Infectious Disease Reports

11 pages, 237 KiB

Open AccessArticle

Endothelial Dysfunction Markers Correlate with the Time Since Completion of Tuberculosis Treatment and the Number of Previous Tuberculosis Episodes

by Chrisstoffel Jumaar, Steve Jacobs, Carmen Payne, Olakunle Sanni, Elize Louw, Nicola Baines, David Maree, Benjamin Botha, Merga Belina Feyasa, Hans Strijdom, Brian Allwood and Gerald J. Maarman

Infect. Dis. Rep. 2025, 17(2), 21; https://doi.org/10.3390/idr17020021 - 28 Feb 2025

Abstract

Background: Despite “successful” treatment, some lung tuberculosis (TB) patients develop long-term lung impairments that includes damage to the parenchyma and reduced function, which may predispose them to diseases like pulmonary hypertension. However, this is not well understood. Therefore, we investigated whether previous or [...] Read more.

Background: Despite “successful” treatment, some lung tuberculosis (TB) patients develop long-term lung impairments that includes damage to the parenchyma and reduced function, which may predispose them to diseases like pulmonary hypertension. However, this is not well understood. Therefore, we investigated whether previous or current TB patients would display elevated biomarkers of endothelial dysfunction and vascular remodeling. Methods: We performed assays for ADMA, VCAM-1, VEGF, angiopoietin-1, TBARS, NT-pro-BNP, and cardiac troponin-I. We further stratified the patients based on 1, 2, 3, and >3 previous TB episodes, and 1–5 yrs, 5–10 yrs, 10–15 yrs and >15 yrs after the last TB treatment completion. We also assessed correlations between the biomarkers and the number of previous TB episodes or the time since the completion of the last TB treatment. Results: ADMA was 70 times higher, VEGF was 2000 times higher and angiopoietin-1 was 6500 times higher than the normal range. NT-pro-BNP and cardiac troponin-I were undetected, and TBARS levels were low. There was a positive linear relationship between the number of previous TB episodes and angiopoietin-1, and between VEGF and the number of previous TB episodes. ADMA, VCAM-1 and TBARS exhibited a weak and negative linear association with the number of previous TB episodes. A negligible negative linear association was observed between the time since the completion of the last TB treatment and angiopoietin-1, VEGF and ADMA. Conclusions: Therefore, having >1 previous TB episode, despite the successful completion of TB treatment, associates with an increased risk of endothelial dysfunction/angiogenesis or vascular remodeling. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

15 pages, 2594 KiB

Open AccessArticle

Comprehensive Analysis of Influenza Viruses’ Trends in Italy: Insights from a Nationwide and Regional Perspective

by Francesco Branda , Nicola Petrosillo , Dong Keon Yon , Massimo Ciccozzi and Fabio Scarpa

Infect. Dis. Rep. 2025, 17(2), 20; https://doi.org/10.3390/idr17020020 - 27 Feb 2025

Abstract

Background. Influenza remains a significant public health issue, with seasonal trends varying across regions. This study provides a comprehensive analysis of influenza virus trends in Italy, leveraging epidemiological and virological data from the Istituto Superiore di Sanità (ISS). The primary objective is [...] Read more.

Background. Influenza remains a significant public health issue, with seasonal trends varying across regions. This study provides a comprehensive analysis of influenza virus trends in Italy, leveraging epidemiological and virological data from the Istituto Superiore di Sanità (ISS). The primary objective is to assess influenza activity at both national and regional levels, highlighting variations in incidence rates and viral subtype circulation during the 2023/2024 season. Methods. We conducted a systematic approach to data collection, processing, and visualization, utilizing influenza surveillance data from ISS. Incidence rates, subtype distribution, and co-circulating respiratory viruses were analyzed to identify key trends. Results. Our findings reveal a significant increase in influenza cases during the 2023/2024 season, with incidence rates surpassing pre-pandemic levels. Notably, changes in the circulation of influenza A(H3N2) and influenza B were observed, alongside the presence of other respiratory viruses such as RSV and rhinovirus. Conclusions. This study underscores the importance of real-time surveillance, transparent data sharing, and advanced visualization tools in guiding public health responses. By integrating lessons from COVID-19, we highlight the necessity of standardized surveillance frameworks to enhance preparedness for future seasonal outbreaks and potential pandemics. Full article

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20 pages, 2636 KiB

Open AccessReview

COVID-19 and Parasitic Co-Infection: A Hypothetical Link to Pulmonary Vascular Disease

by Peter S. Nyasulu, Jacques L. Tamuzi, Rudolf K. F. Oliveira, Suellen D. Oliveira, Nicola Petrosillo, Vinicio de Jesus Perez, Navneet Dhillon and Ghazwan Butrous

Infect. Dis. Rep. 2025, 17(2), 19; https://doi.org/10.3390/idr17020019 - 27 Feb 2025

Abstract

Background/Objectives: Before the Coronavirus disease 2019 (COVID-19) era, the global prevalence of pulmonary arterial hypertension (PAH) was between 0.4 and 1.4 per 100,000 people. The long-term effects of protracted COVID-19 associated with pulmonary vascular disease (PVD) risk factors may increase this prevalence. [...] Read more.

Background/Objectives: Before the Coronavirus disease 2019 (COVID-19) era, the global prevalence of pulmonary arterial hypertension (PAH) was between 0.4 and 1.4 per 100,000 people. The long-term effects of protracted COVID-19 associated with pulmonary vascular disease (PVD) risk factors may increase this prevalence. According to preliminary data, the exact prevalence of early estimates places the prevalence of PVD in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at 22%, although its predictive value remains unknown. PVD caused by COVID-19 co-infections is understudied and underreported, and its future impact is unclear. However, due to COVID-19/co-infection pathophysiological effects on pulmonary vascularization, PVD mortality and morbidity may impose a genuine concern—both now and in the near future. Based on reported studies, this literature review focused on the potential link between COVID-19, parasitic co-infection, and PVD. This review article also highlights hypothetical pathophysiological mechanisms between COVID-19 and parasitic co-infection that could trigger PVD. Methods: We conducted a systematic literature review (SLR) searching peer-reviewed articles, including link between COVID-19, parasitic co-infection, and PVD. Results: This review hypothesized that multiple pathways associated with pathogens such as underlying schistosomiasis, human immunodeficiency virus (HIV), pulmonary tuberculosis (PTB), pulmonary aspergillosis, Wuchereria bancrofti, Clonorchis sinensis, paracoccidioidomycosis, human herpesvirus 8, and scrub typhus coupled with acute or long COVID-19, may increase the burden of PVD and worsen its mortality in the future. Conclusions: Further experimental studies are also needed to determine pathophysiological pathways between PVD and a history of COVID-19/co-infections. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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18 pages, 559 KiB

