Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106404
Lin Li , Liyan Mao , Marieke M. van der Zalm , Juan Olivo , Shan Liu , Carlos Vergara , Megan Palmer , Qingbo Shu , Anne-Marie Demers , Christopher J. Lyon , Pierre Goussard , H. Simon Schaaf , Anneke C. Hesseling , Sharon Nachman , Eddy Pérez-Then , Charles D. Mitchell , Elisabetta Ghimenton , Tony Y. Hu
Objectives
Pediatric tuberculosis (TB) diagnosis is complicated by challenges in obtaining invasive respiratory specimens that frequently contain few Mycobacterium tuberculosis (Mtb) bacilli. We report the diagnostic performance of an Mtb antigen-derived peptide (MAP-TB) assay and its ability to monitor TB treatment response.
Methods
Study cohorts enrolled children who presented with presumptive TB at two hospitals in South Africa from 2012 to 2017 (157 children aged <13 years) and at community-based clinics in the Dominican Republic from 2019 to 2023 (101 children aged <18 years). Children were evaluated for TB at enrollment and six months post-enrollment and assigned confirmed, unconfirmed, or unlikely TB diagnoses using the 2015 NIH diagnostic criteria for pediatric TB. MAP-TB assay performance was evaluated using serum collected at baseline and at regular intervals post-enrollment following STARD guidelines.
Results
MAP-TB sensitivity for confirmed and unconfirmed TB was comparable to culture and Xpert sensitivity for confirmed TB, but MAP-TB specificity revealed age-dependence, decreasing from 98·1% to 78·4%, when including children aged <1 year. MAP-TB values decreased by six months post-treatment initiation in children with symptom improvement.
Conclusions
Serum MAP-TB results can effectively diagnose pediatric TB, including unconfirmed and extrapulmonary TB missed by current methods, and correspond to effective treatment.
{"title":"Blood-based diagnosis of pediatric tuberculosis: A prospective cohort study in South Africa and Dominican Republic","authors":"Lin Li , Liyan Mao , Marieke M. van der Zalm , Juan Olivo , Shan Liu , Carlos Vergara , Megan Palmer , Qingbo Shu , Anne-Marie Demers , Christopher J. Lyon , Pierre Goussard , H. Simon Schaaf , Anneke C. Hesseling , Sharon Nachman , Eddy Pérez-Then , Charles D. Mitchell , Elisabetta Ghimenton , Tony Y. Hu","doi":"10.1016/j.jinf.2024.106404","DOIUrl":"10.1016/j.jinf.2024.106404","url":null,"abstract":"<div><h3>Objectives</h3><div>Pediatric tuberculosis (TB) diagnosis is complicated by challenges in obtaining invasive respiratory specimens that frequently contain few <em>Mycobacterium tuberculosis</em> (<em>Mtb</em>) bacilli. We report the diagnostic performance of an <em>Mtb</em> antigen<em>-</em>derived peptide (MAP-TB) assay and its ability to monitor TB treatment response.</div></div><div><h3>Methods</h3><div>Study cohorts enrolled children who presented with presumptive TB at two hospitals in South Africa from 2012 to 2017 (157 children aged <13 years) and at community-based clinics in the Dominican Republic from 2019 to 2023 (101 children aged <18 years). Children were evaluated for TB at enrollment and six months post-enrollment and assigned confirmed, unconfirmed, or unlikely TB diagnoses using the 2015 NIH diagnostic criteria for pediatric TB. MAP-TB assay performance was evaluated using serum collected at baseline and at regular intervals post-enrollment following STARD guidelines.</div></div><div><h3>Results</h3><div>MAP-TB sensitivity for confirmed and unconfirmed TB was comparable to culture and Xpert sensitivity for confirmed TB, but MAP-TB specificity revealed age-dependence, decreasing from 98·1% to 78·4%, when including children aged <1 year. MAP-TB values decreased by six months post-treatment initiation in children with symptom improvement.</div></div><div><h3>Conclusions</h3><div>Serum MAP-TB results can effectively diagnose pediatric TB, including unconfirmed and extrapulmonary TB missed by current methods, and correspond to effective treatment.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106404"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106419
David W. Eyre , Gemma Pill , Bee Yean Ng , Caroline Herin , Bernadette O’Riordan , Douglas Izzard , Louise Dunsmure , Stephane Paulus , Katie Jeffery , Nicola Jones
Objective
To identify the impact of introducing antimicrobial stewardship (AMS) ward rounds.
