Current Opinion in Infectious Diseases最新文献

{"title":"Pathogenesis of brain injury in cerebral malaria: emerging mechanisms and implications for intervention.","authors":"Dibyadyuti Datta, Chandy C John","doi":"10.1097/QCO.0000000000001133","DOIUrl":"10.1097/QCO.0000000000001133","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cerebral malaria (CM) in children has high mortality and leads to substantial long-term cognitive impairment. We review recent advances in defining the pathogenesis of brain injury in pediatric cerebral malaria.</p><p><strong>Recent findings: </strong>The cascade of events leading to brain injury in pediatric CM includes blood-brain barrier (BBB) impairment due to local hypoxemia, ischemia, and endothelial activation after sequestration of infected erythrocytes; and oxidative stress after release of free heme. Tumor necrosis factor alpha (TNF-α), reactive oxygen species, CD8+ T cells and parasite toxins can then cross the impaired BBB and through activation of central nervous system immune responses and direct cytotoxicity lead to neuronal injury. Acute kidney injury and hyperuricemia may worsen BBB impairment and cerebral edema. Cytotoxic or vasogenic edema, abnormal blood flow states, and increased microvascular hemoglobin are present in pediatric CM, but their relationship to brain injury is not yet fully defined.</p><p><strong>Summary: </strong>New studies of CM in children, including neuroimaging and electrophysiology studies, along with novel in vitro BBB model studies and ongoing experimental CM studies, show promise in improving our understanding of brain injury in CM and identifying interventions to decrease this injury.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"378-384"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752646","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":"Data science for pediatric infectious disease: utilizing COVID-19 as a model.","authors":"Bennett J Waxse, Suchitra Rao","doi":"10.1097/QCO.0000000000001139","DOIUrl":"10.1097/QCO.0000000000001139","url":null,"abstract":"<p><strong>Purpose of review: </strong>During the COVID-19 pandemic, governments and public health agencies used data science tools and data sources in real time to evaluate pathogen transmissibility, disease burden, healthcare capacity, and evaluate treatment and preventive measures. The purpose of the review is to highlight the application of these data sources and methods during the COVID-19 response.</p><p><strong>Recent findings: </strong>Advances in the development of common data models enabled multisite data networks to overcome healthcare data fragmentation, enabling national surveillance platforms, and offering unprecedented statistical power to conduct national surveillance and detect emerging clinical entities like MIS-C and long COVID in diverse pediatric populations. These integrated networks were also used in evaluating the effectiveness of vaccines and therapies. New surveillance approaches combining traditional clinical data with novel data sources including wastewater detection, web-based search engines, and mobility patterns yielded comprehensive ensemble approaches that informed public health policy.</p><p><strong>Summary: </strong>The COVID-19 pandemic highlighted the importance of timely evidence for decision-making during outbreak responses and the benefits of using data science tools to help provide real time, actionable insights, which can help guide our public health response to infectious diseases threats in the future.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"493-498"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759407","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":"Long COVID in children and young people: then and now.","authors":"Anna Coughtrey, Snehal M Pinto Pereira, Shamez Ladhani, Roz Shafran, Terence Stephenson","doi":"10.1097/QCO.0000000000001136","DOIUrl":"10.1097/QCO.0000000000001136","url":null,"abstract":"<p><strong>Purpose of review: </strong>On 11 March 2020, the WHO characterized COVID-19 as a pandemic. A clinical case definition for post-COVID-19 condition in children and adolescents by expert consensus was agreed by the WHO in 2023. It is now 5 years since the WHO declared a pandemic, and this review aims to summarize key advances in our understanding of long COVID over those 5 years.</p><p><strong>Recent findings: </strong>That symptoms could persist in adults and CYP for months after initial infection was first reported in Autumn 2020. Long COVID in adults is frequently characterized by symptoms of fatigue and breathlessness but brain-fog, joint and muscle pain have been reported much more commonly in adult follow-up than CYP. The most common persisting symptoms experienced by CYP after COVID-19 infection in initial studies, often with less than a year of follow-up, were fatigue, headache, shortness of breath and persisting loss of smell and taste. With longer follow-up, up to 2 years, the commonest symptoms still include not only fatigue, headache and shortness of breath but also sleep difficulties, whereas loss of smell and taste persisted only in a minority. However, many symptoms were almost as common in test-negative controls, raising questions about the causal role of SARS-CoV-2 virus. Predictors of long COVID, as defined, were female sex, history of asthma, allergy problems, learning difficulties at school and family history of ongoing COVID-19 problems.