Azithromycin has become a cornerstone oral therapy for enteric infections in low- and middle-income countries (LMICs), driven by rising fluoroquinolone resistance, favorable pharmacokinetics, and limited access to diagnostics and parenteral antibiotics. However, escalating resistance among key enteric pathogens including Shigella, typhoidal and non-typhoidal Salmonella, and Campylobacter now threatens its clinical utility. This commentary argues that azithromycin resistance reflects systemic health-system failures rather than isolated microbiological evolution. Prolonged empirical use, driven by diagnostic gaps, over-the-counter availability, and weak stewardship, has intensified selective pressure, compounded by azithromycin’s long half-life, high intestinal exposure, and primarily bacteriostatic activity. Resistance mechanisms and clinical impact vary substantially across pathogens, underscoring the limitations of uniform treatment approaches. We highlight the central role of accessible diagnostics, pathogen-directed stewardship, enteric pathogen surveillance, and vaccination as antimicrobial resistance mitigation strategies. Preserving azithromycin requires integrated, health-system–level interventions that align diagnostics, stewardship, surveillance, and prevention to sustain one of the last effective oral options for severe enteric infections in LMICs.
Introduction Dengue Virus (DENV) is an emerging public health threat in Africa, where its impact is underestimated due to non-specific clinical manifestations and restricted diagnostic capabilities. In Liberia, laboratory-confirmed cases of DENV were initially recorded in an urban febrile surveillance study (2018–2020), yet severe or fatal outcomes had not been previously reported. This paper reports the first laboratory-confirmed fatal dengue case and its implications for national surveillance and policy in Liberia. Case Report On February 2, 2026, a 38-year-old Liberian male arrived at J.J. Dossen Hospital in Maryland County, located in the Southern region of Liberia, who presented with a two-day history of high fever, severe headache, myalgia, weakness, and abdominal discomfort. He had no recent history of travel. The first laboratory investigation using rapid test and microscopy ruled out malaria. Molecular detection performed at the National Public Health Reference Laboratory (NPHRL) was negative for Lassa, Ebola, and Marburg. Despite management with supportive care, his condition deteriorated clinically upon re-admission, and the patient died on February 6, 2026. Serological testing performed at an external laboratory in Ghana detected DENV IgG antibodies and a positive NS1 antigen result, prompting further investigations. Consequently, blood sample was referred to the Institut Pasteur de Dakar, Senegal, where confirmatory testing was conducted to include differential RT-PCR for a diverse array of arboviruses and viral hemorrhagic fevers and differential viral-specific IgM ELISA. The sample tested positive for DENV RNA by RT-PCR, negative for other viruses and negative for Dengue-specific IgM. The absence of detectable IgM may reflect specimen collection during an early stage of infection before seroconversion. However, IgM negativity alone cannot distinguish between primary and secondary infection. Conclusion This is the first molecular confirmation of fatal dengue in Liberia. It highlights the potential for severe outcomes and indicates local transmission in a rural, cross-bordered region of the country. There is critical need for swift implementation of integrated arboviral surveillance in both urban and rural settings, better diagnostic capabilities, and possibly a nationwide sero-epidemiological study to estimate the actual burden of dengue in the country.
Background Leptospirosis is endemic in Colombia and mainly affects vulnerable populations with poor access to health services. However, underreporting and confusion with other acute febrile diseases make it difficult to estimate the true public health impact. Methods This retrospective descriptive study analyzed leptospirosis mortality trends in Colombia between 1997 and 2022. Mortality data were obtained from the Colombian Statistics Department (DANE). Temporal trends were examined using the Joinpoint program to estimate the annual percentage change (APC) and the average annual percentage change (AAPC). Spatial autocorrelation was assessed using Moran’s I index. Results A total of 1.364 deaths were recorded; 72.6% were men, with a mean mortality rate of 0.12 per 100.000 inhabitants, which was higher in men (0.18) than in women (0.07). Atlántico, Valle del Cauca, Bolívar, and Antioquia accounted for 75.2% of deaths. Mortality has shown a significant downward trend since 2000, with an APC of -3.1% per annum. However, some departments exhibited fluctuations, suggesting sporadic outbreaks. Conclusions The mean mortality rate was 0.12/100.000 inhabitants, with four departments accounting for the majority of deaths. Half of the mortality burden was concentrated in the seven Caribbean departments, mainly Bolívar (18.91%) and Atlántico (21.55%). Moran’s I index (0.237681; p=0.008015) indicated significant spatial clustering, confirming that departments with high mortality rates are geographically close, possibly due to shared risk factors such as climatic conditions, predominant economic activities, poor sanitation, and limited access to health services. These findings highlight the structural inequalities that sustain leptospirosis in the most affected regions and inform the need for targeted public health interventions.
Objectives To estimate the six-month proportion of antibiotic self-medication among adults with recent antibiotic use in Narayanganj Sadar, Bangladesh, and examine associated characteristics. Methods This community-based cross-sectional study enrolled 400 adults from 50 clusters across four sampling strata between January and April 2026. The most recent antibiotic course within the preceding six months was the index course. Self-medication was defined by absence of prescribing involvement from a Bangladesh Medical and Dental Council-registered physician. Design-aware modified Poisson regression estimated adjusted prevalence ratios, accounting for clustering and stratification. Self-medicated antibiotics were classified using WHO AWaRe. Results Self-medication occurred in 244/400 participants (61.0%; 95% CI 55.6–66.4%). Higher prevalence was associated with pharmacy access (aPR 1.50, 95% CI 1.29–1.74), poor antibiotic knowledge (1.46, 1.24–1.73), lower educational attainment (1.30, 1.09–1.55), and lack of antimicrobial-resistance awareness (1.22, 1.06–1.41). Watch or Reserve agents accounted for 145/201 classifiable episodes (72.1%) and 117/152 objectively verified episodes (77.0%). Conclusions Antibiotic self-medication was common among recent antibiotic users. Pharmacy access and limited antimicrobial literacy were associated characteristics rather than demonstrated causal determinants. Higher-priority AWaRe exposure remained substantial.
Objectives : Staphylococcus aureus is one of the leading causes of infectious diseases in humans. This study aimed to analyze the recent epidemiological trend of clones and genetic features of methicillin-resistant and susceptible S. aureus (MRSA/MSSA) isolates from children in Myanmar. Methods : S. aureus isolated from various specimens of pediatric patients were classified by genotyping schemes of MLST, coa, agr, spa, and SCCmec. Antimicrobial resistance genes were detected by uniplex/multiplex PCR, along with antimicrobial susceptibility testing by broth microdilution method. Results : A total of 175 S. aureus isolates (30 MRSA and 145 MSSA) and one S. argenteus were obtained during a 19 month-period (Sep. 2023 to Mar. 2025), with an MRSA rate of 17%. Panton-Valentine leukocidin (PVL) genes were detected at higher rate in MSSA (69%) than MRSA (43%). Among MRSA, CC1 (dominant types; ST772 and ST2885) was the major clonal group accounting for 47%, while other common clones were ST121 (CC121) and ST6 (CC5). The most dominant MSSA clone was ST121 (48%), including 86% of PVL-positive isolates, followed by ST88 (14%), and ST2990 (CC1) (9%). An S. argenteus was methicillin-susceptible and assigned as ST2250. In the present study, previously most common ST239 (CC8)-MRSA-III in 2017-2019 was not detected, whereas a growing prevalence was noted for CC1 and ST121 MRSA. Conclusions : The present study revealed the clonal structure of recent MRSA/MSSA isolates from pediatric patients and their potential changing trend in Myanmar.
