Home Life Sciences Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
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Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report

  • Min He EMAIL logo , Yanni Chen , Shanbo Huang , Yongqin Wang , Guanrong Lin and Chaoling Huang
Published/Copyright: October 27, 2025
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Open Life Sciences
From the journal Open Life Sciences Volume 20 Issue 1

Abstract

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. A rare but severe complication is haemophagocytic lymphohistiocytosis (HLH), an aggressive syndrome of excessive immune activation. Managing both conditions is particularly challenging in patients with multiple comorbidities. A 78-year-old male with a complex history, including myasthenia gravis and chronic kidney disease, was admitted with sepsis. Investigations confirmed infection with methicillin-resistant Staphylococcus aureus and human herpesvirus 8. He was subsequently diagnosed with HLH based on bone marrow findings of haemophagocytosis and elevated soluble CD25 levels. He was treated with a combination of antibiotics, immunomodulatory agents, and supportive care. After 21 days of treatment, the patient’s condition improved significantly. This case highlights the importance of early recognition and timely intervention in the management of sepsis and HLH in patients with multiple comorbidities. A multidisciplinary approach and individualised treatment strategies are crucial for improving patient outcomes.

Keywords: sepsis; haemophagocytic syndrome; multiple comorbidities; case report

1 Introduction

Sepsis and haemophagocytic lymphohistiocytosis (HLH, also known as haemophagocytic syndrome) are life-threatening critical illnesses in clinical practice [1,2]. When they coexist, the condition becomes complex and the mortality rate increases considerably. The global incidence of sepsis is approximately 48.9 million cases per year, with a mortality rate as high as 20–30%. This is particularly true among elderly patients, where immunosenescence and underlying diseases further exacerbate poor prognosis [3,4]. As an excessive inflammatory response syndrome, HLH is often triggered by infections, tumours, or autoimmune diseases. Its pathophysiological mechanisms involve cytokine storms and abnormal macrophage activation. Diagnostic criteria include fever, cytopenia, hyperserotonaemia, and haemophagocytosis in the bone marrow [5,6]. Recent studies have shown that mixed bacterial and viral infections, such as methicillin-resistant S. aureus (MRSA) combined with human herpesvirus 8 (HHV-8), can synergistically activate toll-like receptors (TLRs) and interferon pathways, accelerating the progression of HLH [7]. The interplay between pathogens can be particularly potent. This synergistic activation can create a “cytokine storm” that overwhelms regulatory mechanisms, thus accelerating the progression to fulminant HLH.

The considerable overlap in clinical and laboratory features between severe sepsis and secondary HLH creates a significant diagnostic dilemma for clinicians. For example, both conditions present with fever, cytopenias, and hyperferritinemia. This mimicry is particularly challenging because their management strategies diverge critically: while sepsis requires aggressive antimicrobial therapy and supportive care, HLH necessitates prompt immunomodulatory or cytotoxic treatment to control hyperinflammation. This creates a high-stakes clinical scenario, where the delayed diagnosis of HLH or the premature use of potent immunosuppression in a patient with uncontrolled infection can lead to catastrophic outcomes. This challenge is further magnified in elderly patients with multiple comorbidities, where immune senescence and underlying organ dysfunction limit therapeutic options and increase the risk of adverse events.

Infectious triggers of secondary HLH include bacteria (notably staphylococci and streptococci) and herpesviruses [8]; among the latter, HHV-8 (also known as Kaposi sarcoma herpesvirus) is a recognised cause of severe inflammatory syndromes in immunocompromised hosts. In addition, chronic diseases such as hypertensive heart disease, diabetes, and chronic kidney disease not only increase the risk of sepsis but also limit the choice of antimicrobial drugs and immunomodulatory treatments [9]. Diagnostic aids, such as the HScore, and molecular tests, such as metagenomic next-generation sequencing (mNGS), have recently been used to identify multi-pathogen triggers and inform management in complex cases [10].

