Abstract: Tuberculosis (TB) remains one of the leading causes of death from a single infectious agent worldwide, particularly aggravated by HIV co-infection and the increasing burden of drug-resistant strains. This review provides a comprehensive overview of current la-boratory diagnostic methods for active and latent TB, emphasizing their clinical applica-bility across different healthcare settings, diagnostic performance, and implementation in integrated testing workflows. Conventional methods, such as smear microscopy and cul-ture, are discussed alongside modern diagnostic approaches, including automated nucle-ic acid amplification tests (NAATs), loop-mediated isothermal amplification (LAMP), line probe assays (LPA), next-generation sequencing (NGS), and lateral flow assays for the di-agnosis of TB in specific clinical contexts. The strengths and limitations of each method are critically evaluated according to infrastructure level, resource availability, and epide-miological scenario. While traditional techniques remain useful in selected settings, mo-lecular technologies provide higher sensitivity, shorter turnaround times, and expanded capacity for drug resistance detection. The integration of complementary diagnostic strat-egies into hybrid testing algorithms is essential to optimize resource use, ensure diagnos-tic accuracy, promote equitable access, and enable early treatment initiation, thereby sup-porting effective TB control.

Abstract: Patients with End-Stage Renal Disease on hemodialysis (HD) are at high risk for severe influen-za, and their underlying immune dysfunction may limit the magnitude of vaccine-induced pro-tection. This observational study evaluated the immune response in 93 hemodialysis patients vaccinated with the seasonal inactivated influenza vaccine (IIV) across the 2019-2020 (n=22) and 2023-2024 (n=71) seasons. Immune response was comprehensively assessed by measuring hemagglutina-tion inhibition (HAI) and neutralizing antibody titers and by analyzing the frequencies of key immune cells, including plasmablasts, T-follicular helper cells (Tfh), and effector memory T cells (Tem). The results of observation in 2019-2020 showed that the antibody response in HD patients was comparable to that of healthy volunteers, including both younger (18-60) and older (over 60) age groups. By day 7, there was a pronounced increase in activated Tfh1 cells, a corresponding surge in plasmablasts, and a rise in antigen-specific B-cells. A T-cell response followed, mediated by IFNγ-producing and polyfunctional CD4+ effector memory T cells. Subsequent vaccination in 2023-2024 season determined a higher baseline level of the antibody response but did not affect its further dynamics in case of A/H1N1pdm, A/H3N2, B/Yamagata virus antigens. The response to B/Victoria was higher in the revaccinated group throughout the entire observation period. Our findings confirm that standard-dose IIV vaccination is beneficial for HD patients, inducing a robust and compliant humoral and T-cell immune response that is not inferior to that of the general population.

Abstract: This study aimed to investigate the protective effect of Changchun Baike varicella vaccine in Yanji City from 2018 to 2024. Varicella surveillance data from 2018 to 2024 and vaccination records from 2018 to 2020 were collected from the China Disease Prevention and Control Information System and analyzed. In total, 2,452 varicella cases were reported in Yanji from 2018 to 2024, with an average annual incidence rate of 62.71 per 100,000 population. Notably, the annual incidence rates decreased from 142.37 per 100,000 in 2018 to 55.25 per 100,000 population in 2024. Additionally, the highest and lowest incidence rates were observed in the 10–14 and ≥ 40 years age groups, respectively. Moreover, Changchun Baike varicella vaccine showed protective efficacies of 98.0–99.0% and 99% for the first and second doses, respectively, from 2018 to 2024. Importantly, the two-dose varicella vaccination schedule demonstrated superior protective efficacy compared with the single-dose schedule.

