Search Results (152)

For deployed military personnel, a single exposure from a rabies-infected animal can become a death sentence. With a case fatality rate approaching 100%, rabies remains a serious, yet insufficiently acknowledged hazard for service members, for whom prevention in operational environments poses unique challenges. We conducted a systematic literature search to identify relevant studies on rabies risk in armed forces personnel. By analysing rabies-related fatalities in the military, this review highlights the operational challenges posed by animal bites during deployment, including underreporting and delayed access to care, which compromise timely post-exposure prophylaxis (PEP) administration. Special emphasis is placed on prevention strategies, including pre-exposure prophylaxis (PrEP) and animal control protocols tailored to military settings. Its aim is to provide a comprehensive, evidence-based resource for healthcare professionals involved in the protection of deployed forces against this ancient yet still deadly infectious disease. Full article

Background: Leptospirosis is a neglected tropical disease with substantial public health impact in Brazil, closely associated with socio-environmental vulnerabilities and climatic extremes. This study analyzed the epidemiological profile and spatiotemporal distribution of leptospirosis incidence and lethality rates in Brazil from 2015 to 2024. Methods: An ecological time-series study was conducted using secondary data from the Notifiable Diseases Information System (SINAN). Variables included geographic region, probable infection environment, and occupational and educational level (ISCED-2011). Results: A total of 31,397 cases were notified, with an annual average of 3140 cases. The South and North regions exhibited the highest incidence rates, while the Northeast and Southeast presented lethality rates above the national average (9.20%). A marked reduction in notifications occurred during the COVID-19 pandemic. Infections occurred predominantly in the domiciliary environment (64%). Rural workers (27.45%) and civil construction workers (18.63%) were the most affected occupational groups, with a higher incidence rate among illiterate and low-education populations. Conclusions: The dynamics of leptospirosis in Brazil are complex and multifactorial, influenced by climatic variations and driven by deficits in basic sanitation and education level. Mitigating the disease burden requires sustained, region-specific public health strategies, targeted infrastructure improvements, and enhanced epidemiological surveillance to address underreporting. Full article

Sexually transmitted infections (STIs) are common and probably underreported causes of proctitis and colitis. Bacterial (chlamydia, gonorrhoea, syphilis, Mycoplasma genitalium), viral (herpes simplex virus, mpox), and amoebic (Entamoeba histolytica) pathogens can cause inflammatory proctitis or colitis, which, depending on the pathogen, can mimic inflammatory bowel disease both on endoscopy and histopathology. Rectal and colonic masses are uncommon, but important manifestations of these infections, especially with chlamydia, syphilis, and E. histolytica. Testing for HIV is important in this context, since it allows for the inclusion of opportunistic pathogens into the differential diagnosis. Chronic diarrhoea can be a feature of chronic HIV infection. Enteric pathogens, such as Salmonella spp., Shigella spp., or Campylobacter spp., can be transmitted during sex, especially during oral–anal contact (“rimming”). The most common STI, human papillomavirus, is not associated with colitis, but is important because of its causal association with genital warts and anal cancer. Full article

Q fever, caused by Coxiella burnetii, is a globally distributed zoonosis that remains substantially underdiagnosed, despite increasing reports of human and animal infections across Europe. Within the Zoonoses Working Group of the Trás-os-Montes and Alto Douro Academic Clinical Center (CAC TMAD), which integrates human and animal health professionals, an apparent discrepancy emerged. Although no official human notifications had been recorded in Trás-os-Montes in recent years, three clinical cases, at hospital level, were identified in the Bragança district between 2021 and 2024. This unexpected finding prompted an evaluation of local veterinary awareness of Q fever in livestock, given that no cases had ever been reported. A structured, simple questionnaire was provided to all livestock veterinarians in the district, achieving an 88.5% response rate (23/26). Among respondents, 43.5% (10/23) reported laboratory-confirmed C. burnetii-positive results in clinically suspected livestock (both serology and PCR). All reported clinical cases occurred in small ruminants, with abortion as the predominant clinical manifestation. These results provide local evidence of active C. burnetii circulation in both humans and livestock in Bragança, suggesting potential underreporting. This gap supports the need to strengthen clinical recognition and reporting practices among medical and veterinary professionals, firmly embedded within a One Health framework. Full article

