Current Opinion in Infectious Diseases最新文献

{"title":"The plumbing problem: rising antimicrobial resistance in building water systems.","authors":"Claire Hayward, Harriet Whiley, Nicholas J Ashbolt","doi":"10.1097/QCO.0000000000001119","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001119","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the interplay between biological and anthropogenic factors in the development and persistence of antimicrobial resistance (AMR) within building plumbing systems, which is of particular concern in high risk setting such as healthcare facilities. The review highlights the role of biofilms and amoeba as reservoirs for AMR and explores how engineering and design decisions, governance structures, and cleaning protocols influence microbial resistance dynamics.</p><p><strong>Recent findings: </strong>Biofilms provide a protective environment that facilitates horizontal gene transfer and enhances bacterial resistance to disinfection. Amoeba-hosted bacteria can evade standard cleaning practices, further promoting AMR persistence. Emerging technologies, such as digital twin modelling, offer new opportunities to optimize risk mitigation strategies. However, more consideration is needed to be given to design or management decision that may have unintended consequences, such as unintended design outcomes, such as increased biofilm growth from tap mixers and low-flow fixtures, and ineffective cleaning protocols, which can inadvertently worsen AMR.</p><p><strong>Summary: </strong>Effectively managing AMR in plumbing systems requires a multidisciplinary approach that integrates microbiology, engineering, and policy. Data driven risk assessments can identify high-risk areas that may require design changes but also can enable targeted cleaning strategies, reducing reliance on widespread disinfection that may drive resistance. Future policies must consider system-wide implications to prevent unintended consequences. By addressing both biological and anthropogenic drivers, we can develop sustainable solutions to mitigate AMR risks in healthcare and beyond.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory syncytial virus prevention in immunocompromised hosts: gaps and opportunities.","authors":"Alastair Murray, Helen Y Chu","doi":"10.1097/QCO.0000000000001124","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001124","url":null,"abstract":"<p><strong>Purpose of review: </strong>Respiratory syncytial virus (RSV) poses a significant threat to immunocompromised individuals, yet preventive strategies and treatments remain largely unstudied in this population. New vaccines, mAbs, and antiviral agents are becoming available, with implications for high-risk patients.</p><p><strong>Recent findings: </strong>RSV in immunocompromised individuals often leads to severe disease, prolonged illness, and treatment delays. Diagnostic challenges and the heterogeneity of immunosuppression complicate management. Recent advances include preF-based vaccines and monoclonal antibodies, though current recommendations exclude many immunocompromised patients. Early vaccine trials showed mixed immunogenicity results in this group and real-world effectiveness remains unclear. Antiviral agents are also under investigation, though efficacy data in immunocompromised hosts are limited. Infection prevention strategies remain critical in this high-risk group.</p><p><strong>Summary: </strong>Despite promising advances in RSV prevention and treatment, immunocompromised patients remain underrepresented in clinical research. Targeted studies are urgently needed to determine optimal strategies for this vulnerable group. Until then, clinicians must rely on limited evidence and institutional protocols to guide care.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To proceed or delay? The dilemma of community-acquired respiratory viruses in adults and pediatrics before allogeneic stem cell transplantation and chimeric-antigen-receptor T-cell therapy.","authors":"José Luis Piñana, Rodrigo Martino, Simone Cesaro, Dina Averbuch, Per Lujgman","doi":"10.1097/QCO.0000000000001120","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001120","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores the impact of community-acquired respiratory virus (CARV) infections on outcomes before proceeding with hematopoietic cell transplantation (HCT) and chimeric-antigen-receptor T-cell (CAR-T) therapy recipients and which conditions should be considered to delay or proceed with cell therapy. It aims to assess current practices, the risks associated with early CARV infections in cell therapy recipients, and potential modifications to reduce complications and improve clinical outcomes if delay is not an option.</p><p><strong>Recent findings: </strong>Studies have shown that pretransplant CARV infections, particularly those with symptomatic lower respiratory tract disease (LRTD), are linked to increased mortality and prolonged hospitalization after hematopoietic stem cell transplant. The timing of CARV infection regarding the transplant, the type of CARV, and the intensity of immunosuppressive conditioning, among others, are key factors influencing outcomes. Additionally, recent research highlights the potential benefits of delaying transplantation, optimizing immunosuppression, and reducing the duration of neutropenia and lymphopenia to mitigate the risk of severe infections.</p><p><strong>Summary: </strong>Key challenges include determining the optimal timing for transplant in CARV-positive patients, managing cell procedures, and minimizing risk factors to reduce the development of a severe course resulting in poor outcome. Current practices often prioritize timely transplant/CAR-T procedures but may need to be adjusted to account for CARV infections. Implementing strategies such as reduced-intensity conditioning, enhanced infection prevention measures, and antiviral therapy could significantly impact patient outcomes, particularly in preventing progression to LRTD and reducing the risk for fatal outcome.