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Background: Candidozyma auris has emerged globally as a multidrug-resistant pathogen with high rates of colonization and potential for invasive infection. Understanding the progression from colonization to infection and associated outcomes is limited. This study aimed to describe the characteristics and outcomes of C. auris-colonized patients and identify risk factors for progression to infection. Methods: We conducted a single-center retrospective case–control study of hospitalized patients with documented C. auris colonization at a tertiary care center (2018–2024). Cases were patients who progressed to a fungal infection (infection group), while controls remained colonized (colonized group). Demographics, comorbidities, device use, prior antimicrobial exposure, microbiologic characteristics, and outcomes were compared. Results: Among 334 C. auris-colonized patients, 44 (13.2%) progressed to infection. The median age was 66.4 years. Those in the infection group had higher Charlson Comorbidity Index (5.9 ± 3.1 vs. 4.79 ± 2.7, p = 0.0112) and were more likely to have central line (90.9% vs. 71.7%, p = 0.0067), mechanical ventilation (77.3% vs. 60.34%, p = 0.0306), parenteral nutrition (6.82% vs. 1.72%, p = 0.0395), and abdominal surgery (13.64% vs. 4.83%, p = 0.0217). In multivariate analysis, abdominal surgery was the only independent predictor of infection (OR 4.08; 95% CI 1.1–15.1; p = 0.03). In-hospital mortality was significantly higher in the infection group (65.9% vs. 33.1%, p < 0.0001). Conclusions: Approximately one in eight colonized patients developed C. auris infection. Recent abdominal surgery independently predicted progression, while infection was associated with higher mortality and prolonged hospitalization, underscoring the need for targeted prevention in high-risk patients.

Due to their widespread geographic distribution and frequent outbreaks, mosquito-borne flaviviruses, such as DENV (DENV), Zika virus (ZIKV), Japanese encephalitis virus (JEV), yellow fever virus (YFV), and West Nile virus (WNV), are considered significant global public health threats and contribute to dramatic socioeconomic imbalances worldwide. The global prevalence of these viruses is largely driven by extensive international travels and ecological disruptions that create favorable conditions for the breeding of Aedes and Culex species, the mosquito vectors responsible for the spread of these pathogens. Currently, vaccines are available for only DENV, YFV, and JEV, but these face several challenges, including safety concerns, lengthy production processes, and logistical difficulties in distribution, especially in resource-limited regions, highlighting the urgent need for innovative vaccine approaches. Nucleic acid-based platforms, including DNA and mRNA vaccines, have emerged as promising alternatives due to their ability to elicit strong immune responses, facilitate rapid development, and support scalable manufacturing. This review provides a comprehensive update on the progress of DNA and mRNA vaccine development against mosquito-borne flaviviruses, detailing early efforts and current strategies that have produced candidates with remarkable protective efficacy and strong immunogenicity in preclinical models. Furthermore, we explore future directions for advancing nucleic acid vaccine candidates, which hold transformative potential for enhancing global public health.

Brucellosis is the most common zoonotic disease worldwide, with significant heterogeneity in the literature regarding the risk factors and rate of relapse, we reviewed cases of confirmed brucellosis in Saudi Arabia, looking at the rate of relapse, characteristics of relapse cases, and compared it to the existing literature. A retrospective analysis was conducted on confirmed cases of brucellosis. Cases with suspected relapse, as noted in medical charts, were identified. A detailed review of clinical and laboratory findings, along with associated outcomes, was performed to confirm instances of brucellosis relapse. Descriptive analysis was then undertaken to characterize confirmed relapse cases. Of the 1,049 confirmed brucellosis cases over eight years, 73 cases were initially suspected of potential relapse. After excluding misdiagnosis and repeat exposures cases, there were 37 cases confirmed as relapses, resulting in a relapse rate of 3.53%. When considering only cases where patients adhered to the full treatment regimen, 10 patients were considered as \"true relapse\" cases, reducing the relapse rate to 0.95%. Among the 10 true relapse cases, four initially presented with bacteremia, and all ten patients had elevated Brucella titers. None had focal infection initially. All true relapse patients received Doxycycline as the core agent, with rifampin or streptomycin as a second agent. Upon relapse, four patients developed spondylitis, and three had bacteremia. Eight patients received an extended duration and/or triple therapy, and only one patient relapsed for a third time with an infected cardiac device. No mortalities were recorded within 90 days of completing relapse treatment. The relapse rate observed in this study is lower than previously reported in the literature. Further research on brucellosis relapse should prioritize investigating treatment adherence and establishing a standardized definition, which might help address the current discrepancies in reported data.

