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Drug-Induced Parotitis—A Rarity? 药物诱发的腮腺炎--罕见吗?
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-29 DOI: 10.1097/ipc.0000000000001333
Sweatha Kumar, Vidya Devarajan, Ramya Sivaramakrishnan, Srinivasan Kalyanasundaram, Purushothaman P.K, Rufus Vasanth Raj
Unilateral parotitis is due to ductal obstruction. Bilateral parotitis occurs due to viral infections such as mumps, bacterial infections, Sjögren syndrome, and ductal obstruction. Drug-induced parotitis is a relatively uncommon adverse reaction, and it can be unilateral and bilateral. Unilateral causes of drug-induced parotitis can be due to clozapine, chlorpromazine, l-asparaginase, and α-methyldopa, whereas bilateral causes can be due to thioridazine, sulfadiazine, phenylbutazone, oxyphenylbutazone, nitrofurantoin, and valproic acid. Adverse reactions to sulfonamide are rare and manifest as rashes or urticaria. Herein, we report a case of acute unilateral parotitis occurring as a result of cotrimoxazole that resolved within 48 hours after discontinuation of therapy, which highlights that sulfonamide therapy can cause parotitis. Early clinical suspicion and discontinuation of therapy help in the prompt resolution of the allergic reaction to cotrimoxazole.
单侧腮腺炎是由于导管阻塞造成的。双侧腮腺炎发生的原因包括病毒感染(如流行性腮腺炎)、细菌感染、斯约格伦综合征和导管阻塞。药物诱发的腮腺炎是一种比较少见的不良反应,可以是单侧的,也可以是双侧的。药物诱发腮腺炎的单侧原因可能是氯氮平、氯丙嗪、l-天冬酰胺酶和α-甲基多巴,而双侧原因可能是硫利达嗪、磺胺嘧啶、苯基丁氮酮、氧苯基丁氮酮、硝基呋喃妥因和丙戊酸。磺胺类药物的不良反应很少见,表现为皮疹或荨麻疹。在此,我们报告了一例因服用复方新诺明而导致急性单侧腮腺炎的病例,该病例在停药后 48 小时内缓解,这突出表明磺胺类药物治疗可导致腮腺炎。临床上及早怀疑并停止治疗有助于迅速缓解对复方新诺明的过敏反应。
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引用次数: 0
Nasal Methicillin-Resistant Staphylococcus aureus Culture Screens in the Setting of Universal Decolonization 在普遍去势的情况下进行鼻腔耐甲氧西林金黄色葡萄球菌培养筛查
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-29 DOI: 10.1097/ipc.0000000000001328
Arunava Saha, Erin E O'SHEA PAUDEL
The negative predictive value (NPV) of nasal methicillin-resistant Staphylococcus aureus (MRSA) screens has been compromised by universal decolonization practices. We aimed to determine the reliability of the nasal MRSA culture screen to deescalate antibiotic therapy in the setting of decolonization with ethyl alcohol. A retrospective observational cohort study was conducted using 62% ethanol solution intranasally per protocol. Patients were divided into 2 groups based on whether they received decolonization. Data were analyzed to determine NPV of the nasal MRSA culture screen with and without decolonization. A total of 505 cases were screened, and 128 subjects were included. One hundred two received decolonization, whereas 26 did not. Baseline characteristics were well balanced. Overall MRSA infection prevalence was 31.25%. The NPV was 73% in the decolonized group compared with 80% in the group without. Positive predictive value was 63% in the group receiving decolonization compared with 100% in the group without. There was also a higher specificity but lower sensitivity of the nasal MRSA culture screen in the decolonization group. Nine patients in the decolonization group required reescalation of antibiotics compared with nil in the other group. Culture-based nasal MRSA screens are less accurate than PCR tests, as ethyl alcohol leads to false-negative results. A lower NPV in the decolonization group predisposes to increased false negative results, leading to inappropriate antibiotic deescalation and often requiring reinitiation. Nasal MRSA culture screen is less reliable if alcohol has already been administered for decolonization and cannot be used as an appropriate tool to guide antibiotic deescalation.
