FTIR spectroscopy of peripheral blood mononuclear cells and machine learning: Spectral biomarkers for bacteremia, focal bacterial, and viral infections.

We report the case of a previously healthy, 6-year-old boy who presented with 2days of generalized body aches. Given a recent viral illness with cough and congestion, the emergency department's initial diagnosis of the condition was viral myositis. He was admitted for pain treatment. During his hospitalization, he developed worsening pain, decreased mobility, and intermittent nocturnal desaturations. The team elicited additional history of snoring and witnessed apneas, which raised concern for obstructive sleep apnea. They consulted pulmonology who was concerned for central sleep apnea and respiratory depression and recommended consulting neurology. Neurology recommended a lumbar puncture, the results of which led to the eventual diagnosis. This case highlights the importance of critical reasoning and knowledge of the pediatric presentation of diseases that affect both adults and children.

Streptococcus pyogenes meningitis is a rare but potentially life-threatening infection in infancy. It can occur as a primary infection or as a complication of viral illnesses such as varicella, which can increase the risk of invasive bacterial disease. We report a previously healthy 3-month-old boy who presented with fever, poor feeding, and a vesicular rash following varicella exposure. Despite outpatient acyclovir therapy, the patient developed dehydration and persistent fever. Cerebrospinal fluid (CSF) analysis revealed markedly elevated white blood cell counts, elevated protein, and low glucose. CSF Gram stain demonstrated gram-positive cocci in pairs, and CSF culture subsequently confirmed Streptococcus pyogenes (Group A Streptococcus) that was susceptible to penicillin, vancomycin, amoxicillin/clavulanic acid, ceftriaxone, teicoplanin and cefotaxime. The patient received broad-spectrum antibiotics, antivirals, and supportive care. Despite escalation to a tertiary pediatric intensive care unit (PICU), he developed progressive cerebral edema, refractory seizures, and loss of brainstem reflexes. Brain death was confirmed by clinical examination, apnea tests, and electroencephalography. On the final day of hospitalization, the patient developed endotracheal bleeding with cardiovascular collapse and could not be resuscitated. This case highlights the fulminant course of invasive S. pyogenes infection in infants, particularly following varicella. These findings underscore the need for early recognition, aggressive management, and potential role of varicella vaccination in preventing secondary bacterial complications.

Beyond a mild viral illness: long-term consequences in travellers with chikungunya from Paraguay.

Continuation versus discontinuation of beta-blockers during hospitalisation for viral pneumonia in patients with COPD and HFrEF

Current State of Button Battery Ingestion Injuries.

BackgroundSince the 2022 outbreak, the number of Monkeypox cases worldwide has been increasing at an alarming rate. As of August 2024, approximately 99,000 people have been infected with the virus. The severity of this situation is further highlighted by the World Health Organization's (WHO) classification of the Mpox virus as a Public Health Emergency of International Concern (PHEIC) due to the increased fatality rate of approximately 3.6% in clade I.ObjectivesTargeting the virus's membrane-bound, enveloped, and extracellular proteins, our goal was to computationally develop and assess a broad-spectrum multi-epitope vaccine that elicits humoral and adaptive immune responses against Monkeypox virus (MPXV) infection.MethodsDuring an outbreak, a pan-genome-based reverse vaccinology approach can offer rapid, practical solutions to enduring problems in experimental vaccine design. The method involved screening 16 monkeypox genomes to identify viral targets, from which viral proteins were selected based on their antigenicity, location, and solubility. Immunoinformatics methods and algorithms were used to extract the proteins’ putative T-cell and B-cell epitopes, which were combined to form several vaccine constructions. The tertiary structure of the chimeric vaccine construct's interaction with Toll-like receptor 4 (TLR4) was thoroughly assessed using the advanced techniques of molecular docking and molecular dynamics simulation.ResultsA pan-genomic analysis identified 80 core genes, which were then screened for proteins suitable for epitope-based vaccine design. From four of these selected proteins, T-cell and B-cell epitopes were extracted to create four distinct vaccine constructs. Appropriate adjuvants and linkers were incorporated into each construct to enhance its potential efficacy. Stability and immunogenicity analyses of each vaccine design yielded promising results. These findings suggest that the vaccine constructs could be effective in preventing monkeypox, warranting further experimental validation and supporting the application of similar strategies to combat other viral illnesses.

Finish-line collapse is a unique phenomenon among athletes and includes a broad working differential. We explore the case of a young, healthy runner who collapsed at the end of a half marathon in the fall from exertional heat illness. This illness covers a wide range of severity from the mild symptoms of heat cramps to heat exhaustion and the extreme of life-threatening heat stroke. Development of these conditions is often associated with patient-specific acquired or congenital vulnerability factors such as extremes of age, fitness, obesity, medication use (eg, antipsychotics, anticholinergics, and amphetamines), or chronic disease. Environmental factors such as high humidity and heat are commonly implicated. Our case explores the possible impact of a recent viral illness on temperature regulation and the development of exertional heat illness in an otherwise well-trained athlete.

