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Aspergillus terreus pulmonary infection in a patient with late-onset combined immunodeficiency: a case report with literature review. 一名晚发型联合免疫缺陷患者的土曲霉肺部感染:病例报告与文献综述。
IF 3.8 Q2 INFECTIOUS DISEASES Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241265932
Naman Lodha, Durga Shankar Meena, Pyrus Bhellum, Neetha T R, Sadiya F C, Yash Khatod, Vidhi Jain, Deepak Kumar, Taruna Yadav

Common variable immunodeficiency (CVID) is the most common humoral immune deficiency in adults, characterized by recurrent sinopulmonary bacterial infections. Invasive fungal infections are rarely associated with CVID. Late-onset combined immunodeficiency (LOCID) is a recently recognized variant of CVID with low CD4 counts and immunoglobulins deficiency. The current study reveals the first documented case of invasive pulmonary aspergillosis (Aspergillus terreus) in a patient with LOCID. A 52-year-old female with a recurrent history of sinopulmonary infections presented with acute onset fever and shortness of breath. Blood culture and bronchoalveolar lavage culture grew A. terreus. Further evaluation revealed low immunoglobulins (IgG, IgM and IgA). Moreover, she also had low CD4 counts (<200 cells/µL). The patient was successfully treated with voriconazole and immunoglobulin therapy. Finally, the study discusses LOCID as a potential risk factor for invasive fungal infections, which can be easily overlooked and cause poor outcomes.

常见变异性免疫缺陷症(CVID)是成人中最常见的体液免疫缺陷,其特点是反复发生窦肺细菌感染。侵袭性真菌感染很少与 CVID 相关。晚发型联合免疫缺陷症(LOCID)是最近才被发现的一种 CD4 细胞计数低和免疫球蛋白缺乏的 CVID 变异型。本研究揭示了首例有记录的 LOCID 患者侵袭性肺曲霉菌病(赤曲霉)病例。一名 52 岁的女性患者有反复鼻窦肺部感染病史,起病急、发热、呼吸急促。血液培养和支气管肺泡灌洗液培养均检出了赤霉菌。进一步检查发现,她的免疫球蛋白(IgG、IgM 和 IgA)偏低。此外,她的 CD4 细胞计数也偏低(0.5%)。
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引用次数: 0
Corrigendum to Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study. 巴拿马一个大型城市抗逆转录病毒治疗诊所的艾滋病毒感染者梅毒患病率:一项横断面流行病学研究的更正。
IF 3.8 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-20 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241263641

[This corrects the article DOI: 10.1177/20499361241256290.].

[此处更正了文章 DOI:10.1177/20499361241256290]。
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引用次数: 0
Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges. 慢性肺曲霉菌病:流行病学、治疗和悬而未决难题的全面见解。
IF 3.8 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-18 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241253751
Masato Tashiro, Takahiro Takazono, Koichi Izumikawa

Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43-76%, voriconazole 32-80%, posaconazole 44-61%, isavuconazole 82.7%, echinocandins 42-77%, and liposomal amphotericin B 52-73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.

慢性肺曲霉菌病(CPA)是由环境真菌曲霉菌引起的一种棘手的呼吸道感染。CPA 的预后较差,据报道 1 年死亡率为 7% 至 32%,5 年死亡率为 38% 至 52%。全面了解病原体、病理生理学、风险因素、诊断、手术、咯血治疗、药物治疗和预后对有效治疗 CPA 至关重要。尤其是曲霉菌的耐药性和隐匿菌种构成了重大挑战。CPA 缺乏组织侵袭,具有曲霉瘤等特殊特征。发生 CPA 的最关键风险因素是肺空洞症。诊断方法因 CPA 亚型而异,计算机断层扫描(CT)成像和曲霉菌 IgG 抗体是关键。治疗策略包括手术、咯血处理和抗真菌治疗。手术是治愈的选择。但据报道,术后死亡率从 0% 到 5% 不等,并发症从 11% 到 63% 不等。单纯曲霉瘤的术后死亡率通常较低,因此手术是首选。50% 的 CPA 患者会出现咯血,这是一个重要的症状,可能危及生命。支气管动脉栓塞可使64%至100%的病例止血,但50%的病例会反复咯血。抗真菌治疗对 CPA 的疗效各不相同,据报道伊曲康唑为 43-76%,伏立康唑为 32-80%,泊沙康唑为 44-61%,异黄酮唑为 82.7%,棘白菌素类为 42-77%,脂质体两性霉素 B 为 52-73%。支气管镜三唑给药、吸入或在感染部位直接注射两性霉素 B 等综合疗法也显示出疗效。建议疗程超过 6 个月,据报道超过 1 年的疗效更好。为了改善 CPA 的治疗,基础和临床研究的不断进步有望为 CPA 的未来治疗做出贡献。
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引用次数: 0
The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation. 降钙素原在识别接受体外膜氧合的流感或 COVID-19 患者继发感染中的作用。
IF 5.7 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-13 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241255873
Kajal D Patel, James K Aden, Michal J Sobieszczyk, Joseph E Marcus

