International Journal of Infectious Diseases最新文献

Objectives: To develop and evaluate a rapid, one-pot molecular assay for the detection of Treponema pallidum subspecies pallidum (TPA), addressing the limitations of current diagnostic methods influenced by sample type and pathogen load.

Methods: A one-pot assay integrating recombinase polymerase amplification (RPA) and Cas13a-based collateral cleavage activity was established for isothermal detection of TPA. The assay targeted the tpp47/tp0574 gene and was validated using 186 clinical specimens, including whole blood, lesion exudate, and cerebrospinal fluid (CSF) samples.

Results: The one-pot RPA-Cas13a assay demonstrated high analytical sensitivity and specificity for TPA detection. Clinical sensitivities were 58.97% in whole blood, 84.21% in lesion exudate, and 57.14% in CSF, with 100% specificity across all sample types.

Conclusions: This one-pot isothermal assay enables rapid and accurate detection of T. pallidum directly from diverse clinical samples. Its high specificity and field-friendly format make it a promising complementary tool to conventional diagnostic approaches, particularly for point-of-care testing and screening in resource-limited or high-risk settings.

Objectives: To develop a CT-based multimodal transformer model to precisely predict lymph node (LN) metastasis in hepatic alveolar echinococcosis (HAE) patients.

Methods: A total of 318 HAE patients from three centers were allocated to a training set, an internal validation set, and two external validation sets. Radiomics, 3D deep learning (3DDL), and 2D deep learning (2DDL) features were retrieved from contrast-enhanced CT images of the hepatic hilar LN. Random forest models were constructed utilizing various features. Ultimately, we developed and assessed a transformer-based multimodal fusion model. Model performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

Results: Compared with both the radiomics and the 2DDL models, the 3DDL model exhibited enhanced discriminative ability for LN status. The transformer model achieved the highest AUC (95%CI) of 0.951 (0.898-1.000), 0.927 (0.850-1.000), and 0.933 (0.847-1.000) for the three validation sets. DCA revealed that the transformer model produced the greatest net clinical advantage.

Conclusion: This study innovatively constructed a transformer-based multimodal fusion model, providing a practical and reliable tool for predicting LN metastasis in HAE patients. More importantly, this model provides a foundation for guiding LN dissection in HAE patients and is readily applicable in clinical settings.

Objectives: To estimate the prevalence of oncogenic oral HPV among sex workers in Brazil and examine socio-behavioral covariates.

Methods: A cross-sectional, multicenter study was conducted from 2019 to 2023 and recruited male and female sex workers from all Brazilian regions using respondent-driven sampling (RDS). Trained professionals conducted structured interviews assessing sociodemographic characteristics and sexual behaviors. Oral samples were tested for HPV genotypes using PCR-based methods. RDS-II estimation accounted for sampling design, with robust Poisson regression estimating crude and adjusted prevalence ratios.

Results: Most participants were female (84.2% [95% CI 78.1-90.4]), worked in commercial sex for under five years (54.2% [48.3-60.2]), and reported consistent condom use (53.4% [47.3-59.6]). Among 940 participants, high-risk HPV prevalence was 7.2% (95% CI 4.1-10.3), with significantly higher rates among sex workers in Central-west/Southeast/South regions (adjusted PR 4.39 [1.89-10.2]) and those with >15 weekly sexual partners (adjusted PR 4.11 [1.54-11.0]).

Conclusions: Disparities in oral HPV prevalence among Brazilian sex workers suggest that structural and behavioral factors influence infection risk. These findings highlight the need for interventions tailored for this high-risk population, including HPV vaccination and sexual health education.

Strongyloidiasis can persist lifelong through autoinfection and may abruptly progress to hyperinfection with disseminated disease. We report a 38-year-old woman from southwestern Colombia with two months of postprandial bilious vomiting, oral intolerance, abdominal pain and 19 kg weight loss, initially managed as upper gastrointestinal bleeding and constitutional syndrome with suspected malignancy. Endoscopy showed hemorrhagic/atrophic gastritis, a deformed pylorus and irregular duodenal mucosa. On day 4 she deteriorated with hypoxemia and refractory shock; intubation, vasopressors, broad-spectrum antibiotics and corticosteroids were instituted, but she died due to refractory septic shock and multiorgan failure. Histopathology of duodenal biopsies revealed numerous Strongyloides stercoralis larvae. Autopsy confirmed disseminated strongyloidiasis with hyperinfection, polymicrobial pulmonary and central nervous system infection, and multiorgan failure. This case illustrates a lethal gastrointestinal presentation mimicking gastric outlet obstruction without overt immunosuppression. In endemic settings, the combination of severe malnutrition, unexplained upper gastrointestinal symptoms and characteristic duodenal mucosal changes should prompt early testing for Strongyloides to avoid corticosteroid-triggered hyperinfection. Timely diagnosis and ivermectin-based therapy are essential to prevent catastrophic outcomes.

Antibiotic-resistant Salmonella infections pose a serious therapeutic challenge in children. We report two pediatric cases that were successfully treated with washed microbiota transplantation (WMT) as salvage therapy. Both patients achieved sustained clinical and microbiological remission, suggesting WMT is a promising option for refractory pediatric salmonellosis.

Objectives: Current multiplex assays cannot detect all four WHO priority pathogens for meningitis diagnosis (Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus agalactiae). This work developed a novel real-time PCR assay capable of simultaneously detecting these pathogens.

