International Journal of Infectious Diseases最新文献

{"title":"Beyond Oxygen Requirement: Rethinking Patient Selection for Oral Antiviral Therapy to Inform Trial Design in the Omicron Era.","authors":"B Davido, P Loubet","doi":"10.1016/j.ijid.2026.109171","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109171","url":null,"abstract":"<p><p>Current COVID-19 therapeutic recommendations for oral antiviral therapy rely on a stage-based framework established during the first pandemic waves, restricting treatment to patients presenting within five days of symptom onset who do not require supplemental oxygen, whereas corticosteroids are recommended for hospitalized patients requiring supplemental oxygen. Although this strategy remains supported by randomized evidence, the biological and clinical landscape of COVID-19 has profoundly evolved with widespread hybrid immunity, Omicron sublineages, and an older and immunocompromised hospitalized population. We propose that oral antiviral eligibility, primarily in the context of nirmatrelvir/ritonavir, should progressively move beyond an oxygen-centered eligibility algorithm toward an integrated clinical assessment including symptom duration, host characteristics, pulmonary involvement on chest CT, virological burden (when available), and oxygen requirement. Importantly, this perspective does not challenge early antiviral initiation within the approved therapeutic window. Rather, it argues that future studies should determine whether a more integrated patient selection strategy can optimize the use of oral antiviral therapy in contemporary COVID-19 caused by Omicron sublineages.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109171"},"PeriodicalIF":4.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex vivo functional immune alterations in ICU patients with Legionnaires' Disease, a proof-of-concept study.","authors":"Camille Allam, William Mouton, Chloé Albert-Vega, Marine Ibranosyan, Christophe Ginevra, Ghislaine Descours, Laetitia Beraud, Annelise Chapalain, Abdelrahim Zoued, Laurent Argaud, Arnaud Friggeri, Vanessa Labeye, Yvan Jamilloux, Anne-Claire Lukaszewicz, Guillaume Monneret, Jonathan Lopez, Nathalie Freymond, Gerard Lina, Patricia Doublet, Jean-Christophe Richard, Fabienne Venet, Florence Ader, Sophie Trouillet-Assant, Sophie Jarraud","doi":"10.1016/j.ijid.2026.109164","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109164","url":null,"abstract":"<p><strong>Objectives: </strong>Legionnaires' disease (LD), caused by Legionella pneumophila intracellular bacterium, leads to intensive care unit (ICU) admission in 20-40% of cases. While ICU-LD patients display lung injury or septic shock, their functional immune response remains poorly understood. This proof-of-concept study assessed ex vivo immune gene expression in ICU-LD and non-ICU-LD patients.</p><p><strong>Methods: </strong>Whole blood from ICU-LD (n=6), non-ICU-LD (n=8), LD-unrelated septic shock (n=14), and healthy volunteers (n=9) was stimulated with lipopolysaccharide (LPS). Expression of 93 immune-related genes was quantified using nCounter (NanoString Technologies) and expressed relative to healthy volunteers. Functional enrichment analyses were performed using the STRING database.</p><p><strong>Results: </strong>ICU-LD patients displayed a 1.6-fold higher number of less induced genes (35/93 vs 22/93) and lower gene expression (median log2(FC): -1.9 vs -1.2, p=0.0011) than non-ICU-LD. Top five pathways identified as enriched in ICU-LD but not in non-ICU-LD patients were cellular response to LPS, regulation of IFN-β production, I-κB/NF-κB complex, IFN regulatory factor complex, and TRAF6-mediated NF-κB activation.</p><p><strong>Conclusions: </strong>Ex vivo immune gene expression alterations were found in LD patients, particularly in ICU-LD patients. ICU-LD patients displayed lower expression of genes involved in crucial pathways for Legionella replication control. These preliminary findings support further studies to evaluate the impact of LD patients' immune response on disease severity.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109164"},"PeriodicalIF":4.