Methods
We used an interrupted time-series approach to investigate the impact of implementing AMS ward rounds with in-person feedback from a multidisciplinary team in Hospital-1, also comparing to Hospital-2 in the same city where AMS ward rounds were not yet implemented. Regression models were used to identify predictors of advice given and of whether advice was followed, and associations between advice uptake and length of stay.
Results
Introducing AMS ward rounds was followed by new or accelerated declines in ceftriaxone, ciprofloxacin, amoxicillin-clavulanate, meropenem and piperacillin-tazobactam use at Hospital-1. Except for ceftriaxone, similar declines were not seen at Hospital-2. Half of reviews (3471/6878; 50%) recommended an intervention; 2003/2726 (73%) subsequently evaluated recommendations were implemented. Senior doctors were more likely than pharmacists or specialist doctors in training to recommend de-escalation/stopping antibiotics and to have their advice followed. The more prior AMS reviews completed, the more likely advice was to be followed. Following advice to de-escalate/stop antimicrobials was associated with a 0.58 day [95%CI 0.22–0.94] reduction in hospital stay.
Conclusions
Multidisciplinary AMS ward rounds reduced antibiotic use and likely reduced length of hospital stay. Senior clinician input and more AMS experience increased advice uptake.
{"title":"The impact of antimicrobial stewardship ward rounds on antimicrobial use and predictors of advice, uptake, and outcomes","authors":"David W. Eyre , Gemma Pill , Bee Yean Ng , Caroline Herin , Bernadette O’Riordan , Douglas Izzard , Louise Dunsmure , Stephane Paulus , Katie Jeffery , Nicola Jones","doi":"10.1016/j.jinf.2025.106419","DOIUrl":"10.1016/j.jinf.2025.106419","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the impact of introducing antimicrobial stewardship (AMS) ward rounds.</div></div><div><h3>Methods</h3><div>We used an interrupted time-series approach to investigate the impact of implementing AMS ward rounds with in-person feedback from a multidisciplinary team in Hospital-1, also comparing to Hospital-2 in the same city where AMS ward rounds were not yet implemented. Regression models were used to identify predictors of advice given and of whether advice was followed, and associations between advice uptake and length of stay.</div></div><div><h3>Results</h3><div>Introducing AMS ward rounds was followed by new or accelerated declines in ceftriaxone, ciprofloxacin, amoxicillin-clavulanate, meropenem and piperacillin-tazobactam use at Hospital-1. Except for ceftriaxone, similar declines were not seen at Hospital-2. Half of reviews (3471/6878; 50%) recommended an intervention; 2003/2726 (73%) subsequently evaluated recommendations were implemented. Senior doctors were more likely than pharmacists or specialist doctors in training to recommend de-escalation/stopping antibiotics and to have their advice followed. The more prior AMS reviews completed, the more likely advice was to be followed. Following advice to de-escalate/stop antimicrobials was associated with a 0.58 day [95%CI 0.22–0.94] reduction in hospital stay.</div></div><div><h3>Conclusions</h3><div>Multidisciplinary AMS ward rounds reduced antibiotic use and likely reduced length of hospital stay. Senior clinician input and more AMS experience increased advice uptake.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106419"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106379
Daniel Adon Mapamba , Issa Sabi , Julieth Lalashowi , Elingarami Sauli , Joram Buza , Willyhelmina Olomi , Bariki Mtafya , Michael Kibona , Abhishek Bakuli , Andrea Rachow , Kavindhran Velen , Michael Hoelscher , Nyanda E. Ntinginya , Salome Charalambous , Gavin Churchyard , Robert S. Wallis , the TB SEQUEL consortium
Background
Half the global tuberculosis health burden is due to post-tuberculosis lung disease. Host-directed therapies have been proposed to reduce this burden. N-acetylcysteine (NAC) provides the conditionally essential amino acid cysteine required for synthesis of glutathione, an antioxidant thiol. We recently reported clinical outcomes of a trial of adjunctive NAC in patients with pulmonary tuberculosis, finding that NAC improved the secondary endpoint of recovery of lung function. Here we report the effects of NAC on biomarkers of oxidation, inflammation, and infection in that trial.
