Infect. Dis. Rep., Volume 16, Issue 6 (December 2024) – 14 articles

Background: The global push to eliminate tuberculosis (TB) as a public health threat is increasingly urgent, particularly in high-burden areas like the Oliver Reginald Tambo District Municipality, South Africa. Drug-resistant TB (DR-TB) poses a significant challenge to TB control efforts and is a leading cause of TB-related deaths. This study aimed to assess DR-TB transmission patterns and predict future cases using geospatial and predictive modeling techniques. Methods: A retrospective cross-sectional study was conducted across five decentralized DR-TB facilities in the O.R. Tambo District Municipality from January 2018 to December 2020. Data were obtained from Statistics South Africa, and patient GPS coordinates were used to identify clusters of DR-TB cases via DBSCAN clustering. Hotspot analysis (Getis-Ord Gi) was performed, and two predictive models (Linear Regression and Random Forest) were developed to estimate future DR-TB cases. Analyses were conducted using Python 3.8 and R 4.1.1, with significance set at p < 0.05. Results: A total of 456 patients with DR-TB were enrolled, with 56.1% males and 43.9% females. The mean age was 37.5 (±14.9) years. The incidence of DR-TB was 11.89 cases per 100,000 population, with males being disproportionately affected. Key risk factors included poverty, lack of education, and occupational exposure. The DR-TB types included RR-TB (60%), MDR-TB (30%), Pre-XDR-TB (5%), XDR-TB (3%), and INHR-TB (2%). Spatial analysis revealed significant clustering in socio-economically disadvantaged areas. A major cluster was identified, along with a distinct outlier. The analyses of DR-TB case trends using historical data (2018–2021) and projections (2022–2026) from Linear Regression and Random Forest models reveal historical data with a sharp decline in DR-TB case, from 186 in 2018 to 15 in 2021, highlighting substantial progress. The Linear Regression model predicts a continued decline to zero cases by 2026, with an R² = 0.865, a mean squared error (MSE) of 507.175, and a mean absolute error (MAE) of 18.65. Conversely, the Random Forest model forecasts stabilization to around 30–50 cases annually after 2021, achieving an R² = 0.882, an MSE of 443.226, and an MAE of 19.03. These models underscore the importance of adaptive strategies to sustain progress and avoid plateauing in DR-TB reduction efforts. Conclusions: This study highlights the need for targeted interventions in vulnerable populations to curb DR-TB transmission and improve treatment outcomes. Full article

Background: Salmonella enterica serovar Hvittingfoss, a member of the non-typhoidal Salmonella group, is an important foodborne serovar most frequently identified in regions (Australia, Belgium, and the United States) with active surveillance systems. This serovar has been implicated in outbreaks of foodborne illness. Soft cheese, crab cocktail, beef, and rock melon are commonly involved in these outbreaks. Although the definitive host of this serovar is not yet established, Salmonella Hvittingfoss can be found in wild animals (Feral pigs), bird populations (Bar-tailed godwit, Plumed whistling ducks, White-naped crane, and Sharp-tailed sandpiper), and domestic birds like chickens. Case presentation: We report the first case of Salmonella enterica serovar Hvittingfoss causing acute gastroenteritis in a 52-year-old male labourer and agriculturist from a rural area of Mysuru, South India. This is the first documented case of Salmonella Hvittingfoss causing acute gastroenteritis in India. Conclusions: While non-typhoidal Salmonella infections typically resolve on their own, they can be particularly dangerous for certain demographics, such as children, the elderly, and those with compromised immune systems. Therefore, studying the different serotypes of these infections in both clinical and subclinical cases is crucial for targeting effective surveillance, hygiene practises, and food safety measures that can mitigate their impact on public health. Full article

Introduction: Invasive aspergillosis (IA) is an opportunistic fungal infection that typically occurs in the immunocompromised host and is associated with severe morbidity and mortality. Myocardial abscess formation is seldomly described. Detailed Case Description: We present a case of IA with purulent myocarditis. The patient was on long-term high-dose corticosteroid and mycophenolate mofetil therapy for severe lupus nephritis. After multiple visits to his general practitioner and nephrologist for general malaise, he was admitted to our hospital with visual complaints. Within several days, he developed atrial fibrillation, respiratory insufficiency, and, finally, a decreased level of consciousness. After admission to the intensive care unit, the broncho alveolar lavage (BAL) fluid galactomannan (GM) index was normal, but the serum GM index was severely elevated. Despite initiation of antifungal therapy, the patient passed away shortly thereafter. Autopsy revealed massive intracranial hemorrhage and disseminated IA affecting the lungs, brain, and myocardium, with macroscopic myocardial abscess formation. Discussion: This classic case of diagnostic uncertainty illustrates how invasive fungal infections can progress to disseminated disease while showing nonspecific symptoms only. It emphasizes the importance of vigilance for opportunistic fungal infections in a growing category of immunocompromised patients. Conclusion: Clinicians should have a low threshold of suspicion for fungal infections in patients on combination immunosuppressive medication, such as high-dose corticosteroid therapy in combination with T-cell inhibitors like MMF. Full article

