Le infezioni in medicina最新文献

Our confidence on the efficacy of antiretroviral therapy has steadily increased in the last decade thanks to the continuous improvement of drugs, strategies and the ability to cope with the increase in life expectancy of people with HIV (PWH). Nevertheless antiretroviral therapy keeps on being a lifelong commitment and the current clinical research on anti-HIV treatment also points on the possibility to mitigate a series of remaining difficulties like patients' adherence, stigma and the logistic burden associated to periodical monitoring and drug refills. The newly developed long-acting injectables drugs made it possible to reduce the frequency of administration and improved adherence, but at present the recipients of these new solutions are asked to join the outpatient HIV services at least every two months to receive their injections and undergo immunovirological monitoring. This also because these newly developed options consist of two (2DR) instead of three drugs and such close monitoring might be necessary due to the lesser genetic barrier and forgiveness. The patients who instead are under stable oral antiretroviral therapy with persistent virologic suppression may benefit from extension of the time between consecutive controls. This particularly applies when 2^nd generation integrase inhibitors (INSTIs)-based three-drug regimens (3DR) are considered. Properties like intrinsic potency, genetic barrier, forgiveness, tolerability and safety make such regimens well suitable for less frequent immunovirological monitoring. The case of the single-tablet regimen consisting of Bictegravir/Emtricitabine/Tenofovir alafenamide (BIC/FTC/TAF) is unique, as in a single pill with a total net weight of 275 mg we actually find all the necessary ingredients to ensure the success of such initiative. Such powerful option looks as the most promising treatment to successfully increase the time between consultations and monitoring up to 9 or 12 months and thus providing the resulting advantages.

Philippe Ricord was a French physician who made significant contributions to the field of venereal diseases, particularly syphilis and gonorrhea, during the 19th century. He is known for his work in distinguishing between the two diseases, which were often confused due to their similar symptoms. Although his opinion on the etiology of gonorrhea turned out to be wrong, his contribution to its treatment was significant. The humorous way he conveyed his instructions, as well as its treatment, was challenging. Nevertheless, his work laid the foundations for the discovery of its cause and the appropriate treatment of gonorrhea in the future.

Background: Mycobacterial and bacterial spondylodiscitis require distinct therapeutic approaches. However, microbiological diagnosis is often delayed or unavailable in resource-limited settings. This study aimed to validate a clinical scoring system developed in a prior retrospective cohort study in Karnataka (India) to differentiate these aetiologies.

Methods: We conducted a retrospective cohort study of patients with microbiologically confirmed spondylodiscitis admitted between January 2017 and August 2024 in a tertiary care centre in Kerala, India. Demographic, clinical, laboratory, imaging, and treatment data were compared between the two groups, and the scoring system's diagnostic performance was assessed.

Results: Of 151 patients with infectious spondylodiscitis, 73 patients with community-acquired microbiologically confirmed infection were included. Of these, 32 (44%) had mycobacterial, and 41 (56%) had bacterial spondylodiscitis [Staphylococcus aureus (37%), Escherichia coli (11%), Klebsiella pneumoniae (11%), Streptococcus spp (4.1%), Salmonella spp (1.4%)]. The scoring system demonstrated good diagnostic accuracy for bacterial aetiology (AUC: 0.78; 95% CI: 0.67-0.88). Mycobacterial cases were younger, had longer symptom duration, lower C-reactive protein and leukocyte counts, and more frequent vertebral height loss on imaging. The rate of clinical improvement was similar between groups.

Conclusions: The validated clinical scoring system reliably distinguishes mycobacterial from bacterial spondylodiscitis and may guide empirical management in settings where timely microbiological diagnosis is not feasible.

