The Journal of Infection in Developing Countries
A peer-reviewed open access medical journal, focusing on global health.
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Integrative analysis of miRNA-RBP-splicing interactions during respiratory syncytial virus infection
Introduction: Respiratory syncytial virus (RSV) is a major cause of severe acute lower respiratory tract infections (ALRI), with incomplete elucidation of its pathogenesis and intricate host-virus crosstalk constraining the development of effective therapies. The post-transcriptional interplay among microRNAs (miRNAs), RNA-binding proteins (RBPs), and alternative splicing (AS) is a critical, yet underexplored host response layer. Methodology: We integrated and analyzed three public datasets (GSE231784, GSE231788, and GSE155151) of RSV-infected A549 cells, screened differentially expressed miRNAs, identified conserved differentially expressed RBPs, used SUVA to detect AS events, and constructed a miRNA-RBP-AS network to find core axis. This integrated bioinformatics approach enabled systematic dissection of multi-layered post-transcriptional regulation during RSV infection. Results: Our analysis revealed that RSV infection substantially alters host post-transcriptional regulation, with 86 conserved differentially expressed RBPs and 94 conserved AS events identified. A potential miRNA-RBP-AS axis was uncovered via regulatory network construction. Crucially, this axis suggests that the downregulation of let-7 family miRNAs (e.g., let-7f-2-3p, let-7a-3p) is strongly associated with the upregulation of the RBP genes SAMD4A and ENOX1. The expression of these RBPs, in turn, correlates with the AS of host genes that are implicated in viral replication and immunity, such as TNIP1 and NR5A2. Conclusions: These findings propose that RSV may exploit this post-transcriptional crosstalk to modulate host immunity and facilitate viral replication. Through bioinformatics analysis, this study provides a novel, system-level map of RSV-host interactions and identifies the let-7-SAMD4A/ENOX1-TNIP1/NR5A2 axis as a promising new target for future antiviral strategies, though this requires further experimental validation.
Copyright (c) 2026 Mingzhen Cheng, Hongtao Xu, Fang Yuan, Shuangshuang Li https://creativecommons.org/licenses/by/4.0
Global burden of respiratory infections and tuberculosis attributable to risk factors, 1990–2021: demographic and SDI analysis
Introduction: Respiratory infections and tuberculosis are leading causes of global morbidity and mortality; yet comprehensive research on their associated risk factors remains limited, hindering the development of effective preventive strategies. Methodology: The 2021 Global Burden of Disease data from 204 countries (1990–2021) was used to measure deaths, disability-adjusted life years (DALYs), and their age-standardized rates (ASMR and ASDR) tied to 9 risk factors. The trends were analyzed by age, gender, and socio-demographic index (SDI) regions, with annual and average annual percentage changes (APC, AAPC) used to track changes over time. Results: Globally, mortality rates (ASMR) for respiratory infections and tuberculosis linked to traditional risks—malnutrition, air pollution, and alcohol use—declined significantly; annual decreases of 4.46%, 3.18%, and 3.35%, respectively. Deaths attributed to metabolic risks like high BMI and blood sugar increased, despite falling ASMR. Geographic disparities were notable: Lesotho saw the sharpest rise in BMI-related mortality (3.92%), while Hungary had the steepest decline (−7.4%). Men faced a higher burden from behavioral risks, with tobacco-related mortality 3.6 times higher than in women. Children under 5 years were especially vulnerable to environmental risks, with unsafe water and sanitation contributing to a 4.55% annual decline in mortality rates. Conclusions: This study highlights the need for targeted actions, such as tobacco control in high-middle SDI regions, air quality improvements in South Asia, and nutrition programs in Sub-Saharan Africa. It offers a precise public health framework to reduce respiratory infections and tuberculosis, and promote global health equity by analyzing sociodemographic and time trends.