Methods: Forty-four DNA samples, including type cultures (NCTC and ATCC), were tested. Specific primers and probes targeting sodC, to detect N. meningitidis, dmsA for H. influenzae, SP2020 for S. pneumoniae, and cfb for S. agalactiae were evaluated in monoplex and multiplex. Standard curves were generated, and limits of detection (LLD), slope, intercept, and R² were determined. Sensitivity, specificity, and predictive values (PPV/NPV) were assessed for both monoplex and multiplex assays.

Results: Monoplex and multiplex assays showed equivalent performance. Sensitivities were 100% for all targets; specificities ranged 91.7-100%, PPVs 72.7-100%, and NPVs 100%. The multiplex assay showed high efficiency and consistent amplification for each target gene. LLDs ranged from 24 (S. pneumoniae) to 66 (H. influenzae) genome copies/µl.

Conclusions: The multiplex PCR assay showed good performance for rapid and accurate detection of meningitis-associated bacteria. This test has applications for improved diagnosis of meningitis in LMICs, where laboratory confirmation of major pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis and Group B Streptococcus remains limited. Field validation with clinical specimens is required before implementation.

Objectives: In Kilifi, pentavalent coverage remains below the 90% target, with no reported diphtheria or tetanus cases and sporadic pertussis. However, absence of disease does not guarantee immunity. To characterize age-specific gaps and waning protection not captured by routine surveillance, we conducted serial seroprevalence studies of diphtheria, pertussis, and tetanus.

Methods: We analyzed randomly selected participants from multiple cross-sectional surveys within the Kilifi Health and Demographic Surveillance System. Immunoglobulin G antibodies were measured using a fluorescent bead-based multiplex immunoassay applying protective thresholds ≥0.011 IU/ml for diphtheria and tetanus. Pertussis antibodies were grouped by time since infection. Bayesian multilevel regression with post-stratification adjusted estimates for population structure and assay performance; associations with age and year were assessed using logistic regression.

Results: Diphtheria seroprotection was low; only 5% of children had long-term seroprotection, with full protection ranging from 11% to 34% and minimal seroprotection from 40% to 52%. Minimal seroprotection increased over time (τ = 0.68, P = 0.04). Tetanus protection was higher, with long-term seroprotection ranging from 10% to 39% and susceptibility <1%; trends were not significant. Older age was associated with lower seroprevalence. Among adults, <1% had long-term diphtheria seroprotection vs 36% for tetanus. Pertussis circulation was minimal, with 5% of children and <1% of adults, with antibody concentrations consistent with recent infection.

Conclusions: Although conventional serological thresholds suggest immunity gaps, particularly, for diphtheria, no diphtheria or tetanus outbreaks have occurred in Kilifi over the past decade. This indicates that antibody concentrations below standard thresholds may not equate to immediate susceptibility, but they do reflect a narrower margin of population immunity. Although this has not yet translated into disease, it could become relevant if transmission conditions change, underscoring the need to sustain high vaccination coverage and sensitive surveillance. Serology should, therefore, be viewed as a complementary tool, useful for tracking emerging vulnerability and informing future booster decisions if susceptibility increases.

Pasteurella species are gram-negative, non-motile coccobacilli colonizing the oral cavity and upper respiratory tract of cats and dogs. Soft tissue infections after bites, scratches, or trauma are most often caused by P. multocida. Pasteurella stomatis, though rarely reported, may also colonize humans and present with a spectrum ranging from mild skin infections to sepsis and death. We describe a zoonotic P. stomatis infection presenting as a verrucous tumor-like mass following contact with a household dog.

Background: Mucormycosis is a rare, aggressive, and life-threatening fungal infection that predominantly affects immunocompromised individuals and is associated with a high mortality rate.

Case presentation: We treated a 72-year-old woman with myelodysplastic syndrome (MDS) who developed disseminated mucormycosis involving the lungs, skin, and central nervous system (CNS). Diagnosis was supported by metagenomic next-generation sequencing (mNGS), and she received combination antifungal therapy with liposomal amphotericin B and isavuconazole. Her clinical status stabilized after 4 weeks of treatment. She later died approximately 2 weeks after discharge because of carbapenem-resistant Pseudomonas aeruginosa bacteremia.

Conclusions: Our case highlights the importance of prompt diagnosis and timely initiation of therapy for mucormycosis and indicates that combination antifungal therapy may be an effective approach to managing severe disseminated mucormycosis in immunocompromised patients.

Objectives: To compare nephrotoxicity between teicoplanin and vancomycin in older patients, investigate the correlation between teicoplanin average steady-state trough concentrations (C_min,ss) and nephrotoxicity, and identify independent risk factors for teicoplanin-associated nephrotoxicity.

Design or methods: This study enrolled older patients treated with teicoplanin or vancomycin at four tertiary hospitals in Beijing, China. Propensity score matching (PSM) was utilized to mitigate potential bias. Dynamic monitoring of C_min,ss was performed, with multivariate analysis used to identify independent risk factors for teicoplanin-associated nephrotoxicity.

Results: After PSM, 186 patients (93 per group) were analyzed. The incidence of nephrotoxicity was significantly lower in teicoplanin than in vancomycin (16.13% vs 32.26%, OR = 3.50, P = 0.006). Among 203 teicoplanin-treated patients, 39 developed nephrotoxicity. Multivariate analysis identified exposure duration (OR = 1.060, P = 0.028) and baseline creatinine (OR = 1.057, P = 0.019) as independent risk factors for teicoplanin-associated nephrotoxicity. Notably, when C_min,ss was <40 mg/L, the risk of nephrotoxicity did not significantly increase with rising values.

Conclusion: Teicoplanin demonstrated superior renal safety compared to vancomycin in older patients. The C_min,ss <40 mg/L was associated with a manageable risk of nephrotoxicity, whereas exposure duration and baseline creatinine could serve as critical parameters for clinical decision-making.