Journal of Infection in Developing Countries最新文献

Introduction: Tuberculous empyema, a severe complication of pulmonary tuberculosis, often requires surgical intervention in stage III to remove fibrotic tissue and restore lung function.

Methodology: This retrospective study enrolled 224 stage III tuberculous empyema patients undergoing single-port thoracoscopic decortication and closed chest drainage. Patients were divided into three groups: Single-Tube group (n = 42), Double-Tube group (n = 51), and Double-Tube with Negative Pressure (Double-NP) group (n = 131, with -8 to -10 cm H₂O negative pressure applied from postoperative day 2). Primary outcomes included postoperative drainage volume, chest tube duration, hospital stay, complications, and Visual Analog Scale (VAS) pain scores. Data were analyzed using Analysis of Variance (ANOVA), chi-square tests, and multivariate regression.

Results: Baseline characteristics were comparable across groups. Postoperative drainage volumes were similar, but chest tube duration and hospital stay were significantly shorter in the Double-Tube and Double-NP groups compared to the Single-Tube group (p < 0.05). The Double-NP group exhibited lower rates of persistent air leak, pleural effusion, atelectasis, and reintubation (p < 0.05). VAS scores were significantly lower in the Single-Tube group than in the Double-Tube and Double-NP groups (p < 0.01).

Conclusions: While the double-tube with delayed low-negative-pressure drainage strategy did not reduce postoperative pain, it significantly shortened chest tube duration and hospital stay while reducing complications, thereby improving overall prognosis in stage III tuberculous empyema patients.

Introduction: The objectives of this study were to identify clinical and laboratory markers of infectious mononucleosis (IM) in children, investigate the risk factors for liver damage and prolonged hospitalization, and enhance Epstein-Barr virus (EBV) diagnostic precision.

Methodology: This retrospective study analyzed 288 pediatric IM cases hospitalized from January 2023 to December 2024. Clinical features, laboratory parameters, and EBV-DNA loads were evaluated using statistical analyses to identify predictors of disease severity and outcomes.

Results: Among the 288 children (median age: 5 years; 48.3% male), fever, cervical lymphadenopathy, creatine kinase (CK), IgM, and CD4/CD8 ratios were significantly associated with high EBV-DNA load. Liver damage (35.1% of cases) correlated with age, splenomegaly, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), ferritin, and immune markers (p < 0.05). Prolonged hospitalization was associated with hepatomegaly, ALT, AST, GGT, LDH, and ferritin levels (p < 0.05). Multivariate analysis identified fever as a predictor of high EBV-DNA load; while age, LDH, and ferritin were independent risk factors for liver damage. Hepatomegaly was a key predictor of extended hospitalization (p < 0.05).

Conclusions: IM predominantly affected children aged 3-7 years in Hangzhou. Fever predicted high EBV-DNA load, while elevated LDH, ferritin, and hepatomegaly signaled increased risks of liver damage and prolonged hospitalization, informing more precise management strategies.

Introduction: Glycosylated hemoglobin (HbA1c) levels are routinely used in secondary and tertiary care centers for monitoring diabetes patients. However, since it is an expensive test, it is not routinely tested in primary care or used as a screening test. This study aimed to examine the relationship between HbA1c levels and in-hospital costs in hospitalized patients during the pandemic period to draw attention to the issue and to be prepared for future pandemics.

Methodology: The design of the study was retrospective and cross-sectional. The study was conducted in a tertiary hospital between March and December 2020. Independent variables, including HbA1c levels, comorbidities, age, and gender; and dependent variables including in-hospital costs, prolonged hospital stay (≥ 14 days), and 30-day mortality; were statistically analyzed.

Results: Overall, 517 patients were included in the study, and 96 of them had high HbA1c levels (HbA1c ≥ 7). The in-hospital costs were significantly correlated with HbA1c ≥ 7 as continuous variables, and HbA1c ≥ 7 was a better indicator of in-hospital costs compared to the diagnosis of diabetes. Patients with HbA1c ≥ 7 also had prolonged hospital stays and higher mortality rates, in addition to high in-hospital costs.

