Enfermedades infecciosas y microbiologia clinica最新文献

英文中文

Tecovirimat hepatotoxicity in a man with Mpox infection 替可韦莫对m痘患者的肝毒性

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503030

Diana Ruiz-Cabrera , Francisco Montoya , Joaquín Sáez-Peñataro , José Riera , Pablo Manuel Vargas , Ester López-Suñé , María López-Pont , Marina Martinez-Illán , Alba Catala , Montse Tuset , Irene Fuertes , Xavier Forns , Jose Luis Blanco

Introduction

In the context of the global Mpox outbreak from 2022 to 2024, tecovirimat has been widely used for Mpox treatment, initially demonstrating good tolerance and low toxicity. However, recent studies suggest limited efficacy in reducing Mpox lesions.

Methods

We present the first reported case of significant hepatocellular injury associated with tecovirimat in a patient with Mpox. Pharmacovigilance databases were reviewed to identify any previously reported cases and a literature review was conducted to support the plausibility of this adverse drug reaction.

Results

A 53-year-old man without HIV infection presented with Mpox involving mucocutaneous lesions and suspected encephalitis. Forty-eight hours after initiating tecovirimat, a two-fold increase in liver enzymes was observed. After one week, peak values were recorded: AST 881 U/L, ALT 656 U/L, and LDH 1011 U/L. By the third week, thrombocytopenia (nadir 106,000/mm³) and prolonged prothrombin time (lowest value 55.3%) developed, consistent with moderate liver injury per the US DILIN severity index. Tecovirimat was discontinued on day 7 due to suspected drug-induced liver injury. A thorough evaluation ruled out alternative causes of hepatic damage. Following discontinuation, liver function tests gradually improved, and by week six post-initiation, complete resolution of hepatocellular injury and liver dysfunction was achieved without sequelae.

Conclusions

This case highlights the need for caution when prescribing tecovirimat, particularly given its uncertain clinical efficacy, and stresses the importance of close monitoring for potential hepatotoxic effects.

在2022年至2024年全球Mpox暴发的背景下，tecovirimat已被广泛用于Mpox治疗，初步显示出良好的耐受性和低毒性。然而，最近的研究表明，减少m痘病变的疗效有限。方法：我们报道了首例与替可韦莫相关的显著肝细胞损伤病例。对药物警戒数据库进行了审查，以确定任何先前报告的病例，并对文献进行了回顾，以支持这种药物不良反应的合理性。结果1例53岁男性，未感染HIV，出现m痘，伴粘膜皮肤病变，疑似脑炎。服用替可维明48小时后，观察到肝酶增加两倍。一周后测得峰值：AST 881 U/L， ALT 656 U/L, LDH 1011 U/L。到第三周，出现血小板减少（最低106,000/mm3）和凝血酶原时间延长（最低55.3%），符合美国DILIN严重程度指数的中度肝损伤。由于怀疑药物性肝损伤，在第7天停用替科维莫。彻底的评估排除了肝损伤的其他原因。停药后，肝功能测试逐渐改善，到开始治疗后第6周，肝细胞损伤和肝功能障碍完全消除，无后遗症。结论：本病例强调了在处方替科韦利莫时需要谨慎，特别是考虑到其不确定的临床疗效，并强调了密切监测潜在肝毒性作用的重要性。

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引用次数: 0

Desarrollo de indicadores de humanización en la atención a la persona con infección bacteriana grave: propuesta y validación 制定护理严重细菌感染患者的人性化指标：提议和验证

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503036

Julio Zarco Rodríguez , Jaime Lora-Tamayo Morillo-Velarde , Laura Morata Ruiz , Irantzu Rosselló Taberna , Xavier Oleart Martínez

Introduction

The care of patients with severe bacterial infections presents clinical, organizational, and human challenges. This study proposes a system to objectively assess the quality of humanized care in this context.

Methods

Using a multidisciplinary approach, unmet needs were identified and five strategic lines, twenty subdimensions, and a set of evaluation indicators were defined. The proposal was validated through a pilot in two hospitals.

Results

The indicators were designed to be applicable in different hospital settings to assess aspects such as treatment, care coordination, and communication. The pilot confirmed the feasibility of implementation and their usefulness for improvement planning.

