BMC Infectious Diseases[JOURNAL]
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200 papers
Measles epidemic in Yakusu Health Zone, Democratic Republic of Congo, 2018-2019: a retrospective observational study.
Ale F, Riccio ME, Katuala Y … +5 more , Maloko T, Tonamou G, Gignoux E, Ciglenecki I, Polonsky J
BMC Infect Dis · 2026 Jun · PMID 42316061 · Full text
BACKGROUND: A large measles outbreak occurred in Yakusu Health Zone, Democratic Republic of the Congo, between January 2018 and June 2019. We aimed to estimate the magnitude, mortality burden, and vaccination coverage of...
BACKGROUND: A large measles outbreak occurred in Yakusu Health Zone, Democratic Republic of the Congo, between January 2018 and June 2019. We aimed to estimate the magnitude, mortality burden, and vaccination coverage of this epidemic, and to evaluate whether the reactive mass vaccination campaign reached previously unvaccinated children. METHODS: We conducted a retrospective two-stage cluster household survey to estimate the attack rate (AR), case fatality ratio (CFR), mortality rates, and vaccination coverage. We extrapolated survey-weighted estimates to the population of Yakusu to estimate true outbreak size. Kaplan-Meier survival analysis characterised the temporal distribution of post-measles mortality. Geospatial analyses described the spatial distribution of vaccination coverage and attack rates, and Spearman rank correlation quantified the spatial relationship between routine and campaign coverage at the cluster level. RESULTS: Among 8,968 individuals surveyed, 1,390 (15.5%, 95% CI: 13.2-17.8) reported measles during the recall period. The estimated true outbreak size was 22,068 cases (95% CI: 18,785-25,351), suggesting routine surveillance detected only 27.9% of cases. Among children under 5 years, the AR was 45.7% (95% CI: 39.6-51.9) and the 31-day CFR was 4.9% (95% CI: 3.4-6.3). Among infants under 1 year, survival at 31 days post-onset was only 78.7%, with deaths continuing to accrue beyond this point, reflecting a distribution of onset-to-death intervals that extends beyond the standard attribution cutoff. Routine EPI and campaign vaccination coverage were each approximately two-thirds of the target population (68.2% and 67.7%, respectively). Over half of the target age group (53.5%, 95% CI: 46.8-60.3) had received both EPI and campaign vaccination, while 19.2% had received neither. Among children vaccinated during the campaign, 81.6% had already received routine EPI vaccination, while only 39.8% of previously unvaccinated children were reached. EPI and campaign coverage were strongly spatially correlated at the cluster level (Spearman ρ = 0.59, p < 0.001). CONCLUSIONS: This was a severe epidemic with high attack rates and case fatality, particularly among infants. The reactive vaccination campaign, implemented more than one year into the outbreak, overwhelmingly reached children already vaccinated through routine services while failing to reach the majority of unvaccinated children. Reactive campaigns in similar settings should prioritise identifying and reaching unvaccinated populations through improved microplanning and spatial targeting, rather than maximising total doses administered.
Prevalence and determinants of tuberculosis and COVID-19 among patients with presumptive tuberculosis in a Nigerian tertiary hospital.
Mike-Ogburia MI, Precious DF, Alozie FC … +3 more , Ofurum FC, Israel DE, Bekee D
BMC Infect Dis · 2026 Jun · PMID 42316051 · Full text
BACKGROUND: Tuberculosis (TB) remains a major public health challenge in Nigeria, while the overlap between TB and coronavirus disease 2019 (COVID-19) in symptomatic patients has been less clearly described in routine cl...
BACKGROUND: Tuberculosis (TB) remains a major public health challenge in Nigeria, while the overlap between TB and coronavirus disease 2019 (COVID-19) in symptomatic patients has been less clearly described in routine clinical settings. This study assessed the prevalence and determinants of TB and COVID-19 among presumptive TB patients in a tertiary hospital in Port Harcourt, Nigeria. METHODS: This hospital-based cross-sectional study, conducted between April and August 2024, involved 242 presumptive TB patients attending Rivers State University Teaching Hospital, Port Harcourt recruited using consecutive sampling. Sociodemographic characteristics, medical-related, and behavioural/environmental data were collected using a structured interviewer-administered questionnaire, while TB and COVID-19 were assessed using Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) assay and STANDARD Q COVID-19 Ag Test, respectively. Statistical analysis involved descriptive statistics, chi-square tests, and multivariable logistic regression analyses using GraphPad Prism 9, with statistical significance set at p ≤ 0.05. RESULTS: TB was detected in 21.9% of participants; however, no participant tested positive for COVID-19, yielding a COVID-19 prevalence of 0.0%, and no case of TB/COVID-19 co-infection was identified. None of the sociodemographic characteristics examined was significantly associated with TB prevalence (p > 0.05). However, contact with someone with prolonged coughing (aOR: 5.41, 95% CI: 2.55-11.70; p < 0.0001) and HIV-positive status (aOR: 3.02, 95% CI: 1.08-8.37; p = 0.0334) were significant determinants of TB infection. In addition, current smoking (aOR: 5.18, 95% CI: 1.74-15.70; p = 0.0031) and living in a densely populated area with limited ventilation (aOR: 2.82, 95% CI: 1.29-6.12; p = 0.0086) independently predicted TB infection. CONCLUSIONS: TB remains a considerable burden among presumptive TB patients in this setting, whereas no COVID-19 or TB/COVID-19 co-infection was detected during the study period. TB risk was driven mainly by exposure-related, behavioural, clinical, and environmental factors rather than sociodemographic characteristics. Strengthening routine TB screening, contact investigation, bidirectional TB/HIV services, smoking-cessation support, and interventions addressing overcrowded, poorly ventilated living conditions may improve TB control in similar high-burden settings.
Prevalence of HIV and associated sociobehavioral factors among men with urethral discharge syndrome attending public health facilities in Kampala, Uganda.
