Diabetes mellitus (DM) is a complex and multifactorial disorder associated with elevated blood sugar levels, poor insulin sensitivity, and inadequate insulin production. It has a major impact on the immune system, making a person more susceptible to and influenced by a variety of infectious illnesses. This narrative review summarizes the relationship between chronic inflammation and high glucose levels in DM, on susceptibility and outcomes in endemic infectious diseases. We focused on impact of DM on disease progression, and treatment response in these infections. Literature was identified through searches of PubMed, Scopus, and Google Scholar, focusing on epidemiologic, clinical, and mechanistic studies. The evidences suggest that immune modulation in DM has profound inverse relations with the outcome of infectious diseases including tuberculosis, COVID-19, and HIV/AIDS. DM increases the risk of developing severe forms of infectious diseases due to downregulation of the immune system which is associated with glycemic control. There is a need to understand the relationship between DM and immunological control for developing methods to reduce these risks and improve outcomes for the affected population.
{"title":"Immune dysregulation in type 2 diabetes mellitus: Implications for tuberculosis, COVID-19, and HIV/AIDS","authors":"Uzair Abbas , Harendra Kumar , Niaz Hussain , Ishfaque Ahmed , Rabeel Nawaz Laghari , Misha Tanveer , Mohammad Hadif , Kashaf Fatima , Muhib Ullah Khalid , Khadija Anwar , Mahtab Khan","doi":"10.1016/j.imj.2025.100211","DOIUrl":"10.1016/j.imj.2025.100211","url":null,"abstract":"<div><div>Diabetes mellitus (DM) is a complex and multifactorial disorder associated with elevated blood sugar levels, poor insulin sensitivity, and inadequate insulin production. It has a major impact on the immune system, making a person more susceptible to and influenced by a variety of infectious illnesses. This narrative review summarizes the relationship between chronic inflammation and high glucose levels in DM, on susceptibility and outcomes in endemic infectious diseases. We focused on impact of DM on disease progression, and treatment response in these infections. Literature was identified through searches of PubMed, Scopus, and Google Scholar, focusing on epidemiologic, clinical, and mechanistic studies. The evidences suggest that immune modulation in DM has profound inverse relations with the outcome of infectious diseases including tuberculosis, COVID-19, and HIV/AIDS. DM increases the risk of developing severe forms of infectious diseases due to downregulation of the immune system which is associated with glycemic control. There is a need to understand the relationship between DM and immunological control for developing methods to reduce these risks and improve outcomes for the affected population.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 4","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.imj.2025.100198
Xiuhua Kang , Huaming Guo , Shanting Zhao , Wenzhen Zhang , Peng Liu , Yanfang Mei , Ling Zeng , Dandan Wei
Background
Elizabethkingia infections have become life-threatening hospital-acquired infections worldwide, marked by rising morbidity, multidrug resistance, and poor prognoses. However, information on the epidemiological and clinical characteristics of Elizabethkingia infections in mainland China is limited. This study aimed to analyze the molecular and clinical characteristics, and drug susceptibility of clinical Elizabethkingia isolates from a hospital in Jiangxi Province, China.
Methods
A total of 103 Elizabethkingia isolates, identified by conventional methods, were collected from patients at a university-affiliated hospital in 2022 and 2023. Species identification was conducted using 16S rRNA gene sequencing. The feasibility of the Vitek MS was also evaluated. Antimicrobial susceptibility testing, resistance gene identification, and pulsed-field gel electrophoresis were performed.
Results
The mean age of the patients was 61 years (excluding one 13-day-old infant) and 75.3 % were men. In total, 86.4 % of patients admitted to the intensive care unit were infected with Elizabethkingia. COVID-19, respiratory disease, and ICU admission were significantly different between the surviving and dying groups (p < 0.05). Sequencing of 103 isolates identified 92 strains of Elizabethkingia anophelis, eight strains of Elizabethkingia meningoseptica, two strains of Elizabethkingia bruuniana, and one strain of Elizabethkingia ursingii. The Vitek MS had a correct identification rate of 87 % for Elizabethkingia anophelis. More than 90 % of the Elizabethkingia isolates were susceptible to minocycline, but resistant to other drugs, including ceftazidime, aztreonam, and imipenem. Resistance genotype analysis showed that blaBlaB and blaCME were highly prevalent in the Elizabethkingia isolates. Molecular typing revealed 29 different pulsed-field gel electrophoresis types with clonal transmission between wards.
