Infectious Disease Reports

Dating applications have become central components of contemporary sexual networks, yet HIV prevention remains largely organised outside these digital environments. We propose that dating applications should be conceptualised as potential HIV and sexual health prevention ecosystems, connecting testing, PrEP and PEP navigation, STI services, vaccination, telemedicine, partner notification, behavioural support, and artificial intelligence-enabled health navigation. Existing evidence supports the effectiveness of many of these digital interventions individually, while emerging integrated models suggest opportunities to connect digital engagement with real-world care pathways. Artificial intelligence may provide an additional navigation layer capable of improving personalisation and continuity across prevention services. However, implementation will require careful attention to privacy, governance, equity, healthcare accessibility, and differences across health systems. Rather than replacing existing healthcare services, digital prevention ecosystems could complement them by bringing prevention closer to the environments where sexual interactions increasingly originate. Full article

Background/Objectives: Doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) is used as a switch regimen in treatment-experienced people with HIV (PWH), particularly when simplification, lipid improvement, or avoidance of interaction-prone regimens is needed. We evaluated 48-week virologic effectiveness and laboratory changes after switching to DOR/3TC/TDF in routine care. Methods: This multicenter retrospective study included adults with HIV who switched to fixed-dose DOR/3TC/TDF at seven Italian HIV centers within the Sardinian HIV Network-Sicilian HIV Cohort (SHINe-SHIC) network. The switch visit served as baseline; follow-up data were extracted at 24 and 48 weeks. The primary endpoint was HIV RNA < 50 copies/mL at 48 weeks in an observed analysis. Secondary endpoints were changes in lipid and lipid-derived parameters, renal function, and hepatic laboratory markers. Results: Ninety-eight participants were included; 75 (76.5%) were male, and the median age was 52.4 years. At 48 weeks, 72/81 participants (88.9%) had HIV RNA < 50 copies/mL and 78/81 (96.3%) had HIV RNA < 200 copies/mL. Total cholesterol decreased from 199 to 165 mg/dL (median paired change, −22 mg/dL; p < 0.001), low-density lipoprotein cholesterol from 118 to 106.5 mg/dL (−13.5 mg/dL; p = 0.001), and triglycerides from 112.5 to 94 mg/dL (−10.5 mg/dL; p = 0.021). Non-high-density lipoprotein cholesterol and the total cholesterol/high-density lipoprotein cholesterol ratio improved, whereas high-density lipoprotein cholesterol decreased modestly. Serum creatinine and estimated glomerular filtration rate remained stable. Alanine aminotransferase increased modestly; aspartate aminotransferase and gamma-glutamyl transferase did not significantly change. Conclusions: Switching to DOR/3TC/TDF maintained virologic control, improved lipid and lipid-derived parameters, and was not associated with renal function decline among participants with follow-up data. In selected treatment-experienced PWH, DOR/3TC/TDF may be useful when lipid improvement, simplification, or management of drug-drug interaction concerns are treatment goals. Full article

Background/Objectives: Transgender (trans) individuals experience a disproportionate burden of HIV and other sexually transmitted infections (STIs), although evidence based on point-of-care testing remains limited in Brazil. This study aimed to estimate the prevalence of reactive STI rapid test results and associated factors among transgender individuals receiving care in specialized health services in São Paulo, Brazil. Methods: A cross-sectional study was conducted between July and December 2025 with 400 participants attending two specialized healthcare services. Sociodemographic, behavioral, substance use, clinical, and HIV prevention-related data were collected. The primary outcome was reactivity to at least one rapid test for HIV, syphilis, hepatitis B, or hepatitis C; reactive results could include previously known infections and therefore were not interpreted as newly diagnosed or active infections. Associations were estimated using Poisson regression with robust variance. Results: Overall, 19.2% of participants had at least one reactive rapid test result, with HIV accounting for the largest proportion of reactive results (14.8%). In the adjusted model, increasing age was associated with a higher prevalence of the outcome (PR = 1.04; 95% CI: 1.02–1.05), whereas transgender men had a lower prevalence than transgender women (PR = 0.38; 95% CI: 0.19–0.73). Reported HIV prevention through PrEP and/or PEP was inversely associated with the outcome (PR = 0.37; 95% CI: 0.17–0.82); however, this association should not be interpreted as a direct protective effect because most reactive HIV results occurred among participants with previously known HIV, who would not be eligible for PrEP. Conclusions: These findings indicate a substantial frequency of reactive STI rapid test results among transgender individuals attending specialized health services and support continued access to testing, prevention, and culturally competent sexual healthcare. Full article

