Journal of Infection and Chemotherapy最新文献_第4页

A comparative study of out-of-pocket expenditure and quality of life in chronic pulmonary aspergillosis and post-tuberculosis lung disease patients 慢性肺曲霉病与结核后肺病患者自费支出与生活质量的比较研究。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102873

Renuka Titiyal , Sanjukta Sarkar , Megha Priyadarshi , Ved Prakash Meena , Prayas Sethi , G. Rahul Krishnan , Bindu Prakash , Gagandeep Singh , Immaculata Xess , Surabhi Vyas , Neeraj Nischal , Manish Soneja , Sanjeev Sinha , Naveet Wig , Animesh Ray

Background

Chronic pulmonary aspergillosis (CPA) comprises a spectrum of conditions that frequently affect individuals with chronic lung diseases, particularly post-tuberculosis lung disease (PTLD). Both disorders contribute to significant morbidity and impaired quality of life (QoL). In addition, they impose financial burden, much of which is borne directly by patients in low- and middle-income countries. However, data on out-of-pocket expenditure (OOPE) and its relationship with QoL in these groups remain limited.

Methods

This cross-sectional study, conducted at a tertiary referral centre in India, aimed to estimate OOPE (direct and indirect costs) in patients with CPA and PTLD, identify determinants of expenditure, and assess associations with QoL. Data on OOPE, borrowing, and catastrophic health expenditure during the preceding year were collected through structured interviews. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). Results: Both the direct ($406.42 ± 543.95 vs $251.81 ± 245.42, p value: 0.0038) and indirect costs ($49.93 ± 72.07 vs $39.81 ± 123.32, p value: 0.001) were significantly higher in the CPA group compared with the PTLD group. Subgroup analyses revealed higher diagnostic, transport, and food-related expenses in CPA individuals. Catastrophic expenditure was comparable in both groups (CPA: 60.5 %; PTLD: 67.9 %; p:0.325). Hemoptysis independently predicted poorer QoL across groups. QoL was significantly worse in CPA than PTLD (SGRQ total: 37.32 vs 31.16, p: 0.0125) and significant correlation between OOPE and QoL.

Conclusion

CPA imposes a greater financial burden and is associated with a poorer QoL compared with PTLD, underscoring the need for financial protection measures to improve outcomes in these patients.

背景：慢性肺曲霉病（CPA）包括一系列经常影响慢性肺病患者的疾病，特别是结核后肺病（PTLD）。这两种疾病都会导致显著的发病率和生活质量（QoL）受损。此外，它们造成经济负担，其中大部分由低收入和中等收入国家的患者直接承担。然而，关于自费支出（OOPE）及其与这些群体生活质量关系的数据仍然有限。方法：这项横断面研究在印度的一家三级转诊中心进行，旨在估计CPA和PTLD患者的OOPE（直接和间接成本），确定支出的决定因素，并评估与生活质量的关系。通过结构化访谈收集了前一年的对外开放、借款和灾难性卫生支出数据。使用圣乔治呼吸问卷（SGRQ）评估生活质量。结果：CPA组的直接成本（$406.42 + 543.95 vs $251.81 + 245.42， p值：0.0038）和间接成本（$49.93 + 72.07 vs $39.81+ 123.32， p值：0.001）均显著高于PTLD组。亚组分析显示，CPA个体的诊断、运输和食品相关费用较高。两组的灾难性支出具有可比性（CPA: 60.5%; PTLD: 67.9%; p:0.325）。咯血独立预测各组较差的生活质量。CPA患者的生活质量明显差于PTLD患者（SGRQ总分：37.32 vs 31.16, p: 0.0125）， OOPE与生活质量之间存在显著相关性。结论：与PTLD相比，CPA患者的经济负担和生活质量负担更大，需要采取经济保护措施来改善这些患者的预后。

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引用次数: 0

Recurrent familial furunculosis associated with Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus sublineage of the USA300 clone in Tokyo 复发性家族性真菌病与东京USA300克隆的潘通-瓦伦丁白细胞素阳性耐甲氧西林金黄色葡萄球菌亚系相关

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102872

Ayano Fukushima-Nomura , Saeko Takamiyagi , Yoshihiro Ito , Kaede Sawada , Hiroshi Kawasaki , Motoyuki Sugai , Junzo Hisatsune

