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Germs, Volume 15, Issue 4 (December 2025) – 6 articles

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16 pages, 665 KB

Open AccessReview

Tubo-Ovarian Abscess, Sepsis and Diffuse Peritonitis in Pelvic Inflammatory Disease—A Diagnostic and Therapeutic Review

by Yavor Kornovski, Stoyan Kostov, Yonka Ivanova, Stanislav Slavchev, Angel Yordanov and Eva Tsoneva

Germs 2025, 15(4), 6; https://doi.org/10.3390/germs15040006 - 18 Dec 2025

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Abstract

Background: Pelvic inflammatory disease (PID) is a common and potentially severe infection of the upper genital tract. Complications such as tubo-ovarian abscess (TOA), sepsis, and diffuse peritonitis contribute significantly to reproductive morbidity, particularly when diagnosis or treatment is delayed. Aim: The aim of this review is to present an updated, clinically relevant synthesis of the current evidence on the epidemiology, microbiology, diagnostic approach, imaging modalities, and management of PID, with a focus on severe forms including TOA, sepsis, and peritonitis. Content: PID is most frequently initiated by sexually transmitted pathogens—primarily Chlamydia trachomatis and Neisseria gonorrhoeae—which rapidly progresses to a polymicrobial infection involving anaerobic and enteric organisms. Diagnosis is predominantly clinical, supported by nucleic acid amplification tests, inflammatory markers, and imaging. Transvaginal ultrasonography remains the first-line diagnostic approach for suspected TOA, while CT or MRI is reserved for unclear cases or to assess rupture. Mild to moderate disease is managed with broad-spectrum combination antibiotics, whereas severe PID or TOA requires hospitalization, parenteral therapy, and timely source control through image-guided drainage or surgery. Ruptured abscesses and PID-associated sepsis demand urgent surgical intervention and multidisciplinary supportive care. Tailored approaches are necessary in pregnancy, adolescence, and immunosuppressed and postmenopausal patients. Conclusions: Prompt recognition, a low threshold for empiric antimicrobial therapy, the appropriate use of imaging, and decisive escalation to drainage or surgery are essential to limit morbidity and preserve reproductive health. Integrating guideline-based practice with structured clinical pathways may improve outcomes and reduce long-term sequelae of PID. Full article

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15 pages, 564 KB

Open AccessArticle

Early Bacterial Infections After Liver Transplantation: Risk Factors, Microbiological Spectrum, and Outcomes in an Eastern European Cohort

by Iulian Buzincu, Mihaela Blaj, Eliza Isabela Buzincu, Adi-Ionuț Ciumanghel, Irina Gîrleanu, Irina Ciumanghel, Ana-Maria Trofin, Vlad Nuțu, Alexandru Năstase, Ramona Cadar, Vlad Carp, Beatrice Cobzaru, George Mălureanu, Corina Lupașcu Ursulescu and Cristian Dumitru Lupașcu

Germs 2025, 15(4), 5; https://doi.org/10.3390/germs15040005 - 16 Dec 2025

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Abstract

Early bacterial infections (EBI) remain a major cause of morbidity and mortality after liver transplantation (LT). This study aimed to characterize their incidence, microbiological spectrum, risk factors, and clinical impact in an Eastern European cohort. We retrospectively analyzed 64 adult LT recipients from a tertiary center, focusing on perioperative parameters, infection profiles, and postoperative outcomes. EBI, defined as infections occurring within 30 days after transplantation and diagnosed according to CDC/NHSN criteria, occurred in 48.4% of patients. Gram-negative bacilli predominated (73.7%), mainly Pseudomonas aeruginosa (34.2%) and Klebsiella pneumoniae (15.8%), while Clostridioides difficile (CDI) accounted for 18.4% of confirmed cases diagnosed by stool toxin assay. Infected patients had greater intraoperative blood loss (median 6500 mL vs. 5000 mL, p = 0.036) and required more transfusions. The higher infection rate in our cohort may also be related to longer surgical duration. All deaths within the first postoperative year occurred among infected recipients, yet overall 30-day (7.8%) and 1-year (14.1%) mortality rates remained within the range reported internationally, suggesting that timely diagnosis and adequate management limited the impact of infections on survival. These findings emphasize the importance of infection prevention, optimized transfusion and bleeding control, and tailored antibiotic prophylaxis based on local microbiological patterns after LT. Full article

