Objective: To evaluate the effectiveness of DTwP-HB-Hib vaccination dosing intervals at eight weeks versus four weeks on the immunogenicity of the diphtheria component.

Methods: This is a randomized, open-label, parallel, controlled trial on healthy two-month-old infants who had not received DTwP-HB- Hib vaccinations. The infants received three doses of the vaccine either at an eight-week or four-week interval. The anti-diphtheria toxoid IgG antibody levels before and after three doses of the vaccination were measured using ELISA.

Results: Eighty infants were enrolled in this study, with 64 fulfilling the study requirements and randomized into two groups. All study participants exhibited uncertain protection against diphtheria antibodies (0.01-0.99 IU/mL) at the beginning of the study with an average of (0.023±0.009) IU/mL and (0.026±0.009) IU/mL in eight weeks and four weeks groups. Following three doses of the vaccination, the antibody level rose to an average of (1.320±0.234) IU/mL in the eight-week group and (1.307±0.186) IU/mL in the four-week group, with no statistically significant difference in the antibody levels observed (P=0.814).

Conclusions: DTwP-HB-Hib vaccinations can be administered at an eight-week or four-week interval, as they do not significantly affect the level of anti-diphtheria IgG antibodies.

Objective: To identify clinical and laboratory parameters associated with severe disease requiring intensive care among pediatric Crimean-Congo hemorrhagic fever (CCHF) patients.

Methods: Twenty-three children with confirmed CCHF were divided into two groups: Pediatric intensive care unit (PICU) patients (n=12) and general ward patients (n=11). Laboratory parameters including platelet count, platelet mass index (PMI), liver enzymes, and inflammatory markers were analyzed at admission through univariate and multivariate logistic regression as well as receiver operating characteristic curve analysis.

Results: PICU patients had significant lower platelet counts and PMI (P=0.002 for both), and higher aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and ferritin levels (P<0.01). Univariate analysis identified platelet count (OR 0.99, P=0.026), PMI (OR 0.98, P=0.021), AST (OR 1.03, P=0.025), and alanine aminotransferase (OR 1.03, P=0.050) as significant predictors of PICU admission. Multivariate analysis demonstrated PMI as an independent predictor (adjusted OR 0.98; 95% CI 0.97-0.99, P=0.021). The area under the curve (AUC) was the highest for aspartate aminotransferase (AUC=0.886, 95% CI 0.69-0.98), fol-lowed by lactate dehydrogenase (AUC=0.879, 95% CI 0.68-0.98), platelet mass index (AUC=0.864, 95% CI 0.66-0.97), platelet count (AUC=0.860, 95% CI 0.65-0.97), ferritin (AUC=0.811, 95% CI 0.59-0.94), and alanine aminotransferase (AUC=0.796, 95% CI 0.58-0.93).

Conclusions: PMI showed promising predictive value for intensive care requirement in pediatric CCHF patients, maintaining significance in multivariate analysis. Several laboratory parameters including AST, LDH, and platelet count showed high diagnostic accuracy for identifying severe disease. These readily available parameters can guide early risk stratification and resource allocation in pediatric CCHF management.

Objective: To analyze the risk factors associated with multidrug- resistant tuberculosis (MDR-TB) as a first national survey in Indonesia.

Methods: This national coverage cross-sectional study was conducted from 2017 to 2018. The study subjects were selected using a multi-stage probability random sampling method. MDR- TB is tuberculosis caused by bacteria resistant to at least isoniazid and rifampicin. The dependent variable was MDR-TB. Independent variables included age, sex, education, employment status, place of residence, history of living with TB patients, and the number of household members. Univariate and multivariate logistic regression models were used to analyze the risk factors associated with MDR- TB. All the data were analyzed using STATA V.14.0 (Stata Corp LLC, College Station, TX).

Results: This study found the MDR rate was 109/3 234 (3.4%) among positive pulmonary TB patients. More than twice as many patients had MDR re-treatment (74/3 234, 2.3%), compared to 35/3 234 (1.1%) who had new TB diagnoses or were getting initial treatment. After adjusting for employment status, individuals with a prior history of tuberculosis treatment were found to have significantly higher odds of developing MDR-TB, with an odds ratio of 7.22 (95% CI 3.87-13.44).

Conclusions: Increasing attention should be paid to these patients to prevent MDR-TB, and MDR-TB transmission is an urgent challenge for controlling TB worldwide. Early detection of MDR-TB is a critical part of TB control programs.

