Background and Clinical Significance: Simultaneous, multiple infections coinfections caused by zoonotic or fecal-orally transmitted diseases are common in tropical and subtropical regions. Published data report that leptospirosis may coexist with other infections, complicating the clinical presentation and trajectory due to overlapping symptoms and leading to more severe clinical progress. Case Presentation: We describe a clinical case of a 34-year-old female diagnosed with a triple infection caused by Leptospira, Hepatitis A Virus, and Hepatitis E Virus. To our knowledge, this is the first case described in the literature in a non-endemic area without travel history to tropical or subtropical regions. The patient presented with one-week history of influenced clinical status, myalgia, headaches, nausea, high fever, bloody diarrheas, and abdominal pain. During the last two days, she also developed jaundice. Swimming in the rock pools of the island where she lives was indicated as the source of the infection. The laboratory tests revealed increased values of inflammatory markers, thrombocytopenia, and severe abnormalities of liver function. Serological and PCR tests for a wide range of pathogens proved an acute infection caused by Leptospira interogans, Hepatitis A virus, and Hepatitis E Virus. The patient received intravenous fluids and antibiotic treatment with ceftriaxone for seven days leading to gradual clinical improvement and normalization of liver function tests with subsequent reduction in jaundice within 30 days. Conclusions: This case report suggests that clinical suspicion and laboratory investigation should include the probability of coinfections even in non-endemic areas based on medical history of the patients. An early diagnosis of a zoonotic disease and other infective agents of acute hepatitis are vital in order to choose the appropriate treatment option and avoid severe complications.

Background: After the implementations of Highly Active Antiretroviral Therapy (HAART) HIV infection became a chronic condition and the clinical focus on non-AIDS-related comorbidities such as hypertension and chronic kidney disease has increased. This study aims to investigate the prevalence and independent predictors of hypertension and albuminuria in a cohort of people with HIV (PWHIV) with high rates of viral suppression. Methods: This is a cross-sectional study of 183 HAART-experienced PWHIV. Hypertension, defined as office systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg and albuminuria, was defined as a sex-based albumin–creatinine ratio (ACR) of >355 mg/g for females and >250 mg/g for males. Univariable and multivariable logistic regression was conducted to identify the association of hypertension and albuminuria with demographic, clinical, and HIV-specific factors. Results: The prevalence of hypertension was 43.9% (n = 74) and albuminuria was 22.4% (n = 41). In the multivariable analysis, factors independently associated with prevalence of HTN were older age, overweight/obesity, and diabetes mellitus. TDF-based ART was explored as a potential factor but did not reach statistical significance (aRR = 1.85, p = 0.065). For albuminuria, older age, diabetes mellitus, and duration of HAART (aRR = 1.03 per year) were revealed as independent predictors. Conclusions: The results of this study demonstrate that the development of hypertension is primarily driven by traditional metabolic risk factors. However, the progression to albuminuria appears to be influenced not only by these comorbidities but also by long-term HIV disease and HAART exposure. These findings underline the critical need for the screening and management of hypertension and other comorbidities to mitigate the risk of long-term cardiovascular and renal complications in this aging population of PWHIV.

Oral manifestations are common in people living with HIV (PLWH) and may affect oral health-related quality of life (OHRQoL), while data from Greece remain limited. This multicenter prospective cohort study evaluated oral health status and OHRQoL among PLWH and explored associations with antiretroviral therapy (ART) and clinical factors. Overall, 370 PLWH from seven referral centers were included. Participants underwent oral examination, with oral hygiene assessed using the Simplified Oral Hygiene Index (OHI-S), and completed the Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed using IBM SPSS Statistics v29.0, while multinomial and binary logistic regression identified predictors of oral hygiene status and OHRQoL, respectively. Most participants were male (76.5%), had CD4 counts ≥ 200 cells/μL (95.4%), and were receiving ART (98.6%). Annual dental check-ups, daily tooth brushing, mouthwash use, and dental floss use were reported by 54.1%, 69.5%, 31.9%, and 23.8%, respectively. The median OHI-S score was 2.0 (IQR:1.5–2.7), with 16.9% having poor OHI-S; the median OHIP-14 score was 11 (IQR: 7–15), with 64.4% reporting poor OHRQoL. Male sex was associated with lower odds of poor OHRQoL (OR = 0.377; p = 0.006), whereas ART regimen independently predicted poor OHRQoL. These findings support patient-centered oral healthcare within HIV care.

Background/Objectives: The rise of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales has led to an increased carbapenem use, raising concerns regarding selection pressure for carbapenem-resistant organisms. Ceftolozane–tazobactam (C/T) is a potential effective carbapenem-sparing alternative. This single-centre retrospective study evaluated the clinical effectiveness and mortality predictors of ceftolozane–tazobactam versus meropenem as definitive targeted therapy for ESBL-producing Enterobacterales bloodstream infections (BSIs). Methods: We conducted a single-center retrospective analysis of adult hospitalized patients between January 2022 and February 2024 who presented with BSIs caused by ESBL-producing Enterobacterales. Patients (N = 185) were included if they received either C/T (n = 73) or optimized high-dose meropenem (n = 112) for at least 48 h. The primary clinical endpoint was all-cause 30-day mortality. Secondary endpoints included clinical success (cure), in-hospital mortality, treatment duration, microbiological eradication, and infection recurrence rates. A multivariable logistic regression model was executed to determine independent predictors of 30-day mortality. Results: Escherichia coli (54.1%) and Klebsiella pneumoniae (35.1%) were the primary pathogens. The raw clinical success rate was higher with C/T than meropenem (83.6% vs. 71.6%, p = 0.078). Unadjusted 30-day mortality was 12.3% for C/T and 19.6% for meropenem (p = 0.342). Zero recurrences occurred with C/T compared to an 8.0% recurrence rate with meropenem (0/73 [0.0%] in C/T vs. 9/112 [8.0%] in meropenem, p = 0.015). In the multivariable logistic regression analysis, definitive targeted treatment with C/T was independently associated with lower odds of all-cause 30-day mortality (Adjusted Odds Ratio [aOR] 0.60; 95% Confidence Interval [CI] 0.33–0.92; p = 0.022). Conversely, independent clinical mortality risks included male gender (p = 0.027), baseline SOFA score (p = 0.001), septic shock (p = 0.001), and an unknown primary infection source (p = 0.001). Conclusions: In this single-center retrospective observational cohort, definitive targeted therapy with ceftolozane–tazobactam was associated with favorable clinical success and lower adjusted 30-day mortality compared to meropenem in patients with ESBL Enterobacterales BSIs. These observational data support further prospective evaluation of C/T as a potential carbapenem-sparing option. Prospective randomized controlled trials are required to confirm these findings before clinical practice algorithms are modified.