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16 pages, 1202 KB

Open AccessArticle

Dynamics of Anxiety, Depression, and Sleep Quality Following COVID-19 Hospitalization in Romania

by Mihaela-Camelia Vasile, Catalin Plesea-Condratovici, Mariana Stuparu-Cretu, Anca-Adriana Arbune, Claudiu-Ionut Vasile and Manuela Arbune

Germs 2025, 15(4), 4; https://doi.org/10.3390/germs15040004 - 15 Dec 2025

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Abstract

Background: COVID-19 has been associated with neurological and psychiatric manifestations, both at disease onset and during post-infectious sequelae, such as anxiety, depression, and sleep disturbances. Previous pandemics suggest potential for long-term neuropsychiatric consequences. Materials and Methods: We conducted a prospective longitudinal study in patients hospitalized with non-critical COVID-19, evaluating symptoms using validated psychometric instruments at discharge and after 3–6 and 12 months post-infection. Additionally, a four-year follow-up was performed through telephone interviews to document newly diagnosed psychiatric disorders and mortality. Results: At baseline, 22% of patients reported anxiety, 8% depression, and 16% poor sleep. Most symptoms improved within the first year, particularly during the first 3–6 months. At four-year follow-up, mortality reached 5%, while clinician-diagnosed psychiatric disorders increased to 6% for anxiety, 11% for depression, and 3% for mixed disorders. Anxiety and poor sleep—but not depression—were associated with the severity of the acute episode. Conclusions: Overall, post-COVID-19 anxiety, depression, and sleep disturbances were more prevalent than in the general population, though the rates were lower than those reported in other studies. Most symptoms resolved within the first year. However, new-onset cases of depression and other psychiatric disorders emerged during long-term follow-up, suggesting distinct trajectories of post-COVID-19 psychiatric morbidity. Full article

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8 pages, 209 KB

Open AccessCase Report

Typhoid Fever in a Non-Endemic Country: Diagnostic and Therapeutic Challenges in a Returning Traveler

by Ekaterina Lyutsova, Teodora Stoyanova, Andi Isidro, Iliyan Todorov and Diana Radkova

Germs 2025, 15(4), 3; https://doi.org/10.3390/germs15040003 - 10 Nov 2025

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Abstract

Background: Typhoid fever (TF) is a systemic infection caused by Salmonella enterica serovar Typhi, typically associated with regions where sanitation and access to clean water are inadequate. Although rare in non-endemic countries, TF remains a diagnostic consideration in travelers returning from endemic areas with febrile illness. Case report: We present the case of an 18-year-old female who developed TF following recent travel to Nigeria. The initial clinical presentation, including fever, dysuria, and abdominal pain, led to a misdiagnosis of acute pyelonephritis. Malaria, arboviral infections, acute viral hepatitis, and parasitic diseases were systematically ruled out through clinical evaluation, serological testing, and parasitological analysis. The clinical course was marked by fever, abdominal pain, somnolence, and hematological and hepatic abnormalities. Blood cultures confirmed the diagnosis, with the isolate verified and serotyped by the National Center of Infectious and Parasitic Diseases. Targeted antimicrobial treatment with ceftriaxone and levofloxacin resulted in full recovery, with no evidence of relapse or chronic carriage over a three-month follow-up period. Conclusions: This case highlights the critical importance of a structured differential diagnostic approach and microbiological confirmation in febrile patients with relevant travel history. In non-endemic settings, where TF may be underrecognized, early recognition, pathogen identification, and appropriate antimicrobial therapy remain essential to favorable outcomes and public health safety. Full article

2 pages, 172 KB

Open AccessEditorial

Building on Strong Foundations: A Message from the Editor-in-Chief of Germs

by Oana Săndulescu

Germs 2025, 15(4), 2; https://doi.org/10.3390/germs15040002 - 15 Oct 2025

Viewed by 905

Abstract

It is with both gratitude and anticipation that I write these words, looking back on almost 15 years of continued publication and marking the transition of Germs into a new chapter through our collaboration with MDPI [...] Full article

1 pages, 162 KB

Open AccessEditorial

Publisher’s Note: A New Chapter for Germs—Continued Publication by MDPI

by Clàudia Aunós

Germs 2025, 15(4), 1; https://doi.org/10.3390/germs15040001 - 1 Oct 2025

Viewed by 746

Abstract

We are pleased to announce that, beginning with Volume 15, Issue 4 (2025), Germs (ISSN: 2248-2997) will now be published by MDPI [...] Full article

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