International Journal of Infectious Diseases最新文献

Background: Among people living with HIV (PWH), the use of integrase strand transfer inhibitors (INSTIs) has been increasingly linked to notable weight gain, raising clinical concern. Much of the available evidence originates from trials in Western regions and Africa, while observational data from Asian settings remain scarce.

Methods: This retrospective, multicenter cohort study analyzed treatment-naïve PWH at eleven HIV care centers in Taiwan and mainland China between 2019 and 2025. Treatment-naïve patients initiating dolutegravir/lamivudine (DTG/3TC) or bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) were included. The primary endpoint was the proportion of patients with ≥10% weight gain. Secondary endpoints were virologic suppression (<200 copies/mL) between weeks 24-96 and changes in lipid profiles. Logistic regression with inverse probability weighting was used to identify the predictors of ≥10% weight gain.

Results: A TOTAL OF 1,087 PATIENTS WERE ENROLLED (DTG/3TC: 406; BIC/FTC/TAF: 681). Baseline CD4 counts were higher in the DTG/3TC group (315 vs. 281 cells/μL, p=0.01), while HIV RNA levels were lower (4.68 vs. 4.96 log10 copies/mL, p<0.01). Both regimens achieved comparable virologic suppression overall, including in participants presenting with advanced HIV disease. Weight gain was greater with BIC/FTC/TAF at week 48 (4.2 vs. 2.2 kg; difference 2.0 kg; 95% CI, 1.1-2.9; p<0.01) and week 96 (5.1 vs. 2.8 kg; difference 2.3 kg; 95% CI, -1.1-3.5; p<0.01). At week 48 and 96, 21.6% and 30.5% experienced ≥10% weight gain, respectively. After calculating IPTW, logistic regression analysis identified the following predictors included CD4 <200 cells/μL (aOR 2.54 and 2.89), BMI <24 kg/m² (aOR 2.59 and 2.35), and BIC/FTC/TAF (aOR 1.83 and 1.83) at week 48 and 96, respectively. At week 48 and 96, HDL cholesterol was significantly lower in the BIC/FTC/TAF group (mean differences = -2.4, and -2.4 mg/dL, respectively; p<0.05).

Conclusions: In this large real-world Asian cohort, BIC/FTC/TAF and DTG/3TC demonstrated comparable virological efficacy. However, TAF-containing regimen-particularly among individuals with lower CD4 counts and BMI-were associated with greater weight gain and attenuated increases in HDL cholesterol, highlighting the need for careful metabolic monitoring.

Paragonimiasis is a food-borne parasitic disease that typically presents with pulmonary manifestations but can rarely involve the pericardium. We report a 10-year-old boy from an endemic area in China who presented with acute gastrointestinal symptoms and massive pericardial effusion without respiratory signs. Despite repeated pericardiocenteses and empirical anti-infective therapy, the effusion persisted. Laboratory testing revealed exudative pericardial fluid with negative cytology, acid-fast staining, and mNGS, while peripheral eosinophilia and stool ova were absent. Echocardiography showed a characteristic "cocoon-like" pericardial pattern, and serology was positive for Paragonimus IgG. The patient improved after praziquantel and corticosteroids, but progressive pericardial thickening required pericardiectomy, which confirmed necrotizing granulomatous inflammation. This case underscores the diagnostic challenges of ectopic paragonimiasis presenting as isolated pericardial effusion and highlights the importance of epidemiological history, echocardiographic features, and serology for early recognition, timely intervention, and prevention of constrictive pericarditis in children from endemic regions.

We report a rare case of live T. callipaeda found in the vitreous cavity following combined vitrectomy and cataract surgery. The parasite's continuous survival in the vitreous cavity necessitated a second specialized procedure to remove it. This case underscores the importance of thorough preoperative evaluation and highlights the potential for unusual original sites of infection.

Objectives: Late-stage HIV diagnoses among heterosexuals remains a problem in Europe, yet little is known about its risk factors. We aimed to identify trends and factors associated with late-stage HIV diagnosis among heterosexuals in the Netherlands.

Methods: We used national HIV surveillance data and included individuals diagnosed between 2012-2022 with heterosexual contact as the suspected transmission route. We applied descriptive statistics and logistic regression analyses.