This study discusses an elderly patient with multiple comorbidities who developed MRSA bacteraemia with concurrent HHV-8 viremia, resulting in secondary HLH. The case highlights diagnostic and therapeutic dilemmas, including integration of culture and mNGS results, decision-making about immunomodulation in the context of active bacteraemia, and tailored post-discharge follow-up in a frail patient. Our objective is to present the diagnostic reasoning and management decisions that may inform care for similar high-risk patients.

Therefore, this case report aims to illustrate the diagnostic and therapeutic complexities encountered in an elderly, immunocompromised patient with sepsis-triggered HLH due to a dual bacterial-viral infection. We highlight the challenges of (1) integrating novel diagnostic results like mNGS with traditional culture methods, (2) carefully titrating immunomodulatory therapy in the setting of active bacteremia, and (3) developing a tailored, long-term follow-up plan for a frail patient. Through this case, we aim to provide insights that may aid clinicians in managing this high-risk and challenging patient population.

2 Case presentation

2.1 Patient information

2.1.1 Patient profile

A 78-year-old man with a history of grade 2 hypertension, hypertensive heart disease (New York Heart Association Class II), chronic kidney disease (Stage 3), myasthenia gravis, and thymoma was admitted to our hospital on 24 December 2022, with a chief complaint of chills and fever for 1 day. His past medical history was notable for multiple prior hospitalisations due to pneumonia and sepsis, and he was on long-term immunosuppressive therapy with oral prednisone 10 mg twice daily and mycophenolate mofetil 0.5 g twice daily for myasthenia gravis. One month prior to the current admission, he had been hospitalised for MRSA-related pneumonia and sepsis. He did not meet the criteria for HLH at that time and was discharged with a 14-day course of oral linezolid (600 mg twice daily).

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the Ethics Committee of Shishi General Hospital.

2.1.2 Chief complaints and admission history

The patient presented with persistent high fever (maximum temperature 39.5°C), cough, expectoration of yellow purulent sputum, dyspnoea on exertion, and worsening of a skin ulcer on the left lower limb. One month prior to admission, he was hospitalised for “pulmonary infection and sepsis (S. aureus).” After discharge, he regularly took linezolid tablets, steroids, and immunomodulatory drugs. Three days before this admission, he developed high fever and dyspnoea, with progressive thrombocytopenia (72 → 40 × 109/L). Three days prior to admission, he experienced coughing (mild, single coughs, worse at night, mainly dry cough) with chest discomfort, dyspnoea on exertion (relieved by rest), and bilateral lower limb oedema. He did not report chills, fever, sore throat, nasal congestion, rhinorrhoea, headache, myalgia, palpitations, oliguria, facial oedema, abdominal pain, bloating, vomiting, dizziness, or fatigue. His symptoms recurred, and he self-measured a temperature of 37.4°C with peripheral oxygen saturation of 80%. He sought further diagnosis and treatment at the hospital.

2.1.3 Admission examination

On admission, his temperature was 37.5°C, heart rate 85 bpm, respiratory rate 20/min, blood pressure 105/64 mmHg, and oxygen saturation 96% with 50% oxygen via face mask. Physical examination revealed bilateral crackles on lung auscultation, a 3 cm × 5 cm necrotic ulcer with purulent discharge on the left lower limb, and an uninfected sacral wound (Figure 1). Laboratory evaluation (Table 1) revealed leukopenia and progressive thrombocytopenia (platelets 40 × 10⁹/L, haemoglobin 111 g/L), elevated inflammatory markers (C-reactive protein [CRP] 128.53 mg/L, procalcitonin [PCT] 27.78 ng/mL, erythrocyte sedimentation rate 115 mm/h), hypoalbuminemia (24 g/L), hyponatremia (126.1 mmol/L), and fasting hyperglycaemia (15.4 mmol/L). Blood cultures yielded MRSA, and HHV-8 was detected in peripheral blood by PCR (92.29%). Bone marrow aspiration demonstrated haemophagocytosis (2.8%) and markedly elevated serum soluble CD25 (sCD25) (14,227 U/mL). Although serum ferritin and triglyceride values were not initially available, the patient fulfilled at least five HLH-2004 diagnostic criteria, supporting the diagnosis of secondary HLH. Chest computed tomography (CT) showed bilateral patchy consolidations and moderate pleural effusions. Echocardiography indicated mildly elevated pulmonary artery systolic pressure (estimated 44 mmHg) with preserved left ventricular ejection fraction. The pleural effusion was presumed to be due to inflammation. No ascites or pericardial effusion was noted.

