Le infezioni in medicina最新文献

This study aims to bridge the informational gap regarding the clinical and epidemiological aspects of spondylodiscitis in India, addressing the dearth of substantial evidence in this domain. This study was conducted in a tertiary care hospital over three years, involving 145 adult patients diagnosed with spondylodiscitis. Among them, 28 (19.3%) had Brucellar spondylodiscitis with a younger mean age of 40.1 years, 76 (52.4%) had tubercular spondylodiscitis with a higher mean age of 50.7 years, and 27 (18.6%) had pyogenic spondylodiscitis. Common symptoms included pain while walking (82.1% Brucellar, 93.4% TB, 77.8% pyogenic), fever (39.3% Brucellar, 38.2% TB, 33.3% pyogenic), and limb weakness (25% Brucellar, 46.1% TB, 66.7% pyogenic). CRP (mg/L) levels were elevated in Brucellar (mean 58.75) and pyogenic (mean 60.4) spondylodiscitis patients, with debridement and decompression performed in 50% Brucellar, 55.3% tubercular, and 70.4% pyogenic patients. The study reveals the clinical and epidemiological aspects of spondylodiscitis in South India, contributing to the enrichment of existing knowledge in diagnosis and management.

Introduction: Scabies is a neglected disease that cause outbreaks in facilities such as hospitals and prisons. In Europe, treatment with 2 doses of ivermectin 200 mcg/kg, 7 days apart, is authorised and recommended especially in population mass treatment. We describe the management of a mass pre-emptive therapy of primary contacts of a confirmed case of classic scabies among health care workers.

Patients and methods: Hospital personnel were evaluated, and at-risk contacts were treated with oral ivermectin 200 mcg/kg single dose if asymptomatic. Hospital staff were called after 7, 30, and 60 days after the first visit to assess presence of adverse drug reactions (ADRs) or symptoms compatible with scabies.

Results: Among 27 patients evaluated, 19/27 (70.4%) received single dose ivermectin for scabies pre-emptive therapy. A total of 11/13 patients were nurses, and 8/14 were healthcare assistants. A total of 87 tablets of ivermectin were administered, with a total cost of 423.69 euros. Two people reported ADRs at 7 days; one and two patients reported possible ADRs at 30 and 60 days, respectively. The efficacy in preventing scabies was 100%.

Discussion and conclusions: To our knowledge, this is the first Italian experience in which a single dose of ivermectin has been implemented for mass pre-emptive therapy in asymptomatic primary contacts of classical scabies, showing excellent efficacy of the drug even when used as a single dose.

Respiratory syncytial virus (RSV) is a respiratory virus that usually causes mild upper respiratory tract symptoms. However, it can lead to a severe lower respiratory tract disease in high-risk populations, with severe complications such as pneumonia and respiratory failure. RSV poses a significant public health threat not only to children, but also to adults, particularly those over 75 years of age and individuals with comorbidities. The high incidence and severity of RSV infections in these vulnerable groups highlights the urgent need for effective preventive strategies. Despite advancements in the clinical management of respiratory infections, preventing RSV remains a significant challenge. The symptoms of RSV are often underestimated and misdiagnosed due to their similarity to other respiratory infections like influenza and COVID-19. This leads to a substantial disease burden not only for patients but also for healthcare systems, due to increased hospitalizations and prolonged treatments. In recent years, there has been a significant progress in the development of RSV vaccines, offering new hope for disease prevention. Our aim is to promote RSV vaccination, emphasizing the importance of large-scale prevention efforts to enhance the quality of life for at-risk individuals and optimize healthcare resource allocation. This paper will report efficacy and safety data for the three main vaccines currently available for healthcare practitioners, providing a comprehensive and balanced overview of vaccine options and supporting informed decision-making by healthcare professionals and regulatory authorities.

