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Our evidence suggests that NiV can recrudesce in previously infected adult bats, thus providing a new potential mechanism for maintenance in natural hosts.
Heightened awareness of possible infection with multiple strains, either from reinfection or coinfection, is critical when monitoring patients who are not improving or who recrudesce despite therapy guided by drug-resistance testing.
In general, plague foci in the western US exist in xeric semi-desert environments, and plague recrudesces in epizootic form in response to moderately dry seasons and temperatures (157-159), but with sufficient moisture to sustain hosts, fleas and the plague bacillus below ground.