Open Forum Infectious Diseases最新文献_第5页

Utility of Cerebrospinal Fluid Unstimulated Interferon Gamma (IRISA-TB) as a Same-Day Test for TB Meningitis in a TB-Endemic Resource-Poor Setting 在结核病流行、资源贫乏的环境中，脑脊液非刺激性γ干扰素（IRISA-TB）作为结核性脑膜炎当日检验的实用性

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-29 DOI: 10.1093/ofid/ofae496

Philippa Randall, Junior Mutsvangwa, Marriott Nliwasa, Lindsay Wilson, Beauty Makamure, Edson Makambwa, Richard Meldau, Keertan Dheda, Shungu Munyati, Omar Siddiqi, Liz Corbett, Ali Esmail

Background TB meningitis mortality is high and current diagnostics perform sub-optimally. We therefore evaluated the diagnostic performance of a DNA-based assay (GeneXpert-Ultra) against a new same-day immunodiagnostic assay that detects unstimulated interferon gamma (IRISA-TB). Methods In a preliminary go/no-go stage-1 evaluation IRISA-TB was first evaluated in bio-banked samples from Zambia (n=82; TB and non-TBM), and specificity in a South African biobank (n= 291; non-TBM only). Given encouraging results, a prospective stage-2 evaluation was performed in 668 patients with suspected TBM from Zimbabwe and Malawi. Patients were classified as having definite-TBM, probable-TBM, possible-TBM, and non-TBM based on their microbiological results, CSF chemistry, and whether they received TBM treatment. Results In the stage-1 evaluation sensitivity and specificity of IRISA-TB was 75% and 87% in the archived Zambian samples, and specificity 100% in the South African samples with normal CSF chemistry. In the prospective stage-2 validation, IRISA-TB sensitivity (95%CI) was significantly higher than Xpert-Ultra [76.2%(55.0; 89.4) versus 25%(8.9; 53.3); p= 0.0048) when trace readouts were excluded (considered negative). Specificity was similar for both assays [91.4% (88.8; 93.4) versus 86.9% (83.4; 89.8)]. When the Xpert-Ultra PCR product was verified by sequencing, the PPV of trace readouts in CSF was 27.8%. Xpert-Ultra specificity dropped substantially (to ∼40%) when trace results were included. Sensitivity of IRISA-TB was higher in HIV-infected versus uninfected participants (85.8% versus 66.7%). Conclusion As a same-day rule-in test IRISA-TB had significantly better sensitivity than Xpert Ultra in a TB and HIV endemic setting. An immunodiagnostic approach in TBM is promising and further studies are warranted.

背景结核性脑膜炎死亡率很高，而目前的诊断方法效果不理想。因此，我们评估了一种基于 DNA 的检测方法（GeneXpert-Ultra）与一种检测非刺激干扰素γ（IRISA-TB）的新型即日免疫诊断检测方法的诊断性能。方法首先在赞比亚的生物库样本（样本数=82；结核病和非结核病）中对 IRISA-TB 进行了 "进行/不进行 "的第一阶段初步评估，并在南非的生物库样本（样本数=291；仅非结核病）中对其特异性进行了评估。鉴于结果令人鼓舞，我们对来自津巴布韦和马拉维的 668 名疑似 TBM 患者进行了前瞻性第二阶段评估。根据微生物学结果、脑脊液化学成分以及是否接受过 TBM 治疗，患者被分为明确 TBM、可能 TBM、可能 TBM 和非 TBM 患者。结果在第一阶段评估中，IRISA-TB 在赞比亚存档样本中的灵敏度和特异度分别为 75% 和 87%，在 CSF 化学指标正常的南非样本中的特异度为 100%。在前瞻性的第二阶段验证中，如果排除微量读数（视为阴性），IRISA-TB 的灵敏度（95%CI）明显高于 Xpert-Ultra[76.2%(55.0; 89.4) 对 25%(8.9; 53.3); p=0.0048]。两种检测方法的特异性相似[91.4% (88.8; 93.4) 对 86.9% (83.4; 89.8)]。当 Xpert-Ultra PCR 产物通过测序验证时，CSF 中微量读数的 PPV 为 27.8%。当包括微量结果时，Xpert-Ultra 的特异性大幅下降（降至 40%）。与未感染者相比，感染艾滋病毒者使用 IRISA-TB 的灵敏度更高（85.8% 对 66.7%）。结论在结核病和艾滋病流行的环境中，IRISA-TB 作为一种当日即可检测的方法，其灵敏度明显高于 Xpert Ultra。在 TBM 中采用免疫诊断方法很有前景，需要进一步研究。