鼻腔耐甲氧西林金黄色葡萄球菌(MRSA)筛查的阴性预测值(NPV)已被普遍的去菌实践所削弱。我们旨在确定鼻腔 MRSA 培养筛查的可靠性,以便在使用乙醇去菌的情况下降低抗生素治疗的等级。 我们按照方案使用 62% 的乙醇溶液进行鼻腔内治疗,开展了一项回顾性观察队列研究。根据患者是否接受去菌落治疗将其分为两组。对数据进行分析,以确定鼻腔 MRSA 培养筛查中是否进行了去菌处理的 NPV。 共筛查了 505 个病例,128 名受试者被纳入其中。其中 122 人接受了去菌落治疗,26 人未接受治疗。基线特征非常均衡。总体 MRSA 感染率为 31.25%。去菌落组的 NPV 为 73%,而未去菌落组的 NPV 为 80%。接受去菌落治疗组的阳性预测值为 63%,而未接受去菌落治疗组的阳性预测值为 100%。此外,去菌落组鼻腔 MRSA 培养筛查的特异性较高,但敏感性较低。去殖民化组有九名患者需要重新使用抗生素,而另一组则为零。 鼻腔 MRSA 培养筛查不如 PCR 检测准确,因为乙醇会导致假阴性结果。去殖民化组的 NPV 较低,容易导致假阴性结果增加,从而导致不适当的抗生素降级,而且往往需要重新使用抗生素。如果已使用酒精进行去菌落,则鼻腔 MRSA 培养筛查的可靠性较低,不能作为指导抗生素降级的适当工具。
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引用次数: 0
A Red Swollen Leg 红肿的腿
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001325
Shivakumar Narayanan, Edward C. Traver, Aaron David Greenblatt
We present a case of pseudocellulitis in a patient with chronic wounds from active injection drug use and edema and edema from secondary amyloidosis and highlight diagnostic challenges and approaches to differentiate infection from vascular and other noninfectious causes as well as the opportunity to intervene at a reachable moment to try to mitigate risk related to injection drug use.
我们介绍了一例假性蜂窝织炎病例,患者因积极使用注射毒品而留下慢性伤口,继发性淀粉样变性引起水肿,我们强调了诊断难题和区分感染与血管和其他非感染原因的方法,以及在可及时刻进行干预的机会,以努力降低与注射毒品使用有关的风险。
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引用次数: 0
Lumbar Osteomyelitis and Epidural Abscess Caused by Cardiobacterium hominis—First Reported Case in the Pediatric Population: The Role of Universal 16S rRNA Gene PCR and Sequencing 人型心脏杆菌引起的腰椎骨髓炎和硬膜外脓肿--儿科首例报告病例:通用 16S rRNA 基因 PCR 和测序的作用
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001329
Moamen Al Zoubi, Huma M. Khan, Sona Najafi
This report presents a case of a 14-year-old female patient diagnosed with lumbar (L2–L3) epidural abscess and vertebral osteomyelitis caused by Cardiobacterium hominis. The diagnosis was made using universal 16S rRNA polymerase chain reaction. To the best of our knowledge, this is the first reported case of C. hominis lumbar epidural abscess and vertebral osteomyelitis in pediatric population. This case serves to illustrate the potential value of polymerase chain reaction and DNA sequencing in diagnosing culture-negative vertebral osteomyelitis and the potential role of C. hominis in causing this infection.
本报告介绍了一例 14 岁女性患者的病例,她被诊断为腰椎(L2-L3)硬膜外脓肿和脊椎骨髓炎,病因是人类心脏杆菌(Cardiobacterium hominis)。诊断是通过通用 16S rRNA 聚合酶链反应做出的。据我们所知,这是首例报道的儿童腰椎硬膜外脓肿和椎体骨髓炎病例。该病例说明了聚合酶链式反应和 DNA 测序在诊断培养阴性的脊椎骨髓炎中的潜在价值,以及人尾蚴在导致这种感染中的潜在作用。
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引用次数: 0
Treatment Experience With Oral Antivirals for US Veterans With COVID-19 Infection 美国退伍军人感染 COVID-19 后口服抗病毒药物的治疗经验
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001320
A. Njoroge, Morgan Froehlich, G. Psevdos
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引用次数: 0
An Atypical Presentation of Disseminated Varicella Infection 播散型水痘感染的非典型表现
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001323
Derrick Ferguson, Javier Antonio Aguilar-Aragon, Imad Obeid
We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.