Abstract: Background and aim: Staphylococcus aureus nasal carriage is an important source of community- and hospital-associated infections, including methicillin-resistant strains (MRSA). Detecting MRSA colonization is essential for infection prevention and may help guide antimicrobial therapy. This study aimed to determine the prevalence of nasal colonization by S. aureus and assess methicillin and glycopeptide resistance patterns in hospital and non-hospital settings in Maputo, Mozambique. Methods: This is a cross-sectional study was conducted among symptomatic outpatients and asymptomatic university students. Nasal specimens were cultured on Mannitol Salt and HiCrome™ Rapid MRSA agar, with isolates identified by Gram stain, catalase, and Microgen^® Staph tests. Antimicrobial susceptibility to cefoxitin, vancomycin, and teicoplanin was assessed using the Kirby-Bauer method. Results: A total of 50 (39.1%) S. aureus isolates were obtained from 128 collected nasal samples, in which 104 (31.3%) were from university students and 24 (7.8%) from outpatient’s form university clinic. The isolates showed a low overall 7.8% resistance to cefoxitin and, 14.1% and 11.7% presumptive resistance to teicoplanin and vancomycin, respectively. Conclusion: Methicillin and glycopeptide resistant S. aureus were highly prevalent in asymptomatic students. These observations call for strategies to prevent S. aureus spread to more vulnerable populations where the consequences can be severe.

Abstract:

The COVID-19 pandemic has disrupted both health and occupational functioning for people with multiple sclerosis (PwMS). This review synthesizes evidence from 51 studies (18,379 PwMS) on psychological, social, and work-related outcomes during the pandemic. Findings indicate elevated depression and stress, variable anxiety, and substantial employment disruption, including job loss, reduced hours, and shifts to remote work. Socioeconomic stressors compounded these effects, while workplace accommodations were rarely assessed. Evidence gaps remain regarding occupation-specific hazards, lived experiences, and long-term outcomes. These results underscore the need for disability-inclusive employment policies, mental-health support, and longitudinal research to guide interventions for PwMS in crisis contexts.

Abstract: In the context of a rapidly spreading pandemic, early detection of active infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains essential to break the chain of transmission and limit associated complications. In the Democratic Republic of the Congo (DRC), access to nucleic acid amplification tests (NAATs), such as RT-PCR, remains limited due to logistical, technical, and financial constraints. The introduction of rapid antigen diagnostic tests (RATs) represented a major advance in strengthening diagnosis. We conducted a descriptive cross-sectional study in Kinshasa to assess the operational and epidemiological contribution of RATs in detecting active SARS-CoV-2 infection. Two approved antigen tests (Panbio™ from Abbott and Standard Q™ from SD Biosensor), validated by the World Health Organization (WHO), the High Authority of Health (HAH) internationally and locally by the Institut National de Recherche Biomédicale (INRB). A total of 111,278 people suspected of infection were tested during the study period. Of these, 56,846 (51.1%) were diagnosed by RT-PCR, with a positivity rate of 30.2%, while 54,432 (48.9%) were tested by RATs, with a positivity rate of 16.8%. The male gender represented 59 780 (53,7%) and the female gender 51 498 (46,3%), with the estimated mean age at 36.9±15.9 years. The age group ≤ 21 years had the highest rate (19.1%), with a tendency for positivity to increase with age. Females had a slightly higher positivity rate than males (17.1% vs. 16.4%). All Health Zones in Kinshasa had deployed RATs, with the Barumbu Health Zone showing the highest positivity rate (37.8%). Fever (≥ 38°C) was the symptom most frequently associated with RATs positivity (16.5%). All other symptoms, including close contact with a confirmed case, showed a significant association with positivity, with the exception of cough and dyspnea. RATs played a key role in the detection of SARS-CoV-2 during the third and fourth epidemic waves, complementing RT-PCR. These results highlight the relevance of their use in resource-limited settings to improve rapid detection and guide response strategies to emerging or re-emerging respiratory epidemic threats.

Abstract: Drug-resistant tuberculosis (DR-TB) represents a major public health threat, particularly in the prisons of Latin America and the Caribbean, where rates are up to 40 times higher than those observed in the general population. These facilities act as community amplifiers due to overcrowding, poor ventilation, diagnostic delays, and treatment discontinuity. This study offers a critical reflection on the magnitude, determinants, and implications of DR-TB in regional penitentiary contexts. An analytical review was conducted in PubMed, Scopus, Web of Science, SciELO, and LILACS, complemented by WHO and PAHO reports, prioritising studies from 2019 to 2024. The findings reveal MDR-TB and pre-XDR outbreaks in Peru, Paraguay, and the Dominican Republic, as well as community transmission linked to prisons in Brazil and Colombia. Persistent gaps remain in systematic screening, drug susceptibility testing coverage, and post-release follow-up. Scientific production continues to be uneven and predominantly biomedical, with limited consideration of social and human rights determinants. DR-TB in prisons reflects the structural deficiencies of health and justice systems; its control requires intersectoral policies, genomic surveillance, and strategies that ensure early diagnosis, treatment continuity, and dignified detention conditions.

