You seem to have javascript disabled. Please note that many of the page functionalities won't work as expected without javascript enabled.

Search for Articles:

Title / Keyword

Author / Affiliation / Email

Journal

Article Type

Advanced Search

Section

Special Issue

Volume

Issue

Number

Page

Logical OperatorOperator

Search Text

Search Type

Journal Description

Germs

Germs is an international, peer-reviewed, open access journal on the knowledge and practice in the area of infectious diseases in humans, published quarterly online. It is the official journal of the Infection Science Forum (ISF). The Association for Increasing the Visibility of Scientific Research (ACVCS) and National Institute for Infectious Diseases “Prof. Dr. Matei Balș” are affiliated with Germs.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, ESCI (Web of Science), Embase, and other databases.
Journal Rank: CiteScore - Q2 (Public Health, Environmental and Occupational Health)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 14.9 days after submission; acceptance to publication is undertaken in 4.1 days (median values for papers published in this journal in the second half of 2025).
Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.

Impact Factor: 1.7 (2024); 5-Year Impact Factor: 1.9 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2248-2997

Latest Articles

16 pages, 566 KB

Open AccessArticle

Bridging Knowledge–Practice Gaps in Syphilis Prevention: A Nationwide, Online Cross-Sectional Survey of Knowledge, Attitudes, Practices, and Policy Acceptance in Saudi Arabia

by Hind Muteb Albadrani

Germs 2026, 16(2), 13; https://doi.org/10.3390/germs16020013 - 11 May 2026

Introduction: Syphilis is a preventable sexually transmitted infection (STI) with severe health outcomes, yet it is not included in Saudi Arabia’s national premarital and antenatal STI screening programs. This study assessed knowledge, attitudes, and practices (KAP) toward syphilis in Saudi Arabia and identified [...] Read more.

Introduction: Syphilis is a preventable sexually transmitted infection (STI) with severe health outcomes, yet it is not included in Saudi Arabia’s national premarital and antenatal STI screening programs. This study assessed knowledge, attitudes, and practices (KAP) toward syphilis in Saudi Arabia and identified predictors of acceptance for including syphilis testing in such programs. Methods: A cross-sectional online survey was conducted among 935 participants aged ≥20 years. Data included sociodemographic characteristics and measures of KAP and screening acceptance. Continuous variables were summarized as medians (IQR) and categorical variables as frequencies and percentages, with bivariate and multivariate logistic regression used to identify predictors of screening acceptance. Results: Knowledge and preventive practices were low, while attitudes were predominantly neutral (median attitude score: 34 IQR 32–38). Although intentions for personal testing were low (17%), support for syphilis testing in premarital (60.8%) and antenatal (48.9%) programs was considerable. Employment in the health sector, older age, and positive attitudes predicted acceptance of screening policies. Knowledge and practice showed a weak correlation (r = 0.14), whereas knowledge and attitude were moderately correlated (r = 0.55). Conclusion: KAP toward syphilis is influenced by specific sociodemographic factors. Although acceptance of screening is high at the policy level, individual-level preventive behaviors remain low. Full article

31 pages, 2481 KB

Open AccessReview

Decoding Norovirus Biology: Insights into Epidemiology, Structural Dynamics, Host Interactions, and Viral Replication

by Mudra Sikenis, Bhavna Prajapati, Ashutosh Kumar Singh, Karmveer Yadav, Ashish Kumar Vyas, Narapity Pathirannehalage Sunil-Chandra, Akansha Tandekar, Surya Singh, Tarun Patil, Subhabrata Kar, Rajnarayan R. Tiwari and Ram Kumar Nema

Germs 2026, 16(2), 12; https://doi.org/10.3390/germs16020012 - 11 May 2026

Norovirus is the leading cause of acute infectious gastroenteritis in the world and accounts for a significant proportion of outbreaks at the food-borne and person-to-person levels. Due to their low infectious dose, persistence in the environment, and broad genetic diversity, they can quickly [...] Read more.

