Background Whether cytomegalovirus (CMV) infection is a cause or consequence of relapse or therapeutic refractoriness in patients with ulcerative colitis (UC) remains debatable. This study aimed to evaluate the frequency of CMV infection and the association between mucosal CMV DNA load and medical management failure in patients with acute severe ulcerative colitis (ASUC). Methods Consecutive patients with ASUC admitted between May 2023 and November 2024 were included. All patients received intravenous (IV) hydrocortisone and ganciclovir when quantitative CMV DNA real-time polymerase chain reaction (RT-PCR) levels were >250 copies/mg and/or histopathology demonstrated CMV infection. The primary outcome was to determine the frequency of CMV infection and to evaluate the association between quantitative CMV PCR levels from biopsy samples obtained during sigmoidoscopy and the risk of medical management failure (IV steroids ± ganciclovir). The secondary outcome was medical management failure, defined as the need for rescue therapy. Results CMV infection was detected in 70 (64.8%) patients with ASUC (44 by RT-PCR alone, one by inclusion bodies alone, and 25 by both methods). Patients with medical management failure had a significantly higher CMV DNA load than responders (44,990,045.76 copies/mg (0-754,359,454.0) vs. 249,720.95 copies/mg (0-9,729,500.00); p < 0.05) and a higher proportion of CMV DNA titres >250 and >1000 copies/mg (p < 0.05). Eight patients developed toxic megacolon, among whom seven (87.5%) had CMV infection. Overall, 17 (15.7%) of the 108 patients with ASUC experienced medical management failure. Conclusion Higher mucosal CMV DNA load was associated with medical management failure in patients with ASUC. Patients with higher CMV DNA loads also had higher frequencies of rescue therapy, toxic megacolon, and mortality.

TERPT and LA-TERPT are widely used minimally invasive procedures for HD treatment. However, the comparative superiority of either technique in terms of postoperative complications and long-term functional outcomes remains uncertain. An SRMA was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261378340). PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, and trial registries were searched from inception to May 3, 2026. Comparative studies evaluating TERPT and LA-TERPT in children with HD were included. The primary outcomes were constipation, soiling, fecal incontinence, BFS, HAEC, anastomotic stricture, and anastomotic leak. Secondary outcomes included operative time and hospital stay. A random-effects meta-analysis was performed using log risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Twenty-three studies involving 1,668 children with HD were included, comprising 980 TERPT and 688 LA-TERPT procedures. No significant differences were observed between TERPT and LA-TERPT for constipation (log RR = 0.11), soiling (log RR = 0.05), fecal incontinence (log RR = 0.05), HAEC (log RR = 0.09), BFS > 17 (log RR = - 0.08), anastomotic stricture (log RR = 0.28), or anastomotic leak (log RR = 0.06). TERPT was associated with a significantly shorter operative time (MD = -43.25 min). Post-op hospital stay was comparable between groups (MD = 0.20 days). Most outcomes showed low heterogeneity, whereas operative time and hospital stay showed substantial heterogeneity. This SRMA found no clear evidence that either TERPT or LA-TERPT yields superior postoperative or functional outcomes in children with RSHD. However, the available evidence is largely observational and has low to moderate certainty, so it should be interpreted cautiously. Until higher-quality evidence becomes available, the choice of surgical approach should be guided by disease characteristics, technical considerations, and surgeon expertise.

Invasive gastrointestinal aspergillosis is rare and typically occurs in immunocompromised hosts. We present a case of a 24-year-old man with intermittent corticosteroid use presenting with diarrhea and abdominal pain found to have toxic megacolon on imaging. He developed colonic necrosis and perforation requiring emergent colectomy. Histopathology revealed invasive Aspergillus with transmural necrosis. His course was complicated by septic shock, acute kidney injury requiring dialysis, and pulmonary candidiasis. Primary colonic aspergillosis in immunocompetent patients is exceedingly uncommon. This case highlights the importance of early consideration of invasive fungal infection and prompt antifungal treatment in a patient with fulminant colitis unresponsive to standard therapy.