Open AccessArticle

Utilizing an Educational Intervention to Enhance Influenza Vaccine Literacy and Acceptance Among Minoritized Adults in Southern Californian Vulnerable Communities in the Post-COVID-19 Era

by Jacinda C. Abdul-Mutakabbir, Raheem Abdul-Mutakabbir and Samuel J. Casey

Infect. Dis. Rep. 2025, 17(2), 18; https://doi.org/10.3390/idr17020018 - 26 Feb 2025

Abstract

Background/Objectives: Since the COVID-19 pandemic began, vaccination rates for preventable diseases, including influenza, have significantly dropped among racially and ethnically minoritized (REM) individuals in the United States. This study explored the effects of a community-based educational intervention designed to improve influenza vaccine literacy [...] Read more.

Background/Objectives: Since the COVID-19 pandemic began, vaccination rates for preventable diseases, including influenza, have significantly dropped among racially and ethnically minoritized (REM) individuals in the United States. This study explored the effects of a community-based educational intervention designed to improve influenza vaccine literacy and acceptance among vulnerable REM individuals. Methods: The intervention included four 45 min interactive educational sessions on the influenza vaccine. The session attendees (18+) were invited to participate in a pre-/post-intervention study where an anonymous survey measured their post-COVID-19 pandemic attitudes, knowledge, and behaviors regarding the influenza virus and vaccine. To assess the effect of the intervention on vaccine literacy, we used a Mann–Whitney U test to test for differences between the pre-/post-intervention survey responses to seven knowledge-based questions. Descriptive statistics were employed to assess the impact of intervention on vaccine acceptance. Results: A total of 116 participants completed the pre-intervention survey, and 90 (78%) completed the post-intervention survey. All (100%) identified as REM, and 99% lived in highly vulnerable areas. Only 43% believed they were at risk for viral infection before the intervention, but 60% said the intervention helped them reassess their risk. We found significant differences in vaccine literacy when comparing the pre-/post-intervention survey responses, particularly regarding guideline-based vaccine recommendations (p < 0.05). Before the intervention, 65% of the participants indicated a high likelihood of receiving the influenza vaccine. In contrast, after the intervention, 81% of respondents indicated a high likelihood of being vaccinated, and 72% indicated that they were “extremely likely” to receive the immunization. Conclusions: Community-based educational interventions can have a positive impact on influenza vaccine literacy and acceptance among vulnerable REM populations in the post-COVID-19 era. Full article

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9 pages, 1143 KiB

Open AccessArticle

Effectiveness and Tolerability of Dual Antiviral Therapy in Immunosuppressed Patients with Protracted SARS-CoV-2 Infection

by Giovanna Travi, Francesco Peracchi, Marco Merli, Emanuele Ravano, Anna Frustaci, Marina Deodato, Diana Fanti, Alice Nava, Valeriana Colombo, Nicholas Brian Bana, Carlotta Rogati, Alessandro Raimondi, Cristina Moioli, Anna Maria Pazzi, Marta Vecchi, Davide Motta, Roberto Rossotti, Chiara Oltolini, Fulvio Crippa, Enrico Minetti, Chiara Vismara, Roberto Cairoli and Massimo Puoti Show full author list Hide full author list

Infect. Dis. Rep. 2025, 17(2), 17; https://doi.org/10.3390/idr17020017 - 26 Feb 2025

Abstract

Background: Immunosuppressed patients still exhibit a high mortality rate due to SARS-CoV-2 infection, up to 21%. Persistent viral load replication and protracted viral symptoms result in a high risk of developing pneumonia, a potential risk of antiviral resistance, and a subsequent delay of [...] Read more.

Background: Immunosuppressed patients still exhibit a high mortality rate due to SARS-CoV-2 infection, up to 21%. Persistent viral load replication and protracted viral symptoms result in a high risk of developing pneumonia, a potential risk of antiviral resistance, and a subsequent delay of onco-hematological treatments. Methods: Hematological patients and kidney transplant patients with SARS-CoV-2 infection, treated at GOM Niguarda Hospital (Milan) with combined antiviral therapy (remdesivir plus nirmatrelvir/ritonavir at standard doses) between November 2022 and March 2024, were retrospectively reviewed. Results: Thirty-four patients were analyzed. Twenty-four (71%) patients had pneumonia. The median duration of SARS-CoV-2 positivity before antiviral treatment was 40 (10–34) days. The median treatment duration was 11 (10–10) days. All patients went through clinical resolution. Thirteen patients were exposed to a new immune-chemotherapy cycle early after antiviral treatment (median 13, IQR 6–12 days), while five resumed a standard immunosuppressive regimen immediately after viral clearance. No relapse or recurrence of symptoms was reported for up to 226 (106–318) days of follow-up. Antiviral therapy was well tolerated, and no adverse events were observed. The 30-day overall survival was 94%, while the 90-day survival was 88%. No patient died of SARS-CoV-2 infection. Conclusions: The administration of nirmatrelvir/ritonavir and remdesivir lead to the complete resolution of SARS-CoV-2 pneumonia with no side effects in this cohort. The combination of these two antivirals may be a safe option in immunosuppressed population at risk of severe complications and prolonged SARS-CoV-2 infection in order to treat severe clinical presentation and to avoid viral recurrence after chemotherapy. Full article

(This article belongs to the Section Viral Infections)

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14 pages, 1444 KiB

Open AccessArticle

Imported Typhoid Fever in Romania Between 2010 and 2024

by Dragos Stefan Lazar, George Sebastian Gherlan, Simin Aysel Florescu, Corneliu Petru Popescu and Maria Nica

Infect. Dis. Rep. 2025, 17(2), 16; https://doi.org/10.3390/idr17020016 - 25 Feb 2025

Abstract

Background/Objectives: Although a “forgotten” disease in developed countries, typhoid fever remains a significant global health problem, especially in regions with inadequate sanitation and overcrowding. Despite medical advances, this systemic bacterial infection, caused by Salmonella Typhi, continues to affect millions worldwide. Accurate diagnosis and [...] Read more.

