BMC Infectious Diseases[JOURNAL]
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200 papers
Cost-benefit analysis of a potential hepatitis C vaccine: a modelling study.
Houdroge F, Luong P, Zuk J … +6 more , Seaman C, Maynard K, Drummer H, Zimmer-Harwood P, McDonald C, Scott N
BMC Infect Dis · 2026 Jul · PMID 42393549 · Full text
BACKGROUND: The increased availability and cost-reduction of curative hepatitis C therapies and global commitments to elimination through treatment scale-up have made the value proposition for a hepatitis C vaccine uncle...
BACKGROUND: The increased availability and cost-reduction of curative hepatitis C therapies and global commitments to elimination through treatment scale-up have made the value proposition for a hepatitis C vaccine unclear. This study aimed to estimate the health impact and benefit-cost ratio of a potential hepatitis C vaccine under different use scenarios. METHODS: A compartmental model of hepatitis C transmission, disease progression and care cascade was calibrated to 116 countries, with populations stratified by age, sex, injection drug use status and incarceration status. Model inputs were taken from global datasets (e.g. United Nations, Institute of Health Metrics and Evaluation), published academic literature and WHO reports. Scenarios projected for 2026-2050 included: (1) test-treat-vaccinate for people who inject drugs at existing country-specific testing coverage; (2) Scenario 1 plus a one-off test-treat-vaccinate campaign for people who inject drugs; (3) Scenario 2 plus test-treat-vaccinate of prison populations; (4) Scenario 3 plus school-based vaccination; and (5) Scenario 4 plus a five-year adult catch-up campaign. Each scenario's comparator was a counterfactual with equivalent testing and treatment but no vaccine. Only RNA-negative individuals were eligible for the vaccine (i.e. following negative test or post-treatment), and the vaccine was modelled to increase spontaneous clearance rates to 80% for a mean five-year period. Vaccination costs included commodity (assumed US$5 per person in low and lower-middle income settings, with cost ratio of 1:2:15 for upper-middle and high income settings), service delivery and programmatic costs. Benefits included reduced confirmatory testing, treatment, disease management and productivity losses. RESULTS: Globally, scenarios 1-5 averted 1.13-8.76 million infections and 2,490-24,100 deaths. Scenarios 1, 2 and 3 had benefit-cost ratios of 2.86, 3.24, and 2.20 respectively. Scenario 4 only had a benefit-cost ratio > 1 for a vaccine with longer duration of protection. Scenario 5 had a benefit-cost ratio < 1 for all characteristics tested. CONCLUSIONS: In the context of heterogeneous treatment scale-up among countries, a hepatitis C vaccine is likely to have a positive return-on-investment when used to vaccinate populations at highest risk of infection. TRIAL REGISTRATION: Not applicable.
Risk factors for catheter-related infection in patients with acute kidney injury undergoing continuous blood purification.
Ruan J, Wang Q, Zhu N … +1 more , Jiang J
BMC Infect Dis · 2026 Jul · PMID 42387468 · Full text
OBJECTIVE: This study aimed to identify independent risk factors for catheter-related infection (CRI) in patients with acute kidney injury (AKI) undergoing continuous blood purification (CBP) and to provide evidence for...
OBJECTIVE: This study aimed to identify independent risk factors for catheter-related infection (CRI) in patients with acute kidney injury (AKI) undergoing continuous blood purification (CBP) and to provide evidence for its prevention and clinical management. METHODS: A retrospective analysis was conducted in 300 AKI patients who received CBP therapy. The incidence of CRI and the distribution of causative pathogens were analyzed. Patients were categorized into a CRI group (n = 38) and a Non-CRI group (n = 262). Potential risk factors were initially evaluated using univariate analysis and subsequently entered into a multivariate logistic regression model to identify independent predictors of CRI. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of these factors. The 30-day cumulative survival rates were compared using the Kaplan-Meier method with the log-rank test. RESULTS: Among the 300 patients with AKI who underwent CBP, 38 developed CRI, yielding an incidence of 12.67% (38/300). The identified CRIs comprised 18 bloodstream infections (47.37%), 15 exit-site infections (39.47%), and 5 tunnel infections (13.16%). A total of 44 pathogens were isolated, including 29 Gram-positive bacteria (65.91%), with Staphylococcus aureus (14 isolates, 31.82%) and Staphylococcus epidermidis (7 isolates, 15.91%) being the predominant species; and 15 Gram-negative bacteria (34.09%), predominantly Escherichia coli (7, 15.91%) and Pseudomonas aeruginosa (4, 9.09%). Univariate analysis revealed significant differences between the CRI and Non-CRI groups in age, diabetes, hypoproteinemia, catheter insertion site, number of punctures, and catheter dwell time (P < 0.05). Binary logistic regression identified age ≥ 60 years [2.509 (1.074-5.863)], diabetes [2.154 (0.979-4.739)], hypoproteinemia [1.823 (0.827-4.018)], femoral vein insertion [6.430 (2.655-15.569)], punctures ≥ 1 [3.699 (1.597-8.566)], and dwell time ≥ 10 days [6.251 (2.348-16.644)] as independent risk factors for CRI (P < 0.05). ROC curve analysis showed that the AUCs (95% CIs) for age, catheter insertion site, number of punctures, and dwell time were 0.601 (0.508-0.694), 0.681 (0.593-0.770), 0.615 (0.515-0.714), and 0.688 (0.607-0.770), respectively (P < 0.05). The 30-day all-cause mortality rate was significantly higher in the CRI group (23.91%) than in the Non-CRI group (9.84%) (Log-Rank χ² = 8.055, P = 0.005). CONCLUSION: Advanced age, femoral vein catheterization, repeated puncture attempts, and prolonged catheter dwell time were independently associated with an increased risk of CRI in AKI patients undergoing CBP. CRI was associated with markedly poorer 30-day survival, highlighting the importance of early risk assessment and targeted preventive interventions. CLINICAL TRIAL NUMBER: Not applicable.
Seroprevalence of hepatitis C virus infection among individuals attending a private clinic in Luanda, Angola.
Fernando J, Quixari L, Epalanga MS … +14 more , Pascoal MJ, Cassinela EK, Inaculo S, Púcuta E, Sacomboio E, Jandondo D, Sebastião JMK, Silva MLS, Francisco N, Pingarilho M, Abecasis AB, Morais J, Pimentel V, Sebastião CS
BMC Infect Dis · 2026 Jul · PMID 42387461 · Full text
BACKGROUND: Hepatitis C virus (HCV) infection remains a major public health concern in sub-Saharan Africa (SSA), where epidemiological data are limited, particularly in countries such as Angola. Herein, we estimated the...
