Pub Date : 2024-09-04DOI: 10.1016/j.ijid.2024.107230
Lingyun Song , Yilin Zhang , Feng Sun , Yuanbo Lan , Jie Tong , Shijia Ge , Zhen Feng , Rong Li , Hongying Yu , Yang Li , Wenhong Zhang
Objectives
Efforts to shorten rifampicin-resistant tuberculosis (RR-TB) treatment have led to concerns about hepatotoxicity in shorter regimens. We evaluated hepatotoxicity in two novel regimens against the standard shorter regimen recommended by the World Health Organization (WHO).
Methods
Participants from the TB-TRUST and TB-TRUST plus trials were assigned to the WHO shorter regimen, a levofloxacin (Lfx)-based regimen, or a bedaquiline (Bdq)-based regimen. Liver function was tested bi-weekly in the first month, then monthly until treatment ended. Eligibility required receiving at least one drug dose and undergoing at least two liver function tests.
Results
Of 429 patients, hepatotoxicity was most prevalent in the WHO shorter group (26.7% of 169), compared to 4.7% in the Lfx group (172 patients), and 5.7% in the Bdq group (88 patients). The median peak alanine aminotransferase levels were 1.67 × upper limit of normal (ULN) for WHO, 0.82 × ULN for Lfx, and 0.88 × ULN for Bdq groups. The incidence of drug-induced liver injury was significantly higher in the WHO group (18.3%) than in the Lfx (3.5%) and Bdq (4.6%) groups. The time to significant alanine aminotransferase elevation was about 2.8 months, with no differences between groups.
Conclusions
Two novel regimens demonstrated lower hepatotoxicity compared to the WHO's shorter regimen. Entire course management monitoring is recommended in RR-TB treatment.
{"title":"Assessing hepatotoxicity in novel and standard short regimens for rifampicin-resistant tuberculosis: Insights from the TB-TRUST and TB-TRUST-plus trials","authors":"Lingyun Song , Yilin Zhang , Feng Sun , Yuanbo Lan , Jie Tong , Shijia Ge , Zhen Feng , Rong Li , Hongying Yu , Yang Li , Wenhong Zhang","doi":"10.1016/j.ijid.2024.107230","DOIUrl":"10.1016/j.ijid.2024.107230","url":null,"abstract":"<div><h3>Objectives</h3><div>Efforts to shorten rifampicin-resistant tuberculosis (RR-TB) treatment have led to concerns about hepatotoxicity in shorter regimens. We evaluated hepatotoxicity in two novel regimens against the standard shorter regimen recommended by the World Health Organization (WHO).</div></div><div><h3>Methods</h3><div>Participants from the TB-TRUST and TB-TRUST plus trials were assigned to the WHO shorter regimen, a levofloxacin (Lfx)-based regimen, or a bedaquiline (Bdq)-based regimen. Liver function was tested bi-weekly in the first month, then monthly until treatment ended. Eligibility required receiving at least one drug dose and undergoing at least two liver function tests.</div></div><div><h3>Results</h3><div>Of 429 patients, hepatotoxicity was most prevalent in the WHO shorter group (26.7% of 169), compared to 4.7% in the Lfx group (172 patients), and 5.7% in the Bdq group (88 patients). The median peak alanine aminotransferase levels were 1.67 × upper limit of normal (ULN) for WHO, 0.82 × ULN for Lfx, and 0.88 × ULN for Bdq groups. The incidence of drug-induced liver injury was significantly higher in the WHO group (18.3%) than in the Lfx (3.5%) and Bdq (4.6%) groups. The time to significant alanine aminotransferase elevation was about 2.8 months, with no differences between groups.</div></div><div><h3>Conclusions</h3><div>Two novel regimens demonstrated lower hepatotoxicity compared to the WHO's shorter regimen. Entire course management monitoring is recommended in RR-TB treatment.</div></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1016/j.ijid.2024.107234
Yazed Saleh Alsowaida , Khalid Al Sulaiman , Ahmad J. Mahrous , Aisha Alharbi , Nisrin Bifari , Walaa A. Alshahrani , Thamer A. Almangour , Nader Damfu , Aseel A. Banamah , Raghad R. Abu Raya , Raghad A. Sadawi , Arwa Alharbi , Ahmed Alsolami , Yahya Essa , Alaa Ghaze Almagthali , Shahad F. Alhejaili , Wed A. Qawwas , Ghaida Salamah Alharbi , Atheer Suleiman Alkeraidees , Afnan Alshomrani , Ohoud Aljuhani
Objectives
To evaluate the clinical outcomes of anidulafungin for candidemia treatment in critically ill patients with obesity.
