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Suboptimal primaquine adherence in Plasmodium vivax malaria: Evidence from high-burden tribal districts in Odisha 间日疟原虫疟疾的次优伯氨喹依从性:来自奥里萨邦高负担部落地区的证据
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-30 DOI: 10.1016/j.jiph.2025.103123
Anju Viswan K , Kannan Thiruvengadam , Rohit Sharma, Nandhini Perumalsamy, Renuka Devi Arumugam, Srikanth Srirama, Arya Rahul , Manju Rahi

Background

Eliminating Plasmodium vivax malaria in India’s tribal regions is challenging, mainly due to poor adherence to primaquine, the only hypnozoiticidal drug for radical cure under national policy. Incomplete adherence to the 14-day primaquine regimen leads to relapse, treatment failure, ongoing transmission, and may contribute to antimalarial resistance. This study quantified primaquine adherence, and explored behavioral factors influencing non-adherence in high-burden tribal districts of Odisha.

Methods

This prospective cohort study conducted from January to December 2024 in two high-burden tribal districts (Malkangiri, Koraput) enrolled 269 laboratory-confirmed P. vivax patients aged over one year. Structured questionnaires collected demographic, clinical, and treatment data. Adherence to the 14-day primaquine regimen was assessed on days 7 and 14 via self-report, pill counts, and blister pack inspection. Uni- and multivariable analyses identified predictors of non-adherence.

Results

Adherence to chloroquine (3 days) and artesunate–SP (mixed infections) exceeded 93 %, while only 58.7 % (95 % CI: 52.6–64.9) completed the 14-day primaquine course. Healthcare workers dispensed drugs according to guidelines. Treatment discontinuation was mainly due to symptom resolution (61.9 %) and forgetfulness (21.4 %); only one patient discontinued primaquine due to an adverse event. Older age and household malaria history were associated with better adherence.

Conclusion

Suboptimal primaquine adherence delays P. vivax elimination despite adequate drug supply and correct dosing. Addressing behavioral drivers of early treatment cessation is critical to interrupt relapse transmission. Programmatic focus should include intensified social behavior change communication, targeted directly observed therapy, and evaluation of shorter primaquine or single-dose tafenoquine treatments with G6PD testing to enhance radical cure and accelerate India’s 2030 malaria elimination goal.
背景:在印度部落地区划定间日疟原虫疟疾是一项挑战,主要是由于对伯氨喹的依从性差,而伯氨喹是国家政策下唯一用于根治的催眠杀虫药物。不完全坚持14天伯氨喹治疗方案会导致复发、治疗失败、持续传播,并可能导致抗疟药耐药性。本研究量化了奥里萨邦高负担部落地区的伯氨喹依从性,并探讨了影响不依从性的行为因素。方法本前瞻性队列研究于2024年1月至12月在两个高负担部落区(Malkangiri, Koraput)进行,纳入269例1岁以上实验室确诊的间日疟原虫患者。结构化问卷收集了人口统计、临床和治疗数据。在第7天和第14天通过自我报告、药片计数和泡罩包装检查来评估14天伯氨喹方案的依从性。单变量和多变量分析确定了不依从性的预测因素。结果氯喹(3 d)和青蒿琥酯- sp(混合感染)的依从率超过93 %,而完成伯氨喹14 d疗程的只有58.7 %(95 % CI: 52.6 ~ 64.9)。医护人员根据指南配药。停止治疗的主要原因是症状缓解(61.9 %)和健忘(21.4% %);只有一名患者因不良事件停用伯氨喹。年龄较大和家庭疟疾史与较好的依从性相关。结论尽管有充足的药物供应和正确的剂量,但非最佳的伯氨喹依从性会延迟间日疟的消除。解决早期停止治疗的行为驱动因素对于阻断复发传播至关重要。规划重点应包括加强社会行为改变沟通,有针对性的直接观察治疗,以及评估较短的伯氨喹或单剂量他非诺喹治疗与G6PD测试,以加强根治和加速印度2030年消除疟疾的目标。
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引用次数: 0
The genetic diversity of drug resistance in Mycobacterium tuberculosis strains from the Tibetan Plateau 青藏高原结核分枝杆菌耐药遗传多样性研究
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-29 DOI: 10.1016/j.jiph.2025.103120
Anyue Xia , Jie Luo , Xiaohui Yu , Sijuan Ding , Dongfang Feng , Bin Zhu , Maoshi Li , Shangshi Li , Li Shi , Huan Xu