Copyright (c) 2026 Shareli Caikai, Jing Jiang, Yi Shi, Hongli Zhang, Sicheng Xu https://creativecommons.org/licenses/by/4.0
Community and healthcare-associated UTIs: antimicrobial resistance patterns in a Tunisian emergency-intensive care unit
Introduction: Urinary tract infections (UTIs) are a leading cause of antibiotic use globally, with rising antimicrobial resistance (AMR) complicating management—particularly in healthcare settings. Methodology: This cross-sectional study compared community-acquired (CA-UTI) and healthcare-associated UTIs (HA-UTI) at the Habib Thameur Hospital’s emergency–intensive care unit in Tunis during 2022–2023. Results: Out of a total of 4,474 urine samples, 446 (10%) were culture-positive. The patients were predominantly elderly (73.3% were ≥ 60 years). More females had CA-UTI (M:F = 0.57) than HA-UTI (M:F = 0.78). Escherichia coli was the main pathogen causing both CA-UTI (57.4%) and HA-UTI (44.6%), while Klebsiella pneumoniae was the more common pathogen in HA-UTI (26.1% vs. 23.3%). Gram-negative bacteria accounted for 90.6% of isolates. Among the K. pneumoniae isolates, resistance to imipenem was significantly higher among HA-UTI isolates (29.2% vs. 5.9%; p = 0.02). Among the E. coli isolates, resistance to nitrofurantoin was significantly higher among HA-UTI isolates (3.7% vs. 12.5%; p = 0.01). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were detected in 8.5% of isolates (mostly E. coli and K. pneumoniae), and carbapenem-resistant Enterobacteriaceae (CRE) in 8.7% (predominantly K. pneumoniae in HA-UTI). CRE showed near-complete β-lactam resistance and high non-β-lactam resistance in HA-UTI. Conclusions: Rising UTI rates and alarming AMR trends, particularly in HA-UTIs, highlight the need for enhanced antibiotic stewardship and tailored empirical therapy. The predominance of multidrug-resistant strains underscores the urgency for infection control measures in Tunisian healthcare settings.
Copyright (c) 2026 Manel Ennaceur, Sofien Bouzazi, Sonia Chouaieb https://creativecommons.org/licenses/by/4.0
Impact of standardized penicillin therapy on pregnancy outcomes in maternal syphilis: a retrospective cohort study (2013–2023)
Introduction: The aim of this study was to assess the impact of standardized benzathine penicillin therapy on adverse pregnancy outcomes in high-titer toluidine red unheated serum test (TRUST) positive (≥ 1:16) syphilis cases and refine prevention of mother-to-child transmission (PMTCT) strategies. Methodology: This retrospective cohort study analyzed 2,229 pregnant women with syphilis from the National PMTCT System of Taizhou City (2013–2023). Standardized treatment was defined as 3 weekly intramuscular benzathine penicillin doses (2.4 MU each). Multivariable logistic regression adjusted for gestational age, maternal age, and comorbidities was used to analyze the outcomes. Results: A total of 1,651 women (74.1%) received standardized therapy and the risk of adverse pregnancy outcomes was significantly lower in this group compared to those with non-standardized treatment: perinatal death (0.55% vs. 2.60%), congenital syphilis (0.24% vs. 2.60%), preterm birth/low birth weight (7.81% vs. 16.78%), and total adverse outcomes (8.60% vs. 38.75%) (all p < 0.001). Adjusted analysis demonstrated 58% risk reduction with standardized treatment (aOR = 0.42, 95% CI: 0.31–0.57, p < 0.001). Early initiation (≤ 20 weeks) enhanced efficacy (aOR = 2.12, 95% CI: 1.45–3.10, p < 0.001), with married (aOR = 2.41) and educated women (aOR = 1.89) showing higher adherence. Conclusions: Standardized penicillin regimens significantly mitigate adverse pregnancy outcomes by 58%, emphasizing early diagnosis, timely treatment, and targeted patient education for PMTCT success. Marital status and education level were independently associated with treatment adherence.
Copyright (c) 2026 Xiaolin Li, Yan Ji https://creativecommons.org/licenses/by/4.0
Prevalence and associated factors of pneumococcal carriage among children with respiratory viral infections in Türkiye
Introduction: The interaction between nasopharyngeal pneumococcal carriage (NPC) and respiratory viral infections (RVI) is poorly understood. This study aimed to investigate the prevalence and epidemiology of NPC, and its correlation with RVI. Methodology: This retrospective study included patients aged < 18 years who presented with RVI symptoms between 1 February and 30 June 2023. Naso-oropharyngeal swabs were tested using quantitative polymerase chain reaction (PCR) for Streptococcus pneumoniae and respiratory viruses. Patients were grouped by NPC status and compared for viral detection, and clinical and demographic characteristics. Results: NPC was detected in 15.7% (n = 1,185) of the 7,522 samples analyzed. The mean age was 56.5 ± 49.3 months, being significantly lower in NPC-positive patients (p < 0.001). Most (82%) were fully vaccinated against pneumococcus; 16% had underlying conditions. The most frequent viruses were adenovirus (17.2%), influenza B (9.0%), severe acute respiratory syndrome coronavirus 2 (5.3%), respiratory syncytial virus (4.9%), and influenza A (2.8%). Adenovirus (19.7%) and influenza B (11.0%) were significantly more frequent in NPC-positive patients than in NPC-negative patients (p < 0.001 for both). Overall, 20.5% were hospitalized, and 2.4% required intensive care. Intensive care admission was higher among NPC-positive patients, whereas mortality did not differ. Conclusions: NPC was epidemiologically associated with the detection of certain respiratory viruses, particularly adenovirus and influenza B. Given the retrospective design and lack of pneumococcal serotype data, these findings should be interpreted as associations rather than evidence of causality. Further prospective studies are warranted to clarify the bacterial–viral interactions and their clinical relevance.
