BMC Infectious Diseases[JOURNAL]
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200 papers
Antimicrobial resistance patterns of isolated bacteria at Bukoba Regional Referral Hospital in Patients attended from 2019 to 2023.
Felician EK, Ibrahimu T, Mosha S … +8 more , Kayenzi J, Mosha G, Mosses W, Minani L, Mkebezi V, Milambo G, Seni J, Nyakiroto M
BMC Infect Dis · 2026 Jun · PMID 42343275 · Full text
BACKGROUND: Antimicrobial resistance (AMR) has emerged as a global public health concern, increasing morbidity, mortality, and healthcare costs. Limited surveillance data exist from regional referral hospitals in Tanzani...
BACKGROUND: Antimicrobial resistance (AMR) has emerged as a global public health concern, increasing morbidity, mortality, and healthcare costs. Limited surveillance data exist from regional referral hospitals in Tanzania, including Bukoba Regional Referral Hospital (BRRH). Understanding local AMR patterns is essential to guide empirical therapy and inform infection prevention and control strategies. This study aimed to determine the patterns, trends, and factors associated with AMR among bacterial isolates at BRRH between 2019 and 2023. METHODOLOGY: A retrospective cross-sectional study was conducted using laboratory records and patient files from Bukoba Regional Referral Hospital between January 2019 and December 2023. Clinical specimens were cultured, bacterial isolates identified using standard microbiological procedures, and antimicrobial susceptibility testing performed using the Kirby-Bauer disk diffusion method according to CLSI 2024 guidelines. Chi-square test was used to assess associations between bacterial isolates and prescribed antimicrobial agents, with statistical significance considered at P < 0.05. RESULTS: A total of 1,680 specimens were processed during the observation period, the proportion of specimens yielding pathogenic bacterial growth was 297 (17.7%) and 15 (0.9%) of culture samples were discarded due to contamination. The median age of patients was 28 years, with 58% female. Urine 110 (36.9%), pus 99 (33.2%), and stool 76 (25.5%) were the most common samples. Escherichia coli 60 (76.9%), Staphylococcus aureus 32 (86.5%), and Salmonella typhi 63 (100%) were the predominant isolates from urine, pus and stool samples respectively. E. coli showed high resistance to azithromycin (95.0%) and ampicillin (84.4%); S. aureus and coagulase-negative Staphylococci exhibited 100% and 90% resistance to penicillin, respectively. High levels of resistance to commonly used antimicrobial agents on Azithromycin 60 (88.2%), Ceftriaxone 118 (84.3%) and Ampicillin 82 (83.7%) were observed where 17.4% of patients were not prescribed antimicrobial agents despite culture positivity, while mismatches between susceptibility results and prescriptions were common. CONCLUSION: This study demonstrates a high prevalence of antimicrobial resistance among commonly isolated bacterial pathogens at Bukoba Regional Referral Hospital. Routine development of local antibiograms, strengthening antimicrobial stewardship programs, promoting rational antibiotic prescribing, and enhancing IPC practices are urgently needed to combat AMR at BRRH and similar settings.
Hepatitis B coinfection and awareness among patients with active tuberculosis in Georgia: a cross-sectional study.
Kanchelashvili G, Collins J, Avaliani Z … +7 more , Kipiani M, Tukvadze N, Chincharauli M, Gulbiani L, Bzishvili N, Kamkamidze G, Butsashvili M
BMC Infect Dis · 2026 Jun · PMID 42343265 · Full text
BACKGROUND: Patients with TB disease in Georgia are not routinely tested for HBV and the prevalence of chronic HBV among TB patients is unknown. We aimed to assess the prevalence of HBV coinfection and immunity among per...
BACKGROUND: Patients with TB disease in Georgia are not routinely tested for HBV and the prevalence of chronic HBV among TB patients is unknown. We aimed to assess the prevalence of HBV coinfection and immunity among persons with TB in Georgia and evaluate their HBV-related knowledge and attitudes toward vaccination. METHODS: We conducted a cross-sectional study among persons with active TB disease at the National Center for Tuberculosis and Lung Diseases in Georgia from September 20, 2024 to February 20, 2025. Participants underwent serologic testing (HBsAg, anti-HBs, anti-HBc) and completed a questionnaire on HBV knowledge, vaccination history, and willingness to vaccinate. RESULTS: We enrolled 110 participants (median age = 44.0, IQR:35.0-56.3), of which 63.6% were male. Four participants (3.6%) were HBsAg positive. HBV test results showed 14 (12.7%) had past HBV infection with anti-HBc+/anti-HBs+, and 7 (6.4%) had isolated anti-HBc positivity (anti-HBc+/anti-HBs-). Another seven (6.4%) had vaccine-induced immunity (anti-HBc-/anti-HBs+), and 82 (74.5%) were susceptible to HBV infection. While 74.5% reported having heard of HBV, only 50.0% correctly identified transmission routes. Only 16 patients (14.5%) were willing to receive vaccination. Among those unwilling, the main barriers were concerns about vaccine safety (34.9%), effectiveness (23.3%), and perceived infection risk (20.9%). Participants aged ≤ 40 years were significantly more likely to be aware of HBV compared to those over 40 (OR=3.39, 95% CI: 1.25-9.20). CONCLUSION: TB-HBV coinfection observed in this study suggests that routine HBV screening among TB patients in Georgia may be beneficial. Low vaccination coverage and limited knowledge highlight the importance of integrating HBV education and vaccination into TB programs to improve outcomes.
Magnetic resonance imaging characteristics of ependymal tuberculosis in patients with intracranial tuberculosis.
Zhang L, Fu XW, Wei JL … +5 more , Qi M, Gan W, Pu Y, Shen LJ, Li X
BMC Infect Dis · 2026 Jun · PMID 42343254 · Full text
OBJECTIVE: This study aimed to characterize the magnetic resonance imaging (MRI) features of ependymal tuberculosis in patients with intracranial tuberculosis. METHODS: A retrospective analysis was performed on 21 patien...
