Clinical Infection in Practice最新文献

英文中文

Emerging Covid-19 subvariants and waning immunity: A renewed threat to India’s public health 新出现的Covid-19亚型和免疫力下降：对印度公共卫生的新威胁

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-06-26 DOI: 10.1016/j.clinpr.2025.100500

Shriyansh Srivastava , Dheeraj Sharma , Malakapogu Ravindra Babu , Muhammed Fairoos A , Sachin Kumar , Aroop Mohanty , Sanjit Sah , Ranjan K. Mohapatra , Rachana Mehta

引用次数: 0

Re-emergence of KFD and the public health imperative Kyasanur Forest Disease in Karnataka – a silent storm in the tropics KFD的再次出现和卡纳塔克邦的公共卫生迫切需要的Kyasanur森林病-热带地区的无声风暴

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-06-15 DOI: 10.1016/j.clinpr.2025.100499

Tarun Kumar Suvvari, Rachana Mehta, Sakshi Sharma, Aroop Mohanty, Shriyansh Srivastava, Sanjit Sah

引用次数: 0

Determinants of mortality in HIV-associated cryptococcal meningitis in Vietnam: Implications for optimizing management for resource-limited settings 越南hiv相关隐球菌脑膜炎死亡率的决定因素：资源有限环境下优化管理的意义

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-05-31 DOI: 10.1016/j.clinpr.2025.100497

Tra Thu Doan , Ngan Thi Dieu Ta , Hai Ngoc Bui , Thanh Van Do , Vuong Minh Nong , Thach Ngoc Pham , Cuong Duy Do , Co Xuan Dao , Giap Van Vu

Background

Cryptococcal meningitis causes substantial HIV-related mortality globally.

Aim

This study aimed to identify determinants of mortality among HIV-infected adults with cryptococcal meningitis in Vietnam to inform targeted intervention strategies.

Methods

This retrospective cohort study analyzed medical records of 51 HIV-infected adults hospitalized for cryptococcal meningitis at two major hospitals in Hanoi, Vietnam from January 2018 to June 2023. Patients were eligible if aged ≥ 18 years, had confirmed HIV infection, and CSF testing positive for Cryptococcus neoformans. Demographic, clinical, treatment, and outcome data were extracted from paper and electronic records using a standardized collection form. Determinants of mortality using Kaplan-Meier survival and Cox proportional hazards regression analysis.

Results

Of 51 cryptococcal meningitis patients, 18 (35 %) died during hospitalization over 1319 days of follow-up. Non-survivors were older, had more comorbidities, lower CD4 counts, and higher illness severity compared to survivors. Labs showed non-survivors had more inflammation, organ injury, and severe neurological abnormalities. Despite similar initial antifungal therapy, non-survivors received shorter amphotericin B courses and had more antibiotic use, reduced fluconazole susceptibility, and complications. Using multivariate Cox regression, we found lower CD4 counts, neurological abnormalities, and delayed amphotericin B initiation were associated with higher mortality.

Conclusion

Out findings identify low CD4 cell counts due to late presentation and inadequate antifungal therapy duration as independent predictors of mortality. These findings support implementation of early HIV diagnosis, cryptococcal screening, and optimized antifungal protocols in comparable resource-limited settings.

在全球范围内，隐球菌性脑膜炎导致大量与hiv相关的死亡率。目的本研究旨在确定越南感染艾滋病毒的成人隐球菌脑膜炎患者死亡的决定因素，为有针对性的干预策略提供信息。方法回顾性队列研究分析2018年1月至2023年6月在越南河内市两大医院因隐球菌性脑膜炎住院的51例hiv感染成人的医疗记录。患者年龄≥18岁，确诊HIV感染，脑脊液新隐球菌检测阳性。使用标准化的收集表格从纸质和电子记录中提取人口统计、临床、治疗和结局数据。使用Kaplan-Meier生存和Cox比例风险回归分析死亡率的决定因素。结果51例隐球菌性脑膜炎患者中，有18例（35%）在随访1319天的住院期间死亡。与幸存者相比，非幸存者年龄更大，合并症更多，CD4计数更低，疾病严重程度更高。实验室显示，非幸存者有更多的炎症、器官损伤和严重的神经异常。尽管初始抗真菌治疗相似，但非幸存者接受的两性霉素B疗程较短，抗生素使用较多，氟康唑敏感性降低，并发症也较少。通过多变量Cox回归，我们发现较低的CD4计数、神经异常和两性霉素B起始延迟与较高的死亡率相关。结论：我们的研究结果表明，CD4细胞计数较晚导致的低水平和抗真菌治疗时间不足是死亡率的独立预测因素。这些发现支持在资源有限的环境中实施早期HIV诊断、隐球菌筛查和优化的抗真菌方案。

