BMC Infectious Diseases最新文献

{"title":"TyG index and TyG-WHtR as predictors of all-cause mortality in patients with prior hepatitis A or B virus infections.","authors":"Fan Bai, Wen Li, Ni Luo, Yange Li","doi":"10.1186/s12879-026-14058-z","DOIUrl":"10.1186/s12879-026-14058-z","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the association between the triglyceride glucose (TyG) index and the TyG-to-waist-height ratio (TyG-WHtR) with the risk of all-cause mortality in patients with prior hepatitis A virus (HAV) or hepatitis B virus (HBV) infection.</p><p><strong>Method: </strong>This study was a retrospective cohort study that included patients from 1999 to 2018 with available data on HAV/HBV, TyG-related indices, and survival and mortality information. Multiple imputation methods were utilized to address missing variables. A weighted multivariable Cox regression model was employed to analyze the relationship between TyG and TyG-WHtR with all-cause mortality in the study patients. Subgroup analyses were conducted based on age, gender, smoking, diabetes, cardiovascular disease, and hypertension. All analysis results were presented as hazards with a 95% confidence interval (CI).</p><p><strong>Results: </strong>The study included a total of 6,413 patients, of which 1,692 were dead. The follow-up period concluded in December 2019, with a total duration of 119.31 ± 1.53 months. Analysis revealed that in patients with prior HAV or HBV infection, the TyG (HR: 1.22, 95%CI: 1.10-1.36) and TyG-WHtR (HR: 1.53, 95%CI: 1.34-1.75) were associated with an increased risk of all-cause mortality. Separate studies conducted in patients with prior HAV or HBV infection also demonstrated an association between the TyG and TyG-WHtR indices with all-cause mortality (former: HR: 1.20, 95%CI: 1.07-1.34; latter: HR: 2.02, 95%CI: 1.49-2.74). Subgroup analysis results indicated that the association between TyG-WHtR and all-cause mortality was similar across age, gender, smoking, and hypertension groups (all P < 0.05).</p><p><strong>Conclusion: </strong>In patients with prior HAV or HBV infection, the TyG and TyG-WHtR indices were associated with an increased risk of all-cause mortality. This study underscores the importance of the TyG and TyG-WHtR for patients with prior viral hepatitis, potentially aiding in the improvement of health management for this group.</p><p><strong>Clinical trial: </strong>Our research is not a clinical trial.</p><p><strong>Clinical trial number: </strong>not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227029","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":"Prevalence of Y93H resistance-associated substitution in treatment-naïve hepatitis C virus genotype 1b patients: a systematic review and meta-analysis.","authors":"Dilip Kumar Kakru, Do-Youn Lee, Navin Kumar, Rekha Arcot, Sorabh Lakhanpal, Saumya Das, Sanjay Kumar, Sushma Narsing Katkuri, Jeffrin Reneus Paul, Abhay M Gaidhane, Prakasini Satapathy","doi":"10.1186/s12879-026-14091-y","DOIUrl":"10.1186/s12879-026-14091-y","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) genotype 1b infection remains a leading cause of chronic liver disease despite advances in direct-acting antivirals (DAAs). Resistance-associated substitutions (RASs) in the non-structural 5 A (NS5A) region, particularly the Y93H mutation, have been associated with reduced antiviral susceptibility and variable treatment outcomes. The global baseline prevalence of this substitution in treatment-naïve populations has not been systematically characterized.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO. Observational and randomized studies reporting baseline NS5A Y93H prevalence in treatment-naïve HCV genotype 1b patients were identified through PubMed, Embase, and Web of Science. Data were synthesized using a random-effects model, and heterogeneity was quantified by the I² statistic. Sensitivity and publication bias analyses were performed using leave-one-out and DOI plot methods.</p><p><strong>Results: </strong>Nine studies comprising 1,560 treatment-naïve patients from Asia and Europe, were included. The pooled prevalence of Y93H was 12% (95% CI, 6%-20%), with substantial heterogeneity (I² = 82.4%). Sensitivity analyses confirmed result stability, and minor asymmetry in the DOI plot suggested low publication bias.</p><p><strong>Conclusion: </strong>The Y93H substitution is a frequent naturally occurring variant in untreated HCV genotype 1b infection. Despite reduced clinical relevance with pangenotypic DAAs, its persistence warrants continued monitoring. Standardized sequencing and global resistance surveillance remain essential for optimizing treatment strategies and informing antiviral policy.