Journal of Infection in Developing Countries最新文献

Introduction: In developing countries like Vietnam, childhood diarrhea remains frequent and is often treated empirically without an etiological diagnosis.

Methodology: Patients aged under five years, hospitalized at a gastroenterology department with acute diarrhea, were recruited at one hospital. Enteric pathogens were tested by real-time PCR.

Results: 451 children with diarrhea were included, 65.2% were male. 56.3% were aged under 12 months. Upon inclusion, 49.7% (224/451) had nausea and vomiting, and 17.5% had bloody diarrhea. 27.1% of children had a fever, and 37.7% and 4.2% had moderate and severe dehydration, respectively. Almost all patients (437/451, 96.9%) received empirical antimicrobial treatment. 76.5% of children were positive for at least one pathogen, with 37.9% positive for two to four pathogens. Adenovirus, norovirus, and enterovirus were the most frequent viruses detected, with a proportion of 35.7%, 25.7%, and 20.6%, respectively, while Campylobacter jejuni was the most frequent bacterium detected (14.2%), followed by Salmonella spp. and Escherichia coli pathotypes. Male gender, patients positive for at least one virus, and rotavirus were associated with an increased risk of severe disease (OR = 1.55, p = 0.04, OR = 2.23, p < 0.001, and OR = 1.86, p = 0.03, respectively).

Conclusions: These findings underscore the complex interplay of viral and bacterial pathogens in pediatric diarrheal illness and highlight the need for targeted interventions focusing on appropriate diagnostic strategies, antimicrobial stewardship, and gender-specific considerations to mitigate the burden of childhood diarrhea in resource-limited settings like Vietnam.

Introduction: Interactions between host and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are incompletely understood. Studies have highlighted the roles of L-dopa decarboxylase (DDC), interferon-inducible truncated isoform of angiotensin-converting enzyme 2 (dACE2), and immunomodulatory hypoxia-regulated gene erythropoietin (EPO) in viral infections. This study investigated the expression levels of DDC, dACE2, and EPO in 136 coronavirus disease 2019 (COVID-19) patients and 88 controls.

Methodology: Real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to quantify mRNA levels of DDC, dACE2, and EPO; and the SARS-CoV-2 viral load in nasopharyngeal swabs.

Results: Significantly elevated levels of dACE2 (p = 0.003), DDC (p = 0.004), and EPO (p = 0.006) were observed in patients compared to controls. No correlation with the viral load (DDC: r = 0.12, p = 0.136; EPO: r = 0.02, p = 0.802; dACE2: r = 0.05, p = 0.491), and no associations with age or gender (all p > 0.05) were noted. There were positive correlations between DDC and dACE2 mRNA levels in infected (r = 0.31, p = 0.0002) and uninfected individuals (r = 0.25, p = 0.015); and between DDC and EPO in infected (r = 0.22, p = 0.008) and uninfected individuals (r = 0.27, p = 0.010). There was a positive correlation between dACE2 and EPO mRNA levels in both groups (infected: r = 0.22, p = 0.007; uninfected: r = 0.38, p = 0.0002).

Conclusions: DDC, dACE2, and EPO may contribute to COVID-19 pathogenesis through mechanisms independent of viral load, age, or gender.

Introduction: The COVID-19 pandemic influenced the behaviour of numerous diseases, overloading health systems and weakening public health infrastructure and access.

Methodology: This study aimed to analyse the repercussions of the COVID-19 pandemic on tuberculosis diagnosis indicators. A systematic review was conducted, examining studies published between 2020 and 2024 in Portuguese, English, or Spanish across five databases and Google Scholar. The search, performed in March 2024, led to the identification of 6,378 studies, of which 23 were included after an independent review of titles, abstracts, and full texts. Data were extracted and narratively synthesized following a methodological quality assessment.

Results: The review revealed significant declines in TB incidence, detection, notification, and diagnosis during the pandemic, alongside reduced etiological confirmation of cases.

Conclusions: The findings highlight a need to reorganize and enhance health service responses to address the disruptions caused by the pandemic. Strengthening these services is crucial to recover missed TB cases and improve indicators, supporting the goal of eliminating TB by 2030.

Introduction: Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic with clinical manifestations ranging from asymptomatic infection to life-threatening illness. While physician assessment of disease severity is largely objective, patient perception of illness is often influenced by psychosocial and demographic factors. This study aimed to explore determinants of illness perception among patients hospitalized with COVID-19.

Methodology: A cohort of 262 patients with confirmed SARS-CoV-2 infection was evaluated. Baseline characteristics included age, gender, smoking history, body mass index, and sociodemographic information (relationship status, education, employment, and physical activity). Disease severity was assessed using chest computed tomography (CT) scans. Illness perception was measured with the Brief Illness Perception Questionnaire (BIPQ).

Results: The median patient age was 56.3 years, and 65.6% were male. More than half (56.5%) had completed higher education, 90% were married or in a relationship, 57.6% were unemployed, and 85.9% reported no regular physical activity. Male patients demonstrated higher absolute CT scores (p = 0.018) but lower BIPQ scores. Severe pneumonia, as defined by CT findings, correlated with longer hospitalization, although no significant differences in total BIPQ scores were observed across CT severity groups. Illness perception was not influenced by education (p = 0.43), employment (p = 0.096), or physical activity (p = 0.94). However, relationship status significantly affected total BIPQ scores (p = 0.034).

Conclusions: The study found BIPQ useful for rapid illness perception assessment, recommended for routine practice. Socio-economic factors influenced responses, while CT severity did not. Linking CT scores with BIPQ may identify patients at risk of psychological distress.

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.