Results: Of 1,637 HIV diagnoses among heterosexuals, 932 (57%) were late-stage. The proportion of late-stage diagnoses was stable during 2012-2022 (range 51-62%). Significant risk factors for late-stage diagnosis were male sex (adjusted odds ratio [AOR] = 1·72; 95% confidence interval [CI] = 1·40, 2·13), older age (every 10-year increase: AOR = 1·48; 95% CI = 1·34, 1·62), being born in Africa (AOR = 2.21; 95% CI = 1·70, 2·88]), and Asia (AOR = 2·93; 95% CI = 1·88, 4·65). People born in Eastern Europe approached significance (AOR = 1·70; 95% CI = 0·97, 3·05). Most late-stage diagnoses occurred in hospitals.

Conclusions: The proportion of late-stage HIV diagnoses remains high among heterosexuals in the Netherlands. Men, older people, and those born in Africa, Asia, and Eastern Europe were associated with late-stage diagnosis.

The development of needle-free, nonintrusive vaccine technologies promises to transform public health campaigns by improving acceptability and ease of administration. However, this convenience introduces a critical ethical vulnerability: the potential for large-scale deployment without individual knowledge or consent, leading to nonconsensual immunization. This paper analyzes this risk through the lens of established bioethical principles-autonomy, non-maleficence, beneficence, and justice-and historical precedents, examining how the ease of use of nonintrusive formats, combined with precedents of rapidly enforced mandates, could undermine informed consent. To address this challenge, we propose a proactive governance framework based on three pillars: strengthening international ethical guidelines, enacting national laws against covert mass medication, and exploring technological monitoring of public infrastructure. This approach aims not to impede public health action, but to reinforce it by upholding individual autonomy and maintaining essential public trust.

Background: Relapsing fever (RF) remains a major public health concern in Ethiopia, causing severe illness and high mortality despite global declines since the 1940s. Mortality may reach 70% without treatment, yet research on outcomes and risk factors is limited in resource-limited settings. This study, conducted at Yekatit-12 Hospital Medical College, aimed to evaluate the clinical features, complications, and determinants of death among patients with RF, addressing a critical knowledge gap in Ethiopia.

Methods: A retrospective cross-sectional study was conducted among patients aged 14 years and older with blood film-confirmed relapsing fever between September 2021 and February 2023. A structured data collection tool was used to extract clinical, demographic, and laboratory information. Patient characteristics were described using descriptive statistics, while multivariable logistic regression was used to determine the independent predictors of mortality, and results were presented as adjusted odds ratios (AOR) with 95% confidence intervals.

Results: A total of 119 male patients were included, with a mean age of 24.1 years. Most were daily laborers (42.0%) or homeless (39.5%). The leading symptoms were fever (85.5%), chills (67.2%), respiratory distress (54.6%), and altered mental status (46.2%). Complications were observed in 88.2% of cases, most commonly anemia (74.7%), acute respiratory distress syndrome (69.7%), shock (60.5%), and Jarisch-Herxheimer reaction (36.1%). Mortality was 45.4% (n=54), primarily from multi-organ failure (64.8%) and respiratory failure (25.9%). Independent predictors of death were symptom duration >5 days before admission (AOR = 3.1; 95% CI: 1.24-7.9), Jarisch-Herxheimer reaction (AOR = 2.8; 95% CI: 1.09-7.64), multi-organ failure (AOR = 3.8; 95% CI: 1.23-11.6), and requirement for mechanical ventilation (AOR = 2.7; 95% CI: 1.05-7.1).

Conclusion: In Ethiopia, relapsing fever affects young, socioeconomically disadvantaged men, with high complication and mortality rates. Delayed treatment, Jarisch-Herxheimer reaction, multi-organ failure, and requiring mechanical ventilation during admission were predictors of mortality in mens, highlighting the importance of early diagnosis, antibiotics, and critical care.

Objectives: To compare 30-day all-cause mortality between patients with coronavirus disease 2019 (COVID-19) and those with seasonal influenza in South Korea.

Design: This nationwide, population-based cohort study utilized the National Health Insurance claim database, including individuals newly diagnosed with COVID-19 or influenza between July 2022 and December 2023. The primary outcome was 30-day all-cause mortality. Logistic regression analysis was conducted to compare mortality risks, adjusting for demographic and clinical covariates.

Results: A total of 12,802,169 patients with COVID-19 and 2,888,777 patients with influenza were analyzed. COVID-19 was associated with significantly higher 30-day all-cause mortality compared with influenza (adjusted odds ratio [aOR], 1.76; 95% CI, 1.60-1.94). This elevated risk remained consistent across most subgroups defined by age, sex, healthcare utilization, and comorbidities. Particularly higher risks were observed among adults aged 18-64 years (aOR, 2.93), hospitalized patients (aOR, 2.55), and those with myocardial infarction (aOR, 2.24).