Background/Objectives: Healthcare-associated infections (HAI) affect an estimated 4.3 million patients annually in EU/EEA hospitals; yet, reported prevalence rates vary nearly fivefold across member states, a degree of variation inconsistent with clinical or epidemiological differences alone. Romania exemplifies this paradox: it records one of the lowest reported HAI prevalence rates in Europe while sustaining one of the highest antimicrobial consumption levels on the continent. This study examines whether antimicrobial consumption data can serve as a cross-check on reported HAI prevalence across EU/EEA countries and discusses implications for European funding mechanisms. Methods: A cross-sectional ecological analysis was conducted using data from 26 EU/EEA countries. HAI prevalence was extracted from the ECDC Point Prevalence Survey 2022–2023; antimicrobial consumption indicators from the ESAC-Net Annual Epidemiological Report 2023. Pearson and Spearman correlations, multiple linear regression with Cook’s distance diagnostics, bootstrap resampling, and k-means cluster analysis were performed. Variance inflation factors were computed to assess multicollinearity; community sector AMC was excluded from the final regression model due to near-perfect collinearity with total AMC. Results: No antimicrobial consumption indicator was significantly associated with reported HAI prevalence (total AMC: r = 0.274, p = 0.175; broad-spectrum hospital proportion: r = 0.082, p = 0.692); bootstrap confidence intervals confirmed the instability of all estimates. Romania and Bulgaria were identified as influential outliers whose consumption profiles are substantially inconsistent with their reported infection rates, with model-based estimates of 7.3% and 7.0% respectively against reported values of 3.1% and 3.7%. Cluster analysis placed both countries in an isolated group with the highest antimicrobial consumption and broad-spectrum hospital antibiotic use in the sample alongside the lowest reported HAI prevalence, a configuration not replicated elsewhere in the EU/EEA. Conclusions: The absence of a significant aggregate association between antimicrobial consumption and reported HAI prevalence, combined with the systematic identification of Romania and Bulgaria as influential observations whose consumption profiles are inconsistent with their reported infection rates, raises the hypothesis of surveillance underreporting as a plausible explanation, though the ecological design does not permit causal inference and alternative explanations, including differences in antimicrobial stewardship maturity and prescribing culture, cannot be excluded. Antimicrobial consumption indicators, particularly the proportion of broad-spectrum antibiotics in hospital use, may serve as a proxy for HAI burden where direct surveillance is incomplete, and their integration into European surveillance frameworks is warranted. These findings have direct policy relevance for the allocation of resources under EU4Health, EU-JAMRAI 2, and national recovery and resilience programmes, and support investment in surveillance reform as a precondition for effective infection prevention programmes. Full article

Background/Objectives: Healthcare-associated infections (HAIs) are a major and preventable threat to patient safety, yet reported figures in Central and Eastern Europe are widely affected by under-reporting, which can distort both the apparent infection profile and the perceived burden of disease. Patient-level regional surveillance data were analysed to characterise the reported HAI profile, the determinants of in-hospital mortality, and between-hospital surveillance quality in post-pandemic Southeast Romania. Methods: This was a retrospective, cross-sectional analysis of 2878 HAI cases reported across a five-county, multicentre network of 32 hospitals during 2024. Infections were grouped as Clostridioides difficile infection (CDI) versus non-CDI. Logistic regression was applied for in-hospital mortality, Cox and competing-risks models for time to death, negative binomial regression for length of stay, and a Spiegelhalter funnel plot for between-hospital variation. Results:Clostridioides difficile infection accounted for 56.3% of reported cases, a markedly higher proportion than that described in European point-prevalence surveys, although differences in design and denominator preclude direct comparison. CDIs and non-CDIs formed distinct clinical phenotypes. In-hospital mortality was lower in CDI than in non-CDIs (14.9% versus 26.1%) and was independently associated with intensive care admission, age, and immunosuppression, while CDI remained associated with lower mortality. The reported CDI proportion ranged from approximately 1% to 93% between hospitals, with most institutions lying outside the funnel control limits. Conclusions: The predominance of CDI among reported HAIs is best interpreted as a signal of selective ascertainment rather than as direct evidence of a genuinely higher CDI burden. Because the dataset lacked admission or patient-day denominators, the CDI-to-total ratio should be regarded as a simple screening indicator of potential surveillance imbalance, useful for identifying hospitals where non-CDIs may be under-detected. Full article

