Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503056
Concha Amador , Juan Ambrosioni , Luz Martín-Carbonero , Carmen Hidalgo-Tenorio , Juan Tiraboschi , Santiago Moreno
Integrase strand inhibitor (INSTI)-based antiretroviral regimens are the preferred choices for treating people with human immunodeficiency virus (PWH). The once-daily single-tablet combination of INSTI bictegravir, co-formulated with emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), has shown effectiveness and good tolerability in randomized clinical trials, both in treatment-naïve (TN) and virologically suppressed patients switched to this regimen. Real-world evidence represents clinical practice and may fill data gaps left by pivotal studies. Based on literature search for real-world studies in Spain within five years, and using clinical trial data as a contextual framework, this narrative review synthesizes observational experience with BIC/FTC/TAF, focusing on the interplay between comorbidities, advanced age, and treatment outcomes from underrepresented subgroups in clinical trials. This fixed-dose combination proved effective and well-tolerated for TN and treatment-experienced PWH, with low virological failure even in difficult-to-treat patients. Low rates of treatment discontinuations due to adverse events or drug-drug interactions aligned with clinical trial findings.
{"title":"Bictegravir/emtricitabine/tenofovir alafenamide: A review of the real-world experience in Spain within the last five years","authors":"Concha Amador , Juan Ambrosioni , Luz Martín-Carbonero , Carmen Hidalgo-Tenorio , Juan Tiraboschi , Santiago Moreno","doi":"10.1016/j.eimc.2025.503056","DOIUrl":"10.1016/j.eimc.2025.503056","url":null,"abstract":"<div><div>Integrase strand inhibitor (INSTI)-based antiretroviral regimens are the preferred choices for treating people with human immunodeficiency virus (PWH). The once-daily single-tablet combination of INSTI bictegravir, co-formulated with emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), has shown effectiveness and good tolerability in randomized clinical trials, both in treatment-naïve (TN) and virologically suppressed patients switched to this regimen. Real-world evidence represents clinical practice and may fill data gaps left by pivotal studies. Based on literature search for real-world studies in Spain within five years, and using clinical trial data as a contextual framework, this narrative review synthesizes observational experience with BIC/FTC/TAF, focusing on the interplay between comorbidities, advanced age, and treatment outcomes from underrepresented subgroups in clinical trials. This fixed-dose combination proved effective and well-tolerated for TN and treatment-experienced PWH, with low virological failure even in difficult-to-treat patients. Low rates of treatment discontinuations due to adverse events or drug-drug interactions aligned with clinical trial findings.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503056"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503059
Maria Giulia Caponcello , María Del Rocío Fernández-Ojeda , Natalia Maldonado , Manuel Diéguez-Serrano , Ana Laura Blanco-Taboada , Paula Olivares Navarro , Adriana Rivera-Sequeiros , Rafael Perera , Jose A. Delgado-Torralbo , Luisa González-Iglesias , Miguel A. Rico-Corral , María Dolores Del Toro , Jesús Rodríguez-Baño , Zaira R. Palacios-Baena , Belén Gutiérrez-Gutiérrez
Introduction
The FEN-COVID study identified 3 clinical phenotypes (PhA, PhB and PhC) in hospital-admitted patients with COVID-19, which were associated with mortality. The aim of this study is to validate the assignment to phenotypes and their association with mortality in two hospitals in Spain across the first 4 waves of the pandemic, including the impact of corticosteroids and anticoagulant drugs.
Methods
A prospective cohort study of patients admitted for COVID-19 in the first 4 waves in two hospitals was performed. Phenotypes were assigned using the FEN-COVID calculator. The primary outcome was 30-day all-cause mortality. Kaplan–Meier (KM) curves were compared using the log-rank test. Multivariate analysis was performed using Cox regression analysis to assess the association of phenotypes with mortality.
Results
1839 patients were included. Of these, 257 patients were identified as PhA, 1451 as PhB and 130 as PhC; their 30-day mortality was 1.9%, 15.4% and 45.4%, respectively. In multivariate analysis and controlling for wave effect, belonging to phenotype B and phenotype C was associated with progressive increased hazards of death. In addition, appropriate treatment with corticosteroids was significantly associated with lower mortality in PhB, while low-molecular weight heparin use was significantly associated with lower mortality in PhB and PhC.