Background: Phage therapy, a treatment utilizing bacteriophages to combat bacterial infections, is gaining attention as a promising alternative to antibiotics, particularly for managing antibiotic-resistant bacteria. This study aims to provide a comprehensive review of phage therapy by examining its safety, efficacy, influencing factors, future prospects, and regulatory considerations. The study also seeks to identify strategies for optimizing its application and to propose a systematic framework for its clinical implementation. Methods: A comprehensive analysis of preclinical studies, clinical trials, and regulatory frameworks was undertaken to evaluate the therapeutic potential of phage therapy. This included an in-depth assessment of key factors influencing clinical outcomes, such as infection site, phage–host specificity, bacterial burden, and immune response. Additionally, innovative strategies—such as combination therapies, bioengineered phages, and phage cocktails—were explored to enhance efficacy. Critical considerations related to dosing, including inoculum size, multiplicity of infection, therapeutic windows, and personalized medicine approaches, were also examined to optimize treatment outcomes. Results: Phage therapy has demonstrated a favorable safety profile in both preclinical and clinical settings, with minimal adverse effects. Its ability to specifically target harmful bacteria while preserving beneficial microbiota underpins its efficacy in treating a range of infections. However, variable outcomes in some studies highlight the importance of addressing critical factors that influence therapeutic success. Innovative approaches, including combination therapies, bioengineered phages, expanded access to diverse phage banks, phage cocktails, and personalized medicine, hold significant promise for improving efficacy. Optimizing dosing strategies remains a key area for enhancement, with critical considerations including inoculum size, multiplicity of infection, phage kinetics, resistance potential, therapeutic windows, dosing frequency, and patient-specific factors. To support the clinical application of phage therapy, a streamlined four-step guideline has been developed, providing a systematic framework for effective treatment planning and implementation. Conclusion: Phage therapy offers a highly adaptable, targeted, and cost-effective approach to addressing antibiotic-resistant infections. While several critical factors must be thoroughly evaluated to optimize treatment efficacy, there remains significant potential for improvement through innovative strategies and refined methodologies. Although phage therapy has yet to achieve widespread approval in the U.S. and Europe, its accessibility through Expanded Access programs and FDA authorizations for food pathogen control underscores its promise. Established practices in countries such as Poland and Georgia further demonstrate its clinical feasibility. To enable broader adoption, regulatory harmonization and advancements in production, delivery, and quality control will be essential. Notably, the affordability and scalability of phage therapy position it as an especially valuable solution for developing regions grappling with escalating rates of antibiotic resistance. Full article

Background: The current economic and social crisis in Latin America has caused migration to the USA, bringing with it Public Health challenges due to the importation of various infectious diseases. Migrants, particularly those with chronic conditions, such as HIV infection and other sexually transmitted infections (STI), are at greater risk due to pharmacological interruption and access to medical care, so the timely detection of diseases acquired during their migration, such as malaria, is crucial to avoid health complications. Objective: To outline by a multidisciplinary approach (Infectology, Parasitology, Epidemiology, molecular Biology, Venereology, and Public Health) the diagnosis and management of a male case with malaria imported to Mexican territory, HIV chronic infection, and latent syphilis. Methods: A male migrant of Venezuelan nationality attended the Clínica Especializada Condesa Iztapalapa in Mexico City for health complications. A comprehensive analysis of laboratory and molecular tests was performed to confirm HIV infection. During the STI diagnostic algorithm, latent syphilis was detected and microscopic observation of blood smears revealed parasitic forms compatible with malaria. Standard and molecular tests were applied under the operational definition for malaria cases for identification, diagnosis, and treatment. Finally, study of clinical history and migration route by questioning for the investigation of the imported case was performed. Results: The immigrant was diagnosed with HIV chronic-stage infection with interrupted antiretroviral therapy (ART), latent syphilis, and malaria by Plasmodium vivax. The ART administered was chosen based on the possible drug interaction with antimalarials and genetic barrier to the HLA-B* allele. Finally, antimicrobial therapy against syphilis was penicillin. From the analysis of the migratory route, incubation time of imported malaria, and questioning, we speculated that the migrant acquired the P. vivax infection in Panama. Conclusions: This case highlights the complex health problems faced by migrants with HIV infection, particularly when they contract additional infections such as malaria during migration and highlights the need for comprehensive access to healthcare and ART, antimalarial and antimicrobial treatments to mitigate the health risks of this vulnerable population. Full article