Conclusions

The proposed indicator system is a useful tool to support progress toward more humanized and objectively measurable care for patients with severe bacterial infections.

对严重细菌感染患者的护理提出了临床、组织和人员方面的挑战。本研究提出了一个系统来客观地评估在这种情况下的人性化护理的质量。方法采用多学科方法，确定未满足的需求，定义5条战略线、20个子维度和一套评价指标。该建议在两家医院进行了试点，得到了证实。结果设计的指标适用于不同的医院环境，以评估治疗、护理协调和沟通等方面。试验证实了实施的可行性及其对改进计划的有用性。结论该指标体系是支持重症细菌感染患者向更加人性化和客观可衡量的护理方向发展的有效工具。

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引用次数: 0

Respiratory syncytial virus infection in non-severely immunocompromised adults: Clinical features and outcomes from a tertiary university hospital in Argentina 非严重免疫功能低下成人呼吸道合胞病毒感染：阿根廷一所三级大学医院的临床特征和结果

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503076

Emilse Daniela Diaz Lobo , Emilio Felipe Huaier Arriazu , Mariana Vaena , Diana Hongn , Jessica del Valle Molina , Diego Hernan Giunta , Gabriela Alejandra Blugerman , Marisa del Lujan Sanchez

Introduction

Respiratory syncytial virus (RSV) is an increasingly recognised cause of morbidity and mortality in older adults. However, data on RSV burden in Latin American countries remain limited. We aim to describe the clinical characteristics and outcomes of RSV infection in non-severely immunocompromised adults receiving care at a tertiary hospital in Argentina.

Methods

We conducted a retrospective cohort study including adults aged ≥60 years, or ≥50 with comorbidities, diagnosed with RSV between January 2013 and December 2019. The primary outcome was clinical status at days 0, 7, and 30 after diagnosis. Secondary outcomes included 30-day mortality, hospitalisation, ICU admission, and healthcare utilisation.

Results

Of 262 patients included (median age: 82 years), 77.5% were hospitalised at diagnosis. The most common symptoms were cough (62.2%) and dyspnea (58.0%), with abnormal chest imaging in 55.8% of cases. Lower respiratory tract infection (LRTI) was present in 63.7% and severe LRTI in 53.4%. At 30 days, only 57.3% had fully recovered. The 30-day all-cause mortality was 7.6%. ICU admission occurred in 27.1% of patients. Factors associated with worse clinical outcomes included age >85 years, history of heart disease, hypoxemia, abnormal imaging, and ICU admission.

Conclusions

RSV infection in adults is associated with a significant clinical burden and considerable functional impairment. At 30 days post-diagnosis, only 57.3% of patients had been discharged and returned to normal activities. These findings underscore the need for improved preventive strategies and strengthened surveillance in this population.

呼吸道合胞病毒（RSV）越来越被认为是老年人发病和死亡的原因。然而，关于拉丁美洲国家RSV负担的数据仍然有限。我们的目的是描述在阿根廷一家三级医院接受治疗的非严重免疫功能低下成人RSV感染的临床特征和结果。方法：我们进行了一项回顾性队列研究，纳入了2013年1月至2019年12月期间诊断为RSV的年龄≥60岁或≥50岁并伴有合并症的成年人。主要结局是诊断后第0、7和30天的临床状况。次要结局包括30天死亡率、住院率、ICU入院率和医疗保健利用率。结果纳入的262例患者（中位年龄：82岁）中，77.5%的患者在诊断时住院。最常见的症状是咳嗽（62.2%）和呼吸困难（58.0%），胸部影像学异常占55.8%。下呼吸道感染（LRTI）占63.7%，重度下呼吸道感染占53.4%。30天后，只有57.3%的患者完全康复。30天全因死亡率为7.6%。27.1%的患者入住ICU。与较差临床结果相关的因素包括年龄（85岁）、心脏病史、低氧血症、异常影像学和ICU入院情况。结论成人srsv感染与显著的临床负担和相当大的功能损害相关。在诊断后30天，只有57.3%的患者出院并恢复正常活动。这些发现强调了在这一人群中改进预防战略和加强监测的必要性。

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引用次数: 0

Clinical evaluation of a rapid antigen detection test for the diagnosis of tinea unguium 一种快速抗原检测试验诊断甲癣的临床评价

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503067

Lucía Argente-Colás , Miren Urmeneta , Sayoa Hernán-Gómez , Ana Navascués-Ortega , María-Eugenia Portillo , Miguel Fernández-Huerta

Introduction

Currently, diagnosis of dermatophyte onychomycosis relies on direct microscopic examination (DME) and fungal cultures of nail material. Herein, we aim to evaluate the clinical performance of the rapid antigen detection (RAD) assay PreventID Dermatophyte in comparison to conventional methods for the diagnosis of tinea unguium.

