Clinical Infection in Practice最新文献

英文中文

Somatic STAT3 Gain-of-Function (GOF) syndrome underlying susceptibility to Parvovirus B19, Pseudomonas aeruginosa, and Histoplasma capsulatum infections 体细胞 STAT3 功能增益 (GOF) 综合征是 Parvovirus B19、铜绿假单胞菌和荚膜组织胞浆菌感染易感性的基础

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-10-14 DOI: 10.1016/j.clinpr.2024.100393

Cedric Julien , Stephane Bernier , Denis Cournoyer , Yichun Sun , Anna Perez , Joy Agbonze , Isabelle Angers , Lucie Roussel , Gizelle Popradi , Donald C. Vinh

Infections in overtly immunocompromised persons (e.g. those living with advanced HIV, receiving malignancy-targeting chemotherapy, or recipients of transplants), may present with severe disease. In the absence of overt immunosuppression, unexplained severe disease due to prevalent microbes may reflect an underlying “inborn error of immunity” (IEI). IEI are monogenic penetrant defects of immunity: Classically, the genetic mutation is germline, that is, derived from germ cells, vertically transmitted to offspring in Mendelian fashion (autosomal dominant, autosomal recessive, or X-linked), and present in all cells of the affected individual. IEI may also be caused by naturally-occurring autoantibodies directed to immunologic components (such as cytokines) (Casanova et al., 2024) or by somatic mutations (Aluri and Cooper, 2023). Somatic mutations occur when a deleterious genetic variant occurs in the post-zygotic stage of development and can affect any body cell, other than germ cells; they are well-known causes of solid and hematologic malignancies. Somatic IEI syndromes are emerging, typically associated with lymphoproliferative diseases or autoinflammatory disorders. We report the case of a young woman with unexplained severe infections in whom a somatic gain-of-function (GOF) mutation in Signal transducer and activator of transcription 3 (STAT3) was found.

免疫力明显低下的人（如晚期艾滋病毒感染者、接受恶性肿瘤靶向化疗者或接受移植者）感染后可能会出现严重的疾病。在没有明显免疫抑制的情况下，由流行微生物引起的原因不明的严重疾病可能反映了潜在的 "先天性免疫错误"（IEI）。先天性免疫缺陷是一种单基因渗透性免疫缺陷：一般来说，基因突变是生殖性的，即来自生殖细胞，以孟德尔方式垂直传递给后代（常染色体显性、常染色体隐性或 X 连锁），并存在于受影响个体的所有细胞中。IEI 也可能由针对免疫成分（如细胞因子）的天然自身抗体（Casanova 等人，2024 年）或体细胞突变（Aluri 和 Cooper，2023 年）引起。体细胞突变是指有害的基因变异发生在后染色体发育阶段，可影响生殖细胞以外的任何体细胞；体细胞突变是众所周知的实体瘤和血液系统恶性肿瘤的病因。体细胞 IEI 综合征正在出现，通常与淋巴组织增生性疾病或自身炎症性疾病相关。我们报告了一例年轻女性不明原因的严重感染病例，在她体内发现了信号转导和激活转录 3（STAT3）的体细胞功能增益（GOF）突变。

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引用次数: 0

Addressing the Nipah virus threat: A call for global vigilance and coordinated action 应对尼帕病毒威胁：呼吁全球保持警惕并采取协调行动

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-10-12 DOI: 10.1016/j.clinpr.2024.100390

Priyanka Mohapatra , Mahalaqua Nazli Khatib , Muhammed Shabil , Pranchal Rajput , Naveen Sharma , Prakasini Satapathy , Kiran Bhopte , Diptismita Jena , Sanjit Sah , Ganesh Bushi

