistant-gonorrhea-302464710.html
2. Multi-drug resistant gonorrhea. World Health Organization. July 11, 2023. Accessed July 14, 2025. 

https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea


3. Landhuis EW. Multidrug-resistant “super gonorrhea” rallies multipronged effort. 

 2024;331(20):1695-1697. doi:10.1001/jama.2023.15355



TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discusses dihydrofolate reductase inhibitors as a novel approach to combat resistant Neisseria gonorrhoeae. 

Conferences

A Group of Antimicrobial Compounds Shows Novelty Action Against Multidrug-Resistant Gonorrhea

Johns Hopkins is offering its Pamela Tucker transplant and oncology infectious diseases course, and its director, Shmuel Shoham, MD, offers more information about this learning opportunity. 

An Education Opportunity for Transplant and Oncology Infections 

Shmuel Shoham, MD, professor of clinical medicine in the Division of Infectious Diseases at Johns Hopkins University School of Medicine, was looking for a course for transplant and oncology infectious diseases. When he couldn’t locate one, he and his team developed one.

Specifically, Johns Hopkins Medicine is offering its new course, 

the Pamela Tucker Course in Transplant & Oncology Infectious Diseases

, on infectious complications in patients undergoing transplant (solid organ and stem cell) and patients with cancer.

“We worked together to create one that starts from the bottom in terms of what patients, doctors, and clinicians can expect in terms of transplantation, in terms of oncology, from the oncologists and the surgeons and the physicians' side and then what can be expected from the infectious disease side,” Shoham said. 

This will be a 2-day, in-person educational activity held from September 8 to 9 at the 

Johns Hopkins University Bloomberg Center

, which is located at 555 Pennsylvania Avenue NW in Washington, DC.

The course will expand expertise on infectious complications in patients undergoing transplant (solid organ and stem cell) and patients with cancer. It will feature lectures from experts in the ﬁeld and provide attendees with the knowledge and skills to provide infectious diseases care to patients undergoing transplant and those with cancer.

“We'll be talking about how organisms get to the places where they don't belong, the impact of resistance, antibacterial and antifungal resistance on those infections, and then have people really know what infections to expect,” Shoham said. “Also, viral infections are huge. So we'll have world experts in CMV [cytomegalovirus], other herpes virus infections, and respiratory viral infections talking about how those infections happen, how to prevent them, how to manage them—cutting-edge approaches to diagnosis and treatment.”  

Shoham also said they are going to be covering xenotransplantation infections.

AMA PRA Category 1 Credits. For those who are interested in learning more or signing up for the course, clinicians can go 

Johns Hopkins is offering its Pamela Tucker transplant and oncology infectious diseases course. Its director, Shmuel Shoham, MD, offers more information about this continuing education opportunity. 

VOLITION and OPERA study data presented at IAS 2025 show patient preference and real-world use of injectable CAB + RPV LA, informing the treatment strategy of ViiV CMO Jean van Wyk.     Ask ChatGPT

Nearly 90% of treatment-naïve people with HIV chose to switch to long-acting injectable therapy after achieving viral suppression, according to findings from the Phase IIIb VOLITION study presented by ViiV Healthcare at IAS 2025. The study enrolled 145 newly diagnosed individuals who began treatment with the daily oral regimen dolutegravir/lamivudine (DTG/3TC). Once they achieved viral suppression, typically in just over four weeks, participants were given a choice: remain on daily oral medication or switch to the long-acting injectable regimen, cabotegravir plus rilpivirine (CAB + RPV LA), administered every two months. An overwhelming 89% (n=129) opted for the long-acting option at their next study visit.

Jean van Wyk, MBChB, MFPM, chief medical officer at ViiV Healthcare, explained, “This study was specifically designed to see how quickly we can get treatment-naive individuals to get to a point where they can potentially choose long-acting injectable therapy."

“They were started on a medication called Dovato, which is a combination of dolutegravir and lamivudine... the moment they became undetectable—which means that they have no virus replicating in their blood—they were immediately given the choice: do they want to stay on the daily oral medication, or do they want to switch to long-acting injectable therapy?”

Participants reached viral suppression with a median time of 4.14 weeks, and data showed that convenience was a key driver in their decision-making.“About 80% of them said it’s because they don’t want to worry about forgetting to take a tablet every day, and about two-thirds of them said it removed the worry about traveling with medication,” van Wyk added.

This strong preference aligns with outcomes from other studies and real-world experiences.“We’ve seen this in studies and in real-world evidence, and it’s just a testament to the power of choice—giving people the choice of a medication that might be best suited to them,” said van Wyk.

OPERA Real-World Data Reinforces Effectiveness in Treatment-Experienced Populations

While VOLITION focused on newly diagnosed individuals, real-world data from the OPERA cohort broadened the picture to include treatment-experienced people living with HIV, especially those with viremia at baseline.