Background: Community-acquired pneumonia (CAP) causes significant long-term morbidity and mortality. Existing clinical scores focus on short-term outcomes, highlighting the need to validate tools that accurately predict 12-month mortality in hospitalized patients. Materials and Methods: A retrospective cohort of adults hospitalized with CAP from 2012 to 2020 was analyzed. Clinical, laboratory, radiological, and hospitalization-related data were collected. A Cox proportional hazards model was developed to predict post-acute mortality between 30 days and 12 months after hospital admission among patients with CAP who survived the first 30 days, with the cohort split 50:50. Model performance was evaluated using Area Under the Receiver Operating Characteristic Curve (AUROC) and standard diagnostic accuracy metrics. Results: A total of 13,851 patients with CAP were included. In the derivation cohort, independent predictors were altered mental status (HR 2.08; 95% CI 1.49–2.90; p < 0.05), elevated BUN (>30 mg/dL; HR 1.98; 95% CI 1.48–2.63; p < 0.05), temperature extremes (<35 °C or >39.9 °C; HR 1.98; 95% CI 1.43–2.74; p < 0.05), corticosteroid use (HR 1.85; 95% CI 1.40–2.44; p < 0.05), neoplasia (HR 1.58; 95% CI 1.08–2.32; p < 0.05), and hospital stays longer than 8 days (HR 1.39; 95% CI 1.06–1.82; p < 0.05). The new score achieved the highest AUROC (0.69; 95% CI: 0.66–0.73), followed by PSI (0.65; 95% CI: 0.62–0.69), CURB-65 (0.63; 95% CI: 0.59–0.67), and CAPSI (0.62; 95% CI: 0.58–0.67). The optimal cutoff point for the new score was 3, as determined by the Youden index (0.339). The model sensitivity was 83.0%, specificity: 50.9%, PPV: 8.9%, and NPV: 99.0%. The LR+ was 1.69 (95% CI: 1.38–2.06), and the LR− was 0.33 (95% CI: 0.27–0.41). Conclusions: The new score demonstrated weak-to-moderate discriminatory capacity. The variables included in the new score reflect multiorgan involvement, disease severity, and comorbidity burden, all of which are associated with long-term mortality. Full article

Introduction: Gastrointestinal basidiobolomycosis is an uncommon invasive fungal infection caused by Basidiobolus ranarum, an environmental mould endemic to the arid south-west of Saudi Arabia and to a handful of other hot, dry regions. Its non-specific presentation routinely invites misdiagnosis as inflammatory bowel disease, tuberculosis or malignancy, and extension to the biliary tree is decidedly rare. Case Presentation: We report a 25-year-old Saudi woman who developed chronic watery diarrhoea and pronounced weight loss two months after her first delivery. Severe microcytic anaemia, leukocytosis, a very high erythrocyte sedimentation rate and multisegmental colonic wall thickening were initially attributed to inflammatory bowel disease complicated by Clostridioides difficile colitis. She subsequently required cholecystectomy for acalculous cholecystitis and then deteriorated, with gastric outlet obstruction and collections at the gallbladder bed. Re-examination of the gallbladder specimen revealed broad, pauci-septate hyphae enveloped by the Splendore–Hoeppli phenomenon, and culture yielded an isolate phenotypically identified as B. ranarum. Voriconazole followed by itraconazole achieved near-complete clinical and radiological recovery. Discussion: We hypothesise that the early puerperium could represent a possible, though as yet unproven, window of susceptibility to this infection. Conclusions: In endemic regions, gastrointestinal basidiobolomycosis should be considered when presumed inflammatory bowel disease behaves atypically; deep tissue sampling is often decisive, and prolonged triazole therapy can achieve an excellent outcome. Full article

