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This study aimed to report a tularemia outbreak in Sivas and describe the epidemiological and diagnostic characteristics of the patients. Patients aged 18 and over followed up with a diagnosis of tularemia in Sivas Cumhuriyet University Hospital, Sivas Numune State Hospital, and Sivas State Hospital Infectious Diseases Outpatient Clinics and wards between November 2023 and May 2024 were evaluated. 205 adult patients with tularemia were included. The most common symptoms were sore throat (73.2 %, n=150), swelling in the neck (70.2 %, n = 144), and fatigue (55.1 %, n = 113). The most common form was oropharyngeal (82.4 %, n = 169) and glandular (14.6 %, n = 30). Lymphadenopathy was detected in 182 (88.8 %) patients, the most is cervical lymphadenopathy (60 %, n = 123). Lymph node drainage/excision was performed on 50 patients (24.3 %). There have been no deaths in this outbreak. This study presents patient data from the tularemia outbreak in Sivas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study assessed antimicrobial susceptibility, biofilm formation, hypervirulence traits, and virulence-related genes in K. pneumoniae. 119 isolates underwent antibiotic susceptibility testing using the Kirby-Bauer method, biofilm assessment through Congo red agar and Microtiter plate assays, PCR for various genes, and the String test for hypermucoviscosity. Clinical characteristics and virulence factors of hypervirulent (hvKP) were compared to classic K. pneumoniae (cKP) strains. Among the isolates, 77.3% were multi-drug resistant (MDR), and 83.2% showed biofilm-forming ability, with a higher MDR incidence in biofilm producers. A significant correlation was found between biofilm formation and the presence of the bla CTX-M15 gene. Genes luxS, mrkA, pgaA, and wzm were significantly related to biofilm production. Three K. pneumoniae (2.5%) were identified as hvKP, with higher prevalence of capsular serotypes K1/K2 and virulence-related genes iuc, rmpA, and rmpA2 than cKP. The study underscores the importance of surveillance and stewardship in combating MDR, biofilm-forming, highly virulent K. pneumoniae., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Masoud Yousefi reports financial support was provided by Birjand University of Medical Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Although Providencia species are recognised as important causes of bloodstream infections (BSI), their epidemiology is not well defined due to their infrequent occurrence. Our objective was to determine the overall incidence, determinants, and outcomes of Providencia species BSI, and compare the epidemiology of P. stuartii and P. rettgeri in a large population., Methods: All patients within Queensland, Australia with Providencia species BSI between 2000-2019 were included with clinical and outcome data collected from state-wide datasets., Results: Among 268 residents, there was 273 incident episodes of Providencia species BSI; with 118 cases (43.2%) due to P. rettgeri, 150 cases (55.0%) due to P. stuartii, for age and sex adjusted incidence rates of 1.5, and 2.1 per million respectively. Five cases (<2.0%) were due to other Providencia species. The median age was 73.9 years, 80% were male, and most episodes were of community onset. As compared to P. rettgeri, patients with P. stuartii BSI were more likely to have dementia, peptic ulcer disease, and hemiplegia but less likely to have comorbid liver disease. The overall distribution of infection foci were different with P. stuartii more commonly associated with lower respiratory tract source and P. rettgeri with urinary source. All cause 30-day case fatality was significantly higher for P. rettgeri versus P. stuartii (35; 29.7% vs. 24; 16%; p=0.007)., Conclusions: Providencia species are important causes of community onset BSI especially in older males. Although they share similar incidence, P. stuartii and P. rettgeri BSI differ on many clinical aspects., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Patrick Harris reports a relationship with OpGen Inc that includes: consulting or advisory. Patrick Harris reports a relationship with Merck Sharp & Dohme UK Ltd that includes: consulting or advisory. Patrick Harris reports a relationship with Sandoz Inc that includes: consulting or advisory. Patrick Harris reports a relationship with Pfizer that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to assess the prevalence of colistin resistance in the study group and compare alternative methods with the gold standard. It sought to evaluate the prevalence of plasmid-mediated colistin resistance genes., Material and