Infectious Disease Reports

10 pages, 687 KiB

Open AccessCase Report

Vasculonecrotic Reaction Caused by Mycobacterium Lepromatosis Infection—A Case Report of an HIV/Leprosy-Coinfected Patient

by Fernando Amador-Lara, Jorge L. Mayorga-Garibaldi, Felipe J. Bustos-Rodríguez, Luz A. González-Hernández, Pedro Martínez-Ayala and Jaime F. Andrade-Villanueva

Infect. Dis. Rep. 2025, 17(3), 58; https://doi.org/10.3390/idr17030058 (registering DOI) - 23 May 2025

Abstract

Background: Vasculonecrotic reactions in leprosy are typically associated with type 2 reactions. Differentiating between necrotizing erythema nodosum leprosum (nENL) and Lucio’s phenomenon (LP) can be difficult, as overlapping clinical and histopathological features have been reported. Mycobacterium lepromatosis, a recently identified species causing [...] Read more.

Background: Vasculonecrotic reactions in leprosy are typically associated with type 2 reactions. Differentiating between necrotizing erythema nodosum leprosum (nENL) and Lucio’s phenomenon (LP) can be difficult, as overlapping clinical and histopathological features have been reported. Mycobacterium lepromatosis, a recently identified species causing leprosy, has been sporadically linked to LP. While type 1 reactions are more commonly observed in HIV-coinfected individuals, reports of LP or ENL occurring outside the context of immune reconstitution inflammatory syndrome (IRIS) remain rare. Methods: We report a case of a vasculonecrotic leprosy reaction due to M. lepromatosis in an antiretroviral-naive patient with advanced HIV infection. Results: The patient presented with a two-month history of papules and nodules that progressed to painful necrotic ulcers, accompanied by systemic symptoms. Clinically, the presentation was consistent with nENL; however, histopathological analysis supported a diagnosis of LP. The patient rapidly deteriorated, developing septic shock and dying shortly thereafter. To our knowledge, this is the first reported case of a leprosy-associated vasculonecrotic reaction caused by M. lepromatosis in an HIV-infected individual not associated with IRIS. Conclusions: Vasculonecrotic reactions in leprosy are life-threatening emergencies due to their potential for rapid clinical deterioration and sepsis. In individuals with advanced HIV infection, recognition of these reactions may be challenging, as they can mimic other opportunistic infections, including fungal diseases, malignant syphilis, and disseminated mycobacterial infections. Early identification and prompt treatment are critical to improving outcomes. Full article

11 pages, 461 KiB

Open AccessReview

Spatial, Social and Serological Factors in the Prevalence and Risk of Leprosy in Areas of High Endemicity: An Integrative Review

by Daniele dos Santos Lages, Isabela Cristina Lana Maciel, Sarah Lamas Vidal and Francisco Carlos Félix Lana

Infect. Dis. Rep. 2025, 17(3), 57; https://doi.org/10.3390/idr17030057 - 22 May 2025

Abstract

Background/Objectives: Leprosy remains a global public health challenge, especially in hyperendemic areas, where spatial, socioeconomic and serological factors influence its persistence. In this study, an integrative review was carried out to analyze the relationship between these factors and the prevalence of Mycobacterium leprae [...] Read more.

Background/Objectives: Leprosy remains a global public health challenge, especially in hyperendemic areas, where spatial, socioeconomic and serological factors influence its persistence. In this study, an integrative review was carried out to analyze the relationship between these factors and the prevalence of Mycobacterium leprae infection, as well as the risk of falling ill. Methods: The integrative search was conducted in the BVS (Medline and LILACS) and Scopus databases, including studies published between 2010 and 2024; PRISMA was followed. Results: The findings indicate that spatial analysis, using geographic information systems, is essential for identifying transmission clusters and targeting control strategies. Poor socioeconomic conditions, such as low income and inadequate sanitation, significantly increase the risk of infection. In addition, serology, especially the detection of Anti-PGL-1 antibodies, has proved to be a promising tool for tracking subclinical infections and improving epidemiological surveillance. However, the integration of spatial, social and serological factors is still limited in the literature. Conclusions: We conclude that multidisciplinary approaches, combining spatial, socioeconomic and serological factors, are fundamental to optimizing control strategies and reducing leprosy transmission in vulnerable populations. Full article

(This article belongs to the Section Neglected Tropical Diseases)

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24 pages, 392 KiB

Open AccessSystematic Review

Long COVID: A Systematic Review of Preventive Strategies

by Sun O. Park and Neha Nanda

Infect. Dis. Rep. 2025, 17(3), 56; https://doi.org/10.3390/idr17030056 - 21 May 2025

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Abstract

Background: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, long COVID (LC) has become a significant global health burden. While knowledge about LC is accumulating, studies on its prevention are still lacking. Methods: We conducted a systematic [...] Read more.

Background: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, long COVID (LC) has become a significant global health burden. While knowledge about LC is accumulating, studies on its prevention are still lacking. Methods: We conducted a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to investigate prevention options for LC. We identified fifteen articles on vaccines, seven on antivirals, and six on other interventions after searching for articles in the PubMed/MEDLINE database using the MeSH terms. Results: Most vaccine-related studies demonstrated a protective effect of COVID-19 vaccines against developing LC. Our review found an equivocal effect of antivirals, while metformin had a protective effect in outpatients and corticosteroids were protective in hospitalized patients against LC. Conversely, COVID-19 convalescent plasma and multiple micronutrient supplement did not confer any protection against LC. Conclusions: COVID-19 vaccination is vital as it not only prevents COVID-19 but also reduces the severity of illness and may help prevent LC. Further studies are warranted to shed light on preventive strategies for long COVID. Full article

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12 pages, 1206 KiB

Open AccessSystematic Review

The Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker of Fournier’s Gangrene Severity: A Meta-Analysis

by Konstantinos Seretis, Nikolaos Bounas, Konstantinos Sfaelos, Georgios Gaitanis and Ioannis Bassukas

Infect. Dis. Rep. 2025, 17(3), 55; https://doi.org/10.3390/idr17030055 - 15 May 2025

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Abstract

Background/Objectives: Fournier’s Gangrene (FG) is a severe and potentially fatal necrotizing infection of the perianal and genital regions, which necessitates prompt therapeutic interventions to prevent disease progression. Accruing evidence from recent research indicates that the neutrophil‒to-lymphocyte ratio (NLR) can predict clinical severity and [...] Read more.

