INTRODUCTION:Climate variability and extreme weather events may impact climate-sensitive infectious diseases, one example being leptospirosis. This study provided an updated descriptive and exploratory analysis of leptospirosis in Brazil, focusing not only on temporal and regional patterns, but also on the 2024 floods in Rio Grande do Sul, which lent themselves to interpretation of climate-related health effects. METHODS:Nationwide surveillance data on reported leptospirosis cases, deaths, and case-fatality rates were analyzed across Brazil's five geographic regions from 2014 to 2025, together with mean annual regional precipitation data. Exploratory correlation analyses were conducted using data from 2014 to 2024. While data from 2025 were included descriptively, the epidemiological dataset was incomplete, rendering corresponding precipitation data unavailable, and these data were excluded from correlation analyses. Additional analyses dealt with the epidemiological situation during the 2024 floods in Rio Grande do Sul. RESULTS:Between 2014 and 2024, Brazil reported 36,261 leptospirosis cases and 3170 deaths. Nationwide, cases increased from 3428 in 2023 to 4142 in 2024, and deaths from 290 to 362. The southern region showed the largest increase, from 1238 to 1988. During the 2024 floods in Rio Grande do Sul, 242 confirmed cases, 17 deaths, and 3270 suspected cases were reported. Even though exploratory analyses identified positive correlations between annual precipitation and leptospirosis cases and deaths in the South and nationwide, their associations were heterogeneous. CONCLUSIONS:As they illustrate the complexity of assessing climate-related health effects in cases of leptospirosis, these findings should not be interpreted as evidence of causality. Integrated epidemiological, climatic, environmental, and socioeconomic surveillance is essential to the development of climate-informed preparedness and of timely responses to climate-sensitive infectious diseases.
INTRODUCTION:Caused by pneumocystis jirovecii, pneumocystosis is a severe opportunistic infection primarily affecting immunocompromised patients who are not infected with HIV. Mortality in this heterogeneous population is high, with estimates ranging from 25% to 50%. While the benefits of corticosteroids for HIV-infected patients are well-established, in other immunosuppression contexts their role remains uncertain, with contradictory results reported in the literature. PATIENTS AND METHODS:This single-center retrospective study included 101 non-HIV immunocompromised patients hospitalized at Caen University Hospital between 2013 and 2024 for proven or probable pneumocystosis. RESULTS:Thirty-nine patients received adjunctive corticosteroid therapy. Thirty-day mortality was 26% in the corticosteroid group versus 18% in the non-corticosteroid group, with no significant difference after adjustment. Similarly, no benefit was observed at 90 days or at one year. Nor did corticosteroid therapy reduce the duration of oxygen therapy, affect the incidence of secondary infections or, more generally, emerge as protective. Conversely, the factors associated with higher survival rates were admission to conventional care units and younger age. CONCLUSION:In contrast with HIV settings, this study does not show corticosteroid therapy to be beneficial for non-HIV patients with pneumocystosis,. However, recent data from the PIC trial suggest potentially improved benefit 90-day survival in the most severe forms; further targeted studies consequently appear justified, particularly with regard to immunodeficiency subtypes.
BACKGROUND:Hepatitis E virus (HEV) infection in late pregnancy is associated with adverse maternal and pregnancy outcomes. We evaluated HEV infection at delivery among South African women with and without human immunodeficiency virus (HIV) infection. METHODS:Archived maternal serum samples collected at delivery from 333 South African women with and without HIV (147 term births, 130 preterm births, and 56 stillbirths) were tested for HEV-specific immunoglobulin M (IgM) and immunoglobulin G (IgG). RESULTS:Acute HEV infection (IgM-positive) was detected in two women [0.6% (95% CI: 0.15%-2.38%; 2/333)], both of whom were living with HIV. HEV IgG seropositivity was found in 2.4% (95% CI: 1.20%-4.74%; 8/333), including 3.55% (95% CI: 1.48%-8.26%; 5/141) of women with HIV and 1.57% (95% CI: 0.50%-4.77%; 3/191) without HIV infection. HEV sero-positivity did not differ with regard to pregnancy outcomes. CONCLUSION:Among South African women, prevalence at delivery of acute or past HEV infection was low.