本病例是一名 61 岁的女性,有类风湿性关节炎病史,正在接受免疫抑制治疗,出现全身无力、进行性干咳和呼吸困难。她的病情迅速发展为严重的急性低氧血症呼吸衰竭,需要启动机械通气支持。随后,她被发现腹部出现弥漫性水泡状皮疹,皮疹边界不清,并向背部和颈部扩散。诊断检测证实,她感染了水痘带状疱疹病毒,并伴有水痘肺炎。播散性水痘感染并不少见,最常见于免疫抑制患者,但在无明显免疫抑制的患者中也经常有病例记录。在与播散性水痘感染相关的并发症中,水痘肺炎是最致命的。播散性水痘感染并发水痘肺炎的死亡率为 10%至 30%。然而,对于那些呼吸极度衰竭、需要机械通气的患者,死亡率可高达 50%。最常见的表现是患者的皮肤疹不呈皮疹状分布,随后在出疹后 2 至 5 天内出现肺部症状。然而,我们的病例为水痘肺炎的罕见表现提供了另一个例子,即病毒性红斑在发病前出现呼吸衰竭。认识到在水痘播散性感染的典型皮肤表现之前出现呼吸道症状的可能性是非常重要的一课,因为这样可以更早地发现并开始治疗。与水痘肺炎相关的死亡率很高,因此有必要进一步开展专门研究,以改进预防和治疗,而提高医生对这一临床实体的认识将有助于实现这一目标。
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引用次数: 0
Ramadan Fasting 斋月斋戒
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001321
Bilal Irfan, Aneela Yaqoob, Ihsaan Yasin, Denise Kirschner
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引用次数: 0
Nervous System Involvement in Hospitalized Patients With COVID-19 COVID-19 住院患者的神经系统受累情况
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001332
M. Harirchian, M. Ghabaee, P. Sarraf, Sakineh Ranji-Burachaloo, Elmira Agah, Seyed Vahid Mousavi, Aminreza Abkhoo, Kiana Amani, Nina Javadian, Ghasem Farahmand, Hanna Magrouni, Fatemeh Alizadeh Boroujeni, Fatemeh Nazari, S. Ghafouri, Maryam Hosseinzadeh, Sonya Enayati, Samaneh Kabiri, Yeganeh Pasebani, A. Rafati, Mehdi Azizmohammad Looha, Abbas Tafakhori, M. Jameie
COVID-19 patients with neurological manifestations have poorer outcomes. We investigated the association between clinicodemographic and laboratory findings with poorer outcomes among COVID-19 inpatients with neurological manifestations. This was a retrospective study of consecutive medical records (March–April 2020). Neurological manifestations (altered level of consciousness, acute cerebrovascular disease, ataxia, seizure, headaches, dizziness/vertigo, muscle weakness, and peripheral neuropathies) were categorized into serious and nonserious. Of 119 COVID-19 inpatients, 38 with neurological manifestations were included (age, 63.7 ± 13.4 years; male, 65.8%), of whom 27 (71.1%) had serious manifestations. Muscle weakness (57.9%), impaired consciousness (47.4%), and acute cerebrovascular disease (23.7%) were the most frequent manifestations. The in-hospital mortality rate was 28.9%. Patients with serious manifestations were significantly older (66.9 vs 55.7, P = 0.018), with significantly higher white blood cell count (6.8 vs 5.1 × 103/μL, P = 0.023), direct bilirubin (0.3 vs 0.2 mg/dL, P = 0.030), prothrombin time (PT) (15.4 vs 14.4 seconds, P = 0.006), international normalized ratio (1.2 vs 1.1, P = 0.005), and model for end-stage liver disease (MELD) scores (10 vs 7, P = 0.011), compared with those with nonserious manifestations. In addition, the nonsurvivors had higher potassium (4.5 vs 4.0 mEq/L, P = 0.021), total bilirubin (1.1 vs 0.6 mg/dL, P = 0.008), and MELD scores (12 vs 8, P = 0.025) compared with the survivors. After adjustment, we found significant impacts of age (adjusted odds ratio [aOR], 1.11; P = 0.032), PT (aOR, 5.04; P = 0.019), and MELD score (aOR, 1.27, P = 0.047) on poorer outcomes. Older age, higher white blood cell count, bilirubin, PT, international normalized ratio, potassium, and MELD scores were associated with poorer outcomes in COVID-19 inpatients with neurological manifestations.
