Search Results (9,161)

Background: The COVID-19 pandemic substantially altered the epidemiology of respiratory infections. Its impact on the clinical course of influenza in hospitalised children remains insufficiently characterised. Objectives: We aimed to compare the clinical course, complications, and selected laboratory parameters of influenza in children before, during, and after the COVID-19 pandemic. Methods: This single-centre retrospective study included 553 children hospitalised with laboratory-confirmed influenza between September 2017 and August 2025. Patients were divided into three groups: pre-pandemic, pandemic, and post-pandemic. Clinical complications and inflammatory markers (CRP, PCT, neutrophil counts) were analysed. Results: Influenza-related complications occurred in 59.5% of patients and were significantly more frequent after the pandemic compared to the pre-pandemic period (64.3% vs. 52.9%, p = 0.02). Pneumonia was the most common complication across all groups, but its incidence was lowest during the pandemic. Myositis occurred most frequently during the pandemic and appears to coincide with a higher proportion of influenza B infections. No significant differences were observed in CRP, PCT concentrations, or neutropenia rates between groups. Conclusions: The COVID-19 pandemic influenced the clinical presentation of influenza in children, with a post-pandemic increase in complications. These findings may reflect delayed access to healthcare and the phenomenon of immunity debt, highlighting the need for continued surveillance and preventive strategies. Full article

Biofilm formation by non-C. albicans Candida (NAC) species is a major factor in device-associated infections, yet few studies have examined their development under physiologically relevant conditions. This study evaluated the biofilm-forming capacity of Candida tropicalis, Candida parapsilosis sensu stricto and Candida albicans on stainless steel surfaces in the presence of artificial saliva, simulating the respiratory tract environment of tracheostomized patients. Standardized inocula were incubated for 24 h, and biofilms were assessed through quantification of viable cells, biomass, biofilm matrix production and structural characterization by scanning electron microscopy (SEM). C. tropicalis produced the most robust biofilms compared to C. albicans and C. parapsilosis stricto sensu isolates, with significantly higher biomass and biofilm matrix (p < 0.001). C. parapsilosis sensu stricto developed less dense yet structurally defined biofilm networks. SEM confirmed mature and compact biofilm architecture, especially in C. tropicalis. These results demonstrate the strong intrinsic biofilm-forming ability of NAC species on stainless steel under host-like conditions, reinforcing their capacity to persist on medical surfaces and their relevance as independent contributors to biofilm-related contamination and infection. Full article

Bacteriophage (phage) therapy, including monophage preparations, phage cocktails, engineered phages, and phage-derived enzymes, has re-emerged as a potential option for difficult-to-treat and biofilm-associated infections in the context of rising antimicrobial resistance. Recent scientific and regulatory developments, such as the 2024 World Health Organization Bacterial Priority Pathogens List and the introduction of the European Pharmacopoeia general chapter 5.31 on phage therapy medicinal products, highlight the growing interest in establishing quality, safety, and governance standards for clinical implementation. This narrative review provides an overview of current clinical applications of phage therapy, drawing on published case reports, case series, early-phase clinical studies, and regulatory experiences across different healthcare settings. Clinical use has been reported in respiratory, urinary tract, musculoskeletal, cardiovascular, and device-associated infections, particularly in cases involving multidrug-resistant pathogens, often in combination with antibiotics. At the same time, the biological characteristics of phages, such as strain specificity, adaptive composition of phage cocktails, and the need for individualized formulations, pose significant regulatory and translational challenges. Access to phage therapy currently relies on heterogeneous regulatory mechanisms, including compassionate use programmes, magistral preparations, named-patient pathways, and other national frameworks. Overall, phage therapy represents a promising strategy for selected infections, but its broader clinical adoption will depend on harmonized regulatory approaches, robust quality standards, and the generation of stronger clinical evidence to support safe and scalable use. Full article

