Journal of Infection in Developing Countries最新文献

Introduction: Talaromyces marneffei is a pathogenic dimorphic fungus known for causing severe opportunistic infections that can be life-threatening. The fungus is most commonly found in Southeast Asia and southern China.

Case report: This case report describes the case of a young male patient infected with T. marneffei who was neither human immunodeficiency virus (HIV)-positive nor possessed anti-IFN-γ antibodies, and who resided outside the typical endemic regions. The patient developed cough and sputum three months after the removal of the left arm fracture fixator, and was initially misdiagnosed with tuberculosis; however, the response to anti-tuberculosis treatment was not good. The diagnosis of subsequent recurrence was unknown. The condition recurred during the illness, and he was ultimately diagnosed with talaromycosis via metagenomic next-generation sequencing (mNGS). The patient's condition improved after appropriate treatment with liposomal amphotericin B.

Conclusions: Previous studies have found that T. marneffei infections are concentrated in patients with acquired immunodeficiency syndrome due to HIV infection, and in anti-IFN-γ antibody-positive patients. However, infections are increasing in individuals who are not immunosuppressed and are often misdiagnosed and underdiagnosed during the initial course of the disease. Therefore, clinicians should be aware that mNGS is an effective technique for detecting T. marneffei infection in non-endemic areas where they encounter non-HIV infected patients. This case report aims to raise the awareness of physicians regarding this rare disease in non-endemic areas and non-HIV patients.

Introduction: Cytomegalovirus (CMV) seroprevalence varies globally. This study aimed to detect CMV seroprevalence and reactivation among patients who had been exposed to hepatitis B virus (HBV) or hepatitis C virus (HCV).

Methodology: The study was conducted between 2017 and 2022 and included adult participants who were serologically diagnosed with hepatitis B (63 participants) or hepatitis C (69 participants), as well as 132 control respondents. CMV IgG and IgM levels were measured for all 264 respondents; CMV IgG avidity was further determined for those who tested positive for CMV IgG and IgM.

Results: The total CMV IgG seroprevalence observed in the study was 95.4%, with 98.5% in HCV-positive, 96.8% in HBV-positive, and 95.2% in control respondents; and with a slightly higher prevalence in women (97.1%) compared to men (94.9%). The overall CMV reactivation rate among anti-HCV positive respondents was 2.9%. Although no significant difference was found in the reactivation rate of CMV between anti-HCV positive and negative respondents, the reactivation rate of CMV within the subgroup of HCV RNA positive individuals was higher at 4.4%. In contrast, no CMV reactivation was observed in the respondents without detectable HCV RNA. No CMV reactivation was detected in the HBV group.

Conclusions: This study did not confirm a higher reactivation rate of CMV in HBV- or HCV-positive respondents compared to the control cases. Given the high CMV seroprevalence among adults in Bosnia and Herzegovina, future research should include CMV DNA testing for more accurate assessment.

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a bacterium in "critical" category on the World Health Organization's list of "priority pathogens". The aim of our study is to identify the carbapenem resistance genes of K. pneumoniae isolates obtained from blood and cerebrospinal fluid samples sent from the intensive care units of our hospital and to investigate the clonal relationship among them.

Methodology: K. pneumoniae strains isolated from blood and CSF samples routinely collected from the intensive care units of our hospital over a two-year period were included in the study. Carbapenemase screening of CRKP strains was performed using Carba NP and CIM tests. Additionally, carbapenemase resistance genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48) and clone analysis were performed using AP-PCR on these strains.

Results: A total of 186 strains with reduced susceptibility to at least one carbapenem were detected. In carbapenemase screening, the sensitivity of the CIM test was 98.3% (169/172), specificity was 7.1% (1/14); the sensitivity of Carba NP was 90.7% (156/172), specificity was 78.6% (11/14). 83.9% of the strains were blaOXA-48, 4.8% blaNDM, and 3.8% blaKPC positive. blaIMP and blaVIM resistance genes were not detected. One hundred and eighty-six K. pneumoniae isolates were identified with 62 different genotypes, and isolates showing clustering were grouped into 30 different clusters. The clustering rate of these isolates was 82.8%.

Conclusions: Resistant bacteria can cause small outbreaks in ICUs. Therefore, to identify high-risk clones and prevent further spread, there is a need to increase capacity to support outbreak investigations and surveillance with real-time whole genome sequencing.

Introduction: This study was conducted with a profound sense of urgency and has provided significant results that will complement previous studies carried out in Mauritania-a country with unique socio-economic and healthcare characteristics-to monitor the epidemiological situation of coronavirus disease 2019 (COVID-19). The study aimed to comprehensively and rigorously investigate the epidemiological profile of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains circulating in Mauritanian patients.

Methodology: This descriptive study was carried out on 84 patients at the Cheikh Mohamed Ben Zayed Hospital and the National Institute of Hepato-Virology in Nouakchott. The samples were sequenced by next-generation sequencing (NGS) of the Illumina NextSeq 2000 type. The data were analyzed by the EPI Info 7 and SPSS 21 software.

