Journal of Infection in Developing Countries最新文献

Introduction: Diabetic foot ulcers (DFU) are the main devastating complications for diabetic patients. The involvement of multidrug-resistant microorganisms with the ability to produce biofilms in DFUs renders them difficult to treat. Nanotechnology has emerged as an innovative and promising technology in the therapy of diabetic foot lesions. Therefore, this study was designed to assess the prevalence of drug resistance and biofilm-forming pathogens in DFU and the antimicrobial activity of nanoparticles against these pathogens.

Methodology: A total of 111 adults with diabetic foot ulcers were randomly included. The clinical parameters and data of the classification and grading of the wound, along with microbiological factors, were analyzed.

Results: Nanoparticles were synthesized from Withania coagulans and Fagonia cretica. The results showed that the majority of patients were male (76%), with an average age of 54 years. The majority of ulcers were polymicrobial (56%), while Staphylococcus aureus (21.2%) was the predominant pathogen. A significant increase in methicillin-resistant Staphylococcus aureus (76.5%), extended-spectrum β-lactamase (ESBL) producers (55.8%), carbapenem-resistant Pseudomonas aeruginosa (46%), and vancomycin-resistant Enterococci (18.1%) was observed. Gram-negative isolates (31%), particularly Pseudomonas aeruginosa, exhibited strong biofilm formation activity compared to gram-positive (6%) and fungal isolates (24%).

Conclusions: The tested nanoparticles showed significant antimicrobial activity against strong biofilm forming bacterial and fungal isolates. Controlling certain extrinsic and metabolic parameters and comprehensively evaluating nanoparticle-based therapeutics can serve as powerful tools in curing chronic diabetic wounds.

Strongyloidiasis is considered one of the most serious parasitic infections globally, especially in tropical and subtropical regions. The disease's public health significance is substantial, as the infection can remain dormant for decades in the host and may be activated as hyperinfection after immunity dysregulation caused by immunosuppression. Strongyloides stercoralis infection is prevalent in tropical regions, whereas cases are usually reported sporadically in non-tropical countries and are estimated to cause asymptomatic chronic infection in 600 million people worldwide. Strongyloidiasis remains neglected in many Mediterranean countries, highlighting the urgent need for increased awareness among healthcare providers, especially regarding possible carriers returning from endemic regions. This narrative review updates the status of S. stercoralis and its corresponding disease in the Mediterranean countries. This article searched internet databases such as PubMed, Science Direct, Google Scholar, and MEDLINE for Strongyloidiasis studies and cases published over the last ten years in the Mediterranean countries. Strongyloidiasis remains neglected in many Mediterranean countries, highlighting the urgent need for increased awareness among healthcare providers, especially regarding possible carriers returning from endemic regions.

Introduction: The incidence of infections caused by multidrug-resistant pathogens is increasing worldwide, resulting in significant morbidity and mortality. Tigecycline has become a good option because it has a broad spectrum of antibacterial activity. This study aimed to reveal the clinical, microbiological, and laboratory outcomes of hospitalized children treated with tigecycline.

Methodology: We retrospectively collected the medical records of the hospitalized pediatric patients treated with tigecycline from April 1, 2018, to Apr 30, 2023, at Ege University Children's Hospital. Demographic features and clinical and laboratory findings were evaluated to determine the efficacy and safety of tigecycline therapy.

Results: Sixty-seven patients (65.7% male) with a median age of 6 years (2.5 months-17.5 years) were included. There was an underlying condition in 83.5% of the patients, and 55.2% were immunosuppressed. The most common infections were; lower respiratory tract infections (29.8%), intra-abdominal infections (20.9%), bloodstream infections (17.9%), and soft tissue infections (13.4%), respectively. Acinetobacter spp. (28.4%) was the most isolated microorganism, followed by Klebsiella spp. (19.4%) and Enterococcus spp. (14.9%). Tigecycline was used as a targeted treatment in 76.1% of the patients and was often used as a combination therapy (80.6%) with a median duration of 12 days (range, 2-60 days). Clinical response was achieved in 65.6% of patients, microbiologic response in 62.6%, and treatment failure in 34.3%. No major adverse events were noted during the therapy.