The Nipah virus, classified by the World Health Organization as a priority pathogen due to its potential to cause epidemics, continues to present substantial challenges to public health systems with its episodic outbreaks and significant mortality rates. This zoonotic virus induces severe respiratory and neurological symptoms, often leading to multiorgan failure and high mortality. In India, the state of Kerala has become a focal point for NiV surveillance following repeated outbreaks that have highlighted the deadly impact of the virus and the urgent need for effective management strategies. Despite advances in diagnostics, the absence of specific treatments and vaccines complicates the effective management of these outbreaks. This article discusses the epidemiological trends, clinical challenges, and strategic imperatives for managing and preventing NiV. It highlights the ongoing transmission dynamics, including the genetic consistency of NiV that suggests a stable but continuously threatening viral reservoir in local bat populations. Moreover, the transmission mechanisms from fruit bats to humans, the pathogenesis within the human body, and the severe health outcomes resulting from infection have been discussed. The public health responses are essentially focused on surveillance, community engagement, and education, which are vital yet challenged by the lack of specific medical countermeasures. There is a need for global collaboration in research and public health preparedness to effectively address the challenges posed by NiV and promptly reduce the impact of future outbreaks.

尼帕病毒因其可能导致流行病而被世界卫生组织列为重点病原体，它的偶发性爆发和高死亡率继续给公共卫生系统带来巨大挑战。这种人畜共患病病毒会引发严重的呼吸道和神经系统症状，往往导致多器官衰竭和高死亡率。在印度，喀拉拉邦多次爆发 NiV疫情，凸显了该病毒的致命影响以及对有效管理策略的迫切需求，因此该邦已成为 NiV 监测的重点地区。尽管诊断技术不断进步，但由于缺乏特定的治疗方法和疫苗，有效控制疫情变得更加复杂。本文讨论了流行病学趋势、临床挑战以及管理和预防 NiV 的战略要务。文章强调了正在发生的传播动态，包括 NiV 的遗传一致性，这表明在当地蝙蝠种群中存在一个稳定但持续存在威胁的病毒库。此外，还讨论了从果蝠到人类的传播机制、人体内的致病机理以及感染导致的严重健康后果。公共卫生应对措施主要集中在监测、社区参与和教育方面，这些措施至关重要，但由于缺乏具体的医疗对策而面临挑战。有必要在研究和公共卫生准备方面开展全球合作，以有效应对 NiV 带来的挑战，并迅速降低未来疫情爆发的影响。

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引用次数: 0

I could smell there was something wrong with him: Clinical case of a decade of chronic undiagnosed brucellosis 我能感觉到他有些不对劲：十年未确诊的慢性布鲁氏菌病临床病例

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-10-11 DOI: 10.1016/j.clinpr.2024.100389

F.D. Halstead , E. Tennant , B.P. Wordsworth

Background

Brucellosis is a zoonotic infection, typically transmitted by ingestion of unpasteurised dairy products or direct contact with infected animals. It is associated with specific occupations, and travel to endemic countries. There are numerous reports of delayed diagnosis, particularly in non-endemic areas because diagnosis requires a high level of clinical suspicion. However, chronic brucellosis of 10-year duration is rare.

Case report

A 43-year-old previously well sportsman presented to primary care with acute flu-like symptoms and large joint arthralgia following travel to Southern France with his young family. The initial symptoms resolved, but recurred every few months over the subsequent decade with fever, depression, joint pain and malodorous perspiration. Approximately one year into the infection, a diagnosis of inflammatory polyarthritis was made, which was treated with oral corticosteroidssteroids.

However, this treatment was ineffective, and over the next nine years the patient experienced recurrent episodes of acute inflammation associated with extensive synovitis and severe erosive disease involving the left ankle and both knees, which eventually required joint replacement surgery.

Only following further microbiology testing Only during the work up for joint replacement surgery was the diagnosis of septic arthritis established when a small sinus track was identified discharging small amounts of serous fluid. Brucella melitensis was cultured from the ankle and knee joints and confirmed through serology. Following antibiotic treatment joint replacement was undertaken and the patient made an excellent recovery.

Conclusion

Although this patient had clinical features compatible with brucellosis, and relevant travel history, this diagnosis (nor any infective cause) was not considered for nearly a decade. Indeed, the initial steroid treatment could have exacerbated the infection.

We emphasise the importance of considering brucellosis in individuals who present with atypical osteoarticular inflammation, where there is a compatible travel history and for whom conventional microbiology has been negative.

