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A survey-based exploratory study of factors influencing women's intentions to utilise pre-exposure prophylaxis in the Eastern Cape Province, South Africa: sociodemographic characteristics, HIV risk behaviours and transactional sex. 一项基于调查的探索性研究,探讨了影响南非东开普省妇女使用接触前预防的意向的因素:社会人口特征、艾滋病毒风险行为和交易性行为。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-03-13 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251399765
Rosemary Kalenga, Gary Sharp, Anne M Teitelman, Monde Makiwane, Larry D Icard, John B Jemmott

Background: South Africa has the third-highest adult prevalence rate globally, with women comprising 64% of cases. Despite the accessibility of pre-exposure prophylaxis (PrEP), its adoption among women, particularly young women, remains alarmingly low.

Objectives: The objective of this initial investigation is to explore factors influencing the intentions of South African women to use PrEP, focusing on sociodemographic factors, HIV sexual risk behaviours and involvement in transactional sex.

Design: The research utilised an exploratory design employing surveys.

Methods: Surveys were conducted in 2015 with 64 women aged 19-49 residing in the Eastern Cape Province of South Africa. The data were analysed using descriptive statistics and multiple logistic regression. Data analysis was performed using SPSS 28.0 and R.

Results: Younger women, compared to older women, were more inclined to intend to use PrEP (p = 0.056, χ2 = 3.655, df = 1, OR 0.92, CI (0.89, 0.99)). Women who used a condom were less likely to intend to use PrEP (p = 0.082, χ2 = 3.025, df = 1, OR 0.29, CI (0.09, 1.14)). Respondents who engaged in transactional sex were more inclined to intend to use PrEP (p = 0.007, χ2 = 7.330, df = 1, OR 6.86, CI (1.82, 31.0)).

Conclusion: Addressing factors that impact South African women's intentions to use PrEP is crucial for enhancing the adoption of PrEP among this population.

背景:南非是全球成人患病率第三高的国家,女性占病例的64%。尽管暴露前预防(PrEP)的可及性,但其在妇女,特别是年轻妇女中的采用率仍然低得惊人。目的:这项初步调查的目的是探讨影响南非妇女使用PrEP意向的因素,重点是社会人口因素、艾滋病毒性风险行为和参与交易性行为。设计:本研究采用探索性设计,采用问卷调查。方法:2015年对居住在南非东开普省的64名19-49岁女性进行调查。采用描述性统计和多元逻辑回归对数据进行分析。结果:与老年妇女相比,年轻妇女更倾向于使用PrEP (p = 0.056, χ2 = 3.655, df = 1, OR 0.92, CI(0.89, 0.99))。使用避孕套的妇女较少打算使用PrEP (p = 0.082, χ2 = 3.025, df = 1, OR 0.29, CI(0.09, 1.14))。从事交易性行为的受访者更倾向于使用PrEP (p = 0.007, χ2 = 7.330, df = 1, OR 6.86, CI(1.82, 31.0))。结论:解决影响南非妇女使用PrEP意图的因素对于提高该人群中PrEP的采用至关重要。
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引用次数: 0
Non-adherence and its predictors among pediatric household contacts on tuberculosis preventive therapy in the 3HP era: A multicenter observational study. 3HP时代儿童家庭接触者结核病预防治疗依从性及其预测因素:一项多中心观察性研究
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-03-05 eCollection Date: 2026-01-01 DOI: 10.1177/20499361261426969
Woretaw Sisay Zewdu, Muluken Adela Alemu, Tilaye Arega Moges, Sisay Sitotaw Anberbr, Desalegn Addis Mussie, Abel Temeche Kassaw, Demewoz Kefale, Tigabu Eskeziya Zerihun, Fisseha Nigussie Dagnew, Samuel Berihun Dagnew

Background: Despite prophylactic pharmacotherapy being ranked as the best intervention yet, poor treatment adherence tempers tuberculosis preventive therapy (TPT) efficacy.

Objectives: This study aimed to investigate TPT non-adherence among household contacts and its determinants following the rollout of the 3HP regimen in northwest Ethiopia.

Design: A facility-based multicenter retrospective study was conducted in selected hospitals of northwest Ethiopia from October 17 to February 21, 2024.

Methods: Target populations were TPT-eligible household contacts (⩽15 years old) based on the national tuberculosis treatment guideline. Univariate and multivariate binary logistic regression model was fitted to identify potential predictors. p-Value < 0.05 was employed to adjudicate the significance level.

Results: Among 494 household contacts (HHCs) enrolled in this study, 27.94% were non-adherent. Age (5-10 years: adjusted odds ratio (AOR) (95% CI): 1.92 (1.05-3.19); 10-15 years: AOR (95% CI): 2.04 (1.01-4.12)), parental status (AOR (95% CI): 1.87 (1.02-5.24)), comorbidity (AOR (95% CI): 2.92 (1.08-5.69)), poor nutritional status (AOR (95% CI): 1.30 (1.06-2.43)), adverse drug reactions (AOR (95% CI): 4.01 (1.03-8.20)), adherence support (AOR (95% CI): 1.56 (1.08-6.69)) and TPT regimen type (AOR (95% CI): 4.23 (1.85-6.53)) predicts non-adherence.

