Infectious Disease Reports最新文献

Background: Treatment failure continues to play a role in HIV-related morbidity in Mozambique. Antiretroviral therapy (ART) regimen switches are decided empirically, as HIV genotypic resistance testing (HIV-GT) is unavailable in Mozambique's public health system. Since 2016, Médecins Sans Frontières (MSF) and I-TECH have provided access to HIV-GT at Alto Maé Health Center, Maputo. We describe the cohort of people with virologic failure (VF) that underwent HIV-GT and analyze dolutegravir (DTG) resistance (R) patterns. Methods: This cross-sectional assessment of routine programmatic data between July 2020 and February 2024 was conducted to guide future program enhancements. People living with HIV (PLWH) receiving ART beyond the first line with confirmed VF were included. Mutations were interpreted according to the Stanford HIVdb algorithm. We applied Bayesian bootstrapping for analysis, and the threshold for significance of effects was defined as a probability of 95%. Results: A total of 106 persons underwent HIV-GT following a structured adherence strategy, 62 (58.5%) of whom were on a DTG-based regimen. Fifty-seven of the 62 samples from persons on a DTG-based regimen were sequenced, and 51 (89.5% [95% CrI: 80.7, 96.2]) had confirmed resistance to DTG; the mean DTG-R score was 70.2 (95% CrI: 62.2, 78). Samples with DTG-R had a median of three INSTI mutations (IQR 1-4). Major DTG-associated mutations were found in 46 out of 57 samples: G118R (n = 28), R263K (n = 15), and Q148RK (n = 7). None of the people on the protease inhibitor regimen had an INSTI mutation. Conclusions: In contexts with limited access to resistance testing, the introduction of algorithms to identify PLWH at risk of developing drug resistance is strongly recommended. The proposed algorithm incorporates adherence reinforcement strategies, as recommended in national policies, followed by a short, supervised antiretroviral therapy (ART) support strategy. This approach has shown a high predictive value for identifying PLWH with resistance mutations to dolutegravir (DTG), thereby allowing the continuation of the effective DTG regimen without unnecessary regimen switches.

Background/Objectives: Retail workers may have been at an increased risk of contracting SARS-CoV-2 during the COVID-19 pandemic. To better understand this group, we set up a longitudinal cohort to document the occurrence of SARS-CoV-2 infection, vaccination uptake and to study immune response. Methods: Participants were enrolled between 20 April and 22 October 2021 and attended up to 5 visits over 48 weeks. Information collected was: participant characteristics, SARS-CoV-2 detection tests performed, COVID-19 symptoms, and vaccination (influenza and SARS-CoV-2). Findings: We included 304 participants aged 18 to 75; of those, 117 had a first positive SARS-CoV-2 test, mostly (85.5%) during Omicron wave. Forty-two (13.8%) participants got seasonal influenza vaccine within the year (2020-2021) prior to the first visit, and 95.9% had received the primary series of 2 doses of SARS-CoV-2 vaccine by the beginning of Omicron wave. Participants vaccinated for influenza (adjusted hazard ratio (aHR) 2.48; 95% confidence interval (CI): 1.54-3.98) and older patients (aHR 2.39; 95% CI: 1.40-4.10), were more likely to get a first booster of SARS-CoV-2 vaccine compared to those who did not receive influenza vaccine. In contrast, participants who traveled (aHR 0,62; 95% CI: 0.43-0.91) or participated in frequent gatherings (aHR 0.58; 95% CI: 0.39-0.85) were less likely to be boosted. Conclusions: Variations in vaccine uptake that are usually observed within populations had little effect on completion of the primary SARS-CoV-2 vaccine series. However, these differences became apparent for booster doses, at a period during which most infections in this cohort were recorded.

Background: Reactive Infectious Mucocutaneous Eruption (RIME) is a mucositis-predominant syndrome that usually follows respiratory infections in children. Although Mycoplasma pneumoniae is a well-established trigger, viral pathogens as triggers-especially SARS-CoV-2-have been increasingly reported. RIME is often misclassified as Stevens-Johnson syndrome (SJS), which may lead to inappropriate management. Case Presentation: We describe a 12-year-old previously healthy boy who presented with fever, dry cough, odynophagia, and vomiting for 9 days. On admission, he had severe oral ulcerations, bilateral conjunctivitis, and a non-blanching maculopapular rash. Laboratory tests confirmed co-infection with M. pneumoniae and SARS-CoV-2. Inflammatory markers were mildly elevated. Notably, the patient also developed asymptomatic sinus bradycardia, with no signs of structural heart disease. He was treated with antibiotics, intravenous corticosteroids, and supportive care. His mucosal symptoms improved rapidly, and he was discharged in stable condition on day 7. Follow-up at 12 days showed near-complete resolution of all lesions. Conclusions: This case illustrates several clinically relevant features. First, it highlights a dual infectious trigger-M. pneumoniae and SARS-CoV-2-that may have contributed to a more severe mucosal reaction. Second, the patient developed transient sinus bradycardia without myocardial involvement, suggesting a possible inflammatory autonomic response, rarely reported in RIME. Finally, this case supports the early use of corticosteroids in severe mucosal disease, with good outcomes and no complications. Prompt recognition of RIME, especially in the context of viral-bacterial coinfection, is essential to avoid misdiagnosis and to guide appropriate, multidisciplinary management.