Historically, pandemics constitute a major nuisance to public health. They have a debilitating impact on global health with previous occurrences causing major mortalities worldwide. The adverse outcomes are not limited to health outcomes but ravage the social, economic, and political landscapes. The World Health Organization (WHO) stands at the front of the pandemic response, strategizing to contain and mitigate the impacts on humans and the environment. It also intervenes in regional disease outbreaks that pose a threat to global health through strategic technical guidance, resource allocations, and expert support. With emerging pathogens, and in the aftermath of the COVID-19 pandemic, discussions are currently underway on global preparedness for a potential future pandemic. The effects of previous pandemics underscore the need to improve global health preparedness for upcoming pandemics. The WHO's July 2024 updated list of emerging pathogens serves as a potential tool to foster global health readiness for a future pandemic. It represents a change in the world's approach to emerging and re-emerging pathogens, shifting focus from specific pathogens to adopting a broader family-focused approach. This new list recognizes the shortcomings of previous lists and adopts a more forward-thinking, proactive, and flexible approach to dealing with familiar and unfamiliar pandemic risks, now incorporating 'Prototype Pathogens' and 'Pathogen X' into its risk classification. The WHO has set the pace, developing tools and guidelines for practice. This updated list of high-priority pathogens seeks to gear research and development toward combating and neutralizing the virulence of these pathogens. Recent outbreaks of Cholera, Mpox, and Dengue fever in Africa, Avian influenza (H5N2) in Mexico, Nipah virus disease in Bangladesh, and Oropouche virus in the Americas necessitate intensifying regional disease surveillance Research organizations and institutions must prioritize incorporating these tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies in the Preparedness and Resilience for Emerging Threats (PRET) Initiative as outlined by WHO.

Background: Health care-associated infections (HAIs), albeit being the most frequent adverse event in health care, are mostly preventable through hand hygiene (HH). Given the extremely low HH compliance among healthcare workers (HCWs), educational initiatives aimed at this group are crucial. This study used an ultraviolet (UV)-based technology to assess the efficacy of an educational and training program on HH for HCWs in a second-level hospital in southern Italy.

Methods: A quasi-experimental study was conducted between November 2020 and February 2022. Participants were asked to rub their hands with an UV-labelled disinfectant solution before having digital images of both sides of their hands taken under UV-A light, using a device that recorded the solution's distribution on each surface before and after the training session. The instrument recorded the percentage of surface covered (quantitative data) for each measurement along with the eventual passing of the 95% threshold (qualitative data).

Results: Following the training session, we observed a significant increase in the number of valid procedures as well as the mean coverage (expressed as the percentage of surface covered) for each surface examined. From 16.9% in the pre-interventional phase to 48.7% in the post-interventional phase, the percentage of HCWs who exceeded the 95% threshold on both sides of hands increased significantly (p<0,001).

Conclusions: The findings of our study show that the training intervention was effective in raising participants HH performance. Secondly, they suggest that giving HCWs immediate visual feedback on their progress throughout the learning process could help increase HH adequacy.

Introduction: Invasive pneumococcal disease (IPD) remains a pediatric health challenge despite national vaccination efforts in Colombia. We described the socio-demographic, epidemiological, and clinical characteristics of children (<18 years of age) with IPD at a pediatric reference center in Bolívar, Colombia.

Methods: Descriptive cross-sectional study of all pediatric patients (under 18 years of age) diagnosed with IPD between 2016 and 2023. Data was collected retrospectively from medical records. IPD was defined as identifying Streptococcus pneumoniae (Spn) in blood, cerebrospinal, pleural, synovial, peritoneal, or pericardial fluid. Spn serotyping data was provided by the Colombian National Institute of Health. Descriptive statistics were performed to describe all variables.