BACKGROUND: Hepatitis C virus (HCV) infection remains a major public health concern in sub-Saharan Africa (SSA), where epidemiological data are limited, particularly in countries such as Angola. Herein, we estimated the seroprevalence of HCV infection and demographic characteristics related to the infection in a large urban population in Luanda, the capital city of Angola. METHODS: This was a retrospective cross-sectional analysis of existing laboratory records from 5,399 individuals using an immunoassay test for detecting anti-HCV antibodies, between 2020 and 2024 at the MEDIAG Laboratory, a private healthcare facility in Luanda, Angola. RESULTS: Overall, 1.1% (57/5399) of participants were anti-HCV reactive. The mean age of reactive individuals was significantly higher than that of non-reactive participants (47.5 ± 15.7 vs. 37.3 ± 12.5 years, p < 0.001). Young individuals aged 20-30 years (AOR: 0.30, p = 0.003) or 31-40 years (AOR: 0.31, p < 0.001) showed lower odds of anti-HCV reactivity. Males showed numerically higher anti-HCV reactivity (AOR: 1.26, p = 0.407), but this association did not reach statistical significance. Between 2020 and 2024, overall anti-HCV reactivity among tested individuals changed slightly, from 0.9% to 1.1%, without statistical evidence of a temporal increase (p = 0.984). Among the 57 anti-HCV-reactive individuals, changes in the distribution of cases across age groups were observed over time, with the proportion in those under 20 years ranging from 0% to 5.9%, in those aged 20-30 years from 12.5% to 23.5%, and in those over 40 years from 50% to 64.7%, while a decrease was observed in the 31-40 years group (37.5% to 5.9%). Similarly, variations were observed by gender, with females decreasing from 75% to 47.1% and males increasing from 25% to 52.9%. CONCLUSION: Anti-HCV reactivity was more frequent among individuals aged over 40 years. The observed age and gender distributions may help identify groups for further surveillance and targeted screening strategies. However, these findings are based on individuals tested at a private healthcare facility and on anti-HCV antibody reactivity without HCV RNA confirmation, limiting inference regarding active infection and population prevalence. Further population-based studies with HCV RNA confirmation are needed to better estimate the true burden of HCV infection in Angola. CLINICAL TRIAL NUMBER: Not applicable.
Bacterial profile and antimicrobial resistance in patients with pulmonary infection: a retrospective tertiary hospital-based study.
Ulziijargal J, Faermark E, Khenchbish U … +5 more , Bauyrjan T, Erdenebaatar A, Jukhai L, Otgon-Uul Z, Dashtseren I
BMC Infect Dis · 2026 Jul · PMID 42387436 · Full text
BACKGROUND: Pulmonary infections remain a major cause of global morbidity and mortality, particularly in low- and middle-income countries (LMICs). The rapid emergence of antimicrobial resistance (AMR) has significantly l...
BACKGROUND: Pulmonary infections remain a major cause of global morbidity and mortality, particularly in low- and middle-income countries (LMICs). The rapid emergence of antimicrobial resistance (AMR) has significantly limited therapeutic options and increased healthcare burden. This study aimed to investigate the bacterial profile and AMR patterns among patients with confirmed pulmonary infections at a tertiary referral hospital in Mongolia, where data from tertiary care settings and internationally disseminated studies on AMR are still scarce, especially in the context of pulmonary infections. METHODS: A retrospective descriptive study was conducted among patients with pulmonary disorders who submitted respiratory specimens for microbiological analysis at Mongolia-Japan Hospital, Ulaanbaatar, between 2023 and 2024. Data were extracted from the electronic medical record (EMR) system. To avoid duplication bias, only the first bacterial isolate recovered from each patient during a single hospitalization episode was included in the analysis. Antimicrobial resistance phenotypes were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR), or pandrug-resistant (PDR) based on the Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) criteria. Clinical characteristics, bacterial profiles, antimicrobial resistance patterns, and clinical outcomes were analyzed. RESULTS: A total of 354 patients were included, of whom 276/354 (78.0%) had an identified bacterial pathogen. The most frequently isolated organisms were Klebsiella pneumoniae 100/276 (36.2%), Acinetobacter baumannii 47/276 (17.0%), methicillin-resistant Staphylococcus aureus (MRSA) 30/276 (10.9%), and Pseudomonas aeruginosa 17/276 (6.2%). Multidrug resistance was observed in 22/30 (73.3%) of MRSA isolates, while 15/47 (31.9%) of Acinetobacter baumannii isolates were classified as PDR. Patients with cardiovascular disease were significantly more likely to harbor MDR isolates (cOR: 2.669; 95% CI: 1.048-6.796). All-cause hospital mortality was higher among culture-positive than culture-negative patients (21/112 [18.8%] vs. 1/34 [2.9%], p = 0.024). CONCLUSIONS: Gram-negative pathogens, particularly Klebsiella pneumoniae and Acinetobacter baumannii, predominated in pulmonary infections and demonstrated substantial AMR. The high burden of MDR/XDR pathogens highlights major therapeutic challenges and underscores the need for enhanced infection control, antimicrobial stewardship, and ongoing resistance surveillance.
Liver function impairment and associated factors among adult human immunodeficency virus infected individuals on antiretroviral therapy at Hosanna town, Central Ethiopia.
Abebe S, Ataro Z, Husen J … +1 more , Ayana DA
BMC Infect Dis · 2026 Jul · PMID 42387424 · Full text
BACKGROUND: Antiretroviral therapy significantly reduces human immunodeficiency virus-related morbidity and mortality. However, this therapy, along with other factors, can cause liver damage. There is a dearth of evidenc...