有神经系统表现的 COVID-19 患者预后较差。我们调查了有神经系统表现的 COVID-19 住院患者的临床人口学和实验室结果与较差预后之间的关系。 这是一项对连续病历(2020 年 3 月至 4 月)的回顾性研究。神经系统表现(意识水平改变、急性脑血管疾病、共济失调、癫痫发作、头痛、头晕/眩晕、肌无力和周围神经病)分为严重和非严重两种。 在 119 名 COVID-19 住院病人中,有 38 人有神经系统表现(年龄为 63.7 ± 13.4 岁;男性占 65.8%),其中 27 人(71.1%)有严重表现。肌肉无力(57.9%)、意识障碍(47.4%)和急性脑血管病(23.7%)是最常见的表现。院内死亡率为 28.9%。有严重表现的患者年龄明显偏大(66.9 对 55.7,P = 0.018),白细胞计数(6.8 对 5.1 × 103/μL,P = 0.023)、直接胆红素(0.3 对 0.2 mg/dL,P = 0.030 )、凝血酶原时间(PT)(15.4 对 14.4 秒,P = 0.006)、国际标准化比率(1.2 对 1.1,P = 0.005)和终末期肝病模型(MELD)评分(10 对 7,P = 0.011)。此外,与存活者相比,非存活者的血钾(4.5 vs 4.0 mEq/L,P = 0.021)、总胆红素(1.1 vs 0.6 mg/dL,P = 0.008)和 MELD 评分(12 vs 8,P = 0.025)更高。经过调整后,我们发现年龄(调整后比值比 [aOR],1.11;P = 0.032)、PT(aOR,5.04;P = 0.019)和 MELD 评分(aOR,1.27,P = 0.047)对较差的预后有明显影响。 年龄较大、白细胞计数、胆红素、PT、国际标准化比值、血钾和 MELD 评分较高与 COVID-19 神经系统表现住院患者较差的预后有关。
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引用次数: 0
Antibiotic Use in Patients With COVID-19 COVID-19 患者使用抗生素的情况
IF 0.5 Q4 INFECTIOUS DISEASES Pub Date : 2023-11-20 DOI: 10.1097/ipc.0000000000001324
Niloofar Hooshmand, Batool Zarei, Zahra Sadat Mireskandari, F. Sheybani, Mahboubeh Haddad, Sepideh Elyasi, N. Morovatdar, Hamed Hossein Abdollahi Dashtbayaz
Antimicrobial resistance is a serious threat to public health. The ongoing antimicrobial resistance pandemic has been fueled by the COVID-19 pandemic. We analyzed patients 15 years or older with COVID-19 who were admitted to a teaching hospital in Mashhad, Iran, during the period between the third and fourth COVID-19 waves. COVID-19 was diagnosed if the SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction test was positive in patients with compatible clinical syndromes. Overall, 532 episodes of COVID-19 were diagnosed. The median age of patients was 61 years (interquartile range, 48–73). One hundred twenty-five patients (23.4%) with COVID-19 died, and 165 (31%) experienced major complications. Over the study period, 134 DDD (defined daily dose) per 100 hospital bed days of antibacterial were used. Glycopeptides, third-generation cephalosporins, and carbapenems were the antibacterials most frequently used, based on the DDD per 100 hospital bed days. In a multivariate analysis, factors associated with antibacterial prescription in COVID-19 patients were lung involvement of greater than 50% (odds ratio [OR], 14.6), C-reactive protein of greater than 100 mg/L (OR, 3.35), and hypoxia (OR, 3.06). Univariate but not multivariate analysis showed that antibiotic use in COVID-19 patients was associated with 4 times increase in the chance of death (OR, 4.23). Our study highlights a high rate of antibacterial use in COVID-19 patients. Hypoxia, C-reactive protein of greater than 100 mg/L, and severe lung involvement were associated with a higher rate of antibacterial prescription. The patients who received antibiotics died 4.23 times more often than patients treated without antibiotics. These findings emphasize the need for integrating antimicrobial stewardship programs as an integral part of the pandemic response and the need for improving diagnostic tests for early detection of bacterial coinfections in COVID-19 patients.
