Echinocandin-resistant Candida albicans (C. albicans) is a rare but increasing global concern. In Japan, at least three cases had been confirmed by the end of 2015. Mutations in FKS cause echinocandin resistance in Candida species, which is primarily driven by previous echinocandin antifungal use. C. albicans resistance to echinocandins is raising clinicians' concerns globally and could pose a threat to Japan in the near future. The fungus is also an antimicrobial-resistant pathogen, raising awareness of the risk of resistance to prophylactic antifungals. Herein, we report a case of echinocandin-resistant C. albicans at our hospital. Mutations in the FKS gene that cause echinocandin resistance in Candida species have been detected.
{"title":"Echinocandin-resistant Candida albicans: A case report from Japan","authors":"Sayaka Hikida , Yutaro Akiyama , Masahiro Ishikane , Hiroshi Shimazu , Ryo Nasu , Takayuki Shinohara , Minoru Nagi , Rei Shirai , Makiko Onakado , Nobuko Nakayama , Yoshitsugu Miyazaki , Akira Hangaishi , Norio Ohmagari","doi":"10.1016/j.jiac.2025.102856","DOIUrl":"10.1016/j.jiac.2025.102856","url":null,"abstract":"<div><div>Echinocandin-resistant Candida albicans (<em>C. albicans</em>) is a rare but increasing global concern. In Japan, at least three cases had been confirmed by the end of 2015. Mutations in FKS cause echinocandin resistance in <em>Candida</em> species, which is primarily driven by previous echinocandin antifungal use. <em>C. albicans</em> resistance to echinocandins is raising clinicians' concerns globally and could pose a threat to Japan in the near future. The fungus is also an antimicrobial-resistant pathogen, raising awareness of the risk of resistance to prophylactic antifungals. Herein, we report a case of echinocandin-resistant <em>C. albicans</em> at our hospital. Mutations in the FKS gene that cause echinocandin resistance in <em>Candida</em> species have been detected.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102856"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145481878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reports on serum acyclovir (ACV) concentrations in patients undergoing continuous hemodiafiltration (CHDF) remain limited. We present a case describing the impact of CHDF on serum ACV levels in a patient with encephalopathy. A Japanese woman in her 70s was prescribed oral valacyclovir (VACV) at a dose of 1000 mg three times daily for herpes zoster ophthalmicus. After 7 days of treatment, she was admitted to a local hospital with fever, dysarthria, altered consciousness, hallucinations, and headache. Her serum creatinine level was elevated at 4.02 mg/dL. Intravenous ACV was initiated under the clinical suspicion of varicella zoster virus (VZV) encephalitis. However, after 3 days of treatment without improvement in consciousness, she was transferred to our hospital. Her serum ACV concentration upon admission was 14.1 μg/mL. Suspecting ACV-induced encephalopathy and renal dysfunction, CHDF was promptly initiated. Following CHDF therapy, serum ACV levels declined rapidly, accompanied by a gradual improvement in consciousness. This case suggests that CHDF may be an effective therapeutic option for managing ACV-associated nephropathy and encephalopathy.
{"title":"Impact of continuous hemodiafiltration on serum acyclovir concentrations in a patient with encephalopathy","authors":"Takahiro Ito , Kotaro Itohara , Sachi Hirata , Takeshi Kimura , Yumi Kitahiro , Tomohiro Omura , Joji Kotani , Ikuko Yano","doi":"10.1016/j.jiac.2025.102859","DOIUrl":"10.1016/j.jiac.2025.102859","url":null,"abstract":"<div><div>Reports on serum acyclovir (ACV) concentrations in patients undergoing continuous hemodiafiltration (CHDF) remain limited. We present a case describing the impact of CHDF on serum ACV levels in a patient with encephalopathy. A Japanese woman in her 70s was prescribed oral valacyclovir (VACV) at a dose of 1000 mg three times daily for herpes zoster ophthalmicus. After 7 days of treatment, she was admitted to a local hospital with fever, dysarthria, altered consciousness, hallucinations, and headache. Her serum creatinine level was elevated at 4.02 mg/dL. Intravenous ACV was initiated under the clinical suspicion of varicella zoster virus (VZV) encephalitis. However, after 3 days of treatment without improvement in consciousness, she was transferred to our hospital. Her serum ACV concentration upon admission was 14.1 μg/mL. Suspecting ACV-induced encephalopathy and renal dysfunction, CHDF was promptly initiated. Following CHDF therapy, serum ACV levels declined rapidly, accompanied by a gradual improvement in consciousness. This case suggests that CHDF may be an effective therapeutic option for managing ACV-associated nephropathy and encephalopathy.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102859"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-24DOI: 10.1016/j.jiac.2025.102842
Takeyuki Goto , Yong Chong , Tomonori Sato , Naoki Tani , Shouta Saiki , Satoru Ishida , Naoki Kawai , Takuma Bando , Hideyuki Ikematsu
Introduction
Data on the correlation between SARS-CoV-2 neutralizing activity and strain-specific anti-RBD IgG antibody (anti-RBD) titers is limited, particularly in the context of XBB.1.5-adapted vaccination.