Figure 1 Skin ulcer of 3 cm × 5 cm was found in the left lower limb, with basal necrosis and purulent secretion. The white arrow indicates basal necrosis, and the black arrow indicates purulent secretion.
Figure 1

Skin ulcer of 3 cm × 5 cm was found in the left lower limb, with basal necrosis and purulent secretion. The white arrow indicates basal necrosis, and the black arrow indicates purulent secretion.

Table 1

Changes in key clinical indicators from admission to discharge

Category On admission At discharge Notes
Vital signs
Temperature (°C) 37.5 Normal Temperature returned to normal
Heart rate (bpm) 85 Normal Heart rate returned to normal
Respiratory rate (bpm) 20 Normal Respiratory rate returned to normal
Blood pressure (mmHg) 105/64 Stable Blood pressure stabilised
SpO2 (%) 96 (supplemental oxygen) Normal Blood oxygen saturation returned to normal
Inflammatory indicators
CRP (mg/L) 128.53 3.43 Significant decrease
PCT (ng/mL) 27.78 0.16 Significant decrease
ESR (mm/h) 115 Normal Significant decrease
Laboratory tests
Platelets (×109/L) 40 545 Increase
Haemoglobin (g/L) 111 Normal Increased to the normal range
Albumin (g/L) 24 >30 Supplemented to the normal target range
Sodium (mmol/L) 126.1 Normal Corrected to the normal range
Fasting plasma glucose (mmol/L) 15.4 <10 Significant decrease
Imaging
Chest CT Patchy consolidation with pleural effusion 70% absorption of infectious foci and pleural effusion is basically absorbed Significant improvement
Echocardiography Elevated PA pressure (44 mmHg) Maintained control Maintained control of PA pressure

“Normal” refers to values within the institutional reference range at our center.

2.1.4 Key diagnoses

The patient was diagnosed with sepsis, presenting with a mixed infection involving MRSA bacteria and HHV-8, meeting the criteria for systemic inflammatory response syndrome. Furthermore, the patient fulfilled the HLH-2004 diagnostic criteria, exhibiting fever, cytopenia, haemophagocytosis in the bone marrow, and elevated sCD25 levels, confirming HLH. Additionally, the patient had multiple comorbidities, including pulmonary infection (confirmed by imaging and aetiology), steroid-induced diabetes (fasting blood glucose 15.4 mmol/L), thrombocytopenia, moderate anaemia, hypoproteinaemia, myasthenia gravis, Grade 2 hypertension (very high risk), hypertensive nephropathy, atherosclerosis of the aorta and coronary arteries, and multiple pulmonary nodules.

2.1.5 Treatment course

Antimicrobial therapy was initiated with intravenous meropenem 1 g every 12 h and vancomycin 1 g every 12 h, which was later narrowed to vancomycin monotherapy for 14 days based on culture sensitivity. Ganciclovir 350 mg every 12 h was administered intravenously to target HHV-8 viremia. Immunomodulatory treatment included intravenous methylprednisolone at 40 mg once daily, tapered to 24 mg daily over 10 days, and intravenous immunoglobulin (IVIG) 20 g daily for 5 consecutive days. Supportive care included platelet transfusions for counts <20 × 109/L, red blood cell transfusions for symptomatic anaemia, continuous insulin infusion to control hyperglycaemia (target fasting glucose <10 mmol/L), and intravenous albumin supplementation to maintain serum albumin >30 g/L. Loop diuretics (torasemide) were used to control fluid balance and pulmonary congestion.