Methods
140 adults with moderate or far-advanced pulmonary tuberculosis were randomly assigned to standard tuberculosis treatment with or without NAC 1200 mg twice daily for months 1–4. Sputum and blood samples were obtained at specified intervals to measure total glutathione, MTB-induced cytokines, hemoglobin, whole blood mycobactericidal activity (WBA), and sputum MTB burden.
Results
NAC treatment rapidly increased total glutathione (P<.0001), but levels did not reach those of healthy volunteers (P<.001). NAC reduced MTB-induced TNF-α (P =.011) without affecting IL-10, and accelerated the recovery of hemoglobin in participants with low values on entry. NAC did not affect killing in ex vivo whole blood culture but did slow the clearance of MTB from sputum (P=0.003).
Conclusion
Adjunctive NAC showed antioxidant and anti-inflammatory effects consistent with the amelioration of immunopathology seen in preclinical models. Two biomarkers of antimicrobial activity showed discordant results; neither demonstrated the enhanced antimicrobial effects seen preclinically. The reduction of oxidative stress and inflammation by NAC may explain its effects on the recovery of lung function post-TB.
{"title":"N-acetylcysteine modulates markers of oxidation, inflammation and infection in tuberculosis","authors":"Daniel Adon Mapamba , Issa Sabi , Julieth Lalashowi , Elingarami Sauli , Joram Buza , Willyhelmina Olomi , Bariki Mtafya , Michael Kibona , Abhishek Bakuli , Andrea Rachow , Kavindhran Velen , Michael Hoelscher , Nyanda E. Ntinginya , Salome Charalambous , Gavin Churchyard , Robert S. Wallis , the TB SEQUEL consortium","doi":"10.1016/j.jinf.2024.106379","DOIUrl":"10.1016/j.jinf.2024.106379","url":null,"abstract":"<div><h3>Background</h3><div>Half the global tuberculosis health burden is due to post-tuberculosis lung disease. Host-directed therapies have been proposed to reduce this burden. N-acetylcysteine (NAC) provides the conditionally essential amino acid cysteine required for synthesis of glutathione, an antioxidant thiol. We recently reported clinical outcomes of a trial of adjunctive NAC in patients with pulmonary tuberculosis, finding that NAC improved the secondary endpoint of recovery of lung function. Here we report the effects of NAC on biomarkers of oxidation, inflammation, and infection in that trial.</div></div><div><h3>Methods</h3><div>140 adults with moderate or far-advanced pulmonary tuberculosis were randomly assigned to standard tuberculosis treatment with or without NAC 1200 mg twice daily for months 1–4. Sputum and blood samples were obtained at specified intervals to measure total glutathione, MTB-induced cytokines, hemoglobin, whole blood mycobactericidal activity (WBA), and sputum MTB burden.</div></div><div><h3>Results</h3><div>NAC treatment rapidly increased total glutathione (P<.0001), but levels did not reach those of healthy volunteers (P<.001). NAC reduced MTB-induced TNF-α (P =.011) without affecting IL-10, and accelerated the recovery of hemoglobin in participants with low values on entry. NAC did not affect killing in <em>ex vivo</em> whole blood culture but did slow the clearance of MTB from sputum (P=0.003).</div></div><div><h3>Conclusion</h3><div>Adjunctive NAC showed antioxidant and anti-inflammatory effects consistent with the amelioration of immunopathology seen in preclinical models. Two biomarkers of antimicrobial activity showed discordant results; neither demonstrated the enhanced antimicrobial effects seen preclinically. The reduction of oxidative stress and inflammation by NAC may explain its effects on the recovery of lung function post-TB.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106379"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106399
Marit Neumann , Maja Reimann , Dumitru Chesov , Cristina Popa , Antonela Dragomir , Oana Popescu , Roxana Munteanu , Alexandra Hölscher , Isobella Honeyborne , Jan Heyckendorf , Christoph Lange , Christoph Hölscher , Barbara Kalsdorf
Objectives
Early detection of treatment failure is essential to improve the management of drug-resistant tuberculosis (DR-TB). We evaluated the molecular bacterial load assay (MBLA) in comparison to standard diagnostic tests for monitoring therapy of patients affected by drug-resistant TB.