Astroviruses are non-enveloped, positive-sense single-stranded RNA viruses known to infect various mammals and birds, including humans, often causing gastrointestinal disorders. In recent years, astroviruses have also been linked to neurological and respiratory diseases across several species, including ruminants, mink, deer, and other mammals. Notably, astrovirus infections in goats have been documented in countries such as Switzerland and China, where novel genotypes have been identified in fecal samples. However, their role in the context of disease remains unclear, and reports focusing solely on goat astrovirus in the United States have not been published. A necropsy case of a Boer goat kid with a history of diarrhea was submitted for investigation following death in January 2025. Fresh tissues were received and used for histopathology and enteric pathogen testing, including parasitic, bacterial, and viral workups. Metagenomic-based next-generation sequencing (mNGS) was also applied for this case. Histological examination revealed severe necrotizing enterocolitis. The small intestine exhibited epithelial ulcerations, villus atrophy, hyperplastic and dilated crypts with necrotic debris, few intraenterocytic coccidian parasites, and increased inflammatory cells in the lamina propria. The large intestine showed similar findings with pleomorphic crypt enterocytes. Standard enteric pathogen tests were negative except for aerobic culture that identified Escherichia.coli and Enterococcus hirae. mNGS and bioinformatic analysis identified a novel astrovirus in the intestinal content that showed the highest nucleotide identity (86%) to the sheep strain Mamastrovirus 13 sheep/HA3 from China based on BLAST analysis. Phylogenetic analysis indicated that the newly identified caprine astrovirus IL90175 clustered with astrovirus strains from small ruminants in Asia and Europe. This research reports the discovery, histopathologic features, and genetic characteristics of a gastrointestinal disease-causing astrovirus in a goat kid, which had not been previously described in the United States. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study aimed to evaluate longitudinal changes in pulmonary function among patients with PCS, in relation to the severity of the acute COVID-19 episode and the time elapsed since infection. Methods: A retrospective, observational study was conducted at the Clinical Hospital of Pulmonary Diseases Iași, Romania, between January 2021 and December 2022, including 97 adult patients with confirmed PCS. Demographic, clinical, and functional data were collected from medical records. Pulmonary function tests (PFTs) were performed according to ATS/ERS standards, assessing Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV₁), FEV₁/FVC ratio (Tiffeneau Index), Maximal Expiratory Flow at 50% and 25% of FVC (MEF50, MEF25), Diffusing Capacity of the Lung for Carbon Monoxide (adjusted for haemoglobin) (DLCO), Carbon Monoxide Transfer Coefficient (KCO), Alveolar Volume (AV), Total Lung Capacity (TLC) and Residual Volume (RV). Patients were grouped by time elapsed since infection (1–3, 4–7, 9–12, and up to 22 months). Statistical analyses included the Mann–Whitney U test, Spearman’s correlation, ROC curve analysis, and Principal Component Analysis (PCA). Results: A progressive improvement in FVC was observed up to 9–18 months post-infection (p < 0.05), while FEV₁ remained stable, suggesting a predominantly restrictive ventilatory pattern. Patients with moderate acute COVID-19 presented significantly lower FVC%, FEV₁%, DLCO%, and KCO% values compared with those with mild disease (p < 0.05). Diffusion abnormalities (DLCO and KCO) persisted beyond 12 months, indicating lasting alveolar-capillary impairment. ROC analysis identified TLC (AUC = 0.857), AV (AUC = 0.855), and KCO (AUC = 0.805) as the most discriminative parameters for residual dysfunction. PCA revealed three major functional domains—airflow limitation, diffusion capacity, and lung volume—explaining up to 70% of total variance. Conclusions: We are facing the emergence of a new phenomenon, namely a secondary post-COVID-19 pandemic of patients confronting with persistent post-COVID-19 symptoms who present with functional respiratory changes and who require careful monitoring in dynamics, personalized treatments and a multidisciplinary approach. Full article

Background/Objectives: Post-COVID-19 condition (PCC) remains poorly characterized beyond two years, particularly among intensive care unit (ICU) survivors. We aimed to describe the prevalence, persistence, and late consequences of PCC up to 32 months after discharge in an ICU cohort. Methods: This single-center longitudinal cohort included 170 adults with confirmed SARS-CoV-2 infection admitted to an ICU in Cáceres (Spain) between March 2020 and March 2021. 94 survivors entered follow-up at discharge and 3, 6, 12, 18, 24, and 32 months. PCC manifestations were grouped into five organ system domains (respiratory, cardiovascular, renal, infectious, and musculoskeletal/neuromuscular) and recorded only when supported by clinician-confirmed diagnoses or diagnostic tests. Prevalence at each visit, persistence, and new onset of manifestations between 3 and 6 months, and the cumulative incidence of new chronic diseases between 18 and 32 months were estimated with 95% confidence intervals. Results: Any PCC manifestation was almost universal at discharge (96.8% [95% CI, 91.1–98.9]) and remained high at 12 months (85.2% [95% CI, 76.3–91.2]), declining to 48.6% at 24 months and 25.7% at 32 months. Respiratory manifestations predominated early and were largely resolved by 32 months, whereas musculoskeletal/neuromuscular involvement remained relatively stable. From 18 to 32 months, 36.5% (95% CI, 26.4–47.9) of survivors developed at least one chronic condition, most frequently cardiovascular disease (14.9% [95% CI, 8.5–24.7]). Conclusions: Long-term PCC manifestations and incident chronic diseases are common among ICU COVID-19 survivors, underscoring the need for prolonged follow-up and post-ICU care. Full article

