Infectious Disease Reports

17 pages, 450 KB

Open AccessReview

Antimicrobial Resistance as a Global Public Health Challenge: Epidemiological Burden, Bioethical Dimensions and Emerging Therapeutic Strategies

by Christos Ntais and Ioanna P. Chatziprodromidou

Infect. Dis. Rep. 2026, 18(4), 70; https://doi.org/10.3390/idr18040070 - 9 Jul 2026

Abstract

Background/Objectives: Antimicrobial resistance (AMR) is a major global public health threat, compromising prevention and treatment of infectious diseases. This narrative review examines AMR as a multifactorial and transnational crisis through epidemiological, One Health, social and bioethical perspectives, and discusses emerging non-antibiotic preventive and [...] Read more.

Background/Objectives: Antimicrobial resistance (AMR) is a major global public health threat, compromising prevention and treatment of infectious diseases. This narrative review examines AMR as a multifactorial and transnational crisis through epidemiological, One Health, social and bioethical perspectives, and discusses emerging non-antibiotic preventive and therapeutic strategies. Methods: PubMed and Scopus were searched using terms related to AMR, epidemiology, public health, surveillance, One Health, bioethics, equity and alternative therapies. Peer-reviewed medical and public health articles were considered, together with selected reports from international organizations and public health agencies. Results: AMR is driven by inappropriate antibiotic use in human medicine, livestock, aquaculture and agriculture, combined with weaknesses in infection prevention, stewardship, environmental control and surveillance. Epidemiological evidence shows a substantial global burden, marked regional inequalities in resistance patterns, surveillance capacity and policy response, and major consequences, including increased mortality, prolonged hospitalization, rising healthcare costs and disproportionate effects on vulnerable populations. Key bioethical concerns include collective responsibility, equitable access to effective treatment, stewardship, global justice and intergenerational accountability. Emerging non-antibiotic strategies vary in translational maturity: vaccines and selected microbiome-based interventions have preventive or supportive roles in defined settings, bacteriophage therapy is used mainly in compassionate or specialized contexts, and many antimicrobial peptides and nanotechnology-based platforms remain experimental or early translational. Conclusions: AMR requires coordinated global action grounded in One Health, strong public health systems, integrated surveillance, responsible antimicrobial use and sustained innovation. Effective containment must also address social inequalities, ethical stewardship, equitable access to diagnostics and treatment, and responsibility toward future generations. Full article

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24 pages, 1400 KB

Open AccessReview

Infection-Associated Pediatric Acute-Onset Neuropsychiatric Syndrome: A Review of Immunological Mechanisms, Clinical Phenotypes, and Therapeutic Strategies

by Enoch Chi Ngai Lim, Nga Chong Lisa Cheng and Chi Eung Danforn Lim

Infect. Dis. Rep. 2026, 18(4), 69; https://doi.org/10.3390/idr18040069 - 7 Jul 2026

Abstract

Background/Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) describes the rapid onset of obsessive–compulsive symptoms or severe food restriction, accompanied by neuropsychiatric or somatic features that are not better explained by another disorder. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a related, [...] Read more.

Background/Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) describes the rapid onset of obsessive–compulsive symptoms or severe food restriction, accompanied by neuropsychiatric or somatic features that are not better explained by another disorder. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a related, more narrowly defined construct in which symptoms are temporally associated with group A Streptococcus infection. This review examines clinical symptoms, infectious associations, proposed immune mechanisms, biomarker limitations, and treatment strategies for infection-associated PANS/PANDAS. Methods: A structured narrative search of PubMed/MEDLINE, Embase, the Cochrane Library, Google Scholar/publisher-indexed literature, ClinicalTrials.gov, and reference lists was performed up to 16 June 2026. Original cohorts, case series, systematic reviews, narrative reviews, consensus guidance, mechanistic studies, and registered prospective studies were prioritized. The review was not designed as a PRISMA-ScR scoping review; however, the methods were expanded to improve transparency and align with SANRA principles. Results: Group A Streptococcus remains the best characterized infectious association, although prospective studies have not uniformly demonstrated a consistent temporal relationship between streptococcal infection and neuropsychiatric exacerbations. Parent-reported surveys and case-based literature also describe temporal associations with Mycoplasma pneumoniae, influenza-like illnesses, upper respiratory infections, Borrelia burgdorferi, Epstein–Barr virus, and SARS-CoV-2. Proposed mechanisms include molecular mimicry, anti-D1R and anti-D2R antibodies, other antineuronal antibodies, calcium/calmodulin-dependent protein kinase II signaling, blood–brain barrier vulnerability, cytokine and Th17 effects, neuroinflammatory amplification, basal ganglia/CSTC circuit dysfunction, and gut–oral–brain immune interactions. None currently provides a definitive diagnostic biomarker. Conclusions: Infection-associated PANS is best approached as a clinically defined, heterogeneous neuroimmune presentation that requires rigorous differential diagnosis, multidisciplinary care, cautious treatment escalation, prospective biomarker validation, and large, multicenter treatment trials. Full article

(This article belongs to the Special Issue Review on Infectious Diseases)

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7 pages, 628 KB

Open AccessCase Report

A Case of Spinal Epidural Abscess and Paraplegia After Group A Streptococcal Pharyngitis

by Blake J. McKinley, Rob M. Seby, Robert C. Chase, Tatjana Gavrancic, Jeremy Collado and Libardo Rueda Prada

Infect. Dis. Rep. 2026, 18(4), 68; https://doi.org/10.3390/idr18040068 - 4 Jul 2026

Abstract

Background: Spinal epidural abscesses (SEA) are rare, occurring 2.5–3 times per 10,000 hospital admissions. While streptococcus species comprise 7% of reported SEAs, Group A Streptococcus (GAS) has been described only once in the medical literature to our knowledge. Case presentation: We [...] Read more.

