Background:Understanding changes in the severity of respiratory virus infections over time is critical for guiding public health interventions. Few studies have been conducted in middle-income countries (MICs), where healthcare infrastructure, COVID-19 and influenza vaccine coverage, and antiviral availability and use differ from high-income countries. Methods:We compared the odds of severe outcome and death by virus test result among patients ≥18 years old hospitalized with severe acute respiratory infection (SARI) in five MICs and areas (Albania, Georgia, Kyrgyzstan, North Macedonia, and Kosovo). Severe outcome included ICU admission, mechanical ventilation, ECMO, or death during hospitalization. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe outcome and death by respiratory virus PCR test result. Influenza-positive patients were the reference group. We grouped SARS-CoV-2 patients into three periods based on COVID-19 activity and circulating Omicron subvariants [Period 1 (6 December 2021-18 December 2022), Period 2 (19 December 2022-9 July 2023), and Period 3 (10 July 2023-6 August 2024).] We adjusted for age, sex, comorbidities, COVID-19 vaccination status, and country. Findings:Of 7671 patients who met the inclusion criteria, 963 (13%) patients had a severe outcome; 749 (10%) were admitted to ICU, 202 (3%) received mechanical ventilation or ECMO and 285 (4%) died. Compared to influenza patients, SARS-CoV-2-positive patients had a higher odds of severe outcome in Period 1 [ aOR = 1.80 (95% CI 1.23-2.64)], P2 [aOR = 1.94 (95% CI 1.25-3.01)], and Period 3 [aOR = 1.63 (95% CI 1.05-2.54)]. COVID-19 patients in Period 1 (aOR = 2.80; 1.67-4.82) and Period 3 (aOR = 2.25; 95% CI 1.23-4.18) had a higher aOR for death compared to influenza-positive patients; for Period 2 the aOR was 1.04 (95% CI 0.48-2.15). Interpretation:The odds of severe outcome were higher for SARS-CoV-2 patients compared to influenza-positive patients for all periods, while the odds of death were higher during Period 1 and Period 3. These results underscore the continued severity of COVID-19, and need for COVID-19-related health interventions, including COVID-19 vaccination and in-hospital patient management. Funding:This study was funded by the World Health Organization/Regional Office for Europe, in part through a cooperative agreement with the U.S. Centers for Disease Control and Prevention.

This viewpoint highlights the evolving threat of microbial pathogens in the post-pandemic era, where beyond COVID-19, a parallel and less visible shift is occurring across healthcare and environmental settings, driven by antimicrobial misuse, globalization, climate change, and increased human–animal interactions. Emerging pathogens such as Candida auris, Elizabethkingia anophelis, Mycobacterium chimaera, and the resurgence of mpox illustrate the growing complexity of infectious diseases. On the other hands, antimicrobial resistance remains the main driver, limiting therapeutic options and necessitating innovative approaches, including combination therapies, novel antifungals, and drug repurposing. Seen from this point of view, adopting a One Health framework is essential to address interconnected human, animal, and environmental determinants. Strengthened surveillance, antimicrobial innovation, equitable access, and international collaboration are critical to confronting this ongoing microbial evolution and mitigating future infectious threats. The article discusses key drivers of this phenomenon, such as antimicrobial resistance, climate change, globalization, healthcare-associated factors, and zoonotic spillover. It also outlines current therapeutic and diagnostic challenges, emphasizing the need for antimicrobial innovation, rapid detection tools, One Health strategies, and equitable global access to effective interventions.