We report a familial case of recurrent furunculosis caused by Panton-Valentine leukocidin (PVL)-positive community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Tokyo. The index case, a 34-year-old female, and her family members (her husband and their 8-month-old son) were also affected, and all recovered after treatment with oral clindamycin, intranasal mupirocin, and hygiene interventions. Whole-genome sequencing revealed that five isolates from skin and nasal swabs belonged to ST8-IVa-t304, carrying ACME type I and PVL genes. All isolates were resistant to levofloxacin but susceptible to other anti-MRSA agents. Genomic analysis showed the absence of the SaPI5 island and the sek/seq genes. Based on phylogenetic analysis, we concluded that these strains represent a unique USA300-like sublineage that diverged from the closest USA300-NAE lineage. The USA300 clone has emerged globally as a dominant CA-MRSA lineage responsible for severe skin and soft tissue infections. In Japan, PVL-positive USA300-related clones have been increasingly identified in recent years, indicating ongoing diversification of community-associated MRSA lineages. This case illustrates the growing presence of USA300-related clones in Japan and the need for genomic surveillance and early intervention to prevent further spread in community settings.

我们报告一例东京潘通-瓦伦丁白细胞素（PVL）阳性社区相关耐甲氧西林金黄色葡萄球菌（CA-MRSA）引起的复发性肺结核的家族性病例。指示病例为一名34岁女性及其家庭成员（其丈夫及其8个月大的儿子）也受到影响，经口服克林霉素、鼻用莫匹罗星和卫生干预治疗后全部康复。全基因组测序结果显示，来自皮肤和鼻拭子的5株分离株属于ST8-IVa-t304，携带ACME I型和PVL基因。所有分离株均对左氧氟沙星耐药，但对其他抗mrsa药物敏感。基因组分析显示SaPI5岛和sek/seq基因缺失。基于系统发育分析，我们得出结论，这些菌株代表了一个独特的usa300样亚谱系，从最近的USA300-NAE谱系中分化出来。USA300克隆在全球范围内已成为CA-MRSA的主要分支，可导致严重的皮肤和软组织感染。在日本，近年来越来越多地发现pvl阳性usa300相关克隆，这表明社区相关MRSA谱系正在不断多样化。该病例表明，日本出现了越来越多的usa300相关克隆，需要进行基因组监测和早期干预，以防止在社区环境中进一步传播。

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引用次数: 0

Factors associated with TDF-to-TAF switching in chronic hepatitis B: A nationwide cohort study in South Korea 慢性乙型肝炎患者tdf - taf转换相关因素：韩国一项全国性队列研究

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102860

Hyemin Ha , Kwang Il Seo , Nam Kyung Je

Background

Chronic hepatitis B, a primary cause of liver disease and cancer, requires long-term antiviral therapy. Tenofovir alafenamide (TAF), a novel targeted prodrug of tenofovir disoproxil fumarate (TDF), has reduced renal and bone toxicities while delivering comparable antiviral efficacy at a lower dose. This study aimed to identify factors associated with TAF switching within one year of its introduction in patients receiving TDF.

Methods

This retrospective cohort study included adult patients (≥18 years) with chronic hepatitis B who were receiving TDF on the day TAF became reimbursable in Korea, November 1, 2017. Antiviral prescriptions were tracked for one year to identify patients who switched to TAF. Switching rates were calculated as events per 100 person-months. Factors associated with TAF switching were evaluated using Cox proportional hazards models.

Results

Among 95,819 patients receiving TDF on the index date, 1.4 % switched to TAF within one year. Switching was more likely in males, older adults, and those with hypertension, renal disease, or bone disease. Use of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin II receptor blockers (ARBs) was associated with an increased likelihood of switching, whereas nonsteroidal anti-inflammatory drug use and the presence of hepatocellular carcinoma were associated with lower odds. Patients treated in Seoul and at tertiary hospitals had higher switching rates than those in other regions or healthcare settings.

Conclusion

In this nationwide cohort study, the TAF switching rate among patients receiving TDF was 1.4 % within one year of TAF's reimbursement approval in South Korea. Switching was significantly associated with renal disease, bone disease, age ≥60 years, hypertension, and ACEi/ARB use. Although the higher switching rate in patients with renal or bone disease aligns with reimbursement criteria, other at-risk groups not currently covered may benefit from earlier access.

