首页 > 最新文献

Open Forum Infectious Diseases最新文献

英文 中文
Evaluating the Usefulness of Artificial Intelligence-based Chest X-Ray Screening in Improving Tuberculosis Detection Among the High-Risk Tribal Population of Chhattisgarh, India: A Prospective Multi-Centre Study. 评估基于人工智能的胸部x线筛查在提高印度恰蒂斯加尔邦高危部落人群结核病检测中的有效性:一项前瞻性多中心研究
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-07 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofaf780
Abhishek Gupta, Aswathy M Nair, Shobha Ekka, Dharmendra Gahwai, Nisha Sharma, Faisal Raza Khan, Manisha Damani, Suraj Kumar, Saniya Pawar, Justy Antony Chiramal, Dennis Robert, Manoj Tadepalli, Shibu Vijayan, Pranav S Krishnan, Nidhi A Patil

Background: India accounts for the highest Tuberculosis (TB) burden globally. The incidence and prevalence of TB are higher in tribal population than general population. In this study, we assessed the effectiveness of artificial intelligence (AI) based chest X-ray (CXR) interpretation software device (qXR version 3), in detecting TB from a predominantly tribal population setting.

Methods: In this multicenter prospective study, all the CXRs of patients aged > 15 years taken for any reason at 3 public health facilities in the Chhattisgarh state of India between 01 August 2023 and 31 March 2024 were included. Patients flagged by AI as TB presumptive were directed to undergo sputum testing, who are subsequently confirmed either microbiologically or clinically.

Results: Out of 2745 CXRs screened, 363 patients (median age, 44 years [IQR: 30-53]; 261 [71.9%] male) were identified as presumptive for TB. 162 cases were confirmed with TB positivity rate of 44.63% (95% CI: 39.44-49.91). Among the AI-flagged cases, 51 (14.04%) patients were asymptomatic, and 20 (39.22%) of them were confirmed with TB. Descriptively, when compared with baseline (August-2022 to March-2023), an 80.21% (P < .001) increase in the number of TB case notifications was observed during the AI implemented period.

Conclusions: This study highlights the potential of AI to enhance TB detection and feasibility in a resource-limited tribal setting. Above 40% of the patients flagged by AI were subsequently confirmed to have the TB disease. Additionally, the study demonstrated the potential of AI in identifying asymptomatic individuals who would otherwise have been missed or diagnosed late.

背景:印度是全球结核病负担最高的国家。部落人口中结核病的发病率和流行率高于一般人口。在本研究中,我们评估了基于人工智能(AI)的胸部x射线(CXR)解释软件设备(qXR版本3)在主要部落人口环境中检测结核病的有效性。方法:在这项多中心前瞻性研究中,纳入了2023年8月1日至2024年3月31日期间在印度恰蒂斯加尔邦3家公共卫生机构因任何原因拍摄的所有年龄在bb0 - 15岁患者的cxr。被人工智能标记为结核病推定的患者被指示进行痰液检测,随后得到微生物学或临床证实。结果:在筛查的2745例cxr中,363例患者(中位年龄44岁[IQR: 30-53]; 261例(71.9%)男性)被确定为推定结核病。确诊162例,结核阳性率44.63% (95% CI: 39.44 ~ 49.91)。在ai标记病例中,51例(14.04%)患者无症状,20例(39.22%)患者确诊结核。描述性地,与基线(2022年8月至2023年3月)相比,在实施人工智能期间,结核病病例报告数量增加了80.21% (P < 0.001)。结论:本研究强调了人工智能在资源有限的部落环境中加强结核病检测的潜力和可行性。在AI标记的患者中,超过40%的人随后被证实患有结核病。此外,该研究还证明了人工智能在识别无症状个体方面的潜力,否则这些个体可能会被遗漏或诊断较晚。
{"title":"Evaluating the Usefulness of Artificial Intelligence-based Chest X-Ray Screening in Improving Tuberculosis Detection Among the High-Risk Tribal Population of Chhattisgarh, India: A Prospective Multi-Centre Study.","authors":"Abhishek Gupta, Aswathy M Nair, Shobha Ekka, Dharmendra Gahwai, Nisha Sharma, Faisal Raza Khan, Manisha Damani, Suraj Kumar, Saniya Pawar, Justy Antony Chiramal, Dennis Robert, Manoj Tadepalli, Shibu Vijayan, Pranav S Krishnan, Nidhi A Patil","doi":"10.1093/ofid/ofaf780","DOIUrl":"10.1093/ofid/ofaf780","url":null,"abstract":"<p><strong>Background: </strong>India accounts for the highest Tuberculosis (TB) burden globally. The incidence and prevalence of TB are higher in tribal population than general population. In this study, we assessed the effectiveness of artificial intelligence (AI) based chest X-ray (CXR) interpretation software device (qXR version 3), in detecting TB from a predominantly tribal population setting.</p><p><strong>Methods: </strong>In this multicenter prospective study, all the CXRs of patients aged > 15 years taken for any reason at 3 public health facilities in the Chhattisgarh state of India between 01 August 2023 and 31 March 2024 were included. Patients flagged by AI as TB presumptive were directed to undergo sputum testing, who are subsequently confirmed either microbiologically or clinically.</p><p><strong>Results: </strong>Out of 2745 CXRs screened, 363 patients (median age, 44 years [IQR: 30-53]; 261 [71.9%] male) were identified as presumptive for TB. 162 cases were confirmed with TB positivity rate of 44.63% (95% CI: 39.44-49.91). Among the AI-flagged cases, 51 (14.04%) patients were asymptomatic, and 20 (39.22%) of them were confirmed with TB. Descriptively, when compared with baseline (August-2022 to March-2023), an 80.21% (<i>P</i> < .001) increase in the number of TB case notifications was observed during the AI implemented period.</p><p><strong>Conclusions: </strong>This study highlights the potential of AI to enhance TB detection and feasibility in a resource-limited tribal setting. Above 40% of the patients flagged by AI were subsequently confirmed to have the TB disease. Additionally, the study demonstrated the potential of AI in identifying asymptomatic individuals who would otherwise have been missed or diagnosed late.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofaf780"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
C-Reactive Protein for Pulmonary Tuberculosis Screening and Treatment Response Monitoring in Children. c反应蛋白在儿童肺结核筛查和治疗反应监测中的应用。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-07 eCollection Date: 2026-02-01 DOI: 10.1093/ofid/ofaf816
Joy Githua, Jerphason Mecha, Joshua Stern, Jaclyn N Escudero, Lilian Njagi, Lucy Kijaro, Jacqueline Mirera, Wilfred Murithi, Grace John-Stewart, Elizabeth Maleche-Obimbo, Videlis Nduba, Sylvia M LaCourse

