Mold bloodstream infections are rare but highly fatal, especially with Lomentospora prolificans and Scedosporium spp. Among 84 episodes over 20 years, the 30-day mortality rate was 38%. Cancer, intensive care unit admission, and healthcare-onset infection were linked to increased mortality rates, highlighting the need for early detection and better management strategies.
Background: With effective antiretroviral treatment, more children with perinatally acquired human immunodeficiency virus (HIV) reach adulthood. We assessed their long-term socioeconomic outcomes-educational level, reliance on social welfare or absence of income, and living in poverty-using a sibling comparison design to disentangle biological from familial and environmental influences.
Methods: We conducted a retrospective cohort study from the Netherlands using data from the ATHENA cohort and nonpublic microdata from Statistics Netherlands (CBS). We included individuals aged ≥18 years with perinatally acquired HIV and siblings without HIV (identified through maternal CBS data). Logistic regression evaluated associations between sociodemographic and HIV-related factors with outcomes. Generalized estimating equations assessed differences between groups.
Results: Among 145 individuals with HIV, 12% had low educational level, 17% relied on social welfare or had no income, and 15% lived in poverty. Receiving HIV care before 1996 was associated with low educational level (odds ratio [OR], 4.58 [95% confidence interval {CI}, 1.46-14.43]; P = .01), while older age increased odds of having no income or reliance on social welfare (OR, 1.24/year [95% CI, 1.10-1.39]; P = .0001). Older age at HIV diagnosis was linked to living in poverty (OR, 1.20/year [95% CI, 1.06-1.34]; P = .003). Compared to 94 siblings, individuals with HIV had higher odds of low education (adjusted OR [aOR], 6.59 [95% CI, 1.91-22.73]; P < .01) and having no income or social welfare reliance (aOR, 2.54 [95% CI, 1.05-6.12]; P = .04). Poverty rates did not differ significantly between groups.
Conclusions: Adults with perinatally acquired HIV face educational and economic disadvantages compared to their siblings without HIV, highlighting the lasting impact of perinatal HIV beyond familial or environmental background.
Background: Research on HDV prevalence among people with HBV/HIV coinfection in China is limited. The impact of HDV on antiretroviral therapy (ART) efficacy and liver disease progression in this population remains unclear.
Methods: This retrospective cohort study included people with HBV/HIV-1 between 2005 and 2022. Baseline plasma was tested for HDV IgM/IgG; HDV RNA was measured if antibodies were positive. Demographics, liver complications, and ART responses were compared by HDV status.
Results: Overall, 1130 people with HBV/HIV-1 were included, of whom 84 (7.4%) tested positive for HDV antibodies. Among these, 19 (22.6%) were HDV RNA-positive. Approximately 41.7% of HDV antibody-positive individuals had HCV coinfection. The median duration of ART was 7.4 years (interquartile range [IQR]: 5.1, 9.9). Longitudinal samples were available from 14 individuals with HDV RNA positivity. Baseline HDV RNA was 2.98 (IQR: 2.17, 4.78) log10 IU/mL. After a rapid decline during ART, 92.8% (13/14) of individuals reached undetectable levels at 7 years. When adjusted for HCV infection, HIV and HBV virological suppression, HBsAg clearance, and immunological nonresponders were comparable between HDV antibody-positive and -negative individuals (all P > .05), and between HDV RNA-positive and -negative individuals (all P > .05). The incidence rates of newly developed cirrhosis and hepatocellular carcinoma were also similar.
Conclusions: HDV coinfection was observed in 7.4% of people with HBV/HIV-1, as a defective virus reliant on HBV, HDV RNA declined rapidly during long-term ART and HDV coinfection did not compromise HIV or HBV treatment efficacy.
Artificial intelligence (AI) is rapidly transforming healthcare, with agentic AI systems positioned to perceive, reason, and act within clinical environments. For infectious diseases (ID) clinicians, agentic AI presents both opportunity and imperative; to embrace AI literacy and remain actively engaged in shaping their design rather than becoming passive adopters in clinical care, antimicrobial stewardship, and infection control. Historical examples show that professions failing to adapt to automation faced challenges, highlighting the urgency for ID specialists to understand AI's evolving role. While AI can streamline documentation, surveillance, and decision support, clinicians must advocate for high-quality data, define appropriate automation boundaries, and ensure human oversight in critical decisions. ID communities should lead efforts to educate clinicians, establish AI governance policies in ID operational practices, and foster interdisciplinary collaboration to guide responsible AI integration. AI literacy is the "no-regret" investment that will enable clinicians to lead this transformation-ensuring that AI supports, augments, and, when appropriate, automates the repetitive, searchable, and time-consuming tasks. The future of ID practice will be defined by how effectively clinicians leverage AI to enhance care, promote equitable access, and reclaim time for the human dimensions of medicine.