Methods
A direct comparison of neutralizing activity, measured as 50 % neutralization (NT50), and anti-RBD titers, measured using an ELISA, was conducted using serum samples collected in Japan before and after XBB.1.5-adapted mRNA vaccination.
Results
A total of 108 serum samples from 54 patients were analyzed. A strong correlation between neutralizing activity and anti-RBD titers was observed for the wild-type (WT), XBB.1.5, JN.1, and KP.3 strains (r = 0.94, 0.87, 0.86, and 0.82, respectively). This correlation persisted when stratifying pre- and post-vaccination samples (r = 0.92, 0.83, 0.85, and 0.82, respectively, for pre-vaccination samples and r = 0.96, 0.85, 0.82, and 0.75, respectively, for post-vaccination samples). Both NT50 and anti-RBD titers significantly increased against all four tested strains after vaccination (p < 0.001), with the highest fold change observed for the XBB.1.5 variant. Additionally, variant specificity, defined as the ratio of variant to WT values, significantly increased for XBB.1.5, JN.1, and KP.3 after vaccination in NT50 and was also observed in anti-RBD titers.
Conclusions
These findings, demonstrating a strong correlation with neutralizing activity not only against the WT strain but also against the XBB.1.5, JN.1, and KP.3 variants, suggest that strain-specific anti-RBD IgG antibody titers would be useful as an indicator of humoral immunity following XBB.1.5-adapted vaccination.
{"title":"Strain-specific anti-RBD IgG antibody titers against the WT, XBB.1.5, JN.1, and KP.3 strains consistently correlate with neutralizing activity following SARS-CoV-2 XBB.1.5-adapted mRNA vaccination","authors":"Takeyuki Goto , Yong Chong , Tomonori Sato , Naoki Tani , Shouta Saiki , Satoru Ishida , Naoki Kawai , Takuma Bando , Hideyuki Ikematsu","doi":"10.1016/j.jiac.2025.102842","DOIUrl":"10.1016/j.jiac.2025.102842","url":null,"abstract":"<div><h3>Introduction</h3><div>Data on the correlation between SARS-CoV-2 neutralizing activity and strain-specific anti-RBD IgG antibody (anti-RBD) titers is limited, particularly in the context of XBB.1.5-adapted vaccination.</div></div><div><h3>Methods</h3><div>A direct comparison of neutralizing activity, measured as 50 % neutralization (NT<sub>50</sub>), and anti-RBD titers, measured using an ELISA, was conducted using serum samples collected in Japan before and after XBB.1.5-adapted mRNA vaccination.</div></div><div><h3>Results</h3><div>A total of 108 serum samples from 54 patients were analyzed. A strong correlation between neutralizing activity and anti-RBD titers was observed for the wild-type (WT), XBB.1.5, JN.1, and KP.3 strains (r = 0.94, 0.87, 0.86, and 0.82, respectively). This correlation persisted when stratifying pre- and post-vaccination samples (r = 0.92, 0.83, 0.85, and 0.82, respectively, for pre-vaccination samples and r = 0.96, 0.85, 0.82, and 0.75, respectively, for post-vaccination samples). Both NT<sub>50</sub> and anti-RBD titers significantly increased against all four tested strains after vaccination (<em>p</em> < 0.001), with the highest fold change observed for the XBB.1.5 variant. Additionally, variant specificity, defined as the ratio of variant to WT values, significantly increased for XBB.1.5, JN.1, and KP.3 after vaccination in NT<sub>50</sub> and was also observed in anti-RBD titers.</div></div><div><h3>Conclusions</h3><div>These findings, demonstrating a strong correlation with neutralizing activity not only against the WT strain but also against the XBB.1.5, JN.1, and KP.3 variants, suggest that strain-specific anti-RBD IgG antibody titers would be useful as an indicator of humoral immunity following XBB.1.5-adapted vaccination.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102842"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-25DOI: 10.1016/j.jiac.2025.102835
Nguyen Sy Thau , Hong Khanh Vu , Thi Hoai Ngo , Thi Thanh Nhan Pham , Thu Trang Do , Trong The Nguyen