C-reactive protein (CRP) was evaluated as a biomarker for pulmonary tuberculosis (TB) diagnosis and treatment response monitoring in 292 Kenyan children. Although diagnostic sensitivity was suboptimal (35.5%-50.0%), the median CRP level decreased during TB treatment in children with confirmed (P = .02) or unconfirmed (P < .001) TB, primarily among those with baseline CRP elevation ≥5 mg/L (40% [39 of 97]).

在292名肯尼亚儿童中,c反应蛋白(CRP)作为肺结核(TB)诊断和治疗反应监测的生物标志物进行评估。虽然诊断敏感性不理想(35.5%-50.0%),但确诊(P = 0.02)或未确诊(P < 0.001)结核病儿童的中位CRP水平在结核病治疗期间下降,主要发生在基线CRP升高≥5mg /L的患者中(40%[97中的39])。
{"title":"C-Reactive Protein for Pulmonary Tuberculosis Screening and Treatment Response Monitoring in Children.","authors":"Joy Githua, Jerphason Mecha, Joshua Stern, Jaclyn N Escudero, Lilian Njagi, Lucy Kijaro, Jacqueline Mirera, Wilfred Murithi, Grace John-Stewart, Elizabeth Maleche-Obimbo, Videlis Nduba, Sylvia M LaCourse","doi":"10.1093/ofid/ofaf816","DOIUrl":"10.1093/ofid/ofaf816","url":null,"abstract":"<p><p>C-reactive protein (CRP) was evaluated as a biomarker for pulmonary tuberculosis (TB) diagnosis and treatment response monitoring in 292 Kenyan children. Although diagnostic sensitivity was suboptimal (35.5%-50.0%), the median CRP level decreased during TB treatment in children with confirmed (<i>P</i> = .02) or unconfirmed (<i>P</i> < .001) TB, primarily among those with baseline CRP elevation ≥5 mg/L (40% [39 of 97]).</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 2","pages":"ofaf816"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute Respiratory Infections Due to Antibiotic-nonsusceptible Streptococcus pneumoniae in US Adults. 美国成人抗生素不敏感肺炎链球菌引起的急性呼吸道感染。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-07 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofaf774
Laura M King, Kristin L Andrejko, Miwako Kobayashi, Wei Xing, Adam L Cohen, Joseph A Lewnard

Background: We aimed to estimate the burden of antibiotic-nonsusceptible nonbacteremic pneumonia and sinusitis due to Streptococcus pneumoniae (pneumococcus) in US adults (aged ≥18 years).

Methods: We estimated antibiotic-nonsusceptible pneumococcal sinusitis and nonbacteremic pneumonia incidence as products of pneumococcal pneumonia and sinusitis incidence rates, serotype distribution, and serotype-specific antimicrobial nonsusceptibility prevalences from 2016 through 2019. Nonsusceptibility was considered by antibiotic class and guideline-recommended agents. We estimated pneumonia and sinusitis incidence rates from national surveys and administrative datasets and derived pneumococcal-attributable percents and serotype distributions from published data. Serotype-specific nonsusceptibility estimates were from Active Bacterial Core surveillance data. We evaluated nonsusceptibility for all serotypes and those targeted by 15-, 20-, and 21-valent pneumococcal conjugate vaccines (PCV15/20/21).

Results: An estimated 16.4% (95% confidence interval, 12.8-21.4) of nonbacteremic pneumococcal pneumonia and 19.0% (14.8-24.9%) of sinusitis cases were nonsusceptible to ≥ 3 antibiotic classes, translating to 243 521 (179 673-333 675) and 1 844 726 (1 070 763-2 904 089) outpatient visits for pneumonia and sinusitis, respectively, and 10 155 (7542-13 803) pneumonia hospitalizations annually. An estimated 31.2% (26.6%-36.3%) of nonbacteremic pneumococcal pneumonia and 10.5% (9.4%-12.0%) of pneumococcal sinusitis cases were nonsusceptible to ≥ 1 outpatient first-line antibiotic agent. Cases attributable to serotypes targeted by PCV15, PCV20, and PCV21 that were nonsusceptible to ≥3 antibiotic classes accounted for 7.4% (4.7%-11.1%), 8.5% (5.8-12.1%), and 12.6% (9.2-17.5%) of nonbacteremic pneumococcal pneumonia, and 8.4% (5.3-12.5%), 9.4% (6.2-13.4), and 14.4% (10.4-20.0%) of pneumococcal sinusitis.

Conclusions: We estimated high proportions of antibiotic-nonsusceptibility in nonbacteremic pneumococcal pneumonia and sinusitis in US adults. Use of PCVs and antibiotic stewardship may mitigate the burden of antibiotic-nonsusceptible pneumococcal disease.

