International Journal of Infectious Diseases最新文献

Objective: To evaluate the effectiveness of viral load (VL)-based triage strategies for human papillomavirus (HPV)-positive women, utilizing data from two large cohort screening studies.

Methods: We analyzed 1,656 HPV-positive cases identified among 25,419 screening participants. Collected data included HPV testing, cytology, and pathologically confirmed diagnoses. VL-based triage strategies were compared to a guideline-recommended cytology-based triage. The cycle threshold (Ct) value, representing HPV VL, was used for triage, with the 75th percentile of Ct values established as the cut-off. Outcomes were assessed for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+.

Results: The mean participant age was 43 ± 7.99 years. Two triage strategies were compared: (1) HPV-16/18 & other types with Ct ≤ the 75th percentile cut-off (higher viral load), and (2) HPV-16/18 & other types with cytology (referring those with ≥ atypical squamous cells of undetermined significance [ASCUS] for colposcopy). The VL-based strategy demonstrated higher sensitivity than the cytology-based strategy for detecting CIN2+ (91.52% vs. 85.27%, p = 0.016) and was comparable for detecting CIN3+ (95.60% vs. 96.70%, p = 1.000). Similarly, the strategy using HPV-16/18 with Ct ≤ 75th & other types with Ct ≤75th was also comparable to the cytology-based approach for detecting both CIN2+ (87.05% vs. 85.27%, p = 0.636) and CIN3+ (95.60% vs. 96.70%, p = 1.000).

Conclusion: Viral load-based triage effectively identifies cervical precancer/ cancer in HPV-positive individuals without cytology, allows single-sample collection, reduces multiple visits, and may be most useful where cytology is unavailable or unreliable-acknowledging an increased colposcopy referral.

Introduction: In Sri Lanka, reliable diagnostics for rickettsial infections are limited. We assessed the burden, seroprevalence, and molecular diversity of rickettsial infections in hospitalized patients with acute undifferentiated febrile illness(AUFI).

Methods: AUFI patients were enrolled from the Western (n=540) and Central (n=260) Provinces. Clinical and exposure data, acute and convalescent sera, and buffy coat/eschar samples were collected. Orientia tsutsugamushi(OT) and Rickettsia spp. were detected using OT-specific (47 kDa) and pan-Rickettsia (17 kDa) qPCR assays. Group-specific IgG ELISAs were performed for scrub typhus(STG), typhus group(TG), and spotted fever group(SFG). Acute infection was defined by qPCR positivity and/or a ≥4-fold rise in IgG titres. Genetic diversity was assessed using OT 56kDa TSA and Rickettsia ompB gene sequencing.

Results: qPCR identified 38/800(5%) STG and 25/800(3%) TG/SFG infections. Among participants with paired sera (n=493), acute infections included 25(5%) STG, 11(2%) TG, and 17(3%) SFG cases. Overall, rickettsioses accounted for 86/800(11%) of AUFI cases. SFG seroprevalence was higher in the Central Province (17% vs 6%), while STG seroprevalence was higher in the Western Province (20% vs 13%). Genetic analysis on OT cases showed clustering with Karp, Kato, Buie, TH1811, TH1826 and Ikeda strains. Two cases of rickettsial infections were speciated as R. felis and R. sibirica. Only 19% of acute cases were clinically recognized and 58% received doxycycline.

Conclusion: Rickettsioses were under-recognized, highlighting the need for combining qPCR and ELISA diagnostics to strengthen clinical management and surveillance.

Background: The global SARS-CoV-2 pandemic highlighted the urgent demand for reliable serological assays to track infection and immune responses. Enzyme immunoassays (EIA) targeting viral antibodies provide a practical platform for quantifying antibody responses in humans and animals, serving as a framework for future pandemic preparedness and response.

Objectives: This study aimed to develop and evaluate an in-house EIA for the detection of total antibodies against SARS-CoV-2 using recombinant antigens: Spike Protein (SP), Receptor Binding Domain (RBD), and Nucleocapsid Protein (NP).

Methods: Recombinant antigens were conjugated to horseradish peroxidase (HRP) for detection in a double-sandwich ELISA format. The optimized assay was compared with an electrochemiluminescence assay (ECLIA) to determine cut-off values via receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden's J statistic were calculated. Assay optimization included testing dilutional linearity, incubation time, and reaction volume. The assay was applied to human and animal serum samples to assess versatility.

Results: Among the antigens tested, the receptor binding domain (RBD) exhibited the highest signal intensity and demonstrated dilutional linearity, outperforming both the spike protein and nucleoprotein in assay sensitivity. The assay demonstrated a sensitivity of 85% and specificity of 100%, with a PPV of 100% and an NPV of 68%. The high Youden's J statistic (0.85) and clear separation between true positive and negative samples underscore the robustness of the RBD antigen in reliably detecting SARS-CoV-2-specific antibodies for serological diagnostics. The optimized EIA protocol allowed for a reduced incubation time without compromising assay performance, and increasing the reaction volume two-fold did not result in a significant gain in signal intensity.