Objective

This study aimed to characterize the genetic diversity of drug resistance in Mycobacterium tuberculosis (MTB) isolates from the Tibetan Plateau, elucidate the molecular epidemiological profile of tuberculosis (TB) in this high-altitude region, and offer a molecular basis to guide improved diagnostic, therapeutic, and preventive strategies.

Methods

A total of 169 clinical MTB isolates were collected from the General Hospital of Xizang Military Command between January 2024 and April 2025. Drug resistance-associated mutations were identified via targeted gene sequencing.

Results

Among the 169 isolates, the overall rate of genotypic resistance was 20.71 %, comprising mono-resistance (14.79 %), poly-resistance (1.78 %), and multidrug-resistance (MDR, 4.14 %). Retreated patients exhibited a higher resistance rate than newly treated cases (26.09 % vs. 14.29 %), with MDR exclusively identified in the retreatment group. Resistance to streptomycin was most prevalent (8.28 %), followed by isoniazid (7.69 %) and rifampicin (7.10 %). The predominant mutations observed were rpsL K43R and katG S315T. No mutations conferring resistance to second-line drugs were detected.

Conclusion

The substantial burden of drug-resistant TB on the Tibetan Plateau—particularly streptomycin resistance—underscores the critical need for implementing precision diagnostics and optimizing therapeutic regimens.
目的研究青藏高原结核分枝杆菌(MTB)耐药遗传多样性,阐明该地区结核病的分子流行病学特征,为改进诊断、治疗和预防策略提供分子基础。方法收集西藏军区总医院2024年1月~ 2025年4月临床结核分枝杆菌分离株169株。通过靶向基因测序鉴定耐药相关突变。结果169株菌株基因型总耐药率为20.71 %,其中单耐药(14.79 %)、多耐药(1.78 %)、多药耐药(4.14 %)。复发患者的耐药率高于新治疗患者(26.09 % vs. 14.29 %),耐多药仅在再治疗组中发现。链霉素耐药最多(8.28 %),其次是异烟肼(7.69 %)和利福平(7.10 %)。观察到的主要突变是rpsL K43R和katG S315T。未发现对二线药物产生耐药性的突变。结论青藏高原耐药结核病的巨大负担,特别是链霉素耐药性,强调了实施精确诊断和优化治疗方案的迫切需要。
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引用次数: 0
Best Paper Award “Journal of Infection and Public Health” – 2025 Edition 最佳论文奖“感染与公共卫生杂志” - 2025年版
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-29 DOI: 10.1016/j.jiph.2025.103125
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引用次数: 0
Epidemiological and clinical trends in pediatric dengue: A six-year retrospective hospital-based study on pre-vs pandemic patterns in Puducherry, India 儿科登革热的流行病学和临床趋势:印度普杜切里一项基于医院的6年回顾性研究
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-29 DOI: 10.1016/j.jiph.2025.103121
Arya Rahul , Gnanasekaran Vijayalaksmi , Balakrishnan Vijayakumar , R. Amala , B.V. Balachandar , Thekkumkara Surendran Anish

Background

Dengue is a rapidly spreading mosquito-borne viral disease posing a significant public health challenge across tropical and subtropical regions, including India. While children are particularly vulnerable, age-specific clinical and epidemiological trends remain underexplored, especially in low-and middle-income country settings. This study describes the clinical and epidemiological trends of pediatric dengue in Puducherry from 2017 to 2022 and the impact of the COVID-19 pandemic on the disease trends.

