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Keywords = infection in hematology

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19 pages, 635 KB  
Review
Predictors of Mortality in Pseudomonas aeruginosa Bloodstream Infections: A Scoping Review
by Kartini Abdul Jabar, Nur Izzatul Auni Romli, Kumutha Malar Vellasamy, Vinod Pallath and Anis Rageh Al-Maleki
Pathogens 2026, 15(1), 61; https://doi.org/10.3390/pathogens15010061 - 7 Jan 2026
Abstract
Pseudomonas aeruginosa bloodstream infections (PABSIs) are a major clinical challenge due to their association with significant mortality and antimicrobial resistance mechanisms. The COVID-19 pandemic changed antimicrobial practices, intensive care management, and patient risk profiles, potentially influencing the epidemiology and outcomes of PABSIs. In [...] Read more.
Pseudomonas aeruginosa bloodstream infections (PABSIs) are a major clinical challenge due to their association with significant mortality and antimicrobial resistance mechanisms. The COVID-19 pandemic changed antimicrobial practices, intensive care management, and patient risk profiles, potentially influencing the epidemiology and outcomes of PABSIs. In the post-pandemic period, practices were expected to revert to normal. The objective of this scoping review was to identify and summarize reported mortality rates and risk factors for PABSIs in studies published between 2023 and 2025. Literature searches were conducted across PubMed, Web of Science, Embase, and Scopus. Screening was performed in accordance with PRISMA-ScR guidelines. Twenty-two eligible studies were included. Mortality rates varied across the study setting and populations; however, several consistent predictors were consistently identified, including carbapenem exposure, multidrug-resistant Pseudomonas aeruginosa, hematologic disease or malignancy, corticosteroid therapy, sepsis or septic shock, mechanical ventilation, and higher severity-of-illness scores. Few studies have linked molecular mechanisms to patient outcomes, highlighting important gaps in knowledge. Notably, only a small number of studies included the post-pandemic period but did not analyze the data separately. Despite limited available evidence, critically ill and immunocompromised patients remain at greatest risk of death from PABSIs. This review highlights the need for a broader comparative analysis in future. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in the Post-COVID Era: A Silent Pandemic)
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15 pages, 1984 KB  
Article
Recurrent Urinary Tract Infections in a Patient with Diffuse Large B-Cell Lymphoma and Severe COVID-19: A Single Case of Suspected Immunosuppression Where Antibacterial Therapy Was Not Enough
by Paula Irina Barata, Liana Maria Chicea, Irena Nedelea, Carmen Nicoleta Strauti, Diana Deleanu, Maria Daniela Moț, Coralia Cotoraci and Cristian Oancea
Antibiotics 2026, 15(1), 48; https://doi.org/10.3390/antibiotics15010048 - 3 Jan 2026
Viewed by 192
Abstract
Background: Non-Hodgkin lymphoma (NHL) is a malignancy of the immune system that includes several subtypes, most commonly diffuse large B-cell lymphoma and follicular lymphoma. Its etiology is multifactorial, with risk factors such as immunosuppressive therapy, infections, chemical exposure, and advanced age. A key [...] Read more.
Background: Non-Hodgkin lymphoma (NHL) is a malignancy of the immune system that includes several subtypes, most commonly diffuse large B-cell lymphoma and follicular lymphoma. Its etiology is multifactorial, with risk factors such as immunosuppressive therapy, infections, chemical exposure, and advanced age. A key aspect is the bidirectional relationship between lymphoma and immunodeficiency, which increases susceptibility to recurrent infections and complicates disease management. Case presentation: One particularly challenging case during the COVID-19 pandemic involved a patient with a personal history of diffuse B-cell non-Hodgkin lymphoma, diagnosed 5 years earlier, who had undergone eight cycles of rituximab-based chemotherapy. The patient tested positive for SARS-CoV-2 for three consecutive months and experienced repeated urinary tract infections warranting more in-depth investigations. The uniqueness of this case lies in the rare association of non-Hodgkin lymphoma, suspected post-rituximab immunodeficiency, severe COVID-19 infection, and recurrent urinary tract infections, which complicated clinical management. Despite appropriate treatment for both respiratory and urinary infections, as well as eight cycles of chemotherapy, the patient’s condition continued to deteriorate significantly, ultimately requiring intravenous immunoglobulin replacement therapy. Following the treatment, the patient presented a remarkable clinical improvement, with resolution of the signs and symptoms, and an absence of further recurrent infections. The patient remained clinically stable under regular immunoglobulin replacement therapy, with sustained infection control and improved quality of life. Conclusions: This case highlights the importance of assessing immune status in patients with a hematological malignancy, especially when recurrent infections persist. Full article
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17 pages, 3299 KB  
Article
Transmissible Gastroenteritis Virus Binding to Red Blood Cells Disrupts Iron Homeostasis and Promotes Viral Infection
by Lu Xia, Ziqi Wang, Yeqing He, Jingwen Wang, Junyuan Ren, Erhao Zhang, Zhonghu Liu, Yilei Li, Zi Li and Zhanyong Wei
Vet. Sci. 2026, 13(1), 42; https://doi.org/10.3390/vetsci13010042 - 3 Jan 2026
Viewed by 165
Abstract
Red blood cells (RBCs) are essential for transporting oxygen from lungs to peripheral tissues. However, the impact of transmissible gastroenteritis virus (TGEV) infection on RBCs and its potential pathophysiological significance during disease progression remain largely unexplored. In this study, hematological analysis of TGEV-infected [...] Read more.