Emphysematous esophagogastritis (EEG) is a rare and potentially fatal infection of the upper gastrointestinal tract, marked by gas within the walls of the esophagus and stomach. It is typically associated with gas-forming organisms such as K. pneumoniae, P. aeruginosa, S. aureus, and S. anginosus; however, we report a unique case caused by Streptococcus constellatus, a species known for its aggressive tissue-invasive behavior but rarely implicated in EEG. A previously healthy adult presented with acute epigastric pain, fever, and septic shock. Computed tomography demonstrated diffuse intramural gas and wall thickening of both the esophagus and stomach, consistent with EEG. Blood cultures identified S. constellatus as the causative pathogen. The patient was managed conservatively with intravenous meropenem, proton pump inhibitors, bowel rest, and intensive supportive care. The patient made a complete clinical recovery without requiring surgery in the acute phase. However, a delayed complication, gastric outlet obstruction due to an antral-pyloric stricture, developed during follow-up and necessitated surgical correction. This case underscores the critical importance of early diagnosis, coordinated multidisciplinary care, and prolonged follow-up in managing EEG, and highlights Streptococcus constellatus as a rare but highly invasive pathogen in this life-threatening condition.
{"title":"Emphysematous Esophagogastritis: a rare and life-threatening presentation of Streptococcus constellatus infection","authors":"Nguyen Sy Thau , Hong Khanh Vu , Thi Hoai Ngo , Thi Thanh Nhan Pham , Thu Trang Do , Trong The Nguyen","doi":"10.1016/j.jiac.2025.102835","DOIUrl":"10.1016/j.jiac.2025.102835","url":null,"abstract":"<div><div>Emphysematous esophagogastritis (EEG) is a rare and potentially fatal infection of the upper gastrointestinal tract, marked by gas within the walls of the esophagus and stomach. It is typically associated with gas-forming organisms such as <em>K. pneumoniae, P. aeruginosa, S. aureus,</em> and <em>S. anginosus</em>; however, we report a unique case caused by <em>Streptococcus constellatus</em>, a species known for its aggressive tissue-invasive behavior but rarely implicated in EEG. A previously healthy adult presented with acute epigastric pain, fever, and septic shock. Computed tomography demonstrated diffuse intramural gas and wall thickening of both the esophagus and stomach, consistent with EEG. Blood cultures identified <em>S. constellatus</em> as the causative pathogen. The patient was managed conservatively with intravenous meropenem, proton pump inhibitors, bowel rest, and intensive supportive care. The patient made a complete clinical recovery without requiring surgery in the acute phase. However, a delayed complication, gastric outlet obstruction due to an antral-pyloric stricture, developed during follow-up and necessitated surgical correction. This case underscores the critical importance of early diagnosis, coordinated multidisciplinary care, and prolonged follow-up in managing EEG, and highlights <em>Streptococcus constellatus</em> as a rare but highly invasive pathogen in this life-threatening condition.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102835"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to develop and evaluate a population pharmacokinetic model and optimal dosing regimen for vancomycin in overweight and obese adults.
Methods
A population pharmacokinetic model using a two-compartment system was constructed using a nonlinear mixed-effects approach, incorporating 527 data points from 184 participants. External validation of the model was carried out using an additional 55 data points from 21 participants; these were not used in the construction of the model. Monte Carlo simulations were used to determine the dosage that achieved the steady state area under the curve value falling between 400 μg h/mL and 600 μg h/mL.
Results
In the final model, vancomycin clearance was found to be a significant predictor of blood vancomycin levels, alongside creatinine clearance (CCr), blood urea nitrogen levels, and incidence of heart failure. CCr was calculated with adjusted body weight (AdjBW). AdjBW was selected as a predictor of the volume of distribution in the central and peripheral compartments. External validation showed that the highest proportion of cases had deviations of less than 15 % between measured and predicted values in the final model developed in this study. This indicates that our model outperforms previously developed models (five for obese patients and four for non-obese patients).
