Infectious Disease Reports

15 pages, 826 KB

Open AccessArticle

Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort

by Maria Ruano, Antonio Flores, Aleny Couto, Irénio Gaspar, Sabine Yerly, Ana Gabriela Gutierrez Zamudio, Rosa Bene, Adelina Maiela, Helder Macuacua, Jeff Lane, Florindo Mudender and Edy Nacarapa

Infect. Dis. Rep. 2025, 17(5), 123; https://doi.org/10.3390/idr17050123 - 30 Sep 2025

Abstract

Background: Treatment failure continues to play a role in HIV-related morbidity in Mozambique. Antiretroviral therapy (ART) regimen switches are decided empirically, as HIV genotypic resistance testing (HIV-GT) is unavailable in Mozambique’s public health system. Since 2016, Médecins Sans Frontières (MSF) and I-TECH have [...] Read more.

Background: Treatment failure continues to play a role in HIV-related morbidity in Mozambique. Antiretroviral therapy (ART) regimen switches are decided empirically, as HIV genotypic resistance testing (HIV-GT) is unavailable in Mozambique’s public health system. Since 2016, Médecins Sans Frontières (MSF) and I-TECH have provided access to HIV-GT at Alto Maé Health Center, Maputo. We describe the cohort of people with virologic failure (VF) that underwent HIV-GT and analyze dolutegravir (DTG) resistance (R) patterns. Methods: This cross-sectional assessment of routine programmatic data between July 2020 and February 2024 was conducted to guide future program enhancements. People living with HIV (PLWH) receiving ART beyond the first line with confirmed VF were included. Mutations were interpreted according to the Stanford HIVdb algorithm. We applied Bayesian bootstrapping for analysis, and the threshold for significance of effects was defined as a probability of 95%. Results: A total of 106 persons underwent HIV-GT following a structured adherence strategy, 62 (58.5%) of whom were on a DTG-based regimen. Fifty-seven of the 62 samples from persons on a DTG-based regimen were sequenced, and 51 (89.5% [95% CrI: 80.7, 96.2]) had confirmed resistance to DTG; the mean DTG-R score was 70.2 (95% CrI: 62.2, 78). Samples with DTG-R had a median of three INSTI mutations (IQR 1–4). Major DTG-associated mutations were found in 46 out of 57 samples: G118R (n = 28), R263K (n = 15), and Q148RK (n = 7). None of the people on the protease inhibitor regimen had an INSTI mutation. Conclusions: In contexts with limited access to resistance testing, the introduction of algorithms to identify PLWH at risk of developing drug resistance is strongly recommended. The proposed algorithm incorporates adherence reinforcement strategies, as recommended in national policies, followed by a short, supervised antiretroviral therapy (ART) support strategy. This approach has shown a high predictive value for identifying PLWH with resistance mutations to dolutegravir (DTG), thereby allowing the continuation of the effective DTG regimen without unnecessary regimen switches. Full article

18 pages, 554 KB

Open AccessArticle

Profile, Infection, and Vaccination Uptake: A Cohort of Canadian Retail Workers During the SARS-CoV-2 Pandemic

by Mathieu Thériault, Kim Santerre, Nicholas Brousseau, Samuel Rochette, Rabeea F. Omar, Joelle N. Pelletier, Caroline Gilbert, Jean-François Masson, Mariana Baz, Denis Boudreau and Sylvie Trottier

Infect. Dis. Rep. 2025, 17(5), 122; https://doi.org/10.3390/idr17050122 - 29 Sep 2025

Abstract

Background/Objectives: Retail workers may have been at an increased risk of contracting SARS-CoV-2 during the COVID-19 pandemic. To better understand this group, we set up a longitudinal cohort to document the occurrence of SARS-CoV-2 infection, vaccination uptake and to study immune response. Methods: [...] Read more.

Background/Objectives: Retail workers may have been at an increased risk of contracting SARS-CoV-2 during the COVID-19 pandemic. To better understand this group, we set up a longitudinal cohort to document the occurrence of SARS-CoV-2 infection, vaccination uptake and to study immune response. Methods: Participants were enrolled between 20 April and 22 October 2021 and attended up to 5 visits over 48 weeks. Information collected was: participant characteristics, SARS-CoV-2 detection tests performed, COVID-19 symptoms, and vaccination (influenza and SARS-CoV-2). Findings: We included 304 participants aged 18 to 75; of those, 117 had a first positive SARS-CoV-2 test, mostly (85.5%) during Omicron wave. Forty-two (13.8%) participants got seasonal influenza vaccine within the year (2020–2021) prior to the first visit, and 95.9% had received the primary series of 2 doses of SARS-CoV-2 vaccine by the beginning of Omicron wave. Participants vaccinated for influenza (adjusted hazard ratio (aHR) 2.48; 95% confidence interval (CI): 1.54–3.98) and older patients (aHR 2.39; 95% CI: 1.40–4.10), were more likely to get a first booster of SARS-CoV-2 vaccine compared to those who did not receive influenza vaccine. In contrast, participants who traveled (aHR 0,62; 95% CI: 0.43–0.91) or participated in frequent gatherings (aHR 0.58; 95% CI: 0.39–0.85) were less likely to be boosted. Conclusions: Variations in vaccine uptake that are usually observed within populations had little effect on completion of the primary SARS-CoV-2 vaccine series. However, these differences became apparent for booster doses, at a period during which most infections in this cohort were recorded. Full article

(This article belongs to the Special Issue Prevention, Diagnosis and Treatment of Infectious Diseases)

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14 pages, 2012 KB

Open AccessCase Report

More than Mucositis: Pediatric RIME Following Co-Infection with SARS-CoV-2 and Mycoplasma pneumoniae—A Case Report and Mini-Review

by Alina Corina Grama, Ovidiu Grama, Măriuca Mănescu and Mihaela Chinceșan

Infect. Dis. Rep. 2025, 17(5), 121; https://doi.org/10.3390/idr17050121 - 24 Sep 2025

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Abstract

Background: Reactive Infectious Mucocutaneous Eruption (RIME) is a mucositis-predominant syndrome that usually follows respiratory infections in children. Although Mycoplasma pneumoniae is a well-established trigger, viral pathogens as triggers—especially SARS-CoV-2—have been increasingly reported. RIME is often misclassified as Stevens–Johnson syndrome (SJS), which may lead [...] Read more.