Background: Spinal epidural abscesses (SEA) are rare, occurring 2.5–3 times per 10,000 hospital admissions. While streptococcus species comprise 7% of reported SEAs, Group A Streptococcus (GAS) has been described only once in the medical literature to our knowledge. Case presentation: We present a case of GAS pharyngitis with subsequent paraplegia from a GAS SEA. A 33-year-old female presented to the emergency department (ED) and was initially diagnosed with GAS pharyngitis and a suspected strained lower back. Following treatment with amoxicillin, she returned with worsened back pain, radiculopathy, and leukocytosis, for which she was treated with cyclobenzaprine. On her third presentation, she had new bilateral lower extremity weakness with decreased sensation, bilateral ankle clonus, and hyperreflexia. MRI of the thoracic and lumbar spine revealed a multiloculated SEA at T5-T10 requiring laminectomy and abscess evacuation. Intraoperative cultures grew Streptococcus pyogenes. Despite surgery, medical management, and physical therapy, she remained paraplegic. Conclusions: To our knowledge, this is the first report of SEA preceded by GAS pharyngitis. This case exposes the critical association between a recent infection, progression of back pain, eventual neurologic symptoms, and inflammatory markers that should trigger concern for SEA and early evaluation with MRI. Full article

(This article belongs to the Section Bacterial Diseases)

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17 pages, 1753 KB

Open AccessSystematic Review

Clostridioides difficile Infection (CDI) Disease Burden (Cases, Hospitalizations, and Deaths) in China: A Systematic Literature Review

by Frederick J. Angulo, Genming Zhao, Yuan Wu, Zundong Yin, Jin Yang, Shahnaz Khan, Daniel Khuong Tran, Elisa N. Gonzalez, Anli Sun, Steven Shen and Jamie Findlow

Infect. Dis. Rep. 2026, 18(4), 67; https://doi.org/10.3390/idr18040067 - 3 Jul 2026

Abstract

Background/Objectives: Although Clostridioides difficile infection (CDI) is a key cause of global morbidity and mortality, the burden of CDI in mainland China is not well-defined. The objective of this systematic literature review was to summarize the available epidemiologic evidence on the CDI disease [...] Read more.

Background/Objectives: Although Clostridioides difficile infection (CDI) is a key cause of global morbidity and mortality, the burden of CDI in mainland China is not well-defined. The objective of this systematic literature review was to summarize the available epidemiologic evidence on the CDI disease burden (cases, hospitalizations, and deaths) in mainland China. Methods: Six databases (three global [PubMed, Embase, Cochrane] and three Chinese [Chinese National Knowledge Infrastructure, Chinese Science Citation, Wanfang]) were searched on 5 August 2025 using CDI-related and epidemiological search terms. No date or language limits were applied. Real-world epidemiologic studies of adults and/or children with laboratory-confirmed CDI in mainland China reporting population-based CDI incidence, hospital-based CDI incidence, and/or CDI admission rates were included. All studies not meeting these criteria were excluded. Risk-of-bias (RoB) assessment was performed using the Newcastle–Ottawa Scale. Results were summarized descriptively. Results: In total, 11 articles formed the evidence base for this review; each was a single-center, hospital-based study conducted in one of six cities in mainland China and published between 2014 and 2023. RoB assessment indicated that the evidence base was appropriate for this study. No study reported population-based CDI incidence. In total, 10 studies reported hospital-based CDI incidence (0 to 82.0/10,000 patient-days), and four reported CDI admission rates (0 to 23.1/1000 admissions). Eight studies reported mortality rates, which varied across studies. Conclusions: Several single-center, hospital-based studies demonstrate that CDI is present in hospitals in mainland China, but there are no published population-based CDI incidence estimates. These results should be interpreted considering this study’s limitations, including potential publication and selection bias, heterogeneity, and limited generalizability. Overall, the burden of CDI is poorly understood in mainland China. Thus, prospective epidemiological studies, including those with sensitive detection methods, are needed to examine CDI burden across multiple cities in mainland China. These efforts would help illuminate the CDI burden and guide prevention efforts. (PROSPERO ID 1140152; registered 17 March 2026; funding by Pfizer Inc.). Full article

9 pages, 4516 KB

Open AccessCase Report

Cytomegalovirus Retinitis in Newly Diagnosed Advanced HIV Infection: A Three-Case Series Emphasizing Multidisciplinary Infection Screening

by Shintaro Yataka, Kinya Tsubota, Kei Wakatsuki, Risa Sugawara, Masaki Asakage and Yoshihiko Usui

Infect. Dis. Rep. 2026, 18(4), 66; https://doi.org/10.3390/idr18040066 - 30 Jun 2026

Abstract

Background/Objectives: Cytomegalovirus (CMV) retinitis remains a significant opportunistic infection in patients with advanced human immunodeficiency virus (HIV) infection, particularly with late HIV diagnoses. This three-case series aimed to describe HIV-associated CMV retinitis in newly diagnosed advanced HIV infection with documented concurrent and/or prior [...] Read more.

