Bacterial infections continue to pose a significant health risk with CNS infections contributing to a huge death toll every year. Pathogens such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis are the prominent causes of these infections. Over the recent years, many of these bacteria have become resistant to antibiotics. Phage therapy can complement and supplement the traditional antibiotics as it employs bacteriophages to specifically target pathogenic bacteria. Phages reported in many research studies have been able to successfully target pathogens of the CNS. A number of pre-clinical studies have investigated the pharmacological effectiveness of phage therapy in CNS infections exhibiting adequate transport across the blood brain barrier. These findings have enhanced the confidence in the therapeutic potential of phages as they can inhibit bacterial infections, relieve inflammatory responses and subsequently, treat CNS infections. Phages and endolysins given systemically can be detected and measured in brain and CSF, but the extent of BBB crossing should be further investigated as it has limited direct evidence. However, today, owing to its targeted action, adequate tissue distribution and autodosing, phage therapy can serve as an ideal option for addressing hard-to-treat CNS infections caused by antibiotic resistant bacteria, despite of its challenging pharmacokinetics and formulation development. The current review presents the opportunities and challenges, in terms of pharmacological, therapeutic and regulatory aspects, with relevance to the incorporation of phage therapy in clinical settings for the treatment of CNS infections.

Antimicrobial resistance (AMR) varies across hospitals, patient populations, and care settings, limiting the clinical utility of aggregate surveillance data. We characterized bacterial distribution and antimicrobial resistance at a tertiary hospital in Zigong, southwestern China, during 2023-2025, with explicit stratification by age and care setting.

Lower respiratory tract infections (LRTIs) contribute substantially to morbidity and mortality in the elderly. This study aimed to investigate the distribution and epidemiological features of 10 common respiratory pathogens detected by multiplex Loop-Mediated Isothermal Amplification (LAMP) in elderly patients in Guangzhou, China, from 2022 to 2024, to support precise clinical management, rational antimicrobial use, and regional infection control. A cross-sectional study was performed, enrolling 4,010 elderly patients who underwent respiratory pathogen testing by multiplex LAMP from April 2022 to March 2024 at Guangdong Provincial People's Hospital. Multiplex LAMP was used to detect 10 major pathogens. Epidemiological characteristics were analyzed across genders, ages, seasons, months, specimen types, and departments. At least one pathogen was detected in 1,474 (36.76%) patients. Single detection was dominant (72.18%, 1,064/1,474). The detection rates of Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Stenotrophomonas maltophilia, Escherichia coli, Streptococcus pneumoniae, Mycobacterium tuberculosis complex, and Mycoplasma pneumoniae were 11.40%, 10.75%, 8.10%, 5.89%, 5.41%, 3.02%, 2.66%, 2.64%, 0.56%, and 0.33%, respectively. The detection rates of Kpn and Mtb were significantly higher in males (P < 0.05). Significant age-group differences were observed for Sau, Eco, Pae, Aba, and Sma (P < 0.001) and for Kpn (P = 0.028). Kpn and Pae showed significant seasonal variation (P < 0.05). Pae positivity peaked in April 2022 (36.54%). Significant differences across specimen types and departments were observed for several pathogens (P < 0.05). Haemophilus influenzae was the most prevalent pathogen detected by multiplex LAMP in this elderly cohort in Guangzhou. Single-pathogen detection was the predominant pattern. These findings provide a basis for empirical antimicrobial therapy and regional epidemiological surveillance in elderly patients undergoing respiratory pathogen testing.

Streptococcus pneumoniae (pneumococcus) represents a key clinical challenge, being a major global cause of morbidity and mortality. Typically existing as a nasopharyngeal commensal, pneumococcus undergoes significant metabolic changes during its switch to a virulent pathogen, when it can cause severe pneumoniae, bacteriemia and meningitis. This switch is poorly understood but is thought to be influenced by environmental signals arising from co-infections between pneumococcus and other bacteria as well as viruses in the nasopharynx. This review provides a comprehensive overview of the multi-stage progression of pneumococcal invasive disease, from initial colonisation to host barrier migration. We examine environmental triggers that drive the lifestyle switch from commensal to virulent, highlighting the role of other organisms in this stimulation. In particular, we focus on influenza A and respiratory syncytial virus, as well as other bacteria including Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenzae. Overall, we bring the current understanding of the field into the context of the growing antimicrobial resistance global threat, demonstrating that understanding these complex cross-species interactions is vital for developing clinical interventions against secondary pneumococcal infections.