BACKGROUND: Antiretroviral therapy significantly reduces human immunodeficiency virus-related morbidity and mortality. However, this therapy, along with other factors, can cause liver damage. There is a dearth of evidence on liver function impairment among human immunodeficiency virus patients receiving antiretroviral therapy in central Ethiopia. This study aimed to assess the prevalence and factors associated with liver function impairment in adult patients infected with human immunodeficiency virus. METHODS: A cross-sectional study among 307 human immunodeficiency virus-positive adults receiving antiretroviral therapy was conducted from December 10, 2023, to March 15, 2024, at Wachamo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Ethiopia. The antiretroviral therapy clinic attendants were recruited consecutively, a structured questionnaire was used to collect sociodemographic data, and additional clinical data were collected from medical records. Blood samples were collected, and liver function analytes were determined via a Cobas C311 chemistry analyzer. Hepatitis B and C viruses were tested via a serological test strip. Logistic regression analysis was performed to identify factors associated with liver function impairment via SPSS Version 27.0. P values < 0.05 with a 95% confidence level were considered statistically significant. RESULTS: Among the 307 Human immunodeficiency virus patients receiving antiretroviral therapy, 19.2% (95% CI = 15.0-24.1%) had abnormal liver function. All the impairments were Grade I. HBsAg positivity (AOR = 4.03; 95% CI = 1.1-14.8, P = 0.036), the use of herbal medicine (AOR = 4.46; 95% CI = 1.18-16.9, P = 0.028), and the use of anti-tuberculosis drugs (AOR = 3.6; 95% CI = 1.003-13.01, p = 0.05) were factors associated with liver function impairments. CONCLUSION: According to this study, liver function impairment was common among individuals living with human immunodeficiency virus and was significantly associated with hepatitis B virus coinfection, herbal medicine use and the use of anti-tuberculosis drugs. Therefore, ART treated patients with these factors require close monitoring before severe adverse consequences occur. CLINICAL TRIAL NUMBER: Not applicable.
Epidemiology, bacterial coinfection risk factors, and inflammatory markers in children with RSV, AdV, and hMPV pneumonia in Zunyi, China.
Zhou D, Tang K, Zhao Y … +3 more , Yue H, Ma J, Zha H
BMC Infect Dis · 2026 Jul · PMID 42387423 · Full text
BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of illness and death in children under five worldwide. This study characterized the epidemiology of Respiratory syncytial virus (RSV), adenovirus (AdV), and...
BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of illness and death in children under five worldwide. This study characterized the epidemiology of Respiratory syncytial virus (RSV), adenovirus (AdV), and human metapneumovirus (hMPV) associated CAP in Zunyi children and identified bacterial co-infection risk factors to provide a scientific basis for individualized pediatric CAP management in this region. METHODS: A retrospective analysis of clinical data from 2,315 children with CAP admitted to Zunyi First People's Hospital (Third Affiliated Hospital of Zunyi Medical University) between January and December 2025 was performed. Univariate and multivariate logistic regression analyses identified risk factors for bacterial co-infection, and receiver operating characteristic (ROC) curve analysis evaluated the predictive value of inflammatory markers. RESULTS: A total of 2,315 children with CAP were enrolled. The RSV positive rate (22.76%) was significantly higher than that for AdV (9.72%) and hMPV (9.84%, P < 0.05). For all three viruses, single virus pneumonia (SVP) and viral and bacterial co-infected pneumonia (VBCP) were the main types. Specifically, the positive rates of Respiratory syncytial virus and bacterial co-infected pneumonia (RSV-VBCP), Adenovirus and bacterial co-infected pneumonia (AdV-VBCP), and Human metapneumovirus and bacterial co-infected pneumonia (hMPV-VBCP) were 42.31%, 27.11%, and 37.28%, respectively. Patterns of infection varied seasonally: RSV infection peaked in autumn and winter, with the highest positivity in children under 1 year. By contrast, AdV infection occurred year-round and was most common in children aged 1-5 years. Meanwhile, hMPV infection was concentrated from January to April, predominantly in children aged 1-3 years. Clinically, children with RSV pneumonia were the youngest and that had obvious wheezing and myocardial damage. Those with AdV pneumonia had the highest rates of high fever, tonsillar enlargement, and sepsis, the shortest hospital stay, and significantly higher Interleukin (IL-) 6 and white blood cell (WBC) levels. Finally, multivariate logistic regression showed that elevated IL-6 was an independent risk factor for RSV-VBCP (OR = 1.031, 95% CI: 1.011-1.052, P = 0.002), AdV-VBCP (OR = 1.035, 95% CI: 1.015-1.056, P = 0.001), and hMPV-VBCP (OR = 1.026, 95% CI: 1.006-1.046, P = 0.009). In the analysis of RSV-VBCP, WBC was an additional independent risk factor (OR = 1.062, 95% CI: 1.005-1.122, P = 0.032). Notably, no other indicators exhibited independent predictive value. Receiver operating characteristic (ROC) curve analysis demonstrated that, when combined, the detection of inflammatory markers provided predictive value for VBCP. CONCLUSIONS: RSV, AdV, and hMPV cause different patterns of illness and inflammation in children with pneumonia in Zunyi, China. When these viruses co-occur with bacteria, the disease becomes more severe, and the risks vary by virus. High IL-6 levels are a shared, early warning sign of viral and bacterial co-infection for all three viruses. CLINICAL TRIAL NUMBER: Not applicable.
Blepharoconjunctivitis mimicking conjunctival tumor associated with Streptococcus intermedius sinusitis: case report and literature review.
Ishio D, Eguchi H, Hotta F … +1 more , Miyamoto T
BMC Infect Dis · 2026 Jul · PMID 42387416 · Full text
Streptococcus intermedius, a commensal bacterium in the human oral cavity, can occasionally cause severe infections in deep tissues. The patient was referred because of a conjunctival tumor. She had severe nasal cavity a...
Streptococcus intermedius, a commensal bacterium in the human oral cavity, can occasionally cause severe infections in deep tissues. The patient was referred because of a conjunctival tumor. She had severe nasal cavity and periocular tissue inflammation that persisted for over a year. Microbiological examination of the nasal and ocular specimens identified S. intermedius as the pathogenic strain. The inflammation and the conjunctival mass subsided after systemic and topical administration of a susceptible antibiotic. Smear microscopy of the eye and nasal discharge was useful for the differential diagnosis. 16S metagenomic analysis using MinION as an adjunctive diagnostic tool has contributed to the species identification of the pathogenic strain.
Effectiveness of conventional antimicrobial agents against carbapenem resistant non-carbapenem β-lactams susceptible Pseudomonas aeruginosa infection in critically ill patients: a multicentre retrospective study.
Wang SH, Chen WC, Chan MC … +11 more , Yang KY, Sheu CC, Wu BR, Huang WH, Feng JY, Chen CM, Weng TH, Chiu YL, Peng CK, Shen CH, T-CARE (Taiwan Critical Care and Infection) Group
BMC Infect Dis · 2026 Jul · PMID 42387410 · Full text
BACKGROUND: Carbapenem resistant non-carbapenem β-lactam susceptible (CRBS) Pseudomonas aeruginosa (PA) is a unique phenotype of carbapenem-resistant Pseudomonas aeruginosa (CRPA). While guidelines suggest using conventi...
