Objective. To assess the preliminary efficacy, safety, tolerability, and clinical impact of vonoprazan-amoxicillin for Helicobacter pylori eradication in South Indian dyspeptic patients as a pilot study. Materials and methods. This prospective, open-label, single-arm pilot study enrolled 50 adults with histologically confirmed H. pylori infection. Participants received vonoprazan (20 mg twice daily) and amoxicillin (750 mg thrice daily) for 10 days. Eradication was confirmed via a urea breath test (UBT) conducted 4 weeks post-treatment. Secondary outcomes included short-form Nepean Dyspepsia Index (sf-NDI), Gastrointestinal Symptom Rating Scale (GSRS), 24-hour gastric pH (n = 15 subset), adherence, adverse events (AEs), and antibiotic resistance (n = 15). Outcomes. Eradication was achieved in 45/50 patients (90.0%, 95% CI 78.2-96.7%). sf-NDI decreased from 58.1 ± 12.3 to 22.6 ± 8.8 (p < 0.001); GSRS improved from 3.8 ± 0.9 to 1.9 ± 0.6 (p < 0.001). Gastric pH rose from 2.1 ± 0.4 to 5.8 ± 0.7 (p = 0.003). Adherence was 94.0%; AEs were mild (16.0%: nausea 6.0%, diarrhea 4.0%, headache 6.0%). Clarithromycin resistance was observed in 40% of the tested subset (6/15); no amoxicillin resistance was detected. Conclusions. Vonoprazan-amoxicillin shows high efficacy, safety, and QoL improvement in this pilot study, potentially outperforming historical PPI-based regimens, which have shown eradication rates around 70%. Larger controlled trials are needed to confirm findings in high-resistance settings.

Background and objectives. Neuroinfections are significant due to their epidemiology, unpredictable nature, and diverse clinical manifestations. This study aimed to determine the characteristic of neuroinfections in patients admitted to an infectious diseases hospital. Materials and methods. The study was conducted on 106 patients with acute neuroinfections at the “T. Ciorba” Hospital for Infectious Diseases in the Republic of Moldova from 2019 to 2024. Results. Neuroinfections were suspected upon admission in 51 (48.1%) cases. The ratio of patients with aseptic CSF to those with septic CSF was 66 (62.3%) to 40 (37.7%) cases. Significant differences between aseptic vs septic CSF neuroinfections were observed for patient age 34.9±15.8 years and 19±18 years (p < 0.0001); headache 98.4% vs 67.5% (p < 0.0001); neck stiffness 72.7% vs 42.5% (p = 0.0021); vomiting 57.5% vs 77.5% (p = 0.0372); photophobia 37.8% vs 17.5% (p = 0.0280). The aetiology was identified or suspected in 28 (42.4%) patients with aseptic CSF compared to 36 (90%) with septic CSF. The disease progressed more severely in septic CSF cases – 92% (37 patients) vs 40.9% (27 patients) with aseptic CSF (p < 0.0001), and in children – 80.6% (25 cases) vs adults – 52% (39 cases) (p = 0.0064). Complications developed in 71 (66.9%) patients, primarily in septic meningitis. These included cerebral edema, toxic shock, pneumonia, reactive arthritis, and decreased cognitive abilities. A total of 10 patients (9.4%) died. Conclusions. Neuroinfections are a medical emergency in the Republic of Moldova, associated with frequent and potentially fatal sequelae. Timely management involves point-of-care diagnostics, including PCR tests, and early pathogen-directed therapy. Prioritization should focus on enhancing vaccination coverage and strengthening surveillance networks.

Background. Differential diagnosing of a mediastinal mass is a common challenge in clinical practice due to the many organs and vascular structures contained within mediastinum. One of the less common causes is tuberculosis, which may present as a mass-like lesion that mimics a mediastinal tumor. Case report. We report an unusual case of mediastinal tuberculosis in a 19-year-old male who presented with shortness of breath and right chest pain as chief complaints, followed by cough and fever. Chest X-ray and computed tomography (CT) scan revealed a lobulated anterior mediastinal mass, but histopathological examination confirmed the diagnosis of chronic granulomatous lymphadenitis consistent with tuberculosis. Conclusions. Diagnostic imaging plays a critical role in the evaluation of mediastinal masses, beginning with basic radiography and extending to advanced imaging such as CT scanning. Although CT can strongly suggest the diagnosis, tissue biopsy remains essential for definitive confirmation.