Objectives: To assess the prevalence of high-risk human papillomavirus (hrHPV) infection and selected genitourinary pathogens and to examine their co-detection patterns in sexually active adolescent females. Methods: In this single-center cross-sectional study, 167 consecutive outpatients aged 13–17 years with self-reported sexual initiation underwent multi-pathogen polymerase chain reaction (PCR) testing for hrHPV, Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Ureaplasma parvum (UP), and Mycoplasma genitalium (MG). Prevalence estimates are reported with 95% confidence intervals (CIs). Associations with hrHPV positivity were explored using univariable and parsimonious multivariable logistic regression; sensitivity analyses examined alternative age parameterization and exclusion of sparse variables. Results: The prevalence of hrHPV was 28.1% (47/167; 95% CI: 21.5–35.6). The prevalence of CT, UU, UP, and MG was 3.0%, 28.1%, 25.1%, and 0.6%, respectively. Any bacterial pathogen was detected in 61/167 participants (36.5%), while hrHPV–bacterial co-detection was observed in 24/167 (14.4%). In univariable analysis, UU was associated with hrHPV positivity (OR 2.55, 95% CI: 1.24–5.24; p = 0.013); this signal remained in the primary multivariable model (adjusted OR 2.46, 95% CI: 1.07–5.93; p = 0.035). A graded increase in hrHPV positivity was observed with increasing bacterial burden (p for trend = 0.018). Conclusions: Sexually active adolescent girls attending gynecologic outpatient care showed a substantial burden of hrHPV and bacterial genitourinary pathogen detection. This Central and Eastern European adolescent outpatient cohort contributes integrated multi-pathogen PCR-based epidemiologic data from a clinically relevant and underreported population. An exploratory association between UU and hrHPV positivity was observed; this signal is best interpreted as reflecting shared sexual exposure or the cervicovaginal microbial milieu rather than as evidence of an independent causal role for UU. The absence of vaccination status, behavioral, and longitudinal data represents a principal limitation. Prospective studies incorporating these variables are needed to clarify the epidemiology of hrHPV and co-detected pathogens in adolescents. Full article

Toxoplasmosis remains one of the most common parasitic infections affecting humans, with significant implications for pregnancy and fetal health. Maternal primary infection during gestation can result in transplacental transmission of Toxoplasma gondii, leading to a wide spectrum of congenital disease. The risk of vertical transmission increases with gestational age, whereas disease severity is inversely related—early infections causing severe neurological and ocular damage, and late infections often resulting in subclinical forms. Advances in serological testing, including IgG avidity assays and molecular diagnostics such as PCR on amniotic fluid, have improved early detection and management. Prenatal treatment with spiramycin or pyrimethamine–sulfadiazine–folinic acid combinations has been associated with reduced transmission and less severe fetal disease in several studies, although the magnitude of benefit remains debated. Long-term follow-up is essential, as late-onset manifestations, particularly chorioretinitis and neurodevelopmental impairment, are common. This narrative review was based on a comprehensive literature search of major medical databases and summarizes current knowledge on the epidemiology, pathophysiology, diagnosis, treatment, and outcomes of toxoplasmosis in pregnancy. Particular emphasis is placed on high-prevalence countries, where greater parasite genetic diversity, distinct epidemiological patterns, and a higher burden of congenital disease pose unique clinical and public health challenges. Despite progress in understanding parasite biology, pathogenesis, and treatment efficacy, congenital toxoplasmosis continues to be underdiagnosed and underreported, especially in low-resource settings. Ongoing challenges include optimizing screening strategies, ensuring access to standardized therapies, and strengthening surveillance systems. Full article

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement. Full article

Orthohantavirus infections are classically associated with hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. However, accumulating evidence indicates that the clinical spectrum is considerably broader, with frequent involvement of organ systems beyond the kidney and lung. Hepatic manifestations, in particular, may mimic acute viral hepatitis, leading to diagnostic challenges and underrecognition. This paper synthesizes published evidence on hepatic involvement in orthohantavirus infection, with a focus on clinical presentation, pathogenic mechanisms, differential diagnosis, biomarkers, and public health implications. Relevant literature was identified through searches of peer-reviewed articles, with emphasis on studies reporting hypertransaminasemia, hepatitis-like illness, and liver injury in confirmed hantavirus infections. Mild to moderate elevations in aminotransferases are common during acute orthohantavirus infection, and in some patients the clinical picture may be dominated by fever, thrombocytopenia, and hepatitis-like abnormalities, closely resembling dengue, leptospirosis, or classical viral hepatitis. Hepatic injury appears to result primarily from systemic endothelial dysfunction, immune-mediated inflammation, and microvascular leakage rather than direct hepatocytopathic effects. Emerging biomarkers of severity, including thrombocytopenia, neutrophil-to-lymphocyte ratio, soluble thrombomodulin, and IL-6 trans-signaling, reflect widespread vascular and inflammatory activation. Diagnostic delays are frequent, particularly in non-endemic regions, due to low clinical awareness and overlapping features with more common febrile hepatotropic syndromes. Orthohantavirus infection should be considered in the differential diagnosis of acute febrile illness with unexplained hypertransaminasemia and thrombocytopenia, especially when epidemiological clues suggest rodent exposure or compatible environmental contexts. Recognizing hepatic involvement as part of a systemic endothelial syndrome may improve diagnostic accuracy, reduce underreporting, and facilitate earlier supportive management. Increased awareness among hepatologists, infectious disease specialists, and emergency physicians is warranted. Full article

