Current diagnostic workup for infectious uveitis relies on the use of various immunoassays and polymerase chain reaction (PCR) tests on ocular fluids that are time consuming and not comprehensive, requiring large sample volumes to probe for all causes. To streamline the diagnostic process, improve turnaround time, and target inclusivity, we developed a highly multiplexed pan-ocular-pathogen panel (OcuPan) that can be used for broad-range pathogen detection in only 1 assay, with PCR-level sensitivity and in a timely fashion (12 hours). Here, we assessed the clinical usefulness and performance of this innovative assay as a novel tool for rapid and accurate laboratory diagnosis of infectious uveitis. Laboratory evaluation of a novel diagnostic test and technology PARTICIPANTS AND CONTROLS: A total of 109 patients from 2 centers were included, including 78 infectious uveitis cases and 31 controls. Intraocular samples (n = 108 from patients and 43 from controls) were processed by PCR and the OcuPan diagnostic assay that detects 46 ocular pathogens plus 2 resistance/virulence markers. Clinical sensitivity and specificity, quantification capabilities, and agreement between PCR and the OcuPan assay. The clinical sensitivity and specificity of the OcuPan assay were 50.9% (95% CI, 41.3-60.5) and 100% (95% CI 89.7%-100%), respectively. Sensitivity varied according to the sample matrix tested, with undiluted vitreous having the highest positivity rates (72.4%, 95% CI 55.1-89.7), followed by dilute vitreous (53.3%, 95% CI 34.4-72.3) and aqueous (36.7%, 95% CI 22.7-50.7). There was excellent overall agreement (93.5%) between the OcuPan assay and PCR (kappa of 0.870 ± 0.047; P < .001) with positive (PPA) and negative (NPA) percentage agreements >92% for all targets. PPA was 100% for herpesviruses and Treponema pallidum, whereas the NPA values ranged from 96.6% to 100% for these pathogens. For Toxoplasma gondii, the PPA was 75% and NPA 100%. We also found significant correlation (Spearman ρ = -0.7506, P < .0001) between the quantitative metric for the OcuPan assay and the real-time PCR cycle threshold values. The OcuPan assay offers an all-in-one highly multiplexed detection system for rapid, comprehensive, quantitative, and accurate diagnosis of infectious uveitis.

Parvovirus B19 is a known cause of erythema infectiosum, aplastic crises and severe anemia, especially in patients with hemolytic anemia. The aim of this study was to investigate the clinical and diagnostic parameters of parvovirus B19 infection in children with and without hemolytic anemia and to record the course of case numbers in recent years. We retrospectively included all patients diagnosed with acute parvovirus B19 infection at the Department of Pediatrics, Jena University Hospital, Jena, Germany between 2016 and 2024. Diagnosis was confirmed by positive parvovirus B19 IgM serology and/or PCR testing. Both demographic and clinical data as well as diagnostic parameters were collected and analyzed, focusing on differences between children with and without underlying hemolytic anemia. Among the 40 pediatric patients included in this study, 14 patients were diagnosed with hemolytic anemia. Children with hemolytic anemia suffered from a significantly greater hemoglobin drop and a significantly higher need for transfusion compared to children without hemolytic anemia. A Poisson regression model, adjusted for observation time, was used to compare case rates between 2016 and 2022 and 2023-2024.The model demonstrated a more than fivefold increase in parvovirus B19 cases in 2023-2024 compared to 2016-2022. Children with hemolytic anemia, such as spherocytosis, are at higher risk of severe anemia and require more frequently transfusions during acute parvovirus B19 infection. The observed increase in cases after 2022 suggests changing epidemiological patterns and highlights the need for careful surveillance and early diagnostic and therapeutic interventions in affected children.

SARS-CoV-2 reinfections and subsequent risk of hospital-diagnosed post-acute sequelae in Denmark (2020-2022): a nationwide cohort study.

Circular genome of human bocavirus 1 associated with high load of viral DNA, positive antigen and increased risk of severe pneumonia in children.

