GERMS

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Open AccessCase Report

Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor

by Diego Fernando Severiche-Bueno, Silvia J Galvis-Blanco and Jacqueline Mugnier

GERMS 2025, 15(2), 189-194; https://doi.org/10.18683/germs.2025.1467 - 30 Jun 2025

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Introduction: Co-infection with Histoplasma capsulatum and Pneumocystis jirovecii is rarely documented in HIV-negative immunocompromised patients and poses significant diagnostic challenges due to overlapping radiological patterns and limited access to advanced mycological testing. Case report: A 58-year-old woman with systemic lupus erythematosus and lupus [...] Read more.

Introduction: Co-infection with Histoplasma capsulatum and Pneumocystis jirovecii is rarely documented in HIV-negative immunocompromised patients and poses significant diagnostic challenges due to overlapping radiological patterns and limited access to advanced mycological testing. Case report: A 58-year-old woman with systemic lupus erythematosus and lupus nephritis, under treatment with corticosteroids and cyclophosphamide, presented with fever and hypoxemia. Chest computed tomography demonstrated bilateral micronodules, ground-glass opacities, and mediastinal lymphadenopathy. HIV testing and initial cultures were negative. Bronchoalveolar lavage revealed P. jirovecii, prompting the initiation of trimethoprim-sulfamethoxazole. Despite targeted therapy, the patient developed progressive respiratory failure, requiring intensive care. Transbronchial biopsy later confirmed coinfection with H. capsulatum. Antifungal therapy with liposomal amphotericin B and itraconazole was initiated; however, the clinical course was marked by progressive deterioration, culminating in death. Conclusions: This case highlights the need for high clinical suspicion of dual opportunistic infections in non-HIV immunocompromised patients. Diagnostic delays, particularly in resource-limited settings without fungal PCR, may adversely affect outcomes. In such complex hosts, early invasive diagnostics and broader access to rapid molecular testing are critical to improving prognosis in this vulnerable population. Full article

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Open AccessReview

Colistin Heteroresistance, Mechanisms, Diagnostic Methods, and Therapeutic Options: A Review

by Razieh Dehbanipour, Vala Taghi Zadeh Maleki and Zohreh Ghalavand

GERMS 2025, 15(2), 166-188; https://doi.org/10.18683/germs.2025.1466 - 30 Jun 2025

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Abstract

The heteroresistance phenotype refers to the presence of bacterial subpopulations with reduced antibiotic susceptibility compared with the main population. Mathematical modelling and computer simulations suggest that heteroresistance can lead to negative treatment outcomes and finally, treatment failure. Due to the low frequency and [...] Read more.

The heteroresistance phenotype refers to the presence of bacterial subpopulations with reduced antibiotic susceptibility compared with the main population. Mathematical modelling and computer simulations suggest that heteroresistance can lead to negative treatment outcomes and finally, treatment failure. Due to the low frequency and resistance level of resistant subpopulations, detection of heteroresistance phenotype in the diagnostic laboratory is problematic. Routine laboratory tests do not have the ability to accurately detect heteroresistance, but on the other hand, specific methods are time consuming and expensive. The emergence of colistin heteroresistance is a public health concern that threatens human health. Colistin heteroresistance to date has been reported in eight pathogens including Acinetobacter spp., Klebsiella spp., Enterobacter spp., Pseudomonas spp., Escherichia coli, Salmonella enterica serovar Typhimurium (referred to as Salmonella Typhimurium), Neisseria meningitidis and Stenotrophomonas maltophilia. The growing emergence of colistin heteroresistance worldwide underscores the crucial need for coordinated global action to combat it. Understanding the mechanisms of colistin heteroresistance can help to provide better guidelines for reducing antibiotic resistance and to achieve new therapeutic approaches. Our review showed that the prevalence of colistin heteroresistance strains varies in different countries. It seems that the use of different treatment strategies, especially combination therapy, can be effective in reducing the incidence of resistant subpopulations. Also, the use of new generation diagnostic methods can have a significant impact on treatment. Our findings in this review are needed to raise the awareness of microbiologists and specialists to the colistin heteroresistance mechanisms and to achieve effective treatment. Full article

