International Journal of Infectious Diseases最新文献

Objective: To assess whether anti-interferon (anti-IFN) autoantibodies are associated with more severe clinical and laboratory outcomes in West Nile virus (WNV) patients.

Methods: We prospectively evaluated 19 patients diagnosed with WNV during a 2024 outbreak. Serum anti-IFN autoantibodies were measured using a luciferase-based neutralization assay. Patients were stratified into two groups: high anti-IFN levels (n=5) and normal levels (n=14) compared to controls (n=18). Clinical features, neurologic findings, laboratory values, and outcomes were compared.

Results: Patients with elevated anti-IFN antibodies had significantly more severe disease. Cerebrospinal fluid (CSF) analysis revealed markedly higher white blood cell counts (712 vs. 73 cells/µL, p=0.02), a higher percentage of polymorphonuclear leukocytes (PMN, 24 vs. 72%, p=0.009), and elevated protein levels (74 vs. 98 mg/dL). C-reactive protein (CRP) was also higher (1.23 vs. 8.6 mg/dL). Neurological manifestations, including cranial nerve palsy, motor symptoms, and meningitis, were more common. Rash occurred more frequently (60% vs. 21.4%). Clinical cure was less frequent (60% vs. 100%), and while most patients in the normal antibody levels group were discharged home, none were in the high antibody group. Mortality was 40% vs. 21.4%.

Conclusion: Elevated anti-IFN antibodies were associated with increased neuroinflammation and worse outcomes. These findings support their potential role as prognostic biomarkers in WNV infection.

Background: Marburg Virus Disease (MVD) presents a major public health threat due to its high case fatality rate and potential for rapid human-to-human transmission. Following Rwanda's first confirmed MVD outbreak in September 2024, a community-based surveillance approach was implemented to enhance early case detection and containment. This study aimed to assess the effectiveness of community-based active case finding in detecting MVD cases and evaluating geographic distribution of surveillance coverage across Rwanda's provinces.

Methods: From October 5-7, 2024, community health workers (CHWs) conducted a house-to-house active case search across six provinces under the supervision of health facilities and the Marburg Virus Outbreak National Command Post. CHWs screened individuals for MVD symptoms and referred suspected cases for testing. Data were collected via the electronic Infectious Diseases Surveillance and Response (e-IDSR) system.

Results: A total of 9,483,570 individuals were screened representing 72% of Rwanda's population with 57 symptomatic individuals identified making a detection rate of 0.0006% who were sent to health facilities for further MVD screening by healthcare workers. Screening intensity varied geographically, with Kigali City and the Western Province reporting the highest numbers of symptomatic cases. The northeastern region demonstrated the strongest community engagement, whereas lower screening rates were observed in southern regions, highlighting disparities in surveillance coverage.

Conclusions: The study demonstrates the effectiveness of community-based active surveillance in reaching large populations for early detection of MVD cases. Regional disparities in screening highlight the need for targeted interventions, enhanced public awareness, and strengthened CHW training. Continued investment in community surveillance systems is critical to ensuring Rwanda's readiness for future outbreak threats.

Objectives: Growing evidence suggests that lymphocyte subsets are declined in COVID-19 patients, but it is unclear if these alterations persist after widespread exposure to SARS-CoV-2 or how long they last.

Methods: We analyzed lymphocyte subset data from 40,537 patients across three phases: pre-COVID, mass infection, and post-COVID. The counts of lymphocyte subsets and CD4⁺/CD8⁺ ratios were compared using Mann-Whitney U test or Kruskal-Wallis H test. Monthly post-exposure data were compared with pre-exposure data to assess the persistence of impact on lymphocyte subsets by SARS-CoV-2, and subgroup analyses were performed in patients with cardiovascular disease.

Results: During mass infection, T cells, CD4⁺T cells, CD8⁺T cells, NK cells, and B cells dropped significantly. Even 20 months post-infection, CD8⁺ T cells remained 9.9% below baseline. Baseline lymphocyte subsets differed significantly by sex and age. Immune recovery varied by age and sex, with older adults and males showing prolonged lymphopenia. In cardiovascular disease patients, T lymphocytes remained 72.9% below baseline for 20 months post-infection.

Conclusions: Our findings redefine SARS-CoV-2 infection as a condition of long-lasting immune compromise. The sustained subnormal lymphocytes-particularly in cardiovascular disease cohorts-highlight a key immunologic feature of long COVID and underscore the need for personalized care.

Objective: Despite growing recognition of pandemic preparedness gaps in low- and lower-middle-income countries (LLMICs), empirical evidence on facility-level capacity remains limited. This study assesses the capacity of health facilities in LLMICs to respond to infectious disease pandemics and identifies structural determinants influencing that capacity.