Conclusions
Our model shows that determining effective vancomycin doses for overweight and obese patients depend on estimated CCr rates, AdjBW, BUN levels, and incidence of heart failure.
{"title":"Development and external validation of a population pharmacokinetic model and optimal Vancomycin dosing regimen for overweight and obese patients","authors":"Toshiaki Komatsu , Atsushi Tomizawa , Masaru Samura , Ayako Suzuki , Tomoyuki Ishigo , Satoshi Fujii , Yuta Ibe , Hiroaki Yoshida , Hiroaki Tanaka , Hisato Fujihara , Fumihiro Yamaguchi , Fumiya Ebihara , Takumi Maruyama , Yusuke Yagi , Yukihiro Hamada , Fumio Nagumo , Akitoshi Takuma , Hiroaki Chiba , Yoshifumi Nishi , Yuki Igarashi , Kazuaki Matsumoto","doi":"10.1016/j.jiac.2025.102838","DOIUrl":"10.1016/j.jiac.2025.102838","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to develop and evaluate a population pharmacokinetic model and optimal dosing regimen for vancomycin in overweight and obese adults.</div></div><div><h3>Methods</h3><div>A population pharmacokinetic model using a two-compartment system was constructed using a nonlinear mixed-effects approach, incorporating 527 data points from 184 participants. External validation of the model was carried out using an additional 55 data points from 21 participants; these were not used in the construction of the model. Monte Carlo simulations were used to determine the dosage that achieved the steady state area under the curve value falling between 400 μg h/mL and 600 μg h/mL.</div></div><div><h3>Results</h3><div>In the final model, vancomycin clearance was found to be a significant predictor of blood vancomycin levels, alongside creatinine clearance (CCr), blood urea nitrogen levels, and incidence of heart failure. CCr was calculated with adjusted body weight (AdjBW). AdjBW was selected as a predictor of the volume of distribution in the central and peripheral compartments. External validation showed that the highest proportion of cases had deviations of less than 15 % between measured and predicted values in the final model developed in this study. This indicates that our model outperforms previously developed models (five for obese patients and four for non-obese patients).</div></div><div><h3>Conclusions</h3><div>Our model shows that determining effective vancomycin doses for overweight and obese patients depend on estimated CCr rates, AdjBW, BUN levels, and incidence of heart failure.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102838"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When one kidney is lost, the other works to compensate. The renally excreted antibiotic vancomycin (VCM) requires therapeutic drug monitoring to avoid renal injury and ensure efficacy. However, no studies have clarified whether the dosing regimen for patients with two kidneys can be used in patients with one kidney. We investigated whether patients with one kidney are able to receive VCM with the same dosing regimen as patients with two kidneys.
Methods
This retrospective case series included patients with one kidney who were treated with VCM at Chiba University Hospital. Changes in serum creatinine (Scr) values and VCM trough concentrations were assessed. To evaluate individual VCM pharmacokinetic (PK) parameters in patients with one kidney, we performed Bayesian estimation using two population PK models for Japanese patients with two kidneys.
Results
Six patients with one kidney were included in this study. The median loading dose and maintenance dose were 20.6 mg/kg and 28.3 mg/kg/day, respectively. Scr showed little change from before to after VCM administration (before, median 0.93 [0.72–1.32] mg/dL; after, 0.85 [0.69–1.22] mg/dL), and no patients developed VCM-associated nephrotoxicity. The trough concentration of VCM remained within the effective blood range of 10–20 μg/mL in almost all patients. There was a significant and strong correlation between the observed and Bayesian-estimated VCM trough concentrations for both population PK models.
Conclusion
Patients with one kidney may be able to receive VCM with the same dosing regimen as patients with two kidneys.