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引用次数: 0

Short Versus Long Antibiotic Duration in Streptococcus pneumoniae Bacteremia 肺炎链球菌菌血症中抗生素使用时间长短的比较

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-29 DOI: 10.1093/ofid/ofae478

Matthew Crotty, Hadley Devall, Natalie Cook, Francis Fischer, Julie Alexander, Leigh Hunter, Edward Dominguez

Background Streptococcus pneumoniae is a common pathogen associated with bloodstream infections (BSI), respiratory infections, peritonitis, infective endocarditis, and meningitis. Literature assessing duration of antibiotic therapy for a S. pneumoniae bacteremia secondary to common infection is scarce, leading to variability in practice. Therefore, this study evaluated the effectiveness of short (5-10 days) versus long (11-16 days) antibiotic durations for S. pneumoniae bacteremia. Methods This retrospective, single-center cohort study assessed hospitalized patients with S. pneumoniae positive blood cultures, who received active antibiotics within 48 hours of first positive blood culture collection and achieved clinical stability by day 10 of the first positive blood culture collection. Exclusion criteria included treatment duration <5 or >16 days, death before completion of 10 days of therapy, polymicrobial BSI, and invasive infection. Rates of clinical failure (composite of 30-day hospital readmission, bacteremia recurrence, and mortality) were compared between the groups. Results A total of 162 patients were included with 51 patients in the short and 111 patients in the long duration group. Pneumonia was the suspected source of bacteremia in 90.1% of patients. Rates of clinical failure were not significantly different between the two groups. Patients received a median antibiotic course of 7 days in the short group compared to 14 days in the long group, however, there was no significant difference observed in the median hospital length of stay (LOS), median ICU LOS, or rate of Clostridioides difficile infection. Conclusion Shorter antibiotic courses may be appropriate in patients with S. pneumoniae bacteremia secondary to community-acquired pneumonia.

背景肺炎链球菌是一种常见的病原体，与血流感染（BSI）、呼吸道感染、腹膜炎、感染性心内膜炎和脑膜炎有关。评估继发于普通感染的肺炎双球菌菌血症的抗生素治疗持续时间的文献很少，导致实践中的差异。因此，本研究评估了短期（5-10 天）与长期（11-16 天）抗生素治疗肺炎双球菌菌血症的效果。方法该回顾性单中心队列研究评估了肺炎双球菌血培养阳性的住院患者，这些患者在首次血培养阳性后 48 小时内接受了积极的抗生素治疗，并在首次血培养阳性后第 10 天达到临床稳定。排除标准包括治疗持续时间<5或>16天、治疗10天前死亡、多菌性BSI和侵袭性感染。比较了两组患者的临床失败率（30 天再入院、菌血症复发和死亡率的综合）。结果共纳入 162 名患者，其中短病程组 51 人，长病程组 111 人。90.1%的患者怀疑菌血症来源于肺炎。两组患者的临床失败率无明显差异。短疗程组患者的中位抗生素疗程为 7 天，而长疗程组为 14 天，但在中位住院时间（LOS）、中位重症监护室住院时间或艰难梭菌感染率方面均无明显差异。结论对于继发于社区获得性肺炎的肺炎双球菌菌血症患者，缩短抗生素疗程可能是合适的。

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引用次数: 0

Effectiveness of Original Monovalent and Bivalent COVID-19 Vaccines Against COVID-19-associated Emergency Department and Urgent Care Encounters in Immunocompetent Pregnant Persons, VISION Network, June 2022–August 2023 原始单价和二价 COVID-19 疫苗对免疫功能正常的孕妇接种 COVID-19 相关急诊科和急诊护理的有效性，VISION 网络，2022 年 6 月至 2023 年 8 月

