Journal of Infection in Developing Countries最新文献

Introduction: The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of public knowledge, vaccination, government preparedness, and a strong healthcare system in managing infectious diseases. Recently, monkeypox (mpox) cases have emerged globally. This study aimed to assess: (i) the public knowledge related to COVID-19 and its translation into preventive behavior, and (ii) the preparedness of the government and healthcare providers in addressing mpox.

Methodology: An online survey was conducted among the adults in Odisha, India. Data were analyzed using SPSS version 26.

Results: Most participants recognized mpox as a viral infection transmitted between animals and humans. Awareness of its cause and symptoms was generally good. However, knowledge about vaccine availability and treatment was limited. The COVID-19 experience positively influenced attitudes toward vaccination, trust in the World Health Organization (WHO) guidance, preventive behavior, and digital health adoption. Despite this, participants felt that the government's response to mpox lacked sufficient preparedness.

Conclusions: These findings highlight gaps in awareness and government readiness. They emphasize the need for stronger preventive strategies to avoid future epidemics or pandemics.

Introduction: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation are known complications in immunocompromised hosts, particularly transplant recipients. However, their occurrence and clinical implications in patients with solid tumors remain underexplored. The introduction of immune checkpoint inhibitors (ICIs) has transformed cancer therapy, but immune-related adverse events (irAEs), including colitis, are increasingly recognized. The potential role of viral reactivation in exacerbating these toxicities is not well established.

Cases presentation: We report two cases of patients with solid tumors treated with ICIs who developed severe, refractory immune-related colitis. Extensive evaluation revealed markedly elevated CMV and EBV viral loads in colonic biopsies, confirmed by histopathology. Both patients showed significant clinical and endoscopic improvement following antiviral therapy with ganciclovir, highlighting the role of CMV and EBV in modulating the severity of ICI-induced colitis.

Conclusions: CMV and EBV reactivation may contribute to the persistence or worsening of ICI-induced colitis. Early recognition and treatment of viral reactivation in patients with irAEs may improve outcomes. Clinical judgment and serial viral monitoring are essential for guiding management decisions.

Introduction: This study aimed to examine the impact of Epstein-Barr virus (EBV) infection on the occurrence and prognosis of Henoch-Schönlein purpura (HSP).

Methodology: A total of 120 children diagnosed with HSP were selected as the experimental group, and 100 healthy children who underwent physical examinations were the control group. We compared renal function markers and quantified 24-hour urine protein in HSP children with different EBV infection statuses, and analyzed the association between EBV infection and Henoch-Schönlein purpura nephritis (HSPN).

Results: The detection rate of EBV-DNA load in the experimental group (30.83%) was significantly higher than that in the control group (10.00%) (p < 0.05). Among children with HSP, the detection rate of EBV-DNA load was significantly higher in those with abdominal involvement compared to those with joint or mixed types (p < 0.05). Serum levels of serum creatinine, blood urea nitrogen, and urine protein quantification were significantly higher in the EBV-positive group than in the EBV-negative group (p < 0.05). The detection rate of EBV-DNA load was significantly higher in the HSPN group compared to the non-HSPN group (p < 0.05). The detection rate of EBV-DNA load was significantly higher in the recurrence group than in the non-recurrence group (p < 0.05), and it was also higher in the relapse group compared to the non-relapse group (p < 0.05).

Conclusions: EBV infection is associated with the development of HSP; and gastrointestinal, joint, and renal damage. It is also an early warning sign for disease recurrence, which highlights its clinical significance.

Background: Pneumonia with an empyema caused by anaerobic bacteria is rare but can be life-threatening, especially in immunocompromised patients.

Case presentation: A 67-year-old man with diabetes and hypertension who presented with pneumonia and pleural effusion and was unresponsive to initial broad-spectrum antibiotics is presented. Next-generation sequencing identified Parvimonas micra and other pathogens. Therefore, targeted therapy with levornidazole was initiated. The patient's condition improved significantly after this treatment.

Conclusions: This case highlights the importance of considering anaerobic bacteria in immunocompromised patients and the utility of next-generation sequencing in identifying atypical pathogens.

