Le infezioni in medicina最新文献

Fever of Unknown Origin (FUO) remains a diagnostic challenge for clinicians, with multiple infectious and non-infectious etiologies. SARS-CoV-2 can determine a prolonged viral shedding in the immunocompromised host, firstly in those receiving B-cell targeted therapies, being responsible of persistent infection which may configure as a FUO. We report two cases of long-lasting fever in patients with multiple sclerosis and B-cell depletion, finally diagnosed as COVID-19. We suggest the inclusion of SARS-CoV-2 testing in the differential diagnosis of FUO.

Background: Tuberculosis (TB) remains a pressing health challenge in Nigerian correctional facilities, where the prevalence can be ten times higher than in the general population. Many facilities rely on passive TB case detection, often missing asymptomatic TB cases. This study evaluated a systematic active case-finding (ACF) approach using symptom-based screening followed by GeneXpert MTB/RIF testing across two high-volume Nigerian correctional facilities in Lagos and Ogun States.

Methods: Between April and September 2021, 2,244 inmates underwent standardized TB symptom screening (e.g., cough ≥2 weeks, weight loss, fever). Individuals with presumptive symptoms of TB provided sputum for GeneXpert analysis. The intervention comprised three strategies: (1) outreach screening in awaiting-trial mass cells, (2) cell-to-cell active case search, and (3) contact tracing of confirmed TB cases. Collected data were analysed to determine detection rates per 100,000 inmates and the overall positivity yield. Ethical clearance was obtained from the Lagos and Ogun State Ministries of Health, with formal permission granted by authorities of correctional facilities.

Results: Of the 2,244 inmates screened, 678 were identified as presumptive and tested, 45 were confirmed TB cases with estimated prevalence of 0.5% (approximately 489 per 100,000 inmates). The estimated prevalence is more than double the national prevalence 0.2% (219 per 100,000). The overall TB positivity rate among presumptive inmates was 7%. Inmates from Lagos recorded a TB point prevalence of 500 per 100,000, while prevalence in Ogun state was 458 per 100,000. A targeted outreach in one facility achieved a 32% TB yield. All detected TB cases were rifampicin-sensitive, and no drug-resistant strains was found in this cohort.

Conclusions: These findings highlight the effectiveness of symptom-based GeneXpert screening within correctional facilities which was substantially higher that conventional passive TB detection rates. All confirmed TB cases (n = 45) were rifampicin-sensitive, and no MDR or XDR strains were identified, an important observation in the prison environment. Regular, systematic ACF, especially in overcrowded and high-turnover environments, can significantly enhance early TB diagnosis and treatment initiation. Policymakers should institutionalize routine ACF in correctional facilities through universal entry screening for all new admissions and at least annual facility-wide screening, with symptom checklists plus rapid molecular testi. Where feasible, this should be combined with portable digital CXR/CAD triage alongside improvement in living conditions and post-release linkage to DOTS.

Background: Infective endocarditis (IE) is a high-mortality condition that requires multidisciplinary expertise. In elderly patients with multiple comorbidities, surgery is often precluded by prohibitive risks or technical difficulties, leading to poor patient outcomes. Long-term suppressive antimicrobial therapy (SAT) is an alternative approach aimed at reducing relapse risk and maintaining clinical stability, with limited but growing evidence.

Methods: We conducted a retrospective, single-center observational study in northeastern Italy, that included 34 adult patients diagnosed with IE from January 1, 2020, to July 31, 2024. These patients were managed with SAT after completing a standard intravenous antimicrobial course and were either ineligible for curative surgery or had experienced failed surgical intervention, as determined by the Multidisciplinary Endocarditis Team (MET). The primary outcomes were all-cause mortality at the last available follow-up and documented infection relapse. Secondary outcomes included SAT characteristics (treatment duration, type of antimicrobial agent, discontinuation and its causes, and clinical course), as well as the occurrence of adverse drug events (ADEs) or tolerance issues attributable to SAT.

Results: The median age was 77 years (IQR 67-82), and the median Charlson Comorbidity Index was 6 (IQR 5-8). Prosthetic valve endocarditis (PVE) was the most common presentation, affecting 24 patients (70.6%). The blood culture positivity rate was 88.2%, with the main isolated microorganisms including staphylococci (13, 40.6% - mostly methicillin-susceptible Staphylococcus aureus - MSSA), streptococci (11, 34.4%), and Enterococcus faecalis (6, 18.8%). All-cause mortality during follow-up was 5/34 (14.7%), and the relapse rate was 4/34 (11.8%), all occurring during treatment. Median follow-up was 845 days (IQR 446-1488). ADEs affected 6/34 patients (17.6%), resulting in one hospitalization but without requiring treatment suspension. SAT was terminated by MET decision in 12 patients, with no subsequent relapses.

