The Journal of Infection in Developing Countries
A peer-reviewed open access medical journal, focusing on global health.
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
Clock-like behavior across Orthoebolavirus species suggests alternative evolution of the 2026 Bundibugyo virus outbreak
Introduction: Recent increase in reported cases of Bundibugyo virus (species Orthoebolavirus bundibugyoense) in the Democratic Republic of the Congo and Uganda highlight the importance of understanding their evolutionary dynamics. Methodology: We analyzed publicly available genomes obtained from the Pathoplexus database representing 3 medically relevant species of the Orthoebolavirus genus: Ebola virus (n = 3,388), Zaire virus (n = 166), and Bundibugyo virus (n = 49). We investigated whether genetic divergence is associated with sampling time utilizing root-to-tip regression analyses derived from temporally calibrated phylogenies as an indicator of molecular clock behavior. Results: Sudan virus (R2 = 0.855) and Ebola virus (R2 = 0.709) exhibited significant temporal structures between sampling time and genetic divergence. Bundibugyo virus displayed strong clock-like behavior after exclusion of 2026 genomes (R2 = 0.983), which showed a marked substitution deficit relative to the historical molecular clock and deviated substantially from the inferred regression. Date randomization tests supported the presence of temporal signal across all datasets (p < 0.001), indicating that the temporal signals exceeded expectations under a null model without temporal structure. Conclusions: These results provide a comparative assessment of the temporal structures across 3 medically relevant Orthoebolavirus species. While historical genomes largely conformed to molecular clock expectations, the inclusion of genomes from the ongoing 2026 Bundibugyo virus outbreak deviated from these projections, suggesting an alternative evolutionary process for 2026 Bundibugyo virus, such as viral persistence in immune-privileged anatomical sites of previously infected individuals or an independent zoonotic spillover event in an alternative species, in which the virus evolved within its natural reservoir prior to human infection.
Copyright (c) 2026 Gustavo Sganzerla Martinez, Anuj Kumar, Mansi Dutt, Misaki Wayengera, Wilber Sabiiti, David J Kelvin, Henry Kyobe Bosa https://creativecommons.org/licenses/by/4.0
The overlooked burden: anxiety and depression in patients with tuberculosis
Background: Tuberculosis (TB) is a major global cause of infectious disease–related morbidity and mortality. Beyond its physical burden, TB is associated with significant psychological distress. Anxiety and depression are highly prevalent among TB patients but often remain underrecognized and undertreated, despite their negative impact on treatment adherence, disease outcomes, and quality of life. Objective: This review summarizes current evidence on the prevalence, biological mechanisms, treatment-related factors, and psychosocial determinants of anxiety and depression in patients with TB, and highlights the importance of routine mental health screening in integrated TB care. Methodology: A narrative review of the literature was conducted focusing on epidemiology, underlying biological pathways, neuropsychiatric effects of anti-tuberculosis medications, psychosocial risk factors, and validated screening tools for anxiety and depression in TB populations. Results: Depression affects nearly 45% of TB patients, while anxiety is present in 32–38%, with higher prevalence in low- and middle-income countries and among patients with multidrug-resistant TB. Biological mechanisms include chronic inflammation, cytokine-mediated neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, altered tryptophan metabolism, and neuropsychiatric effects of medications such as isoniazid and cycloserine. Psychosocial factors, including stigma, social isolation, poverty, and limited social support, further contribute to psychological distress. Screening tools such as PHQ-9, GAD-7, HADS, and Zung SAS have demonstrated feasibility and validity in TB settings. Conclusions: Anxiety and depression in TB result from interacting biological, pharmacological, and psychosocial factors. Integrating systematic and repeated mental health screening into routine TB care is essential to improve detection, support timely interventions, enhance adherence, and optimize treatment outcomes.
