Expert Review of Anti-infective Therapy

Tonutti, Antonio; Polverini, Davide; De Nicola, Stella; Ceribelli, Angela; Soleri, Matteo; De Santis, Maria; Aghemo, Alessio; Selmi, Carlo; Pugliese, Nicola

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2442475pmid: 39749733

Introduction Hepatitis C virus (HCV) infection represents a significant global health burden, particularly due to its extrahepatic immune-mediated manifestations, such as mixed cryoglobulinemia, associated vasculitis (CryoVas), and non-Hodgkin B-cell lymphoma (B-NHL), which pose significant challenges. The advent of direct-acting antiviral (DAA) has changed the therapeutic landscape for HCV-related complications. Areas covered This review explores the evolving epidemiology and management of HCV extrahepatic manifestation and lymphoproliferative disorders in the era of DAAs. It examines the efficacy of DAAs in controlling CryoVas and their complex role in HCV-related B-cell lymphoma. The literature search included studies on the immunological dynamics between HCV, CryoVas, and lymphoma, focusing on the impact of sustained virological response (SVR) on immune dysregulation, relapse risk, refractory disease, and patient stratification based on risk profiles. Expert opinion DAAs have significantly improved the management of HCV-related CryoVas and autoimmune manifestations, but remain a challenge in refractory cases and the risk of lymphoma. Future strategies should focus on refining risk stratification and integrating new therapeutic approaches to better address immune dysregulation and associated complications.

Ibe, Chibuike; Otu, Akaninyene; Pohl, Carolina Henritta

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2448844pmid: 39754518

Introduction There is a rise in the emergence of multidrug resistant fungal pathogens worldwide, including in Africa. Method This systematic review summarized the published data on the mechanisms and epidemiology of antifungal resistance in Candida species in Africa between 2000 and early 2024. Result Seventeen reports from seven African countries were analyzed but due to the paucity of data, the prevalence of antifungal resistant Candida isolates in Africa could not be estimated. However, a total of 1376 (out of 2812) resistant isolates were documented with South Africa reporting the most. Candida auris was the most reported species with multidrug and pandrug resistant strains documented in South Africa. Generally, azoles but not posaconazole or isavuconazole, resistance was reported. Fluconazole resistant isolates harbored Erg11 Y132F, VF125LA and K177A/R/N335S/E343D substitutions, MRR1 gain of function mutations or efflux pump protein over expression. Resistance to members of the echinocandin family was also reported and Fks1 S639P substitution was observed. Conclusion The data highlight that the increasing Candida species resistance to cell wall and cell membrane active antifungals is a cause for serious concern in Africa. There is need to increase antifungal research capacity and mount epidemiological surveillance to determine the true scale of the problem. Prospero registration number CRD42024550231.

Shabil, Muhammed; Bushi, Ganesh; Apostolopoulos, Vasso; Alrahbeni, Tahani; AL-Mugheed, Khalid; Khatib, Mahalaqua Nazli; Gaidhane, Shilpa; Zahiruddin, Quazi Syed; Kukreti, Neelima; Rustagi, Sarvesh; Alhashem, Yousef N.; Alotaibi, Jawaher; Kaabi, Nawal A. Al; Sulaiman, Tarek; Alturaifi, Hussain R.; Khamis, Faryal; Rabaan, Ali A.; Satapathy, Prakasini

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2448721pmid: 39745180

Introduction Dengue fever is a significant health concern globally, especially in tropical regions. Identifying reliable markers for severe dengue, such as hypoalbuminemia, is crucial for early diagnosis and treatment. Methods This review systematically explores the association between hypoalbuminemia and severe dengue. We searched databases including PubMed, Embase, Scopus, Cochrane, and Web of Science until 28 December 2023, focusing on studies that reported albumin levels in dengue patients. Our selection criteria aimed at observational studies, from which data extraction and quality assessment were performed using Nested- Knowledge and the Newcastle-Ottawa Scale. Results A meta-analysis of 17 studies involving 974 severe and 18,496 non-severe dengue patients identified a standardized mean difference (SMD) in albumin levels of −1.625 g/dL (95% CI: −3.618 to −0.369). Subgroup analysis indicated more pronounced hypoalbuminemia in pediatric patients, with a pooled SMD of −1.08 g/dL (95% CI: −1.71 to −0.45). Our analysis demonstrated the link between hypoalbuminemia and severe dengue, indicating a significant pooled relative risk of 2.286, within 95% CI 1.308 to 3.996. Conclusions The study confirms hypoalbuminemia as a significant predictor of severe dengue. Recognizing hypoalbuminemia in dengue patients can aid clinicians in forecasting the severity, potentially improving patient outcomes through targeted therapeutic strategies.