Methods: The colistin susceptibility of 151 K. pneumoniae strains was determined using Sensititre™, CBDE, ETEST®, and VITEK®2. Results were compared with BMD. The presence of the mcr gene was assessed using polymerase chain reaction., Results: The colistin resistance rate was 16,6 %. The categorical agreement of Sensititre™, CBDE, and ETEST® was 100 %. VITEK®2 had a CA of 98 %, a major error of 0.79 %, and a very major error of 8 %. Essential agreement for Sensititre™, ETEST®, and VITEK®2 was 92.7 %, 52.3 %, and 78.1 %, respectively. There were no mcr genes in any strains., Conclusions: Due to the difficulty of applying BMD, colistin resistance data are insufficient globally. Continuous epidemiological studies and validation of alternative methods are needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for Diagnostic Microbiology & Infectious Disease and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We evaluated the diagnostic performance of Rapiim SARS-CoV-2-H (Rapiim-H)-a point-of-care qualitative antigen test-using nasopharyngeal swabs (NPS) and saliva samples and compared its results with those from antigen quantification and nucleic acid amplification tests. NPS and saliva were collected from patients with confirmed and suspected coronavirus disease (COVID-19). In total, 142 NPS and saliva samples were collected. In symptomatic cases, in which the first NPS sample was collected within 10 days of disease onset, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for COVID-19 diagnosis were 91.7 %, 88.6 %, 93.2 %, and 86.1 %, respectively. A similar analysis was performed on saliva samples, and the sensitivity, specificity, PPV, and NPV were 50.8 %, 91.4 %, 91.2 %, and 51.6 %, respectively. The Rapiim-H test using NPS demonstrated approximately 90 % sensitivity and specificity, particularly within the first 10 days after disease onset., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kei Yamamoto reports financial support was provided by Canon Medical Systems Corporation. Hideaki Kato reports a relationship with Shionogi and Co Ltd that includes: funding grants. Hideaki Kato reports a relationship with Asahi Kasei Pharma Corporation that includes: funding grants. Kei Yamamoto reports a relationship with FUJIREBIO Inc that includes: funding grants. Kei Yamamoto reports a relationship with Mizuho Medy Co Ltd that includes: funding grants. Kei Yamamoto reports a relationship with VisGene Co. Ltd. that includes: funding grants. Kei Yamamoto reports a relationship with Sanyo Chemical Industries Ltd that includes: funding grants. Kei Yamamoto reports a relationship with CarbGeM Inc. that includes: funding grants. Kei Yamamoto reports a relationship with Sysmex Corp that includes: funding grants. Kei Yamamoto reports a relationship with Toyobo Co Ltd that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

To investigate differences in the clinical features of patients with sporotrichosis and cutaneous Mycobacterium marinum infection, and develop a prediction model for the initial identification. A total of 121 patients were selected based on the results from etiological culture. Logistic regression analyses were employed to identify the most valuable variables. In the multivariate logistic regression analysis, the following were finally considered independent predictors (OR = 3.650∼14.024, P<0.05) of cutaneous M. marinum infection: age<60 years (P = 0.031); female (P = 0.001); only the extremities involved (P = 0.031); clear triggers (P = 0.022); and presence of swelling (P = 0.024). A nomogram was developed based on these factors, and the area under the curve was 0.860. The model presented is based on clinical features and can help identify patients with sporotrichosis and cutaneous M. marinum infection. This may help increase the accuracy of doctors' initial examination and diagnostic outcomes., Competing Interests: Declaration of competing interest The authors declare no financial interests or personal relationships that could have appeared to influence the work reported in this paper. No conflict of interest was reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Trimethoprim/sulfamethoxazole (TMP/SMZ), traditionally a second-line drug, is now proposed as the primary alternative treatment for macrolide-resistant Bordetella pertussis (B.pertussis). Thus, there is an urgent need to evaluate the phenotypic profile of B. pertussis regarding susceptibility to TMP/SMZ., Methods: Kirby-Bauer (KB) disk diffusion methods and E-test strips were employed to assess the in vitro susceptibility profiles of 128 B. pertussis strains isolated in China between 2017 and 2022 against