Search Results (1,896)

Antimicrobial resistance is a major global health challenge that requires a One Health approach integrating humans, animals, wildlife, food systems and the environment. Among resistant bacteria, extended-spectrum β-lactamase-producing Escherichia coli (ESBL-producing E. coli) is particularly relevant because it is widely distributed across hosts and ecosystems, may carry mobile resistance genes and is commonly used as an indicator for antimicrobial resistance surveillance. This narrative review examines the occurrence, characteristics and transmission dynamics of ESBL-producing E. coli at the wildlife–livestock interface, with emphasis on its public health relevance and strategies for mitigation and control. The reviewed evidence indicates that livestock, wildlife and environmental matrices can be interconnected reservoirs of resistant E. coli and resistance genes. Transmission should not be interpreted as a simple linear process from livestock to wildlife or humans but rather as a bidirectional and ecological phenomenon shaped by antimicrobial use, farm management, biosecurity, wildlife ecology, environmental contamination and mobile genetic elements. Wildlife may function as a sentinel, reservoir or disperser of resistant bacteria, although detection alone does not demonstrate direct transmission. Integrated surveillance combining livestock, wildlife, food-chain and environmental sampling, supported by genomic analysis, is essential to clarify transmission pathways and guide effective control measures. Full article

Background: Crimean–Congo hemorrhagic fever virus (CCHFV) is an important tick-borne zoonosis and an emerging public health threat across Africa. Although evidence of viral circulation is mounting, information remains fragmented, limiting a comprehensive understanding of transmission ecology, regional hotspot heterogeneity, and preparedness needs across the continent. Methods: This narrative review critically synthesized published literature on CCHFV in Africa, identified through PubMed, Scopus, and Google Scholar and supplemented by citation tracking and authoritative public health reports. Evidence from epidemiological, ecological, molecular, surveillance, and One Health studies was integrated to examine transmission dynamics, geographic hotspot distribution, viral diversity, risk factors, diagnostic and surveillance challenges, and preparedness strategies. Results: Available evidence shows marked geographic heterogeneity in CCHFV transmission across Africa, with hotspot regions shaped by ecological suitability, Hyalomma tick distribution, livestock–human interactions, and health system capacity. Livestock consistently show higher exposure than humans, underscoring their role as key indicators of viral circulation. Diagnostic limitations, passive surveillance, ecological variability, and serological cross-reactivity contribute to substantial under recognition of disease burden, while molecular studies reveal considerable viral diversity and ongoing evolution across African regions. Conclusions: CCHFV remains underdiagnosed and underreported in many African settings because of limited surveillance and diagnostic capacity. Strengthening integrated One Health surveillance, expanding laboratory and genomic capacity, utilizing livestock as sentinel populations, and improving cross-sectoral collaboration are critical for enhancing early detection, outbreak preparedness, and effective public health response across the continent. Full article

The global rise in multidrug-resistant (MDR) fungal pathogens has positioned Candida auris and Candida glabrata as major threats to public health. In recent years, these pathogens have increasingly been reported beyond traditional hospital settings, including neonatal intensive care units, long-term care facilities, oncology wards, and post-pandemic critical care environments. International surveillance bodies, including the Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO), and regional monitoring networks, have documented escalating antifungal resistance, complex outbreak dynamics, and persistent gaps in infection control implementation. C. auris has emerged as a major etiological agent of healthcare-associated outbreaks, particularly in intensive care and neonatal units. Surveillance data indicate that a high proportion of C. auris isolates exhibit resistance to azoles, often exceeding 80% in some regions, while echinocandin resistance remains variable. Resistance patterns have evolved from predominantly azole resistance to broader multidrug-resistant phenotypes, including treatment-emergent echinocandin resistance. Six genetically distinct clades (I–VI) have been identified, with Clades I, III, and IV associated with large-scale outbreaks, whereas available data suggests that Clades II, V, and VI are more geographically restricted, although evidence for the recently described clades remains limited. C. glabrata is increasingly recognized as a major cause of invasive candidiasis, with rising resistance reported across multiple regions. While reduced azole susceptibility was historically predominant, emerging evidence highlights rising dual azole–echinocandin resistance, adaptive microevolution during antifungal therapy, and biofilm-associated tolerance mechanisms. Despite these advances, significant gaps persist in global resistance surveillance and in the mechanistic understanding of virulence and antifungal adaptation. Current mitigation strategies include antifungal stewardship programs, expanded resistance testing, and strengthened surveillance systems. Advances in rapid diagnostic technologies such as matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry, polymerase chain reaction (PCR)-based assays, and genomic surveillance have improved pathogen identification and outbreak detection, although accessibility remains limited in resource-constrained settings. This review examines emerging epidemiological, genomic, and antifungal resistance trends in C. auris and C. glabrata and highlights key priorities for improving diagnosis, surveillance, stewardship, and management of multidrug-resistant Candida infections. Full article

