Clinical Infection in Practice最新文献

英文中文

Unusual fungal infection of the spine: A case report of Acremonium-induced vertebral osteomyelitis 脊柱异常真菌感染：阿克雷蒙尼诱发椎体骨髓炎1例

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.clinpr.2025.100523

Hufriya Mondegarian , Jibraiel Malick Rehman , Syed Muhammad Hasan Naqavi , Joveria Farooqi , Syed Faisal Mahmood

Background

Fungal vertebral osteomyelitis (VO) is a rare disease, typically caused by Aspergillus or Candida spp. Acremonium spp., especially in the spine, is uncommon. While classically affecting immuno-compromised patients, cases in immuno-competent hosts are increasingly reported. Diagnosis relies on beta D-glucan, MRI and galactomannan assays, with voriconazole as preferred therapy.

Case report

We report a rare case of fungal osteomyelitis in a 33-year-old immunocompetent adult male, with complaints of gradually progressing back pain accompanied by pain in the right leg for three months. Over the past year, this patient underwent L5-S1 laminectomy for disc radiculopathy after failed conservative treatment to resolve symptoms of left leg numbness. Magnetic Resonance Imaging showed discitis at surgical site without an abscess. After six weeks, a repeat scan revealed disease progression with an abscess and a new disc protrusion. Transforaminal lumbar interbody fusion (TLIF) with posterior instrumentation and fusion (PSIF) was performed, and fungal smears showed septate hyphae. Beta D-glucan was 99 pg/mL and galactomannan was 0.1 ODI. Cultures later yielded Acremonium spp. and voriconazole was started empirically.

Results

This case highlights three critical points being, fungal VO must be considered in refractory spinal infections; Acremonium can infect immunocompetent hosts; and voriconazole shows efficacy against this organism. The rising incidence of nosocomial fungal infections warrants increased suspicion for atypical pathogens, even without classic risk factors. Tests like galactomannan and beta-D-glucan, although non-specific, in addition to PCR can aid diagnosis when cultures are pending. While amphotericin B remains first-line for many systemic mycoses, voriconazole’s safety profile makes it preferable for long-term treatment.

Conclusion

This case will emphasize the rarity of Acremonium as a causative agent for osteomyelitis and discuss the importance of an accurate, quick diagnosis and treatment plan for similar cases. In addition, further studies should be conducted regarding similar case presentations.

真菌性椎体骨髓炎（VO）是一种罕见的疾病，通常由曲霉或念珠菌引起，尤其是在脊柱中，是罕见的。虽然通常影响免疫功能低下的患者，但免疫能力强的宿主的病例越来越多。诊断依赖于β - d -葡聚糖，MRI和半乳甘露聚糖检测，伏立康唑是首选治疗方法。病例报告我们报告一例罕见的真菌性骨髓炎病例，患者为33岁具有免疫功能的成年男性，主诉为逐渐进展的背部疼痛并伴有右腿疼痛3个月。在过去的一年里，该患者在保守治疗未能解决左腿麻木症状后，接受了L5-S1椎板切除术。磁共振成像显示手术部位椎间盘炎，无脓肿。六周后，再次扫描显示疾病进展为脓肿和新的椎间盘突出。经椎间孔腰椎椎体间融合术（TLIF）与后路内固定和融合术（PSIF）进行，真菌涂片显示分离菌丝。β - d -葡聚糖为99 pg/mL，半乳甘露聚糖为0.1 ODI。后来的培养产生了阿克雷蒙菌，伏立康唑开始了经验。结果本病例突出了三个关键点：难治性脊柱感染必须考虑真菌性VO；甲状念珠菌可感染免疫正常的宿主；伏立康唑对这种细菌有效。医院真菌感染的发病率不断上升，即使没有典型的危险因素，也需要增加对非典型病原体的怀疑。像半乳甘露聚糖和β - d -葡聚糖这样的测试，虽然没有特异性，但除了PCR之外，可以在培养待定时帮助诊断。两性霉素B仍然是许多系统性真菌病的一线治疗药物，伏立康唑的安全性使其更适合长期治疗。结论本病例将强调骨铵作为骨髓炎病原体的罕见性，并讨论对类似病例准确、快速诊断和治疗方案的重要性。此外，应进一步研究类似的案例报告。