Background/objectives: RSV is a major cause of mortality in infants, and despite recent progress to prevent RSV in the very young, an RSV vaccine for this population is still highly warranted. Clinical studies in infants in the 1960s using formalin-inactivated RSV (FI-RSV) led to life-threatening enhanced respiratory disease (ERD). Therefore, a thorough safety assessment of RSV vaccine candidates intended for RSV seronegative infants is crucial. Methods: Prior to clinical pediatric development of Ad26.RSV.preF, an adenovirus type 26 vector-encoding RSV F protein stabilized in its prefusion conformation, predisposition to ERD was extensively assessed in cotton rat and mouse models. Results: Cotton rats intramuscularly immunized with a wide dose range of Ad26.RSV.preF, including low and sub-protective vaccine doses, and challenged with vaccine homologous RSV A2 or heterologous RSV B Wash 18537, did not show signs of predisposition to ERD. Histopathology scores for alveolitis, peribronchiolitis, interstitial pneumonia, and perivasculitis after challenge were significantly lower for Ad26.RSV.preF-immunized cotton rats compared to FI-RSV-immunized cotton rats and comparable to or lower than scores in cotton rats intranasally pre-exposed to RSV prior to challenge to mimic natural repeated infection. These results were observed in animals with or without viral replication in the lung after RSV challenge, in the presence or absence of vaccine-induced antibodies. Similar results were observed in mice, where more extensive assessment of mono- and polymorphonuclear cell alveolitis, mucus cell hyperplasia, and mucus accumulation was performed. Conclusions: Based on these extensive analyses, we conclude that there are no indications of ERD predisposition after Ad26.RSV.preF vaccination in rodent models, irrespective of the vaccine dose, challenge virus strain, or presence of viral replication in the lung. These results are crucial for the pediatric development of this vaccine. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) remain frequent and increase morbidity, mortality, and resource use. Preoperative risk scores (ARISCAT, NSQIP-derived calculators) use mostly static variables and may miss the dynamic perioperative host response preceding respiratory deterioration or infection. We address the gap in clinically interpretable syntheses of perioperative blood biomarker trajectories that distinguish infectious from non-infectious PPCs and clarify bedside-ready versus exploratory markers. Methods: We conducted a narrative review with a structured Medline search (inception to 1 November 2025) plus reference screening. We included English-language adult surgical studies (observational or interventional) evaluating perioperative blood biomarkers in relation to PPCs or postoperative pulmonary infection; case reports, editorials, and reviews were excluded. No formal risk-of-bias assessment or quantitative meta-analysis was performed. Results: Across 298 cited publications, serial patterns of routinely available biomarkers (C-reactive protein, procalcitonin, lactate, albumin, and leukocyte-derived indices) were most consistently associated with PPC risk and helped separate expected postoperative inflammation from evolving infection when interpreted longitudinally rather than as single values. Mechanistic biomarkers (cytokines/immune-function assays, endothelial injury and coagulation/fibrinolysis markers, oxidative stress indicators) add biological insight but are limited by assay availability, heterogeneous sampling windows, and absent standardized cut-offs. Omics signatures and machine learning models combining biomarker kinetics with clinical variables are promising but require prospective, transportable validation. Conclusions: Key barriers to implementation include biological variability, non-specificity across postoperative syndromes, heterogeneous sampling windows, and lack of standardized cut-offs. Integrating multimarker panels into validated, dynamic predictive frameworks represents a promising direction for perioperative precision medicine. Full article