TMP/SMZ. Additionally, whole genome sequencing was performed on one strain exhibiting a heterogeneous phenotype., Results: B. pertussis displayed three phenotypes to TMP/SMZ based on the first 10 days of culture: a predominant fuzzy-bordered phenotype (118/128, 92.2 %), a minority with a clear-bordered phenotype (8/128, 6.3 %), and a sporadic heterogeneous phenotype (2/128, 1.6 %) where TMP/SMZ heterozygous colonies emerged on the 9th day of incubation. The diameter of the inhibition zone around the paper disk will decrease as the culture time extends, while the MIC value will change in the opposite direction. Almost in all tests, the bacterial colony will cover the entire inhibitory zone after 10-14 days of incubation. Strains exhibiting heterogeneity were compared with the complete genomes of Tohama I and CS strains, and 191 and 179 point mutation sites were identified, respectively, with multiple variants associated with the expression of transcriptional regulators., Conclusion: This study highlights the diverse drug sensitivity phenotypes of B. pertussis to TMP/SMZ and the importance of uniform testing protocols. Continuous and dynamic monitoring of B. pertussis isolates for TMP/SMZ sensitivity, along with investigating its correlation with epidemiological changes, is essential for establishing a scientific foundation for the effective management and control of pertussis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestation of tuberculosis. Lymphadenitis due to Listeria monocytogenes is rarely described. We present a case of a 59-year-old woman from Mexico presented to the Emergency Department with a 2-week history of erythematous and painful swelling in the right retromandibular area. An ultrasound-guided bedside needle aspiration of the lump was performed by an infectious diseases specialist and a diagnosis of Listeria monocytogenes and tuberculous coinfection was done. To our knowledge this is the first case of tuberculous and Listeria-associated lymphadenitis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

In recent years, the widespread emergence of drug resistance in yeasts and filamentous fungi to existing antifungal armamentariums has become a severe threat to global health. There is also concern regarding increased rates of azole resistance in Aspergillus fumigatus and Terbinafine resistance in Trichophyton species. To overcome this concern of resistance to regular therapies, new antifungal drugs with novel and effective mechanisms are crucially needed. Herbal remedies may be promising strategies for the treatment of resistant infections. We aimed to investigate the in vitro and silico activity of piperlongumine against clinical azole susceptible/resistant A. fumigatus and terbinafine-susceptible/resistant Trichophyton species. In the current study, piperlongumine demonstrated potent antifungal activity, with minimum inhibitory concentrations (MICs) ranging from 0.016-4 μg/mL against Trichophyton isolates and 0.25-2 μg/mL for A. fumigatus isolates. Additionally, molecular docking studies indicated that piperlongumine has a strong binding affinity to the active sites of squalene epoxidase and sterol 14-alpha demethylase. However, further studies are warranted to correlate these findings with clinical outcomes and provide the basis for further investigations to pave the way for developing novel antifungal agents., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Iman Haghani reports financial support was provided by Mazandaran University of Medical Sciences. This research was financially supported by grant number 17588 from Mazandaran University of Medical Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Concerning the progression of dermatophytosis and its prognosis, quantification studies play a significant role. Present work aims to develop an automated grading system for quantifying fungal loads in KOH microscopic images of skin scrapings collected from dermatophytosis patients. Fungal filaments in the images were segmented using a U-Net model to obtain the pixel counts. In the absence of any threshold value for pixel counts to grade these images as low, moderate, or high, experts were assigned the task of manual grading. Grades and corresponding pixel counts were subjected to statistical procedures involving cumulative receiver operating characteristic curve analysis for developing an automated grading system. The model's specificity, accuracy, precision, and sensitivity metrics crossed 92%, 86%, 82%, and 76%, respectively. 