Conclusions
Our results confirmed that the clinical phenotypes identified in the FEN-COVID study were predictive of mortality across all waves studied. Furthermore, we confirmed the importance of identifying the phenotype to which a patient belongs on admission when considering appropriate treatment with corticosteroids and/or anticoagulants.
{"title":"Validation of FEN-COVID phenotypes in hospitalised COVID-19 patients across the first four waves of the pandemic","authors":"Maria Giulia Caponcello , María Del Rocío Fernández-Ojeda , Natalia Maldonado , Manuel Diéguez-Serrano , Ana Laura Blanco-Taboada , Paula Olivares Navarro , Adriana Rivera-Sequeiros , Rafael Perera , Jose A. Delgado-Torralbo , Luisa González-Iglesias , Miguel A. Rico-Corral , María Dolores Del Toro , Jesús Rodríguez-Baño , Zaira R. Palacios-Baena , Belén Gutiérrez-Gutiérrez","doi":"10.1016/j.eimc.2025.503059","DOIUrl":"10.1016/j.eimc.2025.503059","url":null,"abstract":"<div><h3>Introduction</h3><div>The FEN-COVID study identified 3 clinical phenotypes (PhA, PhB and PhC) in hospital-admitted patients with COVID-19, which were associated with mortality. The aim of this study is to validate the assignment to phenotypes and their association with mortality in two hospitals in Spain across the first 4 waves of the pandemic, including the impact of corticosteroids and anticoagulant drugs.</div></div><div><h3>Methods</h3><div>A prospective cohort study of patients admitted for COVID-19 in the first 4 waves in two hospitals was performed. Phenotypes were assigned using the FEN-COVID calculator. The primary outcome was 30-day all-cause mortality. Kaplan–Meier (KM) curves were compared using the log-rank test. Multivariate analysis was performed using Cox regression analysis to assess the association of phenotypes with mortality.</div></div><div><h3>Results</h3><div>1839 patients were included. Of these, 257 patients were identified as PhA, 1451 as PhB and 130 as PhC; their 30-day mortality was 1.9%, 15.4% and 45.4%, respectively. In multivariate analysis and controlling for wave effect, belonging to phenotype B and phenotype C was associated with progressive increased hazards of death. In addition, appropriate treatment with corticosteroids was significantly associated with lower mortality in PhB, while low-molecular weight heparin use was significantly associated with lower mortality in PhB and PhC.</div></div><div><h3>Conclusions</h3><div>Our results confirmed that the clinical phenotypes identified in the FEN-COVID study were predictive of mortality across all waves studied. Furthermore, we confirmed the importance of identifying the phenotype to which a patient belongs on admission when considering appropriate treatment with corticosteroids and/or anticoagulants.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503059"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503072
Laura Pérez-Martínez , Lourdes Romero , Esther Palacios , Raquel Barbero , Ana Moreno-Blanco , Rosa del Campo , José Ramón Blanco
Introduction
The COVID-19 pandemic continues to pose a substantial threat to global public health. While most efforts have focused on the acute phase SARS-CoV-2 infection, a significant proportion of individuals experience persistent symptoms after infection, known as “persistent COVID disease” (PCD). The etiology of PCD remains poorly understood, although some evidence suggests that microbiota, particularly those located in the upper respiratory tract, may play a role. The aim of this study was to investigate differences in the composition of the oral microbiota, salivary cytokine, and short-chain fatty acids (SCFAs) concentration, between PCD and healthy controls.
Methods
We conducted an age- and sex-matched case–control study. Oral bacterial communities were profiled by 16S rDNA gene (V3–V4) amplicon high-throughput sequencing. Salivary IL-6 and TNF-α concentrations were measured, and SCFA were quantified by liquid chromatography–tandem mass spectrometry. Cognitive and fatigue status were assessed with the Montreal Cognitive Assessment (MoCA) and the Modified Fatigue Impact Scale (MFIS).
Results
Oral-microbiota α/β-diversity did not differ between groups; salivary cytokines were likewise similar. After Benjamini–Hochberg correction, no SCFA differences were significant (q > 0.05); valeric acid showed the strongest uncorrected signal (p = 0.02; r = 0.52) but not after adjustment (q = 0.23; power ≈0.73). CPD participants had lower MoCA and higher MFIS scores than controls (both p < 0.005).
