Infectious Disease Reports

15 pages, 379 KB

Open AccessEditor’s ChoiceReview

Cardiovascular Manifestations Documented in Patients with Lyme Disease: Clinical Presentation, Management Strategies, and Outcomes

by Luis Antonio Cortes Islas, Priscila Mishelle Bartolo Gomez, Nora Denice Cuevas Obispo, Ayelen Xicohtencatl Muñoz, Lao Yuling Lopez Lucero and Juan Pablo Ramirez Hinojosa

Infect. Dis. Rep. 2026, 18(3), 40; https://doi.org/10.3390/idr18030040 - 27 Apr 2026

Viewed by 1272

Abstract

Background/Objectives: Lyme disease is a tick-borne zoonosis caused by Borrelia burgdorferi that can affect multiple organ systems. Although cardiovascular involvement is considered uncommon, it may lead to severe and potentially life-threatening complications, particularly conduction disturbances and inflammatory cardiac conditions. This review aims to [...] Read more.

Background/Objectives: Lyme disease is a tick-borne zoonosis caused by Borrelia burgdorferi that can affect multiple organ systems. Although cardiovascular involvement is considered uncommon, it may lead to severe and potentially life-threatening complications, particularly conduction disturbances and inflammatory cardiac conditions. This review aims to describe the spectrum of cardiovascular manifestations documented in patients with Lyme disease, focusing on clinical presentation, diagnostic approaches, management strategies, and reported outcomes. Methods: A narrative literature review was performed using PubMed, MEDLINE, and Google Scholar. Articles published between January 2000 and July 2025 in English or Spanish were screened. Eligible studies included original research articles, systematic and narrative reviews, case series, and case reports describing confirmed Lyme disease with cardiovascular involvement. A total of 30 studies were included. The available evidence was predominantly based on case reports and small case series, with considerable heterogeneity in study design, patient populations, and reported outcomes. Data on clinical manifestations, diagnostic methods, treatment strategies, and outcomes were extracted and synthesized. Results: Atrioventricular conduction disturbances were the most frequently reported cardiovascular manifestation, ranging from first-degree block to complete heart block, often presenting abruptly with syncope or bradycardia. Other reported manifestations included atrial and ventricular arrhythmias, myocarditis, pericarditis, myopericarditis, valvular endocarditis, aortitis, and vasculitis. Diagnosis relied on a combination of clinical suspicion, epidemiologic exposure, serologic testing, electrocardiographic monitoring, and cardiac imaging. Most patients were treated with antimicrobial therapy, commonly intravenous ceftriaxone followed by oral doxycycline, with temporary pacemaker support required in selected cases. Overall, clinical outcomes were favorable when treatment was initiated promptly. Conclusions: Cardiovascular involvement in Lyme disease, although infrequent, encompasses a broad clinical spectrum with potentially serious consequences. Early recognition, appropriate diagnostic evaluation, and timely antimicrobial therapy are essential to ensure reversibility of cardiac manifestations and favorable outcomes. However, the available evidence is limited by heterogeneity and the predominance of low-level-evidence studies. Full article

(This article belongs to the Section Bacterial Diseases)

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11 pages, 1102 KB

Open AccessEditor’s ChoiceArticle

Trends in Outpatient Antibiotic Prescriptions Issued in Croatian Primary Healthcare, 2015–2024

by Anamaria Jurčević, Jelena Dimnjaković and Rok Čivljak

Infect. Dis. Rep. 2026, 18(2), 36; https://doi.org/10.3390/idr18020036 - 14 Apr 2026

Viewed by 855

Abstract

Objectives: Outpatient antibiotic prescribing is a major driver of antimicrobial resistance, yet detailed long-term analyses of prescribing patterns in Croatia remain limited. This study aimed to analyze trends in outpatient antibiotic prescriptions issued in Croatian primary healthcare from 2015 to 2024, stratified by [...] Read more.

Objectives: Outpatient antibiotic prescribing is a major driver of antimicrobial resistance, yet detailed long-term analyses of prescribing patterns in Croatia remain limited. This study aimed to analyze trends in outpatient antibiotic prescriptions issued in Croatian primary healthcare from 2015 to 2024, stratified by antibiotic class, substance, and the WHO AWaRe classification. Methods: A retrospective analysis of nationwide data on antibiotic prescriptions issued in primary care outpatient settings was conducted using the data from the Central Health Information System of the Republic of Croatia. All prescriptions for ATC group J01 antibiotics issued between 1 January 2015 and 31 December 2024 were included. The primary outcome was the annual number of issued outpatient antibiotic prescriptions, described overall and by substance. Annual counts were additionally expressed as a percentage of the 2015 baseline (index year = 100%) to enable the comparison across substances with different prescribing volumes. The prescriptions were classified according to the WHO AWaRe framework. Results: A total of 31,048,414 outpatient antibiotic prescriptions were issued between 2015 and 2024. Overall prescribing declined by 5.6% from 2015 to 2019, followed by a marked decrease of 21.0% in 2020, and subsequently rebounded to 3,338,235 prescriptions by 2024, a number virtually identical to pre-pandemic levels. Co-amoxiclav and azithromycin together accounted for 49.5% of all prescriptions. By 2024, prescribing third-generation cephalosporins increased by 281.9% compared to the 2015 levels, while prescribing amoxicillin decreased by 43.6% over the same period. The proportion of Access antibiotics declined from 64.7% in 2015 to 57.9% in 2024. Conclusions: The main challenge for antimicrobial stewardship in Croatia lies not only in overall prescribing volume but in prescribing composition. Targeted interventions are needed to reduce reliance on broad-spectrum agents and promote the use of narrower-spectrum first-line alternatives. Full article

(This article belongs to the Section Antimicrobial Stewardship and Resistance)

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7 pages, 526 KB

Open AccessEditor’s ChoiceCase Report

Progressive Multifocal Leukoencephalopathy in AIDS: The Diagnostic Role of PET Imaging

by Virginia Donini, Riccardo Paggi, Alberto Farese, Costanza Malcontenti, Enrico Tagliaferri, Claudio Caroselli, Spartaco Sani, Maria Matteini, Alessandro Bartoloni and Lorenzo Zammarchi

Infect. Dis. Rep. 2026, 18(2), 33; https://doi.org/10.3390/idr18020033 - 8 Apr 2026

Viewed by 500

Abstract

Introduction: The majority of progressive multifocal leukoencephalopathy (PML) cases is still represented by patients affected by acquired immunodeficiency syndrome (AIDS). Diagnosis of PML relies on histopathological findings or by the combination of clinical signs, radiological evidence, and molecular positivity of the JC virus [...] Read more.

