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Purpose: Describe a case of rapidly diagnosed Listeria monocytogenes endophthalmitis, with a clearly established route of endogenous seeding, treated with dual antibiotics, with outcomes better than many reported.

Observations: A 79-year-old male developed Listeria monocytogenes endophthalmitis after a gastrointestinal infection with an associated bacteraemia. Rapid microbiologic diagnosis was obtained via matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). The case was managed with 3 weeks of benzylpenicillin and 6 weeks of trimethoprim-sulfamethoxazole. Visual acuity in the affected eye was preserved with a mild to moderate residual deficit.

Conclusion: Clinicians should be aware of the potential for Listeria monocytogenes endophthalmitis associated with preceding gastrointestinal symptoms. Better outcomes are associated with rapid diagnosis, and the use of dual antimicrobial therapy should be considered.

Background: Tularemia is a re-emerging disease in Sweden, frequently affecting working-age individuals and often resulting in prolonged recovery times. The disease-related economic impact has not previously been investigated outside bioterrorism scenarios. In this study we assess the economic burden associated with endemic tularemia in Sweden.  

Method: Data on primary care visits, hospital admissions, and sick leaves were collected from participants with serology-confirmed tularemia through questionnaires and electronic medical records in Northern Sweden from 2011 to 2021. The dataset was enhanced with national cost-of-care data for tularemia in primary and specialist care from NordDRG (Diagnosis Related Group; 2021-2023), and sickness benefit data from the Social Insurance Agency (2011-2023). Total direct and indirect costs were estimated by integrating these data sources and adjusted for inflation to 2025 levels. Average salary and labor productivity (Gross Domestic Product [GDP] per person employed) was assumed.

Results: Among participants (n=294), the mean age was 52 years; 68.1% were employed or job-seeking, with 71.3% of these reporting sick leave during illness. Healthcare costs were primarily driven by general practitioner visits (mean 1.74 visits; 5,125 SEK per participant [p.p.]) and hospital admissions (15.6% of participants; mean 4.7 days; 11,268 SEK p.p.) with relatively low complexity (mean DRG weight 0.8), while antibiotic treatment and diagnostics were less costly (figure 1). Indirect costs included sick pay (≤14 days; 70.0%; 4,106 SEK p.p.), sickness benefit (>14 days; 30.0%; 5,835 SEK p.p.), and lost GDP-based productivity, and made up 75.7% of total costs (78,503 SEK p.p.).

A mean of 394 (range 87-1,048) tularemia cases per year were reported to the Swedish Public Health Agency between 2011-2023. The estimated annual societal cost of human tularemia infection was 30.9 million SEK (range 6.8-82.3 million SEK). 

Conclusion: Tularemia imposes a significant socioeconomic burden on society primarily through morbidity and prolonged recovery. Regional outbreaks could have detrimental effects on local economy and public services. Further evaluation of the cost-effectiveness of primary and secondary preventive measures is required. 

Background: Tularaemia is a geographically widespread disease affecting animals and humans. In Sweden, transmission patterns are complex, occurring mainly through mosquito vectors. We investigated human exposure and whether passive tularaemia surveillance (reported by the public) of deceased wild hares could be used to temporally and geographically predict outbreaks among humans. 

Methods: A survey was sent to the 830 cases of reported tularaemia in Norrbotten county, Sweden, between 2011-2021; and 313/415 (75.4%) respondents with laboratory-evidence of tularaemia were included. Geographic data from human infections in 2019 (n=54) and 2020 (n=77) was compared to data on deceased forest hares from the Swedish Veterinary Agency, matched by year and region.

Results: Respondents (n=313) rarely reported direct exposure to hares (8,6%) and/or other rodents (3.8%) during the 2-weeks prior to illness; while recreational activities (forest hiking 61.6%; mushroom/berry-picking 24.0%; fishing 11.5%; and hunting 3.8%) were more common. Peak incidence of reported deceased hares in 2019 and 2020 (n=84 and n=66; 11/15 [73.3%] and 19/21 [90.4%] PCR-positive for tularaemia, respectively) corresponded to peak incidence of symptom onset of human cases (median difference +6 days [2019] and -2 days [2020]; p=0.066 and p=0.695, respectively). Distribution of reported hares corresponded with municipalities with highest incidence of human tularaemia and location of self-reported suspected infection (Figure 1). Most reported their location of infection to be within their residential municipality (n=92/106, 86.8%).