Background/Objectives: Although a “forgotten” disease in developed countries, typhoid fever remains a significant global health problem, especially in regions with inadequate sanitation and overcrowding. Despite medical advances, this systemic bacterial infection, caused by Salmonella Typhi, continues to affect millions worldwide. Accurate diagnosis and timely treatment are crucial to prevent severe complications and mortality. Even though antibiotic therapy is effective, the emergence of drug-resistant strains is a growing challenge. Methods: We present a series of cases encountered in a tertiary infectious disease hospital in Romania over 15 years. Results: The hospitalised patients were mainly from Sub-Saharan Africa and the Indian subcontinent; the median time between the onset of the first symptoms and hospital admission was 15 days. The symptoms encountered along with fever were headache, chills, cough, diarrhoea and tachycardia, an unusual feature in the clinical picture of this disease. Aneosinophilia (the absence of peripheral eosinophilic granulocytes) was the most frequently encountered laboratory finding, followed by increased serum transaminases and inflammatory syndrome. Conclusions: S. Typhi was generally identified from blood culture, demonstrating, except in one case, resistance to ciprofloxacin and, in several cases, multi-drug resistance (MDR). In this series of cases, all strains were sensitive to ceftriaxone. Full article

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13 pages, 276 KiB

Open AccessReview

Genetics of Long COVID: Exploring the Molecular Drivers of Persistent Pulmonary Vascular Disease Symptoms

by Sana Ayyoub, Navneet Kaur Dhillon and Olga Tura-Ceide

Infect. Dis. Rep. 2025, 17(1), 15; https://doi.org/10.3390/idr17010015 - 13 Feb 2025

Abstract

Background/ Objectives: Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC) are symptoms that manifest despite passing the acute infection phase. These manifestations encompass a wide range of symptoms, the most common being fatigue, shortness of breath, and cognitive dysfunction. Genetic predisposition is [...] Read more.

Background/ Objectives: Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC) are symptoms that manifest despite passing the acute infection phase. These manifestations encompass a wide range of symptoms, the most common being fatigue, shortness of breath, and cognitive dysfunction. Genetic predisposition is clearly involved in the susceptibility of individuals to developing these persistent symptoms and the variation in the severity and forms. This review summarizes the role of genetic factors and gene polymorphisms in the development of major pulmonary vascular disorders associated with long COVID. Methods: A comprehensive review of current literature was conducted to examine the genetic contributions to pulmonary complications following SARS-CoV-2 infection. Studies investigating genetic polymorphisms linked to pulmonary hypertension, pulmonary thromboembolism, and pulmonary vascular endothelialitis were reviewed and summarized. Results: Findings show that specific genetic variants contribute to increased susceptibility to pulmonary vascular complications in long COVID patients. Variants associated with endothelial dysfunction, coagulation pathways, and inflammatory responses have been implicated in the development of pulmonary hypertension and thromboembolic events. Genetic predispositions influencing vascular integrity and immune responses appear to influence disease severity and progression. Conclusions: Understanding these mechanisms and genetic predispositions could pave the way for targeted therapeutic interventions to alleviate the burden on patients experiencing long COVID. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

10 pages, 916 KiB

Open AccessCase Report

Atypical Hemolytic Uremic Syndrome Associated with BNT162b2 mRNA COVID-19 Vaccine in a Kidney Transplant Recipient: A Case Report and Literature Review

by Eleonora Francesca Pattonieri, Marilena Gregorini, Maria Antonietta Grignano, Tefik Islami, Gioacchino D’Ambrosio, Gianluigi Ardissino and Teresa Rampino

Infect. Dis. Rep. 2025, 17(1), 14; https://doi.org/10.3390/idr17010014 - 11 Feb 2025

Abstract

Case Report: We report a case of a 37-year-old female with kidney transplant, who was admitted at our hospital due to worsening renal function, nephrotic proteinuria, and anemia developed 21 days after the second dose of BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Laboratory tests revealed [...] Read more.

Case Report: We report a case of a 37-year-old female with kidney transplant, who was admitted at our hospital due to worsening renal function, nephrotic proteinuria, and anemia developed 21 days after the second dose of BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury. Given the clinical picture of Thrombotic Micro-angiopathy (TMA) and severe renal impairment, plasma exchange (PEX) and dialysis were immediately started. Laboratory workup showed low C3 and C4 levels, normal activity of ADAMTS13, and the absence of anti-factor H antibodies. Molecular biology investigations revealed a heterozygous variant in exon 22 (SCR20) of the CFH gene (c.3628C>T; p.Arg1210Cys) described as an atypical Hemolytic Uremic Syndrome (aHUS) causative mutation. Our patient completed two sessions of PEX followed by eculizumab treatment with hematological improvement but no recovery of renal function. This is the first reported case of aHUS triggered by SARS-CoV-2 vaccination in a kidney transplant patient without recovery of renal function. Conclusion: Although rare, clinicians should be aware of possible nephrological complications that may appear after vaccination. Full article

(This article belongs to the Section Immunology and Vaccines)