Methods
The performance of MBLA in tracking treatment response in a prospective cohort of patients with pulmonary MDR/RR- and pre-XDR/XDR-TB was compared with mycobacterial culture, mycobacterial DNA detection using GeneXpert (Xpert) and microscopy detection of sputum acid-fast-bacilli.
Results
Mycobacterium tuberculosis culture conversion was used as the read-out for treatment responses. The MBLA was most concordant during the early phase of treatment, detecting changes in bacterial load with similar accuracy to microscopy and outperforming Xpert. When considering all timepoints, concordance with MGIT results was 72.1% for MBLA, 57.4% for Xpert and 76.7% for microscopy. The AUC for culture conversion was higher for MBLA (0.88, CI 0.84–0.95) than for Xpert (0.78, CI 0.72–0.85) and microscopy (0.77, CI 0.71–0.83).
Conclusions
MBLA was superior in the early identification of successful culture conversion compared to microscopy and Xpert and could be a useful biomarker to evaluate novel entities in Phase IIA early-bactericidal-activity drug trials regardless of the degree of M. tuberculosis drug resistance.
{"title":"The molecular bacterial load assay predicts treatment responses in patients with pre-XDR/XDR-tuberculosis more accurately than GeneXpert Ultra MTB/Rif","authors":"Marit Neumann , Maja Reimann , Dumitru Chesov , Cristina Popa , Antonela Dragomir , Oana Popescu , Roxana Munteanu , Alexandra Hölscher , Isobella Honeyborne , Jan Heyckendorf , Christoph Lange , Christoph Hölscher , Barbara Kalsdorf","doi":"10.1016/j.jinf.2024.106399","DOIUrl":"10.1016/j.jinf.2024.106399","url":null,"abstract":"<div><h3>Objectives</h3><div>Early detection of treatment failure is essential to improve the management of drug-resistant tuberculosis (DR-TB). We evaluated the molecular bacterial load assay (MBLA) in comparison to standard diagnostic tests for monitoring therapy of patients affected by drug-resistant TB.</div></div><div><h3>Methods</h3><div>The performance of MBLA in tracking treatment response in a prospective cohort of patients with pulmonary MDR/RR- and pre-XDR/XDR-TB was compared with mycobacterial culture, mycobacterial DNA detection using GeneXpert (Xpert) and microscopy detection of sputum acid-fast-bacilli.</div></div><div><h3>Results</h3><div><em>Mycobacterium tuberculosis</em> culture conversion was used as the read-out for treatment responses. The MBLA was most concordant during the early phase of treatment, detecting changes in bacterial load with similar accuracy to microscopy and outperforming Xpert. When considering all timepoints, concordance with MGIT results was 72.1% for MBLA, 57.4% for Xpert and 76.7% for microscopy. The AUC for culture conversion was higher for MBLA (0.88, CI 0.84–0.95) than for Xpert (0.78, CI 0.72–0.85) and microscopy (0.77, CI 0.71–0.83).</div></div><div><h3>Conclusions</h3><div>MBLA was superior in the early identification of successful culture conversion compared to microscopy and Xpert and could be a useful biomarker to evaluate novel entities in Phase IIA early-bactericidal-activity drug trials regardless of the degree of <em>M. tuberculosis</em> drug resistance.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106399"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106390
Darren Suryawijaya Ong , Matthew Harris , John D. Hart , Fiona M. Russell
Objectives
In this ecological study, we describe SARS-CoV-2 case incidence and COVID-19 hospitalisation and death rates for school-aged and adult populations during the Delta and early Omicron periods, before and after schools reopened in five countries.