Background/objectives: Carbapenem-resistant Gram-negative bacilli (CR-GNB) pose a growing challenge to public health worldwide due to limited treatment options. This cross-sectional study investigated the characteristics of CR-GNB isolated from clinical specimens in Lagos, Nigeria.

Methods: Gram-negative bacilli (GNB) and clinical data were obtained from three multi-specialist private hospitals between March and June 2023. The GNB were identified using the Analytical Profile Index (API) and investigated for CR-GNB by disk diffusion. Antimicrobial resistance patterns and carbapenemase gene data for presumptive carbapenemase-producing Gram-negative bacilli (CP-GNB) were analyzed using Vitek-2 and polymerase chain reaction (PCR).

Results: Of 317 GNB, 29.0% (n = 92) were CR-GNB. Significantly higher numbers of CR-GNB were reported from the intensive care unit and oncology department (p = 0.009). Of all CR-GNB, 17 isolates (18.5%) were classified as presumptive CP-GNB. In this subgroup, resistance rates of ampicillin/sulbactam (100.0%) and trimethoprim/sulfamethoxazole (100.0%) were highest. Ten (10) CP-GNB were confirmed, representing 3.15% of all GNB tested. Seven isolates of New Delhi Metallo-β-lactamase (bla_NDM) were found among P. aeruginosa, K. pneumoniae, E. coli, and A. baumannii. The bla_NDM was identified in strains classified as extensively drug-resistant (XDR) and pandrug-resistant. Conversely, the bla_KPC was detected solely in multidrug-resistant and XDR strains.

Conclusions: Emerging CR-GNB, specifically CP-GNB, in Nigeria emphasize the need for specific therapeutic management of infected patients. Antimicrobial stewardship and long-term surveillance efforts must be implemented in healthcare settings, as well as improved, accelerated microorganism identification techniques.

Background/objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence and finding research gaps to inform evidence-based recommendations for healthcare facilities.

Methods: Following PRISMA Scoping Review guidelines, we conducted comprehensive searches on PubMed and Scopus databases from 2010-2025 using terms related to environmental monitoring, surface sampling, air sampling, and infection control in hospital settings. Eighteen studies met inclusion criteria; data were extracted using standardized forms and synthesized narratively, organizing findings by monitoring approach categories.

Results: These studies revealed diverse monitoring approaches including fluorescent markers (22.2%), ATP bioluminescence assays (33.3%), microbiological methods (44.4%), and direct observation techniques (27.8%). MRSA was the most frequently targeted pathogen (55.6%), with limited attention to Gram-negative multidrug-resistant organisms and fungi. Studies showed significant variability in pass/fail thresholds (ATP: 50-500 RLU) and lack of standardized benchmarks. Recent research (50% post-2021) increasingly incorporates molecular techniques and digital technologies, though implementation remains resource intensive.

Conclusions: A multimodal approach combining visual inspection, ATP assays, and microbiological methods appears most effective for comprehensive environmental monitoring. Critical gaps include lack of standardized thresholds, limited pathogen diversity focus, and insufficient integration of emerging digital technologies. Future research should focus on setting universal standards, expanding pathogen coverage, and assessing cost-effective monitoring strategies, all while ensuring legal compliance with hygiene regulations to enhance patient safety.

Vaccines are biological preparations used to elicit an immune response, in order to prevent future infections or minimize damage from possible future infection [...].

Background: Dengue virus infection is a significant challenge for global health, with 100 million symptomatic cases, 2.3 million DALYs and 20,000 deaths annually. Dengue vaccines must provide long-lasting immunity against all four virus serotypes, especially in dengue-naïve individuals, in order to avoid the severe manifestations of secondary infections. Methods: This scoping review summarizes current evidence on licensed dengue vaccines and vaccine candidates, focusing on immunogenicity, efficacy, and safety outcomes. To identify relevant trials, in October 2023 we queried ClinicalTrials.gov using the search term "dengue vaccines" to identify past and present vaccine candidates; the search was repeated in February 2025. Vaccines were categorized into licensed (CYD-TDV and TAK-003), late-stage (TV003/TV005), and early-stage candidates (TDEN, DPIV, V180, TVDV). Results: CYD-TDV (Dengvaxia^®) showed moderate efficacy in large trials, with higher efficacy in seropositive than in seronegative individuals. Following commercialization, an increased hospitalization risk was discovered in the latter group. Due to these findings and impossibility of screening for prior exposure in endemic settings newer vaccines are now preferred and CYD-TDV production has recently been discontinued due to declining demand. TAK-003 (Qdenga^®) demonstrated high efficacy against virologically confirmed dengue (VCD) and dengue-related hospitalization. This vaccine was generally well tolerated and is currently recommended by scientific societies and national authorities for travelers and by WHO for routine use in adults and children in endemic settings. TV003 and TV005, developed by NIAID, showed strong immunogenicity and efficacy in phase II trials and human challenge models. Preliminary results show that a single-dose of TV003 has an efficacy of 79.6% in seronegatives and 89.2% in seropositives against VCD at a 2-year follow-up. Both formulations elicited tetravalent responses with an acceptable safety profile. Other vaccine strategies, including TDEN (live-attenuated), DPIV (purified inactivated), V180 (subunit), and TVDV (DNA-based) are still in early-phase development and suffer from waning antibody titers and limited efficacy in naïve subjects. Conclusions: The development of a safe and effective vaccine remains complex due to immunologic challenges. Currently, TAK-003 is regarded as the best option for broad implementation, while TV003 and TV005 remain promising candidates due to their shorter schedule and robust immunogenicity. Further research is needed to optimize vaccine strategies in seronegative populations, immunocompromised subjects, older adults, and travelers.

