Journal of Infection in Developing Countries最新文献

Introduction: Patients with perianal necrotizing fasciitis (PNF) frequently require admission to the intensive care unit (ICU). The study aimed to develop a novel scoring system to predict ICU admission in PNF patients.

Methodology: This cohort study retrospectively recruited patients in the Nanjing Hospital of Chinese Medicine. The outcome was the admission to the ICU. Random forest was used to select variables for the development of a new scoring system, whose performance was assessed using the area under the curve (AUC) with a 95% confidence interval (CI). Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were applied to assess the performance improvement of Sequential Organ Failure Assessment (SOFA) score and Fournier's Gangrene Severity Index (FGSI) compared to the new scoring system.

Results: Totally 106 eligible individuals with PNF were enrolled. SOFA, age, course of disease, and extent of disease were selected to develop the new scoring system, which was named "modified SOFA" (mSOFA). The AUC of the mSOFA was 0.974 (95% CI: 0.931-1.000). SOFA (NRI: -0.72, p = 0.010; IDI = -0.05, p = 0.002) and FGSI (NRI: -1.50, p < 0.001; IDI = -0.55, p < 0.001) demonstrated a decreased predictive performance for the ICU admission compared to mSOFA.

Conclusions: The mSOFA scoring system had a better predictive performance for the ICU admission than SOFA and FGSI, indicating that mSOFA may be a reliable tool for the prediction of ICU admission in PNF patients.

Introduction: Serum cryptococcal antigen (CrAg) screening is crucial for early diagnosis of cryptococcal meningitis. This study presents the results of CrAg screening among people living with HIV (PLWH) followed in our clinic over the past six years.

Methodology: Patients with a CD4+ T cell count below 200 cells/µL who were tested for CrAg were included in the study. Data regarding age, gender, comorbidities, CD4+ T cell count, HIV RNA level, blood culture results, and cerebrospinal fluid (CSF) findings-including CrAg, microscopy, culture, and PCR-were retrospectively collected. Descriptive statistical methods were used for the analysis.

Results: Serum CrAg testing was performed on 99 patients, nine of whom tested positive. Among the patients with positive antigenemia, four were diagnosed with cryptococcal meningitis. In two cases, serum CrAg positivity was interpreted as false-positive due to the absence of clinical or laboratory findings consistent with cryptococcal infection. One patient died shortly after the CrAg test and could not be further evaluated. Two patients were lost to follow-up; however, one of them presented with symptoms two months later and was diagnosed with cryptococcal meningitis. Additionally, there was one patient with confirmed cryptococcal meningitis despite an initial negative serum CrAg result.

Conclusions: CrAg positivity may be detected during the asymptomatic phase of cryptococcal infection. Although current guidelines recommend serum CrAg screening for individuals with CD4+ T cell counts below 100 cells/µL, the detection of positive results in those with CD4+ T cell counts above this threshold should also be carefully evaluated, considering the possibility of false-positive or false-negative results.

Introduction: Most COVID-19 cases are mild, but some require hospitalization due to pneumonia, with symptoms like hypoxia and dyspnea. This has led to speculation about erythrocyte involvement in the infection. This study aimed to examine the differences in the presence of dysmorphic erythrocytes in COVID-19 patients upon admission compared to healthy subjects, as well as to assess these differences in relation to the severity of the clinical presentation of COVID-19.

Methodology: This study included 150 participants: 100 COVID-19 patients and 50 healthy subjects who formed the control group. The COVID-19 positive participants were divided into two groups based on the deterioration or improvement of their health conditions during hospitalization. Hematological parameters were analyzed, and peripheral blood smears were prepared to observe morphological changes in erythrocytes.

Results: The morphological changes observed in hospitalized COVID-19 patients included spiculated red blood cells (RBCs), spherocytes, stomatocytes, schistocytes, knizocytes, keratocytes, as well as mushroom- and cup-shaped RBCs. At admission, spiculated RBCs and spherocytes were more prevalent in patients showing improvement. Conversely, stomatocytes, knizocytes, keratocytes, and mushroom-shaped RBCs were more frequent in patients experiencing deterioration. Additionally, spiculated RBCs were more common in patients with improvement, while stomatocytes, schistocytes, knizocytes, keratocytes, mushroom-, and cup-shaped RBCs were more prevalent in deteriorating patients.

Conclusions: The complete blood count and the examination of peripheral blood smears in hospitalized patients may serve as fundamental tools to assist clinicians in differentiating disease severity and improving treatment decision-making.

Introduction: Severe viral and bacterial pneumonia are among the most common causes of death worldwide. This study investigated the effects and mechanisms of latent transforming growth factor beta binding protein 1 (LTBP1)'s on methicillin-sensitive Staphylococcus aureus (MSSA)-induced severe pneumonia following cytomegalovirus (CMV) reactivation.

