Search Results (1,277)

Chiroptera includes over 1400 bat species, with at least 35 of these present in Italy. Due to their role as Lyssavirus reservoirs, bats found dead, with and without signs suggestive of this infection, are routinely submitted to the laboratory network of the Istituti Zooprofilattici Sperimentali in the framework of the rabies national passive and active surveillance program. Carcasses and biological samples collected from January to December 2021 in Latium and Tuscany, regions of our jurisdiction, were further screened for the presence of Coronaviruses (CoVs) and Herpesviruses using pan-family virus PCR tests, and relative PCR products were Sanger sequenced. Genetic characterization through sequencing detected AlphaCoVs in Miniopterus schreibersii and Beta- and Gammaherpesviruses in Tadarida teniotis. Samples were also submitted to bat genetic species identification. Full article

Chronic atrophic gastritis and intestinal metaplasia (IM) are gastric precancerous conditions (GPCs) associated with an increased risk of gastric cancer. Early detection and accurate characterization of GPC are therefore crucial for risk stratification and the implementation of preventive strategies. In the absence of clear mucosal changes observed through white-light imaging (WLI) or virtual chromoendoscopy, endocytoscopy can help unveil the presence of GPC by enabling in vivo assessment of nuclear and cellular structures at ultra-high magnification. Endocytoscopy is typically performed using WLI following dye-based staining of the mucosa. In this case, we demonstrate that combining endocytoscopy with the texture and color enhancement imaging (TXI) mode substantially improves the assessment of the gastric mucosa. In a 61-year-old man undergoing esophagogastroduodenoscopy, WLI showed multifocal erythema in the stomach, without clearly visible lesions on either WLI or narrow-band imaging. Conventional endocytoscopy revealed multiple small spots of IM with characteristic changes in glandular structures, which were even more evident when using the TXI mode. Histological analysis of targeted biopsies confirmed small foci of IM in both the antrum and corpus. The patient was enrolled in a surveillance program because of his clinical background. The combination of endocytoscopy with the TXI mode significantly enhances the delineation of mucosal and cellular architecture, supporting a more accurate optical diagnosis. Full article

Background: The 2022 conflict in Ukraine triggered mass migration, leading to a significant influx of Ukrainian refugee children into Poland. This situation raises concerns about hepatitis B virus immunity, as Ukraine’s hepatitis B vaccination coverage has been inconsistent compared to Poland’s high vaccination rates. Objective: To evaluate hepatitis B immunity and infection prevalence among Ukrainian refugee children residing in Southern Poland and to assess implications for vaccination strategies in the host country. Methods: A prospective cross-sectional study was conducted on 1322 Ukrainian refugee children (0–18 years) presenting to a pediatric infectious diseases department in Southern Poland between February 2022 and March 2024. Data on vaccination history, demographic characteristics, and selected laboratory parameters, including hepatitis B surface antigen and anti-HBs antibody levels, were collected. Protective immunity was defined as anti-HBs antibody levels ≥10 IU/L. Results: Among the participants (mean age 9.9 years; 50.2% female), 83.2% were reported as vaccinated according to national immunization programs, but only 64.9% demonstrated protective anti-HBs antibody levels. Protective antibody prevalence declined significantly with age, with less than half of adolescents aged 15–18 years showing immunity. Five children (0.4%) were diagnosed with chronic hepatitis B, four of whom were unvaccinated. Conclusions: This study identifies a significant gap in hepatitis B immunity among Ukrainian adolescent refugees residing in Southern Poland, with less than half possessing protective anti-HBs antibody levels. This immunity gap and the high risk of sexual transmission of the hepatitis B virus in adolescents highlight the urgent need for comprehensive surveillance, screening, and catch-up vaccination programs. Full article

