On 18 February 2021, the National IHR Focal Point for the Russian Federation notified WHO of detection of avian influenza A(H5N8) in seven human clinical specimens. These are the first reported detection of avian influenza A(H5N8) in humans. Positive clinical specimens were collected from poultry farm workers who participated in a response operation to contain an avian influenza A(H5N8) outbreak detected in a poultry farm in Astrakhan Oblast in the Russian Federation. The laboratory confirmation of the seven specimens were performed by the State Research Centre for Virology and Biotechnology VECTOR (WHO H5 Reference Laboratory). The age of seven positive cases ranged between 29 to 60 years and five were female.

Between 3 and 11 December, a total of 101 000 of 900 000 egg laying hens on the farm died. This high mortality rate prompted an investigation. Samples were collected from these birds and an initial detection of avian influenza A(H5N8) was performed by the Russian regional veterinary laboratory. On 11 December, the outbreak was confirmed by the World Organisation for Animal Health (OIE) Reference laboratory, and the Federal Centre for Animal Health (FGBI-ARRIAH), in Vladimir, the Russian Federation. Outbreak containment operations started immediately and continued for several days due to the large size of the poultry farm.

On 14 February 2021, the Ministry of Health (MoH) of Guinea informed WHO of a cluster of Ebola Virus

Rift Valley fever (RVF) has been reported in Kenya in humans in Isiolo and Mandera counties and in

To the Editor—We thank Yamaoka and colleagues for their interest and comments on our paper [1]. Yamaoka et al point out that there are cross-reactivities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length nucleoprotein (FL-NP) with antibodies to other common human coronaviruses (HCoVs), which may cause false positive results in serological assays. They propose to use a truncated version of NP lacking the N-terminal (ΔNP) to detect SARS-CoV-2 antibodies.

Abstract

Background

Antimicrobial-resistant infections are commonly encountered in US hospitals and result in significant morbidity and mortality. This guidance document provides recommendations for the treatment of infections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa).

Methods

A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated common questions regarding the treatment of ESBL-E, CRE, and DTR-P. aeruginosa infections. Based on review of the published literature and clinical experience, the panel provide recommendations and associated rationale for each recommendation. Because of significant differences in the molecular epidemiology of resistance and the availability of specific anti-infective agents globally, this document focuses on treatment of antimicrobial-resistant infections in the United States.

Results

Approaches to empiric treatment selection, duration of therapy, and other management considerations are briefly discussed. The majority of guidance focuses on preferred and alternative treatment recommendations for antimicrobial-resistant infections, assuming that the causative organism has been identified and antibiotic susceptibility testing results are known. Treatment recommendations apply to both adults and children.

Conclusions

The field of antimicrobial resistance is dynamic and rapidly evolving, and the treatment of antimicrobial-resistant infections will continue to challenge clinicians. This guidance document is current as of 17 September 2020. Updates to this guidance document will occur periodically as new data emerge. Furthermore, the panel will expand recommendations to include other problematic gram-negative pathogens in future versions. The most current version of the guidance including the date of publication can be found at www.idsociety.org/practice-guideline/amr-guidance/.

A 48-year-old female with no past medical history presented to the emergency department in June 2020 with a 6-month history of productive cough associated with nausea, vomiting, and 20-kg weight loss. She had no other symptoms. She lived in mainland France for 20 years, and had been living in Martinique for the past 9 years. She works as a caregiver, and her husband is a goat breeder. She has a dog and a cat. At clinical examination, the patient had no fever and no evidence of respiratory distress. She had a normal oxygen saturation. Heart and lung auscultation were unremarkable. The rest of the examination was normal. The peripheral white blood cell count was 5.84 G/L, of which 0.42 G/L were eosinophils. A mild normochromic normocytic anemia (hemoglobin, 11.6 g/dL) was found. There was no thrombocytopenia, and the C-reactive protein level was <3 mg/L. Liver and kidney function markers were also within normal ranges. Computed tomography of the chest revealed a ground-glass opacity at the base of the middle lobe (Figure 1). A bronchoscopy was performed. Bronchial mucosa appeared to be slightly inflamed with yellowish mucous secretions. During exploration of the right basal pyramid, the endoscopist found and removed a Y-shaped whitish–red motile body. The entire structure was sent to the parasitology laboratory for further identification (Figure 2).