The emerging neonatal bacterial pathogen Paenibacillus thiaminolyticus causes sepsis and postinfectious hydrocephalus, yet few tools are available to study or specifically detect it. We developed fluorescent probes based on cell wall-binding domains (CBDs) from bacteriophage-derived cell-wall hydrolases. CBDs can target structurally conserved cell-wall glycans, making them attractive affinity reagents for bacterial detection. None of the 11 probes we designed labeled intact cells under standard conditions, and we identified a surface layer (S-layer) that prevented access to their cell-wall targets. Brief acidic treatment (pH 2.0) released abundant high-molecular-mass proteins from the cell surface and enabled labeling by five distinct CBD probes, each containing a single C-terminal S-layer homology domain. Mass spectrometry identified the main released protein as an ortholog of the P. alvei SpaA S-layer protein, which we designate SlsA. Across 26 surveyed P. thiaminolyticus genomes, we identified four distinct SlsA variants with 58-79% pairwise amino acid identity, encoded within a conserved cluster homologous to the P. alvei S-layer-associated locus. After either the acidic treatment or a quick flame fixation, the lead probe mGL-BDPt9 labeled six P. thiaminolyticus strains, including three Ugandan clinical isolates, as well as a P. dendritiformis clinical isolate from a US infant, and three additional Paenibacillus species. mGL-BDPt9 also distinguished P. thiaminolyticus from five gram-positive sepsis pathogens in pairwise mixtures and detected it in a five-species suspension. Together, these findings establish the presence of an S-layer in P. thiaminolyticus and provide a rapid fluorescent labeling strategy for multiple Paenibacillus pathogens associated with neonatal paenibacilliosis.

Long COVID, including the difficulty in defining it and caring for patients experiencing it, is discussed by JAMA Senior Editor Derek C. Angus, MD, MPH, and E. Wesley Ely, MD, MPH, professor of medici...

SARS-CoV-2 offers a new context to evaluate the relationship between viral infection and allergic disease. A biologically plausible mechanism exists for postinfectious type 2 helper T cell–skewed resp...

Recurrent diarrhea after an episode of Clostridioides difficile infection (CDI) is common although not always secondary to recurrent disease. Bacterial and viral gastroenteritis has been associated with postinfectious functional bowel disorders (FBDs). We aimed to compare characteristics of patients diagnosed with CDI-associated FBD with those of patients diagnosed with initial or recurrent CDI alone.MethodsThis was a retrospective review of the electronic medical records of patients referred to the Complicated C. difficile Clinic at University of Virginia Health from March 2020 to January 2023. The characteristics of the patients we studied included demographics, risk factors, and outcomes.ResultsOf 159 patients seen at the clinic, 44 (27.7%) referred for recurrent CDI had symptoms of FBD; 90 (56.6%) had symptoms of CDI alone. Compared with patients with CDI only, patients with CDI-associated FBD were younger (P = .001), more likely to be female (P = .029), had fewer comorbidities (P < .001), and more frequently had a history of anxiety (P < .001) and depression (P = .003). In a multiple regression model, FBD remained associated with fewer comorbidities (P = .032). At 3 months, patients with FBD were less frequently well (P = .039) and more frequently continued to have gastrointestinal symptoms (P < .001) than patients with CDI alone.ConclusionsCDI-associated FBD is prevalent but may be misdiagnosed as solely CDI recurrence, contributing to incomplete resolution of symptoms despite anti–C. difficile treatments.

AbstractNeuropsychiatric symptoms are a common complication of COVID-19, with symptoms documented both during acute COVID-19 infection (parainfectious) and p...

Postinfectious IBS is a condition that occurs after a GI illness. Our overview covers symptoms, treatment, and more.

AbstractElevated opening pressures on lumbar puncture were followed in 7 nonimmunocompromised patients being treated for a postinfectious inflammatory response syndrome that had begun following antifungal treatment of cryptococcal meningitis. During the initial period of high-dose corticosteroid therapy, opening pressures on lumbar puncture fell an average of 14 cm. Despite this, 5 of 7 patients later required a ventriculoperitoneal shunt for pressure control.

AbstractMultisystem inflammatory syndrome in children (MIS-C) is an emergent postinfectious hyperinflammatory disorder predominantly affecting the pediatric population following COVID-19 infection. Clinically, it is characterized by persistent fever, shock, multiorgan involvement, and potentially severe cardiovascular involvement. This comprehensive review synthesizes current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic criteria, with particular emphasis on the management of MIS-C. We also stress on the importance of distinguishing MIS-C from phenotypically similar entities. Acute-phase management centers on supportive care, hemodynamic stabilization, and targeted immunomodulation, with intravenous immunoglobulin, corticosteroids, and biologic forming the therapeutic cornerstone. Thromboprophylaxis is frequently warranted due to the elevated thromboembolic risk, and long-term follow-up is essential to monitor for cardiac, gastrointestinal, and neurologic complications. Additional considerations include postrecovery vaccination protocols and the use of extracorporeal membrane oxygenation in cases of refractory cardiorespiratory failure. Despite advancements in clinical outcomes, diagnostic ambiguity and heterogeneous management guidelines continue to pose significant challenges.

Takayasu arteritis (TAK) is a rare large-vessel vasculitis affecting the aorta and its major branches. Although autoimmune mechanisms are central, prior mycobacterial infections have been hypothesized to contribute to the disease onset. A 55-year-old South Asian woman with a history of vitiligo and …