Background/Objectives: Cytomegalovirus (CMV) retinitis remains a significant opportunistic infection in patients with advanced human immunodeficiency virus (HIV) infection, particularly with late HIV diagnoses. This three-case series aimed to describe HIV-associated CMV retinitis in newly diagnosed advanced HIV infection with documented concurrent and/or prior infectious conditions, and to highlight the importance of bord systemic screening and multidisciplinary management. Methods: We retrospectively reviewed three male patients diagnosed with HIV-associated CMV retinitis at a tertiary ophthalmology referral center. Clinical findings, CD4-positive T-cell counts, HIV-RNA levels, aqueous humor CMV-DNA results, systemic infectious conditions, treatment and ocular outcomes were summarized. Results: All patients had marked cellular immunodeficiency, with CD4-positive T-cell counts ranging from 46 to 141 cells/µL, and CMV-DNA was detected in aqueous humor in all cases. The infectious burden was substantial: all three patients had syphilis and hepatitis B virus infection, two had oral candidiasis, and individual patients had chlamydia infection, tuberculosis, amebic colitis, or a history of herpes zoster. One patient was initially suspected of having syphilitic uveitis, which illustrates how coinfections may obscure the diagnosis of CMV retinitis. Retinal detachment occurred in two cases and was surgically repaired with anatomical recovery. Conclusions: These cases emphasize that CMV retinitis in newly diagnosed advanced HIV infection should prompt broad infection screening and multidisciplinary evaluation, particularly in the setting of delayed HIV diagnosis and severe immunosuppression. Comprehensive screening for opportunistic and sexually transmitted infections, prompt ocular virological confirmation, and multidisciplinary management are essential in patients with HIV-associated CMV retinitis. Full article

(This article belongs to the Section Viral Infections)

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34 pages, 2395 KB

Open AccessReview

Multitarget Therapeutic Strategies for Chagas Disease: Natural Compounds, Antimicrobial Peptides, and Cell-Based Immunomodulation

by Ana María Fernández-Presas, Katia Jarquín-Yáñez, Adolfo Cruz-Reséndiz, Oscar Rodríguez-Lima, Jaime Zamora-Chimal and Blanca Esther Blancas-Luciano

Infect. Dis. Rep. 2026, 18(4), 65; https://doi.org/10.3390/idr18040065 - 30 Jun 2026

Abstract

Chagas disease, caused by Trypanosoma cruzi, remains a major public health problem in Latin America and an emerging global health concern due to population mobility. Although benznidazole and nifurtimox remain the only approved antiparasitic drugs, their limited efficacy in chronic infection, prolonged [...] Read more.

Chagas disease, caused by Trypanosoma cruzi, remains a major public health problem in Latin America and an emerging global health concern due to population mobility. Although benznidazole and nifurtimox remain the only approved antiparasitic drugs, their limited efficacy in chronic infection, prolonged treatment regimens, frequent adverse effects, and variable activity across parasite strains highlight the need for new therapeutic strategies. In addition, the pathogenesis of chronic Chagas disease is driven not only by parasite persistence but also by immune-mediated tissue damage, particularly in chronic Chagas cardiomyopathy. In this review, we examine emerging therapeutic approaches that extend beyond conventional trypanocidal chemotherapy, with emphasis on natural products, antimicrobial peptides, and cell-based immunomodulatory strategies. Plant compounds and essential oils have shown antiparasitic activity through mechanisms including oxidative stress induction, membrane disruption, interference with sterol biosynthesis, and mitochondrial dysfunction, while some extracts also modulate host immune responses. Antimicrobial peptides display dual potential by directly damaging parasite membranes and organelles or by reshaping infection-associated inflammatory responses. In parallel, cell-based therapies such as mesenchymal stromal cells, tolerogenic dendritic cells, and bone marrow-derived cells have demonstrated promising cardioprotective and immunoregulatory effects in experimental chronic Chagas disease. Collectively, these approaches support a multitarget therapeutic framework in which parasite-directed and host-directed interventions may complement each other. Further mechanistic studies, standardization, and translational validation will be essential to advance these candidates toward clinically useful therapies for Chagas disease. Full article

(This article belongs to the Section Parasitological Diseases)

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Graphical abstract

9 pages, 4623 KB

Open AccessCase Report

Multiple Brain Microabscesses and a Lung Abscess Caused by Streptococcus intermedius Following COVID-19: A Case Report and Literature Review

by Ryoma Takeda, Kazunori Yamada, Takenori Abe, Tomoyuki Ishigo and Hirohiko Nakamura

Infect. Dis. Rep. 2026, 18(4), 64; https://doi.org/10.3390/idr18040064 - 24 Jun 2026

Abstract

Background: Secondary bacterial infections are increasingly recognized after coronavirus disease 2019 (COVID-19); however, bacterial abscess formation remains uncommon, and the simultaneous occurrence of brain and lung abscesses has not been previously reported. We report a rare case of Streptococcus intermedius infection presenting with [...] Read more.