Background: Surgical site infection (SSI) is a common complication that increases morbidity, prolongs hospital stays, and raises healthcare costs. Perioperative hypothermia may contribute to its development by altering tissue perfusion, oxygenation, and the immune response. Objective: To evaluate the association between perioperative hypothermia and the risk of SSI in adult patients. Methods: A scoping review was conducted following the methodological framework of Arksey and O’Malley, expanded by Levac, the recommendations of the Joanna Briggs Institute, and the PRISMA-ScR guidelines. A systematic search was performed in PubMed and Scopus through 30 April 2026. We included observational studies and clinical trials in adults undergoing surgery that evaluated the association between perioperative or intraoperative hypothermia and the occurrence of SSI or other postoperative infectious complications. Results: A total of 28 studies were included. Retrospective observational studies were the most common design, comprising 19/28 studies (67.9%), followed by 6/28 prospective cohorts (21.4%) and 4/28 randomized clinical trials (14.3%). The studies were conducted across 12 countries, with the United States contributing the largest proportion (14/28, 50%), followed by China, Turkey, and Japan with two studies each (7.1% per country). Regarding the main findings, 14 studies (50%) reported a positive association between perioperative hypothermia and an increased risk of SSI or other postoperative infections, whereas 11 studies (39.3%) found no statistically significant association. Most studies (15/28, 53.6%) used a fixed temperature threshold of <36 °C, while a smaller proportion applied lower cutoffs such as <35–35.5 °C (3/28, 10.7%); in the remaining studies (10/28, 35.7%), the threshold was not clearly specified. Temperature measurement methods were frequently underreported (21/28, 75.0%). Among studies that did report them, approaches included repeated measurements (3/28, 10.7%), continuous monitoring (2/28, 7.1%), mean intraoperative temperature (1/28, 3.6%), nadir temperature (1/28, 3.6%), and single-point measurements (1/28, 3.6%). Conclusions: Perioperative hypothermia may be associated with an increased risk of SSI; however, the available evidence is inconsistent across surgical settings. Rather than indicating a clear independent effect, the findings suggest that hypothermia could play a context-dependent role within a broader set of perioperative factors influencing infection risk. Full article

In Africa, the disease burden of diarrheal and respiratory diseases is amplified by limited surveillance capacity, diagnostic limitations, and socioeconomic inequalities. In rapidly urbanizing settings such as Kigali (Rwanda), integrating wastewater-based epidemiology (WBE) into existing surveillance systems offers a promising strategy for generating real-time epidemiological intelligence, identifying community-level hotspots, and addressing gaps in traditional reporting systems. Gastrointestinal and respiratory infections remain major causes of morbidity and mortality globally, particularly in low- and middle-income countries (LMICs), where traditional clinical surveillance systems frequently underreport the true disease burden. This systematic review synthesizes current evidence on the detection of gastrointestinal and respiratory pathogens in wastewater and evaluates the utility of WBE for early warning and public health action. A narrative review approach was used to identify peer-reviewed literature, global health reports, and surveillance studies focusing on the wastewater detection of gastrointestinal and respiratory pathogens. Databases including PubMed, Scopus, and Google Scholar were searched for studies published between 2000 and 2026. The search yielded 1247 records, of which 312 duplicates were removed. After title/abstract screening, 228 full-text articles were retrieved and assessed for eligibility. After a detailed evaluation, 108 studies were excluded for the following reasons: absence of pathogen-specific wastewater data (n = 46), a focus on environmental monitoring without public health relevance (n = 25), insufficient methodological description (n = 21), or other eligibility limitations such as a lack of primary data (n = 16). WBE provides a non-invasive, cost-effective approach for monitoring symptomatic and asymptomatic infections. Challenges involve variability in sampling, environmental factors affecting viral decay, and differences in laboratory workflows. WBE is a powerful complement to traditional infectious disease surveillance, offering early warning capabilities, population-level coverage, and real-time insights into pathogen circulation. Integrating WBE into surveillance programs, especially in LMICs such as Rwanda, can significantly strengthen epidemic preparedness, guide resource allocation, and improve outbreak response. Sustained investment in laboratory capacity, standardized protocols, and multisector collaboration is essential to fully leverage WBE for public health protection. Full article