Conclusions: Tigecycline, which was mostly preferred in combination therapy, had high clinical response and microbiologic eradication rates, but these rates varied according to infection sites and microorganism species.

Introduction: Cryptococcal meningitis (CM) typically affects immunocompromised individuals and are commonly caused by Cryptococcus neoformans.

Case report: We present CM case involving an immunocompetent male due to Cryptococcus gattii molecular type VGI.

Results: This case illustrates the diagnostic and management challenges associated with CM and emphasizes the need for continued vigilance in monitoring and understanding the epidemiology of cryptococcal infections in diverse patient populations.

Conclusions: Our case highlights the significant morbidity associated with cryptococcosis.

Introduction: Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been occurring more frequently. Healthcare workers are among the most at-risk groups due to their direct exposure to SARS-CoV-2 while providing medical care. We aimed to understand the potential factors that affect reinfection.

Methodology: 1399 healthy workers at the General Hospital of Central Theater Command were enrolled for an online questionnaire from 27 June to 10 July 2023. The selected individuals were divided into the primary infection group and the secondary infection group based on the number of SARS-CoV-2 infections.

Results: About 95% of the total population had been vaccinated. A higher proportion of the primary group had received 3 doses of vaccines and inactivated vaccines, than the secondary group (p < 0.001). The symptoms, duration, and severity of the majority of participants significantly decreased during secondary infection, compared to primary infection. After adjusting for factors such as gender, age, vaccine dose, and vaccine type; multiple regression analysis indicated that the patients with disease duration > 7 days or long coronavirus disease 2019 (long COVID-19) history during primary infection had a higher risk of secondary infection with Omicron (odds ratio, OR = 2.2, p < 0.001; OR = 2.4, p < 0.001).

Conclusions: The patients with history of long COVID-19 or longer duration of disease after primary infection had a higher risk of Omicron reinfection. This study identified the clinical manifestations during Omicron primary and secondary infection; and the potential factors that may influence reinfection.

Background: Accumulating evidence implicated H. pylori infection in the disease progression of patients with chronic liver. Highly virulent H. pylori mediate proinflammatory cytokines and ensuing inflammatory alterations. We aimed to assess the correlation between H. pylori infection and disease progression in chronic hepatitis C (HCV) patients with special concern on virulence traits and susceptibility patterns of isolated H. pylori strains.

Methods: After clinical, laboratory, and radiological evaluations, 189 chronic HCV patients were assigned into Group I (74 patients with chronic HCV), Group II (77 cirrhotic patients), and Group III (38 hepatocellular carcinoma (HCC) patients on top of cirrhosis). Fecal samples were analyzed using ELISA to detect H. pylori antigens. Upper gastrointestinal (GIT) gastric biopsies were processed to identify and isolate H. pylori strains. PCR assay verified cagA, VacAs1 & VacAs2 gens in isolated strains to be correlated with the degree of hepatic disease.

Results: H. pylori Ag in stool was identified in 73.02% of studied patients. H. pylori Ag was 55.4%, 84.4%, and 84.2% (p < 0.001); additionally, culture yielded viable H. pylori bacilli in 31.1%, 44.2%, and 55.3% (p = 0.039), and PCR assay revealed 47.8%, 85.3%, and 85.7% (p = 0.004) were positive for cagA and/or vacAs2 virulence genes in chronic hepatitis, cirrhosis, and HCC patients, respectively. The presence of H. pylori positive culture and/or genetic profile is associated with advanced-stage liver disease, hepatic encephalopathy, and portal hypertensive gastropathy.

Conclusions: H. pylori infection should be assessed in all patients with liver impairment. Early H. pylori detection and subsequent eradication may lessen the severity of decompensation.

Introduction: To systematically appraise the prognostic predictive value of the modified HALP (m-HALP) score in critically ill septic patients.