Background: Identifying secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to the ECMO circuit's influence on traditional signs of infection.

Objectives: This study evaluates procalcitonin as a diagnostic marker for secondary infections in patients receiving ECMO with influenza or COVID-19 infection.

Design: Single-center retrospective cohort study.

Methods: All adult patients receiving veno-venous ECMO with underlying influenza or COVID-19 from November 2017 to October 2021 were included. Patient demographics, time receiving ECMO, culture data, and procalcitonin levels were examined. The first procalcitonin within 3 days of infection was compared to negative workups that were collected at least 10 days from the last positive culture. Furthermore, we compared procalcitonin levels by the type of pathogen and site of infection.

Results: In this study, 84 patients with influenza or COVID-19 who received ECMO were included. A total of 276 procalcitonin labs were ordered in this cohort, with 33/92 (36%) of the secondary infections having an associated procalcitonin value. When comparing procalcitonin levels, there was no significant difference between the infection and negative workup groups [1 ng/mL (interquartile ranges, IQR: 0.4-1.2) versus 1.3 (0.5-4.3), p = 0.19]. Using 0.5 ng/mL as the cut-off, the sensitivity of procalcitonin was 67% and the specificity was 30%. In our cohort, the positive predictive value of procalcitonin was 14.5% and the negative predictive value was 84%. There was no difference in procalcitonin by type of organism or site of infection. Procalcitonin levels did not routinely decline even after an infection was identified.

Conclusion: While procalcitonin is a proposed potential diagnostic marker for secondary infections in patients receiving ECMO, this single-center study demonstrated low sensitivity and specificity of procalcitonin in identifying secondary infections. Furthermore, there was no association of procalcitonin levels with etiology of infection when one was present. Procalcitonin should be used cautiously in identifying infections in veno-venous ECMO.

背景:在接受体外膜氧合(ECMO)的患者中识别继发性感染是一项挑战,因为 ECMO 电路会影响传统的感染迹象:本研究评估了降钙素原作为接受 ECMO 的流感或 COVID-19 感染患者继发感染的诊断标志物:单中心回顾性队列研究:纳入2017年11月至2021年10月期间所有接受静脉-静脉ECMO并伴有基础流感或COVID-19的成人患者。研究考察了患者的人口统计学特征、接受 ECMO 的时间、培养数据和降钙素原水平。我们将感染后 3 天内的首次降钙素原与上次培养阳性后至少 10 天收集的阴性培养结果进行了比较。此外,我们还根据病原体类型和感染部位对降钙素原水平进行了比较:本研究共纳入 84 名接受 ECMO 的流感或 COVID-19 患者。该组患者共接受了 276 次降钙素原检测,其中 33/92 例(36%)继发感染的患者有相关的降钙素原值。在比较降钙素原水平时,感染组和阴性检查组之间没有显著差异[1 纳克/毫升(四分位数间距,IQR:0.4-1.2)对 1.3(0.5-4.3),P = 0.19]。以 0.5 纳克/毫升为临界值,降钙素原的敏感性为 67%,特异性为 30%。在我们的队列中,降钙素原的阳性预测值为 14.5%,阴性预测值为 84%。不同病原体类型或感染部位的降钙素原无差异。即使在确定感染后,降钙素原水平也不会常规下降:尽管降钙素原是接受 ECMO 患者继发感染的潜在诊断指标,但这项单中心研究表明,降钙素原在识别继发感染方面的敏感性和特异性较低。此外,即使存在感染,降钙素原水平与感染病因也没有关联。在识别静脉-静脉 ECMO 感染时应谨慎使用降钙素原。
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引用次数: 0
Noma disease among internally displaced persons in Northeast Nigeria: a retrospective descriptive study. 尼日利亚东北部国内流离失所者中的坏疽性口炎:一项回顾性描述研究。
IF 5.7 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-13 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241261269
Mohammed A S Abdullahi, Muhammad R Balarabe, Jennifer A Tyndall, Faith O Alele, Abdulrazaq G Habib, Oyelola A Adegboye