Methods: We used a secondary analysis of pooled Service Provision Assessment (SPA) survey data conducted in nine LLMICs between 2013 and 2022.Thirty-one facility indicators were grouped into four domains (infection prevention, personal protective equipment, diagnostic capacity, and therapeutic capacity) to construct an overall capacity index. Machine learning algorithms and hierarchical regression models were applied to identify key facility characteristics associated with pandemic response capacity.

Results: This study evaluated health system capacity in 9,632 facilities across nine LLMICs comprising 834 hospitals (7.9%) and 8,868 non-hospital facilities (92.1%). Overall capacity was low: only 22% of facilities achieved a capacity index above 50%. Overall capacity was low: only 22% of facilities achieved a capacity index above 50%. Therapeutic capacity emerged as the weakest domain across all countries. The strongest predictors of pandemic preparedness capacity were facility type, ownership, and location, reflecting the systematic system-wide challenges of LLMIC health systems and providing strategic intervention point.

Conclusions: Therapeutic capacity represents a critical vulnerability in LLMIC health systems. Non-hospital facilities, which serve as the backbone of health service delivery in these settings, demonstrate particularly low capacity levels. These findings underscore the urgent need for targeted investment in facility-level infrastructure, particularly therapeutic resources in non-hospital facilities, to strengthen pandemic preparedness in LLMICs.

Introduction: In early 2025, a patient died in the South of France with confirmed rabies following a dog bite while traveling in Morocco to visit relatives. This report summarizes the patient's clinical course and the subsequent public health investigation.

Material and methods: Demographics, epidemiological and medical data from the infected patient and from contacts at risk of exposure were retrospectively retrieved from medical files.

Results: The patient presented with fever, cardiac and neurological symptoms. Initial clinical presentation mimicking psychiatric disorders and suggesting a myocarditis led to multiple exposures of family members and health care workers (HCWs). Rabies virus was retrieved from saliva, skin biopsy and post-mortem brain biopsy. A total of 44 potentially exposed persons were identified among family and community contacts and among HCWs who care the patient, and received rabies post-exposure prophylaxis (RPEP). Most family members shared food and drinks with the patient, notably during a large family meal with potential mucosal exposure to infected saliva. Several HCWs had a contact with the patient's body fluids without application of standard of isolation precautions.

Conclusions: Recommendations for RPEP in contacts with a human rabies case differ between countries, and practices differ between teams. The dramatic nature of the disease often leads to irrational fear that may compromise the strict application of recommendations. Travelers to North African countries, including those visiting friends and relatives should be informed about the risk for rabies when injured by dogs or cats and about the need to receive an adequate RPEP.

Eggerthella lenta is an anaerobic gram-positive bacillus and a part of the healthy human intestinal microbial community. E. lenta causes local infections, such as sinusitis, appendicitis, necrotizing fascitis, cutaneous abscesses, and liver abscesses. This case report details an instance of sepsis attributable to Eggerthella lenta bacteremia in a 78-year-old male patient recently diagnosed with Fournier's gangrene. The management strategy included an escalation of antibiotic therapy from piperacillin-tazobactam to meropenem, which successfully resolved the sepsis and eradicated the bacteremia. The patient developed Fournier's gangrene, necessitating surgical intervention, but subsequently experienced septic shock and was diagnosed with an E. lenta infection. The patient underwent surgery with antimicrobial therapy, made a good recovery and was discharged after a 24-day hospital admission.

Background: Undernutrition affects nearly half of persons with tuberculosis (PWTB) in India and is a major determinant of poor treatment outcomes and impaired recovery. Randomized evidence on macronutrient supplementation in PWTB remains limited. We evaluated whether an energy-dense nutritional supplement (EDNS) could improve weight gain among undernourished adults with drug-sensitive pulmonary TB.

Methods: We conducted an open-label, two-arm randomized controlled trial in Faridabad, India (2020-2023). Adults with microbiologically confirmed pulmonary TB and mild to moderate undernutrition (BMI 14-18.5 kg/m²) were randomized to receive either EDNS plus standard dietary advice or standard dietary advice alone. Participants in the intervention arm received two sachets of EDNS daily for up to six months. Primary outcomes were ≥5% weight gain at two months and ≥10% at treatment completion. We conducted multivariable logistic regression to assess the impact of EDNS.

Results: Among 335 participants randomized (171 intervention; 164 control), the intervention group had higher proportions achieving ≥5% weight gain at two months (53.9% vs. 39.3%; p=0.015) and ≥10% at six months (55.8% vs. 41.0%; p=0.023). After adjusting for covariates, EDNS improved odds of achieving these outcomes (month 2 adjusted odds ratio [aOR] 2.02 [95% CI 1.25-3.30]; month 6 aOR 1.89 [95% CI 1.13-3.18]). Acceptability and adherence were high. Gastrointestinal symptoms were more frequent but did not require treatment modification.