OBJECTIVE: This study aimed to characterize the magnetic resonance imaging (MRI) features of ependymal tuberculosis in patients with intracranial tuberculosis. METHODS: A retrospective analysis was performed on 21 patients diagnosed with ependymal tuberculosis, defined as direct ventricular involvement caused by Mycobacterium tuberculosis infection, between July 2019 and May 2024. Craniocerebral MRI findings were reviewed, and the imaging characteristics and their temporal progression were systematically evaluated. RESULTS: Two distinct MRI patterns of ependymal tuberculosis were identified: nodular and mixed types. The nodular type was characterized by intraventricular nodular lesions demonstrating isointensity on T1-weighted imaging (T1WI), iso- to hypointensity on T2-weighted imaging, mild hyperintensity on T2 fluid-attenuated inversion recovery imaging, and absence of diffusion restriction on diffusion-weighted imaging. On contrast-enhanced T1WI, the nodules demonstrated either homogeneous or ring enhancement. The mixed type was characterized by intraventricular nodules associated with linear thickening of the ventricular wall. Both the nodules and the thickened ependymal lining demonstrated homogeneous or ring enhancement on contrast-enhanced T1WI. Leptomeningeal tuberculosis was identified as linear or nodular meningeal thickening involving the basal cisterns, Sylvian fissures, or cerebral convexities. In patients with concomitant parenchymal tuberculosis, nodular or ring-enhancing lesions were observed within the cerebral, cerebellar, or brainstem parenchyma and were occasionally associated with surrounding edema. Following anti-tuberculosis therapy, progression of ependymal tuberculosis was observed in 13 of 21 patients, whereas improvement was observed in 8 patients. Disease progression was characterized by enlargement of pre-existing intraventricular nodules, which in some cases resulted in localized hydrocephalus. Improvement was characterized by reduction in nodule size. CONCLUSION: MRI findings of ependymal tuberculosis include homogeneously or ring-enhancing intraventricular nodules, with or without associated linear ependymal thickening, and possible development of hydrocephalus. Despite anti-tuberculosis therapy, a substantial proportion of patients may exhibit paradoxical worsening characterized by enlargement of pre-existing lesions. CLINICAL TRIAL: Not applicable.
Risk factors and a prediction model of poor prognosis in patients with invasive aspergillosis in a general hospital.
Li X, Niu M, Zhang M … +5 more , Zheng Q, Ge X, Zhang W, Yu T, Zhang H
BMC Infect Dis · 2026 Jun · PMID 42343253 · Full text
BACKGROUND: This study retrospectively analyzed the epidemiological trends of invasive aspergillosis (IA) at the Anhui Public Health Clinical Center. By evaluating the clinical risk factors associated with IA, an individ...
BACKGROUND: This study retrospectively analyzed the epidemiological trends of invasive aspergillosis (IA) at the Anhui Public Health Clinical Center. By evaluating the clinical risk factors associated with IA, an individualized nomogram prediction model was constructed. This study aims to improve early diagnosis and clinical management of severe invasive aspergillosis. METHODS: A retrospective analysis was conducted on the clinical data of 307 patients diagnosed with IA between January 2019 and March 2024. Patients were categorized into two groups based on clinical outcomes: the favorable outcome group (n = 268) and the unfavorable outcome group (n = 39). Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were employed to identify independent risk factors associated with poor prognosis. Subsequently, a nomogram was constructed to develop a risk prediction model for IA. RESULTS: Four variables associated with poor prognosis were identified via LASSO regression: ICU length of stay, elevated C-reactive protein (CRP), elevated blood glucose, and renal dysfunction (all P < 0.05). Multivariable logistic regression revealed that ICU length of stay (OR = 1.049, 95%CI: 1.003-1.096, P = 0.028), C-reactive protein (OR = 1.007, 95%CI: 1.003-1.012, P = 0.001), blood glucose (OR = 1.119, 95%CI: 1.041-1.206, P = 0.003), and renal failure (yes vs. no, OR = 3.187, 95%CI: 1.412-7.048, P = 0.004) were independent risk factors for poor prognosis. The area under the receiver operating characteristic curve (AUC) was 0.810, with a bootstrap-validated AUC of 0.7962, demonstrating favourable discrimination and stability. Calibration curves indicated favourable agreement between predicted and observed probabilities, and the Hosmer-Lemeshow test showed no significant deviation (P = 0.615), confirming favorable model fit. CONCLUSIONS: IA detection increased significantly over the past two years. We developed and validated a risk-factor-based nomogram that demonstrates good predictive accuracy and robustness in identifying poor prognosis among IA patients. This individualized tool, accessible via an interactive web-based application, provides clinicians with a good basis for early risk stratification and timely therapeutic intervention, ultimately aiming to improve clinical outcomes in high-risk populations.
Prevalence of left ventricular systolic dysfunction in HIV-infected children from sub-saharan Africa: a systematic review and meta-analysis.
Bassey K, Nku C, Meremikwu M … +1 more , Ebiekpi I
BMC Infect Dis · 2026 Jun · PMID 42343252 · Full text
BACKGROUND: Left ventricular systolic dysfunction (LVSD) is an emerging non-communicable complication among children living with Human Immunodeficiency Virus (HIV), particularly in Sub-Saharan Africa, where paediatric HI...
BACKGROUND: Left ventricular systolic dysfunction (LVSD) is an emerging non-communicable complication among children living with Human Immunodeficiency Virus (HIV), particularly in Sub-Saharan Africa, where paediatric HIV burden remains high. However, reported prevalence varies widely across studies and treatment eras, reflecting differences in antiretroviral therapy (ART) exposure, disease severity, and diagnostic criteria. AIM: To estimate the prevalence of LVSD among children living with HIV in Sub-Saharan Africa and evaluate study-level factors associated with variability. METHODS: A systematic review was conducted according to PRISMA 2020 guidelines. Databases including PubMed, MEDLINE, Scopus, AJOL, and ScienceDirect were searched. Studies reporting echocardiographically defined LVSD (EF < 55% or FS < 28%) in individuals aged 0-19 years were included. Random-effects meta-analysis was performed using RevMan 5.4. Subgroup analyses were conducted by ART era, ART coverage, echocardiographic method, ART duration, and study quality. Sub-group and meta-regression analyses were performed using R (metafor package). Publication bias was assessed using Egger's test. RESULTS: Twenty studies (n = 3,994) were included. The pooled prevalence of LVSD was 6.0% (95% CI: 3.0-12.0%) with high heterogeneity (I² = 95%). Prevalence was substantially higher in pre-ART/early ART studies (27.8%) compared with ART-era studies (3.6%). Studies with ≥ 80% ART coverage reported lower prevalence (2.6%) compared with < 80% coverage (12.8%). There was, however, persistent high heterogeneity in subgroup analyses. Meta-regression showed that increasing ART coverage was associated with lower LVSD prevalence (OR 0.75 per 10% increase; p = 0.01). Echocardiographic method significantly influenced estimates, with FS-based studies reporting higher prevalence than EF-based studies. Egger's test showed no evidence of publication bias (p = 0.86). CONCLUSION: LVSD remains present in a persistent proportion of children living with HIV in Sub-Saharan Africa, although prevalence varies substantially across settings and treatment eras. Higher ART coverage and sustained treatment are associated with lower prevalence. Findings should be interpreted cautiously due to high heterogeneity. Longitudinal studies using standardised definitions are needed.