抗菌药耐药性是对公共卫生的严重威胁。COVID-19大流行助长了抗菌药耐药性的持续流行。 我们对伊朗马什哈德一家教学医院在 COVID-19 第三波至第四波期间收治的 15 岁及以上 COVID-19 患者进行了分析。如果临床综合征相符的患者的 SARS-COV-2(严重急性呼吸系统综合征冠状病毒 2)聚合酶链反应检测呈阳性,则可诊断为 COVID-19。 共诊断出 532 例 COVID-19 病例。患者的中位年龄为 61 岁(四分位数间距为 48-73)。125名COVID-19患者(23.4%)死亡,165名患者(31%)出现重大并发症。在研究期间,每 100 个住院日使用了 134 DDD(规定日剂量)抗菌药物。根据每 100 个住院日的 DDD 计算,糖肽类、第三代头孢菌素和碳青霉烯类是最常用的抗菌药物。在一项多变量分析中,COVID-19 患者抗菌药物处方的相关因素包括肺部受累超过 50%(比值比 [OR],14.6)、C 反应蛋白超过 100 mg/L(OR,3.35)和缺氧(OR,3.06)。单变量而非多变量分析显示,COVID-19 患者使用抗生素与死亡几率增加 4 倍(OR,4.23)有关。 我们的研究表明,COVID-19 患者的抗菌药物使用率很高。缺氧、C 反应蛋白超过 100 毫克/升和严重肺部受累与较高的抗菌药物处方率有关。接受抗生素治疗的患者的死亡人数是未接受抗生素治疗患者的 4.23 倍。这些研究结果表明,有必要将抗菌药物管理计划作为大流行应对措施的一个组成部分,同时有必要改进诊断测试,以便及早发现 COVID-19 患者的细菌并发感染。
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引用次数: 0
Interpreting Serogical Markers in Hepatitis B Virus Infection 乙型肝炎病毒感染的血清学标志物的解释
Q4 INFECTIOUS DISEASES Pub Date : 2023-10-31 DOI: 10.1097/ipc.0000000000001322
Yasmeen Ahmed, Mohamed El-Kassas
Abstract Hepatitis B virus (HBV) is considered a global health-related problem. The World Health Organization estimates an incidence of approximately 1.5 million new cases annually despite an available effective vaccine, and approximately 296 million people worldwide are living with chronic hepatitis B. This large number of patients require continuous monitoring of the treatment efficacy, disease progression, and screening for the HBV-related liver complications. Recently, it has become more evident that we need better predictive markers to allow treatment cessation when there is a reduced risk of viral reactivation, in addition to the present need to predict disease outcome and improve the management of people living with chronic hepatitis B. Novel HBV biomarkers are focused on in this minireview. These new markers include quantification of serum HBV RNA, hepatitis B core–related antigen, quantitative hepatitis B surface antigen, quantitative anti–hepatitis B core antigen, and detection of HBV nucleic acid–related antigen. The target of finding new markers for HBV replication is to provide crucial clinical data in a noninvasive way for detecting the replicative and transcriptional activity of the virus. This may support better management of patients compared with the criterion-standard invasive marker for detecting the intrahepatic replication and transcription of HBV, which is the quantification of covalently closed circular DNA.
乙型肝炎病毒(HBV)被认为是一个全球性的健康相关问题。世界卫生组织估计,尽管有有效的疫苗,每年仍有大约150万例新病例发生,全世界约有2.96亿人患有慢性乙型肝炎。大量患者需要持续监测治疗效果、疾病进展和筛查hbv相关的肝脏并发症。最近,越来越明显的是,除了目前需要预测疾病结局和改善慢性乙型肝炎患者的管理外,我们还需要更好的预测标志物来允许在降低病毒再激活风险的情况下停止治疗。这些新的标志物包括血清HBV RNA定量、乙型肝炎核心相关抗原定量、乙型肝炎表面抗原定量、抗乙型肝炎核心抗原定量和HBV核酸相关抗原检测。寻找HBV复制新标志物的目标是以一种无创的方式为检测病毒的复制和转录活性提供关键的临床数据。与检测HBV肝内复制和转录的标准-标准侵入性标志物(共价闭合环状DNA的定量)相比,这可能支持更好的患者管理。
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引用次数: 0
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Infectious Diseases in Clinical Practice
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