This systematic review aims to evaluate the incidence, key risk factors, and the effectiveness of antiviral prophylactic strategies for hepatitis B virus (HBV) reactivation in patients with hematologic malignancies undergoing novel targeted and immunotherapeutic treatments, specifically anti-CD20 monoclonal antibodies, Bruton tyrosine kinase (BTK) inhibitors, and chimeric antigen receptor T-cell (CAR-T) therapies. Analysis of 29 studies involving 5,559 patients revealed that HBV reactivation rates varied from 0
Necrotizing soft tissue infections (NSTIs), chronic osteomyelitis, and invasive fungal infections remain challenging conditions associated with substantial morbidity and mortality despite advances in antimicrobial therapy and surgical management. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment; however, its clinical effectiveness remains uncertain. This systematic review aimed to evaluate the available evidence regarding the impact of HBOT when added to standard care in patients with NSTIs, osteomyelitis, and invasive fungal infections. The available literature consists predominantly of observational studies and case series investigating NSTIs, chronic osteomyelitis, and, to a lesser extent, invasive fungal infections. Across these conditions, HBOT was frequently associated with improved clinical outcomes, including infection control, wound healing, limb preservation, and reduced mortality. However, the certainty of evidence was generally low to very low according to GRADE assessments, reflecting methodological limitations, risk of bias, and substantial heterogeneity among studies and treatment protocols. Current evidence suggests that HBOT may provide clinical benefit as an adjunct to standard treatment in selected patients with NSTIs, chronic osteomyelitis, and invasive fungal infections. Nevertheless, the available evidence is derived mainly from observational studies and should be interpreted with caution. Further high-quality prospective studies are required to clarify the magnitude of benefit, identify the patient populations most likely to benefit, and support the development of standardized treatment protocols.
Scrub typhus infection is a re-emerging, vector-borne zoonotic infection. For symptomatic scrub typhus, a well-defined diagnostic, therapeutic, and prognostic framework is available. In contrast, the evidence base for asymptomatic infection is limited and primarily indirect, derived from serosurveys. This lack of information further constrains and limits the epidemiological model and complicates public health surveillance and intervention strategies that primarily focus on symptomatic cases. Community-based seroprevalence scrub typhus studies indicate that approximately 1 in 4 individuals is seropositive without clinical symptoms, with one study reporting an 8.9
This review provides a comprehensive, critically appraised summary of recent research on the prevention and management of ventriculitis, with contextualization within the broader pre-2020 evidence base. Beyond confirming established risk factors such as duration of central nervous system (CNS) devices and cerebrospinal fluid (CSF) leaks, recent studies have refined risk stratification by identifying procedural and patient-level contributors. Advanced diagnostics — notably multiplex polymerase chain reaction (PCR) panels and metagenomic next-generation sequencing (mNGS) — have accelerated and broadened pathogen identification, revealing polymicrobial and fungal contributions previously under-appreciated. Novel CSF biomarkers (presepsin, HMGB-1, cell index, and cytokine profiles including the IL-17/IL-23 axis) offer incremental diagnostic and prognostic value. Management of multidrug-resistant (MDR) organisms increasingly relies on intraventricular antibiotic protocols, pharmacokinetically informed systemic dosing, and neuroendoscopic interventions. Evidence-based care bundles have continued to demonstrate sustained reductions in infection rates in long-term, multi-centre cohorts. Current literature offers more granular risk stratification, improved etiological characterization via molecular diagnostics, emerging biomarkers, refined treatment strategies for complex infections, and robust real-world evidence for prevention bundles. However, methodological heterogeneity — inconsistent definitions, predominance of single-centre observational designs, and limited evidence-quality appraisal — continues to limit the generalisability of findings.
There is ongoing interest in shortening durations of antibiotic treatment for bacteremia in solid organ transplant (SOT) patients. The majority of literature excludes SOT recipients or only includes a limited number of “immunocompromised” individuals, of which the immunosuppression is usually not well defined. The data for shorter durations of treatment is growing within the general population, but data related to transplant recipients remains limited. This review evaluates the literature on bacteremia treatment duration for solid organ transplant patients, with a focus on type of organism (gram positive or gram negative), source of infection, and the role of the Infectious Disease clinician.