Epidemiological trends in antibiotic resistant Klebsiella pneumoniae in healthcare settings in Burkina Faso: a systematic review and meta-analysis.
Soma D, Diarra FBJ, Diallo D … +7 more , Somda NS, Garba Z, Sore S, Bako E, Nikiema MEM, Barro N, Bonkoungou IJO
BMC Infect Dis · 2026 Jun · PMID 42343245 · Full text
INTRODUCTION: Klebsiella pneumoniae (K. pneumoniae) is a major pathogen involved in nosocomial and community-acquired infections, whose multidrug resistance (MDR) constitutes a public health emergency. Data reporting of...
INTRODUCTION: Klebsiella pneumoniae (K. pneumoniae) is a major pathogen involved in nosocomial and community-acquired infections, whose multidrug resistance (MDR) constitutes a public health emergency. Data reporting of antibiotic-resistant K. pneumoniae in healthcare settings in Burkina Faso is often insufficient and poorly documented. This study aimed to estimate, through a meta-analysis, the prevalence of phenotypic and molecular resistance to antibiotics of K. pneumoniae in Burkina Faso. METHODS: A systematic review and meta-analysis were conducted using studies published between 2015 and 2025, identified through PubMed, African Journals Online, Scopus, and Google Scholar, using specific keywords, following the PRISMA guidelines. Data on resistance to different classes of antibiotics and genetic determinants were extracted. A meta-analysis of proportions using a random effects model was used to estimate the pooled resistance rates. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID: CRD420261290027. RESULTS: The pooled prevalence of resistance in K. pneumoniae was 44% (95% CI: 0.36-0.53). The highest resistance rates were observed to penicillin (85%) and third-generation cephalosporins (50%), while carbapenems remained the most effective class (11%). The molecular analysis revealed that aminoglycoside resistance genes were the most prevalent (53%), driven by aac(3)-IIc (78%) and aac(6')-Ib (62%) genes. Extended Spectrum Betalactamas (ESBL) genes (34%) were dominated by the bla variant (up to 100%). Finally, the emergence of carbapenemases was confirmed by the presence of bla (10%) and bla (25%). CONCLUSION: Our results indicate a burden of multidrug resistance in K. pneumoniae within Burkina Faso, characterized by the co-occurrence of various genotypic resistance markers. These findings call for a review of empirical treatment protocols and urgent reinforcement of molecular surveillance and hospital hygiene to preserve the last remaining treatment options. CLINICAL TRIAL NUMBER: Not applicable.
Staphylococcus aureus bacteremia: clinical outcomes and predictors of 28-day mortality in a tertiary-care cohort.
Gucluer Kocaoglu MN, Kahraman H, Nayman S … +2 more , Erben N, Kartal ED
BMC Infect Dis · 2026 Jun · PMID 42343244 · Full text
BACKGROUND: Staphylococcus aureus bacteremia (SAB) is associated with substantial short-term mortality, but the relative contributions of methicillin resistance, treatment adequacy, and host-related factors to outcome re...
BACKGROUND: Staphylococcus aureus bacteremia (SAB) is associated with substantial short-term mortality, but the relative contributions of methicillin resistance, treatment adequacy, and host-related factors to outcome remain unclear. This study aimed to evaluate the clinical and microbiological characteristics of SAB, compare methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) episodes, and identify independent predictors of 28-day mortality in a Turkish tertiary-care cohort. METHODS: This retrospective cohort study included adult patients hospitalized with monomicrobial S. aureus bacteremia at Eskisehir Osmangazi University Faculty of Medicine Hospital between January 2019 and May 2023. Demographic, clinical, microbiological, and treatment-related data were collected retrospectively. Factors associated with 28-day all-cause mortality were assessed using univariable and multivariable logistic regression analyses. RESULTS: A total of 372 patients were included, of whom 293 (78.8%) had MSSA bacteremia and 79 (21.2%) had MRSA bacteremia. The two groups were comparable with respect to age, comorbidity burden, illness severity, and source or presumed focus of infection. Appropriate empirical therapy was significantly more frequent in MSSA than in MRSA bacteremia (90.8% vs. 44.3%, p < 0.001), and time to appropriate therapy was shorter in the MSSA group (median 0 vs. 2 days, p < 0.001). Despite these differences, mortality did not differ significantly between MSSA and MRSA bacteremia at 7 days (14.3% vs. 15.2%, p = 0.848), cumulative 14 days (16.7% vs. 16.5%, p = 0.955), or 28 days (30.7% vs. 27.8%, p = 0.620). Overall, 28-day mortality was 30.1% (112/372). In multivariable analysis, older age (OR 1.03, 95% CI 1.01-1.05; p = 0.014), higher Pitt Bacteremia Score (OR 1.76, 95% CI 1.41-2.20; p < 0.001), and intensive care unit (ICU) admission (OR 2.87, 95% CI 1.62-5.09; p < 0.001) were independently associated with 28-day mortality. Methicillin resistance, appropriateness of empirical therapy, and time to appropriate treatment were not independently associated with mortality. CONCLUSIONS: In this cohort, short-term mortality in SAB was more strongly associated with host-related factors and acute illness severity than with methicillin resistance or treatment timing. Early risk stratification at the time of diagnosis may help guide the intensity of monitoring and management in patients with SAB.
Temporal trends and clinical outcomes of pediatric invasive fungal diseases: a ten-year retrospective study from a tertiary-care center in Thailand.
Niyomthammarat C, Meesilpavikkai K, Chintanapakdee W … +4 more , Sophonphan J, Anugulruengkitt S, Puthanakit T, Jantarabenjakul W
BMC Infect Dis · 2026 Jun · PMID 42343235 · Full text
BACKGROUND: Invasive fungal diseases (IFDs) remain an important cause of morbidity and mortality among immunocompromised children. Changes in diagnostic criteria and increasing use of antifungal prophylaxis may influence...
