Diagnostic microbiology and infectious disease最新文献

Fungal and mycobacterial cultures are routinely sent on orthopedic operative specimens, but their impact on clinical care is not well established. Processing fungal and mycobacterial cultures is time and labor intensive, associated with significant healthcare costs, and may yield false-positive results due to contamination. The objective of this study was to determine the utility and diagnostic yield of fungal and mycobacterial cultures from orthopedic operative specimens. Patients undergoing surgery by the orthopedic or podiatry service that had operative specimens sent for fungal and mycobacterial cultures from January through December 2022 were included. Fungal and mycobacterial cultures were ordered on a total of 1109 operative specimens in 428 patients. A mean of 2 (standard deviation 1.3) specimens was collected per operative procedure. A microorganism was identified in 34 (3.1 %) of fungal cultures and in no mycobacterial cultures. Fungal microorganisms included yeast (89.7 %), mold (7.7 %) and dermatophytes (2.6 %). Results of the fungal cultures alone led to a change in management for 4 (0.9 %) patients. Results of the mycobacterial cultures did not lead to a change in management for any patient. The diagnostic yield of fungal and mycobacterial cultures on operative specimens in orthopedic and podiatry surgery is low and rarely results in a change in therapeutic management. Standardized approaches for targeted rather than routine use of these cultures should be developed to improve stewardship of laboratory resources.

Background: Pulmonary tuberculosis (PTB) remains a major global public health challenge, with diagnostic delays being a key factor contributing to its high morbidity and mortality. Growing evidence suggests that neutrophil extracellular traps (NETs) are closely associated with PTB pathogenesis. This study focuses on elucidating the role of NETs in PTB and identifying critical diagnostic methods and potential biomarkers.

Methods: Weighted gene co-expression network analysis (WGCNA) was employed to identify the three modules most strongly correlated with NETs. Differentially expressed genes (DEGs) from GSE39939 dataset were intersected with module genes to obtain NET-related DEGs. Four machine learning algorithms (LASSO, random forest, RFE, and Boruta) were applied to select feature genes and develop a PTB diagnostic model. Model's performance was evaluated using support vector machine (SVM)-based receiver operating characteristic (ROC) and precision-recall (PR) curves, with validation in the GSE39940 dataset. The optimal algorithm was selected to refine feature genes and construct a miRNA-gene regulatory network.

Results: ROC and PR curve analyses revealed that RFE and Boruta algorithms exhibited superior diagnostic efficacy in distinguishing active PTB from latent TB infection (LTBI). Further analysis identified five overlapping high-ranking feature genes (GPR84, SIGLEC10, CCR2, TMEM167A, and GYG1) between the RFE and Boruta algorithms. hsa-miR-1264, hsa-miR-664a-3p, hsa-miR-548e-5p, hsa-miR-4775, and hsa-miR-5056 were predicted to potentially target these genes.

Conclusion: RFE algorithm achieves high diagnostic accuracy for PTB and identifies five potential biomarkers (GPR84, SIGLEC10, CCR2, TMEM167A, and GYG1). These findings may provide valuable tools for PTB diagnosis and treatment.

Introduction: Multi-carbapenemases producing Enterobacterales (MCP-EB) represents a new public health challenge due to their ability to display complex resistance phenotypes.

Methods: MCP-EB isolates identified from patients admitted to an Italian Center in the period 2020-2024 were included. Clinical features were collected.

