Infectious Disease Reports最新文献

Background: Tuberculosis (TB) remains a public health concern in Saudi Arabia, where primary care physicians play a crucial role in early detection and infection control. This study assessed physicians' knowledge, attitudes, and practices (KAP) regarding TB infection control in Riyadh. Methods: A cross-sectional survey was conducted among 205 physicians in primary healthcare centers using a validated electronic questionnaire. Knowledge scores were classified as good (≥8/14 correct) or poor (<8). Descriptive statistics and chi-square/t-tests were applied. Results: The mean knowledge score was 8.5 (SD = 2.1); 57.1% of physicians demonstrated good knowledge. Knowledge was significantly associated with specialization (p = 0.049), position (p = 0.031), and monthly patient load (p = 0.031). While 92.7% correctly identified airborne transmission, only 30.7% knew when a TB patient becomes noninfectious. Most participants (80%) had not received TB-related training in the past year. Conclusions: Primary care physicians in Riyadh show moderate knowledge and positive attitudes, but important gaps remain in diagnostic clarity and infection control timelines. Strengthening continuous medical education and integrating TB-specific modules into the Saudi national TB control program are essential to standardize practices and improve patient outcomes.

Background/objectives: Legionella micdadei is a clinically significant species within the Legionella genus, requiring accurate detection methods, surveillance, and precise clinical diagnosis. Our objective was to develop a sensitive polymerase chain reaction (PCR) assay specific for L. micdadei to detect its presence in environmental specimens.

Methods: We targeted the 23S-5S intergenic spacer region, which can differentiate Legionella spp. We tested the detection of L. micdadei with 20 strains and determined the limit of detection with 2 strains. We verified assay specificity with 17 strains of other Legionella spp., 62 strains of other bacterial and fungal genera, and three human DNA specimens. We evaluated intra- and inter-run precision. We tested 15 environmental specimens (water, swabs of water faucets, mulch, and soil) by PCR.

Results: The PCR assay demonstrated 100% analytical specificity (no cross-reactivity with non-targeted species), 100% inclusivity (detection of all L. micdadei strains), and high precision, with a coefficient of variation ≤ 2% across replicates. The limit of detection was estimated at 5 genomic DNA copies per reaction. We detected L. micdadei in environmental specimens.

Conclusions: This PCR assay enables accurate detection of L. micdadei and is not subject to competition with other Legionella spp., thereby addressing limitations of current broad-spectrum Legionella approaches. The evaluation supports its application in environmental detection for surveillance.

Background: Gonorrhoea is a common sexually transmitted infection with serious health consequences if not well-treated. Resistance to common therapeutic agents and limited diagnostics further heighten its burden on sexual and reproductive health. This study determined the positivity level, spatial distribution and factors influencing test positivity for Neisseria gonorrhoeae in Kampala, Uganda. Methods: Clinical data and urethral swabs were primarily collected from men with urethritis at 10 high-volume surveillance facilities. Laboratory analysis followed conventional microbiology techniques. Statistical analysis was conducted using R 4.4.3. Results: Among 1663 participants, 923 (56%, 95% CI: 53-58%) tested positive for N. gonorrhoeae, with comparable levels in Kampala divisions. Co-positivity of HIV and N. gonorrhoeae ranged from 5-27%. At bivariable analysis, there was a lower risk of testing positive for N. gonorrhoeae among participants aged above 24 years. Individuals who never use condoms or infrequently use them were marginally at a higher risk for positivity compared to routine users. Only age was the independent predictor for positivity with N. gonorrhoeae (aPR = 0.93, 95% CI: 0.87-0.99, p-value = 0.017), with men aged above 24 years being less likely to test positive for N. gonorrhoeae. Conclusions: Spatial distribution of N. gonorrhoeae positivity in Kampala was found not to be significantly influenced by location in any of the five divisions. Public health interventions should be tailored to focus on the high-risk groups such as men aged below 25 years, incorporating targeted education and prevention programs, particularly emphasizing consistent condom use among sexually active individuals to improve sexual and reproductive health in Kampala and greater Uganda.

Background: Digital polymerase chain reaction (dPCR) is a highly sensitive molecular method that allows rapid detection of bacterial DNA and resistance genes, requiring only a small blood volume. Although not a new technology, its application in pediatric patients with suspected catheter-related bloodstream infection (CRBSI) remains limited. Case presentation: A 16-year-old female, diagnosed with recurrent acute myelogenous leukemia, received re-induction chemotherapy through a peripherally inserted central venous catheter (PICC). The patient developed a fever, and the blood culture (BC) drawn from the PICC was positive for methicillin-resistant S. epidermidis, leading to suspicion of CRBSI. Several antibiotics were used, and the PICC was replaced. Eventually, the fever subsided, and the BC was negative after PICC removal. The levels of S. epidermidis-specific DNA sequences and mecA genes were correlated with the results of the BC and clinical course. Turnaround time was significantly shorter in dPCR (3.5 h) than in the BC (14-21 h); dPCR was performed using only 400 µL of blood. Conclusions: This case highlights the potential of dPCR as a complementary tool to conventional BCs in the management of pediatric CRBSI. dPCR may support rapid decision-making and monitoring of the treatment response, particularly when sample volumes are limited.