背景布鲁氏菌病是一种人畜共患传染病，通常通过摄入未经巴氏消毒的乳制品或直接接触受感染的动物传播。它与特定的职业和前往流行国家有关。由于诊断需要高度的临床怀疑，因此有许多延误诊断的报告，特别是在非流行地区。病例报告一位 43 岁的运动员在与年轻的家人到法国南部旅行后，因急性流感样症状和大关节痛到初级保健中心就诊。最初的症状缓解了，但在随后的十年中，每隔几个月就会复发一次，并伴有发热、精神萎靡、关节疼痛和恶汗。感染大约一年后，患者被诊断为炎性多关节炎，并接受了口服皮质类固醇类药物的治疗。然而，治疗效果不佳，在接下来的九年里，患者的急性炎症反复发作，并伴有广泛的滑膜炎和严重的侵蚀性疾病，左脚踝和双膝均受累，最终需要接受关节置换手术。在进行关节置换手术前的准备工作中，患者被发现有一个小窦道排出少量浆液性液体，经过进一步的微生物检测后，化脓性关节炎的诊断才得以确立。从踝关节和膝关节中培养出了布鲁氏菌，并通过血清学检查得到了证实。结论虽然该患者的临床特征与布鲁氏菌病相符，并有相关的旅行史，但近十年来一直没有考虑过这一诊断（也没有考虑过任何感染原因）。我们强调，对于出现非典型骨关节炎、有相关旅行史且常规微生物学检查呈阴性的患者，考虑布鲁氏菌病非常重要。

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引用次数: 0

Detection of vaccine-derived poliovirus type-3 in sewage of Kathmandu Valley, Nepal 在尼泊尔加德满都谷地的污水中检测到疫苗衍生的 3 型脊髓灰质炎病毒

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-10-10 DOI: 10.1016/j.clinpr.2024.100388

Rachana Mehta , Amrendra Kushwaha , Sanjit Sah , Jack Feehan , Vasso Apostolopoulos

Enteroviruses include polioviruses, which are classified into three types: type 1, type 2, and type 3. The oral polio vaccine (OPV), which contains attenuated strains of these three types, has been pivotal in reducing polio incidence worldwide. However, OPV can lead to vaccine-derived poliovirus (VDPV) cases, including circulating VDPV1 (cVDPV1), cVDPV2, and cVDPV3. In contrast, the inactivated or ‘killed’ polio vaccine (IPV), effectively prevents poliomyelitis without the risk of causing cVDPV cases. On 26 May 2024, a novel mutated form of poliovirus was detected in sewage samples from Kathmandu, Nepal, indicating an ongoing risk of poliovirus reintroduction and transmission. This finding highlights the importance of robust surveillance and containment measures. Historically, the Salk vaccine (IPV) and the Sabin vaccine (OPV) have been used against poliovirus, each with its advantages and limitations. Moving forward, it is necessary to replace OPV with genetically modified OPV, or new IPV formulations. Enhanced vaccination strategies and continued surveillance are crucial for achieving complete poliovirus eradication and preventing future outbreaks.

肠道病毒包括脊髓灰质炎病毒，分为三种类型：1 型、2 型和 3 型。口服脊髓灰质炎疫苗（OPV）含有这三种类型的减毒株，在降低全球脊髓灰质炎发病率方面发挥了关键作用。然而，口服脊髓灰质炎疫苗会导致疫苗衍生脊髓灰质炎病毒（VDPV）病例，包括循环 VDPV1（cVDPV1）、cVDPV2 和 cVDPV3。相比之下，灭活或 "杀死 "脊髓灰质炎疫苗（IPV）可有效预防脊髓灰质炎，而不会有引起 cVDPV 病例的风险。2024 年 5 月 26 日，在尼泊尔加德满都的污水样本中检测到一种新型变异脊髓灰质炎病毒，这表明脊髓灰质炎病毒仍有重新引入和传播的风险。这一发现凸显了强有力的监控和遏制措施的重要性。历史上，人们一直使用索尔克疫苗（IPV）和萨宾疫苗（OPV）来预防脊髓灰质炎病毒，这两种疫苗各有优势和局限性。展望未来，有必要用转基因 OPV 或新的 IPV 配方取代 OPV。强化疫苗接种策略和持续监测对于实现彻底根除脊灰病毒和防止未来疫情爆发至关重要。