Congenital hypothyroidism (CH) is a leading preventable cause of neurocognitive impairment. Its incidence appears to be rising in several countries. We analysed 27 years of newborn-screening data (1997–2023) from the largest Chilean screening centre, covering 3,225,216 newborns (51.1% of national births), to characterise temporal trends and potential drivers of CH incidence. Annual CH incidence was modelled with Prais–Winsten regression to correct for first-order autocorrelation; additional models assessed trends in gestational age, sex, biochemical markers, and aetiological subtypes. We identified 1550 CH cases, giving a mean incidence of 4.9 per 10,000 live births and a significant yearly increase of 0.067 per 10,000 (95 % CI 0.037–0.098; p < 0.001). Mild cases (confirmation TSH < 20 mU/L) rose (+0.89 percentage points per year; p = 0.002). The program’s recall was low (0.05%). Over time, screening and diagnostic TSH values declined, total and free T4 concentrations rose, gestational age at diagnosis fell, and a shift from thyroid ectopy toward hypoplasia emerged; no regional differences were detected. The sustained increase in CH incidence, alongside falling TSH thresholds and growing detection of in situ glands, suggests enhanced recognition of milder disease. Ongoing surveillance should integrate environmental, iodine-nutrition, and genetic factors to clarify the causes of this trend. Full article

Background: Salmonella enterica and Escherichia coli are common foodborne pathogens of global concern, particularly due to their antimicrobial resistance, notably to cephalosporins. Objective: This study aimed to evaluate a polymerase chain reaction-based lateral flow strip (PCR-LFS) assay for the detection of Salmonella spp. and E. coli harboring the bla_CTX-M gene, which confers resistance to third-generation cephalosporins. Methods: Two duplex PCRs (dPCR) were established to detect E. coli-harboring bla_CTX-M (set 1) and Salmonella-harboring bla_CTX-M (set 2). 600 bacterial isolates and raw pork mince spiked with bla_CTX-M-harboring E. coli and Salmonella were used to evaluated. Results: Both dPCR assays successfully detected bla_CTX-M-positive E. coli or Salmonella strains, while strains lacking the gene showed no amplification. Non-E. coli and non-Salmonella strains were PCR-negative unless they carried bla_CTX-M. The dPCR-LFS showed 100% validity including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for both E. coli or Salmonella spp. harboring or lacking bla_CTX-M. The assay accurately detected target strains without cross-reactivity with other bacteria or antimicrobial resistance genes. Cohen’s Kappa coefficient indicated perfect agreement (κ = 1), reflecting the high reliability of the dPCR-LFS. The assay could detect as low as 25 CFU/mL for bla_CTX-M-positive E. coli and 40 CFU/mL for bla_CTX-M-positive Salmonella in spiked raw pork mince. Conclusions: This assay is rapid, easy to interpret, and suitable for large-scale screening in surveillance programs. Full article

In 2022, consecutive sweeps of highly transmissible SARS-CoV-2 Omicron-derived lineages (B.1.1.529*) maintained viral transmission despite extensive antigen exposure from both vaccinations and infections. To better understand Omicron variant emergence in the context of the dynamic fitness landscape of 2022, we aimed to explore putative drivers behind SARS-CoV-2 lineage replacements. Variant fitness is determined through its ability to either outrun previously dominant lineages or more efficiently circumvent host immune responses to previous infections and vaccinations. By analyzing data collected through our local genomic surveillance program from Connecticut, USA, we compared emerging Omicron lineages’ growth rates, estimated infections, effective reproductive rates, average viral copy numbers, and likelihood for causing infections in recently vaccinated individuals. We find that newly emerging Omicron lineages outcompeted dominant lineages through a combination of enhanced viral shedding or advanced immune escape depending on the population-level exposure state. This analysis integrates individual-level sequencing data with demographic, vaccination, laboratory, and epidemiological data and provides further insights into host–pathogen dynamics beyond public aggregate data. Full article