Background: Reactive Infectious Mucocutaneous Eruption (RIME) is a mucositis-predominant syndrome that usually follows respiratory infections in children. Although Mycoplasma pneumoniae is a well-established trigger, viral pathogens as triggers—especially SARS-CoV-2—have been increasingly reported. RIME is often misclassified as Stevens–Johnson syndrome (SJS), which may lead to inappropriate management. Case Presentation: We describe a 12-year-old previously healthy boy who presented with fever, dry cough, odynophagia, and vomiting for 9 days. On admission, he had severe oral ulcerations, bilateral conjunctivitis, and a non-blanching maculopapular rash. Laboratory tests confirmed co-infection with M. pneumoniae and SARS-CoV-2. Inflammatory markers were mildly elevated. Notably, the patient also developed asymptomatic sinus bradycardia, with no signs of structural heart disease. He was treated with antibiotics, intravenous corticosteroids, and supportive care. His mucosal symptoms improved rapidly, and he was discharged in stable condition on day 7. Follow-up at 12 days showed near-complete resolution of all lesions. Conclusions: This case illustrates several clinically relevant features. First, it highlights a dual infectious trigger—M. pneumoniae and SARS-CoV-2—that may have contributed to a more severe mucosal reaction. Second, the patient developed transient sinus bradycardia without myocardial involvement, suggesting a possible inflammatory autonomic response, rarely reported in RIME. Finally, this case supports the early use of corticosteroids in severe mucosal disease, with good outcomes and no complications. Prompt recognition of RIME, especially in the context of viral–bacterial coinfection, is essential to avoid misdiagnosis and to guide appropriate, multidisciplinary management. Full article

(This article belongs to the Section Bacterial Diseases)

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16 pages, 648 KB

Open AccessReview

Clean to Prevent, Monitor to Protect: A Scoping Review on Strategies for Monitoring Cleaning in Hospitals to Prevent HAIs

by Biagio Santella, Antonio Donato, Luigi Fortino, Vittoria Satriani, Rosaria Flora Ferrara, Emanuela Santoro, Walter Longanella, Gianluigi Franci, Mario Capunzo and Giovanni Boccia

Infect. Dis. Rep. 2025, 17(5), 120; https://doi.org/10.3390/idr17050120 - 21 Sep 2025

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Abstract

Background/Objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence [...] Read more.

Background/Objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence and finding research gaps to inform evidence-based recommendations for healthcare facilities. Methods: Following PRISMA Scoping Review guidelines, we conducted comprehensive searches on PubMed and Scopus databases from 2010–2025 using terms related to environmental monitoring, surface sampling, air sampling, and infection control in hospital settings. Eighteen studies met inclusion criteria; data were extracted using standardized forms and synthesized narratively, organizing findings by monitoring approach categories. Results: These studies revealed diverse monitoring approaches including fluorescent markers (22.2%), ATP bioluminescence assays (33.3%), microbiological methods (44.4%), and direct observation techniques (27.8%). MRSA was the most frequently targeted pathogen (55.6%), with limited attention to Gram-negative multidrug-resistant organisms and fungi. Studies showed significant variability in pass/fail thresholds (ATP: 50–500 RLU) and lack of standardized benchmarks. Recent research (50% post-2021) increasingly incorporates molecular techniques and digital technologies, though implementation remains resource intensive. Conclusions: A multimodal approach combining visual inspection, ATP assays, and microbiological methods appears most effective for comprehensive environmental monitoring. Critical gaps include lack of standardized thresholds, limited pathogen diversity focus, and insufficient integration of emerging digital technologies. Future research should focus on setting universal standards, expanding pathogen coverage, and assessing cost-effective monitoring strategies, all while ensuring legal compliance with hygiene regulations to enhance patient safety. Full article

(This article belongs to the Special Issue Containment Strategies of Infectious Diseases: Epidemiology, Surveillance and Prophylaxis)

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16 pages, 610 KB

Open AccessArticle

Characterization of Carbapenem-Resistant Gram-Negative Bacilli Isolates in Multispecialty Private Hospitals in Lagos, Nigeria

by Moruf Salau, Uraiwan Kositanont, Pirom Noisumdaeng, Folasade Ogunsola, Abdul-Wahab Omo-ope Ettu, Damilola Adewojo, Chinonso Ojimma, Omamode Ojomaikre and Kanjana Changkaew

Infect. Dis. Rep. 2025, 17(5), 119; https://doi.org/10.3390/idr17050119 - 21 Sep 2025

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Abstract

Background/Objectives: Carbapenem-resistant Gram-negative bacilli (CR-GNB) pose a growing challenge to public health worldwide due to limited treatment options. This cross-sectional study investigated the characteristics of CR-GNB isolated from clinical specimens in Lagos, Nigeria. Methods: Gram-negative bacilli (GNB) and clinical data were obtained from [...] Read more.

Background/Objectives: Carbapenem-resistant Gram-negative bacilli (CR-GNB) pose a growing challenge to public health worldwide due to limited treatment options. This cross-sectional study investigated the characteristics of CR-GNB isolated from clinical specimens in Lagos, Nigeria. Methods: Gram-negative bacilli (GNB) and clinical data were obtained from three multi-specialist private hospitals between March and June 2023. The GNB were identified using the Analytical Profile Index (API) and investigated for CR-GNB by disk diffusion. Antimicrobial resistance patterns and carbapenemase gene data for presumptive carbapenemase-producing Gram-negative bacilli (CP-GNB) were analyzed using Vitek-2 and polymerase chain reaction (PCR). Results: Of 317 GNB, 29.0% (n = 92) were CR-GNB. Significantly higher numbers of CR-GNB were reported from the intensive care unit and oncology department (p = 0.009). Of all CR-GNB, 17 isolates (18.5%) were classified as presumptive CP-GNB. In this subgroup, resistance rates of ampicillin/sulbactam (100.0%) and trimethoprim/sulfamethoxazole (100.0%) were highest. Ten (10) CP-GNB were confirmed, representing 3.15% of all GNB tested. Seven isolates of New Delhi Metallo-β-lactamase (bla_NDM) were found among P. aeruginosa, K. pneumoniae, E. coli, and A. baumannii. The bla_NDM was identified in strains classified as extensively drug-resistant (XDR) and pandrug-resistant. Conversely, the bla_KPC was detected solely in multidrug-resistant and XDR strains. Conclusions: Emerging CR-GNB, specifically CP-GNB, in Nigeria emphasize the need for specific therapeutic management of infected patients. Antimicrobial stewardship and long-term surveillance efforts must be implemented in healthcare settings, as well as improved, accelerated microorganism identification techniques. Full article

