Search Results (1,073)

Cryptosporidium is a genus of protozoa that infects the gastrointestinal and respiratory epithelium of various host species. The aim of this study was to perform experimental infection in conventional mice with three Cryptosporidium species isolated from humans. The three Cryptosporidium species, namely Cryptosporidium canis, Cryptosporidium parvum, and Cryptosporidium ryanae, were obtained from fecal samples collected from patients hospitalized in an infectious disease hospital. The mice, from 10-day-old litters kept with their mother, were divided into three groups and orally infected with one of the Cryptosporidium species. The first oocysts were identified in the feces of the mice four days post-infection. The infection was successful with all three Cryptosporidium species, but the infection level (expressed as the number of oocysts per microscopic field) was low. The infection was detected using a rapid immunochromatographic test 40 days post-infection. Furthermore, starting on the 17th day after infection, the mothers also tested positive on the rapid immunochromatographic test, having been negative until that point. It was concluded that mice could represent a source of infection for the three Cryptosporidium species in other susceptible species, including humans. No behavioral changes or diarrhea were observed in any of the experimental cases. Full article

Background/Objectives: Opportunistic fungal infections are common among people living with HIV (PLHIV) and contribute substantially to morbidity, mortality, and hospitalization rates in this population. This study aimed to determine the prevalence of dermatological manifestations of fungal infections in HIV-positive patients and examine their association with demographic, clinical, and immunological characteristics. Methods: A retrospective review of medical records from 2500 PLHIV treated at the Infectious Diseases Unit of “Andreas Syggros” Hospital for Skin and Venereal Diseases between 1988 and 2017. Data from patients diagnosed with opportunistic fungal infections were analyzed. Participants were classified as either antiretroviral therapy (ART)-naïve or already receiving treatment. Recorded fungal infections were correlated with epidemiological variables and CD4+ T-cell counts. Results: Opportunistic fungal infections were identified in 859 patients (34.36%), with a marked male predominance. Candidiasis was the most frequently reported condition, with a higher prevalence among female patients. Lower CD4+ counts were significantly associated with an increased risk of cryptococcal meningitis, esophageal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and oral candidiasis, whereas higher CD4+ counts were more common in patients with dermatophytosis, onychomycosis, and pityriasis/tinea versicolor. Conclusions: Opportunistic fungal infections remain highly prevalent in PLHIV, particularly among those with advanced immunosuppression. CD4+ T-cell counts are key diagnostic and prognostic markers, reinforcing their importance in monitoring disease progression and guiding clinical management. Full article

Introduction: Scrub typhus is a mite-borne infectious disease caused by “Orientia tsutsugamushi”, a bacterium that was formerly classified under the genus Rickettsia. It is transmitted to humans through the bites of infected chigger mites (larval trombiculid mites). However, clinical data on the cardiac manifestations of scrub typhus and their outcomes remain limited. Methods: This research was retrospectively conducted at a tertiary care hospital in South India. The study included all patients admitted from January 2016 to September 2021 who fulfilled the clinical criteria for a diagnosis of scrub typhus. Data were collected for 426 patients. Patients with previously diagnosed heart disease and mixed infections (leptospirosis, dengue fever, blood culture positivity, and COVID-19 positivity) were excluded. Comprehensive assessments of clinical presentation, electrocardiography (ECG), 2D echocardiography, and outcomes, including all-cause mortality and probable myocarditis, were performed. Multivariate regression analysis was performed to identify independent predictors of all-cause mortality and probable myocarditis. Results: Out of 426 patients, 200 (46.9%) were male and 226 (53.1%) were female. The mean age at presentation was 49.29 ± 14.43 years. A total of 108 (25.4%) patients had diabetes and 82 (19.25%) had hypertension. Sinus tachycardia (29.3%) was the most frequent ECG finding. Echocardiographic evidence of probable myocarditis was observed in 20 (4.7%) patients, while 6 (1.4%) patients had isolated RV dysfunction, 4 (0.9%) had biventricular dysfunction, 7 (1.6%) had significant pulmonary hypertension, and 40 (9.4%) had trivial pericardial effusion. A total of 78 (18.3%) patients had acute respiratory distress syndrome. All-cause mortality was observed in 12 (2.8%) patients. A total of 56 (13.1%) patients developed multiorgan dysfunction syndrome (MODS) during their hospitalization. A total of 78 (18.3%) patients were documented to have acute kidney injury (AKI), and 22 (5.2%) patients underwent hemodialysis. Multivariable binary logistic regression analysis revealed that probable myocarditis and MODS were independent predictors of mortality among patients with scrub typhus, and age, female gender, and LV systolic dysfunction were identified as predictors of overall complications, including mortality, probable myocarditis, congestive heart failure, MODS, AKI, and the need for hemodialysis. Conclusions: Probable myocarditis was the most frequent cardiac manifestation noted in patients with scrub typhus, and in addition to MODS, probable myocarditis was an independent predictor of mortality in this cohort. Thus, it is crucial to maintain clinical vigilance regarding the cardiac status of such patients. Full article