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and poor socioeconomic status further compromise prevention, early diagnosis, and treatment. Clinical algorithms for early screening, including hand-held echocardiography and point-of-care testing performed by non-specialists, are needed in rural Sub-Saharan Africa to decentralize care and improve outcomes. Methods: We describe a case of pulmonary hypertension diagnosed in a child living in Mozambique, to discuss the challenges for the diagnosis of infectious pulmonary arterial hypertension in rural settings in Africa, based on a short literature review.

Backgrunod/Objectives: Routine identification of common bacterial pathogens is typically efficient, utilizing standardized, cost-effective methods. However, the diagnostic process becomes significantly more complex when dealing with rare or unexpected microorganisms, especially as they can be considered colonizers in many cases. Methods: This study presents diagnostic details of an uncommon pathogen, Vibrio alginolyticus, isolated from auricular discharge in a patient with non-Hodgkin lymphoma diagnosed with persistent otitis externa and explores its identification through both conventional and modern laboratory approaches. Sequential ear discharge cultures resulted in phenotypically similar but genomically different Vibrio alginolyticus isolates. We complemented classical methods like conventional culture (on Columbia agar and CLED agar), Vitek2 Compact identification, and EUCAST disk diffusion antimicrobial susceptibility testing (following the EUCAST version 12.0 guidelines) with MALDI-TOF mass spectrometry and Illumina/Nanopore whole genome sequencing. Comparative analysis of the genomes was performed with the PeGAS pipeline, Unicycler, and 1928Diagnostics SNP analysis. Results: The Vitek2 analysis identified both isolates as V. alginolyticus with 99% confidence, and this was supported by the MALDI-TOF MS results. The first isolate (A) was fully susceptible to the antibiotics tested, while the second (B) showed resistance to ciprofloxacin. Whole genome sequencing revealed 99.23% and 98.60% nucleotide identity to the V. alginolyticus reference genome for isolates A and B, respectively, with a 99.8% match between them. Isolate B acquired a gyrA (c.1870C>T) mutation that correlates with the ciprofloxacin resistance (MIC > 0.5 mg/L). Both genomes carry hlyA (hemolysin), toxR (cholera toxin regulator), genes involved in biofilm formation (rpoN, relA, spoT, opp), luxS (motility), proA, vacB (virulence factors), and tet(34) (oxytetracycline resistance). A core genome SNP distance of <100 indicates clonal relatedness. Our integrated (phenotypic and genomic) diagnostic approach confirmed V. alginolyticus and documented host resistance evolution, with a virulence repertoire that could explain the clinical evolution. Conclusions: This case highlights the utility of molecular methods in confirming species identity, detecting resistance markers, characterizing virulence determinants, and differentiating a pathogen from a colonizer, supporting targeted clinical management.

Background/objectives: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants. In the 2024-2025 season, passive newborn immunization with nirsevimab, a long-acting anti-RSV monoclonal antibody, was introduced for the first time in Italy. However, the immunization campaign was not uniformly implemented on a regional basis due to supply and organizational difficulties. The aim of the study was to assess the real-world impact of nirsevimab prophylaxis during the 2024-2025 bronchiolitis season in four regions of Italy.

Methods: This multicenter observational study included infants <12 months hospitalized for bronchiolitis across four Italian centers. Hospitalizations due to RSV and non-RSV bronchiolitis were compared across the 2023-2024 and 2024-2025 seasons, in relation to the timing and coverage of nirsevimab's introduction in each of the four regions.

Results: Early and widespread nirsevimab administration was associated with a significant reduction in RSV hospitalizations and severity of disease. Centers located in regions that had delayed implementation of immunization observed higher RSV burden and intensive care unit admissions. Admissions for non-RSV bronchiolitis remained stable.

Conclusions: Timely and universal administration of nirsevimab significantly reduced RSV hospitalizations and severity, while delayed implementation resulted in limited benefit. These findings support early and uniform prophylaxis to mitigate health disparities and seasonal pressure on pediatric healthcare systems.