As of 15 June, there have been, globally, a total of 2103 laboratory-confirmed cases and one probable case of Monkeypox, including one death. We report two cases of vesicular infectious diseases, one of those is the first case of Monkeypox in the Campania Region. The report, therefore, highlights a recrudescent infection disease that could represent a challenge in differential diagnosis with other vesicular infectious diseases such as Varicella Zoster Virus, during a pandemic season that does not seem to end. Indeed, varicella should be carefullu considered in differential diagnosis according to its vesicular or pustular rash to have a prompt diagnosis and public health response in case of monkeypox infection.

Few data are available regarding the effectiveness of anti-SARS-CoV-2 vaccine in immunocompromised patients. Vaccination may have a suboptimal efficacy in this population, in particular if patients are exposed to anti-B-cell therapy. We report the virological and clinical characteristics of a patient with follicle center lymphoma under bimonthly maintenance therapy with obinutuzumab, an anti-CD20 monoclonal antibody. Despite three doses of BNT162b2 vaccine, the patient was infected by the SARS-CoV-2 Omicron variant. After an initial period of clinical and molecular remission due to early therapy with sotrovimab, the patient experienced a fatal relapse sustained by the same viral strain.

Background and aims. Real-time reverse transcription polymerase chain reaction (RT-PCR) is the gold-standard assay to detect SARS-CoV-2, but it has limitations compared to viral load analysis. Quantitative detection improves surveillance, diagnosis, and prevention. We performed a comparative study of qualitative and quantitative tests for the diagnosis of COVID-19 on respiratory samples from patients screened for SARS-CoV-2 infection, and explored the correlation between viral load compared to the threshold cycle (Ct) value obtained in RT-PCR.Materials and methods. Sixty respiratory samples from patients affected by SARS-CoV-2 were subjected to both the qualitative (Allplex ™ 2019-nCoV Seegene) and the quantitative (Clonit® Quanty COVID-19) assays, and the relationship between viral load and Ct value was assessed by Spearman correlation analysis (ρ). In addition, the viral load of samples collected from a patient with symptomatic cancer was monitored. Results. The results show 100% agreement between the results obtained with quantitative assay and the reference standards, whereas 99.2% agreement was found for the qualitative test. A strong negative Spearman’s correlation between the Ct values of the N genes and RdRP gene was observed from qualitative assay values and viral loads.Conclusions. Quantitative assay has a higher sensitivity than qualitative assay, and viral load testing allows the clinicians to better orient themself in the choice of therapeutic treatment to be adopted. The constantly higher viral load of clinical cases considered, irrespective of the different therapies used, confirms that viral load monitoring could represent a great advantage in clinical practice.

Background: The antimicrobial resistance crisis is driven by antibiotic overuse, often due to the difficulty in distinguishing bacterial from viral infections. In the European Union, acute respiratory tract infections account for about 38% of all antibiotic prescriptions in community and emergency settings, and an estimated 30–50% of these prescriptions are potentially inappropriate. Point-of-care C-reactive protein (CRP) testing can support the distinction between bacterial and viral infections, but its diagnostic accuracy is often compromised by chronic inflammatory comorbidities that elevate baseline CRP levels. Objective: This exploratory, hypothesis-generating study evaluated the diagnostic utility of CRP in an Emergency Department (ED) cohort and proposed a novel “Comorbidity Confounder Score” (CCS) prototyped pilot tool as support to identify patient subgroups in whom CRP retains high diagnostic value. Methods: We conducted an exploratory, hypothesis-driven retrospective cohort study of 92 patients presenting to a tertiary ED with acute flu-like symptoms between 2023 and 2025. Microbiological diagnoses were confirmed using culture and PCR. ROC curve analysis and AUC comparisons were performed using the pROC package in R (v4.2.0; DeLong method). A post hoc power analysis confirmed 81% power at alpha = 0.05. The diagnostic performance of CRP (Area Under the Curve—AUC) was assessed in the total cohort and stratified into “Low-Utility” (high comorbidity, CCS ≥ 2) and “High-Utility” (low comorbidity, CCS < 2) subgroups. Results: In the unselected total cohort, CRP demonstrated suboptimal diagnostic performance (AUC = 0.61, 95% CI: 0.49–0.73). However, exploratory post hoc stratification revealed divergence. In the “Low-Utility” group, CRP had no diagnostic value (AUC = 0.52). In the “High-Utility” group, a preliminary signal of improved CRP discriminatory performance was observed (AUC = 0.84; DeLong test vs. total cohort, p = 0.004), subject to the optimistic bias inherent in derivation-cohort stratification. The AUC improvement was statistically significant (DeLong test, p = 0.004). The empirically derived optimal cutoff in the High-Utility group was 31.5 mg/L (Youden Index J = 0.54). Conclusions: These exploratory, post hoc findings are a first step into evaluation based on a pilot ML tool and require prospective multicenter validation before any conclusions regarding clinical utility can be drawn. The CCS represents a hypothesis-generating construct only and must not be used for clinical decision-making in its current form.

Background: The antimicrobial resistance crisis is driven by antibiotic overuse, often due to the difficulty in distinguishing bacterial from viral infections. While Point-of-care C-Reactive Protein (CRP) testing aids in this differentiation, its diagnostic accuracy is frequently compromised by chronic inflammatory comorbidities that elevate baseline CRP levels.Objective: This study evaluated the diagnostic utility of CRP in an Emergency Department (ED) cohort and validated a novel “Comorbidity Confounder Score” (CCS) to identify patient subgroups in whom CRP retains high diagnostic value.Methods: We conducted a retrospective cohort study of 92 patients presenting to a tertiary ED with acute flu-like symptoms between 2023 and 2025. Microbiological diagnoses were confirmed using culture and PCR. The diagnostic performance of CRP (Area Under the Curve - AUC) was assessed in the total cohort and stratified into “Low-Utility” (high comorbidity, CCS $\ge$ 2) and “High-Utility” (low comorbidity, CCS < 2) subgroups.Results: In the unselected total cohort, CRP demonstrated poor diagnostic utility (AUC = 0.61). However, stratification revealed significant divergence. In the “Low-Utility” group, CRP had no diagnostic value (AUC = 0.52). Conversely, in the “High-Utility” group, CRP performance improved markedly (AUC = 0.84).Conclusion: The diagnostic value of CRP in unselected ED patients is clinically insufficient due to confounding comorbidities. Applying the CCS algorithm effectively identifies specific patient populations for whom CRP testing remains a reliable diagnostic tool.