Eighteen-year laboratory-based surveillance of human coronavirus OC43 in a single tertiary hospital in the Republic of Korea: Temporal inflection, seasonal stability, and age-dependent risk.

We describe the occurrence of bacteria associated with bovine respiratory disease (BRD) on Austrian beef operations and compare bacterial culture results from double guarded deep nasopharyngeal swab (DNS) and non-endoscopic bronchoalveolar lavage (BAL) samples. Fifty pre-weaned beef calves from 13 conveniently selected commercial beef operations with a history of BRD were sampled between April and August 2024. From each calf a DNS and a BAL sample was obtained and cultured for Pasteurella multocida, Mannheimia haemolytica, Histophilus somni, Bibersteinia trehalosi, Mannheimia spp. and Mycoplasma bovis. Additionally, a M. bovis specific PCR was carried out on all samples. The objectives of this study were to describe and compare the occurrence of bacteria in DNS and BAL samples from Austrian beef calves on beef operations with a history of BRD, and to determine the agreement between M. bovis culture and PCR test results in these samples. In total, 21 bacterial isolates were obtained from 15 of the 50 DNS samples and 22 isolates from 17 of the 48 BAL samples. P. multocida, Ma. haemolytica, H. somni, B. trehalosi and Mannheimia spp. were isolated from 4, 2, 5, 0, and 3 DNS samples, and from 4, 3, 3, 2, and 1 BAL samples, respectively. M. bovis was cultured most frequently, i.e. from 7/50 DNS samples and 9/48 BAL samples. All PCR positive BAL (21/48) samples showed a PCR positive DNS (26/50) as well. Of the PCR positive samples, M. bovis was cultured in 27% of DNS samples and in 43% of BAL samples. A consistent culture result was found in 4/48 calves from both DNS and BAL samples, with M. bovis identified in all cases. The study showed moderate agreement for M. bovis culture (κ = 0.45) and almost perfect agreement for PCR (κ = 0.88) between DNS and BAL, respectively, but poor agreement for other bacteria (κ=-0.91 - -0.03). Common BRD-associated bacteria occur on beef operations in Austria even in calves with mild BRD signs. Additionally, BAL and DNS are suitable for bacterial isolation from the respiratory tract and can provide an overview of the BRD-associated bacteria involved on the farm. We detected a poor agreement between the results of bacterial isolation from DNS and BAL samples in this study, except for M. bovis.

Nationwide follow-up studies of long-term post-acute COVID-19 sequelae compared with sequelae of other infections have been lacking. Using nationwide registers, we analyzed all SARS-CoV-2 PCR test results, prescriptions for anti-infective agents, and hospitalizations with COVID-19 or other infections in Denmark from March 2020 to June 2023, including up to 40-month follow-up. We used Cox proportional hazards models with time-varying exposures to estimate the rates of first-time mental disorders (n = 5,306,132) and general medical conditions (n = 3,517,630). Here we show that positive SARS-CoV-2 PCR tests alone were not associated with clinically relevant increased rates of mental disorders or general medical conditions when compared with negative SARS-CoV-2 PCR tests, nor when compared to individuals with anti-infective prescriptions. Rates of general medical conditions after a positive compared with a negative SARS-CoV-2 PCR test were only elevated for virus types preceding Omicron and for individuals with less than 3 vaccinationdoses. Compared with the general population, the rates of mental disorders or general medical conditions were elevated among hospitalized COVID-19 patients, and particularly when ICU treatment was required. However, when comparing patients hospitalized with COVID-19 to patients hospitalized with non-COVID-19 pulmonary infections or other infections, the rates of mental disorders or general medical conditions were increased to the same extent. In conclusion, severe COVID-19 post-infection sequelae are comparable to sequelae observed after other infections of similar severity.