背景：慢性乙型肝炎是肝脏疾病和癌症的主要原因，需要长期抗病毒治疗。替诺福韦alafenamide （TAF）是富马酸替诺福韦二氧吡酯（TDF）的一种新型靶向前药，在降低肾脏和骨骼毒性的同时，以较低剂量提供相当的抗病毒效果。本研究旨在确定在接受TDF的患者引入TAF后一年内与TAF转换相关的因素。方法：这项回顾性队列研究纳入了2017年11月1日在韩国TAF可报销当日接受TDF治疗的成年慢性乙型肝炎患者（≥18岁）。抗病毒药物的处方被追踪了一年，以确定那些转而使用TAF的患者。转换率以每100人月的事件数计算。使用Cox比例风险模型评估与TAF转换相关的因素。结果：在指标日接受TDF的95,819例患者中，1.4%的患者在一年内转为TAF。在男性、老年人、高血压、肾病或骨病患者中更有可能发生转换。血管紧张素转换酶抑制剂(ACEis)/血管紧张素受体阻滞剂（ARBs）的使用与转换的可能性增加相关，而非甾体抗炎药的使用和肝细胞癌的存在与转换的可能性较低相关。在首尔和三级医院接受治疗的患者的转换率高于其他地区或医疗机构。结论：在这项全国性队列研究中，韩国接受TDF的患者在TAF报销批准后一年内的TAF转换率为1.4%。转换与肾脏疾病、骨病、年龄≥60岁、高血压和ACEi/ARB使用显著相关。虽然肾病或骨病患者较高的转换率符合报销标准，但目前未覆盖的其他高危人群可能会从早期准入中受益。

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引用次数: 0

Corrigendum to "Development of traceable international standard materials using sequence-customized lentivirus, modeled on SARS-CoV-2 nucleic acid amplification tests, and validation through a pilot external quality assessment" [J Infect Chemother 31 (5) 2025 102694]. 基于SARS-CoV-2核酸扩增试验的序列定制慢病毒可溯源国际标准材料开发及外部质量试点评估验证[j].感染与化疗杂志，第31卷，第5期，2025,102694。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102880

Mizuki Itano, Kotaro Aoki, Haruka Nakagawa Kamura, Yoshikazu Ishii, Kazuhiro Tateda

引用次数: 0

The current status of neonatal echovirus 11 infections in Japan: A comparison to the global situation 日本新生儿埃可病毒11型感染现状：与全球比较

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102879

Takanori Funaki , Kensuke Shoji

Enteroviruses (EVs) are one of the most common causes of severe neonatal infections. The spectrum of diseases varies with age, sex, and immune status. As molecular methods have evolved, several new EVs have been identified, bringing the total number of serotypes to over 100. Since 2022, the World Health Organization has published Disease Outbreak News on echovirus 11 (E11) infections due to an increase in severe neonatal E11 infections in several European countries. In Japan, several life-threatening neonatal cases were also reported in the summer of 2024. Clinical characteristics of severe cases include rapid clinical deterioration with multiorgan failure, hemophagocytic lymphohistiocytosis-like inflammatory features, and a high mortality rate. Male infants are likely to experience severe outcomes, specifically in neonates, onset soon after birth, and possible maternal peripartum infection. Meanwhile, older infants with aseptic meningitis often show mild, self-limited disease. Genomic characteristics indicate that a new recombinant genotype D5 is the predominant circulating E11 lineage worldwide. Recent severe neonatal cases linked to a closely related genetic variant that may have increased pathogenicity. This evidence suggests both viral evolution and immature neonatal immunity may contribute to the disease severity. Given the newly initiated nationwide surveillance in Japan, enhanced EV surveillance and rapid genomic characterization are crucial for early identification of severe E11 infection in neonates.