</p><p><strong>Summary: </strong>The implications of the findings for clinical practice and research are that long COVID is not the same in CYP as adults; both their physical and mental health should be studied; and intervention trials are needed.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"487-492"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834473","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":"Targeted strategies for pediatric cancer and post-transplant fever: the role of host and pathogen biomarkers.","authors":"Sandra Castejon-Ramirez, Gabriela Maron","doi":"10.1097/QCO.0000000000001132","DOIUrl":"10.1097/QCO.0000000000001132","url":null,"abstract":"<p><strong>Purpose of review: </strong>Host and pathogen biomarkers may lead to improved management of fever in children with cancer and post hematopoietic cell transplant (HCT). This review summarizes current evidence on biomarkers for predicting infections.</p><p><strong>Recent findings: </strong>Host biomarkers show promise for distinguishing between infectious and noninfectious causes of fever in patients with cancer or post HCT. Combining multiple biomarkers and integrating them into risk-stratification clinical scores may enhance predictive accuracy with the potential of individualizing antimicrobial treatment. Molecular diagnostic methods like multiplex PCR provide rapid detection of many pathogens. Emerging technologies such as transcriptomics, metabolomics, and microbial metagenomic next-generation sequencing demonstrate potential but require further evaluation. Large prospective studies are needed to validate standardized cutoffs and algorithms incorporating biomarkers into clinical decision-making. The integration of host and pathogen biomarkers holds the promise of optimizing antimicrobial therapy by tailoring treatment when indicated and minimizing unnecessary antimicrobials, ultimately enhancing patient outcomes.</p><p><strong>Summary: </strong>Targeted biomarker-based strategies have the potential to improve antimicrobial stewardship and outcomes in immunocompromised pediatric patients.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"477-486"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689413","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":"Neurological complications of scrub typhus.","authors":"Hallel Reba, Karthik Gunasekaran, Angel Miraclin T","doi":"10.1097/QCO.0000000000001135","DOIUrl":"10.1097/QCO.0000000000001135","url":null,"abstract":"<p><strong>Purpose of review: </strong>Scrub typhus, caused by the intracellular bacterium Orientia tsutsugamushi , presents a significant global health threat, contributing to a high burden of febrile illnesses, especially in endemic regions. This review aims to detail the neurological complications associated with scrub typhus and discuss its pathogenesis, diagnosis, management, and prevention.</p><p><strong>Recent findings: </strong>Research has demonstrated an expanding geographical distribution of scrub typhus beyond its traditional Asia-Pacific epicentre, with an increasing incidence reported in regions such as Africa, the Arabian Peninsula, and South America. Neurological complications, notably encephalitis and meningitis, have emerged as significant clinical manifestations, considerably affecting morbidity and mortality rates among affected individuals. The pathogenesis of scrub typhus involves intricate interactions, with Orientia tsutsugamushi selectively targeting dermal and endothelial cells, facilitating systemic dissemination and subsequent neurological implications. These findings highlight the imperative for heightened awareness and recognition of these severe complications to enhance patient outcomes and inform effective management strategies.</p><p><strong>Summary: </strong>Scrub typhus remains a growing public health challenge, necessitating enhanced awareness and diagnostic capabilities to mitigate case under-reporting. Recognizing neurological manifestations is crucial, highlighting the need for further research into the disease's mechanisms and management strategies. Timely interventions and preventive measures are essential, particularly in emerging regions.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"355-363"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759410","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":"Current status of primary, secondary and tertiary prevention of congenital cytomegalovirus disease: a call to action.","authors":"Heather Bailey, Helen Payne, Hermione Lyall","doi":"10.1097/QCO.0000000000001137","DOIUrl":"10.1097/QCO.0000000000001137","url":null,"abstract":"<p><strong>Purpose of review: </strong>Globally, sequelae of congenital CMV (CCMV) impact an estimated 350 000 children born annually. In this review, we consider new evidence across primary, secondary and tertiary prevention approaches, and remaining evidence gaps.