Red blood cells (RBCs) are essential for transporting oxygen from lungs to peripheral tissues. However, the impact of transmissible gastroenteritis virus (TGEV) infection on RBCs and its potential pathophysiological significance during disease progression remain largely unexplored. In this study, hematological analysis of TGEV-infected piglets revealed significant reduction in both RBC distribution width–coefficient of variation and RBC distribution width–standard deviation, alongside elevated pCO2 levels. Viral detection confirmed the presence of TGEV within RBCs from infected piglets. Further investigation demonstrated that TGEV could bind to, but not replicate in, RBCs. TGEV-bound RBCs exhibited crenated and impaired deformability, which were associated with reduced oxygen-carrying capacity. Additionally, TGEV infection promoted macrophage-mediated phagocytosis of RBCs and led to decreased serum iron levels, factors that might enhance TGEV infection. Collectively, these results demonstrated the involvement of RBCs in the progression of TGEV infection, providing new insights for the development of diagnostic and therapeutic strategies. Full article
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14 pages, 467 KB  
Article
15-Day Duration of Venetoclax Combined with Azacitidine in Treatment-Naive Higher-Risk Myelodysplastic Syndromes: A Prospective Multicenter Study
by Binbin Lai, Chen Mei, Xiao Yan, Lieguang Chen, Yi Wang, Lixia Sheng, Shanhao Tang, Liping Mao, Ping Zhang, Yongcheng Sun, Wanzhuo Xie, De Zhou, Wenyuan Mai, Huafeng Wang, Liya Ma, Yinjun Lou, Wenjun Wu, Huifang Jiang, Jin Zhang, Baodong Ye, Hongyan Tong and Guifang Ouyangadd Show full author list remove Hide full author list
Cancers 2026, 18(1), 159; https://doi.org/10.3390/cancers18010159 - 2 Jan 2026
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Abstract
Background: Higher-risk myelodysplastic syndromes (HR-MDS) carry a high risk of progression to acute myeloid leukemia and poor overall survival. Hypomethylating agents (HMAs), such as azacitidine, remain the standard of care but have limited efficacy. A 15-day venetoclax-azacitidine regimen has shown promising objective response [...] Read more.
Background: Higher-risk myelodysplastic syndromes (HR-MDS) carry a high risk of progression to acute myeloid leukemia and poor overall survival. Hypomethylating agents (HMAs), such as azacitidine, remain the standard of care but have limited efficacy. A 15-day venetoclax-azacitidine regimen has shown promising objective response rates (ORR) and potential as a bridge to allogeneic hematopoietic stem cell transplantation (HSCT) in relapsed/refractory HR-MDS. We conducted a prospective multicenter trial to evaluate its efficacy and safety in previously untreated patients. Methods: This multicenter prospective study enrolled treatment-naïve HR-MDS patients (IPSS-R > 3.5). Venetoclax was administered on days 1–15 (escalated from 100 to 400 mg), combined with azacitidine (75 mg/m2) on days 1–7 of each 28-day cycle. The primary endpoint was ORR (2006 IWG criteria); secondary endpoints included complete remission (CR), overall survival (OS), and AML progression. Results: Twenty-eight patients (median age: 63 years) were enrolled, with a median follow-up of 8.5 months. ORR was 85.7% per 2006 IWG (CR: 35.7%, marrow CR: 50.0%), and 78.6% per 2023 IWG (CR: 35.7%). Responses were consistent across molecular and IPSS-R subgroups. Median OS was not reached. High neutrophil count and high cytogenetic risk were favorable factors; TP53 mutation/deletion was an adverse prognostic marker. Grade 3–4 hematologic toxicities included neutropenia (96.4%), anemia (71.4%), and thrombocytopenia (64.3%). Serious adverse events (35.7%) were mainly infections. No dose-limiting or unexpected toxicities were observed. Conclusions: The 15-day venetoclax plus azacitidine regimen demonstrated high efficacy and manageable toxicity in treatment-naïve HR-MDS. It may be particularly beneficial for patients with high neutrophil counts, adverse cytogenetics, or those eligible for HSCT, supporting further investigation in larger trials. Full article
(This article belongs to the Section Cancer Therapy)
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9 pages, 501 KB  
Communication
Antifungal Susceptibility Testing Experience in the Management of Culture-Positive Mucormycosis: Observation from a Large Healthcare System
by Maryam Naveed, Tirdad T. Zangeneh, Nathan P. Wiederhold, William Lainhart and Mohanad M. Al-Obaidi
J. Fungi 2026, 12(1), 34; https://doi.org/10.3390/jof12010034 - 1 Jan 2026
Viewed by 241
Abstract
Background: Mucormycosis, an invasive fungal infection with high morbidity and mortality rates, requires prompt surgical and antifungal therapies; however, the role of antifungal susceptibility testing (AFST) in clinical management of mucormycosis remains underexplored. We aimed to describe the experience of using AFST in [...] Read more.