BACKGROUND: Invasive fungal diseases (IFDs) remain an important cause of morbidity and mortality among immunocompromised children. Changes in diagnostic criteria and increasing use of antifungal prophylaxis may influence the epidemiology and clinical presentation of pediatric IFDs. Longitudinal data from Southeast Asia remain limited. This study aimed to characterize temporal trends, clinical features, and outcomes of pediatric IFDs using the 2020 EORTC/MSGERC criteria. METHODS: We retrospectively reviewed children aged 0-15 years diagnosed with IFDs at a tertiary-care hospital in Bangkok, Thailand, from 2014 to 2023. IFD episodes were classified as proven, probable, or possible according to the 2020 EORTC/MSGERC criteria and categorized by causative organism. Temporal trends, clinical characteristics, antifungal prophylaxis exposure, and outcomes were analyzed. RESULTS: Among 156 patients, 171 IFD episodes were identified: invasive aspergillosis (60 episodes), invasive candidiasis (61), Pneumocystis pneumonia (33), cryptococcosis (5), other invasive mold infections (8), and endemic mycoses (4). Invasive aspergillosis and Pneumocystis pneumonia demonstrated greater year-to-year variability with higher case numbers in later years, whereas invasive candidiasis occurred consistently throughout the study. A proportion of IFD episodes occurred despite antifungal prophylaxis, including 23.3% of invasive aspergillosis, 8.2% of invasive candidiasis, and 12.1% of Pneumocystis pneumonia. Hematologic malignancies were the most common underlying conditions among children with invasive aspergillosis (68.3%) and Pneumocystis pneumonia (27.3%). Invasive candidiasis primarily affected infants and young children with chronic conditions, including chronic liver or gastrointestinal disease (25.4%) and congenital heart disease (25.4%), and was strongly associated with central venous catheter use (88.9%). Candida albicans remained the most common pathogen, with overall low antifungal resistance. The clinical manifestations were non-specific and overlapped across pathogens, most commonly presenting with fever and organ-specific symptoms. Ninety-day all-cause mortality was 20.3% for aspergillosis, 24.8% for candidiasis, and 12.9% for Pneumocystis pneumonia. CONCLUSIONS: Pediatric IFDs remained associated with substantial mortality despite evolving diagnostic criteria and increasing use of antifungal prophylaxis, underscoring the need for improved diagnostic and preventive strategies.
Competing risks of AIDS and death in people living with HIV: a left-truncated and right-censored retrospective cohort study in Khuzestan, Iran (2001-2022).
Kajkolahi K, Askarishahi M, Barzian KA … +2 more , Daneshi N, Loeloe MS
BMC Infect Dis · 2026 Jun · PMID 42337730 · Full text
OBJECTIVE: This study aimed to estimate the risks of AIDS progression and death among people living with HIV using left-truncated and right-censored survival methods. Competing-risk methods were used to evaluate AIDS pro...
OBJECTIVE: This study aimed to estimate the risks of AIDS progression and death among people living with HIV using left-truncated and right-censored survival methods. Competing-risk methods were used to evaluate AIDS progression in the presence of death as a competing event. METHODS: A retrospective cohort study was conducted using data from Behavioral Disease Counseling Centers (BDCC) in East Khuzestan, Iran, from 2001 to 2022. Survival analyses were performed within a left-truncated and right-censored framework, in which the physician-estimated HIV infection date served as the biological time origin and HIV diagnosis was treated as delayed entry. Competing-risk methods were used to evaluate AIDS progression in the presence of death as a competing event. Late HIV diagnosis, defined as a baseline CD4 count below 350 cells/mm³, was a key variable of interest. RESULTS: Throughout the follow-up period, the cumulative incidence of death exceeded that of AIDS in most time intervals. Late diagnosis was associated with significantly higher hazards for both death and AIDS, with a two-fold increase in the hazard of death (HR = 2.1, p < 0.001). Other significant predictors of death included age ≥ 50 (HR = 2.4, p < 0.001), male sex (HR = 2.84, p = 0.014), and TB co-infection (HR = 2.02, p < 0.001). CONCLUSION: Accounting for left truncation and right censoring is essential when analyzing registry-based HIV cohorts. Late HIV diagnosis was strongly associated with increased risks of both AIDS progression and death, highlighting the importance of earlier testing, timely diagnosis, and prompt linkage to care. Appropriate survival methods that accommodate delayed entry and competing risks can provide more accurate estimates of disease progression and mortality in HIV populations.
Invasive pneumococcal disease with widespread metastatic involvement in a healthy adult: a case report.
Fox S, Munteanu D
BMC Infect Dis · 2026 Jun · PMID 42337724 · Full text
BACKGROUND: This was an unusual case of invasive pneumococcal disease in an immunocompetent adult without serious underlying medical conditions. Streptococcus pneumoniae bacteraemia was found with multiple distant sites...
BACKGROUND: This was an unusual case of invasive pneumococcal disease in an immunocompetent adult without serious underlying medical conditions. Streptococcus pneumoniae bacteraemia was found with multiple distant sites of infection, including polyarticular septic arthritis, osteomyelitis, multi-level spondylodiscitis, and paravertebral, psoas and pelvic abscesses. CASE PRESENTATION: A fit and well 56 year old woman presented with a 10 day history of fevers, rigors, and multiple hot, swollen, tender joints. Septic arthritis was initially thought unlikely, but when blood tests showed marked inflammatory response and the patient was febrile, joint aspiration was performed. Streptococcus pneumoniae was grown from blood cultures and aspirates from multiple joints. MRI confirmed distant sites of infection including left sacroiliac joint osteomyelitis, multi-level spondylodiscitis, and small paravertebral, psoas and pelvic abscesses, which were not amenable to drainage. The patient completed 11 weeks of antibiotic therapy, with IV Amoxicillin followed by IV Ceftriaxone, and made a good recovery with full resolution of joint disease. The patient had obesity but was not in a recognised risk group for invasive pneumococcal disease. No underlying medical conditions were found that would predispose her to such widespread infection. CONCLUSIONS: Septic arthritis can be polyarticular. Urgent joint aspiration and blood cultures should be undertaken for any patient in whom septic arthritis is considered. Patients with invasive pneumococcal disease should be investigated for predisposing risk factors and should be adequately immunised. This case provides a timely reminder of the virulence of pneumococcus, the severity of invasive pneumococcal disease, and the importance of vaccination.