Introduction: The majority of progressive multifocal leukoencephalopathy (PML) cases is still represented by patients affected by acquired immunodeficiency syndrome (AIDS). Diagnosis of PML relies on histopathological findings or by the combination of clinical signs, radiological evidence, and molecular positivity of the JC virus in cerebrospinal fluid. However, AIDS status predisposes to various diseases involving the brain, testing the diagnostic ability of the clinician. Case description: We describe a PML case in a patient with AIDS, in whom lumbar puncture was initially impossible for severe thrombocytopenia and magnetic resonance showed an hyperintense lesion and was unable to distinguish between PML and lymphoma. In this case, [¹⁸F]-fluorodeoxyglucose (FDG)-PET imaging showing a hypometabolism of the lesion helped to initially orient toward PML, as diagnosis was later confirmed by lumbar puncture. We collected 21 cases in the literature in which [¹⁸F]-FDG-PET was helpful in cases of PML. Discussion and Conclusions: PET imaging is not considered a standard diagnostic tool for PML. However, in selected cases, it may provide valuable information to direct the diagnosis towards PML. Full article

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9 pages, 799 KB

Open AccessEditor’s ChoiceArticle

Heart Failure Incidence and Risk Factors in U.S. Adults Receiving Bezlotoxumab: A Large Database Analysis

by Chia-Yu Chiu, Daniel B. Chastain, Joseph Sassine and Andrés F. Henao-Martínez

Infect. Dis. Rep. 2026, 18(2), 28; https://doi.org/10.3390/idr18020028 - 31 Mar 2026

Viewed by 836

Abstract

Background: Bezlotoxumab is used to prevent recurrent Clostridioides difficile infection. Although well tolerated, heart failure (HF) exacerbations have been reported as adverse events in clinical trials. This study evaluates the incidence and predictors of HF exacerbation following bezlotoxumab. Methods: We used the TriNetX [...] Read more.

Background: Bezlotoxumab is used to prevent recurrent Clostridioides difficile infection. Although well tolerated, heart failure (HF) exacerbations have been reported as adverse events in clinical trials. This study evaluates the incidence and predictors of HF exacerbation following bezlotoxumab. Methods: We used the TriNetX research database to identify U.S. adults who received bezlotoxumab and stratified them into three groups based on HF history: no HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). The 90-day cumulative incidence of HF events and mortality were assessed. Cox proportional hazard models identified predictors of HF events. Results: Among 2515 patients, 89% had no HF history, 4% had HFpEF, and 7% had HFrEF. The 90-day HF event rates were 1%, 29%, and 52% for the no HF, HFpEF, and HFrEF groups, respectively (p < 0.001). The 90-day all-cause mortality was 0.9%. Corresponding 90-day all-cause mortality rates were 0.04%, 4%, and 11%, respectively (p < 0.001). Independent positive predictors of HF events included HFrEF (aHR 19.400), HFpEF (adjusted hazard ratio [aHR] 8.632), heart transplant (aHR 7.485), hyperlipidemia (aHR 3.184), valvular heart disease (aHR 2.267), chronic kidney disease stage ≥ 3 (aHR 1.715), and ischemic heart disease (aHR 1.987). Protective factors included non-cardiac solid organ transplant (aHR 0.333). Conclusions: Bezlotoxumab appears safe in patients without HF history but is associated with a significantly increased risk of HF exacerbation in those with pre-existing HF, especially HFrEF. Full article

(This article belongs to the Section Bacterial Diseases)

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5 pages, 390 KB

Open AccessEditor’s ChoiceEditorial

Addressing Infectious Diseases in Vulnerable Populations Under the Auspices of One Health: A Call for Action in Europe

by Botond Lakatos, Ferenc Balázs Farkas, Giacomo Guido, Annalisa Saracino and Francesco Di Gennaro

Infect. Dis. Rep. 2026, 18(1), 12; https://doi.org/10.3390/idr18010012 - 15 Jan 2026

Cited by 1 | Viewed by 1108

Abstract

While infectious diseases represent a daunting challenge to public health worldwide, their impact is disproportionately felt among the most vulnerable and marginalized segments of society [...] Full article

(This article belongs to the Special Issue Infections in Vulnerable Populations)

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14 pages, 962 KB

Open AccessEditor’s ChoiceReview

Diagnostic Accuracy of Utilizing Artificial Intelligence for Malaria Diagnostic: A Systematic Review and Meta-Analysis

by Icha Farihah Deniyati Faratisha, Khadijah Cahya Yunita, Hanifa Rizky Rahmawati, Loeki Enggar Fitri, Nuning Winaris and Lailil Muflikah

Infect. Dis. Rep. 2026, 18(1), 11; https://doi.org/10.3390/idr18010011 - 13 Jan 2026

Cited by 3 | Viewed by 1946

Abstract

Background: Malaria remains a major public health concern around the world. Microscopic blood smear examination continues to be the gold standard for diagnosis; however, it requires high technical skills and expertise, limiting diagnostic accuracy in resource-poor settings. Artificial intelligence (AI) has emerged as [...] Read more.

Background: Malaria remains a major public health concern around the world. Microscopic blood smear examination continues to be the gold standard for diagnosis; however, it requires high technical skills and expertise, limiting diagnostic accuracy in resource-poor settings. Artificial intelligence (AI) has emerged as a promising tool to support malaria detection. This systematic review provides an overview of the diagnostic performance of AI-based systems for malaria diagnosis in a clinical setting. Methods: This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and involved articles within the last 10 years that were collected from PubMed, ScienceDirect, Cochrane, EBSCO, and Wiley Online Library. Original articles that reported AI diagnostic accuracy with external validation were involved. The quality of each study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Results: Ten studies with 6754 patients were analyzed. Pooled results of sensitivity [87.7% (95% CI: 78.2–93.4)] and specificity [91.4% (95% CI: 77.3–97.1)] revealed how much the AI agrees with each method when that method is used as a gold standard. Additionally, AI achieved a sensitivity of 87.7% and a specificity of 91.4% compared to microscopy examination and a sensitivity of 90.7% and a specificity of 88.3% compared to polymerase chain reaction (PCR). Conclusions: AI-based systems improve malaria diagnosis by providing high accuracy, automation, and lower costs. Showing performance comparable to reference methods such as microscopy and PCR, AI is a promising complementary tool for malaria control. Full article

(This article belongs to the Section Neglected Tropical Diseases)

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16 pages, 737 KB

Open AccessEditor’s ChoiceReview

Metabolomics in Infectious Diseases and Vaccine Response: Insights into Neglected Tropical and Non-Neglected Pathogens

by Mahbuba Rahman, Hasbun Nahar Hera and Urbana Islam Barsha

Infect. Dis. Rep. 2026, 18(1), 10; https://doi.org/10.3390/idr18010010 - 12 Jan 2026

Cited by 1 | Viewed by 1494

Abstract

Background/objectives: Metabolomics has emerged as a powerful systems-biology tool for deciphering dynamic metabolic alterations occurring during infectious diseases and following vaccination. While genomics and proteomics provide extensive molecular and regulatory information, metabolomics uniquely reflects the biochemical phenotype associated with infection, immune activation, and [...] Read more.

