New Microbiologica最新文献

We present the case of a 47-year-old man living with HIV who had experienced fever, night sweats, cough and occasional haemoptysis for the previous two months. Computed tomography of the chest revealed a lesion measuring 57 mm in diameter with cavitation in the left lower superior segment. His CD4+ T cell count was 220 cells/mm³ and his HIV RNA level was 406,756 copies/ml. Acid-resistant coccobacilli were isolated from the transthoracic biopsy of the lesion and were initially identified as Mycobacterium lentiflavum. However, 16S rDNA sequence analysis identified it as Rhodococcus equi. A histopathological examination revealing malakoplakia with Michaelis-Gutmann bodies supported the diagnosis. The patient responded dramatically to a 3-month course of treatment with azithromycin and moxifloxacin. The most obvious epidemiological risk factor in this case was that the patient regularly took care of multiple stray cats. Rhodococcus equi should be considered in differential diagnosis of cavitary pneumonia in patients with cellular immunodeficiencies, especially when there is a contact history not only with horses, but with other herbivores.

Recent European winter seasons have been characterized by the simultaneous circulation of influenza A virus, SARS-CoV-2, respiratory syncytial virus, Mycoplasma pneumoniae, and an unusual rise in group A streptococcal infections, including invasive disease. This overlap has transformed seasonal influenza from a largely predictable event into a complex clinical and epidemiological scenario where viral-bacterial interactions amplify disease severity, extend risk to previously healthy individuals, and stress both surveillance and diagnostic systems. We analyse this evolving landscape through an integrated One Health perspective, examining how local epidemiology, rapid multiplex diagnostics, adaptive antimicrobial stewardship, occupational health surveillance, and infection-prevention-oriented architectural design converge to mitigate the impact of overlapping respiratory epidemics. Such multidimensional preparedness is essential to prevent avoidable mortality, protect healthcare workers, and ensure the resilience of healthcare infrastructures facing concurrent viral and bacterial outbreaks.

During the early phase of the COVID-19 pandemic in Saudi Arabia, sero-epidemiological studies focused primarily on healthcare workers and blood donors, leaving significant gaps in understanding risk factors for other vulnerable groups. This study aimed to assess the seroprevalence of COVID-19 among sanitation and janitorial workers. A total of 2,597 serum samples were analyzed, including 1,279 from sanitation and janitorial workers, collected from 1 April to 30 June 2020, and 1,318 samples collected from healthy blood donors from 1 April to 5 August 2020 as a control group. The seroprevalence of COVID-19 antibodies was higher among sanitation and janitorial workers: 32.21% (412/1,279) compared to 4.78% (63/1,318) in the blood donor control group. Sanitation and janitorial workers had a markedly higher likelihood of contracting COVID-19 (odds ratio = 0.11, 95% CI=0.08011-0.1397, p<0.0001). A minor but statistically significant effect of gender was observed, with males showing higher susceptibility (odds ratio = 1.74, 95% CI = 1.162-2.660, p = 0.01), while nationality had no significant impact on seroprevalence rates (odds ratio = 0.94, 95% CI = 0.6705-1.323, p=0.8). This study highlights sanitation and janitorial workers as a high-risk group for COVID-19, reporting the highest seroprevalence rate locally during the early pandemic phase.

Understanding immune responses to SARS-CoV-2, particularly the dynamics of natural versus hybrid immunity (infection plus vaccination), is essential for shaping public health strategies. A prospective cohort of 171 adults with mild to moderate COVID-19 was followed from February to July 2021. Participants were grouped as having natural (without COVID-19 vaccination, n=129) or hybrid (vaccinated before and/or after infection, n=42) immunity. Anti-RBD IgG and neutralizing antibodies were measured at the 1st, 3rd, and 6th months. ROC analysis identified an IgG cut-off to predict neutralizing antibody positivity. Reinfections were monitored for 12 months. Hybrid immunity was associated with significantly higher IgG levels across all time points. IgG and NAb levels were strongly correlated (r=0.86 at 1st, r=0.80 at 3rd month). An IgG threshold of 303.8 AU/mL predicted NAb positivity with 91.9% sensitivity and 90% specificity. Reinfection occurred in 4.6% of participants during the Omicron wave, often despite high antibody levels. An IgG level ≥303.8 AU/mL is a strong predictor of NAb positivity and can serve as a practical surrogate marker of functional immunity, especially where neutralization testing is unavailable. Reinfections despite high IgG/NAb levels highlight the limitations of static thresholds, particularly against different variants.

Malaria remains a significant global health challenge, disproportionately affecting Sub-Saharan Africa. Pregnant women represent one of the most vulnerable populations. Despite numerous advances in malaria control measures, lost-to-follow-up (LTFU) in antenatal care (ANC) programs poses a critical barrier to achieving optimal maternal and neonatal outcomes and the success of public health interventions. The factors driving LTFU, particularly in rural, high-burden settings, are not completely understood. This study investigates the determinants of LTFU among pregnant women receiving malaria screening in the context of the ERASE-Rise Against Malaria project in Northern Uganda. An observational retrospective cohort study was conducted on 1,558 women, recruited from July 2022 to June 2024, during the operational research held to assess the impact of antimalarial resistance on malaria care among pregnant women in three healthcare facilities in Oyam and Kole districts. Data on individual level (sociodemographic and clinical) and health care-related factors were analyzed using a multilevel logistic regression model to identify predictors of LTFU, defined as the absence of cohort outcome data 30 days after the expected delivery date. Efforts to recover missing data included delivery register consultation, active phone calls, and contact tracing by village health team workers. 871 (55.9%) of the 1,558 women were LTFU. Recovery strategies reduced the missing data rate to 29.1% (n=454). Protective factors against LTFU included higher education (aOR=0.75, 95% CI: 0.54-1.03, p=0.0798), being primigravida (aOR=0.73, 95% CI: 0.56-0.97, p=0.0275), and experiencing malaria during pregnancy (aOR=0.61, 95% CI: 0.48-0.78, p<0.0001). Women attending Aboke Health Center IV (n=385) were over five times more likely to be LTFU than those at Aber Hospital (n=955) (aOR=5.57, 95% CI: 4.08-7.71, p<0.0001), highlighting significant geographic and structural barriers. The high rate of LTFU in malaria screening programs underscores the need for targeted interventions addressing individual, systemic and structural barriers. Strengthening community-level support, improving healthcare infrastructures, and integrating malaria prevention into broader maternal health services are crucial for enhancing retention in care. Addressing determinants of LTFU, systematically, through further qualitative and quantitative research, is essential to improving maternal and neonatal health outcomes and achieving malaria eradication goals in high-burden settings.