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227032","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":"Changes in the microbial spectrum and antimicrobial resistance of bloodstream infections in intensive care units before and during the COVID-19 pandemic.","authors":"Sümeyye Bayram, Funda Şimşek, Çiğdem Arabacı, Zekeriya Ervatan","doi":"10.1186/s12879-026-14069-w","DOIUrl":"10.1186/s12879-026-14069-w","url":null,"abstract":"<p><strong>Background: </strong>Bloodstream infections (BSIs) are major infectious conditions associated with high morbidity and mortality, particularly in intensive care units (ICUs). In critically ill patients, early and appropriate empirical antimicrobial therapy plays an important role in preventing adverse clinical outcomes. However, the increasing burden of antimicrobial resistance necessitates that empirical treatment strategies be continuously reassessed based on up-to-date local resistance data. This study aimed to compare the distribution of bacterial pathogens and antimicrobial resistance profiles of BSIs identified in ICUs before and during the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Methods: </strong>A total of 388 patients diagnosed with BSIs while hospitalized in the ICUs of Health Sciences University Prof. Dr. Cemil Taşçıoğlu City Hospital between March 2019 and April 2021 were retrospectively evaluated. During the pandemic period, patients with and without COVID-19 were analyzed together without stratification. Bacterial isolates recovered from blood cultures and their antimicrobial susceptibility results were compared between the pre-pandemic and pandemic periods. Multivariable analysis identified independent risk factors for multidrug resistance (MDR) in Klebsiella pneumoniae, adjusting for clinical confounders.</p><p><strong>Results: </strong>Pre-pandemic, the predominant pathogens were K. pneumoniae (30.1%), A. baumannii complex (21.9%), and S. aureus (9.7%); during the pandemic, K. pneumoniae (34.4%), A. baumannii complex (21.2%), and E. faecium (10.4%) led the distribution. During the pandemic, non-fermentative Gram-negative bacilli showed a significant increase in ceftazidime resistance, while resistance to amikacin, gentamicin, and meropenem declined. In Enterobacterales, extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance increased during the pandemic. In K. pneumoniae, while carbapenem resistance remained statistically stable, colistin resistance increased significantly, raising a new concern. Prior antimicrobial therapy was the sole independent predictor of MDR in K. pneumoniae (adjusted Odds Ratio [aOR] = 8.296, 95% Confidence Interval [CI] = 1.471-46.794, p = 0.017).</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic, Gram-negative pathogens continued to predominate among BSIs identified in ICUs, with an observed trend toward increased antimicrobial resistance, particularly among Enterobacterales species. Notably, prior antibiotic exposure was identified as the key independent determinant of MDR status in K. pneumoniae. Given the dynamic nature of pathogen distribution and resistance profiles in BSIs, consideration of local and period-specific resistance patterns in ICU settings may help inform empirical antimicrobial treatment strategies.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227113","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":"Clinical factors associated with CT-confirmed pneumonia in febrile patients: a retrospective study addressing verification bias with inverse probability weighting.","authors":"Shu-Rou Qin, Xin-Qi Li, Jing-Qi Pei, Lin-Ni Tang, Hong Cai, Ying-Gang Zhu, Shao-Hua Cui","doi":"10.1186/s12879-026-14083-y","DOIUrl":"10.1186/s12879-026-14083-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Identifying pneumonia among febrile patients is clinically important, particularly in real-world settings where chest computed tomography (CT) is not performed uniformly. We aimed to identify clinical factors associated with CT-confirmed pneumonia in febrile patients and to examine the robustness of these associations after accounting for potential verification bias due to non-random CT completion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational study included 902 febrile patients from Huadong Hospital between December 2022 and May 2023. The primary analysis was restricted to patients who underwent chest CT, among whom CT findings were categorized as no pneumonia (n = 335) or pneumonia (n = 210); 357 did not undergo CT. Baseline characteristics were compared using the Wilcoxon rank-sum test or chi-square test, as appropriate. Right-skewed biomarkers, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were transformed using log(x + 1). Candidate predictors were screened using univariable logistic regression and 10-fold cross-validated least absolute shrinkage and selection operator (LASSO) regression, followed by a non-penalized multivariable logistic regression model to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated by discrimination, calibration, decision curve analysis, and bootstrap internal validation (B = 1000). To address potential verification bias arising from selective CT completion, stabilized inverse probability weighting (IPW) was applied as a sensitivity analysis. Supplementary analyses evaluated the incremental discriminative value of laboratory biomarkers beyond respiratory symptoms and assessed sensitivity to a stricter pneumonia outcome definition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among patients who underwent CT, those with CT-confirmed pneumonia were older and had higher CRP levels than those without pneumonia. The final multivariable model included age, sex, body temperature, monocyte percentage, eosinophil percentage, log-transformed CRP, and log-transformed LMR. Older age (OR 1.02, 95% CI 1.01-1.03, p &lt; 0.001) and higher log-transformed CRP (OR 1.42, 95% CI 1.18-1.70, p &lt; 0.001) were robustly associated with CT-confirmed pneumonia. A positive association was also observed for higher log-transformed LMR (OR 1.86, 95% CI 1.10-3.15, p = 0.021), but this association was sensitive to parameterization and should be regarded as exploratory. The model showed modest discrimination, with an apparent area under the receiver operating characteristic curve (AUC) of 0.691 and a bootstrap-corrected AUC of 0.673 (95% CI 0.630-0.716); the Brier score was 0.211. The final model outperformed CRP, NLR, and white blood cell count alone in discrimination. Respiratory symptoms were nearly identically distributed between patients with and without pneumonia and did not improve discrimi","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227155","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":"Brucella melitensis infection complicated by secondary hemophagocytic lymphohistiocytosis, meningitis, and multiorgan damage: a case report and literature review.","authors":"Yiqun Li, Xinmei Chen, Juanqiang Wang, Mingxi Yang, Caixia Zhang","doi":"10.1186/s12879-026-14074-z","DOIUrl":"10.1186/s12879-026-14074-z","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis is one of the most widespread zoonotic diseases globally. Of the twelve known Brucella species that affect mammals, Brucella melitensis is the most significant cause of human infection. Others include B. abortus, B. suis, and B. canis, with transmission occurring via unpasteurized dairy, direct animal contact, or occupational exposure (veterinarians, farmers, and laboratory workers). Although hemophagocytic lymphohistiocytosis (HLH) and neurological complications are known sequelae of brucellosis, their simultaneous occurrence with multiorgan failure is rarely reported.</p><p><strong>Case presentation: </strong>A 59-year-old female was admitted with dizziness and fatigue for more than 20 days, accompanied by fever and lethargy for 3 days. An epidemiological history revealed that the patient had close contact with goats, which was considered a key risk factor. On physical examination, the patient appeared lethargic, with petechiae on the skin and mucous membranes, oral blood blisters, gingival bleeding, and splenomegaly. Laboratory results revealed significantly increased ferritin levels, decreased fibrinogen levels, pancytopenia, and elevated transaminase levels. Bone marrow aspiration confirmed the presence of hemophagocytes. Cerebrospinal fluid (CSF) examination supported a diagnosis of meningitis. Blood cultures grew Brucella melitensis, and metagenomic next-generation sequencing (mNGS) of CSF revealed a large number of B. melitensis-specific nucleic acid sequences. Chest computed tomography (CT) revealed bilateral pulmonary infiltrates. The patient was ultimately diagnosed with B. melitensis infection complicated by HLH, meningitis, and multiorgan dysfunction. The patient was treated with ceftriaxone sodium, doxycycline, rifampicin, glucocorticoids, and supportive therapy. Following treatment, her consciousness improved, the fever subsided, the total platelet count rose, and liver enzyme levels gradually decreased. The patient was discharged in stable condition. At the 2-month follow-up, the patient remained in remission with normal haematological indicators, no recurrent fever, and stable neurological function.