{"title":"Analysis of vancomycin administration to patients with one kidney","authors":"Hitomi Motomura , Masashi Uchida , Shingo Yamazaki , Itsuko Ishii","doi":"10.1016/j.jiac.2025.102848","DOIUrl":"10.1016/j.jiac.2025.102848","url":null,"abstract":"<div><h3>Introduction</h3><div>When one kidney is lost, the other works to compensate. The renally excreted antibiotic vancomycin (VCM) requires therapeutic drug monitoring to avoid renal injury and ensure efficacy. However, no studies have clarified whether the dosing regimen for patients with two kidneys can be used in patients with one kidney. We investigated whether patients with one kidney are able to receive VCM with the same dosing regimen as patients with two kidneys.</div></div><div><h3>Methods</h3><div>This retrospective case series included patients with one kidney who were treated with VCM at Chiba University Hospital. Changes in serum creatinine (Scr) values and VCM trough concentrations were assessed. To evaluate individual VCM pharmacokinetic (PK) parameters in patients with one kidney, we performed Bayesian estimation using two population PK models for Japanese patients with two kidneys.</div></div><div><h3>Results</h3><div>Six patients with one kidney were included in this study. The median loading dose and maintenance dose were 20.6 mg/kg and 28.3 mg/kg/day, respectively. Scr showed little change from before to after VCM administration (before, median 0.93 [0.72–1.32] mg/dL; after, 0.85 [0.69–1.22] mg/dL), and no patients developed VCM-associated nephrotoxicity. The trough concentration of VCM remained within the effective blood range of 10–20 μg/mL in almost all patients. There was a significant and strong correlation between the observed and Bayesian-estimated VCM trough concentrations for both population PK models.</div></div><div><h3>Conclusion</h3><div>Patients with one kidney may be able to receive VCM with the same dosing regimen as patients with two kidneys.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102848"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-05DOI: 10.1016/j.jiac.2025.102855
Mohd Saleem , Azharuddin Sajid Syed Khaja , Soha Moursi , Ghorashy Eltayeb Yousif Mohammed , Syed Monowar Alam Shahid , Sahar Hammam , Nuzhat Parveen , Sheeba Afreen
Background and aim
Pelvic inflammatory disease (PID) is a common gynecological condition caused primarily by bacterial pathogens. However, recent evidence suggests that fungal organisms, particularly Candida species, may also contribute, especially in immunocompromised individuals. This study aimed to investigate the ward-wise distribution of PID cases, determine the prevalence of Candida species, and assess their antifungal susceptibility patterns in Hail, Saudi Arabia.
Methods
This retrospective cross-sectional study included 370 PID patients from multiple hospital departments between January 2019 and December 2023. Demographic, clinical, and microbiological data were analyzed. High vaginal swabs were cultured for Candida identification, and antifungal susceptibility testing was performed using the Vitek 2 system. Data were analyzed using SPSS (v.23).
Results
The mean patient age was 34.52 ± 9.73 years, with the highest prevalence among women aged 25–44 years (54.9 %). Most patients were married (60.8 %). Most cases were reported in the gynecology emergency (45.4 %) and the outpatient (31.6 %) wards. Candida albicans was the predominant species (69.8 %), followed by C. glabrata (7.0 %) and other non-albicans species. No significant difference in species distribution was found between the emergency and non-emergency settings (p = 0.263). C. albicans demonstrated high susceptibility to caspofungin (97 %), fluconazole (95 %), and voriconazole (97 %).
Conclusion
Candida species, particularly C. albicans, are prevalent in PID cases in Hail. As a retrospective descriptive study, these findings are preliminary and do not establish causality. Nevertheless, routine fungal diagnostics and antifungal susceptibility testing are recommended, particularly for patients with risk factors or a history of poor response to antibiotic therapy.