Conclusions
The increase of valeric acid levels in PCD patients warrants further investigation to clarify its potential biological role and implications in the pathophysiology of this syndrome.
{"title":"Oral microbiota in patients with long COVID: A pilot study","authors":"Laura Pérez-Martínez , Lourdes Romero , Esther Palacios , Raquel Barbero , Ana Moreno-Blanco , Rosa del Campo , José Ramón Blanco","doi":"10.1016/j.eimc.2025.503072","DOIUrl":"10.1016/j.eimc.2025.503072","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic continues to pose a substantial threat to global public health. While most efforts have focused on the acute phase SARS-CoV-2 infection, a significant proportion of individuals experience persistent symptoms after infection, known as “persistent COVID disease” (PCD). The etiology of PCD remains poorly understood, although some evidence suggests that microbiota, particularly those located in the upper respiratory tract, may play a role. The aim of this study was to investigate differences in the composition of the oral microbiota, salivary cytokine, and short-chain fatty acids (SCFAs) concentration, between PCD and healthy controls.</div></div><div><h3>Methods</h3><div>We conducted an age- and sex-matched case–control study. Oral bacterial communities were profiled by 16S rDNA gene (V3–V4) amplicon high-throughput sequencing. Salivary IL-6 and TNF-α concentrations were measured, and SCFA were quantified by liquid chromatography–tandem mass spectrometry. Cognitive and fatigue status were assessed with the Montreal Cognitive Assessment (MoCA) and the Modified Fatigue Impact Scale (MFIS).</div></div><div><h3>Results</h3><div>Oral-microbiota α/β-diversity did not differ between groups; salivary cytokines were likewise similar. After Benjamini–Hochberg correction, no SCFA differences were significant (<em>q</em> <!-->><!--> <!-->0.05); valeric acid showed the strongest uncorrected signal (<em>p</em> <!-->=<!--> <!-->0.02; <em>r</em> <!-->=<!--> <!-->0.52) but not after adjustment (<em>q</em> <!-->=<!--> <!-->0.23; power ≈0.73). CPD participants had lower MoCA and higher MFIS scores than controls (both <em>p</em> <!--><<!--> <!-->0.005).</div></div><div><h3>Conclusions</h3><div>The increase of valeric acid levels in PCD patients warrants further investigation to clarify its potential biological role and implications in the pathophysiology of this syndrome.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503072"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503054
Raquel Zaragozá González , Carlos de Leonardo Simón , Melisa Hernández Febles , Eduardo Lagarejos González , Iñigo Rúa-Figueroa , María del Val Groba Marco , María del Mar Perera Alvarez , Antonio García Quintana , María José Pena López
Introduction
Human parvovirus B19 (PVB19) is associated with diverse clinical manifestations. While acute infection in immunocompetent adults is generally considered mild, recent European outbreaks and an increase in severe cases highlight the need to always keep this virus in mind. This study aimed to describe the clinical and epidemiological features of acute PVB19 infection in immunocompetent adults requiring hospital care.
Methods
We conducted a retrospective study of immunocompetent patients over 14 years old diagnosed with acute PVB19 infection at a Gran Canaria tertiary hospital (2014–2024). Diagnosis was based on detection of viral DNA and/or specific IgM.
Results
Forty-three patients were included (mean age 40.6 ± 13.9 years; 44.2% male). A marked increase in cases was observed in 2024 (51.2% of total). Clinical manifestations included acute polyarthritis (37.2%), cardiac involvement (34.9%), erythema (16.3%), fever of unknown origin, meningitis, and gastrointestinal symptoms. Cardiac involvement, mostly in males, included dilated cardiomyopathy, pericarditis, and myocarditis, and was associated with two deaths. Hematological abnormalities were frequent (up to 80% in cardiac patients). Two additional patients developed systemic inflammatory diseases. Serological testing alone failed to confirm diagnosis in several cases, needing molecular testing of alternative samples.
Conclusions
Our findings underscore the diverse and potentially severe presentation of PVB19 infection in immunocompetent adults. The high incidence of cardiac involvement and diagnostic challenges highlight the need for enhanced surveillance and clinical awareness. Incorporating PVB19 into differential diagnoses for hospitalized patients with unexplained inflammatory or hematological syndromes may improve timely recognition and management.