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引用次数: 0

Acute gastroenteritis infection quick reference guide 急性肠胃炎感染快速参考指南

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-24 DOI: 10.1016/j.clinpr.2024.100377

Natasha Ratnaraja, On behalf of the Clinical Services Committee, British Infection Association

引用次数: 0

IQRG investigation of skin and soft tissue infection 皮肤和软组织感染的 IQRG 调查

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-24 DOI: 10.1016/j.clinpr.2024.100376

Elizabeth L.A. Cross , Rebecca K. Sutherland , on behalf of the British Infection Association Clinical Services Committee

The Infection Quick Reference Guide (IQRG) Investigation of Skin & Soft Tissue Infection (SSTI) is a general resource for frontline NHS clinicians to use in caring for adults with SSTIs. It should be used alongside current guidance on managing SSTIs and is not intended for use in diabetic foot infections. The IQRGs are available on the BIA website and are published within and aligned to the Standards for Microbiology Investigations, where appropriate. They are endorsed by both the Royal College of Physicians and the Royal College of Pathologists.

感染快速参考指南》（IQRG）《皮肤及软组织感染（SSTI）调查》是供 NHS 一线临床医生在护理成人 SSTI 患者时使用的通用资料。该指南应与当前的 SSTI 管理指南一起使用，但不适用于糖尿病足感染。IQRGs 可在 BIA 网站上查阅，并酌情在《微生物学检查标准》中发布，且与《微生物学检查标准》保持一致。它们得到了皇家内科医学院和皇家病理学院的认可。

引用次数: 0

Investigation of sepsis in adult hospital patients; Infection quick reference guide 成人医院患者败血症调查；感染快速参考指南

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-21 DOI: 10.1016/j.clinpr.2024.100381

Jo Salkeld , Anna L. Goodman

引用次数: 0

Preliminary evidence supporting use of UK consensus definitions for necrotising otitis externa 支持使用英国一致同意的坏死性外耳道炎定义的初步证据

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-19 DOI: 10.1016/j.clinpr.2024.100387

Junko Takata , Victoria J. Sinclair , Holly Hendron , Robert Wilson , Laura Wilkins , Charlotte Miles , Jessica Larwood , Alanna Wall , Oliver Bannister , Monique I. Andersson , Susanne H. Hodgson

Background

Infections of the external ear canal (EAC) exist as a spectrum of disease from severe otitis externa (SOE) to necrotising otitis externa (NOE), but distinguishing between these is challenging. The UK consensus case definition (UKCCD) was established in 2022, but had not yet been assessed in clinical practice.

Methods

All consecutive adult patients undergoing CT to investigate a diagnosis of possible NOE between November 2018 and October 2019 were prospectively included in the cohort. Clinical diagnosis at baseline and the end of 12 months follow-up were compared to the diagnosis defined by UKCCD.

Results

55 patients were included in the analysis. 27 % (15/55) had an initial clinical diagnosis of NOE, of which 47 % (7/15) did not have changes on CT consistent with NOE. Only 9 % (5/55) patients had an MRI scan performed within 7 days of the baseline CT. At the end of 12 months, 9 % (5/55) patients had a change in diagnosis to or from NOE. All cases diagnosed as NOE by UKCCD had a clinical diagnosis of ‘NOE’ at baseline, while no cases clinically diagnosed as NOE were mislabelled by UKCCD as ‘not NOE’. All cases that had a change of diagnosis in the 12-month period or had an initial CT with no changes consistent with NOE, were captured by the UKCCD category of ‘possible NOE’. Median duration of antibiotics of clinically defined NOE cases were 14 days of intravenous (IQR: 7.3–23.8), 28 days of oral (IQR: 21.0–40.3), and 49.5 days combined (IQR: 29.8–67.3).