Respiratory syncytial virus (RSV) in older adults: from infection to outcomes - who gets sick, who gets hospitalized, who survives?
Dossou NC, Cerasuolo D, Dubus C … +8 more , Francois C, Réguème A, Corroyer B, Schanen C, Ar Gouilh M, Plantier JC, Morello R, Vabret A
BMC Infect Dis · 2026 Jun · PMID 42337480 · Full text
Respiratory syncytial virus (RSV) is a virus responsible for acute respiratory infections and is widely recognized as a major pathogen in the paediatric population. Thus, the burden of RSV in the adult population remains...
Respiratory syncytial virus (RSV) is a virus responsible for acute respiratory infections and is widely recognized as a major pathogen in the paediatric population. Thus, the burden of RSV in the adult population remains poorly understood, as epidemiological studies mainly rely on PMSI (Medicalization of Information Systems Program) data, which are coded for economic purposes, and because many adults RSV infections remain underdiagnosed. The aim of this study was to describe epidemiological and clinical characteristics of RSV infections in elderly population across four university hospitals in north-western France during the 2022-2023 epidemic season. This retrospective cohort included all patients aged 60 years and older who tested positive for RSV between September 1st, 2022, and January 31st, 2023, in four university hospitals. Viral detection was performed using molecular assays on respiratory samples. Clinical, demographic, biological, and coding data were collected from medical records and hospital information systems. Outcomes included need for oxygen therapy, intensive care admission, in-hospital mortality, length of stay, readmission within 90 days for a respiratory or cardiac reason, and changes in living arrangements. Statistical analyses used descriptive methods and standard tests for comparisons. A total of 647 patients were included. The mean age was 77.8 years, and most patients had at least one chronic medical condition, primarily respiratory or cardiac. 508 (78.5%) patients were hospitalized. The mean hospital stay was 16.2 days, and oxygen therapy was required in 68.3% of cases. In-hospital mortality reached 11.0%. Among survivors, 38.0% were readmitted within 90 days for a respiratory or cardiac reason. A notable proportion of patients experienced a loss of autonomy leading to institutional placement at discharge. RSV was coded in the PMSI database as a diagnosis in approximately two-thirds of hospitalizations, with substantial variations between centers. RSV infection in older adults was associated with significant morbidity, prolonged hospitalization, and a frequent decline in functional status. The study also identified heterogeneity in coding practices and emphasized limitations of PMSI data for capturing respiratory syncytial virus burden. These findings support the need for expanded screening, along with targeted preventive strategies and structured post-discharge follow-up to reduce the long-term burden of RSV in older populations.
Seroprevalence and molecular detection of Toxoplasma gondii in patients with obsessive-compulsive disorder: a case-control study in northern Iran.
Zakariaei Z, Hosseini SH, Alizadeh-Navaei R … +4 more , Malekbala M, Montazeri M, Fakhar M, Talabaki H
BMC Infect Dis · 2026 Jun · PMID 42337477 · Full text
BACKGROUND: The infectious hypothesis of obsessive-compulsive disorder (OCD) has gained traction, with Toxoplasma gondii (T. gondii) proposed as a potential risk factor due to its neurotropic properties and ability to al...
BACKGROUND: The infectious hypothesis of obsessive-compulsive disorder (OCD) has gained traction, with Toxoplasma gondii (T. gondii) proposed as a potential risk factor due to its neurotropic properties and ability to alter neurotransmitter systems. However, epidemiological evidence for an association remains inconsistent. This study aimed to investigate the potential association between acute and chronic T. gondii infection and OCD in a region with high toxoplasmosis prevalence. METHODS: A case-control study was conducted involving 120 OCD patients and 135 healthy controls matched for age and gender in Mazandaran Province, Iran. Serum samples were tested for anti-T. gondii immunoglobulin (Ig) G and IgM antibodies using a commercial ELISA kit. Additionally, buffy coat samples were analyzed for T. gondii DNA using a nested-PCR assay targeting the 529 bp RE gene. We employed descriptive statistics to summarize demographic and clinical variables, used the Chi-square test for categorical data, and conducted independent-samples t-tests for continuous variables. Additionally, we applied logistic regression to evaluate the association between T. gondii infection and OCD, adjusting for confounding factors, with significance set at P < 0.05. RESULTS: The seroprevalence of anti-T. gondii IgG was not significantly different between OCD patients (55.0%, 66/120) and healthy controls (52.6%, 71/135) (OR: 1.10; 95% CI: 0.67-1.81, P = 0.70). All participants were negative for IgM. Molecular detection by PCR was positive in 5.8% (7/120) of patients and 3.7% (5/135) of controls, a non-significant difference (OR: 1.33; 95% CI: 0.44-4.08, P = 0.62). A significant correlation was observed between increasing age and IgG seropositivity in both groups (P < 0.05). CONCLUSION: This study found no significant association between latent T. gondii infection and OCD. The seroprevalence and molecular evidence do not support a direct causal role for T. gondii in OCD pathogenesis within the studied population. Further longitudinal research is needed to investigate this relationship.
Crimean-congo haemorrhagic fever virus in ticks and small ruminants in western Iran: epidemiological insights and genotyping.
Amrollahi A, Moravedji M, Esmaeili S … +7 more , Baneh NK, Jalali T, Rahravani M, Tavakoli M, Hosseini Z, Salehi-Vaziri M, Pouriayevali MH
BMC Infect Dis · 2026 Jun · PMID 42337474 · Full text
BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is an emerging zoonotic disease of significant public health concern caused by Crimean-Congo haemorrhagic fever virus (CCHFV), primarily transmitted by tick vectors. It...
BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is an emerging zoonotic disease of significant public health concern caused by Crimean-Congo haemorrhagic fever virus (CCHFV), primarily transmitted by tick vectors. Its spread is further compounded by global warming, tick range expansion, and traditional farming practices. This study aimed to assess the prevalence of CCHFV in ticks parasitizing livestock in Kermanshah Province, Iran, which borders Iraq, a country that has experienced major CCHF outbreaks in recent years. METHODS: Serum and tick samples were collected from 302 small ruminants (SRs) in six districts, considering previous CCHF cases and regional differences. Following RNA extraction from both ticks and sera, a homemade real-time RT-PCR was used to detect CCHFV infection. RESULTS: All sera tested negative, while 0.67% (4/604) of ticks were infected with CCHFV (Hyalomma asiaticum and Rhipicephalus sanguineus were positive). This study confirms the circulation of CCHFV in the western region of Iran and, more importantly, reports the detection of an Aigai virus (formerly CCHFV genotype VI or AP-92-like strain) in tick populations for the first time in Iran. CONCLUSIONS: These findings emphasize the need for continued molecular surveillance, vector control, and cross-border cooperation to mitigate the risk of CCHF transmission in humans.