2.1.6 Outcome

After 21 days of treatment, the patient’s temperature normalised, inflammatory markers significantly decreased (CRP 3.43 mg/L, PCT 0.16 ng/mL), and platelets increased to 545 × 109/L. Chest CT showed 70% absorption of the infectious foci. At discharge, he occasionally coughed but had no fever or dyspnoea, with stable blood glucose and blood pressure. Regular follow-up of blood routine, inflammatory markers, and imaging changes was recommended after discharge. The patient’s inflammatory markers gradually decreased, blood cells increased, and physiological indicators stabilised. At discharge, his cough and dyspnoea were significantly relieved, with no fever, mild fatigue, improved mental status, appetite and sleep, normal bowel movements, no oliguria, stable weight, and normal urinalysis. The patient’s condition was stable, and he was discharged in good general condition.

2.1.7 Follow-up and prognosis

The patient was advised to return for structured outpatient follow-up given his advanced age, multiple comorbidities, and recent immunosuppressive therapy. A practical monitoring plan was arranged as follows: (1) a telephone check within 7 days after discharge to review symptoms and medication adherence; (2) outpatient clinic visits at 2–4 weeks and 8–12 weeks after discharge, then every 3 months up to 1 year or as clinically indicated; (3) laboratory monitoring with complete blood count and basic metabolic panel weekly until haematologic recovery, then every 2–4 weeks until 3 months and thereafter at each clinic visit; inflammatory markers (CRP, PCT as appropriate), serum ferritin and liver/renal function tests at each visit; (4) targeted monitoring of HHV-8 viral load (if available) and sCD25/ferritin in the early post-discharge period (monthly for the first 3 months) to detect reactivation or relapse; and (5) early re-presentation if fever, new cytopenia, dyspnoea or wound deterioration occurs. Follow-up priorities included infection surveillance, glucose control, medication reconciliation (especially immunosuppressants/antibiotics), and functional assessment/rehabilitation planning. The schedule was individualised and could be intensified according to clinical course.

3 Discussion

This case involves a 78-year-old male patient with comorbidities, including hypertensive heart disease, myasthenia gravis, and thymoma. He developed sepsis complicated by HLH due to a mixed infection of MRSA and HHV-8. The diagnosis and treatment process highlighted the complexity of the interplay between immune dysfunction and infection in elderly patients with multiple comorbidities. The following analysis is presented from three aspects: pathophysiological mechanisms, therapeutic contradictions, and clinical insights.

3.1 Ageing and immune deficiency: The vicious cycle of infection and HLH

Advanced age and comorbidities are associated with immune senescence and increased risk of both severe bacterial infection and viral reactivation. In this patient, bacteraemia with MRSA likely provided a potent pro-inflammatory stimulus, and concurrent HHV-8 viremia may have acted as a second hit, amplifying immune activation [11]. In this case, bone marrow examination revealed haemophagocytic cells accounting for 2.8%, with significantly elevated sCD25 (14,227 U/mL), meeting the diagnostic criteria for HLH. The markedly elevated and sCD25 alongside progressive cytopenia are consistent with cytokine-mediated haemophagocytic activity and informed our decision to institute cautious immunomodulation (low-to-moderate dose corticosteroids with close infection surveillance), rather than aggressive cytotoxic therapy. Moreover, recent research has shown that HHV-8 can activate macrophages via the TLR3/4 pathway and induce excessive secretion of interferon gamma (IFN-γ), further amplifying the inflammatory cascade of HLH [12].

