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Pathogens
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Emerging and Neglected Pathogens in the Balkans
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Emerging and Neglected Pathogens in the Balkans

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: 10 December 2025 | Viewed by 4136

Special Issue Editors

Dr. Ljiljana Žmak

E-Mail Website
Guest Editor
TB department, Croatian Institute of Public Health; School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
Interests: tuberculosis; non-tuberculous mycobacteria; biosafety; biosecurity
Dr. Tatjana Vilibic-Cavlek

E-Mail Website
Guest Editor
1. Croatian Institute of Public Health, 10000 Zagreb, Croatia
2. School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
Interests: airborne viruses; emerging viruses; zoonoses; TORCH; serology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, we have witnessed an increase in the number of infections caused by emerging pathogens. Along with predominant emerging viral infections, a significant proportion of these cases are caused by both bacterial and parasitic pathogens. Considering the close geographical connection of these infections, neighboring countries often share similar patterns of disease transmission and epidemiology, which is also true for the Balkan region.

The SARS-CoV-2 pandemic is the best example of how important it is to monitor the epidemiological situation in a certain area, to cooperate both at the national and international level, and to share information and experience to be better prepared for a possible infectious threat.

We are aware that infectious diseases have been for centuries one of the leading causes of death globally and that they represent an important threat to public health. However, the scientific spotlight is not evenly distributed to individual pathogens. In the medical community, there is a need to better characterize neglected pathogens and to gather knowledge and information regarding those infections in the Balkan area. It is of paramount importance that in these times of increasing climate change, we continue to focus on emerging pathogens to raise awareness of potential infectious agents when dealing with our patients. We must not forget the complex connection between humans, animals, and the environment. Many emerging infectious diseases are of zoonotic origin; thus, a One-Health approach is needed to better understand the interplay between animals, humans, and the environment. Namely, the epidemiology of zoonotic pathogens is continuously changing due to spreading into new areas, vectors, and hosts. As the number of emerging zoonotic pathogens is growing rapidly, knowledge regarding the epidemiology, pathogenesis, diagnostics, and treatment of these pathogens needs continuous updating.

In this Special Issue, we would like to focus on all aspects of emerging and neglected pathogens in the Balkan area. Topics of interest include (but are not limited to) epidemiology, vector competence and ecology, disease pathogenesis, pathogen–host interactions, virulence factors, clinical aspects, immune response, and diagnostic methods. This Special Issue will also highlight the role of a multidisciplinary approach ('One Health') in the surveillance and control of zoonotic diseases.

Dr. Ljiljana Žmak
Dr. Tatjana Vilibic-Cavlek
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • emerging pathogens
  • neglected pathogens
  • zoonoses
  • epidemiology
  • pathogenesis
  • clinical aspects
  • immune response
  • diagnosis
  • surveillance

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Published Papers (6 papers)

