Infection and Drug Resistance最新文献

Background: Bacterial meningitis is a major cause of mortality and morbidity in children worldwide. Meanwhile, mixed bacterial meningitis is a rare entity. However, it is difficult to identify anaerobic pathogens using traditional culture methods. Disorders such as neurosurgical interventions are considered risk factors for the development of such cerebral infection. Early diagnosis and appropriate therapy may contribute to patient survival.

Case presentation: We report the use of metagenomic next-generation sequencing (mNGS) to facilitate the diagnosis and treatment of polymicrobial meningitis in a 35-month-old male child with a history of detethering procedure for tethered cord syndrome (TCS). The mNGS tests identified six bacterial species from CSF specimens, including four ones of anaerobic bacteria. The subsequent examination of magnetic resonance imaging (MRI) revealed abnormal imaging findings of the lumbosacral area. The patient eventually recovered from severe infections due to long-term antibiotic treatment and radical surgery.

Conclusion: This case demonstrates the advantages of mNGS for the rapid and accurate diagnosis of mixed bacterial meningitis, highlighting its application of identifying uncommon pathogens in severe infections. For patients who suffered from exacerbated brain infection with history of detethering surgery, anaerobic cultivation is needed and empiric antibiotic therapy should consider mixed infection in these situations.

Background: Tropheryma whipplei (T. whipplei) is a rod-shaped, Gram-positive, acid-fast bacterium. Classical Whipple's disease, a rare chronic infectious condition affecting multiple systems, is traditionally attributed to T. whipplei infection. The conventional treatment regimen consists of a one-year course of oral doxycycline (100 mg twice daily) and hydroxychloroquine (600 mg daily), followed by lifelong doxycycline maintenance therapy. However, the literature lacks discussion on short-term antimicrobial treatment for acute T. whipplei infections, such as pulmonary abscesses caused by this pathogen.

Presentation: This case report describes a 57-year-old male presenting with a pulmonary abscess. The patient underwent bronchoscopic alveolar lavage and pus cavity irrigation. The collected sample was subjected to pathogen targeted next-generation sequencing (tNGS) analysis. The tNGS results indicated that T. whipplei was the primary etiological agent responsible for the pulmonary abscess. Treatment with 6 weeks amoxicillin clavulanate led to a favorable clinical outcomes.

Conclusion: Existing case reports typically employ treatment protocols for classic Whipple's disease, such as oral doxycycline combined with hydroxychloroquine or trimethoprim/sulfamethoxazole for a one-year duration. The use of amoxicillin/clavulanic acid for short-term antimicrobial treatment of T. whipplei-induced pulmonary abscesses achieved favorable clinical outcomes. This case study explores the feasibility of short-term antimicrobial therapy for an acute T. whipplei infection.

Objective: This study aims to evaluate the clinical efficacy of integrated traditional Chinese and Western medicine rehabilitation treatment during the recovery period of COVID-19, providing a scientific basis for developing more effective rehabilitation protocols.

Methods: The study included 120 COVID-19 (novel coronavirus) recovery patients treated at our hospital from November 2021 to April 2022. After registration, patients were randomly divided into two groups, namely the study group and the control group. The control group received conventional rehabilitation treatment, while the study group underwent integrated traditional Chinese and Western medicine rehabilitation treatment, with 60 cases in each group. The clinical observation indicators in this study include the results of the 6-minute walk test (6MWT), respiratory and circulatory parameters, pulmonary function, changes in respiratory muscle strength, and quality of life in both groups of patients.

Results: The 6MWT distance increased significantly in both groups, with the study group showing a larger improvement (P < 0.05). SpO2 and PaO2 values improved significantly in both groups, with greater increases in the study group (P < 0.05). Lung function parameters (FEV1 and FEV1/FVC) improved significantly in the study group compared to the control group (P < 0.05). Diaphragmatic thickness and mobility were also significantly higher in the study group (P < 0.05). The SF-36 quality of life scores were significantly better in the study group (P < 0.05).

Conclusion: Integrated traditional Chinese and Western medicine rehabilitation treatment has achieved significant efficacy during the recovery period of COVID-19. The complementary use of traditional Chinese medicine's differential diagnosis and treatment and modern medical approaches from Western medicine provides patients with comprehensive and personalized rehabilitation services, offering new ideas and methods to improve the quality of patient recovery.