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Adjunctive Interferon-γ Therapy for Complex Mycobacterial Disease in Patients with Advanced HIV: A Case Series.","authors":"Seán Donohue, Clara O'Flaherty, Annmarie White, Colm Bergin","doi":"10.1016/j.ijid.2026.109167","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109167","url":null,"abstract":"<p><p>Management of mycobacterial opportunistic infection remains challenging in patients living with HIV, particularly when infection persists despite antiretroviral therapy (ART) and optimised antimycobacterial therapy (AMT). Interferon-γ is a key mediator of macrophage activation and intracellular pathogen killing, providing a rationale for its use as adjunctive host-directed therapy in selected patients. We describe three patients with advanced HIV and complex mycobacterial disease treated with adjunctive interferon-γ. One patient had disseminated tuberculosis with recurrent psoas abscesses after completion of AMT, while two had disseminated macrolide-resistant Mycobacterium avium complex (MAC) infection with persistent disease despite optimised therapy. Interferon-γ initiation was followed by improvement in all three cases, including radiological resolution of a recurrent psoas abscess and culture sterilisation in the two patients with disseminated MAC. Treatment was well tolerated, with only mild influenza-like symptoms. Concurrent ART-mediated immune reconstitution and AMT optimisation limit causal inference, but the temporal association between interferon-γ initiation and improvement supports further evaluation of interferon-γ as adjunctive therapy in refractory mycobacterial disease in patients with advanced HIV.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109167"},"PeriodicalIF":4.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recorded Human Leishmaniasis and Notification Gaps in Central Tuscany, Italy, 2014-2024: a Multisource Surveillance Study.","authors":"Claudia Cosma, Carla Maia, Nicolas Ray, Ezio Ferroglio, Benjamin Rader, Paolo Bonanni, Chiara Lorini, Guglielmo Bonaccorsi, Alice Fanfani, Andrea Aiello, Loria Bianchi, Maria Infantino, Mariangela Manfredi, Francesca Veneziani, Elisa Contini, Andrea D'Agosto, Elisabetta Venturini, Silvia Ricci, Luisa Galli, Michele Spinicci, Valentina Petrini, Lorenzo Zammarchi, Alessandro Bartoloni, Anna Barbiero, Francesco Profili, Fabio Voller, Margherita Cacini, Barbara Rossi, Giovanna Bianco, Enrico Loretti, Marco Del Riccio","doi":"10.1016/j.ijid.2026.109166","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109166","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether mandatory notification adequately captures recorded human leishmaniasis in Central Tuscany, Italy, by describing source-specific trends during 2014-2024 and evaluating notification completeness for 2022-2024.</p><p><strong>Methods: </strong>We conducted a retrospective multisource surveillance study using laboratory-positive records, mandatory notifications and first leishmaniasis-coded hospital discharge records. For 2022-2024, records from the three sources were deterministically linked at the individual level; observed notification completeness was defined as the proportion of linked individuals identified in at least one source who were present in the notification source, and three-source log-linear capture-recapture was performed.</p><p><strong>Results: </strong>During 2014-2024, 280 laboratory records, 89 notifications and 157 first leishmaniasis-coded hospital discharge records were identified. Counts increased from 2021, peaked in 2023 and remained elevated in 2024. In 2022-2024, linkage identified 185 unique individuals across the three sources; 65 (35.1%) were present in the notification source, 179 (96.8%) in laboratory records and 91 (49.2%) in hospital discharge records. Children aged 0-9 years were prominent, ranking first in notification and hospital sources. Capture-recapture estimated 214 cases (95% CI: 185-1,078), with imprecise estimates of unobserved cases.</p><p><strong>Conclusions: </strong>Mandatory notification incompletely represented individuals identified across the available routine data sources in this endemic Italian setting. Laboratory-linked notification and routine reconciliation of routine data sources could strengthen surveillance; recent increases should be interpreted as increases in recorded cases rather than as evidence of increased local transmission.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109166"},"PeriodicalIF":4.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xpert MTB/RIF Ultra on nasopharyngeal swabs has lower sensitivity for pulmonary tuberculosis than tongue swabs: a nested case-control study in South African primary care.","authors":"Robinah Nakawunde, Jay Achar, Brian Allwood, Suventha Moodley, Loren Rockman, Welile V Nwamba, Anna Okunola, Daphne Naidoo, Niaz Banaei, Charissa C Marsh, Grant Theron","doi":"10.1016/j.ijid.2026.109161","DOIUrl":"10.1016/j.ijid.2026.109161","url":null,"abstract":"<p><strong>Background: </strong>Non-sputum alternatives for tuberculosis (TB) diagnosis are a priority. Nasopharyngeal swabs (NPSs), routinely used for viral testing, may have promise. Comparative performance to tongue swabs (TSs), which are recommended for TB detection but have suboptimal sensitivity, is unknown.