Norovirus is the leading cause of acute infectious gastroenteritis in the world and accounts for a significant proportion of outbreaks at the food-borne and person-to-person levels. Due to their low infectious dose, persistence in the environment, and broad genetic diversity, they can quickly spread and reappear in even the most diverse populations. This review integrates current knowledge on the epidemiology of noroviruses, genomic organization, structural biology, virus–host interactions, and replication mechanisms, with a focus on factors that determine virus evolution and strain dominance. Literature has been systematically searched in the PubMed and Scopus databases to incorporate recent experimental and epidemiological findings. Analysis of global surveillance data indicates ongoing genetic diversification of circulating strains, with periodic replacement of major variants, particularly the GII.4 lineage. Variability of the capsid and recognition of histo-blood Group Antigens strongly affects the host’s susceptibility, viral attachment and immune escape. The capsid consists of most of the viral protein complexes. The structural proteins VP1 and VP2 are responsible for determining the contours of the capsid and antigenic specificity. Non-structural proteins are responsible for coordinating the genome replication and the modification of host cell pathways to favor the production of the virus. Eliminating these gaps by means of integrated genomic surveillance and functional studies will provide insight into the evolution of norovirus and help to develop broadly effective vaccines and antiviral strategies. Full article

3 pages, 161 KB

Open AccessEditorial

Editorial Judgment in Infectious Diseases

by Terenzio Cosio

Germs 2026, 16(2), 11; https://doi.org/10.3390/germs16020011 - 7 May 2026

Infectious diseases have become increasingly dependent on diagnostic systems, whose reach have expanded, largely through advances in clinical microbiology, far more quickly than efforts to verify the reliability and accurate interpretation of their findings [...] Full article

10 pages, 474 KB

Open AccessArticle

The Characteristics of the Main Nontuberculous Mycobacteria Species Among Patients with HIV at a Single Center in Poland

by Jakub Młoźniak, Adam Szymański, Gabriela Stondzik, Dagny Clea Krankowska, Tomasz Mikuła, Agnieszka Lembas, Joanna Kozłowska, Regina Podlasin, Magdalena Thompson, Grażyna Cholewińska, Aleksandra Chylak-Nowosielska, Anna Zabost, Ewa Augustynowicz-Kopeć and Alicja Wiercińska-Drapało

Germs 2026, 16(2), 10; https://doi.org/10.3390/germs16020010 - 9 Apr 2026

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms capable of causing diverse clinical manifestations. Their epidemiology among people with HIV remains insufficiently characterized. This study examined the epidemiology of NTM among people with HIV admitted to the Hospital for Infectious Diseases in Warsaw between [...] Read more.

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms capable of causing diverse clinical manifestations. Their epidemiology among people with HIV remains insufficiently characterized. This study examined the epidemiology of NTM among people with HIV admitted to the Hospital for Infectious Diseases in Warsaw between 2017 and 2023. Data on CD4+ T-cell counts, type of NTM involvement, species identification, and antimicrobial resistance were obtained from medical records. In the analyzed group the median of the CD4+ T-cell count was 25 cells/mm³ (IQR 65 cells/mm³). Late HIV diagnosis was observed in n = 45/50 (90.0%) patients. NTM colonization was identified in n = 20 (33.9%) patients, while n = 39 (66.1%) had active NTM disease, including pulmonary (53.9%), disseminated (41.0%), and extrapulmonary (5.1%) forms. Mycobacterium kansasii was the most common species among colonized patients, n = 7/24 (29.2%), whereas Mycobacterium avium predominated among patients with NTM disease, n = 30/42 (71.4%). Among patients with NTM disease, in vitro resistance to at least one antimicrobial agent was observed in 80.0% of M. avium isolates. High levels of resistance of M. avium were noted for ethambutol (n = 8/8, 100%), moxifloxacin (n = 16/22, 72.8%) and linezolid (n = 9/21, 42.9%). Proper identification of Mycobacterium species and its antibiotic resistance might be helpful in selecting effective antimicrobial therapy. Early HIV diagnosis is needed to prevent NTM disease. Full article