Background: Plantar warts, caused by human papillomavirus (HPV), are a common condition that can be painful and resistant to treatment. There are various therapeutic options for managing them, but it is not always clear which are the most effective and tolerated by patients. Among the most commonly used treatments are a zinc and nitric complex (nitrizinc complex), cantharidin, and bleomycin, each with different mechanisms of action and profiles in terms of pain and patient satisfaction. Objectives: We aimed to evaluate and compare the clinical efficacy, post-treatment pain, and patient satisfaction among three common treatments (zinc and nitric complex, cantharidin, and bleomycin) in subjects with plantar warts, as well as identify the most effective and best-tolerated treatment. Materials and Methods: This is a retrospective case series study analyzing 60 records of subjects aged 18 to 40 years diagnosed with plantar warts without systemic diseases or allergies and without any prior treatment. Complete records from 2020 to 2023 were selected. Subjects were divided into three groups according to the treatment received (zinc and nitric complex, cantharidin, bleomycin), and demographic variables, post-treatment pain (measured using the visual analog scale), the number of sessions required, and satisfaction after discharge (evaluated with the Likert scale) were analyzed. Results: Of the 60 subjects included, the group treated with bleomycin experienced higher levels of pain after the first session (mean of 7.1 points on the VAS) compared to the cantharidin group (2.7 points) and the zinc and nitric complex group (1.1 points). However, the bleomycin group required fewer sessions for complete healing (an average of 1.8 sessions), while the nitric acid group needed more (3.4 sessions), with cantharidin falling in between (2.5 sessions). Regarding post-discharge satisfaction, all groups showed comparable scores (between 7.9 and 8.5 points), although cantharidin demonstrated slightly higher satisfaction. A statistical analysis showed significant differences in the number of sessions and post-treatment pain between treatments (p < 0.05) but not in final satisfaction. Conclusions: Although bleomycin treatment is more painful, it is the most effective in terms of reducing the number of sessions required for complete healing. Cantharidin offers a good balance between efficacy and patient satisfaction, while a zinc and nitric complex, although less painful, requires more sessions for complete treatment. Each treatment has specific advantages, suggesting that therapeutic choices should be personalized according to the patient’s needs and preferences. Full article

Background: Leprosy control remains challenging in Brazil and has been aggravated by the COVID-19 pandemic. Objective: To analyze the impact of the COVID-19 pandemic on the epidemiological scenario of leprosy through the detection rate of new cases, the risk of illness, and the hidden prevalence of leprosy according to high-risk micro-region in Minas Gerais, Brazil. Methods: An ecological study conducted in the health micro-regions of Minas Gerais, using data on new leprosy cases diagnosed between 2015 and 2023. The annual detection rate of new cases, the risk of illness index and the hidden prevalence of leprosy were evaluated. The time trend was evaluated by calculating the annual percentage change (APC) of the detection rate, based on segmented linear regression, considered significant when it showed p < 0.05. Results: The state of Minas Gerais showed a significant negative annual increase between 2015 and 2020 (APC = −7.91; 95%CI −21.76–−1.72), and in 2020 it showed an inflection point, with an annual increase of 9.91 in the period from 2020 to 2023. When evaluating the hidden prevalence of leprosy in Minas Gerais, we observed a reduction in the estimates’ average from 2015–2019 (2.78) to 2020–2023 (2.00). The state as a whole showed an upward trend in the risk of illness, with the average index varying from 0.28 (medium risk) to 0.55 (high risk). Conclusions: The pandemic has had a considerable and heterogeneous impact on the detection of new cases, as well as on the risk of becoming ill and the hidden prevalence of leprosy, with repercussions for the control of the endemic in populations. There is a need to implement public health policies that prioritize the early identification of cases and ensure that vulnerable populations are monitored. Full article