Copyright (c) 2026 Mirjana Stjepanović, Aleksa Golubović, Filip Marković, Ivan Milivojević, Olga Golubović, Jelena Djordjević https://creativecommons.org/licenses/by/4.0
Efficacy and safety of Tanreqing Injection combined with conventional antimicrobial therapy in the treatment of multidrug-resistant bacterial pneumonia: a meta-analysis
Background: Multidrug-resistant (MDR) bacterial pneumonia is a growing public health concern with limited treatment options and high mortality rates. Tanreqing injection, a traditional Chinese medicine with anti-inflammatory, antibacterial, and immunomodulatory properties, has shown potential as an adjunctive therapy, but its efficacy and safety remain unclear. Methods: A systematic search of six English and Chinese databases was conducted to identify randomized controlled trials (RCTs) published before July 2025 evaluating Tanreqing injection for MDR pneumonia. Meta-analysis was performed using RevMan 5.4. Primary outcomes included clinical effectiveness and 28-day all-cause mortality. Secondary outcomes included bacterial clearance, inflammatory markers (WBC, CRP, PCT), healthcare utilization (duration of antibiotic use, mechanical ventilation, hospital stay), and adverse events. Risk of bias was assessed using the RoB 2.0 tool. Results: Seventeen RCTs involving 1,616 patients were included. All studies were conducted in China. Tanreqing combined with standard therapy significantly improved clinical effectiveness (RR = 1.21) and bacterial clearance (RR = 1.42), and reduced CRP, WBC, PCT, antibiotic duration (MD = -3.55 days), ventilation time (MD = -1.57 days), and hospital stay (MD = -4.98 days). A trend toward lower 28-day mortality was observed (RR = 0.56, p = 0.15). No serious adverse events were reported. Publication bias was not significant (Harbord test, p = 0.639). Conclusions: Tanreqing injection may enhance the clinical outcomes of patients with MDR pneumonia when used alongside antibiotics and appears to be safe and well-tolerated. Further high-quality RCTs are needed to confirm these findings.
Copyright (c) 2026 Bofei Shu, Tingting Qiu, Keke Li, Xiaolin Wang, Bangjiang Fang https://creativecommons.org/licenses/by/4.0
Developing a Data Set for Mpox Disease: A Scoping Review and Consensus-based Classification
Introduction: The emergence of Mpox as a major public health problem has drawn attention toward comprehensive data that could inform effective disease management and control efforts. This study aims to create a standardized data set for Mpox, which will be useful for purposes of collecting, analyzing, and reporting critical data elements. Methods: The scoping review was done in accordance with Arksey and O'Malley's framework and under the PRISMA-ScR guidelines. Searches for the terms "minimum data set" and "Monkeypox" were conducted without time limitation until June 9, 2024, in the PubMed, Scopus, and Web of Science databases. Two researchers independently screened the titles, abstracts, and full texts. Data extraction was carried out in Excel. Results: 670 studies were identified, although the inclusion criteria was met by 16. Most studies were conducted in the Democratic Republic of the Congo. Data elements were divided into administrative (10 core and 15 extended data elements) and clinical (26 core and 51 extended data elements). Patient demographics, socioeconomic factors, residence, and healthcare providers appear in administrative data. Disease exposure, symptoms, medical history, diagnostics, treatments, follow-up, and vaccination form part of the clinical data. A total data set with 104 elements was created. Conclusions: Identifying the data set is crucial to improving the public health responses to Mpox outbreaks. It will enable healthcare professionals and researchers to enhance disease monitoring and control efforts globally. Future studies should validate the data set in diverse settings, adapt it to the disease’s evolving nature, and integrate it into health information systems for real-time data utilization.
Copyright (c) 2026 Azam Sabahi, Hamideh Ehtesham, Leila Ahmadian, Fatemeh Bahador, Somayeh Paydar, Farzaneh Behnam https://creativecommons.org/licenses/by/4.0
Association between Paxlovid and mortality in severe COVID-19 patients: a retrospective cohort study
Introduction: With limited research on the clinical effectiveness of Paxlovid for hospitalized patients with severe COVID-19, this study aims to assess its impact on clinical outcomes, providing essential insights for patient care. Methodology: We collected consecutive data from SARS-CoV-2-infected patients at four hospitals between December 2022 and July 2023. We compared patient characteristics, clinical parameters, and treatment regimens between the Paxlovid and control groups. Analyses included crude, multivariable, doubly robust, and propensity score methods to evaluate Paxlovid's impact on 28-day mortality and to identify subgroup interactions. Results: Of 574 patients treated with Paxlovid, 10.3% died within 28 days, versus 29.9% of 645 untreated patients. Unadjusted analysis showed a significant Paxlovid-associated reduction in 28-day mortality (OR 0.268, 95% CI 0.195-0.369; p < 0.001), sustained after adjustment (adjusted OR 0.298, 95% CI 0.198-0.447; p < 0.001). Paxlovid significantly decreased mortality in patients with infection durations ≤ 5 days (OR 0.401, 95% CI 0.227-0.707, p < 0.001) and > 5 days (OR 0.540, 95% CI 0.309-0.946, p < 0.001). Hospital stays were longer with Paxlovid (median 11 vs. 10 days, p = 0.001), with no significant effect on ICU admission rates. Conclusions: Our findings suggest that Paxlovid significantly reduces 28-day mortality in severe COVID-19 patients, irrespective of infection duration over 5 days.