Community-acquired pneumonia (CAP) remains a significant global health challenge. This review summarizes the major advances in clinical research or CAP between October 1, 2024, and September 30, 2025. Given the high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in China, PCR test for MRMP was recommended in pediatric patients to guide appropriate antibiotic selection. Increased attention is warranted for respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) due to their increasing prevalence and poor prognosis. PSI and CURB-65 scores remain the reliable tools for assessing the severity of CAP, while the SOFA-2 score may offer a promising approach for identifying patients requiring intensive care unit (ICU) admission. Although multiplex PCR (mPCR), targeted next-generation sequencing (tNGS), and metagenomic next-generation sequencing (mNGS) have been widely adopted in clinical practice, current evidence does not demonstrate sufficient benefits in improving patient survival or optimizing antibiotic stewardship. A rational, empirical antibiotic strategy should be individualized according to local pathogen epidemiology, risk of antimicrobial resistance and aspiration, and patient's clinical presentation. Short-course antibiotic therapy guided by "clinical stability" criteria is reliable, yet achieving stability requires more time in elderly patients and cases with comorbidities. Cefpirome and lefamulin are new antimicrobial agents on the market, but further clinical data are needed to support their use in severe cases and elderly patients. Suraxavir marboxil (GP681), a newly antiviral agent drug targeting the polymerase acidic protein of the influenza virus RNA polymerase, has recently been approved in China. Extending the administration of steroids to severe CAP without septic shock should be approached with extreme caution. High level of C-reactive protein may serve as a potential indicator for identifying cases who could benefit from steroids. In addition, RSV vaccines and monoclonal antibodies will emerge as important strategies for preventing RSV pneumonia in high-risk populations.

Abstract The COVID-19 pandemic prompted diverse policies to manage safety in schools, balancing transmission control with educational continuity. This study assessed the impact of an experimental weekly screening protocol through salivary PCR tests compared to nationally implemented reactive strategies (i.e., class closure or class screening upon the detection of a positive case) in 25 primary schools in the Auvergne-Rhône-Alpes region of France during the Delta (November-December 2021) and Omicron (January-February 2022) waves. We used an agent-based model for SARS-CoV-2 transmission in schools parameterized with empirical data characterizing school contacts over time to estimate the contribution of school transmission on overall cases and evaluate the effectiveness of weekly screening in reducing within-school infections and student-days lost. Following the experimental protocol in place, we simulated weekly screening by enforcing a seven-day isolation for each positive case, and the class closure after detection of 3 cases within a class. We parametrized the model to reproduce the Delta and Omicron variants dominant in the study period, accounting for introductions from community surveillance data. We fitted the model to the observed prevalence in 18 schools selected for the analysis. School transmission was estimated to account for 67% (IQR 53-78%) of student cases in Rhône and 67% (IQR 50-82%) in Savoie during the Delta wave, and 52% (IQR 47-57%) in Rhône during the Omicron wave. The experimental weekly screening protocol was estimated to reduce transmission in school by 40% (IQR 18-53%) during the Delta wave and by 39% (IQR 31-46%) during the Omicron wave, compared to the reactive strategies applied in the same period in the rest of the country. Student-days lost under weekly screening were comparable to those under the national reactive strategies during the Delta wave (217 (IQR 93-294) vs. 183 (IQR 68-335) in Rhône; 143 (IQR 57-231) vs. 158 (IQR 101-241) in Savoie). Removing the closure rule halved absences, with only marginal effects on transmission reduction. During the Omicron wave, weekly screening with class closure achieved greater transmission reduction than weekly screening without closure, but at the cost of approximately 6-fold higher disruption. Across both periods, weekly screening without class closure achieved the highest overall efficiency, reflecting a favorable balance between reductions in school transmission and limited educational disruption. Weekly screening proved to be a more structured and effective approach to controlling transmission, mitigating asymptomatic spread and limiting school disruption, while offering the operational advantage of a predictable testing schedule compared to the unpredictability and logistical burden of strengthened reactive screening. These results support the importance of proactive interventions in pandemic response strategies. By explicitly quantifying trade-offs between transmission control and educational continuity, these findings provide evidence to inform the design of future school-based interventions during pandemics.

