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Respiratory viral infections in children with cancer and febrile neutropenia and children undergoing hematopoietic stem cell transplantation. 癌症和发热性中性粒细胞减少症患儿以及接受造血干细胞移植患儿的呼吸道病毒感染。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1097/QCO.0000000000001049
Juan P Torres, María E Santolaya

Purpose of review: The scope of this review is to understand the epidemiology and potential role of respiratory viral infections in children with cancer and febrile neutropenia, as well as in children, undergoing hematopoietic stem cell transplantation. Early detection of respiratory viral infections through molecular diagnostic techniques has allowed recent randomized clinical studies to advance the possibility of more rational use of antimicrobials in this susceptible population.

Recent findings: Progress has been made in the early detection of respiratory viruses in episodes of fever and neutropenia in children with cancer. In selected patients who meet specific clinical safety criteria and have negative bacterial cultures, it has been possible to safely and effectively discontinue antimicrobials. This has been validated in recent randomized clinical studies. However, more evidence is still needed for a similar indication in children, undergoing hematopoietic stem cell transplantation with viral respiratory infection episodes.

Summary: Understanding the role of respiratory viral infections in populations of immunocompromised children may contribute to a more rational use of antimicrobials and, in the near future, may help to decrease antimicrobial resistance in this susceptible population.

综述目的:本综述旨在了解呼吸道病毒感染在癌症和发热性中性粒细胞减少症患儿以及造血干细胞移植患儿中的流行病学和潜在作用。通过分子诊断技术对呼吸道病毒感染进行早期检测,使最近的随机临床研究得以推进在这一易感人群中更合理使用抗菌药物的可能性:癌症患儿发热和中性粒细胞减少时呼吸道病毒的早期检测已取得进展。对于符合特定临床安全标准且细菌培养阴性的特定患者,可以安全有效地停用抗菌药物。最近的随机临床研究已经验证了这一点。小结:了解呼吸道病毒感染在免疫力低下儿童群体中的作用,有助于更合理地使用抗菌药物,并在不久的将来帮助减少这一易感人群对抗菌药物的耐药性。
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引用次数: 0
Harnessing artificial intelligence microscopy to improve diagnostics for soil-transmitted helminthiasis and schistosomiasis: a review of recent advances and future pathways. 利用人工智能显微镜改进对土壤传播的蠕虫病和血吸虫病的诊断:最新进展和未来途径综述。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1097/QCO.0000000000001048
Peter Ward, Bruno Levecke, Sitara Ajjampur

Purpose of review: This opinion piece aims to explore the transformative potential of integrating artificial intelligence with digital microscopy to enhance diagnostics for soil-transmitted helminthiasis (STH) and schistosomiasis (SCH), two pervasive neglected tropical diseases (NTDs). By aligning innovative artificial intelligence-driven solutions with WHO's strategic objectives and calls for better, more accessible, and more integrated diagnostics, we highlight the latest advancements that may support improved health outcomes in affected communities.

Recent findings: The review covers recent advancements in artificial intelligence-based diagnostic technologies, emphasizing automated egg detection and quantification. These technologies promise to mitigate challenges such as human error and the need for skilled technicians.

Summary: The findings have significant implications for public health, ethical considerations and regulatory pathways, particularly in resource-limited settings. The authors advocate for interdisciplinary collaboration and a strategic focus on meeting WHO target product profiles to ensure uptake, ultimately to support reaching WHO NTD targets.

综述的目的:这篇评论文章旨在探讨将人工智能与数字显微技术相结合的变革潜力,以加强对土壤传播的蠕虫病(STH)和血吸虫病(SCH)这两种普遍被忽视的热带疾病(NTD)的诊断。通过将人工智能驱动的创新解决方案与世卫组织的战略目标以及对更好、更易获得和更综合的诊断方法的呼吁相结合,我们重点介绍了可能有助于改善受影响社区健康状况的最新进展:本综述涵盖了基于人工智能的诊断技术的最新进展,强调了鸡蛋的自动检测和量化。这些技术有望减少人为错误和对熟练技术人员的需求等挑战。总结:研究结果对公共卫生、伦理考虑和监管途径具有重要影响,尤其是在资源有限的环境中。作者主张开展跨学科合作,并将战略重点放在满足世卫组织的目标产品要求上,以确保产品的普及,最终支持实现世卫组织的非传染性疾病目标。
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引用次数: 0
Malaria in pregnancy: baby steps. 孕期疟疾:小步快跑。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-10 DOI: 10.1097/QCO.0000000000001037
Stephen J Rogerson, Elizabeth H Aitken

Purpose of review: Malaria threatens pregnant women and their babies, particularly in Africa.