Abstract: (1) Background: Antimicrobial resistance (AMR) is a global health threat, increasing morbidity, mortality, and healthcare costs. Multi-drug resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae) cause most hospital-acquired infections. Local data on their resistance profiles remain limited in low-income settings. This study assessed the prevalence and resistance patterns of ESKAPE pathogens isolated from clinical specimens at Rwanda Military Referral and Teaching Hospital. (2) Methods: A descriptive cross-sectional study was conducted from June 2022 to January 2023. ESKAPE isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix M50 System. Data on sample type, ward, and demographics were analyzed. (3) Results: Of 744 bacterial findings, 207 (30%) were ESKAPE isolates. After excluding duplicates and non-recovered isolates, 156 were analyzed. Klebsiella pneumoniae was most common (41%), followed by Staphylococcus aureus (27%), Acinetobacter baumannii (13%), Pseudomonas aeruginosa (11%), and Enterobacter cloacae (8%); no Enterococcus faecium was detected. Among Gram-negatives, 63% were resistant to third-generation cephalosporins and 32% to carbapenems, with A. baumannii showing highest resistance (85% and 75%). MRSA prevalence was 7%. (4) Conclusions: This first hospital-based study in Rwanda shows high cephalosporin and carbapenem resistance, highlighting the need to strengthen diagnostics and stewardship.

Abstract: Background: Methamphetamine (MA) use in people living with HIV (PLWH) has been linked to neurocognitive and behavioral dysregulation. We hypothesized that PLWH with active MA use (MAHIV) would show poorer cognitive performance, greater emotional and sleep burden, higher behavioral risk, and alterations in circulating bi-omarkers of immune activation and neuronal injury, relative to PLWH without MA use and HIV-negative controls. Methods: Cross-sectional analytic study of 121 adults: PLWH with methamphetamine use (MAHIV, n=40), PLWH without use (n=42), and HIV-negative controls (n=39). Outcomes were ART discontinuation, physical activity, neurocognition (MoCA), depression (BDI), anxiety (GAD-7), sleep (PSQI), and sub-stance use (ASSIST). Circulating biomarkers measured by ELISA: sCD14, neuron-specific enolase (NSE), S100B, and neurofilament light chain (NfL). Results: MAHIV participants had more frequent ART discontinuation than PLWH and the lowest physical activity. Chemsex with polysubstance use, condomless sex, and multiple partners were most prevalent in MAHIV. This group showed the highest anxiety and depressive burdens, and the greatest sleep disturbances. Global cognition (MoCA) was lowest in MAHIV, with significant deficits in executive function, memory, atten-tion, and language; 82.5% had at least mild cognitive impairment. sCD14 was significantly higher in MAHIV than in PLWH and controls, and NSE was elevated in both MAHIV and PLWH versus controls. sCD14 correlated inversely with MoCA and posi-tively with GAD-7 and BDI-II. Conclusions: Among PLWH, MA use is associated with greater ART nonadherence, syndemic mental-health and sleep disturbances, broader neurocognitive deficits, and elevations in circulating sCD14 and NSE. The sCD14–cognition and sCD14–mood relationships highlight chronic immune activation as a candidate pathway for neurocognitive and affective impairment and support sCD14 and NSE as potential stratification and monitoring biomarkers in MA-using PLWH.

