Infectious Disease Reports doi: 10.3390/idr18050107

Authors: Rabab AlGhaithi Shawg AlSalamah

Background: Congenital syphilis remains a significant cause of adverse birth outcomes despite effective screening and treatment. Data on its epidemiology in Saudi Arabia are limited. This study aims to describe the incidence, clinical characteristics, and outcomes of congenital syphilis at a tertiary pediatric center in Riyadh, Saudi Arabia, and to identify gaps in antenatal care and prevention. Methods: We conducted a retrospective chart review of all infants diagnosed with congenital syphilis (aged 0–24 months) and pregnant women with positive syphilis serology who presented to our center between January 2021 and December 2025. Cases were classified as highly probable, possible, less likely, or unlikely based on Center for Disease Control (CDC) and European criteria. Incidence rates were calculated per 1000 live births. Results: Over the five-year study period, there were 11,722 live births and 12 cases of probable or possible congenital syphilis, yielding an incidence rate of 1 per 1000 live births. An additional two cases were classified as less likely due to successful prevention of mother-to-child transmission. The majority of cases (n = 7) were attributed to inadequate maternal treatment. Three cases of abortion and intrauterine fetal demise were identified, probably due to untreated maternal syphilis. Most infants were asymptomatic at birth; however, one patient presented with hepatosplenomegaly, cytopenia, and cholestasis, while two had abnormal long bone findings. No cases of neurosyphilis were identified. Five infants were born to mothers with suspected false-positive serology but were managed as possible cases due to incomplete follow-up. Favorable neurodevelopmental outcomes were observed in all patients who completed follow-up (n = 5). Conclusions: We report congenital syphilis incidence rates that align with the global upward trend. We also identified multiple missed opportunities for screening and early treatment—findings that can inform future guidelines and enhance awareness among healthcare providers and the public.

Infectious Disease Reports doi: 10.3390/idr18050106

Authors: Francesco De Maria Paolo Fusco Alessandro Russo

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

Infectious Disease Reports doi: 10.3390/idr18050105

Authors: Manuela Ceccarelli Emmanuele Venanzi Rullo Andrea Marino Andrea De Vito Cristina Micali Serena Spampinato Ylenia Russotto Antonio Albanese Maria Chiara Frasca Sonia Agata Sofia Giovanni Francesco Pellicanò Benedetto Maurizio Celesia Paolo Maggi Giordano Madeddu Giuseppe Nunnari

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

Infectious Disease Reports doi: 10.3390/idr18050104

Authors: Talia Gomes Luz Lariane Angel Cepas Isadora Silva de Carvalho Alvaro Francisco Lopes de Sousa Talita Morais Fernandes Camila Marcheto de Sousa Lorena Marcheto de Sousa Ruan Nilton Rodrigues Melo Lucas Brandão dos Santos Mayara Souza Gomes Lucia Alves da Silva Lara Ariadne Ribeiro Fatima Morales Inês Fronteira Ana Paula Morais Fernandes

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

Infectious Disease Reports doi: 10.3390/idr18050103

Authors: Gabriela Guerron-Gomez Eduardo Tuta-Quintero Alirio Bastidas Luis F. Giraldo-Cadavid Maria Pérez-Escobar Luisa F. Martínez Maria Castillo-Páez Isabella Criado-Quintero Manuela Trujillo-Herrera Angie Sandoval-Blanco Gabriela Osorio-Betancourt Laura Medellín-Ortiz Laura Chaves-Pauwels Paola Martínez-Sáenz Luis F. Reyes

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

Infectious Disease Reports doi: 10.3390/idr18050102

Authors: Abdullah Mohammed Alshehri Abdulaziz Hassan Alamri Khaled Abdulwahab Amer Anas Khalid Alqarni

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

Infectious Disease Reports doi: 10.3390/idr18050101

Authors: Mieko Tokano Norihito Tarumoto

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

Infectious Disease Reports doi: 10.3390/idr18050100

Authors: Muambangu Jean Paul Milambo Christian Ngandu

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

Infectious Disease Reports doi: 10.3390/idr18050099

Authors: Kamvelihle Sabisa Lindiwe Modest Faye Ntandazo Dlatu Teke Ruffin Apalata

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

Infectious Disease Reports doi: 10.3390/idr18050098

Authors: Carmen Cantarero-Lozano Aroa Tardáguila-García Esther García-Morales Yolanda García-Álvarez David Navarro-Pérez José Luis Lázaro-Martínez

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

Infectious Disease Reports doi: 10.3390/idr18050097

Authors: Amir Hossein Pirasteh Katrin Streubel Sabine Wagner Jorge Hugo Coello Alvarez Christopher Nimsky Sabrina Viktoria Kirchleitner

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

Infectious Disease Reports doi: 10.3390/idr18050096

Authors: Sarah P. Maxwell Connie L. McNeely James R. Harrington Kevin C. Thomas

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

Infectious Disease Reports doi: 10.3390/idr18050095

Authors: Mariantonia Braile Giusy Corvino Rosamaria Abate Mariano Conticelli

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

Infectious Disease Reports doi: 10.3390/idr18050094

Authors: Francesco De Maria Francesco Branda Ivailo Alexiev Dong Keon Yon Ayşe Banu Demir Giancarlo Ceccarelli Fabio Scarpa Massimo Ciccozzi Alessandro Russo

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

Infectious Disease Reports doi: 10.3390/idr18050093

Authors: Bram Vanmechelen Fedoua Echahidi Stijn Jonckheere Patricia Vandecandelaere Ines Malysse Oriane Soetens Charlotte Michel

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

Infectious Disease Reports doi: 10.3390/idr18050092

Authors: Lauren Bernard Juliana S. Sherchan Nazary Nebeluk David Zapata Murtaza Dawood Douglas Anderson Ramon A. Riojas Shivakumar Narayanan

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

Infectious Disease Reports doi: 10.3390/idr18040091

Authors: Marialuisa Valente Giovanni Fumagalli Valentina Caputo Niccolò Riccardi Lucia Allavena Maurizio Ferrarese Luigi Ruffo Codecasa

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

Infectious Disease Reports doi: 10.3390/idr18040090

Authors: Song Kwon Rachel Gabor Philip Whitfield

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

Infectious Disease Reports doi: 10.3390/idr18040089

Authors: Pierre Guarino Francesco Chiari Luigi La Via Andrea Marino Jerome Rene Lechien Mario Lentini Salvatore Lavalle Giuseppe Nunnari Salvatore Maira Carmelo Giancarlo Botto Salvatore Ferlito Antonino Maniaci

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

Infectious Disease Reports doi: 10.3390/idr18040088

Authors: Chinchana Shylaja Eshwarappa Mahadevaiah Neelambike Sumana Yogeesh D. Maheshwarappa Morubagal Raghavendra Rao Vidyavathi B. Chitharagi Neetha S. Murthy Supreeta R. Shettar Veerabhadra Swamy G S G K Megha Shruthishree S C

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

Infectious Disease Reports doi: 10.3390/idr18040087

Authors: Rana Barakat Zeinab Ezzeddine Rana El Haidari Samara Hassan Ghassan Ghssein

Background: Respiratory tract infections (RTIs) and urinary tract infections (UTIs) are among the most common infections in humans. It is estimated that millions of deaths occur each year worldwide due to these infections. Pseudomonas aeruginosa (P. aeruginosa), in particular, represents a public health threat since it has a high ability to acquire resistance to different antibiotic classes. The aim of this study was to determine the prevalence and antimicrobial resistance patterns of P. aeruginosa isolates from patients with RTIs and UTIs in Lebanon. Methods: This retrospective study was performed during 2020–2022 and 2024–2025. Samples were collected from both inpatients and outpatients, where identification and isolation of bacteria were performed along with antibiotic susceptibility testing. Results: The overall prevalence of P. aeruginosa isolates in RTI cases over the study period was 10.9%, and that of UTI cases was 1.3%. The general antimicrobial resistance profile of P. aeruginosa isolates from RTI and UTI cases showed the highest resistance for Piperacillin–Tazobactam and Aztreonam, respectively. For RTIs, antibiotic resistance decreased from 48.1% in 2020 to 36.7% in 2025 and increased from 16.7% to 19.4% for UTIs. Conclusions: According to our research, P. aeruginosa with low antibiotic susceptibility is frequently found in isolated samples, highlighting the significant challenge in treating severe infectious illnesses. To choose focused and efficient antibiotic therapy for RTIs and UTIs and to stop the emergence of multidrug-resistant (MDR) bacteria, it is essential to accurately identify the pathogenic microorganisms and their antibiotic susceptibility patterns.

Infectious Disease Reports doi: 10.3390/idr18040086

Authors: Qianhao Zhou Dongqi Xiong Xuandong Wang Qingmei Zhu Nadira Dolkun Zureguli Tuxun Zehao Zhang Qian Wang Xuejun Xiao

Background: Brucellosis remains a widespread zoonotic disease where serodiagnosis is critical for control. Outer membrane protein 25 (Omp25) has emerged as a promising diagnostic antigen, yet the optimal antigen format for Omp25-based serological assays remains unclear. Methods: We performed a systematic review and meta-analysis of diagnostic accuracy studies following PRISMA-DTA 2020 guidelines. Four electronic databases were searched through July 16, 2026. Risk of bias was assessed using QUADAS-2. Diagnostic accuracy was synthesized using the bivariate binomial model, with subgroup analyses stratified by host species and antigen format. Results: Ten diagnostic accuracy studies comprising 23 study arms were included. Substantial heterogeneity was observed (I2 = 86.2% for sensitivity, 68.4% for specificity). In human serum, pooled sensitivity was 0.93 (95% CI: 0.89–0.96) and specificity was 0.97 (95% CI: 0.93–0.99). In ruminant serum, pooled sensitivity was 0.89 (95% CI: 0.81–0.94) and specificity was 0.95 (95% CI: 0.91–0.97). Multi-protein formats demonstrated narrower confidence intervals and more consistent diagnostic reliability than monomeric Omp25, despite a marginally lower pooled sensitivity point estimate. Single Omp25 exhibited the widest cross-species performance variation. Reference standard heterogeneity affected apparent specificity, with RBT + SAT dual standards yielding higher specificity than single RBT. Conclusions: Multi-protein antigen formats offer more consistent diagnostic reliability than monomeric Omp25 for brucellosis serodiagnosis, though performance varies significantly by host species. Clinical translation requires standardized antigen preparation protocols, uniform reference standards, and cautious species-specific application. Future research should prioritize larger, species-stratified, multi-center validation and prospective trials to establish Omp25-based DIVA capability.

Infectious Disease Reports doi: 10.3390/idr18040085

Authors: Gang Liu Zhongkai Liao Jie Huang Zhiyuan Zhu Mingzhu Liu Sheng Liu Ru Liu

Background: Invasive aspergillosis (IA) is a severe complication after solid organ transplantation, especially in patients receiving long-term immunosuppressive therapy. Pulmonary artery involvement caused by Aspergillus fumigatus is extremely rare and may mimic pulmonary artery thrombosis or malignancy, resulting in diagnostic challenges. Case Presentation: A 61-year-old male developed fatigue, intermittent fever, cough, and chest discomfort seven months after orthotopic heart transplantation. Computed tomography pulmonary angiography revealed a mass-like filling defect involving the main pulmonary artery and left pulmonary artery, which was initially suspected to represent pulmonary artery thrombosis or tumor. Whole-blood next-generation sequencing identified Aspergillus fumigatus and Streptococcus mitis. The patient was treated with voriconazole, anticoagulation therapy, and adjustment of immunosuppressive therapy. Follow-up imaging demonstrated progressive regression of pulmonary artery lesions and disappearance of pulmonary nodules without evidence of graft rejection. Conclusions: Pulmonary artery aspergillosis should be considered in heart transplant recipients presenting with pulmonary artery-occupying lesions, particularly when imaging findings are atypical. Early pathogen identification combined with appropriate antifungal therapy, individualized immunosuppression adjustment, and careful monitoring may improve clinical outcomes.

Infectious Disease Reports doi: 10.3390/idr18040084

Authors: Luisa Cavalletto Sara Valpione Chiara Giraudo Claudia Mescoli Valeria M. Besutti Liliana Chemello

Background: The movement of endemic diseases from tropical and disadvantaged areas is gradually spreading to developed countries as well. Amoebiasis, in particular, represents a significant threat to public health, amplified by globalization and increasing contact between humans and animals or vectors. In this way, atypical diseases may emerge in our country, also through an unusual mode of transmission—likely sexual, as “sexually transmitted enteric (STE) diseases”. Objective: We report and discuss the clinic approach to a rare case of dual human infestations by ecto- and endo-parasites with multiple liver abscesses presentation in a young truck driver residing in Northern Italy. Methods: The patient underwent a comprehensive screening with laboratory and microbiological tests, and CT images. Results: In July, the patient was admitted to our hepatology unit following the ultrasound identification of two hypoechoic lesions in the right lobe of the liver. In his medical history, in April, after a seemingly harmless infestation of body lice, effectively treated, he suffered from a prolonged and debilitating episode of acute diarrhea, lasting a month. This status was also accompanied by intestinal cramps, weight loss, and recurring fever episodes. Afterwards also appeared a Quincke’s-like angioedema involving the lips and mouth mucosa, with evening time exacerbation. Conclusions: The differential diagnosis of this complex and unusual clinical picture, together with the temporal evolution of the patient’s signs and symptoms, led us to hypothesize the presence of concomitant infections. These were most likely borreliosis and a STE disease, the latter ultimately diagnosed as amebiasis with hepatic invasion, allowing appropriate treatment and a favorable clinical outcome.