Cisgender women experience unique risks of human immunodeficiency virus (HIV) acquisition due to biological, social, and cultural factors. This narrative review provides an overview of ongoing clinical trials focused on emerging biomedical advances and behavioral interventions for pre-exposure prophylaxis (PrEP) among women. The ClinicalTrials.gov database was queried for ongoing trials, and as of March 21, 2025, 6 eligible biomedical intervention and 22 behavioral intervention trials related to HIV PrEP among cisgender women. The sample size of the trials included ranged from 30 to 9,000 participants. The biomedical intervention trials enrolling women spanned diverse geographies and evaluated oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), long- acting cabotegravir, and lenacapavir/tenofovir alafenamide (TAF) regimens for PrEP. Long-acting agents examined in the trials offer innovative options for women to enhance treatment experience and overcome challenges associated with daily oral regimens. Behavioral interventions commonly involved mobile applications, social media, and counseling, with adherence and uptake as the most frequent outcomes assessed. Equity was a major focus in both biomedical and behavioral intervention trials, and trial populations included adolescent girls and young women from underserved communities around the world. Together, these findings underscore the progress in both biomedical and behavioral PrEP research for women. Future trials should continue to prioritize adolescents, young women, and participants from developing countries. Additionally, beyond long-acting formulations, other durable options need to be researched for cisgender women at risk of HIV.
Chlorhexidine gluconate (CHG) bathing is widely used as an infection prevention and control (IPC) strategy to reduce healthcare-associated infections (HAIs) and multidrug-resistant organism (MDRO) transmission, particularly in intensive care unit (ICU) settings. This review provides a contemporary synthesis of the clinical effectiveness, implementation considerations, and emerging applications of CHG bathing across healthcare environments. Recent evidence suggests that CHG bathing is associated with reductions in selected infection-related outcomes, including device-associated infections and microbial colonization. However, these benefits do not consistently translate into improvements in broader patient-centered outcomes such as mortality, clinical severity, or length of stay. Large randomized trials and updated meta-analyses have demonstrated substantial heterogeneity in effectiveness depending on the clinical endpoint, bathing protocol, and accompanying co-interventions. Emerging literature further highlights the importance of implementation-related factors, including protocol adherence, staff training, and integration into clinical workflows. Expanding use in non-ICU, outpatient, and long-term care settings has also introduced additional challenges related to feasibility, adherence, and contextual variability. CHG bathing should be considered a targeted IPC strategy whose effectiveness varies according to clinical setting, implementation quality, and outcome selection. Although CHG bathing may contribute to reductions in MDRO burden and selected infection-related outcomes, current evidence does not consistently support improvements in broader clinical outcomes across all patient populations. Future research should prioritize standardized protocols, implementation-focused designs, and patient-centered outcomes to better define the optimal role of CHG bathing across diverse healthcare settings.
Understanding the timeline of infections after solid organ transplantation is essential for prevention, diagnosis, and appropriate empiric therapy. Preventive strategies have substantially reduced some infections, while the increasing prevalence of multidrug-resistant organisms challenges traditional empiric approaches. Contemporary epidemiology demonstrates a shift in post-transplant infections. Opportunistic infections have become uncommon, while bacterial infections now predominate, particularly those caused by Enterobacterales, non-fermenting gram-negative bacilli, and gram-positive pathogens. The success in the control of opportunistic infections is increasingly challenged by the rise of multidrug-resistant organisms. Strengthened strategies to prevent bacterial infections, especially those due to multidrug-resistant pathogens, are needed in solid organ transplant recipients.
The aim of this review is to provide a comprehensive update on the management, screening, prevention and treatment of Chagas disease in solid organ transplantation. Global migration has extended the relevance of Trypanosoma cruzi infection beyond endemic regions, making systematic risk assessment essential in transplant programs. An increasing body of evidence supports the safety and feasibility of transplanting kidneys and livers from T. cruzi–infected donors into seronegative recipients, (thereby expanding the donor pool) provided that structured post-transplant surveillance is implemented. Likewise, all types of solid organ transplantation can be performed in T. cruzi–infected recipients, although immunosuppression increases the risk of reactivation. For optimal outcomes, standardized qPCR-based surveillance provides the strongest evidence for early detection and management of donor-derived transmission or reactivation, enabling patient and graft survival rates comparable to those of non-Chagas recipients. However, validated parasitic load thresholds predicting progression to symptomatic disease are lacking, and most monitoring strategies are consensus-based rather than supported by prospective trials. When transmission or reactivation occurs, trypanocidal treatment with benznidazole or nifurtimox is generally well tolerated and highly effective. Unmet needs persist, particularly the development of validated biomarkers to assess treatment response and test-of-cure. Solid organ transplantation in patients at risk for Chagas disease can be performed safely with appropriate screening, structured monitoring, and timely treatment. Further prospective studies are needed to strengthen the evidence base guiding transplant-specific management strategies.