Introduction: Hospital adverse events are a global patient safety problem that account for avoidable death, long-term disability, extended length of stay, and increased healthcare costs. Underreporting, wherein fewer than 10% of events are indeed recorded, is prevalent and is characterized primarily by cultural and organizational determinants. Artificial intelligence, in the form of machine learning and natural language processing, has been described as a potential tool for enhancing adverse events detection and prediction with the use of large-scale clinical data. Materials and Methods: PRISMA-DTA guidelines were followed in this systematic review. Scopus, PubMed, and Web of Science were searched employing keywords associated with adverse events, artificial intelligence methodologies (e.g., machine learning, deep learning, natural language processing), and healthcare settings. Inclusion criteria included original research on artificial intelligence-based solutions for the detection or prediction of adverse events such as medication errors, hospital-acquired infections, and complications during surgery. Reviews, meta-analyses, and non-artificial intelligence studies were excluded. Following screening, 15 studies were found to meet inclusion criteria. Results: The referenced studies show a shift from rule-based natural language processing models to advanced deep learning and Bidirectional Encoder Representations from Transformers models. Early approaches, i.e., Support Vector Machine classifiers, achieved AUC scores as high as 0.92, while later models (Random Forest, LightGBM, XGBoost) mirrored AUCs of over 0.93. Large language models achieved F1-scores of 0.84 for named entity recognition. Artificial intelligence models even identified unreported incidents. Discussion: Artificial intelligence-powered methods are transforming adverse events detection from retrospective to predictive, proactive monitoring. There remain some challenges, however, including limited external validation, class imbalance, and interpretability of complex models. Future studies must address explainable artificial intelligence, multicenter trials, and high-quality well-annotated datasets to offer secure clinical integration. Full article

Salmonella remains a leading cause of foodborne illness worldwide, with non-typhoidal Salmonella (NTS) responsible for an estimated 93.8 million infections and substantial global morbidity and mortality. This review synthesizes current evidence on the epidemiology, molecular pathogenesis, and prevention of both typhoidal and nontyphoidal Salmonella, with emphasis on emerging challenges in disease control. We highlight key virulence mechanisms, including Salmonella pathogenicity islands and Type III secretion systems, that mediate host cell invasion, intracellular survival, and immune modulation, alongside differences in host adaptation, reservoirs, and clinical outcomes between major serotypes. Epidemiological synthesis demonstrates marked geographic variability in disease burden, driven by underreporting, limited diagnostic capacity, and social determinants of health, with particularly high mortality from invasive NTS (iNTS) disease in sub-Saharan Africa. This review further identifies major challenges, including the global rise of multidrug-resistant Salmonella lineages, the emergence of high-risk serotypes such as monophasic S. Typhimurium and S. Infantis, and the increasing complexity of transmission across the farm-to-fork continuum. While advances in whole genome sequencing and integrated surveillance platforms (e.g., PulseNet and GenomeTrakr) have improved outbreak detection and source attribution, gaps in cross-sector coordination persist. Collectively, the evidence underscores the need for integrated One Health approaches that link human, animal, and environmental systems, alongside strengthened surveillance, targeted prevention strategies, and antimicrobial stewardship. Advances in vaccination, including licensed typhoidal vaccines such as Ty21a and Vi polysaccharide, and conjugate vaccines, as well as emerging live attenuated and glycoconjugate candidates targeting NTS, represent promising strategies for reducing the global burden of Salmonella infections. Future efforts should focus on improving global surveillance harmonization, addressing environmental and climate-related drivers of transmission, and advancing vaccine development and implementation. Full article

In the early stages of the COVID-19 pandemic, uncertainty around the extent of SARS-CoV-2 spread hampered policymakers’ understanding of the epidemic’s extent. Mathematical models, which proved vital for aiding decision-making, relied primarily on reported cases that were unreliable due to significant underdetection and underreporting. While serological data was used to improve understanding of the epidemiology, it can be costly and difficult to implement without bias. To counter these issues, we integrated serological data from 7229 remnant serum samples collected in 15 Maryland emergency departments (EDs) in Maryland between August and December 2020 into a Bayesian modeling approach to derive an estimate of the incidence of infection and the case fatality rate during the pandemic’s initial wave. We estimated that 5.2% (95% CI, 3.7–7.2%) of the population of Maryland had been infected by late fall 2020. The inferred reporting rate that was estimated started low (<10% in March 2020) and increased to 32% (95% HDI = 26–41%) by the fall, while the estimated infection fatality rate was likely initially higher but fell to 0.51% (95% HDI = 0.43–0.68%) after 1 September 2020. These results demonstrate how existing ED infrastructure can be leveraged to generate less biased, more accurate estimates of the true prevalence of a disease, improving the ability to make decisions and allocate resources under uncertainty. Full article