The COVID-19 pandemic has significantly affected Albania, with over 319959 cases and 3625 deaths by December 2023. Despite a national vaccination campaign initiated in January 2021, only 44.1% of the eligible population had completed the full vaccination regimen by late 2023. In this study, we aim to estimate the effectiveness of COVID-19 vaccines in preventing severe outcomes and in assessing association of prior SARS-CoV-2 infection among adults hospitalized with COVID-19 in Albania. A test-negative case-control study was conducted using SARI sentinel surveillance data from July 2022 to July 2023. The study included 1858 hospitalized SARI patients aged 18 and older, with 410 testing positive for SARS-CoV-2 (cases) and 1448 testing negative (controls). Vaccine effectiveness was calculated using logistic regression, adjusting for age, sex, comorbidities, and hospital stay duration. The overall adjusted vaccine effectiveness (VE) for preventing hospitalization was 30.1% for those fully vaccinated with two doses and 31.4% for those with a booster. VE against severe outcomes was 30.6%, increasing to 37.8% after a booster. The highest VE was observed in patients aged 80 and above, reaching 52.5% after a booster. Prior SARS-CoV-2 infection combined with vaccination was associated with higher VE to 76.2%. However, many VE estimates had wide confidence intervals overlapping zero, indicating considerable uncertainty and lack of statistical significance in some subgroup results. This study provides real-world evidence of an association between COVID-19 vaccination, particularly with booster doses, and lower odds of severe outcomes. VE was highest among elderly patients and in those with prior SARS-CoV-2 infection, emphasizing the importance of booster campaigns in vulnerable populations.

Introduction: Fasciitis is an inflammation of the fascia, the connective tissue that surrounds muscles, blood vessels, and nerves, which can rapidly progress to necrosis of these structures, leading to life-threatening situations. It is a polymicrobial infection caused by bacterial agents, fungi, viruses, and parasites, resulting in septicemia, multiorgan failure, septic shock, and potentially death. The LRINEC score is a valuable tool in diagnosing necrotizing fasciitis (NF). Case Presentation: The patient is a 62-year-old woman with a history of Diabetes Mellitus type 2 and Bilinear Myelodysplasia, currently receiving high-dose corticosteroid therapy. She was recently diagnosed with Herpes Zoster affecting the S1, S2, S3, S4, and S5 dermatomes. Initially, she was treated for 8 days with antivirals and antibiotics for symptoms of fever, fatigue, and pain in the gluteal and lumbar regions. However, her condition worsened, prompting her readmission to the hospital, where she developed signs of sepsis. After imaging, laboratory tests, and consultations with surgeons, she was diagnosed with necrotizing fasciitis. Multidisciplinary management and complex therapy led to an excellent outcome. Conclusion: Necrotizing fasciitis presents a significant diagnostic challenge due to its rarity and its clinical resemblance to other critical conditions. It is an urgent pathology that requires not only surgical intervention but also immediate medical attention. It has always intrigued healthcare professionals both locally and internationally. Early diagnosis remains the primary challenge, and the management of these patients by experienced senior surgeons is crucial for successful outcomes.

Background: Influenza A is a seasonal viral infection that continues to pose a significant public health burden globally. Objective: This study aimed to investigate the complications associated with laboratory-confirmed Influenza A in hospitalized patients at the Service of Infectious Diseases, University Hospital Center (UHC), Tirana, from December 2024 to February 2025. Methods: We retrospectively analyzed medical records of 32 patients aged 14 years or older with serologically confirmed Influenza A. Demographic data, underlying conditions, clinical complications, and laboratory biomarkers (PCR, neutrophils, monocytes, hepatic and renal markers) were collected. Results: Among the 32 confirmed cases, 15 patients (46.9%) developed complications. Pneumonia was the most frequent complication (9 cases), followed by bronchopneumonia (2), acute bronchitis (2), encephalitis (2), tonsillitis (1), and sepsis (1). The majority of complicated cases were elderly (>60 years) and/or had comorbidities such as hypertension, diabetes, or chronic pulmonary or renal disease. PCR, and neutrophil counts demonstrated high diagnostic specificity. Conclusion: Influenza A can result in severe complications, particularly in elderly and comorbid patients. Early recognition, biomarker-guided diagnosis, and targeted interventions are essential to reduce morbidity and mortality.