Conclusions
Multidrug-resistant Elizabethkingia is being increasingly detected. Therefore, a larger database is required for Elizabethkingia strain identification. This database could be beneficial for the subsequent determination of optimal antimicrobial drugs for treating infections caused by various Elizabethkingia strains. Our pulsed-field gel electrophoresis model showed that most Elizabethkingia isolates exhibit sufficient genetic diversity and clonal transmission. Therefore, adequate attention should be directed towards this pathogen.
{"title":"Prevalence, microbiological features, and clinical characteristics of Elizabethkingia isolates in a tertiary hospital, Jiangxi Province, China","authors":"Xiuhua Kang , Huaming Guo , Shanting Zhao , Wenzhen Zhang , Peng Liu , Yanfang Mei , Ling Zeng , Dandan Wei","doi":"10.1016/j.imj.2025.100198","DOIUrl":"10.1016/j.imj.2025.100198","url":null,"abstract":"<div><h3>Background</h3><div><em>Elizabethkingia</em> infections have become life-threatening hospital-acquired infections worldwide, marked by rising morbidity, multidrug resistance, and poor prognoses. However, information on the epidemiological and clinical characteristics of <em>Elizabethkingia</em> infections in mainland China is limited. This study aimed to analyze the molecular and clinical characteristics, and drug susceptibility of clinical <em>Elizabethkingia</em> isolates from a hospital in Jiangxi Province, China.</div></div><div><h3>Methods</h3><div>A total of 103 <em>Elizabethkingia</em> isolates, identified by conventional methods, were collected from patients at a university-affiliated hospital in 2022 and 2023. Species identification was conducted using 16S rRNA gene sequencing. The feasibility of the Vitek MS was also evaluated. Antimicrobial susceptibility testing, resistance gene identification, and pulsed-field gel electrophoresis were performed.</div></div><div><h3>Results</h3><div>The mean age of the patients was 61 years (excluding one 13-day-old infant) and 75.3 % were men. In total, 86.4 % of patients admitted to the intensive care unit were infected with <em>Elizabethkingia</em>. COVID-19, respiratory disease, and ICU admission were significantly different between the surviving and dying groups (<em>p</em> < 0.05). Sequencing of 103 isolates identified 92 strains of <em>Elizabethkingia anophelis</em>, eight strains of <em>Elizabethkingia meningoseptica,</em> two strains of <em>Elizabethkingia bruuniana</em>, and one strain of <em>Elizabethkingia ursingii.</em> The Vitek MS had a correct identification rate of 87 % for <em>Elizabethkingia anophelis</em>. More than 90 % of the <em>Elizabethkingia</em> isolates were susceptible to minocycline, but resistant to other drugs, including ceftazidime, aztreonam, and imipenem. Resistance genotype analysis showed that <em>blaBlaB</em> and <em>blaCME</em> were highly prevalent in the <em>Elizabethkingia</em> isolates. Molecular typing revealed 29 different pulsed-field gel electrophoresis types with clonal transmission between wards.</div></div><div><h3>Conclusions</h3><div>Multidrug-resistant <em>Elizabethkingia</em> is being increasingly detected. Therefore, a larger database is required for <em>Elizabethkingia</em> strain identification. This database could be beneficial for the subsequent determination of optimal antimicrobial drugs for treating infections caused by various <em>Elizabethkingia</em> strains. Our pulsed-field gel electrophoresis model showed that most <em>Elizabethkingia</em> isolates exhibit sufficient genetic diversity and clonal transmission. Therefore, adequate attention should be directed towards this pathogen.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.imj.2025.100201
Zian Lin , Weiyi Cai , Yanan Liu , Juan Liu , Hongbiao Chen , Shaojian Xu , Qiuju Xie , Danting Lou , Yuying Zhang , Hairong Nan , Jiahui Li , Lixian Su
Background
China's Notifiable Disease Reporting System comprehensively collects data on pediatric acute gastroenteritis cases from all levels of healthcare. This study evaluated the effectiveness of the pentavalent rotavirus vaccine against rotavirus gastroenteritis in children under five years of age during seasonal epidemic periods.
Methods
Using a test-negative design, we analyzed laboratory data from diarrhea patients aged 2–59 months who sought medical care in Longhua District, Shenzhen, Guangdong Province, China between January 2020 and March 2024. Vaccination history and potential confounders, including sex, household registration status, prematurity, and birth weight, were collected retrospectively. Directed acyclic graphs were used to identify adjustment variables. Vaccine effectiveness was calculated as (1 − adjusted odds ratio) × 100 % using unconditional logistic regression, comparing rotavirus-positive cases with rotavirus-negative controls.
