BMC Infectious Diseases[JOURNAL]
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200 papers
Comparison of the treatment outcomes and identification of the risk factors associated with unfavorable outcomes among extra pulmonary and pulmonary tuberculosis patients under NTEP.
Gupta A, Gupta A, Nadda A … +1 more , Singh N
BMC Infect Dis · 2026 Jun · PMID 42286532 · Full text
BACKGROUND: India contributes approximately 27% to the global Tuberculosis burden, with Pulmonary TB representing the predominant form of the disease. Extrapulmonary Tuberculosis contributes to around 20% of total TB bur...
BACKGROUND: India contributes approximately 27% to the global Tuberculosis burden, with Pulmonary TB representing the predominant form of the disease. Extrapulmonary Tuberculosis contributes to around 20% of total TB burden worldwide. Diagnosing epTB is more challenging compared to pTB. Despite adequate awareness and efforts, it still remains under-diagnosed and underreported even in high burden countries like India. Identification of the risk factors associated with unfavorable outcomes can definitely improve morbidity and mortality burden of the disease. MATERIAL METHODS: Medical records of 2624 patients above 18 years of age and treated for TB under NTEP over 1 year (1 June 2023 to 31 May 2024) at district Mohali were reviewed retrospectively. Treatment outcomes were classified as favorable (cured/treatment completed) and unfavorable (death, failure, lost to follow-up, regimen change). Multivariable binary logistic regression was performed to identify factors associated with unfavorable outcomes and death. RESULTS: Out of 2624, 1729 (65.9%) had pTB and 895 (34.1%)epTB. Favorable treatment outcome was observed in 1603 (61%) pTB and 878 (33.5%) epTB. Deaths were more in pTB(69,3.9%) as compared to epTB(14,1.6%). On regression analysis for death as an outcome, factors like recurrent TB (AOR 3.695; CI [1.356-10.070]; p-0.011), age 41-60 years (AOR 4.138; CI [2.217-7.723]; p-<0.001), Age > 60 years (AOR 2.409; CI [1.246-4.658]; p-0.009), were independently associated with higher odds of unfavorable treatment outcome. CONCLUSION: Recurrent TB in young adults is associated with unfavorable treatment outcomes whereas BMI above 25 is associated with unfavorable outcome in epTB patients. Enhanced clinical awareness about the disease presentation for early diagnosis, availability of diagnostic tests for microbiological confirmation and detection of resistance are important for early diagnosis and optimal management of TB.
Epidemiological, clinical and virological profile of Mpox in Kinshasa, democratic republic of the Congo, 2024-2025: a cross-sectional study.
Lassio GM, Kayembe HC, Vakaniaki EH … +7 more , Bandali PA, Kapour Kieng Katsang G, Katsang K, Tshibola T, Kalubi TM, Mukayonde JV, Bompangue DN
BMC Infect Dis · 2026 Jun · PMID 42286531 · Full text
BACKGROUND: Mpox is an emerging viral zoonosis whose transmission has gradually moved to urban settings since 2022. This study aimed to describe the epidemiological, clinical, and virological characteristics of confirmed...
BACKGROUND: Mpox is an emerging viral zoonosis whose transmission has gradually moved to urban settings since 2022. This study aimed to describe the epidemiological, clinical, and virological characteristics of confirmed cases of Mpox in Kinshasa, the capital of the Democratic Republic of Congo (DRC), between 2024 and 2025. METHODS: We conducted a descriptive cross-sectional study using data collected from mpox treatment centers and the National Institute for Biomedical Research. Patients with polymerase chain reaction (PCR) results and complete medical records were included in the study. We calculated incidence from laboratory-confirmed cases and described the geographic distribution at the health zone level. The chi-square test or Fisher's exact test, as appropriate, as well as the Mann-Whitney test, were performed to compare sociodemographic, clinical, and virological characteristics. RESULTS: Between 2024 and 2025, the vast majority of health zones were affected, with the highest incidences observed in urban areas: Limete, Bumbu, Kalamu II, Kokolo, and Lingwala. At the individual level, a higher proportion of positive mpox cases were observed among people aged 15 to 34 years (58.3%), married (33.3%), unemployed (27.6%), and involved in sex work (93.0%). In addition, comorbidities were rare but significant, with longer hospitalization (15 [9-20] days) and frequent reports of fever, pruritus, lymphadenopathy, and skin ulcers. Overall, 55.5% of laboratory-confirmed cases were associated with clade Ia, compared to 45.5% with clade Ib. In the most affected age group mentioned above, the proportion of clade Ia was higher in males, while clade Ib was prevalent in females. CONCLUSION: Mpox in Kinshasa is characterized by persistent transmission in urban areas, affecting the majority of health zones, as well as by the co-circulation of subclades Ia and Ib. Young adults aged 15 to 34 years were the most affected group, with clade Ia predominance in males and clade Ib in females. These results highlight the need to strengthen epidemiological surveillance, early detection, and case follow-up to adapt mpox control strategies in the urban context of Kinshasa.
Clinical manifestations and laboratory findings in patients coinfected with dengue virus and SARS-CoV-2: a systematic review.
Adnyanaschah R, Abdulah R, Oktora MP
BMC Infect Dis · 2026 Jun · PMID 42286517 · Full text
BACKGROUND: Dengue Hemorrhagic Fever and Coronavirus disease 2019 (COVID-19) are infectious diseases caused by dengue virus (DENV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While DENV remains ende...
BACKGROUND: Dengue Hemorrhagic Fever and Coronavirus disease 2019 (COVID-19) are infectious diseases caused by dengue virus (DENV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While DENV remains endemic in many tropical regions, SARS-CoV-2 spread globally beginning in 2020. Reports of coinfection have emerged from several countries. This systematic review describes the clinical manifestations and laboratory findings reported in patients coinfected with DENV and SARS-CoV-2. METHODS: This review followed the PRISMA guidelines and collecting data from PubMed for articles published between 2020 and 2025 that discussed DENV and SARS-CoV-2 coinfection. Eligible study designs included theoretical articles, case reports, case series, and cohort studies. Data were synthesized descriptively due to heterogeneity and the absence of comparator groups. RESULTS: Fifteen studies met the inclusion criteria, identifying 65 patients with SARS-CoV-2 and DENV coinfection. Reported symptoms included fever (69%), vomiting (57%), abdominal pain (55%), rash (54%), and shock (51%). Laboratory findings also showed hematological and physiological alterations including hypotension (57.14%), tachypnea (50%), fever (62.5%), neutropenia (33.33%), neutrophilia (50%), lymphopenia (42.86%), and lymphocytosis (28.57%). These percentages represent descriptive counts across heterogeneous case reports and do not reflect prevalence estimates. CONCLUSIONS: Patients with DENV and SARS-CoV-2 coinfection exhibit a range of clinical and laboratory abnormalities, but the available evidence-primarily case reports and case series without comparator groups-does not allow conclusions about disease severity or prognosis relative to monoinfection. The findings should therefore be interpreted as descriptive and hypothesis-generating. Careful diagnostic evaluation and clinical monitoring remain essential in suspected coinfection cases. CLINICAL TRIAL NUMBER: Not applicable.