Background/Objectives: Fournier’s Gangrene (FG) is a severe and potentially fatal necrotizing infection of the perianal and genital regions, which necessitates prompt therapeutic interventions to prevent disease progression. Accruing evidence from recent research indicates that the neutrophil‒to-lymphocyte ratio (NLR) can predict clinical severity and mortality risk in patients with critical illnesses across various etiologies. This meta-analysis aimed to assess the efficacy of NLR as a prognostic indicator for mortality in patients with FG. Methods: An electronic literature search was conducted across several databases from their inception to 31 May 2024, following a predetermined protocol. Study quality was evaluated using the Cochrane risk of bias tool. A random-effect model was utilized to synthesize the available data. Results: Twelve studies reporting on 767 patients were included in the meta-analysis. Higher NLR levels at presentation were recorded in non-survivors than in survivors (MD = 4.49 [95% CI: 0.67–8.32]; p = 0.02). A 76% increased mortality risk was detected for patients with an NLR ≥ 8 (1.76 RR [1.35–2.3], p = 0.0001), and the mortality risk was more than twofold greater for patients with an NLR ≥ 10 compared to the remaining patients (RR = 2.31 [1.27–4.21], p = 0.006). All included studies exhibited a moderate to serious risk of bias. Conclusions: This meta-analysis reveals that the NLR represents a promising biomarker that can serve as a prognostic indicator in patients with FG. Future studies should address the establishment of proper disease-specific cutoff values to aid in clinical decision-making. Full article

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13 pages, 1428 KiB

Open AccessArticle

The PJI-TNM Classification as Predictor for Revision-Free Implant Survival Rates in Patients with Periprosthetic Joint Infection of the Hip or Knee Joint

by Frank Sebastian Fröschen, Lisa Greber, Ernst Molitor, Gunnar Thorben Rembert Hischebeth, Alexander Franz and Thomas Martin Randau

Infect. Dis. Rep. 2025, 17(3), 54; https://doi.org/10.3390/idr17030054 - 15 May 2025

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Abstract

Background: Periprosthetic joint infections (PJIs) remain a major challenge in arthroplasty. This study tries to evaluate the PJI-TNM classification as predictor for the revision-free implant survival in patients with PJI of the hip or knee joint. Methods: To this end, we perform a [...] Read more.

Background: Periprosthetic joint infections (PJIs) remain a major challenge in arthroplasty. This study tries to evaluate the PJI-TNM classification as predictor for the revision-free implant survival in patients with PJI of the hip or knee joint. Methods: To this end, we perform a retrospective study of all consecutive patients with PJI of an inlying hip or knee arthroplasty between January 2015 and December 2019. Results: A total of 443 cases (hip: n = 247; knee n = 196) were identified. In total, 439 patients underwent surgery (DAIR: n = 138 cases (31%), explantation: n = 272 (61%), irrigation with debridement without exchange of implant components: n = 29 (6.5%)). Four patients refused surgical treatment and 39.5% were lost to follow-up. In total, 78 patients died during follow-up and 27 deaths were directly related to PJI/complications during treatment. Patients with inlying “standard”-implants (p < 0.001) and without previous history of PJI (p = 0.002) displayed a significantly higher postoperative revision-free implant survival. In terms of the PJI-TNM subclassification, patients with loosened implants but without soft-tissue defects (T1) displayed the highest revision-free implant survival. In contrast, patients classified as M3 (no surgical treatment possible) displayed an inferior outcome compared to M0, M1, or M2. Patients with different N-subclassifications (“non-human cells”/causative pathogen) did not display differences in revision-free implant survival. Conclusions: The PJI-TNM classification is well suited to classify PJIs. Its complexity allows for more than 500 different combinations of classifications. Further validation data are needed, but to us, the PJI-TNM classification seems to offer the possibility of comparing patients with PJIs. It may, therefore, be a very valuable tool in order to compare cohorts with PJIs and provide individual data for patient specific outcomes. Full article

(This article belongs to the Section Bacterial Diseases)

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9 pages, 1123 KiB

Open AccessCase Report

A Case of Pulmonary Fibrosis and COVID-19-Related Pneumonia in a Pembrolizumab-Treated Patient

by Alberto Zolezzi, Gina Gualano, Annelisa Mastrobattista, Pietro Vittozzi, Virginia Di Bari, Carlotta Cerva, Silvia Mosti, Antonio Lugini, Fabrizio Albarello, Federica Di Stefano, Maria Beatrice Valli and Fabrizio Palmieri

Infect. Dis. Rep. 2025, 17(3), 53; https://doi.org/10.3390/idr17030053 - 12 May 2025

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Abstract

Pembrolizumab is used as a first-line treatment of non-small cell lung cancer. Pneumonitis and interstitial lung disease are among the most common immune-related adverse events. The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on patients with cancer treated with chemotherapy [...] Read more.

