PURPOSE OF REVIEW:Invasive fungal diseases (IFD) are severe complications of burn injury and are associated with substantial morbidity and mortality. Despite increasing recognition of their clinical impact, evidence guiding diagnosis, prevention, and management remains limited. This review summarizes recent advances in the understanding of host susceptibility, diagnostic approaches, and therapeutic strategies for IFD in burn patients. RECENT FINDINGS:Recent literature converges on three major themes: the characterization of burn-induced immunosuppression, the need to associate conventional diagnostics and molecular tools, including quantitative PCR and the central role of comprehensive source control, to which systemic antifungal therapy must be systematically added and pharmacokinetically optimized to account for the profound physiological alterations inherent to severe burn injury. SUMMARY:Optimal management of IFD in burn patients requires a multidisciplinary approach combining immune risk stratification, refined diagnostic algorithms, and individualized antifungal therapy. Consensus on case definitions and prospective multicentre data are urgently needed to consolidate the evidence base and meaningfully improve outcomes in this vulnerable population.
PURPOSE OF REVIEW:Triazole-resistant Aspergillus fumigatus is a growing clinical problem. Resistance can develop with clinical exposure and with environmental exposure to azole and azole-like compounds used as fungicides in agriculture. The purpose of this review is to provide an update of our current understanding of the epidemiology and prevalence of this emerging problem. RECENT FINDINGS:Triazole-resistant A. fumigatus is now a worldwide problem. Resistant isolates have been found in clinical and environmental samples collected from many countries on all inhabitable continents. The most commonly identified mechanisms of resistance are those associated with environmental exposure. Although the prevalence of triazole-resistant Aspergillus has been most extensively studied in Europe, hotspots have emerged in other countries, both in the environment and in clinical settings. However, the true extent of the problem is not well understood secondary to limitations with small studies of limited duration and the lack of comprehensive surveillance programs. SUMMARY:Triazole-resistant A. fumigatus is an emerging issue both clinically and in the environment. Greater attention and more resources are needed to better understand the extent of the problem.
PURPOSE OF REVIEW:Despite the efforts of national and international health agencies to eradicate measles virus (MeV), the causative agent of measles, progress has stagnated and cases are rising. Since 1963, a well tolerated and efficacious live-attenuated vaccine has been used to remarkable success, leading to the near eradication of measles virus. Nevertheless, increased vaccine hesitancy has led to a resurgence in the past decade. The development of specific antiviral therapeutics to combat measles is lagging but increased efforts are justified considering the current measles resurgence and needs to protect vulnerable populations. RECENT FINDINGS:While no specific therapeutics have been approved to date, major advances in the development of measles-specific small molecule antivirals and biologics have been made recently. In this review, we provide an update on their development covering three major areas: drugs targeting viral entry; drugs targeting viral replication; and drugs targeting host factors utilized by MeV. Finally, we identify critical gaps and novel approaches that may enhance our current repertoire of antivirals targeting MeV. SUMMARY:The recent advances in the development and preclinical testing of MeV-targeting antivirals offer multiple independent avenues for their clinical evaluation.
PURPOSE OF REVIEW:Bacteriophage therapy is a promising treatment on the horizon for multidrug resistant (MDR) and difficult-to-treat infections. RECENT FINDINGS:There have been a number of case reports and case series using bacteriophages to treat MDR infections. This has sparked interest by many patients and providers in accessing this treatment. However, the timeline from start of screening for phages to quality control in manufacturing to regulatory applications and the actual administration can be quite long. It is therefore important to be realistic with persons seeking treatment. Bacteriophage therapy is in its infancy. We are only beginning to understand the pharmacokinetics and pharmacodynamics of phages and how the development of phage-specific immune response may impact efficacy. Patients do develop neutralizing antibodies against bacteriophages. This is akin to someone receiving a first-time vaccination or first-time exposure to a viral infection. These neutralizing antibodies have the potential to impede efficacy, particularly if treatment extends past the 14-day window during which a patient first seroconverts from an IgM response to an IgG response. Finally, bacteriophages are useful tools to disrupt biofilms in patients with recurrent urinary tract infections, pulmonary infections, and those with retained hardware. SUMMARY:Understanding the protocol for phage therapy in addition to the potential setbacks is essential to eventually formulating "off-the-shelf" therapy.