Background: Recently recognized by the World Health Organization as a neglected tropical disease, Noma, an acute and destructive gangrenous disease affecting the gums and facial structures within the oral cavity, has a high mortality rate if untreated.

Objectives: To investigate the prevalence and impact of Noma among internally displaced populations in Northeastern Nigeria.

Design: A retrospective study.

Methods: This retrospective study investigates the prevalence and impact of Noma among internally displaced populations in Northeastern Nigeria. Noma is endemic in Northern Nigeria, Africa, and its occurrence has been linked to extreme poverty, malnutrition, poor hygiene, and inadequate healthcare - conditions exacerbated by the ongoing Boko Haram conflict.

Results: The retrospective descriptive cross-sectional analysis of 17 cases reveals a median age of 8 years, with most of the patients being children who suffer significant social stigmas, such as difficulties in speaking, eating, and social integration, including reduced school attendance and marital prospects.

Conclusion: The study highlights the urgent need for comprehensive research into the etiology of Noma and its socio-economic impact. It emphasizes the necessity for early and effective intervention strategies, particularly in conflict-stricken areas with limited healthcare access.

背景:坏疽性口炎是一种影响口腔内牙龈和面部结构的急性破坏性坏疽疾病,最近被世界卫生组织认定为一种被忽视的热带疾病:调查坏疽性口炎在尼日利亚东北部国内流离失所者中的发病率和影响:设计:回顾性研究:这项回顾性研究调查了坏疽性口炎在尼日利亚东北部国内流离失所者中的流行情况和影响。坏疽性口炎是非洲尼日利亚北部的地方病,其发生与极端贫困、营养不良、卫生条件差和医疗保健不足有关,而持续不断的 "博科哈拉姆 "组织冲突加剧了这些状况:对 17 例病例进行的回顾性描述性横断面分析显示,患者的中位年龄为 8 岁,大多数患者为儿童,他们遭受着严重的社会耻辱,如说话、进食和社会融合困难,包括入学率和婚姻前景下降:本研究强调,迫切需要对坏疽性口炎的病因及其社会经济影响进行全面研究。研究强调了早期有效干预战略的必要性,尤其是在医疗服务有限的冲突地区。
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引用次数: 0
Distribution of Aspergillus species and risk factors for aspergillosis in mainland China: a systematic review. 中国大陆曲霉菌种的分布与曲霉菌病的风险因素:系统综述。
IF 5.7 Q2 INFECTIOUS DISEASES Pub Date : 2024-06-04 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241252537
Sabir Khan, Hazrat Bilal, Muhammad Shafiq, Dongxing Zhang, Muhammad Awais, Canhua Chen, Muhammad Nadeem Khan, Qian Wang, Lin Cai, Rehmat Islam, Yuebin Zeng

Background: Aspergillus, a widespread fungus in the natural environment, poses a significant threat to human health by entering the human body via the airways and causing a disease called aspergillosis. This study comprehensively analyzed data on aspergillosis in published articles from mainland China to investigate the prevalence of Aspergillus, and risk factors, mortality rate, and underlying condition associated with aspergillosis.

Methods: Published articles were retrieved from Google Scholar, PubMed, and Science Direct online search engines. In the 101 analyzed studies, 3558 Aspergillus isolates were meticulously collected and classified. GraphPad Prism 8 was used to statistically examine the epidemiology and clinical characteristics of aspergillosis.

