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[Correspondence] Residual antimicrobials in food can select for antimicrobial resistance

We thank Sheeba Santhini Manoharan-Basil and colleagues for their Correspondence1 and for extending the discussion initiated by our Comment published in The Lancet Microbe.2 Our paper primarily focused on the French context and Europe more broadly in light of the measurable progress achieved through national programmes, such as the EcoAntibio plans in France.

[Correspondence] Residual antimicrobials in food can select for antimicrobial resistance

In their recent article in The Lancet Microbe, Elissa Khamisse and colleagues propose that the impact of antimicrobial use in animal husbandry on antimicrobial resistance (AMR) in humans is exaggerated.1 The authors argue that there is little evidence of direct transmission of AMR in clinically relevant bacteria from animals to humans via food. However, Khamisse and colleagues omit one important pathway. Growing evidence indicates that antimicrobial residues in food can select for AMR in the human gut microbiome.

[Correspondence] Implementation of cholera RDTs: bridging laboratory precision and field reality

The comprehensive study by Javier Perez-Saez and colleagues, published in The Lancet Microbe, demonstrates a remarkable performance of cholera rapid diagnostic tests (RDTs) in Bangladesh, revealing 93·5% sensitivity and 97·3% specificity through rigorous Bayesian latent class analysis.1 The methodological advancement in accounting for imperfect reference standards represents a key contribution of the study, particularly considering the global rollout of 1·2 million RDTs across 14 high-risk countries initiated in 2024 under the Gavi diagnostic support programme.

[Correspondence] Revisiting quantitative PCR positivity thresholds to inform the development of shorter benznidazole regimens

We read with great interest the Article by James A Watson and colleagues published in The Lancet Microbe,1 who applied a hierarchical Bayesian model to individual patient data from the E1224 and BENDITA trials. This innovative pooled analysis showed that 4-week daily benznidazole regimens achieved cure rates approaching those of the 8-week standard—an important observation with implications for optimising future treatment strategies. However, the interpretation of the observation depends crucially on how quantitative PCR (qPCR) positivity is defined.

[Correspondence] Therapeutic potential of targeting ORF6 in persistent SARS-CoV-2 infections

In their study published in The Lancet Microbe, Mahan Ghafari and colleagues1 provide compelling evidence to suggest that ORF6 is under strong purifying selection during persistent SARS-CoV-2 infections, showing the lowest non-synonymous diversity and evolutionary rate among all viral genes. This remarkable conservation suggests that ORF6 could be an ideal target for novel antiviral therapies.

[Comment] Bridging microbial physiology and diagnostic interpretation in cholera surveillance

The Article by Javier Perez-Saez and colleagues,1 published in The Lancet Microbe provides a field-based reanalysis of cholera diagnostics performance based on the latent-class Bayesian model. The authors discovered that the CholKit rapid diagnostic test (RDT) possesses high sensitivity (93·5%) and specificity (97·3%). Conventional culture fails in comparison (73·7%), which is a substantial breakthrough in the assessment of diagnostics in endemic conditions. The study reported that younger age, previous exposure to antibiotics, and sampling delays significantly diminish culture sensitivity but do not affect the accuracy of RDTs, which also correlates with the multifaceted nature of host, microbial, and methodological influences on diagnostic outcomes.

[Comment] Genomics to function: integrating rapid metagenomics with quorum-sensing biosensing for precision infectious disease management

Microbial disease detection is central to addressing the global problem of antimicrobial resistance. We still depend on the gold standard microbial culturing technique to detect infection-causing pathogens. Rapid detection of pathogens helps to guide patient care with appropriate antibiotics and thereby minimises the risk of resistance development. In this regard, several techniques have been proposed for the effective detection of pathogens. The most recent addition is the technique proposed by Adela Alcolea-Medina and colleagues,1 published in 2025 in The Lancet Microbe, which emphasises the tremendous potential of rapid pan-microbial metagenomics for identifying broad-spectrum infections in the intensive care unit (ICU).

