GERMS

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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 (registering DOI) - 1 Oct 2025

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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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

Abstract

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

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

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

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

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

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 and minimize the infectious risk, 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

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

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 patients with measles and COVID-19 regarding SDNN (p = 0.016), rMSSD (p = 0.002), and between patients with COVID-19 and HIV, both for SDNN (p = 0.029) and rMSSD (p = 0.017). SDNN and rMSSD had the highest value in the COVID-19 group and the lowest value (lower than in the control group) in patients with HIV and measles. All frequency-domain parameters reached their highest values in patients with COVID-19, 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 patients with measles and HIV, 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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Open AccessCommunication

Extending Mental Health Support to the Survivors of Ebola Virus Disease by Overcoming Challenges

by Saurabh RamBihariLal Shrivastava and Prateek Sudhakar Bobhate

GERMS 2025, 15(1), 83-87; https://doi.org/10.18683/germs.2025.1458 - 31 Mar 2025

Abstract

Ebola virus disease (EVD) is a rare infectious tropical disease, which is a serious illness among humans, and is often fatal [...] Full article

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Open AccessCase Report

Acute Chlamydia pneumoniae Infection in a Child, Complicated by Retrobulbar Optic Neuritis

by Gheorghiţă Jugulete, Bianca Borcoş and Mădălina Maria Merişescu

GERMS 2025, 15(1), 77-82; https://doi.org/10.18683/germs.2025.1457 - 31 Mar 2025

Abstract

Introduction: This case highlights a rare and significant complication of Chlamydia pneumoniae infection: optic neuritis (ON). Acute Chlamydia pneumoniae infection in children typically presents with respiratory tract symptoms and may occasionally lead to complications or sequelae. ON is a condition most commonly associated [...] Read more.

Introduction: This case highlights a rare and significant complication of Chlamydia pneumoniae infection: optic neuritis (ON). Acute Chlamydia pneumoniae infection in children typically presents with respiratory tract symptoms and may occasionally lead to complications or sequelae. ON is a condition most commonly associated with viral infections or other demyelinating diseases. Case report: The patient, a 10-year-old girl, initially presented with the typical systemic symptoms of Chlamydia pneumoniae infection, including fever, chills, and headache, in addition to an atypical symptom—chromatic deficit, or visual disturbances. This prompted further investigation into potential neurological complications, ultimately leading to a diagnosis of ON. The case underscores the importance of a comprehensive diagnostic workup, including serological testing (IgM ELISA) and PCR analysis of nasopharyngeal specimens, to confirm the underlying infection. Additionally, imaging studies (CT, MRI) and consultations with specialists in neurology and ophthalmology were critical for excluding other potential causes and assessing the extent of complications. The rapid and favorable response to treatment highlights the importance of early diagnosis and appropriate management. Conclusions: Although ON is a rare complication of Chlamydia pneumoniae infection, it should be considered in pediatric patients with unexplained visual symptoms, particularly when the clinical course does not improve or worsens despite treatment for the primary infection. This case further emphasizes the importance of interdisciplinary collaboration in managing complex cases and the need for vigilant monitoring of potential neurological complications in children with respiratory infections. Full article

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Open AccessCase Report

Rare Cutaneous Fungal Infection Due to Nigrograna chromolaenae in a Heart Transplant Recipient

by Maud Foissac, Lucas Balloy, Guillaume Wartel, Anne-Gaёlle Leroy and Marie-Pierre Moiton

GERMS 2025, 15(1), 71-76; https://doi.org/10.18683/germs.2025.1456 - 31 Mar 2025

Abstract

Introduction: Solid organ transplant recipients are particularly prone to infections, and many germs can be involved, including opportunistic pathogens. Regarding catheter-related infections however, the number of causative microorganisms is most often limited to germs of the skin flora, rare enterobacteria and Pseudomonas aeruginosa [...] Read more.

