International Journal of Infectious Diseases最新文献

Objectives: We report a case of bloodstream infection caused by Chromobacterium haemolyticum in an 80-year-old man following traumatic exposure to contaminated rice field water. The patient presented with rapidly progressive lower extremity soft tissue infection and septic shock.

Design or methods: Initial identification was performed using MALDI-TOF MS. Due to atypical phenotypic characteristics, including absence of violacein pigmentation and presence of β-hemolysis, whole-genome sequencing (WGS) was conducted for definitive species confirmation.

Result: Preliminary MALDI-TOF MS identification indicates that it is Chromobacterium violaceum; Definitive identification by whole-genome sequencing (WGS) confirmed C. haemolyticum. Antimicrobial susceptibility testing (AST) revealed high-level resistance to β-lactam antibiotics, including carbapenems, while the isolate remained susceptible to fluoroquinolones and tetracyclines. WGS identified the bla_CRH-1 gene, likely contributing to the resistance phenotype.

Conclusion: This case emphasizes the importance of accurate species-level identification and AST in managing Chromobacterium infections, especially in immunocompromised or severely ill patients. Increased awareness of C. haemolyticum as a distinct clinical pathogen is essential, given its potential for misidentification and multidrug resistance.

The synergistic interaction between Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible Staphylococcus aureus (MSSA) and influenza virus can cause fulminant necrotizing pneumonia. We report a cluster of two cases involving epidemiologically linked construction workers illustrating this life-threatening synergy. After shared occupational exposure, one patient died of rapidly progressive pneumonia, while the other survived after prolonged intensive care. As conventional diagnostics failed, metagenomic next-generation sequencing (mNGS) of sputum and bronchoalveolar lavage fluid (BALF) identified co-infection with PVL-positive sequence type 22 (ST22) MSSA and influenza B virus (IBV) in case 2, guiding a successful shift to targeted therapy. This report demonstrates the extreme virulence of PVL-positive MSSA-influenza co-infection, highlights the diagnostic value of mNGS in severe treatment-refractory pneumonia, and emphasizes the need for effective respiratory protection in high-risk occupational environments.

Background: Enterococcus faecium bloodstream infections (EF BSIs) cause significant morbidity and mortality in healthcare settings. We herein report a cohort of EF BSIs aiming at identifying predictors of 30-day in-hospital mortality.

Methods: Retrospective cohort including hospitalized patients with EF BSIs from 2019-2023. We collected data about demographics, clinical and microbiological information, laboratory findings, treatments and deaths. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI) for 30-day in-hospital mortality, to quantify the prognostic significance of risk factors after multivariable adjustment. A backward variable selection process in the Cox regression model was implemented to identify risk factors with statistically significant association with mortality.

Results: 604 patients were included. The overall 30-day in-hospital mortality rate was 25.8%. Significant predictors of mortality included presence of septic shock, Pitt score values at least of 2, liver cirrhosis, while early source control and infectious diseases consultation were associated with a reduction in mortality rates. No statistically significant differences were observed in terms of mortality between vancomycin susceptible and vancomycin resistant BSIs.

Conclusions: EF BSIs mortality was influenced by host- and disease-specific factors, including its severity. Vancomycin resistance seemed to have not an impact on mortality. Early source control and ID consultation played a critical role in improving survival, Future research should focus on prospective validation of these predictors and the development of tools and scores to early identify high-risk populations, optimizing clinical management and patient's outcomes.

Introduction: Community-acquired respiratory viruses (CARV) can cause severe infections in patients with cancer. To characterize epidemiology and outcome, the multicenter registry OncoReVir was established in November 2018.

Patients and methods: From November 2018 to October 2024, 2,080 patients with cancer and CARV infection were enrolled. Only patients with a single CARV infection were analyzed (n=1,975). Data included demographics, cancer characteristics, and clinical course. A subgroup (n=381) compared epidemiology and outcome across pre-, peri, and post-pandemic periods. Predefined endpoints were pneumonia, ICU admission, and infection-related mortality.