Conclusion: Altogether, this study revealed a high level of non-adherence among HHCs in northwest Ethiopia, falling short of the national 2025/26 TPT targets. TPT should be accompanied by firm counseling and routine supervision to improve adherence.

背景:尽管预防性药物治疗被列为最好的干预措施,但治疗依从性差影响了结核病预防治疗(TPT)的疗效。目的:本研究旨在调查埃塞俄比亚西北部3HP方案推出后家庭接触者中TPT不依从性及其决定因素。设计:于2024年10月17日至2月21日在埃塞俄比亚西北部选定的医院进行了一项基于设施的多中心回顾性研究。方法:目标人群为符合tpt标准的家庭接触者(≥15岁)。拟合单变量和多变量二元logistic回归模型以确定潜在的预测因子。p值结果:在纳入本研究的494名家庭接触者中,27.94%为非依从性接触者。年龄(5-10岁):调整优势比(AOR) (95% CI): 1.92 (1.05-3.19);10-15岁:AOR (95% CI): 2.04(1.01-4.12)),父母状况(AOR (95% CI): 1.87(1.02-5.24)),共病(AOR (95% CI): 2.92(1.08-5.69)),营养状况不良(AOR (95% CI): 1.30(1.06-2.43)),药物不良反应(AOR (95% CI): 4.01(1.03-8.20)),依从性支持(AOR (95% CI): 1.56(1.08-6.69))和TPT方案类型(AOR (95% CI): 4.23(1.85-6.53))预测不依从性。结论:总的来说,本研究揭示了埃塞俄比亚西北部hhc的高依从性,未达到2025/26年国家TPT目标。TPT应辅以坚定的咨询和日常监督,以提高依从性。
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引用次数: 0
Fatal dissemination of Strongyloides stercoralis in an HIV-positive patient with preserved immunity: a case report. 粪类圆线虫在免疫保存的hiv阳性患者中的致命传播:一个病例报告。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-02-20 eCollection Date: 2026-01-01 DOI: 10.1177/20499361261425327
Joel Hurtado Dominguez, Silvana Fernanda Loza Mollinedo

We report the case of a 38-year-old woman with human immunodeficiency virus (HIV) infection diagnosed in 2010 and on antiretroviral treatment since 2014, with an undetectable viral load and a CD4 lymphocyte count of 527 cells/µL. The patient presented with weight loss, fever, hyporexia, nausea, vomiting, progressive dyspnea, purpuric abdominal lesions, and lower extremity edema. During hospitalization, she developed hemoptysis and severe respiratory failure and died a few hours later. Parasitological studies of sputum and stool showed abundant Strongyloides stercoralis larvae, confirming disseminated strongyloidiasis. This case highlights that severe S. stercoralis infection can occur even in patients with clinically controlled HIV, underscoring the need for screening in endemic regions.

我们报告一例38岁的女性感染人类免疫缺陷病毒(HIV)于2010年诊断,并自2014年开始抗逆转录病毒治疗,病毒载量检测不到,CD4淋巴细胞计数为527细胞/µL。患者表现为体重减轻、发热、缺氧、恶心、呕吐、进行性呼吸困难、腹部紫癜性病变和下肢水肿。住院期间,她出现咯血和严重呼吸衰竭,几小时后死亡。痰和粪便的寄生虫学研究显示大量的粪圆形线虫幼虫,证实播散性圆形线虫病。本病例突出表明,即使在临床控制HIV的患者中也可能发生严重的粪球菌感染,强调了在流行地区进行筛查的必要性。
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引用次数: 0
Invasive pulmonary aspergillosis in the post-COVID-19 era: diagnosis, treatment, and what lies ahead. 后covid -19时代的侵袭性肺曲霉病:诊断、治疗和未来
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-02-13 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251406189
Cong Nguyen Hai

Invasive pulmonary aspergillosis (IPA) is a severe opportunistic fungal infection that predominantly affects immunocompromised individuals, including those with hematologic malignancies, organ transplants, and, more recently, patients with post-COVID-19 immune dysregulation. Despite advancements in medical mycology, IPA continues to pose significant diagnostic and therapeutic challenges, contributing to high global morbidity and mortality. Diagnostic accuracy remains limited due to nonspecific clinical manifestations and the suboptimal performance of conventional tools such as bronchoalveolar lavage culture and galactomannan testing. However, recent innovations including polymerase chain reaction-based molecular assays, lateral flow devices, and immuno-positron emission tomography/magnetic resonance imaging offer improved sensitivity, specificity, and speed. Therapeutically, triazoles remain the cornerstone of IPA management, complemented by echinocandins and liposomal amphotericin B in refractory cases. The role of combination therapy and antifungal susceptibility testing is growing in response to rising azole resistance. Additionally, novel antifungal agents and immunotherapeutic approaches are currently under clinical investigation. Effective management of IPA requires a timely, multidisciplinary approach that combines advanced diagnostics with personalized antifungal strategies. Continued research is essential to standardize molecular techniques, refine immunotherapy, and expand access to next-generation antifungals to reduce the global burden of this life-threatening infection. This review aims to synthesize current evidence on the diagnosis and treatment of IPA, critically evaluate the strengths and limitations of existing diagnostic and therapeutic approaches, and explore emerging strategies to enhance clinical outcomes in the context of rising antifungal resistance.