Among 3,304 participants in OPERA, 11% (n=368) had viral loads above 50 copies/mL at initiation of CAB + RPV LA. Remarkably, 88% of these viremic individuals achieved suppression to <50 copies/mL, showing the potential of long-acting treatment even for those with complicated treatment histories.“This time, specifically, we looked at people who are treatment-experienced… but for whatever reason, it wasn't working for them and they became viremic again,” van Wyk explained.

“We had well over 300—nearly 400—people included in this analysis, and they had viremia… what we found was that, over time, they had really good responses—very good effectiveness rates from this OPERA analysis—with around 88% of individuals having an undetectable viral load.”

A separate sub-analysis of viremic women in the OPERA cohort demonstrated even more impressive results, with 92% achieving viral suppression after switching to long-acting therapy.“Again, we saw very similar and good treatment outcomes—just over 90%, 92% of women—having an undetectable viral load after they’d gone on to long-acting injectable therapy,” van Wyk said.

In addition to VOLITION and OPERA, ViiV is building a growing portfolio of real-world effectiveness data. Supporting studies such as CARLOS (Germany), COMBINE-2 (Europe), and BEYOND (U.S.) continue to confirm low virologic failure, strong adherence, and high patient satisfaction across diverse populations—including both virally suppressed and viremic individuals at the time of switch.

“That includes viremic and suppressed populations at the time of switch—again, showing really good effectiveness rates, low rates of virologic failure, and persistence on treatment over time,” noted van Wyk. As the HIV treatment landscape shifts toward personalization and patient-centric care, Jean van Wyk’s leadership at ViiV is shaping a strategy rooted in flexibility, access, and real-world insight.“It’s just a testament to the power of choice,” he said. “Giving people the choice of a medication that might be best suited to them.”

Stay tuned for part two, where we explore how long-acting regimens like CAB + RPV LA are helping to reduce stigma, improve adherence, and expand access, and how these findings are shaping Wyk’s vision for the future of HIV prevention and treatment.

ViiV Healthcare data show 89% of treatment-naïve people with HIV choose to switch to long-acting injectable 

 from daily pills after achieving rapid viral suppression. 

. June 14, 2025. Accessed June 14, 2-25. https://www.businesswire.com/news/home/20250714839509/en/ViiV-Healthcare-data-show-89-of-treatment-nave-people-with-HIV-choose-to-switch-to-long-acting-injectable-Vocabria-Rekambys-from-daily-pills-after-achieving-rapid-viral-suppression

At IAS 2025, the VOLITION and OPERA study data presented at IAS 2025 show patient preference and real-world use of injectable CAB + RPV LA, informing the treatment strategy of ViiV CMO Jean van Wyk.


Long-Acting HIV Therapy Gains Ground in Both New and Experienced Patients

This article was originally published on our sister site, 

Use of an artificial intelligence (AI)–guided infection prevention bundle may support 

 prevention and antimicrobial stewardship in hospital settings, according to findings from a recent study.

The prospective, single-center quality improvement study was conducted at Michigan Medicine, the academic medical center affiliated with the University of Michigan, and compared patient outcomes before and post implementation of a previously validated institution-specific AI model for CDI risk prediction. Results showed that although use of the AI bundle was not associated with a significant reduction in CDI incidence, it was linked to substantial reductions in CDI-associated antimicrobial use.

“Numerous artificial intelligence models have been developed to predict CDI risk in hospitalized patients with the goal of identifying high-risk patients who may potentially benefit from targeted infection prevention resources,” Jenna Wiens, PhD, an associate professor of computer science and engineering at the University of Michigan in Ann Arbor, and colleagues wrote.

 “Although these models have shown promise in prospective validation and in identifying patients prior to colonization, their association with patient outcomes in clinical care remains unknown.”

According to the US Centers for Disease Control and Prevention, 

, a bacterium that causes diarrhea and colitis, is estimated to cause almost half a million infections in the United States each year.

 can live on people's skin and is resistant to alcohol-based hand sanitizers, effective CDI prevention often includes handwashing with soap and water. Receipt of certain antimicrobials is also associated with increased susceptibility to CDI.

Applying these practices at scale can be challenging due to resource constraints at most hospitals, necessitating targeted prevention efforts for patients at the greatest risk of acquiring CDI.

To evaluate the association between an AI-guided infection prevention bundle and CDI incidence in a hospital setting, investigators evaluated adult inpatient hospitalizations before and after the integration of a previously validated institution-specific AI model into clinical workflows at Michigan Medicine. The CDI risk score is calculated by an L2-regularized logistic regression model with time-varying parameters and leverages routinely collected electronic health record data to estimate the daily risk of a patient acquiring CDI in the remainder of their hospitalization.

The pre-AI period was from September 2021 to August 2022, and the post-AI period was from January to December 2023. Of note, investigators excluded the 4-month implementation rollout period from September 2022 to December 2022 from the analysis.

The primary outcome was CDI incidence rate. Secondary outcomes included antimicrobial use and qualitative assessments of bundle implementation.

