The right to health for all people means that healthcare services and programs are available, accessible, and acceptable for everyone in need. However, certain groups in the society may be marginalized from their needed healthcare services. In this regard, this paper discusses the challenges in providing HIV-related services to sex workers, a group that remains marginalized in Philippine society. Prior to the COVID-19 pandemic, the Philippines had one of the fastest-growing epidemics in the world[1,2]. Between 2012 and 2023, the daily incidence of HIV in the Philippines increased by 411%[1]. As of January 2023, more than 110 000 HIV cases had been reported in the country, and the number of people living with HIV is projected to increase to 364 000 by 2030[1]. Among the most affected are key populations, including sex workers[1]. While HIV has been documented among sex workers in the Philippines since the late 1980s, official government data collection of the HIV and AIDS registry of the country only started in 2012[3]. Between then and December 2022, official government data revealed that 5 508 people diagnosed with HIV infection had accepted payment for sex[3]. On the other hand, between January and December 2022, the country’s surveillance data revealed that 632 of those newly diagnosed with HIV were sex workers who accepted payment for sex, with a majority of them being males (n=605)[3]. Sex workers are often frowned upon in Philippine society[4]. They suffer on the fringes of the country and are stigmatized and marginalized for their disadvantaged identities and profession[5]. For example, they may be perceived as immoral and therefore worthy of condemnation and social oppression[4]. This stigmatization and marginalization are reflected in the Philippines’ codified norms, such as the Philippine’s Revised Penal Code, which criminalizes sex work in the country[4]. As such, they can be more vulnerable to sexual abuse and harassment by government officials, further complicating their risks for HIV infection[2]. On the other hand, those with HIV infection may be forced to disclose their engagement in sex work due to fears of false positive results during a mandatory drug test and consequentially being stigmatized an “addict”[4,6]. As a result, they may avoid institutions tasked to offer them help, safety, and protection. Despite the vulnerability of sex workers to HIV, evidence in the Philippines supports that they may not be tested for HIV due to intersectional stigma arising from their social positions and stigmatized profession. At the same time, HIV infection alone can be a significant barrier to help-seeking in the country[1]. Its intersections with the often marginalized positions of sex workers, such as economic disadvantage and drug use, present additional challenges to their help-seeking behaviors. For example, participants in the study by Urada et al.[2] shared that only one in five economically disadvantaged street sex workers have been tested for HIV. Similarly, the study by Estacio et al.[6] suggests that there may be low HIV testing among sex workers who have used drugs due to the stigma attached to both drug use and sex work. Likewise, they also identified that legal policies that criminalize both behaviors present as challenging barriers to seeking help[2,4,6]. Given the above-mentioned challenges, sex workers in the Philippines may have difficulty availing and accessing HIV-related healthcare services. Therefore, reforms in the structural and social determinants, as well as in existing healthcare programs, are needed to afford them their right to health. In doing so, collaboration among various stakeholders and duty-bearers, including advocacy groups, non-government institutions, academe, and government institutions tasked by law to address HIV infections in the country, including the Department of Health and Department of Social Welfare and Development, may help inform existing policies and programs towards equitable healthcare for sex workers.

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

Objective: To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey. Methods: COVID-19 patients followed in the pandemic services across Turkey between January 1, 2021, and March 31, 2022 were investigated retrospectively. Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19 ≥5 days after hospital admission. The primary outcome of this study was in-hospital mortality; demographic features and vaccination status was compared between survivors and non-survivors. Results: During the study period, 15 573 COVID-19 patients were followed in 18 centers and 543 (3.5%) patients were nosocomial COVID-19. Most patients with nosocomial COVID-19 (80.4%) were transferred from medical wards. 162 (29.8%) of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138 (25.4%) of the patients died during hospital stay. Advanced age (≥65 years) and number of comorbid diseases (≥2) was found to be associated with mortality in nosocomial COVID-19 (OR 1.74, 95% CI 1.11-2.74 and OR 1.60, 95% CI 1.02-2.56, respectively). Vaccination was associated with survival in nosocomial COVID-19 (OR 0.25, 95% CI 0.16-0.38). Conclusions: Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate. Vaccination can decrease the in-hospital mortality rate.

Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility ofS. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573-18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused byS. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.