侵袭性肺曲霉病(IPA)是一种严重的机会性真菌感染,主要影响免疫功能低下的个体,包括血液病恶性肿瘤患者、器官移植患者,以及最近出现的covid -19后免疫失调患者。尽管医学真菌学取得了进步,但IPA继续构成重大的诊断和治疗挑战,导致全球高发病率和死亡率。由于非特异性临床表现和传统工具(如支气管肺泡灌洗培养和半乳甘露聚糖检测)的性能不佳,诊断准确性仍然有限。然而,最近的创新包括基于聚合酶链反应的分子检测、横向流动装置和免疫正电子发射断层扫描/磁共振成像,提高了灵敏度、特异性和速度。在治疗上,三唑类药物仍然是IPA治疗的基础,在难治性病例中辅以棘白菌素和两性霉素B脂体。联合治疗和抗真菌药敏试验的作用越来越大,以应对不断上升的唑耐药性。此外,新的抗真菌药物和免疫治疗方法目前正在临床研究中。IPA的有效管理需要及时,多学科的方法,结合先进的诊断和个性化的抗真菌策略。持续的研究对于标准化分子技术、改进免疫疗法和扩大下一代抗真菌药物的可及性以减轻这种危及生命的感染的全球负担至关重要。本综述旨在综合目前关于IPA诊断和治疗的证据,批判性地评估现有诊断和治疗方法的优势和局限性,并探讨在抗真菌耐药性上升的背景下提高临床结果的新策略。
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引用次数: 0
Research progress of metagenomic next-generation sequencing in infectious diseases of the spine: a systematic review. 新一代宏基因组测序在脊柱感染性疾病中的研究进展
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-02-10 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251412789
Ziyan Zhu, Xinxin Miao

Background: Infectious diseases of the spine (IDS) cause structural destruction and abscess formation, requiring precise early diagnosis. While conventional culture methods show limited sensitivity and slow turnaround, metagenomic next-generation sequencing (mNGS) offers a promising alternative with its broader pathogen spectrum, rapid turnaround time, high detection rate, and sensitivity, showing significant advantages in the diagnosis of IDS.

Objectives: This systematic review aims to synthesize the current evidence on the advantages and clinical utility of mNGS in diagnosing and managing IDS, focusing on pyogenic and granulomatous spinal infections.

Design: The systematic review conducted in accordance with PRISMA guidelines.

Data sources and methods: A comprehensive literature search was performed across nine electronic databases (including PubMed, Web of Science, and Embase) from 2010 to April 2025. Studies reporting on mNGS for pathogen detection in patients with suspected or confirmed spinal infections were included. The quality of included observational studies was assessed using the STROBE checklist. Data on detection spectrum, rate, sensitivity, turnaround time, and clinical impact were extracted and synthesized narratively due to high heterogeneity.

Results: Twenty-nine studies (25 retrospective studies and 4 case reports) from China were included. mNGS demonstrated a significantly broader detection spectrum, identifying common pathogens (e.g., Staphylococcus aureus, Mycobacterium tuberculosis) as well as rare and fastidious organisms that were missed by conventional methods. The pooled detection rate of mNGS (36.8%-95.5%) was consistently and significantly higher than that of culture (5.9%-59.2%). mNGS also showed superior sensitivity (39%-94.7%) compared to culture. The average turnaround time for mNGS (29-53 h) was substantially faster than for culture (2-10 days). mNGS-guided therapy was associated with improved clinical outcomes, including significant reductions in inflammatory markers.

Conclusion: mNGS represents a powerful diagnostic tool for IDS, offering broader detection spectrum, higher detection rate, faster turnaround time, and greater sensitivity compared to conventional methods. This enables more targeted antimicrobial therapy and improves clinical management. Challenges including high costs and difficulty in distinguishing colonization from infection remain. Future efforts should focus on technical optimization, workflow automation, protocol standardization, and outcome validation in larger prospective studies.

Trial registration: CRD420251170912.