Copyright (c) 2026 Saliha Kanık-Yüksek, Selin Yıldız, Metehan Yaşar Tekin, Sümeyye Aybike Servi-Genç, Belgin Gülhan, Tuğba Erat, Hatice Kübra Konca, Seval Özen, Aysun Yahşi, Gülsüm İclal Bayhan, Sibel Aydoğan, Aslı Nur Özkaya-Parlakay, Bedia Dinç https://creativecommons.org/licenses/by/4.0
Antibiotic resistance and bacterial profiles in an Iranian hospital (2018-2021)
Introduction: Antimicrobial resistance (AMR) poses a significant global health challenge, complicating the treatment of bacterial infections. This study investigated the prevalence of AMR among clinical isolates in an Iranian hospital from 2018 to 2021. Methodology: This four-year retrospective study was conducted at Ganjavian Hospital in Dezful, Iran. A total of 4,522 clinical specimens were analyzed. Bacterial identification and antimicrobial susceptibility testing were performed using standard microbiological methods and the Kirby-Bauer disk diffusion method, and interpreted per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis included descriptive statistics, Chisquare tests for trend, and 95% confidence intervals (CIs) for resistance proportions. Results: A total of 4,282 bacterial isolates were recovered; of which 78% were Gram-negative, with Enterobacterales constituting the predominant group (51.4%). Among Escherichia coli isolates, 72.3% (95% CI: 69.9–74.6%) were non-susceptible to ceftriaxone. The prevalence of multidrug-resistant (MDR) Enterobacterales was 41.4% (95% CI: 39.2–43.6%), with significant annual variation observed during the study period (χ² = 5.48, p < 0.001). Acinetobacter spp. exhibited high resistance to third-generation cephalosporins (94.1%; 95% CI: 91.1–96.2%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 29.7% (95% CI: 25.6–34.1%), and 40.0% of Enterococcus spp. were vancomycin-resistant. Conclusions: The findings highlight the urgent need for enhanced infection-control and antimicrobial-stewardship programs. The high rates of resistance among common pathogens underscore the complexity of treating infections in critical care settings. This study emphasizes the necessity for surveillance and the development of targeted interventions to combat AMR, ensuring that effective treatment options remain available.
Copyright (c) 2026 Hamid Malvirani, Behnaz Deihim, Aziz Kassani https://creativecommons.org/licenses/by/4.0
Risk factors and clinical characteristics of bloodstream infection caused by ESBL-producing Klebsiella pneumoniae
Introduction: The aim of this study was to analyze the clinical characteristics and risk factors of bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (KP). Methodology: A retrospective study was conducted by enrolling clinically confirmed KP-BSI cases (2019–2023). Clinical data were collected and analyzed through review of the electronic medical records. Patients with ESBL-positive KP-BSI were compared to those with ESBL-negative KP-BSI. Multivariate logistic regression analysis was used to identify risk factors associated with ESBL-producing KP-BSI. Results: A total of 199 patients were included, among whom 47 (23.6%) had ESBL-producing KP-BSI. Univariate analysis revealed that the proportion of patients undergoing surgery within 48 hours before blood sampling was higher in the ESBL-positive group than in the ESBL-negative group (40.4% vs. 23.0%, p < 0.05). Regarding infection source, liver-origin infections were less frequent in the ESBL-positive group compared to the ESBL-negative group (6.4% vs. 24.3%, p < 0.05), while urinary tract-origin infections were significantly more frequent in the ESBL-positive group (38.3% vs. 18.4%, p < 0.05). Hospital-acquired infection was more common in the ESBL-positive group than in the ESBL-negative group (40.4% vs. 23.7%, p < 0.05). Multivariate analysis identified urinary tract origin (adjusted odds ratio [aOR], 2.162; 95% confidence interval [CI], 1.003–4.661) as an independent risk factor for ESBL-producing KP-BSI. Conclusions: Primary urinary tract infections constitute an independent risk factor for ESBL-producing KP-BSI. Given the therapeutic complexity of ESBL-producing strains, KP-BSI of urinary tract origin warrant heightened clinical vigilance among clinicians.
