Search Results (208)

Global cancer incidence reached 20 million new cases across 185 countries in 2022, with approximately 10 million cancer-related deaths annually. Among adults with solid tumors and hematological malignancies, infections are a major contributor to morbidity and mortality, with respiratory infections playing a particularly significant role. These infections not only reduce life expectancy but can also delay cancer therapy, negatively affect treatment outcomes, and increase healthcare costs. In recent years, the burden of respiratory infections in this population has been driven by influenza virus, SARS-CoV-2, respiratory syncytial virus, Streptococcus pneumoniae, and Bordetella pertussis. Effective vaccines are available for all these pathogens and are recommended for adults with cancer, yet vaccination uptake remains suboptimal despite their heightened vulnerability. This review provides practical guidance for healthcare professionals on vaccinating adults with cancer against respiratory infections, summarizing key information to help clinicians address vaccination-related complacency, confidence, and convenience. Evidence from studies in both the general population and cancer patients consistently shows that vaccination benefits outweigh potential risks, with adverse event rates comparable to those seen in individuals without cancer. Early vaccination is encouraged, as there is limited justification for delaying immunization even when immune responses may be reduced. Vaccine dosing aligns with recommendations for the general population, with important exceptions. Live attenuated vaccines should be avoided because of the risk of replication and disease in immunocompromised patients, and selected groups may require booster doses to achieve adequate protection. Notably, cancer immunotherapy does not appear to impair vaccine-induced immune responses. Full article

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in the elderly. While pneumococcal vaccination is a core preventive measure, it remains unclear whether its association with severe CAP is uniform across all elderly subgroups. Our study aimed to evaluate the overall association of pneumococcal vaccination with the risk of severe CAP in hospitalized patients aged ≥ 65 years and to explore potential heterogeneity in this association using a causal forest model. Methods: We conducted a retrospective cohort study of patients discharged between January 2023 and June 2025, aged ≥ 65 years, with a primary diagnosis of CAP. We used multivariable logistic regression to estimate the average association and a causal forest model to explore heterogeneous patterns in the conditional average treatment effect (CATE). Results: Among 1906 included patients (severe CAP: 924; non-severe CAP: 982), PPSV23 vaccination was independently associated with reduced odds of all-cause severe CAP (adjusted OR = 0.610, 95% CI: 0.401–0.930). The causal forest model yielded an average treatment effect (ATE) estimate of −0.112 (95% CI: −0.200 to −0.023), corresponding to an 11.2 percentage-point reduction in absolute risk. Exploratory analysis suggested potential heterogeneity: the association appeared most pronounced in patients aged 65–74 years (CATE = −0.122) and showed an attenuating trend in older groups. Age was the primary variable associated with heterogeneity, followed by hypertension, SARS-CoV-2 infection, and sex. Conclusions: In this observational cohort study, PPSV23 vaccination was associated with a reduced risk of severe CAP in elderly inpatients under strong assumptions of no unmeasured confounding. Exploratory analyses suggested potential heterogeneity in this association, which appeared to attenuate with advancing age and may be influenced by comorbidities. These hypothesis-generating findings indicate that further investigation is needed to determine whether prevention strategies should be tailored for the very old and those with specific chronic conditions. Full article

Background: Children with congenital heart disease (CHD) are at substantially increased risk for respiratory infections, which occur more frequently and with greater severity than in healthy peers. This heightened vulnerability stems from multifactorial immune impairment, including defects in innate and adaptive immunity, chronic inflammation related to abnormal hemodynamics and hypoxia, reduced thymic function, and genetic syndromes affecting both cardiac and immune development. Viral pathogens—particularly respiratory syncytial virus (RSV), influenza viruses, and SARS-CoV-2—account for most infections, although bacterial pathogens remain relevant, especially in postoperative settings. Methods: This narrative review summarizes current evidence on infection susceptibility in children with CHD, the epidemiology and clinical relevance of major respiratory pathogens, and the effectiveness of available preventive measures. Literature evaluating immunological mechanisms, infection burden, vaccine effectiveness, and passive immunization strategies was examined, along with existing national and international immunization guidelines. Results: Children with CHD consistently exhibit higher rates of hospitalization, intensive care unit admission, mechanical ventilation, and mortality following respiratory infections. RSV, influenza, and SARS-CoV-2 infections are particularly severe in this population, while bacterial infections, though less common, contribute substantially to postoperative morbidity. Preventive options—including routine childhood vaccines, pneumococcal and Haemophilus influenzae type b vaccines, influenza vaccines, COVID-19 mRNA vaccines, and RSV monoclonal antibodies—demonstrate strong protective effects. New long-acting RSV monoclonal antibodies and maternal vaccination markedly enhance prevention in early infancy. However, vaccine coverage remains insufficient due to parental hesitancy, provider uncertainty, delayed immunization, and limited CHD-specific evidence. Conclusions: Respiratory infections pose a significant and preventable health burden in children with CHD. Enhancing the use of both active and passive immunization is essential to reduce morbidity and mortality. Strengthening evidence-based guidelines, improving coordination between specialists and primary care providers, integrating immunization checks into routine CHD management, and providing clear, condition-specific counseling to families can substantially improve vaccine uptake and clinical outcomes in this vulnerable population. Full article