► Show Figures

Figure 1

18 pages, 1742 KB

Open AccessArticle

Microbial Contamination in Hard-Shell Capsule Traditional Medicines and Health Supplements in Malaysia: GMP Regulatory Oversight and Encapsulation Practices

by Muhammad Amirul Amil, Jun Hao Koo, Xin Yun Yah, Norizzati Adila Salam and Muhammad Mawardi Zakaria

Germs 2026, 16(2), 9; https://doi.org/10.3390/germs16020009 - 9 Apr 2026

Introduction: The growing demand for traditional medicines and health supplements (TMHS) in Malaysia has raised concerns regarding microbial contamination in hard-shell capsule products. Despite regulatory oversight, recurring recalls highlight persistent non-compliance with Good Manufacturing Practice (GMP) standards. This study examines the risks [...] Read more.

Introduction: The growing demand for traditional medicines and health supplements (TMHS) in Malaysia has raised concerns regarding microbial contamination in hard-shell capsule products. Despite regulatory oversight, recurring recalls highlight persistent non-compliance with Good Manufacturing Practice (GMP) standards. This study examines the risks of microbial contamination, recall patterns, and encapsulation practices among TMHS hard-shell capsule manufacturers in Malaysia. Methods: A cross-sectional approach was employed, comprising a review of regulatory guidelines, analysis of NPRA recall data from 2020 to 2024, and a structured survey of 86 TMHS manufacturers on equipment and production parameters. Results: Review of GMP guidance indicated that greater automation and reduced manual handling in capsule-filling processes help minimise microbial contamination. In line with this, TMHS products were recalled at a rate of 4.73%, more than 4 times the pharmaceutical recall rate (1.09%). Among the 245 TMHS recalls, 68 involved hard-shell capsule products that failed microbial testing, primarily total aerobic microbial count (73.53%). Additionally, manufacturers with 50–100 registered products had significantly higher odds of recall (OR = 10.0, 95% CI: 2.35–42.47). However, no significant associations were found between recall status and equipment type, capsule size, or production frequency. Conclusions: Microbial contamination remains a critical issue in TMHS hard-shell capsule products. Regulatory efforts should focus on medium-scale manufacturers and reinforce risk-based GMP adherence to enhance product safety and public health protection. Full article

► Show Figures

Graphical abstract

11 pages, 889 KB

Open AccessReview

A National Multidisciplinary Consensus to Develop an HIV Pre-Exposure Prophylaxis (PrEP) Referral Framework in Romania

by Oana Săndulescu, Anca Streinu-Cercel, Cătălina Poiană, Viorel Jinga, Beatrice Mahler, Gheorghe Gindrovel Dumitra, Sandra Adalgiza Alexiu, Simona Negreș, Cristina-Elena Zbârcea, George-Sorin Țiplică, Mihai Mitran, Robert Stoica, Mariana Mărdărescu, Șerban Benea, Adrian Gabriel Marinescu, Victor Daniel Miron, Elena Mătăsaru, Odette Chirilă, Sorin Petrea, Iulian Petre, Mihai Lixandru and Adrian Streinu-Cercel Show full author list Hide full author list

Germs 2026, 16(1), 8; https://doi.org/10.3390/germs16010008 - 17 Mar 2026

Background: Despite major advances in antiretroviral therapy, HIV transmission remains an important public health challenge. Pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, offering a significant opportunity to further reduce new HIV infections through expanded access and optimized implementation. Methods: [...] Read more.