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 DOI: 10.1093/ofid/ofae481

Allison Avrich Ciesla, Victoria Lazariu, Kristin Dascomb, Stephanie A Irving, Brian E Dixon, Manjusha Gaglani, Allison L Naleway, Shaun J Grannis, Sarah Ball, Anupam B Kharbanda, Gabriela Vazquez-Benitez, Nicola P Klein, Karthik Natarajan, Toan C Ong, Peter J Embi, Katherine E Fleming-Dutra, Ruth Link-Gelles, Ousseny Zerbo

Pregnant people face increased risk of severe COVID-19. Current guidelines recommend Updated (2023-2024) COVID-19 vaccination for those aged ≥6 months, irrespective of pregnancy status. To refine recommendations for pregnant people, further data is needed. Using a test-negative design, we evaluated COVID-19 vaccine effectiveness (VE) against medically-attended COVID-19 with COVID-19–like illness among pregnant people aged 18-45 years during June 2022–August 2023. VE of doses received during pregnancy was 52% (95%CI: 29-67%), <6 months prior to pregnancy was 28% (95%CI: 11-42%), and ≥6 months prior to pregnancy was 6% (95%CI: -11-21%). Pregnant people should stay up to date with recommended COVID-19 vaccination.

孕妇罹患严重 COVID-19 的风险增加。目前的指导方针建议年龄≥6 个月的人群接种最新（2023-2024 年）COVID-19 疫苗，无论是否怀孕。要完善针对孕妇的建议，还需要进一步的数据。我们采用阴性试验设计，评估了2022年6月至2023年8月期间18-45岁孕妇接种COVID-19疫苗预防COVID-19类疾病的有效性（VE）。怀孕期间接种疫苗的有效率为52%（95%CI：29-67%），怀孕前6个月接种疫苗的有效率为28%（95%CI：11-42%），怀孕前≥6个月接种疫苗的有效率为6%（95%CI：-11-21%）。孕妇应及时接种推荐的 COVID-19 疫苗。

引用次数: 0

Antiretroviral Therapy and Cardiovascular Risk in People with HIV in the United States - An Updated Analysis 美国艾滋病毒感染者的抗逆转录病毒疗法和心血管风险 - 最新分析

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 DOI: 10.1093/ofid/ofae485

Luis Parra-Rodriguez, John M Sahrmann, Anne M Butler, Margaret A Olsen, William G Powderly, Jane A O’Halloran

Background Several antiretroviral therapy (ART) medications have been associated with increased cardiovascular risk, but less is known about the safety of modern ART. We sought to compare the risk of major adverse cardiac events (MACE) among different ART regimens. Methods Using insurance claims databases from 2008-2020, we identified adults <65 years who newly initiated ART. We compared nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens to protease inhibitors (PI)- and integrase inhibitors (INSTI)-based regimens. We used propensity score-weighted Kaplan-Meier functions to estimate the 6, 12, 18, 24, 36, and 48-months risk and risk differences (RD) of MACE. Results Among 37,935 ART initiators (median age 40 years, 23% female, 26% Medicaid-insured), 45% started INSTI-, 16% PI-, and 39% NNRTI-based regimens. MACE occurred in 418 individuals (1.1%) within 48 months after ART initiation. Compared to NNRTI initiators, the risk of MACE was higher at 12 months [RD 0.50, 95% CI (0.14, 0.99)], 18 months [RD 0.53, 95% CI (0.11, 1.06)], and 24 months [RD 0.62, 95% CI (0.04, 1.29)] for PI initiators, and at 12 [RD 0.20, 95% CI (0.03, 0.37)] and 18 months [RD 0.31, 95% CI (0.06, 0.54)] for INSTI initiators; the precision of estimates was limited for longer duration of follow-up. Conclusions Among ART initiators, PI-based and INSTI-based regimens were associated with higher short-term risk of MACE compared to NNRTI-based regimens. The pattern of association between INSTIs and PIs with excess risk of MACE was similar.