Methodology: A young mouse model of severe pneumonia was established using Staphylococcus aureus and CMV. LTBP1 overexpression was induced, and pathological changes in lung tissue were assessed through H&E staining. Serum levels of inflammatory factors, including tumor necrosis factor (TNF)-α, interleukin (IL)-6, and interleukin (IL)-1β, were measured using ELISA. Bacterial load in the lungs was quantified, and protein expression levels of LTBP1, TGF-β1, Smad2, p-Smad2, Smad3, and p-Smad3 in lung tissue were analyzed using Western blot.

Results: The LTBP1 expression was reduced in the young mouse model of severe pneumonia induced by Staphylococcus aureus after cytomegalovirus reactivation. Overexpression of LTBP1 inhibited lung damage, reduced serum levels of inflammatory factors (IL-6, IL-1β, and TNF-α), and decreased bacterial load in the lungs. Additionally, overexpression of LTBP1 inhibited the activation of the TGF-β1/Smad signaling pathway.

Conclusions: LTBP1 efficiently reduces severe pneumonia by activating the TGF-β1/Smad signaling pathway, highlighting its potential as a therapeutic target for treating this condition.

Introduction: This study aimed to assess tetanus seropositivity levels among adult patients admitted to a tertiary care hospital following rabies risk exposure, and to explore potential factors influencing their immunological status.

Methodology: This cross-sectional descriptive epidemiological study included 182 adult individuals (68 females and 114 males) who presented to the hospital following rabies risk exposure. The demographic data was collected during a face-to-face interview, and the tetanus antibody concentrations were assessed using a micro-enzyme-linked immunosorbent assay (ELISA) kit. Serum antibody levels of ≥ 0.1 IU/mL were defined as "seropositive", while values below this threshold were considered "seronegative".

Results: Seropositivity was identified in 81.9% of the patients. There was a significant decline in antibody levels with age (p < 0.001). The Spearman correlation analysis showed a moderately significant negative correlation between age and antibody titers (r = - 0.404, p < 0.001). In addition, there were significantly higher tetanus antibody levels in patients from urban areas, those vaccinated during pregnancy, and those vaccinated within the past 10 years (p = 0.025, 0.036, and 0.013, respectively).

Conclusions: Overall, the results highlight a reduction in tetanus antibody levels with age, emphasizing the importance of receiving a booster dose every 10 years. In addition, rabies risk exposure, particularly in older adults, presents a valuable opportunity to administer tetanus vaccination.

Introduction: With the large-scale use of antibiotics, the detection rate and mortality of carbapenem resistant Escherichia coli (CR-EC) have gradually increased. This study investigated the molecular characteristics and prevalence of CR-EC in order to supplement the isolated data of CR-EC in Hangzhou, China.

Methodology: The minimal inhibitory concentration was determined by microbroth dilution method. The drug resistance genes were detected by polymerase chain reaction. The transferability of plasmid was verified by the conjugation test and genetic homology was detected by pulsed-field gel electrophoresis. The whole genome was sequenced (WGS) using the Illumina MiSeq technology.

Results: A total of 8 non-duplicated CR-EC isolates were collected, and all exhibited a multidrug-resistant phenotype. Two different New Delhi metallo-β-lactamase (NDM) variants, blaNDM-5 and blaNDM-13, were found with detection rates of 62.5% and 12.5%, respectively. The success rate of conjugation was 100% (6/6). Homology analysis showed that there was no widespread cloning outbreak of CR-EC, and blaNDM-5-ST410 was prevalent in the local area as a dominant group. WGS also indicated the rate of occurrence of resistance genes carrying resistance for more types of antibiotics, as well as exposed potential virulence risks.

Conclusions: This was a survey on the prevalence and molecular characteristics of CR-EC in Hangzhou. blaNDM-like production combined with extended spectrum beta-lactamase (ESBLs) and/or AmpC was the main resistance mechanism of CR-EC in this area. The dominant blaNDM-5-ST410 requires enhanced attention. The horizontal transformation of plasmids, complex drug resistance, and potential virulence risks also need close attention.

Introduction: Cystic echinococcosis is a parasitic disease recognized as a global public health problem in countries engaged in agriculture and animal husbandry. In natural life cycle, ungulates are intermediate hosts: canids are definitive hosts. It could be accidentally transmitted to humans by the fecal-oral route and migrate to the liver and other visceral organs to form cystic echinococcosis. It spreads hematogenously, lymphatically, and locally. The majority of initially asymptomatic patients develop liver and lung involvement. Involvement of other organs is rare. Cystic echinococcosis is a disease diagnosed by radiologic imaging and confirmed by histopathology, serologic, and molecular tests that can be used for diagnosis and follow-up primary and secondary infections. In this case report, the involvement of multiple and rare organs of cystic echinococcosis is presented.

Case presentation: An 82-year-old patient was admitted to the hospital with an inability to urinate. A glob vesicle was detected during examination, and urine output was achieved through urinary catheterization. Imaging techniques revealed multiple cysts in the abdomen, ureter, and bladder. Urine flow in ureter orifice was obstructed by cysts. Cystectomy was performed for the intraabdominal, intravesical, and ureteral cysts. Perioperative albendazole treatment was started as adjuvant and antiparasitic treatment was completed for one month. The case was confirmed histopathologically, and no secondary infection or complication was detected in one-year follow-up.