[Comment] Polio outbreaks due to vaccine-derived viruses demand a re-definition of vaccine safety

Vaccine safety is regarded as the absence of any serious adverse event following immunisation (sAEFI) in the vaccinated individual. The live oral poliovirus vaccine (OPV) causes an sAEFI—vaccine-associated paralytic polio (VAPP)—at a sufficiently low frequency (1 per 100 000 to 750 000 infants vaccinated with one or more doses), resulting in WHO declaring OPV to be safe for wide use.1,2 Thus, WHO, in effect, modified the standard definition of vaccine safety to be the absence of any sAEFI at an unacceptable frequency, thus introducing a subjective, arbitrary, element into the definition.

[Comment] Addressing methodological bias in phageome research to clarify bacteriophage diversity

Bacteriophages are the most abundant biological entities on Earth; however, their ecological and clinical relevance remains incompletely understood. The Article by Rachel M Wheatley and colleagues in The Lancet Microbe makes a crucial contribution to this field by evaluating whether changes in virome α or β diversity are associated with dysbiosis across multiple publicly available datasets.1 Their work advances the integration of viral ecology into studies of microbiome health and disease, offering valuable insights into how phageome diversity might serve as an indicator of microbial imbalance.

[Editorial] Action on infection needs grounding in the social sciences

In a Personal View, Claas Kirchhelle and colleagues argue for stronger involvement of social sciences in global frameworks for addressing the antimicrobial resistance (AMR) crisis. While not novel, it is a timely proposition, not only in the context of AMR, given the upcoming update of the WHO Global Action Plan (GAP) on AMR, but also as a reminder of the contributions social sciences can make in infectious disease control more broadly.

[Clinical Picture] Pneumatosis cystoides intestinalis in overlap syndrome

A 76-year-old woman with systemic sclerosis–myositis overlap being treated with mycophenolic acid and hydroxychloroquine was admitted for weight loss of 19 kg over 1 year, myositis relapse, new constellation of pancytopenia (haemoglobin 6·7 g/dL, white blood cell count 1·82 × 109 per L, and platelet count 88 × 109 per L), proteinuria (0·3 g per day), and low complement C3 concentrations (53 mg/dL [normal C3 range 83–193 mg/dL]). She was afebrile with stable blood pressure, heart rate, respiratory rate, and oxygen saturation on room air.

[Viewpoint] Oral glucocorticoid pulse therapy: a modest change in clinical practice with major benefits

Glucocorticoid pulse therapy is commonly prescribed by rheumatologists worldwide for a wide variety of serious and potentially life-threatening diseases. Pulse therapy also has the potential to lower the cumulative glucocorticoid burden, which has already been proven in systemic lupus erythematosus and giant cell arteritis. The standard practice in rheumatology is to administer this therapy intravenously, but current literature suggests that oral methylprednisolone is a non-inferior option for clinical outcomes and safety.

[Review] The path to interception in psoriatic disease: from conceptual clarity to clinical translation

Psoriatic arthritis develops in up to one-third of individuals with psoriasis, typically following a prolonged subclinical phase. Diagnostic delays are common, often exceeding 2 years, and can result in irreversible joint damage. The growing recognition of this latent period has fuelled interest in earlier identification and interception. However, efforts are hampered by inconsistent definitions of early or subclinical psoriatic arthritis, insufficient prognostic tools, and an absence of consensus on the outcome for interception studies.

[Articles] Clinical phenotypes, classification, and long-term outcomes of childhood-onset Sjögren's disease into adulthood: a single-centre cohort study

This preliminary evaluation of long-term outcomes of childhood-onset Sjögren's disease in adulthood showed distinct patterns of disease and symptom trajectories and that a high proportion of children and young people develop damage in early adulthood. These findings highlight the need for improved research quality and evidence-based management strategies for better outcomes in this population.

[Articles] Cardiovascular risk factor control in antiphospholipid syndrome, and differences between primary and systemic lupus erythematosus-related antiphospholipid syndrome (SURF-SLE and APS project): a cross-sectional study of 1003 individuals from 11 countries

In this large real-world study, high prevalence and suboptimal cardiovascular risk factor control were observed in patients with APS, highlighting the need for increased cardiovascular risk awareness, especially in those with primary APS, whose cardiovascular risk is often overlooked.