肠病毒（ev）是严重新生儿感染的最常见原因之一。疾病的范围因年龄、性别和免疫状况而异。随着分子方法的发展，已经发现了几种新的ev，使血清型总数超过100种。自2022年以来，世界卫生组织发布了关于埃可病毒11 （E11）感染的疾病暴发新闻，原因是几个欧洲国家新生儿严重感染E11的病例有所增加。在日本，2024年夏天也报告了几例危及生命的新生儿病例。重症病例的临床特点为临床迅速恶化，伴多器官功能衰竭，有噬血细胞淋巴组织细胞病样炎症特征，病死率高。男性婴儿可能会经历严重的后果，特别是新生儿，出生后不久发病，并可能出现母体围产期感染。同时，年龄较大的无菌性脑膜炎患儿通常表现为轻度、自限性疾病。基因组特征表明，新的重组基因型D5是世界范围内主要的循环E11谱系。最近的严重新生儿病例与一种密切相关的基因变异有关，这种变异可能增加了致病性。这一证据表明，病毒进化和不成熟的新生儿免疫都可能导致疾病的严重程度。鉴于日本新启动的全国监测，加强EV监测和快速基因组鉴定对于早期识别新生儿严重E11感染至关重要。

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引用次数: 0

Multi-biomarker integration in predicting bedaquiline treatment response among diabetic MDR-TB patients 多生物标志物整合预测糖尿病耐多药结核病患者贝达喹啉治疗反应。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-11-26 DOI: 10.1016/j.jiac.2025.102878

Liqing Zhu , Mengmeng Li , Zhongjian Wang

Background

Diabetes mellitus significantly complicates multidrug-resistant tuberculosis (MDR-TB) treatment outcomes. This study investigated the predictive value of integrating bedaquiline pharmacokinetics, inflammatory markers, and glycemic parameters for treatment response in diabetic MDR-TB patients.

Methods

We conducted a retrospective cohort study of 186 patients with MDR-TB and diabetes mellitus receiving bedaquiline-containing regimens from January 2019 to December 2023. Bedaquiline trough concentrations, inflammatory markers (CRP, IL-6, TNF-α), and glycemic indices (HbA1c, fasting glucose) were measured at baseline and during follow-up. The primary outcome was sputum culture conversion or clinical improvement at 6 months. Multivariate logistic regression identified predictors of treatment response, and a predictive model was developed using 70 % training and 30 % validation cohorts.

Results

Overall treatment response rate was 72.0 %. Responders demonstrated significantly higher bedaquiline trough concentrations and better glycemic control. The integrated predictive model incorporating bedaquiline concentration, baseline CRP, HbA1c, and HbA1c change achieved superior discrimination compared to individual biomarkers. Subgroup analysis revealed a critical interaction between glycemic control and drug exposure, with poor glycemic control patients showing 0 % response in the lowest bedaquiline quartile but 100 % response in higher quartiles.

Conclusions

Multi-biomarker integration effectively predicts bedaquiline treatment response in diabetic MDR-TB patients. The synergistic relationship between adequate drug exposure and glycemic control underscores the necessity for integrated therapeutic drug monitoring and diabetes management strategies in this high-risk population.

背景：糖尿病严重影响耐多药结核病（MDR-TB）的治疗结果。本研究探讨了整合贝达喹啉药代动力学、炎症标志物和血糖参数对糖尿病耐多药结核病患者治疗反应的预测价值。方法：我们对2019年1月至2023年12月接受含贝达喹啉方案治疗的186例耐多药结核病和糖尿病患者进行了回顾性队列研究。在基线和随访期间测量贝达喹啉谷浓度、炎症标志物（CRP、IL-6、TNF-α）和血糖指数（HbA1c、空腹血糖）。主要结果为6个月时痰培养转化或临床改善。多变量逻辑回归确定了治疗反应的预测因素，并使用70%的训练队列和30%的验证队列建立了预测模型。结果：总有效率为72.0%。反应者表现出明显更高的贝达喹啉谷浓度和更好的血糖控制。与单个生物标志物相比，结合贝达喹啉浓度、基线CRP、HbA1c和HbA1c变化的综合预测模型具有更好的辨别能力。亚组分析显示血糖控制和药物暴露之间存在关键的相互作用，血糖控制较差的患者在最低的贝达喹啉四分位数中显示0%的应答，而在较高的四分位数中显示100%的应答。结论：多生物标志物整合可有效预测糖尿病耐多药结核病患者贝达喹啉治疗反应。充分的药物暴露和血糖控制之间的协同关系强调了在这一高危人群中进行综合治疗药物监测和糖尿病管理策略的必要性。

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引用次数: 0

Chronic pulmonary coccidioidomycosis complicated with meningitis: A case report 慢性肺球虫菌病合并脑膜炎1例。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-11-22 DOI: 10.1016/j.jiac.2025.102870