Results
The incidence of rotavirus gastroenteritis peaked and then progressively declined from January 2020 through March 2023, with no seasonal resurgence observed in the first quarter of 2023. Analysis of 928 epidemic-season cases (674 RV+; 254 RV–) revealed an overall pentavalent rotavirus (RV5) vaccine effectiveness of 79.6 % (95 % CI: 68.9 %–86.6 %). Dose-specific vaccine effectiveness varied substantially: 1 dose vaccine effectiveness registered at 26.7 % (95 % CI: −162.1 %–79.5 %), rising to 76.6 % (95 % CI: 46.2 %–89.8 %) for 2 doses, and reaching 82.7 % (95 % CI: 72.2 %–89.2 %) for 3 doses. Age-stratified analysis showed vaccine effectiveness of 79.5 % (95 % CI: 56.8 %–90.3 %) in children aged 2–11 months, 83.8 % (95 % CI: 66.4 %–92.2 %) for 12–23 months, and 79.6 % (95 % CI: 68.9 %–86.6 %) in those aged 24–35 months, while vaccine effectiveness was 31.2 % (95 % CI: −251.8 %–86.5 %) in children aged 36–59 months.
Conclusions
A three-dose regimen of pentavalent rotavirus vaccine provides significant effectiveness against rotavirus gastroenteritis for children under 36 months of age during epidemic seasons, thereby alleviating the burden on public health systems.
{"title":"Pentavalent rotavirus vaccine effectiveness among children in Shenzhen, China: A population-based test-negative design with directed acyclic graphs bias adjustment","authors":"Zian Lin , Weiyi Cai , Yanan Liu , Juan Liu , Hongbiao Chen , Shaojian Xu , Qiuju Xie , Danting Lou , Yuying Zhang , Hairong Nan , Jiahui Li , Lixian Su","doi":"10.1016/j.imj.2025.100201","DOIUrl":"10.1016/j.imj.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>China's Notifiable Disease Reporting System comprehensively collects data on pediatric acute gastroenteritis cases from all levels of healthcare. This study evaluated the effectiveness of the pentavalent rotavirus vaccine against rotavirus gastroenteritis in children under five years of age during seasonal epidemic periods.</div></div><div><h3>Methods</h3><div>Using a test-negative design, we analyzed laboratory data from diarrhea patients aged 2–59 months who sought medical care in Longhua District, Shenzhen, Guangdong Province, China between January 2020 and March 2024. Vaccination history and potential confounders, including sex, household registration status, prematurity, and birth weight, were collected retrospectively. Directed acyclic graphs were used to identify adjustment variables. Vaccine effectiveness was calculated as (1 − adjusted odds ratio) × 100 % using unconditional logistic regression, comparing rotavirus-positive cases with rotavirus-negative controls.</div></div><div><h3>Results</h3><div>The incidence of rotavirus gastroenteritis peaked and then progressively declined from January 2020 through March 2023, with no seasonal resurgence observed in the first quarter of 2023. Analysis of 928 epidemic-season cases (674 RV+; 254 RV–) revealed an overall pentavalent rotavirus (RV5) vaccine effectiveness of 79.6 % (95 % CI: 68.9 %–86.6 %). Dose-specific vaccine effectiveness varied substantially: 1 dose vaccine effectiveness registered at 26.7 % (95 % CI: −162.1 %–79.5 %), rising to 76.6 % (95 % CI: 46.2 %–89.8 %) for 2 doses, and reaching 82.7 % (95 % CI: 72.2 %–89.2 %) for 3 doses. Age-stratified analysis showed vaccine effectiveness of 79.5 % (95 % CI: 56.8 %–90.3 %) in children aged 2–11 months, 83.8 % (95 % CI: 66.4 %–92.2 %) for 12–23 months, and 79.6 % (95 % CI: 68.9 %–86.6 %) in those aged 24–35 months, while vaccine effectiveness was 31.2 % (95 % CI: −251.8 %–86.5 %) in children aged 36–59 months.</div></div><div><h3>Conclusions</h3><div>A three-dose regimen of pentavalent rotavirus vaccine provides significant effectiveness against rotavirus gastroenteritis for children under 36 months of age during epidemic seasons, thereby alleviating the burden on public health systems.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The fasting duration in aspiration pneumonia negatively affects the patient's treatment duration and swallowing function. The relationship among serious COVID-19 infection, fasting duration, and patient prognosis remains unclear. We aimed to determine the effect of the fasting duration on mortality after COVID-19.