Background: Secondary bacterial infections are increasingly recognized after coronavirus disease 2019 (COVID-19); however, bacterial abscess formation remains uncommon, and the simultaneous occurrence of brain and lung abscesses has not been previously reported. We report a rare case of Streptococcus intermedius infection presenting with multiple brain microabscesses and a lung abscess following COVID-19. Case Presentation: A 75-year-old man with no significant medical history except cholelithiasis experienced persistent fever following a diagnosis of COVID-19 and subsequently developed impaired consciousness 17 days later. Because bacterial meningitis was suspected, he was admitted to a neurology-specialized hospital on the same day. Brain MRI revealed more than 80 small enhancing lesions scattered throughout the brain parenchyma, consistent with multiple microabscesses. Chest CT demonstrated a mass-like lesion in the left lower lobe. Although cerebrospinal fluid cultures were negative, blood cultures obtained on admission yielded S. intermedius. Further investigation of the source of infection revealed moderate periodontitis, suggesting the oral cavity as the probable portal of entry. The patient was treated with intravenous antibiotics for eight weeks based on antimicrobial susceptibility testing, resulting in near-complete resolution of the lesions. Conclusions: Although a causal relationship between COVID-19 and abscess formation cannot be established, COVID-19-associated immune and mucosal barrier dysfunction may have contributed to the progression and dissemination of infection in this patient. Clinicians should be aware of the possibility of severe bacterial superinfection when fever or respiratory symptoms related to COVID-19 persist, even in patients without overt immunocompromise, particularly in those with pre-existing oral infections. Full article

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10 pages, 469 KB

Open AccessArticle

Is Virulence Gene papGII a Predictor of Urosepsis in Uropathogenic E. coli?

by Nihitta Hanna, Suji Thangamani, Rosemol Varghese, Jiji Smila Arockiasamy, Balaji Veeraraghavan and Rani Diana Sahni

Infect. Dis. Rep. 2026, 18(4), 63; https://doi.org/10.3390/idr18040063 - 24 Jun 2026

Abstract

Background: Urosepsis is a life-threatening condition accounting for approximately 20–30% of all sepsis cases and typically arises from ascending infection by uropathogenic Escherichia coli (UPEC). Disease progression is mediated by virulence factors, including adhesins, iron acquisition systems, and toxins. Among these, P fimbriae, [...] Read more.

Background: Urosepsis is a life-threatening condition accounting for approximately 20–30% of all sepsis cases and typically arises from ascending infection by uropathogenic Escherichia coli (UPEC). Disease progression is mediated by virulence factors, including adhesins, iron acquisition systems, and toxins. Among these, P fimbriae, particularly papGII adhesin subunit, have been implicated in the transition from uncomplicated urinary tract infection (UTI) to severe urosepsis. This study aimed to evaluate whether papGII carriage, alone or in combination with other UPEC virulence determinants and clinical risk factors, can predict urosepsis. Methods: A total of 60 paired Escherichia coli isolates from concurrent blood and urine samples of adults with clinical sepsis were collected between January and June 2024. Control isolates were obtained from patients with cystitis (n = 28) and pyelonephritis (n = 32). Polymerase chain reaction (PCR) assays were used to detect fifteen virulence-associated genes, including the pap operon (with papG allelic variants), the type 1 fimbriae (fimH), S fimbriae (sfaS), curli fimbriae (csgA), afa/Dr adhesin operon genes, cytotoxic necrotizing factor 1 (cnf1), and the aerobactin biosynthesis (iucD) and receptor (iutA) genes. Associations between gene carriage and clinical groups were analyzed using chi-square tests. Results: The incidence of urosepsis increased with age, peaking in the 60–69-year age group. Renal disease and catheterization were identified as significant risk factors (p < 0.05). More than 95% of UPEC isolates carried the csgA gene associated with biofilm formation and the iucD gene. The α- hemolysin toxin (hlyA) was significantly associated with urosepsis [X²(1, N = 120) = 6.62, p = 0.03]. No significant differences were observed in the carriage of papA, papC, or fimH. Although papGII was present in 65% of urosepsis-associated UPEC isolates, it did not demonstrate a statistically significant independent association with urosepsis [p = 0.1]. Conclusion: This study demonstrates that while papGII may contribute to the pathogenic potential of UPEC and facilitate systemic infection, it is not a reliable independent predictor of urosepsis. Full article

(This article belongs to the Section Bacterial Diseases)

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9 pages, 605 KB

Open AccessCase Report

Cardiovascular Complications of Anaplasmosis: A Case of Acute Pulmonary Embolism and Literature Review

by Aleksandar Gavrancic, Christian M. Jacobson, Veljko Rabasovic, Erik Sviggum, Jelena Stojsavljevic, Nestor G. Tarragona, Peter J. Mattingly and Igor Dumic

Infect. Dis. Rep. 2026, 18(3), 62; https://doi.org/10.3390/idr18030062 - 20 Jun 2026

Abstract

Background: Anaplasmosis is an emerging tick-borne infection that typically presents as a non-specific febrile illness, with variable degrees of cytopenias and liver tests abnormalities. Severe complications remain atypical and uncommon. Case Report: We report a case of acute pulmonary embolism (PE) occurring [...] Read more.

