BMC Infectious Diseases[JOURNAL]
Sun
200 papers
Integrating host mRNA signatures and clinical trajectories with machine learning for risk stratification and survival prediction in sepsis: an ICU-based prospective cohort study.
Wu Z, Zhao L, Yao Y … +9 more , Ma H, Zheng X, Xia J, Bai H, Yu H, Yu Y, Cai H, Zhou J, Zhou H
BMC Infect Dis · 2026 Jun · PMID 42332588 · Full text
BACKGROUND: Sepsis remains a leading cause of death in critically ill patients. Host mRNA biomarkers may provide complementary biological information for prognostic assessment in sepsis. This study aimed to integrate hos...
BACKGROUND: Sepsis remains a leading cause of death in critically ill patients. Host mRNA biomarkers may provide complementary biological information for prognostic assessment in sepsis. This study aimed to integrate host mRNA biomarkers and clinical parameters to develop and compare predictive models for short-term mortality using both conventional and machine learning (ML) approaches. METHODS: In this prospective ICU study (Dec 2022-Mar 2024), 249 patients meeting Sepsis-3 criteria were initially enrolled, and 198 patients with available host mRNA measurements were included in the final analysis. 35 candidate mRNAs were quantified using droplet digital PCR (ddPCR). After initial transcriptomic screening and LASSO-based feature selection, one immune transcript (PAX5) and four clinical variables (hematologic disease, sex, SOFA score, positive blood culture) were retained for model development. Five models were evaluated for predicting 7-, 14-, and 28-day mortality, including Cox proportional hazards regression, random survival forest (RSF), Deep Survival Analysis (DeepSurv), support vector machine (SVM), and extreme gradient boosting (XGBoost). Model discrimination was assessed using AUCs and compared using DeLong's test. Internal validation was performed using the bootstrap 0.632 method. RESULTS: Among the 198 patients included in the final analysis, mortality was 18.7% at 7 days, 28.3% at 14 days, and 30.3% at 28 days. RSF achieved the highest AUCs for 7-, 14-, and 28-day mortality (0.834, 0.854, and 0.847, respectively). DeLong's test showed that RSF significantly outperformed Cox regression, DeepSurv, and survival SVM at all time points, while its performance was comparable to XGBoost. Bootstrap 0.632 internal validation confirmed favorable overall performance of RSF. In variable importance analysis, hematologic disease, sex, SOFA score, PAX5 and positive blood culture were among the main contributors to model performance. Incremental analysis showed that clinical variables contributed the largest improvement beyond SOFA, whereas inclusion of PAX5 provided complementary prognostic value. CONCLUSION: The integration of host mRNA biomarkers with clinical parameters supported the development of a ML-based prognostic framework for short-term mortality in sepsis. RSF showed favorable discriminative performance in this cohort and performed comparably to XGBoost. PAX5 may serve as a complementary prognostic biomarker, although clinical variables remained the dominant contributors to model discrimination.
Evolution of HIV epidemic trends and diagnostic delays in French Guiana: how can we make further progress?
Nacher M, Lucarelli A, Vergeade F … +12 more , Rabier S, Delin C, Epelboin L, Michaud C, Abboud P, Turnier PL, Guedj ME, Vaz T, Cisse H, Djossou F, Couppié P, Adenis A
BMC Infect Dis · 2026 Jun · PMID 42332585 · Full text
BACKGROUND: As antiretroviral treatment indications evolved, an increasing proportion of patients have been treated; since 2017, most patients receive antiretroviral treatment, irrespective of their CD4 count, in French...
BACKGROUND: As antiretroviral treatment indications evolved, an increasing proportion of patients have been treated; since 2017, most patients receive antiretroviral treatment, irrespective of their CD4 count, in French Guiana and neighboring countries. In this context, we aimed to model the epidemic and to study the evolution of the estimates of the intervals between HIV-infection and HIV diagnosis in French Guiana. METHODS: The study was descriptive and comparative. Anonymous data from all persons in the DAT'AIDS HIV cohort based on quality-controlled clinical records was aggregated into yearly statistics between 2000 and 2023. We estimated year of infection using the rate of CD4 decline between the CD4 count at diagnosis and the estimation of the CD4 count at the time of HIV infection. The HIV modelling platform version 3.0.2 used the annual number of new HIV infections, the number of new AIDS cases, the number of new HIV infections that had AIDS, and CD4 strata to compute incidence, number of diagnosed and undiagnosed persons, and diagnostic delay. RESULTS: All indicators improved markedly over time. Incidence declined, diagnostic delay declined, the proportion of undiagnosed patients declined, and deaths declined. However, the estimated interval between HIV infection and diagnosis was heterogenous between groups: It was about 2 years longer among males than among females, and it was about 3 years longer among Surinamese or Brazilian immigrants. Overall, 5% of all persons with HIV were undiagnosed, 9% of diagnosed persons were not on antiretroviral therapy and 6% of those on antiretroviral therapy were in virological failure. For a population of about 4,000 persons with HIV this represents a residual source of transmission. CONCLUSIONS: The scaling up of testing, antiretroviral treatment, and preexposure prophylaxis has led to remarkable progress. Nevertheless, further shrinking the reservoir of undiagnosed infections and maximizing the proportion of successfully treated persons living with HIV is still likely to further improve control of the epidemic. CLINICAL TRIAL: This is not a clinical trial.
Global disparities in COVID-19 vaccine coverage associated with trajectories of SARS-CoV-2 adaptation.
Yang L, Zhou Z, Lin Q … +3 more , Chen Y, Sun Y, Wang Z
BMC Infect Dis · 2026 Jun · PMID 42332584 · Full text
BACKGROUND: Vaccination serves as an effective intervention for health promotion and disease prevention across the socioecological systems and has played an important role during the COVID-19 pandemic. However, global di...
