International Journal of Infectious Diseases最新文献

Background: Testing nucleic acid (NA) from dried stool spots (DSS) on Whatman903 filter paper provides a simple approach to detect enteric pathogens, especially in low-resource settings where cold-chain transport and lab infrastructure are limited. DSS samples are easily collected, stored, transported, and processed. This study evaluates NA stability from DSS samples stored under different times and temperatures.

Methods: DSS were prepared by spotting stool from patients infected with Shigella spp. (dsDNA), rotavirus (dsRNA) and norovirus (ssRNA) onto filter paper. Pathogen detection using NA extracted from DSS at Time Zero (T0) and after storage at room temperature (RT), 4°C, -20°C or -80°C for 3-6 months, 6-12 months, and 12-18 months was compared to NA column-extracted from stool (the gold standard) using qPCR.

Findings: Cycle threshold (CT) values for each pathogen remained stable over time and temperature. RT-stored DSS performed similarly to cold- or frozen-stored samples. Shigella DSS showed no significant difference from column-extracted NA Mean CT after 18 months of storage: 28.33 RT vs. 28.64 GS, 95% CI: (-0.44, 0.84). Rotavirus DSS showed lower CTs than column-extracted samples; mean CT after 18 months: 19.40 RT vs. 26.92 GS, 95% CI: (6.57, 8.66), indicating increased nucleic acid yield from DSS. Norovirus DSS showed higher CTs from DSS, with consistent CT from DSS from time zero through 18 months: 30.63 RT vs. 25.79 GS, 95% CI: (-5.98, -4.06). This suggests initial NA loss upon spotting, but CTs remained stable thereafter for the duration of the study.

Interpretation: DSS samples remained stable for NA extraction at RT for at least 18 months for Shigella and rotavirus. Norovirus detection from DSS showed slight initial degradation but remained detectable with stable CTs over time. DSS thus provides a practical, low-cost tool to enhance stool-based pathogen detection in global diarrheal surveillance.

Background: The indeterminate (IM) phase of chronic hepatitis B lies between immune clearance and inactivity. We evaluated liver histology to guide treatment decisions.

Methods: Treatment-naïve patients were enrolled from 33 Chinese centers (2018-2020). Serum sIL-2R was measured via chemiluminescence. IM patients were stratified by HBeAg status and ALT levels. Histopathology was analyzed, and a diagnostic nomogram constructed.

Results: Among 211 IM patients, 74.9% had significant histological disease, with a higher rate in HBeAg(+) than HBeAg(-) patients (90.5% vs. 68.2%, p = 0.0012). Serum sIL-2R independently predicted histological injury in IM patients (middle tertile: OR=2.29, p = 0.034; highest tertile: OR=3.69, p = 0.004). A nomogram integrating sIL-2R, AST, and ALB showed good and consistent discriminative ability, with an AUC of 0.743 in the training set and 0.747 in the validation set. In 56 treated CHB patients, sIL-2R significantly declined after 78 weeks of entecavir (448.0 to 382.5 U/mL, p = 0.038), correlating with ALT reduction (r = 0.327, p = 0.025). Public data linked high hepatic IL2RA to immune activation and impaired function.

Conclusion: sIL-2R effectively identifies significant histological disease in IM patients. The derived nomogram aids risk stratification, while dynamic sIL-2R monitoring reflects therapeutic response, supporting its clinical utility.

Background: The World Health Organization targets the elimination of viral hepatitis as a public health threat by 2030, requiring scalable strategies for hepatitis B (HBV) and C (HCV), especially in underserved populations. Emergency departments (EDs) offer a key setting for opt-out blood-borne virus screening, enabling early diagnosis and monitoring of elimination efforts.

Methods: We reviewed Western European ED-based HCV and HBV screening studies (2005-2025), including HCV antibody positivity with confirmatory HCV-RNA testing and/or HBsAg positivity. Temporal trends in HCV-RNA+/Ab+ and HBsAg prevalence were analyzed across countries.

Results: Seventeen HCV studies from five countries (1,500,659 individuals) identified 26,081 HCV Ab+ and 4,347 HCV-RNA+ cases. Weighted viraemic HCV prevalence declined from 56% in the pre-DAA era (2008-2015) to 10% in 2022-2024, consistently in Spain, England, and Ireland. Ten HBV studies (1,425,954 individuals) showed stable HBsAg prevalence (0.70%).

