Journal of Infection最新文献

Background: Haemophilus ducreyi, traditionally recognised as the etiological agent of chancroid, a genital ulcer disease, is increasingly being identified as a significant cause of cutaneous ulcers in yaws-endemic regions across the South Pacific, Southeast Asia, and Sub-Saharan Africa. Despite its clinical relevance, this pathogen remains poorly characterized, and comprehensive genetic tools for analysing isolate relationships are still lacking.

Methods: In this study, we present a follow-up of our previous research and developed a multilocus sequence typing (MLST) approach based on six of the seven loci from the Haemophilus influenzae MLST scheme and applied it to 82 primary clinical samples, previously confirmed to contain H. ducreyi, without culture. We also performed whole-genome sequencing (WGS) and antibiotic susceptibility testing on four cultured isolates obtained from cutaneous ulcers in yaws endemic health districts of Cameroon.

Results: Antibiotic susceptibility testing of H. ducreyi cultured isolates revealed sensitivity to all tested antibiotics, including ceftriaxone, azithromycin, and ciprofloxacin. MLST analysis, using data extracted from WGS and directly from clinical samples, identified 38 complete profiles across the six loci (34 from direct samples and four from cultured isolates), identifying 14 distinct sequence types (STs). BURST analysis of the six MLST genes grouped the STs into two distinct clonal complexes. An additional, polymorphism was observed in the ftsI gene, which encodes the penicillin-binding protein 3.

Conclusions: This study highlights the need for genetic typing of H. ducreyi strains circulating in the yaws-endemic regions of Cameroon. The developed MLST scheme offered effective strain discrimination and provided valuable insights into their genetic relationships in these areas.

Objectives: The incidence of syphilis in several areas of England has risen substantially. National programmes for blood-borne viruses (BBV) screening in emergency departments (ED) have been ongoing for several years however have not included syphilis. We hypothesised that screening for syphilis in an ED in a region of high prevalence might identify significant numbers of cases.

Methods: Universal opt-out syphilis screening was included with BBVs in a Northeast England ED, where a regional outbreak is ongoing. Those with reactive tests were invited to sexual health service (SHS) for further evaluation.

Results: Of 3,312 ED attenders having blood drawn, 38 (1.2%) were confirmed T. pallidum EIA positive (45% RPR-positive). Compared to ED attenders testing negative, those with positive tests were younger and lived in more deprived areas, however had similar gender and ethnicity. 71% of those identified as needing assessment were seen in the SHS and 59% treated.

Conclusions: Universal screening for syphilis appears effective in identifying people with syphilis who traditionally don't access SHS. This population has different demographics to people with syphilis attending SHS in England, being predominantly heterosexual and equal proportions of women. Routine ED screening for syphilis along with BBVs may be warranted in areas of high transmission.

Background: RSV is a leading cause of ARI, including CAP, in older adults. Data available often underestimate RSV ARI incidence. We estimated RSV-related ARI hospitalization incidence from a prospective CAP study, adjusting for undiagnosed RSV infections due to nasopharyngeal/nasal swab testing only.

Methods: Active surveillance of adult CAP hospitalizations in Germany was conducted between 2021-2023. Nasopharyngeal/nasal swabs were RSV-tested, and age-group specific proportions were applied to calculate RSV-related CAP incidence. This was divided by the CAP proportions among RSV-related ARI hospitalizations (from multispecimen study) to extrapolate RSV-related ARI rates.

Results: Among 1,040 radiologically confirmed CAP cases, 3.7% tested RSV-positive via nasopharyngeal/nasal swab, corresponding to 7.8% after adjusting for underdetection. For 18-59 and ≥60 years, adjusted RSV-related CAP hospitalization rates (95% CI) were 4.9 (1.8-10.9) and 115.6 (78.8-163.6). Adjusted RSV-related ARI hospitalization rates were 19.8 (6.8-50.1) and 401.6 (260.7-609.3) per 100,000, respectively. Within 30 days of an RSV-related CAP admission, 18.2% of those ≥65 years died, and 11.1% and 36.4% had cardiovascular events among those 18-64 and ≥65 years, respectively.

Conclusions: Older adults in Germany experience a high burden of RSV-related ARI hospitalizations, including CAP, underscoring RSV vaccination's potential utility for this population.