Background. Parvovirus B19 infection is typically asymptomatic or presents with mild symptoms such as fever, rash, and joint discomfort. However, infection can lead to significant hematological complications in patients with underlying hematological disorders or immunosuppression. Purpose. To present two cases of pancytopenia associated with parvovirus B19 infection. Case presentation. We report two patients who developed pancytopenia three months after renal transplantation. One patient had a history of acute lymphoblastic leukemia with chronic pancytopenia, while the other presented with fever, myalgia, rash, and arthralgia. Parvovirus B19 infection was confirmed in both patients by polymerase chain reaction (PCR) testing. Bone marrow aspiration revealed hypocellularity, with the presence of giant proerythroblasts and arrested erythroid progenitor cell maturation. Supportive care, including serial complete blood count (CBC) monitoring, was provided. Gradual hematological recovery was observed in both cases. Conclusion. Parvovirus B19 infection should be considered in the differential diagnosis of cytopenia in both immunocompromised and immunocompetent individuals. In addition to pure red cell aplasia, the infection can cause thrombocytopenia, leukopenia, and pancytopenia.

Introduction. Streptococcus agalactiae (group B Streptococcus, GBS) is an emerging pathogen associated with adult bacterial meningitis, which has traditionally been associated with neonatal infections. While it primarily affects the elderly and immunocompromised individuals, recent reports indicate a rise in cases among immunocompetent adults. Aim. This study aims to evaluate the clinical presentation, laboratory findings, neuroimaging features, treatment responses, and outcomes of adult patients diagnosed with GBS meningitis at Saveetha Medical College in Chennai. Material and methods. This retrospective case series includes four adult patients diagnosed with GBS meningitis through CSF culture and microbiological analysis. Clinical symptoms, laboratory parameters, neuroimaging findings, and treatment regimens were documented. All patients received standard empirical intravenous (IV) Ceftriaxone, Vancomycin, and adjunctive therapy tailored to their individual clinical needs. Outcomes were assessed and compared with previous studies. Results. The study included four patients (aged 39-64 years), of whom three had no comorbidities. The most common symptoms were fever (100%)and altered sensorium (75%), with one patient (25%) experiencing seizures. CSF analysis indicated neutrophilic pleocytosis, elevated protein, and low glucose levels in all cases, while CSF cultures confirmed the presence of Streptococcus agalactiae. Positive blood cultures were found in 50% of the cases. MRI revealed brain abnormalities in two patients (50%), showing cerebral edema, infarcts, and restricted diffusion. Two patients fully recovered, one developed neurological deficit (limb weakness, cognitive impairment), and one patient ultimately succumbed to the illness (25% mortality). Compared to previous studies, a higher proportion of immunocompetent individuals were affected, and vascular complications were observed in one case. Conclusion. GBS meningitis in adults is increasingly being reported, even among previously healthy adults. The condition often presents with fever, altered sensorium, and neutrophilic pleocytosis, while neuroimaging may reveal vascular complications in some instances. Despite prompt antibiotic therapy, neurological sequelae and mortality continue to raise significant concerns. This study emphasizes the importance of early recognition, optimized treatment strategies, and further research into long-term outcomes in adult GBS meningitis.

The overlapping clinical presentation of tuberculosis (TB) and sarcoidosis presents a significant diagnostic and therapeutic challenge, particularly in TB-endemic regions. This case study reports a 52-year-old female presenting with disseminated granulomatous disease affecting the lungs, lymph nodes, skin, and bone, raising concerns for both TB and sarcoidosis. The diagnostic evaluation included serum angiotensin-converting enzyme (ACE) levels, bronchoalveolar lavage (BAL), whole-body PET-CT, histopathological examination, and CBNAAT testing. Results revealed non-caseating granulomas without evidence of Mycobacterium tuberculosis. Despite the absence of microbiological confirmation for TB, the presence of osteolytic bone lesions further complicated the differential diagnosis. In light of the diagnostic uncertainty, the patient initially received empirical antifungal therapy, followed by a corticosteroid trial, which led to partial clinical improvement. However, the persistence of fever and systemic symptoms prompted the initiation of anti-tubercular therapy (ATT). A marked response to the combination of corticosteroids and ATT supported the possibility of an overlap syndrome, namely tuberculous sarcoidosis. This case highlights the intricate interplay between TB and sarcoidosis and underscores the value of multimodal diagnostic strategies and a stepwise therapeutic approach in endemic settings. It also emphasizes the importance of long-term follow-up to monitor treatment response and assess the risk of relapse or corticosteroid dependence.