Comparative efficacy and safety of colistin sulfate versus polymyxin B in critically ill patients with carbapenem-resistant gram-negative infections: a pilot inverse probability of treatment weighting-based retrospective cohort study.
Xu Y, Zhang S, Wang L … +2 more , Deng Y, Hu N
BMC Infect Dis · 2026 Jun · PMID 42337470 · Full text
OBJECTIVE: The efficacy and safety of colistin sulfate (CS) and polymyxin B sulfate (PBS) were evaluated in critically ill patients with carbapenem-resistant Gram-negative bacteria (CR-GNB) infections, and predictors aff...
OBJECTIVE: The efficacy and safety of colistin sulfate (CS) and polymyxin B sulfate (PBS) were evaluated in critically ill patients with carbapenem-resistant Gram-negative bacteria (CR-GNB) infections, and predictors affecting clinical outcomes were identified. METHODS: CR-GNB-infected ICU patients treated between February 2023 and December 2024 were retrospectively analyzed. Patients were grouped according to treatment, and inverse probability of treatment weighting (IPTW) was applied to balance confounding factors and compare clinical efficacy, microbiological clearance rates, and safety between groups. Prespecified subgroup analyses by pathogen type were conducted, with doubly robust estimation applied in the CRAB subgroup. Differences in trough concentrations (C) were evaluated among clinical efficacy groups, acute kidney injury (AKI) groups, and mortality groups. Univariate and multivariate analyses were performed to identify prognostic factors for efficacy and mortality. RESULTS: The CS group and the PBS group have 85 and 78 patients, respectively. Following IPTW adjustment for indication-based confounders, the two groups were well-balanced in baseline demographic characteristics, and showed no significant differences in clinical and microbiological efficacy, or in 14-day and 28-day mortality rates. However, the PBS group exhibited a significantly higher proportion of severe AKI (stages II and III) compared to the CS group (OR = 6.865, 95% CI: 1.463-32.221, P = 0.015).In prespecified subgroup analyses, the risks of both overall AKI (OR = 4.84, 95% CI 1.45-16.15, P = 0.011) and severe AKI (OR = 7.63, 95% CI 1.57-36.97, P = 0.012) were significantly elevated with PBS in patients with CRAB infection, with a significant treatment-by-pathogen interaction. No significant differences in C were observed across the clinical efficacy groups, AKI groups, and mortality groups. Multivariable analysis showed that in the CS group, the use of vasoactive drugs was an independent risk factor for poor clinical efficacy and 28-day mortality; In the PBS group, CRAB infection and age were independent risk factors for 28-day mortality, whereas vasoactive drug use was an independent risk factor for poor clinical efficacy, and loading dose administration served as an independent protective factor for clinical efficacy. CONCLUSIONS: CS and PBS showed comparable clinical and microbiological efficacy. PBS was associated with a higher risk of severe AKI in the overall cohort. Notably, within the CRAB subgroup, PBS showed significantly elevated risks for both overall and severe AKI.
Second-line antiretroviral therapy success rates and predictors among people living with HIV in Rwanda, 2019-2023.
Kwizera JC, Simbi CMC, Rwibasira GN … +2 more , Uwamahoro B, Andegiorgish KA
BMC Infect Dis · 2026 Jun · PMID 42337468 · Full text
BACKGROUND: Despite advances in HIV treatment, managing people living with HIV (PLHIV) on second-line antiretroviral therapy (ART) remains challenging. Globally, second-line ART achieves an average viral suppression rate...
BACKGROUND: Despite advances in HIV treatment, managing people living with HIV (PLHIV) on second-line antiretroviral therapy (ART) remains challenging. Globally, second-line ART achieves an average viral suppression rate (VLS) of 81.2%. In Rwanda, evidence is limited; the most recent national study in 2016 reported a 17% failure rate. This study assessed current VLS proportions and predictors of second-line ART success in Rwanda. METHODS: A retrospective cohort study was conducted at 277 health facilities across Rwanda, including PLHIV who initiated second-line ART between January 2019 and December 2023. The primary outcome was VLS, defined as a viral load of ≤ 1000 copies/mL at the most recent measurement recorded at least six months after second-line initiation. Data were abstracted from patient files using a standardized tool, and multivariate logistic regression identified independent predictors of VLS. RESULTS: Analysis included 726 individuals; overall VLS was 88.8% (645/726). Most participants were female (63.9%), aged 35-49 years (38.7%), on protease inhibitor-based regimens (78.7%), and on ART for 10 years or more (80.9%). Participants aged 15-24 years had lower odds of VLS compared with the 35-49 year reference group (aOR = 0.34; 95% CI: 0.13-0.92), and students had lower odds than participants (aOR = 0.18; 95% CI: 0.06-0.51). Residence in Kigali City (aOR = 2.47; 95% CI: 1.07-6.26), Northern (aOR = 3.57; 95% CI: 1.37-10.95), and Southern Province (aOR = 3.84; 95% CI: 1.58-10.53) was independently associated with higher odds of VLS compared with Eastern Province. PLHIV with poor or moderate ART adherence had 0.25 times the odds of VLS (aOR = 0.25; 95% CI: 0.14-0.44); alcohol or illicit drug use (aOR = 0.44; 95% CI: 0.22-0.94) and NCD comorbidity (aOR = 0.22; 95% CI: 0.06-0.80) were also independently associated with lower VLS. CONCLUSION: Rwanda's second-line VLS of 88.8% exceeds the global average and improves on the 2016 estimate but remains below the UNAIDS 95% target. Targeted interventions addressing adherence, substance use, and regional disparities, and integrated NCD services are needed. Tailored youth-friendly care, peer support, and integrated mental health services should be prioritized to improve outcomes among younger populations.
Non-risk-based HCV screening at point of care: a prospective pilot.
Paulose J, Jagarlamudi N, Shek D … +9 more , Markovic S, Wong I, Read S, George J, Kenny J, Cain K, Almir A, Derrett A, Ahlenstiel G
BMC Infect Dis · 2026 Jun · PMID 42337461 · Full text
BACKGROUND: Hepatitis C virus (HCV) transmission continues to be a significant problem among high-risk populations and has prompted widespread risk-factor based screening in Australia. Current evidence indicates a higher...