Methods
Data were extracted from government websites. Cases and COVID-19 hospitalisation and death incidence rates were calculated during the Delta and early Omicron periods in Australia, Canada, Denmark, Finland and the United Kingdom, for two weeks preceding and six weeks after schools reopened. We summarised stringency of public health measures (GRI), COVID-19 vaccination rates by age and SARS-CoV-2 testing rates.
Results
During Delta, cases increased in 2/7 sites after schools reopened, hospitalisations increased in 1/5 sites, while deaths decreased in one and increased then decreased in another. During Omicron, cases increased in 2/8 sites, hospitalisations increased in 1/6 sites and deaths increased in 1/4 sites. The hospitalisation and death rate trends that commenced before schools reopened continued on the same trajectory after schools reopened. Vaccination rates in ≥70-year-olds were 75–100% during Delta and 95–100% during Omicron. Wide variations in testing rates may explain differences in case incidence. GRI were higher and more variable during Delta than during Omicron.
Conclusions
Reopening schools did not change the existing trajectory of COVID-19 rates.
{"title":"Lack of correlation between school reopening and trends in adult COVID-19 hospitalisations and death rates during the Delta and early Omicron periods: An ecological analysis of five countries","authors":"Darren Suryawijaya Ong , Matthew Harris , John D. Hart , Fiona M. Russell","doi":"10.1016/j.jinf.2024.106390","DOIUrl":"10.1016/j.jinf.2024.106390","url":null,"abstract":"<div><h3>Objectives</h3><div>In this ecological study, we describe SARS-CoV-2 case incidence and COVID-19 hospitalisation and death rates for school-aged and adult populations during the Delta and early Omicron periods, before and after schools reopened in five countries.</div></div><div><h3>Methods</h3><div>Data were extracted from government websites. Cases and COVID-19 hospitalisation and death incidence rates were calculated during the Delta and early Omicron periods in Australia, Canada, Denmark, Finland and the United Kingdom, for two weeks preceding and six weeks after schools reopened. We summarised stringency of public health measures (GRI), COVID-19 vaccination rates by age and SARS-CoV-2 testing rates.</div></div><div><h3>Results</h3><div>During Delta, cases increased in 2/7 sites after schools reopened, hospitalisations increased in 1/5 sites, while deaths decreased in one and increased then decreased in another. During Omicron, cases increased in 2/8 sites, hospitalisations increased in 1/6 sites and deaths increased in 1/4 sites. The hospitalisation and death rate trends that commenced before schools reopened continued on the same trajectory after schools reopened. Vaccination rates in ≥70-year-olds were 75–100% during Delta and 95–100% during Omicron. Wide variations in testing rates may explain differences in case incidence. GRI were higher and more variable during Delta than during Omicron.</div></div><div><h3>Conclusions</h3><div>Reopening schools did not change the existing trajectory of COVID-19 rates.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106390"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106416
Shimo Zhang, Jue Liu
{"title":"Optimization of Diphtheria, Tetanus and Pertussis (DTP) vaccination strategy in China","authors":"Shimo Zhang, Jue Liu","doi":"10.1016/j.jinf.2025.106416","DOIUrl":"10.1016/j.jinf.2025.106416","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106416"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106425
Borbala Zsigmond, Nadia Trecchi, Shamez N. Ladhani, Katja Doerholt
{"title":"Early outpatient treatment of SARS-COV-2 infection in non-hospitalised high-risk paediatric patients in London, UK","authors":"Borbala Zsigmond, Nadia Trecchi, Shamez N. Ladhani, Katja Doerholt","doi":"10.1016/j.jinf.2025.106425","DOIUrl":"10.1016/j.jinf.2025.106425","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106425"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106394
Jacob Bodilsen , Emilie Marie Eriksen , Mikkel Dreyer Nielsen , Lærke Storgaard Duerlund , Theis Mariager , Henrik Nielsen , Matthijs C. Brouwer
Objective
To describe the clinical features and outcome of brain abscess since introduction of computerised tomography and magnetic resonance imaging.
Methods
MEDLINE and Embase were searched using “brain abscess” or “cerebral abscess” from 1970 through 2023 and analyses restricted to study populations hospitalised after 1980. Single-variable meta-analyses were done using a random-effects model.