Background/objectives: Metabolomics has emerged as a powerful systems-biology tool for deciphering dynamic metabolic alterations occurring during infectious diseases and following vaccination. While genomics and proteomics provide extensive molecular and regulatory information, metabolomics uniquely reflects the biochemical phenotype associated with infection, immune activation, and immunometabolic reprogramming. The objective of this review is to provide an integrated analysis of metabolomics applications across both neglected tropical diseases (NTDs) and non-NTD pathogens, highlighting its dual role in biomarker discovery and vaccine response evaluation. Methods: A comprehensive literature-based synthesis was conducted to examine metabolomic studies in infectious diseases and vaccinology. Metabolic perturbations associated with specific pathogens, as well as vaccine-induced metabolic changes and correlates of immune responses, were systematically analyzed and compared across NTD and non-NTD contexts. Results: Distinct pathogen- and vaccine-associated metabolic signatures were identified, reflecting alterations in glycolysis, amino acid metabolism, lipid remodeling, and immunoregulatory pathways. Comparative analysis revealed both shared and disease-specific metabolic biomarkers across NTDs and non-NTD infections. Importantly, vaccine-related metabolic correlates were shown to mirror immune activation states and, in some cases, predict immunogenicity and response durability. Conclusions: This review bridges metabolomics research in infectious disease pathogenesis and vaccine immunology across the NTD and non-NTD spectrum. By integrating these domains, it introduces the concept of “metabolic immuno-signatures” as predictive and translational tools for evaluating vaccine efficacy and immune response outcomes. Full article

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

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8 pages, 241 KB

Open AccessEditor’s ChoiceEssay

Faster than Virus: The Physics of Pandemic Prediction

by Serena Vita, Giovanni Morlino, Alessandra D’Abramo, Laura Scorzolini, Gaetano Maffongelli, Delia Goletti, Francesco Vairo, Enrico Girardi, Massimo Ciccozzi and Emanuele Nicastri

Infect. Dis. Rep. 2026, 18(1), 7; https://doi.org/10.3390/idr18010007 - 9 Jan 2026

Viewed by 876

Abstract

Background: Zoonotic spillover events with pandemic potential are increasingly associated with environmental change, ecosystem disruption, and intensified human–animal interactions. Although the specific origin and timing of future pandemics remain uncertain, there is a clear need to complement traditional preparedness strategies with approaches that [...] Read more.

Background: Zoonotic spillover events with pandemic potential are increasingly associated with environmental change, ecosystem disruption, and intensified human–animal interactions. Although the specific origin and timing of future pandemics remain uncertain, there is a clear need to complement traditional preparedness strategies with approaches that support earlier anticipation and prevention. Objectives: This study aims to propose a conceptual approach to reframe pandemic preparedness toward proactive surveillance and spillover prevention. Methods: We introduce a tachyon-inspired conceptual approach, using a thought experiment based on hypothetical faster-than-light particles to illustrate anticipatory observation of pandemic emergence. The framework is informed by interdisciplinary literature on emerging infectious diseases, One Health surveillance, predictive epidemiology, and public-health preparedness. Results: The proposed approach highlights the importance of proactive, integrated surveillance systems that combine human, animal, and environmental data. Key elements include the use of advanced analytical tools such as neural networks, early characterization of population risk profiles, strengthened public-health infrastructure, coordinated governance, adaptable financial resources, and a resilient healthcare workforce. The integration of animal welfare considerations, translational research, and planetary health principles is emphasized as central to reducing spillover risk. Conclusions: Tachyon-inspired thinking offers a conceptual tool to support a shift from reactive pandemic response toward proactive anticipation and prevention. Embedding integrated surveillance and One Health principles into public-health systems may enhance early detection capacity and contribute to mitigating the impact of future pandemics. Full article

(This article belongs to the Section Viral Infections)

4 pages, 180 KB

Open AccessEditor’s ChoiceEditorial

Raising the Bar of PK/PD Target Attainment of Beta-Lactams in Daily Clinical Practice: An Effective Strategy to Overcome Resistance Development to Novel Beta-Lactams?

by Milo Gatti and Federico Pea

Infect. Dis. Rep. 2026, 18(1), 3; https://doi.org/10.3390/idr18010003 - 23 Dec 2025

Cited by 3 | Viewed by 1186

Abstract

The increase of infections caused by difficult-to-treat resistant (DTR) Gram-negatives is becoming an ever-growing remarkable issue for public health [...] Full article

26 pages, 3504 KB

Open AccessEditor’s ChoiceReview

The Evolution of Artificial Intelligence in Ocular Toxoplasmosis Detection: A Scoping Review on Diagnostic Models, Data Challenges, and Future Directions

by Dodit Suprianto, Loeki Enggar Fitri, Ovi Sofia, Akhmad Sabarudin, Wayan Firdaus Mahmudy, Muhammad Hatta Prabowo and Werasak Surareungchai

Infect. Dis. Rep. 2025, 17(6), 148; https://doi.org/10.3390/idr17060148 - 8 Dec 2025

Cited by 2 | Viewed by 1721

Abstract

Ocular Toxoplasmosis (OT), a leading cause of infectious posterior uveitis, presents significant diagnostic challenges in atypical cases due to phenotypic overlap with other retinochoroiditides and a reliance on expert interpretation of multimodal imaging. This scoping review systematically maps the burgeoning application of artificial [...] Read more.

Ocular Toxoplasmosis (OT), a leading cause of infectious posterior uveitis, presents significant diagnostic challenges in atypical cases due to phenotypic overlap with other retinochoroiditides and a reliance on expert interpretation of multimodal imaging. This scoping review systematically maps the burgeoning application of artificial intelligence (AI), particularly deep learning, in automating OT diagnosis. We synthesized 22 studies to characterize the current evidence, data landscape, and clinical translation readiness. Findings reveal a field in its nascent yet rapidly accelerating phase, dominated by convolutional neural networks (CNNs) applied to fundus photography for binary classification tasks, often reporting high accuracy (87–99.2%). However, development is critically constrained by small, imbalanced, single-center datasets, a near-universal lack of external validation, and insufficient explainable AI (XAI), creating a significant gap between technical promise and clinical utility. While AI demonstrates strong potential to standardize diagnosis and reduce subjectivity, its path to integration is hampered by over-reliance on internal validation, the “black box” nature of models, and an absence of implementation strategies. Future progress hinges on collaborative multi-center data curation, mandatory external and prospective validation, the integration of XAI for transparency, and a focused shift towards developing AI tools that assist in the complex differential diagnosis of posterior uveitis, ultimately bridging the translational chasm to clinical practice. Full article

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9 pages, 1516 KB

Open AccessEditor’s ChoiceArticle

Repurposing Agents as Anti-Infective Therapeutics to Aid in the Treatment of Candida auris Infections

by Nazary Nebeluk and James B. Doub

Infect. Dis. Rep. 2025, 17(6), 144; https://doi.org/10.3390/idr17060144 - 27 Nov 2025

Cited by 1 | Viewed by 1140

Abstract

Background: Candida auris is an emerging nosocomial fungal pathogen whose inherent multidrug resistance and ability to form biofilms make treatment extremely difficult. Given the limited number of therapeutic options available and the poor clinical outcomes associated with current therapeutics, this study evaluated the [...] Read more.

