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A Revision to Organ Failure Assessment in Critically Ill Patients

Modern intensive care of critically ill patients is evolving. Nearly 1 in 5 hospitalized patients receive intensive care, and there are new diseases, treatments, and approaches to organ support. Many intensive care unit (ICU) patients develop acute, vital organ failure—a nefarious and unremitting cause of death—and structured measures of vital organ function help to quantify illness severity. These scores were developed almost 50 years ago and were meant to be generic and independent of the cause of multiple organ failure. Now, organ failure scores are still incorporated into contemporary risk prediction models, syndromic criteria like Sepsis-3, and disaster triage tools and are also used to compare ICU populations and outcomes from randomized clinical trials. Organ failure scores are used widely by clinicians, researchers, and quality improvement teams. But how these scores should evolve with changes in modern intensive care is debated.

Capillary Refill Time in Sepsis

Almost 25 years ago, a landmark trial of early goal-directed therapy (EGDT) by Rivers and colleagues reshaped the care of septic shock by introducing the concept that “early” management was crucial. Although implementation has varied across high- and low-resource settings, the importance of early sepsis recognition and treatment is now nearly universally accepted. In contrast, the specific manner by which goal-directed therapy for septic shock should be provided remains highly controversial. Conceptually, goal-directed therapy is a resuscitation protocol involving a goal to be achieved, serial assessments of the patient’s physiologic status, and administration of therapies that the assessments indicate will help achieve the goal. But what are the right goals, assessments, and therapies to improve outcomes for patients with early sepsis?

[Clinical Picture] Candida albicans fungal ball in the eyeball

A 70-year-old man with diabetes and gastrinoma presented to the Department of Ophthalmology at Kochi Medical School Hospital with a 2-month history of decreased visual acuity (20/1000) in his right eye. 2 months earlier, he had received a posterior sub-Tenon's injection of 20 mg of triamcinolone for uveitis without improvement. Slit-lamp examination revealed anterior chamber inflammation with hypopyon. Fundus examination showed vitreous haze and a large white lesion in the temporal retina (figure A).

[Grand Round] Haemophagocytic lymphohistiocytosis (HLH) secondary to measles in an adult with a loss of post-vaccination humoral immunity following rituximab

Measles is an important re-emergent infectious disease globally. Vaccine immunity at the population level is key to the prevention of outbreaks, as unvaccinated or immunosuppressed adults are particularly vulnerable to severe infection. With the increasing use of immunomodulatory treatments for autoimmune and malignant conditions, the long-term effects of CD20-expressing cell-depleting therapies on the vaccine-induced humoral immunity to measles remain unclear. Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with high mortality commonly triggered by infection and is possibly under-reported in association with measles.

[Personal View] The health impact of identifying a person with tuberculosis through systematic screening

Screening populations at high risk for tuberculosis might improve clinical outcomes and reduce transmission, but the value and cost-effectiveness of population-based screening depend on the uncertain health impact of early tuberculosis detection. In this Personal View, we propose a framework for estimating the incremental health impact of systematic screening, including effects on tuberculosis morbidity, mortality, sequelae, and transmission. Our framework accounts for the timing of screening, relative to when routine diagnosis might occur and when health effects become inevitable.

[Review] Tetanus: recognition and management

Currently a rarity in high-income countries, tetanus is a diagnosis not to miss. Deaths from tetanus fell by almost 90% between 1990 and 2019, largely reflecting the success of WHO's Maternal and Neonatal Tetanus Elimination campaign. However, deaths among children and adults have plateaued, and tetanus remains an important vaccine-preventable cause of morbidity and mortality, notably in southern Asia, southeast Asia, and sub-Saharan Africa. Tetanus results from infections with spore-forming Clostridium tetani bacteria, usually acquired via contaminated wounds and burns.

[Review] The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and psychometric validation study

Reducing stigma during infectious disease outbreaks is crucial for delivering an effective response. However, no validated stigma scales exist for use across outbreaks, and outbreak-specific scales are developed too slowly to guide timely interventions. To enable more real-time monitoring and mitigation of stigma across outbreak contexts, we developed and validated the (Re)-emerging and ePidemic Infectious Diseases (RAPID) Stigma Scales. Field testing and psychometric validation were conducted in communities affected by Ebola disease in Uganda, mpox in the UK, and Nipah virus disease in Bangladesh.