PURPOSE OF REVIEW:Κlebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales infections are currently treatable with novel β-lactam-β-lactamase inhibitors (BLBLIs) combinations, but their optimal use in daily practice requires defining when ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam (MER-VAB), and imipenem-cilastatin-relebactam (IMI-REL) are clinically interchangeable and when treatment should be individualized. RECENT FINDINGS:Contemporary surveillance and observational data support high activity of all three agents against confirmed KPC-producing Enterobacterales, providing a rationale for interchangeability in low-risk infections with source control and no recent BLBLI exposure. However, clinically relevant differences are increasingly recognized. CAZ-AVI resistance is most often linked to KPC variants, whereas reduced MER-VAB and IMI-REL susceptibility more frequently involves porin loss, reduced permeability, and increased β-lactamase expression. Pneumonia, high MICs, altered renal function, renal replacement therapy, prior BLBLI exposure, persistent colonization, immunocompromise, and delayed source control may narrow interchangeability. SUMMARY:BLBLI with KPC activity interchangeability is clinically reasonable only in selected, microbiologically confirmed, low-risk scenarios. In complex infections, therapy should be guided according to resistance mechanism, infection site, pharmacokinetics/pharmacodynamics (PK/PD) parameters, and host factors.
PURPOSE OF REVIEW:Alveolar echinococcosis is a wildlife zoonotic disease. Clinically and radiologically, it presents in a manner similar to hepatic malignancy. The aim of our review is to summarize the current standard of clinical management of alveolar echinococcosis. We also want to raise awareness and promote an integrated approach for this neglected tropical disease (NTD). RECENT FINDINGS:Data suggest increased prevalence of alveolar echinococcosis in some parts of the world. This may be due to intensified surveillance, spread of the disease, decreasing control efforts or a combination of these. Development of new diagnostics and treatment modalities is very slow, constrained by lack of investment into research. SUMMARY:Treatment options for alveolar echinococcosis have not changed in decades. Cure is only available for early and limited hepatic disease amenable to R0-surgical resection. Advanced disease, ineligible for surgery, is treated with benzimidazoles with a parasitostatic effect on Echinococcus multilocularis. The prognosis of alveolar echinococcosis ranges from excellent to poor depending mainly on the extent of hepatopathy induced by irreversible damage to the biliary and vascular system of the liver. Benzimidazole intolerance dramatically worsens prognosis, as parasitic growth cannot be suppressed in inoperable patients.
PURPOSE OF REVIEW:Acute hematogenous osteomyelitis (AHO) remains a potentially devastating infection in children, in which delayed diagnosis or inadequate therapy can result in significant long-term sequelae. This review provides an update of the epidemiology, diagnosis and management of pediatric AHO, with particular emphasis on emerging diagnostic tools and evolving therapeutic strategies aimed at preventing complications. RECENT FINDINGS:Improved recognition by clinical and laboratory algorithms of age-specific pathogens, like Kingella kingae in young children or highly virulent organisms including methicillin-resistant Staphylococcus aureus (MRSA), may allow for individualized therapy. Novel molecular techniques, such as metagenomic next-generation sequencing (mNGS), offer the potential for broader and faster microbiological diagnosis. Multidisciplinary protocols that integrate early MRI may enhance anatomic delineation of infection and lead to faster detection of complications. Antibiotic stewardship programs based on local epidemiology support optimized empiric and targeted therapy, while early transition to oral antibiotics has been shown to improve quality of life and reduce healthcare resource utilization without compromising clinical outcomes. SUMMARY:Although AHO continues to pose diagnostic and therapeutic challenges, its management is shifting toward individualized, evidence-based care driven by advances in diagnostics, risk stratification and antimicrobial stewardship. Future research should focus on developing and validating multidisciplinary protocols to further improve the accuracy of diagnosis.