Background: Although the relationship between androgen deprivation therapy (ADT) for prostate cancer (PC) and the biological mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unequivocally unclear, it is possible that exposure to the virus may influence PC evolution by altering TMPRSS2 expression. This study aims to evaluate the long-term oncological outcomes of patients with metastatic PC who were undergoing medical therapy at the time of contracting SARS-CoV-2 and who resumed/continued anticancer treatment after recovery. Methods: We retrospectively evaluated a consecutive series of 151 metastatic PC patients who developed SARS-CoV-2 infection while receiving one active systemic anticancer therapy (125 metastatic castration-resistant PC (mCRPC) patients and 26 metastatic hormone-sensitive PC (mHSPC) patients). We evaluated variables that influence the ability to maintain or resume the ongoing therapy. For the maintained/resumed therapies, we calculated the post-infection overall survival (piOS) and the overall survival (OS). Results: Of the patients, 12.6% died due to SARS-CoV-2 infection, 10.6% recovered from the infection but failed to maintain/resume the ongoing anticancer treatment, and the remaining 76.8% maintained/resumed the treatment after recovery. Hospitalization, duration of infection, and the type of ongoing anticancer agent influenced these treatment changes. In the cohort of mCRPC patients, the median piOS was 32 months, and the median OS was 67.8 months. The median piOS was not achieved in the cohort of mHSPC patients, while the median OS was 122 months. The outcomes of single anticancer agents were in line with those of pivotal trials. Conclusions: Although observed in a highly selected population of PC patients who survived SARS-CoV-2 infection and were able to resume/maintain anticancer therapy, the survival outcomes of this study appear to be in line with those reported in pivotal studies, and SARS-CoV-2 infection does not seem to have adversely affected long-term oncological outcomes. Full article

This study aimed to develop an immersive virtual reality (VR) program and conduct preliminary evaluation of its feasibility and learner perception for enhancing nursing students’ clinical practicum education. The VR program was designed using the ADDIE model (analysis, design, development, implementation, and evaluation) and implemented on the UNITY 3D platform. Expert evaluation was conducted through a VR application, and its effectiveness was further assessed among 25 fourth-year nursing students in terms of immersion, presence, and satisfaction. The expert evaluation yielded a mean score of 6.54 out of 7, indicating acceptable content validity. Among learners, evaluation demonstrated immersion at 42.28 ± 2.37 out of 50 (95% CI: 41.30–43.26), presence at 81.36 ± 7.32 out of 95 (95% CI: 78.34–84.38), and satisfaction at 13.48 ± 1.26 out of 15 (95% CI: 12.96–14.00). Overall, the developed VR program demonstrated acceptable expert validity and positive learner perceptions. These preliminary findings suggest feasibility as a supplementary practicum. However, the single-group design without control comparison and reliance on self-reported measures preclude conclusions about educational effectiveness. Full article

Interferons (IFNs) are essential mediators of the innate immune response to viral infections. Among the type III IFNs, the role of IFN-λ4 in respiratory viral infections remains largely understudied. Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) are clinically significant pneumoviruses that elicit divergent IFN responses in epithelial cells. Here, we investigate the virus-specific induction and antiviral activity of IFN-λ4 by HMPV and RSV infections. We demonstrate that RSV induces a limited expression of IFN-λ4, which is regulated by the expression of the NS1 protein. Furthermore, RSV and HMPV rely primarily on RIG-I for IFN-λ4 induction. Finally, we show that IFN-λ4 exerts antiviral activity against both viruses, with RSV displaying greater sensitivity. These findings highlight the antiviral role of IFN-λ4 to clinically relevant respiratory viruses. Full article

Background/Objectives: Acute sinusitis (AS) is a common infection of the upper respiratory tract that places considerable clinical and economic burden worldwide. Although frequently encountered in practice, the factors that predispose individuals to AS remain poorly understood. This study examined how different respiratory disorders and comorbidities influence the likelihood of developing AS, aiming to clarify its underlying risk profile. Methods: A longitudinal analysis was performed using electronic health records from the Clinical Center of the University of Debrecen Hospital. The study cohort (2007–2022) encompassed 37,164 observations. To evaluate the risk of AS progression, Log-Rank tests and Cox proportional hazards regressions were applied whilst adjusting for covariates. Results: The risk of developing AS was significantly higher among individuals with preceding respiratory conditions. Patients with common cold demonstrated a 2.3-fold increased risk of developing AS (95% CI [1.51–3.40]). Compared to those without such disorders, participants with acute bronchitis had a 2.5-fold higher hazard of AS (95% CI 1.90–3.26). The strongest association was observed for allergic rhinitis (HR = 4.04, 95% CI 3.18–5.13), followed by chronic sinusitis (HR = 3.10, 95% CI 2.13–4.51). Chronic obstructive pulmonary disease was also identified as a significant predictor for AS (HR = 1.62, 95% CI 1.04–2.52), whereas dental pathologies were associated with a modest protective effect (HR = 0.69, 95% CI 0.48–0.97). Conclusions: Patients with allergic rhinitis, chronic sinusitis, acute bronchitis, common cold, or chronic obstructive pulmonary disease have a markedly higher risk of developing AS. Clinicians should actively screen for these conditions when assessing patients with recurrent or severe sinus infections. Early recognition and management of underlying respiratory disorders may reduce AS episodes, promote symptom control, and lessen healthcare burdens. Future research should concentrate on precision medicine to leverage AS preventive and management strategies. Full article