3.2 Pathogenesis: Ageing, immune senescence, and mixed infectious triggers

The mortality rate increases considerably in elderly patients with mixed bacterial and viral infections. In this case, blood culture detected MRSA, and mNGS suggested HHV-8 infection. The synergistic effect of the two exacerbated immune dysfunction. Studies have shown that superantigens secreted by S. aureus (such as toxic shock syndrome toxin-1) can non-specifically activate T cells, driving the progression of HLH, together with IFN-γ release mediated by the virus [13]. However, there were multiple contradictions in the treatment – broad-spectrum antibiotics (such as vancomycin) could control bacterial infections but may worsen kidney damage; glucocorticoids could suppress cytokine storms but increase the risk of blood glucose fluctuations and infection spread. In this case, meropenem combined with vancomycin was used to cover MRSA. The choice of a moderate initial dose of methylprednisolone (40 mg daily) was a deliberate strategy to balance the suppression of the HLH-associated hyperinflammation against the significant risk of exacerbating the underlying bacterial infection in a frail, elderly patient [14]. The subsequent tapering to 24 mg daily was not based on a fixed schedule but was dynamically guided by close monitoring of the patient’s clinical and laboratory response. Specifically, the decision to taper was made after observing a consistent normalisation of temperature for over 72 h and a sharp decline in inflammatory markers, particularly C-reactive protein (CRP) and procalcitonin (PCT). This approach allowed for an individualised treatment that minimised the total steroid exposure while ensuring the inflammatory process was adequately controlled. The choice was made empirically because antivirals such as ganciclovir/valganciclovir have been shown to suppress HHV-8 replication and have been used in HHV-8-associated conditions (e.g. Kaposi sarcoma and multicentric Castleman disease) and in case reports of HHV-8-associated hyperinflammation; however, randomised evidence for clear clinical benefit in HHV-8-associated HLH is lacking. We therefore used antiviral therapy as adjunctive care while prioritising targeted antibiotics and immunomodulatory treatment [15].

3.3 Treatment challenges: Balancing immunosuppression and infection control

Understanding these mechanisms clarified the therapeutic priorities, namely suppressing deleterious hyperinflammation while preserving anti-infective defences. Elderly patients with multiple comorbidities require multidisciplinary collaboration to optimise treatment. In this case, the patient had comorbid hypertensive heart disease and steroid-induced diabetes, limiting fluid resuscitation and hormone dosage. Research indicated that dynamic monitoring of blood volume (such as echocardiography) and strict blood glucose control (target range 7.8–10 mmol/L) could improve prognosis [16]. Additionally, the use of IVIG needed to weigh cost against benefit; in this case, IVIG 20 g × 5 days was administered, which increased the platelet count in the short term. However, a recent meta-analysis suggested that IVIG had limited improvement on long-term survival rate in secondary HLH, recommending its use only in severe or refractory cases [17].

3.4 Literature comparison and clinical insights

In this case, plasma mNGS identified HHV-8 viremia that was not detected by routine culture methods. As mNGS can broaden pathogen detection in complex cases, we treated the mNGS HHV-8 result as supportive evidence, prompting confirmatory testing. Recent literature has highlighted several issues relevant to our case. First, HHV-8 reactivation is an established trigger of severe inflammatory syndromes in immunosuppressed hosts; antiviral agents, such as ganciclovir/valganciclovir, reduce HHV-8 replication and have been used in Kaposi sarcoma and multicentric Castleman disease, although high-quality evidence for HHV-8-related HLH is limited [18]. Therefore, antiviral therapy may be considered as adjunctive management in cases with documented high viral load, particularly in immunocompromised patients. Second, adult HLH management is evolving; beyond the HLH-94/2004 paradigms, newer targeted approaches (e.g. JAK inhibitors, such as ruxolitinib, and cytokine-targeting agents, such as emapalumab) show promise in refractory or relapsed secondary HLH and are subjects of active study [19]. However, evidence in elderly patients and the setting of active bacterial sepsis remains limited and should be weighed against infection risk and drug access/cost. Third, elderly sepsis survivors are at high risk of early readmission, functional decline, and mortality; therefore, in this case, etoposide was not used, and the condition was stabilised through enhanced supportive treatment (platelet transfusion and albumin supplementation), providing an alternative strategy for frail elderly patients [20].