Background: Despite pre-transplantation vaccination against invasive pneumococcal disease (IPD) and hepatitis B virus (HBV), most solid organ transplant (SOT) recipients are without post-transplantation seroprotection against IPD and HBV. We aimed to determine the seroprotection rates and changes in antibody concentrations after booster vaccination against IPD and HBV in SOT recipients without post-transplantation seroprotection after pre-transplantation vaccination. Furthermore, we aimed to identify risk factors associated with non-response to booster vaccination. Methods: In this prospective cohort study, we included adult SOT recipients without post-transplantation seroprotection against IPD who then received the 23-valent pneumococcal polysaccharide vaccine (PPSV23) booster, as well as adult SOT recipients without seroprotection against HBV who then received the Engerix-B^® booster after pre-transplantation vaccination. Logistic regression models were used to analyze risk factors for non-response to booster vaccination. Results: We included 50 SOT recipients in analyses of booster vaccination against IPD and 52 SOT recipients in analyses of booster vaccination against HBV. Seroprotection rates were 52% after booster vaccination against IPD and 7.7% after booster vaccination against HBV. The median geometric mean concentration of pneumococcal antibodies increased from 0.54 µg/mL IgG (interquartile range, IQR: 0.35–0.77) to 1.21 µg/mL IgG (IQR: 0.87–1.62) after booster vaccination (p < 0.001). Having pre-transplantation seroprotection against IPD at time of listing was associated with lower odds of non-response to booster vaccination. We were not able to identify risk factors for non-response to HBV booster vaccination. Conclusions: Booster vaccination improved seroprotection against IPD, but not HBV. Further studies are needed to examine optimal vaccination strategies for SOT recipients. Full article

Background:Streptococcus pneumoniae is a well-known pathogen responsible for respiratory and invasive diseases; however, central nervous system (CNS) involvement in the form of bacterial myelitis is exceedingly rare, particularly in immunocompetent adults. Moreover, the association between pneumococcal infections and reactive arthritis is scarcely documented. We report an unusual case of pneumococcal myelitis complicated by reactive arthritis in an elderly patient with no evident immunosuppression. Case Presentation: A 68-year-old man with a medical history of hypertension, benign prostatic hyperplasia, multiple disc herniations, and a resected pancreatic neuroendocrine tumour presented to the emergency department with acute urinary retention and fever (38.5 °C). The neurological examination revealed lower limb weakness and decreased deep tendon reflexes. Spinal magnetic resonance demonstrated T2 hyperintense lesions suggestive of longitudinally transverse myelitis. Cerebrospinal fluid (CSF) analysis showed pleocytosis with elevated protein levels; the polymerase chain reaction (PCR) test resulted positive result for Streptococcus pneumoniae. The patient received intravenous antimicrobial and corticosteroid therapy with partial neurological improvement. Within days, he developed acute monoarthritis of the right ankle. Joint aspiration revealed sterile inflammatory fluid, negative for crystals and cultures, supporting a diagnosis of reactive arthritis. The articular symptoms resolved with the use of prednisone. An extensive immunological work-up was negative, and no other infectious or autoimmune triggers were identified. The patient underwent a structured rehabilitation program with gradual improvement in motor function over the following weeks. Conclusions: This case illustrates a rare clinical scenario of pneumococcal myelitis associated with reactive arthritis in a patient without overt immunosuppression. It highlights the importance of considering bacterial aetiologies in cases of acute transverse myelitis and the potential for unusual systemic immune responses such as reactive arthritis. Early recognition and the administration of appropriate antimicrobial and supportive therapies are crucial for improving neurological and systemic outcomes. To our knowledge, this is one of the first reported cases describing the co-occurrence of these two conditions in the context of S. pneumoniae infection. Full article

