International Journal of Infectious Diseases最新文献

We report two cases of HIV-positive individuals virologically suppressed on antiretroviral treatment who developed nephrotic-range glomerular disease with massive proteinuria. Both were treated with tacrolimus to control proteinuria, achieving complete and sustained remission for over five years. Subsequently, they developed Kaposi sarcoma, raising concerns about prolonged use of calcineurin inhibitors in people living with HIV with glomerular diseases. This may impair oncogenic immune surveillance and promote reactivation of latent viruses such as human herpesvirus-8. These cases underscore the need for caution when using long-term immunosuppression in PLWH with glomerular disease, as treatment options remain limited. This clinical course has not been previously reported.

Objectives: To elucidate the global origins, evolutionary trajectory, and adaptive strategies of the MT28-ptxP3 macrolide-resistant Bordetella pertussis (MRBP) lineage driving the recent resurgence.

Methods: We integrated long-term epidemiological surveillance data from Shenzhen (2013-2024) with comparative genomic analysis of 632 isolates (2018-2024), including early international MT28 strains from the USA, Japan, Austria, and Vietnam. MLVA and SNP-based phylogenetics were used to define population structure and evolutionary dynamics.

Results: The study revealed a dramatic clonal replacement: the MT28 lineage surged from 6.5% in 2018 to 89.4% in 2024 (p < 0.001), establishing dominance. Phylogenetic analysis traced the global seeding of the MT28 backbone to the USA in 2018 and Japan/Austria in 2019. These early strains lacked the 23S rRNA A2047G mutation, suggesting that the recent resurgence may be due to the localized fixation of resistance within this lineage. This genotype-phenotype convergence provided a decisive fitness advantage in an antibiotic-rich environment. Epidemiologically, this expansion coincided with a significant shift in infection burden towards adolescents (7-15 years), indicating effective transmission in populations with waning vaccine-induced immunity.

Conclusions: The 2024 resurgence in China is linked to the localized fixation of macrolide resistance within the globally dispersed MT28 lineage. Its evolution, combining resistance, hyper-virulence, and vaccine escape (prn deficiency), highlights the urgent need for revisions in global antibiotic stewardship and vaccination strategies.

This study reports a case of extrapulmonary infection caused by Mycoplasma pneumoniae manifesting as soft tissue abscesses in an immunocompromised host. A 17-year-old female with a history of aplastic anemia and haploidentical hematopoietic stem cell transplantation presented with recurrent fever and pelvic/psoas abscesses. mNGS of abscess drainage identified M. pneumoniae as the dominant pathogen and revealed a macrolide-resistant 23S rRNA A2063G mutation. Targeted therapy with tigecycline and omadacycline led to clinical resolution. This case underscores the critical role of mNGS in diagnosing culture-negative extrapulmonary infections and guiding antimicrobial therapy based on resistance profiling in immunocompromised patients.

Background: Enterovirus (EV) infections cause a range of illness in neonates, from mild febrile episodes to life-threatening conditions. This study assessed incidence, risk factors, and hospitalization costs of neonates with EV infections in Denmark.

Methods: We used register data on the full population of Denmark from 2015 through 2023, covering 544,168 neonates. The International Classification of Disease (ICD-10) identified severe EV disease. Risk factors, including gestational age, parity, and birth month, were analyzed using logistic regression in a case-control framework, with birth month as a proxy for EV seasonality.

Results: A total of 181 hospital admissions of neonates with an ICD-10 code of EV infection and/or a positive EV PCR test were included. The overall incidence was 34 per 100,000 live births. Most cases (147; 82%) occurred June-November, and birth month was significantly associated with EV infection. EV infections involved CNS in 87 cases (48%) and sepsis in 36 (20%). EV was associated with higher parity; affected neonates were more often later-born than those without neonatal hospitalizations (OR 2.39, 95% CI 1.65-3.49). Total hospitalization costs were €5.3 million, averaging €29,213 per patient.

Conclusion: Neonatal EV infections in Denmark are rare but can be clinically severe and economically burdensome. Birth month and parity are significant risk factors, reflecting seasonal transmission and household exposure. These findings highlight the need for heightened clinical awareness and preventive strategies, particularly during high-risk months.

Background: A recent outbreak of mumps showed a concerningly low number of classical disease notifications, prompting evaluation of the efficacy of local wastewater monitoring.

Methods: Suspected mumps cases were recorded by local GP practices (n = 13) for 20 weeks and laboratory-reported notifications were collected. Local wastewater monitoring using passive samplers was deployed downstream of a confirmed case and their school, and in wastewater pumping stations serving the involved and neighbouring towns. Wastewater samples were analysed using RT-PCR.

Results: GPs reported 50 suspected patients, of which 24 were confirmed. The passive sampler near the confirmed case detected virus RNA directly post-diagnosis, followed by a negative signal afterwards, while samplers at the school and the local pumping station detected rising concentrations as more cases were reported. Samplers in neighbouring towns showed further spread, including a town with no reported cases.

Conclusion: This study demonstrates the first successful proof-of-concept for local wastewater monitoring of mumps and indicates a possible correlation between wastewater and clinical monitoring. These results suggest a role for local wastewater monitoring using passive samplers in creating situational awareness during an outbreak, even when cases are not reported.

Objectives: This systematic review and meta-analysis (SRMA) was designed to determine the prevalence, patterns, and determinants of major transfusion-transmitted infections (TTIs), as well as address this gap and propose solutions to the current identified blood transfusion-related challenges in Cameroon.

Methods: Pooled estimates of TTI-related infection rates, i.e., human immunodeficiency virus - HIV, hepatitis B/C viruses - HBV/HCV, and Treponema pallidum, were computed using random models. Subgroup and sensitivity analyses were performed, and methodological bias analysis was assessed using the JBI tools.

