Pub Date : 2026-01-14DOI: 10.1016/j.jinf.2026.106686
Eloïse Le Banner, Joseph Le Moulec, Mallorie Kerjouan, Vincent Grosbost, Antoine Parrot, Murielle Rondeau-Lutz, Vanessa Leguy Seguin, Christian Lavigne, Anne Contis, Morgane Mourguet, Shirine Mohamed, Étienne-Marie Jutant, Sandra Blivet, Johana Pradelli, Olivier Espitia, Laurent Chaussavoine, Sabine Revuz, Matthieu Revest, Pierre Tattevin, Sophie Dupuis-Girod, Alexandre Guilhem, David Luque Paz
Objectives: Patients with hereditary hemorrhagic telangiectasia (HHT) present increased risk of severe infections. Studies focusing on infections in HHT population are scarce. We aimed to assess characteristics and outcomes of infections in patients with HHT.
Methods: A retrospective study was conducted in a nationwide cohort of 4,502 HHT patients. Patients with HHT hospitalized for infection across 16 referral centers in France between 2010 and 2024 were identified, and data were collected through a standardized questionnaire.
Results: We included 163 HHT patients (median age, 60 years [49-69], 52% male), who experienced a total of 249 bacterial infections. One third (n=53/163) experienced recurrent infections requiring hospitalization. Infections caused by Staphylococcus aureus were reported in 80 patients representing 107 episodes of infection. Brain abscesses were reported in 43 patients representing 51 episodes, often despite prior pulmonary arteriovenous malformations embolization (n=17/43). In multivariable analysis, factors associated with 1-year mortality (n=27/163, 17%) were age (aHR=1.06, 95%CI:1.01-1.16) and infective endocarditis (aHR=2.88, 95%CI:1.10-7.87).
Conclusions: In this HHT cohort, severe infections were predominantly due to S. aureus, far ahead of brain abscesses caused by oral bacteria. Considering the high rate of recurrent infections, further studies focusing on prophylaxis strategies in HHT patients are needed.
{"title":"A contemporary picture of bacterial infections in patients with hereditary hemorrhagic telangiectasia: a nationwide cohort study.","authors":"Eloïse Le Banner, Joseph Le Moulec, Mallorie Kerjouan, Vincent Grosbost, Antoine Parrot, Murielle Rondeau-Lutz, Vanessa Leguy Seguin, Christian Lavigne, Anne Contis, Morgane Mourguet, Shirine Mohamed, Étienne-Marie Jutant, Sandra Blivet, Johana Pradelli, Olivier Espitia, Laurent Chaussavoine, Sabine Revuz, Matthieu Revest, Pierre Tattevin, Sophie Dupuis-Girod, Alexandre Guilhem, David Luque Paz","doi":"10.1016/j.jinf.2026.106686","DOIUrl":"https://doi.org/10.1016/j.jinf.2026.106686","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with hereditary hemorrhagic telangiectasia (HHT) present increased risk of severe infections. Studies focusing on infections in HHT population are scarce. We aimed to assess characteristics and outcomes of infections in patients with HHT.</p><p><strong>Methods: </strong>A retrospective study was conducted in a nationwide cohort of 4,502 HHT patients. Patients with HHT hospitalized for infection across 16 referral centers in France between 2010 and 2024 were identified, and data were collected through a standardized questionnaire.</p><p><strong>Results: </strong>We included 163 HHT patients (median age, 60 years [49-69], 52% male), who experienced a total of 249 bacterial infections. One third (n=53/163) experienced recurrent infections requiring hospitalization. Infections caused by Staphylococcus aureus were reported in 80 patients representing 107 episodes of infection. Brain abscesses were reported in 43 patients representing 51 episodes, often despite prior pulmonary arteriovenous malformations embolization (n=17/43). In multivariable analysis, factors associated with 1-year mortality (n=27/163, 17%) were age (aHR=1.06, 95%CI:1.01-1.16) and infective endocarditis (aHR=2.88, 95%CI:1.10-7.87).</p><p><strong>Conclusions: </strong>In this HHT cohort, severe infections were predominantly due to S. aureus, far ahead of brain abscesses caused by oral bacteria. Considering the high rate of recurrent infections, further studies focusing on prophylaxis strategies in HHT patients are needed.</p>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":" ","pages":"106686"},"PeriodicalIF":11.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.jinf.2026.106691