背景一些抗逆转录病毒疗法（ART）药物与心血管风险增加有关，但人们对现代抗逆转录病毒疗法的安全性知之甚少。我们试图比较不同抗逆转录病毒疗法发生重大心脏不良事件（MACE）的风险。方法利用 2008-2020 年的保险理赔数据库，我们确定了新开始接受抗逆转录病毒疗法的 65 岁成人。我们比较了以核苷类逆转录酶抑制剂 (NNRTI) 为基础的治疗方案和以蛋白酶抑制剂 (PI) 和整合酶抑制剂 (INSTI) 为基础的治疗方案。我们使用倾向得分加权的 Kaplan-Meier 函数估算了 6、12、18、24、36 和 48 个月的 MACE 风险和风险差异 (RD)。结果在 37,935 名开始接受抗逆转录病毒疗法的患者中（中位年龄为 40 岁，23% 为女性，26% 有医疗补助保险），45% 开始采用 INSTI 方案，16% 采用 PI 方案，39% 采用 NNRTI 方案。在开始接受抗逆转录病毒疗法后的 48 个月内，有 418 人（1.1%）发生了 MACE。与 NNRTI 启动者相比，PI 启动者在 12 个月[RD 0.50，95% CI (0.14，0.99)]、18 个月[RD 0.53，95% CI (0.11，1.06)]和 24 个月[RD 0.62，95% CI (0.04，1.29)]发生 MACE 的风险较高。29）]，INSTI 启动者在 12 个月[RD 0.20，95% CI (0.03，0.37)]和 18 个月[RD 0.31，95% CI (0.06，0.54)]；随访时间越长，估计值的精确度越有限。结论在抗逆转录病毒疗法启动者中，与基于 NNRTI 的疗法相比，基于 PI 和 INSTI 的疗法与较高的短期 MACE 风险相关。INSTIs 和 PIs 与 MACE 超额风险的关联模式相似。

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引用次数: 0

Association of COVID-19 Vaccination with Risk of Medically-Attended Post-Acute Sequelae of COVID-19 During the Ancestral, Alpha, Delta, and Omicron Variant Eras COVID-19疫苗接种与COVID-19祖先、阿尔法、德尔塔和奥米克隆变异时代医疗后遗症风险的关系

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 DOI: 10.1093/ofid/ofae495

Melanie D Swift, Laura E Breeher, Ross Dierkhising, Joel Hickman, Matthew G Johnson, Daniel L Roellinger, Abinash Virk

Structured Abstract Background Uncertainty exists regarding the effectiveness of COVID-19 vaccine to prevent Post-Acute Sequelae of COVID-19 (PASC) following a breakthrough infection. While most studies using symptom surveys found an association between preinfection vaccination status and PASC symptoms, studies of medically attended PASC are less common and have reported conflicting findings. Methods In this retrospective cohort of patients with an initial SARS-CoV-2 infection, who were continually empaneled for primary care in a large US health system, the electronic health record was queried for pre-infection vaccination status, demographics, comorbidity index, and diagnosed conditions. Multivariable logistic regression was used to model the outcome of a medically-attended PASC diagnosis within 6 months of SARS-CoV-2 infection. Likelihood ratio tests were used to assess the interaction between vaccination status and prevalent variant at the time of infection, and between vaccination status and hospitalization for the SARS-CoV-2 infection. Results During the observation period, 6.9% of patients experienced medically-attended and diagnosed PASC. A diagnosis of PASC was associated with older age, female sex, hospitalization for the initial infection, and an increased severity-weighted comorbidity index, and was inversely associated with infection during the Omicron period. No difference in the development of diagnosed PASC was observed between unvaccinated patients, those vaccinated with 2 doses of an mRNA vaccine, and those with >2 doses. Conclusions We found no association between vaccination status at time of infection and subsequent development of medically diagnosed PASC. Vaccine remains an important measure to prevent SARS-CoV-2 infection and severity. Further research is needed to identify effective measures to prevent and treat PASC.