Background/Objectives: The COVID-19 pandemic has revolutionized vaccine production and compelled a massive global vaccination campaign. This study aimed to estimate the positivity and levels of SARS-CoV-2 IgG antibodies acquired due to vaccination and infection in the academic population of a Portuguese university. Methods: Blood samples were collected and analyzed through the ELISA methodology, and statistical analysis was performed. Results: A total of 529 volunteers with at least one dose of the vaccine were enrolled in this study. Individuals without a prior COVID-19 diagnosis were divided into two groups: 350, who received a full vaccination, and 114, who received a full vaccination and a booster dose of the same vaccine (81) and mixed vaccines (33). Regarding the individuals who reported a prior SARS-CoV-2 infection, 31 received a full vaccination, and 34 received only one vaccination dose. Data analysis showed a higher level of IgG against SARS-CoV-2 in individuals who were younger, female, who received the Moderna vaccine, with recent post-vaccine administration, a mixed booster dose, and prior SARS-CoV-2 infection. Conclusions: Assessing vaccination’s effectiveness and group immunity is crucial for pandemic management, particularly in academic environments with high individual mobility, in order to define groups at risk and redirect infection control strategies. Full article

Background/Objectives: Cutaneous infections of fungal and bacterial origins are common. An accurate diagnosis—especially concerning pathogens that are difficult to isolate on culture—can be achieved using molecular methods (PCR) with a short turnaround time. Methods: We reviewed records of skin specimens (superficial scrapings) submitted by dermatologists across the United States with a clinically suspected dermatitis. As per physician’s order, specimens were tested for infections either fungal (N = 4262) or bacterial (N = 1707) in origin. All unique specimens (one per patient) were subjected to real-time PCR assays where cases suspected of a fungal etiology were tested for dermatophytes, Malassezia and Candida, and cases suspected of a bacterial etiology were tested for Streptococcus pyogenes, Staphylococcus aureus, and the mecA gene potentially conferring β-lactam resistance. Results: Fungal agents were detected in 32.8% (SD: 4.5) of the submitted specimens, with most attributed to dermatophytes (19.3% (SD: 4.9)), followed by Malassezia (8.7% (SD: 2.8)) and Candida (2.9% (SD: 1.0)). Dermatophyte detection was more common in the elderly (≥65 years) compared to young adults (18–44 years) (OR: 1.8 (95% CI: 1.5, 2.2)), whereas Malassezia was more commonly detected in younger age groups (12.1–13.6%) than the elderly (5.6%). Candida was more frequently observed in females while dermatophytes and Malassezia were more frequently observed in males. Approximately one quarter of the submitted skin specimens tested positive for S. aureus (23.6% (SD: 3.4)), of which 34.4% (SD: 9.8) exhibited concurrent detection of the mecA gene. An S. aureus detection was more frequently observed in males (OR: 1.5 (95% CI: 1.2, 1.9)) and in children (OR: 1.7 (95% CI: 1.2, 2.5)). Streptococcus pyogenes was rarely detected. Among specimens positive for dermatophytes, 12.0% (20/166) showed co-detection of S. aureus and mecA, which is in contrast to 6.8% (70/1023) detected in samples without a fungal co-detection and 6.2% (8/130) in samples positive for Malassezia. Conclusions: PCR testing, when available, can be valuable as a part of routine care for diagnosing patients with clinically suspected skin infections. Further studies are warranted to survey the prevalence of resistant S. aureus isolates in dermatology outpatients, in particular with regard to the association with dermatophyte infections. Full article

Background: Lemierre syndrome is a rare and life-threatening disease. It is characterized by septic thrombophlebitis of the internal jugular vein, historically associated with Fusobacterium necrophorum infection. However, atypical cases and associations with other organisms have been reported. Methods: Here, we describe a challenging case of Lemierre syndrome in a 71-year-old woman caused by Streptococcus constellatus and review the related literature. Case: The patient experienced multiple hospital admissions due to misdiagnoses and developed thrombosis involving the internal jugular vein and transverse sinus bilaterally, pulmonary complications including the formation of a pseudoaneurysm, and occipital abscess. She presented with headaches, neck pain, and blindness. Prolonged antibiotic therapy was administered, leading to gradual improvement of symptoms, with partial resolution of blindness. Prophylaxis with intramuscular penicillin was prescribed at discharge. Conclusions: Our case underscores the importance of considering Lemierre syndrome in patients who present with multiple thrombotic events affecting the intracranial circulation and/or jugular veins, particularly in those already receiving anticoagulation therapy or with no identifiable cause for thrombosis, even in the absence of sore throat or fever. Full article