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BACKGROUND The incidence of syphilis is rising all over the world, partly due to the increased transmission in HIV patients and other high risk groups such as men who have sex with men Materials This is a retrospective study carried out at Infectious Disease Service in Tirana, Albania. It aims to assess the prevalence of HIV/syphilis co-infection and describe the epidemiological, clinical and therapeutic features of syphilis diagnosed among newly diagnosed HIV cases during 2023. RESULTS Out of 100 patients diagnosed with HIV infection, 53 patients were tested at baseline and 15 cases (28.3%) were diagnosed with syphilis. All were male with average age of 38 years (21-58 years). 4 cases (26%) declared homosexual relationships. Median CD4 level at baseline was 280 cells/ul, 5 cases (36%) had CD4 < 200 cells, 11 cases had CD4 < 350 cells. 3 cases (20%) were presented as primary syphilis, 7 cases (47%) as secondary syphilis and 5 cases (33%) as latent. Clinical signs included primary chancre, inguinal lymphadenopathy, systemic lymphadenopathy, maculo-papular, nodular rash. In two cases uveitis was described. Diagnosis was made by serology tests where the highest titer of RPR was 1:64. Therapy was carried out by giving benzathine penicillin in 12 cases, oral doxycycline in 1 case and ceftriaxone in 2 cases. CONCLUSIONS The prevalence of 28.3% of syphilis among newly diagnosed HIV cases indicates an emergency situation of this sexually transmitted infection. This requires a review of innovative public health strategies to control this re-emerging epidemic.

Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963-0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970-4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564-6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012-2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599-4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC +/- SE = 0.707 +/- 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. Conclusion: Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.

Introduction: Pneumomediastinum is a rare complication that occurs in patients with Pneumonia caused by COVID-19 and is more frequent in patients with ARDS that may or may not be related to the use of invasive mechanical ventilation. Pneumomediastinum is an indicator of clinical deterioration with potentially threatening consequences for the patient. Method: We described a case report of a 23-year-old man with Pneumomediastinum, infected with COVID-19 in conditions of respiratory failure due to interstitial pneumonia. Case presentation: A 23-year-old man, who had no pre-existing health conditions presented to the Infectious Diseases service with complaints of difficulty in breathing, dry cough, chest pain, muscle pain, joint pain, loss of taste, sore throat, pronounced body weakness, diarrhea. Symptoms started 11 days ago. On admission the patient refers that he doesn’t suffer from any other disease. The patient was not vaccinated against COVID-19. At the time of admission to the hospital, the objective examination revealed cervical subcutaneous emphysema and harsh respiration in both lungs. The nasopharyngeal swab test (RT-PCR) for Covid-19 was positive from the Institute of Public Health. The CT scan of the chest confirmed the presence of pneumomediastinum major, subcutaneous emphysema and bilateral ground glass opacities. Conclusion: Pneumomediastinum is a rare complication of pneumonia caused by Covid-19 in which the etiopathogenesis consists of severe pulmonary involvement that may or may not be affected using invasive mechanical ventilation. Timely diagnosis of pneumomediastinum in patients with Covid-19 would prevent the occurrence of life-threatening complications. Keywords: Covid-19, pneumomediastinum, ARDS, Macklin effect, vaccine.

Abstract Purpose: Blood culture negative endocarditis (BCNE) presents diagnostic challenges, necessitating precise identification of high-risk patient cohorts. Hence, our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data was collected via the Infectious Diseases International Research Initiative (ID-IRI). The primary study analysing one of the largest case series ever reported and was published in the European Journal of Clinical Microbiology and Infectious Diseases in 2019, was conducted across 41 centres in 13 countries. We performed a re-analysis of the database to determine the predictors of BCNE. Results: 867 cases with definite endocarditis were included in the study. Blood cultures were negative in 101 (11.65%) patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95% CI 0.963-0.987, p<0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95% CI 0.970-4.276, p=0.049), aortic stenosis (OR 3.066, 95% CI 1.564-6.010, p=0.001), mitral regurgitation (OR 1.693, 95% CI 1.012-2.833, p=0.045), and prosthetic valves (OR 2.539, 95% CI 1.599-4.031, p<0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE=0.707±0.027). The final model demonstrates a sensitivity of 70.3% and a specificity of 57.0%. Conclusion: Our study reveals a high prevalence of negative blood cultures in patients with concurrent cardiac disorders, particularly in younger cases. Therefore, caution is indicated in diagnosing and treating endocarditis in these particular patient subgroups.