Methods
A multicenter, retrospective cohort study was conducted in Saudi Arabia for critically ill adults with candidemia who received anidulafungin. Patients with obesity have a body mass index ≥30 kg/m2. The primary outcome was the clinical cure rate.
Results
A total of 146 patients were included, 64 of whom were obese. There were no statistically significant differences in the clinical cure rate (P = 0.63), microbiological cure rate (P = 0.27), or the median time for a clinical cure (P = 0.13) for patients with obesity compared to non-obese patients. The median time for a microbiological cure was longer in non-obese patients than in patients with obesity (P = 0.04). The median hospital length of stay and the median mechanical ventilation durations were numerically longer in patients with obesity.
Conclusions
Clinical and microbiological cure rates and time for clinical cure were statistically similar for both groups. Considering the study's limitations (especially with a small sample size), it is uncertain if patients with obesity have similar effectiveness to non-obese patients. Future studies with larger sample sizes are warranted to evaluate if obesity negatively impacts anidulafungin's clinical outcomes for candidemia.
{"title":"Evaluation of clinical outcomes of anidulafungin for the treatment of candidemia in hospitalized critically ill patients with obesity: A multicenter, retrospective cohort study","authors":"Yazed Saleh Alsowaida , Khalid Al Sulaiman , Ahmad J. Mahrous , Aisha Alharbi , Nisrin Bifari , Walaa A. Alshahrani , Thamer A. Almangour , Nader Damfu , Aseel A. Banamah , Raghad R. Abu Raya , Raghad A. Sadawi , Arwa Alharbi , Ahmed Alsolami , Yahya Essa , Alaa Ghaze Almagthali , Shahad F. Alhejaili , Wed A. Qawwas , Ghaida Salamah Alharbi , Atheer Suleiman Alkeraidees , Afnan Alshomrani , Ohoud Aljuhani","doi":"10.1016/j.ijid.2024.107234","DOIUrl":"10.1016/j.ijid.2024.107234","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the clinical outcomes of anidulafungin for candidemia treatment in critically ill patients with obesity.</div></div><div><h3>Methods</h3><div>A multicenter, retrospective cohort study was conducted in Saudi Arabia for critically ill adults with candidemia who received anidulafungin. Patients with obesity have a body mass index ≥30 kg/m<sup>2</sup>. The primary outcome was the clinical cure rate.</div></div><div><h3>Results</h3><div>A total of 146 patients were included, 64 of whom were obese. There were no statistically significant differences in the clinical cure rate (<em>P</em> = 0.63), microbiological cure rate (<em>P</em> = 0.27), or the median time for a clinical cure (<em>P</em> = 0.13) for patients with obesity compared to non-obese patients. The median time for a microbiological cure was longer in non-obese patients than in patients with obesity (<em>P</em> = 0.04). The median hospital length of stay and the median mechanical ventilation durations were numerically longer in patients with obesity.</div></div><div><h3>Conclusions</h3><div>Clinical and microbiological cure rates and time for clinical cure were statistically similar for both groups. Considering the study's limitations (especially with a small sample size), it is uncertain if patients with obesity have similar effectiveness to non-obese patients. Future studies with larger sample sizes are warranted to evaluate if obesity negatively impacts anidulafungin's clinical outcomes for candidemia.</div></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the characteristics and prognosis of patients with nontuberculous mycobacterial (NTM) pulmonary disease (PD) with pleuroparenchymal fibroelastosis (PPFE) with those of patients with nodular/bronchiectatic (NB) and fibrocavitary (FC) NTM-PD.
Methods
This multicenter, retrospective, observational study enrolled 32 patients with NTM-PPFE (median age: 70.5 years, 15 females) from six institutions in Japan from January 2003 to December 2018. Their clinical characteristics and response to therapy were compared with age- and sex-matched cohorts of patients with noncavitary NB and cavitary NB/FC NTM-PD.
Results
Patients with NTM-PPFE had a lower body mass index and a higher standard NTM-PD therapy initiation rate than patients with other NTM-PD types. Sputum culture conversion rates were comparable between groups; however, patients with NTM-PPFE had a higher incidence of treatment-related adverse events, including optic neuropathy associated with high-dose ethambutol therapy, lower percent predicted forced vital capacity values, higher serum Krebs von den Lungen-6 (KL-6) levels, and poorer treatment outcomes than the other groups. Cox regression revealed that NTM-PPFE was an independent risk factor for death/pneumothorax (adjusted hazard ratio: 35.3, 95% confidence interval: 3.90-4692).
Conclusion
NTM-PPFE is a unique NTM-PD phenotype with a poorer prognosis than the NB and FC phenotypes.