Copyright (c) 2026 Bin Liu, Bo Xie, Li Jiang, HongLi Xia, Chunmei Zhu, Jing Hu, Jing Cai, Yan Zhang, Mingjin Yang, Yanchao Liang https://creativecommons.org/licenses/by/4.0
Self-medication with antibiotics during the COVID-19 pandemic: knowledge and practice among non-medical university students
Introduction: Self-medication with antibiotics (SMA) presents a major public health problem, particularly through the emergence of multidrug-resistant microorganisms. The coronavirus disease 2019 (COVID-19) pandemic may have intensified this practice. This study investigates the prevalence, knowledge, and key determinants of SMA among non-medical university students in M’sila Province, Algeria, during the pandemic. Methodology: Descriptive statistics, including frequencies and cross-tabulations of selected variables, were calculated. The Chi-square test was used to assess associations between categorical variables. Logistic regression analysis was conducted to identify factors independently associated with SMA. Results: A total of 415 students (78.1% female) consented to participate in the study between May 2021 and March 2022. The prevalence of SMA for treating COVID-19 symptoms among non-medical students was 40.5%. Higher rates were observed among biology, single, and graduate students, at 44.4%, 41.2%, and 41.9%, respectively. In case of mild illness, 34.7% of biology respondents self-medicated with antibiotics compared to higher proportion (42.4%) of non-biology students (p = 0.048). Logistic regression analysis showed that students who were supposed to have excellent knowledge of medications were more likely to self-medicate (OR = 6.613; p < 0.05). Furthermore, the COVID-19 pandemic context increased the likelihood of SMA by more than 3-fold (OR = 3.104; p < 0.001). Conclusions: The COVID-19 pandemic significantly increased SMA among non-medical university students, highlighting the urgent need for targeted awareness campaigns and educational interventions to promote rational antibiotic use during health crises. Furthermore, relevant health authorities should strengthen their control measures during pandemics to prevent drug delivery misuse.
Copyright (c) 2026 Mohamed Lamine Freidja, Tarek Benameur, Khelaf Saidani , Mohammed-Elfatih Twfieg , Lila Boulekbache-Makhlouf https://creativecommons.org/licenses/by/4.0
Status and weaknesses of epidemiological investigation and emergency response in Guizhou Province, China
Introduction: Epidemiological investigation and emergency response are crucial during public health emergencies. This work investigated the status and weaknesses of the Center for Disease Control and Prevention (CDC) system in Guizhou Province, China, before and after the coronavirus disease 2019 (COVID-19) pandemic to address the weaknesses of public health emergency preparedness. Methodology: This research was observational. It adopted a cross-sectional design, and designed two electronic questionnaires to collect data. One questionnaire was for 98 CDC agencies and the other was for 1026 individuals in Guizhou Province, China. The questionnaires focused on workforce, epidemiological investigation capacity, detection capacity, emergency material preparation, information technology application, and emergency response. Respondents completed electronic questionnaires via a WeChat application or by visiting a website link directly. Results: The workforce and detection capacity of CDC agencies have considerably increased. Among the factors influencing individual capacity, willingness to learn (OR = 4.649, 95% CI = 2.782, 7.767) was the most related to workers with strong capacity. Furthermore, weaknesses involving epidemiological investigation and emergency response were found in each CDC level. Conclusions: Remarkable improvements occurred during the COVID-19 pandemic in Guizhou Province, China. This study identified the weaknesses of epidemiological investigation and emergency response. It could provide decision-makers with directions for improvement, targeting each weakness at each CDC level to prepare for future disasters.