Infectious Disease Reports doi: 10.3390/idr18040083

Authors: Alexandra Vasilakopoulou Evaggelia Oikonomoula Vasiliki Anagnosti Pavlos Siozos Ioannis Liakopoulos Eleni Kalogeropoulou Sofia Damianidou Polyxeni Karakosta Sophia Vourli Panagiota-Christina Georgiou Anastasios Ioannidis Spyros Pournaras

Background: Ignatzschineria species are rare emerging human pathogens that are typically associated with myiasis. Methods: We report the first case of Ignatzschineria indica bacteraemia in Greece in a male patient presenting with maggot-infested wounds of the thorax, shoulders, and arms. The isolate was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and antimicrobial susceptibility testing was performed according to EUCAST guidance. A review of the published literature on I. indica bacteraemia was also conducted. Results: The patient was diagnosed with bacteraemia caused by a multisusceptible I. indica isolate and was successfully treated with antibiotic therapy, resulting in complete recovery. This represents the first reported case of I. indica infection in Greece. Review of the literature showed that most published I. indica isolates were susceptible to a broad range of antimicrobial agents, and all reported patients survived, although some required limb amputation because of severe underlying soft tissue disease. Conclusions: Ignatzschineria indica infection should be considered in patients with neglected, maggot-infested wounds. Increased awareness of this emerging pathogen, together with the use of modern microbiological identification methods, may improve recognition of these uncommon infections. Socio-economic inequalities and the changing distribution of insect vectors due to climate change may contribute to the occurrence of such infections.

Infectious Disease Reports doi: 10.3390/idr18040082

Authors: Yuanyuan Zhang Yan Shao Suizan Zhou Qianlan Wu Ningning Du Mingzhi Zhang Qian Feng Lin Bao Yuanyuan Pang Yayun Tan Pengwei Cui Jun Zhang Haibing Yang Suping Zhang Liling Chen Ying Song W. William Schluter

Background/Objectives: This prospective cohort study assessed the impact of seasonal influenza during pregnancy on fetal and infant health outcomes. Methods: Pregnant women with laboratory-confirmed influenza were matched (1:4) by age and pregnancy loss history with women without influenza from annual cohorts in Suzhou, China, during 2015–2018. Participants underwent twice-weekly follow-up for influenza illness, and medical records were linked to ascertain outcomes. Multivariable regression models were used to estimate associations. Results: We included 441 pregnant women with influenza and 1764 without it. Four (0.9%) in the influenza group had late pregnancy loss, whereas one (0.1%) in the non-influenza group did. Influenza was associated with late pregnancy loss (adjusted hazard ratio [aHR] 31.1, 95% Confidence Interval [CI]: 1.3–756.8, p = 0.035). Four (0.9%) in the influenza group experienced early pregnancy loss, while five (0.3%) in the non-influenza group did. Influenza was not significantly associated with early pregnancy loss (aHR 2.1, 95% CI: 0.4–10.4, p = 0.374). By 8 months of age, infants born to 198 of the 441 mothers (44.9%) in the influenza group met the criteria for the program-defined child health monitoring indicator, compared with infants born to 650 of the 1764 mothers (36.8%) in the non-influenza group. Overweight/obesity was the largest contributor: 142 (32.2%) versus 470 (26.6%). Maternal influenza was associated with higher odds of meeting program-defined child health monitoring indicator in offspring (adjusted odds ratio [aOR] 1.4, 95% CI: 1.1–1.8, p = 0.006), with a significant contribution from overweight/obesity (aOR 1.3, 95% CI: 1.0–1.7, p = 0.045). Conclusions: In this cohort, influenza during pregnancy was associated with an increased risk of late pregnancy loss and program-defined child health monitoring indicator in offspring, particularly overweight/obesity. Because the observed association with pregnancy loss was based on a small number of events and had a wide confidence interval, it should be interpreted cautiously and confirmed in larger studies. These findings are consistent with current recommendations supporting influenza vaccination during pregnancy to protect maternal and infant health.

Infectious Disease Reports doi: 10.3390/idr18040081

Authors: Viwe Sodo-Mbotya Ntandazo Dlatu Geoffrey A. B. Buga

Background: Despite substantial progress in prevention of mother-to-child transmission (PMTCT) programmes and widespread access to antiretroviral therapy (ART), maternal HIV infection remains associated with adverse maternal and neonatal outcomes in many high HIV-burden settings. This study compared maternal and perinatal outcomes among women living with HIV and HIV-negative women delivering at a tertiary referral hospital in the Eastern Cape Province, South Africa. Methods: A retrospective comparative cohort study was conducted using routinely collected clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered at Nelson Mandela Academic Hospital between January and December 2019. Maternal, obstetric, and neonatal characteristics were compared according to maternal HIV status. Associations were evaluated using chi-square tests, multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: Women living with HIV were older, had higher parity, and were more likely to have documented anaemia and delayed antenatal care attendance than HIV-negative women. HIV-exposed pregnancies had higher frequencies of preterm birth (26.3% vs. 20.3%) and low birthweight (LBW). In adjusted analyses, maternal HIV-positive status remained independently associated with increased odds of LBW (AOR = 1.88; 95% CI: 1.18–3.00; p = 0.008). LBW was independently associated with neonatal intensive care unit (NICU) admission (AOR = 2.45; 95% CI: 1.46–4.11; p < 0.001) and an increased hazard of in-hospital neonatal mortality (HR = 2.40; 95% CI: 1.55–3.70; p < 0.001). Maternal HIV-positive status (HR = 1.75; 95% CI: 1.12–2.71; p = 0.015) and unsuppressed maternal viral load (HR = 2.05; 95% CI: 1.13–3.73; p = 0.018) were also associated with increased hazards of neonatal mortality. However, these findings should be interpreted cautiously, given the limited number of neonatal mortality events (n = 32). Among HIV-exposed infants with documented HIV test results, the observed mother-to-child transmission rate was 1.7%. However, incomplete infant follow-up and HIV testing data limited the precision of this estimate. Among women living with HIV, birthweight did not differ significantly according to the timing of ART initiation. Conclusions: In this tertiary referral hospital cohort, maternal HIV infection was associated with adverse maternal and neonatal outcomes, particularly anemia, preterm birth, and LBW. LBW emerged as an important predictor of neonatal morbidity and mortality. These findings support continued efforts to strengthen integrated HIV and maternal healthcare services, promote early antenatal care engagement, maintain maternal viral suppression, and improve monitoring and care of high-risk neonates. Given the retrospective observational design, incomplete follow-up for selected outcomes, limited numbers of neonatal mortality events, and the tertiary referral setting, the findings should be interpreted as associations rather than evidence of causal relationships and may not be generalizable to lower-level healthcare facilities or community-based obstetric populations.

Infectious Disease Reports doi: 10.3390/idr18040080

Authors: Grant Whitmer Maria Joyce

Background/Objectives: Bacteria of the order Flavobacteriales are environmental Gram-negative bacilli. Several organisms within the order represent rare but clinically important causes of infection in human hosts, particularly in immunocompromised and hospitalized individuals. Eight genera have been implicated in human infections: Elizabethkingia, Capnocytophaga, Chryseobacterium, Myroides, Bergeyella, Flavobacterium, Empedobacter, and Weeksella. Despite their clinical relevance, there has been, as yet, no consolidated summary of clinical characteristics or resistance patterns across pathogens within the order. Methods: This narrative review examines the currently published data on human infections caused by organisms within Flavobacteriales. 63 sources, including 57 peer-reviewed articles, were included. Results: The clinical associations of infections caused by each of the above genera are discussed. In addition, available antimicrobial resistance data for the same organisms are summarized. Knowledge gaps are identified, including the lack of dedicated antimicrobial susceptibility breakpoints and limited data on rare categories of organisms. Conclusions: Human pathogens within Flavobacteriales display a number of commonalities, including a predilection for immunocompromised hosts, and frequently display resistance to carbapenems and aminoglycosides. Additional studies to better characterize these pathogens and optimize the approach to their treatment are strongly warranted.

Infectious Disease Reports doi: 10.3390/idr18040079

Authors: Debora Agreiter Stefan Fuchs Franziska Marti

Background: Acute rheumatic fever (ARF) is a clinical syndrome triggered by group A streptococcal (GAS) infections and characterized by fever, carditis, and arthritis as its main manifestations. Diagnosis relies on the revised Jones criteria. We report a rare case of ARF diagnosed in Switzerland. Case Presentation: An 18-year-old woman presented to the emergency department five days after returning from a one-week stay in Egypt with intermittent fever and a transient sore throat, followed by migratory joint pain. Laboratory testing revealed leukocytosis, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Chest X-ray, urine analysis, and (travel-associated) pathogen-testing (Epstein–Barr virus, Cytomegalovirus, human immunodeficiency virus, Malaria, Dengue, Zika, Chikungunya) were unremarkable. Blood cultures remained negative. Initially, a viral respiratory infection was suspected and symptomatic treatment established. Days later the patient was re-evaluated due to persistent symptoms. Leukocyte count (Lc) and CRP further increased and subcutaneous nodules appeared. The antistreptolysin-O (ASO)-titer was elevated more than three times higher than the normal upper limit and proofed serological evidence of a preceding streptococcal infection (GAS throat culture had not been performed). ARF was diagnosed according to the Jones criteria. Treatment with amoxicillin and a high dose of acetylsalicylic acid (ASA) led to a rapid clinical improvement. Secondary prophylaxis with depot penicillin (benzathine penicillin G; 1.2 million units; once monthly) was initiated to prevent rheumatic heart disease. Conclusions: This case highlights a rare occurrence of ARF following travel to Egypt, with probable acquisition of group A streptococcal infection during the trip. It emphasizes consideration of ARF even in Western countries with low ARF-prevalence if clinical history is suggestive. Early recognition and initiation of antimicrobial and anti-inflammatory therapy is crucial to prevent cardiac involvement. To the best of our knowledge, this represents one of the first cases diagnosed in Switzerland in the past 20 years.

Infectious Disease Reports doi: 10.3390/idr18040078

Authors: Francesco Branda Lilia Andriani Riccardo Lucis Annamaria Defilippo Ugo Lomoio Barbara Puccio Giancarlo Ceccarelli Massimo Ciccozzi Fabio Scarpa Pierangelo Veltri Pietro Hiram Guzzi

Background: Accurate and timely malaria diagnosis with species-level identification of Plasmodium parasites is critical for guiding effective treatment and disease management. Although light microscopy remains the diagnostic gold standard, its dependence on highly trained personnel limits accessibility, particularly in resource-constrained settings. Recent advances in deep learning have enabled automated image-based diagnosis with promising performance; however, reliable differentiation among Plasmodium species continues to pose a major challenge. This study aims to evaluate and compare the effectiveness of different deep learning architectures for automated species identification from microscopy images. Methods: Three deep learning architectures were systematically assessed: a convolutional backbone (ResNet50), a Vision Transformer (ViT), and a hybrid ResNetViT model. All models were trained from scratch, without using pretrained weights, on a dataset comprising real-world thick blood smear images augmented with publicly available microscopy data from Kaggle. In the hybrid architecture, the ResNet module was used to extract robust local morphological features, while the ViT component captured long-range dependencies and contextual relationships within images. Results: In cross-validation experiments, all three architectures consistently achieved high diagnostic performance. ResNet50 attained the highest accuracy (96.9%), an F1-score of 96.3%, and an ROC-AUC of 0.997. The Vision Transformer achieved 93.1% accuracy, 91.7% F1-score, and an ROC-AUC of 0.989. The hybrid ResNetViT reached 95.2% accuracy, 94.2% F1-score, and an ROC-AUC of 0.995. These results confirm that all architectures can reliably distinguish among Plasmodium species. Although ResNet50 achieved the highest raw accuracy, the hybrid model showed the most stable calibration and the closest qualitative agreement between its attention maps and expert-annotated parasite locations. Conclusions: The findings demonstrate that convolutional, transformer-based, and hybrid deep learning architectures can be successfully trained on real microscopy data for species-level malaria diagnosis. These results support the feasibility of deploying scalable, automated diagnostic systems to improve both accuracy and accessibility of malaria detection, particularly in resource-limited healthcare settings.

Infectious Disease Reports doi: 10.3390/idr18040077

Authors: Claudia Gyimah Prasamsa Pudasaini Allison LeMahieu Phillip Schulte Yewande E. Odeyemi

Background/Objective: To externally validate our previously published machine learning model for identifying hospitalized patients with community-acquired pneumonia (CAP) at low risk of respiratory deterioration or death using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Methods: This is a retrospective cohort study of adult patients (≥18 years) who were admitted with CAP and acute hypoxemic respiratory failure using the publicly available MIMIC-IV critical care dataset (Beth Israel Deaconess Medical Center, Boston, MA). We conducted an external validation study of a previously developed gradient boosting machine (GBM) model without recalibration using data available within the first 6 h of hospital admission. Results: For the primary composite outcome (need for advanced respiratory support [high flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV)] or in-hospital death), the gradient boosting model demonstrated comparable performance in the derivation and external validation cohorts. The area under the receiver operating characteristic curve (AUC) was 0.713 in the Mayo cohort (n = 4379) and 0.689 in the MIMIC-IV cohort. Accuracy was 0.612 (95% confidence interval [CI], 0.595–0.628) versus 0.606 (95% CI 0.600–0.611), specificity 0.574 versus 0.523, sensitivity 0.723 versus 0.754, NPV 0.860 versus 0.842, and PPV 0.364 versus 0.401, respectively. For secondary outcomes, model discrimination was comparable between cohorts. The AUC for in-hospital mortality was 0.727 in the Mayo Cohort versus 0.733 in MIMIC-IV; for IMV, 0.736 versus 0.724; and for NIMV, 0.732 versus 0.708. Conclusions: Our machine learning algorithm demonstrated good discrimination and a high negative predictive value for identifying low-risk hospitalized CAP patients for respiratory deterioration or death in the external MIMIC-IV dataset, supporting its potential utility for prognostic enrichment in pneumonia clinical trials.