Methods

Between February and July 2024, 48 nail samples, collected at the Navarra University Hospital, Spain, were included in the evaluation. In addition to DME and culture, the RAD test was executed. In case of discrepancies, the qPCR assay Novaplex™ Dermatophyte was utilized.

Results

Overall, the RAD test performed well, comparable to DME or culture, with concordances of 80.9% and 80.0%, respectively. The existence of falsely-negative and falsely-positive results reinforces the use of complementary diagnostic procedures, such as DME and culture, for confirmatory testing.

Conclusions

In conclusion, the PreventID Dermatophyte test provides rapid and reliable results with acceptable performance.

目前，皮肤真菌甲真菌病的诊断依赖于直接显微镜检查（DME）和指甲材料的真菌培养。在此，我们的目的是评估快速抗原检测（RAD）法预防皮肤癣的临床性能，比较传统方法诊断蹄癣。方法选取2024年2月至7月在西班牙纳瓦拉大学医院采集的48份指甲标本进行评价。除了二甲醚和培养外，还进行了RAD测试。如有差异，采用qPCR检测Novaplex™Dermatophyte。结果总体而言，RAD测试表现良好，与DME或培养相当，一致性分别为80.9%和80.0%。假阴性和假阳性结果的存在加强了补充诊断程序的使用，如二甲醚和培养，用于确认测试。结论本试验结果快速、可靠，性能可接受。

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引用次数: 0

An unexpected opportunistic infection in a patient with diffuse large B-cell lymphoma 弥漫性大b细胞淋巴瘤患者的意外机会性感染

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503061

Claudia Beatriz Pérez González , Isabel Fradejas Villajos , Lucía Villalón Blanco , Leonor Moreno Núñez

引用次数: 0

Dengue serotypes and their severity correlation: A hospital-based observational study 登革热血清型及其严重程度相关性：一项基于医院的观察性研究

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503074

Anju Dinkar , Jitendra Singh

Introduction

Dengue virus (DENV) infection can present a range of clinical manifestations, from mild fever to severe complications. Emerging data suggest that specific viral serotypes may influence disease severity. This study aimed to evaluate the circulating DENV serotypes and their correlation with clinical outcomes in hospitalized patients.

Methods

A retrospective, cross-sectional study was conducted at a tertiary care center in northern India from August 2022 to January 2023. Laboratory-confirmed dengue cases (N = 356) were included, and serotyping was performed via nested reverse transcription-polymerase chain reaction (nested RT-PCR). Demographic, clinical, and biochemical data were analyzed. Statistical comparisons and relative risk analyses were performed to identify associations between serotypes and disease severity, including mortality predictors.

Results

Out of the 111 dengue cases, 7 had mixed serotypes. Among the remaining 104 patients, DENV-2 was the predominant serotype (71.2%), followed by DENV-3 (26.9%), DENV-1 (1.9%), and mixed serotypes (6.3%) infections. Overall, 71.2% of patients presented with warning signs, and 28.8% progressed to severe dengue. The highest severe dengue cases were observed in DENV-2 (33.8%) and in mixed DENV-2 & 3 infections (100%). DENV-2 was significantly associated with severe manifestations such as plasma leakage (RR = 24.73, p < 0.001), hemorrhagic rash, and elevated transaminases. Mortality (21.6%) occurred exclusively in DENV-2 and mixed DENV-2 and 3 infections. Predictors of mortality included thrombocytopenia, leucopenia, elevated SGPT/SGOT, and hypoalbuminemia.

Conclusion

DENV-2 is the principal serotype associated with severe dengue and adverse outcomes in this region. Early identification of serotype and key laboratory parameters can improve risk stratification and clinical management, with implications for surveillance and public health response.

