HIV incidence is crucial for monitoring epidemics. This analysis of retrospective, programmatic HIV screening data aimed to estimate HIV incidence density within a repeatedly tested cohort, reflecting new infection detection among individuals who accessed testing services, and to explore associated demographic factors. We analyzed data from 1,863,802 individuals who accessed routine services across all city health facilities, tracking those initially seronegative. The overall incidence density was higher in males (1.21 per 1,000 person-years) than females (0.46), with peaks observed in males aged 70-79 (1.42) and females aged 50-59 (0.72). Cox regression identified demographic characteristics associated with higher incidence: male gender (HR = 2.69, 95% CI: 2.51-2.90), age 50-59 years (HR = 4.19, 95% CI: 2.83-6.21), and widowed/divorced status (HR = 2.01, 95% CI: 1.81-2.22). Higher education was associated with lower incidence (HR = 0.68, 95% CI: 0.52-0.90). The findings highlight a substantial HIV burden among middle-aged and older males, with females in these groups having approximately half the incidence of males. Tailored interventions should focus on these populations, particularly individuals with lower educational attainment and those who are unmarried, divorced, or widowed.

Nosocomial infections caused by multidrug-resistant bacteria represent a major global public health threat. They occur most frequently in Intensive Care Units (ICUs), particularly due to Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) and carbapenem-resistant Acinetobacter baumannii (CRAB). Only a limited number of studies have examined sex as a predictor of KPC-KP and CRAB infections. In this study, we investigated whether sex influences patterns of KPC-KP and CRAB colonization in ICU patients, as well as the risk and timing of bloodstream infection (BSI) development among colonized individuals. We included critically ill patients who developed rectal colonization by CRAB or KPC-Kp during the ICU stay. The two-sided Mann-Whitney U test, the Student's t test, the χ2 test or the Fisher's exact test were applied to analyse the differences in age, colonising pathogens, comorbidities, rate of BSI and mortality between male and female patients. Two age categories were created: 0-54 and over 55 years. Cox regression analysis was conducted to identify independent risk factors for colonization and BSI outcomes. For mortality outcomes backward stepwise logistic regression models were applied. For survival analysis, the Kaplan-Meier method was used. A total of 273 patients, 185 men and 88 women, were included in the study. The prevalence of KPC-KP and CRAB BSI was 31.8%. Our results show that sex and age affected both the risk and timing of BSI onset after admission to ICU. In particular, we found that the overall risk of BSI irrespective of sex and age was higher in patients with KPC-KP colonization than in those with CRAB colonization (IRR=1.56; 95%CI 1.00-2.45). After stratifying for sex, this risk was statistically higher in men than in women (IRR=2.06; 95%CI 1.22-3.49). Women presented a lower rate (19% vs 31%) and later onset [median 35 days (15-56) days vs 16.5 days (10-24.5), p<0.05] of CRAB BSI in comparison to men. After stratifying for age in women over 55 years, the proportion of BSI was lower and the onset occurred later for both pathogens, while, for KPC-KP BSI, women in 0-54 years group had the highest proportion and earliest onset compared to men irrespective of age group and older women. Our data show that both the risk of developing systemic infections due to KPC-KP and CRAB, as well as the timing from colonization to BSI in critically ill patients colonized with KPC-KP and CRAB, are influenced by sex and age. We therefore propose that sex and age should be incorporated into risk stratification analyses aimed at identifying predictors of systemic infections in colonized critically ill patients.

Although there is currently a large number of guidelines, expert consensus statements, and declarations on central venous catheters (CVCs), the methodological rigor and reporting quality of these documents remain unclear. The study design followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Embase, and Web of Science databases, as well as guideline databases and websites specifically dedicated to infusion therapy, were comprehensively searched for articles and information on CPGs for CVC published from database inception until 2024. Excel was used for the extraction of basic information and recommendations for CVC care. Four researchers assessed the methodological and reporting quality of the CPGs via the AGREE II instrument and the RIGHT checklist. The review protocol has been registered with the International Prospective Register of Systematic Reviews (CRD42024513864). Thirty-seven guidelines and consensus statements regarding CVC placement were reviewed. The average scores for the AGREE II domains were 50.14% for scope and purpose, 36.84% for participants, 37.86% for rigor, 45.87% for clarity, 28.34% for application, and 47.11% for editorial independence. In terms of the RIGHT evaluation items, item 13a had the highest reporting rate at 100.00%, followed by items 1a at 97.00%, 1b at 95.00%, 4/5/6 at 92.00%, 2 at 89.00%, 7a/15/19a at 84.00%, 20 at 81.00%, 1c at 76.00%, and 9b at 73.00%, with items 12 and 17 both at 68.00% and item 16 at 65.00%. The remaining items had reporting rates less than 60%. Subgroup analysis revealed that guidelines generally scored higher than consensus statements did in all AGREE II domains (rigor, clarity, application, and independence). A comparison of the guidelines and consensus statements in terms of region indicated that the average scores for both were lower in Asia than in other regions, particularly in the areas of scope and purpose, participants, and clarity. In terms of publication year, guidelines and consensus statements published after 2017 scored higher in AGREE II clarity, as well as in the basic information and evidence dimensions of the RIGHT tool, than those published before 2017. The quality of the guidelines varied, although five guidelines stood out as being of particularly high quality. These guidelines hold significant potential for practical application and could be modified to align with local regulations and protocols.

