Le infezioni in medicina最新文献

Pasteurella multocida is a Gram-negative coccobacillus that is a part of normal oral flora of animals, especially cats and dogs. It is the most common causative agent for soft tissue infections following a bite or scratch from domestic pets. Prosthetic Joint Infections (PJIs) due to Pasteurella multocida are rarely but increasingly reported. Since 1992, only a few cases of PJIs caused by P. multocida have been described. Herein we present a case of a 67-year-old immunocompetent elderly female who developed total hip arthroplasty infection due to P. multocida and was treated successfully with left hip washout, pseudo-tumor removal, and intravenous antibiotics and a review of the literature on prosthetic joint infections caused by P. multocida since 1992.

Latent Tuberculosis Infection (LTBI) is a state of persistent immune response to Mycobacterium tuberculosis complex antigens without clinical, radiological and microbiological signs of active disease. Effective diagnosis and preventive treatment of LTBI are crucial for tuberculosis (TB) control, especially in high-risk groups. Currently, two main tests are used for LTBI diagnosis: the Tuberculin Skin Test (TST) and the Interferon-Gamma Release Assays (IGRA), including the QuantiFERON-TB Gold Plus (QFT-Plus) and the T-SPOT.TB. Our study evaluated the performance of the T-SPOT.TB test in patients with indeterminate QFT-Plus results, using data from the Clinical Microbiology and Virology Laboratory (M&V) of Papa Giovanni XXIII Hospital in Bergamo, Italy. Blood samples from patients tested for LTBI with QFT-Plus from January 1, 2017 to May 15, 2024 were analyzed. The QFT-Plus is the most widely used test in routine diagnostics for LTBI screening due to the availability of automated systems. Out of 20,995 samples tested with QFT-Plus, 576 (2.7%) gave indeterminate results. In all cases of indeterminate QFT-Plus results, M&V recommends performing the T-SPOT.TB test. However, of the 576 patients who obtained an indeterminate outcome, only 137 (23.8%) followed the indication. The T-SPOT.TB provided a definitive result in 87.6% of the cases, resolving 120 (80 negative and 40 positive) of 137 indeterminate QFT-Plus outcomes. Specifically, 78 of 92 cases, equal to 84.8%, were settled when the T-SPOT. TB test was performed within 30 days of the QFT-Plus. The T-SPOT.TB test has shown potential effectiveness in addressing indeterminate QFT-Plus results (84.8% resolution), indicating its possible role as a complementary diagnostic tool for LTBI. The proposed algorithm for LTBI screening is based on national and international guidelines recommending the use of the TST and/or an IGRA test for individuals at risk. However, it particularly emphasizes the use of QFT-Plus, due to its practicality and rapid execution, while recommending the addition of the T-SPOT.TB within 30 days in cases of indeterminate QFT-Plus results. Nevertheless, the conclusions should be regarded as preliminary and require confirmation through larger or controlled studies.

Yellow fever poses a substantial global health concern as one of the re-emerging diseases with pandemic potential in a scenario of the worldwide distribution of some vectors (such as Aedes aegypti); in the context of climatic change, an unclear knowledge about the immune behaviour of the virus, between other determinants. This review details the historical foundations, intricate evolution of geographical spread, and transmission mechanisms of the disease to understand the behaviour of outbreaks over time in a multifactorial context that could be difficult to understand. This article approaches to epidemiological, pathophysiological, immunological, social determinants, and climatic crisis by understanding possible control mechanisms and anticipating potential future epidemics. This article explores the evidence of yellow fever virus (YFV) pathogenesis and its complex interactions with the immune response in the host, the vector, and in the context of immunisation. These discussions contribute to a more comprehensive understanding of the disease's progression. Despite the global presence of the vector and other factors that could facilitate an epidemic spread, yellow fever outbreaks have remained confined to specific endemic areas. This limited distribution is not entirely understood. However, it may be influenced by the complex immune interactions between the virus, the vector, and the host, preventing its spread to other regions.