Ryo Mizushima , Yuki Moriyama , Akira Watanabe , Keigo Ueno , Takayuki Shinohara , Yoshitsugu Miyazaki , Norio Ohmagari

We encountered a case of chronic pulmonary coccidioidomycosis complicated with meningitis in a 53-year-old African-American veteran with a history of staying in Arizona, United States of America. The patient was referred from another hospital with complaints of cough, blood-stained phlegm, hemoptysis, and headache. Chronic pulmonary coccidioidomycosis was suspected based on the presence of multiple pulmonary cavity lesions on computed tomography (CT) and a relevant exposure history, and the diagnosis was confirmed by serological antibody tests (coccidioidomycosis IgG, positive; coccidioidomycosis IgM, negative). Treatment was initiated with oral fluconazole (FLCZ) 400 mg daily, but there was no improvement in symptoms, and CT revealed gradual enlargement of the pulmonary cavitary lesions. Therefore, the oral FLCZ dose was increased to 800 mg; however, the patient developed worsening headache, and subsequent cerebrospinal fluid analysis revealed a slight increase in cell count with positive IgG, negative IgM, and negative polymerase chain reaction results. Suspecting meningitis, the oral FLCZ dose was further increased to 1200 mg, leading to marked improvement in symptoms at the following visit. In coccidioidomycosis, an increase in any antibody titer should be considered an indicator of active infection. In addition, if headache develops during the course of the disease, appropriate treatment for meningitis should be initiated even if cerebrospinal fluid findings are minimal.

我们遇到了一例慢性肺球虫菌病合并脑膜炎的病例，患者是一位53岁的非裔美国退伍军人，曾在美国亚利桑那州居住。患者从另一家医院转诊，主诉为咳嗽、痰染血、咯血和头痛。基于计算机断层扫描（CT）显示肺部多腔病变及相关暴露史，怀疑为慢性肺球孢子菌病，并通过血清学抗体检测（球孢子菌病IgG阳性，球孢子菌病IgM阴性）确认诊断。治疗开始时口服氟康唑（FLCZ） 400mg，每日，但症状没有改善，CT显示肺空洞病变逐渐扩大。因此，口服FLCZ剂量增加至800 mg；然而，患者头痛加重，随后的脑脊液分析显示细胞计数轻微增加，IgG阳性，IgM阴性，聚合酶链反应阴性。怀疑是脑膜炎，口服氟氯联苯剂量进一步增加到1200毫克，导致在接下来的访问中症状明显改善。在球孢子菌病中，任何抗体滴度的增加都应被视为活动性感染的指标。此外，如果在疾病过程中出现头痛，即使脑脊液发现很少，也应开始适当的脑膜炎治疗。

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引用次数: 0

Longitudinal monitoring of Toxoplasma gondii antibodies in people with HIV in Japan 日本HIV感染者弓形虫抗体的纵向监测。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-11-21 DOI: 10.1016/j.jiac.2025.102867

Tokio Hoshina , Tomomi Miyamoto , Makiko Miyajima , Kwangyole Lee , Tetsuya Horino , Hirotaka Kanuka , Masaki Yoshida

Introduction

While the decline of Toxoplasma gondii IgG (TpIgG) titers over time has been documented in HIV-negative populations, the long-term trajectory of TpIgG in people with HIV (PWH) receiving antiretroviral therapy (ART) remains poorly understood. Moreover, potential associations with ART and CD4-positive lymphocyte count have not yet been clarified.

Methods

This single-center, cross-sectional study was conducted between 2021 and 2022 at Jikei University Hospital. TpIgG titers were measured by ELISA in PWH who visited the hospital during the study period and were compared with results from our previous cross-sectional survey performed in 2015–2016. Clinical information, including CD4 profiles and duration of ART, was extracted from medical records to evaluate correlations with longitudinal changes in TpIgG titers. In addition, historical TpIgG measurements recorded outside of the 2015–2016 and 2021–2022 surveys were retrieved from medical records to provide extended longitudinal observations.

Results

Among 416 PWH enrolled, 7.2 % (30/416) tested positive for TpIgG in 2021–2022, with no significant demographic differences between TpIgG-positive and -negative groups. In 22 participants with paired measurements from 2015 to 2016 and 2021–2022, TpIgG titers showed a significant decline over time (p = 0.00593). While antibody trajectories were generally downward, correlation analyses revealed no significant associations between TpIgG changes and nadir CD4 count, CD4 recovery, or ART duration.

