Open Forum Infectious Diseases最新文献

We report an adolescent with perinatal HIV-1 infection treated from 1 month of age. Despite persistent viremia until age 4, he exhibited negative or weakly reactive serologies and no detectable intact proviruses at 11 and 18 years. This case questions current definitions of seroconversion, HIV persistence and remission in children.

Background: Oropouche virus (OROV), an arbovirus causing acute febrile illness, was mostly restricted to the Amazon basin until 2023, when a reassortant lineage spread across Latin America. Increasing numbers of cases have subsequently been reported in extra-Amazonian regions of Brazil. However, follow-up and detailed clinical description is limited. This study aimed to describe viral, clinical, and epidemiological characteristics of OROV cases in the Brazilian states of Rio de Janeiro and Minas Gerais.

Methods: This longitudinal study enrolled adults with OROV exposure. Clinical and laboratorial data were assessed, and serum, urine, and saliva samples were tested for OROV RNA and sequenced.

Results: From December 2024 to May 2025, 55 OROV cases were recruited (median age: 46, 65% female). The novel OROV reassortant was confirmed by RNA sequencing. The acute phase was characterized by headache (87%), malaise (87%), fever (82%), myalgia (75%), and rash (45%). Recurrence of symptoms occurred in one-third of participants, including malaise (53%), fever (41%), arthralgia (41%), and chills (41%), but without resurgence of viral load. Viral RNA in serum and saliva was primarily detected in the first week of disease, and beyond the third week in urine.

Conclusions: Cases appeared in clusters and rash was frequently observed. Symptoms returned after 1 week, indicating the importance of patient follow-up. Cases either lived near banana plantations or participated in recreational activities at waterfalls, raising concerns about ecotourism in the Atlantic Forest. Since OROV RNA was detectable in urine for a prolonged period, urine samples may be useful for diagnosis.

Background: Carriage of Neisseria lactamica (Nlac), a harmless nasopharyngeal commensal, correlates inversely with carriage of Neisseria meningitidis (Nmen), a common cause of meningitis and sepsis outbreaks in sub-Saharan Africa. Nasally administered lyophilized Nlac (LyoNlac) might interrupt carriage and transmission of Nmen in sub-Saharan settings without requirement of a cold chain, but whether LyoNlac can establish colonization is undetermined.

Methods: Healthy adult volunteers aged 18-45 years were inoculated intranasally with 10⁴-10⁷ colony forming units (CFU) of reconstituted, lyophilized Nlac strain Y92-1009 (LyoNlac) in 2 dose-ranging controlled human infection studies conducted in the United Kingdom and Mali. Safety was measured as a primary objective. Secondary objectives included the dose achieving ≥70% colonization rates for each setting, colonization kinetics, and serological responses. Both trials were registered with ClinicalTrials.gov (United Kingdom: NCT04135053, Mali: NCT04665791) and are complete.

Results: Intranasal inoculation with LyoNlac was well tolerated with no significant safety concerns. In the United Kingdom, 10⁵ CFU yielded 100% colonization (n = 10/10) while in Mali, 10⁷ CFU achieved 65% colonization (n = 13/20). An increase in Nlac- and Nmen-specific IgG from pre-challenge to day 28 post-challenge was observed in colonized participants-median fold-change [interquartile range] United Kingdom: Nlac 2.24 [1.37-4.24], Nmen 1.39 [1.20-3.70] and Mali: Nlac 1.31 [1.04-1.94], Nmen 1.32 [0.99-1.73]. No significant seroconversion occurred in non-colonized participants.

Conclusions: Intranasal inoculation with LyoNlac was safe and induced immunogenic nasopharyngeal colonization in healthy adults in the United Kingdom and Mali. Future clinical trials to determine whether LyoNlac reduces meningococcal carriage and transmission in the meningitis belt are warranted.

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.

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]).

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.

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.

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.

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.

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.