背景:我们的目的是评估美国成年人(年龄≥18岁)因肺炎链球菌(肺炎球菌)引起的抗生素不敏感的非菌源性肺炎和鼻窦炎的负担。方法:我们估计了2016年至2019年肺炎球菌性肺炎和鼻窦炎发病率、血清型分布和血清型特异性抗菌药物不敏感患病率的产物,即抗生素非敏感肺炎球菌性鼻窦炎和非菌源性肺炎发病率。根据抗生素类别和指南推荐的药物考虑非敏感性。我们从国家调查和行政数据集中估计肺炎和鼻窦炎的发病率,并从已发表的数据中得出肺炎球菌归因百分比和血清型分布。血清型特异性非敏感性估计来自活性细菌核心监测数据。我们评估了所有血清型和15价、20价和21价肺炎球菌结合疫苗(PCV15/20/21)的非敏感性。结果:估计有16.4%(95%可信区间12.8 ~ 21.4)的非菌源性肺炎球菌肺炎和19.0%(14.8 ~ 24.9%)的鼻窦炎患者对≥3种抗生素不敏感,分别为肺炎和鼻窦炎的年门诊次数分别为243 521次(179 673 ~ 333 675)和1 844 726次(1 070 763 ~ 904 089),肺炎住院次数为10 155次(7542 ~ 13 803)。据估计,31.2%(26.6%-36.3%)的非菌血症性肺炎球菌肺炎和10.5%(9.4%-12.0%)的肺炎球菌性鼻窦炎患者对≥1种门诊一线抗生素不敏感。PCV15、PCV20和PCV21血清型对≥3种抗生素不敏感的病例占非菌血症性肺炎球菌肺炎的7.4%(4.7% ~ 11.1%)、8.5%(5.8 ~ 12.1%)和12.6%(9.2 ~ 17.5%),肺炎球菌性鼻窦炎的8.4%(5.3 ~ 12.5%)、9.4%(6.2 ~ 13.4)和14.4%(10.4 ~ 20.0%)。结论:我们估计在美国成人非菌血症性肺炎球菌肺炎和鼻窦炎中抗生素不敏感的比例很高。使用pcv和抗生素管理可减轻抗生素不敏感肺炎球菌疾病的负担。
{"title":"Acute Respiratory Infections Due to Antibiotic-nonsusceptible <i>Streptococcus pneumoniae</i> in US Adults.","authors":"Laura M King, Kristin L Andrejko, Miwako Kobayashi, Wei Xing, Adam L Cohen, Joseph A Lewnard","doi":"10.1093/ofid/ofaf774","DOIUrl":"10.1093/ofid/ofaf774","url":null,"abstract":"<p><strong>Background: </strong>We aimed to estimate the burden of antibiotic-nonsusceptible nonbacteremic pneumonia and sinusitis due to <i>Streptococcus pneumoniae</i> (pneumococcus) in US adults (aged ≥18 years).</p><p><strong>Methods: </strong>We estimated antibiotic-nonsusceptible pneumococcal sinusitis and nonbacteremic pneumonia incidence as products of pneumococcal pneumonia and sinusitis incidence rates, serotype distribution, and serotype-specific antimicrobial nonsusceptibility prevalences from 2016 through 2019. Nonsusceptibility was considered by antibiotic class and guideline-recommended agents. We estimated pneumonia and sinusitis incidence rates from national surveys and administrative datasets and derived pneumococcal-attributable percents and serotype distributions from published data. Serotype-specific nonsusceptibility estimates were from Active Bacterial Core surveillance data. We evaluated nonsusceptibility for all serotypes and those targeted by 15-, 20-, and 21-valent pneumococcal conjugate vaccines (PCV15/20/21).</p><p><strong>Results: </strong>An estimated 16.4% (95% confidence interval, 12.8-21.4) of nonbacteremic pneumococcal pneumonia and 19.0% (14.8-24.9%) of sinusitis cases were nonsusceptible to ≥ 3 antibiotic classes, translating to 243 521 (179 673-333 675) and 1 844 726 (1 070 763-2 904 089) outpatient visits for pneumonia and sinusitis, respectively, and 10 155 (7542-13 803) pneumonia hospitalizations annually. An estimated 31.2% (26.6%-36.3%) of nonbacteremic pneumococcal pneumonia and 10.5% (9.4%-12.0%) of pneumococcal sinusitis cases were nonsusceptible to ≥ 1 outpatient first-line antibiotic agent. Cases attributable to serotypes targeted by PCV15, PCV20, and PCV21 that were nonsusceptible to ≥3 antibiotic classes accounted for 7.4% (4.7%-11.1%), 8.5% (5.8-12.1%), and 12.6% (9.2-17.5%) of nonbacteremic pneumococcal pneumonia, and 8.4% (5.3-12.5%), 9.4% (6.2-13.4), and 14.4% (10.4-20.0%) of pneumococcal sinusitis.</p><p><strong>Conclusions: </strong>We estimated high proportions of antibiotic-nonsusceptibility in nonbacteremic pneumococcal pneumonia and sinusitis in US adults. Use of PCVs and antibiotic stewardship may mitigate the burden of antibiotic-nonsusceptible pneumococcal disease.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofaf774"},"PeriodicalIF":3.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12777965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do Sonication Results of Mobile Parts Predict Failure After Debridement and Implant Retention in Acute Periprosthetic Joint Infection? 在急性假体周围关节感染中,活动部件的超声结果能预测清创失败和种植体保留吗?
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-06 eCollection Date: 2026-02-01 DOI: 10.1093/ofid/ofaf807
Loris Oehen, Mario Morgenstern, Daniel Goldenberger, Richard Kuehl, Brigitta Gahl, Martin Clauss, Parham Sendi

In 57 periprosthetic joint infections with presumed acute presentations, the 2-year successful outcomes of debridement and implant retention were 64% (when sonication results revealed <1000 cfu/mL) and 21% (≥1000 cfu/mL). The odds for failure were 5.2 (P < .01) when the sonication result reported ≥1000 cfu/mL.