Introduction: Solid organ transplant recipients are particularly prone to infections, and many germs can be involved, including opportunistic pathogens. Regarding catheter-related infections however, the number of causative microorganisms is most often limited to germs of the skin flora, rare enterobacteria and Pseudomonas aeruginosa. Case report: We present here a case of venous catheter-related cutaneous infection in a man with immunosuppression, which was surprisingly caused by a rare environmental fungus, named Nigrograna chromolaenae. The therapeutic strategy combining posaconazole and removal surgery appears to have been effective, with no relapse more than 2 months after surgery. Conclusions: Due to advances in molecular biology techniques, it is possible that infections with Nigrograna spp. will be increasingly described. At the moment the reported cases are few in number, and the treatment is not yet standardized, which is why we thought this new case could support the literature about these opportunistic pathogens. Full article

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Open AccessArticle

Mycoplasma pneumoniae and Chlamydia pneumoniae Community-Acquired Pneumonia in Young Adults from a Family Medicine Practice

by Ana-Maria Slănină, Adorata Elena Coman, Antoneta-Dacia Petroaie, Carmen Liliana Barbacariu, Otilia Novac, Elena Popa, Mihaela Manole, Agnes Iacinta Bacuşcă and Adriana Cosmescu

GERMS 2025, 15(1), 64-70; https://doi.org/10.18683/germs.2025.1455 - 31 Mar 2025

Cited by 1

Abstract

Introduction: A major area of pathology in primary care practice is represented by respiratory infections, from common colds to severe lower respiratory tract illness. Our aim was to evaluate the incidence of Mycoplasma pneumoniae and Chlamydia pneumoniae pneumonia among the patients with suspected [...] Read more.

Introduction: A major area of pathology in primary care practice is represented by respiratory infections, from common colds to severe lower respiratory tract illness. Our aim was to evaluate the incidence of Mycoplasma pneumoniae and Chlamydia pneumoniae pneumonia among the patients with suspected atypical pneumonia from a family medicine urban setting in Iaşi, Romania, to study serological retrospective diagnosis, the therapeutic outcome and the modified immunologic parameters in a subgroup of patients. Methods: We enrolled 93 patients with suspected atypical community-acquired pneumonia (CAP); enzyme-linked immunosorbent assay (ELISA) testing for Mycoplasma pneumoniae and Chlamydia pneumoniae was performed, both immunoglobulins M and G being determined. Considering the systemic inflammation associated to atypical germs infections, in a subgroup of 13 patients, with positive results for Mycoplasma and Chlamydia pneumoniae, interleukin 5, interleukin 8, tumor necrosis factor α and interferon γ levels were determined, using chemiluminescence method (EI-CLA). Results: Positive IgM serology for atypical germs was recorded in 25.8% of patients. Mycoplasma pneumoniae infection was confirmed in 10.8% of patients, Chlamydia pneumoniae infection in 6.5% of patients, and co-infection (both Mycoplasma pneumoniae and Chlamydia pneumoniae) in 8.6% of patients. A number of 41 patients (44.0%) presented chronic cough/bronchial hyperreactivity despite the treatment. Modified values were recorded for all immunological parameters tested, confirming the role in chronic airway inflammation. Conclusions: Mycoplasma and Chlamydia pneumoniae CAP, frequent among young adults, is successfully treated with macrolides, still, the residual symptoms and the modified immunologic parameters need further studies regarding chronic inflammation. Full article

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Open AccessArticle

A Clinical Analysis of the 2024 Pertussis Outbreak Among Pediatric Patients in an Infectious Diseases Hospital in Bucharest, Romania

by Mădălina Maria Merişescu, Gheorghiţă Jugulete, Irina Dijmărescu, Andreea Mihaela Băluţă and Anca Oana Dragomirescu

GERMS 2025, 15(1), 56-63; https://doi.org/10.18683/germs.2025.1454 - 31 Mar 2025

Abstract

Introduction: The objective of this study was to identify and analyze cases of pertussis hospitalized in 2024 that met the clinical criteria, epidemiological context, and laboratory confirmation through polymerase chain reaction (PCR) or serological testing for Bordetella pertussis. This study aimed to assess [...] Read more.