Background: Latent tuberculosis infection (LTBI) is a major global health concern, particularly among individuals with chronic kidney disease (CKD), who are at increased risk of reactivation due to impaired immunity and frequent exposure to immunosuppressive therapies. Despite growing reliance on interferon-gamma release assays (IGRAs) such as QuantiFERON-TB Gold In-Tube (QFT-GIT) in BCG-vaccinated populations, data on IGRA performance across CKD stages remain limited in resource-limited settings. Objective: To determine the prevalence of LTBI and indeterminate IGRA results across CKD stages in a Thai population and assess the clinical utility of IGRA in this context. Materials and Methods: We conducted a cross-sectional study among 785 Thai adults receiving care at a national infectious disease institute, including diabetes clinic patients, hospital staff, and individuals on hemodialysis. Each participant underwent QFT-GIT testing, and the CKD stage was classified using the estimated glomerular filtration rate (eGFR) closest prior to testing. Results: Overall IGRA positivity was 22.2%, peaking in CKD stage G3 (31.6%) and declining in stage G5 (11.0%), where indeterminate results were also highest (6.8%). Limitations: Single-center design and lack of confirmatory testing may limit generalizability. Conclusions: IGRA performance is reliable in early-to-moderate CKD but less so in advanced stages. LTBI is prevalent in CKD stages G2–G4, supporting stage-specific approaches to LTBI screening and caution against overreliance on IGRA in advanced renal impairment. Full article

The incidence of allergic diseases has increased notably in recent years. The reasons for this increase include air pollution, diet, and infectious factors. This study aims to analyze the interactions between aeroallergens, environmental pollutants, and meteorological factors and their impact on allergenic sensitization in Toledo, Spain. An aerobiological study was conducted over the past 30 years (1994–2023) using a Burkard collector and the SEAIC (Spanish Society of Allergology and Clinical Immunology) methodology. Meteorological data were obtained from the State Meteorological Agency (AEMET) and pollutant data were acquired from the Castilla-La Mancha Air Quality Monitoring Network. Patients presenting with seasonal allergic symptoms at the University Hospital of Toledo were selected for skin testing with various types of airborne pollen. A total of twenty pollen taxa were identified in the Toledo atmosphere, as follows: Cupressaceae (26.53%); Olea europaea (21.62%); Quercus (21.12%); Poaceae (10.30%); Urticaceae (2.58%); Plantago (2.48%); Platanus (2.00%); Amaranthaceae (1.72%); Rumex (1.68%); and Morus, Pistacia, Populus, Artemisia, Fraxinus, Alnus, Carex, and Ericaceae (less than 1% each). The average temperature increased by 1.2 °C, while the level of precipitation remained stable. Among all pollutants, only a moderate increase in ozone levels was observed; however, the concentrations of particulate matter and nitrogen oxides decreased. The prevalence of pollen sensitization in allergic patients ranged from 8% for Pinus nigra to 84% for Phleum pratense. In conclusion, the rise in temperature due to climate change, coupled with high concentrations of pollutants such as ozone, can result in increased concentrations of the main types of wind-borne pollen. Thus, this can lead to a greater sensitivity to pollen and, consequently, more people becoming allergic to pollen. Full article