Infectious Disease Reports doi: 10.3390/idr18040076

Authors: Cesare De Virgilio Suglia Renato Laforgia Marcella Schiavone Anna Belfiore Giacomo Guido Rosa Buonamassa Alba Cuxart-Graell Martina Di Noto Valeria Mele Emanuele Costanza Venilia Cocco Alexandre Meduri Lucia Raho Nicole Laforgia Roberta Iatta Giovanni Putoto Francesco Di Gennaro

Background: Migrant agricultural workers in Italy often experience social and health vulnerabilities, including unstable housing and limited access to primary care. In Southern Italy, many live in informal settlements and seek care through outreach services. This study describes patterns of pharmacological treatment in this population and examines how they relate to the clinical conditions managed in mobile clinics. Methods: We analyzed routinely collected data from 2928 unique patients (8547 clinical encounters; 8965 treatment occurrences) managed by Doctors with Africa CUAMM mobile clinics in 12 informal settlements in Apulia, Italy, between 2017 and 2026. Diagnoses were grouped into clinical categories, and pharmacological treatments were classified by therapeutic class. We conducted a descriptive analysis of the distribution of diagnostic categories and associated treatments. Results: The population was predominantly male (96.5%), young (81% <45 years), and largely excluded from regular primary care (93.5% without a General Practitioner). Musculoskeletal disorders and fatigue were the leading diagnostic category (34.0%), followed by gastrointestinal (13.5%) and respiratory conditions (13.0%). Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics were the most frequently recorded treatments (32.6% of treatment occurrences). Among musculoskeletal presentations, NSAIDs were used in 76% of cases. Gastroprotective agents were documented in 52% of encounters with gastrointestinal symptoms. Among cardiovascular presentations, 87.7% of treatment occurrences involved chronic management with antihypertensives or beta-blockers. Conclusions: In this outreach setting, medication use provides a descriptive picture of common health problems and treatment responses among migrant agricultural workers living in informal settlements. The prominent use of symptomatic pharmacological relief, particularly NSAIDs in musculoskeletal conditions, suggests that care is often focused on managing pain and acute complaints in a population facing barriers to continuous primary care. These findings support the need for stronger inclusion of migrant workers in the National Health Service and for policies that address underlying social and structural determinants of health.

Infectious Disease Reports doi: 10.3390/idr18040075

Authors: Nicole Liang Jenna DeTemple Christopher E. Potts Usman Alizai Charles Meadows

Background: Immunosuppressed patients are at an increased risk for developing odontogenic and orofacial infections, which can present with atypical processes and features that may mimic rare but life-threatening infections such as Ludwig’s angina. Differentiating cellulitis from a deep neck space infection is often challenging in this population in acute settings due to a broad differential diagnosis and blunted inflammatory responses. This diagnostic uncertainty complicates acute risk stratification and may delay recognition of conditions requiring early airway evaluation and intervention. Case Presentation: We present the case of a 28-year-old male with chronic myelogenous leukemia on immunosuppression with dasatinib who developed unilateral facial swelling and severe odontogenic pain that was refractory to empiric antibiotic therapy. The patient’s presentation with rapid clinical progression, early trismus, submandibular involvement, and floor-of-mouth tenderness raised significant concern for evolving Ludwig’s angina. Laboratory evaluation demonstrated elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, further complicating early assessment. Imaging was promptly obtained to determine the nature of the infection, and the patient was admitted for intravenous antibiotic therapy and airway monitoring. Clinical improvement ensued. Conclusions: This case highlights the diagnostic overlap between facial cellulitis and Ludwig’s angina and underscores the importance of prompt imaging, airway monitoring, and clinical vigilance for risk stratification of immunocompromised patients in the acute setting to prevent life-threatening complications.

Infectious Disease Reports doi: 10.3390/idr18040074

Authors: Manuel Sierra Elsa Palou Fernando Baires Helen Hoffman Heike Hesse Miguel Sierra-Hoffman Amy C. Madril

Background: Rickettsial diseases, particularly typhus group rickettsioses, remain underrecognized across the Americas despite ecological conditions favorable for transmission. Concurrently, Central America is experiencing one of its largest dengue epidemics, with an unexpectedly low proportion of laboratory-confirmed cases. Objective: We aimed to explore whether typhus group rickettsioses may contribute to dengue-like febrile illness in Central America in the context of low dengue diagnostic confirmation. Materials and Methods: An analytical narrative review was conducted integrating secondary epidemiological data from the Pan American Health Organization (PAHO) Arbovirus Surveillance Portal and the peer-reviewed literature. Data from seven Central American countries (2024) were analyzed to estimate the proportion of laboratory-confirmed dengue cases. A focused literature review examined epidemiological, clinical, and ecological evidence supporting rickettsial transmission. Results: Of 543,006 reported dengue cases in Central America in 2024, only 62,285 (11%) were laboratory-confirmed. Evidence from Costa Rica and regional serologic studies suggests ongoing rickettsial transmission. Ecological and socioeconomic conditions—including vector abundance, peridomestic reservoirs, and climate variability—mirror those of South Texas, where murine typhus is endemic. Conclusions: The discrepancy between reported and confirmed dengue cases suggests a potential diagnostic gap. Typhus group rickettsioses represent a plausible, underrecognized contributor to febrile illness in Central America. Strengthening surveillance, diagnostics, and clinical awareness is essential to address this hidden burden.

Infectious Disease Reports doi: 10.3390/idr18040073

Authors: Kumaran Oudhaya Ellappan Kalaiarasan Anoop Alex Kooleri Padinjare Veetil Hyma Harishni Padmanaban Sangitha Jayagandan Noyal Mariya Joseph

Background: Mycobacterium abscessus complex (MABC), comprising Mycobacterium abscessus subsp. abscessus (MABa), Mycobacterium abscessus subsp. bolletii (MABb), and Mycobacterium abscessus subsp. massiliense (MABm), is an emerging group of non-tuberculous mycobacteria with clinically significant infections and challenging treatment outcomes due to extensive antimicrobial resistance. Accurate subspecies identification and characterization of resistance- and virulence-associated determinants are essential for effective disease management. This study aimed to determine the prevalence and subspecies distribution of MABC and to characterize resistance-associated mutations and virulence factors, including biofilm formation. Methods: A total of 1110 NTM-suspected clinical samples were screened during the study period, between January 2024 and October 2025. Samples negative by GeneXpert MTB/RIF were subjected to Mycobacteria Growth Indicator Tube (MGIT) culture, followed by Ziehl–Neelsen staining and MPT64 antigen testing. Acid-fast bacilli-positive, MPT64-negative isolates were identified as NTM and analyzed using GenoType CM and NTM-DR line probe assays (LPA) for species identification and detection of resistance-associated mutations. A polymerase chain reaction (PCR) assay was optimized to differentiate MABa and MABm. All MABC clinical strains were further characterized for colony morphology (smooth and rough) and biofilm formation. Three biofilm-producing MABa strains (2 rough and 1 smooth) that were detected as macrolide-resistant by NTM-DR were subjected to whole-genome sequencing (WGS). Results: Among 1110 clinical samples, MABC was identified in 2.25% (n = 25) of cases, while other NTM species accounted for 4.41% (n = 49). Among 25 MABC clinical strains, 14 (56%) were MABm, and 11 (44%) were MABa, as confirmed by both LPA and PCR. LPA-NTM DR detected erm(41) T28 sequevar (n = 9) and C28 mutation (n = 2) among MABa strains, with one strain exhibiting aminoglycoside resistance-associated rrs mutation. Nineteen isolates displayed a smooth morphotype (MABa = 8 and MABm = 11), and six were rough (MABa = 3 and MABm = 3). Biofilm formation was observed in both smooth (n = 5) and rough (n = 4) morphotypes. WGS analysis confirmed erm(41) T28 sequevar, identified a missense mutation (A238G), and revealed genes associated with glycopeptidolipid biosynthesis. Conclusions: Our findings provide important insights into subspecies identification and genetic determinants associated with drug resistance and virulence in MABC. The biofilm-forming ability observed in both smooth and rough morphotypes emphasizes its potential role in persistence and treatment challenges, emphasizing the need for comprehensive diagnostic strategies.

Infectious Disease Reports doi: 10.3390/idr18040072

Authors: Panashe Nyengera Hilary Takunda Takawira Farai Fredric Mlambo

Background: Sub-Saharan Africa suffers the greatest impact of malaria, with the 2024 Health Organization (WHO )report stating that the region represents 94% of global cases and 95% of deaths. Challenges in malaria elimination stem from weak health systems and limitations of traditional diagnostic methods like microscopy and malaria Rapid Diagnostic Tests (mRDTs), which result in missed diagnoses, delays in treatment, and preventable fatalities in resource-limited settings. This paper addresses these diagnostic limitations by developing and systematically evaluating a machine learning (ML) framework for malaria diagnosis that leverages routine clinical symptoms and demographic information tailored for these environments. Methods: Examining 637 patient records from Gutu Mission Hospital and Gweru Provincial Hospital in Zimbabwe, the research analyzed clinical symptoms (fever, chills, abdominal pain, headache, diarrhea) and demographic data (age, gender, residence, travel history). Data preprocessing involved addressing class imbalance with the Synthetic Minority Oversampling Technique (SMOTE) and employing Recursive Feature Elimination (RFE) for feature selection. Seven ML models were trained: Logistic Regression, Random Forest, Decision Trees, Gradient Boosting, K-Nearest Neighbor, Naive Bayes, and XGBoost. These individual models were used to construct ensemble models like Bagging, Stacking, Soft Voting, and AdaBoost. Performance metrics included accuracy, precision, confusion matrices, recall, F1 score, and AUC-ROC. Results: Statistically significant predictors for malaria included chills (p = 0.001), fever (p = 0.003), diarrhea (p = 0.01), and abdominal pain (p < 0.001), with travel history showing significance among demographic factors (p = 0.02). The stacking ensemble model yielded superior performance, achieving an accuracy of 0.96, precision of 0.95, recall of 0.98, F1 score of 0.96, and AUC-ROC of 0.98. Conclusions: This study underscores the potential of ML, particularly ensemble techniques, to enhance malaria management in resource-limited settings, providing a scalable and cost-effective diagnostic alternative that utilizes accessible clinical and demographic data, thereby supporting healthcare workers and control programs in areas where traditional methods are inadequate.

Infectious Disease Reports doi: 10.3390/idr18040071

Authors: Amruta Pramod Moghe Emaly Starrett Leak Jennifer May Laplante Kirsten St. George

Background: Influenza viruses can cause mild to severe illnesses. The burden of disease varies widely depending on multiple factors, including the type and subtype of circulating viruses, timing of the season, flu vaccine efficacy and vaccination rates. Influenza viruses are also highly prone to genetic change and rapid spread due to modern human movement patterns, making influenza surveillance vital for public health awareness, guidance, policy, disease mitigation, and annual recommendations on vaccine composition. Methods: A network of three National Influenza Reference Centers (NIRCs) was established in the United States more than 10 years ago to support the Centers for Disease Control and Prevention’s (CDC) Influenza Division with its national influenza surveillance efforts. Located in California, New York, and Wisconsin, they are funded by CDC via a collaborative agreement with the Association of Public Health Laboratories (APHL). The role of the NIRCs is critical to national and global influenza surveillance, providing rapid information on circulating influenza strains from three arms of laboratory testing: (1) the virus isolation project (VIP), (2) next-generation sequencing (NGS), and (3) anti-viral drug resistance testing. Results: Here, we review the data generated in the VIP lab of the New York State (NYS) NIRC before, during, and after the COVID-19 pandemic and discuss its utility in an understanding of disease dynamics and viral evolution, as well as public health policy and decision making during this historic period in health care. Conclusion: Continued preparedness and surveillance are critical to mitigating the impact of evolving influenza viruses.

Infectious Disease Reports doi: 10.3390/idr18040070

Authors: Christos Ntais Ioanna P. Chatziprodromidou

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

Infectious Disease Reports doi: 10.3390/idr18040069

Authors: Enoch Chi Ngai Lim Nga Chong Lisa Cheng Chi Eung Danforn Lim

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

Infectious Disease Reports doi: 10.3390/idr18040068

Authors: Blake J. McKinley Rob M. Seby Robert C. Chase Tatjana Gavrancic Jeremy Collado Libardo Rueda Prada

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

Infectious Disease Reports doi: 10.3390/idr18040067

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

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

Infectious Disease Reports doi: 10.3390/idr18040066

Authors: Shintaro Yataka Kinya Tsubota Kei Wakatsuki Risa Sugawara Masaki Asakage Yoshihiko Usui

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

Infectious Disease Reports doi: 10.3390/idr18040065

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

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

Infectious Disease Reports doi: 10.3390/idr18040064

Authors: Ryoma Takeda Kazunori Yamada Takenori Abe Tomoyuki Ishigo Hirohiko Nakamura

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

Infectious Disease Reports doi: 10.3390/idr18040063

Authors: Nihitta Hanna Suji Thangamani Rosemol Varghese Jiji Smila Arockiasamy Balaji Veeraraghavan Rani Diana Sahni

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

Infectious Disease Reports doi: 10.3390/idr18030062

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

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

Infectious Disease Reports doi: 10.3390/idr18030061

Authors: Hayden D. Hedman

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

Infectious Disease Reports doi: 10.3390/idr18030060

Authors: Amanda Hempel Gregory D. Hawley Jahmar Hewitt Maxime Billick Adrienne J. Showler Kevin C. Kain Andrea K. Boggild

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

Infectious Disease Reports doi: 10.3390/idr18030059

Authors: Laura Scorzolini Alessandra D’Abramo Enrico Girardi Emanuele Nicastri

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

Infectious Disease Reports doi: 10.3390/idr18030058

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

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

Infectious Disease Reports doi: 10.3390/idr18030057

Authors: Shuaibu Abdullahi Hudu Emad A. Morad Ghusun M. Alhazimi Abdulgafar Olayiwola Jimoh

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

Infectious Disease Reports doi: 10.3390/idr18030056

Authors: Alma Trnacevic Emir Trnacevic Merjema Mahmutovic Amra Serak Humera Porobic Jahic Jasminka Petrovic Dilista Piljic Rahima Jahic Danijel Bijedic Amela Becirovic

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

Infectious Disease Reports doi: 10.3390/idr18030055

Authors: Ayesha Siddiqa Prosenjit Choudhury Nabil Jahan Mahim Suman Paul Syed Sayeem Uddin Ahmed Md Bashir Uddin

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

Infectious Disease Reports doi: 10.3390/idr18030054

Authors: Suzana Zivojinovic Tijana Prodanovic Nikola Prodanovic Rasa Medovic Milica Cekerevac Dragana Savic Bojana Markovic Slobodan Jankovic

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

Infectious Disease Reports doi: 10.3390/idr18030053

Authors: Stefano Picchi Augusto Minieri Francesco Lassandro Giuseppe Russo Giulia Lassandro