Background: Patients with autoimmune rheumatic diseases (ARDs) such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are at increased risk of infections due to immune dysregulation and immunosuppressive therapy. Vaccination is a cornerstone of infection prevention, but uptake is still inadequate. Methods: We conducted an observational, multicenter study at four Italian rheumatology centers. Adult patients with RA or SLE on immunosuppressive therapy completed a standardized questionnaire assessing demographics, disease activity, treatments, vaccination status for influenza, pneumococcus, varicella-zoster virus [VZV], hepatitis B virus [HBV], human papillomavirus [HPV], adverse events, and reasons for or against vaccination. Results: A total of 325 patients were included (226 RA, 99 SLE; median age 60 years; 84.6% females). Overall vaccine coverage was 68.0%, with influenza being the most frequent (54.2%), followed by pneumococcal (30.8%), HBV (21.2%), VZV (12.9%) and HPV (5.9%). RA patients showed higher influenza and pneumococcal uptake, while HBV vaccine was more common in SLE. Education was associated with higher pneumococcal and HBV coverage in both groups. Major adverse events and disease flares were rare. Physician recommendation was the main motivator, with rheumatologists driving VZV uptake and general practitioners influencing influenza and HBV. Among unvaccinated patients, the leading barrier was not being offered vaccination (42.5%), followed by concerns about efficacy/safety (18.3%) and lack of awareness (15.7%). Cluster analysis identified three subgroups: “Not offered” (largest), “Unaware,” and “Skeptical,” with age distribution differing across clusters. Conclusions: Vaccination coverage among Italian ARD patients remains insufficient. Physician recommendation is pivotal, while lack of physician offer and awareness are major barriers. Targeted educational strategies and proactive physician involvement are needed to improve vaccine uptake in this high-risk population. Full article

Respiratory infections are a leading cause of sickness and death in Australia. In Australia, there is a funded immunisation program for both adults and children aimed at preventing and controlling vaccine-preventable respiratory infections (VPRI), such as pneumococcal disease (PD), influenza A/B, respiratory syncytial virus (RSV) infection, and COVID-19. This narrative review outlines the current Australian adult and paediatric immunisation guidance for VPRIs. It also examines the literature that supports the current risk group recommendations, including the clinical and economic burden of VPRIs, vaccination effectiveness, and coverage. Gaps in current risk group definitions, as well as additional risk groups that could be included in vaccine recommendations, are also discussed. Further research is needed to determine the optimum age for vaccination in adults which may enable alignment of age recommendations across different VPRIs. Individuals with multiple risk factors, commonly referred to as risk stacking, are at a greater risk of developing severe disease for VPRIs. This emphasises the importance of vaccinating these individuals. More research is needed to evaluate the effectiveness of vaccines in older adults and to create more effective vaccines for high-risk paediatric groups, such as those with compromised immunity or for children who have undergone haematopoietic stem cell transplantation. Full article

Background: Pediatric SARS-CoV-2 infection is usually mild, but in rare cases may lead to severe complications. Early recognition and comprehensive management are critical for favorable outcomes. Case Presentation: We present the case of a 2-year-old girl, previously healthy and unvaccinated against Streptococcus Pneumoniae (S. pneumoniae), who developed SARS-CoV-2 infection and acute otitis media. Initial laboratory evaluation revealed leukocytosis with neutrophilia and increased inflammatory markers. Antiviral and antibiotic treatment was initiated, but she remained febrile, polypneic, and tachycardic. The diagnosis of MIS-C was excluded; there was no involvement of two organs, and infection with S. pneumoniae serotype 19 F was identified. Given the unfavorable evolution, corticosteroid therapy and immunoglobulin were instituted, and subsequently, following the antibiogram result, antibiotic therapy was escalated to Meropenem and Linezolid. Clinical and laboratory parameters improved, but pericarditis with a small fluid slide and ECG changes were associated. The evolution was favorable with complete cardiac recovery at 30 days. Conclusion: This case highlights the importance of vigilant assessment for secondary bacterial infections and cardiac complications in pediatric COVID-19. Prompt recognition and targeted treatment are essential, and pneumococcal vaccination remains a fundamental preventive measure. Moreover, the scarcity of literature documenting SARS-CoV-2 infections complicated by pericarditis further underscores the uniqueness of this case and its relevance for specialists in the field. Full article