Conclusions: In non-operable IE patients, SAT has proven to be a feasible long-term strategy, weighing the risks of recurrence, drug-related events, and prolonged antibiotic exposure. Careful patient selection and strict follow-up are crucial.

A previously healthy 12-year-old boy was brought to our attention due to worsening respiratory symptoms and persistent emesis. During hospitalization, the child developed right-sided otalgia followed by otorrhea. An otorhinolaryngologic exam revealed tympanic membrane perforation and discharge. An ear sample culture yielded Vibrio cholerae. A computed tomography scan confirmed the presence of otitis media complicated with otomastoiditis. Treatment with amoxicillin/clavulanate was complemented with ciprofloxacin and dexamethasone otic drops and led to a complete recovery without sequelae. While the child had no predisposing conditions, most published cases of otitis caused by Vibrio spp. describe a history of ear diseases or trauma and water exposure. In a context where vibriosis is increasingly common, our case exemplifies the importance of considering Vibrio spp. among the possible causative agents of otitis, especially in coastal areas or when exposure to potentially contaminated water cannot be ruled out, even in the absence of predisposing conditions.

Objectives: To identify the prevalence and potential predictive factors of severe dengue among children in Vietnam.

Methods: A retrospective study was conducted at Thai Binh Pediatric Hospital, in children from 0 to 16 years, hospitalized for dengue infection from January 2023 to December 2024. Dengue severity was classified according to WHO 2009 guidelines. Potential predictive factors of severe disease were investigated using logistic regression.

Results: A total of 332 children hospitalized for dengue infection were included: median age was 14 months and male gender accounted for 63.0% of the patients. 15.1% (n=50) presented with dengue with warning sign (DWS). None of the children developed severe dengue. The mean time from symptom onset to diagnosis of DWS was 4.0 ± 2.3 days. The most common clinical manifestations in DWS cases were right upper quadrant abdominal pain (34.0%), rapid decrease in platelet count (32.0%), and hepatomegaly (26.0%). Thrombocytopenia at admission was independent predictor (OR = 13.36, 95%CI [4.26-41.88]. Children older than five years and female patients also had higher odds of DWS (OR = 11.21, 95%CI [4.71-26.66] and OR = 2.32, 95%CI [1.05-5.13], respectively. Elevated hematocrit, hypoalbuminemia, elevated transaminases, abnormal nutritional status, petechiae and admission at ≥ 4 days from symptom onset were not associated with DWS after adjustment. The model achieved a sensitivity of 74% and a specificity of 92%, corresponding to an area under the receiver-operating-characteristic curve of 0.83, giving an overall accuracy of 89.5%.

Conclusions: Our findings identified predictive factors of DWS among children, especially low platelet count at admission is proposed as a practical tool for predicting DWS. This makes a practical tool for early risk stratification and resource allocation in settings with limited laboratory capacity in low- and middle-income countries.

Introduction: Throughout human history, pandemics such as Black Death, Smallpox, Spanish Flu and COVID-19 caused global outbreaks and spread of infectious pathogens resulting in significant morbidity and mortality. They also had profound social, cultural, political and economic effects. Various public health containment measures and treatment strategies were implemented in response to the outbreaks. Societal responses to the pandemics and the recommended control measures, though variable, followed common central themes over the centuries. Some of common themes included blaming outsiders or marginalized communities for the spread of diseases, defiance of public health measures, demands for change through social unrest, the spread of misinformation about diseases and unproven treatments, and complaints about healthcare disparities and socioeconomic inequalities.

Methods: Literature reviews were conducted via academic search engines Medline, Google Scholar, Web of Science and to identify pertinent historical and modern research and review articles related to the topic.

Results: The paper reviews the historical significance of the four pandemics, their pathophysiology, the public health strategies against the infectious agents and the psychosocial impacts of the outbreaks. The findings suggest that successful response to pandemic recurrences is not only driven by scientific advancements and government mandates but is also dependent on societal behavior and reactions as well as community environments and social determinants of health.

Discussion: Throughout previous pandemics, valuable lessons were overlooked, and little attention was placed on psychosocial factors. Understanding societal behaviors, human nature, disparities in socioeconomic status and inequalities can have a profound impact in combating the next pandemic.

This case report describes the use of long-acting injectable (LAI) antiretrovirals administered via an alternative injection site in an individual with HIV who was unable to receive intramuscular gluteal injections. Specifically, it focuses on intensive pharmacokinetic monitoring following deltoid administration of LAI rilpivirine and cabotegravir in a 29-year-old transgender woman with progressive multifocal leukoencephalopathy and swallowing difficulties. Gluteal injection was contraindicated due to prior silicone injections in that region. Peak plasma concentrations were reached on day 3 post-injection for both drugs, with cabotegravir peaking at 1278 ng/mL and rilpivirine at 30 ng/mL. Rilpivirine plasma levels declined more rapidly than cabotegravir levels. By day 10, the patient's clinical condition had deteriorated, leading to hospice care and subsequent death. Rilpivirine exposure after deltoid injection appeared lower than that typically reported after gluteal or thigh administration, although intracellular drug concentrations may differ from plasma levels, potentially mitigating clinical concerns.