Methods

A retrospective review was conducted on 632 pediatric patients admitted with dengue fever to a woman and child speciality public sector tertiary care hospital in Puducherry between 2017 and 2022. Data on demographic, clinical, and laboratory parameters were extracted from inpatient records. Dengue severity was categorized using WHO 2009 criteria. Statistical analyses were performed to assess associations and identify risk factors.

Results

Among the 632 patients, 54 % showed warning signs of dengue, and 3.5 % progressed to severe dengue. Fever (99.0 %), vomiting(51.3 %), and abdominal pain(37.3 %) were the common symptoms. Children under five years were significantly more likely to present with respiratory symptoms (cough: OR 1.85(1.27–2.70), p = 0.001; rhinitis: OR 1.67(1.13–2.46), p = 0.01), while gastrointestinal and musculoskeletal complaints were more common in the older children. The mean duration from symptom onset to diagnosis was 5.8 ± 2.8 days, with a significant prolongation in children aged 1–5 years (6.5 ± 3.6 days, p = 0.013). During the COVID-19 pandemic (2020–2022), time to diagnosis increased significantly (≥7 days in 27.2 % vs. 15.5 % pre-pandemic, OR 2.03, p < 0.001), although no significant differences in disease severity or demographic characteristics were noted.

Conclusions

This study highlights distinct age-related clinical patterns in pediatric dengue, with younger children tending to present more likely with respiratory symptoms and experience a longer time to diagnosis. Strengthening clinical recognition, adapting age-appropriate diagnostic protocols, and promoting early care-seeking are essential for timely detection and response to dengue in endemic regions.
登革热是一种迅速传播的蚊媒病毒性疾病,对包括印度在内的热带和亚热带地区的公共卫生构成重大挑战。虽然儿童特别脆弱,但针对特定年龄的临床和流行病学趋势仍未得到充分探讨,特别是在低收入和中等收入国家环境中。本研究描述了2017 - 2022年普杜切里县儿童登革热的临床和流行病学趋势,以及2019冠状病毒病大流行对疾病趋势的影响。方法对2017 - 2022年印度普杜切里市某妇幼专科公立三级医院收治的632例登革热患儿进行回顾性分析。人口统计、临床和实验室参数的数据从住院患者记录中提取。根据世卫组织2009年的标准对登革热严重程度进行了分类。进行统计分析以评估关联并确定危险因素。结果632例患者中,54. %出现登革热前兆,3.5% %进展为重症登革热。常见症状为发热(99.0 %)、呕吐(51.3 %)、腹痛(37.3 %)。5岁以下儿童明显更容易出现呼吸道症状(咳嗽:OR 1.85(1.27-2.70), p = 0.001;鼻炎:OR 1.67(1.13-2.46), p = 0.01),而胃肠和肌肉骨骼疾患在年龄较大的儿童中更为常见。从症状出现到诊断的平均时间为5.8 ± 2.8天,1-5岁儿童的平均时间明显延长(6.5 ± 3.6天,p = 0.013)。在COVID-19大流行期间(2020-2022),诊断时间显着增加(27.2% % vs. 15.5% %,OR 2.03, p <; 0.001),尽管没有注意到疾病严重程度或人口统计学特征的显着差异。结论:本研究突出了儿童登革热不同的年龄相关临床模式,年龄较小的儿童更容易出现呼吸道症状,并且需要更长的时间才能确诊。加强临床认识、调整适合年龄的诊断方案和促进早期求医,对于在登革热流行地区及时发现和应对登革热至关重要。
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引用次数: 0
Calls for papers: Antimicrobial resistance and one health: interdisciplinary strategies to address a global challenge – Virtual special issue 征文:抗菌素耐药性和一种健康:应对全球挑战的跨学科战略——虚拟特刊
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-27 DOI: 10.1016/j.jiph.2025.103122
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引用次数: 0
Environmental and socioeconomic determinants of dengue fever risk in Lao People's Democratic Republic: A systematic review 老挝人民民主共和国登革热风险的环境和社会经济决定因素:系统综述
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-26 DOI: 10.1016/j.jiph.2025.103119
Muhammad Umar , Sobia Asghar , Sumaira Zafar