Conclusions

TpIgG titers significantly declined during long-term ART, with no clear correlation to immunological parameters. Continued monitoring and further research are warranted to clarify the clinical implications of these antibody dynamics.

导读：虽然在HIV阴性人群中，弓形虫IgG （TpIgG）滴度随着时间的推移而下降，但在接受抗逆转录病毒治疗（ART）的HIV感染者（PWH）中，TpIgG的长期变化轨迹仍然知之甚少。此外，与ART和cd4阳性淋巴细胞计数的潜在关联尚未明确。方法：这项单中心横断面研究于2021年至2022年在冀庆大学医院进行。在研究期间到访医院的PWH患者中，采用ELISA检测TpIgG滴度，并与我们之前2015-2016年进行的横断面调查结果进行比较。从医疗记录中提取临床信息，包括CD4谱和ART持续时间，以评估与TpIgG滴度纵向变化的相关性。此外，从医疗记录中检索了2015-2016年和2021-2022年调查之外记录的TpIgG历史测量值，以提供扩展的纵向观察。结果：在纳入的416名PWH患者中，7.2%（30/416）在2021-2022年TpIgG检测呈阳性，TpIgG阳性组和阴性组之间无显著人口统计学差异。在2015-2016年和2021-2022年进行配对测量的22名参与者中，TpIgG滴度随时间显著下降（p = 0.00593）。虽然抗体轨迹通常是下降的，但相关分析显示TpIgG变化与最低点CD4计数、CD4恢复或抗逆转录病毒治疗持续时间之间没有显著关联。结论：长期抗逆转录病毒治疗期间，TpIgG滴度明显下降，与免疫参数无明显相关性。继续监测和进一步的研究是必要的，以澄清这些抗体动力学的临床意义。

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引用次数: 0

Central nervous system cryptococcosis with brain stem hemorrhage during chemotherapy for pediatric acute myeloblastic leukemia patient 小儿急性髓母细胞白血病化疗期间中枢神经系统隐球菌病并发脑干出血

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-11-21 DOI: 10.1016/j.jiac.2025.102876

Sawa Tomomatsu , Kozo Nagai , Kanji Tsuruta , Yoshito Honma , Sanae Kawakami , Fumihiro Ochi , Eiichi Yamamoto

Cryptococcosis is a deep-seated fungal disease caused by the fungus Cryptococcus neoformans and is known to be a rare occurrence in cancer patients during chemotherapy. A 10-year-old girl was diagnosed with acute myeloid leukemia (AML), and intensive chemotherapy was initiated following the JPLSG-AML-20 protocol. Complete remission was achieved after the first induction therapy. She reached nadir following the third consolidation chemotherapy and suffered from high-grade fever. Subsequently, right hemiplegia and left abducens nerve palsy appeared, and MRI revealed two loci of T1 low/T2 high intensity in the brain stem area. Cerebrospinal fluid (CSF) analysis did not show any common inflammatory findings, but cryptococcus neoformans was detected by a Biofire® FilmArray® meningitis/encephalitis (ME) panel. She received a combination of liposomal amphotericin B for six weeks and 5-fluorocytosine for four weeks as induction therapy, followed by maintenance therapy with fluconazole for 12 months. During recovery from bone marrow suppression, the patient developed immune reconstitution inflammatory syndrome (IRIS) accompanied by worsening headache and vomiting, which improved with steroids. Right hemiplegia gradually improved within a month and left abducens nerve palsy resolved at 4 months after initiation of treatment. We experienced an atypical case of cryptococcal meningoencephalitis presenting with stroke-like symptoms during intensive chemotherapy. When a central nervous system (CNS) infection occurs during neutropenia, abnormalities in the CSF examination are less likely to be detected. Multiplex genetic testing of CSF may be considered a useful diagnostic adjunct in immunocompromised patients with neurologic symptoms.