BACKGROUND: Carbapenem resistant non-carbapenem β-lactam susceptible (CRBS) Pseudomonas aeruginosa (PA) is a unique phenotype of carbapenem-resistant Pseudomonas aeruginosa (CRPA). While guidelines suggest using conventional β-lactams, clinical evidence supporting their effectiveness in critically ill patients remains limited. This study evaluated the associations of conventional antimicrobial agents with clinical outcomes in CRBS PA infections in the intensive care unit (ICU). METHODS: This multicentre retrospective cohort study included 178 patients with CRPA-associated pneumonia or bloodstream infections, comprising 119 patients with CRBS PA and 59 patients with carbapenem-resistant non-carbapenem β-lactam resistant (CRBR) PA. Patient outcomes were compared between phenotypes. The primary endpoint was to evaluate the associations between specific antimicrobial agents and clinical outcomes in CRBS PA infections, using multivariable stepwise logistic regression analyses for in-hospital mortality, day-28 mortality, day-28 clinical failure, and day-28 microbiological eradication. RESULTS: The CRBS PA group demonstrated significantly lower clinical failure rates compared to the CRBR PA group (45.4% vs. 62.7%, p = 0.034), suggesting potential clinical relevance of this phenotype. In the multivariable analysis of CRBS PA infections, treatment with piperacillin-tazobactam (OR: 0.52, p = 0.03) and ceftazidime (OR: 0.27, p = 0.01) was independently associated with lower in-hospital mortality. Levofloxacin was also associated with lower in-hospital mortality (OR: 0.40, p = 0.01), lower day-28 clinical failure, and higher day-28 microbiological eradication rates (OR: 4.87, p = 0.02), although this finding should be interpreted separately from the β-lactam-based CRBS phenotype. CONCLUSIONS: This study suggests that piperacillin-tazobactam, ceftazidime, and levofloxacin may be reasonable definitive treatment options for critically ill patients with CRBS PA infections. These findings support the consideration of carbapenem-sparing approaches in this specific CRPA phenotype, in line with current therapeutic guidance.
Integrated surveillance of polio-negative acute flaccid paralysis cases for childhood tuberculosis: a novel GeneXpert-based screening approach in Rivers State, Nigeria.
Ifeoma N, Victor OO, Golden O … +9 more , Giwa A, Chinenye O, Bosede E, Deborah U, Philip E, Ayakeme E, Kolude O, Victor A, Adaeze O
BMC Infect Dis · 2026 Jul · PMID 42387406 · Full text
BACKGROUND: Nigeria was certified free of indigenous wild poliovirus transmission in 2020; however, acute flaccid paralysis (AFP) surveillance remains operational nationwide to detect poliovirus re-emergence and monitor...
BACKGROUND: Nigeria was certified free of indigenous wild poliovirus transmission in 2020; however, acute flaccid paralysis (AFP) surveillance remains operational nationwide to detect poliovirus re-emergence and monitor eradication gains [1]. Simultaneously, tuberculosis (TB) remains a major public health challenge, particularly among children, in whom diagnosis is often delayed or missed because of nonspecific clinical presentations and difficulties in obtaining bacteriological confirmation [2, 3]. Innovative strategies that leverage existing surveillance systems may help bridge the persistent gap in detecting childhood TB. This study assessed the feasibility of integrating stool GeneXpert MTB/RIF testing into AFP surveillance and determined the yield of GeneXpert positivity among children with polio-negative AFP in Rivers State, Nigeria. METHODS: We conducted a retrospective analysis of integrated AFP-TB surveillance data collected between January 2022 and March 2025 in Rivers State, Nigeria. During the study period, 147 cases of AFP were reported among children aged less than 15 years. Following exclusion of poliovirus-positive cases and cases with inadequate stool specimens, 118 polio-negative AFP cases underwent stool GeneXpert MTB/RIF testing. The primary outcome was stool GeneXpert positivity for Mycobacterium tuberculosis complex. Data were summarized using descriptive statistics. RESULTS: Among the 118 children tested, five had positive stool GeneXpert MTB/RIF results, yielding a GeneXpert positivity rate of 4.2% (95% CI: 1.6-9.6%). Four of the five positive cases were younger than five years. Three positive results were reported as "trace detected, rifampicin resistance indeterminate." All GeneXpert-positive cases presented with acute limb weakness or paralysis and were successfully linked to the National Tuberculosis Programme for further evaluation and management. Data completeness was 100% for age, sex, local government area, and GeneXpert result. CONCLUSIONS: Integration of stool GeneXpert testing into AFP surveillance was operationally feasible and identified additional children with microbiological evidence of Mycobacterium tuberculosis DNA. Although GeneXpert positivity does not confirm active TB disease; this approach demonstrates the potential of leveraging existing surveillance platforms to strengthen childhood TB case-finding in high-burden settings. Larger studies incorporating clinical confirmation, treatment outcomes, and economic evaluation are warranted. CLINICAL TRIAL NUMBER: Not applicable.
Prevalence and kinetics of viral infections during the first 100 days after pediatric hematopoietic stem cell transplantation at the Children's Hospital in Rabat.
Hassaine M, Lakhrissi M, Kababri ME … +10 more , Touyar N, Amine GE, Zouaki A, Arrad AE, Kili A, Khorassani ME, Ansari NE, Isfaoun Z, Hessissen L, Kabbaj H
BMC Infect Dis · 2026 Jul · PMID 42387393 · Full text
BACKGROUND: Viral infections are a major cause of morbidity and mortality in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), particularly during the first 100 days post-transplant, a period...