3.5 Long-term prognosis and follow-up limitations

Despite the patient’s successful recovery and discharge, it is crucial to acknowledge that his long-term prognosis remains guarded. Survivors of sepsis and HLH, particularly the elderly with multiple comorbidities, are at a high risk of post-sepsis syndrome, characterised by functional decline, cognitive impairment, and increased susceptibility to future infections. Moreover, the underlying myasthenia gravis necessitates ongoing immunosuppression, which perpetually increases the risk of both HLH relapse and recurrent sepsis. Our proposed follow-up plan, while structured, has inherent limitations. The practical feasibility of frequent laboratory monitoring, including specialised tests like sCD25 and HHV-8 viral load, can be challenging in an outpatient setting due to cost and accessibility. Furthermore, patient adherence to such a rigorous schedule can be variable. This underscores the need for a highly vigilant, multidisciplinary approach to post-discharge care, with a low threshold for re-evaluation if any new symptoms arise.

4 Conclusion

This case highlights the diagnostic and therapeutic complexities when sepsis and HLH coexist in an elderly patient with multiple comorbidities and prior immunosuppression. Early recognition, targeted antimicrobial therapy, and multidisciplinary management remain central to favourable outcomes. Beyond these points, the case underscores three broader implications: (1) in immunocompromised elderly adults, clinicians should consider combined infectious triggers (bacterial and viral) and, where available, include viral load monitoring to guide adjunctive antiviral therapy; (2) immunomodulatory strategies must be individualised – balancing control of hyperinflammation and infection risk – and close post-discharge surveillance is essential to detect relapse or complications; and (3) further research into rapid diagnostics, biomarkers (e.g. dynamic ferritin and sCD25) and age-appropriate therapeutic algorithms (including investigation of targeted agents, such as JAK inhibitors or IFN-γ antagonists in refractory cases) is needed to improve outcomes in this high-risk population.

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  1. Funding information: Authors state no funding involved.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and consented to its submission to the journal, reviewed all the results and approved the final version of the manuscript. M.H. designed the experiments, and Y.N.C., S.B.H., and Y.Q.W. carried them out. G.R.L.  and C.L.H.  analyzed and interpreted the data. M.H. prepared the manuscript with contributions from all co-authors.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Received: 2025-03-25
Revised: 2025-09-05
Accepted: 2025-09-05
Published Online: 2025-10-27

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  123. Kynurenine facilitates renal cell carcinoma progression by suppressing M2 macrophage pyroptosis through inhibition of CASP1 cleavage
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  126. Phytochemicals of Roman chamomile: Antioxidant, anti-aging, and whitening activities of distillation residues
  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
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  197. Corrigendum
  198. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  199. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans”
  200. Retraction
  201. Retraction of “Down-regulation of miR-539 indicates poor prognosis in patients with pancreatic cancer”
https://doi.org/10.1515/biol-2025-1186
Keywords for this article
sepsis; haemophagocytic syndrome; multiple comorbidities; case report
Creative Commons
BY 4.0