Background: Despite major advances in antiretroviral therapy, HIV transmission remains an important public health challenge. Pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, offering a significant opportunity to further reduce new HIV infections through expanded access and optimized implementation. Methods: A national multidisciplinary consensus process was conducted to define principles and operational pathways for PrEP referral and linkage in Romania. Experts from different medical fields, professional societies, academic institutions, and community-based organizations participated in structured discussions. Results: The consensus highlighted relevant knowledge gaps related to HIV prevention and PrEP among specialists working outside the field of infectious diseases, including difficulty recognizing risk factors for HIV, uncertainty about next steps after identifying risk factors, and uneasiness discussing sexual health. The consensus also emphasized a shared commitment of these professional societies to address these gaps through pragmatic, specialty-adapted training. Key priorities included improved HIV risk recognition in routine care, development of communication skills, and clear referral pathways to PrEP services. Existing barriers were also discussed, underscoring the importance of multidisciplinary networks and community engagement. Conclusions: This consensus provides a structured, context-adapted framework to support the upcoming nationwide implementation of PrEP in Romania. By strengthening provider education, clarifying clinical pathways, and fostering interdisciplinary collaboration, it offers a foundation for equitable and sustainable HIV prevention. Full article

► Show Figures

Figure 1

18 pages, 1682 KB

Open AccessSystematic Review

Comparative Effectiveness and Safety of Monotherapy and Defined Combination Regimens for Stenotrophomonas maltophilia. Infections: A Network Meta-Analysis

by Ming-Ying Ai and Wei-Lun Chang

Germs 2026, 16(1), 7; https://doi.org/10.3390/germs16010007 - 2 Mar 2026

Background: Stenotrophomonas maltophilia is a multidrug-resistant pathogen with limited therapeutic options that predominantly affects critically ill and immunocompromised patients. Trimethoprim–sulfamethoxazole (TMP/SMX) remains the conventional first-line therapy; however, emerging resistance and toxicity concerns necessitate alternative regimens. This study represents, to our knowledge, the first [...] Read more.

Background: Stenotrophomonas maltophilia is a multidrug-resistant pathogen with limited therapeutic options that predominantly affects critically ill and immunocompromised patients. Trimethoprim–sulfamethoxazole (TMP/SMX) remains the conventional first-line therapy; however, emerging resistance and toxicity concerns necessitate alternative regimens. This study represents, to our knowledge, the first network meta-analysis (NMA) comparing the efficacy and safety of clearly defined monotherapy and combination antibiotic regimens for S. maltophilia infections. Materials and methods: A systematic search of PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov (inception to January 2026) identified eligible randomized-controlled studies and retrospective studies. Data were analyzed using a frequentist random-effects NMA with TMP/SMX as the reference. Evaluated regimens included TMP/SMX, fluoroquinolone (FQ), minocycline (MIN), TMP/SMX + FQ, TMP/SMX + MIN, FQ + MIN and FQ + other. Primary and secondary outcomes were all-cause mortality, clinical cure, and adverse effects. Results: Thirteen retrospective studies encompassing 2980 patients were included. Using TMP/SMX as the reference, network meta-analysis demonstrated heterogeneity in all-cause mortality across antimicrobial regimens. FQ and MIN monotherapies were associated with lower odds of mortality (effect sizes: 0.65, 95% CI: 0.49–0.85 and 0.50, 95% CI: 0.28–0.90), whereas combination therapy with TMP/SMX plus FQ was associated with higher mortality (effect size: 2.93, 95% CI: 1.18–7.31). Treatment ranking based on effect sizes suggested more favorable mortality profiles for MIN and FQ regimsens. No significant differences were observed in clinical cure, while FQ was associated with a lower incidence of adverse effects compared with TMP/SMX. Conclusions: This network meta-analysis suggests that FQ and MIN monotherapies may be associated with more favorable survival and tolerability compared with TMP/SMX monotherapy. No clear differences were observed for combination therapy relative to other active monotherapy options. Prospective randomized studies are required to validate these observations and to better inform the management of S. maltophilia infections. Full article