Background: Candida auris is an emerging nosocomial fungal pathogen whose inherent multidrug resistance and ability to form biofilms make treatment extremely difficult. Given the limited number of therapeutic options available and the poor clinical outcomes associated with current therapeutics, this study evaluated the potential of repurposing existing agents to treat C. auris infections. Methods: Six clinical C. auris isolates from a single tertiary care center were tested for in vitro susceptibility to topical agents (hypochlorous acid, chlorhexidine gluconate, sodium hypochlorite) and systemic agents (N-acetylcysteine, ethylenediaminetetraacetic acid, ethyl pyruvate). Furthermore, these six isolates were allowed to form biofilms and the ability of repurposed agents to disrupt C. auris biofilms was measured. Results: All agents except N-acetylcysteine demonstrated inhibitory activity against planktonic C. auris. With respect to C. auris biofilms, these were characterized using electron microscopy and all six agents showed statistically significant (p < 0.05) ability to disrupt biofilms over controls. Moreover, the ability to disrupt biofilms was also statistically significant (p < 0.05) when compared to use of either normal saline or amphotericin B. Discussion: These findings support the potential clinical utility of repurposing existing agents, such as Ethyl Pyruvate or EDTA, for systemic C. auris infections, or hypochlorous acid for C. auris wound infections. Yet, further studies are needed to optimize dosing parameters and evaluate in vivo efficacy and tolerability. Full article

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7 pages, 248 KB

Open AccessEditor’s ChoiceArticle

The Neutrophil/Lymphocyte Ratio Was Identified as a Marker of Severe Influenza During the 2024–2025 Outbreak in France

by Matteo Vassallo, Marion Derollez, Marc-Hadrien Veaute, Nicolas Clement, Roxane Fabre, Laurene Lotte, Yanis Kouchit, Sabrina Manni, Ursula Moracchini, Elea Blanchouin, Julie Better, Ludivine Rerolle, Raphael Chambon, Pierre Alfonsi Bertrand, Sarah Baccialone, Jerome Lemoine, Audrey Sindt and Pierre-Marie Bertrand

Infect. Dis. Rep. 2025, 17(5), 127; https://doi.org/10.3390/idr17050127 - 10 Oct 2025

Cited by 1 | Viewed by 1028

Abstract

Background/Objectives: Influenza continues to cause high morbidity and mortality rates worldwide, inflicting a major burden on the public health system. There is little data available on the 2024–2025 seasonal outbreak. Moreover, biomarkers for rapidly identifying subjects at higher risk for severe forms are [...] Read more.

Background/Objectives: Influenza continues to cause high morbidity and mortality rates worldwide, inflicting a major burden on the public health system. There is little data available on the 2024–2025 seasonal outbreak. Moreover, biomarkers for rapidly identifying subjects at higher risk for severe forms are needed. Methods: We retrospectively collected hospitalization data for influenza in Cannes, France, during the 2024–2025 seasonal outbreak. Severe forms were defined as cases either requiring admission to the Intensive Care Unit (ICU) or resulting in death. They were compared to uncomplicated forms. Main demographic, clinical, radiological, and laboratory characteristics were collected for each patient. Results: From October 2024 to May 2025, 59 patients were admitted to either the Infectious Diseases Department or the ICU (56% male, age 72 years, 27% vaccinated, influenza type A 93%, symptom duration 3.5 days prior to hospitalization, 31% admissions to ICU, 14% deaths). Vaccination status did not differ between severe and uncomplicated forms. In the univariate analysis, severe forms had higher neutrophil/lymphocyte and platelet/lymphocyte ratios upon admission and included more cases of acute hepatitis, pneumonia, and oseltamivir use than uncomplicated forms. A neutrophil/lymphocyte ratio > 15 was independently associated with severity (OR_adj 8.79, 95% CI: 1.34–57.6, p = 0.023), with 40.9% sensitivity, 94.6% specificity, 81.8% positive predictive value, and 72.3% negative predictive value for predicting a severe form. Conclusions: The N/L ratio was an easy-to-perform predictive marker for influenza severity during the 2024–2025 seasonal outbreak, warranting further prospective studies Full article

7 pages, 515 KB

Open AccessEditor’s ChoiceCase Report

Cutaneous Leishmaniasis in the Immunocompromised: Diagnostic and Therapeutic Insights from a Case Documented in Central Italy

by Laura Povolo, Anna Barbiero, Michele Spinicci, Nicola Petrosillo, Alessandro Bartoloni and Lorenzo Zammarchi

Infect. Dis. Rep. 2025, 17(5), 125; https://doi.org/10.3390/idr17050125 - 8 Oct 2025

Cited by 2 | Viewed by 1551

Abstract

Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression. [...] Read more.

Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression. Case presentation: We present the case of a 63-year-old woman on anti-tumor necrosis factor (TNF) therapy, who underwent surgical excision for the diagnostic purposes of a chronic non-healing lesion located on her right arm. The histopathological examination revealed the presence of Leishmania amastigotes. CL relapsed in the following months, with new lesions appearing both close to the excision scar and at a different body site. At this point, in order to avoid another surgical intervention, cutaneous swabs for Leishmania Polymerase Chain Reaction (PCR) were performed on both lesions. Both samples yielded positive results, and the patient was treated with a 4-week course of miltefosine. Conclusions: These results support the use of cutaneous swabs as a highly sensitive and less invasive tool for the diagnostic workup of CL. In addition, our case prompts a reflection on the management of immunosuppressed patients with CL, with particular emphasis on the risk of reactivation or simultaneous involvement of multiple anatomical sites, thus suggesting the need for specific considerations and personalized management for this group of subjects. Full article

(This article belongs to the Section Neglected Tropical Diseases)

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13 pages, 407 KB

Open AccessEditor’s ChoiceReview

Public Health Impact of the MVA-BN Vaccine During the 2022 Mpox Outbreak: A Systematic Review

by Sarah C. Katsandres, Suzanne K. Scheele, Takako Kiener and Lisa Bloudek

Infect. Dis. Rep. 2025, 17(5), 124; https://doi.org/10.3390/idr17050124 - 7 Oct 2025

Cited by 2 | Viewed by 1986

Abstract

Background/Objectives: Previously endemic to sub-Saharan Africa, mpox has since emerged globally, resulting in more than 150,000 cases in over 100 countries in the 2022 outbreak. The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine is licensed and recommended for at-risk populations in many countries and [...] Read more.

