Le infezioni in medicina最新文献

{"title":"Nipah virus infection: what clinicians need to know.","authors":"Nitin Gupta, Shreya Das Adhikari, Mukund Gupta, Sonali Singh, Tirlangi Praveen Kumar, Alfonso J Rodriguez-Morales, Carl Boodman","doi":"10.53854/liim-3402-6","DOIUrl":"10.53854/liim-3402-6","url":null,"abstract":"<p><p>Nipah virus infection is an uncommon but highly lethal zoonotic illness that primarily presents with acute encephalitis and respiratory disease in humans. After its initial identification during the Malaysia-Singapore outbreak of 1998-1999, human outbreaks have since been reported in Bangladesh and India. Despite the relatively small number of reported cases, the Nipah virus remains a major clinical and public health concern because of its high mortality, capacity for person-to-person transmission, lack of approved antiviral treatment, and potential for amplification within healthcare settings. For clinicians, the major challenge lies in early recognition of a disease that initially presents with nonspecific febrile symptoms but may rapidly progress to severe encephalitis, acute respiratory distress syndrome, or both. Human-to-human transmission has been well documented in South Asian outbreaks, particularly in household and healthcare settings, underscoring the importance of prompt isolation and infection prevention measures. Laboratory confirmation relies primarily on reverse transcription polymerase chain reaction, with serology providing supportive evidence later in the course of illness. Management remains largely supportive, with intensive care often required in severe cases. This review provides a practical clinician-oriented overview of Nipah virus infection, focusing on epidemiology relevant to frontline practice, clinical presentation, transmission, diagnostic approach, infection control, treatment, prognosis, and outbreak response.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"164-176"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rezafungin and catheter-related candidemia: a new player in a high-stakes game.","authors":"Sergio Venturini, Ingrid Reffo, Agnese Zanus-Fortes, Giovanni Del Fabro, Astrid Callegari, Federico Giovagnorio, Camilla Negri, Mariateresa Casarotto, Giancarlo Basaglia, Chiara Zanusso, Barbara Basso","doi":"10.53854/liim-3402-11","DOIUrl":"10.53854/liim-3402-11","url":null,"abstract":"<p><p>Candidemia remains a significant healthcare-associated infection characterized by high mortality rates and considerable resource utilization. While echinocandins are established as first-line treatment, extended daily intravenous administration often delays patient discharge, particularly when transitioning to oral azoles is not feasible. Rezafungin, a novel long-acting echinocandin, offers once-weekly dosing with predictable pharmacokinetics. This prospective observational pilot study examined consecutive cases of guideline-defined catheter-related candidemia (CRC) diagnosed in medical wards at two Italian hospitals in 2025. All subjects initially received short-acting echinocandin therapy alongside catheter removal for source control. Upon meeting predefined clinical and microbiological stability criteria, patients were administered a single dose of rezafungin on day 7. Primary outcomes included clinical success and microbiological clearance at 30 days. Secondary endpoints encompassed reductions in hospital length of stay, relapse rates, mortality, and adverse drug events. Seven patients received rezafungin as consolidation therapy. The cohort was characterized by advanced age and a high comorbidity burden. Microbiological eradication was achieved in all cases. No drug-related adverse events, relapses, or deaths were observed at 30- and 90-day follow-up. The median estimated decrease in hospital stay was four days, translating to 28 bed-days saved. This real-world pilot cohort demonstrated that a stepwise antifungal strategy incorporating rezafungin following initial echinocandin therapy is feasible, well-tolerated, and associated with favorable short-term outcomes. Such an approach may facilitate earlier patient discharge, mitigate vascular-access issues, and support more efficient management of catheter-related candidemia. Larger, multicenter controlled studies are necessary to verify the clinical, economic, and sustainability benefits.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"220-226"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Some considerations on hantavirus infections and Andes virus epidemic on the cruise ship Hondius.","authors":"Massimo Galli, Cristina Mussini","doi":"10.53854/liim-3402-2","DOIUrl":"10.53854/liim-3402-2","url":null,"abstract":"","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"126-130"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV-2 infection in Europe - persistence by migrant flows from West Africa but low spillover into the native population.","authors":"Vicente Soriano, María Del Carmen Nieto, Ana Belén Lozano, María José Pena, José Manuel Ramos, Sonia Algarate, Ariadna Rando, Víctor Moreno-Torres, Pablo Barreiro, Carmen de