PURPOSE:Early tuberculosis (TB) diagnosis is critical for overall health, enabling prompt treatment initiation and decreased mortality. This study is aimed at evaluating the respective performances of Xpert MTB/RIF Ultra, BD MAX MDR-TB and Anyplex MTB/NTM compared to microbiological methods of diagnosing mycobacteria. METHODS:Respiratory specimens taken from a third-level hospital in Monterrey, Mexico between January 2025 and January 2026 were included. Samples were processed for mycobacteria identification by microbiological (Lowenstein-Jensen, MGIT culture, and MALDI-TOF mass spectrometry) and molecular methods (Xpert MTB/RIF Ultra, BD MAX MDR-TB, and Anyplex MTB/NTM). The diagnostic performance of each methodology was evaluated in terms of sensitivity and specificity, as well as degree of agreement between results. RESULTS:During the study period, 131 samples were tested for microbiological culture and concomitantly processed by Anyplex (n = 121, 92.4%), BD Max (n = 82, 62.6%), and Xpert (n = 41, 31.3%). The sensitivity, specificity, and concordance of each molecular method with regard to microbiological culture was 100%, 70.4%, and κ = 0.619 for Xpert; 97.1%, 83.7%, and κ =0.728 for Anyplex; and 88.9%, 85.0% and κ =0.730 for BD MAX. Comparison of Xpert, Anyplex, and BD MAX, including paired samples (n = 41), showed high sensitivity (100%, 100%, and 92.9%), moderate specificity (70.4%, 81.5%, and 77.5%), and good concordance (κ =0.619, 0.750, and 0.650) with microbiological culture. CONCLUSION:All three molecular methods showed good concordance with the reference method for MTC detection. While Xpert had lower specificity than Anyplex and BD MAX, the three methodologies all showed good concordance with microbiological culture.
INTRODUCTION:Hepatitis D virus (HDV) is a defective RNA virus that requires hepatitis B virus (HBV) for replication and is associated with severe liver disease. This study aimed to determine the serological and molecular prevalence of HDV infection and to characterize HDV genotypes among HBsAg-positive individuals in Antananarivo, Madagascar. METHODS:A prospective descriptive study was conducted from May to October 2024 at the Immunology Laboratory of JRA UHC. HBsAg-positive patients attending Clinical Department of JRA and JRB UHC who provided informed consent were included. RESULTS:Among 146 participants (mean age: 32.98 ± 9.53 years; sex ratio: 6.7), anti-HDV antibodies were detected in four patients (2.73%). HDV RNA was identified in three cases (2.05%), all with genotype 1. A male predominance and one case of HDV-HIV co-infection were observed. CONCLUSION:This first report of HBV-HDV co-infection in Antananarivo highlights the need for systematic HDV screening in all HBsAg-positive patients.
Cryptococcus neoformans is a yeast-like fungus found in soil contaminated with avian droppings. It most often produces disseminated disease in immunocompromised hosts, particularly individuals with impaired T-cell mediated immunity such as those with HIV infection, patients receiving corticosteroids or other immunosuppressive therapy, and solid organ transplant recipients. The usual clinical manifestations are meningoencephalitis and pulmonary involvement, and it remains the most common systemic mycosis in patients with acquired immunodeficiency syndrome. Although the organism can involve nearly any organ, gastrointestinal cryptococcosis is exceedingly rare and has been described only in isolated case reports. Gastric and intestinal disease may present with acute abdominal symptoms or with more indolent features such as dyspepsia, nausea, vomiting, diarrhea, or melena. Diagnosis depends on endoscopic evaluation with histopathological confirmation, yet the condition is frequently unrecognized during life and is often identified primarily at postmortem examination. Reported endoscopic findings include ulcers, nodular lesions, and whitish petechiae. Prognosis is often poor, which highlights the need for early consideration of this entity in immunocompromised patients and prompt diagnostic evaluation given the absence of specific presenting features. This review summarizes susceptible host categories, the clinical spectrum of gastrointestinal cryptococcosis, diagnostic approaches, treatment considerations, and reported outcomes.
The diagnosis of acute community-acquired bacterial urinary tract infections (UTIs) in adult men presently recognizes four key clinical entities: cystitis, prostatitis, pyelonephritis, and epididymo-orchitis, each with distinct diagnostic criteria. Bacteriuria of clinically undetermined significance, defined as documented bacteriuria with non-specific systemic symptoms (e.g., confusion, functional decline, or isolated fever) but no localized UTI signs, is common in elderly patients and requires evaluation with sepsis risk scores so as to avoid unnecessary antibiotics. Urinary colonization, frequent in older men, does not warrant treatment unless prior to urological procedures. Cystitis is diagnosed by local symptoms (dysuria, urgency, suprapubic pain), absence of fever, and positive urine culture, ruling out prostatitis or pyelonephritis. Acute prostatitis is identified by cystitis symptoms plus fever or sepsis, with imaging reserved for complications. Acute pyelonephritis is diagnosed by fever or sepsis, flank pain (spontaneous or on percussion), and positive urine culture; cystitis symptoms may be absent. Urine culture (thresholds: ≥103 CFU/mL for bacteriuria, leukocyturia >30 × 103/mL) remains the gold standard, while urine dipstick testing is not recommended due to low predictive value. Routine blood tests (inflammatory markers, PSA, or blood cultures) are unnecessary in outpatient management, even for febrile UTIs, unless acute kidney injury or complications are suspected. Pyelonephritis requires imaging (urgent in cases of sepsis or obstruction) to assess for uropathy, and epididymo-orchitis mandates STI screening.