背景:脊柱感染性疾病(IDS)可导致结构破坏和脓肿形成,需要精确的早期诊断。传统的培养方法灵敏度有限,周转慢,而新一代宏基因组测序(mNGS)以其更广泛的病原体谱、快速的周转时间、高的检出率和灵敏度为IDS的诊断提供了一个有希望的替代方法,在IDS的诊断中显示出显着的优势。目的:本系统综述旨在综合mNGS在诊断和治疗IDS中的优势和临床应用的现有证据,重点是化脓性和肉芽肿性脊柱感染。设计:按照PRISMA指南进行系统评价。数据来源和方法:从2010年到2025年4月,对9个电子数据库(包括PubMed、Web of Science和Embase)进行了全面的文献检索。研究报告了mNGS用于疑似或确诊脊柱感染患者的病原体检测。纳入的观察性研究的质量采用STROBE检查表进行评估。检测光谱、率、灵敏度、周转时间和临床影响的数据提取和综合叙述,由于高度异质性。结果:共纳入来自中国的29项研究(25项回顾性研究和4例病例报告)。mNGS显示出更广泛的检测光谱,可以识别常见的病原体(例如,金黄色葡萄球菌,结核分枝杆菌)以及传统方法无法识别的罕见和挑剔的生物。mNGS的合并检出率(36.8% ~ 95.5%)持续显著高于培养(5.9% ~ 59.2%)。与培养相比,mNGS也显示出更高的灵敏度(39%-94.7%)。mNGS的平均周转时间(29-53 h)明显快于培养(2-10天)。mngs引导的治疗与改善的临床结果相关,包括炎症标志物的显著减少。结论:与传统方法相比,mNGS具有更广泛的检测光谱、更高的检出率、更快的周转时间和更高的灵敏度,是一种强大的IDS诊断工具。这使得更有针对性的抗菌治疗和改善临床管理成为可能。包括高成本和难以区分定植和感染在内的挑战仍然存在。未来的努力应集中在技术优化、工作流程自动化、协议标准化和更大规模前瞻性研究的结果验证上。试验注册号:CRD420251170912。
{"title":"Research progress of metagenomic next-generation sequencing in infectious diseases of the spine: a systematic review.","authors":"Ziyan Zhu, Xinxin Miao","doi":"10.1177/20499361251412789","DOIUrl":"10.1177/20499361251412789","url":null,"abstract":"<p><strong>Background: </strong>Infectious diseases of the spine (IDS) cause structural destruction and abscess formation, requiring precise early diagnosis. While conventional culture methods show limited sensitivity and slow turnaround, metagenomic next-generation sequencing (mNGS) offers a promising alternative with its broader pathogen spectrum, rapid turnaround time, high detection rate, and sensitivity, showing significant advantages in the diagnosis of IDS.</p><p><strong>Objectives: </strong>This systematic review aims to synthesize the current evidence on the advantages and clinical utility of mNGS in diagnosing and managing IDS, focusing on pyogenic and granulomatous spinal infections.</p><p><strong>Design: </strong>The systematic review conducted in accordance with PRISMA guidelines.</p><p><strong>Data sources and methods: </strong>A comprehensive literature search was performed across nine electronic databases (including PubMed, Web of Science, and Embase) from 2010 to April 2025. Studies reporting on mNGS for pathogen detection in patients with suspected or confirmed spinal infections were included. The quality of included observational studies was assessed using the STROBE checklist. Data on detection spectrum, rate, sensitivity, turnaround time, and clinical impact were extracted and synthesized narratively due to high heterogeneity.</p><p><strong>Results: </strong>Twenty-nine studies (25 retrospective studies and 4 case reports) from China were included. mNGS demonstrated a significantly broader detection spectrum, identifying common pathogens (e.g., <i>Staphylococcus aureus</i>, <i>Mycobacterium tuberculosis</i>) as well as rare and fastidious organisms that were missed by conventional methods. The pooled detection rate of mNGS (36.8%-95.5%) was consistently and significantly higher than that of culture (5.9%-59.2%). mNGS also showed superior sensitivity (39%-94.7%) compared to culture. The average turnaround time for mNGS (29-53 h) was substantially faster than for culture (2-10 days). mNGS-guided therapy was associated with improved clinical outcomes, including significant reductions in inflammatory markers.</p><p><strong>Conclusion: </strong>mNGS represents a powerful diagnostic tool for IDS, offering broader detection spectrum, higher detection rate, faster turnaround time, and greater sensitivity compared to conventional methods. This enables more targeted antimicrobial therapy and improves clinical management. Challenges including high costs and difficulty in distinguishing colonization from infection remain. Future efforts should focus on technical optimization, workflow automation, protocol standardization, and outcome validation in larger prospective studies.</p><p><strong>Trial registration: </strong>CRD420251170912.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361251412789"},"PeriodicalIF":3.4,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancing peptide-based vaccines against viral pathogens: a narrative review. 针对病毒性病原体的肽基疫苗的进展:叙述性综述。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-02-01 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251411188
Hamid Reza Jahantigh, Solaleh Rezanavaz Gheshlagh, Ladan Mafakher, Nahid Ahmadi, Behzad Shahbazi, Khadijeh Ahmadi

Peptide-based vaccines, utilizing defined B- and T-cell epitopes, have emerged over the past two decades as promising alternatives to conventional vaccine platforms. Their key advantages, including excellent safety profiles, precise immunological targeting, and ease of manufacture, position them as a versatile tool in modern immunology. However, the widespread clinical application of these vaccines is significantly challenged by inherent limitations, most notably their low inherent immunogenicity and susceptibility to enzymatic degradation in vivo, leading to structural instability and short half-lives. This review systematically examines the innovative strategies being developed to overcome these critical obstacles. It delves into advances in rational vaccine design, highlighting the pivotal role of bioinformatics and computational tools for precise epitope selection and the engineering of sophisticated multi-epitope constructs that elicit broader immune responses. Furthermore, we provide a comprehensive analysis of novel drug delivery systems, such as a diverse range of nanoparticle carriers (e.g., liposomes, polymer-based), and review the mechanism of action of next-generation adjuvants. These technologies are crucial for enhancing antigen presentation, protecting the peptide payload, and promoting robust, durable cellular and humoral immunity. By synthesizing current literature from databases like PubMed and Google Scholar, this review offers a detailed overview of recent progress in peptide vaccine development against viral pathogens, drawing on key findings from both preclinical and clinical studies. It highlights key findings from preclinical and clinical studies and provides insights into the mechanistic actions and future potential of these precision vaccines in combating evolving viral threats.