Onzia AA, Nakate V, Dawa BM … +7 more , Castelnuovo B, Reynolds SJ, Parkes-Ratanshi R, Wang TH, Manabe YC, Melendez JH, Hamill MM
BMC Infect Dis · 2026 Jun · PMID 42316049 · Full text
INTRODUCTION: Epidemiological data on HIV infection in male urethral discharge syndrome (UDS) in Africa are limited. We describe the prevalence of HIV and associated demographic and sociobehavioral factors among men with...
INTRODUCTION: Epidemiological data on HIV infection in male urethral discharge syndrome (UDS) in Africa are limited. We describe the prevalence of HIV and associated demographic and sociobehavioral factors among men with UDS in selected public clinics in Kampala, Uganda. METHODS: Within a cross-sectional study of men seeking care for UDS from October 2019 to July 2022, we performed interviewer-administered demographic and sociobehavioral questionnaires. Point-of-care (POC) rapid sequential algorithmic HIV testing was conducted. Bivariate and adjusted multivariable log-binomial regression analyses were performed to determine factors associated with HIV. RESULTS: Of 450 male participants, 441(98%) were included in this analysis; 9 declined HIV testing. Median (IQR) age was 24 (22-32) years, 87% (n = 384) reported a previous HIV test. Overall, 18.4% (n = 81) were people living with HIV (PLWHIV). Of these, 86.4% and 13.6% were aged ≥ 25 and < 25 years, respectively. Overall, 8.6% (n = 7) were newly diagnosed with HIV; of those, 42.9% (n = 3) were aged < 25 years. While 94% (70/74) with known HIV reported antiretroviral therapy (ART) use, 52.9% (n = 37) had suppressed viral loads by self-report. Five of the 441 participants (1.1%) reported 'always' condom use, 45.4% (n = 200) reported transactional sex, 59.6% (n = 263) ≥ 2 sexual partners in the past six months; 46.7% (n = 206) had notified their partners of UDS symptoms. Multivariable analysis demonstrated significant associations between HIV and older age ≥ 25 years (aPR,6.35; 95% C.I., 3.44-11.75; P < 0.001), and hazardous alcohol use (aPR,1.62; 95% C.I., 1.03-2.54; P = 0.038). CONCLUSIONS: Almost one in five men presenting with UDS were PLWHIV, with just over half of those on ART reporting viral suppression. Older age and hazardous alcohol use were associated with HIV. Men with UDS represent a key population where HIV diagnosis, prevention, and ART adherence interventions may have a significant impact.
HIV self-testing and its associated factors among nursing and medical university students: A cross-sectional study in EasternUganda.
Nambi W, Nabirye RC, Olowo S … +8 more , Nabawanuka B, Kakyo TA, Turyasiima M, Nakato G, Aleni M, Lume I, Nabachenje P, Epuitai J
BMC Infect Dis · 2026 Jun · PMID 42316041 · Full text
INTRODUCTION: The uptake of HIV testing services is sub-optimal among young people. HIV self-testing (HIVST) offers opportunities to improve the uptake of HIV testing services among young people. The study was conducted...
INTRODUCTION: The uptake of HIV testing services is sub-optimal among young people. HIV self-testing (HIVST) offers opportunities to improve the uptake of HIV testing services among young people. The study was conducted to determine preferences for HIVST, its uptake, and the factors associated with uptake of HIVST among young adults. METHODS: The study was a descriptive cross-sectional design. Data collection was done using self-administered questionnaires. We interviewed 384 university students and collected information about their HIV testing practices and preferences. Logistic regression analysis was used to determine the factors associated with HIVST among young people. The study obtained ethical clearance from a Research and Ethics Committee. RESULTS: The median age of the participants was 24 (interquartile range: 22-28). Uptake of HIVST was 55% among participants. A similar proportion (56%) of young people preferred HIVST over facility-based HIV testing in the future. Privacy (46%), confidentiality (7%), and convenience (32%) were the most common reasons given for preference for HIVST. Participants, who preferred health facility-based HIV testing, cited the need for counselling services (21%) and the perceived accuracy and credibility (59%) of results from health facility-based testing. HIVST was significantly associated with increasing age (AOR = 0.89, 95% CI: 0.80-0.98), the fourth year of study (AOR = 2.90, 95% CI:1.01-8.31), students of anaesthesia program (AOR = 0.40, 95% CI:0.17-0.95), Muslim religion (AOR = 0. 07, 95% CI:0.01-0.41), consistent use of condoms (AOR = 0.36, 95% CI: 0.15-0.88), and having multiple sexual partners (AOR = 3.22, 95% CI:1.49-7.00). CONCLUSION: Young people preferred HIVST over health facility-based testing because of privacy, confidentiality, and convenience. Addressing concerns about the accuracy of test results from HIVST and the need for counseling services may improve the uptake of HIVST among young people.
Carbapenemase-producing Enterobacterales infections: a real-world cohort study from a secondary hospital in Shanghai, China.
Zhu W, Liang Y, Dai F … +1 more , Weng C
BMC Infect Dis · 2026 Jun · PMID 42316040 · Full text
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) have become a major global public health concern. The production and spread of carbapenemases have rendered carbapenemase-producing Enterobacterales (CPE) a severe...