Rat hepatitis E virus (rat HEV) is an emerging zoonotic virus detected in rodents worldwide, with increasing evidence of presence in environmental sources such as surface water, wastewater and bivalves. This systematic review compiles and analyzes all the published research on rat HEV contamination in these matrices, as well as its implications for human health. A comprehensive literature search was conducted using databases such as PubMed, Scopus, Web of Science, and Mendeley, including studies published up until 27 May 2025. Studies were included if they evaluated rat HEV in water- or food-related matrices using molecular detection. The risk of bias was not assessed. The certainty of evidence was not formally evaluated. Limitations include reliance on PCR methods without infectivity confirmation. Following PRISMA inclusion and exclusion criteria, eight eligible studies were analyzed. The results show high detection rates of rat HEV RNA in influent wastewater samples from several high-income European countries, namely Sweden, France, Italy, Spain and Portugal. Lower detection rates were found in effluent wastewater and surface waters in Sweden. In bivalve mollusks sampled in Brazil, rat HEV RNA was detected in 2.2% of samples. These findings show the widespread environmental presence of rat HEV, particularly in urban wastewater systems. While human infections by rat HEV have been documented, the true extent of rat HEV zoonotic potential remains unclear. Given the risks associated with this environmental rat HEV contamination, enhanced surveillance, standardized detection methods, and targeted monitoring programs in food production and water management systems are essential to mitigate potential public health threats. Establishing such programs will be crucial for understanding the impact of rat HEV on human health. Full article

Klebsiella pneumoniae carbapenemases (KPCs) are a group of class A β-lactamases of Gram-negative bacteria leading to difficult-to-treat infections. We evaluated the global epidemiology of KPC-producing Gram-negative clinical isolates. A systematic search of six databases (Cochrane Library, Embase, Google Scholar, PubMed, Scopus, and Web of Science) was conducted. Extracted data were tabulated and evaluated. After screening 1993 articles, 119 were included in the study. The included studies originated from Asia (n = 49), Europe (n = 29), North America (n = 14), South America (n = 11), and Africa (n = 3); 13 studies were multicontinental. The most commonly reported KPC-producing species were Klebsiella pneumoniae (96 studies) and Escherichia coli (52 studies), followed by Enterobacter cloacae (31), Citrobacter spp. (24), Klebsiella oxytoca (23), Serratia spp. (15), Enterobacter spp. (15), Acinetobacter baumannii complex (13), Providencia spp. (11), Morganella spp. (11), Klebsiella aerogenes (9), Pseudomonas aeruginosa (8), Raoultella spp. (8), Proteus spp. (8), and Enterobacter aerogenes (6). Among the studies with specific bla_KPC gene detection, 52/57 (91%) reported the isolation of bla_KPC-2 and 26/57 (46%) reported bla_KPC-3. The antimicrobial resistance of the studied KPC-producing isolates was the lowest for ceftazidime–avibactam (0–4%). Resistance to polymyxins, tigecycline, and trimethoprim–sulfamethoxazole in the evaluated studies was 4–80%, 0–73%, and 5.6–100%, respectively. Conclusions: The findings presented in this work indicate that KPC-producing Gram-negative bacteria have spread globally across all continents. Implementing proper infection control measures, antimicrobial stewardship programs, and enhanced surveillance is crucial. Full article

Sternal bursitis is an underexplored lesion in poultry, often overlooked in microbiological diagnostics. In this study, we characterized 36 Escherichia coli isolates recovered from sternal bursitis in broiler chickens, combining phenotypic antimicrobial susceptibility testing, PCR-based screening, and whole genome sequencing (WGS). The genetic analysis revealed a diverse population spanning 15 sequence types, including ST155, ST201, and ST58. Resistance to tetracycline and ciprofloxacin was common, and several isolates carried genes encoding β-lactamases, including blaTEM-1B. Chromosomal mutations associated with quinolone and fosfomycin resistance (e.g., gyrA p.S83L, glpT_E448K) were also identified. WGS revealed a high number of virulence-associated genes per isolate (58–96), notably those linked to adhesion (fim, ecp clusters), secretion systems (T6SS), and iron acquisition (ent, fep, fes), suggesting strong pathogenic potential. Many isolates harbored virulence markers typical of ExPEC/APEC, such as iss, ompT, and traT, even in the absence of multidrug resistance. Our findings suggest that E. coli from sternal bursitis may act as reservoirs of resistance and virulence traits relevant to animal and public health. This highlights the need for including such lesions in genomic surveillance programs and reinforces the importance of integrated One Health approaches. Full article

