QuantiFERON-CMV (QFT-CMV) is a standardized assay for the evaluation of cytomegalovirus-specific cell-mediated immunity (CMV-CMI). Objectives of this study were to assess the evolution of CMV-CMI post-transplant and the clinical utility of QFT-CMV for prediction of post-prophylaxis CMV disease in CMV-seronegative recipients of CMV-seropositive donor kidneys (D+R- KTRs).

Clinical practice guidelines profoundly influence patient care, making transparency, rigor, and fairness in their development essential. The 2025 community-acquired pneumonia (CAP) guideline update, developed by the American Thoracic Society (ATS) and initially co-sponsored by the Infectious Diseases Society of America (IDSA), included a recommendation to prescribe antibacterials for CAP upon detection of a respiratory viral pathogen. Here, we acknowledge the guidelines' strengths with respect to supporting shorter treatment duration but highlight the lack of supporting data for antibacterial therapy in CAP with a respiratory virus. We additionally reflect on shortcomings in the guideline development process itself, which may have led to this recommendation, including meeting logistics, communication, and methodology, using these observations to offer suggestions for future infectious diseases guidelines panels. Despite the unfortunate outcome, we commend IDSA for their difficult but principled decision to withdraw support, preserving stewardship priorities and the commitment to first do no harm.

Streptococcus pneumoniae is a major global cause of invasive pneumococcal disease (IPD) and death. Introduction of the pneumococcal conjugate vaccine (PCV) has led to substantial declines in IPD incidence in many countries. Long-term, population-based studies on mortality trends among survivors of acute IPD are scarce.

Human rabies underdetection is a global challenge due in part to under-testing. Antemortem diagnosis obviates challenges associated with postmortem testing and is critical to timely clinical and public health decision-making. This study aimed to characterize diagnostic sensitivity associated with specific antemortem sample types and timing of collection.

This publication represents the first part of an update to the clinical practice guideline on the diagnosis and management of group A streptococcal (Streptococcus pyogenes or GAS) pharyngitis, developed by the Infectious Diseases Society of America (IDSA). Diagnosis of GAS pharyngitis by clinician judgement alone is unreliable, and unselective testing incurs cost and inconvenience for individuals at low risk of having GAS infection. Clinical scoring systems have been used to quantify the probability of a positive GAS throat culture based on standardized criteria such as the presence of fever; tonsillar enlargement or exudate; tender and enlarged anterior cervical lymph nodes; and the absence of cough. The goal of this paper is to determine whether a scoring system should be used to decide which patients should have a diagnostic test performed by rapid antigen detection test (RADT), molecular methods, and/or throat culture. We performed a systematic review of randomized and non-randomized studies that compared the use of a clinical scoring system to clinician judgement alone in predicting the outcome of a throat culture. Evidence from studies in children and adults suggests the diagnostic accuracy of a clinical scoring system is comparable to or slightly higher than clinician judgement alone. However, the studies are limited due to small size, lack of uniformity in outcome measures, and incomplete data. The consensus of the panel is that the balance of benefits and harms favors use of a clinical scoring system as part of the evaluation of patients with sore throat. The principal utility of using a scoring system is to identify patients with low probability of GAS pharyngitis and to reduce unnecessary testing.

Being an ID consultant is challenging. While ID has always been busy with direct patient care, reviewing microbiology results, teaching, or conducting research, lately, our invaluable time and expertise have never been more accessible or in demand. "Consult fitness" combines clinical excellence, effective triage of tasks, and boundary setting. The H.U.S.T.L.E. (H - hone your skills, U - update your toolbox, S - seek an effective approach, T, L - take action and lead, E - emphasize your role) framework can help ID professionals achieve consult fitness, and both minimize burnout and job dissatisfaction.

Rabies, a fatal zoonotic encephalitis, is preventable through timely post-exposure prophylaxis (PEP), which includes wound care, vaccination, and local infiltration of immunoglobulins. However, reports of rabies despite PEP raise concerns about vaccine efficacy and protocol adherence. This study aimed to assess the burden and underlying causes of such apparent rabies "breakthrough" infections.

Cytomegalovirus (CMV)-specific cell-mediated immunity (CMV-CMI) prevents CMV reactivation after hematopoietic cell transplant (HCT). Trends in CMV-CMI using the QuantiFERON-CMV assay and its clinical utility in a phase 3 study were evaluated.