{"title":"Human parvovirus B19 infection in immunocompetent adults: A diagnostic challenge due to its multiple clinical manifestations","authors":"Raquel Zaragozá González , Carlos de Leonardo Simón , Melisa Hernández Febles , Eduardo Lagarejos González , Iñigo Rúa-Figueroa , María del Val Groba Marco , María del Mar Perera Alvarez , Antonio García Quintana , María José Pena López","doi":"10.1016/j.eimc.2025.503054","DOIUrl":"10.1016/j.eimc.2025.503054","url":null,"abstract":"<div><h3>Introduction</h3><div>Human parvovirus B19 (PVB19) is associated with diverse clinical manifestations. While acute infection in immunocompetent adults is generally considered mild, recent European outbreaks and an increase in severe cases highlight the need to always keep this virus in mind. This study aimed to describe the clinical and epidemiological features of acute PVB19 infection in immunocompetent adults requiring hospital care.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of immunocompetent patients over 14 years old diagnosed with acute PVB19 infection at a Gran Canaria tertiary hospital (2014–2024). Diagnosis was based on detection of viral DNA and/or specific IgM.</div></div><div><h3>Results</h3><div>Forty-three patients were included (mean age 40.6<!--> <!-->±<!--> <!-->13.9 years; 44.2% male). A marked increase in cases was observed in 2024 (51.2% of total). Clinical manifestations included acute polyarthritis (37.2%), cardiac involvement (34.9%), erythema (16.3%), fever of unknown origin, meningitis, and gastrointestinal symptoms. Cardiac involvement, mostly in males, included dilated cardiomyopathy, pericarditis, and myocarditis, and was associated with two deaths. Hematological abnormalities were frequent (up to 80% in cardiac patients). Two additional patients developed systemic inflammatory diseases. Serological testing alone failed to confirm diagnosis in several cases, needing molecular testing of alternative samples.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the diverse and potentially severe presentation of PVB19 infection in immunocompetent adults. The high incidence of cardiac involvement and diagnostic challenges highlight the need for enhanced surveillance and clinical awareness. Incorporating PVB19 into differential diagnoses for hospitalized patients with unexplained inflammatory or hematological syndromes may improve timely recognition and management.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503054"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503071
Ana Hernandez-Aceituno , Diana Sanabria Curbelo , Isabel Falcón García , Álvaro Torres Lana , Roque Abián Montesdeoca Melián , Eneko Larumbe-Zabala
Introduction
Measles, a highly contagious airborne disease, has seen a resurgence in Spain despite the successful implementation of vaccination programs. This study examines two cases of vaccine-associated measles in children attending the same nursery school, both of whom received the measles–mumps–rubella vaccine.
Methods
Retrospective descriptive study of two children with vaccine-associated measles in May 2025 on the island of Gran Canaria (Spain).
Results
The first case involved a 12-month-old girl who developed symptoms six days post-vaccination, while the second case, a 13-month-old boy, exhibited symptoms eight days after receiving the vaccine. Both cases were confirmed as genotype A, indicating the vaccine strain. The investigation included extensive contact tracing, identifying 107 close contacts, with vaccinations administered to susceptible individuals. Laboratory tests confirmed measles through polymerase chain reaction (PCR) analysis. The findings highlight the rarity of clinically significant vaccine-associated disease and the absence of evidence for human-to-human transmission of the vaccine strain.
Conclusion
This study underscores the importance of genotyping in distinguishing between vaccine-associated rash illness and wild-type measles, as well as the need for continued vigilance in monitoring vaccine efficacy and outbreak responses. Ultimately, while the possibility of transmission cannot be entirely dismissed, the evidence suggests that these cases are more likely coincidental rather than a result of transmission.