Dengue fever is endemic in Laos, and changing land use and land cover (LULC), along with climate, are increasing the risk of dengue fever. While climate–dengue associations are well understood, the impacts of LULC remain uncertain and understudied. This review reports that, along with climate, LULCs such as urban/built-up areas, rubber plantations, and wetlands (marsh, swamp, and paddy fields) could increase DF risk by providing suitable habitats for its vector. Agricultural transformation from crops to plantations or forests to plantations is causing an amplified proliferation of Ae. albopictus in rural and peri-urban areas. Socioeconomic determinants, including water availability, sanitation and hygiene, housing materials, and poverty, also significantly impact DF. Knowledge, attitudes, and practices studies indicating awareness of DF and vector control methods among selected population during training programs. Understanding how climate, LULC, and socioeconomic factors interact is essential for designing effective, context-specific strategies to control dengue in Laos.
登革热是老挝的地方病,不断变化的土地利用和土地覆盖(LULC)以及气候正在增加登革热的风险。虽然气候-登革热的关联已被很好地理解,但LULC的影响仍然不确定且研究不足。本综述报告说,除了气候之外,城市/建成区、橡胶种植园和湿地(沼泽、沼泽和水田)等lulc可能为其病媒提供适宜的栖息地,从而增加登革热风险。从作物到人工林或从森林到人工林的农业转型正在导致伊蚊的扩大增殖。农村和城郊地区的白纹伊蚊。社会经济决定因素,包括水供应、环境卫生和个人卫生、住房材料和贫困,也对发展中国家有重大影响。知识、态度和实践研究表明,在培训项目中选定人群对登革热和病媒控制方法的认识。了解气候、LULC和社会经济因素如何相互作用,对于设计有效的、针对老挝具体情况的登革热控制策略至关重要。
{"title":"Environmental and socioeconomic determinants of dengue fever risk in Lao People's Democratic Republic: A systematic review","authors":"Muhammad Umar ,&nbsp;Sobia Asghar ,&nbsp;Sumaira Zafar","doi":"10.1016/j.jiph.2025.103119","DOIUrl":"10.1016/j.jiph.2025.103119","url":null,"abstract":"<div><div>Dengue fever is endemic in Laos, and changing land use and land cover (LULC), along with climate, are increasing the risk of dengue fever. While climate–dengue associations are well understood, the impacts of LULC remain uncertain and understudied. This review reports that, along with climate, LULCs such as urban/built-up areas, rubber plantations, and wetlands (marsh, swamp, and paddy fields) could increase DF risk by providing suitable habitats for its vector. Agricultural transformation from crops to plantations or forests to plantations is causing an amplified proliferation of <em>Ae. albopictus</em> in rural and peri-urban areas. Socioeconomic determinants, including water availability, sanitation and hygiene, housing materials, and poverty, also significantly impact DF. Knowledge, attitudes, and practices studies indicating awareness of DF and vector control methods among selected population during training programs. Understanding how climate, LULC, and socioeconomic factors interact is essential for designing effective, context-specific strategies to control dengue in Laos.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"19 3","pages":"Article 103119"},"PeriodicalIF":4.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Molecular and bacteriological characterization of colistin and carbapenem-resistant nosocomial isolates of Acinetobacter baumannii isolated from different Iraqi hospitals 伊拉克不同医院鲍曼不动杆菌耐粘菌素和耐碳青霉烯医院分离株的分子和细菌学特征
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-26 DOI: 10.1016/j.jiph.2025.103118
Dhuha A. Abbas , Mushtak T.S. Al-Ouqaili , Mohammed J. Alfeehan

Background

Colistin- and carbapenem-resistant Acinetobacter (A.) baumannii pose a global health threat in healthcare settings due to difficult-to-treat infections. This study investigates their prevalence, resistance mechanisms, and the role of biofilm formation in persistence and pathogenicity.