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) have become a major global public health concern. The production and spread of carbapenemases have rendered carbapenemase-producing Enterobacterales (CPE) a severe clinical threat. Epidemiological data regarding CPE infections remain scarce in secondary hospitals. This study aims to characterize carbapenemase phenotypes and antimicrobial resistance profiles of CRE isolates from a secondary hospital, and explore factors associated with patient clinical outcome. METHODS: A cohort study was conducted on clinical CRE isolates collected from January 2023 to September 2024. Carbapenemases were identified by immunochromatography. Univariate and multivariate logistic regression models were conducted to identify factors associated with clinical failure of CPE-infected patients. RESULTS: Of 131 strains from enrolled CRE infected patients, the detection rate of carbapenemases was 100% via immunochromatography. Phenotypes distribution revealed 98 (74.8%) Klebsiella pneumoniae carbapenemase (KPC), 25 (19.1%) metallo-β-lactamases (MBL) and 8 (6.1%) double carbapenemases-producer (DCP), with distinct antimicrobial resistance features across groups. Elevated aCCI (aOR 1.4, 95% CI 1.1-1.8, p = 0.007), mechanical ventilation (aOR 7.8, 95% CI 2.2-28.1, p = 0.002) and hospital-onset (aOR 6.7, 95% CI 2.0-23.0, p = 0.002) were independent factors associated with clinical failure. CONCLUSION: The secondary hospitals face intense carbapenemase prevalence pressure and complex resistance profiles, particularly among DCP strains. Patients with more comorbidities and hospital-acquired infection may develop poor clinical outcomes. These findings underscore the urgent need for enzyme-guided precision therapy and tailored infection control strategies in these high-risk, community-linked medical institutions. CLINICAL TRIAL NUMBER: Not applicable.
A rare case report of cysteiniphilumlitorale infection: clinical presentation and diagnostic challenges.
Zhou W, Yang T, Zou X … +7 more , Yi F, Lv Z, Dong Y, Alhaskawi A, Hu J, Han D, Lu H
BMC Infect Dis · 2026 Jun · PMID 42316039 · Full text
Cysteiniphilum litorale is a Gram-negative, non-motile, non-spore-forming bacterium. It is dependent on L-cysteine for growth. This report describes the case of a 46-year-old male who developed a severe soft-tissue infec...
Cysteiniphilum litorale is a Gram-negative, non-motile, non-spore-forming bacterium. It is dependent on L-cysteine for growth. This report describes the case of a 46-year-old male who developed a severe soft-tissue infection after a sea-shrimp puncture injury to the finger, which was subsequently identified as Cysteiniphilum litorale infection. The patient's clinical course, diagnosis, and treatment are discussed, along with an emphasis on the need for early identification and appropriate management of Cysteiniphilum litorale infections.
Elevated procalcitonin levels in febrile children with exanthema subitum undergoing clinically indicated PCT testing: a retrospective cohort study.
Inoue H, Tsuda Y, Nawata Y … +1 more , Ichihara K
BMC Infect Dis · 2026 Jun · PMID 42310599 · Full text
BACKGROUND: Human herpesvirus 6 (HHV-6), the causative agent of exanthema subitum (ES), is a major viral cause of acute encephalopathy in Japan. Serum procalcitonin (PCT) is widely used as a biomarker of severe bacterial...
BACKGROUND: Human herpesvirus 6 (HHV-6), the causative agent of exanthema subitum (ES), is a major viral cause of acute encephalopathy in Japan. Serum procalcitonin (PCT) is widely used as a biomarker of severe bacterial infections and has also been proposed as an early predictor of encephalopathy. However, elevated PCT levels are occasionally observed in ES without bacterial co-infection or encephalopathy, potentially complicating interpretation of PCT levels in febrile children. The association between primary HHV-6 infection and PCT elevation remains unclear. We therefore investigated clinical and laboratory factors associated with serum PCT levels in young children with primary HHV-6 infection. METHODS: We conducted a retrospective cohort study of 188 febrile children aged < 60 months who underwent serum PCT measurement between April 2021 and May 2024. Thirty children with clinically diagnosed ES and laboratory-confirmed primary HHV-6 infection were compared with 53 children with other virologically confirmed febrile illnesses. In exploratory analyses, multivariable logistic regression identified factors associated with ES, and multivariable linear regression explored factors associated with serum PCT levels in the ES group. RESULTS: Median serum PCT levels were significantly higher in the ES group than in controls (0.28 [interquartile range (IQR) 0.10-0.61] vs. 0.10 [IQR 0.10-0.31] ng/mL; P = 0.018). The PCT/C-reactive protein ratio was also higher in ES (P = 0.018). ES patients had lower white blood cell, neutrophil, and platelet counts, and higher aspartate aminotransferase and lactate dehydrogenase levels. In exploratory multivariable analysis, younger age (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.87-0.98; P = 0.006), lower platelet count (OR 0.88; 95% CI 0.82-0.94; P < 0.001), and higher PCT level (OR 1.74; 95% CI 1.02-2.95; P = 0.042) were associated with ES. Among patients with ES, lower lymphocyte count and absence of febrile seizures were associated with higher PCT levels. All ES patients had a self-limited clinical course without encephalopathy. CONCLUSIONS: Among febrile children undergoing clinically indicated PCT testing, primary HHV-6 infection was associated with modest PCT elevation. These elevations may reflect HHV-6-associated hematologic alterations rather than bacterial co-infection or disease severity, highlighting the need for cautious interpretation of PCT in ES.
Correction: Clinical performance of a dual-target SARS CoV-2 antibody assay using sera from Ghana.
Pappoe-Ashong PJ, Mingle JAA, Tetteh D … +4 more , Dsane-Lamptey MS, Oliver-Commey JA, Puplampu P, Jassoy C
BMC Infect Dis · 2026 Jun · PMID 42310582 · Full text
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Hospitalizations for schistosomiasis in Spain by sex: a population-based study using the national hospital discharge database (2016-2023).
Ramos-Belinchon A, Otero-Rodriguez S, Belinchon-Romero I … +1 more , Ramos-Rincon JM
BMC Infect Dis · 2026 Jun · PMID 42310580 · Full text
BACKGROUND: Schistosomiasis is an emerging imported parasitic disease in Europe, but information on its clinical burden among hospitalized patients in non-endemic countries remains limited. OBJECTIVE: To describe the epi...