Background: Mucormycosis, an invasive fungal infection with high morbidity and mortality rates, requires prompt surgical and antifungal therapies; however, the role of antifungal susceptibility testing (AFST) in clinical management of mucormycosis remains underexplored. We aimed to describe the experience of using AFST in the clinical management of mucormycosis. Methods: We conducted a retrospective study from 1 October 2017 to 8 February 2023. We included non-pregnant patients aged ≥ 18 years old with a positive culture for Mucorales and with proven or probable mucormycosis. We collected clinical and microbiological data using a chart review. Results: Over the study period, a total of 119 patients were included, with 36 (30%) undergoing AFST. Of all patients, the median age was 54 years, with 80 (67%) being White and not Hispanic and 73 (61%) being male. Fifty-three (45%) patients had DM, 27 (23%) had hematological malignancy, 15 (13%) had SOT, and 23 (19%) had COVID-19. Half of the cases met the criteria of proven invasive mucormycosis, with pulmonary involvement being the most common presentation (46, 39%), followed by rhino-cerebral-orbital involvement (35, 29%). The majority of Mucorales isolates were Rhizopus species (79, 66%). Among the 36 who underwent AFST, posaconazole minimal inhibitory concentrations (MICs) were lower than isavuconazole (range 0.03 to 2 µg/mL versus 0.1 to 16 µg/mL, respectively). AFST resulted in a change in antifungal therapy from isavuconazole to posaconazole in 3/36 (8%) cases. There was no statistically significant difference in the mortality between the patients whose isolates received AFST versus those who did not have AFST performed. Conclusions: AFST led to a change in antifungal therapy in a minority of mucormycosis cases. Further studies to understand the epidemiological range of antifungal MICs and the effect of AFST-informed antifungal therapy are needed. Full article
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11 pages, 541 KB  
Article
Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel
by Monia Marchetti, Giovanni Barosi, Francesco Passamonti, Marco Falcone, Emanuele Nicastri, Simona Sica, Pellegrino Musto, Francesca Romana Mauro and Corrado Girmenia
Vaccines 2026, 14(1), 46; https://doi.org/10.3390/vaccines14010046 - 30 Dec 2025
Viewed by 203
Abstract
Background: Pre-exposure passive immune prophylaxis (PrEP) might contribute to improve hematologic malignancy (HM) outcomes; however, there are currently no specific guidelines to inform patient selection. Methods: A literature review and a Delphi consensus process were used to identify COVID-19 risk factors, critical COVID-19 [...] Read more.
Background: Pre-exposure passive immune prophylaxis (PrEP) might contribute to improve hematologic malignancy (HM) outcomes; however, there are currently no specific guidelines to inform patient selection. Methods: A literature review and a Delphi consensus process were used to identify COVID-19 risk factors, critical COVID-19 outcomes, and efficacy of PrEP against SARS-CoV-2 in HMs. An analytic hierarchy process was used to assign a priority score to candidate outcomes and to determine the PrEP indications. For these decisions, the experts assumed adequate compliance with anti-COVID-19 vaccination and acknowledged the effectiveness of PrEP in reducing SARS-CoV-2-related mortality and hospital admissions. Results: Based on the literature review, the expert panel identified 80 risk categories among patients with HM and prioritized eight clinical outcomes related to SARS-CoV-2 PrEP. The highest mean priority scores were observed for HM-related mortality (7.0), intensive care unit admission (6.7), and delays in anti-HM treatment (6.6). Based on such a framework, the experts deemed that if there was a variant-specific PrEP promptly available, it would be considered mandatory for all candidates receiving allogeneic hematopoietic cell transplantation, CAR-T therapy, or bispecific antibodies, regardless of local viral epidemiology. During epidemiological waves, variant-specific PrEP would also be recommended for patients with HMs at high risk of unfavorable COVID-19 clinical outcomes. Conclusions: This study identified PrEP indications for patients with HM receiving appropriate active immunization against COVID-19. Full article
(This article belongs to the Special Issue Vaccination for Patients with Hematologic Diseases)
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15 pages, 1020 KB  
Article
Burden of Clostridioides difficile Infection and Risk Factors for Recurrences in an Italian Tertiary Care University Hospital: A Prospective Observational Study
by Maria Chiara Gagliano, Giulio D’Agati, Alice Annalisa Medaglia, Luca Pipitò, Bianca Catania, Claudia Conti, Antonino Tuttolomondo, Angelo Baldassare Cefalù, Calogero Cammà, Nicola Scichilone, Anna Licata, Mario Barbagallo, Rita Immordino, Roberta Virruso, Giovanni Maurizio Giammanco and Antonio Cascio
Antibiotics 2026, 15(1), 23; https://doi.org/10.3390/antibiotics15010023 - 25 Dec 2025
Viewed by 540
Abstract
Background:  Clostridioides difficile infection (CDI) remains a challenging condition, particularly in severe or recurrent cases. This study aimed to identify factors associated with recurrent CDI (rCDI), severe disease (defined by ZAR score or ESCMID criteria), death during CDI, and bloodstream infections (BSI) [...] Read more.