{"title":"Distribution and antifungal susceptibility of Candida species in pelvic inflammatory disease patients from Hail, Saudi Arabia: A retrospective study","authors":"Mohd Saleem , Azharuddin Sajid Syed Khaja , Soha Moursi , Ghorashy Eltayeb Yousif Mohammed , Syed Monowar Alam Shahid , Sahar Hammam , Nuzhat Parveen , Sheeba Afreen","doi":"10.1016/j.jiac.2025.102855","DOIUrl":"10.1016/j.jiac.2025.102855","url":null,"abstract":"<div><h3>Background and aim</h3><div>Pelvic inflammatory disease (PID) is a common gynecological condition caused primarily by bacterial pathogens. However, recent evidence suggests that fungal organisms, particularly <em>Candida</em> species, may also contribute, especially in immunocompromised individuals. This study aimed to investigate the ward-wise distribution of PID cases, determine the prevalence of <em>Candida</em> species, and assess their antifungal susceptibility patterns in Hail, Saudi Arabia.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study included 370 PID patients from multiple hospital departments between January 2019 and December 2023. Demographic, clinical, and microbiological data were analyzed. High vaginal swabs were cultured for <em>Candida</em> identification, and antifungal susceptibility testing was performed using the Vitek 2 system. Data were analyzed using SPSS (v.23).</div></div><div><h3>Results</h3><div>The mean patient age was 34.52 ± 9.73 years, with the highest prevalence among women aged 25–44 years (54.9 %). Most patients were married (60.8 %). Most cases were reported in the gynecology emergency (45.4 %) and the outpatient (31.6 %) wards. <em>Candida albicans</em> was the predominant species (69.8 %), followed by <em>C. glabrata</em> (7.0 %) and other non-<em>albicans</em> species. No significant difference in species distribution was found between the emergency and non-emergency settings (p = 0.263). <em>C. albicans</em> demonstrated high susceptibility to caspofungin (97 %), fluconazole (95 %), and voriconazole (97 %).</div></div><div><h3>Conclusion</h3><div><em>Candida</em> species, particularly <em>C. albicans</em>, are prevalent in PID cases in Hail. As a retrospective descriptive study, these findings are preliminary and do not establish causality. Nevertheless, routine fungal diagnostics and antifungal susceptibility testing are recommended, particularly for patients with risk factors or a history of poor response to antibiotic therapy.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102855"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Capnocytophaga canis is a zoonotic pathogen not previously linked to infective endocarditis (IE). We report the first case of recurrent IE caused by C. canis, initially presumed to be culture-negative. The diagnosis was established through prolonged blood culture and 16S rRNA-based analysis.
A 66-year-old man had two hospitalizations within six months for culture-negative IE. No causative pathogen was identified, as all 16 blood culture sets remained negative. Two months after discharge, he presented again with fever and peripheral embolic signs. Echocardiography showed vegetations on both the mitral and aortic valves, consistent with recurrent IE. Prolonged incubation of repeat blood cultures yielded Gram-negative rods on the seventh day. Conventional methods failed to identify the organism. Subsequent 16S rRNA-based analysis at a reference laboratory identified C. canis. The patient had close daily contact with a domestic cat, suggesting a zoonotic source. He underwent double valve replacement and received six weeks of intravenous antibiotics, with a favorable outcome.
This case provides some clinical insights. First, C. canis should be considered as a potential pathogen in culture-negative IE, particularly in patients with animal exposure. Second, C. canis IE may present with a subacute or recurrent course with minimal valvular damage, making early recognition difficult. Careful history-taking, prolonged blood cultures, and molecular diagnostic methods are essential for accurate evaluation of culture-negative IE.
{"title":"First case of infective endocarditis caused by Capnocytophaga canis: Confirmed by prolonged blood culture and molecular analysis","authors":"Tatsuro Wakizaka , Kenichiro Yokoi , Hiroyuki Ote , Chikao Teramoto , Takenori Yamazaki , Kiyofumi Ohkusu","doi":"10.1016/j.jiac.2025.102850","DOIUrl":"10.1016/j.jiac.2025.102850","url":null,"abstract":"<div><div><em>Capnocytophaga canis</em> is a zoonotic pathogen not previously linked to infective endocarditis (IE). We report the first case of recurrent IE caused by <em>C. canis</em>, initially presumed to be culture-negative. The diagnosis was established through prolonged blood culture and 16S rRNA-based analysis.