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical public health threat because infections caused by this pathogen are associated with high morbidity, mortality, and limited effective therapeutic options. Whilst the majority of studies have concentrated on inter-patient bacterial transmission, within-host genomic analysis offers unprecedented resolution for tracking dynamic clone predominance, plasmid rearrangements, and microevolution under clinical selection pressures. Methods and Results: Whole-genome sequencing (WGS) of nine isolates recovered from oral and rectal swabs revealed an exceptional case of CRKP clonal turnover in an intensive care unit (ICU) patient. Three distinct high-risk clones were identified during the 18 days of surveillance: an initial ST101 (Clonal Group (CG) 101) strain (days 1–7) followed by concurrent colonization with ST395 (carrying bla_NDM-5) and ST512 lineages (both CG258, days 11–18). Conclusions: This study describes a rare instance of within-host heterogeneity of CRKP, involving three distinct STs spanning two CGs. Whole-genome analysis revealed potential structural rearrangements of resistance- and virulence-associated plasmids between coexisting lineages. These genomic shifts likely reflect rapid adaptation under the intense selective pressure of broad-spectrum antibiotic therapy, culminating in the persistence of a less virulent yet multidrug-resistant ST512 clone and a favorable clinical outcome with patient recovery. Full article

The rapid emergence of SARS-CoV-2 variants underscores the need for accurate, rapid, and affordable diagnostic tools, particularly in resource-limited settings. An isothermal amplification-based assay was developed integrating reverse-transcriptase recombinase polymerase amplification (RT-RPA), T7 transcription, and duplex-specific nuclease (DSN)-mediated detection for variant discrimination. The assay targets three genomic regions: a conserved region within ORF1a and two variant regions, ORF1a (Δ3675–3677) and the S gene (Δ69–70), enabling differentiation between the Wuhan-Hu-1 reference isolate and the B.1.1.7 variant. The method demonstrated high specificity and a limit of detection of 200 copies per sample using low-cost instrumentation. DSN-mediated cleavage improved discrimination between matched and mismatched RNA targets while enabling signal amplification through target recycling. The assay requires minimal laboratory infrastructure, relying on a heat block and fluorescent plate reader. These results demonstrate a scalable and cost-effective strategy for SARS-CoV-2 variant screening with potential as a future strategy for pathogen screening and variant surveillance. Full article

Hantaviruses are emerging rodent-borne pathogens that pose increasing global public health concerns due to their association with hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), both of which can result in substantial morbidity and mortality. Environmental change, climate variability, urbanization, and land-use transformation are increasingly recognized as critical drivers of hantavirus emergence and transmission. This review summarizes current evidence regarding hantavirus virology, epidemiology, pathogenesis, clinical manifestations, diagnostics, surveillance systems, prevention strategies, and One Health preparedness approaches. Emphasis is placed on the influence of climate change and ecological disruption on rodent reservoir dynamics and spillover risk, as well as major surveillance and diagnostic gaps in tropical and Caribbean regions where hantavirus circulation may be underrecognized. Advances in molecular diagnostics, genomic surveillance, vaccine development, monoclonal antibody therapies, and climate-based early warning systems are also discussed. Existing evidence highlights the importance of integrated One Health surveillance systems that combine human, animal, and environmental monitoring to improve early detection and outbreak preparedness. Strengthening laboratory capacity, ecological surveillance, regional collaboration, and public health infrastructure will be essential for reducing the global burden of hantavirus infections and improving preparedness for future zoonotic disease threats. Full article