Copyright (c) 2026 Panpan Xu, Qingqing Chen, Yifeng Mao, Xijiang Zhang, Qin Si, Cheng Zheng https://creativecommons.org/licenses/by/4.0
Relationship between OprD porin downregulation and in-vitro interactions in Pseudomonas aeruginosa
Introduction: OprD porin plays a critical role in antibiotic uptake. However, the role of OprD in antimicrobial interactions is not yet fully understood. This study investigated the relationship between OprD downregulation and in vitro interactions of meropenem (MEM) with combinations of colistin (CT), ertapenem (ETP), and fosfomycin (FF) in Pseudomonas aeruginosa. Methodology: A total of 40 P. aeruginosa isolates were included in the study and divided into two groups (group-1, 20 isolates with confirmed OprD suppression; group-2; 20 isolates without OprD suppression). Antimicrobial interactions were examined using the checkerboard method. Results: The synergy rates of MEM/CT, MEM/ETP, and MEM/FF combinations in group-1/group-2 isolates were determined as 45%/30%, 5%/5%, and 15%/10% respectively. The minimum inhibitory concentration (MIC) of antimicrobials in combinations were examined for group-1 and group-2 isolates, and a decrease of 90%, 90% for MEM and 70%, 40% for CT was detected in the MEM/CT combination, 50%, 45% for MEM and 35%, 40% for ETP in the MEM/ETP combination, and 35%, 20% for MEM and 55%, 45% for FF in the MEM/FF combination, respectively. Conclusions: While significant synergy was observed between MEM/CT in OprD-deficient isolates, the limited synergistic effects observed with other combinations, such as MEM/ETP and MEM/FF, suggest that the impact of OprD downregulation on antimicrobial resistance is multifactorial and complex. The findings suggest that CT, when combined with MEM, may overcome certain resistance mechanisms mediated by OprD downregulation. Further investigations incorporating molecular diagnostics and in vivo validation are warranted to fully elucidate the therapeutic potential of these combinations.
Copyright (c) 2026 Tuba Muderris, Ufuk Akbayırlı, Rıza Durmaz, Selçuk Kaya, Tuba Dal, Ziya Cibali Açıkgöz, Ayşegül Aksoy Gökmen https://creativecommons.org/licenses/by/4.0
Assessment of knowledge, attitudes and behavior, perception, risk factors, practices, One Health, and interventions regarding Monkeypox in Pakistan
Introduction: The monkeypox virus, a species of the Orthopoxvirus genus in the Poxviridae family, is the etiological agent of monkeypox, a rare but re-emerging zoonotic disease in non-endemic regions Aim and Objectives: This study assessed the knowledge, attitudes, and awareness, as well as the risk factors related to monkeypox, among the general population of Pakistan. It also investigated preventive practices, healthcare-seeking behavior, and One Health awareness to inform evidence-based strategies for reducing monkeypox incidence in Pakistan. Methodology: A cross-sectional study was conducted in Pakistan from June to December 2023 to evaluate knowledge, attitudes, perceptions, risk factors, practices, One Health, and interventions related to monkeypox. A standard, pre-validated questionnaire addressing critical questions about monkeypox was used, and 640 participants completed the study. Results: Among 640 study participants, the majority were male (56.6%). Overall, 75.6% of participants had poor knowledge of monkeypox. A positive attitude was reported in 58.8% of participants, and 74.8% expressed willingness to adopt precautionary measures. The chi-square test results showed significant associations between socio-demographic characteristics and knowledge, including gender (p < 0.033), education (p < 0.028), occupation (p < 0.038), and smoking status (p < 0.000). For attitudes, significant associations were observed with gender (p < 0.003), income (p < 0.003), occupation (p < 0.007), and smoking status (p < 0.000). Conclusions: Although most participants demonstrated insufficient knowledge and positive attitudes towards monkeypox. This underscores the need for a comprehensive public health education initiative aimed at preventing the emergence and transmission of monkeypox in Pakistan.