Background Patients’ race and ethnicity may play a role in mortality from Covid-19. Studies in China, the US, and Europe have been conducted on the predictors of Covid-19 mortality, yet in the EMR countries, such studies are scarce. Therefore, we aimed to describe the hospitalization rate, ICU-admission, and in-hospital mortality of Covid-19 and predictors of in-hospital mortality in Saudi Arabia. Methods E-medical records were examined for all Covid-19 patients diagnosed in five tertiary hospitals affiliated with the Saudi-National Guard-Health Affairs during March 21, 2020, and September 12, 2021, based on a positive SARS-CoV-2 RT-PCR test, (n = 35,284). Data were collected on patients’ characteristics, comorbidities, laboratory findings, hospitalization, ICU admission, and in-hospital and overall mortality. Logestic regressions were used to identify the independent predictors of in-hospital mortality. The best laboratory parameters cut-off values to predict in-hospital mortality were identified using the area under the receiver operating characteristic curve (AUC). Significance was considered at p < 0.05. Results Of all 35,284 Covid-19 patients, 81.8% were adults and 21.7% were hospitalized. Compared to non-hospitalized patients, hospitalized patients were more of female gender (52.1% versus 47.3%, p < 0.001) and had higher mean age (p < 0.001), higher mean BMI (p < 0.001), and higher rates of: diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), cancer (p < 0.001), COPD (p < 0.001) and asthma (p = 0.011). The study showed 3.1% overall case-fatality, 20.3% ICU admission rate, and 9.7% in-hospital mortality. Predictors of in-hospital mortality among adult patients were; patients’ age ≥ 70 years (OR = 6.93, 95% CI 1.94–24.79), ischemic heart disease (OR = 1.80, 95% CI 1.05–3.09), ICU admission (OR = 24.38, 95% CI 15.64–38.01), abnormal C-reactive protein “CRP” (OR = 1.85, 95% CI 1.08–3.16), abnormal D-dimer (OR = 1.96, 95% CI 1.15–3.36), lymphopenia (OR = 2.76, 95% CI 2.03–3.3.76), high neutrophil count (OR = 2.10, 95% CI 1.54–2.87), and abnormal procalcitonin (OR = 3.33, 95% CI 1.88–5.90). The best laboratory parameters cut-off values to predict in-hospital mortality were CRP > 72.25 mg/L (AUC = 0.64), d -dimer > 1125 µg/L (AUC = 0.75), neutrophils count > 5,745 × 10^9/L (AUC = 0.70), lymphocytic count < 1.10 × 10^9/L (AUC = 0.72), and procalcitonin > 0.18 ng/mL (AUC = 0.76). Conclusions Rates of hospitalization, ICU-admission, in-hospital mortality and overall case fatality were nearly comparable to the rates in western countries. Early interventions are necessary for high-risk Covid-19 patients, especially elderly patients and those with cardiac diseases.

[This corrects the article DOI: 10.3389/fcimb.2025.1734182.].

Non-coding RNAs (ncRNAs), including microRNA (miRNA), long non-coding RNA (lncRNA) and circular RNA (circRNA), serve as key regulatory molecules in the context of viral infection. They play dual roles by modulating host immune responses and influencing viral replication, persistence, and disease progression. Numerous ncRNAs have been implicated in infections caused by viruses such as HCV, DENV and SARS-CoV. This review highlights the biogenesis and multifaceted functions of both host-encoded and virus-encoded ncRNAs in shaping host-pathogen interactions. It also examines their potential as novel biomarkers and therapeutic agents for viral infections. We discuss translational applications such as Miravirsen, a miRNA inhibitor that reached clinical trials for Hepatitis C Virus (HCV) and diagnostic relevance of lncRNA NEAT1 in SARS-CoV-2 infection. In the end, we have also addressed the current challenges and limitations involved in translating research observations of ncRNAs to clinical outcomes.