隐球菌病是一种由新型隐球菌引起的深层真菌疾病，在癌症患者化疗期间罕见发生。一名10岁女孩被诊断为急性髓性白血病（AML），并根据JPLSG-AML-20方案开始强化化疗。第一次诱导治疗后完全缓解。她在第三次巩固化疗后达到最低点，并出现高热。随后出现右半瘫、左展神经麻痹，MRI示脑干区T1低/T2高2个位点。脑脊液（CSF）分析未显示任何常见的炎症发现，但通过Biofire®FilmArray®脑膜炎/脑炎（ME）小组检测到新型隐球菌。患者接受两性霉素B脂质体联合诱导治疗6周，5-氟胞嘧啶联合诱导治疗4周，随后氟康唑维持治疗12个月。在骨髓抑制恢复期间，患者出现免疫重建炎症综合征（IRIS），并伴有头痛和呕吐加重，类固醇治疗后症状得到改善。右偏瘫在1个月内逐渐改善，左外展神经麻痹在开始治疗后4个月消退。我们经历了一个不典型的隐球菌性脑膜脑炎病例，在强化化疗期间出现中风样症状。当中性粒细胞减少期间发生中枢神经系统（CNS）感染时，脑脊液检查中的异常不太可能被发现。脑脊液的多重基因检测可能被认为是一个有用的诊断辅助免疫功能低下患者的神经系统症状。

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引用次数: 0

Transplacental transfer of antibodies against pertussis and respiratory syncytial virus and follow-up after birth 经胎盘转移抗百日咳和呼吸道合胞病毒抗体及出生后随访。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-11-21 DOI: 10.1016/j.jiac.2025.102877

Yukako Kosaka , Takashi Ito , Kyoko Hattori , Ayumi Saito , Yusuke Okuda , Daigo Ochiai , Kenji Ishikura , Kazuhiko Katayama , Tetsuo Nakayama

Objectives

Maternal immunization is recommended through transplacental antibody transfer to protect newborn babies against respiratory syncytial virus (RSV) and pertussis. The objective of the study is to realize the current situation of maternal transfer of antibodies against RSV and pertussis before introduction of RSV maternal vaccine.

Methods

Maternal serum samples were taken from 421 pregnant women before delivery, and 366 paired umbilical cord blood samples were obtained. Pertussis toxin (PT) antibodies and neutralizing test (NT) antibodies against RSV were examined. Follow-up serum samples were obtained from 22 infants at 2 and 6 months, and one and 1.5 years after birth.

Results

RSV NT antibody was positive in all maternal sera and showed higher levels in umbilical cord blood, with a 1.31-fold increase. It decreased to 1/3 levels at 2 months and 1/8–9 levels at 6 months after birth in comparison with umbilical blood. Three subjects were considered RSV infection between 2 and 6 months after birth. The positive rate of PT antibody was approximately 30 % in pregnant women with extremely low levels, which decreased to undetectable at 2 months, increased at 6 months with routine immunization, decreased at one year, and increased at 1.5 years with a booster dose of pertussis-containing vaccine.

Conclusion

The transplacental transfer ratio was 1.31 for both RSV and pertussis antibodies. Transferred RSV NT decreased to 1/3 levels at 2 months and 1/8–9 levels at 6 months. PT antibody levels were undetectable until 2 months. The data suggests the critical role of maternal immunization.

目的：建议孕妇通过经胎盘抗体转移免疫，以保护新生儿免受呼吸道合胞病毒（RSV）和百日咳的侵害。本研究的目的是在引入RSV母源疫苗前了解抗RSV和百日咳抗体的母源转移现状。方法：抽取421例孕妇产前血清和366例配对脐带血。检测百日咳毒素（PT）抗体和抗RSV的中和试验（NT）抗体。22名婴儿在出生后2个月和6个月，1岁和1.5岁时获得随访血清样本。结果：RSV NT抗体在所有母体血清中均呈阳性，脐带血中RSV NT抗体水平较高，升高1.31倍。与脐血相比，2个月时降至1/3,6个月时降至1/8-9。三名受试者在出生后2至6个月被认为感染了呼吸道合胞病毒。在极低水平的孕妇中，PT抗体的阳性率约为30%，在2个月时降至检测不到，在6个月时常规免疫增加，在1年时下降，在1.5岁时加强剂量的百日咳疫苗增加。结论：RSV抗体和百日咳抗体经胎盘转移率均为1.31。转移的RSV NT在2个月时降至1/3，在6个月时降至1/8-9。直到2个月后才检测到PT抗体水平。这些数据表明，孕产妇免疫发挥了关键作用。

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