{"title":"Distinctive clinical features of radiological pleuroparenchymal fibroelastosis with nontuberculous mycobacterial pulmonary disease: A multicenter retrospective cohort study","authors":"Hiromu Tanaka , Takanori Asakura , Satoshi Okamori , Koji Furuuchi , Mitsuaki Yagi , Yuji Nakayama , Junko Kuramoto , Kazuma Yagi , Isano Hase , Hirofumi Kamata , Keiji Fujiwara , Akira Nakao , Yohei Masugi , Yasunori Sato , Yae Kanai , Ho Namkoong , Koichi Fukunaga , Taku Nakagawa , Kozo Morimoto , Masaki Fujita , Naoki Hasegawa","doi":"10.1016/j.ijid.2024.107233","DOIUrl":"10.1016/j.ijid.2024.107233","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the characteristics and prognosis of patients with nontuberculous mycobacterial (NTM) pulmonary disease (PD) with pleuroparenchymal fibroelastosis (PPFE) with those of patients with nodular/bronchiectatic (NB) and fibrocavitary (FC) NTM-PD.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective, observational study enrolled 32 patients with NTM-PPFE (median age: 70.5 years, 15 females) from six institutions in Japan from January 2003 to December 2018. Their clinical characteristics and response to therapy were compared with age- and sex-matched cohorts of patients with noncavitary NB and cavitary NB/FC NTM-PD.</div></div><div><h3>Results</h3><div>Patients with NTM-PPFE had a lower body mass index and a higher standard NTM-PD therapy initiation rate than patients with other NTM-PD types. Sputum culture conversion rates were comparable between groups; however, patients with NTM-PPFE had a higher incidence of treatment-related adverse events, including optic neuropathy associated with high-dose ethambutol therapy, lower percent predicted forced vital capacity values, higher serum Krebs von den Lungen-6 (KL-6) levels, and poorer treatment outcomes than the other groups. Cox regression revealed that NTM-PPFE was an independent risk factor for death/pneumothorax (adjusted hazard ratio: 35.3, 95% confidence interval: 3.90-4692).</div></div><div><h3>Conclusion</h3><div>NTM-PPFE is a unique NTM-PD phenotype with a poorer prognosis than the NB and FC phenotypes.</div></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.ijid.2024.107167
Kathleen Beegle , Gabriel Demombynes , Damien de Walque , Paul Gubbins , Jeremy Veillard
Objective
To analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level.
Methods
We used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age.
Findings
Men die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021.
Conclusion
The COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.
{"title":"COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries","authors":"Kathleen Beegle , Gabriel Demombynes , Damien de Walque , Paul Gubbins , Jeremy Veillard","doi":"10.1016/j.ijid.2024.107167","DOIUrl":"10.1016/j.ijid.2024.107167","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level.</div></div><div><h3>Methods</h3><div>We used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age.</div></div><div><h3>Findings</h3><div>Men die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.</div></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.ijid.2024.107221
Coralie Geric , Gamuchirai Tavaziva , Marianne Breuninger , Keertan Dheda , Ali Esmail , Alex Scott , Mary Kagujje , Monde Muyoyeta , Klaus Reither , Aamir J. Khan , Andrea Benedetti , Faiz Ahmad Khan
Objectives
Computer-aided detection (CAD) software packages quantify tuberculosis (TB)-compatible chest X-ray (CXR) abnormality as continuous scores. In practice, a threshold value is selected for binary CXR classification. We assessed the diagnostic accuracy of an alternative approach to applying CAD for TB triage: incorporating CAD scores in multivariable modeling.
Methods
We pooled individual patient data from four studies. Separately, for two commercial CAD, we used logistic regression to model microbiologically confirmed TB. Models included CAD score, study site, age, sex, human immunodeficiency virus status, and prior TB. We compared specificity at target sensitivities ≥90% between the multivariable model and the current threshold-based approach for CAD use.
Results
We included 4,733/5,640 (84%) participants with complete covariate data (median age 36 years; 45% female; 22% with prior TB; 22% people living with human immunodeficiency virus). A total of 805 (17%) had TB. Multivariable models demonstrated excellent performance (areas under the receiver operating characteristic curve [95% confidence interval]: software A, 0.91 [0.90-0.93]; software B, 0.92 [0.91-0.93]). Compared with threshold scores, multivariable models increased specificity (e.g., at 90% sensitivity, threshold vs model specificity [95% confidence interval]: software A, 71% [68-74%] vs 75% [74-77%]; software B, 69% [63-75%] vs 75% [74-77%]).