Recent findings: This century, the number of women at risk of malaria in pregnancy has decreased globally, apart from in Africa, where it has increased. Low and sub microscopic infections are increasingly documented but remain hard to diagnose with current point-of-care tests, and their contribution to morbidity and transmission are unclear. Artemether-lumefantrine has been endorsed for treatment in first trimester, but many women attend antenatal clinics later in pregnancy, and reaching high-risk young, first-time mothers is particularly difficult. Small-for-gestational-age babies frequently result from malaria, which affects the placenta's development and its functions such as nutrient transport. Resistance to continues to increase to sulphadoxine-pyrimethamine, the mainstay of intermittent preventive treatment in pregnancy. The alternative, dihydroartemisinin-piperaquine controls malaria better, but does not improve pregnancy outcomes, suggesting that sulphadoxine-pyrimethamine may have nonmalarial effects including improving gut function or reducing dangerous inflammation. Understanding of how the malaria parasite uses the VAR2CSA protein to bind to its placental receptor is increasing, informing the search for a vaccine to prevent pregnancy malaria.

Summary: Progress in several areas increases optimism that improved prevention and control of malaria in pregnancy is possible, but obstacles remain.

审查目的:疟疾威胁着孕妇及其婴儿,尤其是在非洲:本世纪以来,全球面临妊娠疟疾风险的妇女人数有所减少,只有非洲有所增加。低度和亚微量感染的记录越来越多,但目前的护理点检测仍难以诊断,它们对发病率和传播的影响尚不清楚。蒿甲醚-本芴醇(Artemether-lumefantrine)已被批准用于妊娠头三个月的治疗,但许多妇女在怀孕后期才去产前诊所就诊,而帮助高风险的年轻初产妇尤其困难。疟疾会影响胎盘的发育和营养输送等功能,因此经常会导致妊娠期婴儿过小。对磺胺多辛-嘧啶的抗药性不断增加,而磺胺多辛-嘧啶是孕期间歇性预防治疗的主要药物。替代药物双氢青蒿素-哌喹能更好地控制疟疾,但不能改善妊娠结局,这表明磺胺乙胺嘧啶可能具有非疟疾作用,包括改善肠道功能或减少危险的炎症。人们对疟原虫如何利用 VAR2CSA 蛋白与其胎盘受体结合的了解正在加深,这为寻找预防妊娠期疟疾的疫苗提供了信息。摘要:多个领域取得的进展使人们更加乐观地认为,改善妊娠期疟疾的预防和控制是可能的,但障碍依然存在。
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引用次数: 0
Immune responses and severe dengue: what have we learned? 免疫反应与严重登革热:我们学到了什么?
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-24 DOI: 10.1097/QCO.0000000000001040
Gathsaurie Neelika Malavige, Graham S Ogg

Purpose of review: With the marked rise in dengue globally, developing well tolerated and effective vaccines and therapeutics is becoming more important. Here we discuss the recent developments in the understanding of immune mechanisms that lead to severe dengue and the learnings from the past, that can help us to find therapeutic targets, prognostic markers, and vaccines to prevent development of severe disease.

Recent findings: The extent and duration of viraemia often appears to be associated with clinical disease severity but with some variability. However, there also appear to be significant differences in the kinetics of viraemia and nonstructural protein 1 (NS1) antigenemia and pathogenicity between different serotypes and genotypes of the DENV. These differences may have significant implications for development of treatments and in inducing robust immunity through dengue vaccines. Although generally higher levels of neutralizing antibodies are thought to protect against infection and severe disease, there have been exceptions and the specificity, breadth and functionality of the antibody responses are likely to be important.

Summary: Although there have been many advances in our understanding of dengue pathogenesis, viral and host factors associated with occurrence of severe dengue, vascular leak and the immune correlates of protection remain poorly understood.