► Show Figures

Figure 1

9 pages, 218 KB

Open AccessArticle

The Use of Unproven Drugs for COVID-19 Treatment in People Living with HIV in Central and Eastern Europe

by Blazej Rozplochowski, Justyna D. Kowalska, Arjan Harxhi, Lukas Fleischhans, Sergii Antoniak, Deniz Gokengin, Anna Vassilenko, Kerstin Aimla, Raimonda Matulionyte, Antonios Papadopoulos, Nino Rukhadze, Botond Lakatos, Dalibor Sedlacek, Gordana Dragovic, Marta Vasylyev, David Jilich, Anatonija Verhaz, Nina Yancheva, Josip Begovac, Agata Skrzat-Klapaczynska and Cristiana Oprea Show full author list Hide full author list

Germs 2026, 16(1), 6; https://doi.org/10.3390/germs16010006 - 19 Feb 2026

Early in 2020, the WHO recommended that existing drugs be evaluated as a repurposed resource to fight the SARS-CoV-2 pandemic. Here, we investigate the trends of using repurposed and off-label drugs among people living with HIV in Central and Eastern Europe (CEE). From [...] Read more.

Early in 2020, the WHO recommended that existing drugs be evaluated as a repurposed resource to fight the SARS-CoV-2 pandemic. Here, we investigate the trends of using repurposed and off-label drugs among people living with HIV in Central and Eastern Europe (CEE). From November 2020 to May 2021, data on the clinical outcomes of HIV-positive patients diagnosed with COVID-19 were collected on eCRFs (SurveyMonkey^® platform, Inc. San Mateo, CA, USA). Factors associated with the off-label drugs available at this time (chloroquine, hydroxychloroquine, favipiravir, oseltamivir, and lopinavir/ritonavir) were identified using logistic regression models. Of the 557 HIV-positive patients assessed with COVID-19 disease, 67 (12.0%) received off-label drugs, as well as 11.6% (16/138) of hospitalized and 12.2% (51/419) of ambulatory patients (p = 0.8564). In the adjusted logistic regression model, higher odds of off-label drug use were found in patients who had their diagnoses confirmed by an RT PCR test (aOR 5.08 [95%CI 1.17–22.0], p = 0.0396), and who came from a non-EU region (aOR 6.79 [95%CI 3.51–13.1], p < 0.0001). The only factor decreasing the odds of off-label drug use was co-infection (aOR 0.31 [95%CI 0.10–0.94], p < 0.0395). In a cohort of HIV patients from the CEE, 12% were prescribed off-label drugs for COVID-19. Symptomatic patients with confirmed SARS-CoV-2 infection or who were from non-EU countries were more likely to receive a repurposed drug. Drug repurposing is an immediate solution to emerging pandemics. All data regarding the safety and effectiveness of such use should be monitored, reported, and publicly available. Access patterns within and outside the EU should be analyzed to prevent potential inequalities in access to care during epidemics in European settings. Full article

9 pages, 606 KB

Open AccessBrief Report

Burkholderia cepacia Complex Comprising Divergent Strains Identified as a Dominant Cause of Pediatric Bloodstream Infections in Myanmar

by Thida San, Meiji Soe Aung, Nan Aye Aye Oo, Linn Linn Htun, Myat Myint Zu Aung, Lynn Waddy and Nobumichi Kobayashi

Germs 2026, 16(1), 5; https://doi.org/10.3390/germs16010005 - 9 Feb 2026

Burkholderia cepacia complex (Bcc) consists of genetically diverse species having highly pathogenic potential to humans, causing nosocomial infections via environmental sources. In Myanmar, Bcc has been known as one of the common pathogens of infectious diseases, with relatively low prevalence. However, recently, an [...] Read more.