Conclusions: COVID-19 is associated with markedly higher short-term mortality than influenza across diverse clinical and demographic subgroups. These findings underscore the ongoing need for vigilant prevention efforts, and vaccination. This study represents the first large-scale nationwide analysis, and the first in Asia, conducted in the post-COVID-19 era.

Objectives: Elizabethkingia spp. infections pose a major threat to human health with high mortality. This study aimed to further understand its detection status, co-detection patterns, pathogenicity, and antimicrobial resistance in lower respiratory tract infections (LRTI) through metagenomic high throughput sequencing (mNGS)-based real-world research.

Design and methods: We retrospectively analyzed 105 LRTI patients positive for Elizabethkingia spp. by mNGS from July 2021 to February 2025. Pathogen profiles, antimicrobial management, and outcomes were reviewed via electronic medical records.

Results: mNGS detection rates for Elizabethkingia spp. in respiratory samples were 21.5% in General Intensive Care Unit (GICU) and 11.1% in Emergency Intensive Care Unit (EICU), more sensitive than culture. Polymicrobial co-detection was ubiquitous (99%), indicating a diverse polymicrobial community. Clinical isolates exhibited variable susceptibility (74%-100%) to trimethoprim-sulfamethoxazole, ciprofloxacin, levofloxacin, doxycycline, minocycline, rifampicin, and azithromycin. Patients receiving targeted antimicrobial therapy based on mNGS indicators (Stringent Map Read Number (SMRN) rank ≤2, normalized SMRN (nSMRN) ≥1000, or SMRN percentage ≥25%) had significantly higher effective treatment rates.

Conclusions: Elizabethkingia spp. detection rates in ICU respiratory samples are high, frequently complicated by polymicrobial co-detection. Lack of targeted therapy is a key factor in treatment failure. mNGS-derived indicators and local susceptibility databases are essential for guiding effective intervention.

In this case-control study of 231 hospitalized patients with community-acquired pneumonia (CAP), 61% achieved clinical stability by Day 3. Residence in a long-term care facility (adjusted OR 4.1, 95% CI 1.6-11.4) and active neoplasia (adjusted OR 5.5, 95% CI 1.5-25.9) were independently associated with failure to reach early stability. Persistent oxygen requirement was the leading criterion for instability. Early stability correlated with lower mortality (2.1% vs 17.8%) and fewer ICU admissions (0% vs 12.2%). These findings underscore the prognostic value of stability assessment and support individualized antibiotic duration based on patient characteristics.

Background: Long-acting injectable Rilpivirine (RPV-LA) is an essential component of current HIV maintenance therapy. Local injection-site reactions, particularly pain, are common and may influence treatment adherence. The product label advises allowing vials to reach room temperature before administration, although here is limited clinical evidence to support this practice.

Methods: We conducted a prospective observational study to assess whether the time elapsed between removing the RPV-LA vial from refrigerated storage and intramuscular injection ("tempering time") was associated with the intensity of pain at the injection site. Pain was recorded immediately after administration using a 0-10 visual analogue scale (VAS) and on days 3 and 5. Tempering time was measured in minutes. Linear regression and mixed-effects models assessed the relationship between tempering time and pain, adjusting for demographic and clinical factors.

Results: A total of 179 participants contributed 195 injections. The median tempering time was 85 minutes (IQR 50-150). Median immediate pain score was 4.0 (IQR 2.0-6.0). In univariable analysis, longer tempering time was associated with lower pain (r = -0.31; 95% CI -0.56 to -0.03; p = 0.03). However, in multivariable analysis adjusting for tempering time, age and number of injection, the association was attenuated and no longer statistically significant (β = -0.27; 95% CI -0.59 to 0.06; p = 0.11). Age remained independently associated with lower pain scores (β = -0.03; 95% CI -0.05 to -0.01; p = 0.01). No associations were observed on days 3 or 5 post-injection.

Conclusions: In this real-world cohort, tempering time of RPV-LA was not independently associated with injection-site pain. Age was the only consistent predictor of pain intensity. These findings suggest that strict adherence to tempering recommendations may not substantially influence patient comfort. Further randomized studies are warranted to confirm these observations and explore additional strategies to minimize injection-site discomfort.