Background: Hospital construction and renovation are recognized risk factors for healthcare-associated aspergillosis because demolition work can disperse airborne fungal spores into the air. However, environmental dissemination pathways during renovations remain incompletely understood. Methods: We conducted a prospective environmental surveillance study during the renovation of a high-care unit (HCU) at a 1000-bed tertiary care hospital in Japan. Air sampling was performed before, during, and after the renovation at five locations using an air sampler (500 L/sample). Fungal isolates were identified using internal transcribed spacer sequencing. Dust collected from the ceiling void above the HCU before the renovation was also cultured. Results: Aspergillus fumigatus was isolated from dust collected from the ceiling void before renovation. During renovation, Aspergillus spp. were detected only in areas sharing the ceiling void with the construction site and on the floor immediately below the renovation area. No Aspergillus spp. were detected in the intensive care unit, which did not share the ceiling void. These findings suggest that demolition-related vibrations may have disturbed dust accumulated within the ceiling voids, suggesting a possible mechanism for localized fungal dissemination. Additionally, to assess the clinical impact of the renovation, the quarterly number of patients with positive Aspergillus-related microbiological or serological findings from 2015 to 2025 was reviewed. No apparent increase in the number of patients with positive Aspergillus-related microbiological or serological findings was observed during the renovation period. Our findings suggest that connected ceiling voids may represent potential pathways for localized fungal dispersal during demolition, while emphasizing that this proposed pathway was not directly confirmed. Conclusions: These findings highlight the importance of environmental surveillance and appropriate infection control measures during hospital renovation. Full article

Background: The 2026 outbreak of Bundibugyo Ebola virus disease (BDBV) in eastern Democratic Republic of the Congo (DRC), centered in Ituri Province, represents the largest documented outbreak caused by Bundibugyo ebolavirus since its discovery in Uganda in 2007. The outbreak evolved within a complex humanitarian setting characterized by armed conflict, population displacement, mining-related migration, weak health systems, extensive population mobility, and an infodemic environment marked by misinformation and reduced public trust. We conducted a field investigation to assess epidemiological, operational, laboratory, infection prevention and control (IPC), community engagement, risk communication, and infodemic management challenges and identify priority interventions to strengthen outbreak control. Methods: A rapid field assessment was conducted between 12–15 June 2026 in Bunia, Rwampara Health Zone, and the Ituri Provincial Public Health Laboratory. Data were collected through direct observation, review of surveillance and laboratory reports, health facility assessments, stakeholder interviews, and analysis of outbreak response indicators. Epidemiological trends, surveillance performance, laboratory capacity, clinical care, IPC activities, logistics, risk communication, community engagement, and infodemic management approaches were evaluated. Results: As of 12 July 2026, the outbreak had resulted in 1926 laboratory-confirmed cases and 702 deaths, corresponding to an overall case fatality rate (CFR) of 36.4% across affected provinces. Ituri Province remained the epicenter, accounting for 90.8% of confirmed cases (1705/1877) and 85.5% of reported deaths (577/675). During the preceding 24 h, 53 new confirmed cases and 30 deaths were reported, including 20 community deaths (66.7%), highlighting persistent delays in detection, referral, and access to care. Surveillance systems identified 766 alerts, of which 678 (88.5%) were investigated, resulting in 235 suspected cases. Contact tracing remained a major challenge, with only 64.4% (4171/6475) of registered contacts successfully followed, below the recommended ≥95% target. Laboratory activities included testing of 137 specimens, with 29 positive results and an overall positivity rate of 21.2%. Decentralized molecular diagnostic platforms improved access to testing; however, data inconsistencies, delayed investigations, and gaps in outcome classification affected response monitoring. Major operational challenges included limited treatment capacity, high occupancy of Ebola treatment centres, shortages of trained personnel and IPC supplies, insecurity affecting response teams, and insufficient preparedness in newly affected areas. Community resistance, attacks on burial teams, detention of frontline responders, misinformation, and rumors contributed to delayed care-seeking, reduced acceptance of public health measures, and incomplete cooperation with contact tracing. Risk communication and community engagement efforts were constrained by limited outreach capacity, language barriers, low trust, and inadequate systems for rumor detection and infodemic response. Conclusions: The ongoing BDBV outbreak in eastern DRC demonstrates the difficulty of controlling Ebola transmission in conflict-affected and socially complex settings. Sustained transmission, community deaths, geographic expansion, and operational constraints highlight the urgent need to strengthen surveillance, contact tracing, laboratory systems, IPC capacity, clinical care, and integrated risk communication and infodemic management strategies. Building trust through community-centered approaches, proactive misinformation management, and engagement of trusted local actors will be essential to accelerate outbreak containment and strengthen preparedness across the Great Lakes region. Full article