Maternal cytokine profile and anti-bacterial specific antibody response associated with neonatal infection by E. coli and K. pneumoniae.
Chakroun A, Amar N, Ben-Taleb H … +7 more , Mohtadi K, Lamrissi A, Badre A, Habti N, Alj HS, Saïle R, Chamekh M
BMC Infect Dis · 2026 Jun · PMID 42286508 · Full text
BACKGROUND: The transmission of pathogenic Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae from mother to child during pregnancy contributes significantly to neonatal morbidity and mortality, pa...
BACKGROUND: The transmission of pathogenic Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae from mother to child during pregnancy contributes significantly to neonatal morbidity and mortality, particularly in low and middle-income countries. Identifying maternal risk factors associated with vertical transmission is crucial. This prospective study aimed to investigate the maternal cytokine profile and anti-LPS-specific antibodies in pregnant mothers with positive cultures for E. coli and K. pneumoniae, exploring their potential association with neonatal invasive disease. METHODS: This prospective study examined groups of pregnant women with a positive culture for E. coli or K. pneumoniae, who had or had not given birth to newborns with invasive diseases. A group of age-matched mothers negative for E coli and K. pneumoniae was used as a control. A panel of circulating inflammatory cytokines was measured in mother-infant dyads using Luminex multiplex assays or ELISA in maternal and cord blood, as well as in the supernatants of blood leucocytes stimulated with TLR4 and TLR1/2 ligands. The serum levels of specific IgG anti-LPS E. coli and anti-LPS K. pneumoniae were quantified using ELISA. RESULTS: Mothers with a positive culture for E. coli and K. pneumoniae and their newborns exhibited elevated plasma levels of IL-6, IL-8, and TNF-α compared to healthy mothers and their newborns. Similar results were observed for IL-6 and TNF-α when blood leucocytes were stimulated by TLR4 and TLR1/2 ligands. Mothers who gave birth to newborns with severe infectious diseases had higher IL-6 levels and lower specific IgG anti-LPS E. coli or anti-LPS K. pneumoniae levels compared to those with healthy newborns. Receiver operating characteristic (ROC) analysis demonstrated a strong association between maternal IL-6 and specific IgG levels and perinatal bacterial transmission. CONCLUSION: Pregnant women with positive cultures for E. coli or K. pneumoniae, as well as higher plasma levels of IL-6 and lower levels of specific anti-bacterial IgG, are at increased risk of perinatal bacterial transmission. This data could help improve the monitoring of mother-child dyads and optimize prenatal care. TRIAL REGISTRATION: Clinical trial number: not applicable.
The U-shaped relationship between triglyceride glucose-body mass index and prognosis of sepsis patients: a retrospective study.
Chen Z, Qin P, Yang Y … +7 more , Liu J, Zhang C, Zan X, Yao J, Li Y, Li L, Tian X
BMC Infect Dis · 2026 Jun · PMID 42286503 · Full text
BACKGROUND: The triglyceride glucose-body mass index (TyG-BMI) has been validated as a reliable indicator of insulin resistance in critically ill patients. Despite its established prognostic value in cardiovascular and m...
BACKGROUND: The triglyceride glucose-body mass index (TyG-BMI) has been validated as a reliable indicator of insulin resistance in critically ill patients. Despite its established prognostic value in cardiovascular and metabolic disorders, its role in sepsis outcomes remains controversial. The aim of this study was to clarify the nonlinear relationship between TyG-BMI and all-cause mortality in intensive care unit (ICU)-admitted patients with sepsis. METHODS: Adult patients with sepsis admitted to the ICU for the first time were enrolled from the MIMIC-IV database and stratified into tertiles on the basis of TyG-BMI. The primary outcome was 360-day all-cause mortality, whereas the secondary outcome was 30-day all-cause mortality. Chi-square tests and Kaplan-Meier survival curves were constructed to evaluate survival outcomes across the three groups. Restricted cubic splines, Cox proportional hazards regression models, and exploratory subgroup analyses were further employed to systematically investigate the nonlinear association between TyG-BMI and prognosis in patients with sepsis. RESULTS: A total of 1249 patients were enrolled in this study, with a median age of 64.3 years and a median TyG-BMI of 261.3, among whom 489 (39.2%) were female. Compared with Tertiles 2 and 3, Tertile 1 had the highest mortality rate, with statistically significant associations observed between TyG-BMI and 360-day all-cause mortality (P = 0.028). Restricted cubic spline analysis confirmed a significant U-shaped association between TyG-BMI and 360-day all-cause mortality, with a turning point at TyG-BMI = 289.4. No statistically significant nonlinear association was found between TyG-BMI and the secondary endpoint of 30-day all-cause mortality. In the fully adjusted two‑piecewise Cox regression model (Model 3), each unit increase in TyG‑BMI was associated with a significantly decreased risk of 360‑day all‑cause mortality below the turning point (HR = 0.996, 95% CI 0.993-0.999, P = 0.014), and a significantly increased risk above the turning point (HR = 1.002, 95% CI 1.001-1.004, P = 0.011). Exploratory stratified analyses revealed significant interactions with age, gender, race, and congestive heart failure status, which should be interpreted with caution. CONCLUSIONS: In this cohort, TyG-BMI shows a significant U-shaped association with 360-day all-cause mortality in sepsis patients. The clinical value of TyG‑BMI requires further validation in large‑scale multi‑center studies.
Antibody reactivity to the VAR2CSA DBL5 domain among pregnant women in Northern Ghana.