Background: Cryptosporidium spp. cause opportunistic infections in immunosuppressed individuals, such as people living with HIV (PLWH). However, the association between giardiasis and HIV infection remains uncertain. This study assessed co-infections in Ghanaian PLWH and HIV-negative individuals, analyzing socio-economic, clinical, and immunological implications, including the Giardia duodenalis assemblage and Cryptosporidium spp. sub-family levels. Methods: Stool samples from Ghanaian PLWH were tested using several real-time PCR assays targeting G. duodenalis at the species level and assemblages A and B to optimize diagnostic accuracy. GD60 gene-based Sanger sequencing was used for Cryptosporidium spp. subtyping. Results were correlated with anonymized patient data to evaluate interactions with HIV infection. Results: In PLWH, C. hominis Ib, C. hominis Ie, and C. parvum IIc were detected at similar frequencies, followed by C. hominis Ia, C. hominis Id, and C. parvum IIe in decreasing order. Only C. parvum IIc was repeatedly observed in individuals with CD4+ T cell counts above 200/µL, while other sub-families occurred preferentially in those with lower counts. C. hominis Ia and Ib were associated with PLWH not receiving antiretroviral therapy; C. hominis Ia was linked to recently diagnosed HIV infections. No relevant associations between G. duodenalis assemblages and HIV infection were found. Conclusions: Sub-families Ia and Ib of C. hominis preferentially occur in individuals with severe immunosuppression, while C. parvum IIc is also detectable in individuals with better immune function. The prevalence of giardiasis in Ghana appears to be influenced by factors other than HIV-induced immunosuppression.

Background: Limited molecular surveillance continues to constrain Morocco's HIV response, leaving subtype dynamics largely underreported. Once characterized by a predominance of subtype B, the Moroccan epidemic now appears to reflect shifting patterns shaped by regional and international connectivity. This study aimed to investigate HIV-1 molecular diversity, monitor circulating HIV-1 genetic variants, and inter-gene recombination in a cohort of people living with HIV in Morocco.

Methods: We conducted an analysis of individuals diagnosed with HIV-1 infection or receiving follow-up care. Demographic and clinical data were extracted. Genotypic testing was performed on the protease/reverse transcriptase (PR/RT) and integrase (IN) regions of the pol gene using the HIV-1 Genotyping Kit with Integrase. Subtypes were assigned via Stanford HIVdb and HIV Blast, and phylogenetic relationships were analyzed using MEGA 12.

Results: Of the 73 individuals enrolled, 64 were successfully sequenced. The median age was 43 years (IQR 35-51.3), with over half aged 25-44, and 85.9% were male. Heterosexual transmission was the main route (87.5%), and 59.4% were ART-naïve. Non-B subtypes predominated (87.5%), led by CRF02_AG (73.4%), followed by B (12.5%), C (7.8%), and A3 (3.1%). The cohort showed significant genetic diversity, including multiple CRFs such as CRF45_cpx (1.6%), CRF01_AE (1.6%), B/CRF02_AG (7.8%), G/CRF02_AG (3.1%), C/CRF02_AG (1.6%), CRF02_AG/CRF45_cpx (1.6%) and CRF02_AG/CRF22_01A1 (1.6%).

Conclusions: This study provides updated insight into HIV-1 diversity in Morocco, showing a predominance of non-B subtypes, particularly CRF02_AG, and signals of increasing heterogeneity compared with reports from more than a decade ago that described subtype B predominance. These findings suggest a viral transition shaped in part by regional connectivity and highlight a gap in Morocco's HIV strategy, underscoring the need to implement nationwide molecular surveillance to inform future HIV control efforts.

Background/objectives: Influenza continues to cause high morbidity and mortality rates worldwide, inflicting a major burden on the public health system. There is little data available on the 2024-2025 seasonal outbreak. Moreover, biomarkers for rapidly identifying subjects at higher risk for severe forms are needed.

Methods: We retrospectively collected hospitalization data for influenza in Cannes, France, during the 2024-2025 seasonal outbreak. Severe forms were defined as cases either requiring admission to the Intensive Care Unit (ICU) or resulting in death. They were compared to uncomplicated forms. Main demographic, clinical, radiological, and laboratory characteristics were collected for each patient.