利用明确的B细胞和t细胞表位的肽基疫苗在过去二十年中作为传统疫苗平台的有希望的替代品出现。它们的主要优点,包括优良的安全性,精确的免疫靶向,易于制造,使它们成为现代免疫学中的多功能工具。然而,这些疫苗的广泛临床应用受到其固有局限性的极大挑战,最明显的是其固有免疫原性低,体内易受酶降解,导致结构不稳定和半衰期短。本文系统地审查了为克服这些关键障碍而制定的创新战略。它深入研究了合理疫苗设计的进展,强调了生物信息学和精确表位选择的计算工具的关键作用,以及引发更广泛免疫反应的复杂多表位构建的工程。此外,我们还提供了对新型药物递送系统的全面分析,例如各种纳米颗粒载体(如脂质体,聚合物基),并回顾了下一代佐剂的作用机制。这些技术对于增强抗原呈递、保护肽有效载荷以及促进强健、持久的细胞和体液免疫至关重要。通过综合PubMed和谷歌Scholar等数据库的当前文献,本综述详细概述了针对病毒性病原体的肽疫苗开发的最新进展,并借鉴了临床前和临床研究的关键发现。它强调了临床前和临床研究的主要发现,并提供了这些精确疫苗在对抗不断演变的病毒威胁方面的机制作用和未来潜力的见解。
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引用次数: 0
A lethal combination: fulminant liver failure due to Babesia microti and Borrelia burgdorferi co-infection. 致命的组合:由微小巴贝斯虫和伯氏疏螺旋体共同感染引起的暴发性肝衰竭。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-01-24 eCollection Date: 2026-01-01 DOI: 10.1177/20499361261416190
Aya Elalfy, Danilo Grahovac, Igor Dumic, Tatjana Gavrancic

Babesiosis and Lyme disease are tick-borne infections endemic to the northeastern and upper Midwestern United States. Although both diseases can involve multiple organ systems, acute liver failure (ALF) is exceedingly uncommon. Co-infection with Babesia microti and Borrelia burgdorferi may exacerbate disease severity, create diagnostic uncertainty, and delay appropriate therapy. We describe a 77-year-old man with type II diabetes mellitus, stage IV chronic kidney disease, and heart failure with preserved ejection fraction who presented with dyspnea, cough, and peripheral edema. Initial evaluation suggested decompensated heart failure and acute kidney injury consistent with cardiorenal syndrome. Within 24 h, however, he developed ALF (total bilirubin 6.8 mg/dL; aspartate aminotransferase 2656 U/L; alanine aminotransferase 1421 U/L; INR 3.5), thrombocytopenia (95 × 109/L), acute anemia (hemoglobin 7.7 g/dL), and encephalopathy. Initial infectious, autoimmune, and ischemic evaluations were unrevealing. Despite empiric antimicrobial therapy with intravenous ceftriaxone, vancomycin, and doxycycline, his condition rapidly deteriorated, and he died. Postmortem testing identified B. microti parasitemia of 2.4% and B. burgdorferi co-infection. This case highlights the importance of considering tick-borne coinfections in patients presenting with ALF and shock, even in the absence of classic features such as fever, rash, or overt hemolysis. Increased clinician awareness of atypical presentations of endemic tick-borne diseases may help reduce diagnostic delays and improve outcomes in severe or unusual clinical scenarios.

巴贝斯虫病和莱姆病是美国东北部和中西部上部的地方性蜱传传染病。虽然这两种疾病可累及多个器官系统,但急性肝衰竭(ALF)极为罕见。微巴贝斯虫和伯氏疏螺旋体合并感染可能加重疾病严重程度,造成诊断不确定性,并延误适当的治疗。我们描述了一位77岁的男性,患有II型糖尿病,IV期慢性肾脏疾病和心力衰竭,并保留射血分数,表现为呼吸困难,咳嗽和周围水肿。初步评估提示失代偿性心衰和急性肾损伤与心肾综合征一致。然而,在24小时内,患者出现ALF(总胆红素6.8 mg/dL、天冬氨酸转氨酶2656 U/L、丙氨酸转氨酶1421 U/L、INR 3.5)、血小板减少(95 × 109/L)、急性贫血(血红蛋白7.7 g/dL)和脑病。最初的感染、自身免疫和缺血评估未显示。尽管经验性的静脉注射头孢曲松、万古霉素和强力霉素等抗菌药物治疗,他的病情仍迅速恶化,最终死亡。死后检测发现微螺旋体寄生虫感染2.4%,同时感染伯氏疏螺旋体。本病例强调了在ALF合并休克的患者中考虑蜱传合并感染的重要性,即使没有发热、皮疹或明显溶血等典型特征。提高临床医生对地方性蜱传疾病的非典型表现的认识,可能有助于减少诊断延误,改善严重或不寻常临床情况的结果。
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引用次数: 0
Necrotizing gingival infection due to Trichoderma longibrachiatum in an hematopoietic stem cell transplant recipient: case report. 造血干细胞移植一例长尾木霉所致牙龈坏死性感染。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-01-13 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251403060
Eduardo Aparicio-Minguijón, Nieves López-Muñoz, Pilar Martínez-Sánchez, María Calbacho, Ana Pérez-Ayala, Justino Jiménez-Almonacid, María Asunción Pérez-Jacoiste Asín, Isabel Rodríguez-Goncer