Background: Monitoring treatment outcomes is central to evaluating drug-resistant tuberculosis (DR-TB) programmes and ensuring accountability, particularly in high-burden settings such as South Africa. However, routine surveillance data are often constrained by small sample sizes and incomplete reporting. The increasing proportion of outcomes classified as “not evaluated” raises critical concerns about the validity and interpretability of reported treatment success rates. This study examines longitudinal trends in DR-TB outcomes in two rural Eastern Cape facilities (2020–2024), conceptualising routine outcomes as governance signals reflecting health system performance and data management capacity, rather than clinical performance alone. Methods: A retrospective analysis of aggregated DR-TB treatment outcomes from 2020 to 2024 was conducted using routine programme data. Outcomes included treatment success, failure, loss to follow-up (LTFU), death, and “not evaluated.” Proportions were estimated using Wilson 95% confidence intervals, and year-to-year differences were assessed using chi-square tests, with cautious interpretation due to small sample sizes. Bounding analyses were applied to assess the sensitivity of treatment success estimates to alternative assumptions about incomplete outcome reporting. Results: Treatment success declined over time for both rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB), with a significant decrease observed in MDR-TB (80.9% in 2021 to 38.5% in 2024; p = 0.007). Concurrently, the proportion of outcomes classified as “not evaluated” increased substantially from 2023 onward, reaching 25.8% in RR-TB and 30.8% in MDR-TB by 2024 (p < 0.001). Mortality remained persistently high in RR-TB, while MDR-TB exhibited higher levels of treatment failure and LTFU. Analyses for pre-XDR-TB and XDR-TB were limited by small sample sizes. Bounding analyses demonstrated that treatment success estimates were highly sensitive to incomplete reporting of outcomes. Conclusions: Declining DR-TB treatment success in this setting is closely associated with increasing incomplete outcome reporting, suggesting that observed trends may reflect challenges in surveillance and governance systems rather than clinical deterioration alone. Interpreting routine DR-TB outcomes as governance signals provides a novel systems-based perspective for programme evaluation. Strengthening data completeness, patient tracking, and surveillance systems is essential to improve the reliability of programme indicators and support effective TB control in resource-constrained rural settings. Full article

Background: Diabetic foot infection (DFI) is one of the most frequent diabetes-related complications requiring hospitalisation and is a major contributor to lower-extremity amputation. Infrared thermography has emerged as a non-invasive diagnostic tool capable of detecting temperature changes associated with inflammatory and infectious processes. This systematic review aimed to evaluate the role of thermography in the diagnosis and monitoring of diabetic foot infection. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Risk of bias and methodological quality were assessed using design-specific validated tools, including QUADAS-2 for diagnostic and detection studies and Joanna Briggs Institute critical appraisal checklists for cohort and case-series studies. Original studies evaluating the use of thermography in patients with diabetic foot infection were included. Two authors independently performed study selection, data extraction, and methodological assessment. Results: Six studies met the inclusion criteria, comprising a total of 552 participants with type 1 or type 2 diabetes mellitus. Four observational studies and two pilot studies were included. Increased local skin temperature was consistently associated with acute diabetic foot complications and infection. Several studies identified a temperature difference of approximately 2.2 °C between contralateral foot regions as a clinically relevant threshold for detecting diabetic foot complications. However, no significant relationship was found between plantar thermal asymmetry and the severity or progression of infected diabetic foot ulcers. All included studies presented a level of evidence of 4 and a grade of recommendation of C. Conclusions: Infrared thermography appears to be a promising adjunctive tool for the early detection of diabetic foot infection. However, current evidence does not support its routine use for monitoring infection severity, treatment response, or prognosis, and further prospective studies are required before these applications can be recommended. Full article

