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Pathogens
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Infections and Bone Damage
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Infections and Bone Damage

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Immunological Responses and Immune Defense Mechanisms".

Deadline for manuscript submissions: 10 April 2026 | Viewed by 4758

Special Issue Editors

Dr. María Victoria Delpino

E-Mail Website
Guest Editor
Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Universidad de Buenos Aires (UBA), Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1121, Argentina
Interests: bacterial and viral pathogenesis; Brucella sp.; HIV; hepatitis viruses; SARS-CoV-2
Dr. Jorge Quarleri

E-Mail Website
Guest Editor
Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Universidad de Buenos Aires (UBA), Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1121, Argentina
Interests: viral pathogenesis; HIV; hepatitis viruses; SARS-CoV-2

Special Issue Information

Dear Colleagues,

Infectious diseases significantly affect bone health through various pathways, posing a multi-faceted threat.

Direct attack: Certain pathogens can invade bone tissue, causing osteomyelitis, a condition marked by inflammation, bone deterioration and impaired healing. Untreated, it leads to chronic problems, deformities and persistent pain.

Inflammatory-mediated damage: Many infectious diseases trigger chronic inflammation, disrupting normal bone formation and promoting excessive breakdown. This, seen in HIV/AIDS, tuberculosis or hepatitis, increases the risk of weaker bones and conditions such as osteoporosis.

Nutritional deprivation: Severe infections often lead to malnutrition due to reduced appetite, impaired nutrient absorption or increased energy demands. These deprive bones of vital elements such as calcium, vitamin D and protein, weakening them and increasing fracture risk.

Medication double-edged sword: Some medications used to treat infections can have unintended bone-related side effects. Corticosteroids, used for inflammation control, can suppress bone formation and accelerate its breakdown, increasing fracture risk. Antibiotics and antivirals may also have similar effects.

Hormonal disruption: Infectious diseases can disrupt hormone production, negatively impacting bone metabolism. Hyperthyroidism speeds up bone turnover, leading to osteoporosis, while hypogonadism weakens bones and increases fracture risk. These hormonal imbalances exacerbate bone loss and compromise bone integrity.

This Special Issue will cover a wide range of topics aiming to enhance current knowledge of pathogens and their respective diseases impacting bone. By acknowledging the complexities of this interplay, we can better protect bone health in the face of infectious challenges.

All types of articles will be considered for publication, including short reports, primary research articles and reviews.

We look forward to your contribution.

Dr. María Victoria Delpino
Dr. Jorge Quarleri
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

  • infectious diseases
  • bone
  • osteoclasts
  • osteoblast
  • osteoimmunity
  • mesenchymal cells
  • osteomyelitis
  • osteoporosis
  • antimicrobial therapy

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Published Papers (5 papers)