Mendoza","doi":"10.53854/liim-3402-4","DOIUrl":"10.53854/liim-3402-4","url":null,"abstract":"<p><p>HIV-2 was isolated in 1986 in AIDS patients with negative or indeterminate HIV-1 antibodies. Most HIV-2 patients initially reported were West African migrants living in Europe. Independence wars during the 1960s for French colonies and, in the 1970s, for Portuguese colonies, fueled population exchanges, including military personnel. The Ivory Coast and Guinea-Bissau acted as the respective epicenters of HIV-2 spillover into France and Portugal. Other European countries (i.e., Belgium, the Netherlands, Spain, Italy, Germany, etc.) reported HIV-2 cases in the late 1980s. Although the majority were migrants from West Africa, there were also natives who had traveled to or had sex partners from there. By 1990, nearly 500 cases of HIV-2 infection had been confirmed in Europe. By 2010, nearly 2,000 cases had been reported only in Portugal. National surveillance data across Europe remain scarce, hindering precise and up-to-date estimates of HIV-2 infection. Spain is a notable exception, as it has maintained a register since 1989, with 428 HIV-2 cases reported by the end of 2025. Current consensus indicates that new HIV-2 infections are declining across Europe. Migrants from West Africa continue to be the largest contributors, with no evidence of significant HIV-2 spread into the native European population. This ongoing pattern underscores both the importance of surveillance and the limited transmission of HIV-2 beyond migrant communities.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"144-149"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety Profile of BIC/TAF/FTC in People living with HIV Switched from Other Antiretroviral Regimens: A Real-Life Retrospective Cohort Analysis.","authors":"Giuseppe Pipitone, Domenico Marrali, Marilee Goad, Myriam Giordano, Michelle Abbott, Andrea Gizzi, Adriana Sanfilippo, Federica Guida Marascia, Stefano Agrenzano, Claudia Imburgia, Antonio Cascio, Chiara Iaria","doi":"10.53854/liim-3402-9","DOIUrl":"10.53854/liim-3402-9","url":null,"abstract":"<p><strong>Background: </strong>Switching antiretroviral therapy (ART) is a common strategy in people living with HIV (PLWH) to improve tolerability, to manage comorbidities, and to optimize long-term safety. Bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) is a single-tablet regimen with proven effectiveness in clinical trials. Real-world data continue to confirm its effectiveness across diverse clinical settings.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including PLWH who switched to BIC/TAF/FTC from other ART regimens in routine clinical practice. At both baseline and during follow-up, we collected demographic characteristics, comorbidities, virological and immunological markers, and laboratory safety parameters.</p><p><strong>Results: </strong>The study included 177 PLWH, with a median age of 55 years (IQR 44.4-60.3). 70.6% were male and 68.9% were aged ≥50 years. The median follow-up was 38.7 months (IQR 26.9-52.2). At baseline, 93.2% (165/177) of participants had suppressed HIV-RNA (<50 copies/mL). After switching to BIC/TAF/FTC, virological suppression (HIV-RNA <50 copies/mL) improved to 98.3% (174/177) at follow-up (<i>p</i>=0.007). Three participants had HIV-RNA ≥50 copies/mL at follow-up; none showed confirmed virological failure and no new resistance mutations were identified. Median CD4+ T-cell count showed a non-statistically significant trend toward increase from 562 (IQR 373-774) to 596 cells/μL (IQR 396-753) (<i>p</i>=0.057), while the CD4/CD8 ratio increased from 0.90 (IQR 0.60-1.30) to 0.94 (IQR 0.65-1.51) (<i>p</i><0.001). A statistically significant decrease in total cholesterol (189 <i>vs</i> 180 mg/dL, <i>p</i>=0.013) was also observed. No clinically significant changes were observed in renal, hepatic, or hematological parameters.</p><p><strong>Conclusions: </strong>In this real-life cohort, switching to BIC/TAF/FTC was associated with an improvement in virological suppression, an increase in CD4/CD8 ratio, and a favorable safety and metabolic profile, supporting its use as an effective and well-tolerated switch option in routine clinical practice.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"198-204"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragility of Immunisation and Water Systems in Gaza: Infectious Disease Risks in a Conflict-Affected Setting.","authors":"Angelo Scotto, Vincenzina Fazio, Gaetano Scotto","doi":"10.53854/liim-3402-15","DOIUrl":"10.53854/liim-3402-15","url":null,"abstract":"","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"247-249"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory XDR <i>Klebsiella pneumoniae</i> CAUTI Treated with non-antibiotic urinary acidification: a 12-month follow-up case report and literature review.","authors":"Merin Anna Job, Manu Dius Kandachamkulam, Dani Dius Fernandes","doi":"10.53854/liim-3402-12","DOIUrl":"10.53854/liim-3402-12","url":null,"abstract":"<p><strong>Background: </strong>The increase of catheter-associated urinary tract infections (CAUTIs) caused by extensively drug-resistant (XDR) <i>Klebsiella pneumoniae</i> represents a critical failure of the current antimicrobial paradigm. In geriatric cohorts with significant comorbidities, the exhaustion of conventional therapeutic options often precipitates a cycle of recurrent sepsis, prolonged hospitalization, and prohibitively high healthcare expenditure. When \"last-resort\" agents such as ceftazidime-avibactam and colistin fail, clinicians in resource-limited settings are left with no guideline-endorsed alternatives. This report evaluates the clinical and economic impact of a pragmatic non-antibiotic acidification strategy applied as a salvage intervention in a \"pan-resistant\" scenario.