PURPOSE OF REVIEW:Strongyloidiasis affects an estimated 30-100 million people globally and can have life-threatening consequences in immunocompromised hosts, yet it remains underdiagnosed due to limited access and performance of available diagnostics. Novel assays and anthelmintics may reshape screening, diagnosis, treatment, and prevention for at-risk populations. RECENT FINDINGS:Advances in molecular diagnostics coupled with robust stool extraction methods have supplanted traditional parasitologic methods in settings where nucleic acid amplification is feasible. Transition from standard immunoglobulin G (IgG)-based immunoassays to the new IgG- and IgG4-based rapid diagnostic tests using recombinant Strongyloides stercoralis nematode immunodominant E antigen (NIE) and/or S. stercoralis immunoreactive antigen (SsIR) has facilitated serologic screening at the point of care. The World Health Organization now conditionally recommends community-wide ivermectin mass drug administration in highly endemic settings. Regarding new treatment options, moxidectin is noninferior to ivermectin with 93-94% cure rates and a longer half-life, while emodepside shows 80-90% predicted cure rates in early trials and offers a mechanistically distinct option. Understanding of immunosuppressed populations at risk for hyperinfection has expanded, prompting updated screening recommendations. SUMMARY:Serologic and molecular tools are improving screening and diagnosis, and moxidectin and emodepside may broaden treatment options, but data in severe disease and special populations remain limited. Priorities include harmonized screening algorithms and prospective studies in high-risk groups.
PURPOSE OF REVIEW:This review examines the critical knowledge gaps limiting optimal management of invasive fungal diseases (IFDs) in immunocompromised paediatric patients and proposes a research agenda to address these deficiencies. RECENT FINDINGS:Novel immunomodulatory therapies, including chimeric antigen receptor T-cell therapy, bispecific antibodies, and immune checkpoint inhibitors, are creating new at-risk paediatric populations whose susceptibility to IFDs remains poorly characterized. IFDs in these populations may present differently and beneficial effects from antifungal prophylaxis is not clear. Diagnostic challenges persist due to nonspecific imaging findings, limited performance of fungal biomarkers, and difficult invasive sampling given small sample volumes and procedural risks in children. Therapeutic management still relies on evidence extrapolated from adults, creating uncertainty around optimal antifungal selection, dosing strategies and treatment duration. Age-dependent pharmacokinetic and pharmacodynamic differences add substantial complexity, while newer antifungal agents are only becoming available in a delayed fashion for paediatric use. SUMMARY:Critical research priorities vary from identifying which paediatric populations benefit most from antifungal prophylaxis, to developing more accurate and less invasive diagnostics, defining TDM targets, and developing child-friendly and optimized treatment regimes. Addressing these knowledge gaps through dedicated paediatric research, clinical trials and observational studies is essential for this vulnerable population.
PURPOSE OF REVIEW:Gnathostomiasis is a neglected parasitic infection traditionally endemic in Southeast Asia and Latin America. However, in recent years, the disease has been increasingly reported beyond its traditional endemic regions. This review examines recent evidence on its epidemiology and discusses the challenges in diagnosis and management. RECENT FINDINGS:Gnathostomiasis is now frequently reported in a broader global context, reflecting changing patterns of human behavior and global travel. Transmission is still associated with behaviors, such as the consumption of raw or undercooked freshwater fish, rather than specific local cuisines. Clinical presentations remain diverse, with a growing number of reports describing ocular involvement and neurologic disease. Although immunoblot assays play a central role in diagnosis, its availability remains limited and diagnostic performance may vary across Gnathostoma species. Therapeutic options remain largely unchanged, with albendazole and ivermectin as the mainstay of treatment. However, some patients still experience incomplete responses or relapses. SUMMARY:Gnathostomiasis is increasingly reported in a broader global context, reflecting changing patterns of exposure and mobility of people. Important gaps remain in both diagnostic capacity and therapeutic effectiveness, particularly in severe disease, highlighting the need for improved diagnostic tools and treatment strategies.