Methods
We included patients who underwent rehabilitation after COVID-19 infection between March 1, 2021 and June 30, 2023. We retrospectively extracted data from medical records, including age, sex, albumin levels, fasting duration, Charlson Comorbidity Index (CCI), Revised Hasegawa Dementia Scale score, care level, total hospitalization period, time since disease onset, time to speech therapy intervention, time to death, and ability to eat at disease onset and discharge. Univariate analysis was conducted for each variable. To investigate the relationship between fasting duration and outcomes, we performed logistic regression analysis, adjusting for confounding factors such as age, CCI, and care level. We also divided patients into groups based on fasting duration: ≤ 5 days and > 5 days. We performed logistic regression analysis using fasting duration as the dependent variable and age, CCI, care level, and clinical outcome as independent variables.
Results
There were 71 patients in the survival group and 31 in the mortality group. Fasting duration (p = 0.00826, odds ratio [OR]: 1.01, 95 % confidence interval [CI]: 1.01–1.11) and age (p = 0.0377, OR: 1.07, 95 % CI: 1.001–1.15) were significant independent factors associated with COVID-19 outcomes. In the classification based on fasting duration, higher care level (p < 0.001, OR: 1.65, 95 % CI: 1.24–2.20) and clinical outcome (p < 0.001, OR: 9.19, 95 % CI: 2.80–30.20) were significant independent factors in the group with fasting duration > 5 days.
Conclusion
Fasting duration was independently associated with outcomes after COVID-19 infection. Early rehabilitation intervention may contribute to improved clinical outcomes.
{"title":"Effect of fasting duration on mortality after COVID-19 infection: A retrospective analysis at a single institution","authors":"Naoko Takaku , Koji Hayashi , Hiromi Hayashi , Toyoaki Miura , Kouji Hayashi , Yasutaka Kobayashi , Mamiko Sato , Ippei Sakamaki","doi":"10.1016/j.imj.2025.100202","DOIUrl":"10.1016/j.imj.2025.100202","url":null,"abstract":"<div><h3>Background</h3><div>The fasting duration in aspiration pneumonia negatively affects the patient's treatment duration and swallowing function. The relationship among serious COVID-19 infection, fasting duration, and patient prognosis remains unclear. We aimed to determine the effect of the fasting duration on mortality after COVID-19.</div></div><div><h3>Methods</h3><div>We included patients who underwent rehabilitation after COVID-19 infection between March 1, 2021 and June 30, 2023. We retrospectively extracted data from medical records, including age, sex, albumin levels, fasting duration, Charlson Comorbidity Index (CCI), Revised Hasegawa Dementia Scale score, care level, total hospitalization period, time since disease onset, time to speech therapy intervention, time to death, and ability to eat at disease onset and discharge. Univariate analysis was conducted for each variable. To investigate the relationship between fasting duration and outcomes, we performed logistic regression analysis, adjusting for confounding factors such as age, CCI, and care level. We also divided patients into groups based on fasting duration: ≤ 5 days and > 5 days. We performed logistic regression analysis using fasting duration as the dependent variable and age, CCI, care level, and clinical outcome as independent variables.</div></div><div><h3>Results</h3><div>There were 71 patients in the survival group and 31 in the mortality group. Fasting duration (<em>p</em> = 0.00826, odds ratio [OR]: 1.01, 95 % confidence interval [CI]: 1.01–1.11) and age (<em>p</em> = 0.0377, OR: 1.07, 95 % CI: 1.001–1.15) were significant independent factors associated with COVID-19 outcomes. In the classification based on fasting duration, higher care level (<em>p</em> < 0.001, OR: 1.65, 95 % CI: 1.24–2.20) and clinical outcome (<em>p</em> < 0.001, OR: 9.19, 95 % CI: 2.80–30.20) were significant independent factors in the group with fasting duration > 5 days.</div></div><div><h3>Conclusion</h3><div>Fasting duration was independently associated with outcomes after COVID-19 infection. Early rehabilitation intervention may contribute to improved clinical outcomes.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.imj.2025.100199
Jiaxu Gu , Jiaming Wang , Long Zhong , Bingcheng Lu , Hongqiang Xie , Bo Yu , Yang Guo
Background
Mycobacterial infections such as tuberculosis and leprosy pose significant global health challenges, particularly in impoverished regions. These diseases not only cause severe physical symptoms but also lead to psychological and economic burdens. This study assesses the disease and economic burden of these infections among the global working-age population (15–64 years), identifies influencing factors, and predicts trends until 2045 to guide targeted interventions.