(This article belongs to the Section Antimicrobial Stewardship and Resistance)

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4 pages, 202 KB

Open AccessEditorial

Recombinant Yeast-Based Vaccines: Importance and Applications

by Ravinder Kumar

Infect. Dis. Rep. 2025, 17(5), 118; https://doi.org/10.3390/idr17050118 - 18 Sep 2025

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Abstract

Vaccines are biological preparations used to elicit an immune response, in order to prevent future infections or minimize damage from possible future infection [...] Full article

24 pages, 1287 KB

Open AccessReview

State of the Art on Vaccine Development Against Dengue Infection: Scoping Review of the Literature

by Davide Marangoni, Anna Barbiero, Michele Spinicci, Alessandro Bartoloni, Andrea Rossanese, Paolo Bonanni and Lorenzo Zammarchi

Infect. Dis. Rep. 2025, 17(5), 117; https://doi.org/10.3390/idr17050117 - 17 Sep 2025

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Abstract

Background: Dengue virus infection is a significant challenge for global health, with 100 million symptomatic cases, 2.3 million DALYs and 20,000 deaths annually. Dengue vaccines must provide long-lasting immunity against all four virus serotypes, especially in dengue-naïve individuals, in order to avoid the [...] Read more.

Background: Dengue virus infection is a significant challenge for global health, with 100 million symptomatic cases, 2.3 million DALYs and 20,000 deaths annually. Dengue vaccines must provide long-lasting immunity against all four virus serotypes, especially in dengue-naïve individuals, in order to avoid the severe manifestations of secondary infections. Methods: This scoping review summarizes current evidence on licensed dengue vaccines and vaccine candidates, focusing on immunogenicity, efficacy, and safety outcomes. To identify relevant trials, in October 2023 we queried ClinicalTrials.gov using the search term “dengue vaccines” to identify past and present vaccine candidates; the search was repeated in February 2025. Vaccines were categorized into licensed (CYD-TDV and TAK-003), late-stage (TV003/TV005), and early-stage candidates (TDEN, DPIV, V180, TVDV). Results: CYD-TDV (Dengvaxia^®) showed moderate efficacy in large trials, with higher efficacy in seropositive than in seronegative individuals. Following commercialization, an increased hospitalization risk was discovered in the latter group. Due to these findings and impossibility of screening for prior exposure in endemic settings newer vaccines are now preferred and CYD-TDV production has recently been discontinued due to declining demand. TAK-003 (Qdenga^®) demonstrated high efficacy against virologically confirmed dengue (VCD) and dengue-related hospitalization. This vaccine was generally well tolerated and is currently recommended by scientific societies and national authorities for travelers and by WHO for routine use in adults and children in endemic settings. TV003 and TV005, developed by NIAID, showed strong immunogenicity and efficacy in phase II trials and human challenge models. Preliminary results show that a single-dose of TV003 has an efficacy of 79.6% in seronegatives and 89.2% in seropositives against VCD at a 2-year follow-up. Both formulations elicited tetravalent responses with an acceptable safety profile. Other vaccine strategies, including TDEN (live-attenuated), DPIV (purified inactivated), V180 (subunit), and TVDV (DNA-based) are still in early-phase development and suffer from waning antibody titers and limited efficacy in naïve subjects. Conclusions: The development of a safe and effective vaccine remains complex due to immunologic challenges. Currently, TAK-003 is regarded as the best option for broad implementation, while TV003 and TV005 remain promising candidates due to their shorter schedule and robust immunogenicity. Further research is needed to optimize vaccine strategies in seronegative populations, immunocompromised subjects, older adults, and travelers. Full article

(This article belongs to the Section Immunology and Vaccines)

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8 pages, 465 KB

Open AccessBrief Report

Pathways to Diagnose Infectious Pulmonary Vascular Disease in Rural Mozambique

by Yolanda Sabino, Cizália Ribeiro, Joshua Mungue and Ana Olga Mocumbi

Infect. Dis. Rep. 2025, 17(5), 116; https://doi.org/10.3390/idr17050116 - 15 Sep 2025

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Abstract

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and [...] Read more.

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and poor socioeconomic status further compromise prevention, early diagnosis, and treatment. Clinical algorithms for early screening, including hand-held echocardiography and point-of-care testing performed by non-specialists, are needed in rural Sub-Saharan Africa to decentralize care and improve outcomes. Methods: We describe a case of pulmonary hypertension diagnosed in a child living in Mozambique, to discuss the challenges for the diagnosis of infectious pulmonary arterial hypertension in rural settings in Africa, based on a short literature review. Full article

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

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13 pages, 752 KB

Open AccessArticle

Uneven Implementation of Nirsevimab Prophylaxis Resulted in Non-Uniform Reductions in RSV-Related Hospitalizations in Italy

by Melodie O. Aricò, Francesco Accomando, Daniela Trotta, Giulia Marozzi, Anthea Mariani, Claudia Rossini, Claudio Cafagno, Letizia Lorusso, Martina Fornaro, Enrico Valletta, Désirée Caselli and Maurizio Aricò

Infect. Dis. Rep. 2025, 17(5), 115; https://doi.org/10.3390/idr17050115 - 12 Sep 2025

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Abstract

Background/Objectives: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants. In the 2024–2025 season, passive newborn immunization with nirsevimab, a long-acting anti-RSV monoclonal antibody, was introduced for the first time in Italy. However, the immunization campaign was not uniformly [...] Read more.