</p><p><strong>Methods: </strong>We evaluated Xpert MTB/RIF Ultra (Ultra; Cepheid, USA) on stored wet or dry NPSs (NPSU) from adults with presumptive TB consecutively presenting to primary care in Cape Town, South Africa. Using a nested case-control design, all TB-positive participants had NPSU (n=148) and random selection of TB-negative participants frequency-matched by HIV-status (n=117). We used a microbiological reference standard (MRS) and extended MRS (eMRS). A consecutive subset participant (n=130) also had TSs collected and of these, 62 TB-positive and 68 TB-negative people had TS Ultra (TSU) done.</p><p><strong>Results: </strong>NPSU sensitivity was 35% (95% CI 27, 43) and specificity 88% (80, 93). Wet swabs had higher sensitivity than dry swabs [45% (34, 57) vs 21% (12, 34)]. Overall sensitivity was lower in HIV-positive participants [24% (14, 36) vs 44% (32, 56)]. TSU had higher sensitivity [67% (53, 79); p<0.001] than NPSU in head-to-head comparisons. Specificities were comparable.</p><p><strong>Conclusion: </strong>NPSU sensitivity was lower than TSU, especially among dry NP swabs, and neither NPSU sensitivity nor specificity met WHO benchmarks for non-sputum confirmatory tests. NPSs do not appear useful for TB diagnosis without further optimisation.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109161"},"PeriodicalIF":4.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of sudden complete endotracheal tube occlusion.","authors":"Patricia Mester, Stephan Schmid, Martina Müller, Vlad Pavel","doi":"10.1016/j.ijid.2026.109162","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109162","url":null,"abstract":"","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109162"},"PeriodicalIF":4.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraventricular Vancomycin for Ommaya Reservoir-Associated Staphylococcus hominis Ventriculitis in a Very Preterm Infant with Disseminated Candidiasis: A Case Report.","authors":"Zexu Shen, Yating Song, Ze Yang, Shenmei Wang, Xiang Chen, Fei Bei, Zhiling Li, Xiuxia Ye","doi":"10.1016/j.ijid.2026.109165","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109165","url":null,"abstract":"<p><strong>Objectives: </strong>Coagulase-negative staphylococci (CoNS) commonly infect Ommaya reservoirs, but data on intraventricular (IVT) vancomycin in neonates are very limited. We report a very preterm infant with oxacillin-resistant Staphylococcus hominis (ORSH) ventriculitis who was successfully treated with IVT vancomycin after systemic antibiotic failure.</p><p><strong>Design: </strong>A female infant born at 29+2 weeks (birth weight 1,250 g) developed disseminated Candida albicans infection involving blood, central nervous system, eyes, and urinary tract. Progressive hydrocephalus required Ommaya reservoir placement at postmenstrual age of 37+2 weeks. Three weeks later, she developed ORSH ventriculitis.</p><p><strong>Results: </strong>Intravenous vancomycin for 3 weeks followed by linezolid for 3 weeks failed to eradicate the infection. IVT vancomycin (5 mg every 48 h, 7 doses) was administered via the Ommaya reservoir together with systemic linezolid. The CSF vancomycin trough before the second dose was 18.56 μg/mL; subsequent troughs were 23.7 μg/mL and 18 μg/mL, suggesting a dose-related change in CSF vancomycin exposure. CSF cultures turned to negative after 5 IVT doses and remained negative on three consecutive samples. No ototoxicity or neurologic worsening was observed.</p><p><strong>Conclusions: </strong>IVT vancomycin at 5 mg every 48 h via an Ommaya reservoir may represent a safe and effective salvage treatment for CoNS ventriculitis in preterm infants when systemic antibiotics fail. Therapeutic drug monitoring (TDM) may be particularly important because CSF vancomycin levels vary greatly between individuals. This case provides one of the first serial CSF vancomycin trough measurements in a very preterm infant, suggesting a potential empiric starting approach for IVT vancomycin in this population.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109165"},"PeriodicalIF":4.