International Journal of Infectious Diseases最新文献

Objectives: Chronic hepatitis D virus (HDV) infection accelerates liver-related morbidity and mortality in people living with HIV and hepatitis B virus (HBV). In the Netherlands, HDV testing among HIV/HBV-coinfected adults is currently limited. This study evaluates whether a one-time HDV testing strategy for all HIV/HBsAg-positive adults is cost-effective compared with the current limited testing strategy.

Methods: A Markov model was developed and followed HIV/HBV-coinfected adults through mutually exclusive health states. One-time testing scenario comprised of anti-HDV testing with HDV RNA confirmation, and bulevirtide in combination of interferon therapy for 50 % of viremic patients. Clinical and cost inputs were sourced from clinical studies and the Dutch costing manual. Utilities used EQ-5D values for HBV/HDV patients assuming controlled HIV infection. Sensitivity analyses explored parameter uncertainty.

Results: One-time HDV testing could avert 174 HDV-related deaths, 95 cirrhosis cases, and 111 liver cancer cases per 10,000 individuals with HIV/HBV infection. The intervention yields 0.253 additional quality-adjusted life-years (QALYs) at an incremental cost of €5,026, resulting in an ICER of €19,881/QALY, which is below the Dutch willingness-to-pay threshold of €80,000/QALY.

Conclusions: One-time HDV testing among HIV/HBV-coinfected adults in the Netherlands appears cost-effective and clinically impactful, supporting routine HDV testing into national HIV/HBV care protocols.

Objectives: Persistent symptoms after SARS-CoV-2 infection (PASC, long COVID) remain a major public-health concern. We developed a data-driven definition and static and dynamic PASC scoring systems in a multicenter, prospective-retrospective observational cohort across 12 South Korean institutions.

Methods: Adults enrolled December 2022-March 2025 were followed up to 24 months; 8,761 were recruited (7,208 infected; 1,553 controls) and 4,668 met analysis criteria (4,388 infected; 280 controls). Using participant-reported symptoms, surveys, and laboratory data, we identified nine symptoms robustly associated with PASC, with anosmia/ageusia and fatigue most influential.

Results: A static score integrating indicators observed within 24 months yielded an optimal threshold of 13, classifying 19% of infected participants and 4% of controls as PASC positive. A dynamic score tracking six-month intervals showed symptom burdens peaking at 0-5 months post-infection and declining thereafter; at the same threshold, 33% of infected participants were classified as PASC positive, reflecting temporal fluctuation.

Conclusions: These data establish a quantitative definition of PASC and introduce a dynamic scoring framework to identify and monitor PASC, supporting future clinical research and practice.

Background: Poorly-targeted antibiotic use in primary care is a driver of antimicrobial resistance. Electronic clinical decision support algorithms (eCDSAs) integrating point-of-care tests may improve prescribing. We evaluated the impact of an eCDSA on antibiotic prescriptions among febrile patients attending primary health centres in Cambodia.

Methods: In this cluster randomised controlled trial, 30 PHCs in Battambang Province were randomised (1:1) to either adopt the eCDSA or routine care. The eCDSA integrated clinical assessment with pulse oximetry and C-reactive protein tests. Patients aged ≥1 year with acute febrile illness were eligible. The primary outcome was the proportion of patients prescribed antibiotics, using an age- and sex-adjusted generalised linear mixed model, incorporating PHC as a random effect. Secondary outcomes included hospital referral rates and self-reported recovery at 7 and 14 days.

Results: Between May 2024 and January 2025, 4,752 patients were enrolled (2,324 intervention; 2,428 control). Crude proportions of patients prescribed antibiotics were 56.1% and 60.5% in intervention and control arms, respectively. No difference in prescribing rates between the arms was detected (adjusted odds ratio [aOR] 0.64; 95% CI: 0.20-1.99; p=0.44). Among patients for whom the eCDSA did not recommend antibiotics, almost half (45.6%) received a prescription. Hospital referral was rare (2.0%) and most patients reported full recovery within 7 days (94.3%).

Conclusion: This eCDSA did not reduce antibiotic prescription in this setting. Relatively low adherence to the eCDSA's recommendations suggests that, to support a change in prescribing behaviour, future iterations of this intervention should incorporate enhanced training, greater adaptation to local health sector, and deeper engagement with frontline healthcare workers.

We report the case of an immunocompromised patient with - previously unrecognized - Mendelian susceptibility to Mycobacterial disease (MSMD) due to IL12Rβ1 deficit, who developed fatal disseminated Mycobacterium tilburgii infection. Mycobacterial invasion caused severe neurological complications, including refractory status epilepticus, leading to death despite therapies including surgical interventions.