Persistent low-level viremia (LLV) in heavily treatment-experienced (HTE) people with HIV (PWH) harboring multidrug-resistant virus remains a challenging clinical scenario. We report two cases from the PRESTIGIO Registry of individuals with longstanding HIV infection, high cumulative genotypic resistance, and sustained LLV despite no current adherence issues. In both cases, a regimen confidently containing ≥2 fully active agents was not achievable without incorporating entry and/or capsid inhibitors. Through these cases, we highlight diagnostic and therapeutic uncertainties in the management of LLV, including: the unfeasibility of RNA-based genotyping, the limited availability of data on resistance assessment by DNA-based genotypic testing, and the possibility that such viremia stems from clonal viral production rather than active replication. Although both individuals maintained a stable immune profile and low transmission risk, these cases underscore the need for tailored guidance in managing LLV in HTE PWH.

Stenotrophomonas maltophilia is an emerging, multidrug-resistant pathogen increasingly associated with nosocomial infections, particularly in immunocompromised patients such as those undergoing allogeneic hematopoietic stem cell transplantation or affected by oncological diseases. Therapeutic options are limited due to intrinsic and acquired resistance mechanisms, including β-lactamases and efflux pumps. Although minocycline and trimethoprim-ulfamethoxazole are standard treatments, recent evidence suggests that eravacycline, a novel fluorocycline, may be effective in vitro, though clinical data remain scarce. Two cases of S. maltophilia bloodstream infection (BSI) in immunocompromised patients were reviewed. Both patients received eravacycline as part of combination therapy, following microbiological identification of the pathogen. Clinical course, microbiological outcomes, and antibiotic regimens were analyzed. Both patients, affected by acute myeloid leukemia and cholangiocarcinoma, developed S. maltophilia BSI after prolonged exposure to broad-spectrum antibiotics. Eravacycline (1 mg/kg every 12 hours) was included in both regimens. Blood cultures cleared within 48 hours in both cases. One patient died due to fungal complications, but S. maltophilia BSI was microbiologically controlled in both. These findings suggest a potential role for eravacycline in treating S. maltophilia BSI when standard options are limited. Further clinical studies are needed to establish efficacy and appropriate therapeutic use.

Fungal infections pose a growing threat in hospital settings, particularly among critically ill or immunocompromised patients. A multidisciplinary consensus among fifteen clinical experts from Northern Italy examined the increasing challenge of invasive fungal infections, especially in patients with high-risk complications and in critical settings. The report emphasizes early diagnostic integration through clinical assessment, biomarker evaluation, and the essential role of therapeutic drug monitoring in optimizing outcomes. This consensus aims to consolidate clinical strategies for timely diagnosis, personalized pharmacologic intervention, and antifungal stewardship. Azoles are identified as first-line treatment options. Isavuconazole emerged as a preferred therapeutic agent due to its favorable pharmacokinetic profile, safety in renal impairment, and lack of QT interval prolongation. This consensus supports integrated strategies combining early recognition, rapid diagnostics, individualized pharmacology, and antifungal stewardship to improve outcomes, particularly in critical care settings.

Objectives: This retrospective observational study assesses adherence to antiretroviral therapy before and after the transition to pharmacy-based treatment dispensation.

Methods: Two 14-month periods were identified: before (P1) and after (P2) the transition to pharmacy-based provision of antiretrovirals. P2 also coincided with the SARS-CoV-2 pandemic. Adherence was assessed using a mathematical index to estimate the delay in refilling medication (delay index Di).

Results: 1,266 people with HIV were included. Higher values of Di were found to be associated with P2 (ß 0.17, 95%CI 0.04-0.07), primarily driven by a significant delay in the initial months of the SARSCoV-2 pandemic in Italy, with Di +0.051 ± 0.13 from March to May 2020 vs. Di +0.048 ±0.12 in the rest of P2. Higher Di was also associated with multi-tablet regimens (ß 0.06, 95%CI 0.006-0.03), whereas switching regimens was associated with lower Di (ß -0.06, 95%CI -0.07-0.04). The odds of HIV RNA>50 copies/mL were higher with higher Di (OR 2.78; 95%CI 1.14-6.75), but lower in P2 compared to P1 (OR 0.38; 95%CI 0.27-0.53).

Conclusions: Despite an apparent adherence decline due to delays in treatment refills during the first months of the SARS-CoV-2 pandemic, the transition to pharmacy-based antiretrovirals supply was associated with lower frequency of uncontrolled HIV replication.

We report a rare case of tertiary syphilis in a pregnant woman, presenting with cutaneous gumma and ocular involvement. This case highlights the diagnostic challenges of atypical syphilitic lesions and emphasizes the importance of considering syphilis in the differential diagnosis of facial skin lesions during pregnancy.