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引用次数: 0

Tropical diseases and climate changes: the absence of global mitigation plans 热带病和气候变化：缺乏全球缓解计划

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-05-30 DOI: 10.1016/j.clinpr.2025.100498

Rajiv Gandhi Gopalsamy , Athesh Kumaraswamy , Lucas Alves da Mota Santana , Marina dos Santos Barreto , Eloia Emanuelly Dias Silva , Deise Maria Rego Rodrigues Silva , Pedro Henrique Macedo Moura , Ronaldy de Santana Santos , Adriana Gibara Guimarães , Lysandro Pinto Borges

引用次数: 0

Artificial stone silicosis presenting as suspected Tuberculosis: A series of 3 cases at a district general hospital 以疑似结核为表现的人工石质矽肺病：某区综合医院3例

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-05-16 DOI: 10.1016/j.clinpr.2025.100495

Aimal Ahmad Khan , Veshalee Vernugopan , Gabriel Wallis , Johanna Feary

Silicosis is an ancient condition re-emerging globally due to outbreaks of accelerated disease related to the use of artificial stone. The initial presentations of three patients with silicosis due to artificial stone exposure at a district general hospital in London, all of whom presented with clinical symptoms and radiological features assumed to be tuberculosis, are reported. The associations between silica exposure and this infection are also described. This series aims to highlight that artificial stone silicosis is now a significant occupational lung disease in the UK of which clinicians working in infectious diseases should be aware of.

矽肺病是一种古老的疾病，由于与使用人造石有关的疾病加速爆发，在全球重新出现。本文报告了伦敦某地区综合医院3例因人工石暴露导致矽肺病患者的初步表现，所有患者均表现出假定为肺结核的临床症状和放射学特征。二氧化硅暴露和这种感染之间的联系也被描述。本系列旨在强调人工石质矽肺病现在是一个重要的职业性肺病在英国的临床医生在感染性疾病的工作应该意识到。

引用次数: 0

Disseminated histoplasmosis induced hemophagocytic lymphohistiocytosis in an immunocompromised patient 播散性组织胞浆菌病引起免疫功能低下患者的噬血细胞性淋巴组织细胞增多症

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100488

N.El Bardai , L.M. Vos , H.L. Leavis , M. Jak , A.H.W. Bruns , M. Limper

Background

The search for the trigger of hemophagocytic lymphohistiocytosis (HLH) and its management can be challenging in immunocompromised patients. In HLH triggered by infection, immunosuppressive therapy is desired to suppress hyperinflammation, but may worsen the underlying infection.

Objectives

To review available literature on the management and prognosis of immunocompromised patients with disseminated histoplasmosis induced HLH.

Methods

We describe a case and review all previously reported cases of disseminated histoplasmosis induced HLH on PubMed until June 2023.

Results

The literature review yielded 30 cases. Antifungal therapy was administered in all except one patient. In 18 cases, HLH was treated with immunosuppressive therapy. The most common immunosuppressive regimens were corticosteroid monotherapy and corticosteroids combined with etoposide. This case report is the first to describe the use of anakinra. The overall mortality rate was 23.3 % (n = 7).

Conclusions

Disseminated histoplasmosis induced HLH is a severe disorder, requiring prompt recognition and immediate intervention. Currently, no specific treatment protocol exists for this disorder. Treatment should be tailored to the patient’s condition, symptoms and individual characteristics. Careful consideration regarding immunosuppressive therapy for HLH is needed to prevent worsening of the infection. Additionally, anticipating the progression of the disease is necessary to ensure timely and appropriate interventions.