BACKGROUND: Vaccination serves as an effective intervention for health promotion and disease prevention across the socioecological systems and has played an important role during the COVID-19 pandemic. However, global disparities in vaccine coverage have increased uncertainty about the trajectories of viral adaptation, and the potential interplay between SARS-CoV-2 adaptation and vaccine rollout warrants further quantification. METHODS: Using over 13 million SARS-CoV-2 genomes across 86 countries from March 2020 to September 2022, we analyzed nonlinear associations between SARS-CoV-2 adaptation and vaccination coverage, considering public health and social measures, international travel, and infection dynamics, before and after the emergence of Omicron. Additionally, we examined the relationship between SARS-CoV-2 adaptation and COVID-19 mortality. RESULTS: During the pre-Omicron period, we found positive associations between nonsynonymous to synonymous divergence (dN/dS) ratios in the S1 subunit and medium levels of adjusted vaccine coverage (effect size: 0.96 [95% CI 0.47, 1.45]), while the association became insignificant at high levels (effect size: -1.89 [95% CI -4.20, 0.43]). However, no significant associations were found when Omicron dominated, possibly due to the immune escape ability of Omicron variants and the complex immune landscape shaped by mass hybrid immunity. Moreover, we observed evidence of dynamic interdependence and positive correlations between COVID-19 mortality and SARS-CoV-2 adaptation, with COVID-19 mortality interpreted as a proxy for uncontrolled viral spread. CONCLUSIONS: Our findings suggest a complex nonlinear relationship between vaccine-induced immunity and SARS-CoV-2 adaptation, with high vaccine coverage potentially linked to lower positive selection. We also observed directional coupling between COVID-19 mortality and SARS-CoV-2 adaptation. This may have implications for fair and fast vaccination in pandemic preparedness and response. CLINICAL TRIAL NUMBER: Not applicable.
Unsuppressed viral load and its associated factors among people living with HIV on antiretroviral therapy: a cross-sectional study.
Nuerbolati B, Du Y, He W … +1 more , Xie S
BMC Infect Dis · 2026 Jun · PMID 42324500 · Full text
OBJECTIVE: This study aimed to assess the prevalence of unsuppressed viral load and its associated factors among people living with HIV (PLWH) receiving antiretroviral therapy (ART) in the Xinjiang Production and Constru...
OBJECTIVE: This study aimed to assess the prevalence of unsuppressed viral load and its associated factors among people living with HIV (PLWH) receiving antiretroviral therapy (ART) in the Xinjiang Production and Construction Corps (XPCC). METHODS: Clinical data and questionnaires were collected from four divisions of the XPCC via random sampling. Logistic regression and mediation analyses were performed to identify factors associated with unsuppressed viral load. RESULTS: Among 369 PLWH, 55 (14.91%) had unsuppressed viral load. Associated factors included CD4+ T-cell count ≥ 500 cells/μL, treatment duration ≥ 3 years, alcohol consumption, discrimination, poor ART adherence, and poor self-efficacy (all p < 0.05). ART adherence played a full mediating role between self-efficacy, social support and unsuppressed viral load in PLWH, with a mediation effect value (a*b) of β = -0.010 (95% CI: -0.013, -0.006) and β = -0.021 (95% CI: -0.029, -0.014). Greater social support and higher self-efficacy reduce the risk of unsuppressed viral load in PLWH via improved ART adherence. Additionally, the "social support ⇒ medication adherence" pathway exerted a partial chain mediating role between self-efficacy and viral load suppression in PLWH, with a mediation effect value (a*b) of β = -0.012 (95% CI :-0.017, -0.006).Social support can first enhance patients' self-efficacy, which in turn further improves ART adherence, thereby reducing the risk of unsuppressed viral load. CONCLUSIONS: In the XPCC, the viral suppression rate among PLWH has not yet met the UNAIDS 95-95-95 target. Priority should be given to PLWH with <3 years of treatment and CD4+ T-cell count < 500 cells/μL. HIV-related education should be delivered to individuals, families and the public to enhance social support and self-efficacy, reduce HIV-related stigma, and promote healthy lifestyles (e.g. reduced alcohol consumption). These measures will improve adherence to ART, thereby achieving effective viral load suppression.
Awareness of hepatitis C knowledge among four high-risk populations in Xiamen, China: a cross-sectional study.
Xue JH, Cai CX, Ke R … +2 more , Ma GL, Deng HW
BMC Infect Dis · 2026 Jun · PMID 42323631 · Full text
Introduction Hepatitis C virus (HCV) infection remains a severe global public health challenge. Sufficient HCV knowledge among high-risk populations is essential to achieve the WHO 2030 goal of eliminating viral hepatiti...
Introduction Hepatitis C virus (HCV) infection remains a severe global public health challenge. Sufficient HCV knowledge among high-risk populations is essential to achieve the WHO 2030 goal of eliminating viral hepatitis. Comparative evidence on HCV knowledge awareness and its demographic determinants across men who have sex with men (MSM), drug users (DUS), female sex workers (FSW), and invasive procedure patients is scarce in Fujian Province. This study aimed to investigate the status of HCV knowledge awareness and explore its associated factors among the four high-risk populations in Xiamen, China.Methods A hospital- and community-based cross-sectional study was performed among 1621 valid participants. A standardized questionnaire developed by the Chinese Center for Disease Control and Prevention was adopted to collect sociodemographic information and HCV knowledge. Participants scoring ≥ 6 points in the 8 knowledge-related questions were defined as having adequate awareness level. The Chi‑square test and multivariable logistic regression analysis were used to compare intergroup differences and identify factors associated with adequate HCV knowledge.Results The overall HCV knowledge awareness rate was 76.5%, with significant differences across groups: MSM 91.0%, FSW 87.7%, DUS 75.3%, and invasive procedure patients only 51.9% (χ = 295.5, P < 0.001). Obvious knowledge gaps were identified in HCV curability among MSM and DUS, infection risk of novel psychoactive substance use among DUS, and misconceptions about occult infection and transmission routes among invasive procedure patients. Multivariable logistic regression revealed that college education or above was positively associated with adequate HCV knowledge in MSM (OR = 13.729, 95%CI: 4.030-46.767, P<0.001), DUS (OR = 16.201, 95%CI: 8.874-29.578, P<0.001), and invasive procedure patients (OR = 1.741, 95%CI: 1.074-2.822, P = 0.024). For FSW, aged ≥ 40 years (OR = 2.205, 95%CI: 1.091-4.457, P = 0.028) and Fujian household registration (OR = 2.696, 95%CI: 1.330-5.467, P = 0.006) were independent protective factors for better HCV knowledge.Conclusions Substantial disparities in HCV knowledge awareness exist among the four high-risk populations in Xiamen, with invasive procedure patients and DUS being the most disadvantaged groups. Education level, age and household registration were significantly associated with HCV knowledge awareness. Healthcare system-based interventions are crucial for invasive procedure patients, including preoperative HCV counseling, electronic medical record screening prompts, and clinical staff training. Tailored and differentiated health education interventions targeting elderly, migrant and low-education populations are urgently needed to fill knowledge gaps, block HCV transmission, and facilitate the achievement of national and regional hepatitis C elimination targets by 2030.