BACKGROUND: Schistosomiasis is an emerging imported parasitic disease in Europe, but information on its clinical burden among hospitalized patients in non-endemic countries remains limited. OBJECTIVE: To describe the epidemiology, clinical characteristics, complications, and outcomes of patients hospitalized with schistosomiasis in Spain using nationwide hospital discharge data, with a focus on sex-related differences. METHODS: We conducted a retrospective observational study using the Spanish National Hospital Discharge Database (SNHDD). All hospitalizations with schistosomiasis (ICD-10: B65) recorded between 2016 and 2023 were included. Demographic characteristics, country of birth, clinical conditions, complications, and outcomes were analyzed. Urogenital, hepatosplenic, and intestinal complications were identified using ICD-10 codes. RESULTS: A total of 710 hospitalizations were identified; 550 (77.5%) occurred in men. Women were older than men (median age 46 vs. 34 years; p < 0.001) and had longer hospital stays (9 vs. 7 days; p = 0.041). Urogenital complications were more frequent in men, including bladder cancer (5.1% vs. 0.6%; p = 0.012), hematuria (5.8% vs. 1.3%; p = 0.017), cystitis (6.7% vs. 0.6%; p = 0.003), and obstructive uropathy (5.3% vs. 0%; p = 0.003). Male sex was independently associated with bladder cancer (aOR 16.31, 95% CI 2.12-125; p = 0. 0.007) and cystitis (adjusted OR 9.49, 95% CI 1.28-70; p = 0.028). Age was positively associated with bladder cancer (aOR 1.05, 95% CI 1.043-1.08; p < 0.001), and a lower probability of hematuria. (aOR 0.96, 95% CI 0.93-0.99; p = 0.005. In contrast, hepatosplenic complications were more frequent in women, including portal hypertension (12.5% vs. 4.5%; p < 0.001), esophageal varices (9.4% vs. 1.8%; p < 0.001), splenomegaly (5.6% vs. 1.5%; p = 0.002), and cirrhosis (6.3% vs. 2.7%; p = 0.033). Female sex was independently associated with portal hypertension (aOR 3.10, 95% CI 1.60-5.99), esophageal varices (aOR 7.11, 95% CI 2.92-17.30), and splenomegaly (aOR 5.46, 95% CI 1.88-15.92). ICU admission (8.6%) and in-hospital mortality (1.8%) did not differ significantly by sex. The overall hospitalization rate was 20 per million hospital admissions and was higher in men than in women (32.1 vs. 8.7 per million). CONCLUSION: Hospitalizations for schistosomiasis in Spain predominantly occur in men and are mainly associated with imported infections. Men more frequently present with urogenital complications, whereas women show a higher burden of hepatosplenic manifestations. These findings highlight the importance of increasing clinical awareness and implementing targeted screening and early diagnostic strategies in at-risk populations in non-endemic settings.
Advancing diagnostics for Chagas disease: key product characteristics and harmonized evaluation strategies - an expert meeting report.
Bohorquez LC, Schijman AG, Perez F … +3 more , Coto H, Marchiol A, Pinazo MJ
BMC Infect Dis · 2026 Jun · PMID 42310542 · Full text
Chagas disease is a global public health issue, life-threatening parasitic disease, affecting mostly underserved communities in Latin America. Yet, 10% of infected individuals are diagnosed, and 1% receive etiological tr...
Chagas disease is a global public health issue, life-threatening parasitic disease, affecting mostly underserved communities in Latin America. Yet, 10% of infected individuals are diagnosed, and 1% receive etiological treatment. Priority actions for disease elimination by 2030 are streamlining diagnostic methods and evaluating and developing point-of-care diagnostics. We convened 44 researchers, test developers, and health authorities, to provide scientific advice and reach consensus on (i) a harmonized protocol for evaluation of rapid diagnostic tests; (ii) preferred molecular diagnostics characteristics (scope, performance, operational features, pricing, and evaluation standards); and (iii) economic impact evidence needed to have a transformational impact in primary healthcare. We considered global and national perspectives with discordant evidence from multiple disciplines. Our outcomes provide a reference on practical applications and recommendations to promote test development and evaluation. Finally, we debate about the appropriate approach moving forward to meet the diagnostic gap, and propose how investments could be stimulated.
Rising burden of Plasmodium vivax in Mizoram: an emerging threat to malaria elimination in Northeast India.
Vanlalhriata C, Telugu Prakash P, Balasubramani K … +7 more , Pautu L, Zawmi L, Hlunpuii L, Pilankatta R, Senthil Kumar N, Bhowmick IP, Balabaskaran Nina P
BMC Infect Dis · 2026 Jun · PMID 42310537 · Full text
BACKGROUND: India has made tremendous progress in malaria elimination efforts; however, several malaria pockets with high transmission remain that require continuous focus. The Northeast (NE) state of Mizoram, bordering...
BACKGROUND: India has made tremendous progress in malaria elimination efforts; however, several malaria pockets with high transmission remain that require continuous focus. The Northeast (NE) state of Mizoram, bordering Bangladesh and Myanmar, tops the list for disproportionately contributing to India's malaria burden. Considered a Plasmodium falciparum-endemic region, this study details the shift in malaria epidemiology from P. falciparum to P. vivax in Mizoram, complicating malaria elimination efforts in an already highly vulnerable setting. METHODS: Malaria data for the NE states were obtained from the National Center for Vector Borne Disease Control, while aggregated health center-wise data for Mizoram's Mamit district (2021-2025) were obtained from the Office of the Chief Medical Officer, Mamit district, Mizoram. Spatiotemporal analyses of malaria cases and environmental variables were performed using ArcGIS 10.4 to identify disease trends, clustering, and high-risk areas. RESULTS: In Mizoram, the steep shift in malaria incidence from P. falciparum to P. vivax was noticeable from 2022 onward; from 23% in 2021, P. vivax increased to 47% in 2024 and 42% in 2025. In 2020, Siaha-Mizoram's southern district bordering Myanmar-reported the first increase in P. vivax infections at the state level. In Mizoram's western district of Mamit, P. vivax contributed to 68% of the cases in 2025, and among children < 5 years, 86% of the infections were attributed to P. vivax. While P. falciparum transmission coincided with the monsoon season, P. vivax transmission was perennial. CONCLUSION: The recent surge in Mizoram's P. vivax cases appears to mirror the epidemiological shift from P. falciparum to P. vivax in bordering Myanmar. It is possible P. vivax parasites from Myanmar could have entered Mizoram through the southern districts of Siaha and Lawngtlai. As several studies in the last decade have reported chloroquine-resistant P. vivax infections in Myanmar, it is imperative that therapeutic efficacy studies are urgently carried out in Mizoram to ascertain the status of CQ-resistant parasites.