Hepatitis E virus (HEV) is an under-recognised cause of acute viral hepatitis and remains a major public health concern in Africa. Worldwide, over 20 million HEV infections and nearly 3 million symptomatic cases occur annually, but the true extent in Africa is poorly understood due to limited surveillance, inconsistent diagnostics, gaps in blood safety, unclear zoonotic routes, low public awareness, and underreporting. Outbreaks in several African countries are often associated with floods, displacement, and poor sanitation. Seroprevalence studies show notable variation, from less than 1% in Tanzania to over 80% in Egypt, reflecting diverse epidemiological situations across the continent. In Nigeria, two major outbreaks have been reported, with evidence of widespread human exposure and high infection rates in pigs. Addressing these issues requires a One Health approach that integrates human, veterinary, and environmental health systems. Priority interventions include expanding affordable diagnostics, strengthening Water, Sanitation and Hygiene (WASH) infrastructure, routine animal and blood donor screening, targeted education for high-risk groups, and investment in molecular epidemiology. Therefore, this review consolidates current knowledge of HEV in Africa, with insights from Nigeria, and provides recommendations for control through a coordinated One Health approach.

Objectives: To determine morbidity, mortality, and risk factors of severe disease requiring invasive mechanical ventilation (IMV) in neonates with pneumonia in rural Vietnam.

Methods: A retrospective study was conducted and included all neonates (<28 days) admitted with pneumonia between January and December 2024. Demographics, clinical features, and laboratory results were extracted from standardized patient charts. Univariable and multivariable logistic regression were used to identify independent risk factors for IMV.

Results: Of 1,034 admissions, 612 (59.2%) met pneumonia criteria; mortality rate was 0.2%. Median age at admission was 17 days (IQR 12-23), and 61.6 % were boys. Preterm birth and low birth weight occurred in 4.6% and 6.4% of cases, respectively. Tachypnoea (96.1%), wheeze (93.0%), and signs of respiratory distress (37.7%) were predominant. Abnormal neutrophil counts were observed in 30.2%, and 5.2% had C-reactive protein (CRP) ≥10 mg/L. Independent risk factors for IMV were younger age (adjusted odds ratio [aOR] 0.88 per day; 95% CI 0.85-0.92), neurological symptoms (aOR 24.0; 95% CI 4.07-141.67), and CRP ≥10 mg/L (aOR 3.23; 95% CI 1.22-8.52).

Conclusions: Pneumonia remains a major cause of neonatal morbidity in rural Vietnam, though mortality is low. Younger age, neurological compromise, and elevated CRP identify neonates at greatest risk for requiring IMV. Incorporating these factors into admission triage may streamline escalation of care and optimize resource allocation in neonatal units.

Background: The escalating global crisis of antimicrobial resistance (AMR), particularly among multidrug-resistant (MDR) Gram-negative bacteria (GNB), presents a significant challenge to patient care. Newer β-lactam/β-lactamase inhibitor (BL/BLI) combinations, such as imipenem/cilastatin/relebactam (IMI/REL), have been developed to overcome key resistance mechanisms, including those mediated by KPC and AmpC enzymes, offering new hope for treating severe infections with limited therapeutic options.

Patients and methods: This was a retrospective, single-center, observational study of 195 adult patients with GNB bacteraemia who received IMI/REL for at least 48 hours. The patient cohort was characterized by a high comorbidity burden (median Charlson Comorbidity Index of 4) and significant illness severity (median APACHE II score of 14). The most common pathogens were Pseudomonas aeruginosa (63.1%) and Klebsiella pneumoniae (24.6%), with a high proportion of isolates being carbapenem-non-susceptible (77.5%). The primary outcome was clinical success, and secondary outcomes included 30-day all-cause mortality and safety.

Results: The overall clinical success rate was 72.82%, and the all-cause 30-day mortality rate was 11.3%. Microbiologic failure occurred in 12.3% of patients, and infection recurrence within 30 days was seen in 8.2%. The safety profile was favourable, with adverse drug reactions reported in 4.1% of patients, leading to treatment discontinuation in only two cases (1.02%).

Conclusions: The findings of this study reinforce the value of IMI/REL as an effective and well-tolerated treatment for severe GNB infections in a complex, real-world patient population. These outcomes compare favourably with published data for other new BL/BLI agents, supporting the targeted use of IMI/REL as a crucial component of modern antibiotic stewardship.