Background: Oral lichen planus (OLP) is a chronic immune-mediated mucosal disorder frequently accompanied by Candida colonization. However, the polymicrobial interactions and network alterations underlying this association remain poorly understood. This study aimed to characterize bacterial-fungal community changes and interkingdom network dynamics in OLP patients with Candida detection compared to healthy controls. Methods: Unstimulated saliva samples were collected from 24 OLP patients and 31 healthy controls. Bacterial 16S rRNA (V1-V2) and fungal ITS2 regions were simultaneously sequenced using Illumina NovaSeq. Taxonomic profiling, diversity analyses, differential analysis, and intermicrobial correlations were analyzed. Results: Beta diversity analysis revealed distinct community separation between groups (p = 0.001). OLP exhibited increased Bacteroidetes and decreased Firmicutes compared to controls. Health-associated commensals (Streptococcus salivarius, Rothia mucilaginosa, Haemophilus parainfluenzae, Veillonella sp. HMT 917) were significantly depleted, while pro-inflammatory anaerobes (Prevotella, Fusobacterium, Leptotrichia, Selenomonas) were enriched. At the genus level, Candida abundance was modestly higher in the OLP group (1.38%) compared to Healthy (0.94%), and Candida albicans was the most prominent fungal species, with a mean relative abundance of 1.22% in OLP compared to 0.91% in Healthy controls, calculated using the same sample-level denominator as the genus-level values above. Network analysis demonstrated that Candida occupied a central position with expanded connectivity to disease-associated genera. The disease network showed increased negative correlations and dispersed topology, reflecting inversely correlated taxa and reduced modularity (0.206 vs. 0.260 in healthy), consistent with less distinct community compartmentalization. Conclusions: OLP is characterized by compositional dysbiosis and disrupted bacterial-fungal interaction networks. Candida may function as a network hub associated with interkingdom dysbiosis in OLP. These findings suggest that microbiome-targeted adjunctive therapies-including antifungals, selective antimicrobials, and probiotics-warrant investigation for managing Candida-associated OLP.

Background: Pediatric bacterial meningitis remains an important cause of death and long-term neurological disability despite advances in vaccination, antimicrobial therapy, and supportive care. Because host inflammation contributes substantially to secondary neuronal injury, adjunctive corticosteroids have been investigated as a strategy to reduce inflammation-mediated complications. This narrative review aims to critically evaluate the current evidence on corticosteroid therapy in pediatric meningitis, with particular emphasis on acute bacterial meningitis, major clinical and neurological outcomes, treatment timing, pathogen-specific effects, and the impact of changing post-vaccination epidemiology. Methods: A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for relevant publications available up to June 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international guidelines involving patients aged 0-18 years were considered. Evidence was synthesized narratively, focusing on mortality, hearing loss, neurological sequelae, long-term outcomes, safety, causative pathogen, and timing of corticosteroid administration. Results: Adjunctive dexamethasone has not demonstrated a consistent mortality benefit, while evidence concerning hospital stay, intensive care utilization, and healthcare costs remains limited. Its most reproducible benefit is a reduction in sensorineural hearing loss, particularly in Haemophilus influenzae type b (Hib) meningitis. Benefits in pneumococcal meningitis are less consistent, and evidence supporting routine use in meningococcal disease remains limited. Efficacy appears greatest when dexamethasone is administered before or with the first antibiotic dose and may be less pronounced in the post-vaccination era. In tuberculous meningitis, corticosteroids improve survival, whereas routine use is not supported in uncomplicated viral meningitis or cryptococcal meningitis. Conclusions: Adjunctive dexamethasone should be used selectively in pediatric meningitis, with its clearest benefit being hearing preservation in early-treated Hib meningitis. Treatment decisions should account for pathogen, timing, and epidemiological context.

Backyard chickens have become more popular in the United States in recent years. Due to the private nature of owning backyard chickens, information on these flocks is difficult to obtain. Given the large scale of the commercial poultry industry in the United States, and particularly in Pennsylvania, understanding disease risks that backyard chickens face is vital for public health and the health of commercial flocks. Respiratory pathogens are of particular concern for backyard chickens because they are common and can spread rapidly among birds and cause severe disease. Mycoplasma synoviae (MS), Mycoplasma gallisepticum (MG), Avibacterium paragallinarum, and infectious bronchitis virus (IBV) are among the most common respiratory pathogens detected in backyard flocks. This retrospective cross-sectional study analyzed 835 backyard chicken necropsy submissions to the Pennsylvania Animal Diagnostic Laboratory System from September 1, 2019, to August 31, 2024, for the presence of these four pathogens. Avibacterium paragallinarum was found to be the most common pathogen detected, with 229 positive submissions (229/589, 39%). MS, MG, and IBV had 148 (148/502, 29%), 71 (71/631, 11%), and 71 (71/467, 15%) PCR-positive submissions, respectively. A total of 381 submissions were tested for all four pathogens of interest, and 245 of these submissions (64%) were positive for one or more pathogens. Seasonality was significant for detection of A. paragallinarum and IBV, with the greatest number of detections occurring in the summer and fall. Detections were predominantly in birds from southeastern Pennsylvania, coinciding with the most poultry-dense region of the state.