Conclusions: ED-based screening reflects population-level changes in viral hepatitis. The decline in viraemic HCV highlights the impact of DAA access, while stable HBV prevalence underscores unmet therapeutic needs. ED data could function as a low-cost sentinel surveillance system for hepatitis elimination in Europe.

Objectives: To compare the clinical presentation, management, and outcomes of microbiologically confirmed Pneumocystis jirovecii pneumonia (PJP) in patients with and without HIV infection.

Methods: We conducted a multicentre retrospective study of adults admitted to three tertiary hospitals. Patients were stratified by HIV status, and only microbiologically confirmed PJP cases were included. Clinical, radiological, treatment, and outcome data were analysed. Multivariable logistic regression identified factors associated with PJP-related mortality and, exploratorily, intensive care unit (ICU) admission.

Results: Over the 13-year study period, the estimated incidence was 1.40 cases per 100,000 person-years in a catchment population of approximately 780,000 inhabitants. A total of 142 patients were included. Most were HIV-negative (60.6%) and older than those with HIV. Non-HIV patients more often had atypical imaging and required oxygen therapy, whereas ICU admission was more frequent among HIV-positive patients. PJP-related mortality was 10.6%, with no differences by HIV status. In multivariable analysis, ICU admission was independently associated with lower PJP-related mortality (aOR 0.26, 95% CI 0.07-0.91), while age and HIV status were not. HIV-negative status was independently associated with a lower likelihood of ICU admission compared with PLWH (aOR 0.29, 95% CI 0.11-0.82).

Conclusions: PJP predominantly affects non-HIV immunocompromised patients. Mortality remains substantial but is not independently associated with HIV status. The association between ICU admission and mortality likely reflects selection and survivorship bias, highlighting the need for improved prophylaxis and diagnostic vigilance.

Objective: This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems versus non-carbapenem antibiotics in adult hospitalized patients with AmpC-producing Enterobacterales infections across various infection sites.

Methods: A comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted for observational studies and randomized controlled trials comparing carbapenems with alternative agents. Primary outcomes included 30-day all-cause mortality, microbiological failure, infection recurrence, and adverse drug reactions (ADRs).

Results: Seventeen studies met the inclusion criteria. There was no significant difference in 30-day mortality (OR = 1.29; 95% CI: 0.91-1.82; p = 0.16) or infection recurrence (OR = 0.98; 95% CI: 0.32-2.97; p = 0.97) between carbapenems and non-carbapenems. Microbiological failure rates were also comparable. However, carbapenems were associated with a higher incidence of ADRs (OR = 4.32; 95% CI: 1.73-10.79; p = 0.03). Clinical success trended in favor of non-carbapenem agents, though the difference did not reach statistical significance (OR = 0.56, 95% CI: 0.29-1.08; p = 0.08).

Conclusion: While carbapenems remain effective for AmpC-producing infections, non-carbapenem alternatives offer comparable outcomes with fewer adverse events. These findings support IDSA guidance recommending agents such as cefepime when the MIC is ≤2 µg/mL and highlight the need for individualized, susceptibility-guided therapy.

Objectives: Chronic hepatitis B (CHB) remains a major public health challenge in Vietnam, with an estimated 7.5% of the population infected. The aim was to evaluate the cost-effectiveness of a one-time universal CHB screening strategy.

Methods: A Markov model was used to assess the clinical health impact and cost-effectiveness of a one-time universal screening in Vietnam, with subsequent CHB monitoring and treatment, compared to the current practice. Sensitivity analyses were performed to identify thresholds for cost-effectiveness based on a willingness-to-pay threshold of $12,000/QALY. Scenario analysis was performed to assess what the cost-effectiveness of screening would be if treatment rates were to increase.

Results: The ICER was calculated to be $3,609 per QALY, with an incremental cost difference of $162,730 and an incremental effect difference of 45.1 QALYs, per 100,000 adults screened. Compared to current practice, universal screening would avert an additional 0.5 cases of newly developed cirrhosis, 1.1 cases of newly developed decompensated cirrhosis, 1.3 cases of newly developed hepatocellular carcinoma, 0.5 liver transplantations and 5.7 HBV-related deaths, per 100,000 adults screened.