Quality assurance programs are critical to ensuring the consistency and reliability of point-of-care surveillance test results. In 2022, we launched Laos’ inaugural quality control (QC) and external quality assessment (EQA) program for national HIV recent infection surveillance. Our study aims to implement the first QC and EQA program for national HIV recent infection surveillance in Laos, utilizing non-infectious dried tube specimens (DTS) for quality control testing. This initiative seeks to monitor and assure the quality of HIV infection surveillance. We employed the Asante HIV-1 Rapid Test for Recent Infection (HIV-1 RTRI) point-of-care kit, using plasma specimens from the Thai Red Cross Society to create dried tube specimens (DTS). The DTS panels, including HIV-1 negative, HIV-1 recent, and HIV-1 long-term samples, met ISO 13528:2022 standards to ensure homogeneity and stability. These panels were transported from the Thai National Institute of Health (Thai NIH) to the Laos National Center for Laboratory and Epidemiology (NCLE) and subsequently shipped to 12 remote laboratories at ambient temperature. The laboratory results were electronically transmitted to Thai NIH 15 days after receiving the panel for performance analysis. The concordance results with the sample types were scored, and laboratories that achieved 100% concordance across all sample panels were considered to have satisfactorily met the established standards. Almost all laboratories demonstrated satisfactory results with 100% concordance across all sample panels during all three rounds of QC: 11 out of 12 (92%) in June, 10 out of 12 (83%) in July, and 11 out of 12 (91%) in August. The two rounds of EQA performed in June and August 2022 were satisfied by 8 out of 11 (72%) and 5 out of 10 (50%) laboratories, respectively. QC and EQA monitoring identified errors such as testing protocol mistakes and insufficient DTS panel dissolution, leading to improvements in HIV recency testing quality. Laboratories that reported errors were corrected and implemented further preventive actions. The QC and EQA program for HIV-1 RTRI identified errors in HIV recent infection testing. Implementing a specialized QC and EQA program for DTS marks a significant advancement in improving the accuracy and consistency of HIV recent infection surveillance. Continuous assessment is vital for addressing recurring issues. Full article

Smart cities use advanced infrastructure and technology to improve the quality of life for their citizens. Collaborative services in smart cities are making the smart city ecosystem more reliable. These services are required to enhance the operation of interoperable systems, such as smart transportation services that share their data with smart safety services to execute emergency response, surveillance, and criminal prevention measures. However, an important issue in this ecosystem is data security, which involves the protection of sensitive data exchange during the interoperability of heterogeneous smart services. Researchers have addressed these issues through blockchain integration and the implementation of smart contracts, where collaborative applications can enhance both the efficiency and security of the smart city ecosystem. Despite these facts, complexity is an issue in smart contracts since complex coding associated with their deployment might influence the performance and scalability of collaborative applications in interconnected systems. These challenges underscore the need to optimize smart contract code to ensure efficient and scalable solutions in the smart city ecosystem. In this article, we propose a new framework that integrates generative AI with blockchain in order to eliminate the limitations of smart contracts. We make use of models such as GPT-2, GPT-3, and GPT4, which natively can write and optimize code in an efficient manner and support multiple programming languages, including Python 3.12.x and Solidity. To validate our proposed framework, we integrate these models with already existing frameworks for collaborative smart services to optimize smart contract code, reducing resource-intensive processes while maintaining security and efficiency. Our findings demonstrate that GPT-4-based optimized smart contracts outperform other optimized and non-optimized approaches. This integration reduces smart contract execution overhead, enhances security, and improves scalability, paving the way for a more robust and efficient smart contract ecosystem in smart city applications. Full article