Results: Among 3,117 carbapenemase-producing Enterobacterales clinical strains, 31 (1 %) were MCP-EB and were detected from 28 patients. The most common MCP-EB species was Klebsiella pneumoniae (78.6 %; n = 22). Six combinations of two different carbapenemases were observed: KPC+VIM (75 %; n = 21), KPC+NDM (10.7 %; n=3), VIM+NDM (10.7 %; n = 3), KPC+OXA-48-like (3.6 %; n = 1), VIM+OXA-48-like (7.1 %; n = 2), and NDM+OXA-48-like (3.6 %; n = 1). Patients with MCP-EB had a median age of 67 years [IQR 59-73], were predominantly men (57.1 %; n = 16), and a median Charlson Comorbidity Index of 5 [IQR 4-6]. The comorbidities mainly observed were cardiovascular disease (53.6 %; n = 15), chronic respiratory disease (39.3 %; n = 11), and chronic kidney disease (32.1 %; n = 9). Fifty per cent (n = 14) of patients had been hospitalized in the previous 180 days and 75 % (n = 21) had been exposed to antibiotics in the previous 30 days. Median time from admission to MCP-EB specimen collection was 16 days [IQR 10-24] and 28.6 % (n = 8) of patients showed to carry MCP-EB in more than two body districts. Fourteen-day, 30-day, and in-hospital mortality were 10.7 %, 25 %, and 32.1 %, respectively. MCP-EB showed high rates of resistance to all antibiotics tested except aztreonam/avibactam. Patients with MCP-EB infection (35.7 %; n = 10) were treated with combination regimens, mainly including aztreonam plus ceftazidime/avibactam or cefiderocol. Two patients (20 %) had a recurrence of MCP-EB infection and four (40 %) patients did not survive hospitalisation.

Conclusion: Clinical features of patients with MCP-EB are common in the hospital population with chronic diseases and showed high mortality rates both in infected and carriers-only patients. Aztreonam/avibactam and cefiderocol could be promising treatment options against MCP-EB infections.

The significance of indeterminate rifampin resistance (RR) Xpert results remains unclear. Databases from 2016 to 2023 were reviewed, leading to inclusion of 31 cases. Majority were male, newly-diagnosed, symptomatic, and had comorbidities. On culture, ten were rifampin-susceptible, and two rifampin-resistant. Indeterminate results cannot be interpreted, and final TB cultures should be followed-up.

We evaluated the diagnostic accuracy of two Cepheid Xpert MRSA assay generations using pooled samples from 4,519 patients to detect MRSA carriage in a low-prevalence population. High accuracy, including 95 % sensitivity and 99 % specificity was shown for the Xpert MRSA NxG kit. This supports pooled PCR as a resource-efficient method.

Multisystem inflammatory syndrome in children (MIS-C) constitutes a severe pediatric disorder temporally linked to SARS-CoV-2 infection. Although SARS-CoV-2 may induce cytomegalovirus (CMV) reactivation, MIS-C cases with secondary intestinal CMV infection are exceptionally rare. We describe a pediatric patient with MIS-C treated initially with intravenous immunoglobulin (IVIG) and methylprednisolone, following clinical improvement, sudden high fever and worsening abdominal symptoms occurred. Symptomatic resolution occurred following ganciclovir administration, with CMV infection confirmed by colonic histopathology and metagenomic next-generation sequencing (mNGS).

Clonorchis sinensis, a zoonotic parasitic infection, is contracted by consuming raw freshwater fish harboring infective larvae of the parasite. C. sinensis infection usually cause damage to the liver and biliary tract system. Chronic infection with C. sinensis can lead to long-term liver and bile duct damage, including hepatic fibrosis, and may increase the risk of developing cholangiocarcinoma (CCA). Nevertheless, a significant portion of infected individuals exhibit either asymptomatic or nonspecific, thereby contributing to a high rate of misdiagnosis. CA19-9 is a tumor-associated antigen that is found in normal glandular epithelium. Elevated levels of CA19-9 serve as an indicator for digestive tract and gynecological diseases and tumors. This case report reveals a 42-year-old female with clonorchiasis presented with elevated CA 19-9 levels, increased FDG uptake in the liver and celiac lymph node on FDG-PET imaging, leading to initial misdiagnosis as cholangiocarcinoma due to the overlap of symptoms with other benign conditions. Clonorchiasis often presents with vague symptoms and lacks sensitive diagnostic methods. During the acute phase, imaging findings may resemble inflammatory or malignant lesions, leading to misdiagnosis and missed diagnosis. To avoid unnecessary interventions, clinicians should consider the patient's overall condition and consult thoroughly to identify any atypical infections.