Background: Anaplasmosis is an emerging tick-borne infection that typically presents as a non-specific febrile illness, with variable degrees of cytopenias and liver tests abnormalities. Severe complications remain atypical and uncommon. Case Report: We report a case of acute pulmonary embolism (PE) occurring during confirmed anaplasmosis in a 73-year-old male with no traditional thromboembolic risk factors. The patient presented with fever, constitutional symptoms, thrombocytopenia, leukopenia, and abnormal liver tests, raising suspicion for a tick-borne illness. Despite early clinical improvement on doxycycline, persistent tachycardia triggered further evaluation and uncovered an acute PE. Comprehensive workup at admission and repeated 14 months later excluded inherited and acquired thrombophilias, malignancies, autoimmune diseases, and alternative infectious etiologies. The patient was treated with doxycycline 100 mg orally twice daily for 10 days and anticoagulation with unfractionated heparin followed by 6 months of apixaban for a first episode of provoked PE. He attained complete clinical recovery without recurrence of thrombosis at the two-year follow-up. Discussion: Infectious diseases are increasingly recognized as contributors to thrombosis through inflammation-mediated hypercoagulability and endothelial dysfunction. Pulmonary involvement in anaplasmosis typically manifests as pneumonitis, pneumonia or acute respiratory distress syndrome, but thrombotic complications such as PE are exceedingly rare. This case highlights a rare but clinically significant vascular complication of anaplasmosis and underscores the importance of considering thromboembolic events in patients with persistent or unexplained tachycardia. Conclusions: As the incidence of anaplasmosis continues to rise, greater awareness of its potential cardiovascular manifestations is essential. Early recognition and prompt treatment with doxycycline remain critical, while further studies are needed to better define the thrombotic risk associated with this infection. Full article

(This article belongs to the Section Bacterial Diseases)

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20 pages, 4366 KB

Open AccessArticle

Game Over for the Baseline: Influenza Hospitalization Patterns Before, During, and After the COVID-19 Pandemic (FluSurv-NET, 2009–2025)

by Hayden D. Hedman

Infect. Dis. Rep. 2026, 18(3), 61; https://doi.org/10.3390/idr18030061 - 19 Jun 2026

Abstract

Background/Objectives: The trajectory of influenza hospitalization burden from pre-COVID-19 pandemic baseline through post-pandemic recovery remains poorly characterized at the national level. This study characterized phase-stratified burden and seasonal structure, quantified racial and ethnic disparities, and assessed whether post-pandemic seasons represent anomalous departures from [...] Read more.

Background/Objectives: The trajectory of influenza hospitalization burden from pre-COVID-19 pandemic baseline through post-pandemic recovery remains poorly characterized at the national level. This study characterized phase-stratified burden and seasonal structure, quantified racial and ethnic disparities, and assessed whether post-pandemic seasons represent anomalous departures from pre-pandemic expectations. Methods: Sixteen complete seasons of FluSurv-NET surveillance data (2009–2010 through 2024–2025; 509 observation weeks) were analyzed across pre-pandemic, disruption, and recovery phases using OLS regression with effect-size estimation, bootstrapped age-adjusted rate ratios, seasonal-trend decomposition (STL), Prophet time-series forecasting, and Isolation Forest anomaly detection. Results: Mean peak weekly hospitalization rate nearly doubled from pre-pandemic to recovery (5.1 to 11.1 per 100,000), cumulative seasonal burden increased from 46.3 to 87.0 per 100,000, and median peak timing advanced from MMWR week 9 to week 50. STL decomposition revealed a marked shift from weak pre-pandemic seasonality (Fs = 0.14) to substantially stronger annual regularity (Fs = 0.98) across three recovery seasons, with threefold amplitude increase. Non-Hispanic Black persons had rate ratios of 1.72, 2.16, and 1.99 relative to White persons across phases; American Indian and Alaska Native persons showed the highest disruption-phase ratio (2.24, 95% CI 1.90–3.53), based on two contributing seasons. A flat-growth Prophet model detected first exceedance in February 2020, outperforming a linear-growth specification on held-out validation. Isolation Forest identified 2017–2018, 2023–2024, and 2024–2025 as robust anomalies across all contamination thresholds. Conclusions: Post-COVID-19 pandemic influenza recovery is characterized by intensified and restructured seasonality, persistent racial and ethnic disparities, and anomalous burden exceeding pre-pandemic projections, identified independently by time-series forecasting and unsupervised anomaly detection. Full article

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16 pages, 329 KB

Open AccessReview

Five Hot Topics in Tropical Medicine: 2025

by Amanda Hempel, Gregory D. Hawley, Jahmar Hewitt, Maxime Billick, Adrienne J. Showler, Kevin C. Kain and Andrea K. Boggild

Infect. Dis. Rep. 2026, 18(3), 60; https://doi.org/10.3390/idr18030060 - 19 Jun 2026

Abstract

In 2025, tropical medicine was shaped by advances in diagnostic technology, expanding arboviral epidemics, rapid progress in filovirus vaccine development, evolving regulatory responses to newly licensed vaccines, and translational breakthroughs addressing neglected tropical diseases. This review discusses five select developments that significantly influenced [...] Read more.

