Canadian Journal of Infectious Diseases & Medical Microbiology最新文献

Background: Tuberculosis (TB) remains a major public health problem globally, particularly in resource-limited settings where deprived ventilation, overcrowding, and limited healthcare services. Incarcerated individuals are among vulnerable populations disproportionately affected by TB due to confined living conditions and delayed diagnosis. In Ethiopia, the prison setting provides an environment favorable to the rapid spread of TB and a threat to the outside community. Thus, this study aims to determine the prevalence of undiagnosed pulmonary tuberculosis (PTB) and its predictors among incarcerated individuals in Central Ethiopia. Methods: A facility-based cross-sectional study was conducted from September to December 2023 among 363 selected incarcerated individuals in Central Ethiopia. Sociodemographic, clinical, and other risk-related data were collected using a structured questionnaire. Sputum samples were collected from incarcerated individuals with clinical symptoms of cough for two or more weeks and processed using GeneXpert MTB/RIF. The study was not formally powered to detect specific odds ratios for risk factor analysis; therefore, the associated predictors were explored through multivariable analysis and interpreted cautiously. Results: In 3802 total incarcerated individuals in the region's prisons, 363 (9.5%) with clinical symptoms and 13 (0.34%) already on anti-TB treatment were identified. Among these 363 (9.5%) with clinical symptoms, 35 (9.64%) previously undiagnosed PTB cases were detected. Hence, the point prevalence of undiagnosed PTB among incarcerated individuals was 0.92% or 920 per 100,000 population (95% CI: 830-998/100,000), which is about 7.7 times higher than Ethiopia's general population (119/100,000). This previously undiagnosed PTB was associated with incarcerated individuals who had smoking, increased age, contact with coughing/TB patients, chronic illness comorbidity, overcrowding, and low BMI. Conclusion: This study revealed a high point prevalence of undiagnosed PTB among incarcerated individuals. This mightily highlights that prisons are explicitly taken as a risky place for the transmission of PTB. Routine TB screening during prison entrance and periodical active case finding are highly recommended to identify missing people with TB who have a high spreading. After diagnosis, early treatment must be implemented to limit further transmission to incarcerated individuals and the surrounding community.

Background: In clinical trials, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) or tenofovir alafenamide-emtricitabine (TAF/FTC) is up to 99% efficacious in preventing human immunodeficiency virus (HIV) infection. The real-world effectiveness of PrEP has not been extensively evaluated in Canada. Methods: This population-based cohort included adults without HIV as determined by viral serology and ICD-9/ICD-10 codes from Alberta with ≥ 3 months of PrEP prescriptions. It used provincial administrative data. Patients were followed from their first PrEP prescription until diagnosed HIV infection or censoring. Cox proportional hazard models were used to identify independent predictors of HIV infection. Results: A total of 4750 adults with a mean (SD) age of 35.9 (11) years of which 8% were female were prescribed PrEP including TDF/FTC (97.5%) or TAF/FTC (2.5%). There were 335 HIV infections (92.9% effectiveness) over median cohort follow-up of 1.0 years (IQR 1.9) with 4.89 (95% CI 4.38, 5.44) HIV infections per 100 patient years. Age (HR 1.04, 95% CI 1.03-1.05 per 1 year increase), male sex (HR 0.34, 95% CI 0.27-0.44), CKD Stage G3 (HR 2.39, 95% CI 1.82, 3.14), SES (4th and 5th quintiles versus 1st quintile), drug use (HR 2.11, 95% 1.45, 3.08), and history of STI (HR 0.45, 95% CI 0.29, 0.72) were independent predictors of HIV infection. The HIV incidence decreased to 1.5 (95% CI 1.2, 1.8) and 0.6 (95% CI 0.4, 0.9) per 100 patient years in cohorts with negative baseline HIV serology with 180 and 30 days prior to index PrEP prescription. Conclusion: HIV PrEP appears to be effective for preventing HIV infection in this real-world population-based study in Alberta, Canada. Strategies to mitigate residual HIV risk in PrEP users are needed.