Pembrolizumab is used as a first-line treatment of non-small cell lung cancer. Pneumonitis and interstitial lung disease are among the most common immune-related adverse events. The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on patients with cancer treated with chemotherapy or immune checkpoint inhibitors (ICIs) is not fully known. Blocking immune checkpoints may conversely augment dysfunctional T-cell responses in severe patients and, in turn, mediate immunopathology. Here, we present a case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome (ARDS) and a fibrotic-like pattern in a patient treated with pembrolizumab for lung cancer. The patient showed a dramatic clinical and radiological response after steroid therapy. Further research is needed to better understand the long-term implications of pembrolizumab therapy in patients recovering from coronavirus disease 2019 (COVID-19) and to develop evidence-based guidelines for managing these complex cases. Patients undergoing oncologic immunotherapy might benefit from early high-dose steroid treatment in cases of viral infections, such as SARS-CoV-2. Full article

(This article belongs to the Section Infections in the Immuncompromised Host)

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13 pages, 1944 KiB

Open AccessArticle

Delineating the Significance of Several Inflammatory Markers in a Lung Tuberculosis Cohort During the Active and Post-Tuberculosis Stages of the Disease: An Observational Study in Cape Town, South Africa (2019 to 2024)

by Chrisstoffel Jumaar, Lindiwe Malefane, Steve Jacobs, Olakunle Sanni, Elize Louw, Nicola Baines, Carmen Payne, Sigrid Schulz, Carl Lombard, Merga Feyasa, David Maree, Shantal Windvogel, Hans Strijdom, Benjamin Botha, Brian Allwood and Gerald J. Maarman

Infect. Dis. Rep. 2025, 17(3), 52; https://doi.org/10.3390/idr17030052 - 9 May 2025

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Abstract

Background: Pulmonary tuberculosis (TB) frequently leads to long-term lung complications that contribute to increased mortality. Understanding the pathogenesis of post-TB lung impairments is crucial for improving long-term outcomes in TB patients; yet this area remains poorly researched. Methods: Our study assessed circulatory inflammatory [...] Read more.

Background: Pulmonary tuberculosis (TB) frequently leads to long-term lung complications that contribute to increased mortality. Understanding the pathogenesis of post-TB lung impairments is crucial for improving long-term outcomes in TB patients; yet this area remains poorly researched. Methods: Our study assessed circulatory inflammatory markers in patients who completed TB treatment more than one year before enrolment (population 1) and patients receiving in-hospital treatment for active drug-sensitive TB (population 2). Results: IL-6 was seven times higher in both populations compared to the normal range. IL-8 was below the limit of detection (LOD) in population 1, while it was approximately 2.5 times higher in population 2 compared to the normal range. TNF-α was 21 times higher in population 1 and 19 times higher in population 2 compared to the normal range. CRP was almost 49 times higher in both populations, and IL-1Ra was below the LOD in population 1, while it was ~1.5 times higher in population 2 compared to the normal range. Conclusions: These inflammatory biomarkers correlated well with lung function in the post-TB state, and their high levels suggest a persistent pro-inflammatory state post-TB, which may contribute to post-TB lung disease. More research is warranted to better understand this phenomenon, but these findings may highlight a need to consider anti-inflammatory therapy for patients with post-TB lung disease, especially since these high levels of cytokines can directly contribute to lung damage. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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13 pages, 1964 KiB

Open AccessArticle

Stage-Specific Immune Responses to AgB T-Peptides in Patients with Cystic Echinococcosis

by Settimia Sbarra, Ambra Vola, Francesca Tamarozzi, Saeid Najafi-Fard, Alessandra Ludovisi, Antonella Teggi, Emanuele Nicastri, Fabrizio Albarello, Enrico Brunetti, Delia Goletti and Linda Petrone

Infect. Dis. Rep. 2025, 17(3), 51; https://doi.org/10.3390/idr17030051 - 7 May 2025

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Abstract

Background: The identification of parasite- and stage-specific antigens is crucial for the development of new diagnostic tests for cystic echinococcosis (CE). We previously analysed the interleukin (IL)-4 response to T-specific peptides corresponding to the immunogenic regions of the five antigen B (AgB) subunits, [...] Read more.

Background: The identification of parasite- and stage-specific antigens is crucial for the development of new diagnostic tests for cystic echinococcosis (CE). We previously analysed the interleukin (IL)-4 response to T-specific peptides corresponding to the immunogenic regions of the five antigen B (AgB) subunits, demonstrating that AgB1 is the most immunogenic protein and that the response to all AgB peptides is associated with viable cysts. However, the response in patients with CE3a (WHO-IWGE) cystic stage was not evaluated and no other immunological factors besides IL-4 were included in the analysis. Methods: Four study groups were defined: “CE3a group” (transitional cysts), “CE3b group” (active cysts), “CE4/CE5 group” (inactive cysts), and “NO CE-group” encompassing patients with non-CE cysts (controls). Whole blood was stimulated in vitro with the five different T-specific peptide pools corresponding to the five AgB subunits and with a pool containing all five peptides’ pools (total pool). IL-4 and other immunological markers were evaluated by ELISA and a multiplex assay, respectively. Results: Twenty-four patients with CE (CE3a-group n = 3; CE3b-group n = 6; CE4/CE5-group n = 15) and 14 subjects with non-CE cysts were enrolled. IL-4 levels in response to AgB1 and AgB3 pools were significantly increased in CE compared to NO CE groups (p = 0.0201, p = 0.0041). Within the CE patients, the highest IL-4 median level was observed in response to the AgB total pool, the AgB3 and AgB4 pools, followed by the AgB1 pool. Moreover, the IL-4 levels in response to the AgB1 pool were found to be significantly higher in the CE3b group compared to the CE4/CE5 group (p = 0.0070), while no differences were found for the CE3a group. As for other cytokines, we found higher IL-7 levels in response to the AgB4 pool in the CE4/CE5 group compared to the CE3b group (p = 0.0012), higher IL-2 levels in response to the AgB1 pool and AgB total pool in CE3b patients compared to controls (p = 0.0016), and higher IL-13 levels in response to the AgB total pool in patients with CE3b and CE4/CE5 cysts compared to NO CE (p = 0.0016; p = 0.0009). Conclusions: These results contribute to a better knowledge of the immune interplay in the presence of CE and may be useful for further exploring the use of recombinant proteins/peptides in cytokine release assays for the diagnosis and follow-up of CE. Full article