In 2025, tropical medicine was shaped by advances in diagnostic technology, expanding arboviral epidemics, rapid progress in filovirus vaccine development, evolving regulatory responses to newly licensed vaccines, and translational breakthroughs addressing neglected tropical diseases. This review discusses five select developments that significantly influenced clinical practice and global health policy over the past year, highlighting the implications of each for clinicians, researchers, and public health systems. Full article

(This article belongs to the Section Neglected Tropical Diseases)

5 pages, 176 KB

Open AccessEditorial

Ecotourism and the Hidden Ecology of Infection: The Andes Virus Cruise Outbreak

by Laura Scorzolini, Alessandra D’Abramo, Enrico Girardi and Emanuele Nicastri

Infect. Dis. Rep. 2026, 18(3), 59; https://doi.org/10.3390/idr18030059 - 16 Jun 2026

Abstract

Over the past decade, outdoor recreational activities—including ecotourism, wildlife observation, adventure travel, and expedition cruising—have expanded at an unprecedented pace [...] Full article

(This article belongs to the Section Viral Infections)

11 pages, 1875 KB

Open AccessCase Report

Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis

by Jordan Pyatt, Carlos A. Umaña Mejía, Justice Cruz, Fernando Baires, Helen Hoffman, Joanne Cordero Guerra, Miguel Sierra-Hoffman, Heike Hesse and Amy C. Madril

Infect. Dis. Rep. 2026, 18(3), 58; https://doi.org/10.3390/idr18030058 - 15 Jun 2026

Abstract

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent [...] Read more.

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement. Full article

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16 pages, 4703 KB

Open AccessReview

Climate Change and Emerging Arboviral Threats in Saudi Arabia: Epidemiology, Vector Ecology, and One Health Preparedness

by Shuaibu Abdullahi Hudu, Emad A. Morad, Ghusun M. Alhazimi and Abdulgafar Olayiwola Jimoh

Infect. Dis. Rep. 2026, 18(3), 57; https://doi.org/10.3390/idr18030057 - 12 Jun 2026

Abstract

Arboviral diseases are emerging as important public health threats in Saudi Arabia, driven by rapid urbanization, climate variability, the expansion of Aedes aegypti populations, international travel, and large-scale religious mass gatherings. Dengue virus remains the most established arboviral infection in the Kingdom, particularly [...] Read more.

Arboviral diseases are emerging as important public health threats in Saudi Arabia, driven by rapid urbanization, climate variability, the expansion of Aedes aegypti populations, international travel, and large-scale religious mass gatherings. Dengue virus remains the most established arboviral infection in the Kingdom, particularly in the southwestern regions such as Jazan and the western urban centers of Makkah and Jeddah, where ecological and climatic conditions are conducive to sustained vector survival and transmission. This review synthesizes current evidence on the epidemiology, vector ecology, climatic determinants, diagnostics, and prevention strategies of arboviral diseases in Saudi Arabia. Particular attention is paid to the impacts of rising temperatures, changes in rainfall patterns, urban heat island effects, population mobility, and cross-border movement on vector expansion and disease emergence. The review also identifies gaps in surveillance, diagnostics, insecticide resistance monitoring, and integrated vector management programs. Emerging preparedness strategies include climate-informed early warning systems, Geographic Information System-based risk mapping, multiplex molecular diagnostics, genomic surveillance, and community-based vector control. The review emphasizes the importance of implementing a One Health approach that combines data on humans, the environment, entomology, and climate. Currently, sustained endemic transmission of chikungunya and Zika viruses has not been conclusively demonstrated in Saudi Arabia, but increased environmental suitability and connectivity with other areas highlight the need for proactive surveillance and preparedness. Full article

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15 pages, 1433 KB

Open AccessArticle

Correlation of Age and Laboratory Parameters with Urine Flow Cytometry and Culture Results in Patients with Urinary Tract Infections

by Alma Trnacevic, Emir Trnacevic, Merjema Mahmutovic, Amra Serak, Humera Porobic Jahic, Jasminka Petrovic, Dilista Piljic, Rahima Jahic, Danijel Bijedic and Amela Becirovic

Infect. Dis. Rep. 2026, 18(3), 56; https://doi.org/10.3390/idr18030056 - 9 Jun 2026

Abstract

Background: The diagnosis of urinary tract infection (UTI) remains a clinical challenge, with urine culture as the gold standard. In developing countries like Bosnia and Herzegovina, a high prevalence of antimicrobial resistance and frequent empirical treatment pose significant clinical challenges. Automated urine flow [...] Read more.