In 2025, the Democratic Republic of the Congo (DRC) experienced its 16th Ebola Virus Disease (EVD) outbreak, centered in the Bulape Health Zone of Kasai Province, amid multiple concurrent epidemics and limited health infrastructure. Genomic sequencing revealed a novel zoonotic spillover genetically related to the 1976 Yambuku strain. A Root Cause Analysis (RCA) using the “5 Whys” framework, integrating epidemiological data, genomic analysis, and surveillance reports, identified key contributors to delayed detection and response, with comparative insights drawn from the 2018–2020 North Kivu outbreak. The Mweka outbreak resulted in 28 confirmed, probable, or suspected cases and 15 deaths, including four healthcare workers. Root causes included inadequate ecological surveillance, weak community alert systems, diagnostic delays due to reliance on centralized laboratories, health system overload from concurrent outbreaks, and structural underfunding of preparedness and coordination. Unlike North Kivu, where security issues drove response delays, systemic and ecological vulnerabilities predominated in Mweka. These findings highlight how ecological and structural weaknesses facilitate novel Ebola spillovers and their escalation, emphasizing the need for sustained investment in One Health surveillance, decentralized diagnostics, and resilient public health governance to strengthen outbreak response capacity. Full article

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. Full article

Background/Objectives: Vancomycin-resistant (VRE) and vancomycin-variable (VVE) Enterococcus spp. represent an increasing clinical challenge due to limited treatment options and the potential for undetected dissemination of such resistance genes. Data on Enterococci genomic epidemiology in healthcare settings remain rather limited. Our study aimed to investigate vancomycin resistance determinants in Enterococcus spp., clonal structure, and occurrence of VVE using whole-genome sequencing (WGS) in Latvia. Methods: Clinical isolates collected from hospitalised patients in two tertiary-level hospitals in Latvia (2021–2024) were analysed using WGS following routine laboratory identification. Vancomycin resistance determinants were identified in silico, along with MLST and cgMLST genotyping. Results: Of 532 sequenced isolates, 482 met the quality and inclusion criteria. E. faecalis (56.64%) and E. faecium (40.25%) predominated. Among 125 isolates carrying vancomycin resistance genes, vanB (54.40%) was the most frequent, followed by vanA (38.20%) and vanC (6.40%); vanC was restricted to E. gallinarum and E. casseliflavus. Vancomycin resistance was more prevalent in E. faecium (51.03%) than in E. faecalis (6.59%). cgMLST identified outbreak clusters among E. faecium ST80 and ST78 with complex type-specific resistance patterns and hospital specificity. E. faecalis showed polyclonal endemicity with the vanB gene present in different clades. Three (0.62%) vancomycin-variable E. faecium (VVE) isolates were identified in one hospital, harbouring vanA-type gene clusters comprising vanHAX but lacking the sensory gene vanS and the regulatory gene vanR. Conclusions: The VanB gene predominated in both hospitals, driven by clonal expansion of hospital-adapted E. faecium ST80/ST78, contrasting with earlier vanA predominance in Europe but aligning with recent regional vanB trends. The detection of VVE highlights clinically relevant genotype–phenotype discordance, underscoring the importance of integrating genomic surveillance with routine phenotypic testing to detect cryptic resistance and guide effective antimicrobial therapy. Full article

Cronobacter spp. are opportunistic foodborne pathogens that can cause neonatal meningitis, necrotizing enterocolitis, and sepsis. This study conducted a systematic contamination survey and whole-genome epidemiological analysis of 562 low-water-activity food samples in Hunan Province of China. The results showed an overall Cronobacter spp. detection rate of 41.99% (236/562), with spices exhibiting the highest contamination rate (60.06%), and with high-level contamination samples (>110 MPN/g) concentrated in this category. The 236 isolates comprised 6 species, 120 sequence types, and 39 clonal complexes, with C. sakazakii being the most frequently isolated species (64.83%) and high-risk clones ST4, ST1, ST148, and ST64 prevailing. Multiple virulence genes (TraJ, fur, rcsAB, rpoS) and antimicrobial resistance genes (qnrS1, blaTEM-1, blaCTX-M-55, blaLAP-2, aac(3)-IId, aadA2, tet(A), floR, mcr-9.1, sul2) were detected. Core genome multilocus sequence typing (cgMLST) identified two clustering patterns: Cluster C, whose genetic clustering was consistent with transmission associated with potential common upstream raw materials across different brands and provinces, and Cluster G, whose clustering suggested potential persistent colonization in the production environment across multiple batches of the same brand. This study elucidates the contamination characteristics of Cronobacter spp. in low-water-activity foods from Hunan Province and provides a basis for WGS-based active surveillance and supply chain traceability. Full article