Background: The incidence of mucormycosis surged significantly during the COVID-19 pandemic, particularly among patients with diabetes mellitus (DM), a history of corticosteroid use, or immunosuppression. In Iran, the heightened prevalence of this opportunistic fungal infection underscored the critical importance of timely and comprehensive treatment, encompassing both medical and surgical approaches. Methods and Material: This article aims to analyze the characteristics, clinical presentations, and treatment regimens of mucormycosis patients in Iran. Data from 57 patients referred to Shiraz University of Medical Sciences, all with confirmed pathological cultures, were evaluated. Results: Among these patients, 74% had pre-existing DM, and the most common symptom was periorbital edema (46%), followed by decreased visual acuity (28%). Amphotericin B was administered to 93% of the patients, while 75% received posaconazole. Surgical intervention was performed in 86% of the cases, primarily through functional endoscopic sinus surgery (FESS) (61%). Despite these efforts, the overall mortality rate was 26%. Conclusion: Mucormycosis emerged as a serious complication of COVID-19 in Iran. Therefore, clinicians should include it in the differential diagnosis, particularly for patients with comorbidities or a history of antibiotic or corticosteroid use, and promptly initiate antifungal treatment and surgical intervention during potential future outbreaks.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in the intensive care unit (ICU). Active surveillance cultures (ASCs) for MRSA are often performed in ICUs; however, they may not be optimal in ICUs with a low MRSA prevalence. This study aims to determine the risk factors of MRSA carriage in the ICU and develop a clinical predictive model to optimize the screening process. Methods: All patients who were admitted to the ICU between April 2015 and August 2022 were retrospectively included in this study. At the time of ICU admission, all patients underwent MRSA screening using nasal ASCs. Based on the screening results, patients were categorized into MRSA-positive and MRSA-negative groups. Patients' characteristics were evaluated to determine the prevalence of MRSA and the risk factors. Cost analysis was conducted based on the risk factors identified by our analysis. Results: Of the 3927 ICU patients included, 133 (3.4%) were MRSA-positive. Multivariate analyses showed that risk factors for MRSA carriage were age ≥ 50 years (odds ratio [OR]: 2.11), history of hospitalization within a year (OR: 1.50), and ICD-10 codes classification I, IV, and XII (OR: 4.98). Screening patients based on at least one of the risk factors exhibited high sensitivity (96.9%) to identifying MRSA carriage and could reduce ASC overall costs by 10.9%, equivalent to $4686. Conclusion: This study suggests that universal ASCs to detect MRSA may not be optimal in ICU settings with a low prevalence of MRSA. Targeted screening based on risk factors may reduce the volume and cost of MRSA screening. Prospective multicenter studies are warranted to validate these findings and to assess the generalizability of the proposed screening strategy.

Background: Thromboembolic complications are frequently observed in patients with COVID-19 infection, particularly among those admitted to the intensive care unit (ICU). Moreover, COVID-19 infections today are mostly characterized by mild symptoms and are managed primarily in primary care settings, resulting in limited literature data on thromboembolic complications in this patient group. This study aims to investigate thrombotic event risks and associated factors in the outpatient population. Methods: All outpatient COVID-19 cases managed at two family health centers in Istanbul between June 2020 and December 2021 were retrospectively reviewed. Patients were contacted and informed about the study. Sociodemographic and clinical data were obtained from family health center records, and information on thrombotic events was extracted from hospital discharge summaries. Fisher's exact test and logistic regression were used for analysis. Results: A total of 961 patients were included in the study, of whom, 519 (54%) were female and 442 (46%) were male. The mean age was 41 years (range: 18-97). Thromboembolic events occurred in 4 patients (0.42%) within the first 6 months following COVID-19 infection. Logistic regression analysis identified the use of antacid medications (p=0.01) and the presence of hematological disorders (p=0.03) as significant risk factors. Conclusion: Thromboembolic events may occur even in mild-to-moderate outpatient COVID-19 cases within six months following the infection. Risk assessments focusing on comorbidities and medication use should be performed during outpatient follow-up. Due to the small number of thromboembolic events in this study, the findings should be considered preliminary and interpreted with caution. Trial Registration: ClinicalTrials.gov identifier: NCT06695377.

Cholera remains a global challenge, and understanding how V. cholerae adapts to environmental condition is essential for innovating new management strategies. This research aims to examine the expression of ctxAB, tcpA, and hlyA genes in V. cholerae (El Tor and classical biotypes) after interaction with Caco-2 cells compared to brain heart infusion (BHI) broth. After assaying of viability of Caco-2 cells against V. cholerae at multiplicity of infection (MOI) of 10, 20, 50, and 80, the number of bacteria attached to Caco-2 cells was determined using the adhesion assay. To conduct a valid comparison, an equivalent number of bacteria that attached to Caco-2 cells was inoculated into BHI broth. The expression of ctxAB, tcpA, and hlyA genes in V. cholerae (El Tor and classical biotypes) was assayed using the real-time PCR method. After interaction of Caco-2 cells with V. cholerae, the expression of the genes ctxAB, tcpA, and hlyA in the El Tor biotype increased by 2-, 1.02-, and 7-fold, respectively, while in the classical biotype, it increased by 6-, 2-, and 13-fold, respectively. The expression of the genes ctxAB and hlyA was significantly increased in Caco-2 cells in both biotypes. There was a significant increase in the expression of the gene tcpA in the classical biotype, while no significant increase was detected in the expression of this gene in the El Tor biotype. Caco-2 cells induced the highest increase in hlyA gene expression in the classical biotype, while there was no significant effect on tcpA gene expression in the El Tor biotype of V. cholerae. In conclusion, V. cholerae showed greater pathogenicity in the Caco-2 cells. Knowing the behavior of V. cholerae in different conditions can lead to create innovative strategies for combating and managing cholera.