Background: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB) affecting between 5% and 40% of patients, which leads to hemodynamic instability, an increased risk of thromboembolism, decompensated heart failure, prolonged hospitalization, and higher treatment costs. Currently, there are no universally accepted guidelines for preventing POAF. Methods: A single-center, prospective, randomized controlled trial, “The Effect of Colchicine on the Occurrence of Atrial Fibrillation after Cardiac Surgery” (CAFE), ClinicalTrials.gov ID: NCT06798714, was conducted. The study included 140 patients with coronary artery disease randomized into two groups of 70 patients each. Group 1 (control group) received standard postoperative care. Group 2 (intervention group) received colchicine (Colchicum-Dispert at a dose of 500 mcg 4 h before coronary artery bypass grafting (CABG) with CPB and at a dose of 500 mcg twice daily for 10 days postoperatively) and underwent intraoperative pericardial fenestration using an original technique. Results: Perioperative colchicine administration combined with intraoperative pericardial fenestration reduced POAF incidence to 2.9% compared to the control group with POAF incidence of 12.9% (p < 0.05). This management strategy was not associated with an increased incidence of infectious complications, gastrointestinal disorders, or elevated levels of alanine aminotransferase, aspartate aminotransferase, or creatinine. Conclusions: Perioperative colchicine administration combined with pericardial fenestration during CABG with CPB is associated with a reduced POAF incidence, good tolerability, and does not contribute to an increased incidence of infectious complications or impaired liver and renal function. Full article

Background: Spondylodiscitis is a growing infectious condition with significant morbidity. The impact of multifocal involvement remains understudied. This study compared 90-day all-cause readmission rates between patients with solitary versus multifocal spondylodiscitis and identified the associated risk factors. Methods: A retrospective analysis of the 2020 Nationwide Readmissions Database was conducted. Adult patients with primary spondylodiscitis were identified using ICD-10 codes and categorized into solitary or multifocal involvement groups. Demographic, clinical, and surgical data were extracted. Descriptive statistics and multivariate logistic regression were performed. Results: Of 6132 patients, 585 (9.6%) had multifocal disease. Multifocal patients were slightly younger (58.9 vs. 60.3 years; p = 0.049); had longer hospital stays (14.7 vs. 11.4 days; p < 0.001), time to readmission (p < 0.001); and surgery was more common (p = 0.003). Ninety-day readmission rates were similar (35.6% vs. 34.9%; p = 0.766). Type 2 diabetes was the only comorbidity significantly associated with multifocal disease (p = 0.020) and independently predicted readmission (aOR 1.236). Surgery and longer length of stay were protective (aOR 0.743; 0.0990). Conclusions: Multifocal spondylodiscitis is relatively common but not an independent risk factor for readmission. Readmission rates of both cohorts were similar. Surgery and prolonged hospitalization may reduce readmission risk. Full article

Background and Objectives: Romania has experienced the highest measles incidence rate in the European Union since late 2023, driven by suboptimal measles–mumps–rubella (MMR) uptake. Contemporary data on bedside predictors of clinical deterioration are scarce. The objective was to characterise demographic, clinical and laboratory differences between severe and non-severe measles and derive a multivariable model for intensive-care-unit (ICU) admission. Methods: We undertook a retrospective cohort study at the “Victor Babeș” University Hospital for Infectious Diseases, Timișoara. All admissions from 1 November 2023 to 15 May 2025 with serological or RT-PCR confirmation and a complete baseline laboratory panel were included. Descriptive statistics compared ward-managed versus ICU-managed patients; independent predictors of ICU transfer were identified through logistic regression that incorporated age, vaccination status, leukocyte count, C-reactive protein (CRP) and interleukin-6 (IL-6). Results: Among 455 patients (median age 3.0 y, interquartile range [IQR] 1.0–7.0), 17 (3.7%) required ICU care. Vaccine coverage was 18.0% overall and 0% among ICU cases. Compared with ward peers, ICU patients exhibited higher leukocyte counts (8.1 × 10⁹ L vs. 6.0 × 10⁹ L; p = 0.003) and a near-five-fold elevation in IL-6 (18 pg mL vs. 4 pg mL; p < 0.001), while CRP, procalcitonin and fibrinogen were similar. ICU admission prolonged median length of stay from 5 days (IQR 4–7) to 8 days (5–12; p = 0.004). In multivariable modelling, IL-6 remained the sole independent predictor (odds ratio [OR] 1.07 per pg mL; 95% confidence interval [CI] 1.03–1.12; p = 0.001); the model’s AUC was 0.83, indicating good discrimination. Complete separation precluded reliable estimation of the protective effect of vaccination, but no vaccinated child required ICU care. Conclusions: A simple admission panel centred on IL-6 accurately identified Romanian measles patients at risk of critical deterioration, whereas traditional markers such as CRP and leukocyte count added little incremental value. Even a single documented MMR dose was associated with the complete absence of ICU transfers, underscoring the urgent need for catch-up immunisation campaigns. Integrating IL-6-guided triage with intensified vaccination outreach could substantially reduce measles-related morbidity and health-system strain in low-coverage EU settings. Full article

