The study was conducted from October 2020 to March 2022 in a province in southern Thailand. The inpatients with community-acquired pneumonia (CAP) and more than 18 years old were enrolled. Of the 1511 inpatients with CAP, COVID-19 was the leading cause, accounting for 27%. Among the patients with COVID-19 CAP, mortalities, mechanical ventilators, ICU admissions, ICU stay, and hospital costs were significantly higher than of those with non-COVID-19 CAP. Household and workplace contact with COVID-19, co-morbidities, lymphocytopenia and peripheral infiltration in chest imaging were associated with CAP due to COVID-19. The delta variant yielded the most unfavorable clinical and non-clinical outcomes. While COVID-19 CAP due to B.1.113, Alpha and Omicron variants had relatively similar outcomes. Among those with CAP, COVID-19 infection as well as obesity, a higher Charlson comorbidity index (CCI) and APACHE II score were associated with in-hospital mortality. Among those with COVID-19 CAP, obesity, infection due to the Delta variant, a higher CCI and higher APACHE II score were associated with in-hospital mortality. COVID-19 had a great impact on the epidemiology and outcomes of CAP.

Background: Mycetoma is a chronic subcutaneous infection caused by fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Although recently recognized by the World Health Organization as a neglected tropical disease, data from Southeast Asia are scarce. Previous reports from Thailand were limited and outdated. Methodology/Principal findings: We conducted a 25-year retrospective study (2000–2025) at a tertiary referral hospital in southern Thailand. Patients were identified from hospital records and confirmed by histopathology and/or culture. Fifty patients met inclusion criteria: 31 (62%) had eumycetoma and 19 (38%) had actinomycetoma. The median age was 50 years (IQR 41.8-58.0), and 62% were male. The foot was the most common site (80%), with bone involvement in 28%. Sinus tracts occurred in 43%, but visible grains were recorded in only 12%. Histopathology (performed in 86%) reliably distinguished fungal from bacterial etiologies, whereas culture yield was low, especially for actinomycetoma (27%). Among eumycetoma, identified pathogens included dematiaceous fungi such as Exophiala jeanselmei and hyaline molds such as Scedosporium and Fusarium . Among the few culture-positive actinomycetoma cases, all isolates were Nocardia spp. Itraconazole was the main antifungal, whereas trimethoprim-sulfamethoxazole was used for actinomycetoma. Surgery was performed in 66% of patients. At a median follow-up of 21 months (IQR 7.5–46.0), 54% achieved cure, 24% improved, 10% recurrence, and 3% required amputation. Conclusions/Significance: Mycetoma in southern Thailand is uncommon but clinically significant. Unlike classical endemic regions, eumycetoma predominated and was caused by diverse fungi rather than Madurella mycetomatis . Despite combined medical and surgical therapy, cure rates were modest and complications frequent. These findings highlight regional differences in epidemiology and underscore the need for strengthened diagnostics, access to effective therapy, and region-specific neglected tropical disease strategies in Southeast Asia.

Background: Ocular candidiasis is a serious metastatic complication of candidemia that may lead to irreversible visual impairment. Although recent meta-analyses suggest an overall prevalence of approximately 10%, real-world data from Southeast Asia remain limited. Regional differences in Candida species distribution, antifungal resistance patterns, and health-care resources may influence both the incidence of ocular candidiasis and the utilization of ophthalmic evaluation in routine practice. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with candidemia at a 900-bed tertiary-care university hospital in southern Thailand between January 2014 and August 2025. Only the first episode of candidemia per patient was included. Ophthalmic evaluation was defined as a dilated funduscopic examination performed by an ophthalmologist within 4 weeks of candidemia onset. Ocular candidiasis was classified as Candida chorioretinitis or Candida endophthalmitis according to established definitions. Multivariable logistic regression was used to identify factors independently associated with receipt of ophthalmic evaluation. Results: Among 337 patients with candidemia, 67 (19.9%) underwent ophthalmic evaluation. Ocular candidiasis was diagnosed in 9 of 67 evaluated patients (13.4%), corresponding to an overall incidence of 2.7% in the entire cohort. Five patients (7.5%) had Candida chorioretinitis and four (6.0%) had Candida endophthalmitis, including two concordant and two discordant cases. Visual symptoms were assessable in 35 patients, among whom only 4 (11.4%) reported visual complaints; most patients with ocular candidiasis were asymptomatic at diagnosis. Candida albicans and Candida tropicalis accounted for 55.6% and 44.4% of ocular candidiasis cases, respectively, and bilateral ocular involvement was observed in 77.8%.Ophthalmic findings led to modification of antifungal therapy in 7 of 9 patients with ocular candidiasis (77.8%), most commonly through addition or switching to an azole-based regimen and/or prolongation of treatment duration. In multivariable analysis, vasopressor use at candidemia onset was independently associated with a lower likelihood of ophthalmic evaluation, whereas early infectious diseases consultation were independently associated with increased odds of receiving ophthalmic evaluation. Conclusions: In this Southeast Asian cohort, ophthalmic evaluation was infrequently performed but yielded clinically actionable findings and frequently altered antifungal management. The observed incidence of ocular candidiasis among examined patients was higher than that reported in Western countries. Underutilization of ophthalmic evaluation appears to reflect illness severity and care pathway factors rather than low disease burden, suggesting that the true incidence of ocular candidiasis may be underestimated. Integrating ophthalmic evaluation into standardized candidemia care pathways may improve detection of ocular involvement, particularly in resource-limited settings.