Objective: To evaluate the risk of incident non-tuberculous mycobacterial pulmonary disease (NTM-PD) following pulmonary tuberculosis (TB) in a nationwide longitudinal Korean cohort.

Methods: Using data from the Korean National Health Insurance Service and the Korean Disease Control and Prevention Agency (2013-2017), we identified 13,547 individuals with drug-sensitive pulmonary TB and 40,641 age- and sex-matched controls. Multivariable Cox models were used to evaluate the risk of NTM-PD.

Results: Over a median follow-up of 5.4 years (292,138 person-years), the incidence rate was 1.19 per 1,000 person-years (PY) in the post-TB cohort and 0.10 per 1,000 PY in controls (p<0.01). Prior pulmonary TB was associated with a significantly higher risk of NTM-PD (adjusted hazard ratio [HR] 7.67; 95% CI, 4.60-12.76). Within the post-TB cohort, bronchiectasis increased the risk of NTM-PD (adjusted HR 3.66; 95% CI, 2.09-6.40), whereas female sex (adjusted HR 0.41; 95% CI, 0.18-0.91), overweight status (adjusted HR 0.27; 95% CI, 0.11-0.67), and light smoking (<20 pack-years; adjusted HR 0.11; 95% CI, 0.03-0.49) were negatively associated with NTM-PD risk.

Conclusions: Individuals with prior pulmonary TB have a markedly elevated risk of NTM-PD. Targeted surveillance and early diagnostic strategies for NTM-PD in TB survivors may improve outcomes.

Background: Since the first human case of H10N3 Avian Influenza in Jiangsu, China (April 2021), three cases have been reported globally. However, clinical and treatment data remain limited. Therefore, we describe the fourth patient's epidemiology, clinical manifestations, diagnostics, treatment.

Case presentation: A 23-year-old woman, previously well, presented on 12 Dec 2024 with fever, dry cough and breathlessness after pig and chicken contact. CT showed bilateral pneumonia. Despite high-flow oxygen and broad-spectrum antibiotics she deteriorated, requiring intubation, lung-protective ventilation and VV-ECMO. Bronchoalveolar lavage isolated H10N3 influenza virus. Treatment with oseltamivir and baloxavir plus prone-position ventilation led to clinical improvement.

Conclusion: Due to its nonspecific early symptoms, H10N3 is difficult to diagnose promptly, increasing the risk. Early recognition, antiviral therapy, and aggressive support are essential in managing severe infections.

Background: Rotavirus A (RVA) genotype G1P[8] is epidemiologically significant and a major vaccine target. This study aimed to characterize the genetic features, evolutionary dynamics, and antigenic compatibility with current vaccine strains of G1P[8] RVA circulating in Ningxia, China, in order to assess its local epidemiological shifts and potential implications.

Methods: We conducted continuous surveillance in Ningxia from 2015 to 2023 on diarrheal outpatients from sentinel hospitals for foodborne disease monitoring, and from 2022 to 2024 on hospitalized children under five years of age with diarrhea from sentinel sites for viral diarrhea surveillance. RVA detection and G/P genotyping were performed using RT-PCR. Representative G1P[8] strains were selected for whole-genome sequencing, followed by bioinformatic analyses including antigenic epitope comparison, Bayesian evolutionary analysis, and phylogenetic reconstruction.

Results: The overall RVA positivity rate during the surveillance period was 16.8%. However, G1P[8] was prevalent only in 2015-2016, accounting for 16.83% and 12.50% of cases, respectively. Its circulation declined sharply thereafter, with only one case detected in 2021. Whole-genome analysis revealed that all sequenced strains possessed a typical Wa-like genetic constellation (G1-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1). Antigenic epitope analysis identified multiple amino acid variations in key neutralizing sites of VP7 and VP4 proteins between Ningxia strains and vaccine strains. The VP7 of the 2021 strain showed the highest similarity to the Rotarix vaccine strain, while the VP4 of all Ningxia strains was most similar to that of the Rotavin-M1 vaccine. Evolutionary analysis indicated that the 2015-2016 strains and the 2021 strain belonged to distinct VP7 and VP4 lineages. Although the 2021 strain (20210516) exhibited a G1P[8] genotype, its remaining gene segments (VP1-VP3, VP6, NSP1-NSP5) clustered with G12 strains, suggesting its possible origin from a reassortment event between G12 and G1P[8] viruses. Compared with the contemporaneously reported Palermo 2021 variant from Italy, the Ningxia 20210516 strain showed closer phylogenetic relatedness only in certain gene segments (e.g., NSP5, VP1-VP2, VP4, VP7).