Adda RB, Dassah SD, Mohammed AR … +3 more , Kulariba J, Anabire NG, Abugri J
BMC Infect Dis · 2026 Jun · PMID 42286496 · Full text
BACKGROUND: Pregnancy-associated malaria (PAM), caused predominantly by Plasmodium falciparum, remains a major contributor to maternal and neonatal morbidity in malaria-endemic regions. Placental sequestration of infecte...
BACKGROUND: Pregnancy-associated malaria (PAM), caused predominantly by Plasmodium falciparum, remains a major contributor to maternal and neonatal morbidity in malaria-endemic regions. Placental sequestration of infected erythrocytes is mediated by the parasite protein VAR2CSA, a leading target for PAM vaccine development. However, extensive antigenic polymorphism within VAR2CSA complicates the identification of broadly protective vaccine candidates. Conserved subdomains such as the Duffy Binding-Like 5 (DBL5) domain may contribute to naturally acquired antibody responses during pregnancy. To assess the specificity of DBL5-directed immunity, hepatitis B virus (HBV)-infected pregnant women were included as a non-malarial infectious comparator group. This study evaluated plasma immunoglobulin G (IgG) reactivity to DBL5 and examined its concordance with antibody reactivity to full-length VAR2CSA among pregnant women in Northern Ghana. METHODS: Plasma samples from 156 pregnant women were purposively selected from a cross-sectional antenatal cohort and categorised into P. falciparum-infected (n = 60), HBV-infected (n = 60), and co-infected (n = 36) groups. Recombinant DBL5 was expressed in E. coli, purified, and used in indirect enzyme-linked immunosorbent assays (ELISA) to measure plasma IgG reactivity. A subset of samples was tested in parallel against full-length VAR2CSA to evaluate concordance of antibody responses. Multi-tool immunoinformatics analyses were additionally performed to predict B-cell and T-cell epitopes and estimate population coverage. RESULTS: Plasma IgG reactivity to DBL5 differed significantly across study groups (p < 0.001), with the highest median optical density (OD450) observed among P. falciparum-infected women (1.54), compared with HBV-infected (0.88) and co-infected participants (1.20). DBL5-specific IgG responses demonstrated a strong positive correlation with reactivity to full-length VAR2CSA (Spearman's ρ = 0.75, p < 0.0001), indicating substantial concordance between recognition of the DBL5 domain and the native placental malaria antigen. Immunoinformatics analyses identified multiple conserved DBL5 regions with strong predicted HLA-binding affinity and broad estimated global population coverage. CONCLUSION: Pregnant women exposed to P. falciparum exhibit elevated plasma IgG reactivity to the VAR2CSA DBL5 domain, and these responses closely parallel antibody recognition of full-length VAR2CSA. These findings suggest that DBL5 may represent an immunologically recognisable component of naturally acquired PAM-associated antibody responses. However, given the exploratory cross-sectional design, the observed associations should be interpreted cautiously and warrant further investigation in longitudinal and functional studies evaluating the role of DBL5 in placental malaria immunity and future vaccine research.
Variability in HIV viral load quantification in real-world service delivery settings: findings from an observational cohort study in Rwanda.
Murenzi G, Brazier E, Rutwaza MG … +6 more , Mivumbi JP, Barthel R, Ingabire J, Kanyabwisha F, Yotebieng M, Nash D
BMC Infect Dis · 2026 Jun · PMID 42286495 · Full text
BACKGROUND: While developments in HIV viral load (VL) testing technologies have improved detection of low-level viremia, there is substantial variation in the quantitative results of available polymerase chain reaction t...
BACKGROUND: While developments in HIV viral load (VL) testing technologies have improved detection of low-level viremia, there is substantial variation in the quantitative results of available polymerase chain reaction tests, particularly around assay lower limits of quantification (LLOQ). We aimed to describe testing results for paired specimens from the same participants reported by two laboratories in Rwanda using different assays, characterize discordancy in VL quantification, and identify factors associated with quantifiable VL results at a threshold of 40 copies/mL. METHODS: In an observational cohort study of people living with HIV (PWH), aged ≥ 40 years enrolled in HIV care, we used two laboratories to process paired research specimens. We used Kappa statistics and plots to examine between-lab agreement at the LLOQs for assays used by the two labs (Lab A: 20 copies/mL for COBAS AmpliPrep/Taqman and Abbott Alinity-m HIV1 assays; Lab B: 40 copies/mL for Abbott RealTime assay and at thresholds of 200, 1000 and 2000 copies/mL. We used Poisson regression to examine participant characteristics independently associated with unsuppressed viral loads (≥ 200 copies/mL). RESULTS: 593 results were reported by both laboratories for 572 unique participants. The mean age of study participants was 54.4 years, and 58% were female. Median time on antiretroviral therapy was 16 years, 93.7% were on dolutegravir-based regimens, and 96.9% had CD4 cell counts of > 200 cells/mm. For Lab A, 29.2% of specimens had quantifiable VLs at assay LLOQs of 20 copies/mL and 22.1% had quantifiable VLs at a common threshold of 40 copies/mL, compared with 4.7% of specimens processed by Lab B (LLOQ 40 copies/mL). Kappa statistics showed poor to moderate between-lab agreement below a threshold of 200 copies/mL, with high agreement at thresholds of 1000 and 2000 copies/mL and differences by assay type. CD4 cell counts < 200 cells/mm were associated with unsuppressed VLs reported by each laboratory. CONCLUSIONS: While VL quantification differed substantially between assays and laboratories used in a real-world service delivery setting, there was high agreement at cut-offs generally used in clinical decision-making. Our findings support the use of higher viral suppression cut-offs used in UNAIDS' 95-95-95 targets because lower thresholds are vulnerable to misclassification.
Epidemiological characteristics and risk factors associated with bacteremia caused by intrinsically colistin-resistant gram-negative microorganisms: a case-control study.
Büyüktarakçı Karali C, Baştuğ A, Sertçelik A … +1 more , Bodur H
BMC Infect Dis · 2026 Jun · PMID 42286490 · Full text
OBJECTIVE: To identify risk factors and clinical characteristics of bacteremia caused by intrinsically colistin-resistant Gram-negative microorganisms (ICRMs) in intensive care unit (ICU) patients and to compare them wit...