Abstract: Background: Antimicrobial resistance (AMR), particularly due to extended-spectrum beta-lactamases (ESBL), is a growing threat in sub-Saharan Africa. This study investigates the prevalence, epidemiological characteristics, resistance patterns and over time resistance dynamics of ESBL-producing non-typhoidal Salmonella (NTS) bacteremia in Kisantu, Democratic Republic of Congo (DRC), from 2019 to 2022. Methods: A retrospective observational study used routine bloodstream infection data from the AMR network at Saint Luc Hospital in Kisantu. Blood cultures from suspected bacteremia cases were processed using standard microbiological techniques. Bacterial identification relied on biochemical reactions. Antibiotic susceptibility testing and ESBL-NTS detection were performed by disk diffusion following Clinical and Laboratory Standards Institute guidelines. Quarterly temporal trends in ESBL-positive NTS were evaluated using logistic regression. Results: Of 19,430 blood cultures, 1,681 NTS isolates were identified, 1,568 were screened for ESBL. ESBL production was detected in 1,184 isolates (75.5%), mostly from children under 5 years (1,098/1,184; 92.7%), including nearly 72% under 24 months. ESBL prevalence increased significantly over time (β = 0.139, OR = 1.15, 95% CI: 1.11–1.19, p < 0.001), rising from 14.3% in Q (Quarter) 1 2019 to 95.3% in Q3 2022. High levels of extensively drug-resistant (94.1%) and pan-drug-resistant (6.3%) isolates were observed. No carbapenem resistance was detected, and azithromycin resistance remained low (6.4%). Conclusion: ESBL-producing NTS bacteremia is rising in Kisantu, RDC, manly affecting children under 5 years. Rising resistance to key antibiotics limits treatment options and highlights the need for strengthened AMR surveillance, optimized antibiotic use, and vaccination strategies.

Abstract:

This study investigates potential associations between aluminum-adjuvanted childhood vaccines and inflammatory conditions using population-level data from the National Survey of Children's Health (NSCH) 2020-2023 and the CDC National Immunization Survey (NIS) 2011-2017. By joining datasets across 50 U.S. states and the District of Columbia for birth years 2011-2017, we analyzed vaccine uptake probabilities as proxies for aluminum exposure and prevalences of autism (3.7%), allergies (26.1%), ADHD (8.1%), asthma (8.4%), epilepsy (0.94%), obesity (4.9%), and Tourette’s syndrome (0.21%), with blood disorders (0.46%) as a negative control.Methods involved calculating disease prevalence, disease correlations, and linear regressions between vaccine likelihoods (DTaP, HepB, Hib, PCV, Polio) across age windows (0-36 months) and outcomes.Results revealed strong positive correlations among inflammatory conditions (r=0.19-0.62, p<0.001) but none with blood disorders. Aluminum exposure proxies during 6-12 months forecasted higher disease prevalence (p<0.05), with nonlinear patterns including sign reversals across time periods, consistent with NLRP3 inflammasome's two-step activation threshold.These findings suggest aluminum adjuvants may contribute to NLRP3-mediated inflammation in susceptible populations, warranting further mechanistic and prospective studies to optimize vaccination strategies and explore inflammasome-targeted therapies for reducing chronic childhood disease burdens.

Abstract: COVID-19 has been associated with neurological and psychiatric manifestations, both at disease onset and post-infectious sequelae, most commonly anxiety, depression, and sleep disturbances. Previous pandemics suggest potential for long-term neuropsychiatric consequences. We conducted a prospective study in patients hospitalized with non-critical COVID-19, evaluating symptoms using validated psychometric instruments at discharge, after 3–6 and 12 months post-infection. Additionally, a four-year follow-up was performed through telephone interviews, to document newly diagnosed psychiatric disorders and mortality. At baseline, 22% of patients reported anxiety, 8% depression, and 16% poor sleep. Most symptoms improved within the first year, particularly during the first 3–6 months. At four-year follow-up, mortality reached 5%, while clinician-diagnosed psychiatric disorders increased to 6% for anxiety, 11% for depression, and 3% for mixed disorders. Anxiety and poor sleep—but not depression—were associated with the severity of the acute episode. Overall, post-COVID-19 anxiety, depression, and sleep disturbances were more prevalent than in the general population, though rates were lower than reported in other studies. Most symptoms resolved within the first year. However, new-onset cases of depression and other psychiatric disorders emerged during long-term follow-up, suggesting distinct trajectories of post-COVID psychiatric morbidity.