Burkholderia cepacia complex (Bcc) consists of genetically diverse species having highly pathogenic potential to humans, causing nosocomial infections via environmental sources. In Myanmar, Bcc has been known as one of the common pathogens of infectious diseases, with relatively low prevalence. However, recently, an increase in isolation from bloodstream infections was noted in a pediatric hospital in Yangon. From December 2023 to June 2025, among the organisms isolated from blood samples (n = 586), Bcc was the most dominant species (n = 178, 30.4%), followed by Klebsiella pneumoniae (16.4%) and Candida spp. (12.7%). Species of Bcc and their genetic types were identified by sequence analysis of partial recA and gyrB genes. Based on the recA sequence, Bcc isolates were identified as B. cepacia (49%), B. cenocepacia (43%), and B. contaminans (7%), having 10, 3, and 2 recA-allelic types, respectively. Similarly, sequences of gyrB revealed the three Bcc species with multiple allelic types. Ceftazidime MIC > 32 mg/L and meropenem MIC > 16 mg/L were found in 38% and 34% of Bcc isolates, respectively. These findings indicated that Bcc, comprising three species with genetically diverse clones, has become the main cause of bloodstream infections in the pediatric hospital in Myanmar. Full article

► Show Figures

Figure 1

13 pages, 257 KB

Open AccessArticle

Factors Associated with Transfer to Intensive Care in Younger Adults Hospitalized with COVID-19

by Philip Tenchev, Emilia Naseva and Nina Yancheva

Germs 2026, 16(1), 4; https://doi.org/10.3390/germs16010004 - 30 Jan 2026

Background/Objectives: While COVID-19 severity is strongly associated with older age, younger adults may also develop complications. This study investigated factors associated with transfer to ICU in hospitalized younger adults during May–December 2021. Materials and methods: Eighty-six consecutive patients aged ≥18 and <50 years [...] Read more.

Background/Objectives: While COVID-19 severity is strongly associated with older age, younger adults may also develop complications. This study investigated factors associated with transfer to ICU in hospitalized younger adults during May–December 2021. Materials and methods: Eighty-six consecutive patients aged ≥18 and <50 years were admitted to the University Multi-profile Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia, Bulgaria between 12 May 2021, and 7 December 2021. Results: Among 86 patients (median age 40 years; 55.8% female), common symptoms included fever (89.5%), cough (91.9%), headache (76.7%), and gastrointestinal symptoms (83.7%). Laboratory abnormalities were frequent: lymphopenia (median 0.94 × 10⁹/L), elevated CRP (28.9 mg/L), LDH (333 U/L), and ferritin (198.5 µg/L). Severe andcritical disease occurred in 17.5% of cases, with 43% requiring oxygen therapy. In descriptive/univariate analyses, ICU transfer was more frequent among patients with hypoxemia (SaO₂ < 90%) and higher CRP, D-dimer, vomiting and ferritin. In a Firth penalized logistic regression model (rare-event setting), endocrine/metabolic comorbidity showed a directionally consistent association with ICU transfer; gastrointestinal comorbidity signals were not interpretable because of extremely small cell counts. Conclusions: Younger adults usually present with mild to moderate COVID-19; however, a substantial minority develop severe illness. Hypoxemia and elevated inflammatory and coagulation markers were consistently associated with worse outcomes. Endocrine/metabolic comorbidity showed the most consistent association with transfer to ICU in this cohort, although all comorbidity estimates should be interpreted cautiously, given the small number of events. Full article

8 pages, 227 KB

Open AccessArticle

Comparative Analysis of Direct Hospital Costs for Community Acquired Viral Gastroenteritis in Children Under 60 Months in Brasov, Romania

by Ioana Arbanaș, Gabriela Coja, Vlad Monescu, Bianca Elena Popovici, Ileana-Raluca Lixandru and Oana Falup-Pecurariu

Germs 2026, 16(1), 3; https://doi.org/10.3390/germs16010003 - 19 Jan 2026

Background/Objectives: Viral gastroenteritis leads to a broad range of hospitalization costs globally in children, depending on the region. To our knowledge, no recent studies have examined the hospitalization cost associated with viral gastroenteritis in Romania. The aim of this study is to determine [...] Read more.