Background/Objectives: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants. In the 2024–2025 season, passive newborn immunization with nirsevimab, a long-acting anti-RSV monoclonal antibody, was introduced for the first time in Italy. However, the immunization campaign was not uniformly implemented on a regional basis due to supply and organizational difficulties. The aim of the study was to assess the real-world impact of nirsevimab prophylaxis during the 2024–2025 bronchiolitis season in four regions of Italy. Methods: This multicenter observational study included infants <12 months hospitalized for bronchiolitis across four Italian centers. Hospitalizations due to RSV and non-RSV bronchiolitis were compared across the 2023–2024 and 2024–2025 seasons, in relation to the timing and coverage of nirsevimab’s introduction in each of the four regions. Results: Early and widespread nirsevimab administration was associated with a significant reduction in RSV hospitalizations and severity of disease. Centers located in regions that had delayed implementation of immunization observed higher RSV burden and intensive care unit admissions. Admissions for non-RSV bronchiolitis remained stable. Conclusions: Timely and universal administration of nirsevimab significantly reduced RSV hospitalizations and severity, while delayed implementation resulted in limited benefit. These findings support early and uniform prophylaxis to mitigate health disparities and seasonal pressure on pediatric healthcare systems. Full article

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

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13 pages, 315 KB

Open AccessArticle

Uncommon Pathogens in Common Presentations: Genetic Profiling and Virulence Determinants of Vibrio alginolyticus Isolated from a Case of External Otitis

by Radu Ovidiu Togănel, Razvan Lucian Coșeriu, Anca Delia Mare, Camelia Vintilă, Ioan-Ovidiu Sîrbu, Aimée Rodica Chis, Cristina Elena Gîrbovan and Adrian Man

Infect. Dis. Rep. 2025, 17(5), 114; https://doi.org/10.3390/idr17050114 - 12 Sep 2025

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Abstract

Backgrunod/Objectives: Routine identification of common bacterial pathogens is typically efficient, utilizing standardized, cost-effective methods. However, the diagnostic process becomes significantly more complex when dealing with rare or unexpected microorganisms, especially as they can be considered colonizers in many cases. Methods: This [...] Read more.

Backgrunod/Objectives: Routine identification of common bacterial pathogens is typically efficient, utilizing standardized, cost-effective methods. However, the diagnostic process becomes significantly more complex when dealing with rare or unexpected microorganisms, especially as they can be considered colonizers in many cases. Methods: This study presents diagnostic details of an uncommon pathogen, Vibrio alginolyticus, isolated from auricular discharge in a patient with non-Hodgkin lymphoma diagnosed with persistent otitis externa and explores its identification through both conventional and modern laboratory approaches. Sequential ear discharge cultures resulted in phenotypically similar but genomically different Vibrio alginolyticus isolates. We complemented classical methods like conventional culture (on Columbia agar and CLED agar), Vitek2 Compact identification, and EUCAST disk diffusion antimicrobial susceptibility testing (following the EUCAST version 12.0 guidelines) with MALDI-TOF mass spectrometry and Illumina/Nanopore whole genome sequencing. Comparative analysis of the genomes was performed with the PeGAS pipeline, Unicycler, and 1928Diagnostics SNP analysis. Results: The Vitek2 analysis identified both isolates as V. alginolyticus with 99% confidence, and this was supported by the MALDI-TOF MS results. The first isolate (A) was fully susceptible to the antibiotics tested, while the second (B) showed resistance to ciprofloxacin. Whole genome sequencing revealed 99.23% and 98.60% nucleotide identity to the V. alginolyticus reference genome for isolates A and B, respectively, with a 99.8% match between them. Isolate B acquired a gyrA (c.1870C>T) mutation that correlates with the ciprofloxacin resistance (MIC > 0.5 mg/L). Both genomes carry hlyA (hemolysin), toxR (cholera toxin regulator), genes involved in biofilm formation (rpoN, relA, spoT, opp), luxS (motility), proA, vacB (virulence factors), and tet(34) (oxytetracycline resistance). A core genome SNP distance of <100 indicates clonal relatedness. Our integrated (phenotypic and genomic) diagnostic approach confirmed V. alginolyticus and documented host resistance evolution, with a virulence repertoire that could explain the clinical evolution. Conclusions: This case highlights the utility of molecular methods in confirming species identity, detecting resistance markers, characterizing virulence determinants, and differentiating a pathogen from a colonizer, supporting targeted clinical management. Full article

11 pages, 636 KB

Open AccessArticle

Imported Dengue Fever in Milan, Italy: A Seven-Year Retrospective Study

by Margherita Eleonora Pieruzzi, Davide Mileto, Alessandra Helen Behring, Stefania Caronni, Alessandro Mancon, Luigi Vezzosi, Alberto Rizzo, Andrea Poloni, Andrea Gori, Andrea Giacomelli and Spinello Antinori

Infect. Dis. Rep. 2025, 17(5), 113; https://doi.org/10.3390/idr17050113 - 12 Sep 2025

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Abstract

Background: Dengue fever is an arboviral infection transmitted by Aedes mosquitoes that has recently become a public health concern also in Europe, causing many outbreaks of autochthonous cases. Methods: We retrospectively retrieved dengue cases in returning travelers from tropical areas diagnosed at the [...] Read more.

