Other specific DSP article suggested by Editorial Board
Indirect effect of pneumococcal conjugate vaccines on pneumococcal colonization: persistence and dynamics of vaccine serotypes in Sicily (Italy) eleven years post-introduction, 2009 to 2020
Authors: Fabio Tramuto
Abstract
Background: In Italy, evidence on the long-term impact of pneumococcal conjugate vaccines on nasopharyngeal carriage remains limited. This study investigates pneumococcal carriage prevalence, serotype distribution, and temporal trends in the decade following the introduction of PCV13 and preceding the onset of the COVID-19 pandemic (2009–2020).
Methods: Oropharyngeal samples were collected from 12,733 individuals of all ages presenting with influenza-like illness within the national surveillance network for respiratory pathogens. Streptococcus pneumoniae detection and serotyping were performed using real-time PCR-based assays.
Results: Overall pneumococcal carriage was 27.1%. The maximum value was observed in children aged 2-4 years (51.6%), whereas colonization was about 10% in adults, including those aged ≥75 years. Following vaccine implementation, a marked decline in PCV-covered serotypes was observed, accompanied by the rise of non-vaccine serotypes. After several years of sustained pediatric immunization, vaccine serotypes re-emerged, replacing previously expanding non-PCV types. Some persistent vaccine serotypes, including those associated with a higher risk of invasive disease, continued to circulate despite high and longstanding vaccination coverage. Serotype distribution varied significantly by age, and concurrent viral infections, particularly with hRSV, appeared to increase pneumococcal colonization risk.
Conclusions: Despite sustained high pediatric vaccination, pneumococcal carriage remained substantial across all ages, with persistent circulation of vaccine and non-vaccine serotypes. Viral co-infection, particularly with hRSV, appeared to facilitate colonization. These findings underscore the need for ongoing carriage surveillance and evolving vaccine strategies to address changing pneumococcal ecology.
Other specific DSP article suggested by Editorial Board
Identification and validation of Rhizopus-specific glucoamylase as a novel biomarker for diagnosing mucormycosis
Authors: Hansraj Choudhary
Abstract
Background: Mucormycosis is a life-threatening invasive fungal infection. Current diagnosis relies on insensitive techniques with prolonged turnaround times, underscoring the need for rapid non-invasive diagnostic tools. The study aimed to identify the antigens of Rhizopus arrhizus that can facilitate serodiagnosis of mucormycosis and assess their diagnostic potential in patients.
Methods: Two-stage systematic study combining antigen discovery and clinical validation. Using immunoproteomics, we identified immunoreactive protein spots in R. arrhizus secretory extract using pooled sera from six mucormycosis patients. We performed LC-MS/MS for characterizing the most reactive spot. Next, we developed an indirect ELISA using purified protein and evaluated its diagnostic performance in 92 mucormycosis cases and 41 controls (other mold infections [n=22], diabetes mellitus alone [n=19]). Participants were randomly divided 1:1 into derivation and validation cohorts. ROC curve analysis identified optimal cutoff values.
Results: Immunoproteomics identified three immunoreactive protein spots (70, 45, and 30 kDa) in crude extract. The most reactive 70 kDa spot was identified as Rhizopus-specific glucoamylase (RSG) by LC-MS/MS and confirmed with specific anti-Rhizopus glucoamylase antibody. In the derivation cohort (46 cases, 11 controls), anti-RSG IgG demonstrated area under ROC curve of 0.933. In the validation cohort, anti-RSG IgG achieved 76.1% sensitivity (95% CI: 61.2–87.4%) and 100% specificity (95% CI: 71.5–100%). Besides, the assay detected antibodies in 85.1% of culture-negative but microscopy-positive cases and in 87.5% of mixed fungal infection cases.
Conclusions: RSG is a potential biomarker for diagnosing mucormycosis. Anti-RSG IgG shows strong diagnostic promise and merits prospective multicenter clinical validation.
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How to Differentiate Pediatric Enteroviral Meningoencephalitis from Scrub Typhus Meningitis: A Single-Center Retrospective Study from Yunnan Province, China
Authors: Yonghan Luo
Abstract
Background: During the summer–autumn epidemic season, pediatric scrub typhus meningoencephalitis (ST) and enteroviral meningoencephalitis (EV) often present with overlapping clinical manifestations and routine cerebrospinal fluid (CSF) findings, making early differential diagnosis challenging and delaying appropriate treatment. Practical diagnostic strategies based on readily available parameters are lacking.
Objective: To evaluate whether common clinical and laboratory indicators can differentiate pediatric ST meningoencephalitis from EV meningoencephalitis.
Methods: This single-center retrospective cohort study included 100 children with ST meningoencephalitis and 160 with EV meningoencephalitis admitted between 2019 and 2023. Clinical features and laboratory parameters from peripheral blood and CSF were compared between groups. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Restricted cubic spline (RCS) models explored dose–response relationships, and decision curve analysis (DCA) evaluated clinical utility.
Results: The two groups showed substantial overlap in seasonality, onset patterns, and routine CSF parameters. Compared with the EV group, children with ST exhibited stronger systemic inflammation and multisystem involvement, with significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ferritin, and procalcitonin, and lower platelet count (PLT), fibrinogen, and hemoglobin (all P < 0.001). ALT and ferritin showed the highest discriminatory ability (AUC = 0.946 each), followed by PLT (AUC = 0.915), AST (0.909), fibrinogen (0.887), and procalcitonin (0.842). RCS models demonstrated nonlinear dose–response relationships, and DCA confirmed stable net clinical benefits for ferritin, ALT, and PLT.