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

Ticks are arthropods responsible for transmitting microorganisms important to wild, domestic, and human animals. In ecosystems where they are distributed, interactions between hosts are a constant risk. This study analyzed voluntary case reports of tick infestations in humans and tick collections from wild and domestic animals in six different locations in the flooded savanna region of the Colombian Orinoquia. Classical and molecular taxonomy were used to identify tick species. Individuals infested with ticks were monitored for clinical manifestations related to tick bites. A total of 22 ticks were found infesting five men and one woman, aged between 9 and 60 years. Both classical and molecular taxonomy confirmed that 100% of the ticks infesting humans and animals were Amblyomma mixtum. Two of the six individuals reported primary and secondary skin reactions during and after the tick bite, including mild-to-severe inflammatory reactions, pruritus, and erythematous papules that persisted up to 72 h. This study provides, for the first time, compiled information on clinical skin manifestations caused by A. mixtum in humans in the flooded savanna region and in Colombia as a whole. These findings serve as a theoretical basis for developing surveillance programs targeting infestations caused by this arthropod. Full article

Background/Objectives: Congenital microcephaly is a clinical manifestation with a heterogeneous etiology, and its epidemiological surveillance relies on the systematic identification of cases and investigation of their underlying causes to inform preventive strategies and improve prognostic assessments. In Latin America, despite the existence of congenital anomaly reporting programs since 1967, the surveillance of microcephaly only gained substantial attention following the Zika virus (ZIKV) epidemic in 2015. Since then, efforts have predominantly concentrated on cases of infectious origin, often at the expense of recognizing endogenous etiologies, particularly those of genetic nature. This review aims to examine the role of genetic alterations in microcephaly pathogenesis and evaluates the limitations of current surveillance systems. Methods: A literature review centered on syndromic and non-syndromic genetic etiologies, alongside an analysis of Latin American surveillance frameworks (ECLAMC, RyVEMCE, ICBDSR, ReLAMC) was performed. Results: The findings reveal improved case detection and increased reported prevalence; however, the proportion of genetically attributed cases has remained stable. No systematic studies were found identifying the most common genetic causes; instead, genetic investigations were limited to isolated cases with a family history. Conclusions: While epidemiological surveillance systems in Latin America have advanced in the reporting of congenital microcephaly cases, substantial gaps remain in case ascertainment and etiological investigation, particularly concerning genetic contributions Full article

Antimicrobial resistance (AMR) poses a growing threat to global health, and its spread through the food chain is gaining increasing attention. While AMR in food of animal origin has been extensively studied, less is known about its prevalence in plant-based foods, particularly fresh and ready-to-eat (RTE) vegetables. This study investigated the occurrence of antimicrobial-resistant bacteria in fresh and RTE vegetables. Isolates were subjected to antimicrobial susceptibility testing and molecular analyses for the characterization of antimicrobial resistance genes (ARGs). A significant proportion of samples were found to harbor antimicrobial-resistant bacteria, including multidrug-resistant strains. Several ARGs, including those encoding extended-spectrum β-lactamases (ESBLs) and resistance to critically important antimicrobials, were detected. The findings point to environmental contamination—potentially originating from wastewater reuse and agricultural practices—as a likely contributor to AMR dissemination in vegetables. The presence of antimicrobial-resistant bacteria and ARGs in fresh produce raises concerns about food safety and public health. The current regulatory framework lacks specific criteria for monitoring AMR in vegetables, highlighting the urgent need for surveillance programs and risk mitigation strategies. This study contributes to a better understanding of AMR in the plant-based food sector and supports the implementation of a One Health approach to address this issue. Full article