Background: Dengue fever is an arboviral infection transmitted by Aedes mosquitoes that has recently become a public health concern also in Europe, causing many outbreaks of autochthonous cases. Methods: We retrospectively retrieved dengue cases in returning travelers from tropical areas diagnosed at the Luigi Sacco Hospital between January 2018 and December 2024. All patients with positive serology for DENV (IgM alone or IgM and IgG or neutralizing antibodies detection) and/or positive real-time polymerase chain reaction (RT-PCR) for DENV RNA on plasma and urine were considered. Analyses were descriptive. Results: This analysis included 159 travelers with confirmed (n = 138; 86.8%) or probable (n = 21; 13.2%) dengue fever. The median age was 38 years (interquartile range [IQR] 30–50); 87 (54.7%) were females. The median time between symptom onset and seeking medical attention was four days (IQR 3–6); 29.6% required hospitalization, with a median stay of four days (IQR 0–5). The most common symptoms included fever (100%), myalgia (52.2%), and headache (49.1%). Laboratory findings revealed thrombocytopenia (53.8%), leukopenia (64.1%), elevated ALT (51.9%), and LDH (60.2%). Among the confirmed cases, 128 (92.8%) were diagnosed with RT-PCR. Serotypes 1 and 2 were the most prevalent (28.9% and 27.3%, respectively). Most cases were classified as dengue without warning signs (150, 94.3%), eight cases (5.0%) as dengue with warning signs, and one as severe dengue. Conclusions: Dengue fever is an important cause of fever among travelers returning to Italy from endemic areas. Although severe dengue is rare among travelers, further prospective studies need to address this issue. Diagnosis should be pursued by using molecular tools because of cross-reactivity with other arboviruses. Full article

(This article belongs to the Special Issue Epidemiology, Prevention and Research on Dengue Virus)

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10 pages, 352 KB

Open AccessArticle

A Retrospective Study of Cefiderocol Utilization and Associated Outcomes at an Academic Medical Center

by Samantha G. Rauch, Michelle H. Potter and Emir Kobic

Infect. Dis. Rep. 2025, 17(5), 112; https://doi.org/10.3390/idr17050112 - 11 Sep 2025

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Abstract

Background: This study aimed to describe cefiderocol prescription and associated patient outcomes at a U.S. academic medical center for various multidrug-resistant organisms (MDRO). Notably, limited real-world data exist on cefiderocol’s clinical use in regions where metallo-β-lactamase (MBL)-producing organisms are prevalent. Methods: A retrospective [...] Read more.

Background: This study aimed to describe cefiderocol prescription and associated patient outcomes at a U.S. academic medical center for various multidrug-resistant organisms (MDRO). Notably, limited real-world data exist on cefiderocol’s clinical use in regions where metallo-β-lactamase (MBL)-producing organisms are prevalent. Methods: A retrospective chart review was conducted on adult inpatients who received ≥24 h of cefiderocol between January 2023 and July 2024. Data collected included microbiology, carbapenemase type (CARBA-5), treatment indication, susceptibility profiles, and clinical outcomes: 30-day mortality, re-infection, and re-admission. Descriptive statistics were used. Results: Seventy-six patients were included, with most receiving cefiderocol for carbapenem-resistant Enterobacterales (CRE) (63%) or P. aeruginosa (17%) infections. Overall, 96% of cases met institutional prescribing criteria. NDM was the predominant carbapenemase (77% of CRE isolates). Cefiderocol was used definitively in 68% of cases. The median duration of therapy was 7 days. Thirty-day mortality was 20%, highest among patients with A. baumannii complex (33%). Re-infection and re-admission occurred in 21% and 32% of patients, respectively. Susceptibility to cefiderocol was highest for P. aeruginosa (100%), Stenotrophomonas (100%), and CRE (88%), but only 50% for A. baumannii complex. Conclusions: Cefiderocol was primarily used in accordance with institutional criteria and demonstrated favorable susceptibility against most target pathogens. However, poor outcomes in A. baumannii complex infections highlight the need for cautious use and the need for rapid diagnostics for early targeted therapy in multidrug-resistant infections. Full article

(This article belongs to the Section Bacterial Diseases)

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14 pages, 1054 KB

Open AccessArticle

Circulation of SARS-CoV-2 and Co-Infection with Plasmodium falciparum in Equatorial Guinea

by Diana López-Farfán, Policarpo Ncogo, Consuelo Oki, Matilde Riloha, Valero Ondo, Pablo Cano-Jiménez, Francisco José Martínez-Martínez, Irene Molina-de la Fuente, Iñaki Comas, Nerea Irigoyen, Pedro Berzosa, Agustín Benito Llanes and Elena Gómez-Díaz

Infect. Dis. Rep. 2025, 17(5), 111; https://doi.org/10.3390/idr17050111 - 10 Sep 2025

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Abstract

Background/Objectives: The impact of COVID-19 in Africa has been controversial. Data from African countries are heterogeneous and generally scarce. Many regions are also highly endemic for other infectious diseases like malaria, and it has been suggested that the low incidence and mortality of [...] Read more.

Background/Objectives: The impact of COVID-19 in Africa has been controversial. Data from African countries are heterogeneous and generally scarce. Many regions are also highly endemic for other infectious diseases like malaria, and it has been suggested that the low incidence and mortality of COVID-19 in malaria-endemic regions could have been related to cross-immunity between malaria and SARS-CoV-2. The aim of this study was to determine the prevalence of SARS-CoV-2 and circulating variants as well as the frequency of co-infections with malaria in Equatorial Guinea. Methods: We conducted antigen tests for SARS-CoV-2 and microscopy malaria examinations in 1556 volunteer participants at six health centres in Bioko and Bata from June to October 2021 and performed SARS-CoV-2 whole-genome sequencing on positive samples to determine the diversity and origin of circulating variants. Results: We report 3.03% of SARS-CoV-2 and 22.25% of malaria prevalence over the sampling period; SARS-CoV-2 cases were found at a similar frequency in all age groups, whereas malaria was most frequent in children and teenagers. Six cases of malaria and SARS-CoV-2 co-infection were found, representing 0.37% prevalence. Genome sequences of 43 SARS-CoV-2 isolates are reported, most of which belong to the lineage Delta and, according to pandemic-scale phylogenies, were introduced from Europe on multiple occasions. Conclusions: This study is relevant in providing first-time estimates of the real prevalence of SARS-CoV-2 in this malaria-endemic country, with the identification of circulating variants, their origin, and co-occurrence with malaria. These data regarding the impact of the pandemic and co-infection with endemic diseases are relevant in future pandemics preparedness. Full article

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

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18 pages, 316 KB

Open AccessArticle

One Month Preexposure Prophylaxis Retention Rate and Associated Factors Among Adolescent Girls and Young Women Who Participated in the Namibia DREAMS Program (2018–2024)

by Enos Moyo, Endalkachew Melese, Hadrian Mangwana, Simon Takawira, Rosalia Indongo, Bernadette Harases, Perseverance Moyo, Ntombizodwa Makurira Nyoni, Kopano Robert and Tafadzwa Dzinamarira

Infect. Dis. Rep. 2025, 17(5), 110; https://doi.org/10.3390/idr17050110 - 10 Sep 2025

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Abstract

Background: Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, [...] Read more.

