Background Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets, are leading causes of invasive diseases, including bacteraemic pneumonia and meningitis, and of secondary infections subsequent to post-viral respiratory disease. The aim of this study was to investigate the incidence of invasive disease due to these pathogens during the early months of the COVID-19 pandemic. MethodsIn this prospective analysis of surveillance data, laboratories in 26 countries and territories across six continents submitted data on cases of invasive disease due to S pneumoniae, H influenzae, and N meningitidis from Jan 1, 2018, to May, 31, 2020, as part of the Invasive Respiratory Infection Surveillance (IRIS) Initiative. Numbers of weekly cases in 2020 were compared with corresponding data for 2018 and 2019. Data for invasive disease due to Streptococcus agalactiae, a non-respiratory pathogen, were collected from nine laboratories for comparison. The stringency of COVID-19 containment measures was quantified using the Oxford COVID-19 Government Response Tracker. Changes in population movements were assessed using Google COVID-19 Community Mobility Reports. Interrupted time-series modelling quantified changes in the incidence of invasive disease due to S pneumoniae, H influenzae, and N meningitidis in 2020 relative to when containment measures were imposed. Findings 27 laboratories from 26 countries and territories submitted data to the IRIS Initiative for S pneumoniae (62 434 total cases), 24 laboratories from 24 countries submitted data for H influenzae (7796 total cases), and 21 laboratories from 21 countries submitted data for N meningitidis (5877 total cases). All countries and territories had experienced a significant and sustained reduction in invasive diseases due to S pneumoniae, H influenzae, and N meningitidis in early 2020 (Jan 1 to May 31, 2020), coinciding with the introduction of COVID-19 containment measures in each country. By contrast, no significant changes in the incidence of invasive S agalactiae infections were observed. Similar trends were observed across most countries and territories despite differing stringency in COVID-19 control policies. The incidence of reported S pneumoniae infections decreased by 68% at 4 weeks (incidence rate ratio 0•32 [95% CI 0•27-0•37]) and 82% at 8 weeks (0•18 [0•14-0•23]) following the week in which significant changes in population movements were recorded. Interpretation The introduction of COVID-19 containment policies and public information campaigns likely reduced transmission of S pneumoniae, H influenzae, and N meningitidis, leading to a significant reduction in life-threatening invasive diseases in many countries worldwide.

Listeria innocua is widespread in the environment and in food. This species has to date never been described in association with human disease. We report a case of fatal bacteremia caused by L. innocua in a 62-year-old patient. CASE REPORTA 62-year-old woman was admitted to the hospital with a 3-day history of right-upper-quadrant abdominal pain. Her past medical history included hypertension, asthma, gout, and osteoarthritis. At the time of admission to the emergency service, physical examination revealed features of severe septic shock with hypotension (blood pressure, 83/45 mmHg), tachycardia (120 beats/min), and extreme weakness. Her temperature was 39.9°C with jaundice. Because of rapid deterioration of her neurological condition, she was transferred to the intensive care unit for continuous ventilation and hemodynamic support. A blood test at admission showed a leukocyte count of 9.5 ϫ 10 9 /liter, a hemoglobin level of 9.1 g/dl, a platelet count of 22,000/mm 3 , a creatinine level of 198 mol/liter (normal, 50 to 130 mol/liter), and a serum C-reactive protein level of 210 mg/liter (normal, Ͻ5 mg/liter). Hepatic results showed widespread disturbance: bilirubin, 89 mol/liter (normal, 5 to 30 mol/liter); aspartate aminotransferase, 257 IU/liter (normal, Ͻ38 IU/liter); alanine aminotransferase, 143 IU/liter (normal, Ͻ40 IU/liter); and gammaglutamyl transpeptidase, 641 IU/liter (normal, 5 to 40 IU/liter). Pancreatic enzymes were normal. Arterial blood gases revealed severe metabolic acidosis. An abdominal ultrasonographic examination yielded a 20-mm bile duct stone and an 11-mm gallstone. A diagnosis of cholangitis with severe septic shock was established. Two blood cultures were taken, and empirical antimicrobial therapy with intravenous cefotaxime and ornidazole was initiated. The patient's condition deteriorated rapidly with the appearance of signs of hepatocellular insufficiency and disseminated intravascular coagulation. A surgical intervention was decided on and showed cholangitis with hepatic duct necrosis. Postoperative hours were complicated with the persistence of severe hepatic failure, coagulation troubles, and multiple-organ dysfunction, and the patient died 40 h after admission. Blood cultures became positive 2 days after her death with small gram-positive rods.Blood cultures taken at the time of admission were incubated in the automated BacT/ALERT system (Biomerieux, Marcy l'Etoile, France). Of the samples in the two sets of bottles, both those in bottles maintained under aerobic conditions became positive after 4 days of incubation with small, gram-positive rods with a coryneform appearance. After 24 h of incubation, the colonies were small, white, and nonhemolytic on sheep blood agar plates. Among the positive reactions were catalase production, rapid esculin hydrolysis, and production of acid from glucose, maltose, and lactose. With the use of the Api Coryne system (Biomerieux), the numerical profile 2170164 was obtained, which in the API Plus version 2.0 database corresponds to a "good identi...

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BackgroundSince non-tuberculous mycobacteria (NTM) disease is not notifiable in most European Union (EU) and European Economic Area (EEA) countries, the epidemiological situation of the >150 NTM species is largely unknown. We aimed to collect data on the frequency of NTM detection and NTM species types in EU/EEA countries.MethodsOfficially nominated national tuberculosis reference laboratories of all EU/EEA countries were asked to provide information on: laboratory routines for detection and identification of NTM, including drug sensitivity testing (DST) methods; data on the number and type of NTM species identified; coverage and completeness of the provided data on NTM; type and number of human specimens tested for NTM; and number of specimens tested for Mycobacterium tuberculosis complex and NTM. This information was summarized and the main results are described.ResultsIn total, 99 different NTM species were identified with M. avium, M. gordonae, M. xenopi , M. intracellulare, and M. fortuitum identified most frequently. Seven percent of the NTM species could not be identified. NTM was cultured from between 0.4-2.0% of the specimens (data from four countries). The laboratories use culturing methods optimised for M. tuberculosis complex. Identification is mainly carried out by a commercial line probe assay supplemented with sequencing. Most laboratories carried out DST for rapid growers and only at the explicit clinical request for slow growers.ConclusionIt is likely that the prevalence of NTM is underestimated because diagnostic procedures are not optimized specifically for NTM and isolates may not be referred to the national reference laboratory for identification. Due to the diagnostic challenges and the need to establish the clinical relevance of NTM, we recommend that countries should concentrate detection and identification in only few laboratories.

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