BACKGROUND: Viral infections are a major cause of morbidity and mortality in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), particularly during the first 100 days post-transplant, a period of profound immunosuppression. Data on their prevalence and kinetics in low- and middle-income countries, including Morocco, remain limited. This study aimed to evaluate these infections at the Children's Hospital in Rabat. METHODS: We conducted a retrospective descriptive study of pediatric patients who underwent HSCT at the Children's Hospital in Rabat from January 2018 to June 2025. Post-transplant viral monitoring included weekly quantitative PCR for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) until day 100. Targeted PCR for adenovirus, BK virus, HHV-6, and respiratory viruses was performed in symptomatic patients. RESULTS: Out of 33 patients, CMV was the most frequently detected agent, with an incidence of 51,5% (n = 17), of which 30.3% had a viral load > 2.5 log₁₀ IU/ml. The median time to first reactivation was 3 weeks (IQR: 2-6). The vast majority of episodes occurred in seropositive (R+) recipients, mainly D+/R+. The highest viral loads were observed in patients with CMV viremia temporally associated with pulmonary involvement (2.62 log₁₀ IU/ml [IQR: 0.00-3.42]) compared to those without pulmonary involvement (0.00 log₁₀ IU/ml [IQR: 0.00-2.04]; p = 0.007), despite the absence of virological confirmation of CMV-related pulmonary disease. Similarly, patients with gastrointestinal (GI) complications had higher viral loads (3.13 log₁₀ IU/ml [IQR: 2.23-3.89]) compared with those without GI involvement (0.00 log₁₀ IU/ml [IQR: 0.00-2.04], p = 0.002). Concerning EBV, viral loads showed transient reactivations, fluctuating between quantifiable and undetectable, mainly between the 1st and 7th week post-transplant. Infections were more frequent in recipients who were initially seronegative (D+/R-) included 8 of 13 patients (61.5%), No cases of post-transplant lymphoproliferative disease were reported. BK virus showed an early peak of infection between the 1st and 4th week, strongly associated with the occurrence of hemorrhagic cystitis, highlighting its significant clinical impact during this period. CONCLUSION: This study highlights the particularly early kinetics of CMV, BK virus, and EBV in our pediatric patients after HSCT, with CMV appearing around week 3, transient EBV reactivations in initially seronegative patients, and an early BK virus peak linked to hemorrhagic cystitis.
Abdominal wall abscess due to Mycolicibacterium neworleansense: a case report.
Xiang Y, Fan B, Liu B
BMC Infect Dis · 2026 Jun · PMID 42380938 · Full text
INTRODUCTION: Non-tuberculous mycobacteria (NTM) are widely distributed in the natural environment and can cause skin and soft tissue infections, typically through traumatic injuries or invasive medical procedures, espec...
INTRODUCTION: Non-tuberculous mycobacteria (NTM) are widely distributed in the natural environment and can cause skin and soft tissue infections, typically through traumatic injuries or invasive medical procedures, especially in susceptible populations. Commonly encountered pathogens include Mycobacterium marinum and Mycobacterium abscessus, among others. However, cutaneous infections caused by Mycolicibacterium neworleansense are extremely rare. This report presents a case of abdominal wall abscess caused by Mycolicibacterium neworleansense, which was successfully managed with surgical debridement combined with targeted antimicrobial therapy. The aim of this report is to enhance clinical awareness of Mycolicibacterium neworleansense infections, optimize diagnostic and therapeutic strategies, and provide a reference for clinical practice. CASE PRESENTATION: A 74-year-old male with type 2 diabetes mellitus was admitted to the hospital with an abscess at the long-term insulin injection site on his left abdominal wall. After admission, surgical incision and drainage of the abscess were performed. Microbiological culture of the intraoperative pus specimen grew non-tuberculous mycobacteria, which were subsequently identified as Mycolicibacterium neworleansense using 16S rRNA gene sequencing combined with biochemical profiling. Antimicrobial susceptibility testing demonstrated resistance to macrolides and tetracyclines, but susceptibility to trimethoprim-sulfamethoxazole, aminoglycosides, moxifloxacin, and imipenem. Following surgical intervention, the patient received a combined antibiotic regimen of trimethoprim-sulfamethoxazole and moxifloxacin, leading to successful clinical resolution of the infection. CONCLUSION: Mycolicibacterium neworleansense can cause subcutaneous abscesses following injection-related invasive procedures. Successful management of such infections depends on precise pathogen identification via molecular and biochemical approaches, targeted antimicrobial therapy guided by susceptibility testing, and appropriate surgical intervention.
Predictors and mortality in PCR-positive pneumocystis pneumonia among non-HIV patients.
Kapmaz M, Mızrak B, Bektaş ŞN … +5 more , İrkören P, Şahin M, Okan A, Tekin S, Ergönül Ö
BMC Infect Dis · 2026 Jun · PMID 42380877 · Full text
BACKGROUND: Pneumocystis jirovecii is a major cause of morbidity and mortality in HIV. It also poses a significant risk to non-HIV immunocompromised patients, especially those with cancer or recent chemotherapy. We evalu...
BACKGROUND: Pneumocystis jirovecii is a major cause of morbidity and mortality in HIV. It also poses a significant risk to non-HIV immunocompromised patients, especially those with cancer or recent chemotherapy. We evaluated risk factors, diagnostic markers-including lactate dehydrogenase (LDH)-and mortality predictors in PCR-confirmed pneumocystis pneumonia (PJP). METHODS: We retrospectively analyzed patients with hypoxemia, pulmonary involvement and/or fever who underwent PJP PCR testing at Koç University Hospital between January 2020 and November 2023. Cases were defined as patients with a positive PCR result who fulfilled the EORTC/MSGERC criteria for PJP, whereas the non-PJP group included PCR-negative patients and PCR-positive patients without clinically compatible disease. Clinical, laboratory, and radiologic data-including LDH, fungal load, co-infections, and 4-week mortality-were collected. RESULTS: Of 235 patients, 59 had PCR-confirmed PJP. PJP patients were older (median 70 vs. 64.5, p < 0.001), more often had solid organ malignancies (67.8% vs. 41.5%, p < 0.001), recent chemotherapy (66.1% vs. 41.5%, p = 0.001), and higher fungal loads (median 10,892 vs. 0, p < 0.001). Bilateral lung lesions (81% vs. 66.5%, p = 0.037) and ground-glass opacities (82.8% vs. 67.7%, p = 0.041) were more frequent. Serum LDH increased by 81.6% in PJP vs. 20.7% in controls (p = 0.001), whereas no significant difference was observed among patients with elevated baseline LDH (29.7% vs. 16.3%, p = 0.397). Multivariate analysis identified older age (OR 1.042, p = 0.017), solid organ malignancy (OR 2.304, p = 0.048), and CMV co-infection (OR 3.786, p = 0.006) as independent factors associated with PJP, whereas ICU admission at diagnosis was inversely associated with PJP (OR 0.239, p = 0.005). The 4-week mortality was 37%, with bacterial co-infection as the strongest predictor (OR 5.854, p = 0.009). CONCLUSION: Older age, solid organ malignancy, and CMV co-infection increased PJP risk, while bacterial co-infection predicted mortality. LDH changes supported diagnosis, but not when baseline levels were already elevated, in this predominantly oncology cohort.
Multimorbidity patterns and phenotype transitions in patients with clinician-coded long COVID: a multicenter US electronic health record cohort study.
Wang XF, Huang S, Xu Y … +4 more , Zou Y, Zhang P, Xie Y, Tsuang WM
BMC Infect Dis · 2026 Jul · PMID 42380873 · Full text
BACKGROUND: Long COVID is clinically heterogeneous, but longitudinal changes in documented chronic disease burden and transitions in multimorbidity phenotypes after infection are not well characterized in routine care. M...