Conclusion: Passive surveillance of tularaemia using deceased hares correlates with symptom onset in humans and could predict geographical outbreaks in the community. Surveillance of other affected/reservoir species should be considered. 

PtII based organometallic photosensitizers (PSs) have emerged as novel potent photodynamic inactivation (PDI) reagents through their enhanced intersystem crossing (ISC) processes. Currently, few PtII PSs have been investigated as antibacterial materials, with relatively poor performances reported and with structure-activity relationships not well described. Herein, a pair of configurational isomers are reported of Bis-BODIPY (4,4-difluoro-boradizaindacene) embedded PtII PSs. The cis-isomer (cis-BBP) displayed enhanced 1O2 generation and better bacterial membrane anchoring capability as compared to the trans-isomer (trans-BBP). The effective PDI concentrations (efficiency > 99.9%) for cis-BBP in Acinetobacter baumannii (multi-drug resistant (MDR)) and Staphylococcus aureus are 400 nM (12 J cm−2) and 100 nM (18 J cm−2), respectively; corresponding concentrations and light doses for trans-BBP in the two bacteria are 2.50 µM (30 J cm−2) and 1.50 µM (18 J cm−2), respectively. The 50% and 90% minimum inhibitory concentration (MIC50 and MIC90) ratio of trans-BBP to cis-BBP is 22.22 and 24.02 in A. baumannii (MDR); 21.29 and 22.36 in methicillin resistant S. aureus (MRSA), respectively. Furthermore, cis-BBP displays superior in vivo antibacterial performance, with acceptable dark and photoinduced cytotoxicity. These results demonstrate cis-BBP is a robust light-assisted antibacterial reagent at sub-micromolecular concentrations. More importantly, configuration of PtII PSs should be an important issue to be considered in further PDI reagents design.

Background: Amidst the global crisis of 70.8 million forcibly displaced individuals, of whom 25.9 million are refugees as of 2019, the need for accessible HIV prevention services in humanitarian settings has become increasingly urgent, particularly among young refugees. Leveraging funding from the International AIDS Society Seed Grant, we established a comprehensive HIV prevention and harm reduction service hub within the Adagom refugee settlement in Nigeria, catering specifically to the needs of young Cameroonian refugees.

Description: In collaboration with a local NGO (Today For Tomorrow Foundation) and settlement authorities, a walk-in center was constructed in the heart of the refugee settlement, comprising 41 communities. One young person from each community was selected based on predefined criteria and trained as an HIV peer educator. The training encompassed comprehensive sexuality education, HIV testing methodologies, harm reduction service provision, and other related services. These certified peer educators subsequently returned to their communities to educate peers and gather data using the Kobo Collect app.

Lessons learned: During the initial six-month implementation phase ending in December, the hub serviced 1,500 young refugees, with a notable 63% female attendance. Strikingly, 90% of these individuals had never undergone HIV testing prior. The hub recorded a low HIV-positive rate of 0.45%, with about 31% of the female being teenage mothers. Although quantitatively challenging to measure, the hub witnessed an overwhelming demand post-public sensitization, exhausting supplies intended for a 2,500-population size twice within six months.

Conclusions: The peer-to-peer model has proven remarkably effective in HIV prevention efforts among young refugees in the Adagom settlement. It not only facilitated increased awareness and service uptake but also demonstrated a sustainable, community-driven approach to health education. Building on this success, the next phase aims to scale up the project to other refugee settlements and Internally Displaced Persons camps across Nigeria, potentially amplifying the model''s impact on a national scale. 

Background: Tularemia is an important re-emerging disease with a multimodal transmission-pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden.

Methods: Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011-2021 were collected through review of electronic medical records and participant questionnaires; with 415 out of 784 accepting participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or PCR). A multivariable logistic regression model was used to investigate variables associated with re-treatment.