结构化摘要背景 COVID-19 疫苗对预防突破性感染后 COVID-19 急性后遗症 (PASC) 的效果存在不确定性。大多数通过症状调查进行的研究发现，感染前疫苗接种情况与 PASC 症状之间存在关联，而对 PASC 进行的医学研究则较少见，且研究结果相互矛盾。方法在这项回顾性队列研究中，研究人员对美国一家大型医疗系统中持续接受初级医疗服务的初次感染 SARS-CoV-2 的患者的电子健康记录进行了查询，以了解患者感染前的疫苗接种情况、人口统计学特征、合并症指数和诊断情况。采用多变量逻辑回归对感染 SARS-CoV-2 后 6 个月内就诊的 PASC 诊断结果进行建模。使用似然比检验来评估疫苗接种情况与感染时流行变异体之间的交互作用，以及疫苗接种情况与 SARS-CoV-2 感染住院之间的交互作用。结果在观察期间，有 6.9% 的患者曾就诊并确诊为 PASC。PASC 的诊断与年龄较大、女性、初次感染住院以及严重性加权合并症指数增加有关，与 Omicron 期间的感染成反比。未接种疫苗的患者、接种 2 剂 mRNA 疫苗的患者和接种 >2 剂疫苗的患者在确诊 PASC 的发生率上没有差异。结论我们发现，感染时的疫苗接种情况与随后发生的医学诊断 PASC 之间没有关联。疫苗仍然是预防 SARS-CoV-2 感染和严重程度的重要措施。要确定预防和治疗 PASC 的有效措施，还需要进一步的研究。

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引用次数: 0

The impact of GeneXpert cerebrospinal fluid testing on tuberculous meningitis diagnosis in routine care in Botswana GeneXpert 脑脊液检测对博茨瓦纳常规护理中结核性脑膜炎诊断的影响

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 DOI: 10.1093/ofid/ofae489

James Milburn, Ookeditse Ntwayagae, Kebatshabile Ngoni, Rachita Suresh, Neo Lemme, Cassie Northcott, James Penney, Matthew Kinsella, Imogen Mechie, Samuel Ensor, Tony Chebani, Daniel Grint, Mark W Tenforde, Ava Avalos, Dinah Ramaabya, Ronan Doyle, Margaret Mokomane, Madisa Mine, Katharina Kranzer, Joseph N Jarvis

Introduction Tuberculous meningitis (TBM) disproportionately impacts high-HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis but uptake remains limited. In Botswana, prior to the introduction of GeneXpert, TB testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for CSF testing in resource-limited settings are scarce. Methods Electronic records for patients with CSF tested in government facilities in Botswana between 2016-2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from one site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for Mycobacterium tuberculosis following increased Xpert MTB/RIF capacity were determined. Results The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analysed but the proportion with microbiologically-confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from healthcare facilities >100km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633). Discussion In Botswana access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.

导言结核性脑膜炎（TBM）对艾滋病毒感染率高、资源有限、诊断难度大的地区造成了极大的影响。GeneXpert 平台可用于结核性脑膜炎的诊断，但其普及率仍然有限。在博茨瓦纳，引入 GeneXpert 之前，结核病检测只能通过国家结核病参考实验室的分枝杆菌培养进行。有关在资源有限的环境中常规使用 Xpert MTB/RIF 进行 CSF 检测的数据很少。方法作为国家脑膜炎监测工作的一部分，我们从中央在线存储库中获取了 2016-2022 年间博茨瓦纳政府机构对 CSF 患者进行检测的电子记录。不包括一个普遍进行 Xpert MTB/RIF 检测的地点的样本。确定了 CSF 接受结核病特异性检查的比例，以及 Xpert MTB/RIF 能力提高后结核分枝杆菌呈阳性的人数。结果接受结核病特异性检查的 CSF 样本比例从 2016 年的 4.5%（58/1288）增至 2022 年的 29.0%（201/693），主要原因是 Xpert MTB/RIF 分析能力从 0.9%（11/1288）增至 23.2%（161/693）。每年分析的 CSF 样本数量总体下降，但经微生物确认的 TBM 比例从 0.4% 上升到 1.2%。随着 Xpert MTB/RIF 的推广，从距离国家结核病参考实验室>100 公里的医疗机构采集的结核病检测样本比例从 65.9% (87/132) 增加到 78.0% (494/633)。讨论在博茨瓦纳，偏远地区的人群很难获得结核菌培养；使用 Xpert MTB/RIF 进行更方便的就近检测增加了接受结核病特异性 CSF 检测的患者人数，也增加了确诊 TBM 病例的数量。