The rising incidence of pediatric Clostridioides difficile infection (CDI), particularly in medically complex patients, calls for novel, individualized treatments. While fecal microbiota transplantation (FMT) is well-described for recurrent CDI, this report describes the first pediatric case of fulminant CDI with toxic megacolon successfully treated with FMT. This critically ill patient experienced failure of standard-of-care antibiotics and was a poor surgical candidate due to neutropenia and abdominal radiation for rhabdomyosarcoma. Ultimately, FMT rapidly resolved the patient's symptoms without adverse events. FMT should be considered for pediatric fulminant CDI.

Clostridioides difficile infection (CDI) is a leading healthcare-associated infection worldwide, causing significant morbidity, mortality, healthcare burden, and costs. Clinical manifestations range from mild, self-limiting diarrhea to severe, life-threatening complications such as toxic megacolon and septic shock. Early identification of patients at high risk of severe disease is essential to guide clinical decision-making and optimize therapy. This narrative review summarizes recent epidemiological data, current trends, and known risk factors as clinical context for severity prediction and then examines the utility and limitations of biomarkers that may predict CDI severity, including inflammatory, hematological, fecal, renal, and immune-response biomarkers. While some markers are already used in guideline-based assessment or routine clinical practice (e.g., C-reactive protein, white blood cell count, serum creatinine), they have limited specificity. Other markers emerging from CDI research, including procalcitonin, interleukins, and presepsin, may provide complementary prognostic information. The key challenge is not simply to identify additional biomarkers but to determine which biomarkers are clinically useful, at which stage of CDI progression, and in which patients they add value beyond conventional severity criteria. Validated predictive models integrating combinations of these biomarkers with clinical and microbiological data are needed to support early risk stratification and therapeutic decision-making at the time of diagnosis.

Chagas disease (CD) remains a persistent public health challenge in endemic areas of Brazil, where access to diagnosis, clinical staging, and etiological treatment is often limited. Tremedal and Novo Horizonte, municipalities in the state of Bahia, continue to report chronic cases despite advances in vector control. This study provides a retrospective assessment of CD detection and clinical management in these municipalities prior to the full implementation of the Oxente Chagas Bahia Project. We analyzed individuals tested for CD serology between 2019 and 2023 using data from the Laboratory Environment Manager (GAL) system and electronic primary care records (e-SUS). Sociodemographic characteristics, seropositivity, turnaround time for serological testing, and clinical manifestations were evaluated. A total of 472 individuals underwent serological testing. Testing volume increased markedly in Tremedal over time, whereas Novo Horizonte initiated screening only in 2023. Fourteen individuals (3.0%) tested positive for anti-Trypanosoma cruzi antibodies, all from Tremedal; 13 were included in the clinical analysis. The median age of confirmed cases was 52 years, and 61.5% were female. Among the 13 confirmed cases, the indeterminate form predominated (61.5%), followed by the cardiac and mixed forms (15.4% each) and the digestive form (7.7%) Electrocardiographic conduction abnormalities predominated among individuals with cardiac involvement, while severe digestive manifestations, including megacolon and megaesophagus, were documented in three individuals. Median turnaround time for serological results was longer in Tremedal than in Novo Horizonte. Documentation of etiological treatment with benznidazole was limited, with treatment records identified for only two of the thirteen confirmed cases in the available medical records. These findings highlight the ongoing burden of chronic CD, substantial gaps in screening and treatment, and the need to strengthen diagnostic access and guideline-based management. This study establishes a critical pre-intervention baseline for evaluating the impact of the Oxente Chagas Bahia Project in endemic municipalities.

Short-segment Hirschsprung disease is usually managed by a transanal Soave procedure, sometimes with laparoscopic assistance when proximal mobilization is difficult. We describe endoscope-assisted transanal Soave (ETaS) using a Lap Protector-based access platform without laparoscopy. A 6-year-old boy with constipation since infancy underwent surgery after rectal mucosal biopsies at ages 3 and 5 showed positive acetylcholinesterase staining. Mucosectomy was started 5 mm proximal to the dentate line and extended ~2 cm before closure of the distal cuff. A sealed transanal endoscopic workspace was then created with a LAPPROTECTOR and EZ-Access, allowing deep pelvic dissection and proximal mobilization to the sigmoid-descending junction under stable pneumorectum. After confirmation of mesenteric orientation and ganglion cells on frozen-section full-thickness biopsy, coloanal anastomosis was completed. Operative time was 225 min with minimal blood loss, no abdominal ports, and an uneventful postoperative course. This technique may be a useful option in selected pediatric patients.