Conclusions: By a multidisciplinary approach, the 82-year-old patient was diagnosed with Cystic echinococcosis, with a rare and multi-organ involvement, given the high risk of infection due to the environmental contamination in this country.

Introduction: The potential role of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of coronavirus disease 2019 (COVID-19) is controversial, with concerns mainly about the part RAAS peptides play in the prediction of progression to more severe disease. Given the importance of COVID-19 prognostication at early disease stages, we established and validated a multivariable risk stratification tool for COVID-19 associated lung involvement by utilizing a combination of RAAS peptides.

Methodology: In this prospective study, circulating renin and angiotensin converting enzyme-2 (ACE-2) levels were measured in 116 COVID-19 patients who were admitted to our hospital from March 30, 2021 to January 24, 2022 and underwent a lung computed tomography (CT) scan. Clinical severity was measured with a national early warning score (NEWS). Associations among RAAS peptides, inflammation-dependent biomarkers, demographic variables, and clinical outcomes were studied using logistic regression and Cox proportional-hazards models.

Results: We assessed 116 COVID-19 patients (mean age 45.1 ± 12.6 years; 51.7% male), of whom 66 (56.9%) had COVID-19 associated pneumonia. Baseline circulating ACE-2 (2.63 ± 0.12 ng/mL) and renin levels (85.04 ± 6.8 ng/L) were lower in patients with COVID-19 related pneumonia compared to patients without pneumonia (6.4 ± 0.7 ng/mL and 211.6 ± 21.9 ng/L, respectively) (p < 0.001 for both). Both RAAS components were found to be significantly related to adverse outcomes, including COVID-19 associated pneumonia and intensive care unit (ICU) admission, in both crude and adjusted multivariable logistic regression analyses.

Conclusions: Circulating ACE-2 and renin levels can predict lung involvement in COVID-19 patients, and they display good correlation and agreement with NEWS.

Introduction: Majority of patients admitted to intensive care units (ICUs) succumb to sepsis and its complications. However, currently available predictors fail to reliably gauge the severity of organ damage. There is a pressing need to identify biomarkers that can accurately forecast outcomes. Interleukin-6 (IL-6) has emerged as a potential biomarker, with some studies suggesting its utility as an early predictor of multi-organ failure in sepsis. This study evaluated the role of IL-6 in predicting mortality in an Indian ICU setting.

Methodology: This prospective observational study included adult patients diagnosed with sepsis and a quick SOFA score ≥ 2. IL-6 levels, SOFA scores, and other clinical parameters were measured within 24 hours of admission. Univariate and multivariate analyses identified factors associated with mortality.

Results: The overall ICU mortality rate was 39%. Multivariate analyses indicated that IL-6 levels, total SOFA scores, and number of antibiotics used were independently associated with mortality. The IL-6 levels showed strong positive correlations with the total SOFA score (r = 0.77, p < 0.001) and individual organ dysfunction scores; particularly in cardiovascular (r = 0.61, p < 0.001), renal (r = 0.64, p < 0.001), and central nervous system (r = 0.6, p < 0.001).

Conclusions: IL-6 levels, in combination with SOFA scores, provide a robust predictor of mortality in sepsis patients. The strong correlation between IL-6 levels and organ dysfunction scores suggests its potential as a biomarker for sepsis severity and progression.

Introduction: The objective of this study was to characterize the occurrence of urosepsis in oncology patients and to explore the potential factors influencing its development and outcomes. Urosepsis is a serious systemic infection originating from a urinary tract infection. Its management is particularly challenging in immunocompromised oncology patients.

Methodology: A retrospective review of 337 oncology patients diagnosed with urosepsis between 2019 and 2023 was conducted. Various clinical and demographic factors were examined, including patient gender, type of tumor (solid or liquid), nephrostomy, presence of a double J (DJ) stent, diabetes mellitus, length of hospital stay, and use of central lines. Statistical analysis was performed to assess associations between these variables and urosepsis.

Results: Males were found to be at higher risk to develop urosepsis (p: 0.039). Escherichia coli was the most commonly identified pathogen. However, none of the analyzed factors, including tumor type (p: 0.432), nephrostomy (p: 0.503), DJ stent (p: 0.325), diabetes mellitus (p: 0.637), length of hospital stay (p: 0.185), or presence of a central line (p: 0.122), showed a statistically significant association with the occurrence of urosepsis.

Conclusions: This study is the first to examine urosepsis in oncology patients in Palestine. The findings highlight the increased risk for developing urosepsis in male gender; however, the other factors studied were not significant. The results cannot be generalized to all hospitalized patients as the studied population was in a tertiary hospital, and a bigger sample size is recommended for future studies to allow generalizability of the results.