</p><p><strong>Conclusions: </strong>This case reflects the severe nature of brucellosis when atypical multiorgan involvement is present and highlights the diagnostic challenges and the importance of early and standardized treatment. Maintaining a high level of clinical suspicion and achieving an early definite diagnosis are key to improving treatment outcomes and prognosis. In addition, this case report helps expand the known spectrum of clinical complications related to brucellosis.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227167","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":"Disseminated Nocardia brasiliensis causing septic arthritis in a patient with non-small cell lung adenocarcinoma: a case report.","authors":"Issa Jundi, Wafa Asad, Priyanka Mehotra, Andres Reyes-Corcho","doi":"10.1186/s12879-026-14064-1","DOIUrl":"10.1186/s12879-026-14064-1","url":null,"abstract":"<p><strong>Background: </strong>Nocardia brasiliensis is classically associated with localized cutaneous infection and is a rare cause of disseminated disease. Septic arthritis due to Nocardia species is atypical and has rarely been reported without antecedent trauma. We present a case of N. brasiliensis septic arthritis in a patient with active solid organ malignancy.</p><p><strong>Case presentation: </strong>An 80-year-old male with non-small cell lung adenocarcinoma, chronic obstructive pulmonary disease, and chronic kidney disease stage 3b presented with refractory soft tissue infections of the left upper and right lower extremities despite prior incision and drainage and oral antibiotics. Hospital course was complicated by progressive right knee effusion. Synovial fluid analysis demonstrated 87,000 white blood cells per microliter, 95% neutrophils, glucose less than 20 mg/dL, and no crystals. Nocardia brasiliensis was cultured from multiple noncontiguous sites, including the left upper extremity abscess, right knee synovial fluid, and right lower extremity lesions. Susceptibility testing demonstrated a broad antimicrobial profile but resistance to imipenem and ciprofloxacin. Trimethoprim-sulfamethoxazole and aminoglycosides were relatively contraindicated due to renal function. The patient required right knee arthroscopy with irrigation, debridement, and complete synovectomy, multiple interventional radiology-guided drainages, and prolonged combination antimicrobial therapy with ceftriaxone, linezolid, and minocycline. His course was further complicated by persistent encephalopathy and severe malnutrition requiring enteral nutrition. At the time of reporting, the patient demonstrated clinical improvement of cutaneous and musculoskeletal lesions but remained hospitalized for non-infectious complications.</p><p><strong>Conclusions: </strong>This case highlights that Nocardia brasiliensis can cause disseminated musculoskeletal infection including septic arthritis in immunocompromised patients without clear environmental exposure. In patients with chronic kidney disease, standard first-line therapies may be contraindicated, making early species identification and susceptibility-guided therapy essential, particularly given the potential for carbapenem resistance. The central lesson is that empiric carbapenem therapy may fail in N. brasiliensis and that renal impairment narrows treatment options, so timely identification and susceptibility-directed therapy directly determine management, particularly when advanced malignancy further constrains care.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226946","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":"High tetracycline and azithromycin resistance of Neisseria gonorrhoeae impacting treatment and doxyPEP use - antimicrobial susceptibility patterns of isolates from a prospective cohort of men who have sex with men in Wroclaw, Lower Silesia, Poland 2022-2024 - final report.","authors":"Bartosz Szetela, Beata Mączyńska, Daria Zaręba, Danuta Rurańska-Smutnicka, Paulina Szuba, Martyna Biała","doi":"10.1186/s12879-026-14073-0","DOIUrl":"10.1186/s12879-026-14073-0","url":null,"abstract":"<p><strong>Objectives: </strong>The aim was to ascertain Neisseria gonorrhoeae (NG) antimicrobial resistance patterns among men who have sex with men (MSM), evaluate their impact on treatment and prophylaxis, identify risk factors for infection, and assess whether expanding the sample size beyond the preliminary cohort significantly altered the primary outcomes (1).</p><p><strong>Methods: </strong>This trial was conducted at the outpatient All Saints' HIV clinic in Wroclaw, Poland, between 2022 and 2024. Rectal, urethral, and oropharyngeal swabs were collected from 200 MSM who were wither living with HIV (PLWH) or using pre-exposure prophylaxis (PrEP). Included participants reported high-risk sexual contacts, symptoms, or prior positive results. NG isolates were evaluated for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin.</p><p><strong>Results: </strong>Of the 200 MSM enrolled, 33.5% were PLWH and 66.5% were PrEP users. This extended analysis identified 23 additional isolates alongside the initial 26, yielding 43 viable isolates for susceptibility testing. PrEP users were slightly younger than PLWH (median 34 vs. 36 years) and reported more oral contacts, more sexual partners outside of Poland, and more partners of foreign nationality within Poland. Doxycycline post-exposure prophylaxis (doxyPEP) was more frequently utilized by PLWH (30.3% vs. 14.18%). NG culture positivity rates were similar between PLWH (21.7%) and PrEP users (23.3%). In multivariate logistic regression, NG infection was significantly associated with higher number of oral contacts (OR = 4.05; 95% CI: 1.15-14.27; p = 0.029). While all isolates retained full susceptibility to ceftriaxone and cefixime, resistance to azithromycin was 30.2% (13/43) and tetracycline 48.8% (21/43), demonstrating stability between the preliminary and final analyses.</p><p><strong>Conclusions: </strong>Ceftriaxone and cefixime remain highly effective first-line agents against NG in Poland, whereas high resistance rates dictate that azithromycin should be relegated to alternative therapy status in national guidelines. Furthermore, the high prevalence of tetracycline resistance may compromise the efficacy of doxyPEP. Finally, the initial cohort of 100 MSM was statistically sufficient to accurately ascertain core antimicrobial resistance patterns.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227014","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":"A survey of explainable AI applications in infectious disease diagnosis.","authors":"Hossein Valishirin, Fatemeh Inanloo S A, Kelly A Brayton, Shira L Broschat","doi":"10.1186/s12879-026-14018-7","DOIUrl":"10.1186/s12879-026-14018-7","url":null,"abstract":"<p><p>Artificial intelligence (AI), particularly deep learning, has shown significant promise in accelerating the diagnosis of infectious diseases. However, the inherent \"black box\" nature of deep learning is a major barrier to clinical adoption, preventing trust and accountability. Explainable AI (XAI) tries to address this problem by adding transparency to model decision-making. This paper presents a comprehensive scoping review of XAI applications in infectious disease diagnosis based on literature published between 2023 and 2025. We review studies of major diseases, including COVID-19, tuberculosis, malaria, monkeypox, and dengue, categorizing them by data modality (e.g., imaging, tabular) and the XAI techniques employed (e.g., SHAP, LIME, Grad-CAM). We conclude that XAI methods are effective in identifying clinically relevant features, such as key biomarkers from lab results and pathological regions in medical images, thereby aligning model reasoning with established clinical knowledge. Despite this progress, significant challenges persist, including poor generalizability from small, single-center datasets, the computational overhead of post-hoc methods, and a gap between technical explanations and clinical utility. We outline future directions that should be taken, including the need for standardized evaluation metrics, multi-center validation, and clinician-centered XAI design to facilitate the responsible integration of AI into clinical practice.Clinical trial numberNot applicable.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227149","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":"Neglected tropical diseases in the Arabian Peninsula: a systematic review of leishmaniasis and rickettsioses.","authors":"Shuaibu Abdullahi Hudu, Mohamed Soliman, Naglaa M Shalaby, Emad A Morad, Ghusun M Alhazimi, Abdulgafar Olayiwola Jimoh","doi":"10.1186/s12879-026-14012-z","DOIUrl":"10.1186/s12879-026-14012-z","url":null,"abstract":"<p><strong>Background: </strong>Vector-borne neglected tropical diseases are still an underrecognized public health problem in the Arabian Peninsula. Of these, leishmaniasis is endemic in multiple regions, while the epidemiology of rickettsial infections remains incompletely understood. This systematic review synthesizes existing evidence on the epidemiology, distribution, and surveillance of these two diseases in the region.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, a systematic review was performed. The protocol was registered with PROSPERO. We searched PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and relevant grey literature for studies published from January 2000 to December 2025 that describe human cases of leishmaniasis or rickettsioses in countries of the Arabian Peninsula. Two reviewers independently screened studies, extracted data, and assessed methodological quality (risk of bias) using validated tools.