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Research

14 pages, 1166 KiB  
Article
Unravelling the Persistence of the Rare Serovar Salmonella Mikawasima in a Hospital Setting: A Whole-Genome Sequencing Study
by Ivana Ferencak, Ana Gveric Grginic, Tajana Juzbasic, Irena Tabain, Marija Tonkic, Ivana Goic-Barisic, Dragan Juric, Hrvojka Jankovic, Luka Katic and Anita Novak
Pathogens 2025, 14(5), 408; https://doi.org/10.3390/pathogens14050408 - 24 Apr 2025
Viewed by 312
Abstract
Salmonella Mikawasima is a rare, mainly environmental serovar. In 2020, an outbreak was observed in neonatal and maternal wards of the University Hospital of Split and was established as an endemic until the end of 2024. Using whole-genome sequencing, this study aimed to [...] Read more.
Salmonella Mikawasima is a rare, mainly environmental serovar. In 2020, an outbreak was observed in neonatal and maternal wards of the University Hospital of Split and was established as an endemic until the end of 2024. Using whole-genome sequencing, this study aimed to analyse the phenotypic and genotypic characteristics of S. Mikawasima isolates and to elaborate whether the spread of the same clone occurred. Sequenced isolates were classified as ST2030, with the presence of aminoglycoside and extended spectrum beta-lactam resistance genes. Ten percent of the sequenced isolates exhibit multi-drug resistance. Identified virulence factors that include biofilm formation genes suggest the potential persistence of S. Mikawasima in the hospital environment, while spatial and temporal analysis reveal clonal expansion and possible horizontal transmission between different hospital wards. This study provides a deep understanding of the genomic composition of S. Mikawasima and emphasises the need for more stringent infection prevention measures, especially in vulnerable neonatal and postpartum settings, to mitigate the risk of healthcare-associated infections, and it should be followed by further microbiological and epidemiological investigations to identify the source of infection. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
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12 pages, 988 KiB  
Article
Clinical Features and Laboratory Findings of Hospitalized Children with Infectious Mononucleosis Caused by Epstein–Barr Virus from Croatia
by Laura Prtorić, Ante Šokota, Silvana Karabatić Knezović, Goran Tešović and Snjezana Zidovec-Lepej
Pathogens 2025, 14(4), 374; https://doi.org/10.3390/pathogens14040374 - 10 Apr 2025
Viewed by 341
Abstract
The aim of this retrospective 6-year study was to analyze demographic, laboratory and clinical features of 212 patients (<18 years of age) with EBV-associated infectious mononucleosis (IM) hospitalized in a tertiary clinical care center in southeastern Europe and to identify possible predictors of [...] Read more.
The aim of this retrospective 6-year study was to analyze demographic, laboratory and clinical features of 212 patients (<18 years of age) with EBV-associated infectious mononucleosis (IM) hospitalized in a tertiary clinical care center in southeastern Europe and to identify possible predictors of complications. The median patient age was 14.7 years (IQR 7.7–16.5 years), with 59.4% of patients aged between 13 and 18 years. A total of 51.2% of patients were hospitalized within 7 days following the onset of symptoms (median duration of hospitalization was 9 days, IQR 7–11 days). The most common symptoms included fever (97.16%), tonsillitis (87.3%), lymphadenopathy (79.2%), hepatomegaly (77.4%) and splenomegaly (73.1%). Symptom distribution, maximal fever and fever duration did not differ among different age groups. The most common complications included tonsillar hypertrophy, thrombocytopenia, anemia, neutropenia and leukopenia but all patients showed favorable outcomes. Patients who developed three or more complications and those presenting with thrombocytopenia showed significantly longer hospitalization durations. Platelet count, bilirubin, ESR and AST were identified as the most accurate predictors of hospitalization duration using multiple linear regression analysis. Therefore, our results suggest that clinical assessment of individual patients remains the most reliable parameter for patient management and that laboratory findings play only a supporting role. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
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12 pages, 687 KiB  
Communication
Public Health Risk of Campylobacter spp. Isolated from Slaughterhouse and Retail Poultry Meat: Prevalence and Antimicrobial Resistance Profiles
by Sebastian Alexandru Popa, Viorel Herman, Emil Tîrziu, Adriana Morar, Alexandra Ban-Cucerzan, Mirela Imre, Răzvan-Tudor Pătrînjan and Kálmán Imre
Pathogens 2025, 14(4), 316; https://doi.org/10.3390/pathogens14040316 - 26 Mar 2025
Viewed by 470
Abstract
Campylobacter spp. represents one of the most frequently incriminated pathogens in the evolution of foodborne gastroenteritis in humans worldwide. Alongside Salmonella spp., Yersinia spp., Escherichia coli, and Listeria monocytogenes, these pathogens represent a principal threat to public health because they are vehiculated to humans [...] Read more.
Campylobacter spp. represents one of the most frequently incriminated pathogens in the evolution of foodborne gastroenteritis in humans worldwide. Alongside Salmonella spp., Yersinia spp., Escherichia coli, and Listeria monocytogenes, these pathogens represent a principal threat to public health because they are vehiculated to humans via food products and many of them have developed alarming resistance to different classes of antimicrobials. Thus, the present study aimed to provide scientifically relevant data on the public health risk represented by Campylobacter spp., contamination of chicken carcasses at the slaughterhouse and retail levels, and the antimicrobial resistance of the isolated strains. A total of 130 samples collected from slaughterhouses (n = 40) and retail stores (n = 90) were analyzed using standardized microbiological methods (ISO 10272-1:2017). Of these, the overall prevalence of Campylobacter spp. was 27.7%, with a prevalence at the slaughterhouse level of 32.5% and at the retail level of 25.5%. Following antimicrobial resistance profile determinations using the Kirby–Bauer disc diffusion assay, the isolated strains showed resistance to the following antimicrobials in descending order: ciprofloxacin (41.6%), tetracycline (25.0%), chloramphenicol (16.6%), gentamicin (11.1%), ertapenem (5.6%), and erythromycin (2.8%). The study results confirm that chicken meat may pose a threat to public health and, moreover, that due to the widespread use of antimicrobials, a large number of strains have developed antimicrobial resistance, leading to difficulties in the treatment of various foodborne diseases. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