Background: Fusobacterium necrophorum is an anaerobic Gram-negative organism classically associated with severe head and neck infections and Lemierre syndrome. Central nervous system involvement is uncommon but may be rapidly progressive and fatal, particularly when associated with sinusitis, intracranial empyema, cerebritis, or brain abscess. Case presentation: We report the case of a previously healthy 18-year-old male who presented after four days of high fever up to 41.5 °C, severe holocranial headache, vomiting, and acute hyperactive delirium. On admission, he had meningismus, markedly elevated inflammatory markers, and concomitant Influenza A infection. The initial cranial computer tomography showed a left frontal hypodense lesion with hemorrhagic transformation and perfusion deficit. The cranial magnetic resonance tomography demonstrated left frontopolar cerebritis, intracranial empyema along the falx and tentorium, intraspinal extension, and extensive bilateral frontal, maxillary, and ethmoidal sinusitis, suggesting sinogenic intracranial spread. The patient underwent emergency bilateral pansinus surgery, placement of an external ventricular drain, left hemicraniectomy with evacuation of empyema, repeat evacuation of subdural empyema and frontal abscess drainage, and posterior fossa decompression with C1 laminectomy. Fusobacterium necrophorum was detected in anaerobic blood cultures and the operative intracranial samples. Despite aggressive interdisciplinary management, the patient developed septic multiorgan failure and died on hospital day 4. Conclusions: This case illustrates a rare but potentially fatal sinogenic Fusobacterium necrophorum infection of the central nervous system in a young adult. By providing a detailed report, we intend to increase awareness of this rare yet fatal clinical presentation. Full article

Background: Powassan virus (POWV) is the only tick-borne encephalitis-group flavivirus endemic to the United States (U.S.) and is an increasingly serious public health threat. Reported U.S. cases remain relatively few but have grown steadily—from fewer than two annually before 2005 to a record 60 in 2024—and neuroinvasive disease carries a 10–15% case fatality with lasting neurological sequelae in roughly half of the survivors. Examining POWV through a One Health lens, we conducted a scoping review of its ecological and zoonotic drivers, its interactions with co-circulating tick-borne pathogens, its full clinical spectrum, and its distinction from other tick-borne diseases. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance, we searched PubMed/MEDLINE, U.S. Centers for Disease Control and Prevention (CDC) surveillance databases, state health-department publications, and vetted public-health news through early 2026. The review was conducted as an AI-integrative partnership among the authors, the Global Infectious Diseases and Epidemiology Online Network (GIDEON) database, and Claude (Anthropic), enabling a synthesis of human-curated archival records collected over six years alongside the published literature; this yielded over 200 sources, almost half unavailable through an AI search alone. Results: POWV is maintained in a sylvatic cycle involving I. scapularis ticks, small-mammal reservoirs, and incidental human spillover. Its clinical spectrum spans asymptomatic seroconversion to fatal meningoencephalitis; prodromal fever, headache, vomiting, and fatigue may progress to encephalitis, seizures, aphasia, cranial-nerve palsies, paralysis, and ataxia—the most severe neurological syndrome among U.S. tick-borne diseases. Cases cluster in the northeastern and Great Lakes states, with older males disproportionately affected, while viral evidence extends to the mid-Atlantic, southern, and western regions. POWV is distinguished by its flaviviral etiology, short (as little as 15 min) transmission window, absence of a characteristic rash, and complete antibiotic resistance. Of the 48 states surveyed, only 7 published POWV data. Conclusions: POWV is an escalating One Health threat driven by expanding vector tick ranges, land-use and climate change, and wildlife–human interface dynamics. Enhanced cross-sector surveillance integrating human, animal, and environmental monitoring, alongside improved public-health data reporting, is urgently needed. Full article