Trichoderma is a genus of rare filamentous fungi that can cause invasive fungal infections in immunocompromised patients. We report a case of necrotizing gingival and sinus infection due to T. longibrachiatum in an allogeneic stem cell transplant recipient. The patient received a combination of antifungal and aggressive surgical debridement, achieving clinical cure. The treatment included amphotericin B, voriconazole and caspofungin with the latter switch to rezafungin to consolidate therapy. Rezafungin might represent a useful alternative for fungal infections with limited therapeutic options, but further studies are needed to confirm its role in Trichoderma spp. infections.

木霉是一种罕见的丝状真菌属,可引起免疫功能低下患者的侵袭性真菌感染。我们报告一例坏死性牙龈和鼻窦感染,由于长尾状扁桃体在异基因干细胞移植受体。患者接受抗真菌和积极的手术清创联合治疗,临床治愈。治疗包括两性霉素B、伏立康唑和卡泊芬净,卡泊芬净转为利扎芬净以巩固治疗。Rezafungin可能是治疗真菌感染的有效选择,但需要进一步的研究来证实其在木霉感染中的作用。
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引用次数: 0
Towards personalised empirical antibiotic therapy in febrile neutropenia: a theoretical model based on machine learning and prior colonisation with multidrug-resistant gram-negative bacilli - a retrospective proof-of-concept cohort study. 发热性中性粒细胞减少症个体化经验性抗生素治疗:基于机器学习和多重耐药革兰氏阴性杆菌预先定植的理论模型-一项回顾性概念验证队列研究。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2026-01-12 eCollection Date: 2026-01-01 DOI: 10.1177/20499361251411061
Antonio Gallardo-Pizarro, Christian Teijón-Lumbreras, Tommaso Francesco Aiello, Patricia Monzó-Gallo, Ana Martinez-Urrea, Cynthia Terrones-Campos, Guillermo Cuervo, Laura Morata, Pedro Castro, Climent Casals, Mateu Espasa, Jordi Esteve, Josep Maria Nicolas, Josep Mensa, Alex Soriano, Carolina Garcia-Vidal

Background: Empirical antibiotic therapy (EAT) in febrile neutropenia (FN) remains challenging due to multidrug-resistant (MDR) Gram-negative bacteria, often leading to inappropriate empirical antibiotic therapy (IEAT).

Objective: To demonstrate that risk stratification based on machine learning (ML) and prior colonisation with MDR bacteria may support the tailoring of EAT in patients with haematological malignancies.

Design: Retrospective proof-of-concept cohort study.

Methods: All consecutive FN episodes in patients with haematological malignancies were retrospectively included from January 2020 to March 2023 at a tertiary-level university hospital. We compared real-world, clinician-driven empirical antibiotic use with a simulated approach guided by an ML-based risk stratification model combined with prior colonisation data. The main outcomes were antibiotic selection and rates of IEAT.

Results: A total of 553 FN episodes in 398 haematological patients were analysed. Bloodstream infection (BSI) occurred in 141/553 episodes (25.5%). Anti-pseudomonal (PsA) beta-lactams were prescribed in 515/553 episodes (93.1%), with carbapenems in 406/553 (73.4%). The clinician-driven approach resulted in 16/70 (22.9%) GNB-BSI episodes receiving IEAT. The ML plus colonisation-guided approach would have reduced the use of meropenem by 29.7% (-2.08 days; 95% CI, -2.42 to -1.73; p < 0.001) and anti-PsA beta-lactams by 6.7% (-0.47 days; 95% CI, -0.76 to -0.19; p = 0.001), and would also have led to a reduction in the rate of IEAT from 16/70 (22.9%) to 6/70 (8.6%) (p = 0.035).

Conclusion: ML-based risk stratification combined with colonisation status would allow for personalised antibiotic therapy in FN, potentially reducing IEAT and improving antimicrobial use. These results support integrating these tools into clinical practice.