The management of male urinary tract infections (UTIs) has historically been based on a monolithic approach, under which every episode was treated as acute prostatitis, leading to prolonged antibiotic courses. To address rising bacterial resistance and promote antimicrobial stewardship, the French Infectious Diseases Society (SPILF) updated its guidelines in 2026, introducing a stratified management framework. This review outlines the scientific evidence underlying these updated recommendations. A comprehensive review of recent literature, including randomized controlled trials and large-scale retrospective cohorts, was conducted so as to evaluate antibiotic efficacy, resistance patterns, and optimal treatment durations for male cystitis, febrile UTIs (prostatitis/pyelonephritis), and acute epididymo-orchitis. Evidence validates distinguishing male cystitis from febrile UTI. For male cystitis, 7-day regimens using narrow-spectrum oral agents-such as fosfomycin trometamol, nitrofurantoin, or pivmecillinam-achieve satisfactory clinical success with minimal risk of complications. Conversely, febrile UTIs require initial parenteral third-generation cephalosporins or oral fluoroquinolones. For targeted oral step-down therapy in prostatitis, cotrimoxazole is preferred over fluoroquinolones so as to minimize ecological impact, while amoxicillin remains the drug of choice for enterococcal coverage. Although recent data show that seven days can be sufficient for selected bacteremic presentations, to prevent relapses a conventional 14-day duration remains the standard for acute prostatitis. Non-sexually transmitted orchitis and epididymitis require a 10-day course of fluoroquinolones or cotrimoxazole. The 2026 SPILF guidelines represent a paradigm shift toward a tailored, stratified approach.
Urinary tract infections (UTIs) in men, though less frequent than in women, represent a significant clinical challenge due to their increasing incidence with age and distinct microbiological profiles. This expert review analyzed data of urine cultures in men with community-acquired UTIs, collected from emergency departments of 15 french hospitals, from the private laboratory group Atoutbio (21 sites in Meurthe-et-Moselle and the Vosges French departments, alongside primary care records from the AntibioClic tool and the PRIMO database, to characterize the bacterial epidemiology of community-acquired male UTIs in France. Escherichia coli (39-40%) dominated, followed by Enterococcus faecalis (13-15%), Klebsiella pneumoniae (6-8%), and Proteus mirabilis (5-6%). Resistance rates were as follows amoxicillin (47-53.5%), amoxicillin-clavulanate (24-35.7%), trimethoprim-sulfamethoxazole (25.4-31.5%), and fluoroquinolones (16.3-20.2%). Resistance to third-generation cephalosporins (6.6-9.3%) and mecillinam (6.8-8.9%) was lower, while fosfomycin (1.4-1.5%) and nitrofurantoin (0.4-0.7%) retained high susceptibility. Extended-spectrum β-lactamase (ESBL)-producing E. coli ranged from 2 to 8.4%, with carbapenemase producers remaining rare (0.1%). Resistance was higher in men >65 years, particularly in nursing homes, where 3GC resistance reached 15-18%. « Emerging uropathogens » (Aerococcus urinae 1-1.1%, Actinotignum schaalii 0.1-0.4%) were rare. This study highlights the greater microbial diversity in male UTIs compared to women and underscores the need for systematic urine culture, susceptibility testing, and empirical therapy tailored to resistance patterns, age, and risk factors.