Results: A total of 36 studies, spanning 72 datasets for ∼105,000 blood donations, were included. Most of them were conducted in family donors attending health facilities of three towns, viz. Yaoundé (51.4%), Douala (25.7%), and Bamenda (8.6%). The pooled proportion of TTIs was 15.4% (95%CI 12.7 - 18.2%), and was significantly modulated by several variables (e.g., testing strategy, area). These pathogens could occur as co-infections at a pooled proportion of 1.5%, with HBV + HCV being the most prevalent (3.4%). Across studies, the risk for HIV and T. pallidum infection was consistently higher in family donors. Several challenges, including diagnostic inconsistencies (even within the same assay) and a lack of evidence data on determinants, residual risk, and the extent of occult hepatitis B infection, were identified, primarily due to the paucity and underreporting of data in certain regions.

Conclusions: The review outlines a significant burden of HIV, HBV, HCV, and T. pallidum in blood donors. High-quality studies are needed to fill these gaps to inform public health policymakers and assist the development and implementation of better blood safety strategies and services.

Purpose: Mucormycosis is a rapidly progressive and highly lethal fungal infection in liver transplant recipients, with early diagnosis remaining a major challenge. This study aimed to evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for early detection and management of perioperative mucormycosis in adult liver transplant patients.

Patients and methods: A retrospective analysis was conducted on 539 adult patients who underwent liver transplantation between June 2022 and August 2025 at a single tertiary center. Nine patients with clinically confirmed perioperative mucormycosis, in whom mNGS was the first positive diagnostic tool, were included. Clinical characteristics, diagnostic modalities, antifungal strategies, and outcomes were systematically reviewed.

Results: Mucormycosis was identified in 1.67% (9/539) of liver transplant recipients. All patients were male with a median age of 51 years. Pulmonary mucormycosis was the most common presentation (n = 5), followed by disseminated (n = 3) and cutaneous infection (n = 1). In all cases, mNGS provided the earliest microbiological evidence, preceding culture and histopathology. Species detected included Cunninghamella spp., Rhizopus microsporus, and Rhizomucor pusillus. The mortality rate of disseminated disease was 100%, whereas localized pulmonary and cutaneous infections had a combined cure or improvement rate of 66.7%. Early targeted antifungal therapy guided by mNGS (amphotericin B formulations combined with posaconazole or isavuconazole) was associated with improved outcomes in non-disseminated cases.

Conclusion: mNGS enables earlier detection of perioperative mucormycosis compared to conventional diagnostic methods and supports timely initiation of targeted therapy. Rapid mNGS-guided intervention may prevent progression to disseminated disease and improve prognosis in liver transplant recipients. Integration of mNGS into the diagnostic workflow is recommended for high-risk patients with unexplained pulmonary or cutaneous lesions.

Objectives: This study aimed to investigate the prevalence, genomic features, and plasmid characteristics of carbapenem-resistant Escherichia coli (CR-EC) harboring bla_NDM within a "One Health" framework in rural communities of western Shandong Province, China, to assess potential public health risks.

Methods: A cross-sectional sampling of human, animal, and environmental sources was conducted. Recovered CR-EC isolates underwent antimicrobial susceptibility testing, whole-genome sequencing, and phylogenetic analysis. Plasmid genetic structure was characterized, and conjugation assays were performed to evaluate the transferability of bla_NDM-carrying plasmids.

Results: Among 26 CR-EC isolates, bla_NDM-5 was predominant (84.6%). All strains were extensively drug-resistant. Notably, 10 of 11 isolates belonging to the high-risk global clone ST167 originated from asymptomatic human carriers, suggesting community transmission. Genomic analysis identified IncF-type plasmids carrying bla_NDM with >99% identity to plasmids from clinical strains in Australia and Germany. Conjugation confirmed plasmid transferability. Phylogenetic clustering among human isolates indicated clonal spread, with potential zoonotic links. Multiple virulence genes (e.g., astA, iuc, fim) were detected. The presence of bla_NDM in wastewater highlighted environmental dissemination.

Conclusions: The findings reveal the concerning emergence and dissemination of high-risk CR-EC clones in a rural setting, facilitated by mobile genetic elements across human, animal, and environmental reservoirs. This underscores an urgent need for integrated genomic surveillance and targeted interventions to mitigate the spread of CR-EC in community ecosystems.

Objectives: Health care workers (HCWs) are at high risk of hepatitis B virus (HBV) exposure due to contact with blood and bodily fluids. In Kenya, HCWs are rarely fully vaccinated against HBV. During 2024, Kilifi County Referral Hospital (KCRH) in Kenya implemented HCW HBV testing and vaccination. We assess this implementation, including acceptability, feasibility, and costs.

Methods: A technical working group was formed at KCRH, sensitization was undertaken, and vaccines procured in multi-dose vials. Clinics were run for 2 hours twice weekly over 6 months. Hepatitis B surface antigen testing was available, and vaccination was offered at 0, 1, and 6 months.

Results: A total of 366 of 574 (64%) of staff received at least one vaccine. Of those attending, the number of fully vaccinated staff increased from 189 of 366 (5%) to 164 of 366 (45%), with 289 of 366 (79%) receiving at least two vaccines. A total of 125 of 366 (35%) were tested for hepatitis B surface antigen and four of 125 (3%) tested positive. The overall cost of the vaccination program was estimated at $4176, with each fully vaccinated person costing $25.45. A lack of HBV monovalent vaccine in multi-dose vials limited vaccination completion.

Conclusions: HBV vaccination for HCWs was feasible and acceptable at KCRH and could be offered at other similar sized hospitals. Consistent access to HBV monovalent vaccine must be a priority for Kenya.