This Week in Infectious Disease — Oct 23, 2026
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The week's practice-changing Infectious Disease research, summarized for clinicians.
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Oropouche virus infection in pregnant women in Rio de Janeiro, Brazil: a prospective cohort study.
Confirmed Oropouche infection in pregnancy roughly tripled adverse maternal outcomes including fetal loss and haemorrhage, and was linked to infant central nervous system abnormalities absent in uninfected pregnancies.
The Lancet Infectious Diseases · 2026 · PubMed
This week’s papers
- 01
Oropouche virus infection in pregnant women in Rio de Janeiro, Brazil: a prospective cohort study.
Confirmed Oropouche infection in pregnancy roughly tripled adverse maternal outcomes including fetal loss and haemorrhage, and was linked to infant central nervous system abnormalities absent in uninfected pregnancies.
Brasil P et al. · The Lancet Infectious Diseases · 2026
From the briefingWe start with pathogens that behave worse than we tend to assume, beginning with a prospective cohort in The Lancet Infectious Diseases from Brasil and colleagues, the first to compare Oropouche virus outcomes in pregnancy against uninfected pregnancies [1]. Across Rio de Janeiro state, 544 pregnant women in areas with or at high risk of outbreaks were enrolled and tested repeatedly by RT-PCR in blood, urine and saliva, with serology and placental studies. About a quarter of the women had confirmed infection. Adverse maternal outcomes, meaning maternal death or disability, fetal loss, or haemorrhage, occurred in about 18 percent of women with confirmed infection versus about 7 percent of uninfected women, roughly a tripling of risk after adjustment, and fetal loss and haemorrhage were each about three times more likely. Adverse infant outcomes were markedly more frequent, and central nervous system abnormalities occurred in eight infants of infected mothers and in none of the infants of uninfected mothers. Notably, symptoms did not track with adverse outcomes, so asymptomatic infection was not reassuring. The adjusted estimates for infant outcomes are imprecise given small event numbers, and this is a single region during an outbreak, but the signal is strong enough that the authors frame Oropouche alongside Zika as a congenital threat.
If you only have time for one paper this week, make it the Oropouche pregnancy cohort in The Lancet Infectious Diseases [1]. It is the first study to put comparative numbers on maternal and infant harm from this expanding arbovirus, and it reopens the question of how congenital arbovirus risk is communicated to pregnant travellers and residents of affected regions.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Predictors and Patterns of Metastatic Candidozyma auris Infection, Spain, 2016-2024.
About one in five patients with Candidozyma auris candidemia developed metastatic infection, most often endocarditis, which was associated with roughly doubled mortality at 60 and 90 days.
Suarez-Urquiza P et al. · Emerging Infectious Diseases · 2026
From the briefingSuarez-Urquiza and colleagues reviewed 108 patients with Candidozyma auris candidemia at a Spanish tertiary hospital over eight years and found that about one in five patients developed metastatic infection, most often endocarditis, followed by osteoarticular, meningeal and hepatosplenic disease [2]. A cardiac device or prosthetic valve roughly tripled the risk of metastatic spread, though that association weakened when the analysis was restricted to patients who actually had echocardiography, and persistent candidemia showed a higher but not statistically significant risk. Metastatic infection was associated with roughly double the mortality at 60 and 90 days. The authors conclude the data support echocardiography in patients with intracardiac devices, a reasonable inference from a retrospective single-centre series rather than a tested strategy.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Five-Biomarker Definition for Hypervirulent Klebsiella pneumoniae Bloodstream Infection and Abscess Complications, Japan, 2022-2024.
A five-biomarker genotypic definition identified hypervirulent Klebsiella in 14 percent of bloodstream infections, with abscesses in 61 percent of these versus 13 percent of classical episodes.
Watanabe N et al. · Emerging Infectious Diseases · 2026
From the briefingIn a parallel study from Japan, Watanabe and colleagues applied a five-biomarker genotypic definition of hypervirulent Klebsiella pneumoniae to 207 bloodstream infection episodes [3]. About 14 percent of episodes met the definition, and abscess complications occurred in about 61 percent of those episodes compared with about 13 percent of classical infections. Patients with hypervirulent strains stayed in hospital twice as long and received about three times as many days of antibiotics, and nine of ten sequence type 23 episodes involved abscesses. A small number of hypervirulent isolates also carried CTX-M extended-spectrum beta-lactamase genes, the convergence of virulence and resistance that worries surveillance programmes. The authors present the definition as a surveillance tool; whether it should trigger routine abscess imaging remains untested.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Not All Extrapulmonary Tuberculosis Is Equal: Site-Specific Mortality in a National Indian Cohort.
