International Journal of Infectious Diseases最新文献

Background and aims: Clostridioides difficile ribotypes (RTs) 001 and 176 dominate the epidemiology of C. difficile infection (CDI) in the Czech Republic. We applied whole-genome sequencing (WGS) and broad-range antimicrobial susceptibility testing (AST) to provide detailed characterisation of these lineages.

Methods: Between October and December 2019, 22 hospitals participated. CDI isolates were characterised by PCR ribotyping, toxin gene detection and AST to metronidazole, vancomycin and moxifloxacin. WGS and broad-range AST were performed on selected RT001 and RT176 isolates.

Results: The mean CDI incidence was 5.1 cases/10,000 patient-days. Isolates and epidemiological data were available for 495/524 (94.5%) CDIs. RT001 (n=166, 33.5%), RT014 (n=59, 11.9%) RT176 (n=51, 10.3%) were the most prevalent. Among 21 RT001 isolates, wgMLST (3745 loci) revealed 0-120 allele differences and 21 genomic inserts, eight of which carried antimicrobial resistance (AMR) genes, including cfrB, which encodes linezolid resistance. In 13 RT176 isolates, wgMLST (3298 loci) showed 0-9 allele differences and eleven inserts, eight with AMR genes. The wgMLST confirmed clonal relatedness of RT001 and RT176 isolates from different hospitals (0-3 allelic differences), yet with variation in acquired AMR gene content. Differences between genotype and expected phenotype were observed in PnimB^G and metronidazole, cfrE and linezolid and tet-genes and tetracycline.

Conclusions: RT001 and RT176 predominate in the Czech Republic, and WGS confirmed their inter-hospital clonal relatedness. Importantly, the emergence of linezolid-resistant RT001 strains was detected in nine hospitals. The inclusion of AMR genes in genetic relatedness analysis showed higher discriminatory power compared to cgMLST or wgMLST alone.

Objectives: Immunocompromised patients with COVID-19 are at a higher risk of hospitalization and death. Low seroconversion rate after COVID-19 vaccination are common in immunocompromised patients. Evusheld, a combination of the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibodies tixagevimab-cilgavimab, was previously recommended as COVID-19 pre-exposure prophylaxis for immunocompromised patients. Our study aimed to present the real-world experience of tixagevimab-cilgavimab use in Taiwan.

Methods: Adults who received tixagevimab-cilgavimab at the Taipei Veterans General Hospital during October 2022-June 2023 were identified. The main outcomes were SARS-CoV-2 infection, severe or critical COVID-19, and the 6-month all-cause mortality rate. Multivariate Cox regression analysis was performed to identify factors associated with poor outcomes.

Results: Overall, 352 adult patients received tixagevimab-cilgavimab. The common indications were hematological malignancies (84.1%), autoimmune disease (10.5%), solid organ transplantation (4.8%), and the presence of solid tumors under treatment (4.5%). During the 6-month follow-up, 39 patients (11.1%) test COVID-19 positive, including 29 (8.2%) and 10 (2.8%) who developed mild-to-moderate and severe or critical COVID-19, respectively. The overall 6-month all-cause mortality rate was 4.8%. In patients with COVID-19, the corresponding rate was 1.1%. Age ≥ 70 years (p = 0.038) and the presence of solid tumors under treatment (p = 0.033) were independent risk factors for severe or critical COVID-19.

Conclusions: Tixagevimab/cilgavimab -treated immunocompromised patients had a low rate of subsequent severe or critical COVID-19. Our study provides insights into the role of future monoclonal antibodies as COVID-19 pre-exposure prophylaxis among immunocompromised patients and emphasizes the need for ongoing research.

Chronic hepatitis B virus (HBV) infection is the leading cause of liver fibrosis in West Africa. Metabolic comorbidities may accelerate liver disease among people with HBV (pwHBV). We evaluated the association between metabolic multimorbidity and liver fibrosis in pwHBV in Senegal. We included hepatitis B surface antigen-positive adults with a negative HIV test between 2019 and 2022. Metabolic multimorbidity was defined as the presence of at least two comorbidities, including obesity, hypertension, diabetes mellitus, and dyslipidemia. Significant liver fibrosis was defined as a liver stiffness measurement ≥7.1 kPa using vibration controlled transient elastography. We explored the association between metabolic multimorbidity and significant liver fibrosis using multivariable logistic regression. Among 768 participants, the median age was 31 (25-38), and 360 (46.9%) were women. Metabolic multimorbidity was present in 58 (16.1%) women and 27 (6.6%) men. Significant liver fibrosis was diagnosed in 7 (8.2%) participants with and 83 (12.2%) without metabolic multimorbidity. Multivariable analysis showed no significant association between metabolic multimorbidity and fibrosis (adjusted odds ratio 1.24, 95% confidence interval 0.51-3.03). Metabolic multimorbidity was more frequent in women than men but was not associated with liver fibrosis in pwHBV in Senegal. Long-term data are needed to evaluate the impact of metabolic diseases on liver fibrosis among pwHBV in Africa.