Background: Daily oral preexposure prophylaxis (PrEP) is one strategy employed to decrease HIV transmission among adolescent girls and young women (AGYW). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program, funded by PEPFAR/USAID and implemented by the Project HOPE Namibia (PHN)-led consortium, provided services in the Khomas, Oshikoto, Zambezi, and Oshana regions. This study assessed the one-month PrEP retention rate among AGYW 15–24 and the associated factors. Methods: The program’s target populations for PrEP included AGYW aged 15–24 years who were at substantial risk for HIV, tested HIV-negative, and resided in the regions where the PHN-led consortium was implementing the DREAMS program. Data between 2018 and 2024 were exported from DHIS2 to IBM SPSS version 29 for secondary data analysis. We analyzed the data using Chi-squared tests and binomial and multinomial logistic regression. Results: Among the 17,277 participants newly initiated on oral PrEP and included in this study, only 2466 returned on time for their one-month appointment. The one-month PrEP retention rate among AGYW was 14.3%, 95% CI (13.8–14.8%). The most common reasons for PrEP discontinuation were traveling away from home, not needing PrEP anymore, forgetfulness, and side effects. Participants from Oshakati and Onandjokwe exhibited a higher likelihood of one-month PrEP retention. Additionally, participants who were in the programs for 7–12 months or over 36 months, who attended the safe space HIV prevention sessions, who were unaware of their partners’ HIV status, and who considered themselves at risk of HIV also exhibited a lower likelihood of one-month PrEP retention. In contrast, individuals who had 1–2 children and those who were either pregnant or breastfeeding exhibited a higher likelihood of one-month PrEP retention, (COR) = 1.28, 95% CI (1.15–1.43), and COR = 2.00, 95% CI (1.62–2.46), respectively. Conclusions: Targeted, innovative, and context-specific strategies should be developed to support AGYW in identifying their HIV risk and continuing the use of daily oral PrEP during periods of heightened risk. Additionally, prioritizing the introduction of discreet, long-acting PrEP options that require less frequent administration may better align with their needs and preferences. Full article

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

15 pages, 1891 KB

Open AccessReview

Technical Challenges in Studying Infectious Disease-Associated Pulmonary Hypertension in Low- and Middle-Income Countries with Limited Resources

by Jennifer van Heerden, Irina Mbanze, Elizabeth Louw, Olukayode Aremu, Anastase Dzudie, Ana Mocumbi, Threnesan Naidoo, Brian Allwood and Friedrich Thienemann

Infect. Dis. Rep. 2025, 17(5), 109; https://doi.org/10.3390/idr17050109 - 10 Sep 2025

Viewed by 374

Abstract

Background: Pulmonary hypertension (PH) disproportionately affects those residing in low- and middle-income countries (LMICs). Given that these countries also have a high prevalence of infectious diseases, many cases of PH are either directly or indirectly related to infectious etiologies. Despite this correlation, the [...] Read more.

Background: Pulmonary hypertension (PH) disproportionately affects those residing in low- and middle-income countries (LMICs). Given that these countries also have a high prevalence of infectious diseases, many cases of PH are either directly or indirectly related to infectious etiologies. Despite this correlation, the precise burden of infectious disease-associated PH is largely underappreciated due to a lack of diagnostic resources, a shortage of clinical expertise to carry out right heart catheterization and poor access to healthcare facilities in many low- and middle-income settings. Methods: In this narrative review, we highlight the significant burden of infectious disease-associated PH in LMICs, outline the technical challenges faced by LMICs when diagnosing PH, and propose possible solutions for diagnosing PH in resource-constrained settings. Conclusions: Low-cost and sustainable solutions for infectious disease-associated PH in LMICs should be prioritized. Meaningful solutions require collaborative efforts and capacity building in LMICs. Full article

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

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9 pages, 235 KB

Open AccessArticle

Sex, Age, and COVID-19 Vaccine Characteristics Associated with Adverse Events After Vaccination and Severity: A Retrospective Analysis

by Edgar P. Rodríguez-Vidales, Jesús M. Santos-Flores, Mara I. Garza-Rodríguez, Ana M. Salinas-Martínez, Alejandra G. Martínez-Pérez, Roberto Montes de Oca-Luna and Alma R. Marroquín-Escamilla

Infect. Dis. Rep. 2025, 17(5), 108; https://doi.org/10.3390/idr17050108 - 3 Sep 2025

Viewed by 1636

Abstract

Background: Although the safety of COVID-19 vaccines has been demonstrated in clinical trials, real-world pharmacovigilance remains essential to detect rare or unexpected adverse events following immunization (AEFI). In Mexico, the national AEFI surveillance system is in place, yet there is limited analysis of [...] Read more.