Objective: To determine the diversity of microbiota associated with different breeding habitats of dengue vector mosquitoes Aedes (Ae.) aegypti and Ae. albopictus and to identify any parasitic, epibiont, pathogenic, competitive or predatory species. Methods: Sampling was performed from a variety of breeding habitats using dipping, pipetting and siphoning techniques. Microbiota in water samples were preserved using Rose Bengal solution and Lugol’s iodine, and were identified. Live samples of microbiota were kept under laboratory conditions to observe any pathogenic or parasitic microbiota interacting with larvae. Results: A total of eleven microbiota species (Canthocamptus staphylinus, Canthocamptus microstaphylinus, Parastenocaris brevipes, Lepadella ovalis, Lepadella patella, Rotatoria rotatoria, Rotatoria macrura, Asplanchna brightwelli, Trichocerca rattus, Euglena variabilis, and Flagilaria capucina) belonging to four (4) phyla (Arthropoda, Rotifera, Euglenozoa, and Ochrophyta) and 8 microbiota species belonged to four phyla (Arthropoda, Rotifera, Euglenozoa, and Ochrophyta) were identified from Ae. aegypti and Ae. albopictus breeding habitats respectively. There was a higher percentage (54.54%) of larval habitats positive for the secondary vector Ae. albopictus than through the primary vector Ae. aegypti in the Gampola urban area indicating higher possibility of transmitting the dengue virus through the secondary vector. However, no pathogenic or parasitic ciliates on mosquito larvae were encountered in the present study. Those findings may be due to sampling maingly from temporary container-type breeding habitats. Conclusions: The relative distribution of microbiota associated with mosquito species differed significantly among Ae. aegypti and Ae. albopictus. The overall findings of this study could help in implementing novel eco-friendly vector-control strategies in the study area.

Objective: To determine the prevalence of tick-borne pathogens with a particular focus onRickettsia spp. in ticks collected from cattle in Gauteng and Limpopo Provinces, South Africa. Methods: A total of 200 ticks were collected from cattle within the Madala livestock, Pretoria, Gauteng Province and in Mankweng Township, Polokwane, Limpopo Province in 2019. The ticks were morphologically identified and processed individually for a total genomic DNA extraction. Specific primers targetting ompA, ompB, and the 17KDa genes were used for a molecular screening and delineation of Rickettsia from the extracted genetic materials using polymerase chain reaction (PCR) technique. PCR amplicons of positive samples were sequenced bidirectionally using the Sanger sequencing method. Sequences generated were processed and analysed using appropriate bioinformatics software. Results: The ticks were morphologically identified as Amblyomma spp. PCR profiling of the genomic DNA samples revealed the presence of the Rickettsia pathogen in 42 (21%) of the ticks collected from both Provinces. Out of the genes profiled, 14 (7%) were positive for 17KDa, 42 (21%) for ompA and 32 (16%) were positive for ompB genes respectively. The nucleotide blast of the sequenced genomes showed high similarity, as high as 100% with other referenceRickettsia (R.) africae in the GenBank. The phylogenetic analysis of the sequences further validated them as R. africae with their characteristic clustering pattern with related reference sequences. Conclusions: There is an abundance of R. africae in Amblyomma ticks collected from cattle in the study areas. This has serious public health implications as individuals who accidentally get infested with the ticks could acquire R. africae. Hence, adequate precautions in terms of sensitization of farmers about the risk and mass mobilization drive to control the vectors in the areas are highly recommended to safeguard public health.

Rationale: Anthrax is a zoonotic disease caused by spores of Gram-positive Bacillus anthracis, commonly affects mammals and in rare cases birds. Human infection occurs accidentally through direct or indirect exposure to animal or their products. Patient concerns: A 63-year-old man was referred to our hospital with flu-like symptoms and severe swelling and redness on the face, the roof of the mouth, and nostrils. He had a history of direct contact with a slaughtered mutton two days ago. He declared controlled diabetes, hypertension, hypertriglyceridemia, and heart failure. Lungs were normal in lung high resolution CT, but multiple lymphadenopathies were seen in the mediastinum. Bilateral axillary lymphadenopathy with a maximum sad of 23 mm and pleural effusion on the right side was observed. CT scan of the nose and sinuses showed an increased density of polyps in the left maxillary sinus. Slides were prepared from the patient's lesions and examined under a light microscope. Bacillus shape with Streptococcus bacteria was seen. Diagnosis: Anthrax co-infection with herpes systemic virus andStreptococcus pyogenes. Interventions: Multidrug therapy started with appropriate antibiotics. Outcomes: The symptoms of the patient gradually disappeared. The patient was discharged without any complications. Lessons: Cutaneous anthrax in endemic areas in patients with skin presentations and a history of contact with infected animals or products should be considered a differential diagnosis. This is more important in mixed infections where the main cause of the problem may be hidden.