Copyright (c) 2026 Kainat Bibi, Dr. Huma Khan, Prof. Dr. Muhammad Sohail Afzal, Dr. Abid Ali, Dr. Haroon Ahmed https://creativecommons.org/licenses/by/4.0
Exploration of the diagnostic value and expression levels of IFN-γ and IL-2 in patients with lymph node tuberculosis
Introduction: Lymph node tuberculosis (LNTB) is the most common form of extrapulmonary tuberculosis (TB). The symptoms of LNTB lack specificity, making diagnosis difficult and increasing the likelihood of missed or incorrect diagnoses. Along with IFN-γ Release Assay (IGRA), the detection method using enzyme-linked immunosorbent assay (ELISA) can simultaneously detect IFN-γ and interleukin-2 (IL-2). However, the diagnostic value and expression levels of IFN-γ and IL-2 in patients with LNTB remain unclear. Methodology: A total of 95 patients with enlarged lymph nodes were enrolled. Baseline data were collected, including age, gender, history of TB, histopathology, microbiology test results, and blood levels of IFN-γ and IL-2. Receiver operating characteristic (ROC) curve was used to investigate the diagnostic effect of the IFN-γ and IL-2. A double antibody sandwich ELISA was used to detect the concentrations of IFN-γ and IL-2 in culture supernatants. Results: Based on ROC curves, the cut-off values for IFN-γ/IL-2 for differentiating LNTB from non-TB-lymphadenopathy (LAP) were determined to be 58.267 and 12.207 pg/mL, respectively. In patients with LNTB and non-TB-LAP, the sensitivity of IFN-γ/IL-2 in parallel was 83.33% (95% CI: 71.71–90.99), significantly higher (p < 0.05) than that for IFN-γ alone. The highest specificity (93.10%) (95% CI: 75.78–98.8) was observed when IFN-γ and IL-2 were applied in tandem. Conclusions: The combined detection of IFN-γ and IL-2 showed good diagnostic efficacy in LNTB. In addition, in patients diagnosed with LNTB, the expression level of IL-2 may be related to the burden of MTB and the severity of TB infection.
Copyright (c) 2026 Chun Zhang, Yu Chen, Jun Huang, Ying Liu, Hao Zhang, Tianxing Hang, Lili Huang, Jianqi Gao, Chunmei Hu https://creativecommons.org/licenses/by/4.0
Epidemiology and changes in age distribution of hemorrhagic fever with renal syndrome in Shaanxi, China, from 2004 to 2023
Introduction: Hemorrhagic fever with renal syndrome (HFRS) is a serious viral disease in mainland China, and Shaanxi Province is one of the most severely affected areas. In order to reduce HFRS incidence, an inactivated bivalent vaccine against Hantaan virus (HTNV) and Seoul virus (SEOV) infections was developed and used in China since the 1990s. Methodology: Descriptive epidemiological methods were used to analyze the spatial, temporal, and population distribution of HFRS along with changes in age distribution in Shaanxi Province from January 2004 to December 2023. Results: A total of 34,265 HFRS human cases were reported in Shaanxi Province, including 25,737 males and 8,528 females. HFRS cases were geographically concentrated in the Guanzhong Plain. The local incidence of HFRS fluctuated remarkably over the past 20 years. The primary peak was from October to January. The proportion of HFRS cases in the 15–60 years age group showed a decreasing trend. However, the proportion of HFRS cases among the > 60 years age group increased by 150.94%, rising from 11.68% to 29.31%. Conclusions: Data from a 20-year surveillance study shows that the proportion of HFRS cases in individuals over 60 years of age has increased significantly, which may potentially be due to vaccine coverage limitations. The results can be used to adjust the prevention and control measures of HFRS and to consider age-expanded vaccination strategies.
Copyright (c) 2026 Yuan Zheng, Bu-Yu Zhou, Yan-Hua Du, Ni Zhu https://creativecommons.org/licenses/by/4.0
Predicting suitable spatial niches in the Philippines for Ascaris lumbricoides using bioclimatic envelope models
Introduction: Recent studies on the spatial distribution of A. lumbricoides in the Philippines have used the data available from the nationwide parasitological survey in the early 2000s. This study developed an updated predictive map of the spatial distribution of ascariasis occurrences in the Philippines using data from 2000–2020 to identify high-risk areas for ascariasis. Methodology: Data were acquired from WorldClim and included 19 bioclimatic variables. Additionally, the geographical distribution of species occurrence records was obtained through literature and known medical reports for ascariasis cases. The spatial distribution was mapped using QGIS after running the occurrence and environmental layers in the software Maxent. Result: The predictive map revealed a high percentage of occurrences of ascariasis in Central Luzon, Calabarzon, Western Visayas, Bicol Region, and Central Visayas. The average training area under the receiver operating characteristic curve (AUC) for the replicate runs was 0.873. Analysis of variable contribution showed the highest percentage predictive contribution of the mean temperature during the warmest quarter (49.4%), annual range of temperature (10.9%), and mean temperature during the driest quarter (10.9%). Conclusions: The species predictive map generated in this study can identify bioclimatic variables associated with the high prevalence of A. lumbricoides. Since extensive parasitological surveys can be costly and time-consuming, predictions on A. lumbricoides distribution can fill the gap in areas lacking data. Consequently, a detailed understanding of the distribution of A. lumbricoides will assist in identifying high-risk areas for effective public health intervention, especially in underfunded regions in the Philippines.