Methods
Using data from the Global Burden of Disease Study (1990–2021), age-standardized prevalence rates and disability-adjusted life years were analyzed for tuberculosis and leprosy. Predictive trends were modeled using the Bayesian age–period–cohort framework, and health inequalities were evaluated using concentration indices. Spearman correlation analysis was used to examine associations with economic and health indicators in the World Bank database.
Results
The prevalence of leprosy declined globally (from 14.426/100,000 to 5.942/100,000), and further reductions were projected. Tuberculosis trends were more complex, with potential increases observed in some age groups. Health inequalities persisted, particularly for leprosy, with higher burdens in low-income regions than high-income regions (concentration index: −0.35). Economic factors such as health expenditure (Spearman's rank correlation coefficient, ρ = −0.557) and universal health coverage (ρ = −0.785) were strongly correlated with disease burden.
Conclusions
Although the burden of mycobacterial infection decreased, disparities remained—especially for tuberculosis. Increased public health investment and targeted strategies are essential for mitigating these inequities and their socioeconomic impact.
{"title":"Global disease and economic burden of main mycobacterial infections in the working-age population from 1990 to 2021 with a forecast to 2045","authors":"Jiaxu Gu , Jiaming Wang , Long Zhong , Bingcheng Lu , Hongqiang Xie , Bo Yu , Yang Guo","doi":"10.1016/j.imj.2025.100199","DOIUrl":"10.1016/j.imj.2025.100199","url":null,"abstract":"<div><h3>Background</h3><div>Mycobacterial infections such as tuberculosis and leprosy pose significant global health challenges, particularly in impoverished regions. These diseases not only cause severe physical symptoms but also lead to psychological and economic burdens. This study assesses the disease and economic burden of these infections among the global working-age population (15–64 years), identifies influencing factors, and predicts trends until 2045 to guide targeted interventions.</div></div><div><h3>Methods</h3><div>Using data from the Global Burden of Disease Study (1990–2021), age-standardized prevalence rates and disability-adjusted life years were analyzed for tuberculosis and leprosy. Predictive trends were modeled using the Bayesian age–period–cohort framework, and health inequalities were evaluated using concentration indices. Spearman correlation analysis was used to examine associations with economic and health indicators in the World Bank database.</div></div><div><h3>Results</h3><div>The prevalence of leprosy declined globally (from 14.426/100,000 to 5.942/100,000), and further reductions were projected. Tuberculosis trends were more complex, with potential increases observed in some age groups. Health inequalities persisted, particularly for leprosy, with higher burdens in low-income regions than high-income regions (concentration index: −0.35). Economic factors such as health expenditure (Spearman's rank correlation coefficient, <em>ρ</em> = −0.557) and universal health coverage (<em>ρ</em> = −0.785) were strongly correlated with disease burden.</div></div><div><h3>Conclusions</h3><div>Although the burden of mycobacterial infection decreased, disparities remained—especially for tuberculosis. Increased public health investment and targeted strategies are essential for mitigating these inequities and their socioeconomic impact.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.imj.2025.100203
Mehdi Roshdi Maleki , Seyyed Reza Moaddab
Nontuberculous mycobacteria (NTM) are emerging pathogens responsible for a growing spectrum of diseases, particularly in individuals with underlying lung disorders or immune suppression. Once considered primarily environmental saprophytes, NTM are now recognized as important causes of pulmonary, cutaneous, lymphatic, and disseminated infections. With more than 200 species identified and regional variations in prevalence, their diagnosis and management present significant clinical and microbiological challenges. The lack of standardized reporting systems and overlapping features with tuberculosis complicate epidemiological understanding and case identification.
This review provides an updated and integrated overview of NTM-associated diseases, emphasizing diagnostic advancements, environmental sources, mechanisms of transmission, host immunity, genetic susceptibility, and therapeutic options. Special attention is given to molecular diagnostic techniques, species-level identification strategies, and the role of gene sequencing in differentiating NTM species. We also highlight the limitations of conventional methods, discuss antimicrobial resistance mechanisms, and summarize current treatment guidelines.
By synthesizing current knowledge across microbiology, clinical medicine, and public health, this review aims to support a multidisciplinary approach to NTM diagnosis and management and address the pressing need for increased awareness, better surveillance, and targeted research on this under-recognized group of pathogens.