BACKGROUND: Long COVID is clinically heterogeneous, but longitudinal changes in documented chronic disease burden and transitions in multimorbidity phenotypes after infection are not well characterized in routine care. METHODS: We considered 425,614 patients with clinician-coded long COVID (ICD-10-CM U09.9) and a definable COVID-19 index date between October 1, 2021 and September 16, 2024 using deidentified electronic health record data from Epic Cosmos, a multicenter US network. Pre-index and post-index windows were defined as days - 365 to - 1 and days 91 to 455 relative to infection, respectively; follow-up was available through December 15, 2025. Chronic condition groups derived from ICD-10-CM codes were compared across windows using adjusted generalized estimating equation models. K-modes clustering was used to identify multimorbidity phenotypes, and multinomial regression was used to estimate adjusted transition probabilities. RESULTS: Two pre-index phenotypes were identified: low burden (87.9%) and multimorbid (12.1%). Four post-index phenotypes emerged: low burden (63.3%), multimorbid/systemic (21.0%), respiratory-dominant (4.3%), and high-utilization/low-coded multimorbidity (11.3%). Higher baseline multimorbidity was associated with greater probability of transition to the multimorbid/systemic phenotype, whereas respiratory-dominant and high-utilization phenotypes arose from both baseline groups. Increases were concentrated in neurologic/autonomic, respiratory, hypercoagulable, endocrine/metabolic, sleep-related, and symptom-based domains. The high-utilization/low-coded phenotype was younger, predominantly female, and had greater emergency department and outpatient use. Fewer changes reached statistical significance in children than in adults. CONCLUSIONS: Among patients with clinician-coded long COVID, chronic disease burden increased after infection and diversified into interpretable post-index phenotypes with distinct utilization profiles, supporting phenotype-informed follow-up and health system planning.
From vesicles to ventricles: pediatric group a streptococcal meningitis post-varicella infection - a case report.
Malhis D, Saleh S, Qadi Z … +4 more , Khader Z, Zitawi H, Yasin LJ, Hamdan M
BMC Infect Dis · 2026 Jun · PMID 42380868 · Full text
BACKGROUND: Streptococcus pyogenes meningitis is a rare but potentially life-threatening infection in infancy. It can occur as a primary infection or as a complication of viral illnesses such as varicella, which can incr...
BACKGROUND: Streptococcus pyogenes meningitis is a rare but potentially life-threatening infection in infancy. It can occur as a primary infection or as a complication of viral illnesses such as varicella, which can increase the risk of invasive bacterial disease. CASE PRESENTATION: We report a previously healthy 3-month-old boy who presented with fever, poor feeding, and a vesicular rash following varicella exposure. Despite outpatient acyclovir therapy, the patient developed dehydration and persistent fever. Cerebrospinal fluid (CSF) analysis revealed markedly elevated white blood cell counts, elevated protein, and low glucose. CSF Gram stain demonstrated gram-positive cocci in pairs, and CSF culture subsequently confirmed Streptococcus pyogenes (Group A Streptococcus) that was susceptible to penicillin, vancomycin, amoxicillin/clavulanic acid, ceftriaxone, teicoplanin and cefotaxime. The patient received broad-spectrum antibiotics, antivirals, and supportive care. Despite escalation to a tertiary pediatric intensive care unit (PICU), he developed progressive cerebral edema, refractory seizures, and loss of brainstem reflexes. Brain death was confirmed by clinical examination, apnea tests, and electroencephalography. On the final day of hospitalization, the patient developed endotracheal bleeding with cardiovascular collapse and could not be resuscitated. CONCLUSION: This case highlights the fulminant course of invasive S. pyogenes infection in infants, particularly following varicella. These findings underscore the need for early recognition, aggressive management, and potential role of varicella vaccination in preventing secondary bacterial complications.
Profile of bacterial meningitis pathogens circulating in a cohort of school children in Côte d'Ivoire using 16S rRNA gene sequencing.
Tuo KJ, Diallo K, Amoikon TL … +8 more , Missa KF, Gboko KDT, Gragnon BG, Ngoi JM, Wilkinson RJ, Awandare G, Bonfoh B, Zézé A
BMC Infect Dis · 2026 Jun · PMID 42380864 · Full text
BACKGROUND: Bacterial meningitis represents a critical public health concern in sub-Saharan African school settings, where conditions favor its transmission. This study uses 16S rRNA gene sequencing to investigate the pr...
BACKGROUND: Bacterial meningitis represents a critical public health concern in sub-Saharan African school settings, where conditions favor its transmission. This study uses 16S rRNA gene sequencing to investigate the presence, relative abundance, and genetic relatedness of the three main bacterial meningitis pathogens in oropharyngeal samples from schoolchildren aged 8-12 years in Côte d'Ivoire. METHODS: 76 children from two Ivorian primary schools (37 Korhogo, 39 Abidjan) were followed up for six months. Nucleic acids from oropharyngeal swabs (444 samples) were analyzed by 16S rRNA sequencing, and phylogenetic relationships were inferred using the Maximum Likelihood method. RESULTS: H. influenzae showed the highest carriage prevalence (81.94%, 59/72), Abidjan (81.6%, 31/38) and Korhogo (82.4%, 28/34). Neisseria meningitidis and Streptococcus pneumoniae were rare (1.39%, 1/72 and 2.78%, 2/72, respectively) and detected only in Korhogo (2.9% and 5.9%). Genus-level relative abundances were 15.4% (Haemophilus), 12.9% (Streptococcus) and 5.4% (Neisseria). Species-level relative abundances of Hi, Nm, and Sp were 0.16%, 0.03%, and 0.003%, respectively. Mixed-effects logistic regression showed that Nm (OR = 0.056, 95% CI: 0.014-0.231, p < 0.001) and Sp (OR = 0.055, 95% CI: 0.007-0.407, p = 0.004) were less likely to colonize than Hi. No significant difference was observed between cities (OR = 0.96, 95% CI: 0.58-1.60, p = 0.887). High inter-individual variability (SD = 0.91) was observed, with one-third of bacterial species shared between sites. CONCLUSION: These findings highlight the utility of 16S rRNA sequencing for culture-independent detection of carriage of key meningitis pathogens, pending further species-level confirmation.
Dynamic changes in vasoactive-inotropic score and their prognostic value in severe sepsis and septic shock patients undergoing polymyxin B hemoperfusion: a real-world Asian ICU cohort study.
