Purpose of review Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of morbidity and mortality in adults, particularly in older adults and those with frailty, immunosuppression, or chronic diseases. This review aims to assess the epidemiology, clinical burden, complications, and long-term outcomes of RSV infection in adults. Recent findings The burden of RSV in adults is underestimated, and age alone does not well identify those at risk of severe disease. Frailty is associated with a more than threefold higher risk of severe disease. Bacterial co-infection has been reported in up to 23% of hospitalized adults undergoing microbiological testing, with Streptococcus pneumoniae and Haemophilus influenzae as the most common pathogens. Acute cardiac events occur in about one in five hospitalized adults. Clinically relevant functional decline was reported in 28% of patients at 6–12 months. Summary RSV causes acute and long-term morbidity in vulnerable adults. Risk assessment should consider frailty, comorbidities, and immune status in addition to age. Better identification of high-risk adults may help guide prevention and clinical management.
Purpose of review The at-risk population for invasive mold infections is expanding with broader immunosuppression; because Aspergillus and Mucorales share clinical/imaging features and Mucorales lacks accessible biomarkers, dual infections are often missed. This review synthesizes current evidence on epidemiology, diagnostics, and therapy and proposes a pragmatic threshold to guide initial treatment while tests are pending. Recent findings Invasive aspergillosis is ~10-fold more common than mucormycosis, yet mucormycosis progresses rapidly and carries high mortality; co-infection further worsens outcomes. When systematic PCR is used, reported possible co-infection rates rise (~7–30%). Biomarkers for differentiation are missing; biopsies are often unsuitable. Mucorales PCR has high specificity; bronchoalveolar lavage fluid is more sensitive than blood. Therapeutically, liposomal amphotericin B and isavuconazole usually cover both; voriconazole lacks Mucorales activity. Early active therapy improves survival; fosmanogepix is promising. Summary Clinicians should estimate Mucorales probability from host factors, prior prophylaxis, imaging, and local epidemiology and deploy PCR early. If the estimated probability is ~10% (consider at 5%), start a Mucorales-active first-line therapy while diagnostics proceed. Decisions must balance toxicity and organ function against the high cost of delay. Research should validate risk models, refine definitions/algorithms, and test new agents up-front.
PURPOSE OF REVIEW Cefiderocol is the first clinically available antibiotic to exploit bacterial iron transport systems to enter gram-negative pathogens. As its availability expands, questions remain regarding: its role relative to other agents for infections caused by NDM-producing Enterobacterales, difficult-to-treat resistant (DTR) Pseudomonas aeruginosa , carbapenem-resistant Acinetobacter baumannii complex (CRAB), Stenotrophomonas maltophilia , and rarer nonfermenters; performance and interpretation of antimicrobial susceptibility testing; dosing in special populations; and emergence of resistance. This review addresses these uncertainties, emphasizing practical guidance for clinicians. RECENT FINDINGS Emerging preclinical and clinical data have better defined cefiderocol's role in antimicrobial resistant (AMR) infections, supporting its preferential use for NDM-producing Enterobacterales and S. maltophilia , while reserving it for DTR P. aeruginosa and CRAB when preferred alternatives are unavailable or unsuitable. Susceptibility testing remains complex: breakpoints differ across standards organizations, broth microdilution requires specialized iron-depleted media, and disk diffusion is practical but may overcall resistance. Cefiderocol resistance is typically driven by a convergence of mechanisms, including impaired siderophore uptake, increased β-lactamase production or modification, reduced permeability, or PBP3 alterations. SUMMARY With its unique structure and broad activity against resistant gram-negative pathogens, cefiderocol represents an important and evolving addition to the AMR therapeutic landscape.
Purpose of review To summarize current understanding of the epidemiology, pathogenesis and management of HIV-Associated Nephropathy (HIVAN) and other forms of Apolipoprotein L1 (APOL1)-mediated chronic kidney disease (CKD) in people of African ancestry with HIV. Recent findings The G1 and G2 variants of the APOL1 gene, which have emerged in trypanosomiasis-endemic areas of Africa, predispose to HIV-associated nephropathy (HIVAN) and other forms of CKD. The risk of APOL1-mediated CKD is attenuated with HIV control and carriage of the p.N264K genetic variant. Several treatments targeting the APOL1 gene and the transmembrane ion channel encoded by the APOL1 gene are being evaluated in clinical trials; early findings indicate they achieve rapid and marked reductions in proteinuria in those with established APOL1-mediated CKD. Summary Genetic variants of APOL1 are causally implicated in HIVAN and other forms of severe CKD in populations of African ancestry with HIV. Genetic, epigenetic and environmental factors influence the risk of developing APOL1-mediated CKD, and emerging APOL1-directed therapies offer the prospect of clinical remission to those with established APOL1-mediated CKD.