Background: Mycobacterium marinum is a slow-growing nontuberculous mycobacterium associated with aquatic environments and may cause chronic skin and soft-tissue infections following minor skin trauma. Diagnosis can be delayed because clinical manifestations may mimic conventional bacterial infections. We report an unusual case in a kidney transplant recipient with a positive QuantiFERON-TB Gold test and subsequent M. marinum infection of the hand. Case presentation: A 53-year-old man with a history of kidney transplantation and long-term immunosuppressive therapy developed progressive swelling, pain, erythema, and functional impairment of the right third finger. After independently discontinuing tacrolimus, mycophenolate mofetil, and prednisone following a positive QuantiFERON-TB Gold test, he developed a progressive hand infection despite empirical ciprofloxacin therapy. He reported repeated exposure to a domestic freshwater aquarium and frequent contact with aquarium water and filtration equipment, with minor skin abrasions. Surgical exploration revealed dense, whitish, caseous-appearing material. Histopathology demonstrated chronic granulomatous inflammation, while Ziehl–Neelsen staining showed acid-fast bacilli. Culture yielded slow-growing photochromogenic colonies at 28–32 °C, and species-specific PCR confirmed M. marinum. No antimicrobial susceptibility testing was performed. Following surgical drainage and six days of empirical ciprofloxacin, no targeted antimycobacterial therapy was administered. The patient achieved complete clinical resolution, and immunosuppressive therapy was gradually reintroduced approximately four weeks after surgery. Conclusions: This case highlights the importance of considering M. marinum in persistent or treatment-refractory hand infections, particularly in patients with aquarium exposure and impaired immunity. Early tissue sampling, appropriate culture conditions, and molecular identification are essential for diagnosis. A positive QuantiFERON-TB Gold result should be interpreted cautiously because cross-reactivity with M. marinum is possible. The favorable outcome observed after surgical source control and a short empirical course of ciprofloxacin is unusual and should not be interpreted as evidence supporting short-course monotherapy for deep M. marinum infection. Because antimicrobial susceptibility testing and serial follow-up cultures were unavailable, the contribution of ciprofloxacin to microbiological clearance cannot be determined. Full article

Ebola virus disease (EVD) remains one of the most severe viral hemorrhagic fevers, with recurrent outbreaks challenging global healthcare systems. This narrative review traces the evolving epidemiology of EVD from the first recognized outbreaks in 1976 to the ongoing 2026 Bundibugyo virus public health emergency in the Democratic Republic of the Congo (DRC) and Uganda. Over nearly five decades, the recognized range of Ebola outbreak contexts and amplification mechanisms has broadened considerably: rural zoonotic spillovers remain the predominant mode of emergence, but the scale and reach of subsequent transmission increasingly depend on where introductions occur, on delays in detection, on population mobility, on ecological disruption, on armed conflict, on healthcare-associated transmission, and on viral persistence in survivors. Major advances in molecular epidemiology and genomic surveillance have improved outbreak investigation, enabling real-time transmission reconstruction and detection of survivor-linked resurgence. Vaccination, particularly ring vaccination with rVSV-ZEBOV, has shown high effectiveness against Zaire ebolavirus, yet vaccine equity gaps and the absence of licensed vaccines for Sudan virus and Bundibugyo virus remain critical vulnerabilities, though new candidate vaccines and therapeutics for Bundibugyo virus entered clinical evaluation in mid-2026. Artificial intelligence and digital technologies, including AI-assisted early warning systems, portable sequencing, drones, blockchain, and mobile health platforms, offer promising tools for outbreak preparedness, but robust evidence of their real-world operational impact during filovirus outbreaks remains limited, and their deployment in low-resource settings faces substantial barriers related to infrastructure, literacy, data costs, and governance. Integrated preparedness frameworks that combine ecological surveillance, resilient healthcare systems, community engagement, and international coordination under a One Health umbrella are increasingly viewed as a strategic necessity. The 2026 Bundibugyo outbreak reaffirms that despite decades of lessons, structural weaknesses in surveillance, response timeliness, and community trust continue to recur. Sustainable, multi-year financing, diversified vaccine platforms, regional manufacturing, and local co-design of digital tools are essential to translate lessons into lasting change. Preparedness is best understood as a continuous process rather than a reactive state. Full article