Methodology: The m-HALP scores were computed for septic patients within the initial 24 hours of admission to the intensive care unit (ICU) utilizing data from the MIMIC-IV database. The association between the m-HALP score and 30-day mortality was evaluated using restricted cubic splines and Cox regression. Kaplan-Meier (K-M) analysis was employed to estimate survival differences. Logistic regression was conducted using data from the eICU database to validate the findings. Receiver operator characteristic (ROC) curves were generated to assess predictive value.

Results: The m-HALP score exhibited an L-shaped association with 30-day mortality upon adjustment for multiple variables (HR: 0.84, 95% CI: 0.74-0.96). K-M curves revealed a favorable survival outcome in patients with high m-HALP scores (p < 0.001). In the validation cohort, the m-HALP score proved to be an independent factor influencing in-hospital mortality. The ROC curves suggested that the m-HALP score had a better predictive value for short-term sepsis mortality than the HALP and qSOFA score.

Conclusions: The m-HALP score demonstrated a noteworthy correlation with short-term mortality of septic patients, making it a potentially promising biomarker of prognostic relevance.

Background: The common infection agents causing meningitis in patients with human immunodeficiency virus (HIV) include Cryptococcus neoformans and Treponema pallidum. Furthermore, there is an elevated risk of meningitis in patients with HIV concomitantly infected with SARS-CoV-2.

Case presentation: A 38-year-old male presented with headache and dizziness. After hospitalization, polymerase chain reaction test for SARS-CoV-2 with a nasopharyngeal swab was positive, and lumbar puncture revealed neurosyphilis with concomitant cryptococcal meningitis. He underwent nirmatrelvir-ritonavir, penicillin, antifungal and antiretroviral treatment. The patient had no other neurological symptoms and was stable during the 6-month follow-up period.

Conclusions: During the COVID-19 pandemic patients with HIV, particularly those who did not undergo antiretroviral therapy are at higher risk for severe infections, including central nervous system complications, due to their compromised immune systems.

Asthma is a complex respiratory condition characterized by airway inflammation and hyper-responsiveness, and poses a significant global health burden, affecting millions worldwide. Its origins lie in interactions between genetic, environmental, and host factors. While typically manageable, asthma can lead to severe exacerbations and complications if left untreated. The association between asthma and fungal infections, particularly with Aspergillus species, has garnered attention due to its impact on disease severity and management. We aim to provide a comprehensive overview of this association focusing on its various clinical presentations, risk factors, diagnostic approaches, and treatment strategies. Allergic bronchopulmonary aspergillosis (ABPA) emerges as a prevalent form of aspergillosis in asthmatic individuals, presenting challenges in both diagnosis and management. We discuss the evolving diagnostic criteria for ABPA, emphasizing the importance of clinical suspicion, radiological findings, serological tests, and pulmonary function tests. Moreover, we address the therapeutic interventions, review the roles of systemic glucocorticoids, antifungal agents, and emerging novel therapeutic agents. Early detection and intervention in fungal infections in asthma patients, particularly ABPA, are essential to mitigate exacerbations, improve symptom control, and prevent severe complications. This review underscores the necessity for heightened awareness and proactive management of fungal infections in the context of asthma, aiming to enhance patient care and quality of life.

Introduction: Paracoccidioidomycosis is an endemic mycotic infection caused by Paracoccidioides spp., prevalent in Central and South American countries. Anti-tumor necrosis factor (TNF) alpha agents, commonly used for autoimmune diseases, increase the risk of severe infections. We present a case of anti-TNF alpha-related paracoccidioidomycosis in a 71-year-old male farmer from Colombia.

Case presentation: The patient had oral lesions and chronic cough. A biopsy showed granulomatous inflammation with multinucleated giant cells but no microorganisms. Negative microbiological stains and tests for other infections prompted further investigations. A positive serum immunodiffusion test for Paracoccidioides antibodies at a 1:256 titer led to mediastinoscopy and lung biopsy, which revealed budding yeast in a "captain's wheel" formation. Treatment with liposomal amphotericin B and itraconazole was initiated.

Conclusions: This case highlights the risk of opportunistic infections under anti-TNF alpha therapy and raises awareness of paracoccidioidomycosis associations. Early diagnosis and management are essential for better patient outcomes.