In the United States in 2021, an outbreak of 4 cases of Burkholderia pseudomallei, the etiologic agent of melioidosis and a Tier One Select Agent (potential for deliberate misuse and subsequent harm), resulted in 2 deaths. The causative strain, B. pseudomallei ATS2021, was unintentionally imported into the United States in an aromatherapy spray manufactured in India. We established that ATS2021 represents a virulent strain of B. pseudomallei capable of robust formation of biofilm at physiologic temperatures that may contribute to virulence. By using mouse melioidosis models, we determined median lethal dose estimates and analyzed the bacteriologic and histopathologic characteristics of the organism, particularly the potential neurologic pathogenesis that is probably associated with the bimA(Bm) allele identified in B. pseudomallei strain ATS2021. Our data, combined with previous case reports and the identification of endemic B. pseudomallei strains in Mississippi, support the concept that melioidosis is emerging in the United States.

BACKGROUND: Data from clinical studies show that artemether-lumefantrine (AL) is effective and well tolerated in adults and children with uncomplicated Plasmodium falciparum malaria. However, data on effectiveness and safety of AL in patients in non-endemic settings are limited. METHODS: A 5-year surveillance plan included all AL-treated adult and paediatric patients with confirmed or suspected P. falciparum malaria in the USA, as reported to the National Malaria Surveillance System at the Centers for Disease Control and Prevention. Descriptive analyses included demographics, baseline characteristics, clinical effectiveness, and safety. From May 2010 to April 2015, demographics and baseline characteristics were collected for 203 patients and safety data for 108 patients. Treatment effectiveness data at day 7 were collected for 117 patients and at day 28 for 98 patients. RESULTS: The majority of patients were male (58.6 %), Black (62.6 %), non-Hispanic (92.6 %), and likely malaria non-immune (80.8 %). The median age was 32 (range 1-88) years and the median body mass index was 25.5 (range 13.8-42.4) kg/m(2). All patients with effectiveness data had confirmed (n = 116) or suspected (n = 1) malaria. The overall cure rate for patients treated with AL was 91.5 % (95 % CI 84.8-95.8 %) at day 7 and 96.9 % (95 % CI 91.3-99.4 %) at day 28. Adverse events were reported in four (3.7 %) patients, and there were no new or unexpected safety signals. CONCLUSION: AL was effective and well tolerated in the treatment of likely non-immune patients with P. falciparum malaria.

BACKGROUND: Chlamydia screening practices, positivity, and trends from 2004 to 2009 in publicly funded prenatal clinics have not been described. METHODS: A phone-based survey assessing chlamydia screening practices was conducted among a random sample of clinics providing prenatal services (prenatal, family planning, and integrated clinics: "prenatal clinics") that reported data to the Infertility Prevention Project (IPP) in 2008. Using existing IPP data, chlamydia positivity and trends were assessed among women aged 15 to 24 years seeking care in any prenatal clinic reporting ≥3 years of data to IPP from 2004 to 2009. Linear trends of the effect of year (a continuous variable) on positivity were evaluated using a correlated modeling approach with a random intercept where the unit of analysis was the individual clinic performing chlamydia tests (clinic-based analysis). Covariates included race, age, test technology, and geography. RESULTS: Of 210 sampled clinics, 166 (79%) completed the survey. Of these, 163 (98.2%) had documented chlamydia screening criteria. Most clinics screened all women during their first trimester and reported 100% screening coverage. From 2004 to 2009, 267,416 tests among women aged 15 to 24 years were reported to IPP from eligible prenatal clinics. Overall chlamydia positivity was 8.3%. Controlling for all covariates, positivity decreased from 2004 to 2009 (odds ratio: 0.93 per year, 95% confidence interval: 0.92, 0.95, 35% decrease overall). CONCLUSIONS: The substantial burden of chlamydia among young women tested in prenatal clinics reporting data to IPP suggests the continued need for routine screening. Decreasing trends from 2004 to 2009 in the IPP prenatal population correspond to findings of overall decreasing chlamydia prevalence in the United States.