Purpose: Thymic stromal lymphopoietin (TSLP) is a proinflammatory cytokine produced by epithelial cells that is involved in the activation of allergic disorders. To date, no study has examined TSLP induction during Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Herein, we aimed to study the effects of the recombinant spike protein of MERS-CoV on TSLP production. Additionally, the effects of recombinant human TSLP (rhTSLP) on B cell survival and antibody production were investigated.

Patients and methods: B cells were separated using the Human B Cell Enrichment Kit, and B cell survival was measured using the WST-1 Assay Kit. Enzyme-linked immunosorbent assay (ELISA) was used to measure TSLP levels in the sera of both MERS-CoV-infected (n=4; median age, 53 years) and healthy individuals (n=5; median age, 35 years).

Results: We showed that the group of infected patients had significantly higher levels of TSLP than healthy controls (37.6 pg/mL vs 19.8 pg/mL, *p<0.05). The levels of TSLP in A549 cells were remarkably increased after 48 h of stimulation with recombinant full-length spike protein (rSP) (32.2 pg/mL, p=0.01). B cell survival was greatly enhanced by rhTSLP alone or in combination with rSP (0.02 vs 0.046, and 0.045; **p<0.01, respectively). Our data also showed a significant synergistic effect of rhTSLP and rSP on the augmented response of IgG antibodies against the spike protein of MERS-CoV compared with unstimulated cells (0.156 vs 0.22; *p<0.05).

Conclusion: TSLP production is induced in vivo after MERS-CoV infection and in vitro after treatment with the rSP of MERS-CoV, which has a significant effect on the survival of B cells. Our data suggest that TSLP can be used as a strong mucosal adjuvant for vaccine development against MERS-CoV infection. However, further investigation is required to study the functional role of TSLP in MERS-CoV infection.

Q fever, an infectious zoonotic disease caused by Coxiella burnetii, remains prevalent in China. Systemic infections can result in renal or hepatic complications; however, it is rare for both the kidneys and liver to be simultaneously affected. We present a case of a patient who exhibited fever, rapid deterioration in renal function, thrombocytopenia, and severe ascites. Renal biopsy revealed crescentic glomerulonephritis, while liver biopsy demonstrated non-cirrhotic portal hypertension. Metagenomic next-generation sequencing (mNGS) identified the presence of Coxiella burnetii in both venous blood and liver tissue samples. Notably, the patient's renal insufficiency and ascites showed a positive response to treatment for chronic Q fever. These findings provide valuable insights into the limited understanding of kidney and liver diseases associated with Q fever. Advanced diagnostic technologies, including mNGS and positron emission tomography/computed tomography (PET/CT), have been employed to identify Coxiella burnetii infection.

Background: Elizabethkingia anophelis, an opportunistic pathogen that can cause infections in multiple parts of the human body, has multiple drug resistance and a high mortality rate. However, there have been few reports of infective endocarditis (IE) caused by Elizabethkingia anophelis, which means that diagnosis and treatment face challenges that cannot be ignored. Rapid and accurate identification and drug sensitivity results are needed to make timely treatment adjustments.

Case presentation: An 81-year-old man presented with recurrent fever and increased infection index for more than a month. Based on his clinical symptoms, infection index, reduplicative blood cultures, and results of transesophageal echocardiography, he was ultimately diagnosed with infective endocarditis caused by Elizabethkingia anophelis. The patient had a favorable outcome with a 6-week course of intravenous antibiotic therapy.

Conclusion: This is a rare and successfully cured case of IE caused by the pathogen of Elizabethkingia anophelis, which is difficult not only in diagnosis but also in treatment. This case provides a certain referential significance to the treatment of Elizabethkingia anophelis-caused IE in clinical practice.

Introduction: The role of endocytosis in Candida albicans drug-resistance and pathogenicity remains poorly understood, despite its importance as a fundamental component of intracellular trafficking.

Objective: In order to understand the role of endocytosis in Candida albicans cell wall integrity, drug resistance, and virulence.