Background:  Clostridioides difficile infection (CDI) remains a challenging condition, particularly in severe or recurrent cases. This study aimed to identify factors associated with recurrent CDI (rCDI), severe disease (defined by ZAR score or ESCMID criteria), death during CDI, and bloodstream infections (BSI) or candidemia within 8 weeks of CDI onset. Methods: We conducted a prospective study at an Italian university hospital that included all adult CDI cases diagnosed between November 2022 and December 2024. Statistical analyses were performed with IBM SPSS Statistics. A p-value < 0.05 was considered statistically significant in univariate analyses. For the multivariable analysis, we selected the variables that were statistically significant in the univariate analysis and considered the most clinically relevant. Results: A total of 161 CDI cases were identified. Recurrence occurred in 13%, higher than the 4% reported in a previous retrospective cohort at the same center (2013–2022). In univariate analysis, independent predictors of recurrent CDI (rCDI) were therapeutic regimens including oral vancomycin (p = 0.008; OR 6.17; 95% CI 1.36–27.97), peripheral vascular disease (PVD) (p < 0.001; OR 5.92; 95% CI 2.07–16.94), and dysphagia (p = 0.034; OR 4.61; 95% CI 1.25–17.07), whereas fidaxomicin use was associated with a protective effect (p = 0.016; OR 0.17; 95% CI 0.04–0.78). In multivariable analysis, oral vancomycin use (p = 0.008; OR 15.03) and peripheral vascular disease (p = 0.002; OR 7.27) remained independently associated with rCDI. Overall, 15 of 161 patients (9.3%) died during the CDI episode (either presenting CDI or rCDI), with all deaths directly attributable to CDI. Mortality during CDI was associated with age > 77 years (median value of the study population), transfer from a nursing home or long-term care facility within the previous 3 months, lymphoma, hematological malignancy, peripheral vascular disease, connective tissue disease, immobilization syndrome, dysphagia, elevated lactate levels (>1 mmol/L), septic shock, severe or severe-complicated CDI according to ESCMID criteria, severe-complicated CDI according to ESCMID criteria, leukocytosis (WBC > 15,000/mm3) during CDI, ZAR score ≥ 2, concomitant BSI, and concomitant pneumonia. During follow-up, 11 of 127 (8.7%) patients developed a BSI. BSI was associated with corticosteroid use and osteomyelitis. Only four patients developed candidemia due to Candida albicans during follow-up. Conclusions: Our study confirms that Clostridioides difficile infection remains a major clinical challenge, particularly due to its high recurrence rate and the burden of severe forms. The evidence strongly supports the preferential use of fidaxomicin, which should now be regarded as the standard of reference in clinical practice. Full article
(This article belongs to the Special Issue Clostridioides difficile Infection, 3rd Edition)
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18 pages, 1296 KB  
Article
Preclinical Study on Sabin Strain-Based DTaP-sIPV/Hib Pentavalent Vaccine: Evaluation of Repeated-Dose Toxicity and Immunogenicity
by Ting Zhao, Han Chu, Yan Ma, Qin Gu, Na Gao, Jingyan Li, Qiuyan Ji, Jiana Wen, Xiaoyu Wang, Guoyang Liao, Shengjie Ouyang, Wenzhu Hu, Hongwei Liao, Guang Ji, Hongbo Chen, Lujie Yang, Mingqing Wang, Ling Ping, Yuting Fu, Yixian Fu, Wenlu Kong, Huimei Zheng, Xinhua Qin, Lukui Cai, Jiangli Liang and Jingsi Yangadd Show full author list remove Hide full author list
Vaccines 2026, 14(1), 29; https://doi.org/10.3390/vaccines14010029 - 25 Dec 2025
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Abstract
Background: Pertussis, diphtheria, tetanus, poliomyelitis, and Haemophilus influenzae type b (Hib) infections pose severe threats to children’s health globally. This study evaluated the safety and immunogenicity of a novel Sabin strain-based adsorbed pentavalent vaccine (DTacP-sIPV/Hib), which offers potential advantages in biosafety and cost-effectiveness [...] Read more.