Conclusions: A one-time universal screening is likely to be cost-effective under the current WTP threshold. Clinical impact would be increased if linkage to care and treatment rates were to be improved.

Background: Despite global investments, achieving measles elimination targets remain elusive in low- and middle-income countries (LMICs). This study provides a comprehensive synthesis of measles-containing vaccine (MCV) coverage trends, effectiveness, and uptake determinants to inform strategic realignment.

Methods: We conducted an umbrella review of systematic reviews (2010-2025) and analyzed WHO/UNICEF coverage data (2000-2024) for 79 LMICs. Determinants were synthesized via meta-meta-analysis.

Results: Twelve reviews and longitudinal data for 79 countries were analyzed. In 2024, mean MCV1 coverage was 79.2% (SD=16.0%), with only 17 countries (21.5%) achieving the ≥95% elimination threshold. MCV2 coverage averaged 69.4% (SD=19.9%) and a mean dropout gap (difference between MCV1 and MCV2) of 10.9 percentage points. Regional disparities were profound: the regions of Americas and Africa recorded the lowest mean MCV1 coverage (74.3% and 76.8% respectively), while the African Region faced critical gaps in MCV2 (64.9%). Meta-meta-analysis identified positive maternal perception (Pooled OR=4.05; 95% CI: 2.89-5.66) and awareness of benefits (Pooled OR=2.99) as the strongest predictors of uptake.

Conclusions: Fewer than one-quarter of LMICs currently meet measles elimination targets. The stagnation in coverage and significant dropout rates necessitate a strategic shift to prevent measles resurgence and protect vulnerable children.

Background: Evidence on local therapy for cutaneous leishmaniasis (CL) in the Amazon remains limited, particularly in areas where multiple Leishmania species other than Leishmania braziliensis are prevalent.

Methodology: In this prospective, single-arm study, patients with localized CL were treated with a three-dose schedule intralesional meglumine antimoniate (IL-MA) at a referral center in Santarém, Pará, Brazil. Follow-up and outcome assessment also involved the use of mHealth tools.

Results: Between 2022 and 2024, 127 patients were enrolled. Treatment effectiveness at day 120 ranged from 69.3% (intention-to-treat) to 76.8% (per-protocol) after the initial regimen. Following an additional intralesional cycle, effectiveness increased to 85.6%. One serious adverse event required brief hospitalization.

Conclusions: IL-MA demonstrated favorable safety and moderate-to-high effectiveness, supporting its use as a pragmatic therapeutic option for CL in the Amazon region. The integration of mHealth tools proved valuable for remote monitoring and minimizing loss to follow-up, offering a promising approach for patient management and the generation of real-world evidence in endemic settings.

Objectives: To determine whether mupirocin-based decolonization, compared with placebo, no treatment, or alternative agents, reduces S. aureus-related surgical site infection (SA-SSI), nasal S. aureus colonization and overall SSIs incidence in elective surgery.

Methods: We searched EMBASE, Medline (Ovid), PubMed, CENTRAL, and Google Scholar to 15 May 2024 for randomized controlled trials. Risk ratios (RRs) were pooled using a random-effects model with the restricted maximum likelihood (REML) estimator with the Hartung-Knapp (HK) adjustment. Prespecified subgroup analyses evaluated application strategy, surgical type, and chlorhexidine gluconate (CHG) co-administration.

Results: Seventeen RCTs (15,533 participants) were included. In trials with no-treatment or placebo controls, mupirocin-based decolonization reduced S. aureus-related SSI (SA-SSI) (RR 0.67, 95% CI 0.49-0.91) and nasal colonization (RR 0.22, 95% CI 0.18-0.26). Effects were larger with targeted use in confirmed carriers and when combined with CHG. No reduction was observed for overall SSIs, except in orthopedic surgery (RR 0.80, 95% CI 0.65-0.99). Head-to-head data versus active alternatives were sparse and did not show a consistent advantage for mupirocin.

Conclusions: Targeted preoperative mupirocin, especially when combined with CHG, reduces SA-SSI in elective surgery. The lack of significant impact on overall SSIs is interpreted as a reflection of polymicrobial etiologies in surgical infections. Given the emerging risk of mupirocin resistance, further adequately powered head-to-head trials with standardized outcomes and integrated resistance surveillance are warranted.