Journal of Infection in Developing Countries最新文献

Introduction: China implemented a dynamic zero-COVID strategy to curb viral transmission in response to the coronavirus disease 2019 (COVID-19) pandemic. This strategy was designed to inhibit mutation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. This study explores the dynamics of viral evolution under stringent non-pharmaceutical interventions (NPIs) through real-world observations.

Methodology: Our analysis encompassed all polymerase chain reaction (PCR)-confirmed COVID-19 cases (n = 780) from two consecutive outbreaks occurring in July to August 2021. Epidemiological investigations and in-depth viral genome analyses were conducted to determine the sources of infection and the inter-outbreak linkages.

Results: The outbreaks likely originated via contaminated objects from an imported COVID-19 case to local airport cleaners. Most patients presented clinically mild symptoms. All viral genomes clustered into a single clade, with genomes from the subsequent Yangzhou outbreak forming a distinct branch, diverging from those of the initial Nanjing outbreak. Compared to the Wuhan-Hu-1 strain, the Delta variants isolated from the imported case and early local cases in Nanjing had 35 nucleotide mutations and three deletions. Various single nucleotide variant (SNV) combinations were observed in subsequent transmissions, with NPIs accounting for the termination of 67.2% (92/137) of SNV combinations. Stringent implementation of NPIs resulted in a greater number of terminated SNV combinations than emerging ones. Additionally, vaccination of cases was associated with SNV combination termination.

Conclusions: This study underscores the significant role of NPIs in preventing the accumulation of SARS-CoV-2 mutations.

Introduction: We assessed the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated socio-occupational factors among delivery riders from a Brazilian city at two time points during the pandemic.

Methodology: Surveys for antibody and viral RNA testing were conducted from November 2020 to January 2021, and from March to May 2021 in a group of 117 delivery riders. A questionnaire on socio-occupational characteristics and coronavirus disease 2019 (COVID-19) preventive measures was completed. Factors associated with prevalence were analyzed using bivariate analyses and multiple logistic regression models.

Results: The overall prevalence of COVID-19 was 15.4% (CI 9.0-23.0). Although not statistically significant, the prevalence was higher in the second phase of the survey (12% (CI 6.0-19.0)) than in the first (5.1% (CI 1.0-10.0)). The seroprevalence was significantly higher (p < 0.05) in the second phase of collection (10.3%) than in the first phase (3.4%). There were no statistically significant associations between the social characteristics assessed in the study and prevalence. Five behavioral variables were selected for the final multiple logistic regression model; and only the variable "cleans hands" had a significant association with the outcome, indicating that those who cleaned their hands had lower occurrence.

Conclusions: The prevalence among delivery riders was high and they were potentially exposed to risk of infection. Occupational activity and individual prevention behavior were better determinants of infection than social differences. It is necessary to take specific public measures for this group, especially during outbreaks of communicable diseases such as COVID-19.

Introduction: We aimed to present the changes that may occur in pulmonary functions in children who experienced more severe coronavirus disease 2019 (COVID-19) during long-term follow-up.

Methodology: A prospective longitudinal observational cohort study was conducted with 34 pediatric patients (7-18 years) who were hospitalized with COVID-19 infection (moderate n = 25, severe n = 9), and followed up at our Pediatric Infection Outpatient Clinic for approximately two years. Pulmonary function tests (PFTs) were performed using spirometry.

Results: Data from the hospitalization period revealed no significant differences between the severity groups in terms of demographic, clinical, laboratory, radiological, treatment, and outcome (p > 0.05). The median time interval between COVID-19 infection and PFTs was 15 months (range 11-29 months), and there was no significant difference between severity groups (p = 0.878). Eight patients (24%) had abnormal pulmonary functions; among them, seven had an obstructive pattern (21%) and one had a restrictive pattern (3%). The severity groups had no statistical difference in pulmonary functions (p = 0.105). While forced expiratory volume in 1 second (FEV1) %, FEV1/forced vital capacity (FVC)%, and forced expiratory flow during the middle half of FVC (FEF25-75%) ratios were lower in the severe patient group, Z-scores were similar. Among the patients continuing polyclinic follow-up, 41% had persistent respiratory symptoms before PFTs. No differences were observed in PFTs when compared based on the presence of symptoms (p > 0.05).