Results: Aspergillus fumigatus was prominently reported (n = 2679, 75.14%), followed by A. flavus (n = 437, 12.25%), A. niger (n = 219, 6.14%), and A. terreus (n = 119, 3.33%). Of a total of 9810 patients, 7513 probable cases accounted for the highest number, followed by confirmed cases (n = 1956) and possible cases (n = 341). In patients, cough emerged as the most common complaint (n = 1819, 18.54%), followed by asthma (n = 1029, 10.48%) and fever (1024, 10.44%). Of total studies, invasive pulmonary aspergillosis (IPA) was reported in 47 (45.53%) studies, exhibiting an increased prevalence in Beijing (n = 12, 25.53%), Guangdong (n = 7, 14.89%), and Shanghai (n = 6, 12.76%). Chronic pulmonary aspergillosis (CPA) was reported in 14 (13.86%) studies. Among the total of 14 studies, the occurrence of CPA was 5 (35.71%) in Beijing and 3 (21.42%) in Shanghai. Allergic bronchopulmonary aspergillosis (ABPA), was reported at a lower frequency (n = 8, 7.92%), Guangdong recorded a relatively high number (n = 3, 37.5%), followed by Beijing (n = 2, 25.0%), and Shanghai (n = 1, 12.5%). Percentage of death reported: IPA had the highest rate (n = 447, 68.87%), followed by CPA (n = 181, 27.88%) and ABPA (n = 14, 2.15%). Among the aspergillosis patients, 6220 had underlying conditions, including chronic lung disease (n = 3765, 60.53%), previous tuberculosis (n = 416, 6.68%), and organ transplant or organ failure (n = 648, 10.41%). Aspergillosis was also found in patients using corticosteroid therapy (n = 622, 10.0%).

Conclusion: This review sheds light on the prevalence patterns of Aspergillus species, risk factors of aspergillosis, and gaps in surveillance that could be helpful for the control and treatment of aspergillosis and guide the researchers in future studies.

Registration: This systematic review was prospectively registered on PROSPERO: Registration ID CRD42023476870.

背景:曲霉菌是一种在自然环境中广泛存在的真菌,它通过呼吸道进入人体,引起曲霉菌病,对人类健康构成严重威胁。本研究全面分析了中国大陆发表的文章中有关曲霉菌病的数据,以调查曲霉菌病的发病率、风险因素、死亡率以及与曲霉菌病相关的基础疾病:方法:从 Google Scholar、PubMed 和 Science Direct 在线搜索引擎中检索已发表的文章。在分析的 101 项研究中,对 3558 株曲霉菌分离物进行了细致的收集和分类。使用 GraphPad Prism 8 统计曲霉菌病的流行病学和临床特征:结果:报告的曲霉菌主要是烟曲霉(n = 2679,75.14%),其次是黄曲霉(n = 437,12.25%)、黑曲霉(n = 219,6.14%)和赤曲霉(n = 119,3.33%)。在总共 9810 名患者中,7513 个可能病例最多,其次是确诊病例(n = 1956)和可能病例(n = 341)。在患者中,咳嗽是最常见的主诉(1819 人,占 18.54%),其次是哮喘(1029 人,占 10.48%)和发热(1024 人,占 10.44%)。在所有研究中,有 47 项(45.53%)研究报告了侵袭性肺曲霉菌病(IPA),北京(12 项,25.53%)、广东(7 项,14.89%)和上海(6 项,12.76%)的发病率较高。有 14 项(13.86%)研究报告了慢性肺曲霉菌病(CPA)。在总共 14 项研究中,北京和上海分别有 5 项(35.71%)和 3 项(21.42%)报告了慢性肺曲霉菌病。过敏性支气管肺曲霉菌病(ABPA)的报告频率较低(8 例,7.92%),广东的报告数量相对较多(3 例,37.5%),其次是北京(2 例,25.0%)和上海(1 例,12.5%)。报告的死亡比例:IPA的死亡率最高(447人,68.87%),其次是CPA(181人,27.88%)和ABPA(14人,2.15%)。在曲霉菌病患者中,有 6220 人患有基础疾病,包括慢性肺病(3765 人,60.53%)、既往结核病(416 人,6.68%)、器官移植或器官衰竭(648 人,10.41%)。使用皮质类固醇治疗的患者中也发现了曲霉菌病(n = 622,10.0%):本综述揭示了曲霉菌的流行模式、曲霉菌病的风险因素以及监测方面的不足,有助于控制和治疗曲霉菌病,并为研究人员今后的研究提供指导:本系统综述在 PROSPERO 上进行了前瞻性注册:注册编号为 CRD42023476870。
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引用次数: 0
Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study. 在巴拿马一个大型城市抗逆转录病毒治疗诊所就诊的艾滋病毒感染者中梅毒的流行率:一项横断面流行病学研究。
IF 3.8 Q2 INFECTIOUS DISEASES Pub Date : 2024-05-30 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241256290
Amanda Gabster, Félix Fernández Díaz, Yamitzel Zaldívar, Michelle Hernández, Juan Miguel Pascale, Angelique Orillac, Samuel Moreno-Wynter, Casey D Xavier Hall, Mónica Jhangimal, Anyi Yu-Pon, Cristel Rodríguez-Vargas, Diogenes Arjona-Miranda, Bárbara Fuentes, Germán Henestroza, Ana Belén Araúz