The use of mobile application in antimicrobial prescribing has gained attention for enhancing the stewardship practices. However, evidence on its effectiveness and implementation remains inconclusive and limited. This review aimed to assess the effectiveness of mobile applications on the antimicrobial prescribing with contextual and implementation considerations. An integrative review was conducted in accordance with the approach outlined by Whittemore Knafl. PubMed, Embase, Scopus, and Web of Science were searched from inception to June 2025. Studies that assess the impact of mobile application in various aspects (process, clinical, knowledge, economic outcomes and implementation) of antimicrobial prescribing and stewardship were considered. A total of 15 out of 1,267 records that considered diverse clinical domains were included. Mobile app was focused on improving guideline adherence and practice implementation (n = 8;53.3
The COVID-19 pandemic had a profound global impact with extensive implications for solid organ transplantation. This review summarizes key lessons learned by the transplant community and highlights their relevance for preparedness in future outbreaks. Studies examining the impact of COVID-19 and solid organ transplantation have centered on clinical epidemiology, outcomes in solid organ transplant recipients, the role of vaccines in prevention, peri-transplant management, and application for future outbreaks. The pandemic caused high mortality and reduced transplant volume but also yielded important lessons. Transplant recipients experienced higher rates of hospitalization, mortality, and ICU admissions, with only modest benefit from antivirals. Reduced vaccine efficacy underscored the need for improved preventive strategies. Observational data guided use of SARS-CoV-2–positive donors and recipients peri-transplant. These experiences highlight the importance of robust international networks for research and knowledge sharing to strengthen transplant care and preparedness for future outbreaks.
This comprehensive narrative review aims to provide an in-depth analysis of Human herpesvirus-8/Kaposi Sarcoma-associated herpesvirus (HHV-8/KSHV) and Kaposi sarcoma herpesvirus-associated diseases (KADs), with a special focus on malignancies in the setting of transplantation, by addressing the major issues related to clinical presentations, epidemiology, pathological features, diagnosis, treatment, and outcome. HHV-8/KSHV is an oncogenic virus belonging to the family of the γ-herpesvirus responsible for a wide range of KADs such as Kaposi’s Sarcoma (KS), multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), diffuse large B cell lymphoma not otherwise specified (DLBCL-NOS), and KSHV inflammatory cytokine syndrome (KICS). In solid organ transplant (SOT) recipients, the incidence of HHV-8/KSHV-related malignancies are becoming more frequent because of prolonged life expectancy, and related aging and immunosenescence. HHV-8/KSHV infection in SOT is a rare but serious complication associated with significant morbidity and mortality. Enhanced clinical awareness of the diverse manifestations of KADs is critical for early diagnosis and improved outcomes. Multidisciplinary management is essential, given the complexity of these cases. Future research should focus on establishing standardized protocols for screening, diagnosis, and treatment to improve clinical outcomes. Targeted donors and recipients serological screening strategies, combined with vigilant post-transplant monitoring have the potential to enhance patient care.
Lyme disease (LD) is a tick-borne spirochetal infection that can follow a temporal evolution affecting multiple systems over a period of weeks to months. Lyme arthritis (LA) is a late complication and can have a remitting and relapsing course. Early antimicrobial therapy can reduce LD sequalae and effectively treat LA. Despite a lack of evidence of microbial persistence in the treated host, significant controversy exists from misplaced associations of post- treatment syndromes with persistent LD/LA. Following appropriate treatment of LA, exaggerated host immunological responses can cause persistent symptoms in absence of the Borrelia Burgdorferi spirochete which are either self-limiting or respond to anti-inflammatory therapies. Long-term nonspecific constitutional symptoms (“post-treatment Lyme disease”) have no pathophysiologic basis and do not warrant antibiotics. Infectious disease specialists have an important role to play in provider and patient education regarding the pathogenesis of LD, correct interpretation of diagnostic tests and avoidance of prolonged antibiotics in late LD.
The goal of this review is to synthesize recent evidence on solid organ transplantation (SOT) in people with HIV (PWH), highlight remaining clinical uncertainties, and outline policy and practice implications. Advances in HIV, hepatitis C, and transplant immunosuppression have improved SOT outcomes in PWH. Risk of rejection, though substantially reduced, may remain higher than that of recipients without HIV. Access to transplant has improved with the new practice of transplantation from donors with HIV to recipients with HIV (HIV D+/R+), with noninferior outcomes for HIV D+/R+ kidney transplantation, promising outcomes for HIV D+/R+ liver, and first transplants reported in HIV D+/R+ heart transplantation. Modern data support SOT for PWH as safe and effective. Future priorities include defining mechanisms of rejection, better characterizing risks and long-term outcomes of HIV D+/R+ transplantation, with the potential role of transplantation from donors with HIV to recipients without HIV on the horizon.