Background: Although the safety of COVID-19 vaccines has been demonstrated in clinical trials, real-world pharmacovigilance remains essential to detect rare or unexpected adverse events following immunization (AEFI). In Mexico, the national AEFI surveillance system is in place, yet there is limited analysis of state-level data. Objective: To characterize AEFI related to five COVID-19 vaccines and identify factors associated with AEFI type and seriousness in Nuevo León, Mexico. Methods: A retrospective analysis of the State of Nuevo León AEFI database was conducted, including all AEFI reports between December 2020 and June 2022 (n = 2213). Data included patient sex, age, vaccine type (Pfizer/BioNTech, AstraZeneca, Sinovac, Moderna, CanSino), number of doses (1 or ≥2), symptom categories, and AEFI seriousness. Symptoms were classified as local or systemic and grouped by organ systems. Descriptive analysis and binary multivariate logistic regression were used to examine associations between demographic and vaccine-related factors with AEFI type and severity. Odds ratios (OR) with 95% confidence intervals (CI) were estimated. Results: Most AEFI reports involved females aged 19–59 years and occurred after the first vaccine dose. The most frequently reported unexpected adverse events (UAEs) were mild to moderate, including injection-site reactions, headache, chills, fatigue, nausea, fever, dizziness, weakness, myalgia, and tachycardia. The Pfizer/BioNTech vaccine was associated with higher odds of arm pain and lower odds of hemorrhagic events. Receiving ≥2 doses increased the odds of arm pain and systemic symptoms. Less than 3% of AEFIs were classified as serious. Older adults (≥65 years) and second vaccine doses were associated with increased odds of a serious AEFI, while female sex and receiving the Pfizer/BioNTech vaccine were associated with reduced odds. Conclusions: In Nuevo León, most AEFIs related to COVID-19 vaccination were mild to moderate and resolved without complications. Serious AEFIs were uncommon, with older age and second doses associated with higher risk, and female sex and Pfizer/BioNTech vaccination associated with lower risk. These findings provide a local perspective on vaccine safety that complements national and international evidence. Full article

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

19 pages, 1078 KB

Open AccessArticle

Torque Teno Virus as a Biomarker for Infection Risk in Kidney Transplant Recipients: A Machine Learning-Enabled Cohort Study

by Sara Querido, Luís Ramalhete, Perpétua Gomes and André Weigert

Infect. Dis. Rep. 2025, 17(5), 107; https://doi.org/10.3390/idr17050107 - 2 Sep 2025

Viewed by 441

Abstract

Background: Torque Teno Virus (TTV) viremia has been proposed as a marker for infection risk in kidney transplant (KT) recipients. This study aimed to evaluate the prognostic value of TTV levels for predicting infections post-KT. Methods: A cohort of 82 KT patients was [...] Read more.

Background: Torque Teno Virus (TTV) viremia has been proposed as a marker for infection risk in kidney transplant (KT) recipients. This study aimed to evaluate the prognostic value of TTV levels for predicting infections post-KT. Methods: A cohort of 82 KT patients was analyzed. TTV loads were measured before KT and at the time of cutoff analysis (mean time since KT: 20.2 ± 10.3 months). Infections were tracked within six months following the time of cutoff analysis. Univariable analyses and a supervised machine learning approach (logistic regression with leave-one-out cross-validation) were conducted to rigorously assess TTV’s predictive ability for post-transplant infection. Results: Seventy-two patients (87.8%) had detectable TTV before KT. Of these, 30.5% developed infections, predominantly viral. TTV loads increased significantly from 3.35 ± 1.67 log₁₀ cp/mL before KT to 4.53 ± 1.93 log₁₀ cp/mL at the time of cutoff analysis. Infected patients had significantly higher TTV loads (5.39 ± 1.68 log₁₀ vs. 4.16 ± 1.94 log₁₀ cp/mL, p = 0.0057). The optimal TTV threshold for predicting infection at the time of cutoff analysis was 5.16 log₁₀ cp/mL, with 60% sensitivity and 81% specificity. Machine learning models improved performance, with sensitivity and specificity 0.805 and 0.735, respectively. Conclusions: TTV viremia may serve as a biomarker for infection risk, particularly when used with other clinical variables. The identified TTV threshold of 5.16 log₁₀ cp/mL offers a practical tool for clinical decision-making, particularly when integrated with a machine learning model. Further studies with larger cohorts are needed to validate these findings and refine clinical applications. Full article

(This article belongs to the Section Immunology and Vaccines)

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8 pages, 757 KB

Open AccessCase Report

Hyponatremia Due to VZV-Induced SIADH in an Older Patient: Case Report and Literature Review

by Zuzanna Żak-Skryśkiewicz, Patrycja Krupińska, Carlo Bieńkowski and Przemysław Witek

Infect. Dis. Rep. 2025, 17(5), 106; https://doi.org/10.3390/idr17050106 - 30 Aug 2025

Viewed by 584

Abstract

Introduction: Hyponatremia is a common finding in hospitalized patients, especially the elderly. Symptoms of hyponatremia can vary depending on the concentration of sodium in serum as well as the dynamics of its escalation. Hyponatremia can have many etiologies, including medication, vomiting, or diarrhea, [...] Read more.

Introduction: Hyponatremia is a common finding in hospitalized patients, especially the elderly. Symptoms of hyponatremia can vary depending on the concentration of sodium in serum as well as the dynamics of its escalation. Hyponatremia can have many etiologies, including medication, vomiting, or diarrhea, and central nervous system disorders, including tumors, trauma, and infections. Case report: In this case, we present a 74-year-old patient who was admitted to the Department of Internal Medicine with symptomatic, acute, and severe hyponatremia in the course of the syndrome of inappropriate antidiuretic hormone secretion due to varicella zoster virus meningoencephalitis. Clinical improvement and normalization of natremia occurred after the initiation of causal treatment. Conclusion: Given the complexity of the potential causes of hyponatremia and the variety of treatments available, it is essential to thoroughly consider the possible reasons for electrolyte abnormalities, including uncommon ones such as central nervous system infections. Full article

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

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17 pages, 1604 KB

Open AccessEditor’s ChoiceArticle

Health Disparities in Central Line-Associated Bloodstream Infections: Analysis of the U.S. National Inpatient Sample Database (2016–2022)

by Nicholas Mielke, Ryan W. Walters and Faran Ahmad

Infect. Dis. Rep. 2025, 17(5), 105; https://doi.org/10.3390/idr17050105 - 28 Aug 2025

Viewed by 608

Abstract

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and [...] Read more.