背景：在免疫功能低下的患者中，寻找噬血细胞淋巴组织细胞病（HLH）的触发因素及其管理可能具有挑战性。在由感染引发的HLH中，免疫抑制疗法可以抑制高脂血症，但可能会加重潜在的感染。目的回顾已有文献对播散性组织浆菌病致HLH免疫功能低下患者的治疗和预后进行综述。方法我们描述了一个病例，并回顾了PubMed上截至2023年6月之前报道的所有弥散性组织胞浆菌病诱导的HLH病例。结果文献回顾共30例。除1例患者外，其余患者均给予抗真菌治疗。18例HLH采用免疫抑制治疗。最常见的免疫抑制方案是皮质类固醇单一疗法和皮质类固醇联合依托泊苷。本病例报告首次描述了阿那白的使用。结论弥散性组织胞浆菌病引起的HLH是一种严重的疾病，需要及时发现并及时干预。目前，这种疾病还没有专门的治疗方案。治疗应根据患者的病情、症状和个人特点量身定制。需要仔细考虑对HLH进行免疫抑制治疗，以防止感染恶化。此外，预测疾病的进展是必要的，以确保及时和适当的干预。

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引用次数: 0

Carbapenemase-producing Enterobactericeae screening: Focused patient insights 产碳青霉烯酶肠杆菌筛选：聚焦患者见解

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100491

Saba Farrukh , Jessica Martin , Caroline Chilton , Gillian Fox , Christopher Michael Rooney

Background

Anti-microbial resistance (AMR) is predicted to cause 10 million deaths annually by 2050. This prediction has shaped local policies, with a focus on antimicrobial stewardship and source isolation. However, the impact of these interventions on the individual patient is often overlooked, and the patient perspective is infrequently included in AMR strategies.

Aim(s)/Objective(s)

Our objective was to explore the lived patient experience through a Carbapemase Producing Enterobacterales (CPE) Outbreak. Specifically, we aimed to understand the patient’s knowledge of CPE, risks associated with AMR and their experience with rectal screening and source isolation.

Method(s)

Using a PPIE (public and patient involvement and engagement) framework, during a CPE outbreak, we engaged in one to one conversations with adult inpatients who had capacity, discussing the effects of AMR exposure. CPE-positive (n = 8) and CPE-negative (n = 2) participants were included. The latter had undergone > 3 CPE screens, were high-risk of AMR acquisition and in source isolation.

Results

Our one-on-one conversations revealed poor levels of patient knowledge about CPE and AMR risk, with many participants expressing concerns about the limited or lack of information provided by healthcare providers. Experiences with rectal screening was generally reported as uncomfortable, with passive acceptance for it. Opinions on source isolation were mixed, with feelings of being bored or lonely emerging as a common sentiment.

Discussion and/or Conclusion(s)

These discussions underscore the necessity for improved patient education and communication surrounding CPE and antibiotic resistance, specifically tailored to meet the needs of frailer populations. This study also highlights the critical role of healthcare staff in consistently providing clear information to patients. It is vital patient empowerment is encouraged, and focused efforts made to close this knowledge gap and enhance the patient experience.

预计到2050年，抗微生物药物耐药性（AMR）每年将导致1000万人死亡。这一预测影响了当地的政策，重点是抗菌剂管理和源头隔离。然而，这些干预措施对个体患者的影响往往被忽视，并且患者的观点很少被纳入AMR策略。目的/目的我们的目标是通过碳青霉酶产肠杆菌（CPE）爆发探索患者的生活体验。具体而言，我们旨在了解患者对CPE的了解、与AMR相关的风险以及他们在直肠筛查和源隔离方面的经验。方法：在CPE爆发期间，我们使用PPIE（公众和患者参与和参与）框架与有能力的成年住院患者进行一对一的对话，讨论AMR暴露的影响。包括cpe阳性（n = 8）和cpe阴性（n = 2）的参与者。后者经历了>；3个CPE屏幕是AMR获取的高风险和源隔离。结果我们的一对一谈话显示，患者对CPE和AMR风险的了解程度较低，许多参与者对医疗保健提供者提供的信息有限或缺乏表示担忧。直肠筛查的经历通常被报道为不舒服，被动地接受它。人们对源隔离的看法不一，无聊或孤独的感觉成为一种普遍的情绪。讨论和/或结论：这些讨论强调了改善围绕CPE和抗生素耐药性的患者教育和沟通的必要性，特别是针对虚弱人群的需求。本研究还强调了医护人员在始终如一地向患者提供清晰信息方面的关键作用。至关重要的是，鼓励患者赋权，并集中精力缩小这一知识差距，增强患者体验。

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引用次数: 0

Listeria infections: The unexpected risks in everyday foods 李斯特菌感染：日常食物中意想不到的风险

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100489

Samriddhi Sharma , Arnav Gandhi , Sanjit Sah , Mahendra Pratap Singh , Guru Datt Sharma , Amogh Verma