'Almost perfect agreement' with Fleiss kappa of 0.847 was obtained between automated and manual gradings. This pixel count-based grading of KOH images offers a novel, cost-effective solution for quantifying fungal load., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Rajitha KV: Execution of the experimental steps, result analysis, its validation, and drafting of the manuscript; Sreejith Govindan: Involvement in conceptualization of the project, specimen curing, microscopic examination for confirmation of dermatophytes in the specimen, manual grading, and checklist preparation; Prakash PY: Discussion of the microbiological aspects involved in the work including the manual grading and checklist preparation, assessment of the medical relevance and suggestions to improve clinical insights; Asha Kamath: Conception of the statistical method, result analysis and review of the manuscript; Raghavendra Rao: Confirmation of diagnostic aspects of the fungal infection and providing the required clinical s p e c i m e n ; Keerthana Prasad: Study conception, critical evaluation of the results, their discussion, review of the manuscript and overall guidance., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The importance of cytomegalovirus in clinical practice remains and samples are monitored for CMV DNA titers to predict the development of disease. LAMP assays have gained increasing interest in the diagnosis of many pathogens since they do not require thermocycling, reduce the complexity of the required instrumentation as well as providing sensitivity and rapidity. So far, very few studies on CMV detection by LAMP have been reported in the literature and therefore the performance of LAMP CMV assays needs to be further characterized. In a set-up for biometrological evaluation of the suitability of the LAMP assay for CMV diagnosis, a LAMP assay was performed on a total of 192 samples with 24 replicates of 8 different hCMV DNA concentrations. The LOD was calculated as 39.09 copy/reaction (25.33 copy/reaction to 65.84 copy/reaction) with 95 % confidence, representing a range that is suitable for qualitative detection. Furthermore, the lower limit of quantification was estimated at approximately 100 copy/reaction. The LOD and LLOQ values obtained in this first study to assess the biometrological relevance of LAMP CMV tests are consistent when compared to studies published before. However further study under different conditions is needed for the use of LAMP tests in clinical applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We conducted a systematic review and meta-analysis of studies and reports comparing the performance of antigen rapid diagnostic tests (Ag RDT) for diagnosing Ebola disease (EVD). We searched PubMed, EMBASE, and Web of Science for diagnostic studies published between 1976 and 2023, evaluating them with QUADAS-2. Using a bivariate random-effects model, we estimated the pooled sensitivity and specificity of Ag RDTs. Of 64 eligible full studies and reports, 16 met the inclusion criteria. Pooled sensitivity and specificity were 82.1% (95%CI: 75.2 - 88.0) and 97.0% (95%CI: 95.1-98.2), respectively. We conducted subgroup analysis on 4 Ag RDTs, 3 RT-PCR tests, and 4 sample types, showing varied performance. The high specificity and positive predictive value of Ag RDTs support their use to "rule-in" patients with EVD. However, high-sensitivity RDTs suitable for field settings and capable of detecting multiple ebolavirus species are needed., Competing Interests: Declaration of competing interest That there is no conflict of interest for this paper, (Copyright © 2024. Published by Elsevier Inc.)

This study assessed the diagnostic potential of nonpolar lipid extracts in enzyme-linked immunosorbent assays (ELISAs) for tuberculosis (TB) serodiagnosis. Nonpolar lipid extracts were harvested from Mycobacterium tuberculosis (Mtb) knockout in mce1 operon (∆mce1) and its parental wild type (WT) strains. IgM and IgG anti-nonpolar lipid serum levels were measured in TB patients (n=45), healthy individuals with positive (n=22) and negative (n=44) interferon-gamma release assay (IGRA) results, and symptomatic respiratory (SR) patients with negative TB tests (n=9). IgG anti-WT lipid distinguished TB patients from IGRA-positive individuals with 60% sensitivity and 77.3% specificity. Conversely, IgG anti-∆mce lipid levels didn't vary significantly across groups. Interestingly, most SR patients exhibited significantly higher IgM and IgG anti-WT lipid titers than the IGRA-positive and -nega groups. While the overall diagnostic potential of Mtb nonpolar lipids was limited, the impaired immunogenecity of Δmce1 lipid extract suggests that some missing lipid classes in this extract can potentially induce antibody production in TB patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: In vitro activity of β-lactam enhancer/β-lactam combination zidebactam/cefepime was evaluated against carbapenem- and colistin-resistant Klebsiella pneumoniae isolates., Methods: Non duplicate K. pneumoniae (n=185), resistant to colistin as well as non-susceptible to carbapenems were collected (2018-2019) at two large tertiary care hospitals in India. Colistin resistance-conferring genes mcr1 and mcr3 were screened among 123 of 185 randomly-selected isolates. These isolates were also subjected to multi-locus sequence typing (MLST). Additionally, alterations in mgrB were screened in 109 of these 123 isolates. All the study isolates were screened for presence of carbapenemases genes. MICs of zidebactam/cefepime, colistin, carbapenems, ceftazidime/avibactam, imipenem/relebactam, amikacin and piperacillin/tazobactam were determined by reference CLSI broth dilution method., Results: Among the isolates, 65.4% (121/185) carried bla OXA-48-like gene and 27.6% isolates (51/185) carried dual carbapenemase genes; bla OXA-48-like and bla NDM . Of the remainder, 8 isolates carried bla NDM and 5 isolates lacked carbapenemases gene despite being carbapenem-resistant. None of the isolates showed presence of mcr1 and mcr3. Out of 109 isolates analysed for mgrB, 36 showed mutational changes. The MLST profile revealed at least 14 unique sequence types with ST231 being the dominant clone. All the isolates showed colistin MICs >2 mg/L and were non-susceptible to carbapenems. Zidebactam/cefepime demonstrated potent activity with MIC 50 and MIC 90 of 1 and 2 mg/L, respectively. MIC 90 s of amikacin, ceftazidime/avibactam and imipenem/relebactam were >32 mg/L., Conclusion: Zidebactam/cefepime combination was highly active against multi-clonal, carbapenem-non-susceptible and colistin-resistant K. pneumoniae isolates producing OXA-48-like (Ambler class D) or/and NDM (Ambler class B) carbapenemases, thus potentially offering a valuable treatment options for infections caused by such pan-drug resistant resistotypes. Though, zidebactam is not an inhibitor of class B and D β-lactamases, potent activity of zidebactam/cefepime combination is attributable to β-lactam enhancer mechanism., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To compare outcomes of ceftriaxone to AmpC-stable therapies in patients with bacteremia caused by low-risk AmpC harboring Enterobacterales., Methods: IRB-approved, retrospective cohort of hospitalized patients ≥18 years old with Serratia marcescens, Morganella morganii, or Providencia spp. bacteremia from 1/1/2017-2/28/2024. Patients were compared by definitive therapy with ceftriaxone vs AmpC-stable therapy (cefepime, carbapenem). The primary endpoint was 30-day all-cause mortality; secondary endpoints were clinical failure and development of ceftriaxone resistance., Results: 163 patients were included; 33.1 % received ceftriaxone, 66.9 % AmpC-stable therapies. 30-day all-cause mortality was 9.3 % ceftriaxone vs 10.1 % AmpC stable patients (P = 0.87); ceftriaxone definitive therapy was not associated with 30-day all-cause mortality (adjOR, 0.79; 95 %CI, 0.23-2.3). There were no differences in clinical failure (9.3 % vs 21.1 %, P = 0.059) or relapsing infection (5.6 % vs 9.3 %, P = 0.55) between ceftriaxone and AmpC-stable treated patients., Conclusions: Patients treated with definitive ceftriaxone for low-risk AmpC Enterobacterales bacteremia had similar outcomes to AmpC stable therapies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Antimicrobial resistance and biofilm production in healthcare-associated infections is a health issue worldwide. This study aimed to identify potential biomarker peaks for resistance or biofilm production in ESKAPE pathogens using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility and biofilm production were assessed on selected isolates. Biomarker peaks were identified using MALDI Biotyper and ClinProTools software. Among resistant strains, 90.0 % were carbapenem-resistant Acinetobacter baumannii (CRAB), 39.0 % were methicillin-resistant Staphylococcus aureus (MRSA), 17.98 % were multidrug-resistant (MDR) Pseudomonas aeruginosa, 21.6 % were vancomycinresistant Enterococcus (VRE), and 2.55 % were carbapenem-resistant Enterobacterales (CRE). Biofilm production was 40.0 % in VRE and 45.8 % in MRSA. Although no potential biomarker peaks for biofilm production were detected, several potential biomarker peaks for drug resistance in VRE (n=5), MRSA (n=4), and MDR P. aeruginosa (n=4) were detected, suggesting avenues for the development of rapid diagnostic tools., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)