Nitroimidazole - albendazole combination therapy, quinacrine use, and risk factors in nitroimidazole-refractory giardiasis: a prospective multicentre observational study.
Mørch K, Chiodini P, Nabarro L … +9 more , Hannula R, Neumayr A, Haanshuus CG, Saghaug C, Blomberg B, Pettersen FOD, Sandnes HH, Hanevik K, Langeland N
BMC Infect Dis · 2026 Jun · PMID 42323544 · Full text
BACKGROUND: Nitroimidazole-refractory giardiasis is an increasing problem. We present data on efficacy of a treatment ladder and on clinical characteristics and assemblage types in nitroimidazole-refractory giardiasis. M...
BACKGROUND: Nitroimidazole-refractory giardiasis is an increasing problem. We present data on efficacy of a treatment ladder and on clinical characteristics and assemblage types in nitroimidazole-refractory giardiasis. METHODS: We conducted a prospective clinical observational study of adult patients with giardiasis at four centres in Norway and England during 2009 - 2024. Patients with nitroimidazole-refractory giardiasis were treated with albendazole plus a 5-nitroimidazole followed by quinacrine (mepacrine) if failure. Treatment efficacy was defined as negative stool microscopy and/or PCR four to six weeks after treatment. For analyses of assemblage types and risk factors for treatment failure, patients from a previously published Swiss treatment study were additionally included. Assemblage typing of Giardia isolates was performed collectively in the same laboratory by real-time PCR targeting the glutamate dehydrogenase gene (gdh). Predictors identified by univariate analyses were analysed by multivariate logistic regression for association with nitroimidazole failure. RESULTS: A total of 120 patients were prospectively included; 59 of these had nitroimidazole refractory giardiasis and were treated according to the treatment ladder. In addition, 20 patients from the Swiss cohort were included for assemblage and risk factor analyses. A repeated course of nitroimidazole cured only 24% (5/21). Metronidazole or tinidazole in combination with albendazole cured 76% (35/46). Quinacrine was effective in 100% (15/15). Assemblage B was more common in travellers from India and Africa, but only acquisition of infection in India (aOR 11.9; 95%CI 2.94, 47.6) and more recent year of diagnosis (aOR 1.18, 95% CI 1.03, 1.35) were associated with nitroimidazole failure in multivariate analysis. CONCLUSION: Second line treatment with nitroimidazole in combination with albendazole, and third line treatment with quinacrine, are effective options in nitroimidazole-refractory giardiasis. Nitroimidazole failure seems to be highly associated with infection acquired in India, but not with assemblage A or B. Further studies of resistance mechanisms are needed.
Characteristics, temporal trends and outcomes of Clostridioides difficile infection among hospitalized patients in Spain, 2016-2022.
Fernandez-Cotarelo MJ, Henriquez-Camacho C, Hernandez-Barrera V … +1 more , Gil-de-Miguel A
BMC Infect Dis · 2026 Jun · PMID 42323533 · Full text
BACKGROUND: Clostridioides difficile infection (CDI) is one of the most prevalent hospital-acquired infections, causing high morbidity and mortality. While incidence rates have recently increased in many countries, its e...
BACKGROUND: Clostridioides difficile infection (CDI) is one of the most prevalent hospital-acquired infections, causing high morbidity and mortality. While incidence rates have recently increased in many countries, its epidemiology after the COVID-19 pandemic has yet to be determined. This study analyzes the characteristics and evolution of CDI in hospitalized patients in Spain. METHODS: This retrospective observational study was based on coded hospital discharge reports between 2016 and 2022 using the national hospital discharge database (MBDS), ICD-10 code A04.7. The variables analyzed were sex, age, comorbidities, diagnoses at discharge, procedures, overall severity, whether CDI was coded as a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay, and in-hospital all-cause mortality. RESULTS: There were 66,864 CDI cases (52.8% in women), affecting 0.22% of admissions. The mean age (70.4 years) and mean Charlson comorbidity index (2.49) increased over time. The overall rate per 1,000 admissions and the population-based mean incidence rate almost doubled between 2016 and 2022. Most cases (61.2%) were secondary cases. These patients were younger, more frequently admitted to the ICU, had higher comorbidity, more colectomies, and longer hospital stays. Overall mortality was 11.3%, significantly higher in secondary CDI, and it peaked in 2020. In-hospital all-cause mortality was higher in older patients (OR 1.04), those with more comorbidities (OR 1.14), those in the ICU (OR 28.54) and those with moderate (OR 1.54), high (OR 3.77), or extreme overall severity (OR 10.39). CONCLUSIONS: The CDI incidence has increased in Spain. Age, comorbidities, overall severity, and admission to the ICU predicted poor outcomes in hospitalized patients with CDI. Preventive measures are warranted to decrease the disease burden. CLINICAL TRIAL: Not applicable.
