Objective: To investigate the evolving patterns of antimicrobial resistance against beta-lactam antibiotics in Escherichia coli isolates from urinary tract infection patients in Vietnam, covering the period from 2005 to 2022.

Methods: 29 Descriptive studies published between 2010 and 2022 in English and Vietnamese were included in the analysis. Data on resistance rates to beta-lactam antibiotics, including cephalosporins and carbapenems, were extracted and analyzed. Weighted pooled resistance rates were calculated using random-effects models. Annual trends in resistance were assessed using linear regression analysis.

Results: Among the beta-lactam antibiotics studied, Escherichia coli exhibited varying levels of resistance, with cephalosporins showing higher resistance rates compared to carbapenems. Weighted pooled resistance rates were 66% for cefotaxime, 65% for ceftriaxone, 54% for ceftazidime, and 56% for cefepime. In contrast, carbapenems demonstrated lower resistance rates, with weighted pooled resistance rates ranging from 3% to 4% for meropenem, ertapenem, and imipenem. Resistance rates were also observed for amoxicillin/clavulanate (35%), ticarcillin/clavulanate (26%), and piperacillin/tazobactam (12%). Significant annual increases in resistance were noted for imipenem (0.56%, P<0.001).

Conclusions: This study highlights the critical issue of antimicrobial resistance in urinary tract infections in Vietnam and emphasizes the importance of prudent antibiotic use and the regular monitoring of resistance patterns. These insights are useful for guiding healthcare professionals in optimizing treatment strategies and for policymakers in formulating evidence-based clinical guidelines to combat antibiotic resistance effectively.

Objective: To investigate the environmental and social aspects of poverty contributing to malaria incidence in Indonesia from 2016 to 2020.

Methods: Random forest regression was used to analyse the independent variables contributing to malaria incidence. Environmental conditions were extracted from remotely sensed data, including vegetation, land temperature, soil moisture, precipitation, and elevation. In contrast, the social aspects of poverty were obtained from government statistical reports.

Results: From 2016 to 2020, the contribution of each environmental and social aspect of poverty to malaria incidence fluctuated annually. Generally, the top three essential variables were people aged 15 years and above, experiencing poverty (variable importance/VI=32.0%), people experiencing poverty who work in the agricultural sector (VI=14.4%), and precipitation (VI=9.8%). It was followed by people experiencing poverty who are unemployed (VI=9.2%), land temperature (VI=5.2%), people experiencing poverty who have low education (VI=8.0%), soil moisture (VI=7.4%), elevation (VI=6.0%), and vegetation (VI=3.8%).

Conclusions: Poverty and variables related to climate have become the crucial determinants of malaria in Indonesia. The government must strengthen malaria surveillance through climate change mitigation and adaptation programs and accelerate poverty alleviation programs to support malaria elimination.

Objective: To evaluate the polio laboratory surveillance carried out from January, 2019 to May, 2023 by the Polio Regional Reference Laboratory, Sri Lanka.

Methods: This retrospective study analyzed all stool samples received under the acute flaccid paralysis (AFP) and immunodeficient vaccine-derived poliovirus (VDPV) surveillance at Polio Regional Reference Laboratory, Sri Lanka from January, 2019 to May, 2023. The results of the testing methodologies were extracted from the laboratory data system, i.e., poliovirus virus isolation, intra-typic differentiation/VDPV real time reverse transcriptase polymerase chain reaction (ITD/VDPV rRTPCR) and sequencing, along with the data on timing of reporting results, stool adequacy and socio-demographics. Data was analyzed using descriptive statistics.

Results: A total of 2141 stool samples from 1 644 cases were received for AFP surveillance from Sri Lanka (93.61%), Maldives (1.52%), and immunodeficient VDPV (4.86%) surveillance. Both polioviruses (19/1 644, 1.15%) and non-polio enteroviruses (73/1 644, 4.44%) were isolated, while Sabin-like 3 virus was detected in majority (12/19, 63.15%) among the poliovirus isolated. Wild polioviruses or circulating VDPVs were not detected among the cases. During all years of the study, the non-polio AFP detection rate was >1/100 000 in children aged less than 15 years, whereas stool adequacy rate was >80%. All results were reported within 14 days of receipt, ensuring timely reporting as per global guidelines.

Conclusions: The Polio Regional Reference Laboratory, Sri Lanka plays a vital role in maintaining the polio-free status in the country through its robust laboratory surveillance, while adhering to the surveillance indicators. Non-detection of wild polioviruses and circulating VDPV during the study period reinforces the polio-free status in the country.

Objective: Serological tests are widely used for scrub typhus diagnosis; however, their limitations are evident. This study aims to assess their practical value in clinical settings.

Methods: We analyzed the data of adult patients with suspected scrub typhus who visited a tertiary care hospital in the Republic of Korea from September to December from 2019 to 2021. The included patients had an acute fever and at least one of the following ten secondary findings: myalgia, skin rash, eschar, headache, thrombocytopenia, increased liver enzyme levels, lymphadenopathy, hepatomegaly, splenomegaly, and pleural effusion. The diagnoses were grouped as scrub typhus or other diseases by two infectious disease physicians.

Results: Among 136 patients who met the eligibility criteria, 109 had scrub typhus and 27 had different diseases. Single and paired total antibodies using immunofluorescence assay (IFA), and total antibodies using immunochromatography-based rapid diagnostic testing (ICT) were measured in 98%, 22%, and 75% of all patients, respectively. Confirmation using paired samples for scrub typhus was established at a median of 11 [interquartile range (IQR) 10-16] days following the first visit. Among the 82 admitted patients, the median admission time was 9 (IQR 7-13) days. According to IFA, 58 (55%) patients with scrub typhus had total immunoglobulin titers ≥1:320, while 23 (85%) patients with other disease had titers < 1:320. Positive ICT results were observed in 64 (74%) patients with scrub typhus and 10 (67%) patients with other diseases showed negative ICT results.

Conclusions: Serological testing for scrub typhus is currently insufficient for decision-making in clinical practice.

Rationale: Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent. Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country. Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor.

Patient concerns: A 19-year-old male, presented with a 10-day history of altered mental status, high-grade fever and violent behaviour. 2 Days prior to admission, he developed decreased responsiveness and a muttering delirium with self-talking.

Diagnosis: Coma vigil secondary to salmonellosis.

Interventions: Intravenous ceftriaxone and dexamethasone.

Outcomes: The resolution of the coma vigil and the associated Salmonella infection were observed; however, the patient developed residual mutism.

Lessons: The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide. Additionally, the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.