The main goal of this integrative scoping review was to address the knowledge gap and inform policy and research regarding the impact of post-COVID-19 conditions on frontline healthcare workers (HCWs). An integrative scoping review using Arksey and O'Malley's framework examined post-COVID-19 conditions in frontline HCWs. We searched CINAHL, EMBASE, APA PsycINFO, PubMed, Social Science Database, ProQuest, Social Science Journals, and Web of Science, including dissertations, conference proceedings, and government publications for gray literature. A preestablished data extraction tool was developed to capture relevant information about post-COVID-19 conditions in HCWs. Of the total 42 studies, the majority were cross-sectional in design (29) and conducted mainly in countries such as Italy (4), India (3), and Brazil (3). Study findings reveal that a substantial proportion of HCWs in various countries were diagnosed with post-COVID-19 condition, which included persistent symptoms affecting physical and mental well-being. Persistent symptoms, particularly fatigue and anxiety, were associated with a poorer quality of life, decreased work ability, and impaired health-related quality of life among HCWs. Fatigue was a frequently reported symptom in many studies, often accompanied by weakness, muscle pain, shortness of breath, anxiety, depression, and sleep disturbances. The evidence generated through this research examining post-COVID-19 conditions among HCWs is a foundation for informing policy in the healthcare workforce. These findings also address the gap in research on the broader impacts of the COVID-19 pandemic on employers and the healthcare workforce.

Background: Klebsiella pneumoniae infection causes various diseases and leads to significant morbidity and mortality. The Pitt bacteremia score (PBS) is a well-known prognostic predictor in patients with bacteremia. We aimed to investigate the prognostic role of the PBS in patients with nonbacteremic K. pneumoniae infections and compare its mortality discriminative ability with that of other risk scoring systems. Methods: Data were retrospectively collected from emergency department patients in E-Da Hospital, Kaohsiung, Taiwan, within 2021. All adult patients (aged ≥ 20 years) during this period and diagnosed with K. pneumoniae infections were included. The baseline demographics, laboratory results, infection sources, and clinical outcomes of nonbacteremic patients were extracted, and the patients were further divided into low (< 4) and high (≥ 4) PBS groups for comparison. Results: A total of 863 patients with K. pneumoniae infection were identified, and 639 nonbacteremic patients were enrolled. There were similar demographics between the bacteremic and nonbacteremic groups. Regarding clinical outcomes in nonbacteremic patients, the high PBS group had significantly higher risk of septic shock (77.9% vs. 4.8%, p < 0.01), intensive care unit admission (71.3% vs. 8.2%, p < 0.01), respiratory failure (71.3% vs. 2.4%, p < 0.01), and 30-day mortality (34.6% vs. 3.8%, p < 0.01). The area under the curve of the scoring systems regarding 30-day mortality prediction ability was as follows: sequential organ failure assessment score 0.89 (95% confidence interval [CI] = 0.86-0.91), PBS 0.86 (95% CI = 0.83-0.88), quick sequential organ failure assessment score 0.71 (95% CI = 0.67-0.74), and systemic inflammatory response syndrome 0.62 (95% CI = 0.58-0.66). Conclusion: PBS correlated with adverse outcomes and good mortality prediction ability in patients with nonbacteremic K. pneumoniae infections.

[This corrects the article DOI: 10.1155/2023/9945561.].

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still going on, and as the epidemic situation continues, the genome of SARS-CoV-2 is also mutating and evolving, resulting in more and more SARS-CoV-2 mutant strains, which have brought serious pressure on the prevention and control of COVID-19. Given that the COVID-19 is still spreading, it is extremely important to rapidly identify SARS-CoV-2 variants by nucleic acid assays. Thus, developing highly sensitive and specific assays that are suitable for field testing, high-throughput, and automation, as well as other diagnostic applications for SARS-CoV-2 variants, is urgently needed. This paper reviews the research progress of novel CRISPR-based diagnostic methods for SARS-CoV-2 variants.