Conclusion: EDNS significantly improved weight gain among undernourished PWTB and may represent a practical, scalable approach to complement existing food basket and cash transfer strategies to aid nutritional recovery during TB treatment.

Background: During the COVID-19 pandemic, prolonged nonpharmaceutical interventions (NPIs) reduced the circulation of respiratory pathogens. The effects of NPIs on "immunity debt" in children are unclear, especially after almost three years of NPIs in China.

Methods: Between November 2021 and October 2023, a cross-sectional study of 235 children (age 9 months-5 years) was conducted at the China-Japan Friendship Hospital, Beijing. Serum IgG antibodies against ten respiratory pathogens, including influenza A, influenza B, respiratory syncytial virus (RSV), parainfluenza virus, adenovirus (types 7 and 55), Mycoplasma pneumoniae, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, were measured using a novel antigen-specific detection platform. Antibody levels were compared between the following three periods: during NPIs (2021-2022), after NPIs (January-June 2023), and during the Mycoplasma pneumoniae epidemic (July-Oct 2023). In parallel, hospital-based nucleic acid surveillance from 2017 to 2023 was analyzed.

Findings: IgG levels exhibited pathogen-specific patterns. Antibody titers against M. pneumoniae and influenza A declined significantly during NPIs and rebounded after the restrictions were lifted, coinciding with increased clinical detection of these two pathogens. In contrast, the antibody levels for influenza B, RSV, parainfluenza virus, and adenovirus were stable across all periods. SARS-CoV-2 antibody titers rose after December 2022, reflecting the introduction of this new pathogen.

Interpretation: Our results provide the first multi-pathogen serological evidence that prolonged NPIs led to pathogen-specific immunity debt in young children in China. The effects were most pronounced for pathogens with high pre-pandemic circulation or rapid antigenic drift. Sustained serological surveillance and pathogen-targeted vaccination strategies can mitigate epidemic rebounds after periods of reduced exposure.

Background We compared all-cause mortality, all-cause hospitalization, and emergency department (ED) visit rates among 73,899 influenza outpatients treated with oseltamivir and 1,592 patients treated with baloxavir. Methods Data were drawn from the TriNetX US Collaborative Network, which comprises 69 healthcare organizations and includes patients recorded between January 1, 2016, and December 31, 2023. Subsequently, 1:1 propensity score matching (PSM) was applied between the two groups in order to further control for baseline differences and potential confounders. Results The patients treated with baloxavir displayed significantly lower rates of 1-, 3-, and 6-month hospitalization(1.6%, 3.7%, 5.3% vs 0.6%, 0.6% 0.8%) and 1-, 3-, and 6-month ED visits(1.8%, 4.4%, 7.2vs 1.5%, 3.5% 5.0%) versus those treated with oseltamivir. The all-cause hospitalization was 5.3% for oseltamivir users and 0.8% for baloxavir users (HR 6.49; 95% CI, 3.55-11.90), emergency department visits were 7.2% versus 5.0% (HR 1.34; 95% CI, 1.01-1.78), and mortality was 0.6% for both groups (HR 0.96; 95% CI, 0.14-6.78). Conclusions The outpatients with treatment of baloxavir have lower hospitalization rates and emergency department visits. Mortality rates were nearly identical between groups, showing no significant difference.

Objectives: Jorge Lobo's disease (JLd), a cutaneous mycosis caused by the fungus Paracoccidioides lobogeorgii, follows a chronic course and is refractory to any treatment modality. On histopathological view, the dermis presents crowded macrophages that have M2 polarization, which is associated with an anti-inflammatory profile and maintenance of the infection. Lipid droplets (LDs) are organelles responsible for neutral lipid storage for energetic needs. Intracellular pathogens may utilize LDs both to evade the immune response and as a source of nutrients. LDs in JLd have not yet been evaluated.

Methods: This is an immunohistochemical study of 54 JLd skin samples using anti-adipophilin antibody for LDs analysis and anti-CD163 and anti-CD204 M2 macrophage markers. LDs were characterized as focal or diffuse, and their density was semi-quantitatively evaluated as absent or very scarce, mild, or strong. M2 macrophage density was obtained through the ImageJ software aid.

Results: LDs were present within macrophages in 72.22% of cases, with high density in 53.85%, regardless of M2 macrophage density.

Conclusions: Host-derived LDs may play a role in the pathogenesis of JLd.