Results: Median age was 61 years (IQR 52-69), 42.5% were female, and 85.5% had hematological diseases. Most frequent CARVs were SARS-CoV-2 (36%), influenza (22.5%), human parainfluenza virus (hPIV, 12.5%), and respiratory syncytial virus (RSV, 12%). Epidemiology (excluding SARS-CoV-2) shifted by period: pre-pandemic, influenza predominated (70.5%); pandemic, RSV (31%); post-pandemic, RSV (27.5%), and hPIV (25.5%). Overall, 53% patients were hospitalized, 7% required ICU care, pneumonia occurred in 22.5%, and infection-related mortality was 4% (overall mortality 28%). Endpoint occurrence varied minimally across phases. Influenza drove pre-pandemic severity, whereas other CARVs became relevant during/after the pandemic.

Conclusion: CARV epidemiology in patients with cancer changed substantially across pandemic phases, while clinical severity and infection-related mortality remained largely unchanged.

Objectives: The duration of neutropenia is prolonged in cord blood transplantation, rendering infection management critical. Carbapenems have traditionally been employed as last-resort antibiotics; however, carbapenem-resistant bacteria have emerged as major concerns worldwide. Cefiderocol (CFDC) is a novel antimicrobial agent that exhibits activity against carbapenem-resistant nonfermenting gram-negative bacilli, such as resistant Pseudomonas aeruginosa and Stenotrophomonas maltophilia, and has thus attracted considerable attention.

Design or methods: Herein, we report a case in which a patient who was undergoing cord blood transplantation developed gram-negative rod sepsis after meropenem administration. CFDC was administered before the microbiological results were obtained, but the patient died of septic shock.

Results: The causative organism was later identified as Cupriavidus gilardii, which was resistant to novel antimicrobial agents, including CFDC, ceftazidime/avibactam, and ceftolozane/tazobactam. However, it was susceptible to cefepime and cefotaxime, suggesting a potential pitfall in the sole reliance on novel antibacterial drugs.

Conclusion: The incidence of C. gilardii infection is rare, with only seven cases reported to date. This is the first reported case in the context of hematopoietic cell transplantation and the second diagnosed case using matrix-assisted laser desorption/ionization time-offlight mass spectrometry. Moreover, this report presents a discussion based on a review of the relevant literature.

Background: The COVID-19 pandemic profoundly disrupted healthcare services. This study assessed the impact of the pandemic on the incidence, characteristics, and outcomes of late HIV diagnosis (LD) in Italy.

Methods: All people with HIV (PWH) enrolled in ICONA during 2016-2019 (pre-pandemic) and 2021-2024 (post-pandemic), and diagnosed with HIV within 3 months before enrolment, were included. LD was defined as CD4 <350 cells/mm³ or an AIDS-defining event (ADE) within three months of HIV diagnosis; AIDS presentation (AIDS-P) was considered an ADE at diagnosis. Annual incidence, socio-demographic determinants, and survival outcomes were compared between periods using Poisson regression, Cox proportional hazards models, and Fine-Gray competing risk models.

Results: Among 5,724 newly diagnosed PWH, 56% were enrolled in pre-pandemic and 44% post-pandemic. Overall, 58% presented late and 13% as AIDS-P, with proportions stable across periods. Risk factors for LD - female sex, older age, foreign nationality, heterosexual transmission, lower education, and unemployment - remained consistent, with no significant interaction by time (p = 0.39). During follow-up, 151 deaths occurred. LD and especially AIDS-P were associated with substantially increased all-cause mortality compared with non-LD, particularly within the first-year post-diagnosis. Adjusted hazard ratios were 2.96 for LD and 6.51 for AIDS-P pre-pandemic, and 8.64 and 17.99 post-pandemic. No excess risk was observed for non-AIDS-related mortality.

Conclusions: The prevalence and determinants of LD and AIDS-P in Italy remained stable before and after the COVID-19 pandemic. However, late presentation continues to carry a heavy mortality burden, underscoring the urgent need to strengthen early testing and prompt linkage to care.

Objective: To assess the epidemiology, clinical features, and genotypic characteristics of congenital toxoplasmosis (CT) in Martinique over a 12-year period.

Study design: We conducted a retrospective study of CT cases diagnosed at the University Hospital of Martinique between 2010 and 2022. We then compared the clinical, genotypic, and epidemiological data of these cases with those from the Limousin region in mainland France.

Results: Twenty-five CT cases were identified in Martinique, with no pregnancy terminations or in utero deaths. Clinical findings showed low severity at birth, with ocular involvement of 8% within the first few months and 21% within the first two years. Of the 11 isolates genotyped in Martinique, nine belonged to Caribbean lineages (Caribbean 1, 2, and 3), whereas all the isolates from Limousin were of the Type II lineage. There was no significant difference in clinical severity between the two regions. However, the incidence of CT was three times higher in Martinique than in mainland France.