Vera Bain, Isabela Silva-Avelar, Simone Correa-Silva, Olivia M Matsuo, Yingying Zheng, Andreia Rangel-Santos, Guilherme Souza Gonçalves, Thais de Toledo Fink, Priscila Suguita, Juliana Caires O A Ferreira, Arthur Eduardo Fernandes Ferreira, Camila Sanson Yoshino de Paula, Camilla Astley, Fernanda Martins, Magda Carneiro-Sampaio, Heloisa Helena de Sousa Marques, Clovis A Silva, Patricia Palmeira, Maria Fernanda Bádue Pereira
{"title":"Immune profile of T-lymphocytes in pediatric patients recovered of COVID-19: A longitudinal report.","authors":"Vera Bain, Isabela Silva-Avelar, Simone Correa-Silva, Olivia M Matsuo, Yingying Zheng, Andreia Rangel-Santos, Guilherme Souza Gonçalves, Thais de Toledo Fink, Priscila Suguita, Juliana Caires O A Ferreira, Arthur Eduardo Fernandes Ferreira, Camila Sanson Yoshino de Paula, Camilla Astley, Fernanda Martins, Magda Carneiro-Sampaio, Heloisa Helena de Sousa Marques, Clovis A Silva, Patricia Palmeira, Maria Fernanda Bádue Pereira","doi":"10.1016/j.jinf.2026.106691","DOIUrl":"https://doi.org/10.1016/j.jinf.2026.106691","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":" ","pages":"106691"},"PeriodicalIF":11.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Non-sputum based, child-friendly triage tests are urgently needed to achieve accurate diagnosis and monitoring of tuberculosis (TB) in children. We aimed to assess an Xpert MTB Host Response (MTB-HR) assay, which provides a TB score based on the mRNA expression level of three host genes, for diagnosis and differentiation TB in children and adolescents.
Methods: The multicenter, prospective study was conducted in four provinces of China among children and adolescents which were admitted to hospitals for TB or latent tuberculosis infection (LTBI) screening. Subjects were included in the evaluation of Xpert-MTB-HR from February 2020 to December 2021. Baselines of TB scores were analyzed in healthy children and adolescents with various ages. Accuracy was evaluated in subjects with various TB status, including microbiological data, disease severity and age.
Results: Based on a composite clinical reference standard, among 780 patients enrolled, 403, 41, 109, and 227 were diagnosed as TB, LTBI, non-TB infectious diseases (DC) and healthy controls (HC), respectively. The mean TB scores decreased from 4 (IQR, 3·54-4·46) in infants to 0·91 (IQR, -0·23-2·04) in adolescents aged 17-18 years old. Using the composite clinical reference standard, the area under curves (AUCs) of the MTB-HR assay in discriminating ATB from HC, LTBI, and DC were 0·786 (95% CI, 0·749-0·823), 0·652 (95% CI, 0·559-0·744) and 0·771 (95% CI, 0·718-0·823), respectively.The optimal cutoff value was less than or equal to 2·675, resulting a sensitivity of 75·9% (95% CI, 67·0%-80·9%) and specificity of 70·5% (95%CI, 60·3%-76·7%) in TB diagnosis. The MTB-HR assay showed better auxiliary effect for diagnosis of ATB in children younger than five years of age (AUC, 0·885, 95% CI, 0·824-0·945, P=0·0006). The mean TB scores elevated at one month (P=0·0009) and three months (P=0·0061) after anti-TB treatment initiation.
Conclusions: The MTB-HR assay showed potential for ATB diagnosis and treatment monitoring in children and adolescents, especially in ages under five years old.