(This article belongs to the Section Parasitological Diseases)

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15 pages, 3462 KiB

Open AccessArticle

Exploring the Antibiotic Potential of a Serine Protease from Solanum trilobatum Against Staphylococcus aureus Biofilms

by Manohar Radhakrishnan, Kanal Elamparithi Balu, Lakshminarayanan Karthik, Raghavendra Sashi Krishna Nagampalli, Eswar Kumar Nadendla and Gunasekaran Krishnasamy

Infect. Dis. Rep. 2025, 17(3), 50; https://doi.org/10.3390/idr17030050 - 7 May 2025

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Abstract

Background: Multi-antibiotic resistance has become an alarming issue in treating bacterial infections in both community and medical environments. Globally, the scientific community has been exploring multi-antibiotic techniques to find new ways to address this challenge. To address this critical challenge and explore alternative [...] Read more.

Background: Multi-antibiotic resistance has become an alarming issue in treating bacterial infections in both community and medical environments. Globally, the scientific community has been exploring multi-antibiotic techniques to find new ways to address this challenge. To address this critical challenge and explore alternative antibiotic treatments, we investigated the potential of Solanum trilobatum, an edible and medicinally important herb plant in Ayurvedic medicine. Methods: Our research focused on a 60 kDa serine protease isolated and purified from the leaves of S. trilobatum, which showed evidence of possessing hydrolase activity. In this study, we examined the capability of the purified enzyme to eradicate preformed biofilms of S. aureus in combination with ampicillin. Additionally, we assessed the stability of the enzyme in the presence of metal ions and detergents. Results: Enzyme kinetics revealed a Vmax of 48.63 µM/min and a Km of 14.08 µM, indicating efficient enzymatic activity. Furthermore, the enzyme exhibited maximum activity at physiological pH, suggesting its potential effectiveness under physiological conditions. Conclusions: Our preliminary findings highlight the promising role of this enzyme as a potential agent to combat S. aureus biofilms, especially when used in conjunction with ampicillin, as an alternative antibiotic approach. Full article

(This article belongs to the Special Issue New Advances in Drugs/Vaccines against Infectious Diseases)

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16 pages, 2958 KiB

Open AccessArticle

Microbiological Surveillance and Antimicrobial Susceptibility Observations on Peritoneal Dialysis-Associated Peritonitis in an Outpatient German Reference Center

by Annemarie Albert, Stefan Richter, Lisa C. Costello-Boerrigter, Philipp Stieger, Rainer Peter Woitas, Rüdiger C. Braun-Dullaeus and Christian Albert

Infect. Dis. Rep. 2025, 17(3), 49; https://doi.org/10.3390/idr17030049 - 3 May 2025

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Abstract

Background: Peritonitis is a relevant complication in peritoneal dialysis (PD). The initial empirical antibiotic therapy depends on the center-specific distribution of microorganisms and the microbial susceptibility profiles. However, data on the locoregional germ spectrum in Germany are insufficient regarding the current recommended [...] Read more.

Background: Peritonitis is a relevant complication in peritoneal dialysis (PD). The initial empirical antibiotic therapy depends on the center-specific distribution of microorganisms and the microbial susceptibility profiles. However, data on the locoregional germ spectrum in Germany are insufficient regarding the current recommended empirical antibiotic regimens of either cefepime as monotherapy or the combination of cefazolin and ceftazidime. Methods: This retrospective single-center study of routine clinical patient data analyzes the range of infecting organisms causing PD-associated peritonitis and their corresponding antimicrobial resistances during the 2015 to 2022 timeframe. We used Ordinary Least-Squares regression to model trends in the detection of microbiological spectrum samples. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD) statement was acknowledged. Results: There were 80 documented peritonitis episodes with 99 causal etiologies sampled. Of those, eighty-seven were bacterial, three were fungi (3%), eight had no microbial growth (8%), and one more had missing data. The largest group of microorganisms detected were Gram-positive bacteria (N = 56, 56.6%), predominantly sampled as Staphylococcacea, Enterococcaceae, and Streptococcaceae (Staphylococcus aureus, 14.1%). Gram-negative bacteria were found in 31.3% of samples (N = 31), predominantly Enterobacteriaceae (Escherichia coli, 9%). In total, 34 different microorganisms were identified. On one occasion, methicillin-resistant Staphylococcus epidermidis and one sample of multi-resistant Serratia marcescens were identified. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were not detected. Fungi were found in three peritonitis episodes. Regression analyses did not indicate changes in the general microbiological spectrum during the observational timeframe. The center-specific peritonitis rates were below the recommended rates of the International Society for Peritoneal Dialysis for all years studied. Conclusions: The recommended empiric therapy was suitable at our center, with a few exceptions for non-specific pathogens and for those with β-lactamases or enterococci. When there is no clinical response to empiric therapy, alternative antibiotics should be considered accordingly. The retrospective data are limited to the reported outcome measures. Full article

(This article belongs to the Section Infection Prevention and Control)

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11 pages, 494 KiB

Open AccessArticle

Prevalence of VZV Reactivation and Effectiveness of Vaccination with Recombinant Adjuvanted Zoster Vaccine in Allogeneic Hematopoietic Stem Cell Recipients—A Single-Center Analysis

by Ewa Karakulska-Prystupiuk, Magdalena Feliksbrot-Bratosiewicz, Maria Król, Agnieszka Tomaszewska, Wiesław Wiktor Jędrzejczak and Grzegorz Władysław Basak

Infect. Dis. Rep. 2025, 17(3), 48; https://doi.org/10.3390/idr17030048 - 2 May 2025

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Abstract

Background: Secondary immunodeficiencies in allo-HSCT (allogeneic hematopoietic stem cell transplantation) recipients increase the risk of viral reactivation, making vaccinations a vital issue. There is a paucity of data on the use of recombinant vaccine against herpes zoster (RZV) after allo-HSCT. Methods: This analysis [...] Read more.