综述的目的:随着全球登革热发病率的显著上升,开发耐受性好且有效的疫苗和疗法变得越来越重要。在此,我们将讨论在了解导致严重登革热的免疫机制方面的最新进展,以及从过去的研究中汲取的经验教训,这将有助于我们找到治疗目标、预后标志物和疫苗,以预防严重疾病的发生:病毒血症的程度和持续时间似乎常常与临床疾病的严重程度有关,但存在一定的变异性。然而,在不同血清型和基因型的 DENV 之间,病毒血症和非结构蛋白 1(NS1)抗原血症和致病性的动力学似乎也存在显著差异。这些差异可能会对开发治疗方法和通过登革热疫苗诱导强大的免疫力产生重大影响。总结:尽管我们对登革热发病机制的认识取得了许多进展,但对与严重登革热的发生、血管渗漏和免疫保护相关的病毒和宿主因素仍然知之甚少。
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引用次数: 0
Current challenges in neurocysticercosis: recent data and where we are heading. 神经囊尾蚴病目前面临的挑战:最新数据和我们的方向。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1097/QCO.0000000000001036
Christina M Coyle, Javier A Bustos, Hector H Garcia

Purpose of review: Neurocysticercosis (NCC) is still a significant contributor to neurological disease in vast regions of the world, and increasingly diagnosed in nonendemic countries because of travel and immigration from endemic settings. There is a need for clinicians in endemic and nonendemic regions to understand the complexities of its diagnosis and management.

Recent findings: Recent information on the performance and use of available imaging and immunodiagnostic tools as well as antiparasitic and anti-inflammatory therapeutic regimes were assessed.

Summary: Imaging and serology data should be assessed in the context of the specific type of NCC to improve diagnostic precision. In terms of therapeutic approaches, more controlled data is required on the efficacy and safety of combined antiparasitic therapy, and antiseizure and anti-inflammatory regimes should be optimized to minimize perilesional damage and reduce the risk of epilepsy.

综述的目的:神经囊尾蚴病(NCC)仍然是世界广大地区神经系统疾病的重要致病因素,而且由于来自流行地区的旅行和移民,越来越多的非流行国家也诊断出了NCC。流行地区和非流行地区的临床医生都需要了解其诊断和管理的复杂性:小结:应根据 NCC 的具体类型评估成像和血清学数据,以提高诊断的准确性。在治疗方法方面,需要更多关于联合抗寄生虫治疗的有效性和安全性的对照数据,同时应优化抗癫痫和抗炎治疗方案,以最大限度地减少周围损伤并降低癫痫风险。
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引用次数: 0
H5 and H9 avian influenza - potential re-emergent zoonotic threats to humans. H5 和 H9 禽流感--对人类的潜在再发动物传染病威胁。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-04 DOI: 10.1097/QCO.0000000000001019
Gavin Dabrera

Purpose of review: This review aims to discuss the current state of human infections with Avian Influenza A (H5) and (H9) viruses, to support awareness of the global epidemiology among clinicians and public health professionals interested in emerging respiratory infections.

Recent findings: Among increasing numbers of detections in avian species of Avian Influenza A(H5N1) clade 2.3.4.4b globally, reported human cases of severe infection have been rare.Enhanced surveillance of persons exposed to avian species infected with Influenza A (H5N1) clade 2.3.4.4b in different countries has identified small numbers of asymptomatic individuals with Avian Influenza A (H5N1) detected by PCR from the upper respiratory tract; some of these instances have been considered to represent contamination rather than infection.There have also been recent sporadic human cases of Avian Influenza A(H9N2) internationally, including in China and Cambodia.

Summary: Human infections with Avian Influenza A(H5) and (H9) viruses remain of interest as an emerging infection both to clinicians and public health professionals. While maintaining effective surveillance is essential, one health strategies to control infection in avian species will be key to mitigating these risks.

综述的目的:本综述旨在讨论人类感染甲型禽流感(H5)和(H9)病毒的现状,以帮助对新出现的呼吸道感染感兴趣的临床医生和公共卫生专业人员了解全球流行病学:在全球越来越多的禽类中检测到甲型 H5N1 流感 2.3.4.4b 支系,但报告的人类严重感染病例却很少。3.4.4b 在不同国家发现了少量上呼吸道 PCR 检测出的无症状甲型 H5N1 禽流感患者;其中一些病例被认为是污染而非感染。摘要:人感染甲型禽流感(H5)和(H9)病毒作为一种新出现的传染病,仍然受到临床医生和公共卫生专业人员的关注。虽然保持有效的监测至关重要,但控制禽类感染的卫生策略将是降低这些风险的关键。
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引用次数: 0
Postnatally acquired cytomegalovirus infection among preterm infants. 早产儿产后巨细胞病毒感染。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1097/QCO.0000000000001047
Karen M Puopolo

Purpose of review: Although there are multiple benefits of mother's own milk feeding for very-low birth weight, low gestation infants, those born to cytomegalovirus (CMV)-seropositive mothers are at risk for acquiring postnatal CMV infection. This review will describe the risk and consequences of postnatal CMV infection among very preterm infants.