Public Insurance Is Associated With Increased Emergency Visits After Craniosynostosis Surgery.

Nurse-Led Recognition of Occult Carbon Monoxide Poisoning Following a Minor Motor Vehicle Collision: A Case Report.

ABSTRACTBackground and AimsMonkeypox virus (MPXV) is gaining attention in the global health community due to its potential for human transmission and similarities to the well‐known smallpox virus. Mpox was first detected in the 1970s and mostly affects Central and West Africa. However, it has caused rare outbreaks in isolated regions worldwide, indicating a possible global health impact.MethodologyIn this review, we will look at several elements of mpox, such as its epidemiological patterns, clinical symptoms in infected individuals, and contemporary diagnostic and preventative techniques. A large portion of this review is also devoted to assessing the efficacy and safety of investigational antiviral medicines like cidofovir and brincidofovir. These assessments are based on controlled experiments conducted in laboratory settings and investigations on animal models.ResultsSo far, the medical profession lacks antiviral drugs, particularly intended to combat mpox. However, research has yielded promising outcomes in the usage of investigational medications such as cidofovir and brincidofovir. In the absence of targeted antiviral therapies, mpox is primarily managed by supportive care. This involves attempts to alleviate symptoms, keep hydration and electrolyte balance, and adopt effective infection control techniques.ConclusionThis review provides an informative and thorough examination of mpox, emphasizing its importance and possible hazards in both public health and therapeutic settings. The lack of specialized antiviral therapies for mpox is a huge gap in our medical arsenal. However, continuous research into new medications provides a glimpse of optimism.

Breakbone fever, a mosquito-borne viral illness, is characterized by a spectrum of hematologic abnormalities, most notably thrombocytopenia, which is often a key determinant in clinical decision-making. Platelet transfusion is frequently administered to correct severe thrombocytopenia and prevent hemorrhagic complications, yet its role in modifying hematologic profiles and improving outcomes in dengue remains controversial. The present review summarizes evidence on platelet transfusion effects on platelet indices and leukocyte dynamics, including counts and immune responses. A comprehensive search across PubMed, Scopus and Web of Science was conducted. Studies meeting defined inclusion and exclusion criteria on platelet transfusion were analyzed. Total 9 studies with 1,849 participants with the mean age of 38.32±11.21 years were included for analysis. Findings indicate that transfusion reliably produces short-term increases in platelet count and plateletcrit, while effects on mean platelet volume and platelet distribution width are variable and often influenced by donor characteristics and storage conditions. Leukocyte alterations post-transfusion are typically modest and transient, with limited clinical relevance. Evidence questions prophylactic transfusion's benefit in stable patients due to risks and costs. Gaps include unclear transfusion thresholds, limited immunologic insight, and poor cost-effectiveness evaluation. Future research should prioritize multicenter trials, mechanistic studies, comprehensive hematologic profiling, and standardized reporting to guide evidence-based transfusion practices. The review emphasizes judicious platelet transfusion to enhance safety and resource efficiency.

Febrile infants ≤ 90 days are at increased risk of serious and invasive bacterial infections (SBIs/IBIs), although viral illnesses account for most febrile episodes. Current management algorithms prioritize bacterial risk stratification, while viral epidemiology is inconsistently integrated into pathways. Aim of this study is to describe age-specific bacterial and viral etiologies, seasonality, temporal trends, and co-infections in febrile infants presenting to a tertiary paediatric emergency department. Retrospective observational study including infants ≤ 90 days evaluated between 2018 and 2025. Infants were stratified into three age groups (≤ 28, 29-60, 61-90 days). Bacterial and viral etiologies, co-infections, seasonal distribution, and temporal trends were analysed. Among 1529 infants, SBI represented 15% of cases. IBI was age-dependent, peaking in neonates ≤ 28 days, whereas viral infections predominated across all groups. Approximately 10% of SBIs occurred with documented viral co-infection. Bacterial infections showed no seasonal pattern, while viral infections demonstrated seasonality, with winter respiratory peaks and summer enterovirus/parechovirus circulation. Viral detections declined during 2020-2021 and rebounded in 2022 whereas bacterial rates remained stable. Viral etiologies display pronounced seasonality, whereas bacterial infections remain non-seasonal. Viral positivity does not exclude SBI and urinalysis should remain routine. An epidemiology-aware approach may support without replacing bacterial risk stratification.