Among over 777,000 Indian adults with extrapulmonary tuberculosis, in-treatment mortality varied more than tenfold by site, highest for meningitis, miliary and pericardial disease, with site-specific comorbidity effects.
Singh UB et al. · Clinical Infectious Diseases · 2026
From the briefingRounding out this theme, Singh and colleagues in Clinical Infectious Diseases analysed more than 777,000 Indian adults with extrapulmonary tuberculosis and found in-treatment mortality varied more than tenfold by site [4]. Compared with lymph node disease, tuberculous meningitis carried about twelve times the odds of death, miliary disease about five times, and pericardial disease nearly four times, and the influence of HIV, diabetes, alcohol and tobacco differed by site. The scale is remarkable, though the brief abstract gives limited detail on how sites were ascertained, and the authors' call for risk-stratified, comorbidity-aware care is a framework rather than a tested intervention.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Projected Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections in the United States.
Modelling projects that replacing universal hepatitis B birth-dose vaccination with shared decision making would raise chronic childhood infections by about 83 percent and greatly expand susceptibility.
Mohareb AM et al. · Annals of Internal Medicine · 2026
From the briefingOur second theme is viral hepatitis and HIV, where policy and service design are as consequential as therapeutics. In Annals of Internal Medicine, Mohareb and colleagues modelled the proposed 2026 federal changes to the childhood hepatitis B schedule in the United States [5]. Using a Markov model of a single birth cohort of about 3.6 million infants, they projected that deferring the first dose to two months would increase chronic childhood infections by about a fifth, and that moving to shared decision making would increase them by about 83 percent, largely because vaccine completion was assumed to fall to around half under that approach. By age twenty, the number of people susceptible to hepatitis B would roughly double under deferral and grow nearly eightfold under shared decision making. In a pessimistic scenario with lower coverage and higher prevalence, chronic infections climbed into the low thousands. This is a model, and the authors flag uncertainty around horizontal transmission, but the direction of effect is consistent across scenarios, and the authors explicitly argue for reinstating universal birth-dose vaccination.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Cost-Effectiveness of HCV Screening in Emergency Departments Using DETECT Hep C Trial Results.
Nontargeted hepatitis C screening in emergency departments was cost-effective at about 12,800 dollars per quality-adjusted life-year, outperforming both targeted screening and no screening in simulation.
Czoty LMW et al. · JAMA Internal Medicine · 2026
From the briefingIn JAMA Internal Medicine, Czoty and colleagues used data from the DETECT Hep C trial in three emergency departments to model screening strategies over a lifetime horizon [6]. Nontargeted screening of all emergency department patients was cost-effective, at roughly thirteen thousand dollars per quality-adjusted life-year compared with no screening, and slightly outperformed targeted screening. The per-person gains look tiny because more than nine in ten people screened do not have hepatitis C, but benefits were clear among those who did. The analysis supports nontargeted emergency department screening as part of elimination strategy, with the usual caveat that model inputs come from three academic sites.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Long-term Effectiveness, Treatment Persistence, and Timing of Virological Failure With Long-Acting Cabotegravir Plus Rilpivirine in Real-World HIV Care: RELATIVITY Cohort.
In over 3,300 Spanish adults, long-acting cabotegravir plus rilpivirine maintained suppression in about 96 percent, with rare virological failure clustered mostly within the first year after switching.
Buzón L et al. · Open Forum Infectious Diseases · 2026
From the briefingOn the HIV side, Buzón and colleagues in Open Forum Infectious Diseases report the RELATIVITY cohort, more than 3,300 Spanish adults who switched from oral therapy to long-acting cabotegravir plus rilpivirine in routine care, followed for a median of about two years [7]. Viral suppression was documented in about 96 percent of patients, injection adherence was nearly universal, and close to nine in ten patients remained on the regimen. Virological failure occurred in 28 people, under one percent, but roughly seven in ten of those failures came within the first year after switching, and most failures carried emergent integrase or non-nucleoside resistance. Encouragingly, 24 of the 28 patients resuppressed on oral therapy. As an observational cohort it cannot isolate predictors, but the timing finding supports the authors' case for close virological monitoring early after the switch.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
How do we monitor doxy-PEP impact and when should we consider revisiting guidelines?