PURPOSE OF REVIEW:Tropical sprue, once a major cause of malabsorption syndromes, is declining in prevalence. As a consequence of its rarity, and the absence of specific diagnostic tests, diagnosis of this condition is often delayed or missed. The purpose of this review is to draw attention again to this condition and to its overlap with postinfectious irritable bowel syndrome. RECENT FINDINGS:Sporadic case reports of diagnosis in travelers to endemic countries as well as reports of its continuing occurrence in endemic countries indicate the need for continuing diagnosis of the disease. Most recently, the COVID pandemic saw a large number of patients with postinfection gastrointestinal symptoms that lasted longer than 6 months and were accompanied by malnutrition. These events deserve deeper investigation and resurrect coronaviruses as one possible cause of tropical sprue. Diagnosis of the disease is another evolving area and the original diagnostic criteria have to be modified in view of the lack of access to formal tests of absorption in most laboratories. SUMMARY:Sporadic reports of nonceliac enteropathy with response to antibiotic treatment indicate that the disease needs to be considered in the differential diagnosis of malabsorption in the appropriate clinical context.
PURPOSE OF REVIEW:Current treatments for endemic mycoses are limited by toxicity, drug-drug interactions, the need for therapeutic drug monitoring, and suboptimal penetration to sequestered sites. At the same time, several new antifungal strategies and agents are nearing clinical availability and may change practice. RECENT FINDINGS:Current literature highlights limitations of standard therapy for histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, talaromycosis, sporotrichosis, and emergomycosis, which often rely on amphotericin B-based induction regimens followed by triazole antifungals. Emerging studies are evaluating single high-dose liposomal amphotericin B, shorter treatment durations for histoplasmosis, and flucytosine combined with amphotericin B-based induction for talaromycosis. Novel antifungals such as olorofim, fosmanogepix, and turletricin are especially promising, and treatment strategies guided by patient phenotypes and immune endotypes are also beginning to emerge. SUMMARY:Growing evidence suggests therapy for endemic mycoses may change substantially in the near future. New drugs and alternative treatment approaches have the potential to improve safety, tolerability, oral availability, drug-drug interaction profiles, and treatment duration, with important implications for both clinical care and future research.
PURPOSE OF REVIEW:Malaria rapid diagnostic tests (RDTs) have revolutionized malaria diagnosis in endemic settings. RDTs are simple to use and accurate for clinical cases, although sensitivity is reduced at parasite densities below 200 parasites/μl. However, increasing prevalence of hrp2/3 gene deletions in certain areas threaten utility of histidine-rich protein 2 (HRP2)-based RDTs, and lingering HRP2 antigenemia can generate false-positive results after parasite clearance. This review summarizes current performance of malaria RDTs, threats to their validity, and recent innovations to improve their performance and continued role in malaria diagnosis. RECENT FINDINGS:Most World Health Organization (WHO) prequalified RDTs perform well for clinical diagnosis, with only occasional exceptions, including a recently reported issue affecting several countries. RDT sensitivity is generally related to malaria transmission intensity, with higher proportions of false-negative results in lower-transmission areas. Newly prequalified lactate dehydrogenase (pLDH)-based RDTs perform well for both Plasmodium falciparum in areas with >5% hrp2/3 gene deletions and for Plasmodium vivax diagnosis. Several point-of-care alternatives to RDTs, including micro-fluidic devices, hemozoin-detecting devices, and automated hematology analyzers, have shown promising results in small studies, but require larger-scale trials before widespread use. SUMMARY:RDTs remain a critical tool in clinical diagnosis of malaria, and newer pLDH-based tests perform well in areas where hrp2/3 gene deletions threaten validity of HRP2-based RDTs.