Results
A total of 21,840 patients from 209 studies were included. The mean age was 34 years (95% confidence interval [CI] 30–38) and 11,817/17,406 (66%, 95% CI 64–67) were male. The aetiologies were consistent across time and continents with Streptococcus spp. 2064/6393 (32%, 95% CI 28–36), Staphylococcus spp. 1061/6393 (14%, 95% CI 12–16), and Gram-negative enteric bacteria 696/6393 (9%, 95% CI 7–11) as the most common. Predisposing conditions included otitis media/mastoiditis 1909/6433 (27%, 95% CI 22–33), immunocompromise 1022/4652 (19%, 95% CI 14–24), sinusitis 565/3725 (16%, 95% CI 12–20), and neurosurgery 745/4927 (16%, 95% CI 12–20). The case-fatality was 2444/18,991 (12%, 95% CI 11–14) and good recovery was found in 3419/5409 (63%, 95% CI 58–68).
Conclusions and relevance
Brain abscess remains a disease predominantly occurring in men and is caused by contiguous or distant infections. Case fatality and outcome have not improved during recent decades.
目的：探讨脑脓肿的临床特点及预后。方法：MEDLINE和Embase检索1970年至2023年的“脑脓肿”或“脑脓肿”，分析仅限于1980年以后住院的研究人群。采用随机效应模型进行单变量荟萃分析。结果：209项研究共纳入21840例患者。平均年龄为34岁（95%可信区间[CI] 30-38），男性11,817/17,406 （66%,95% CI 64-67）。不同时间和大陆的病原学一致，最常见的是链球菌2,064/6,393 （32%,95% CI 28-36）、葡萄球菌1,061/6,393 （14%,95% CI 12-16）和革兰氏阴性肠细菌696/6,393 （9%,95% CI 7-11）。易感因素包括中耳炎/乳突炎1,909/6,433 (27%,95% CI 22-33)，免疫功能低下1,022/4,652 (19%,95% CI 14-24)，鼻窦炎565/3,725 （16%,95% CI 12-20）和神经外科745/4,927 （16%,95% CI 12-20）。病死率为2444 / 18991 (12%,95% CI 11-14)，恢复良好的病例为3419 / 5409 （63%,95% CI 58-68）。结论和相关性：脑脓肿仍然是一种主要发生于男性的疾病，由邻近或远处感染引起。近几十年来，病死率和预后没有改善。
{"title":"Clinical features and outcome of brain abscess after introduction of CT and MRI: A meta-analysis","authors":"Jacob Bodilsen , Emilie Marie Eriksen , Mikkel Dreyer Nielsen , Lærke Storgaard Duerlund , Theis Mariager , Henrik Nielsen , Matthijs C. Brouwer","doi":"10.1016/j.jinf.2024.106394","DOIUrl":"10.1016/j.jinf.2024.106394","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical features and outcome of brain abscess since introduction of computerised tomography and magnetic resonance imaging.</div></div><div><h3>Methods</h3><div>MEDLINE and Embase were searched using “brain abscess” or “cerebral abscess” from 1970 through 2023 and analyses restricted to study populations hospitalised after 1980. Single-variable meta-analyses were done using a random-effects model.</div></div><div><h3>Results</h3><div>A total of 21,840 patients from 209 studies were included. The mean age was 34 years (95% confidence interval [CI] 30–38) and 11,817/17,406 (66%, 95% CI 64–67) were male. The aetiologies were consistent across time and continents with <em>Streptococcus spp</em>. 2064/6393 (32%, 95% CI 28–36), <em>Staphylococcus</em> spp. 1061/6393 (14%, 95% CI 12–16), and Gram-negative enteric bacteria 696/6393 (9%, 95% CI 7–11) as the most common. Predisposing conditions included otitis media/mastoiditis 1909/6433 (27%, 95% CI 22–33), immunocompromise 1022/4652 (19%, 95% CI 14–24), sinusitis 565/3725 (16%, 95% CI 12–20), and neurosurgery 745/4927 (16%, 95% CI 12–20). The case-fatality was 2444/18,991 (12%, 95% CI 11–14) and good recovery was found in 3419/5409 (63%, 95% CI 58–68).</div></div><div><h3>Conclusions and relevance</h3><div>Brain abscess remains a disease predominantly occurring in men and is caused by contiguous or distant infections. Case fatality and outcome have not improved during recent decades.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106394"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106406
Khaled Rjoob , Michela Antonelli , Benjamin Murray , Erika Molteni , Nathan Cheetham , Liane S. Canas , Marc Modat , Joan Capdevila Pujol , Christina Hu , Vicky Bowyer , Jonathan Wolf , Tim D. Spector , Sébastien Ourselin , Alexander Hammers , Emma L. Duncan , Claire J. Steves , Carole H. Sudre
Background