A 24-year-old Ukrainian man with post-natal developmental disability was treated for presumptive facial cutaneous TB in 2018 in his home country. After moving to Italy, his nostril lesion recurred in 2021, expanding to the upper lip, but he was lost to follow-up before a diagnosis was made. In 2023, when symptoms worsened, a biopsy was performed showing chronic inflammation and negative microbiological molecular tests and culture. By 2024, the lesion spread to the eyelids with worsening ulcerations. After surgical resection, histology revealed a vegetative, haemorrhagic mucosa with necrotic granulomatous inflammation and rifampin-susceptible Mycobacterium tuberculosis (Mtb) was detected at molecular testing. Diagnosis of recurrent primary cutaneous TB without pulmonary involvement was made and treatment for drug susceptible TB was initiated, leading to complete remission of the facial lesions. Primary cutaneous TB without pulmonary involvement is rare, presenting as nodules, plaques, papules, or ulcers. Diagnosis requires systemic evaluation, imaging, infection screening and expert consultation. Cutaneous TB (CTB) is uncommon in Ukraine and accounts for less than 2% of extrapulmonary TB cases with frequent association with immunosuppression and delayed presentation. Although infrequent, CTB mirrors the wider TB scenario, that is also characterized by MDR-TB in 27% of new and 45% of retreatment cases, and XDR-TB in 13% of MDR-TB cases. In individuals coming from TB endemic areas with strong clinical suspicion, empirical TB diagnosis should always be considered despite negative microbiology to enable timely treatment and prevent progression. A multidisciplinary approach is essential for accurate diagnosis and optimal management.

Progressive multifocal leukoencephalopathy (PML) can rarely occur in individuals with occult immunosuppression. Here, we describe the case of an adult man who presented with PML, in whom CD4+ lymphocytopenia and hypogammaglobulinemia were subsequently identified, leading to a diagnosis of late-onset combined immunodeficiency. Intravenous immunoglobulin replacement therapy was initiated. His clinical course, though complicated by immune reconstitution inflammatory syndrome, was favorable.

Cedecea lapagei is a rare Gram-negative bacterium that has been infrequently associated with human infections. It is a non-encapsulated, facultative anaerobic organism that grows well in nonselective laboratory media and exhibits variable resistance patterns. Although Cedecea lapagei has been identified as a pathogen since 2006, reports of its clinical significance remain scarce, particularly in Europe. Here, we present the case of a 93-year-old male from Southern Italy, with multiple comorbidities and a history of urinary catheterization, who developed a urinary tract infection (UTI) caused by Cedecea lapagei. The patient was successfully treated with ciprofloxacin and fosfomycin, achieving clinical and microbiological healing. This report examines the substantial challenges associated with rare pathogens in clinical practice, focusing on the critical need for prompt and precise identification alongside tailored treatment strategies. Additionally, it highlights the pathogen's alarming multidrug resistance capabilities, underscoring the urgent need for robust antimicrobial stewardship programs and comprehensive research into its epidemiological behavior and resistance mechanisms. Incorporating rare pathogens into differential diagnoses, particularly for elderly patients with recurrent UTIs, could improve patient outcomes significantly. Finally, these findings expand the limited existing data on Cedecea lapagei infections, providing valuable insights into more precise diagnostic methodologies and tailored therapeutic approaches.

Introduction: Despite medical advances, stigma against people living with HIV remains a major issue, especially in healthcare. Factors like ignorance and lack of training contribute to discrimination; studies show stigma varies by setting and provider background. This study in Spain aimed to explore self-perceived stigma and its impact on healthcare access.

Methods: This mixed-methods study in Spain assessed self-perceived stigma among people living with HIV using a validated questionnaire and semi-structured interviews. Participants were recruited via social media and public announcements. Data analysis involved statistical tests and qualitative coding. Ethical approval was obtained, ensuring confidentiality and compliance with European regulations.

Results: The study included 525 participants, mostly men (53.3%), with a median age of 38 years and an average of four years since diagnosis. The majority (96.2%) received care through the public healthcare system. Stigma levels varied; internalised stigma was low, with most rejecting negative feelings about living with HIV. However, anticipated and experienced stigma remained, particularly in healthcare settings, where many reported discrimination and neglect-findings corroborated in interviews. Avoiding physical contact with patients and the excessive use of barrier measures were common behaviours. Analysis showed that stigma decreases with age and time since diagnosis but is higher among non-binary individuals.