Conclusion

UKCCD has excellent clinical concordance with clinical diagnosis. Further work is warranted to assess its utility for risk stratification of patients presenting with severe infections of the EAC in a larger cohort.

背景外耳道（EAC）感染存在从重症外耳道炎（SOE）到坏死性外耳道炎（NOE）的疾病谱，但区分这些疾病具有挑战性。英国共识病例定义（UKCCD）于2022年确立，但尚未在临床实践中进行评估。方法将2018年11月至2019年10月期间所有接受CT检查以诊断可能患有NOE的连续成年患者前瞻性地纳入队列。将基线和 12 个月随访结束时的临床诊断与 UKCCD 所定义的诊断进行比较。27%（15/55）的患者初步临床诊断为 NOE，其中 47%（7/15）的患者 CT 检查未发现与 NOE 一致的变化。只有 9% 的患者（5/55）在基线 CT 检查后 7 天内进行了 MRI 扫描。在 12 个月后，9% 的患者（5/55）的诊断结果由 NOE 转为 NOE。所有被 UKCCD 诊断为 NOE 的病例在基线时的临床诊断均为 "NOE"，而没有临床诊断为 NOE 的病例被 UKCCD 误诊为 "非 NOE"。所有在 12 个月内诊断发生变化的病例，或最初 CT 无变化且与 NOE 一致的病例，均被 UKCCD 归入 "可能 NOE "类别。临床定义为 NOE 病例的抗生素中位持续时间分别为静脉注射 14 天（IQR：7.3-23.8）、口服 28 天（IQR：21.0-40.3）和 49.5 天（IQR：29.8-67.3）。需要进一步开展工作，在更大的群体中评估其对 EAC 严重感染患者进行风险分层的实用性。

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引用次数: 0

What do Infection Specialists do? Defining the types of clinical consultation activity undertaken within Infection services 感染科专家都做些什么？确定感染科开展的临床咨询活动类型

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-11 DOI: 10.1016/j.clinpr.2024.100386

Ann L. Noble

引用次数: 0

Critical evaluation of endotoxin contamination in intravenous solutions: A call for enhanced regulatory oversight and quality control 严格评估静脉注射液中的内毒素污染：呼吁加强监管和质量控制

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2024-09-06 DOI: 10.1016/j.clinpr.2024.100385

K.T. Muhammed Favas , Guru Datt Sharma , Sanjit Sah

The recent identification of bacterial endotoxins in Ringer’s Lactate (RL) from a manufacturing batch by M/s. Vision Parenteral Pvt. Ltd. has raised significant concerns regarding the safety of intravenous solutions. These endotoxins, originating from Gram-negative bacteria, can trigger severe systemic inflammatory responses, worsening conditions like haemorrhagic shock and leading to organ dysfunction and increased mortality. The interaction between RL and endotoxins is particularly problematic, as it can exacerbate inflammation, disrupt fluid balance, and complicate metabolic and immune responses. This situation underscores significant gaps in pharmaceutical manufacturing practices and highlights the urgent need for stricter regulatory oversight and quality control. The healthcare community must reassess the use of RL in clinical settings, particularly in cases where endotoxin contamination could pose a significant risk, to protect patient health and safety.

最近，M/s. Vision Parenteral Pvt Ltd 生产的一批乳酸林格氏液（RL）中发现了细菌内毒素，这引起了人们对静脉注射液安全性的极大关注。Ltd.生产的一批乳酸林格氏液（RL）中发现了细菌内毒素，这引起了人们对静脉注射溶液安全性的极大关注。这些内毒素来自革兰氏阴性细菌，可引发严重的全身炎症反应，使失血性休克等情况恶化，导致器官功能障碍和死亡率上升。RL 与内毒素之间的相互作用尤其成问题，因为它会加剧炎症、破坏体液平衡并使新陈代谢和免疫反应复杂化。这种情况凸显了药品生产实践中存在的巨大差距，并强调了对更严格的监管和质量控制的迫切需要。医疗界必须重新评估 RL 在临床环境中的使用，尤其是在内毒素污染可能造成重大风险的情况下，以保护患者的健康和安全。

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