Jul 2026· International Journal of Infectious Diseases· Vol 171, pp.
108981
· 0 citations· 29 references
Medicine
TL;DR
Surgical intervention and treatment with ceftazidime or trimethoprim-sulfamethoxazole were associated with lower mortality, whereas altered consciousness and diabetes were linked to poorer overall survival.
Abstract
Objectives
Melioidosis is an infectious disease endemic to southeast Asia and northern Australia. Although rare, central nervous system (CNS) melioidosis carries a high mortality. This study aims to determine its clinical characteristics and provide insights facilitating its diagnosis and management.
Methods
We performed a multicenter retrospective analysis of CNS melioidosis cases at six hospitals in Hainan, China, between 2010 and 2025. Demographic and clinical data were collected and analyzed. Antimicrobial susceptibility testing was performed, and comparative statistics were calculated between survivors and non-survivors.
Results
Mortality reached 31.0% (13/42) among CNS melioidosis cases. Intracranial involvement was most common (76.2%, 32/42). Diabetes (59.5%, 25/42) was predominant risk factor. Common presentations included fever (76.2%, 32/42), headache (52.4%, 22/42), localizing neurologic signs (47.6%, 20/42), and altered consciousness (42.9%, 18/42). Bacteremia was confirmed in 59.5% (25/42) of the enrolled cases All tested isolates were susceptible to most common antibiotics. Surgical intervention and treatment with ceftazidime or trimethoprim-sulfamethoxazole were associated with lower mortality, whereas altered consciousness and diabetes were linked to poorer overall survival.
Conclusions
CNS melioidosis in Hainan predominantly affects diabetic males and frequently presents with nonspecific neurologic symptoms mimicking stroke, contributing to delayed diagnosis and high mortality. High clinical vigilance, cultures of multiple specimens, and timely antibiotics plus surgical treatment are critical for improving prognoses.
Paracoccidioidomycosis (PCM) is a neglected systemic mycosis in Latin America. This study aims to characterize the epidemiology and clinical profiles of infant PCM cases (0 to 14 years old) over a 15-year period (2008–2023) in the two primary endemic regions of Argentina, the northeast (NEA) and the northwest (NWA) areas. Results reveal striking regional heterogeneity. Distribution showed clear disparities, 71.1% of cases were recorded in NWA, while 28.9% in the NEA area. The NWA region exhibited a constant temporal occurrence, whereas the NEA showed episodic occurrence/outbreaks potentially triggered by anthropogenic and climatic changes. Severe nutritional impairment and generalized lymphadenopathy were common clinical signs in both regions. Hepatosplenic enlargement and abdominal compromise with gastrointestinal manifestations dominated in the NWA (53.1%), while a higher prevalence of cutaneous/mucocutaneous (76.9%), pulmonary (38.4%) and osteoarticular (38.4%) manifestations characterized the clinical profiles in the NEA. These findings support the existence of distinct regional epidemiological and clinical phenotypes of pediatric PCM in Argentina. Recognizing these disparities is essential to improve clinical suspicion, diagnostic strategies, and the implementation of effective public health strategies for this severe pediatric disease.
G. Giusiano, Y. Chacón, A. Aguilera et al.· Journal of Fungi· 0 citations
Clinicians should maintain a high index of suspicion in patients presenting with severe pneumonia or sepsis, particularly during the rainy season and among individuals with diabetes mellitus or chronic liver disease, and strengthening conventional microbiological capacity remains essential for improving diagnosis and patient outcomes in geographically isolated settings.
Duy-Cuong Le, Dinh-Dung Nguyen, T. Nguyen et al.· BMC Infectious Diseases· 0 citations
Abstract Miliary tuberculosis (TB) represents a potentially fatal form of disseminated TB resulting from the lymphohematogenous dissemination of Mycobacterium tuberculosis. Although accounting for approximately 1–2% of all TB cases in immunocompetent adults, its mortality rate exceeds 30%. This review screened peer-reviewed, original research studies via four databases (PubMed, EMBASE, MEDLINE, and CENTRAL) to synthesize up-to-date evidence. Key risk factors include human immunodeficiency virus (HIV) co-infection, anti-tumor necrosis factor-α (TNF-α) agents and chronic malnutrition. The clinical presentation of miliary TB is notoriously nonspecific, with fever, night sweats, weight loss, and constitutional symptoms predominating. Over 60% of patients have extrapulmonary complications, with central nervous system (CNS) involvement in 10–30%, abdominal involvement in 15–30%, and skeletal involvement in up to 17%. Laboratory abnormalities are common, including elevated erythrocyte sedimentation rate (ESR), anemia, lymphopenia, and nearly universal C-reactive protein (CRP) elevation. Diagnoses remain difficult due to paucibacillary lesions; novel molecular assays and a validated CNS prediction scoring system greatly improve diagnostic efficiency, while multiple microbiological and invasive tissue sampling modalities are briefly summarized for comprehensive clinical reference. Standard 6-month isoniazid, rifampicin, pyrazinamide ethambutol and isoniazid, rifampicin (HRZE-HR) regimens apply to isolated pulmonary miliary TB, whereas 9–12-month extended therapy plus adjunctive dexamethasone is required for CNS complications. Drug resistant cases demand 18–24-month individualized regimens with high blood-brain barrier penetration. Severe complications including tuberculous meningitis and high mortality acute respiratory distress syndrome (ARDS) are fully discussed, and TNF-α antagonists act as salvage therapy for steroid-refractory tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS). Bacillus Calmette–Guérin (BCG) vaccination provides substantial protection against miliary TB in children, with efficacy of approximately 77% and favorable cost-effectiveness. Existing reviews lack integrated post-pandemic epidemiological data, cutting-edge molecular diagnostics and modern extrapulmonary treatment algorithms; this paper fills such gaps to offer balanced clinical guidance for frontline clinicians.