Chikungunya is a mosquito-borne viral illness that is responsible for increased rates of infection and major public health consequences, but no approved vaccine is available yet. This research employed an integrated approach of immunoinformatics and structural vaccinology to develop a promising multi-epitope subunit vaccine candidate. This study focused on the conserved structural polyprotein (NP_690589) for the purpose of epitope predictions. After strict filtering for high antigenicity, safety, and excellent conservation (> 90%), 9 CTL epitopes, 8 HTL epitopes, and 5 B-cell epitopes were selected. The ultimate vaccine formulation, associated with beta-defensin-3 as an adjuvant, demonstrated favorable physicochemical characteristics, robust antigenicity (score 0.7317), and an anticipated global population coverage of 91.79%. Molecular docking revealed very stable binding to human TLR4 and TLR2. TLR4 was further confirmed by 100 ns MD simulation. Thereafter, an immune simulation study revealed the potentiality of the vaccine to augment both innate and adaptive immune responses. Codon optimization was done for efficient expression in E. coli. The mRNA of the proposed vaccine exhibited stability in in vivo conditions. This in silico-designed vaccine candidate suggests it is highly immunogenic, physically stable, and widely protective. It is a strong candidate that now needs experimental validation to move toward preclinical testing.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-026-50862-y.

To determine whether limited versus comprehensive respiratory pathogen panel (RPP) testing in children discharged from the pediatric emergency department (PED) with a viral respiratory illness is associated with 7-day PED return visit rate and return visit management and disposition. We conducted a retrospective cohort study of children 61 days to 18 years of age discharged from a large urban PED between June 1, 2023 to August 31, 2023 and December 1, 2023 to February 29, 2024, who received either limited (SARS-CoV-2, influenza A/B, respiratory syncytial virus) or comprehensive (22 pathogens) RPP testing for a clinically diagnosed viral respiratory illness. We recorded basic demographics, RPP test results, 7-day PED returns, and interventions and disposition during return visits. Of 2346 eligible patients, 1417 (60.4%) received limited RPP testing and 929 (39.6%) received comprehensive RPP testing. No difference was found in the 7-day PED return visit rate for limited testing compared with comprehensive testing after controlling for age, sex, race/ethnicity, insurance, Emergency Severity Index level, and visit season (aOR: 0.96, 95% CI: 0.67-1.38). On return visits, patients who had received limited testing were more likely to undergo additional urine studies (aOR: 2.70, 95% CI: 1.16-6.84); no differences were found in additional blood tests, throat swabs, chest radiographs, IV placements, medication administration, antibiotic prescribing, or disposition. Limited RPP testing is likely sufficient for children with a viral respiratory illness in the outpatient setting, as comprehensive RPP testing was not associated with a reduction in 7-day return visits or return visit interventions.

Acute respiratory infections (ARIs) are frequent childhood occurrences and can result in absences from school or childcare. The effect of pediatric viral ARIs on absenteeism in military-connected children and the subsequent impact to military readiness are not known. This study examines pediatric ARI-related absenteeism among active duty service members (ADSMs) and their children. Participants aged 1 month to 17 years were enrolled in the Pediatric Respiratory Co-infection and Immunologic Response (Peds RECON) study between January 2024 and May 2025. Peds RECON is a prospective, longitudinal cohort study investigating the impact of acute respiratory viral illness in military-connected children. Participants were enrolled before ARI. When symptoms of an ARI developed, participants subsequently underwent respiratory pathogen testing by multiplex PCR. With each ARI, participants completed a 10-day symptom questionnaire that included whether medical care was sought, how many days the child was absent from school or childcare, and how many lost workdays caregivers experienced as a result. Descriptive analyses and non-parametric tests were used to evaluate differences in absenteeism between age, infecting respiratory pathogen, and medical care utilization. Peds RECON study enrolled 47 participants, with 27 ARI evaluations. Symptom questionnaires completion rate was 100%. The child's age or pathogen detection was not associated with increased child absenteeism. However, caregiver absenteeism was higher when the participant was between 0 and 5 years old (P < .002). Among ADSM caregivers, an average of 0.8 (SD 1.0) duty day and a maximum of 3 duty days were lost per pediatric ARI. Health care seeking behavior and clinical setting were not associated with absenteeism. Pediatric ARIs result in child absenteeism as well as adult caregiver absenteeism from work, resulting in lost duty days. Younger children with an ARI are more likely to result in caregiver absenteeism. Given the frequency of infections, common pediatric ARIs likely impact overall ADSM readiness.