Background: Secondary immunodeficiencies in allo-HSCT (allogeneic hematopoietic stem cell transplantation) recipients increase the risk of viral reactivation, making vaccinations a vital issue. There is a paucity of data on the use of recombinant vaccine against herpes zoster (RZV) after allo-HSCT. Methods: This analysis included 149 recipients of allo-HSCT, transplanted in 2012–2022, mainly due to hematological malignancies (>95%). RZV was used from 2021 to 2023 according to the current recommendations of ACIP. The ELISA method was used to assess the VZV IgG antibody titers. Results: VZV reactivation was diagnosed in 49 out of 149 (33%) patients before vaccination, including 5 (3%) patients with reactivation within the first year after transplantation and the remaining 44 (30%) within the subsequent three years. At that time, the majority of patients were not receiving acyclovir prophylaxis. The most common clinical manifestation of reactivation was involvement of intercostal nerves, diagnosed in 40 (81%) patients. Twenty-one recipients (median age: 41) received two doses of RZV (at a median time of 34 months after transplantation, range 12–84 months), the majority of them at an interval of 1 month. The serological post-vaccination response was confirmed in 12 recipients, with a ratio of 2.38–8.3 (median 5.095). The median number of total CD3+CD4+cells in vaccinated patients was 451/μL. Despite vaccination, four patients (19%, three with confirmed serological response) developed herpes zoster. Conclusions: Herpes zoster occurred mainly in the late period after allo-HSCT after completion of acyclovir prophylaxis in over 30% of recipients. The preliminary results indicate that RZV vaccination after allo-HSCT was safe and more than 80% effective at preventing HZ, but some vaccinated individuals did experience HZ. Full article

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15 pages, 2872 KiB

Open AccessCase Report

Bone Marrow Infection by Pneumocystis jirovecii in a Patient with AIDS: A Case Report and Literature Review

by Diego Alejandro Cubides-Diaz, Valentina Negrette-Lazaro, Viviana Poveda-Hurtado, Juan Pablo López-Salazar, Carlos Mauricio Calderón-Vargas and Carlos Arturo Álvarez-Moreno

Infect. Dis. Rep. 2025, 17(3), 47; https://doi.org/10.3390/idr17030047 - 2 May 2025

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Abstract

Background: Pneumocystis jirovecii primarily causes pneumonia in immunosuppressed individuals, particularly those living with advanced HIV/AIDS. Extrapulmonary dissemination is uncommon, with bone marrow involvement described in only a handful of cases globally. Bone marrow infection occurs in the setting of severe immunosuppression, poses diagnostic [...] Read more.

Background: Pneumocystis jirovecii primarily causes pneumonia in immunosuppressed individuals, particularly those living with advanced HIV/AIDS. Extrapulmonary dissemination is uncommon, with bone marrow involvement described in only a handful of cases globally. Bone marrow infection occurs in the setting of severe immunosuppression, poses diagnostic challenges, and carries a high mortality rate. Methods: We describe the case of a 34-year-old man newly diagnosed with HIV/AIDS, presenting with severe immunosuppression and Pneumocystis jirovecii pneumonia. The patient initially improved with cotrimoxazole and corticosteroids, but was readmitted shortly after discharge with abdominal pain, diarrhea, and worsening pancytopenia. A bone marrow biopsy revealed Pneumocystis jirovecii cysts, confirming disseminated infection. Concomitant Kaposi sarcoma involving the skin and gastrointestinal tract was also diagnosed. Despite antimicrobial therapy, the patient’s condition worsened, leading to multisystem organ failure and death two months later. Conclusions: This case highlights a rare presentation of disseminated Pneumocystis jirovecii infection with bone marrow involvement in a patient with advanced HIV/AIDS. Although infrequent, this complication should be considered in individuals with Pneumocystis jirovecii pneumonia who develop persistent cytopenias and systemic symptoms. Diagnosis depends on histopathologic confirmation, which may lead to under-recognition. Early suspicion and individualized management are essential, though the optimal treatment approach for extrapulmonary infection remains undefined. Full article

(This article belongs to the Section Fungal Infections)

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7 pages, 3210 KiB

Open AccessCase Report

The Appearance of Osteomyelitis of the Foot and Disseminated Subcutaneous Abscesses During Treatment for Disseminated Tuberculosis Infection in an Immunocompetent Patient: Case Presentation of a Paradoxical Reaction and Literature Review

by Luca Santilli, Benedetta Canovari, Maria Balducci, Francesco Ginevri, Monia Maracci, Antonio Polenta, Norma Anzalone, Lucia Franca, Beatrice Mariotti, Lucia Sterza and Francesco Barchiesi

Infect. Dis. Rep. 2025, 17(3), 46; https://doi.org/10.3390/idr17030046 - 2 May 2025

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Abstract

Background: The appearance of new clinical manifestations (for example, subcutaneous or skin abscesses) during anti-tuberculosis treatment is generally indicative of therapeutic failure. The cause of therapeutic failure may be the presence of a drug-resistant Mycobacterium infection or to the failure to achieve a [...] Read more.