{"title":"The growing impact of nontuberculous mycobacteria: A multidisciplinary review of ecology, pathogenesis, diagnosis, and treatment","authors":"Mehdi Roshdi Maleki , Seyyed Reza Moaddab","doi":"10.1016/j.imj.2025.100203","DOIUrl":"10.1016/j.imj.2025.100203","url":null,"abstract":"<div><div>Nontuberculous mycobacteria (NTM) are emerging pathogens responsible for a growing spectrum of diseases, particularly in individuals with underlying lung disorders or immune suppression. Once considered primarily environmental saprophytes, NTM are now recognized as important causes of pulmonary, cutaneous, lymphatic, and disseminated infections. With more than 200 species identified and regional variations in prevalence, their diagnosis and management present significant clinical and microbiological challenges. The lack of standardized reporting systems and overlapping features with tuberculosis complicate epidemiological understanding and case identification.</div><div>This review provides an updated and integrated overview of NTM-associated diseases, emphasizing diagnostic advancements, environmental sources, mechanisms of transmission, host immunity, genetic susceptibility, and therapeutic options. Special attention is given to molecular diagnostic techniques, species-level identification strategies, and the role of gene sequencing in differentiating NTM species. We also highlight the limitations of conventional methods, discuss antimicrobial resistance mechanisms, and summarize current treatment guidelines.</div><div>By synthesizing current knowledge across microbiology, clinical medicine, and public health, this review aims to support a multidisciplinary approach to NTM diagnosis and management and address the pressing need for increased awareness, better surveillance, and targeted research on this under-recognized group of pathogens.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Data on tuberculosis-polymerase chain reaction (TB-PCR) diagnostic yield in induced sputum (IS) samples is limited. This study was conducted to evaluate the diagnostic yield of TB-PCR in IS samples from patients with pulmonary TB and to identify factors that are associated with positive TB-PCR results.
Methods
This retrospective cross-sectional study was conducted at the Faculty of Medicine Ramathibodi Hospital. Patients who underwent IS collection for the diagnosis of pulmonary TB were included. Sputum specimens were obtained for acid-fast bacilli (AFB) smear, TB-PCR (Anyplex Seegene MTB/NTM real-time detection assay or Xpert MTB/RIF assay), and TB culture. Multivariate logistic regression analysis was performed to identify factors associated with IS TB-PCR positivity. The McNemar test was used to compare the diagnostic yield of each test.
Results
A total of 124 IS specimens of patients with pulmonary TB were evaluated. There were 65 (52.4%) men, with a mean age of 55.3 ± 19.5 years. The diagnostic yield of IS TB-PCR for the diagnosis of pulmonary TB was 31.5% (95% confidence interval [CI]: 23.2–39.7). The diagnostic yields were 34.4% (95% CI: 22.0–46.0) for Xpert MTB/RIF and 28.6% (95% CI: 17.8–40.2) for Anyplex MTB/NTM, with no significant difference between the two assays (p = 0.49). TB-PCR had a higher diagnostic yield than AFB smear (31.5% vs. 6.5%, p < 0.01). Logistic regression analysis showed that moderately advanced (adjusted odds ratio [aOR] = 3.73, 95% CI: 1.24–11.21, p = 0.019) and far advanced (aOR = 3.95, 95% CI: 1.05–14.82, p = 0.042) radiographic extent of disease were associated with positive IS TB-PCR.
Conclusions
Induced sputum TB-PCR is an effective initial method for patients with suspected pulmonary TB who are unable to produce reliable sputum, especially those with moderately advanced or far advanced radiographic extent of disease.