This narrative review aims to synthesize the epidemiological trends, cutaneous manifestations, and global prevention strategies of Chikungunya fever (CHIKF), with a particular focus on the underrecognized role of dermatologists in disease control and prevention. Although the cutaneous manifestations of CHIKF serve as crucial diagnostic clues, they are often overlooked. Early recognition of the "fever-arthralgia-rash" triad by dermatologists can reduce misdiagnosis rates by 30
Gram-negative antimicrobial resistance continues to pose a growing threat, particularly among high-priority pathogens such as difficult-to-treatPseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Enterobacterales (CRE). The rise in resistance has spurred the development of novel beta-lactam/beta-lactamase inhibitor (BL/BLI) combinations. However, the pace of innovation has lagged behind the rapid emergence of resistance, especially for CRAB and metallo-beta-lactamase (MBL)-producing Enterobacterales, organisms for which effective treatment options have been historically limited. This review outlines the pharmacologic characteristics, activity, and clinical efficacy data for newly approved BL/BLIs The FDA has recently approved Xacduro (sulbactam/durlobactam), Exblifep (cefepime/enmetazobactam), and Emblaveo (aztreonam/avibactam). Additionally, promising pipeline agents such as cefepime/taniborbactam, cefepime/zidebactam, and imipenem/cilastatin/funobactam warrant discussion. These agents offer significant potential to fill longstanding therapeutic gaps. As resistance mechanisms evolve and therapeutic challenges persist, development of novel BL/BLIs will play an increasingly critical role in the management of multidrug-resistant gram-negative infections.
This review examines the transformative impact of artificial intelligence (AI) on managing bone, joint, skin, and soft tissue infections, focusing on recent advancements and barriers to clinical integration across healthcare systems worldwide. Artificial intelligence applications demonstrate superior diagnostic accuracy in detecting subtle infection patterns, including early osteomyelitis and complex soft-tissue infections. Machine learning models predict antibiotic resistance patterns with increasing precision, supporting more targeted antimicrobial therapy. Advanced imaging analysis using deep learning enhances the detection of early-stage infections in magnetic resonance imaging, computed tomography, and ultrasound studies. Implementation challenges include concerns about patient data privacy during model development, algorithmic bias arising from limited diversity in training datasets, and insufficient external validation in varied clinical settings. Successful integration also requires alignment with existing clinical workflows, clinician engagement to ensure the interpretability of algorithm outputs, and adherence to regulatory and ethical standards. Artificial intelligence offers transformative potential for infection management, but realizing these benefits depends on pairing technological innovation with robust ethical safeguards, interdisciplinary collaboration, and supportive policy frameworks. Establishing governance structures for secure data sharing, bias monitoring, and transparent decision-making is essential. Collaboration among clinicians, data scientists, ethicists, and policymakers will foster trustworthy and equitable deployment. Artificial intelligence is already influencing infection management, and future progress hinges on integrated strategies that ensure safe, effective, and accessible care.
The purpose of this review is to provide a comprehensive overview of Chagas disease as an opportunistic infection in AIDS, elucidate critical gaps in the literature, and outline priorities for future clinical research. New promising tools for diagnosis include T. cruzi loop-mediated isothermal amplification, a non-invasive Chunap urine antigen test, and rRNA sequencing. People living with AIDS may benefit from sequential quantitative PCR testing for early detection of reactivation. This method is also a promising tool for treatment response monitoring. Prompt antitrypanosomal treatment and antiretrovirals are crucial for reducing morbidity and mortality. Several novel compounds and repurposed agents have shown preliminary activity against T. cruzi. Secondary prophylaxis may not be necessary, as relapse rarely occurs in patients on antiretrovirals. Although primarily endemic to South America, increasing global migration has increased the prevalence of HIV/T. cruzi coinfection in non-endemic regions. Early recognition, timely treatment, and prevention strategies are crucial to reducing associated morbidity and mortality.
Sexually transmitted infections (STIs) commonly present with cutaneous findings that can serve as important diagnostic clues. This review summarizes the dermatologic manifestations associated with a range of STIs, including bacterial, viral, fungal, and parasitic etiologies. Classic presentations such as syphilitic chancres, herpes simplex ulcers, and condyloma acuminata are discussed alongside emerging infections like Trichophyton mentagrophytes genotype VII and mpox. Recognition of these findings is essential, as skin manifestations may be the first indication of infection. Timely identification and treatment of STI-related skin findings are critical for patient care and for interrupting transmission. As STI epidemiology evolves, clinicians must remain informed about both classic and atypical presentations of sexually transmitted skin disease to ensure accurate diagnosis, appropriate therapy, and effective public health intervention.