</div><div>A 66-year-old man had two hospitalizations within six months for culture-negative IE. No causative pathogen was identified, as all 16 blood culture sets remained negative. Two months after discharge, he presented again with fever and peripheral embolic signs. Echocardiography showed vegetations on both the mitral and aortic valves, consistent with recurrent IE. Prolonged incubation of repeat blood cultures yielded Gram-negative rods on the seventh day. Conventional methods failed to identify the organism. Subsequent 16S rRNA-based analysis at a reference laboratory identified <em>C</em>. <em>canis</em>. The patient had close daily contact with a domestic cat, suggesting a zoonotic source. He underwent double valve replacement and received six weeks of intravenous antibiotics, with a favorable outcome.</div><div>This case provides some clinical insights. First, <em>C. canis</em> should be considered as a potential pathogen in culture-negative IE, particularly in patients with animal exposure. Second, <em>C. canis</em> IE may present with a subacute or recurrent course with minimal valvular damage, making early recognition difficult. Careful history-taking, prolonged blood cultures, and molecular diagnostic methods are essential for accurate evaluation of culture-negative IE.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102850"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-17DOI: 10.1016/j.jiac.2025.102834
Eisuke Adachi , Yoshiyuki Yokomaku , Dai Watanabe , Hiroyuki Gatanaga , Shinichi Oka , Takuma Shirasaka , Ronald D’Amico , Kenneth Sutton , Denise Sutherland-Phillips , Jeremy Roberts , John Thornhill , Andrew Murungi , Kimberley Brown
Cabotegravir + rilpivirine (CAB + RPV) dosed every 2 months (Q2M) is the only complete long-acting (LA) regimen for maintaining HIV-1 virologic suppression. In some regions, prescribing information mandates a 4-week oral lead-in (OLI) before initiating CAB + RPV LA. To support clinical decision-making in these areas, we report a pre-specified analysis in adults living with HIV-1 who switched to CAB + RPV LA with an OLI versus continuing daily oral bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for maintaining virologic suppression in the Phase 3b, randomized, open-label, SOLAR study. In SOLAR, participants with HIV-1 RNA <50 copies/mL were randomized (2:1) to either intramuscular CAB + RPV LA Q2M, with a 1-month optional once-daily OLI of CAB + RPV, or to continue daily oral BIC/FTC/TAF. Month 12 endpoints included virologic response, safety, and patient-reported outcomes. Of 670 participants, 173 (39 %) switched to CAB + RPV LA with OLI, 274 (61 %) switched to CAB + RPV LA starting directly with injections, and 223 (33 %) continued BIC/FTC/TAF. At Month 12, the proportions of participants with HIV-1 RNA ≥50 copies/mL (CAB + RPV LA OLI, 1 % [n = 2/173]; BIC/FTC/TAF, <1 % [n = 1/223]) and HIV-1 RNA <50 copies/mL (CAB + RPV LA OLI, 87 % [n = 151/173]; BIC/FTC/TAF, 93 % [n = 207/223]) were similar between arms. Excluding injection site reactions, adverse events were comparable between arms; however, more participants in the CAB + RPV LA OLI arm had adverse events leading to withdrawal (5 % [n = 8/173] versus <1 % [n = 2/227]). Overall, 87 % (n = 142/163) of participants who switched preferred CAB + RPV LA OLI to BIC/FTC/TAF. Switching to CAB + RPV LA OLI demonstrated comparable efficacy to continuing BIC/FTC/TAF, was well tolerated and preferred by most participants who switched.
{"title":"Month 12 outcomes of switching to long-acting cabotegravir + rilpivirine with an oral lead-in versus continuing bictegravir/emtricitabine/tenofovir alafenamide in the Phase 3b randomized SOLAR study","authors":"Eisuke Adachi , Yoshiyuki Yokomaku , Dai Watanabe , Hiroyuki Gatanaga , Shinichi Oka , Takuma Shirasaka , Ronald D’Amico , Kenneth Sutton , Denise Sutherland-Phillips , Jeremy Roberts , John Thornhill , Andrew Murungi , Kimberley Brown","doi":"10.1016/j.jiac.2025.102834","DOIUrl":"10.1016/j.jiac.2025.102834","url":null,"abstract":"<div><div>Cabotegravir + rilpivirine (CAB + RPV) dosed every 2 months (Q2M) is the only complete long-acting (LA) regimen for maintaining HIV-1 virologic suppression. In some regions, prescribing information mandates a 4-week oral lead-in (OLI) before initiating CAB + RPV LA. To support clinical decision-making in these areas, we report a pre-specified analysis in adults living with HIV-1 who switched to CAB + RPV LA with an OLI versus continuing daily oral bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for maintaining virologic suppression in the Phase 3b, randomized, open-label, SOLAR study. In SOLAR, participants with HIV-1 RNA <50 copies/mL were randomized (2:1) to either intramuscular CAB + RPV LA Q2M, with a 1-month optional once-daily OLI of CAB + RPV, or to continue daily oral BIC/FTC/TAF. Month 12 endpoints included virologic response, safety, and patient-reported outcomes. Of 670 participants, 173 (39 %) switched to CAB + RPV LA with OLI, 274 (61 %) switched to CAB + RPV LA starting