OBJECTIVE: To identify risk factors and clinical characteristics of bacteremia caused by intrinsically colistin-resistant Gram-negative microorganisms (ICRMs) in intensive care unit (ICU) patients and to compare them with Klebsiella pneumoniae bacteremia. METHODS: This retrospective case-control study was conducted in the ICUs of a tertiary-care hospital in Türkiye between January 2023 and February 2024. Adult patients with ICRM-positive blood cultures were compared with those with colistin-susceptible or colistin-resistant Klebsiella pneumoniae bacteremia, and demographic, clinical, and outcome data were analyzed. RESULTS: In total, 439 patients were included: 148 with ICRM bacteremia, 191 with colistin-susceptible K. pneumoniae bacteremia, and 100 with colistin-resistant K. pneumoniae bacteremia. Exposure to colistin or polymyxin B within the previous three months was independently associated with ICRM bacteremia (OR = 2.87, 95% CI = 1.29-6.39, p = 0.010). Polymicrobial bacteremia was identified in 20% of ICRM cases (30/148), most commonly involving Enterococcus spp. (7/30). New-onset BSIs within fourteen days of the initial bacteremia were more frequent in the ICRM group (16.9%, 25/148) than in both K. pneumoniae groups (p < 0.05), with K. pneumoniae as the most common pathogen (40%, 10/25). ICRM bacteremia cases were more often community-acquired or healthcare-associated and were associated with lower Sequential Organ Failure Assessment (SOFA) scores and mortality rates than both K. pneumoniae groups (each p < 0.05). CONCLUSION: ICRM bacteremia poses a growing threat in critically ill patients due to intrinsic and increasing acquired resistance. Prior colistin or polymyxin-B exposure was identified as an independent risk factor, and these infections were more often polymicrobial and community- or healthcare-associated than K. pneumoniae bacteremia. Given the limited ICU-focused evidence on ICRM bacteremia, these findings highlight prior polymyxin exposure as a potentially modifiable risk factor and support antimicrobial stewardship efforts. Therefore, empirical therapy in high-risk patients should consider potential ICRM involvement.
High resistance of Anopheles gambiae s.L. populations to public health insecticides in Ghana: contribution of domestic and agricultural pesticide use.
Yanney SA, Abdulai A, Owusu-Asenso CM … +6 more , Akuamoah-Boateng Y, Mohammed Sabtiu AR, Sraku IK, Machani MG, Attah SK, Afrane YA
BMC Infect Dis · 2026 Jun · PMID 42277740 · Full text
BACKGROUND: Malaria elimination efforts in sub-Saharan Africa are increasingly threatened by the spread of insecticide resistance in Anopheles gambiae sensu lacto (s.l.). The widespread use of insecticides in vector cont...
BACKGROUND: Malaria elimination efforts in sub-Saharan Africa are increasingly threatened by the spread of insecticide resistance in Anopheles gambiae sensu lacto (s.l.). The widespread use of insecticides in vector control and pesticides in agriculture has intensified resistance development in malaria vectors. This study examined the drivers of high insecticide resistance in Anopheles mosquitoes in Ghana's Coastal and Sahel Savannah ecological zones. METHODS: Anopheles larvae were collected from eight sites across the Coastal Savannah (Tuba, Opeibea, Nima, and Teshie) and Sahel Savannah (Kpalsogu, Libga, Taha, and Kulaa) zones and reared to adults. WHO insecticide susceptibility intensity assays were performed on 3-5-day-old female Anopheles gambiae s.l. to assess phenotypic resistance. The polymerase chain reaction (PCR) technique was used to identify species within the An. gambiae s.l. and detect mutations at voltage-gated sodium channels (Vgsc- 1014F, Vgsc-1014S, Vgsc-1575Y) and acetylcholinesterase G119S-Ace-1 mutation. Alongside larval sampling, a survey was conducted to assess household use of insecticide-based vector control products and pesticide application in agriculture. RESULTS: Anopheles gambiae s.l. from the Coastal zone showed high resistance intensity to pyrethroids (Mortality rate: 50 to 85.9% at 10x). In the Sahel zone, moderate resistance intensity (Mortality rate: >98% at 10x) was observed. High resistance intensity to pirimiphos-methyl (80-90% at 10x) was recorded in vectors from Tuba and Opeibea. The prevalence of L1014F-kdr mutation was high (range: 0.81 to 1) in all study sites, while L1014S and N1575Y kdr mutations were present at low to moderate frequencies (range: 0 to 0.39). Household surveys revealed widespread use of pyrethroid-based mosquito control products (88.10%), including aerosol sprays (25.33%) and coils (53.95%). Farm surveys showed extensive application of pesticides containing organophosphates (16.2%), carbamates (11.29%), neonicotinoids (25.7%), and diamides (5.4%). CONCLUSION: This study reveals widespread pyrethroid and organophosphate resistance in Anopheles gambiae s.l,. which could likely be associated with intensive insecticide use in public health and agriculture. With resistance escalating, continuous surveillance and enhanced resistance management strategies are essential to sustain malaria control efforts in Ghana. CLINICAL TRIAL: Not applicable.
Clinical and laboratory characteristics of human brucellosis and predictors of focal involvement: a retrospective cohort study from Türkiye.
Orta Z, Kavak C, Isik-Goren B … +3 more , Demircioglu T, Kardan ME, Utku IK
BMC Infect Dis · 2026 Jun · PMID 42277739 · Full text
BACKGROUND: Brucellosis is a zoonotic infection with a wide clinical spectrum, ranging from nonspecific symptoms to severe focal involvement. Focal involvement significantly affects disease prognosis, yet early predictio...