Dermatophyte infections are common in general practice and occur more often in individuals with type 2 diabetes (T2D), but whether they signal undiagnosed T2D remains unclear. We conducted a register-based cohort study including positive PCR tests for dermatophyte infection from the feet or nails, matched 1:3 to individuals from the same geographic area in Denmark. Those with known diabetes, type 1 diabetes or aged under 20 were excluded. Incidence rates (IRs) and incidence rate ratios (IRRs) for new-onset T2D were estimated using Poisson regression. The final cohort comprised 78,140 individuals, with a median age of 51 years, and 60.8% were male. The IR for T2D was 9.23 per 100 person-years in the exposed group and 9.00 in the unexposed group, with an adjusted IRR of 1.00 (0.91-1.11, p=0.94), indicating no significant association. In a sensitivity analysis excluding unexposed individuals with prior topical antifungal treatment, the IRR increased to 1.15 (1.08-1.23, p=0.001). While the primary analysis showed no significant association, the sensitivity analysis suggested a modest increased risk when exposure misclassification was reduced, supporting dermatophyte infection as a possible early signal of undiagnosed T2D in selected populations.

Antimicrobial resistance (AMR) challenges the effective treatment of bovine respiratory disease (BRD). We evaluated the performance of a recombinase polymerase amplification (RPA) assay, a rapid, isothermal nucleic-acid amplification method, compared with bacterial culture (BC), antimicrobial susceptibility testing (AST), and real-time PCR (rtPCR) testing. We cultured deep nasopharyngeal swabs collected from 800 beef calves within 36 d on feed and at first treatment for BRD for Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni, and screened for these species and Mycoplasmopsis bovis using RPA (M. haemolytica serotypes 1 and 6 only) and rtPCR (M. bovis only). We then tested samples that were RPA-positive for Pasteurellaceae for integrative and conjugative element (ICE) variants containing tetH (ICEtnpA, ICEebrB) and macrolide antimicrobial-resistance genes (ARGs; msrE-mphE, erm42). Bayesian latent class models estimated the clinical sensitivity of BC to be higher than RPA for Pasteurellaceae detection. Both methods were highly specific. RPA sensitivity for M. bovis detection was comparable to rtPCR, but RPA specificity was higher. RPA specificity for detection of macrolide resistance was lower (93.5%) than BC-AST (99.9%), reflecting the identification of ARGs by RPA in non-target bacteria. However, the sensitivity of both tests was low (BC-AST: 20.5%; RPA: 13.3%). Limited RPA sensitivity for Pasteurellaceae identification constrained its downstream performance for detecting ARGs. With our large-scale study, we demonstrated that RPA could detect key BRD-associated pathogens and AMR determinants directly from respiratory samples. Although our RPA results were not sufficient to inform AMU treatment strategies, RPA testing could prove valuable for addressing focused investigations with rapid turnaround.

Tularemia is a rare zoonotic infection most often acquired through exposure to infected animals, arthropods, or contaminated food or water. Diagnosis typically involves serologic or PCR testing, but histopathologic findings can be a clue to the diagnosis. Here, we present a case of inguinal lymphadenopathy in an adolescent patient with a history of multiple animal exposures and possible tick bite. Excisional lymph node biopsy showed necrotizing granulomatous inflammation, and the clinical history, histologic findings, and serologic results together led to the diagnosis of ulceroglandular tularemia. This report adds to the limited available literature on the histopathologic findings of tularemia lymphadenitis and discusses the importance of including this entity in the differential diagnosis for necrotizing granulomatous disease.