Objective To describe the clinical effectiveness and safety of dalbavancin (DAL) for the treatment of Vascular Graft and Endograft Infections (VGEI). Methods A retrospective, single-center observational study was conducted at a tertiary-care university hospital in Rome from January 2020 to December 2024, including all consecutive patients diagnosed with VGEI who received at least one dose of DAL. Cases were identified through the hospital electronic medical record database. VGEIs were diagnosed using MAGIC criteria. Primary outcomes were clinical and radiological response at the end of treatment (EOT) and at six-month follow-up. Results Thirteen patients were included (median age: 76 years; 92% of males; median Charlson Comorbidity Index 5). Aortic vessels were involved in 61.5% of cases, peripheral vessel in 38.5%. Microbiological identification was achieved in 84.6% of cases, with Staphylococcus aureus (MSSA and MRSA) being the most frequent pathogen. Surgical explant was performed in 53.8% of patients, predominantly for peripheral VGEIs. DAL was used to facilitate early discharge (69.2%) or as suppressive antibiotic therapy (30.8%). No adverse events related to DAL were reported. Clinical success was achieved in 84.6% of patients at EOT and maintained in 61.5% at six-month follow-up. Conclusion DAL appears to be an effective and well-tolerated option for the management of VGEI, particularly in frail patients or those not eligible for surgery, both to facilitate early discharge and as long-term suppressive antibiotic therapy (SAT). Further prospective studies are needed to confirm these findings.
Following a first male urinary tract infection (mUTI), systematic investigation for predisposing factors is called for, as mUTIs frequently arise secondarily to anatomical or functional urinary tract abnormalities. Although no international consensus defines a minimal etiological work-up, guidelines from the French (AFU) and European (EAU) Associations of Urology provide a clinical framework. First-line assessment comprises a targeted history (laying emphasis on macroscopic hematuria and lower urinary tract symptoms, LUTS), digital rectal examination (DRE), the International Prostate Symptom Score (IPSS), and urinary tract ultrasonography with post-void residual (PVR) measurement. LUTS, classified as storage (urgency, frequency), voiding (weak stream, straining), or post-micturition (incomplete emptying) may indicate benign prostatic hyperplasia (BPH), the leading aetiology in men over 50. Ultrasound evaluates prostate volume, bladder morphology, and PVR; voiding diaries complement assessment when storage LUTS predominate. Alpha-blockers represent first-line therapy for BPH-related LUTS. Routine PSA testing following mUTI is not recommended, as elevations are non-specific: prostatitis may raise PSA independently of malignancy, and levels can remain elevated up to three months post-infection. No association exists between a first mUTI and prostate cancer, nor between PSA and UTI recurrence. Second-line referral is indicated for pyelonephritis, urinary retention, macroscopic hematuria, IPSS >7, PVR >100 mL, recurrent UTI, age under 40, or imaging abnormalities. Cross-sectional imaging (CT or MRI) is reserved for suspected obstruction, severe presentations, or treatment failure. This stratified approach optimizes cost-effectiveness, ensuring identification of underlying pathology (BPH, urolithiasis, or malignancy) while avoiding unnecessary investigations.
To optimize the management of male urinary tract infections, it is essential to analyze the various pharmacokinetic and pharmacodynamic parameters in the different organs of the male urinary tract. In the literature, the quantity and quality of data vary considerably depending on the class of antibiotics and the methodological approaches used. Beta-lactams achieve effective concentrations in prostate tissue, the testes, and urine, but reach only limited levels in prostatic secretions. Fosfomycin reaches therapeutic concentrations in prostate tissue, prostatic secretions, seminal fluid, bladder tissue, and urine. Trimethoprim-sulfamethoxazole reaches effective concentrations in prostate tissue, the testes, and urine. Only trimethoprim reaches effective concentrations in prostatic secretions and seminal fluid. Fluoroquinolones have the most favorable pharmacokinetic and pharmacodynamic profile and achieve therapeutic concentrations in prostate tissue, prostate secretions, seminal fluid, the testes, bladder tissue, and urine, as well as excellent intracellular diffusion and significant antibiofilm activity. The pharmacokinetics of aminoglycosides in the prostate and testes remain poorly characterized, despite the high concentrations observed in the kidneys and urine. Nitrofurantoin achieves a low plasma concentration, indicating limited tissue distribution. Azithromycin and doxycycline exhibit significant concentrations in prostatic tissue. Further research is needed to enhance understanding of the pharmacokinetics and pharmacodynamics of antibiotics in the male urinary tract, particularly in the context of growing antibiotic resistance.