Introduction: Both aging and malignancy are associated with an increased risk of infections, including bloodstream infections. Despite their clinical significance, research concentrating on the epidemiology, outcomes, and risk factors influencing mortality in older cancer patients is still limited. This study aims to examine the epidemiology of bloodstream infections and factors contributing to mortality among older cancer patients.

Methodology: This retrospective cohort study was conducted at Etlik City Hospital from January to December 2023. The subjects included cancer patients aged 65 years and older who had experienced bloodstream infections and received a minimum of 48 hours of antimicrobial therapy. Data, including demographics, clinical features, microbiological findings, and antimicrobial therapy, were collected. Bloodstream infections were categorized as either hospital-acquired or community-acquired infections and further classified by their source.

Results: Among 160 bloodstream infection episodes observed, 68.8% of them occurred in patients with solid tumors, while 31.3% were found in those with hematological malignancies. Hospital-acquired infections comprised 78.8% of the total cases. Mortality was significantly associated with inappropriate initial antimicrobial therapy, carbapenem resistance, and multidrug resistance. Additionally, patients who presented with septic shock and fungal infections had higher mortality rates.

Conclusion: The findings underscore the urgent need for early implementation of appropriate antimicrobial therapy and effective infection control measures. The persistence of multidrug resistance and hospital-acquired infections presents critical challenges in reducing mortality rates among older cancer patients. The development of tailored infection management strategies and robust antimicrobial stewardship programs is essential for enhancing outcomes in cancer patients.

Introduction: Clostridioides difficile often causes hospital-acquired diarrhea, leading to unfavorable treatment outcomes. This study investigates CDI treatment outcomes and factors affecting severity and mortality at a university hospital in Thailand.

Methodology: A retrospective study was conducted from June 2019 to December 2021. The primary endpoints were treatment outcomes with a 95% CI. Univariable and multivariable Cox regression analyses determined risk factors for severe CDI and 30-day mortality.

Results: Of 187 patients receiving a diagnosis of and receiving treatment for CDI, 103 patients (55.8%) presented non-severe CDI, and 84 patients (44.2%) had severe CDI. The 30-day mortality rate of CDI was 24.1%, which was significantly higher in the severe group (36.9 vs. 13.6%, p ≤ 0.001). Multivariable analysis revealed the independent risk factor for severe CDI was chronic kidney disease (aOR 15.16, 95% CI 6.3, 36.48), and risk factors for all-cause mortality at 30 days were ICU admission (aOR 3.56, 95%CI 1.48, 8.56) and carbapenem exposure (aOR 2.79, 95% CI 1.17, 6.68).

Conclusions: This study demonstrated high mortality rates and a significant incidence of refractory and recurrent infections in the severe CDI group. Chronic kidney disease was an independent risk factor for severe CDI. ICU admission and carbapenem exposure were independent risk factors for all-cause mortality.

Introduction: Candida auris is a yeast that has a high mortality rate in critically ill patients and is resistant to many antifungal agents enhancing its clinical importance. Our study identifies the risk factors for C. auris invasive infection, antifungal susceptibility, and outcomes.

Methodology: A total of 100 adults with C. auris isolated in any clinical specimen between 07.01.2022 and 31.12.2023 were enrolled in this retrospective cohort study. Data were obtained via retrospective screening of patient files. C. auris identification was performed by MALDI-TOF MS. Antifungal susceptibility was carried out by VITEK 2 and CDC methodology. Colonized and infected patients were compared to assess the risk factors for and outcomes of invasive infection.

Results: Twenty (20%) patients developed invasive infections, with 16 (80%) having candidemia. Age, Candida score, prior antifungal agent use, number of previously used antibiotics ≥ 3, presence of central venous catheter or nasogastric catheter, and being monitored out of burn unit were the risk factors, and Candida score was identified as an independent risk factor for invasive infection development. Of the isolates, 55% were resistant to fluconazole and 100% were resistant to amphotericin B. No micafungin resistance was detected. The overall mortality rate in patients with invasive infection was 75%.

Conclusions: Knowing the risk factors for invasive infection will help early initiation of empirical antifungal therapy by ensuring early identification of high-risk patients, and Candida score appears to be an effective method for this. Revealing antifungal susceptibility will also guide the selection of appropriate empirical treatment.