Patients and methods

This cross-sectional observational study was conducted on 335 clinical specimens, specifically isolates of A. baumannii, during the period from December to July 2025. Bacteriological investigation was confirmed using the automated Vitek 2 compact system, and antimicrobial susceptibility was determined using the AST 419 card, in accordance with the CLSI 2025 guidelines. Biofilm formation was assessed using the microtiter plate method. PCR detection for carbapenem and colistin-resistant genes (blaNDM, blaNDM-1, blaVIM, blaIMP, blaOXA-48) and (mcr-1, mcr-5, pmrA, and pmrB), respectively, has been done.

Results

A total of 335 clinical study specimens were analyzed, with 222 (66.2 %) representing bacterial growth. Of these, 64 (28.8 %) were well bacteriologically identified as A. baumannii. Out of these isolates, 50 were multidrug resistant, classified into 31 (62 %) as extensively drug resistant (XDR) and 19 (38 %) as Pan-drug resistant. Biofilm formation was distributed as strong biofilm formation in sputum (31.2 %), wound swabs (25 %), urine (7.1 %), and vaginal swabs (100 %). Molecular analysis revealed that blaNDM-1 (18 %) was the most common carbapenemase-resistant gene, followed by blaVIM (16 %), blaIMP-1 (12 %), blaNDM (4 %), and blaOXA-48 (2 %). For colistin resistance, pmrB (54 %) and pmrA (40 %) were predominant, while mcr-1 was (4 %). Notably, mcr-5 was not detected in all colistin-resistant genes.