{"title":"Two vaccine-associated measles cases: Transmission or coincidental cases?","authors":"Ana Hernandez-Aceituno , Diana Sanabria Curbelo , Isabel Falcón García , Álvaro Torres Lana , Roque Abián Montesdeoca Melián , Eneko Larumbe-Zabala","doi":"10.1016/j.eimc.2025.503071","DOIUrl":"10.1016/j.eimc.2025.503071","url":null,"abstract":"<div><h3>Introduction</h3><div>Measles, a highly contagious airborne disease, has seen a resurgence in Spain despite the successful implementation of vaccination programs. This study examines two cases of vaccine-associated measles in children attending the same nursery school, both of whom received the measles–mumps–rubella vaccine.</div></div><div><h3>Methods</h3><div>Retrospective descriptive study of two children with vaccine-associated measles in May 2025 on the island of Gran Canaria (Spain).</div></div><div><h3>Results</h3><div>The first case involved a 12-month-old girl who developed symptoms six days post-vaccination, while the second case, a 13-month-old boy, exhibited symptoms eight days after receiving the vaccine. Both cases were confirmed as genotype A, indicating the vaccine strain. The investigation included extensive contact tracing, identifying 107 close contacts, with vaccinations administered to susceptible individuals. Laboratory tests confirmed measles through polymerase chain reaction (PCR) analysis. The findings highlight the rarity of clinically significant vaccine-associated disease and the absence of evidence for human-to-human transmission of the vaccine strain.</div></div><div><h3>Conclusion</h3><div>This study underscores the importance of genotyping in distinguishing between vaccine-associated rash illness and wild-type measles, as well as the need for continued vigilance in monitoring vaccine efficacy and outbreak responses. Ultimately, while the possibility of transmission cannot be entirely dismissed, the evidence suggests that these cases are more likely coincidental rather than a result of transmission.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503071"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.eimc.2025.503040
Jordi Martinez-Matencio, Inmaculada Palacios-Garcia, Eduardo Cantón-Puig, José Garnacho-Montero
{"title":"Un caso raro de pericarditis purulenta secundaria a Streptococcus constellatus por contigüidad de lesión hepática a estudio","authors":"Jordi Martinez-Matencio, Inmaculada Palacios-Garcia, Eduardo Cantón-Puig, José Garnacho-Montero","doi":"10.1016/j.eimc.2025.503040","DOIUrl":"10.1016/j.eimc.2025.503040","url":null,"abstract":"","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503040"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.eimc.2025.503047
Miaoni Kong, Wen Zhou
Objective
To characterize the clinical manifestations of Rickettsia japonica (R. japonica) infection and to generate evidence facilitating early diagnosis and targeted treatment.
Methods
We retrospectively reviewed the clinical data of five patients with R. japonica infection who were treated in the Emergency Department, Xiling Campus, Yichang Central People's Hospital, between January 2023 and December 2024.
Results
All patients were residents of Yichang City, Hubei Province, aged 58–70 years, and 80% (4/5) were farmers. The onset of illness occurred exclusively between May and September, and all patients reported a definite history of outdoor exposure. The predominant clinical manifestations were fever, rash, and eschar. Laboratory findings revealed thrombocytopenia, elevated aspartate aminotransferase (AST) and creatine kinase (CK), as well as increased inflammatory markers including C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). R. japonica nucleic acid was detected in all patients by metagenomic next-generation sequencing (mNGS) of blood samples. Three patients initially received empirical doxycycline therapy, which was subsequently adjusted to a standard regimen after diagnostic confirmation. Defervescence occurred at a median of two days (range, 1–7 days), followed by gradual resolution of rash and alleviation of systemic symptoms. All patients achieved complete clinical recovery and were discharged without complications.
Conclusion
This study highlights the importance of heightened clinical awareness of R. japonica infection, emphasizing the integration of epidemiological context with hallmark clinical features – particularly fever, rash, and eschar – during peak transmission seasons in endemic areas. Early recognition allows the timely initiation of doxycycline therapy, which is essential for achieving favorable outcomes. Moreover, metagenomic next-generation sequencing (mNGS) provides the definitive identification of pathogens and guides targeted antimicrobial therapy.