Introduction: To evaluate the characteristics of patients who have undergone surgical operations due to brain abscess and to assess the risk factors for mortality and the outcomes.

Methodology: Patients who have undergone surgical operations due to brain abscess between January 2014 and January 2024 in our hospital were evaluated retrospectively. Patients were divided into 2 groups to determine poor outcome predictive factors.

Results: A total of 57 patients with brain abscess were evaluated. Brain abscess was developed after a surgical procedure in 33% of the patients. Of these patients, 44 (77%) recovered without sequelae, 3 cases had epilepsy, and 2 had hemiplegia. Comparing the patients with poor outcome and the patients with good outcome in terms of symptom duration, time to hospital admission, and C-reactive protein, erythrocyte sedimentation rate and procalcitonin values, we detected statistically significant difference only in erythrocyte sedimentation rate (p = 0.018). Patients with poor outcome had higher C-reactive protein and procalcitonin values and shorter symptom duration and time to hospital admission than the patients with good outcome. Multivariate logistic regression analysis revealed that erythrocyte sedimentation rate is a predictive factor for poor outcome.

Conclusions: Brain abscesses with high mortality and morbidity. Detailed questioning of symptom duration and time to hospital admission in patients presenting with headache who have or have not undergone surgical operation, precisely evaluating C-reactive protein, sedimentation, and procalcitonin values after performing necessary scanning procedures, and swiftly planning surgical and/or antibiotic treatment are associated with survival benefit.

Introduction: Community-acquired pneumonia (CAP) is a common respiratory disease in children and a significant factor in child mortality.

Methodology: We aimed to investigate metagenomic next-generation sequencing (mNGS) technology to explore pathogens and epidemiological characteristics of pediatric CAP. We retrospectively analyzed mNGS detection and microbiological culture results of bronchoalveolar lavage fluid (BALF) and sputum samples from children with CAP.

Results: Mycoplasma pneumoniae was the predominant pathogen. Bacteria/fungi detection rates using mNGS in sputum and BALF were higher than those using microbiological culture (p < 0.05). Cytomegalovirus was the predominant pathogen in children aged 0-1; Mycoplasma pneumoniae was the predominant pathogen in those over 1. Haemophilus influenzae, Mycoplasma pneumoniae, human bocavirus 1, and Streptococcus pneumoniae were the predominant pathogens in spring, summer, autumn, and winter, respectively.

Conclusions: mNGS is superior to traditional microbiological culture for pediatric CAP potential pathogen detection. CAP pathogenic infection characteristics at different ages and seasons detected by mNGS will benefit clinical practitioners in the prevention and treatment of pediatric CAP in their local/regional areas.

Introduction: This study analyzed the age and sex distribution of COVID-19 patients during the initial three COVID-19 waves in Puducherry, India, from August 2020 to March 2022, to understand the distribution of infection across different demographic groups.

Methods: The disease surveillance program conducted at ICMR-Vector Control Research Centre processed 79,705 Throat Swab/Nasal Swab (TSNS) samples received from various institutions in Puducherry through the Integrated Disease Surveillance Program (IDSP). Real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) was performed following approved protocols.

Results: Test positivity rates during the second (14.6%) and third waves (25.1%) were significantly higher than the first wave (11.4%). In the first wave, children (p < 0.001) and elderly individuals (p = 0.017) had a lower risk of testing positive than adults. However, in the second wave, elderly individuals had a 1.12 (95% CI: 1.03 - 1.23) times greater risk of contracting COVID-19 (p = 0.013). Children had a lower risk of testing positive across all waves (p < 0.001). A significant sex difference was noted only in the first wave, with males having a 1.27 (1.18-1.37) times greater chance of being COVID-19 positive. The mean age of female patients was significantly younger than male patients in the third wave (p = 0.008). The third wave showed an increasing trend of infection across all age groups and sexes, especially among younger individuals.

Conclusions: The study highlights an increasing trend of infections across all age groups and sexes during the third wave. Micro-epidemiological analyses are crucial for developing targeted intervention strategies that address age and sex demographics effectively.