Background: Asplenia and splenic dysfunction is associated with an increased risk of severe and fatal infections, especially due to encapsulated bacteria including Streptococcus pneumoniae, Haemophilus influenzae serotype b (Hib) and Neisseria meningitidis. People with sickle cell disease (SCD) develop recurrent splenic infarcts rendering them functionally asplenic. Consequently, additional vaccination against these three pathogens is recommended. There is robust evidence of an increased risk for invasive pneumococcal (IPD) and Hib disease, in people with SCD, but for not invasive meningococcal disease (IMD).

Methods: We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) recommendations. Studies published in any language before June 2024 and including people with SCD of all ages and from all geographical locations were included. Studies were included if they documented bacterial culture and/or PCR in patients with SCD with suspected infection. The primary outcome was to estimate IMD risk in people with SCD. Secondary outcomes included estimating the risk of IMD and Hib disease in people with SCD.

Findings: We identified 3,804 publications and included 86 in the final analyses. Among 74 cohort studies published during 1971-2023, there were three IMD cases among 26,404 persons with SCD compared with 570 IPD and 113 Hib cases. Eight case-control studies published during 1983-2022 reported one IMD case among 1,021 people with SCD (0.1%) compared to 118 IMD cases among 7,143 people without SCD (1.65%). In contrast, there were 112 IPD cases (112/1021, 11.0%) in people with SCD compared to 530 (530/7143, 7.4%) in those without SCD. For Hib, the rates were 28/1021 (2.7%) and 205/7143 (2.9%), respectively. After including all published studies, we identified five IMD cases in people with SCD across studies published worldwide during 1965-1995 and all five survived their infection.

Interpretation: We found no evidence of any increased risk of IMD in people with SCD. This has important implications for policymakers in countries and organisations that currently recommend meningococcal vaccination for people with SCD.

Funding: None.

Objectives: Human papillomavirus (HPV) mediated oropharyngeal cancer (OPC) incidence has increased dramatically. Accurate oral HPV prevalence data are essential for assessing population epidemiology, vaccination and screening programmes. As oral rinse is the most commonly used primary outcome measure for estimating oral HPV prevalence, we aimed to compare the efficacy of oral rinse against other detection methods.

Methods: The Oromouth study enrolled 945 participants, aged 0-65 years (63% female), undergoing tonsillectomy for non-malignant indications, without OPC diagnoses. Samples from oral rinse, pharyngeal wall, tongue base, tonsil tissue and blood were collected. HPV DNA in oral samples was centrally tested via polymerase chain reaction, and serology samples for HPV antibodies. Statistical analyses assessed prevalence, detection rates and ratios.

Results: Combining all four oral collection sites, high-risk (HR)-HPV and any HPV prevalence were 4·3% and 18%, respectively. HR-HPV prevalence was similar between males (4·1%) and females (4·5%). Oral rinse had the highest HR-HPV (4·0%) and any HPV detection rates (16%), but still missed 73% (11/15) identified as HR-HPV-positive by other oral sites. Compared to oral rinse alone, an additional 38% (11/29) HR-HPV infections were picked up by the other three oral collection methods. Addition of serology testing did not result in substantial improvement.

Conclusions: Of the four oral sites, oral rinse demonstrates the highest detection rates by far but has important limitations. These findings should be taken into consideration when estimating oral HPV infection rates, especially for vaccination studies and screening programmes.

Objectives: SARS-CoV-2 nucleocapsid (N) protein antibodies can be used to detect the serological response to natural infection in those previously receiving a COVID-19 spike-based vaccine. Anti-N antibody responses can also be detected in those receiving inactivated whole SARS-CoV-2 virus vaccines, such as CoronaVac. We aimed to characterise antibody responses to the N protein following COVID-19 and following vaccination with CoronaVac.

Methods: Using participants from an international randomised controlled trial, we investigated the evolution of anti-N antibody responses over time in two separate groups: following COVID-19, or following vaccination with CoronaVac.

Results: In 212 participants who had COVID-19, the anti-N seroconversion rate was 96.9% in those infected following an incomplete course of COVID-19 (spike-based) vaccinations and 88.2% in those fully vaccinated. Anti-N antibody indices were highly variable between participants, and higher in participants who had more severe COVID-19 symptoms, were aged ≥60 years, were unvaccinated, had comorbidities and those resident in Brazil. Most participants remained seropositive after 12 months. In 317 separate participants, the anti-N seroconversion rate was 63.5% following CoronaVac vaccination, with variable antibody indices.

Conclusions: Anti-N responses to COVID-19 and CoronaVac are highly variable but persistent. A prior complete COVID-19 spike-based vaccination course reduced both anti-N seroconversion and antibody indices following COVID-19.