Conclusion
Using CAD scores in multivariable models outperformed the current practice of CAD-threshold-based CXR classification for TB diagnosis.
{"title":"Breaking the threshold: Developing multivariable models using computer-aided chest X-ray analysis for tuberculosis triage","authors":"Coralie Geric , Gamuchirai Tavaziva , Marianne Breuninger , Keertan Dheda , Ali Esmail , Alex Scott , Mary Kagujje , Monde Muyoyeta , Klaus Reither , Aamir J. Khan , Andrea Benedetti , Faiz Ahmad Khan","doi":"10.1016/j.ijid.2024.107221","DOIUrl":"10.1016/j.ijid.2024.107221","url":null,"abstract":"<div><h3>Objectives</h3><p>Computer-aided detection (CAD) software packages quantify tuberculosis (TB)-compatible chest X-ray (CXR) abnormality as continuous scores. In practice, a threshold value is selected for binary CXR classification. We assessed the diagnostic accuracy of an alternative approach to applying CAD for TB triage: incorporating CAD scores in multivariable modeling.</p></div><div><h3>Methods</h3><p>We pooled individual patient data from four studies. Separately, for two commercial CAD, we used logistic regression to model microbiologically confirmed TB. Models included CAD score, study site, age, sex, human immunodeficiency virus status, and prior TB. We compared specificity at target sensitivities ≥90% between the multivariable model and the current threshold-based approach for CAD use.</p></div><div><h3>Results</h3><p>We included 4,733/5,640 (84%) participants with complete covariate data (median age 36 years; 45% female; 22% with prior TB; 22% people living with human immunodeficiency virus). A total of 805 (17%) had TB. Multivariable models demonstrated excellent performance (areas under the receiver operating characteristic curve [95% confidence interval]: software A, 0.91 [0.90-0.93]; software B, 0.92 [0.91-0.93]). Compared with threshold scores, multivariable models increased specificity (e.g., at 90% sensitivity, threshold vs model specificity [95% confidence interval]: software A, 71% [68-74%] vs 75% [74-77%]; software B, 69% [63-75%] vs 75% [74-77%]).</p></div><div><h3>Conclusion</h3><p>Using CAD scores in multivariable models outperformed the current practice of CAD-threshold-based CXR classification for TB diagnosis.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1201971224002923/pdfft?md5=9c233dbc9cf6988a43b0f35dee5ce2ec&pid=1-s2.0-S1201971224002923-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ijid.2024.107231
Vieri Lastrucci , Martina Pacifici , Monia Puglia , Giorgia Alderotti , Elettra Berti , Marco Del Riccio , Guglielmo Bonaccorsi , Maria Moriondo , Massimo Resti , Diego Peroni , Marco Martini , Chiara Azzari , Rosa Gini , Fabio Voller
Objectives
To investigate seasonality, epidemiologic characteristics, and clinical severity variations of respiratory syncytial virus (RSV)-associated hospitalizations following the easing of COVID-19 restrictions in Tuscany, Italy, up to the 2022-2023 season.
Methods
From 2017 to 2023, a dynamic cohort consisting of all resident children aged ≤2 years was followed up in regional registries. The person-time incidence rate of RSV-associated hospitalizations per 1,000 person-years and risk of severe hospitalization (intensive care unit, continuous positive airway pressure, or mechanical ventilation) per 100 RSV hospitalizations were calculated. RSV seasonality was investigated with retrospective methods.
Results
A total of 193,244 children were followed up. After the easing of restrictions, RSV epidemics showed earlier seasonality and shorter duration compared with pre-pandemic (2017 to 2019), with this deviation decreased in 2022-2023. In 2021-2022 and 2022-2023, the incidence rate of RSV-associated hospitalizations significantly increased compared with pre-pandemic (2022-2023 risk ratio 3.6, 95% confidence interval 3.3-4.0), with larger increases among older age groups. Among hospitalized children, only those aged ≥12 months showed an increased risk of severe hospitalization, particularly during 2021-2022 (risk ratio 4.7, 95% confidence interval 1.5-24.3).
Conclusions
Our findings suggest a gradual return of RSV epidemics to the pre-pandemic pattern, although relevant increases in disease incidence persist. Reduced regular RSV exposure among older children may lead to declining immunity and increased severe outcome risks.