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引用次数: 0

Evaluation of the Tuberculosis Infection Care Cascade Among Pregnant Individuals in a Low-Tuberculosis-Burden Setting. 对结核病低负担地区孕妇结核病感染护理流程的评估

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae494

Jeffrey I Campbell, Dorine Lavache, Ariane Garing, Vishakha Sabharwal, Jessica E Haberer, Melanie Dubois, Helen E Jenkins, Meredith B Brooks, Naima T Joseph, Katherine Kissler, C Robert Horsburgh, Karen R Jacobson

In the United States, tuberculosis (TB) screening is recommended for pregnant individuals with TB risk factors. We conducted a retrospective study of perinatal TB infection testing and treatment in a tertiary health system. Of 165 pregnant individuals with positive TB infection tests, only 9% completed treatment within 4.6 years of follow-up.

在美国，建议对有结核病风险因素的孕妇进行结核病筛查。我们在一家三级医疗系统开展了一项关于围产期结核感染检测和治疗的回顾性研究。在 165 名结核感染检测呈阳性的孕妇中，只有 9% 的人在 4.6 年的随访期内完成了治疗。

引用次数: 0

Correlates of Nucleocapsid Antibodies and a Combination of Spike and Nucleocapsid Antibodies Against Protection of SARS-CoV-2 Infection During the Omicron XBB.1.16/EG.5-Predominant Wave. 核苷酸抗体以及尖峰抗体和核苷酸抗体的组合与保护Omicron XBB.1.16/EG.5-Predominant波期间SARS-CoV-2感染的相关性。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-28 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae455

Shohei Yamamoto, Yusuke Oshiro, Natsumi Inamura, Takashi Nemoto, Tomofumi Tan, Kumi Horii, Kaori Okudera, Maki Konishi, Tetsuya Mizoue, Haruhito Sugiyama, Nobuyoshi Aoyanagi, Wataru Sugiura, Norio Ohmagari

Background: We aimed to examine the association among nucleocapsid (N) antibodies, a combination of N and spike (S) antibodies, and protection against SARS-CoV-2 reinfection.

Methods: We conducted a prospective cohort study among staff at a national medical research center in Tokyo and followed them for the incidence of SARS-CoV-2 infection between June and September 2023 (Omicron XBB.1.16/EG.5 wave). At baseline, participants donated blood samples to measure N- and S-specific antibodies. Cox regression was used to estimate the hazard ratio and protection ([1 - hazard ratio] × 100) against subsequent SARS-CoV-2 infection across these antibody levels.

Results: Among participants with previous infection, higher pre-reinfection N antibodies were associated with a lower risk of reinfection, even after adjusting S antibody levels (P < .01 for trend). Estimation of the protection matrix for N and S antibodies revealed that high levels in N and S antibodies conferred robust protection (>90%) against subsequent infection. In addition, a pattern of low pre-reinfection N antibodies but high vaccine-enhanced S antibodies showed high protection (>80%).

Conclusions: Pre-reinfection N antibody levels correlated with protection against reinfection, independent of S antibodies. If the N antibodies were low, vaccine-boosted S antibodies might enhance the reinfection protection.

背景：我们的目的是研究核壳抗体（N抗体）、N抗体和尖峰抗体（S抗体）组合与SARS-CoV-2再感染保护之间的关系：我们的目的是研究核壳（N）抗体、N抗体和尖峰（S）抗体的组合与防止SARS-CoV-2再感染之间的关联：我们对东京国立医学研究中心的工作人员进行了一项前瞻性队列研究，并跟踪调查了他们在 2023 年 6 月至 9 月（Omicron XBB.1.16/EG.5 波）期间的 SARS-CoV-2 感染率。在基线期，参与者捐献血液样本以测定 N 和 S 特异性抗体。采用 Cox 回归估算了不同抗体水平的 SARS-CoV-2 感染危险比和保护率（[1-危险比] ×100）：结果：在既往感染过的参与者中，即使调整了 S 抗体水平，再感染前 N 抗体水平越高，再感染风险越低（P < .01 为趋势）。对 N 抗体和 S 抗体的保护矩阵进行估计后发现，高水平的 N 抗体和 S 抗体可对再次感染提供强有力的保护（>90%）。此外，感染前 N 抗体水平较低但疫苗增强的 S 抗体水平较高的模式显示出较高的保护率（>80%）：结论：再感染前的 N 抗体水平与再感染保护率相关，与 S 抗体无关。结论：再感染前的 N 抗体水平与再感染保护率相关，与 S 抗体无关。如果 N 抗体水平低，疫苗增强的 S 抗体可能会提高再感染保护率。