Bonifaz, Alexandro; García-Sotelo, Roxana S.; Lumbán-Ramirez, Fabiola; Vázquez-González, Denisse; Inclán-Reyes, José Iván; Sierra-Garduño, Mario Eduardo; Araiza, Javier; Chandler, David

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2448723pmid: 39760435

Introduction Mycetoma is a chronic granulomatous infection, common throughout tropical regions, and is considered a neglected disease that mostly affects impoverished populations. Mycetoma is divided into eumycetoma, caused by fungi, and actinomycetoma, caused by filamentous bacteria. Clinical presentation is distinctive, and making the diagnosis is usually not difficult; however, access to safe and effective treatments is a major challenge. There is not a single best treatment, with the choice of treatment depending on etiology, severity and extent of disease, and patient comorbidities. Areas covered The following topics regarding actinomycetoma are discussed. I) Background information on actinomycetoma, and etiology. II) Differences between actinomycetoma caused by Nocardia, and cutaneous nocardiosis. III) Review of the treatment options for actinomycetoma, caused by three species – Nocardia, Actinomadura, and Streptomyces. IV) Experience using linezolid in the treatment of mycetoma caused by Nocardia spp. and Actinomadura madurae. Expert opinion Multiple treatment regimens for actinomycetoma were discussed according to the causative agent. Experience in using linezolid in combined therapy for actinomycetoma caused by Nocardia in which conventional treatment options failed was also presented. The first case report of treatment with linezolid for mycetoma caused by Actinomadura madurae is presented in this article.

Srivastava, Shriyansh; Jayaswal, Nandani; Kumar, Sachin; Rao, G. S. N. Koteswara; Budha, Roja Rani; Mohanty, Aroop; Mehta, Rachana; Apostolopoulos, Vasso; Sah, Sanjit; Bonilla-Aldana, D. Katterine; Ulloque-Badaracco, Ricardo; Rodriguez-Morales, Alfonso J.

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2443920pmid: 39688174

Introduction The emergence of the H3N2 influenza virus in 1968 marked a significant event as it crossed the species barrier. This shift led to a pandemic, resulting in the deaths of one million people globally and highlighting the virus’s severe impact on older individuals due to antigenic drift. Area covered This review comprehensively examines the virological characteristics, evolutionary trends, and global epidemiology of the Influenza A (H3N2) virus. It delves into vaccination strategies, antiviral interventions, and emerging diagnostic approaches. The impact of antigenic variation on vaccine design and effectiveness, seasonal outbreak patterns, and pandemic potential are explored. Additionally, the interplay between viral factors and host immune responses is assessed. Researchers are actively investigating innovative strategies to enhance vaccine efficacy against H3N2 mutations, such as precise antigenic material administration, controlled release patterns, understanding immune system mechanisms, and glycan engineering. Expert opinion The ongoing mutational dynamics of the H3N2 virus necessitate regular vaccine updates, as advocated by the WHO. Research in the Western Pacific region underscores the need for heightened awareness and effective control strategies. Evaluating antiviral therapies and addressing drug resistance requires multidisciplinary approaches involving researchers, healthcare professionals, and policymakers. This comprehensive understanding of H3N2 is vital for improving public health interventions and preparing for future influenza challenges.

Katsarou, Angeliki; Tzikopoulou, Maria; Papadopoulos, Dimitrios; Palioura, Sotiria; Falagas, Matthew E.

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2448143pmid: 39727178

Introduction Tedizolid is a novel antibiotic of the class of oxazolidinones. This review evaluates the published literature on the optic and peripheral neuropathy associated with short and prolonged administration of tedizolid. Areas covered A review of published data from 4 databases was conducted, regarding the development of optic and peripheral neuropathy in patients who received tedizolid for short or prolonged duration. A total of 1,212 records were screened; 33 were included in this review. No peripheral or optic neuropathy cases were reported in 6 randomized controlled trials that studied tedizolid use for a short course. In contrast, 2 cases with optic neuropathy (1 not supported by objective findings) in 87 patients of the prospective studies were identified. Additionally, in a total of 277 patients who participated in the 6 retrospective studies, 9 adverse events related to optic or peripheral neuropathy and 1 case with foot drop in 22 patients of the relevant cases reports were recorded. Expert opinion The available data suggests that the safety profile of tedizolid is favorable, especially when given for a short time. However, more clinical studies are needed regarding its long-term use, given that the neurotoxicity induced by oxazolidinones may be time and dose-dependent.

Kelleni, Mina T.

2025 Expert Review of Anti-infective Therapy

doi: 10.1080/14787210.2024.2432277pmid: 39560106