Background: Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic.

Methods: A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis.

Results: In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14).

Conclusion: This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.

背景:梅毒是一项严峻的全球公共卫生挑战。尽管此前在梅毒控制方面取得了进展,但近年来发病率仍在上升。梅毒是艾滋病病毒感染者(PLHIV)中常见的合并感染。在巴拿马,很少有数据描述梅毒在艾滋病病毒感染者中的流行情况。我们描述了梅毒抗体和高滴度(⩾1:8)活动性梅毒在抗逆转录病毒诊所就诊者中的流行情况及相关因素:在 2022 年 2 月至 3 月和 2022 年 9 月至 10 月期间分别对出生时被指定为男性和女性的成年人(⩾18 岁)进行了横断面研究。参与者提供外周血样本并自行填写问卷。样本采用免疫层析法进行筛选;抗体阳性样本采用快速血浆回输法进行检测,稀释比例为 1:512。采用逻辑回归法确定梅毒抗体和高滴度活动梅毒的相关因素:共有 378 名参与者提供了血液样本;377 人参与了问卷调查(216 人自称为男性,158 人自称为女性,3 人为双性人)。年龄中位数为 36 岁(四分位数间距:28-45 岁)。总体而言,在抗体检测呈阳性的样本中,梅毒抗体流行率为 32.3%(122/378)(男性,50.7% [108/2013];女性,5.7% [9/158];双性人,100.0% (3/3)],P n = 30)(男性 27.8% [n = 30];女性 0.0% [0/9];双性人 0.0% [0/3])。在多变量模型中,抗体阳性与男性有关(50.7%,AOR = 24.6,95%CI:1.57-384.53)。高滴度活动梅毒与参与者年龄较小(18-30 岁,13.2%,OR = 4.82,95%CI:1.17-19.83);31-40 岁,7.8%,OR = 4.24,95%CI:1.04-17.21 与 3.2% >40 岁)、同性恋身份(16.0% OR = 34.2,95%CI:4.50-259.27 与 0.在多变量模型中,与异性恋身份(0.6%)相比,与性身份(双性恋 19.1%,AOR = 10.89,95%CI:1.00-119.06)相关,与并发症(⩾1 个持续性关系,15.9%,AOR = 3.09,95%CI:0.94-10.14)弱相关:这项研究发现,在巴拿马的艾滋病毒携带者中,梅毒抗体和高滴度梅毒的发病率非常高。受影响最严重的人群是男性、年轻女性、同时有性关系的人群以及报告有同性恋和双性恋身份的人群。有针对性的干预措施应包括重复检测和治疗,特别是在感染风险可能增加的人群中。
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引用次数: 0
Distribution and antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with HIV in the era of universal test and treat policy in Uganda. 在乌干达实行普遍检测和治疗政策的时代,从艾滋病病毒感染者中分离出的口咽念珠菌的分布和抗真菌药敏谱。
IF 5.7 Q2 INFECTIOUS DISEASES Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241255261
Musinguzi Benson, Laban Turyamuhika, Alex Mwesigwa, Pauline Petra Nalumaga, Immaculate Kabajulizi, Israel Kiiza Njovu, Edson Mwebesa, Tonny Luggya, Francis Ocheng, David Patrick Kateete, Herbert Itabangi, Gerald Mboowa, Obondo James Sande, Beatrice Achan

Background: Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts.