Abstract:

Background: Immunomodulatory therapies, including biologics, JAK inhibitors, immune checkpoint inhibitors (ICIs), and bispecific antibodies (BsAbs), have reshaped the treatment of autoimmune diseases and malignancies. They alter host defenses, but the current landscape of associated infectious risk is not fully defined. Objective: I conducted a scoping review of recent literature to characterize infectious complications associated with modern immunomodulatory drugs, summarize current pathogen patterns, and highlight recommendations for prevention and early recognition in clinical practice. Methods: Following PRISMA-ScR guidelines, I systematically searched Scopus, Science Direct, and PubMed for studies published since 2023. Inclusion criteria focused on adult human subjects, exposure to immunomodulatory therapy, and reported infectious outcomes. After screening 1,046 unique records, 24 studies were included in the final review. Findings: High-dose glucocorticoids remain a primary driver of serious infections across autoimmune diseases. Newer agents present mechanism-specific risk profiles. JAK inhibitors are associated with herpes zoster, while TNF-α inhibitors are linked to opportunistic bacterial infections and reactivation of granulomatous infections. B-cell depletion with rituximab correlates with hypogammaglobulinemia and its associated infections, whereas belimumab may offer a lower infection risk in non-renal SLE. In oncology, bispecific antibodies have a high incidence of severe infections, driven by neutropenia and hypogammaglobulinemia. Immune checkpoint inhibitors were associated with a 26.9% serious infection rate, with complications difficult to distinguish from immune-related adverse events. Conclusion: The infectious risk associated with modern immunomodulators is not one profile, but a spectrum of specific vulnerabilities. This review shows the urgent need for individualized risk stratification, targeted prophylaxis (e.g., for Pneumocystis or zoster), and pre-therapy screening to balance therapeutic efficacy with patient safety.

Abstract:

Background/Objective: High-risk Human papillomavirus (hrHPV) is the leading cause of premalignant lesions and cervical cancer (CC), affecting disproportionally women living with HIV. Mozambique is among the countries with a heavy triple-burden of HIV, hrHPV infections and CC which accounts for more than 5300 new cases and 3800 deaths each year. In this study, we assessed the age-specific distribution and factors associated with hrHPV and cervical lesions among HIV-positive and -negative women from HPV-ISI (HPV Innovative Screening Initiative) study in Maputo, Mozambique. Methods: This cross-sectional study included 1,248 non-pregnant women aged ≥18 years who attended CC screening at the DREAM Sant’Egídio Health Center between July 2021 and April 2022. Screening involved visual inspection with acetic acid (VIA) and high-risk HPV DNA testing. Sociodemographic, lifestyle, and reproductive data were collected through a routine questionnaire. Logistic regression assessed associations between risk factors and hrHPV infection or cervical lesions. Age-specific hrHPV prevalence, partial HPV16/18 genotyping, and abnormal cytology rates were further analyzed by HIV status. Results: The mean age was 43.0±8.6 years. The hrHPV prevalence was 28%, higher in HIV-positive (46.8%) than HIV-negative (23.8%) women. Non-16/18 hrHPV types predominated across all ages. VIA positivity was 11.1%, mostly involving <75% cervical area, and was more frequent in younger (30–45 years) and HIV-positive women. Older age (OR 0.98, 95% CI 0.97–1.00, p=0.017) and higher parity (≥3 vs nulliparous: OR 0.58, 95% CI 0.36–0.94, p=0.029) showed protective effects against hrHPV infection. Contraceptive use (OR 1.65, 95% CI 1.15–2.38, p=0.007) and partially/non-visible SCJ (OR 2.88, 95% CI 1.74–4.79, p<0.001) were associated with VIA positivity. Conclusions: hrHPV infection and cervical lesions were more frequent in younger and HIV-positive women, highlighting the need for strengthened targeted screening within HIV care services in Mozambique.

Abstract: Background/Objectives: Next to malaria, respiratory viruses, particularly respiratory syncytial virus (RSV), are responsible for the hospitalization and death of thousands of young children each year in sub-Saharan Africa. During peak seasons, conducting separate tests is time-consuming and distressing. This underscores the need for efficient, rapid multiplexed diagnostic tools. This study evaluated the clinical performance of a lateral flow assay (LFA) based antigen combo rapid diagnostic test (ML Ag Combo RDT, manufactured by MobiLab) that detects RSV, influenza A and B, and SARS-COV-2. Methods: The Allplex rRT-qPCR assay was used as a reference assay to evaluate the clinical performance of the LFA Ag Combo RDT in pediatric hospital settings and performed using 470 nasopharyngeal swab (NPS) specimens from hospitalized children under two with respiratory symptoms. Results: Based on the comparative analysis of the testing results for 470 NPS, the ML Ag Combo RDT demonstrated high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90.06%, 98.33%, 93.45%, and 97.38% for RSV, and 71.43%, 100%, 100%, and 92.94% for influenza A/B, respectively. Agreement with the Allplex rRT-qPCR was strong (κ = 0.90 for RSV and 0.82 for Flu A/B), with overall accuracies of 96.60% for RSV and 94.47% for Flu A/B. This was further supported by ROC analysis for aggregated data (RSV and Flu) with an AUC value of 0.925. As expected, in samples with high viral loads (Ct < 20), the Ag Combo RDT achieved 100% sensitivity for RSV and Flu A/B. Sensitivity declined slightly at lower viral loads (Ct > 35). Conclusions: The ML Ag Combo RDT demonstrates high specificity and strong diagnostic accuracy for the detection of RSV and Flu A/B in pediatric hospital settings, where timely diagnosis is critical.