Doxycycline post-exposure prophylaxis should be governed adaptively, since falling infection prevalence shrinks benefit per dose while resistance costs grow and attribution of trends remains methodologically difficult.
Grad YH et al. · PLOS Medicine · 2026
From the briefingOur final theme concerns sexually transmitted infection prevention, resistance, and stewardship, with two papers in conversation about gonorrhoea. In PLOS Medicine, Grad and colleagues examine doxycycline post-exposure prophylaxis now that the 2026 World Health Organization guidelines recommend it, arguing it should be governed as an adaptive intervention with periodic transparent review [8]. They note that doxy-PEP is expected to select for resistance in Neisseria gonorrhoeae, Staphylococcus aureus, and the gut and skin microbiome, and that as infection prevalence falls, the benefit per dose shrinks while the resistance cost per dose grows. Attributing trends to doxy-PEP will be methodologically hard, and they argue that a full accounting should include patient-centred benefits such as reduced anxiety and fewer clinic visits, alongside harms such as gastrointestinal effects and pregnancy concerns. This is a policy analysis, not new data, but it frames the questions that surveillance will need to answer.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Enabling Ciprofloxacin Resistance-Guided Therapy for Neisseria gonorrhoeae: Aligning Diagnostics, Regulation, Guidelines, and Reimbursement.
Because a single gyrA mutation predicts gonococcal ciprofloxacin resistance, molecular tests could enable oral single-dose therapy, but implementation requires coordinated diagnostics, regulation, guidelines and reimbursement.
Trainor BW et al. · Clinical Infectious Diseases · 2026
From the briefingPulling in a different direction on gonorrhoea resistance, Trainor and colleagues in Clinical Infectious Diseases summarise a meeting convened by the Antibacterial Resistance Leadership Group on enabling ciprofloxacin resistance-guided therapy in the United States [9]. Because ciprofloxacin resistance is overwhelmingly driven by a single gyrA codon 91 mutation, molecular testing can reliably predict susceptibility, potentially allowing a cheap single oral dose in place of empirical intramuscular ceftriaxone and sparing ceftriaxone selection pressure. A multicentre study is generating regulatory-grade performance data, and the paper argues diagnostics, regulation, guidelines and reimbursement must move together. Neither the doxy-PEP nor the ciprofloxacin paper offers outcome data, but read together they show gonorrhoea management becoming more individualised and more resistance-aware at the same time.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Updated UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT): ensuring quality of care and antimicrobial stewardship in an evolving healthcare landscape.
Updated UK outpatient parenteral antimicrobial therapy recommendations add guidance on self-administration, hard-to-reach groups, education, complex oral regimen monitoring and equity, reflecting increasingly complex patients.
Noble AL et al. · Journal of Antimicrobial Chemotherapy · 2026
From the briefingFinally, in the Journal of Antimicrobial Chemotherapy, Noble and colleagues present updated UK good practice recommendations for outpatient parenteral antimicrobial therapy [10]. New recommendations address self-administration, hard-to-reach groups, patient education, monitoring protocols for complex oral regimens and new parenteral routes, and equitable access, with amended guidance on thromboprophylaxis and early collaboration with vascular access teams. These are consensus recommendations built on a systematic review, reflecting how much more complex the patients managed by these services have become.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Infectious Disease. This week we're covering 10 notable papers spanning emerging and severe invasive infections, viral hepatitis and HIV policy and care, and the shifting ground of sexually transmitted infection prevention and antimicrobial stewardship. Let's dive in.