Methods: A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l'Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto.

Results: The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine.

Conclusion: The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.

背景:尽管口咽念珠菌病在人类免疫缺陷病毒(HIV)感染者中的发病率有所上升,但由于经验性治疗和抗真菌耐药性(AFR)的出现,口咽念珠菌病的治疗已不再有效。本研究旨在调查口咽念珠菌病的发病率,并评估从人类免疫缺陷病毒感染者中分离出的口咽念珠菌的抗真菌敏感性。此外,我们还评估了口咽念珠菌病与 CD4 T 细胞和病毒载量计数之间的相关性:方法:我们在 2023 年 4 月至 10 月期间开展了一项描述性横断面研究,对 384 名艾滋病毒感染者进行了口腔病变临床检查。收集口咽拭子并在沙保露葡萄糖琼脂上进行培养,以分离念珠菌菌种,并使用基质辅助激光解吸电离飞行时间质谱进行鉴定。此外,还使用 VITEK® (Marcy-l'Étoile, France) 紧凑型系统测定了念珠菌分离物对六种抗真菌药物的敏感性。病毒载量数据取自病历,CD4 T 细胞计数检测使用 Becton Dickinson Biosciences 荧光抗体细胞分拣仪 presto 进行:结果:口咽念珠菌病的发病率为 7.6%。口咽念珠菌病与低 CD4 T 细胞计数和高病毒载量明显相关。共获得 35 个分离株,其中白色念珠菌 20 个(占 57.1%),热带念珠菌和光滑念珠菌各 4 个(占 11.4%)。副丝状念珠菌、杜比利念珠菌和克鲁塞念珠菌各占 2 个(5.7%)。此外,7 个分离株(20%)对氟康唑有抗药性,1 个分离株(2.9%)对氟胞嘧啶有抗药性,0.2 个分离株(5.7%)对卡泊芬净有中间抗药性。然而,白僵菌等特定菌株对氟康唑的耐药性分别为 20%(4/20)、50%(2/4)和 50%(1/2)。此外,克鲁塞菌对氟尿嘧啶的耐药性为 50%:结论:口咽念珠菌病(OPC)在艾滋病病毒感染者中的发病率较低,OPC与CD4 T细胞计数和病毒载量之间存在显著关联。白念珠菌是最常分离出的口咽念珠菌种类。在非白念珠菌中,格拉布氏念珠菌和克鲁塞念珠菌的耐药率最高。对氟康唑的耐药性最高。
{"title":"Distribution and antifungal susceptibility profile of oropharyngeal <i>Candida</i> species isolated from people living with HIV in the era of universal test and treat policy in Uganda.","authors":"Musinguzi Benson, Laban Turyamuhika, Alex Mwesigwa, Pauline Petra Nalumaga, Immaculate Kabajulizi, Israel Kiiza Njovu, Edson Mwebesa, Tonny Luggya, Francis Ocheng, David Patrick Kateete, Herbert Itabangi, Gerald Mboowa, Obondo James Sande, Beatrice Achan","doi":"10.1177/20499361241255261","DOIUrl":"10.1177/20499361241255261","url":null,"abstract":"<p><strong>Background: </strong>Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal <i>Candida</i> species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate <i>Candida</i> species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of <i>Candida</i> isolates to six antifungal drugs was determined using VITEK® (Marcy-l'Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto.</p><p><strong>Results: </strong>The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which <i>Candida albicans</i> comprised of 20 (57.1%) while <i>C. tropicalis</i> and <i>C. glabrata</i> comprised 4 (11.4%) each. <i>C. parapsilosis</i>, <i>C. dubliniensis</i> and <i>C. krusei</i> accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like <i>C. albicans</i> showed 20% (4/20), <i>C. glabrata</i> 50% (2/4) and <i>C. krusei</i> 50% (1/2) resistance to fluconazole. Additionally, <i>C. krusei</i> showed 50% resistance to flucytosine.</p><p><strong>Conclusion: </strong>The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. <i>C. albicans</i> was the most frequently isolated oropharyngeal <i>Candida</i> species. <i>C. glabrata</i> and <i>C. krusei</i> exhibited the highest AFR among the non-<i>albicans Candida</i> species. The highest resistance was demonstrated to fluconazole.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"11 ","pages":"20499361241255261"},"PeriodicalIF":5.7,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176349","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
Prevalence of advanced HIV disease and associated factors among antiretroviral therapy naïve adults enrolling in care at public health facilities in Kampala, Uganda. 乌干达坎帕拉公共医疗机构中接受抗逆转录病毒治疗的成人中艾滋病晚期患者的患病率及相关因素。
IF 5.7 Q2 INFECTIOUS DISEASES Pub Date : 2024-05-19 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241251936
Bridget Ainembabazi, Elizabeth Katana, Felix Bongomin, Phillip Wanduru, Roy William Mayega, Aggrey David Mukose