Bluetongue is a vector-borne viral infectious disease primarily affecting ruminants, transmitted by biting midges of the Culicoides species. The first bluetongue virus 3 (BTV-3) cases occurred in Hesse, Germany, in July 2024. From December 2024 onwards, field veterinarians observed calves born with neurological symptoms. A convenience sample of affected calves were admitted to the Veterinary Teaching Hospital at Justus-Liebig-University Giessen, Germany. A total of 13 calves from unvaccinated dams with pronounced neurological symptoms and positive PCR results for BTV-3 were studied. General and neurological examinations were performed and a blood sample was obtained for hematologic, blood biochemical and blood gas analysis. In 11 calves, magnetic resonance imaging (MRI) was performed. Due to the severe neurological lesions, all calves were euthanized and postmortem examinations were performed. The neurological examination of the calves revealed neurological indications consistent with diffuse forebrain disease. MRI revealed that all calves exhibited various stages of cortical parenchyma cell loss and secondary enlargement of the lateral ventricles. Postmortem examination revealed moderate to severe hydrocephalus internus or hydranencephaly. The results of clinical and neurological examinations, MRI, and postmortem examination, indicate severe impairment of brain development presumably associated with transplacental BTV-3 infection. Epidemiologic data and health records from the originating farms suggest that neurologic malformations developed after BTV-3 infection between 95 and 227 of the gestation period. Full article

Workplace violence (WPV) against healthcare workers (HCWs) in infectious disease hospitals, particularly in high-risk settings, remains a critical yet understudied occupational hazard. A mixed-methods study was conducted at a Chinese infectious disease hospital, combining quantitative surveys (N = 675) and semi-structured interviews (28 HCWs, 17 patients/families). Logistic regression was used to analyze WPV incidence and predictors, while a thematic analysis of interview data identified contextual drivers. Psychological violence (34.1%) was significantly more prevalent than physical violence (2.2%), with outpatient departments (44.1%) and temporary staff (OR = 1.72) at the highest risk. Qualitative themes revealed systemic triggers, including communication breakdowns, environmental stressors, and organizational gaps in safety protocols and reporting. This study addressed a critical gap by incorporating the perspectives of HCWs and patients, revealing that WPV perceptions vary due to differing expectations and experiences. From these results, the CARE (Communication, Advocacy, Respect, Education) framework proposes actionable strategies: standardized SBAR communication protocols, enhanced security protocols in high-risk units, and mandatory anti-violence training. These findings underscore the need to strengthen the occupational health system to mitigate WPV and to improve healthcare quality. Full article

In this paper we aimed to compare seasonality, clinical characteristics, and outcomes of Influenza A and COVID-19 in the context of influenza reemergence and ongoing Omicron circulation. We performed a retrospective comparative analysis at the Teaching Hospital of Infectious Diseases in Cluj-Napoca, Romania. We included adult patients hospitalized with Influenza A or COVID-19 between 1 November 2022 and 31 March 2024. Data were collected on demographics, clinical presentation, complications, and in-hospital mortality. We included 899 COVID-19 and 423 Influenza A patients. The median age was 74 years for COVID-19 and 65 for Influenza A (p < 0.001). The age-adjusted Charlson comorbidity index was higher in COVID-19 patients (5 vs. 3, p < 0.001). Despite this age gap, acute respiratory failure was more common in Influenza A (62.8% vs. 55.7%, p = 0.014), but ventilation rates did not differ significantly. Multivariate models showed Influenza A was associated with increased risk of intensive-care unit (ICU) admission or ventilation, whereas older COVID-19 patients had higher in-hospital mortality (5.67% vs. 3.3%, p = 0.064). Omicron COVID-19 disproportionately affected older patients with comorbidities, contributing to higher in-hospital mortality. However, Influenza A remained a significant driver of respiratory failure and ICU admission, underscoring the importance of preventive measures in high-risk groups. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