Does SOFA-2 improve mortality prediction in sepsis? A retrospective single-center observational cohort study comparing SOFA-1 and SOFA-2.
Deveci K, Boran M, Bahar KE … +2 more , Sarıdağ F, Eryılmaz Eren E
BMC Infect Dis · 2026 Jun · PMID 42323529 · Full text
BACKGROUND: The Sequential Organ Failure Assessment (SOFA) score has been widely used for nearly three decades to evaluate organ dysfunction and predict mortality in patients with sepsis. Advances in critical care practi...
BACKGROUND: The Sequential Organ Failure Assessment (SOFA) score has been widely used for nearly three decades to evaluate organ dysfunction and predict mortality in patients with sepsis. Advances in critical care practice have led to the development of an updated version, SOFA-2, incorporating contemporary organ support strategies and revised clinical thresholds. However, real-world comparative data evaluating the prognostic performance of the original SOFA score (SOFA-1) and SOFA-2 remain limited. This study aimed to compare the prognostic performance of SOFA-1 and SOFA-2 for predicting ICU, 28-day, and 90-day mortality in patients with sepsis. METHODS: This retrospective, single-center observational cohort study included adult patients (≥ 18 years) diagnosed with sepsis according to Sepsis-3 criteria and admitted between December 2023 and August 2024. SOFA-1 and SOFA-2 scores were calculated using clinical and laboratory data obtained at ICU admission. The primary outcome was ICU mortality; secondary outcomes were 28-day and 90-day mortality. Multivariable logistic regression was performed to identify independent predictors of mortality. Discriminatory performance was assessed using receiver operating characteristic analysis, and areas under the curve were compared using DeLong's test. Optimal cut-off values were determined using the Youden index. RESULTS: Among 417 screened patients, 222 met the inclusion criteria. ICU mortality was 57.7%. Each one-point increase in SOFA-1 and SOFA-2 scores was associated with a 42% and 43% increase in ICU mortality, respectively (p < 0.001 for both). The area under the curve for ICU mortality prediction was 0.843 (95% CI 0.792-0.895) for SOFA-1 and 0.845 (95% CI 0.795-0.896) for SOFA-2; the difference between the two scores was not statistically significant (p = 0.79). SOFA-2 demonstrated slightly higher specificity, whereas SOFA-1 showed marginally higher sensitivity at the optimal cut-off value. CONCLUSIONS: SOFA-1 and SOFA-2 demonstrated good discriminatory performance for predicting ICU mortality in this cohort. Although no statistically significant difference was observed between the two scoring systems, larger prospective multicenter studies are needed to determine whether clinically meaningful differences exist and to further evaluate the potential advantages of SOFA-2. TRIAL REGISTRATION: Not applicable.
Atypical genital-predominant mpox mimicking chancroid and herpes simplex virus infection: a case report and literature synthesis.
Oshodin AE, Unuane AE, Saka SA … +1 more , Njoku AI
BMC Infect Dis · 2026 Jun · PMID 42321676 · Full text
BACKGROUND: Mpox increasingly presents with atypical genital lesions that often mimic common sexually transmitted infections (STIs) such as herpes simplex virus infection and chancroid, creating diagnostic confusion. Thi...
BACKGROUND: Mpox increasingly presents with atypical genital lesions that often mimic common sexually transmitted infections (STIs) such as herpes simplex virus infection and chancroid, creating diagnostic confusion. This challenge is particularly pronounced in resource-limited settings, where confirmatory testing may be delayed. CASE PRESENTATION: A 21-year-old Nigerian female presented with an acutely painful vulvar ulcer that developed 72 h after sexual intercourse. She was initially treated for genital herpes with acyclovir, but her condition worsened, with progressive vulvar oedema, severe pain, inguinal lymphadenopathy, and high-grade fever. A presumptive diagnosis of chancroid was made, and she was admitted and treated with intramuscular ceftriaxone, followed by oral erythromycin, ciprofloxacin, and diclofenac. Subsequently, she developed a generalized vesiculopustular rash involving the trunk, foot, forearm, palms, and soles. Laboratory testing confirmed mpox infection. She was managed with supportive care while completing antibiotic therapy, resulting in complete resolution of symptoms within two weeks. CONCLUSION: This case highlights the diagnostic dilemma posed by genital mpox, which can initially mimic herpes simplex virus infection or chancroid. Maintaining a high index of clinical suspicion is essential, particularly in patients with epidemiological risk factors and evolving systemic features. These findings are consistent with global reports of atypical, sexually associated mpox presentations.
Low Panton-Valentine leukocidin prevalence in circulating community MRSA: a genomic surveillance study in Qatar.
Kamar R, Alobaidli KJ, Al Nuaimi AN … +7 more , Abu-El-Ruz R, Salih MA, Zughaier SM, Al Thani AA, Alex M, Elawad KH, Eltai NO
BMC Infect Dis · 2026 Jun · PMID 42321672 · Full text
BACKGROUND: Staphylococcus aureus (S. aureus), particularly methicillin-resistant S. aureus (MRSA), is a major human pathogen causing severe infections. While well studied in hospitals, limited data exist on the transmis...