背景:发热性中性粒细胞减少症(FN)的经验性抗生素治疗(EAT)仍然具有挑战性,因为多重耐药(MDR)革兰氏阴性菌,往往导致不适当的经验性抗生素治疗(IEAT)。目的:证明基于机器学习(ML)和耐多药细菌先前定植的风险分层可能支持血液学恶性肿瘤患者的EAT定制。设计:回顾性概念验证队列研究。方法:回顾性分析某三级大学医院2020年1月至2023年3月所有连续FN发作的血液恶性肿瘤患者。我们比较了现实世界中,临床医生驱动的经验性抗生素使用与基于ml的风险分层模型结合先前定植数据指导的模拟方法。主要结果为抗生素选择和IEAT率。结果:对398例血液病患者共553次FN发作进行了分析。血流感染(BSI)发生率为141/553(25.5%)。515/553次(93.1%)使用抗假单胞菌(PsA) β -内酰胺类药物,406/553次(73.4%)使用碳青霉烯类药物。临床驱动的方法导致16/70 (22.9%)GNB-BSI发作接受IEAT。ML +菌落引导方法将美罗培南的使用减少29.7%(-2.08天;95% CI, -2.42至-1.73;p = 0.001),并且还将导致IEAT率从16/70(22.9%)降低到6/70 (8.6%)(p = 0.035)。结论:基于ml的风险分层结合菌落状态将允许FN个体化抗生素治疗,可能减少IEAT并改善抗菌药物的使用。这些结果支持将这些工具整合到临床实践中。
{"title":"Towards personalised empirical antibiotic therapy in febrile neutropenia: a theoretical model based on machine learning and prior colonisation with multidrug-resistant gram-negative bacilli - a retrospective proof-of-concept cohort study.","authors":"Antonio Gallardo-Pizarro, Christian Teijón-Lumbreras, Tommaso Francesco Aiello, Patricia Monzó-Gallo, Ana Martinez-Urrea, Cynthia Terrones-Campos, Guillermo Cuervo, Laura Morata, Pedro Castro, Climent Casals, Mateu Espasa, Jordi Esteve, Josep Maria Nicolas, Josep Mensa, Alex Soriano, Carolina Garcia-Vidal","doi":"10.1177/20499361251411061","DOIUrl":"10.1177/20499361251411061","url":null,"abstract":"<p><strong>Background: </strong>Empirical antibiotic therapy (EAT) in febrile neutropenia (FN) remains challenging due to multidrug-resistant (MDR) Gram-negative bacteria, often leading to inappropriate empirical antibiotic therapy (IEAT).</p><p><strong>Objective: </strong>To demonstrate that risk stratification based on machine learning (ML) and prior colonisation with MDR bacteria may support the tailoring of EAT in patients with haematological malignancies.</p><p><strong>Design: </strong>Retrospective proof-of-concept cohort study.</p><p><strong>Methods: </strong>All consecutive FN episodes in patients with haematological malignancies were retrospectively included from January 2020 to March 2023 at a tertiary-level university hospital. We compared real-world, clinician-driven empirical antibiotic use with a simulated approach guided by an ML-based risk stratification model combined with prior colonisation data. The main outcomes were antibiotic selection and rates of IEAT.</p><p><strong>Results: </strong>A total of 553 FN episodes in 398 haematological patients were analysed. Bloodstream infection (BSI) occurred in 141/553 episodes (25.5%). Anti-pseudomonal (PsA) beta-lactams were prescribed in 515/553 episodes (93.1%), with carbapenems in 406/553 (73.4%). The clinician-driven approach resulted in 16/70 (22.9%) GNB-BSI episodes receiving IEAT. The ML plus colonisation-guided approach would have reduced the use of meropenem by 29.7% (-2.08 days; 95% CI, -2.42 to -1.73; <i>p</i> < 0.001) and anti-PsA beta-lactams by 6.7% (-0.47 days; 95% CI, -0.76 to -0.19; <i>p</i> = 0.001), and would also have led to a reduction in the rate of IEAT from 16/70 (22.9%) to 6/70 (8.6%) (<i>p</i> = 0.035).</p><p><strong>Conclusion: </strong>ML-based risk stratification combined with colonisation status would allow for personalised antibiotic therapy in FN, potentially reducing IEAT and improving antimicrobial use. These results support integrating these tools into clinical practice.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361251411061"},"PeriodicalIF":3.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chronic pulmonary aspergillosis complicating pulmonary cystic echinococcosis: a global systematic review. 慢性肺曲霉病合并肺囊性包虫病:一项全球系统综述。
IF 3.4 Q2 INFECTIOUS DISEASES Pub Date : 2025-12-29 eCollection Date: 2025-01-01 DOI: 10.1177/20499361251404362
Felix Bongomin, Aayush Adhikari, Ronald Olum, Pratik Baral, Iriagbonse Iyabo Osaigbovo, Winnie Kibone, Bassey E Ekeng, Linda Atulinda, Bethan Morgan, Shailendra Katwal, Norman van Rhijn, David W Denning