Conclusions: Routine testing of HbA1c levels might be cost-effective and should be performed at primary healthcare facilities.

Introduction: Neonatal sepsis is a leading cause of neonatal mortality. This study aims to assess the clinical significance of the serum albumin (ALB) to international normalized ratio (INR) ratio (AIR) as a predictor for 30-day mortality in neonates with sepsis.

Methodology: Neonates diagnosed with sepsis between January 2019 and December 2022 were included. Admission data were collected, enabling the categorization of neonates into survival and non-survival groups. Logistic regression analyses and receiver operating characteristic (ROC) curves, were employed.

Results: A total of 195 neonates with sepsis were analyzed. The non-survival group exhibited significantly lower AIR compared to the survival group. Multivariate analysis identified low AIR as an independent risk factor (hazard ratio [HR]: 9.091, p < 0.001), achieving an area under the curve (AUC) of 0.746 for AIR. The sensitivity and specificity of AIR were 79.31% and 66.87%, respectively.

Conclusions: AIR serves as a cost-effective and easily obtainable marker in neonatal sepsis research. It emerges as an independent predictor of adverse outcomes in neonatal sepsis, demonstrating good predictive capabilities.

Introduction: Nocardia spp. are Gram-positive, aerobic actinomycetes, which can cause pulmonary, primary cutaneous, and lymphocutaneous infections. However, severe pneumonia caused by Nocardia otitidiscaviarum has rare reported.

Patient concerns: In this case report, a 73-year-old female presented with a 7-day history of fever, cough, followed by a 1-day history of dyspnea. Both lungs showed patchy shadows on a chest CT scan. Bronchoalveolar lavage and mNGS were performed for the rapid diagnosis of the Nocardia otitidiscaviarum induced infection.

Diagnosis: Community-acquired pneumonia was diagnosed following clinical assessment, including characteristic physical examination findings, abnormal laboratory results, and consolidations observed on CT imaging. And the evidence of pathogen was supplied by mNGS.

Interventions: The anti-infection therapy regimen was: trimethoprim-sulfamethoxazole (1.44 g q6h) for 3 months according to the detection of the Nocardia otitidiscaviarum.

Outcomes: After 3 months of follow-up, the patient has a good outcome and chest CT suggested that the inflammation in the lungs had been almost absorbed.

Conclusions: Rapid pathogen identification is pivotal for enhancing clinical outcomes and survival in severe pneumonia patients. This case report presents an exceptional case of severe pneumonia caused by Nocardia otitidiscaviarum and the uncommon potential occurrence of human-to-human transmission. mNGS could help avoid misdiagnosis and mistreatment in clinical practice.

Introduction: Monkeypox (mpox) is an emerging infectious disease with increasing global incidence. Limited evidence exists regarding its impact on pregnancy and perinatal outcomes, especially in low-resource settings. The objective was to systematically synthesize current evidence on maternal and fetal outcomes associated with mpox infection during pregnancy.

Methodology: A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and Embase (as of 4 September 2024) databases were searched. Case reports, case series, cohorts, and observational designs were included. Duplicates were removed using Rayyan. Only 6 studies (out of 471) met the eligibility criteria. A descriptive analysis was conducted due to heterogeneity and small sample sizes.

Results: A total of 6 studies were included (4 from US, 1 from Spain, 1 from Democratic Republic of Congo), comprising 33 pregnant women aged 18-29 years. Mpox was confirmed by polymerase chain reaction (PCR) in 32 cases. The clinical symptoms included vesicular rash, genital lesions, and systemic manifestations. No maternal deaths were reported. Adverse fetal outcomes included miscarriage (9.1%), stillbirth (6.1%), and 4 intrauterine deaths. Most pregnancies (84.8%) resulted in live births. The reported complications included oligohydramnios, cholestasis, chorioamnionitis, and fetal tachycardia. One study confirmed vertical transmission via placental and fetal tissue analysis.