Australian pythons are extensively kept in captivity. Since the 1990s, native Australian snakes with neuro-respiratory signs of disease, sometimes fatal, had been presenting to veterinarians in Australia. Research conducted at Murdoch University on some of these snakes resulted in the discovery of a novel virus, now named sunshinevirus (Sunviridae). Widespread follow-up PCR testing of pythons throughout Australia linked sunshinevirus infection to both asymptomatic virus-carriers and pythons showing signs of disease. Experimental infections were conducted to determine whether sunshinevirus infection caused disease in Australian pythons. The experiments demonstrated a causal relationship by fulfilling Koch's postulates, and 5/6 infected animals developed neurological disease. Infected pythons shed virus persistently for months, but control animals remained uninfected. Our findings provide veterinarians with valuable information for the management of sunshinevirus in zoos and private collections.

Differential reason-for-testing may bias test-negative estimates. This study aimed to estimate healthcare worker SARS-CoV-2 risk, with adjustment for healthcare seeking behaviour and unmeasured reason-for-testing. 1.2-million workers in Ontario, Canada were followed for SARS-CoV-2 PCR tests from February 2020 to December 2021. Hazard ratios (HR) were used to estimate SARS-CoV-2 risk in healthcare workers versus non-healthcare workers based on the overall and test-negative sub-cohort. Unmeasured reason-for-testing was examined through probabilistic-bias-analyses. In the test-negative sub-cohort, healthcare and non-healthcare workers had similar risk of SARS-CoV-2. However, healthcare workers had an increased risk in the symptomatic-adjusted (HR: 1.15, 95% CI 1.03-1.40) and asymptomatic-adjusted (HR: 2.83, 95% CI: 1.08-9.07) models. Future test-negative studies should account for potential bias from varying symptomatic and asymptomatic testing groups and may consider using probabilistic-bias-analysis methods when reason-for-testing data is missing.

Diagnosis of infection in patients with sepsis takes days via culture, and appropriate treatment of pathogens is delayed awaiting results. We hypothesize that we can use RNA sequencing from patients with sepsis to identify novel targets for faster nucleic acid-based tests. Cohort study of sepsis patients admitted to the intensive care unit with RNA sequencing was done after obtaining the consent. RNA sequencing data that did not map to the human genome were then aligned to resistance genes and pathogen genomes and used to design novel polymerase chain reaction (PCR) tests. These tests were correlated with blood culture diagnosis and clinical outcomes. Forty-six patients were enrolled, and samples from 87 time points were collected. These samples resulted in 8.6 billion RNA sequencing reads to identify pathogen RNA. PCR target discovery focused on positive blood cultures (n = 40 total) due to Escherichia coli (five samples), Staphylococcus aureus (six samples), and Pseudomonas aeruginosa (three samples) as well as identification of resistance genes. From RNA sequencing reads, 40 targets were defined and tested by quantitative PCR. In a cohort of patients (9 of 46) with available samples, some of the proposed PCRs identified all cases of positive blood cultures ( P. aeruginosa and S. aureus ); E. coli had no positive blood cultures in this cohort. RNA sequencing from patients with sepsis can identify RNA from pathogens causing the infection. This is used to design PCR primers that identify patients with positive blood cultures. Translation of these primers to clinical microbiology machines will allow the diagnosis faster than blood culture.