Background: Superinfection with the hepatitis D virus (HDV) leads to a more aggressive form of chronic hepatitis B. While around 5% of hepatitis B surface antigen (HBsAg)-positive individuals are estimated to be hepatitis B virus (HBV)-HDV dually infected globally, the time point of superinfection is unknown and repeated HDV testing is not yet supported by international guidelines. Inci-D is a post hoc analysis from 2 prospective cohorts to evaluate the HDV superinfection rate.
Method: The Inci-D cohort consists of 2 HBV cohorts of clinical meta-data and stored plasma samples or dried-blood spots (DBS) from The Gambia (Prolifica) and France.
Results: Overall, samples from 1016 HBsAg-positive individuals were analyzed (625 from The Gambia, 391 from France); the baseline HDV prevalence was 1.1% (7/625) and 2.5% (10/391), respectively. The median age (interquartile range) was 38 (32-50) years, and 63% were male. Patients in the French cohort were older (P < .001), with higher liver enzymes (P < .001), were more often hepatitis B e antigen positive (P < .001) or anti-HCV positive (P < .001), and had more advanced liver disease (P < .001). In the Gambian cohort, after a median follow-up time of 5.98 years, 14 individuals were detected to be newly HDV antibody (Ab) positive (3.85/1000 patient-years). In the French cohort, after a median follow-up time of 2.1 years, 3 individuals were newly detected to be HDV Ab positive (3.70/1000 patient-years).
Conclusions: Hepatitis Delta superinfection increases considerably in HBsAg-positive carriers in The Gambia as well as in France. These findings support consideration of repeated HDV serology testing in HBsAg-positive individuals.
Background: Antiretroviral therapy (ART) suppresses HIV replication and partially restores immune function, but immunologic abnormalities often persist.
Methods: We performed longitudinal multiparametric flow cytometry on peripheral blood mononuclear cells from 79 people with HIV-1 (51 women, 28 men) who were virologically suppressed and followed over a median 6 years of ART. We assessed T-cell counts and expression of activation (CD38⁺HLA-DR⁺), cycling (Ki67⁺), exhaustion (TIGIT⁺PD-1⁺), cytotoxicity (CD107a⁺), and regulatory (FoxP3⁺CD25⁺) markers across memory subsets, and we examined associations with sex and HIV reservoir size and activity.
Results: CD4⁺ T-cell counts increased and CD8⁺ T-cell counts declined over time, improving CD4/CD8 ratios. Immune activation and cycling markers decreased in both T-cell compartments. TIGIT/PD-1 expression declined significantly in CD4⁺ memory subsets but not in CD8⁺ T cells, while CD107a expression remained elevated in effector memory CD8⁺ and CD4⁺ T cells. Regulatory CD4⁺ T cells declined over time, and no significant associations were observed between T-cell phenotypes and HIV reservoir measures or between sexes.
Conclusions: Long-term ART promotes partial immune normalization, including reduced activation and reversal of CD4⁺ T-cell exhaustion. However, persistent expression of CD8⁺ T-cell surrogate markers of exhaustion and stable cytotoxic profiles suggest ongoing antigenic stimulation, potentially driven by HIV or chronic coinfections.
Background: Respiratory viral infections in patients with hematologic malignancies or hematopoietic stem cell transplants (HCTs) are associated with increased morbidity and mortality. However, the hospital presentations and courses of these infections remain under-described.
Methods: We performed a multicenter retrospective cohort study of hospitalized patients with hematologic malignancy or HCT at 2 comprehensive cancer centers between January 2019 and June 2023. We included all patients with acute viral respiratory infection (identified based on a constellation of test results and objective physiology), comparing clinical presentations, care processes, and patient outcomes across pathogens; the primary outcome was the composite of hospital death or discharge to hospice.
Results: We evaluated 385 hospitalizations from 346 unique patients, 162 (42%) of which were for SARS-CoV-2 infection. The primary outcome of death or discharge to hospice occurred in 54 (14%) encounters and did not significantly differ across pathogens (P = .4). We observed higher radiographic assessment of lung edema scores in SARS-CoV-2 infection (median 28 [interquartile range 22-32]) compared with other viral infections (5 [2-9], P < .001). Care process differences across pathogens included antibiotic (SARS-CoV-2 98/162 [60%], respiratory syncytial virus [RSV] 17/28 [61%], rhino/enterovirus 59/91 [65%], influenza 22/33 [67%], and others 69/86 [80%], P = .034) and corticosteroid use (≥ 40 mg prednisone equivalents daily: SARS-CoV-2 99/162 [61%], RSV 10/28 [36%], rhino/enterovirus 30/91 [33%], influenza 9/33 [27%], and others 37/86 [43%], P < .001).