BACKGROUND: Brucellosis is a zoonotic infection with a wide clinical spectrum, ranging from nonspecific symptoms to severe focal involvement. Focal involvement significantly affects disease prognosis, yet early prediction remains challenging. Easily accessible inflammatory markers may provide a practical solution for early risk stratification. The aim of this study was to evaluate clinical and laboratory factors associated with focal involvement in brucellosis and to investigate the predictive value of inflammatory markers, particularly C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR). METHODS: This retrospective observational study included adult patients diagnosed with brucellosis between January 2021 and December 2025 at a tertiary care center. Focal involvement was defined based on clinical findings confirmed by imaging modalities. Demographic, clinical, epidemiological, and laboratory data were collected. Patients were divided into focal and non-focal groups. Multivariate logistic regression analysis was performed to identify independent predictors. Receiver operating characteristic (ROC) analysis was used to assess predictive performance and determine optimal cut-off values. RESULTS: A total of 173 patients were included, of whom 54 (31.2%) had focal involvement. Osteoarticular involvement, particularly spondylodiscitis, was the most common presentation. Patients with focal involvement were older and had significantly higher CRP, erythrocyte sedimentation rate, NLR, and MLR levels (p < 0.05). In multivariate analysis, CRP (OR 1.015, 95% CI 1.004-1.028, p = 0.003) and NLR (OR 1.341, 95% CI 1.012-1.778, p = 0.041) were identified as independent predictors. The combined CRP-NLR model demonstrated moderate discriminative ability (AUC: 0.714). Optimal cut-off values were 42 mg/L for CRP and 1.62 for NLR. CONCLUSION: Focal involvement in brucellosis is more closely associated with systemic inflammatory response than epidemiological factors. CRP and NLR may serve as cost-effective and clinically useful markers for early identification of patients at risk. Their combined use may support early decision-making and guide the need for further diagnostic evaluation. Larger prospective studies are needed to validate these findings. CLINICAL TRIAL NUMBER: Not applicable.
Outbreak investigation of reemerging chikungunya virus in Malaysia in 2019-2020.
Lim YZ, Teoh BT, Khor CS … +13 more , Arifin NA, Tan KK, Abd-Jamil J, Azizan NS, Yaacob CN, Hanuar NF, Affendi S, Johari J, Tan JY, Vinnie-Siow WY, Sam SS, Low VL, AbuBakar S
BMC Infect Dis · 2026 Jun · PMID 42277731 · Full text
BACKGROUND: Chikungunya virus (CHIKV) is a mosquito-borne pathogen that imposes a substantial public health burden in tropical regions. After a decade of sporadic transmission, Malaysia experienced an alarming resurgence...
BACKGROUND: Chikungunya virus (CHIKV) is a mosquito-borne pathogen that imposes a substantial public health burden in tropical regions. After a decade of sporadic transmission, Malaysia experienced an alarming resurgence of CHIKV cases in 2019. This study investigated the reemergence of CHIKV in Malaysia following this prolonged period of sporadic transmission. METHODS: An outbreak investigation was conducted in two phases across three hotspots in Perak, Malaysia (Kampung Baru Air Kuning, Bidor, and Sungkai) between October 2019 and February 2020. Blood samples were collected from 78 subjects and were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assays (ELISA). CHIKV was isolated and subjected to whole-genome sequencing. The resulting sequences were then analysed using phylogenetic, comparative sequence and selection pressure analyses. RESULTS: A high CHIKV positivity rate of 69.2% (54/78) was observed in this study, with a 9.3% (5/54) rate of dengue virus (DENV) coinfection. Phylogenetic analysis revealed that the CHIKV isolates from this study belonged to the East/Central/South African-Indian Ocean Lineage (ECSA-IOL) genotype and clustered with recent outbreak isolates from Thailand, China, Myanmar, Bangladesh, Italy, Pakistan, and India during 2015-2019, rather than the Malaysia isolate from the previous 2009 outbreak. Malaysia 2019 and Thailand 2018 isolates shared relatively higher nucleotide similarity (99.78-99.89%). The reemerging CHIKV in Malaysia harboured E1-226 A, E1-K211E, and E2-V264A which enhance CHIKV fitness in Aedes aegypti, as well as nsP3-R524Opal that is associated with increased virulence. These mutations were consistent with globally circulating epidemic strains during 2015-2019, highlighting vector adaptation and disease severity. CONCLUSIONS: The reemerging ECSA-IOL strain in Malaysia was genetically distinct from the Malaysia 2009 outbreak strain but closely related to the globally circulating epidemic strains during 2015-2019. Collectively, it was likely introduced from neighbouring Thailand through cross-border transmission.
Carbapenem-resistant Enterobacterales infection at a South African paediatric hospital.
Bockarie Y, Nuttall J, Tootla HD … +2 more , Aniakwaa-Bonsu E, Eley B
BMC Infect Dis · 2026 Jun · PMID 42277728 · Full text
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) cause significant morbidity and mortality. The global dissemination of CRE is a public health concern, and its impact on children is increasingly being recognised i...
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) cause significant morbidity and mortality. The global dissemination of CRE is a public health concern, and its impact on children is increasingly being recognised in low-and middle-income countries (LMIC). Studies describing paediatric CRE infections in LMIC are limited. Therefore, this study describes the incidence risk, clinical and microbiological characteristics, treatment, and outcome of children with CRE infections at Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa. METHODS: A retrospective description was completed on CRE infections diagnosed between January 2016 and December 2021. Clinical and laboratory data were extracted from hospital records and the National Health Laboratory Service database. RESULTS: The overall incidence risk was 8.4/10,000 admissions. Of 85 infections with sufficient clinical and/or antibiotic information, the median age at CRE diagnosis was 3.9 months (interquartile range 0.8-44.4) and (68/85, 85%) were healthcare-associated. Sites of CRE infection included bloodstream (33/85, 39%), urinary tract (19/85, 22%) and respiratory tract (18/85, 21%). Klebsiella species (58/85, 68%) of which Klebsiella pneumoniae (57/58) predominated, and Serratia marcescens (19/85, 22%) were most isolated. Carbapenemase genes were detected in 63 of 72 isolates tested and included OXA-48 (46/63, 73%) and NDM (17/63, 27%). The isolates were most susceptible to amikacin (67/85, 79%) and tigecycline (66/85, 78%). Mortality within 30 days of diagnosis occurred in (28/85, 33%). On multivariable analysis, any organ dysfunction (risk ratio (RR) 3.2, 95% confidence interval (CI) 1.1-9.3), cardiovascular dysfunction or shock (RR 1.8, 95% CI 1.1-3.0), and ceftazidime-avibactam and/or colistin-based therapy (RR 1.9, 95% CI 1.1-3.2) were significantly associated with mortality within 30 days of CRE infection diagnosis. CONCLUSION: This study adds to the limited number of paediatric CRE studies from Africa. The predominant pathogen causing CRE infection was OXA-48-producing K. pneumoniae. In our setting where ceftazidime-avibactam and colistin are used as last-resort agents, the finding of receipt of these agents and organ dysfunction as independent risk factors for mortality suggest that severity of disease and delayed initiation of definitive antibiotic therapy may be impacting mortality. These observations warrant further investigation in larger prospective hospital-based paediatric studies.