Background/Objectives: Previously endemic to sub-Saharan Africa, mpox has since emerged globally, resulting in more than 150,000 cases in over 100 countries in the 2022 outbreak. The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine is licensed and recommended for at-risk populations in many countries and received World Health Organization (WHO) pre-qualification in September 2024. Methods: We conducted this systematic literature review (SLR) to compare analyses, published from 2022 through 2024, of cases averted due to mpox vaccination during the 2022 outbreak to assess the feasibility of estimating the impact on the United States (US). The search included studies that utilized reported case data from any country. Results: Nine studies were identified. Four estimated the impact of the vaccine as directly modeled in the 2022 outbreak, and cases averted ranged from 10% to 79%. One assessed the projected impact on future outbreaks. Four estimated the impact of hypothetical vaccination strategies. Only one model utilized assumptions appropriate for the US outbreak and population, to allow for an estimate of US cases averted (53,499 cases averted due to the synergistic effects of the vaccine and behavioral changes, with 8096 due to the mpox vaccine alone and 5478 due to behavioral changes alone). Conclusions: Variation in estimates for the impact of the vaccine can typically be explained by differing model approaches, assumptions, inputs, and epidemic peaks and vaccination campaign roll-out. Most models were not generalizable to the US outbreak and population, but one yielded a reasonable estimate. Nevertheless, all models emphasized the importance of vaccination combined with other public health interventions. Full article

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16 pages, 648 KB

Open AccessEditor’s ChoiceReview

Clean to Prevent, Monitor to Protect: A Scoping Review on Strategies for Monitoring Cleaning in Hospitals to Prevent HAIs

by Biagio Santella, Antonio Donato, Luigi Fortino, Vittoria Satriani, Rosaria Flora Ferrara, Emanuela Santoro, Walter Longanella, Gianluigi Franci, Mario Capunzo and Giovanni Boccia

Infect. Dis. Rep. 2025, 17(5), 120; https://doi.org/10.3390/idr17050120 - 21 Sep 2025

Cited by 1 | Viewed by 2995

Abstract

Background/Objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence [...] Read more.

Background/Objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence and finding research gaps to inform evidence-based recommendations for healthcare facilities. Methods: Following PRISMA Scoping Review guidelines, we conducted comprehensive searches on PubMed and Scopus databases from 2010–2025 using terms related to environmental monitoring, surface sampling, air sampling, and infection control in hospital settings. Eighteen studies met inclusion criteria; data were extracted using standardized forms and synthesized narratively, organizing findings by monitoring approach categories. Results: These studies revealed diverse monitoring approaches including fluorescent markers (22.2%), ATP bioluminescence assays (33.3%), microbiological methods (44.4%), and direct observation techniques (27.8%). MRSA was the most frequently targeted pathogen (55.6%), with limited attention to Gram-negative multidrug-resistant organisms and fungi. Studies showed significant variability in pass/fail thresholds (ATP: 50–500 RLU) and lack of standardized benchmarks. Recent research (50% post-2021) increasingly incorporates molecular techniques and digital technologies, though implementation remains resource intensive. Conclusions: A multimodal approach combining visual inspection, ATP assays, and microbiological methods appears most effective for comprehensive environmental monitoring. Critical gaps include lack of standardized thresholds, limited pathogen diversity focus, and insufficient integration of emerging digital technologies. Future research should focus on setting universal standards, expanding pathogen coverage, and assessing cost-effective monitoring strategies, all while ensuring legal compliance with hygiene regulations to enhance patient safety. Full article

(This article belongs to the Special Issue Containment Strategies of Infectious Diseases: Epidemiology, Surveillance and Prophylaxis)

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4 pages, 202 KB

Open AccessEditor’s ChoiceEditorial

Recombinant Yeast-Based Vaccines: Importance and Applications

by Ravinder Kumar

Infect. Dis. Rep. 2025, 17(5), 118; https://doi.org/10.3390/idr17050118 - 18 Sep 2025

Cited by 4 | Viewed by 1708

Abstract

Vaccines are biological preparations used to elicit an immune response, in order to prevent future infections or minimize damage from possible future infection [...] Full article

8 pages, 465 KB

Open AccessEditor’s ChoiceBrief Report

Pathways to Diagnose Infectious Pulmonary Vascular Disease in Rural Mozambique

by Yolanda Sabino, Cizália Ribeiro, Joshua Mungue and Ana Olga Mocumbi

Infect. Dis. Rep. 2025, 17(5), 116; https://doi.org/10.3390/idr17050116 - 15 Sep 2025

Viewed by 1102

Abstract

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and [...] Read more.

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and poor socioeconomic status further compromise prevention, early diagnosis, and treatment. Clinical algorithms for early screening, including hand-held echocardiography and point-of-care testing performed by non-specialists, are needed in rural Sub-Saharan Africa to decentralize care and improve outcomes. Methods: We describe a case of pulmonary hypertension diagnosed in a child living in Mozambique, to discuss the challenges for the diagnosis of infectious pulmonary arterial hypertension in rural settings in Africa, based on a short literature review. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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15 pages, 1891 KB

Open AccessEditor’s ChoiceReview

Technical Challenges in Studying Infectious Disease-Associated Pulmonary Hypertension in Low- and Middle-Income Countries with Limited Resources

by Jennifer van Heerden, Irina Mbanze, Elizabeth Louw, Olukayode Aremu, Anastase Dzudie, Ana Mocumbi, Threnesan Naidoo, Brian Allwood and Friedrich Thienemann

Infect. Dis. Rep. 2025, 17(5), 109; https://doi.org/10.3390/idr17050109 - 10 Sep 2025

Cited by 1 | Viewed by 1477

Abstract

Background: Pulmonary hypertension (PH) disproportionately affects those residing in low- and middle-income countries (LMICs). Given that these countries also have a high prevalence of infectious diseases, many cases of PH are either directly or indirectly related to infectious etiologies. Despite this correlation, the [...] Read more.

Background: Pulmonary hypertension (PH) disproportionately affects those residing in low- and middle-income countries (LMICs). Given that these countries also have a high prevalence of infectious diseases, many cases of PH are either directly or indirectly related to infectious etiologies. Despite this correlation, the precise burden of infectious disease-associated PH is largely underappreciated due to a lack of diagnostic resources, a shortage of clinical expertise to carry out right heart catheterization and poor access to healthcare facilities in many low- and middle-income settings. Methods: In this narrative review, we highlight the significant burden of infectious disease-associated PH in LMICs, outline the technical challenges faced by LMICs when diagnosing PH, and propose possible solutions for diagnosing PH in resource-constrained settings. Conclusions: Low-cost and sustainable solutions for infectious disease-associated PH in LMICs should be prioritized. Meaningful solutions require collaborative efforts and capacity building in LMICs. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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17 pages, 1604 KB

Open AccessEditor’s ChoiceArticle

Health Disparities in Central Line-Associated Bloodstream Infections: Analysis of the U.S. National Inpatient Sample Database (2016–2022)

by Nicholas Mielke, Ryan W. Walters and Faran Ahmad

Infect. Dis. Rep. 2025, 17(5), 105; https://doi.org/10.3390/idr17050105 - 28 Aug 2025

Cited by 1 | Viewed by 2649

Abstract

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and [...] Read more.