Traditional methods to evaluate for pediatric pneumonia include clinical examination and chest radiography (CXR). Point-of-care lung ultrasound (LUS) has emerged as a promising, noninvasive alternative for diagnosing pediatric pneumonia. This review highlights the diagnostic accuracy, benefits, and limitations of LUS compared with clinical assessment and CXR in pediatric patients with suspected pneumonia. Multiple meta-analyses demonstrate that LUS offers high sensitivity (up to 94%) and specificity (up to 96%) in diagnosing pediatric pneumonia, comparable to or exceeding CXR performance. LUS provides significant advantages, including no radiation, bedside applicability, and lower costs. However, challenges remain in standardizing LUS interpretation, particularly distinguishing bacterial pneumonia from viral illness and asthma, where overlapping ultrasound findings are common and require careful clinical correlation. Standardized protocols, clinician training, and diagnostic algorithms are essential to optimize LUS utility in pediatric respiratory care. Further research is warranted to refine differentiation between bacterial and viral etiologies and effectively integrate LUS into routine clinical pathways.

Dengue fever is a mosquito-borne viral illness caused by the dengue virus, primarily transmitted by Aedes aegypti mosquitoes. It remains a major public health concern in tropical and subtropical regions worldwide. Clinical presentations range from mild febrile illness to severe complications such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). In recent years, atypical manifestations, including cardiac involvement, have been recognised. The present case report focuses on a nine-year-old male child from a dengue-endemic area who presented with a high-grade fever, myalgia, abdominal pain, and vomiting. Laboratory findings revealed thrombocytopenia and elevated haematocrit levels, meeting the criteria for dengue with warning signs. During the course of the illness, the child was found to have Mobitz type 1 Atrioventricular (AV) block (Wenckebach phenomenon) on an Electrocardiogram (ECG). This cardiac conduction abnormality, though rare in the paediatric population, was transient and resolved spontaneously without the need for intervention. The patient was managed conservatively with close monitoring, fluid management, and supportive care, ultimately making a full recovery. A repeat ECG showed normalisation of the cardiac rhythm. The present case underscores the importance of recognising cardiac complications in dengue fever, even in children, as they may be self-limiting yet clinically significant. Early detection and vigilant monitoring of warning signs, including electrocardiographic changes, can aid in preventing potential morbidity. Clinicians should maintain a high index of suspicion for such atypical manifestations in dengue cases, especially during outbreaks.

Viral and infectious illnesses can exert profound and enduring effects on population health and well-being. In the aftermath of SARS-CoV-2 infection, post-acute sequelae, collectively referred to as Long COVID, have emerged as a major global health challenge, affecting more than 400 million people and contributing to estimated annual economic costs exceeding $1 trillion. Long COVID encompasses a wide and heterogeneous spectrum of debilitating symptoms, including cognitive dysfunction, sleep disturbances, severe fatigue, and post-exertional malaise. Despite its substantial burden, fundamental uncertainties remain regarding its underlying pathophysiology, the development of robust diagnostic criteria, and the identification of effective therapeutic options. This review synthesises current evidence on the biological mechanisms thought to contribute to Long COVID, spanning immune dysregulation, viral persistence, autonomic dysfunction, microvascular pathology, and other emerging hypotheses. We examine advances and limitations in contemporary diagnostic approaches and critically appraise existing treatment strategies, highlighting inconsistencies and gaps that hinder clinical consensus. By integrating interdisciplinary insights, this review underscores the urgent need for mechanistic clarity, validated diagnostic frameworks, and rigorously evaluated treatment pathways. Addressing these gaps will be essential to developing effective, evidence-based management strategies and mitigating the long-term impact of Long COVID on global health.

Introduction: Lassa fever is a viral haemorrhagic illness that remains endemic in Nigeria, where it presents with symptoms that often resemble other common febrile diseases. Because clinical features alone are insufficient for reliable diagnosis, timely laboratory confirmation is essential for effective case detection and outbreak control. This study developed a mathematical modelling approach to evaluate how rapid point-of-care diagnostic tests could be optimised to improve early detection of Lassa fever in Nigeria. Methods: A cross-sectional analytical study was conducted using nationally available epidemiological data. A deterministic compartmental model based on the Susceptible–Exposed–Infectious–Recovered structure was adapted to incorporate the outcomes of rapid point-of-care testing. An individual-based modelling component was added to simulate diagnostic performance under varying epidemiological and operational conditions. Model simulations were conducted using R statistical software, and sensitivity analyses were performed to assess the influence of diagnostic accuracy parameters. Results: Model simulations showed that increasing the probability that a positive test correctly identifies an infected individual results in earlier and more reliable case detection. When the test had a high true-positive rate, the number of infectious individuals detected rose sharply at the onset of transmission but declined over time as immunity increased within the population. Enhanced diagnostic accuracy consistently reduced the pool of undetected infections and improved downstream control efforts. Conclusion: The modelling suggests that rapid diagnostic testing with high true-positive performance substantially strengthens early detection of Lassa fever and contributes to more effective outbreak management. Prioritising deployment of rapid point-of-care tests with strong predictive value will improve surveillance sensitivity, reduce diagnostic delays, and support national efforts to control Lassa fever transmission. Further operational research is recommended to evaluate implementation in real-world settings.