Longitudinal adherence trajectories measured by electronic dose monitoring and viral non-suppression in a South African HIV cohort study.
Ferraris CM, Rosen JG, McDuling C … +6 more , Schiavoni NJF, D'Avanzo PA, Jennings L, Knox J, Remien RH, Orrell C
BMC Infect Dis · 2026 Jun · PMID 42277725 · Full text
BACKGROUND: Sustained adherence to antiretroviral therapy (ART) is essential for maintaining viral suppression among people with HIV (PWH), yet adherence fluctuates over time and is imperfectly captured by routine viral...
BACKGROUND: Sustained adherence to antiretroviral therapy (ART) is essential for maintaining viral suppression among people with HIV (PWH), yet adherence fluctuates over time and is imperfectly captured by routine viral load monitoring in many settings where measurements are often infrequent. We aimed to identify longitudinal ART adherence trajectories using electronic dose monitoring (EDM) and assess their association with viral non-suppression in a South African cohort. METHODS: We analyzed data from a prospective cohort of PWH in Cape Town, South Africa on tenofovir-based ART. Daily adherence was measured using EDM over 12 months and summarized as monthly counts of dose events. Group-based trajectory modelling was applied to monthly adherence proportions to identify distinct adherence patterns. Associations between trajectory membership and time to viral non-suppression (HIV-1 RNA > 50 copies/mL) were assessed using Kaplan-Meier methods and log-rank tests. RESULTS: Among 238 PWH, 5 adherence trajectories were identified: persistently high (49.6%), gradually declining (22.7%), delayed declining (9.6%), rapidly declining (8.0%), and consistently suboptimal adherence (10.1%). Rapidly declining and delayed declining trajectories were associated with earlier and higher incidence of viral non-suppression compared with persistently high and gradually declining trajectories (log-rank p < 0.001). Younger PWH were more likely to be in lower-adherence trajectories; baseline psychosocial characteristics did not differ across groups. CONCLUSIONS: ART adherence is dynamic and heterogeneous; early declines in electronically measured adherence are associated with increased viral non-suppression risk. Longitudinal adherence trajectories may offer clinically actionable signals before routine viral load testing, informing differentiated HIV care programmes.
Machine learning-based prediction of bronchiolitis in children under two years: a multicenter study within a single metropolitan area.
Nopour R, Barzegari S, Shanbehzadeh M … +1 more , Mahmoudvand Z
BMC Infect Dis · 2026 Jun · PMID 42277719 · Full text
BACKGROUND: Bronchiolitis is a leading cause of hospitalization in infants, yet early and accurate risk prediction remains a clinical challenge. Traditional models often lack the complexity to capture nonlinear interacti...
BACKGROUND: Bronchiolitis is a leading cause of hospitalization in infants, yet early and accurate risk prediction remains a clinical challenge. Traditional models often lack the complexity to capture nonlinear interactions or the transparency required for clinical trust. OBJECTIVE: This multicenter study aimed to develop, validate, and interpret machine learning (ML) models for predicting bronchiolitis risk in children under two years of age using clinical and socioeconomic determinants. METHODS: In this retrospective study, data from 1,260 children (529 with bronchiolitis and 731 without) were collected at 5 pediatric centers within a single metropolitan area, from January 2023 through December 2024. Seventeen predictors were analyzed. After rigorous preprocessing and K-NN imputation, eight ML algorithms, including four base learners and four ensemble methods, were developed. Model performance was evaluated using AUC and metrics derived from confusion matrices. Clinical utility was assessed via Decision Curve Analysis (DCA) and calibration plots. Explainable AI (XAI) was implemented using Shapley Additive exPlanations (SHAP) to interpret model decisions. RESULTS: XGBoost achieved an AUC of 0.863 [0.828-0.897] in the test set, demonstrating higher predictive performance than base learners such as NB (AUC: 0.583 [0.529-0.638]). DCA and calibration plots confirmed that XGBoost provides superior net benefit and calibration performance across a range of threshold probabilities. SHAP analysis identified overcrowding, severe acute malnutrition, and maternal smoking as the most influential predictors, highlighting the critical role of socioeconomic and environmental factors in disease susceptibility. CONCLUSION: The integration of XGBoost with SHAP values provides a robust, transparent, and clinically actionable framework for early prediction of bronchiolitis based on variables available at initial clinical presentation. By identifying high-risk infants through interpretable AI, this model supports early triage and optimized resource allocation, fostering the transition toward precision pediatric medicine. CLINICAL TRIAL NUMBER: Not applicable.
Risk factors for tigecycline-associated drug-induced liver injury in critically Ill patients: a 2020-2023 retrospective study from a Chinese hospital.
Wang Y, Zhang S, Shen M … +1 more , Zhang K
BMC Infect Dis · 2026 Jun · PMID 42277713 · Full text
BACKGROUND: Tigecycline is extensively used in Chinese intensive care unit (ICU) for multidrug-resistant infections, yet the profile of its associated drug-induced liver injury (DILI) requires further investigation. Ther...
BACKGROUND: Tigecycline is extensively used in Chinese intensive care unit (ICU) for multidrug-resistant infections, yet the profile of its associated drug-induced liver injury (DILI) requires further investigation. Therefore, this study was designed to explore the incidence, identify independent predictors, and characterize the dose-response relationship and timing of tigecycline-associated DILI in critically ill patients. METHODS: This single-center, retrospective cohort study enrolled all critically ill patients (n = 309) who received intravenous tigecycline between 2020 and 2023. DILI was diagnosed according to established international biochemical criteria (n = 71). We employed Pearson correlation analysis and multivariable logistic regression to assess relationships between clinical factors and DILI development. The dose-response relationship between tigecycline exposure and DILI risk was characterized using ROC analysis and generalized additive models (GAM). Time-to-onset of DILI was evaluated using Kaplan-Meier analysis to estimate cumulative incidence and median event time. RESULTS: The incidence of tigecycline-associated DILI was 23.0%. Multivariable analysis identified total duration of tigecycline therapy (OR = 2.01 per week, 95% CI: 1.42-2.92) and cumulative tigecycline dose (OR = 1.51 per gram, 95% CI: 1.19-1.94) as significant independent risk factors. The dose-response relationship was found to be non-linear, with a GAM revealing an initial increase in risk that attenuated at higher cumulative doses (P < 0.05). The cumulative dose of tigecycline was associated with DILI (AUC = 0.647). The median time to DILI onset among affected patients was 4 days; the Kaplan‑Meier estimate of median DILI‑free survival in the full cohort was 18 days. CONCLUSIONS: In patients who develop DILI, the median onset time of 4 days underscores the importance of early hepatic monitoring; the 18‑day Kaplan‑Meier estimate further supports extended vigilance throughout prolonged therapy. Cumulative dose and treatment duration should be managed to mitigate the risk of hepatotoxicity. CLINICAL TRIAL NUMBER: Not applicable.