Recent findings: Postnatal CMV may manifest as clinically silent infection or as mild to severe and occasionally fatal disease. The risk of disease is balanced by the health benefits of human milk feeding to preterm infants. Postnatal CMV infection has been associated with increased risks of multiple preterm morbidities such as bronchopulmonary dysplasia, necrotizing enterocolitis and neurodevelopmental impairment, but current evidence is limited by the selection bias inherent to reporting in case series and retrospective cohort studies.

Summary: Knowledge gaps exist regarding the risk-benefit balance of pasteurization to inactivate CMV in fresh breast milk, as well as the optimal dosing, duration and efficacy of treating infected infants with antiviral medications. Multicenter, prospective studies are urgently needed to accurately determine the true burden that postnatal CMV infection presents to very preterm infants. Such studies will inform the need for preventive strategies and treatment guidance.

审查目的:尽管母乳喂养对极低出生体重、低妊娠的婴儿有多种益处,但巨细胞病毒(CMV)血清反应阳性母亲所生的婴儿有感染产后 CMV 的风险。本综述将介绍极早产儿产后感染 CMV 的风险和后果:最新发现:产后 CMV 可表现为临床上无症状的感染,也可表现为轻度至重度的疾病,偶尔也可导致死亡。早产儿母乳喂养对健康的益处平衡了疾病风险。产后 CMV 感染与多种早产儿发病风险增加有关,如支气管肺发育不良、坏死性小肠结肠炎和神经发育障碍,但目前的证据受到病例系列报告和回顾性队列研究中固有的选择偏差的限制。摘要:在巴氏灭菌法灭活新鲜母乳中的 CMV 的风险-效益平衡方面,以及用抗病毒药物治疗受感染婴儿的最佳剂量、持续时间和疗效方面,存在知识差距。目前急需开展多中心、前瞻性研究,以准确确定产后 CMV 感染给早产儿带来的真正负担。这些研究将为制定预防策略和治疗指南提供依据。
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引用次数: 0
Babesiosis in immunosuppressed hosts: pathogenesis, diagnosis and management. 免疫抑制宿主的巴贝西亚原虫病:发病机制、诊断和管理。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1097/QCO.0000000000001038
Howard M Heller

Purpose of review: This review provides the most recent evidence of the challenges that occur in the management of babesiosis in immunocompromised hosts.

Recent findings: The epidemiology of babesiosis is affected by climate change leading to increasing numbers of cases as well as increasing areas of endemicity. Immunosuppressed hosts, especially with asplenia or B-cell defects, are at high risk of having severe disease as well as persistent and relapsed infection. Resistance to the primary therapies azithromycin and atovaquone can develop leading to further challenges in treating persistent or relapsed disease in the immunocompromised host.

Summary: Babesiosis is likely to become a more frequent infectious complication in immunosuppressed hosts as the areas of endemicity expand. Reduced efficacy of standard therapies is likely to continue emerging so more effort needs to be placed on methods of assessing resistance in vitro and developing more reliable treatments for resistant infections.

综述的目的:本综述提供了最新的证据,说明了免疫力低下的宿主在处理巴贝西亚原虫病时所面临的挑战:巴贝西亚原虫病的流行病学受到气候变化的影响,导致病例数量增加,流行地区扩大。免疫抑制宿主,尤其是胰腺功能减退或 B 细胞缺陷的宿主,极有可能患上严重疾病以及持续感染和复发感染。对主要疗法阿奇霉素和阿托伐醌的抗药性可能会产生,从而给治疗免疫力低下宿主的持续或复发疾病带来更多挑战。标准疗法的疗效降低可能会继续出现,因此需要在体外抗药性评估方法和开发更可靠的抗药性感染治疗方法方面付出更多努力。
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引用次数: 0
No longer stuck in the past: new advances in artificial intelligence and molecular assays for parasitology screening and diagnosis. 不再停留在过去:用于寄生虫学筛查和诊断的人工智能和分子测定的新进展。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-08-12 DOI: 10.1097/QCO.0000000000001041
Christopher Attaway, Blaine A Mathison, Anisha Misra

Purpose of review: Emerging technologies are revolutionizing parasitology diagnostics and challenging traditional methods reliant on microscopic analysis or serological confirmation, which are known for their limitations in sensitivity and specificity. This article sheds light on the transformative potential of artificial intelligence and molecular assays in the field, promising more accurate and efficient detection methods.