COVID-19 symptoms may persist beyond acute SARS-CoV-2 infection, as ongoing symptomatic COVID-19 [OSC] (symptom duration 4–12 weeks) and post-COVID syndrome [PCS] (symptom duration ≥12 weeks). Vaccination against SARS-CoV-2 decreases OSC/PCS in individuals subsequently infected with SARS-CoV-2 post-vaccination. Whether vaccination against SARS-CoV-2, or any other vaccinations (such as against influenza) affects symptoms in individuals already experiencing OSC/PCS, more than natural symptom evolution, is unknown.
Method
Using data from the ZOE COVID Symptom Study app, two comparative analyses were carried out, both in prospectively-reporting individuals with OSC/PCS: A) symptoms in individuals receiving first vaccination against SARS-CoV-2, compared with unvaccinated individuals, matched for age, sex, BMI and week of test (n=1679 in each group); B) symptoms in individuals receiving vaccination against influenza, compared with unvaccinated individuals, matched for age, sex, BMI, week of test and number of SARS-CoV-2 vaccinations (n=692 in each group). In both analyses, vaccination date (or equivalent time from start of symptoms in the unvaccinated group) was considered as the index time, and symptom evolution was measured by comparing symptoms during the second week before and second week after vaccination. Symptoms were considered by prevalence and burden over the considered periods; all results were adjusted for multiple comparisons.
Results
After first vaccination against SARS-CoV-2, many symptoms in individuals with OSC/PCS improved more rapidly than natural history resolution, including the commonly reported symptoms of fatigue (p<0.0001, β=-−0.9 [95% CI: −1.86; −0.67]) and myalgia (p<0.001, β=−0.3 [95% CI: −0.50; −0.12]). No symptom worsened after vaccination. In contrast, there was no improvement in OSC/PCS symptoms beyond natural history resolution after vaccination against influenza.
Conclusion
In individuals with OSC/PCS, symptom resolution improved after vaccination against SARS-CoV-2 ; this was not observed, however, after other vaccinations.
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Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106415
Nazli Ayhan , Carole Eldin , Remi Charrel
Background
Toscana virus (TOSV) is a sand fly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis.
Study design
The data was gathered from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed.
Results
A total of 95 articles including TOSV infections resulting in a total of 1381 cases, were analyzed. Our findings indicate that TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0. The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years.
Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count.
Conclusions
These findings underscore the diverse clinical manifestations of TOSV infections including flu like symtomps. TOSV is an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sand flies are actively circulating.
{"title":"Toscana virus: A comprehensive review of 1381 cases showing an emerging threat in the Mediterranean regions","authors":"Nazli Ayhan , Carole Eldin , Remi Charrel","doi":"10.1016/j.jinf.2025.106415","DOIUrl":"10.1016/j.jinf.2025.106415","url":null,"abstract":"<div><h3>Background</h3><div>Toscana virus (TOSV) is a sand fly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis.</div></div><div><h3>Study design</h3><div>The data was gathered from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed.</div></div><div><h3>Results</h3><div>A total of 95 articles including TOSV infections resulting in a total of 1381 cases, were analyzed. Our findings indicate that TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0. The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years.</div><div>Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count.</div></div><div><h3>Conclusions</h3><div>These findings underscore the diverse clinical manifestations of TOSV infections including flu like symtomps. TOSV is an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sand flies are actively circulating.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106415"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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