Background. Bacteriocin-like inhibitory substances (BLIS) are antimicrobial peptides produced by certain strains of Lactobacillus, with the ability to inhibit the growth and biofilm formation of various bacterial and fungal pathogens. Biofilms are notoriously resistant to conventional antibiotics and represent a significant clinical challenge, especially in chronic infections and device-associated diseases. Exploring natural antimicrobial alternatives such as BLIS has become increasingly important in the context of rising antimicrobial resistance. Objective. This study aimed to investigate the in vitro antibacterial, antifungal, and anti-biofilm effects of BLIS extracted from different Lactobacillus spp., and to evaluate how physical and nutritional factors influence their production and potency. Methods. BLIS extracted from L. rhamnosus, L. acidophilus, and L. plantarum strains was tested using the agar well diffusion method and microtiter biofilm inhibition assays. Optimization steps assessed the influence of pH, carbon and nitrogen sources on BLIS production. Partial purification was performed using ammonium sulfate precipitation and dialysis. Results. This study isolated and characterized eight Lactobacillus strains (L1-L8) from probiotic dairy and healthy women, showing broad antimicrobial activity against bacterial and fungal pathogens. Strain L4 demonstrated particularly strong inhibition (12-33 mm zones) under optimal conditions (pH 4.5-5, yeast extract, glucose). Partial purification of L. rhamnosus bacteriocin revealed exceptional antimicrobial effects (46 mm zone against S. agalactiae) and potent anti-biofilm activity (90.1% reduction against S. haemolyticus). Testing showed significant biofilm inhibition (63.59-90.10%) across pathogens, with highest efficacy against Gram-positive bacteria and moderate effects on Gram-negatives, while Candida biofilms were reduced by 67.29-81.75%. Conclusion. BLIS from Lactobacillus spp. demonstrated significant in vitro anti-biofilm and antimicrobial effects, especially L. rhamnosus. These results support further exploration of BLIS as a potential therapeutic agent against biofilm-associated infections.

Disseminated tuberculosis is characterized by the involvement of two or more non-contiguous sites due to the hematogenous spread of Mycobacterium tuberculosis. This condition can result from a progressive primary infection or the reactivation of a latent focus with subsequent dissemination. A rare and acute form of disseminated tuberculosis, known as Landouzy septicemia, is marked by a sudden onset of septic shock, multi-organ failure, and disseminated intravascular coagulation. This condition, also known as sepsis tuberculosa acutissima, can present significant diagnostic challenges in immunocompromised individuals. We report a case of Landouzy septicemia in an immunocompetent 62-year-old male, who presented with fatigue, fever, bilateral leg swelling, and symptoms indicative of multi-organ involvement. The diagnosis of Landouzy septicemia was confirmed via the GeneXpert MTB assay and a positive Mycobacterium tuberculosis blood culture. Despite aggressive medical intervention following a diagnosis of Landouzy septicemia, the patient succumbed to the condition. This case highlights the diagnostic and therapeutic challenges of Landouzy septicemia, even in immunocompetent individuals, and underscores the importance of early TB recognition in atypical sepsis presentations.

Background. Measles remains a major public health concern due to its high contagion rate and the increasing number of outbreaks in recent years despite the long-standing vaccination programs. This narrative review examines recent epidemiological data and vaccine coverage trends in Europe and selected Eurasian countries, with a focus on the effectiveness and challenges of measles immunization strategies. Methods. Relevant literature from 2014 to 2024 was reviewed using international and regional medical databases (e.g., eLibrary.ru, PubMed). Studies were selected based on keywords related to measles epidemiology, vaccine (in)effectiveness, immune response durability, and immunological phenomena such as waning immunity and immune imprinting. Results. The review highlights inconsistencies in measles case reporting, gaps in surveillance, and the persistence of measles outbreaks despite high vaccination rates in some regions. It also discusses the structure and immunogenicity of the measles virus, herd immunity thresholds, and possible factors contributing to vaccine failure, including waning immunity and individuals with primary vaccine failure (non-responders). This review critically examines the strengths and limitations of current vaccination strategies and reporting systems. It emphasizes the importance of balanced interpretation of available data and the need for further large-scale, independent studies. Improved diagnostics, transparent public health communication, and robust immunization monitoring systems are essential for effective measles control. Phenomena identified more than half a century ago, such as immune imprinting and antibody-dependent enhancement (ADE), are also discussed, as these remain areas of active investigation. Conclusion. While the measles vaccine remains one of key tools in disease control, evolving epidemiological patterns suggest the need to reassess current immunization schedules and consider complementary strategies. Further research is essential to clarify the mechanisms of breakthrough infections and to optimize long-term protection.