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Corrigendum regarding Missing Ethical Statement in previously published articles 关于先前发表的文章中缺少伦理声明的更正

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.clinpr.2025.100532

引用次数: 0

Corrigendum regarding Missing COI Statement in previously published articles 关于先前发表的文章中缺少COI声明的更正

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.clinpr.2025.100533

引用次数: 0

Corrigendum regarding Missing Ethical Statement in previously published articles 关于先前发表的文章中缺少伦理声明的更正

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2026-01-01 DOI: 10.1016/j.clinpr.2025.100531

引用次数: 0

The BIA meningitis and encephalitis Infection Quick Reference Guide BIA脑膜炎和脑炎感染快速参考指南

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-12-04 DOI: 10.1016/j.clinpr.2025.100524

Cristina Fernandez , Fiona McGill

The Meningitis and Encephalitis Infection Quick Reference Guide (IQRG) is a general resource for frontline NHS healthcare professionals caring for adults with brain infections. It should be used in conjunction with current UK guidance on the management of meningitis and encephalitis in adults. This IQRG provides guidance in the diagnosis, investigation, clinical management, and criteria for clinical escalation of adults with suspected meningitis and encephalitis.

Published IQRGs can be found on the BIA website. They are endorsed by the Royal College of Physicians and the Royal College of Pathologists.

脑膜炎和脑炎感染快速参考指南（IQRG）是一线NHS医疗保健专业人员照顾成人脑感染的一般资源。它应与目前英国成人脑膜炎和脑炎管理指南结合使用。该IQRG为疑似脑膜炎和脑炎的成人的诊断、调查、临床管理和临床升级标准提供指导。已公布的IQRGs可在BIA网站上找到。他们得到了皇家医师学院和皇家病理学家学院的认可。

引用次数: 0

Emphysematous osteomyelitis complicated with liver abscess and pulmonary infection in a diabetic patient: a case report 糖尿病患者肺气肿性骨髓炎并发肝脓肿及肺部感染1例

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-11-26 DOI: 10.1016/j.clinpr.2025.100526

Zidan Yang , Jingxin Zhang , Fan Yang

Emphysematous osteomyelitis (EO) is a life-threatening bone infection. In this case, we present a 67-year-old male patient with congenital deaf-mutism, hypertension, and diabetes mellitus. He was admitted to the emergency department due to “altered mental status for 2 h”, and blood tests revealed a significant elevation of infectious markers. Computed tomography (CT) scans showed multiple gas-density shadows in the L3 vertebral body, along with pneumocele in the spinal canal at the same level, the right psoas major muscle, and the diaphragm. Abdominal CT examination indicated a liver abscess in the right lobe of the patient’s liver. Pulmonary CT suggested multiple infectious lesions in the lungs. Subsequent cultures of blood, liver abscess drainage fluid, and cerebrospinal fluid all confirmed an infection with Klebsiella pneumoniae. The final diagnosis was “emphysematous osteomyelitis”, and the patient received anti-infective treatment and other supportive therapies, leading to the remission of his condition. Diabetes and malignant tumors are recognized as major risk factors for emphysematous osteomyelitis, while iatrogenic intervention may be a potential predisposing factor in the pathogenesis of the disease. Our report emphasizes the key role of identifying EO through unique imaging features (such as the “pumice stone” sign).