BACKGROUND: Staphylococcus aureus (S. aureus), particularly methicillin-resistant S. aureus (MRSA), is a major human pathogen causing severe infections. While well studied in hospitals, limited data exist on the transmission and antimicrobial resistance (AMR) profiles of community-associated MRSA (CA-MRSA) in the Gulf region. This study investigated the AMR patterns of CA-MRSA. METHODS: Nasal and axillary swabs from 576 asymptomatic residents of Qatar without a history of hospitalization, surgery, dialysis, or indwelling medical devices in the preceding 12 months, and those who have not used antibiotics within the previous 3 months were analyzed. S. aureus was isolated on mannitol salt agar, confirmed by VITEK® 2 Compact, and methicillin resistance was determined by cefoxitin disc diffusion. AMR profiling followed CLSI guidelines. PCR and whole-genome sequencing using the GridION platform were performed for molecular confirmation and genomic characterization, including gene annotation and phylogenetic analysis. All sequences were deposited in NCBI. RESULTS: Of 60 confirmed S. aureus isolates (10.4% prevalence), 35% (n = 21) were MRSA, yielding an overall MRSA carriage prevalence of 3.6% (21/576). Most MRSA isolates came from young asymptomatic individuals aged 18 to 45 (80%, 17/21) and from men (58%, 12/21). Among the 21 MRSA isolates identified in this cohort, resistance rates were 29% for erythromycin and ciprofloxacin, 24% for tetracycline, 14% for gentamicin, and 10% for sulfonamides. A total of 71% of the isolates exhibited multidrug resistance. All MRSA isolates carried the methicillin resistance gene (mecA), while 4.7% harbored the Panton-Valentine leukocidin (PVL) gene. Phylogenetic analysis revealed four distinct clusters, indicating a polyclonal community rather than a single spreading strain. CONCLUSIONS: The prevalence of multidrug-resistant MRSA with key virulence factors may represent a continuing public health concern, underscoring the need for strengthened community surveillance, antimicrobial stewardship, and infection control to monitor and limit the spread of multiple circulating strains.
Missed confirmatory HCV RNA testing in anti-HCV-reactive patients and the role of reflex testing in improving completion of the hepatitis C diagnostic care cascade: a laboratory-based retrospective study.
Appak Ö, Danis N, Köse S
BMC Infect Dis · 2026 Jun · PMID 42321669 · Full text
BACKGROUND: Completion of confirmatory HCV RNA testing after anti-HCV reactivity is a critical step in the hepatitis C diagnostic care cascade. However, missed confirmatory testing and repeated anti-HCV testing within ro...
BACKGROUND: Completion of confirmatory HCV RNA testing after anti-HCV reactivity is a critical step in the hepatitis C diagnostic care cascade. However, missed confirmatory testing and repeated anti-HCV testing within routine hospital laboratory workflows remain insufficiently characterized. This study aimed to evaluate the frequency of missed confirmatory HCV RNA testing among anti-HCV-reactive patients, investigate the presence of active infection using archived serum samples, and assess workflow-related diagnostic gaps that could potentially be addressed through laboratory-based reflex testing strategies. METHODS: This retrospective laboratory-based observational study included patients tested for anti-HCV antibodies at a tertiary-care university hospital between January 1 and December 31, 2025. Anti-HCV-reactive patients without confirmatory HCV RNA testing were identified, and retrospective HCV RNA testing was performed on available archived serum samples. Repeated anti-HCV testing patterns and clinic-based differences in confirmatory testing requests were also analyzed to evaluate potential diagnostic workflow gaps. RESULTS: Among 27,984 anti-HCV tests performed in 23,833 unique patients, the anti-HCV seroprevalence rate was 1.28%. Confirmatory HCV RNA testing was not requested in 32.3% of anti-HCV-reactive patients. Retrospective testing of archived serum samples from 79 patients without initial confirmatory testing identified active infection in 3.8% of cases (3/79). Confirmatory testing rates were significantly higher in specialist clinics than in non-specialist clinics (95.0% vs. 71.0%, p < 0.001). Repeated anti-HCV testing was observed in 13.2% of patients, and no seroconversion was detected among individuals tested six or more times. CONCLUSIONS: Missed confirmatory HCV RNA testing represents an important gap in the diagnostic care cascade, particularly in non-specialist clinical settings. Laboratory-based reflex HCV RNA testing strategies may improve completion of confirmatory testing and reduce unnecessary repeat serological testing, supporting more effective diagnostic stewardship and contributing to hepatitis C elimination efforts. CLINICAL TRIAL NUMBER: Not applicable.
Pancreatic tuberculosis mimicking pancreatic malignancy in a young male: a rare case report.
Shahzadi K, Raza A, Akhtar N … +3 more , Saddiqa A, Malik AS, Ajmal U
BMC Infect Dis · 2026 Jun · PMID 42321659 · Full text
BACKGROUND: Isolated pancreatic tuberculosis is a rare form of extrapulmonary TB, often misdiagnosed as malignancy due to overlapping clinical and radiological features. CASE PRESENTATION: We report a case of a 24-year-o...
BACKGROUND: Isolated pancreatic tuberculosis is a rare form of extrapulmonary TB, often misdiagnosed as malignancy due to overlapping clinical and radiological features. CASE PRESENTATION: We report a case of a 24-year-old male presenting with right hypochondrial pain, jaundice and weight loss. A mass was found in the head of pancreas raising strong suspicion for pancreatic cancer. Endoscopic ultrasound guided biopsy was done and histopathology of the tissue revealed caseating granulomas, and GeneXpert revealed Mycobacterium tuberculosis. The patient responded well to anti-tuberculous therapy, with clinical and radiological improvement. CONCLUSION: This case underscores the importance of considering tuberculosis in the differential diagnosis of pancreatic masses, especially in endemic regions. CLINICAL TRIAL NUMBER: Not applicable.
Patient and diagnosis delays among migrant tuberculosis patients in suburban Shanghai, China: a 10-year retrospective study.
Wang Z, Qiao Z, Rao L … +6 more , Xu C, Wang J, Yu Z, Wang Q, Shi W, Shen X
BMC Infect Dis · 2026 Jun · PMID 42321657 · Full text
OBJECTIVE: To analyze the status of patient delay (PD) and diagnosis delay (DD) and explore factors associated with delays among migrant tuberculosis (TB) patients in suburban Shanghai from 2015 to 2024, aiming to provid...