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

Infectious Disease Reports doi: 10.3390/idr18030052

Authors: Olga Pawełczyk Paulina Iwase Bartosz Wierzba Jolanta Szłapka-Kosarzewska

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

Infectious Disease Reports doi: 10.3390/idr18030051

Authors: Malizgani Mhango Enos Moyo Nigel Tungwarara Knowledge Denhere Moses Chirimbana Tafadzwa Dzinamarira

Background: In March 2026, a meningococcal cluster centred on the University of Kent, England, caused two deaths and resulted in over 20 reported cases within the first week, including confirmed and suspected invasive cases. Subsequent UKHSA updates in early April 2026 reported 21 laboratory-confirmed MenB cases (18 linked to the outbreak strain) and two deaths, with the outbreak subsequently spreading to a second Canterbury university, Canterbury Christ Church University, and confirmed as Neisseria meningitidis serogroup B (MenB). Sub-Saharan Africa (SSA) bears a disproportionate global burden of meningococcal disease, yet university settings remain a critically understudied outbreak amplifier. This narrative review extracts epidemiological and policy lessons from the Kent event and applies them to the SSA context. Methods: We conducted a narrative review following the SANRA criteria, searching PubMed, Embase, Scopus, Google Scholar, and African Journals Online (2000–2026), with supplementary grey literature retrieved from World Health Organisation (WHO), Africa Centre for Disease Control, and United Kingdom Health Security Agency (UKHSA). Outbreak data were drawn from official UKHSA public-health statements (grey literature, archived), the University of Kent communications, and peer-reviewed expert commentary. Results: The Canterbury outbreak exposed six reproducible vulnerabilities: unprotected serogroup circulation (confirmed MenB, not covered for the current university-age cohort), nightlife-linked transmission amplification, delayed serogroup identification, poor student symptom-recognition, inadequate institutional response capacity, and, critically, multi-institutional spread via shared nightlife venues (confirmed extension to Canterbury Christ Church University within five days). Each vulnerability is demonstrably more severe in SSA universities, which face a broader multi-serogroup threat environment (NmA, B, C, W, X), virtually no university-entry vaccination requirement, and critical evidence gap of campus-specific meningococcal evidence in the published literature. Conclusions: This review proposes a five-pillar preparedness framework for SSA tertiary institutions, derived from a synthesis of the Kent outbreak and broader epidemiological evidence, intended to inform policy discussion and future research. Moreover, these should be embedded within a broader age-linked prevention strategy that begins before university entry, particularly during the transition into secondary school in high-risk settings. Priority measures include meningococcal vaccination at key educational transition points, prophylactic antibiotic pre-positioning, serogroup-capable surveillance, symptom-recognition training, and pan-continental alert A predominantly reactive response may carry substantial risk in SSA settings.

Infectious Disease Reports doi: 10.3390/idr18030050

Authors: Sujata Srikanth Diana Ivankovic Lucia Gonzales Delphine Dean Luigi Boccuto

Background/Objectives: Long COVID-19 (LC-19), also known as Post-Acute COVID-19 Syndrome (PACS), is a chronic condition some people experience after an initial SARS-CoV-2 infection. The etiology of this complex, multifactorial disease remains largely unknown, although various theories have been propounded. This study aims to profile and compare the metabolic activity of cells of normal and LC-19 patients. Methods: A cohort of 20 individuals, 10 with LC-19 and 10 without LC-19, was selected based on their post-COVID-19 symptomatology. Saliva was tested for opportunistic viruses like Epstein–Barr virus (EBV) and Human Herpesvirus 6 (HHV-6). Lymphoblastoid cell lines derived from blood were analyzed using the Biolog Phenotype Mammalian Microarrays (PM-M1, PM-M6, and PM-M7) to assess metabolic activity across a wide array of growth substrates and effector molecules. Results: Unique metabolic profiles emerged across the controls and LC-19 groups. The SARS-CoV-2 infection causes an over two-fold enhanced utilization of glycolytic and anaerobic substrates and a reduced response to growth factors and effectors. The increased energy source utilization assessed in PM-M1 is unsustainable, and the LC-19 groups demonstrate this with a clear correlation with the number of LC-19 symptoms, demonstrating a trend consistent with metabolic reprogramming. The infection also results in a reduced response to growth factors and effectors, assessed in PM-M6 and PM-M7, with the level of reduction commensurate with the symptom burden. Conclusions: The data from the patient groups were analyzed and compared to construct a metabolic profile unique to individuals who developed LC-19, which could, in the future, be used for diagnosis and to identify targets for therapeutic intervention. Our study identified an LC-19-specific metabolic profile indicative of adaptive responses to stress, cellular dysfunction, and prolonged inflammation, leading to the reprogramming of bioenergetic pathways.

Infectious Disease Reports doi: 10.3390/idr18030049

Authors: Mohammed H. Al-Maliki Celine Tabche Alaa K. Mousa Ali R. Hashim Zeenah Atwan Hassan A. Farid Maitham G. Yousif David Rawaf Nazik Haikaz Hasrat Murtadha Almusafer Anees K. Nile Riyadh Al-Hilfi Azeem Majeed Alessandra Scagliarini Salman Rawaf Roaa Khafaji Juan Carlos de la Torre Haydar Witwit

Background: The impact of climate change on birds’ migration and ticks’ reservoir habits is contributing to the spread of Crimean–Congo hemorrhagic fever (CCHF), caused by CCHF virus (CCHFV), to new continents and countries. CCHF is endemic to the Eastern Mediterranean Region, including Iraq, and is witnessing a substantial surge in confirmed cases with considerable disparity and gaps in managing CCHF cases. The increasing CCHF spread across Asia, Africa, and Europe, including Spain and Turkey, highlights the danger of its expansion. Developing high-confidence diagnostic criteria, identifying risk factors, and accurate predictors of CCHF outcomes are critical to managing suspected and confirmed cases of CCHF and to reducing the current case fatality rate of CCHF, which is the goal of this study. Methods: We completed a retrospective evaluation of 61 confirmed cases of CCHF in Basrah (Iraq). The cases were screened according to the clinical presentation, and CCHF cases were identified by ELISA and validated by PCR. Data was analyzed using SPSS version 22. T-tests, chi-square/Fisher exact tests, and Pearson’s correlation were used, with significance set at p < 0.05 and high significance at p < 0.01. Results: We found that repeated exposure to animals during animal slaughtering was a significant risk factor. In addition, 5% of the patients with confirmed CCHF, mainly from rural areas, reported exposure to rats. Clinical presentations included fever, headache, gastrointestinal problems, eye and orbital symptoms, and hemorrhagic complications. Predictors of death included advanced age, decreased platelet counts, and neuropsychiatric symptoms such as delusions and confusion. Conclusions: Our findings identify clinical and laboratory features of CCHF cases in Iraq, which will help to implement the most effective interventions to manage CCHF cases and protect the public in all Iraqi governorates. In summary, this study highlights a recent and significant rise in CCHF cases in Basrah Governorate, Iraq. Notably, 5% of confirmed cases reported contact with rats. The paper also proposes diagnostic criteria and identifies key predictors of mortality to support improved clinical management of CCHF. These findings underscore the urgent need for strengthened public health interventions, including enhanced infection prevention and control measures, increased awareness, and improved surveillance systems. The findings have important implications for improving control procedures, guiding therapeutic development, informing vaccine strategies, and supporting evidence-based policy alongside future research efforts.

Infectious Disease Reports doi: 10.3390/idr18030048

Authors: Aurelia Sangani Flavia Puci Davide Tirro Simona Villani Camilla Torriani Enrico Brunetti Raffaele Bruno Elisabetta Pagani

Background: Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection characterized by fascial necrosis, with mortality rates of 20–30%. Despite its rarity, NF is increasingly encountered due to the rising prevalence of predisposing factors. Data from Southern European tertiary centers remain scarce. Methods: We retrospectively reviewed all patients ≥18 years with radiological and/or surgical diagnosis of NF managed at IRCCS Policlinico San Matteo, Pavia, Italy, between November 2018 and August 2023. Clinical, microbiological, and treatment data were extracted from electronic medical records. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated retrospectively. The Charlson Comorbidity Index was computed for each patient. Given the small sample size, we adopted a purely descriptive analytical approach without inferential testing. Results: Thirteen patients met inclusion criteria (median age 58 years, IQR 44.5–79.5; 69.2% male). The most common comorbidities were diabetes mellitus (6/13, 46.2%), renal failure (4/13, 30.8%), and chronic liver disease (4/13, 30.8%). The age-adjusted Charlson Index ranged from 0 to 11 (median 4). Lower limbs were the most frequently affected anatomic site (5/13, 38.5%), followed by the perineal/genital region (Fournier gangrene, 4/13, 30.8%). Type II (monomicrobial) NF predominated (9/13, 69.2%). Microbiological cultures were positive in 8/13 patients (61.5%): Gram-positive cocci were isolated in 5/8 (62.5%) and mixed aerobic/anaerobic flora in 3/8 (37.5%). Empirical antibiotic regimens included a piperacillin–tazobactam backbone in 6/12 (50.0%) patients and a meropenem-based combination in 5/12 (41.7%); 6/12 patients underwent targeted de-escalation after culture results. Two patients (15.4%) died in hospital, both with Fournier gangrene and Type I infection (mortality 2/4, 50.0% in Type I vs. 0/9 in Type II). The median length of stay was 26 days (IQR 17–28.5). All patients had LRINEC ≥6 at admission, with 9/13 (69.2%) classified as high risk (≥8). Conclusions: In this small retrospective Italian cohort, NF was most frequently associated with diabetes and high comorbidity burden. Type I (polymicrobial) infections, predominantly involving the perineal region, showed worse outcomes than Type II infections. The clinical experience accumulated during this study period subsequently informed the development of an institutional empirical antimicrobial protocol for skin and soft tissue infections at our hospital.

Infectious Disease Reports doi: 10.3390/idr18030047

Authors: Gracia Viviana González-Enríquez Blanca Miriam Torres-Mendoza Martha Escoto-Delgadillo Efrain Chavarria-Avila Sagrario Karina Esparza-Avila Clara Esperanza Santacruz-Tinoco Bernardo Martínez-Miguel Magally Farah Diva Arenas-Sevilla David Israel Javalera Castro

Background: Climate change has contributed to the global resurgence of dengue, with a spike of more than 14.4 million dengue cases. This study aimed to analyze the association between dengue frequency with climatic factors, circulating serotypes, and disease severity in northwestern Mexico. Methods: A retrospective time-series study was conducted using dengue molecular diagnostic data reported between September 2017 and January 2025 by the Laboratorio de Apoyo a la Vigilancia e Investigación Epidemiológica del Centro de Investigación Biomédica de Occidente, Mexico. Data included dengue frequency, serotype distribution, and clinical severity across seven states in northwestern Mexico (Colima, Guanajuato, Jalisco, Michoacán, Nayarit, Sinaloa, and Sonora). Meteorological data were obtained from the Automatic Meteorological Stations of the National Water Commission. Associations between dengue frequency and climatic variables were evaluated using linear regression models. Statistical analyses were performed using SPSS v24 and R v3.5. Results: In Jalisco, minimum, mean and maximum temperatures, as well as precipitation, were significant predictors of dengue cases, explaining approximately 21.7% of the variance (adjusted R2 = 0.217, p < 0.001). In Colima and Michoacán, precipitation showed no predictive value. In Guanajuato, the maximum temperature was excluded from the model (adjusted R2 = 0.226). Models for Nayarit, Sinaloa, and Sonora excluded two or more climatic variables, with adjusted R2 values of 0.111, 0.151, and 0.049, respectively. Conclusions: Climatic conditions and epidemiological time trends explain a modest proportion of dengue cases in northwestern Mexico, with the strongest association observed in Jalisco. Additional determinants, including vector ecology, host immunity, circulating serotypes, population mobility, and public health interventions, should be considered to better understand dengue dynamics.

Infectious Disease Reports doi: 10.3390/idr18030046

Authors: Aditya K. Gupta Elizabeth Teasell Vasiliki Economopoulos

Background: Superficial fungal infections caused by dermatophyte and non-dermatophyte species are increasing globally. While several comorbid diseases and risk factors have been associated with fungal infections at the individual level, their epidemiological relationships at the population level remains poorly characterized. Objective: We aimed to examine population-level associations between the burden of superficial fungal infections and selected comorbid conditions and risk factors, stratified by age, sex and country. Methods: We obtained years lived with disability (YLDs) for superficial fungal infections, diabetes, psoriasis, and atopic dermatitis and summary exposure values (SEVs) for high body mass index (BMI) and high alcohol intake from Global Burden of Disease Study 2023. Data were obtained for Australia, Brazil, the United Kingdom and the United States for males and females younger than 20 years, 20 to 54 years and 55+ years old. Pearson correlation coefficients were calculated between fungal infection YLDs and each comorbid condition (YLDs) and risk factor (SEVs). Results: Significant positive correlations were observed between superficial fungal infection burden and diabetes (R = 0.6–0.98), high BMI (R = 0.75–0.95), psoriasis (R = 0.59–0.96), and atopic dermatitis (R = 0.51–0.93) in older adults (55 years+). Correlations with high alcohol consumption were more variable across regions and sex. In young–middle-aged adults (20–54 years), moderate-to-strong correlations (R ~ 0.8–0.9) were observed, although patterns were less consistent across countries. In individuals < 20 years, associations were generally weaker, with some positive correlations observed for atopic dermatitis (R = 0.4–0.7) in select countries. Conclusions: The findings demonstrate population-level associations between superficial fungal infections and metabolic, inflammatory, and behavioural risk factors, with stronger correlations observed in older age groups. These patterns may reflect shared demographic, epidemiologic, and clinical patterns across conditions.