Pre- and post-AI samples included 39,046 and 40,515 hospitalizations, respectively. In the pre-AI group, the majority of patients were female (55.4%) and White (78.8%) with a median age of 58 (IQR, 36-70) years. In the post-AI group, the majority of patients were female (55.7%) and White (79.6%) with a median age of 58 (IQR, 37-70) years. Investigators called attention to significant differences in age, COVID-19–related hospitalizations, and recent hospitalization history between the groups.

There were 127 CDI cases for 255,017 patient-days in the pre-AI period and 148 CDI cases for 261,892 patient-days in the post-AI period. After adjusting for differences in clinical characteristics, the incidence CDI rate per 10,000 patient-days was 5.76 (95% CI, 4.87-6.69) in the pre-AI period and 5.65 (95% CI, 4.78-6.56) in the post-AI period (absolute difference, −0.11; 95% CI, −1.43 to 1.18; 

Investigators called attention to significant reductions in the use of ampicillin-sulbactam (−2.82; 95% CI, −4.59 to −1.03; 

 = .03), piperacillin-tazobactam (−9.64; 95% CI, −12.93 to −6.28; 

 < .001), and clindamycin (−1.04; 95% CI, −1.60 to −0.47; 

 = .03), measured in antibiotic days per 1000 days present. Of note, reductions were more prominent in high-risk hospitalizations alerted by the AI tool.

Using qualitative assessments via semistructured interviews and field observations, investigators found health care staff’s experiences with AI-guided workflows varied. Results showed an overall low compliance rate for the enhanced hand hygiene sign whereas pharmacists consistently engaged with the alerts and contacted the patients’ care team based on the alerts.

“Despite limitations of our single-center, quasi-experimental design, the insights gained from this study are broadly applicable to other institutions seeking to use AI models to improve clinical outcomes,” the investigators concluded.

 “Future research should focus on developing novel strategies of ongoing education and stakeholder engagement to overcome implementation barriers, exploring the scalability of these efforts across diverse health care settings, identifying optimal alert thresholds that balance sensitivity and alert burden, and conducting randomized clinical trials to assess their effect on clinical outcomes.”

1. Tang S, Shepard S, Clark R, et al. Guiding 

 infection prevention efforts in a hospital setting with AI. 

2. About C. diff. Centers for Disease Control and Prevention. December 18, 2024. Accessed June 12, 2025. 

https://www.cdc.gov/c-diff/about/index.html

Use of an AI-guided infection prevention bundle did not significantly reduce CDI incidence but was associated with increased antimicrobial stewardship.

AI Tool Demonstrates Potential to Support Antimicrobial Stewardship and Reduce C difficile in Hospitals

A real-world, multicenter study of 67 evaluable patients treated with fecal microbiota, live-jslm (Rebyota; RBL) demonstrated a 77.6% treatment success rate at 8 weeks for preventing recurrent 

 infection (rCDI), with 87% maintaining remission at 6 months. These findings support RBL’s safety and efficacy beyond controlled clinical trials in an older population with comorbidities frequently exposed to multiple rCDI risk factors.

RBL, FDA approved in November 2022 as the first microbiota-based product for rCDI prevention in adults, is administered rectally after standard-of-care antibiotics. The study population had a median age of 74 years and a median Charlson comorbidity score of 4, with over half having 3 or more prior CDI recurrences. Risk factors were prevalent, including advanced age (72%), gastric acid suppressant use (55%), immunocompromise (24%), and recent non-CDI antibiotic exposure (21%).

All patients received prior antibiotics, most commonly fidaxomicin (58%), before RBL administration. Adverse events were minimal, limited to minor leakage in 5 patients. Age of 65 years or more was significantly associated with higher recurrence risk. Among patients experiencing recurrence within 8 weeks, median time to relapse was 28 days. Of 30 patients with 6-month follow-up data, 26 (87%) sustained treatment response.

These data provide important evidence for clinicians managing complex rCDI cases, highlighting RBL as a valuable and well-tolerated intervention to reduce recurrence risk in routine practice.

In relation to RBL, in a recent interview with 

, he emphasized that beyond effectively reducing recurrent CDI, the treatment plays a crucial role in improving patients’ overall quality of life. Feuerstadt described how recurrent CDI often leads to significant anxiety, fear, and social isolation, likening the emotional burden to posttraumatic stress. He noted that RBL not only targets the infection but also helps restore patients’ mental, physical, and social well-being, allowing them to regain confidence and normalcy in their daily lives.

1. Seo S, Hengel R, Krishnan S, et al. Real-world experience with fecal microbiota treatment (live-jslm) for the prevention of recurrent 

 infection. Abstract presented at: Making a Difference in Infectious Diseases Annual Meeting; May 28-31, 2025; Orlando, FL. Abstract 85 E.

2.Improved Symptoms and Health-Related Quality of Life in Adults with Recurrent 

 Infection after Fecal Microbiota, Live-jslm (RBL) Administration by Colonoscopy. Abstract presented at DDW 2025, May 3-6, 2025. Accessed July 1, 2025.

Findings from a multicenter US study confirm that RBL is a safe and effective microbiota-based therapy with sustained remission in a high-risk population with comorbidities.

RAVINDRA SANGITHA, MD

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