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide approaches to bacterial strain typing: a history and review of recent methodological advances.","authors":"William C Shropshire, Blake M Hanson, Samuel A Shelburne","doi":"10.1097/QCO.0000000000001118","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001118","url":null,"abstract":"<p><strong>Purpose of review: </strong>Whole genome sequencing (WGS) has transformed bacterial strain typing, an essential tool for outbreak detection, antimicrobial resistance surveillance, and tracking clonal emergence across clinical, research, and public health settings. Herein, we will review recent advances in WGS-based bacterial strain typing methods for purposes of comparison and classification with a focus on improvements in variant identification, strain classification, and transmission assessment.</p><p><strong>Recent findings: </strong>Advances in sequencing technologies as well as variant calling methodologies and parameter optimization have enhanced the precision and accuracy of single nucleotide variant identification. Hierarchical clustering of gene-by-gene strain typing, combined with novel data management and classification strategies, has improved standardized pathogen typing schemes in an effort to streamline inter-laboratory comparison. Additionally, novel approaches to defining transmission thresholds now better account for species-specific traits, while progress in metagenomic sequencing enables strain identification and tracking within mixed microbial communities.</p><p><strong>Summary: </strong>Recent developments have enhanced the accuracy, portability, scalability, and standardization of bacterial typing methods, integrating variant calling and gene-by-gene approaches into unified genotyping systems. However, challenges still remain in nomenclature consistency, inter-laboratory variant calling compatibility, and capturing bacterial heterogeneity. Future work should focus on refining genotyping frameworks to enhance surveillance and optimize detection of pathogen transmission while accounting for microbial diversity across various environments.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent tuberculosis screening and treatment in solid organ and hematopoietic stem cell transplant candidates and recipients.","authors":"Sonya Krishnan, Robin Avery, Veronica Dioverti, Jeffrey A Tornheim","doi":"10.1097/QCO.0000000000001117","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001117","url":null,"abstract":"<p><strong>Purpose of review: </strong>Tuberculosis disease (TBD) has high mortality in transplant recipients. This review evaluates the current evidence for latent tuberculosis infection (LTBI) screening and treatment in solid organ transplant (SOT) and hematopoietic stem cell transplant recipients (HCST).</p><p><strong>Recent findings: </strong>Untreated LTBI still poses a significant risk in transplant recipients, with reactivation to TBD leading to high mortality rates. Currently available methods to test for LTBI (interferon-gamma release assays and tuberculin skin tests) can have low predictive value for determining who will progress from LTBI to TBD in transplant. Tuberculosis preventive therapy (TPT) is recommended for those with a positive LTBI screening test. Evidence indicates that short-course, rifamycin-based TPT regimens are associated with less hepatoxicity and improved treatment completion compared to isoniazid. In the transplant population, however, drug-drug interactions limit their use, so isoniazid preventive therapy remains the preferred regimen. Several recent studies have evaluated moxifloxacin as a potential TPT regimen in transplant, but this regimen has not yet been incorporated into guidelines. The timing of LTBI treatment can differ for SOT versus HSCT.</p><p><strong>Summary: </strong>While comprehensive LTBI screening and TPT are critical for reducing the risk of TBD, future research should aim to optimize LTBI diagnostic tools and therapeutic regimens to enhance the efficacy of LTBI diagnostics and minimize TPT side effects and drug-drug interactions in the transplant population.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic meningitis: diagnostic and therapeutic challenges.","authors":"Matthew Smyth, Monica Diaz, Deanna Saylor","doi":"10.1097/QCO.0000000000001107","DOIUrl":"10.1097/QCO.0000000000001107","url":null,"abstract":"<p><strong>Purpose of review: </strong>We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered.</p><p><strong>Recent findings: </strong>Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future.</p><p><strong>Summary: </strong>Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"252-260"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox: emergence following smallpox eradication, ongoing outbreaks and strategies for prevention.","authors":"Amy E Bryant, Stanford T Shulman","doi":"10.1097/QCO.0000000000001100","DOIUrl":"10.1097/QCO.0000000000001100","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on the temporal relationship between the discontinuation of the global smallpox eradication effort with the rise of mpox in Africa and worldwide. It also discusses the global 2022 clade II mpox epidemic and the current 2024 clade I mpox outbreak. Newer findings on viral evolution and pathogenesis, plus current and future strategies for disease prevention, are reviewed.</p><p><strong>Recent findings: </strong>The temporal association between the incidence of mpox and the World Health Organization's Global Smallpox Eradication Program (GSEP) is presented. The 2022 global mpox epidemic is discussed. Recent data show that clade IIb monkeypox virus (MPXV)-2022 has novel genetic features supporting a greater propensity for mutations that may be responsible for enhanced human-to-human transmissibility, increased disease severity and accelerated viral evolution. In 2023, another outbreak of mpox began in Africa, this time due to the potentially more virulent MPXV clade Ib strains. This outbreak remains ongoing in Africa, and clade Ib mpox cases have recently been reported elsewhere including the United States and Great Britain. The World Health Organization has deemed mpox to be a global public health emergency. Two smallpox vaccines are approved for mpox prevention in the United States; a third smallpox vaccine and an improved diagnostic test have recently received WHO Emergency Use authorization. Newer mRNA-based vaccines for evolving orthopoxvirus infections are discussed.