Copyright (c) 2026 Yun Gou, Yan Huang, Chun Yu, Can Hu, Zhongfa Tao, Jiao Huang, Bing Deng, Mingyu Lei https://creativecommons.org/licenses/by/4.0
Characterizing the antimicrobial activity of cisplatin against Gram-positive clinical strains: bridging existing gaps
Introduction: Multidrug resistant (MDR) bacteria are one of the most important current threats to public health. Therefore, serious concerns were raised about the effectiveness of traditional antibiotics. Cisplatin, a chemotherapeutic agent that is used mainly in cancer treatment, has recently attracted attention and popularity for its potential antibacterial properties. Our study aim is to evaluate the antibacterial properties of cisplatin against several common MDR and non-MDR Gram-positive strains, including Methicillin-Resistant Staphylococcus aureus (MRSA), Methicillin-Susceptible Staphylococcus aureus (MSSA), Coagulase-Negative Staphylococcus (CoNS), and Vancomycin-Resistant Enterococcus (VRE). Methodology: Cisplatin's Minimum Inhibitory Concentration (MIC) was calculated through standard microdilution methods. Results: Our findings indicated that cisplatin had a minimum inhibitory concentration (MIC) of 256 µg/mL across all tested bacterial strains, reflecting its limited antibacterial efficacy in its currently available formulation. However, although the MIC values were high, this study explored cisplatin’s activity against these bacterial strains which uncovers a potential gap about cisplatin clinical effectiveness and indicates that further enhancement is required. Conclusions: These results confirm that cisplatin antibacterial activity has not been extensively explored against these resistant strains. Cisplatin alone shows limited efficacy based on the relatively high MIC values observed. However, combination therapy with other antibiotics may improve its therapeutic potential. Additionally, novel delivery systems—nanoparticle formulations, for instance—could enhance antibacterial activity while reducing toxicity. Future investigations should evaluate these approaches in more detail.
Copyright (c) 2026 Sulaiman Bani Abdel-Rahman, Hala Altarawneh, Mohammed Abu Lubad, Hamed Alzoubi, Khulud Alhazmi, Ohood Alharbi, Malaz Gazzaz, Mohanned Alharbi, Rawan Altalhi, Waiel Halabi, Asim Sharif, Bayan Redwan, Mazen Ismail, Ahmad Sait, Khalil Alkuwaity, Wafaa Alhazmi, Sultan Alfawaz, Hussam Daghistani, Bandar Saleh, Mona Alqarni, Abdulaziz Alsaedi, Nabeel Alhussainy, Hatoon Niyazi, Hanouf Niyazi, Dalya Attallah, karem Ibrahem https://creativecommons.org/licenses/by/4.0
Molecular detection by PCR of Rickettsia rickettsii in canines in Ciudad Obregón, Sonora, México
Introduction: Rickettsia is an intracellular, Gram-negative, zoonotic bacterium that is transmitted by arthropods, such as ticks, fleas and lice. Rickettsioses have been reported in Mexico since the 1930s, with a higher prevalence in the northern states. Infections affect both dogs and humans in marginalized areas, with Rickettsia rickettsii being the most pathogenic species and associated with high mortality rates. Methodology: This study aimed to detect R. rickettsii in dogs from Ciudad Obregón, Sonora, using the ompA gene PCR. Between July and August 2024, 110 EDTA whole blood samples were collected: 95 from dogs with a presumptive clinical diagnosis of rickettsiosis, and 15 from stray dogs with active tick infestations. DNA extraction, PCR amplification and product purification were performed at the Veterinary Molecular Biology Laboratory of the Instituto Tecnológico de Sonora. Sanger sequencing, Snap Gene Viewer, and BLASTn against GenBank were used to confirm the identity of the sequences. Results: Sequencing of the ompA fragment confirmed 99–100% homology with R. rickettsii. One positive case (6.7%) was detected, corresponding to a stray dog from a disadvantaged area of the municipality of Cajeme, indicating the presence of the pathogen in a localized area. Conclusions: The detection of R. rickettsii in a stray dog in Ciudad Obregón confirms the presence of the pathogen in the area, highlighting the importance of free-roaming canines and environmental conditions in sustaining vectors. Early diagnosis and control of ectoparasites are critical to reducing zoonotic transmission, underlining the importance of continuous molecular surveillance in public health.
Copyright (c) 2026 Daniela García Tirado , José C. Leyva Corona, Javier R. Reyna-Granados, Verónica Ortiz-Encinas, Jaime Palomares-Marín, Claudia L. Cueto-Aragón, Hector R. Pérez-Gómez, Yaxsier de Armas Rodríguez, Carlos Eduardo Aragón López https://creativecommons.org/licenses/by/4.0
Is nasal MRSA carriage a concern among African people and local communities in North Cyprus?
Introduction: The long-standing epidemic of antimicrobial resistance (AMR) has proven to be a challenging problem to solve and is becoming even more complex in a globalized world where there is little evidence of AMR patterns among multinational communities. This study aimed to determine the frequency of methicillin resistant Staphylococcus aureus (MRSA) carriage among African and local students in Northern Cyprus. Methodology: Nasal swabs were collected from African and local students between October 2023 and December 2023. The clinical samples were screened for the presence of MRSA. AMR bacterial isolates were tested by phenotypic and genotypic analysis to determine the MRSA status. Results: A total of 300 participants were included in the study: One hundred and fifty of them were African students (50%) and 150 were local students (50%), The prevalence of nasal MRSA carriage in African and local students was determined as 3% and 6%, respectively. Conclusions: This study is a population-based study investigating the prevalence and distribution of MRSA in Africa and is the first to be conducted in the local population of Northern Cyprus. It highlights the presence of MRSA in the community and the impact of global migration on AMR, highlighting the need for public health measures.