Recent findings: Artificial intelligence has emerged as a promising tool for blood and stool parasite review, when paired with comprehensive databases and expert oversight result in heightened specificity and sensitivity of diagnoses while also increasing efficiency. Significant strides have been made in nucleic acid testing for multiplex panels for enteric pathogen. Both multiplex and single target panels for Plasmodium , Babesia , filaria, and kinetoplastids have been developed and garnered regulatory approval, notably for blood donor screening in the United States. Additional technologies such as MALDI-TOF, metagenomics, flow cytometry, and CRISPR-Cas are under investigation for their diagnostic utility and are currently in the preliminary stages of research and feasibility assessment.

Summary: Recent implementation of artificial intelligence and digital microscopy has enabled swift smear screening and diagnosis, although widespread implementation remains limited. Simultaneously, molecular assays - both targeted and multiplex panels are promising and have demonstrated promise in numerous studies with some assays securing regulatory approval recently. Additional technologies are under investigation for their diagnostic utility and are compelling avenues for future proof-of-concept diagnostics.

综述的目的:新兴技术正在彻底改变寄生虫学诊断方法,并对依赖显微镜分析或血清学确认的传统方法提出挑战。本文揭示了人工智能和分子检测在该领域的变革潜力,有望提供更准确、更高效的检测方法:人工智能已成为血液和粪便寄生虫检查的一种有前途的工具,与综合数据库和专家监督相结合,可提高诊断的特异性和灵敏度,同时还能提高效率。针对肠道病原体的多重样本核酸检测已取得重大进展。针对疟原虫、巴贝西亚原虫、丝虫和奇异变形虫的多重和单一靶标检测板已经开发出来,并获得了监管部门的批准,特别是在美国用于献血者筛查。其他技术,如 MALDI-TOF、元基因组学、流式细胞术和 CRISPR-Cas 等,正在研究其诊断用途,目前正处于初步研究和可行性评估阶段:近年来,人工智能和数字显微镜的应用使涂片筛查和诊断变得更加快捷,但其广泛应用仍受到限制。与此同时,分子检测--包括靶向检测和多重检测--也大有可为,并已在多项研究中得到证实,其中一些检测方法最近还获得了监管部门的批准。其他技术的诊断用途正在研究之中,是未来概念验证诊断的重要途径。
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引用次数: 0
Strongyloides stercoralis infection in solid organ transplant recipients. 实体器官移植受者中的盘尾丝菌感染。
IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1097/QCO.0000000000001046
John I Hogan, Sapna A Mehta

Purpose of review: Strongyloides stercoralis infection remains of concern due to its high associated morbidity among solid organ transplant recipients (SOTR) and the risk of donor-derived infection (DDI). We review key aspects of epidemiology to inform screening for and treatment of chronic infection among organ transplant candidates to reduce the risk of infectious complications in the posttransplant setting.

Recent findings: In this work, we offer guidance regarding the optimal management of Strongyloides hyperinfection syndrome and disseminated infection and offer recommendations regarding posttreatment surveillance and the potential need for repeat treatment during subsequent periods of augmented immunosuppression. This review also provides updated recommendations for screening of deceased and living donors as recently proposed by the Organ Procurement and Transplantation Network's Ad Hoc Disease Transmission Advisory Committee.

Summary: Risk reduction of Strongyloides infection in the SOTR population can be further enhanced by optimized treatment of infection, posttreatment surveillance during at-risk periods and recent proposed policy shifts to universal donor screening.

综述目的:由于实体器官移植受者(SOTR)中的相关发病率较高,且存在供体源性感染(DDI)的风险,因此盘尾丝虫感染仍是一个令人担忧的问题。我们回顾了流行病学的主要方面,为器官移植候选者中慢性感染的筛查和治疗提供依据,以降低移植后感染并发症的风险:在这项工作中,我们为斯特龙线虫高感染综合征和播散性感染的最佳治疗提供了指导,并就治疗后监测以及在随后的增强免疫抑制期间重复治疗的潜在需求提出了建议。本综述还提供了器官获取与移植网络特设疾病传播咨询委员会(Ad Hoc Disease Transmission Advisory Committee)最近提出的关于筛查已故和在世捐献者的最新建议:通过对感染进行优化治疗、在高危期进行治疗后监测以及最近提出的对捐献者进行全面筛查的政策转变,可以进一步降低SOTR人群中感染斯特龙线虫的风险。
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引用次数: 0
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Current Opinion in Infectious Diseases
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