Abstract: Background: Cancer patients are particularly vulnerable to severe outcomes from COVID-19 due to immune suppression, treatment effects, and comorbidities. This population-based study aimed to assess how vaccination, circulating variants, and comorbidities influenced infection and severe disease risks in cancer patients compared with the general population in northern Italy. Methods: The study included 538,516 residents of Reggio Emilia Province, Italy, alive on 20 February 2020, followed until 30 September 2022. Cancer diagnoses (1996–2021) were obtained from the Reggio Emilia Cancer Registry and linked with COVID-19 surveillance, vaccination, hospitalization, and mortality data. Vaccination and prior infection were modeled as time-dependent variables. Hazard ratios (HRs) and odds ratios (ORs) were estimated using Cox and logistic regression models adjusting for sex, age, and comorbidities. Results: Among 33,307 residents who had cancer, 9,135 SARS-CoV-2 infections were recorded. Infection risk was similar to the general population before Omicron (HR 1.00; 95% CI 0.96–1.05) and slightly higher during Omicron (HR 1.08; 95% CI 1.05–1.11). Cancer patients showed higher probability of severe disease once infected (OR 1.33 pre-Omicron; 1.67 Omicron), with the greatest excess in recent diagnoses. Vaccination substantially reduced infection and severe outcomes in both groups in the pre-omicron period; while only hybrid immunity reached high protection from omicron infection. Conclusions: Vaccine was effective in the populations with and without cancer; hybrid immunity conferred the strongest protection. However, because cancer patients, especially those recently diagnosed, retain higher baseline risk of severe disease, vaccination yields even greater individual and public health benefits..

Abstract: Background: Asymptomatic bacteriuria (ASB) is frequently overtreated in emergency departments (ED), contributing to antimicrobial resistance without improving clinical outcomes. Rapid decision-making and high patient turnover in the ED increase the risk of unnecessary antibiotic use. Methods: A quasi-experimental study was conducted in the ED of a tertiary hospital in Barcelona, Spain, from January 2024 to June 2025. The intervention included targeted education for ED staff and daily audit-feedback on antibiotic prescriptions for suspected ASB. Outcomes were compared with a six-month pre-intervention period. The primary outcome was 30-day return visit to the ED for Urinary Tract Infection (UTI) with the same microbiological isolate. Secondary outcomes included 30-day all-cause mortality, overall UTI return visit to the ED, antimicrobial consumption (Daily Defined Dose/1,000 admissions), and urine culture requests. Results: A total of 130 patients in the pre-intervention period and 127 patients in the intervention period were included. In the intervention period, antibiotic discontinuation was recommended in 96 (75.6%) patients; acceptance rate was 29.2%. Despite limited acceptance, antimicrobial consumption declined, with cefalosporins reduced by 21% and carbapenems by 24%. Urine culture requests fell by 16.1%, and uropathogen isolates decreased by 15.9%. Clinical outcomes were similar between both periods: 30-day return visit to the EDs for UTI with the same isolate dropped from 6.2% to 1.6% (p-value=0,103), overall UTI return visit to the EDs from 8.5% to 4.7% (p-value=0.316), and 30-day mortality remained stable (6.2% vs. 3.9%, p-value=0.571), no statistically significant differences across all variables. Conclusions: This program reduced inappropriate antibiotic use and unnecessary urine testing in the ED without compromising patient safety. These results highlight educational and audit-feedback intervention as a safe, practical, and impactful antimicrobial stewardship strategy in high-pressure clinical settings as the ED.