{"title":"Seasonality and severity of respiratory syncytial virus during the COVID-19 pandemic: a dynamic cohort study","authors":"Vieri Lastrucci , Martina Pacifici , Monia Puglia , Giorgia Alderotti , Elettra Berti , Marco Del Riccio , Guglielmo Bonaccorsi , Maria Moriondo , Massimo Resti , Diego Peroni , Marco Martini , Chiara Azzari , Rosa Gini , Fabio Voller","doi":"10.1016/j.ijid.2024.107231","DOIUrl":"10.1016/j.ijid.2024.107231","url":null,"abstract":"<div><h3>Objectives</h3><p>To investigate seasonality, epidemiologic characteristics, and clinical severity variations of respiratory syncytial virus (RSV)-associated hospitalizations following the easing of COVID-19 restrictions in Tuscany, Italy, up to the 2022-2023 season.</p></div><div><h3>Methods</h3><p>From 2017 to 2023, a dynamic cohort consisting of all resident children aged ≤2 years was followed up in regional registries. The person-time incidence rate of RSV-associated hospitalizations per 1,000 person-years and risk of severe hospitalization (intensive care unit, continuous positive airway pressure, or mechanical ventilation) per 100 RSV hospitalizations were calculated. RSV seasonality was investigated with retrospective methods.</p></div><div><h3>Results</h3><p>A total of 193,244 children were followed up. After the easing of restrictions, RSV epidemics showed earlier seasonality and shorter duration compared with pre-pandemic (2017 to 2019), with this deviation decreased in 2022-2023. In 2021-2022 and 2022-2023, the incidence rate of RSV-associated hospitalizations significantly increased compared with pre-pandemic (2022-2023 risk ratio 3.6, 95% confidence interval 3.3-4.0), with larger increases among older age groups. Among hospitalized children, only those aged ≥12 months showed an increased risk of severe hospitalization, particularly during 2021-2022 (risk ratio 4.7, 95% confidence interval 1.5-24.3).</p></div><div><h3>Conclusions</h3><p>Our findings suggest a gradual return of RSV epidemics to the pre-pandemic pattern, although relevant increases in disease incidence persist. Reduced regular RSV exposure among older children may lead to declining immunity and increased severe outcome risks.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1201971224003023/pdfft?md5=aec8f100ab51351026032e3ac22fac95&pid=1-s2.0-S1201971224003023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ijid.2024.107229
Alexandra Serris , Mayda Rahi , Christophe Rioux , Nadhira Fidouh , Veronique Joly , David Boutolleau
Cytomegalovirus (CMV) retinitis caused by drug-resistant viruses poses a major challenge in immunocompromised patients. We present the case of a patient living with HIV with persistently low CD4+ T cells count despite effective antiretroviral therapy, who experienced multiple episodes of CMV retinitis associated with iterative acquisition of resistance. The failure of ganciclovir and foscarnet treatments led us to implement a combined therapy of intravenous cidofovir, high-dose ganciclovir, and anti-CMV immunoglobulin as well as intravitreal injections of ganciclovir. This triple therapy was successful but resulted in significant myelotoxicity. Furthermore, the relapse of CMV retinitis and/or CMV viremia with each therapeutic de-escalation reflects the high level of immunodeficiency in our patient, despite sustained control of HIV viremia for several months. This case report highlights the need for a particular management of CMV infection in patients living with HIV who are immunological nonresponders.
耐药病毒引起的巨细胞病毒（CMV）视网膜炎是免疫功能低下患者面临的一大挑战。我们介绍了一例尽管接受了有效的抗逆转录病毒治疗，但 CD4+ T 细胞计数持续偏低的艾滋病病毒感染者的病例，该患者经历了多次与耐药性反复获得相关的 CMV 视网膜炎。更昔洛韦和氟卡尼治疗失败后，我们采用了静脉注射西多福韦、大剂量更昔洛韦和抗 CMV 免疫球蛋白以及静脉注射更昔洛韦的联合疗法。这种三联疗法取得了成功，但却导致了严重的骨髓毒性。此外，每次治疗降级后，CMV 视网膜炎和/或 CMV 病毒血症都会复发，这反映出患者的免疫缺陷程度很高，尽管 HIV 病毒血症已持续控制了几个月。本病例报告强调，对于免疫无反应的艾滋病病毒感染者，需要对 CMV 感染进行特殊处理。
{"title":"Refractory anti-viral resistant CMV retinitis in an immunological nonresponder person living with HIV","authors":"Alexandra Serris , Mayda Rahi , Christophe Rioux , Nadhira Fidouh , Veronique Joly , David Boutolleau","doi":"10.1016/j.ijid.2024.107229","DOIUrl":"10.1016/j.ijid.2024.107229","url":null,"abstract":"<div><p>Cytomegalovirus (CMV) retinitis caused by drug-resistant viruses poses a major challenge in immunocompromised patients. We present the case of a patient living with HIV with persistently low CD4+ T cells count despite effective antiretroviral therapy, who experienced multiple episodes of CMV retinitis associated with iterative acquisition of resistance. The failure of ganciclovir and foscarnet treatments led us to implement a combined therapy of intravenous cidofovir, high-dose ganciclovir, and anti-CMV immunoglobulin as well as intravitreal injections of ganciclovir. This triple therapy was successful but resulted in significant myelotoxicity. Furthermore, the relapse of CMV retinitis and/or CMV viremia with each therapeutic de-escalation reflects the high level of immunodeficiency in our patient, despite sustained control of HIV viremia for several months. This case report highlights the need for a particular management of CMV infection in patients living with HIV who are immunological nonresponders.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S120197122400300X/pdfft?md5=56187641a390239490dbaa7c6372dac0&pid=1-s2.0-S120197122400300X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.ijid.2024.107228