Interpretation: Among hospitalized patients with hematologic malignancies or HCTs, acute viral respiratory infections display similar initial physiology and outcomes regardless of pathogen. These findings may have implications for clinical practice.
Background: Streptococcus agalactiae (group B Streptococcus [GBS]) may cause pneumonia or may colonize the respiratory tract, making its clinical significance uncertain when detected in respiratory specimens. This study aimed to assess whether clinicians interpreted GBS detected by the BIOFIRE Pneumonia Panel (BF-PP) as a pathogen implicated in pneumonia.
Methods: This retrospective cohort study included adult patients hospitalized with suspected pneumonia at Mayo Clinic, Rochester, between September 2020 and February 2025. Cases were independently classified into pathogen and nonpathogen groups by 2 infectious diseases (ID) specialists, with a third reviewer resolving disagreements. Clinical characteristics and outcomes of both groups were recorded. A subgroup analysis of patients who had an ID consultation was performed.
Results: A total of 109 cases were included. GBS was considered a pneumonia pathogen in 47.7% of cases and a nonpathogen in 52.3%. ID consultation was performed in 33.0% of cases, with GBS considered a pathogen in 30.6% of those. Common comorbid conditions included pulmonary, gastrointestinal, neurologic, and cardiovascular disease and obesity. Rates of endotracheal intubation were similar in the pathogen and nonpathogen groups (51.9% vs 50.9%, respectively), with the in-hospital mortality rate being numerically but not significantly higher in the former versus the latter (21.2% vs 14.0%; P = .33); findings were similar in the ID-assessed subgroup. In 76.1% of GBS detections, other microorganisms-most commonly Staphylococcus aureus-were codetected. Only 10.2% of BF-PP GBS-positive specimens were culture positive for GBS.
Conclusions: While GBS is not an uncommon pneumonia pathogen, the clinical significance of its detection by BF-PP is uncertain in many cases.
Background: Chlamydia trachomatis (CT) is a common sexually transmitted infection, yet its contribution to male infertility remains incompletely understood.
Methods: A systematic review and meta-analysis of case-control studies were conducted following PRISMA guidelines. Literature from PubMed/MEDLINE, Scopus, Cochrane, and Embase (2000 onward) was screened. Random-effects models were used in R, with subgroup analyses by geography, case definition, diagnostics, and matching criteria.
Results: Out of 2941 records, 26 case-control studies (11 706 participants) met inclusion criteria. Most studies used molecular diagnostics (n = 23). A significant association was found between CT infection and male infertility (odds ratio [OR] 3.68 [95% CI 2.24-6.02]), with substantial heterogeneity (I 2 = 65%). Age-matched studies showed higher effect sizes (OR 6.77), and publication bias was detected (trimmed OR 2.75).
Conclusions: While findings suggest that CT infection may impair male fertility, confounding, bias, and the lack of geographical representativeness limit inference. High-quality, large-scale prospective studies are needed to confirm causality and guide targeted interventions.
Background: Clinical prediction scores such as NOVA and DENOVA aim to identify patients with enterococcal bacteremia at low risk of infective endocarditis (IE) in whom imaging might be safely avoided. The aim was to evaluate the performance of NOVA and DENOVA scores and to introduce a modified tool, DENOVi.
Method: This retrospective study included adult patients with enterococcal bacteremia at 2 Swiss tertiary centers (2015-2024). IE was adjudicated by multidisciplinary Endocarditis Teams according to 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria. Patients were stratified as high risk for IE using the adapted NOVA score (cutoff: ≥4), the DENOVA score (≥3), and a newly developed DENOVi score (≥2), which excluded the subjective murmur criterion and broadened "valve disease" to include intracardiac electronic devices (new Vi component).
Results: Among 827 bacteremia episodes, 172 (21%) were diagnosed with IE. The adapted NOVA, DENOVA, and DENOVi scores classified 76%, 26%, and 42% of patients as high risk, respectively. Corresponding NLRs were 0.04 (95% CI, .01-.15), 0.10 (0.06-0.16), and 0.04 (0.02-0.10). The adapted NOVA substantially increased the proportion of echocardiograms needed to be performed from 58% based on clinical evaluation alone to 76%, whereas the DENOVA and DENOVi scores would have reduced this proportion to 26% and 42% of episodes, respectively.
Conclusions: Both adapted NOVA and DENOVi scores reliably ruled out IE, but DENOVi provided the most balanced approach between diagnostic safety and resource utilization. DENOVi therefore represents a pragmatic and objective tool for IE risk stratification in enterococcal bacteremia. Prospective validation is warranted.
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