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Open AccessArticle

Illicit Drugs—Infections and Neonatal Anthropometric Characteristics

by Leonard Năstase, Silvia-Maria Stoicescu, Nicolae Suciu, Laurenţiu Camil Bohîlţea, Eugenia Panaitescu and Adina-Brânduşa Baciu

GERMS 2025, 15(2), 157-165; https://doi.org/10.18683/germs.2025.1465 - 30 Jun 2025

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Abstract

Introduction: The effects of drug addiction in pregnancy are associated with multiple maternal, fetal and neonatal risks in the short and long term. Methods: This was a retrospective descriptive study conducted in the National Institute for Maternal and Child Health "Alessandrescu-Rusescu" Bucharest, Romania [...] Read more.

Introduction: The effects of drug addiction in pregnancy are associated with multiple maternal, fetal and neonatal risks in the short and long term. Methods: This was a retrospective descriptive study conducted in the National Institute for Maternal and Child Health "Alessandrescu-Rusescu" Bucharest, Romania - "Polizu" Hospital of Obstetrics and Gynecology (higher level maternity hospital), includes newborns from the last 22 years (2002–2024) from mothers who used illicit drugs before and during pregnancy. Results: The incidence of newborns born to mothers with drug addiction has steadily increased over the period studied, especially in the last 12 years. Neonatal morbidity was marked by: withdrawal syndrome (61.2% of cases), risk of congenital/perinatal infections through maternal infections (58.16%), prematurity (43.87%), birth weight ≤2500 g (55.10%), intrauterine growth restriction. Conclusions: Illicit drug use in pregnancy, associated with prematurity, intrauterine growth restriction, neonatal withdrawal syndrome, risk of congenital/perinatal infections through maternal infections, is an important risk factor for neonatal morbidity and mortality. Full article

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Open AccessArticle

The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group

by Agata Skrzat-Klapaczyńska, Sergii Antoniak, Svitlana Antonyak, Konstantinos Protopapas, Antonios Papadopoulos, Daniela Maric, Botond Lakatos, Antonija Verhaz, Milan Zlamal, Zofia Bartovska, Milena Stefanovikj, Gordana Dragovic, Arjan Harxhi, David Jilich, Kerstin Aimla, Lilia Cojuhari, Justyna Kowalska and Josip Begovac

GERMS 2025, 15(2), 144-156; https://doi.org/10.18683/germs.2025.1464 - 30 Jun 2025

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Abstract

Introduction: The implementation of nationwide viral hepatitis C elimination programs is challenging in Central and Eastern European countries (CEEC). It is reasonable to start by targeting specific populations, such as people living with HIV (PLWH), who are at higher risk of acquiring HCV [...] Read more.

Introduction: The implementation of nationwide viral hepatitis C elimination programs is challenging in Central and Eastern European countries (CEEC). It is reasonable to start by targeting specific populations, such as people living with HIV (PLWH), who are at higher risk of acquiring HCV or developing HCV-related complications. Methods: Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of infectious diseases from 26 countries in the region. Between April 26th and June 23rd 2023, the group performed an on-line survey consisting of 32 questions. The questionnaire assessed the status of HCV micro-elimination in 2022. Results: Twelve HIV centers from 11 countries responded: Albania, Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Greece, Hungary, Macedonia, Moldova, Serbia and Ukraine. All centers screen for HCV antibody all PLWH at entry into care. The seroprevalence of anti-HCV was <5% in 5 centers (Albania, Croatia, Serbia, North Macedonia and Hungary), 30.2% in Estonia and 29% in Ukraine, Greece and Moldova had high seroprevalence as well, 15.3% and 15.6% respectively. The prevalence of HCV viremia in antibody-positive PLWH was very high in Greece (85%), while in most other treatment centers it ranged from 4.2% to 38.2%. There is also a screening policy of annual HCV-testing of HCV-antibody negative persons in all centers by either testing all PLWH or those considered at risk. Direct-acting antiviral agents (DAA) were not available in one country (Albania). Among PLWH who entered care in 2022, nine out of 12 ECEE centers reported cases of HCV/HIV coinfection, with five centers indicating that at least 50% of these individuals were HCV-viremic. Conclusions: HCV screening in PLWH followed by access to DAA treatments were available in all but one center. Microelimination of HCV in PLWH in the majority of surveyed HIV treatment centers in CEEC has not been achieved and efforts to reach this goal need to be strengthened. Full article