在57例假定为急性表现的假体周围关节感染中,当超声结果报告≥1000 cfu/mL时,2年的成功清创和假体保留率为64%(超声结果显示P < 0.01)。
{"title":"Do Sonication Results of Mobile Parts Predict Failure After Debridement and Implant Retention in Acute Periprosthetic Joint Infection?","authors":"Loris Oehen, Mario Morgenstern, Daniel Goldenberger, Richard Kuehl, Brigitta Gahl, Martin Clauss, Parham Sendi","doi":"10.1093/ofid/ofaf807","DOIUrl":"10.1093/ofid/ofaf807","url":null,"abstract":"<p><p>In 57 periprosthetic joint infections with presumed acute presentations, the 2-year successful outcomes of debridement and implant retention were 64% (when sonication results revealed <1000 cfu/mL) and 21% (≥1000 cfu/mL). The odds for failure were 5.2 (<i>P</i> < .01) when the sonication result reported ≥1000 cfu/mL.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 2","pages":"ofaf807"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12866919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing the Effectiveness of High Intensity Interval Training vs Continuous Moderate Intensity Exercise on Physical Function Among Older Adults With HIV. 比较高强度间歇训练与持续中等强度运动对老年艾滋病毒感染者身体功能的影响。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-06 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofag002
Grace L Kulik, Vitor H F Oliveira, Melissa P Wilson, Vincent Khuu, Catherine M Jankowski, Evelyn Iriarte, Christine Horvat Davey, Paul Cook, Debashis Ghosh, Samantha MaWhinney, Allison R Webel, Kristine M Erlandson

Background: People with HIV (PWH) have accelerated declines in physical function. Although exercise is highly effective for improving function, whether high-intensity interval training (HIIT) imparts greater physical function improvement than continuous moderate-intensity exercise (CME) among older PWH is unknown.

Methods: The HEALTH trial (NCT04550676) enrolled sedentary PWH ≥50 years old on stable antiretroviral therapy (ART). Participants were randomized to perform 16 weeks of HIIT or CME, both with resistance exercise. High-intensity interval training sessions included 5 high-intensity (90% of heart rate reserve [HRR] for 4 minutes) and 4 moderate-intensity (50% of HRR for 3 minutes) bouts; the CME arm walked continuously at 60% of HRR. The primary outcome was percent change in 400-meter walk time (400-MWT).

Results: Of the 118 randomized participants (n = 57 in HIIT, n = 54 in CME), 111 participants were included in the primary analysis; among these, the median age was 57 (interquartile range, 54-61) years, and 14% of participants were female. Participants in both HIIT (5.9% [95% CI], -7.7, -4.1) and CME (4.6% [95% CI, -6.4, -2.8]) had significant improvements in 400-MWT, with no significant difference between arms (P = .33). Among secondary outcomes of physical function and muscle strength, both arms demonstrated improvement (P < .05 for all), with no significant difference between arms at week 16.

Conclusions: Although HIIT demonstrated greater gains in physical function among PWH, the differences from CME were small and not statistically different. Given that both HIIT and CME improved physical function, PWH should be encouraged to select the aerobic exercise according to individual preference.

背景:HIV感染者(PWH)的身体机能加速下降。虽然运动对改善功能非常有效,但在老年PWH中,高强度间歇训练(HIIT)是否比持续中等强度运动(CME)更能改善身体功能尚不清楚。方法:健康试验(NCT04550676)招募久坐的PWH≥50岁,接受稳定抗逆转录病毒治疗(ART)。参与者被随机分配进行16周的HIIT或CME,两者都有阻力运动。高强度间歇训练包括5次高强度(90% HRR持续4分钟)和4次中强度(50% HRR持续3分钟);CME组以60%的HRR连续行走。主要结果是400米步行时间(400-MWT)的百分比变化。结果:118名随机参与者(HIIT组57名,CME组54名)中,111名参与者被纳入初步分析;其中,中位年龄为57岁(四分位数间距为54-61岁),14%的参与者为女性。HIIT组(5.9% [95% CI], -7.7, -4.1)和CME组(4.6% [95% CI, -6.4, -2.8])的受试者400-MWT均有显著改善,两组间无显著差异(P = 0.33)。在身体功能和肌肉力量的次要结局中,两组均表现出改善(P < 0.05),第16周时两组间无显著差异。结论:虽然HIIT在PWH中表现出更大的身体功能改善,但与CME的差异很小,没有统计学差异。鉴于HIIT和CME均能改善身体功能,应鼓励PWH根据个人喜好选择有氧运动。
{"title":"Comparing the Effectiveness of High Intensity Interval Training vs Continuous Moderate Intensity Exercise on Physical Function Among Older Adults With HIV.","authors":"Grace L Kulik, Vitor H F Oliveira, Melissa P Wilson, Vincent Khuu, Catherine M Jankowski, Evelyn Iriarte, Christine Horvat Davey, Paul Cook, Debashis Ghosh, Samantha MaWhinney, Allison R Webel, Kristine M Erlandson","doi":"10.1093/ofid/ofag002","DOIUrl":"10.1093/ofid/ofag002","url":null,"abstract":"<p><strong>Background: </strong>People with HIV (PWH) have accelerated declines in physical function. Although exercise is highly effective for improving function, whether high-intensity interval training (HIIT) imparts greater physical function improvement than continuous moderate-intensity exercise (CME) among older PWH is unknown.</p><p><strong>Methods: </strong>The HEALTH trial (NCT04550676) enrolled sedentary PWH ≥50 years old on stable antiretroviral therapy (ART). Participants were randomized to perform 16 weeks of HIIT or CME, both with resistance exercise. High-intensity interval training sessions included 5 high-intensity (90% of heart rate reserve [HRR] for 4 minutes) and 4 moderate-intensity (50% of HRR for 3 minutes) bouts; the CME arm walked continuously at 60% of HRR. The primary outcome was percent change in 400-meter walk time (400-MWT).</p><p><strong>Results: </strong>Of the 118 randomized participants (n = 57 in HIIT, n = 54 in CME), 111 participants were included in the primary analysis; among these, the median age was 57 (interquartile range, 54-61) years, and 14% of participants were female. Participants in both HIIT (5.9% [95% CI], -7.7, -4.1) and CME (4.6% [95% CI, -6.4, -2.8]) had significant improvements in 400-MWT, with no significant difference between arms (<i>P</i> = .33). Among secondary outcomes of physical function and muscle strength, both arms demonstrated improvement (<i>P</i> < .05 for all), with no significant difference between arms at week 16.</p><p><strong>Conclusions: </strong>Although HIIT demonstrated greater gains in physical function among PWH, the differences from CME were small and not statistically different. Given that both HIIT and CME improved physical function, PWH should be encouraged to select the aerobic exercise according to individual preference.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofag002"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bimonthly Administered Long-Acting Cabotegravir and Rilpivirine Are Highly Effective and Well-Tolerated in People With Human Immunodeficiency Virus Above 65 Years. 长效卡博特韦和利匹韦林对65岁以上人类免疫缺陷病毒感染者非常有效且耐受性良好。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-06 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofaf817
Andrea Calcagno, Caterina Candela, Agostino Riva, Stefano Calza, Benedetta Fioretti, Samuele Gardini, Jovana Milic, Benedetto Maurizio Celesia, Giancarlo Orofino, Andrea De Vito, Giuseppe Vittorio De Socio, Maria Vittoria Cossu, Federica Barrera, Maria Mazzitelli, Silvia Nozza, Giovanni Guaraldi, Emanuele Focà