Results: The average age of the patients was 51 years, and the distribution of cases by age showed that the virus did not select a specific age group. The results indicated that the most frequent variant was Delta (33.33%). The death rate was very high (34.52%) compared to the national death rate, with a peak in the 58-69 years age group.

Conclusions: This study provides an overview of the epidemiological characteristics of COVID-19 in Mauritania. These findings not only help identify what policies or strategies should be designed to combat the COVID-19 pandemic, but also pave the way for a more effective response to similar pandemics in the future.

Introduction: This study aimed to investigate if gene expression modifications due to two different single nucleotide polymorphism (SNP) mutations within the interferon-α/β receptor-2 (IFNAR2) gene had an effect on clinical prognosis in pregnant coronavirus disease 2019 (COVID-19) patients.

Methodology: The study included 173 pregnant patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using real-time polymerase chain reaction (RT-PCR). Oligonucleotides were designed for the SNPs with nucleotide database codes rs13050728 and rs2236757 in the hospital's genetic laboratory, and RT-PCR analyses were performed.

Results: There was a significant difference in upper respiratory tract infection (URTI) symptoms (runny nose, nasal congestion, and fatigue); between rs2236757 normal-carrier-homozygous mutant pregnant women and the occurrence of symptoms (p = 0.004). However, these URTI symptoms were never seen in homozygous mutant pregnant women. Upon analysis of the relationship between rs13050728 normal-carrier-homozygous mutant pregnant women and the occurrence of symptoms, there was a significant difference between URTI symptoms, and nausea and vomiting (p = 0.001, p = 0.027, respectively). The URTI symptoms were never seen in homozygous mutant and carrier pregnant women. There was no significant association between rs13050728 and rs2236757 normal-carrier-homozygous mutant pregnant women and severity of disease, intensive care unit admission, pregnancy complications, need for oxygen support, and radiologic involvement.

Conclusions: The results of this study will serve as a guide in identifying high-risk individuals, providing treatment, and contributing to the understanding of genetic factors in future viral pandemics.

Introduction: Staphylococcus aureus is an important pathogen associated with nosocomial and community-acquired infections. The main reservoirs of S. aureus/MRSA in hospitals are the colonized asymptomatic healthcare workers (HCWs) and patients. The aim of this study was to investigate the prevalence of MSSA and MRSA nasal carriage and their association with pvl and tsst1 genes among HCWs.

Methodology: A cross-sectional study was performed. A total of 230 HCWs and 200 controls were screened for nasal carriage of S. aureus. All isolates were identified by conventional microbiological methods and confirmed by Vitek. Antimicrobial susceptibility was tested using disk-diffusion and MIC method. PCR was used to detect the mecA, pvl and tsst1 genes.

Results: S. aureus nasal colonization was significantly higher (p < 0.0001) among HCWs, 23% (53/230) compared to the control 0.5% (1/200). Prevalence of MRSA was 9.6% (22/230) among HCWs. All isolates were susceptible to vancomycin and linezolid. Highest resistance was observed with ciprofloxacin and erythromycin among both - MSSAand MRSA. One MSSA isolated showed high-level mupirocin resistance (MIC > 1024 µg/mL). PVL and TSST-1genes were detected 7.4% and 0.8% of HCWs, respectively, with higher prevalence in MRSA isolates.

Conclusions: A high rate of S. aureus/MRSA carriage among HCWs was observed . The presence of PVL and TSST-1 raises concern due to poor infection control compliance. Periodic screening and improved infection prevention protocols are recommended.

Introduction: Infections by enterococci pose a unique challenge as their ability to grow in extreme environments and intrinsic resistance to cephalosporin, clindamycin, and multidrug resistance. Enterococcus faecalis and Enterococcus faecium cause infections ranging from urinary tract infections (UTI) to bacteremia.

Methodology: A retrospective study on urine and blood specimens was conducted over 11 months (February-December 2024) to assess the prevalence, age-gender distribution, species isolation, and vancomycin resistant enterococci (VRE) profile to aid treatment. A total of 4,549 urine and 4,070 blood samples were processed and identified by conventional bacteriological methods. The drug susceptibility was assessed based on the Clinical and Laboratory Standards Institute (CLSI) guidelines using the disc diffusion method. E. faecalis (94.05%) outnumbered E. faecium (5.94%).

Results: Enterococci prevalence rose to 7.08% among positive samples compared to 4.1% in 2023 and 2.70% in 2022. Females had more prevalence (69.30%) than males (30.69%); and the 21-40 years age group was the most common. Both species were most resistant to ampicillin and ciprofloxacin. High level aminoglycosides (HLA) and vancomycin resistance were 54.55% and 15.15% in E. faecalis, and 66.67% and 33.33% in E. faecium, respectively. Nitrofurantoin (69.69% sensitive) and fosfomycin (78.79% sensitive) can be good options for E. faecalis while formulating broad spectrum therapy for UTI. VRE isolation was 7.92%.

