International Journal of Infectious Diseases最新文献

Background: Mucormycosis is a rare, aggressive, and life-threatening fungal infection that predominantly affects immunocompromised individuals and is associated with a high mortality rate.

Case presentation: We treated a 72-year-old woman with myelodysplastic syndrome (MDS) who developed disseminated mucormycosis involving the lungs, skin, and central nervous system (CNS). Diagnosis was supported by metagenomic next-generation sequencing (mNGS), and she received combination antifungal therapy with liposomal amphotericin B and isavuconazole. Her clinical status stabilized after 4 weeks of treatment. She later died approximately 2 weeks after discharge because of carbapenem-resistant Pseudomonas aeruginosa bacteremia.

Conclusions: Our case highlights the importance of prompt diagnosis and timely initiation of therapy for mucormycosis and indicates that combination antifungal therapy may be an effective approach to managing severe disseminated mucormycosis in immunocompromised patients.

Objectives: To compare nephrotoxicity between teicoplanin and vancomycin in older patients, investigate the correlation between teicoplanin average steady-state trough concentrations (C_min,ss) and nephrotoxicity, and identify independent risk factors for teicoplanin-associated nephrotoxicity.

Design or methods: This study enrolled older patients treated with teicoplanin or vancomycin at four tertiary hospitals in Beijing, China. Propensity score matching (PSM) was utilized to mitigate potential bias. Dynamic monitoring of C_min,ss was performed, with multivariate analysis used to identify independent risk factors for teicoplanin-associated nephrotoxicity.

Results: After PSM, 186 patients (93 per group) were analyzed. The incidence of nephrotoxicity was significantly lower in teicoplanin than in vancomycin (16.13% vs 32.26%, OR = 3.50, P = 0.006). Among 203 teicoplanin-treated patients, 39 developed nephrotoxicity. Multivariate analysis identified exposure duration (OR = 1.060, P = 0.028) and baseline creatinine (OR = 1.057, P = 0.019) as independent risk factors for teicoplanin-associated nephrotoxicity. Notably, when C_min,ss was <40 mg/L, the risk of nephrotoxicity did not significantly increase with rising values.

Conclusion: Teicoplanin demonstrated superior renal safety compared to vancomycin in older patients. The C_min,ss <40 mg/L was associated with a manageable risk of nephrotoxicity, whereas exposure duration and baseline creatinine could serve as critical parameters for clinical decision-making.

Objective: Encephalitis, is a rare manifestation of cat scratch disease (CSD). We aimed to characterize CSD encephalitis/meningoencephalitis rate, diagnosis, clinical features, and outcome.

Methods: Patients with encephalitis/meningoencephalitis were identified through a national CSD surveillance registry active since 1991. Clinical data were collected. Long-term follow-up was performed, including neurological/cognitive assessments. Outcome was assessed using the Extended Glasgow Outcome Scale (GOSE).

Results: Nineteen patients, 0.5% of the CSD cohort, were identified. Cat contact (84%), fever (79%), and lymphadenopathy (68%) were common. Seizures occurred in 13 patients (68%), including 5 with status epilepticus; 6 requiring mechanical ventilation. Two clinical patterns were identified: an acute form (63%), with rapid onset and shorter recovery, and a subacute form (37%), occurring in older patients (median age of 35 vs 12.5 years), with progressive neurologic manifestations and longer recovery. CSF findings varied. Neuroimaging was normal in 79%. All patients had favorable outcomes: 11 (58%) fully recovered (GOSE 8) while 8 (42%) reported persistent cognitive complaints (GOSE 7) after a median follow-up of 58 months, (range 1-185).

Conclusion: CSD encephalitis/meningoencephalitis presents in two forms: acute and subacute. Prognosis is generally favorable, but recovery may take months and cognitive complaints often persist. Antibiotic and corticosteroid use warrants further investigation.

Introduction: Over 14.5 million infants remain unvaccinated globally, predominantly in low- and middle-income countries (LMICs), where health system gaps and inequities impede progress toward the Immunisation Agenda 2030.

Objective: This scoping review synthesised health system strengthening strategies aligned with the WHO Health Systems Framework to enhance vaccine uptake among children under two years of age in LMICs.

Methods: Following the PRISMA-ScR guidelines, six databases were searched until January 2025.

Results: Of 2897 records, 53 studies met the inclusion criteria: 54.7% from lower-middle-income and 41.5% from low-income countries, with 81.1% being community-based interventions. The mean intervention duration was 39.3 months (SD = 62.1). Health information systems (83.0%), leadership and governance (79.2%), and service delivery (60.4%) were the most frequently targeted, while the health workforce was the least addressed (35.8%). The key strategies included data monitoring (88.7%), coverage tracking (86.8%), and data-driven decision-making (86.8%). Community-centred, data-informed interventions improved service accessibility (67.9%) and quality (41.5%).

Conclusion: Multiple interventions addressing multiple WHO building blocks have demonstrated better outcomes. Strengthening workforce capacity, adopting an integrated health system approach, and addressing financing barriers are essential for achieving the Global Immunisation Agenda 2030.

Introduction: Gut colonization by multidrug-resistant gram-negative bacilli (MDR-GNB) is a common precursor to bacteraemia in haematological patients with malignancies. This study evaluates the efficacy of ceftazidime/avibactam (CAZ/AVI) and ceftolozane/tazobactam (C/T) in eradicating gut MDR-GNB colonization.