Chang WH, Wu WJ, Shen HF … +1 more , Hu TY
BMC Infect Dis · 2026 Jun · PMID 42380846 · Full text
Severe sepsis and septic shock frequently require escalating vasoactive support, but the prognostic utility of vasoactive-inotropic score (VIS) trajectories during polymyxin B hemoperfusion (PMX-HP) in Asian ICUs remains...
Severe sepsis and septic shock frequently require escalating vasoactive support, but the prognostic utility of vasoactive-inotropic score (VIS) trajectories during polymyxin B hemoperfusion (PMX-HP) in Asian ICUs remains unclear. We conducted a retrospective single-center cohort study in a tertiary medical ICU in Taiwan, enrolling consecutive adults with severe sepsis or septic shock who received PMX-HP between July 2013 and December 2019. VIS was calculated before PMX-HP (VIS1), immediately after PMX-HP (VIS2), and approximately 24 h post-treatment (VIS3); the primary outcome was 28-day all-cause mortality. In 64 patients, median VIS decreased from 28.8 (IQR 13.0-47.6) at VIS1 to 18.1 (IQR 7.8-45.0) at VIS2 and was 16.9 (IQR 1.3-45.1) at VIS3 among patients with available VIS3 data. VIS1, VIS2, and VIS3 were higher in non-survivors than survivors. A mixed-effects model using log(VIS + 1) confirmed significant effects of time, survival status, and their interaction. In an exploratory time-dependent Cox model, higher time-updated log(VIS + 1) was associated with 28-day mortality. The immediate VIS change showed limited discrimination for 28-day mortality (AUC 0.57, 95% CI 0.43-0.72), whereas VIS3 demonstrated better discrimination (AUC 0.78, 95% CI 0.66-0.91). Adding VIS3 to APACHE II improved discrimination compared with APACHE II alone (AUC 0.81 vs. 0.63; Delta AUC + 0.18; p = 0.020). Kaplan-Meier analysis using the ROC-derived VIS3 cut-off of 14.56 showed significantly worse 28-day survival when VIS3 remained above this threshold. Late post-treatment VIS monitoring may support bedside risk stratification in severe sepsis and septic shock undergoing PMX-HP; multicenter validation is warranted.Clinical trial number Not applicable.
Dynamics of spatiotemporal pharmacological models for hepatitis B virus infection under lamivudine and pegylated interferon alfa-2b therapies.
Tchioffo BR, Mvogo A, Abiama PE
BMC Infect Dis · 2026 Jun · PMID 42380845 · Full text
Chronic hepatitis B virus (HBV) infection remains a major global health concern due to the limited availability of curative treatment options. In this study, we investigate both analytically and numerically a spatiotempo...
Chronic hepatitis B virus (HBV) infection remains a major global health concern due to the limited availability of curative treatment options. In this study, we investigate both analytically and numerically a spatiotemporal mathematical model of HBV infection incorporating pharmacological effects. The model consists of a system of three partial differential equations describing the dynamics and interactions between healthy hepatocytes (S), infected cells (I) and free viral particles (V). The model also considers spatial diffusion and dual-drug treatment of lamivudine and pegylated interferon alfa-2b (PEG-IFN alfa-2b). A general analytical expression is derived to determine the minimal drug dose required to effectively suppress viral replication and eliminate the infection. The basic reproduction number ([Formula: see text]) is calculated as a function of drug effectiveness and model parameters. To illustrate the relevance of the model, we apply it to clinical data from two HBV infected patients undergoing different therapeutic regimens. The first patient received 200 mg daily of lamivudine, while the second was treated with 200 mg of lamivudine daily and 0.2 mg weekly of PEG-IFN alfa-2b. Using nonlinear least squares, we fit the model to clinical data and estimate relevant parameters. In the absence of treatment, we find [Formula: see text]. Pharmacodynamic results show that after 4 weeks, the first patient experienced a [Formula: see text] copies/ml viral decline (64% effectiveness), while the second exhibited a [Formula: see text] copies/ml decline (69% and 64% effectiveness for PEG-IFN alfa-2b and lamivudine, respectively), corresponding to basic reproduction numbers of 185 and 58, respectively. To achieve sustained viral suppression ([Formula: see text]), we optimize the therapies. Lamivudine alone requires 99% effectiveness, which corresponds to a minimum dose of 565.92 mg daily over 350 days. For combination therapy, a PEG-IFN alfa-2b efficacy of 69% and lamivudine efficacy of 94.36% are sufficient to reach [Formula: see text] after 315 days. A Turing instability analysis reveals the emergence of diffusion-driven instabilities and allows the identification of a critical Turing wave number [Formula: see text]. Numerical simulations confirm the analytical predictions and show the formation of circular patterns. These patterns have been identified as having promising diagnostic and therapeutic value. Under treatment, the model predicts a progressive disappearance of infected patterns and a return toward spatial homogeneity. These findings highlight the crucial role of mathematical modeling in refining HBV treatment protocols and provide valuable insights for optimizing antiviral strategies.
Diagnostic performance of procalcitonin for predicting bloodstream infection and guidance on microbial aetiology: a prospective study at an Egyptian tertiary care hospital.
Abbas AM, Abdel Aziz HS, Raafat Hamed RM … +3 more , Soliman SB, Abd El-Ghani SE, Soliman NS
BMC Infect Dis · 2026 Jun · PMID 42380800 · Full text
BACKGROUND: Blood stream infection (BSI) is a life-threatening condition that implies prompt diagnosis and management. With the time-consuming traditional microbiological culture and limited provision of molecular diagno...
BACKGROUND: Blood stream infection (BSI) is a life-threatening condition that implies prompt diagnosis and management. With the time-consuming traditional microbiological culture and limited provision of molecular diagnostics, procalcitonin (PCT) has emerged as a rising rapid biomarker for prediction of BSI. AIM: We aimed to evaluate the diagnostic performance of PCT in predicting BSI as well as in tentative differentiation of the possible underlying microbial etiology. METHODS: Blood samples were collected from total 328 patients suspected of having BSI and were measured for levels of procalcitonin, C-reactive protein (CRP) and total leucocyte count (TLC). Concomitant microbiological culture was done for detection and identification of microbial etiology. RESULTS: Microbial cultures were positive in 47.9% and negative in 52.1% of patients. Bacterial and fungal growth accounted for 87.8% and 12.1%, respectively, where bacterial growth was differentiated as Gram-positive and Gram-negative bacteria. Culture-positive group displayed significantly higher median values of PCT (2.69 ng/ml) and CRP (117.2 ng/ml) than culture-negative group. PCT levels were significantly higher among Gram-negative than Gram-positive cultures, however were non-significantly higher among bacterial than fungal positive-cultures. Compared to other biomarkers, PCT displayed the highest diagnostic accuracy in differentiating culture-positive and -negative BSI (ROC-AUC: 0.706, P < 0.001) at cut-off value of 0.675 ng/ml, as well as in discriminating Gram-negative and Gram-positive bacteria (ROC-AUC:0.636, P: 0.004) at cut-off value of 2.135 ng/ml. CONCLUSION: PCT exhibited higher diagnostic accuracy than other biomarkers in BSI and in differentiating Gram-negative and Gram-positive bacterial etiology, which may offer a modest guidance in sepsis management and optimization of antibiotic intake. CLINICAL TRIAL: Not applicable.