肺气肿性骨髓炎（EO）是一种危及生命的骨感染。在这个病例中，我们提出了一个67岁的男性先天性聋哑，高血压和糖尿病患者。由于“精神状态改变2小时”，他被送入急诊科，血液检查显示感染标志物显著升高。计算机断层扫描（CT）显示L3椎体有多个气体密度阴影，同时在同一水平的椎管、右侧腰大肌和横膈膜有气肿。腹部CT检查显示患者肝脏右叶有肝脓肿。肺部CT提示肺部多发感染性病变。随后的血液、肝脓肿引流液和脑脊液培养均证实肺炎克雷伯菌感染。最终诊断为“肺气肿性骨髓炎”，患者接受抗感染治疗和其他支持性治疗，病情得到缓解。糖尿病和恶性肿瘤被认为是肺气肿性骨髓炎的主要危险因素，而医源性干预可能是该病发病的潜在诱发因素。我们的报告强调了通过独特的成像特征（如“浮石”标志）识别EO的关键作用。

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引用次数: 0

COVID-19 vaccination in patients at higher risk of anaphylaxis: A safe and pragmatic approach 高危过敏反应患者的COVID-19疫苗接种：一种安全实用的方法

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-11-25 DOI: 10.1016/j.clinpr.2025.100525

Karla Berry , Aisling Barry , David McKay , Lorna Willocks , Rebecca K. Sutherland

At the start of the COVID-19 vaccine rollout, there was significant concern about anaphylaxis. We therefore set up a triage service and monitored vaccine clinic in NHS Lothian, UK. Despite MHRA guidance, we did not perform skin testing, as its reliability was uncertain and posed practical challenges that may have delayed vaccination.

Over 700 patients were triaged by an allergy specialist, who accepted referrals with concern of allergy to vaccine excipients, or a previous serious reaction to a COVID-19 vaccine. Vaccine type was advised at triage, and on 58 occasions pre-treatment with oral antihistamine was advised.

In total, 207 vaccinations were given in a monitored vaccine clinic run by a general physician, to 186 individuals. Fourty-one reactions occurred, with the greatest proportion in those with a previous reaction to a COVID-19 vaccine. All were observed within 30 min and were predominantly orofacial swelling and tingling, and skin reactions. All were managed with antihistamines, paracetamol, or personal rescue medications. No anaphylaxis occurred, and IM adrenaline was never given.

Out of 186 patients, 169 were advised they could have future vaccinations in a community setting. We propose that the format of this clinic could be extended to support all vaccination programmes.

在COVID-19疫苗推出之初，人们对过敏反应非常担忧。因此，我们在英国洛锡安建立了分诊服务和监测疫苗诊所。尽管有MHRA的指导，但我们没有进行皮肤试验，因为其可靠性不确定，并提出了可能延迟疫苗接种的实际挑战。过敏专家对700多名患者进行了分类，他们接受了对疫苗辅料过敏或之前对COVID-19疫苗有严重反应的转诊。在分诊时建议疫苗类型，在58次治疗前建议口服抗组胺药。在由一名普通医生管理的受监测的疫苗诊所，总共为186人接种了207次疫苗。发生了41起反应，其中先前对COVID-19疫苗有反应的人所占比例最大。所有患者均在30分钟内观察到，主要是口面部肿胀、刺痛和皮肤反应。所有患者均使用抗组胺药、扑热息痛或个人急救药物。未发生过敏反应，未给予IM肾上腺素。在186名患者中，169名患者被建议未来可以在社区环境中接种疫苗。我们建议，该诊所的形式可以扩大，以支持所有疫苗接种规划。

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引用次数: 0

Vaccine-derived polio infection (VDPI): From eradication to reintroduction – A global health concern to address early 疫苗源性脊髓灰质炎感染：从根除到重新引入——需要及早处理的全球卫生问题

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-11-22 DOI: 10.1016/j.clinpr.2025.100528

Subrat Kumar , Subhra Subhadra , Snehasish Mishra , Ranjan K. Mohapatra , Aroop Mohanty , Sanjit Sah , Rachana Mehta