{"title":"A blood-based Xpert host response assay for diagnosis and differentiation of active and latent tuberculosis in children and adolescents: a multi-center, prospective study.","authors":"Lin Sun, Min Fang, Yu Chen, Weiwei Jiao, Tingting Zou, Xiaoru Long, Yuqing Wang, Tingting Jiang, Jing Bi, Xinghui Gao, Mengran Li, Li Duan, Lichao Fan, Yun Qi, Manzhi Wang, Jiayun Shi, Tongqiang Zhang, Yongsheng Xu, Yiwei Tang, Chaomin Wan, Hongmei Xu, Yu Zhu, Adong Shen","doi":"10.1016/j.jinf.2026.106678","DOIUrl":"https://doi.org/10.1016/j.jinf.2026.106678","url":null,"abstract":"<p><strong>Objectives: </strong>Non-sputum based, child-friendly triage tests are urgently needed to achieve accurate diagnosis and monitoring of tuberculosis (TB) in children. We aimed to assess an Xpert MTB Host Response (MTB-HR) assay, which provides a TB score based on the mRNA expression level of three host genes, for diagnosis and differentiation TB in children and adolescents.</p><p><strong>Methods: </strong>The multicenter, prospective study was conducted in four provinces of China among children and adolescents which were admitted to hospitals for TB or latent tuberculosis infection (LTBI) screening. Subjects were included in the evaluation of Xpert-MTB-HR from February 2020 to December 2021. Baselines of TB scores were analyzed in healthy children and adolescents with various ages. Accuracy was evaluated in subjects with various TB status, including microbiological data, disease severity and age.</p><p><strong>Results: </strong>Based on a composite clinical reference standard, among 780 patients enrolled, 403, 41, 109, and 227 were diagnosed as TB, LTBI, non-TB infectious diseases (DC) and healthy controls (HC), respectively. The mean TB scores decreased from 4 (IQR, 3·54-4·46) in infants to 0·91 (IQR, -0·23-2·04) in adolescents aged 17-18 years old. Using the composite clinical reference standard, the area under curves (AUCs) of the MTB-HR assay in discriminating ATB from HC, LTBI, and DC were 0·786 (95% CI, 0·749-0·823), 0·652 (95% CI, 0·559-0·744) and 0·771 (95% CI, 0·718-0·823), respectively.The optimal cutoff value was less than or equal to 2·675, resulting a sensitivity of 75·9% (95% CI, 67·0%-80·9%) and specificity of 70·5% (95%CI, 60·3%-76·7%) in TB diagnosis. The MTB-HR assay showed better auxiliary effect for diagnosis of ATB in children younger than five years of age (AUC, 0·885, 95% CI, 0·824-0·945, P=0·0006). The mean TB scores elevated at one month (P=0·0009) and three months (P=0·0061) after anti-TB treatment initiation.</p><p><strong>Conclusions: </strong>The MTB-HR assay showed potential for ATB diagnosis and treatment monitoring in children and adolescents, especially in ages under five years old.</p>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":" ","pages":"106678"},"PeriodicalIF":11.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.jinf.2026.106689
Andreas Widmer , Nadine Imhasly , Christian Brand , Vilijam Zdravkovi , Adrian Spoerri , Kurt Schmidlin , Melanie Wicki , Martin Beck , Rami Sommerstein , for SIRIS and SWISSNOSO
Objective
Evaluate long-term mortality and the role of causative pathogens in periprosthetic joint infection (PJI) following total hip arthroplasty (THA).
Methods
Retrospective nationwide cohort study of adults undergoing THA (2012–2022) using data from the Swiss Joint Registry, Center for Infection Prevention and civil registry. Primary outcome was up to 10-year survival with or without PJI. Adjusted hazard ratios (aHR) were estimated via Gompertz regression, controlling for sex, age, BMI, and ASA. Pathogen-specific mortality hazard was analyzed.
Results
Of 215,678 patients, 89,709 met inclusion criteria (51.3% women; median age 69 years). PJI occurred in 745 (0.8%) patients, 2 752 (3.1%) underwent aseptic revision. PJI was associated with increased mortality (aHR 2.15; 95% CI, 1.79–2.57; p<0.001) compared to no PJI/revision, aseptic revisions were not (aHR 0.92; 95% CI, 0.80–1.06; p=0.27). Pathogens associated with increased mortality included Enterobacterales (aHR 3.17; 95% CI, 2.09–4.83, p<0.001), Staphylococcus aureus (aHR 2.32; 95% CI, 1.65–3.27; p<0.001), Cutibacterium acnes (aHR 2.31; 95% CI, 1.20–4.45; p=0.01), and coagulase-negative staphylococci (aHR 1.65; 95% CI, 1.16–2.35; p=0.006). Streptococcal infections showed no significant association (aHR 1.24; 95% CI, 0.62–2.49; p=0.54).
Conclusion
PJI following THA was associated with an approximately twofold increase in long-term mortality hazard. C. acnes presented an unexpectedly high mortality hazard.