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and costs using the National Inpatient Sample (NIS) from 2016 to 2022. Methods: We conducted a retrospective analysis of adult hospitalizations using the NIS database that included central venous catheter placement and identified CLABSI using AHRQ’s Patient Safety Indicator 07. Primary outcomes included CLABSI incidence and in-hospital mortality; secondary outcomes were LOS and inflation-adjusted hospital costs. Outcomes were analyzed using logistic and lognormal regression models, focusing on demographic and clinical variables that included sex, race, socioeconomic status, and insurance type. Results: Among 11.5 million CVCs placed between 2016 and 2022, 6.56 million met CLABSI eligibility criteria, with 1 in 400 (0.25%) complicated by CLABSI. Blacks had 29.8% higher adjusted odds of CLABSI than Whites (p < 0.001), whereas Medicaid beneficiaries had 18.4% higher odds compared to those privately insured (p = 0.002). CLABSI was associated with a 97% increase in LOS and an 82% increase in hospital costs (both p < 0.001). In-hospital mortality was 13.3% and did not differ significantly by CLABSI status after adjustment. Discussion: Racial and socioeconomic disparities persist in CLABSI incidence and healthcare resource utilization, with Blacks and Medicaid beneficiaries at the highest risk. Although CLABSI rates returned to pre-pandemic levels in 2022, associated costs and LOS remained elevated. Further research and targeted prevention strategies are needed to reduce health disparities and improve patient outcomes. Full article

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11 pages, 910 KB

Open AccessEditor’s ChoiceArticle

Antimicrobial Effect of Gentamicin/Heparin and Gentamicin/Citrate Lock Solutions on Staphylococcus aureus and Pseudomonas aeruginosa Clinical Strains

by Daniel Salas-Treviño, Arantxa N. Rodríguez-Rodríguez, María T. Ramírez-Elizondo, Magaly Padilla-Orozco, Edeer I. Montoya-Hinojosa, Paola Bocanegra-Ibarias, Samantha Flores-Treviño and Adrián Camacho-Ortiz

Infect. Dis. Rep. 2025, 17(4), 98; https://doi.org/10.3390/idr17040098 - 6 Aug 2025

Viewed by 2295

Abstract

Background/Objectives: Hemodialysis catheter-related bloodstream infection (HD-CRBSIs) is a main cause of morbidity in hemodialysis. New preventive strategies have emerged, such as using lock solutions with antiseptic or antibiotic capacity. In this study, the antimicrobial effect was analyzed in vitro and with a catheter [...] Read more.

Background/Objectives: Hemodialysis catheter-related bloodstream infection (HD-CRBSIs) is a main cause of morbidity in hemodialysis. New preventive strategies have emerged, such as using lock solutions with antiseptic or antibiotic capacity. In this study, the antimicrobial effect was analyzed in vitro and with a catheter model of lock solutions of gentamicin (LSG), gentamicin/heparin (LSG/H), and gentamicin/citrate (LSG/C) in clinical and ATCC strains of Pseudomonas aeruginosa and Staphylococcus aureus. Methods: The formation, minimum inhibitory concentration, and minimum inhibitory concentration of the biofilm and minimum biofilm eradication concentration of the lock solutions were determined. Additionally, colony-forming unit assays were performed to evaluate the antimicrobial efficacy of the lock solutions in a hemodialysis catheter inoculation model. Results: The minimum inhibitory concentration (MIC) of planktonic cells of both P. aeruginosa and S. aureus for LSG/H and LSG/C was 4 µg/mL. In the minimum biofilm inhibitory concentration (MBIC) tests, the LSG/H was less effective than LSG/C, requiring higher concentrations for inhibition, contrary to the minimum biofilm eradication concentration (MBEC), where LSG/H was more effective. All lock solutions eradicated P. aeruginosa biofilms in the HD catheter model under standard conditions. Nevertheless, under modified conditions, the lock solutions were not as effective versus ATCC and clinical strains of S. aureus. Conclusions: Our analysis shows that the lock solutions studied managed to eradicate intraluminal mature P. aeruginosa in non-tunneled HD catheters under standard conditions. Biofilm inhibition and eradication were observed at low gentamicin concentrations, which could optimize the gentamicin concentration in lock solutions used in HD catheters. Full article

(This article belongs to the Special Issue Prevention, Diagnosis and Treatment of Healthcare-Associated Infections)

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27 pages, 1161 KB

Open AccessEditor’s ChoiceReview

Antifungal Agents in the 21st Century: Advances, Challenges, and Future Perspectives

by Francesco Branda, Nicola Petrosillo, Giancarlo Ceccarelli, Marta Giovanetti, Andrea De Vito, Giordano Madeddu, Fabio Scarpa and Massimo Ciccozzi

Infect. Dis. Rep. 2025, 17(4), 91; https://doi.org/10.3390/idr17040091 - 1 Aug 2025

Cited by 29 | Viewed by 15586

Abstract

Invasive fungal infections (IFIs) represent a growing global health threat, particularly for immunocompromised populations, with mortality exceeding 1.5 million deaths annually. Despite their clinical and economic burden—costing billions in healthcare expenditures—fungal infections remain underprioritized in public health agendas. This review examines the current [...] Read more.

Invasive fungal infections (IFIs) represent a growing global health threat, particularly for immunocompromised populations, with mortality exceeding 1.5 million deaths annually. Despite their clinical and economic burden—costing billions in healthcare expenditures—fungal infections remain underprioritized in public health agendas. This review examines the current landscape of antifungal therapy, focusing on advances, challenges, and future directions. Key drug classes (polyenes, azoles, echinocandins, and novel agents) are analyzed for their mechanisms of action, pharmacokinetics, and clinical applications, alongside emerging resistance patterns in pathogens like Candida auris and azole-resistant Aspergillus fumigatus. The rise of resistance, driven by agricultural fungicide use and nosocomial transmission, underscores the need for innovative antifungals, rapid diagnostics, and stewardship programs. Promising developments include next-generation echinocandins (e.g., rezafungin), triterpenoids (ibrexafungerp), and orotomides (olorofim), which target resistant strains and offer improved safety profiles. The review also highlights the critical role of “One Health” strategies to mitigate environmental and clinical resistance. Future success hinges on multidisciplinary collaboration, enhanced surveillance, and accelerated drug development to address unmet needs in antifungal therapy. Full article

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9 pages, 350 KB

Open AccessEditor’s ChoiceArticle

Clostridioides difficile Infection in the United States of America—A Comparative Event Risk Analysis of Patients Treated with Fidaxomicin vs. Vancomycin Across 67 Large Healthcare Providers

by Sebastian M. Wingen-Heimann, Christoph Lübbert, Davide Fiore Bavaro and Sina M. Hopff

Infect. Dis. Rep. 2025, 17(4), 87; https://doi.org/10.3390/idr17040087 - 23 Jul 2025

Viewed by 2314

Abstract

Background/Objectives: Clostridioides difficile infection (CDI) is a major cause of infectious diarrhea in the inpatient and community setting. Real-world data outside the strict environment of randomized controlled trials (RCTs) are needed to improve the quality of evidence. The aim of this study was [...] Read more.