Introduction: The objective of this study was to identify and analyze cases of pertussis hospitalized in 2024 that met the clinical criteria, epidemiological context, and laboratory confirmation through polymerase chain reaction (PCR) or serological testing for Bordetella pertussis. This study aimed to assess the age distribution of cases, vaccination rates, identify severe cases, and associated complications such as apnea, acute respiratory failure, and acute pneumonia. The findings aim to provide valuable data to enhance diagnostic and therapeutic strategies for managing pertussis in the pediatric population. Methods: We conducted a retrospective study from January to November 2024, involving pediatric patients admitted to the Pediatric Departments of the National Institute of Infectious Diseases “Prof. Dr. Matei Balş,” Bucharest, Romania, diagnosed with pertussis. The diagnosis was established based on epidemiological and clinical criteria and confirmed through laboratory tests, including serology or PCR testing. The selection criteria focused on hospitalized patients presenting clinical signs suggestive of pertussis, with laboratory confirmation. Results: Among the hospitalized patients, a significant proportion, 56.9%, were unvaccinated, while 12.5% had incomplete vaccination status. Common comorbidities contributing to increased hospitalization risk included prematurity, malnutrition, and asthma. Co-infections were identified in 32% of cases, with common pathogens such as measles, SARS-CoV-2, rhinovirus, and adenovirus. Respiratory complications were frequent, with apnea occurring in 51% of cases, pneumonia in 60%, and respiratory failure in 13.2%. Despite these complications, no fatalities were reported. Conclusions: This study highlights significant concerns related to low vaccination coverage in the pediatric population, emphasizing the importance of improving vaccination rates to prevent severe pertussis cases. The study also identifies the frequent occurrence of severe complications, including respiratory failure, apnea, and pneumonia, underlining the need for early intervention and effective management. Co-infections with respiratory pathogens further complicate diagnosis and treatment, underscoring the importance of comprehensive clinical evaluation in suspected cases of pertussis. Full article

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Open AccessArticle

by Gheorghe Gindrovel Dumitra, Carmen-Adriana Dogaru, Sandra Adalgiza Alexiu, Dorica Sănduţu, Cosmina Berbecel, Monica Curelea, Cristina Vasilica Barbu, Anca Deleanu, Adrian Grom, Maria Lup, Ioana Budiu, Mădălina Vesa, Florin Proşa, Daniela Ştefănescu, Roxana Surugiu, Ştefana Oana Popescu, Anca Lăcătuş, Mihaela Adela Iancu and Adina Turcu-Stiolica

GERMS 2025, 15(1), 37-55; https://doi.org/10.18683/germs.2025.1453 - 31 Mar 2025

Abstract

Introduction: Human papilloma virus (HPV) vaccination is a key strategy for preventing HPV-related cancers, yet vaccine hesitancy remains a challenge due to persistent myths and misconceptions. This study aimed to identify the most frequently encountered HPV vaccine-related myths in clinical practice from the [...] Read more.

Introduction: Human papilloma virus (HPV) vaccination is a key strategy for preventing HPV-related cancers, yet vaccine hesitancy remains a challenge due to persistent myths and misconceptions. This study aimed to identify the most frequently encountered HPV vaccine-related myths in clinical practice from the perspective of family doctors and to assess differences in their prevalence between urban and rural populations. Methods: A cross-sectional study was conducted among family doctors in Romania who reported common myths encountered when discussing HPV vaccination with parents and women eligible for catch-up vaccination. The analysis focused on identifying the most prevalent perceived myths and assessing differences between urban and rural settings, age groups and genders, using Kruskal-Wallis test, followed by post-hoc Dunn’s tests with Holm correction to account for multiple comparisons, as well as Chi-square tests. Results: The most frequently reported myths overall were “The HPV vaccine is only for girls” (mean score ± SD, 2.91 ± 1.27), “The HPV vaccine has severe and long-term side effects” (mean score ± SD, 2.83 ± 1.27), and “There are too many new vaccines” (mean score ± SD, 2.77 ± 1.3). Rural respondents reported significantly higher belief in concerns related to vaccine safety, effectiveness, increasing number of vaccines, necessity in monogamous individuals, fear of injections, and concerns about promiscuity, particularly in their perception of parents of adolescent girls. Conclusions: Family doctors consider that persistent myths continue to fuel vaccine hesitancy, especially in rural areas. Strengthening family doctors' communication skills through motivational interviewing and evidence-based counseling is essential. Public health efforts should focus on targeted educational interventions and social prescription tools to improve vaccine acceptance and reduce the burden of HPV-related diseases. Full article