{"title":"Increased long-term mortality of patients with prosthetic joint infection after primary total hip arthroplasty – A large observational cohort study","authors":"Andreas Widmer , Nadine Imhasly , Christian Brand , Vilijam Zdravkovi , Adrian Spoerri , Kurt Schmidlin , Melanie Wicki , Martin Beck , Rami Sommerstein , for SIRIS and SWISSNOSO","doi":"10.1016/j.jinf.2026.106689","DOIUrl":"10.1016/j.jinf.2026.106689","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate long-term mortality and the role of causative pathogens in periprosthetic joint infection (PJI) following total hip arthroplasty (THA).</div></div><div><h3>Methods</h3><div>Retrospective nationwide cohort study of adults undergoing THA (2012–2022) using data from the Swiss Joint Registry, Center for Infection Prevention and civil registry. Primary outcome was up to 10-year survival with or without PJI. Adjusted hazard ratios (aHR) were estimated via Gompertz regression, controlling for sex, age, BMI, and ASA. Pathogen-specific mortality hazard was analyzed.</div></div><div><h3>Results</h3><div>Of 215,678 patients, 89,709 met inclusion criteria (51.3% women; median age 69 years). PJI occurred in 745 (0.8%) patients, 2 752 (3.1%) underwent aseptic revision. PJI was associated with increased mortality (aHR 2.15; 95% CI, 1.79–2.57; p<0.001) compared to no PJI/revision, aseptic revisions were not (aHR 0.92; 95% CI, 0.80–1.06; p=0.27). Pathogens associated with increased mortality included Enterobacterales (aHR 3.17; 95% CI, 2.09–4.83, p<0.001), <em>Staphylococcus aureus</em> (aHR 2.32; 95% CI, 1.65–3.27; p<0.001), <em>Cutibacterium acnes</em> (aHR 2.31; 95% CI, 1.20–4.45; p=0.01), and coagulase-negative staphylococci (aHR 1.65; 95% CI, 1.16–2.35; p=0.006). Streptococcal infections showed no significant association (aHR 1.24; 95% CI, 0.62–2.49; p=0.54).</div></div><div><h3>Conclusion</h3><div>PJI following THA was associated with an approximately twofold increase in long-term mortality hazard. <em>C. acnes</em> presented an unexpectedly high mortality hazard.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"92 2","pages":"Article 106689"},"PeriodicalIF":11.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.jinf.2026.106683
Estela Giménez , María Ángeles Clari , Eliseo Albert , Nieves Carbonell , David Navarro
This study aimed to assess the association between bacterial loads as quantified by the BIOFIRE® Filmarray Pneumonia Plus Panel (FA-PP) and clinically significant bacterial cultures in different clinical settings, taking into account the type of sample processed and the bacterial targets detected. A comprehensive search was conducted of the PubMed, EMBASE, and Web of Science databases up to November 2024. Pooled odds ratios (ORs) for binned values in genome copies/ml (gc/ml)(104, 105, 106, and ≥107) and their respective 95% confidence intervals (95% CI) are reported throughout the study. Heterogeneity across studies was assessed using the I2 statistic. Twenty-three observational studies comprising a total of 4581 patients and 5147 respiratory samples were finally included in the meta-analysis. Overall, pooled ORs for clinically significant culture results were 4.30 (95% CI, 2.53–7.31; P < 0.001) for ≥107 gc/ml, 1.33 (95% CI, 0.70–2.56; P=0.39) for 106, 0.42 (95% CI, 0.20–0.90; P=0.03) for 105, and 0.15 (95% CI, 0.07–0.37; P < 0.001) for 104 gc/ml. Subgroup analyses conducted according to the type of respiratory sample, bacterial target, and hospital admission ward yielded rather similar conclusions. The heterogeneity across studies was very high (I2 >80%). Our analyses suggested that values ≥107 gc/ml may be considered reliable indicators of clinically significant bacterial infection. Conversely, 104 gc/ml values likely reflect colonization. Intermediate values (105–106 gc/ml) pose a greater interpretative challenge.