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Research

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11 pages, 222 KB  
Article
Dalbavancin for Bone and Joint Infections: A Two-Center Greek Real-World Retrospective Study
by Christina Petropoulou, Petros Ioannou, Georgios Eleftherakis, Stefania Papazisi, Christos Davoulos, Eugenia Drosou, Anastasia Spiliopoulou, Ekaterini Tsiata, Fotini Paliogianni, Diamantis Kofteridis, Markos Marangos and Stelios F. Assimakopoulos
Pathogens 2025, 14(11), 1109; https://doi.org/10.3390/pathogens14111109 - 31 Oct 2025
Viewed by 158
Abstract
Bone and joint infections remain therapeutic challenges, usually requiring prolonged intravenous therapy and hospitalization. Dalbavancin, a long-acting lipoglycopeptide, offers a simplified alternative. We retrospectively analysed 83 patients treated with dalbavancin for osteomyelitis, spondylodiscitis, septic arthritis, or prosthetic joint infection in two tertiary Greek [...] Read more.
Bone and joint infections remain therapeutic challenges, usually requiring prolonged intravenous therapy and hospitalization. Dalbavancin, a long-acting lipoglycopeptide, offers a simplified alternative. We retrospectively analysed 83 patients treated with dalbavancin for osteomyelitis, spondylodiscitis, septic arthritis, or prosthetic joint infection in two tertiary Greek hospitals (2022–2024). Mean age was 69 ± 16 years; 56.6% were male; Charlson Comorbidity Index averaged 4 ± 2.25. Common comorbidities included diabetes (28.9%) and coronary artery disease (18.1%). Infections were vertebral osteomyelitis/spondylodiscitis (48.2%), non-vertebral osteomyelitis (38.5%), prosthetic joint infection (10.8%), and septic arthritis (8.4%). Microbiological diagnosis was established in 62.6%; predominant pathogens were Staphylococcus aureus (38.4%: 30.7% MSSA, 7.7% MRSA) and enterococci (25%, including 5.7% VRE). Dalbavancin was administered as monotherapy (32.4%) or combined with other antibiotics (67.6%), mainly fluoroquinolones (63.6%) and minocycline (23.6%). Mean dosing was 2 ± 2.36 administrations (4 ± 4.38 g total). Surgical debridement was performed in 36.1% of patients. Clinically significant adverse events occurred in 4 patients (4.8%): acute kidney injury (n = 2), angioedema (n = 1), and Clostridioides difficile colitis (n = 1). Clinical cure was achieved in 90.4% at day 90 and 92.8% at day 180. Clinical cure rates were comparable between dalbavancin monotherapy and combination therapy, suggesting that the efficacy observed was primarily attributable to dalbavancin itself. Relapse at one year occurred in 10.8%, mainly due to inadequate source control. Dalbavancin demonstrated high efficacy, favourable safety, and treatment simplification in complex bone and joint infections. Its long half-life and reduced need for prolonged IV access support its role in minimizing hospitalization and catheter-related complications, particularly in regions with limited outpatient parenteral therapy infrastructure. Full article
(This article belongs to the Special Issue Infections and Bone Damage)
16 pages, 6552 KB  
Article
Antibacterial Electrophoretically Loaded Titania Nanotubes on Titanium Alloy Implants Enhance Osseointegration
by Julia Fischer, Deborah J. Hall, Meghan M. Moran, Adrienn Markovics, Peter H. Pennekamp, John L. Hamilton and Markus A. Wimmer
Pathogens 2025, 14(11), 1072; https://doi.org/10.3390/pathogens14111072 - 22 Oct 2025
Viewed by 371
Abstract
Primary hip and knee arthroplasties are common surgeries in the U.S., with periprosthetic joint infection (PJI) being the leading cause of implant revision. Systemic antibiotics often fail to achieve sufficient local concentrations, driving interest in localized drug delivery. Titanium (Ti) implants modified with [...] Read more.
Primary hip and knee arthroplasties are common surgeries in the U.S., with periprosthetic joint infection (PJI) being the leading cause of implant revision. Systemic antibiotics often fail to achieve sufficient local concentrations, driving interest in localized drug delivery. Titanium (Ti) implants modified with titania nanotubes (TNTs) provide an increased surface area for drug loading and controlled release. Previous studies have shown that gentamicin-loaded TNTs inhibit Staphylococcus aureus growth in vitro without compromising osteoblast viability. This study investigated the effect of gentamicin–chitosan (GC)-coated TNT implants in a murine model, hypothesizing a positive impact on osseointegration. Titanium alloy (Ti6Al4V) wires were anodized to form TNTs and then coated with gentamicin–chitosan (GC) via electrophoretic deposition. Implants (Bare, TNT, TNT+GC; n = 30) were inserted bilaterally into femoral canals of C57BL/6J mice. After > 1 month, osseointegration was assessed by histological point counting, scanning electron microscopy (SEM)-based areal analysis, and mechanical pull-out testing. ANOVA was used to identify differences between groups, and linear regression was applied to account for harvest time, bone contact area, and anatomical section. Bone area fraction (BAF) around the implant measured by the SEM–areal method was significantly higher around TNT+GC (18.4% ± 1.1) and TNT (16.5% ± 1.4) versus Bare (9.0% ± 2.3) (p < 0.0028) implants. The maximum fixation strength was higher for TNT (0.878 ± 0.175 N/mm2) and TNT+GC (0.853 ± 0.215N/mm2) when compared to bare implants 0.316 ± 0.082 N/mm2) (p = 0.048 and p = 0.050, respectively). No significant differences appeared between TNT and TNT+GC. These findings indicate that GC coatings on TNT implants do not impair osseointegration and may even enhance bone–implant integration. Such coatings may therefore provide dual benefits, offering antibacterial protection while improving bone fixation, making them a promising strategy for PJI prevention. Further long-term studies are needed to confirm durability and clinical translation. Full article
(This article belongs to the Special Issue Infections and Bone Damage)
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12 pages, 241 KB  
Article
Multicenter Retrospective Analysis of 702 Pediatric Cases of Bone and Joint Infections: Definition of Clinical and Biological Features to Discriminate K. kingae, S. aureus, and Other Bacterial Infections
by Marco Roversi, Francesca Pignatelli, Giacomo De Marco, Oscar Vazquez, Dimitri Ceroni, Antonio Musolino, Marco Cirillo, Laura Lancella, Alberto Villani, Andrzej Krzysztofiak and on behalf of the Osteomyelitis Collaborative Study Group
Pathogens 2025, 14(2), 147; https://doi.org/10.3390/pathogens14020147 - 4 Feb 2025
Cited by 1 | Viewed by 1177
Abstract
This study aimed to identify key differences between K. kingae infections and those caused by S. aureus or other pathogens. Differentiating these infections is crucial due to their nonspecific clinical presentations and overlapping laboratory and radiological findings, particularly when isolates are unavailable. We [...] Read more.
This study aimed to identify key differences between K. kingae infections and those caused by S. aureus or other pathogens. Differentiating these infections is crucial due to their nonspecific clinical presentations and overlapping laboratory and radiological findings, particularly when isolates are unavailable. We retrospectively analyzed data from 702 pediatric patients with bone and joint infections from 2010 to 2023 across two hospitals. The most common diagnoses were osteomyelitis (35.3%) and arthritis (29.6%), with fever present in 46.0% of cases. Pathogen identification showed K. kingae (40.9%) and S. aureus (36.5%) as the most frequent. Patients with K. kingae were significantly younger (median age 1.5 years) than those with S. aureus (10.4 years) or other pathogens (6.8 years) (p < 0.001). Fever was more common in S. aureus (64.3%) and other pathogens (57.5%) than in K. kingae (26.4%) (p < 0.001). CRP levels were lower in K. kingae infections (median 1.5 mg/dl) compared to S. aureus (6.1 mg/dl) and other pathogens (5.0 mg/dl) (p < 0.001). K. kingae infections were predominantly treated with penicillin–clavulanate and had shorter treatment durations and lower sequelae rates (2.3%) compared to other pathogens (19.0%). These findings emphasize K. kingae’s distinct clinical profile and milder course compared to S. aureus and other pathogens. Full article
(This article belongs to the Special Issue Infections and Bone Damage)
14 pages, 2977 KB  
Article
HIV Modulates Osteoblast Differentiation via Upregulation of RANKL and Vitronectin
by Rosa Nicole Freiberger, Cynthia Alicia Marcela López, María Belén Palma, Cintia Cevallos, Franco Agustin Sviercz, Patricio Jarmoluk, Marcela Nilda García, Jorge Quarleri and M. Victoria Delpino
Pathogens 2024, 13(9), 800; https://doi.org/10.3390/pathogens13090800 - 15 Sep 2024
Cited by 1 | Viewed by 1715
Abstract
Bone loss is a prevalent characteristic among people with HIV (PWH). We focused on mesenchymal stem cells (MSCs) and osteoblasts, examining their susceptibility to different HIV strains (R5- and X4-tropic) and the subsequent effects on bone tissue homeostasis. Our findings suggest that MSCs [...] Read more.
Bone loss is a prevalent characteristic among people with HIV (PWH). We focused on mesenchymal stem cells (MSCs) and osteoblasts, examining their susceptibility to different HIV strains (R5- and X4-tropic) and the subsequent effects on bone tissue homeostasis. Our findings suggest that MSCs and osteoblasts are susceptible to R5- and X4-tropic HIV but do not support productive HIV replication. HIV exposure during the osteoblast differentiation process revealed that the virus could not alter mineral and organic matrix deposition. However, the reduction in runt-related transcription factor 2 (RUNX2) transcription, the increase in the transcription of nuclear receptor activator ligand kappa B (RANKL), and the augmentation of vitronectin deposition strongly suggested that X4- and R5-HIV could affect bone homeostasis. This study highlights the HIV ability to alter MSCs’ differentiation into osteoblasts, critical for maintaining bone and adipose tissue homeostasis and function. Full article
(This article belongs to the Special Issue Infections and Bone Damage)
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Review