Background/Objectives: Antimicrobial resistance (AMR), driven by high-risk bacterial pathogens, is a major healthcare threat. This scoping review mapped artificial intelligence/machine learning (AI/ML) and computational approaches integrated with whole-genome sequencing (WGS), genomic surveillance, rapid typing, epidemiological data, or clinical metadata for early warning of AMR outbreak clones. Methods: Following PRISMA-ScR guidance and the Population–Concept–Context (PCC) framework, PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language studies published between 2010 and 2026. Eligible studies addressed AI/ML or computational approaches for AMR outbreak detection, clone surveillance, transmission analysis, or infection prevention and control (IPC). Results: Thirty-eight studies were grouped into five domains: genomic surveillance; rapid typing; resistance, risk-factor, and lineage prediction; transmission reconstruction; and IPC-oriented genomic epidemiology. AI/ML supported automation, isolate prioritization, typing triage, prediction, transmission modelling, and electronic health record (EHR)-linked route identification. Conclusions: AI/ML may enhance WGS-based AMR surveillance, but validation, dataset dependence, heterogeneity, and limited IPC outcome reporting remain key gaps. Full article

Street-food grilling is a common occupation in Asia, yet the occupational health risks associated with cooking-generated polycyclic aromatic hydrocarbons (PAHs) exposure, occurring alongside plausible unmeasured co-exposures such as ambient heat and physical workload, remain under-researched. This study investigated the internal dose of PAH exposure and its association with early biological effects and physiological strain among grill restaurant workers. A cross-sectional study was conducted involving grill workers and 20 age/BMI-matched controls. Urinary 1-hydroxypyrene (1-OHP) was utilized as the primary exposure biomarker. The study assessed early biological effects such as oxidative stress (8-OHdG, F₂-isoprostanes), lung epithelial integrity (CC16), and genotoxicity (BPDE-DNA adducts) via ELISA. Physiological parameters, including blood pressure and heart rate, were recorded to evaluate acute cardiovascular strain. Workers had significantly elevated urinary 1-OHP levels compared to controls (Hodges–Lehmann ratio = 3.66, 95% CI: 1.68–7.12, representing a 3.7-fold median increase), with exposure levels increasing proportionally to smoke proximity. Notably, workers demonstrated a significantly higher median resting heart rate (HL ratio = 1.13, 95% CI: 1.05–1.23; +12.9%) and systolic blood pressure (HL ratio = 1.09, 95% CI: 1.00–1.18; +8.9%) compared to their office-based peers. Although strong correlations were observed among biological effect biomarkers (r_s = 0.42–0.63), there were no significant differences between groups for 8-OHdG, CC16, or BPDE-DNA adducts, suggesting that cardiovascular parameters reflect acute short-term responses, while genomic damage markers may require higher cumulative exposure thresholds to become detectable. The study revealed that grill restaurant workers face substantial internal PAH exposure and significant cardiovascular strain, occurring alongside plausible unmeasured co-exposures including ambient heat and physical workload. The prevalence of chronic cough and elevated heart rate is a critical early warning sign for occupational health. Our findings indicate that current general ventilation is inadequate, highlighting an urgent need for localized engineering controls and comprehensive health surveillance, including cardiovascular monitoring in the service sector. Full article

Microsporum canis is a globally prevalent zoonotic dermatophyte and the major causative agent of dermatophytosis in both pets and humans. The widespread clinical use of antifungal drugs has led to the frequent emergence of decreased susceptibility, while its molecular features and the genomic basis of cross-host transmission remain incompletely elucidated. In this study, 38 clinical M. canis isolates were collected from dogs and cats in Beijing (2025). We determined the minimum inhibitory concentrations (MICs) of six common antifungal agents via microbroth dilution, and performed whole-genome sequencing and comparative genomic analysis. All isolates showed high clonal homogeneity, with ANI $>99.9\%$ to the reference. A local human-derived strain was nested within the pet-derived clade, supporting zoonotic cross-host transmission. Terbinafine exhibited the highest activity, while itraconazole, voriconazole, posaconazole, griseofulvin, and ciclopirox olamine showed higher MICs; 11 isolates showed a multidrug high-MIC phenotype. Notably, copy number variation in the ABC transporter gene CDR1 was positively correlated with MICs of multiple antifungal agents ($p<0.05$). This study provides a genomic basis for optimized antifungal therapy, resistance surveillance and transmission control of zoonotic M. canis. Full article