登革热病毒（DENV）感染可呈现一系列临床表现，从轻度发热到严重并发症。新出现的数据表明，特定的病毒血清型可能影响疾病的严重程度。本研究旨在评估住院患者流行DENV血清型及其与临床结局的相关性。方法回顾性横断面研究于2022年8月至2023年1月在印度北部的一家三级保健中心进行。纳入实验室确诊登革热病例（N = 356），通过巢式逆转录聚合酶链反应（巢式RT-PCR）进行血清分型。分析人口学、临床和生化数据。进行了统计比较和相对风险分析，以确定血清型与疾病严重程度之间的关联，包括死亡率预测因子。结果111例登革热病例中，混合血清型7例。其余104例患者中，以DENV-2型为主（71.2%），其次是DENV-3型（26.9%）、DENV-1型（1.9%）和混合血清型（6.3%）感染。总体而言，71.2%的患者出现警告信号，28.8%的患者进展为严重登革热。重症登革热病例最高的是DENV-2感染（33.8%）和DENV-2和denv - 3混合感染（100%）。DENV-2与血浆漏出（RR = 24.73, p < 0.001）、出疹和转氨酶升高等严重症状显著相关。死亡率（21.6%）仅发生在DENV-2和DENV-2和3混合感染中。死亡率的预测因素包括血小板减少、白细胞减少、SGPT/SGOT升高和低白蛋白血症。结论denv -2是该地区与严重登革热和不良结局相关的主要血清型。早期识别血清型和关键实验室参数可改善风险分层和临床管理，从而对监测和公共卫生应对产生影响。

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引用次数: 0

CMV-specific cellular immunity in solid organ transplantation: Challenges and opportunities for clinical implementation 实体器官移植中巨细胞病毒特异性细胞免疫：临床实施的挑战和机遇

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503078

Estela Giménez , Eliseo Albert

引用次数: 0

MPox virus transmission to healthcare worker in Europe 欧洲麻疹病毒向卫生保健工作者的传播

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503039

Barbara Burgos-Blasco, Noemi Cabello-Clotet, Vicente Estrada, David Díaz-Valle

引用次数: 0

Management of infections caused by Gram-negative bacteria in severely immunocompromised hosts employing Outpatient Parenteral Antimicrobial Therapy (OPAT): Preliminary evidence from a real-world observational study 使用门诊静脉外抗菌治疗（OPAT）管理严重免疫功能低下宿主中革兰氏阴性菌引起的感染：来自现实世界观察性研究的初步证据

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503053

Rosa Anna Passerotto , Gabriele Giuliano , Domenico Tarantino , Francesca Raffaelli , Francesco Taccari , Giuseppe Puma , Enrica Tamburrini , Carlo Torti , Giancarlo Scoppettuolo

Introduction

Infections caused by Gram-negative bacteria pose a significant challenge in immunocompromised patients. Outpatient Parenteral Antimicrobial Therapy (OPAT) has emerged as a promising alternative to inpatient care, allowing patients to receive intravenous antimicrobial therapy at home while potentially improving their quality of life. However, data on the efficacy and safety of OPAT in immunocompromised patients remain limited. This study aims to evaluate the effectiveness, safety, and clinical outcomes of OPAT in this vulnerable population.

Methods

We conducted a retrospective observational cohort study at a teaching hospital in Rome from 2020 to 2024. We included immunocompromised adult patients (≥18 years) with Gram-negative bacterial infections treated with OPAT. The primary effectiveness endpoint was treatment response. Safety endpoints included adverse events and complications.

Results

A total of 149 immunocompromised patients were included, with a median age of 64 years. The most common infections were urinary tract infections (51.7%) and bloodstream infections (16.8%). The most frequently isolated pathogens were Escherichia coli (41.9%), Klebsiella spp. (22.8%), and Pseudomonas aeruginosa (19.1%). The overall clinical cure rate was 88.6% (132/149), while 4.0% (6/149) experienced treatment failure and 3.4% (5/149) had infection recurrence within 60 days. Nearly all patients (91.9%) completed their OPAT treatment course without interruptions. Hospital readmission occurred in 7.4% (11/149) of cases. Complications were rare (5/149, 3.4%).

