Background and Clinical Significance: Cladosporium cladosporioides is a ubiquitous dematiaceous mold that is rarely implicated in invasive human diseases and often considered a saprophyte and plant pathogen. Case Presentation: We report an extremely rare case of C. cladosporioides fungemia in a 61-year-old man with mantle cell lymphoma undergoing chemotherapy. The patient developed fever, dry cough and cavitary pulmonary lesions in the setting of profound immunosuppression. Blood cultures yielded slow-growing dark pigmented mold after prolonged incubation and species identification was achieved using MALDI-TOF mass spectrometry with an alternative fungal database, supported by microscopic morphology. Serum 1,3-β-D-glucan levels were markedly elevated, while galactomannan antigen testing was negative. Antifungal susceptibility testing demonstrated activity of triazoles and targeted therapy with voriconazole led to clinical improvement. A review of the literature identified only five previously reported cases of invasive C. cladosporioides infections worldwide, involving primarily pulmonary and central nervous system disease. Conclusions: To the best of our knowledge, this is the first documented case of fungemia caused by this species. The current report highlights the pathogenic potential of C. cladosporioides in immunocompromised hosts, the diagnostic challenges posed by slow-growing dematiaceous fungi, the importance of prolonged culture incubation, fungal biomarkers and advanced identification techniques for timely diagnosis and management.

Background/Objectives: Immune surveillance is increasingly recognized as a modifier of myeloproliferative neoplasm (MPN) initiation and evolution, yet the contribution of the NKG2D receptor and its ligands MICA/MICB to CALR-mutated disease remains unclear. Methods: We performed high-resolution next-generation sequencing genotyping of MICA and MICB in 43 patients with CALR-mutated MPN (WHO 2022 criteria) and compared the allele and haplotype distributions with those of 156 healthy Bulgarian controls and 85 patients with JAK2 V617F-positive MPN. Associations were tested using age- and sex-adjusted additive generalized linear models; bi-locus haplotypes were evaluated using haplotype score methods. In a genotyped subgroup (35 CALR-mutated MPN patients and 105 controls), functional KLRK1 (NKG2D) polymorphisms were analyzed for haplotype-level associations. We also performed 700 ns molecular dynamics simulations of selected MICA variants in complex with NKG2D and reanalyzed publicly available single-cell RNA-sequencing data (GSE117826) and RNA-sequencing data from CRISPR/Cas9-edited CALR-mutant iPSC-derived megakaryocytes to evaluate MICA/MICB expression. Results: MICA*004:001 was significantly associated with CALR-mutated MPN versus controls (p = 0.004; Bonferroni-adjusted p = 0.047), while MICB*008:001 showed only nominal association. Exploratory haplotype analyses identified a MICA*009:01-MICB*004:001 haplotype associated with CALR-mutated status (p = 0.008) and a KLRK1 G-A-G-T haplotype (rs1049174-rs2617160-rs2246809-rs2617170) associated with increased CALR-mutated MPN risk (OR = 3.61; p = 0.029). Transcriptomic reanalysis indicated a higher fraction of CALR-mutant stem and progenitor cells expressing detectable MICA/MICB transcripts, and heterozygous CALR-mutant megakaryocytes exhibited higher MICA expression than the wild type. Conclusions: Together, these data support an exploratory immunogenetic and transcriptomic link between the NKG2D-MICA/MICB axis and CALR-mutated MPN, but direct protein-level and functional studies are required before mechanistic or therapeutic conclusions can be drawn.

The One Health (OH) concept emphasizes public health collaboration and transdisciplinary research. Following the COVID-19 crisis, Bulgaria’s first OH scientific initiative was launched at the Medical University of Varna to raise national awareness and promote OH principles. Expanding on WHO’s holistic OH definition, the project explores “One Health—Integrated Social and Scientometric Approaches for Better Quality of Life”, involving researchers, students, and the University Publishing Department. This report aims to outline the project’s parallel mixed-methods design (PMMD) and initial findings. Using the nominal group technique and horizon scanning, the project was structured into three thematic research areas: (1) OH and antimicrobial resistance (AMR)—assessing knowledge, attitudes, and practices (KAP) among medical and veterinary professionals, and investigating the potential of integrative approaches to manage AMR; (2) OH and wellbeing—examining the wellbeing levels among students and among chronically ill patients; and (3) OH education and dissemination—integrating OH into education and public awareness campaigns. Preliminary findings show policy gaps, particularly the lack of a national OH Action Plan. A KAP survey was conducted (sample size—228, 2023–2024) and wellbeing studies are ongoing (193 students participated, Februarty 2025), while OH topics are being integrated into the curricula. Despite low awareness in Bulgaria, this project seeks to attract national attention to the EU OH strategies.