Background: The appearance of new clinical manifestations (for example, subcutaneous or skin abscesses) during anti-tuberculosis treatment is generally indicative of therapeutic failure. The cause of therapeutic failure may be the presence of a drug-resistant Mycobacterium infection or to the failure to achieve a sufficient concentration of the drugs in the bloodstream. Case report: Here, we report the case of a 25-year-old man suffering from tuberculosis infection with lymph-node and pulmonary involvement and an atypical response to specific therapy. Two weeks after starting four-drug antitubercular treatment, the patient began to experience fever, pain and functional impotence in the left foot and ankle, with subsequent evidence of ankle and tarsal osteomyelitis. Four weeks after starting treatment, the patient presented with several widespread, painful subcutaneous abscesses on the trunk, back and right lower limb. Drainage was performed from the ankle and from one of the abscesses, and polymerase chain reaction (PCR) showed a positive result for M. tuberculosis in both samples, with the absence of resistance to drugs. Anti-tubercular medications were continued, with resolution of the pulmonary and bone involvement but with persistence of subcutaneous abscesses, although subsequent drainages showed the absence of mycobacterium tuberculosis. Conclusions: We describe an unusual presentation of paradoxical reaction in the form of osteomyelitis and subcutaneous abscesses in an immunocompetent TB patient, and we reported other similar cases of paradoxical reactions described in the literature in the last ten years, which demonstrate the importance of considering paradoxical reactions in patients who present with new or worsening signs and symptoms after starting tuberculosis treatment. Full article

(This article belongs to the Section Tuberculosis and Mycobacteriosis)

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8 pages, 1683 KiB

Open AccessCase Report

Rickettsia parkeri Rickettsiosis Resembling Sweet Syndrome: A Differential Diagnosis for Critical Discussion

by Lucas S. Blanton, Sarah E. Muir, Nicole L. Mendell and David H. Walker

Infect. Dis. Rep. 2025, 17(3), 45; https://doi.org/10.3390/idr17030045 - 1 May 2025

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Abstract

Introduction: Spotted fever group (SFG) rickettsioses are tick-transmitted infections caused by Gram-negative, obligately intracellular bacteria in the genus Rickettsia. They present as an acute undifferentiated febrile illness, and they are often accompanied by rash and/or eschar. Although the rash of SFG rickettsioses [...] Read more.

Introduction: Spotted fever group (SFG) rickettsioses are tick-transmitted infections caused by Gram-negative, obligately intracellular bacteria in the genus Rickettsia. They present as an acute undifferentiated febrile illness, and they are often accompanied by rash and/or eschar. Although the rash of SFG rickettsioses usually consists of macules and papules, some, like in Rickettsia parkeri rickettsiosis, can also manifest with papulovesicular or pustular lesions. Case: We herein present a case of SFG rickettsiosis, due to R. parkeri, that masqueraded as Sweet syndrome (the prototype neutrophilic dermatosis) after the initial results of a shave biopsy. Further investigation of the biopsy specimen by immunohistochemical and PCR analysis would eventually confirm SFG rickettsiosis, with R. parkeri being detected by real-time PCR. Discussion:Rickettsia parkeri is transmitted by the Gulf Coast tick (Amblyomma maculatum) and is an increasingly recognized cause of SFG rickettsiosis in the United States. Rickettsia parkeri should be considered in those with an acute undifferentiated febrile illness with lesions that are pustular or papulovesicular, as prompt recognition and empirical administration of doxycycline results in the rapid resolution of symptoms. Full article

(This article belongs to the Section Bacterial Diseases)

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11 pages, 1738 KiB

Open AccessArticle

Epidemiology and Genetic Characterization of Distinct Ebola Sudan Outbreaks in Uganda

by Francesco Branda, Massimo Ciccozzi and Fabio Scarpa

Infect. Dis. Rep. 2025, 17(3), 44; https://doi.org/10.3390/idr17030044 - 1 May 2025

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Abstract

Background. Sudan virus (SUDV) has caused multiple outbreaks in Uganda over the past two decades, leading to significant morbidity and mortality. The recent outbreaks in 2022 and 2025 highlight the ongoing threat posed by SUDV and the challenges in its containment. This [...] Read more.

Background. Sudan virus (SUDV) has caused multiple outbreaks in Uganda over the past two decades, leading to significant morbidity and mortality. The recent outbreaks in 2022 and 2025 highlight the ongoing threat posed by SUDV and the challenges in its containment. This study aims to characterize the epidemiological patterns and phylogenomic evolution of SUDV outbreaks in Uganda, identifying key factors influencing transmission and disease severity. Methods. We conducted a retrospective observational study analyzing epidemiological and genomic data from SUDV outbreaks in Uganda between 2000 and 2025. Epidemiological data were collected from official sources, including the Ugandan Ministry of Health and the World Health Organization, supplemented with reports from public health organizations. Genomic sequences of SUDV were analyzed to investigate viral evolution and identify genetic variations associated with pathogenicity and transmissibility. Results. The 2022 outbreak involved 164 confirmed cases and a case fatality rate (CFR) of 33.5%, with significant geographic variation in case distribution. The 2025 outbreak, still ongoing, was first detected in Kampala, with evidence of both nosocomial and community transmission. Phylogenomic analysis revealed the presence of two main genetic groups, representing Sudan and Uganda, respectively. The genetic variability of the Ugandan cluster is higher than that observed in Sudan, suggesting a greater expansion potential, which aligns with the current outbreak. Epidemiological findings indicate that human mobility, weaknesses in the health system, and delays in detection contribute to the amplification of the outbreak. Conclusions. Our findings underscore the importance of integrated genomic and epidemiological surveillance in understanding SUDV transmission dynamics. The recurrent emergence of SUDV highlights the need for improved outbreak preparedness, rapid response mechanisms, and international collaboration. Strengthening real-time surveillance and enhancing healthcare system resilience are critical to mitigating the impact of future outbreaks. Full article

(This article belongs to the Special Issue Emerging and Re-Emerging Infections: Surveillance, Diagnostics, and Global Health Impacts)

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8 pages, 559 KiB

Open AccessArticle

Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir

by Kalpana Gupta, William J. O’Brien, Judith Strymish, Anna Chen, Katherine Linsenmeyer, Rebecca Madjarov and Michael E. Charness

Infect. Dis. Rep. 2025, 17(3), 43; https://doi.org/10.3390/idr17030043 - 1 May 2025

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Abstract

Background/Objectives: Recent in vitro data suggest that remdesivir might be less likely than nirmatrelvir–ritonavir to be associated with COVID-19 rebound. We compared the incidence of symptom rebound in our remdesivir-treated cohort with rates reported in the literature for nirmatrelvir–ritonavir. Methods: We performed a [...] Read more.