Copyright (c) 2026 Ayse Arikan, Noor Nassar, John Olayado Awosanya, Meryem Güvenir, Özlem Ünaldi, Zekiye Bakkaloğlu, Serap Süzük Yildiz https://creativecommons.org/licenses/by/4.0
Causal association between 473 types of gut microbiota and neonatal bacterial sepsis: a bidirectional two-sample Mendelian randomization study
Background: Neonatal bacterial sepsis represents a major health threat to newborns, leading to high mortality rates globally. However, the correlation between the gut microbiome and bacterial sepsis in neonates remains unclear. Methods: This study utilized publicly available Genome-Wide Association Study data on 473 gut microbiota taxa as exposures. Instrumental variables were rigorously selected, and bidirectional two-sample Mendelian randomization (MR) analyses were performed. The MR and reverse MR analyses results were validated using Bayesian weighted MR (BWMR) analysis. Positive results from MR analysis will be validated through heterogeneity testing, evaluation of horizontal pleiotropy, and univariate sensitivity analysis. Results: The findings revealed a significant genetic causal association between 18 gut microbial species and neonatal bacterial sepsis, including Acetobacterales (odds ratio [OR]: 159.844; p = 0.04), Campylobacter D (OR: 16.225; p = 0.029), and Firmicutes A (OR: 75.643; p = 0.025). Additionally, both MR and inverse MR analyses confirmed the absence of reverse causation (p < 1e-5), supporting the robustness of the findings (p < 0.05) across five statistical methods. Sensitivity analyses indicated high reliability without significant heterogeneity or pleiotropy (p > 0.05). Furthermore, BWMR analysis highlighted the complex roles of probiotic taxa, including Bacteroides A plebeius (OR: 0.526) and pathogenic bacteria, such as Acetobacterales (OR: 192.449), in neonatal sepsis. Conclusions: A causal genetic association exists between gut microbiota and bacterial sepsis in neonates. These results underscore the potential of gut microbiota as biomarkers and therapeutic targets for the prevention and management of neonatal bacterial sepsis.
Copyright (c) 2026 Shubin Liu, Yang Duan, Fuqiang Sun https://creativecommons.org/licenses/by/4.0
Resistance profiles of uropathogenic E. coli: ESBL and colistin in focus
Introduction: Escherichia coli is among the most common causes of urinary tract infections (UTIs), and the rise in extended-spectrum beta-lactamase (ESBL)-producing isolates is a growing concern because of increasingly limited treatment options. This study aimed to investigate the resistance profiles of ESBL-positive and -negative uropathogenic E. coli isolates to antibiotics used in treatment and colistin. Methodology: Urine samples sent to the Central Laboratory of Istanbul University, Istanbul Faculty of Medicine, for routine examination between September 2023 and January 2024 were included in the study. The presence of ESBL and susceptibility to antibiotics other than colistin were determined by the Vitek2 (bioMérieux, France) automated system, and colistin susceptibility was determined by the reference broth microdilution method. Results: Of the 80 patients with E. coli, 80% were female, and 20% were male; 32.5% were children, and 67.5% were adults. All E. coli isolates were susceptible to nitrofurantoin, ertapenem, and meropenem. 40% of the strains were ESBL-positive. In respect of multidrug-resistant bacteria, among ESBL-positive and-negative isolates, 12.5% and 2.1% were resistant to six, 28.1% and 8.3% to five, 34.4% and 6.25% to four, and 18.75% and 16.7% to three different antibiotic groups, respectively. Of 80 E. coli strains, 92.5% of which were sensitive to colistin, the MIC50 value was 0.5 mg/L, and the MIC90 value was 2 mg/L. Conclusions: Although the colistin resistance rate and minimum inhibitory concentration (MIC) values are not high, it is important to monitor resistance when treating problematic infections with multiple resistance.