Background: Legionnaires’ disease (LD) is most often described as caused by a single Legionella pneumophila (Lp) serogroup (SG), typically SG1. However, mixed infections involving multiple SGs or even different Legionella species can occur within a single host. Such cases remain underrecognized and pose challenges for diagnosis, clinical management, and outbreak investigation. Case presentation: A 61-year-old woman developed acute fever, malaise, and productive cough after visiting a wellness spa in France, with radiological findings consistent with a lower respiratory tract infection. The urinary antigen test (UAT) for Lp was negative, but respiratory multiplex PCR was weakly positive. Subsequent testing at the Belgian National Reference Centre (NRC) for Legionella revealed an unexpected discordance between an in-house SG1-specific PCR and culture-based findings. Further analysis identified co-infection with two distinct Lp strains, SG1 (sequence type, ST146) and SG10 (ST1267), using a combination of direct sequence-based typing (SBT) and culture with serogrouping of multiple colonies. The patient improved rapidly after treatment with oral levofloxacin. Conclusions: Mixed Lp SG infections are likely underrecognized in routine practice, as neither UAT, commercial molecular assays, nor characterization of a single cultured isolate may adequately capture within-host strain diversity. Comprehensive diagnostic approaches combining culture with analysis of multiple colonies and molecular tests are essential for accurate case detection and source attribution. Referral to NRCs is recommended when advanced typing methods are unavailable. This first reported Belgian case illustrates the potential implications for patient management and epidemiological investigations, underscoring the need for broader diagnostic strategies. Full article

Background: People who inject drugs (PWID) comprise the majority of patients with native tricuspid valve (TV) infective endocarditis (IE). Many patients require surgical repair or replacement of their TV, but some may be deemed ineligible for surgical management due to high operative risk or patient preference. Vacuum-assisted percutaneous mechanical aspiration (PMA) has emerged as a potential alternative to surgical management in this population. The objective of this study was to describe real-world patient characteristics and clinical outcomes in PWID who underwent PMA or surgical management of TV IE. Methods: We retrospectively reviewed PWID hospitalized with endocarditis at a single tertiary care center (2016–2025) who underwent an isolated PMA or surgical TV repair/replacement (TVR). Baseline demographic, clinical, microbiologic, and echocardiographic characteristics were described. Clinical outcomes were compared descriptively between groups, recognizing imbalances in treatment selection. Results: A total of 40 PWID met inclusion criteria; 17 underwent PMA and 23 underwent surgical TVR. There was substantial baseline clinical heterogeneity between the two groups. Procedural success was numerically higher with surgery than with PMA (95.7% vs. 88.2%). Clinical success, a composite of procedural success, treatment completion, and lack of need for reintervention, was numerically higher in the TVR group (73.9% vs. 52.9%). One-year mortality was similar between groups. Conclusions: In this single-center retrospective observational cohort of PWID with isolated TV IE, there was no statistical difference in composite clinical or procedural success between patients who underwent PMA or TVR. PMA may be a feasible source-control strategy for select patients not eligible for immediate surgery; however, larger prospective studies are needed to define optimal patient selection factors and comparative effectiveness. Full article