Background/Objectives: Viral gastroenteritis leads to a broad range of hospitalization costs globally in children, depending on the region. To our knowledge, no recent studies have examined the hospitalization cost associated with viral gastroenteritis in Romania. The aim of this study is to determine the direct hospitalization cost of community-acquired viral gastroenteritis (rotavirus, adenovirus and norovirus) in children admitted to Children’s Clinical Hospital of Brașov, Romania, for one year. Methods: All children aged 0–60 months hospitalized for a stool sample positive for rotavirus, adenovirus or norovirus during January 2023 and December 2023 were included in this study. Hospital-acquired gastroenteritis, gastrointestinal coinfections or children with acute coinfection were excluded. The stool specimens were tested using the immunochromatography method. Results: Out of the total of 282 children, 218 children presented rotavirus gastroenteritis, 35 children presented adenovirus gastroenteritis and 29 children presented norovirus gastroenteritis. Regarding patient characteristics, a higher proportion of boys than girls was observed in all three comparison groups, the average age for children with rotavirus was 22.2 months vs. norovirus and adenovirus, and children presented an average age of 16.4 months. Average hospitalization length of stay for rotavirus was 4.64 (±1.95) days, for adenovirus it was 4.54 (±1.52) days and for norovirus it was 4.75 (±1.93) days. Direct hospitalization costs did not differ between rotavirus, adenovirus, and norovirus infections (Kruskal–Wallis H(2) = 0.145, p = 0.930). Conclusions: In this single-center study, rotavirus remained the most frequent cause of viral gastroenteritis requiring hospitalization in young children, followed by adenovirus and norovirus. Although the average length of stay was similar across groups, hospitalization costs varied, with rotavirus-associated cases showing the highest mean expenses and widest cost variability. Full article

9 pages, 375 KB

Open AccessArticle

Variety of Clostridioides difficile Ribotypes in CDI Patients in Las Vegas, NV

by Amber Consul, Mohamad Mubder, Samrawit Misiker, Shadaba Asad, Kimberly D. Leuthner, Chia-Dan Kang, Yassin Shams Eldien Naga, Chad L. Cross and Ernesto Abel-Santos

Germs 2026, 16(1), 2; https://doi.org/10.3390/germs16010002 - 23 Dec 2025

Objective: Although Las Vegas is a major tourist hub, it is not among the counties that are under CDC surveillance for Clostridioides difficile infection (CDI), a major nosocomial infection. To determine the distribution of C. difficile ribotypes in the Las Vegas area, we [...] Read more.

Objective: Although Las Vegas is a major tourist hub, it is not among the counties that are under CDC surveillance for Clostridioides difficile infection (CDI), a major nosocomial infection. To determine the distribution of C. difficile ribotypes in the Las Vegas area, we collected stool samples from CDI-positive patients at the University Medical Center (UMC). Methods: We included adult patients diagnosed with CDI and provided informed consent. C. difficile was isolated from the stool samples and ribotyped. Demographic information was also obtained and analyzed. All information was compared to the surveillance data from the CDC. Results: We identified more frequently in male patients than in the CDC data. Less than half of the patients used antibiotics prior to the infection. We observed several comorbidities in our patient sample pool, with cardiovascular disease and diabetes being the most prevalent comorbidities. Hypervirulent C. difficile strain 027 was the most prevalent ribotype. Except for two samples of ribotype 076, all other samples represented unique singlet ribotypes. Four of these ribotypes (160, 302, 363, and 813) have not been explicitly reported in humans. Conclusions: Due to the unique environment created by the tourism industry in Las Vegas, this population is exposed to national and international visitors. This study shows the pre-COVID landscape of C. difficile ribotypes in Las Vegas and offers valuable insights into the varieties of C. difficile that are currently infecting this community. Full article

► Show Figures

Figure 1

16 pages, 1540 KB

Open AccessArticle

Impact of Manganese Coordination and Cyclodextrin-Assisted Formulation on Thiabendazole Dissolution and Endothelial Cell Migration

by Carmen-Ecaterina Leferman, Lacramioara Ochiuz, Laura Stoica, Liliana Georgeta Foia, Bogdan Minea, Cezar Ilie Foia, Victor Constantinescu, Oana Olariu, Alin Dumitru Ciubotaru and Bogdan Alexandru Stoica