Background/Objectives: Recent in vitro data suggest that remdesivir might be less likely than nirmatrelvir–ritonavir to be associated with COVID-19 rebound. We compared the incidence of symptom rebound in our remdesivir-treated cohort with rates reported in the literature for nirmatrelvir–ritonavir. Methods: We performed a retrospective cohort study of VA Boston Healthcare System patients who were nursing home residents or inpatients treated with remdesivir for mild to moderate COVID-19 that met clinical criteria for nirmatrelvir–ritonavir treatment between 05/2022 and 10/2024. Electronic health records were reviewed for evidence of symptom rebound in daily clinical evaluations and outside hospital care notes for 15–20 days after the diagnosis of COVID-19. Rates for nirmatrelvir–ritonavir were identified via a literature review. Results: Among 194 patients treated with remdesivir, 39 were excluded due to concurrent antiviral use, hypoxia, or ICU-level care. The average age of the remaining 155 patients was 75.1 ± 11.9 years; 147 patients (95%) were male. Evidence of symptom rebound was found in 1 of 155 (0.6%) remdesivir-treated patients, which is a rate lower than that reported in all 12 studies of nirmatrelvir–ritonavir symptom rebound during the Omicron era. Conclusions: Our finding of low rates of COVID-19 symptom rebound after treatment with remdesivir are consistent with the hypothesis that rebound may be less frequent after treatment with remdesivir than with nirmatrelvir–ritonavir. Full article

(This article belongs to the Section Viral Infections)

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10 pages, 2546 KiB

Open AccessBrief Report

Humoral and Cell-Mediated Immunity Against SARS-CoV-2 in Healthcare Personnel Who Received Multiple mRNA Vaccines: A 4-Year Observational Study

by Hideaki Kato, Kaori Sano, Kei Miyakawa, Takayuki Kurosawa, Kazuo Horikawa, Yayoi Kimura, Atsushi Goto and Akihide Ryo

Infect. Dis. Rep. 2025, 17(3), 42; https://doi.org/10.3390/idr17030042 - 29 Apr 2025

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Abstract

Background/Objectives: The long-term effects of multiple updated vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have not been clarified. Humoral or cellular immunity dynamics in healthcare workers for four years were analyzed. Methods: Blood samples were collected at five time points from April [...] Read more.

Background/Objectives: The long-term effects of multiple updated vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have not been clarified. Humoral or cellular immunity dynamics in healthcare workers for four years were analyzed. Methods: Blood samples were collected at five time points from April 2021 to January 2024. Humoral immunity was analyzed using the 50% neutralizing titer (NT₅₀) against the original Omicron XBB and Omicron BA.2.86 strains and cellular immunity were analyzed using the ELISpot interferon-gamma releasing assay. NT₅₀s and the spot-forming count (SFC) of the ELISpot assay were compared in the SARS-CoV-2 Omicron XBB-, Omicron-infected, and uninfected subjects. Results: 32 healthcare workers (median age, 47 years) who received 3–7 vaccine doses were enrolled. The NT₅₀s against the original strain decreased after the second vaccination but were maintained after the third vaccine dose. NT₅₀s against the Omicron XBB and BA.2.86 strains were detected before the Omicron vaccine was introduced and increased following the updated vaccination. The NT₅₀s against the Omicron XBB and BA.2.86 strains were elevated after natural infection by the Omicron strain, albeit without differences compared with the findings in uninfected subjects. Multivariate regression analysis revealed no confounder that affected the antibody titer against the BA.2.86 strain at the fifth blood sampling. The median number of SFCs ranged from 78 to 208 after the first two doses. Conclusions: Multiple vaccinations induced the production of antibodies with divergent activity against emerging mutant strains and enhanced protective effects against the original strain. This finding supported the importance of updated vaccination. Full article

(This article belongs to the Special Issue Viral Infectious Diseases: Epidemiology and Prevention through Vaccination)

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11 pages, 1001 KiB

Open AccessArticle

Analysis of Factors Determining Serologic Response to Treatment of Early Syphilis in Adult Men

by Justyna Czarny, Damian Kadylak, Małgorzata Sokołowska-Wojdyło and Roman J. Nowicki

Infect. Dis. Rep. 2025, 17(3), 41; https://doi.org/10.3390/idr17030041 - 27 Apr 2025

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Abstract

Background: Syphilis is an infectious systemic disease that remains a public health threat, with an increasing incidence worldwide. Despite the availability of diagnostic tests and effective treatments, achieving a serological cure remains challenging for some patients. Methods: A retrospective cohort study of 130 [...] Read more.