Background: The diagnosis of urinary tract infection (UTI) remains a clinical challenge, with urine culture as the gold standard. In developing countries like Bosnia and Herzegovina, a high prevalence of antimicrobial resistance and frequent empirical treatment pose significant clinical challenges. Automated urine flow cytometry has emerged as a rapid tool to optimize diagnostic processes. Objectives: To determine the correlation of age, gender, and laboratory parameters—such as white blood cell (WBC) count, neutrophil count, and C-reactive protein (CRP)—with both urinary bacterial counts and urine culture results. Methods: This retrospective study analyzed 200 adult patients (≥18 years) with symptoms suggestive of UTI at the University Clinical Center Tuzla. Data on age, gender, WBC, neutrophils, CRP, and urine flow cytometry (Sysmex UF-4000) were collected. Statistical analysis was performed using R software (version 4.5.1), utilizing logistic regression models via the ‘glm’ function to identify independent predictors, with statistical significance set at p < 0.05. Results: The mean age of the population was 68.61 ± 15.19 years. Logistic regression demonstrated that WBC count (OR = 1.06, p = 0.004), neutrophil count (OR = 1.04, p = 0.014), and patient age (OR = 1.03, p = 0.001) were significant independent predictors of UTI. Furthermore, patients with a urinary bacterial count > 1200/μL had 83 times higher odds of a positive urine culture (OR = 83, 95% CI 32.25–200, p < 0.001). Conversely, CRP levels and gender were not significant predictors (p > 0.05). Conclusions: Patient age, WBC, and neutrophil counts are key factors for predicting UTIs. Integrating these parameters with urine flow cytometry bacterial counts can significantly enhance diagnostic accuracy and rapid screening in clinical practice. Full article

(This article belongs to the Section Bacterial Diseases)

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13 pages, 2643 KB

Open AccessArticle

Climate Variability Drives Dengue Transmission in Bangladesh

by Ayesha Siddiqa, Prosenjit Choudhury, Nabil Jahan Mahim, Suman Paul, Syed Sayeem Uddin Ahmed and Md Bashir Uddin

Infect. Dis. Rep. 2026, 18(3), 55; https://doi.org/10.3390/idr18030055 - 9 Jun 2026

Abstract

Background: Dengue fever has emerged as a major public health concern in Bangladesh, with increasing incidence and geographic spread of outbreaks in recent years. This study aimed to investigate the lagged and non-linear associations between climatic factors and dengue incidence across all eight [...] Read more.

Background: Dengue fever has emerged as a major public health concern in Bangladesh, with increasing incidence and geographic spread of outbreaks in recent years. This study aimed to investigate the lagged and non-linear associations between climatic factors and dengue incidence across all eight administrative divisions of Bangladesh from 2014 to 2025. Materials and Methods: An ecological time-series design was employed using monthly dengue case data (n = 741,338) and meteorological variables. A generalized additive model (GAM) with a negative binomial distribution was applied to account for overdispersion and capture complex relationships. Descriptive analysis was conducted to assess spatial heterogeneity, and choropleth maps were constructed to visualize the spatial distribution and regional variation in dengue burden across the country. Cross-correlation analysis was performed to identify significant lagged associations between climatic variables and dengue incidence. Results: Descriptive analysis showed substantial spatial heterogeneity, with the highest incidence observed in Dhaka (6.53 per 100,000) and the lowest in Sylhet (0.21 per 100,000). Choropleth maps illustrated distinct spatial distribution and regional variation in dengue burden across the country. Cross-correlation analysis identified significant lagged associations for temperature and rainfall (lag 1–3 months), humidity (lag 1–2 months), and wind speed (lag 2–3 months). The final GAM explained 88.6% of the deviance in dengue incidence (AIC = 7404.15; dispersion = 0.767). The approximate significance of smooth terms revealed that temperature at a lag of 1 month (p < 0.001, edf = 12.28), rainfall at a lag of 3 months (p < 0.001, edf = 2.85), and wind speed at a lag of 2 months (p < 0.001, edf = 2.25) were highly significant non-linear predictors of dengue transmission. Relative humidity was not significantly associated with dengue incidence. Non-linear effects revealed peak dengue risk at temperatures between 25 and 30 °C and moderate rainfall (~10 mm), particularly during monsoon months (June–October). A strong autoregressive effect indicated that prior dengue incidence significantly influenced current transmission. Conclusions: Overall, dengue transmission in Bangladesh is driven by complex, lagged, and non-linear interactions between climatic variables, seasonality, and regional factors. These findings provide critical evidence for climate-based early warning systems, enhance outbreak prediction, and inform evidence-based vector control strategies. Full article

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10 pages, 1614 KB

Open AccessCase Report

Salvage Treatment of Ventilator-Associated Pneumonia Using Sulbactam–Durlobactam in a Preterm Neonate: A Case Report

by Suzana Zivojinovic, Tijana Prodanovic, Nikola Prodanovic, Rasa Medovic, Milica Cekerevac, Dragana Savic, Bojana Markovic and Slobodan Jankovic

Infect. Dis. Rep. 2026, 18(3), 54; https://doi.org/10.3390/idr18030054 - 1 Jun 2026

Abstract

Background: Ventilator-associated pneumonia (VAP) is a leading cause of nosocomial infections in neonatal intensive care units (NICUs) and is associated with significant morbidity, mortality, and prolonged hospitalization, particularly in preterm neonates. Management is complicated by the emergence of multidrug-resistant (MDR) and extensively drug-resistant [...] Read more.