引用次数: 0

Trends in bloodstream infections and antimicrobial resistance among ICU patients with central venous catheters: A four-year retrospective study at Windhoek Central and Katutura Intermediate Hospitals (2020–2023) 中心静脉置管ICU患者血流感染和抗菌素耐药性趋势：温得和克中央医院和卡图图拉中级医院四年回顾性研究（2020-2023）

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-11-22 DOI: 10.1016/j.clinpr.2025.100527

John Mbako , Albertina Mariina Ndinelao Shatri

Bloodstream infections are a major cause of morbidity and mortality in Intensive Care Unit (ICU) patients, especially in resource-limited settings. This study aimed to evaluate the frequency of organisms isolated, antibiotic susceptibility patterns, and trends in multidrug resistance among ICU patients with central venous catheters at Windhoek Central Hospital and Katutura Intermediate Hospital from 2020 to 2023.

A retrospective review of blood culture results was conducted using laboratory data from the Namibia Institute of Pathology for patients with central venous catheters, who had blood culture samples taken while admitted to the ICU. Data collected included organism identification, antibiotic susceptibility, and resistance patterns. Descriptive statistics were used to analyze trends across the four years.

This is the first study to report on bloodstream infections and resistance patterns from Namibia. A total of 464 ICU patients had blood cultures performed, with 421 (96.8%) showing clinically significant infections. The most frequently isolated organisms were Staphylococcus epidermidis, Enterococcus faecium, and Klebsiella pneumoniae. High resistance rates were observed for ciprofloxacin, co-trimoxazole, and benzylpenicillin, while vancomycin and meropenem retained high efficacy. Multi-drug-resistant organisms were present in all four years, with Gram-positive organisms dominating the multi-drug resistance profile.

The study shows high levels of bloodstream infections, antimicrobial resistance, and a persistent burden of MDR organisms in ICU settings. These findings support the need for stronger infection control, updated local antibiograms, and improved antimicrobial stewardship. Future research should include clinical data, molecular diagnostics, and a broader hospital network to guide more effective interventions.

血液感染是重症监护病房（ICU）患者发病和死亡的主要原因，特别是在资源有限的环境中。本研究旨在评估2020年至2023年温得和克中心医院和卡图图拉中级医院ICU中心静脉导管患者中分离出的微生物频率、抗生素敏感性模式和多药耐药趋势。使用纳米比亚病理研究所的实验室数据对中心静脉导管患者的血培养结果进行回顾性审查，这些患者在入住ICU时采集了血培养样本。收集的数据包括微生物鉴定、抗生素敏感性和耐药模式。描述性统计用于分析四年的趋势。这是报告纳米比亚血液感染和耐药性模式的第一项研究。共有464例ICU患者进行了血培养，其中421例（96.8%）出现临床显著感染。最常见的分离生物是表皮葡萄球菌、屎肠球菌和肺炎克雷伯菌。环丙沙星、复方新诺明、青霉素耐药率较高，万古霉素、美罗培南耐药率较高。在所有四年中都存在多重耐药菌，其中革兰氏阳性菌占主导地位。该研究显示，ICU环境中存在高水平的血液感染、抗微生物药物耐药性和耐多药微生物的持续负担。这些发现支持加强感染控制、更新局部抗生素图和改进抗菌药物管理的必要性。未来的研究应该包括临床数据、分子诊断和更广泛的医院网络，以指导更有效的干预措施。

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引用次数: 0

Clinical characteristics, risk factors and outcomes of Human metapneumovirus infection: A 2022–2024 retrospective study in Bangladesh 孟加拉国人偏肺病毒感染的临床特征、危险因素和结局：2022-2024年回顾性研究

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-11-21 DOI: 10.1016/j.clinpr.2025.100529