Conclusion

Most A. baumannii isolates were extensively drug-resistant or pan-drug-resistant and exhibited variable biofilm formation, likely enhancing persistence in hospital environments. High prevalence of blaNDM-1 and blaVIM  carbapenem resistance genes, along with pmrB and pmrA colistin resistance genes, complicates treatment and diagnostics. Prompt detection, effective infection control, and continuous surveillance are urgently needed to limit the spread of these highly resistant strains.
由于难以治疗的感染,耐粘菌素和碳青霉烯不动杆菌(a .)鲍曼尼在医疗保健环境中构成全球健康威胁。本研究探讨了它们的流行、耐药机制以及生物膜形成在持久性和致病性中的作用。患者和方法本横断面观察研究于2025年12月至7月期间对335例临床标本,特别是鲍曼不动杆菌分离株进行了研究。根据CLSI 2025指南,使用自动Vitek 2紧凑型系统确认细菌学调查,并使用AST 419卡确定抗菌药物敏感性。采用微量滴度板法评估生物膜的形成。PCR检测碳青霉烯类耐药基因blaNDM、blaNDM-1、blaVIM、blaIMP、blaOXA-48和mcr-1、mcr-5、pmrA、pmrB。结果共分析临床研究标本335份,其中222份(66.2% %)为细菌生长。其中64例(28.8 %)经细菌学鉴定为鲍曼不动杆菌。其中50株为多药耐药,31株(62 %)为广泛耐药(XDR), 19株(38 %)为泛耐药。在痰液(31.2 %)、伤口拭子(25 %)、尿液(7.1 %)和阴道拭子(100 %)中形成强烈的生物膜。分子分析显示,blaNDM-1(18 %)是最常见的碳青霉烯酶耐药基因,其次是blaVIM(16 %)、blaIMP-1(12 %)、blaNDM(4 %)和blaOXA-48(2 %)。粘菌素耐药以pmrB(54 %)和pmrA(40 %)为主,mcr-1(4 %)为主。值得注意的是,并没有在所有的粘菌素耐药基因中检测到mcr-5。结论大多数鲍曼不动杆菌分离株具有广泛耐药或泛耐药,并表现出可变的生物膜形成,可能增强了在医院环境中的持久性。高流行率的blaNDM-1和blaVIM碳青霉烯耐药基因,以及pmrB和pmrA粘菌素耐药基因,使治疗和诊断复杂化。迫切需要及时发现、有效控制感染和持续监测,以限制这些高耐药菌株的传播。
{"title":"Molecular and bacteriological characterization of colistin and carbapenem-resistant nosocomial isolates of Acinetobacter baumannii isolated from different Iraqi hospitals","authors":"Dhuha A. Abbas ,&nbsp;Mushtak T.S. Al-Ouqaili ,&nbsp;Mohammed J. Alfeehan","doi":"10.1016/j.jiph.2025.103118","DOIUrl":"10.1016/j.jiph.2025.103118","url":null,"abstract":"<div><h3>Background</h3><div>Colistin- and carbapenem-resistant <em>Acinetobacter (A.) baumannii</em> pose a global health threat in healthcare settings due to difficult-to-treat infections. This study investigates their prevalence, resistance mechanisms, and the role of biofilm formation in persistence and pathogenicity.</div></div><div><h3>Patients and methods</h3><div>This cross-sectional observational study was conducted on 335 clinical specimens, specifically isolates of <em>A. baumannii</em>, during the period from December to July 2025. Bacteriological investigation was confirmed using the automated Vitek 2 compact system, and antimicrobial susceptibility was determined using the AST 419 card, in accordance with the CLSI 2025 guidelines. Biofilm formation was assessed using the microtiter plate method. PCR detection for carbapenem and colistin-resistant genes (<em>bla</em><sub><em>NDM</em></sub><em>, bla</em><sub><em>NDM-1</em></sub><em>, bla</em><sub><em>VIM</em></sub><em>, bla</em><sub><em>IMP</em></sub><em>, bla</em><sub><em>OXA-48</em></sub><em>)</em> and (<em>mcr-1</em>, <em>mcr-5</em>, <em>pmrA</em>, and <em>pmrB</em>), respectively, has been done.</div></div><div><h3>Results</h3><div>A total of 335 clinical study specimens were analyzed, with 222 (66.2 %) representing bacterial growth. Of these, 64 (28.8 %) were well bacteriologically identified as <em>A. baumannii</em>. Out of these isolates, 50 were multidrug resistant, classified into 31 (62 %) as extensively drug resistant (XDR) and 19 (38 %) as Pan-drug resistant. Biofilm formation was distributed as strong biofilm formation in sputum (31.2 %), wound swabs (25 %), urine (7.1 %), and vaginal swabs (100 %). Molecular analysis revealed that <em>bla</em><sub><em>NDM-1</em></sub> (18 %) was the most common carbapenemase-resistant gene, followed by <em>blaVIM</em> (16 %), <em>bla</em><sub><em>IMP-1</em></sub> (12 %), <em>bla</em><sub><em>NDM</em></sub> (4 %), and <em>bla</em><sub><em>OXA-48</em></sub> <em>(2 %)</em>. For colistin resistance, <em>pmrB (</em>54 %) and <em>pmrA</em> (40 %) were predominant, while <em>mcr-1</em> was (4 %). Notably, <em>mcr-5</em> was not detected in all colistin-resistant genes.</div></div><div><h3>Conclusion</h3><div>Most <em>A. baumannii</em> isolates were extensively drug-resistant or pan-drug-resistant and exhibited variable biofilm formation, likely enhancing persistence in hospital environments. High prevalence of <em>bla</em><sub><em>NDM-1</em></sub> and <em>bla</em><sub><em>VIM</em> </sub> carbapenem resistance genes, along with <em>pmrB</em> and <em>pmrA</em> colistin resistance genes, complicates treatment and diagnostics. Prompt detection, effective infection control, and continuous surveillance are urgently needed to limit the spread of these highly resistant strains.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"19 3","pages":"Article 103118"},"PeriodicalIF":4.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early prediction of immunological non-responders in people living with HIV using machine learning: Model development and validation in multicenter cohorts in China 使用机器学习对HIV感染者免疫无应答的早期预测:中国多中心队列的模型开发和验证
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-24 DOI: 10.1016/j.jiph.2025.103116
Rui Sun , Binyu Gao , Hanxi Zhang , Xi Wang , Fang Liu , Hongxin Zhao , Lijun Sun , Jianhua Yu , Honglei Liu , Fujie Zhang