</p><p><strong>Summary: </strong>Vaccination to prevent smallpox provides immunologic cross-protection against infection with other members of genus Orthopoxvirus , including mpox. Discontinuation of the global smallpox eradication program in the 1980s and the subsequent waning of herd immunity contributed to the 2022 multinational epidemic of human clade IIb mpox infections. A second multinational outbreak with clade Ib MPXV is ongoing. Vaccination against smallpox remains the gold standard for mpox prevention, however newer multiepitope mRNA-based vaccines are in development and hold promise for prevention of mpox and other orthopoxvirus outbreaks.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"222-227"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lenacapavir: a first-in-class capsid inhibitor for HIV treatment and prevention.","authors":"Mehri S McKellar","doi":"10.1097/QCO.0000000000001113","DOIUrl":"https://doi.org/10.1097/QCO.0000000000001113","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes available data for lenacapavir (LEN), a first-in-class agent that targets several functions of the HIV capsid in the viral cycle, including nuclear entry, viral assembly, and capsid formation.</p><p><strong>Recent findings: </strong>LEN has been approved in the United States as both oral tablets and injectable solution for treatment in heavily treatment-experienced adults with multidrug-resistant HIV-1. The subcutaneous injections are administered every 26 weeks (6 months). In 2024, LEN was named the biggest science breakthrough for HIV prevention, and is currently under review at the FDA.</p><p><strong>Summary: </strong>LEN is a novel agent that can be administered subcutaneously every 6 months. Approved for treatment-experienced adults with multidrug-resistant HIV, lenacapavir may have additional uses including for HIV prevention.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"38 3","pages":"208-213"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aseptic meningitis: a foundation review.","authors":"Hazim Allos, Rodrigo Hasbun","doi":"10.1097/QCO.0000000000001105","DOIUrl":"10.1097/QCO.0000000000001105","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review addresses the multifaceted nature of aseptic meningitis, a condition with diverse infectious and noninfectious etiologies. Despite its common presentation in clinical settings, over half of the cases remain without an identified cause, necessitating a comprehensive examination of diagnostic and management strategies. The increasing availability of advanced molecular diagnostics and the challenge of distinguishing bacterial from nonbacterial cases make this an opportune time to explore its implications for clinical practice.</p><p><strong>Recent findings: </strong>The literature highlights the pivotal role of advanced molecular diagnostics, such as multiplex PCR and metagenomic sequencing, in improving the identification of pathogens in aseptic meningitis. Enteroviruses remain the leading cause, but pathogens like Herpesviridae, arboviruses, and nonviral agents such as fungi and spirochetes also contribute significantly. New diagnostic algorithms and clinical models are emerging to distinguish bacterial from viral meningitis, reducing unnecessary treatments.</p><p><strong>Summary: </strong>Aseptic meningitis management is evolving with advancements in diagnostic technologies that allow for earlier pathogen identification, improving patient outcomes and minimizing healthcare costs. These findings underscore the importance of timely and accurate diagnostics and tailored therapeutic strategies in both clinical and research settings. Enhanced awareness of noninfectious causes is also crucial for comprehensive care.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"261-270"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids for viral central nervous system infections.","authors":"Jacob Bodilsen, Lærke Storgaard Duerlund, Henrik Nielsen","doi":"10.1097/QCO.0000000000001106","DOIUrl":"10.1097/QCO.0000000000001106","url":null,"abstract":"<p><strong>Purpose of review: </strong>Viruses are frequent causes of central nervous system (CNS) infection. Lacking specific antiviral treatment or inadequate clinical response may lead to treatment with corticosteroids. This review describes the rationale for and clinical experience with the use of adjunctive corticosteroids for viral CNS infections.</p><p><strong>Recent findings: </strong>Corticosteroids display anti-inflammatory, immunosuppressive, antiproliferative, and vasoconstrictive effects by genomic and nongenomic regulation of human cells. Recent population-based studies consistently show that empiric dexamethasone during diagnostic work-up for meningitis has neither been associated with improved outcome nor adverse effects in viral meningitis. Myelitis is most often due to noninfectious causes and standard empiric treatment includes high-dose methylprednisolone. There are no convincing data on viral myelitis to support a change of this approach. Corticosteroids have occasionally been employed in different types of viral encephalitis. Observational data and a few randomized clinical trials have not documented any substantial beneficial effects of adjunctive corticosteroids in viral encephalitis. Risks of harm with current treatment regimens remained low in published studies.</p><p><strong>Summary: </strong>Except for myelitis, there are no data to support routine use of corticosteroids for viral CNS infections. Large, multidisciplinary syndromic platform trials of all-cause encephalitis may be a viable way to inform treatment guidelines.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"271-279"},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}