Invasive aspergillosis (IA) remains a common cause of mortality in pediatric immunocompromised populations. Much of our knowledge of IA stems from adult literature. We conducted a retrospective evaluation of cases of proven or probable IA, defined according to the 2019 EORTC/MSG criteria, in patients with underlying immunocompromising conditions at Boston Children's Hospital from January 1, 2007 to January 1, 2019. We estimated survival curves over 12 weeks using the Kaplan-Meier method for all-cause mortality, and we used univariate Cox proportional hazards modeling to evaluate for mortality risk factors. We identified 59 cases, 29% with proven and 71% with probable IA. Pulmonary IA was the most common presentation (78%). The median age at diagnosis was 11 years (range, 0.5–28). Hematopoietic cell transplantation (HCT) was the most frequent predisposing underlying condition (41%). Among affected patients, 44.8% were neutropenic and 59.3% were lymphopenic at diagnosis. The 12-week all-cause mortality rate was 25.4%; HCT recipients comprised the majority of deaths (9/15) with a hazard ratio of 2.47 [95% CI, 0.87–6.95]. No patients with congenital immunodeficiencies (n = 8) died within 12 weeks of IA diagnosis. Other risk factors that were significantly associated with mortality included mechanical ventilation at diagnosis, intensive care unit stay, and lymphopenia; treatment with an Aspergillus-active azole was associated with decreased mortality. In conclusion, our study found that in pediatric immunocompromised hosts, IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the HCT population. This study explores the epidemiology, outcomes and predictors of mortality of invasive aspergillosis (IA) at a high-volume pediatric center for immunocompromised hosts. Much of our understanding of pediatric IA is extrapolated from the adult literature. Our study found that IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the hematopoietic cell transplantation study cohort.

The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE’s low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of Pneumocystis pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE’s national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE.

Background: Wastewater systems provide an integrated One Health perspective on antimicrobial resistance but remain uneven globally, with limited data from rapidly urbanizing and highly connected regions such as the Arabian Gulf. Methods: An eight-month prospective study was conducted in Dubai, United Arab Emirates, with monthly sampling from nine community and two hospital nodes and two wastewater treatment plants (WWTP). Samples were analysed using high-throughput quantitative PCR (HT-qPCR; Resistomap, Finland) with a 72-target One Health gene panel. Results: Across the 120 samples analyzed, the number of detected gene targets ranged from 26 to 68 genes, with the highest diversity in hospital wastewater and the lowest in WWTP effluent. Pathogen-associated markers were detected in all sources, with enterococci, Escherichia coli, and Klebsiella pneumoniae predominant. Hospital wastewater showed broader pathogen-associated gene markers, including those linked to Acinetobacter baumannii and Pseudomonas aeruginosa. Antibiotic resistance genes (ARGs) associated with macrolide–lincosamide–streptogramin B, tetracycline, and aminoglycoside resistance were widespread. Community and influent samples were dominated by msrE, tet(M), and aminoglycoside resistance genes, whereas hospital wastewater showed the highest ARG burden, including enrichment of aac(6′)-Ib, qnrS2, bla_GES, bla_TEM, bla_KPC-2, and bla_IMP-1. Several ARGs, including mcr-1, persisted in WWTP effluent. Mobile genetic elements (MGEs) were ubiquitous, with integron-associated markers prominent in WWTP effluent. ARG–MGE network analysis demonstrated extensive co-occurrence, with MGEs as central hubs linking multiple ARGs. Conclusions: Wastewater captures distinct resistome profiles across urban compartments, supporting its role for AMR surveillance. The persistence of ARGs and MGEs in WWTP effluent highlights the potential for environmental dissemination, through reuse of treated wastewater.

Wastewater-based surveillance (WBS) is valuable for monitoring antimicrobial resistance (AMR). Staphylococci are key targets, as wastewater can facilitate gene transfer and resistance emergence. Data on WBS for population-level AMR in the Arabian-Gulf remain limited. This study assessed Staphylococcus diversity and resistance in Dubai wastewater. Samples were collected over eight months from nine community sites, two hospital nodes, and two wastewater treatment plants (WWTPs) and were analysed by culture-based method. Ninety-six Staphylococcus isolates were recovered from community, hospital, and WWTP influent, with no growth in effluent. Most isolates (n/N = 88/96) were coagulase-negative Staphylococcus (CoNS), spanning 15 species, dominated by S. saprophyticus, S. cohnii and S. sciuri. The only coagulase-positive Staphylococcus was S. aureus (n = 8) and the only species detected across all wastewater sources. Resistance was highest to benzylpenicillin (88%) and fusidic acid (82%), whereas all isolates remained susceptible to glycopeptides, tigecycline, and linezolid. Fusidic acid resistance was higher in community-wastewater isolates, whereas β-lactam resistance predominated in hospital-wastewater isolates. Sixty percent of CoNS were multidrug-resistant; methicillin resistance occurred in 37.5% of CoNS and 50% of S. aureus. Wastewater is a reservoir of diverse multidrug-resistant staphylococci, underscoring One Health relevance reflecting the potential for circulation between humans, animals, and the shared environment. WBS can support population-level AMR monitoring to inform public health and veterinary interventions.

Background: The literature describing clinical presentation, disease course and outcomes of SARS-CoV-2 in infants remains scarce. Methods: We conducted a retrospective study across 2 major pediatric referral centers evaluating the demographics, clinical and laboratory characteristics, management and outcomes of COVID-19 among newborns and infants in the United Arab Emirates (UAE). Clinical and biochemical markers were evaluated for their accuracy in predicting intensive care unit (ICU) transfer and death. Results: A total of 576 COVID-19-positive infants were evaluated with a mean age of 164 days. The mean duration of symptoms was 1.48 days. Fever was present in 36.5% of the cohort, while 44.3% had nasal congestion. Eight infants (of 575; 1.39%) required transfer to the ICU for impending respiratory failure and 2 required invasive ventilation. Symptomatic (fever, nasal congestion) infants were not more likely to be transferred to the ICU (Chi-squared test, P = 0.77). ICU transfer was associated with a higher chance of receiving antibiotics (70.6% vs 35.4%; Chi-squared test, P = 0.003). On multivariate analysis, none of the clinical parameters (age, symptoms, laboratory tests) predicted transfer to the ICU. No deaths were reported during the observation period. Conclusions: Infants with SARS-CoV-2 infection have a benign clinical course with favorable outcomes. Less than 2% require ICU transfer. Clinical vigilance is required as none of the admission parameters predicted ICU transfer.