Background: Toxocariasis represents the most common parasitic infection detected in internationally adopted children, in whom the asymptomatic form typically predominates [1].

Methods: We performed a retrospective study of all internationally adopted children consecutively evaluated at the Infectious Diseases Unit of Meyer Children's University Hospital between 2009 and 2025 as part of the standardized "Adopted child screening." Two diagnostic approaches were used: a one-step protocol based solely on IgG-TES ELISA (2009-2017) and a two-step protocol integrating ELISA with confirmatory IgG-TES Western blot (2018-2025). Clinical characteristics, eosinophil counts, co-infections, second-line diagnostic procedures, and treatment decisions were systematically reviewed.

Results: Among 2,657 children screened for toxocariasis, 2,085 underwent the ELISA-only approach, 370 resulted positives. From 2018 onward, 572 children were tested, with 92 ELISA-positive results; 68 were confirmed by Western blot. Overall, second-line investigations and treatment were required more frequently in the ELISA-only group than in the combined protocol group (p=0.002). Using Western blot as reference, ELISA exhibited high sensitivity (95,8%) but modest specificity (67,1%). Most seropositive children were asymptomatic or displayed covert toxocariasis, with only one visceral case identified. More than one-third of children with eosinophilia were seropositive for Toxocara spp.

Conclusions: Approximately one in six internationally adopted children shows Toxocara spp. seropositivity. While IgG-TES ELISA is a sensitive screening tool, confirmatory Western blot substantially improves specificity and diagnostic stewardship, reducing unnecessary second-level investigations. A substantial proportion of seropositive children likely represent clinically inactive seropositivity, for which it is not possible to differentiate recent infection from past exposure to the parasite. Integrating serology with eosinophil counts, IgE levels, and clinical assessment is crucial to distinguish active from resolved infection and to identify children who require clinical and instrumental follow-up and albendazole therapy, thereby avoiding unnecessary interventions.

Objectives: Few national-scale, multi-setting studies have compared COVID-19 cluster characteristics across successive SARS-CoV-2 variant periods. We assessed how outbreak duration, cluster size, and setting distribution shifted across six facility types and variant periods using nationwide outbreak investigation data.

Methods: We analyzed 4,592 COVID-19 clusters (≥10 cases) in South Korea from January 2020 to February 2022, spanning three variant periods (Before Delta, Delta, and Early Omicron) and six facility types. We compared outbreak duration and cluster size across facility types and periods using nonparametric tests and examined shifts in facility distribution. Sensitivity analyses used threshold combinations for cluster size and duration.

Results: A total of 162,176 cases were linked to 4,592 clusters. Outbreak duration decreased across variant periods (mean 17.31 days Before Delta vs. 8.84 days Early Omicron), while cluster size remained stable by facility type. Religious and public-use facilities predominated during the Before Delta period, whereas educational and long-term care facilities predominated during Early Omicron. Among large and prolonged clusters (≥100 cases and ≥20 days), outbreak durations were similar across periods.

Conclusions: Viral characteristics shape early outbreaks, whereas facility-specific structural vulnerabilities sustain prolonged transmission. An effective response should combine variant-informed early interventions with structural and operational infection-control measures in high-risk settings.

Objectives: Colonization with carbapenem-resistant Pseudomonas spp (CRP) contributes to infections and high mortality. Fecal microbiota transplantation (FMT) offers a strategy for eradicating multidrug-resistant organisms, but experience on CRP decolonization in immunocompromised patients is meagre.

Designs and methods: A single-center retrospective study of gastroscopic FMT in CRP-positive hematological patients. The primary objective was decolonization. Short and long-term post-FMT CRP-related infectious complications were evaluated.