</p><p><strong>Case report: </strong>We describe the complex clinical course of an 82-year-old female with type 2 diabetes and neurogenic bladder following an acute ischemic stroke. Despite rigorous adherence to standard catheter care protocols, she developed intractable, recurrent XDR <i>K. pneumoniae</i> CAUTI. The pathogen demonstrated resistance to all first-line and reserve antibiotics, leading to four ICU admissions within a single trimester. With methenamine hippurate unavailable and the family declining suprapubic diversion, we initiated a physiological acidification protocol. This regimen synergized high-dose oral ascorbic acid (2g/day) - hypothesized to downregulate virulence genes - with twice-daily bladder irrigation using diluted (0.25%) acetic acid to create a hostile pH environment for bacterial adherence.Literature Search Methods and Results: Utilizing PRISMA principles adapted for narrative synthesis, a systematic search of PubMed and Scopus yielded 145 initial results. After screening for relevance to non-antibiotic salvage therapy and biofilm disruption, 17 highly relevant articles were incorporated to validate the mechanistic plausibility of our combined protocol.</p><p><strong>Conclusions: </strong>Following initiation of the intervention, a sustained absence of symptomatic episodes was observed. Over a 12-month follow-up, the patient remained free of CAUTI, requiring no further antibiotic therapy. We posit that low-cost, accessible acidification adjuncts represent a vital \"frugal innovation\" for anti-microbial stewardship in vulnerable populations.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"227-232"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into parvovirus B19 clinical and virological dynamics among blood donors.","authors":"Massimo La Raja, Nicola Benvenuto, Monica Marconi, Venera Costantino, Anna Belgrano, Stefano Di Bella","doi":"10.53854/liim-3402-8","DOIUrl":"10.53854/liim-3402-8","url":null,"abstract":"<p><p>Coinciding with the exceptional European resurgence of human parvovirus B19 (B19V), between 2023 and 2024, twelve B19V DNA-positive blood donations out of 27.737 were detected by the plasma fractionating industry via nucleic acid testing (NAT) and notified to the blood collection centers of Trieste and Gorizia (Italy). In order to prevent potential B19V transmission, the implicated donors were recalled for clinical and virological follow-up for one year. None of the subjects had reported symptoms at the time of donation, though six subjects subsequently recalled either mild, transient symptoms in the days following donation or household exposure to fifth disease. Index viral loads ranged from 6.6×10⁵ to >1.0×10⁹ IU/mL, with the majority of donations exceeding 10⁶ IU/mL. The viral burden exhibited a rapid decline, dropping below 10³ IU/mL after approximately four months and subsequently falling below 5×10³ IU/mL in all the monitored donors by eight months, although low-level viremia persisted. IgG antibodies were detected in all subsequent samples, while IgM persisted for up to 125 days in the majority of donors and remained detectable in three cases, including one instance lasting up to 355 days. Since transfusion-transmitted B19V infection has been documented at viral loads as low as 5×10³ IU/mL, our data suggest that a theoretical risk of transmission may persist for up to nine months. Nevertheless, based on hemovigilance, transfusion-transmitted B19V infection appears to have limited clinical impact, likely due to the high level of population immunity and the pre-dominance of non-infectious viral DNA during the late phase of infection. Overall, these observations support current policies that do not mandate routine B19V screening, while underscoring the importance of targeted testing in high-risk recipients and the temporary deferral of highly viraemic donors for 4-6 months.