Clinical characteristics and an admission-time predictive model for severe scrub typhus and secondary HLH in adults.
Guo C, Zhang X, Li C … +5 more , Huang Y, Su J, Wang Y, Zhuo C, Yang L
BMC Infect Dis · 2026 Jun · PMID 42380792 · Full text
BACKGROUND: Scrub typhus can rapidly progress to severe disease with multi-organ dysfunction. Secondary hemophagocytic lymphohistiocytosis (HLH) is an increasingly recognized hyperinflammatory complication associated wit...
BACKGROUND: Scrub typhus can rapidly progress to severe disease with multi-organ dysfunction. Secondary hemophagocytic lymphohistiocytosis (HLH) is an increasingly recognized hyperinflammatory complication associated with high mortality, but adult data and simple admission-time risk tools remain limited. METHODS: We conducted a single-center retrospective cohort study of hospitalized adults with scrub typhus at the First Affiliated Hospital of Guangzhou Medical University (May 2013-July 2025). Severe scrub typhus was defined by major organ involvement, shock, or in-hospital death. Variables available at admission were compared between severe and non-severe groups. Independent predictors were identified using multivariable logistic regression, and model performance was evaluated using ROC analysis. Among severe cases, HLH was identified according to standard diagnostic criteria, and clinical characteristics were compared between HLH and non-HLH patients. RESULTS: Among 135 patients, 44 (32.6%) developed severe scrub typhus and overall in-hospital mortality was 2.2% (3/135). Lower hemoglobin (Hb) (OR 0.965, 95% CI 0.947-0.982), higher serum creatinine (SCr) (OR 1.019, 95% CI 1.008-1.029), and lower fibrinogen (FIB) (OR 0.629, 95% CI 0.435-0.909) were independent predictors of severe disease. A parsimonious three-variable model showed good discrimination (AUC = 0.843). At the sensitivity-prioritized ROC threshold, sensitivity was 88%, specificity 46%, and the Youden index 0.34. HLH was identified in 6 patients overall, including 5 patients among the severe cases. Among severe patients, HLH cases showed higher observed in-hospital mortality than non-HLH cases (40.0% vs. 2.6%). They also had more severe thrombocytopenia and greater coagulation and organ-function abnormalities. CONCLUSIONS: A simple admission-time triad (Hb, SCr, and FIB) provides an interpretable tool for early identification of severe scrub typhus in hospitalized adults. HLH cases showed higher observed mortality and more severe thrombocytopenia/coagulation derangement; however, these findings should be interpreted descriptively due to the small number of cases.
Infectious pathogens associated with stillbirth and under-five mortality by sickle cell disease in Western Kenya: a cross-sectional study.
Wasilwa MO, Simiyu V, Onduru F … +7 more , Kiplelgo E, Nyanjom M, Otieno K, Muttai H, Omore R, Akelo V, Obiri-Yeboah D
BMC Infect Dis · 2026 Jun · PMID 42380786 · Full text
BACKGROUND: Infectious Pathogens (IP) remain a significant contributor to stillbirths and under-five deaths in resource-limited settings. Children with sickle cell disease (SCD) are susceptible due to weakened immunity,...
BACKGROUND: Infectious Pathogens (IP) remain a significant contributor to stillbirths and under-five deaths in resource-limited settings. Children with sickle cell disease (SCD) are susceptible due to weakened immunity, influencing infection outcomes. This sub-study, nested within the Kenya Child Health and Mortality Prevention Surveillance (CHAMPS) network, investigated infectious pathogens associated with stillbirths and under-five deaths in Western Kenya, as well as the role of the sickle cell condition. METHODS: We analysed stillbirths (n = 387) and ≤ 5 child deaths (n = 945) enrolled in CHAMPS in Karemo (Siaya) and Manyatta (Kisumu), both in western Kenya, between May 2017 and Dec 2024. Minimally invasive tissue sampling (MITS) specimens were processed on a TaqMan Array Card using the QuantStudio 7 real-time PCR (TAC qPCR) and cultured. All participants were screened for sickle cell status using the point-of-care Gazelle™ Hb Variant device, and confirmed by High Performance Liquid Chromatography (HPLC) and pathological diagnosis. Statistical analyses were performed using R programming software (version 4.5.1). FINDINGS: A total of 1,332 cases were investigated, 499, 37.5% (95% CI:34.9-40.1) had an infectious pathogen (IP), with lower prevalence among stillbirths (4.1%, 95%CI:2.6-6.6) and higher prevalence among under-five deaths (51.1%, 95%CI:47.9-54.3). SCD was identified in 46 cases (3.5%) and sickle cell trait in 256 cases (19.2%), for a total of 302 cases (22.7%) with SCD/trait. IP prevalence was higher in SCD (60.9%, 95%CI: 46.3-73.9) than in sickle cell trait (25.8%, 95%CI: 20.6-31.6). Among SCD and sickle cell trait cases, the most frequently identified pathogens were Plasmodium falciparum (39.3% and 18.2%), Klebsiella pneumoniae (7.1% and 37.9%), and Streptococcus pneumoniae (21.4% and 9.1%), respectively. Overall, the leading pathogens identified in post-mortem specimens in both SCD/trait and non-SCD/trait groups were K. pneumoniae (28.7% vs. 25.5%), P. falciparum (24.5% vs. 35.9%), S. pneumoniae (12.8% vs. 12.1%), HIV (8.5% vs. 8.7%), cytomegalovirus (7.4% vs. 7.4%), and respiratory syncytial virus (3.2% vs. 1.5%). CONCLUSIONS: Infectious pathogens were significantly associated with stillbirth and under-five mortality in Western Kenya, highlighting the need to strengthen infection prevention, diagnosis, and management during pregnancy and early childhood in line with WHO recommendations and targeted preventive care for vulnerable populations like those with SCD. CLINICAL TRIAL NUMBER: Not applicable.
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