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Open AccessArticle

The Presence of Exotoxin Genes and Biofilm Production in Carbapenem-Resistant Pseudomonas aeruginosa Clinical Isolates

by Amany Gamal Thabit, Magda Nasser Sediek and Mona Sallam Embarek Mohamed

GERMS 2025, 15(1), 26-36; https://doi.org/10.18683/germs.2025.1452 - 31 Mar 2025

Cited by 1

Abstract

Introduction: Pseudomonas aeruginosa produces many exotoxins which are essential for the bacterial pathogenesis. The aim of this study was to identify Pseudomonas aeruginosa from clinical specimens, detect the sensitivity pattern, biofilm production, and the frequency of exogenes. Methods: Pseudomonas aeruginosa clinical isolates were [...] Read more.

Introduction: Pseudomonas aeruginosa produces many exotoxins which are essential for the bacterial pathogenesis. The aim of this study was to identify Pseudomonas aeruginosa from clinical specimens, detect the sensitivity pattern, biofilm production, and the frequency of exogenes. Methods: Pseudomonas aeruginosa clinical isolates were identified by conventional and genotypic methods. Antibiotic susceptibility patterns and biofilm production were performed. Molecular detection of exotoxin genes exoS, exoT, exoU, and exoY in Pseudomonas aeruginosa isolates was performed by PCR. Results: Seventy-five Pseudomonas aeruginosa were identified in 400 clinical specimens. Sixty-six (88%) isolates were carbapenem-resistant. A total of 25 (33.3%) isolates were extensively drug resistant, 18 (24%) were multidrug resistant, and 11 (14.7%) were pandrug resistant. Sixty-three (84%) isolates were biofilm producers. Biofilm formation was detected in 56 (85%) of carbapenem-resistant isolates. Totally, 70 (93.3%) isolates carried exoS, 68 (90.7%) carried exoY, 65 (86.7%) carried exoT, and 28 (37.3%) carried exoU. Exogenes were highly expressed in carbapenem-resistant isolates. Coexistence of more than one gene was detected in nearly all isolates. Conclusions: Pseudomonas aeruginosa clinical isolates were resistant to many anti-pseudomonal antibiotics. Most of isolates were biofilm-producers. The genes exoT, exoS and exoY were identified in almost all P. aeruginosa strains and are considered an inevitable component of P. aeruginosa virulence. Full article

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Open AccessArticle

Bibliometric Analysis of Highly Pathogenic Avian Influenza Research Globally from 2003 to 2023

by Clement Meseko, Uwem Okon Edet, Okoroiwu Henshaw, Nicodemus Mkpuma, Kayode Abraham Olawuyi and Charles Archibong

GERMS 2025, 15(1), 11-25; https://doi.org/10.18683/germs.2025.1451 - 31 Mar 2025

Abstract

Introduction: Despite decades of research on highly pathogenic avian influenza, especially H5N1, an understanding of the impact of research outputs on policy, the impact of funding and policies, collaboration between authors, and other bibliometric measurable indices is elusive. Methods: H5N1 research data were [...] Read more.