Dengue-associated spinal cord involvement is an uncommon but clinically important neurological complication of dengue infection. Existing evidence is fragmented and largely limited to isolated case reports, case series, and small observational studies. This systematic review evaluated the clinical spectrum, neuroimaging findings, pathogenesis, treatment approaches, and outcomes of dengue-associated spinal cord involvement. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Google Scholar were searched from inception to the final search date. Case reports, case series, and cohort studies describing spinal cord involvement associated with dengue infection were included. A total of 85 individual cases and 13 cohort studies were analyzed. Acute transverse myelitis (24/85, 28%) and longitudinally extensive transverse myelitis (22/85, 26%) were the most common syndromes, while hemorrhagic or compressive spinal cord syndromes accounted for 18/85 (21%). Neurological manifestations developed during the acute or parainfectious phase in 46/85 (54%) and during the postinfectious phase in 35/85 (41%). Long-segment spinal cord lesions were identified in 34/85 (40%), and hemorrhagic spinal lesions in 21/85 (25%). Brain or cranial nerve involvement accompanied spinal disease in 35/85 (41%). Intravenous corticosteroids were administered in 53/85 (62%) patients. Complete or near-complete neurological recovery occurred in 39/85 (46%), whereas persistent severe disability occurred in 11/85 (13%). Cohort studies confirmed that dengue-associated myelitis is rare but clinically significant. Dengue-associated spinal cord disease represents a heterogeneous neuro-immunological spectrum requiring early recognition and timely management.
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OBJECTIVES:This single-center, observational, retrospective, before-after comparative study conducted in a tertiary care public hospital assessed the impact of discontinuing routine antibiotic susceptibility testing for Enterococcus faecalis in urine cultures on antibiotic prescribing patterns. Secondary objectives were to evaluate prescriber acceptability and the impact of the intervention by patient sex and on targeted antibiotic therapies. PATIENTS AND METHODS:A total of 229 consecutive monomicrobial E. faecalis-positive urine cultures from hospitalized adults were included. Two study periods were compared according to the intervention's implementation. In the pre-intervention period (December 2018-December 2019), antibiotic susceptibility testing was performed and fully reported, while in the post-intervention period (December 2019-December 2020), this was replaced by the following standardized sentence: "Species (usually) sensitive to amoxicillin; selective reporting of antibiotic susceptibility testing may be carried out upon request if there is a contraindication to the use of amoxicillin." RESULTS:Overall, 120 urine cultures were analyzed during the pre-intervention period and 109 during the post-intervention period. Penicillin prescriptions increased in the overall cohort (28/67 vs 36/55; p = 0.011) and among male patients (21/54 vs 24/33; p = 0.004). Non-significant decreases were observed in overall fluoroquinolone use (12/67 vs 3/55; p = 0.051) and targeted antibiotic therapies (9/39 vs 3/43, p = 0.059). Acceptability rate was high (97%). CONCLUSION:Discontinuation of routine antibiotic susceptibility testing reporting for E. faecalis-positive urine cultures was associated with a shift in antibiotic prescribing patterns, with increased penicillin use and a possible reduction in fluoroquinolone prescriptions.
CONTEXT:While health-related carbon emissions are a recognizably increasing concern, the environmental impacts of choosing cefotaxime over ceftriaxone have yet to be assessed on a hospital-wide scale. METHODS:We collected data on antibiotic consumption from 38 university hospitals in 2023. Using the new Carebone® tool, the respective carbon footprints of antibiotics and medical devices were calculated by life cycle assessment. RESULTS:Daily cefotaxime administration (1 g q8h) generates 5.40 kgCO₂eq (±48%), costs €5.5, and produces 274 g of waste, compared with 1.78 kgCO₂eq (±48%), €1.4, and 88 g of waste from ceftriaxone (1 g q24h). Seven hospitals have already implemented policies replacing ceftriaxone with cefotaxime. Similar policies in all 38 hospitals participating in the survey would annually generate 392,543 kgCO₂eq, 20 tons of waste and an additional cost of €440,713. Conversely, replacing cefotaxime with ceftriaxone could save 436,579 kgCO₂e, 22 tons of waste and €490,154 annually. CONCLUSIONS:Policies favoring cefotaxime have environmental and economic costs that should be integrated into antibiotic stewardship recommendations alongside other factors (resistance selection, etc.).
INTRODUCTION:While recent guidelines for treatment of community-acquired pneumonia (CAP) recommend short antibiotic duration, evidence regarding Legionella pneumophila pneumonia remains limited. METHODS:We conducted a narrative review of studies identified via PubMed and Embase, including randomized trials, observational studies and meta-analyses assessing treatment duration and outcomes. RESULTS:No randomized trials specifically address legionellosis. Data from CAP consistently support short courses (≤5-7 days), even for atypical pathogens. Observational studies suggest a clinical course similar to that applied for typical CAP, with rapidly attained stability and short intravenous treatment durations. Meta-analyses show no differences in clinical cure, relapse, or mortality between short and long regimens, with fewer adverse events occurring in shorter courses. CONCLUSION:While short-course therapy appears appropriate for legionellosis (3-5 days for non-severe cases, 10-14 days for severe cases and/or immunocompromised patients), prospective studies remain needed.