Results: Median age of participants was 54 years (IQR 41.5-65) and 49.2% were female. While ulceroglandular tularemia was the predominant form (n=215, 65.7%), there were several cases of pulmonary tularemia (n=40; 12.2%). Inflammatory markers were largely non-specific, with monocytosis frequently observed (n=36/75; 48%). Tularemia was often misdiagnosed upon presentation (n=158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics, and 102 (31.2%) re-treated. Persistent lymphadenopathy was infrequent (n=22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with re-treatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR 3.25-20.75] vs. 7 [IQR 4-11.25] days; adjusted p=0.076), and doxycycline-based treatment regimen (vs. ciprofloxacin; adjusted p=0.084), although not significant after correction for multiple comparisons.

Conclusion: We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis and timely commencement of treatment for an appropriate duration.

BACKGROUND: Outbreaks of vaccine-preventable diseases (VPDs) in healthcare workers (HCWs) can result in morbidity and mortality and cause significant disruptions to healthcare services, patients, and visitors as well as an added burden on the healthcare system. This scoping review aimed to describe the epidemiology of VPD outbreaks in HCWs caused by diseases that are prevented by the 10 vaccines recommended by the World Health Organization for HCWs.

METHODS: In April 2022, CINAHL, MEDLINE, Global Health, and EMBASE were searched for all articles reporting on VPD outbreaks in HCWs since the year 2000. Articles were included regardless of language and study type. Clinical and epidemiological characteristics of VPD outbreaks were described.

RESULTS: Our search found 9363 articles, of which 216 met the inclusion criteria. Studies describing 6 of the 10 VPDs were found: influenza, measles, varicella, tuberculosis, pertussis, and rubella. Most articles (93%) were from high- and upper-middle-income countries. While most outbreaks occurred in hospitals, several influenza outbreaks were reported in long-term-care facilities. Based on available data, vaccination rates among HCWs were rarely reported.

CONCLUSIONS: We describe several VPD outbreaks in HCWs from 2000 to April 2022. The review emphasizes the need to understand the factors influencing outbreaks in HCWs and highlights the importance of vaccination among HCWs.

Background: Young women and adolescent girls (15-30years) are disproportionately affected by discrimination, sexual violence, unplanned pregnancy, and gender-based violence; even more so when they are at the intersection of multiple stigmatized identities. Nevertheless, sexual and reproductive health rights (SRH-R) services are often inaccessible due to costs, as well as lack of awareness and sensitivity by service providers. This study explored the impact of the COVID-19 pandemic and how civil society organizations and communities adapted to provide SRHR services to young women in Lebanon, Guatemala, Mozambique, Uganda and Nigeria.

Methods: Data was collected electronically by a team of 11 young female researchers and advocates from 5 different countries using the KoboCollect toolkit between October and December, 2022. A mixed methods approach with surveys and interviews was used to investigate the lived experiences and perspectives of 227 young women identified primarily from existing networks and through chain-referral sampling. Targeted populations were young women and girls: living with HIV; identifying as lesbian, bisexual, transgender, and/or intersex (LBTI); affected by displacement; and/or living with disabilities. Both in-person and virtual interviews due to COVID-19 disruptions were conducted.

Results: Several respondents (35%) were directly involved in implementing SRHR advocacy actions in their communities. A third (33%) of respondents described barriers inaccessing SRHR services, including stigmatization for being sexually active. In particular, young women with disabilities and young LBTI women faced discriminatory attitudes from health care professionals. The fear of contracting COVID-19 coupled with lockdown measures (including lack of transportation and diversion of resources) kept young women away from seeking SRHR services and left nearly half (46%) feeling the pandemic worsened accessing healthcare. Difficulty access-ing contraceptives during the pandemic and associated unplanned pregnancies was identified as a key barrier among 65% of respondents. Notably, sensitive counselling and cervical cancer screening was the least accessed SRHR services in all the included countries.

Conclusions: Our findings show that there is an ongoing need for joint initiatives to address a range of issues surrounding the current advocacy efforts around SRHR in order to attain high standards of health, and ensure equality, non-discrimination, privacy, and confidentiality for young women and girls.