Non-traumatic necrotizing fasciitis caused by Bacillus cereus in a child with acute lymphoblastic leukemia: a case report and proposed gastrointestinal-to-hematogenous pathway.
Liu Y, Lin X, Zhang J … +5 more , Tang T, Xi Y, Zheng L, Sun S, Zhang W
BMC Infect Dis · 2026 Jun · PMID 42304272 · Full text
BACKGROUND: Bacillus cereus (B. cereus) is generally considered a self-limiting foodborne pathogen but can cause severe invasive infections in immunocompromised hosts. Necrotizing fasciitis (NF) due to B. cereus is excee...
BACKGROUND: Bacillus cereus (B. cereus) is generally considered a self-limiting foodborne pathogen but can cause severe invasive infections in immunocompromised hosts. Necrotizing fasciitis (NF) due to B. cereus is exceedingly rare, particularly in pediatric oncology patients. Moreover, hematogenous NF without antecedent trauma is uncommon, and its pathogenesis remains poorly understood. This case is reported to highlight a potential gastrointestinal-to-hematogenous route of infection and its clinical implications. CASE PRESENTATION: A 10-year-old boy with acute lymphoblastic leukemia developed fulminant, non-traumatic NF and septic shock during chemotherapy-induced myelosuppression. The illness began with gastrointestinal symptoms after food intake and rapidly progressed to extensive soft tissue necrosis and circulatory collapse. B. cereus was isolated from both blood and tissue cultures. Due to profound neutropenia, severe thrombocytopenia, coagulopathy, and hemodynamic instability, immediate radical surgical debridement was considered prohibitively risky. The patient was initially treated with broad-spectrum antimicrobial therapy, intensive organ support, and correction of coagulopathy. Following clinical stabilization, staged surgical debridement and vacuum-assisted closure were performed. The patient recovered and was able to resume leukemia treatment. CONCLUSION: This case expands the clinical spectrum of invasive B. cereus infection and suggests a potential paradigm in which gastrointestinal translocation may lead to hematogenous NF in immunocompromised hosts, even in the absence of trauma. It underscores the importance of early recognition, multidisciplinary collaboration, and individualized decision-making regarding surgical timing. Further studies are warranted to better define the pathogenesis and optimal management strategies for this rare but life-threatening condition.
Comparison of CDC and ECDC reverse sequence algorithms for syphilis diagnosis: clinical implications of discordant serological results.
Karpuz T, Ongut G, Ozyurt OK … +8 more , Yazisiz H, Turkoglu MA, Felek R, Ogunc D, Mutlu D, Donmez L, Inan D, Colak D
BMC Infect Dis · 2026 Jun · PMID 42304261 · Full text
BACKGROUND: Reverse sequence algorithms are increasingly used for the serological diagnosis of syphilis in clinical practice; however, differences between the approaches recommended by the U.S. Centers for Disease Contro...
BACKGROUND: Reverse sequence algorithms are increasingly used for the serological diagnosis of syphilis in clinical practice; however, differences between the approaches recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) may influence test interpretation. METHODS: We performed a retrospective laboratory-based study including 82 serum samples with reactive Treponema pallidum electrochemiluminescence immunoassay (ECLIA) results collected at a tertiary-care university hospital. Samples were evaluated according to CDC and ECDC reverse sequence algorithms using rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) in the respective testing sequence. Agreement between algorithms was assessed using percentage concordance and Cohen's κ statistic, and discordant results were further evaluated using available clinical and follow-up data. RESULTS: Discordant serological patterns were identified between the two algorithms. Although overall agreement between the algorithms was high (96.3%; κ = 0.709), the wide confidence interval of Cohen's κ suggested statistical uncertainty, likely related to the limited number of discordant cases. Using the ECDC algorithm, three of 82 (3.7%) ECLIA-reactive samples with reactive RPR but nonreactive TPHA results did not fulfill the serological criteria of the testing sequence at the time of evaluation; follow-up serological findings in two of these cases were considered compatible with recent or early active syphilis. CONCLUSIONS: Although overall agreement between the algorithms was high, interpretation of discordant serological patterns may vary depending on testing sequence and assay selection. These findings suggest that early incorporation of nontreponemal testing may aid interpretation of discordant serological patterns in routine clinical practice. CLINICAL TRIAL NUMBER: Not applicable.
High frequency of HIV-1 drug resistance among individuals with persistent low-level viremia during first-line antiretroviral therapy in Uganda.
Sanyu G, Mayanja Y, Omooja J … +8 more , Asio JN, Nannyonjo M, Ssemanda P, Hellen N, Ssewanyana I, Drago KC, Kaleebu P, Ssemwanga D
BMC Infect Dis · 2026 Jun · PMID 42304252 · Full text
BACKGROUND: Although persistent low-level viremia (PLLV) has been associated with treatment failure, there is limited data about HIV drug resistance (HIVDR) during PLLV among Ugandans living with HIV. This study assessed...