<p><strong>Background: </strong>Human cystic echinococcosis frequently involves the lungs, and colonization of a residual cavity with <i>Aspergillus</i> spores can lead to chronic pulmonary aspergillosis (CPA).</p><p><strong>Objectives: </strong>We pooled and characterized cases of CPA co-existing with pulmonary cystic echinococcosis (PCE) through a systematic review of globally published data.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources and methods: </strong>Primary literature was identified through searches of various electronic databases, including CINAHL, Ovid MEDLINE, MEDLINE (PubMed), EMBASE, Google Scholar, the Cochrane Database of Systematic Reviews, and African Journal Online. The search encompassed articles from inception to February 2024, using medical subject heading search terms "chronic pulmonary aspergillosis" OR "<i>Aspergillus</i>" OR "aspergilloma" OR "aspergillosis" AND "hydatid disease" OR "hydatidosis" OR "echinococcosis" OR "<i>Echinococcus."</i> Two reviewers independently assessed titles, abstracts, and full texts for eligibility using the Rayyan web-based software. The eligible studies comprised original observational research, single case reports, and case series that reported on CPA in patients with PCE based on established criteria (microbiological and/or radiological diagnosis of PCE) without language or geographic restrictions. Cochrane Risk of Bias Tools (ROB2 and ROBINS-I) were used to assess study quality and risk of bias, and the quality of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluations tool. The extracted data were summarized using descriptive statistics.</p><p><strong>Results: </strong>A total of 148 studies were initially identified from a literature search, and after the screening, 52 articles were selected for full-text review. We included 41 studies published from 1996 to 2023 that met the eligibility criteria and involved 3035 participants. The studies comprised case reports (75.6%, <i>n</i> = 31), case series (12.2%, <i>n</i> = 5), retrospective cohort studies (7.3%, <i>n</i> = 3), and one (2.4%) each of prospective cohort and cross-sectional study, respectively. More than two-thirds were conducted in India (36.6%, <i>n</i> = 15), followed by Turkey (14.6%, <i>n</i> = 6) and Iran (12.2%, <i>n</i> = 5). Among the 72 CPA cases, 50% were male, and 38.9% were female, with a median age of 38 years. Common comorbidities included pulmonary tuberculosis (<i>n</i> = 5) and diabetes mellitus (<i>n</i> = 3). The most frequent symptoms were cough (<i>n</i> = 32), hemoptysis (<i>n</i> = 21), and fever (<i>n</i> = 16). Radiological examinations were conducted in 74.4% of hydatid disease cases, while histological examinations were performed in 82.1% of aspergillosis cases. Cavitary lesions were noted in 21.4% of radiological findings. Treatment involved both surgical and medical management for 43.1% of patients, with antifungals (50%
背景:人类囊性包虫病经常累及肺部,曲霉孢子在残留腔内定植可导致慢性肺曲霉病(CPA)。目的:我们通过对全球已发表的数据进行系统回顾,汇总CPA与肺囊性包虫病(PCE)共存的病例并对其进行特征分析。设计:系统回顾。数据来源和方法:通过检索各种电子数据库确定主要文献,包括CINAHL、Ovid MEDLINE、MEDLINE (PubMed)、EMBASE、谷歌Scholar、Cochrane系统评价数据库和African Journal Online。检索包括从成立到2024年2月的文章,使用医学主题标题搜索词“慢性肺曲霉病”或“曲霉病”或“曲霉瘤”或“曲霉病”和“包虫病”或“包虫病”或“包虫病”。两位审稿人使用Rayyan网络软件独立评估标题、摘要和全文的合格性。符合条件的研究包括原始观察性研究、单个病例报告和病例系列,这些研究基于既定标准(PCE的微生物学和/或放射学诊断)报道了PCE患者的CPA,没有语言或地理限制。使用Cochrane风险偏倚工具(ROB2和ROBINS-I)评估研究质量和偏倚风险,并使用推荐、评估、发展和评估分级工具对证据质量进行评级。提取的数据用描述性统计进行汇总。结果:从文献检索中初步筛选出148篇研究,筛选后选择52篇进行全文综述。我们纳入了1996年至2023年间发表的41项符合资格标准的研究,涉及3035名参与者。这些研究包括病例报告(75.6%,n = 31)、病例系列(12.2%,n = 5)、回顾性队列研究(7.3%,n = 3)以及前瞻性队列研究和横断面研究各1项(2.4%)。超过三分之二的研究在印度进行(36.6%,n = 15),其次是土耳其(14.6%,n = 6)和伊朗(12.2%,n = 5)。72例CPA患者中,男性占50%,女性占38.9%,中位年龄38岁。常见的合并症包括肺结核(n = 5)和糖尿病(n = 3)。最常见的症状是咳嗽(32例)、咯血(21例)和发烧(16例)。74.4%的包虫病患者行放射学检查,82.1%的曲霉病患者行组织学检查。21.4%的影像学表现为空洞性病变。43.1%的患者治疗包括手术和医疗管理,常用抗真菌药物(50%)和驱虫药(50%)。手术治疗包括膀胱切除术(57.9%)和肺叶切除术(55.3%)。所有报告结果的患者均治愈。结论:CPA是PCE的并发症,具有相似的临床和影像学特征。诊断方法主要包括放射学和组织学,而治疗通常涉及手术和医疗管理的结合,通常使用抗真菌和驱虫药。尽管CPA的复杂性,患者通常通过适当的治疗获得良好的结果。需要进一步的研究来优化诊断和治疗策略。试验注册:PROSPERO (CRD42024510441)。
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引用次数: 0
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Therapeutic Advances in Infectious Disease
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