Copyright (c) 2026 Loida M Recopuerto-Medina, Princess Ann T Dizon, Paulene DG Dumo, Aya R El Oirdighi, Dana Patricia P Fernandez, Karla Sophia L Lumang, Nikki Heherson Dagamac https://creativecommons.org/licenses/by/4.0
Serological survey for Toxoplasma gondii infection in two riverside communities in Northeastern Brazil
Introduction: Toxoplasmosis, a zoonosis caused by the parasite Toxoplasma gondii, is a significant global public health concern. Riverside communities often face unfavorable socioeconomic conditions that can lead to increased exposure to pathogens. This study aimed to investigate the frequency of antibodies against Toxoplasma gondii in two riverside communities in Northeastern Brazil. Methodology: A cross-sectional, descriptive study was conducted between April/2022 and August/2024, involving the populations of the cities of Cabaceiras do Paraguaçu and Cachoeira in the Recôncavo Baiano region, Northeastern Brazil. Sociodemographic data were collected, and serological tests were performed to evaluate anti-T. gondii IgM and IgG. Results: A total of 237 individuals were tested serologically for toxoplasmosis. The majority were female, self-identified as Black, with family incomes below the minimum Brazilian wage. In Cabaceiras do Paraguaçu, 40/74 (54.1%) individuals presented reactive anti-T. gondii IgG, while one (1.4%) was reactive for IgM. In Cachoeira, 80/163 (49.1%) were reactive for anti-T. gondii IgG, while 6 (3.7%) presented seropositivity for IgM. Individuals aged 31 years or older (Cabaceiras do Paraguaçu) and 15 years or older (Cachoeira) were associated with a higher chance of presenting anti-T. gondii IgG. Conclusions: This study contributes to our understanding of the prevalence of toxoplasmosis and associated risk factors in riverside communities. The seroprevalence rates of toxoplasmosis identified in this study, including IgM-positive cases, reinforce the urgent need for interventions to prevent toxoplasmosis in riverside populations.
Copyright (c) 2026 Wellington S. Rosa , Lara C. S. Vieira, Camila T. Souza, Victor O. Martinez, Antônio Márcio S. Fernandes, Helen R. S. S. Matos, Joelma N. de Souza, Neci M. Soares, Ana L. M. Amor, Márcia C. A. Teixeira , Carina C. Santos https://creativecommons.org/licenses/by/4.0
Factors associated with the occurrence of various skin fungal infections in patients at Al-Qadisiyah Province, Iraq
Introduction: Fungal infections may damage the skin and become invasive with the possibility of spreading to other individuals. The goal of the current study was to detect the most common fungal agents causing skin infections, and to investigate the various factors associated with such infections. Methodology: The study involved 100 patients; who had suffered from various skin infections. All information related to the site of lesion, age, gender, date of collection, and history was recorded. Statistical analysis was carried out using SPSS version 27. Results: All the patients included in the study were diagnosed clinically and confirmed by laboratory diagnosis. The skin infections were caused by dermatophytes (72%), Trichophyton rubrum (56.9%), Microsporum canis (20.8%), and yeast (24%). Among the yeast infections, 54.2% were by Malassezia furfur, and 45.8% by Candida albicans. There was significant association between type of fungal infection and age group, and the majority of the patients with dermatophytes were ≤ 30 years old. Males constituted 62% and females 38%. There was a significant association between the type of fungal infection and family history of patients, and there was a positive association with households with animals. Conclusions: Dermatophytes (such as Trichophyton rubrum, Microsporum canis) were a crucial health problem. Males were more susceptible to fungal skin infections than females, with the majority of infections happening in the 11–40 years age group. Households with animals and family history of infection had significant association with the occurrence of fungal skin infections.