Meyha Sahin , Ali Mert , Ahmet Naci Emecen , Natalija Planinc Strunjas , Lenka Fasanekova , Ayse Batirel , Ilad Alavi Darazam , Shabboo Ansari , Ghazaleh Golchoub Firouzjaei , Roman Stebel , Elif Tukenmez Tigen , Buket Erturk Sengel , Olga Dzupova , Maya Belitova , Maha Abid , Nazife Duygu Demirbaş , Serpil Erol , Halil Kul , Abdullah Umut Pekok , Tülay Ünver Ulusoy , Hakan Erdem
Objectives
This study of 331 primary brain abscess (PBA) patients aimed to understand infecting agents, predisposing factors, and outcomes, with a focus on factors affecting mortality.
Methods
Data were collected from 39 centers across 16 countries between January 2010 and December 2022, and clinical, radiological, and microbiological findings, along with their impact on mortality, were analyzed.
Results
The patients had a mean ± SD age of 46.8 ± 16.3 years, with a male predominance of 71.6%. Common symptoms included headache (77.9%), fever (54.4%), and focal neurological deficits (53.5%). Gram-positive cocci were the predominant pathogens, with Viridans group streptococci identified as the most frequently isolated organisms. All patients received antimicrobial therapy and 71.6% underwent interventional therapies. The 42-day and 180-day survival rates were 91.9% and 86.1%, respectively. Significant predictors of 42-day mortality included intravenous drug addiction (HR: 6.02, 95% CI: 1.38-26.26), malignancy (HR: 3.61, 95% CI: 1.23-10.58), confusion (HR: 2.65, 95% CI: 1.19-5.88), and unidentified bacteria (HR: 4.68, 95% CI: 1.76-12.43). Significant predictors of 180-day mortality included malignancy (HR: 2.70, 95% CI: 1.07-6.81), confusion (HR: 2.14, 95% CI: 1.11-4.15), temporal lobe involvement (HR: 2.10, 95% CI: 1.08-4.08), and unidentified bacteria (HR: 3.02, 95% CI: 1.49-6.15).
Conclusion
The risk of death in PBA extends beyond the infection phase, with different factors influencing the 42-day and 180-day mortality rates. Intravenous drug addiction was associated with early mortality, while temporal lobe involvement was associated with late mortality.
{"title":"Profiles of primary brain abscesses and their impact on survival: An international ID-IRI study","authors":"Meyha Sahin , Ali Mert , Ahmet Naci Emecen , Natalija Planinc Strunjas , Lenka Fasanekova , Ayse Batirel , Ilad Alavi Darazam , Shabboo Ansari , Ghazaleh Golchoub Firouzjaei , Roman Stebel , Elif Tukenmez Tigen , Buket Erturk Sengel , Olga Dzupova , Maya Belitova , Maha Abid , Nazife Duygu Demirbaş , Serpil Erol , Halil Kul , Abdullah Umut Pekok , Tülay Ünver Ulusoy , Hakan Erdem","doi":"10.1016/j.ijid.2024.107228","DOIUrl":"10.1016/j.ijid.2024.107228","url":null,"abstract":"<div><h3>Objectives</h3><p>This study of 331 primary brain abscess (PBA) patients aimed to understand infecting agents, predisposing factors, and outcomes, with a focus on factors affecting mortality.</p></div><div><h3>Methods</h3><p>Data were collected from 39 centers across 16 countries between January 2010 and December 2022, and clinical, radiological, and microbiological findings, along with their impact on mortality, were analyzed.</p></div><div><h3>Results</h3><p>The patients had a mean ± SD age of 46.8 ± 16.3 years, with a male predominance of 71.6%. Common symptoms included headache (77.9%), fever (54.4%), and focal neurological deficits (53.5%). Gram-positive cocci were the predominant pathogens, with Viridans group streptococci identified as the most frequently isolated organisms. All patients received antimicrobial therapy and 71.6% underwent interventional therapies. The 42-day and 180-day survival rates were 91.9% and 86.1%, respectively. Significant predictors of 42-day mortality included intravenous drug addiction (HR: 6.02, 95% CI: 1.38-26.26), malignancy (HR: 3.61, 95% CI: 1.23-10.58), confusion (HR: 2.65, 95% CI: 1.19-5.88), and unidentified bacteria (HR: 4.68, 95% CI: 1.76-12.43). Significant predictors of 180-day mortality included malignancy (HR: 2.70, 95% CI: 1.07-6.81), confusion (HR: 2.14, 95% CI: 1.11-4.15), temporal lobe involvement (HR: 2.10, 95% CI: 1.08-4.08), and unidentified bacteria (HR: 3.02, 95% CI: 1.49-6.15).</p></div><div><h3>Conclusion</h3><p>The risk of death in PBA extends beyond the infection phase, with different factors influencing the 42-day and 180-day mortality rates. Intravenous drug addiction was associated with early mortality, while temporal lobe involvement was associated with late mortality.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1201971224002996/pdfft?md5=31b90c4c7f74ffdd095ca04cd89c9687&pid=1-s2.0-S1201971224002996-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.ijid.2024.107224
