Clinical Infectious Diseases最新文献

This publication represents the first part of an update to the clinical practice guideline on the diagnosis and management of group A streptococcal (GAS) pharyngitis, developed by the Infectious Diseases Society of America (IDSA). Diagnosis of GAS pharyngitis by clinician judgement alone is unreliable, and universal testing incurs cost and inconvenience for individuals at low risk of having GAS infection. Clinical scoring systems have been used to quantify the probability of a positive GAS throat culture based on standardized criteria such as the presence of fever; tonsillar enlargement or exudate; tender and enlarged anterior cervical lymph nodes; and the absence of cough. The goal of this manuscript is to review the evidence and provide a recommendation as to whether a scoring system should be used to decide which patients should have a GAS diagnostic test (i.e., rapid antigen test (RADT), molecular method, and/or throat culture) performed. We performed a systematic review of randomized and non-randomized studies that compared the use of a clinical scoring system to clinician judgement alone in predicting the result of a throat culture. Evidence from studies in children and adults suggests the diagnostic accuracy is comparable or slightly higher using a scoring system compared to clinician judgement alone. Although the studies are limited due to small size, lack of uniformity in outcome measures, and incomplete data, the consensus of the panel is that the balance of benefits and harms favors incorporation of a clinical scoring system as part of the evaluation of patients with sore throat and suspected GAS pharyngitis.

Background: Appalachian states are disproportionately impacted by poverty, high rates of fatal overdose, hepatitis A, acute hepatitis B, acute hepatitis C, and human immunodeficiency virus (HIV). We evaluated trends for these syndemic conditions by Appalachian subregion to better inform prevention measures.

Methods: For the United States, non-Appalachian United States and Appalachian subregions, we calculated annual rates per 100 000 population for unintentional and undetermined fatal overdoses, hepatitis A, acute hepatitis B and acute hepatitis C during 2000-2023; and diagnoses of HIV for persons aged ≥ 15 years attributed to injection drug use (IDU) during 2008-2023. We calculated age and sex-specific rates during 2014-2023 for all diseases and conditions.

Results: During 2000-2023 in the central Appalachian subregions, age-adjusted rates of fatal drug overdose, hepatitis A, acute hepatitis B, and acute hepatitis C peaked at 985%, 2173%, 223% and 336% over the year 2000 rates. During 2008-2023, rates of new HIV infections attributable to IDU peaked at 380% over year 2008 rates. Rates of all conditions were higher in the Appalachian Region than in the non-Appalachian USA, especially in adults aged 25-44 years in Central and North Central Appalachian subregions.

Conclusions: We documented elevated rates of infectious diseases and fatal drug overdose against a background of increased economic distress in the central Appalachian subregions, especially among working-age adults of reproductive age. Interventions to address social determinants of health and expand access to comprehensive integrated medical and substance use disorder treatment, overdose prevention, and syringe services are critical to control this syndemic.

Background: Households are a focus of tuberculosis (TB) active case finding strategies. However, little is known about patterns of (non-infectious) latent TB infection clustering in households without a known infectious index case, or how household membership affects progression through the TB infection care cascade.

Methods: Using data from a multistate community health center network in the US, we identified individuals with a positive TST or IGRA between 2014-2022. We implemented an algorithm to link these "sentinel patients" with household members in the database. We determined rates and predictors of TST/IGRA testing, test positivity among those tested, and treatment prescription among household members.

Results: We identified 35,772 sentinel patients with a positive TST or IGRA, who were linked to 129,432 household members. Of household members, 33,821 (26.1%) had a TST/IGRA within two years of the sentinel patient's positive test, of whom 3,127 (9.3%) had a positive test and 641 (20.6%) were prescribed TB infection treatment. Whether the sentinel patient was prescribed treatment was associated with household member being tested (aOR 1.16 [95%CI 1.10, 1.21]) and being prescribed treatment (aOR 9.68 [95%CI: 7.71, 12.16]).

Conclusions: Most household members had no documented TB infection test before or within 2 years after a sentinel patient in the household had a positive test. Household member and sentinel patient characteristics, conditions, and treatment were associated with household member testing, test positivity, and treatment prescription. Households may be an effective but underutilized context to identify and treat individuals with TB infection, even when no TB disease cases are present.

Endocarditis from melioidosis is rarely reported; only 14 cases have been reported in the literature. We present a fatal case of native aortic valve endocarditis due to Burkholderia pseudomallei complicated by embolic stroke and subdural empyema that occurred in a traveler who returned from Thailand to the United States.