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Open AccessArticle

Human Papillomavirus Knowledge, Vaccination Status, and Barriers to Vaccination in an Urban Transgender Clinic Population

by Hannah Sinks, Caitlin Waters, Alejandro Alvarez, Gary L. Goldberg, David W. Rosenthal and Elizabeth O. Schmidt

GERMS 2025, 15(2), 127-143; https://doi.org/10.18683/germs.2025.1463 - 30 Jun 2025

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Abstract

Introduction: This study aimed to better understand patient-reported human papillomavirus (HPV) vaccination rates and barriers to vaccination among transgender patients receiving care at a gender-affirming clinic in urban New York. Methods: All patients with arrived appointments at the Center for Transgender Care at [...] Read more.

Introduction: This study aimed to better understand patient-reported human papillomavirus (HPV) vaccination rates and barriers to vaccination among transgender patients receiving care at a gender-affirming clinic in urban New York. Methods: All patients with arrived appointments at the Center for Transgender Care at Northwell Health from 1 January 2020 through 14 July 2021, aged 14 and up, were invited to participate. Participants were sent an online consent form followed by a survey that assessed HPV knowledge, personal vaccination history, and reasons for or against vaccination. Data were collected in RedCap and analyzed using descriptive and basic inferential statistics. We received 79 completed consent forms and 70 completed surveys. Results: At least 68 of the 70 participants identified as transgender or gender diverse. Only 61.4% (43/70) of participants reported ever being offered the HPV vaccine and 55.7% (39/70) reported ever receiving at least one dose. Common reasons in favor of vaccination included doctor recommendation and decreasing cancer risk. Common reasons mentioned against HPV vaccination included sexual inactivity, concern over side effects, and assumption of low-risk HPV status. Of unvaccinated participants, 58.1% (18/31) reported they were more likely to get vaccinated after completing the survey. Conclusions: The HPV vaccination rate in this study was higher than the rates seen in previous studies involving sexual and gender minority participants. Provider recommendation was found to be important in promoting vaccination. Full article

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Open AccessReview

Laser Labiaplasty and Vaginal Rejuvenation: How to Reach Zero Post-Operative Infections. An Expert Opinion and Short Narrative Review on Protocols, Safety and Outcome

by Filis Demirgean, Simona Albu, Maria-Magdalena Constantin and Adrian Streinu-Cercel

GERMS 2025, 15(2), 121-126; https://doi.org/10.18683/germs.2025.1462 - 30 Jun 2025

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Abstract

Labiaplasty, the surgical modification of the labia minora, has gained popularity lately due to increasing functional and aesthetic concerns. We examine the preoperative considerations, postoperative outcomes, and potential complications associated with this intervention, while describing our center’s protocol for laser labiaplasty. The use [...] Read more.

Labiaplasty, the surgical modification of the labia minora, has gained popularity lately due to increasing functional and aesthetic concerns. We examine the preoperative considerations, postoperative outcomes, and potential complications associated with this intervention, while describing our center’s protocol for laser labiaplasty. The use of laser technology appears to enhance surgical outcomes, by minimizing tissue trauma and expediting recovery. This paper highlights the importance of individualized patient care, surgeon expertise, and adherence to best practices to optimize safety and results. As labiaplasty techniques continue to evolve, further studies are necessary to evaluate their benefits, risks and long-term outcomes. Full article

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Open AccessArticle

Post-Procedural Infection Risk Following Laser Vaginal Rejuvenation: Clinical Experience from a Single Center

by Filis Demirgean, Simona Albu, Maria-Magdalena Constantin and Adrian Streinu-Cercel

GERMS 2025, 15(2), 116-120; https://doi.org/10.18683/germs.2025.1461 - 30 Jun 2025

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Abstract

Introduction: Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) significantly impact women’s quality of life, leading to symptoms such as vaginal dryness, irritation, dyspareunia, and urinary incontinence. While traditional treatments include hormonal therapy and surgical interventions, these approaches may not be suitable [...] Read more.