Older people with HIV (PWH) may benefit from long-acting cabotegravir/rilpivirine (LA-CAB/RPV), a population underrepresented in trials and observational cohorts. In the GEPPO cohort, 135 PWH >65 years of age received bimonthly LA-CAB/RPV. After 17.4 months, virological suppression (HIV-RNA <50 copies/mL) was maintained in all, while 15 participants discontinued them (11.1%, 10% in the first 12 months): 1 participant with isolated HbCAb at baseline showed a late HBV reactivation (19.4 months after starting). These findings support LA-CAB/RPV's efficacy and tolerability in older PWH.

老年艾滋病毒感染者(PWH)可能受益于长效卡博特韦/利匹韦林(LA-CAB/RPV),这一人群在试验和观察性队列中代表性不足。在GEPPO队列中,135名65岁的PWH患者每两个月接受一次LA-CAB/RPV治疗。17.4个月后,病毒抑制(HIV-RNA)
{"title":"Bimonthly Administered Long-Acting Cabotegravir and Rilpivirine Are Highly Effective and Well-Tolerated in People With Human Immunodeficiency Virus Above 65 Years.","authors":"Andrea Calcagno, Caterina Candela, Agostino Riva, Stefano Calza, Benedetta Fioretti, Samuele Gardini, Jovana Milic, Benedetto Maurizio Celesia, Giancarlo Orofino, Andrea De Vito, Giuseppe Vittorio De Socio, Maria Vittoria Cossu, Federica Barrera, Maria Mazzitelli, Silvia Nozza, Giovanni Guaraldi, Emanuele Focà","doi":"10.1093/ofid/ofaf817","DOIUrl":"10.1093/ofid/ofaf817","url":null,"abstract":"<p><p>Older people with HIV (PWH) may benefit from long-acting cabotegravir/rilpivirine (LA-CAB/RPV), a population underrepresented in trials and observational cohorts. In the GEPPO cohort, 135 PWH >65 years of age received bimonthly LA-CAB/RPV. After 17.4 months, virological suppression (HIV-RNA <50 copies/mL) was maintained in all, while 15 participants discontinued them (11.1%, 10% in the first 12 months): 1 participant with isolated HbCAb at baseline showed a late HBV reactivation (19.4 months after starting). These findings support LA-CAB/RPV's efficacy and tolerability in older PWH.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofaf817"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transitioning to Shorter, Oral Antimicrobial Therapy for Pelvic Osteomyelitis in Patients Living With Spinal Cord Injury. 脊髓损伤患者盆腔骨髓炎过渡到较短的口服抗菌药物治疗。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-06 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofaf805
Dhineli Perera, Ben Clegg, Ash Thomas, Sara Vogrin, Satwik Motaganahalli, Richard Clements, Caroline McFarlane, Estelle Petch, Andrew Nunn, Jason A Trubiano, Gemma K Reynolds

An 8-year prospective cohort study of pelvic osteomyelitis in patients living with spinal cord injury shows that 4- to 6-week, post-debridement, quinolone-sparing oral antimicrobial regimens were effective within multidisciplinary care. Clinical cure (89% at 12 months) remained high with shorter durations. These real-world findings support stewardship and inform prescribing and future trials.

一项针对脊髓损伤患者盆腔骨髓炎的8年前瞻性队列研究表明,在清创后4- 6周,不使用喹诺酮类药物的口服抗菌方案在多学科治疗中是有效的。临床治愈率(12个月89%)在较短的时间内仍然很高。这些真实世界的发现支持管理,并为处方和未来的试验提供信息。
{"title":"Transitioning to Shorter, Oral Antimicrobial Therapy for Pelvic Osteomyelitis in Patients Living With Spinal Cord Injury.","authors":"Dhineli Perera, Ben Clegg, Ash Thomas, Sara Vogrin, Satwik Motaganahalli, Richard Clements, Caroline McFarlane, Estelle Petch, Andrew Nunn, Jason A Trubiano, Gemma K Reynolds","doi":"10.1093/ofid/ofaf805","DOIUrl":"10.1093/ofid/ofaf805","url":null,"abstract":"<p><p>An 8-year prospective cohort study of pelvic osteomyelitis in patients living with spinal cord injury shows that 4- to 6-week, post-debridement, quinolone-sparing oral antimicrobial regimens were effective within multidisciplinary care. Clinical cure (89% at 12 months) remained high with shorter durations. These real-world findings support stewardship and inform prescribing and future trials.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofaf805"},"PeriodicalIF":3.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Characteristics and Management of Non-Tuberculous Mycobacterial Skin and Soft Tissue Infections: A Retrospective Cohort Study. 非结核分枝杆菌皮肤和软组织感染的临床特征和处理:一项回顾性队列研究。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-05 eCollection Date: 2026-01-01 DOI: 10.1093/ofid/ofaf788
Wouter Peeters, Chang van Lier, Jakko van Ingen, Claire van Houdt, Reinout van Crevel, Colette van Hees, Hannelore Bax, Juul van den Reek, Arjan van Laarhoven

Background: Non-tuberculous mycobacterial (NTM) skin and soft tissue infections (SSTI) present a significant treatment challenge, requiring prolonged, multidrug antibiotic regimens often associated with substantial toxicity and suboptimal clinical outcomes. We aim to describe the clinical characteristics and treatment of patients with NTM-SSTI in the Netherlands, focusing on host immune status and drug toxicity.