Whipple's disease (WD) is a rare systemic infection caused by Tropheryma whipplei, often misdiagnosed as seronegative rheumatoid arthritis (RA) due to overlapping clinical features. Delayed diagnosis may lead to multisystem complications, particularly in patients treated with immunosuppressive or biologic therapies. We describe two cases of WD initially misdiagnosed as refractory seronegative rheumatoid arthritis. Both patients were middle-aged men with persistently elevated inflammatory markers and poor responses to multiple biologic treatments. One developed constrictive pericarditis-the first reported to be successfully treated with anakinra-while the other presented with immune reconstitution inflammatory syndrome (IRIS)-related myositis, representing the first reported IRIS myositis in WD. A literature review of 215 cases of WD misdiagnosed as RA or RA-like arthritis (including the two current cases) revealed that 77% were male, and most were seronegative. Among 139 patients with serologic data, 13.6% were RF-positive; of 132 with ACPA results, only 3.7% were positive. Erosive disease was reported in 33%. The median diagnostic delay was 7years (range: 3-35years). Gastrointestinal and constitutional symptoms were the most frequent triggers for reevaluation. Non-invasive PCR testing (saliva, stool) has emerged as a sensitive and practical diagnostic approach, particularly in localized or rheumatology-predominant presentations. WD remains underrecognized in rheumatology practice. Early consideration in patients with refractory seronegative arthritis-especially middle-aged men with persistent inflammation-may prevent unnecessary immunosuppression and life-threatening complications. Based on accumulated evidence, we propose a pragmatic, tiered diagnostic algorithm to guide screening and confirmation of WD in rheumatologic settings, emphasizing the integration of noninvasive PCR-based testing to improve diagnostic yield and reduce delays. Key Points • Whipple's disease should be considered in inflammatory arthritis that is refractory to treatment and often seronegative with elevated CRP despite multiple immunosuppressive therapies. • Structured screening strategies may be warranted in rheumatology settings for patients meeting "high-risk criteria". Further studies are needed to assess the utility and cost-effectiveness of such approaches. • Saliva and stool PCR testing demonstrate high negative predictive value in the literature and are proposed as suitable non-invasive tools for initial screening. • Immune reconstitution inflammatory syndrome (IRIS) is a potentially serious complication following antimicrobial therapy for Whipple's disease, especially in patients previously treated with immunosuppressive agents. Early recognition is critical for appropriate management.

We assessed the diagnostic accuracy of an adapted antibody ELISA (ELISA-Ab) test, originally designed for bulk milk samples but applied on individual DHI-collected milk samples, to identify the bovine leukosis virus infection status of individual cows. Blood real-time PCR (qPCR) and blood lymphocyte count (LC) tests were used for comparison. For the milk ELISA-Ab, secondary objectives included identifying a fit-for-purpose threshold for result interpretation and evaluating whether the test's specificity could be influenced by the sampling technique (i.e., DHI-collected milk samples). Additionally, we evaluated whether the accuracy of each test varied with cow age, categorizing cows as young (2-4 yr old) or older (>4 yr old). In 2023, 8 dairy herds in Québec, Canada, were selected based on their historical within-herd leukosis prevalence, which was estimated to range from 10% to 75%. From all milking cows within these herds (n = 637), milk samples were collected during regular DHI, and blood samples were collected by the research team within one week of the DHI sampling. The indirect IDEXX Leukosis Milk Screening ELISA test was adapted to accommodate individual cow milk samples (as opposed to bulk tank milk samples), whereas an in-house qPCR assay targeting gag-pro-pol gene regions and LC determination were applied to blood samples. Bayesian latent class models were used to estimate the diagnostic accuracy of the tests. An optical density threshold of ≥0.5 for the ELISA-Ab provided an optimal control of the misclassification cost across various leukosis prevalence and, to a lesser extent, false negative to false positive cost ratio scenarios. With this threshold, the sensitivity and specificity estimates (95% Bayesian credible interval [BCI]) were 92% (BCI: 88%, 95%) and 99% (BCI: 96%, 100%), respectively. Sensitivity was higher in cows >4 yr old (99%, BCI: 96%, 100%) compared with cows 2 to 4 yr old (88%, BCI: 80%, 94%). We observed lower ELISA-Ab specificity in cows milked immediately after a positive cow (median: 82%, BCI: 72%, 97%) compared with those milked after a negative cow (median: 91%, BCI: 85%, 99%), suggesting a milk carryover effect due to the sampling technique. This carryover effect had a more pronounced impact on the false positive rate in herds with 30% to 50% leukosis prevalence, with the largest differences observed at the 30% prevalence scenario. However, the overall influence of the carryover effect remained limited. The qPCR test showed a sensitivity of 81% (BCI: 75%, 86%) and a specificity of 100% (98%, 100), whereas the LC test had a sensitivity of 55% (49%, 61%) and a specificity of 96% (93%, 98%). Both the qPCR and LC test accuracy parameters remained similar across age groups. In conclusion, the adapted ELISA-Ab test appears suitable for individual cow testing using DHI-collected milk samples, with higher sensitivity in cows >4 yr old. Its integration into existing milk recording programs provides a practical opportunity for herd-level leukosis monitoring.