OBJECTIVE: To analyze the status of patient delay (PD) and diagnosis delay (DD) and explore factors associated with delays among migrant tuberculosis (TB) patients in suburban Shanghai from 2015 to 2024, aiming to provide a scientific basis for targeted TB control strategies. METHODS: A retrospective surveillance-based study was conducted using pulmonary tuberculosis (PTB) case data from Fengxian District, Shanghai, obtained from the Tuberculosis Information Management System. Statistical analyses, including the Mann-Whitney U test, chi-square test, multivariable logistic regression, and generalized least squares (GLS) analysis, were performed to examine factors associated with delays. Joinpoint regression was used to analyze temporal trends. RESULTS: A total of 3,178 PTB cases (1,573 locals and 1,605 migrants) were included. Compared with locals, migrants exhibited a significantly shorter median PD (8 vs. 11 days; P < 0.001) but a longer median DD (9 vs. 7 days; P < 0.001). Regarding PD, a significant upward trend was observed among migrants from 2017 to 2024 (Annual Percentage Change [APC] = 5.28%, P = 0.015). PD was more likely among female patients, those aged 30-69 years, and those seeking first diagnosis outside Fengxian. DD was less likely among patients seeking first diagnosis outside the district, but more likely among those with negative bacteriological results. CONCLUSION: Migrants in suburban Shanghai are characterized by a pattern of "shorter PD but prolonged DD." However, the rising trend in PD and the complex effects of cross-district care seeking highlight the urgent need for strengthened inter-district coordination and improved molecular diagnostics at the district level. CLINICAL TRIAL: Not applicable.
Uncovering COVID-19 vaccine acceptance and intent in 15 developing countries: a multi-level, clustered analysis of six months of repeated, cross-sectional data.
Smith CA, Handysides D, Cupino A … +2 more , Nelson A, Beeson WL
BMC Infect Dis · 2026 Jun · PMID 42321649 · Full text
BACKGROUND: COVID-19 vaccination hesitancy is antithetical to preventing communicable disease. The study's aim was to determine social ecological factors associated with vaccination acceptance / intent in select developi...
BACKGROUND: COVID-19 vaccination hesitancy is antithetical to preventing communicable disease. The study's aim was to determine social ecological factors associated with vaccination acceptance / intent in select developing countries. METHODS: To examine vaccine acceptance / intent in fifteen developing countries, data was sourced from the Global COVID-19 Trends and Impacts Survey and analyzed with a multi-level, clustered, cross-sectional design. Weighted Generalized Additive Modeling (GAM) with 1,000 stratified cluster bootstraps mitigated intra-cluster correlation and temporal dependencies. RESULTS: Statistically significant linear variables included those age 55 + (OR = 1.204, 95% CI [1.095, 1.324], p < 0.001) and identification as female (OR = 1.538, 95% CI [1.448, 1.630], p < 0.001), which were responsible for increased odds of vaccine acceptance / intent. Percent Fear of Vaccine Side Effects (EDF = 2.50, p < 0.001) demonstrated a nonlinear decline in vaccine acceptance / intent. Time (Month) (EDF = 1.94, p < 0.001) was associated with a concave parabolic trend. Cultural Principal Components (PCs) 1-3, respectively, (EDF = 3.97, p < 0.001). EDF = 4.87, p < 0.001), and (EDF = 4.95, p < 0.001) demonstrated oscillating patterns of vaccine acceptance / intent depending upon cultural score direction and magnitude. All PCs demonstrated lower levels of vaccination acceptance / intent with no definitive cultural leaning. There was, however, a push-pull effect among all three dimensions, demonstrating PCs either drove or suppressed vaccination acceptance / intent. CONCLUSIONS: Vaccine decision-making complexities are associated with cultural and individual influences. Such findings could inform future vaccine campaign strategies.
Factors associated with late HIV diagnosis among adults living with HIV in Oman: a 32-year ambidirectional cohort study at a tertiary referral hospital.
Al-Zadjali ZM, Khamis F, Jaju S … +9 more , Al Sabei SD, Aimaq R, Al-Naamani J, Al-Maskari IK, Al-Balushi Z, Al-Abri S, Ba'Omar M, Al-Saadi LS, Al-Farsi YM
BMC Infect Dis · 2026 Jun · PMID 42321645 · Full text
BACKGROUND: Despite advances in the management of Human Immunodeficiency Virus (HIV), delayed diagnosis remains a major public health challenge. Evidence on late HIV diagnosis in Oman and the wider Gulf region remains li...
BACKGROUND: Despite advances in the management of Human Immunodeficiency Virus (HIV), delayed diagnosis remains a major public health challenge. Evidence on late HIV diagnosis in Oman and the wider Gulf region remains limited. This study aimed to identify factors associated with late HIV diagnosis among adult patients of people living with HIV (PLWH) in Oman. METHODS: A 32-year ambidirectional cohort study was conducted at the Royal Hospital, a tertiary referral hospital and the national HIV referral centre in Muscat, Oman, including adults aged ≥ 18 years diagnosed with HIV between 1992 and 2024. Participants with available baseline Cluster of Differentiation 4 (CD4) count, viral load, and haemoglobin measurements were included. Late diagnosis was defined as a CD4 count ≤ 350 cells/mm³ at diagnosis. Data were extracted from electronic medical records and analysed using multivariable Poisson regression with robust variance. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) were reported. RESULTS: Among 549 patients, 30.1% were diagnosed late. Of those diagnosed late, 72.1% acquired HIV through sexual transmission, 64.8% were asymptomatic at presentation, and 61.8% had no comorbidities. Younger age was independently associated with higher risk of late diagnosis among individuals aged 18-27 years (aRR 5.66; 95% CI: 2.26-14.21), 28-37 years (aRR 3.25; 95% CI: 1.33-7.94), and 38-47 years (aRR 3.51; 95% CI: 1.40-8.77), compared with those aged > 47 years. Low haemoglobin (≤ 10 g/dL) was associated with increased risk (aRR 3.03; 95% CI: 1.42-6.67). Heart disease (aRR 5.38; 95% CI: 1.36-21.31) and hypertension (aRR 3.34; 95% CI: 1.13-9.91) were also significant predictors. Sex, mode of HIV transmission, and reason for HIV testing were not significantly associated with late HIV diagnosis in the adjusted analysis. WHO clinical stage 2 was also not significantly associated. CONCLUSION: Late HIV diagnosis remains common in Oman and is associated with younger age, anaemia, and comorbidities. These findings highlight missed opportunities for earlier HIV testing, as a substantial proportion of late-diagnosed individuals were asymptomatic and many were young adults. Strengthening targeted testing strategies, reducing stigma, and improving early linkage to care are essential to support timely diagnosis and progress toward the UNAIDS 95-95-95 targets.
