The immune response to heterologous coronavirus disease (COVID-19) vaccination in people living with HIV (PLWH) is still unclear. Herein, our prospective cohort study aimed to compare the immune response of heterologous vaccination with CoronaVac (Sinovac) and Vaxzevria (AstraZeneca) between PLWH having CD4 counts ≤ 200 cells/µL (low CD4+) and > 200 cells/µL (high CD4+). Anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels and the percentage inhibition of neutralizing antibodies (nAbs) were analyzed at 2 and 12 weeks after immunization. Participants in the low and high CD4+ groups had mean CD4+ counts of 139 and 575 cell/µL, respectively. Two and 12 weeks after immunization, in the low CD4 group, the median anti-RBD-IgG levels were 159 IU/mL and 143 IU/mL, respectively, whereas the nAb level was 71% and decreased to 47.2%, respectively. Contrarily, the median anti-RBD-IgG levels in the high CD4+ group were 273 IU/mL and 294 IU/mL, respectively, whereas the nAb levels were 89.3% and relatively stable at 81.6%. However, although immune responses between the two study groups were not significantly different, a decline in nAb levels was observed at 12 weeks in the low CD4+ group. Therefore, a COVID-19 booster vaccine dose is suggested for immunoprotection.

BACKGROUND Lactobacillus johnsonii is a probiotic bacterium commonly found in the gastrointestinal tracts of humans and other animals. It is non-pathogenic and plays a crucial role in maintaining gut health. L. johnsonii is often associated with beneficial effects on the host immune system and digestion. However, reports of L. johnsonii infections are rare, and their clinical characteristics remain poorly understood. This article reports a case of L. johnsonii isolated from a patient's blood - the first such case documented in Thailand. Whole-genome sequencing (WGS) was performed on the isolate (LJ-PSU-blood) to investigate its genomic characteristics. CASE REPORT A 25-year-old Thai woman with a large abdominal mass was diagnosed with diffuse large B-cell lymphoma, and she was started on rituximab-cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone chemotherapy. During her first rituximab infusion, she developed a fever, tachypnea, and tachycardia. Her blood cultures revealed an organism after 1 day. L. johnsonii was initially identified and subjected to WGS, and the sequence data were analyzed using bioinformatics tools. The findings demonstrated that the LJ-PSU-blood isolate possessed antibiotic resistance and virulence-associated genes. In addition, this isolate harbored bacteriocin-encoding genes and integrated bacteriophage sequences. Our genome was compared with 21 published genomes from various countries, hosts, and isolation sources. They were grouped into 3 monophyletic clades based on single-nucleotide polymorphism distances. CONCLUSIONS This case report describes the characteristics of L. johnsonii isolated from the blood of a Thai patient. Clinical and WGS data highlight important public health concerns associated with L. johnsonii infections.

Corynebacterium species are often regarded as blood culture contaminants, but they are increasingly recognized as true pathogens. However, their clinical s

: Melioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Septic arthritis caused by this infection is uncommon and difficult to treat. The role of adjunctive open arthrotomy in this type of infection has not yet been elucidated. We conducted a retrospective study of patients with microbiologically confirmed melioidosis between January 2002 and December 2022. Patients with a clinical condition of septic arthritis and positive cultures for B. pseudomallei were included. Comparisons were made between patients who received adjunctive therapy with open arthrotomy with conventional standard treatment and those who did not in terms of clinical outcomes and hospital expenditures. Of the 478 patients diagnosed with melioidosis microbiological confirmation, 81 patients had septic arthritis, accounting for 17% of cases. Among these patients, only 36 (44%) underwent adjunctive therapy with open arthrotomy. The 14-day and 30-day in-hospital mortality and length of hospital stays of patients who underwent adjunctive therapy with open arthrotomy were more favorable than those of patients who did not receive adjunctive therapy with open arthrotomy; however, the difference was not statistically significant. Patients who underwent adjunctive therapy with open arthrotomy had lower hospital expenditures (antimicrobial and non-antimicrobial costs) than those who did not undergo open arthrotomy. Adjunctive therapy with open arthrotomy for patients with septic arthritis due to melioidosis was associated with favorable clinical outcomes and significantly lower hospital expenditures.

This retrospective study was conducted to evaluate the characteristics and outcomes of patients with ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia (S. maltophilia), focusing on the impact of appropriate empirical antimicrobial treatment. Of the enrolled 240 patients with VAP due to S. maltophilia (median age: 45 years) in a tertiary-care hospital in southern Thailand between January 2010 and December 2021, 90% had medical comorbidities and 91% had previously received carbapenems. In addition, only 45% of the patients were initially admitted to the intensive care unit. Patients administered appropriate empirical antimicrobial treatment including colistin alone and colistin plus TMP-SMX or fluoroquinolone-based regimens had significantly lower 14-day, 30-day, and in-hospital mortalities, compared with those who did not receive appropriate empirical antimicrobial treatment (21% and 2% vs. 31%; 30% and 5% vs. 44%; and 30% and 12% vs. 53%, respectively). Thus, the use of appropriate empirical antimicrobial treatments led to a significantly reduced length of hospital stay, duration of ventilation, and hospital costs. The current study suggests that the use of appropriate empirical antimicrobial treatment based on susceptibility testing without considering pharmacokinetic properties and administration dosages improves the outcomes of patients with VAP due to S. maltophilia.

Background: Strongyloidiasis is a neglected tropical infection that can progress to life-threatening disease in immunocompromised hosts. However, predictors of severe disease and mortality remain incompletely defined, particularly in endemic regions. We aimed to identify clinical predictors of severe strongyloidiasis and 30-day mortality among hospitalized patients in southern Thailand. Methods: We conducted a 16-year retrospective cohort study of hospitalized patients aged ≥13 years with laboratory-confirmed Strongyloides stercoralis infection at a tertiary-care hospital between 2009 and 2025. Severe strongyloidiasis was defined by larval detection in extraintestinal or respiratory specimens or compatible clinical manifestations involving multiple organ systems with infectious complications. Multivariable logistic regression was used to identify predictors of severe disease and mortality. Results: Among 735 patients, 47 (6.4%) had severe strongyloidiasis. Corticosteroid exposure within 60 days was independently associated with severe disease (adjusted odds ratio [aOR] 3.25, 95% CI 1.65–6.73), whereas eosinophilia (absolute eosinophil count ≥500 cells/µL) was associated with lower odds (aOR 0.41, 95% CI 0.19–0.82). Bacteremia was more frequent in severe cases (38.3% vs 4.1%, p < 0.001), predominantly due to gram-negative organisms. Severe strongyloidiasis was associated with higher 30-day mortality (38.3% vs 14.0%, p < 0.001). In multivariable analysis, increasing age (aOR 1.22 per 10-year increase), higher National Early Warning Score (aOR 1.41 per point), and bacteremia (aOR 3.38) were independently associated with mortality, whereas eosinophilia was associated with lower odds of death and severe strongyloidiasis itself was not. Conclusions: Corticosteroid exposure was the strongest predictor of severe strongyloidiasis, while eosinophilia was protective. Mortality was driven primarily by bacteremia and physiologic instability. Early recognition and treatment are essential to improve outcomes in endemic settings.