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and costs using the National Inpatient Sample (NIS) from 2016 to 2022. Methods: We conducted a retrospective analysis of adult hospitalizations using the NIS database that included central venous catheter placement and identified CLABSI using AHRQ’s Patient Safety Indicator 07. Primary outcomes included CLABSI incidence and in-hospital mortality; secondary outcomes were LOS and inflation-adjusted hospital costs. Outcomes were analyzed using logistic and lognormal regression models, focusing on demographic and clinical variables that included sex, race, socioeconomic status, and insurance type. Results: Among 11.5 million CVCs placed between 2016 and 2022, 6.56 million met CLABSI eligibility criteria, with 1 in 400 (0.25%) complicated by CLABSI. Blacks had 29.8% higher adjusted odds of CLABSI than Whites (p < 0.001), whereas Medicaid beneficiaries had 18.4% higher odds compared to those privately insured (p = 0.002). CLABSI was associated with a 97% increase in LOS and an 82% increase in hospital costs (both p < 0.001). In-hospital mortality was 13.3% and did not differ significantly by CLABSI status after adjustment. Discussion: Racial and socioeconomic disparities persist in CLABSI incidence and healthcare resource utilization, with Blacks and Medicaid beneficiaries at the highest risk. Although CLABSI rates returned to pre-pandemic levels in 2022, associated costs and LOS remained elevated. Further research and targeted prevention strategies are needed to reduce health disparities and improve patient outcomes. Full article

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20 pages, 2364 KB

Open AccessArticle

Oral Immunization with Yeast-Surface Display of SARS-CoV-2 Antigens in Pichia pastoris Induces Humoral Responses in BALB/C Mice

by Larissa Silva de Macêdo, Benigno Cristofer Flores Espinoza, Maria da Conceição Viana Invenção, Samara Sousa de Pinho, Lígia Rosa Sales Leal, Micaela Evellin dos Santos Silva, Beatriz Mendonça Alves Bandeira, Pedro Vinícius Silva Novis, Tiago Henrique dos Santos Souza, Julliano Matheus de Lima Maux, Jacinto da Costa Silva Neto, Antonio Carlos de Freitas and Anna Jéssica Duarte Silva

Infect. Dis. Rep. 2025, 17(5), 104; https://doi.org/10.3390/idr17050104 - 27 Aug 2025

Cited by 1 | Viewed by 580

Abstract

Background/Objectives: The pandemic caused by SARS-CoV-2 boosted the development of different vaccine models. In parallel, yeasts stand out as a vaccine platform in healthcare biotechnology. Species such as Saccharomyces cerevisiae and Pichia pastoris can express heterologous proteins, which are capable of inducing [...] Read more.

Background/Objectives: The pandemic caused by SARS-CoV-2 boosted the development of different vaccine models. In parallel, yeasts stand out as a vaccine platform in healthcare biotechnology. Species such as Saccharomyces cerevisiae and Pichia pastoris can express heterologous proteins, which are capable of inducing specific antibodies and can perform as an attractive vaccine vehicle with immunomodulating properties due to their cell wall composition. Furthermore, the yeast surface display system facilitates antigen presentation to immune cells. We developed an oral vaccine based on P. pastoris displaying a synthetic antigen composed of Spike and Nucleocapsid epitopes. Methods: The vaccine was administered to BALB/c mice. Systemic immune response was measured through antibody detection in blood samples, and mucosal immunity was assessed via IgA levels in feces. Histopathological analysis of intestinal and gastric tissues was also conducted. Results: The yeast-based vaccine elicited a humoral immune response, reflected in the production of neutralizing antibodies and elevated levels of IgG2a and IgG2. No structural alterations or pathological changes were observed in gastrointestinal tissues. Conclusions: This study demonstrates the feasibility of using P. pastoris as an oral vaccine delivery system, supporting previous findings with other yeast species such as Saccharomyces cerevisiae, and highlighting its potential in developing effective mucosal vaccines. Full article

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7 pages, 411 KB

Open AccessCase Report

Concomitant Neck and Lung Masses Post Dental Procedure—A Potential Novel Presentation of the Cellulosimicrobium Species in Humans

by Kevin M. Sheehan, Geraldine Moloney, Olive Murphy, Paul Ryan, Triona Hayes, Madeleine R. Harney, Michael Harney and Oisin O’Connell

Infect. Dis. Rep. 2025, 17(5), 103; https://doi.org/10.3390/idr17050103 - 22 Aug 2025

Viewed by 429

Abstract

Background: Cellulosimicrobium, formerly known as the Oerskovia genus, is a Gram-positive organism known for its characteristic bright yellow colonies. While abundant in nature, it is very rarely linked to pathogenesis in humans. While there is no classical presentation for Cellulosimicrobium-associated infections, [...] Read more.

Background: Cellulosimicrobium, formerly known as the Oerskovia genus, is a Gram-positive organism known for its characteristic bright yellow colonies. While abundant in nature, it is very rarely linked to pathogenesis in humans. While there is no classical presentation for Cellulosimicrobium-associated infections, cases tend to be foreign body-related or involve immunocompromised patients. Rates of Cellulosimicrobium-associated infections have been hypothesised to rise in the future, due to rising numbers of immunocompromised patients in the community and increasing usage of foreign bodies such as prostheses and long-term catheters. Existing technical difficulties regarding misidentifying cultures as other species (often other coryneforms) may also play a significant role in the low number of documented cases, and this may change in the near future with diagnostic advancements such as whole genomic sequencing. Case Presentation: A 57-year-old immunocompetent Irish male presented with concomitant neck and lung masses. Notably, this was found to be directly following a recent dental procedure. During extensive investigations, Cellulosimicrobium was isolated from biopsied lung tissue using 16S ribosomal ribonucleic acid gene-sequencing analysis. The patient was treated with long-term oral amoxicillin and safely discharged, with both masses showing measurable reductions in size on subsequent imaging. Conclusions: Should Cellulosimicrobium represent the causative pathological organism in this case, then we believe this to represent a potential novel documented presentation of the organism’s pathogenesis in humans. We provide detailed discussion surrounding the successful management of this patient and the evaluation of the evolving differential diagnosis throughout this case. Full article

(This article belongs to the Section Bacterial Diseases)

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Infect. Dis. Rep., Volume 17, Issue 5 (October 2025) – 21 articles

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