Introduction: Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) significantly impact women’s quality of life, leading to symptoms such as vaginal dryness, irritation, dyspareunia, and urinary incontinence. While traditional treatments include hormonal therapy and surgical interventions, these approaches may not be suitable for all patients. Laser vaginal rejuvenation has emerged as a promising, minimally invasive alternative that enhances vaginal tissue health with minimal downtime. Methods: This retrospective study analyzes data from 53 patients who underwent internal, external, or combined laser vaginal rejuvenation. Patient demographics, medical and gynecological history, treatment indications, procedural details, and post-treatment outcomes were assessed. Results: The most common reasons for seeking treatment included vaginal laxity (69.8%), urinary incontinence (47.2%), and vaginal discomfort (15.1%). The majority (90.6%) opted for combined internal and external treatment, with most undergoing three sessions. Post-procedure symptoms were minimal, limited to transient discomfort and minor, self-limiting bleeding in three patients. No patients developed wound infections; this finding is reflected in the postoperative reevaluation, using genital cultures. Conclusions: Findings suggest laser vaginal rejuvenation is well-tolerated, with high adherence and satisfaction rates. While our study is limited by its descriptive nature and single-center design, results align with existing literature, supporting the procedure’s safety and efficacy. Full article

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Open AccessArticle

The Heart Rate Variability Changes in Measles, HIV, and Sars-Cov-2 Infections; A Subtle Autonomic Involvement—A Pilot Study

by Ilinca Savulescu-Fiedler, Teodora Deaconu, Roxana Siliste, Corina Homentcovschi, Adriana Gurghean, Ioana Toader and Serban Benea

GERMS 2025, 15(2), 104-115; https://doi.org/10.18683/germs.2025.1460 - 30 Jun 2025

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Abstract

Introduction: Inflammation may induce dysautonomia, which is revealed by the decrease in heart rate variability (HRV) parameters. Our pilot study compares changes in HRV and the association between HRV and inflammatory markers in three RNA viral infections: acute (SARS-CoV-2, measles) and chronic (HIV). [...] Read more.

Introduction: Inflammation may induce dysautonomia, which is revealed by the decrease in heart rate variability (HRV) parameters. Our pilot study compares changes in HRV and the association between HRV and inflammatory markers in three RNA viral infections: acute (SARS-CoV-2, measles) and chronic (HIV). Methods: We evaluated 25 patients with viral infections and 8 control patients without viral disease, with similar mean age and comorbidities. Patients with measles and COVID-19 were hospitalized for mild to moderate respiratory symptoms, while those with HIV were assessed during follow-up visits. HRV parameters were assessed in time and spectral domains, under standardized conditions. Results: Significant differences were identified between measles and COVID-19 patients regarding SDNN (p = 0.016), rMSSD (p = 0.002), and between COVID-19 and HIV patients, both for SDNN (p = 0.029) and rMSSD (p = 0.017). SDNN and rMSSD had the highest value in COVID-19 group and the lowest value (lower than in the control group) in HIV and measles patients. All frequency-domain parameters reached their highest values in COVID-19 patients, whereas they were consistently lower in those with HIV and measles. A significant correlation of LF/HF ratio with serum fibrinogen was observed only in patients with measles and HIV infection (r = 0.793, p = 0.011, respectively r = 0.955, p < 0.001). Conclusions: Our study showed a significant decrease in HRV parameters in measles and HIV patients, with a more stable autonomic response in mild-moderate COVID-19 forms. A correlation between inflammation and markers of sympathetic dominance was found in patients with measles and HIV but not in COVID-19. Further studies may assess the relation between inflammation in viral infections and subtle changes in HRV parameters Full article

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GERMS, Volume 15, Issue 2 (06 2025) – 8 articles , Pages 104-194

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