Background. Pulmonary superinfections increase the mortality risk among COVID-19 patients, highlighting the need for enhanced understanding to enable early and accurate diagnosis. Methods. We present the case of a patient, a 76-year-old man, hospitalized for a severe form of COVID-19, with a ground-glass pneumonia, involving 40–45% of lung surfaces. Results. In evolution, the clinical condition worsened, presenting leukocytosis with neutrophilia, imaging towards resorption, and computer tomography images showing the appearance of pulmonary condensations in the right lower lobe, the posterior portion of the left lower lobe and pleural collections. Carbapenemase-producing Klebsiella pneumoniae was isolated from the tracheal aspirate, and the real-time polymerase chain reaction test was positive for Klebsiella pneumoniae and Legionella pneumophila. The investigations that were carried out allowed us to establish the coinfections as a probable case of Legionnaire’s disease and a ventilator-associated pneumonia with Klebsiella pneumoniae. Conclusions. The case analysis revealed that rare pneumonias may remain undiagnosed, and coinfections may be conditioned by pathophysiological factors or components of COVID-19 critical form treatment. Enhanced understanding of these aspects in clinical practice may contribute to reducing mortality risk in COVID-19 patients. Full article

(1) Background: Necrotizing fasciitis is known as a severe condition with a high risk of mortality, placing it among the most feared infections. In most cases, it has a polymicrobial etiology (type 1), requiring complex treatment that is continuously adapted to the evolving microbiological status. The facial localization of the disease is rare, fulminant progressing, and is often life-threatening. (2) Methods: We present the case of a patient with multiple comorbidities who, following trauma to the nasal dorsum, developed a wound with a rapid and severe progression to extensive bilateral periorbital necrosis. This was accompanied by a dramatic deterioration in their general condition, a polymicrobial biological status, and fluctuating progression despite instituted treatment (both medical and surgical). (3) Results: The patient required multiple surgical interventions by multidisciplinary teams (plastic surgery; ear, nose, and throat specialist (ENT); maxillofacial surgery; and ophthalmology), experiencing periods of a severe, life-threatening general condition, necessitating prolonged orotracheal intubation. Wounds with fluctuating progression, extensive skin necrosis, and significant post-excisional soft tissue defects required skin graft coverage. The result meant a saved life and functional and aesthetic sequelae at the level of the face. (4) Conclusions: Necrotizing fasciitis of the face is a rare and severe disease that must be recognized early and treated appropriately by a multidisciplinary team to save the patient’s life and minimize the resulting functional and aesthetic sequelae. Full article

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection that has a high mortality rate. Proprotein convertase subtilisin kexin 9 (PCSK9) is a serine protease secreted by the liver. Its binding to the low-density lipoprotein (LDL) receptor enhances its degradation, causing an increase in LDL levels in the blood. Objectives: Administering a PCSK9 inhibitor leading to an increase in lipid uptake by the liver may positively affect septic patients due to the increased removal of endotoxins. Methods: This preliminary study aimed to examine the safety of PCSK9 inhibitor use in septic and septic shock patients. We treated five septic patients in the intensive care unit with 300 mg of alirocumab following serious adverse events for 28 days. Results: Four of our patients did not experience any adverse events, and all of them survived. One patient died after discharge from the intensive care unit, and this death was presumably not related to the study drug. The patients rapidly recovered from the inflammatory stage of sepsis. Conclusions: Alirocumab appears safe in severe sepsis and septic shock patients. The outcome data are promising. Only a basic safety profile can be assessed based on this pilot study. Further study with a PCSK-9 inhibitor in septic or septic shock patients is required to further determine its benefit in ICU patients. Full article

(1) Background/Objectives: Delayed esophageal perforation following anterior cervical (spine) discectomy and fusion (ACDF) is rare but can lead to serious infectious complications. The treatment usually involves hardware explanation and prolonged intravenous antibiotics; however, there are scarce reports about the microbiology of these infections and corresponding targeted therapy. (2) Methods: Patients diagnosed or treated for delayed esophageal perforation after anterior cervical fusion between 2000–2020 at a tertiary medical center were studied. (3) Results: Seven patients with delayed esophageal perforation following ACDF were identified. The most common bacteria isolated included Streptococcus, Haemophilus, and Mycobacterium species. The cultures from five patients grew fungal species, including Candida albicans and C. glabrata. All the patients received several weeks of broad-spectrum antibiotics, and, notably, 5/7 patients received antifungal therapy targeting Candida. (4) Conclusions: Although the incidence of delayed esophageal perforation following ACDF is low, providers should remain aware of this entity due to the serious infectious complications. Most infections are polymicrobial in nature, and providers should consider empiric antifungal coverage specifically targeting Candida species when treating patients with this complication. Full article