BACKGROUND: Hepatitis C virus (HCV) transmission continues to be a significant problem among high-risk populations and has prompted widespread risk-factor based screening in Australia. Current evidence indicates a higher-than-expected local HCV prevalence in non-high-risk populations, justifying broader screening strategies in support of national HCV elimination efforts. This pilot study evaluated the feasibility and scalability of a non-risk-based point-of-care HCV screening approach with a focus on consumer experience and acceptability. METHODS: Over a 10-month period, individuals attending outpatient and community services were offered point-of-care HCV screening using the Abbott Bioline rapid HCV antibody test. Participants with reactive results received HCV-related education and were referred for confirmatory HCV antibody and RNA testing at local pathology services. Patients with detectable HCV RNA were offered expedited access to the Liver Clinic for assessment and treatment, coordinated by the Liver Clinical Nurse Consultant (CNC). RESULTS: A total of 1,086 individuals were screened, among whom 1.7% (n = 19) tested positive for HCV antibodies. This is notably higher than the national notification rate of 0.0281% indicating an unrecognised burden of HCV in this population. Among participants, 60.2% reported never having undergone HCV testing before. Consumer satisfaction was highly favourable, with > 95% of patients reporting that the test was easy to complete, and they would recommend it to family and friends. Each patient interaction, including consent, testing, result interpretation, counselling, and documentation, was completed within 20 min. Importantly, the Bioline test did not require laboratory infrastructure or skill set, is easily administered in community or outpatient settings, and delivers immediate results, enabling timely counselling, education, and linkage to care. CONCLUSIONS: This proof-of-concept study demonstrates that non-risk-based opportunistic approach to HCV screening is both acceptable to our community and effective in identifying individuals with previously undiagnosed chronic HCV infection. The approach is scalable, resource-efficient, and represents a viable alternative to traditional, risk-based screening strategies in the context of broader public health efforts toward HCV elimination. Notably, our non-stigmatising "why not?" approach of testing allowed for concomitant education of our consumers and improved awareness of Hepatitis C and other blood-borne viruses.
Development and validation of an interpretable machine learning model for early hospital-based differentiation of chikungunya and dengue fever using routine clinical data.
Zhang L, Liu J, Mai JL … +3 more , Yang Q, Zhao JY, Hong MH
BMC Infect Dis · 2026 Jun · PMID 42337454 · Full text
BACKGROUND: Chikungunya fever (CHIKF) and dengue fever are mosquito-borne viral diseases. These infections often circulate in the same regions at the same time. Early symptoms can look very similar between the two diseas...
BACKGROUND: Chikungunya fever (CHIKF) and dengue fever are mosquito-borne viral diseases. These infections often circulate in the same regions at the same time. Early symptoms can look very similar between the two diseases. This overlap makes early and accurate diagnosis difficult. Many endemic clinics do not have easy access to molecular tests such as RT-PCR [1, 2]. Clinicians therefore need other practical tools for early decision-making. In this study, we aimed to develop an interpretable machine learning model. The model uses routine clinical signs and standard laboratory results. We also aimed to validate the model for differentiation of CHIKF from dengue fever at initial hospital-based assessment. METHODS: This retrospective observational study analyzed 1,058 laboratory-confirmed arboviral infections, including 366 patients with CHIKF and 692 patients with dengue fever. The dataset was stratified by diagnosis and randomly divided into a training set (n = 742) and a held-out test set (n = 316) at a 7:3 ratio. The team collected clinical symptoms, complete blood count (CBC) results, and inflammatory marker data. The team then used these variables to build eight machine learning models. The study evaluated model performance with discrimination metrics. The study also assessed calibration. The study further used decision curve analysis to estimate clinical usefulness. The team examined feature importance with Shapley Additive Explanations (SHAP). The team deployed the best-performing model as a web-based clinical decision-support tool. RESULTS: Among the tested approaches, the gradient boosting model (GBM) showed the best and most consistent performance. The GBM achieved a high area under the ROC curve (AUC) in both the training and test sets. The GBM also delivered strong sensitivity and specificity across both cohorts. The SHAP analysis repeatedly highlighted platelet count (PLT) and rash as the most important predictors of CHIKF. These findings match well with known clinical patterns. The online deployment integrated the final model into a simple platform. The platform provides automated, real-time risk estimates using only a small set of routinely available variables. CONCLUSION: This study shows that interpretable machine learning models can help clinicians distinguish CHIKF from dengue fever early. The models rely on routine clinical information and standard laboratory tests. These inputs are widely available in many settings. The study also presents a web-based tool that applies the best model at the bedside. The tool may be especially useful in resource-limited clinics. However, the tool still needs external validation. Future studies should test the model in multicenter, prospective cohorts.
Bacterial bloodstream infections in cardiac patients: microbiological spectrum, antimicrobial susceptibility patterns, and biomarker correlation analysis at a cardiac tertiary care centre.
Khan MA, Saeed S, Afrozuddin Z … +1 more , Khan WA
BMC Infect Dis · 2026 Jun · PMID 42337442 · Full text
INTRODUCTION: Bloodstream infections (BSIs) in cardiac patients represent a significant clinical challenge with substantial morbidity and mortality. Understanding the microbiological profile and biomarker patterns in thi...