Methods: Detection of intracellular endocytosis by FM4-64 staining; Scanning electron microscopy is used to detect cell wall components; Spot assay for detecting drug sensitivity; Co-ip is used to detect protein interactions.

Results: In this study, we found the functions of Sla1 in regulating endocytosis is conserved among pathogenic fungi. Our results also revealed that the deletion of the SLA1 gene altered cell wall properties, composition, and gene expression. In addition, we showed that C. albicans Sla1 was responsible for hyphal development in vitro and for fungal pathogenicity in a murine infection model. Intriguingly, sla1∆/∆ mutant demonstrated enhanced drug resistance, and Sla1 was found to interact with the transcription factor Efg1; the relationship between Sla1 and Efg1 impacts the expression of genes encoding components of the ergosterol biosynthesis pathway, including ERG1, EGR11, and ERG25.

Discussion: These findings have expanded our knowledge of the capabilities of Sla1 beyond its role as an endocytosis adapter and provided insights into a potential new therapeutic target for the treatment of fungal infections.

Objective: The role of chest computed tomography (CT) in distinguishing the causative pathogens of pulmonary infections in patients with hematological malignancies (HM) is unclear. The aim of our study was to compare and assess the clinical characteristics, radiologic features and potential differential diagnostic value of CT in HM patients and other different immune statuses patients with pulmonary infections.

Methods: Patients were divided into immunocompetent (105 cases) and immunocompromised groups (99 cases) according to immune status. Immunocompromised patients included the HM group (63 cases) and the non-HM group (42 cases). The basic clinical data and CT findings were collected and statistically analyzed.

Results: Regarding the pathogen distribution, viral, Pneumocystis jirovecii and mixed infections were more common in the immunocompromised group than the immunocompetent (p < 0.01), but viral infections were more common in the HM group than in the non-HM group (p=0.013). Immunocompromised patients had more diverse CT findings and more serious lesions (mostly graded 2-4) than immunocompetent patients. The most common CT findings in HM patients were consolidation and ground-glass opacities (GGO), which were also found in the non-HM group. The overall diagnostic accuracy of CT was lower in immunocompromised patients than in immunocompetent patients (25.7% vs 50.5%, p< 0.01). CT had better diagnostic efficacy for fungi and Pneumocystis jirovecii in HM patients.

Conclusion: CT diagnosis is less efficient in distinguishing the causative pathogens of HM patients. However, CT can help distinguish fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients.

Clinical relevance statement: Our study might facilitate clinical decision-making in fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients.

The development of antibiotic resistance complicates the treatment of infectious diseases and is a global public health threat. However, drug repurposing can address this resistance issue and reduce research and development costs. Niclosamide is a salicylanilide compound approved by the Food and Drug Administration (FDA), and it has been used clinically for treating parasitic infections for many years. Recent studies have shown that niclosamide can inhibit bacterial and fungus activity by affecting the quorum sensing system, biofilm formation, cell membrane potential, and other mechanisms. Here, we discuss recent advances in the antimicrobial applications of niclosamide and its derivatives to provide new perspectives in treating infectious diseases.

Peptoniphilus asaccharolyticus is a gram-positive anaerobic coccus that can cause infections in immunocompromised individuals. P. asaccharolyticus causing empyema has not been reported earlier. Here, we present a novel case of empyema caused by P. asaccharolyticus. A 72-year-old male had a constant fever with difficulty breathing. A chest computed tomography scan revealed infiltration in the right lower lobe and pleural effusion. Following hospital admission, pleural fluid drainage was conducted, and the culture isolated P. asaccharolyticus. Initially treated with piperacillin/tazobactam, the patient experienced excessive thick sputum production, prompting a tracheostomy. Subsequent sputum cultures identified Acinetobacter baumannii. After transitioning to cefoperazone/sulbactam for antibiotic treatment and continued pleural effusion drainage, recovery was achieved. Empyema can be caused by P. asaccharolyticus and further complicated by a secondary infection with A. baumannii. Management should include appropriate antibiotic therapy, pleural drainage, vigilant monitoring, and supportive care. We aim to raise clinicians' awareness of the potential for P. asaccharolyticus to cause empyema in immunocompromised patients and to provide early treatments, thereby improving morbidity and mortality.