Results: Between 2016-2023, we identified fifty-four pediatric IPD cases. Most cases were reported among children in the 2-9 age group (44.4%), male sex (57.4%), low socio-economic strata (100%), and previous medical conditions (61.1%). Half of the patients were vaccinated. Serotyping data were available from 35 (64.8%) isolates. Fifteen Spn serotypes were identified, Spn19A being the most frequent (20.4%). All Spn isolates were vancomycin sensitive, while 34% had meropenem-decreased sensitivity. Three-quarters of the patients (76.0%) were diagnosed with bacteremia (bacteremic pneumonia/meningitis and bacteremia without known focus). The 79.6% of children were admitted to the pediatric intensive care unit (PICU). The median hospitalization days were 13.5 (IQR 5.5-23.5) while the median PICU length of stay was 9.5 (IQR 4-18) days. Nineteen patients died (35.2%).

Conclusion: IPD disproportionately affects vulnerable children, resulting in high PICU admission and mortality rates and prolonged hospital stay in Bolívar, Colombia. In addition, the emergence of resistance to carbapenems is of concern.

Guinea worm is a debilitating waterborne parasitic disease with a long history. This paper examines the ways guinea worm was understood in English-language scientific literature between 1688 and 1931. In the early eighteenth century, guinea worm was principally understood by English-speaking physicians as an exotic wonder of faraway lands. It became viewed as an African disease over the course of the eighteenth century, as transatlantic slavery exposed enslaved Africans to infection with the worm. Worms acquired in West Africa often emerged after arrival to the Caribbean, where the disease briefly established local transmission. However, British medicine only began to take any significant interest in guinea worm in the early nineteenth century, as British and British-employed troops in India began to contract the worm. This resulted in knowledge and specimens of guinea worm travelling to Britain, where they were used to develop the new science of zoology through the nineteenth century. Zoologists elsewhere, particularly in Germany, benefitted from British-Indian knowledge, which allowed Russian parasitologist Alexei Fedchenko to discover the full mechanism of guinea worm's transmission in Samarkand. This zoological knowledge, and zoological view of guinea worm, was then incorporated into the emerging tropical medicine of the 1890s and twentieth century. A long history of guinea worm therefore provides important insights into the circulation of knowledge along imperial networks, and into the history of tropical medicine and parasitology.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae complex, remains a significant global health concern despite being curable with multidrug therapy. Delayed diagnosis is common, particularly in non-endemic regions or when presenting with atypical symptoms. This can lead to missed opportunities for early intervention, potential disabilities, and increased transmission. Misdiagnosis is often compounded by leprosy's ability to mimic other conditions, as illustrated in this case report. We present a 43-year-old Filipino woman residing in Eastern Saudi Arabia, who presented to a dermatology clinic with a four-year history of recurrent skin rashes and a one-year history of painful, itchy nodules on her shins. She denied any systemic symptoms, recent travel, or known tuberculosis (TB) contact. Physical examination revealed multiple erythematous nodules on her shins with hyperpigmentation, but no lymphadenopathy or other skin lesions. Initial laboratory tests, including blood counts, liver and kidney function, inflammatory markers, and HIV screening, were normal. Chest X-ray was unremarkable. The patient's clinical presentation and laboratory results led to a provisional diagnosis of extrapulmonary TB, and she was started on anti-TB treatment. However, her condition did not improve after several months of treatment. A skin biopsy was performed, and histopathological examination revealed granulomatous inflammation with acid-fast bacilli, raising suspicion for leprosy. Subsequent culture of the skin biopsy unexpectedly yielded Mycobacterium leprae, confirming the diagnosis of lepromatous leprosy. The case study highlights the diagnostic challenges associated with leprosy, especially in non-endemic regions. The patient's atypical presentation, lack of systemic symptoms, and the unexpected growth of M. leprae in cell-free culture media contributed to the initial misdiagnosis and delayed treatment. Early suspicion, prompt skin biopsy, and appropriate culture techniques are crucial for accurate diagnosis and timely initiation of effective therapy to prevent disability and transmission. This case also underscores the importance of considering leprosy as a differential diagnosis in patients presenting with atypical skin lesions, even in non-endemic areas. Continued awareness and education among healthcare providers are essential to improve early recognition and management of this treatable disease.