Gestational psittacosis is a rare but severe zoonotic infection caused by Chlamydia psittaci. This systematic review aims to evaluate the clinical characteristics, diagnostic challenges, therapeutic interventions, and maternal-fetal outcomes of this condition. A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang Data from inception to October 31, 2025. Two investigators independently performed study selection and data extraction encompassing maternal demographics, clinical manifestations, laboratory findings, diagnostic modalities, antimicrobial regimens, and maternal-fetal outcomes. A total of 32 cases from 30 publications were included. The median maternal age was 29 years (IQR: 26-32), and the median gestational age at diagnosis was 26.5 weeks (IQR: 21-30). All patients presented with fever (32/32, 100%), and common symptoms included headache (17/32, 53%), cough (15/32, 47%), and dyspnea (15/32, 47%). Severe disease was frequent: 66% (21/32) required intensive care unit (ICU) admission, 34% (11/32) required endotracheal intubation, and maternal mortality was 13% (4/32). Thrombocytopenia (26/32, 81%), hepatic dysfunction (27/32, 84%), renal impairment (18/32, 56%), and disseminated intravascular coagulation (DIC) (15/32, 47%) were the most prominent laboratory abnormalities. Diagnostic approaches evolved from serology to molecular methods. Recent studies have demonstrated the potential value of metagenomic next-generation sequencing (mNGS) in diagnosis, but further research is needed to confirm its clinical utility. The overall fetal and neonatal mortality was 68% (21/31 with available data), primarily due to stillbirth, spontaneous abortion, or therapeutic induction. These estimates reflect outcomes among reported cases and may overestimate true population-level risk. Gestational psittacosis is a rare but life-threatening infection associated with substantial maternal morbidity and a high risk of fetal loss, although these outcomes may be influenced by publication bias. mNGS has facilitated earlier diagnosis in recent case reports; however, comparative performance data for gestational psittacosis remain limited. PROSPERO, CRD420251275911 (Registered 30 December 2025). Not applicable.

Talaromyces marneffei (TM) is an opportunistic dimorphic fungus that increasingly affects immunocompromised individuals, including kidney transplant recipients. However, data on the clinical features, diagnosis, treatment, and prognosis of Talaromyces marneffei pneumonia (TMP) in this population remain limited. This retrospective study included 8 HIV-negative kidney transplant recipients diagnosed with TMP at the Second Xiangya Hospital of Central South University between January 2015 and January 2025. Clinical data, including demographic characteristics, clinical manifestations, imaging findings, microbiological results, treatment regimens and outcomes, were collected and analyzed. The cohort consisted of 7 males and 1 female with a mean age of 45.12 ± 9.03 years. The median time from transplantation to TMP onset was 356.5 days (IQR, 302.75-771.75). All patients presented with fever, and chest CT showed diverse pulmonary lesions, including nodules and patchy opacities. Metagenomic next-generation sequencing (mNGS) was the primary diagnostic tool, identifying TM in 7 cases (87.5%), with a mean diagnostic time of 5 ± 2.56 days, while conventional culture was positive in only 3 cases. All patients received antifungal therapy, mainly amphotericin B for induction followed by oral azoles for maintenance. Immunosuppressive regimens were adjusted during treatment. All patients achieved clinical cure without severe adverse events, and graft function remained stable. TMP is a rare but serious infection in kidney transplant recipients receiving long-term immunosuppression. Early diagnosis using mNGS combined with conventional culture can improve detection efficiency. Timely antifungal therapy with amphotericin B followed by azole maintenance, along with careful adjustment of immunosuppressants, is associated with favorable prognosis.