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Host factors, not Mycobacterium tuberculosis lineage, predict unfavorable outcomes in drug-susceptible pulmonary tuberculosis: evidence from RePORT-Brazil.","authors":"Emilyn Costa Conceição, Yrneh Yadamis Prado Palacios, Klauss Villalva-Serra, Mariana Araújo-Pereira, Bruna Moreira, Guilherme da Silva Lourenço Carvalho, Jaquelane Silva, Saulo Reis Nery Santos, Marina Cruvinel Figueiredo, Leonardo Bruno Paz Ferreira Barreto, Guislaine Refrégier, Fernanda Carvalho de Queiroz Mello, Marcelo Cordeiro-Santos, Bruno B Andrade, Valeria C Rolla, Timothy R Sterling, Maria Cristina da Silva Lourenço","doi":"10.1016/j.ijid.2026.109149","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109149","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether Mycobacterium tuberculosis (Mtb) lineage was independently associated with clinical presentation and unfavorable treatment outcomes in drug-susceptible pulmonary tuberculosis (TB) in a large Brazilian cohort.</p><p><strong>Methods: </strong>We analyzed 900 rifampicin- and isoniazid-susceptible Mtb isolates from adults enrolled in the multicenter RePORT-Brazil cohort using 24-loci MIRU-VNTR genotyping. Treatment outcome analyses included 772 participants with complete follow-up. Associations between lineage and a composite unfavorable outcome (death, failure, or recurrence) were evaluated using pre-specified multivariable Firth logistic regression adjusted for demographic, clinical, and geographic factors.</p><p><strong>Results: </strong>Thirteen lineages were identified, predominantly LAM (56.7%) and Haarlem (30.6%). Although lineage distribution varied by region, lineage was not independently associated with unfavorable outcomes. HIV infection and older age were the strongest predictors. Baseline clinical features and treatment outcomes were largely similar across lineages. Among 43 participants with positive month-2 cultures, 22 were genotyped and in 5/22 (22.7%) the month-2 isolate belonged to a different lineage from the baseline isolate, consistent with reinfection or mixed infection.</p><p><strong>Conclusion: </strong>In drug-susceptible pulmonary TB, host-related factors, rather than Mtb lineage, were more strongly associated with unfavorable treatment outcomes.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109149"},"PeriodicalIF":4.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of response to Buruli ulcer treatment shortening with novel beta-lactam-containing antimicrobial combinations.","authors":"Umberto Villani, Salvatore D'Agate, Emma Sáez-López, Santiago Ramón-García, Oscar Della Pasqua","doi":"10.1016/j.ijid.2026.109152","DOIUrl":"https://doi.org/10.1016/j.ijid.2026.109152","url":null,"abstract":"<p><strong>Objectives: </strong>Whilst rifampicin (RIF, q.d.) plus clarithromycin (CLA, b.i.d.) for 8 weeks is an effective treatment for Buruli ulcer (BU), this prolonged regimen presents challenges for adherence, particularly in community-based settings. Using a mechanism-based modelling and simulation framework, informed by In vitro bactericidal activity data, this study aimed to predict whether adding amoxicillin-clavulanate (AMX/CLV) could shorten BU treatment.</p><p><strong>Methods: </strong>In vitro time-kill data for RIF, CLA, and AMX/CLV, alone and in combination, against Mycobacterium ulcerans isolates were analysed using a nonlinear mixed-effects approach. Clinical trial simulations (n=70/arm) then assessed bacterial eradication times for standard therapy versus AMX/CLV-containing regimens, including higher RIF doses, while accounting for population pharmacokinetic variability and drug skin penetration.</p><p><strong>Results: </strong>In vitro time-kill analyses showed that, excluding isolate ITM070290, AMX/CLV-containing combinations provide comparable or superior potency and faster killing rates than the standard of care. Clinical trial simulations predicted these regimens can reliably achieve bacterial eradication within 4 and 6 weeks for moderate and high bacterial loads, respectively, with only one exception requiring over 8 weeks in high-burden scenarios.</p><p><strong>Conclusions: </strong>Incorporating AMX/CLV alongside optimized RIF doses shows strong potential to shorten BU treatment from 8 weeks down to 4-6 weeks, supporting its ongoing evaluation in clinical trials.</p>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109152"},"PeriodicalIF":4.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelled assumptions are the only way to estimate the possibility to prevent iGAS.","authors":"Ronny Gunnarsson, Erik Wiezell, Carl Wikberg, Pär-Daniel Sundvall, Karin Rystedt","doi":"10.1016/j.ijid.2026.109005","DOIUrl":"10.1016/j.ijid.2026.109005","url":null,"abstract":"","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":" ","pages":"109005"},"PeriodicalIF":4.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}