Copyright (c) 2026 Saleem Abbas Ajzan, Furqan Mohammed Al-Asady, Huda Hadi Nema https://creativecommons.org/licenses/by/4.0
Treatment of infection caused by animal commensal pathogen Staphylococcus simulans
Introduction: Staphylococcus simulans is an animal pathogen belonging to the coagulase-negative staphylococci (CoNS) group that was occasionally identified in the skin of healthy people. Although it was suggested that S. simulans share some virulence factors with S. aureus, little is known about human infections, and clinical relevance is limited to a few reports. Herein, we report a case of bacteremia caused by S. simulans. Case presentation: A 39-year-old man was brought to the hospital due to heart attack. During the course of admission, his procalcitonin, C-reactive protein, and erythrocyte sedimentation rate were elevated. He was empirically started on vancomycin and meropenem. However, meropenem was discontinued after the identification of the fact that S. simulans was susceptible to oxacillin, as well as the identification of Streptococcus mitis in blood culture. Repeat blood culture a day after antibiotic initiation was persistently positive for S. simulans only, while the second repeat blood culture 3 days after antibiotic initiation was negative. The patient remained hemodynamically stable, and the laboratory values were back to normal. He continued the antibiotic course for a total of 14 days and was discharged in stable condition. Conclusions: CoNS should not be easily discarded as a sample contaminant and pathogen identification to species level is crucial. Clinicians should be aware of the virulence potential of S. simulans.
Copyright (c) 2026 Thamer A Almangour, Abeer A Alanazi, Sarah T Al Dughaish, Fahad M Al Majid https://creativecommons.org/licenses/by/4.0
Two unfavorable cases of Plasmodium falciparum infection returning from Tanzania
Introduction: Malaria has been eradicated in China; however, with the expansion of international trade in recent years, imported malaria cases have become non-negligible. Case presentation: We report two cases of patients infected with Plasmodium falciparum who returned from Tanzania to Yunnan, China. The patients sought treatment at different hospitals after developing symptoms, mainly fever. However, the exact cause was not identified in time, and the patients’ condition worsened progressively. Although the patients were finally diagnosed with malaria infection and received specific antimalarial drugs in our hospital, both died because of missing the optimal treatment window. Conclusions: Chinese doctors should enhance their awareness of Plasmodium detection and receive professional training for timely diagnosis of malaria patients who return home after being infected abroad.
Copyright (c) 2026 Junjie Li, Yaman Du, Junhai Lu, Yue Chen, Yu Liang, Jian Wu https://creativecommons.org/licenses/by/4.0
Clinical characteristics and risk factors for prediction of severity in patients with COVID-19: a retrospective multicentre study
Introduction: This study aimed to investigate the clinical characteristics of patients infected with coronavirus disease 2019 (COVID-19) and to identify risk factors associated with severe infection among Chinese patients. Methodology: We collected demographic data, clinical characteristics, and laboratory test results at admission for COVID-19 patients hospitalized in one of two designated tertiary hospitals in Yili Prefecture, Xinjiang Province, between July 2022 and October 2022. Patients were categorized into Group A (asymptomatic, mild, and moderate cases) and Group B (severe and critical cases) based on disease severity. Multivariate regression analysis was conducted to identify risk factors for severe disease, and a nomogram prediction model was developed using these factors. Additionally, stratified analyses were performed by comorbidity status. Results: Multivariate analysis indicated that older age, male sex, elevated urea nitrogen, higher D-dimer levels, and combined laboratory parameters at admission were positively associated with disease severity. The predictive performance of these factors, measured by area under the curve, was 0.872 (95% CI: 0.819–0.925), 0.613 (95% CI: 0.514–0.712), 0.813 (95% CI: 0.724–0.902), 0.790 (95% CI: 0.717–0.862), and 0.931 (95% CI: 0.891–0.971), respectively. Conversely, vaccination appeared to mitigate progression to severe disease to some extent. Conclusions: Patient age, sex, urea nitrogen, D-dimer, and serum creatinine levels at admission, as well as vaccination status and comorbidities, significantly influence disease progression in COVID-19 patients. Clinical management can be optimized by tailoring early warning systems and intervention strategies based on these patient-specific risk factors, thereby supporting informed decisions for diagnosis, treatment, prevention, and control.
Copyright (c) 2026 Maidina Abudouaini, Wenjuan Zeng, Shengtao Zeng, Bing Liu, Liang Dong, Amar Aynazar, Dilare Asimu, Jinquan Ma, Dongmei Lu https://creativecommons.org/licenses/by/4.0
Detection of the DNA methylation of seven genes contributes to monitoring recovery from COVID-19
Introduction: DNA methylation might influence the expression of genes that regulate coronavirus disease 2019 (COVID-19) progression. This work explored the significance of DNA methylation of 7 genes (TAC1, CDO1, HOXA9, ZFP42, SOX17, RASSF1A, and SHOX2) in blood circulating free DNA (cfDNA) in differentiating COVID-19 infections and recoveries. The correlation with changes in the proportion of immune cell populations in the recovery period was analyzed. Methodology: 18 COVID-19-infected, 65 COVID-19-recovered, and 11 uninfected individuals were included. DNA methylation expression was determined by quantitative multiplex methylation-specific PCR (qMSP). The immune function of the recovered group versus uninfected group was evaluated by full-spectrum flow cytometry. Results: The infected population showed a higher methylation positivity rate for 7 genes compared to the uninfected/recovered population. A model was constructed to distinguish the infected patients from uninfected/recovered individuals using the methylation status of 7 genes, with a sensitivity, specificity and area under curve (AUC) of 0.889, 0.842 and 0.931, respectively. The results of flow cytometry revealed that CD8+ T cells and CD38+ CD8+ T cells were significantly upregulated in recovered individuals compared to those in uninfected individuals. DNA methylation was correlated with immune cell changes, with a significant increase in the percentage of T cells, PD-1+ function CD4+ T cells, TCRγδ+ cells, and CD38+ NKT cells upon an increase in 7 gene methylation positivity. Conclusions: This work revealed the significance of 7 gene methylation in the diagnosis of COVID-19 recovery, and demonstrated that these genes were significant in evaluating the immune function during the recovery period.