Copyright (c) 2026 Şafak Ceren Uçak, Ahmet Aktaş, Deniz Bahar Akgün Karapınar, Yaşar Nakipoğlu, Betigül Öngen https://creativecommons.org/licenses/by/4.0
Etiology and antimicrobial resistance in pediatric urinary tract infections: a 10-year retrospective study in Hohhot, China
Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections in children, yet regional pathogen distribution and antimicrobial resistance patterns remain understudied in resource-limited settings. This study aimed to characterize UTI pathogens and their resistance profiles in Hohhot, China, including molecular analysis of the YadC gene in Escherichia coli (E. coli). Methodology: This was a retrospective analysis of 550 pediatric UTI cases from December 2014 to December 2024. Urine cultures, antimicrobial susceptibility testing, and YadC gene detection (polymerase chain reaction, PCR) for 46 E. coli isolates were performed in 2023. Statistical analysis used χ² tests or Fisher's exact tests (SPSS 27.0; p < 0.05). Results: Among 312 culture-positive cases (56.7%), Gram-negative bacteria (64.1%, predominantly E. coli [41.7%]), Gram-positive bacteria (35.3%, mainly Enterococcus faecium (E. faecium) [20.2%]), and 2 yeast isolates (Candida tropicalis and Candida albicans; 1 strain each; 0.6%) were identified. YadC-positive E. coli isolates exhibited a significantly higher rate of multidrug resistance compared to YadC-negative isolates (83.3% vs. 37.5%, p = 0.002). Resistance rates exceeded 70% for penicillin and erythromycin in E. faecium, while E. coli showed high resistance to ampicillin/sulbactam (73.1%) and third-generation cephalosporins. Nitrofurantoin and β-lactam/β-lactamase inhibitors (e.g., ampicillin/sulbactam) remained effective for E. faecalis isolates. Conclusions: E. coli remains the predominant UTI pathogen in Hohhot. The high YadC prevalence (65.2%) and its association with cephalosporin resistance indicate its surveillance potential. Empirical therapy should favor agents like ceftazidime, while managing complicated UTIs requires integrating imaging and susceptibility testing to curb resistance and prevent renal injury.
Copyright (c) 2026 Ruixuan Li, Yanyan Guo, Xue Zhou, Yun Zhao, Qian Zhang https://creativecommons.org/licenses/by/4.0
Predictors of mortality in post-neurosurgical Gram-negative bacterial meningitis: a five-year retrospective study
Introduction: The incidence of Gram-negative bacterial meningitis (GNBM) has increased with the growing number of neurosurgical procedures. Concurrently, global antimicrobial resistance, particularly among Gram-negative pathogens causing healthcare-associated infections, has contributed to high morbidity and mortality. This study aimed to identify clinical and laboratory parameters associated with mortality in post-neurosurgical GNBM (PN-GNBM). Methodology: This retrospective study included adult patients who developed GNBM at least 48 hours after a neurosurgical procedure in the intensive care unit of a tertiary hospital between January 2019 and March 2024. Clinical findings and laboratory results before and at the time of diagnosis were obtained from the hospital information system. The factors associated with all-cause 28-day mortality were evaluated. Statistical analyses were performed using SPSS version 19, with p < 0.05 considered statistically significant. Results: A total of 21 PN-GNBM patients were included. The 28-day mortality rate was 60%. Evaluation of peripheral blood leukocyte ratios at the time of diagnosis revealed that a low lymphocyte-to-platelet ratio (LPR) significantly predicted mortality on days 7, 14, and 21 (p = 0.046, 0.003, and 0.005, respectively), whereas a high neutrophil-to-lymphocyte ratio (NLR) predicted 14-day mortality (p = 0.035). Acinetobacter baumannii was the most frequently isolated pathogen with 81.81% carbapenem resistance rate. Conclusions: NLR and LPR are inexpensive and readily accessible biomarkers that may support early mortality prediction and risk stratification in PN-GNBM. These preliminary findings should be validated in larger multicenter studies.