Loods are among the most frequent natural disasters globally and are recognized as drivers of infectious disease outbreaks. Knowledge of local endemic disease patterns may help anticipate post-flood risks. This narrative review examines how flooding may amplify these risks, drawing on the 2025 Hat Yai flood to identify clinical and public health preparedness priorities.Potential mechanisms include pathogen mobilization, vector breeding, host susceptibility, and healthcare system disruption. During the 2025 flood, approximately 1,300 millimetres of rainfall were recorded, with floodwaters peaking between 22 and 25 November. Five of six major hospitals became inoperable, leaving Songklanagarind Hospital as the sole functioning facility for over 700,000 people. Routine surveillance data are presented descriptively. Reported leptospirosis cases peaked one to two weeks after the flood, while dengue, melioidosis, and diarrheal disease showed differing temporal patterns. Higher rates of carbapenem-resistant organism detection and central line-associated bloodstream infection were reported in November and December than in the preceding months, coinciding with staffing shortages, intensive care unit (ICU) expansion, and increased patient transfers. However, these temporal patterns do not establish causation. Surveillance disruption may have affected reporting completeness and accuracy, limiting interpretation.Preparedness priorities informed by local endemic disease patterns include maintaining clinical awareness of flood-associated infections, preventing healthcare-associated infections, establishing contingency plans for healthcare disruption, and strengthening surveillance through automation. The 2025 Hat Yai experience underscores the need to integrate these priorities into preparedness for future floods.

Background/Objectives: Achromobacter bacteremia is uncommon, difficult to treat and lacks historically consistent organism-specific susceptibility criteria. We described its clinical characteristics, antimicrobial exposure, susceptibility patterns, treatment, and outcomes over 20 years. Methods: We retrospectively reviewed adults with Achromobacter-positive blood cultures at a Thai tertiary-care hospital during 2006–2025. The first eligible episode per patient was used for patient-level analyses. Historical susceptibility categories were retained as reported. Available matched blood-isolate minimum inhibitory concentrations (MICs) were retrospectively interpreted using Clinical and Laboratory Standards Institute (CLSI) M100, 36th edition. Results: Forty-nine eligible episodes occurred in 47 patients, of which 43/47 (91.5%) were nosocomial. Prior systemic antibiotics and carbapenems had been received by 43/45 (95.6%) and 26/45 (57.8%) patients, respectively. Prior carbapenem exposure was associated with meropenem non-susceptibility (50.0% vs. 11.1%; odds ratio (OR) 7.64, p = 0.010). Thirty-day mortality was 23/46 (50.0%). Non-survivors had higher median National Early Warning Score (NEWS) than survivors (6 vs. 3; p = 0.005). Mortality was lower among patients receiving active than inactive empiric therapy (39.4% vs. 76.9%; OR 0.20, p = 0.047), but the association attenuated after adjustment for vasopressor use. Historical disk and contemporary MIC categories were not fully concordant in the small matched subset (n = 7). Conclusions: Achromobacter bacteremia occurred predominantly as a nosocomial infection in heavily antibiotic-exposed patients and was associated with high mortality. Prior carbapenem exposure was associated with meropenem non-susceptibility, while mortality was closely related to acute illness severity. Historical susceptibility results should be interpreted in the context of the testing method and breakpoint framework.

Background: Ocular candidiasis is a serious metastatic complication of candidemia that may lead to irreversible visual impairment. Although recent meta-analyses suggest an overall prevalence of approximately 10%, real-world data from Southeast Asia remain limited. Regional differences in Candida species distribution, antifungal resistance patterns, and health-care resources may influence both the incidence of ocular candidiasis and the utilization of ophthalmic evaluation in routine practice. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with candidemia at a 900-bed tertiary-care university hospital in southern Thailand between January 2014 and August 2025. Only the first episode of candidemia per patient was included. Ophthalmic evaluation was defined as a dilated funduscopic examination performed by an ophthalmologist within 4 weeks of candidemia onset. Ocular candidiasis was classified as Candida chorioretinitis or Candida endophthalmitis according to established definitions. Multivariable logistic regression was used to identify factors independently associated with receipt of ophthalmic evaluation. Results: Among 337 patients with candidemia, 67 (19.9%) underwent ophthalmic evaluation. Ocular candidiasis was diagnosed in 9 of 67 evaluated patients (13.4%), corresponding to an overall incidence of 2.7% in the entire cohort. Five patients (7.5%) had Candida chorioretinitis and four (6.0%) had Candida endophthalmitis, including two concordant and two discordant cases. Visual symptoms were assessable in 35 patients, among whom only 4 (11.4%) reported visual complaints; most patients with ocular candidiasis were asymptomatic at diagnosis. Candida albicans and Candida tropicalis accounted for 55.6% and 44.4% of ocular candidiasis cases, respectively, and bilateral ocular involvement was observed in 77.8%. Ophthalmic findings led to modification of antifungal therapy in 7 of 9 patients with ocular candidiasis (77.8%), most commonly through addition or switching to an azole-based regimen and/or prolongation of treatment duration. In multivariable analysis, vasopressor use at candidemia onset was independently associated with a lower likelihood of ophthalmic evaluation, whereas early infectious diseases consultation was independently associated with increased odds of receiving ophthalmic evaluation. Conclusions: In this Southeast Asian cohort, ophthalmic evaluation was infrequently performed but yielded clinically actionable findings and frequently altered antifungal management. The observed incidence of ocular candidiasis among examined patients was higher than that reported in Western countries. Underutilization of an ophthalmic evaluation appears to reflect illness severity and care pathway factors rather than low disease burden, suggesting that the true incidence of ocular candidiasis may be underestimated. Integrating ophthalmic evaluation into standardized candidemia care pathways may improve detection of ocular involvement, particularly in resource-limited settings.