Background/Objectives: Streptococcus pneumoniae is a major human pathogen causing illnesses that range from mild respiratory infections to severe invasive diseases. More than 100 known S. pneumoniae serotypes differ in their virulence, prevalence, and levels of drug resistance. Additionally, different clonal types within the same serotype may exhibit varying disease potential and genetic characteristics. This study aimed to determine phenotypic and molecular characteristics of S. pneumoniae isolated from patients with invasive pneumococcal disease (IPD). Methods: The serotypes of invasive S. pneumoniae isolates collected between 2022 and 2025 from adult patients hospitalized in a tertiary hospital were determined. Multilocus sequence typing (MLST) was performed on isolates with reduced susceptibility to penicillin to assess their molecular epidemiology. Results: Serotype 3 was the most common among all invasive isolates (29/85; 34.1%), followed by serotype 19A (22/85; 25.9%). Most penicillin-resistant isolates belonged to serotypes 19A and 19F. Three of the eight 19A isolates with reduced penicillin susceptibility were assigned to ST320 (37.5%), a clinically significant clone due to its high virulence and antibiotic resistance. While 15.3% of all isolates were multidrug-resistant (MDR), nearly half of the isolates with reduced penicillin susceptibility were MDR, most frequently exhibiting the erythromycin–clindamycin–tetracycline resistotype. Conclusions: This study highlights the predominance of serotype 19A, particularly the highly virulent and resistant ST320 clone, among invasive isolates with reduced penicillin susceptibility. These findings underscore the ongoing threat of antimicrobial resistance in IPD and the importance of continued surveillance of serotype distribution and resistance patterns to guide treatment strategies and vaccination policy decisions. Full article

Background/Objectives: Patients with rheumatic diseases have an increased burden of infection owing to biological disease-modifying antirheumatic drug (bDMARD) therapy. Therefore, vaccination is crucial for the prevention of infection in these patients. In this case–control study, we aimed to evaluate vaccine response to hepatitis B, pneumococcus, and measles using antibody titers in patients undergoing biological therapy. Methods: This study included 16 patients aged 5–18 years of age who received bDMARD treatment and 20 healthy controls. Serum samples of the patients were collected at baseline and subsequently on the 3rd and 6th months after bDMARD therapy, and IgG antibodies against pneumococcal capsular polysaccharide antigen (PCP), measles, and hepatitis B were measured. Results: There were no statistically significant differences in mean anti-HBsAg, anti-PCP, and anti-measles antibody titers between the study and control groups. The percentages of patients with anti-HbsAg, anti-PCP, and anti-measles protective antibodies were 68.8% (n = 11/16), 100% (n = 16/16), and 56.25% (n = 9/16), respectively. There were no statistically significant differences in the mean antibody titers at baseline and 3rd month. Only the anti-measles IgG titer level decreased below 200 (mIU/mL) in one patient in the 3rd month and in two patients in the 6th month. Conclusions: Patients with low or declining hepatitis B and measles antibody titers before or during bDMARD treatment may require close monitoring to ensure adequate protection against vaccine-preventable diseases. Regular screening and follow-up are essential in this patient population. Full article

Streptococcus pneumoniae is a major opportunistic pathogen and a leading cause of severe infections in infants under two years of age. Human milk oligosaccharides (HMOs), key bioactive components of breast milk, possess immunomodulatory and antimicrobial properties. In this study, the antipneumococcal effects of HMOs are investigated across multiple S. pneumoniae serotypes, focusing on concentration-dependent activity and underlying mechanisms. Growth inhibition and bacterial viability were evaluated using growth curve analysis and colony-forming unit (CFU) assays. HMOs inhibited pneumococcal growth in a concentration-dependent manner, with suppression observed at 1.5–2.5 mg/mL and complete killing at 5 mg/mL for all serotypes. Nonencapsulated strains were more sensitive, with inhibition at 1 mg/mL. In the CFU assays, killing occurred at 1.25–5 mg/mL depending on the strain. At physiologically relevant colostrum concentrations (20–25 mg/mL), HMOs achieved complete bactericidal effects across all the tested strains. In contrast, lactose at equivalent doses showed no measurable antimicrobial activity, confirming the specificity of the observed effects. Overall, HMOs exhibit serotype-independent antipneumococcal activity, possibly through interference with bacterial adhesion or metabolic disruption. These findings suggest a potential role for HMOs as adjunctive agents in the prevention of pneumococcal infections in vulnerable populations, such as infants, and warrant further in vivo studies to validate these effects and explore clinical applications. Full article