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhizobium radiobacter bloodstream infection associated with long-term central venous access in an infant with Pompe disease.","authors":"Alessandra Cuccia, Chiara Albano, Valeria Garbo, Laura Venuti, Giovanni Boncori, Giulia Linares, Laura Saporito, Federico Falletta, Claudia Colomba","doi":"10.53854/liim-3402-13","DOIUrl":"10.53854/liim-3402-13","url":null,"abstract":"<p><p><i>Rhizobium radiobacter</i> (formerly <i>Agrobacterium tumefaciens</i>) is an environmental Gram-negative bacillus increasingly recognized as an opportunistic human pathogen, particularly in association with indwelling medical devices. Bloodstream infections (BSI) caused by this organism are rarely reported in children. We describe a 10-month-old girl with infantile-onset Pompe disease undergoing weekly enzyme replacement therapy (ERT) via central venous catheter who presented with fever and clinical deterioration 72 hours after infusion. Initial inflammatory markers were not significantly elevated, and multiplex molecular assays were negative for bacterial pathogens. Blood culture obtained from the catheter became positive after 25 hours, yielding Gram-negative bacilli subsequently identified as <i>R. radiobacter</i>. The isolate showed susceptibility to aminoglycosides, carbapenems, and fluoroquinolones, with intermediate susceptibility to piperacillin/tazobactam. Targeted antimicrobial therapy led to rapid clinical improvement and clearance of bacteremia without catheter removal. This case highlights both the pathogenic potential of uncommon environmental microorganisms in fragile children with long-term intravascular devices and the continuing diagnostic value of conventional blood cultures, particularly when rapid molecular assays are negative. Our experience also supports the possibility of catheter salvage in clinically stable patients responsive to appropriate antimicrobial therapy.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"233-238"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of imported malaria in an area of North-Eastern Italy (2016-2025): clinical focus on cerebral malaria.","authors":"Lucia Corich, Maria Teresa Bortolin, Rosamaria Tedeschi, Mariateresa Casarotto, Antonella Pancino, Alberto Molaro, Valentina Anzanello, Giancarlo Basaglia, Maria Ada Corich","doi":"10.53854/liim-3402-10","DOIUrl":"10.53854/liim-3402-10","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In non-endemic settings, imported malaria poses diagnostic challenges due to non-specific presentations and lack of immunity, especially in visiting friends and relatives (VFRs). Focusing on the Western Friuli (Italy) observatory, this work aims to optimize triage by identifying early severity predictors. Through the analysis of clinical parameters, paediatric cerebral cases, and host genetics - including an illustrative case of HbS/β-thalassaemia - we evaluate the drivers of &lt;i&gt;Plasmodium falciparum&lt;/i&gt; progression to improve patient management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study (2016-2025) analysed symptomatic malaria cases in the Friuli Occidentale Health Authority, combining epidemiological data with illustrative clinical cases. Diagnosis was confirmed via microscopy and molecular methods. Using WHO/AMCLI criteria, we evaluated admission parameters, including procalcitonin (PCT), C-reactive protein (CRP), and platelet count, to identify predictors of severe malaria, adopting a ≥2% parasitaemia threshold. Diagnostic accuracy was assessed via multivariable logistic regression and ROC analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 124 malaria cases (&lt;i&gt;P. falciparum&lt;/i&gt; 88.71%), 90.32% were VFRs, primarily from West Africa; only 12% reported adequate prophylaxis. Severe malaria occurred in 19.35% (24/124), including two cerebral malaria (CM) cases, with no fatalities. Severity fluctuated significantly, peaking at 60% (6/10; 95% CI 26.2%-87.8%) in 2025. Multivariable analysis identified parasitaemia ≥2% (aOR 8.44; 95% CI 2.41-29.58; &lt;i&gt;p&lt;/i&gt;=0.001) and PCT (aOR 1.23; 95% CI 1.06-1.42; &lt;i&gt;p&lt;/i&gt;=0.007) as the only independent severity predictors. PCT outperformed CRP (AUC 0.84 &lt;i&gt;vs&lt;/i&gt; 0.73); at a 5.10 ng/mL cut-off, PCT demonstrated a 95.9% negative predictive value (NPV), effectively identifying low-risk patients. CM Case 1 (2017): A 5-year-old male with HbS/β-thalassaemia (VFR, from Ghana) admitted for &lt;i&gt;P. falciparum&lt;/i&gt; malaria (9.5% parasitaemia) and severe anaemia, evolving into CM (loss of consciousness, seizures, BCS score 0); successfully treated with IV artesunate, antiepileptics, and blood transfusions, without sequelae. CM Case 2 (2022): A 3-year-old male (VFR, from Burkina Faso) with &lt;i&gt;P. falciparum&lt;/i&gt; malaria (12.6% parasitaemia) evolving into CM (altered state of consciousness, EEG signs of cerebral distress, retinal haemorrhage, BCS score 2); resolved with IV artesunate and antiepileptics without sequelae.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Imported malaria remains a critical challenge due to unpredictable severity trends and non-specific onset of CM. PCT, combined with parasitaemia, outperformed CRP and platelet count as an independent predictor of severity. High PCT levels should serve as a \"red flag\" for immediate triage and parenteral therapy. Integrating PCT into clinical guidelines is essential for effective risk stratification and preventing life-threatening compl","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"34 2","pages":"205-219"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}