Background: Pertussis, diphtheria, tetanus, poliomyelitis, and Haemophilus influenzae type b (Hib) infections pose severe threats to children’s health globally. This study evaluated the safety and immunogenicity of a novel Sabin strain-based adsorbed pentavalent vaccine (DTacP-sIPV/Hib), which offers potential advantages in biosafety and cost-effectiveness compared to wild-type poliovirus-based vaccines. Methods: A repeated-dose toxicity study was conducted in 190 Sprague-Dawley rats, randomly divided into negative control, adjuvant control, low-dose, and high-dose groups. Animals received five intramuscular injections at 21-day intervals, followed by a 56-day recovery period. Parameters assessed included local reactions, body temperature, hematology, serum biochemistry, coagulation, histopathology, T-cell subsets, cytokine levels, and antigen-specific immunogenicity. Results: The primary adverse reaction was dose-dependent local muscle swelling, which was fully reversible within 3–21 days. Only transient body temperature fluctuations and adjuvant-related hematological/biochemical abnormalities were observed, all resolving after the recovery period. No vaccine-related damage occurred in hepatic/renal function or immune organs. Immunogenicity data showed 100% seroconversion for all bacterial components 21 days after the first dose. The high-dose group achieved 100% seropositivity for all poliovirus serotypes after the second dose, while the low-dose group reached the same after the third dose, with no significant difference in antibody levels between dose groups. Conclusions: The DTacP-sIPV/Hib vaccine exhibits a favorable safety profile and robust immunogenicity in rats, supporting its further clinical development. The use of Sabin strains reduces biosafety risks and manufacturing costs, making this vaccine a promising candidate for immunization programs, especially in resource-limited regions. Full article
(This article belongs to the Section Vaccines, Clinical Advancement, and Associated Immunology)
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14 pages, 590 KB  
Article
Impact of Anatomical Extent and Combined Surgical–Medical Therapy on Survival in Sinonasal and Rhino-Orbito-Cerebral Mucormycosis: A 14-Year Retrospective ENT Cohort
by Günay Kozan, Serkan Dedeoğlu, Muhammed Ayral and Mehmet Akdağ
J. Clin. Med. 2026, 15(1), 127; https://doi.org/10.3390/jcm15010127 - 24 Dec 2025
Viewed by 184
Abstract
Background/Objectives: Mucormycosis is a rapidly progressive invasive fungal infection that commonly involves the sinonasal region and skull base in patients with systemic comorbidities, yet robust ENT data from middle-income settings are scarce. Methods: We performed a single-center retrospective review of all [...] Read more.
Background/Objectives: Mucormycosis is a rapidly progressive invasive fungal infection that commonly involves the sinonasal region and skull base in patients with systemic comorbidities, yet robust ENT data from middle-income settings are scarce. Methods: We performed a single-center retrospective review of all patients with histopathologically confirmed mucormycosis treated in the Otorhinolaryngology Department of Dicle University between 2010 and 2023, covering a 14-year period. Eligible patients had paranasal sinus computed tomography at presentation and received surgical and/or systemic antifungal therapy. Demographic data, comorbidities, disease subtype, radiological extent, treatment modality and survival were extracted from records. Survival was estimated using Kaplan–Meier analysis, and group differences were tested with chi-square statistics (p ≤ 0.05). Results: Fifty-two patients met the inclusion criteria (mean age 56.5 ± 15.2 years; 57.7% male); 73.1% had at least one systemic comorbidity, most frequently diabetes mellitus (65.4%) and hematological malignancy (19.2%). Disease was sinonasal in 42.3%, rhino-orbital in 28.8% and rhino-orbito-cerebral in 28.8%. Baseline CT showed intracranial extension in 26.9%. Overall survival was 59.6% and differed markedly by subtype, highest in isolated sinonasal disease (81.8%) and lowest in rhino-orbito-cerebral disease (26.7%). Intracranial extension was associated with higher mortality (71.4% vs. 28.9%). Combined surgical debridement plus systemic antifungal therapy, used in 84.6% of patients, yielded lower mortality than antifungal therapy alone (31.8% vs. 87.5%). Conclusions: In this ENT cohort, prognosis was mainly determined by anatomical extent and treatment strategy. Our findings suggest that timely combined surgical and antifungal management, when feasible and in appropriately selected patients, is associated with improved survival outcomes. Full article
(This article belongs to the Special Issue New Insights into Head and Neck Surgery—2nd Edition)
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15 pages, 1837 KB  
Systematic Review
Colchicine Use in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
by Huey Chiat Cheong, Meng Hsuan Kuo, Chih-Wei Tseng and Yi-Da Li
J. Clin. Med. 2026, 15(1), 105; https://doi.org/10.3390/jcm15010105 - 23 Dec 2025
Viewed by 347
Abstract
Background: This study aimed to assess the efficacy, optimal dosing, and timing of colchicine therapy in reducing major adverse cardiovascular events (MACE), its impact on inflammatory markers, and safety concerns in patients following acute coronary syndrome (ACS) through a systematic review and [...] Read more.