{"title":"Clinical characteristics and outcomes of Rickettsia japonica infection: A retrospective case series of five patients","authors":"Miaoni Kong, Wen Zhou","doi":"10.1016/j.eimc.2025.503047","DOIUrl":"10.1016/j.eimc.2025.503047","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the clinical manifestations of <em>Rickettsia japonica</em> (<em>R. japonica</em>) infection and to generate evidence facilitating early diagnosis and targeted treatment.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the clinical data of five patients with <em>R. japonica</em> infection who were treated in the Emergency Department, Xiling Campus, Yichang Central People's Hospital, between January 2023 and December 2024.</div></div><div><h3>Results</h3><div>All patients were residents of Yichang City, Hubei Province, aged 58–70 years, and 80% (4/5) were farmers. The onset of illness occurred exclusively between May and September, and all patients reported a definite history of outdoor exposure. The predominant clinical manifestations were fever, rash, and eschar. Laboratory findings revealed thrombocytopenia, elevated aspartate aminotransferase (AST) and creatine kinase (CK), as well as increased inflammatory markers including C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). <em>R. japonica</em> nucleic acid was detected in all patients by metagenomic next-generation sequencing (mNGS) of blood samples. Three patients initially received empirical doxycycline therapy, which was subsequently adjusted to a standard regimen after diagnostic confirmation. Defervescence occurred at a median of two days (range, 1–7 days), followed by gradual resolution of rash and alleviation of systemic symptoms. All patients achieved complete clinical recovery and were discharged without complications.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of heightened clinical awareness of <em>R. japonica</em> infection, emphasizing the integration of epidemiological context with hallmark clinical features – particularly fever, rash, and eschar – during peak transmission seasons in endemic areas. Early recognition allows the timely initiation of doxycycline therapy, which is essential for achieving favorable outcomes. Moreover, metagenomic next-generation sequencing (mNGS) provides the definitive identification of pathogens and guides targeted antimicrobial therapy.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 1","pages":"Article 503047"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BD Phoenix™ Emerge panel incorporates the CPO detect test (CPO-T), which enables both detection and classification of carbapenemases. Integrating reliable carbapenemase detection – particularly group D enzymes – into routine antimicrobial susceptibility testing (AST), along with rapid susceptibility results, supports early optimization of antimicrobial therapy and implementation of infection control measures. These actions are essential for improving clinical outcomes and limiting the spread of resistance. This study evaluated the performance of CPO-T in detecting carbapenemase activity in a well-characterized collection of Escherichia coli isolates producing only OXA-48, without co-production of ESBL or pAmpC (OXA48-NoE-NoA-E. coli). Additionally, we assessed the BD Phoenix™ system ability to provide rapid antimicrobial susceptibility results.
Methods
Fifty-one OXA48-NoE-NoA-E. coli isolates were included. Ten carbapenem-resistant, non-carbapenemase-producing isolates served as negative controls (NC). All isolates underwent whole-genome sequencing using Illumina technology, and carbapenem MICs were determined by reference broth microdilution.
Results
CPO-T detected carbapenemase activity in 100% of the OXA48-NoE-NoA-E. coli isolates, with 82.4% correctly assigned to Ambler class D. Three NC isolates were misclassified as carbapenemase producers. The BD Phoenix™ system provided definitive susceptibility results in under 8 h for 64.6% of the antibiotics tested.
Conclusions
CPO-T is a reliable tool for detecting OXA48-NoE-NoA-E. coli, even in phenotypically complex cases. To ensure rapid and accurate classification, a confirmatory test – such as immunochromatography – should be performed. The BD Phoenix™ system also enables timely AST, supporting early and informed therapeutic decisions.
{"title":"Performance of the BD Phoenix CPO detect assay for the detection and classification of OXA-48 producing-Escherichia coli that do not co-produce ESBL/pAmpC","authors":"Fátima Galán-Sánchez , Inés Portillo-Calderón , Manuel Rodriguez-Iglesias , Álvaro Pascual , Lorena López-Cerero","doi":"10.1016/j.eimc.2025.503035","DOIUrl":"10.1016/j.eimc.2025.503035","url":null,"abstract":"<div><h3>Introduction</h3><div>The BD Phoenix™ Emerge panel incorporates the CPO detect test (CPO-T), which enables both detection and classification of carbapenemases. Integrating reliable carbapenemase detection – particularly group D enzymes – into routine antimicrobial susceptibility testing (AST), along with rapid susceptibility results, supports early optimization of antimicrobial therapy and implementation of infection control measures. These actions are essential for improving clinical outcomes and limiting the spread of resistance. This study evaluated the performance of CPO-T in detecting carbapenemase activity in a well-characterized collection of <em>Escherichia coli</em> isolates producing only OXA-48, without co-production of ESBL or p<em>AmpC</em> (OXA48-NoE-NoA-<em>E. coli</em>). Additionally, we assessed the BD Phoenix™ system ability to provide rapid antimicrobial susceptibility results.