Methods: We retrospectively collected data from adults with NTM-SSTI treated at 2 Dutch tertiary referral centers for mycobacterial disease between 2017 and 2024. Data included sociodemographics, medical history, antibiotic regimens, drug toxicity, and treatment outcomes.

Results: We included 73 patients, of whom 39 (49%) were immunocompromised. Disseminated disease was almost exclusively observed in immunocompromised patients (14/15). The most isolated species were Mycobacterium chelonae (23/73; 32%) and Mycobacterium marinum (17/73; 23%). Azithromycin, the most prescribed drug, was discontinued prematurely because of toxicity in 35% (18/52) of patients, ethambutol in 33% (9/27), and clofazimine in only 12% (3/26). These discontinuations occurred mostly within the first 4 months. Immunocompromised patients with disseminated infections had longer (median 10.1 vs 7.6 vs 6.4 months) treatment durations and lower remission rates (29% vs 59% vs 86%) compared to immunocompromised patients with localized disease and immunocompetent patients, respectively.

Conclusions: Immunocompromised status is associated with disseminated NTM-SSTI and worse treatment outcomes. Regardless of immune status, antimycobacterial drugs often cause toxicity, leading to treatment changes.

背景:非结核性分枝杆菌(NTM)皮肤和软组织感染(SSTI)是一项重大的治疗挑战,需要长期的多药抗生素治疗方案,通常伴有严重的毒性和不理想的临床结果。我们的目的是描述荷兰NTM-SSTI患者的临床特征和治疗,重点是宿主免疫状态和药物毒性。方法:我们回顾性收集了2017年至2024年间在荷兰2个分支杆菌疾病三级转诊中心治疗的NTM-SSTI成人患者的数据。数据包括社会人口统计学、病史、抗生素治疗方案、药物毒性和治疗结果。结果:我们纳入73例患者,其中39例(49%)免疫功能低下。播散性疾病几乎只发生在免疫功能低下的患者中(14/15)。分离种最多的是龟分枝杆菌(23/73;32%)和海洋分枝杆菌(17/73;23%)。阿奇霉素是处方最多的药物,35%(18/52)的患者因毒性过早停药,乙胺丁醇为33%(9/27),氯法齐明仅为12%(3/26)。这些停药主要发生在前4个月内。与局部疾病免疫功能低下患者和免疫功能正常患者相比,播散性感染免疫功能低下患者的治疗持续时间更长(中位10.1个月vs 7.6个月vs 6.4个月),缓解率更低(29% vs 59% vs 86%)。结论:免疫功能低下与播散性NTM-SSTI和较差的治疗结果相关。无论免疫状态如何,抗真菌药物往往会引起毒性,导致治疗改变。
{"title":"Clinical Characteristics and Management of Non-Tuberculous Mycobacterial Skin and Soft Tissue Infections: A Retrospective Cohort Study.","authors":"Wouter Peeters, Chang van Lier, Jakko van Ingen, Claire van Houdt, Reinout van Crevel, Colette van Hees, Hannelore Bax, Juul van den Reek, Arjan van Laarhoven","doi":"10.1093/ofid/ofaf788","DOIUrl":"10.1093/ofid/ofaf788","url":null,"abstract":"<p><strong>Background: </strong>Non-tuberculous mycobacterial (NTM) skin and soft tissue infections (SSTI) present a significant treatment challenge, requiring prolonged, multidrug antibiotic regimens often associated with substantial toxicity and suboptimal clinical outcomes. We aim to describe the clinical characteristics and treatment of patients with NTM-SSTI in the Netherlands, focusing on host immune status and drug toxicity.</p><p><strong>Methods: </strong>We retrospectively collected data from adults with NTM-SSTI treated at 2 Dutch tertiary referral centers for mycobacterial disease between 2017 and 2024. Data included sociodemographics, medical history, antibiotic regimens, drug toxicity, and treatment outcomes.</p><p><strong>Results: </strong>We included 73 patients, of whom 39 (49%) were immunocompromised. Disseminated disease was almost exclusively observed in immunocompromised patients (14/15). The most isolated species were <i>Mycobacterium chelonae</i> (23/73; 32%) and <i>Mycobacterium marinum</i> (17/73; 23%). Azithromycin, the most prescribed drug, was discontinued prematurely because of toxicity in 35% (18/52) of patients, ethambutol in 33% (9/27), and clofazimine in only 12% (3/26). These discontinuations occurred mostly within the first 4 months. Immunocompromised patients with disseminated infections had longer (median 10.1 vs 7.6 vs 6.4 months) treatment durations and lower remission rates (29% vs 59% vs 86%) compared to immunocompromised patients with localized disease and immunocompetent patients, respectively.</p><p><strong>Conclusions: </strong>Immunocompromised status is associated with disseminated NTM-SSTI and worse treatment outcomes. Regardless of immune status, antimycobacterial drugs often cause toxicity, leading to treatment changes.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 1","pages":"ofaf788"},"PeriodicalIF":3.8,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systemic Inflammation and Growth in Children Born to Mothers With and Without HIV in Rural Zimbabwe. 津巴布韦农村携带和未携带艾滋病毒母亲所生儿童的全身性炎症和生长。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-05 eCollection Date: 2026-02-01 DOI: 10.1093/ofid/ofaf810
Ceri Evans, Jonathan P Sturgeon, Sandra Rukobo, Margaret Govha, Bernard Chasekwa, Florence D Majo, Batsirai Mutasa, Naume Tavengwa, Robert Ntozini, Jean H Humphrey, Kuda Mutasa, Andrew J Prendergast

Background: Sixteen million children are HIV-exposed but uninfected (HEU) due to the prevention of vertical transmission. Despite avoiding HIV, children who are HEU face higher risks of infections and poorer growth and development than children HIV-unexposed (HU), though mechanisms remain unclear. We hypothesized that systemic and vascular inflammations contribute to disparities.