Background/Objectives: Genetic abnormalities are critical for the diagnosis, prognosis, and therapeutic management of myelodysplastic syndromes (MDS). This study aims to evaluate the clinical utility of Multiplex Ligation-dependent Probe Amplification (MLPA) as a rapid and cost-effective method, determining its place alongside Next-Generation Sequencing (NGS) for the initial genetic assessment of patients with MDS. Methods: Bone marrow samples from 68 patients newly diagnosed with MDS were analyzed. Genomic DNA was investigated using the SALSA MLPA P414-C1 MDS probe mix to detect common copy number variations (CNVs). Results: MLPA detected genetic variants in 25 patients (36.8%). The most common finding was a single chromosomal abnormality (26.5%). Multiple pathological findings were observed in only 1.5% of patients, and a JAK2 mutation was observed in 8.8% of the cohort. However, the presence of these aberrations did not show a statistically significant association with overall survival (OS) in the cohort. Patient sex was identified as the only variable that was associated with a marginal level of statistical significance regarding OS, indicating a worse prognosis for males. Conclusions: MLPA is a valuable, rapid, and cost-effective tool for initial genetic screening in low-resource settings. This was highlighted by our finding that sex was the sole significant prognostic factor, while the MLPA-detected variants were not found to be significant. The findings suggest that comprehensive risk stratification aligned with international standards requires more advanced molecular technologies.

Objective: To assess the incidence, timing of onset and etiological spectrum of bacterial infections in patients with hematologic malignancies after allogeneic hematopoietic stem cell transplantation (HSCT), and to compare haploidentical and non-haploidentical recipients. Material and Methods: This retrospective single-center cohort study included 115 consecutive patients with hematologic malignancies who underwent allogeneic HSCT between December 2017 and December 2025 at the Transplant Department of University Hospital “St. Marina”—Varna, Bulgaria. Of these, 38 (33%) received haploidentical and 77 (67%) non-haploidentical grafts. Only microbiologically documented bacterial infections were analyzed. The cumulative incidence (CI) of first bacterial infection of any type and first bloodstream infection (BSI) was estimated using competing-risk methodology, with death before respective infection treated as a competing event. CI curves were compared using Gray’s test and the potential risk factors for first bacterial infection were assessed by Fine–Gray competing-risk regression. Results: Overall, 65 patients (56.5%) developed at least one bacterial infection, with a median time to the first infection of 11 days (IQR: 6–36). The CI of first bacterial infection was 40.0% at day +30 and 52.7% at 1 year; the corresponding cumulative incidences of first BSI were 27.8% and 35.0%, respectively. No statistically significant differences were observed between haploidentical and non-haploidentical recipients in the CI of first bacterial infection or first BSI. A total of 105 bacterial infectious episodes were documented. Their temporal distribution showed different patterns between the two groups, with a greater proportion of early episodes among the non-haploidentical recipients and a greater proportion of later episodes among the haploidentical ones. BSIs were the predominant infectious syndrome, occurring in 46 patients (40.0%; 46/115) and accounting for 63 episodes. Gram-negative bacteria represented 66.2% of BSI isolates, of which 44.2% were multidrug-resistant (MDR). None of the evaluated patient-, disease-, or transplant-related variables was significantly associated with the CI of first bacterial infection. Conclusions: Bacterial infections were common complications after allogeneic HSCT, particularly during the early post-transplant period, with BSIs representing the predominant infectious syndrome. Gram-negative bacteria accounted for most BSI isolates, and a substantial proportion exhibited MDR. No statistically significant differences in the CI of first bacterial infection were observed between haploidentical and non-haploidentical recipients, and donor type was not significantly associated with the risk of first bacterial infection. The distribution of all infectious episodes over the studied time periods showed different patterns between the two groups. These findings should be interpreted in the context of the retrospective single-center design and the relatively small haploidentical subgroup.

Myelodysplastic syndromes (MDSs) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and their diagnosis remains challenging, requiring integration of clinical, morphological, and genetic data. MicroRNAs (miRNAs) have emerged as potential biomarkers in MDS, offering insights into disease mechanisms and patient stratification. This study aimed to evaluate the diagnostic and prognostic significance of five plasma microRNAs (miR-22-3p, miR-144-3p, miR-16-5p, let-7a-5p, and miR-451a) in 40 patients with MDS, diagnosed according to WHO 2016 criteria and stratified by R-IPSS, and ten healthy controls. Plasma miRNA levels were measured by RT-qPCR. Expression profiles were compared between patients and controls, and further assessed in relation to disease subtypes, risk categories, and clinicopathological features. Expression analysis showed that miR-144-3p, miR-16-5p, let-7a-5p, and miR-451a were significantly lower in MDS patients compared to controls. MiR-451a demonstrated the highest diagnostic predictive value (p = 0.0022), followed by miR-16-5p (p = 0.0055), miR-144-3p (p = 0.0074), and let-7a-5p (p = 0.0092). Let-7a-5p was higher in MDS with excess blasts and both let-7a-5p and miR-451a were lower in the low-risk R-IPSS group. Strong correlations between miR-16-5p, miR-144-3p, and miR-451a were observed, probably reflecting their function in erythropoiesis. None of the investigated microRNAs showed independent prognostic significance for overall survival. In conclusion, circulating microRNAs, particularly miR-451a and let-7a-5p, show promise as supportive biomarkers that may complement existing diagnostic and risk assessment tools in MDS. Further studies are needed to validate their clinical applicability.