directly with injections, and 223 (33 %) continued BIC/FTC/TAF. At Month 12, the proportions of participants with HIV-1 RNA ≥50 copies/mL (CAB + RPV LA OLI, 1 % [n = 2/173]; BIC/FTC/TAF, <1 % [n = 1/223]) and HIV-1 RNA <50 copies/mL (CAB + RPV LA OLI, 87 % [n = 151/173]; BIC/FTC/TAF, 93 % [n = 207/223]) were similar between arms. Excluding injection site reactions, adverse events were comparable between arms; however, more participants in the CAB + RPV LA OLI arm had adverse events leading to withdrawal (5 % [n = 8/173] versus <1 % [n = 2/227]). Overall, 87 % (n = 142/163) of participants who switched preferred CAB + RPV LA OLI to BIC/FTC/TAF. Switching to CAB + RPV LA OLI demonstrated comparable efficacy to continuing BIC/FTC/TAF, was well tolerated and preferred by most participants who switched.</div><div>ClinicalTrials.gov; NCT04542070 (<span><span>https://clinicaltrials.gov/study/NCT04542070</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102834"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lelliottia amnigena is a facultative anaerobe that is generally considered to show low pathogenicity, and few reports have described human infection. We describe herein a case of bacteremia due to L. amnigena in a patient with sigmoid colon cancer and schizophrenia. A 64-year-old Japanese man with schizophrenia was transferred to our hospital from a psychiatric hospital after experiencing several weeks of bloody bowel discharge and fever. He presented with hypotension, an elevated white blood cell count, raised levels of C-reactive protein, and decreased hemoglobin levels. Blood culture on transfer to our hospital detected Gram-negative rods, identified as L. amnigena by matrix-assisted laser desorption/ionization mass spectrometry and 16S rRNA gene sequencing. Antimicrobial therapy was initiated with piperacillin/tazobactam, which was later de-escalated to ampicillin/sulbactam according to the results of antimicrobial susceptibility testing, resulting in a total of 14 days of antimicrobial treatment. Computed tomography and colonoscopy revealed that the patient had sigmoid colon cancer, which was subsequently surgically resected. The sigmoid colon cancer was considered to represent the gateway for L. amnigena entry into the bloodstream. The course of treatment was favorable and the patient was transferred back to the original hospital 98 days after admission. L. amnigena bacteremia has rarely been reported, and the present case appears to represent the first detailed description. L. amnigena can cause bacteremia and sometimes lead to serious conditions in patients.
{"title":"Lelliottia amnigena bacteremia in a patient with sigmoid colon cancer and schizophrenia: a case report","authors":"Hiroshi Umemura , Yumiko Tanimichi , Ayami Karita , Hirokazu Kobayashi , Masaki Nakajima , Sachio Tsuchida , Fumitaka Ihara , Yuta Kojima , Suguru Nakajima , Kou Nagai , Tadashi Kanamori , Masahiro Suzuki , Kiyofumi Ohkusu , Tomohiro Nakayama","doi":"10.1016/j.jiac.2025.102858","DOIUrl":"10.1016/j.jiac.2025.102858","url":null,"abstract":"<div><div><em>Lelliottia amnigena</em> is a facultative anaerobe that is generally considered to show low pathogenicity, and few reports have described human infection. We describe herein a case of bacteremia due to <em>L. amnigena</em> in a patient with sigmoid colon cancer and schizophrenia. A 64-year-old Japanese man with schizophrenia was transferred to our hospital from a psychiatric hospital after experiencing several weeks of bloody bowel discharge and fever. He presented with hypotension, an elevated white blood cell count, raised levels of C-reactive protein, and decreased hemoglobin levels. Blood culture on transfer to our hospital detected Gram-negative rods, identified as <em>L. amnigena</em> by matrix-assisted laser desorption/ionization mass spectrometry and 16S rRNA gene sequencing. Antimicrobial therapy was initiated with piperacillin/tazobactam, which was later de-escalated to ampicillin/sulbactam according to the results of antimicrobial susceptibility testing, resulting in a total of 14 days of antimicrobial treatment. Computed tomography and colonoscopy revealed that the patient had sigmoid colon cancer, which was subsequently surgically resected. The sigmoid colon cancer was considered to represent the gateway for <em>L. amnigena</em> entry into the bloodstream. The course of treatment was favorable and the patient was transferred back to the original hospital 98 days after admission. <em>L. amnigena</em> bacteremia has rarely been reported, and the present case appears to represent the first detailed description. <em>L. amnigena</em> can cause bacteremia and sometimes lead to serious conditions in patients.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 12","pages":"Article 102858"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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