Pediatric skeletal system infections are medical emergencies that may cause severe acute complications and long-term orthopedic disabilities. Because the clinical presentation of septic arthritis and osteomyelitis may mimic non-infectious conditions, early identification of the causative agent and determination of its antibiotic susceptibility profile are cornerstones of patient management. The etiology of childhood skeletal system infections has changed over time, reflecting the implementation of conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae, as well as the development of sensitive molecular detection tests. These novel laboratory methods, coupled with rapid pathogen identification by MALDI-TOF technology, have reduced the fraction of "culture-negative" infections and shortened the turnaround time for pathogen identification from days to hours. However, even today, a substantial fraction of bone and joint infections remains microbiologically unconfirmed. Metagenomic next-generation sequencing holds great promise, but its high cost, the need for technical expertise, and the detection of commensal organisms of dubious significance severely limit its routine use. On the other hand, metagenomic next-generation sequencing has not expanded the list of known pediatric skeletal system pathogens, suggesting that underutilization of current diagnostic methodologies, rather than reduced sensitivity, drives suboptimal diagnosis.

Rapid and accurate detection of pathogens causing meningitis/encephalitis (MEN/EN) is critical to improving clinical outcomes. Multiplex polymerase chain reaction (PCR) enables simultaneous detection of multiple pathogens from the cerebrospinal fluid (CSF), offering advantages over traditional methods. This multicenter study evaluated the performance of the QIAstat-Dx Meningitis/Encephalitis (ME) Panel versus conventional methods, including the BioFire FilmArray ME (BFME) Panel. The CSF samples from patients with suspected MEN/EN along with contrived samples were tested across 13 sites in Europe/USA. Positive percent agreement (PPA) and negative percent agreement (NPA) between the QIAstat-Dx ME Panel and comparator methods were determined. A total of 1,667 clinical samples (1,527 prospective, 140 archived) were tested. Pathogens were detected by the QIAstat-Dx ME Panel in 115 (7.5%) prospective samples, including Streptococcus pneumoniae (1.1%), Haemophilus influenzae (0.5%), Listeria monocytogenes (0.3%), S. agalactiae (0.2%), Escherichia coli K1 (0.1%), Neisseria meningitidis (0.1%), S. pyogenes (0.1%), enterovirus (1.5%), human herpesvirus-6 (1.0%), herpes simplex virus-2 (0.9%) and -1 (0.3%), varicella zoster virus (0.7%), cytomegalovirus (0.3%), human parechovirus (0.3%), and Cryptococcus gattii/neoformans (0.4%). Overall PPA versus BFME (n = 1,664) was 85.4%, increasing to 95.3% after discordance resolution. PPA was 100% for N. meningitidis, S. pneumoniae, and S. agalactiae. Overall NPA was 99.9%. Among 1,154 contrived positive samples, only 27 (2.3%) incorrect results were observed. The QIAstat-Dx ME Panel demonstrated high concordance with BFME, supporting its use as a reliable, fully automated multiplex PCR platform for rapid diagnosis of community-acquired MEN/EN.IMPORTANCEThis multicenter study demonstrated that the QIAstat-Dx ME Panel delivers clinical performance comparable to that of the BioFire FilmArray ME (BFME) Panel, supporting its validity as a reliable syndromic molecular diagnostic tool for MEN/EN. With its broad pathogen coverage, rapid turnaround time (TAT), and the ability to provide amplification curves and Ct values, the QIAstat-Dx ME Panel offers a valuable option for broad and timely detection of bacterial, viral, and fungal CNS pathogens. When used alongside the SoC diagnostic methods, this panel has the potential to improve early diagnosis, guide targeted therapy, and support effective clinical management of patients with suspected MEN/EN.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection profoundly affects the upper respiratory tract, yet the dynamics of the resident virome across different stages of Coronavirus Disease 2019 (COVID-19) and recovery remain poorly understood.

Older adults are vulnerable to influenza-like illness (ILI). To study how infection shapes the respiratory microbiota, we profiled nasopharyngeal (NP) and oropharyngeal (OP) communities alongside local immune mediators in adults aged 60-88, comparing asymptomatic, ILI, and recovery states. NP communities clustered into three community state types (CSTs): Moraxella-dominated (CST-1), Haemophilus/Streptococcus/Staphylococcus-associated (CST-2), and Corynebacterium/Dolosigranulum-dominated (CST-3). During infection, compositional shifts were restricted to the NP niche, where CST-1 and CST-2 were more frequent. Streptococcus, Haemophilus and Moraxella were positively associated with inflammatory and interferon-related mediators, including IL-6, CXCL9 and CXCL10, while Corynebacterium showed negative associations. Immune activation was strong in the NP but limited in the OP, and stayed above healthy levels at follow-up, suggesting incomplete recovery. NP composition was also associated with symptom burden, viral and bacterial co-detection and smoking status. These site-specific microbiota-immune relationships identify the nasopharynx as the primary site of immune modulation during ILI in older adults.