Crimean-Congo haemorrhagic fever (CCHF) is an emerging severe tick-borne illness. The expanding habitat of Hyalomma ticks, coupled with migratory birds harbouring CCHF-infected ticks, contributes to an increasing number of potential hosts. The seroprevalence of anti-CCHF virus antibodies in livestock is approximately one-quarter, with a noticeable upward trend in recent years. The management of CCHF patients predominantly relies on supportive therapy, although a potential arsenal of antivirals, convalescent and hyperimmune plasma, monoclonal antibodies, and vaccines exists, both currently and in the future. This review aims to critically examine the current therapeutic approaches to managing CCHF, highlighting both the potential and limitations of existing treatments, and identifying future directions for improving patient outcomes.

Our aim was to estimate the prevalence of HCV in a highly vulnerable population of substance users living with social difficulties and marginality who came into contact with the mobile harm reduction service in the city of Bologna (Northern Italy). Testing was offered in a van (mobile unit) by using a point-of-care HCV antibody test. For the HCV RNA test, the Xpert HCV Viral Load Fingerstick Test was used. Participants with a detectable HCV RNA were accompanied within two weeks to the Infectious Diseases Department Sant' Orsola Hospital Bologna to start HCV treatment. With regard to the main study findings, 54% reported having never been HCV tested before; a prevalence of HCV RNA of 6% among all participants and 22% among those injecting drugs was found; among the HCV RNA positive participants, 80% were accompanied to treatment. Our study suggests that mobile harm reduction services, in networks with healthcare facilities, are able to offer a continuous HCV screening service and linkage to care for people with drug use living in socially marginalized conditions.

Crete, strategically situated at the crossroads of three continents, was historically embroiled in incessant conflicts between colonisers and Greek revolutionaries, as well as recurrent battles against disease. In 1918, the island faced a novel adversary: influenza. In response, the state, local authorities, and medical professionals on the island mounted a formidable defence. Hospitals, health centres, and the military all contributed to the effort. Essential provisions of medicine and food were distributed to support the populations in areas most inflicted. The Heraklion-based newspaper Nea Ephimeris played a crucial role in documenting these events. Through its articles, reports, interviews, and reviews of the influenza situation, it disseminated vital information that helped the public understand both preventive measures and the necessary actions to combat the spread of the virus. This study examines the coverage by Nea Ephimeris from January 1918 to January 1919, assessing how the newspaper informed, supported, and uplifted the urban and rural populations of Crete. The data collected reconstruct the events of that period and demonstrate how historical pandemics offer lessons that can prepare health professionals for future challenges.

In the summer of 1630, Milan experienced the most devastating plague epidemic in its history. In this study, addressed to investigate the earliest phases of the epidemic in the autumn of 1629, a set of unpublished and only partially known primary sources produced by the city's Officium Sanitatis was consulted and compared for the first time. Including those of two foreigners who died in the Lazzaretto, it was possible to ascertain a total of 39 cases of plague occurred in Milan between 9 October 1629 and the first weeks of 1630, of which 29 (74.4%) ended in death. Seven deaths presumably occurred at home were not recorded in the Liber Mortuorum, in which at least three other deaths caused by plague were deliberately attributed to a different cause. In particular, the case of the Vicario di Provisione in charge, Alfonso Visconti, probably the first death from plague occurred in Milan that year, was deliberately concealed for political reasons. Nevertheless, the spread of the disease remained limited in autumn 1629 and it was probably stopped until the following spring more by climatic factors than by the interventions of public health officials.

Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) are herpesviruses that cause different clinical syndromes depending on the host's immune status. EBV is known for causing infectious mononucleosis (IMN), which presents with fever, pharyngitis, cervical lymphadenopathy, and atypical lymphocytes. CMV can also cause a mononucleosis syndrome with similar symptoms but is less frequently reported. Comparative studies on IMN and CMV mononucleosis from India are rare. This study aimed to elucidate the clinical characteristics of IMN and CMV mononucleosis in a South Indian tertiary care center, emphasizing the differences in their presentations. A retrospective analysis using Electronic Medical Records (EMR) from a tertiary care hospital at Thiruvananthapuram, Kerala, was conducted, including patients diagnosed with IMN or CMV mononucleosis based on clinical and serological tests during 2017 to 2023. Immunocompromised patients were excluded. The study compared demographic, clinical, and laboratory characteristics between the two groups. Out of 136 IMN cases and 17 CMV mononucleosis cases, the CMV group had a significantly higher median age (34.0 years) compared to the IMN group (20.0 years). The CMV group experienced a longer duration of fever (median 14.0 days) compared to the IMN group (5.0 days). Sore throat, cervical lymphadenopathy, and tonsil enlargement were significantly less common in CMV cases. The study concludes that CMV mononucleosis is more likely in older adults with prolonged fever and an absence of sore throat, tonsillitis, or cervical lymphadenopathy.

Introduction: Scrub typhus is a mite-borne tropical febrile illness with high mortality if untreated. The presence of eschar is pathognomonic, but a wide range of frequencies of eschar positivity has been reported in Indian patients. Therefore, this systematic review and meta-analysis aimed to ascertain the frequency (overall and geographic region-wise) and anatomical distribution of eschar in scrub typhus in India.

Methodology: We searched articles in two databases using: [(scrub OR typhus OR Orientia) AND (eschar) AND (India)]. The articles were independently screened and critically appraised by two authors. The frequency and distribution of eschar in patients with scrub typhus were pooled using a random-effect model.

Results: After the title-abstract and full-text screening, 107 articles (34002 cases of scrub typhus) were finally included. The overall pooled proportion of eschar positivity was 28.5% (95% CI: 24.1 to 32.9%). The pooled eschar positivity varied from ≤12% in Haryana, Rajasthan, Madhya Pradesh, Punjab, and Meghalaya to ≥46% in Tamil Nadu and Tripura. The pooled proportion of eschar positivity in the 'trunk' (39.3%), 'groin' (23.8%), and 'axilla' (16.5%) was higher than in the 'limbs' (9.9%) and 'head' (11.3%).

Conclusion: Eschar is reported in less than a third of the patients with scrub typhus in India. Most eschars were in the groin, axilla, and the trunk. There is a need to create awareness amongst physicians of the need for thorough physical examination.

Objective: MALDI-TOF-MS facilitates the identification of microorganisms from positive cultures in a timely and accurate manner. It eliminates the necessity for the application of biochemicals and operates on the principle of proteomics. It decreases the time required to report culture results. Prompt detection and notification of the pathogen, prior to the disclosure of antimicrobial susceptibilities, could potentially shorten the duration until the initial antibiotic adjustment is necessary, thereby influencing patients' clinical prognoses.

Methodology: Fifty patients in the conventional arm and one hundred patients in the interventional arm were compared in a pre and post quasi-experimental study conducted at a tertiary care centre in North India. Patients with positive cultures from medical wards and intensive care units were included. Comparing the time to first antibiotic modification after culture positivity, MALDI-TOF-MS-based identification, and clinical outcomes in both arms was the primary objective. Antibiotic modifications, escalation, and de-escalation were all recorded.

Results: The intervention arm exhibited a substantially shorter median time to first antibiotic modification (2010 mins vs 2905 mins, p=0.002) than the conventional arm. In the interventional group, a total of 44 out of 100 antibiotic modifications were implemented. Of these, 19 (43.3%) were determined solely by the MALDI report, without the anticipation of susceptibility assessments. De-escalation of antibiotics constituted the pre-dominant form of modification (47.4%). The difference between the 27% and 32% mortality rates in the intervention arm and the conventional arm was not statistically significant (p=0.52).

Conclusion: MALDI-TOF-MS facilitates the modification of antibiotics early on. The primary benefit lies in the reduction of superfluous antibiotic usage. Early organism identification and reporting prior to the availability of susceptibility results did not result in any mortality benefit. This strategy, when combined with a strong antimicrobial stewardship programme, can aid in the reduction of antibiotic use.