Results: By April 30, 2025, 14 patients (5 ALL, 5 AML, 2 MDS, 1 APL, 1 NHL) were enrolled; 8 had received allo-HCT. With a median follow-up of 16 months (1,45-26), decolonization was achieved in 10 in a median of 14 days (9-34) and was durable in 6. Eradication failure occurred in 4 due to persistence and 4 due to recurrence. Median time to recolonization was 83 (32-173). 9 patients experienced CRP-related infections following FMT: bloodstream infections (BSI) 67%, soft tissue 56%, gastrointestinal 56%, urinary tract 33%, pneumonia 22%, septic shock 22%. A total of 7 died; due to infections in 6, with CRP responsible in 5. No severe adverse events of FMT were reported.

Conclusions: FMT demonstrates safety and efficacy in early decolonization of CRP. In failure, CRP-related infections remain a leading cause of mortality.

Capnocytophaga cynodegmi, a commensal of canine and feline oral flora, is rarely implicated in human infections, with most cases limited to localized soft tissue infections. We present the first case of C. cynodegmi-associated infective endocarditis (IE) in a 39-year-old man with bicuspid aortic valve and alcohol use disorder. The patient presented with sepsis, aortic valve vegetations, and systemic complications, including heart failure and shock liver. Despite negative blood and valve cultures, metagenomic sequencing of plasma (Karius test) initially detected Capnocytophaga canimorsus, while targeted Next-Generation Sequencing (NGS) of explanted valve tissue confirmed C. cynodegmi (100% match). The patient underwent valve replacement and completed a 6-week course of ampicillin-sulbactam with clinical recovery. This case underscores the diagnostic challenges of fastidious pathogens and demonstrates the potential of C. cynodegmi to cause life-threatening IE. It highlights the necessity of advanced molecular diagnostics, such as NGS, in atypical cases of IE. Clinicians should consider zoonotic Capnocytophaga spp. in culture-negative IE, particularly in high-risk patients with animal exposure or valvular abnormalities.

Objective: This study investigated the impact of diabetes status, including whether individuals have diabetes and the various stages of diabetes, on the incidence of tuberculosis (TB), providing insights for more precise prevention and control of TB.

Methods: This population-based cohort study drew on a database from the Shanghai Suburban Adult Cohort and Biobank (SSACB), comprising 35,842 participants. Adult participants with no prior history of TB who visited community health service centers for health screening between April 2016 and October 2017 were enrolled. Follow-up of eligible participants was conducted for incident TB cases after their health screening date until March 7, 2025. Cases were sourced from the database of new diagnoses spanning 2016 to 2025. Participants without TB served as controls and were selected through propensity score matching, with each case matched to four controls by age, sex, body mass index (BMI), smoking behavior, and alcohol consumption behavior. TB risk was compared across different groups using multivariate logistic regression.

Results: In total, 58 participants developed TB during follow-up. The TB incidence rate was higher in participants with newly diagnosed diabetes, at 44.00 cases per 100,000 person-years, compared to 18.55 cases in the non-DM group (p = 0.018). The nested case-control study indicated that the newly diagnosed diabetes group had a higher incidence of TB compared to the non-diabetic group (OR 2.50, p = 0.039).

Conclusion: Newly diagnosed diabetes patients have a higher risk of tuberculosis. Enhancing diabetes management through the prompt identification of undiagnosed cases could thereby indirectly contribute to tuberculosis control.

We report a case of bloodstream infection caused by Chromobacterium haemolyticum in an 80-year-old man following traumatic exposure to contaminated rice field water. The patient presented with rapidly progressive lower extremity soft tissue infection and septic shock. Preliminary MALDI-TOF MS identification indicates that it is C. violaceum; however, the absence of violacein pigmentation and presence of β-hemolysis raised concern regarding species-level misidentification. Definitive identification by whole-genome sequencing (WGS) confirmed C. haemolyticum. Antimicrobial susceptibility testing revealed high-level resistance to β-lactam antibiotics, including carbapenems, while the isolate remained susceptible to fluoroquinolones and tetracyclines. WGS identified the bla_CRH-1 gene, likely contributing to the resistance phenotype. This case emphasizes the importance of accurate species-level identification and antimicrobial susceptibility testing in managing Chromobacterium infections, especially in immunocompromised or severely ill patients. Increased awareness of C. haemolyticum as a distinct clinical pathogen is essential, given its potential for misidentification and multidrug resistance.