Background

Despite antiretroviral therapy (ART), 10–40 % of people living with HIV (PLWH) fail to normalize CD4+ T cells, known as immune non-responders (INR), associated with poor clinical outcomes. Due to the complex pathogenesis and the absence of effective treatments, early prediction and intervention of INR are critical. With the rapid advancements in artificial intelligence, particularly in machine learning (ML), developing an interpretable ML model to identify individuals at high risk of INR can facilitate personalized treatment strategies and improve clinical management.

Methods

This retrospective study was conducted from a long-term multicenter cohort involving 30938 PLWH attending three hospitals from January 2003 to December 2023. Seven ML algorithms were employed to construct prediction models. The area under the receiver operating characteristic curve (AUC), precision–recall curves, calibration plots, clinical impact curves, and decision curve analysis were used to evaluate and identify the optimal model. We evaluated the final model using internal cross-validation and validated it in an external cohort. The Python-based Streamlit framework was applied to develop a web platform.

Results

11287 PLWH, including 1325 (11.74 %) INR, were analyzed in the derivation cohort. Twenty baseline clinical indicators of PLWH were used to construct ML models. After feature reduction and comparative evaluation, the 9-feature RF model demonstrated strong discrimination (AUC = 0.864), superior calibration, and favorable clinical utility, outperforming the traditional model (AUC = 0.856) and other models. The model performance was also confirmed in internal validation (mean AUC = 0.884 ± 0.003) and the external validation (AUC = 0.855).