Conclusions: The RBD-based EIA provides a reliable, efficient platform for COVID-19 serological surveillance, suitable for both human and animal testing, and supports broader applications in vaccine evaluation and One Health monitoring.

Background: Sepsis-induced myocardial injury (SIMI) is a severe complication with high mortality. Beta-blocker therapy in SIMI remains controversial, lacking large-sample evidence.

Objective: To evaluate beta-blocker impact on mortality in SIMI patients using MIMIC-IV and eICU databases.

Methods: A retrospective cohort study based on MIMIC-IV (2008-2022) and eICU (2014-2015) databases included adult SIMI patients meeting Sepsis-3.0 criteria with elevated cardiac troponin. The primary exposure was beta-blocker use during ICU stay, and the primary outcome was in-hospital all-cause mortality. 1:1 propensity score matching was used to balance baseline characteristics, with multiple sensitivity analyses to verify result robustness.

Results: MIMIC-IV included 2,368 SIMI patients (1,338 using beta-blockers); eICU included 3,805 patients (1,030 using beta-blockers). After propensity score matching (MIMIC-IV: 837/group; eICU: 902/group), beta-blocker use was associated with a significant reduction in in-hospital mortality (MIMIC-IV: 19.7% vs 29.9%, OR=0.75, 95%CI: 0.60-0.94; eICU: 28.6% vs 35.1%, OR=0.70, 95%CI: 0.56-0.88). Long-term mortality was lower by 39% (28-day), 33% (90-day), and 27% (1-year) (all P<0.001). Multiple sensitivity analyses confirmed robustness (E-value: 2.00-2.21). Severely ill patients (SOFA≥8) had the greatest mortality reduction associated with beta-blocker use (55%). Prolonged hospital stay was consistent with a survival benefit rather than adverse effects.

Conclusions: Beta-blocker use is associated with reduced mortality and better long-term survival in SIMI patients, requiring prospective validation.

Objective: We explored factors contributing to the low human MERS-CoV prevalence in Africa by assessing MERS-CoV epidemiological and genomic features.

Methods: We followed the PRISMA guidelines. We searched for articles on epidemiological and virological MERS-CoV characteristics in humans and camels in Africa until August 2025. We used a generalised linear mixed-effects model to calculate pooled proportions. We identified relevant polymorphisms in African MERS-CoV lineages compared with the prototypic EMC/2012 and contemporary Arabian MERS-CoV (clade B5).

Results: We included 53 articles, with 31 used in the meta-analysis. Kenya, Egypt, and Ethiopia contributed to 66.03% of all included studies. Pooled MERS-CoV RNA positivity in African dromedaries was 6.09%, with juveniles (15.29%) having a higher incidence than adults (4.51%). The pooled MERS-CoV seroprevalence was 73.67%, with adults (80.96%) higher than juveniles (36.02%). In human-focused studies, only nine PCR-confirmed MERS cases were reported, six travel-associated and three autochthonous cases, despite a pooled seroprevalence of 2.4%. Genomic analyses identified MERS-CoV clade C-specific polymorphisms in the Spike and accessory genes with putative phenotypic impact.

Conclusion: We found the highest MERS-CoV RNA positivity in young dromedaries. Elevated MERS-CoV seroprevalence in mainly asymptomatic camel-exposed humans suggests an underestimation of MERS-CoV infections in Africa. The ongoing MERS-CoV evolution emphasises the need for active genomic surveillance to monitor signatures of human adaptation.

Objectives: Prolonged severe acute respiratory syndrome coronavirus 2 infection in immunocompromised individuals creates an environment conducive to intra-host viral evolution. We report persistent infection in a patient with advanced human immunodeficiency virus (HIV), aiming to delineate how partial immune reconstitution shapes viral evolution.

Methods: Nasopharyngeal swabs were obtained at 12 time points over a period of 154 days. Viral RNA was extracted and analyzed using whole-genome sequencing (WGS). Viral genome dynamics were analyzed longitudinally.

Results: All sequenced isolates were classified as Omicron sublineage BF.5 (BA.5.2.1.5). Between days 10 and 86, sequencing identified 30-60 mixed nucleotide positions per sample, indicating intra-host diversity. By day 93, a genetically uniform dominant genotype emerged and persisted through rebound detection, carrying multiple spike mutations atypical of BF.5, including T33K, R346K, V486F, T547K, and E554K. Phylogenetic analysis confirmed the patient-derived strain diverged significantly from other BF.5 isolates.