This study presents an extended approach to compartmental modeling of infectious disease spread, focusing on regional heterogeneity within affected areas. Using classical SIS, SIR, and SEIR frameworks, we simulate the dynamics of COVID-19 across two major regions of Ukraine—Dnipropetrovsk and Kharkiv—during the period 2020–2024. The proposed mathematical model incorporates regionally distributed subpopulations and applies a system of differential equations solved using the classical fourth-order Runge–Kutta method. The simulations are validated against real-world epidemiological data from national and international sources. The SEIR model demonstrated superior performance, achieving maximum relative errors of 4.81% and 5.60% in the Kharkiv and Dnipropetrovsk regions, respectively, outperforming the SIS and SIR models. Despite limited mobility and social contact data, the regionally adapted models achieved acceptable accuracy for medium-term forecasting. This validates the practical applicability of extended compartmental models in public health planning, particularly in settings with constrained data availability. The results further support the use of these models for estimating critical epidemiological indicators such as infection peaks and hospital resource demands. The proposed framework offers a scalable and computationally efficient tool for regional epidemic forecasting, with potential applications to future outbreaks in geographically heterogeneous environments. Full article

Sepsis is a serious public health problem. sTREM-1 is a marker of inflammatory and infectious processes that has the potential to become a useful tool for predicting the evolution of sepsis. A prediction model for sepsis was constructed by combining sTREM-1, CRP, and a leukogram via a Bayesian network. A translational study carried out with 32 children with congenital heart disease who had undergone surgical correction at a public referral hospital in Northeast Brazil. In the postoperative period, the mean value of sTREM-1 was greater among patients diagnosed with sepsis than among those not diagnosed with sepsis (394.58 pg/mL versus 239.93 pg/mL, p < 0.001). Analysis of the ROC curve for sTREM-1 and sepsis revealed that the area under the curve was 0.761, with a 95% CI (0.587–0.935) and p = 0.013. With the Bayesian model, we found that a 100% probability of sepsis was related to postoperative blood concentrations of CRP above 71 mg/dL, a leukogram above 14,000 cells/μL, and sTREM-1 concentrations above the cutoff point (283.53 pg/mL). The proposed model using the Bayesian network approach with the combination of CRP, leukocyte count, and postoperative sTREM-1 showed promise for the diagnosis of sepsis. Full article

Background and Objectives: Euthyroid sick syndrome, or non-thyroidal illness syndrome, has been observed in severely ill patients and has been found to be an index of prognosis. It has been detected in patients with severe infectious diseases, e.g., those with severe COVID-19 infection. Prognostic indicators of the outcome of severe COVID-19 disease are important for the prognosis of individual as well as groups of patients. The aim of this study was to identify euthyroid sick syndrome in patients admitted for severe COVID-19 disease and its relationship to disease severity and outcome. Materials and Methods: In a cohort of patients admitted to hospital for severe COVID-19 disease, thyroid function in patients requiring hospitalization was evaluated by measuring TSH, FreeT₃ (FT₃), and FreeT₄ (FT₄) levels. Patients were classified into four groups: a group with uncompromised respiratory function (pO2 > 70 mmHg, without need of oxygen supplementation) (disease severity 1); a group with mild respiratory insufficiency (pO2 50–60 mmHg, in need of oxygen supplementation with nasal cannula) (disease severity 2); a group with severe respiratory insufficiency (pO2 < 50 mmHg, in need of oxygen supplementation with high flow oxygen) (disease severity 3); and a group with severe respiratory insufficiency requiring intubation (pO2 < 60 mmHg on high flow oxygen supplementation) (disease severity 4). Results: In this cohort, euthyroid sick syndrome was diagnosed in 57.1% of the patients. The presence of euthyroid sick syndrome was related to increased disease severity and adverse disease outcome, i.e., death. FT₃ levels were inversely related to CRP levels. Conclusions: Euthyroid sick syndrome may be observed in severe COVID-19 disease and is related to increased disease severity and adverse outcomes. Measurement of thyroid hormones in patients hospitalized for severe COVID-19 infection may aid in the prognosis of the disease. Full article