Cerebral tuberculoma in pregnancy (Jan 1975-May 2025): a systematic review and descriptive analysis of 33 published cases.
Rebellón-Sánchez DE, Vinueza D, Castro Restrepo DE … +2 more , Llanos JA, Rosso F
BMC Infect Dis · 2026 Jun · PMID 42316360 · Full text
BACKGROUND: Cerebral tuberculoma is an infrequent but life-threatening manifestation of tuberculosis whose diagnosis and treatment are uniquely complicated by pregnancy-related physiological changes. Evidence to guide cl...
BACKGROUND: Cerebral tuberculoma is an infrequent but life-threatening manifestation of tuberculosis whose diagnosis and treatment are uniquely complicated by pregnancy-related physiological changes. Evidence to guide clinicians remains fragmented and largely anecdotal. METHODS: We systematically searched MEDLINE, LILACS and grey literature to May 2025 for reports of cerebral tuberculoma in pregnant or postpartum women. Twenty-seven studies (24 case reports, 2 descriptive studies, 1 case series) from 20 countries met inclusion criteria, yielding individual-level data on 33 patients. Demographics, clinical features, diagnostics, management and maternal-fetal outcomes were extracted and synthesized. RESULTS: Median maternal age was 26 years (IQR 23-29). Diagnosis occurred ante-partum in 45% and post-partum in 55%, at a median gestational age of 31 weeks. Headache (59%), fever (56%) and seizures (48%) predominated; cranial-nerve palsies (54%) and focal paresis (50%) were common neurologic signs. Magnetic resonance imaging (MRI) revealed solitary or multiple contrast-enhancing lesions, chiefly supratentorial but infratentorial in 35%. Cerebrospinal fluid (CSF) showed proteinorrachia (n = 10/15) and mononuclear pleocytosis (n = 8/12, 66.67%); positivity of CSF or biopsy interferon-γ release assays (100%, n = 3/3) outperformed CSF culture (33.3%, n = 3/9) and CSF polymerase chain reaction (PCR; 12.5%, n = 1/8). Standard four-drug therapy plus corticosteroids was administered in 97%, typically > 12 months; 60% underwent neurosurgical biopsy or resection. Maternal mortality was 4.6%, and persistent neurological sequelae occurred in 33.3% of cases (n = 7/21). Among 26 live pregnancies, preterm delivery occurred in 72%; neonatal complications affected 50%, including congenital tuberculosis (17%) and neonatal death (17%). CONCLUSIONS: Although cerebral tuberculoma during pregnancy is rare, delayed recognition contributes to substantial maternal morbidity and adverse neonatal outcomes. Our synthesis underscores the diagnostic value of advanced imaging and CSF interferon-γ assays, supports prolonged first-line therapy with adjunctive steroids, and highlights critical gaps in evidence-based guidelines. Multicentre prospective registries are urgently needed to refine diagnostic algorithms and optimise maternal-fetal care.
Varicella epidemiology, susceptibility and cost burden in Chongqing China: implications for prevention and control strategies.
Yao N, Kuang S, Deng J … +5 more , Liu Y, Zhao H, Ji H, Zhou C, Xu J
BMC Infect Dis · 2026 Jun · PMID 42316096 · Full text
BACKGROUND: To characterize the epidemiological profile, population seroprotection levels, and economic impact of varicella in Chongqing, and to provide evidence to optimize immunization strategies to reduce incidence an...
BACKGROUND: To characterize the epidemiological profile, population seroprotection levels, and economic impact of varicella in Chongqing, and to provide evidence to optimize immunization strategies to reduce incidence and economic burden. METHODS: The epidemiological trends of varicella in Chongqing were ascertained from routine surveillance data (2011-2024). Population sero-epidemiology was evaluated using a randomized cross-sectional serosurvey (n = 960, 2024), and economic burden was estimated from 14,779 outpatient and 298 inpatient cases (2019-2022). Statistical analyses (descriptive statistics, Chi-squared test, Kruskal-Wallis test, and Wilcoxon rank-sum test) were conducted to quantify incidence trends, factors associated with antibody levels, and heterogeneity in economic burden. RESULTS: A total of 301,714 cases were reported during 2011-2024, with 53.56% in children < 15 years. Incidence exhibited an inverted U-shaped trend. The overall crude varicella IgG seroprevalence was 78.33% (geometric mean concentration, GMC: 351.3 mIU/mL). Notably, children (< 15 years) showed a significant seroprotection gap (seroprevalence: 70.54%; GMC: 240 mIU/mL), which aligned with their disproportionately high incidence. Two-dose vaccination was associated with significantly higher seropositivity (83.50% vs. 66.07%) and GMC (343.7 vs. 189.1 mIU/mL) than one dose (p < 0.01). Adults aged > 50 years exhibited the highest GMC (744.7 mIU/mL) and seropositivity (96.15%), aligning with the lowest incidence recorded in 2024. The pediatric inpatients (< 15 years) had a higher burden ($1375.74 vs. $1012.70, p < 0.01) than individuals over 15 years. CONCLUSIONS: Varicella incidence remains high and children show suboptimal seroprotection against varicella in Chongqing. The disease imposes a substantial financial burden, particularly among pediatric inpatients. It is recommended to expand two-dose varicella vaccine immunization coverage to reduce both incidence and disease burden.
