Clinical Microbiology Newsletter最新文献

Cervical cancer screening recommendations proposed by natural societies and organizations have been reviewed and revised numerous times over the last decade. The most recent guidelines from the American Cancer Society and U.S. Preventive Services Task Force added human papillomavirus (HPV) primary screening for women starting at age 25 or 30 years, respectively, and ending at age 65 for those with an adequate history of negative screening. Cervical cancer screening for HPV has significantly reduced the incidence of cervical cancer. Currently, the majority of cervical cancers are reported among women who have never been screened or who were under-screened. Many organizations and institutions have explored different strategies to improve screening participation among the difficult-to-reach populations, including community outreach and specimen self-collection for HPV testing.

Human schistosomiasis is caused by trematode parasites of the genus Schistosoma. Four species and two distinct clinical syndromes are relevant to humans, including S. haematobium, which is associated with urogenital schistosomiasis, whereas S. mansoni, S. mekongi, and S. japonicum are responsible for intestinal schistosomiasis. These flukes reside in the venous plexus of the human bladder and in mesenteric veins and release eggs that, when trapped in tissues, cause inflammation and fibrosis. More specifically, S. mansoni, S. mekongi, and S. japonicum can cause intestinal inflammation, hepatosplenic periportal fibrosis, portal hypertension, and esophageal varices that can bleed and cause death. In contrast, S. haematobium, a recognized carcinogenic organism, can drive bladder carcinoma and contribute to infertility and cervical cancer. Additionally, schistosomiasis can cause general anaemia, stunted growth, and cognitive impairment.

Despite the chronic complications associated with schistosomiasis, public awareness in areas of non-endemicity is limited, and travelers rarely consider risk of infection. We describe the diagnostics available in areas of endemicity, as well as in reference laboratories, to diagnose schistosomiasis in returning travelers or migrants to resource-rich locations.

Antibiotics are the most widely used treatment for infections yet there has been minimal antibiotic discovery in recent years despite rising drug resistance and treatment failures. A better understanding of antibiotic pharmacokinetics (PK) and pharmacodynamics (PD), along with the development of novel dosing strategies, such as extended (EI) and continuous infusions (CI), has helped to overcome these barriers. Studies have consistently demonstrated that EI/CI administration of beta-lactams and vancomycin in particular, improves PK-PD target attainment compared to intermittent infusions. However, the effects of EI/CI on clinical outcomes, including efficacy and safety, remain controversial. Emerging data focus on patient populations with altered PK that may benefit from EI/CI beta-lactams or vancomycin (e.g., critically ill, cystic fibrosis, or outpatient parenteral antibiotic therapy). Logistical barriers limit EI/CI use in practice, including intravenous access, drug stability and drug incompatibility. This review highlights beta-lactam and vancomycin PK-PD, EI/CI dosing strategies and relevant evidence for practice.

Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba species are free-living amebae that are ubiquitously found in soil and water and can opportunistically cause invasive, deadly infections in humans. In this review, we present four patient cases due to free-living amebae and review the epidemiology and clinical significance of the diseases they cause. Specifically, primary amebic encephalitis due to N. fowleri, granulomatous amebic encephalitis due to B. mandrillaris and Acanthamoeba spp., keratitis due to Acanthamoeba spp., and non-central nervous system systemic infections (due to B. mandrillaris and Acanthamoeba spp.) are reviewed, and the clinical utility of microbiologic and histopathologic methods for diagnosing infections due to free-living amebae are compared.

The debate over federal regulation of diagnostic tests is not new, but scientific advances, societal developments, and global events over the past decade have accelerated efforts by the Food and Drug Administration (FDA) and members of Congress to revise the regulatory oversight of these devices, including laboratory-developed tests (LDTs). Despite years of congressional hearings and public meetings, legislation in the House and Senate, draft guidance from the FDA, and debate in the stakeholder community, LDT regulation remains unchanged, and the path forward remains unclear. LDTs play an essential role in infectious disease (ID) management and treatment, and changes in their regulation will have far-reaching implications for diagnostic laboratories. LDTs are widely used by clinical microbiology laboratories for the diagnosis and monitoring of a myriad infectious diseases, and until three years ago, such testing was conducted largely out of the spotlight. The COVID-19 pandemic changed this by bringing ID tests into the forefront. As the 118th Congress gets under way, the regulation and oversight of diagnostic tests, including LDTs, remains at the forefront of health care policy discussions on Capitol Hill and with the FDA. Change is coming, and it is important that clinical microbiologists, ID physicians, and other laboratorians have a seat at the table when such changes are being discussed.

Tickborne illnesses are constantly evolving, requiring proficiency to guide diagnostic and therapeutic measures. Diagnosing tickborne illnesses can be challenging due to the wide range of potential symptoms and their overlap with those of other conditions. Various diagnostic modalities can be used to identify the etiology of a tickborne illness accurately; however, not all tests have the same diagnostic value, particularly as a patient's disease progresses. This review investigates the diagnostic modalities for four tickborne illnesses to determine their clinical utility. These four illnesses (Lyme disease, anaplasmosis, spotted fever rickettsiosis, and ehrlichiosis) are the most reported tickborne illnesses nationwide. This article aims to provide an updated summative review to guide practitioners in diagnosing these infections.