Background: The rapid rise in antimicrobial resistance (AMR) represents one of the most pressing global health challenges of the 21st century, threatening antibiotic effectiveness, compromising clinical outcomes, and undermining healthcare systems. Understanding how resistant pathogens emerge and spread across human, animal, and environmental sectors is essential for effective global response. Main body: This review evaluates traditional and advanced AMR detection methodologies, including phenotypic assays, molecular diagnostics, whole-genome sequencing (WGS), metagenomics, and biosensor-based technologies. It also highlights the role of bioinformatics tools, surveillance databases, and integrated platforms that support real-time analysis. Genomic surveillance provides unparalleled resolution for characterizing resistance mechanisms, transmission patterns, and evolutionary trajectories of multidrug-resistant organisms. Techniques such as WGS and metagenomics allow timely and precise identification of resistance genes, improving outbreak detection and strengthening antimicrobial stewardship. Despite these advantages, the adoption of genomic surveillance faces barriers in low- and middle-income countries, including high costs, limited infrastructure, insufficient technical expertise, and the lack of standardized data frameworks. Conclusions: Genomic surveillance is a transformative tool for combating AMR and strengthening global health systems. Effective implementation requires sustained investment, capacity-building, coordinated cross-sector collaboration, and commitment to the One Health approach to ensure equitable access and long-term global impact. Full article

Background: Therapeutic resistance following cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) plus endocrine therapy (ET) represents a key unmet need in hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer (mBC). Treatment paradigms have advanced from non-targeted options, such as fulvestrant monotherapy or everolimus-based combinations, to precision medicine strategies, including inhibitors of the PI3K/AKT pathway, oral selective estrogen receptor degraders (SERDs), and novel ER-modulating agents, often guided by biomarkers and molecular surveillance. Methods: This narrative review synthesizes evidence from randomized clinical trials, real-world studies, and biomarker-driven analyses published from 2010 to 2026, with emphasis on next-generation sequencing (NGS)-guided genomic profiling, targeted pathway therapies, and circulating tumor DNA (ctDNA)-based proactive interventions in the post-CDK4/6i setting. This review was conducted and reported in accordance with the SANRA recommendations for narrative reviews. Results: Early second-line standards, including fulvestrant and alpelisib for PIK3CA-mutated tumors, established the basis for biomarker-guided treatment in hormone receptor–positive, HER2-negative metastatic breast cancer. With the widespread use of CDK4/6 inhibitors in the first-line setting, the optimal post-progression strategy has shifted toward molecularly selected combination approaches rather than single-agent endocrine therapy, as endocrine monotherapy has shown limited efficacy in acquired resistance. Multiple randomized studies have demonstrated that adding targeted agents to endocrine therapy improves progression-free survival compared with hormonal therapy alone, supporting combination regimens as the preferred strategy after CDK4/6 inhibitor progression, except in carefully selected patients with low disease burden, indolent biology, or frailty where tolerability is a major concern. Precision-based trials have further refined this approach. Elacestrant improved progression-free survival in ESR1-mutated disease in the EMERALD trial, capivasertib plus fulvestrant demonstrated significant benefit in tumors harboring AKT/PIK3CA/PTEN pathway alterations in CAPItello-291, and inavolisib plus palbociclib and fulvestrant achieved both progression-free and overall survival improvement in PIK3CA-mutated patients with early relapse in INAVO120. Real-world analyses further support the effectiveness of these biomarker-directed strategies across diverse clinical subgroups. Comprehensive genomic profiling has identified multiple resistance mechanisms, including ESR1 mutations, PI3K/AKT/mTOR pathway activation, RB1 loss, and FGFR alterations, which may co-occur and reduce sensitivity to endocrine monotherapy. While ESR1 and PI3K pathway alterations now guide approved therapies, FGFR alterations remain investigational targets, with ongoing trials evaluating selective FGFR inhibitors. Proactive switching approaches evaluated in SERENA-6 and PADA-1 demonstrate that serial circulating tumor DNA (ctDNA) monitoring can detect emergent ESR1 mutations before radiographic progression, providing a clinically actionable lead time for early therapeutic modification and extending endocrine-based disease control by approximately 5 to 7 months. Conclusions: Post-CDK4/6i management increasingly relies on NGS-guided precision approaches, integrating pathway-specific therapies and ctDNA surveillance to tailor sequencing based on resistance profiles, prior ET response, and tumor heterogeneity. Future investigations into novel ER degraders and multi-targeted combinations hold potential to further optimize algorithms, extend non-chemotherapy options, and enhance survival in HR+/HER2− mBC. Full article