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Diagnostic workup. The red “NO” indicates the excluded diagnostic hypotheses. “HGB”: hemoglobin; “PLT”: Platelets; “LDH”: Lactate DeHydrogenase; “Ab”: Antibody; “NEG”: Negative; “TTP”: Thrombotic Thrombocytopenic purpura; “HUS”: Hemolytic Uremic Syndrome; “STX”: Shiga-like ToXin; “STEC-HUS”: Shiga Toxin-producing Escherichia Coli-associated Hemolytic Uremic Syndrome; “aHUS”: atypical Hemolytic Uremic Syndrome; “CMV”: Cytomegalovirus; “HCV”: Hepatitis C Virus; “EBV”: Epstein-Bar Virus; “HIV”: Human Immunodeficiency Virus; “SARS-CoV-2”: Severe Acute Respiratory Syndrome CoronaVirus-2; “S. Pneumoniae”: Streptococcus Pneumoniae; “ANA”: AntiNuclear Antibody; “ds-DNA Ab”: double stranded DNA Antibody; “ACA”: Anti-Cardiolipin Antibody; “β2GPI Ab”: β2 Glycoprotein I Antibody; “c- and p-ANCA”: cytoplasmic and perinuclear AntiNeutrophil Cytoplasmic Antibody; “LAC”: Lupus AntiCoagulant; “cAMBR”: chronic active Antibody-Mediated Rejection. Full article ">Figure 2
Molecular pathways of aHUS in our case. (1) The mRNA vaccine activates the complement system, leading to the formation of the (2) Membrane Attack Complex (MAC) which causes endothelial cell injury, a decrease in antithrombotic substances (PGI2 and NO), and platelet activation. (3) Chronic vascular rejection (cABMR) makes the endothelium more susceptible to thrombus formation. (4) The mutation of CFH, a key protein in the regulation of the complement system, causes an overproduction of the anaphylatoxin C5a. C5a stimulates both (5) the expression of adhesion molecules on endothelial cells and (6) the activation of neutrophils with the release of NETs. (7) NETs enhance the state of hypercoagulation indirectly through the release of inflammatory cytokines and direct binding to coagulation factors and platelets. Created with BioRender.com. Full article ">

9 pages, 8367 KiB

Open AccessCase Report

A Report of Two Uncommon Cases of Mycobacterium chelonae with Localized and Disseminated Skin and Soft Tissue Infection

by Libardo Rueda Prada, Marko Gorasevic, Tatjana Gavrancic, Aayushi J. Rajani, Jason C. Sluzevich, Sangeeta Nair-Collins and Ravi V. Durvasula

Infect. Dis. Rep. 2025, 17(1), 13; https://doi.org/10.3390/idr17010013 - 8 Feb 2025

Abstract

Background: Mycobacterium chelonae is a ubiquitous, rapidly growing, nontuberculous mycobacteria that primarily affects immunocompromised patients. The most common presentation is an atypical, chronic skin and soft tissue infection. Due to its high resistance rate, early diagnosis based on clinical suspicion, risk factor [...] Read more.

Background: Mycobacterium chelonae is a ubiquitous, rapidly growing, nontuberculous mycobacteria that primarily affects immunocompromised patients. The most common presentation is an atypical, chronic skin and soft tissue infection. Due to its high resistance rate, early diagnosis based on clinical suspicion, risk factor assessment, and exposure history is crucial for initiating appropriate multi-drug treatment. Methods: We report two cases of M. chelonae skin and soft tissue infections, one presenting with localized disease and the other with disseminated involvement. One case had a specific exposure to fish-related activities, a risk factor more commonly associated with Mycobacterium marinum infections rather than M. chelonae. Results: One of the cases involved osteomyelitis and tenosynovitis which are rare presentations of M. chelonae infection. While the limbs are the most commonly affected sites in disseminated M. chelonae infections, involvement of the lower extremities, as seen in one of our cases, is rarely reported. Treatment posed challenges due to antibiotic resistance and patient tolerance. However, in both cases where follow up was possible, prolonged multi-drug therapy led to complete resolution of the lesions. Conclusions: These cases highlight the importance of considering M. chelonae in chronic skin and soft tissue infections, especially in patient with relevant exposures or immunosupression. Uncommon presentations require a high index of suspicion. Given the challenges of treatment resistance and patient tolerance, prolonged multi-drug therapy remains essential for successful outcomes. Full article

(This article belongs to the Section Tuberculosis and Mycobacteriosis)

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(A) Dorsum of the right hand with a 2 × 2 cm non-fluctuating nodule between the second and third metacarpals. (B) Pinpoint fluctuant lesion in distal phalanx of the right index finger. (C) H&E stain ×10. Sparse interstitial lymphohistiocytic infiltrate with neutrophils and dilated papillary dermal lymphatics. (D) AFB stain ×40. No acid-fast bacilli seen. Full article ">Figure 2
(A) Dorsum of the left hand with surrounding erythema and swelling predominant in the left index finger. (B) H&E stain ×16. Superficial dermal ulcer with necrosis and brisk superficial neutrophilic inflammation without vasculitis. (C) AFB stain ×25. No acid-fast bacilli seen. Full article ">Figure 3
(A) Area of swelling and redness in the left index finger with an area of fluctuance at its base. (B) H&E stain ×4. Surgical pathology showing subcutaneous abscess with basophilic fat necrosis and dermal fibrosis. (C) AFB stain ×80 with clusters of rod-shaped organisms (circle) within the neutrophilic infiltrate. Full article ">Figure 4
(A) Front view of left leg with scattered violaceous-dusky, maculopapular rash. (B) Lateral view of left leg with same described rash and large chronic ulcerated necrotic plaque. (C) Right upper extremity with scattered plaques with a violaceous center. Full article ">Figure 5
(A) H&E stain ×10. Florid neutrophilic lobular panniculitis with granulomatous inflammation. (B) AFB stain ×80 numerous rod-shaped organisms (circled) in areas of suppuration within the subcutis. (C) H&E stain ×13. Basophilic dermal necrosis with numerous neutrophils with extensive leukocytoclasia and early epidermal necrosis. (D) AFB stain ×25. No acid-fast bacilli seen. Full article ">

24 pages, 1857 KiB

Open AccessReview

Immune Alterations and Viral Reservoir Atlas in SIV-Infected Chinese Rhesus Macaques

by Julien A. Clain, Morgane Picard, Henintsoa Rabezanahary, Sonia André, Steven Boutrais, Ella Goma Matsetse, Juliette Dewatines, Quentin Dueymes, Elise Thiboutot, Gina Racine, Calaiselvy Soundaramourty, Fabrizio Mammano, Pierre Corbeau, Ouafa Zghidi-Abouzid and Jérôme Estaquier

Infect. Dis. Rep. 2025, 17(1), 12; https://doi.org/10.3390/idr17010012 - 6 Feb 2025

Abstract

Background/Objectives: Over the last decades, our projects have been dedicated to clarifying immunopathological and virological events associated with Human Immunodeficiency Virus (HIV) infection. Methods: By using non-human primate models of pathogenic and non-pathogenic lentiviral infections, we aimed at identifying the cells and tissues [...] Read more.