Conclusions: Mpox infection during pregnancy is associated with significant risk of adverse perinatal outcomes. Although current evidence is limited, these findings highlight the urgent need for more robust data to inform clinical and public health guidance.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of public knowledge, vaccination, government preparedness, and a strong healthcare system in managing infectious diseases. Recently, monkeypox (mpox) cases have emerged globally. This study aimed to assess: (i) the public knowledge related to COVID-19 and its translation into preventive behavior, and (ii) the preparedness of the government and healthcare providers in addressing mpox.

Methodology: An online survey was conducted among the adults in Odisha, India. Data were analyzed using SPSS version 26.

Results: Most participants recognized mpox as a viral infection transmitted between animals and humans. Awareness of its cause and symptoms was generally good. However, knowledge about vaccine availability and treatment was limited. The COVID-19 experience positively influenced attitudes toward vaccination, trust in the World Health Organization (WHO) guidance, preventive behavior, and digital health adoption. Despite this, participants felt that the government's response to mpox lacked sufficient preparedness.

Conclusions: These findings highlight gaps in awareness and government readiness. They emphasize the need for stronger preventive strategies to avoid future epidemics or pandemics.

Introduction: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation are known complications in immunocompromised hosts, particularly transplant recipients. However, their occurrence and clinical implications in patients with solid tumors remain underexplored. The introduction of immune checkpoint inhibitors (ICIs) has transformed cancer therapy, but immune-related adverse events (irAEs), including colitis, are increasingly recognized. The potential role of viral reactivation in exacerbating these toxicities is not well established.

Cases presentation: We report two cases of patients with solid tumors treated with ICIs who developed severe, refractory immune-related colitis. Extensive evaluation revealed markedly elevated CMV and EBV viral loads in colonic biopsies, confirmed by histopathology. Both patients showed significant clinical and endoscopic improvement following antiviral therapy with ganciclovir, highlighting the role of CMV and EBV in modulating the severity of ICI-induced colitis.

Conclusions: CMV and EBV reactivation may contribute to the persistence or worsening of ICI-induced colitis. Early recognition and treatment of viral reactivation in patients with irAEs may improve outcomes. Clinical judgment and serial viral monitoring are essential for guiding management decisions.

Introduction: This study aimed to examine the impact of Epstein-Barr virus (EBV) infection on the occurrence and prognosis of Henoch-Schönlein purpura (HSP).

Methodology: A total of 120 children diagnosed with HSP were selected as the experimental group, and 100 healthy children who underwent physical examinations were the control group. We compared renal function markers and quantified 24-hour urine protein in HSP children with different EBV infection statuses, and analyzed the association between EBV infection and Henoch-Schönlein purpura nephritis (HSPN).

Results: The detection rate of EBV-DNA load in the experimental group (30.83%) was significantly higher than that in the control group (10.00%) (p < 0.05). Among children with HSP, the detection rate of EBV-DNA load was significantly higher in those with abdominal involvement compared to those with joint or mixed types (p < 0.05). Serum levels of serum creatinine, blood urea nitrogen, and urine protein quantification were significantly higher in the EBV-positive group than in the EBV-negative group (p < 0.05). The detection rate of EBV-DNA load was significantly higher in the HSPN group compared to the non-HSPN group (p < 0.05). The detection rate of EBV-DNA load was significantly higher in the recurrence group than in the non-recurrence group (p < 0.05), and it was also higher in the relapse group compared to the non-relapse group (p < 0.05).

Conclusions: EBV infection is associated with the development of HSP; and gastrointestinal, joint, and renal damage. It is also an early warning sign for disease recurrence, which highlights its clinical significance.

Background: Pneumonia with an empyema caused by anaerobic bacteria is rare but can be life-threatening, especially in immunocompromised patients.

Case presentation: A 67-year-old man with diabetes and hypertension who presented with pneumonia and pleural effusion and was unresponsive to initial broad-spectrum antibiotics is presented. Next-generation sequencing identified Parvimonas micra and other pathogens. Therefore, targeted therapy with levornidazole was initiated. The patient's condition improved significantly after this treatment.

Conclusions: This case highlights the importance of considering anaerobic bacteria in immunocompromised patients and the utility of next-generation sequencing in identifying atypical pathogens.