HIV continues to disproportionately affect Sub-Saharan African (SSA) migrants in Italy, who often experience late diagnosis and complex clinical and social challenges. This multicenter cross-sectional study evaluated determinants of poor immunological and virological outcomes and sex-based differences among 762 SSA migrants living with HIV in the Veneto, Friuli Venezia Giulia and Trentino Alto Adige regions (northeast Italy). Data on demographic, clinical, and social factors were collected from ten Infectious Diseases Centers between January and August 2023. Sex-based differences in clinical and socio-demographic characteristics were assessed using bivariate analyses. Univariate and multivariable logistic regression analyses were performed to evaluate determinants of immunological and virological outcomes, adjusting for relevant covariates. Late HIV diagnosis affected over two-thirds of participants. Despite high antiretroviral therapy coverage, only 38.3% achieved full virological suppression, while 60.6% had HIV-RNA < 200 copies/mL. Temporary residence permits were significantly associated with detectable viremia, underscoring the role of social and structural vulnerability on treatment outcomes. Females, who represented the majority of the cohort, had higher unemployment and longer HIV infection duration but better immunological profiles and fewer coinfections than males. Comorbidities, including psychiatric conditions, were similarly prevalent among both sexes, yet females accessed psychological support more frequently. These findings highlight the need for integrated, gender-sensitive healthcare and social interventions to improve early diagnosis, treatment continuity, and HIV outcomes in SSA migrant populations in Italy.
Clostridioides difficile is a leading cause of healthcare-associated gastrointestinal infection, with outcomes that range widely in severity. The pathogenesis of C. difficile is driven by virulence factors that induce colonic inflammation and epithelial damage. This illness is categorized as an urgent threat, and in recent years, its prevalence has increased, with recurrent episodes occurring in approximately 15-35% of cases. The life cycle of C. difficile infection (CDI) is multifactorial and strongly influenced by antibiotic exposure, host immune responses, the gut microbiota, and microbial metabolites. Disruption of intestinal homeostasis gradually alters the ecological niches of C. difficile and the immunological landscape of the disease. In addition to these risk factors, recurrent C. difficile infection (rCDI) can be exacerbated by certain 'hypervirulent' strains that are more difficult to eradicate. As in many infectious diseases, host immunological responses, particularly in rCDI, appear to play a crucial role in determining recovery versus recurrence. Recent strategies to address this problem include fecal microbiota transplantation (FMT) and novel therapeutic approaches such as polyclonal and monoclonal antibodies. Nevertheless, the immunological mechanisms underlying rCDI remain incompletely understood. A deeper insight into how the immune response develops and functions during rCDI may facilitate the identification of new therapeutic targets. In this review, we summarize current knowledge on C. difficile recurrence and highlight the host immune response in the context of rCDI.
SARS-CoV-2 XFG (nicknamed Stratus), a recombinant lineage arising from LP.8.1.2 and LF.7, is currently the most prevalent circulating lineage. Although most recombinant lineages do not pose a significant public health concern, some have shown the capacity to emerge and spread, highlighting the importance of their investigation. In this context, we performed a genome-based analysis to assess the genetic variability of XFG and to identify its recombination breakpoint. The breakpoint was mapped to approximately position 1507 within the spike (S) gene, in the distal region of the receptor-binding domain. This configuration suggests that LP.8.1.2 contributed the genomic backbone as the acceptor, whereas LF.7 acted as the donor. Phylodynamic survey suggests that XFG originated in early 2024, approximately 10 months before its first genomic detection. Bayesian Skyline Plot revealed a transient expansion phase beginning in August 2024, followed by a plateau, indicating limited and non-sustained growth. The estimated evolutionary rate of XFG (2.90 × 10-4 subs/site/year) was comparable to those of its parental lineages, supporting a relatively low level of genetic variability. Overall, these findings suggest that the widespread prevalence of XFG is more likely driven by lineage turnover rather than increased transmissibility, highlighting the importance of continuous genomic surveillance for monitoring emerging SARS-CoV-2 lineages.
Leptospirosis, a zoonotic disease caused by Leptospira spp. poses significant public health and economic challenges. Its transmission is favored in interface environments where wild and synanthropic rodents acting as maintenance hosts contaminate surroundings with urine. Additionally, water sources can harbor leptospires, serving as an infection risk for humans and animals. This study aimed to investigate the presence of Leptospira spp. in surface and underground water resources, detect leptospiras in wild and synanthropic rodents, and identify/genotype isolation in rural environments from Tandil county, Argentina. Thirty-five water samples and kidney samples from 30 rodents were collected. Leptospira spp. Isolation was attempted via culture in a selective EMJH-STAFF medium with observations made through fluorescence microscopy. Growth of leptospires was observed in one rodent kidney tissue sample. The presence of a pathogenic Leptospira strain was confirmed by 16S rRNA PCR and subsequently genotyped by MLST. Notably, this represents the first isolation of Leptospira interrogans serogroup Canicola allelic profile ST3 from Akodon Azarae in Argentina, making a significant epidemiological finding for the region. While Leptospira spp. was not detected in the analyzed water samples, the isolation of L. interrogans highlights the role of wild rodents as persistent reservoirs in the rural-urban interface. This finding suggests that the transmission dynamics may involve a more complex network of wild reservoirs, highlighting the potential public health risk to local inhabitants and domestic animals.
The persistence of human rabies transmitted by dogs in informal urban settings poses a significant challenge to global health. Although almost always fatal but completely preventable, the disease disproportionately affects marginalized populations. This suggests that the limitations in rabies elimination are not only biological but also reflect spatial, infrastructural, and governance determinants specific to informal settlements. To develop a conceptual framework integrating urban planning, the One Health approach, and rabies epidemiology to understand why existing biomedical strategies are less effective in informal settings and to identify spatial factors useful for more sustainable elimination strategies. An interdisciplinary conceptual research approach was adopted, synthesizing evidence from rabies epidemiology, One Health governance, and urban planning. The analysis focused on how spatial and infrastructural determinants influence the effectiveness of rabies control interventions at the neighborhood level. Rabies is treated as an urban-structural phenomenon, linking urban spatial configurations to dog ecology, human exposure, and access to prevention. The RABIES-SAFE SETTLEMENT framework integrates these dimensions through a micro-territorial One Health perspective, highlighting the role of urban planning as an upstream factor that can influence the performance of established biomedical interventions. Progress toward rabies elimination is influenced not only by the availability of effective biomedical tools, but also by the material and spatial characteristics of urban settlements. Integrating urban planning considerations into One Health approaches can promote more equitable and sustainable reductions in human rabies transmitted by dogs, especially in informal communities.