PURPOSE OF REVIEW:This review provides an update on the epidemiology, risk factors, clinical presentation, diagnosis, and management recommendations incorporating recommendations from recent publications including the Infectious Disease Society of America guidelines for the management of pulmonary and disseminated histoplasmosis. RECENT FINDINGS:Updates to the epidemiology of histoplasmosis indicate a broader geographic range than historically defined. Updated guidelines do not recommend routine treatment for asymptomatic, mild and moderate pulmonary histoplasmosis although itraconazole can be offered for immunocompromised children or for prolonged or worsening symptoms. Liposomal amphotericin B is recommended as initial treatment for severe histoplasmosis syndromes (severe pulmonary and disseminated histoplasmosis). Fibrosing mediastinitis, a late complication of histoplasmosis is treated with stenting of vessels and bronchi. Recent studies demonstrate that rituximab (anti-CD20 monoclonal antibody) may stop progression or lead to regression of progressive fibrosis. SUMMARY:Histoplasmosis has manifold manifestations, many of which are self-limited and do not require treatment. Severe histoplasmosis and its complications should be treated with liposomal amphotericin B followed by itraconazole. Clinical trials are needed to assess the efficacy of rituximab for the treatment of fibrosing mediastinitis.
PURPOSE OF REVIEW:Typhoidal and invasive non-typhoidal Salmonella (iNTS) serovars remain leading causes of bloodstream infection, mortality and morbidity, particularly in South Asia and sub-Saharan Africa. The rising burden of antimicrobial resistance has strengthened the case for vaccination as a control strategy. This review summarises recent advances in Salmonella vaccine development, highlighting progress, remaining challenges and future directions. RECENT FINDINGS:The introduction of typhoid conjugate vaccine (TCV) programmes across some endemic countries represents a major public health milestone. Important questions remain, however. These include the durability of protection, optimal booster strategies and performance in diverse epidemiological settings. Vaccine development for S. Paratyphi A and iNTS has also accelerated, with candidates including conjugate, outer membrane vesicle/GMMA and live-attenuated, platforms advancing through preclinical and early clinical evaluation. Multivalent vaccine strategies have attracted growing interest. However, the divergent epidemiology of typhoidal and non-typhoidal disease, including differences in age-specific risk and geographic distribution, raises important questions about whether a single combination product is suitable for all settings. SUMMARY:The Salmonella vaccine landscape is evolving rapidly from a focus on typhoid alone toward broader protection against multiple clinically important serovars. Although recent progress is encouraging, important scientific, regulatory, and implementation challenges remain. The practical case for integrated Salmonella vaccine strategies will depend on careful matching of vaccine composition to the differing epidemiology, age-specific risks, and delivery contexts of typhoidal and nontyphoidal disease.
Purpose of review Measles has reemerged as a significant global public health threat, with increasing morbidity and mortality associated with declining vaccination rates. This review summarizes current global outbreaks, history of measles, vaccination and elimination status, vaccine hesitancy, and outbreak response and lessons learned highlighting different novel digital epidemiological tools. Recent findings Measles continues to surge worldwide with an estimated 11 million infections in 2024, which is more than prepandemic levels. Developing and developed countries are both facing measles outbreaks, with the United States at risk of losing measles elimination status. Recent studies have showed that worldwide percentages of two-dose measles vaccination were lower than 95% that is required to interrupt measles transmission in all WHO regions. Novel epidemiological tools such as interactive simulators, real-time use of dynamic models, serosurveillance, and others are transforming measles outbreak response and enable earlier outbreak detection, tracking, and targeted public health interventions. Summary Vaccine hesitancy is one of the top global health threats and developing a tailored evidence-based approach is necessary to establish and maintain measles elimination.
PURPOSE OF REVIEW:New World screwworm (NWS) is an emerging parasitic threat in Central America and Mexico, which is spreading northward into the southern United States. Here we highlight the changing epidemiology, lifecycle of the NWS fly, clinical presentation, identification, treatment, and potential complications of NWS myiasis. RECENT FINDINGS:Despite decades of successfully containing NWS flies south of the Darien Gap in southern Panama, NWS flies reemerged in the Central America region in 2023 and have continued to spread northward ever since. On 3 June 2026, United States Department of Agriculture (USDA) confirmed the identification of an NWS infestation in a young calf in southern Texas. In addition to describing the current epidemiology of the NWS outbreak, we present information about clinical presentation and management of NWS myiasis in patients and include representative cases of patients who experienced NWS myiasis. SUMMARY:This review provides important epidemiologic and clinical updates to an emerging parasitic threat so clinicians can understand the risks and clinical management for patients with suspected NWS myiasis.