Mycoplasma pneumoniae (MP) is a common cause of pediatric respiratory infections, but its diagnosis remains challenging due to nonspecific clinical features and the limitations of conventional laboratory tests. We evaluated the diagnostic and clinical utility of P30 detection using the ultrasensitive TN-cyclon™ assay in 67 hospitalized children with respiratory tract infections. Diagnostic accuracy was compared with bacterial culture, respiratory PCR, and serum IgM testing. Associations between P30 levels and clinical course, laboratory findings, co-infection status, radiographic severity, and macrolide resistance were also analyzed. P30 TN-cyclon™ showed strong diagnostic performance (sensitivity 83.33 %, specificity 92.31 %), outperforming serum IgM (sensitivity 48.08 %) while remaining slightly less sensitive than PCR (sensitivity 93.94 %) but comparable in overall diagnostic performance. ROC analysis yielded an AUC of 0.892, with an optimal cutoff of 0.4 pg/mL for MP infection. Patients with co-infections had lower mean P30 levels than those with mono-infection, though not statistically significant. P30 concentrations were not associated with radiographic severity. In macrolide-resistant cases, higher P30 levels were observed, with ROC analysis identifying 2.45 pg/mL as a potential threshold (AUC = 0.66). P30 is a reliable biomarker for the rapid diagnosis of MP, with superior accuracy to serology and practical advantages over PCR in clinical settings. While its predictive value for macrolide resistance is modest, integration with other biomarkers may enhance its clinical utility. TN-cyclon™ offers a promising tool for timely management of MP infections in children.

Pleural tuberculosis is a common manifestation of extrapulmonary tuberculosis; however, its diagnosis remains challenging in paucibacillary disease, where clinical presentation may be atypical and microbiological tests frequently yield negative results. We report the case of a 27-year-old Syrian male who presented with a one-year history of left-sided pleuritic chest pain and unintentional weight loss. Imaging studies revealed left-sided pleural-based subpleural nodules with mild metabolic activity. Repeated sputum acid-fast bacilli smears, polymerase chain reaction testing for Mycobacterium tuberculosis, and bronchoscopy were all negative. Due to persistent clinical suspicion, thoracoscopic exploration was performed, revealing multiple subpleural nodules on both the parietal and visceral pleura. Histopathological examination demonstrated necrotizing granulomatous inflammation with caseous material, consistent with pleural tuberculosis. The patient was treated with a standard six-month antituberculous regimen and showed favorable clinical recovery. Pleural tuberculosis represents a diagnostic challenge due to its frequent paucibacillary nature and nonspecific clinical presentation, which often results in low sensitivity of conventional microbiological and molecular tests such as direct smears using Ziehl-Neelsen and Auramine staining. In this case, prolonged pleuritic chest pain with minimal systemic symptoms and repeatedly negative sputum smears and PCR delayed microbiological confirmation. Definitive diagnosis was achieved only through thoracoscopic pleural biopsy and histopathological examination. This highlights the limitations of noninvasive investigations in pleural TB and underscores the importance of early escalation to pleural biopsy when clinical suspicion persists despite inconclusive results. This case highlights pleural tuberculosis presenting as subpleural nodules as a diagnostic challenge in the setting of negative microbiological tests. Maintaining a high index of suspicion and early escalation to tissue diagnosis are essential to ensure timely treatment and prevent misdiagnosis.

Vietnamese herbal extracts exhibit potent antibacterial activity against Vibrio parahaemolyticus causing acute hepatopancreatic necrosis disease in shrimp aquaculture.