Importance
The FA-PP assay has emerged as an ancillary tool for diagnosing lower respiratory tract infections and adjusting empirical antimicrobial therapies; consequently, it is being increasingly requested by clinicians. The current study fills a critical gap in the interpretation of quantitative data returned by the FA-PP for nosocomial bacterial targets. Assessment of the clinical relevance of FA-PP binned gc/ml values seems mandatory for clinical and therapeutic decision-making processes in patients with severe community-acquired or nosocomial pneumonia. Our analyses showed that values ≥107 gc/ml are consistently associated with a high probability of culture positivity, regardless of the respiratory sample type and the bacterial target considered. In contrast, values of 104 gc/ml likely reflect colonization. Our study emphasizes the need for well-designed and homogeneous studies to gauge the clinical relevance of intermediate FA-PP binned values (105 and 106 gc/ml).
{"title":"Performance of the BIOFIRE® Filmarray Pneumonia Plus Panel for quantifiable bacterial targets compared to semiquantitative culture methods: A systematic review and meta-analysis","authors":"Estela Giménez , María Ángeles Clari , Eliseo Albert , Nieves Carbonell , David Navarro","doi":"10.1016/j.jinf.2026.106683","DOIUrl":"10.1016/j.jinf.2026.106683","url":null,"abstract":"<div><div>This study aimed to assess the association between bacterial loads as quantified by the BIOFIRE® Filmarray Pneumonia Plus Panel (FA-PP) and clinically significant bacterial cultures in different clinical settings, taking into account the type of sample processed and the bacterial targets detected. A comprehensive search was conducted of the PubMed, EMBASE, and Web of Science databases up to November 2024. Pooled odds ratios (ORs) for binned values in genome copies/ml (gc/ml)(10<sup>4</sup>, 10<sup>5</sup>, 10<sup>6</sup>, and ≥10<sup>7</sup>) and their respective 95% confidence intervals (95% CI) are reported throughout the study. Heterogeneity across studies was assessed using the I<sup>2</sup> statistic. Twenty-three observational studies comprising a total of 4581 patients and 5147 respiratory samples were finally included in the meta-analysis. Overall, pooled ORs for clinically significant culture results were 4.30 (95% CI, 2.53–7.31; <em>P</em> < 0.001) for ≥10<sup>7</sup> gc/ml, 1.33 (95% CI, 0.70–2.56; <em>P</em>=0.39) for 10<sup>6</sup>, 0.42 (95% CI, 0.20–0.90; <em>P</em>=0.03) for 10<sup>5</sup>, and 0.1<sup>5</sup> (95% CI, 0.07–0.37; <em>P</em> < 0.001) for 10<sup>4</sup> gc/ml. Subgroup analyses conducted according to the type of respiratory sample, bacterial target, and hospital admission ward yielded rather similar conclusions. The heterogeneity across studies was very high (I<sup>2</sup> >80%). Our analyses suggested that values ≥10<sup>7</sup> gc/ml may be considered reliable indicators of clinically significant bacterial infection. Conversely, 10<sup>4</sup> gc/ml values likely reflect colonization. Intermediate values (10<sup>5</sup>–10<sup>6</sup> gc/ml) pose a greater interpretative challenge.</div></div><div><h3>Importance</h3><div>The FA-PP assay has emerged as an ancillary tool for diagnosing lower respiratory tract infections and adjusting empirical antimicrobial therapies; consequently, it is being increasingly requested by clinicians. The current study fills a critical gap in the interpretation of quantitative data returned by the FA-PP for nosocomial bacterial targets. Assessment of the clinical relevance of FA-PP binned gc/ml values seems mandatory for clinical and therapeutic decision-making processes in patients with severe community-acquired or nosocomial pneumonia. Our analyses showed that values ≥10<sup>7</sup> gc/ml are consistently associated with a high probability of culture positivity, regardless of the respiratory sample type and the bacterial target considered. In contrast, values of 10<sup>4</sup> gc/ml likely reflect colonization. Our study emphasizes the need for well-designed and homogeneous studies to gauge the clinical relevance of intermediate FA-PP binned values (10<sup>5</sup> and 10<sup>6</sup> gc/ml).</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"92 2","pages":"Article 106683"},"PeriodicalIF":11.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.jinf.2025.106675
Umaporn Limothai , Nattachai Srisawat , David A. Haake
Leptospirosis is a globally prevalent zoonotic infection causing more than one million cases and nearly 60,000 deaths annually yet is often diagnosed late after organ dysfunction and other complications have arisen. Delayed diagnosis leads to late initiation of antibiotics and other therapeutic interventions, at which point complications such as renal failure, jaundice, or pulmonary hemorrhage are more common and therapy is less effective. This review highlights the critical importance of early recognition and intervention, emphasizing the therapeutic window during the leptospiremic phase when antibiotics are most effective. We examine the limitations of current clinical and laboratory diagnostic methods, the evolving role of molecular and biomarker-based platforms, and the potential of integrated scoring systems for frontline triage. Evidence supporting early antibiotic therapy, supportive care strategies, and severity prediction tools is summarized. We propose a paradigm shift toward field-adaptable, point-of-care diagnostics and integrated care pathways to ensure earlier treatment, improved outcomes, and reduced global disease burden.