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  57. FTO alleviated the diabetic nephropathy progression by regulating the N6-methyladenosine levels of DACT1
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  59. Zinc valproic acid complex promotes osteoblast differentiation and exhibits anti-osteoporotic potential
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  78. Evaluation and application analysis of animal models of PIPNP based on data mining
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  86. Hypereosinophilic syndrome with elevated IgG4 and T-cell clonality: A report of two cases
  87. Electroacupuncture alleviates sciatic nerve injury in sciatica rats by regulating BDNF and NGF levels, myelin sheath degradation, and autophagy
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  95. Overexpression of the ferroptosis-related gene, NFS1, corresponds to gastric cancer growth and tumor immune infiltration
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  119. Novel cuproptosis-related genes C1QBP and PFKP identified as prognostic and therapeutic targets in lung adenocarcinoma
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  122. Comparative bioinformatics analysis of the Wnt pathway in breast cancer: Selection of novel biomarker panels associated with ER status
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  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
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  131. Construction of pectinase gene engineering microbe and its application in tobacco sheets
  132. Construction of a microbial abundance prognostic scoring model based on intratumoral microbial data for predicting the prognosis of lung squamous cell carcinoma
  133. Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
  134. Sarcopenia in liver transplantation: A comprehensive bibliometric study of current research trends and future directions
  135. Advances in cancer immunotherapy and future directions in personalized medicine
  136. Can coronavirus disease 2019 affect male fertility or cause spontaneous abortion? A two-sample Mendelian randomization analysis
  137. Heat stroke associated with novel leukaemia inhibitory factor receptor gene variant in a Chinese infant
  138. PSME2 exacerbates ulcerative colitis by disrupting intestinal barrier function and promoting autophagy-dependent inflammation
  139. Hyperosmolar hyperglycemic state with severe hypernatremia coexisting with central diabetes insipidus: A case report and literature review
  140. Efficacy and mechanism of escin in improving the tissue microenvironment of blood vessel walls via anti-inflammatory and anticoagulant effects: Implications for clinical practice
  141. Merkel cell carcinoma: Clinicopathological analysis of three patients and literature review
  142. Genetic variants in VWF exon 26 and their implications for type 1 Von Willebrand disease in a Saudi Arabian population
  143. Lipoxin A4 improves myocardial ischemia/reperfusion injury through the Notch1-Nrf2 signaling pathway
  144. High levels of EPHB2 expression predict a poor prognosis and promote tumor progression in endometrial cancer
  145. Knockdown of SHP-2 delays renal tubular epithelial cell injury in diabetic nephropathy by inhibiting NLRP3 inflammasome-mediated pyroptosis
  146. Exploring the toxicity mechanisms and detoxification methods of Rhizoma Paridis
  147. Concomitant gastric carcinoma and primary hepatic angiosarcoma in a patient: A case report
  148. Ecology and Environmental Science
  149. Optimization and comparative study of Bacillus consortia for cellulolytic potential and cellulase enzyme activity
  150. The complete mitochondrial genome analysis of Haemaphysalis hystricis Supino, 1897 (Ixodida: Ixodidae) and its phylogenetic implications
  151. Epidemiological characteristics and risk factors analysis of multidrug-resistant tuberculosis among tuberculosis population in Huzhou City, Eastern China
  152. Indices of human impacts on landscapes: How do they reflect the proportions of natural habitats?
  153. Genetic analysis of the Siberian flying squirrel population in the northern Changbai Mountains, Northeast China: Insights into population status and conservation
  154. Diversity and environmental drivers of Suillus communities in Pinus sylvestris var. mongolica forests of Inner Mongolia
  155. Global assessment of the fate of nitrogen deposition in forest ecosystems: Insights from 15N tracer studies
  156. Fungal and bacterial pathogenic co-infections mainly lead to the assembly of microbial community in tobacco stems
  157. Influencing of coal industry related airborne particulate matter on ocular surface tear film injury and inflammatory factor expression in Sprague-Dawley rats