Conclusions: Serial WGS in advanced HIV infection revealed a selective sweep with fixation of spike substitutions atypical of the infecting lineage, consistent with immune-driven adaptation during prolonged infection. These findings highlight that persistent infections under profound immunosuppression can generate antigenically and genetically distinct viruses, emphasizing the value of longitudinal sequencing and targeted monitoring/management strategies in severely immunocompromised hosts.

Objectives: Central nervous system (CNS) paragonimiasis is relatively uncommon and its imaging findings have not been fully described in the limited literature. Our aim was to investigate the comprehensive imaging features of CNS paragonimiasis based on a large-scale case series study, with an emphasis on the unreported imaging findings.

Materials and methods: The clinical and imaging data of 206 pediatric patients with CNS paragonimiasis were continuously collected from 1181 cases of paragonimiasis in the past 12 years at the Children's Hospital of Chongqing Medical University (China). All patients underwent CT and/or MR scans. The lesion location and the comprehensive imaging features including the previously unreported imaging signs were reviewed and analyzed.

Results: The incidence of paragonimiasis involving the CNS was 17.4% (206/1181), with intracranial and intraspinal involvement accounting for 94.7% (195/206) and 5.3% (11/206) respectively. Imaging features of intracranial lesions included hemorrhage (79.5%, 155/195), ring-shaped lesions (63.6%, 124/195), pseudoaneurysms (17.4%, 34/195), meningeal lesions (19.5%, 38/195), and the unreported pure patchy edema (4.1%, 8/195), which was characterized by the absence of combined other typical signs and by its absorption with short-term follow-up. Imaging features of intraspinal lesions included the extradural granuloma (11/11) and the unreported intramedullary lesions (4/11), which were characterized by ring-shaped enhancement and invariably accompanied by the extradural granuloma.

Conclusion: The CNS paragonimiasis has relatively specific imaging features, which are of great value for early diagnosis of the disease. The two previously unreported signs we described will enrich the imaging spectrum of CNS Paragonimiasis.

Background: The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is associated with the status of inflammation, immunity, and nutrition in inflammatory diseases. The present research intends to investigate the relationships of the CALLY index with disease severity and clinical prognosis among patients with coronavirus disease 2019 (COVID-19).

Methods: The present study included 1049 COVID-19 subjects from two medical centers. Clinical information was gathered, and the CALLY index was calculated. The links of CALLY index with severity and prognosis were analyzed among COVID-19 cases.

Results: With disease severity scores increasing, the levels of CALLY on admission gradually decreased. Spearman correlative analyses showed that CALLY index was closely correlated with many clinical parameters. Linear and logistic regression analyses disclosed that the CALLY index was inversely related to disease severity scores. Simultaneously, the higher CALLY index on admission elevated the risks of mechanical ventilation, vasoactive agent, ICU admission, and death in COVID-19 patients during hospitalization. Logistic regression analysis further validated that the CALLY index was inversely linked to the poorly clinical outcomes. Moreover, the severity scores and the CALLY index on admission have similar predictive capacity for the poor prognosis in COVID-19 patients.

Conclusions: The CALLY index displays a negative relationship with disease severity and poor prognosis, indicating it can be served as a disease severity indicator and a prognostic tool for COVID-19 patients.

This case report describes a patient with prolonged fever following a stay in Kinshasa, Democratic Republic of the Congo (DRC). The patient was initially treated for malaria in Kinshasa but was subsequently hospitalized upon returning to Italy. Comprehensive diagnostic investigations, including serological, microbiological, and imaging studies, were conducted. Ultimately, Next Generation Sequencing (NGS) enabled the identification of Human Pegivirus as the likely causative agent, leading to a definitive diagnosis and clinical improvement. This report highlights the diagnostic challenges posed by tropical febrile illnesses and emphasizes the valuable role of NGS in detecting elusive pathogens.

Objectives: Dengue fever remains a critical public health challenge worldwide, especially in endemic regions such as Vietnam, where rapid urbanization and climate change exacerbate transmission. Despite frequent outbreaks, the spatiotemporal epidemiology of dengue in Vietnam is poorly characterized. This study aimed to elucidate the epidemic dynamics to inform targeted intervention strategies.

Methods: We analyzed national case and mortality data from 1998 to 2020, employing advanced geospatial analysis tools (R and SatScan) to identify high-risk areas and transmission patterns.

Results: Over 23 years, the case fatality rate was consistently low (0.1-0.2%), despite discrepancies between reported dengue virus strains and clinical cases. Key high-risk zones included the Mekong Delta, southern metropolitan areas, south-central Vietnam, and Hanoi, with distinct temporal peaks, primarily between June and November. Notably, southern Vietnam experienced persistent simultaneous outbreaks, whereas the epidemic activity in Hanoi was more localized.

Conclusions: Our findings delineate the critical zones and seasons of dengue transmission in Vietnam, providing essential evidence for optimizing resource allocation and surveillance efforts. These insights are vital for developing preemptive public health interventions in resource-constrained endemic settings.