Listeria monocytogenes remains a major public health concern due to its ability to survive in diverse environments, including under refrigerated conditions, and cause severe illness in vulnerable populations. In July 2024, a Listeria outbreak linked to deli-sliced meats in the United States resulted in 61 confirmed cases, 60 hospitalizations, and 10 deaths across 19 states, underscoring persistent challenges in food safety. Historical outbreaks involving dairy, produce, and processed meats highlight the complexity of contamination routes and the importance of comprehensive preventive measures. As an intracellular pathogen, Listeria requires prompt diagnosis and targeted antibiotic therapy, typically involving ampicillin and gentamicin. Control efforts are complicated by the bacterium’s propensity for biofilm formation and its resilience under cold storage. Advances in sanitation protocols, whole-genome sequencing, and public health initiatives are key to reducing the incidence of listeriosis. Nevertheless, continued outbreaks emphasize the need for rigorous food safety practices, high-risk population awareness, and ongoing surveillance.

单核细胞增生李斯特菌能够在多种环境中生存，包括在冷藏条件下，并在脆弱人群中引起严重疾病，因此仍然是一个主要的公共卫生问题。2024年7月，美国爆发了与熟食切片肉有关的李斯特菌疫情，导致19个州的61例确诊病例、60例住院治疗和10例死亡，突显了食品安全方面的持续挑战。涉及乳制品、农产品和加工肉类的历史疫情突出了污染途径的复杂性和综合预防措施的重要性。作为一种细胞内病原体，李斯特菌需要及时诊断和靶向抗生素治疗，通常涉及氨苄西林和庆大霉素。由于细菌的生物膜形成倾向及其在冷藏条件下的恢复能力，控制工作变得复杂。卫生规程、全基因组测序和公共卫生行动方面的进展是减少李斯特菌病发病率的关键。然而，持续的疫情强调了严格的食品安全措施、高风险人群意识和持续监测的必要性。

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引用次数: 0

Corrigendum to “Clinical manifestations and outcomes of human mpox infection from 1970 to 2023: A systematic literature review” [Clin. Infect. Pract. 24 (2024) 100397] “1970年至2023年人类痘感染的临床表现和结果：系统文献综述”的勘误表[临床。感染。惯例24 (2024)100397]

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100492

Chukwuyem Abejegah , Kennedy O. Obohwemu , Mselenge Mdegela

引用次数: 0

A rare case of Candida albicans-associated meningitis; A case report study 罕见的白色念珠菌相关性脑膜炎病例；个案报告研究

Q3 Medicine

Clinical Infection in Practice

Pub Date : 2025-04-01 DOI: 10.1016/j.clinpr.2025.100490

Solmaz Askari , Mahila Monajati , Sedigheh Erfani , Narges Lashkarbolouk , Seyedeh Sedigheh Hosseini

Background

Fungal infections of the Central Nervous System (CNS) are rare but can have devastating consequences. In immunocompromised patients, such as those on chronic dexamethasone therapy, Candida can invade the bloodstream and enter the CNS, causing meningitis. Diagnosis of fungal infections often relies on pathogen culture, which is time-consuming and insensitive.

Case presentation

we present a 60-year-old female with chronic use of dexamethasone, with Candida albicans-associated meningitis, diagnosed using phenotyping, genotyping, and sequencing methods. Unfortunately, her condition deteriorated despite antifungal therapy, and she eventually succumbed to severe sepsis and septic shock.

Conclusion

Physicians must remain vigilant regarding fungal infections, particularly those affecting the brain, in immunosuppressed patients. Prompt diagnosis and the early treatment is crucial in preventing adverse outcomes. The efficacy of treatment may differ based on the infection’s severity and the patient’s immune status, making the early identification of clinical deterioration vital for effective management and prognosis.

背景中枢神经系统（CNS）的真菌感染非常罕见，但可造成严重后果。在免疫力低下的患者中，如长期接受地塞米松治疗的患者，念珠菌可侵入血液并进入中枢神经系统，导致脑膜炎。真菌感染的诊断通常依赖于病原体培养，这种方法既耗时又不敏感。病例介绍我们介绍了一位 60 岁的女性患者，她长期服用地塞米松，并患有白色念珠菌相关性脑膜炎，通过表型、基因分型和测序方法确诊。不幸的是，尽管进行了抗真菌治疗，她的病情还是恶化了，最终死于严重的败血症和脓毒性休克。及时诊断和早期治疗对于预防不良后果至关重要。根据感染的严重程度和患者的免疫状况，治疗效果可能会有所不同，因此及早发现临床恶化对有效治疗和预后至关重要。

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