  158. Temperature-dependent development, predation, and life table of Sphaerophoria macrogaster (Thomson) (Diptera: Syrphidae) feeding on Myzus persicae (Sulzer) (Homoptera: Aphididae)
  159. Eleonora’s falcon trophic interactions with insects within its breeding range: A systematic review
  160. Agriculture
  161. Integrated analysis of transcriptome, sRNAome, and degradome involved in the drought-response of maize Zhengdan958
  162. Variation in flower frost tolerance among seven apple cultivars and transcriptome response patterns in two contrastingly frost-tolerant selected cultivars
  163. Heritability of durable resistance to stripe rust in bread wheat (Triticum aestivum L.)
  164. Molecular mechanism of follicular development in laying hens based on the regulation of water metabolism
  165. Animal Science
  166. Effect of sex ratio on the life history traits of an important invasive species, Spodoptera frugiperda
  167. Plant Sciences
  168. Hairpin in a haystack: In silico identification and characterization of plant-conserved microRNA in Rafflesiaceae
  169. Widely targeted metabolomics of different tissues in Rubus corchorifolius
  170. The complete chloroplast genome of Gerbera piloselloides (L.) Cass., 1820 (Carduoideae, Asteraceae) and its phylogenetic analysis
  171. Field trial to correlate mineral solubilization activity of Pseudomonas aeruginosa and biochemical content of groundnut plants
  172. Correlation analysis between semen routine parameters and sperm DNA fragmentation index in patients with semen non-liquefaction: A retrospective study
  173. Plasticity of the anatomical traits of Rhododendron L. (Ericaceae) leaves and its implications in adaptation to the plateau environment
  174. Effects of Piriformospora indica and arbuscular mycorrhizal fungus on growth and physiology of Moringa oleifera under low-temperature stress
  175. Effects of different sources of potassium fertiliser on yield, fruit quality and nutrient absorption in “Harward” kiwifruit (Actinidia deliciosa)
  176. Comparative efficiency and residue levels of spraying programs against powdery mildew in grape varieties
  177. The DREB7 transcription factor enhances salt tolerance in soybean plants under salt stress
  178. Using plant electrical signals of water hyacinth (Eichhornia crassipes) for water pollution monitoring
  179. Food Science
  180. Phytochemical analysis of Stachys iva: Discovering the optimal extract conditions and its bioactive compounds
  181. Review on role of honey in disease prevention and treatment through modulation of biological activities
  182. Computational analysis of polymorphic residues in maltose and maltotriose transporters of a wild Saccharomyces cerevisiae strain
  183. Optimization of phenolic compound extraction from Tunisian squash by-products: A sustainable approach for antioxidant and antibacterial applications
  184. Liupao tea aqueous extract alleviates dextran sulfate sodium-induced ulcerative colitis in rats by modulating the gut microbiota
  185. Toxicological qualities and detoxification trends of fruit by-products for valorization: A review
  186. Polyphenolic spectrum of cornelian cherry fruits and their health-promoting effect
  187. Optimizing the encapsulation of the refined extract of squash peels for functional food applications: A sustainable approach to reduce food waste
  188. Advancements in curcuminoid formulations: An update on bioavailability enhancement strategies curcuminoid bioavailability and formulations
  189. Impact of saline sprouting on antioxidant properties and bioactive compounds in chia seeds
  190. The dilemma of food genetics and improvement
  191. Bioengineering and Biotechnology
  192. Impact of hyaluronic acid-modified hafnium metalorganic frameworks containing rhynchophylline on Alzheimer’s disease
  193. Emerging patterns in nanoparticle-based therapeutic approaches for rheumatoid arthritis: A comprehensive bibliometric and visual analysis spanning two decades
  194. Application of CRISPR/Cas gene editing for infectious disease control in poultry
  195. Preparation of hafnium nitride-coated titanium implants by magnetron sputtering technology and evaluation of their antibacterial properties and biocompatibility
  196. Preparation and characterization of lemongrass oil nanoemulsion: Antimicrobial, antibiofilm, antioxidant, and anticancer activities
  197. Corrigendum
  198. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  199. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans”
  200. Retraction
  201. Retraction of “Down-regulation of miR-539 indicates poor prognosis in patients with pancreatic cancer”
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