Pathogen detection in central nervous system infections: moving metagenomic sequencing closer to clinical practice.
Cumley N, Quick J, Brier T … +5 more , Wilkinson S, Kent C, Hassan-Smith Z, Loman N, Hassan-Smith G
BMC Infect Dis · 2026 Jun · PMID 42277703 · Full text
BACKGROUND: Central nervous system infections (CNSI) contribute significantly to global disability and mortality, but the causative agent is often undetected. Metagenomic sequencing offers the potential to enhance diagno...
BACKGROUND: Central nervous system infections (CNSI) contribute significantly to global disability and mortality, but the causative agent is often undetected. Metagenomic sequencing offers the potential to enhance diagnostic sensitivity, particularly in cases of unusual or partially treated infections. However, caution is required in interpretation of metagenomics data due to technical artefacts from contamination or non-specific read mapping which can reveal a broad spectrum of biologically plausible but diagnostically unlikely organisms. METHODS: This study compares the performance of metagenomic sequencing with standard clinical microbiology methods using cerebrospinal fluid (CSF) from patients with CNSI and non-infected control samples. To evaluate sensitivity of different laboratory approaches, we sequenced DNA and RNA metagenomic libraries extracted from CSF, using both cell-free and cellular fractions. We then devised a set of simple, easily interpreted yet rigorous filters tailored for clinical metagenomics to generate a framework for result interpretation that can be readily applied by clinical scientists. RESULTS: We demonstrate that composite filtering strategies are essential to reduce misleading signals and support standardised workflows. Additionally, our results suggest that a cell-free sample preparation approach can improve confidence in identifying clinically relevant pathogens, highlighting the impact of sample preparation on results quality. CONCLUSION: In this study we describe a reproducible method that can be incorporated into a practical framework for clinical application of metagenomic sequencing in CNSI diagnostics.
Assessing human judgment forecasts in the rapid spread of the mpox outbreak: insights and challenges for pandemic preparedness.
Mcandrew T, Majumder MS, Lover AA … +10 more , Venkatramanan S, Bocchini P, Besiroglu T, Codi A, Dempsey G, Abbott S, Chevalier S, Bosse NI, Cambeiro J, Braun D
BMC Infect Dis · 2026 Jun · PMID 42277702 · Full text
BACKGROUND: In May 2022, mpox (formerly monkeypox) spread to non-endemic countries rapidly. Human judgment is a forecasting approach that has been sparsely evaluated during the beginning of an outbreak. METHODS: We colle...
BACKGROUND: In May 2022, mpox (formerly monkeypox) spread to non-endemic countries rapidly. Human judgment is a forecasting approach that has been sparsely evaluated during the beginning of an outbreak. METHODS: We collected-between May 19, 2022 and July 31, 2022-1275 forecasts from 442 individuals of six questions about the mpox outbreak where ground truth data are now available. Individual human judgment forecasts and an equally weighted ensemble were evaluated, as well as compared to a random walk, autoregressive, and doubling time model. RESULTS: We found (1) individual human judgment forecasts underestimated outbreak size, (2) the ensemble forecast median moved closer to the ground truth over time but uncertainty around the median did not appreciably decrease, and (3) compared to computational models, for 2-8 week ahead forecasts, the human judgment ensemble outperformed all three models when using median absolute error and weighted interval score; for one week ahead forecasts a random walk outperformed human judgment. CONCLUSIONS: We propose two possible explanations: at the time a forecast was submitted, the mode was correlated with the most recent (and smaller) observation that would eventually determine ground truth. Several forecasts were solicited on a logarithmic scale which may have caused humans to generate forecasts with unintended, large uncertainty intervals. To aide in outbreak preparedness, platforms that solicit human judgment forecasts may wish to assess whether specifying a forecast on logarithmic scale matches an individual's intended forecast, support human judgment by finding cues that are typically used to build forecasts, and, to improve performance, tailor their platform to allow forecasters to assign zero probability to events.
Strongyloides stercoralis infection in patients presenting with lower respiratory tract infections: a retrospective case series from a tertiary hospital in Vietnam.
Van Giap V, Xuan Co D, Thu Phuong P … +2 more , Thi Quynh Huong P, Thanh Thuy P
BMC Infect Dis · 2026 Jun · PMID 42277677 · Full text
BACKGROUND: Strongyloides stercoralis infection is frequently overlooked in patients presenting with lower respiratory tract infections (LRTIs) because of nonspecific clinical manifestations, despite its potential to cau...
BACKGROUND: Strongyloides stercoralis infection is frequently overlooked in patients presenting with lower respiratory tract infections (LRTIs) because of nonspecific clinical manifestations, despite its potential to cause severe pulmonary involvement, particularly in endemic regions. METHODS: We conducted a retrospective case series at Bach Mai Hospital, a tertiary referral center in northern Vietnam. Adult patients hospitalized between January 2024 and July 2025 with LRTIs and confirmed S. stercoralis infection were included. Patients were classified as having chronic strongyloidiasis (including parasitologically confirmed and serology-only probable cases) or hyperinfection syndrome. Clinical, laboratory, radiological, microbiological, and diagnostic data were analyzed. RESULTS: A total of 42 patients were included (mean age 73.3 ± 10.2 years; 83.3% male). Among the 42 patients, 59.5% were classified as chronic strongyloidiasis, including both parasitologically confirmed and serology-only probable cases, whereas 40.5% had hyperinfection syndrome. In the hyperinfection group, respiratory involvement was more frequent than gastrointestinal involvement (58.8% vs. 41.2%). Pneumonia and acute exacerbations of chronic obstructive pulmonary disease were the predominant clinical presentations. Laboratory abnormalities were common, including hypoalbuminemia (88.1%), anemia (64.3%), and hyponatremia (50.0%), whereas eosinophilia was observed in only 23.8% of patients. Serological testing using ELISA showed the highest diagnostic yield (90.5%), while direct parasitological methods demonstrated limited sensitivity. Gram-negative enteric bacteria predominated among microbiological isolates. CONCLUSIONS: This retrospective case series characterizes the clinical and laboratory features of LRTIs in patients with concomitant S. stercoralis infection. Pneumonia and COPD exacerbations were predominant presentations, often with marked laboratory abnormalities despite infrequent eosinophilia. Although hyperinfection was frequent and direct parasitological tests showed limited sensitivity, no inference can be made regarding the frequency or strength of this association due to the descriptive design and lack of a comparator group. These findings may help clinicians consider strongyloidiasis in selected patients with unexplained or refractory LRTIs in endemic settings.