Conclusions: The rising trend of enterococci and the alarming rates of resistance highlight the need for rational and restricted drug use, with early detection and use of the susceptibility report to prevent treatment failures and spread of resistance.

Introduction: This study investigates the impact of lung microbiota on COVID-19 outcomes.

Methodology: Clinical data and bronchoalveolar lavage fluid (BALF) data and bronchoalveolar lavage fluid (BALF) samples were retrospectively collected from 40 COVID-19 patients for Targeted Next-generation Sequencing (TNGS). Microbial diversity was then analyzed across different clinical severity groups. Additionally, biomarkers were identified using Linear Discriminant Analysis Effect Size (LEfSe) and evaluated by Receiver Operating Characteristic (ROC) - Area Under the Curve (AUC).

Results: The patients were classified by severity as mild (n = 3), moderate (n = 13), severe (n = 16), or critical (n = 8) symptoms. The α-diversity of respiratory flora showed no significant differences between groups (p > 0.05). While β-diversity analysis revealed significant compositional distinctions (p < 0.05). Critically ill patients had higher levels of Pseudomonas aeruginosa compared to other groups, ROC-plot AUC value of 0.856. Patients were then categorized into two outcome-based groups: Non-survivors (n = 5) and Survivors (n = 35). No significant differences in α-diversity of respiratory flora were observed between the two groups (p > 0.05), while β-diversity revealed distinct compositional differences (p < 0.05). Furthermore, the ROC curve for Pseudomonas aeruginosa (AUC = 0.846) indicated its predictive value for mortality.

Conclusions: This study has elucidated the characteristics of pulmonary microbiota across different COVID-19 severities, identifying bacteria associated with severe illness, mortality, and relevant clinical markers. The lung microbiota exhibits low diversity, making the pulmonary microecology more vulnerable to disruption. Therefore, invasive species may influence clinical outcomes in affected patients.

Introduction: Bloodstream infection (BSI) is a major contributor to morbidity and mortality in hemodialysis patients. Our objective was to identify pathogens causing BSI, its incidence, and associated risk factors.

Methodology: Retrospective positive blood culture data were analyzed from five hemodialysis centers (January 2019 until December 2023) across Saudi Arabia.

Results: There were 437 bacteremia episodes in 432 patients, with 405 central line and 367 peripheral samples. The BSI rate was 0.67 per 100 patient months. 375 (85.8%) patients had a Central Venous Catheter (CVC), 27 (6.17%) had an arteriovenous fistula (AVF), 5 (1.14%) had an arteriovenous graft (AVG), and 30 (6.9%) had dual access. The central line-associated bloodstream infection (CLABSI) rate was 1.41 per 100 patient months. Gram-positive organisms in the central line blood culture were 169 (44%), and Gram-negative were 200 (51.81%); 16 (4%) cases were polymicrobial, and there was one case of fungi. In peripheral blood cultures, 158 (48.9%) were Gram-positive and 150 (46.4%) were Gram-negative. The most common pathogens were Staphylococcus aureus, MRSA, and Staphylococcus epidermidis in Gram-positive organisms, and Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa in Gram-negative organisms. Three cases of fungal infection occurred during the study period. Two-thirds of patients (68%) required hospital treatment, and in 54% of the cases, there was loss of vascular access. Mortality due to sepsis within 4 weeks occurred in five patients.

Conclusions: The risk of BSI in hemodialysis patients is high. Gram-negative pathogens contribute to half of the events. In Saudi Arabia, Gram-negative pathogen incidence is significant, and measures are required to curtail it.

Introduction: Antimicrobial resistance is recognized as one of the major health challenges. Thus, urgent therapeutic solutions are needed. This study aims to test the activity of plant extracts against multi-resistant bacteria, as well as the synergistic effect of these extracts with some antibiotics.

Methodology: The evaluation of the antibacterial effect of eight medicinal extract plants (G. alypum, R. graveolens, U. dioica, P. lentiscus, A. vulgaris, L. angustifolia, T. vulgaris, and J. phoenicea) against 10 bacterial strains (K. pneumoniae, E. coli, C. freundii, S. haemolyticus, S. epidermidis, S. saprophyticus) has been performed using both wells and disks diffusion methods (DDM/WDM). The evaluation of the synergistic effect of some of the natural extracts with some antibiotics has been performed using the disk diffusion method (DDM).

Results: A significant difference resulting from the effect of various plant extracts on different bacterial species has been observed. Interestingly, an important inhibition zone related to the effect of the essential oil of T. vulgaris and L. angustifolia was observed in all bacterial strains. The combination of plants/antibiotics does not always give a more effective effect than the antibiotic /or the plant extract alone. The lavender oil seems to be able to enhance the activity of ertapenem on C. freundii, while the combination of A. vulgaris/ertapenem induced the reduction of the inhibition zone on the same species.

Conclusions: These results are of great importance; regarding the valorization of natural resources for the creation of solutions to urgent health problems while taking advantage of existing pharmaceutical resources.