We start with pathogens that behave worse than we tend to assume, beginning with a prospective cohort in The Lancet Infectious Diseases from Brasil and colleagues, the first to compare Oropouche virus outcomes in pregnancy against uninfected pregnancies [1]. Across Rio de Janeiro state, 544 pregnant women in areas with or at high risk of outbreaks were enrolled and tested repeatedly by RT-PCR in blood, urine and saliva, with serology and placental studies. About a quarter of the women had confirmed infection. Adverse maternal outcomes, meaning maternal death or disability, fetal loss, or haemorrhage, occurred in about 18 percent of women with confirmed infection versus about 7 percent of uninfected women, roughly a tripling of risk after adjustment, and fetal loss and haemorrhage were each about three times more likely. Adverse infant outcomes were markedly more frequent, and central nervous system abnormalities occurred in eight infants of infected mothers and in none of the infants of uninfected mothers. Notably, symptoms did not track with adverse outcomes, so asymptomatic infection was not reassuring. The adjusted estimates for infant outcomes are imprecise given small event numbers, and this is a single region during an outbreak, but the signal is strong enough that the authors frame Oropouche alongside Zika as a congenital threat.
Two papers in Emerging Infectious Diseases look at bloodstream infections that seed distant sites. Suarez-Urquiza and colleagues reviewed 108 patients with Candidozyma auris candidemia at a Spanish tertiary hospital over eight years and found that about one in five patients developed metastatic infection, most often endocarditis, followed by osteoarticular, meningeal and hepatosplenic disease [2]. A cardiac device or prosthetic valve roughly tripled the risk of metastatic spread, though that association weakened when the analysis was restricted to patients who actually had echocardiography, and persistent candidemia showed a higher but not statistically significant risk. Metastatic infection was associated with roughly double the mortality at 60 and 90 days. The authors conclude the data support echocardiography in patients with intracardiac devices, a reasonable inference from a retrospective single-centre series rather than a tested strategy. In a parallel study from Japan, Watanabe and colleagues applied a five-biomarker genotypic definition of hypervirulent Klebsiella pneumoniae to 207 bloodstream infection episodes [3]. About 14 percent of episodes met the definition, and abscess complications occurred in about 61 percent of those episodes compared with about 13 percent of classical infections. Patients with hypervirulent strains stayed in hospital twice as long and received about three times as many days of antibiotics, and nine of ten sequence type 23 episodes involved abscesses. A small number of hypervirulent isolates also carried CTX-M extended-spectrum beta-lactamase genes, the convergence of virulence and resistance that worries surveillance programmes. The authors present the definition as a surveillance tool; whether it should trigger routine abscess imaging remains untested.
Rounding out this theme, Singh and colleagues in Clinical Infectious Diseases analysed more than 777,000 Indian adults with extrapulmonary tuberculosis and found in-treatment mortality varied more than tenfold by site [4]. Compared with lymph node disease, tuberculous meningitis carried about twelve times the odds of death, miliary disease about five times, and pericardial disease nearly four times, and the influence of HIV, diabetes, alcohol and tobacco differed by site. The scale is remarkable, though the brief abstract gives limited detail on how sites were ascertained, and the authors' call for risk-stratified, comorbidity-aware care is a framework rather than a tested intervention.
Our second theme is viral hepatitis and HIV, where policy and service design are as consequential as therapeutics. In Annals of Internal Medicine, Mohareb and colleagues modelled the proposed 2026 federal changes to the childhood hepatitis B schedule in the United States [5]. Using a Markov model of a single birth cohort of about 3.6 million infants, they projected that deferring the first dose to two months would increase chronic childhood infections by about a fifth, and that moving to shared decision making would increase them by about 83 percent, largely because vaccine completion was assumed to fall to around half under that approach. By age twenty, the number of people susceptible to hepatitis B would roughly double under deferral and grow nearly eightfold under shared decision making. In a pessimistic scenario with lower coverage and higher prevalence, chronic infections climbed into the low thousands. This is a model, and the authors flag uncertainty around horizontal transmission, but the direction of effect is consistent across scenarios, and the authors explicitly argue for reinstating universal birth-dose vaccination.
In JAMA Internal Medicine, Czoty and colleagues used data from the DETECT Hep C trial in three emergency departments to model screening strategies over a lifetime horizon [6]. Nontargeted screening of all emergency department patients was cost-effective, at roughly thirteen thousand dollars per quality-adjusted life-year compared with no screening, and slightly outperformed targeted screening. The per-person gains look tiny because more than nine in ten people screened do not have hepatitis C, but benefits were clear among those who did. The analysis supports nontargeted emergency department screening as part of elimination strategy, with the usual caveat that model inputs come from three academic sites.