BACKGROUND: Although persistent low-level viremia (PLLV) has been associated with treatment failure, there is limited data about HIV drug resistance (HIVDR) during PLLV among Ugandans living with HIV. This study assessed HIVDR prevalence, patterns and associated factors among individuals on HIV-1 first-line antiretroviral therapy (ART) who were experiencing PLLV. METHODS: A cross-sectional study among individuals with PLLV defined by two consecutive detectable viral load (VL) results < 1000 copies/mL and whose adherence scores were ≥ 95% over a twelve-month period. At 12 months, plasma samples of 444 individuals with PLLV during first-line ART were retrieved. HIVDR genotyping was performed on the protease, reverse transcriptase, and integrase regions of the HIV genome, and factors associated with HIVDR were assessed by logistic regression. RESULTS: Of the 444 individuals analyzed, 67 (15.1%) were successfully genotyped. HIVDR prevalence was detected in 42/67 (62.7%) of those genotyped. NNRTI mutations existed in 38/67 (56.7%), 29/67 (43.3%) had NRTI mutations while 26/67 (38.8%) had dual class (both NNRTI and NRTI) mutations. The most prevalent NRTI drug resistance mutations (DRMs) were M184V (35.8%) and K65R (14.9%). The most prevalent NNRTI DRMs were K103N (28.4%), G190A (23.9%) and Y181C (9.0%). The prevalence of INSTI mutations (1.5%) was the same as that of PI mutations. Having a VL between 500 and 999 copies/mL) (aOR: 6.4; 95% CI: (1.49-27.89); p = 0.01) and being below 25 years of age (aOR: 0.13; 95% CI (0.02-0.73); p = 0.02) were factors significantly associated with HIVDR during PLLV. CONCLUSION: We report a high frequency of HIVDR among individuals on first-line ART despite persistent low-level viremia and good drug adherence. HIVDR among individuals with PLLV was associated with a VL of 500 to 999 copies/mL and young age of below 25 years. HIVDR genotyping for individuals on first-line ART experiencing detectable PLLV is highly recommended. Low genotyping success rates present a major impediment to HIVDR studies among individuals with PLLV, suggesting a need to adopt robust next-generation platforms for deep sequencing. Also, HIV intervention programs targeted toward the youth may positively impact HIV control.
Clinical and laboratory characteristics associated with liver failure in hospitalized dengue patients: insights from a non-endemic region.
Zhao SY, Zhang YP, Zhou Z … +2 more , Wu Y, Hu JW
BMC Infect Dis · 2026 Jun · PMID 42304250 · Full text
BACKGROUND: Dengue fever is an emerging public health issue expanding into non-endemic regions like Changsha, China. Liver involvement is a critical complication, and early identification of patients at risk of liver fai...
BACKGROUND: Dengue fever is an emerging public health issue expanding into non-endemic regions like Changsha, China. Liver involvement is a critical complication, and early identification of patients at risk of liver failure remains challenging. This study aimed to characterize hospitalized dengue patients, identify routine laboratory parameters significantly associated with liver failure, and utilize a machine learning model to corroborate the importance of these parameters in this non-endemic setting. METHODS: A retrospective chart review was conducted on 86 laboratory-confirmed dengue patients hospitalized at the First Hospital of Changsha between 2023 and 2024. Routine demographic and laboratory data were collected. Statistical analyses were performed to identify parameters associated with liver failure within this cohort. Separately, a random forest model was developed using an independent dataset of dengue patients and healthy controls to rank feature importance for distinguishing dengue from a healthy baseline. RESULTS: Among 86 dengue patients, mean age was 38.8 years, with 48.8% male. Cases peaked in summer and autumn. Common abnormalities included leukopenia (83.7%), thrombocytopenia (47.7%), elevated ALT (52.3%), AST (48.8%), and LDH (46.9%). After excluding patients with pre-existing liver disease or co-infections, 79 patients were analyzed for liver failure risk factors. Compared with patients without liver failure (n = 40), those with liver failure (n = 39) had significantly lower platelet counts (P = 0.003) and higher ALT (P = 0.005), AST (P = 0.045), and LDH (P = 0.041). A random forest model ranked AST, platelets, and ALT among its top features for distinguishing dengue from healthy status. CONCLUSION: Platelet count, ALT, AST, and LDH were identified as laboratory parameters associated with dengue-related liver failure in hospitalized patients. A complementary machine learning-based feature importance analysis showed consistent ranking of key variables in an independent dataset. These findings provide potential biomarkers for risk stratification and support future prospective validation studies.
Epidemiology of source-related candidaemia and breakthrough candidaemia in intensive care units.
Şişman AS, Önal U, Çalışır B … +8 more , Yılmaz E, Kazak E, Heper Y, Özkaya G, İşçimen R, Özakın C, Ener B, Akalın H
BMC Infect Dis · 2026 Jun · PMID 42304234 · Full text
BACKGROUND: A review of the literature reveals that there is no descriptive epidemiological study based on the source of candidaemia in intensive care units(ICUs). In addition to that the number and scope of studies eval...
BACKGROUND: A review of the literature reveals that there is no descriptive epidemiological study based on the source of candidaemia in intensive care units(ICUs). In addition to that the number and scope of studies evaluating breakthrough candidaemia in ICUs are limited. The primary objective of this study was to analyse the epidemiology of candidaemia in our ICUs based on the source of each case, and the secondary aim was to evaluate breakthrough candidaemia. METHODS: 141 adult patients(≥ 18 years) who had Candida spp. growth in their blood cultures 48 h after admission to an ICU were included in the study. Statistical comparisons were made between groups for abdominal, central venous catheter and primary candidaemia. The level of significance was set at α = 0.05. RESULTS: In the classification based on the sources of candidaemia, 52 (37%) were abdominal, 32 (23%) were central venous catheter-related, 55 (39%) were primary candidaemia and 2 (1%) were urinary tract-related. Total parenteral nutrition use rates were significantly lower in primary candidaemia than in abdominal candidaemia (p < 0.001). Steroid use rates were significantly higher in primary candidaemia than in abdominal candidaemia (p = 0.021). Mortality rates on days 14 and 28 did not differ significantly according to the source of infection. Beakthrough candidaemia rates were significantly higher in abdominal candidaemia. The acute physiology and chronic health evaluation II (APACHE-II) score at ICU admission was significantly higher in the breakthrough candidaemia(p = 0.037). CONCLUSIONS: A significant proportion of candidemia cases in our intensive care units were non-catheter-related candidemia. Breakthrough candidaemia was found to be more common in patients with high APACHE-II scores at ICU admission and in candidaemia originating from the abdomen.