Copyright (c) 2026 Xiao Xiao, Ren Xu, Chaoxiang Du, Jun Yin, Beibei Xin, Zhonghe Ke, Xiyan Li, Hao Zhang, Xinyu Chen https://creativecommons.org/licenses/by/4.0
The quantitative evaluation of antibiotic utilization in community health centers during the COVID-19 pandemic: a cross-sectional multicenter study
Introduction: Uncertainty and rapid changes in treatment guidelines are influencing factors for medication use during the COVID-19 pandemic. Therefore, this study aimed to evaluate antibiotic utilization in Community Health Centers (CHCs) between 2020 and 2021. Methodology: Prescription data from adult outpatient visits (≥ 18 years) receiving prescription services at 35 CHCs in South Jakarta, Malang regency, and Bengkulu city, comprising 796,598 prescriptions, were examined using the ATC/DDD methodology and DU90% analysis. These regions were purposively selected to represent three distinct healthcare archetypes, namely metropolitan (South Jakarta), rural-urban continuum (Malang Regency), and regional cities outside Java (Bengkulu City). Wilcoxon signed-rank and Chi-square tests were used to determine statistical differences between years. Results: The proportion of adult patient visits receiving a minimum of one antibiotic prescription decreased by 1.56% in 2021 (p < 0.001). Malang Regency recorded the highest rates, decreasing by 2.24% in 2021. Furthermore, the highest DDD values for all antibiotics each year were recorded in South Jakarta, except for Cefadroxil, which peaked in Malang regency. Six antibiotics were constituted in the DU90% segment, with Amoxicillin accounting for over 50% of prescriptions and reaching 425 DDD/1000 patient visits/year in South Jakarta in 2020. In 2021, Azithromycin prescriptions increased significantly by 7.51%, as shown by a p of 0.0161. The average prescribing rate (14.57%) remained below the WHO optimal indicator (< 30%). Conclusions: Antibiotic use in CHCs declined during the pandemic, but there was a significant increase in Azithromycin prescriptions.
Copyright (c) 2026 Zamharira Muslim, Angga Iswara Widigda Effendi, Kartika Citra Dewi Permata Sari, Ayuk Lawuningtyas Hariadini, Larasati Arrum Kusumawardani https://creativecommons.org/licenses/by/4.0
Positivity rate of respiratory syncytial virus (RSV) using multiplex PCR test in Indonesia
Introduction: Respiratory syncytial virus (RSV) is highly prevalent as a cause of acute respiratory tract infection. Detection of RSV using nucleic acid amplification tests provides rapid results that can help physicians manage patients with acute respiratory symptoms and avoid unnecessary antibiotics. This study aimed to report the positivity rate of RSV among patients with acute respiratory symptoms. Methodology: Nasopharyngeal swab specimens were obtained from primary healthcare facilities and hospital outpatient clinics from January 2023 to June 2024. The specimens were processed using the multiplex QIAStat-Dx Respiratory SARS-CoV-2 Panel (QIAGEN GmbH, Hilden, Germany). Results: A total of 1339 tests were performed and RSV was positive in 10.3% of tested patients (138/1339). Regarding the monthly positivity rate, the highest rate of RSV positivity was in November 2023, followed by January 2023, and March 2023. Conclusions: This study shows a moderate RSV positivity rate in outpatient settings and suggests a seasonal trend, with higher circulation during the rainy season. These findings highlight the value of RSV surveillance for guiding clinical and public health responses in tropical regions.
Copyright (c) 2026 Fariz Nurwidya, Ricky Tjahjadi, Arini Purwono, Linda Mahardhika, Fanny Fachrucha https://creativecommons.org/licenses/by/4.0