Infectious Disease Reports doi: 10.3390/idr18030045

Authors: Zofia Gniadek Estera Jachowicz-Matczak Cezary Kapturkiewicz Izabella Bylica Dorota Romaniszyn Jadwiga Wójkowska-Mach

Background: Vaccinations prevent severe respiratory infections in older adults, yet uptake in Polish long-term care facilities (LTCFs) remains poorly characterized. We assessed influenza and pneumococcal vaccination coverage and factors associated with uptake, including the influence of local government financing. Methods: In this prospective observational study (January–June 2022), residents aged ≥65 years from eight LTCFs in southern Poland (four public, four private) were evaluated. Clinical data and geriatric assessments (Barthel Index, ADL, FRAIL-NH) were obtained from medical records and questionnaires. Comparative analyses were limited to residents living in facilities where vaccination activities were implemented and for whom complete data were available. Results: Overall, 429 residents were assessed: 136 (31.7%) received influenza vaccination and 77 (17.9%) received pneumococcal vaccination. Three of the eight LTCFs administered neither influenza nor pneumococcal vaccines, highlighting a facility-level access gap. For individual-level comparisons, 260 residents with complete data from LTCFs offering vaccination were analyzed (245 for pneumococcal outcomes). Influenza vaccination was not associated with most comorbidities or functional measures, but was more common among residents with dementia. Pneumococcal vaccine recipients were younger, had better functional status, and exhibited a lower burden of comorbidities than unvaccinated residents, suggesting preferential vaccination of fitter individuals. Municipality-level data showed low uptake of publicly funded pneumococcal programs (6.1% in Kraków; 3.6% in Wilkowice). Conclusions: Vaccination coverage among LTCF residents was low and strongly influenced by structural access at the facility level. Simplifying costs, reducing out-of-pocket costs and addressing potential age-related biases are essential to improving equitable immunization in Polish LTCFs.

Infectious Disease Reports doi: 10.3390/idr18030044

Authors: Zeynep Ture Emine Alp

Background/Objectives: The increasing burden of multidrug-resistant (MDR) microorganisms and limited resources in healthcare settings are making traditional strategies based on routine isolation of all carriers unsustainable. Methods: A clinical narrative review was conducted by searching PubMed, Web of Science, and Google Scholar for studies published between 2011 and 2025. International guidelines were analyzed to synthesize a sustainable infection control strategy. Results: High-quality evidence, including cluster-randomized trials, indicates that routine contact isolation for endemic ESBL-producing Enterobacterales (IRR: 0.99) and VRE (RR: 0.93) provides no additional benefit over standard precautions. In contrast, strict isolation remains vital for high-threat pathogens such as Carbapenem-Resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Candidozyma auris due to their high environmental resilience and limited treatment options. Prioritization should be guided by pathogen biology, patient-specific transmission traits (e.g., diarrhea), and facility infrastructure. Conclusions: Traditional one-size-fits-all infection control is increasingly unsustainable under resource constraints. A risk-based approach prioritizing horizontal measures for low-risk pathogens enables a more balanced allocation of limited resources toward high-threat containment.

Infectious Disease Reports doi: 10.3390/idr18030043

Authors: Yuki Hanai Shusuke Uekusa Mizuki Mori Kohei Shimoyama Hayato Ohashi Koji Nishimura Sachiko Yanagino Takahiro Matsumoto Kazuhiro Matsuo

Background: Anti-MRSA agents are essential for treating severe infections, yet their use is constrained by distinct toxicity profiles. However, comparative real-world data remain scarce. Methods: This nationwide pharmacovigilance study used the Japanese Adverse Drug Event Report (JADER) database (2004–2025). Disproportionality analyses (proportional reporting ratio [PRR]) were performed at the Standardized MedDRA Query and Preferred Term levels, complemented by Weibull-based time-to-onset modeling, to characterize AE patterns associated with vancomycin (VCM), teicoplanin (TEIC), arbekacin (ABK), daptomycin (DAP), linezolid (LZD), and tedizolid (TZD). Results: Distinct agent-specific AE profiles were observed. VCM showed disproportionate reporting of acute renal failure (PRR 6.66) and severe cutaneous reactions. TEIC displayed fewer renal signals but relatively higher reporting of hematologic events (PRR 3.51). ABK demonstrated high disproportionality in acute and chronic renal failure, reflecting aminoglycoside nephrotoxicity. DAP showed a high reporting signal for eosinophilic pneumonia (PRR 23.30), interstitial lung disease, and creatine kinase elevation/rhabdomyolysis, with wear-out hazard patterns suggesting a possible time-dependent reporting tendency. LZD exhibited hematopoietic signals (PRR 6.13) and additional associations with hyponatremia, lactic acidosis, and optic neuropathy, consistent with marrow suppression and mitochondrial toxicity. Weibull analysis indicated cumulative “wear-out” risks for renal, hepatic, and hematologic events, whereas hypersensitivity and many pulmonary events followed random-failure patterns. Conclusions: This large-scale JADER analysis delineated the distinct safety profiles of the six anti-MRSA agents. The key findings included DAP pulmonary and muscle toxicities, LZD hematological events, and VCM nephrotoxicity. Time-to-onset modeling indicates potential cumulative versus random risk patterns, suggesting the need for individualized monitoring and cross-validation.

Infectious Disease Reports doi: 10.3390/idr18030042

Authors: Zaineb Hamzaoui Hajer Kilani Alain Ocampo-Sosa Sana Ferjani Elaa Maamar Lamia Kanzari Ahmed Fakhfakh Amel Rehaiem Luis Martínez-Martínez Ilhem Boutiba Ben Boubaker

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major nosocomial pathogen. Although newer agents have reduced colistin use in high-income countries, this polymyxin remains important in many low- and middle-income settings. Colistin resistance in K. pneumoniae is most commonly associated with chromosomal alterations affecting the MgrB–PhoPQ pathway, or with plasmid-mediated mcr genes. This study aimed to investigate chromosomally mediated colistin resistance in CRKP clinical isolates from a Tunisian tertiary hospital. Methods: Between 2010 and 2015, 317 non-duplicate CRKP isolates were collected at Charles Nicolle Hospital, Tunis. Colistin MICs were determined by broth microdilution. Phenotypic tests and PCR characterized carbapenemases, extended-spectrum β-lactamases, AmpC, plasmid-mediated quinolone resistance, mcr and virulence genes. Porins (OmpK35/OmpK36) and the mgrB, phoP and phoQ loci were analyzed by SDS-PAGE and sequencing. Clonal relatedness was assessed by ERIC-PCR and multilocus sequence typing. We additionally compared colistin-resistant isolates with a panel of colistin-susceptible CRKP controls and assessed phenotypic stability after serial passages without colistin. Results: Five isolates (1.6%) were colistin-resistant. All were multidrug-resistant, produced OXA-48, and two also carried NDM-1. The isolates belonged to five distinct sequence types, including high-risk clones (ST11, ST101, ST147). No mcr genes were detected. Four isolates carried disruptive mutations in mgrB, and the remaining strain harbored inactivating mutations in both phoP and phoQ with an intact mgrB. Truncating alterations in PhoP/PhoQ and frequent loss or truncation of OmpK35/OmpK36 were observed. No mgrB/phoP/phoQ alterations were detected among colistin-susceptible controls, and colistin MICs remained stable after 7 days of drug-free passaging. Conclusions: In Tunisian CRKP, colistin resistance was associated with chromosomal alterations, predominantly involving disruption of the MgrB–PhoPQ pathway, in the absence of mcr genes. These mechanisms in both high-risk and emerging sequence types underscore the adaptability of CRKP and the need for surveillance where colistin remains an important therapeutic option.

Infectious Disease Reports doi: 10.3390/idr18030041

Authors: John Dotis Athina Papadopoulou Maria Fourikou Marianna Papakonstantinou Ioustini Kalaitzopoulou Charalampos Antachopoulos

Background/Objectives: Fungal peritonitis is a severe complication of peritoneal dialysis (PD) associated with catheter removal, technique failure, and increased mortality. Although Candida albicans was traditionally the predominant pathogen, non-albicans Candida (NAC) species are increasingly reported. This review summarizes the epidemiology and outcomes of PD-associated NAC peritonitis. Methods: A systematic review was performed following PRISMA guidelines. PubMed/MEDLINE, Scopus, and Google Scholar were searched (January 1990–March 2026) for NAC peritonitis studies. Case reports and series with species-level identification were included. Results: 31 studies met the inclusion criteria, comprising 25 individual case reports and 6 case series, totaling 89 NAC isolates. Candida parapsilosis was the most frequently reported species (n = 50), followed by Candida tropicalis (n = 15). Other pathogens included Candida glabrata, Candida guilliermondii, and several rare NAC species. Fluconazole was the most commonly used initial antifungal therapy. Catheter removal was performed in most cases, with the majority of patients requiring transition to hemodialysis. Overall mortality was 20% among individual case reports vs. 24% across case series. Species-specific differences were observed: C. parapsilosis and C. guilliermondii were generally associated with favorable outcomes, whereas infections involving C. glabrata and other emerging NAC species more frequently required treatment escalation and were linked to poorer outcomes. Conclusions: NAC species are an important cause of fungal peritonitis in PD patients and show considerable heterogeneity in clinical outcomes and antifungal susceptibility. Early species-level identification and prompt catheter removal remain essential for optimal management.

Infectious Disease Reports doi: 10.3390/idr18030040

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

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.

Infectious Disease Reports doi: 10.3390/idr18030039

Authors: Roberto Miguel Damián-Negrete Alondra Denisse Hernández-Luna Rocío Guadalupe Cano-Arias Antonio Durán-Plaza Judith Carolina De Arcos-Jiménez Kathya Analí Rodríguez-González Braulio Dazahel González-Flores Pedro Iván Navarro-González Jaime Briseno-Ramírez

Measles remains a major global public health challenge as declining vaccination coverage fuels outbreaks worldwide. Although pneumonia is the most recognized respiratory complication, spontaneous air leak syndrome—including pneumomediastinum, subcutaneous emphysema, and pneumoperitoneum—is rarely documented. We report the case of a 9-year-old previously healthy girl with no documented measles–rubella vaccination who presented with fever, maculopapular exanthem, Koplik spots, and persistent cough. Measles was confirmed by both immunoglobulin M enzyme-linked immunosorbent assay and real-time reverse transcription polymerase chain reaction. She developed sudden cervicothoracic swelling and chest pain. Chest radiography revealed pneumomediastinum and subcutaneous emphysema; computed tomography confirmed extensive air leak including pneumoperitoneum. Flexible bronchoscopy and upper gastrointestinal endoscopy excluded structural airway and esophageal injury. Laboratory evaluation revealed elevated hepatic transaminases, gamma-glutamyl transferase, lactate dehydrogenase, and D-dimer. Conservative management with high-flow supplemental oxygen and clinical surveillance led to progressive resolution. The patient was discharged on hospital day three, asymptomatic and breathing room air. This case highlights the spectrum of air leak complications in measles and supports conservative management in hemodynamically stable pediatric patients when structural injury has been excluded.

Infectious Disease Reports doi: 10.3390/idr18030038

Authors: Anna Marija Prince Indra Zeltiņa Aigars Reinis Olga Valciņa Angelika Krūmiņa

Objective: Hepatitis B virus (HBV) is a globally distributed infectious disease affecting the liver. This literature review aims to summarize all available relevant information on the PubMed database about HBV’s connection to the microbiome and to consider possible treatment adjuncts. Materials and methods: Database used: PubMed. Keywords used: “HBV”, “Hepatitis B”, “microbiome”. In the PubMed database, 179 research publications were identified using these keywords; 69 studies were excluded as they were irrelevant or retracted. Of the remaining, 110 were analyzed in this literature review, and four additional literature sources were used to supply background information and context. Information was summarized. The analysed studies in total included 14,814 participants (excluding animal studies), of whom 8564 were HBV-infected individuals. Results: Results characterizing abundance or decrease in specific bacterial, viral, and fungal species are heterogeneous; multiple studies support that the HBV patient oral and fecal microbiome is different from that in healthy controls (HCs) and varies throughout disease progression. The HBV seems to transform the microbiome negatively, leading to dysbiosis and decreased microbial diversity in most studies. Evidence links HBV microbiome changes with influence on HbeAg seroconversion, HBV-DNA load, metabolic pathways, liver cirrhosis, and hepatocellular carcinoma. The research proposes that members of microbiota could potentially promote or protect against liver injury in HBV. Four studies proposed that the plasma virome in HBV patients was primarily composed of members of the Anelloviridae. One study researched a parasite (Entamoeba gingivalis) in HBV patients. Two studies analyzed HBV patients’ fungal profiles. Conclusions: Microbiota research, although promising, at the present moment is heterogeneous. HBV patients’ microbiota is distinguishable from HCs, and multiple studies have tried to identify the HBV characteristic microbiome; however, more precise information is needed to draw conclusions. Fecal microbiota transplantation and probiotics have the potential to be therapy adjuncts for HBV patients, but more research is needed.

Infectious Disease Reports doi: 10.3390/idr18020037

Authors: Francesco Branda Nicola Petrosillo Giancarlo Ceccarelli Fabio Scarpa Marta Giovanetti Massimo Ciccozzi

Background: Influenza A(H3N2) continues to evolve rapidly, frequently eroding population immunity and challenging seasonal vaccine strain selection. During the 2025/26 season, the A(H3N2) subclade K (J.2.4.1) expanded quickly across multiple regions and showed evidence of antigenic divergence in standard assays. Methods: In this study, we combined phylogenetic analyses of hemagglutinin (HA) and neuraminidase (NA) sequences with a systematic synthesis of recent peer-reviewed studies and official surveillance reports to comprehensively define the molecular profile and early epidemiological dynamics of subclade K. Results: Our phylogenetic reconstructions of HA and NA genes confirmed the emergence of a coherent and recently diversified lineage characterized by coordinated evolution of surface glycoproteins and broad geographic representation during 2025. Integration of molecular, temporal, and surveillance evidence further supported rapid expansion with limited early regional structuring. Antigenic analyses reported in peer-reviewed studies described reduced haemagglutination inhibition reactivity to vaccine reference antisera for many subclade K viruses, whereas vaccine effectiveness (VE) estimates from multiple settings remained moderate. Conclusions: Overall, the available genetic, antigenic, and epidemiological evidence indicates that subclade K represents a recently diversified A(H3N2) lineage associated with rapid international spread during the 2025/26 season, highlighting the importance of integrated HA/NA genomic surveillance and timely antigenic characterization to support evidence-based vaccine strain selection.

Infectious Disease Reports doi: 10.3390/idr18020036

Authors: Anamaria Jurčević Jelena Dimnjaković Rok Čivljak

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.