Background: Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary fungal disease, predominantly caused by Aspergillus fumigatus, which develops in patients with pre-existing structural lung abnormalities. Chronic cavitary pulmonary aspergillosis (CCPA), the most common form of CPA, is characterized by one or more pulmonary cavities, with or without intracavitary fungal balls (aspergillomas), and requires prolonged oral triazole therapy. Long-term treatment may be limited by adverse events, drug–drug interactions, and the need for therapeutic drug monitoring with conventional azoles. Case Presentation: A 69-year-old former smoker with a history of breast cancer and right upper lobectomy for pulmonary adenocarcinoma presented with fever, productive cough, hyporexia, sarcopenia, and an unintentional 6 kg weight loss over three months. Two years earlier, she had undergone atypical pulmonary resection for an Aspergillus fumigatus aspergilloma and had been treated with amphotericin B followed by voriconazole for six months. HRCT revealed a recurrent intracavitary fungal lesion within a residual post-surgical cavity with extensive inflammatory consolidation. Bronchoalveolar lavage demonstrated a positive galactomannan index (4.74) and septate fungal hyphae on cytology, supporting the diagnosis of recurrent CCPA. Treatment with oral isavuconazole resulted in clinical recovery, weight gain, and complete radiological resolution after six months, without treatment-related adverse events or QTc abnormalities. Conclusions: This case highlights the successful outpatient management of CCPA developing within a persistent post-lobectomy cavity despite previous surgical resection and antifungal therapy. The favourable clinical response, excellent tolerability, and absence of treatment-related toxicity support the growing evidence that isavuconazole may represent a valuable therapeutic option for selected patients with recurrent CCPA. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is associated with substantial morbidity and high recurrence rates. Current guidelines recommend fidaxomicin over oral vancomycin due to reduced recurrence; however, its high acquisition cost limits widespread adoption. Our health system implemented criteria restricting fidaxomicin to patients with the highest risk for recurrence. This study evaluated the impact of this strategy on CDI recurrence and antimicrobial expenditures. Methods: We conducted a multicenter, retrospective matched cohort study across a rural health system from January 2023 through March 2026. The fidaxomicin criteria for use (intervention) went into effect on 1 January 2025. Adult hospitalized patients with an initial CDI episode treated with oral vancomycin and/or fidaxomicin were included. Patients with severe CDI or prior CDI episodes were excluded. A 2:1 matching algorithm based on key recurrence risk factors was used to compare pre-implementation (before criteria for use) and post-implementation (after criteria for use) cohorts. The primary outcomes were 28-day and 90-day CDI recurrences. Secondary outcomes included antimicrobial utilization and annualized expenditures. Results: A total of 144 matched patients were analyzed (96 control and 48 intervention). Fidaxomicin use decreased from 40.6% to 8.3% following implementation (p < 0.001). Annualized fidaxomicin expenditures declined by 54.7%. CDI recurrence rates were similar between groups: 28-day recurrence was 5.2% in the control group versus 6.2% in the intervention group, and 90-day recurrence was 7.3% versus 10.4%, respectively, with statistical non-inferiority at 28 days (p = 0.014). Conclusions: Implementation of risk-based fidaxomicin use criteria significantly reduced utilization and costs without a statistically significant increase in CDI recurrence. These findings support a targeted stewardship approach to optimize resource use while maintaining comparable clinical outcomes. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. Full article

Background: Salmonellosis is a major global public health concern, commonly caused by serovars such as Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis. Rare serovars, however, may represent underrecognized links between environmental reservoirs and human infection. Salmonella enterica serovar Haifa is a sporadic serotype primarily associated with livestock and environmental sources and has previously been reported in Indian poultry but not in human clinical cases to date. Case Presentation: A 70-year-old male with a history of type 2 diabetes, presented with acute watery diarrhea and dehydration. One week prior to symptom onset, the patient reported direct contact with cattle and poultry in a rural setting. Laboratory investigations revealed leucopenia and elevated procalcitonin (3.73 ng/mL). Stool culture yielded non-lactose fermenting colonies on MacConkey agar and H₂S-producing colonies on Hektoen enteric agar. The isolate was identified via VITEK 2 and confirmed as Salmonella enterica serovar Haifa by the National Institute for Research in Bacterial Infections (NIRBI). Antimicrobial susceptibility testing (AST) revealed that the isolate showed resistance to ampicillin, ceftriaxone, and ciprofloxacin. The patient was successfully treated with a three-day course of intravenous Azithromycin (1 g) and achieved rapid clinical recovery. Conclusions: To the best of our knowledge, this case represents the first reported human infection caused by S. Haifa in India. The finding highlights the potential zoonotic risk of rare non-typhoidal Salmonella serovars and emphasizes the importance of surveillance, routine serotyping, and antimicrobial resistance monitoring within a One Health framework. Full article