The American Thoracic Society recently released updated community-acquired pneumonia (CAP) guidelines. The Infectious Diseases Society of America (IDSA) agreed with 8 of the 10 recommendations in the guidelines but declined to endorse the guidelines because they include recommendations for use of antibiotics in outpatients with comorbidities and inpatients with nonsevere CAP who test positive for respiratory viruses. It is noted in the guidelines that bacterial coinfections are common and that delaying antibiotics may be harmful. IDSA notes, however, that nondiscriminatory use of antibiotics for patients with CAP and positive viral assays confers more risks than benefits. Most patients do not have bacterial coinfections, and briefly withholding antibiotics for patients with nonsevere illness to clarify the diagnosis is safe. In this era of precision medicine, IDSA instead recommends individualized, dynamic decision-making that takes into account each patient´s evolving trajectory, severity of illness and balance of clinical features for and against coinfection.

For over a century, tuberculosis (TB) has referred to the disease caused by Mycobacterium tuberculosis-an infection that can take many forms and exist without symptoms. Recently, WHO introduced the term 'asymptomatic tuberculosis' (aTB) for cases without reported symptoms during screening. While intended to highlight the importance of aTB and limitations of symptom-based screening, this Viewpoint questions whether the term helps or hinders these aims. aTB relies on ill-defined 'symptom report', leading to variable interpretation, misunderstanding, and paradoxically reinforcing symptom-screening. Terminologically splitting TB has also led to aTB being misunderstood as a distinct, milder 'condition', prompting speculation its treatment may be unnecessary-contrary to WHO's intent. Rather than reframing TB to highlight the inaccuracy of symptom-based screening, this Viewpoint calls for removing symptom-based screening from guidelines and the promotion of evidence-based methods and terminology. TB remains the most accurate, programmatically relevant and compelling term for all forms of the disease.

The next pandemic may demand faster, more flexible responses with better risk-benefit and cost-benefit ratios than current systems can deliver. During COVID-19, R&D funding allocation strongly favored vaccines over antivirals and regulatory approvals of vaccines far exceeded approvals for antivirals. Moreover, early evidence on antiviral effectiveness was often limited or even misleading. Antivirals may have advantages in early outbreak control, high-risk populations, and settings with delayed vaccine uptake. For future pandemics, we propose a dedicated antiviral agenda to coordinate R&D for broad-spectrum agents, fund Phase 2/3 trials for high-severity pathogens, enable rapid manufacturing scale-up for demonstrably effective interventions, and secure equitable global access through tiered pricing, stockpiling, and technology transfer. This platform would fill the critical therapeutic blind spot in existing pandemic vaccine-centric strategies. The proposed approach should ensure transparency, strengthen equity, and provide rigorous evidence for both vaccines and antivirals, dissecting their relative benefits, limitations, complementarity and cost-benefit.

Group B Streptococcus (GBS) is a major cause of infant meningitis, often requiring intensive care. The molecular determinants of severe disease (meningitis/Intensive Care Unit (ICU) admission) remain unclear. Although late-onset disease (LOD) and very late-onset disease (VLOD) appear clinically similar, their genomic distinctions are not well described.

Tuberculosis (TB) infection is a driver of the global TB epidemic. Accurate, affordable, and simpler diagnostics are crucial for identifying people for preventive therapy. We evaluated the diagnostic performance of the STANDARD F TB-Feron FIA (TB-Feron), a near-point-of-care (POC) assay for detecting TB infection.

Point-of-care testing (POCT), particularly nucleic acid-based assays, is reshaping infectious disease diagnostics by enabling faster, decentralized decision-making. Drawing on real-world hospital deployments, we identify key operational lessons and propose a roadmap for broader implementation. Using implementation research frameworks, we highlight common barriers (workflow integration, limited stewardship, financial planning) and facilitators (institutional support, clinical engagement, training, quality assurance and perceived quick results). We advocate for structured POCT integration in critical care, where diagnostic delays impact outcomes, and suggest embedding testing within Diagnostic and Antimicrobial Stewardship Teams. We also examine outpatient and primary care expansion, emphasizing the need for multidisciplinary organization and continuity between hospital and community settings. To guide future strategies, we outline core principles: equity, sustainability, and clinical alignment. These can inform scalable approaches to diagnostic integration across diverse health systems, including resource-limited contexts. This viewpoint offers practical, experience-based guidance to support smarter, coordinated, and stewardship-aligned deployment of POCT.

We previously reported reductions in weight and cardiometabolic risk factors in people with HIV (PWH) receiving semaglutide; here we explored the durability of these changes after treatment cessation.

Clinical heterogeneity in Staphylococcus aureus bacteremia (SAB) complicates clinical management and research. We have previously identified five clinically distinct subphenotypes of SAB associated with differences in outcomes and response to adjunctive rifampicin. Here, we aimed to identify these subphenotypes in geographically diverse observational cohorts, including a higher prevalence of methicillin-resistant S. aureus (MRSA) bacteremia and the USA300 clone.