Infectious Disease Reports doi: 10.3390/idr18020035

Authors: Hiroshige Mikamo Yuka Yamagishi Daisuke Sakanashi

Background/Objectives: Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STIs) and is increasingly recognized for its association with cervicitis and pelvic inflammatory disease. However, prevalence data in specific Japanese subpopulations, particularly comparing pregnant and non-pregnant women, remains limited. This study aimed to determine the prevalence of M. genitalium and its co-infection rates with Chlamydia trachomatis and Neisseria gonorrhoeae among Japanese women. Methods: A cross-sectional study was conducted using vaginal swab specimens collected between April 2021 and November 2022 from patients visiting two clinics in Gifu, Japan. The study population comprised 2138 non-pregnant women presenting with urogenital symptoms or sexual contact history, and 236 pregnant women undergoing routine antenatal screening. Detection was performed using real-time polymerase chain reaction assays on the cobas® 8800 system (Roche Diagnostics). Results: Among non-pregnant women, the overall prevalence was 3.8% (82/2138) for M. genitalium, 3.4% (72/2138) for C. trachomatis, and 0.4% (9/2138) for N. gonorrhoeae. Co-infection rates were low; M. genitalium and C. trachomatis co-infection was observed in 0.2% of cases. Among pregnant women, the prevalence was 3.8% (9/236) for both M. genitalium and C. trachomatis, and 0.4% (1/236) for N. gonorrhoeae. No statistically significant differences in prevalence were observed between pregnant and non-pregnant women for any pathogen. Conclusions: The prevalence of M. genitalium in this Japanese cohort was comparable to that of C. trachomatis in both pregnant and non-pregnant women, highlighting its significance as a major STI pathogen. These findings underscore the importance of including M. genitalium in routine STI screening panels for symptomatic women and antenatal care to prevent reproductive health complications. Given the high rates of antimicrobial resistance documented in Japanese M. genitalium strains, specific diagnostic testing is essential to enable targeted, resistance-guided therapy.

Infectious Disease Reports doi: 10.3390/idr18020034

Authors: Guido Granata Nicola Petrosillo

Background: The antibiotic ibezapolstat and the live biotherapeutic product live-JSLM are promising future approaches for treating Clostridioides difficile infection. Ibezapostat is a highly specific antibiotic for Clostridioides difficile, with minimal impact on the intestinal flora. Live-JSLM is designed to restore healthy intestinal microbiota, thus preventing recurrence of Clostridioides difficile infection. In this narrative review, we reviewed available data on ibezapostat and live-JSLM, considering that they are prototypes of two distinct, unique mechanisms of action against Clostridioides difficile. Methods: Data sources: PubMed and SCOPUS databases were searched from 1 January 2012 to 15 November 2025. Original articles reporting data on ibezapolstat and live-JSLM were included. Results: 31 studies were included. When compared to conventional anti-Clostridioides difficile antibiotics, ibezapolstat had a similar level of effectiveness and minimal impact on the gut microbiota. The available data confirm live-JSLM safety and efficacy in restoring the gut microbiota following the conclusion of the standard anti-Clostridioides difficile antibiotic regimen. Conclusions: The results on ibezapolstat efficacy are promising, but require confirmation in larger patient populations through double-blind, randomised phase III trials. In the near future, an integrated approach may enhance the management of Clostridioides difficile infection: starting with highly specific antibiotics, i.e., ibezapolstat, followed by microbiome-based therapies such as live-JSLM.

Infectious Disease Reports doi: 10.3390/idr18020033

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

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.

Infectious Disease Reports doi: 10.3390/idr18020032

Authors: Fernando Baires Erin Arias María José Díaz Cesar Burgos Carlos A. Umaña Mejia Justice Cruz Joanne Cordero Guerra Helen Hoffman Jack Bordovsky Jana Radwanski Miguel Sierra-Hoffman Amy C. Madril

Background: The genus Brucella has expanded considerably in the 21st century. With the advent of advanced phylogenetic analyses, a close genetic relationship between Brucella and Ochrobactrum has been identified, leading to reclassification of Ochrobactrum species within the genus Brucella. Among these, Brucella anthropi (formerly Ochrobactrum anthropi) is increasingly recognized as a rare cause of invasive human infection. We report a clinically significant case of B. anthropi infective endocarditis and review the available literature. Methods: We report a case of B. anthropi infective endocarditis and conducted a narrative review of the English-language medical literature through 2025. Cases were analyzed for demographics, clinical presentation, antimicrobial susceptibility, and outcomes. Results: A 75-year-old man with a prosthetic aortic valve and prior endocarditis presented with fever of unknown origin, weight loss, and prior transient ischemic attacks. Blood cultures grew B. anthropi after prolonged incubation. Transesophageal echocardiography demonstrated vegetations involving both the aortic and tricuspid valves, and the patient required targeted combination antimicrobial therapy due to persistent bacteremia. Seven additional cases of B. anthropi infective endocarditis were identified on review of the literature. Most patients had underlying valvular disease or prosthetic material. Reported lethality approached 25%. Antimicrobial susceptibility patterns were variable, underscoring the importance of targeted individualized therapy. Conclusion: Consistent with other Gram-negative bacilli, B. anthropi is a rare but established cause of acute bacterial endocarditis. Despite its rarity, it may represent an under-recognized cause of invasive disease. This case highlights the importance of prolonged culture incubation, careful microbiologic interpretation, and susceptibility-guided therapy.

Infectious Disease Reports doi: 10.3390/idr18020031

Authors: Anabel Franco-Moreno Ana Bustamante-Fermosel Juan Torres-Macho Belén Comeche-Fernández

Background/Objectives: Septic venous thrombosis is an uncommon complication but clinically significant due to its high morbidity and mortality and the complexity of therapeutic decision-making. The lack of standardized guidelines and the scarcity of high-quality studies complicate clinical management, as most available evidence derives from highly heterogeneous case series and retrospective studies. In this context, a comprehensive overview is essential to guide real-world practice. Methods: This manuscritp provides an in-depth review of the treatment of septic venous thrombosis at its most frequent sites, including the portal vein and its branches, the pelvic veins, catheter-associated events, the internal jugular vein, and dural venous sinus thrombosis. Results: Across all scenarios, early initiation of appropriate antibiotic therapy is the cornerstone of treatment and must be tailored to the suspected source of infection and the patient’s clinical course. In parallel, although the role of anticoagulation remains debated, several observational studies suggest potential benefits in terms of recanalization and complication prevention, particularly in selected patients. Conclusions: However, the decision to anticoagulate should be carefully individualized within a multidisciplinary framework. Despite the recent progress, many clinical uncertainties remain. Therefore, well-designed clinical trials are needed to define optimal therapeutic strategies for this condition.

Infectious Disease Reports doi: 10.3390/idr18020030

Authors: Gabriel A. Godart Vidit Yadav Joseph M. Bestic Bradley S. Schoch Bryan D. Springer Ravi V. Durvasula Sammer M. Elwasila Justin M. Oring

Background/Objectives: Non-typhoidal Salmonella (NTS) species are well-recognized causes of invasive infection in patients with sickle cell disease (SCD), with a particular predilection for the musculoskeletal system. Although Salmonella osteomyelitis is well described in this population, septic arthritis is uncommon, especially involving the shoulder joint. We describe a case of NTS bacteremia complicated by native shoulder septic arthritis in a patient with SCD and review its clinical implications. Methods: We report the clinical course, diagnostic evaluation, microbiologic findings, imaging studies, and management of a 22-year-old man with homozygous SCD who presented with a vaso-occlusive pain crisis and subsequently developed severe sepsis with persistent Salmonella enterica bacteremia following ingestion of undercooked poultry. Persistent bacteremia prompted further evaluation for metastatic infection using advanced imaging and diagnostic arthrocentesis. Results: Whole-body imaging identified septic arthritis of the native right shoulder, which was confirmed by synovial fluid cultures growing Salmonella species. The patient underwent arthroscopic irrigation and debridement for source control. Antimicrobial therapy was narrowed to intravenous ceftriaxone based on susceptibility data and continued for six weeks. The patient demonstrated clinical improvement with resolution of bacteremia and was discharged to rehabilitation to complete therapy. Conclusions: This case highlights the importance of a careful exposure history, including foodborne sources, in patients with SCD presenting with invasive Salmonella infection. Persistent bacteremia should prompt early investigation for metastatic foci, and timely surgical source control combined with targeted antimicrobial therapy is essential for optimal outcomes in this population.

Infectious Disease Reports doi: 10.3390/idr18020029

Authors: Ilaria Galliano Stefania Alfonsina Liguori Anna Pau Paola Montanari Cristina Calvi Anna Clemente Anna Massobrio Claudia Linari Stefano Gambarino Alessandra Conio Massimiliano Bergallo

Background: Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and hospitalization in infancy. Reliable biomarkers reflecting host antiviral responses and disease dynamics are still lacking. Methods: We evaluated the expression of the interferon-stimulated genes IFI44L, IFI27, and RSAD2 in peripheral blood of infants hospitalized with RSV bronchiolitis at admission and discharge, and in healthy controls, using multiplex RT-qPCR. A composite interferon-based Viral Score was derived from coordinated ISG expression. Results: All three ISGs and the Viral Score were markedly elevated during acute RSV infection at hospital admission compared with discharge and healthy controls. Following clinical recovery, ISG expression and Viral Score declined significantly and approached baseline levels. The Viral Score clearly discriminated acute infection from recovery and healthy states, reflecting dynamic systemic interferon activation. Conclusions: A Viral Score based on IFI44L, IFI27, and RSAD2 captures systemic antiviral immune responses in infants with RSV bronchiolitis and declines with disease resolution. This interferon-based host-response signature represents a promising biomarker for defining viral infection status and monitoring disease dynamics in pediatric respiratory infections.

Infectious Disease Reports doi: 10.3390/idr18020028

Authors: Chia-Yu Chiu Daniel B. Chastain Joseph Sassine Andrés F. Henao-Martínez

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.

Infectious Disease Reports doi: 10.3390/idr18020027

Authors: Hagen Frickmann Andreas Hahn Kirsten Alexandra Eberhardt Ulrike Loderstädt Norbert Georg Schwarz Ralf Matthias Hagen

Background: Schistosoma spp. are trematodes occurring in tropical endemic areas but can be imported to non-endemic regions as causes of travel-associated infections. In this study, two pan-trematode-specific real-time PCR assays were evaluated for their diagnostic sensitivity in detecting Schistosoma spp. DNA in diagnostic human samples. Methods: Two previously described pan-trematode-specific real-time PCR assays were comparatively assessed using diagnostic samples containing DNA of either the S. haematobium complex or the S. mansoni complex, as confirmed by Schistosoma species complex-specific real-time PCR. Results: Out of a total of 655 samples containing Schistosoma spp. DNA, positive signals in at least one of the two pan-trematode real-time PCR assays were recorded for 17 (2.6%) nucleic acid extractions. Although sensitivity was in the >90% range for stool samples, only a few individual blood plasma and serum samples, and none of the Schistosoma spp. DNA-containing tissue or urine samples, tested positive by pan-trematode PCR. The lower sensitivity of pan-trematode PCR compared with Schistosoma spp.-specific PCR was semi-quantitatively confirmed by higher cycle threshold (Ct) values in the former. When comparing samples with concordant versus discordant positive results for Schistosoma spp.-specific and pan-trematode PCR, Ct values of the Schistosoma spp.-specific PCR were lower in concordantly positive samples than in discordantly positive samples. Conclusions: While the assessed pan-trematode PCR assays showed insufficient sensitivity as screening tools for blood plasma, blood serum, tissue, and urine samples from individuals with suspected schistosomiasis, they were sufficiently sensitive when applied to stool samples, in which substantial amounts of target DNA, as indicated by low Ct values in the Schistosoma species complex-specific real-time PCR assays, can be expected. For screening for Schistosoma spp. DNA in sample materials other than stool, the use of highly sensitive target-specific PCR remains necessary.

Infectious Disease Reports doi: 10.3390/idr18020026

Authors: Wafaa Hussien Habeeb Noor Hameed Hanoush Meena Thaar Alani Ali Hazim Abdulkareem Mohammed Obaid Ibrahim Mohammed Salih Al-Janaby Mohammed Mukhles Ahmed Saja Saadallah Abduljaleel Zaid Mustafa Khaleel

Background: Dengue virus (DENV) does not have any effective antiviral therapy. The Cinnamomum verum has cinnamic acid and oleic acid that could inhibit important viral proteins. Aim: To compare their inhibitory capacity with the key DENV proteins through molecular docking, molecular dynamics and in silico ADMET. Methods: Phytochemical profiling of the ethanolic extract of the bark was done by GCMS. AutoDock Vina (version 1.2.0) was used to dock cinnamic acid and oleic acid to key proteins of DENV (NS5, NS3, and envelope) in the presence of ribavirin as the reference. The best complexes were then subjected to 50 ns of molecular dynamics simulation and stability measured by RMSD, RMSF, Rg, SASA, hydrogen bonding and RDF. Validated in silico tools were used to predict the ADMET properties. Results: Analysis of GC–MS revealed cinnamic acid (85.92%) and oleic acid (5.33%). The outcome of docking was that the cinnamic acid had the greatest affinity with NS5 (−5.970 kcal/mol) and the capsid protein (−5.755 kcal/mol), and oleic acid showed the highest affinity with the capsid (−6.150 kcal/mol) and then with NS5 (−5.209 kcal/mol). Both ligands had a relatively weak interaction with NS3. Simulation of the molecular dynamics showed the stability of the top complexes, especially the cinnamic acid–NS5 complex, that retained low RMSD (1.6–1.9 A), stable Rg and SASA profiles, and continued hydrogen bonding during the 50 ns period. The use of cinnamic acid in ADMET projections was more preferable, as it was more soluble, orally bioavailable (0.91), and drug-like (QED 0.65), but oleic acid revealed higher lipophilicity and lower drug-like properties (QED 0.29). Conclusions: Cinnamic acid showed specificity towards the NS5 proteins with the help of stable dynamics and good predicted pharmacokinetics, which are features that make it a promising multi-target anti-DENV scaffold. Oleic acid exhibited poor affinity and poor pharmacokinetic properties. The findings are predictive and must be validated using biochemical, cellular, and toxicological means to prove the antiviral efficacy and safety.