</p><p><strong>Recent findings: </strong>Education on hygiene precautions can reduce risk of primary CMV acquisition in pregnancy, and may have a role in some settings in reducing CCMV cases resulting from nonprimary infection, but public and health worker knowledge and awareness remains low. Evidence that valaciclovir treatment can reduce CMV vertical transmission has led to renewed interest in antenatal CMV screening in some high-income countries over recent years, although there is a lack of recommendation in most guidelines and significant evidence gaps remain. Newborn CCMV screening has been adopted in some states/provinces in Canada/USA, with first results recently published. Newborn prognostic scoring systems are evolving, with potential for more effective targeting of newborn treatment and tertiary prevention of CCMV disease.</p><p><strong>Summary: </strong>We make suggestions for clinical practice and research, particularly to address evidence gaps around: safety and effectiveness of antenatal CMV screening and antiviral prophylaxis; findings relating to detection of nonprimary infection in pregnancy; new prognostic neonatal scoring systems; and learning from follow-up of children born into state-wide universal CMV screening programmes.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"450-457"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820817","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":"Travellers' diarrhoea - solidifying our knowledgebase.","authors":"Thomas H A Samuels, Clare E Warrell","doi":"10.1097/QCO.0000000000001131","DOIUrl":"10.1097/QCO.0000000000001131","url":null,"abstract":"<p><strong>Purpose of review: </strong>Travellers' diarrhoea remains one of the most common diseases amongst international travellers. However, significant uncertainty remains about the most effective strategies for its prevention and management. This review summarises recent advances in travellers' diarrhoea epidemiology, diagnostics, and management, focusing on new severity definitions, the impact of molecular diagnostics, antimicrobial resistance, and postinfectious sequelae.</p><p><strong>Recent findings: </strong>The incidence of travellers' diarrhoea remains substantial although much of this is attributable to mild disease. Viral travellers' diarrhoea is more frequently recognised due to the improved sensitivity of molecular diagnostics. Advances in microbiome research reveal both acute and persistent disruption to the microbiota following travellers' diarrhoea and antibiotic use. New severity definitions incorporating functional impairment offer improved clinical relevance but consensus over use remains lacking. Nonabsorptive antibiotics and probiotics show promise for treatment and prevention, but antimicrobial resistance continues to rise. Postinfectious irritable bowel syndrome (IBS) significantly impacts the recovery of some travellers' diarrhoea patients.</p><p><strong>Summary: </strong>Consensus on severity definitions is needed to support successful research into new vaccines and therapeutics. Surveillance of resistance, research into microbiome disruption and recovery, and development of vaccines and probiotics are key priorities. Better pathophysiological understanding and new intervention strategies are required to help alleviate the suffering of post-travellers' diarrhoea IBS.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"419-425"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689414","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":"Evolving strategies to optimize immunization and protection of pediatric transplantation recipients.","authors":"Dana Danino, Monica I Ardura","doi":"10.1097/QCO.0000000000001125","DOIUrl":"10.1097/QCO.0000000000001125","url":null,"abstract":"<p><strong>Purpose of review: </strong>Indications for pediatric solid organ (SOT) and hematopoietic cell transplantation (HCT) have expanded concurrently with a repertoire of new biologics and transplant-related immunosuppression regimens, leading to a growing population of immunocompromised children who remain at risk for infections. Immunization of these children is fundamental in preventing and mitigating the risk of vaccine-preventable diseases (VPD), yet remains suboptimal. This review summarizes emerging pediatric data, including new vaccine formulations, guidance updates, and evolving immunization strategies aimed at optimizing vaccine-mediated protection in pediatric transplant recipients, while highlighting ongoing knowledge gaps.