Conclusion

OPAT proved to be an effective and safe strategy for managing Gram-negative infections in immunocompromised patients. Close clinical and laboratory monitoring contributed to favorable outcomes. Further studies are needed to optimize OPAT protocols in this population.

革兰氏阴性菌引起的感染对免疫功能低下患者构成了重大挑战。门诊静脉外抗菌治疗（OPAT）已成为住院治疗的一种有希望的替代方案，允许患者在家中接受静脉内抗菌治疗，同时可能提高他们的生活质量。然而，关于OPAT在免疫功能低下患者中的有效性和安全性的数据仍然有限。本研究旨在评估OPAT在这一弱势人群中的有效性、安全性和临床结果。方法于2020 - 2024年在罗马某教学医院进行回顾性观察队列研究。我们纳入了接受OPAT治疗的革兰氏阴性细菌感染的免疫功能低下的成年患者（≥18岁）。主要疗效终点为治疗反应。安全性终点包括不良事件和并发症。结果共纳入免疫功能低下患者149例，中位年龄64岁。最常见的感染是尿路感染（51.7%）和血流感染（16.8%）。最常见的病原菌为大肠杆菌（41.9%）、克雷伯氏菌（22.8%）和铜绿假单胞菌（19.1%）。临床总治愈率为88.6%(132/149)，治疗失败4.0% (6/149)，60 d内感染复发3.4%（5/149）。几乎所有患者（91.9%）完成了OPAT疗程，没有中断。再入院率为7.4%（11/149）。并发症罕见（5/149,3.4%）。结论opat治疗免疫功能低下患者革兰氏阴性感染是一种安全有效的治疗策略。密切的临床和实验室监测有助于取得良好的结果。需要进一步的研究来优化该人群的OPAT方案。

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引用次数: 0

Bictegravir/emtricitabine/tenofovir alafenamide: A review of the real-world experience in Spain within the last five years Bictegravir/emtricitabine/替诺福韦alafenamide：回顾过去五年来西班牙的实际经验

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2026-02-01 DOI: 10.1016/j.eimc.2025.503056

Concha Amador , Juan Ambrosioni , Luz Martín-Carbonero , Carmen Hidalgo-Tenorio , Juan Tiraboschi , Santiago Moreno

Integrase strand inhibitor (INSTI)-based antiretroviral regimens are the preferred choices for treating people with human immunodeficiency virus (PWH). The once-daily single-tablet combination of INSTI bictegravir, co-formulated with emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), has shown effectiveness and good tolerability in randomized clinical trials, both in treatment-naïve (TN) and virologically suppressed patients switched to this regimen. Real-world evidence represents clinical practice and may fill data gaps left by pivotal studies. Based on literature search for real-world studies in Spain within five years, and using clinical trial data as a contextual framework, this narrative review synthesizes observational experience with BIC/FTC/TAF, focusing on the interplay between comorbidities, advanced age, and treatment outcomes from underrepresented subgroups in clinical trials. This fixed-dose combination proved effective and well-tolerated for TN and treatment-experienced PWH, with low virological failure even in difficult-to-treat patients. Low rates of treatment discontinuations due to adverse events or drug-drug interactions aligned with clinical trial findings.

基于整合酶链抑制剂（INSTI）的抗逆转录病毒治疗方案是治疗人类免疫缺陷病毒（PWH）患者的首选方案。每日一次的INSTI bictegravir单片剂联合恩曲他滨和替诺福韦alafenamide （BIC/FTC/TAF）在随机临床试验中显示出有效性和良好的耐受性，无论是treatment-naïve （TN）还是改用该方案的病毒学抑制患者。真实世界的证据代表临床实践，可能填补关键研究留下的数据空白。基于对五年内西班牙真实世界研究的文献检索，并以临床试验数据为背景框架，本叙述性综述综合了BIC/FTC/TAF的观察经验，重点关注临床试验中代表性不足亚组的合并症、高龄和治疗结果之间的相互作用。这种固定剂量组合被证明对TN和治疗经验丰富的PWH有效且耐受性良好，即使在难以治疗的患者中也具有低病毒学失败。由于不良事件或药物-药物相互作用导致的低停药率与临床试验结果一致。

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