Despite successful viral suppression with antiretroviral therapy (ART), incomplete immune reconstitution and chronic inflammation persist in people with HIV, contributing to an increased burden of non-AIDS-defining comorbidities. Emerging evidence points to cytomegalovirus (CMV) co-infection as a critical driver of this residual inflammation. Consequently, this study aims to elucidate the specific role of CMV in sustaining inflammatory pathways in the context of HIV. This prospective observational study included 200 participants divided into three groups: 50 with HIV/CMV co‑infection, 100 with HIV mono‑infection, and 50 healthy controls. Baseline immunophenotyping and cytokine profiling were assessed using flow cytometry and enzyme-linked immunosorbent assays. To account for baseline HIV disease severity and demographic imbalances, cross-sectional comparisons were evaluated using multivariable linear regression adjusted for age, sex, and baseline absolute CD4⁺ T-cell counts, supplemented by CD4-stratified analyses (< 100 and > 200 cells/µL). To evaluate the longitudinal impact of CMV viral load dynamics, co‑infected participants were classified after 6 months follow‑up into "CMV responders" (≥ 68% reduction in CMV DNA load) and "CMV non‑responders" (< 68% reduction or increase). The overall cohort was predominantly CMV IgG positive (97.5%). At baseline, the unadjusted expansion of CD8⁺ T-cells observed in HIV/CMV co-infected patients lost statistical significance after multivariable adjustment for baseline CD4⁺ counts (adjusted p = 0.150), indicating this was primarily related to advanced HIV immunosuppression. In contrast, CMV DNAemia remained independently associated with significantly elevated systemic TNF-α levels (adjusted p = 0.043). Stratified analysis revealed that this independent TNF-α elevation was particularly pronounced in patients with relatively preserved immune function (CD4 > 200 cells/µL; adjusted p = 0.042), whereas these differences were obscured in severe immunosuppression (CD4 < 100 cells/µL). Longitudinal analysis revealed that effective reduction of CMV viral load was associated with significant HIV viral suppression in responders (p = 0.0039), whereas no significant reduction was observed in non-responders (p = 0.3894), and seemingly facilitated the resolution of systemic TNF-α levels. In contrast, significant recovery of CD4⁺ T-cell absolute counts occurred in both groups (p < 0.01) and the rate of recovery did not differ significantly between CMV responders and non-responders. These findings suggest that CMV DNAemia is independently associated with persistent TNF-α elevation in PLWH, particularly in those with preserved CD4 + counts. Rather than directly causing broad T-cell exhaustion, CMV appears to act as a specific driver of the TNF-α inflammatory pathway. Addressing adherence to anti-CMV interventions alongside ART may offer a potential strategy for reducing long-term inflammatory risks.

Human cytomegalovirus (HCMV) is a common pathogen that poses significant health risks, particularly to immunocompromised individuals. This study aims to improve diagnostic accuracy by developing a novel enzyme-linked immunosorbent assay (ELISA) and colloidal gold immunochromatography assay (GICA) utilizing recombinant HCMV proteins (fusion of pp150 and pp28), which offer improved sensitivity and specificity. A recombinant HCMV antigen was synthesized for the detection of CMV IgG antibodies in 573 serum samples collected from Hangzhou, Zhejiang Province. All samples were analyzed using two in-house developed assays (indirect ELISA and GICA), and 528 of these samples were identified as CMV IgG-positive by a commercial ELISA kit. The diagnostic performance and reliability of the two in-house assays were subsequently compared with those of this commercial ELISA kit. The assays showed no cross-reactivity with other viruses, with a coefficient of variation of less than 10%, indicating excellent reproducibility. Compared to the commercial ELISA kit, the concordance rates of the recombinant antigen-based ELISA and GICA were 98.9% and 99.7%, respectively. The ELISA and GICA developed in this study demonstrate high sensitivity and specificity, making them suitable for screening CMV IgG antibodies particularly in immunocompromised individuals. These findings highlight the potential of recombinant antigen-based assays to advance in infectious disease diagnostics. Not applicable.

Progressive back pain in elderly individuals may be caused by spine infections, metastatic cancers, or hematologic malignancies. Spine infections, such as spondylodiscitis, often result from hematogenous spread by staphylococci, streptococci, or gram-negative bacilli, whereas Clostridium species is a rare cause of spondylodiscitis. Lymphoma involving the spine can mimic infectious spondylodiscitis and lead to irreversible neurological damage. We report an elderly Thai woman with clostridial spondylodiscitis and lymphoma coexisting at the thoracic spine, highlighting the importance of a broad differential diagnosis in such cases. A 79-year-old Thai woman with osteoporosis and a previous T10 compression fracture, treated with denosumab, presented with worsening back pain radiating to both legs for five months, along with fatigue, anorexia, and a 7kg weight loss. She developed a fever and weakness before admission. Initial treatment with ceftriaxone and cefixime temporarily alleviated her symptoms, but paralysis and sensory loss later worsened. At Siriraj Hospital, examination revealed complete paraplegia, and MRI showed spondylodiscitis and epidural abscesses at T10-T11, causing spinal cord compression. CT-guided biopsy identified gram-positive bacilli, and partial 16S rRNA sequencing showed 97.23% identity with Clostridium tarantellae. IV metronidazole was started. Additionally, tissue pathology revealed diffuse large B-cell lymphoma involving the thoracic spine. Staging CT showed extensive lymphadenopathy, but her bone marrow was unaffected. After four weeks of metronidazole, her pain improved, but neurological deficits remained. R-CHOP chemotherapy was initiated while continuing metronidazole. Unfortunately, she developed severe Acinetobacter baumannii pneumonia, which led to septic shock and respiratory failure. She died 74 days after admission. This case highlights the rare coexistence of spinal infection and lymphoma-an uncommon and challenging diagnosis in elderly patients with progressive back pain. The coexistence of infectious spondylodiscitis and spinal lymphoma is rare, posing diagnostic and therapeutic challenges that demand multimodal evaluation and prompt treatment to prevent complications and improve outcomes.