Yu-Kun Qiu, Yubin Tang, Shuqing Yu et al.· Infection and Drug Resistanc...· 0 citations
Background Nontuberculous mycobacteria (NTM) can disseminate and infect various organs throughout the body. However, whether NTM can infect tracheobronchial tissue is rarely reported. This study aimed to address the knowledge gap regarding the epidemiological, demographic, and clinical characteristics of patients with tracheobronchial NTM infection. Methods In this multicenter retrospective cohort study, clinical, demographic, microbiological, and radiological data from hospitalized patients with tracheobronchial NTM infections from January 2015 to May 2025 were collected and analyzed descriptively. Results Twenty-nine patients (2.3%) were included, and all the patients presented with disseminated NTM infection. Seventeen patients had comorbidities, including 5 with acquired immunodeficiency syndrome and 1 with anti-interferon-γ autoantibody syndrome. Median diagnostic delay was 130 days, and 89.7% of the patients were initially misdiagnosed with tuberculosis or malignancy. The most common symptoms were cough, expectoration, anemia, fever, weight loss, skin lesions, and bone pain. Chest CT revealed nodules, patchy opacities, mass-like shadows, and bronchial stenosis, with or without hilar/mediastinal lymphadenopathy, whereas osteolytic bone destruction was evident in 11 patients. The most common features of bronchoscopy were intraluminal masses/neoplasms/nodules. Metagenomic next-generation sequencing (mNGS) of BALF (n=12) demonstrated 100% positivity, outperforming BALF culture (46.2%, 12/26) and sputum culture (39.3%, 11/28). Mycobacterium colombiense accounted for 24.1% of cases. With respect to therapeutic management, 27 patients received systemic antimicrobial therapy, while 2 did not receive specific anti-N™ treatment. One patient underwent combined endoscopic resection. Overall, 23 patients (79.3%) achieved improvement or cure, 5 showed disease progression, 1 experienced relapse, and 1 died. Conclusions Tracheobronchial NTM infection is rare but clinically significant, often occurring in the context of disseminated disease with pulmonary involvement. Immunocompromised hosts, particularly those with AIDS or anti–IFN-γ autoantibody syndrome, are highly susceptible. Bronchoscopy typically reveals mass lesions causing luminal stenosis or occlusion. In this cohort, M. colombiense was the most frequently isolated NTM species. Early bronchoscopy, mNGS-based pathogen detection, and timely systemic or endoscopic intervention should be considered to prevent irreversible airway stenosis. Further studies are needed to validate optimal treatment strategies. Clinical Trial Registration https://www.ClinicalTrials.gov, identifier NCT07377864.
M. Pan, Yaqin Wei, Chunyuan Luo et al.· Frontiers in Cellular and In...· 0 citations
Pediatric melioidosis follows a phenotype-severity continuum, with outcomes strongly influenced by disease pattern and timeliness of diagnosis, and key priorities for clinical practice and future research are highlighted.
G. Vithiya, S. Ponnusamy, V. Mangayarkarasi et al.· Indian Journal of Medical Mi...· 0 citations
Primary amoebic meningoencephalitis (PAM), caused by Naegleria fowleri, is a rare but often fatal central nervous system infection that mimics bacterial meningitis. This similarity can lead to misdiagnosis and delayed treatment, especially in neonates and infants, resulting in poor outcomes. This study evaluates the clinical and paraclinical features, diagnostic challenges, treatment strategies, and outcomes of PAM in this vulnerable population, emphasizing the importance of early and accurate diagnosis and treatment. This systematic review followed the PRISMA statement. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar to identify studies without language restrictions describing PAM in neonates and infants published up to December 2025. Thirteen studies reporting 13 patients (2 neonates and 11 infants, aged 11 days to 12 months) were included. Fever was found in all patients. Other prevalent manifestations were seizure, decreased level of consciousness, and vomiting. Exposure histories were heterogeneous and often involved contaminated well water and other freshwater sources. Cerebrospinal fluid (CSF) analysis consistently demonstrated neutrophilic pleocytosis, elevated protein levels, and reduced glucose concentrations. Neuroimaging findings varied, with survivors commonly exhibiting limited abnormalities such as hydrocephalus or focal lesions. Microbiologic confirmation was primarily done by CSF microscopy, followed by CSF culture and CSF polymerase chain reaction. Amphotericin B–based combination therapy was the most frequently employed treatment; however, outcomes remained variable, with a high overall mortality rate. PAM in neonates and infants presents substantial diagnostic and therapeutic challenges due to nonspecific clinical manifestations, often unclear or atypical exposure histories, and rapid disease progression. The clinical presentation frequently resembles acute bacterial meningitis, which may lead to empiric antibacterial therapy and delays in initiating appropriate anti-amoebic treatment. Early clinical suspicion, timely use of microbiological diagnostic methods, and prompt initiation of targeted therapy may be associated with improved survival. Preventive measures, emphasizing the use of safe household water, are important, especially preventing neonates and infants from being exposed to untreated environmental water sources such as well water. Considering the high mortality rate, enhancing early diagnostic methods and optimizing therapeutic interventions remain essential to improving outcomes in these patients.
J. Mahdavi, Setareh Pirayeshfar, A. Shariati et al.· BMC Infectious Diseases· 0 citations