During infection, myeloid cells are subjected to a fast increase in energy demand. Glucose transporter 1 (GLUT1) is a key mediator of glucose metabolism, especially for glycolysis. The present study aimed to investigate GLUT1 expression in monocytes and neutrophils from patients with community-acquired pneumonia (CAP) and to determine the functional role of GLUT1 in the responsiveness during pneumonia evoked in mice by Streptococcus (S.) pneumoniae, the most common causative pathogen in CAP. GLUT1 expression in monocytes and neutrophils of patients and controls was determined by RNA sequencing and flow cytometry analysis. Myeloid cell-specific GLUT1-deficient mice and controls were intranasally infected with S. pneumoniae, after which bacterial loads, lung pathology, and cytokine levels were analyzed. GLUT1 gene expression was upregulated in monocytes from CAP patients in comparison to matched subjects without infection, and protein expression was increased upon ex vivo activation. In neutrophils, GLUT1 mRNA levels were significantly upregulated in CAP patients, but protein levels were not altered. Surprisingly, myeloid-specific GLUT1-deficient mice displayed an unaltered host response during pneumococcal pneumonia. These data suggest that GLUT1 may contribute to immune responses of myeloid cells during CAP, but that its role may be superseded by other mechanisms during pneumococcal pneumonia. Full article

Pneumococcal meningoencephalitis is a severe infection associated with high morbidity and mortality. Although typically community-acquired, postoperative cases following elective ENT surgery are exceedingly rare. Antimicrobial resistance (AMR) among Streptococcus pneumoniae further complicates management, and missed opportunities for vaccination represent preventable risks. We report a case of a 41-year-old man with multiple comorbidities who developed fulminant S. pneumoniae meningitis 48 h after septoturbinoplasty. The clinical course was atypical, with altered consciousness but no classical meningeal signs, necessitating urgent intubation and intensive care admission. Cerebrospinal fluid cultures identified an MDR pneumococcal strain resistant to penicillin and macrolides but susceptible to vancomycin and meropenem. Empirical therapy with vancomycin and meropenem, combined with adjunctive corticosteroids and multidisciplinary ICU care, led to complete neurological recovery. This case highlights a rare but life-threatening postoperative complication and underscores two critical lessons. First, the growing challenge of multidrug-resistant pneumococcus requires timely recognition, aggressive empiric therapy, and access to effective agents. Second, the absence of pneumococcal vaccination in this high-risk surgical patient illustrates a preventable gap in care. Integrating vaccination screening into preoperative evaluations may reduce the risk of catastrophic postoperative CNS infections. Full article

Healthcare professionals (HCPs) working in paediatric settings are routinely exposed to respiratory pathogens, increasing their risk of asymptomatic colonisation by meningitis-associated bacteria. This study is the first to assess oropharyngeal and nasopharyngeal carriage of major bacterial meningitis pathogens among paediatric HCPs in Benin, and to identify associated risk factors. A cross-sectional analytical study was conducted in nine hospitals between 1 September 2023 and 30 September 2024. Data collection involved a structured questionnaire and paired oropharyngeal and nasopharyngeal swabs. Culture-based identification and antimicrobial susceptibility testing were performed according to CA-SFM guidelines. By culture method, Streptococcus pneumoniae was the most frequently isolated pathogen, mainly from oropharyngeal samples (47.5%). Most of these strains exhibited multidrug resistance. In nasopharyngeal samples analysed by real-time PCR, detection rates for S. pneumoniae were markedly higher (24.4%) compared to culture (5.0%), highlighting the limited sensitivity of conventional methods in detecting asymptomatic carriage. Pneumococcal colonisation was significantly associated with recent respiratory tract infections, and residence in high-risk areas (p < 0.05). These findings underscore the need for enhanced molecular surveillance, along with strengthened infection control measures and targeted vaccination strategies, to mitigate the risk of horizontal transmission in paediatric wards. Full article

Elite athletes are at an increased risk of infections due to behavioral and social factors and frequent travel. Furthermore, heavy physical exercise may induce immunosuppression. Most infections in athletes are acute respiratory illnesses (ARIs) with various viral etiologies. Although athletes, as young, healthy adults, are not at risk for severe infections, a prolonged ARI may ruin a training season or a significant competition or may spread within a sports team. Many common infections are vaccine-preventable. This Opinion advocates for more active vaccination among athletes, although some of the vaccines are not officially recommended for young adults. New respiratory syncytial virus (RSV) protein vaccines are effective and well-tolerated. Yearly influenza and COVID-19 vaccinations are strongly recommended. Conjugated polyvalent pneumococcal vaccines are recommended because they may also induce protection against respiratory viral infections. Pertussis and measles outbreaks are occurring globally. The history of measles vaccination should be reviewed, and consideration should be given to a pertussis booster vaccination (Tdap). A recombinant vaccine can effectively prevent herpes zoster. The vaccination of elite athletes is a cost-effective and powerful tool, but it is currently underused. The sports medicine community can address vaccine hesitancy among athletes by listening to their concerns and giving accurate information. Full article