The global emergence of carbapenem-resistant Enterobacterales (CRE) infections has critically reduced therapeutic options and are associated with high mortality. While CRE epidemiology has been extensively studied worldwide, data on intestinal CRE colonization in Saudi Arabia remain limited. This study aims to determine the prevalence of intestinal Carbapenem Producing Organisms (CPO) carriage, characterize carbapenemase genes, and evaluate associated clinical outcomes among hospitalized patients. A retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Hospitalized adult patients (≥ 18 years) in critical care and hematology/oncology areas were screened for CPO colonization via rectal swab and tested utilizing Cepheid Xpert® Carba-R test. Demographics, clinical data, carbapenemase gene types, and clinical and microbiologic outcomes were collected from electronic medical records. Associations between carbapenemase gene types, clinical characteristics, and outcomes were analyzed using the chi-square test and t-tests. (p < 0.05). Among 6405 screened patients, 778 carbapenemase-producing isolates were detected (12.1%), OXA-48 was most prevalent (49.7%), followed by NDM (23.6%), OXA-48 + NDM co-producers (15.2%), KPC (4.8%), VIM (5.0%), and IMP-1 (1.7%). Most patients were ≥ 65 years (52.3%), and 84.3% were ICU inpatients. Common comorbidities included hypertension (57.5%) and diabetes mellitus (57.5%). Recent antibiotic exposure occurred in 73.3% of patients. The 30-day mortality rate was 24.6%, with no significant difference among carbapenemase types (p = 0.44). Subsequent infection within 90 days occurred in 29%, significantly associated with enzyme type (p = 0.001), highest among KPC (48.6%) and OXA-48 + NDM (38.1%) producers. Persistent colonization occurred in 29.3% of cases (p = 0.006), particularly among VIM (46.2%) and KPC (40.5%) producers. OXA-48 and NDM were the dominant carbapenemase genes among intestinal CPO carriers in this tertiary care hospital. High rates of subsequent infection and mortality highlight the clinical importance of CPO colonization, especially in the ICU and elderly populations. Strengthened infection control practices and active surveillance are essential to limit CPO spread and improve patient outcomes. Not applicable.

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease with substantial mortality in endemic regions. CT findings, particularly lymphadenopathy with perinodal fat stranding, may be under-recognized. We evaluated CT findings and factors associated with in-hospital mortality in an endemic setting. We retrospectively reviewed 16 RT-qPCR-confirmed SFTS patients treated at Ehime Prefectural Central Hospital and Kagawa University Hospital (January 2013-December 2024). CT images were reviewed by a board-certified diagnostic radiologist and an infectious diseases physician for lymphadenopathy and perinodal fat stranding. Clinical and laboratory variables were compared between non-survivors and survivors using permutation tests with bootstrap 95% confidence intervals; categorical factors were assessed by univariable analysis. Median age was 69 years (44-86), and 11 (68.8%) were male. CT showed lymphadenopathy with perinodal fat stranding in 15/16 (93.8%), with one case showing no lymphadenopathy. Two patients (12.5%) died in hospital. Lymph node size was not associated with mortality (difference [non-survivors - survivors], - 0.28cm; 95% CI, - 0.54 to 0.84; P = 0.549). Non-survivors had higher aspartate aminotransferase (difference, 190.21 U/L; 95% CI, 37.36 to 343.50; P = 0.040) and lower platelet counts (difference, - 5.99 × 10³/µL; 95% CI, - 7.52 to - 4.40; P = 0.009). No categorical factor reached statistical significance (altered mental status, borderline; P = 0.050). In this cohort, CT frequently revealed lymphadenopathy with perinodal fat stranding, an under-recognized pattern that may support earlier recognition of SFTS in patients with compatible clinical and epidemiological features. Additionally, elevated aspartate aminotransferase and decreased platelet counts were associated with in-hospital mortality in this cohort and may be useful as exploratory markers for early risk stratification.