Journal of Infection in Developing Countries最新文献

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.

Introduction: Hepatitis C virus (HCV) genotype 1 is a significant cause of hepatocellular carcinoma (HCC) in Vietnam. Direct-acting antivirals (DAAs) are effective in achieving sustained virologic response (SVR), potentially reducing HCC incidence. This study evaluated how DAA regimens affect HCC incidence in Vietnamese patients with chronic liver disease related to HCV genotype 1.

Methodology: A retrospective cohort study was conducted with 450 HCV-1 patients treated with DAAs at the Liver Clinic, University Medical Center Ho Chi Minh City, Vietnam. Patients were followed for a median duration of 0.5 years. Treatment regimens included combinations of NS5A inhibitors with NS3/4A protease inhibitors or NS5B polymerase inhibitors. Data on demographics, baseline clinical characteristics (e.g., alpha-fetoprotein, albumin levels), and liver function were collected before initiating DAA treatment. Follow-up data, including SVR rates and HCC incidence, were assessed at the end of treatment and during the post-treatment observation period (median follow-up of 0.5 years). This approach allowed us to compare pre-treatment baseline data with post-treatment outcomes to evaluate the impact of DAA therapy on HCC risk factors and incidence.

Results: SVR was achieved in 94.8% of patients, with an HCC incidence of 1.1% at 1 year for SVR patients, versus 6.5% for non-SVR patients. Significant risk factors for HCC included hypoalbuminemia, elevated alpha-fetoprotein levels, and non-SVR status.

Conclusions: DAAs significantly reduce HCC incidence in Vietnamese patients with HCV-1; however, ongoing surveillance is essential for high-risk patients.

Introduction: Phage therapy is a promising alternative for combating multidrug-resistant bacteria, including Acinetobacter baumannii (AB). However, the development of phage-resistant variants after treatment, particularly when using phage cocktails, poses a significant challenge. This resistance can hinder the effectiveness of future phage-based treatments against pathogenic AB.

Methodology: Three AB-specific phages-AB-phage 22, AB-phage 27, and AB-phage 32-susceptible to an AB isolate, designated ABU-3, were used as a model to study phage resistance development in AB following phage treatment. This study proposes a strategy to effectively eliminate pathogenic AB using an optimal multiplicity of infection (MOI), referred to as the MOI clearance value.

Results: The MOI clearance values required for complete elimination of ABU-3 were determined to be 10 for AB-phages 22 and 32 and 100 for AB-phage 27. Surviving ABU-3 colonies from lower MOI treatments were analyzed for phage resistance. ABU-3 treated with AB-phage 27 developed resistance to AB-phage 27 but remained susceptible to AB-phages 22 and 32. ABU-3 treated with AB-phage 22 developed resistance to AB-phage 22 but retained partial susceptibility to the other phages at reduced MOI. In contrast, ABU-3 treated with AB-phage 32 displayed complete resistance to all three phages.

Conclusions: These findings highlight a key challenge in phage therapy: insufficient MOI ratio can promote phage resistance. The distinct resistance profiles observed emphasize the importance of optimizing phage combinations and dosages to prevent resistance development during treatment.

Introduction: Drug-resistant Acinetobacter baumannii poses a global health crisis, especially in Asia. It has a propensity to become clonally endemic in healthcare settings. However, its clonal distribution in a broad geographic area is unclear.

Methodology: The clonality of A. baumannii was characterized nationwide by collecting 572 drug-resistant A. baumannii from 18 hospitals across Thailand regions between 2017-2018 and genotyping them by random amplified polymorphic DNA (RAPD) polymerase chain reaction (PCR) in association with carbapenemase genes data.

Results: The results depicted 12 types of RAPD banding. Strikingly, two types were predominant in all hospitals (79%). Of those, 96% harbored the blaOXA-23 gene. The banding pattern matched the preexisting strain in the institution, suggesting an ongoing nationwide circulation of the resistant clone. Interestingly, a unique banding type was identified in high proportion in two nearby hospitals in the northern region (21%, 53/252). Two isolates with the same banding pattern were also identified in a hospital in Bangkok, suggesting the possibility of transfer between regions. Most of the subset of isolates analyzed belonged to sequence type (ST) 2, the most prominent ST in the Asia-Pacific region.

Conclusions: This study demonstrated continuous dissemination of predominating A. baumannii clones across the country, and the emergence of endemic hospital-specific clones, all with high burdens of blaOXA-23; suggesting a strong selection for these resistance determinants. In addition, genotyping with RAPD can be a simple and cost-effective epidemiological tool with efficient discriminatory power for A. baumannii in developing countries.

Introduction: Parrot fever, caused by Chlamydia psittaci, is a zoonotic disease typically treated with tetracyclines. Omadacycline, a novel aminomethyl tetracycline, has limited reports on its efficacy in severe Chlamydia psittaci pneumonia in the literature.

Case presentation: We present a case of a patient with severe Chlamydia psittaci pneumonia showing symptoms of chills, high fever, shock, hepatic and renal insufficiency, and acute respiratory failure with copious yellow watery sputum. Chlamydia psittaci was confirmed by metagenomic next-generation sequencing (mNGS). Despite initial treatment with moxifloxacin and doxycycline, the patient did not improve and was subsequently discharged after receiving omadacycline.

Conclusions: Our findings highlight the potential of mNGS for rapid diagnosis of Chlamydia psittaci pneumonia and suggest omadacycline as a potential therapeutic option for severe cases that do not respond to conventional treatment.