Background/Objectives: Clostridioides difficile infection (CDI) is a major cause of infectious diarrhea in the inpatient and community setting. Real-world data outside the strict environment of randomized controlled trials (RCTs) are needed to improve the quality of evidence. The aim of this study was to compare different clinical outcomes of CDI patients treated with fidaxomicin with those treated with vancomycin using a representative patient population in the United States of America (USA). Methods: Comprehensive real-world data were analyzed for this retrospective observational study, provided by the TriNetX database, an international research network with electronic health records from multiple USA healthcare providers. This includes in- and outpatients treated with fidaxomicin (FDX) or vancomycin (VAN) for CDI between 01/2013 and 12/2023. The following cohorts were compared: (i) patients treated with fidaxomicin within 10 days following CDI diagnosis (FDX group) vs. (ii) patients treated with vancomycin within 10 days following CDI diagnosis (VAN group). Outcomes analysis between the two cohorts was performed after propensity score matching and included event risk and Kaplan–Meier survival analyses for the following concomitant diseases/events occurring during an observational period of 12 months following CDI diagnosis: death, sepsis, candidiasis, infections caused by vancomycin-resistant enterococci, inflammatory bowel disease, cardiovascular disease, psychological disease, central line-associated blood stream infection, surgical site infection, and ventilator-associated pneumonia. Results: Following propensity score matching, 2170 patients were included in the FDX group and VAN groups, respectively. The event risk analysis demonstrated improved outcomes of patients treated with FDX compared to VAN in 6 out of the 10 events that were analyzed. The highest risk ratio (RR) and odds ratio (OR) were found for sepsis (RR: 3.409; OR: 3.635), candidiasis (RR: 2.347; OR: 2.431), and death (RR: 1.710; OR: 1.811). The Kaplan–Meier survival analysis showed an overall survival rate until the end of the 12-month observational period of 87.06% in the FDX group and 78.49% in the VAN group (log-rank p < 0.001). Conclusions: Our comparative event risk analysis demonstrated improved outcomes for patients treated with FDX compared to VAN in most of the observed events and underlines the results of previously conducted RCTs, highlighting the beneficial role of FDX compared to VAN. Further big data analyses from other industrialized countries are needed for comparison with our observations. Full article

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12 pages, 939 KB

Open AccessEditor’s ChoiceBrief Report

Pulmonary Hypertension Secondary to Fungal Infections: Underexplored Pathological Links

by Andrea Jazel Rodríguez-Herrera, Sabrina Setembre Batah, Maria Júlia Faci do Marco, Carlos Mario González-Zambrano, Luciane Alarcão Dias-Melicio and Alexandre Todorovic Fabro

Infect. Dis. Rep. 2025, 17(4), 84; https://doi.org/10.3390/idr17040084 - 12 Jul 2025

Viewed by 1876

Abstract

Background/Objective: Pulmonary fungal infections are a significant diagnostic challenge, primarily affecting immunocompromised individuals, such as those with HIV, cancer, or organ transplants, and they often lead to substantial morbidity and mortality if untreated. These infections trigger acute inflammatory and immune responses, which may [...] Read more.

Background/Objective: Pulmonary fungal infections are a significant diagnostic challenge, primarily affecting immunocompromised individuals, such as those with HIV, cancer, or organ transplants, and they often lead to substantial morbidity and mortality if untreated. These infections trigger acute inflammatory and immune responses, which may progress to chronic inflammation. This process involves myofibroblast recruitment, the deposition of extracellular matrix, and vascular remodeling, ultimately contributing to pulmonary hypertension. Despite its clinical relevance, pulmonary hypertension secondary to fungal infections remains under-recognized in practice and poorly studied in research. Results/Conclusion: This narrative mini-review explores three key mechanisms underlying vascular remodeling in this context: (1) endothelial injury caused by fungal emboli or autoimmune reactions, (2) direct vascular remodeling during chronic infection driven by inflammation and fibrosis, and (3) distant vascular remodeling post-infection, as seen in granulomatous diseases like paracoccidioidomycosis. Further research and clinical screening for pulmonary hypertension in fungal infections are crucial to improving patient outcomes. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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23 pages, 1088 KB

Open AccessEditor’s ChoiceReview

The Role of Type I Interferons in Tuberculosis and in Tuberculosis-Risk-Associated Comorbidities

by Florence Mutua, Ruey-Chyi Su, Terry Blake Ball and Sandra Kiazyk

Infect. Dis. Rep. 2025, 17(4), 81; https://doi.org/10.3390/idr17040081 - 8 Jul 2025

Cited by 3 | Viewed by 3171

Abstract

The identification of a type I interferon-induced transcriptomic signature in active tuberculosis suggests a potential role for these interferons in the pathogenesis of tuberculosis. Comorbidities such as human immunodeficiency virus, diabetes, systemic lupus erythematosus, end-stage renal disease, and coronavirus disease are epidemiologically linked [...] Read more.

The identification of a type I interferon-induced transcriptomic signature in active tuberculosis suggests a potential role for these interferons in the pathogenesis of tuberculosis. Comorbidities such as human immunodeficiency virus, diabetes, systemic lupus erythematosus, end-stage renal disease, and coronavirus disease are epidemiologically linked to an increased risk for reactivation of latent tuberculosis infection. Notably, type I interferons are also implicated in the pathogenesis of these conditions, with a recognizable type I interferon transcriptomic signature. The mechanisms by which type I interferons in tuberculosis-risk-associated comorbidities may drive the progression of tuberculosis or maintenance of latent infection however remain largely unknown. This review summarizes the existing literature on the increased association between type I interferons, focusing on interferon-α and -β, and the heightened risk of tuberculosis reactivation. It also underscores the similarities in the immunopathogenesis of these comorbidities. A better understanding of these mechanisms is essential to guide the development of host-directed interferon therapies and improving diagnostic biomarkers in M. tuberculosis infection. Full article

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8 pages, 206 KB

Open AccessEditor’s ChoiceCommentary

Clinical and Occupational Predictors of Mortality in Ebola Virus Disease: A Commentary from the Democratic Republic of Congo (2018–2020)

by Jean Paul Muambangu Milambo and Charles Bitamazire Businge

Infect. Dis. Rep. 2025, 17(3), 71; https://doi.org/10.3390/idr17030071 - 18 Jun 2025

Cited by 2 | Viewed by 1616

Abstract

Background: This commentary analyzes demographic, clinical, and occupational characteristics associated with Ebola virus disease (EVD) outcomes during the 2018–2020 outbreak in the Democratic Republic of Congo (DRC). Methods: A total of 3477 EVD cases were included. Descriptive statistics and univariate and multivariate Cox [...] Read more.