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15 pages, 711 KiB  
Article
Epidemiological and Clinical Characteristics of Adult RSV Infections: A Retrospective Analysis at University Hospital Center Zagreb (2022–2024)
by Antonio Perčinić, Tara Vuletić, Nina Lizzul, Andrea Vukić Dugac, Ana Gverić Grginić, Irena Tabain, Dragan Jurić and Ana Budimir
Pathogens 2025, 14(3), 284; https://doi.org/10.3390/pathogens14030284 - 14 Mar 2025
Viewed by 535
Abstract
Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in adults, particularly among older adults and individuals with chronic diseases. While traditionally linked to pediatric populations, RSV’s impact on adults, especially the elderly, is increasingly recognized but remains understudied in many [...] Read more.
Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in adults, particularly among older adults and individuals with chronic diseases. While traditionally linked to pediatric populations, RSV’s impact on adults, especially the elderly, is increasingly recognized but remains understudied in many regions. This retrospective study, conducted at the University Hospital Center Zagreb from October 2022 to April 2024, is the first to analyze RSV-positive adults in Croatia. Using RT-PCR testing, we evaluated clinical and epidemiological characteristics in both hospitalized and outpatient populations, focusing on those aged > 65 years. Among 2631 tested individuals, the RSV prevalence was 5.25%, with older adults experiencing the most severe outcomes, including pneumonia, COPD exacerbation, and intensive care admissions. Seasonal analysis confirmed a winter peak in RSV cases, while chronic conditions such as cardiovascular and respiratory diseases were strongly associated with higher complication rates. These findings demonstrate that older adults with comorbidities bear the greatest burden of RSV infection, highlighting the need for the early identification of high-risk patients. By providing detailed insights into RSV-related outcomes in this population, this study supports the development of targeted prevention and management strategies to reduce the burden of RSV in vulnerable groups. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
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10 pages, 202 KiB  
Article
Clinical Characteristics, Neuroimaging Findings and Long-Term Sequelae in Children with Congenital Cytomegalovirus Infection: A Single Centre Study
by Ivana Valenčak, Lorna Stemberger Marić, Maja Vrdoljak Pažur, Snježana Židovec Lepej, Nenad Šuvak and Goran Tešović
Pathogens 2025, 14(3), 280; https://doi.org/10.3390/pathogens14030280 - 14 Mar 2025
Viewed by 515
Abstract
Congenital cytomegalovirus infection is the most common congenital infection worldwide and an important cause of neurodevelopmental delay and sensorineural hearing loss. Neuroimaging represents the best prognostic marker in cCMV infection. The aim of this study was to establish the role of cranial ultrasound [...] Read more.
Congenital cytomegalovirus infection is the most common congenital infection worldwide and an important cause of neurodevelopmental delay and sensorineural hearing loss. Neuroimaging represents the best prognostic marker in cCMV infection. The aim of this study was to establish the role of cranial ultrasound and brain magnetic resonance imaging in the development of long-term sequelae in symptomatic and asymptomatic children with cCMV infection. Of the 47 children enrolled in the study, 25 (53.1%) were classified as symptomatic at birth. In 27/47 patients, SNHL was diagnosed with a similar proportion among the symptomatic and asymptomatic at birth (51.8% and 48.1%, respectively; p = 1.0). Thirty case patients had available data on follow-up. Neurological sequelae were more frequently seen in patients with symptomatic cCMV, but only cerebral abnormalities seen on initial MRI results had a consequential link with the later development of motor (OR 17.5; 95% Cl: 2667, 114,846; p = 0.002) and speech disorders (OR 15; 95% Cl: 2477, 90,843; p = 0.02). Although not statistically significant, hearing deterioration was more frequent in children with abnormal MRI results (OR 5; 95% Cl: 0.846, 29,567; p = 0.121). Neuroimaging abnormalities, as identified through both cranial ultrasound (CrUS) and MRI, are critical prognostic indicators for long-term sequelae, applicable to both symptomatic and asymptomatic children. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
13 pages, 3807 KiB  
Article
First Detection of West Nile Virus Lineage 2 in Culex pipiens Vectors in Croatia
by Goran Vignjević, Nataša Bušić, Nataša Turić, Zsaklin Varga, Brigitta Zana, Ágota Ábrahám, Kornélia Kurucz, Ivana Vrućina and Enrih Merdić
Pathogens 2024, 13(12), 1131; https://doi.org/10.3390/pathogens13121131 - 21 Dec 2024
Viewed by 1388
Abstract
The West Nile virus (WNV) has recently become more widespread, posing a threat to both human and animal health. In Western Europe, most outbreaks have been caused by WNV lineage 1, while in Eastern Europe, WNV lineage 2 has led to human and [...] Read more.
The West Nile virus (WNV) has recently become more widespread, posing a threat to both human and animal health. In Western Europe, most outbreaks have been caused by WNV lineage 1, while in Eastern Europe, WNV lineage 2 has led to human and bird mortality. The ability to appropriately manage this threat is dependent on integrated surveillance and early detection. This study aimed to quantify the prevalence of WNV infection in mosquitoes and to identify the circulating viral lineage in eastern Croatia. Mosquito traps were set up in rural and urban areas during the 2021–2023 seasons, and the collected specimens were identified morphologically. Mosquito species Culex pipiens and Aedes albopictus were tested for Flaviviruses using conventional PCR in a heminested system. The positive samples were then subjected to a specific real-time PCR designed to detect WNV. A total of 385 mosquito pools were tested, and positive pools were found in samples from Osijek-Baranja and Vukovar-Srijem, both of which contained Cx. pipiens mosquitoes. Sequencing of amplicons revealed WNV lineage 2 partial NS5 gene sequences. Phylogenetic analysis suggests the Hungarian origin of strain, which complements birds’ migratory routes. These findings indicate the first detection of WNV in mosquitoes in Croatia. This suggests that human cases in this region are likely due to infections with lineage 2 transmitted by local Culex mosquitoes. Full article
(This article belongs to the Special Issue Emerging and Neglected Pathogens in the Balkans)
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