Risk factors for community-acquired pneumonia in older adults in Japan after the introduction of the childhood PCV13.
Inoshima N, Nakashima K, Suzuki K … +9 more , Nagasaka H, Niwa T, Nakahama C, Miyashita N, Iwamoto S, Kan S, Kondo K, Ohfuji S, Fukushima W
BMC Infect Dis · 2026 Jun · PMID 42304222 · Full text
BACKGROUND: Community-acquired pneumonia (CAP) remains a leading cause of death globally. Although childhood 13-valent pneumococcal conjugate vaccine (PCV13) has altered the epidemiology of pneumococcal disease in childr...
BACKGROUND: Community-acquired pneumonia (CAP) remains a leading cause of death globally. Although childhood 13-valent pneumococcal conjugate vaccine (PCV13) has altered the epidemiology of pneumococcal disease in children, risk factors for CAP in older adults remain insufficiently explored. Additionally, few studies have compared risks between those aged 65-74 and ≥ 75 years. We evaluated risk factors for CAP in older Japanese adults by age. METHODS: We conducted a secondary analysis of data from a multicenter, nationwide case-control study conducted between October 2016 and December 2019. Cases were individuals aged ≥ 65 years with CAP. Up to five controls per case were matched by sex, fiscal-year age, and visit date. Clinical and lifestyle data were questionnaire-based. Adjusted odds ratios (aORs) were calculated for participants overall and stratified by age (65-74 and ≥ 75 years) using conditional logistic regression. RESULTS: Analysis included 142 cases and 596 controls. CAP risk was associated with living with children ≤ 6 years (aOR: 6.15, 95% confidence interval [CI]: 2.84-13.32), low body mass index (BMI) (< 18.5 kg/m²) (aOR: 1.78, 95% CI: 1.02-3.09), and impaired activities of daily living (ADL) (aOR: 2.44, 95% CI: 1.12-5.30). High BMI (≥ 25.0 kg/m²) was associated with a reduced risk (aOR: 0.55, 95% CI: 0.31-0.95). Among those aged 65-74 years, living with children ≤ 6 years (aOR: 4.89, 95% CI: 1.83-13.08) was a risk factor for CAP, whereas high BMI (aOR: 0.41, 95% CI: 0.18-0.89) and gastrointestinal disease (aOR: 0.19, 95% CI: 0.04-0.84) were associated with a reduced risk. Among those aged ≥ 75 years, chronic obstructive pulmonary disease (aOR: 3.59, 95% CI: 1.29-9.93), asthma (aOR: 2.99, 95% CI: 1.25-7.16), living with children ≤ 6 years (aOR: 11.62, 95% CI: 3.12-43.33), and impaired ADL (aOR: 2.90, 95% CI: 1.10-7.65) were risk factors for CAP. Only living with children ≤ 6 years was significant for pneumococcal CAP (aOR: 7.22, 95% CI: 1.23-42.34). CONCLUSIONS: Living with children ≤ 6 years remains a major CAP risk factor in older adults after childhood PCV13 introduction. However, risk factors differ by age. Respiratory comorbidities and functional decline are dominant drivers of CAP in adults aged ≥ 75 years. Prevention strategies should consider age-specific dominant risk factors.
Performance and clinical utility of image-based machine learning models for the diagnosis of neglected tropical diseases in low- and middle-income countries: a systematic review.
Innocent DC, Anyakorah PE, Innocent RC … +3 more , Dozie INS, Chukwuocha UM, Emerole CO
BMC Infect Dis · 2026 Jun · PMID 42298484 · Full text
BACKGROUND: Neglected tropical diseases (NTDs) disproportionately affect populations in low- and middle-income countries (LMICs), where diagnostic capacity is often limited. Image-based machine learning (ML) has emerged...
BACKGROUND: Neglected tropical diseases (NTDs) disproportionately affect populations in low- and middle-income countries (LMICs), where diagnostic capacity is often limited. Image-based machine learning (ML) has emerged as a potential tool to support diagnosis, but its clinical utility remains unclear. AIM: To systematically evaluate the diagnostic performance and clinical utility of image-based machine learning models for NTD diagnosis in LMICs. METHODS: This review was registered on PROSPERO and conducted in accordance with PRISMA guidelines. Searches were performed in PubMed/MEDLINE, Embase, Scopus, Web of Science, and IEEE Xplore from January 2010 up until January 31st, 2026. Peer-reviewed primary studies evaluating image-based ML models for NTD diagnosis in LMICs and reporting diagnostic performance metrics were included. Risk of bias was assessed using QUADAS-2, and findings were synthesised narratively. RESULTS: Eight studies met the inclusion criteria. Microscopy-based ML models demonstrated consistently high performance, with reported sensitivities and specificities frequently above 90%, particularly for malaria and helminth infections. Clinical image-based models for skin NTDs showed more variable accuracy. External validation and implementation evaluation were inconsistently reported, limiting generalisability and clinical applicability. CONCLUSION: Image-based ML models show strong diagnostic potential for NTDs in LMICs, especially in microscopy-supported workflows. However, translation into routine practice is constrained by limited dataset representativeness, inadequate external validation, and insufficient attention to operational feasibility and explainability. Future research must prioritise implementation-oriented evaluation to realise public health impact. CLINICAL TRIAL NUMBER: Not applicable. PROSPERO: CRD420261339435.