Copyright (c) 2026 Bahar Ormen, Hasan Kamil Sucu , Cansu Aksit Aksoy , Banu Karaca, Nesrin Turker , Ismail Ertan Sevin https://creativecommons.org/licenses/by/4.0
Neutrophil‑ and platelet‑to‑lymphocyte ratios in sepsis: mortality links in diabetic patients and hospital burden in acute kidney injury
Introduction: Timely identification of sepsis patients at elevated risk for in-hospital mortality or prolonged hospitalization remains a clinical imperative. This study aimed to assess the prognostic utility of two readily available hematological biomarkers, namely the neutrophil-to-lymphocyte count ratio (NLCR) and platelet-to-lymphocyte count ratio (PLCR), for their association with mortality and length of stay (LOS) among sepsis patients, including high-risk subgroups with acute kidney injury (AKI) or type 2 diabetes mellitus (T2DM). Methodology: This retrospective 1-year cohort study included 202 adult sepsis patients. NLCR and PLCR were derived from admission complete blood counts. Receiver operating characteristic (ROC) curve analysis was used to evaluate discriminative performance, with optimal thresholds determined using Youden’s index. Kaplan–Meier and log-rank tests assessed survival differences, while LOS comparisons were analyzed using Mann–Whitney and Chi-square tests. Results: NLCR demonstrated limited overall prognostic value for mortality (AUC 0.560; sensitivity 53.68%; specificity 63.55%) but showed improved discrimination in patients with T2DM (AUC 0.603). PLCR was not associated with mortality in any subgroup (AUCs: 0.438–0.539). Diabetic patients with low NLCR had significantly higher survival (62.4% vs. 32.8%; p = 0.039). No significant survival differences were observed in the overall or AKI cohorts. Both NLCR and PLCR had poor association with LOS (AUC < 0.55). However, AKI patients with elevated NLCR had significantly prolonged hospitalization (11.5 ± 4.9 vs. 7.83 ± 4.5 days; p = 0.039). PLCR was not significantly associated with LOS. Conclusions: NLCR may provide modest, preliminary prognostic value in specific sepsis subgroups, particularly those with T2DM or AKI, and may serve as a low-cost adjunct for early risk stratification.
Copyright (c) 2026 Nuril Farid Abshori, Muhammad Iqhrammullah , Raihan Radliyatul Mardliyyah, R. Moch Satrio Siliwangi Syariffatihmulia Negara, Achmad Zainudin Arif, Iwal Reza Ahdi, Muhammad Habiburrahman https://creativecommons.org/licenses/by/4.0
Burden of infectious diseases in a West African tertiary hospital: a two-year retrospective study at CHNU de Fann, Senegal
Introduction: Despite progress in prevention and treatment, infectious diseases remain a major cause of morbidity and mortality in West Africa. Hospital-level data are limited. This study aimed to assess the burden, clinical spectrum, and outcomes of infectious diseases at a referral hospital in Senegal. Methodology: A retrospective study of all non-coronavirus disease 2019 (COVID-19) infectious disease admissions at the Centre Hospitalier National Universitaire (CHNU) de Fann from January 2021 to December 2022 was conducted. Sociodemographic, clinical, diagnostic, and outcome variables were recorded. Logistic regression identified factors independently associated with in-hospital mortality. Results: A total of 1,098 patients (median age 42, 57.2% male) were included. Tuberculosis (TB; 21.8%), malaria (13%), and community-acquired pneumonia (9.2%) were the leading diagnoses. Human immunodeficiency virus (HIV) infection was present in 28.1% of patients, with 58.4% having opportunistic infections. Overall mortality was 25.0%. Independent predictors of death included HIV-positive status (OR: 2.1; 95% CI: 1.4–3.2), neurological involvement (OR: 1.7; 95% CI: 1.2–2.5), age > 60 years (OR: 1.9; 95% CI: 1.1–3.1), and sepsis (OR: 2.3; 95% CI: 1.5–3.6). Conclusions: Infectious diseases remain a leading cause of hospitalization and death in Senegal. Improving early diagnostics, integrating TB/HIV services, and expanding access to fungal testing are crucial to improve outcomes in resource-limited hospital settings.
Copyright (c) 2026 Alassane Sarr, Dunia Alves , Viviane Marie Pierre Cissé-Diallo; Papa Latyr Junior Diouf; Daouda Thioub, Louise Fortes, Moussa Seydi https://creativecommons.org/licenses/by/4.0
A six-year experience of catheter-related bloodstream infections in hemodialysis patients
Introduction: This study investigated the clinical characteristics, causative microorganisms, and antibiotic resistance patterns of catheter-related bloodstream infections (CRBSIs) in hemodialysis patients at a tertiary healthcare institution. Methodology: A retrospective analysis of 300 patients treated for CRBSIs between January 2018 and December 2023 was conducted. Patients were divided into two groups: those with less than 1 year of hemodialysis (Group 1) and those with more than 1 year of hemodialysis (Group 2). Risk factors for intensive care unit (ICU) transfer and 28-day mortality were analyzed. Results: The median age was 68 years. Gram-positive bacteria were the predominant pathogens (69%), with Staphylococcus aureus being the most frequent. Group 1 had significantly higher rates of recent hospitalization (p = 0.014) and a history of previous ICU admission (p = 0.001). However, no significant differences were found in causative microorganisms or antimicrobial resistance between the two groups. Risk factors for ICU transfer included carbapenem resistance (OR: 7.657, p = 0.013), history of catheter revision (OR: 4.632, p = 0.022), and leukocytosis (OR: 1.150, p = 0.004). The 28-day mortality rate was 8%. Significant risk factors for mortality were ICU transfer (OR: 17.29; p = 0.001) and Vancomycin-Resistant Enterococcus (VRE) infection (OR: 14.10; p = 0.002). Conclusions: Despite shorter-term dialysis patients having more frequent hospitalizations, the distribution and resistance of pathogens remain similar regardless of hemodialysis duration. Empirical therapy should prioritize broad anti-staphylococcal coverage and be tailored to specific risk factors such as VRE or carbapenem resistance rather than hemodialysis duration.