Conclusions: We observed no significant long-term differences in pulmonary function between moderate and severe COVID-19 cases in children.

Introduction: Coronavirus disease 2019 (COVID-19) is a life-threatening disease that was declared a pandemic in March 2020. Organ transplant recipients are vulnerable to infection and complications from COVID-19. The objective of this study was to investigate the rates of infection, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and patients on the waiting list for organ allocation in the period prior to the availability of specific vaccines.

Methodology: This was an observational study of official sources that are used to report information on COVID-19. Quantitative variables were described with arithmetic means and categorical variables with proportions. Percentages of positivity to infection, number of deaths, CFR, and all-cause mortality were calculated for each group and subgroup.

Results: There were 2,551 eligible subjects; 602 (26.2%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There were 265 (10.4%) deaths from all causes during the follow-up period; 119 (44.9%) of them were associated with COVID-19, which indicated a COVID-19-related mortality rate of 4.7 %. CFRs were 21.4% and 17.1% in transplant recipients and waitlisted patients, respectively. CFR was significantly higher in transplant recipients (23.8%) than in patients waitlisted for kidney (16.5%; p = 0.044) Among SARS-CoV-2-positive patients, the probability of dying from COVID-19 was higher in the first group (87.3% and 73%, respectively; p = 0.034).

Conclusions: COVID-19 had a significant impact on the deaths of transplant patients and patients on the solid organ waiting list during the first year of the pandemic in Colombia, before the availability of vaccines.

Introduction: This study investigated the role of fibroblast growth factor 23 (FGF23)/Klotho in the mortality of patients hospitalized with coronavirus disease 2019 (COVID-19), excluding those with chronic kidney disease (CKD).

Methodology: A prospective cross-sectional study was conducted from April 2021 to May 2022. Patients who tested positive for COVID-19 via polymerase chain reaction and were hospitalized, were classified into two groups (survivors and non-survivors) at the end of their hospital follow-up. Demographic data, clinical status, and prognosis were analyzed.

Results: A total of 66 patients (age 58.8 ± 17.0 years, 60.6% male) were included. The mean age of non-survivors (67.2 ± 1 years) was significantly higher than the survivors (49.2 ± 1 years; p < 0.0001). FGF23 was significantly elevated in non-survivors (301 ± 20 pg/mL), compared to survivors (160 ± 36 pg/mL; p < 0.0001). Factors with significant differences (p < 0.001) between the two groups were investigated as independent mortality predictors using logistic regression analysis. FGF23 (p = 0.01), age (p = 0.045), and oxygen saturation at admission (p = 0.02) were independent predictors of mortality. High serum FGF23 levels were associated with COVID-19-related mortality; Klotho levels were lower (p = 0.028). Vitamin D was not significantly different between the groups.

Conclusion: Elevated serum FGF23 and parathyroid hormone (PTH), and lower Klotho levels, were associated with COVID-19-related mortality in patients without CKD. There was no association with serum vitamin D levels. Further studies are required to establish the relationship between mortality and FGF23/Klotho, PTH, and vitamin D levels.

Introduction: Invasive candidiasis is an important cause of nosocomial infection and recent studies have shown an increase in the number of cases during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to evaluate the epidemiology and incidence of invasive candidiasis before and during the COVID-19 pandemic at a reference tertiary hospital in Brazil.

Methodology: A retrospective observational study was performed with 148 patients infected with Candida spp.

Results: The incidence of invasive candidiasis was 3.43 cases per 1000 admissions in the pre-pandemic period and 4.54 cases per 1000 admissions in the pandemic period, with a particularly high incidence in the intensive care unit. Compared to the pre-pandemic period, patients presented more frequently with immunosuppression (p = 0.01), sepsis (p = 0.03), and need for mechanical ventilation (p = 0.01) during the pandemic. The prevailing type of Candida spp. infection was candidemia, mostly by C. albicans. Invasive candidiasis was associated with high mortality; 52% of the infected patients died from this disease in the pre-pandemic period, while 62% died in the pandemic period. COVID-19, mechanical ventilation, and sepsis were significantly associated with mortality (p = 0.008, p < 0.001, and p < 0.001 respectively).