Epidemiological shifts and clinical characteristics of childhood Chlamydia pneumoniae pneumonia in Beijing before, during, and after public health interventions (2017-2025).
Qian J, Liu M, Zhu C … +1 more , Wang Y
BMC Infect Dis · 2026 Jun · PMID 42298460 · Full text
OBJECTIVE: To systematically explore the impact of public health intervention measures (including strict non-pharmaceutical interventions and subsequent relaxation) on the epidemiological trends and clinical characterist...
OBJECTIVE: To systematically explore the impact of public health intervention measures (including strict non-pharmaceutical interventions and subsequent relaxation) on the epidemiological trends and clinical characteristics of childhood Chlamydia pneumoniae (CP) pneumonia in Beijing, and provide evidence for precise prevention, control, diagnosis, and treatment. METHODS: A retrospective cohort study was conducted on 331 hospitalized children with laboratory-confirmed CPP pneumonia (January 2017-September 2025) from the Capital Center for Children's Health. Patients were stratified into three groups based on the intensity of population-level public health non-pharmaceutical interventions(NPIs) implemented in Beijing. Demographic data and clinical characteristics were collected. RESULTS: Among the 331 patients (male: female ratio = 1.75:1), a significant surge was observed from January to September 2025 in the post-intervention group, which accounted for 7.91% (133 patients) of community-acquired pneumonia (CAP) cases. The primary affected age group shifted from 0 to 3 years (60.4% in the pre-intervention group; 75.6% in the during-intervention group) to 6-18 years (90.1% in the post-intervention group; H = 172.24, P < 0.001). Compared to the pre-intervention group, the post-intervention group had significantly higher rates of co-infection (45.4% vs. 6.7%; χ²=12.8, P < 0.001), consolidation detected by computed tomography (56.6% vs. 26.1%; χ²=56.2, P < 0.001), subpleural masses (34.9% vs. 13.4%; χ²=89.4, P < 0.001), and bronchoscopy utilization (34.9% vs. 3.7%; χ²=85.3, P < 0.001). Markers of inflammation, such as C-reactive protein (CRP), and myocardial injury markers, such as creatine kinase-MB (CK-MB), were also significantly elevated (P < 0.05). The poor response rate to macrolides increased from 3.7% in the pre-intervention group to 34.9% in the post-intervention group (χ²=19.8, P < 0.001). CONCLUSIONS: Public health interventions caused a "suppression-rebound" effect in childhood Chlamydia pneumoniae (CP) pneumonia. This effect led to a shift in incidence toward school-aged children in Beijing. Following this rebound, post-intervention cases have shown more severe imaging findings and higher rates of macrolide unresponsiveness among CP pneumonia cases, which indicates the need for targeted school-based prevention and optimized antibiotic treatment. CLINICAL TRIAL NUMBER: Not applicable.
Epidemiological characteristics of Echinococcus granulosus infection in children from some sites in Xinjiang and its association with platelets.
Jiao H, Hao Q, Liu Y … +9 more , Guo G, Lu P, Wu C, Song C, Yue Y, Qi W, Li J, Zhang W, Yan M
BMC Infect Dis · 2026 Jun · PMID 42298459 · Full text
OBJECTIVE: The aim of this study was to delineate the epidemiological features of echinococcosis in children of patient data collected and to identify any associations between the infection and increased platelet paramet...
OBJECTIVE: The aim of this study was to delineate the epidemiological features of echinococcosis in children of patient data collected and to identify any associations between the infection and increased platelet parameters. METHODS: Between 2007 and 2024, we conducted a comprehensive analysis of cases with E.granulosus s.s. infection children aged 0-14 years and analysis blood routine examination results involving with E.granulosus s.s. infection and normal children. A total of 930 children were collected, including 316 infected children and 496 normal children after screening. Data were sourced from the case systems of the First Affiliated Hospital of Xinjiang Medical University and Yili Friendship Hospital. Information on age, gender, ethnicity, residential address, diagnosis, chief complaints, and medical history were collected for both infected and non-infected children. 1:1 matching was carried out when counting platelets and their related indexes. Data abstraction adhered to established guidelines and was independently performed by two reviewers. Quality assessment utilized a critical appraisal checklist for prevalence studies. The study adopted a retrospective design, involving two-center case collection and subsequent data analysis. RESULTS: In children infected with E.granulosus s.s., gender, age, and ethnicity are not the primary factors influencing platelet counts. Additionally, the main infection sites are predominantly located in the liver. Among the cases analyzed, the proportion of infections in the Yili Kazakh Autonomous Prefecture in northern Xinjiang was higher compared to other regions, suggesting potential inclusion and statistical bias. Before and after propensity score matching, the platelet values in children infected with E.granulosus s.s. were significantly higher than those in healthy children, with statistically significant differences (all P < 0.001). The MPV values in children infected with E.granulosus s.s. were significantly lower than those in healthy children, also with statistically significant differences (all P < 0.001). Prior to propensity score matching, the PCT values in children infected with E.granulosus s.s. were higher than those in healthy children, with a statistically significant difference (P = 0.0201). After propensity score matching, there was no statistically significant difference between the two groups (P = 0.9419). Both before and after propensity score matching, the PDW values in children infected with E.granulosus s.s. were higher than those in healthy children, with statistically significant differences (all P < 0.001). CONCLUSIONS: The collection and analysis of clinical case data revealed the following findings: Firstly, in pediatric cases of E.granulosus s.s. infection, the primary site of infection was predominantly concentrated in the liver. In northern regions of Xinjiang, such as the Yili Kazak Autonomous Prefecture, the infection rate was significantly higher compared to other areas, the proportion of infected children in rural areas is higher than that in urban areas. Secondly, children infected with E.granulosus s.s. exhibited higher platelet counts, lower MPV, and higher PDW compared to healthy children. This indicates that E.granulosus s.s. infection affects platelet parameters.
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