{"title":"Diagnostic yield of polymerase chain reaction on induced sputum for pulmonary tuberculosis: A single-center retrospective cross-sectional study","authors":"Kiartipong Virapongsiri , Dararat Eksombatchai , Monruadee Chatreewarote , Viboon Boonsarngsuk","doi":"10.1016/j.imj.2025.100197","DOIUrl":"10.1016/j.imj.2025.100197","url":null,"abstract":"<div><h3>Background</h3><div>Data on tuberculosis-polymerase chain reaction (TB-PCR) diagnostic yield in induced sputum (IS) samples is limited. This study was conducted to evaluate the diagnostic yield of TB-PCR in IS samples from patients with pulmonary TB and to identify factors that are associated with positive TB-PCR results.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study was conducted at the Faculty of Medicine Ramathibodi Hospital. Patients who underwent IS collection for the diagnosis of pulmonary TB were included. Sputum specimens were obtained for acid-fast bacilli (AFB) smear, TB-PCR (Anyplex Seegene MTB/NTM real-time detection assay or Xpert MTB/RIF assay), and TB culture. Multivariate logistic regression analysis was performed to identify factors associated with IS TB-PCR positivity. The McNemar test was used to compare the diagnostic yield of each test.</div></div><div><h3>Results</h3><div>A total of 124 IS specimens of patients with pulmonary TB were evaluated. There were 65 (52.4%) men, with a mean age of 55.3 ± 19.5 years. The diagnostic yield of IS TB-PCR for the diagnosis of pulmonary TB was 31.5% (95% confidence interval [CI]: 23.2–39.7). The diagnostic yields were 34.4% (95% CI: 22.0–46.0) for Xpert MTB/RIF and 28.6% (95% CI: 17.8–40.2) for Anyplex MTB/NTM, with no significant difference between the two assays (<em>p</em> = 0.49). TB-PCR had a higher diagnostic yield than AFB smear (31.5% vs. 6.5%, <em>p</em> < 0.01). Logistic regression analysis showed that moderately advanced (adjusted odds ratio [aOR] = 3.73, 95% CI: 1.24–11.21, <em>p</em> = 0.019) and far advanced (aOR = 3.95, 95% CI: 1.05–14.82, <em>p</em> = 0.042) radiographic extent of disease were associated with positive IS TB-PCR.</div></div><div><h3>Conclusions</h3><div>Induced sputum TB-PCR is an effective initial method for patients with suspected pulmonary TB who are unable to produce reliable sputum, especially those with moderately advanced or far advanced radiographic extent of disease.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-19eCollection Date: 2025-09-01DOI: 10.1016/j.imj.2025.100196
Fuli Tan, Yuchang Li, Xiaoping Kang, Yuehong Chen, Sen Zhang, Jing Li, Ye Feng, Xiaokun Li, Runxin Liang, Fei Wang, Xiangdong Li, Tao Jiang
Background: In recent years, frequent outbreaks of infectious diseases caused by hemorrhagic fever viruses have posed serious threats to global public health. The pathogens are variable and highly infectious, such as Sudan ebolavirus (SEBOV), Zaire ebolavirus (ZEBOV), Marburg marburgvirus (MARV), Lassa mammarenavirus (LASV), Rift Valley fever phlebovirus (RVFV), Sin Nombre orthohantavirus (SNV), etc. To improve the efficiency of pathogen detection, a method for simultaneous screening multiplex targets is in a great demand.
Methods: Utilizing dual-probe hybridization and melting curve analysis, a multiplex nucleic acid polymerase assay for eight hemorrhagic fever viruses test (named the MPA-eight-virus assay) was developed in this study. The sensitivity for each target was improved by optimizing primer and probe selection as well as amplification conditions; the usability of MPA-eight-virus assay was validated by simulated samples preparation and test.
Results: The MPA-eight-virus assay achieved high sensitivity and specificity for the targets, with a limit of detection (LOD) of 1.83-691.00 copies/µL for all eight targets; Notably, the LOD for MARV was 1.83 copies/µL and that for SNV was 9.32 copies/µL.
Conclusions: The MPA-eight-virus assay is high throughput, time-saving, accurate, and cost-effective, making it potentially useful for prevention and control of severe viral hemorrhagic fever.
{"title":"Multiplex nucleic acid polymerase assay for eight severe hemorrhagic fever viruses based on dual-probe hybridization and melting curve analysis.","authors":"Fuli Tan, Yuchang Li, Xiaoping Kang, Yuehong Chen, Sen Zhang, Jing Li, Ye Feng, Xiaokun Li, Runxin Liang, Fei Wang, Xiangdong Li, Tao Jiang","doi":"10.1016/j.imj.2025.100196","DOIUrl":"10.1016/j.imj.2025.100196","url":null,"abstract":"<p><strong>Background: </strong>In recent years, frequent outbreaks of infectious diseases caused by hemorrhagic fever viruses have posed serious threats to global public health. The pathogens are variable and highly infectious, such as Sudan <i>ebolavirus</i> (SEBOV), Zaire <i>ebolavirus</i> (ZEBOV), Marburg <i>marburgvirus</i> (MARV), <i>Lassa mammarenavirus</i> (LASV), Rift Valley fever <i>phlebovirus</i> (RVFV), Sin Nombre <i>orthohantavirus</i> (SNV), etc. To improve the efficiency of pathogen detection, a method for simultaneous screening multiplex targets is in a great demand.</p><p><strong>Methods: </strong>Utilizing dual-probe hybridization and melting curve analysis, a multiplex nucleic acid polymerase assay for eight hemorrhagic fever viruses test (named the MPA-eight-virus assay) was developed in this study. The sensitivity for each target was improved by optimizing primer and probe selection as well as amplification conditions; the usability of MPA-eight-virus assay was validated by simulated samples preparation and test.</p><p><strong>Results: </strong>The MPA-eight-virus assay achieved high sensitivity and specificity for the targets, with a limit of detection (LOD) of 1.83-691.00 copies/µL for all eight targets; Notably, the LOD for MARV was 1.83 copies/µL and that for SNV was 9.32 copies/µL.</p><p><strong>Conclusions: </strong>The MPA-eight-virus assay is high throughput, time-saving, accurate, and cost-effective, making it potentially useful for prevention and control of severe viral hemorrhagic fever.</p>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"100196"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-25DOI: 10.1016/j.imj.2025.100195
Shuang Wang , Xiaolin Yu , Ming Fang , Hengjie Xie , Lu Liu , Ziqing Liu , Guangjian Wu , Yuzhen Chen , Ti Liu , Peng Yang
Background
Salmonella Paratyphi C is an infrequent etiological agent of enteric fever, with sporadic cases primarily reported in Asia and Africa. Documented outbreaks remain exceedingly rare, and epidemiological data on such events are notably scarce.