Sebastian Nielsen , Ane B. Fisker , Ali Sie , Olaf Müller , Eric Nebie , Heiko Becher , Fiona van der Klis , Sofie Biering-Sørensen , Stine Byberg , Sanne M. Thysen , Isaquel da Silva , Amabelia Rodrigues , Cesario Martins , Hilton C. Whittle , Peter Aaby , Christine S. Benn
Objectives
Between 2003 and 2019, three trials (randomised controlled trials [RCTs]) in Guinea-Bissau randomised infants to an early 2-dose measles vaccine (MV) schedule at 4 and 9 months vs standard MV at 9 months. The RCTs produced contradictory mortality results; the effect being beneficial in the 2-dose group in the first but tending to have higher mortality in the last two RCTs. We hypothesised that increased frequency of campaigns with oral polio vaccine (C-OPV) explained the pattern.
Methods
We performed per-protocol analysis of individual-level survival data from the three RCTs in Cox proportional hazards models yielding hazard ratios (HR) for the 2-dose vs the 1-dose MV group. We examined whether timing of C-OPVs and early administration of OPV0 (birth to day 14) affected the HRs for 2-dose/1-dose MV.
Results
The combined HR(2-dose/1-dose) was 0.79 (95% confidence interval: 0.62-1.00) for children receiving no C-OPV-before-enrolment, but 1.39 (0.97-1.99) for those receiving C-OPV-before-enrolment (homogeneity, P = 0.01). C-OPV-before-enrolment had a beneficial effect in the 1-dose group but tended to have a negative effect in the 2-dose group, especially in females. These effects were amplified further by early administration of OPV0.
Conclusion
In the absence of C-OPVs, an early 2-dose MV strategy had beneficial effects on mortality, but frequent C-OPVs may have benefitted the 1-dose group more than the 2-dose MV group, leading to varying results depending on the intensity of C-OPVs.
{"title":"Contradictory mortality results in early 2-dose measles vaccine trials: interactions with oral polio vaccine may explain differences","authors":"Sebastian Nielsen , Ane B. Fisker , Ali Sie , Olaf Müller , Eric Nebie , Heiko Becher , Fiona van der Klis , Sofie Biering-Sørensen , Stine Byberg , Sanne M. Thysen , Isaquel da Silva , Amabelia Rodrigues , Cesario Martins , Hilton C. Whittle , Peter Aaby , Christine S. Benn","doi":"10.1016/j.ijid.2024.107224","DOIUrl":"10.1016/j.ijid.2024.107224","url":null,"abstract":"<div><h3>Objectives</h3><p>Between 2003 and 2019, three trials (randomised controlled trials [RCTs]) in Guinea-Bissau randomised infants to an early 2-dose measles vaccine (MV) schedule at 4 and 9 months vs standard MV at 9 months. The RCTs produced contradictory mortality results; the effect being beneficial in the 2-dose group in the first but tending to have higher mortality in the last two RCTs. We hypothesised that increased frequency of campaigns with oral polio vaccine (C-OPV) explained the pattern.</p></div><div><h3>Methods</h3><p>We performed per-protocol analysis of individual-level survival data from the three RCTs in Cox proportional hazards models yielding hazard ratios (HR) for the 2-dose vs the 1-dose MV group. We examined whether timing of C-OPVs and early administration of OPV0 (birth to day 14) affected the HRs for 2-dose/1-dose MV.</p></div><div><h3>Results</h3><p>The combined HR(2-dose/1-dose) was 0.79 (95% confidence interval: 0.62-1.00) for children receiving no C-OPV-before-enrolment, but 1.39 (0.97-1.99) for those receiving C-OPV-before-enrolment (homogeneity, <em>P</em> = 0.01). C-OPV-before-enrolment had a beneficial effect in the 1-dose group but tended to have a negative effect in the 2-dose group, especially in females. These effects were amplified further by early administration of OPV0.</p></div><div><h3>Conclusion</h3><p>In the absence of C-OPVs, an early 2-dose MV strategy had beneficial effects on mortality, but frequent C-OPVs may have benefitted the 1-dose group more than the 2-dose MV group, leading to varying results depending on the intensity of C-OPVs.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1201971224002959/pdfft?md5=62cdae432bd3405c2b92f3b7d3054af5&pid=1-s2.0-S1201971224002959-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/j.ijid.2024.107223
Yuta Okada, Minami Ueda, Hiroshi Nishiura
Objectives
To reconstruct age-structured case counts of COVID-19 using sentinel reporting, which replaced universal reporting of COVID-19 from May 2023 in Japan.