Background: Ventilator-associated pneumonia (VAP) is a leading cause of nosocomial infections in neonatal intensive care units (NICUs) and is associated with significant morbidity, mortality, and prolonged hospitalization, particularly in preterm neonates. Management is complicated by the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, with very limited evidence supporting the use of reserve antibiotics in this population. Case Presentation: We report a male neonate born at 25 weeks of gestation (birth weight 740 g) who developed severe VAP caused by XDR Acinetobacter calcoaceticus-baumannii complex and Pseudomonas aeruginosa. After failure of multiple antibiotic regimens, including ampicillin, amikacin, meropenem, vancomycin, cefepime with inhaled colistin, tigecycline, and ceftazidime-avibactam combined with fosfomycin, the infant was treated with sulbactam–durlobactam (25 mg/kg/dose every 6 h) in combination with ceftazidime-avibactam. After 12 days of this regimen, the neonate was successfully extubated. Conclusions: This case highlights the therapeutic challenges of XDR infections in extremely preterm neonates and suggests that sulbactam–durlobactam may represent a viable salvage treatment option. Further pharmacokinetic and clinical studies are needed to establish optimal dosing and safety in the neonatal population. Full article

(This article belongs to the Special Issue Nosocomial Infections and Ventilator-Associated Pneumonia (VAP) in Non-Invasive Ventilatory Support)

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24 pages, 6565 KB

Open AccessReview

Bacterial Granulomatous Lung Diseases: Radiological Findings and Differential Diagnosis

by Stefano Giusto Picchi, Augusto Minieri, Francesco Lassandro, Giuseppe Russo and Giulia Lassandro

Infect. Dis. Rep. 2026, 18(3), 53; https://doi.org/10.3390/idr18030053 - 28 May 2026

Abstract

Background Granulomatous lung diseases include a spectrum of disorders, both infectious and noninfectious, unified by the presence of granulomas in the lung parenchyma. Granulomas are microscopic, organized collections of immune cells that arise as a response to persistent antigenic stimulation. Infectious granulomatous lung [...] Read more.

Background Granulomatous lung diseases include a spectrum of disorders, both infectious and noninfectious, unified by the presence of granulomas in the lung parenchyma. Granulomas are microscopic, organized collections of immune cells that arise as a response to persistent antigenic stimulation. Infectious granulomatous lung diseases arise from a variety of microbial agents, that include most frequently Mycobacterium tuberculosis, non-tuberculous mycobacteria, Nocardia, and Borrelia, as well as a wide range of fungal pathogens including Histoplasma, Cryptococcus, Pneumocystis, and Aspergillus species. Methods and Results: Definitive diagnosis is achieved through direct identification and subsequent culture of the causative pathogen in appropriate clinical specimens, including sputum, bronchoscopic samples, gastric aspirates, or pleural fluid. Imaging is fundamental for the detection and characterization of pulmonary granulomas. HRCT allows precise assessment of the number, size, and distribution of granulomatous lesions, can suggest an infectious etiology based on specific imaging patterns, and is essential for monitoring response to therapy over time. Differential diagnosis is challenging due to the numerous different imaging appearances with whom granulomatous lung diseases may manifest. Conclusions: The purpose of our review is to describe the spectrum of infectious granulomatous lung diseases caused by bacterial pathogens, highlighting their diverse radiologic presentations in order to assist radiologists in recognizing these entities and improving diagnostic accuracy. Full article

(This article belongs to the Section Bacterial Diseases)

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11 pages, 418 KB

Open AccessCommunication

Dirofilaria spp. Detection in Dog Blood Samples from Southern Poland—A Retrospective Data Analysis

by Olga Pawełczyk, Paulina Iwase, Bartosz Wierzba and Jolanta Szłapka-Kosarzewska

Infect. Dis. Rep. 2026, 18(3), 52; https://doi.org/10.3390/idr18030052 - 27 May 2026

Abstract

Background: Dirofilaria spp. is an etiological agent of dirofilariasis, a mosquito-borne parasitic disease of increasing zoonotic concern in Europe. The aim of this study was to assess the occurrence of Dirofilaria spp. in dogs from Southern Poland using retrospective data from a commercial [...] Read more.

Background: Dirofilaria spp. is an etiological agent of dirofilariasis, a mosquito-borne parasitic disease of increasing zoonotic concern in Europe. The aim of this study was to assess the occurrence of Dirofilaria spp. in dogs from Southern Poland using retrospective data from a commercial veterinary diagnostic laboratory (Vetlab, Katowice, Poland). Methods: Blood tests from 2060 dogs were analyzed between 1 August 2018 and 31 December 2022. All samples were collected by the clinicians during routine veterinary activity and examined by a specific test—microscopic (blood smear/blood smear and Knott’s test), molecular or both—from the Vetlab laboratory offer (test selected by clinician). Results: Out of all examined dogs, 19 (0.92%) tested positive for Dirofilaria. Positive samples originated from the Śląskie (n = 13), Opolskie (n = 3), and Małopolskie (n = 3) voivodeships. Co-infections with Babesia spp. and Anaplasma spp. were identified in two blood samples. Conclusions: This study demonstrates the presence of Dirofilaria spp. in dogs from Southern Poland, a region where data about dirofilariasis cases remain limited. Its overall occurrence was low in comparison to endemic areas in Central Poland. However, the presence of confirmed cases highlights the need for increased veterinary awareness, implementation of preventive measures, and further molecular epidemiological studies to better evaluate the risk of exposure to Dirofilaria in this region. Full article

(This article belongs to the Topic Vector-Borne Disease Spatial Epidemiology, Disease Ecology, and Zoonoses)

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