On the HIV side, Buzón and colleagues in Open Forum Infectious Diseases report the RELATIVITY cohort, more than 3,300 Spanish adults who switched from oral therapy to long-acting cabotegravir plus rilpivirine in routine care, followed for a median of about two years [7]. Viral suppression was documented in about 96 percent of patients, injection adherence was nearly universal, and close to nine in ten patients remained on the regimen. Virological failure occurred in 28 people, under one percent, but roughly seven in ten of those failures came within the first year after switching, and most failures carried emergent integrase or non-nucleoside resistance. Encouragingly, 24 of the 28 patients resuppressed on oral therapy. As an observational cohort it cannot isolate predictors, but the timing finding supports the authors' case for close virological monitoring early after the switch.
Our final theme concerns sexually transmitted infection prevention, resistance, and stewardship, with two papers in conversation about gonorrhoea. In PLOS Medicine, Grad and colleagues examine doxycycline post-exposure prophylaxis now that the 2026 World Health Organization guidelines recommend it, arguing it should be governed as an adaptive intervention with periodic transparent review [8]. They note that doxy-PEP is expected to select for resistance in Neisseria gonorrhoeae, Staphylococcus aureus, and the gut and skin microbiome, and that as infection prevalence falls, the benefit per dose shrinks while the resistance cost per dose grows. Attributing trends to doxy-PEP will be methodologically hard, and they argue that a full accounting should include patient-centred benefits such as reduced anxiety and fewer clinic visits, alongside harms such as gastrointestinal effects and pregnancy concerns. This is a policy analysis, not new data, but it frames the questions that surveillance will need to answer.
Pulling in a different direction on gonorrhoea resistance, Trainor and colleagues in Clinical Infectious Diseases summarise a meeting convened by the Antibacterial Resistance Leadership Group on enabling ciprofloxacin resistance-guided therapy in the United States [9]. Because ciprofloxacin resistance is overwhelmingly driven by a single gyrA codon 91 mutation, molecular testing can reliably predict susceptibility, potentially allowing a cheap single oral dose in place of empirical intramuscular ceftriaxone and sparing ceftriaxone selection pressure. A multicentre study is generating regulatory-grade performance data, and the paper argues diagnostics, regulation, guidelines and reimbursement must move together. Neither the doxy-PEP nor the ciprofloxacin paper offers outcome data, but read together they show gonorrhoea management becoming more individualised and more resistance-aware at the same time.
Finally, in the Journal of Antimicrobial Chemotherapy, Noble and colleagues present updated UK good practice recommendations for outpatient parenteral antimicrobial therapy [10]. New recommendations address self-administration, hard-to-reach groups, patient education, monitoring protocols for complex oral regimens and new parenteral routes, and equitable access, with amended guidance on thromboprophylaxis and early collaboration with vascular access teams. These are consensus recommendations built on a systematic review, reflecting how much more complex the patients managed by these services have become.
If you only have time for one paper this week, make it the Oropouche pregnancy cohort in The Lancet Infectious Diseases [1]. It is the first study to put comparative numbers on maternal and infant harm from this expanding arbovirus, and it reopens the question of how congenital arbovirus risk is communicated to pregnant travellers and residents of affected regions.
Here is what this week's evidence adds up to in Infectious Disease. First, Oropouche infection in pregnancy is now associated with roughly tripled maternal harm and central nervous system abnormalities in infants, from one prospective cohort with imprecise infant estimates and no data yet from other regions. Second, metastatic spread is common in both Candidozyma auris candidemia and hypervirulent Klebsiella bacteremia, though both signals come from single-centre retrospective series and the value of systematic imaging is untested. Third, modelling projects that weakening the hepatitis B birth-dose recommendation in the United States would substantially increase childhood chronic infections, and separate modelling supports nontargeted hepatitis C screening in emergency departments as cost-effective. Fourth, real-world long-acting cabotegravir plus rilpivirine performs well over two years, with rare failures concentrated in the first year. And fifth, gonorrhoea prevention and treatment are entering a resistance-conscious phase, with doxy-PEP governance and ciprofloxacin-guided therapy both still awaiting outcome data.
That's your roundup for This Week in Infectious Disease. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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