Conclusion: This study confirms that G1P[8] RVA prevalence in Ningxia remains low; however, novel variants arising from reassortment may still emerge locally, accompanied by changes in antigenicity and genetic background. Sustained genotype surveillance and whole-genome analysis of RVA are essential for tracking epidemiological trends, evaluating vaccine effectiveness, and informing prevention and control strategies.

Objectives: Influenza is a seasonal viral respiratory disease causing significant global mortality but preventable through vaccination. Despite WHO recommendations, vaccination rates in Italy remain low due to mistrust, misinformation, and vaccine hesitancy. This study investigates determinants of influenza vaccine uptake in the post-COVID-19 era to identify barriers and guide targeted interventions.

Methods: A cross-sectional survey was conducted on a representative sample of 8,067 Italian adults between December 2024 and January 2025 through an anonymous online questionnaire. The survey explored sociodemographic characteristics, infectious disease behaviors, COVID-19 pandemic experiences, and vaccination attitudes.

Results: Overall, 33·7% of respondents received the influenza vaccine, while 61·8% reported no vaccination intention. Multinomial logistic regression identified three key domains of predictors. Sociodemographic determinants associated with uptake included age 65-75 years (OR=1·89; 95% CI: 1·11-3·19), inactive employment status (OR=1·73; 95% CI: 1·12-2·67), and comorbidities (OR=1·23; 95% CI: 1·00-1·50). Past vaccination history emerged as the strongest driver of uptake (OR=8·19; 95% CI: 3·98-16·84). Finally, behavioral factors, specifically the perception of mask usefulness, were significantly associated with vaccination intention among the unvaccinated (OR=1·39; 95% CI: 1·11-1·75).

Conclusions: Influenza vaccination adherence in Italy is influenced by sociodemographic factors and preventive health practices, but most strongly by past vaccination behavior that should, thus, strength long-term engagement with vaccination programs.

Objective: This study aimed to characterize the clinical profiles of patients hospitalized with chikungunya fever in Shunde, China (2025), and to use time-to-event analysis to identify predictors of prolonged viral clearance.

Methods: A retrospective cohort study included 1,721 confirmed chikungunya patients from July to August 2025. Patients were stratified by age and comorbidities. Disease course was classified as regular (≤7 days) or prolonged (>7 days). Cox proportional hazards regression was used to identify factors independently associated with the time to viral RNA clearance.

Results: The cohort (mean age 43.6±21.8 years) exhibited high frequencies of key symptoms: fever (88.4%), arthralgia (88.3%), and rash (71.4%). Clinical profiles differed significantly by age: pediatric cases (n=276) had more prominent fever, whereas arthralgia duration increased and viral clearance slowed progressively from pediatric to adult to geriatric groups (median clearance: pediatric 5 days vs. geriatric 8 days, all log-rank P<0.001). A prolonged disease course (>7 days) occurred in 13.7% of patients (n=235/1,721) and was independently associated with advanced age (HR=0.994, P<0.001) and ischemic encephalopathy (HR=0.593, P=0.038). Patients with comorbidities, especially diabetes, had more severe laboratory abnormalities and delay viral clearance. Higher baseline viral load was correlated with older age, specific comorbidities, and the presence of arthralgia.

Conclusion: Age and comorbidities significantly influence chikungunya manifestations and outcomes, supporting early stratification and personalized management.

Background: Blastomycosis is a disease caused by the dimorphic fungus Blastomyces species. This infection occurs most frequently among individuals residing in the midwestern, southeastern, and south-central United States, as well as in Canadian provinces bordering the Great Lakes and the St. Lawrence Seaway. Sporadic cases have been reported in China, the diagnosis of imported cases remains a significant challenge.

Case presentation: We report a diagnostically challenging case of primary cutaneous blastomycosis in a Chinese-Canadian girl, presenting as two nodules of different sizes on her left lower leg and left arm. The patient was initially diagnosed with insect bite dermatitis in Canada, which showed poor response to treatment. Direct microscopic examination revealed large spherical yeast cells, some with broad-based budding, initially interpreted as protothecosis or coccidioidomycosis. However, metagenomic next-generation sequencing (mNGS) indicated B. dermatitidis, which was subsequently confirmed by fungal culture and ITS sequencing. The patient was prescribed oral itraconazole at 50 mg/day and has since returned to Canada to continue treatment.

Conclusions: For diagnosing infections caused by highly pathogenic pathogens such as imported blastomycosis, the combination of mNGS and direct microscopic examination represents a valuable diagnostic approach.