KFM Ayaz, Chowdhury Adnan Sami, Sumaiya Farah Marisa, Mizanur Rahman, Nikhat Shahla Afsar, Md.Imrul Hasan, Mohammad Mahfuzur Rahman, Rayhan Uddin Ahmed, Nishat Ali, Anik Ehsan

Background

Human metapneumovirus (hMPV) causes a significant proportion of acute respiratory tract infections, particularly in elderly patients and young children. Although clinical recognition is growing in Bangladesh, epidemiology, risk factors, and outcomes have incomplete data. In this study we aimed to assess clinical characteristics, risk factors and outcomes of hMPV infection in a tertiary care facility situated at Dhaka, Bangladesh from 2022 to 2024.

Methods

This retrospective observational study was conducted at the Evercare Hospital, Dhaka. 78 RT-PCR confirmed HMPV subjects had their medical records reviewed. Hospitalization status, demographics, clinical presentation, laboratory data complications, and outcomes were extracted. Independent predictors were identified using multivariate logistic regression.

Results

78 patients were diagnosed with hMPV infection between 2022 and 2024 with male slightly higher 44 (56.4 %) and mean age 42.8 (24.1) years. Of the 78 patients, 41 (52.6 %) were treated as outpatients, whereas 37 (47.2 %) in patients. Cough (69.2 %) and fever (65.4 %) were the most common symptoms, and hospitalization was substantially correlated with dyspnea (p < 0.001). 50 % of patients had comorbidities, with the most prevalent being hypertension (21.8 %). 47.4 % of cases required hospitalization, 20.5 % required intensive care unit admission, and 3.8 % resulted in death (all adults). Multivariate analysis revealed elevated C-reactive protein (OR = 5.41, p 0.021), radiological chest abnormalities (OR = 6.51, p 0.014), lymphopenia (OR = 23.2, p 0.048), and age extremes (<18 years: OR = 12.7, p 0.011; >50 years: OR = 6.31, p 0.041) were associated with hospitalization.

Conclusion

HMPV infection represents a significant illness burden in children and elderly populations due to high hospitalization rates and serious consequences. Key predictors of hospitalization consist of lymphopenia, high CRP and abnormalities on chest imaging highlighting the significance of early risk stratification and of targeted surveillance.

人偏肺病毒（hMPV）引起很大比例的急性呼吸道感染，特别是在老年患者和幼儿中。尽管孟加拉国的临床认识正在增加，但流行病学、危险因素和结果的数据不完整。在这项研究中，我们旨在评估2022年至2024年孟加拉国达卡一家三级医疗机构中hMPV感染的临床特征、危险因素和结果。方法回顾性观察性研究在达卡Evercare医院进行，78例经RT-PCR证实的HMPV患者的医疗记录被回顾。提取住院状况、人口统计学、临床表现、实验室数据、并发症和结果。使用多元逻辑回归确定独立预测因子。结果2022 - 2024年共确诊hMPV感染78例，男性44例（56.4%），平均年龄42.8（24.1）岁；78例患者中，41例（52.6%）为门诊患者，37例（47.2%）为住院患者。咳嗽（69.2%）和发烧（65.4%）是最常见的症状，住院与呼吸困难有显著相关性（p < 0.001）。50%的患者有合并症，其中最常见的是高血压（21.8%）。47.4%的病例需要住院治疗，20.5%需要入住重症监护病房，3.8%导致死亡（所有成年人）。多因素分析显示，c反应蛋白升高（OR = 5.41, p 0.021）、胸部影像学异常（OR = 6.51, p 0.014）、淋巴细胞减少（OR = 23.2, p 0.048）和极端年龄（18岁：OR = 12.7, p 0.011； 50岁：OR = 6.31, p 0.041）与住院有关。结论hmpv感染是儿童和老年人的重要疾病负担，住院率高，后果严重。住院的关键预测因素包括淋巴细胞减少、高CRP和胸部影像学异常，这突出了早期风险分层和靶向监测的重要性。

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