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引用次数: 0

Postacute Sequelae of COVID (PASC or Long COVID): An Evidenced-Based Approach. COVID 后遗症（PASC 或 Long COVID）：基于证据的方法。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-27 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae462

Daniel O Griffin

While the acute manifestations of infectious diseases are well known, in some individuals, symptoms can either persist or appear after the acute period. Postviral fatigue syndromes are recognized with other viral infections and are described after coronavirus disease 2019 (COVID-19). We have a growing number of individuals with symptoms that persist for weeks, months, and years. Here, we share the evidence regarding the abnormalities associated with postacute sequelae of COVID-19 (PASC) and therapeutics. We describe physiological and biochemical abnormalities seen in individuals reporting PASC. We describe the several evidence-based interventions to offer patients. It is expected that this growing understanding of the mechanisms driving PASC and the benefits seen with certain therapeutics may not only lead to better outcomes for those with PASC but may also have the potential for understanding and treating other postinfectious sequelae.

虽然传染病的急性表现众所周知，但在某些人身上，症状可能会持续存在或在急性期过后出现。病毒感染后疲劳综合征在其他病毒感染中已得到确认，在 2019 年冠状病毒病（COVID-19）后也有描述。越来越多的患者症状持续数周、数月甚至数年。在此，我们分享与 COVID-19 急性后遗症（PASC）相关的异常现象和疗法的证据。我们描述了在报告 PASC 的患者中出现的生理和生化异常。我们介绍了为患者提供的几种循证干预措施。预计人们对 PASC 的驱动机制和某些治疗方法的益处的日益深入的了解不仅会为 PASC 患者带来更好的治疗效果，而且还可能有助于了解和治疗其他感染后遗症。

引用次数: 0

Evolution of laboratory diagnostics for cryptococcosis and missing links to optimize diagnosis and outcomes in resource-constrained settings 隐球菌病实验室诊断的发展以及在资源有限的环境中优化诊断和结果的缺失环节

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-27 DOI: 10.1093/ofid/ofae487

Richard Kwizera, Tadeo K Kiiza, Andrew Akampurira, Sarah Kimuda, Timothy Mugabi, David B Meya

Cryptococcal meningitis is one of the leading causes of death in sub-Saharan Africa among advanced HIV disease patients. Early diagnosis is crucial in improving treatment outcomes. Despite advances and the availability of modern and point-of-care diagnostics for cryptococcosis, gaps still exist in resource-constrained settings leading to unfavorable treatment outcomes. Here, we review the current outstanding issues or missing links that need to be filled to optimize the diagnosis of cryptococcosis in resource-constrained settings to improve treatment outcomes. We highlight the evolution of cryptococcosis diagnostics, the role of early fungicidal activity, CrAg titres, antifungal susceptibility testing, therapeutic drug monitoring and the missing links to optimize diagnosis and outcomes, including some practical recommendations.

在撒哈拉以南非洲地区，隐球菌脑膜炎是晚期艾滋病患者的主要死因之一。早期诊断对于改善治疗效果至关重要。尽管隐球菌病的现代诊断和床旁诊断取得了进步，但在资源有限的环境中仍存在差距，导致治疗效果不佳。在此，我们回顾了目前尚未解决的问题或需要填补的缺失环节，以便在资源有限的环境中优化隐球菌病的诊断，从而改善治疗效果。我们强调了隐球菌病诊断的演变、早期杀菌活性的作用、CrAg 滴度、抗真菌药敏试验、治疗药物监测以及优化诊断和治疗效果的缺失环节，包括一些实用建议。

引用次数: 0