Background: Despite adoption of the 'test-and-treat' strategy, a high proportion of antiretroviral therapy (ART) naïve people living with HIV (PLHIV) enrol in care with, and die of advanced HIV disease (AHD) in Uganda. In this study, we aimed to determine the prevalence of AHD among ART naïve adults enrolling in care and associated factors at selected public health facilities in Kampala, Uganda.

Methods: From April to July 2022, we conducted a mixed-methods study at Kiswa Health Centre III, Kitebi Health Centre III, and Kawaala Health Centre IV. The study involved cross-sectional enrolment and evaluation of 581 participants, utilizing an interviewer-administered questionnaire and chart reviews. Modified Poisson regression was employed to identify factors associated with AHD, complemented by a qualitative component comprising fifteen in-depth interviews, with data analysed through thematic analysis.

Results: Overall, 35.1% (204/581) of the study participants had AHD. Being male [adjusted prevalence ratio (aPR): 1.4, 95% CI: 1.04-1.88] and aged 35-50 years (aPR: 1.81, 95% CI: 1.14-2.88) were associated with AHD. Participants with no personal health perception barriers had 37% lower odds of presenting to care with AHD (aPR: 0.63, 95% CI: 0.46-0.85). Qualitative findings indicated that individual factors, such as waiting until physical health deteriorated and initially opting for alternative therapies, took precedence in contributing to enrolment in care with AHD.

Conclusion: Over one in every three ART naïve adults presents to public health facilities in Uganda with AHD. Male gender, age 35-50 years, and personal health perception barriers emerged as significant factors associated with AHD; emphasizing the need for targeted interventions to address these disparities and enhance early detection and engagement in care. Routine HIV testing should be emphasized and incentivized especially for men and persons aged 35-50 years.

背景:尽管乌干达采取了 "先检测后治疗 "的策略,但仍有很高比例的抗逆转录病毒疗法(ART)未获成功的艾滋病病毒感染者(PLHIV)在接受治疗时患有晚期艾滋病并死于晚期艾滋病(AHD)。在这项研究中,我们旨在确定在乌干达坎帕拉选定的公共卫生机构中,接受抗逆转录病毒疗法(ART)治疗的成人中晚期艾滋病感染者的发病率及相关因素:2022 年 4 月至 7 月,我们在 Kiswa 第三医疗中心、Kitebi 第三医疗中心和 Kawaala 第四医疗中心开展了一项混合方法研究。研究采用访谈员发放问卷和病历审查的方式,对 581 名参与者进行了横断面登记和评估。研究采用了修正的泊松回归法来确定与急性营养不良症相关的因素,并辅以 15 个深入访谈的定性部分,通过主题分析法对数据进行了分析:总体而言,35.1%(204/581)的研究参与者患有急性肾功能衰竭。男性[调整流行率(aPR):1.4,95% CI:1.04-1.88]和 35-50 岁(aPR:1.81,95% CI:1.14-2.88)与急性肾功能衰竭有关。没有个人健康认知障碍的参与者因急性心肌缺血而就诊的几率要低 37%(aPR:0.63,95% CI:0.46-0.85)。定性研究结果表明,个人因素(如等到身体健康状况恶化时才就诊以及最初选择替代疗法)是导致接受抗逆转录病毒疗法治疗的首要因素:结论:在乌干达的公共医疗机构中,每三名抗逆转录病毒疗法未接受治疗的成年人中就有一人患有急性肾功能衰竭。男性性别、35-50 岁以及个人健康观念障碍是与艾滋病相关的重要因素;强调需要采取有针对性的干预措施来解决这些差异,并加强早期检测和就医。应强调并鼓励进行常规艾滋病毒检测,尤其是针对男性和 35-50 岁的人群。
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引用次数: 0
Examining biopsychosocial predictors of risk for cognitive impairment among a racially diverse sample of men who have sex with men living with HIV. 在不同种族的男男性行为者样本中,研究认知障碍风险的生物心理社会预测因素。
IF 3.8 Q2 INFECTIOUS DISEASES Pub Date : 2024-05-14 eCollection Date: 2024-01-01 DOI: 10.1177/20499361241249657
Casey D Xavier Hall, Beth Okantey, Zhuo Meng, Crim Sabuncu, Brittany Lane, Eugenia Millender, Artur Queiroz, Jung Hyo Kim, Lorie Okada, Avrum Gillespie, Gina Simoncini, John 'Jack' P Barile, Grace X Ma, Frank 'Frankie' Y Wong