Purpose of review Invasive fungal infections remain associated with high morbidity and mortality despite advances in antifungal therapy. Current treatments are largely pathogen-directed and fail to address the dysregulated host immune responses that drive severe disease. Together with expanding at-risk populations and environmental changes that promote fungal adaptation, spread, and emergence resistance of fungal pathogens, this underscores the need for complementary immunotherapy. Recent findings Disease outcome in invasive fungal infections is determined not only by fungal burden but also by host immune dysfunction. Improved understanding of antifungal immunity has led to a growing range of adjunctive immunotherapies. These include both immune-enhancing and immune-restraining approaches, such as cytokine-based therapies, pattern-recognition receptor agonists, immune checkpoint blockade, monoclonal antibodies, vaccines, cellular therapies, small-molecule immunomodulators, and corticosteroids. Accumulating evidence indicates that their efficacy depends on timing and the patient's immune status, underscoring the need for a balanced, context-specific personalized immunomodulation. Summary Antifungal therapy remains the cornerstone of treatment for invasive fungal diseases, but outcomes depend on drug efficacy and host immunity. Combining antifungals with tailored immunomodulation, whether immune restraining, enhancing, or both, offers a promising way to improve outcomes. Future progress will rely on personalized, immune-guided therapies that restore antifungal immunity while limiting immunopathology.
Purpose of review Despite recent advances in understanding dengue infection, substantial gaps remain in its epidemiology, pathogenesis, diagnosis, and prevention, including vaccine development and its long-term impact. This review summarizes recent findings and highlights the most pressing research needs to advance the field and reduce individual and public health burden. Recent findings Dengue burden has increased, particularly among children and adolescents, and it has expanded into previously unaffected regions. Still, current data likely underestimates the true burden due to suboptimal surveillance systems. Improving control will require a better understanding of severe dengue pathogenesis, where key gaps remain, alongside reassessment of diagnostic limitations in the context of increasing vaccine availability. Vaccines represent an important complementary tool, with several candidates under study and two currently in use, each with distinct strengths, limitations, and unresolved questions. Summary More extensive research and investment are needed to address the growing burden of dengue, including severe outbreaks and geographic spread. Meanwhile, stronger regulatory engagement in the development and evaluation of innovative therapeutic and preventive measures is essential, particularly in low-income and middle-income regions that bear the highest burden. Clear communication and education on dengue, its impact, and available preventive measures proven to be well tolerated and effective are also critical to strengthen trust, improve uptake, and maximize public health impact.
PURPOSE OF REVIEW:This review examines the gap between evidence-based indications for glove use and current practice, and analyzes sustainability and implementation science strategies to optimize their use. RECENT FINDINGS:A growing body of literature describes the misuse and overuse of nonsterile gloves in healthcare, along with emerging evidence on the causes of inappropriate use. Gloves account for a substantial proportion of personal protective equipment waste, prompting increased attention to their environmental impact. Recent publications have highlighted the scale of inappropriate use and practical tools to promote more rational, risk-based practices. SUMMARY:Glove use is often driven by a mistaken belief in protection, leading to use without clear indications or proven benefits. Rather than enhancing safety, inappropriate use may increase cross-contamination when gloves are worn for prolonged periods or not changed appropriately. Additionally, glove production and disposal contribute to greenhouse gas emissions, resource depletion, and ecosystem damage. Optimizing glove use requires reframing gloves as a targeted intervention indicated only for specific task-related risks, with timely removal and prioritization of hand hygiene. Campaigns focused on reducing glove use have demonstrated decreased environmental impact and costs without compromising patient safety. These improvements can be achieved through targeted education, behavior change, workflow integration, feedback, and audit strategies.