Conclusions: A high incidence of Candida infection was observed at a tertiary general hospital in Brazil between 2018 and 2022. An increase in incidence of Candida infection during the COVID-19 pandemic was associated with a greater number of critical patients. Sepsis, mechanical ventilation, and COVID-19 were related to higher mortality in patients with invasive candidiasis.

Introduction: Convalescent plasma (CP) therapy is a form of passive immunization which has been used as a treatment for coronavirus disease 2019 (COVID-19). This study aims to evaluate the efficacy and safety of CP therapy in patients with severe COVID-19.

Methodology: In this retrospective cohort study, 50 patients with severe COVID-19 treated with CP at Shahid Beheshti Hospital, Kashan, in 2019 were evaluated. Eligible plasma donors were COVID-19 survivors with high IgG levels and no comorbidities. Clinical and laboratory parameters, including vital signs, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) levels, were measured before and after CP therapy at specified intervals including 24 h and 48 h post-therapy.

Results: The average age of the patients was 55.96 years, and 46% had comorbidities. No adverse effects from CP therapy were reported. Significant associations were observed between baseline ESR levels and factors such as age, comorbidities, hypertension history, and intubation status. However, there was no significant correlation between the outcomes of WBC, ESR, and CRP levels and the IgG levels in recipients.

Conclusions: CP therapy appears to be a safe and potentially effective treatment for severe COVID-19, especially in patients with certain baseline characteristics. These findings add valuable insights into the management of severe COVID-19 cases, although further research is needed to fully understand the implications and optimize treatment protocols.

Introduction: Significant challenges to implementing international health regulations (IHR) at points of entry (PoEs) have been highlighted by the coronavirus disease 2019 (COVID-19) pandemic. Better assessment of the capacities of the PoEs may promote focused interventions. This study aimed to assess the capacities and practices at PoEs.

Methodology: A self-filled questionnaire based on the World Health Organization (WHO) Joint External Evaluation Tool was distributed to frontline workers at four major PoEs. A total of 368 questionnaires were distributed and 308 were completed. Online interviews were conducted with key informants (n = 16). The capacity of PoE was scored by referencing the WHO checklist for core capacity requirement, and categorized into limited, partial, or full capacity. Pearson's Chi square test was used to compare differences among PoEs. Qualitative data was thematically analyzed.

Results: The majority of the 308 participants in the survey were from Ngwenya (59.4%). Approximately 68% were government employees, and 81% had more than 2 years of experience. Participants reported shortage of resources, such as medical facility (30.5%), staff (37.7%), gloves (47.7%), masks (48.4%), and isolation room; and inconsistencies in practices such as record keeping, reporting cases, and quarantine measures. The overall capacity for IHR implementation was limited, with the airport PoE showing partial capacity and the three ground PoEs having limited capacity.

Conclusions: The capacity to implement the IHR at Eswatini PoEs was limited. The results suggest the need to allocate resources to PoEs and to enhance training on practices regarding case handling, reporting, and record keeping.

Introduction: The frequency of scabies and its relationship with the coronavirus disease 2019 (COVID-19) pandemic is a current scientific curiosity in Turkey and worldwide. The data presented in this article will help raise awareness of dermatologists in situations such as pandemic-induced quarantines where scabies can spread rapidly.

Methodology: This was a retrospective study to compare patients who presented with scabies and were evaluated during the COVID-19 pandemic, with those who presented before and after the pandemic, in terms of the diagnosis ratios. In addition, the recurrence rates were compared in terms of age, nationality, and the environment in which they lived.

Results: The frequency of scabies was statistically significantly higher in the post-COVID period in all quarters of the year, with a higher rate of patients in the first and last quarters, which is typical of scabies patients. However, a significant difference in recurrence rates was not detected.

Conclusions: Several factors might be responsible for the increased frequency of scabies during the lockdown periods in Turkey. First, entire families, including relatives, had to live together in a crowded space. Second, there was a relative increase in doctor visits, in spite of the stay-at-home policy, owing to the overwhelming itchiness of scabies.

Introduction: Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic.

Methodology: This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis.

Results: Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58).

Conclusions: There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.