Background: This commentary analyzes demographic, clinical, and occupational characteristics associated with Ebola virus disease (EVD) outcomes during the 2018–2020 outbreak in the Democratic Republic of Congo (DRC). Methods: A total of 3477 EVD cases were included. Descriptive statistics and univariate and multivariate Cox regression analyses were performed to evaluate associations between clinical outcomes and patient characteristics. Comorbidity estimates and healthcare worker (HCW) occupational exposure data were incorporated based on the literature. Results: The median age was 26.5 years (SD = 16.1), with the majority (59.7%) aged 20–59. Males represented 51.3% of the cohort. Most patients (81.8%) worked in occupations that were not disease-exposing. Overall, 450 patients (12.9%) died. Although comorbidities initially appeared predictive of mortality (unadjusted HR: 3.05; 95% CI: 2.41–3.87), their effect was not statistically significant after adjustment (adjusted HR: 1.17; 95% CI: 0.87–1.59; p = 0.301). The strongest predictor of death was clinical status at admission: patients classified as “very sick” had an alarmingly high adjusted hazard ratio (HR) of 236.26 (95% CI: 33.18–1682.21; p < 0.001). Non-disease-exposing occupations were also associated with increased mortality (adjusted HR: 1.75; 95% CI: 1.33–2.31; p < 0.001). Conclusions: Despite improvements in outbreak response, mortality remains disproportionately high among patients presenting in critical condition and those outside the health sector. These findings underscore the importance of early detection strategies and enhanced protection for all occupational groups during EVD outbreaks. Full article

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

16 pages, 1995 KB

Open AccessEditor’s ChoiceReview

Gut Microbiome in Pulmonary Arterial Hypertension—An Emerging Frontier

by Sasha Z. Prisco, Suellen D. Oliveira, E. Kenneth Weir, Thenappan Thenappan and Imad Al Ghouleh

Infect. Dis. Rep. 2025, 17(3), 66; https://doi.org/10.3390/idr17030066 - 9 Jun 2025

Cited by 4 | Viewed by 3330

Abstract

Pulmonary arterial hypertension (PAH) is an irreversible disease characterized by vascular and systemic inflammation, ultimately leading to right ventricular failure. There is a great need for adjunctive therapies to extend survival for PAH patients. The gut microbiome influences the host immune system and [...] Read more.

Pulmonary arterial hypertension (PAH) is an irreversible disease characterized by vascular and systemic inflammation, ultimately leading to right ventricular failure. There is a great need for adjunctive therapies to extend survival for PAH patients. The gut microbiome influences the host immune system and is a potential novel target for PAH treatment. We review the emerging preclinical and clinical evidence which strongly suggests that there is gut dysbiosis in PAH and that alterations in the gut microbiome may either initiate or facilitate the progression of PAH by modifying systemic immune responses. We also outline approaches to modify the intestinal microbiome and delineate some practical challenges that may impact efforts to translate preclinical microbiome findings to PAH patients. Finally, we briefly describe studies that demonstrate contributions of infections to PAH pathogenesis. We hope that this review will propel further investigations into the mechanisms by which gut dysbiosis impacts PAH and/or right ventricular function, approaches to modify the gut microbiome, and the impact of infections on PAH development or progression. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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19 pages, 7883 KB

Open AccessEditor’s ChoiceArticle

Differential Effects of Human Immunodeficiency Virus Nef Variants on Pulmonary Vascular Endothelial Cell Dysfunction

by Amanda K. Garcia, Noelia C. Lujea, Javaria Baig, Eli Heath, Minh T. Nguyen, Mario Rodriguez, Preston Campbell, Isabel Castro Piedras, Edu Suarez Martinez and Sharilyn Almodovar

Infect. Dis. Rep. 2025, 17(3), 65; https://doi.org/10.3390/idr17030065 - 6 Jun 2025

Cited by 1 | Viewed by 2025

Abstract

Background: Human Immunodeficiency Virus (HIV) infections remain a source of cardiopulmonary complications among people receiving antiretroviral therapy. Still to this day, pulmonary hypertension (PH) severely affects the prognosis in this patient population. The persistent expression of HIV proteins, even during viral suppression, has [...] Read more.

Background: Human Immunodeficiency Virus (HIV) infections remain a source of cardiopulmonary complications among people receiving antiretroviral therapy. Still to this day, pulmonary hypertension (PH) severely affects the prognosis in this patient population. The persistent expression of HIV proteins, even during viral suppression, has been implicated in vascular dysfunction; however, little is known about the specific effects of these proteins on the pulmonary vasculature. This study investigates the impact of Nef variants derived from HIV-positive pulmonary hypertensive and normotensive donors on pulmonary vascular cells in vitro. Methods: We utilized well-characterized Nef molecular constructs to examine their effects on cell adhesion molecule gene expression (ICAM1, VCAM1, and SELE), pro-apoptotic gene expression (BAX, BAK), and vasoconstrictive endothelin-1 (EDN1) gene expression in endothelial nitric oxide synthase (eNOS) nitric oxide and the production and secretion of pro-inflammatory cytokines over 24, 48, and 72 h post-transfections with Nef variants. Results: HIV Nef variants SF2, NA7, and PH-associated Fr17 and 3236 induced a significant increase in adhesion molecule gene expression of ICAM1, VCAM1, and SELE. Pulmonary normotensive Nef 1138 decreased ICAM1 gene expression, but had increased VCAM1. PH Nef ItVR showed a consistent decrease in ICAM1 and no changes in SELE and VCAM1 expression. Further gene expression analyses of pro-apoptotic genes BAX and BAK demonstrated that Nef NA7, SF2, normotensive Nef 1138, and PH Nef Fr8, Fr9, Fr17, and 3236 variants significantly increased gene expression for apoptosis. Normotensive Nef 1138, as well as PH Nef Fr9 and ItVR, all displayed a statistically significant decrease in BAX expression. The expression of EDN1 had a statistically significant increase in samples treated with Nef NA7, SF2, normotensive Nef 2044 and PH Nef 3236, Fr17, and Fr8. Notably, PH-associated Nef variants sustained pro-inflammatory cytokine production, including IL-2, IL-4, and TNFα, while anti-inflammatory cytokine levels remained insufficient. Furthermore, eNOS was transiently upregulated by all Nef variants except for normotensive Nef 2044. Conclusions: The distinct effects of Nef variants on pulmonary vascular cell biology highlight the complex interplay between Nef, host factors, and vascular pathogenesis according to the variants. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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