Abstract: Escherichia coli, Streptococcus equi subsp zooepidemicus, Klebsiella oxytoca and Enterococcus durans cause a wide range of diseases in both animals and humans. These microorganisms are associated with fatal disease in immunocompromised and comorbid patients. The aim of this study is to present a rare clinical case of an unusual mixed infection of the indicated pathogens, which ended fatally. We found no such clinical case described in a patient with a fatal outcome in our literature review. We present a 65-year-old man admitted at the Clinic of Infectious Diseases, St. George University Hospital, Plovdiv, with severe diarrheal syndrome in a state of toxic-infectious shock. Patient has been ill for 2 days with general weakness, chest and abdominal pain, fever, and about 10 liquid, light brownish stools daily, without mucus and blood. One day before the onset of complaints, he consumed green salad and lamb. He has some accompanying diseases-chronic heart and liver failure with complications. After hospitalization, the patient's condition rapidly worsened, leading to death. Escherichia coli and Streptococcus equi subsp zooepidemicus were isolated from the microbiological examination of cadaver material from the intestinal wall, and from the spleen Klebsiella oxytoca and Enterococcus durans. Histological examination confirmed catarrhal enteritis with characteristic changes–fibrinous plaques, edema in the wall and mucosa and inflammatory infiltrate. To our knowledge, the present clinical case is the first report of a mixed infection by these four pathogens.

Abstract: Background/Objectives: Gastroenteritis remains a major global health concern, particularly in resource-limited regions, where rapid and accurate diagnosis is crucial for effective patient management. Syndromic multiplex PCR panels, such as the FilmArray gastrointestinal (FAGI) panel, offer the potential to significantly improve diagnostic yield and turnaround time, enabling more targeted treatments and reducing unnecessary antibiotic use. However, real-world data on their performance in low-resource settings remains scarce. This study evaluates the performance, clinical impact, and cost-effectiveness of the FAGI panel compared to standard of care (SOC) diagnostic methods in gastroenteritis cases at São José Hospital for Infectious Diseases in Fortaleza, Brazil, a resource-limited region of a middle-income country. Methods: A retrospective observational study was conducted between patients tested with FAGI (n=161) and a historical control group tested only with SOC methods (n=166). Results: The FAGI panel was associated with a significant reduction in the turnaround time, antimicrobial use, and total treatment costs while increasing the pathogen detection rate. Specifically, the median diagnostic time was reduced by 18%, with a 77% increase in pathogen detection compared to SOC methods. Moreover, the FAGI group experienced a 30% reduction in antibiotic use, with a corresponding 83% reduction in antimicrobial costs. Conclusions: These results suggest that the FilmArray panel may offer substantial benefits in terms of efficiency and cost savings, highlighting its potential for broader implementation in clinical practice, especially in resource-limited settings, to improve patient outcomes in infectious disease management.

Abstract: Evaluation of vaccine effectiveness (VE) was essential to implement strategies of prevention, and our objective was estimated the VE of SARS-CoV-2 messenger RNA (mRNA) vaccines to prevent SARS-CoV-2 infection. We performed a population-based prospective cohort study in the Borriana COVID-19 cohort (Valencia Community, Spain) during the period 2021-2023, with two approaches, considering firstly, all cases occurred after SARS-CoV-2 vaccine campaign started in January 2021, and then secondly, only symptomatic cases. Multivariable robust Poisson regression models were employed. Results: In first approach, of 301 participants, 285 were vaccinated, 228 with only SARS-CoV-2 mRNA vaccines, and 57 with mRNA vaccine and other vaccines. A total of 226 cases occurred with 75 non-cases. Adjusted VE for 3 doses of vaccine received was 37% (95% Confidence interval [CI] 22%-49%). The second approach, with 153 symptomatic cases, excluding 73 asymptomatic cases, adjusted VE for 3 doses of vaccine received was 50% (95% CI 33%-63%). While one or two doses of vaccines presented a low VE with insufficient to protect against infection, 3 doses of vaccine reached modest and significant protection. Exclusion of asymptomatic cases improved the VE estimation. Conclusion: Development of new vaccines is needed to improve control and prevention strategies against SARS-CoV-2.