Background: This study aimed to assess the efficacy, optimal dosing, and timing of colchicine therapy in reducing major adverse cardiovascular events (MACE), its impact on inflammatory markers, and safety concerns in patients following acute coronary syndrome (ACS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted in accordance with PRISMA guidelines to identify RCTs comparing colchicine versus placebo or standard treatment in ACS patients. The primary outcome was MACE and secondary outcomes included all-cause and cardiovascular mortality, non-fatal MI, stroke, revascularization, heart failure, CRP/hs-CRP changes, and adverse effects. Fifteen RCTs involving 19,131 patients were analyzed. Results: The benefit of colchicine in reducing MACE risk was marginally significant (RR = 0.79, 95% CI: 0.63–0.99, p = 0.04, I2 = 59%). No significant reduction was observed for all-cause mortality, cardiovascular mortality, other cardiovascular outcomes, early initiation of colchicine (≤3 days), or choice of dosage (≤0.5 mg/day vs. >0.5 mg/day). The findings pertaining to the delayed time-to-initiation (>3 days) and changes in CRP or hs-CRP levels were inconclusive. Gastrointestinal side effects, especially diarrhea (RR = 1.76, 95% CI: 1.16–2.66, p = 0.001), were most common. No increase in hematologic events or infections was observed. Conclusions: Colchicine potentially reduces MACE in ACS patients, without evidence of benefit in improving all-cause mortality or other cardiovascular outcomes. Gastrointestinal intolerance is the most common side effect. This result is consistent with current clinical guidelines: a Class IIb recommendation for colchicine use in ACS. There is a need for further high-quality trials to refine patient selection and optimize treatment regimens. Full article
(This article belongs to the Section Cardiology)
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15 pages, 7747 KB  
Case Report
A Rare Case of Rhizomucor pusillus Infection in a 3-Year-Old Child with Acute Lymphoblastic Leukemia, Presenting with Lung and Brain Abscesses—Case Report
by Yanko Pahnev, Boryana Avramova, Natalia Gabrovska, Yolin Dontcheva, Genoveva Tacheva, Krasimir Minkin, Hans Kreipe, Nadezhda Yurukova, Marin Penkov, Nikola Kartulev, Zdravka Antonova, Velichka Oparanova, Nadezhda Tolekova, Petia Moutaftchieva, Bogdan Mladenov, Plamena Hristova, Kaloyan Gabrovski, Svetlana Velizarova, Albena Spasova and Hristo Shivachev
Infect. Dis. Rep. 2026, 18(1), 2; https://doi.org/10.3390/idr18010002 - 23 Dec 2025
Viewed by 158
Abstract
Invasive Mucormycosis (IM) is an extremely rare infection with a high mortality rate, caused by a group of fungi classified as Mucorales moulds. Rhizomucor pusillus is a saprophitic, thermophilic, and angioinvasive microorganism that grows and lives at about 45 °C and is usually [...] Read more.
Invasive Mucormycosis (IM) is an extremely rare infection with a high mortality rate, caused by a group of fungi classified as Mucorales moulds. Rhizomucor pusillus is a saprophitic, thermophilic, and angioinvasive microorganism that grows and lives at about 45 °C and is usually found in different environmental spaces such as soil, air, water, food, and other organic matter. These features predispose the infection to wide dissemination, especially in immunocompromised patients and most often in children after chemotherapy for hematological malignancies (HMs). Mucormycosis in patients with hematologic malignancies and neutropenia represents between 0.07% and 4.29% of the concomitant diseases. IM can develop into an infection in different sites, but its most common manifestation is pulmonary, followed by rhino-orbital–cerebral and disseminated forms. In recent years, an increased morbidity rate has been associated with the ongoing COVID-19 pandemic, as cited in the literature. There are many publications with COVID-19-associated mucormycosis (CAM) cases. The present treatment protocol includes extensive and radical surgical debridement and systemic antifungal therapy with Liposomal Amphotericin B (L-AmB), Posaconazole, and Isavuconazole, either combined or as monotherapy. Despite these new treatment modalities, the mortality rate remains over 50%. We present a rare case of a 3-year-old child with acute lymphoblastic leukemia (ALL) and systemic Rhizomucor pusillus infection, diagnosed on the occasion of lung and brain abscesses. The patient underwent lung and brain surgery and is recovering well with no further complications. The two-year follow-up period shows no signs of recurrence of the disease. Full article
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12 pages, 229 KB  
Article
Pan-Immune Inflammation Value and Clinical Outcomes in Subacute Sclerosing Panencephalitis: A Retrospective Study
by Bilge Özgör, Murat Çağlar Şahin, Işınsu Bıçakcıoğlu, Gül Yücel, Meral Karadağ and Serdal Güngör
Viruses 2026, 18(1), 18; https://doi.org/10.3390/v18010018 - 22 Dec 2025
Viewed by 297
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurological disorder caused by persistent measles virus infection. Reliable prognostic biomarkers remain limited. Systemic inflammation has been implicated in the pathogenesis of neuroinfectious diseases, and hematology-derived indices are increasingly recognized as accessible markers [...] Read more.
Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurological disorder caused by persistent measles virus infection. Reliable prognostic biomarkers remain limited. Systemic inflammation has been implicated in the pathogenesis of neuroinfectious diseases, and hematology-derived indices are increasingly recognized as accessible markers of inflammatory burden. This retrospective case–control study was conducted at İnönü University Faculty of Medicine, Malatya, Türkiye, between 2010 and 2025, including 40 pediatric patients with SSPE and 40 age- and sex-matched healthy controls. Demographic and laboratory data were retrieved from institutional records, and disease severity was classified according to Jabbour stages. Compared with controls, patients with SSPE had significantly higher pan-immune inflammation value (PIV: 710.5 [320–1050] vs. 280.0 [150–460], p < 0.001), systemic immune-inflammation index (SII: 640.0 [310–1240] vs. 410.0 [210–720], p = 0.02), and neutrophil-to-lymphocyte ratio (NLR: 2.1 [1.2–3.8] vs. 1.6 [1.0–2.5], p = 0.03), along with lower lymphocyte counts (p = 0.04). Elevated PIVs were strongly associated with advanced Jabbour stages, impaired ambulation, and a higher case-fatality ratio (35%). Multivariate regression identified PIV as an independent predictor of death (OR: 3.25, 95% CI: 1.45–7.28, p = 0.004), and receiver operating characteristic analysis demonstrated superior discriminative accuracy of PIV (AUC = 0.87) compared with other indices. These findings suggest that PIV, a simple and inexpensive biomarker derived from routine blood tests, may provide useful prognostic information in SSPE and aid early risk stratification. Further multicenter, prospective studies are warranted to validate its clinical utility. Full article
(This article belongs to the Section Human Virology and Viral Diseases)
24 pages, 677 KB  
Article
Prospective Analysis of Perioperative Stress Response in Living Donor Liver Transplantation for Hepatitis B-Related Liver Disease
by Adem Tuncer, Sami Akbulut, Tevfik Tolga Sahin, Basri Satilmis, Zeki Ogut, Yasin Dalda and Sezai Yilmaz
J. Clin. Med. 2025, 14(24), 8970; https://doi.org/10.3390/jcm14248970 - 18 Dec 2025
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Abstract
Background: Liver transplantation is a life-saving procedure for patients with end-stage liver disease, yet the immunological consequences of surgical trauma in these patients are not fully understood. The liver plays a central role in immune regulation, and its dysfunction in HBV-related chronic [...] Read more.
Background: Liver transplantation is a life-saving procedure for patients with end-stage liver disease, yet the immunological consequences of surgical trauma in these patients are not fully understood. The liver plays a central role in immune regulation, and its dysfunction in HBV-related chronic liver disease may alter the systemic stress response to surgery. Aim: This study aims to evaluate the stress response to surgical trauma of patients undergoing living donor liver transplantation (LDLT) for HBV-related chronic liver disease in comparison to living liver donors (LLDs). Methods: This prospective study included 20 LDLT recipients with HBV infection and 20 LLDs who underwent living donor hepatectomy between August 2020 and February 2021. Specific biochemical markers (IL-1, IL-4, IL-6, IL-22, IFN-γ, TNF-α, TGF-β, GM-CSF, GLDH, and GalactB) were measured at designated intervals: preoperative day 0 (Preop), immediately after incision (Incision), post-hepatectomy (Hepatectomy), postoperative day 0 (POD0), POD1, and POD3 using enzyme-linked immunosorbent assay (ELISA). Routine hematological and biochemical parameters (WBC, HGB, PLT, RDW, MPV, PDW, AST, ALT, ALP, GGT, albumin, total bilirubin, plateletcrit, phosphorus, fibrinogen, and INR) were measured regularly at five predetermined times: Preop, POD0, POD1, POD2, and POD3. Results: Prior to LDLT, LDLT recipients had significantly lower levels of pro-inflammatory cytokines (IL-1, IL-6, TNF-α, IFN-γ) compared to LLDs (p < 0.05). However, following liver implantation, these cytokine levels increased significantly at POD0, POD1, and POD3 (p < 0.001). Specifically, IL-1 levels elevated from 0 in the preop period to 21.5 (97.5) in POD3, and IL-6 elevated from 0 in the preop period to 28.3 at POD3 (p = 0.056). Similarly, TNF-α and IFN-γ levels exhibited significant upward trends (p < 0.05). In contrast, cytokine levels in LLDs remained stable throughout the perioperative period, revealing no statistically significant variations (p > 0.05). Routine hematological and biochemical parameters demonstrated significant postoperative fluctuations in LDLT recipients, reflecting the metabolic and immune restoration process. Conclusions: These findings indicate that patients with HBV-related chronic liver disease exhibit a diminished stress response to trauma due to underlying immune dysregulation caused by chronic hepatic dysfunction. However, after LDLT, the stress response gradually normalizes, suggesting that liver transplantation not only restores hepatic function but also reestablishes immune homeostasis, potentially reducing infection risks and improving postoperative recovery. These findings emphasize the crucial role of the liver in regulating the body’s stress response to trauma and highlight the immunological benefits of LDLT in restoring immune homeostasis. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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16 pages, 600 KB  
Article
Ceftazidime-Avibactam Regimens for the Treatment of Bacteremic and Non-Bacteremic Episodes of Carbapenemase-Producing Enterobacterales Infections in Immunosuppressed Patients
by Fabián Herrera, Diego Torres, María Leone, Maximiliano Gabriel Castro, Jorge López Camelo, Elena Temporiti, Natalin Grippo, Silvia Relloso and Pablo Bonvehí
Pathogens 2025, 14(12), 1300; https://doi.org/10.3390/pathogens14121300 - 18 Dec 2025
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Abstract
Ceftazidime-avibactam (CA) and CA plus aztreonam (ATM) are the preferred treatment options for KPC and MBL carbapenemase-producing Enterobacterales infections (CPEis). All episodes of monomicrobial CPEis in immunosuppressed patients (IPs) admitted from May 2019 to November 2024, who received definitive antibiotic therapy (AT) with [...] Read more.