Results: From October 2024 to May 2025, 59 patients were admitted to either the Infectious Diseases Department or the ICU (56% male, age 72 years, 27% vaccinated, influenza type A 93%, symptom duration 3.5 days prior to hospitalization, 31% admissions to ICU, 14% deaths). Vaccination status did not differ between severe and uncomplicated forms. In the univariate analysis, severe forms had higher neutrophil/lymphocyte and platelet/lymphocyte ratios upon admission and included more cases of acute hepatitis, pneumonia, and oseltamivir use than uncomplicated forms. A neutrophil/lymphocyte ratio > 15 was independently associated with severity (OR_adj 8.79, 95% CI: 1.34-57.6, p = 0.023), with 40.9% sensitivity, 94.6% specificity, 81.8% positive predictive value, and 72.3% negative predictive value for predicting a severe form.

Conclusions: The N/L ratio was an easy-to-perform predictive marker for influenza severity during the 2024-2025 seasonal outbreak, warranting further prospective studies.

Background: Cervical cancer remains a significant global public health concern, with human papillomavirus (HPV) vaccination serving as an effective preventive measure. Despite its proven efficacy, HPV vaccine uptake in Jordan remains low. This study aimed to assess the knowledge, attitudes, and practices (KAP) influencing HPV vaccine recommendation among healthcare professionals.

Methods: A cross-sectional survey was conducted between August 2023 and February 2024 among 304 healthcare professionals and trainees in Amman, Jordan, using a pre-validated questionnaire. Descriptive statistics, correlational analyses, and Firth's penalized logistic regression were employed to examine predictors of vaccine recommendation behavior.

Results: Positive attitudes (OR = 3.89; p < 0.001) and active clinical practice (OR = 5.02; p < 0.001) were strong predictors of HPV vaccine recommendation. Unexpectedly, higher knowledge scores were associated with reduced likelihood of recommending the vaccine (OR = 0.44; p = 0.032). Significant variation in KAP scores was observed across professional groups, with physicians and academic staff demonstrating higher levels of engagement.

Conclusions: Attitudes and practical engagement were more influential than knowledge alone in shaping HPV vaccine recommendation behavior among healthcare professionals. These findings underscore the need for interventions that not only enhance knowledge but also foster supportive attitudes and strengthen clinical advocacy skills. The results provide actionable evidence to inform targeted strategies for increasing HPV vaccine uptake and reducing cervical cancer incidence in Jordan.

Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression.

Case presentation: We present the case of a 63-year-old woman on anti-tumor necrosis factor (TNF) therapy, who underwent surgical excision for the diagnostic purposes of a chronic non-healing lesion located on her right arm. The histopathological examination revealed the presence of Leishmania amastigotes. CL relapsed in the following months, with new lesions appearing both close to the excision scar and at a different body site. At this point, in order to avoid another surgical intervention, cutaneous swabs for Leishmania Polymerase Chain Reaction (PCR) were performed on both lesions. Both samples yielded positive results, and the patient was treated with a 4-week course of miltefosine.

Conclusions: These results support the use of cutaneous swabs as a highly sensitive and less invasive tool for the diagnostic workup of CL. In addition, our case prompts a reflection on the management of immunosuppressed patients with CL, with particular emphasis on the risk of reactivation or simultaneous involvement of multiple anatomical sites, thus suggesting the need for specific considerations and personalized management for this group of subjects.

Background/objectives: Previously endemic to sub-Saharan Africa, mpox has since emerged globally, resulting in more than 150,000 cases in over 100 countries in the 2022 outbreak. The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine is licensed and recommended for at-risk populations in many countries and received World Health Organization (WHO) pre-qualification in September 2024.

Methods: We conducted this systematic literature review (SLR) to compare analyses, published from 2022 through 2024, of cases averted due to mpox vaccination during the 2022 outbreak to assess the feasibility of estimating the impact on the United States (US). The search included studies that utilized reported case data from any country.

Results: Nine studies were identified. Four estimated the impact of the vaccine as directly modeled in the 2022 outbreak, and cases averted ranged from 10% to 79%. One assessed the projected impact on future outbreaks. Four estimated the impact of hypothetical vaccination strategies. Only one model utilized assumptions appropriate for the US outbreak and population, to allow for an estimate of US cases averted (53,499 cases averted due to the synergistic effects of the vaccine and behavioral changes, with 8096 due to the mpox vaccine alone and 5478 due to behavioral changes alone).

Conclusions: Variation in estimates for the impact of the vaccine can typically be explained by differing model approaches, assumptions, inputs, and epidemic peaks and vaccination campaign roll-out. Most models were not generalizable to the US outbreak and population, but one yielded a reasonable estimate. Nevertheless, all models emphasized the importance of vaccination combined with other public health interventions.