Methods: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial recruited pregnant women at ∼12 gestational weeks between 2012 and 2015 in rural Zimbabwe (∼15% HIV prevalence, >80% antiretroviral therapy coverage). Plasma biomarkers were measured using enzyme-linked immunosorbent assay (ELISA) and multiplex assays in a subgroup of children at 1 month of age and compared using generalized estimating equations adjusted for trial arm, maternal age, birthweight, prematurity, sex, and age. Principal component analysis was used to reduce dimensionality of biomarkers.

Results: Seventy-one children who are HEU and 62 who are HU were included. Twenty-two of 27 biomarkers were raised in HEU versus HU. Systemic inflammatory markers (IL-1β/interferon-γ/TNF-α/sCD14) and vascular activation markers (L-selectin/VCAM-1) were significantly higher. HIV-exposed but uninfected infants gained 6.1 g/day less than HU infants in the first month after birth. Although one principal component, primarily driven by vascular endothelial growth factor, was associated with increased growth rate, the difference between HEU and HU growth trajectories was not affected by differences in any principal components, suggesting that inflammation does not explain lower growth amongst HEU children.

Conclusions: Children who are HEU have significantly elevated systemic and vascular inflammatory biomarkers compared with those who are HU. Understanding causes and consequences of this inflammatory imbalance may identify new intervention targets for improving outcomes in this vulnerable group.

背景:由于预防垂直传播,1600万儿童暴露于艾滋病毒但未感染(HEU)。尽管避免了艾滋病毒,HEU儿童比未感染艾滋病毒的儿童面临更高的感染风险和更差的生长发育,尽管机制尚不清楚。我们假设全身和血管炎症导致了差异。方法:婴儿营养功效(SHINE)试验在2012年至2015年期间招募了津巴布韦农村地区12孕周的孕妇(艾滋病毒感染率为15%,抗逆转录病毒治疗覆盖率为80%)。在1月龄儿童亚组中,采用酶联免疫吸附测定法(ELISA)和多重测定法测量血浆生物标志物,并使用经试验组、母亲年龄、出生体重、早产、性别和年龄调整的广义估计方程进行比较。主成分分析用于降低生物标志物的维数。结果:纳入HEU患儿71例,HU患儿62例。HEU组27项生物标志物中有22项高于HU组。全身炎症标志物(IL-1β/干扰素-γ/TNF-α/sCD14)和血管激活标志物(l -选择素/VCAM-1)显著升高。在出生后的第一个月,暴露于艾滋病毒但未感染的婴儿比HU婴儿每天增加6.1克。虽然一个主要由血管内皮生长因子驱动的主成分与生长速度的增加有关,但HEU和HU生长轨迹的差异不受任何主成分差异的影响,这表明炎症不能解释HEU儿童生长速度较低。结论:与HU患儿相比,HEU患儿的全身和血管炎症生物标志物显著升高。了解这种炎症失衡的原因和后果可以确定新的干预目标,以改善这一弱势群体的预后。
{"title":"Systemic Inflammation and Growth in Children Born to Mothers With and Without HIV in Rural Zimbabwe.","authors":"Ceri Evans, Jonathan P Sturgeon, Sandra Rukobo, Margaret Govha, Bernard Chasekwa, Florence D Majo, Batsirai Mutasa, Naume Tavengwa, Robert Ntozini, Jean H Humphrey, Kuda Mutasa, Andrew J Prendergast","doi":"10.1093/ofid/ofaf810","DOIUrl":"10.1093/ofid/ofaf810","url":null,"abstract":"<p><strong>Background: </strong>Sixteen million children are HIV-exposed but uninfected (HEU) due to the prevention of vertical transmission. Despite avoiding HIV, children who are HEU face higher risks of infections and poorer growth and development than children HIV-unexposed (HU), though mechanisms remain unclear. We hypothesized that systemic and vascular inflammations contribute to disparities.</p><p><strong>Methods: </strong>The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial recruited pregnant women at ∼12 gestational weeks between 2012 and 2015 in rural Zimbabwe (∼15% HIV prevalence, >80% antiretroviral therapy coverage). Plasma biomarkers were measured using enzyme-linked immunosorbent assay (ELISA) and multiplex assays in a subgroup of children at 1 month of age and compared using generalized estimating equations adjusted for trial arm, maternal age, birthweight, prematurity, sex, and age. Principal component analysis was used to reduce dimensionality of biomarkers.</p><p><strong>Results: </strong>Seventy-one children who are HEU and 62 who are HU were included. Twenty-two of 27 biomarkers were raised in HEU versus HU. Systemic inflammatory markers (IL-1β/interferon-γ/TNF-α/sCD14) and vascular activation markers (L-selectin/VCAM-1) were significantly higher. HIV-exposed but uninfected infants gained 6.1 g/day less than HU infants in the first month after birth. Although one principal component, primarily driven by vascular endothelial growth factor, was associated with increased growth rate, the difference between HEU and HU growth trajectories was not affected by differences in any principal components, suggesting that inflammation does not explain lower growth amongst HEU children.</p><p><strong>Conclusions: </strong>Children who are HEU have significantly elevated systemic and vascular inflammatory biomarkers compared with those who are HU. Understanding causes and consequences of this inflammatory imbalance may identify new intervention targets for improving outcomes in this vulnerable group.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 2","pages":"ofaf810"},"PeriodicalIF":3.8,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distinct Clinico-pathogenic Subgroups in Pediatric Lyme Neuroborreliosis. 儿童莱姆病的不同临床致病亚群。
IF 3.8 4区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-03 eCollection Date: 2026-02-01 DOI: 10.1093/ofid/ofaf812
Semjon Sidorov, Beat M Greiter, Ester Osuna, Annette Hackenberg, Michelle Seiler, Roland Martin, Martina Marchesi, Stefanie von Felten, Adrian Egli, Christoph Berger, Patrick M Meyer Sauteur

Background: Lyme neuroborreliosis (LNB) is a common manifestation of Lyme disease in children. It is caused by the bacterium Borrelia burgdorferi and can affect both the peripheral nervous system (PNS) and the central nervous system (CNS). This study aimed to describe clinical and immunological features of LNB in children.