Background: Cognitive decline among people living with HIV (PLWH) is growing concern as world populations become increasing older including higher proportions of PLWH. It is vitally important to understand psychosocial predictors of age-related cognitive decline men who have sex with men (MSM) living with HIV.

Objectives: The current study seeks to examine psychosocial risk factors the contribute to the risk of age-related cognitive impairment as measured by Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score in a racially diverse sample of MSM living with HIV.

Design: The present analysis utilizes data from the baseline (n = 196) and 6-month follow-up (n = 135) time points of a longitudinal cohort study of PLWH.

Methods: Using a self-report survey, we examine the associations between psychosocial predictors (e.g. trauma, mental health, chronic pain, sleep disturbance, etc.) and risk of dementia using the CAIDE risk score. Analyses include linear and logistic regression.

Results: In adjusted model stress, chronic pain, Black racial identity, and having a sexual identity that is bisexual or another category are all positively associated with CAIDE scores. Childhood sexual abuse history was negatively associated with CAIDE scores indicating a protective effect. Sleep disorder has a positive association with CAIDE scores after adjusting for the baseline CAIDE scores.

Conclusion: These results indicate modifiable correlates of cognitive risk (stress and chronic pain). Interventions should seek to address these comorbid factors including the consideration of minority stress and stigma. Interventions should seek to reach Black and bisexual men living with HIV, including possible cultural tailoring to interventions and messaging. Lastly, future research should examine the impact of variation within childhood sexual abuse histories to better understand their association with cognitive impairment later in life. This may include considering the nature, severity, and potential treatment of trauma symptoms.

背景:随着世界人口(包括更高比例的艾滋病病毒感染者)年龄的增长,艾滋病病毒感染者(PLWH)的认知能力下降问题日益受到关注。了解感染艾滋病毒的男男性行为者(MSM)与年龄相关的认知能力下降的社会心理预测因素至关重要:本研究旨在通过心血管风险因素、老龄化和痴呆症发病率(CAIDE)评分,对感染了艾滋病病毒的不同种族 MSM 样本中导致年龄相关性认知障碍风险的社会心理风险因素进行研究:本分析利用了一项艾滋病毒感染者纵向队列研究的基线(n = 196)和 6 个月随访(n = 135)时间点的数据:我们利用自我报告调查,使用 CAIDE 风险评分法研究了心理社会预测因素(如创伤、心理健康、慢性疼痛、睡眠障碍等)与痴呆风险之间的关联。分析包括线性回归和逻辑回归:在调整后的模型中,压力、慢性疼痛、黑人种族身份以及双性恋或其他类型的性身份都与 CAIDE 评分呈正相关。童年性虐待史与 CAIDE 分数呈负相关,表明存在保护作用。在对 CAIDE 基线分数进行调整后,睡眠障碍与 CAIDE 分数呈正相关:这些结果表明,认知风险的相关因素(压力和慢性疼痛)是可以改变的。干预措施应设法解决这些合并因素,包括考虑少数群体的压力和耻辱感。干预措施应设法覆盖感染艾滋病毒的黑人和双性恋男性,包括对干预措施和信息进行可能的文化调整。最后,未来的研究应检查童年性虐待史的变化所产生的影响,以更好地了解它们与日后认知障碍的关系。这可能包括考虑创伤症状的性质、严重程度和可能的治疗方法。
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引用次数: 0
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