Background: Syphilis is an infectious systemic disease that remains a public health threat, with an increasing incidence worldwide. Despite the availability of diagnostic tests and effective treatments, achieving a serological cure remains challenging for some patients. Methods: A retrospective cohort study of 130 male patients with early syphilis who attended the Department of Dermatology Venereology and Allergology in Gdansk was carried out between 2021 and 2024. This study assessed the rates of proper serological response and seroreversion of the VDRL test during the posttreatment follow-up period and analyzed selected factors influencing the achievement of these points. Results: The treatment outcomes were favorable; 96.15% of the patients achieved a proper serological response at a median of 1.54 months and seroreversion of the VDRL test within 18 months (median time = 7 months). A significantly greater proper serological response was observed in the primary and secondary syphilis patients than in the early latent syphilis patients (p = 0.005). A proper serological response was associated with age over 30 years (risk ratio (RR) = 1.381, p = 0.008) and VDRL baseline titers (≥1:32) (RR = 1.484, p = 0.005). The patients in the secondary or latent stage of early syphilis had a lower risk of seroreversion than those in the primary stage did (RR = 0.590, p = 0.030; RR = 0.560, p = 0.019, respectively). High titers at baseline (≥1:32) were also associated with a 30.8% reduced risk of seroreversion compared with lower titers (RR = 0.692, p = 0.038). Conclusions: These results suggest that age, syphilis stage, and titer level are significant predictors of the response rate. Based on these results, it is recommended that serological follow-up be concentrated within the first three months posttreatment, as this period accounts for the majority of treatment responses. Full article

(This article belongs to the Section Sexually Transmitted Diseases)

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12 pages, 1128 KiB

Open AccessReview

Treatment of Condyloma Acuminata with Tirbanibulin 1% Ointment in People Living with HIV: A Case Series with Literature Review

by Fabio Artosi, Terenzio Cosio, Lorenzo Ansaldo, Alessandro Cavasio, Loredana Sarmati, Luca Bianchi and Elena Campione

Infect. Dis. Rep. 2025, 17(3), 40; https://doi.org/10.3390/idr17030040 - 25 Apr 2025

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Abstract

Background: Condyloma acuminata (CA) are dysplastic lesions caused by human papillomavirus (HPV) infection. Condylomata acuminata are common in Human Immunodeficiency Virus- (HIV) infected individuals and have been linked to HIV transmission. Current therapeutic options for CA encompass laser, cryotherapy, imiquimod, sinecatechins, podophyllotoxin, and [...] Read more.

Background: Condyloma acuminata (CA) are dysplastic lesions caused by human papillomavirus (HPV) infection. Condylomata acuminata are common in Human Immunodeficiency Virus- (HIV) infected individuals and have been linked to HIV transmission. Current therapeutic options for CA encompass laser, cryotherapy, imiquimod, sinecatechins, podophyllotoxin, and trichloroacetate. These topical therapies have limitations caused by significant local skin reactions, high recurrence rates, prolonged application times, and, in some cases, a supposed lower efficacy in people living with Human Immunodeficiency Virus (PLWH). Previous studies evaluated the effect in the CA treatment of tirbanibulin 1% ointment since it is a synthetic antiproliferative drug approved for the topical treatment of actinic keratoses, acting in two distinct ways: it inhibits microtubule polymerization and Src kinase signaling. Human papilloma virus can up-regulate the kinases Src and Yes, so the tirbanibulin efficient treatment of CA may be due to the suppression of Src kinase signaling. Methods: Here, we present for the first time a retrospective case series of three PLWHIV affected by CA. Case: The patients experienced variable outcomes, with complete resolution of smaller condylomas for 2 out of 3 patients. Adverse events were local and of mild to moderate severity, lasting one week or less. Conclusions: While in need of larger studies, it is possible to hypothesize tirbanibulin 1% ointment as a therapeutic alternative for people living with HIV, especially for condylomas smaller than 1 cm in size. Full article

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13 pages, 233 KiB

Open AccessArticle

Diagnostic Challenges in Extrapulmonary Tuberculosis: A Single-Center Experience in a High-Resource Setting at a German Tertiary Care Center

by Jonas Wilmink, Richard Vollenberg, Ioana D. Olaru, Julia Fischer, Jonel Trebicka and Phil-Robin Tepasse

Infect. Dis. Rep. 2025, 17(3), 39; https://doi.org/10.3390/idr17030039 - 23 Apr 2025

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Abstract

Background/Objectives: Extrapulmonary tuberculosis accounts for a significant portion of tuberculosis cases, presenting unique diagnostic challenges due to its heterogeneous manifestations and paucibacillary nature. This study aims to fill this gap by evaluating the diagnostic outcomes and correlations between different specimen types and [...] Read more.

Background/Objectives: Extrapulmonary tuberculosis accounts for a significant portion of tuberculosis cases, presenting unique diagnostic challenges due to its heterogeneous manifestations and paucibacillary nature. This study aims to fill this gap by evaluating the diagnostic outcomes and correlations between different specimen types and test results. Methods: A retrospective analysis of electronic medical records of patients diagnosed with TB between January 2013 and December 2023 was carried out. The data extracted included patient demographics, comorbidities, TB classification, specimen types, microbiological test results, and time intervals to diagnosis. Statistical analysis was applied to compare the variables between pulmonary and extrapulmonary/disseminated TB groups. Results: Most patients were male (62.4%) and born outside of Germany (74.2%). Comorbidities, such as diabetes, cardiac disease, immunosuppressed status, and HIV, were common. Among the 194 patients, 98 had pulmonary TB, and 96 had extrapulmonary/disseminated TB. A comparison of pulmonary vs. extrapulmonary TB showed that extrapulmonary TB patients had a longer diagnostic delay (p = 0.013), more symptoms (p = 0.001), and more complications (42.7% vs. 16.3%, p < 0.001). Diagnostic challenges were evident, with multiple invasive procedures required in 43.5% of the extrapulmonary TB cases. Conclusions: This study highlights the complex clinical presentation of tuberculosis, particularly in patients with extrapulmonary and disseminated forms, who experience delayed diagnosis and more complications. These challenges in diagnosing extrapulmonary TB emphasize the need for improved diagnostic strategies and early identification, especially in high-risk populations. Full article

(This article belongs to the Section Tuberculosis and Mycobacteriosis)

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Infect. Dis. Rep., Volume 17, Issue 3 (June 2025) – 20 articles

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