{"title":"Early diagnosis and treatment of leptospirosis: Optimizing clinical outcomes","authors":"Umaporn Limothai , Nattachai Srisawat , David A. Haake","doi":"10.1016/j.jinf.2025.106675","DOIUrl":"10.1016/j.jinf.2025.106675","url":null,"abstract":"<div><div>Leptospirosis is a globally prevalent zoonotic infection causing more than one million cases and nearly 60,000 deaths annually yet is often diagnosed late after organ dysfunction and other complications have arisen. Delayed diagnosis leads to late initiation of antibiotics and other therapeutic interventions, at which point complications such as renal failure, jaundice, or pulmonary hemorrhage are more common and therapy is less effective. This review highlights the critical importance of early recognition and intervention, emphasizing the therapeutic window during the leptospiremic phase when antibiotics are most effective. We examine the limitations of current clinical and laboratory diagnostic methods, the evolving role of molecular and biomarker-based platforms, and the potential of integrated scoring systems for frontline triage. Evidence supporting early antibiotic therapy, supportive care strategies, and severity prediction tools is summarized. We propose a paradigm shift toward field-adaptable, point-of-care diagnostics and integrated care pathways to ensure earlier treatment, improved outcomes, and reduced global disease burden.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"92 2","pages":"Article 106675"},"PeriodicalIF":11.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.jinf.2026.106680
Matteo RICCO', Claudio COSTANTINO, Paolo MANZONI, Antonio BALDASSARRE, Gianluca Pasquale GIURI, Antonio CASCIO
{"title":"Respiratory syncytial virus and healthcare workers, an unmet need? Insights from SIREN study and systematic review of available evidence","authors":"Matteo RICCO', Claudio COSTANTINO, Paolo MANZONI, Antonio BALDASSARRE, Gianluca Pasquale GIURI, Antonio CASCIO","doi":"10.1016/j.jinf.2026.106680","DOIUrl":"10.1016/j.jinf.2026.106680","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"92 2","pages":"Article 106680"},"PeriodicalIF":11.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.jinf.2026.106688
Manon Jaboyedoff, Pierre Alex Crisinel, Zaba Valtuille, Inès Fafi, Margherita Plebani, Yves Fougère, Karim Abawi, Romain Basmaci, Naïm Ouldali, François Angoulvant
Background: Infections remain a leading cause of childhood mortality. Non-pharmaceutical interventions (NPI) implemented during COVID-19 pandemic altered the circulation of communicable pathogens. We aimed to assess how these changes affected paediatric infection-related mortality.
Methods: We conducted a population-based interrupted time-series analysis using national data from France and Switzerland (2015 to 2023), including deaths among individuals < 18 years. Monthly infection-related mortality was analysed using quasi-Poisson regression models seasonally adjusted. Mortality rate ratios (MRR) were calculated to compare infection-related mortality among birth cohorts exposed to NPI or post-NPI periods versus pre-NPI cohorts.
Results: Among 32,619 paediatric deaths during the study period, 8272 were related to an infection. During the NPI period, infection-related mortality declined by 16% (95% CI: -23% to -7%), corresponding to an estimated reduction of 221 (95% CI: 90 to 371) deaths. Compared to pre-NPI birth cohorts, 2019 and 2020 cohorts had significantly lower infection-related MRR (0·80, 95% CI 0·66 to 0·98 and 0·80, 95% CI 0·65 to 0·98).
Conclusion: The reduction in paediatric infection-related deaths during the NPI period underscores the ongoing burden of preventable paediatric mortality and suggests that targeted preventive strategies may sustainably reduce infection-related deaths beyond pandemic settings.