Background/Objectives: Over the last decades, our projects have been dedicated to clarifying immunopathological and virological events associated with Human Immunodeficiency Virus (HIV) infection. Methods: By using non-human primate models of pathogenic and non-pathogenic lentiviral infections, we aimed at identifying the cells and tissues in which the virus persists, despite antiretroviral therapy (ART). Indeed, the eradication of viral reservoirs is a major challenge for HIV cure. Results: We present a series of results performed in rhesus macaques of Chinese origin deciphering the virological and immunological events associated with ART that can be of interest for people living with HIV. Conclusions: This model could be of interest for understanding in whole body the clinical alteration that persist despite ART. Full article

(This article belongs to the Special Issue Prevention, Diagnosis and Treatment of Infectious Diseases)

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10 pages, 467 KiB

Open AccessArticle

Impact of Severity of COVID-19 in TB Disease Patients: Experience from an Italian Infectious Disease Referral Hospital

by Virginia Di Bari, Carlotta Cerva, Raffaella Libertone, Serena Maria Carli, Maria Musso, Delia Goletti, Alessandra Aiello, Antonio Mazzarelli, Angela Cannas, Giulia Matusali, Fabrizio Palmieri, Gina Gualano and on behalf of the TB-INMI Working Group

Infect. Dis. Rep. 2025, 17(1), 11; https://doi.org/10.3390/idr17010011 - 5 Feb 2025

Abstract

Background/Objectives: Tuberculosis (TB) remains a major global health issue, further complicated by the COVID-19 pandemic. This study assesses the clinical outcomes of TB-COVID-19-coinfected patients compared to those with TB disease alone at an Italian infectious disease hospital during the pandemic’s first two years. [...] Read more.

Background/Objectives: Tuberculosis (TB) remains a major global health issue, further complicated by the COVID-19 pandemic. This study assesses the clinical outcomes of TB-COVID-19-coinfected patients compared to those with TB disease alone at an Italian infectious disease hospital during the pandemic’s first two years. Methods: Retrospective data analysis was conducted on TB patients hospitalized from March 2020 to June 2022. Data included demographics, comorbidities, clinical characteristics, and outcomes. Coinfection was defined as concurrent TB disease and SARS-CoV-2 infection. Statistical methods included Fisher’s exact test and Mann–Whitney statistics. Results: Of 267 TB patients, 25 (9.4%) had concurrent COVID-19 infection. The TB-COVID-19 group showed higher rates of diabetes and cough. Acute respiratory failure was more prevalent in coinfected patients (odds ratio, 5.99), and coinfection was associated with worse outcomes compared to TB alone (odds ratio, 0.15). Despite similar socio-demographic factors, the coexistence of TB and COVID-19 led to exacerbated respiratory failure and increased mortality. Conclusions: Coinfection with TB and COVID-19 significantly increases the risk of acute respiratory failure and poor outcomes. Clinicians should be aware of this risk, especially in patients with pulmonary involvement. Although specific protocols are unavailable, prompt diagnosis and management may enhance outcomes. Additional research is necessary to understand the long-term effects of TB-COVID-19 coinfection, particularly as COVID-19 becomes endemic. Full article

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15 pages, 1885 KiB

Open AccessArticle

Plasma Lipopolysaccharide-Binding Protein (LBP) Is Induced in Critically Ill Females with Gram-Negative Infections—Preliminary Study

by Alexander Utrata, Niklas Schmidtner, Patricia Mester, Stephan Schmid, Martina Müller, Vlad Pavel and Christa Buechler

Infect. Dis. Rep. 2025, 17(1), 10; https://doi.org/10.3390/idr17010010 - 28 Jan 2025

Abstract

Background/Objectives: Men are more susceptible to sepsis than women, but the underlying pathways have not been fully clarified. Lipopolysaccharide-binding protein (LBP) is an acute-phase protein that is highly elevated in sepsis. Experimental evidence shows that LBP increases to a much greater extent in [...] Read more.

Background/Objectives: Men are more susceptible to sepsis than women, but the underlying pathways have not been fully clarified. Lipopolysaccharide-binding protein (LBP) is an acute-phase protein that is highly elevated in sepsis. Experimental evidence shows that LBP increases to a much greater extent in male than in female mice following exposure to lipopolysaccharide. However, gender-specific studies of circulating LBP levels in sepsis patients are scarce. Methods: In the plasma of 189 patients with systemic inflammatory response syndrome (SIRS), sepsis, and septic shock, LBP levels were measured by enzyme-linked immunosorbent assay. Results: Patients with liver cirrhosis had reduced circulating LBP levels, regardless of gender. Further analysis within the non-cirrhotic patients showed no significant differences in LBP levels between sexes in patients with SIRS, sepsis, and septic shock. Ventilation, dialysis, and vasopressor therapy had no effect on LBP levels in either sex. A positive correlation between LBP and C-reactive protein was observed in the total cohort, males, and females. Infection with Gram-negative or Gram-positive bacteria had no effect on plasma LBP levels in males. However, female patients with Gram-negative infection had increased plasma LBP levels compared to females with negative and Gram-positive blood cultures, and 70 µg/mL LBP discriminates Gram-negative infections in females with a sensitivity of 88% and a specificity of 74%. Infection with SARS-CoV-2 did not change plasma LBP levels in either men or women. Female patients who did not survive had lower plasma LBP levels compared to female survivors and male non-survivors. Conclusions: This investigation highlights the influence of sex on plasma LBP levels in SIRS/sepsis patients, suggesting that LBP could be a sex-specific biomarker in critically ill patients. Full article

(This article belongs to the Section Infection Prevention and Control)