Methods
This study investigated a paratyphoid fever outbreak caused by S. Paratyphi C at a secondary school in China in 2023. Comprehensive field epidemiological investigations were conducted, including environmental sampling and the collection of clinical specimens. All outbreak-associated isolates underwent antimicrobial susceptibility testing, whole-genome sequencing, and in-depth bioinformatics analysis. Single-nucleotide polymorphism profiling and core genome multilocus sequence typing were employed to elucidate the genetic relatedness of the isolates.
Results
A total of 11 S. Paratyphi C strains, characterized by the antigenic formula 6,7:c:1,5, were recovered from a variety of sample sources. Genomic analyses revealed striking homogeneity across all isolates, with uniform multilocus sequence types, identical antimicrobial resistance patterns, and shared virulence-associated genes. Phylogenetic reconstruction demonstrated a tightly clustered lineage, corroborated by highly similar circular genome structures, suggesting a common source of infection.
Conclusions
This investigation offered critical insights into a rare foodborne outbreak caused by S. Paratyphi C, bridging significant knowledge gaps regarding its epidemiology and genetic characteristics. The findings underscored the global diversity and potential public health threat of S. Paratyphi C, reinforcing the urgent need to enhance food safety monitoring and improve outbreak preparedness strategies both in China and internationally.
{"title":"A foodborne outbreak of Salmonella Paratyphi C in a Chinese middle school: Genomic tracing and epidemiological characterization","authors":"Shuang Wang , Xiaolin Yu , Ming Fang , Hengjie Xie , Lu Liu , Ziqing Liu , Guangjian Wu , Yuzhen Chen , Ti Liu , Peng Yang","doi":"10.1016/j.imj.2025.100195","DOIUrl":"10.1016/j.imj.2025.100195","url":null,"abstract":"<div><h3>Background</h3><div><em>Salmonella</em> Paratyphi C is an infrequent etiological agent of enteric fever, with sporadic cases primarily reported in Asia and Africa. Documented outbreaks remain exceedingly rare, and epidemiological data on such events are notably scarce.</div></div><div><h3>Methods</h3><div>This study investigated a paratyphoid fever outbreak caused by <em>S.</em> Paratyphi C at a secondary school in China in 2023. Comprehensive field epidemiological investigations were conducted, including environmental sampling and the collection of clinical specimens. All outbreak-associated isolates underwent antimicrobial susceptibility testing, whole-genome sequencing, and in-depth bioinformatics analysis. Single-nucleotide polymorphism profiling and core genome multilocus sequence typing were employed to elucidate the genetic relatedness of the isolates.</div></div><div><h3>Results</h3><div>A total of 11 <em>S.</em> Paratyphi C strains, characterized by the antigenic formula 6,7:c:1,5, were recovered from a variety of sample sources. Genomic analyses revealed striking homogeneity across all isolates, with uniform multilocus sequence types, identical antimicrobial resistance patterns, and shared virulence-associated genes. Phylogenetic reconstruction demonstrated a tightly clustered lineage, corroborated by highly similar circular genome structures, suggesting a common source of infection.</div></div><div><h3>Conclusions</h3><div>This investigation offered critical insights into a rare foodborne outbreak caused by <em>S.</em> Paratyphi C, bridging significant knowledge gaps regarding its epidemiology and genetic characteristics. The findings underscored the global diversity and potential public health threat of <em>S.</em> Paratyphi C, reinforcing the urgent need to enhance food safety monitoring and improve outbreak preparedness strategies both in China and internationally.</div></div>","PeriodicalId":100667,"journal":{"name":"Infectious Medicine","volume":"4 3","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}