Methods: This retrospective cohort included haematologic patients admitted to a tertiary hospital (2020-2023), colonized with carbapenem-resistant Enterobacterales or difficult-to-treat resistant (DTR) Pseudomonas aeruginosa and treated with CAZ/AVI or C/T. Decolonization was defined as clearance of baseline MDR-GNB in two consecutive post-treatment rectal swabs.

Results: Twenty treatment episodes were analysed. At the first post-treatment rectal swab, the previously identified colonizing MDR-GNB was not detected in 15/20 episodes (75.0%). The same colonizing MDR-GNB was re-identified in 3/15 cases (20.0%) on subsequent rectal swabs after a median of 8.0 days (IQR 7.5-11.0). Overall, 12/20 episodes (60.0%) achieved decolonization. Median follow-up was 327.0 days (IQR 225.0-480.8); sustained decolonization (≥180 days of follow-up) was documented in 9 episodes, while 5/12 episodes (41.7%) were recolonized with a different MDR-GNB. Among the eight episodes that remained colonized post-treatment, seven involved <7 days of therapy or DTR P. aeruginosa infection. Gut decolonization was more frequently observed in low-inoculum infections and in episodes treated for ≥7 days.

Conclusion: CAZ/AVI and C/T may facilitate gut MDR-GNB decolonization in haematological patients. Sustained decolonization rates suggest a potential role in mitigating infection risks, warranting confirmation in larger cohorts.

Background: Acute encephalitis caused by human parvovirus B19 (PVB19) is an uncommon clinical manifestation observed in both immunocompetent and immunocompromised individuals. Angioimmunoblastic T-cell lymphoma (AITL) is a distinct subtype of lymphoma characterized by aberrant immune dysregulation, predisposing patients to opportunistic infections even in the absence of chemotherapy.

Case presentation: A 66-year-old woman with newly diagnosed, treatment-naïve AITL presented with acute confusion, dysarthria, and severe anemia. Cerebrospinal fluid (CSF) analysis and neuroimaging findings were non-specific. PVB19 DNA was subsequently detected in both the CSF and serum. A bone marrow biopsy confirmed PVB19-associated pure red cell aplasia (PRCA). Intravenous immunoglobulin therapy resulted in a declining viral load and clinical improvement. The patient's clinical course was complicated by multiple subsequent infections, and she ultimately died five months after discharge.

Conclusion: This case highlights the immunodeficiency caused by AITL, which predisposes patients to opportunistic infections. PVB19 infection should be considered for patients presenting with unexplained encephalitis, particularly in those with underlying immunocompromised conditions.

Purpose: This study characterizes the epidemiological trends and resistance profiles of respiratory tract infections (RTIs) in the United Arab Emirates (UAE) from 2010 to 2022, aiming to inform national control strategies.

Method: We conducted a retrospective observational study of RTI cases across 345 UAE healthcare settings using data from the national surveillance network. Pathogen identification and resistance profiling were performed using advanced diagnostics and standardized antimicrobial susceptibility testing, in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Lower respiratory tract infections (LRI) comprised most cases (73.1%; n=100,856), including 6,416 due to Mycobacterium tuberculosis, while upper respiratory infections made up 26.9%. LRI incidence was stable until 2014 but rose significantly from 2015-2022 (AAPC= 1.58; 95% CI 1.58 - 3.87), especially in the Northern Emirates. Carbapenem resistance among Enterobacterales was 22.5% (14.4% in K. pneumoniae), and third-generation cephalosporin resistance 30.1% (62.3% in E. coli). Resistance was highest in A. baumannii (61%) and P. aeruginosa (27.4%). Macrolide and MRSA resistance increased significantly. The majority (85%) of tuberculosis cases were identified among individuals from South Asian and East African regions, with a post-COVID surge, while drug resistance remained below 15%.

Conclusion: These findings underscore the urgent need for regionally tailored infection control strategies, enhanced antimicrobial stewardship, and expanded pathogen surveillance to prevent further escalation of AMR.

Objectives: To characterize the early spatiotemporal transmission dynamics of SARS-CoV-2 following the Chinese government's adjustment of the long-standing "zero-COVID" policy in December 2022, focusing on both overseas importation and subsequent domestic dissemination, and to identify key factors driving these transmission pathways.

Methods: We analyzed 55,142 high-quality SARS-CoV-2 genomes from the Chinese mainland, covering six predominant Omicron sublineages (BA.5, BF.7, DY, XBB, EG.5, and HK) circulating during the policy-adjustment period. Genomes were grouped into three phases according to temporal shifts in lineage predominance. Mutation-network approaches were applied to infer spatiotemporal transmission patterns, and international air travel data were integrated to assess the contribution of global mobility to viral importation.

Results: South Korea, the United States, Japan, and several Asia-Pacific regions were the major sources of overseas introductions, with international passenger volume identified as the primary driver. Beijing and Shanghai functioned as key domestic transmission hubs at different stages. Beijing was predominantly affected during the early introduction phase, whereas Shanghai became the main hub later due to the highest inflow of international travelers.

Conclusion: This study reveals the spatiotemporal dynamics and major drivers of SARS-CoV-2 transmission in the Chinese mainland in the post-"zero-COVID" period, underscoring the value of integrating genomic surveillance with mobility data to guide future preparedness and public health decision-making.