Copyright (c) 2026 Zeynep Ture, Alparslan Demiray, Kadir Demirkutlu, Beyza Hayırlıdağ, Fatma Cevahir, İsmail Kocyiğit https://creativecommons.org/licenses/by/4.0
Age and Gender-Based Clinical and Laboratory Features in Dengue Infection: A Comparative Study
Background: Dengue infection remains prevalent globally, with a shift toward adult cases. WHO diagnosis relies on clinical and laboratory criteria to identify and manage the disease effectively. Aim: This study aims to investigate the differences in clinical and laboratory findings of dengue infection based on age and gender. Materials and methods: This analytical cross-sectional study utilized medical record data from 162 pediatric and adult dengue patients diagnosed with dengue fever (DF) or dengue hemorrhagic fever (DHF) in Surabaya hospital in 2022. The study assessed hemoglobin, hematocrit, leukocyte, and platelet levels across six age groups: toddlers (0–5 years), children (6–10 years), adolescents (11–18 years), young adults (19–29 years), and adults (30–59 years). The variables observed in this study include age, gender, classification, and type of dengue infection among hospitalized patients diagnosed with dengue. Results: The findings of this study indicate no statistically significant difference between pediatric and adult patients regarding the classification of DF and DHF (p = 0.085). However, laboratory results revealed a significant difference in the incidence of thrombocytopenia between children and adults (p = 0.019). Furthermore, a significant association was found between platelet count and dengue classification, with lower platelet levels observed in DHF cases compared to DF (p = 0.001). Conclusions: This study shows significant clinical and laboratory differences between children and adults with dengue, highlighting the necessity of age-specific diagnostics to enhance early detection and appropriate treatment.
Copyright (c) 2026 Sulistiawati sulistiawati, Linda Dewanti, Alpha Fardah Athiyyah; Bilqis Inayatillah; Jan Nouwen, Lady Savita Nabila; Avita Diva Choirun Nisa; Ronald Pratama Adiwinoto https://creativecommons.org/licenses/by/4.0
USP18-driven macrophage M2 polarization through fatty acid β-oxidation inhibits immune responses induced by RSV infection
Introduction: Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory infections in infants under six months, with limited treatment options available. Macrophages play a pivotal role in antiviral immunity, where their polarization state directly modulates immune responses. Methodology: The expression changes of ubiquitin-specific protease 18 (USP18) in RSV-infected samples were analyzed through the Gene Expression Omnibus database. An RSV infection model was established in C57BL/6 mice, and USP18 expression in lung tissues was measured by quantitative polymerase chain reaction (qPCR). Adenovirus-mediated USP18 knockdown was performed via tail vein injection, and its effects on immune cells were assessed using enzyme-linked immunosorbent assay (ELISA) and qPCR. THP-1 macrophage models with USP18 overexpression and knockdown were constructed. The effects of USP18 on macrophage polarization, immune function, and fatty acid β-oxidation during RSV infection were evaluated using immunofluorescence, ELISA, fatty acid oxidation (FAO) assays, boron-dipyrromethene (BODIPY) staining, and Western blot. Results: USP18 was markedly overexpressed in RSV-infected samples. USP18 knockdown in mice alleviated lung damage, reduced M2 macrophage markers, and enhanced CD8+ T cell activity. Cellular experiments demonstrated that USP18 promotes M2 macrophage polarization by enhancing fatty acid β-oxidation and regulating the expression of related enzymes, including ACLY, FASN, and ACC1. Elevated USP18 in macrophages during RSV infection inhibits CD8+ T cell activation, contributing to immune suppression. These effects were reversible with FAO inhibitors. Conclusions: USP18 upregulation in RSV-infected cells induces M2 macrophage polarization via fatty acid β-oxidation, thereby promoting immune suppression.
Copyright (c) 2026 Dannv Yang, Liyan Zhao, Li Liu, Jian Zhang, Jingwen Wang https://creativecommons.org/licenses/by/4.0