Background: Nirsevimab, a monoclonal antibody for respiratory syncytial virus (RSV), reduces medically attended RSV infections. It was introduced in the 2023–24 RSV season. This study examined the association between caregiver vaccination (seasonal influenza vaccine (SIV), COVID-19, and boosters) and intent to immunize infants against RSV. Methods: Data from 118 caregivers with infants ≤ 8 months were analyzed. Chi-squared tests and logistic regression assessed the relationship between caregiver vaccination and intent to immunize against RSV. Results: In total, 74.6% of caregivers intended to immunize their infants against RSV. Intent was positively associated with caregiver receipt of a seasonal influenza vaccine (p < 0.001), COVID-19 vaccine (p < 0.001), and COVID-19 booster (p < 0.001). Intent was also associated with older child seasonal vaccination. Caregiver receipt of both COVID-19 vaccinations and boosters had a strong relationship with RSV immunization intent (OR 7.91 (1.90–33.0, p = 0.004)). Conclusions: Caregiver vaccination behaviors are linked to RSV immunization intent, helping physicians identify hesitant families and prepare for immunization conversations. Full article

Mycoplasma ovipneumoniae poses a major threat to sheep respiratory health, contributing to significant economic losses in farming communities. In this study, we isolated a novel strain, IM-DMQ, from a Hu sheep in Inner Mongolia that exhibited pulmonary adenomatous-like lesions, which is an uncommon pathological manifestation for this pathogen. The complete genome was sequenced using a hybrid Nanopore and Illumina approach, revealing a 1,039,804 bp circular chromosome with a GC content of 29.15%, encoding 1529 genes. Functional annotation highlighted genes involved in essential metabolic processes and potential virulence mechanisms. Comparative genomic analysis demonstrated that IM-DMQ shares the closest ancestry (ANI: 98.3%) with the Chinese strain NXNK2203, while structural variations and 14 unique genes distinguished it from other global strains. Furthermore, microbial community profiling of the original lung tissue revealed a co-infection background involving multiple bacterial pathogens, offering an etiological context for the severe disease presentation. These results provide the first complete genomic resource for an M. ovipneumoniae strain from Inner Mongolia associated with unusual pulmonary pathology, offering insights into its genetic diversity and supporting the future development of targeted diagnostics and vaccines for regional disease control. Full article

Background/Objectives: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to pose a significant global health challenge due to its high transmissibility and potential for severe clinical outcomes. Early identification of patients at risk of hospitalization is essential for effective triage in emergency departments and for the optimal allocation of healthcare resources. Methods: This prospective study included 84 patients aged over 18 years who presented to the emergency department on 23 December 2020, with suspected SARS-CoV-2 infection. Initially, 100 patients were evaluated, and 16 were excluded based on predefined exclusion criteria. The mean age of the participants was 53.65 ± 13.62 years, and 39 (46.4%) were women. Results: At admission, the mean signal peptide, CUB domain, EGF (SCUBE-1) level among SARS-CoV-2 patients was 0.16 ± 0.08 ng/mL. There was no significant difference in SCUBE-1 levels between patient and control groups (n = 59 vs. 25), but levels differed significantly between hospitalized and home-treated patients (n = 37 vs. 22; p = 0.001). Neutrophil count (p = 0.001) and NLR (p = 0.010) were higher in patients than controls and also higher in hospitalized than home-treated patients (p = 0.003 and p = 0.015). ROC analysis revealed that SCUBE-1 predicted hospitalization with 84.6% sensitivity and 88.9% specificity. A positive correlation was observed between SCUBE-1 levels and length of hospital stay (p = 0.007, r = 0.554), with a median stay of 9.0 (5.0–11.0) days. Conclusions: SCUBE-1 levels were significantly associated with disease severity in SARS-CoV-2 patients and may serve as a promising biomarker to support clinical decision-making for hospitalization versus home-based management. Full article