Conclusions: Although the genetic diversity of Toxoplasma gondii strains associated with diagnosed cases of CT in Martinique differed from that observed in mainland France, no increase in clinical severity was observed; however, a higher risk of transplacental passage was possible. These findings provide important data to improve our understanding of the epidemiological and clinical aspects of CT in relation to the genetic diversity of circulating strains in Martinique. Furthermore, they emphasize the importance of screening for CT on an ongoing basis and monitoring affected children.

Background: Ticks transmit multiple pathogens, including B. burgdorferi, the agent of Lyme disease, and tick-borne encephalitis virus (TBEV), which can cause severe neurological disease and death despite frequent pauci- or asymptomatic infections. The Limousin region is considered at risk for TBEV because of dense tick (Ixodes) populations, although no clinical TBE cases have yet been reported there.

Methods: This study assessed TBEV seroprevalence in 880 patients tested for Lyme disease at Limoges University Hospital between January 2020 and January 2023. Presence of neutralizing antibodies was confirmed with a microneutralization assay. Seropositive TBEV cases were asked about epidemiological data.

Results: Anti-TBEV IgG antibodies were detected in 2.61% (23/880) of sera. Three cases had high titers of neutralizing antibodies. For two of them, travel history or missing epidemiological data limited interpretation, but one case from Corrèze department, exhibited an exposure history and lab testing data that strongly support TBEV infection.

Conclusion: For the first time, this study enabled the identification of several factors supporting the hypothesis of the circulation of TBEV in the Limousin region, France, confirming the spread of TBEV from the east to the west of the country and the need for increasing TBEV surveillance.

Objectives: Oxazolidinones are antibiotics of remarkable clinical importance, and resistance to these drugs is a matter of concern. This study investigated the presence of optrA, poxtA and cfr transferable oxazolidinone resistance determinants among enterococci and other nonobligate anaerobic fecal Gram-positives from healthy children living in a rural area of Bolivia.

Methods: Fecal samples were collected in transport medium and screened for isolates growing on Colistin-Nalidixic Acid blood agar containing florfenicol 16 mg/L. Isolates were identified by MALDI-ToF mass spectrometry and subjected to Real-time PCR to detect the presence of optrA, poxtA and cfr genes. Antimicrobial susceptibility to florfenicol, vancomycin and linezolid was tested by reference broth microdilution.

Results: Overall, 184/420 (43.8%) faecal samples yielded growth on the selective medium and 241 isolates of 13 different species of Lactobacillales (mostly Enterococcus spp. but also lactococci and Vagococcus teuberi) were obtained for further investigation. Most of them carried either optrA (182/241) or poxtA (43/241) or a combination thereof (7/241). cfr was detected in 5/241 isolates, always in combination with the other genes.

Conclusions: Present findings report the highest prevalence of faecal carriage of optrA- and poxtA-positive commensals so far observed in healthy subjects, raising concerns about the potential clinical and epidemiological implications.

Objectives: This prospective study aimed to (1) determine the intrarenal prevalence of hepatitis B virus (HBV) DNA in HBV surface antigen (HBsAg) negative patients with renal cell carcinoma (RCC), and (2) characterize its molecular forms, including cccDNA and integrated sequences.

Methods: Renal tissues from 83 consecutive HBsAg-negative patients who underwent nephrectomy for RCC (n = 54) or for nonmalignant disease (control group, n = 29) were tested by highly sensitive PCR for total HBV DNA, cccDNA, and viral RNA, and subjected to high-throughput HBV DNA integration sequencing. Among RCC cases, 36/54 had clear cell RCC (ccRCC), and 18/54 had papillary or chromophobe RCC.

Results: HBV DNA was detected in 35.2% (19/54) of RCC cases vs 3.4% (1/29) of controls (P = 0.001). Among RCC subtypes, HBV DNA prevalence was 25% (9/36) in ccRCC vs 55.6% (10/18) in non-ccRCC (papillary or chromophobe) (P = 0.03). Both cccDNA and integrated HBV sequences were present in RCC tissues harboring viral DNA.

Conclusion: Intrarenal presence of HBV DNA is a frequently occurring event strongly associated with RCC, suggesting a potential direct role of HBV in renal carcinogenesis.