Background Different pathologies are encountered more often in human immunodeficiency virus (HIV)-infected patients, such as bacterial, fungal, viral infection, and neoplastic diseases. Recently, studies have shown that HIV-infected individuals have poorer oral health outcomes, worse dentition, and aggressive forms of periodontitis. This study aims to investigate the dental and periodontal status of HIV-infected patients, the correlation between CD4+ level and the CD4 percentage with dentition, and periodontal status. Methodology A prospective observational study was conducted in the University Dental Clinic and the Infective Service of University Hospital Center "Mother Teresa" in Tirana, Albania. All patients newly diagnosed with HIV infection (35 patients, 40.7%) and those without HIV infection (51 patients, 59.3%) who underwent oral examination from April through July 2024 were included. Patients were grouped according to HIV status into two groups. This study evaluated the basic demographic characteristics, laboratory measurements, especially CD4 counts, oral hygiene, and the presence of dental and periodontal lesions. The dentition status was assessed using the values of decay teeth (DT), filled teeth (FT), and missing teeth (MT), presented as DMFT. The periodontal status was evaluated through a periodontal probe measuring community periodontal index (CPI) and loss of attachment (LOA), as recommended by the World Health Organization's Oral Health Assessment Form 2013. The Pearson's correlation coefficient (r) was used to evaluate the correlation between the levels of CD4+ and DMFT, CD4+ and CPI, CD4+ and LOA, CD4+/lymphocyte percentage (CD4%) and DMFT, CD4% and CPI, and CD4% and LOA. P-values ≤0.05 were considered statistically significant. Results HIV-infected patients had a worse dentition status, with higher DT, higher MT, and higher DMFT index values (9.71 ± 6.72 vs. 5.96 ± 4.49, p = 0.003) compared to those without HIV. HIV-infected patients also had a worse periodontal status, with higher CPI (2.63 ± 1.06 vs. 0.94 ± 0.68) and LOA (2.57 ± 1.06 vs. 0.94 ± 0.68) compared to those without HIV. An important negative correlation was found between CD4+ and dentition and periodontal status. A lower level of CD4+ was correlated with a higher DMFT (r = -0.52, p = 0.01, CPI (r = -0.38, p = 0.024, and LOA (r = -0.37, p = 0.029). Conclusions HIV-infected patients manifest a worse dentition and periodontal status, with the worsening strongly correlated with the initial CD4+ levels. Periodontal disease may serve as a significant clinical indicator for the early diagnosis of HIV and its progression. Dental professionals should be vigilant in assessing periodontal health, especially in high-risk populations, as it may prompt timely testing and intervention for HIV infection.

Introduction: Listeria monocytogenes is a gram-positive facultative intracellular bacterium, commonly transmitted through the consumption of contaminated food. In immunocompetent individuals, it typically results in self-limiting gastroenteritis, whereas in immunocompromised patients, it can lead to more severe manifestations, including septicemia, meningitis, and encephalitis. Clinically, listeriosis may present with altered mental status, and seizures occur in approximately 25% of cases. Despite appropriate antimicrobial therapy, the mortality rate for listeriosis remains around 30%. Case presentation: We report the case of a 60-year-old female with a 5-day history of high-grade fever (up to 40°C), headache, nausea, watery diarrhea, fatigue, and myalgia, who presented to the Infectious Diseases Emergency Department at UHC “Mother Teresa” in January 2024. The patient had a known history of diffuse infiltrative carcinoma of the gastric fundus and was undergoing chemotherapy. Laboratory investigations revealed severe leukopenia with a white blood cell (WBC) count of 1.0 K/μL. Despite the initiation of empirical antimicrobial therapy with ciprofloxacin and metronidazole, the treatment regimen was adjusted to target Listeria after blood cultures confirmed the presence of Listeria monocytogenes. On the fourth day of hospitalization, the patient developed 3-4 episodes of generalized tonic-clonic seizures, characterized by eye fixation and limb rigidity. Neurological evaluation, including a head computed tomography (CT) scan and lumbar puncture (LP), showed no abnormalities in cerebrospinal fluid (CSF) analysis. The patient was subsequently transferred to the intensive care unit (ICU) and intubated. However, despite aggressive treatment, her clinical condition continued to deteriorate, with a further decline in WBC count to 0.2 K/μL. Unfortunately, on the seventh day of hospitalization, the patient succumbed to the infection, resulting in Exitus Letalis. Conclusion: Chemotherapy-induced intestinal paralysis, malnutrition, and myeloablation significantly increase the risk of bacterial translocation and sepsis, exacerbating the severity and worsening the prognosis of listeriosis. These factors must be carefully considered when selecting empirical anti-listerial antibiotic therapy for patients undergoing cytotoxic treatment. Although Listeria monocytogenes infections are rare, they represent a substantial threat to immunocompromised patients, often leading to severe and fatal outcomes, as demonstrated in this case.