Conclusions: Ferritin, ALT, and PLT are effective and accessible indicators for differentiating pediatric ST from EV meningoencephalitis, particularly in resource-limited epidemic settings.
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The role of medical imaging in translational research into early pulmonary tuberculosis
Authors: Yingda L. Xie
Abstract
Early detection of tuberculosis (TB) is central to global efforts for TB care and prevention. Conventional symptom-based screening and sputum microbiology fail to identify a substantial proportion of cases, particularly those that are asymptomatic or have low bacillary burden. Non-invasive medical imaging offers a critical solution for visualizing pulmonary pathology before individuals with TB develop characteristic symptoms. Chest X-ray (CXR) has long been central to community screening, and recent advances in computer-aided detection (CAD) systems endorsed by the World Health Organization have improved scalability and reduced reliance on expert interpretation. However, limitations in sensitivity for the earliest stages of disease and reduced specificity in individuals with prior lung pathology persist, underscoring the need for further research to improve performance for early TB detection.
High-resolution modalities such as computed tomography (CT), Magnetic Resonance Imaging (MRI) and functional imaging approaches such as positron emission tomography (PET) and Single-Photon Emission Computed Tomography (SPECT) provide unparalleled insights into lesion dynamics, disease activity, and treatment response. They can be utilised to benchmark development of novel diagnostic tests for bacteriologically unconfirmed TB and define imaging correlates of early disease progression and resolution. Furthermore, emerging innovations in pathogen-specific radiotracers may enable localisation of viable bacilli in vivo. As a result, these new high-resolution imaging technologies offer transformative potential to address key knowledge gaps in the natural history, pathogenesis, dissemination, and therapeutic approaches to early pulmonary TB.
Together, clinical imaging provides a framework for the development and validation of clinically relevant biomarkers and quantitative readouts that capture early, asymptomatic TB pathology and disease activity prior to conventional microbiologic confirmation. Future work should focus on integrating advanced imaging with microbiology, host-response biomarkers, and artificial intelligence to define actionable imaging phenotypes that inform early diagnosis, risk stratification, and treatment decision-making across diverse settings.”
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How to safely discontinue antifungal treatment in invasive pulmonary aspergillosis? – Clinical considerations in haematology.
Authors: Stemler J, et al
Abstract
Background: Treatment duration in invasive pulmonary aspergillosis (IPA) in patients with haematological malignancies is not well defined through clinical trials and is therefore often driven more by experience than evidence, with implications for outome, patient quality-of-life, drug toxicity, costs, and antifungal stewardship.
Objectives: To review current evidence and provide expert considerations regarding cessation of antifungal therapy for IPA, and to propose pragmatic criteria and follow-up strategies to guide safe discontinuation and early detection of recurrence. Sources: Narrative review of clinical trials, observational and biomarker studies, imaging data, and expert guidance related to IPA treatment response, recurrence, and antifungal toxicity.
Content: Shared definitions of treatment success exist, but standardized criteria for treatment failure, stable disease, and stopping therapy are lacking. Decisions to discontinue antifungals rely on individualized assessment of host immune status and recovery, clinical stability, mycological markers (notably serum galactomannan), and imaging findings, primarily chest CT, with adjunctive roles for [18F]FDG PET and emerging biomarkers. All of the above have limited sensitivity, require thorough interpretation and are to be used as a bundle, not as stand-alone criterion. This review outlines prerequisites for stopping treatment, structured surveillance after cessation, triggers for immediate re-evaluation, and scenarios in which treatment should not be stopped. Risks of recurrence, particularly in persistently immunocompromised patients, are weighed against cumulative toxicity and drug-drug interactions of prolonged antifungal use. Management options for antifungal toxicity and potential utility of novel antifungal agents are discussed.
Implications: Stopping antifungal therapy for IPA should be a standardized and patient-specific decision supported by predefined monitoring and rapid response pathways within standardized institutional procedures. Prospective trials comparing cessation strategies are needed to increase knowledge on optimal duration, in specific during reoccurring or ongoing immunosuppression.
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Antimicrobial resistance: a critical public health challenge in Albania.
DOI: 10.3855/jidc.22337
Authors: Shapo L, et al
Abstract
Antimicrobial resistance (amr): AMR represents a critical challenge for healthcare systems globally and in Albania. The increasing ability of microorganisms to withstand standard therapies complicates infection management, elevates morbidity and mortality, and drives up healthcare costs. Overprescribing and incomplete antibiotic courses are principal contributors, underscoring the necessity for robust stewardship and ongoing education. Continued research and the development of novel antimicrobials are essential.
Growing concern: AMR is exacerbated by inappropriate antimicrobial use, suboptimal infection control, and global mobility. Both human and veterinary medicine are affected, with resistance spreading via direct contact and the food chain. The “One Health” approach-integrating human, animal, and environmental health-is essential for effective AMR management; and without intervention, AMR could result in millions of deaths annually. The major drivers of AMR include (i) unnecessary prescriptions and incomplete treatment courses; (ii) poor hygiene and infection control in clinical settings; (iii) international movement of people and goods; and (iv) limited development of new antimicrobial agents. Albania is experiencing rising rates of antibiotic resistance, particularly in urinary tract infections (UTIs) and community-acquired pathogens. Excessive antibiotic prescribing among certain healthcare professionals highlights the need for improved stewardship and adherence to clinical guidelines. The National Action Plan on AMR exists, but its implementation requires further evaluation.
Conclusions: Albania has established a functioning AMR surveillance system and continues to implement awareness campaigns. Ongoing research and targeted interventions are needed to address resistance trends. Strengthening stewardship and surveillance is critical to mitigating the impact of AMR on patient outcomes and public health.