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LBP in plasma of controls and SIRS/sepsis patients. (a) Plasma LBP levels of the 43 controls and the 189 SIRS/sepsis patients. The statistical test used: Mann–Whitney-U-test; (b) Plasma LBP levels of the 18 female controls, the 51 female SIRS/sepsis patients, the 25 male controls, and the 138 male SIRS/sepsis patients. Statistical test used: Kruskal-Wallis test.*** p < 0.001. Full article ">Figure 2
LBP in plasma of female and male SIRS/sepsis patients without (No) and with (Yes) liver cirrhosis. Statistical test used: Kruskall–Wallis test ** p < 0.01. Full article ">Figure 3
Plasma LBP levels of SIRS/sepsis patients without liver cirrhosis are categorized according to the SIRS criteria and the Sepsis-3 definition. Statistical test used: Kruskall–Wallis test. Full article ">Figure 4
LBP in plasma of patients with SIRS/sepsis stratified for type of bacterial infection. (a) LBP in plasma of female and male patients with SIRS/sepsis stratified for type of bacterial infection; Statistical test used: Kruskal–Wallis test; (b) Receiver operating characteristic for discrimination of females with Gram-negative infections from those with no or Gram-positive infections by plasma LBP. * p < 0.05, ** p < 0.01. Full article ">Figure 5
Association of plasma LBP levels with survival. Plasma LBP levels of the female and male SIRS/sepsis patients who survived and the patients who did not survive. Full article ">

11 pages, 917 KiB

Open AccessArticle

Mpox Cases in Serbia, 2022

by Petar Đurić, Verica Jovanović, Mitra B. Drakulović, Dragana Plavša, Jovan Malinić, Aleksandar Medarević, Jelena Protić and Nana Mebonia

Infect. Dis. Rep. 2025, 17(1), 9; https://doi.org/10.3390/idr17010009 - 27 Jan 2025

Abstract

Background: On 23 July 2022, the World Health Organization (WHO) declared the mpox multi-country outbreak as a Public Health Emergency of International Concern. This study aimed to identify the epidemiological and clinical characteristics of confirmed mpox cases reported in Serbia in 2022. Methods: [...] Read more.

Background: On 23 July 2022, the World Health Organization (WHO) declared the mpox multi-country outbreak as a Public Health Emergency of International Concern. This study aimed to identify the epidemiological and clinical characteristics of confirmed mpox cases reported in Serbia in 2022. Methods: The mpox WHO case definition was used. Incidence rates (IRs) and incidence rate ratios (IRRs) by age groups and nomenclature of territorial units for statistics level 3 (NUTS-3) with 95% confidence intervals (CIs) were calculated. Results: Between June and October 2022, 43 laboratory-confirmed cases were reported. All were unvaccinated males, with the mean age of 34 (±7.4) years. Out of the total, 72.1% cases were men who have sex with men (MSM), who reported sexual intercourse either with multiple or unknown partners (p < 0.01). Fifteen cases (34.9%) lived with HIV, mostly in the 30–39 age group (p = 0.023). People living in Belgrade City NUTS-3 were six times more likely to become infected compared to South Backa citizens (IRR: 6.03, 95% CI: 1.47–25.53). Conclusions: In Serbia, mpox mainly affected MSM aged 30–39 and living in urban areas. Health promotion and vaccine implementation should be prioritized in populations with a higher risk. Full article

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8 pages, 465 KiB

Open AccessArticle

Cytomegalovirus Blood DNAemia in Patients with Severe SARS-CoV-2 Pneumonia

by Jean-Baptiste Mesland, Christine Collienne, Virginie Montiel, Alexis Werion, Philippe Hantson, Xavier Wittebole, Pierre-François Laterre and Ludovic Gerard

Infect. Dis. Rep. 2025, 17(1), 8; https://doi.org/10.3390/idr17010008 - 26 Jan 2025

Abstract

Introduction: Cytomegalovirus (CMV) DNAemia has been described in critically ill patients, including patients with severe acute respiratory syndrome-coronavirus2 (SARS-CoV-2) infection. Our objective is to evaluate the prevalence and clinical impact of CMV DNAemia among patients undergoing invasive mechanical ventilation (IMV) for severe SARS-CoV-2 [...] Read more.

Introduction: Cytomegalovirus (CMV) DNAemia has been described in critically ill patients, including patients with severe acute respiratory syndrome-coronavirus2 (SARS-CoV-2) infection. Our objective is to evaluate the prevalence and clinical impact of CMV DNAemia among patients undergoing invasive mechanical ventilation (IMV) for severe SARS-CoV-2 infection and to explore the association between CMV DNAemia levels and clinical outcomes. Methods: In this retrospective monocentric study, we included patients admitted in a tertiary ICU for severe COVID-19 and who required IMV. We aimed to compare clinical and demographic variables between patients with and without CMV DNAemia. Univariate and Cox regression analyses were performed to identify factors associated with CMV DNAemia. Results: During the study period, CMV blood DNAemia occurred in 30/135 patients (22%). Patients with CMV blood DNAemia had longer ICU and hospital length of stay, as well as longer duration of IMV, and were more likely to have received dexamethasone. However, there was no significant difference in ICU mortality between patients with and without CMV DNAemia (64.8% vs. 56.7%, p = 0.42). The Cox regression analysis showed that dexamethasone was the only factor independently associated with CMV blood DNAemia (HR 4.23 [1.006–17.792], p = 0.049). Conclusions: In patients with severe SARS-CoV-2 pneumonia requiring IMV, CMV DNAemia is common and associated with prolonged ventilation and increased LOS but not with increased mortality. Full article

(This article belongs to the Topic Post COVID-19: Latest Advances, Challenges and Methodologies)

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12 pages, 1091 KiB

Open AccessArticle

Safety and Efficacy of a 48-Month Efinaconazole 10% Solution Treatment/Maintenance Regimen: 24-Month Daily Use Followed by 24-Month Intermittent Use

by Aditya K. Gupta and Elizabeth A. Cooper

Infect. Dis. Rep. 2025, 17(1), 7; https://doi.org/10.3390/idr17010007 - 13 Jan 2025

Abstract

Background/Objectives: In an 18- to 24-month Treatment Phase with once-daily efinaconazole 10% solution, subjects with onychomycosis showed an increased rate of cure at Month 24 versus the phase III trials. In order to further improve efficacy, we initiated an extended intermittent efinaconazole Maintenance [...] Read more.