Objective: To investigate the associations between Plasmodium falciparum merozoite surface protein allelic families (Pfmsp1, Pfmsp2), infection clonality and drug-resistant haplotypes (Pfcrt, Pfdhfr, Pfdhps, Pfmdrl and Pfkelch13) in malaria samples collected over 30 years in India.

Methods: Infection clonality was assessed using Pfmsp1 (K1, MAD20, RO33) and Pfmsp2 (IC/3D7, FC27) allelic families. Five key drug resistance genes were analysed by PCR and Sanger sequencing. Statistical analyses were performed to evaluate associations between specific Pfmsp allelic families, infection clonality and drug-resistant haplotypes.

Results: Significant associations were observed between Pfmsp allelic families, infection clonality and resistant haplotypes across four genes (Pfcrt, Pfdhfr, Pfdhps and Pfmdrl). For Pfcrt, K1 (P=0.026) and IC/3D7 (P<0.001) alleles were significantly associated with wild-type CVMNK haplotype, while FC27 allele was linked to SVMNT haplotype (P=0.005). Similarly, Pfmdr1 FC27 allele was significantly associated with NFSND haplotype (P=0.034) and IC/3D7 allele with NYSND haplotype (P<0.001). Analyses revealed that both K1 and RO33 alleles were associated with resistant Pfdhfr and Pfdhps haplotypes, whereas MAD20 was exclusively associated with resistant Pfdhps (P<0.001) haplotypes. Additionally, Pfdhfr and Pfdhps haplotypes exhibited distinct associations with both Pfmsp2 allelic families.

Conclusions: The findings suggest potential associations between antigenic diversity markers and drug-resistant haplotypes, and some patterns may reflect shared ancestral origins, though the basis of certain associations remains unclear. Further studies with larger datasets are needed to validate these observations and elucidate the genetic and ecological factors underlying these relationships.

Objective: To describe the clinical features and outcomes of arboviral infections in solid organ transplant recipients (SOTRs).

Methods: This study included SOTRs identified from a passive surveillance cohort of 1 466 patients with acute undifferentiated febrile illness between 2012 and 2019. Diagnosis of arboviral infection was confirmed using RT-PCR and/or serological testing. Clinical, laboratory, and outcome data were extracted and analyzed descriptively.

Results: Eleven SOTRs (10 kidney, 1 heart transplant recipient) were diagnosed with arboviral infections: 8 with dengue (DENV), 2 with chikungunya virus (CHIKV), and 1 with Zika virus (ZIKV) infection. The median time from transplantation to symptom onset was 35.0 days (IQR 28.5-111.0). DENV infection was associated with severe disease, including dengue shock syndrome (50%, 4/8) and dengue hemorrhagic fever (25%, 2/8). Six patients (75%, 6/8) required ICU admission. Common laboratory abnormalities in dengue patients included leukopenia (100%, 8/8), thrombocytopenia (100%, 8/8), elevated transaminases (87.5%, 7/8), and acute kidney injury (50%, 4/8). CHIKV and ZIKV cases presented as mild, self-limiting febrile illnesses without complications. All patients recovered without long-term morbidity.

Conclusions: DENV infection in SOTRs is associated with significant morbidity, particularly early post-transplant, and requires heightened clinical vigilance. In contrast, CHIKV and ZIKV infections tend to follow a benign course. Enhanced vector control, early diagnostic testing, supportive management, and consideration of dengue vaccination in appropriate candidates are essential to mitigate the impact of arboviral infections in transplant recipients in endemic areas.

Rationale: Central nervous system (CNS) actinomycosis is rare, spreading hematogenously from distant infections. Cutaneous actinomycosis with skull/meninges spread is especially unusual.

Patient concerns: A 57-year-old man presented with complaints of discharge from the back of his scalp for six months, an ataxic gait, and bilateral upper and lower limb weakness and numbness over the past 4-5 months.

Diagnosis: CNS actinomycosis.

Interventions: Intravenous injection of ceftriaxone followed by oral amoxicillin-clavulanic acid therapy.

Outcomes: The patient was able to walk without support, with complete resolution of sinus discharge.

Lessons: In patients presenting with discharging sinuses especially when accompanied by CNS symptoms, actinomycosis should be considered as a differential, along with tuberculosis, non-tubercular mycobacterial infection, and aspergillosis. Microbiological confirmation should be attempted wherever possible, for accurate diagnosis and treatment, as clinic-radiological picture alone may not differentiate these infections, as treatment of each is diametrically opposite and patients can be cured with timely and appropriate treatment.