</div></div><div><h3>Methods</h3><div>Fifty-one OXA48-NoE-NoA-<em>E. coli</em> isolates were included. Ten carbapenem-resistant, non-carbapenemase-producing isolates served as negative controls (NC). All isolates underwent whole-genome sequencing using Illumina technology, and carbapenem MICs were determined by reference broth microdilution.</div></div><div><h3>Results</h3><div>CPO-T detected carbapenemase activity in 100% of the OXA48-NoE-NoA-<em>E. coli</em> isolates, with 82.4% correctly assigned to Ambler class D. Three NC isolates were misclassified as carbapenemase producers. The BD Phoenix™ system provided definitive susceptibility results in under 8<!--> <!-->h for 64.6% of the antibiotics tested.</div></div><div><h3>Conclusions</h3><div>CPO-T is a reliable tool for detecting OXA48-NoE-NoA-<em>E. coli</em>, even in phenotypically complex cases. To ensure rapid and accurate classification, a confirmatory test – such as immunochromatography – should be performed. The BD Phoenix™ system also enables timely AST, supporting early and informed therapeutic decisions.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 1","pages":"Article 503035"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.eimc.2025.503029
Javier Ugedo , Carla Andrea Alonso , Nisa Boukichou-Abdelkader , Marta Lamata , Carlos Ruiz-Martínez , José-Ramón Blanco
Introduction
Understanding the local epidemiology of nontuberculous mycobacteria (NTM) and assessing clinical practices related to NTM pulmonary disease (NTM-PD) are crucial for optimizing patient management. To this end, we analysed these aspects in the Spanish region of La Rioja.
Methods
A retrospective descriptive study was conducted using data of all patients with NTM isolated from respiratory specimens in La Rioja between 2006 and 2019. Demographic, microbiological, clinical, radiological, therapeutic, and outcome data were collected.
Results
A total of 305 patients were identified, 61 of whom met criteria for NTM-PD. The mean incidence rate of NTM isolations was 6.85 per 100,000 person-year and that of PD-NTM was 1.37. The annual incidence of PD-NTM remained stable during most of the period studied. Municipalities in the west of La Rioja had higher rates of isolation and PD-NTM than those in the east. Mycobacterium avium complex and Mycobacterium xenopi were the most frequently caused PD-NTM. Notably, 32.8% of patients with PD-NTM did not receive the antibiotic treatment recommended by guidelines.
Conclusions
NTM isolation and PD-NTM rates and the most frequently isolated species are in line with results from other regions of Spain and Europe, however, marked differences are appreciated between the different municipalities of La Rioja. The annual rate of EP-NTM did not show the upward trend described in other studies. The degree of adherence to the guidelines could be improved.
{"title":"Trends in the epidemiology and management of nontuberculous mycobacteria pulmonary disease in La Rioja-Spain (2006–2019)","authors":"Javier Ugedo , Carla Andrea Alonso , Nisa Boukichou-Abdelkader , Marta Lamata , Carlos Ruiz-Martínez , José-Ramón Blanco","doi":"10.1016/j.eimc.2025.503029","DOIUrl":"10.1016/j.eimc.2025.503029","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding the local epidemiology of nontuberculous mycobacteria (NTM) and assessing clinical practices related to NTM pulmonary disease (NTM-PD) are crucial for optimizing patient management. To this end, we analysed these aspects in the Spanish region of La Rioja.</div></div><div><h3>Methods</h3><div>A retrospective descriptive study was conducted using data of all patients with NTM isolated from respiratory specimens in La Rioja between 2006 and 2019. Demographic, microbiological, clinical, radiological, therapeutic, and outcome data were collected.</div></div><div><h3>Results</h3><div>A total of 305 patients were identified, 61 of whom met criteria for NTM-PD. The mean incidence rate of NTM isolations was 6.85 per 100,000 person-year and that of PD-NTM was 1.37. The annual incidence of PD-NTM remained stable during most of the period studied. Municipalities in the west of La Rioja had higher rates of isolation and PD-NTM than those in the east. <em>Mycobacterium avium</em> complex and <em>Mycobacterium xenopi</em> were the most frequently caused PD-NTM. Notably, 32.8% of patients with PD-NTM did not receive the antibiotic treatment recommended by guidelines.</div></div><div><h3>Conclusions</h3><div>NTM isolation and PD-NTM rates and the most frequently isolated species are in line with results from other regions of Spain and Europe, however, marked differences are appreciated between the different municipalities of La Rioja. The annual rate of EP-NTM did not show the upward trend described in other studies. The degree of adherence to the guidelines could be improved.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 1","pages":"Article 503029"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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