Background Enterovirus D68 (EV‐D68) has emerged as a significant respiratory and neurological pathogen, particularly affecting children with severe respiratory illnesses and acute flaccid myelitis. Understanding the interaction between EV‐D68 and the host immune system is crucial for developing effective prevention and treatment strategies. Objectives This review aims to examine the immune response to EV‐D68, its mechanisms of immune evasion, and the current progress in vaccine and antiviral development while identifying gaps in knowledge and future research directions. Methods A comprehensive review of the literature was conducted, focusing on the innate and adaptive immune responses to EV‐D68, its strategies for immune evasion, and advancements in therapeutic interventions. Results Pattern recognition receptors detect EV‐D68 and trigger antiviral defenses, including interferon production and activation of natural killer cells. B cells generate antibodies, while T cells coordinate a targeted response to the virus. EV‐D68 employs mechanisms such as antigenic variation and disruption of host antiviral pathways to evade immune detection. Progress in vaccine and antiviral research shows promise but remains in the early stages. Conclusions EV‐D68 represents a complex and evolving public health challenge. Although the immune system mounts a robust response, the virus's ability to evade these defenses complicates efforts to control it. Continued research is essential to develop effective vaccines and antivirals and to address gaps in understanding its pathogenesis and immune interactions. Implications A multidisciplinary approach is critical to improving diagnostic, preventive, and therapeutic strategies for EV‐D68, ensuring better preparedness for future outbreaks. This review provides a comprehensive overview of the immunological responses to Enterovirus D68, offering valuable insights for researchers, clinicians, and public health professionals working towards effective prevention and control strategies.

To evaluate the outcome of complicated osteoarticular brucellosis. A retrospective chart review was conducted at King Abdulaziz Medical City (KAMC), in Riyadh, Saudi Arabia. All patients aged more than 14 who have been diagnosed with complicated brucellosis with osteoarticular disease between July 2016 and December 2022 were included. A total of 82 (10.7%) patients met the criteria, with a male predominance of 66 (80.4%), and their mean age was 56.4 ± 19.3 years. A positive blood culture was found in 33 (40.2%). The most common clinical presentation was fever (57.3%). All patients received a doxycycline-based regimen except one. 62 (75.60%) patients were treated with three or more medication regimens, while 20 (24.40%) patients received two drug regimens. The mean duration of therapy was 94.2 days for two-drug therapy and 116.4 days for three-drug therapy. A total of 78 out of 82 (95.1%) cases were cured at the end of treatment. Unfavorable outcomes were documented in four cases (two relapses and two treatment failures). Neither using three drugs regimen nor longer duration of therapy was associated with better outcome. Unfavorable outcomes have been noticed to be minimal in our cohort of patients with osteoarticular brucellosis, treated mainly with a three-drug regimen and a longer duration of therapy.

Prophages are bacteriophages that integrate their genomes into the bacterial chromosome. This research aimed to analyze and characterize prophages integrated into 44 Pseudomonas aeruginosa strains isolated from tertiary hospitals in Saudi Arabia. A total of 97 intact prophages were identified among clinical strains, with 16 prophages found present in more than one strain simultaneously. All prophages were found to have lengths ranging from 7.7 kb to 74.1 kb, and their GC content was found to be between 49.91% and 64.9%. Our findings show that prophages are present in the majority of the isolated P. aeruginosa strains (41 out of 44). Additionally, several proteins related to viral defense (toxin/antitoxin modules and proteins against restriction-modification enzymes) were identified, supporting the idea that prophages influence bacterial pathogenesis and anti-phage defenses.

Immunoglobulins (Igs) play a crucial role in host’s defense and in developing therapies against inflammatory diseases and cancer. Herein, we first studied the relative distribution of IgM and IgG in mouse models with acute or chronic inflammation. We found that IgM showed a more selective distribution towards inflammation sites than IgG. Similarly, in a tumor-bearing mouse model, IgM showed a higher tumor-to-blood or -to healthy organs ratio than IgG. We hypothesized that the difference in the sizes between IgM and IgG may have contributed to the differences in their relative distribution, which was supported by using an IgG nanoparticle system that was similar to IgM in size. To confirm the findings in clinics, we investigated IgM and IgG levels in the blood and bronchoalveolar lavage fluid (BALF) of patients diagnosed with fungal pneumonia and showed that the relative distribution of IgM was significantly higher than IgG in the BALF samples as compared to that in serum. Such an understanding of our immune system at the nano-level may help us develop more effective biotechnological interventions against inflammatory diseases and cancers. Graphical Abstract