背景：感染仍然是儿童死亡的主要原因。在COVID-19大流行期间实施的非药物干预措施改变了传染性病原体的传播。我们的目的是评估这些变化如何影响儿科感染相关死亡率。方法：我们使用法国和瑞士的国家数据（2015年至2023年）进行了基于人群的中断时间序列分析，包括18岁以下个体的死亡。使用准泊松回归模型进行季节性调整，分析每月感染相关死亡率。计算死亡率比率（MRR）以比较暴露于新生儿感染新感染或新生儿感染后与新生儿感染前的出生队列的感染相关死亡率。结果：在研究期间的32,619例儿童死亡中，8272例与感染有关。在新方案实施期间，感染相关死亡率下降了16%(95%置信区间：-23%至-7%)，相当于估计减少221例死亡（95%置信区间：90至371）。与npi前出生队列相比，2019年和2020年队列的感染相关MRR显著降低（0.80,95% CI 0.66至0.98和0.80,95% CI 0.65至0.98）。结论：在新方案实施期间，儿童感染相关死亡的减少强调了可预防的儿童死亡率的持续负担，并表明有针对性的预防战略可以在大流行环境之外持续减少感染相关死亡。
{"title":"Infection-related mortality in children in two European countries, 2015 - 2023: an interrupted time-series analysis.","authors":"Manon Jaboyedoff, Pierre Alex Crisinel, Zaba Valtuille, Inès Fafi, Margherita Plebani, Yves Fougère, Karim Abawi, Romain Basmaci, Naïm Ouldali, François Angoulvant","doi":"10.1016/j.jinf.2026.106688","DOIUrl":"https://doi.org/10.1016/j.jinf.2026.106688","url":null,"abstract":"<p><strong>Background: </strong>Infections remain a leading cause of childhood mortality. Non-pharmaceutical interventions (NPI) implemented during COVID-19 pandemic altered the circulation of communicable pathogens. We aimed to assess how these changes affected paediatric infection-related mortality.</p><p><strong>Methods: </strong>We conducted a population-based interrupted time-series analysis using national data from France and Switzerland (2015 to 2023), including deaths among individuals < 18 years. Monthly infection-related mortality was analysed using quasi-Poisson regression models seasonally adjusted. Mortality rate ratios (MRR) were calculated to compare infection-related mortality among birth cohorts exposed to NPI or post-NPI periods versus pre-NPI cohorts.</p><p><strong>Results: </strong>Among 32,619 paediatric deaths during the study period, 8272 were related to an infection. During the NPI period, infection-related mortality declined by 16% (95% CI: -23% to -7%), corresponding to an estimated reduction of 221 (95% CI: 90 to 371) deaths. Compared to pre-NPI birth cohorts, 2019 and 2020 cohorts had significantly lower infection-related MRR (0·80, 95% CI 0·66 to 0·98 and 0·80, 95% CI 0·65 to 0·98).</p><p><strong>Conclusion: </strong>The reduction in paediatric infection-related deaths during the NPI period underscores the ongoing burden of preventable paediatric mortality and suggests that targeted preventive strategies may sustainably reduce infection-related deaths beyond pandemic settings.</p>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":" ","pages":"106688"},"PeriodicalIF":11.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.jinf.2026.106690
Xichi Tang , Ang Li , Leiliang Zhang
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Pub Date : 2026-01-08DOI: 10.1016/j.jinf.2026.106682
Sheila F. Lumley , Beatrice Kimono , Joseph Mugisha , Ronald Makanga , Moses Kwizera Mbonye , Kevin Ojambo , Elizabeth Waddilove , Chris Kent , Brian Ssengendo , Richard Ndungutse , Anna L. McNaughton , Florence Nambaziira Muzaale , Janet Seeley , Josh Quick , Ponsiano Ocama , Robert Newton , Philippa C. Matthews
Background
The World Health Organization (WHO) 2024 Hepatitis B virus (HBV) treatment guidelines expand eligibility for nucleos(t)ide analogue treatment in individuals with chronic HBV infection. For countries to implement these guidelines, there is a critical need to understand the population who are treatment eligible. While HBV drug resistance (HBVDR) is uncommon, monitoring for any potential resistance is a relevant public health consideration.