Ceftazidime-avibactam (CA) and CA plus aztreonam (ATM) are the preferred treatment options for KPC and MBL carbapenemase-producing Enterobacterales infections (CPEis). All episodes of monomicrobial CPEis in immunosuppressed patients (IPs) admitted from May 2019 to November 2024, who received definitive antibiotic therapy (AT) with CA or CA + ATM for at least 72 h, were prospectively included. Bacteremic episodes (BEs) and non-bacteremic episodes (NBEs) were compared. Logistic regressions adjusted by propensity score were used to identify variables associated with 30-day overall mortality. In total, 82 CPEis were included (38 NBEs and 44 BEs). BEs more frequently occurred in hematological malignancies (52.3% vs. 15.8%, p = 0.0006), while NBEs were more commonly observed in solid organ transplantation (73.7% vs. 34.1%, p = 0.001). K. pneumoniae was the main isolated microorganism; KPC-CPE was the most common resistance mechanism in both groups, followed by MBL-CPE. The 7-day clinical response, 30-day overall and infection-related mortality between NBEs and BEs were 92.1% vs. 88.6%, p = 0.59, 10.5% vs. 27.3%, p = 0.09, and 2.6% vs. 13.6%, p = 0.11. Septic shock, OR 6.5, 95% CI, 1.58–26.72 (p = 0.01), and refractory malignancy, OR 5.6, 95% CI, 1.03–30.14 (p = 0.046), were associated with 30-day mortality, whereas BEs were not, OR 1.5, 95% CI, 0.36–6.2 (p = 0.56). CPEis in both NBE and BE IPs who received definitive AT with CA or CA + ATM correlated with a high rate of 7-day clinical response and low 30-day infection-related mortality. Underlying malignancy and disease severity were associated with 30-day overall mortality. Regional knowledge of bacterial antibiotic resistance enables the implementation of individualized AT to improve patient survival. Full article
(This article belongs to the Special Issue Emerging Infectious Diseases: A Perpetual Challenge)
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17 pages, 1726 KB  
Article
Complications of Haploidentical Hematopoietic Cell Transplantation with Post-Transplant Cyclophosphamide—A Prospective Study on Behalf of the EBMT Transplant Complications Working Party
by Agnieszka Tomaszewska, Grzegorz W. Basak, Christophe Peczynski, Emmanuelle Polge, Pascale Ambron, William Boreland, Simona Sica, Mutlu Arat, Jakob Passweg, Jose Luis Lopez Lorenzo, Urpu Salmenniemi, Pavel Jindra, Alexander Kulagin, Rodrigo Martino Bufarull, Matthias Eder, Mohamed-Amine Bekadja, Alberto Mussetti, Charlotte E. Graham, Hélène Schoemans, Olaf Penack, Ivan Moiseev and Zinaida Perićadd Show full author list remove Hide full author list
Cancers 2025, 17(24), 4029; https://doi.org/10.3390/cancers17244029 - 18 Dec 2025
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Abstract
Background: Haploidentical hematopoietic cell transplantations (haplo-HCTs) with post-transplant cyclophosphamide (PT-Cy) are standard practice, but complications causing morbidity and mortality are not well described. Methods: The aim of this prospective non-interventional multicenter study was to document frequency of potential non-infectious and infection-related complications and [...] Read more.
Background: Haploidentical hematopoietic cell transplantations (haplo-HCTs) with post-transplant cyclophosphamide (PT-Cy) are standard practice, but complications causing morbidity and mortality are not well described. Methods: The aim of this prospective non-interventional multicenter study was to document frequency of potential non-infectious and infection-related complications and main transplant outcomes after the first unmanipulated haplo-HCT with PT-Cy between 2017 and 2019 in 129 adult patients with hematological malignancies. The median follow-up was 37.3 months [95% CI: 34.3–39.7]. Results: The cumulative incidence (CI) of acute graft versus host disease (aGvHD) at day +100 was 22.4% grade II-IV [95% CI: 15.5–30.1] and 8.8% grade III-IV [95% CI: 4.6–14.6], respectively. The cumulative incidence of chronic GvHD (cGvHD) at 24 months was 25.8% [95% CI: 18.5–33.6]; extensive cGvHD was 10.9% [95% CI: 6.3–17.1], respectively. The most frequent non-infectious complications for the whole study population were mucositis—37.5% (n = 48); renal insufficiency—18% (n = 23); and cardiovascular complications—10.9% (n = 14). The following infection-related complications were diagnosed: bacterial in 84 (65.1%), viral in 66 (51.6%), and fungal in 24 (18.6%) recipients. Two-year OS was 58.1% [95% CI: 50.2–67.3]; NRM—27.1% [95% CI: 19.7–35]; PFS—50.4% [95% CI: 42.5–59.8]; and GRFS—38.8% [95% CI: 31.2–48.1]. About 50% of all deaths were directly caused by infection or infection-related conditions. Conclusions: Disease remission status at transplant significantly affected PFS, chronic GvHD, and GRFS. Although clinical applications of haplo-HCT with PTCy are widespread, the study confirms the need to reduce infection-related mortality after this type of GvHD prophylaxis. Full article
(This article belongs to the Section Transplant Oncology)
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