Methods
Using COVID-19 sentinel data stratified by discrete age groups in selected prefectures and referring to universal case count data up to May 8, 2023, we fitted a statistical model to handle weekly growth rates as a function of age and time so as to convert sentinel data to case counts after cessation of universal reporting.
Results
The age distribution of cases in sentinel reporting was significantly biased toward younger age groups compared to universal reporting. When comparing the epidemic size of the 9th wave (May 8 to September 18, 2023) to the 8th wave (October 3, 2022 to April 10, 2023), using the wave-on-wave ratio of total cumulative sentinel cases led to a significant underestimation of the wave-on-wave in Tokyo (0.975, vs 1.461 by universal reporting) and Okinawa (1.299, vs 1.472). The estimates of growth rates, scaling factors between universal and sentinel cases, and expected universal case count showed robustness to changes in the ending week of the data period.
Conclusion
Our model quantified COVID-19 dynamics, comparably to universal reporting that ended in May 2023, enabling detailed and up-to-date health burden analysis using sentinel reports. The cumulative incidence was greater than that suggested from sentinel data in Tokyo, Nara, and Okinawa. Per-population burdens among children were particularly high in Osaka and Nara, indicating a strong bias in sentinel reporting toward pediatric cases.
{"title":"Reconstructing the age-structured case count of COVID-19 from sentinel surveillance data in Japan: A modeling study","authors":"Yuta Okada, Minami Ueda, Hiroshi Nishiura","doi":"10.1016/j.ijid.2024.107223","DOIUrl":"10.1016/j.ijid.2024.107223","url":null,"abstract":"<div><h3>Objectives</h3><p>To reconstruct age-structured case counts of COVID-19 using sentinel reporting, which replaced universal reporting of COVID-19 from May 2023 in Japan.</p></div><div><h3>Methods</h3><p>Using COVID-19 sentinel data stratified by discrete age groups in selected prefectures and referring to universal case count data up to May 8, 2023, we fitted a statistical model to handle weekly growth rates as a function of age and time so as to convert sentinel data to case counts after cessation of universal reporting.</p></div><div><h3>Results</h3><p>The age distribution of cases in sentinel reporting was significantly biased toward younger age groups compared to universal reporting. When comparing the epidemic size of the 9th wave (May 8 to September 18, 2023) to the 8th wave (October 3, 2022 to April 10, 2023), using the wave-on-wave ratio of total cumulative sentinel cases led to a significant underestimation of the wave-on-wave in Tokyo (0.975, vs 1.461 by universal reporting) and Okinawa (1.299, vs 1.472). The estimates of growth rates, scaling factors between universal and sentinel cases, and expected universal case count showed robustness to changes in the ending week of the data period.</p></div><div><h3>Conclusion</h3><p>Our model quantified COVID-19 dynamics, comparably to universal reporting that ended in May 2023, enabling detailed and up-to-date health burden analysis using sentinel reports. The cumulative incidence was greater than that suggested from sentinel data in Tokyo, Nara, and Okinawa. Per-population burdens among children were particularly high in Osaka and Nara, indicating a strong bias in sentinel reporting toward pediatric cases.</p></div>","PeriodicalId":14006,"journal":{"name":"International Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1201971224002947/pdfft?md5=b02a1d37b9f6ecc0058509b8e648ad25&pid=1-s2.0-S1201971224002947-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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