Modeling antiretroviral therapy adherence among people living with HIV: a cross-sectional study at Pantang Hospital, Ghana.
Nyarko E, Kretchy IA, Allotey-Babington GL … +8 more , Kwakye AO, Tagoe B, Atuahene NO, Kalenu X, Koduah A, Nimako SG, Opuni KF, Amponsah SK
BMC Infect Dis · 2026 Jun · PMID 42316094 · Full text
BACKGROUND: Poor adherence to antiretroviral therapy (ART) continues to undermine HIV treatment outcomes in sub-Saharan Africa, including Ghana. OBJECTIVE: This study aimed to quantify ART treatment adherence among peopl...
BACKGROUND: Poor adherence to antiretroviral therapy (ART) continues to undermine HIV treatment outcomes in sub-Saharan Africa, including Ghana. OBJECTIVE: This study aimed to quantify ART treatment adherence among people living with HIV (PLHIV) at Pantang Hospital in Ghana. METHODS: This study took place from July to October 2025 among people living with HIV who receive care at Pantang Hospital in Accra, Ghana. Using random sampling, data were collected from 151 participants through interviewer-administered questionnaires assessing sociodemographic characteristics and ART adherence behaviors. A hold-back validation method was used to split the final dataset, allocating 80% to training and 20% to validation. Six machine learning models were applied to identify and rank key adherence predictors, and model performance was compared. RESULTS: In all, 151 participants were recruited. Participants had a median age of 42 years; 75.5% were female, and 39.7% were older than 45 years. Most participants were Christian (88.7%), lived in peri-urban areas (70.9%), and were self-employed (72.2%). Non-adherence behaviors were common: 66.9% reported forgetting to take medication, 64.2% reported carelessness, and 85.4% reported stopping medication when feeling worse. Among the six models, Elastic Net regression demonstrated the best overall performance. The strongest predictors of non-adherence were not taking medication over the past weekend (utility estimate 0.3471, 95% confidence interval 0.2292-0.4650) and missing medication 6-10 times in the past week (utility estimate 0.2693, 95% confidence interval 0.1538-0.3848). CONCLUSIONS: The study showed poor adherence to ART among this cohort of PLHIV which increases the risk of community-level transmission. This study provides quantitative data to help develop effective interventions to address poor adherence to improve health outcomes of PLHIV.
Evolution, hotspots, and future directions of global research on ventilator-associated pneumonia (VAP) care interventions: a visual analysis using CiteSpace and VOSviewer (2005-2025).
Mei Y, Zhang H, Li Y
BMC Infect Dis · 2026 Jun · PMID 42316082 · Full text
BACKGROUND: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in critically ill patients. This bibliometric study aimed to map the global research landscape and intellectual evolution of n...
BACKGROUND: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in critically ill patients. This bibliometric study aimed to map the global research landscape and intellectual evolution of nursing care interventions for VAP from January 1, 2005 to December 31, 2025. METHODS: Publications were retrieved from the Web of Science Core Collection. Scientometric analysis and visualization were performed using CiteSpace and VOSviewer to examine publication trends, collaboration networks (countries, institutions, authors), and thematic evolution through keyword co-occurrence, burst detection, and timeline analysis. RESULTS: Annual publication output showed a steady increase, with a notable rise after 2022. Collaboration networks revealed distinct regional clusters centered in Europe/North America, Asia, and Latin America/Europe. The most cited publications were clinical practice guidelines. Research themes evolved from foundational epidemiology and risk factors to the development and evaluation of preventive "care bundles." Recent frontiers emphasize implementation science, with "oral hygiene," "management," and "implementation" as current research hotspots. CONCLUSIONS: Research on VAP nursing interventions has matured, solidifying care bundles as a core prevention strategy. The field is now shifting towards optimizing implementation and practical integration of evidence into clinical workflows. Future efforts should foster greater global and interdisciplinary collaboration to enhance the adaptability and impact of these interventions across diverse healthcare settings.
Maxillofacial tubercular osteomyelitis: diagnostic and therapeutic perspectives from a case series.
Gupta S, Gupta S, Tyagi P … +7 more , Syed AF, Kapoor A, Ramasamy P, Ghosh S, Sidiq Z, Kumar J, Khurana N
BMC Infect Dis · 2026 Jun · PMID 42316079 · Full text
INTRODUCTION: Extrapulmonary tuberculosis (TB) contributes significantly to the disease burden in Southeast Asia, yet maxillofacial involvement is rare and often misdiagnosed due to nonspecific features such as swelling,...
INTRODUCTION: Extrapulmonary tuberculosis (TB) contributes significantly to the disease burden in Southeast Asia, yet maxillofacial involvement is rare and often misdiagnosed due to nonspecific features such as swelling, ulceration, or trismus. Conventional microbiology shows low sensitivity in these paucibacillary lesions, emphasizing the role of rapid molecular tests such as Cartridge-Based Nucleic Acid Amplification Testing (CBNAAT). This case series outlines the diagnostic challenges of maxillofacial TB in an endemic region. Nine patients (aged 9-33 years) presented with chronic lesions in maxillofacial region. Imaging commonly demonstrated osteolysis, cortical breach, periosteal reaction, or soft-tissue abscess. Mantoux testing, cytology, and Ziehl-Neelsen staining were often inconclusive, whereas CBNAAT or culture confirmed Mycobacterium tuberculosis in most cases. All patients received standard anti-tubercular therapy with significant clinical and radiographic improvement. CONCLUSION: Maxillofacial TB should be considered in persistent jaw lesions. Early molecular testing enhances diagnosis and supports timely, effective therapy.
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