Conclusions: This study highlighted varying levels of stigma affecting people living with HIV, particularly in healthcare. While internalised stigma was low, many anticipated or experienced discrimination, often due to impersonal treatment and unfounded fears, emphasising the need for education and awareness to foster respectful, empathetic care.

In medicine, fly larvae play a dual role: they can be both harmful causative agents of diseases and therapeutic agents. In fact maggot debridement therapy (biosurgery) is the controlled use of larvae to treat infected wounds and dates back to the beginnings of medicine. Ambroise Paré and Dominique-Jean Larrey pioneered the field of biosurgery before the 19th century, but it was John Forney Zacharias during the American Civil War who officially documented and promoted this medical application. The success of this method was immediate. Nevertheless, germ theory and the postulates of Robert Koch discouraged physicians from using potentially contaminated material such as larvae from the second half of the 19th century onwards. In the first half of the 20th century, however, the practice regained momentum thanks to the sterilization of fly eggs and the success of Dr. Stanton K. Livingston in the treatment of chronic osteomyelitis with biotherapy. The use of larvae for therapeutic purposes was discontinued after the Second World War due to the discovery of penicillin and is now receiving some attention again due to the emergence of antibiotic- resistant bacteria. Although biosurgery is rarely encouraged, the results of systematic reviews and meta- analyzes support its use. Previous and current evidence shows that this practice may be as useful as ever in the age of antibiotic resistance. It is likely that larval therapy will be considered as a stand-alone tool in the near future.

Aspergillus fumigatus endocarditis is a rare but severe infection associated with high mortality, typically affecting immunocompromised individuals. Diagnosing fungal endocarditis can be challenging due to the often negative blood cultures and nonspecific symptoms. We present a case of Aspergillus fumigatus infective endocarditis in a 59-year-old immunocompetent man with no typical risk factors, diagnosed with the assistance of metagenomic microbial plasma cell-free DNA next-generation sequencing assay (Karius test). The patient presented with ocular symptoms and was found to have a heart murmur and a hypodense liver lesion, leading to suspicion of infective endocarditis. Blood cultures failed to reveal a pathogen, but elevated fungal biomarkers and the Karius test supported Aspergillus fumigatus as the causal agent. The patient received antifungal therapy with voriconazole and liposomal amphotericin B followed by surgical intervention for mitral valve replacement. The case exemplifies the difficulty in diagnosing Aspergillus endocarditis, as blood cultures are often negative and histological confirmation may be delayed. Molecular diagnostics, such as metagenomic microbial plasma cell-free DNA next-generation sequencing assay, significantly enhance pathogen detection in culture-negative cases. However, although treatment with antifungal therapy and surgery can improve outcomes, the high mortality associated with Aspergillus endocarditis remains a critical concern, highlighting the need for further research and advancements in both diagnostic and therapeutic approaches.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a critical global health threat, particularly among hospitalized and critically ill patients, due to its association with severe, difficult-to-treat infections. Its high resistance stems from genomic plasticity, biofilm formation, and environmental persistence, leading to limited treatment options and high mortality. Existing treatments often rely on sulbactam-based combinations, yet resistance continues to rise and new agents remain limited.

Aims: This review aims to highlight the therapeutic potential of zosurabalpin, a first-in-class lipopolysaccharide (LPS) transport inhibitor with selective activity against A. baumannii, by summarizing preclinical and early clinical data on its efficacy, mechanism of action, pharmacokinetics, and safety.

Sources: Peer-reviewed publications from PubMed and Scopus, clinical data from ClinicalTrials.gov, and relevant conference materials ECCMID and IDWeek.

Content: Zosurabalpin inhibits the LptB-FGC complex, blocking LPS transport and causing lethal intracellular accumulation. Preclinical data demonstrate potent in vitro and in vivo activity against CRAB, with high selectivity and favorable pharmacokinetics. Phase 1 studies report good tolerability and a promising safety profile.Its novel mechanism makes zosurabalpin a strong candidate for treating CRAB.

Implications: With rising resistance and limited effective treatments, zosurabalpin offers a new, targeted therapeutic approach. Continued clinical development could help close a critical gap in the management of multidrug-resistant Acinetobacter baumannii.