Infectious Disease Reports doi: 10.3390/idr18020025

Authors: Andreas Sarantopoulos Annalisa Quattrocchi Ioannis Kopsidas Oliver A. Cornely Danila Seidel Itamar Grotto Zoi Dorothea Pana

Background/Objectives: Primary amoebic meningoencephalitis (PAM) is a rare, fulminant, and often fatal central nervous system infection caused by the opportunistic free-living amoeba Naegleria fowleri. Although Naegleria species are widely present in freshwater and soil worldwide, human disease is associated specifically with pathogenic N. fowleri rather than the many nonpathogenic environmental species, and virulence may vary across N. fowleri isolates. This systematic review aimed to synthesize contemporary global data from 2000 to 2024 to identify recent trends in epidemiology, clinical presentation, diagnosis, treatment, and outcomes. Methods: A systematic literature search was conducted across PubMed, Scopus, and the Cochrane Library, identifying 58 eligible publications encompassing 66 individual cases. Results: Most reports originated from the United States, India, and China. The median patient age was 14 years, with 78% of cases occurring in males. Annual case reports increased from one per year (2000–2005) to over four per year (2020–2024), reflecting either a true rise in incidence or improved detection. Common presenting symptoms included fever, headache, and altered mental status. Diagnosis was confirmed via polymerase chain reaction (PCR) testing or post-mortem biopsy in nearly one-third of cases. Treatment regimens varied, with amphotericin B and miltefosine being the most frequently used agents. Overall mortality was 83%, with survival strongly associated with early initiation of combination therapy. Pediatric patients had a higher survival rate (22%) compared to adults (7.1%). Conclusions: The findings highlight the need for heightened clinical awareness, especially in the context of climate-driven ecological changes that may expand N. fowleri’s geographic range. This review underscores critical gaps in surveillance and diagnostics and emphasizes the importance of a One Health approach to addressing emerging threats like PAM. Further research into novel therapeutics, rapid diagnostics, and global case reporting systems is urgently needed.

Infectious Disease Reports doi: 10.3390/idr18020024

Authors: Chenxia Guo Cuihong Sun Jiajia Zheng Qingtao Zhou Ying Liang

Background: Cupriavidus is an aerobic Gram-negative bacterium and a rare conditional pathogen that mainly infects immunocompromised patients or those undergoing invasive procedures. Methods: We present the case of a 70-year-old male with diabetes mellitus who developed septic shock following influenza A virus (IAV) pneumonia. Cupriavidus gilardii (C. gilardii) was identified in his blood and sputum samples. Through a literature review, we identified 31 reported cases of Cupriavidus infections. Clinical data, including demographic information, clinical characteristics, comorbidities, laboratory results, Cupriavidus species, treatment, and clinical outcomes, were collected. Results: Among these 32 patients (including our patient), 23 were male (71.9%) and 9 were female (28.1%). The median patient age was 32.5 (2.12–70) years. Most patients had relevant risk factors or comorbidities before Cupriavidus infection, including exposure to polluted environments and recent invasive procedures (68.9%). Among these cases, Cupriavidus pauculus was the most common strain, accounting for 56.3% of cases. The mortality rate was the highest for Cupriavidus pauculus infections. Conclusions: Cupriavidus is a rare opportunistic pathogen in patients with compromised immune function. Early identification of pathogen and timely treatment are crucial. When traditional microbiological detection methods encounter difficulties, gene sequencing can be used as an auxiliary diagnostic tool and can further predict drug resistance. Targeted anti-infection treatment is effective in most cases, but some severe infection cases may lead to death due to serious complications.

Infectious Disease Reports doi: 10.3390/idr18020023

Authors: Selen Şahin İrem Tümkaya Kılınç Eda Yüksel Çağla Mehmet Bedia Dinç Emine Alp Meşe

Background/Objectives: Prosthetic valve endocarditis caused by non-tuberculous mycobacteria is a rare but serious condition and is often associated with delayed diagnosis due to initially negative routine blood cultures with late positivity after prolonged incubation. Mycobacterium fortuitum, a rapidly growing mycobacterium, is an uncommon cause of endocarditis but may result in significant morbidity if not promptly identified. Methods: We report a 67-year-old man with prior cardiac surgery who presented 18 months later with recurrent fever, weight loss, and renal dysfunction. Initial blood cultures, echocardiography, and standard imaging were non-diagnostic. Ongoing clinical suspicion prompted extended mycobacterial cultures with prolonged incubation and molecular identification performed at a reference laboratory, which revealed M. fortuitum. Results: Antimicrobial susceptibility testing demonstrated susceptibility to amikacin, ciprofloxacin, and clarithromycin, and treatment was initiated with an amikacin-based combination regimen. The patient showed marked clinical and laboratory improvement, including resolution of fever and stabilization of renal function. Conclusions: This case highlights the diagnostic and therapeutic challenges of M. fortuitum prosthetic valve endocarditis and underscores the limitations of routine diagnostic methods in culture-negative endocarditis. It also emphasizes the importance of prolonged incubation and targeted microbiological workflows in suspected cases.

Infectious Disease Reports doi: 10.3390/idr18020022

Authors: Carla Mariana da Silva Medeiros Michely da Silva Sousa Lucas Hestevan Malta Alfredo Jemmyson Romário de Jesus Cícero Alves Lopes Júnior

Introduction: Trace elements such as zinc, selenium, iron, copper, and manganese play a vital role in human health—especially in how the immune system responds and how the body handles viral infections. These trace elements have complex and sometimes context-dependent effects: while they can strengthen the body’s defenses, imbalances may promote viral replication and worsen tissue damage. Methods: Relevant articles discussed in this narrative review were identified through searches in major databases, including PubMed, Scopus, and Web of Science, primarily those published from 2020 onwards. Discussion: In this review, we examine key findings on how trace elements influence antioxidant defense, modulate viral replication, and regulate cytokine signaling, considering the context of innate immunity and the pathology of viral diseases. We discuss their impact on major infections such as HIV, viral hepatitis, and coronaviruses, highlighting how deficiencies or excesses of certain minerals can affect disease severity, immune responses, and clinical outcomes. The therapeutic use of trace element supplementation is also examined, emphasizing the importance of maintaining proper balance to avoid harmful effects. Conclusions: These findings contribute to a deeper understanding of the complex relationship between micronutrients and viral infections, which can inform the development of more effective prevention and treatment strategies. This review underscores the need for further clinical and experimental studies to define optimal levels of these elements in different health and disease scenarios.

Infectious Disease Reports doi: 10.3390/idr18020021

Authors: Gabriel A. Godart Vidit Yadav Elizabeth P. Wellings Rupert O. Stanborough Vincent C. Zummo Bryan D. Springer Ravi V. Durvasula Sammer M. Elwasila

Background/Objectives: Streptococcus intermedius, a member of the Streptococcus anginosus group, is characterized by a marked propensity for abscess formation but only rarely causes native-joint septic arthritis. Involvement of the acromioclavicular (AC) joint is particularly uncommon. We describe a case of native AC joint septic arthritis due to S. intermedius in a patient with multiple predisposing factors and highlight diagnostic and management considerations. Methods: We report the clinical course of a 72-year-old man with poorly controlled type 2 diabetes mellitus who presented with progressive right shoulder pain, erythema, and swelling following recurrent minor skin abrasions from a newly adopted dog. Initial management for presumed inflammatory shoulder pathology included brief systemic corticosteroids and an ultrasound-guided intra-articular ketorolac injection. Magnetic resonance imaging (MRI) was performed after symptom progression. The patient underwent operative irrigation and debridement with collection of synovial fluid and deep tissue cultures. Blood cultures and transthoracic echocardiography were obtained to evaluate for systemic involvement. Results: MRI demonstrated multiloculated periarticular abscesses and osteolysis centered on the AC joint. Operative cultures yielded high colony counts of S. intermedius from synovial fluid and deep tissues. Blood cultures and echocardiography were negative. The patient required multiple operative debridements with irrigation, adjunctive local antibiotic therapy, and prolonged targeted β-lactam treatment. Clinical and radiographic improvement was achieved following surgical source control and antimicrobial therapy. Conclusions: Native AC joint septic arthritis due to S. intermedius is rare. Older age, uncontrolled diabetes, recent intra-articular intervention, and possible zoonotic inoculation from canine wound licking may represent contributory risk factors. Early imaging, prompt surgical source control, and guideline-concordant antimicrobial therapy are essential when bone and soft tissue involvement is present.

Infectious Disease Reports doi: 10.3390/idr18020020

Authors: Sithabile Moso Laston Gonah Mojisola Clara Hosu Ntandazo Dlatu Teke Apalata Lindiwe Modest Faye

Background: Rabies remains a neglected zoonotic disease in South Africa, particularly in rural areas where surveillance weaknesses, behavioral gaps, and limited One Health coordination persist. Objectives: This study assessed rabies surveillance, behavioral risk factors, and system responsiveness in two rural Eastern Cape communities, with a focus on post-pandemic resilience within a One Health framework. Methods: A cross-sectional, community-based pilot study was conducted among 109 residents using structured questionnaires to collect data on demographics, rabies awareness, vaccination practices, and service disruptions. Descriptive, bivariate, and multivariate analyses identified predictors of dog-bite exposure and pet vaccination. Machine learning models (Decision Tree and Random Forest) were applied to explore risk hierarchies. A composite Surveillance Gap Index (SGI) was developed to integrate behavioral and systemic indicators. Results: While 88% of participants were aware of rabies, only 35% attended awareness campaigns. Dog-bite exposure affected 51% of households, with significantly higher risk among males (aOR = 4.33; p = 0.003). Education was positively associated with pet vaccination (aOR = 1.78). Despite 45% reporting COVID-19 disruptions, communities maintained high post-pandemic vaccination coverage (85.7%). Predictive models (AUC = 0.82–0.86) identified education, gender, awareness, and distance as key risk drivers. Conclusions: Integrating behavioral insights and predictive analytics into One Health strategies can strengthen rabies surveillance and support progress toward eliminating human rabies by 2030.

Infectious Disease Reports doi: 10.3390/idr18010019

Authors: Eun Bin Lee Anna Schotthoefer Philip Whitfield

Background/Objectives: The 2020 Infectious Diseases Society of America (IDSA) guidelines recommend a single 200 mg dose of doxycycline within 72 h of tick removal after a high-risk bite for Lyme disease prophylaxis. However, limited data are available on prescribing practices related to this recommendation in highly endemic Lyme disease areas. Methods: We conducted a retrospective chart review on adult patients (aged ≥ 18 years) who received a single dose of oral doxycycline for Lyme disease prevention for the period 2022–2024 within a rural Wisconsin health system. Patient and provider prescribing characteristics were evaluated. Manual data abstraction was performed on a random sample of 155 prescribing events to assess adherence to IDSA guidelines. Results: A total of 2404 prophylaxis prescriptions were identified; 44% were prescribed to older adults between 65 and 79 years of age, 54% were prescribed to males, and 66% were prescribed to patients living in rural areas. Prescriptions peaked in spring and summer months, consistent with the known seasonal trends in tick activity. Prescribing was distributed relatively evenly across provider types, with the majority (77%) of cases occurring in outpatient and urgent care settings. Upon manual abstraction, doxycycline was indicated in 12% with the remainder either classified as possibly indicated or not indicated due to suboptimal documentation and nonadherence. Conclusions: Our study identified high rates of incomplete documentation and uncertainty in guideline concordance in a Lyme-endemic health system, highlighting the opportunities to support evidence-based prescribing and to improve documentation practices.

Infectious Disease Reports doi: 10.3390/idr18010018

Authors: Paolo Valesella Antonio Curtoni Alessio Leone Marco Iannaccone Fabrizia Pittaluga Elisa Zanotto Alessandro Bondi Rocco Francesco Rinaldo Nour Shbaklo Silvia Corcione Simone Baldovino Irene Cecchi Elisa Menegatti Paolo Solidoro Cristina Costa

Background: Climate change represents a major global health challenge, with rising temperatures and altered precipitation patterns influencing the spread of infectious diseases. This study investigated the association between climatic factors (average temperature and precipitation) and the monthly proportion of laboratory-confirmed Legionella pneumophila serogroup 1 and West Nile Virus infections among clinically suspected patients in a large teaching hospital in Northern Italy. Methods: We retrospectively analyzed data from 2021 to 2024. The primary outcome was the monthly proportion of positive tests (standardized per 1000 clinically suspected patients) for Legionella pneumophila serogroup 1 (urinary antigen) and West Nile Virus (serology). Associations with climatic variables were assessed using linear and multivariate regression models, as well as Generalized Additive Models (GAMs). Seasonal effects were evaluated through ANOVA. Results: For Legionella pneumophila, precipitation was not significantly associated with the proportion of positive tests (p = 0.1438; R2 = 0.049). In contrast, average temperature was a significant predictor: each 1 °C increase was associated with +0.52 positive cases per 1000 tested patients (p = 0.000283; R2 = 0.267). Multivariate models confirmed temperature as the dominant factor. For West Nile Virus, precipitation showed no meaningful effect (p = 0.914). However, average temperature demonstrated a significant positive association with the proportion of positive cases (p = 0.00293; coefficient = 9.33), with seasonal analysis highlighting a marked summer peak (mean = 399.68 positive cases per 1000 tested; p = 0.00653). Conclusions: Our findings underline the predominant role of temperature over precipitation in driving the burden of both Legionella pneumophila and West Nile Virus infections among hospitalized patients. These results strengthen the evidence that the life cycles of these pathogens are tightly climate-dependent. Developing effective adaptation strategies is essential to mitigate climate-related health risks.