Background/Objectives: In an 18- to 24-month Treatment Phase with once-daily efinaconazole 10% solution, subjects with onychomycosis showed an increased rate of cure at Month 24 versus the phase III trials. In order to further improve efficacy, we initiated an extended intermittent efinaconazole Maintenance Phase with use 2–3 times weekly for an additional 24 months from Month 24 to Month 48. These are the first data presented for a 48-month efinaconazole use period. Methods: For patients completing 18–24 months of once-daily efinaconazole, the target great toenail from the Treatment Phase was graded as ‘Clinical Cure’ (≤10% affected area) or ‘No Clinical Cure’ (>10% affected area) at Month 24. Mycological and clinical outcomes were assessed every 4 months from Month 24 to Month 48. There were 35 patients who enrolled in the extension and continued intermittent efinaconazole use to Month 48. Patients with ‘Clinical Cure’ at M24 were reviewed for sustained cure at M48; patients with ‘No Clinical Cure’ were reviewed for development of ‘Cure’ at M48. All patients were reviewed at all visits for adverse events that may be related to efinaconazole use. Results: ‘Clinical Cure’ was found in 6 of 35 enrolled patients at Month 24, and clinical cure status was sustained to Month 48 with intermittent efinaconazole maintenance use. For 29 patients with ‘No Clinical Cure’, 3/29 achieved ‘Clinical Cure’ status at Month 48 with intermittent efinaconazole. Effective Cure and Complete Cure rates improved over the maintenance period to Month 48 in subjects without clinical cure at Month 24. Younger patients showed higher cure rates over the maintenance period, but age group cure differences did not reach statistical significance in this dataset, and 49% of the ≥70-year population had at least a 20% reduction in nail area with maintenance therapy to Month 48. There was only 1 case of possible efinaconazole application site reaction in the Intermittent Maintenance Period to Month 48; prolonged efinaconazole use to Month 48 does not appear to increase the risk of reaction. Efinaconazole use periods are associated with very low positive culture rates in this dataset, including typical contaminant organisms, suggesting efinaconazole presence in the nail plate is providing prophylactic therapy. Conclusions: Intermittent efinaconazole may provide suitable prophylaxis of onychomycosis relapse. Prolonged efinaconazole therapy to Month 48 appears to be safe for all ages and can continue to provide prophylaxis of onychomycosis with Intermittent Maintenance use beyond Month 24 to Month 48. Full article

(This article belongs to the Section Fungal Infections)

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15 pages, 2735 KiB

Open AccessArticle

Etiological Insights and the Role of Individual Factors in Infectious Spondylodiscitis

by Diana Elena Vulpe, Dana-Georgiana Nedelea, Serban Dragosloveanu, Oana Sandulescu and Cristian Scheau

Infect. Dis. Rep. 2025, 17(1), 6; https://doi.org/10.3390/idr17010006 - 10 Jan 2025

Abstract

Objectives: Spondylodiscitis can be caused by various microorganisms and has shown a continuous rise in incidence and mortality. The purpose of our study was to analyze the demographic and laboratory data, as well as comorbidities of patients that were surgically treated for spondylodiscitis [...] Read more.

Objectives: Spondylodiscitis can be caused by various microorganisms and has shown a continuous rise in incidence and mortality. The purpose of our study was to analyze the demographic and laboratory data, as well as comorbidities of patients that were surgically treated for spondylodiscitis in our hospital. The causative pathogens involved in the etiology of spinal infections were also assessed. Methods: The study included 92 patients who underwent clinical, radiological, and microbiological analyses including bacterial isolation. According to their culture results, patients were divided into three groups: negative results (n = 29), positive results with Mycobacterium tuberculosis (M. tb.) (n = 26), and positive results with other pathological agents (n = 37). Results: Patients with M. tb. had a significantly lower body mass index (p = 0.022) and were significantly younger (p = 0.024) than the others. The analysis of the complete blood work showed significant differences between the groups regarding fibrinogen levels (p = 0.023), C-reactive protein (p = 0.009), and erythrocyte sedimentation rates (p = 0.042). Results also showed significant differences (p = 0.023) for patients with diabetes mellitus who were more prone to a tuberculosis etiology for their spondylodiscitis compared with patients without the disease. Conclusions: These findings have important implications for adopting individualized treatment strategies underlining the need for identification of patients at high risk for specific causative pathogens. Full article

(This article belongs to the Special Issue Emerging and Re-Emerging Infections: Surveillance, Diagnostics, and Global Health Impacts)

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Figure 1
Schematic representation of the management of microbiological identification from patient samples. All samples are divided into three groups: one used for microscopic identification, one used for cultures on different culture media, and the third one used for enrichment. Full article ">Figure 2
Schematic representation of the microbiological identification and results. An automatic identification of pathogens is used at 24 h, 48 h, and 14 days, followed by the antibiogram done manually with disk diffusion or semi-automatic with minimum inhibitory concentration, according to the latest recommendations by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Full article ">Figure 3
Frankel scale percentage distribution of results between the study groups. Full article ">Figure 4
Reported pain according to the Visual Analogue Scale (VAS) between the study groups with percentage distribution. Full article ">Figure 5
ESR, FBG, and Hb levels between the study groups. ESR = erythrocyte sedimentation rate, FBG = fibrinogen, Hb = hemoglobin. Significant differences (p < 0.05) between groups are marked with *. Circles represent outside values (beyond the lower/upper quartile ± 1.5 times the interquartile range); squares represent far out values (beyond the lower/upper quartile ± 3 times the interquartile range). Note: three extreme outliers were excluded from the CRP graph. Full article ">

13 pages, 1200 KiB

Open AccessArticle

Early Use of Liraglutide for the Treatment of Acute COVID-19 Infection: An Open-Label Single-Center Phase II Safety Study with Biomarker Profiling

by Eloara V. M. Ferreira, Rudolf K. F. Oliveira, Reinaldo Salomao, Milena K. C. Brunialti, Martyella B. A. Cardoso, Chien-nien Chen, Lan Zhao and Colm McCabe

Infect. Dis. Rep. 2025, 17(1), 5; https://doi.org/10.3390/idr17010005 - 10 Jan 2025

Abstract

Background: Glucagon-like peptide-1 (GLP-1) agonists are an existing treatment option for patients with insulin-resistant states, which elicit further pleiotropic effects related to immune cell recruitment and vascular inflammation. GLP-1 agonists downregulate the cluster of differentiation 147 (CD147) receptor, one of several receptors for [...] Read more.