Germs 2026, 16(1), 1; https://doi.org/10.3390/germs16010001 - 22 Dec 2025

Background: Thiabendazole (TBZ), a benzimidazole with established antifungal and anthelmintic properties, has also been reported to exert antiangiogenic effects relevant to tissue remodeling and chronic inflammatory microenvironments. The present study examined how manganese coordination and cyclodextrin modify the dissolution behavior and endothelial activity [...] Read more.

Background: Thiabendazole (TBZ), a benzimidazole with established antifungal and anthelmintic properties, has also been reported to exert antiangiogenic effects relevant to tissue remodeling and chronic inflammatory microenvironments. The present study examined how manganese coordination and cyclodextrin modify the dissolution behavior and endothelial activity of TBZ. Methods: Antiangiogenic potential was assessed through a human umbilical vein endothelial cells (HUVECs) scratch-wound migration assay. Dissolution profiles of TBZ, manganese–thiabendazole (MnTBZ), and MnTBZ/monochlorotriazynil-β-cyclodextrin (MCT-β-CD) formulation were evaluated under biorelevant pH conditions (1.2, 4.5, 6.8, 7.4) using the paddle method. Results: TBZ displayed a more rapid and extensive dissolution at pH 1.2, compared to MnTBZ. Partial dissociation at pH 4.5 modestly improved TBZ availability, while dissolution remained minimal at neutral pH. MCT-β-CD enhanced the solubility of MnTBZ at pH ≥ 6.8. In agreement with these profiles, TBZ exerted the strongest inhibition of endothelial migration, followed by MnTBZ/MCT-β-CD and MnTBZ. Conclusions: Manganese coordination and cyclodextrin formulation modulate both the dissolution behavior and endothelial migration-inhibitory activity of TBZ, suggesting that such formulation approaches may influence the delivery-related and functional properties of benzimidazole derivatives. Full article

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

► Show Figures

Figure 1

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

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 [...] Read more.

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

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

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

4 pages, 187 KB

Open AccessCommunication

Innovative Approaches in RSV Prevention: The Expanding Role of Monoclonal Antibodies in Protection for All Infants

by Florin-Dumitru Mihălţan, Ruxandra Ulmeanu, Roxana-Maria Nemeş, Sorin Petrea, Anca Streinu-Cercel and Oana Săndulescu

Germs 2025, 15(3), 279-282; https://doi.org/10.18683/germs.2025.1475 - 30 Sep 2025

Cited by 2

Respiratory syncytial virus (RSV) continues to be a predominant cause of lower respiratory tract infections among infants and toddlers, posing a substantial burden on pediatric health and healthcare systems worldwide. Full article

More Articles...

Submit to Germs Review for Germs

Journal Menu

Journal Browser

► Journal Browser

Highly Accessed Articles

View More...

Latest Books

More Books and Reprints...

E-Mail Alert

News

13 May 2026
Meet Us at the American Society for Virology 45th Annual Meeting (ASV), 27–30 July 2026, Minneapolis, USA

6 May 2026
MDPI INSIGHTS: The CEO's Letter #34 - MDPI US Office, Coatings 2026, Media and Partnerships, Recapping Poland Summit & Serbia Salon

24 April 2026
Prof. Dr. William Gerwick Appointed Chair of the 2026 Tu Youyou Award Committee

More News & Announcements...

Topics

Propose a Topic

Conferences

Propose a Conference Collaboration

Special Issues

Propose a Special Issue

Special Issue in Germs

Selected Papers From the Infectious Diseases and HIV Dialogues Conference 2026 Guest Editors: Oana Săndulescu, Anca Streinu-Cercel
Deadline: 15 December 2026

Back to TopTop