Introduction: Despite decades of research on highly pathogenic avian influenza, especially H5N1, an understanding of the impact of research outputs on policy, the impact of funding and policies, collaboration between authors, and other bibliometric measurable indices is elusive. Methods: H5N1 research data were retrieved from the PubMed database using “H5N1”, “highly pathogenic”, and “influenza” as keywords, and combined with the Boolean operator, “OR”. The evaluated growth pattern of H5N1 research was analysed using Microsoft Excel, while the VOS viewer window version 1.6.15 was utilized in analyzing the keywords, authors’ inputs, and collaborations amongst research institutes/universities involved in H5N1 research. Results: A total of 8411 articles published within 2003 and 2023 were retrieved. The trend of the published articles indicates that 2003 to 2004 had the lowest number of articles, while the highest were observed for 2009 and 2010. Since then, there has been a gradual decline. The most dominant article type was original research article (89.80%), followed by reviews with 7.54%. The most productive countries were Japan, the United States of America, China, and Egypt in Africa. The top 15 authors accounted for 12.40% of the total published data. Keywords analysis revealed the emergence of newer keywords such as H5N8, wild birds, mammals, and Nigeria; however, as expected, influenza virus avian H5N1 subtype was the dominant keyword. Research institutes with backgrounds in agriculture and veterinary medicine dominated the top 15 organizations involved in H5N1 research. Conclusions: Our findings suggest that research aimed at developing therapeutics and vaccines, as well as continuous surveillance in high-risk areas is urgently needed. Furthermore, the findings provide baseline data for all the stakeholders involved in H5N1 research, which could inform future research, funding, and policies. Full article

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Open AccessCommunication

Attitudes and Acceptance of COVID-19 Vaccination Among Serbian Medical Students

by Katarina Maksimovic, Sandra Šipetić-Grujičić, Jelena Ilić Živojinović, Milena Tomanić and Isidora Vujčić

GERMS 2024, 14(4), 402-405; https://doi.org/10.18683/germs.2024.1449 - 31 Dec 2024

Cited by 1

Abstract

Efforts to reduce the spread of COVID-19 led to the temporary closing of schools, colleges, and restrictions on freedom of movement [...] Full article

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Open AccessReview

Prevalence of icaADBC Genes, and Correlation with Biofilms and Antibiotic Resistance in S. aureus: A Systematic Review and Meta-Analysis

by Khadijeh Bamneshin, Mohsen Poudineh, Roya Haji Alibabaei, Mohammad Reza Jabbari Amiri, Zahra Sadat Fateminasab, Zahra Ghorbani, Reyhaneh Maleki and Azad Khaledi

GERMS 2024, 14(4), 387-401; https://doi.org/10.18683/germs.2024.1448 - 31 Dec 2024

Abstract

We evaluated the gene prevalence of the icaADBC operon, its correlation with biofilm formation and antibiotic resistance through a global meta-analysis. We searched for articles that reported the prevalence of icaADBC operon, biofilm, and antibiotic resistance in S. aureus from 2000 up to [...] Read more.

We evaluated the gene prevalence of the icaADBC operon, its correlation with biofilm formation and antibiotic resistance through a global meta-analysis. We searched for articles that reported the prevalence of icaADBC operon, biofilm, and antibiotic resistance in S. aureus from 2000 up to 1st March 2024. The search was done in scientific databases such as PubMed, Scopus, Google Scholar, EMBASE, and Web of Science. The MESH keywords were: icaADBC operon, biofilm, methicillin-resistant Staphylococcus aureus, antibiotic resistance. Comprehensive Meta-Analysis Software was used for data analysis. The estimation of the combined prevalence of each desired variable was performed by depicting a forest plot through the random-effects model with a 95% confidence interval. Data heterogeneity was estimated by Q and I² indices, and p-value <0.05 was reflected as statistically significant heterogeneity. Fifteen articles were eligible for inclusion. The prevalence of ica operon genes varied between 28–51.5%. The prevalence of total ica operon genes in S. aureus was reported at 42.4% (95%CI: 29.4–56.5). Biofilm formation prevalence of S. aureus isolates in different studies was reported between 10-100%. The rate of total biofilm in S. aureus was 95.8%. The rate of total strong, moderate, and weak biofilm in S. aureus was reported at 35.4%, 35.3%, and 23.9%, respectively. Most reviewed studies reported a correlation between ica genes and biofilm. We found that many studies reported a correlation between the high prevalence of ica operon genes, phenotypic biofilm production, and antibiotic resistance. Also, regardless of whether the strains were MRSA or not, the high biofilm formation ability was reported at 95.8% by most studies. Full article

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