</p><p><strong>Recent findings: </strong>Despite published recommendations, immunization remains an underutilized prevention strategy resulting in pediatric SOT and HCT candidates and recipients remaining sub-optimally vaccinated and at risk for VPD. New immunizations, including recombinant hepatitis B, higher-valency pneumococcal conjugate, recombinant zoster, meningococcal b and polyvalent meningitis vaccines, and long-acting RSV monoclonal antibodies, show promise in providing enhanced immunogenicity and vaccine efficacy, but remain largely off-label or insufficiently studied in pediatric transplant recipients. Emerging evidence support the safety and immunogenicity of live attenuated viral vaccines (MMR, varicella) in selected pediatric SOT recipients and high-dose inactivated influenza vaccine in pediatric allogeneic HCT recipients. Inclusion of transplant recipients in vaccine clinical trials is essential, as is additional research to improve our understanding of mechanisms of vaccine immunogenicity and evaluation of both humoral and cell-mediated immune responses that could best serve as surrogates of protective immunity in this population and inform individual vaccine recommendations.</p><p><strong>Summary: </strong>Recent advances in immunizations offer new opportunities to prioritize vaccination both before and after SOT and HCT to enhance the protection against VPD in pediatric transplant recipients and improve their clinical outcomes. Future research should prioritize inclusion of pediatric transplant recipients in clinical trials and studies aimed at improving our understanding of vaccine safety, efficacy, and effectiveness in this population.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"458-467"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689410","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":"Management of neonates born to mothers with active genital herpes simplex virus infection: an alternative approach.","authors":"Pablo J Sánchez, Natalie O White, Rachel J Graf, Jeanette Taveras","doi":"10.1097/QCO.0000000000001129","DOIUrl":"10.1097/QCO.0000000000001129","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although considered a rare disease, neonatal HSV infection represents a disease in urgent need of preventive strategies, as it results in substantial neonatal morbidity and mortality. This review summarizes its current epidemiology and discusses guidances on the management of the asymptomatic neonate born to mothers with active genital HSV infection.</p><p><strong>Recent findings: </strong>Timely detection and early high-dose acyclovir treatment of neonatal HSV infection decreases mortality. All neonates born to mothers with active genital HSV infection in the third trimester or at delivery should be tested for HSV infection. The newborn management has depended on whether the mother has experienced a primary or recurrent genital HSV infection based on maternal serologic testing and PCR testing of the genital lesion. An alternative strategy on neonatal management is proposed that is based on type of maternal HSV infection and perinatal risk factors.</p><p><strong>Summary: </strong>The incidence of neonatal HSV infection is increasing with more infections due to HSV-1 than HSV-2. Guidances addressing management of the asymptomatic newborn exposed to active maternal genital HSV infection are discussed.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"443-449"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689411","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":"Cryptococcosis: update on therapeutics and new targets.","authors":"Arturo Casadevall, Shmuel Shoham","doi":"10.1097/QCO.0000000000001138","DOIUrl":"10.1097/QCO.0000000000001138","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cryptococcus neoformans was recently declared a top priority fungal pathogen because of its propensity to cause a life-threatening meningoencephalitis, which continues to have high mortality and morbidity despite antifungal therapy. Our goal is to review recent developments in antifungal therapy while synthesizing how these are integrated into advances in understanding the pathophysiology of cryptococcosis.</p><p><strong>Recent findings: </strong>The therapeutic outcomes for cryptococcosis continue to improve but the disease still carries an unacceptably high mortality and morbidity. Advances in therapy have largely come from optimizing the use of existing antifungal drugs, management of intracerebral and early diagnosis. A major development in the past decade was the recognition that immune responses contributed to damage in cryptococcosis, which has led to new research on the use of adjunctive immune modulators.</p><p><strong>Summary: </strong>While progress continues to be made in the therapy of cryptococcosis by finding better ways to use existing antifungal agents and improve clinical management it is possible that this strategy is reaching its asymptote. Consequently, transformative reductions in mortality and morbidity are likely to require new antifungal agents and/or adjunctive immunotherapies. Fortunately, there are there several promising approaches in the horizon that will hopefully future drive clinical investigation.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"372-377"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759406","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}