Methods: We performed a large retrospective cohort study of children diagnosed with LNB at the University Children's Hospital Zurich from 1 January 2006 to 31 December 2020.

Results: A total of 190 children diagnosed with LNB were included (median age, 7.6 years). Meningitis was the most frequent manifestation of LNB (n = 115, 60.5%), followed by isolated cranial neuropathy (iCN) (n = 55, 28.9%) and meningoradiculitis (n = 15, 7.9%). Five (2.7%) patients presented with rare, severe CNS manifestations, including acute myelitis and cerebral vasculitis. The most frequent specific clinical signs were facial palsy (n = 136, 71.6%) and a history of erythema migrans (n = 33, 17.4%). Borrelia burgdorferi-specific IgM and IgG antibody responses in cerebrospinal fluid (CSF) and blood were primarily directed against the following 3 antigens: VlsE, p41, and OspC, with broader responses in blood. Compared to patients with meningitis or meningoradiculitis, iCN patients had lower CSF inflammation, reduced positivity in B burgdorferi-specific tests (ELISA, immunoblot, and/or intrathecal antibody production), weaker antibody responses to VlsE, p41, and OspC, and shorter post-treatment symptom duration.

Conclusions: Lyme neuroborreliosis in children presents with a broad clinical spectrum, with meningitis and iCN being the most common manifestations. We observed distinct clinico-pathogenic subgroups of LNB: iCN reflects a more localized, PNS-restricted disease, whereas meningitis and meningoradiculitis represent a more systemic involvement of both PNS and CNS. These findings may improve diagnostic accuracy and guide the management of children with LNB.

背景:莱姆病(Lyme neuroborreliosis, LNB)是儿童莱姆病的一种常见表现。它是由伯氏疏螺旋体引起的,可以影响周围神经系统(PNS)和中枢神经系统(CNS)。本研究旨在描述儿童LNB的临床和免疫学特征。方法:我们对2006年1月1日至2020年12月31日在苏黎世大学儿童医院诊断为LNB的儿童进行了一项大型回顾性队列研究。结果:共纳入190例诊断为LNB的儿童(中位年龄7.6岁)。LNB最常见的表现是脑膜炎(n = 115, 60.5%),其次是孤立性颅神经病变(n = 55, 28.9%)和脑膜根炎(n = 15, 7.9%)。5例(2.7%)患者表现为罕见、严重的中枢神经系统表现,包括急性脊髓炎和脑血管炎。最常见的特殊临床症状是面瘫(n = 136, 71.6%)和迁移性红斑史(n = 33, 17.4%)。脑脊液和血液中的伯氏疏螺旋体特异性IgM和IgG抗体反应主要针对以下3种抗原:VlsE、p41和OspC,血液中的反应范围更广。与脑膜炎或脑膜根炎患者相比,iCN患者脑脊液炎症程度较低,伯氏疏螺旋体特异性试验(ELISA、免疫印迹和/或鞘内抗体产生)阳性程度较低,对VlsE、p41和OspC的抗体反应较弱,治疗后症状持续时间较短。结论:儿童莱姆病具有广泛的临床表现,以脑膜炎和iCN为最常见的表现。我们观察到LNB不同的临床致病亚群:iCN反映了更局部的PNS限制性疾病,而脑膜炎和脑膜根炎代表了PNS和CNS的更全身性累及。这些发现可能会提高诊断的准确性,并指导LNB患儿的治疗。
{"title":"Distinct Clinico-pathogenic Subgroups in Pediatric Lyme Neuroborreliosis.","authors":"Semjon Sidorov, Beat M Greiter, Ester Osuna, Annette Hackenberg, Michelle Seiler, Roland Martin, Martina Marchesi, Stefanie von Felten, Adrian Egli, Christoph Berger, Patrick M Meyer Sauteur","doi":"10.1093/ofid/ofaf812","DOIUrl":"10.1093/ofid/ofaf812","url":null,"abstract":"<p><strong>Background: </strong>Lyme neuroborreliosis (LNB) is a common manifestation of Lyme disease in children. It is caused by the bacterium <i>Borrelia burgdorferi</i> and can affect both the peripheral nervous system (PNS) and the central nervous system (CNS). This study aimed to describe clinical and immunological features of LNB in children.</p><p><strong>Methods: </strong>We performed a large retrospective cohort study of children diagnosed with LNB at the University Children's Hospital Zurich from 1 January 2006 to 31 December 2020.</p><p><strong>Results: </strong>A total of 190 children diagnosed with LNB were included (median age, 7.6 years). Meningitis was the most frequent manifestation of LNB (<i>n</i> = 115, 60.5%), followed by isolated cranial neuropathy (iCN) (<i>n</i> = 55, 28.9%) and meningoradiculitis (<i>n</i> = 15, 7.9%). Five (2.7%) patients presented with rare, severe CNS manifestations, including acute myelitis and cerebral vasculitis. The most frequent specific clinical signs were facial palsy (<i>n</i> = 136, 71.6%) and a history of erythema migrans (<i>n</i> = 33, 17.4%). <i>Borrelia burgdorferi</i>-specific IgM and IgG antibody responses in cerebrospinal fluid (CSF) and blood were primarily directed against the following 3 antigens: VlsE, p41, and OspC, with broader responses in blood. Compared to patients with meningitis or meningoradiculitis, iCN patients had lower CSF inflammation, reduced positivity in <i>B burgdorferi</i>-specific tests (ELISA, immunoblot, and/or intrathecal antibody production), weaker antibody responses to VlsE, p41, and OspC, and shorter post-treatment symptom duration.</p><p><strong>Conclusions: </strong>Lyme neuroborreliosis in children presents with a broad clinical spectrum, with meningitis and iCN being the most common manifestations. We observed distinct clinico-pathogenic subgroups of LNB: iCN reflects a more localized, PNS-restricted disease, whereas meningitis and meningoradiculitis represent a more systemic involvement of both PNS and CNS. These findings may improve diagnostic accuracy and guide the management of children with LNB.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"13 2","pages":"ofaf812"},"PeriodicalIF":3.8,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12871429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Open Forum Infectious Diseases
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1