Introduction: poses a critical challenge in Intensive Care Units (ICUs), exacerbated by the overuse of broad-spectrum antibiotics in managing sepsis and other infections in critically ill patients. The aims of this study are to explore the principles and practices of antibiotic stewardship programs (ASPs) in ICU settings to mitigate the emergence of multidrug-resistant (MDR) pathogens. Material and methodology: We made research in PubMed, Cochrane Library and Medline with words: Antimicrobial resistance (AMR) AND Intensive Care Units (ICUs). A systematic approach to implementing early and appropriate antibiotic therapy, followed by de-escalation based on culture and sensitivity results, is emphasized. Results: In PubMed with words: Antimicrobial resistance (AMR), during last 10 years, are published 8587 papers. With words: Antimicrobial resistance (AMR) AND Intensive Care Units (ICUs) we found only 32 papers. Conclusions: The study highlights the benefits of ASPs, including reduced MDR pathogen risk, minimized drug toxicity, and preservation of antibiotic efficacy. Challenges in resource-limited settings, such as low- and middle-income countries (LMICs), are discussed, underscoring the need for global collaboration in combating AMR. The findings advocate for interdisciplinary ASP frameworks that integrate evidence-based practices to improve patient outcomes and sustain healthcare systems worldwide. By addressing AMR through robust stewardship efforts, this study underscores the ethical and clinical imperatives to preserve antibiotics for future generations.

Introduction: The SARS COV 2 epidemic has caused thousands of deaths due to different mechanisms of organ injury, starting from the respiratory and cardiovascular system and followed with significant involvement of kidneys, liver, pancreas and several metabolic dysfunctions which all caused a rapid progression of disease leading to death within the second week of hospitalization. Method: We present the case of a 67-year-old woman who died within 24 hours of admission due to a rapid deterioration of her clinical condition with several successive complications. Results: The patient developed a fulminant clinical course, starting with flu-like prodromal symptoms proceeding to altered mental status, metabolic acidosis, acute respiratory distress syndrome (ARDS) and renal failure within 3 days. The rapid involvement of several vital organs predicted a poor diagnosis since the first evaluation in admission which resulted to be irreversible. Conclusion: The predictors of poor prognosis and severity may help clinicians to apply therapeutic regimens in order to avoid disease progression to multiorgan damage and potentially death. Key words: Covid-19, multi-organ dysfunction, cascade, case report.

Introduction; An increasing number of intravenous drug users are seen in now days. Intravenous drug users (IDUs) are a group of subjects who inject different drugs, generally in the extremities. This way of taking drugs, apart from leading to an addiction, on the other hand also serves as the possibility of taking or spreading infections. The aim of this paper is to provide a brief overview of IDUs patients, who were presented to the emergency department of the infectious diseases service, and required further hospitalization, during the period January 2012 - December 2015. Material and methods: The study is retrospective and was carried out in the emergency department of the infectious disease service and the infectious disease service as well. During the period January 2012 – December 2015, 26 patients were hospitalized in our hospital as IDUs. There were 20 male patients. The average age of the patients was 32 years. The main clinical symptoms were fever, dyspnea, chest pain, pain in the extremities, edema of the extremities, necrotic ulcers at the injection site, jaundice in the sclera, confusional state. The resulting diagnoses were viral infections (HIV/AIDS infection, viral hepatitis), septic conditions (endocarditis, fasciitis), skin infections (cellulitis, S. aureus infections), pulmonary infections. Conclusions: Viral, bacterial and fungal infectious diseases are quite frequent among the people of this community. This is related to the way of life (poor social economic conditions, poor hygiene), risky sexual behaviors and the use of syringes from one person to another. The screening of this community is important to prevent any infectious disease.