Methods
We studied a population in rural Uganda to describe the proportion of individuals eligible for treatment based on the 2024 WHO treatment guidelines. We determined how this proportion varies according to the eligibility criteria used, comparing the performance of different assessment tools. We calculated Aspartate Aminotransferase-to-Platelet Ratio Index; APRI, Gamma-Glutamyl Transpeptidase-to-Platelet Ratio; GPR and transient elastography; TE and performed HBV sequencing using Oxford Nanopore Technology to determine the prevalence of HBVDR in treatment naive and treatment experienced individuals.
Results
In this cohort, 24/63 (38%) individuals with CHB were eligible for treatment. This fell to 14/63 (22%) in a hypothetical scenario where TE was not available for the assessment of liver fibrosis. We demonstrate a lack of concordance between non-invasive tests (NIT) of liver disease in treatment-naive HBV mono-infected individuals. An APRI cut-off of 0.5 had a sensitivity of 23.0% for predicting a TE score of >7 kPa (F2 fibrosis). Sensitivity for detecting F2 fibrosis was increased to 38.5% using an APRI cut off of 0.36, and to 46.2% using the GPR. We did not identify any HBVDR in the HBV mono-infected treatment-naive population (n=58). 24/210 individuals were living with HIV/HBV coinfection; HBV was sequenced in 5 of these of whom 2 had genomic evidence of nucleos(t)ide analogue resistance (rt180M/204V).
Conclusions
While the WHO 2024 treatment criteria offer an opportunity to expand access to care, there is a need to determine how assessment tools differ in determination of eligibility in different settings. HBVDR remains uncommon but more research is needed to understand its prevalence and clinical impact in African populations.
{"title":"Eligibility for hepatitis B virus (HBV) treatment and prevalence of drug resistance in a Ugandan population cohort","authors":"Sheila F. Lumley , Beatrice Kimono , Joseph Mugisha , Ronald Makanga , Moses Kwizera Mbonye , Kevin Ojambo , Elizabeth Waddilove , Chris Kent , Brian Ssengendo , Richard Ndungutse , Anna L. McNaughton , Florence Nambaziira Muzaale , Janet Seeley , Josh Quick , Ponsiano Ocama , Robert Newton , Philippa C. Matthews","doi":"10.1016/j.jinf.2026.106682","DOIUrl":"10.1016/j.jinf.2026.106682","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization (WHO) 2024 Hepatitis B virus (HBV) treatment guidelines expand eligibility for nucleos(t)ide analogue treatment in individuals with chronic HBV infection. For countries to implement these guidelines, there is a critical need to understand the population who are treatment eligible. While HBV drug resistance (HBVDR) is uncommon, monitoring for any potential resistance is a relevant public health consideration.</div></div><div><h3>Methods</h3><div>We studied a population in rural Uganda to describe the proportion of individuals eligible for treatment based on the 2024 WHO treatment guidelines. We determined how this proportion varies according to the eligibility criteria used, comparing the performance of different assessment tools. We calculated Aspartate Aminotransferase-to-Platelet Ratio Index; APRI, Gamma-Glutamyl Transpeptidase-to-Platelet Ratio; GPR and transient elastography; TE and performed HBV sequencing using Oxford Nanopore Technology to determine the prevalence of HBVDR in treatment naive and treatment experienced individuals.</div></div><div><h3>Results</h3><div>In this cohort, 24/63 (38%) individuals with CHB were eligible for treatment. This fell to 14/63 (22%) in a hypothetical scenario where TE was not available for the assessment of liver fibrosis. We demonstrate a lack of concordance between non-invasive tests (NIT) of liver disease in treatment-naive HBV mono-infected individuals. An APRI cut-off of 0.5 had a sensitivity of 23.0% for predicting a TE score of >7 kPa (F2 fibrosis). Sensitivity for detecting F2 fibrosis was increased to 38.5% using an APRI cut off of 0.36, and to 46.2% using the GPR. We did not identify any HBVDR in the HBV mono-infected treatment-naive population (n=58). 24/210 individuals were living with HIV/HBV coinfection; HBV was sequenced in 5 of these of whom 2 had genomic evidence of nucleos(t)ide analogue resistance (rt180M/204V).</div></div><div><h3>Conclusions</h3><div>While the WHO 2024 treatment criteria offer an opportunity to expand access to care, there is a need to determine how assessment tools differ in determination of eligibility in different settings. HBVDR remains uncommon but more research is needed to understand its prevalence and clinical impact in African populations.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"92 2","pages":"Article 106682"},"PeriodicalIF":11.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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