Background: Glucagon-like peptide-1 (GLP-1) agonists are an existing treatment option for patients with insulin-resistant states, which elicit further pleiotropic effects related to immune cell recruitment and vascular inflammation. GLP-1 agonists downregulate the cluster of differentiation 147 (CD147) receptor, one of several receptors for the SARS-CoV-2 spike protein that mediate viral infection of host cells. Methods: We conducted an open-label prospective safety and tolerability study including biomarker responses of the GLP-1 agonist Liraglutide, administered for 5 days as an add-on therapy to the standard of care within 48 h of presentation in a cohort of 13 patients hospitalized with COVID-19 pneumonia. Biomarker responses were compared in patients admitted to critical care and those not requiring critical care admission (non-critical group). Results: Liraglutide (0.6 mg, subcutaneously) was well tolerated by all patients and all patients were alive 30 days after diagnosis. Plasma soluble CD147 levels were reduced in the non-critical patient group at day 5 in contrast to critical care-treated patients, who demonstrated an increase in soluble CD147 levels between day 0 and day 5. Patients with milder COVID-19 pneumonia severity also demonstrated improvement in echocardiographic parameters of right and left ventricular function, reduction in plasma Troponin levels, increased CD147 expression on T lymphocytes, and reduction in plasma IL-8. Conclusions: This first-in-disease use of the GLP-1 agonist Liraglutide demonstrates its safety and tolerability in an unselected cohort of patients hospitalized with COVID-19 pneumonia across a range of clinical severities. Full article

(This article belongs to the Special Issue Pulmonary Vascular Manifestations of Infectious Diseases)

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16 pages, 592 KiB

Open AccessSystematic Review

Treatment of Onychomycosis and the Drug–Drug Interactions in Patients with Diabetes Mellitus and Diabetic Foot Syndrome: A Systematic Review

by David Navarro-Pérez, Aroa Tardáguila-García, Sara García-Oreja, Francisco Javier Álvaro-Afonso, Mateo López-Moral and José Luis Lázaro-Martínez

Infect. Dis. Rep. 2025, 17(1), 4; https://doi.org/10.3390/idr17010004 - 9 Jan 2025

Abstract

Background: This systematic review reports on treatments for onychomycosis in patients with diabetes and the drug interactions with other drugs in regard to the complicated diabetic patient profile. Methods: The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist [...] Read more.

Background: This systematic review reports on treatments for onychomycosis in patients with diabetes and the drug interactions with other drugs in regard to the complicated diabetic patient profile. Methods: The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied and the included studies were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) statement and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Searches were conducted in November 2023, using the PubMed (Medline), Scopus, Cochrane Library, and Web of Science databases; studies on antifungal treatments for onychomycosis in patients with diabetes were included. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussions with a third reviewer. This review was registered in PROSPERO (CRD42023442107). Results: The systematic review included 10 studies that met the selection criteria. Mycological cures for mild to moderate onychomycosis were: Ageratina pichinchensis (8.6%), 8% ciclopirox (8.6% 24 weeks and 54.3% 48 weeks), 10% efinaconazole (56.5–58.33%), terbinafine (73–76.6%), itraconazole (88.2%), and laser therapy (43.8%). No serious adverse effects or drug interactions were observed because patients with major complications, such as peripheral vascular disease, diabetic neuropathy, liver and renal dysfunction, poorly controlled diabetes, and severe onychomycosis, were excluded. Conclusions: The antifungal treatments described in the included studies are safe for patients with well-controlled diabetes, but there are currently no studies involving patients with diabetes and multiple complications, such as diabetic foot syndrome or severe onychomycosis. Thus, further research is needed in terms of this patient profile. Full article

(This article belongs to the Special Issue Challenges in the Management of Onychomycosis and Other Superficial Fungal Infections)

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17 pages, 499 KiB

Open AccessArticle

Addressing Vaccine Hesitancy: Validating the PACV Survey for Croatian Parents

by Ana Ćurković and Antonela Matana

Infect. Dis. Rep. 2025, 17(1), 3; https://doi.org/10.3390/idr17010003 - 8 Jan 2025

Abstract

Background/Objectives: Vaccine hesitancy, recognized by the WHO as a significant global health threat, undermines vaccination efforts. This study aimed to adapt and validate the Parent Attitudes about Childhood Vaccines (PACV) Survey for Croatian parents to understand vaccine hesitancy better. Methods: A cross-sectional study [...] Read more.

Background/Objectives: Vaccine hesitancy, recognized by the WHO as a significant global health threat, undermines vaccination efforts. This study aimed to adapt and validate the Parent Attitudes about Childhood Vaccines (PACV) Survey for Croatian parents to understand vaccine hesitancy better. Methods: A cross-sectional study with 1814 Croatian parents was conducted using the PACV survey, translated using a double-back translation method. The psychometrics of the questionnaire were examined, including content validity, dimensionality, construct validity, discriminant validity, and reliability. Confirmatory factor analysis (CFA) assessed the original model’s validity, but the original model fit poorly, prompting exploratory factor analysis (EFA) to identify latent factors. Reliability was measured using Cronbach’s alpha and McDonald’s omega. Results: EFA identified a five-factor model with factors labeled “Safety”, “Schedule”, “Attitudes”, “Behavior”, and “Trust”. Subsequent CFA confirmed this model with acceptable to good fit indices. Discriminant validity was also confirmed. Reliability analyses indicated high internal consistency, with total Cronbach’s alpha at 0.926 and McDonald’s omega at 0.931. Conclusions: The adapted PACV is a valid and reliable tool for identifying vaccine hesitancy among Croatian parents. This study revealed high vaccine hesitancy among Croatian parents, emphasizing the need for targeted interventions. Full article

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