INTRODUCTION: Bloodstream infections (BSIs) in cardiac patients represent a significant clinical challenge with substantial morbidity and mortality. Understanding the microbiological profile and biomarker patterns in this high-risk population is crucial for optimizing treatment strategies and infection prevention measures. METHODS: A retrospective observational study was conducted analyzing patient data from 1st November 2024 to 31st October 2025 at a tertiary cardiac care centre in Karachi, Pakistan. During this period, 25,532 cardiac patients were admitted, and 547 blood cultures were obtained from admitted patients. Blood cultures from 113 BSI episodes in cardiac inpatients were analyzed for bacterial identification and susceptibility patterns. Procalcitonin (PCT) and C-reactive protein (CRP) levels were measured simultaneously with microbiological investigation. Correlation analysis between biomarkers and pathogen types was performed using both Pearson and Spearman correlation coefficients. RESULTS: One hundred and thirteen BSI episodes yielding bacterial isolates were identified with gram-negative bacteria predominating (63.7%, n = 72) over gram-positive organisms (36.3%, n = 41). Escherichia coli was the most prevalent pathogen (17.7%, n = 20), followed by Acinetobacter species (9.7%, n = 11) and Enterobacter species (8.8%, n = 10). Multidrug-resistant organisms accounted for 16.8% (n = 19) of isolates, with Vancomycin-Resistant Enterococcus (8.8%) and Methicillin-Resistant Staphylococcus aureus (8.0%) being the most common. Gram-negative bacteria demonstrated higher mean PCT levels (16.60 ng/mL) compared to gram-positive bacteria (12.24 ng/mL), though not statistically significant (p = 0.094). CRP levels were similarly elevated in both groups (gram-negative: 138.18 mg/L vs. gram-positive: 118.09 mg/L, p = 0.216). Spearman correlation analysis revealed a statistically significant correlation between PCT and CRP (ρ = 0.444, p < 0.001) overall, with stronger correlation in gram-positive infections (ρ = 0.510) compared to gram-negative infections (ρ = 0.372). CONCLUSION: This study confirms the critical importance of understanding local microbiological epidemiology and biomarker patterns in cardiac patients with BSI, providing evidence-based guidance for empirical antimicrobial therapy, infection prevention strategies, and diagnostic algorithm optimization in tertiary cardiac care settings. PCT and CRP both serve as valuable biomarkers in this population, with their combined use potentially enhancing diagnostic accuracy, supporting their complementary role in sepsis management and antimicrobial stewardship in cardiac patients. CLINICAL TRIAL NUMBER: Not applicable.
HPV genotype distribution and risk factors for cervical dysplasia among HPV-positive women with or without HIV infection in Shanghai, China.
Ma Y, Liu M
BMC Infect Dis · 2026 Jun · PMID 42332625 · Full text
BACKGROUND: Human papillomavirus (HPV) and human immunodeficiency virus (HIV) co-infection exerts a substantial impact on women's health globally. This study enrolled confirmed HPV-infected women in Shanghai stratified b...
BACKGROUND: Human papillomavirus (HPV) and human immunodeficiency virus (HIV) co-infection exerts a substantial impact on women's health globally. This study enrolled confirmed HPV-infected women in Shanghai stratified by HIV status to compare the profiles of HPV genotype distribution and cervical lesions between two groups, and to identify the risk factors for cervical dysplasia among women with HIV-HPV co-infection. METHODS: A total of 238 confirmed HPV-infected women who attended the Shanghai Public Health Clinical Center between January 2019 and July 2023 were enrolled in this cross-sectional study. All participants were divided into HIV-positive and HIV-negative groups. We compared the pathological distribution characteristics, high/low-risk HPV infection patterns and cervical cytological abnormalities between the two groups. Multivariate logistic regression was used to explore risk factors for cervical dysplasia in HIV-HPV co-infected women. RESULTS: Among the 238 HPV-positive patients, 47.9% (114/238) were HIV-HPV co-infected. The top five predominant HPV genotypes were HPV16, HPV52, HPV58, HPV53, and HPV18. The HIV-positive group had significantly higher rates of HR-HPV infection (χ²=4.537, p = 0.037) and multiple HR-HPV infections (χ²=15.878, p < 0.001) than the HIV-negative group. HPV33 and HPV66 were more prevalent in the HIV-positive group, and the positivity rates of HPV genotypes covered by 2-valent, 4-valent, and 9-valent HPV vaccines were all significantly higher in the HIV-positive group than in the HIV-negative group. HPV52 and HPV58 (13.10%, 11/84) were the most common genotypes in multiple HPV infections. The HIV-positive group had a significantly higher rate of cytological abnormalities (χ²=11.658, p < 0.001). Multivariate logistic regression analysis indicated that HIV RNA load > 1000 copies/µl was an independent risk factor (OR 9.845, 95%CI 1.324-73.202, p = 0.026) for cervical dysplasia in the HIV-positive group. CONCLUSIONS: Within the HPV-positive female population, HIV-positive women exhibit higher burdens of multiple HPV infection and cervical cytological abnormalities. Elevated HIV RNA load is a key independent risk factor for cervical dysplasia in this co-infected population. Immediate initiation of antiretroviral therapy, prioritized 9-valent HPV vaccination, and regular cervical cancer screening are recommended to reduce the risk of cervical lesions and alleviate the disease burden among HIV-HPV co-infected women.
Clinical and genomic features of mitis group streptococcal bacteremia in patients with febrile neutropenia.
Arakawa Y, Yagi Y, Nishida Y … +3 more , Iwame S, Mikamo H, Yamagishi Y
BMC Infect Dis · 2026 Jun · PMID 42332621 · Full text
BACKGROUND: Viridans group streptococci (VGS) can cause the life-threatening viridans streptococcal shock syndrome (VSSS) in patients with febrile neutropenia (FN). The Mitis group, a major subgroup of VGS, is frequently...
BACKGROUND: Viridans group streptococci (VGS) can cause the life-threatening viridans streptococcal shock syndrome (VSSS) in patients with febrile neutropenia (FN). The Mitis group, a major subgroup of VGS, is frequently implicated in these severe infections, but its specific clinical and genomic characteristics remain incompletely characterized, particularly in patients with FN. This study aimed to systematically describe these features in this population. METHODS: In this single-center retrospective study, we compared the clinical data and whole-genome sequencing (WGS) results of Mitis group streptococcal isolates from patients with and without FN. Virulence-associated and antimicrobial resistance genes were initially screened using a reference-based approach, followed by assembly-based reanalysis and manual sequence validation. RESULTS: Compared with the non-FN cohort (n = 34), the FN cohort (n = 61) was significantly younger, had a higher prevalence of hematologic malignancy, and more frequently presented with primary bacteremia. VSSS occurred exclusively in the FN group (11.5%) and was associated with high mortality (14-day mortality, 42.9%), which did not correlate with in vitro antimicrobial susceptibility. Genomic analyses revealed marked diversity among isolates. Initial screening suggested variable detection of several virulence-associated loci, including pavA, slrA, and rfb-related loci; however, subsequent assembly-based analyses indicated that many apparent absences were attributable to extreme allelic divergence rather than true gene loss. No single virulence determinant clearly segregated with clinical severity. CONCLUSIONS: Mitis group bacteremia in patients with FN appears to be characterized by distinct clinical features and marked genomic diversity. Our findings suggest that the development of severe disease, including VSSS, may not be explained by microbial factors alone and potentially reflects complex host-pathogen interactions. CLINICAL TRIAL: Not applicable.
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