Conclusions

In this study, an interpretable ML model with nine baseline clinical indicators was constructed for early INR prediction in ART-naïve PLWH and was incorporated into a convenient web platform to facilitate individualized treatment and management.
尽管抗逆转录病毒治疗(ART), 10 - 40% %的艾滋病毒感染者(PLWH)不能使CD4+ T细胞正常化,被称为免疫无应答(INR),与不良的临床结果相关。由于其复杂的发病机制和缺乏有效的治疗方法,早期预测和干预是至关重要的。随着人工智能,特别是机器学习(ML)的快速发展,开发可解释的ML模型来识别INR高风险个体可以促进个性化治疗策略并改善临床管理。方法对2003年1月至2023年12月在三家医院就诊的30938名PLWH患者进行长期多中心队列回顾性研究。采用7种ML算法构建预测模型。采用受试者工作特征曲线(AUC)下面积、精密度-召回率曲线、校准图、临床影响曲线和决策曲线分析来评价和确定最优模型。我们使用内部交叉验证评估了最终模型,并在外部队列中进行了验证。应用基于python的Streamlit框架开发web平台。结果在衍生队列中分析了11287例PLWH,其中1325例(11.74 %)INR。采用PLWH的20项基线临床指标构建ML模型。经过特征约简和对比评价,9特征射频模型具有较强的鉴别能力(AUC = 0.864)、较好的校准能力和较好的临床实用性,优于传统模型(AUC = 0.856)和其他模型。内部验证(平均AUC = 0.884 ± 0.003)和外部验证(AUC = 0.855)也证实了模型的性能。结论本研究构建了包含9个基线临床指标的可解释性ML模型,用于ART-naïve PLWH患者INR的早期预测,并将其纳入便捷的web平台,便于个体化治疗和管理。
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引用次数: 0
Corneal transplantation strategies for Acanthamoeba Keratitis: A systematic review and meta-analysis 棘阿米巴角膜炎的角膜移植策略:系统回顾和荟萃分析
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-17 DOI: 10.1016/j.jiph.2025.103114
Shangyang Jiang , Leying Wang , Zijun Zhang, Zhenyu Wei, Kai Cao, Qingfeng Liang
Acanthamoeba keratitis (AK) is an uncommon yet vision-threatening corneal infection, and the lack of an international consensus on its surgical management often complicates clinical decision-making. To address this gap, a comprehensive literature review was conducted across PubMed, EMBASE, Web of Science, and the Cochrane Library from database inception to July 1, 2025, focusing on clinical studies that reported outcomes of keratoplasty. The analysis included 24 studies encompassing 487 eyes and compared different keratoplasty techniques, specifically therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), and therapeutic deep anterior lamellar keratoplasty (TDALK). The data indicated that Acanthamoeba infection control sufficient to permit OPK was associated with the most favorable results. In eyes with infection confined to the anterior stroma and thus eligible for TDALK, graft survival was higher and postoperative complications were fewer. In cases with persistent full-thickness infection, TPK was required and was associated with poorer visual recovery and higher rates of graft failure, recurrent infection, and regrafting.
棘阿米巴角膜炎(AK)是一种罕见但威胁视力的角膜感染,其手术治疗缺乏国际共识,往往使临床决策复杂化。为了解决这一差距,我们对PubMed、EMBASE、Web of Science和Cochrane图书馆从数据库建立到2025年7月1日进行了全面的文献综述,重点关注报道角膜移植结果的临床研究。该分析包括24项研究,涵盖487只眼睛,并比较了不同的角膜移植技术,特别是治疗性穿透性角膜移植(TPK)、光学穿透性角膜移植(OPK)和治疗性深前板层角膜移植(TDALK)。数据表明,棘阿米巴感染控制足以允许OPK与最有利的结果相关。在感染局限于前基质的眼睛中,适合进行TDALK,移植物存活率较高,术后并发症较少。在持续性全层感染的病例中,TPK是必需的,并且与较差的视力恢复和较高的移植物失败、复发感染和再移植率相关。
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引用次数: 0
Peritoneal tuberculosis impersonating ovarian malignancy: A case series from a high tuberculosis burden country 冒充卵巢恶性肿瘤的腹膜结核:来自结核病高负担国家的病例系列
IF 4 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-12-17 DOI: 10.1016/j.jiph.2025.103113
S.A. Susilo, A.B. Harsono, G.N.A. Winarno, S. Salima, K.I. Mantilidewi
An uncommon form of extrapulmonary tuberculosis is abdominal tuberculosis (TB). Due to its vague symptoms, abdominal TB remains difficult to diagnose. We report three cases of peritoneal TB with abdominal enlargement in Bandung, Indonesia, which were initially misdiagnosed as ovarian carcinoma and treated with biopsy and laparotomy. To avoid unnecessary invasive procedures that pose risks to patients, we assess the need for a diagnostic strategy to differentiate between ovarian cancer and abdominal TB based on our experiences and existing literature. Peritoneal TB closely mimics ovarian cancer in clinical presentation, imaging findings, and tumor marker profiles. Elevated CA-125 and ascitic fluid analysis may mislead clinicians, especially in resource-limited settings. To prevent misdiagnosis, careful diagnostic procedures should be undertaken.
腹结核是肺外结核的一种罕见形式。由于其症状模糊,腹部结核仍然难以诊断。我们报告三例腹膜结核伴腹部增大的病例,在印度尼西亚万隆,最初被误诊为卵巢癌,并进行活检和剖腹手术治疗。为了避免不必要的侵入性手术给患者带来风险,我们根据我们的经验和现有文献评估了区分卵巢癌和腹部结核病的诊断策略的必要性。腹膜结核在临床表现、影像学表现和肿瘤标志物方面与卵巢癌非常相似。CA-125升高和腹水分析可能会误导临床医生,特别是在资源有限的情况下。为防止误诊,应采取仔细的诊断程序。
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Journal of Infection and Public Health
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