Infectious Disease Reports doi: 10.3390/idr18010017

Authors: Raffaele Ferri Francesco Mucedola Marcella Conserva Jacopo Vecchiet Katia Falasca

Prosthetic-valve endocarditis (PVE) represents one of the most serious forms of infective endocarditis, marked by high mortality and considerable management complexity. The 2023 European Society of Cardiology (ESC) Guidelines emphasise the diagnostic centrality of repeatedly positive blood cultures. Nonetheless, a significant area of uncertainty remains regarding the diagnostic and prognostic value of cultures from explanted prosthetic valves—particularly in centres lacking access to molecular diagnostics. Case Presentation: We report a case of prosthetic-valve endocarditis on a bioprosthesis, in which repeated blood-culture sets yielded Streptococcus acidominimus, whereas culture of the explanted valve revealed Staphylococcus warnerii. The patient received six weeks of intravenous vancomycin, with treatment tailored according to the patient’s clinical and laboratory parameters and in alignment with international endocarditis guidelines, obtaining a clear clinical and laboratory improvement. Discussion: The literature reports that discordance between blood-culture and valve-culture results in infective endocarditis may range from approximately 10% to 29%, attributable to contamination, biofilm formation or polymicrobial infection. In our case, management guided by the microorganism repeatedly isolated from blood cultures proved effective and aligned with the 2023 European Society of Cardiology (ESC) guidelines. The case underlines the importance of a multidisciplinary team and an integrated interpretation of microbiological, clinical and surgical data. Conclusions: Infective endocarditis with discordant isolates presents a complex diagnostic challenge. The etiological diagnosis must rely primarily on the results of blood cultures, whereas valve culture plays a complementary role—useful more for prognostic stratification than for initial diagnostic purposes. A multidisciplinary approach and a critical interpretation of microbiological findings are essential to optimise therapeutic management and improve patient outcomes.

Infectious Disease Reports doi: 10.3390/idr18010016

Authors: Hakim Ullah Wazir Abdul Muqeet Khuram I M Khalid Reza Hafsa Ajmal Hafsa Parveen Zeeshan Ahmed Yousra Iftequar Noora Inam Ilyas Muhammad Sulaiman Nayanika Tummala Hafiz Muhammad Moaaz Sajid Anum Zia Khan Ussama Shafaqat

Background: Growing antibiotic resistance and the limited availability of key components in standard Helicobacter pylori treatments have driven the search for effective alternatives. Minocycline, with its broad-spectrum activity and favorable pharmacokinetics, has emerged as a promising substitute. This meta-analysis compares the safety and efficacy of minocycline-containing bismuth quadruple therapy (MBQT) to conventional first-line BQT regimens, incorporating data from the recent study by Lin et al. Methods: The inclusion criteria were randomized controlled trials (RCTs) with a target population of both treatment-naïve and previously treated patients diagnosed with Helicobacter pylori (H. pylori) infection. The intervention received by eligible patients was a minocycline–bismuth quadruple therapy (MBQT) regimen containing bismuth, minocycline, proton pump inhibitors (PPI), and any additional antibiotic with a minimum period of 2 weeks of administration. We excluded study designs other than RCT and clinical trials that include patients without confirmed H. pylori infection, animal populations, in vitro experiments, and reports of other outcomes that did not include a minimum intervention duration of 2 weeks. A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Library, and ScienceDirect from inception to 20 May 2025. After screening via Rayyan, data were extracted on an Excel spreadsheet. Quality was assessed using the Cochrane RoB 2.0 tool. Eligible randomized controlled trials (RCTs) were included and analyzed using RevMan 5.4. Outcomes assessed were intention-to-treat and per-protocol eradication rates. Adverse effects were compared among therapies. A random-effects model was used; an I2 < 50% and p-value < 0.05 indicated homogeneity and significant results respectively. Results: Five RCTs with 7 interventions involving 2812 patients were included. The pooled odds ratio (OR) for MBQT in intention-to-treat (ITT) analysis was 1.25 (95% CI: 0.96–1.61), showing a non-significant trend. No heterogeneity was detected (I2 = 0.0%). In the modified ITT (mITT) analysis (2 studies), MBQT showed higher eradication (OR: 1.70, 95% CI: 0.00–1042.90), but wide CI and high heterogeneity (I2 = 70.7%) limited interpretation. All studies were included in the per-protocol (PP) analysis, which showed a statistically significant improvement with MBQT (OR: 1.67, 95% CI: 1.14–2.45) and low heterogeneity (I2 = 5.2%), suggesting consistent results. Although not statistically significant, MBQT was associated with a slightly lower rate of adverse events compared to standard therapy (OR: 0.81, 95% CI: 0.59–1.12). I2 = 50.6% showed moderate heterogeneity in safety outcomes. Discussion: the number of included RCTs was modest, with only five studies meeting eligibility criteria, and only two contributing to the modified intention-to-treat analysis. The risk-of-bias assessment showed variation in methodological quality across the included studies. Several studies exhibited high risk judgments in critical domains. particularly randomization, deviations from intervention, and selective reporting. Patients who completed the treatment benefited more from MBQT, which also had a comparable safety profile to conventional BQT regimens. In the treatment of H. pylori infection, MBQT may be considered a safe alternative for first-line treatment.

Infectious Disease Reports doi: 10.3390/idr18010015

Authors: Saurav Jyoti Patgiri Anukalpa Saikia Sushmita Yadav Md. Atique Ahmed Luna Adhikari Chimanjita Phukan Chiranjay Mukhopadhyay Harpreet Kaur

Background: Melioidosis, caused by Burkholderia pseudomallei, is a severe and often underdiagnosed infection endemic to South Asia, Southeast Asia, and northern Australia. While pneumonia and sepsis are the classical presentations, the disease is increasingly recognized for its diverse and atypical clinical manifestations. Objective: The objective is to improve diagnostic accuracy and increase clinical awareness in both endemic and non-endemic settings by reviewing and classifying atypical presentations of melioidosis that have been documented in the literature. Methods: A narrative, case-based review was conducted using 238 published case reports and series from endemic and transitional regions during the period from 2000 to 2025. Cases with non-respiratory presentations or anatomical locations not commonly linked to melioidosis were classified as atypical. Clinical syndromes were used to classify the extracted cases, and common patterns in presentation, diagnosis, and outcome were examined. Results: One hundred and sixty published articles were included after a full text review. The most frequent atypical presentations included neurological involvement (e.g., brain abscess, encephalomyelitis), musculoskeletal infections (osteomyelitis, myositis), thyroid abscess, tubo-ovarian abscess, and dermatologic manifestations such as erythema nodosum. Imported and pediatric cases were also found. Numerous cases were misidentified as cancer, fungal infections, or tuberculosis. Among risk factors, diabetes mellitus was the most prevalent. Non-specific symptoms, a lack of laboratory capacity, and incorrect pathogen identification frequently resulted in delays in diagnosis. Conclusions: In endemic areas, melioidosis should be taken into account when making a differential diagnosis of a variety of clinical syndromes, especially in patients who have diabetes or have had relevant environmental exposure. Poor outcomes and diagnostic delays are greatly exacerbated by atypical presentations. Improving diagnostic capabilities and raising awareness are crucial to lessening the worldwide burden of this often ignored but potentially deadly infection.

Infectious Disease Reports doi: 10.3390/idr18010014

Authors: Hassan Almarhabi Abdulmajeed Sarhan Murad Essatari Hassan Huwait

Background/Objectives: Fusarium species are recognized as difficult-to-treat opportunistic pathogens due to extensive antifungal resistance and high mortality rates. Variability in its incidence and outcomes exists across different countries and centers. Large studies on Fusarium species are lacking in Saudi Arabia, with most previous publications being case reports. We describe all cases of invasive fusariosis identified at a tertiary center during a 10-year period and review previous reports in the country. Methods: A retrospective search of hospital records and the microbiology database was conducted to identify cases of invasive fusariosis among patients admitted during 2016–2025 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Results: Three cases of invasive fusariosis occurring over a 10-year period were identified. All cases occurred in the last three years of the study period. The incidence during those three years was 0.4 cases per 10,000 admissions per year. Clinical manifestations were fungemia in two immunocompetent patients and ulcers progressing to osteomyelitis in an immunocompromised patient. None of the patients progressed to death within 30 days of diagnosis. Conclusions: Data on Fusarium species are scarce in Saudi Arabia. Additional studies are required to better understand differences in invasive fusariosis between countries.

Infectious Disease Reports doi: 10.3390/idr18010013

Authors: Grisel Burgos-Barreto Daniel Reyes Raymond L. Tremblay

Background: Millions of people have died from AIDS-related illnesses since the start of the epidemic. The objective of this study is to determine the relationship between life years lost and demographic factors in the subset of individuals in Puerto Rico with advanced HIV disease, i.e., who received a diagnosis of AIDS, and to evaluate trends in poverty, age, and number of diagnoses and deaths over this timeframe. Methods: We identified 3624 individuals diagnosed with AIDS who received services under the Eligible Metropolitan Area (EMA) of San Juan, Puerto Rico, between 2000–2020, and correlated demographic factors with AIDS descriptive statistics using a retrospective cohort study design. We used socioeconomic characteristics to describe the population, estimated the life years lost (LYL) compared with the life expectancy of the general population of Puerto Rico at a given age as the null model, and evaluated the relationship of demographic variables with LYL, as well as trends in poverty and age/number of deaths/diagnoses over time. Results: More life years are lost with earlier AIDS onset, and there is also an association between LYL and the level of poverty, documented mode of transmission, and insurance status. LYL were higher among AIDS patients with lower income, with perinatal transmission, and among those without insurance in the age bracket of 40–49 years. No relationship between LYL and gender was detected. Moreover, over the years included in the timeframe of this study, certain trends emerged: we observed a greater proportion of AIDS to HIV diagnoses over time; HIV/AIDS diagnoses and deaths occurred on average at a higher age; the number of diagnoses per year initially rose over time and then declined; and the number of deaths per year as well as the poverty level in those diagnosed with HIV/AIDS increased over time. Conclusions: This study demonstrates the continued recent impact of the HIV epidemic specifically on those with advanced disease (AIDS), and further reaffirms the importance of treatment and prevention as well as demographic and social determinants of health, including age, poverty level, insurance status, and lifestyle, highlighting the disproportionate burden of HIV/AIDS among those with greater levels of poverty.

Infectious Disease Reports doi: 10.3390/idr18010012

Authors: Botond Lakatos Ferenc Balázs Farkas Giacomo Guido Annalisa Saracino Francesco Di Gennaro

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 [...]

Infectious Disease Reports doi: 10.3390/idr18010011

Authors: Icha Farihah Deniyati Faratisha Khadijah Cahya Yunita Hanifa Rizky Rahmawati Loeki Enggar Fitri Nuning Winaris Lailil Muflikah

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.

Infectious Disease Reports doi: 10.3390/idr18010010

Authors: Mahbuba Rahman Hasbun Nahar Hera Urbana Islam Barsha

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.

Infectious Disease Reports doi: 10.3390/idr18010009

Authors: Andreea-Iuliana Ciobanu Sebastian Ionescu Ana Maria Tudor Mariana Mărdărescu Laurențiu-Mihăiță Stratan Adrian Gabriel Marinescu Cătălin Tiliscan Aida-Isabela Adamescu Oana Ganea Sorin Ștefan Aramă Victoria Aramă

Background/Objectives: This study presents a comprehensive and updated epidemiological and public health assessment of human immunodeficiency virus (HIV) in Romania during 2022–2024, situated within the wider European context. Methods: For this retrospective descriptive study, we analyzed national surveillance data from the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” and European Centre for Disease Prevention and Control (ECDC) reports, between 1985–2024, focusing especially on 2022–2024 period. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. Results: Between 1985 and 2024, Romania registered a cumulative total of 28,793 HIV cases, with 18,768 individuals living with HIV (PLHIV) as of 2024. In that year, 810 new HIV cases were diagnoses, indicating a modest uptick compared with 2022–2023. Heterosexual transmission continued to predominate (59.4%), followed by cases among men who have sex with men (MSM) (30.5%) and intravenous drug users (IDUs) (5.2%). Men represented more than three-quarters of all new infections. Mortality displayed considerable year-to-year variability, increasing from 125 HIV-related deaths in 2023 to 193 in 2024. Despite this, treatment coverage improved steadily, with 16,464 individuals receiving antiretroviral therapy (ART) by the end of 2024. At 2.51 cases per 100,000 population, Romania’s incidence remained below the European average of 3.5 per 100,000. Nonetheless, the proportion of infections attributable to MSM transmission rose sharply—from 3.91% in 2007 to 32% in 2024—bringing Romania’s epidemiological profile increasingly in line with broader trends observed in Eastern Europe. Conclusions: These findings suggest that although Romania maintains a comparatively lower HIV incidence than the European average, the evolving transmission dynamics—most notably the substantial increase in MSM-related cases—signal a shifting epidemiological landscape that warrants strengthened, population-specific prevention measures and continued investment in comprehensive treatment and monitoring frameworks.

Infectious Disease Reports doi: 10.3390/idr18010008

Authors: Ana Roel Conde Francisco Javier Membrillo de Novales María Navarro Téllez Carlos Gutiérrez Ortega Miriam Estébanez Muñoz

Background/Objectives: This study aimed to determine the prevalence of persistent symptoms and the radiological and laboratory evolution at 6 months and 5 years after discharge in patients hospitalized for SARS-CoV-2 pneumonia during the first wave of the pandemic in Spain and to estimate the healthcare impact of their follow-up. Methods: A retrospective longitudinal observational study was conducted at the “Hospital Central de la Defensa”. A total of 200 patients aged >18 years with a diagnosis of SARS-CoV-2 pneumonia were screened. Clinical, radiological, and laboratory data were collected from electronic medical records. Patients with symptoms or radiological abnormalities at discharge underwent in-person evaluations, while the remainder were assessed by telephone. Results: A total of 182 patients met the inclusion and exclusion criteria. Of these, 112 were assessed in the outpatient setting; 60.7% required in-person evaluations, with normal pulmonary auscultation in 93.6%, complete radiological resolution in 85%, and normalized laboratory parameters in almost all cases. At 6 months, 26.5% presented at least one residual symptom, whereas only three patients (4.5%) reported symptoms at 5 years. No risk factors associated with symptom persistence were identified. The estimated cumulative healthcare cost was EUR 21,627.50. Conclusions: Among patients hospitalized for SARS-CoV-2 pneumonia during the first wave of the pandemic, 26.7% and 4.46% presented at least one persistent symptom at 6 months and 5 years after discharge, respectively.