A nomogram for predicting 30-day mortality in patients with carbapenem-resistant Klebsiella pneumoniae infection: a retrospective cohort study.
Zhang P, Wang L, Jiang C … +3 more , Qin X, Zhou X, Deng Y
BMC Infect Dis · 2026 Jun · PMID 42277662 · Full text
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a significant global health threat due to its high virulence. This study aims to analyze the risk factors of 30-day mortality in patients with...
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a significant global health threat due to its high virulence. This study aims to analyze the risk factors of 30-day mortality in patients with CRKP infection and to construct a nomogram model for predicting 30-day mortality risk, offering valuable insights for clinical decision-making. METHODS: This study retrospectively enrolled 290 patients with CRKP infection from January 2022 to December 2025 at the Public Health Clinical Center Affiliated to Shandong University. Patients were categorized into the survival (n = 230) and non-survival (n = 60) groups based on clinical outcomes at 30 days. Multivariate logistic analysis was conducted to identify independent risk factors. A nomogram model was developed using R software. The model's performance was evaluated using the area under the ROC curve (AUC), the Hosmer-Lemeshow test, and calibration plots. The clinical utility of the model was evaluated using decision curve analysis (DCA), while the bootstrap technique was applied for the model's internal validation. RESULTS: The 30-day mortality rate was 20.7% in patients with CRKP infection. Septic shock (aOR 16.850, 95% CI 5.915-48.000, P < 0.001), Charlson Comorbidity Index (CCI) score (aOR 1.242, 95% CI 1.032-1.493, P = 0.022), and appropriate antibiotic therapy within 3 days of infection onset (aOR 0.200, 95% CI 0.074-0.542, P = 0.002) were identified as independent predictors of mortality. Compared with thrombocytopenia (< 100 × 10⁹/L), normal platelet count (aOR 0.046, 95% CI 0.014-0.151) and thrombocytosis (aOR 0.030, 95% CI 0.006-0.155) were independently protective (both P < 0.001). A nomogram incorporating these predictors demonstrated excellent discrimination (AUC 0.908, 95% CI 0.865-0.951) and adequate calibration (Hosmer-Lemeshow P = 0.989, Brier score = 0.092). The DCA curve demonstrated significant potential for clinical application. Internal validation was conducted using 1,000 bootstrap cycles. The model bias-corrected C-index was 0.903 (95% CI 0.835-0.966). CONCLUSIONS: The study identified independent risk factors associated with the 30-day mortality of CRKP-infected patients. The nomogram model exhibited promising discriminatory capability and clinical applicability, providing an effective tool for early identification of at-risk patients.
Time to viral load suppression with 8-week versus 12-week ravidasvir/sofosbuvir regimens among chronic hepatitis C patients in Malaysia: a non-inferiority, randomized clinical trial.
Muhamad NA, Mohd Dali NS, Maamor NH … +6 more , Rosli IA, Leman FN, Awaluddin SM, Chan HK, Mohd Zin R, Abu Hassan MR
BMC Infect Dis · 2026 Jun · PMID 42277657 · Full text
BACKGROUND: Hepatitis C virus (HCV) infection remains a major global health burden, contributing to chronic liver disease and significant mortality. Malaysia has implemented direct-acting antiviral (DAA) therapy to suppo...
BACKGROUND: Hepatitis C virus (HCV) infection remains a major global health burden, contributing to chronic liver disease and significant mortality. Malaysia has implemented direct-acting antiviral (DAA) therapy to support the World Health Organization's goal of eliminating HCV by 2030. Ravidasvir/sofosbuvir (RDV/SOF) is a potent, pan-genotypic DAA regimen with high efficacy. Yet evidence comparing time to viral load suppression between shorter and standard treatment durations remains limited. This study aimed to determine the time to HCV RNA viral load suppression for the 8-week and 12-week RDV/SOF regimens among chronic HCV patients in Malaysia and to identify factors associated with the time to suppression. METHODS: This secondary analysis utilized data from a randomized, open-label, multicenter, non-inferiority clinical trial (2016-2020) involving 321 adult patients with chronic HCV infection. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to evaluate time to viral suppression (HCV RNA < 15 IU/mL) and associated predictors. The final model was stratified by baseline HCV RNA load, concomitant medications, and imprisonment risk to satisfy the proportional hazards assumption. RESULTS: The median time to viral load suppression was 28 days for both treatment groups, with no significant difference in Kaplan-Meier analysis (p = 0.076). In multivariable Cox regression, patients receiving the 8-week regimen were more likely to achieve viral suppression earlier than those on the 12-week regimen (adjusted hazard ratio [aHR] = 1.29, 95% CI: 1.01-1.63, p = 0.038). Higher baseline HCV RNA load was significantly associated with delayed suppression (p < 0.001). Other demographic and clinical factors were not significant. CONCLUSION: Both 8-week and 12-week RDV/SOF regimens achieved rapid viral suppression, with comparable median times to viral suppression. The 8-week regimen was associated with a higher likelihood of earlier suppression; however, given the modest statistical power, this finding should be interpreted with caution. The results suggest potential as an effective alternative in Genotype 1 patients. However, given the significant treatment-by-genotype interaction, the magnitude of benefit with the shorter regimen in the predominant Genotype 3 population warrants further investigation before broad programmatic recommendations can be made. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04885855 [09/05/2021].
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