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15 pages, 580 KB  
Review
Nocardia Osteomyelitis in Humans—A Narrative Review of Reported Cases, Microbiology, and Management
by Afroditi Ziogou, Alexios Giannakodimos, Ilias Giannakodimos, Stella Baliou, Andreas G. Tsantes and Petros Ioannou
Pathogens 2025, 14(10), 1032; https://doi.org/10.3390/pathogens14101032 - 12 Oct 2025
Viewed by 634
Abstract
Nocardiosis is an infection caused by Gram-positive, saprophytic bacteria most often affecting immunocompromised hosts. The lungs, central nervous system, and skin are the sites most typically involved, although any organ may be affected. Skeletal involvement, particularly osteomyelitis, remains uncommon. This study is a [...] Read more.
Nocardiosis is an infection caused by Gram-positive, saprophytic bacteria most often affecting immunocompromised hosts. The lungs, central nervous system, and skin are the sites most typically involved, although any organ may be affected. Skeletal involvement, particularly osteomyelitis, remains uncommon. This study is a review of all published cases of Nocardia osteomyelitis in humans, emphasizing epidemiology, microbiology, clinical features, management, and patient outcomes. A narrative review was performed using data from the PubMed/MedLine and Scopus databases. Fifty studies describing 55 patients were included. The median age was 54 years, and 65.5% were male. The main risk factors were immunosuppression (21.8%) and trauma (18.2%). The vertebrae constituted the most commonly affected site (25.5%), followed by the lower limb bones (20%); 23.6% had multifocal disease. Nocardia asteroides accounted for the majority of cases (34.8%). Trimethoprim-sulfamethoxazole was the most frequently administered agent (81.5%), followed by cephalosporins (29.6%) and carbapenems (27.8%). Overall mortality was 9.3%, with 5.6% of reported deaths directly attributed to the infection. Although uncommon, osteomyelitis due to Nocardia spp. should be considered when Gram-positive, filamentous microorganisms are detected in bone specimens, particularly in immunocompromised or post-trauma patients, as early suspicion and targeted therapy may improve survival. Full article
(This article belongs to the Special Issue Infections and Bone Damage)
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