</p><p><strong>Results: </strong>A total of 44 studies were included. The majority of studies investigated leishmaniasis (n = 31), with fewer on rickettsioses (n = 9) or mixed febrile illness (n = 4). Most publications originated from Saudi Arabia. In the Arabian Peninsula, particularly in Saudi Arabia, cutaneous leishmaniasis remains endemic, with localized transmission hotspots and the coexistence of multiple Leishmania species, including L. major and L. tropica. Evidence for rickettsial infections remains sparse, primarily derived from case reports and serologic surveys.</p><p><strong>Conclusion: </strong>Leishmaniasis remains a public health challenge in the Arabian Peninsula, particularly in Saudi Arabia. In contrast, rickettsioses are likely underdiagnosed due to limited surveillance and diagnostic capacity. Improved, integrated surveillance systems, paired with febrile illness investigations that include diagnostic testing for rickettsial pathogens, will lead to fewer missed cases, contributing to disease detection and control.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227009","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":"Developing laboratory indicators to predict the probability of in-hospital progression to severe disease in elderly patients with influenza A virus infection.","authors":"Liu Xiu, Feng Bianying, Zhang Zhifan, Zhou Hao, Zhou Nana, Man Qiuhong","doi":"10.1186/s12879-026-14007-w","DOIUrl":"10.1186/s12879-026-14007-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The progression of respiratory viral infections to severe disease, and the associated high mortality in elderly patients, pose a significant clinical challenge. Currently, effective warning tools specific for predicting severe influenza are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To preliminarily develop a laboratory‑based prediction model using routine clinical laboratory markers to estimate the risk of in-hospital progression to severe disease in elderly patients with influenza A virus infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study was conducted at Shanghai Fourth People's Hospital, affiliated with Tongji University, from March 2023 to February 2025. Data were extracted from the hospital's electronic medical record system. A total of 198 elderly patients (aged &gt; 60 years) with laboratory-confirmed influenza A virus infection were enrolled; those co-infected with other respiratory pathogens were excluded. All patients had complete demographic and outcome data, and laboratory biomarkers were measured within 24 h of admission. The primary outcome was progression to severe influenza, defined according to the Chinese \"Diagnosis and Treatment Protocol for Influenza\" (2025 Edition). Patients were randomly split into a training set and a validation set in a 7:3 ratio. Elastic net regression was employed to select candidate variables for constructing a prognostic model of disease severity. Model performance was evaluated based on discrimination and calibration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 198 elderly hospitalized patients with influenza A virus infection, 50 developed severe disease, while 148 remained non-severe. There were no significant differences in age or sex between the two groups. However, 16 clinical laboratory markers, including procalcitonin, interleukin-6, and albumin, showed significant differences. Using a machine learning-based variable selection procedure, we identified white blood cell count, procalcitonin, interleukin-6, and myoglobin and incorporated them into the prediction model. The model showed discriminatory performance in both the training set (C-index: 0.851, 95% CI: 0.797-0.905) and the validation set (C-index: 0.819, 95% CI: 0.709-0.929). Calibration analysis suggested potentially acceptable calibration at day 14.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We developed and preliminarily evaluated a laboratory‑based prognostic model to predict the risk of in-hospital progression to severe disease in elderly patients with influenza A virus infection. The model showed moderate discriminative ability in this single‑center cohort. Given the modest sample size and limited number of events, all results should be interpreted with caution and considered preliminary and exploratory. It will be important to conduct external validation in larger, independent cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The study protocol was retrospectively registered with the Chi","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227115","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}