[Articles] Delpazolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-DECODE-01): a prospective, randomised, open-label, phase 2b, dose-finding trial

The pharmacokinetic–pharmacodynamic modelling results suggest that delpazolid adds efficacy on top of bedaquiline, delamanid, and moxifloxacin; and that a dose of 1200 mg once daily would result in exposures with maximum efficacy. That dose was shown to be safe, raising hope that linezolid toxicities could be averted in long-term treatment. Delpazolid is a promising drug for future tuberculosis treatment regimens and could be widely usable if safety and efficacy are confirmed in larger trials.

[Articles] Sutezolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-SUDOCU-01): a prospective, open-label, randomised, phase 2b dose-finding trial

Sutezolid, combined with bedaquiline, delamanid, and moxifloxacin, was shown to be efficacious and added activity to the background drug combination, although we cannot make a final dose recommendation yet. This study provides valuable information for the selection of sutezolid doses for future studies, and described no oxazolidinone class toxicities at the doses used.

[Media Watch] The challenges of PrEP

Oral pre-exposure prophylaxis (PrEP), a mix of medications that is taken for HIV prevention, is the focus of Morten Skovdal's book Paradoxes of PrEP for HIV Prevention. Focusing on the lived experiences of PrEP users, the author offers insight into the dynamics between social context within the PrEP community, as well as individual insights on the medication and how it can affect a person in their day-to-day life. The book encompasses the common considerations that PrEP users must face within six contradictory paradoxes: free, yet costly; eligible, yet ineligible; responsible, yet irresponsible; healthy, yet a patient; safe, yet unsafe; and liberating, yet constraining.

[Media Watch] The dignity of Indian female sex workers

In her book Risk, Stigma, Agency: Life Histories of Women Involved in Sex Work in Kolkata, India, Sunny Sinha explores the complex social, cultural, and political dimensions of sex work in India and emphasises the voices and agency of female sex workers through the life stories of three women: Trupti, Geetanjali, and Srishti. At its core, this body of work critiques dominant risk discourses that focus narrowly on health issues like HIV/AIDS but typically ignore the broader social dangers stemming from systemic inequalities and moral judgments that silence women's perspectives.

[Profile] Lyda Osorio—tackling South America's infectious diseases

Hailing from a small town in the middle of Colombia, Lyda Osorio's interest in science was sparked during a high-school project on Gregor Mendel's plant experiments. Her teachers saw she loved genetics and encouraged her to learn more. “I couldn’t get enough of genetics”, she tells The Lancet Infectious Diseases. “I then discovered Darwin and was absorbing anything else I could find.” Although her family was poor, Lyda ended up with a high score in the national exams, which qualified her to study medicine at a public university, Universidad de Caldas, some 8 h drive from her home.

[Comment] Preventing vertical HIV transmission in India: the final push

Elimination of vertical HIV transmission is the cornerstone of achieving the goal to end HIV/AIDS as a public health threat by 2030.1 Globally, annual vertical HIV transmissions declined by 50% between 2010 and 2021, reflecting substantial progress.1 India, which is home to the world's second-largest HIV epidemic, with 2·6 million adults and children living with HIV in 2024, is pivotal to the global HIV response.1,2 India's coordinated efforts in the prevention of vertical transmission have substantially reduced paediatric HIV in the country, with the vertical transmission rate falling from over 40% in 2010 to 11·75% in 2022–23.

[Newsdesk] Research in brief

In a double-blind randomised trial, researchers in Uganda investigated whether treating cloth wraps with permethrin insect repellent every 4 weeks would protect infants from malaria compared with placebo treatment. 200 mothers with a child aged 6–18 months were randomly assigned to permethrin wraps and 200 to placebo. After 24 weeks, the incidence of clinical malaria in children in the permethrin group was significantly lower than in the placebo group, with 34 cases in the permethrin group versus 94 in the placebo group.

[Newsdesk] Infectious disease surveillance update

As of Oct 1, 2025, an estimated 714 cases of West Nile virus infection and 49 deaths had been reported in Italy this year. The worst affected provinces are Latina with 210 cases and Napoli with 73 cases. Most cases are among males aged 65 years and older, and the hospitalisation rate is currently around 91%. Public health authorities have responded by implementing an awareness campaign relating to personal protective behaviour and community participation in mosquito control. Additionally, health-care professionals have been given training to improve clinical suspicion, diagnostic accuracy, and prompt case reporting.